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Breast cancer is the most common non-skin cancer in Australia, affecting 1 in 7 women by the age of 85 years. Current management of early breast cancer is becoming increasingly variable and complex. The typical range of treatments include some combination of surgery, chemotherapy and targeted therapy, immunotherapy, radiotherapy, and endocrine therapy. Neoadjuvant chemotherapy (NACT) in carefully selected patients can facilitate increased rates of breast conservation therapy, and when successful, offers improved cosmesis due to less extensive resection of tissue. A neoadjuvant approach also provides biological insight into a patient's tumour, prognostication based on a patient's response to therapy, as well as enabling their treating oncologist to personalise adjuvant strategies based on the presence or absence of residual cancer at surgery. Neoadjuvant chemotherapy has become an integral element in the provision of breast conserving surgery to selected early-stage breast cancer patients. Appreciating the indications and understanding the likely outcomes from NACT in select situations, can result in significant improvements in patient tailored care. • Neoadjuvant chemotherapy has significantly influenced surgical management. • There are multiple indications for NACT, however weaknesses do exist. • An understanding of NACT can provide best oncological and cosmetic outcomes for patients. [ABSTRACT FROM AUTHOR]

Objective: It has been consistently demonstrated that many women with breast disease will experience psychosocial distress at some stage along the patient journey. Psychosocial care has recently gained more prominence and is increasingly recognised as an important aspect of care offered to patients with breast cancer. The purpose of this project was to develop a model that improved the way psychosocial services were provided to patients. The aim of this paper is to describe the process in developing this psychosocial model of care for patients with breast disease. Methods: Using in-depth semi-structured interviews with a sample of patients and staff, we examined psychosocial concerns experienced by breast patients and the factors associated with the effective assessment and delivery of psychosocial care. The project was approved by the Royal Women's hospital ethics secretariat as a quality assurance project. Results: An inductive analysis of staff responses indicated that a standardised screening and referral pathway was needed in a context of well defined staff roles and a multidisciplinary team environment. An inductive analysis of patient responses indicated that psychosocial concerns were common, but varied, and a tailored approach to the provision of psychosocial care was warranted. Discussion: In line with these findings, a standardised assessment and referral pathway was developed for The Breast Service that may be extended for use in other clinical settings and tumour streams. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this descriptive study was to determine the curricular utilization of Evidence-Based (EB) philosophies in dental hygiene education in both baccalaureate and nonbaccalaureate U.S. dental hygiene programs. METHODS: Data were gathered via a 1999 survey of all 235 U.S. dental hygiene program directors. The 21-question survey included one open-ended and 20 closed-ended items. Initially, the survey was pilot tested using a convenience sample of seven U.S. dental hygiene program directors. A final, revised survey was mailed to the cohort population. A response rate of 71% (N = 167) was achieved after two mailings. RESULTS: The demographic results of this study revealed the majority of respondents (77%) were from nonbaccalaureate dental hygiene programs, while the remainder (23%) were from baccalaureate degree programs. Respondents were asked if and to what degree the fundamentals of research were taught in their curriculum. Baccalaureate programs' responses indicated a much greater degree of utilization. Sixty-two percent of baccalaureate respondents provide a separate course on research, and 32% teach research as a portion of another dental hygiene course. However, 3% of the responding baccalaureate programs reported that no research was included in the curriculum. These results demonstrate an overall high utilization of research by baccalaureate curricula. In comparison, nonbaccalaureate programs' responses show a lesser degree of research utilization when compared with the baccalaureate programs. Only 8% of nonbaccalaureate programs had a separate research course. The majority, 80%, of nonbaccalaureate respondents reported that they teach research as a portion of another dental hygiene course. Finally, 10% of the nonbaccalaureate degree respondents reported teaching no research. Overwhelmingly, both baccalaureate and nonbaccalaureate students received formal orientation in the use of library--100% and 84%, respectively. Ninety-seven percent of baccalaureate and 82% of nonbaccalaureate programs provided students with formal instruction in using both literature indices and databases. To a lesser extent, both baccalaureate and nonbaccalaureate programs introduced students to the Internet and encouraged them to use it for conducting literature searches--83% and 78%, respectively. In fact, seventy-four percent of baccalaureate programs and 68% of nonbaccalaureate programs reported formally teaching the evaluation of information retrieved from the Internet. Both baccalaureate and nonbaccalaureate programs similarly indicated teaching the evaluation of research findings for validity, reliability, and clinical importance. To a lesser extent, 86% of baccalaureate and 61% of nonbaccalaureate programs reported that they encourage students to make EB recommendations to patients and teach students how to apply EB findings to clinical situations. CONCLUSION: The findings of this descriptive study indicate both baccalaureate and nonbaccalaureate degree programs incorporate some aspects of an EB philosophy into the curriculum. Survey results reveal baccalaureate degree programs incorporated research and taught the use of library facilities, journal indices, and electronic databases. In addition, baccalaureate degree programs also emphasized and encouraged the application of critically appraised evidence into practice. The nonbaccalaureate respondents utilized the library facilities, journal indices, and electronic databases to a slightly lesser extent than their baccalaureate counterparts. The nonbaccalaureate respondents also demonstrated less application of EB findings to clinical situations, including actual patient treatment. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of this research was to survey U.S. dental hygiene program directors to determine: (1) demographic information, (2) specific Evidence-Based (EB) student instruction methods used, (3) if and how f programs use an EB philosophy, (4) perceptions of faculty skills in incorporating EB instruction, and (5) opinions and attitudes regarding future; need to incorporate EB philosophies in dental hygiene education.Methods. Data were gathered by surveying all 235 United States dental hygiene program directors in 1999. The survey included 20 closed items and 1 open-ended item. Initially, the survey was pilot tested using , a convenience sample of seven U.S. dental hygiene program directors. A final, revised survey was mailed to the cohort population. A response rate of 70% (n=164) was achieved after two mailings, and responses were analyzed using descriptive statistics.Results. The demographic results of this study revealed the majority of respondents were from associate degree/certificate dental hygiene programs (77%). Results revealed that most dental hygiene programs are beginning to include some fundamental EB concepts and skills into their curriculum, primarily by incorporating analysis of scientific literature. Most programs provide students with formal library orientation (88%), instruct students in the use of library indices or library databases (86%), and teach the use of the Internet for conducting literature searches (79%). Respondents indicated the major barriers for fully incorporating an EB approach in their dental hygiene program were: lack of faculty skills (37%), no available time (34%), lack of financial resources (33%), and lack of technical support (28%).Conclusion. Findings of this study suggest dental hygiene educators have made small strides in creating an EB philosophy dental hygiene curriculum. However, the future of dental hygiene education must address the need for faculty development and training in areas such as computer utilization in core dental hygiene courses, strategies to improve the curriculum to stimulate students' critical thinking skills, and to develop educators' skills in the use of evidence for clinical decision-making. [ABSTRACT FROM AUTHOR]