Isabella Dash | The University Of East Anglia (original) (raw)
Papers by Isabella Dash
Clinical Radiology, 2017
To assess the rate of upgrade in our screening population to determine whether open excision biop... more To assess the rate of upgrade in our screening population to determine whether open excision biopsy of mucocoele-like lesions (MLL) is still required. MATERIALS AND METHODS: A retrospective review of the breast screening database from 1999e2014 was performed. RESULTS: MLL were identified on core biopsy in 113 women (0.6% of those recalled for a core biopsy). The majority (n¼100, 88%) had a localised cluster of calcification prompting screening recall. Eighty-seven percent (n¼99) underwent an excision biopsy; there was a 5% upgrade rate to malignancy (all low/intermediate ductal carcinoma in situ [DCIS]) and 15 women (15%) were found to have an additional "B3" lesion. Fourteen women did not undergo excision biopsy; none of these women had a subsequent cancer at an average of 5-years follow-up. Within the follow-up period, five additional cancers were identified, one of these was in the ipsilateral breast and location, albeit 9-years later. CONCLUSION: This is the largest study of MLL in the literature to date. The present findings show a 5% upgrade rate to DCIS. As long as the current management of low-risk DCIS remains surgical excision, the present results support continued excision of MLLs, either surgically or by vacuum-assisted biopsy.
European Journal of Surgical Oncology, 2018
current practices regarding therapeutic mammoplasty in Scotland compared to other techniques, and... more current practices regarding therapeutic mammoplasty in Scotland compared to other techniques, and assess for delay to adjuvant treatment in these patients. Methods: Patients who underwent TM, wide local excision (WLE), mastectomy, or mastectomy with immediate reconstruction (MIR) as their definitive surgery for breast cancer in Scotland between 01/01/2014 and 31/12/2015 were identified from prospectively maintained databases within the Managed Clinical Networks of Scotland. Patient and tumour characteristics were compared between the four groups using Chi square tests. Results: 8075 patients were included in the study, of which 217 had TM as their definitive procedure. 217/5458 (4.0%) breast conserving operations were TMs, whereas the overall rate of oncoplastic surgery was 11.5%. Patients who underwent TM were younger than patients who had WLE or mastectomy but slightly older than MIR patients (median: TM 55 years (29-81), WLE 62yrs (23-97), mastectomy 70yrs (25-96), MIR 50yrs (24-78), p<0.0001). TM patients had larger tumours than those who had WLE, but smaller than both mastectomy groups (median whole tumour size: TM 25mm (1-20), WLE 17mm (0-123), mastectomy 33mm (0-190), MIR 35mm (1-246), p<0.0001). No delay to start of adjuvant chemotherapy was observed (median: TM 42 days (26-161), WLE 40d (11-407), p¼0.528). Conclusions: Our data shows that in current Scottish practice, as might be expected, TM is carried out for younger patients with larger tumours than those who have simple WLE. No delay to chemotherapy was demonstrated.
British Journal of Cancer, 2021
Background The B-MaP-C study aimed to determine alterations to breast cancer (BC) management duri... more Background The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-bas...
The Breast, 2018
for the individual follow-up, we reviewed each patient's answered questionnaires and quantified t... more for the individual follow-up, we reviewed each patient's answered questionnaires and quantified those who had completed all the corresponding surveys since time of inclusion. Results: To date, 360 patients have been accrued in the "Joven & Fuerte" cohort at three sites. Six-month, 1-y and 2-y follow-up has been reached for 306, 242 and 115 patients, respectively. Correspondingly, the rate of answered surveys is 69%, 92%, and 65% for each timeframe. Regarding individual follow-up, we identified that a significant number of unanswered questionnaires occurs at the 6-m follow-up, as 52% patients completed baseline, 6-m and 1-y follow-up surveys compared to 69% who answered baseline and 1-y. Also, we identified that only 47% have completed all the predetermined surveys up to 2-y of follow-up. Conclusions: The "Joven & Fuerte" prospective cohort has accrued a significant number of YWBC patients in Mexico and will provide a meaningful contribution to the current knowledge of BC in this unique and understudied population. The challenges of patient retention and data collection are predominantly of a logistical nature due to lack of human and financial resources, which poses a risk of patient saturation and loss to follow-up. To overcome these setbacks, less number of questionnaires during follow-up will be applied and patients will be reached by other means like social media and telephone. Finally, the program will keep seeking to be fully incorporated to the institutional protocols for enhanced coordination and improvement of patient retention.
