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Conventional benign tumor excision leaves scars on the skin surface of the breast, which is unacceptable for young patients. The feasibility and clinical results of endoscopic resection of benign breast tumors through a single axillary incision via an inflatable method were evaluated. METHODS: Clinicopathological data from 62 patients who underwent this procedure from June 2022 to July 2023 were retrospectively collected. The surgical success rate, number of tumors excised, operative time, intraoperative conditions, postoperative complications, and clinical outcomes were analyzed. RESULTS: A total of 144 benign tumors were resected, and the surgical success rate was 100% (62/62). The time required to resect tumors located in the inner quadrant with larger diameters was shorter than the time to resect tumors located in the outer quadrant with smaller tumors. Sixty-two patients experienced reduced intraoperative bleeding and did not experience skin burns, incision infections, or poor healing. However, all patients experienced varying degrees of subcutaneous emphysema during the postoperative period. Fourteen patients experienced minor local effusions, and 3 patients experienced mild upper limb dysfunction, which resolved within one month. During the six-month follow-up period, there were no cases of tumor recurrence or new tumors. The ABNSW score was above 14 points, and patient satisfaction was high. CONCLUSION: Endoscopic resection of benign breast tumors through a single incision in the axilla via the inflatable method could quickly remove lesions larger than 3.0 cm. This method also results in hidden scars and good cosmetic effects on the shape of the breast. This is a new and effective treatment for benign breast tumors. TRIAL REGISTRATION: This retrospective study was registered in the National Medical Research Registry filing system ( https://www.medicalresearch.org.cn ) (No. MR-44-22-007981) and recorded in the Medical Research Division of our hospital (No. NYXJS-22-021).

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The aim of this study was to summarise the best evidence for the prevention and control of pressure ulcer at the support surface based on the site and stage of the pressure ulcer in order to reduce the incidence of pressure ulcer and improve the quality of care. In accordance with the top-down principle of the 6 S model of evidence-based resources, evidence from domestic and international databases and websites on the prevention and control of pressure ulcer on support surfaces, including randomised controlled trials, systematic reviews, evidence-based guidelines, and evidence summaries, was systematically searched for the period from January 2000 to July 2022. Evidence grading based on the Joanna Briggs Institute Evidence-Based Health Care Centre Evidence Pre-grading System (2014 version), Australia. The outcomes mainly embraced 12 papers, including three randomised controlled trials, three systematic reviews, three evidence-based guidelines, and three evidence summaries. The best evidence summarised included a total of 19 recommendations in three areas: type of support surface selection assessment, use of support surfaces, and team management and quality control.

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BACKGROUND: Cecal intubation time is an important component for quality colonoscopy. Cecum is the turning point that determines the insertion and withdrawal phase of the colonoscope. For this reason, obtaining information related with location of the cecum in the endoscopic procedure is very useful. Also, it is necessary to detect the direction of colonoscope's movement and time-location of the cecum. METHODS: In order to analysis the direction of scope's movement, the Horn-Schunck algorithm was used to compute the pixel's motion change between consecutive frames. Horn-Schunk-algorithm applied images were trained and tested through convolutional neural network deep learning methods, and classified to the insertion, withdrawal and stop movements. Based on the scope's movement, the graph was drawn with a value of +1 for insertion, -1 for withdrawal, and 0 for stop. We regarded the turning point as a cecum candidate point when the total graph area sum in a certain section recorded the lowest. RESULTS: A total of 328,927 frame images were obtained from 112 patients. The overall accuracy, drawn from 5-fold cross-validation, was 95.6%. When the value of "t" was 30 s, accuracy of cecum discovery was 96.7%. In order to increase visibility, the movement of the scope was added to summary report of colonoscopy video. Insertion, withdrawal, and stop movements were mapped to each color and expressed with various scale. As the scale increased, the distinction between the insertion phase and the withdrawal phase became clearer. CONCLUSION: Information obtained in this study can be utilized as metadata for proficiency assessment. Since insertion and withdrawal are technically different movements, data of scope's movement and phase can be quantified and utilized to express pattern unique to the colonoscopist and to assess proficiency. Also, we hope that the findings of this study can contribute to the informatics field of medical records so that medical charts can be transmitted graphically and effectively in the field of colonoscopy.

