1. Screening Mammography

Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel them. Current guidelines recommend a screening mammography every year for women, beginning at age 40.

Research has shown that annual mammograms lead to early detection of breast cancers, when they are most curable and breast-conservation therapies are available (Mammography).

2. Diagnostic Mammography

Diagnostic mammography is used to evaluate a patient with abnormal clinical findings such as a breast lump or lumps that have been found by the woman or a doctor (Mammography).

Routine Mammogram Saved Her Life

Following a routine mammogram in July 1998, Debi Koon received a call from her physician saying there was an area of concern in one of her breasts. A follow-up visit and second mammogram the next day both identified an abnormal area. A biopsy taken shortly after…...

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Bibliography

Haus, Arthur G. "Technical Aspects and Image Quality in Mammography." n.d. American

Association of Physicists in Medicine. 04 March 2009  http://www.aapm.org/meetings/02AM/pdf/8395-26604.pdf .

Mammography." 2008. Radiology Info. 04 March 2009  http://www.radiologyinfo.org/en/info.cfm?PG=mammo#part_one .

New Mammography Technology Effective in Detecting Breast Cancer." 03 December 2008.

D. (http://www.cancernews.com/data/Article/210.asp).
The created a need to research and develop a better method of mammography, which lead to the development of the new digital machine.

What is digital mammography?

Conventional film screen mammography uses low energy x-rays that pass through a compressed breast during a mammography examination. The exiting x-rays are absorbed by film (x-ray film) which is then developed into a mammography image that can be held and looked at by the radiologist. With digital mammography, low energy x-rays pass through the breast exactly like conventional mammograms but are recorded by means of an electronic digital detector instead of the film (Digital Mammography Submitted by: Mark Helvie, M.D. (http://www.cancernews.com/data/Article/210.asp)."

This image can be displayed on television styled monitors almost instantly, which provides the screener the ability to manipulate the image while the patient is still in the exam room. If another image is needed it can be done quickly at that time.

The examination…...

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References

QUESTIONS and ANSWERS ABOUT DIGITAL MAMMOGRAPHY

http://www.westchesterimagingforwomen.com/digital_faq.html

Digital Mammography

 http://www.cancer.gov/newscenter/pressreleases/DMISTQandA

Missed reast Carcinomas
Mammography is a particular type of imaging which use an x-ray system, which has a low-dose for the purpose of detecting breast cancer at a very early stage. ut even with the help of Mammography, in 10-30% cases of breast cancers would be missed. y way of this paper an attempt has been made to understand the factors, which cause for missed breast cancers, and discuss ways to reduce the false negative rate of mammography.

The false negative rate of mammography was around 8-10% according to the data of the reast Cancer Detection Demonstration project. Another study was of the opinion that the rate of missed breast cancers with regard to mammography was very high as 35%. (Harvey, Fajardo, Lnnis, 1993) In another study of 10 radiologists the true cases of cancers were considered to be in 74-96% cases which were understood after analyzing 150 mammograms. (Elmore, Wells, Lee,…...

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Bibliography

Harvey J.A, Fajardo L.L, Lnnis C.A. (1993) Preview mammograms on patients with impalpable with breast carcinomas: retrospective vs. blind interpretation, AJR Am J, Roentegenol, 161:1167, 1172

Elmore JG, Wells C.K, Lee C.H, et al. (1994) Variability in Radiologists' interpretation of mammograms. N Engl J. Med, 331: 1493-1499

Patel MR, Whitman GJ (1998) Negative mammograms in symptomatic patients with breast cancer. Acad Radiol, 5:26-33

Burrel HC, Sibbering DM, Wilson AR, et al. (1996) Screening interval breast cancers: mammographic features and prognosis factors. Radiology, 199: 811-817

Dr. obb-Nicholson's data best supports the scenario that more incidents of breast cancer will be discovered due to the reduced number of screenings that the new guidelines suggest. According to the numbers she gives, the mortality rate for breast cancer decreases every year and this decrease can be attributed to the previous screening guidelines. She writes that the USPSTF has based the new guidelines on statistics rather than clinical data and the message that they are conveying to the public is that the number of deaths that regular screenings at beginning at the age of forty is too small to keep the guidelines as they were previously. (6)

The best approach would be to keep the guidelines the way they were before the change. There was not enough clinical data to support the change in guidelines. Also, because the mortality rate for breast cancer has steadily declined with women following the…...

