Mark Kane Goldstein

Improved detection of human breast lesions following experimental training

This study was designed to evaluate the effect of breast examination training with silicone models on the detection of lesions in natural breast tissue. Six women with a total of 13 benign breast lumps were examined by 20 trainees before and after a 20–30 minute training session or a period of unrelated activity. Following the training, percentage of correct detections, duration of examination, and reports of false positives increased. Confidence in correct detections and false positives also increased, although confidence in correct detections was greater than confidence in false positives. The results indicate the effectiveness of the training and suggest a need for a more complex model for training discrimination between normal nodularity and breast lesions.

Progress in manual breast examination

Manual breast examination, despite recent advances in mechanical screening devices, remains a primary diagnostic procedure for early detection of breast cancer. The potential effectiveness of breast self—examination for reducing mortality relies on the effectiveness of a technology for training women to detect small tumors through manual palpation. Research indicates that although the regular practice of breast self—examination can lead to the detection of small tumors, current training methods are inadequate to ensure proper performance and maintain regular practice. An alternative interdisciplinary research and training approach, involving medicine, biomaterials engineering, psychophysics, and experimental psychology, is suggested. A dynamic lifelike breast model with variable lumps would provide the basis for generating systematic data regarding the factors affecting detection of small lumps and lead to development and evaluation of efficient and effective methods to teach manual examination. Cancer 40:364–370, 1977.

Lump detection in simulated human breasts

Sixteen observers palpated silicone models of human breasts containing lumps 1.6-12.1 mm in diameter. Detectability depended on the size of the lump, producing a systematic psychometric function. In eight observers who participated in three or more sessions, performance improved with practice, with most improvement occurring within one or two 26-trial sessions. Three-week retention measures disclosed no appreciable decrease in performance, but a significant correlation was found between the number of lumps detected and duration of trial (p < .01). There was no difference in performance between four observers who used their preferred hands and four observers who used their nonpreferred hands. These data establish that examination of breast models for the detection of lumps simulating cancer is a task amenable to experimental analysis.

Toward an Effective Technology of Instruction in Breast Self-examination

aged 40 to 44 and is the leading cause of cancer deaths in women aged 25 to 74. It is estimated that 1 of every 11 American women will develop breast cancer at some time during her life, about 107,000 new cases being diagnosed in 1980 alone [ 1, 2] . In addition to a profound reduction in life expectancy, victims of breast cancer must also face the prospect of expensive, disfiguring, and often partially disabling surgery. The aggregate cost of breast cancer to our society, in terms of both morbidity and mortality, is impossible to estimate; but any significant reduction in its toll with respect to either of these factors would constitute a major contribution to womens health.

NEW: an interactive data management system for monitoring ambulatory patients.

Biobehavioral monitoring is a method of gathering daily biological and behavioral measurements from ambulatory patients so that hospital-based care can be extended to the home. Such data can also serve many other purposes such as peer review and assesing the outcome of treatment. To assist in handling the increased information about patients, NEW, a system of three interactive APL Plus computer program packages, has been developed. The program packages, NEWDATA, EVALUATION, and WARNINGS, form an interactive data management system to provide: a rapid means of entering and verifying each patients data from either a single day or a group of days; a flexible and simple means of retrieving and analyzing the data for an individual patient or for groups of patients; and a means of reviewing, detecting, and signaling trends in the data that deviate from present clinical criteria.

Optokinetic suppression of aberrant vestibular reactions: an observation.

It has long been known that optokinetic nystagmus may be modified by vestibular inputs. We have suppressed an aberrant vestibular response and associated gastrointestinal sensations by use of an optokinetic stimulus simultaneous to the positional stimulus in a patient with paroxysmal positional vertigo. This single subject study utilized several optokinetic conditions, and patterned its stimulus presentations to control for visual fixation and vestibular habituation. Objective recordings of eye movements (ENG) were made simultaneously with subjective evaluation of “dizziness” on a simple magnitude estimation scale.