Community gardens vary enormously in what they offer, according to local needs and circumstance.This article reports on research and experience from the USA. The context in which these findings are discussed is the implementation of Local Agenda and sustainable development policies. In particular, emphasis is given to exploring the social dimension of sustainable development policies by linking issues of health, education, community development and food security with the use of green space in towns and cities. The article concludes that the use of urban open spaces for parks and gardens is closely associated with environmental justice and equity.
Localization methods for breast lesions including cancers have changed and advanced since their inception. Currently, the most widely used technique in the United Kingdom is the image‐guided hook wire localizer developed in the 1970s. It remains as the gold standard for localization of impalpable breast tumors. Besides its advantages, there are some disadvantages associated with this technique. In recent years, novel wire‐free techniques (eg, Magseed®, SCOUT®, and LOCalizer™) have been developed to not only localize impalpable breast lesions but also negate the disadvantages of wire localization. This article reviews the variety of techniques from their origins to the most recent advancements that are used to localize breast lesions. The future is heading toward non‐wire technology and wire localization may then be reserved for special cases.
Background: Surgery to the primary tumour in women with metastatic breast cancer (MBC) has traditionally been reserved for palliative purposes, and European guidelines suggest it should be performed on an individualised basis 1 . A lack of consensus on the effectiveness of a procedure can lead to treatment variation in clinical practice. We examined what proportion of women with MBC aged 50+yrs received surgery to the primary tumour, and explored what patient and clinical characteristics influence receipt of surgery, as part of the National Audit of Breast Cancer in Older Patients (NABCOP).Methods: Details of the NABCOP are available at www.nabcop.org.uk. Data on women aged 50+yrs newly diagnosed with MBC at diagnosis between January 2014 and December 2018 in England and Wales were obtained from national cancer registry datasets linked to routine hospital episodes. Receipt of surgery up to 3 years from diagnosis was examined using Kaplan Meier estimates, both nationally and between Cancer Alliances. The relationship between patient/tumour factors and time to surgery was analysed using log rank tests and a flexible parametric regression model (FPM).Results: Between 2014 and 2018, 7316 women aged 50+yrs with MBC at diagnosis were identified. Overall, 18.7% women had surgery to the primary tumour within 1 year from diagnosis. Having surgery at 1 year was more common among younger women (50-59 yrs vs 80+yrs: 29.8% vs 8.6%, adjusted HR 1.79), those with T1/T2 tumours (T1/T2 vs T3/T4: 33.1% vs 20.8%, adjusted HR 1.72), and positive nodal stage (N0 vs N+: 19.3% vs 29.1%, adjusted HR 1.54). Rates of surgery within 1 year from diagnosis reduced over time, from 23.7% in 2014 to 15.7% in 2018, but to a greater degree among women aged 50-69 yrs (34.8% in 2014 to 21.1% in 2018) compared with women aged 70+yrs: 15.6% to 11.5%. Overall rates of surgery varied from 11.6% to 32.2% between the 20 Cancer Alliance/regions across England and Wales.Conclusions: Almost 20% of women aged 50+yrs with MBC at diagnosis received breast surgery within 1 year from diagnosis, but this varied between regions in England and Wales, and the use of surgery has decreased in recent years. Research is required to understand why treatment variation exists as well as to generate better evidence on the value of surgery in patients with MBC.
Aims
Prior to March 2020, at Princess Royal University Hospital (PRUH), Kings College NHS Foundation Trust, almost daily face to face benign/malignant breast clinic follow ups occurred. On March 23rd 2020 the UK went into official COVID-19 pandemic lockdown. The effect on elective follow up practice was swift with cancellation, triaging and replacement of face-to-face by telephonic/virtual consultations.
We compared the change of follow up pattern, pre and post COVID-19. Could this effect the future of consultations at PRUH?
Methods
A comparison of all patients attending PRUH breast unit outpatients in January 2020 (preCOVID-19) for follow up, with those attending in April 2020 (postCOVID-19).
Data collection from clinic lists and electronic patient records, with Excel version 16 analysis.
Results
343 patient follow up consultations 01/2020. 53 patient follow up consultations 04/2020.
Malignant cases: January 65%, April 60%
Benign/B3 cases: January 35%, April 20%
Summary follow up types.
Conclusions
Impact of COVID has been widespread in our practice. Our results show a significant reduction in face-to-face appointments, to allow social distancing. Further evaluation of this model will show its sustainability. Patient satisfaction will have to be assessed, with a view to a full move to video/telephone consultation where indicated.
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