317 research outputs found
Selective primary systemic treatment for operable breast cancer: a randomised trial
No full textSurgical excision has been the method of choice for initial treatment of operable breast
cancer, but is limited in its potential to produce cure. Postoperative systemic therapy
prolongs survival, but kinetics theory and experimental data suggest it may be more
effective if given preoperatively, with the added advantage of leaving the tumour as a
marker of treatment progress. Important questions regarding the efficacy of primary
systemic treatment (PST), its effects on known prognostic indicators, and its influence on
surgical and psychological morbidity remain to be answered. These were addressed in this
thesis.171 women aged 27 -69 with operable (T2_31\10.1 M0) breast cancers 31 -85 mm in diameter
were randomised over 68 months, 86 to conventional treatment (CONV) and 85 to PST. In
CONY, surgery was followed by tamoxifen, except for node -positive premenopausal women
who received 6 cycles of cyclophosphamide, methotrexate and 5- fluorouracil. PST was
started after tumour oestrogen receptor (ER) measurement. Patients with ERA 9 fmol /mg
were treated by goserelin if premenopausal or with tamoxifen if postmenopausal. Response
was assessed by weekly examination. Sequential mammography and ultrasound, and
serum CA 15 -3 and HMFG2 measurements were studied as alternative means of
monitoring response. Non responding patients and all patients with ER<20 fmol /mg were
treated with 6 cycles of cyclophosphamide, doxorubicin and prednisolone (CAP). Surgery
followed 12 -16 weeks of PST. The first part of the trial included 79 patients with tumours
>40 mm, all of whom underwent mastectomy. The second part allowed tumours >30 mm,
and breast conservation was an option.The first 79 patients were studied for morbidity. All toxicity was recorded. Psychological
morbidity was assessed by means of the Hospital Anxiety and Depression, and the Mental
Adjustment to Cancer questionnaires, completed before, during and after treatment.
Surgical morbidity was recorded prospectively according to a pre- defined protocol.170 evaluable patients have been followed up for a median of 37 months and have
sustained 53 events. No survival difference has emerged. Axillary lymph nodes, ER and
tumour response have emerged as independent indicators of prognosis. Systemic therapy
produced significant changes in tumour characteristics but post treatment prognostic data
was qualitatively similar to conventionally gathered information.Patients experienced increased anxiety during PST, but psychological adjustment was
similar after completion of all treatment. Despite longer treatment for PST, quality adjusted
survival was identical to that found for CONY. Surgical morbidity was similar for both
groups.Ultrasound proved a highly effective method for measuring tumour size and response to
primary systemic therapy. Tumour marker levels were generally low and did not reflect
response.The present package of primary systemic treatment is a safe and effective method for
treating operable breast cancer, does not lead to excess morbidity, and offers the
advantages of a response based approach to therapy
Atendimento de parto humanizado por enfermeiras obstetras em Porto Alegre : relato de experiência
No full textEste trabalho trata do relato de experiência de parto humanizado hospitalar, vivenciado pela autora. O relato abrangeu todos os momentos do desenvolvimento do seu trabalho de parto e parto, buscando na literatura o embasamento científico necessário para tornar sua experiência de parto com atendimento por médicos e enfermeiras obstetras, em um hospital de Porto Alegre, uma produção acadêmica. Considera-se que o parto é um momento de renascimento e nascimento, e, deve ser uma experiência respeitosa e humanizada, que deveria ser vivenciada por todas as mulheres que assim o desejarem, sendo incentivadas pelos profissionais de saúde à buscar a sua realização da maneira mais natural possível, como o parto vivenciado pela autora neste relato. O atendimento recebido pela autora na parturição foi o modelo de cuidado colaborativo, com a participação entre a autora e profissionais de saúde. O atendimento ao parto foi de responsabilidade da enfermeira e do recémnascido do pediatra. A maior parte das ações de cuidado previstas no Plano de Parto da autora foram contempladas. As enfermeiras obstetras, inseridas neste modelo de cuidado, são profissionais capazes de atender a um parto de uma mulher risco habitual garantindo que o parto e o nascimento transcorram de forma mais natural e segura.This work deals with the report of humanized hospital delivery experience, experienced by the author. The report covered all the moments of the development of her labor and delivery, searching in the literature for the scientific background needed to make her delivery experience attended by doctors and obstetrician nurses, in a hospital in Porto Alegre, an academic production. It is considered that childbirth is a time of rebirth and birth, and should be a respectful and humanized experience that should be experienced by all women who so desire, being encouraged by health professionals to seek their fulfillment in the way More natural, such as the birth experienced by the author in this story. The care received by the author in the parturition was the model of collaborative care, with the participation between the author and health professionals. Birth attendance was the responsibility of the nurse and the pediatrician's newborn. Most of the care actions foreseen in the author's Birth Plan were considered. Obstetrical nurses, inserted in this model of care, are professionals able to attend to a woman's normal birth risk, ensuring that labor and delivery take place more naturally and safely
Outcomes of intraoperative versus pre-operative ultrasound localisation of impalpable breast lesions in the Cambridge breast unit
No full textAcciones preventivas en enfermería para trabajo de parto prematuro
No full textEl trabajo de parto prematuro es quel que se presenta entre el período 20 y 37semanas de gestación (140-259 días). En las múltiples instauraciones médico-científicas, se crearon métodos para identificar procesos fisiopatológicos gestacionales, dentro las señales de riesgo para determinar un nacimiento prematuro son; el cálculo ultrasonográfico de la distancia del cuello uterino y la decisión de fibronectina fetal en mucosidad vaginal.La labor del parto prematuro es uno de los principales problemas a nivel médico-obstétrico.
