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This article presents an overview of a literature review on how prone positioning can alleviate pathophysiological changes in ARDS and improve ventilation and perfusion. Improvement of gas exchange, efficiency of oxygenation and lung function are emphasized. Literature on the pathophysiology of ARDS, and the physiological effects of prone positioning on haemodynamics and lung function is examined. There are both advantages and disadvantages in turning a patient from the supine to the prone position. There are also contraindications in rotating between the supine and prone positions. Nevertheless, by rotating patients with ARDS, it is possible to achieve a significant improvement in A-aDO2, decrease shunting, and therefore improve oxygenation without use of expensive, invasive and experimental procedures. Placing patients with ARDS in the prone position can reduce inspiratory oxygen concentrations and peak inspiratory pressures, which minimizes the chance for barotrauma and the iatrogenic effects of hyperventilation oxygen toxicity. [ABSTRACT FROM AUTHOR]

Background: Geographic location and national income may influence access to innovation in healthcare. We aimed to study if geographical location and national income influenced the timelines to activate the global phase III APHINITY trial, evaluating adjuvant pertuzumab in patients with HER2-positive early breast cancer., Methods: Time from regulatory authority (RA) submission to approval (RAA), time to Ethics Committee/Institutional Review Board (EC/IRB) approval, time from study approval by EC/IRB to first randomised patient and from first to last randomised patient were collected. Analyses were conducted grouping countries by geographical region or economic income classification., Results: Forty-one countries (of 42) had data available regarding all relevant timelines. No statistical difference was observed between the time to RAA and geographical region ( p = 0.47), although there was a trend to longer time to RAA in upper middle-income economies ( p = 0.07). Except for time from first to last patient randomised, there was wide variation in timelines overall and within geographical regions and economic income groups., Conclusions: Geographical location and income classification did not appear to be the major drivers influencing time for clinical trial activation. Wide variability in activation timelines within geographical regions and income groups exists and is worthy of further investigation., Competing Interests: MAF, OE, DP, SG and LR: none. CT: Travel grant, Roche; advisory board: AstraZeneca, Eisai, Daiichi Sankyo, MSD. Speaker: Pfizer and Eisai. MP: MP’s institution received funding from Roche in respect of the APHINITY trial. NP: advisory board: Lilly; contracted research: Novartis, AstraZeneca, Daichii Sankyo, Roche and Pfizer; speaker: Novartis, Lilly, AstraZeneca and Roche. DE: funding for his research fellowship (2018–2019): Novartis; speaker fee: Janssen; salary paid by Roche. EA: honoraria and/or advisory board from Roche/GNE, Novartis, Seattle Genetics, Zodiac and Libbs; travel grants from Roche/GNE and GSK/Novartis; research grant to my institution from Roche/GNE, Astra-Zeneca, GSK/Novartis and Servier. JB: travel expenses: AstraZeneca and Roche; consultant: AstraZeneca, Daiichi Sankyo, Genomic Health, Libbs, Lilly MSD, Novartis, Pfizer and Roche. EC: employee of Roche Products Ltd; issued patent: Uses for and article of manufacture including HER2 dimerisation inhibitor pertuzumab, 13/649591., (© the authors; licensee ecancermedicalscience.)

