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1.
Health Expect ; 18(6): 2825-40, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25200668

RESUMO

BACKGROUND: While previous studies have analysed features of interaction in cancer consultations using observational coding frames, relatively little attention is being given to how actual interactions are sequentially organized and achieved by participants in the course of talk-in-interaction. Research into the interactional practices in consultations, which involves Chinese patients, is largely absent. OBJECTIVE: To provide insight into the talk-in-interaction in surgical-oncology consultations in the context of a Chinese medical setting. METHODS: Thirty-one consultations involving 31 patients with breast cancer and eight surgeons were videotaped. The recordings were transcribed verbatim and analysed using conversation analysis. RESULTS: The manner in which surgeons delivered the diagnostic results was fairly similar across all the consultations. Most surgeons gave the diagnosis in a very straightforward and abrupt manner at the outset of the consultation with no mitigation. While patients in our study conformed to the traditional information giving and receiving roles, how information was presented by surgeons shaped the subsequent sequential organization of surgeon-patient interaction and turn-taking patterns. More importantly, there was a tendency by the surgeons to move from issues of psychosocial nature to clinical matters regardless of the topics taken up in the specific encounter. CONCLUSIONS: This study demonstrated the potential of conversation analysis as a context-sensitive method that enabled researchers to gain a more thorough understanding of dynamics of interaction in cancer consultations, thereby informing training interventions for surgeons. Our findings underscore the importance of discursive practices in shaping and encouraging (or discouraging) patient participation in oncology consultation.


Assuntos
Neoplasias da Mama/psicologia , Comunicação , Oncologia , Relações Médico-Paciente , Adulto , Idoso , Neoplasias da Mama/cirurgia , China , Feminino , Humanos , Oncologia/métodos , Pessoa de Meia-Idade , Gravação em Vídeo
2.
Patient Educ Couns ; 94(2): 243-9, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24316055

RESUMO

OBJECTIVE: To assess the extent to which breast surgical consultations used shared decision making (SDM), identify factors associated with use of SDM, and assess if using SDM increases decision-making satisfaction. METHODS: Two hundred and eighty-three video-recorded diagnostic-treatment decision consultations between breast surgeons and women with breast cancer were assessed using the Decision Analysis System for Oncology (DAS-O) coding system designed for assessing SDM behaviors. Women completed a questionnaire at pre-consultation, one-week post-consultation and one-month post-surgery. Patient outcomes included decision conflict, patient satisfaction with medical consultation, and decision regret. RESULTS: Overall, the level of SDM behaviors was low. The extent of SDM behavior within consultation was related to greater consultation duration (p<0.001), more than one treatment being offered (p<0.001), and fewer questions raised by patients/companions (p<0.05). While use of SDM consultation did not influence post-consultation decision conflict, it increased satisfaction with information given and explained, patients' feelings of trust and confidence in their surgeons, and reduced post-surgical decision regret. CONCLUSION: These breast surgical consultations mostly adopted informed treatment decision-making approaches. Using SDM improved patient consultation and decision satisfaction. PRACTICE IMPLICATIONS: The study findings highlight a need to reinforce the importance of SDM in consultations among breast surgeons.


Assuntos
Povo Asiático/psicologia , Neoplasias da Mama/psicologia , Tomada de Decisões , Avaliação de Processos e Resultados em Cuidados de Saúde , Participação do Paciente , Satisfação do Paciente/etnologia , Adulto , Neoplasias da Mama/etnologia , Neoplasias da Mama/cirurgia , China , Feminino , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Satisfação Pessoal , Relações Médico-Paciente , Encaminhamento e Consulta , Inquéritos e Questionários , Gravação em Fita
3.
Asian J Surg ; 34(2): 81-5, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21723471

RESUMO

BACKGROUND: Sentinel lymph node biopsy (SLNB) has become the standard treatment for patients with invasive breast cancer. Intra-operative frozen section allows for the detection of nodal metastases, thereby allowing a simultaneous axillary lymph node dissection (ALND) for those patients with nodal metastases. We herein report the accuracy of frozen section in the detection of SLN metastases. METHODS: Patients with operable breast cancer and clinically negative axillae were recruited for SLNB. The SLNs were identified by blue dye, an isotope, or a combination. Enlarged lymph nodes that were not SLNs were also excised. All nodes were examined by intra-operative frozen section. ALND was performed if frozen section was positive. For those without metastases on frozen section, ALND was not performed. All lymph nodes underwent further paraffin sectioning with immuno-histochemical staining. RESULTS: A total of 260 SLNB procedures were performed for invasive carcinoma over a 3-year period. The SLN was identified in 93.5% of patients. Of the 243 successful procedures, 53 had nodal metastases on frozen section. A total of 33 patients had false-negative frozen sections (false-negative rate, 38.4%), and 97% of them were less than 2 mm in size. The false-negative rate for macro-metastases, micro-metastases, and isolated tumour cells_were 2.4%, 57.7%, and 94.4%, respectively (p < 0.0001). A total of 22 patients had delayed ALND, and the re-operation rate was 8.5%. CONCLUSION: Frozen section was useful for the detection of nodal metastases in the SLNs and allowed for ALND to be performed in the same operation. The main failure of frozen sections was in the detection of micro-metastases.