Metodologia : Una busquedada de 22 articulos para cidentificar lasactividades que realiza el personal de enfermeria para prevencion del parto prematuro, iinicalmente se hacen los controles preconcepcional que se apoya en la asesoría medica anticipada del embarazo con la finalidad de identificar e intentar las patologías similares con un mal resultado reproductivo, posterior a esto se realizan controles prenatales para identificar si el embarazo tiene algun tipo de riesgo he inicar tratamientos pertinentes,evitando de esta manera que se precenten complicaciones durante el embarazo,durante el parto y posparto.
Conclusiones: comparando las acciones de enfermería en el control prenatal, es determinante para adoptar la mejor acción a implementar en contribuir al mantenimiento eficaz de la salud en la gestante, se catalogan como acciones de prevención y promoción para su la salud integral de feto y la gestante. Evaluando con base en la eficacia del cerclaje en mujeres con factores de riesgo más precedentes para determinar la mejor forma de tratamiento y manejo terapéutico eficaz por parte del equipo de enfermería para adoptar la mejor conducta saludable para su salud.Introduction: Premature labor is one that occurs between 20 and 37 weeks of gestation (140-259 days). In the multiple medical-scientific establishments, methods were created to identify gestational pathophysiological processes, within the risk signs to determine a premature birth are; the ultrasonographic calculation of the distance from the cervix and the determination of fetal fibronectin in vaginal mucus. Premature labor is one of the main problems at the medical-obstetric level.
Methodology: A search of 22 articles to identify the activities carried out by the nursing staff for the prevention of premature birth, initially the preconception controls are carried out, which is supported by the anticipated medical advice of pregnancy in order to identify and try similar pathologies with a poor reproductive outcome, after this prenatal controls are carried out to identify if the pregnancy has any type of risk and to initiate relevant treatments, thus avoiding complications during pregnancy, during childbirth and postpartum.
Conclusion: comparing the nursing actions in prenatal control, it is decisive to adopt the best action to implement in contributing to the effective maintenance of health in the pregnant woman, they are classified as prevention and promotion actions for the integral health of the fetus and the pregnant. Evaluating based on the efficacy of cerclage in women with more previous risk factors to determine the best form of treatment and effective therapeutic management by the nursing team to adopt the best healthy behavior for their health.Resumen-- Introducción -- 1. Planteamiento del problema -- 2. Justificación -- 3. Objetivos -- 3.1 Objetivo general -- 3.2 Objetivos específicos -- 4. Marco teórico -- 4.1 El control preconcepcional -- 4.2 Tipos de embarazo -- 4.2.1 Intrauterino -- 4.2.2 Molar -- 4.2.3 Ectópico -- 4.2.4 Múltiple y embarazo intraabdominal -- 4.3 Infecciones en el embarazo -- 4.4Control prenatal -- 4.4.1 Importancia -- 4.5 Trabajo de parto -- 5. Metodología -- 5.1 Búsqueda de información -- 5.1.1 Bases de datos electrónicas -- 5.1.2 Criterios de Inclusión: (seleccionar según su estudio y objetivos) -- 5.1.3 Criterios de exclusión -- 5.1.4 Aspectos éticos -- 6. Resultados -- 6.1 Acciones de enfermería en control prenatal -- 6.2 Acciones de enfermería para la prevención del parto prematuro -- 7. Discusión-- 8. Conclusiones -- 9. Recomendaciones -- [email protected]
Utilizing the Total Design Method in medicine: maximizing response rates in long, non-incentivized, personal questionnaire postal surveys
No full textFawz Kazzazi,1 Rebecca Haggie,1 Parto Forouhi,2 Nazar Kazzazi,3 Charles M Malata2,4,5 1Clinical School, University of Cambridge, Cambridge, UK; 2Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s University Hospital, Cambridge, UK; 3Jasmine Breast Centre, Doncaster Royal Infirmary, Doncaster, UK; 4Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s University Hospital, Cambridge, UK; 5Postgraduate Medical Institute, Faculty of Medical Sciences, Anglia Ruskin University School of Medicine, Cambridge, UK Introduction: Maximizing response rates in questionnaires can improve their validity and quality by reducing non-response bias. A comprehensive analysis is essential for producing reasonable conclusions in patient-reported outcome research particularly for topics of a sensitive nature. This often makes long (≥7 pages) questionnaires necessary but these have been shown to reduce response rates in mail surveys. Our work adapted the “Total Design Method,” initially produced for commercial