European Journal of Surgical Oncology, 2019
European Journal of Surgical Oncology (EJSO), 2017
Introduction: Mucocele like lesions (MLL) are classified as an indeterminate 'B3' lesion, due to ... more Introduction: Mucocele like lesions (MLL) are classified as an indeterminate 'B3' lesion, due to difficulties distinguishing them from mucinous carcinoma on percutaneous breast biopsy (PBB). Current guidelines for surgical excision biopsy (EB) are based on small case series with varying rates of upgrade. Aim: To assess our rates of upgrade in order to identify whether EB is necessary. Methods: We performed a retrospective review of the Breast Screen Western Australia (BSWA) database from 1995e2014. Results: Of the 32,400 (9%) women undergoing PBB in the time period, 89 were diagnosed with an MLL (0.4%). The mean age was 51 (40e80 years). The mammographic abnormality for 67 (75%) was 'localised cluster of calcifications'. Stereotactic PBB was performed for 73 (82%). Seventy-six (85%) underwent Hookwire EB. Fifty-seven patients (75%) had a final benign result, 12 (16%) had an indeterminate result and 7 (9%) had a malignant result. This included a grade 1 papillary carcinoma, a mucinous high grade ductal carcinoma in situ (DCIS) and 5 cases of low grade DCIS. The mean length of follow up was 5 years (1e15 years). Three (3%) further ipsilateral cancers were identified, all in patients who had had previous excision biopsies, 3, 4 and 9 years subsequently. Conclusion: None of our patients had an upgrade to mucinous carcinoma. The upgrade rate for MLL with atypia is 18%, however MLL without atypia is upgraded in only 7.5%. The increasing use of Vacuum assisted excision biopsy, may allow careful selection of patients with pure MLL who can avoid EB.
Primary Health Care Research & Development, 2016
Aim To assess and improve the quality of Secondary to Primary Care communication on discharge wit... more Aim To assess and improve the quality of Secondary to Primary Care communication on discharge with a focus on post-surgical wound care. Background Hospital discharge summaries are the principle means of relaying accurate information back to primary care healthcare providers regarding a patient’s hospital attendance and any ongoing care that is required. The quality of these summaries can be quiet varied both nationally and local to our Trust. Subsequently the Surgical Directorate were seeing an increased level of additional emergency communication from Primary Care providers especially in relation to post-operative wound care. Methods A survey was distributed to local Primary Care practitioners to assess satisfaction with the General Surgical Department wound care information located on the discharge summary. Using these results, a wound closure information document was developed and distributed to general practice surgeries, and a patient-held ‘wound care’ card was piloted for two ...
