Reducing Decisional Conflict and Enhancing Satisfaction with Information among Women Considering Breast Reconstruction following Mastectomy: Results from the BRECONDA Randomized Controlled Trial

Background: Deciding whether or not to have breast reconstruction following breast cancer diagnosis is a complex decision process. This randomized controlled trial assessed the impact of an online decision aid [Breast RECONstruction Decision Aid (BRECONDA)] on breast reconstruction decision-making. Methods: Women (n = 222) diagnosed with breast cancer or ductal carcinoma in situ, and eligible for reconstruction following mastectomy, completed an online baseline questionnaire. They were then assigned randomly to receive either standard online information about breast reconstruction (control) or standard information plus access to BRECONDA (intervention). Participants then completed questionnaires at 1 and 6 months after randomization. The primary outcome was participants' decisional conflict 1 month after exposure to the intervention. Secondary outcomes included decisional conflict at 6 months, satisfaction with information at 1 and 6 months, and 6-month decisional regret. Results: Linear mixed-model analyses revealed that 1-month decisional conflict was significantly lower in the intervention group (27.18) compared with the control group (35.5). This difference was also sustained at the 6-month follow-up. Intervention participants reported greater satisfaction with information at 1- and 6-month follow-up, and there was a nonsignificant trend for lower decisional regret in the intervention group at 6-month follow-up. Intervention participants' ratings for BRECONDA demonstrated high user acceptability and overall satisfaction. Conclusions: Women who accessed BRECONDA benefited by experiencing significantly less decisional conflict and being more satisfied with information regarding the reconstruction decisional process than women receiving standard care alone. These findings support the efficacy of BRECONDA in helping women to arrive at their breast reconstruction decision

The academic backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors

Background: Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude). Sex and ethnic differences were also analyzed in light of the changing demographics of medical students over the past decades. Methods: Data from five cohort studies were available: the Westminster Study (began clinical studies from 1975 to 1982), the 1980, 1985, and 1990 cohort studies (entered medical school in 1981, 1986, and 1991), and the University College London Medical School (UCLMS) Cohort Study (entered clinical studies in 2005 and 2006). Different studies had different outcome measures, but most had performance on basic medical sciences and clinical examinations at medical school, performance in Membership of the Royal Colleges of Physicians (MRCP(UK)) examinations, and being on the General Medical Council Specialist Register. Results: Correlation matrices and path analyses are presented. There were robust correlations across different years at medical school, and medical school performance also predicted MRCP(UK) performance and being on the GMC Specialist Register. A-levels correlated somewhat less with undergraduate and post-graduate performance, but there was restriction of range in entrants. General Certificate of Secondary Education (GCSE)/O-level results also predicted undergraduate and post-graduate outcomes, but less so than did A-level results, but there may be incremental validity for clinical and post-graduate performance. The AH5 had some significant correlations with outcome, but they were inconsistent. Sex and ethnicity also had predictive effects on measures of educational attainment, undergraduate, and post-graduate performance. Women performed better in assessments but were less likely to be on the Specialist Register. Non-white participants generally underperformed in undergraduate and post-graduate assessments, but were equally likely to be on the Specialist Register. There was a suggestion of smaller ethnicity effects in earlier studies. Conclusions: The existence of the Academic Backbone concept is strongly supported, with attainment at secondary school predicting performance in undergraduate and post-graduate medical assessments, and the effects spanning many years. The Academic Backbone is conceptualized in terms of the development of more sophisticated underlying structures of knowledge ('cognitive capital’ and 'medical capital’). The Academic Backbone provides strong support for using measures of educational attainment, particularly A-levels, in student selection

Young Adults’ Conceptions of the Sacred in Finland Today

Peer reviewe

Defining Quality Indicators for Breast Device Surgery: Using Registries for Global Benchmarking

Background: Breast device registries monitor devices encompassing breast implants, tissue expanders and dermal matrices, and the quality of care and patient outcomes for breast device surgery. Defining a standard set of quality indicators and risk adjustment factors will enable consistency and adjustment for case-mix in benchmarking quality of care across breast implant registries. This study aimed to develop a set of quality indicators to enable assessment and reporting of quality of care for breast device surgery which can be applied globally. Methods: A scoping literature review was undertaken, and potential quality indicators were identified. Consensus on the final list of quality indicators was obtained using a modified Delphi approach. This process involved a series of online surveys, and teleconferences over 6 months. The Delphi panel included participants from various countries and representation from surgical specialty groups including breast and general surgeons, plastic and reconstructive surgeons, cosmetic surgeons, a breast-care nurse, a consumer, a devices regulator (Therapeutic Goods Administration), and a biostatistician. A total of 12 candidate indicators were proposed: Intraoperative antibiotic wash, intraoperative antiseptic wash, preoperative antibiotics, nipple shields, surgical plane, volume of implant, funnels, immediate versus delayed reconstruction, time to revision, reoperation due to complications, patient satisfaction, and volume of activity. Results: Three of the 12 proposed indicators were endorsed by the panel: preoperative intravenous antibiotics, reoperation due to complication, and patient reported outcome measures. Conclusion: The 3 endorsed quality indicator measures will enable breast device registries to standardize benchmarking of care internationally for patients undergoing breast device surgery

