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1.
J Appl Gerontol ; 41(1): 62-72, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32996374

RESUMO

Antipsychotic medication use for nursing home residents with dementia poses major patient safety challenges. This article investigates health professionals' experiences with decision-making during changes under the National Partnership to Improve Dementia Care in Nursing Homes (National Partnership) and its companion state coalitions. These programs were introduced in 2012 to encourage reductions in antipsychotic use and increased use of nonpharmacological treatments for dementia. Interviews with 40 nursing home physicians and staff in seven states found that reducing antipsychotics is more time and resource-intensive than relying on medication, because it requires a person-centered approach. However, respondents supported reductions in antipsychotic use, and indicated that with sufficient staffing, effective communications, and training, they could create or implement individualized treatments. Their positive attitudes suggest that the National Partnership has been a catalyst in reducing antipsychotic medications, and their perspectives can inform further research, policy and practice in nursing homes toward achieving quality dementia care.

2.
J Subst Abuse Treat ; 132: 108424, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34144299

RESUMO

INTRODUCTION: Access to medication for opioid use disorder (MOUD) is a recognized public health challenge to improving the health of people with opioid use disorder (OUD) in many communities. Prior studies have shown that although MOUD availability has increased over time, particularly in some states, many substance use treatment facilities still do not offer medications. The relationship between greater availability of MOUD and use of MOUD among patients in treatment programs is not well understood. METHODS: We used the National Survey of Substance Abuse Treatment Services to calculate the percent of specialty facilities per state providing MOUD from 2007 to 2018 and the Treatment Episode Data Set-Admissions (TEDS-A) to estimate the likelihood that a patient would have MOUD as part of their treatment plan during the same time period. We estimated models with patient-level TEDS-A data as the outcome and state-aggregated one-year lagged availability of MOUD in facilities as the main predictor, stratifying by treatment facility type (intensive outpatient, non-intensive outpatient, and residential). RESULTS: We found that increasing MOUD availability at the facility level was associated with increased MOUD use in non-intensive and residential facilities at the patient level. Specifically, a 10 percentage point increase in MOUD availability was associated with a 4.5 percentage point increase in MOUD use among patients of non-intensive outpatient facilities (p-value = 0.03), and a 2.5 percentage points increase in residential facilities (p-value = 0.02). Non-Whites and patients in the Northeast had greater likelihoods of increased MOUD use in response to increased availability by facilities. CONCLUSION: Increasing MOUD availability among specialty treatment facilities is likely to promote better access to MOUD for patients seeking treatment for OUD.

4.
ANZ J Surg ; 91(11): 2447-2452, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34427029

RESUMO

BACKGROUND: Neoadjuvant therapy may increase the likelihood of complete (R0) resection for borderline resectable pancreatic cancer. The optimal approach is unknown and differs amongst treatment centres. METHODS: We identified patients with biopsy-proven borderline resectable pancreatic adenocarcinoma who commenced neoadjuvant therapy between January 2012 and June 2019 at three centres in Sydney, Australia. Patterns of care and outcomes of varying approaches were examined. RESULTS: Forty-eight patients were identified. Median age was 66 years (range: 41-84). Staging included endoscopic ultrasound in 98%, PET-CT scan in 77%, laparoscopy in 46%. Neoadjuvant regimens used were a combination of chemotherapy and chemo-radiation (58%), chemotherapy alone (13%) and chemoradiation alone (29%). Radiologic complete or partial response occurred in 33% and progression in 25%. Complete macroscopic surgical resection was achieved in 50%, and R0 resection in 38%. At median follow-up of 15 months, the 1-year and 2-year overall survival was 75% and 63% respectively, and the 1-year and 2-year progression-free survival was 50% and 29% respectively. Significant predictors of macroscopic resectability were radiologic response (p = 0.005) but not addition of radiotherapy to chemotherapy (OR 0.87, p = 0.81). Predictors of overall survival included baseline Ca19.9 level (p = 0.04) and a trend to the use of systemic chemotherapy (HR 0.51, p = 0.07), but not use of radiotherapy (HR 0.70, p = 0.47). CONCLUSION: There is high variability in staging and neoadjuvant approaches for borderline resectable pancreas cancer. Despite aggressive neoadjuvant therapies, R0 resection and prolonged survival are uncommon. The incremental benefit of neoadjuvant radiotherapy after neoadjuvant chemotherapy was not demonstrated in this observational study.