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We present the regional professional network to support the Renal Epidemiology Information Network (REIN) registry in maintaining high quality data production and information analyses in Ile-De-France region. The network is based on a long term partnership between the nephrologists and a regional methodology support unit. It integrates clinical research assistants for data quality control. We also present organizational methods on maintaining the registry and enhancing information analyses and automating analyses reports.

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BACKGROUND: A plain-language summary is a short and clearly stated version of a study's results using non-scientific vocabulary that provide many advantages for patients and clinicians in the process of shared decision-making. OBJECTIVES: The primary objective was to investigate the extent to which published reports of physiotherapy interventions provide plain-language summaries. We investigate as the secondary objectives if the available plain-language summaries are at a suitable reading level for a lay person and if inclusion of plain-language summaries in these reports is increasing over time and is associated with trial quality (i.e. PEDro score). DATA SOURCES: All 4421 randomised controlled trials (RCT), systematic reviews and clinical practice guidelines that included plain-language summaries indexed on Physiotherapy Evidence Database (PEDro) were included. MAIN OUTCOME MEASURES: Proportion of published reports with plain-language summaries, Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Grade Level (FKGL). RESULTS: The number of published reports with a plain-language summary doubled in the last 6 years. From a total of 34,444 reports indexed on PEDro, only 4421 reports had English plain-language summaries. RCTs with plain-language summaries had higher PEDro scores than RCTs without plain-language summaries (mean difference=0.8 points, 95%CI 0.7 to 0.8). Only 2% of reports were considered at a suitable reading level by the FKGL formula and 0.1% by the FRES formula. CONCLUSIONS: Although the publication of plain-language summaries is increasing over time, the current number corresponds to only 13% of all published reports. In addition the majority of plain-language summaries are written at an advanced reading level.

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PURPOSE: The colonoscopy adenoma detection rate depends largely on physician experience and skill, and overlooked colorectal adenomas could develop into cancer. This study assessed a system that detects polyps and summarizes meaningful information from colonoscopy videos. METHODS: One hundred thirteen consecutive patients had colonoscopy videos prospectively recorded at the Seoul National University Hospital. Informative video frames were extracted using a MATLAB support vector machine (SVM) model and classified as bleeding, polypectomy, tool, residue, thin wrinkle, folded wrinkle, or common. Thin wrinkle, folded wrinkle, and common frames were reanalyzed using SVM for polyp detection. The SVM model was applied hierarchically for effective classification and optimization of the SVM. RESULTS: The mean classification accuracy according to type was over 93%; sensitivity was over 87%. The mean sensitivity for polyp detection was 82.1%, and the positive predicted value (PPV) was 39.3%. Polyps detected using the system were larger (6.3 ± 6.4 vs. 4.9 ± 2.5 mm; P = 0.003) with a more pedunculated morphology (Yamada type III, 10.2 vs. 0%; P < 0.001; Yamada type IV, 2.8 vs. 0%; P < 0.001) than polyps missed by the system. There were no statistically significant differences in polyp distribution or histology between the groups. Informative frames and suspected polyps were presented on a timeline. This summary was evaluated using the system usability scale questionnaire; 89.3% of participants expressed positive opinions. CONCLUSIONS: We developed and verified a system to extract meaningful information from colonoscopy videos. Although further improvement and validation of the system is needed, the proposed system is useful for physicians and patients.

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OBJECTIVE: To assess the relationship between live birth rates (LBRs) and the incidence of under-reported cycles by IVF clinics. DESIGN: Cohort study. SETTING: Not applicable. PATIENT(S): All patients undergoing IVF cycles in the aforementioned clinics. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): The reporting percentage (RP), defined as number of cycles with reported pregnancy rates divided by total cycles performed. Results from cryopreservation cycles are only presented by SART if an embryo transfer occurs. Thus, RP decreases as incidence of embryo or oocyte banking cycles increases. The LBRs in women aged <35 years were compared between clinics. RESULT(S): The median RP of all clinics was 93%-97%. Clinics with RP <80% increased from 2 in 2004 to 30 in 2012. Twenty-one clinics had an RP that fell 2 standard deviations below the mean in any year. Over the 9 years, there was a negative correlation between RP and LBR of -0.17, but for the 21 outlier clinics the correlation increased to -0.26. In 2012 alone, in outlier clinics, for every 10% drop in RP there was an associated rise in LBR of 4.3%; some clinics reported 40% fewer cycles than the median. CONCLUSION(S): In clinics with very low RP, the cycles that are reported have higher success rates. Regardless of intent, the reduction of reported data to SART makes it increasingly difficult for clinicians and patients to accurately assess a clinic's success rates.

