annual age-adjusted breast cancer death rates for women in the United States remained remarkably constant, oscillating around 32 deaths per 100,000 over 60 years.During this long timeframe, the surgical treatment of breast cancer evolved from radical mastectomy with mandatory lymph node dissection to lumpectomy coupled with radiation therapy.With this new paradigm, lymph node dissection was reserved for women with tumor-invaded axillary lymph nodes.Beginning in the 1970s, chemotherapy after surgery (adjuvant) and before surgery (neoadjuvant) was added to surgical treatment.The radical diminution in the scope of breast surgery did not alter the national breast cancer death rate.Doing less surgery was neither harmful nor beneficial to long-term survival from breast cancer.In the 1980s two events changed this static picture: the addition of tamoxifen to adjuvant and neoadjuvant chemotherapy, and the introduction of mammography.Beginning in 1990 annual breast cancer death rates in the United States began to fall, and have continued to fall each year since then.In 2001, the last year of published statistics, the breast cancer death rate was 26 deaths per 100,000.Best estimates for where to credit this dramatic drop in death rate place approximately 50% of the credit with improved adjuvant chemotherapy and 50% with mammography.Abnormal mammograms demand a breast biopsy since only one in five abnormal mammograms is actually a breast cancer.Consequently, widespread adoption of mammography has produced an image-guided breast biopsy industry in the United States.Open, surgical breast biopsy has been replaced with image-guided breast biopsy because improved breast biopsy tools have made image-guided breast biopsy equivalent in accuracy to open, surgical breast biopsy.These tools, in turn, have changed the professional lives of surgeons, pathologists, and mammographers, leading to the development of dedicated breast surgeons, breast pathologists, and interventional breast radiologists. Evaluation of digital mammography: update on the UK position
Evidence currently suggests that many people would prefer to die at home. However, optimal end-of-life homecare depends on the patient's ability to express their care preferences, prognostic awareness, complexity of care, concordance of patient/carer preferences and availability of appropriate services/support. This study explores Irish Head and Neck Cancer (HNC) patient and caregivers' views on end-of-life care (EoLC), an area hitherto little studied.Qualitative data were collected using semistructured, one-to-one interviews with HNC patients with therapeutic experience and their nearest caregivers (n=10, 7 patients, 3 carers). Interview topic guide was developed from the PRISMA EoLC survey. Thematic content analysis was employed to interpret findings.Thematic analysis identified five broad EoLC themes: prognostication, decision making, preferred focus of care/advanced care planning (ACP), preferred place of care/death, perceived barriers/supports to home death. Participants were very willing to discuss most aspects of EoLC, exhibiting no signs of distress. Patients were reluctant to discuss preferred focus-of-care and ACP. This seemed linked to an overly optimistic view of aggressive medical intervention. While carers favoured full patient involvement in decision making, patients were divided between wanting autonomy and those preferring a more passive approach. All expressed a preference for homecare, and most felt they would ideally prefer to die at home. However, decision making was considered a complex process intertwined with risks, responsibilities and commitments to others. Carer burden and symptom control were major concerns.Normalising discussions on EoLC may benefit those affected by HNC. However, in HNC, this needs to be done alongside discussions regarding potentially life-extending treatment, symptom management and support.
AbstractBackground: The teaching of the discipline of pharmacology is in constant flux. In order to meet the challenges of teaching pharmacology effectively we investigated a new teaching and learning strategy. Aim: Our aim was to investigate whether structured periodic review sessions could improve teaching and learning for students in a multidisciplinary undergraduate pharmacology module. Methods: Following each lecture students were asked to identify topics of difficulty in pharmacology using the one minute paper classroom assessment technique (CAT). Three review sessions were then introduced based on the problematic issues identified by students. They completed a pre- and post-review session MCQ examination to gauge improvements in their learning. Feedback was obtained from students at the end of the module regarding the acceptability, advantages and limitations of the CATs and the review sessions. Results: There was active participation by students in all thirteen CATs (71.15% ± 1.2%), three review sessions (78.3% ± 1.6%) and the end of module questionnaire (81%). A significant increase in student learning across all disciplines was observed in all three review sessions (**, p<0.01; ***,p<0.001 and **, p<0.01 for review sessions 1-3 respectively). The majority of students (99%) expressed the opinion that the review sessions enhanced their learning of pharmacology. A limitation expressed by some students was the necessity to complete multiple CATs to support each of the three review sessions. Conclusion: Strategically structured student directed review sessions which are carefully designed and executed are an interesting and effective educational tool for improving and complementing student learning across the disciplines in pharmacology.
