Breast MRI BI-RADS Assessments and Abnormal Interpretation Rates by Clinical Indication in US Community Practices

As breast MRI use grows, benchmark performance parameters are needed for auditing and quality assurance purposes. We describe the variation in breast MRI abnormal interpretation rates (AIRs) by clinical indication among a large sample of U.S. community practices

Appropriate referral and selection of patients with chronic pain for spinal cord stimulation: European consensus recommendations and e-health tool

Background: Spinal cord stimulation (SCS) is an established treatment for chronic neuropathic, neuropathic-like and ischaemic pain. However, the heterogeneity of patients in daily clinical practice makes it often challenging to determine which patients are eligible for this treatment, resulting in undesirable practice variations. This study aimed to establish patient-specific recommendations for referral and selection of SCS in chronic pain. Methods: A multidisciplinary European panel used the RAND/UCLA Appropriateness Method (RUAM) to assess the appropriateness of (referral for) SCS for 386 clinical scenarios in four pain areas: chronic low back pain and/or leg pain, complex regional pain syndrome, neuropathic pain syndromes and ischaemic pain syndromes. In addition, the panel identified a set of psychosocial factors that are relevant to the decision for SCS treatment. Results: Appropriateness of SCS was strongly determined by the neuropathic or neuropathic-like pain component, location and spread of pain, anatomic abnormalities and previous response to therapies targeting pain processing (e.g. nerve block). Psychosocial factors considered relevant for SCS selection were as follows: lack of engagement, dysfunctional coping, unrealistic expectations, inadequate daily activity level, problematic social support, secondary gain, psychological distress and unwillingness to reduce high-dose opioids. An educational e-health tool was developed that combines clinical and psychosocial factors into an advice on referral/selection for SCS. Conclusions: The RUAM was useful to establish a consensus on patient-specific criteria for referral/selection for SCS in chronic pain. The e-health tool may help physicians learn to apply an integrated approach of clinical and psychosocial factors. Significance: Determining the eligibility of SCS in patients with chronic pain requires careful consideration of a variety of clinical and psychosocial factors. Using a systematic approach to combine evidence from clinical studies and expert opinion, a multidisciplinary European expert panel developed detailed recommendations to support appropriate referral and selection for SCS in chronic pain. These recommendations are available as an educational e-health tool (https://www.scstool.org/)

Breast MRI BI-RADS Assessments and Abnormal Interpretation Rates by Clinical Indication in US Community Practices

RATIONALE AND OBJECTIVES: As breast MRI use grows, benchmark performance parameters are needed for auditing and quality assurance purposes. We describe the variation in breast MRI abnormal interpretation rates (AIRs) by clinical indication among a large sample of U.S. community practices. MATERIALS AND METHODS: We analyzed data from 41 facilities across five Breast Cancer Surveillance Consortium imaging registries. Each registry obtained IRB approval for this HIPAA compliant analysis. We included 11,654 breast MRI exams conducted in 2005–2010 among women aged 18–79 years. We categorized clinical indications as: 1) screening; 2) extent of disease; 3) diagnostic (e.g., breast symptoms); and 4) other (e.g., short-interval follow-up). We characterized assessments as positive (i.e., BI-RADS 0, 4, and 5) or negative (i.e., BI-RADS 1, 2, 6), and provide results with BI-RADS 3 categorized as positive and as negative. We tested for differences in AIRs across clinical indications both unadjusted and adjusted for patient characteristics and registry, and assessed for changes in AIRs by indication over time. RESULTS: When categorizing BI-RADS 3 as positive, AIRs were 21.0% (95% CI: 19.8, 22.3) for screening, 31.7% (95% CI: 29.6, 33.8) for extent of disease, 29.7% (95% CI: 28.3, 31.1) for diagnostic, and 27.4% (95% CI: 25.0, 29.8) for other indications (p<0.0001). When categorizing BI-RADS 3 as negative, AIRs were 10.5% (95% CI: 9.5, 11.4) for screening, 21.8% (95% CI: 19.9, 23.6) for extent of disease, 17.7% (95% CI: 16.5, 18.8) for diagnostic, and 13.3% (95% CI: 11.6, 15.2) for other indications (p<0.0001). The significant differences in AIRs by indication persisted even after adjusting for patient characteristics and registry (p<0.0001). In addition, for most indications, there were no significant changes in AIRs over time. CONCLUSION: Breast MRI AIRs differ significantly by clinical indication. Practices should stratify breast MRI exams by indication for quality assurance and auditing purposes

Concordance of BI-RADS Assessments and Management Recommendations for Breast MRI in Community Practice.

