Factors that Influence Treatment Delay for Patients with Breast Cancer.

INTRODUCTION: The diagnosis or treatment of breast cancer is sometimes delayed. A lengthy delay may have a negative psychological impact on patients. The aim of our study was to evaluate the sociodemographic, clinical and pathological factors associated with delay in the provision of surgical treatment for localised breast cancer, in a prospective cohort of patients. METHODS: This observational, prospective, multicentre study was conducted in ten hospitals belonging to the Spanish national public health system, located in four Autonomous Communities (regions). The study included 1236 patients, diagnosed through a screening programme or found to be symptomatic, between April 2013 and May 2015. The study variables analysed included each patient's personal history, care situation, tumour history and data on the surgical intervention, pathological anatomy, hospital admission and follow-up. Treatment delay was defined as more than 30 days elapsed between biopsy and surgery. RESULTS: Over half of the study population experienced surgical treatment delay. This delay was greater for patients with no formal education and among widows, persons not requiring assistance for usual activities, those experiencing anxiety or depression, those who had a high BMI or an above-average number of comorbidities, those who were symptomatic, who did not receive NMR spectroscopy, who presented a histology other than infiltrating ductal carcinoma or who had poorly differentiated carcinomas. CONCLUSIONS: Certain sociodemographic and clinical variables are associated with surgical treatment delay. This study identifies factors that influence surgical delays, highlighting the importance of preventing these factors and of raising awareness among the population at risk and among health personnel.

Psychiatric patients' attitudes towards concordance and shared decision making.

OBJECTIVES: To assess psychiatric outpatients' attitudes towards concordance and shared decision making in a psychiatric setting and to evaluate the role that self-perceived knowledge and beliefs about psychiatric medicines play in those attitudes. METHODS: The Leeds Attitude to Concordance Scale (LATCon) was tested on a sample of 435 psychiatric outpatients. Principal Component Analysis was used to assess the structure of LATCon items. Regression analysis on LATCon scores was performed with sociodemographics, Belief about Medicines Questionnaire (BMQ) subscales, self-perceived knowledge, perceived psychiatrist behaviour and current medications as predictor variables. RESULTS: The LATCon scale showed a good factorial validity, with a monofactorial structure and high internal consistency. Psychiatric outpatients tended to be in agreement with the concept of concordance, but they did not share some relevant aspects of the construct. Cognitive representations of psychiatric medications, assessed by the BMQ subscales, significantly predicted scores on the LATCon scale. CONCLUSION: Psychiatric outpatients show a considerable desire to participate in decision making about their treatment. The Spanish version of the LATCon Scale seems to be a valid instrument. PRACTICE IMPLICATIONS: Psychiatrists must consider their patients' desire to participate in treatment decisions and explore how patients' views about psychiatric medications influence their attitudes towards concordance.

Protein-embedding technique: a potential approach to standardization of immunohistochemistry for formalin-fixed, paraffin-embedded tissue sections.

A serial study was performed to develop a protein-embedding technique for standardization of immunohistochemistry (IHC) on formalin-fixed, paraffin-embedded (FFPE) tissue sections. A protein carrier matrix must have two phases, a liquid phase to allow uniform mixing of a protein and a solid phase forming a 'block' that can be fixed and processed in the same manner as human tissue. This standardized protein block would serve as a source of thin sections for control of IHC and therefore must also withstand the boiling conditions of antigen retrieval (AR). After multiple experiments, a method was developed utilizing polymer microsphere (beads) as a support medium for protein. The method showed particular promise for quantitative IHC.