The rise of medical expenses is a common problem in the whole- wide world. All those countries implementing National Health Insurance have been anxiously looking for solutions, and clinical pathway has been found to be the most effective tool to control the growth of medical expense and maintain the quality of healthcare. This study focuses on the development and implementation of clinical pathway of breast cancer who underwent modified radical mastectomy, and investigate the impact of implementation of clinical pathway on the control of the length of stay, inpatient medical care expenditures, healthcare quality, and patient¡¦s medical satisfaction. The 90 patients of MRM before implementation ( July 1999 to Sep. 2000 ) and 80 patients after implementation ( Jan. 2001 to Feb. 2002 ) are taken as the targets of this study. The major findings of the study are listed as follows: 1. Clinical pathway can reasonably control the length of stay. 2. Clinical pathway can reduce inpatient medical care expenditures. 3. Clinical pathway can improve healthcare quality. 4. Clinical pathway can improve patient¡¦s medical satisfaction. 5. Clinical pathway can influence doctor¡¦s partial practice pattern. Finally this study concludes that clinical pathway is an instructive tool for hospital management. Based on the results and discussion from the study, we suggest the implementation of clinical pathway cones best in conjunction with the impact of case payment; besides, the quality of medical care should be assured under the controlled medical cost.

Background: Breast cancer is the most common cancer diagnosis in women. Treatments of breast cancer are constantly developing which leads to a high rate of surviving women. Being affected of breast cancer can result in many intense feelings and a changed body. Most of the women who get affected by breast cancer are treated with surgical treatment. One operation that is used is mastectomy, an surgical operation where one or both breasts are being removed. This may lead to several feelings, changed body image and the women have to adapt to their new body. Aim: The aim of the overview was to explore women's experiences, thoughts and emotions after a mastectomy, due to breast cancer. Method: A literature overview study based on seven qualitative and three quantitative studies. Results: In the result four themes emerged, The body betrays and is no longer complete, You are not the same person anymore, Femininity and sexuality are lost and The social limitations. Conclusion: One of the main findings shown in the result was how the mastectomy changed the women's body image. It seemed to be difficult to accept the changed body, which became a constant reminder of the disease. The women no longer recognized themselves and therefore had a hard time when it came to show themselves in front of people in the surroundings. The women also felt limitations in social situations and the body became an obstacle; they did not feel comfortable, isolated themselves and avoided everyday activities. This is important to acknowledge as a nurse and be able to give adequate support in both short term and long term.

Made available in DSpace on 2014-06-11T19:23:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-03-04Bitstream added on 2014-06-13T20:10:27Z : No. of bitstreams: 1 ribeiro_ghfp_me_botfm.pdf: 202757 bytes, checksum: a228e2c941a14ad9806caa5f27608410 (MD5) / Empresa Privada / Fundação Pio Xii - Barretos / A mastectomia radical modificada ainda se constitui em um dos principais procedimentos cirúrgicos em mastologia. A principal complicação relacionada a cirurgia constitui o seroma axilar. O bisturi Harmônico, apesar de pouco difundido, foi descrito como um mecanismo para diminuir a formação do seroma axilar, associado a diminuição do tempo de utilização do dreno. Estudo prospectivo randomizado utilizando-se o bisturi harmônico ou o elétrico de pacientes submetidas a mastectomia radical no Hospital de Câncer de Barretos, no ano de 2008, sendo que a randomização ocorreu em função do índice de massa corpórea. As variáveis relacionadas às pacientes, às cirurgias e suas principais complicações pós operatórias (seroma, necrose de retalhos, hematomas e infecção) foram tabuladas e submetidas a análise estatística. Das 95 pacientes submetidas a mastectomia, em 49 foi utilizado o bisturi harmônico. A comparação entre os bisturis na realização da mastectomia radical mostrou diferença estatística na ocorrência da necrose de retalhos das cirurgias. Outras complicações (seroma, hematoma e infecção) não tiveram significância estatística. A utilização do bisturi harmônico em mastectomias radicais proporciona menor risco de necrose de retalhos. O tipo do bisturi utilizado não influencia na formação de seroma. O índice de massa corpórea, volume de drenagem ao sétimo dia pós-operatório e redução percentual da drenagem do 2° ao 7° dia pós-operatório são fatores independentes na formação de seroma. A utilização do bisturi harmônico proporciona diminuição significativa da necrose de retalho em relação ao bisturi elétrico. / This randomized prospective study has the purpose of comparing the post-operative complication rates on the electric scalpel and the harmonic scalpel. The study was accomplished in the Hospital de Câncer de Barretos from January to November, 2008. The breast cancer patients with radical mastectomy proposal were randomized into two groups according to their body mass index (bmi): electric scalpel (46) and harmonic scalpel (49). The variables related to the patients, to the surgeries and its their post-operative main complications (seroma, flap necrosis, haematomas and infections), were tabulated and submitted to statistical analysis. The comparison between the scalpels on the radical mastectomy has show statistic difference on the occurrence of the flap necrosis on the surgeries. Other complications (seroma, haematoma and infection) have not had statistic significance). The usage of the harmonic scalpel in radical mastectomies provides smaller risk of flap necrosis in comparison with the electric scalpel.