ObjectiveThe purpose of this study was to evaluate concordance between BI-RADS assessments and management recommendations for breast MRI in community practice.Materials and methodsBreast MRI data were collected from four regional Breast Cancer Surveillance Consortium registries from 2005 to 2011 for women who were 18-79 years old. Assessments and recommendations were compared to determine concordance according to BI-RADS guidelines. Concordance was compared by assessment category as well as by year of examination and clinical indication.ResultsIn all, 8283 MRI examinations were included in the analysis. Concordance was highest (93% [2475/2657]) in examinations with a BI-RADS category 2 (benign) assessment. Concordance was also high in examinations with category 1 (negative) (87% [1669/1909]), category 0 (incomplete) (83% [348/417]), category 5 (highly suggestive of malignancy) (83% [208/252]), and category 4 (suspicious) (74% [734/993]) assessments. Examinations with categories 3 (probably benign) and 6 (known biopsy-proven malignancy) assessments had the lowest concordance rates (36% [302/837] and 56% [676/1218], respectively). The most frequent discordant recommendation for a category 3 assessment was routine follow-up. The most frequent discordant recommendation for a category 6 assessment was biopsy. Concordance of assessments and management recommendations differed across clinical indications (p &lt; 0.0001), with the lowest concordance in examinations to assess disease extent.ConclusionBreast MRI BI-RADS management recommendations were most concordant for assessments of negative, incomplete, suspicious, and highly suggestive of malignancy. Lower concordance for assessments of probably benign and known biopsy-proven malignancy and for examinations performed to assess disease extent highlight areas for interventions to improve breast MRI reporting

Concordance of BI-RADS Assessments and Management Recommendations for Breast MRI in Community Practice

ObjectiveThe purpose of this study was to evaluate concordance between BI-RADS assessments and management recommendations for breast MRI in community practice.Materials and methodsBreast MRI data were collected from four regional Breast Cancer Surveillance Consortium registries from 2005 to 2011 for women who were 18-79 years old. Assessments and recommendations were compared to determine concordance according to BI-RADS guidelines. Concordance was compared by assessment category as well as by year of examination and clinical indication.ResultsIn all, 8283 MRI examinations were included in the analysis. Concordance was highest (93% [2475/2657]) in examinations with a BI-RADS category 2 (benign) assessment. Concordance was also high in examinations with category 1 (negative) (87% [1669/1909]), category 0 (incomplete) (83% [348/417]), category 5 (highly suggestive of malignancy) (83% [208/252]), and category 4 (suspicious) (74% [734/993]) assessments. Examinations with categories 3 (probably benign) and 6 (known biopsy-proven malignancy) assessments had the lowest concordance rates (36% [302/837] and 56% [676/1218], respectively). The most frequent discordant recommendation for a category 3 assessment was routine follow-up. The most frequent discordant recommendation for a category 6 assessment was biopsy. Concordance of assessments and management recommendations differed across clinical indications (p &lt; 0.0001), with the lowest concordance in examinations to assess disease extent.ConclusionBreast MRI BI-RADS management recommendations were most concordant for assessments of negative, incomplete, suspicious, and highly suggestive of malignancy. Lower concordance for assessments of probably benign and known biopsy-proven malignancy and for examinations performed to assess disease extent highlight areas for interventions to improve breast MRI reporting

eGirls, eCitizens

eGirls, eCitizens is a landmark work that explores the many forces that shape girls’ and young women’s experiences of privacy, identity, and equality in our digitally networked society. Drawing on the multi-disciplinary expertise of a remarkable team of leading Canadian and international scholars, as well as Canada’s foremost digital literacy organization, MediaSmarts, this collection presents the complex realities of digitized communications for girls and young women as revealed through the findings of The eGirls Project (www.egirlsproject.ca) and other important research initiatives. Aimed at moving dialogues on scholarship and policy around girls and technology away from established binaries of good vs bad, or risk vs opportunity, these seminal contributions explore the interplay of factors that shape online environments characterized by a gendered gaze and too often punctuated by sexualized violence. Perhaps most importantly, this collection offers first-hand perspectives collected from girls and young women themselves, providing a unique window on what it is to be a girl in today’s digitized society

Functional movement disorder gender, age and phenotype study: a systematic review and individual patient meta-analysis of 4905 cases

: Functional movement disorder (FMD) is a common manifestation of functional neurological disorder presenting with diverse phenotypes such as tremor, weakness and gait disorder. Our current understanding of the basic epidemiological features of this condition is unclear. We aimed to describe and examine the relationship between age at onset, phenotype and gender in FMD in a large meta-analysis of published and unpublished individual patient cases. An electronic search of PubMed was conducted for studies from 1968 to 2019 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Individual patient data were collected through a research network. We described the distribution of age of onset and how this varied by gender and motor phenotype. A one-stage meta-analysis was performed using multilevel mixed-effects linear regression, including random intercepts for country and data source. A total of 4905 individual cases were analysed (72.6% woman). The mean age at onset was 39.6 years (SD 16.1). Women had a significantly earlier age of onset than men (39.1 years vs 41.0 years). Mixed FMD (23.1%), tremor (21.6%) and weakness (18.1%) were the most common phenotypes. Compared with tremor (40.7 years), the mean ages at onset of dystonia (34.5 years) and weakness (36.4 years) were significantly younger, while gait disorders (43.2 years) had a significantly later age at onset. The interaction between gender and phenotype was not significant. FMD peaks in midlife with varying effects of gender on age at onset and phenotype. The data gives some support to 'lumping' FMD as a unitary disorder but also highlights the value in 'splitting' into individual phenotypes where relevant