Use of a chaperone during breast examination: the attitude and practice of consultant breast surgeons in the United Kingdom

BACKGROUND

Professional guidelines and clinical practice regarding use of chaperones vary substantially in different health care settings. Although there are several studies in primary care practice, no such studies are available in a breast care setting. We have undertaken a questionnaire survey of practicing consultant breast surgeons in the U.K. regarding the use of a chaperone during breast examination.

METHOD

A self-completion questionnaire, with 18 items was developed, piloted, modified and mailed to 400 consultant breast surgeons across the U.K.

RESULT

302/400 questionnaires were returned (76%). Sixty-five per cent had a policy on the use of chaperone. Although 73% always offer a chaperone, the majority never documented the offer (74%) or identity (73%). Overall use of chaperone was significantly higher among male (82%), compared to female surgeons (38%, p < 0.001). The majority said that patient embarrassment (54%) and the availability of a nurse (57%) strongly influence chaperone use unlike patient's age, marital status, ethnicity, anxiety, instinct. Seventy per cent of respondents believed that the presence of a chaperone was important for medico-legal protection of doctor and patient (55%).

CONCLUSION

Our study shows that the majority of consultant breast surgeons in the UK use a chaperone. The overall use of a chaperone in secondary breast care setting is higher compared to previous studies in primary care. Documentation of the offer and identity of the chaperone is very poor.

Patients' attitude towards the use of a chaperone in breast examination

INTRODUCTION

The aim of this study was to assess the attitude and the preferences of patients towards the use of a chaperone during breast examination.

PATIENTS AND METHODS

A two-part questionnaire was circulated among 204 consecutive new patients, attending both symptomatic breast and screened assessment clinics.

RESULTS

A total of 200 questionnaires were fully completed and returned. Although 104 (52%) patients felt that they did not need a chaperone during breast examination, 65 (33%) preferred to have one. Amongst these 65 patients, the majority (52%) wanted a chaperone in the presence of both a male and female doctor whereas 19 (29%) wanted a chaperone in the presence of a male doctor. When patients were asked which person would be the best chaperone for them, 63 patients (32%) preferred their spouse to act as a chaperone, whereas 57 (29%) preferred a clinic nurse. However, the majority of teenagers and young adults (10-30 years) preferred their parents to act as a chaperone. On asking the reason for preferring a chaperone during breast examination, 69% felt a chaperone helped them to feel more at ease, 28% felt they get more support, 23% get less embarrassed and 10% felt safer. The majority (54%) preferred the nurse to offer a chaperone instead of the doctor (22%). Patients generally said they were comfortable in asking for a chaperone (68%). Overall, 68% of patients considered the offer of a chaperone as a sign of respect and the majority felt the attitude (32%) and gender (20%) of the clinician are the two most important factors influencing the chaperone use. Most patients were of the opinion that the presence of a chaperone does not have a negative effect on the doctor-patient relationship (75%), patient confidentiality (74%) and do not cause embarrassment (68%). Following their assessment in clinic, the patients' views on the use of a chaperone were not significantly changed.

CONCLUSIONS

There is a wide variety of opinion among patients about the desirability of a chaperone during breast examination. However, the majority consider the offer of a chaperone as a sign of respect and many patients commented that the presence of a chaperone is important for medicolegal protection of both patient and clinician. In recent years, there has been an increasing call from medicolegal societies and medical insurance companies for greater use of chaperones during intimate examinations. We feel that recommendations regarding the use of a chaperone should now be incorporated into the British Association of Surgical Oncology guidelines.

Physical and chemical properties of lysozyme

The conformations of lysozyme in crystals and in aqueous solution are discussed and it is shown that the basic conformation is similar in the two states. Certain parts of the molecule have mobility. The reactions of lysozyme with protons, metal ions and some organic reagents are examined in the light of the conformations and their dynamics. The reactions considered are mainly those of tyrosyl, tryptophyl and carboxylate residues. The reactivity data are used in a discussion of the energy states of the reacting side-chains. In particular the reactivity of Glu-35 and its interaction with Trp-108 lead to suggestions for some new aspects in the hypothesis for the mechanism of action of lysozyme. In most respects the X-ray crystal diffraction and the nuclear magnetic resonance solution studies are in accord and complementary.