Orientador: Evanisi Teresa Palomari / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-07T06:55:24Z (GMT). No. of bitstreams: 1 Stroppa_AnaElisaZuliani_M.pdf: 2875772 bytes, checksum: b30b658905fd1cdd9d192d8acdc518ab (MD5) Previous issue date: 2006 / Resumo: A mastectomia radical é uma técnica cirúrgica muito agressiva, que causam sensações de estresse, gerando ansiedade e depressão. Esses fatores são responsáveis por desequilíbrios no organismo, como mialgias, retardo motor e fadiga. O objetivo deste trabalho foi investigar variações na atividade eletromiográfica da porção superior do músculo trapézio em mulheres mastectomizadas comparando com a interferência da sintomatologia depressiva e dominância dos MMSS. O estudo foi realizado em 23 mulheres com mastectomia radical do tipo Patey e Madden ou total simples e em 9 mulheres saudáveis portadoras ou não de sintomatologia de depressão, quantificada pelo Inventário de Depressão de Beck. Para a aquisição dos dados utilizou-se um eletromiógrafo, composto de 4 canais, com canais compostos por filtros com banda de freqüência entre 20 (FPA) e 500 Hz (FPB), placa de conversão AIO, de 12 bits de resolução e freqüência de amostragem de 1000 Hz, eletrodos bipolares ativos de Ag-Ag CI, conectados a eletrodos auto adesivos e eletrodo terra. Para análise estatística foram utilizados modelos de regressão linear. Os resultados não foram estatisticamente significantes, entretanto, houve tendências à diminuição nos valores de mediana da amplitude do sinal em RMS para o grupo mastectomizado (GM), quando comparado ao grupo controle (GC), ambos depressivo, o que sugere que a dor no local da cirurgia reduz a atividade; notou-se também, aumento desta amplitude, para o (GM) lado com cirurgia, quando comparado ao lado sem cirurgia, exceto para o (GM) sem sintomatologia depressiva, sugerindo que a postura antálgica aumente a atividade mioelétrica; para o fator psicológico e a dominância dos membros não se observou nem mesmo tendências / Abstract: The radical mastectomy is one very agrgressive technique surgical, that they cause sensations de stress, generating anxiety and depression. These factors cause some disorders in the organism, like a muscle pain, slow motor response and fatigue. This study was carried out with women who have undergone mastectomies in order to investigate possible changes in electromyographic activity of the upper trapezius muscle and compare the influence on symptoms of depression. The present study assessed bilaterally in 23 women underwent to Simple or Patey and Madden's radical mastectomies and in 9 healthy women with or without depression's symptoms, quantified by Beck Depression Inventory. The clinical records were picked up by a four-channel electromyographer. The channels were composed of filters with a frequency range between 20 (FPA) and 500 Hz (FPB), A/O conversion plate with 12 bits resolution and sampling frequency of 1000 Hz and active bipolar electrodos de Ag-Ag CI connected the adhesive electrodes and reference electrode. For statistical analysis a model of linear regression was used. Was noted tendencies in the depressive group~ thought the data were not statistically significant. It was observed the CDG had the higher median, which suggested that the pain on the site of the surgery reduces the EMG activity. On the other hand, in the MDG side with surgery, it was observed an increase in the EMG activity in comparison with the si de without surgery, which suggests that antalgic posture increases the myoelectric activity. For non-depression group, the data did not permit any conclusive data, and, in none of the cases, the dominance interfered in the myoelectric activity. Nevertheless, the data obtained was not statiscally sígnificant / Mestrado / Anatomia / Mestre em Biologia Celular e Estrutural

