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Prerequisites for data collection Before you start obtaining information from potential respondents it is imperative that you make sure of their: motivation to share the required information – It is essential for respondents to be willing to share information with you medicine man dispensary buy discount isordil. You should make every effort to motivate them by explaining clearly and in simple terms the objectives and relevance of the study, either at the time of the interview or in the covering letter accompanying the questionnaire and/or through interactive statements in the questionnaire. If respondents do not understand a question clearly, the response given may be either wrong or irrelevant, or make no sense. This is of particular importance when you are seeking factual or technical information. Methods of data collection in qualitative research To draw a clear distinction between quantitative and qualitative methods of data collection is both difficult and inappropriate because of the overlap between them. The difference between them mainly lies in the manner in which a method is applied in an actual data collection situation. Use of these methods in quantitative research demands standardisation of questions to be asked of the respondents, a rigid adherence to their structure and order, an adoption of a process that is tested and predetermined, and making sure of the validity and reliability of the process as well as the questions. However, the methods of data collection in qualitative research follow a convention which is almost opposite to quantitative research. The wording, order and format of these questions are neither predetermined nor standardised. Qualitative methods are characterised by flexibility and freedom in terms of structure and order given to the researcher. As mentioned in the previous chapter, most qualitative study designs are method based: that is, the method of data collection seems to determine the design. In some situations it becomes difficult to separate a study design from the method of data collection. For example, in-depth interviewing, narratives and oral history are both designs and methods of data collection. Participant observation has been adequately covered earlier in this chapter and secondary sources will be covered in a later section, so at this point we will focus on unstructured interviews, which are by far the most commonly used method of data collection in qualitative research. Flexibility, freedom and spontaneity in contents and structure underpin an interaction in all types of unstructured interview. This interaction can be at a one-to-one (researcher and a respondent) or a group (researcher and a group of respondents) level. There are several types of unstructured interview that are prevalent in qualitative research, for example in-depth interviewing, focus group interviewing, narratives and oral histories. For a detailed understanding readers should consult the relevant references listed in the Bibliography. In-depth interviews the theoretical roots of in-depth interviewing are in what is known as the interpretive tradition. According to Taylor and Bogdan, in-depth interviewing is ‘repeated face-to-face encounters between the researcher and informants directed towards understanding informants’ perspectives on their lives, experiences, or situations as expressed in their own words’ (1998: 77). This definition underlines two essential characteristics of in-depth interviewing: (1) it involves face-to-face, repeated interaction between the researcher and his/her informant(s); and (2) it seeks to understand the latter’s perspectives. Because this method involves repeated contacts and hence an extended length of time spent with an informant, it is assumed that the rapport between researcher and informant will be enhanced, and that the corresponding understanding and confidence between the two will lead to in-depth and accurate information. Focus group interviews the only difference between a focus group interview and an in-depth interview is that the former is undertaken with a group and the latter with an individual. In a focus group interview, you explore the perceptions, experiences and understandings of a group of people who have some experience in common with regard to a situation or event. For example, you may explore with relevant groups such issues as domestic violence, physical disability or refugees. In focus group interviews, broad discussion topics are developed beforehand, either by the researcher or by the group. You, as a researcher, need to ensure that whatever is expressed or discussed is recorded accurately. You may audiotape discussions, employ someone else to record them or record them yourself immediately after each session. If you are taking your own notes during discussions, you need to be careful not to lose something of importance because of your involvement in discussions. You can and should take your write-up on discussions back to your focus group for correction, verification and confirmation. Narratives the narrative technique of gathering information has even less structure than the focus group. Narratives have almost no predetermined contents except that the researcher seeks to hear a person’s retelling of an incident or happening in his/her life. Essentially, the person tells his/her story about an incident or situation and you, as the researcher, listen passively. Occasionally, you encourage the individual by using active listening techniques; that is, you say words such as ‘uh huh’, ‘mmmm’, ‘yeah’, ‘right’ and nod as appropriate. Narratives are a very powerful method of data collection for situations which are sensitive in nature. For example, you may want to find out about the impact of child sexual abuse on people who have gone through such an experience. You, as a researcher, ask these people to narrate their experiences and how they have been affected. Narratives may have a therapeutic impact; that is, sometimes simply telling their story may help a person to feel more at ease with the event. As with focus group interviews, you need to choose the recording system that suits you the best. Having completed narrative sessions you need to write your detailed notes and give them back to the respondent to check for accuracy. Oral histories Oral histories, like narratives, involve the use of both passive and active listening. Oral histories, however, are more commonly used for learning about a historical event or episode that took place in the past or for gaining information about a cultural, custom or story that has been passed from generation to generation. Narratives are more about a person’s personal experiences whereas historical, social or cultural events are the subjects of oral histories. Suppose you want to find out about the life after the Second World War in some regional town of Western Australia or about the living conditions of Aboriginal and Torres Strait Islander people in the 1960s. You would talk to persons who were alive during that period and ask them about life at that time. Data collection through unstructured interviewing is extremely useful in situations where either indepth information is needed or little is known about the area. The flexibility allowed to the interviewer in what s/he asks of a respondent is an asset as it can elicit extremely rich information. As it provides indepth information, this technique is used by many researchers for constructing a structured research instrument. On the other hand, since an unstructured interview does not list specific questions to be asked of respondents, the comparability of questions asked and responses obtained may become a problem. As the researcher gains experience during the interviews, the questions asked of respondents change; hence, the type of information obtained from those who are interviewed at the beginning may be markedly different from that obtained from those interviewed towards the end. Using an interview guide as a means of data collection requires much more skill on the part of the researcher than does using a structured interview. Constructing a research instrument in qualitative research Data in qualitative research are not collected through a set of predetermined questions but by raising issues around different areas of enquiry. Hence there are no predetermined research tools, as such, in qualitative research. However, many people develop a loose list of issues that they want to discuss with respondents or to have ready in case what they want to discuss does not surface during the discussions. In the author’s opinion, particularly for a newcomer, it is important to develop an interview guide to ensure desired coverage of the areas of enquiry and comparability of information across respondents. Note that in-depth interviewing is both a method of data collection and a study design in qualitative research and the interview guide is a research tool that is used to collect data in this design. Recently the author conducted a study using in-depth interviewing and focus group methodologies to construct a conceptual service delivery model for providing child protection services through family consultation, involvement and engagement. The project was designed to develop a model that can be used by the field workers when dealing with a family on matters relating to child protection. The author conducted a number of in-depth interviews with some staff members working at different levels to gather ideas of the issues that service providers and managers thought to be important. On the basis of the information obtained from these in-depth interviews, a list of likely topics/issues was prepared. This list, the interview guide, became the basis of collecting the required information from individuals and focus groups in order to construct the conceptual model. Though this list was developed the focus groups were encouraged to raise any issue relating to the service delivery.

