• Qualitative Article Appraisal Criteria Your Evaluation Article Citation in APA Format Author(s), date, title, publisher, volume number, issue number, pages, may include retrieved from and hyperlink or DOI Abstract What are the key terms in the abstract? Are the key terms similar to your own search terms? Is the journal peer reviewed and how do you know? (hint see journal main web page. May have to click on information for authors, or editorial review tab) Introduction Does the introduction provide a background of a phenomena? Does the introduction include the problem statement? Does the introduction include a theoretical framework? Is the literature reviewed? What are the concepts/phenomena the study will investigate? What is the research question (s) or inquiry Method What is the Qualitative study method? E.g. Phenomenology, ethnography etc. Are legal/ethical implications addressed (ALL have legal/ethical implications. Consider principles in the Belmont report and address 2 or more principles) What is the sample? What are the characteristics of the sample? Does the article indicate who was excluded from the study? What type of instruments were used? Was saturation reached? How did the researchers plan to analyze the data? (Did they code, use member checking, or thematic analysis?) Results What were the findings? Summarize major themes in your own words. Discussion/Recommendations Was the research question answered? What insights were uncovered by the research? What are the future implications? Summary What is your overall impression? Was this a valid and useful study? (Athenticity, credibility, dependability, confirmability etc.) Is the research applicable in the real world? Are the findings applicable/to other populations? • Quantitative Article Appraisal Criteria Article Citation in APA Format Author(s), date, title, publisher, volume number, issue number, pages, may include retrieved from and hyperlink or DOI Your Evaluation Abstract What are the key terms in the abstract? Are the key terms similar to your own search terms? Is the journal peer reviewed and how do you know? (hint see journal main web page. May have to click on information for authors, or editorial review tab) Introduction Does the introduction include the purpose of the study? Does the introduction include a theoretical framework? Is the literature reviewed? Are the independent/dependent variables defined? What are the independent/dependent variables? What is the research question/hypothesis? Method What is the Quantitative study method? E.g. RCT, survey, cohort etc. Are legal/ethical implications addressed (ALL have legal/ethical implications. Consider principles in the Belmont report and address 2 or more principles) What is the sample? What are the characteristics of the sample? Does the article indicate who was excluded from the study? What instruments were used in the study? How did the researchers plan the analysis? (Did they use statistics?) Results What were the findings? Are statistically significant results reported? Discussion/Recommendations Was the research question answered? What insights were uncovered by the research? What are the future implications? Summary What is your overall impression? Was this a valid and useful study? (internal/external validity addressed) Is the research applicable in the real world? Are the findings applicable/ generalizable to other populations? • Proposed Project This is the final written assignment for the course. In this assignment you will describe the plan for conducting a proposed research or quality improvement project based on your initial inquiry, literature review paper, and article appraisals. Using complete sentences and APA format, complete your proposal according to the following criteria: *You may provide your responses directly on the table below or in a narrative essay format complete with title page and reference list. Criteria Research inquiry Provide a few summary statements about what was found in the literature and how it applies to this proposed project (include in text citations in APA format and a list of references) Briefly state the purpose/rationale for this proposed project What is your question? Population Who is the population (nurses, patients, students etc.) How is your population/sample to be recruited for the project? Setting- Where will you recruit your population/sample Ethics What are the ethical implications for the study? How could any ethical implications be addressed/prevented/avoided? Plan What type of research/project? (qualitative, quantitative, mixed method?) How will you go about collecting data/conducting the study? What instrument/measurement tool will be used? What are the expected findings? Findings What are the nursing implications for the proposed project and/or relevance of expected findings? Summary Your Response Who will be informed of the project/findings? How would you go about informing others of the project results? Total