markets, to raise response rates in a long (total: 11 pages, 116 questions), non-incentivized, very personal postal survey sent to almost 350 women.Patients and methods: A total of 346 women who had undergone mastectomy and immediate breast reconstruction from 2008–2014 (inclusive) at Addenbrooke’s University Hospital were sent our study pack (Breast-Q satisfaction questionnaire and support documents) using our modified “Total Design Method.” Participants were sent packs and reminders according to our designed schedule. Results: Of the 346 participants, we received 258 responses, an overall response rate of 74.5% with a useable response rate of 72.3%. One hundred and six responses were received before the week 1 reminder (30.6%), 120 before week 3 (34.6%), 225 before the week 7 reminder (64.6%) and the remainder within 3 weeks of the final pack being sent. The median age of patients that the survey was sent to, and the median age of the respondents, was 54 years.Conclusion: In this study, we have demonstrated the successful implementation of a novel approach to postal surveys. Despite the length of the questionnaire (nine pages, 116 questions) and limitations of expenses to mail a survey to ~350 women, we were able to attain a response rate of 74.6%. Keywords: breast, surgery, postal survey, oncology, cancer, breast reconstruction, immediate postmastectomy breast reconstruction, patient satisfaction, PROM
Regulatory Dynamics, Institutional Cohesiveness, and Regional Sustainability By
No full textI hereby declare that I am the sole author of this thesis. This is a true copy of the thesis, including any required final revisions, as accepted by my examiners. I understand that my thesis may be made electronically available to the public. i
Análisis antropológico del cuerpo en los relatos de parto normal de mujeres y profesionales de Barcelona
No full textAim: To produce an anthropological analysis about how normal birth is thought through the notion of ‘body’ explained by Barcelona’s women and professionals personal experiences.Materials and Method: Data have been extracted from part of the ethnographic materials that the author has been collecting from 2009 to this day. These researches are the basis of her Ph.D. work, which is focused into the birth humanization processes held in Barcelona. The data gathering main technique has been the participant observation plus 16 semi-structured interviews to key informants.Results and Conclusions: Normal birth ideology projects an image of the female body as an active, autonomous and efficient one, which is also naturally gifted with all the necessary biological tools for the achievement of a successful birth. The normal birth is based on a body image that considers the body as something that possesses, even before the birth, all the necessary sage for the birth process. For all these previous reasons, the normal birth paradigm can be considered as a maieutic birth.Objetivo:Realizar un análisis antropológico sobre cómo es pensado el parto normal en los relatos de las mujeres y profesionales de Barcelona a través de la noción de cuerpo.Material y Método: Los datos presentados forman parte del material etnográfico que la autora ha ido recopilando desde el 2009 hasta el momento actual como parte de su investigación doctoral, que gira en torno a los procesos de humanización del nacimiento en Barcelona. La principal técnica de recopilación de datos ha sido la información participante y 16 entrevistas semi-estructuradas realizadas a informantes clave.Resultados y conclusiones: La ideología del parto normal proyecta una imagen del cuerpo femenino activo, dinámico, autónomo y eficaz que está naturalmente dotada con todas las herramientas biológicas necesarias para afrontar el parto. El parto normal descansa sobre una imagen de un cuerpo que ya contiene antes del alumbramiento toda la sabiduría necesaria para poder dar a luz. Y por ello, el paradigma del parto normal se puede considerar como el de un parto mayéutico
Elaboração do plano de parto em uma unidade básica de saúde : relato de experiência
