No abstract

Adolescent girls receiving DMPA had significant loss in BMD, compared with bone gain in the OC and untreated group. However, the clinical significance of this finding is mitigated by slowed loss after the 1st year of DMPA use and general maintenance of bone density values within the normal range in the DMPA group.

The intent of this study was to document current practices in breast cancer genetic counseling and identify areas of variability for patients with a variant of uncertain significance (VUS) in the BRCA1 or BRCA2 gene. Registered members of the National Society of Genetic Counselors (NSGC) Cancer Special Interest Group (SIG) were sent an invitation via electronic mail to participate in an online questionnaire. The questionnaire was divided into three sections: clinical experience, clinical meaning, and risk perceptions and clinical recommendations for clinical situations involving a VUS. Fifty-seven of the eligible members responded. During the pre-test counseling session for a BRCA risk assessment patient, the vast majority of counselors (80.7%) mention VUS as a possible test result. Nearly half, 49.1%, report having given such a result to their patients at least one to four times. However, only 63.2% felt as though their patients understood the meaning of a VUS result. When asked to conclude the implication of a VUS and make medical management recommendations, the responses were varied. Nevertheless, a good proportion of counselors expressed the importance of testing other family members to help clarify the proband's risk and aid in medical management issues. Although the recent recommendations by the American College of Medical Genetics suggest standards for the interpretation of sequence variations, they do not provide guidelines for making clinical recommendations based on these variations. The results of this study reveal significant diversity in the personal interpretation of a VUS result, leading to various clinical recommendations, and suggest a need for clinical management recommendations as well.

Purpose: To investigate the hypothesis that the outer boundary of the hyperintense region observed in hyperacute (several minutes post-ablation) T2 and gadolinium contrast-enhanced (CE) T1-weighted magnetic resonance (MR) lesion images is an accurate predictor of eventual cell death from radiofrequency (RF) thermal ablation. Materials and Methods: A low-field, open MR imaging system was used to guide an ablation electrode into a thigh muscle of five rabbits and acquire in vivo T2 and CE T1-weighted MR volumes. Ablation occurred by applying RF current for two minutes with the electrode's temperature maintained at 90°Ϯ 2°C. After fixation, we sliced and photographed the tissue at 3 mm intervals, using a specially designed apparatus, to obtain a volume of tissue images. Digital images of hematoxylin and eosin (H&E) and Masson trichrome-stained histologic samples were obtained, and distinct regions of tissue damage were labeled using a video microscopy system. After the MR and histology images were aligned using a three-dimensional registration method, we compared tissue damage boundaries identified in histology with boundaries marked in MR images. Results: The lesions have distinct zones of tissue damage histologically: a central zone of necrotic cells surrounded by an outer zone with cells that appeared non-viable and associated with marked interstitial edema. In 14 histology images from five lesions, the inner and outer boundaries of the outer zone were compared with the boundaries of a hyperintense rim that surrounds a central hypointense region in the T2 and CE T1-weighted MR images. For T2 and CE T1-weighted MR images, respectively, the mean absolute distance was 1.04 Ϯ 0.30 mm (mean Ϯ SD) and 1.00 Ϯ 0.34 mm for the inner boundaries, and 0.96 Ϯ 0.34 mm and 0.94 Ϯ 0.44 mm for the outer boundaries. The mean absolute distances for T2 and CE T1-weighted MR images were not sufficiently different to achieve statistical significance (P ϭ 0.745, 0.818, for the inner and outer boundary, respectively). Conclusion:In hyperacute T2 and CE T1-weighted MR lesion images, observations strongly suggest that the outer boundary of the hyperintense rim corresponds to the region of eventual cell necrosis within a distance comparable to our ability to measure. This is good evidence that during RF ablation procedures, MR lesion images can be used to accurately localize the zone of irreversible tissue damage at the lesion margin.

ABSTRACT. Objective. To determine the effect of a single telephone call reminder on appointment compliance among adolescents in an inner city, hospital-based clinic.Methods. A randomized clinical trial was conducted at the Adolescent Clinic, a part of the Ambulatory Pediatric Practice Clinic in Cleveland, Ohio, from December 1995 to November 1996. A total of 703 routine adolescent ambulatory appointments were randomized to receive either a single telephone call reminder 1 day before the appointment or to receive no reminder. A single telephone call attempt was directed primarily to the parent or guardian of the patient in the assignment group. If not available, the reminder message was left with the patient or other family member, or on the answering machine. The study variables selected included age, gender, appointment time, distance from clinic, and payment source, and for the intervention group, the recipient of the reminder telephone call. The outcome measure was the attendance rate.Results. The intervention group (n ‫؍‬ 347) and control group (n ‫؍‬ 356) were well balanced for all study variables. The overall attendance rate was 49.8%. Only 204 (58.8%) of the 347 attempted intervention appointments were contacted successfully by telephone. In the attempted intervention analysis, the attendance rate of 55.6% in the intervention group (n ‫؍‬ 347), regardless of whether subjects were successfully contacted by telephone, was 26.1% greater than the 44.1% attendance rate in the control group. In the completed intervention analysis, the attendance rate of 65.2% in the successfully contacted individuals within the intervention group (n ‫؍‬ 204) was increased by 47.8% over that in the control group. In the univariate analysis, attendance for selfpaying patients (25.4%) was worse than that for any group. In the logistic regression analysis, both the reminder telephone call intervention and the payment source were independent predictors of attendance. In the group that was called successfully (n ‫؍‬ 204), there was no association between attendance and the recipient of the telephone call.Conclusions. Telephone reminders are a very effective method of increasing attendance in a hospital-based adolescent clinic. The reminder is a consistently effective intervention whether the message is delivered to the patient, to the parent or other family member, or to a telephone answering machine. Adolescent patients whose visits are not covered by Medicaid or commercial insurance are least likely to attend their clinic appointments, and a telephone call reminder has no effect on this pattern. Pediatrics 1998;101(6). URL: http://www. pediatrics.org/cgi/content/full/101/6/e6; adolescents, appointment compliance, telephone reminder.ABBREVIATIONS. CI, confidence interval; OR, odds ratio; RR, rate ratio; SES, socioeconomic status.A major limitation in health care delivery to adolescents is their poor attendance at ambulatory clinics. The failed appointment rate in this age group can be as high as 60%.1-6 A recent large national surve...