Preoperative assessment of breast volume could contribute significantly to the planning of breast-related procedures. The availability of 3D scanning technology provides us with an innovative method ...for doing this. We performed this study to compare measurements by this technology with breast volume measurement by water displacement. A total of 30 patients undergoing 39 mastectomies were recruited from our center. The volume of each patient's breast(s) was determined with a preoperative 3D laser scan. The volume of the mastectomy specimen was then measured in the operating theater by water displacement. There was a strong linear association between breast volumes measured using the 2 different methods when using a Pearson correlation (r = 0.95, P < 0.001). The mastectomy mean volume was defined by the equation: mastectomy mean volume = (scan mean volume × 1.03) -70.6. This close correlation validates the Cyberware WBX Scanner as a tool for assessment of breast volume.
There is still a need for competent breast lump detection palpation skills, especially in developing countries. Our goal is to design, develop, and establish a test to determine whether students can, ...by touch alone, identify and discriminate between a range of different simulated lesions at different adiposity levels.
Common lesions, breast cancers, and cysts were physically simulated and hidden in a test object referred to as the "tactile landscape" (TL). Ribs, intercostal muscle, and nodularity-normal anatomical features-increased their realistic complexity. Varying depths of features simulated varying degrees of adiposity. A testing protocol was created to determine the testee's ability to identify and discriminate different commonly occurring breast masses using palpation. Five experts (four breast surgeons and one general practitioner) and 20 inexperienced medical students were recruited and tested. Results were compared.
The TL has been based on previously verified breast models and has softness similar to 53% of women's breasts and nodularity similar to 60% as assessed in a breast clinic by breast surgeons. The five experts indicated that the simulated lesions felt like those they might encounter in clinical practice and all of them identified the lesions and nonlesions hidden in the TL 100% correctly, thus indicating the value of the model. In contrast, only one student was able to identify all the lesions. One student identified none of them. The remaining students mean score was 65%.
All students but one performed poorly in comparison to the experts. This indicates that the test could be useful to test students' ability to identify and discriminate breast masses. If successful, it will add previously missing capability to the mix of assessment instruments already used, thus potentially improving clinical breast examination training and assessment.
Clinical Breast Examination (CBE) is the examination of a women's breasts by a healthcare professional, such as a breast surgeon, family physician or breast-care nurse who is trained to recognise ...many different types of abnormalities and warning signs in the breast 1. CBE is particularly important in rural areas and developing countries who have limited access to technology such as mammography. CBE needs to be taught to health professionals like any other clinical skill used by medical professionals in the workplace. CBE in part involves palpation of the breast, that is, determining by touch which breast lumps are normal and which are suspicious in feeling. The gold standard for assessing tactile skills in CBE is seeing whether students can accurately identify and discriminate between different breast lumps also known as masses (IDBM) on actual patients in a clinical setting. However, this is not practical in a medical education setting. Usually the testing methods 'go through the motions' of feeling the breast as part of CBE. So the students' technique is examined either using unrealistic simulation models or using an intimate examination associate (IEA), an actor/volunteer who permits students to examine their intimate body parts such as breast or genitals for teaching purposes. These volunteers do not have any abnormalities so this teaching does not include the actual detection of suspicious lumps. We undertook a study of clinical skill with 10 medical students to examine different methods of assessing novice student clinical skills after a brief training in CBE.
This study aims to evaluate the effectiveness of current training and assessment of novice students in CBE and their capacity to identify and discriminate breast masses (IDBM) on actual patients.
We assessed each student's IDBM ability in an actual clinical situation, a breast clinic with a mixture of eight IEAs and one real patient with a large, easily palpable, putative breast cancer. We recruited 10 clinically inexperienced medical students, who were trained for 30 minutes by two breast surgeons using an IEA. Students were tested in a simulated clinical setting, a breast clinic where each examined 4 IEAs and one patient. The students were blind to who was the real patient and who was an IEA. Patients were examined by a breast surgeon in private prior to the commencement in the study. The breast surgeon recorded any clinical finding on the patients during the initial examination. The surgeon coached each patient on how to mark the students and showed the patient their results so the patients had a benchmark. After each examination was finished the students had four different assessments: 1) patients marked each student, 2) students were independently proctored - that is, marked by an expert, 3) students recorded their clinical findings and 4) students recorded how confident they were that they had the correct findings. Results from different kinds of student assessments were compared.RESULTSA chi-square test for independence between true positive or negative masses versus student-assessed positive or negative masses was not significant at alpha = .05. This means that there was no statistical association in the indication of positive or negative presence of masses versus whether such masses were actually present or absent. By comparison, experts (breast surgeons) were able to detect normal and abnormal breast masses by palpation alone 100% of the time and rate their confidence level as 'certain'. Unlike the experts, student self-reported confidence was unrelated to their competence score (CS). Proctoring was inversely related to the students' CS.CONCLUSIONSThe main conclusion is that novice students do not seem to be able to accurately detect breast masses in a clinical setting even after training. On the basis of these results, we believe that a comprehension component in the current CBE testing is needed in addition to the current methods of testing.
