We have performed a narrative synthesis. A literature search was conducted between January 2000 and June 2014 in 7 databases. The initial search identified 2717 articles; 319 underwent abstract screening, 67 underwent full-text screening, and 25 final articles were included. This review looked at early stage breast cancer in women only, excluding ductal carcinoma in situ and advanced breast cancer. A conceptual framework was created to organize the central constructs underlying women's choices: clinicopathologic factors, physician factors, and individual factors with subgroups of sociodemographic, geographic, and personal beliefs and preferences. This framework guided our review's synthesis and analysis. We found that larger tumor size and increasing stage was associated with increased rates of mastectomy. The results for age varied, but suggested that old and young extremes of diagnostic age were associated with an increased likelihood of mastectomy. Higher socioeconomic status was associated with higher breast conservation therapy (BCT) rates. Resident rural location and increasing distance from radiation treatment facilities were associated with lower rates of BCT. Individual belief factors influencing women's choice of mastectomy (mastectomy being reassuring, avoiding radiation, an expedient treatment) differed from factors influencing choice of BCT (body image and femininity, physician recommendation, survival equivalence, less surgery). Surgeon factors, including female gender, higher case numbers, and individual surgeon practice, were associated with increased BCT rates. The decision-making process for women with early stage breast cancer is complicated and affected by multiple factors. Organizing these factors into central constructs of clinicopathologic, individual, and physician factors may aid health-care professionals to better understand this process.

Objective:To identify factors that influence Saskatchewan women’s choice between breast conserving therapy (BCT) and mastectomy in early-stage breast cancer (ESBC) and to compare and contrast underlying reasons behind choice of BCT versus mastectomy.Methods:Interpretive description methods guided this practice-based qualitative study. Data were analyzed using thematic analysis and presented in thematic maps.Results:Women who chose mastectomy described 1 of the 3 main themes: worry about cancer recurrence, perceived consequences of BCT treatment, or breast-tumor size perception. In contrast, women chose BCT because of 3 different themes: mastectomy being too radical, surgeon influence, and feminine identity.Conclusions:Although individual reasons for choosing mastectomy versus BCT have been discussed in the literature before, different rationale underlying each choice has not been previously described. These results are novel in identifying interdependent subthemes and secondary reasons for each choice. This is important for increased understanding of factors influencing a complicated decision-making process.

Introduction: Neuronal extracellular vesicle (nEV) tau and insulin signaling biomarkers may detect preclinical Alzheimer's disease and age-associated cognitive decline. Methods: This case-control study used repeated serum samples from 73 cognitively declining and 73 stable Wisconsin Registry for Alzheimer's Prevention participants (62.4 ± 6.3 years old). We immunocaptured nEVs; measured tau and insulin signaling biomarkers; and examined biomarker differences by group, their performance in group classification in training and test datasets (97, 49 individuals, respectively), and whether they predict cognitive performance change. Results: Declining compared to stable individuals showed higher baseline total, p231-, and p181-tau with older age and higher annualized change for p-IR and p-IGF-1R. Combining biomarkers classified decliners with 94% area under the curve (AUC), 86.0% sensitivity and 86.7% specificity, in training data, and 75% AUC, 71.4% sensitivity, and 77.3% specificity, in test data. Insulin biomarkers predicted cognitive performance change prospectively. Discussion: Combining nEV biomarkers can identify individuals with age-associated cognitive decline.

