Paul E. Preece

Needle aspiration of the breast with immediate reporting of material.

Needle aspiration with immediate cytological reporting has been practised in a breast clinic for one year. Patients benefit by receiving immediately the provisional diagnosis and, when indicated, appointments for metastatic surveys. Close co-operation between surgeon and cytologist has resulted in increased skill in aspiration, better preparation of samples, and greater accuracy in interpretation of reports. Since 5% of clinically benign lesions have proved malignant, even on immediate reporting, we would recommend cytological examination of all breast lumps.

Twelve tips for setting up an ambulatory care (outpatient) teaching centre

The ambulatory care setting is becoming an increasingly important environment for clinical teaching. This reflects the changing focus of healthcare delivery with more procedures and patient treatment being delivered in this setting. Maximizing learning opportunities for students without compromising patient care has never provided a greater challenge. This paper shares 12 educational tips for developing an ambulatory care teaching centre where both students and patients benefit from a protected yet realistic clinical setting.

Can a dedicated teaching and learning environment in ambulatory care improve the acquisition of learning outcomes

Current trends in undergraduate medical education are moving away from traditional ward based learning to ambulatory care teaching. We wanted to know whether students gain more learning outcomes from a dedicated ambulatory teaching environment than a conventional outpatient clinic. A comparative evaluation study using a semi-structured student questionnaire and a structured patient questionnaire was performed. Results indicated the learning environment and organization of the teaching in the Ambulatory Care Teaching Centre (ACTC) rated higher. Surprisingly, however, more learning outcomes were achieved in the conventional outpatient clinic setting, but each venue demonstrated particular strengths with regard to individual outcomes. The level of patient satisfaction in the ACTC was high implying patient care was not adversely affected utilizing this setting. This information will inform practice for the content of future teaching sessions in the outpatient setting.

Serum proteinase-like peptidase activities and proteinase inhibitors in women with breast disease

The pre-treatment serum activities of several proteinase-like peptidases and the proteinase inhibitors, alpha 1-antitrypsin (alpha 1AT) and alpha 2-macroglobulin (alpha 2M), have been determined in 102 women with breast cancer and compared with those in 20 women with benign disease and in 30 healthy women of cancer bearing age. There were no significant differences in serum proteinase-like peptidase activities associated specifically with breast cancer. However, trypsin-like and plasmin-like activities were significantly lower than normal in women with breast disease. Serum alpha 1AT and alpha 2M levels were higher in patients with breast cancer than in healthy women or women with benign breast disease. These results indicate that, at presentation, breast cancer is not associated with abnormal serum levels of the proteinase-like peptidases studied, possibly as a result of an increase in the concentration of proteinase inhibitors.

Educational benefits of student self-marking of short-answer questions

A pilot study was undertaken to evaluate the feasibility and reliability of undergraduate medical student selfmarking of degree written examinations, and to survey student opinion regarding the process. The correlation between student and faculty staff scores for individual questions and the total examination was high (correlation coefficient ranged from 0.77 to 0.91: p < 0.001). There were no significant differences between the mean student and mean faculty staff scores for individual questions or the total examination: 98% (97199) of student scores fell within ± 15% of the faculty staff score, with 92% (91199) of students falling within ± 10%. Although the approach was demonstrated to be reliable, students generally failed to acknowledge the potential value of self-marking in terms of feedback and as a learning opponunity, and found the process stressful.

Tamoxifen metabolism is altered by simultaneous administration of medroxyprogesterone acetate in breast cancer patients

SummaryWe have measured the levels of tamoxifen and three of its metabolites in the blood of patients receiving tamoxifen alone or combination therapy with tamoxifen and medroxyprogesterone acetate. Our results indicate that addition of the progestogen significantly alters the metabolism of tamoxifen over a six-month period. We suggest that the interaction between these drugs may involve additional sites (probably hepatic) besides the desired target tumour.