Assuntos
Adenocarcinoma , Neoplasias Pancreáticas , Adenocarcinoma/tratamento farmacológico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Antígeno CA-19-9 , Humanos , Terapia Neoadjuvante , Neoplasias Pancreáticas/terapia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
5.
BMJ Open ; 11(7): e045075, 2021 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253662

RESUMO

INTRODUCTION: Women who inherit a pathogenic mutation in Breast Cancer Susceptibility Genes 1 or 2 (BRCA1 or BRCA2) are at substantially higher risk of developing breast and ovarian cancer than the average woman. Several cancer risk management strategies exist to address this increased risk. Decisions about which risk management strategies to choose are complex, personal and multifactorial for these women. This scoping review will map evidence relevant to cancer risk management decision making in BRCA mutation carriers without a personal history of cancer. The objective is to identify and describe the features of patient decision aids that have been developed for BRCA mutation carriers. This information may be beneficial for designing new decision aids or adapting existing decision aids to support decision making in this population. METHODS AND ANALYSIS: This scoping review will be conducted according to the Joanna Briggs Institute's scoping review methodological framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist will be used for guidance. Studies on decision aids for women with a BRCA mutation who are unaffected by breast or ovarian cancer will be considered for inclusion. Five electronic databases will be searched (MEDLINE, EMBASE, Cochrane Library, CINAHL, Web of Science) with no restrictions applied for language or publication date. Studies for inclusion will be selected independently by two review authors. Data will be extracted using a predefined data extraction form. Findings will be presented in tabular form. A narrative description of the evidence will complement the tabulated results. ETHICS AND DISSEMINATION: Ethical approval for conducting this scoping review is not required as this study will involve secondary analysis of existing literature. Findings will be published in a peer-reviewed journal and presented at relevant conferences.


Assuntos
Genes BRCA2 , Neoplasias Ovarianas , Técnicas de Apoio para a Decisão , Feminino , Genes BRCA1 , Humanos , Mutação , Neoplasias Ovarianas/genética , Projetos de Pesquisa , Literatura de Revisão como Assunto , Revisões Sistemáticas como Assunto
6.
Cancer Med ; 10(8): 2645-2659, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33713582

RESUMO

BACKGROUND: This observational, retrospective effort across Europe, US, Australia, and Asia aimed to assess the activity of systemic therapies in EHE, an ultra-rare sarcoma, marked by WWTR1-CAMTA1 or YAP1-TFE3 fusions. METHODS: Twenty sarcoma reference centres contributed data. Patients with advanced EHE diagnosed from 2000 onwards and treated with systemic therapies, were selected. Local pathologic review and molecular confirmation were required. Radiological response was retrospectively assessed by local investigators according to RECIST. Progression free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier method. RESULTS: Overall, 73 patients were included; 21 had more than one treatment. Thirty-three patients received anthracyclines regimens, achieving 1 (3%) partial response (PR), 25 (76%) stable disease (SD), 7 (21%) progressive disease (PD). The median (m-) PFS and m-OS were 5.5 and 14.3 months respectively. Eleven patients received paclitaxel, achieving 1 (9%) PR, 6 (55%) SD, 4 (36%) PD. The m-PFS and m-OS were 2.9 and 18.6 months, respectively. Twelve patients received pazopanib, achieving 3 (25%) SD, 9 (75%) PD. The m-PFS and m-OS were.2.9 and 8.5 months, respectively. Fifteen patients received INF-α 2b, achieving 1 (7%) PR, 11 (73%) SD, 3 (20%) PD. The m-PFS and m-OS were 8.9 months and 64.3, respectively. Among 27 patients treated with other regimens, 1 PR (ifosfamide) and 9 SD (5 gemcitabine +docetaxel, 2 oral cyclophosphamide, 2 others) were reported. CONCLUSION: Systemic therapies available for advanced sarcomas have limited activity in EHE. The identification of new active compounds, especially for rapidly progressive cases, is acutely needed.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Hemangioendotelioma Epitelioide/tratamento farmacológico , Sarcoma/tratamento farmacológico , Adulto , Feminino , Seguimentos , Hemangioendotelioma Epitelioide/patologia , Humanos , Agências Internacionais , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sarcoma/patologia , Taxa de Sobrevida
7.
Elife ; 102021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33527895

