A visita prÃ-operatÃria à o primeiro passo para a SistematizaÃÃo da AssistÃncia de Enfermagem PerioperatÃria â SAEP, representando valioso instrumento para a humanizaÃÃo da assistÃncia de enfermagem. A utilizaÃÃo de um instrumento permite nortear esta visita, em que serÃo registradas as necessidades biopsicossociais e espirituais do paciente e estabelece uma comunicaÃÃo entre os enfermeiros da clÃnica e do bloco cirÃrgico, garantindo a continuidade da assistÃncia perioperatÃria. Este estudo teve como objetivo construir e validar um instrumento de coleta de dados para a visita prÃ-operatÃria de enfermagem (VPOE) de cirurgia de mama, fundamentado no modelo Conjunto de Dados de Enfermagem PerioperatÃria (PNDS â Perioperative Nursing Data Set), que padroniza diagnÃsticos de Enfermagem nos domÃnios seguranÃa, respostas fisiolÃgicas e respostas comportamentais do paciente e famÃlia. Para a construÃÃo do instrumento de coleta de dados foram consideradas quatro fases: 1) revisÃo da literatura e identificaÃÃo dos itens importantes; 2) elaboraÃÃo do instrumento de coleta de dados; 3) avaliaÃÃo por especialistas da Ãrea; 4) validaÃÃo de aparÃncia e conteÃdo, e 5) reduÃÃo final do instrumento e anÃlise estatÃstica. Para a busca dos artigos, nas bases de dados selecionadas, as palavras utilizadas como descritores foram: mama, prÃ-operatÃrio, perioperatÃrio e enfermagem, realizando-se todas as combinaÃÃes possÃveis. ApÃs essa busca, foi elaborada a primeira versÃo do instrumento de coleta de dados para a VPOE de cirurgia de mama, composto por 47 itens, organizado em trÃs seÃÃes - dados estruturais, elementos de dados da Enfermagem e dados de Enfermagem prÃ-operatÃria, distribuÃdos da seguinte maneira: domÃnio seguranÃa (06), domÃnio respostas fisiolÃgicas (28) e respostas comportamentais (13). Para a validaÃÃo do conteÃdo, os instrumentos foram encaminhados para a apreciaÃÃo de 22 juÃzes, expertos na Ãrea do construto, sendo 15 enfermeiras assistenciais, quatro docentes e trÃs trabalhavam na assistÃncia e na docÃncia. A concordÃncia entre os juÃzes foi analisada pelo teste binomial, como mÃtodo de anÃlise de proporÃÃo que compara as visÃes e opiniÃes entre os expertos a respeito das mesmas questÃes. O nÃvel de significÃncia considerado foi de 5% (p>0,05). Para a anÃlise de concordÃncia das respostas dos juÃzes para o instrumento, realizou-se a anÃlise das frequÃncias das respostas (discordo totalmente, discordo, concordo parcialmente, concordo, concordo totalmente), bem como se efetivou a anÃlise descritiva das sugestÃes de alteraÃÃes dos juÃzes. A construÃÃo deste instrumento nortearà a visita prÃ-operatÃria, contribuindo na assistÃncia de Enfermagem perioperatÃria, assegurando um cuidado humanizado ao paciente cirÃrgico. / The preoperative visit is the first step for the Systematization of Perioperative Nursing Care - SPNC, representing a valuable tool for humanizing nursing care. The use of an instrument allows guiding this visit, where will be recorded the biopsychosocial and spiritual needs of the patient and establishes a communication between the nurses and the surgical clinic, ensuring continuity of perioperative care. This study aimed to develop and validate an instrument to collect data for the preoperative visit nursing (PVN) breast surgery, based on the model Data Set Perioperative Nursing (PNDS - Perioperative Nursing Data Set), which standardized nursing diagnoses in the areas: safety, physiological and behavioral responses of the patient and family. For the construction of the instrument of data collection were considered four phases: 1) literature review and identification of key items, 2) development of the instrument for data collection, 3) evaluation by experts; 4) validation of appearance and content and 5) final reduction of the instrument and statistical analysis. To search for articles in the databases selected, the words used as descriptors were: breast cancer, preoperative, perioperative nursing, performing all possible combinations. After this search, was drafted the first version of the instrument for data collection for VPOE breast surgery consists of 47 items, organized into three sections: structural data, data elements of nursing and nursing data preoperative distributed follows: security area (06), domain physiological responses (28) and behavioral responses (13).To validate the contents, instruments were referred for assessment of 22 judges, experts in the area of the construct: 15 assistant nurses, 04 teachers and 03 of them worked in care and teaching. The agreement among the judges was analyzed by the binomial test as a method of analysis that compares the ratio of views and opinions among experts about the same issues. The level of significance was set at 5% (p >0.05). For the analysis of the concordance of judges responses for the instrument, the analysis of the frequencies of responses was conducted (strongly disagree, disagree, partially agree, agree, strongly agree), and the descriptive analysis of the suggested changes of the judges. The construction of this instrument will guide the preoperative visit, contributing to perioperative nursing care, ensuring a humanized care to surgical patients.

