ObjectiveTo evaluate the efficacy of intraoperative ultrasound in obtaining adequate surgical margins in women undergoing lumpectomy for palpable breast cancer. Summary Background DataAdequacy of surgical margins is a subject of debate in the literature for women undergoing breast-conserving therapy. The emerging technology of intraoperative ultrasound-guided surgery lends itself well to a prospective study evaluating surgical accuracy and margin status after lumpectomy. MethodsTwo groups of women undergoing lumpectomy for palpable breast cancer were studied, one group using intraoperative ultrasound (n ϭ 27) and the other without (n ϭ 24). Pathologic specimens were evaluated for size, margins, and accuracy, and patients were questioned about satisfaction with cosmetic results. ResultsSurgical accuracy was improved with intraoperative ultrasound-guided surgery. Margin status was improved, patient satisfaction was equivalent, and cost was not affected using ultrasound technology. Intraoperative ultrasound appears especially efficacious for women whose preoperative mammogram shows dense parenchyma surrounding the lesion. ConclusionsThe use of ultrasound-guided surgery optimizes the surgeon's ability to obtain satisfactory margins for breast-conserving techniques in patients with breast cancer. Patient satisfaction is excellent and a cost savings is most likely realized.Although A-mode or non-real-time B-mode ultrasound imaging started in the 1960s, it was of limited clinical utility. With the introduction of high-frequency real-time B-mode ultrasound in the late 1970s, the surgeon could use ultrasound to guide surgical procedures. Special intraoperative probes were developed, and in the 1980s intraoperative ultrasound (IOUS) was developed for hepatobiliary surgery, neurosurgery, and vascular surgery.1 Breast surgeons were quick to begin using office-based ultrasound for defining breast lesions and guiding needle biopsy of ultrasound-visible lesions, but the transfer of this technology to the surgical suite for breast procedures has been a recent phenomenon.Breast-conserving therapy (BCT) has gained wide acceptance as providing long-term survival equal to that seen with mastectomy for early-stage breast cancers, and accordingly the number of lumpectomy procedures has increased dramatically. Too often, however, the surgeon is disappointed to discover that a lumpectomy performed for a small palpable tumor fails to achieve a complete excision with histopathologically negative margins. The patient may then undergo a second resection with the goal of obtaining clear pathologic margins. This recommendation for reexcision often occurs even as conflicting data are published about the need for such margins to be completely free of malignancy.
This module describes some common standard‐setting procedures used to derive performance levels for achievement tests in education, licensure, and certification. Upon completing the module, readers will be able to: describe what standard setting is; understand why standard setting is necessary; recognize some of the purposes of standard setting; calculate cut scores using various methods; and identify elements to be considered when evaluating standard‐setting procedures. A self‐test and annotated bibliography are provided at the end of the module. Teaching aids to accompany the module are available through NCME.
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Title III of Public Law 107-110 (No Child Left Behind; NCLB) provided for creation of assessments of English language learners (ELLs) and established, through the Enhanced Assessment Grant program, a platform from which four consortia of states developed ELL tests aligned to rigorous statewide content standards. Those four tests (ACCESS for ELLs, CELLA, ELDA, and MWA) are now in use in one or more states, along with a host of other commercially available or locally developed tests. The tests (those developed by consortia as well as the others) are quite similar in many ways, principally in their contents: Listening, Speaking, Reading, and Writing. Most measure these domains with a combination of multiple-choice (MC) and open-ended (OE) test items. This article provides an overview to the four consortium-developed tests as well as an in-depth analysis of one representative example. It also provides a summary of the characteristics of four commercially available tests. Not surprisingly, the four commercially available tests are rather similar to one another and to the consortium-developed tests in terms of content, psychometric characteristics, and development. The primary difference between the two sets is that the commercially available tests tend to report percentile ranks as well as proficiency levels. Now that the Race to the Top program is in place, we face many of the same challenges we faced a decade ago when NCLB was passed. While the Enhanced Assessment Grant competition emphasized summative assessment, the latest competition emphasizes formative assessment, which gives rise to the hope that educators can not only discover students’ strengths and weaknesses with these new tests, but do so in a timely manner and have opportunities to use the information constructively. Current work by at least one organization is encouraging in this regard.
Automated scoring of essays is founded upon the pioneer work of Dr. Ellis B. Page. His creation of Project Essay Grade (PEG) sparked the growth of a field that now includes universities and major corporations whose computer programs are capable of analyzing not only essays but short-answer responses to content-based questions. This chapter provides a brief history of automated scoring, describes in general terms how the programs work, outlines some of the current uses as well as challenges, and offers a glimpse of the future of automated scoring.
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