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Nel D, McNamee L, Wright M, Alseidi AA, Cairncross L, Jonas E, Burch V. Competency Assessment of General Surgery Trainees: A Perspective From the Global South, in a CBME-Naive Context. J Surg Educ 2023; 80:1462-1471. [PMID: 37453897 DOI: 10.1016/j.jsurg.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/30/2023] [Accepted: 06/18/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Before proceeding with local implementation of competency-based medical education-related assessment practices designed and evaluated in the Global North, we sought to challenge the assumption that this would be perceived as both necessary and acceptable in our context where training and assessment is based on a traditional, knowledge-focused approach. The aim of this study was to determine the perspectives of general surgery trainees and consultants towards the assessment of competence, how this has been achieved previously, and how it should be performed in the future at the University of Cape Town (UCT), South Africa. DESIGN Semi-structured interviews were conducted with consultants and trainees. Interviews were transcribed and then analyzed using a Reflexive Thematic Analysis approach. SETTING AND PARTICIPANTS Ten consultants (5 senior and 5 junior) and 10 trainees (5 South African and 5 international) from the Division of General Surgery at UCT in August 2022. RESULTS Five unique themes were developed: (1) Assessment of competence is essential, (2) competence includes multiple domains of practice, (3) a surgeon must be able to operate, (4) previously used methods were inadequate to assess competence, and (5) frequent assessment with feedback is desired. The themes were considered in the context of Situated Learning Theory, particularly Communities of Practice and their role in the training for, and authentic assessment of, competence in general surgery trainees. CONCLUSIONS Participants described a need to develop and implement a new competency assessment program for general surgery training in this context, which is aligned with described competency-based medical education principles. Thoughtful integration of the formative and summative use of direct observation in the workplace, with a clear emphasis on procedural ability and the provision of high-quality feedback, may enhance the successful implementation of a strategy for competency-based assessment in general surgery training programs.
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Affiliation(s)
- D Nel
- Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
| | - L McNamee
- Center for Higher Education Development, University of Cape Town, Cape Town, South Africa
| | - M Wright
- Department of Radiodiagnosis, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - A A Alseidi
- Department of Surgery, University of California, San Francisco, California
| | - L Cairncross
- Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - E Jonas
- Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - V Burch
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, and the Colleges of Medicine of South Africa, South Africa
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Boden R, Majiet I, Balde I, Naledi T, Panieri E, Cairncross L, Maswime S. Surgical training and capacity development in the South African internship programme. S Afr Med J 2023; 113:17-21. [PMID: 37882121 DOI: 10.7196/samj.2023.v113i8.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Indexed: 10/27/2023] Open
Abstract
Medical practitioners in South Africa manage a quadruple burden of disease. Junior doctors, who contribute significantly to the health workforce, must complete 2 years of internship training and 1 year of community service work in state health facilities after graduation to register as an independent medical practitioner. The aim of this article is to give a critical appraisal of the current national internship programme and why it was implemented, and outline suggestions for future changes. There is a compelling need to train competent, confident doctors while ensuring that the requirements and demands of our health system remain a central concern.
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Affiliation(s)
- R Boden
- Medical intern, Pietermaritzburg Hospital Complex, KwaZulu-Natal Province, South Africa.
| | - I Majiet
- Medical intern, Paarl Hospital, Western Cape Province, South Africa.
| | - I Balde
- Medical intern, Klerksdorp/Tshepong Hospital Complex, North West Province, South Africa.
| | - T Naledi
- Deputy Dean: Health Services, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - E Panieri
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - L Cairncross
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - S Maswime
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa.
