Purpose
The formal application of project risk management (PRM) in green building projects is still an emergent part of project management. The purpose of this paper is to provide a conceptual PRM framework that increases the probability of success in green building projects by minimizing unexpected events.
Design/methodology/approach
This paper interprets the related literature and uses the opinion of green building experts. It exposes some pertinent elements needed for structuring the PRM framework and suggests some mitigation actions for high-ranked risks. It also performs ex-post analysis on a case study to practically validate the proposed framework.
Findings
It is found that high initial cost, lack of experienced contractors and subcontractors, consideration of lifecycle inflation and experience in green building project management are the most significant risks. To address them, the framework proposes a rigorous selection of contractors, provision of financial incentives from the government, setting of a time buffer to accommodate legal process and development of a deliberate proactive financial model.
Originality/value
This paper contributes to the body of knowledge and practice by providing a reasonable strategy for employing the PRM framework capable of effectively managing risk in green building projects to keep organizations competitive within the business environment. The overall aim of this study is to contribute to the further development of the area of risk assessment and risk management from a knowledge-based perspective.
Introduction and importance
Phyllodes tumor is a biphasic fibroepithelial tumor which accounts for less than 1% of all breast neoplasms. We aim to raise awareness among clinicians that a male breast lump may be indicative of underlying sinister pathology and therefore, should be investigated thoroughly.
Case presentation
A 62 year old male presented in clinic with right beast lump for the last 6 weeks. A preoperative diagnosis of spindle cell tumor was made on core needle biopsy. Neoadjuvant chemotherapy was administered in order to downsize the tumor as it was inseparable from underlying muscle. A post-operative diagnosis of malignant phyllodes was made following mastectomy. As the tumor was 1 mm from the deep margin, adjuvant radiotherapy was administered.
Clinical discussion
Differential diagnoses of malignant phyllodes include metaplastic carcinomas metastatic/primary sarcomas and fibroadenomas. Metaplastic carcinomas are morphologically heterogeneous and include adenosquamous carcinoma, squamous cell carcinoma and spindle cell carcinoma. In some malignant phyllodes, extensive stromal proliferation can make detection of epithelial component very difficult. This highlights the limitation of core biopsy in establishing an accurate preoperative diagnosis.
The standard treatment for phyllodes treatment is surgical resection with margins of 1 cm or more. Adjuvant radiotherapy is used in cases with threatened margins.
Conclusion
Malignant phyllodes tumor of breast can exist in men, and its accurate pre-operative diagnosis is difficult given the limitations of core biopsy. This case report draws attention to the challenges associated with the diagnosis of this rare condition and highlights the role of different treatment modalities in its management.
Objective: To analyse outcomes of breast conservation surgery and to identify the factors that could have affected the outcomes.
Method: The retrospectively study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of breast conservation surgery cases done between January 2011 and October 2014 in order to cover up for the 5-year follow-up of the last enrolled patient. Data, obtained through the institutional information and database system, included disease-recurrence, 5-year disease-free survival and overall survival. Data was statistically analysed using SPSS 20.
Results: Of the 553 cases, 417(75%) had no loco-regional recurrence or distant metastasis, while 136(25%) had some form of loco-regional, distant or contralateral metastasis at 5-year follow-up. In patients who had recurrence or metastasis, only progesterone receptor status, nodal status and mode of treatment showed significant association (p<0.05). Mortality at 5-year follow-up was 77(14%). Amongst the patients who died, only progesterone receptor status and nodal status had significant association (p<0.05). Five-year overall survival for the cohort was 476(86%), whereas 5-year disease-free survival was 409(74%).
Conclusion: Breast conservation surgery was found to have favourable outcomes, while progesterone status, nodal involvement and mode of treatment significantly affected the outcome.
Key Words: Breast cancer, Breast conserving surgery, 5-year disease free survival, 5-year overall survival
Continuous...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.