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Sonographically guided 14-gauge core Percutaneous vacuum-assisted core breast biopsy with upright stereotactic equipneedle biopsy of breast masses: a review of 2 symptoms 7 dpo bfp cheap isordil uk,420 cases with long-term follow-up. Ultrasound-guided core needle biopsy of breast tologic heterogeneity of masses at percutaneous breast biopsy. UltrasoundStereotactic 11-gauge vacuum-assisted breast biopsy: a validation study. Accuracy of Mammotome core biopsy for mammary microcalcification: analysis of 160 biopsonographically guided 14-gauge core-needle biopsy: results of 715 consecutive sies from 142 women with surgical and radiologic followup. Can Assoc Ultrasound-guided large-core needle biopsies of breast lesions: analysis of 962 Radiol J. Three-dimensional ultrasound-validated large10894010] core needle biopsy: is it a reliable method for the histological assessment of breast 66. The accuracy of ultrasound, stereotactic, and clinical core biopsies 1997;185:224-8. Stereotactic and sonographic large-core biopsy of nonpalpable breast lesions: guided large-core needle biopsy of the breast: accuracy and cost-effectiveness. Stereotactic histologic biopsy in breasts with imthe breast: a 3-year experience. Randomized in vitro and in vivo evaluation of different biopsy needles and deTreadwell, K. A prospective randomized study of two gauges of biopty-cut needle in Drafting of the article: W. Were the patient inclusion/exclusion criteria consistently applied to all literature patients? Were the patients assessed by using the gold standard (open surgical Used a device that is no longer commercially procedure) regardless of the initial biopsy results? Were patients assessed by using a reference standard regardless of the Enrolled a high-risk population: 30 biopsy results? Was funding for this study provided by a source that does not have an Articles Enrolled <10 patients: 8 obvious financial interest in the findings of the study? Were readers of the reference standard blinded to the results of the Enrolled patients with recurrent breast biopsy? Were readers of the reference standard blinded to all other clinical Not English language: 2 information? Duplicate report: 1 Unresolvable multiple discrepancies in data * this instrument is based on a modification of the Quality Assessment of Diagreporting: 1 nostic Accuracy Studies instrument (5). Each question in the instrument addresses Studies an aspect of study design or conduct that can help to protect against bias. A summary quality score was computed in order to reduce the (n = 107) subjectivity of the assessment of the potential for bias present in the evidence base. A summary score was computed on the basis of 1 point for each yes, –1 point for each no, and 0 point for each not reported. Consequently, a study that used all 14 features would score 10, a study that used none would score 0, and a study that did not report any of these features would score 5, which acknowledges that published studies may not provide information on all study procedures that were performed. To evaluate the overall quality of the evidence base for each conclusion, we computed the median quality score of the studies contributing to that conclusion. Breast Imaging for Screening and Diagnosing Cancer Page 1 of 12 UnitedHealthcare Commercial Medical Policy Effective 05/01/2019 Proprietary Information of UnitedHealthcare. The documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested. The high center-frequency significantly sharpens detail resolution while the ultra-broadband performance simultaneously delivers distinct contrast differentiation. The test is performed with a gamma camera after intravenous administration of radioactive tracers. Scintimammography has been proposed primarily as an adjunct to mammography and physical examination to improve selection for biopsy in patients who have palpable masses or suspicious mammograms. For this test, a small, microphone-like instrument called a transducer is placed on the skin (which is often first lubricated with ultrasound gel). The echoes are converted by a computer into a black and white image on a computer screen. Ultrasound is useful for evaluating some breast masses and is the only way to tell if a suspicious area is a cyst (fluidfilled sac) without placing a needle into it to aspirate (draw out) fluid. Breast ultrasound may also be used to help doctors guide a biopsy needle into some breast lesions. These systems have been developed to promote standardized breast ultrasound reporting. As the clinician gently moves the hand-held sensor across the breast and underarm area, data signals are then processed into multi-dimensional color images that instantly appear on a computer screen in real-time, allowing the clinician to view the size, shape, hardness and location of suspicious masses immediately. Since malignant tissue tends to conduct more electricity than normal tissue, the electrical current produced creates a conductivity map of the breast which automatically identifies sites that appear suspicious. The transmission of electricity into the body is via an electrical patch on the arm or a handheld device which travels to the breast. Specifically, the elastic modulus of breast cancer tissue is approximately 5to 20-fold higher than that of the surrounding fibroglandular tissue, i. This difference can be measured by applying a known stressor and measuring the resulting deformation. Listing of a code in this policy does not imply that the service described by the code is a covered or noncovered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. However, efforts to provide new insights regarding the origins of breast disease and to find different approaches for addressing several key challenges in breast cancer, including detecting disease in mammographically dense tissue, distinguishing between malignant and benign lesions, and understanding the impact of neoadjuvant chemotherapies, has led to the investigation of several novel methods of breast imaging for breast cancer management. Further review is required to confirm abstract content and, therefore, conclusions about the safety and effectiveness of this technology cannot be made until a full assessment has been completed. The methods were assessed for each breast and each detected lesion separately and classified into two categories: breasts with mammographic suspicion of malignancy and breasts with a negative mammogram. Due to the small size of this study population, further investigation with larger study populations is necessary before the implementation of such practice. Breast Imaging for Screening and Diagnosing Cancer Page 4 of 12 UnitedHealthcare Commercial Medical Policy Effective 05/01/2019 Proprietary Information of UnitedHealthcare. Literature review located three systematic reviews that included women at high risk of developing breast cancer. Two reviews by Phi et al (2015, 2017) reported 2 individual patient data meta-analyses from the same 6 studies published between 2010 and 2013. The Warner (2008) review did not present a risk of bias or quality assessment of included studies. They do not recommend routine use of alternative or adjunctive tests to screening mammography in women with dense breasts who are asymptomatic and have no additional risk factors. The College strongly supports additional research to identify more effective screening methods that will enhance meaningful improvements in cancer outcomes for women with dense breasts and minimize false-positive screening results. Magnetic Resonance Elastography of the Breast A prospective study by Siegmann et al. In a 2016 systematic review and meta-analysis, the authors sought to establish if Tc-99m sestamibi scintimammography is useful in the prediction of neoadjuvant chemotherapy responses in breast cancer. Electronic database were searched for relevant publications in English, and fourteen studies, for a total of 503 individuals, fulfilled the inclusion criteria. Eligible patients were identified as women at increased risk for breast cancer and whose most recent mammogram was benign. Examinations exhibiting focally increased radiotracer uptake were considered positive. Patients ranged in age from 26 to 83 with a mean age of 57 Eleven of 14 cancers were detected in women with dense breasts. In addition, unlike biopsy, breast-specific gamma imaging does not provide a definitive diagnosis since it incorrectly indicates that 15% to 40% of benign lesions are cancerous.