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OBJECTIVE: Most electronic health record (EHR) systems have the capability of generating a printed after-visit summary (AVS), but there has been little research on optimal content. We conducted a qualitative study and a randomized trial to understand the effect of AVS content on patient recall and satisfaction. METHODS: Adult primary care patients (n = 272) with at least 1 chronic condition were randomly assigned to 4 AVS content conditions: minimum, intermediate, maximum, or standard AVS. Demographics and health literacy were measured at an index clinic visit. Recall and satisfaction were measured by telephone 2 days and 2 to 3 weeks after the clinic visit. RESULTS: Average age was 52 years; 75% of patients were female, 61% were Hispanic, and 21% were African American, and 64% had adequate health literacy. Average medication recall accuracy was 53% at 2 days and 52% at 3 weeks, with no significant difference among groups at either time. Satisfaction with AVS content was high and did not differ among groups. Recall of specific content categories was low and unrelated to group assignment. Health literacy was unrelated to recall and satisfaction. CONCLUSION: Primary care patients like to receive an AVS, but the amount of information included does not affect content recall or satisfaction with the information.

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PIP: Globally, vaccines are administered to a number of healthy individuals, mostly infants, in the National Immunization Programs (NIPs). Hence safety and quality issues are of paramount importance. Problems in vaccine quality can have a major negative impact on NIPs. Unsafe or ineffective vaccines threaten to disable vaccine delivery systems that might otherwise prevent the deaths of millions of infants and children each year. This article explores quality issues related to vaccines. The paper begins with a brief review of how poliomyelitis has been successfully eradicated globally. It then discusses vaccine production, control and regulation issues. The functions of the National Control Authority/National Regulatory Authority (NRA) with regard to vaccine production are outlined. These control functions are designed to ensure safety and efficacy of vaccines produced and to guarantee the consistency of production: 1) a published set of requirements for licensing, 2) surveillance of vaccine field performance, 3) system of lot release, 4) use of the laboratory when needed, 5) regular infections for good manufacturing and laboratory practices, and 6) evaluation of regular performance. Finally, the paper illustrates how locally blended oral polio vaccine and vaccine vial monitors has been successfully implemented in India and the role of NRA in its success. It is noted that the vaccine used in NIP is safe and efficacious as the number of reported cases of polio has declined dramatically in 1998 and 1999.^ieng

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PIP: This paper focuses on the efforts of the Teen Health Initiative (THI) to meet the needs of teenagers for an accurate understanding of their rights to health care in New York. In particular, THI makes the state's laws understandable and explains the legal rights of minors to health care. In addition to the extensive training for professionals who work with adolescents, THI runs a peer education program. The program provides teenagers the opportunity to discuss their rights to confidential health care and gives them the tools to present that information to other adolescents around the state. An important aspect of the THI program is that it focuses on teenagers educating teenagers. Its workshop covers areas of health care to which minors can give informed consent and that they can receive confidentiality such as mental health care, drug and alcohol counseling, as well as areas of reproductive health such as birth control, pregnancy testing, prenatal care and counseling, testing and treatment for sexually transmitted diseases, HIV/AIDS testing and treatment, and abortion. The group believes that, when fully educated and treated respectfully, most teenagers are willing and able to make responsible choices about their health and their lives.^ieng

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PIP: Researchers at the Institute of Human Virology in Baltimore announced its plans to begin human tests of an oral vaccine for AIDS in Uganda, where 1.5 million people are already infected with the AIDS virus. The AIDS vaccine being developed by virologist Robert Gallo's team with the support of the International AIDS Vaccine Initiative is produced by an innovative approach that uses engineered Salmonella bacteria to deliver genetic material encoding vaccine DNA to human cells. Designed to be taken orally as a pill, this vaccine is inexpensive to manufacture, easy to distribute widely, and can be administered easily and safely by community health workers who would need little or no medical training. The Uganda vaccine, if it proves effective, would only combat the HIV strains prevalent in East Africa. However, segments of other HIV genes from other parts of Africa or India or Southeast Asia could be readily spliced into the Salmonella genome to target populations in those regions. The effort to develop these vaccines will be aided by the HIV Vaccine Initiative, which will focus on strengthening the capacity of poorer countries to continue to hold vaccine trials.^ieng