Assuntos
Neoplasias da Mama/patologia , Secções Congeladas , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/cirurgia , Reações Falso-Negativas , Feminino , Humanos , Período Intraoperatório , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Sensibilidade e Especificidade
4.
Breast Cancer ; 18(2): 124-8, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19943129

RESUMO

BACKGROUND: Radiofrequency ablation (RFA) is an emerging minimally invasive technique for breast cancer treatment. There are two different needle designs. One is to deploy a series of arrays to allow an even distribution of heat within the tumor. A new design is a straight needle with continuous infusion of cold saline to prevent charring and ensure continuous heat delivery. We report the first comparative study using two different needles for ablation of breast cancer. METHODS: Chinese patients with breast cancer less than 2 cm were prospectively recruited. Multifocal tumor was excluded. RFA was performed under general anesthesia following sentinel node biopsy. Sequential allocation was used. In the first group, tumor was ablated by using the LeVeen needle. Cool-tip needle was used in the subsequent group. The tumor was then resected. Tumor viability was assessed by nicotinamide adenine dinucleotide-diaphorase (NADH) staining. Complete ablation rate was compared. Evidence of thermal damage to the skin was also assessed. RESULTS: Twenty patients were recruited. Mean tumor size was 14 mm. Complete ablation rate was the same (90% versus 89% for the Cool-tip and the LeVeen, respectively). Cool-tip has a shorter ablation time when compared with LeVeen (12 versus 28 min), and the Cool-tip needle was found to be easier to insert. There was no visible skin burn after RFA. CONCLUSIONS: Cool-tip and LeVeen systems had the same efficacy in ablation of breast cancer, but Cool-tip was easier to insert and had a shorter ablation time.


Assuntos
Neoplasias da Mama/cirurgia , Ablação por Cateter/instrumentação , Idoso , Neoplasias da Mama/patologia , Ablação por Cateter/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Agulhas , Receptores de Estrogênio/análise
5.
World J Surg ; 35(1): 165-9, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20924761

RESUMO

BACKGROUND: The hook-wire technique is used to guide surgical excision of nonpalpable breast lesions. Recently, isotope has been used to guide the excision, and when sentinel node biopsy is performed during the same operation, the procedure is termed Sentinel Node and Occult Lesion Localization (SNOLL). We evaluated the use of this procedure for nonpalpable cancers in Chinese women. METHODS: Seventy-four patients underwent SNOLL before breast-conserving surgery. Intratumoral injection of sulfur colloid and lymphoscintigraphy (LSG) were performed. A gamma probe was used for resection planning and localization of the sentinel node (SN). Blue dye mapping was used in patients with negative LSG. Complete excision was defined as a tumor-free margin greater than 1 mm. RESULTS: The primary breast lesion was successfully removed in 73 patients (99%). Complete excision was achieved in 61 patients (82%). Drainage to axilla was detected by LSG in 53 patients (72%). The gamma probe was more sensitive than LSG and had an 82% SN identification rate. Patients with a positive LSG had a higher chance of SN localization by gamma probe than patients with a negative LSG (100% vs. 38%, p < 0.001). In patients with a negative LSG, supplementary blue dye mapping increased the SN localization rate from 38 to 90%. The SN identification rate was 97% in the whole series. CONCLUSION: Isotope-guided surgery was reliable, with a 99% localization rate for nonpalpable breast lesions and an 82% SN localization rate. The success rate of SN identification could be improved to 97% with the addition of blue dye mapping for patients with negative drainage on lymphoscintigraphy.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Axila , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , China , Corantes , Feminino , Humanos , Imuno-Histoquímica , Mastectomia Segmentar , Pessoa de Meia-Idade , Invasividade Neoplásica , Palpação , Estudos Prospectivos , Cintilografia , Compostos Radiofarmacêuticos , Corantes de Rosanilina , Sensibilidade e Especificidade , Biópsia de Linfonodo Sentinela , Coloide de Enxofre Marcado com Tecnécio Tc 99m
6.
Breast Cancer ; 17(4): 276-80, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19756924