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Trata-se de uma revisÃo integrativa da literatura, que teve como objetivo buscar e avaliar as evidÃncias disponÃveis na literatura sobre o cuidado no perÃodo perioperatÃrio prestado à paciente submetida à mastectomia. Para a seleÃÃo dos estudos, foram consultadas as bases de dados PUBMED, LILACS e CINAHL. A amostra constituiu-se de sete estudos. NÃo foi identificado nenhum estudo nas bases de dados LILACS e CINAHL, sete estudos foram provenientes do PUBMED. Houve uma prevalÃncia de seis estudos (86%) com nÃvel de evidÃncia 2 e um estudo (14%) com nÃvel de evidÃncia 3. ApÃs a anÃlise dos aspectos abordados nestes artigos, reuniu-se em uma categoria temÃtica: o manejo da dor, contendo os sete estudos. O primeiro estudo concluiu que uma dose de 600 mg de gabapentina administrada uma hora antes da cirurgia produz analgesia pÃs-operatÃria significativa apÃs a mastectomia total. O segundo estudo demonstrou que o uso do EMLA em pacientes mastectomizadas reduziu a solicitaÃÃo de analgÃsicos no pÃs-operatÃrio e uma reduÃÃo da incidÃncia e a intensidade da dor crÃnica. No terceiro estudo nÃo foram encontradas diferenÃas no manejo da dor pÃs-operatÃria entre 3,75 mg / ml de ropivacaÃna e infiltraÃÃo da ferida com soluÃÃo salina antes da mastectomia. O quarto estudo concluiu que a administraÃÃo preventiva com cetoprofeno por via endovenosa (100 mg) produz maior alÃvio da dor pÃs-operatÃria em pacientes submetidas à mastectomia. O quinto estudo evidenciou que a administraÃÃo de 8 mg de dexametasona diminui efetivamente o uso de analgÃsicos em mulheres submetidas à anestesia geral para a mastectomia. O sexto estudo nÃo demonstrou associaÃÃo entre o Ãndice de Ãxido nÃtrico e o desenvolvimento de dor crÃnica pÃs-operatÃria. O sÃtimo estudo concluiu que a administraÃÃo perioperatÃria de venlafaxina reduz significativamente a incidÃncia de sÃndrome da dor pÃs-mastectomia. O estudo apresentou como limitaÃÃes o fato de que ao longo dos 10 anos pesquisados, o Ãnico cuidado perioperatÃrio da cirurgia de mastectomia encontrado na literatura foi relacionado ao manejo farmacolÃgico da dor, ademais os estudos analisados nÃo mostraram uma associaÃÃo entre si, visto que em cada um foi avaliado uma droga diferente, dificultando o consenso e a recomendaÃÃo relacionada ao uso de fÃrmacos para o controle/minimizaÃÃo da dor. A evidÃncia nÃo apresentou um consenso para o cuidado perioperatÃrio de mastectomia, pois encontrou-se uma diversidade de uso de fÃrmacos para o controle da dor e em grande parte dos estudos existiu divergÃncias e divisÃo de opiniÃes. Contudo, observou-se a preocupaÃÃo por parte dos profissionais em minimizar/prevenir a dor prÃ, intra e pÃs-operatÃria. Desse modo, a enfermagem deve estar atenta, tanto à atualizaÃÃo dos tratamentos farmacolÃgicos no manejo da dor quanto ao desenvolvimento de futuras pesquisas relacionadas ao cuidado de enfermagem no perÃodo perioperatÃrio de mastectomia. / It is an integrative literature review, which aimed to search and evaluate the available evidence in the literature on perioperative care provided to patients undergoing mastectomy. To select the studies were consulted the databases PUBMED, LILACS and CINAHL and the sample consisted of seven studies. No study has been identified in the databases LILACS and CINAHL, and all seven studies were from the PUBMED. There was a prevalence of 6 studies (86%) with level of evidence 2 and 1 study (14%) with level of evidence 3. After analyzing the issues addressed in these articles, gathered in atopical category: pain management, containing the seven studies. The first study found that a dose of 600 mg of gabapentin administered 1 h before surgery produces significant postoperative analgesia after total mastectomy. The second study showed that use of EMLA in mastectomy patientsreduced the request of analgesics postoperatively and a reductionin the incidence and intensity of chronic pain. In the study 03 found no differences in the management of postoperative pain between 3.75 mg / ml and ropivacaine wound infiltration with saline prior to mastectomy. The fourth study found that preventive administration of ketoprofen intravenously (100 mg) produces greater relief of postoperative pain in patients undergoing mastectomy. The fifth study showed that administration of dexamethasone 8 mgeffectively decreases the use of analgesics in women undergoinggeneral anesthesia for mastectomy. The sixth study showed no association between the index of nitric oxide and the development of chronic postoperative pain. The seventh study found that perioperative administration of venlafaxine significantly reduces the incidence of pain syndromeafter mastectomy. The study had limitations the fact that over the 10 years studied, the only perioperative care of the mastectomy surgery in the literature was related to the pharmacological management of pain and the studies analyzed did not show an association between them, since in each was assessed a different drug, hindering consensus and recommendation regarding the use of drugs to control / minimize the pain. The evidence did not show a consensus for the perioperative care of mastectomy, because we found a diversity of use of drugs for pain control and in most studies there were differences and division of opinion. However, we noted the concern on the part of professionals to minimize / prevent pain before, during and after surgery, and nursing must be attentive to both the update of pharmacological treatments in pain management, for the development of future research related to the care of perioperative nursing.