Sustainable Sizing Robinette, Kathleen M.; Veitch, Daisy
Human factors,
08/2016, Letnik:
58, Številka:
5
Journal Article
Recenzirano
Objective:
To provide a review of sustainable sizing practices that reduce waste,
increase sales, and simultaneously produce safer, better fitting,
accommodating products.
Background:
Sustainable ...sizing involves a set of methods good for both the environment
(sustainable environment) and business (sustainable business). Sustainable
sizing methods reduce (1) materials used, (2) the number of sizes or
adjustments, and (3) the amount of product unsold or marked down for sale.
This reduces waste and cost. The methods can also increase sales by fitting
more people in the target market and produce happier, loyal customers with
better fitting products. This is a mini-review of methods that result in
more sustainable sizing practices. It also reviews and contrasts current
statistical and modeling practices that lead to poor fit and sizing.
Fit-mapping and the use of cases are two excellent methods suited for
creating sustainable sizing, when real people (vs. virtual people) are used.
These methods are described and reviewed. Evidence presented supports the
view that virtual fitting with simulated people and products is not yet
effective.
Conclusions:
Fit-mapping and cases with real people and actual products result in good
design and products that are fit for person, fit for purpose, with good
accommodation and comfortable, optimized sizing. While virtual models have
been shown to be ineffective for predicting or representing fit, there is an
opportunity to improve them by adding fit-mapping data to the models. This
will require saving fit data, product data, anthropometry, and demographics
in a standardized manner. For this success to extend to the wider design
community, the development of a standardized method of data collection for
fit-mapping with a globally shared fit-map database is needed. It will
enable the world community to build knowledge of fit and accommodation and
generate effective virtual fitting for the future.
Application:
A standardized method of data collection that tests products’ fit
methodically and quantitatively will increase our predictive power to
determine fit and accommodation, thereby facilitating improved, effective
design. These methods apply to all products people wear, use, or occupy.
Pleural diseases are common in clinical practice. Doctors in training often encounter these patients and are expected to perform diagnostic and therapeutic pleural procedures with confidence and ...safely. However, pleural procedures can be associated with significant complications, especially when performed by less experienced. Structured training such as use of training manikin and procedural skills workshop may help trainee doctors to achieve competence. However, high costs involved in acquiring simulation technology or attending a workshop may be a hurdle. We hereby describe a training model using a simple manikin developed in our institution and provide an effective way to document skill acquisition and assessment among trainee medical officers.
This was a prospective observational study. The need for training, competence and confidence of trainees in performing pleural procedures was assessed through an online survey. Trainees underwent structured simulation training through a simple manikin developed at our institute. Follow-up survey after the training was then performed to access confidence and competence in performing pleural procedures.
Forty-seven trainees responded to an online survey and 91% of those expressed that they would like further training in pleural procedure skills. 81% and 85% of responders, respectively, indicated preferred method of training is either practising on manikin or performing the procedure under supervision. Follow-up survey showed improvement in the confidence and competence.
Our pleural procedure training manikin model is a reliable, novel and cost-effective method for acquiring competences in pleural procedures.
