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[Therapy of breast cancer--change from radical to quality-controlled individualized treatment].

The treatment of breast cancer is changing continually. Thus, sentinel lymph node dissection is considered today as standard in the therapy of small unifocal breast carcinoma with clinically negative axillary lymph nodes. Concerning adjuvant therapy, the 9th Early Adjuvant Breast Cancer Meeting, along with a consensus conference, took place in Saint Gall on January 26-29, 2005. The publication of the corresponding congress report is expected for early summer of 2005.

Breast Neoplasms↗

Proposed geriatric psychiatry core competencies for subspecialty training.

The authors present and discuss the theoretical and practical development of proposed core competencies for subspecialty training and certification in geriatric psychiatry as required by the Accreditation Council For Graduate Medical Education (ACGME) and the American Board of Psychiatry and Neurology (ABPN). Changes were derived from a concern that graduate medical education programs must do a better job of ensuring that residents completing their training are competent to practice medicine and adequately prepared to practice in a rapidly changing healthcare environment. Between July 2006 and June 2011, programs will be expected to focus on data-driven measures, both internal and national, for resident and education-program performance. After July 2011, programs will begin to focus on identifying and developing educational centers of excellence.

Accreditation↗

Prediction of "critical" coronary disease: are the "Consensus Conference" guidelines adequate?

Presenting features of 100 patients with significant left main coronary stenosis (LMCS) were reviewed. All presented with angina--on minimal exertion in 45, moderate exertion in 38, and severe exertion in 6--and 11 had unstable angina. Although the resting ECG was normal in 44, exercise testing was positive in 92% of patients tested. The authors conclude that symptoms and the resting ECG alone are unhelpful in predicting "critical" coronary disease. However, application of a management plan similar to that suggested by the Consensus Conference on coronary artery surgery would have selected the vast majority of such patients for angiography.

Adult↗

Food and Drug Administration workshop on indirect mechanisms of carcinogenesis.

A workshop sponsored by the Food and Drug Administration (FDA) was held on March 4-5, 1996, at the Lister Hill Auditorium of the National Institutes of Health (NIH) Campus in Bethesda, Maryland. The workshop considered both the scientific aspects and the regulatory implications of indirect-acting carcinogens. A wide variety of agents and of prospective mechanisms was discussed. The organizing committee for the workshop consisted of Drs. James Farrelly and Joseph DeGeorge of the Center for Drug Evaluation and Research (CDER), Ronald J. Lorentzen and Sidney Green of the Center for Food Safety and Applied Nutrition (CFSAN), Martin D. Green of the Center for Biologics, Evaluation and Research (CBER), C. Darnell Jackson and Lionel A. Poirier of the National Center for Toxicological Research (NCTR). Rosalie K. Elespuru of the Center for Devices and Radiological Health (CDRH), and David G. Longfellow of the National Cancer Institute (NCI). Following an introduction by Dr. Poirier, who provided a description of indirect carcinogens, the major talks were grouped into three formal sessions: indirect-acting compounds and agents of FDA interest, biological and biochemical endpoints commonly seen with indirect agents, and specific problems associated with the indirect-acting compounds. A panel discussion followed and the concluding remarks were made by Dr. Bernard A. Schwetz, Associate Commissioner for Science, FDA.

Carcinogens↗

Comparison of appropriateness ratings for cataract surgery between convened and mail-only multidisciplinary panels.

BACKGROUND: In this article, the authors determine the reproducibility of appropriateness ratings for cataract surgery between a multidisciplinary physician panel that convened and a multidisciplinary physician panel that completed ratings by mail. METHODS: Eighteen panelists, who constituted 2 distinct multidisciplinary panels, rated 2894 clinical scenarios as an appropriate, inappropriate, or uncertain indication to perform cataract surgery. Each panel's summary score for each scenario was calculated. Weighted kappa values were determined to assess the level of agreement between the ratings of the 2 panels. RESULTS: The panels had a substantial level of agreement overall, with a weighted kappa statistic of 0.64. There was agreement on about 68% of the scenarios, and serious disagreement, in which one panel rated an indication appropriate and the other rated it inappropriate, occurred in only 1% of the ratings. CONCLUSION: There was substantial agreement about the ratings by the 2 panels. The panel that convened rated fewer scenarios uncertain and more appropriate, suggesting the impact of group dynamics and face-to-face discussion on resolution of uncertainty.

Cataract Extraction↗