European Journal of Surgical Oncology (EJSO), 2016
Introduction: Over the past decade, the mean length of stay (LOS) after breast surgery has nearly... more Introduction: Over the past decade, the mean length of stay (LOS) after breast surgery has nearly halved. Day surgery for breast cancer has been shown to be safe and become increasingly popular with good patient feedback. We present the audit results for non-reconstructive breast cancer surgery in the practice of a single oncoplastic surgeon. Methods: All patients undergoing non-reconstructive surgery including wide local excision (WLE) or mastectomy with or without sentinel node biopsy or axillary clearance were prospectively entered into a database. Patient demographics, type of operation, LOS and any readmissions were noted. The time at which mastectomy patients returned to the ward was noted. Patient satisfaction questionnaires asking about e (i) adequacy of information given, (ii) any readmission, (iii) analgesic requirements and (iv) if they would opt for day surgery again were handed to patients upon discharge and collected anonymously. Results: Between Sept-14 and Sept-15, 96 non-reconstructive breast operations were performed. Mastectomy patients planned for day surgery, on average returned to the ward postoperatively by 2pm. Two patients had unplanned overnight stay (1 following blue-dye reaction and 1 due to bleeding). 44 patients have returned the questionnaire with extremely high satisfaction rates for all the questions (range 93e100%) with all patients happy to recommend day surgery. Conclusions: Day surgery for non-reconstructed breast surgery was found to be safe and highly acceptable to patients. With good planning, mastectomy patients had adequate time to recover after their operations and go home the same day.
Emergency Medicine Journal, 2015
Interpersonal violence is an epidemic in South Africa and remains an under-reported and expensive... more Interpersonal violence is an epidemic in South Africa and remains an under-reported and expensive burden on health resources. In most of the developing world there is little or no descriptive information about the expense of treating the consequences of interpersonal violence. To review the direct burden of interpersonal violence on a tertiary hospital in Northern KwaZulu-Natal, an area known to have high rates of poverty and violent crime. A retrospective case note review of emergency hospital admissions between January and March 2013 was carried out. The reports included demographic characteristics, admitting diagnosis and surgical management. Case files were reviewed to determine cost drivers, such as radiological investigations, blood products, theatre usage and specialist care. Trauma accounted for 374 hospital admissions from the emergency department, of which 142 (38%) were attributable to interpersonal violence (16% of total admissions). One hundred and fifty-six hospital bed days were used over the study period. The average inpatient stay was 9.8 days with 58% requiring a resuscitation bed on admission. One-third of patients underwent emergency surgery and eight patients required postoperative intensive care. The minimum hospital expenditure for interpersonal violence injuries over 3 months was R8 367 788 ($783 960). Interpersonal violence is the source of a significant financial burden on the South African health system. Patients are often severely injured and require a high level of specialist investigations and surgical care. This study gives evidence to improve budget and workload planning for regional surgical departments and supports the need for more effective primary prevention.
International Journal of Surgery, 2014
Results: Of the 202 appendicectomies, 23 (11%) were histologically negative for appendicitis and ... more Results: Of the 202 appendicectomies, 23 (11%) were histologically negative for appendicitis and there were 31 (15%) cases of perforated appendix. When comparing the "negative appendicitis" vs. "inflamed appendix" group, we found no significant difference between the frequency of raised WCC, NC, CRP. The sensitivity and specificity of each blood test for a diagnosis of acute appendicitis were as follows: WCC (62.6% and 52.2%), NC (72.6% and 43.5%), CRP (70.9% and 47.8%), and for 2 combined tests (70.9% and 43.5%). When comparing "perforated appendix" vs. "non-perforated" group, there was a significant difference in the number of cases with raised CRP (p<0.05). CRP was 90.3% sensitive for perforated appendix. Conclusions: Inflammatory markers, including WCC, NC and CRP are not accurate enough to diagnose acute appendicitis. However, CRP alone is a sensitive marker for cases of perforated appendix.
International Journal of Surgery, 2014
Thirty-five students completed all three sessions (M:F 8:27). Mean score in first session:59.6/70... more Thirty-five students completed all three sessions (M:F 8:27). Mean score in first session:59.6/70 (Range 18-70). After feedback, second session scores: Verbal mean: 49.0 (16-70), Video mean: 56.0 (8-70); demonstrating higher skill retention in the video feedback group. Following cross-over for final session, mean score for group now receiving video: 60.2(46-70), mean score for verbal: 59.5 (28-70), showing increased skill retention with video feedback. Conclusions: Video feedback improves performance in undergraduate practical skills, allowing greater skill retention, with implications for surgical training.
