Holland Hospital

Abstract Introduction The use of magnetic resonance imaging (MRI) in preoperative staging of breast cancer remains arbitrary. The high sensitivity together with the somewhat lower specificity of MRI provides a unique balance between finding true extent/new lesions and overdiagnostics/overtreatment. This study aims to assess a cohort of breast cancer patients examined with preoperative MRI and estimate the potential benefits and negative effects. Method This retrospective, single center cohort study included patients examined with preoperative MRI before primary surgery for breast cancer between 2019 and 2022. Result In total, 94 patients were included. Median age was 54 years, 37.2% were premenopausal and 35.1% had invasive lobular carcinoma. The detection rate of occult contralateral breast cancer was 9.6%. Reoperation rate due to positive margins was 6.4%. Bland-Altman statistics showed higher agreement between estimated extent by MRI and postoperative histopathological extent, compared to estimation by ultrasound or mammography. MRI contributed to correct change of operation method in 18.1%, but also less favorable choice of surgery in 5.3% of patients (such as unnecessary mastectomy). The total mastectomy rate was 54.3%. Unnecessary biopsies of benign lesions after MRI were performed in 11.7% of patients. Discussion In this cohort, breast MRI had a clear impact on the surgical treatment of breast cancer, affecting choice of operation method. About a fifth of patients examined with MRI received a benefit with a better management of their breast cancer, however an equally large part received less optimal diagnostics and treatment.

Abstract The Buck Creek ultramafic complex is a fragment of oceanic cumulate emplaced into the lower Laurentian continental crust during Ordovician Taconic subduction. We document olivine fabrics in the relatively pristine dunites preserved from peak metamorphic conditions of ∼850°C and 1.0–1.4 GPa confining pressure. Mineral assemblages and microstructures indicate nearly anhydrous conditions at peak metamorphism and the activity of dislocation creep with minor evidence of grain boundary sliding. Grain size piezometry indicates stress conditions of ∼17–25 MPa. Analysis of crystallographic preferred orientations (CPO) and intracrystalline misorientations indicate the primary activity of the [001](010) slip system leading to the development of B‐type olivine fabrics. We suggest that the Buck Creek dunites formed as ocean crust cumulates and were partially subducted beneath the Laurentian continental crust to deformation conditions similar to those in the shallow mantle wedge. We document that deformation at Buck Creek occurred at lower differential stress conditions and lower water content than typically associated with B‐type CPOs, broadening the range of known conditions in which these fabrics may form.

ObjectivesTo describe contemporary characteristics and diagnoses in prehospital patients with chest pain and to identify factors suitable for the early recognition of high-risk and low-risk conditions.DesignProspective observational cohort study.SettingTwo centre study in a Swedish county emergency medical services (EMS) organisation.ParticipantsUnselected inclusion of 2917 patients with chest pain contacting the EMS due to chest pain during 2018.Primary outcome measuresLow-risk or high-risk condition, that is, occurrence of time-sensitive diagnosis on hospital discharge.ResultsOf included EMS missions, 68% concerned patients with a low-risk condition without medical need of acute hospital treatment in hindsight. Sixteen per cent concerned patients with a high-risk condition in need of rapid transport to hospital care. Numerous variables with significant association with low-risk or high-risk conditions were found. In total high-risk and low-risk prediction models shared six predictive variables of which ST-depression on ECG and age were most important. Previously known risk factors such as history of acute coronary syndrome, diabetes and hypertension had no predictive value in the multivariate analyses. Some aspects of the symptoms such as pain intensity, pain in the right arm and paleness did on the other hand appear to be helpful. The area under the curve (AUC) for prediction of low-risk candidates was 0.786 and for high-risk candidates 0.796. The addition of troponin in a subset increased the AUC to >0.8 for both.ConclusionsA majority of patients with chest pain cared for by the EMS suffer from a low-risk condition and have no prognostic reason for acute hospital care given their diagnosis on hospital discharge. A smaller proportion has a high-risk condition and is in need of prompt specialist care. Building models with good accuracy for prehospital identification of these groups is possible. The use of risk stratification models could make a more personalised care possible with increased patient safety.