Thousands of women in Canada continue to be diagnosed every year with breast cancer, many undergoing surgical mastectomy as part of their treatment to eradicate or control the spread of disease. At present, the recommendation for breast conserving surgery (BCS) and breast reconstruction dominates discourse in oncological settings, limiting conversations about alternative options for women to consider following the removal of their breast(s). Interesting however is the decision, made by some women in contemporary society, to undertake unconventional practices such as being inscribed with tattoos where breasts once occupied space. Unfortunately, little is known about the experiences of women who have foregone reconstructive surgery and chose to be tattooed post mastectomy. A Gadamerian philosophical hermeneutic approach was used to explore the phenomenon of being tattooed post mastectomy. Six women with mastectomy tattoos were interviewed to learn about the experiences of being tattooed where breast(s) once occupied space. Participants in this study were between 48 and 65 years of age and tattooed from one month to five years after surgery. Meanings about being tattooed post mastectomy surfaced through conversation and photographs. Gadamer’s hermeneutic teachings were engaged to analyze women’s thoughts, feelings, and photographed images of participant tattoos, surfacing meaning about being tattooed where breasts once existed. To establish a passage for understanding, three publishable manuscripts constitute the body of the dissertation. The first manuscript presents my personal narrative [in part] of being diagnosed with breast cancer and undergoing a mastectomy without reconstruction. In the second manuscript, the socio-cultural context of why the mastectomized female body is considered abject in contemporary society is examined. Further, I explore how a mastectomy tattoo may be an emerging alternative for some women following the loss of their breasts(s). In the third manuscript the key interpretive discoveries through hermeneutic analysis of interviews and photographs are presented and include: (1) Feeling sad and damaged post mastectomy (2) Reclaiming self: Taking back power and control; and (3) Transformation: Embodying the tattoo as a novel representation of self. These interpretive findings suggest aesthetic options such as tattooing embolden participants to reclaim power and control lost to cancer and transformed their self perceptions of beauty, femininity, and sexual identity post mastectomy. This dissertation contributes to women’s health, specifically within the field of oncology by offering what I understand to be the first phenomenological study interpreting lived experiences of being tattooed post mastectomy. Understanding how women may feel sad and damaged following surgery opens avenues for empathetic questioning and therapeutic supports from nurses. Sharing experiences of women who found the process of designing and being tattooed transformational and empowering may introduce new options post mastectomy that include aesthetics and beauty. Gaining insight into this unique phenomenon can help make meaning about how aesthetic options such as tattooing can empower some women who may be searching for alternatives to breast reconstruction post mastectomy. Furthermore, challenging dominant discourses specific to how women’s bodies should look can create spaces for discursive conversations and optimistically expand options beyond those currently offered post mastectomy. / Graduate