The problem investigated Four studies investigated the phenomenon of cancer-related fatigue (CRF) in women who had received adjuvant treatment for early-stage breast cancer, with a view to reducing the diagnostic uncertainty surrounding the syndrome and thus facilitating progress in both clinical management and aetiological research. Procedures and results A cross-sectional study of 109 women compared a ???cancer-specific??? self-report questionnaire (FACT-F) (canvassing fatigue symptoms) and a more generic questionnaire (SPHERE) (identifying depression and fatigue). Thirty-seven percent of women reported fatigue. Overall in 20%, fatigue was associated with psychological distress. Seventeen percent of women had fatigue but no depression. A qualitative study utilised focus groups to identify and compare the distinctive features of CRF with those of women with chronic fatigue syndrome (CFS). A similar set of symptoms was found in both groups, including overwhelming fatigue, un-refreshing sleep and subjective concentration problems. However, women with CFS also reported myalgia and arthralgia. Using the Structured Clinical Interview for Neurasthenia- SCIN, the third study compared the symptoms of three groups of women with fatigue: those with CRF, CFS or major depression. The detailed ???interviewer guide??? provided explicit directions for evaluating and classifying symptoms. This study confirmed the core symptom of ???profound fatigue unrelieved by rest???, and additional features that distinguished between the clinical diagnoses. The fourth study compared features of the evolution of clinically-identified fatigue syndromes in women from two prospective cohort studies; women with post-cancer fatigue (PCF) and women with post-infective fatigue syndrome (PIFS). Major conclusions A syndrome of PCF, present at least six months following adjuvant treatment and unexplained by medical or psychiatric disorder was investigated. The characteristics of PCF and those of CFS are very similar, with the fatigue state having indistinguishable descriptors. Longitudinal evaluation of the symptom complexes of PCF and PIFS suggests divergent pathways may be relevant. Co-morbid features like sleep disturbance; physical deconditioning and mood disturbance may be implicated as factors in the evolution and prolongation of PCF. These studies provide a basis for a more uniform and rigorous classification system - a necessary first step towards advancing the field both in investigating aetiology and new intervention strategies.

Typescript (photocopy) / 163 leaves, [8] leaves of plates : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.D.)--Dept. of Surgery, University of Adelaide, 1981

Background: Axillary lymph node dissection as routine part of breast cancer treatment has been questioned in relation to the balance between benefits and morbidity. The purpose of this study is to determine the association of tumor size, age and histological grade with axillary lymph node metastasis, to determine if some patients could be exempted from axillary dissection. Methods: The data are derived from BreastScreen NSW, the government sponsored population-based breast screening program. In New South Wales (NSW) Australia between 1995 and 2002, 7,221 patients with invasive breast carcinoma were diagnosed and 5,290 patients were eligible for this study. The relationship between incidence of positive axillary lymph nodes and three study factors (tumor size, age and histological grade) was investigated by univariate and multivariate analysis. Logistic regression models were used to predict probability of axillary metastases. Results: The incidence of axillary lymph node metastases was 28.6% (95% CI: 27.4%- 29.8%). Univariate analysis showed that age, tumor size and histological grade were significant predictors of axillary lymph node metastases (p<0.0001). Multivariate analysis identified age, tumor size and histological grade remained as independent predictors (p<0.0001). From multivariate analysis, patients with T1a (Less than or equal to 5mm) and grade I tumors regardless of age had 5.2% (95% CI: 1.2%- 9.3%) frequency of node metastases. Patients 70 years or older with grade I, T1a and T1b (6-10mm) tumors had 4.9% (95% CI: 3.2%- 7.5%) and 6.6% (95% CI: 5.3%-8.3%) predicted frequency of node metastases. Conclusions: Tumor size, age and histological grade are predictors of axillary lymph node metastases. Routine axillary lymph node dissection could be avoided in some patient groups with a low frequency of involved lymph nodes if the benefits are considered to exceed the risks.