Purpose: APHINITY, at 45 months median follow-up, showed that pertuzumab added to adjuvant trastuzumab and chemotherapy significantly improved invasive disease-free survival (IDFS) (hazard ratio 0.81 [95% CI, 0.66 to 1.00], P = .045) for patients with early human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC), specifically those with node-positive or hormone receptor (HR)-negative disease. We now report the preplanned second interim overall survival (OS) and descriptive updated IDFS analysis with 74 months median follow-up., Methods: After surgery and central HER2-positive confirmation, 4,805 patients with node-positive or high-risk node-negative BC were randomly assigned (1:1) to either 1-year pertuzumab or placebo added to standard adjuvant chemotherapy and 1-year trastuzumab., Results: This interim OS analysis comparing pertuzumab versus placebo did not reach the P = .0012 level required for statistical significance ( P = .17, hazard ratio 0.85). Six-year OS were 95% versus 94% with 125 deaths (5.2%) versus 147 (6.1%), respectively. IDFS analysis based on 508 events (intent-to-treat population) showed a hazard ratio of 0.76 (95% CI, 0.64 to 0.91) and 6-year IDFS of 91% and 88% for pertuzumab and placebo groups, respectively. The node-positive cohort continues to derive clear IDFS benefit from pertuzumab (hazard ratio 0.72 [95% CI, 0.59 to 0.87]), 6-year IDFS being 88% and 83%, respectively. Benefit was not seen in the node-negative cohort. In a subset analysis, IDFS benefit from pertuzumab showed a hazard ratio of 0.73 (95% CI, 0.59 to 0.92) for HR-positive disease and a hazard ratio of 0.83 (95% CI, 0.63 to 1.10) for HR-negative disease. Primary cardiac events remain < 1% in both the treatment groups. No new safety signals were seen., Conclusion: This analysis confirms the IDFS benefit from adding pertuzumab to standard adjuvant therapy for patients with node-positive HER2-positive early BC. Longer follow-up is needed to fully assess OS benefit., Competing Interests: Martine PiccartConsulting or Advisory Role: AstraZeneca, Lilly, MSD, Novartis, Pfizer, Debiopharm Group, Odonate Therapeutics, Menarini, Seattle Genetics, Camel-IDS, Immunomedics, Roche/Genentech, ImmutepResearch Funding: AstraZeneca, Lilly, MSD, Novartis, Pfizer, Roche/Genentech, Radius Health, Synthon, ServierOther Relationship: Oncolytics, EU Cancer Mission Board Marion ProcterResearch Funding: Roche/GenentechOther Relationship: Roche/Genentech Debora FumagalliResearch Funding: Roche/Genentech, AstraZeneca, Novartis, GlaxoSmithKline, Servier, Pfizer, Tesaro Evandro de AzambujaHonoraria: Roche/Genentech, Seattle Genetics, Zodiac PharmaConsulting or Advisory Role: Roche/Genentech, NovartisResearch Funding: Roche/Genentech, AstraZeneca, Servier/Pfizer, GlaxoSmithKline/NovartisTravel, Accommodations, Expenses: Roche/Genentech, GlaxoSmithKline Emma ClarkEmployment: RochePatents, Royalties, Other Intellectual Property: Issued patent: Uses for and article of manufacture including HER2 dimerization inhibitor pertuzumab, 13/649591 Michael S. EwerConsulting or Advisory Role: Bayer, AstraZeneca, Boehringer IngelheimPatents, Royalties, Other Intellectual Property: Author of the book Cancer and the Heart Eleonora RestucciaEmployment: Hoffmann LaRoche LtdLeadership: VectivBio AGStock and Other Ownership Interests: Hoffmann LaRoche Ltd, VectivBio AGTravel, Accommodations, Expenses: Hoffmann LaRoche Ltd, VectivBio Guy JerusalemHonoraria: Novartis, Roche, Lilly, Pfizer, Amgen, Bristol-Myers Squibb, AstraZeneca, Daiichi Sankyo, AbbvieConsulting or Advisory Role: Novartis, Roche, Amgen, Pfizer, Bristol-Myers Squibb, Lilly, AstraZeneca, Daiichi Sankyo, AbbvieResearch Funding: Novartis, Roche, PfizerTravel, Accommodations, Expenses: Novartis, Roche, Pfizer, Lilly, Amgen, Bristol-Myers Squibb, AstraZeneca, Medimmune, Merck Susan DentHonoraria: Novartis Canada Pharmaceuticals IncResearch Funding: NovartisTravel, Accommodations, Expenses: Novartis Linda ReabyTravel, Accommodations, Expenses: Roche Hervé BonnefoiHonoraria: RocheResearch Funding: BayerTravel, Accommodations, Expenses: Roche, Pfizer Ian KropEmployment: AMAG Pharmaceuticals, Freeline TherapeuticsLeadership: AMAG Pharmaceuticals, Freeline TherapeuticsStock and Other Ownership Interests: AMAG Pharmaceuticals, Freeline Therapeutics, VertexHonoraria: Genentech/Roche, AstraZeneca, CelltrionConsulting or Advisory Role: Genentech/Roche, Seattle Genetics, Daiichi Sankyo, Macrogenics, Taiho Pharmaceutical, Context Therapeutics, Novartis, Merck, ION Pharma, Bristol-Myers SquibbResearch Funding: Genentech, Pfizer Tadeusz PieńkowskiHonoraria: Novartis, RocheConsulting or Advisory Role: AstraZenecaSpeakers' Bureau: Roche, AstraZeneca, Novartis, PfizerTravel, Accommodations, Expenses: Roche Masakazu ToiHonoraria: Novartis, Takeda, AstraZeneca, Eisai, Genomic Health, Chugai Pharma, Taiho Pharmaceutical, Daiichi Sankyo, Yakult Pharmaceutical, Shimadzu, Pfizer, Konica Minolta, Lilly, Kyowa Hakko Kirin, Devicore medical JapanConsulting or Advisory Role: Daiichi Sankyo, Kyowa Hakko Kirin, Konica Minolta, Bertis, Athenex, Bristol-Myers SquibbSpeakers' Bureau: Pfizer, AstraZeneca, LillyResearch Funding: Taiho Pharmaceutical, Chugai Pharma, Shimadzu, Astellas Pharma, AFI technology, Japan Breast Cancer Research Group, Pfizer, Eisai, Daiichi Sankyo, AstraZeneca, Ono Pharmaceutical, Nippon Kayaku, Kyoto Breast cancer Research NetworkPatents, Royalties, Other Intellectual Property: JP 2017-143763, PCT/JP2016/004374Travel, Accommodations, Expenses: Eisai, TakedaOther Relationship: Japan Breast Cancer Research Group, Kyoto Breast Cancer Research Network, Organization for Oncology and Translational Research Nicholas WilckenHonoraria: Roche/GenentechTravel, Accommodations, Expenses: Amgen Hans-Joachim LueckConsulting or Advisory Role: AstraZeneca, GlaxoSmithKline, Lilly, Seagen, MSD OncologySpeakers' Bureau: Roche, Pfizer, Amgen, Novartis Estefania MonturusEmployment: RocheStock and Other Ownership Interests: RocheOther Relationship: F. Hoffmann-La Roche Ltd (support for third-party writing assistance) Mihaela SicoeResearch Funding: Roche, Pfizer/EMD Serono, Novartis Sébastien GuillaumeResearch Funding: Roche, AstraZeneca, NovartisTravel, Accommodations, Expenses: Roche José BinesHonoraria: Roche, Lilly, Novartis, MSD, PfizerConsulting or Advisory Role: Roche, Lilly, MSDTravel, Accommodations, Expenses: Roche Richard D. GelberResearch Funding: AstraZeneca, Novartis, Roche, Celgene, Merck, Pfizer, Ipsen, FerringTravel, Accommodations, Expenses: Roche, AstraZeneca, Novartis Giuseppe VialeHonoraria: MSD Oncology, Pfizer, Daiichi Sankyo Europe GmbHConsulting or Advisory Role: Dako, Roche/Genentech, Novartis, Bayer, Daiichi Sankyo, MSD Oncology, MenariniSpeakers' Bureau: Roche/GenentechResearch Funding: Roche/Genentech, Ventana Medical Systems, Dako/Agilent Technologies, CepheidTravel, Accommodations, Expenses: Roche Christoph ThomssenHonoraria: AstraZeneca, Celgene, Daiichi Sankyo Europe GmbH, Eisai Germany, Lilly, Pfizer, Roche, Pierre Fabre, MSD, Vifor PharmaConsulting or Advisory Role: Amgen, AstraZeneca, Celgene, Daiichi Sankyo Europe GmbH, MSD, Pfizer, RocheResearch Funding: AstraZeneca, Daiichi Sankyo Europe GmbH, Novartis, Pfizer, RocheTravel, Accommodations, Expenses: Daiichi Sankyo Europe GmbH, Pfizer, RocheNo other potential conflicts of interest were reported.

