Extreme Oncoplasty: Breast Conservation in Patients with Large, Multifocal, and Multicentric Breast Cancer.

Introduction: Extreme Oncoplastic Breast Conservation Surgery (EOBCS) is offered in selected patients with multifocal or multicentric breast cancer (MFMC). Recent evidence has suggested that EOBCS may be a valuable resource for patients with MFMC who may avoid the risk associated with mastectomy in favour of the benefits of breast conservation without risking their oncological outcomes. Our study examined the practice of EOBCS in two regional breast units in Glasgow, United Kingdom.

Rare cutaneous metastasis from sarcomatoid carcinoma of lung.

We present the case of a 57-year-old woman diagnosed with stage 4 sarcomatoid carcinoma of the lung who concurrently developed a scalp lesion, thought to be a cyst, which continued to grow and ulcerate. Excision revealed a rare case, only four previously reported in the literature, of metastatic sarcomatoid carcinoma of the lung. While a very unusual case, we would like to emphasise the importance of considering skin metastases when presented with unusual skin lesions, and importantly listening to the patient's concerns, showing empathy and respecting their autonomy and referring to an appropriate specialist when considering the management of what may seem to be a minor skin report.

A prospective cohort study of the safety of breast cancer surgery during COVID-19 pandemic in the West of Scotland.

Introduction: In order to minimise the risk of breast cancer patients for COVID-19 infection related morbidity and mortality prioritisation of care has utmost importance since the onset of the pandemic. However, COVID-19 related risk in patients undergoing breast cancer surgery has not been studied yet. We evaluated the safety of breast cancer surgery during COVID-19 pandemic in the West of Scotland region.

Reconstructive trends following mastectomies in Scotland: A comparison with England.

Introduction: In England there has been a substantial increase in the use of immediate implant-based reconstruction, accounting for over half of all immediate reconstructions (IR). Less than one third of patients in England undergo autologous reconstruction IR. Our aim was to examine IR trends in Scotland.

Advance care planning in patients referred to hospital for acute medical care: Results of a national day of care survey.

Background: Advance care planning (ACP) is a voluntary process of discussion about future care between an individual and their care provider. ACP is a key focus of national policy as a means to improve patient centered care at the end-of-life. Despite a wide held belief that ACP is beneficial, uptake is sporadic with considerable variation depending on age, ethnicity, location and disease group.

Case finding for dementia during acute hospital admissions: a mixed-methods study exploring the impacts on patient care after discharge and costs for the English National Health Service.

Objective: Between 2012 and 2017 dementia case finding was routinely carried out on people aged 75 years and over with unplanned admissions to acute hospitals across England. The assumption was that this would lead to better planning of care and treatment for patients with dementia following discharge from hospital. However, little is known about the experiences of patients and carers or the impacts on other health services.

Oncoplastic breast conservation occupies a niche between standard breast conservation and mastectomy - A population-based prospective audit in Scotland.

Introduction: The role of oncoplastic breast conservation (OBC) surgery is not fully defined in terms of whether it is equivalent to standard breast conservation (SBC), or more an alternative to mastectomy, or whether it occupies its own niche somewhere between the two. Therefore, we have carried out a population-based prospective audit of the current OBC practice in Scotland.

Methods: All patients diagnosed with breast cancer in the whole of Scotland between 01/01/2014 and 31/12/2015 were prospectively recorded within the National Managed Clinical Networks databases.

The tip of the iceberg: finding patients with heart failure with preserved ejection fraction in primary care. An observational study.

Background: Heart failure with preserved ejection fraction (HFpEF) is under-identified in primary care.

Aim: The aim of this study was to determine what information is available in patients' primary care practice records that would identify patients with HFpEF.

Design & Setting: Record review in two practices in east of England.

A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland - An analysis of 589 patients.

Introduction: Current evidence for oncoplastic breast conservation (OBC) is based on single institutional series. Therefore, we carried out a population-based audit of OBC practice and outcomes in Scotland.

Methods: A predefined database of patients treated with OBC was completed retrospectively in all breast units practicing OBC in Scotland.

GPs' perceptions of advance care planning with frail and older people: a qualitative study.

Background: Frail and older people are estimated to account for 40% of deaths. Despite conversations about end-of-life care being an important component of the national End of Life Care Strategy, there is a marked disparity between the majority who would like to discuss advance care plans, and the minority who currently have this opportunity.

Aim: To investigate the attitudes of GPs to advance care planning (ACP) discussions with frail and older individuals.

Discussion and documentation of future care: a before-and-after study examining the impact of an alternative approach to recording treatment decisions on advance care planning in an acute hospital.