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Nel D, Cairncross L, Burch V, Burch E, Green-Thompson L, Koto Z, Montwedi O, Fagan J, Jonas E. Workplace-based assessment - a new era of surgical training competency assessment in South Africa. S AFR J SURG 2022. [DOI: 10.17159/2078-5151/sajs3972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Malherbe F, Roodt L, Noor F, Gamieldien R, Chetty D, Anderson D, Thebe T, Cairncross L. Magseed placement before neoadjuvant chemotherapy to facilitate subsequent breastconserving surgery - a single-centre audit. S AFR J SURG 2022; 60:109-114. [PMID: 35851364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND A radio-opaque clip is placed in all patients planned for breast-conserving surgery (BCS) receiving neoadjuvant chemotherapy (NACT) to localise the tumour bed in case response to chemotherapy makes later localisation impossible. A tumour that was localised with a radio-opaque clip before NACT will then need a second localisation procedure, after the completion of NACT to aid BCS. The two most commonly used methods are hookwire and radioguided occult lesion localisation. Magseed®, a newly available technology consisting of a small magnetic seed, has now become available. The seed is placed instead of a radio-opaque clip before the start of or during NACT and can remain in place until the time of BCS. METHODS A retrospective cohort study was performed, collecting data on patients who had a Magseed placed before or during NACT from December 2018 to February 2020. RESULTS Twenty-one Magseed devices were placed into the breasts of 20 patients, 18 under ultrasound guidance, and three under stereotactic guidance. The average breast volume of individuals who had seeds placed was 1 532 g ± 869 g. The duration that the seeds were in situ was 138 days ± 45 days. All preoperatively placed seeds were retrieved at the surgery with no observed migration outside the tumour bed. CONCLUSION Magseed placement before NACT is a safe and technically simple technique that can be done under ultrasound guidance in the majority of cases. It has the advantage of being a single procedure with an associated reduction in time off work and travel cost to the patient, as well as flexibility in terms of the time of placement.
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Affiliation(s)
- F Malherbe
- Division of General Surgery, University of Cape Town, South Africa
| | - L Roodt
- Division of General Surgery, University of Cape Town, South Africa
| | - F Noor
- Division of General Surgery, University of Cape Town, South Africa
| | - R Gamieldien
- Division of Radiology, University of Cape Town, South Africa
| | - D Chetty
- Division of Anatomical Pathology, University of Cape Town, South Africa
| | - D Anderson
- Division of Radiation Oncology, University of Cape Town, South Africa
| | - T Thebe
- Division of Radiation Oncology, University of Cape Town, South Africa
| | - L Cairncross
- Division of General Surgery, University of Cape Town, South Africa
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5
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Van Wyngaard T, Cairncross L, Maswime S, Roodt L, Malherbe F. Impact of COVID-19 on breast cancer diagnostic and surgical services at a South African academic hospital. S AFR J SURG 2022; 60:119-123. [PMID: 35851366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The purpose of the study was to describe the impact of the COVID-19 pandemic on diagnostic and surgical breast cancer services at Groote Schuur Hospital (GSH) and affiliated hospitals. METHODS All patients, newly diagnosed, awaiting surgery, and listed for neoadjuvant chemotherapy (NACT) by the breast surgical service from 23 March - 23 June 2020 were included. A historic control was used where appropriate consisting of patients presenting in the same period in 2019. Clinic attendance records and surgical waiting lists were used to identify patients in the three months and data were extracted from hospital records including hospital admission records and surgical operative notes. RESULTS The number of patients who presented with a new breast symptom to the diagnostic breast clinic decreased from 1 094 in 2019 to 299 in 2020, representing a 72.6% decrease. Telemedicine use as a function of the total follow-ups increased from 53% (n = 1 350) in 2019 to 75% (n = 735) in 2020. The overall number of new breast cancers diagnosed decreased from 146 in 2019 to 79 in 2020, but the proportion of patients seen with a new breast symptom who were diagnosed with breast cancer increased from 13% (n = 1 094) in 2019 to 26% (n = 299) in 2020. Eighteen per cent (n = 105) fewer breast cancer surgeries were performed in 2020 compared to 2019, with immediate breast reconstructive procedures representing the largest decrease of 40%. CONCLUSION The impact of COVID-19 on breast cancer services has been both at the diagnostic level and in delays to surgery. A new online referral system improved referral efficacy translating to more cancers being diagnosed as a function of total referrals. The drop in absolute numbers of cancer diagnoses, however, represents an unmet health need. An expansion of our telemedicine service mitigated COVID risk in the outpatient setting. The greatest impact on our treatment decisions was seen in the cohort of patients placed on neo-adjuvant endocrine therapy (NET). We saw a global decrease in breast surgeries performed, with the greatest decrease being in reconstructions.
