scholarly journals A145 ENDOSCOPICALLY NON-VISIBLE INTERVAL COLONIC ADENOCARCINOMA DESPITE HIGH-QUALITY SURVEILLANCE.

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 135-137
Author(s):  
D C Vu ◽  
A Busca ◽  
R Lee
Keyword(s):  
Bowel Obstruction ◽  
Gold Standard ◽  
Cpg Island ◽  
Pathological Examination ◽  
Polypoid Mass ◽  
High Quality ◽  
Related Factors ◽  
Adenoma Detection ◽  
Incidence And Mortality ◽  
Mucosal Involvement

Abstract Background Colonoscopy remains the gold-standard for screening and surveillance of colorectal cancer (CRC). Regular colonoscopy with polypectomy has been associated with reduced CRC incidence and mortality. However, interval CRC, defined as cancer diagnosed between initial screening and subsequent surveillance colonoscopies, occurs at rates of 2–14%. Identified risk factors for interval cancers include patient-related factors (older age, diverticular disease, proximal CRC), endoscopy-related factors (colonoscopy by non-gastroenterologists or in an outpatient setting; endoscopists with low rates of completion, adenoma detection or polypectomy) and biologic factors (microsatellite instability (MSI), CpG island methylation). We report a patient with interval metastatic ileo-cecal adenocarcinoma despite multiple, high-quality surveillance colonoscopies, not endoscopically visible as no visible intra-luminal mucosal component was present. Aims To describe a case of an interval CRC without an endoscopically visible intra-luminal component. Methods Case description and literature review. Results A 69-year-old male, with a history of multiple advanced colonic polyps requiring multiple surveillance colonoscopies and polypectomies, presented with symptoms of bowel obstruction. An abdominal CT scan revealed findings of terminal ileitis and upstream small bowel obstruction. Colonoscopy was performed, revealing obstruction of the ileo-cecal valve with a firm cecal submucosal lesion without abnormal overlying mucosal abnormalities. Exploratory laparoscopy revealed a mass at the ileo-cecal valve with associated peritoneal deposits. A right hemicolectomy was performed, and pathological examination demonstrated metastatic invasive adenocarcinoma involving the cecum, the terminal ileum and ileo-cecal valve without extension into the lumen or formation of an overt polypoid mass. The tumour extended into the wall of the distal ileum in a circumferential fashion, involving the immediate deep serosa, but with only minimal, focal mucosal ileal involvement and no overt polypoid mass. An independent review of the case and resection specimen by a second pathologist confirmed absence of significant ileal or colonic mucosal involvement and no obstructing intraluminal component. Conclusions This case illustrates a rare presentation of an interval CRC that was not identified despite several high-quality surveillance colonoscopies, as only minimal mucosal involvement was present. As endoscopy remains the gold-standard for early detection and removal of pre-malignant lesions and early malignancy, the patient’s presentation with interval malignant bowel obstruction and metastatic disease, despite adequate quality surveillance, demonstrates an inherent limitation of colonoscopy. To our knowledge, this is only the third documented case of endoscopically non-visible interval CRC. Funding Agencies NoneNone

scholarly journals Rare presentation of a testicular angiofibroma treated with testis sparing surgery

2016 ◽  
Vol 88 (4) ◽  
pp. 330 ◽  
Author(s):  
Luca Leone ◽  
Paola Fulvi ◽  
Giulia Sbrollini ◽  
Alessandra Filosa ◽  
Enrico Caraceni ◽  
...  
Keyword(s):  
Case Report ◽  
Malignant Tumor ◽  
Gold Standard ◽  
Conservative Surgery ◽  
Pathological Examination ◽  
Benign Tumors ◽  
Frozen Sections ◽  
Rare Presentation ◽  
Final Histology

Introduction: Testicular benign tumors are very rare (< 5%). Testicular Angiofibroma (AF) is one of those, however the gold standard of treatment and follow-up is still unclear. Case report: A 47 years-old man with only one functioning testis was referred to our clinic for a palpable right testicular mass and atrophic contralateral testis. Patient underwent testis-sparing surgery with inguinal approach and intraoperative frozen sections examination with diagnosis of AF. Final histology confirmed AF. Post-operative follow-up was uneventful. Clinical and ultrasonographic follow-up was negative after 8 months. Conclusion: We report a conservative surgery in a patient with AF of the solitary testis. AF is a benign para-testicular fibrous neoplasm that could be misinterpreted as malignant tumor and treated with orchiectomy. Testis-sparing surgery is recommended in this case with intraoperative pathological examination. The excision of the mass is enough but in front of a possible recurrence a long follow-up is advisable.