P • Qualitative Article Appraisal Criteria Your Evaluation Article Citation in APA Format Author(s), date, title, publisher, volume number, issue number, pages, may include retrieved from and hyperlink or DOI Abstract What are the key terms in the abstract? Are the key terms similar to your own search terms? Is the journal peer reviewed and how do you know? (hint see journal main web page. May have to click on information for authors, or editorial review tab) Introduction Does the introduction provide a background of a phenomena? Does the introduction include the problem statement? Does the introduction include a theoretical framework? Is the literature reviewed? What are the concepts/phenomena the study will investigate? What is the research question (s) or inquiry Method What is the Qualitative study method? E.g. Phenomenology, ethnography etc. Are legal/ethical implications addressed (ALL have legal/ethical implications. Consider principles in the Belmont report and address 2 or more principles) What is the sample? What are the characteristics of the sample? Does the article indicate who was excluded from the study? What type of instruments were used? Was saturation reached? How did the researchers plan to analyze the data? (Did they code, use member checking, or thematic analysis?) Results What were the findings? Summarize major themes in your own words. Discussion/Recommendations Was the research question answered? What insights were uncovered by the research? What are the future implications? Summary What is your overall impression? Was this a valid and useful study? (Athenticity, credibility, dependability, confirmability etc.) Is the research applicable in the real world? Are the findings applicable/to other populations? • Quantitative Article Appraisal Criteria Article Citation in APA Format Author(s), date, title, publisher, volume number, issue number, pages, may include retrieved from and hyperlink or DOI Your Evaluation Abstract What are the key terms in the abstract? Are the key terms similar to your own search terms? Is the journal peer reviewed and how do you know? (hint see journal main web page. May have to click on information for authors, or editorial review tab) Introduction Does the introduction include the purpose of the study? Does the introduction include a theoretical framework? Is the literature reviewed? Are the independent/dependent variables defined? What are the independent/dependent variables? What is the research question/hypothesis? Method What is the Quantitative study method? E.g. RCT, survey, cohort etc. Are legal/ethical implications addressed (ALL have legal/ethical implications. Consider principles in the Belmont report and address 2 or more principles) What is the sample? What are the characteristics of the sample? Does the article indicate who was excluded from the study? What instruments were used in the study? How did the researchers plan the analysis? (Did they use statistics?) Results What were the findings? Are statistically significant results reported? Discussion/Recommendations Was the research question answered? What insights were uncovered by the research? What are the future implications? Summary What is your overall impression? Was this a valid and useful study? (internal/external validity addressed) Is the research applicable in the real world? Are the findings applicable/ generalizable to other populations? • Proposed Project This is the final written assignment for the course. In this assignment you will describe the plan for conducting a proposed research or quality improvement project based on your initial inquiry, literature review paper, and article appraisals. Using complete sentences and APA format, complete your proposal according to the following criteria: *You may provide your responses directly on the table below or in a narrative essay format complete with title page and reference list. Criteria Research inquiry Provide a few summary statements about what was found in the literature and how it applies to this proposed project (include in text citations in APA format and a list of references) Briefly state the purpose/rationale for this proposed project What is your question? Population Who is the population (nurses, patients, students etc.) How is your population/sample to be recruited for the project? Setting- Where will you recruit your population/sample Ethics What are the ethical implications for the study? How could any ethical implications be addressed/prevented/avoided? Plan What type of research/project? (qualitative, quantitative, mixed method?) How will you go about collecting data/conducting the study? What instrument/measurement tool will be used? What are the expected findings? Findings What are the nursing implications for the proposed project and/or relevance of expected findings? Summary Your Response Who will be informed of the project/findings? How would you go about informing others of the project results? Total