Introduction: Although sentinel lymph node biopsy (SLNB) is the gold standard for clinical and ra... more Introduction: Although sentinel lymph node biopsy (SLNB) is the gold standard for clinical and radiological negative axillae in breast cancer, the subsequent management of positive nodes is currently under scrutiny with the Z0011 trial publication causing much debate. Our aim was to determine whether there were any predictive factors in our cohort of patients that could assist in the decision of whether the patient required a further axillary lymph node clearance. Methods: A retrospective analysis of a prospectively maintained database of patients who underwent SLNB and their histology was performed. Univariate and multivariate analysis was performed to identify any predictive factors. Results: Our Breast Unit performed 457 SLNB over the three years. The mean age of patients was 61.9 years (range 31-89 years). Of these 457 SLNB, 122 (26.7%) were positive for metastatic involvement, and of these patients only 34% were found to have further lymph node involvement after axillary lymph node clearance (ALNC). Only 8% of our total patient cohort had non sentinel node involvement at completion ALNC. Using univariate analysis, lymphovascular invasion (p0.009), grade (p0.007) and size (p0.006) were all significant predictors for having a positive ALNC. Conclusion: Only 8% of the total number of patients had an additional positive lymph node found in their completion axillary clearance. Our results add to this existing knowledge on the subject, and show that there are certain factors which should be carefully considered pre-operatively in order to help inform patient and surgeon choice regarding management of the axilla.
Indian journal of surgical oncology, 2012
Neuroendocrine tumours (NET) frequently metastasise to the liver (NLM) and are associated with si... more Neuroendocrine tumours (NET) frequently metastasise to the liver (NLM) and are associated with significant morbidity and mortality. Numerous treatment options have been implemented both for cure, and to implement disease control. Surgical treatment includes curative resection, palliative cytoreductive resection and transplantation. Complete surgical resection is only possible in a subset of people with NLMs due to excessive metastatic burden and anatomical location. Ablative therapies may be used either as an adjunct to surgery or as a primary treatment. The purpose of the following article is to summarise surgical treatment strategies in the management of patients with hepatic neuroendocrine metastases, based on the available literature.
European Journal of Surgical Oncology (EJSO), 2014
effect size ¼ 2.39), social functioning (p¼0.027, effect size ¼ 2.21), pain (p¼0.035, effect size... more effect size ¼ 2.39), social functioning (p¼0.027, effect size ¼ 2.21), pain (p¼0.035, effect size ¼ 2.11) and physical wellbeing (p¼0.035, effect size ¼ 2.11). Younger age adversely affected psychosocial functioning with decreased role functioning (p¼0.055, effect size¼ 1.92) and social functioning (p¼0.025, effect size¼ 2.24). Conclusion: Evaluation of HRQL effects particularly in functional domains (role and social) are important beyond 12 months up to 3 years, particularly following early surgical complications and in younger women. The effects of PMRT may be considered a surrogate for more aggressive tumours affecting social functioning and arm symptoms in the context of improvements in most HRQL domains, notably global QL. Disease-specific PROMS have a complimentary role alongside surgery-specific PROMS and require future analyses in cohort studies.
European Journal of Surgical Oncology (EJSO), 2013
Although rare in incidence, patients with neuroendocrine tumours (NET) live for many years and so... more Although rare in incidence, patients with neuroendocrine tumours (NET) live for many years and so have a high prevalence, and NETs frequently metastasise to the liver (NLM). Numerous treatment options have been implemented both for cure, and to implement disease control. Surgical treatment consists of curative resection, palliative cytoreductive resection and transplantation. Complete surgical resection is possible only in a subset of people with NLMs due to various factors. Ablative therapies may also be used, either as an adjunct to surgery or as a primary treatment. The purpose of the article is to summarise surgical treatment strategies in the management of patients with hepatic neuroendocrine metastases.
