The use of a mixed reality breast simulator with an innovative touch map feedback system to teach breast history-taking and examination skills

Abstract #2105

Introduction: Physical examination remains an important method of breast cancer detection. Unfortunately, many health care professionals express concerns about missing breast lesions and current methods of teaching this essential skill are limited. Through an interdisciplinary collaboration, we created an immersive virtual patient to teach health professions students history-taking and breast examination skills.
 Methods: Fifteen physician's assistant (PA) and 13 medical students (MS) interacted with a mixed reality human (MRH, a computer avatar with a mannequin-based breast simulator) with a breast complaint (Figure 1).
 
 Students spoke to and touched the MRH to take a history and examine a simulated breast with two masses of differing size and consistency. Subjects were surveyed regarding the usefulness of the virtual teaching tool and composed a patient note documenting pertinent history and physical examination findings. Students received feedback regarding the content of their patient note (number of 17 essential content items documented) and on the completeness of their breast examination (percentage area covered) using a color-coded touch map.
 Results: Student feedback related to the utility of this virtual educational tool was positive. Students only documented a mean of 7.8±2.7 (range=4-15) essential content items in the breast history. The completeness of the breast exam was a mean of 82% (range=62% to 97%) of total breast area examined (Figure 2, green=area examined, red=area missed).
 
 More clinically experienced students (MS 3 and 4, N=9) performed better than those with no clinical experience (MS 1 and PA 1, N=19) in both history-taking (58% vs. 40%, p<0.05) and completeness of exam (90% vs. 84%, p<0.05). Fifty percent of students were able to locate at least one mass but only 14% were able to correctly document the location of both lesions.
 Conclusions: The simulated experience differentiated performance among students with varying levels of clinical experience and identified a need for improved teaching and greater practice among all students. MRH scenarios provide a less anxious learning environment for students to practice breast history-taking and examination.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2105.

Early thrombosis of the superior vena cava in a patient with a central venous catheter and carcinoma of the ampulla of Vater

Superior vena cava syndrome results from obstruction of flow through the vessel either by external compression or thrombosis. External compression by intrathoracic neoplasms is the most common etiology. Thrombosis of the vessel most often occurs in the setting of indwelling catheters or pacemakers. The diagnosis is suggested by the clinical manifestations of facial and upper extremity swelling, dyspnea, and cough. It is confirmed by CT scan showing the development of collateral flow around the lesion. In this report, we present a patient who developed superior vena cava thrombosis after undergoing a short period of central venous catheterization and a Whipple procedure for adenocarcinoma of the ampulla of Vater. The endothelial damage caused by the catheter, the low-flow state induced by the large fluid shifts during the operation, and the hypercoagulable state induced by malignancy fulfill Virchow's triad for venous thrombosis. To our knowledge, this is the first reported case of superior vena cava syndrome after the Whipple procedure with symptoms appearing after a shorter period of catheterization than previously reported in the adult literature.

Early Thrombosis of the Superior Vena Cava in a Patient with a Central Venous Catheter and Carcinoma of the Ampulla of Vater

Superior vena cava syndrome results from obstruction of flow through the vessel either by external compression or thrombosis. External compression by intrathoracic neoplasms is the most common etiology. Thrombosis of the vessel most often occurs in the setting of indwelling catheters or pacemakers. The diagnosis is suggested by the clinical manifestations of facial and upper extremity swelling, dyspnea, and cough. It is confirmed by CT scan showing the development of collateral flow around the lesion. In this report, we present a patient who developed superior vena cava thrombosis after undergoing a short period of central venous catheterization and a Whipple procedure for adenocarcinoma of the ampulla of Vater. The endothelial damage caused by the catheter, the low-flow state induced by the large fluid shifts during the operation, and the hypercoagulable state induced by malignancy fulfill Virchow's triad for venous thrombosis. To our knowledge, this is the first reported case of superior vena cava syndrome after the Whipple procedure with symptoms appearing after a shorter period of catheterization than previously reported in the adult literature.

Primary structure of the 2-O-methyl-alpha-L-fucose-containing side chain of the pectic polysaccharide, rhamnogalacturonan II

A 2-O-methylfucosyl-containing heptasaccharide was released from red wine rhamnogalacturonan II (RG-II) by acid hydrolysis of the glycosidic linkage of the aceryl acid residue (AceA) and purified to homogeneity by size-exclusion and high-performance anion-exchange chromatographies. The primary structure of the heptasaccharide was determined by glycosyl-residue and glycosyl-linkage composition analyses, ESIMS, and by 1H and 13C NMR spectroscopy. The NMR data indicated that the pyranose ring of the 2,3-linked L-arabinosyl residue is conformationally flexible. The L-Arap residue was confirmed to be alpha-linked by NMR analysis of a tetraglycosyl-glycerol fragment, [alpha-L-Arap-(1-->4)-beta-D-Galp-(1-->2)-alpha-L-AcefA-(1-->3)-beta-L-Rhap-(1-->3)-Gro], generated by Smith degradation of RG-II. Our data together with the results of a previous study,(1) establish that the 2-O-Me Fuc-containing nonasaccharide side chain of wine RG-II has the structure (Api [triple bond] apiose): [see structure]. Data are presented to show that in Arabidopsis RG-II the predominant 2-O-MeFuc-containing side chain is a mono-O-acetylated heptasaccharide that lacks the non-reducing terminal beta-L-Araf and the alpha-L-Rhap residue attached to the O-3 of Arap, both of which are present on the wine nonasaccharide.