Irish journal of medical science
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Management of axillary disease in breast cancer has evolved significantly over the last two decades with the introduction of SLNB and a trend towards less radical surgery. Data from the American College of Surgeons Oncology Group Z0011 trial proposes that not all patients with positive axillary lymph nodes require completion axillary dissection. ⋯ There has been a change in clinical practice since the publication of the Z0011 trial, illustrated by a decrease in the rate of axillary clearance in node-positive breast cancers.
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The implementation of the European work-time directive has created increased transitions of care during weekends as doctors adhere to a shift-work structure. This raises concerns over continuity of care and patient safety. To address this, doctors must develop a time efficient yet safe system of handover of patients to the team on-call. Intuitively weekend care provides the ideal setting to develop a handover tool. ⋯ The standardisation of weekend handover using a combination of an electronic tool supplemented with verbal handover is feasible. It resulted in a significant improvement in surrogate markers of patient care quality.
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Planar bone scintigraphy (PBS) is a standard radiological technique to detect skeletal metastases from prostate cancer (PC), the addition of SPECT-CT to PBS improves its diagnostic accuracy. The aim of this study was to assess the additional value of targeted SPECT-CT with PBS in detecting skeletal metastasis form prostate cancer, considering resource implications in an Irish hospital setting. ⋯ SPECT-CT improves the diagnostic accuracy of PBS in detecting skeletal metastasis from PC and is superior to PBS alone in differentiating benign from malignant lesions. Notwithstanding resource implications of increased cost, specialist equipment and specialist manpower hours; we recommend the use of SPECT-CT in conjunction with PBS for targeted evaluation of suspicious bony lesions in this cohort of patients.
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Observational Study
The relevance of basic sciences in undergraduate medical education.
Evolving and changing undergraduate medical curricula raise concerns that there will no longer be a place for basic sciences. National and international trends show that 5-year programmes with a pre-requisite for school chemistry are growing more prevalent. National reports in Ireland show a decline in the availability of school chemistry and physics. ⋯ University basic sciences were found to be more predictive than school sciences in undergraduate medical performance in our institution. The increasing emphasis of basic sciences in medical practice and the declining availability of school sciences should mandate medical schools in Ireland to consider how removing basic sciences from the curriculum might impact on future applicants.
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The aim of this study is to review a cohort of cases with vaginal intraepithelial neoplasia (VAIN) in a Chinese tertiary centre and to analyze the relationship between VAIN and cervical neoplasm, the treatment of the disease, and the outcomes. ⋯ VAIN is a disease which has a close relationship with cervical neoplasia. Electrofulguration treatment with local resection is a suitable treatment with a much lower recurrence rate. For VAIN 1, observation may be a good choice especially for younger patients.