The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Development of Diagnostic Tools for the Seed Potato Industry

The Australian potato industry is threatened by inadequate measures to control the virus health of seed potatoes. Potatoes are vegetatively propagated; therefore infection can result in disease spreading through generations. This has the potential to cause significant economic losses. Virus testing on tuber sprouts is currently conducted by ELISA, however a significant time delay of several weeks can occur while tubers sprout. There is a considerable need for a rapid, quantitative and cost effective virus test directly on bulked samples of dormant tubers to identify infected lots during seed multiplication. The potato viruses of economic importance in Western Australia are Potato virus S, (PVS), Potato virus X, (PVX), Potato leafroll virus, (PLRV) and Tomato spotted wilt virus (TSWV). The main aim of this project was to develop reliable PCR-based methods for multiplex real-time quantitative detection of these viruses in bulked potato tuber samples for seed certification for domestic and export markets. Knowledge of the distribution of the viruses within tuber tissue was needed to develop more effective methods of RNA extraction. The distribution of the viruses in histological sections of potato tubers was investigated using immunohistochemistry and in situ hybridization. All four viruses were found to be distributed at the stolon end of freshly harvested infected potato tubers. Extraction of RNA from tuber tissue is problematic because it contains starches and phenolics which inhibit RT-PCR. Extracting RNA from the tuber peelings would overcome this problem; however one of the viruses, PLRV, is restricted to the phloem in potato tubers. The distribution of the phloem in the superficial tissue of potato tubers was therefore investigated using histological staining and transmission electron microscopy. The vascular tissue was found to be within 2 mm below the epidermis of the tuber. With this knowledge, total RNA was extracted rapidly and efficiently from bulked potato peelings equivalent to 300 dormant tubers to detect single infections of PLRV, PVX, PVS and TSWV. For the quantitative detection of these viruses in potato leaves and tuber tissue, specific primers and fluorescent-labeled TaqMan® probes were designed. A realtime multiplex, single tube RT-PCR assay was developed. The main tasks involved primer design, optimization of reagents, standardization of RNA samples from which standard curves for analysis were generated, and identification of a baseline on which to interpret results. Limits of detection sensitivity were established using a range of virus transcript copy numbers (8 x 101 to 8 x 109 copies of PVX and PVS, 1 x 102 to 1 x 1010 copies of PLRV and 1 x 103 to 1 x 1010 copies of TSWV). The multiplexed assay was validated in blind studies. This high-throughput test is accurate and sensitive, and as a result this test is in the process of being commercialized and used by the seed potato industry of Western Australia as a cost-effective diagnostic tool to detect viruses reliably in bulked samples of dormant potato tubers

Terminology preferences in mental health

People with a mental illness may be exposed to stigma which, when internalised, negatively influences self-esteem, personal goal attainment and quality of life. Avoiding the use of stigmatising language and using terminology that does not exclude the positive characteristics of the individual may play an important role in challenging stigma. This study involved a mixed method approach to identify the terminology preferences of people with a mental illness in Australia. N = 173 participants were recruited via convenience sampling. The humanistic terms ‘individual’ and ‘person with lived experience’ were identified as the preferred terms. Qualitatively there was a wide variation in how the terms made the respondents think or feel, with only one of the terms – ‘survivor,’ having solely negative themes. When contrasting the two most commonly used clinical terms, ‘client’ was significantly preferred to ‘patient’. The term ‘consumer’ was one of the least preferred terms. This suggests that the use of this term, which is in regular use in Australia, should be reconsidered

Association between temporomandibular symptoms, anxiety and quality of life among nursing students

Background Anxiety is inherent in the everyday life of a nursing student. One of the physiological disorders associated with anxiety is temporomandibular disorder (TMD). Although the relationship between TMD and anxiety is well established, temporomandibular-related symptoms in nursing students has yet to be examined. Aim To investigate the association between anxiety and temporomandibular-related symptoms in nursing students, and the effect on quality of life. Methods 281 nursing students completed an online survey that included the Oral Health Impact Profile-TMD (OHIP-TMD) questionnaire and the Patient-Reported Outcome Measurement Information System (PROMIS) short form questionnaire. The OHIP-TMD psychometric properties were assessed using principal component analysis. Linear regression models were used to examine demographic predictors for anxiety and TMD, and a general linear model was used to assess the association between anxiety and the psychosocial and function scales. Findings The mean value for the OHIP-TMD and the PROMIS short form was respectively 1.6 (SD = 0.7) and 10.8 (SD = 4.1). Linear regression demonstrated that there was an inverse association between oral related quality of life and year of study; nursing students in higher course years reported lower levels of oral related quality of life. The general linear model analysis revealed that increased anxiety was significantly associated with high levels of oral physical function impairment and elevated psychosocial distress. Discussion With TMD reported as frequent among qualified nurses these findings are relevant and pave the way for further investigation of temporomandibular-related symptoms in nursing students. Conclusion Strategies to mitigate students’ anxiety levels should be implemented throughout the nursing course

Cochrane Corner summary of review titled: “Peer support for people with schizophrenia or other serious mental illness”

Serious mental illnesses affect how people feel, think, and behave, and frequently contribute to disability in psychosocial and occupational functioning and quality of life (American Psychiatric Association 2015; Harvey & Strassnig, 2012; Mohamed et al., 2008). Psychosocial interventions designed to support people with schizophrenia and their families have shown to improve the person’s rehabilitation, reintegration into the community, and recovery (The National Collaborating Centre for Mental Health, 2009; Pharoah et al., 2012). Peer workers are defined as individuals with lived experience of mental illness (Aguey-Zinsou et al., 2018), with peer support principles based on shared responsibility and mutual respect (Mead et al., 2001). These peer workers have been identified to contribute to the recovery of people with various mental health problems (Hurley et al., 2016). Peer support programmes are an increasingly important strategy in managing complex conditions and establishing partnerships (Bradstreet & Pratt, 2010). Clinical staff report value and numerous benefits that lived experience brings to services, as peers share their experience to support others in their recovery journey (Aguey-Zinsou et al., 2018). Peer support increases hope, empowerment, and quality of life, which are the essential components in mental health recovery (Aguey-Zinsou et al., 2018). Collaboration between mental health nurses and peer support workers has the potential to improve recovery-orientated care. Peer workers who advocate for individuals with similar health problems that they had experienced before, and facilitate related decision-making in illness management are viewed favourably in a clinical context (Cleary et al., 2018)