Pathology-supported genetic testing for the application of breast cancer pharmacodiagnostics: family counselling, lifestyle adjustments and change of medication.

BACKGROUND: Pathology-supported genetic testing (PSGT) enables transitioning of risk stratification from the study population to the individual. RESEARCH DESIGN AND METHODS: We provide an overview of the translational research performed in postmenopausal breast cancer patients at increased risk of osteoporosis due to aromatase inhibitor therapy, as the indication for referral. Both tumor histopathology and blood biochemistry levels were assessed to identify actionable disease pathways using whole exome sequencing (WES). RESULTS: The causes and consequences of inadequate vitamin D levels as a modifiable risk factor for bone loss were highlighted in 116 patients with hormone receptor-positive breast cancer. Comparison of lifestyle factors and WES data between cases with vitamin D levels at extreme upper and lower ranges identified obesity as a major discriminating factor, with the lowest levels recorded during winter. Functional polymorphisms in the vitamin D receptor gene contributed independently to therapy-related osteoporosis risk. In a patient with invasive lobular carcinoma, genetic counseling facilitated investigation of the potential modifying effect of a rare CDH1 variant co-occurring with BRCA1 c.66dup (p.Glu23ArgfsTer18). CONCLUSION: Validation of PSGT as a three-pronged pharmacodiagnostics tool for generation of adaptive reports and data reinterpretation during follow-up represents a new paradigm in personalized medicine, exposing significant limitations to overcome.

Online anatomy education during the Covid-19 pandemic: Opinions of medical, speech therapy, and BSc Anatomy students.

With the emergence of the Covid-19 pandemic in 2020, it was difficult to predict if the "cadaveric-based (golden) standard" of teaching anatomy would be possible in the unforeseeable future. This forced traditional anatomical teaching and learning practices to be transitioned to remote online platforms. This study explored the opinions of anatomy students (n = 51), on their online learning experience of anatomy during the Covid-19 pandemic. A mixed methods approach using a descriptive, exploratory study design was conducted, by use of an online survey. The survey consisted of a six-point Likert scale and was assembled into four sub-categories. Likert scale options ranged from; strongly disagree, to strongly agree, and not applicable. Results obtained seem to tally with expectations, indicating an adequate theoretical course component with room to improve practical online teaching. Most participants had a positive perception of the theoretical course content, duration, and platforms of communication. Virtual classes were simple to navigate with few technical difficulties experienced by the participants. Students also noted having access to sufficient study material, videos, and additional online material. Overall, more than half of all participants reported adapting well to the remote learning environment, however, the greatest challenge experienced highlighted a sense of deprivation from the lack of cadaver exposure and hands-on instruction. This research highlighted the effects of the pandemic on the modality of anatomy education and how it affected students. Although anatomy is multi-modal, it can be concluded that it is possible to achieve academic success by using online learning methods.

Student-Perceived Value on the Use of Clay Modelling in Undergraduate Clinical Anatomy.

Clay modelling is increasingly used as an anatomy teaching method to supplement practical dissection sessions. The use of clay modelling is an active, tactile learning tool utilized to improve student engagement and enhance students' understanding of anatomical relationships in human anatomy. Furthermore, not only does clay modelling engage more senses in the learning process, but it was also found that there are educational advantages to the group interactions that are associated with the construction process to further collaborative learning.The aim of the study was to explore the effect of building anatomical clay models on students' awareness and understanding of their own thought processes as well as to explore whether clay modelling promoted collaborative learning. This cross-sectional study entailed the use of clay modelling and reflective practice to promote metacognition in third-year BSc students (n = 10), at the University of Stellenbosch's (SU) Division of Clinical Anatomy. The third-year BSc students were asked to build anatomical clay models (in groups), complete a reflective assignment and an evaluation form as part of their assessment of the Applied Anatomy module. The reflective assignment was based on Gibb's reflective cycle. The inclusion of such an assignment would trigger students to reflect upon their learning experiences and thus promote their metacognition.Ten (10) BSc students volunteered to take part in the study. A mixed method approach was followed; the reflective assignments were qualitatively analyzed, while the evaluation forms were quantitatively (statistically) analyzed. Data obtained from the online evaluation forms indicated agreeable responses confirming that the clay modelling was a valuable learning tool. However, the participants preferred cadaveric dissection instead of clay modelling to learn anatomy. Furthermore, three themes became prominent from the thematic analysis of the reflective assignments, namely, (1) Advantages of clay modelling, (2) Challenges of clay modelling, and (3) Suggestions for future practice.The research suggests that the inclusion of hands-on clay modelling in the undergraduate clinical anatomy is a valuable learning tool. The participants perceived that it enhanced their anatomical knowledge and improved collaborative learning.