P Epidemiological risk factors associated with inflammatory breast cancer subtypes. Authors: Atkinson, Rachel; El-Zein, Randa; Valero, Vicente; Lucci, Anthony; Bevers, Therese; Fouad, Tamer; Liao, Weiqin; Ueno, Naoto; Woodward, Wendy; Brewster, Abenaa; Atkinson, Rachel L; Bevers, Therese B; Ueno, Naoto T; Woodward, Wendy A; Brewster, Abenaa M Affiliation: Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1360 Houston 77230 USA Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1360, P.O. Box 301439, Houston, TX, 77230, USA MD Anderson Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, Houston, TX, USA Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Source: Cancer Causes & Control (CANCER CAUSES CONTR), Mar2016; 27(3): 359-366. (8p) Publication Type: journal article - research, tables/charts Language: English M a j o r S u b j e c t s : Breast Neoplasms -- Pathology Receptors, Cell Surface -- Metabolism Proteins -- Metabolism Adult; Breast Neoplasms -- Epidemiology; Breast Neoplasms -- Etiology; Risk Factors; Logistic Regression; Age Factors; Body Mass Index; Aged, 80 and Over; Middle Age; Aged; Pregnancy; Case Control Studies; Young Adult; Obesity - Epidemiology; Female; Breast Feeding -- Statistics and Numerical Data; Funding Source; Human Background: In this single-institution case-control study, we identified risk factors associated with inflammatory breast cancer (IBC) subtypes based on staining of estrogen receptor (ER), progesterone receptor (PR) and expression of human epidermal growth factor 2 (HER2neu) to determine distinct etiologic pathways.Methods: We identified 224 women with IBC and 396 cancer-free women seen at the MD Anderson Cancer Center. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for associations between breast cancer risk factors and the IBC tumor subtypes: luminal (ER+ and/or PR+/HER2neu-), HER2neu+ (any ER and PR, HER2neu+), and triple-negative (ER-/PR/HER2neu-).Results: In multivariable analysis, compared with women age ≥26 at first pregnancy, women age 40 microcalcifications. The number of masses was given as the true number. Level of density and number of microcalcifications and masses, as well as the differences in density and number of microcalcifications and masses between breasts, were used in the model. On the basis of self-reported information, dichotomous variables were created for current use of HRT, history of breast cancer in first-degree relatives, and menopausal status. Current use of HRT was defined as use within the last 12 months. BMI and age were assessed at the time of study entry, which was the time the baseline mammogram was taken. Screening-detected breast cancer was defined as breast cancer diagnosed within 3 months of a screen. An interval breast cancer was defined as a breast cancer diagnosed at least 3 months after a negative screen but before the date of the next scheduled screen [11]. Descriptive statistics were presented for participant characteristics and to describe mammographic features in the tumor breast side (where the tumor eventually was diagnosed) versus the nontumor breast side in the cases. Differences between the breasts were calculated without assuming knowledge of the tumor breast side. These absolute differences were calculated as the standard deviation (SD) of the two breasts for each mammographic feature and were used as continuous predictors in the final model. The continuous predictors in the conditional logistic regression model were tested for the best transformation using the Sauerbrei method [12] with fractional polynomials, and the predictors for the absolute breast differences were transformed as reciprocal numbers. The functional form of the final model was assessed using the branch-and-bound Furnival and Wilson statistics for main effects and interaction terms [13]. Relative risks were reported as HRs in this prospective study design. Absolute risks were calculated using the Individualized Coherent Absolute Risk Estimator (iCARE) package in R [14]. The Swedish national incidence rates of breast cancer and competing mortality risks were used and calculated as the average rates from 2007 to 2011. Prevalence rates of HRT use and family history of breast cancer were derived from the KARMA cohort, and the relative risks from the regression analyses were entered into the model matrix. Missing data from nonreported risk factors were imputed with model averaged risk estimates using the iCARE protocol (Additional file 1: Supplementary methods 3). Using the same data, a cross-validated AUC was calculated and compared with values generated by the established Tyrer-Cuzick and Gail risk models. The numbers of invasive and in situ cases that were diagnosed during follow-up were tabulated by quintile of the 2-year Eriksson et al. Breast Cancer Research (2017) 19:29 Page 3 of 8 tumor side (for cases versus corresponding side for control subjects, 6.1 vs. 2.6; p = 4.0 × 10−20) and the contralateral side in cases