Underreported and underrecognized: a comprehensive imaging review of breast injury

Breast injury is commonly encountered yet it remains significantly underreported. Injury to the breast may arise from either primary mechanisms or secondary or iatrogenic mechanisms. Primary mechanisms of breast injury include blunt force, seat-belt, penetrating, and thermal injury. Secondary or iatrogenic mechanisms of breast injury include breast biopsy or intervention as well as operative intervention and cardiopulmonary resuscitation. The severity of breast injury arising from these mechanisms is broad, ranging from breast contusion to avulsion. Sequelae of breast injury include fat necrosis and Mondor's disease. Radiologists play an integral role in the evaluation and management of breast injury both in the acute and non-acute settings. In the acute setting, radiologists must be able to recognize breast injury arising from primary mechanisms or iatrogenic or secondary mechanisms and to identify rare but potentially life-threatening complications promptly to ensure timely, appropriate management. In the non-acute setting, radiologists must be able to discern the sequalae of breast injury from other processes to prevent potentially unnecessary further evaluation and intervention. Nonetheless, though breast injury is commonly encountered there remain few guidelines and a lack of established recommendations for the evaluation and management of breast injury. We provide a comprehensive multi-modality imaging review of breast injury arising in the acute setting as well as the sequela of breast injury arising in the non-acute setting. Moreover, we provide an overview of the management of breast injury.

Assessment of Musculoskeletal Discomfort and Evaluation of Radiology Workstation Ergonomics in a National Radiology Workforce

RATIONALE AND OBJECTIVES

We assessed the presence of musculoskeletal discomfort and evaluated the ergonomics parameters of radiology workstations and the impact of poor radiology workstation ergonomics on musculoskeletal discomfort in a national radiology workforce.

METHODS

This was a cross-sectional, questionnaire-based study. All radiologist and radiology trainee members of the Canadian Association of Radiologists were eligible to participate. Radiology workstation ergonomics parameters and self-reported data on musculoskeletal discomfort were recorded. A binary logistic regression model was fitted to the data to ascertain the impact of participants' radiology workstation ergonomics parameters on the likelihood of experience of musculoskeletal discomfort while adjusting for demographic variables.

RESULTS

A total of 191 questionnaires were completed. The median (interquartile range) age of participants was 42.0 years (17.0 years) and 56.8% of participants were female. One hundred fifty participants (78.5%) self-reported the presence of musculoskeletal discomfort. Ergonomics parameters most commonly implemented included having monitors an arm's length away (82.6%) and hands being shoulder-width apart (77.1%). Binary logistic regression revealed participants either not having the top of the monitor screen at eye level when in a seated position or not having the wrists straight and relatively flat when using the mouse was associated with an increased likelihood of experience of musculoskeletal discomfort. The majority of participants (92.7%) self-reported their musculoskeletal discomfort to affect work productivity.

CONCLUSION

A high proportion of musculoskeletal discomfort, limited implementation of ergonomics parameters of radiology workstations, and an association of two of these ergonomics parameters with an increased likelihood of experience of musculoskeletal discomfort were observed in a national radiology workforce.

Evaluation of the Association Between Sociodemographic Status and Breast Screening Volumes During the COVID-19 Pandemic in a Provincial, Population-Based Organized Breast Screening Program

OBJECTIVES

We sought to evaluate the association between patient sociodemographic status and breast screening volumes (BSVs) during the COVID-19 pandemic in a large, population-based breast screening program that serves a provincial population of over 5 million.

METHODS

All patients who completed breast screening between April 1st, 2017 and March 31st, 2021 were eligible to participate. An average of 3 annual periods between April 1st, 2017 and March 31st, 2020 were defined as the pre-COVID period while the period between April 1st, 2020 and March 31st, 2021 was defined as the COVID-impacted period. The Postal CodeOM Conversion File Plus was applied to map patient residential postal codes to 2016 census standard geographical areas, which provided information on community size, income quintile and dissemination areas. Dissemination areas were subsequently linked to the Canadian Index of Multiple Deprivation (CIMD).

RESULTS

Overall BSV was reduced by 23.0% during the COVID-impacted period as compared to the pre-COVID period. Percent reductions in BSVs were greatest among younger patients aged 40 to 49 years (31.3%) and patients residing in communities with a population of less than 10,000 (27.0%). Percent reduction in BSV was greatest among patients in the lowest income quintile (28.1%). Percent reductions in BSVs were greatest for patients in the most deprived quintiles across all 4 dimensions of the CIMD.