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Affiliation(s)
- T Van Wyngaard
- Breast and Endocrine Unit, Division of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - L Cairncross
- Breast and Endocrine Unit, Division of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - S Maswime
- Division of Global Surgery, University of Cape Town, South Africa
| | - L Roodt
- Breast and Endocrine Unit, Division of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - F Malherbe
- Breast and Endocrine Unit, Division of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
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van Wyngaard T, Cairncross L, Maswime S, Roodt L, Malherbe F. Impact of COVID-19 on breast cancer diagnostic and surgical services at a South African academic hospital. S AFR J SURG 2022. [DOI: 10.17159/2078-5151/sajs3750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: The purpose of the study was to describe the impact of the COVID-19 pandemic on diagnostic and surgical breast cancer services at Groote Schuur Hospital (GSH) and affiliated hospitals. METHODS: All patients, newly diagnosed, awaiting surgery, and listed for neoadjuvant chemotherapy (NACT) by the breast surgical service from 23 March-23 June 2020 were included. A historic control was used where appropriate consisting of patients presenting in the same period in 2019. Clinic attendance records and surgical waiting lists were used to identify patients in the three months and data were extracted from hospital records including hospital admission records and surgical operative notes. RESULTS: The number of patients who presented with a new breast symptom to the diagnostic breast clinic decreased from 1 094 in 2019 to 299 in 2020, representing a 72.6% decrease. Telemedicine use as a function of the total follow-ups increased from 53% (n = 1 350) in 2019 to 75% (n = 735) in 2020. The overall number of new breast cancers diagnosed decreased from 146 in 2019 to 79 in 2020, but the proportion of patients seen with a new breast symptom who were diagnosed with breast cancer increased from 13% (n = 1 094) in 2019 to 26% (n = 299) in 2020. Eighteen per cent (n = 105) fewer breast cancer surgeries were performed in 2020 compared to 2019, with immediate breast reconstructive procedures representing the largest decrease of 40%. CONCLUSION: The impact of COVID-19 on breast cancer services has been both at the diagnostic level and in delays to surgery. A new online referral system improved referral efficacy translating to more cancers being diagnosed as a function of total referrals. The drop in absolute numbers of cancer diagnoses, however, represents an unmet health need. An expansion of our telemedicine service mitigated COVID risk in the outpatient setting. The greatest impact on our treatment decisions was seen in the cohort of patients placed on neo-adjuvant endocrine therapy (NET). We saw a global decrease in breast surgeries performed, with the greatest decrease being in reconstructions.
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7
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Malherbe F, Roodt L, Noor F, Gamieldien R, Chetty D, Anderson D, Thebe T, Cairncross L. Magseed placement before neoadjuvant chemotherapy to facilitate subsequent breast-conserving surgery – a single-centre audit. S AFR J SURG 2022. [DOI: 10.17159/2078-5151/sajs3679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: A radio-opaque clip is placed in all patients planned for breast-conserving surgery (BCS) receiving neoadjuvant chemotherapy (NACT) to localise the tumour bed in case response to chemotherapy makes later localisation impossible. A tumour that was localised with a radio-opaque clip before NACT will then need a second localisation procedure, after the completion of NACT to aid BCS. The two most commonly used methods are hookwire and radio-guided occult lesion localisation. Magseed®, a newly available technology consisting of a small magnetic seed, has now become available. The seed is placed instead of a radio-opaque clip before the start of or during NACT and can remain in place until the time of BCS. METHODS: A retrospective cohort study was performed, collecting data on patients who had a Magseed placed before or during NACT from December 2018 to February 2020. RESULTS: Twenty-one Magseed devices were placed into the breasts of 20 patients, 18 under ultrasound guidance, and three under stereotactic guidance. The average breast volume of individuals who had seeds placed was 1 532 g ± 869 g. The duration that the seeds were in situ was 138 days ± 45 days. All preoperatively placed seeds were retrieved at the surgery with no observed migration outside the tumour bed. CONCLUSION: Magseed placement before NACT is a safe and technically simple technique that can be done under ultrasound guidance in the majority of cases. It has the advantage of being a single procedure with an associated reduction in time off work and travel cost to the patient, as well as flexibility in terms of the time of placement.