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Sexual health is topical with many factors impacting upon its concept and hence provision. In 1995 the Sexual Health Service in East Berkshire was formed by the integration of the clinical services of Family Planning, Genitourinary and HIV Medicine with Sexual Health Promotion. The philosophy of the service is to provide holistic sexual healthcare in one visit, on one site by one clinical team. This article outlines the practical developments and the strengths and weaknesses of this model of service.

PIP: In 1995, the Sexual Health Service in East Berkshire, UK, was formed by the integration of the clinical services of Family Planning, Genitourinary, and HIV Medicine with Sexual Health Promotion. The philosophy of the service was to provide holistic sexual health care in one visit, in one site, by one clinical team. In an outline of the practical developments and the strengths and weaknesses of such a model of service, the critical success factors in the process of developing the service were identified. These include the business case, changing the culture, training, common conditions of service, consumer view, and engineering the patient process. Moreover, the strengths and weaknesses of the model were considered from the viewpoint of the patient, the staff, the public health, and finance. It is noted that the concept of patient-focused care, where related services are brought to the patient, instead of the traditional model of making the patient do the work, has demonstrable effect.

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Few studies provide population-based estimates of intimate partner violence (IPV) for men and women, especially at the state level. IPV may result in adverse health effects for victims and perpetrators (1-3). To estimate the lifetime incidence of IPV by type of violence (e.g., physical, sexual, and perceived emotional abuse) and to explore demographic correlates of reporting IPV among men and women, the South Carolina Department of Health and Environmental Control and the University of South Carolina conducted a population-based random-digit-dialed telephone survey of adults in the state. This report summarizes the results of the survey, which indicated that approximately 25% of women and 13% of men have experienced some type of IPV during their lifetime. Although women were significantly more likely to report physical and sexual IPV, men were as likely as women to report emotional abuse without concurrent physical or sexual IPV.

PIP: This report summarizes the results of the survey conducted by the South Carolina Department of Health and Environmental Control and the University of South Carolina. The purpose of the survey was to estimate the lifetime incidence of intimate partner violence (IPV) by type of violence (e.g., physical, sexual, and perceived emotional abuse) and to explore demographic correlates of reporting IPV among men and women. Data were collected using a population-based random-digit-dialed telephone survey of adults in the state. Overall, findings revealed that approximately 25% of women and 13% of men surveyed have experienced some type of IPV during their lifetime. Although women were significantly more likely to report physical and sexual IPV, men were as likely as women to report emotional abuse without concurrent physical or sexual IPV.

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An intervention developed to teach young men in the urban slums of Lucknow, India, about sexually transmitted diseases is described in detail. This community-based intervention was designed to impart core educational messages and to address preexisting ideas about sexual health and STD-prevention practices among participants. Indicators of knowledge recorded before and after the intervention are presented and evaluated against the scores of a control group. Levels of sexual activity and factors associated with risky sex are discussed. The intervention was successful in raising the young men's awareness of STDs significantly in all areas except for the length of time that symptoms take to manifest following risky sex and the ineffectiveness of washing one's genitals after sex to avoid acquiring STDs. Lessons learned during the intervention are described as a means of informing future STD-education programs, and issues requiring prompt attention are identified.

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PIP: This cross sectional survey determined the extent of regretted sexual intercourse among young teenagers in Scotland. Using a questionnaire, data were obtained from 7395 third-year pupils (3365 boys and 3730 girls) aged 13 years and 6 months to 14 years and 9 months in 24 nondenominational state secondary schools. Regretted sexual intercourse, measured on a three-point scale, was analyzed by ordinal logistic regression. The data revealed that 18% (661) of boys and 15.4% (576) of girls had experienced sexual intercourse, of which 74.8% occurred since their 13th birthday. Boys, compared with girls, reported higher levels of regret. For boys, higher levels of regret were significantly associated with having exerted pressure to have sex. On multivariate analysis, reports of being pressured, exerting pressure, not having planned sexual intercourse with partner, and high levels of parental monitoring were significantly related to girls' regret. For women, regret seemed to be related to lack of control. Sex education should focus on assisting young people to develop relationship and negotiation skills. In addition, making teenagers aware of potential emotional and relationship consequences of early sexual intercourse may delay first intercourse.^ieng

