Management of skin-sparing mastectomy: Results of a survey of German Hospitals

Background: The aim of this study was to evaluate the current management of skin-sparing mastectomy in German hospitals and to determine its oncologic safety. For this purpose, 100 surgeons were surveyed regarding their use of skin-sparing mastectomy. Results: Almost all surveyed hospitals performed skin-sparing mastectomy. Most of them believe that the recurrence rate is equal to that of conventional mastectomy. 95% regard inflammatory cancer as a contraindication to skin-sparing surgery. Most of the hospitals thin out the skin without leaving any macroscopic glandular tissue behind, and 73% leave the nipple-areola complex (NAC) on the basis of frozen sections. Volume replacement is most commonly done with latissimus dorsi muscle flaps and pedicled TRAM flaps. In 76% of the surveyed hospitals, reconstruction after mastectomy is performed by the gynecological department. Conclusion: Skin-sparing mastectomy is considered to be the best cosmetic option for breast reconstruction in selected breast cancer patients. At present, statistical proof of its oncologic safety is lacking. The surgical techniques used for skin-sparing mastectomy have not yet been standardized. In order to achieve standardization, careful discussion-making and evaluation remain important

Pregnancy-associated breast cancer - Special features in diagnosis and treatment

For obvious psychological reasons it is difficult to associate pregnancy - a life-giving period of our existence with life-threatening malignancies. Symptoms pointing to malignancy are often ignored by both patients and physicians, and this, together with the greater difficulty of diagnostic imaging, probably results in the proven delay in the detection of breast cancers during pregnancy. The diagnosis and treatment of breast cancer are becoming more and more important, as the fulfillment of the desire to have children is increasingly postponed until a later age associated with a higher risk of carcinoma, and improved cure rates of solid tumors no longer exclude subsequent pregnancies. The following article summarizes the special features of the diagnosis and primary therapy of pregnancy-associated breast cancer with particular consideration of cytostatic therapy

PERANAN PERBANKAN SEBAGAI LEMBAGA PENYALUR KREDIT BAGI MASYARAKAT

Bank merupakan lembaga keuangan yang mempunyai peranan yang sangat strategis dalam menyerahkan dan mengembangkan unsur – unsur Trilogi Pembangunan nasional. Kegiatan utama dari perbankan adalah menyerap dana dari masyarakat dan menyalurkan kembali kepada masyarakat. Hal ini terutama karena fungsi bank sebagai perantara pihak – pihak surplus of funds (kelebihan dana) dan pihak lack of funds (memerlukan dana).Manurut pasal 3 dan 4 Undang – Undang Nomor 7 Tahun 1992 yang telah dirubah dengan Undang-Undang Nomor 10 Tahun 1998 tentang Perbankan, menyebutkan fungsi dan tujuan perbankan Indonesia, yaitu :Fungsi Utama Perbankan Indonesia adalah sebagai penghimpunan dan penyalur dana masyarakat. Perbankan Indonesia bertujuan menunjang pelaksaan pembangunan nasional dalam rangka meningkatkan pemerataan, pertumbuhan ekonomi dan stabilitas nasional ke arah peningkatan kesejahteraan rakyat banyakKata Kunci: Perbankan, lembaga keuangan, dana masyarakat, Kredit, fungsi bank ABSTRACTBanks are financial institutions that have a very strategic role in submitting and developing elements of the National Development Trilogy. The main activity of the banking sector is to absorb funds from the community and channel them back to the community. This is mainly due to the function of the bank as an intermediary for the surplus of funding and the lack of funding.According to articles 3 and 4 of Law Number 7 of 1992 which has been amended by Law Number 10 of 1998 concerning Banking, mentioning the functions and objectives of Indonesian banking, namely:The Main Function of Indonesian Banking is as a collection and distributor of public funds. Indonesian Banking aims to support the implementation of national development in order to improve equity, economic growth and national stability towards increasing the welfare of the peopl

PENYELESAIAN PERKARA PERDATA MELALUI PROSES MEDIASI

Mediasi merupakan cara penyelesaian sengketa melalui proses damai yaitu para pihak yang bersengketa menyerahkan penyelesaiannya kepada seorang mediator untuk mncapai hasil akhir yang adil, tanpa membuang biaya yang besar. Keharusan melaksanakan mediasi berlaku dalam proses perkara di pengadilan, baik dalam lingkungan peradilan umum maupun peradilan agama. Salah satu ketentuan menarik dari pasal 2 Peraturan Mahkamah Agung Nomor 1 Tahun 2016 tentang Prosedur Mediasi di Pengadilan adalah ketentuan yang tidak boleh diabaikan adalah putusan batal demi hukum, jika tidak melakukan prosedur mediasi yang didasarkan pada Peraturan Mahkamah Agung RI Nomor 1 Tahun 2016 Tentang Prosedur Mediasi di Pengadilan. Pasal 3 (2) Peraturan Mahkamah Agung RI tersebut menyatakan bahwa Hakim Pemeriksa Perkara dalam pertimbangan putusan wajib menyebutkan bahwa perkara telah diupayakan perdamaian melalui mediasi dengan menyebut mediatornya. Tulisan ini akan mengulas tentang mediasi dalam perkara perdata. Diterapkannya Peraturan Mahkamah Agung RI Nomor 1 Tahun 2016 Tentang Prosedur Mediasi di Pengadilan, diharapkan dapat menjadi pilihan utama dalam penyelesaian perkara perdata sehingga akan mengurangi penumpukan jumlah perkara perdata di pengadilan, serta akan lebih menguntungkan para pihak

Reducing preventable adverse events in obstetrics by improving interprofessional communication skills - Results of an intervention study.