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8
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Pereira MC, Adewale OB, Roux S, Cairncross L, Davids H. Biochemical assessment of the neurotoxicity of gold nanoparticles functionalized with colorectal cancer-targeting peptides in a rat model. Hum Exp Toxicol 2021; 40:1962-1973. [PMID: 34002645 DOI: 10.1177/09603271211017611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The application of gold nanoparticle-peptide conjugates as theranostic agents for colorectal cancer shows much promise. This study aimed at determining the neurotoxic impact of 14 nm gold nanoparticles (AuNPs) functionalized with colorectal cancer-targeting peptides (namely p.C, p.L or p.14) in a rat model. Brain tissue samples, obtained from Wistar rats that received a single injection of citrate-capped AuNPs, polyethylene glycol-coated (PEG) AuNPs, p.C-PEG-AuNPs, p.L-PEG-AuNPs or p.14-PEG-AuNPs, and sacrificed after 2- and 12-weeks, respectively, were analysed. Inflammation marker (tumour necrosis factor-α, interleukin-6, interleukin-1β), oxidative stress (superoxide dismutase, catalase, glutathione peroxidase) and apoptotic biomarker (cytochrome c, caspase-3) levels were measured. Gold nanoparticle-treated groups sacrificed after 2-weeks did not exhibit any significant inflammatory, oxidative stress or apoptotic effects in brain tissue compared to the untreated control group. In brain tissue from rats that were exposed to citrate-capped AuNPs for 12-weeks, tumour necrosis factor-α and interleukin-6 levels were significantly increased compared to the untreated control. Exposure to PEG-AuNP, p.C-PEG-AuNP, p.L-PEG-AuNP and p.14-PEG-AuNP did not elicit significant toxic effects compared to the control after 12-weeks, as evidenced by the absence of inflammatory, oxidative stress and apoptotic effects in brain tissue. We thus report on the safety of PEG-coated AuNP-peptide conjugates for potential application in the diagnosis of colorectal cancer; however, exposure to citrate-capped AuNPs could induce delayed neuro-inflammation, and as such, warrants further investigation.
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Affiliation(s)
- M C Pereira
- Department of Human Physiology, Nelson Mandela University, Port Elizabeth, South Africa
| | - O B Adewale
- Department of Chemical Sciences, Biochemistry, Afe Babalola University, Ado-Ekiti, Nigeria.,Department of Biochemistry and Microbiology, Nelson Mandela University, Port Elizabeth, South Africa
| | - S Roux
- Department of Human Physiology, Nelson Mandela University, Port Elizabeth, South Africa
| | - L Cairncross
- Department of Biochemistry and Microbiology, Nelson Mandela University, Port Elizabeth, South Africa
| | - H Davids
- Department of Human Physiology, Nelson Mandela University, Port Elizabeth, South Africa
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9
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Nel D, Panieri E, Malherbe F, Steyn R, Cairncross L. Surgery for Pheochromocytoma: A Single-Center Review of 60 Cases from South Africa. World J Surg 2021; 44:1918-1924. [PMID: 32055970 DOI: 10.1007/s00268-020-05420-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a paucity of data on the presentation and surgical management of pheochromocytoma in developing nations, particularly in Africa. METHODS This study was a retrospective review, which included all patients managed by the Groote Schuur Hospital/University of Cape Town Endocrine Surgery unit for pheochromocytoma and abdominal paragangliomas, from January 2002 to June 2019. RESULTS Sixty patients were included in the study, of which 33% were male and 67% female. The mean age was 47 years (range 14-81). The median tumor size was 6 cm, with 45% larger than 6 cm. 92% were located in the adrenal gland (87% unilateral, 5% bilateral), and 8% were extra-adrenal. The conversion rate for laparoscopic cases was 20%, with 55% of cases overall completed laparoscopically. Eleven patients with tumors > 6 cm were initially attempted laparoscopically, of which 3 were converted to open, without any associated increased morbidity. A major adverse event was recorded for 5 cases (8%), including 1 mortality. Overall morbidity, blood loss, operating time and hospital stay were all significantly reduced in the laparoscopic group. There were 5 patients with malignant disease (8%). CONCLUSION This large series, from an established academic endocrine surgery unit in Africa, can serve as a benchmark for units with similar settings and resource limitations, to compare their surgical management and perioperative outcomes.