Aims and objectives To identify and describe the triggers of emotional distress among long‐term caregivers (more than 1 year postdiagnosis) of people with head and neck cancer. Background Limited research has been conducted on the factors that cause head and neck cancer caregivers to become distressed. Design Qualitative cross‐sectional. Methods In‐depth semi‐structured interviews. Interviews were conducted via telephone. The study setting was the Republic of Ireland. Results Interviews were conducted with 31 long‐term caregivers (mean time since diagnosis 5·7 years, SD 2·9 years). Head and neck cancer caregivers experienced significant distress. Six key triggers of emotional distress were identified: understandings and fears of illness, lifestyle restrictions and competing demands, facial disfigurement, financial problems, comorbid health problems and witnessing suffering. Cutting across all of these individual causes of distress was a strong feeling of loss caused by head and neck cancer. Conclusions Some head and neck cancer caregivers became considerably distressed by their caring role. Although distress appears to decline with time for many caregivers, some continue to be distressed for years following the patient's diagnosis. It would be useful for future research to explicitly investigate caregivers' experiences of loss. Relevance to clinical practice Health professionals may be able to reduce distress in this group if they can help caregivers to access resources that can be used to buffer financial problems. Health professionals may also be able to reduce distress if they can work with caregivers to help them to obtain something of personal value or significance from their experience of loss and suffering.
Abstract Objective Cancer survivors are susceptible to financial hardship. In head and neck cancer (HNC) survivors, we investigated (a) predictors for cancer‐related financial hardship and (b) associations between financial hardship and health‐related quality of life (HRQoL). Methods We conducted a cross‐sectional study in HNC survivors identified from the National Cancer Registry Ireland. HRQoL was based on the Functional Assessment for Cancer Therapy General (FACT‐G) plus Head and Neck Module (FACT‐HN). Objective cancer‐related financial hardship (financial stress) was assessed as household ability to make ends meet due to cancer and subjective financial hardship (financial strain) as feelings about household financial situation due to cancer. Modified Poisson regression was used to identify predictors for financial hardship. Bootstrap linear regression was used to estimate associations between hardship and FACT domain scores. Results Pre‐diagnosis retirement (relative risk [RR] 0.50, 95% confidence interval [CI] 0.37‐0.67), pre‐diagnosis financial stress (RR 1.85, 95% CI 1.58‐2.15), and treatment were significantly associated with objective financial hardship. Predictors of subjective financial hardship were similar: aged greater than or equal to 65 years, pre‐diagnosis financial stress, and treatment. Participants with objective financial hardship reported significantly lower physical (coefficient −3.45, 95% CI −4.39 to −2.44), emotional (−2.01, 95% CI −2.83 to −1.24), functional (−2.56, 95% CI −3.77 to −1.33) and HN‐specific HRQoL (−3.55, 95% CI −5.04 to −2.23). Physical, emotional, and functional HN‐specific HRQoL were also significantly lower in participants with subjective financial hardship. Conclusion Cancer‐related financial hardship is common and associated with worse HRQoL among HNC survivors. This supports the need for services and supports to address financial concerns among HNC survivors.
ABSTRACT Spray drying of skim milk was evaluated as a means of preserving Lactobacillus paracasei NFBC 338 and Lactobacillus salivarius UCC 118, which are human-derived strains with probiotic potential. Our initial experiments revealed that NFBC 338 is considerably more heat resistant in 20% (wt/vol) skim milk than UCC 118 is; the comparable decimal reduction times were 11.1 and 1.1 min, respectively, at 59°C. An air outlet temperature of 80 to 85°C was optimal for spray drying; these conditions resulted in powders with moisture contents of 4.1 to 4.2% and viable counts of 3.2 × 10 9 CFU/g for NFBC 338 and 5.2 × 10 7 CFU/g for UCC 118. Thus, L. paracasei NFBC 338 survived better than L. salivarius UCC 118 during spray drying; similar results were obtained when we used confocal scanning laser microscopy and LIVE/DEAD Bac Light viability staining. In addition, confocal scanning laser microscopy revealed that the probiotic lactobacilli were located primarily in the powder particles. Although both spray-dried cultures appeared to be stressed, as shown by increased sensitivity to NaCl, bacteriocin production by UCC 118 was not affected by the process, nor was the activity of the bacteriocin peptide. The level of survival of NFBC 338 remained constant at ∼1 × 10 9 CFU/g during 2 months of powder storage at 4°C, while a decline in the level of survival of approximately 1 log (from 7.2 × 10 7 to 9.5 × 10 6 CFU/g) was observed for UCC 118 stored under the same conditions. However, survival of both Lactobacillus strains during powder storage was inversely related to the storage temperature. Our data demonstrate that spray drying may be a cost-effective way to produce large quantities of some probiotic cultures.