"December 2003" / Includes bibliographical references (leaves 106-128) / xii, 128 leaves : ill., plates ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Medicine and The Hanson Institute, 2004

"October 2003" / Bibliography: leaves 223-271. / xiii, 271 leaves : ill. (some col.), plates (col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / 1. Hormonal control of human breast cancer -- 2. General materials and methods -- 3. Proliferative effects of androgens -- 4. Cross-talk between androgen and estrogen signalling pathways -- 5. Androgen receptor function in the MDA-MB-453 cell line -- 6. Gene expression profiles in breast cancer cells: identification of androgen regulated genes -- 7. Regulation of BRCA1 expression -- 8. Regulation of prostate specific antigen expression -- 9. General discussion. / Thesis (Ph.D.)--University of Adelaide, Dept. of Medicine, 2004

The problem investigated Four studies investigated the phenomenon of cancer-related fatigue (CRF) in women who had received adjuvant treatment for early-stage breast cancer, with a view to reducing the diagnostic uncertainty surrounding the syndrome and thus facilitating progress in both clinical management and aetiological research. Procedures and results A cross-sectional study of 109 women compared a ???cancer-specific??? self-report questionnaire (FACT-F) (canvassing fatigue symptoms) and a more generic questionnaire (SPHERE) (identifying depression and fatigue). Thirty-seven percent of women reported fatigue. Overall in 20%, fatigue was associated with psychological distress. Seventeen percent of women had fatigue but no depression. A qualitative study utilised focus groups to identify and compare the distinctive features of CRF with those of women with chronic fatigue syndrome (CFS). A similar set of symptoms was found in both groups, including overwhelming fatigue, un-refreshing sleep and subjective concentration problems. However, women with CFS also reported myalgia and arthralgia. Using the Structured Clinical Interview for Neurasthenia- SCIN, the third study compared the symptoms of three groups of women with fatigue: those with CRF, CFS or major depression. The detailed ???interviewer guide??? provided explicit directions for evaluating and classifying symptoms. This study confirmed the core symptom of ???profound fatigue unrelieved by rest???, and additional features that distinguished between the clinical diagnoses. The fourth study compared features of the evolution of clinically-identified fatigue syndromes in women from two prospective cohort studies; women with post-cancer fatigue (PCF) and women with post-infective fatigue syndrome (PIFS). Major conclusions A syndrome of PCF, present at least six months following adjuvant treatment and unexplained by medical or psychiatric disorder was investigated. The characteristics of PCF and those of CFS are very similar, with the fatigue state having indistinguishable descriptors. Longitudinal evaluation of the symptom complexes of PCF and PIFS suggests divergent pathways may be relevant. Co-morbid features like sleep disturbance; physical deconditioning and mood disturbance may be implicated as factors in the evolution and prolongation of PCF. These studies provide a basis for a more uniform and rigorous classification system - a necessary first step towards advancing the field both in investigating aetiology and new intervention strategies.

