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Biomedical subjects

Jane Fox

Publications and source records attributed to Jane Fox.

9 recordsLinked to original sources
PubMed2003

Impact of core biopsy on the management of screen-detected ductal carcinoma in situ of the breast.

BACKGROUND: Screen-detected ductal carcinoma in situ (DCIS) usually presents as clinically impalpable microcalcification. Although core biopsy is well established as a diagnostic modality for invasive breast cancers, few reports address its impact on the management of screen-detected DCIS. We examined the sensitivity of core biopsy in diagnosing screen-detected DCIS, as well as its role in facilitating one-step surgery in the community, especially a breast-conserving approach. METHODS: Through the Monash BreastScreen database, we reviewed the management of 148 patients diagnosed with pure DCIS over a 4-year period. Particular attention was paid to the sensitivity and surgical margin status of 63 patients who underwent initial assessment with core biopsy, compared to patients who underwent excisional biopsy or fine needle aspiration cytology (FNAC). RESULTS: Core specimens in 63 patients yielded positive histology in 57 (90%), allowing for breast-conserving surgery in 45 and mastectomy in 12. Negative margins were obtained in 73% of those treated by breast-conserving surgery, compared to 51% negative margins among those who underwent excisional biopsy initially. Overall, 45 of 57 patients with a positive core biopsy histology (79%) underwent one-step surgery. Those assessed by FNAC had a 48% incidence of non-diagnostic/benign cytology. CONCLUSIONS: Core biopsy facilitates one-step surgery for screen-detected DCIS, and potentially reduces the number of surgical procedures. Stereotactic core biopsy for suspicious microcalcifications should replace hookwire-guided excisional biopsy and FNAC as the diagnostic modality of choice.

Biopsy, Needle↗
PubMed2002

Increased incidence of benign breast disease in female renal transplant patients receiving cyclosporin.

BACKGROUND: Unlike other cancers, breast cancer does not occur at increased frequency in renal transplant patients but fibroadenomata may be more common as a result of exposure to cyclosporin. In order to determine the incidence of benign breast disease in renal transplant patients at Monash Medical Centre, current female patients were studied. METHODS: The study was divided into two parts: (i) a retrospective review of those who presented with clinically detectable breast lumps; and (ii) mammographic screening of current female transplant patients who had been transplanted for more than 1 year. RESULTS: In the retrospective study there were 11 patients with 16 breast lumps among a total of 85 patients. All were confirmed by biopsy. The mean age at diagnosis of breast lumps was 41.5 years (range 25-70 years). The mean time to presentation was 3.5 years after transplantation. Nine out of 11 patients had benign breast disease including fibroadenoma (six patients), fibrocystic disease (two patients) and intraductal papillomatosis (one patient). Two patients had breast cancer. Five of the patients with fibroadenoma had multiple lumps and a recurrent course. All patients with fibroadenomata had received cyclosporin. In the second part, 54 patients were further screened. The mean duration of transplantation was 6.4 years (range 1.25-18.5 years). Eighty-seven per cent of the patients had received cyclosporin, and 80% had a negative (normal) study. Seven of 54 had abnormalities including cysts and calcification, of whom two patients had fibroadenomata. Four patients had 'dense mammograms', all of whom received cyclosporin as a part of their immunosuppression. No breast cancer was detected during the study. CONCLUSION: The incidence of benign breast disease in the female transplant patients studied was far greater then the general population. The increase in fibroadenomata, in particular, may relate to the use of cyclosporin.

Adult↗
PubMed2002

Technical developments and a team approach leads to an improved outcome: lessons learnt implementing laparoscopic splenectomy.

