The patient and clinician experience of informed consent for surgery: a systematic review of the qualitative evidence

BACKGROUND

Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set (COS) to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the informed consent process.

METHODS

This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies.

RESULTS

Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making.

CONCLUSIONS

This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery.

REGISTRATION

The study protocol was registered on the international prospective register for systematic reviews (PROSPERO ID: CRD42017077101).

Long Term Follow Up of Male Breast Cancer

INTRODUCTION

Male breast cancer accounts for less than 1% of breast cancers with published overall and disease free survival being lower than in females.

AIMS

To determine treatment and long term outcomes for male breast cancer patients in our unit.

METHODS

A database has been maintained for all breast cancer patients diagnosed in our unit since 1993. Patients were identified using the database and information was collated on patient demographics, tumour pathology, treatment and outcomes using the database and retrospective chart review. Patients were followed to cause of death.

RESULTS

From 1994-2009 twenty-four cancers were diagnosed in twenty-two patients. Mean age at diagnosis was 69. Male breast cancer patients were treated using similar principles to female breast cancer. Twenty patients underwent mastectomy, two patients underwent wide local excision. No patients developed local recurrence. One patient died from their breast cancer with systemic metastases. 10-year overall survival was 22%, 10 year disease-specific survival was 80%. Other causes of death included medical co-morbidity and secondary cancers.

DISCUSSION

Disease free survival in our unit is comparable to other published studies. High age at diagnosis and co-morbidity are the most important factors in determining overall outcome. Treatment pathways for male breast cancer should follow guidelines for female disease in order to optimise outcomes. Future research at national or international level is necessary to ensure the most effective treatments are implemented for male breast cancer patients.

Potato Psyllid (Hemiptera: Triozidae) Response to Insecticides Under Controlled Greenhouse Conditions

Bactericera cockerelli (Šulc) is a common pest of solanaceous crops largely known for vectoring "psyllid yellows" in potatoes. In recent years, however, this pest has attracted considerable attention for vectoring Zebra Chip, a devastating bacterial disease that was first reported in the United States in 2004 and has spread across the southern and northwestern states, causing significant economic losses to potato growers and the industry. Management of the disease is mainly achieved by reducing the psyllid population using insecticides, including pyrethroids and neonicotinoids; however, new insecticides with different modes of action are needed to avoid the acquisition of resistance. In the current study, the immediate and residual effects of conventional and new materials were tested under greenhouse conditions against adults and nymphs. Cyantraniliprole at a high rate and spinetoram showed the highest immediate and residual activity against adults, whereas cyantraniliprole and oxamyl (low and high rates) were effective against nymphs, with no differences between rates. Soil applications of cyantraniliprole, oxamyl, and imidacloprid were still toxic to adults and nymphs 7 and 14 d after treatment. Also, cyantraniliprole and tolfenpyrad were detrimental to psyllid reproduction. The incorporation of new chemistry in rotation programs may provide a useful management tool against this pest.

Effects of in-furrow and water-run oxamyl on Paratrichodorus allius and corky ringspot disease of potato in the klamath basin

Corky ringspot disease (CRS) of potato (Solanum tuberosum) is caused by the tobacco rattle virus (TRV), which is vectored by stubby-root nematodes, Paratrichodorus spp. and Trichodorus spp., and is a significant threat to potato quality and production in many areas of the western United States. Between 2002 and 2005, fields with a history of CRS were planted to potato and treated with various combinations of in-furrow (IF) and chemigated (water run, WR) oxamyl [Methyl N'N'-dimethyl-N-[(methyl carbamoyl)oxy]-1-thiooxamimidate] applications. Soil samples were collected to determine how Paratrichodorus allius populations responded to the various treatment regimes (2002-2004); potato tubers were evaluated for symptoms of CRS in 2004-2005. Applications of oxamyl to potato (1.1 kg a.i./ha) did not cause significant mortality of P. allius but did prevent the populations from increasing. Oxamyl applications that began at 55 days after planting (DAP) or later did not control CRS and were not different from the untreated control. However, application schedules that began early-season, either IF at planting, early WR (33 - 41 DAP), or both, significantly reduced CRS expression in cv. Yukon Gold. Therefore, oxamyl applications must be made early in the growing season to be effective in controlling CRS. Effects of oxamyl on CRS may be due to nematostatic action that suppresses feeding activity during early field season when most virus transmission probably occurs.

Sled-Skiing: Winter Challenge for the Disabled

Sled-skiing is easy to learn and allows individuals with mobility impairments to share the slopes with Alpine skiers.