Background  The choice of mastectomy compared with breast-conservation therapy (bct) in early-stage breast cancer (esbca) is a complicated decision-making process. Interprovincially, Canada’s mastectomy rates vary from 25% to 68%, with Saskatchewan reporting the nation’s second-highest mastectomy rate at 63%. The aim of our research was to better understand why women with esbca choose mastectomy rather than bct in Saskatchewan.Methods  We created a survey based on a previously developed framework that organizes influencing factors into 3 constructs: clinicopathologic, physician, and individual belief factors.Results  Treatment choice was found to be influenced by disease stage and multiple individual belief factors. Compared with their counterparts having stage i disease, women with stage ii disease were significantly more likely to undergo mastectomy [odds ratio (or): 7.48]. Patients rating “worry about cancer recurrence” and “total treatment time” as more influential in their choice were also more likely to undergo mastectomy (or: 3.4 and 1.8 respectively). Conversely, women rating “wanting to keep own breast tissue,” “tumour size,” and “surgeon’s opinion” as influential in their choice were more likely to undergo bct (or: 0.17, 0.66, and 0.69 respectively).Conclusions  Our study demonstrates that treatment choices for Saskatchewan women with esbca are influenced primarily by disease stage and individual belief factors. Those findings suggest that women are making their treatment choices predominantly based on individual values and preferences. The use of rates of mastectomy and bct as indicators of quality of care might be misleading. Instead, a shift in attention toward patient-centred care might be more appropriate.

BackgroundClinical medicine has lagged behind other fields in understanding and utilizing frameworks to guide research. In this article, we introduce a new framework to examine why women choose mastectomy versus breast conserving therapy in early stage breast cancer, and highlight the importance of utilizing a conceptual framework to guide clinical research.MethodsThe framework we present was developed through integrating previous literature, frameworks, theories, models, and the author’s past research.ResultsWe present a conceptual framework that illustrates the central domains that influence women’s choice between mastectomy versus breast conserving therapy. These have been organized into three broad constructs: clinicopathological factors, physician factors, and individual factors with subgroups of sociodemographic, geographic, and individual belief factors. The aim of this framework is to provide a comprehensive basis to describe, examine, and explain the factors that influence women’s choice of mastectomy versus breast conserving therapy at the individual level.ConclusionWe have developed a framework with the purpose of helping health care workers and policy makers better understand the multitude of factors that influence a patient’s choice of therapy at an individual level. We hope this framework is useful for future scholars to utilize, challenge, and build upon in their own work on decision-making in the setting of breast cancer. For clinician-researchers who have limited experience with frameworks, this paper will highlight the importance of utilizing a conceptual framework to guide future research and provide an example.

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Obesity and type 2 diabetes mellitus (T2DM) are globally escalating major health care issues.For both obesity and T2DM management, it has been well established that bariatric surgery is superior to lifestyle and medical management alone. Over the past two decades, the introduction of laparoscopic vertical sleeve gastrectomy (LVSG) has seen a marked rise in usage, and combined with laparoscopic Roux-en-Y gastric bypass (LRYGB), these two procedures represent more than 80% of all bariatric surgeries globally.However, the differences in effectiveness between these two procedures have been less clearly defined. This article will serve as a focused review of the literature comparing LRYGB and LVSG for T2DM management.Based on our review, we believe that both procedures are very effective at improving T2DM care, especially compared with conventional medical management. However, there may be a modest benefit to be had by using LRYGB over LVSG.

Competency-based curricula require the development of novel simulation-based programs focused on the assessment of entrustable professional activities. The design and delivery of simulation-based programs are labor-intensive and expensive. Furthermore, they are often developed by individual programs and are rarely shared between institutions, resulting in duplicate efforts and the inefficient use of resources.The purpose of this study is to demonstrate the feasibility of implementing a previously developed simulation-based curriculum at a second institution. We sought to demonstrate comparable program-level outcomes between our two study sites.A multi-disciplinary, simulation-based, resuscitation skills training curriculum developed at Queen’s University was implemented at the University of Saskatchewan. Standardized simulation cases, assessment tools, and program evaluation instruments were used at both institutions.Across both sites, 87 first-year postgraduate medical trainees from 14 different residency programs participated in the course and the related research. A total of 226 simulated cases were completed in over 80 sessions. Program evaluation data demonstrated that the instructor experience and learner experience were consistent between sites. The average confidence score (on a 5-point scale) across sites for resuscitating acutely ill patients was 3.14 before the course and 4.23 (p < 0.001) after the course.We have described the successful implementation of a previously developed simulation-based resuscitation curriculum at a second institution. With the growing need for competency-based instructional methods and assessment tools, we believe that programs will benefit from standardizing and sharing simulation resources rather than developing curricula de novo.