BACKGROUND: To document the technical aspects, outcome and lessons learnt during the learning curve phase of implementing laparoscopic splenectomy, by comparing the results before and after the introduction of a standardized technique. METHODS: We present a retrospective and prospective review of laparoscopic splenectomies over a 4-year period. Two chronological periods were studied, before and after the implementation of a standardized technique of a laparoscopic splenectomy involving: (i) hilar dissection with ultrasonic shears; (ii) two experienced laparoscopic surgeons; and (iii) trained dedicated equipment and staff using a checklist approach in the preparation and conduct of the operation. Two groups of patients were studied relating to the periods before and after the implementation of a standardized technique. Statistical methods used were the Wilcoxon's rank sum test and the two-sample test. RESULTS: Thirty-one laparoscopic splenectomies were attempted. The most common indication was for idiopathic thrombocytopenic purpura. When comparing the early phase (n = 15) with the standardized technique phase (n = 16), there was a significant reduction in conversion rates (40% vs 6%), operating times (218 min vs 171 min), complication rates (6 cases including 1 death vs none) and length of stay (11 days vs 4 days). The results were significant for reduction in hospital stay, conversion rates and complications rates. CONCLUSIONS: A reduction in conversion rates, operating time, morbidity and length of stay was realized during the learning curve of implementing laparoscopic splenectomy by adopting a standardized technique. This technique involved hilar dissection using the ultrasonic shears, two experienced laparoscopic surgeons performing the surgery, dedicated equipment and trained staff using the checklist approach. We recommend such a standardized technique in performing laparoscopic splenectomy.

Adult↗
PubMedDate not supplied

Consumerism 1: the different perspectives within health care.

This is the first of two articles which collectively consider the evolving concept of 'consumerism' within the NHS and the degree to which this can be seen as having informed preregistration nursing and midwifery education within England. The impact upon preregistration education is the focus of the second article within which findings from a four-stage study will be explored. This first article considers the nature of consumerism in relation to the health service. It seeks to explore the place of consumerism within the NHS reforms heralded in 2000, while acknowledging that as a concept it remains problematic. The potential distinction between the individualistic and more collectively based notion of consumerism is highlighted. Finally, the article suggests that in order to adopt fully the consumer ethos in the NHS - more latterly redefined as a user- or partnership-based service - appropriate resources and education are required.

Community Participation↗
PubMedDate not supplied

Consumerism 2: preregistration nursing and midwifery curricula.

This article, the second of two parts, presents findings from a four-stage study exploring the extent to which consumerism and its related aspects have been incorporated into the preregistration nursing and midwifery curriculum. The study was undertaken in recognition that NHS policy (as considered in the first article: Vol 12(5): 321-6) increasingly gave emphasis to the development of a health service that was more consumer and user focused. The study involved use of a Delphi panel, postal questionnaire, review of curriculum documentation, and timetables, together with a small focused group discussion. Findings indicate some aspects relevant to consumerism in health care, e.g. communication and ethical principles were included in the curriculum. Other aspects, such as advocacy, quality assurance, and lay health beliefs, were viewed logically from the perspective of the professional role. In essence, no curriculum transparently addressed consumerism in a central and focused way, although midwifery--and to some extent mental health, learning disabilities, and child branches--gave more overt attention to consumerism than adult branches.

Consumer Behavior↗
PubMedDate not supplied

Case study of alopecia universalis and web-based news groups.

This article presents findings from an 18-month case study of a web-based news group used by individuals with alopecia universalis. Content analysis of 228 episodes of web-based communication that occurred in relation to themes of discussion was undertaken, supported by the use of concept mapping (Northcott, 1996). Analysis identified a core concept relating to that of a community of shared experience together with four supportive themes. The themes were the search for understanding and meaning, carrying on, seeking balance between past, present and future, and relating to new self, others, and the world. The article discusses the increased growth in the use of the web as a vehicle for exploring health concerns and the specific ethical and methodological issues raised by research in this area.

Adaptation, Psychological↗
PubMedDate not supplied

The role of the expert patient in the management of chronic illness.

The concept of the expert patient is an increasingly important one in healthcare policy and delivery. To date, however, there has been relatively limited consideration of the nature and characteristics of the knowledge and skills underpinning the role of expert patient or the relationship to more traditional health professional expertise. This article considers the emerging concept of the expert patient in the UK, its relationship to the emergence of the expert patient elsewhere (notably in Canada), together with exploration of the supporting rationales, assumptions and possible implications associated with the initiative.

Chronic Disease↗