Clinical Radiology, 2017
To assess the rate of upgrade in our screening population to determine whether open excision biop... more To assess the rate of upgrade in our screening population to determine whether open excision biopsy of mucocoele-like lesions (MLL) is still required. MATERIALS AND METHODS: A retrospective review of the breast screening database from 1999e2014 was performed. RESULTS: MLL were identified on core biopsy in 113 women (0.6% of those recalled for a core biopsy). The majority (n¼100, 88%) had a localised cluster of calcification prompting screening recall. Eighty-seven percent (n¼99) underwent an excision biopsy; there was a 5% upgrade rate to malignancy (all low/intermediate ductal carcinoma in situ [DCIS]) and 15 women (15%) were found to have an additional "B3" lesion. Fourteen women did not undergo excision biopsy; none of these women had a subsequent cancer at an average of 5-years follow-up. Within the follow-up period, five additional cancers were identified, one of these was in the ipsilateral breast and location, albeit 9-years later. CONCLUSION: This is the largest study of MLL in the literature to date. The present findings show a 5% upgrade rate to DCIS. As long as the current management of low-risk DCIS remains surgical excision, the present results support continued excision of MLLs, either surgically or by vacuum-assisted biopsy.
European Journal of Surgical Oncology, 2018
current practices regarding therapeutic mammoplasty in Scotland compared to other techniques, and... more current practices regarding therapeutic mammoplasty in Scotland compared to other techniques, and assess for delay to adjuvant treatment in these patients. Methods: Patients who underwent TM, wide local excision (WLE), mastectomy, or mastectomy with immediate reconstruction (MIR) as their definitive surgery for breast cancer in Scotland between 01/01/2014 and 31/12/2015 were identified from prospectively maintained databases within the Managed Clinical Networks of Scotland. Patient and tumour characteristics were compared between the four groups using Chi square tests. Results: 8075 patients were included in the study, of which 217 had TM as their definitive procedure. 217/5458 (4.0%) breast conserving operations were TMs, whereas the overall rate of oncoplastic surgery was 11.5%. Patients who underwent TM were younger than patients who had WLE or mastectomy but slightly older than MIR patients (median: TM 55 years (29-81), WLE 62yrs (23-97), mastectomy 70yrs (25-96), MIR 50yrs (24-78), p<0.0001). TM patients had larger tumours than those who had WLE, but smaller than both mastectomy groups (median whole tumour size: TM 25mm (1-20), WLE 17mm (0-123), mastectomy 33mm (0-190), MIR 35mm (1-246), p<0.0001). No delay to start of adjuvant chemotherapy was observed (median: TM 42 days (26-161), WLE 40d (11-407), p¼0.528). Conclusions: Our data shows that in current Scottish practice, as might be expected, TM is carried out for younger patients with larger tumours than those who have simple WLE. No delay to chemotherapy was demonstrated.
British Journal of Cancer, 2021
Background The B-MaP-C study aimed to determine alterations to breast cancer (BC) management duri... more Background The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-bas...
The Breast, 2018
for the individual follow-up, we reviewed each patient's answered questionnaires and quantified t... more for the individual follow-up, we reviewed each patient's answered questionnaires and quantified those who had completed all the corresponding surveys since time of inclusion. Results: To date, 360 patients have been accrued in the "Joven & Fuerte" cohort at three sites. Six-month, 1-y and 2-y follow-up has been reached for 306, 242 and 115 patients, respectively. Correspondingly, the rate of answered surveys is 69%, 92%, and 65% for each timeframe. Regarding individual follow-up, we identified that a significant number of unanswered questionnaires occurs at the 6-m follow-up, as 52% patients completed baseline, 6-m and 1-y follow-up surveys compared to 69% who answered baseline and 1-y. Also, we identified that only 47% have completed all the predetermined surveys up to 2-y of follow-up. Conclusions: The "Joven & Fuerte" prospective cohort has accrued a significant number of YWBC patients in Mexico and will provide a meaningful contribution to the current knowledge of BC in this unique and understudied population. The challenges of patient retention and data collection are predominantly of a logistical nature due to lack of human and financial resources, which poses a risk of patient saturation and loss to follow-up. To overcome these setbacks, less number of questionnaires during follow-up will be applied and patients will be reached by other means like social media and telephone. Finally, the program will keep seeking to be fully incorporated to the institutional protocols for enhanced coordination and improvement of patient retention.