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Department of Agriculture symptoms 10 days post ovulation buy isordil online, Agricultural Research Service, Nutrient Data Laboratory. Omega-3 (n-3) fatty acids are a type of polyunsaturated fats found in seafood, such as salmon, trout, herring, tuna, and mackerel, and in fax seeds and walnuts. Monounsaturated fats also are part of most animal fats such as fats from chicken, pork, beef, and wild game. They also are found in other animal fats, such as pork and chicken fats and in other plant fats, such as nuts. They are structurally different from the unsaturated fatty acids that occur naturally in plant foods and differ in their health effects. The proportions of fatty acids in a particular fat determine the physical form of the fat: Fats with a higher amount of polyunsaturated and monounsaturated fatty acids are usually liquid at room temperature and are referred to as oils. A relevant detail in the complexity of making food-based recommendations that consider nutrients is the difference between the terms saturated fats and solid fats. The term saturated fats refers to saturated fatty acids, a nutrient found in foods, while the term solid fats describes the physical manifestation of the fats in a food. Some solid fats, such as the strip of fat around a piece of meat, can easily be seen. For example, the solid fats in whole milk are suspended in the fuid milk by the process of homogenization. Margarines and margarine-like vegetable oil spreads are food products composed of one or more oils or solid fats designed to replace butter, which is high in saturated fats. Margarine and vegetable oil spreads generally contain less saturated fats than butter. However, they vary in their total fat and calorie content and in the fat and oil blends used to make them and, thus, in the proportions of saturated, unsaturated, and trans fats they contain. It is important to read the Nutrition Facts label to identify the calorie and saturated and trans fats content of the spread and choose foods with no trans fats and lower amounts of saturated fats. The Dietary Guidelines provides recommendations on saturated fats as well as on solid fats because its aim is to improve the health of the U. It includes recommendations on solid fats because, as discussed in Chapter 2, they are abundant in the diets of the U. Page 27 — 2015-2020 Dietary Guidelines for Americans Chapter 1• Limits on Calories That Remain excess calories without contributing to Added Sugars After Food Group Needs Are meeting food group recommendations. Healthy Intake: Added sugars include Met in Nutrient-Dense Forms the excess calories consumed from these syrups and other caloric sweeteners. Consumption of added sugars From a public health perspective, it is Patterns are based on consuming foods can make it diffcult for individuals to meet important to identify the calories that are in their nutrient-dense forms. Naturally occurring sugars, inform guidance on limits from calories from fat forms, see Appendix 6). For nearly [21] such as those in fruit or milk, are not added added sugars, solid fats, alcohol, or other all calorie levels, most of the calories in sugars. In the 2,000-calorie this recommendation is a target to help many calories are available to select foods pattern, the limit for other uses is 270 the public achieve a healthy eating pattern, from a food group that are not in nutrientcalories and in the 2,800-calorie pattern, which means meeting nutrient and food dense forms. As discussed in the next 400 calories (see Appendix 3, Appendix 4, group needs through nutrient-dense food portion of the chapter, additional constraints and Appendix 5). Calories up to the limit and beverage choices and staying within apply related to other dietary components for the specifc pattern can be used to calorie limits. This target also is informed or solid fats) or to eat more than the In addition to the food groups, it is important by national data on intakes of calories recommended amount of nutrient-dense to consider other food components when from added sugars, which as discussed in foods. The Chapter 2, account on average for almost from alcoholic beverages should also be components discussed here include 270 calories, or more than 13 percent of accounted for within this limit to keep total added sugars, saturated fats, trans fats, calories per day in the U. For each component, information is provided As discussed in Chapter 2, in contrast on how the component relates to eating to the healthy choices that make up the patterns and outlines considerations related Patterns, foods from most food groups as to the component. See Chapter 2 they are typically consumed in the United for a further discussion of each of these States are not in nutrient-dense forms. Hidden Components in Eating Patterns Many of the foods and beverages we eat contain sodium, saturated fats, and added sugars. Making careful choices, as in this example, keeps amounts of these components within their limits while meeting nutrient needs to achieve a healthy eating pattern. As discussed in not exceed the acceptable daily intake, even pattern with enough foods from all food Chapter 2, the two main sources of added for high consumers of each substance. There is room on calories for other uses are more than 10 for Americans to include limited amounts percent per day. The recommendation to limit of added sugars in their eating patterns, added sugars to no more than 10 percent of including to improve the palatability of Saturated Fats, Trans Fats, calories is a target that applies to all calorie some nutrient-dense foods, such as fruits & Cholesterol levels to help individuals move toward and vegetables that are naturally tart. Healthy eating Healthy Intake: Intake of saturated patterns can accommodate other nutrientAlthough the evidence for added sugars fats should be limited to less than 10 dense foods with small amounts of added and health outcomes is still developing, percent of calories per day by replacing sugars, such as whole-grain breakfast the recommendation to limit calories from them with unsaturated fats and while cereals or fat-free yogurt, as long as added sugars is consistent with research keeping total dietary fats within the agecalories from added sugars do not exceed examining eating patterns and health. Individuals include lower intake of sources of added It should be noted that replacing added 2 years and older therefore have no sugars are associated with reduced risk sugars with high-intensity sweeteners may dietary requirement for saturated fats. Based on the available shows that replacing saturated fats not necessarily to an isolated aspect of scientifc evidence, these high-intensity with polyunsaturated fats is associated the diet. Page 31 — 2015-2020 Dietary Guidelines for Americans Chapter 1• for monounsaturated fats is not as strong in margarines, and by limiting other solid Dietary Cholesterol as the evidence base for replacement fats. A number of studies have observed the body uses cholesterol for physiological with polyunsaturated fats. Trans fatty dietary cholesterol, such as fatty meats and fats in the diet should be replaced with acids produced this way are referred to as high-fat dairy products, are also higher in polyunsaturated and monounsaturated fats. Artifcial trans fatty acids are limited in saturated fats, and because of the the main sources of saturated fats in the U. Although some saturated fats are the amounts of artifcial trans fats in many cholesterol across the 12 calorie levels. Healthy foods in recent years, these fats can still Current average intake of dietary cholesterol eating patterns can accommodate nutrientbe found in some processed foods, such as among those 1 year and older in the United dense foods with small amounts of saturated some desserts, microwave popcorn, frozen States is approximately 270 mg per day. Because natural trans earlier, eating patterns consist of multiple, Individuals should limit intake of trans fats fats are present in dairy products and meats interacting food components and the to as low as possible by limiting