RESUMO

BACKGROUND: When ductal carcinoma in situ (DCIS) is found on core biopsy, histological underestimation can occur due to sampling error. When an invasive cancer is subsequently found, another operation is required for nodal staging. Sentinel lymph node biopsy (SLNB) enables nodal staging at the same operation. We examine the value of SLNB in patients with a preoperative diagnosis of DCIS focusing on the need for reoperation. METHODS: Patients with a preoperative core biopsy of DCIS underwent SLNB at the time of definitive surgery. The results of SLNB in relation to histological upstaging were analyzed. RESULTS: One hundred and seven patients with a core biopsy diagnosis of DCIS underwent simultaneous SLNB at the time of definitive surgery. SLNB was successful in 103 patients (96.3%) and 12 (11.7%) had SLN metastases. Thirty-two patients (29.9%) had histological upstaging and SLN was positive in nine (28.1%). Seventy-five patients had "pure DCIS" but three (4%) had SLN metastases. The presence of a palpable mass and radiological mass lesion were associated with histological upstaging. If SLNB were not performed, 32 patients (29.9%) with upstaging would require another surgery to stage the axilla. In the present series, 84% of these patients had appropriate axillary staging without the need for a second operation. CONCLUSION: Underestimation of invasive disease was frequent on core biopsy. Performing SLNB during definitive surgery allowed correct nodal staging in a single operation. SLN metastasis was rare in patients with "pure DCIS" on final pathology. However, additional systemic treatment may be indicated for patients with SLN micrometastases.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Estadiamento de Neoplasias/métodos , Biópsia de Linfonodo Sentinela , Axila , Biópsia por Agulha , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Feminino , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica
7.
Asian J Surg ; 31(1): 6-10, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18334462

RESUMO

Surgical resection is indicated for gastrointestinal stromal tumour (GIST). Laparoscopic resection with clear margins is effective in gastric GIST. However, GIST located in the posterior gastric wall with close proximity to the oesophagogastric junction poses special challenges. Laparoscopic intragastric resection offers a new approach to the management of these tumours. The surgical technique, our experience and a summary of the literature are presented.


Assuntos
Gastrectomia/métodos , Tumores do Estroma Gastrointestinal/cirurgia , Laparoscopia/métodos , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos
8.
ANZ J Surg ; 77(8): 677-81, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17635283

RESUMO

BACKGROUND: To study the effects of pantoprazole on gastric pH and recurrent bleeding after endoscopic treatment for bleeding peptic ulcers. METHODS: After endoscopic haemostasis, patients were randomly assigned to infusion group (pantoprazole 80 mg i.v. bolus followed by continuous infusion of 8 mg/h for 3 days), bolus group (pantoprazole 80 mg i.v. bolus followed by 40 mg i.v. bolus every 12 h for 3 days) and no-treatment group (no acid suppression in the first 3 days). Gastric pH was monitored. Rebleeding rate within 30 days, the need for surgery, transfusion requirement, total hospital stay, mortality rate and gastric pH were compared. RESULTS: One hundred and sixty-eight patients were included, with 15 patients excluded from the analysis. There were 54 patients in the infusion group, 49 in the bolus group and 50 in the no-treatment group. There was fewer rebleeding (3.7 vs 16.0%, P = 0.034), less operative intervention (0 vs 8.0%, P = 0.034) and shorter hospital stay (6.4 vs 8.2 days, P = 0.040) in the infusion group compared with that in no-treatment group. When the bolus group was compared with no-treatment group, there were fewer rebleed (4.1 vs 16.0%, P = 0.049) and less blood transfusion (1.5 vs 2.9 units, P = 0.007). There was no difference in mortality among the three groups. Patients who received either pantoprazole infusion or bolus had significantly higher mean pH and longer duration of pH above 6 compared with the no-treatment group. There was no difference in the rebleeding rate, transfusion requirement, need for operation and hospital stay between the infusion and bolus groups. The mean pH and the duration of pH above 6 were also similar. CONCLUSION: Pantoprazole either as infusion or bolus decreased rebleeding after endoscopic treatment for bleeding peptic ulcer.


Assuntos
2-Piridinilmetilsulfinilbenzimidazóis/administração & dosagem , Antiulcerosos/administração & dosagem , Suco Gástrico/química , Úlcera Péptica Hemorrágica/tratamento farmacológico , Transfusão de Sangue , Feminino , Determinação da Acidez Gástrica , Humanos , Concentração de Íons de Hidrogênio , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pantoprazol , Úlcera Péptica Hemorrágica/cirurgia , Recidiva
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