RESUMO

Understanding how injury to the central nervous system induces de novo neurogenesis in animals would help promote regeneration in humans. Regenerative neurogenesis could originate from glia and glial neuron-glia antigen-2 (NG2) may sense injury-induced neuronal signals, but these are unknown. Here, we used Drosophila to search for genes functionally related to the NG2 homologue kon-tiki (kon), and identified Islet Antigen-2 (Ia-2), required in neurons for insulin secretion. Both loss and over-expression of ia-2 induced neural stem cell gene expression, injury increased ia-2 expression and induced ectopic neural stem cells. Using genetic analysis and lineage tracing, we demonstrate that Ia-2 and Kon regulate Drosophila insulin-like peptide 6 (Dilp-6) to induce glial proliferation and neural stem cells from glia. Ectopic neural stem cells can divide, and limited de novo neurogenesis could be traced back to glial cells. Altogether, Ia-2 and Dilp-6 drive a neuron-glia relay that restores glia and reprogrammes glia into neural stem cells for regeneration.

8.
Breast Cancer ; 28(1): 168-174, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32780320

RESUMO

BACKGROUND: Breast fibromatosis is a rare clinical entity, but poses significant diagnostic and therapeutic challenges. In light of recent changes in management practices, the aim was to review our institutional experience of breast fibromatosis and provide a review of current available literature on such management. METHODS: A search of pathological databases within two tertiary institutions for all patients diagnosed with fibromatosis of the breast over a 10-year period (2007-2016) was performed. Clinicopathological characteristics and modes of treatment were recorded for each patient. Concurrently a comprehensive literature search was performed and studies relating to breast fibromatosis and its management were identified and reviewed. RESULTS: Sixteen patients were identified. Median age at diagnosis was 42 (range 21-70) and all patients were diagnosed with core biopsy. The most useful imaging modality in diagnosis was ultrasonography and magnetic resonance imaging. 13/16 were treated surgically whilst 3/16 were treated using a watch-and-wait approach. 6/13 (46%) required re-excision of margins and 2/13 (15%) had recurrence after surgery. On review of the literature, there is no dedicated guideline in place for the management of breast fibromatosis. Currently a 'watch and wait' approach is favoured over surgical intervention due to high levels of recurrence and associated surgical morbidity. All cases should be discussed at a sarcoma multidisciplinary team meeting and tyrosine kinase inhibitors should be considered in advanced cases. CONCLUSIONS: Breast fibromatosis is rare but affects young patients. Active surveillance is now favoured over surgical resection due to high recurrence rates and extensive morbidity. Dedicated guidelines are required to ensure best outcomes.


Assuntos
Neoplasias da Mama/terapia , Fibroma/terapia , Mastectomia/estatística & dados numéricos , Recidiva Local de Neoplasia/epidemiologia , Conduta Expectante/estatística & dados numéricos , Adulto , Idoso , Biópsia com Agulha de Grande Calibre , Mama/diagnóstico por imagem , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Feminino , Fibroma/diagnóstico , Fibroma/epidemiologia , Fibroma/patologia , Humanos , Imageamento por Ressonância Magnética , Mastectomia/efeitos adversos , Mastectomia/normas , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Reoperação/estatística & dados numéricos , Ultrassonografia Mamária , Conduta Expectante/normas , Adulto Jovem
9.
Cancer Rep (Hoboken) ; 3(5): e1250, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33085845

RESUMO

BACKGROUND: Nivolumab has been associated with immune-related adverse events, including nephritis, with acute interstitial nephritis being the most commonly reported renal manifestation. CASE: We describe the first case to our knowledge of minimal change disease with nephrotic syndrome associated with the PD-1 checkpoint inhibitor, Nivolumab. Minimal change disease has been reported with other immune checkpoint inhibitors; however, this is the first reported case with Nivolumab. We report development of nephrotic syndrome with acute kidney injury in a 57-year-old man, 1 month after commencement of Nivolumab for metastatic squamous cell carcinoma of the tongue. Minimal change disease was confirmed by renal biopsy. Management with corticosteroids and cessation of Nivolumab failed to improve kidney function or nephrosis. CONCLUSION: This case adds to current literature identifying minimal change as an additional complication of immune checkpoint inhibitor-associated acute kidney injury. Given the increasing use of immune checkpoint inhibitors for a range of malignancies, nephrologists, oncologist and generalists should be aware of the spectrum of kidney pathologies associated with their use.