foods in only small quantities and these foods can relationships to health exist for the overall that contain synthetic sources of trans be important sources of nutrients, these foods eating pattern, not necessarily to an isolated fats, such as partially hydrogenated oils do not need to be eliminated from the diet. It is low in saturated fats and rich in potassium, calcium, and magnesium, as well as dietary fber and protein. It also is lower in sodium than the typical American diet, and includes menus with two levels of sodium, 2,300 and 1,500 mg per day. Caffeine Caffeine is not a nutrient; it is a dietary component that functions in the body as a stimulant. If caffeine is added to a food, it must be included in the listing of ingredients on the food label. Caffeinated coffee beverages include drip/brewed coffee (12 mg/f oz), instant coffee (8 mg/f oz), espresso (64 mg/f oz), and specialty beverages made from coffee or espresso, such as cappuccinos and lattes. Amounts of caffeine in other beverages such as brewed black tea (6 mg/f oz), brewed green tea (2-5 mg/f oz), and caffeinated soda[26] (1-4 mg/f oz) also vary. Beverages within the energy drinks category have the greatest variability (3-35 mg/f oz). Moderate coffee consumption (three to fve 8-oz cups/day or providing up to 400 mg/day of caffeine) can be incorporated into healthy eating patterns. This guidance on coffee is informed by strong and consistent evidence showing that, in healthy adults, moderate coffee consumption is not associated with an increased risk of major chronic diseases. However, individuals who do not consume caffeinated coffee or other caffeinated beverages are not encouraged to incorporate them into their eating pattern. Limited and mixed evidence is available from randomized controlled trials examining the relationship between those energy drinks which have high caffeine content and cardiovascular risk factors and other health outcomes. In addition, caffeinated beverages, such as some sodas or energy drinks, may include calories from added sugars, and although coffee itself has minimal calories, coffee beverages often contain added calories from cream, whole or 2% milk, creamer, and added sugars, which should be limited. The same considerations apply to calories added to tea or other similar beverages. Those who choose to drink alcohol should be cautious about mixing caffeine and alcohol together or consuming them at the same time; see Appendix 9. In addition, women who are capable of becoming pregnant or who are trying to , or who are pregnant, and those who are breastfeeding should consult their health care providers for advice concerning caffeine consumption. Page 33 — 2015-2020 Dietary Guidelines for Americans Chapter 1• regarding the dose-response relationship linear dose-response relationship between Considerations: As a food ingredient, between dietary cholesterol and blood increased sodium intake and increased blood sodium has multiple uses, such as in curing cholesterol levels. In addition, moderate meat, baking, thickening, enhancing favor available for a quantitative limit for dietary evidence suggests an association between (including the favor of other ingredients), cholesterol specifc to the Dietary Guidelines. A few foods, found in foods across the food supply, including notably egg yolks and some shellfsh, Calorie intake is highly associated with mixed dishes such as burgers, sandwiches, are higher in dietary cholesterol but not sodium intake.

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Digital Imaging – Preanalytic Testing Phase American Journal of Surgical Pathology symptoms joint pain fatigue buy isordil line. Tissue ischemia time affects gene and protein Time frame Minutes Hours expression patterns within minutes Warm ischemic time following surgical tumor excision BioTechniques, Vol. Fluorescence In-situ prior to placing in cassettes Hybridization on Formalin-fixed and Paraffin-Embedded Tissue: Optimizing Time cassettes are held prior to loading onto tissue the Method. Applied processor Immunohistochemistry & Molecular Fixation time on tissue processor (delay time plus Morphology. The use of surgical instruments should be avoided or limited as much as Association of Surgical Technologists Tissue Collection and possible when handing the specimen to prevent crushing or damaging the tissue. All fresh specimens are to be submitted to the pathology department as soon as possible with instructions for special testing or processes. Surgical specimen identification errors: A new measure of quality in soon as possible and refrigerated until placed into appropriate fixative. Specimens not in fixative should be placed in a sterile basin and kept moist not forgotten: the search for the lost with sterile saline or wrapped in saline-soaked sponges until the specimen surgical specimens: Application of can be properly placed in fixative. Special guidelines are required for the handling of breast tissues to ensure fixative World Health Organization. Chain of custody ensures continuity of quality care for the patient and provides a the Joint Commission. Guidelines (time/date) for the safe transport of infectious substances and diagnostic specimens. Specimen receipt procedure must be available to all personnel in the pathology the Joint Commission. Guidelines for the safe transport of infectious substances and diagnostic specimens. In some instances, the specimen can be considered to be a rejection specimen and only the originator should be making the appropriate labeling changes. Specimen Rejection Criteria National Patient Safety Goals Hospital handling o Identification of the patient sample (labeling) Program. Tissue Transport o Completion of the requisition to include all required demographic and clinical. Quality Assurance data Department of Health and Human Monitors o Specimen container to be used Services, Centers for Medicare and 3. Clinical laboratory Acceptance o Transport packing, temperature and method improvement amendments of 1988; o Additional specialized instructions final rule. Health care facility policy and procedure should be followed for the proper Carson F, Hladik C. Histotechnology A tissue collection and collection and handling of general biopsies. Specimen specific o Type and volume of fixative recommendations o Transport and holding instructions Bancroft J, Gamble M. If this cannot be completed in a timely manner, the biopsy should be placed in a the Joint Commission. Surgical specimen identification errors: A new measure of quality in surgical care. Histotechnology A tissue collection and collection and handling of bone marrow cores and aspirates. Bone marrow cores/aspirates should be placed in fixative immediately after the recommendations procedure. Health care facility policy and procedure should be followed for the proper American Society of Clinical Oncology. Retrieved handling o Type of collection container Specimen Collection Manual Elements. Adequate Storage Recommendations for Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer. Clinical laboratory o Labeling procedure for sub specimens improvement amendments of 1988; o Holding and transport instructions for specialized testing. If insufficient fixative is present when the specimen is received in the Handling of Referred Specimens Histotechnology A Self-Instructional ii. Generally, this should be a volume such that there is a 15-20:1 ratio of fixative to 2014. The specimen container should remain sealed so that drying or other specimen damage cannot occur. Health care facility policy and procedure should be followed for the proper Consultation collection and handling of specimens for intra-operative consultation. A College of American Pathologists Q-probes study of 90 538 cases in 461 institutions. Decontamination of the cryostat is documented and records are available for Approved Guideline M29-A4; examination. Intra-Operative o Reagents to be used – concentration and volumes Biohazard Waste Disposal Final Critique. The laboratory has sufficient space and utilities are adequate for gross Clinical Laboratory i. Activities and the nature of supervision is defined in a