Objective: To determine whether discussion and documentation of decisions about future care was improved following the introduction of a new approach to recording treatment decisions: the Universal Form of Treatment Options (UFTO).

Methods: Retrospective review of the medical records of patients who died within 90 days of admission to oncology or respiratory medicine wards over two 3-month periods, preimplementation and postimplementation of the UFTO. A sample size of 70 per group was required to provide 80% power to observe a change from 15% to 35% in discussion or documentation of advance care planning (ACP), using a two-sided test at the 5% significance level.

Themes and variations: An exploratory international investigation into resuscitation decision-making.

Background: Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions are made in hospitals throughout the globe. International variation in clinicians' perception of DNACPR decision-making and implementation and the factors influencing such variation has not previously been explored.

Methods: A questionnaire asking how DNACPR decisions are made, communicated and perceived in their country was composed: it consisted of seven closed-answer and four open-answer questions.

DNACPR decisions: challenging and changing practice in the wake of the Tracey judgment.

The Court of Appeal judgment that Janet Tracey's human rights had been breached when a 'do not attempt cardiopulmonary resuscitation' (DNACPR) form was written about her without her knowledge has far-reaching implications for clinical practice. The 'duty to consult' extends to all patients apart from those in whom it is likely that discussion would cause 'physical or psychological harm'. The ethical basis for this judgment is strong: if a patient is unaware that a resuscitation decision has been made, he or she cannot ask questions, plan the future or ask for second opinions.

The use of real-time digital video in the assessment of post-operative outcomes of breast reconstruction.

Introduction: Outcome measures of breast reconstruction have used panel assessment of photographs. This provides limited information to the assessor as these images are static..

The Universal Form of Treatment Options (UFTO) as an alternative to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders: a mixed methods evaluation of the effects on clinical practice and patient care.

Aims: To determine whether the introduction of the Universal Form of Treatment Options (the UFTO), as an alternative approach to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders, reduces harms in patients in whom a decision not to attempt cardiopulmonary resuscitation (CPR) was made, and to understand the mechanism for any observed change.

Methods: A mixed-methods before-and-after study with contemporaneous case controls was conducted in an acute hospital. We examined DNACPR (103 patients with DNACPR orders in 530 admissions) and UFTO (118 decisions not to attempt resuscitation in 560 admissions) practice.

Becker expander implants: truly a long term single stage reconstruction?

Despite being more expensive than conventional tissue expanders, Becker expanders offer the advantage of single stage breast reconstruction. However, the large series in published literature which report good outcomes of Becker expanders in breast reconstruction have a mean follow up period of less than three years. This does not allow for definitive conclusions as to whether the Becker expander truly meets its design goal of a lasting single stage breast reconstruction.

A comparison of serial halving and the rule of nines as a pre-hospital assessment tool in burns.

Following endorsement of serial halving by the Faculty of Pre-Hospital Care of the Royal College of Surgeons of Edinburgh this study aimed to determine whether the technique was comparable to the rule of nines in making initial assessments of body surface area burned. Ten 'casualties' were made up to represent burn victims (range 6-61%). An external panel of six consultants and one specialist registrar in plastic surgery were invited to assess the simulated casualties.

The effect of radiotherapy on the use of immediate breast reconstruction.

Background: Immediate breast reconstruction techniques include tissue-expansion, latissimus dorsi flap with or without an implant, pedicled TRAM flap and free tissue-transfer. Adjuvant radiotherapy decreases loco-regional recurrence and increases overall survival. Radiotherapy in the presence of a tissue-expander or an implant can lead to an increased number of complications and poor cosmetic outcome.

The impact of intraoperative hypotension on the development of wound haematoma after breast reduction.

A wound haematoma occurring after breast reduction may need to be drained surgically, and may prolong both hospital stay and the total recovery time following surgery. Intraoperative hypotension has been implicated in the development of various complications, but has not been previously studied in relation to breast reduction. A retrospective analysis of 238 breast reductions was performed with the aim of identifying risk factors for the development of wound haematoma after breast reduction.

Expanding silicone granuloma.

Complications of breast augmentation using silicone implants have been the subject of much discussion. We report a single case of a silicone granuloma, which has exhibited unusual behaviour in that it has grown rapidly and significantly. Whilst silicone granulomata have been reported on many occasions in the past, to our knowledge this is the first report of a rapidly growing example.

How many procedures to make a breast?

The construction of a new breast after mastectomy involves fashioning the breast mound and creating a projecting nipple and a coloured areola. This should involve three episodes for a patient, but is this the experience of patients embarking on breast reconstruction? We identified 177 patients who had undergone breast reconstruction between 1 September 1997 and 31 March 1999. The clinical records for 164 of these patients were found and the data summarised.