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References Cited

1. Cancer Weekly. Concerned Federal Screening Mammography Guidelines to Limit Access for Younger Women. Susan G. Komen for the Cure. 2010: 1665.

2. Earthtimes.org. Stick with Older Mammography Recommendations. Stanford Experts Say. March 3, 2010 (Press Release from Stanford Hospital & Clinics).

3. Hoppel, Ann M. To screen, and when to screen: the mammography age divide. Clinician Reviews. 2009: 19.12.

4. Journal of the American Academy of Physicians Assistants. USP-STF: no routine mammography for women younger than 50 years. 2010; 23.2, p.66.

As a woman enters her geriatric years, many unique problems are also faced. Her post-menopausal period leaves a woman with increased risk of osteoporosis, and hormone-replacement therapy may need to be considered or dismissed depending upon the needs and wellness of the individual women. Additionally, increased risk for obesity begins nearly at the adolescent period, when women's hormone loads change and often activity of childhood decreases. The incidence of obesity and overweight among women perpetually increases with every year of life. ("Overweight, Obesity Threaten U.S.," 2002, p. 8)Obesity and overweight, as one of the most significant conditions associated with several chronic diseases, such as type 2 diabetes, heart disease, increased risk of stroke and hypertension should be developed as a lifespan issue, as the needs of intervention and prevention change as women age and go through various stages of life.
While women have functional characteristics that require specialized health care,…...

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References

Blackwell, Daria, 2002. Women in the Healthcare Industry Reaching for the Top. Medical Marketing & Media, Dec2002, Vol. 37 Issue 12, p44, 8p.

Fleming, Carl, 2004. Healthcare Access: Conflicts of Interest Presented by Managed Care Icu Bedside Rationing and Their Impact on Minorities and Women. Georgetown Journal of Gender & the Law, Spring2004, Vol. 5 Issue 1, p663-676.

Heyman, B., & Henriksen, M. (2001). Risk, Age and Pregnancy: A Case Study of Prenatal Genetic Screening and Testing / . New York: Palgrave.

Lueck, T.L., & Chang, H. (2002). Tribune's 'WomanNews' Gives Voice to Women's Issues. Newspaper Research Journal, 23(1), 59.

Epidemiology
The Agency for Healthcare esearch and Quality has issued its recommendations for breast cancer screening. In this article, they make a few different recommendations. First, they recommend screening for women 50-74 years. They note that women under 50 should make the choice for themselves as to whether or not they wish to begin screening. They note that there is little evidence to support screening age 75 onward. This body, however, recommends against teaching breast self-examination.

Also noted is that "the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond mammography. They also find that there is insufficient evidence of incremental benefits for the use of digital mammography or MI. The lack of evidence does not mean that these things are ineffective or do not provide value, just that there is no evidence that they do, which is different.

The most controversial aspect of this recommendation…...

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References

Agency for Healthcare Research and Quality. (2009). U.S. Preventive Services Task Force: Screening for breast cancer. Retrieved from  http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm 

Dundar, P., Ozmen, D., Ozturk, B., Haspolat, G., Akydiz, F., Coban, S. & Cakiroglu, G. (2006). The knowledge and attitudes of breast self-examination and mammography in a group of women in a rural area in Western Turkey. BioMedCentral. Retrieved April 19, 2016 from  http://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-6-43 

Gwarzo, U., Sabitu, K, & Idris, S. (2009). Knowledge and practice of breast self-examination among female undergraduate students of Ahmadu Bello University, Zaria, Northwestern Nigeia. Annals of African Medicine. Vol. 8 (1) 55-58.