No description available.

Excerpt: Manganiello et al., (2010) aimed to evaluate the sexual functioning of mastectomy patients and its association with their quality of life. There are two shortcomings with this study that render its conclusions invalid, or at least, weakly supported.

yes / Breast reconstruction is the opportunity that provides the chance of having breast after undergoing surgical removal of the breast tissue due to cancer-related surgery. However, this varies on the stage of the cancer diagnosis and the procedure undertaken. There are many regenerative medicine methods that provide several initiatives and direct solutions to problems such as the development of “bioactive tissue,” which can regenerate adipose tissues with similar normal functions and structures. There have been several studies which have previously explored for the improvement of breast reconstruction including different variations of biomaterials, different fabrication and processing techniques, cells as well as growth factors which enable bioengineers and tissue engineers to reconstruct a suitable breast for patients with breast cancer. Many factors such as shape, proper volume, mechanical properties have been studies but very scattered with not adequate solutions for existing patients worldwide. This review article aims to cover recent advances in biomaterials, which can be used for reconstruction of breasts as well as looking at the various factors that might lead to individuals needing reconstruction and the materials that are available. The focus would be to look at the various biomaterials that are available to use for reconstruction, their properties, and their structural integrity.

The risk for upper extremity lymphedema post-mastectomy in women surgically treated for breast cancer is a concern since it is often painful, aesthetically displeasing, and can increase the risk of infection. However, there is a paucity of data examining if diagnostic procedures performed in the ipsilateral arm post-mastectomy increases the risk of lymphedema. The purpose of this research is to examine the relationship between diagnostic procedures performed in the ipsilateral arm post-mastectomy and the occurrence of lymphedema with or without related complications. A systematic review of the literature was conducted from multiple, online databases available from 1992 through 2014, and included CINAHL, MedLine, PsychInfo, and ERIC. Search terms included lymphedema, breast cancer, mastectomy, blood pressure, and infection. Exclusion criteria comprised articles focused on male gender, primary lymphedema, metastases, survival, quality of life studies, reoccurrence breast cancer, breast conservation, lymphedema management, lymphedema, and lymphoma. The results of this study were inconclusive concerning a relationship between upper extremity lymphedema and procedures performed in the ipsilateral arm after mastectomy. This literature review outlines gaps in the data showing a need for more focused research on the causes of secondary lymphedema after breast cancer surgery with lymph node removal. Further research on the impact of diagnostic and other invasive procedures on the ispilateral arm after mastectomy should be considered.