Attachment Management Research Articles

Abstract PO2-29-02: Towards Precision Medicine in Breast Imaging: A Novel Open Mammography Database with Tailor-Made 3D Image Retrieval for Artificial Intelligence and Teaching

Abstract Objectives: According to the World Health Organization (WHO), breast cancer is the most frequent malignant neoplasia and leading cause of cancer death among women worldwide. Low- and middle-income countries hold the worst survival rates mainly owing to a lack of access to appropriate diagnosis and treatment related resources. For proper early diagnosis, it is established that besides the physical structure itself (e.g., mammography units), there's a need for adequate interpretation of imaging and that might be a particularly major problem in low-income societies once there is a tendency of greater education setbacks. Mammography datasets can improve this resource-driven gap by enabling the development of artificial intelligence technologies (AI) which can make breast cancer diagnosis more accurate in a cost-effective and scalable way. We aim to create a new database of high quality digital mammography images suitable for AI development and education. Methods: Our mammography database was developed by means of retrospective selection of 100 exams performed by Hospital São Paulo - Federal University of São Paulo ranging from 2019 to 2023. The project is assumed to be safe, versatile, and usable, and required an extensive search for the appropriate tool. Ambra Health, an American company, has developed cloud-based software for medical image management and stood out as a viable alternative. Their platform meets international data security criteria, they also made the intended careful customization possible, in addition to the possibility of associating image and text attachments. The categories were created in accordance with the BI-RADS® descriptors, a wide range of clinical scenarios and additional materials available, and they served as the basis for the advanced search feature, which intuitively filters exams that meet the selected criteria simultaneously. The platform was integrated with an automatic anonymization system upon upload, ensuring data privacy. After submission, the exams are retained in a restricted area for anonymization verification, categorization, and attachment management, before being released to the end-user. So as to broaden geographic coverage, the descriptors were entered in American English, respecting the origin of the BI-RADS® lexicon, as for the website structure, automatic translation to the accessing browser standard language was selected. Results: Our website is active and available at http://mamografia.unifesp.br, with access granted upon a simple registration process. 941 mammography images from 100 anonymized cases, 62% of which include 3D images, can be filtered based on the combination of 113 clinical and imaging variables, as well as attachment availability. The language is adaptable to the user's native language, and categorized searches can be accessed directly from the browser or downloaded as customized datasets. Additionally, features such as saved searches or starred exams are also available. Conclusion: We have developed an online and free mammography database that is completely innovative by integrating various resources into a single platform. We provide high-resolution and 3D digital images that can be searched using an advanced search system. Moreover, we offer supplementary clinical information in various attachment formats, favoring a rich clinical correlation. In this way, we have achieved the ambivalence of our goal, which was to promote education and research. *"images speak louder than words" Database: https://mamografia.unifesp.br Tutorials: https://www.youtube.com/@Mamografiaunifesp e-mail: acesso@mamografia.unifesp.br password: acesso@mamografia12 (valid until dec/23) Citation Format: Natália Cordeiro, Gil Facina, Afonso Nazário, Vanessa Sanvido, Joaquim Araujo Neto, Morgana Silva, Simone Elias. Towards Precision Medicine in Breast Imaging: A Novel Open Mammography Database with Tailor-Made 3D Image Retrieval for Artificial Intelligence and Teaching [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-29-02.

Conditions for Feasibility of a Multicomponent Intervention to Reduce Social Isolation and Loneliness in Noninstitutionalized Older Adults.