scholarly journals Critical analysis of the drafting of physical therapy randomized controlled trials published in Portuguese

2016 ◽  
Vol 29 (2) ◽  
pp. 421-427
Author(s):  
Ercole da Cruz Rubini ◽  
Fabio Dutra Pereira ◽  
Renato Sobral Monteiro-Junior ◽  
Patricia Zaidan ◽  
Cintia Pereira de Souza ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Randomized Controlled Trials ◽  
Gold Standard ◽  
Critical Analysis ◽  
Physical Therapists ◽  
Controlled Trials ◽  
High Quality ◽  
Randomized Controlled ◽  
Methodological Procedures

Abstract Introduction: randomized controlled trials are high quality studies. Many problems related to the drafting of these studies have been identified and consequently various national and international journals, in an attempt to improve this writing, have adopted the Consolidated Standards of Reporting Trials recommendations. Regarding the studies written specifically by physical therapists, until now, the quality of the drafting in Portuguese has been unknown. Aim: To critically analyze the drafting of RCTs in the area of physical therapy, published in Portuguese, in relation to the CONSORT recommendations. Materials and Methods: On 17th Oct, 2012, 548 RCTs in Portuguese were recovered from the MEDLINE and PEDro databases, which were divided among four evaluators who, after reading the abstracts, selected those related to physical therapy. Of these studies, 78 RCTs were related to physical therapy, which were divided among the four evaluators for the analysis of the drafting according to the CONSORT recommendations. The four evaluators who participated in this study previously obtained a median kappa above 70% when their analyses were compared to the analyses of the evaluator considered the gold standard due to having greater experience. Results: The quantity of items of the CONSORT recommendations according to year of publication was very small, corresponding to a mean of 43% of the items in the articles analyzed. Conclusion: The results make very clear the need to improve the quality of the drafting of the RCTs related to physical therapy in Portuguese and to include more rigorous methodological procedures, such as sample size, randomization and blinding. The dissemination and adoption of the CONSORT recommendations by physical therapy researchers would, without doubt, be a big step towards improving this quality.

scholarly journals Learning from Disagreement: A Survey

2021 ◽  
Vol 72 ◽  
pp. 1385-1470
Author(s):  
Alexandra N. Uma ◽  
Tommaso Fornaciari ◽  
Dirk Hovy ◽  
Silviu Paun ◽  
Barbara Plank ◽  
...  
Keyword(s):  
Language Processing ◽  
Gold Standard ◽  
Training Methods ◽  
High Quality ◽  
Training Models ◽  
Part Of Speech Tagging ◽  
Part Of Speech ◽  
Growing Body ◽  
Research Questions ◽  
Speech Tagging

Many tasks in Natural Language Processing (NLP) and Computer Vision (CV) offer evidence that humans disagree, from objective tasks such as part-of-speech tagging to more subjective tasks such as classifying an image or deciding whether a proposition follows from certain premises. While most learning in artificial intelligence (AI) still relies on the assumption that a single (gold) interpretation exists for each item, a growing body of research aims to develop learning methods that do not rely on this assumption. In this survey, we review the evidence for disagreements on NLP and CV tasks, focusing on tasks for which substantial datasets containing this information have been created. We discuss the most popular approaches to training models from datasets containing multiple judgments potentially in disagreement. We systematically compare these different approaches by training them with each of the available datasets, considering several ways to evaluate the resulting models. Finally, we discuss the results in depth, focusing on four key research questions, and assess how the type of evaluation and the characteristics of a dataset determine the answers to these questions. Our results suggest, first of all, that even if we abandon the assumption of a gold standard, it is still essential to reach a consensus on how to evaluate models. This is because the relative performance of the various training methods is critically affected by the chosen form of evaluation. Secondly, we observed a strong dataset effect. With substantial datasets, providing many judgments by high-quality coders for each item, training directly with soft labels achieved better results than training from aggregated or even gold labels. This result holds for both hard and soft evaluation. But when the above conditions do not hold, leveraging both gold and soft labels generally achieved the best results in the hard evaluation. All datasets and models employed in this paper are freely available as supplementary materials.

