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Ballance L, Wilson RL, Kirwan CC, Boundouki G, Taxiarchi VP, Baker BG, Rusius V, Rowland M, Henderson JR, Marikakis N, McAleer J, Harvey JR, Northwest Breast Research Collaborative OBOT. Return to Activities of Daily Living after Breast Cancer Surgery: An Observational Prospective Questionnaire-Based Study of Patients Undergoing Mastectomy with or without Immediate Reconstruction. Breast J 2023; 2023:9345780. [PMID: 37771428 PMCID: PMC10533274 DOI: 10.1155/2023/9345780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023]
Abstract
Background Patients often ask about the time taken to return to activities of daily living (ADLs) after breast surgery, but there is a lack of data to give accurate guidance. We aimed to assess the feasibility of a study to determine the time taken to return to ADLs after mastectomy with or without breast reconstruction. Materials and Methods A prospective multicentre, self-reported questionnaire-based feasibility study of women who had undergone mastectomy ± reconstruction was performed, between Jan 2017 and Dec 2019. Women were asked to self-report when they returned to 15 ADLs with a 5-option time scale for "return to activity." Results The questionnaire was returned by 42 patients (median [range] age: 64 [31-84]). Of these, 22 had simple mastectomy, seven mastectomy and implant reconstruction, seven mastectomy and autologous reconstruction (DIEP), and six did not specify. Overall, over 90% could manage stairs and brush hair by two weeks and 84% could get in and out of the bath by four weeks. By 1-2 months, 92% could do their own shopping and 86% could drive. 68% of women employed returned to work within four months. Compared to simple mastectomy, patients undergoing reconstruction took a longer time to return to getting in/out of bath (<2 vs. 2-4 weeks), vacuuming (2-4 weeks vs. 1-2 months), and fitness (1-2 vs. 3-4 months). There was a slower return to shopping (1-2 months vs. 2-4 weeks), driving and work (both 3-4 vs. 1-2 months), and sports (3-4 vs. 1-2 months) in autologous reconstruction compared to implant reconstruction. Conclusion This study is feasible. It highlights slower return to specific activities (particularly strength-based) in reconstruction patients, slower in autologous compared with implant reconstruction. The impact on return to ADLs should be discussed as part of the preoperative counselling as it will inform patients and help guide their decision making. A larger study is required to confirm these results.
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Affiliation(s)
- L. Ballance
- The Nightingale Breast Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
| | - R. L. Wilson
- The Nightingale Breast Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
| | - C. C. Kirwan
- The Nightingale Breast Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - G. Boundouki
- Sheffield Breast Unit, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - V. P. Taxiarchi
- The Nightingale Breast Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - B. G. Baker
- The Nightingale Breast Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
| | - V. Rusius
- Burnley Breast Unit, Burnley General Hospital, East Lancashire Hospitals NHS Trust, Casterton Avenue, Burnley BB10 2PQ, UK
| | - M. Rowland
- Liverpool Breast Unit, Linda McCartney Centre, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - J. R. Henderson
- Liverpool Breast Unit, Linda McCartney Centre, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - N. Marikakis
- Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Southwick Hill Road, Cosham, Portsmouth, Hampshire PO6 3LY, UK
| | - J. McAleer
- Breast Care Centre, Ainscoe House, Blackpool Victoria Hospital, 12 E Park Dr, Blackpool FY3 8DX, UK
| | - J. R. Harvey
- The Nightingale Breast Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Affiliation(s)
- B G Baker
- 1 Department of Burns & Plastic Surgery, University Hospital South Manchester, Wythenshawe, UK
| | - L Joseph
- 2 Department of Pathology, University Hospital South Manchester, Wythenshawe, UK
| | - A Mishra
- 1 Department of Burns & Plastic Surgery, University Hospital South Manchester, Wythenshawe, UK
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Baker BG, Rosich-Medina A, Shah M. Ischaemia-reperfusion injury masquerading as an infected finger in a 12 month old. J Hand Surg Eur Vol 2017; 42:195-196. [PMID: 26261227 DOI: 10.1177/1753193415596473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- B G Baker
- Department of Burns & Plastic Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - A Rosich-Medina
- Department of Burns & Plastic Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - M Shah
- Department of Burns & Plastic Surgery, Royal Manchester Children's Hospital, Manchester, UK
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Baker BG, Bhalla A, Doleman B, Yarnold E, Simons S, Lund JN, Williams JP. Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment. Med Teach 2017; 39:53-57. [PMID: 27631579 DOI: 10.1080/0142159x.2016.1230188] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Simulation-based training (SBT) has become an increasingly important method by which doctors learn. Stress has an impact upon learning, performance, technical, and non-technical skills. However, there are currently no studies that compare stress in the clinical and simulated environment. We aimed to compare objective (heart rate variability, HRV) and subjective (state trait anxiety inventory, STAI) measures of stress theatre with a simulated environment. METHODS HRV recordings were obtained from eight anesthetic trainees performing an uncomplicated rapid sequence induction at pre-determined procedural steps using a wireless Polar RS800CX monitor © in an emergency theatre setting. This was repeated in the simulated environment. Participants completed an STAI before and after the procedure. RESULTS Eight trainees completed the study. The theatre environment caused an increase in objective stress vs baseline (p = .004). There was no significant difference between average objective stress levels across all time points (p = .20) between environments. However, there was a significant interaction between the variables of objective stress and environment (p = .045). There was no significant difference in subjective stress (p = .27) between environments. DISCUSSION Simulation was unable to accurately replicate the stress of the technical procedure. This is the first study that compares the stress during SBT with the theatre environment and has implications for the assessment of simulated environments for use in examinations, rating of technical and non-technical skills, and stress management training.
