Mitotic Index of Invasive Breast Carcinoma

2009 ◽  
Vol 133 (11) ◽  
pp. 1826-1833 ◽  
Author(s):  
John S. Meyer ◽  
Eric Cosatto ◽  
Hans Peter Graf
Keyword(s):  
Breast Carcinoma ◽  
Mitotic Index ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Mitotic Cell ◽  
Standard Errors ◽  
Mitotic Figure ◽  
Binomial Probability ◽  
Breast Carcinomas ◽  
Coefficients Of Variation

Abstract Context.—Mitotic figure counts are related to breast cancer behavior but have not been sufficiently reproducible to be accepted for clinical decision-making. Objective.—To improve reproducibility and accuracy of the mitotic count. Design.—Mitotic index (MI) was defined as the mitotic cell count per 10 high-power fields (HPFs), an area 0.183 mm2. Two to 6 replicate sets of 10 HPFs were counted from 328 invasive breast carcinomas. Standard errors and coefficients of variation for mean MI were compared with expected results predicted by the binomial distribution. Results.—The boundaries for MI that separated the data into equal thirds (tertials) were 1.14 and 5.33. Standard errors and coefficients of variation for MI followed distributions predicted by binomial probability. Mean coefficient of variation was 147% for the low tertial, 72% for the midtertial, and 34.6% for the upper tertial. Conclusions.—Standard errors for MI based on a single count of 10 HPFs are too broad and coefficients of variation too large to be acceptable for clinical use. This is explained as a binomial probability effect, possibly with a contribution from tumor heterogeneity. Errors can be reduced in proportion to the square root of the number of sets of 10 HPFs counted. Tertial cutoffs of MI of the Nottingham system currently used in breast carcinoma grading are too high to be applicable to the population we studied. We recommend validation of cutoffs before they are applied to a particular population of breast carcinomas. Counting 5 sets of 10 HPFs is necessary to accurately rank carcinomas with low MIs.

scholarly journals Morphometric evaluation of relevant radiographic parameters of the forefeet of clinically normal donkeys (Equus αsinus)

2018 ◽  
Vol 68 (3) ◽  
pp. 467 ◽  
Author(s):  
E. A. EL-SHAFAEY ◽  
M. G. SALEM ◽  
E. MOSBAH ◽  
A. E. ZAGHLOUL
Keyword(s):  
Digital Imaging ◽  
Clinical Decision Making ◽  
Reference Data ◽  
Clinical Decision ◽  
Repeated Measurements ◽  
Vertical Position ◽  
Clinically Normal ◽  
Radiographic Parameters ◽  
Coefficients Of Variation ◽  
Morphometric Evaluation

This study provides a standard database of morphometric evaluation of the digital bone and hoof parameters of the forefeet of clinically normal donkeys using Digital Imaging and Communications in Medicine (DICOM) software programme, as a means to improve diagnosis and clinical decision-making regarding foot lameness in equine practice. Thirty orthopedically sound donkeys were included in this study. For each donkey forefoot, lateromedial (LM) and dorsopalmar (DP) radiographs were obtained with the foot in a vertical position. A total of 26 digital bone and hoof parameters obtained from the LM and DP radiographs were evaluated through repeated measurements of the same digitalized radiograph by three operators using DICOM software. Data of the morphometric radiographic parameters of the forefeet were statistically analyzed for the frequency distribution and calculation of the intra-assay and interassay coefficients of variation (CVs) of the reproducibility of the measured parameters. Mean ± SD of digital bone and hoof parameters were significantly different among the measurements obtained for the 26 parameters. However, intra-assay and interassay CVs for digital bone and hoof parameters measurements did not differ significantly between the three examiners. In conclusion, morphometric evaluation of the radiographic parameters of the forefeet in clinically normal donkeys, establishes a reference data base correspondingly for the donkey different to those accepted for the horse.

Analytical Goals for Quantities Used to Assess Thyrometabolic Status

1989 ◽  
Vol 26 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Margaret C K Browning
Keyword(s):  
Reference Values ◽  
Clinical Decision Making ◽  
Extreme Values ◽  
State Of The Art ◽  
Clinical Decision ◽  
Reference Intervals ◽  
Confidence Limits ◽  
Analytical Goals ◽  
Coefficients Of Variation ◽  
Variation Data

Analytical goals for imprecision derived from data on intra-individual variation for total T4, free T4, total T3, free T3 and thyrotropin (TSH) are coefficients of variation (CV) ⩽ 2·5, 4·7, 5·2, 3·9 and 8·1%, respectively. If total T4 is used to monitor replacement therapy with thyroxine, a more stringent goal of CV ⩽ 1·;4% is appropriate. For those analytes for which biological variation data are not available, analytical goals may be derived either from reference intervals or from the ‘state of the art’ as judged from the performance of a stated proportion of laboratories participating in an interlaboratory quality assessment scheme. Analytical goals for imprecision for reverse T3 and thyroxine-binding globulin derived from reference values are CV ⩽ 10·;7 and 7·;2%, respectively. The goal for inaccuracy is that there should be none. Statements regarding the detection limit of an assay should be replaced with information about the range of concentrations over which specified goals for imprecision are met. If goals are not achieved at concentrations which are used for clinical decision making the 95% confidence limits of the extreme values of the ‘working range’ should be calculated using the relevant imprecision. Improved analytical performance will result in better between-laboratory comparability and eventually allow the use of universally applicable reference values.

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

Clinical Decision-Making for Stroke and Aphasia in the Older Adult

2009 ◽  
Vol 14 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Jacqueline Hinckley
Keyword(s):  
Executive Function ◽  
Cerebrovascular Disease ◽  
Cognitive Abilities ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cognitive Profile ◽  
Focal Lesion ◽  
Cognitive Profiles ◽  
Supportive Communication ◽  
Spaced Retrieval

Abstract A patient with aphasia that is uncomplicated by other cognitive abilities will usually show a primary impairment of language. The frequency of additional cognitive impairments associated with cerebrovascular disease, multiple (silent or diagnosed) infarcts, or dementia increases with age and can complicate a single focal lesion that produces aphasia. The typical cognitive profiles of vascular dementia or dementia due to cerebrovascular disease may differ from the cognitive profile of patients with Alzheimer's dementia. In order to complete effective treatment selection, clinicians must know the cognitive profile of the patient and choose treatments accordingly. When attention, memory, and executive function are relatively preserved, strategy-based and conversation-based interventions provide the best choices to target personally relevant communication abilities. Examples of treatments in this category include PACE and Response Elaboration Training. When patients with aphasia have co-occurring episodic memory or executive function impairments, treatments that rely less on these abilities should be selected. Examples of treatments that fit these selection criteria include spaced retrieval and errorless learning. Finally, training caregivers in the use of supportive communication strategies is helpful to patients with aphasia, with or without additional cognitive complications.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

Management of thoracic aortic lesions - the future is endovascular

VASA ◽  
2012 ◽  
Vol 41 (3) ◽  
pp. 163-176 ◽  
Author(s):  
Weidenhagen ◽  
Bombien ◽  
Meimarakis ◽  
Geisler ◽  
A. Koeppel
Keyword(s):  
Thoracic Aorta ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Treatment Modalities ◽  
Traumatic Rupture ◽  
Descending Thoracic Aorta ◽  
New Treatment ◽  
Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the “state-of-the-art” treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

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