Where exactly is the human waist? How do definitions work for women who deviate from the conventional body shape? Does the measuring instrument matter? Waist is conventionally understood to be a ...measurable zone within the abdominal region of the torso, a zone of considerable importance. There needs to be a good consistent waist definition, one accurate and valid for everyone. Incorrect definition and measurement will result in technical errors, commercial wastage and customer dissatisfaction. This paper investigates the waist's location and size from the point of view of garment construction for 90 adult women scanned and manually measured in a breast reduction study at Flinders Medical Center, South Australia. There are differing definitions of the location of the human waist as well as different measuring instruments. This study compares:• Two definitions:• ISO 8559, 2.1.11 and • CAESAR, Waist Circumference Preferred.• Two different instruments:• the traditional tape measure, and • software-extracted computer-aided anthropometry (CAA). Substantial discrepancies between the results from these two locations-definitions were found. The choice of instrument used seriously affects the measurement obtained. This study demonstrates three things:• waist is not horizontal for a significant sub group of the population,• CAA extracted waist measurements are not accurate (same as real values) or valid (measures the characteristic) for a sub group, and • manually measured CAESAR Preferred Waist accurately and validly measured all individuals studied. There is a clear need to modify ISO waist definition for garment construction to include the full range of anatomical variation encountered amongst women.
ObjectivesTo assess the health burden of breast hypertrophy and the comparative effectiveness of breast reduction surgery in improving health-related quality of life.DesignProspective cohort ...study.SettingA major public tertiary care hospital in Australia.ParticipantsWomen with symptomatic breast hypertrophy who underwent breast reduction surgery were followed for 12 months. A comparison control cohort comprised women with breast hypertrophy who did not undergo surgery.InterventionsBilateral breast reduction surgery for women in the surgical cohort.Main outcome measuresThe primary outcome measure was health-related quality of life measured preoperatively and at 3, 6 and 12 months postoperatively using the Short Form-36 (SF-36) questionnaire. Secondary outcome measures included post-surgical complications.Results209 patients in the surgical cohort completed questionnaires before and after surgery. 124 patients in the control hypertrophy cohort completed baseline and 12-month follow-up questionnaires. At baseline, both groups had significantly lower scores compared with population norms across all scales (p<0.001). In the surgical cohort significant improvements were seen across all eight SF-36 scales (p<0.001) following surgery. Within 3 months of surgery scores were equivalent to those of the normal population and this improvement was sustained at 12 months. SF-36 physical and mental component scores both significantly improved following surgery, with a mean change of 10.2 and 9.2 points, respectively (p<0.001). In contrast, SF-36 scores for breast hypertrophy controls remained at baseline across 12 months. The improvement in quality of life was independent of breast resection weight and body mass index.ConclusionBreast reduction significantly improved quality of life in women with breast hypertrophy. This increase was most pronounced within 3 months of surgery and sustained at 12-month follow-up. This improvement in quality of life is comparable to other widely accepted surgical procedures. Furthermore, women benefit from surgery regardless of factors including body mass index and resection weight.
Our objective was to design, develop and validate better clinical breast examination (CBE) models addressing the deficiencies of previous models. Detailed research and a methodological design ...approach led to the development of a new technique for creating lifelike models for teaching CBE.
Six multi-layered breast models representing a range of normal human variation for durity (hardness/softness), nodularity (fibro-glandular tissue) and adiposity (fatty tissue) were developed and validated. Various construction materials, MRI scans, traditional casting and three-dimensional (3D) printing were used to build models with lifelike look and feel (biofidelic). The models realistic in anthropometry (size and shape), feel (durity and nodularity) and appearance (skin feel and colouring) - visual biofidelity enhances perception of feel - incorporate anatomically correct layering of ribs, soft adipose tissue, nodularity and additional signs of breast disease, both benign and pathological.
These were validated by four breast surgeons who compared their feel alongside a sample of breast patients (N = 78). Models were rated as 'undecided', 'similar' or 'very similar' to 81% of patients for nodularity and 82% for durity.
These are the first models to incorporate normal human variability and be validated with real patients. These novel biofidelic models provide a standardized way of teaching health professionals normal from abnormal.
Assessment of breast volume is an important tool for preoperative planning in various breast surgeries and other applications, such as bra development. Accurate assessment can improve the consistency ...and quality of surgery outcomes. This study outlines a non-invasive method to measure breast volume using a whole body 3D laser surface anatomy scanner, the Cyberware WBX. It expands on a previous publication where this method was validated against patients undergoing mastectomy. It specifically outlines and expands the computer-aided anthropometric (CAA) method for extracting breast volumes in a non-invasive way from patients enrolled in a breast reduction study at Flinders Medical Centre, South Australia. This step-by-step description allows others to replicate this work and provides an additional tool to assist them in their own clinical practice and development of designs.
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