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PIP: This article presents reactions in the development of the Guide to Community Preventive Services, which brings public health to the same level of scientific scrutiny with evidence-based recommendations for community prevention services. The first reaction found this development a good change that should be supported, encouraged, and continued. It would help health providers know which practices are based on some level of evidence and which practices warrant more study. The second reaction welcomed the development as a step in the institutionalization of public health, subsequently developing public health systems, standardizing the training of public health workers, and incorporating epidemiology in public health practice. In addition, it is noted that the Guide aggregates the experiences of those who have tried and documented preventive practices. In the third reaction, it is viewed that the Guide would point the way to those activities for which additional attention and study is needed. The fourth reaction indicated that the guidelines would further improve collective knowledge. Finally, the fifth reaction stated that this publication would provide local health departments with an abundance of clear and factual information to plan activities, and educate the community.^ieng

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PIP: This article discusses some of the public health practice needs that would be met by the Guide to Clinical Preventive Services (GCPS) and highlights some of the challenges that lie ahead in using the recommendations to actually improve the health of the population and communities. Overall, the discussions indicate that the Guide would be useful across public health settings from academia to health departments. It is noted that it would be the first comprehensive, evidence-based evaluation of community preventive services. In addition, the focus of the Guide on economic evaluation would prove to be extremely helpful to decision-makers in both public health and managed care settings in which fixed (or shrinking) budgets have become the norm. However, in terms of challenges, the implementation of the Guide is seen as the most difficult process, despite its clear and compelling recommendations. A number of initiatives are being developed and carried out that would support the dissemination and implementation of the Guide.^ieng

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PIP: This article presents the comments of Len Duhl, MD, on the Guide to Community Preventive Services. According to Duhl, health suffers when the bottom line is cost-effectiveness and profit and not basic human and health needs. This indicates that social values differ. Even nonmonetary, spiritual values are critical to communities. Duhl based this statement on the situations cited in the article. The first situation involved the story reported by a student on the outbreak of malaria and the treatment response implemented in southern Africa. From the story, it is concluded that when conflicting values social diversity and multiple values occur, the health of those concerned is jeopardized. In the second story, that of the experience of Duhl in Healthy Cities and Communities program, it is noted that change in a community resides in all levels of government, the local private sector and the global corporations. Thus, Duhl compliments the authors of the Guide, stating that the publication is an important piece of research.^ieng

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PIP: In both clinical medicine and in public health, programs, services and advice have been built based on individual judgments or professional consensus. There has been a lack of educational commitment, a knowledge base and a practice ethic solidly grounded in research and evaluation. The introduction of the Guide to Community Preventive Services, which has a clear link with the categories of immunizations, counseling services and screening tests, is considered to be influential in academic health centers who are engaged in research and evaluation studies. In addition, principles and guidelines for community-based research will facilitate real-world tests of ideas and guidelines for community preventive services. Performance standards and cost-effectiveness analyses will be expected by all payers and by policy-makers. Moreover, scientific advances, especially in the emerging field of public health genetics, will be incorporated. Thus, academics, practitioners, and employers should join forces to persuade payers to accept evidence-based convergence of related clinical guidelines. Such initiatives will improve the chances for increased investment in preventive medicine and public health.^ieng

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PIP: In a health care system with ever-rising demand and limited resources, economic assessment of medical technologies is important for those who make resource allocation decisions that affect the health of populations. Cost-effectiveness analysis (CEA) is the best developed tool available for comparing the relative health benefits for expenditure among a myriad of available health interventions. Although guidelines for systematic reviews of economic evaluations in community prevention presented in the American Journal of Preventive Medicine address the issue of facilitating comparison of programs, other issues that limit usefulness of CEA to decision-makers in the field arise. The issues include availability of studies, poorly developed and inconsistent evaluations, omission of key resources from the CEA in community prevention, and shifts in public awareness, social norms, and technologic improvements. Extensive discussion of these issues is provided in the article. In conclusion, the methods for systematic review of economic evaluations in the American Journal of Preventive Medicine are important steps. However, it is advisable to use caution in applying them.^ieng

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