Background: Aromatase inhibitor induced musculoskeletal syndrome is experienced by approximately half of women taking aromatase inhibitors, impairing quality of life and leading some to discontinue treatment. Evidence for effective treatments is lacking. We aimed to understand the manifestations and impact of this syndrome in the Australian breast cancer community, and strategies used for its management., Methods: A survey invitation was sent to 2390 members of the Breast Cancer Network Australia Review and Survey Group in April 2014. The online questionnaire included 45 questions covering demographics, aromatase inhibitor use, clinical manifestations and risk factors for the aromatase inhibitor musculoskeletal syndrome, reasons for treatment discontinuation and efficacy of interventions used., Results: Aromatase inhibitor induced musculoskeletal syndrome was reported by 302 (82 %) of 370 respondents. Twenty-seven percent had discontinued treatment for any reason and of these, 68 % discontinued because of the musculoskeletal syndrome. Eighty-one percent had used at least one intervention from the following three categories to manage the syndrome: doctor prescribed medications, over-the-counter/complementary medicines or alternative/non-drug therapies. Anti-inflammatories, paracetamol (acetaminophen) and yoga were most successful in relieving symptoms in each of the respective categories. Almost a third of respondents reported that one or more interventions helped prevent aromatase inhibitor discontinuation. However, approximately 20 % of respondents found no intervention effective in any category., Conclusion: We conclude that aromatase inhibitor induced musculoskeletal syndrome is a significant issue for Australian women and is an important reason for treatment discontinuation. Women use a variety of interventions to manage this syndrome; however, their efficacy appears limited.