CONCLUSION

Disproportionate reductions in BSVs were observed during the COVID-19 pandemic among younger patients, patients residing in rural communities, patients in lower income quintiles, and patients in the most deprived quintiles across all 4 dimensions of the CIMD.

Knowledge and Perceptions of Competency-Based Medical Education in Diagnostic Radiology Post-Graduate Medical Education: Identifying Priorities and Developing a Framework for Professional Development Activities

Introduction: We evaluated knowledge and perceptions of an established Competency-Based Medical Education (CBME) model developed by the Royal College of Physicians and Surgeons of Canada, Competence by Design (CBD), and identified evidence-informed priorities for professional development activities (PDAs). Materials and Methods: Teaching faculty and residents at a single, large diagnostic radiology post-graduate medical education (PGME) program were eligible to participate in this cross-sectional, survey-based study. Knowledge of CBD was evaluated through multiple choice questions (MCQs), which assessed participants' understanding of major principles and terms associated with CBD. Participants' perceptions of the anticipated impact of CBD on resident education and patient care were evaluated and priorities for PDAs were identified, which informed a framework for CBD PDAs. Results: Fifty faculty and residents participated. The faculty and resident response rates were 11.6% (n = 29/249) and 55.3% (n = 21/38), respectively. The mean ± standard deviation overall score on MCQs was 39.0% ± 20.4%. The majority of participants perceived the impact of CBD on resident education to be equivocal and to not impact patient care. Knowledge of CBD was not statistically significantly associated with participants' perceptions of the impact of CBD on either resident education or patient care (P > .05). Delivery of high-quality feedback was the greatest priority identified for PDAs. Discussion: Our results and proposed CBD PDAs framework may help to guide diagnostic radiology PGME programs in designing evidence-informed PDAs, which may meaningfully contribute to the successful implementation of CBD in diagnostic radiology PGME. As diagnostic radiology PGME programs throughout the world increasingly implement CBME models, evidence-informed PDAs will become of increasing importance.

Review of Challenges to the Implementation of Competence by Design in Post-Graduate Medical Education: What Can Diagnostic Radiology Learn from the Experience of Other Specialty Disciplines?

Competence by Design (CBD) is a medical education initiative instituted by the Royal College of Physicians and Surgeons of Canada to improve the training of resident physicians in specialty disciplines. CBD integrates Competency Based Medical Education with traditional specialty discipline post-graduate medical education (PGME) training through the application of an organizational framework of competencies. Various specialty disciplines in Canada have transitioned to CBD since 2017 in a staggered approach. Diagnostic radiology PGME programs in Canada are expected to transition to CBD in 2022 for the incoming resident physician cohort. This article reviews potential challenges to the implementation of CBD in diagnostic radiology PGME programs and proposes evidence-informed targeted strategies and solutions to address these challenges. It is important for diagnostic radiology PGME programs to understand the challenges pertaining to the implementation of CBD so that they may be able to successfully implement this or similar medical education initiatives in their programs. Moreover, as radiology subspecialty PGME programs, such as nuclear medicine, interventional radiology, neuroradiology, and pediatric radiology, likewise transition to CBD and diagnostic radiology PGME programs internationally increasingly implement other Competency Based Medical Education models, the implications of the challenges pertaining to the implementation of CBD will further become of increasing importance.

Preparedness of Residents and Medical Students for the Transition to Competence by Design in Diagnostic Radiology Post-Graduate Medical Education

Introduction: This needs assessment evaluated residents' and medical students' knowledge of Competence by Design (CBD), perceived benefits of and challenges or barriers to the transition to CBD for residents, and perceived overall preparedness for the transition to CBD in diagnostic radiology. Materials and Methods: All diagnostic radiology residents and medical students in Canada were eligible to participate in this national cross-sectional, questionnaire-based needs assessment. Knowledge of CBD was evaluated through participants' self-reported rating of their knowledge of CBD on a 5-point Likert scale. Perceived benefits of and challenges or barriers to the transition to CBD for residents were rank ordered. Participants' overall self-reported preparedness for the transition to CBD was assessed on a 5-point Likert scale. Data were summarized by descriptive statistics and bivariate analyses were conducted as appropriate. Results: Ninety-four residents (n = 77) and medical students (n = 17) participated in this needs assessment. Participants' mean ± standard deviation self-reported rating of their overall knowledge of CBD was 2.86 ± .94. Provision of meaningful feedback to learners and learners' ability to identify their own educational needs were among the highest ranked perceived benefits of the transition to CBD, while demands on time and increased frequency of evaluation were among the highest ranked perceived challenges or barriers to the transition to CBD. Few participants reported being either "prepared" (4.7%) or "somewhat prepared" (14.0%) for the transition to CBD. Conclusion: Preparedness for the transition to CBD in diagnostic radiology may be improved. Targeted interventions to augment the preparedness of residents and medical students should be considered.