Elemental analysis of neurofibrillary tangles in Alzheimer's disease using proton-induced X-ray analysis

We have investigated the elemental content of hippocampal slices from normal human brain and from brains of Alzheimer's disease patients by X-ray fluorescence using both electron and proton beam microprobes. The sections have been stained with a dye--toluidine blue--which contains sulphur so that the X-ray fluorescence map can be correlated with known intracellular sites as seen under the light microscope. The results show that associated with neurofibrillary tangles and Hirano bodies (the distinctive internal visual features of cells from Alzheimer's disease patients) there is increased calcium. We cannot confirm that there are peculiarities in the distribution of aluminium in cells.

Introduction to silicon chemistry and biochemistry

An outline of the chemistry of silicon is given, stressing the reactions in water. In biological systems the metabolism of silicon is little known but much silica is deposited in a variety of amorphous forms. The differences between this biological silica and mineral silicas and silicates, which can be health hazards, are indicated. However both manufactured mineral phase and molecules containing silica can be valuable in medicine.

The physics and chemistry of the calcium-binding proteins

The structures of several calcium-binding proteins are known in considerable detail in both crystalline and solution states. The changes of structure with the binding of calcium, protons, magnesium and hydrophobic molecules are also known. It appears that some calcium-binding structures contain relays of cooperative interaction which run via helices between different parts of these proteins, for example in calmodulin. In others the effect of binding, of for instance calcium, is minimal, as in phospholipase A2. In another group the effect of binding of ions leads to cooperative further binding so that ternary or higher-order complexes are formed, as in the activation of prothrombin. The linking of cellular activities to calcium is thus dependent on several highly developed properties of particular proteins in special environments which have been selected to take advantage of the peculiarities of the calcium ion, namely its particular coordination chemistry and its speed of reaction. The link between calcium, its proteins and activity is not directly to catalysis but is primarily to mechanical properties.

Residual capacitive coupling and the measurement of permittivity in magnetic induction tomography

In an ideal magnetic induction tomography (MIT) system, the coupling between the coils and the sample is entirely by the magnetic field. In a practical system, unwanted electric-field (capacitive) coupling can also exist and cause large errors in the MIT measurements unless the hardware is designed carefully. A series of tests was carried out to assess the magnitude of capacitive coupling present in a 10 MHz MIT system designed for biomedical use and other applications involving low-conductivity samples (<or=10 S m(-1)). The tests indicated that, even with the individual coils left unscreened, the signal contamination from capacitive coupling was very small compared with the true MIT signal. Because the contamination was small, it was demonstrated possible to derive the permittivity of the sample from the real part of the MIT signal. This was shown to work well when the conductivity of the sample was less than about 0.5 S m(-1), but for higher conductivities, when the skin depth became comparable with the width of the sample, the commonly used theoretical expression for the MIT signal began to break down. This implies that the measurement of permittivity (and permeability) in real biological tissues (which have conductivities of up to 2 S m(-1)) will require a more detailed derivation taking into account both the real and imaginary parts of the signals.

Internalization of near-infrared fluorescent dyes within isolated macrophage populations

The development and application of microsensor technology has enhanced the ability of scientists to further understand various biological activities, such as changes in the intracellular environment after injury or toxic exposure. NIR microsensor technology may be useful in detecting the cellular injuries or adverse changes during the early onset period, allowing for the administration of therapies to initiate recovery. The development and use of Infrared (IR) and near infrared (NIR) dyes as biological micro-sensors due to their advanced spectral characteristics may be helpful. Three of the more useful NIR dye characteristics include the ability to minimize background interference by extraneous biological matrices, the ability to exhibit optimal molar absorptivity and quantum yields, and the ability to maintain normal cellular activity. Thus, the current study was designed to investigate the ability of selected NIR micro-sensor dyes to undergo cellular internalization, demonstrate intracellular NIR fluorescent signaling, and maintain normal cellular activity. The results demonstrate that the selected NIR micro-sensor dyes undergo cellular internalization. The presence of the dyes within the cells did not affect cell viability. In addition, these dyes demonstrate changes in absorbance and fluorescence after the immune cells were challenged with a stimulant. Moreover, critical cellular functions, such as tumor necrosis factor release and superoxide production were not compromised by the internalization of the fluorescent dyes. These data suggest that selected NIR micro-sensor dyes can undergo intracellular internalization within isolated macrophages without adversely affecting various parameters of normal cellular activity.

