The patient and clinician experience of informed consent for surgery: a systematic review of the qualitative evidence.

BACKGROUND: Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set (COS) to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the informed consent process. METHODS: This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. RESULTS: Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. CONCLUSIONS: This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. REGISTRATION: The study protocol was registered on the international prospective register for systematic reviews (PROSPERO ID: CRD42017077101).

Long Term Follow Up of Male Breast Cancer.

INTRODUCTION: Male breast cancer accounts for less than 1% of breast cancers with published overall and disease free survival being lower than in females. AIMS: To determine treatment and long term outcomes for male breast cancer patients in our unit. METHODS: A database has been maintained for all breast cancer patients diagnosed in our unit since 1993. Patients were identified using the database and information was collated on patient demographics, tumour pathology, treatment and outcomes using the database and retrospective chart review. Patients were followed to cause of death. RESULTS: From 1994-2009 twenty-four cancers were diagnosed in twenty-two patients. Mean age at diagnosis was 69. Male breast cancer patients were treated using similar principles to female breast cancer. Twenty patients underwent mastectomy, two patients underwent wide local excision. No patients developed local recurrence. One patient died from their breast cancer with systemic metastases. 10-year overall survival was 22%, 10 year disease-specific survival was 80%. Other causes of death included medical co-morbidity and secondary cancers. DISCUSSION: Disease free survival in our unit is comparable to other published studies. High age at diagnosis and co-morbidity are the most important factors in determining overall outcome. Treatment pathways for male breast cancer should follow guidelines for female disease in order to optimise outcomes. Future research at national or international level is necessary to ensure the most effective treatments are implemented for male breast cancer patients.

Potato Psyllid (Hemiptera: Triozidae) Response to Insecticides Under Controlled Greenhouse Conditions.

Bactericera cockerelli (Sulc) is a common pest of solanaceous crops largely known for vectoring "psyllid yellows" in potatoes. In recent years, however, this pest has attracted considerable attention for vectoring Zebra Chip, a devastating bacterial disease that was first reported in the United States in 2004 and has spread across the southern and northwestern states, causing significant economic losses to potato growers and the industry. Management of the disease is mainly achieved by reducing the psyllid population using insecticides, including pyrethroids and neonicotinoids; however, new insecticides with different modes of action are needed to avoid the acquisition of resistance. In the current study, the immediate and residual effects of conventional and new materials were tested under greenhouse conditions against adults and nymphs. Cyantraniliprole at a high rate and spinetoram showed the highest immediate and residual activity against adults, whereas cyantraniliprole and oxamyl (low and high rates) were effective against nymphs, with no differences between rates. Soil applications of cyantraniliprole, oxamyl, and imidacloprid were still toxic to adults and nymphs 7 and 14 d after treatment. Also, cyantraniliprole and tolfenpyrad were detrimental to psyllid reproduction. The incorporation of new chemistry in rotation programs may provide a useful management tool against this pest.

Effects of in-furrow and water-run oxamyl on Paratrichodorus allius and corky ringspot disease of potato in the klamath basin.

Corky ringspot disease (CRS) of potato (Solanum tuberosum) is caused by the tobacco rattle virus (TRV), which is vectored by stubby-root nematodes, Paratrichodorus spp. and Trichodorus spp., and is a significant threat to potato quality and production in many areas of the western United States. Between 2002 and 2005, fields with a history of CRS were planted to potato and treated with various combinations of in-furrow (IF) and chemigated (water run, WR) oxamyl [Methyl N'N'-dimethyl-N-[(methyl carbamoyl)oxy]-1-thiooxamimidate] applications. Soil samples were collected to determine how Paratrichodorus allius populations responded to the various treatment regimes (2002-2004); potato tubers were evaluated for symptoms of CRS in 2004-2005. Applications of oxamyl to potato (1.1 kg a.i./ha) did not cause significant mortality of P. allius but did prevent the populations from increasing. Oxamyl applications that began at 55 days after planting (DAP) or later did not control CRS and were not different from the untreated control. However, application schedules that began early-season, either IF at planting, early WR (33 - 41 DAP), or both, significantly reduced CRS expression in cv. Yukon Gold. Therefore, oxamyl applications must be made early in the growing season to be effective in controlling CRS. Effects of oxamyl on CRS may be due to nematostatic action that suppresses feeding activity during early field season when most virus transmission probably occurs.

Women and objectified body consciousness: mothers' and daughters' body experience in cultural, developmental, and familial context.

Hypotheses about age-related differences in objectified body consciousness (OBC; McKinley & Hyde, 1996) based on the cultural, developmental, and familial contexts of women's body experience were tested on 151 undergraduate women and their middle-aged mothers. Mothers had lower levels of surveillance (watching the body as an outside observer) and body shame (feeling one is a bad person when appearance does not meet cultural standards) than daughters. No differences were found in appearance control beliefs, body esteem, or restricted eating, even though mothers weighed more and were less satisfied with their weight than daughters. OBC was related to measures of psychological well-being in both age groups; body esteem was more strongly related to some measures of daughters' psychological well-being than mothers'. Relationships of partner and family approval and OBC and body esteem were also examined.

Cervical cancer and STD health beliefs: predicting pelvic exam intentions in undergraduates.

We surveyed 119 female undergraduates to investigate if the health belief model for both cervical cancer and sexually transmitted diseases (STDs) would predict pelvic examination intentions. Results for cervical cancer and STDs were similar, with barriers to obtaining an exam and perceived susceptibility contributing most consistently to intentions. Respondents rated themselves as more susceptible to cervical cancer than to STDs and rated STDs more serious than cancer. Discriminant analysis found sexual activity, barriers, susceptibility to STDs, benefits of a pelvic exam for cervical cancer, and age to reliably distinguish women who had gotten a pelvic exam from those who had not. Contrary to previous research, physique anxiety was a positive predictor of intentions when health beliefs were controlled, suggesting it may represent generalized body anxiety for some women.

Iliac crest versus spinous process grafts in posttraumatic spinal fusions.

Results of posttraumatic spine fusions in 34 patients who had autogenous iliac crest grafts were compared with those of 70 patients who had autogenous spinous process grafts. The two groups of patients were otherwise homogenous, and fusion occurred in 32 (94%) of the iliac crest graft patients and 70 (100%) spinous process graft patients. However, average operative time (225 vs. 200 minutes) and operative blood loss (1371 vs. 1136 cc) were significantly higher in iliac crest graft patients (P less than 0.05), and five iliac crest graft patients had significant donor site complications. Use of spinous process grafts eliminated donor site problems, reduced operative time and blood loss, and produced a rate of arthrodesis equal to that of iliac crest grafts.

Sled-Skiing: Winter Challenge for the Disabled.

Sled-skiing is easy to learn and allows individuals with mobility impairments to share the slopes with Alpine skiers.