96 research outputs found

    National trends in immediate and delayed post-mastectomy reconstruction procedures in England: A seven-year population-based cohort study.

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    Little is known about post-mastectomy reconstruction procedural trends in women diagnosed with breast cancer in England. Our aim was to examine patterns of immediate and delayed reconstruction procedures over time and within regions. Women with breast cancer who underwent unilateral index immediate or delayed post-mastectomy reconstruction between 2007 and 2014 were identified using the National Hospital Episode Statistics database. Women were grouped into categories based on the type of reconstruction procedure. Adjusted rates of implant and free flap reconstructions were then calculated across regional Cancer Networks using a regression model to adjust for age, disease, comorbidities, ethnicity, and deprivation. Between 2007 and 2014, 21 862 women underwent immediate reconstruction and 8653 delayed reconstruction. Immediate implant reconstruction increased from 30% to 54%, and immediate free flap reconstruction from 17% to 21%. Adjusted immediate implant and free flap proportions ranged from 17 to 68% and 9-63%, respectively, across regions. Free flaps became more common in the delayed setting, rising from 25% to 42%. However, adjusted rates ranged from 23% to 74% across regions. Networks with high/low rates of free flaps for immediate tended to have high/low rates for delayed reconstruction. There has been a substantial increase in the use of immediate implant reconstruction in England. In comparison, there has been an increasing use of autologous free flap reconstruction for delayed procedures. Significant regional variation exists in the type of reconstruction performed, and these patterns need to be examined to determine if variation is related to service provision and/or capacity barriers

    Alternative methods of follow up in breast cancer: a systematic review of the literature

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    Regular clinical follow up after breast cancer is a common practice. Evidence from retrospective reviews casts doubt on the efficacy of this practice and the various guidelines for follow up show little concordance. Our aim was to investigate what alternative follow-up methods (including reduced frequency of visits) have been subjected to controlled trial and to establish what evidence exists from controlled trials to advise the guidelines. The study involved systematic review of the literature using MEDLINE, Embase, CancerLit, Web of Sciences and EBM reviews as data sources. Methods included reviewing all randomised controlled trials comparing different follow-up frequencies or comparing an alternative method with clinical follow up after breast cancer. All outcome measures addressed in the trials were analysed. Two trials compared frequency of traditional follow up. Five trials assessed alternative methods. All were of inadequate power or duration to establish ideal frequency of clinic visits or safety of alternative follow-up methods. Alternative follow up had no detrimental effect on satisfaction or outcome. Few trials have been conducted, all of which are underpowered to establish safety of reducing or replacing clinic visits. Alternative methods of follow up are acceptable to patients and may be associated with other benefits. Larger trials are required

    Estas son algunas de las habilidades blandas demandadas en Colombia

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    Este producto forma parte de una serie de infografías de divulgación científica que buscan reseñar algunas de las investigaciones más importantes en las que ha tenido participación la Universidad EAFIT, publicadas en las revistas especializadas más prestigiosas del mund

    Surgical trainees' attitudes to specialization in breast surgery

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    Background: Subspecialization in general surgery is being encouraged by various surgical societies. The aim of this study was to view attitudes of Royal Australasian College of Surgeons (RACS) trainees to subspecialization in surgery, in particular, breast ­surgery. Methods: A postal questionnaire survey of registered RACS basic and advanced surgical trainees was conducted in February 2002. Trainees were asked to nominate their preferred specialty and to indicate the level of support and interest for subspecialty training in breast surgery. Trainees indicating breast surgery as their preferred career choice were then asked to nominate their reasons for choosing breast surgery, preferred options for cross-specialty training and for vocation specifications such as a continuing ‘on-call’ responsibility. Results: Trainees returned 291 of 1049 (28%) completed questionnaires. One hundred and sixty-nine trainees felt that the concept of breast subspecialization in general surgery was reasonable (58%). For all respondents, the most popular specialty choices were plastic surgery (15.8%), orthopaedics (15.5%) and general surgery (15.4%). Breast surgery was chosen by 14 of 291 (4.8%) respondents as their first specialty preference and a further 25 respondents as their second specialty preference. Of 189 trainees who did not choose breast surgery as their preferred specialty, 45% stated repetitive stress, escalating litigation or demanding patients as deterrent factors. Only 36% of trainees interested in breast surgery were interested in undertaking after hours ‘on-call’ work as a consultant, although 36 of 39 (92%) were interested in other forms of general or subspecialty elective surgical operating (i.e., endocrine surgery, surgical oncology) after completion of their training. According to trainees with an interest in breast surgery, the two most important aspects requiring inclusion in the proposed provisional training program were breast reconstruction (38%) and breast screen assessment (34%). Conclusion: Breast surgery is an unpopular subspecialty for RACS trainees. Breast surgery is likely to experience increasing ­problems with recruitment unless the skill base is reviewed and revised in line with the aspirations and needs of today's trainees.James Kollias and Richard Rainsbur
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