Influence on screening performance of second reading strategies in two lowvolume programs

BACKGROUND: The European Guidelines specify a minimum of 5,000 screening cases to be read yearly by radiologists carrying out second reading in non-centralized programs. This professional requirement is difficult to reach and/or to implement in regional programs covering a sparse population with a high number of participating radiology units, so that alternative blind double reading strategies must be devised. OBJECTIVE: To evaluate the effect on breast cancer screening performances of two second reading strategies used in non-centralized, low-volume programs. METHODS: Reading performances in two Swiss regional breast cancer screening programs (cantons of Wallis and Vaud), covering female populations, aged 50-69, of about 31'000 and 72'000 inhabitants were computed and compared. Both programs had similar screening regimens and organizations, but differed with respect to second reading. One setting applied a selective strategy whereby only experienced radiologists performed second reading; the other elicited not to restrict second readers on the basis of their individual screening activity. Analysis included some 140,000 mammograms performed between 1999 and 2005. RESULTS: Overall, screening performances improved with increasing total volume of reading, albeit not in a linear fashion. Regardless of setting, radiologists attained a higher level of screening accuracy when performing second rather than first readings, and incident rather than prevalent screening cases. The effect of a selective, small group of second readers appeared to impact favorably on the false-positive rate and other indicators of screening quality. As the learning curve depends on the number of mammograms read, these distinct strategies may bear different outcome in the long run. Implications and practical issues for low-volume programs are discussed.

M. [André] Honnorat [ministre de l'Instruction publique] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58115

M. [André] Honnorat [ministre de l'Instruction publique] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58116

Management options for accidental injection of epinephrine from an autoinjector: a case report.

INTRODUCTION: Epinephrine autoinjector devices are used with increasing frequency to treat severe anaphylactic reactions. Accidental injection, usually involving a finger, is a potential complication. CASE PRESENTATION: A physician in a Family Practice training program accidentally injected epinephrine into his left thumb while reading the operating instructions of an autoinjector (Epipen((R))). He developed swelling, pallor, and pain in the thumb. Treatment included topical nitroglycerin, oral vasodilators and warming of the thumb. As expected, none caused an immediate response; however, after 8 hours, the thumb was pink and warm. There was full recovery 2 months after the accident. We reviewed the treatment of accidental epinephrine injection, and found that the use of parenteral adrenergic alpha blocker phentolamine would have produced immediate recovery. CONCLUSIONS: All health professionals concerned with the use of epinephrine autoinjectors should receive adequate instruction on their use. A regimen for management of accidental epinephrine injection, in particular the use of phentolamine, should be emphasized.

M. [André] Honnorat [ministre de l'Instruction publique] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58117

19/12/19, MM. Pannetier, Pericaud, Aubignac faisant partie de la délégation des comités de défense des intérêts des étudiants français qui sont reçus aujourd'hui par le ministre [Léon] Bérard de l'Instruction publique : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 57267

Instruction sur l'exercice de la cavalerie... Du 29 juin 1753

[Acte. 1753-06-29]