Evaluation of a breast cancer patient information and support program.

CONTEXT: Women with newly diagnosed breast cancer seek answers to many questions about their disease, treatment options, and prognosis. Failure to meet these needs may cause dissatisfaction with the care process. OBJECTIVE: To evaluate the impact of a support and information program for women with newly diagnosed breast cancer. INTERVENTION: A support and information program that featured a program coordinator, information resources, and mentoring from a breast cancer survivor. DESIGN AND OUTCOME MEASURES: Women in whom breast cancer was diagnosed at program sites (n = 111) and a random sample of women whose breast cancer was diagnosed at nonprogram sites (n = 277) were surveyed by mail to ascertain their level of satisfaction with various aspects of their medical care. The response rates were 74% and 81%, respectively. RESULTS: 75% of women at program sites used the information resources, and 60% requested a patient mentor. Demographic characteristics and satisfaction with non-breast cancer care were almost identical among program and non-program site respondents. For overall breast cancer care, 71% of program site respondents but only 56% of non-program site respondents were very satisfied. More than half of program site respondents rated presurgery care, provision of information, and support received as excellent, versus about 40% of non-program site respondents. Program site respondents were consistently more likely to rate the amount of reassurance and support provided by physicians and nurses as excellent and were less likely to want a second opinion (35% vs. 51%). CONCLUSIONS: The support and information program appears to have had a positive impact on satisfaction with breast cancer care.

Glenoid deformity secondary to brachial plexus birth palsy.

The association between internal rotation contracture secondary to brachial plexus birth palsy and deformity and posterior dislocation of the glenohumeral joint has been known for a long time. The precise nature of these deformities and their pathogenesis, however, remain unclear. Twenty-five children, ranging in age from 1.5 to 13.5 years, had an operation to release an internal rotation contracture secondary to brachial plexus birth palsy; eleven had a latissimus dorsi transfer to augment external rotation power as well. Arthrograms were made intraoperatively in order to clarify the pathological changes that occur in the glenohumeral joint during growth in patients who have this condition. Seven children had a concentric glenohumeral joint (the humeral head was well centered in the glenoid fossa). The remaining eighteen children (72 per cent) had a deformity of the posterior aspect of the glenoid. Five of these children had flattening of the posterior aspect of the glenoid, seven had a biconcave glenoid with the humeral head articulating with the posterior of the two concavities, and six had a so-called pseudoglenoid (the most severe deformity, in which the humeral head articulated with a distinct, retroverted, posterior articular surface). Internal rotation contracture secondary to brachial plexus birth palsy may lead to glenoid deformity that is severely advanced by the time that the child is two years old. In patients who have such a contracture, we recommend early imaging of the shoulder with arthrography or some other modality to allow visualization of the skeletally immature glenohumeral joint.

Bone and joint surgery--looking ahead.

Looking ahead, one envisions an era of remarkable progress in the study of the healing of bone and cartilage. The physical, biochemical, and biomechanical factors governing bone and cartilage healing will be defined and manipulated to accelerate the healing process. Joint stiffness, the undesirable sequela of many simple fractures of the hand as a result of prolonged immobilization, will be obviated. For cases of limited joint damage, techniques for joint reconstruction will be refined. For non-salvageable bone and joint destruction, microvascular allogenic transplantation of skeletal units will become a reality. Silastic implants in the wrist will become historical oddities.

Coverage of the calvarium with a free parascapular flap.

The reconstructive problems associated with providing durable coverage for full-thickness loss of the scalp are detailed and the options reviewed. Free tissue transfer offers a break-through in these difficult problems. A case of a successful parascapular flap transfer is described, offering an alternative to previously described methods.