written protocol Medicaid Services. Education/training equivalent to the above that includes at least 60 semester Improvement Amendments of 1988; hours or equivalent from an accredited institution. Guideline for the safe ▪ Procedures should distinguish policy regarding specimens with low use of radioactive materials during radioactivity levels (such as sentinel lymph nodes) and high localization and resection of sentinel radioactivity level specimens such as implant devices. Recommendations for handling radioactive specimens obtained by sentinel lymphadenectomy. Arch Pathol tonsils and adenoids in children below a certain age, foreskin in Lab Med. There is a complete list of devices required for tracking under the Safe Medical Reg. The guideline should include: Quality improvement manual in o Time of retention – minimum of two weeks after report issued and results anatomic pathology, second edition. Guidelines Document physical parameters of sections submitted for histologic examination: College of American Pathologists. Quality improvement manual in o the number of biopsies or cores should be limited to enable proper anatomic pathology, 2nd ed. A written policy and procedure for the use of recycled formalin should include: Section 19 of Occupational Safety and i. Recycling formalin o Documentation of the initial verification of quality of recycled formalin. Type of fixative Specimen Collection Manual Elements SelfInstructional Text, 3rd ed. Biotech o Safety precautions and spill clean up Histochem 82:161; 2007 Bancroft J, Gamble M. Other fixatives, such as alcoholic formalin or Anatomic Pathology Checklist, Pathologists Guideline Update Bouin, may have different guidelines. Fixation documented based on: Specimen Collection Manual Elements Dowsett,M, et al: American Society of Times/Factors Clinical Oncology/College of American b. Journal of ▪ Dense tissue such as uterus or cervixrequires extended fixation Clinical Oncology, Vol 31, No. Histotechnology A bloody, like breast, colon and spleen, usually require extended times in most rd SelfInstructional Text, 3 ed. Gross dissection manual should include information about the size and thickness ii. A gross dissection manual should include specific instructions related to the SelfInstructional Text, 3rd ed. Theory and ▪ Opening / slicing of whole organs Practice of Histological Techniques, 6th ▪ Exchange fixative ed. Large specimens should be opened or regularly sliced to maximize surface exposure to fixative reagents.

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Most animals used Mouse Rabies vaccine in research are specifcally bred for Pig Skin grafts for burn victims use in medical research symptoms esophageal cancer generic 10 mg isordil with visa. These studies almost always Rat Carcinogen screening require the results of preliminary tests in animal research studies. All medical research is carefully planned, and this includes medical research with animals. Experts who review a scientist’s proposed experiment involving animals weigh several considerations before approving each study. The most important thing is that the research must be relevant to human or animal health. That means that only the fewest number of the most appropriate species may be used. Under federal law, all animals must be treated humanely and undergo the least distress possible. These scientists study animals because they are a lot like people when it comes to basic body functions like breathing, eating, hearing, and seeing. Throughout vast evolutionary time—from bacteria to plants to people—the same biological processes are recycled over and over. Veterinarians with specialized training in laboratory animal medicine are an integral part of a medical research team. As part of this research group, veterinarians assure the humane treatment of animals and provide medical and surgical support throughout research studies. Congress and the Public Health Service have set up laws, regulations, and policies to ensure humane treatment of all animals in research. The Public Health Service Policy on Humane Care and Use of Laboratory Animals, the Guide for the Care and Use of Laboratory Animals, and the Animal Welfare Act give details about day-to-day animal care. How big should the cages be, and how warm or cool do the animals need to be to stay healthy? What kind of food is best, and how much noise do the animals like to have (some like it very quiet)? Do the animals like bright or dim light, and do they need other animals or toys to play with? Results from animal studies are crucial for closing knowledge gaps about health and disease in both humans and animals. Understanding cell and organ function—which is similar in all vertebrates—helps researchers design experiments to test new treatments in people. Cell culture studies or computers are important but cannot at present take the place of research models that use animals. No single set of results from a particular model—whether animal, cell, or computer— can predict exactly what will happen, so researchers often ask the same questions in different kinds of studies. When different models yield similar results, the results are much more believable. Computer Models in Research Even though computer models are very valuable, they are limited by what is already known about a process or disease. Thus, medical research with animals and computer modeling studies work together to increase our understanding of health and disease. In Vitro Studies in Research In vitro experiments are performed in test tubes and plastic dishes. When scientists study living cells in laboratory containers, they cannot reproduce the whole, complex, interactive system that is present in an animal or a human. The results of these experiments help scientists design further experiments to conduct in an animal. The National Institutes of Health funds most of the basic medical research in the United States and beyond. These committees are responsible for making sure that all the researchers at the institution obey the animal welfare laws. Additionally, the government even has rules about who should serve on these committees. Scientists don’t understand human biology enough to risk using new medical treatments or surgical procedures directly on people. Because research is a quest to understand the unknown, the rate of progress varies a lot. Nearly everyone considers fnding lifesaving cures through biomedical research to be one of humanity’s highest purposes. Medical Research that Helps Animals themselves, humans are also the only species capable of considering Discovery How it Helps Animals the needs of other species on the Research on viruses Dog parvovirus vaccine planet we share. For the entities, compliance with these regulations, known treating physician, duties of confidentiality have as the Privacy Rule, was required as of April 14, long been established under well-known legal and 2003. As the Federal privacy standards are certain circumstances or under certain conditions. With certain adhere to a common set of national standards for exceptions, the Privacy Rule applies to individu­ protecting the privacy of patients and clinical ally identifiable health information created or research subjects. Covered entities are health plans, health care clearinghouses, and this fact sheet discusses the Privacy Rule and its health care providers that transmit health infor­ impact on covered entities that conduct clinical mation electronically in connection with certain research. Additional information about the Privacy providers and engage in any of the covered Rule’s potential impact on other research activi­ electronic transactions. The Privacy Rule also information is held or transmitted by a covered permits disclosures to business associates. When an Authoriza­ individual’s legally authorized representative tion is obtained for research purposes, the Privacy signs the Authorization, a description of the Rule requires that it pertain only to a specific representative’s authority to act for the indi­ research study, not to future, unspecified projects. An section of the covered entity’s notice of privacy informed consent, on