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Failure to Engage in Breast Screening and Risk Assessment Results in More Advanced Stage at Diagnosis

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Advances in Breast Cancer Research 2015年第2期4卷 53-62页

作者： Alison Johnston Sharon Curran michael sugrue Breast Centre North West Letterkenny Hospital Donegal Clinical Research Academy Donegal Ireland

Background: Although well established, population based screening and family risk assessment for breast cancer have come under increasing scrutiny. The concept of over diagnosis is increasingly cited in cancer publications. This study assessed the impact of failure to screen or risk assess patients attending with a new diagnosis of breast cancer. Methods: A retrospective review was undertaken of 200 consecutive patients diagnosed with breast cancer between January 2010 and September 2012 at Letterkenny Hospital. Appropriate screening was defined as biennial in those aged 50 - 66 and in those 40 - 49 with moderate/high family history risk (NICE criteria or IBIS criteria). Patient demographics, screening history, diagnosis date and stage (TNM) were?documented. Patients with previous breast cancer were not included (n = 17). Results: 200 consecutive patients, whose mean age was 61 (range 28 - 99), were studied. 112/200 (56%) met no criteria for screening or family history assessment, and 88/200 (44%) met criteria for either screening (in 56) or family history assessment (in 32). 61/88 (69.3%) meeting criteria did not have a mammogram or risk assessment. The stage of breast cancer was significantly earlier in those screened appropriately, with early stage cancer in n = 111/139 (79.9 %) and late in n = 28/139 (20.1%), compared with 38/61 (62.3%) and 23/61 (37.7%) in those failing to be screened appropriately (p = 0.01?χ2?df1). Conclusion:?Failure to engage in breast screening and risk assessment resulted in more advanced stage at diagnosis.

关键词： Breast Cancer Breast Cancer Detection Breast Screening Breast Outcomes

Are Family Doctors Compliant with Breast Family History Guidelines?

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Advances in Breast Cancer Research 2013年第4期2卷 149-153页

作者： Joe Thomas michael sugrue Sharon Curran Michelle Furey Ryan sugrue Donegal Clinical and Research Academy Breast Centre North West Letterkenny Hospital Donegal Ireland National University of Ireland Galway University Road Galway Ireland

Introduction: Optimizing breast cancer care involves accurate risk assessment. Referrals to secondary care need to be appropriate both in terms of healthcare resource utilisation and the reduction of unnecessary patient anxiety. Aim: This study undertook an evaluation of family doctors compliance with NICE guidelines for asymptomatic family history referrals to a breast unit. Methods: A retrospective audit of general practice in County Donegal was carried out between January 2010 and May 2011. NICE guidelines and IBIS computerised model were used to assess whether referrals were appropriate. Results: 77.6% (90/116) met a criterion for secondary care referral. 51.7% (60/116) met the NICE criteria and 64.7% (75/116) met the IBIS criteria for referral to secondary care. 38.8% (45/116) met both. 6 were of low risk, 45 were of moderate risk and 1 was of high risk. 80.4% (45/56) of the patients who did not meet the NICE criteria, failed to do so because they had one 1st degree relative with breast cancer who was over the age of 40. Conclusion: 77.6% of referrals complied with international criteria for referral to secondary care. A greater understanding of what constitutes appropriate referral of 1st degree relatives would enhance the referral process.

关键词： Referral Guidelines Family History Breast Cancer Risk Assessment

An Evaluation of FaHRAS Computer Programmes’ Utility in Family History Triage of Breast Cancer

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Advances in Breast Cancer Research 2014年第2期3卷 17-21页

作者： áine Gorman michael sugrue Zuhair Ahmed Alison Johnston Donegal Clinical and Research Academy Breast Centre North West Letterkenny Hospital Donegal Ireland

Introduction: Rapid and appropriate family risk assessment and triage of patients are essential for patients presenting to a symptomatic breast unit and international criteria for review are well established. Family History Risk Assessment Software (FaHRAS) is a computerized program, involving different modalities of risk assessment, which is available but has not been widely assessed. Aims: This study evaluated the FaHRAS software scoring of family history risk. Its analysis was compared to multi-tool family history risk assessment models in a cohort of 353 patients on a historic family history waiting list. Methods: A recent published pilot study assessed and categorized family history risk in 353 patients on a historic family history waiting list, according to international guidelines including NICE criteria, Gail and IBIS risk estimates. The current study involved a reassessment of all 353 patients using the FaHRAS software program to determine its accuracy and ease of use. Patient demographics and time required to perform the analysis were documented. Results: FaHRAS identified 73 (20.7%) patients had an IBIS family history score of 17% or greater and 89 (25.2%) patients met the NICE guidelines criteria for management beyond primary care. In the previous study, this was 79 (22.4%) and 112 (31.7%) respectively. Using the largest denominator (NICE guidelines), 264/353 (74.8%) patients could be discharged to primary care using FaHRAS. Using this largest denominator, FaHRAS also identified a total of 28 (7.9%) patients requiring referral to tertiary care while the previous study identified 3 (0.8%). Conclusion: This is one of the first studies to validate FaHRAS, which is accurate and easy to use. FaHRAS system can enable clinicians to become more efficient gatekeepers to genetic services.