Changes in plasma cortisol and ascorbic acid in horses with and without recurrent airway obstruction upon exercise and ascorbic acid supplementation

Diminished basal plasma cortisol concentrations and a blunted cortisol response to exercise have been observed in human asthmatics. In horses with recurrent airway obstruction (RAO), plasma concentrations of cortisol at rest are not significantly different from those of healthy horses, but the effect of exercise on endogenous cortisol concentrations has not been described. Ascorbic acid is a non-enzymatic antioxidant with proposed immune-modulating properties. In man, supplementation with ascorbic acid has been shown to attenuate the exercise-induced increase in plasma cortisol following prolonged, submaximal exercise. The relationship between cortisol and ascorbic acid has not previously been investigated in the horse. In a blinded cross-over design, five horses with RAO and six healthy non-RAO controls performed a standard exercise test following 4 weeks of supplementation with either an antioxidant (providing 10 mg ascorbic acid kg−1day−1) or a placebo (<1 mg ascorbic acid kg−1day−1). Venous blood samples were obtained 1 h prior to exercise and at 0, 15, 60 min and 24 h thereafter. Exercise resulted in a significant increase in plasma cortisol concentrations in both groups of horses (P<0.05). Basal and post-exercise concentrations of plasma cortisol in the RAO group (136±16 and 210±16 μmol l−1, respectively) were not significantly different from those in the non-RAO group (129±43 and 218±30 μmol l−1, respectively). Antioxidant supplementation increased basal and post-exercise concentrations of plasma ascorbic acid in RAO and non-RAO horses (P<0.05) but had no effect on plasma cortisol concentration in either group, before or after exercise (RAO: rest 157±27 μmol l−1, post-exercise 222±21 μmol l−1; non-RAO: rest 140±11 μmol l−1, post-exercise 227±35 μmol l−1). In conclusion, RAO-affected horses in remission demonstrate the same cortisol response to exercise as healthy controls. Antioxidant supplementation had no impact on post-exercise concentrations of plasma cortisol in either healthy or RAO-affected horses in remission.

Trial fitting of a removable partial denture framework made using computer-aided design and rapid prototyping techniques

Previous studies of CAD/CAM-produced sacrificial patterns for removable partial denture frameworks have been documented but to date, no such restorations have been test-fitted to a patient. This paper provides details of the first trial fitting to a patient of an RPD framework, the sacrificial pattern of which was produced by CAD/CAM and RP technologies. A cast of the patient was scanned and the normal procedures of dental surveying and pattern build were undertaken with reference to the scanned model using computer-aided design. A sacrificial pattern of the design was produced by rapid prototyping technology. After spruing the pattern, investment-casting and finishing techniques were carried out according to conventional principles. The framework was successfully trial-fitted to the patient and clinically judged to be acceptable for the next stage of denture fabrication, that of adding acrylic bases and artificial teeth.

Evaporative Tunnel Cooling of Dairy Cows in the Southeast. I: Effect on Body Temperature and Respiration Rate

The techniques used to mitigate the effects of heat stress on lactating dairy cows are often overwhelmed in the southeastern United States, where elevated heat and humidity often persist for extended periods. A model free-stall barn located at the North Mississippi Branch Experiment Station in Holly Springs was used to evaluate the potential of tunnel ventilation with evaporative cooling to alleviate heat stress in lactating dairy cows. Two studies were conducted using 2 groups of 10 lactating Holsteins housed in the tunnel barn (inside) and 2 groups of matched herdmates housed in an adjacent covered free-stall barn (outside), which was cooled by fans and sprinklers during 2001 or by shade and fans alone in 2003. Peak daytime temperatures inside were 5.2 +/- 0.18 degrees C below that outside in 2001 and 3.1 +/- 0.20 degrees C lower in 2003. Although evaporative cooling increased humidity by 22%, cows housed in the tunnel barn received 84% less exposure to moderate heat stress (temperature-humidity index > 80) in both years. Cooling cows with evaporative tunnel ventilation reduced respiration rates by 15.5 +/- 0.56 breaths/min and rectal temperatures by 0.6 +/- 0.02 degrees C compared with shade and fans alone in 2003. Cooling cows with evaporative tunnel ventilation reduced respiration rates by 13.1 +/- 0.78 breaths/min and rectal temperatures by 0.4 +/- 0.03 degrees C compared with fans and sprinklers in 2001. Thus, tunnel ventilation cooling dramatically reduced the exposure to heat stress and improved the comfort of lactating dairy cows when compared with traditional cooling technologies under the conditions present in the southeastern United States.