Assuntos
Autoimunidade/efeitos dos fármacos , Nefrose Lipoide/diagnóstico , Nivolumabe/efeitos adversos , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Neoplasias da Língua/terapia , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/métodos , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Nefrose Lipoide/induzido quimicamente , Nefrose Lipoide/imunologia , Cuidados Paliativos/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/imunologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/secundário , Neoplasias da Língua/imunologia , Neoplasias da Língua/patologia
10.
J Surg Oncol ; 122(5): 861-868, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32613608

RESUMO

INTRODUCTION: Breast cancer patients respond differently to neoadjuvant chemotherapy(NAC) based on receptor subtype. The aim of this study was to assess the impact of progesterone receptor (PgR) status on response to neoadjuvant chemotherapy (NAC) in estrogen receptor (ER)+, human epidermal growth factor receptor (HER)- breast cancer patients. METHODS: ER+ and HER- patients receiving NAC over a 7-year period (2011-2017) were identified. The primary outcome was breast complete pathological response (pCR) rate. Secondary outcomes included axillary pCR, axillary/breast pCR and complete radiological response (cRR). RESULTS: A total of 203 patients were identified (149 in the ER+, PgR+, and HER- group and 54 in the ER+, PgR-, and HER- group). Compared with the PgR+ group, PgR- patients were significantly associated with breast pCR (31.5% vs 7.4%; χ² test; P < .01). In multivariable analysis, PgR- status (odds ratio [OR], 4.58; 95% confidence interval [CI]: 1.58,13.28; P = .005), radiological size >50 mm (OR, 5.38; 95% CI: 1.07,27.04; P = .04) and grade (OR, 3.52;95% CI: 1.21,10.23;P = .02) were significant predictors of breast pCR. Only PgR- status was a significant predictor of cRR (OR, 6.234; 95% CI: 2.531, 15.355; P < .001). In node positive patients, PgR negativity was associated with a trend towards breast/axillary nodal pCR (22% vs 12.7%; χ² test; P = .055). CONCLUSION: Over 30% of ER+, PgR-, and HER- patients will have a breast pCR after NAC. PgR- is the only significant predictor of breast pCR/cRR in this tumor subtype. ER+, PgR-, and HER- patients should be considered for NAC.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/metabolismo , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Metástase Linfática , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Receptor ErbB-2/metabolismo , Estudos Retrospectivos
12.
Breast Cancer Res Treat ; 181(3): 571-580, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32378053

RESUMO

PURPOSE: The association between pathological complete response (pCR) in patients receiving neoadjuvant chemotherapy (NAC) for breast cancer and Circulating Tumour Cells (CTCs) is not clear. The aim of this study was to assess whether CTC enumeration could be used to predict pathological response to NAC in breast cancer as measured by the Miller-Payne grading system. METHODS: Twenty-six patients were recruited, and blood samples were taken pre- and post-NAC. CTCs were isolated using the ScreenCell device and stained using a modified Giemsa stain. CTCs were enumerated by 2 pathologists and classified as single CTCs, doublets, clusters/microemboli and correlated with the pathological response as measured by the Miller-Payne grading system. χ2 or ANOVA was performed in SPSS 24.0 statistics software for associations. RESULTS: 89% of patients had invasive ductal carcinoma (IDC) and 11% invasive lobular carcinoma (ILC). At baseline 85% of patients had CTCs present, median 7 (0-161) CTCs per 3 ml of whole blood. Post-chemotherapy, 58% had an increase in CTCs. This did not correlate with the Miller-Payne grade of response. No significant association was identified between the number of CTCs and clinical characteristics; however, we did observe a correlation between pre-treatment CTC counts and body mass index, p < 0.05. CONCLUSIONS: Patients with a complete response to NAC still had CTCs present, suggesting enumeration is not sufficient to aid surgery stratification. Additional characterisation and larger studies are needed to further characterise CTCs isolated pre- and post-chemotherapy. Long-term follow-up of these patients will determine the significance of CTCs in NAC breast cancer patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Lobular/patologia , Terapia Neoadjuvante/mortalidade , Células Neoplásicas Circulantes/patologia , Adulto , Idoso , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/metabolismo , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/metabolismo , Carcinoma Lobular/tratamento farmacológico , Carcinoma Lobular/metabolismo , Estudos de Coortes , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Células Neoplásicas Circulantes/efeitos dos fármacos , Receptor ErbB-2/metabolismo , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Taxa de Sobrevida
13.
Psychooncology ; 29(10): 1638-1645, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33463858