The need for change in nurse education: a literature review

The implementation of the Project 2000 diploma course in 1989 meant that nurse education was moving rapidly from an apprenticeship system of preparation to an education led system in which students have student status. There is nothing new in the idea of student status for nurse learners; it had been suggested over 40 years before it actually came to fruition. This paper critically analyses the literature and looks at the reasons for the need for change in nurse education. An examination is made of the reasons why this change was not implemented earlier. The Project 2000 proposals are then explored with the benefit of hindsight, and the conclusion is reached that there is need for ongoing research to evaluate the impact of the course not that it is the established method of preparation for nurse learners.

The organisation of health care in Nepal

The focus of this paper is to examine the organisation of health care in Nepal from the literature available. After setting the study in context and examining health care in general, a more in-depth, look is taken at Primary Health Care (PHC) and how this recent emphasis is affecting nurse education. This leads into an analysis of whether or not nurses are the most appropriate personnel to deliver PHC. The fundamental issues of improving adult female literacy rates and providing a clean water supply are suggested as means whereby Nepal's health provision could be greatly improved.

Expression of bone morphogenetic proteins in human prostatic adenocarcinoma and benign prostatic hyperplasia

There are important interactions between prostatic tumours and bone. This study was designed to examine whether prostatic tissue can express bone inductive factors, in particular, the Bone Morphogenetic Proteins (BMPs). The polymerase chain reaction (PCR) has been used to screen for the expression of BMPs one to six in the prostatic tissue of patients with benign prostatic hyperplasia (BPH), non-metastatic prostatic adenocarcinoma and metastatic prostatic adenocarcinoma. BMPs were expressed in both benign and malignant prostate tissue and in the prostate tumour cell lines, PC3 and DU145. BMPs were also expressed in ocular melanoma tissue, a tissue which rarely metastasizes to bone. BMP-6 expression was detected in the prostate tissue of over 50% of patients with clinically defined metastatic prostate adenocarcinoma, but was not detected in non-metastatic or benign prostate samples or in ocular melanoma tissue. These findings suggest that the BMPs may play a role in the osteoinductive activity of prostate metastases and that the pattern of expression of BMPs may be important in the pathogenesis of osteoblastic metastases associated with prostate adenocarcinoma.

Detection of mRNA for the transforming growth factor beta family in human articular chondrocytes by the polymerase chain reaction

The Transforming Growth Factor-beta (TGF beta) family of polypeptides elicits diverse biological actions on a wide range of cell types. There are known to be several isoforms of TGF beta coded for by different genes, with possibly differential expression and potencies. We have demonstrated that there is constitutive expression of three forms of transforming growth factor beta in adult human articular chondrocytes. The presence of 10% fetal calf serum in the culture medium may influence expression. The addition of transforming growth factor beta or interleukin 1 beta to the culture medium does not appear to consistently influence the expression of TGF beta by the cells.

Latent HSV-1 infection in mice immunized with a zwitterionic detergent-extracted HSV-1 antigen preparation

A HSV-1 antigen preparation obtained by zwitterionic detergent-extraction of HSV-1 infected Vero cells was investigated for its ability to protect mice against establishment of latent infection in the trigeminal ganglion following HSV-1 challenge by ear scarification. The antigen preparation was shown to induce antibody production and correlation between pre-challenge antibody level and establishment of latency was found. Although immunization did not reduce the overall incidence of ear erythema following challenge the duration of erythema was significantly decreased. Latency in the trigeminal ganglion was also significantly reduced in vaccinated mice and in addition, a correlation was found between the duration of erythema and latency, there being significantly more latent infections in mice with erythema of three or more days duration, than in those with erythema lasting less than three days.

Trypsin inhibitor activity in the field bean (Vicia faba L.)

In vitro evidence is presented for the presence of a heat‐labile inhibitor of trypsin in both cotyledon and testa of the field bean (Vicia faba L.). Inhibitor activity is destroyed by heating at 110°C for 40 min. The inhibitor has, in vitro, approximately one fifth of the strength of an extract of raw soyabeans.