Citations

Abstract Percent mammographic breast density (PMD) is a strong heritable risk factor for breast cancer. However, the pathways through which this risk is mediated are still unclear. To explore whether PMD and breast cancer have a shared genetic basis, we identified genetic variants most strongly associated with PMD in a published meta-analysis of five genome-wide association studies (GWAS) and used these to construct risk scores for 3,628 breast cancer cases and 5,190 controls from the UK2 GWAS of breast cancer. The signed per-allele effect estimates of single-nucleotide polymorphisms (SNP) were multiplied with the respective allele counts in the individual and summed over all SNPs to derive the risk score for an individual. These scores were included as the exposure variable in a logistic regression model with breast cancer case–control status as the outcome. This analysis was repeated using 10 different cutoff points for the most significant density SNPs (1%–10% representing 5,222–50,899 SNPs). Permutation analysis was also conducted across all 10 cutoff points. The association between risk score and breast cancer was significant for all cutoff points from 3% to 10% of top density SNPs, being most significant for the 6% (2-sided P = 0.002) to 10% (P = 0.001) cutoff points (overall permutation P = 0.003). Women in the top 10% of the risk score distribution had a 31% increased risk of breast cancer [OR = 1.31; 95% confidence interval (CI), 1.08–1.59] compared with women in the bottom 10%. Together, our results show that PMD and breast cancer have a shared genetic basis that is mediated through a large number of common variants. Cancer Res; 72(6); 1478–84. ©2012 AACR.

Background: Communication breakdowns are a common cause of adverse events in high consequence industries. It has become increasingly evident that within healthcare systems that poor communication is the causal factor of a large percentage of sentinel events. Methods: All communication exchanges between surgeon and perfusionist were monitored via observation for 18 cardiovascular surgery cases. Breakdowns were analyzed by stage and type of breakdown and a communication protocol designed based on the breakdowns. The protocol was then implemented, and use of the protocol was then monitored for 16 cardiovascular surgery cases. Results: Breakdowns decreased at each stage of cardiovascular surgery. Specific types of breakdowns decreased dramatically, most by more than half. Conclusions: This study shows that protocolizing communication can have a profound impact on communication breakdowns in the cardiovascular surgery operating theatre.

Background: Many researchers have previously explored the correlation between surgical flow disruptions (distractions and interruptions) and error in cardiac surgery, however there is no reliable tool to prospectively categorize surgical flow disruptions and the conditions that predispose a surgical team to error. Methods and Results: Two independent raters of different medical and human factors expertise observed 12 cardiovascular operations and iteratively designed a tool to characterize surgical flow disruptions and the latent factors that contribute to error. Categories to characterize surgical flow disruptions were based on human factors models of human error. Following the design period, both raters observed 10 surgical cases using the tool, to assess validity and inter-rater reliability. Rating agreement (weighted kappa) for each category across the 10 surgeries was moderate to very high, resulting in strong inter-rater reliability for each category on the surgical flow disruption tool (SFDT). Conclusions: This research depicts the development and utility of a tool to analyze surgical flow disruptions in the cardiovascular operating room with satisfactory inter-rater reliability. This tool is an important first step in systematically categorizing and measuring surgical flow disruptions and their impact on patient safety in the operating room.

Objective: Design a protocol for conducting preoperative briefings within the context of cardiovascular surgery. Method: A combined questionnaire and semi-structured focus group approach involving four subspecialties of surgical staff (n = 47) was conducted to gather information concerning (1) attitudes towards preoperative briefings, (2) logistical issues related to the conduct and content of briefings and (3) potential barriers that might impede implementation. Results: Analyses revealed consensus among surgical staff concerning briefing benefits (majority were very positive), duration (< 10 min), location (in the OR), content (procedure, patient, and equipment issues) and potential barriers (staff availability, attitudes, case scheduling, and lack of resources). Differences in opinions arose concerning timing of the brief (e.g., before vs. after patient enters OR) and the role of key participants. Discussion: A prototype checklist for conducting preoperative briefings was developed based on these results. Additional research is needed to implement and validate its effectiveness.

Objectives: To determine if the METI laparoscopic surgical simulator can discriminate between novices and experts and to assess learning curves among novices. Methods: Twenty novices and 5 experts performed five repetitions on the following modules: place arrow, retract, dissect, and traverse tube. For each module, median baseline performance was calculated. Novices performed 35 additional repetitions to assess learning with practice. Results: Experts out-performed novices at baseline for completion time of the dissect, place arrow, and traverse tube modules, as well as for error frequency on the traverse tube and retract modules. Novices' performance times improved significantly with practice, approaching the experts' baseline in all modules. Conclusion: The METI simulator exhibits construct validity on three of four basic-skills modules when considering completion time and on two modules when considering error frequency. Among novices, learning occurred with additional repetitions. Whether acquired skills transfer to the actual surgical environment has yet to be determined.