RESUMO

OBJECTIVE: Leventhal's common sense model of self-regulation highlights how specific beliefs about illness influence psychological outcomes. Little is known on how such beliefs relate to BRCA1/2 adjustment. Furthermore, beliefs about one's self-concept may be relevant to genetic conditions and may relate to psychological wellbeing. METHODS: One-hundred and eighteen female BRCA1/2 carriers from an Irish University Hospital completed questionnaires for this cross-sectional study. Outcomes measured were state anxiety and physical and mental health-related quality of life (HRQOL). Explanatory variables included sociodemographics, health anxiety, illness perceptions, coping and self-concept. Hierarchical multiple regression analyses were conducted. RESULTS: Then, 44% of participants had clinically significant state anxiety and 12% had clinically significant health anxiety. Vulnerability, stigma, mastery and health anxiety explained 42% of the variance in state anxiety. Previous mental health difficulty, vulnerability, stigma, mastery and health anxiety explained 40% of the variance in mental HRQOL. Dysfunctional coping strategies were strongly related to the physical functioning aspect of quality of life. CONCLUSION: BRCA-specific beliefs related to self and health anxiety are important factors to consider in the adjustment to BRCA1/2 confirmation.


Assuntos
Ansiedade/etiologia , Proteína BRCA1 , Neoplasias da Mama/psicologia , Predisposição Genética para Doença/psicologia , Qualidade de Vida/psicologia , Autoimagem , Adaptação Psicológica , Adulto , Idoso , Ansiedade/psicologia , Neoplasias da Mama/genética , Estudos Transversais , Feminino , Testes Genéticos , Humanos , Saúde Mental , Pessoa de Meia-Idade , Inquéritos e Questionários
15.
Breast ; 32: 126-129, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28178606

RESUMO

INTRODUCTION: This study evaluated the readability, accessibility and quality of information pertaining to breast reconstruction post mastectomy on the Internet in the English language. METHODS: Using the Google© search engine the keywords "Breast reconstruction post mastectomy" were searched for. We analyzed the top 75 sites. The Flesch Reading Ease Score and Gunning Fog Index were calculated to assess readability. Web site quality was assessed objectively using the University of Michigan Consumer Health Web site Evaluation Checklist. Accessibility was determined using an automated accessibility tool. In addition, the country of origin, type of organisation producing the site and presence of Health on the Net (HoN) Certification status was recorded. RESULTS: The Web sites were difficult to read and comprehend. The mean Flesch Reading Ease scores were 55.5. The mean Gunning Fog Index scores was 8.6. The mean Michigan score was 34.8 indicating weak quality of websites. Websites with HoN certification ranked higher in the search results (p = 0.007). Website quality was influenced by organisation type (p < 0.0001) with academic/healthcare, not for profit and government sites having higher Michigan scores. 20% of sites met the minimum accessibility criteria. CONCLUSIONS: Internet information on breast reconstruction post mastectomy and procedures is poorly written and we suggest that Webpages providing information must be made more readable and accessible. We suggest that health professionals should recommend Web sites that are easy to read and contain high-quality surgical information. Medical information on the Internet should be readable, accessible, reliable and of a consistent quality.