the other hand, is the practices. An informed consent provides research eligibility of benefits can be conditioned on subjects with a description of the study and of its Authorization, including research-related anticipated risks and/or benefits, and a description treatment and consequences of refusing to sign of how the confidentiality of records will be the Authorization, if applicable. Whether combined with an informed general statement that the Privacy Rule may no consent or separate, an Authorization must contain longer protect health information disclosed to the specific core elements and required statements the recipient. The individual’s revocation is effective closed, identifying the information in a specific when the covered entity receives the written and meaningful manner revocation, except to the extent that the covered · the names or other specific identification of the entity has taken action in reliance upon the person or persons (or class of persons) autho­ Authorization. For example, a covered entity is not rized to make the requested use or disclosure required to retrieve information that it disclosed · the names or other specific identification of the under a valid Authorization before receiving the person or persons (or class of persons) to whom revocation. These reviews a covered health care provider may discuss allow the researcher to determine, for example, treatment alternatives, which may include whether there is a sufficient number or type of participating in a clinical trial, with the patient records to conduct the research. Importantly, the as part of the patient’s treatment or the covered covered entity may not permit the researcher to entity’s health care operations. To covered entity may contract with a business permit the researcher to conduct a review prepara­ associate—who may be a researcher—to assist tory to research, the covered entity must receive in contacting individuals on behalf of the from the researcher representations that: covered entity to obtain their Authorizations. Prior to the Privacy Rule’s Compliance Date Identifying Research Participants Sections 164. What kinds of activities are considered preparatory Questions and Answers to research? In addition, informed consent of the subjects, about whom When a preparatory to research activity (i) identifiable private information. Covered entities are required to account under the Privacy Rule and legally effective for disclosures made pursuant to an altered informed consent for research provided for Authorization. However, where a and the Privacy Rule apply, institutions must covered entity discloses the records of 50 or adhere to both sets of regulations. The period participant to obtain Authorization after covered by the accounting is no more than 6 identifying these individuals? They may allow a researcher to identify, but not contact, potential study participants. As such, acceptable to give a clinical summary of a they are not subject to enforcement by U. These types of conversations may arise clinical research recruitment database of under a variety of circumstances. For example, possible research participants, such as a prea physician may for treatment purposes screening log? Also, the Privacy rization must inform the individual of the Rule generally permits a covered entity to purpose for which. Q: One common method for recruiting research Similarly, if a physician knows of a study in participants involves organizing a call center which his or her patient might enroll that is for potential research participants to contact being conducted by others, the physician may in response to advertisements about the discuss such a trial with the patient and give research. Would a call center be required to the patient the researcher’s contact informa­ obtain the individual’s Authorization before tion so the patient may contact the researcher speaking to the individual about the trial? However, the physician may only contact the researchers about the patient so A: Call centers in many cases will not be part of a long as de-identified information is disclosed, covered entity (health plan, health care clearinghouse, certain health care providers), and thus, are not required to comply with the 9 Privacy Rule.

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The new framework sought to cut red tape symptoms questions cheap 10mg isordil with amex, avoiding many ex-ante obligations, and to hold those handling personal data accountable on the basis of how they structure and ensure adequate levels of protection. The higher the risk to individuals, the higher the level of protection, therefore of positive obligations, and safeguards to implement for data controllers and processors. Scientific research often involves the processing and sharing of sensitive types of personal data of the people involved. Nevertheless, many companies including the big platforms state in their privacy policies that they may share data with researchers. Data protection rules are a framework for, not an obstacle to , proportionate disclosure of information to researchers, where there is a valid legal basis and appropriate safeguards depending on the risk. Risks indicators include: sensitivity or highly personal nature of the data, vulnerability of the data subjects, the large scale of the processing activities, the systematic nature of the monitoring, the innovative use or application of technological solutions, the evaluation of individuals, the combination of datasets, the legal or similarly 137 significant effect of automated decision making. Professional ethical standards governing a particular research project would also be considered a safeguard. Where researchers deploy Artificial Intelligence systems, there is the same need for safeguards and oversight. Appropriate safeguards could include conducting a data protection impact assessment of likely 139 risks for rights and freedoms of natural persons, appointing a data protection officer (mandatory in case of a public authority or body, regular and systematic monitoring of data 140 subjects on a large scale, processing on a large scale of special categories of data), notifying a data breach, without undue delay and no later than 72 hours, when the breach is likely to pose 141 142 a risk to the rights and freedoms of the data subjects, guaranteeing data security, and data minimisation through pseudonymisation or (unless it would impair the research) anonymisation. Recommendations Dialogue between the scientific research community and data protection authorities is deepening, especially in the area of medical research. Ethics committees can play a meaningful role in ensuring that the respect of human rights, including right to data protection, is embedded in the research project from the early planning stage. They are likely to continue to play an important role in ensuring that research projects are designed from the start with data protection principles in mind. In research, codes of conduct can improve convergence of practices and increase 145 confidence in compliance. They would also be beneficial for the free 146 movement of researchers, a key aim of the European Research Area. Specialised codes might be particularly relevant for fields such as biobanking, 148 genomic research or social networks research. In addition, accredited certification bodies will be able to issue certifications to controllers or processors, such as data protection seals and marks, for a maximum and renewable period of three years. Their purpose is to demonstrate the compliance of processing operations with the 149 Regulation. The research community is by nature heterogeneous, so a multiplicity of such instruments may 151 be envisaged. Research projects seeking funding under the framework need to go through a vigorous ethics review process which starts with a self-assessment. It requires researchers to reflect on the design of the research project and prescribes that data protection requirements should be part 152 of the ethical review process. This process has considerable potential to align the data protection practices of all research institutions