Rosotowich, V. (2006). Breast self-examination. SOGC Committee Opinion. Retrieved April 19, 2016 from  http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.174.6517&rep=rep1&type=pdf

An appointment will enhance a woman's life by providing peace of mind knowing that there is no sign of breast disease or cancer or assisting with detection of breast disease or cancer and allow for a plan of action to take place for treatment.
Studies consistently show that low income, low educational attainment, lack of health insurance, inability to speak English, lack of awareness of breast cancer risks and screening methods, acculturation level and lack of physician referral play important roles in the lower rates of screening utilization by Hispanic and African-American women. Hispanic women have lower breast cancer rates but are 20% more likely to die from the disease because they are less likely to seek health care services than other ethnic groups. Breast cancer is the most common cancer among African-American women and they are more likely to be diagnosed with larger tumors and more advanced stages of…...

Overall sensitivity for whole-body and PET/CT was 96% and 93% respectively, while specificity was 87% and 88% respectively.
Conclusions

The study showed that both methods are relevant for detecting metastases in breast cancer patients, but also showed that the method chosen should be appropriate to the type of tumor which may be suspected based upon the laboratory and clinical findings. While the study found that both 1.5- and 3-tesla MI scanning were feasible for the purpose of finding metastases, the team discovered that there is still much work to be done on refining the methods used for 3-tesla scanning. This could lead to further improvements in the results yielded by this method.

Breast gamma imaging spots DCIS better than mammo, M

Introduction

Breast-specific gamma imaging (BSGI) is a functional study which is unaffected by dense tissue, implants or architectural distortion in the breast. The aim of the study was to assess the effectiveness of…...

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References

Jeong-Sik Yu et al. (2007) Fat containing nodules in the cirrhotic liver: Chemical shift MRI features and clinical implications. AJR, 188: 1009-1016.

Pal, S. (2007) Breast gamma imaging spots DCIS better than mammo, MR. Retrieved September 5, 2007, at  http://AuntMinnie.com .

Tilke, B. (2007) PET/CT, whole-body MRI each have merits in metastatic breast disease. Retrieved September 5, 2007, at

Systematic esearch eview
Critique of Systemic esearch (S) ELATED TO NUSING

Critique of a Systematic esearch eview (S):

Breast self-examination, breast awareness, and practices of systemic review

Breast cancer is one of the most deadly and fastest-spreading cancers in the world today. To mitigate the tide of this epidemic should ideally include preventative measures as well as proactive treatments. The purpose of the literature review "Breast self-examination, breast awareness, and practices of systemic review" by Parvani (2011) was to assess the current research findings on the degree to which breast self-examination and more general breast self-awareness campaigns were useful in increasing the rates of early detection of breast cancer.

esearch rigor of selected studies

Studies were not screened for specific levels of research rigor. General medical databases were searched for relevant studies using Medline, CINAHL, PubMed, Science Direct, and Cochrane using words such as "breast awareness," difference," "breast self-examination," breast cancer screening" and "breast screening" (Parvani…...

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Reference

Parvani, Z. (2011). Breast self-examination, breast awareness, and practices of systemic review.

Professional Medical Journal, 18(2), 336-339.

Nursing, Best Practices
The disorder selected from the Women's Health Initiative study is breast cancer. As inferred by Amonet al (2012), breast cancer continues to be the second leading cause of cancer mortality amongst women in the United States. Similar to all kinds of cancer, the anomalous tissue that constitutes breast cancer is the patient's individual cells that have multiplied beyond normative levels. In addition, these particular cells may also travel to different parts of the body in which they are usually not found. When these cells move throughout the body randomly, the cancer is deemed to have advanced. Statistics indicate that, in the year 2015, 230,000 women in the United States were diagnosed with breast cancer and out of this, 40,000 of them died. This indicates the importance of treating the disease across the world (Ziegler et al., 2016). The stages of breast cancer range from early breast cancer that…...

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References

Amon, L. M., Pitteri, S. J., Li, C. I., Mcintosh, M., Ladd, J. J., Disis, M.,... & Prentice, R. L. (2012). Concordant release of glycolysis proteins into the plasma preceding a diagnosis of ER+ breast cancer. Cancer research, 72(8), 1935-1942.