Teaching Controversial Issues

2022 ◽  
pp. 252-272
Author(s):  
William Paul Bintz
Keyword(s):  
United States ◽  
Instructional Strategies ◽  
Picture Books ◽  
The United States ◽  
Controversial Issues ◽  
High Quality ◽  
Related Factors ◽  
Award Winning ◽  
Research Findings ◽  
The Way

This chapter describes recent research findings on homelessness in the United States and its relationship to poverty and other related factors. It also provides an introduction to text clusters, a curricular resource that includes high-quality and award-winning picture books and is anchored in the Way-In and Stay-In books. It continues by presenting a text cluster on the topic of homelessness, along with a variety of research-based instructional strategies that K-8 teachers can use with this text cluster, as well as with other text clusters on controversial issues. It ends with some final thoughts.

scholarly journals High-quality colon cleansing and multiple neoplasia detection with 1L NER1006 versus mid-volume options: Post hoc analysis of phase 3 clinical trials

2020 ◽  
Vol 08 (05) ◽  
pp. E628-E635
Author(s):  
Michael S. Epstein ◽  
Robert Benamouzig ◽  
Juha Halonen ◽  
Raf Bisschops
Keyword(s):  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Combined Treatment ◽  
Sulfate Solution ◽  
Lesion Detection ◽  
High Quality ◽  
Post Hoc Analysis ◽  
Colon Cleansing ◽  
Adenoma Detection ◽  
Post Hoc

Abstract Background and study aims Multiple neoplasia increase the risk of colorectal cancer. High-quality cleansing may improve adenoma detection. We assessed whether a new bowel preparation can improve colon cleansing and multiple lesion detection. Patients and methods This post hoc analysis of two randomized clinical trials in Europe and the US assessed the per study and combined cleansing efficacy of overnight split dosing with (preparation + clear fluids) 1 + 1 L polyethylene glycol (PEG) NER1006 versus 2 + 1 L PEG + ascorbate (2LPEG) or 1 + 2 L oral sulfate solution (OSS) combined. Treatment-blinded central readers assessed cleansing quality using the Harefield Cleansing Scale (HCS). Patients with full segmental scoring were included. HCS segmental scores 0–4 (high-quality = HCS 3–4) were analyzed for NER1006 versus 2LPEG/OSS. Mean number of polyps or adenomas per patient (MPP/MAP) was calculated for treatments in patients with at least one polyp or adenoma. Results In 1037 patients, NER1006 attained a greater rate of HCS 3 scores (29 % vs. 20 %; P < 0.001) and HCS 4 scores (20 % vs. 17 %; P = 0.007) versus 2LPEG/OSS. More polyps (678 versus 585) and adenomas (397 versus 331) were detected with NER1006 (N = 517) versus 2LPEG/OSS (N = 520). In all neoplasia-positive patients, with increasing minimal per-patient neoplasia multiplicity from 1 to 10, NER1006 numerically improved MPP (difference ± SE: 0.48 ± 0.24 to 3.89 ± 3.37) and MAP (0.47 ± 0.26 to 7.50 ± 9.00) versus 2LPEG/OSS. Conclusions Low-volume NER1006 enhances high-quality cleansing versus medium-volume 2LPEG or OSS, individually and when combined. NER1006 may consequently facilitate the detection of multiple neoplasia in patients.

Patients’ Experiences of Colorectal Cancer and Oncology Services in North Queensland

2008 ◽  
Vol 14 (3) ◽  
pp. 93 ◽  
Author(s):  
Craig Veitch ◽  
Lisa Crossland ◽  
Heather Hanks ◽  
Yik-Hong Ho ◽  
Marlous Steeghs
Keyword(s):  
Colorectal Cancer ◽  
Metropolitan Areas ◽  
Full Range ◽  
Signs And Symptoms ◽  
Incidence Rates ◽  
Postal Survey ◽  
Warning Signs ◽  
Related Factors ◽  
Incidence And Mortality

Colorectal cancer (CRC) accounts for 15% of cancer incidence and mortality in Australia. Incidence rates have been rising for two decades. Little is known about the experiences, attitudes and perceptions of people with CRC who live in non-metropolitan areas. The aim of this study was to investigate participants? experiences with and attitudes to CRC. This Cancer Council of Queensland-funded project collected data in three phases - focus groups, individual interviews, postal survey - from patients treated for CRC in north Queensland. Qualitative and quantitative approaches were used to analyse the data. Participants had very little knowledge of CRC signs and symptoms pre-diagnosis, which sometimes led to delays in diagnosis. The speed of diagnosis was dependent on several practitioner-related factors. Treatment-related issues included coming to grips with the diagnosis and preparedness for treatment and side-effects. Personal beliefs and attitudes influenced treatment and follow-up decisions. Rural participants encountered travel-related difficulties, particularly during treatment as outpatients. There was a strong belief in the need for more public education about CRC in general, warning signs and symptoms, and familial risk factors. Good understanding of people?s knowledge of CRC, their attitudes towards screening, diagnosis, treatment and follow-up, will enable health and cancer services provide focused and relevant support to people with CRC, their families and carers. This is especially important in non-metropolitan areas where the full range of specialist services is not locally available.