European Journal of Surgical Oncology, 2019
European Journal of Surgical Oncology (EJSO), 2017
Introduction: Mucocele like lesions (MLL) are classified as an indeterminate 'B3' lesion, due to ... more Introduction: Mucocele like lesions (MLL) are classified as an indeterminate 'B3' lesion, due to difficulties distinguishing them from mucinous carcinoma on percutaneous breast biopsy (PBB). Current guidelines for surgical excision biopsy (EB) are based on small case series with varying rates of upgrade. Aim: To assess our rates of upgrade in order to identify whether EB is necessary. Methods: We performed a retrospective review of the Breast Screen Western Australia (BSWA) database from 1995e2014. Results: Of the 32,400 (9%) women undergoing PBB in the time period, 89 were diagnosed with an MLL (0.4%). The mean age was 51 (40e80 years). The mammographic abnormality for 67 (75%) was 'localised cluster of calcifications'. Stereotactic PBB was performed for 73 (82%). Seventy-six (85%) underwent Hookwire EB. Fifty-seven patients (75%) had a final benign result, 12 (16%) had an indeterminate result and 7 (9%) had a malignant result. This included a grade 1 papillary carcinoma, a mucinous high grade ductal carcinoma in situ (DCIS) and 5 cases of low grade DCIS. The mean length of follow up was 5 years (1e15 years). Three (3%) further ipsilateral cancers were identified, all in patients who had had previous excision biopsies, 3, 4 and 9 years subsequently. Conclusion: None of our patients had an upgrade to mucinous carcinoma. The upgrade rate for MLL with atypia is 18%, however MLL without atypia is upgraded in only 7.5%. The increasing use of Vacuum assisted excision biopsy, may allow careful selection of patients with pure MLL who can avoid EB.
Primary Health Care Research & Development, 2016
Aim To assess and improve the quality of Secondary to Primary Care communication on discharge wit... more Aim To assess and improve the quality of Secondary to Primary Care communication on discharge with a focus on post-surgical wound care. Background Hospital discharge summaries are the principle means of relaying accurate information back to primary care healthcare providers regarding a patient’s hospital attendance and any ongoing care that is required. The quality of these summaries can be quiet varied both nationally and local to our Trust. Subsequently the Surgical Directorate were seeing an increased level of additional emergency communication from Primary Care providers especially in relation to post-operative wound care. Methods A survey was distributed to local Primary Care practitioners to assess satisfaction with the General Surgical Department wound care information located on the discharge summary. Using these results, a wound closure information document was developed and distributed to general practice surgeries, and a patient-held ‘wound care’ card was piloted for two ...
