Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Outcome of minimally invasive procedures for early breast cancer(College of Surgeons of Sri Lanka, 2015) Atulugama, N.S.; Bandaranayake, B.M.V.C.; de Silva, G.K.S.; Ariyapala, K.S.K.; Ediriweera, E.P.D.S.INTRODUCTION: Worldwide incidence of stage I breast cancer is around 41%. For primary breast lesions management trend has changed from mastectomy to breast conservation (BCS) and for axillary staging from routine nodal dissection (ALND) to Sentinel Lymph node Biopsy (SLNB) in clinically negative axillae. In many studies it has been proven that this paradigm shift has brought increase patient satisfaction with less morbidity and with same oncological outcome. MATERIAL AND METHODS: Patients with early breast cancer and clinically negative axillae were prospectively analysed in a single unit from January 2013. They were offered breast conservation or mastectomy (on patient's request) with SLNB. We used Isolated Methylene Blue technique (IMBT) for SLNB. All patients followed up for 2 years with standard surveillance protocol and data comprising of pre-op evaluation, surgical data, histological details and surveillance were recorded in a database. RESULTS: Total number of patients included were 253. BCS was offered for 157 (62.05%) patients. Ninety five (60.5%) had Primary closure, 49(31.2%) had Volume displacements and 15 (9%) had Volume replacements. Twenty eight patients needed re-surgery immediately due to inadequate margins and 14 ended up in mastectomy. Out of mastectomy patients 6 had TRAM and 4 had LD immediate reconstructions. Median age for BCS 53yrs and mastectomy 54yrs. Only 3 patients had axillary recurrences but no breast recurrences during the study period. CONCLUSIONS: BCS and SLNB with IMBT can be offered for early breast cancer patients with non-inferior oncological outcome compared to standard treatment of mastectomy and axillary clearance.Item Quality of breast cancer early detection services in the well women clinics in the district of Gampaha(Sri Lanka Medical Association, 2012) Vithana, P.V.S.C.; Ariyarathne, M.A.Y.; Jayawardena, P.L.AIMS: To evaluate selected aspects of breast cancer early detection services implemented through well woman clinics (WWCs) in the Gampaha District. METHODS: Clinical breast-examination(CBE) coverage of target age group women(TGW) of 35-59 years was assessed in all the WWCs in Gampaha district from 2003-2007. Quality assessment of breast cancer early detection services was done using Lot Quality Assurance Sampling. The lot size and threshold value computed were twenty and six clinics respectively. Checklists were used in assessing coverage, physical facilities and clinic activities. Client-satisfaction on WWC services was assessed among 200 TGW attending 20 WWCs using an interviewer-administered questionnaires. RESULTS: CBE coverage in the Gampaha district increased from 1.1% (3389/318711) to 2.2% (7248/326271) from 2003-2007. With regard to physical facilities, the number of clinics that were rated substandard varied between 7-18 (35% - 90%). Adequacy in relation to notice boards, stationery, furniture and linen, and cleanliness outside premises and toilets were identified as substandard. With regard to services, punctuality of staff arrival and in commencement of clinics, provision of healtheducation, availability of supervision and CBE and breast self-examination (BSE) services were observed as substandard in 7-20 clinics (35%-100%). Median satisfaction score among TGW was 45.2% (IQR: 38.7 - 54.8%). Only 11% had a score of >70%; the threshold for satisfaction. CONCLUSIONS: Coverage of breast cancer early detection service in the Gampaha district in 2007,11 years after commencing WWC services, was still very low (2.2%). All 20 clinics were substandard for overallCBEand BSE services.Item Effectiveness of an educational intervention on early detection of breast cancer in the district of Gampaha(Sri Lanka Medical Association, 2012) Vithana, P.V.S.C.; Ariyarathne, M.A.Y.; Jayawardena, P.L.INTRODUCTION AND AIMS: To assess the effectiveness of an educational intervention on improving knowledge, attitudes and practices (KAP) on early detection of breast cancer among Public Health Midwives (PHMs) and target group women (TGW) in the district of Gampaha. METHODS: A community-based intervention was conducted in Gampaha district using two Medical Officer of Health areas selected by random sampling as intervention (IA) and control (CA). The study participants were all PHMs in IA (n=38) and CA (n=47J and 260 TGW from each area. PHMs who were exposed to the educational intervention first, conducted the same among the TGW. For PHMs, post-intervention survey was conducted at one and six months and for TGW at six months after intervention. RESULTS: The overall median scores for KAP respectively were as follows: PHMs: Pre-intervention: IA: 58%[IQR: 53- 69%), 90%(IQR: 70-100%) and 62%(IQR: 57-70%). CA: 64%(IQR: 56-69%), 90%{IQR: 70-90%) and 62%( IQR: 50-77%). Post-intervention; six months IA: 93% (IQR: 91-93%), 100%(IQR: 90-100%), and 81%(IQR: 77-89%). CA: 67%(IQR: 58- 71%), 90%(IQR: 90-100%), and 62%( IQR: 58-73%). TGW: Pre-intervention: IA: 54%(IQR: 46-59%), 50%(IQR: 41-59%), and 0%(IQR: 0-20%). CA: 54%(IQR: 44- 59%), 50%(IQR: 36-59%), and 0%( IQR: 0-20%). Post-intervention: six months IA: 77%(IQR: 72-82%), 68%(IQR: 59- 76 %) and 40%(IQR: 20-60%). CA: 54%(1QR: 46- 59%), 50%(IQR: 36-64%), and 0%( IQR: 0-20%). All the post-intervention scores of PHMs and TGW in the IA were significantly higher in comparison to CA (p<0.001). CONCLUSIONS: This planned educational intervention had a significant impact on improving KAP of PHMs and TGW in the Gampaha district