breastfeeding in breast cancer survivors pattern behaviour and effect on breast cancer outcome

Abstract Little is known regarding the safety and feasibility of breastfeeding in women with a history of breast cancer. We have performed a survey among breast cancer patients who completed their pregnancy following breast cancer management to examine their lactation behaviours and its effect on breast cancer outcome. Out of 32 women identified, 20 were reachable and accepted to take the questionnaire. Ten women initiated breastfeeding, 4 stopped within one month and 6 had long-term success with a median period of 11 months (7–17 months). The latter were all previously subjected to breast conserving surgery and received qualified lactation counselling at delivery. The main reasons for not initiating breastfeeding were "uncertainty regarding maternal safety" and "a priori unfeasibility" expressed either by the obstetrician or by the oncologist. At a median follow-up of 48 months following delivery, all 20 women were alive with two relapses; one in each group (i.e., lactating and non-lactating). This analysis adds to the limited available evidence on the feasibility and safety of breastfeeding in breast cancer survivors. Proper fertility and survivorship counselling is crucial and requires more attention in breast cancer clinics

Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis

<div><p>Importance</p><p>Despite the rapidly declining number of physician-investigators, there is no consistent structure within medical education so far for involving medical students in research.</p><p>Objective</p><p>To conduct an integrated mixed-methods systematic review and meta-analysis of published studies about medical students' participation in research, and to evaluate the evidence in order to guide policy decision-making regarding this issue.</p><p>Evidence Review</p><p>We followed the PRISMA statement guidelines during the preparation of this review and meta-analysis. We searched various databases as well as the bibliographies of the included studies between March 2012 and September 2013. We identified all relevant quantitative and qualitative studies assessing the effect of medical student participation in research, without restrictions regarding study design or publication date. Prespecified outcome-specific quality criteria were used to judge the admission of each quantitative outcome into the meta-analysis. Initial screening of titles and abstracts resulted in the retrieval of 256 articles for full-text assessment. Eventually, 79 articles were included in our study, including eight qualitative studies. An integrated approach was used to combine quantitative and qualitative studies into a single synthesis. Once all included studies were identified, a data-driven thematic analysis was performed.</p><p>Findings and Conclusions</p><p>Medical student participation in research is associated with improved short- and long- term scientific productivity, more informed career choices and improved knowledge about-, interest in- and attitudes towards research. Financial worries, gender, having a higher degree (MSc or PhD) before matriculation and perceived competitiveness of the residency of choice are among the factors that affect the engagement of medical students in research and/or their scientific productivity. Intercalated BSc degrees, mandatory graduation theses and curricular research components may help in standardizing research education during medical school.</p></div

Factors related to- or affecting medical student research (i)–Effects of previous research experience, academic success and higher degree graduate-entry into medical school.

<p><b>Forest Plot symbols: *</b> The axis, not the data, is shown in log scale for aesthetic purposes. <b>Abbreviations used: D</b>, developing countries; <b>I</b>, intercalated Bachelor of Science degree (iBSc); <b>M</b>, motivation to perform research; <b>K</b>, research knowledge or skills; <b>C</b>, confidence in research competencies; <b>In</b>, interest in research. For some studies, odds ratios and 95% confidence interval values were reported, but not the raw numbers.</p

Miscellaneous topics related to medical student research.

<p><b>Forest Plot symbols: *</b> The axis, not the data, is shown in log scale for aesthetic purposes. <b>Abbreviations used: D,</b> developing countries; <b>I,</b> intercalated Bachelor of Science degree (iBSc); <b>FC</b>, studies measuring final year academic performance and controlling for baseline performance. Dates are shown beside studies that may be confused with others referenced in this review having the same similar first-author names. For some studies, odds ratios and 95% confidence interval values were reported, but not the raw numbers.</p

Factors related to- or affecting medical student research (ii)–The effect of financial factors on appeal of research to medical students.

<p>Factors related to- or affecting medical student research (ii)–The effect of financial factors on appeal of research to medical students.</p

Assessing the current situation: Interest in- and exposure- to research among medical students.

<p><b>Forest Plot symbols: *</b> The axis, not the data, is shown in logit scale for aesthetic purposes. <b>Table symbols: *</b> Mandatory exposure (in the form of curricular components or graduation theses) was excluded from this analysis. <b>Abbreviations used: D,</b> developing countries; <b>H,</b> higher commitment to a research career; <b>I,</b> intercalated Bachelor of Science degree (iBSc). Dates are shown beside studies that may be confused with others referenced in this review having the same similar first-author names.</p

The proportion of medical student research resulting in a peer-reviewed journal publication.

<p>Since the duration of research exposure will almost always affect the publication outcome, it has been shown too. <b>Forest Plot symbols: *</b> The axis, not the data, is shown in logit scale for aesthetic purposes. <b>Table symbols: *</b> The duration is probably prolonged (possibly months long); <b>**</b> 20–40 European medical school credits; <b>||</b> For published projects, the average duration was 18 months. <b>D</b>, developing countries; <b>I</b>, intercalated Bachelor of Science degree (iBSc); <b>HQ</b>, relatively high quality publication (indexed in Medline, Scopus or Medic), <b>HF</b>, first-author publication in a relatively high quality journal. Dates are shown beside studies that may be confused with others referenced in this review having the same similar first-author names.</p

The impact of medical student research–Impact of medical student research on career choice and long-term academic success.

<p><b>Forest Plot symbols: *</b> The axis, not the data, is shown in log scale for aesthetic purposes. <b>Table symbols: *</b> at least one first-author publication; ** at least one citation; <b>||</b> more than 20 citations. For some studies, odds ratios and 95% confidence interval values were reported, but not the raw numbers.</p

Flow diagram of the citation screening and article selection process followed in this systematic review.

<p>Flow diagram of the citation screening and article selection process followed in this systematic review.</p

Studies with a qualita3tive component.

<p>Abbreviations: <b>X</b>, cross-sectional; <b>Ret</b>, retrospective; <b>Q</b>, questionnaire; <b>IN</b>, interview; <b>GTM</b>, grounded theory methodology; <b>SG</b>, student groups; <b>FG</b>, focus groups; <b>PA</b>, project analysis; <b>CS</b>, case study.</p><p>Studies with a qualita3tive component.</p