Impact of health talks on knowledge, attitudes and perception of breast cancer screening and treatment amongst healthcare staff by a breast surgical unit in a public healthcare institution: a cross-sectional study.

BACKGROUND: In October 2019, surgeons from Changi General Hospital (CGH) Breast Centre delivered a series of health talk for its employees to assess the knowledge and perception of breast cancer screening and to improve the level of related knowledge amongst the institution's healthcare workers. This was to enable CGH, a healthcare provider to not only care for our patients, but also to look after its staff. METHODS: 141 hospital staff attended a 40-min talk followed by an open question and answer forum. Pre and post talk surveys were conducted to gauge knowledge, attitudes, beliefs and misconceptions towards breast cancer screening and treatment. Question domains were divided into (1) breast cancer knowledge, (2) breast cancer screening guidelines and (3) attitudes and perception of breast cancer screening and treatment. Univariate and multivariate logistic regression analysis were used to examine the relationship between demographics and performance in question domains. RESULTS: The overall response rate was 131 out of a total of 141 attendees (92.9%). The median age was 44 years old (range, 22-67), with nursing staff making up 40% of the cohort. Analysis showed statistically significant improvement in median score across all 3 domains. (p < 0.05) after the forum. We found that respondents who were women ≥ 40 years (eligible age for screening), had higher income, lived in larger housing types, had attended previous talks, had served > 10 years in healthcare and had personal encounter with breast cancer patients performed better. Surprisingly, being a nurse or having a university degree did not translate to a better score. 99% of respondents found the forum beneficial and would recommend it to others. Several knowledge gaps about breast cancer screening and misconceptions were identified. Future campaigns should focus on raising awareness of the national screening program BreastScreen Singapore. We aim to reinforce its recommendations, promote on the affordability and ready accessibility. CONCLUSIONS: A simple Breast Cancer Awareness Month campaign targeted at healthcare workers was found to be effective at educating hospital staff on breast cancer, screening practices and improving perception of screening and treatment practices. This may empower them to not only care for themselves but also to serve patients better.

Limb Stent Occlusion from Intraoperative Nellix Stent Migration and Prolapse.

BACKGROUND: Incidence of Nellix stent migration is uncommon despite the absence of a proximal fixation mechanism. We present a case of intraoperative Nellix stent migration to highlight the potential complications. Our patient had renal artery occlusion and threatened limb stent perfusion as a result of intraoperative stent migration, with resultant prolapse of the Nellix endobag. We also present a successful salvage procedure to deploy an additional stent to restore limb stent flow. CASE: A 71-year-old Chinese gentleman with symptomatic concomitant infrarenal abdominal aortic aneurysm and bilateral common iliac aneurysms was discussed at a multidisciplinary meeting and deemed suitable for endovascular sealing of the aneurysms with the Nellix device. Prefilling imaging confirmed satisfactory stent positions bilaterally below the level of renal arteries. Routine filling of endobag was performed with stent-graft molding by standard angioplasty technique. Final check angiogram did not identify any endoleaks and demonstrated adequate sealing of the aneurysm. Unfortunately, patient developed acute kidney injury postoperatively. This was attributed to contrast-induced nephropathy. The creatinine level peaked at 150 µmol/L and stabilized. Ultrasound duplex on the seventh postoperative day however diagnosed absent left renal artery flow. An interval computed tomography aortogram at 3 month also detected threatened limb stent occlusion from the contralateral endobag prolapse. Subsequently, the patient underwent successful extension of the threatened limb stent to restore luminal flow. DISCUSSION: Retrospective examination of angiographic images confirmed that the left renal artery flow was preserved on the completion angiogram. The difference in level of limb stents observed postmolding compared to premolding widened from 1 mm to 6 mm due to a degree of stent bowing within the iliac arteries. We postulate the left renal artery occlusion was either caused by further proximal migration of the right limb stent due to the left stent bowing within the curve of the iliac artery or endobag prolapse post molding. Mismatched, unopposed filling of the endobags after the molding process could result in an unexpected behavior of prolapsing into the contralateral limb stent and obstruct luminal flow. This case highlights a significant sequalae of proximal migration after the molding process of Nellix. Augmenting the level of limb stent to the same level may be necessary and easily achieved with additional stent deployment. We recommend close inspection of completion angiogram to check for stent migration, and if required for additional angiograms to be taken perpendicular to each other or use of adjuncts such as intravascular ultrasound post endobag filling to document stent positions in relation to adjacent renal arteries, luminal flow, and detect any early intraoperative migration.