Aims: To identify the factors conditioning the feasibility of an intervention to reduce social isolation and loneliness in noninstitutionalized older adults from the perspective of the intervention agents. Design: A Dimensional Grounded Theory study conducted from December 2019 to January 2020. Methods: Twelve participants were recruited from an experimental study developed in a health district of a southern Spanish city. Data were collected through focus group meetings, individual interviews, biograms, anecdote notebooks, and the field diaries of two participants not included in the other techniques. Transcripts were analyzed using thematic analysis. Findings: Findings were divided into three themes: (a) the elderly between the walls of loneliness, economic difficulties, losses, and the past; (b) intervention agents/volunteers between the walls of inexperience in the management of psychological/emotional processes, lack of moral authority, and difficulty in planning results adapted to the (elderly) person; and (c) intervention between the walls of (interest in) company and assistance at home, lack of involvement (“waiting for you to save them”), and withdrawal/“abandonment”. Conclusion: A profile of the specialized intervention agent, professionalized (or at least a mentored agent), with both technical and relational competencies; a clear understanding of the purposes of the intervention (empowerment, as opposed to having company or being helped with household chores) and the commitment to active participation by the elder; or adequate management of the completion of the intervention (flexibility, attachment management) are some of the main factors contributing to the feasibility of these approaches. Impact: The findings have potential implications in the field of primary healthcare because primary and community healthcare services can implement corrections to the proposed intervention and ensure its effectiveness under feasible conditions. The nurse is shown as the most appropriate profile to conduct this intervention, although more research is needed to analyze the feasibility of this type of intervention in the daily practice of community nurses.

64 Is it enough: An Assessment of Parental Satisfaction with an International Adoption Clinic at a Pediatric Tertiary Care Center

Abstract Background The circumstance in which internationally adopted children are born and live prior to adoption put them at high risk for health issues. Nearly all adoptees have complex medical conditions, the most common being cleft lip/palate, orthopaedic problems, infectious diseases, congenital heart diseases, and/or nutritional deficiencies, as well as cognitive impairments, and/or developmental delays. Specifically, nearly all institutionalized children will have expressive language delays and most will have motor delays. Although improvement can be seen with time, most do not attain their full potential. Additionally, by nature of adoption, all children experience trauma. In some situations, this will be further compounded by neglect and/or abuse faced prior to adoption, or during institutionalization. Consequently, almost all adoptees develop attachment difficulties. Trained medical professionals are required to screen, monitor, and provide management suggestions for this complex and unique population. Objectives To our knowledge, parental experience of an international adoption clinic has not yet been published. This parent-based evaluation of the parental experience at a pediatric tertiary care center’s international adoption clinic, provides insights that may help guide provision of care for this high-risk population in our centre, throughout the country, and internationally. Design/Methods A qualitative, exploratory design was employed using telephone interviews of eighteen parents of adoptees assessed by a pediatric tertiary care center’s international adoption clinic since 2010. This approach was chosen to allow for more extensive exploration of parental experience, and to identify barriers and facilitators of care. Interviews were 30 to 90 minutes, semi-structured, and transcribed verbatim. Field notes were made during the interviews to note intonation and major concerns, and were used to supplement transcripts during data analysis. Questions covered experiences with pre-adoption counselling, arranging the first clinic visit, health and developmental assessments, life after clinic discharge, and general comments/suggestions. Thematic analysis was performed on the transcripts using Maguire’s step-by-step guide. Results Analysis resulted in four main themes and seven subthemes. The first theme was “difficulty of international adoption”. The second theme “utility and impact of services offered” was subdivided into “pre-adoption counselling”, “clinic visits and medical assessments”, and “post adoption seminars”. The third theme “the administrative procedures of the clinic” was subdivided into “timing and ease of organizing a first visit”, and “hours of operation”. The final theme “gaps in care” was divided into “ongoing difficulty with attachment”, and “allied healthcare services”. These results demonstrate that parents of internationally adopted children often feel overwhelmed by the medical needs of their children and feel unsupported. They recommend comprehensive and in-person pre-adoption counselling with standard referral processes to ensure timely access to care. Post-arrival medical and developmental assessments should be flexible and complete. Most importantly, clinics should incorporate support from allied healthcare professionals, including social work, psychology, occupational therapy, and physiotherapy. In particular, parents were interested in further management of attachment. Conclusion This first parent-based evaluation of the parental experience at a pediatric tertiary care center’s international adoption clinic provides insights that may help guide provision of care to this high-risk population in centres across Canada and internationally.