Impacts of climate change on the fate and behaviour of pesticides in surface and groundwater--A UK perspective

Over the last two decades significant effort has been dedicated to understanding the fate and transport of pesticides in surface water and groundwater and to use this understanding in the development of environmental policy and regulation. However, there have been few studies that have investigated the relationships between pesticides and climate change, and where this work has been undertaken it has principally been in relation to the impacts of climate change on agricultural production rather than in the context of environmental protection. This study addresses that gap by reviewing how climate change may impact the fate and transport of pesticides in surface and groundwaters as a pre-cursor to quantitative studies. In order to structure the review, we have adopted a source-pathway-receptor approach where climate sensitivities of pesticide source terms, environmental pathways and receptors are reviewed. The main climate drivers for changing pesticide fate and behaviour are thought to be changes in rainfall seasonality and intensity and increased temperatures, but the effect of climate change on pesticide fate and transport is likely to be very variable and difficult to predict. In the long-term, indirect impacts, such as land-use change driven by changes in climate, may have a more significant effect on pesticides in surface and groundwaters than the direct impacts of climate change on pesticide fate and transport. The review focuses on climate change scenarios and case studies from the UK; however, the general conclusions can be applied more widely.

Evaporative Tunnel Cooling of Dairy Cows in the Southeast. II: Impact on Lactation Performance

Heat stress has a dramatic impact on the dairy industry, reducing production and profitability throughout the southeastern United States. In many regions, management techniques can be used to mitigate the effects of heat stress, but available cooling technologies are often overwhelmed by the conditions of chronic heat stress present in southeastern United States. Although combining tunnel ventilation and evaporative cooling (evaporative tunnel cooling) seems to provide superior cooling for dairy cows, there is a dearth of reports on the impact of this technology on milk production. A model evaporative tunnel cooling facility in northern Mississippi was studied using 2 groups of 10 lactating Holstein cows housed in the tunnel barn and 2 groups of 10 matched herdmates housed in an adjacent naturally ventilated free-stall barn. Two 10-wk trials were performed in 2 yr beginning June 25, 2001, and May 26, 2003, in which cows housed outside were cooled by traditional fans and shade alone (2003) or with sprinklers (2001). In both years, the use of evaporative tunnel cooling decreased exposure to conditions of moderate heat stress by 84%. Cows cooled by evaporative tunnel ventilation increased feed intake by 12 and 11% over cows housed outside in 2001 and 2003, respectively. Evaporative tunnel cooling had no effect on milk composition, but increased milk yield over the 10-wk trial by 2.6 +/- 0.27 and 2.8 +/- 0.19 kg/cow per day in 2001 and 2003, respectively. In addition, somatic cell count was decreased 27 to 49% by evaporative tunnel cooling. Thus, under the range of environmental conditions present, evaporative tunnel cooling reliably reduced exposure to conditions of heat stress and improved milk production of lactating dairy cows during the summer season.

Use of CAD/CAM technology to fabricate a removable partial denture framework

This article reports on the first patient-fitted chromium cobalt removable partial denture framework produced by computer-assisted design, computer-assisted manufacture and rapid prototype technologies. Once the dental cast was scanned, virtual surveying and design of the framework on a 3-dimensional computer model was accomplished. A rapid prototype machine was used for direct fabrication of the alloy framework. Traditional finishing techniques were applied, the framework was assessed by a clinician in a conventional manner, fitted to the patient, and judged to be satisfactory by both the patient and clinician.