CE: Late and Long-Term Sequelae of Breast Cancer Treatment.

: More than 12% of women will be diagnosed with breast cancer at some point in their lives, and 78% of them can be expected to survive for at least 15 years. More than 2.8 million breast cancer survivors currently reside in the United States. After breast cancer treatment, as many as 90% of survivors report physical problems that can reduce functional ability, produce or exacerbate emotional problems, negatively affect body image, and diminish quality of life. Many survivors will seek care for late and long-term effects of treatment, which will not necessarily be recognized as such by health care providers and appropriately treated. In this article, the authors discuss the underlying causes of late and long-term sequelae of breast cancer treatment and describe effective assessment and management strategies. They focus specifically on the most common and potentially debilitating upper body effects of breast cancer surgery and external radiation therapy: lymphedema, axillary web syndrome, postmastectomy pain syndrome, rotator cuff syndrome, adhesive capsulitis, arthralgias, cervical radiculopathy, and brachial plexopathy.

Using the multifaceted Rasch model to improve the TAT/PSE measure of need for achievement.

We used the Rasch (1980) model to develop new pictures for the Thematic Apperception Test (C. D. Morgan & Murray, 1938; McClelland, Atkinson, Clark, & Lowell, 1953) or picture story exercise to measure need for achievement (nAch). In Experiments 1 and 2, we analyzed stories to assess the difficulty level of a total of 8 pictures using the multifaceted Rasch model with picture difficulty, story probe difficulty, and participant ability as facets with a partial credit model (FACETS; Linacre, 2005). A total of 6 pictures were retained and 4 new ones added for Experiment 3 in which 201 participants wrote 6 stories to a random set of the 10 pictures. FACETS analysis revealed improved person separation reliability. In Experiment 4, 206 participants wrote 1 story to the Studying picture either before or after filling out a battery of achievement-related questionnaires. The 2 experimental groups did not differ in the amount of nAch in their stories. The coder facet was demonstrated with 2 independent coders using the revised coding system for nAch.

Dobutamine-induced bradycardia in a dog.

An otherwise healthy 8-year-old neutered male, mixed breed dog was anesthetized for surgical removal of multiple uroliths. Pre-anesthetic medication was midazolam, glycopyrrolate, and morphine. Anesthesia was induced with propofol and maintained with isoflurane in oxygen. One hour after induction, the patient moved and propofol was administered. Subsequently, the patient developed hypotension. Dobutamine administered at this time produced a rapid and profound decrease in heart rate that was treated successfully with atropine. The bradycardia in this case may be the result of the Bezold-Jarisch reflex, an intracardiac parasympathetic nervous reflex. Discontinuation of dobutamine and/or administration of a parasympatholytic drug should be performed if bradycardia occurs during dobutamine infusion.