Development of a patient decision aid for patients with breast cancer who consider immediate breast reconstruction after mastectomy

Purpose The aim of this study was to develop a patient decision aid (pDA) that could support patients with breast cancer (BC) in making an informed decision about breast reconstruction (BR) after mastectomy. Methods The development included four stages: (i) Establishment of a multidisciplinary team; (ii) Needs assessment consisting of semi-structured interviews in patients and a survey among healthcare professionals (HCPs); (iii) Creation of content, design and technical system; and (iv) Acceptability and usability testing using a think-aloud approach in patients and interviews among HCPs and representatives of the Dutch Breast Cancer Patient Organization. Results From the needs assessment, three themes were identified: Challenging period to make a decision, Diverse motivations for a personal decision and Information needed to make a decision about BR. HCPs valued the development of a pDA, especially to prepare patients for consultation. The pDA that was developed contained three parts: first, a consultation sheet for oncological breast surgeons to introduce the choice; second, an online tool including an overview of reconstructive options, the pros and cons of each option, information on the consequences of each option for daily life, exercises to clarify personal values and patient stories; and third, a summary sheet with patients' values, preferences and questions to help inform and guide the discussion between the patient and her plastic surgeon. The pDA was perceived to be informative, helpful and easy to use by patients and HCPs. Conclusion Consistent with information needs, a pDA was developed to support patients with BC who consider immediate BR in making an informed decision together with their plastic surgeon. Patient or Public Contribution Patients participated in the needs assessment and in acceptability and usability testing.Hereditary cancer genetic

Enhanced port-wine stain lightening achieved with combined treatment of selective photothermolysis and imiquimod

BACKGROUND: Pulsed dye laser is the gold standard for treatment of port wine stain birthmarks but multiple treatments are required and complete resolution is often not achieved. Post-treatment vessel recurrence is thought to be a factor that limits efficacy of pulsed dye laser treatment of port wine stains. Imiquimod 5% cream is an immunomodulator with anti-angiogenic effects. OBJECTIVE: To determine if application of imiquimod 5% cream after pulsed dye laser improves treatment outcome. METHODS: Healthy patients with port wine stains (n = 24) were treated with pulsed dye laser and then randomized to apply post-treatment placebo or imiquimod 5% cream for 8 weeks. Chromameter measurements (CIE L*a*b* colorspace) for 57 port wine stain sites (multiple sites per subject) were taken at baseline and compared with measurements taken 8 weeks post-treatment. The change in a* and ΔE were measured to quantify treatment outcome. RESULTS: Two subjects developed minor skin irritation. Other adverse effects weren't noted. Average Δa* was 0.43 for pulsed dye laser + placebo sites (n = 25) and 1.27 for pulsed dye laser + imiquimod sites (n = 32) (p value = 0.0294) indicating a greater reduction in erythema with imiquimod. Average ΔE was 2.59 for pulsed dye laser + placebo and 4.08 for pulsed dye laser + imiquimod (p value = 0.0363), again indicating a greater color improvement with imiquimod. LIMITATIONS: Effects were evaluated after a single treatment and duration of effect is unknown. CONCLUSION: Combined selective photothermolysis and anti-angiogenic therapy may enhance port wine stain treatment efficacy

Alternative surgical exposure of the rat heart in vivo using a simple abdominal approach

Access to the heart in laboratory rats is usually performed via a median sternotomy or a lateral thoracotomy. An alternative, less traumatic approach to the in vivo rat heart with improved survival is described. The technique uses an upper median laparotomy extending alongside the xyphoid bone. The xyphoid bone is retracted in a rostral direction, and a T-shaped cut is made in the diaphragm thus opening the thoracic cavity. Using a retractor the opening in the diaphragm is spread and the heart is exposed. We performed this abdominal approach in 23 anaesthetised and mechanically ventilated (for 2 h) rats and found physiologic intra-operative haemodynamics, a good postoperative recovery and 0% mortalit