Knowledge of pharmacology is essential for dental students and for its safe application in the clinical environment.The goals of our study were to assess dental students' performances in pharmacology with and without shared instruction, to investigate correlations between students' final grades in pre-clinical and clinical pharmacology, to determine if gender affects test performance and to explore characteristics of effective dental student learning.A 9 year mixed method study was undertaken comprising (i) quantitative analysis of undergraduate performances in basic and clinical pharmacology (n = 320) and (ii) quantitative and qualitative exploration of student perceptions on teaching and learning in pharmacology.Mean basic pharmacology scores were not significantly different when dental students were co-taught with medical and pharmacy students. Regression analysis showed a statistically significant correlation (r = 0.582, P < 0.01) between basic and clinical pharmacology dental student scores. Interestingly, correlation was independent of gender with female student scores demonstrating a correlation of r = 0.480, P < 0.01 and males a correlation of 0.684, P < 0.01. Quantitative and qualitative feedback highlighted four thematic areas of effective dental student learning namely: (i) quality of instructors, (ii) lecture content, (iii) assessment type and (iv) learning environment.Teaching basic pharmacology in a multidisciplinary environment did not adversely affect dental students' examination performances. Dental students who perform well in basic pharmacology perform similarly well in clinical pharmacology. However, whether students' understanding and the application of pharmacology affects the quality of patient care in the clinical environment awaits further investigation.
Abstract All emergency and casualty bovines in the Republic of Ireland that are deemed to be fit for human consumption must be accompanied to the slaughterhouse by an official veterinary certificate (VC). Cullinane et al (2010) conducted a review of bovine cases consigned under veterinary certification to emergency (ES) and casualty (CS) slaughter in the Republic of Ireland during 2006 to 2008. The current paper further evaluates these results, with emphasis on the period of validity, transport distance and transport conditions, and considers whether the current VC adequately protects welfare. Of 1,255 veterinary certificates, the median time between certification and slaughter was 1 (minimum 0, maximum 452) day, with one-fifth in excess of three days. The median straight-line distance between farm and slaughterhouse was 22 km; 82 and 98% study animals were transported distances of no more than 40 and 100 km, respectively. In 27% of VCs, no slaughterhouse was designated; hence the transport distance was not limited. In 77% of all cases, the disability/injury was related to the locomotor system, including 35% with limb fractures. Veterinary certification of the latter as being fit for transport appears to have been in contravention of animal transport and welfare legislation. The welfare of animals would be improved if each VC included a certified period of validity. In future, veterinary certificates should state clearly a maximum period of validity between certification and slaughter, a maximum distance that the animal should be transported and a minimum level of comfort under which the animal must be transported. Historically, in the Republic of Ireland, there was no suitable non-transport alternative available to cattle producers wanting to salvage an otherwise healthy animal that had suffered an accident or injury resulting in acute pain. An alternative is now available, with the introduction of an on-farm emergency slaughter policy.
Osteoradionecrosis is a long-term, serious side effect of head and neck radiation therapy and is associated with significant morbidity and quality of life issues.
Abstract Objectives Emerging cancer‐survivorship research suggests that self‐management can lead to improved outcomes. However, research examining the impact of self‐management behaviours on quality of life (QoL) and fear of recurrence (FoR) in cancer survivors is lacking. This study investigated the relationship between self‐management behaviours and QoL and FoR following treatment for head and neck cancer (HNC). Methods Postal surveys were sent to 734 eligible HNC survivors (ICD10 C01‐C14; C32) in the Republic of Ireland who were 12‐ to 60‐months post diagnosis. QoL and FoR were measured using the Functional Assessment of Cancer Therapy (FACT‐G and Head and Neck Cancer Subscale) measure and Fear of Relapse/Recurrence Scale, respectively. Seven self‐management behaviours were measured using the Health Education Impact Questionnaire. Results Three hundred and ninety‐five HNC survivors completed surveys (50.3% response rate). After controlling for sociodemographic and clinical characteristics, self‐management behaviours accounted for 20% to 39.4% of the variance in QoL and FoR. Higher scores on positive and active engagement in life , constructive attitudes and approaches , and skill and technique acquisition were significantly associated with higher global QoL and lower FoR, whilst higher scores on positive and active engagement in life and constructive attitudes and approaches only were significantly associated with higher HNC‐specific QoL. Additionally, lower scores on self‐monitoring and insight were significantly associated with higher HNC‐specific and global QoL and lower FoR. Conclusions The findings highlight the potential utility of self‐management interventions promoting active problem solving, positive self‐talk, and skill acquisition amongst cancer survivors. However, increased self‐monitoring may relate to negative outcomes in HNC, a finding that warrants further investigation.
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