Contraindications of sentinel lymph node biopsy: Áre there any really?

BACKGROUND: One of the most exciting and talked about new surgical techniques in breast cancer surgery is the sentinel lymph node biopsy. It is an alternative procedure to standard axillary lymph node dissection, which makes possible less invasive surgery and side effects for patients with early breast cancer that wouldn't benefit further from axillary lymph node clearance. Sentinel lymph node biopsy helps to accurately evaluate the status of the axilla and the extent of disease, but also determines appropriate adjuvant treatment and long-term follow-up. However, like all surgical procedures, the sentinel lymph node biopsy is not appropriate for each and every patient. METHODS: In this article we review the absolute and relative contraindications of the procedure in respect to clinically positive axilla, neoadjuvant therapy, tumor size, multicentric and multifocal disease, in situ carcinoma, pregnancy, age, body-mass index, allergies to dye and/or radio colloid and prior breast and/or axillary surgery. RESULTS: Certain conditions involving host factors and tumor biologic characteristics may have a negative impact on the success rate and accuracy of the procedure. The overall fraction of patients unsuitable or with multiple risk factors that may compromise the success of the sentinel lymph node biopsy, is very small. Nevertheless, these patients need to be successfully identified, appropriately advised and cautioned, and so do the surgeons that perform the procedure. CONCLUSION: When performed by an experienced multi-disciplinary team, the SLNB is a highly effective and accurate alternative to standard level I and II axillary clearance in the vast majority of patients with early breast cancer

Trait plasticity in species interactions: a driving force of community dynamics.

Evolutionary community ecology is an emerging field of study that includes evolutionary principles such as individual trait variation and plasticity of traits to provide a more mechanistic insight as to how species diversity is maintained and community processes are shaped across time and space. In this review we explore phenotypic plasticity in functional traits and its consequences at the community level. We argue that resource requirement and resource uptake are plastic traits that can alter fundamental and realised niches of species in the community if environmental conditions change. We conceptually add to niche models by including phenotypic plasticity in traits involved in resource allocation under stress. Two qualitative predictions that we derive are: (1) plasticity in resource requirement induced by availability of resources enlarges the fundamental niche of species and causes a reduction of vacant niches for other species and (2) plasticity in the proportional resource uptake results in expansion of the realized niche, causing a reduction in the possibility for coexistence with other species. We illustrate these predictions with data on the competitive impact of invasive species. Furthermore, we review the quickly increasing number of empirical studies on evolutionary community ecology and demonstrate the impact of phenotypic plasticity on community composition. Among others, we give examples that show that differences in the level of phenotypic plasticity can disrupt species interactions when environmental conditions change, due to effects on realized niches. Finally, we indicate several promising directions for future phenotypic plasticity research in a community context. We need an integrative, trait-based approach that has its roots in community and evolutionary ecology in order to face fast changing environmental conditions such as global warming and urbanization that pose ecological as well as evolutionary challenges. © Springer Science+Business Media B.V. 2010

Mutual suffering: a nurse\u27s story of caring for the living as they are dying

The aim of this study was to uncover the meaning of the lived experience of mutual suffering in relation to the care of a dying patient. The study took place within an acute medical ward in a district general hospital on the south coast of England as part of a reflective practice development programme. Parse\u27s human becoming theory provided a framework for the study and Parse\u27s research methodology was adopted. Understanding the nature of human relationships within nursing practice is central to nursing work, enabling patients and their health-professional carers to live and work healthily in the context of human becoming. Illuminating mutual suffering through reflection enables nursing and health-care professionals to acknowledge the paradoxes of practice and, thus, create new strategies for the provision of care and the improvement of practice, so that quality of life is maximized for the patient and for themselves

Using learning circles to develop intersubjectivity

Intersubjectivity or the ability to understand and work with others is essential in healthcare. Intersubjective processes include workplace relationships where clinicians seek to make sense of and identify stakeholders’ interests. Students may develop intersubjectivity through group work, structured around classroom activities. However, less well established is how the types of skills required for the temporary, fleeting and partial everyday healthcare collaborations amongst nurses, patients, families, doctors and allied health professionals are developed. The study discussed here aimed to evaluate the feasibility of, and learning experienced by students who participated in, learning circles conducted in health workplaces. A mixed methods approach was used with a convenience sample of nursing students undertaking clinical placement at one tertiary hospital. The learning circle is a pedagogic activity for developing students’ knowledge of nursing through checking and comparing experiences, feelings and conceptual understanding. It may prove to be an educational pedagogy that enhances student intersubjectivity and practice. The structured learning circle activity focused on a shared topic derived from students’ own clinical cases, which were drawn in the form of a concept map. Data were collected from students via individual concept maps, written feedback on their learning in relation to the learning circle and follow-up telephone interviews. Common themes were developed from the multiple data sources. We found that the students [n = 37] valued the learning circle activity generally, commenting on the value of hearing others’ perspectives and experiences and securing peer feedback on their own ideas. The learning circle was feasible in terms of student availability and interest, but the challenge of securing space in the hospital for the 1-hour sessions was significant and threatens sustainability. A concept mapping exercise, used as a data collection instrument, emerged as an important feature of the activity, with students commenting on how drawing the map helped them to deconstruct the clinical situation and map their thoughts on paper. The student-led learning circle activity provided students with an opportunity to develop intersubjective skills, with the socio-political pattern of knowing produced following these discussions. How concept maps can be used with other practical activities in undergraduate education, such as simulation, should be explored. © Springer Nature Switzerland AG 2019