Relationship between the number of new nodules and lung cancer probability in incidence screening rounds of CT lung cancer screening:The NELSON study

textabstractBackground: New nodules are regularly found after the baseline round of low-dose computed tomography (LDCT) lung cancer screening. The relationship between a participant's number of new nodules and lung cancer probability is unknown. Methods: Participants of the ongoing Dutch-Belgian Randomized Lung Cancer Screening (NELSON) Trial with (sub)solid nodules detected after baseline and registered as new by the NELSON radiologists were included. The correlation between a participant's new nodule count and the largest new nodule size was assessed using Spearman's rank correlation. To evaluate the new nodule count as predictor for new nodule lung cancer together with largest new nodule size, a multivariable logistic regression analysis was performed. Results: In total, 705 participants with 964 new nodules were included. In 48% (336/705) of participants no nodule had been found previously during baseline screening and in 22% (154/705) of participants >1 new nodule was detected (range 1–12 new nodules). Eventually, 9% (65/705) of the participants had lung cancer in a new nodule. In 100% (65/65) of participants with new nodule lung cancer, the lung cancer was the largest or only new nodule at initial detection. The new nodule lung cancer probability did not differ significantly between participants with 1 (10% [56/551], 95%CI 8–13%) or >1 new nodule (6% [9/154], 95%CI 3–11%, P =.116). An increased number of new nodules positively correlated with a participant's largest nodule size (P < 0.001, Spearman's rho 0.177). When adjusted for largest new nodule size, the new nodule count had a significant negative association with lung cancer (odds ratio 0.59, 0.37–0.95, P =.03). Conclusion: A participant's new nodule count alone only has limited association with lung cancer. However, a higher new nodule count correlates with an increased largest new nodule size, while the lung cancer probability remains equivalent, and may improve lung cancer risk prediction by size only

The role of 'confounding by indication' in assessing the effect of quality of care on disease outcomes in general practice: results of a case-control study.

BACKGROUND: In quality of care research, limited information is found on the relationship between quality of care and disease outcomes. This case-control study was conducted with the aim to assess the effect of guideline adherence for stroke prevention on the occurrence of stroke in general practice. We report on the problems related to a variant of confounding by indication, that may be common in quality of care studies. METHODS: Stroke patients (cases) and controls were recruited from the general practitioner's (GP) patient register, and an expert panel assessed the quality of care of cases and controls using guideline-based review criteria. RESULTS: A total of 86 patients was assessed. Compared to patients without shortcomings in preventive care, patients who received sub-optimal care appeared to have a lower risk of experiencing a stroke (OR 0.60; 95% CI 0.24 to 1.53). This result was partly explained by the presenc

Cognitive Behavioral Intervention Compared to Telephone Counseling Early after Mild Traumatic Brain Injury:A Randomized Trial

Many patients do not return to work (RTW) after mild traumatic brain injury (mTBI) because of persistent complaints that are often resistant to therapy in the chronic phase. Recent studies suggest that psychological interventions should be implemented early post-injury to prevent patients from developing chronic complaints. This study is a randomized, controlled trial that examines the effectiveness of a newly developed cognitive behavioral therapy (CBT) intervention (CBTi) compared to telephonic counseling (TC) in at-risk mTBI patients (patients with high reports of early complaints). Patients underwent either five sessions of CBT treatment or five phone conversations starting 4-6 weeks post-trauma. The main outcome measure was RTW 6 and 12 months post-trauma. Secondary measures comprised functional outcome at 6 and 12 months, and depression, anxiety, and reported post-traumatic complaints at 3, 6, and 12 months post-injury. After excluding dropouts, CBTi consisted of 39 patients and TC of 45 patients. No significant differences were found with regard to RTW, with 65% of CBTi patients and 67% of TC patients reporting a RTW at previous level. However, TC patients reported fewer complaints at 3 (8 vs. 6; p = 0.010) and 12 months post-injury (9 vs. 5; p = 0.006), and more patients in the TC group showed a full recovery 12 months post-injury compared to the CBTi group (62% vs. 39%). The results of this study suggest that early follow-up of at-risk patients can have a positive influence on patients' well-being, and that a low-intensive, low-cost telephonic intervention might be more effective than a CBT intervention at improving outcome in at-risk patients