BACKGROUND: Progress in medicine involves the structured analysis and communication of errors. Comparability between the individual disciplines is only possible to a limited extent and obstetrics plays a special role: the expectation of a self-determined and joyful event meets with possibly serious complications in highly complex care situations. This must be managed by an interdisciplinary team with an increasingly condensed workload. Adverse events cannot be completely controlled. However, taking controllable risk factors into account and with a focused communication a reduction of preventable adverse events is possible. In the present study, the effect of interprofessional team training on preventable adverse events in an obstetric department was investigated. METHODS: The training consisted of a 4-h interdisciplinary training session based on psychological theories. Preventable adverse events were defined in six categories according to potential patterns of causation. 2,865 case records of a refence year (2018) and 2,846 case records of the year after the intervention (2020) were retrospectively evaluated. To determine the communication training effect, the identified preventable adverse events of 2018 and 2020 were compared according to categories and analyzed for obstetrically relevant controllable and uncontrollable risk factors. Questionnaires were used to identify improvements in self-reported perceptions and behaviors. RESULTS: The results show that preventable adverse events in obstetrics were significantly reduced after the intervention compared to the reference year before the intervention (13.35% in the year 2018 vs. 8.83% in 2020, p < 0.005). Moreover, obstetrically controllable risk factors show a significant reduction in the year after the communication training. The questionnaires revealed an increase in perceived patient safety (t(28) = 4.09, p < .001), perceived communication behavior (t(30) = -2.95, p = .006), and self-efficacy to cope with difficult situations (t(28) = -2.64, p = .013). CONCLUSIONS: This study shows that the communication training was able to reduce preventable adverse events and thus increase patient safety. In the future, regular trainings should be implemented alongside medical emergency trainings in obstetrics to improve patient safety. Additionally, this leads to the strengthening of human factors and ultimately also to the prevention of second victims. Further research should follow up implementing active control groups and a randomized-controlled trail study design. TRIAL REGISTRATION: The study was approved by the Ethics Committee of University Hospital  (protocol code 114/19-FSt/Sta, date of approval 29 May 2019), study registration: NCT03855735

Prognostic relevance of disseminated tumor cells in the bone marrow and biological factors of 265 primary breast carcinomas

Introduction The prognostic significance of disseminated tumor cells in the bone marrow (DTC-BM) of breast cancer patients has been demonstrated in many studies. Yet, it is not clear which of the primary tumors' biological factors predict hematogenous dissemination. We therefore examined `tissue micro arrays' (TMAs) of 265 primary breast carcinomas from patients with known bone marrow ( BM) status for HER2, Topoisomerase IIa ( Top IIa), Ki 67, and p53. Methods BM analysis was performed by cytospin preparation and immunocytochemical staining for cytokeratin (CK). TMAs were examined by immunohistochemistry (IHC) for HER2, Top IIa, Ki 67 and p53, and fluorescence in situ hybridization ( FISH) for HER2. Results HER2 ( 2+/ 3+) was positive in 35/167 (21%) cases ( FISH 24.3%), Top IIa (> 10%) in 87/187 (46%), Ki 67 in 52/ 184 (28%) and p53 (> 5%) in 61/174 cases (34%). Of 265 patients, 68 (25.7%) showed DTC-BM with a median of 2/2 x 106 cells ( 1 to 1,500). None of the examined factors significantly predicted BM positivity. Significant correlation was seen between HER2 IHC and Top IIa ( p = 0.06), Ki 67 ( p = 0.031), and p53 ( p <.001). Top IIa correlated with Ki 67 and p53, and Ki 67 also with p53 ( p = 0.004). After a median follow-up of 60.5 months ( 7 to 255), the presence of DTC-BM showed prognostic relevance for overall survival ( p = 0.03), whereas HER2 ( IHC, p = 0.04; FISH, p = 0.03) and Ki 67 ( p = 0.04) correlated with disease free survival, and HER2 with distant disease free survival ( IHC, p = 0.06; FISH, p = 0.05). Discussion The congruence of the examined factors' expression rates indicates a causal line of suppressor, proliferation, and mitosis markers, and growth factor receptors. Hematogenous tumor cell spread seems to be an independent process. The examination of these factors on DTC-BM is the aim of ongoing research