High-intensity interval training (HIIT) is gaining popularity as a training approach for patients attending cardiac rehabilitation (CR). While the literature has focused on the efficacy of HIIT for improving cardiorespiratory fitness (CRF), particularly when compared with moderate intensity exercise, less emphasis has been placed on adherence to HIIT. The aim of this review was to summarize the current literature regarding adherence to HIIT in CR patients with coronary artery disease. A review identified 36 studies investigating HIIT in CR patients with coronary artery disease. Methods and data were extracted for exercise or training adherence (to attendance, intensity, and duration), feasibility of protocols, and CRF. The review summarizes reporting of adherence; adherence to HIIT and comparator/s; the influence of adherence on changes in CRF; and feasibility of HIIT. Adherence to the attendance of HIIT sessions was high and comparable with moderate-intensity exercise. However, adherence to the intensity and duration of HIIT was variable and underreported, which has implications for determining the treatment effect of the exercise interventions being compared. Furthermore, additional research is needed to investigate the utility of home-based HIIT and long-term adherence to HIIT following supervised programs. This review provides recommendations for researchers in the measurement and reporting of adherence to HIIT and other exercise interventions to facilitate a sufficient and consistent approach for future studies. This article also highlights strategies for clinicians to improve adherence, feasibility, and enjoyment of HIIT for their patients.

Update concussion recovery curves by considering pre- and postinjury modifying factors. Determine whether there is a dose-response for modifying factors on recovery. Sports medicine concussion clinic. A total of 314 athletes aged 12-23 years within 7 days of a concussion enrolled between 2015 and 2018. Prospective cohort study. Categorical recovery time defined as days from injury to full medical clearance for return to play per established criteria. Preinjury factors included age, gender, concussion history, and migraine history. Postinjury factors included loss of consciousness, posttraumatic amnesia, posttraumatic migraine symptoms, and high symptom burden. Average recovery was 27.5 ± 25 days. Five factors were prognostic of recovery: (1) younger than 18 years, (2) female, (3) history of migraine, (4) posttraumatic migraine symptoms, and (5) high symptom burden (P < .05). Recovery percentage at 21 days after injury was 96.7% for participants with 0 factor, 65.3% for those with 1 to 2, and 31.8% for those with 3 to 5-with prognostic separation in low- to high-risk groups of 62%. Findings support a dose-response for combined pre- and postinjury factors on recovery. Both the type and quantity of modifying factors influence recovery and should be considered in prognosis and approaches to multidisciplinary care.

Review of this book on theology and film for Modern Believing.

Purpose The value of interprofessional education (IPE) and interprofessional collaborative practice (IPCP) is well documented for health care professionals and settings. The World Health Organizati...

Sleep quality in people with cystic fibrosis (CF) is known to be poor, whereas participating in regular physical activity is associated with less decline in lung function (forced expiratory volume in 1 sec [FEV1]). The relationship between sleep quality and physical activity in people with CF is unknown. Secondary analysis of sleep and activity data collected via actigraphy. Adults with CF in stable health, participating in a study of physical activity (including assessment of exercise capacity), completed 7 d of activity and sleep assessment (SenseWear Armband [SWA]; BodyMedia). Sleep characteristics were derived from accelerometer positional data and registration of sleep state by the SWA, determined by energy expenditure. Sleep and activity data were available for 47 participants [n = 28 male; mean ± standard deviation age = 29 ± 8 yr; median (IQR) FEV1 = 60 (50, 82) % predicted]. More fragmented sleep was associated with poorer exercise capacity (rs = -0.303, P = .04), less time spent in moderate-vigorous physical activity (rs = -0.337, P = .020), and poorer FEV1 (rs = -0.344, P = .018). Regression analysis showed that less fragmented sleep was an independent predictor of more total daily activity time (β = -1.0, standard error [SE] of β = .4, P = .02) and trended toward significance for more moderate-vigorous physical activity (β = -.3, SE of β = -.26, P = .08). Greater total sleep time and sleep efficiency were related to better exercise capacity and lung function (P < .05). This secondary analysis demonstrated a modest relationship between sleep parameters and physical activity and exercise capacity in adults with CF. Future studies of interventions to promote physical activity participation in this group should consider the relationship between sleep and activity performance.