Clinicians' opinions on the clinical relevance of anatomy education at Stellenbosch University.

Anatomical science is a fundamental element of undergraduate medical education; thus, it is imperative that the course serves future medical professionals when entering clinical practice. However, anatomical education has faced challenges in recent years including decreased allocated time, increased class sizes and over-stretched staff. Technological advancements in anatomical education may provide relief to these issues. Therefore, exploring clinicians' perspective on the clinical relevance and efficacy of anatomical education, within an African context, can inform its future. This study used a qualitative research approach within an interpretive paradigm. Eight semi-structured one-on-one interviews were conducted with clinicians associated with Stellenbosch University and Tygerberg Hospital. Thematic analysis was employed to analyze the data, creating themes and codes. Trust worthiness of the data was ensured through peer debriefing and member checking. Results reveal that clinicians find clinically relevant anatomy valuable to students. However, some feel that this is not delivered effectively at present. Clinicians see potential for the incorporation of clinical technologies into anatomical pedagogy. Although clinicians are hopeful for new technological developments in anatomical education, concerns were reported about its autonomous nature. This study concludes that although clinically relevant anatomical education is beneficial to students, the time and the resources via which it is delivered should be considered. There is optimism for the future of anatomical education with the advancements of technologically based educational resources, however, new resources should be incorporated with planning and supervision.

Development of a Virtual Journal Club in Anatomy: a Responsive Pandemic Pedagogy.

The COVID-19 pandemic forced changes to online teaching worldwide. The Clinical Anatomy journal club (JC) is key in the Bachelor of Science Honours (BScHons) programme and aims to improve scientific appraisal and communication abilities in anatomical research. An online JC through synchronous contact between members was deemed fitting as it could bridge the newly enforced geographical limitations due to the national lockdown in South Africa. Although common in clinical specialties, there are no published reports of anatomy themed online JCs. This project aimed to develop, implement, and appraise a synchronous virtual JC for Clinical Anatomy during the COVID-19 South African lockdown. A qualitative exploratory study design within an interpretive/constructivist paradigm was followed and aimed to explore students' perceptions of a virtual anatomy JC during the lockdown. The study was conducted at a South African institution, within the BScHons programme, and all enrolled students were invited to participate. Upon receipt of informed consent, an anonymous questionnaire was administered via Moodle for the BScHons students. The responses were analysed by thematic analysis, codes were developed, and themes were generated. Two main themes were generated from the results: the first related to the virtual format of the JC and the second focused on the content and topics covered during the JC sessions. The Clinical Anatomy staff and students adapted rapidly to the virtual JC and formed a community of practice. The benefits of teaching and learning within JC were maintained during the virtual format. It is envisioned that the JC will continue in a hybrid format (face-to-face and virtual) in future academic years. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01325-8.

Point-of-view technology to teach surgery.

BACKGROUND: Varied and limited opportunities to assist during operations, hamper surgical procedural training. Furthermore, the trainee's view of the procedure differs from that of the operating surgeon. New solutions could emerge when instruction under direct supervision can be combined with technological advances in surgical practice. This study assesses the feasibility of using the GoPro HERO™ to record operations for educational purposes, from the perspective of the surgical and technical team. METHOD: A "point-of-view" wearable GoPro camera was used to record standard operations at Tygerberg Academic Hospital, affiliated with Stellenbosch University, in Cape Town. Semi-structured interviews evaluated the practical acceptability of the GoPro in theatre by clinical personnel. The technical team reflected on picture quality, video editing and formatting. Techsmith Camtasia Studio 9® programme was employed for post- recording editing. RESULTS: Eight operations were performed by three surgeons. No interference with operative sterility, procedural length, nor functioning in the operating room was encountered by clinical personnel. Technically, the quality and picture field were adequate. All surgeons found the camera head band tight and the camera heavy. The limited battery life during recording was problematic throughout the study. CONCLUSION: Wearable cameras allow recordings of surgical procedures from the surgeon's view, for adjunctive educational purposes. This study confirms the feasibility and utility of GoPro to record real time operations without compromising patient care. The videos have cross-discipline potential for teaching within medicine. Creation of a video library as a resource to evaluate the educational value for trainees is envisioned.