关键词： Breast Cancer Risk Assessment Family History

The Keys to Optimising Breast Wounds: A Meta-Analysis

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Advances in Breast Cancer Research 2019年第3期8卷 87-111页

作者： Stephanie Mary Anne Vincent Mary Gallagher Alison Johnston Risal Djohan Manvydas Varzgalis michael sugrue Department of Breast Surgery Letterkenny University Hospital Donegal Clinical Research Academy Donegal Ireland National University of Ireland Galway Ireland Department of Plastic Surgery Cleveland Clinic Cleveland OH USA

Background: Breast disease and breast cancer management form a major part of healthcare delivery. Surgical site occurrence (SSO) poses septic and oncological risks to patients. This study undertook a meta-analysis to identify key risk factors and interventions that may alter the incidence of SSO in patients undergoing breast surgery. Methods: An ethically approved, PROSPERO-registered meta-analysis following PRISMA guidelines and Cochrane Handbook for Systematic Reviews was undertaken of all published English articles using electronic databases from 2010 to 2017 incorporating MeSH terms “risk factors”, “surgical site infections”, “breast surgery”, and “interventions”. Articles scoring > 10 for non-comparative studies and >15 for comparative studies, using MINORS criteria were included. The OR or RR using random-effects, Mantel-Haenszel method were computed for each risk factor and intervention respectively with RevMan 5. Results: The pre-operative factors affecting breast surgery SSO were diabetes mellitus (OR = 2.52, CI = 1.78 - 3.59, p < 0.001), smoking (OR = 2.39, CI = 1.57 - 3.63, p < 0.001), ASA ≥ III (OR = 2.37, CI = 1.51 - 3.74, p < 0.001), obese versus non-obese (OR = 1.84, CI = 1.52 - 2.24, p < 0.001), over-weight/obese versus normal BMI (OR = 1.70, CI = 1.36 - 2.13, p < 0.001), hypertension (OR = 1.63, CI = 1.39 - 1.90, p < 0.001), and antibiotics prophylaxis (RR = 0.58, CI = 0.36 - 0.95, p = 0.03). The intraoperative factors were surgical wound classifications 3 - 4 (OR = 6.16, CI = 2.52 - 15.02, p < 0.001), surgical drains (OR = 2.80, CI = 1.06 - 7.38, p = 0.04), and axillary lymph node dissection (OR = 1.46, CI = 1.18 - 1.80, p < 0.001). The post-operative factors were adjuvant radiotherapy (OR = 1.77, CI = 1.26 - 2.50, p = 0.001), re-operated patients (OR = 1.65, CI = 1.01 - 2.70, p = 0.05), post-operative antibiotics (RR = 0.57, CI = 0.33 - 0.98, p = 0.04), and drain antisepsis care (RR = 0.15, CI = 0.03 - 0.82, p = 0.03). Conclusions: This study iden

关键词： Breast Wound Care Breast Wound Infection Breast Surgical Site Adverse Outcomes Breast Implant Loss Return to the Operating Theatre

Combined Patients and Medical Related Cosmetic Breast Cancer Outcomes—A Preferred Approach to Outcomes Assessment

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Advances in Breast Cancer Research 2019年第1期8卷 31-44页

作者： michael sugrue Alison Johnston Amy Degnim Isabel T. Rubio M. Petrouska Van den Tol Risal Djohan Mark Valentine Geraldine Mac Gregor Breast Centre North West Letterkenny University Hospital Donegal Ireland Donegal Clinical Research Academy Donegal Ireland Mayo Clinic Rochester NY USA Vall d’Hebron Hospital Universitario Barcelona Spain University Medical Centre Amsterdam Netherlands University Medical Centre Amsterdam Netherlands