Women diagnosed with breast cancer have many physiological and psychological adjustments to make following mastectomy. The present study described in this article sought to determine the decision-making patterns used by two groups of women. Nurses need to be well informed and professionally confident to provide the individualized care and support deserved by women throughout the breast cancer trajectory. A major outcome of such professional care is confident women who understand their disease, treatments, and methods to manage stresses as they occur.

The purpose of this study was to explore the breast restoration decision-making patterns used by women who opted to have their breast cancer treated by mastectomy. Sixty-four women wearing external breast prostheses and 31 women with breast reconstructions were interviewed. Modified versions of Simon's notion of "bounded rationality" and Janis and Mann's conflict model provided the conceptual scaffolding for the study. Five breast restoration decision-making patterns emerged from the analysis of the interview data: (a) Enlightened (actively seeks information, considers positive and negative aspects, and demonstrates deliberation on the alternatives), (b) Contented (passively accepts minimum information on alternatives because of a preference toward a particular type), (c) Sideliner (uncritically adopts any alternative that is easy and simple to implement), (d) Shifter (gives over the decision to others), and (e) Panic-stricken (can make no rational decision on alternatives). In the prosthesis group, the major pattern used was the Sideliner, and in the reconstruction group it was the Contented. None of the participants used the Enlightened pattern. The data indicated that there was no evidence of active information-seeking behavior or deliberation on the alternatives as part of the women's decision-making process. The findings suggest a need for a registered nurse oncology specialist to be accessible to women during the period when decisions regarding breast restoration are made. This professional has the knowledge to interact effectively with these women and serve as their advocate during the decision-making process. Implications for professional practice and a model for competent breast restoration decision making are presented.

Breast reconstruction after mastectomy is chosen by approximately 10 percent of Australian women. Younger women are more likely to have this surgical procedure. This suggests that there may be many factors determining this choice. Sixty-four women who wore an external postmastectomy breast prosthesis and 31 women who had postmastectomy breast reconstruction participated in the present study. The purpose was to gain a greater understanding through semi-structured interviews of why women who had breast reconstruction chose this alternative and why women who wore the external postmastectomy breast prosthesis elected not to have reconstruction. The study also ascertained how difficult it was for the women in both groups to decide their particular breast restoration alternative. The most frequently endorsed reasons for not having breast reconstruction in the prosthesis group included: (1) not essential for physical well being, (2) not essential for emotional well being, (3) not having enough information about the procedure, and (4) not wanting anything unnatural in the body. When each member of the group was asked to identify a major reason for not having reconstruction, two predominant issues emerged: (1) fearing complications and (2) perceiving themselves as being too old for the procedure. Twelve percent of the prosthesis group experienced difficulty in making the decision not to have reconstruction. Three factors accounted for this difficulty: (1) the lack of family support, (2) the inability to have a specific type of reconstruction, and (3) the perception that friends and acquaintances saw the surgery as cosmetic. The most frequently reported reasons given by the reconstruction group for having reconstruction included: (1) to get rid of the external breast prosthesis, (2) to be able to wear many different types of clothing, (3) to regain femininity, and (4) to feel whole again. The least influential factors were to improve marital and sexual relations. The major reason cited most often by this group was to feel whole again. None of the women in the reconstruction group experienced any difficulty when deciding their method of breast restoration. What factors are taken into consideration by women when they decide either to have or not to have reconstruction need to be understood by physicians. This knowledge will assist them in conveying appropriate information regarding alternatives and will help them deal with the women's concerns and/or misconceptions.