No full textIntrodução: Este estudo é um relato sobre a experiência da autora nos projetos de implementação de Planos de Parto durante a atenção pré-natal, vivenciada como aluna de graduação, monitoria e extensão da Universidade Federal do Rio Grande do Sul. Objetivo: Relatar a experiência de uma acadêmica de enfermagem na implementação do plano de parto em uma Unidade Básica de Saúde (UBS) de Porto Alegre, RS, Brasil. Método: Trata-se de um método qualitativo, o relato de experiência é um projeto que se constitui de aspectos vivenciados pela autora no processo de implementação do Plano de Parto, na oportunidade de um estágio curricular, de atividade de monitoria da disciplina de Cuidado às Mulheres e aos Recém-nascidos e de participações no grupo de gestantes em uma UBS, durante o ano letivo de 2015. Resultados: A experiência da monitoria acadêmica oportunizou à autora um olhar humano a saúde das mulheres em vários cenários de cuidado. Também se alcançou o aprendizado sobre o plano de parto e seus benefícios para as usuárias do serviço público de saúde, pois é uma ferramenta que pode garantir algumas práticas na atenção ao parto e cuidados com o binômio mãe-bebê. Considerações finais: O plano de parto traz a mulher o protagonismo da luta pelo direito de conhecer e decidir sobre o seu corpo e seu bebê. A construção do plano de parto permitiu um vínculo da gestante e sua família com a equipe da atenção básica e certeza de suas escolhas, o que se pode traduzir em empoderamento feminino. Observamos que estas mulheres saíram fortalecidas desta experiência.Background: This study is about the author's experience on birth plans implementation projects during the antenatal attention, experienced as graduation student, monitoring and extension student of Universidade Federal do Rio Grande do Sul. Objectives: Report the experiences of nursery school student on the birth plan implementation in a Basic Unit of Health (BUH) of Porto Alegre, RS, Brazil. Method: It is a qualitative method, the reporting is a project that compose of experience aspects of author on the process of birth plan implementation, on the opportunity of an internship, monitoring activity on the subject of Care for Women and the Newborns and participation on classes to pregnant women in a BUH, during the academic year of 2015. Results: The monitoring students experience has provided the opportunity to the author of a humane view to the women’s health in many care scenarios. The author also achieved the knowledge about the birth plan and it is their benefits to the women, as it is a tool that can ensure some practices in the birth attention and minimum care to mother and baby. Final considerations: The birth plan brings to the woman the protagonism of their fight for the right to know and decide about their bodies and their babies. The making of a birth plan allowed a bond between the pregnant woman and their relatives to and the care providers and beyond that, the certainty of their choices, which we can translate to feminine empowering. We observed that these women were strengthened after this experience
Explorando o poder da palavra escrita: parto hospitalar, conversas fiadas e a produção de narrativas de maternidade
No full textThe events surrounding the expectations and experiences of a hospitalised childbirth in Northern Portugal are presented as an auto-ethnography, written in 2004, in the format of a diary and commented upon with hindsight by the author. The original motivation for writing the diary was to re-gain a degree of power over the birth process which, even before going into labour, the author felt she had already lost in comparison to her previous experiences of homebirth abroad. The diary elucidates how notions of childbirth and maternity care circulate in the social imaginary, moulding women’s expectations. It also illustrates how maternity care in Northern Portugal in the decade 2000 was governed by the authoritative knowledge of biomedicine. Reflections in the diary on the potentially liberating role of auto-ethnography are re-examined in the article through a discussion of the research potential for promoting the writing of birth narratives.Os eventos que cercam as expectativas e experiências de um parto hospitalizado no Norte de Portugal são apresentados como uma autoetnografia, escrita em 2004, no formato de um diário e comentado em retrospetiva pela autora. A motivação original para escrever o diário era voltar a ganhar um grau de poder sobre o processo do nascimento que, mesmo antes de entrar em trabalho de parto, a autora sentiu que já havia perdido em comparação com as suas experiências anteriores de parto em casa no estrangeiro. O diário elucida como noções de parto e cuidados de maternidade circulam no imaginário social e moldam as expectativas das mulheres e ilustra como os cuidados de maternidade no Norte de Portugal na década 2000 foram governados pela autoridade do conhecimento da biomedicina. Reflexões no diário sobre o papel potencialmente libertador da autoetnografia são reexaminadas no artigo, através de uma discussão sobre o potencial da investigação para promover a escrita de narrativas do nascimento.(undefined)info:eu-repo/semantics/publishedVersio
An evaluation of incidental metastases to internal mammary lymph nodes detected during microvascular abdominal free flap breast reconstruction
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