WebMD. (2016). Breast Cancer Health Centre. Retrieved 4 August 2016 from:  http://www.webmd.com/breast-cancer/ 

Ziegler YS, Moresco JJ, Yates JR III, Nardulli AM (2016) Integration of Breast Cancer Secretomes with Clinical Data Elucidates Potential Serum Markers for Disease Detection, Diagnosis, and Prognosis. PLoS ONE 11(6): e0158296. doi:10.1371/journal.pone.0158296

Department of Health and Human Services, National Institutes of Health, & National Heart, Lung, and Blood Institute. (n.d.). Women's Health Initiative: WHI background and overview. Retrieved August 3, 2016, from  http://www.nhlbi.nih.gov/whi/background.htm

Anticipatory Guidance Project
Mammogram screenings guidelines

The suitability of screening mammography has been a contentious issue because of a number of reasons. For instance, the lack of consistency of screening guidelines reveals the complexities in coming up with definitive conclusions on the suitability of the procedure. Another issue with mammographic screening is the degree to which a mammography helps to reduce mortality among women. There have been arguments from some quarters that there is no evidence that mammography reduces mortality. In addition, sometimes screening can provide false-positive results resulting in needless additional testing, which may include the probability of invasive surgical processes. These controversies have elicited intense debates from various components of the society.

Background information about the guidelines

The American Cancer Society gives a number of guidelines on mammogram screenings (The American Cancer Society, 2013). First, it recommends that women who are 40 years and older of age should undergo a mammogram every…...

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References

American Cancer Society (2013). American Cancer Society recommendations for early breast cancer detection in women without breast symptoms. Breast Cancer: Early Detection. Retrieved from:  http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs 

Brant, W.E., & Helms, C.A. (2012). Fundamentals of diagnostic radiology. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.

Kwabi-Addo, B., & Lindstrom, T.L. (2011). Cancer causes and controversies: Understanding risk reduction and prevention. Santa Barbara, Calif: Praeger.

Nundy, S. (2010). Stay healthy at every age: What your doctor wants you to know. Baltimore: Johns Hopkins University Press.

Demographic Perception Survey of Patients with Atypical CP Who Present to Cardiac Care Doctors and Patient Outcomes
This study intends to examine gender differences in individuals who present to cardiac doctors with chest pain and specifically, atypical chest pain in women. The work of Debra L. Issac (2000) states that over the past ten years "there has been increasing awareness of both the importance of CAD in women and of the significant differences between men and women who have the disease. Potential gender biases, both within the medical community and within the general population of women themselves also have been identified. These gender differences and biases have the potential to influence investigation and management of suspected or confirmed CAD in women, and should be taken into consideration when faced with a woman with potential cardiovascular disease." (p.157)

Issac also states that chest pain in women is "common and often non-ischemic. Conversely, the…...

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References

Cayley, WE (2005) Diagnosing the Case of Chest Pain. American Family Physician. 15 Nob 2005. Retrieved from:  http://www.aafp.org/afp/2005/1115/p2012.html 

Gotzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev. (1):CD001877, 2011.

Issac, DL (2000) Women with Ischemic Heart Disease. Presented at the Canadian Cardiovascular Congress, Vancouver, British Columbia, October 2000. Retrieved from:  http://www.stacommunications.com/journals/cme/images/cmepdf/oct01/womencv.pdf 

Khan, JJ, Albarran, JW, Lopez, V, and Chair, SY (2010) Gender Differences on Chest Pain Perception associated with Acute Myocardial infarction in Chinese patients: A Questionnaire Survey. J Clin Nurs. 2010 Oct, 19 (19-20)2720-0. Retrieved from:  http://www.ncbi.nlm.nih.gov/pubmed/20846222

Attorneys, however, note that the suits are reflective of an increase in negligent doctors, who are hard pressed to serve a larger and more demanding patient load. Medical care is more costly and it is true that doctors fail to establish bedside relationships with their patients. Others point out that problems lie at the door of the insurance industry and management of hospitals (Committee, p. 1).
Because we discovered the problem in time, Mr. Jones was able to apologize and explain to the patients affected concerning the true nature of his outbursts. They did not have to pay for their treatment and none of them brought lawsuits against Mr. Jones or the hospital. We retained Mr. Jones, but advised him to notify the management if it appeared that there might be future outbursts. It is true that hospitals are much more diligent today because of risk management practices. Because of…...