Assuntos
Informação de Saúde ao Consumidor/normas , Internet/normas , Mamoplastia , Mastectomia , Ferramenta de Busca/normas , Adulto , Neoplasias da Mama , Compreensão , Feminino , Letramento em Saúde , Humanos , Pessoa de Meia-Idade
16.
J Plast Reconstr Aesthet Surg ; 69(9): 1248-53, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27406254

RESUMO

BACKGROUND: Patient reported outcomes are increasingly being taken into account in planning health service provision. Few studies have examined how the process of care influences patients' perception of outcome. The aim of the current study was to quantify patient satisfaction with breast reconstruction and to examine the demographic, disease and process-of-care variables that contributed to satisfaction with breasts and overall outcome. METHODS: A cross-sectional study was designed and the BREAST-Q outcomes assessment instrument was used to evaluate patient-reported psychosocial, physical and sexual well-being, as well as satisfaction with breasts, overall outcome and process of care. To identify factors predictive of satisfaction with breasts and overall outcome, the relation between covariates and each of these scales was assessed using linear regression models. RESULTS: Sixty one patients, with a mean age of 50 years, completed the survey. Mean satisfaction with breasts was 59.6% and satisfaction with overall outcome was 73.2%. Satisfaction across health-related quality of life scales ranged from 44.6% for sexual well-being to 74.6% for physical well-being. The mean rating for psychosocial well-being was 67.9%. Satisfaction ratings for surgeon, medical staff and office staff were all over 90%. Satisfaction with plastic surgeon was predictive of satisfaction with outcome and satisfaction with breasts (P = 0.001 and 0.021 respectively). DISCUSSION: The surgeon-patient relationship significantly influences patient reported outcomes in breast reconstruction. Further service development must recognize the need for additional time and personnel to deliver high standard, patient-centered care.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/psicologia , Avaliação de Resultados em Cuidados de Saúde , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Relações Médico-Paciente , Qualidade de Vida , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários
17.
Work ; 50(3): 465-72, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25672961

RESUMO

BACKGROUND: Mothering is a major occupational role for many women however the research to date tends to focus on the transition to parenthood and mothering young children. Missing from the literature is an exploration of mothering beyond the early years of a child's life. OBJECTIVE: This qualitative research study uses grounded theory methods to explore the experience of mothering typically developing emerging adult children. METHODS: In-depth semi structured interviews and a focus group were conducted with 14 women between the ages of 47-63 years old with at least one child who was between the ages of 18-29 years old (an emerging adult). All of the participants were living in the Midwestern United States. The goal of this study is to explore how mothering experience changes and evolves over time. RESULTS: Findings presented here focus on the work of mothering emerging adult children and the themes include providing a listening ear, emotional and financial support, and worrying. CONCLUSIONS: The findings illuminate a beginning understanding of the work involved with mothering children at this stage and add to Ruddick's theories on maternal practice.


Assuntos
Relações Mãe-Filho , Mães/psicologia , Poder Familiar/psicologia , Adolescente , Adulto , Ansiedade/psicologia , Emoções , Feminino , Apoio Financeiro , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
18.
J Pharmacol Exp Ther ; 351(3): 576-84, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25253884

RESUMO

Dietary substances, including herbal products and citrus juices, can perpetrate interactions with conventional medications. Regulatory guidances for dietary substance-drug interaction assessment are lacking. This deficiency is due in part to challenges unique to dietary substances, a lack of requisite human-derived data, and limited jurisdiction. An in vitro-in vivo extrapolation (IVIVE) approach to help address some of these hurdles was evaluated using the exemplar dietary substance grapefruit juice (GFJ), the candidate marker constituent 6',7'-dihydroxybergamottin (DHB), and the purported victim drug loperamide. First, the GFJ-loperamide interaction was assessed in 16 healthy volunteers. Loperamide (16 mg) was administered with 240 ml of water or GFJ; plasma was collected from 0 to 72 hours. Relative to water, GFJ increased the geometric mean loperamide area under the plasma concentration-time curve (AUC) significantly (1.7-fold). Second, the mechanism-based inhibition kinetics for DHB were recovered using human intestinal microsomes and the index CYP3A4 reaction, loperamide N-desmethylation (KI [concentration needed to achieve one-half kinact], 5.0 ± 0.9 µM; kinact [maximum inactivation rate constant], 0.38 ± 0.02 minute(-1)). These parameters were incorporated into a mechanistic static model, which predicted a 1.6-fold increase in loperamide AUC. Third, the successful IVIVE prompted further application to 15 previously reported GFJ-drug interaction studies selected according to predefined criteria. Twelve of the interactions were predicted to within the 25% predefined criterion. Results suggest that DHB could be used to predict the CYP3A4-mediated effect of GFJ. This time- and cost-effective IVIVE approach could be applied to other dietary substance-drug interactions to help prioritize new and existing drugs for more advanced (dynamic) modeling and simulation and clinical assessment.