Water Quality Studies of Beaver Creek and Turkey Creek

Proceedings of the 2003 Georgia Water Resources Conference, held April 23-24, 2003, at the University of Georgia.Within the area served by the Middle Flint Regional Development Center at least 19 streams were placed on the 303(b)/303(d) list for 2002. A commonly violated criterion has been fecal coliform numbers. Both Beaver and Turkey Creeks were listed as impaired for fecal coliform counts. In response to the listing of the streams and to facilitate development of Total Maximum Daily Loads (TMDL), fecal coliform studies were undertaken on impaired segments of Turkey Creek and Beaver Creek, tributaries of the Flint River. Samples, collected from 3 locations in Beaver Creek and 4 locations in Turkey Creek for a four month period during the summer of 2002, were tested for fecal coliforms using the membrane filter technique. Data were collected for air temperature, water temperature, pH, dissolved oxygen, conductivity, and rainfall. For both creeks, these parameters were largely stable during the study period. Rainfall was sporadic and limited. Within Beaver Creek, 2 of the 3 sampling locations generally met State and Federal requirements for fecal coliforms. Within Turkey Creek, all 4 sampling locations generally exceeded State and Federal requirements for fecal coliforms. Possible sources of fecal coliforms include agriculture and the large, diverse wildlife population. Further testing, based on targeted sampling, will be necessary to determine the exact sources of the fecal coliforms

Axillary reverse mapping in patients with breast cancer : is it oncologically safe?

Axillary reverse mapping (ARM) is a technique used to identify the lymphatics draining the arm. The aim of this study was to examine the prevalence and predictors of ARM node metastases in breast cancer patients undergoing an axillary lymph node dissection (ALND). A total of 87 patients were enrolled in this study. Patent V Blue dye was injected in the upper arm for ARM node localization. All patients had an ALND with the identified ARM node removed and sent separately for histologic analysis. Of 67 (77%) patients in whom an ARM node was identified, 49 (73%) were negative and 18 (27%) were positive for metastases on final histopathology. Positive ARM node status was significantly associated with advanced axillary disease, and larger primary cancers. Patients requiring a completion ALND due to a positive sentinel lymph node biopsy (SLNB) with non-suspicious ARM nodes during surgery did not have ARM node metastases. There is a high risk of ARM node involvement, approximately a quarter, in patients with preoperatively known lymph node metastases from breast cancer. However, it may be safe to preserve a clinically non-suspicious ARM node in patients with a positive SLNB who require a completion ALND.6 page(s

Management of Early Breast Cancer at an Australian NSW Cancer Centre During the Early Phase of COVID-19 Pandemic

Background: This study aimed to prospectively record changes to treatment for early breast cancer patients during the first wave of the COVID-19 pandemic in Australia. The purpose was to assess the impact on breast cancer outcomes and to determine the need for any mitigative actions. Methods: The study was conducted in the breast cancer unit of a tertiary referral hospital. Consecutive patients with invasive cancer or ductal cancer in situ (DCIS) discussed in multidisciplinary team (MDT) meetings three times a week between March and June 2020 were included. Patients were newly diagnosed, post-operative or post-neoadjuvant chemotherapy. Standard treatment was defined by Westmead Breast Cancer Institute protocols and any variations related to the pandemic were recorded. Results:145 patients were included (median age 59 years). Pandemic related changes to management were noted in 13 of 145 (9·0%) patients discussed in the MDT meeting. Four patients experienced a delay to cancer treatments, four were not offered reconstructive/symmetrisation surgical procedures, three had altered radiotherapy protocols and two patients were not offered enrolment to a clinical trial. These impacts affected the groups presenting with new cancers (n=7/86, 8·1%), post-operative cases (n=4/25, 16·0%) and post-neoadjuvant chemotherapy cases presenting for surgical planning (n=2/34, 5·9%). Conclusion: Most patients (91·0%) received standard treatment during the first wave of the pandemic. Variations from institutional protocols are not expected to affect local control or survival in this patient cohort and no mitigative actions have been implemented. Quality of life may have been affected for four patients who had downgraded or delayed reconstructive procedures. Institutional strategies such as utilising telemedicine and COVID-free facilities were successfully implemented within the study period.Trial Registration: The study was registered with the Australian New Zealand Clinical Trials Registry(ACTRN12620000869976).Funding Statement: None.Declaration of Interests: RH has participated in advisory boards for AstraZeneca, Bristol Myers Squibb, Eli Lilly, Merck, Merck Sharp and Dohme, Novartis, Oncosec, Pfizer, Roche and Seagen; and has received speaker honoraria from Merck Sharp and Dohme, Novartis and Roche. EE has participated in advisory board for Merck Sharp and Dohme. There are no conflicts of interests to declare for the other authors.Ethics Approval Statement: Approval was obtained from the Sydney West Human Research EthicsCommittee (Project ID 2020/PID00900)