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Affiliation(s)
- D Nel
- Division of General Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
| | - E Panieri
- Division of General Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - F Malherbe
- Division of General Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - R Steyn
- Division of Nuclear Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - L Cairncross
- Division of General Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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10
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Cairncross L, Snow HA, Strauss DC, Smith MJF, Sjokvist O, Messiou C, Thway K, Hayes AJ. Diagnostic performance of MRI and histology in assessment of deep lipomatous tumours. Br J Surg 2019; 106:1794-1799. [PMID: 31502664 DOI: 10.1002/bjs.11309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/07/2019] [Accepted: 06/11/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Deep lipomatous tumours can be benign lipomas or intermediate/locally recurring atypical lipomatous tumours (ALTs). Differentiating between these two entities clinically and radiologically is difficult. The aims of this study were to report a series of deep lipomatous tumours, comparing the clinical, radiological and pathological features of ALTs and lipomas; and to predict the likelihood of a lipomatous tumour being ALT based on anatomical site and MRI characteristics. METHODS This was a retrospective review of patients with deep lipomatous tumours presenting over 6 years to a tertiary sarcoma centre, with preoperative MRI, and preoperative or postoperative histology including MDM2 gene analysis. Sensitivity, specificity, predictive values and accuracy in diagnosing ALT were calculated for MRI and histopathological features. RESULTS Some 248 patients were included; 81 (32·7 per cent) had a final diagnosis of ALT. ALTs were larger than lipomas (median 19 versus 10 cm; P < 0·001); there was no ALT smaller than 5 cm. A tumour presenting in the lower limb was more likely to be an ALT than a lesion at any other site (48·4 versus 13·5 per cent; P < 0·001). In patients with lipomatous tumours at sites other than the lower limbs, MRI had a negative predictive value of 95 per cent for excluding ALT. CONCLUSION Despite concern, most deep lipomatous tumours (nearly 70 per cent) are benign lipomas. Certain features imply that tumours are almost never ALT: smaller than 5 cm or located outside the lower limb with no suspicious characteristics on MRI. Tumours with these features might safely and confidently be managed outside tertiary sarcoma centres.