Assuntos
Bebidas , Citrus paradisi , Citocromo P-450 CYP3A/metabolismo , Interações Alimento-Droga/fisiologia , Loperamida/sangue , Adulto , Biomarcadores/sangue , Estudos Cross-Over , Feminino , Previsões , Humanos , Loperamida/administração & dosagem , Masculino , Microssomos/efeitos dos fármacos , Microssomos/enzimologia , Pessoa de Meia-Idade , Estudos Prospectivos , Especificidade por Substrato/efeitos dos fármacos , Especificidade por Substrato/fisiologia , Adulto Jovem
19.
Cancer Nurs ; 37(5): 355-62, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24088604

RESUMO

BACKGROUND: Adjuvant breast cancer treatment is associated with a number of adverse physical changes, including weight gain, and therefore may represent a critical period for the development of metabolic disturbance. OBJECTIVE: The aim of this study was to evaluate changes in the presentation of the metabolic syndrome (MetSyn) and insulin resistance from breast cancer surgery to postcompletion of adjuvant treatment. METHODS: Sixty-one participants who had completed metabolic screening, including fasting blood samples and anthropometric measurements, on the morning of breast cancer surgery were recruited. Measures were repeated after completion of adjuvant treatment. Change in the proportion of participants presenting with the MetSyn was evaluated using the related-samples McNemar test, and changes in measures of glucose metabolism (fasting insulin, insulin resistance [homeostatic model assessment index], and glycosylated hemoglobin [HbA1c]) were analyzed using paired t tests. The Kruskal-Wallis test was used to compare differences in changes in metabolic parameters across clinical and lifestyle characteristics. RESULTS: There was a significant (P < .001) increase in fasting insulin (mean [SE] change, 2.73 [0.57] mU/L), homeostatic model assessment index (0.58 [0.14]), and HbA1c level (4.49 [5.63] mmol/mol) from baseline to follow-up along with an increase in the proportion diagnosed with the MetSyn (P = .03). Those with the MetSyn at diagnosis experienced a greater increase in insulin resistance. Premenopausal women experienced greatest increases in HbA1c level. CONCLUSIONS: Results demonstrate the development of significant metabolic dysfunction, characterized by glucose dysmetabolism and MetSyn, after adjuvant treatment for breast cancer. IMPLICATIONS FOR PRACTICE: Interventions to improve the metabolic profile of breast cancer survivors are warranted.


Assuntos
Neoplasias da Mama/complicações , Resistência à Insulina/fisiologia , Síndrome Metabólica/etiologia , Adulto , Idoso , Neoplasias da Mama/metabolismo , Neoplasias da Mama/cirurgia , Feminino , Humanos , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Sobreviventes
20.
Breast Cancer ; 21(6): 765-8, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21990037

RESUMO

Osteopoikilosis (OPK) is a rare, congenital bone disorder characterised by multiple round or ovoid radio densities appearing throughout the axial and appendicular skeleton. It is usually an asymptomatic condition diagnosed incidentally on radiological imaging, and may mimic other bone disorders, including osseous metastases. In this case report, we present a patient with lobular breast cancer whose computed tomography findings were thought to be consistent with osseous cancer metastases. Radionuclide bone scintigraphy plays a key role in distinguishing OPK from osteoblastic bone metastases. This case demonstrates the importance of a clinical awareness of OPK to ensure that patients with potentially curable disease are properly diagnosed.


Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias da Mama/patologia , Osteopecilose/diagnóstico , Idoso , Neoplasias Ósseas/secundário , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Osteopecilose/patologia , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X
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