European Journal of Surgical Oncology (EJSO), 2016
Introduction: Over the past decade, the mean length of stay (LOS) after breast surgery has nearly... more Introduction: Over the past decade, the mean length of stay (LOS) after breast surgery has nearly halved. Day surgery for breast cancer has been shown to be safe and become increasingly popular with good patient feedback. We present the audit results for non-reconstructive breast cancer surgery in the practice of a single oncoplastic surgeon. Methods: All patients undergoing non-reconstructive surgery including wide local excision (WLE) or mastectomy with or without sentinel node biopsy or axillary clearance were prospectively entered into a database. Patient demographics, type of operation, LOS and any readmissions were noted. The time at which mastectomy patients returned to the ward was noted. Patient satisfaction questionnaires asking about e (i) adequacy of information given, (ii) any readmission, (iii) analgesic requirements and (iv) if they would opt for day surgery again were handed to patients upon discharge and collected anonymously. Results: Between Sept-14 and Sept-15, 96 non-reconstructive breast operations were performed. Mastectomy patients planned for day surgery, on average returned to the ward postoperatively by 2pm. Two patients had unplanned overnight stay (1 following blue-dye reaction and 1 due to bleeding). 44 patients have returned the questionnaire with extremely high satisfaction rates for all the questions (range 93e100%) with all patients happy to recommend day surgery. Conclusions: Day surgery for non-reconstructed breast surgery was found to be safe and highly acceptable to patients. With good planning, mastectomy patients had adequate time to recover after their operations and go home the same day.
Emergency Medicine Journal, 2015
Interpersonal violence is an epidemic in South Africa and remains an under-reported and expensive... more Interpersonal violence is an epidemic in South Africa and remains an under-reported and expensive burden on health resources. In most of the developing world there is little or no descriptive information about the expense of treating the consequences of interpersonal violence. To review the direct burden of interpersonal violence on a tertiary hospital in Northern KwaZulu-Natal, an area known to have high rates of poverty and violent crime. A retrospective case note review of emergency hospital admissions between January and March 2013 was carried out. The reports included demographic characteristics, admitting diagnosis and surgical management. Case files were reviewed to determine cost drivers, such as radiological investigations, blood products, theatre usage and specialist care. Trauma accounted for 374 hospital admissions from the emergency department, of which 142 (38%) were attributable to interpersonal violence (16% of total admissions). One hundred and fifty-six hospital bed days were used over the study period. The average inpatient stay was 9.8 days with 58% requiring a resuscitation bed on admission. One-third of patients underwent emergency surgery and eight patients required postoperative intensive care. The minimum hospital expenditure for interpersonal violence injuries over 3 months was R8 367 788 ($783 960). Interpersonal violence is the source of a significant financial burden on the South African health system. Patients are often severely injured and require a high level of specialist investigations and surgical care. This study gives evidence to improve budget and workload planning for regional surgical departments and supports the need for more effective primary prevention.
International Journal of Surgery, 2014
Results: Of the 202 appendicectomies, 23 (11%) were histologically negative for appendicitis and ... more Results: Of the 202 appendicectomies, 23 (11%) were histologically negative for appendicitis and there were 31 (15%) cases of perforated appendix. When comparing the "negative appendicitis" vs. "inflamed appendix" group, we found no significant difference between the frequency of raised WCC, NC, CRP. The sensitivity and specificity of each blood test for a diagnosis of acute appendicitis were as follows: WCC (62.6% and 52.2%), NC (72.6% and 43.5%), CRP (70.9% and 47.8%), and for 2 combined tests (70.9% and 43.5%). When comparing "perforated appendix" vs. "non-perforated" group, there was a significant difference in the number of cases with raised CRP (p<0.05). CRP was 90.3% sensitive for perforated appendix. Conclusions: Inflammatory markers, including WCC, NC and CRP are not accurate enough to diagnose acute appendicitis. However, CRP alone is a sensitive marker for cases of perforated appendix.
International Journal of Surgery, 2014
Thirty-five students completed all three sessions (M:F 8:27). Mean score in first session:59.6/70... more Thirty-five students completed all three sessions (M:F 8:27). Mean score in first session:59.6/70 (Range 18-70). After feedback, second session scores: Verbal mean: 49.0 (16-70), Video mean: 56.0 (8-70); demonstrating higher skill retention in the video feedback group. Following cross-over for final session, mean score for group now receiving video: 60.2(46-70), mean score for verbal: 59.5 (28-70), showing increased skill retention with video feedback. Conclusions: Video feedback improves performance in undergraduate practical skills, allowing greater skill retention, with implications for surgical training.