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Affiliation(s)
- L Cairncross
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - H A Snow
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - D C Strauss
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - M J F Smith
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - O Sjokvist
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - C Messiou
- Department of Radiology, Royal Marsden Hospital, London, UK
| | - K Thway
- Department of Pathology, Royal Marsden Hospital, London, UK
| | - A J Hayes
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
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11
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Moodley J, Scott SE, Mwaka AD, Constant D, Githaiga JN, Stewart TS, Payne A, Cairncross L, Somdyala NIM, Walter FM. Development and validation of the African Women Awareness of CANcer (AWACAN) tool for breast and cervical cancer. PLoS One 2019; 14:e0220545. [PMID: 31386684 PMCID: PMC6684059 DOI: 10.1371/journal.pone.0220545] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/18/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Measuring factors influencing time to presentation is important in developing and evaluating interventions to promote timely cancer diagnosis, yet there is a lack of validated, culturally relevant measurement tools. This study aimed to develop and validate the African Women Awareness of CANcer (AWACAN) tool to measure awareness of breast and cervical cancer in Sub-Saharan Africa (SSA). METHODS Development of the AWACAN tool followed 4 steps: 1) Item generation based on existing measures and relevant literature. 2) Refinement of items via assessment of content and face validity using cancer experts' ratings and think aloud interviews with community participants in Uganda and South Africa. 3) Administration of the tool to community participants, university staff and cancer experts for assessment of validity using test-retest reliability (using Intra-Class Correlation (ICC) and adjusted Kappa coefficients), construct validity (comparing expert and community participant responses using t-tests) and internal reliability (using the Kuder-Richarson (KR-20) coefficient). 4) Translation of the final AWACAN tool into isiXhosa and Acholi. RESULTS ICC scores indicated good test-retest reliability (≥ 0.7) for all breast cancer knowledge domains and cervical cancer risk factor and lay belief domains. Experts had higher knowledge of breast cancer risk factors (p < 0.001), and cervical cancer risk factors (p = 0.003) and symptoms (p = 0.001) than community participants, but similar knowledge of breast cancer symptoms (p = 0.066). Internal reliability for breast cancer risk factors, lay beliefs and symptom and cervical cancer symptom subscales was good with KR-20 values > 0.7, and lower (0.6) for the cervical cancer risk subscale. CONCLUSION The final AWACAN tool includes items on socio-demographic details; breast and cervical cancer symptom awareness, risk factor awareness, lay beliefs, anticipated help-seeking behaviour; and barriers to seeking care. The tools showed evidence of content, face, construct and internal validity and test-retrest reliability and are available for use in SSA in three languages.
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Affiliation(s)
- J. Moodley
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town; Observatory, Cape Town, South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town; Observatory, Cape Town, South Africa
- SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, South Africa
- * E-mail:
| | - S. E. Scott
- Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King’s College London, London, United Kingdom
| | - A. D. Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - D. Constant
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town; Observatory, Cape Town, South Africa
| | - J. N. Githaiga
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town; Observatory, Cape Town, South Africa
| | - T. S. Stewart
- Department of Obstetrics & Gynaecology, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, Devon, United Kingdom
| | - A. Payne
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town; Observatory, Cape Town, South Africa
| | - L. Cairncross
- Surgical Endocrine Oncology Unit, Division of General Surgery, Department of Surgery, University of Cape Town; Observatory, Cape Town, South Africa
| | - N. I. M. Somdyala
- Eastern Cape Cancer Registry, South African Medical Research Council, Burden of Disease Research Unit, Tygerberg, South Africa
| | - F. M. Walter
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
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12
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Robertson B, Parker M, Shepherd L, Panieri E, Cairncross L, Malherbe F, Ross IL, Omar F, Hunter A. Nodal disease predicts recurrence whereas other traditional factors affect survival in a cohort of South African patients with differentiated thyroid carcinoma. Cancers Head Neck 2018; 3:10. [PMID: 31093363 PMCID: PMC6460678 DOI: 10.1186/s41199-018-0037-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/31/2018] [Indexed: 11/21/2022]
Abstract
Background and aim Information on patients with differentiated thyroid carcinoma in South Africa is limited. The objective of this study was to review demographics and tumour characteristics in a cohort of patients with differentiated thyroid carcinoma, presenting to Groote Schuur Hospital and evaluate risk factors for recurrence and survival. Patients and methodology Retrospective demographic and clinical data were collected on all patients referred between January 2003 and December 2013. Prognostic factors for recurrence free survival and cancer specific survival were assessed using univariate and multivariate analyses. Results The total number of patients was 231.The median age at presentation was 44 years and 82% were female patients. The pathological sub-types were papillary (60.6%), follicular (38.9%) and poorly differentiated (0.5%). Total thyroidectomy was performed in 191 patients and 30 patients required neck dissections. A total of 171 (74%) patients received 131Iodine. The recurrence free and cause specific survival rates at 10 years were 83 and 91%, respectively. Nodal disease at presentation was the only significant risk factor for recurrence (p < 0.001) on multivariate analysis. Significant risk factors for cause specific mortality were age ≥ 45 years (p = 0.006), follicular pathology (p = 0.004), extra-thyroid extension (p = 0.013) and residual tumour (p = 0.004). Conclusions Consistent with international trends, patients with differentiated thyroid carcinoma treated at Groote Schuur Hospital had a favourable prognosis. The known risk factors associated with recurrence and survival in this South African cohort were consistent with those reported in developed countries.
