Reducing Decisional Conflict and Enhancing Satisfaction with Information among Women Considering Breast Reconstruction following Mastectomy: Results from the BRECONDA Randomized Controlled Trial

Background: Deciding whether or not to have breast reconstruction following breast cancer diagnosis is a complex decision process. This randomized controlled trial assessed the impact of an online decision aid [Breast RECONstruction Decision Aid (BRECONDA)] on breast reconstruction decision-making. Methods: Women (n = 222) diagnosed with breast cancer or ductal carcinoma in situ, and eligible for reconstruction following mastectomy, completed an online baseline questionnaire. They were then assigned randomly to receive either standard online information about breast reconstruction (control) or standard information plus access to BRECONDA (intervention). Participants then completed questionnaires at 1 and 6 months after randomization. The primary outcome was participants' decisional conflict 1 month after exposure to the intervention. Secondary outcomes included decisional conflict at 6 months, satisfaction with information at 1 and 6 months, and 6-month decisional regret. Results: Linear mixed-model analyses revealed that 1-month decisional conflict was significantly lower in the intervention group (27.18) compared with the control group (35.5). This difference was also sustained at the 6-month follow-up. Intervention participants reported greater satisfaction with information at 1- and 6-month follow-up, and there was a nonsignificant trend for lower decisional regret in the intervention group at 6-month follow-up. Intervention participants' ratings for BRECONDA demonstrated high user acceptability and overall satisfaction. Conclusions: Women who accessed BRECONDA benefited by experiencing significantly less decisional conflict and being more satisfied with information regarding the reconstruction decisional process than women receiving standard care alone. These findings support the efficacy of BRECONDA in helping women to arrive at their breast reconstruction decision

Patient participation: A qualitative study of immigrant women and their experiences

Patient participation in healthcare is a neglected area of interest in the rather extensive amount of research on immigrant so-called Selma patients in Swedish health care as well as worldwide. The aim is to explore the phenomenon “patient participation” in the context of the Swedish health care from the perspective of immigrants non-fluent in Swedish. A phenomenological lifeworld approach was chosen. Data were collected from patients within a municipal home care setting in Sweden. Eight women agreed to participate. In seven interviews, an interpreter was necessary for the translation of the interview. Five authorized interpreters were used. Data were analysed in accordance to a descriptive phenomenological method for caring research. The analysis led to an essence of the phenomenon with three constituents, “to experience participation,” “to refrain from participation,” and “to be deprived of participation.” Patient participation from the perspective of immigrant women means that patients are involved and active in their own health and caring processes. For these women, it is particularly important to have the opportunity to express themselves. Patient participation presupposes professional caregivers who act in a way that increases the patients' opportunities to take part. A skilled interpreter is often necessary in order to enable the patient participation

To be an immigrant and a patient in Sweden: A study with an individualised perspective

The aim is to describe how experiences of being an immigrant can influence the situation when becoming a patient in Swedish health care. A hermeneutic approach was used. Sixteen persons born in non-Nordic countries were interviewed. The data was analysed with an empirical hermeneutical method. The findings indicate that positive experiences (i.e., establishing oneself in a new home country) enhance the possibilities of taking part in caring situations and vice versa. Hence, there is a need for individually adapted care that takes one's whole life situation into consideration. Consequently, it is suggested that the concept, “cultural competence” merely serves the purpose of illuminating caregivers' need for categorisation. It does not illuminate individual needs in a caring situation

Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy

Aim: Demand for nipple-and skin-sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario. Methods: A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology. Results: The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recom-mendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR. Conclusions: The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BRPeer reviewe

Defining Quality Indicators for Breast Device Surgery: Using Registries for Global Benchmarking

Background: Breast device registries monitor devices encompassing breast implants, tissue expanders and dermal matrices, and the quality of care and patient outcomes for breast device surgery. Defining a standard set of quality indicators and risk adjustment factors will enable consistency and adjustment for case-mix in benchmarking quality of care across breast implant registries. This study aimed to develop a set of quality indicators to enable assessment and reporting of quality of care for breast device surgery which can be applied globally. Methods: A scoping literature review was undertaken, and potential quality indicators were identified. Consensus on the final list of quality indicators was obtained using a modified Delphi approach. This process involved a series of online surveys, and teleconferences over 6 months. The Delphi panel included participants from various countries and representation from surgical specialty groups including breast and general surgeons, plastic and reconstructive surgeons, cosmetic surgeons, a breast-care nurse, a consumer, a devices regulator (Therapeutic Goods Administration), and a biostatistician. A total of 12 candidate indicators were proposed: Intraoperative antibiotic wash, intraoperative antiseptic wash, preoperative antibiotics, nipple shields, surgical plane, volume of implant, funnels, immediate versus delayed reconstruction, time to revision, reoperation due to complications, patient satisfaction, and volume of activity. Results: Three of the 12 proposed indicators were endorsed by the panel: preoperative intravenous antibiotics, reoperation due to complication, and patient reported outcome measures. Conclusion: The 3 endorsed quality indicator measures will enable breast device registries to standardize benchmarking of care internationally for patients undergoing breast device surgery

