Radioactive seed localization compared with wire-guided localization of non-palpable breast carcinoma in breast conservation surgery- the first experience in the United Kingdom.

OBJECTIVE: In the UK, guidewires have traditionally been used for localization of non-palpable breast lesions in patients undergoing breast conservation surgery (BCS). Radioactive seed localization (RSL) using Iodine-125 seeds is an alternative localization method and involves inserting a titanium capsule, containing radioactive Iodine-125, into the breast lesion. We aim to demonstrate feasibility of RSL compared with guidewire-localization (GWL) for BCS in the UK. METHODS: Data were collected on 100 patients with non-palpable unifocal invasive carcinoma of the breast undergoing GWL WLE prior to the introduction of RSL and the first 100 patients treated with RSL WLE. Statistical comparisons were made using Χ2-squared analysis or unpaired two-sample t-test. Significance was determined to be at p ≤ 0.05. RESULTS: Mean total tumour size was 19.44 mm (range: 5-55) in the GWL group and 18.61 mm (range: 3.8-59) in the RSL group (p = 0.548), while mean total specimen excision weight was significantly lower in the RSL group; 31.55 g (range: 4.5-112) vs 37.42 g (range: 7.8-157.1) (p = 0.018). Although 15 patients had inadequate surgical resection margins in the GWL group compared the 13 in the RSL group (15 vs 13%, respectively, p = 0.684), 10 of the patients in the GWL group had invasive carcinoma present resulting in at least one positive margin compared with only 3 patients in the RSL group (10 vs 3%, respectively, p = 0.045). CONCLUSION: In this study, RSL is shown to be non-inferior to the use of GWL for non-palpable carcinoma in patients undergoing BCS and we suggest that it could be introduced successfully in other breast units. Advances in knowledge: Here we have demonstrated the use of RSL localization results in significant lower weight resection specimens of breast carcinoma when compared with a matched group using GWL, without any significant differences in oncological outcome between the groups.

Occupational therapy students rating the social profile of their educational group: do they agree?

BACKGROUND: During the curriculum, occupational therapy students learn to administer a range of assessment procedures. Interrater agreement between occupational therapy students' ratings of group functioning has not yet been examined. AIMS: To examine the interrater agreement within groups of students' ratings using the Social Profile. METHODS AND MATERIALS: The Social Profile assesses the social interaction behaviours in activity groups, and 35 students completed the measure. Two methods of obtaining an overall Social Profile score were explored. Intraclass correlation coefficients (ICC) were calculated to assess the level of agreement within groups of raters. RESULTS: Social interaction in the study groups occurred more frequently within the basic cooperative level. There was substantial agreement within groups of raters on this level, whereas there was low to moderate agreement on the other four levels. The weighted method of obtaining an overall Social Profile score showed higher ICC than the simpler method. CONCLUSION AND SIGNIFICANCE: It appears to be easier to reach high interrater agreement when considering frequently occurring behaviours in a group. The weighted method of obtaining an overall Social Profile score showed the best ICC results and should preferably be used in future studies where an overall measure is sought.

Implementation of HIV treatment as prevention strategy in 17 Canadian sites: immediate and sustained outcomes from a 35-month Quality Improvement Collaborative.

BACKGROUND: Rapid scale-up of effective antiretroviral therapy (ART) is required to meet global targets to eliminate new HIV infections and AIDS-related deaths. Yet, gaps persist in all nations striving for these targets. In the intervention setting of British Columbia (BC), Canada, where ART is publicly funded, 73% of HIV-diagnosed were on ART in 2011, and only 49% were achieving viral suppression. METHODS: An observational case descriptive study of HIV care sites in BC recruited to participate in a 35-month Breakthrough Series Quality Improvement Collaborative and sustainability network. Sites collected four quality indicators, qualitative change descriptions and implemented the chronic care model (CCM) and HIV care and treatment guidelines. Two reviewers assigned monthly implementation scores to evaluate site progress (January 2011-2012). All quality indicators were pooled and analysed using probability-based run chart rules. RESULTS: Seventeen teams with a pooled median population of 2296 HIV patients joined the initiative. Comprehensive CCM implementation and evidence of improvement was achieved by 29% of sites (implementation score of 4.0 or higher on 5.0 scale). Evidence of sustained improvement was observed for patient engagement (88.8-90.4%), ART uptake among patients unequivocally in need (92.9-94.8%), and ART uptake (≥6 months) and achieving viral suppression (57.3-78.4%) (all p<0.05). CONCLUSIONS: This study shows evidence of sustained improvements in HIV care processes and treatment outcomes for an estimated population of 2296 HIV patients in 17 BC sites. Overall success points to opportunities for other high-income countries seeking to improve HIV health outcomes.

Formal aminocyanation of α,ß-unsaturated cyclic enones for the efficient synthesis of α-amino ketones.

Installation of amino functionality on organic molecules through direct CN bond formation is an important research objective. To achieve this goal, a 1,2-aminocyanation reaction was developed. The reaction occurs through the formation of pyrazolines by means of a formal dipolar cycloaddition of cyclic α,ß-unsaturated ketones with lithium trimethylsilyldiazomethane followed by novel protonolytic N-N bond cleavage under mild conditions. This two-step process provides a diverse array of structurally complex free and mono-alkylated α-amino ketones in excellent yields.

Legal pressures and incentives for personalized medicine.

Legal liability has the potential to be a powerful driver pushing implementation of personalized medicine. Individuals injured by adverse drug effects are increasingly likely to bring lawsuits alleging that they have a polymorphism or biomarker conferring susceptibility to the drug that should have been identified and used to alter their drug treatment. Likely targets of such lawsuits include drug manufacturers, third party payors, physicians and pharmacists, of which physicians are most at risk of substantial liability.