Mastectomy is the surgical removal of a breast to treat breast cancer. There are different types of mastectomies, and the choice of which to perform depends on the stage of cancer, size of the tumor, size of the breast, and whether the lymph nodes are involved. A total (simple) mastectomy involves the removal of breast tissue and nipple; in a modified radical mastectomy, most of the lymph nodes under the arm and often the lining over the chest muscles are removed, but the nipple may be spared. Mastectomies are major surgery and require a hospitalization. Afterwards, patients will take several weeks to recover fully as the swelling goes down. Physical therapy following the operation is typical, particularly so that patients return to their normal range of motion. Some patients at very high risk of breast cancer, usually as determined by genetic testing and family history, may have double mastectomies to remove both breasts in an attempt to reduce their breast-cancer risk. Many women have breast reconstruction to rebuild the breast(s) after a mastectomy. For breast reconstruction, a breast implant, or a patient's natural skin, fat and muscle, is used to recreate a natural-looking breast.
The UAB Medicine cancer program is ranked among the best in the nation. Patients who come to UAB Medicine for breast cancer treatment have access to the full array of specialists within our system, including medical, surgical, and radiation oncologists, certified oncology nurses, nurse navigators, reconstructive surgeons, and more.
UAB Medicine's Breast Health Center is unique in that we deliver the full range of breast health services including screening, diagnosis, treatment, rehabilitation, and research. Through our Lynne Cohen Preventive Care Program for Women's Cancer, we also offer comprehensive risk assessments and prevention strategies for breast, ovarian, and uterine cancer, arming women with knowledge to make informed decisions about their cancer risk and care. For women whose cancer is now in remission, our Breast Cancer Survivorship Clinic provides the ongoing medical and emotional support they need to remain healthy long after their treatment has come to an end.
As a part of the O'Neal Comprehensive Cancer Center at UAB, our innovative Interdisciplinary Breast Cancer Clinic utilizes a team of dedicated breast specialists to help patients evaluate their options as effectively as possible, which also allows patients and their families to meet with our various team members in one convenient visit. This approach facilitates better communication among team members, patients, and their families. Each patient is evaluated initially by one of our breast specialists before meeting face to face with other team members to discuss long-term treatment planning. Individualized care plans are developed in roundtable discussions and discussed with the patient and family members during the same visit, which allows questions to be asked of each team member.
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High-tech Simulators Boost UAB Emergency Department CPR Training
University of Alabama at Birmingham Hospital Emergency Department has acquired two high-tech simulators from the American Heart Association to enhance training for nurses and other emergency department staff on the fine points of proper cardiopulmonary resuscitation.
UAB is the fifth hospital in the United States and the first in Alabama to acquire the technology.
“Emergency department staff at hospitals across the country are required to undergo CPR recertification every two years, but studies have shown that their skills begin to degrade the moment the training session ends, and most people have lost effective skills within 90 days,” said Michael Kurz, M.D., associate professor in the Department of Emergency Medicine. “The new simulators allow us to approach CPR training in a whole new way, and we are seeing remarkable improvement.”
The machines, called RQI or the Resuscitation Quality Improvement system, consist of two sophisticated mannequins — one adult and one pediatric — attached to an even more sophisticated computer system. The machines measure all the variables involved with performing CPR and provide instantaneous feedback as a staff member is practicing.
The RQI machines are housed in the emergency department, which means staff does not have to take time off from work to attend a CPR class. The new training regimen calls for nurses and patient care technicians to undergo 10-minute updates every three months, using different modules that work on different skill sets. The computer records trainees’ performance and tracks their improvement over time. It even records whether trainees have placed their hands in the proper position on the mannequin.
“The machine measures variables such as depth of the CPR compression, the rate and the recoil, and the trainee can see on the screen whether they are reaching the appropriate benchmarks in these areas,” said Michael Lovelace, R.N., an emergency department nurse and lead CPR trainer.
Kurz, who is the vice chair for the Systeims of Care subcommitee for emergency cardiovascular care commitee with the Heart Association, says training every three months rather than at two-year intervals has made a significant difference.
UAB is only the fifth hospital in the nation to have the RQI machines and the first in Alabama. Kurz, who is the vice-chair for the Systems of Care sub-committee for emergency cardiovascular care committee with the Heart Association, says training every three months rather than at two-year intervals has made a significant difference.
“Retention of the skills is better; performance is better,” Kurz said. “One important variable is chest compression fraction, which measures the efficiency of the CPR. Since we began using the RQI machines in June 2015, our overall scores for chest compression fraction have improved 14 percent.”
Kurz says there are five main variables the machine tracks, and he is pushing for the emergency staff to reach a collective average score of 90 on each variable.
“For example, before we began using the RQI machines, our chest compression fraction score was about 72,” he said. “It’s now up to 86, and we should hit 90 in the near future. The RQI machines are having a major impact on enhancing our clinical care.”
Better CPR skills means a better chance of survival for patients with cardiac arrest, and not just in the emergency room. Last spring, UAB Hospital emergency nurse Tamicka Jones was at the Atlanta airport when she saw a group of people attempting to assist in man in obvious distress
“The man’s face was gray, and he had no pulse,” Jones recalled. “I was the only medical professional present, so I began CPR and called for a defibrillator. Training on the RQI machine meant that my skills were sharp, and I had confidence that I was performing CPR at a high level of effectiveness.”
Jones performed CPR and delivered a shock from the defibrillator until the arrival of an EMS crew. She has since heard from the man’s family that he survived.
“Using these machines really changes the paradigm of how we teach and practice CPR,” Kurz said. “This is the largest change in our approach in over 60 years and really brings CPR training into the modern era.”
Source: UAB News