Can the Blending of Mindfulness, Humanistic Psychology, and Years of Clinical Experience Transform Our Approach to Working With High-Risk Adolescents?

PsycCRITIQUES ◽  
2013 ◽  
Vol 58 (50) ◽  
Author(s):  
Debbie Chiodo ◽  
David A. Wolfe
Keyword(s):  
High Risk ◽  
Clinical Experience ◽  
Humanistic Psychology

scholarly journals Core Biopsy and FNA: A Comparison of Diagnostic Yield in Lymph Nodes of Different Ultrasound Determined Malignant Potential

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 37s-37s
Author(s):  
B. May ◽  
A. Rossiter ◽  
P. Heyworth
Keyword(s):  
Lymph Node ◽  
High Risk ◽  
Lymph Nodes ◽  
Clinical Experience ◽  
Core Biopsy ◽  
Diagnostic Yield ◽  
Sampling Technique ◽  
Malignant Potential ◽  
Low Risk ◽  
Risk Of Malignancy

Background: The tissue diagnosis of lymphoma and metastases is commonly obtained from affected lymph nodes. The lymph nodes chosen for biopsy are often the consequence of their appearance on ultrasound, which determines their risk of malignancy. Two frequently used percutaneous sampling techniques are core biopsy and fine needle aspiration (FNA). While core biopsy obtains a larger tissue sample and provides a degree of architectural information, FNA is considered less invasive and has the advantage of immediate confirmation of adequacy by the attending cytologist. Anecdotally, core biopsy is more commonly used when a lymph node is suspected of harboring neoplasia, however a feature of malignancy is hypercellularity, which theoretically should increase the diagnostic yield of FNA. Aim: The aim of this project was to compare the diagnostic capability of FNA and core biopsy in lymph nodes of different malignant potential, as defined by ultrasound, and determine if the radiologic appearance can guide clinicians in their choice of sampling technique. The project also reviewed the role of clinical experience in both the choice of sampling technique and diagnostic yield. Methods: Retrospective study of percutaneous lymph node biopsies performed at a large tertiary hospital between July 2016 and March 2018. The associated ultrasounds were reviewed and the lymph nodes were classified as high or low risk of malignancy by their sonographic appearance. The end point for analysis was the capacity for FNA or core biopsy to provide a definitive diagnosis. The diagnostic yield was then separately assessed for lymph nodes of high and low malignant potential. The effect of clinical experience on diagnostic yield was also examined, by comparing the outcomes of radiology consultants and radiology trainees. Results: 296 lymph node biopsies were reviewed and statistical analysis was performed using logistic regression analysis. Core biopsy, in comparison with FNA, was used twice as often in lymph nodes of high malignant potential, supporting the aforementioned anecdotal evidence. Core biopsy demonstrated superior diagnostic yield in comparison with FNA, providing a diagnostic sample 45% ( P = 0.313) more often in low-risk lymph nodes and 209% ( P = < 0.05) more often in high-risk lymph nodes. Consultant radiologists used FNA 81% more often than core biopsy in lymph nodes of high malignant potential, while radiology trainees used core biopsy 104% more often than FNA in the same group. In high-risk lymph nodes, trainees were 117% ( P = 0.105) more likely to obtain a diagnostic sample than consultants. Conclusion: Core biopsy is superior to FNA in the tissue sampling of lymph nodes regardless of ultrasound determined risk of malignancy. Biopsies obtained by radiology trainees provided a diagnosis twice as often as those obtained by radiology consultants. This appeared to be the consequence of consultant preference for FNA over core biopsy.

P1852The clinical experience of J valve transapical transcatheter aortic valve replacement system in high-risk patients with severe pure aortic regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
W Liu ◽  
Y J Zhou ◽  
H B Zhang ◽  
X U Meng ◽  
Y N Gao
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Clinical Experience ◽  
Bleeding Complications ◽  
High Risk Patients ◽  
Transcatheter Aortic Valve ◽  
Risk Patients

Abstract Objective Patients with severe pure aortic regurgitation (PAR) undergoing transcatheter aortic valve implantation (TAVI) is still under controversial. J valve™, a China Food and Drug Administration (CFDA) certified device, has specific positioning and anchoring system, which makes this device indicated in PAR patients. We aim to introduce the clinical experience of J valve in the treatment of PAR in high risk patients. Methods A total of 53 severe PAR patients (STS score 6,3±1.8, mean age, 76.4±5.2 years) who underwent TAVI using J valve™ in our Hospital from June 2017 to December 2018 were retrospectively enrolled. All patients underwent echocardiography and contrast-enhanced computed tomography to evaluate their baseline and follow-up characteristics. The 30 days outcomes were reported according to the Valve Academic Research Consortium-2 (VARC) definitions. Results All patients underwent transapical TAVI, and J valve was in implanted successfully in 51 patients (96,2%). J valve was dislodged in two patients, one patient was successful implanted with another J valve and the dislodged valve placed in descending aorta. The other patient was converted to urgent surgery for aortic valve replacement. One patient was converted to surgery due to severe aortic regurgitation after J-valve placement. The 30 days mortality was 9.2% (n=5), 1 patient died of acute heart failure and 2 patients died of infection. During the hospitalization, none of the patients had stroke or transient ischemic attack (TIA) and periprocedural myocardial infarction (MI). There were 5 (n=14.3%) patients presenting with bleeding complications (BARC 4 definition of major bleeding). 1 (2.9%). Pacemaker implantation was performed in 2 (5.7%) patients. Paravalvular regurgitation was none or trace in 90.7% (n=49), mild to moderate in 5.6% (n=3), and moderate to severe 1.8% (n=1) after the procedure. Mean intensive care unit stay was 29.30±15.30 h. Working illustration of J valve Conclusion TAVI by J valve™ can be an alternative option for high risk patients with PAR, but more evidences are still needed to further prove its safety and feasibility.

3D conformal HDR-brachy- and external beam therapy plus simultaneous Cisplatin for high-risk cervical cancer: Clinical experience with 3 year follow-up

2006 ◽  
Vol 79 (1) ◽  
pp. 80-86 ◽  
Author(s):  
Richard Pötter ◽  
Johannes Dimopoulos ◽  
Barbara Bachtiary ◽  
Gerhard Sissolak ◽  
Beata Klos ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Clinical Experience ◽  
External Beam

Clinical experience of urine D-arabinitol/L-arabinitol ratio in the early diagnosis of invasive candidiasis in paediatric high risk populations

2007 ◽  
Vol 39 (2) ◽  
pp. 146-151 ◽  
Author(s):  
Gudrun Sigmundsdottir ◽  
Lennart Larsson ◽  
Thomas Wiebe ◽  
Lars J. Björklund ◽  
Bertil Christensson
Keyword(s):  
High Risk ◽  
Early Diagnosis ◽  
Clinical Experience ◽  
Invasive Candidiasis ◽  
High Risk Populations
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