or independent researchers seeking to obtain European research funding. Researchers should seek guidance from data protection experts and 153 authorities in the development of these research proposals. There should be no loophole to the protection of fundamental rights, and uncertainty around what counts as ‘scientific research’ itself poses a risk of such loopholes emerging. At the same time, there is growing concern about how digitisation has involved the exponential growth in data generation while also concentrating the control of the means for converting that data into valuable knowledge in the hands of a few powerful private companies. Through their existing terms of service and privacy policies these companies allow themselves ample scope to determine how they wish to process personal data and with whom to share it. There therefore seems little obstacle to these terms of service providing for sharing data with genuine researchers operating within proper ethical governance. Digitisation has created new potential for individual empowerment and addressing acute social issues like public health. It has also resulted in enormous accumulation and concentration personal data for the private benefit of a few global 26 | P a g e companies, with the blurring of the boundaries between public interest, academic freedom and 155 private gain. Digital technology has been used to experiment on people online for private benefit. Data protection rules aim to ensure safety and transparency while minimising interference with ethical research that aim at generalisable knowledge and societal good. Timmers et al refer to ‘an inherent tension between critical care research and data protection’. See Adrian Thorogood, ‘Canada: will privacy rules continue to favour open science? Dove et al, ‘Ethics review for international data-intensive research’ (20 April 2016), 351 (6280) Science 1399; Deborah Mascalzoni et al, ‘International Charter of Principles for Sharing Bio-Specimens and Data’ (24 September 2014), 23 European Journal of Human Genetics 721. The old definition was ‘an entity, such as university or research institute, irrespective of its legal status (organised under public or private law) or way of financing, whose primary goal is to conduct fundamental research, industrial research or experimental development and to disseminate their results by way of teaching, publication or technology transfer; all profits are reinvested in these activities, the dissemination of their results or teaching; undertakings that can exert influence upon such an entity, in the quality of, for example, shareholders or members, shall enjoy no preferential access to the research capacities of such an entity or to the research results generated by it. Wolf et al, ‘The Past Present and Future of Informed Consent in Research and Translational Medicine, pp. Hancock, ‘Experimental evidence of massive-scale emotional contagion through social networks’ (June 2014) National Academy of Sciences. Social Science One is an attempted collaboration between academics and private industry to analyse the latter’s troves of information for wider societal benefit; socialscience. Merrill, ‘Facebook moves to block Ad Transparency Toolsincluding ours’ (28 January 2019), ProPublica. The European Commission urged Facebook to agree with the European research community a ‘framework that facilitates access to a broader set of data, in compliance with privacy rules, in order to allow a comprehensive assessment of the Code of Practice implementation’; European Commission, Code of Practice on Disinformation: Intermediate Targeted Monitoring – March Reports. Due to the diversity of such entities, it is important to have a common understanding of the beneficiaries of the exception. Despite different legal forms and structures, research organisations across Member States generally have in common that they act either on a not for profit basis or in the context of a public-interest mission recognised by the State. Such a public-interest mission may, for example, be reflected through public funding or through provisions in national laws or public contracts. At the same time, organisations upon which commercial undertakings have a decisive influence allowing them to exercise control because of structural situations such as their quality of shareholders or members, which may result in preferential access to the results of the research, should not be considered research organisations for the purposes of this Directive. The European Commission has also issued two helpful guidelines: Opinion Nr 17 on Ethical Aspects of Clinical Research in Developing Countries (2003), available at op. As an example, researchers who wish to collect personal data in Finland must fill in the description of the scientific research data file and they usually need to submit it to the ethical review boards. Food and Drug Administration pilot program to evaluate the sharing of clinical trial documents. Subject to the principle of proportionality, limitations may be made only if they are necessary and genuinely meet objectives of general interest recognised by the Union or the need to protect the rights and freedoms of other. In a research context providing such information may sometimes prove problematic where the data was collected long time ago; for instance, where a university hospital intends to use data from decades old patients’ records. They are the professional result of health care and based on the best possible understanding and scientific data of the patient’s condition. Outside critical care they will also reflect the choices the patient has made about possible diagnostic and therapeutic interventions but win those limitations as set by the patient, the data should reflect the professional norm comparable to similar patients. In the context of clinical trials, it will focus on the secondary use of data which are not covered by the Clinical Trials Directive. The Code of Conduct relates to processing of personal data for online access management purposes in the research and education sector. For more information on the process, the online manual on the procedure is available at: ec. Reprinted 2007, 2008 (twice), 2009 (twice) this third edition published 2011 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. Intervention–development–evaluation process Perspectives in the classification of evaluation studies Types of evaluation from a focus perspective Evaluation for programme/intervention planning Process/monitoring evaluation Evaluating participation of the target population Evaluating service delivery manner Impact/outcome evaluation Cost–benefit/cost-effectiveness evaluation Types of evaluation from a philosophical perspective Goal-centred/objective-oriented evaluation Consumer-oriented/client-centred evaluation Improvement-oriented evaluation Holistic/illuminative evaluation Undertaking an evaluation: the process Step 1: Determining the purpose of evaluation Step 2: Developing objectives or evaluation questions Step 3: Converting concepts into indicators into variables Step 4: Developing evaluation methodology Step 5: Collecting data Step 6: Analysing data Step 7: Writing an evaluation report Step 8: Sharing findings with stakeholders Involving stakeholders in evaluation Ethics in evaluation Summary Appendix: Developing a research project: a set of exercises for beginners Glossary Bibliography Index Figures 1. The difficulties I faced in understanding research as a student, my discoveries about what was applicable and inapplicable in the field as a practitioner, and my development of the ability effectively to communicate difficult concepts in simple language without sacrificing technicality and accuracy as a teacher have become the basis of this book. Research methodology is taught as a supporting subject in several ways in many academic disciplines such as health, education, psychology, social work, nursing, public health, library studies and marketing research. The core philosophical base for this book comes from my conviction that, although these disciplines vary in content, their broad approach to a research enquiry is similar.