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Affiliation(s)
- B G Baker
- a Division of Surgery, Royal Derby Hospital , Derby , UK
| | - A Bhalla
- a Division of Surgery, Royal Derby Hospital , Derby , UK
| | - B Doleman
- b Division of Medical Sciences and Graduate Entry Medicine , University of Nottingham , Derby , UK
| | - E Yarnold
- b Division of Medical Sciences and Graduate Entry Medicine , University of Nottingham , Derby , UK
| | - S Simons
- b Division of Medical Sciences and Graduate Entry Medicine , University of Nottingham , Derby , UK
| | - J N Lund
- a Division of Surgery, Royal Derby Hospital , Derby , UK
- b Division of Medical Sciences and Graduate Entry Medicine , University of Nottingham , Derby , UK
| | - J P Williams
- a Division of Surgery, Royal Derby Hospital , Derby , UK
- b Division of Medical Sciences and Graduate Entry Medicine , University of Nottingham , Derby , UK
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Baker BG, Ball GR, Rakha EA, Nolan CC, Caldas C, Ellis IO, Green AR. Lack of expression of the proteins GMPR2 and PPARα are associated with the basal phenotype and patient outcome in breast cancer. Breast Cancer Res Treat 2013; 137:127-37. [PMID: 23208589 DOI: 10.1007/s10549-012-2302-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED Basal-like tumours (BP) are a poor prognostic class of breast cancer but remain a biologically and clinically heterogeneous group. We have previously identified two novel genes PPARα (positive) and GMPR2 (negative) whose expression was significantly associated with BP at the transcriptome level. In this study, using a large and well-characterised series of operable invasive breast carcinomas (1,043 cases) prepared as TMAs, we assessed these targets at the protein level using immunohistochemistry and investigated associations with clinicopathological variables and patient outcome. RESULTS Lack of PPARα and GMPR2 protein expression was associated with BP, as defined by the expression of cytokeratin (CK) 5/6 and/or CK14, (p = 0.023, p = 0.001, respectively) or as triple-negative (ER-, PR-, HER2-) phenotype (p < 0.001 for both proteins). Positive expression of both markers was associated ER and PR positive status (p < 0.05) and with the good Nottingham Prognostic Index group (p = 0.012, p < 0.001, respectively). Univariate survival analysis showed an association between lack of expression of PPARα and GMPR2 and poor outcome in terms of shorter disease-free survival and shorter breast cancer-specific survival, respectively. However, multivariate analysis showed that these associations were not independent of other prognostic variables, namely tumour size, grade, and nodal stage. In conclusion, this study demonstrates that loss of expression of GMPR2 and PPARα is associated with BP at the protein level; indicating that they may play a role in carcinogenesis of this molecularly complex and clinically important subtype. Further studies into their relevance in further classification of BP are warranted.
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MESH Headings
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/metabolism
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/secondary
- Disease-Free Survival
- Female
- GMP Reductase/genetics
- GMP Reductase/metabolism
- Gene Expression
- Humans
- Kaplan-Meier Estimate
- Lymphatic Metastasis
- Middle Aged
- Multivariate Analysis
- Neoplasms, Basal Cell/metabolism
- Neoplasms, Basal Cell/mortality
- Neoplasms, Basal Cell/secondary
- PPAR alpha/genetics
- PPAR alpha/metabolism
- Phenotype
- Proportional Hazards Models
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Affiliation(s)
- B G Baker
- School of Molecular Medical Sciences and Cellular Pathology, Nottingham University Hospitals and University of Nottingham, Nottingham, UK
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Abstract
Three techniques giving information on composition and chemical states of atoms in the first few monolayers of a surface are described: X-ray photoelectron spectroscopy, Auger electron spectroscopy and secondary ion mass spectrometry. Their application to industrial problem solving, optimization of process or materials, and long-term research and development is illustrated in three case studies. Analysis of the effectiveness of surface treatments for steel pipe before fusion-bonded epoxy application revealed thin phosphate layers and partial separation of chromate from silicate in passivation. Aluminosilicate layers on glacial quartz used for glass making were detected giving handling and melting difficulties. These problems were overcome by changes to process conditions resulting from the surface investigation and plant trials. Exploratory research has produced a Fischer-Tropsch catalyst effective in totally converting CO and H2 (H2/CO ≥ 1) into short-chain alkenes at 300°, with H2O and CO2 (H2O/CO2 = 2) as by-products. The catalyst is made from natural bauxite. Characterization of the surface properties by surface analysis and electron microscopy is described. Examples of other projects for Australian industry are summarized.
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