Introduction: Although sentinel lymph node biopsy (SLNB) is the gold standard for clinical and ra... more Introduction: Although sentinel lymph node biopsy (SLNB) is the gold standard for clinical and radiological negative axillae in breast cancer, the subsequent management of positive nodes is currently under scrutiny with the Z0011 trial publication causing much debate. Our aim was to determine whether there were any predictive factors in our cohort of patients that could assist in the decision of whether the patient required a further axillary lymph node clearance. Methods: A retrospective analysis of a prospectively maintained database of patients who underwent SLNB and their histology was performed. Univariate and multivariate analysis was performed to identify any predictive factors. Results: Our Breast Unit performed 457 SLNB over the three years. The mean age of patients was 61.9 years (range 31-89 years). Of these 457 SLNB, 122 (26.7%) were positive for metastatic involvement, and of these patients only 34% were found to have further lymph node involvement after axillary lymph node clearance (ALNC). Only 8% of our total patient cohort had non sentinel node involvement at completion ALNC. Using univariate analysis, lymphovascular invasion (p0.009), grade (p0.007) and size (p0.006) were all significant predictors for having a positive ALNC. Conclusion: Only 8% of the total number of patients had an additional positive lymph node found in their completion axillary clearance. Our results add to this existing knowledge on the subject, and show that there are certain factors which should be carefully considered pre-operatively in order to help inform patient and surgeon choice regarding management of the axilla.
Indian journal of surgical oncology, 2012
Neuroendocrine tumours (NET) frequently metastasise to the liver (NLM) and are associated with si... more Neuroendocrine tumours (NET) frequently metastasise to the liver (NLM) and are associated with significant morbidity and mortality. Numerous treatment options have been implemented both for cure, and to implement disease control. Surgical treatment includes curative resection, palliative cytoreductive resection and transplantation. Complete surgical resection is only possible in a subset of people with NLMs due to excessive metastatic burden and anatomical location. Ablative therapies may be used either as an adjunct to surgery or as a primary treatment. The purpose of the following article is to summarise surgical treatment strategies in the management of patients with hepatic neuroendocrine metastases, based on the available literature.
European Journal of Surgical Oncology (EJSO), 2014
effect size ¼ 2.39), social functioning (p¼0.027, effect size ¼ 2.21), pain (p¼0.035, effect size... more effect size ¼ 2.39), social functioning (p¼0.027, effect size ¼ 2.21), pain (p¼0.035, effect size ¼ 2.11) and physical wellbeing (p¼0.035, effect size ¼ 2.11). Younger age adversely affected psychosocial functioning with decreased role functioning (p¼0.055, effect size¼ 1.92) and social functioning (p¼0.025, effect size¼ 2.24). Conclusion: Evaluation of HRQL effects particularly in functional domains (role and social) are important beyond 12 months up to 3 years, particularly following early surgical complications and in younger women. The effects of PMRT may be considered a surrogate for more aggressive tumours affecting social functioning and arm symptoms in the context of improvements in most HRQL domains, notably global QL. Disease-specific PROMS have a complimentary role alongside surgery-specific PROMS and require future analyses in cohort studies.
European Journal of Surgical Oncology (EJSO), 2013
Although rare in incidence, patients with neuroendocrine tumours (NET) live for many years and so... more Although rare in incidence, patients with neuroendocrine tumours (NET) live for many years and so have a high prevalence, and NETs frequently metastasise to the liver (NLM). Numerous treatment options have been implemented both for cure, and to implement disease control. Surgical treatment consists of curative resection, palliative cytoreductive resection and transplantation. Complete surgical resection is possible only in a subset of people with NLMs due to various factors. Ablative therapies may also be used, either as an adjunct to surgery or as a primary treatment. The purpose of the article is to summarise surgical treatment strategies in the management of patients with hepatic neuroendocrine metastases.