PHP48 COST SENSITIVENESS AND PHYSICIAN TREATMENT CHOICES

Objectives To explore the relationship between nodule count and lung cancer probability in baseline low-dose CT lung cancer screening. Materials and Methods Included were participants from the NELSON trial with at least one baseline nodule (3392 participants [45% of screen-group], 7258 nodules). We determined nodule count per participant. Malignancy was confirmed by histology. Nodules not diagnosed as screen-detected or interval cancer until the end of the fourth screening round were regarded as benign. We compared lung cancer probability per nodule count category. Results 1746 (51.5%) participants had one nodule, 800 (23.6%) had two nodules, 354 (10.4%) had three nodules, 191 (5.6%) had four nodules, and 301 (8.9%) had > 4 nodules. Lung cancer in a baseline nodule was diagnosed in 134 participants (139 cancers; 4.0%). Median nodule count in participants with only benign nodules was 1 (Inter-quartile range [IQR]: 1–2), and 2 (IQR 1–3) in participants with lung cancer (p = NS). At baseline, malignancy was detected mostly in the largest nodule (64/66 cancers). Lung cancer probability was 62/1746 (3.6%) in case a participant had one nodule, 33/800 (4.1%) for two nodules, 17/354 (4.8%) for three nodules, 12/191 (6.3%) for four nodules and 10/301 (3.3%) for > 4 nodules (p = NS). Conclusion In baseline lung cancer CT screening, half of participants with lung nodules have more than one nodule. Lung cancer probability does not significantly change with the number of nodules. Baseline nodule count will not help to differentiate between benign and malignant nodules. Each nodule found in lung cancer screening should be assessed separately independent of the presence of other nodules

Trabalho infantil : uma análise das tentativas de sua erradicação no Brasil

Orientadora: Profª Drª Silvia Maria P. AraújoDissertaçao (mestrado) - Universidade Federal do Paraná, Setor de Ciencias Humanas, Letras e Artes, Programa de Pós-Graduaçao em Sociologia. Defesa: Curitiba, 22/12/2003Inclui bibliografiaResumo: Esta dissertação pretende analisar a problemática da erradicação do trabalho infantil a partir dos discursos que se produziram ao longo da história moderna, relativos às descrições de infância e dos contextos que separam o mundo adulto do mundo infantil, ou, ao retrato da construção social do que representa a infância: o mundo do trabalho como retrato do universo adulto e a educação formal (escola) como síntese da vida em formação. Os pressupostos da educação formal e do trabalho norteiam as discussões que embasam os discursos a partir dos quais, a reprodução de valores inerentes ao sistema capitalista e suas contradições, evidenciam a necessidade de se elaborar um problema social, o qual necessita de descrição, avaliação e intervenção. Ao trazer a problemática da construção do trabalho infantil como problema social, esta pesquisa pretende analisar o processo histórico da construção da problemática do trabalho infantil retratado como um problema que deve ser exterminado, segundo os discursos, tendo como base categorias trabalho e infância. Pretende ainda, compreender o contexto histórico e socioeconômico no qual o trabalho infantil passou a ser combatido como um problema social, mais precisamente no Brasil, por meio de políticas públicas, bem como, identificar no processo do que se denomina de erradicação, a garantia do controle da formação de mão-de-obra, através dos programas voltados aos jovens e às crianças pobres e vulneráveis. Por fim, esta pesquisa lança uma reflexão sobre a necessidade de participação das crianças na elaboração de documentos ou iniciativas, que garantam os direitos da infância e da adolescência e que as mesmas possam escolher dentro de suas respectivas realidades, como traçar seus destinos. A pesquisa tem como base a coleta de dados documentais que evidenciam o pressuposto de trabalho infantil como um problema social, bem como, as contradições no discurso da erradicação, contemplando documentos do PETI (Programa de Erradicação do Trabalho Infantil), do Fórum Nacional de Prevenção e Erradicação do Trabalho Infantil e do ECA (Estatuto da Criança e do Adolescente), além de participações nas reuniões do Fórum, em Curitiba, na Procuradoria Regional do Trabalho, durante o ano de 2002

Influence of lung nodule margin on volume- and diameter-based reader variability in CT lung cancer screening

OBJECTIVE: To evaluate the influence of nodule margin on inter- and intra-reader variability in manual diameter measurements and semi-automatic volume measurements of solid nodules detected in low-dose CT lung cancer screening. METHODS: Twenty-five nodules of each morphological category (smooth, lobulated, spiculated and irregular) were randomly selected from 93 participants of the Dutch-Belgian randomized lung cancer screening trial (NELSON). Semi-automatic volume measurements were performed using Syngo LungCARE® software. Three radiologists independently measured mean diameters manually. Impact of nodule margin on inter-reader variability was evaluated based on systematic error and 95% limits of agreement. Inter-reader variability was compared to the nodule growth cutoff as used in Lung-RADS (+1.5mm diameter) and NELSON/British Thoracic Society (+25% volume). RESULTS: For manual diameter measurements, a significant systematic error (up to 1.2mm) between readers was found in all morphological categories. For semi-automatic volume measurements, no statistically significant systematic error was found. The inter-reader variability in mean diameter measurements exceeded the 1.5mm cut-off for nodule growth for all morphological categories (smooth: ±1.9mm [+27%], lobulated: ±2.0mm [+33%], spiculated: ±3.5mm [+133%], irregular: ±4.5mm [+200%]). The 25%-volume growth cut-off was exceeded slightly for spiculated (28% [+12%]) and irregular (27% [+8%]) nodules. CONCLUSION: Lung nodule sizing based on manual diameter measurement is affected by nodule margin. Inter-reader variability increases especially for nodules with spiculated and irregular margins, and may cause misclassification of nodule growth. This effect is much smaller for semi-automated volume measurements. Advances in knowledge: Semi-automatic volume measurements are superior for both size and growth determination of pulmonary nodules

Hosting an Educational Careers Day Within the Virtual Paradigm: The Neurology and Neurosurgery Interest Group Experience.

