199 research outputs found
Performance of Mammography in Women Aged under 40 Years
No full text Evaluation of: Yankaskas BC, Haneuse S, Kapp JM, Kerlikowske K, Geller B, Buist DSM; For the Breast Cancer Surveillance Consortium: Performance of first mammography examination in women younger than 40 years. J. Natl Cancer Inst. 102(10), 692–700 (2010). By using pooled data from six mammography registries across the USA, 117,737 women aged 18–39 years were identified who had received their first mammography in the period 1995–2005. A distinction was made between diagnostic mammography for women who presented with a breast problem (n = 30,956), and screening mammography (n = 86,781). The age-adjusted positive predictive value of screening mammography was 1.3% (95% CI: 1.1–1.5%), as compared with 14.6% (95% CI: 13.3–15.8%) for diagnostic mammography. Considering the high recall rates, the high number of false-positive test results and the low cancer detection rate, the appropriateness of mammography for women younger than 40 without symptoms is questionable. </jats:p
Searching for prognostic variables for secondary worsening after ischaemic stroke
No full textSecondary worsening of stroke symptoms is described in 13-37% of stroke patients, but the exact mechanism of this phenomenon remains unclear. The aim of this study is to find prognostic variables in correlation to secondary worsening of stroke symptoms in patients with lacunar or cortical strokes. In this prospective observational study we included all patients with ischaemic stroke; patients with transient ischaemic attack were excluded. Patients undergoing thrombolysis and becoming symptom-free after 24 h were still included in our analyses. Secondary worsening of stroke symptoms was defined as an increase of two or more points on the NIH Stroke Scale (NIHSS). The NIHSS score was assessed on admission, at discharge, and when patients had symptoms that indicated worsening of stroke. Applying univariate and multivariable analysis, we studied the relation between symptoms indicating secondary worsening of stroke and prognostic variables such as extreme nocturnal blood pressure falls (> 20% of the average blood pressure), infection, diabetes mellitus, hypertension, smoking, dyslipidaemia, a history of cardiovascular or cerebrovascular disease and thrombolysis. This study included 202 patients with a mean age of 72 years, 48.8% were men and 43% had a lacunar stroke. Secondary worsening of stroke symptoms occurred in 13.5% of all patients, more often but not significantly (NS) after lacunar than cortical strokes (16.8 and 11.4%, respectively), and in patients with extreme nocturnal blood pressure falls versus without (15.6 and 11.8%, respectively (NS)). There was no significant relation between the analysed prognostic variables and secondary worsening of stroke symptoms. This study did not show significant correlation between several variables and secondary worsening of stroke symptoms in patients with recent ischaemic stroke
Treatment of the Primary Tumour in the Presence of Metastases: Lessons from Breast Cancer
No full textImpact of breast surgery on survival in patients with distant metastases at initial presentation: a systematic review of the literature
No full textAccording to current treatment standards, patients with metastatic breast cancer at diagnosis receive palliative therapy. Local treatment of the breast is only recommended if the primary tumor is symptomatic. Recent studies suggest that surgical removal of the primary tumor has a favorable impact on the prognosis of patients with primary metastatic breast cancer. We performed a systematic review of the literature to weigh the evidence for and against breast surgery in this patient group. Ten retrospective studies were found in which the use of breast surgery in primary metastatic breast cancer and its impact on survival was examined. The hazard ratios of the studies were pooled to provide an estimate of the overall effect of surgery, and the results and conclusions of the studies were analyzed. A crude analysis, without adjustment for potential confounders, showed that surgical removal of the breast lesion in stage-IV disease was associated with a significantly higher overall survival rate in seven of the ten studies, and a trend toward a better survival in the three remaining studies. Surgery of the primary tumor appeared to be an independent factor for an improved survival in the multivariate analyses from the individual studies, with hazard ratios ranging from 0.47 to 0.71. The pooled hazard ratio for overall mortality was 0.65 (95% CI 0.59-0.72) in favor of the patients undergoing surgery. This systematic review of the literature suggests that surgery of the primary breast tumor in patients with stage-IV disease at initial presentation does have a positive impact on survival. In order to provide a definite answer on whether local tumor control in patients with primary metastatic disease improves survival, a randomized controlled trial comparing systemic therapy with and without breast surgery is needed
The Influence of Big Data Implementation towards Business Models in Different Sectors
No full textThere is nowadays an increased use of data, reaching 2.5 exabytes globally, and is expected to double every two years (Morvan, 2016). An enormous amount of data can now be generated, ranging from smartphones to sensors in machineries. However, most organizations are reported to be able to only create and store data, and creating added value from data is a major challenge for many organizations (Akerkar et al., 2015). Only 4% of companies across industries have the capabilities to create value through Big Data (Bertocco & Padmanabhan, 2014). Organizations might want to look into their business model, as adjusting their business model can facilitate the implementation (Muhtaroğlu, Demir, Obalı, & Girgin, 2013), and can result in more efficient business operations (Loebbecke & Picot, 2015). Organizations also face different circumstances (e.g. problems, challenges, applications), since they are located in different sectors (Vega-Gorgojo, Fjellheim, Roman, Akerkar, & Waaler, 2016). Therefore, this study aims to see more into the relationship between sector characteristics and the impact on business model when implementing Big Data, by means of interviews in the setting of explorative & qualitative study. Oil & gas, manufacturing, and health sector are chosen for the purpose of this study, due to the potential of Big Data implementation in these three sectors. Canvas