scholarly journals The importance of colonoscopy bowel preparation for the detection of colorectal lesions and colorectal cancer prevention

2020 ◽  
Vol 08 (05) ◽  
pp. E673-E683 ◽  
Author(s):  
Prateek Sharma ◽  
Carol A. Burke ◽  
David A. Johnson ◽  
Brooks D. Cash
Keyword(s):  
Colorectal Cancer ◽  
Bowel Preparation ◽  
Clinical Importance ◽  
High Volume ◽  
High Quality ◽  
Crc Screening ◽  
Incidence And Mortality ◽  
Low Volume ◽  
Split Dosing ◽  
Bowel Preparations

Abstract Background and study aims Colonoscopy for colorectal cancer (CRC) screening has reduced CRC incidence and mortality and improved prognosis. Optimal bowel preparation and high-quality endoscopic technique facilitate early CRC detection.This review provides a narrative on the clinical importance of bowel preparation for colonoscopy and highlights available bowel preparations. Methods A PubMed search was conducted through June 2019 to identify studies evaluating clinical outcomes, efficacy, safety, and tolerability associated with bowel preparation for CRC screening-related colonoscopy. Results Selecting the optimal bowel preparation regimen is based on considerations of efficacy, safety, and tolerability, in conjunction with individual patient characteristics and preferences. Available bowel preparations include high-volume (4 L) and low-volume (2 L and 1 L), polyethylene glycol (PEG) solutions, sodium sulfate, sodium picosulfate/magnesium oxide plus anhydrous citric acid, sodium phosphate tablets, and the over-the-counter preparations magnesium citrate and PEG-3350. These preparations may be administered as a single dose on the same day or evening before, or as two doses administered the same day or evening before/morning of colonoscopy. Ingesting at least half the bowel preparation on the day of colonoscopy (split-dosing) is associated with higher adequate bowel preparation quality versus evening-before dosing (odds ratio [OR], 2.5; 95 % confidence interval [CI], 1.9−3.4). Conclusions High-quality bowel preparation is integral for optimal CRC screening/surveillance by colonoscopy. Over the last 30 years, patients and providers have gained more options for bowel preparation, including low-volume agents with enhanced tolerability and cleansing quality that are equivalent to 4 L preparations. Split-dosing is preferred for achieving a high-quality preparation.

scholarly journals The Thorny Problem of Translation and Interpreting Quality

2018 ◽  
Vol 16 ◽  
Author(s):  
Geoffrey S. Koby ◽  
Isabel Lacruz
Keyword(s):  
Quality Assessment ◽  
Machine Translation ◽  
Gold Standard ◽  
Holistic Approach ◽  
Translation Studies ◽  
Focused Attention ◽  
High Quality

Judging quality in translation and interpreting and in the associated task of revision has a long and controversial history. We briefly comment on some aspects of this history to provide context for the contemporary perspectives on and investigations into quality assessment that are represented in this volume of Linguistica Antverpiensia, New Series: Themes in Translation Studies. A fundamental obstacle to progress is the lack of consensus about how to characterize high-quality translation or interpreting, let alone the identification of broadly accepted models for measuring translation or interpreting quality or the ability of translators or interpreters. The advent of machine translation and post-editing has focused attention on the very nature of quality: Is it proximity to a “gold standard” of perfection or is it characteristic of a product that simply serves its purpose well enough to satisfy the needs of the consumer? In other words, is quality something that should be measured and judged in absolute terms or in relative terms? Different philosophies of quality assessment reflect these dichotomies, with the absolutists seeking objective assessments based on detailed analyses of taxonomies of errors, whereas the relativists prefer a more holistic approach that is more sympathetic to subjective judgements. The contributors to this volume present a broad range of approaches to quality assessment in a variety of contexts. We describe their achievements and provide brief analyses through the lens of the framework above. 

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