Baseline bone health status in multi-ethnic South African postmenopausal breast cancer patients at initiation of aromatase inhibitor therapy: A descriptive study.

INTRODUCTION: Osteoporosis (OP) risk factor assessment and bone mineral density (BMD) testing are frequently omitted at baseline in aromatase inhibitor (AI) studies, which may lead to misinterpretation of AI associated bone loss. The present study describes bone health of South African postmenopausal women of predominantly Mixed Ancestry, prior to AI treatment. METHODS: This descriptive baseline study, nested in a prospective AI cohort study, included postmenopausal women with endocrine sensitive breast cancer, aged 50 to 80 years. A baseline questionnaire documented demographic-, medical-, lifestyle- and fracture history. Body weight was assessed clinically, and body composition and BMD measured via dual energy absorptiometry (DXA). Data was analysed in STATA 14 using descriptive and inferential statistics. RESULTS: 101 participants were recruited, with a mean age of 61±7 years. Nearly a third (n = 32) of women at baseline fulfilled global criteria for bone protection (BMD T-score ≥-2SD (n = 18); BMD T-score -1.5SD to < -2SD with risk factors (n = 14). Lower body weight, body mass index (BMI), fat mass index and lean mass index were significantly associated with the participants with a BMD measurement in keeping with a diagnosis of OP (p <0.001). Low vitamin D was present in 93% of the cohort tested (n = 95), whilst deficient vitamin D status (<20ng/ml) was documented in 52 women (55%). CONCLUSIONS: In this study, a third of postmenopausal women considered for AI therapy fulfilled international criteria for bone protective pharmacological intervention. This emphasizes the need for clinical risk and BMD assessment in postmenopausal breast cancer patients at baseline. Body composition and bone health associations highlight bone fragility associated with lower body weight.

Surgeon-read screening mammography: an analysis of 11,948 examinations.

INTRODUCTION: Mammography was pioneered by surgeons but is now the domain of radiologists. With ever-increasing cost pressures it must be examined whether interpretation of mammography by clinicians and radiation technologists is comparable to that of breast radiologists. We present the largest series of surgeon-read screening mammography to date. METHODS: All mammography performed between 2003 and 2009 at a comprehensive breast centre was recorded prospectively. First assessment was by a radiation technologist and consensus established after second reading by a breast surgeon, who took responsibility for the reading. Data recorded were: age, hormonal replacement therapy, prior breast surgery, indications for mammography and outcomes. Outcomes were classified based using the Breast Imaging Reporting and Data System (BIRADS). Indeterminate lesions were imaged further or underwent tissue acquisition. All BIRADS 5 lesions underwent tissue acquisition. RESULTS: Of 11,948 mammograms, 538 were reported as indeterminate/compatible with malignancy; 240 biopsies were performed, and 87 cancers diagnosed. In 40-49-year-old women (4,956 mammograms), the recall rate was 4.2%, the biopsy rate was 1.6%, the malignancy rate of biopsy was 23.7% and the cancer diagnosis rate was 3.6/1,000 examinations; for 50-69-year-old women these figures were 6,546, 4.7, 2.2, 44.1% and 10.0/1,000, respectively, and in women older than 70 years, they were 446, 5.6, 3.4, 33.3% and 11.2/1,000, respectively. Of all cancers, 32.2% were non-invasive; of invasive cancers, 49.1% were 10 mm or less in diameter and 75% were node negative. CONCLUSIONS: These results are similar to those in high-quality organized screening programs. The role of breast surgeons in mammography interpretation should be expanded.