business model template is chosen to provide the clarity of the impact on business model. From this study, Big Data is seen as a systemic innovation, due to the necessary changes in technological, organizational, and institutional aspects of the existing innovation system in a sector. The study also shows that activities, resources, and value propositions are core in the implementation, where implementing Big Data into the activities will result in improvement of value proposition, and enabled by resources. The changes in those three aspects can lead to changes in other aspects of business model, such as partnership, customer relationship, and financial. Customer segments remain unaffected, due to the specificity of value perceived by a certain segment. However, it might change in the future in the case that a new value is offered. It is found that a certain sector characteristic or combination of sector characteristics influences how organization adjusts their business model, but more importantly, the causes that shapes such characteristics need to be considered well.Management of Technology (MoT
Frequency and characteristics of additionally detected ipsilateral breast lesions following recall at screening mammography
No full textPurpose: To determine the frequency and outcome of additionally detected ipsilateral breast abnormalities following recall at screening mammography. Methods and materials: We included a consecutive series of 130,338 screening mammograms obtained between January 1, 2014 and January 1, 2016. During 2-year follow-up, clinical data were collected of all recalls. Women with a bilateral recall (115) and women recalled for multiple lesions in one breast (165) were excluded from the analyses. Screening outcome parameters were determined for recalled women with or without evaluation of additional ipsilateral breast abnormalities following recall. Results: A total of 3995 women were recalled (recall rate, 3.1%). In 258 (6.4%) of these women, another lesion was detected in the ipsilateral breast than the one for which she had been recalled. Biopsy was more frequently performed of additionally detected ipsilateral lesions than of recalled lesions (55.8% (144/258)) versus 39.7% (1375/3457), (p Conclusion: A substantial proportion of women are analyzed for additional ipsilateral breast lesions following recall. These lesions are more frequently biopsied than recalled lesions, but have a comparable probability of being malignant. The majority of additionally detected cancerous lesions are part of multifocal or multicentric malignancies. (C) 2018 Elsevier Ltd. All rights reserved
What to Do with Non-visualized Sentinel Nodes? A Dutch Nationwide Survey Study
Get PDFIntroduction. International guidelines differ regarding their recommendations on axillary treatment of patients with non-visualized sentinel lymph nodes (non-vSLN). Therefore, we distributed a survey among Dutch oncological surgeons to determine their routine practice and opinion regarding axillary treatment in case of a non-vSLN, with the emphasis on whether these practices and opinions have changed since publication of the Z0011 trial. Methods. A Dutch nationwide survey containing 10 questions regarding clinical routine during the sentinel node procedure and axillary treatment of non-vSLN patients was distributed among 510 oncological surgeons. Results. The survey was completed by 122 (24%) oncological surgeons, of whom 116 (95%) were registered as specialized breast surgeons. These surgeons had, on average, 13 years of experience. The majority of respondents used both lymphoscintigraphy and Patent Blue during the sentinel node procedure, and 39% estimated the prevalence of a non-vSLN to be 1-2%. Most surgeons are currently more reserved when considering whether to perform an axillary lymph node dissection (ALND) than prior to publication of the Z0011 trial (15 vs. 80%, respectively). Sixty percent base their decision on various clinicopathological characteristics. Twenty-three respondents (20%) opted for an alternative axillary treatment. Conclusion. This study shows that, in daily practice, most specialized breast surgeons think that a non-vSLN is rare. If so, most currently opt not to perform an ALND, whereas a small proportion consider an alternative axillary treatment. These decisions differ than in the period prior to the Z0011 trial. More research is needed to provide optimal treatment recommendations in case of a non-vSLN
Screening outcome in women repeatedly recalled for the same mammographic abnormality before, during and after the transition from screen-film to full-field digital screening mammography
No full textThe aim of this study was to retrospectively determine screening outcome in women recalled twice for the same mammographic lesion before, during, and after transition from screen-film (SFM) to full-field digital screening mammography (FFDM). We included women with a repeated recall for the same mammographic abnormality (37 at subsequent SFM-screening, obtained between January 2000-April 2010; respectively 54 and 65 women with a prior SFM-screen or FFDM-screen followed by subsequent FFDM-screening, obtained between May 2009-July 2013). At SFM-screening, repeated recalls for the same lesion comprised 1.2 % of recalls (37/3217), including 13 malignancies (positive predictive value (PPV), 35.1 %). During the SFM to FFDM transition (SFM-screen followed by FFDM-screen), FFDM recalls comprised more repeated recalls for the same lesion (2.2 %, P = 0.002), with a lower PPV (14.8 %, P = 0.02). This proportion increased to 2.8 % after transition to FFDM (i.e., two successive FFDM-screens), with 16 malignancies (PPV, 24.6 %). Invasive cancers at repeated recall were smaller than interval cancers (T1a-c, 79.4 versus 46.8 %, P = 0.001), with less lymph node involvement (20.6 versus 46.5 %, P = 0.007). More women are repeatedly recalled for the same mammographic abnormality during and after the transition from SFM to FFDM-screening, with comparable cancer risks before and after the transition. These cancers show better prognostic characteristics than interval cancers. aEuro cent FFDM-screening increases the number of repeated recalls for the same mammographic abnormality. aEuro cent The PPV of these recalls is comparable before and after transition to FFDM-screening. aEuro cent Cancers diagnosed after a repeated recall are smaller than interval cancers. aEuro cent These cancers also show less lymph node involvement than interval cancers
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