INTRODUCTION:  To explore our experience of hosting the 10th Annual Neurology and Neurosurgery Interest Group-Society of British Neurological Surgeons (NANSIG-SBNS) Neurosurgery Careers Day, held virtually for the first time. METHODS:  Reflective feedback and review of an international, virtual neurosurgery careers day. The authors reflect on the logistics of organizing the event, and the pre- and post-event feedback provided by delegates. Recommendations have been made on how to successfully host a virtual event. The key themes that permeated the event have been outlined and discussed in the context of the feedback received. RESULTS:  The event was attended by 231 delegates from 20 countries worldwide. Knowledge of neurosurgery as a career and the application process increased after attending the careers day (4.27/5 to 4.51/5, p=0.003 and 3.12/5 to 4.31/5, p<0.001 respectively). The key themes identified from the event include attendance, networking, and education. Qualitative feedback was positive and indicated a positive perception of the careers day. CONCLUSIONS:  The future of educational events is unclear, and a hybrid approach is recommended to retain the benefits of the online space when in-person events eventually return

Hosting an Educational Careers Day Within the Virtual Paradigm: The Neurology and Neurosurgery Interest Group Experience.

INTRODUCTION:  To explore our experience of hosting the 10th Annual Neurology and Neurosurgery Interest Group-Society of British Neurological Surgeons (NANSIG-SBNS) Neurosurgery Careers Day, held virtually for the first time. METHODS:  Reflective feedback and review of an international, virtual neurosurgery careers day. The authors reflect on the logistics of organizing the event, and the pre- and post-event feedback provided by delegates. Recommendations have been made on how to successfully host a virtual event. The key themes that permeated the event have been outlined and discussed in the context of the feedback received. RESULTS:  The event was attended by 231 delegates from 20 countries worldwide. Knowledge of neurosurgery as a career and the application process increased after attending the careers day (4.27/5 to 4.51/5, p=0.003 and 3.12/5 to 4.31/5, p<0.001 respectively). The key themes identified from the event include attendance, networking, and education. Qualitative feedback was positive and indicated a positive perception of the careers day. CONCLUSIONS:  The future of educational events is unclear, and a hybrid approach is recommended to retain the benefits of the online space when in-person events eventually return

The FOAM study : Is Hysterosalpingo foam sonography (HyFoSy) a cost-effective alternative for hysterosalpingography (HSG) in assessing tubal patency in subfertile women? Study protocol for a randomized controlled trial

This is an investigator initiated trial, VU medical center Amsterdam is the sponsor, contact information: prof. CJM de Groot, Department of Obstetrics and Gynaecology, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands, Tel: + 31-204444444. This study is funded by ZonMw, a Dutch organization for Health Research and Development, project number 837001504. ZonMW gives financial support for the whole project. IQ Medical Ventures provides the ExEm FOAM® kits. The funding bodies have no role in the design of the study; collection, analysis, and interpretation of data; and in writing the manuscript.Peer reviewedPublisher PD

Relationship between the number of new nodules and lung cancer probability in incidence screening rounds of CT lung cancer screening: The NELSON study

Background: New nodules are regularly found after the baseline round of low-dose computed tomography (LDCT) lung cancer screening. The relationship between a participant's number of new nodules and lung cancer probability is unknown. Methods: Participants of the ongoing Dutch-Belgian Randomized Lung Cancer Screening (NELSON) Trial with (sub)solid nodules detected after baseline and registered as new by the NELSON radiologists were included. The correlation between a participant's new nodule count and the largest new nodule size was assessed using Spearman's rank correlation. To evaluate the new nodule count as predictor for new nodule lung cancer together with largest new nodule size, a multivariable logistic regression analysis was performed. Results: In total, 705 participants with 964 new nodules were included. In 48% (336/705) of participants no nodule had been found previously during baseline screening and in 22% (154/705) of participants >1 new nodule was detected (range 1–12 new nodules). Eventually, 9% (65/705) of the participants had lung cancer in a new nodule. In 100% (65/65) of participants with new nodule lung cancer, the lung cancer was the largest or only new nodule at initial detection. The new nodule lung cancer probability did not differ significantly between participants with 1 (10% [56/551], 95%CI 8–13%) or >1 new nodule (6% [9/154], 95%CI 3–11%, P =.116). An increased number of new nodules positively correlated with a participant's largest nodule size (P < 0.001, Spearman's rho 0.177). When adjusted for largest new nodule size, the new nodule count had a significant negative association with lung cancer (odds ratio 0.59, 0.37–0.95, P =.03). Conclusion: A participant's new nodule count alone only has limited association with lung cancer. However, a higher new nodule count correlates with an increased largest new nodule size, while the lung cancer probability remains equivalent, and may improve lung cancer risk prediction by size only