The development and evaluation of a nationwide training program for oncology health professionals in the provision of genetic testing for ovarian cancer patients.

BACKGROUND: BRCA1/2 mutation status has increasing relevance for ovarian cancer treatments, making traditional coordination of genetic testing by genetic services unsustainable. Consequently alternative models of genetic testing have been developed to improve testing at the initial diagnosis for all eligible women. METHODS: A training module to enable mainstreamed genetic testing by oncology healthcare professionals was developed by genetic health professionals. Oncology healthcare professionals completed questionnaires before and 12 months post-training to assess perceived skills, competence and barriers to their coordinating genetic testing for women with high-grade non-mucinous epithelial ovarian cancer. Genetic health professionals were surveyed 12 months post-training to assess perceived barriers to implementation of mainstreaming. RESULTS: 185 oncology healthcare professionals were trained in 42 workshops at 35 Australasian hospitals. Of the 273 tests ordered by oncology healthcare professionals post-training, 241 (93.1%) met national testing guidelines. The number of tests ordered by genetic health professionals reduced significantly (z = 45.0, p = 0.008). Oncology healthcare professionals' perceived barriers to mainstreamed testing decreased from baseline to follow-up (t = 2.39, p = 0.023), particularly perceived skills, knowledge and attitudes. However, only 58% reported either 'always' or 'nearly always' having ordered BRCA testing for eligible patients at 12 months, suggesting oncology healthcare professionals' perceived barriers were not systematically addressed through training. CONCLUSIONS: Oncology healthcare professionals have demonstrated a willingness to be involved in the provision of genetic testing in a mainstreaming model. If oncology services are to hold responsibility for coordinating genetic testing, their readiness will require understanding of barriers not addressed by training alone to inform future intervention design.

Anatomy of the vestibule of the omental bursa and epiploic foramen in the horse.

REASONS FOR PERFORMING STUDY: Epiploic foramen entrapment (EFE) is a common cause of colic in horses and available anatomical descriptions of this foramen and the associated vestibule of the omental bursa tend to be inconsistent, contradictory and inaccurate. OBJECTIVES: To describe the anatomy of the vestibule of the omental bursa and epiploic foramen. STUDY DESIGN: Dissection of 21 fresh equine cadavers shortly after euthanasia. METHODS: The anatomy of the vestibule of the omental bursa, epiploic foramen and related structures in the cranial abdomen were examined in situ and after removal from the abdomen. Photographs were taken and illustrations rendered to bring the relationship of the different folds, ligaments and organs involved into a 3D concept. RESULTS: The entrance into the vestibule and the passageway through it to the epiploic foramen is bounded by the gastropancreatic fold dorsally, caudally and ventrally. This fold constitutes the caudoventral boundary of the epiploic foramen along with the portal vein cranially and ventrally. The craniodorsal boundary of the epiploic foramen is formed by the caudate lobe of the liver. CONCLUSIONS: The gastropancreatic fold plays a more important role in the anatomy of the vestibule of the omental bursa and the epiploic foramen than has been documented in the most widely used anatomy textbooks written in English. Because of the importance of EFE in horses, information from this study about the relevant anatomy could provide a first step towards improved methods for treatment and laparoscopic prevention of these diseases.