and control subjects (3.4 vs. 2.6, p = 0.03). The comparison between tumor and nontumor sides in cases showed a mean difference of 2.7 microcalcifications (p = 1.9 × 10−3) (Table 2). The mean number of detected masses in cases versus control subjects was significantly different on the tumor side (for cases and corresponding side for control subjects, 0.77 vs. 0.56; p = 8.4 × 10−6) but not on the contralateral side in cases and control subjects. The pairwise comparison between tumor and nontumor sides in cases showed a mean difference of 0.26 masses (p = 9.2 × 10−3) (Table 2). In the lower part of Table 2, the absolute differences between the breasts are presented to contrast cases and control subjects. It can be seen that cases have a more uneven distribution of mammographic density (p = 1.7 × 10−6), microcalcifications (p = 4.0 × 10−16), and masses (p = 0.02). Relative risks of breast cancer within 3 years from a negative mammographic screening result at baseline were calculated using two models (Table 3). In the fully adjusted model, the risk of breast cancer in women with a family history of the disease was 1.3 (95% CI 1.0–1.7). A significant difference was seen for women with the highest versus lowest cBIRADS scores (HR 4.8), in women with microcalcifications in category 4 compared with no microcalcifications (HR 2.0), in women with significant difference in density (HR 1.9), and in microcalcifications (HR 2.8) between left and right breasts (Table 3). A more detailed stratification is provided in Additional file 1: Table S1. Dividing cases into invasive (n = 383) and in situ (n = 50) cancers (Additional file 1: Table S2) revealed that microcalcifications were significantly more likely to identify risk of absolute risks predicted at baseline. The increase in number of diagnosed cases by quintile of baseline risk was calculated and tested for linear trend. All statistical tests were two-sided at a significance level of 0.05 and calculated using SAS version 9.4 software (SAS Institute, Cary, NC, USA) for descriptive statistics and relative risks. Absolute risks were evaluated with R 3.3.0 software using the iCARE package 1.0.0. Results In all, 433 women had a negative mammogram result more than 3 months prior to diagnosis and had full information on risk factors. The data of these women were used to develop the model (Table 1). The median followup time between the baseline mammogram and diagnosis of breast cancer was 1.7 years, mean age at breast cancer diagnosis was 59.0 years, 88% of the breast cancers were invasive, and 63% were detected by screening. Significantly more cases were current users of HRT (6.9% in cases and 4.4% in control subjects, p = 0.05) and had a family history of breast cancer (19% of cases and 13% of control subjects, p = 4.5 × 10−4) (Table 1). At baseline, the median mammographic density was 23.0% in cases on the tumor side (i.e., on the side where the tumor was diagnosed at follow-up) and 12.2% in control subjects (p = 4.0 × 10−10) in the breast corresponding to the tumor side in cases (Table 2). The corresponding figures for the contralateral side in cases and control subjects were 21.7% and 12.5%, respectively (p = 2.5 × 10−7). Comparing density pairwise between the tumor side and nontumor side in cases showed a mean difference of 1.1% (p = 3.4 × 10−3) (Table 2). The mean number of microcalcifications in cases and control subjects was significantly different on both the Table 1 Characteristics of cases and control subjects Study participant characteristics Cases Control subjects p Valuea Number of women 433 1732 – Age at breast cancer diagnosis, mean (SD) 59.0 (9.4) – – Years from mammography to breast cancer, median 1.74 – – Invasive breast cancer, % 88 – – Screening detected breast cancer, % 63 – – Age at mammography, mean (SD) 57.4 (9.2) 57.4 (9.2) 0.99 BMI, mean (SD) 25.6 (4.6) 25.3 (4.0) 0.19 Age at menarche, mean (SD) 13.1 (1.4) 13.2 (1.5) 0.61 Parity, % 89 88 0.56 Age at first birth, mean (SD) 27.1 (5.4) 26.6 (5.2) 0.11 Current use of HRT, % 6.9 4.4 0.05 Postmenopausal, % 65 65 0.78 Breast cancer in family, % 19 13 4.5 × 10−4 BMI Body mass index, HRT Hormone replacement therapy a p Values for means were calculated with Student’s t test, medians with Wilcoxon rank-sum test, and percentages with the chi-square test Eriksson et al. Breast Cancer Research (2017) 19:29 Page 4 of 8 Table 2 Mammographic features in tumor and nontumor side in cases and control subjects Mammographic features Cases (n = 433) Control subjects (n = 1732) p Valuea Percentage mammographic density on tumor side, median (IQR) 23.0 (6.1–44.1) 12.2 (2.4–32.8) 4.0 × 10−10 Percentage mammographic density on nontumor side, median (IQR) 21.7 (5.1–43.4) 12.5 (2.7–33.2) 2.5 × 10−7 Tumor vs. nontumor side, percentage mammographic density 1.1 (7.8) – 3.4 × 10−3 Number of microcalcifications on tumor side, mean (SD) 6.1 (15.3) 2.6 (13.1) 4.0 × 10−20 Number of microcalcifications on nontumor side, mean (SD) 3.4 (13.0) 2.6 (12.2) 0.03 Tumor vs. nontumor side, microcalcifications 2.7 (17.9) – 1.9 × 10−3 Number of masses on tumor side, mean (SD) 0.77 (0.92) 0.56 (0.76) 8.4 × 10−6 Number of masses on nontumor side, mean (SD) 0.51 (0.75) 0.55 (0.78) 0.39 Tumor vs. nontumor side, masses 0.26 (1.1) – 9.2 × 10−3 Percentage mammographic density, mean (SD) 3.8 (4.0) 3.1 (3.7) 1.7 × 10−6 Microcalcifications, mean (SD) 2.9 (6.1) 1.6 (5.7) 4.0 × 10−16 Number of masses, mean (SD) 0.33 (0.42) 0.28 (0.40) 0.02 b Individual absolute difference between breasts p Values of median values were calculated with Wilcoxon rank-sum test. p Values of means were calculated with Student’s t test. Mediolateral oblique and craniocaudal view mammograms are used. The individual microcalcifications are within calcification cluster(s) b Absolute difference between the two breasts was calculated as the standard deviation SD of density of the left and right breasts for each woman a future cancer in situ than invasive cancers (p = 0.03 for number of microcalcifications and p = 0.01 for absolute difference in microcalcifications between breast sides). When stratifying on mode of detection (i.e., screening-detected [n = 275] vs. interval [n = 158] breast cancers), we observed that all mammographic features, including the absolute differences between the breasts, were more likely to identify interval cancers than screening-detected cancers (Additional file 1: Table S2). Women with a cBIRADS score of 4, microcalcifications in category 3 or higher, and three or more masses had a nearly ninefold higher risk of breast cancer than women with a cBIRADS score of 1 and no microcalcifications or masses (Table 4). The final model including the selected risk factors, stratified by menopausal status, is provided in Additional file 1: Table S3 and was used for calculating absolute risks. We plotted the frequency distribution of the predicted absolute risk of breast cancer using the generated relative risks and prevalence of risk factors in 570 incident breast cancer cases and 60,237 healthy women in the KARMA cohort (Fig. 1). This was done after exclusion of women with previous breast cancers and/or lack of mammograms (Additional file 1: Supplementary methods 3). To conform to the National Institute for Health and Care Excellence guidelines [15], we divided the 10-year risk cutoffs (general, moderate, high) by 5 to get 2-year Table 3 Relative risks of breast cancer within 3 years of a negative mammographic screening result in relation to use of hormone replacement therapy, family history of breast cancer, and mammographic features Study participant and mammographic features HRa (95% CI) HRb (95% CI) Current use of HRT (same-year user vs. previous or nonuser) 1.4 (0.9–2.1) 1.3 (0.9–2.0) Family history of breast cancer 1.3 (1.1–1.7) 1.3 (1.0–1.7) Percentage mammographic density (cBIRADS 4 vs. 1) 4.9 (2.8–8.6) 4.8 (2.6–8.8) Percentage mammographic density (per SD) 1.6 (1.4–1.8) 1.6 (1.4–1.8) Number of microcalcificationsc (category 4 vs. 0) 2.0 (1.3–3.1) 2.0 (1.3–3.2) Number of masses (4 vs. 0) 1.7 (0.8–3.5) 1.7 (0.8–3.5) 3.4 (2.2–5.2) 1.9 (1.2–3.0) Individual absolute difference between breastsd Percentage mammographic density Number of microcalcifications 2.5 (1.9–3.1) 2.8 (1.8–4.5) Number of masses 1.4 (0.9–2.2) 1.1 (0.6–1.9) HRT Hormone replacement therapy a Adjusted for age, body mass index b Adjusted for age, body mass index, mammographic density, microcalcifications, masses, breast cancer in family, menopausal status, and current use of HRT c Category 0 means 0 microcalcifications, and 1 is 1–10 microcalcifications. The corresponding numbers for 2, 3, and 4 are 11–20, 21–40, and >40 microcalcifications, respectively d Absolute difference between right and left breasts was calculated as the standard deviation SD of the breasts for each mammographic feature Eriksson et al. Breast Cancer Research (2017) 19:29 Page 5 of 8 Table 4 Relative risk of developing breast cancer in relation to the combined effect of mammographic density, number of microcalcifications, and number of masses Mammographic features combined HRa (95% CI) HRb (95% CI) 1. cBIRADS 1, microcalcification category 0c, 0 masses, reference 1.0 1.0 2. cBIRADS 2, microcalcification category 1, 1 masses 4.2 (2.5–7.1) 4.3 (2.4–7.5) 3. cBIRADS 3, microcalcification category 2, 2 masses 7.9 (4.3–14.4) 7.9 (4.2–15.2) 4. cBIRADS 4, microcalcification category ≥3, ≥3 masses 8.0 (4.5–14.3) 8.7 (4.7–16.0) cBIRADS Computer-generated Breast Imaging Reporting and Data System score a Adjusted for age, body mass index b Adjusted for age, body mass index, family history of breast cancer, menopausal status, and current use of hormone replacement therapy c Category 0 means 0 microcalcifications, and 1 is 1–10 microcalcifications. The corresponding numbers for 2, 3, and 4 are 11–20, 21–40, and >40 microcalcifications, respectively risk cutoffs (i.e.,
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