Potential Hydroponic Application of an Organic N-Halamine Disinfectant

Proceedings of the 1993 Georgia Water Resources Conference, April 20-21, 1993, Athens, Georgia.As industrial development and expanding population result in increased water recycling in Georgia, effective water treatment is becoming a higher priority for many communities. Although chlorination procedures are commonly used for disinfecting potable water, the free chlorine, hydantoins, and isocyanurates employed have brief useful lifetimes in water and can react with organic impurities to produce trihalomethanes which have been linked to cancer in laboratory animals. Chlorine dioxide and ozone do not provide long-term residuals and being strong oxiding agents, could react with organic matter in water to produce byproducts of unknown health risks. Many of the organic and inorganic chloramines lack stability in solid form or in aqueous solutions. (Tsao et al., 1991) Iodination procedures, which are proven water treatments, depend on compounds which prove toxic to plants thus limiting the recycling capabilities for waste water. Ideally a disinfectant will be stable in solid and aqueous forms, nontoxic, noncorrosive, tasteless, odorless, and effective against a broad spectrum of organisms (Barnela et al., 196). These qualities are present in the organic N-halamines described below.Sponsored and Organized by: U.S. Geological Survey, Georgia Department of Natural Resources, The University of Georgia, Georgia State University, Georgia Institute of TechnologyThis book was published by the Institute of Natural Resources, The University of Georgia, Athens, Georgia 30602 with partial funding provided by the U.S. Department of Interior, Geological Survey, through the Georgia Water Research Institute as authorized by the Water Resources Research Act of 1984 (P.L. 98-242). The views and statements advanced in this publication are solely those of the authors and do not represent official views or policies of the University of Georgia or the U.S. Geological Survey or the conference sponsors

Water Quality Assessment for Lake Blackshear, Georgia

Proceedings of the 2001 Georgia Water Resources Conference, April 26 and 27, 2001, Athens, Georgia.Lake Blackshear, a man-made impoundment of the Flint River, is used extensively for recreational activities as well as for power generation. The purpose of this study was to monitor water quality in two representative areas of the Lake, Spring Creek and Warren Slough. Samples from seven locations were collected four times each month from December 1999, through December 2000. Samples were monitored for total coliforrns and fecal conforms with the most probable number method and for heterotrophic plate counts with nutrient agar. In situ determinations of temperature, dissolved oxygen, and pH were made respectively with an YSI meter and a pHTestr2. Seasonal variations, high temperatures with low dissolved oxygen during summer months and lower temperatures with higher dissolved oxygen levels in winter months, were observed. The pH remained relatively constant throughout the study period. Spatial and seasonal variations occurred in the bacterial counts but coliform counts generally met Georgia requirements for recreational and fishing waters.Sponsored and Organized by: U.S. Geological Survey, Georgia Department of Natural Resources, Natural Resources Conservation Service, The University of Georgia, Georgia State University, Georgia Institute of TechnologyThis book was published by the Institute of Ecology, The University of Georgia, Athens, Georgia 30602-2202. The views and statements advanced in this publication are solely those of the authors and do not represent official views or policies of The University of Georgia, the U.S. Geological Survey, the Georgia Water Research Institute as authorized by the Water Resources Research Act of 1990 (P.L. 101-397) or the other conference sponsors

Use of Organic N-Halamines as Water Disinfectants

Proceedings of the 1991 Georgia Water Resources Conference, March 19-20, 1991, Athens, Georgia.Purpose. For many years potable water has been disinfected primarily through chlorination. A resulting problem has been the production of toxic trihalomethanes through reactions of free chlorine with organic impurities (Vogt and Regli, 1981; Brodtmann and Russo, 1979). Other current disinfectants such as chlorine dioxide, ozone, alkaline hypochlorites, and many of the inorganic and organic halamines lack stability in solid form or in aqueous solutions (Barnela et aI., 1986). With industrial development, water recycling, increasing population, and problems caused by chlorination, finding alternative water disinfectants is of increasing importance. The purpose of this study is to determine the efficacies several organic N-halamines as alternative water disinfectants. Ideally a disinfectant will be stable in solid and aqueous forms, nontoxic, noncorrosive, odorless, tasteless, and effective against a variety of potential pathogens. Some of the organic N-halamines appear to have these qualities (Worley et al., 1985). Early Studies. Much of the work has focused on 3-chloro-4,4-dimethyl-2-oxazolidinone (compound I). This compound, originally found to be bactericidal by Kaminski et a1. (1976) and Kosugi et a1. (1976), has been found to be effective against several genera of bacteria including Staphylococcus, Pseudomonas, Escherichia, Klebsiella, Proteus, Salmonella, Serratia, Enterobacter, and Sphaerotilus (Elder et al., 1986; Williams et al., 1985; Worley et al., 1985; Worley et a., 1983a; Worley et al, 1981). It has also been found to be effective against several fungal genera including Candida and Rhodotorula, several protozoal genera including Giardia and Entamoeba, and poliovirus type I (Worley et al, 1985). Compound I has been found not to be toxic to chickens in drinking water (Mora et al., 1982). In the presence of organic demand compound I reacts much less rapidly with organic impurities than other disinfectants such as calcium hypochlorite (Worley et al., 1984a; Vogt and Regli, 1981; Brodtmann and Russo, 1979). Trihalomethane production is greatly reduced by the decreased reactivity. Compound I is stable in both acidic and neutral aqueous solutions and in solid form (Worley and Burkett, 1984; Worley et al., 1984b; Worley et al., 1983a; Worley et al., 1983b; Burkett et al., 1981).Sponsored by U.S. Geological Survey, Georgia Department of Natural Resources, the University of Georgia, Georgia State University, and Georgia Institute of Technology.This book was published by the Institute of Natural Resources, The University of Georgia, Athens, Georgia 30602 with partial funding provided by the U.S. Department of the Interior, Geological Survey, through the Georgia Water Research Institute as authorized by the Water Resources Research Act of 1984 (P.L. 98242). The views and statements advanced in this publication are solely those of the authors and do not represent official views or policies of The University of Georgia or the U.S. Geological Survey or the conference sponsors