This study addressed issues regarding the decision-making process used by women who had mastectomy as their surgical treatment for breast cancer. The seven criteria for quality decision-making and the conflict model proposed by Janis and Mann (1977) were used as the study's conceptual framework along with the notion by Simon (1957) of 'bounded rationality'. Four coping patterns emerged: vigilance (actively searches for information and advice), satisficing (being satisfied, chooses first solution that meets the desired objectives), complacency (accepts advice without questions or fully comprehending), and defensive avoidance (rationalises and avoids discussion and consideration of the problem). The participants primarily left the decision for surgical treatment of breast cancer to their surgeons using satisficing, complacency and defensive avoidance. When the option of lumpectomy was offered to some of the participants (34%), they rejected this treatment alternative using the coping patterns of satisfying and defensive avoidance. Those women who were not offered lumpectomy (66%) did not seek a rationale for not being given this alternative. The findings indicated that the women's decision-making process was halted in Stage 2 of the criteria for quality decision-making actively searched for and viewed a number of alternatives. The study's findings are discussed in relation to improving the quality of the decision-making process for women regarding their breast cancer surgical treatment.

Sixty-four women who postmastectomy wore an external breast prosthesis and 31 women who had breast reconstruction participated in the present study. It was hypothesized that the breast prosthesis group would exhibit more negative attitudes towards their mastectomy experience compared to the breast reconstruction group. Using the Mastectomy Attitude Scale (MAS) the results indicated that both groups were satisfied with their bodies, had a positive outlook towards their lives, implied that sexuality entailed more than having breasts, and felt that mastectomy treatment was necessary to save their lives. Neither group concealed that they had a mastectomy, however, they were not prone to discuss their mastectomy experiences. The findings from the study indicate that the women postmastectomy already had or developed positive attitudes towards themselves and life in general and the method chosen for breast restoration had no apparent impact on these attitudes. Reasons for the sample's positive attitudes are discussed.

The perceptions of three groups of women regarding their body image, self-concept, total self-image, and self-esteem were compared. The groups included 64 women who had mastectomies and wore external breast prostheses, 31 women who had mastectomies and underwent breast reconstruction, and a control group of 78 women who had not experienced mastectomy. The body image, total self-image, and self-esteem mean scores indicated that the prosthesis and reconstruction groups had more positive feelings regarding their bodies than did the control group. There were no significant differences in self-concept among the three groups. These findings challenge a common assumption that mastectomy automatically results in psychiatric morbidity caused by an altered body image and suggest that health professionals should not make assumptions about how a woman will psychologically respond to mastectomy.

The use of physical assessment skills, though limited, has been an integral part of nursing since the time of Florence Nightingale, when aids such as sight and touch were relied upon to assess patients. Now with more nurses involved in primary health the use of a wider range of physical assessment has become necessary. Below is a report of how Australian nurses are putting more of these skills into practice.

This study investigates the effectiveness of an educational program to teach 22 registered nurses comprehensive physical assessment skills. Administration of questionnaires and tests provided measures of the nurses: a) use of physical assessment skills; b) knowledge of physical assessment; c) changes in nursing practice since learning the skills; d) barriers to the use of these learned skills. The major post program findings regarding increases in the nurses' knowledge and use of physical assessment skills, positive changes in their nursing practice and lack of barriers to their use of these skills indicates that the participants did benefit from this educational experience.

This study examines the effectiveness of a five day educational program designed to teach registered nurses (RNs) comprehensive physical assessment techniques and associated skills. Tests and questionnaires measured nurses' knowledge and use of physical assessment skills before and three months after its completion. It was found that the group had increased its physical assessment knowledge and the majority were using the learned skills.