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References

Abbott, R.L., Weber, P. And Kelley, B. (2005). Medical professional liability insurance and its relation to medical error and healthcare risk management for the practicing physician. American Journal of Ophthalmology. Vol. 140(6).

Committee to Study Medical Professional Liability and the Dellivery of Obstetrical Care, Institute of Medicine. (1989). Medical Professional Liabilityand the Delivery of Obstetrical Care: Vol I. Washington, D.C.: National Academy Press.

Grol, R. (2001). Improving the quality of medical care: Building bridges among professional pride, payer profit, and patient satisfaction. Journal of the American Medical Association. Vol. 286(20). 28 Nov 2001.

Harris, G. (2006). Senators to unveil new drug safety proposals. The New York Times. 21 Jun 2006. Retrieved January 14, 2008 at  http://www.nytimes.com/2006/06/21/health/policy/21fda.html?_r=2&adxnnl=1&oref=slogin&adxnnlx=1200373850-0PNMhVh8RDTFqV4OOSZCpQ .

Ethical Dilemma in a Department of Veterans Affairs Tertiary Healthcare Facility
Selection of the environment.

Selected environment. The environment for the proposed study will be a Department of Veterans Affairs (VA) medical center (hereinafter alternatively "VAMC") that provides the full complement of tertiary healthcare services. The pseudonym for the selected facility will be "Lincolnville VAMC" (because the VA's motto is derived from Lincoln's second inaugural address).

Description of environment and rationale for selection. The Lincolnville VAMC provides tertiary healthcare services for veterans living in a 25-county area in a midwestern state. Besides its operations in the main facility, the Lincolnville VAMC also operates two community-based outpatient clinics. Some of the primary services offered by the Lincolnville VAMC include:

Behavioral Health Service: This service provides consultation, evaluation, and treatment for a variety of issues that can impact emotional well-being.

2) Pharmacy: This service processes more than 80,000 prescriptions each month.

3) Primary Care: This service offers…...

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References

Gomulka, G.T. (2010). Saving military families. Military Review, 90(1), 111-112.

Hendin, H. & Foley, K. (2008). Physician-assisted suicide in Oregon: a medical perspective.

Issues in Law & Medicine, 24(2), 121-122.

Lighthall, A. (2010, November/December). The rules of engagement. Psychotherapy Networker,

omen's Health -- Focused on prevention and care for breast health, mammography, etc.

Transplant Programs - Swedish is one of seven kidney transplant centers and one of just four liver transplant centers serving the entire Pacific Northwest. The Organ Transplant Program at Swedish is at the forefront of new advances in transplantation surgery, including pancreas transplants and transplants between unrelated living organ donors and recipients (Swedish Medical Center, 2011).

Service design, operational activities, strategic decisions- Swedish is nothing but on the move -- strategically and tactically. In October, 2011, Swedish opened a new full-care facility with a 550,000 square foot campus in the city of Issaquah, southeast of Seattle city proper. This new facility was designed to be an entirely new hospital experience. Some of the operational innovations include a new Childbirth Center with eight new Labor/Delivery/Recovery rooms that include sleeping areas for partners, iPod access and a hotel room service-style dining…...

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Works Cited

Arnold, E. (2007). Service-Dominant Logic and Resource Theory. Journal of the Academy of Marketing Sciences, 36(1), 21-24.

Crosby, J. (2011, November). Human Resource - Swedish Hospital.

Institute of Medicine. (2000). To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press.

King, D. (2008). Designing the Digital Experience: How to Use Experience Design. Medford, NJ: Information Today Press.