Introduction: Reducing positive margins and need for re-excision yet maintaining cosmesis is key in breast cancer surgery. This study describes the evaluation of early outcomes of a combined cosmetic assessment programme following breast conservation surgery (BCS). Methods: An ethically approved prospective study was conducted at Letterkenny University Hospital and a 15-month timeframe was chosen. All consecutive patients undergoing conservative breast surgery with complete local excision, from July 2015 to October 2016, were entered into the study. Patients undergoing mastectomy and reconstruction with either implant or autologous tissue were not included. 41 patients undergoing BCS were analysed. Objective and subjective cosmetic evaluations were carried out. Assessments used were the Breast Cancer Conservative Treatment—cosmetic results [*** 2.0] Software, a panel of 4 experts in breast surgery and the Breast Cancer Treatment Outcome Scale (BCTOS). Demographic and pathological data, breast excision weight, % breast volume excised (BVE), margin positivity, complications and re-excision were documented. Data was expressed as mean and standard deviation for normally distributed data and medians and inter quartile range for non-normal data. Scores were also dichotomised to excellent/good and fair/poor and results were analysed. Results: 41 patients’ mean age is 55 ± 13 years. Mean breast volume was 768.3 cm3 ± 440;BVE weighed 78.6g ± 42.6 (18.9 - 214.4) and %BVE 11.3% ± 5.2% (5.1 - 23.3). Re-excision rate was 2/41 (4.9%) all for positive margins. 0/41 infections or haematomas occurred. Cosmetic status of 10 - 14 days post surgery was excellent or good by *** Software 78%, Expert panel 82.9%, BCTOS scale (92.7%), and fair or poor in 22%, 17.1% and 7.3% respectively. Conclusion: This study successfully evaluated objective and subjective cosmetic related outcomes following breast conserving surgery, incorporating both patient and surgeon in these assessments

关键词： Breast Cancer Breast Conserving Surgery Cosmetic Outcome Cosmetic Assessment

Case report on the treatment of atrial fibrillation in a pregnant woman of 33 weeks’ gestation

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Open Journal of Obstetrics and Gynecology 2014年第1期4卷 8-9页

作者： N. Murphy D. sugrue P. McKenna Mater Misericordiae Hospital Dublin Ireland Rotunda Hospital Dublin Ireland

This case report highlights a recent case in the Rotunda Hospital of a patient of 33 weeks’ gestation with fast atrial fibrillation. She had an unusual presentation given that she had no prior cardiac history or obvious aetiology. She underwent successful DC cardioversion and was well on discharge. Follow-up with cardiology has been arranged.

关键词： Atrial Fibrillation Pregnancy Cardioversion

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抗青光眼药

世界临床药物 1987年第4期 213-217+241页

作者： sugrue MF 欧阳泰王慧娟

青光眼是西方世界不可逆失明的首要原因,其特征是伴有视野丧失和/或眼内压过高的视神经损伤。估计约有二百万美国人患青光眼。此外,有多达1千万的美国人被怀疑有眼压高,即不伴有视神经或视野损伤的眼内压升高。遗憾的是,目前还没有一种... 详细信息

青光眼是西方世界不可逆失明的首要原因,其特征是伴有视野丧失和/或眼内压过高的视神经损伤。估计约有二百万美国人患青光眼。此外,有多达1千万的美国人被怀疑有眼压高,即不伴有视神经或视野损伤的眼内压升高。遗憾的是,目前还没有一种方法能可靠地预测哪些眼压高患者会发展成为青光眼。眼内压首先是受眼房水动力学调节的,昕有已知的抗青光眼药物都是通过减少房水

关键词：眼内压视神经青光眼病脑神经眼压房水

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学用结合,控制记忆“橡皮擦”

人力资源 2019年第2期 24-26页

作者： Ross Tartell Brenda sugrue 胡德良

学习记忆一定要通过把学习方法和人们在工作场所的实际工作方式进行全面整合来实现。《培训》杂志发布的《2017年美国培训行业报告》显示:美国各行各业在员工培训方面花去了936.5亿美元,这个数额相当于所有行业的每个学员平均花费了1,07... 详细信息

学习记忆一定要通过把学习方法和人们在工作场所的实际工作方式进行全面整合来实现。《培训》杂志发布的《2017年美国培训行业报告》显示:美国各行各业在员工培训方面花去了936.5亿美元,这个数额相当于所有行业的每个学员平均花费了1,075美元。但是人们认为,培训通常不能产生预期的效果。对培训到工作效率的转换所进行的研究表明,80%的学习内容没有应用到实际工作中去。

关键词：学习记忆意义关联培训成本

基于脑MRI髓鞘形成的深度学习预测新生儿和婴儿的脑龄

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国际医学放射学杂志 2023年第1期46卷 112-112页

作者： J.V.Chen G.Chaudhari C.P.Hess O.A.Glenn L.P.sugrue A.M.Rauschecker 袁园

摘要根据妊娠校正年龄（GCA）在T1WI和T2WI上评估脑的髓鞘化,需要在了解正常髓鞘形成阶段基础上对脑进行主观观察。目的建立基于MRI脑髓鞘形成来预测新生儿和

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