The problem investigated Four studies investigated the phenomenon of cancer-related fatigue (CRF) in women who had received adjuvant treatment for early-stage breast cancer, with a view to reducing the diagnostic uncertainty surrounding the syndrome and thus facilitating progress in both clinical management and aetiological research. Procedures and results A cross-sectional study of 109 women compared a ???cancer-specific??? self-report questionnaire (FACT-F) (canvassing fatigue symptoms) and a more generic questionnaire (SPHERE) (identifying depression and fatigue). Thirty-seven percent of women reported fatigue. Overall in 20%, fatigue was associated with psychological distress. Seventeen percent of women had fatigue but no depression. A qualitative study utilised focus groups to identify and compare the distinctive features of CRF with those of women with chronic fatigue syndrome (CFS). A similar set of symptoms was found in both groups, including overwhelming fatigue, un-refreshing sleep and subjective concentration problems. However, women with CFS also reported myalgia and arthralgia. Using the Structured Clinical Interview for Neurasthenia- SCIN, the third study compared the symptoms of three groups of women with fatigue: those with CRF, CFS or major depression. The detailed ???interviewer guide??? provided explicit directions for evaluating and classifying symptoms. This study confirmed the core symptom of ???profound fatigue unrelieved by rest???, and additional features that distinguished between the clinical diagnoses. The fourth study compared features of the evolution of clinically-identified fatigue syndromes in women from two prospective cohort studies; women with post-cancer fatigue (PCF) and women with post-infective fatigue syndrome (PIFS). Major conclusions A syndrome of PCF, present at least six months following adjuvant treatment and unexplained by medical or psychiatric disorder was investigated. The characteristics of PCF and those of CFS are very similar, with the fatigue state having indistinguishable descriptors. Longitudinal evaluation of the symptom complexes of PCF and PIFS suggests divergent pathways may be relevant. Co-morbid features like sleep disturbance; physical deconditioning and mood disturbance may be implicated as factors in the evolution and prolongation of PCF. These studies provide a basis for a more uniform and rigorous classification system - a necessary first step towards advancing the field both in investigating aetiology and new intervention strategies.

A growing body of work implicates chemokines and their receptors in the progression of various types of cancer, including breast cancer. However, as potent chemotactic factors for leukocytes, chemokines also have the potential to enhance anti-cancer immunity. Evidence suggests that the chemokine CXCL12 and its receptors may be important in a number of aspects of breast cancer progression and site-specific metastasis. Another chemokine, CXCL16, has been identified as a specific chemotactic factor for Type Ipolarised T lymphocytes, which are major effectors of cell-mediated immunity and hence efficacious anti-tumour immune responses. The aim of this study, therefore, was to further elucidate the roles of CXCL12 and CXCL16 in breast cancer development and metastasis. To achieve this, wild-type CXCL12 and CXCL16 and antagonists of CXCL12 and CXCL16 activity, CXCL12[subscript](P2G) and CXCL16[subscript](9-220) respectively, were overexpressed in the 4T1.2 mouse model of breast carcinoma. Overexpression of wild-type CXCL12 potently inhibited both primary tumour growth and metastasis in this model. This was attributed to the induction of an anti-tumour response dependent, in part, on T cells, interferon-g and the cytotoxic mediators perforin and TRAIL. This response was characterised by increased numbers of CD11c⁺ cells in the tumour-draining lymph nodes and enhanced cytolytic activity of lymph node-derived effector cells against tumour cells. Unexpectedly, CXCL12[subscript](P2G) inhibited metastasis of tumour cells to the lungs of tumour-bearing mice, without affecting primary tumour growth. Intravenous injection of tumour cells revealed that CXCL12[subscript](P2G) expression could block metastatic steps occurring post tumour cell escape from the primary tumour, though a role for CXCL12([subscript](P2G) at earlier metastatic steps could not be ruled out. Further work is needed to clarify the precise stages of metastasis at which CXCL12[subscript](P2G) exerts its effects. No obvious effects on primary breast tumour growth were observed when CXCL16 or CXCL16([subscript](9-220) were overexpressed in tumour cells. Interestingly, CXCL16[subscript](9-220) expression inhibited experimental metastasis but not spontaneous metastasis. The findings of this study begin to shed light on the roles of CXCL12 and CXCL16 in breast cancer progression and also highlight the potential therapeutic applications of CXCL12, CXCL16 and/or their antagonists in the treatment of breast cancer and breast cancer metastasis. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297662 / Thesis (Ph.D.) -- University of Adelaide, School of Molecular and Biomedical Science, 2007

Thesis (Ph. D.)--Ohio State University, 1983. / Includes bibliographical references (leaves 136-146). Available online via OhioLINK's ETD Center