ABSTRACT
BACKGROUND: The wait times for breast cancer care in our region do not meet acceptable benchmarks. We implemented the Interior Breast Rapid Access Investigation and Diagnosis (IB-RAPID) nurse navigation program to address this issue. METHODS: The IB-RAPID prospective database was reviewed for patients entering the program between April 1, 2011 and April 30, 2012 (2011/2012 cohort), and was compared with patients from the same area in 2010. The main end point was the time between the 1st diagnostic imaging test and the surgery. Multiple linear regression was performed to investigate factors influencing the wait times. RESULTS: The wait times decreased with the introduction of IB-RAPID (59 vs 48 days; median). Stage of disease, total number of biopsies, and magnetic resonance imaging (MRI) use influenced wait times. MRI significantly delayed surgical intervention in both groups with those not having an MRI having a shorter wait time to surgery (68.5 vs 57.6 days; mean) in 2011/2012. CONCLUSION: The implementation of nurse navigation for patients with breast cancer appears to be effective at reducing the wait times for surgical treatment.
Subject(s)
Breast Neoplasms/nursing , Cancer Care Facilities/organization & administration , Critical Pathways/organization & administration , Health Services Accessibility/statistics & numerical data , Mastectomy/statistics & numerical data , Waiting Lists , Adult , Aged , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , British Columbia , Cancer Care Facilities/statistics & numerical data , Female , Humans , Linear Models , Magnetic Resonance Imaging/statistics & numerical data , Middle Aged , Multivariate Analysis , Time FactorsABSTRACT
ß-methylamino-l-alanine (BMAA) is a naturally occurring nonprotein amino acid originally discovered in cycad seeds and traditional foods of the Chamorro people of Guam. Recent research has implicated BMAA as a potential factor in neurodegenerative disease and described the production of BMAA in cyanobacteria, but conflicting results have complicated the interpretation of data. We hypothesized that the reactivity of BMAA with metal ions in the sample matrix and the formation of metal adducts in electrospray ionization mass spectrometry (MS) analysis confound results. Dilute solutions of TCA, MgCl(2), NaCl, CuCl(2), ZnCl(2) (0.01 M), or artificial ocean water (Instant Ocean, 3.5 g/L) reduced the signal attributable to the BMAA M + H(+) peak by 78-99.7%. The degree of adduct formation was significantly affected by MS settings such as induction voltage. A number of the detected ion peaks in BMAA standards were consistent with the formation of metal-BMAA complexes in addition to the adduct formation. A standard of Zn(BMAA)(2) was synthesized, and the effects of sample preparation, derivatization, column chromatography, pH, and interactions with serine were determined. Together, these data demonstrate that sample matrix, formation of adducts, and mass spectrometry settings complicate analysis of BMAA, that analysis by detection of the parent ion and daughter ion fragmentation patterns are highly susceptible to false negative findings, and that failure to detect BMAA cannot be considered proof of absence of the compound.