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Affiliation(s)
- B Robertson
- Department of Radiation Oncology, Cape Town, South Africa.,2Groote Schuur Hospital, Cape Town, South Africa.,3University of Cape Town, Cape Town, South Africa
| | - M Parker
- Department of Radiation Oncology, Cape Town, South Africa.,3University of Cape Town, Cape Town, South Africa
| | - L Shepherd
- Department of Radiation Oncology, Cape Town, South Africa.,2Groote Schuur Hospital, Cape Town, South Africa.,3University of Cape Town, Cape Town, South Africa
| | - E Panieri
- 2Groote Schuur Hospital, Cape Town, South Africa.,3University of Cape Town, Cape Town, South Africa.,Department of Surgery, Cape Town, South Africa
| | - L Cairncross
- 2Groote Schuur Hospital, Cape Town, South Africa.,3University of Cape Town, Cape Town, South Africa.,Department of Surgery, Cape Town, South Africa
| | - F Malherbe
- 2Groote Schuur Hospital, Cape Town, South Africa.,3University of Cape Town, Cape Town, South Africa.,Department of Surgery, Cape Town, South Africa
| | - I L Ross
- 5Department of Medicine, Cape Town, South Africa.,2Groote Schuur Hospital, Cape Town, South Africa.,3University of Cape Town, Cape Town, South Africa
| | - F Omar
- Division of Chemical Pathology, Cape Town, South Africa.,3University of Cape Town, Cape Town, South Africa
| | - A Hunter
- Department of Radiation Oncology, Cape Town, South Africa.,2Groote Schuur Hospital, Cape Town, South Africa.,3University of Cape Town, Cape Town, South Africa
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13
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Ashburner L, Cairncross L. Just trust us. Health Serv J 1992; 102:20-2. [PMID: 10118796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- L Ashburner
- Centre for Corporate Strategy and Change, Warwick Business School
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14
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Cairncross L, Ashburner L. Out of the bunker. Health Serv J 1992; 102:20-2. [PMID: 10117207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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15
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Abstract
Four human volunteers given a 30 mg oral dose of nicardipine hydrochloride containing 40 microCi of the 14C-labelled material achieved peak plasma levels of compound-related radioactivity within one hour of dosing. Parent compound comprised only a minor fraction of the circulating radioactivity indicating rapid first-pass metabolism. Plasma radioactivity declined to background levels within 96 h and was excreted both in the urine and faeces. Urinary excretion was the favoured route comprising about 60% of the dosed radioactivity. Mean total recovered radioactivity amounted to 94.8%. Both 1,4-dihydropyridine and pyridine metabolites of nicardipine hydrochloride were excreted in the urine. The major urinary metabolites, comprising some 36% of the radioactivity excreted in the 0-8 h post-dose period, were the glucuronide conjugates of +/- 2-hydroxyethyl methyl-1,4-dihydro-2,6-dimethyl-4(m-nitrophenyl)-3,5-pyridine dicarboxylate and its pyridine from 2-hydroxyethyl methyl-2,6-dimethyl-4-(m-nitrophenyl)-3,5-pyridine dicarboxylate.
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