Background
Breast-conserving surgery (BCS) is an integral component of early-stage breast cancer treatment, but costly reexcision procedures are common due to the high prevalence of cancer-positive ...margins on primary resections. A need exists to develop and evaluate improved methods of margin assessment to detect positive margins intraoperatively.
Methods
A prospective trial was conducted through which micro-computed tomography (micro-CT) with radiological interpretation by three independent readers was evaluated for BCS margin assessment. Results were compared to standard-of-care intraoperative margin assessment (i.e., specimen palpation and radiography abbreviated SIA) for detecting cancer-positive margins.
Results
Six hundred margins from 100 patients were analyzed. Twenty-one margins in 14 patients were pathologically positive. On analysis at the specimen-level, SIA yielded a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 42.9%, 76.7%, 23.1%, and 89.2%, respectively. SIA correctly identified six of 14 margin-positive cases with a 23.5% false positive rate (FPR). Micro-CT readers achieved sensitivity, specificity, PPV, and NPV ranges of 35.7–50.0%, 55.8–68.6%, 15.6–15.8%, and 86.8–87.3%, respectively. Micro-CT readers correctly identified five to seven of 14 margin-positive cases with an FPR range of 31.4–44.2%. If micro-CT scanning had been combined with SIA, up to three additional margin-positive specimens would have been identified.
Discussion
Micro-CT identified a similar proportion of margin-positive cases as standard specimen palpation and radiography, but due to difficulty distinguishing between radiodense fibroglandular tissue and cancer, resulted in a higher proportion of false positive margin assessments.
Abstract Osteochondromas are the most common benign bone tumor typically seen in the appendicular skeleton and are rarely found in the spine. We present a case of an osteochondroma of the spine ...presenting with spinal cord compression. 27-year-old male presented with lower extremity weakness and paresthesia, decreased lower extremity sensation, and decreased proprioception. MRI showed a heterogeneous mass with minimal peripheral enhancement and without restricted diffusion. CT demonstrated a calcified mass extending from the left facet joint of T11–T12 with medial extension, resulting in severe central canal stenosis and cord compression. The patient underwent surgical resection with pathology demonstrating an osteochondroma.
The European Union has experienced a refugee influx since 2015. Spain has also seen an increase in the number of refugees since 2015. However, unlike the historical flow of Latin American immigrants, ...immigrants entering Spain since 2015 are increasingly from the Middle East, Africa, and Asia. This can pose an issue towards their integration into Spanish society, as they do not have the same historical and cultural ties to Spain like Latin America. I argue that language is an important resource which allows immigrants to access social capital and resources in the country of reception. The role of language with immigration will be analyzed in the Valencian Community of Spain. Immigration and integration data from Spain are discussed alongside data from 4 other European countries to serve as comparative analysis.
Pain and symptom management is an integral part of the clinical practice of oncology. A number of guidelines have been developed to assist the clinician in optimizing comfort care. We implemented ...clinical guidelines for cancer pain management in the community setting and evaluated whether these guidelines improved care.
Eighty-one cancer patients, aged 37 to 76 years, were enrolled onto a prospective, longitudinal, randomized controlled study from the outpatient clinic settings of 26 western Washington-area medical oncologists. A multilevel treatment algorithm based on the Agency for Health Care Policy and Research Guidelines for Cancer Pain Management was compared with standard-practice (control) pain and symptom management therapies used by community oncologists. The primary outcome of interest was pain (Brief Pain Inventory); secondary outcomes of interest were all other symptoms (Memorial Symptom Assessment Scale) and quality of life (Functional Assessment of Cancer Therapy Scale).
Patients randomized to the pain algorithm group achieved a statistically significant reduction in usual pain intensity, measured as slope scores, when compared with standard community practice (P < .02). Concurrent chemotherapy and patient adherence to treatment were significant mediators of worst pain. There were no significant differences in other symptoms or quality of life between the two treatment groups.
This guideline implementation study supports the use of algorithmic decision making in the management of cancer pain. These findings suggest that comprehensive pain assessment and evidence-based analgesic decision-making processes do enhance usual pain outcomes.
Standard guidelines for cancer pain treatment routinely recommend training patients to reduce barriers to pain relief, use medications appropriately, and communicate their pain-related needs. Methods ...are needed to reduce professional time required while achieving sustained intervention effectiveness. In a multisite, randomized controlled trial, this study tested a pain training method versus a nutrition control. At six oncology clinics, physicians (N=22) and nurses (N=23) enrolled patients (N=93) who were over 18years of age , with cancer diagnoses, pain, and a life expectancy of at least 6months. Pain training and control interventions were matched for materials and method. Patients watched a video followed by about 20min of manual-standardized training with an oncology nurse focused on reviewing the printed material and adapted to individual concerns of patients. A follow-up phone call after 72h addressed individualized treatment content and pain communication. Assessments at baseline, one, three, and 6months included barriers, the Brief Pain Inventory, opioid use, and physician and nurse ratings of their patients’ pain. Trained versus control patients reported reduced barriers to pain relief (P<.001), lower usual pain (P=.03), and greater opioid use (P<.001). No pain training patients reported severe pain (>6 on a 0–10 scale) at 1-month outcomes (P=.03). Physician and nurse ratings were closer to patients’ ratings of pain for trained versus nutrition groups (P=.04 and <.001, respectively). Training efficacy was not modified by patient characteristics. Using video and print materials, with brief individualized training, effectively improved pain management over time for cancer patients of varying diagnostic and demographic groups.
The European Union has experienced a refugee influx since 2015. Spain has also seen an increase in the number of refugees since 2015. However, unlike the historical flow of Latin American immigrants, ...immigrants entering Spain since 2015 are increasingly from the Middle East, Africa, and Asia. This can pose an issue towards their integration into Spanish society, as they do not have the same historical and cultural ties to Spain like Latin America. I argue that language is an important resource which allows immigrants to access social capital and resources in the country of reception. The role of language with immigration will be analyzed in the Valencian Community of Spain. Immigration and integration data from Spain are discussed alongside data from 4 other European countries to serve as comparative analysis.
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