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Is pregnancy after breast routine pretreatment magnetic resonance imaging with time to cancer safe? Discussing fertility younger women: reproductive and late health effects of treatment treatment mastitis generic 10mg isordil free shipping. Fertility life, fertility concerns, and behavioral health outcomes in younger preservation in women with breast cancer undergoing adjuvant breast cancer survivors: a systematic review. Baseline staging tests in primary breast cancer: Practice fertility decision aid collaborative group study. Effect of radiotherapy after breast-conserving surgery on 10Available at: Prognostic factors of treatment versus mastectomy in early breast cancer: patterns of failure breast recurrence in the conservative management of early breast with 15 years of follow-up data. Effect of breastconserving therapy versus radical mastectomy on prognosis for young 152. Breast conserving its association with reduced mortality: evidence for selection bias. Survival outcomes after contralateral prophylactic mastectomy: a decision analysis. Available at: conservation therapy vs mastectomy on disease-specific survival for. Contralateral prophylactic lumpectomy and mastectomy for early stage invasive breast cancer: mastectomy after unilateral breast cancer: a systematic review and the effect of age and hormone receptor status. Radiol early stage breast cancer: A registry-based follow-up study of Bras 2015;48:345-352. Available at: comparison of sentinel-node biopsy with routine axillary dissection in. Learning curves for breast cancer sentinel lymph node mapping based on surgical volume 161. Nonsentinel node metastasis in breast cancer patients: assessment of an existing and a 164. Eur J Cancer calculator for predicting non-sentinel lymph node status in sentinel 1992;28A:1415-1418. Ten-year results of a randomized clinical trial comparing radical mastectomy and total 176. N Engl J Med 1985;312:674a nomogram to predict the risk of nonsentinel lymph node metastases 681. Recurrence rates after axillary lymph nodes in patients with breast cancer with one to three treatment of breast cancer with standard radiotherapy with or without metastatic sentinel lymph nodes. A multicenter randomized after sentinel lymph node dissection with or without axillary dissection trial of breast intensity-modulated radiation therapy to reduce acute in patients with sentinel lymph node metastases: the American radiation dermatitis. Randomized controlled trial of intensity-modulated radiotherapy for early breast 179. J Clin Oncol axillary dissection in women with invasive breast cancer and sentinel Version 3. Radiother whole breast irradiation for patients with large breasts: a randomized Oncol 2000;55:219-232. Available at: radiotherapy hypofractionation for treatment of early breast cancer: a. N Engl J Med breast irradiation consensus statement from the American Society for 2010;362:513-520. Five-year outcome of hypofractionation for treatment of early breast cancer: 10-year followpatients classified using the American Society for Radiation Oncology up results of two randomised controlled trials. Lancet Oncol consensus statement guidelines for the application of accelerated 2013;14:1086-1094. Available chemotherapy: 20-year results of the British Columbia randomized at: Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older 211. Available at: Postmastectomy radiation improves the outcome of patients with. Available at: prosthesis-based breast reconstruction using acellular dermal matrix. Is the benefit of postmastectomy irradiation limited to patients with four or more 221. Locoregional recurrence sparing mastectomy and immediate breast reconstruction with rates and prognostic factors for failure in node-negative patients implants to establish selection criteria. Plast Reconstr Surg treated with mastectomy: implications for postmastectomy radiation. Increased risk of dermis implantation in 153 immediate two-stage tissue expander locoregional recurrence for women With T1-2N0 triple-negative breast breast reconstructions: determining the incidence and significant cancer treated with modified radical mastectomy without adjuvant predictors of complications. Advances in breast of 331 consecutive immediate single-stage implant reconstructions reconstruction after mastectomy. Plast Reconstr Surg to partial mastectomy: an overview of volume-displacement 1999;104:77-84. Oncoplastic techniques mastectomy in the treatment of breast cancer: the Emory experience. Neoadjuvant anastrozole versus tamoxifen in patients receiving goserelin for premenopausal 258. Available at: postmenopausal women with hormone receptor-positive breast. Available at: postmenopausal breast cancer with anastrozole, tamoxifen, or both in. Available at: chemotherapy and concomitant trastuzumab in breast cancer: a. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally 276. A gene-expression recurrence using the 21-gene recurrence score in node-negative and signature as a predictor of survival in breast cancer. Available at: lymph node disease may avoid chemotherapy): A prospective. Prediction of late distant study evaluating the clinical utility of the 70-gene signature recurrence after 5 years of endocrine treatment: a combined analysis (MammaPrint) combined with common clinical-pathological criteria for of patients from the Austrian breast and colorectal cancer study group selection of patients for adjuvant chemotherapy in breast cancer with 0 8 and arimidex, tamoxifen alone or in combination randomized trials to 3 positive nodes [abstract]. J Clin Oncol 2015;33:916Meeting of the American Association for Cancer Research; 2016 Apr 922. Available at: the efficacy of tamoxifen in high-risk postmenopausal breast cancer. Adjuvant chemotherapy and timing of tamoxifen in postmenopausal patients with endocrine328. Available at: fluorouracil: from a randomized comparison of premenopausal. Available at: Tamoxifen, Alone or in Combination) adjuvant breast cancer trial: first. Effect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, Version 3. Available at: anastrozole and tamoxifen alone, and in combination, during adjuvant. Available at: letrozole in postmenopausal women after five years of tamoxifen. Late extended adjuvant cancer: preliminary results of the Italian Tamoxifen Anastrozole Trial. Lack of correlation between gene variants in tamoxifen metabolizing enzymes with primary endpoints in Version 3. Pharmacogenetics of endocrine therapy high risk node negative breast cancer [abstract]. American Society doxorubicin-cyclophosphamide followed by paclitaxel or docetaxel of Clinical Oncology clinical practice guideline update on the use of given every 3 weeks or weekly in operable breast cancer: Results of pharmacologic interventions including tamoxifen, raloxifene, and Intergroup Trial E1199 [abstract]. J Clin Oncol 2007;25 (Suppl 18) aromatase inhibition for breast cancer risk reduction. Randomized trial of doxorubicin-cyclophosphamide with and without interval reinduction dose-dense versus conventionally scheduled and sequential versus therapy compared with 6 months of cyclophosphamide, methotrexate, concurrent combination chemotherapy as postoperative adjuvant and fluorouracil in positive-node breast cancer patients with tamoxifentreatment of node-positive primary breast cancer: first report of nonresponsive tumors: results from the National Surgical Adjuvant Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol prognostic factors: 5-year follow-up results of French Adjuvant Study 2009;27(Suppl 15):Abstract 516.

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The main difference between the model and this example is that in the model you select what is most appropriate for your study and not what you like the most medications vs grapefruit order 10 mg isordil mastercard. For a beginner it is important to go through all the steps, although perhaps not in the same sequence. The eight steps cover the total spectrum of a research endeavour, from problem formulation through to writing a research report. The steps are operational in nature, following a logical sequence, and detailing the various methods and procedures in a simple stepby-step manner. Reflecting on the differences between quantitative and qualitative research (as outlined in Table 2. The place of the literature review in research One of the essential preliminary tasks when you undertake a research study is to go through the existing literature in order to acquaint yourself with the available body of knowledge in your area of interest. Reviewing the literature can be time consuming, daunting and frustrating, but it is also rewarding. The literature review is an integral part of the research process and makes a valuable contribution to almost every operational step. It has value even before the first step; that is, when you are merely thinking about a research question that you may want to find answers to through your research journey. In the initial stages of research it helps you to establish the theoretical roots of your study, clarify your ideas and develop your research methodology. Later in the process, the literature review serves to enhance and consolidate your own knowledge base and helps you to integrate your findings with the existing body of knowledge. Since an important responsibility in research is to compare your findings with those of others, it is here that the literature review plays an extremely important role. During the write-up of your report it helps you to integrate your findings with existing knowledge – that is, to either support or contradict earlier research. The higher the academic level of your research, the more important a thorough integration of your findings with existing literature becomes. In summary, a literature review has the following functions: It provides a theoretical background to your study. It helps you establish the links between what you are proposing to examine and what has already been studied. It enables you to show how your findings have contributed to the existing body of knowledge in your profession. It helps you to integrate your research findings into the existing body of knowledge. Bringing clarity and focus to your research problem the literature review involves a paradox. On the one hand, you cannot effectively undertake a literature search without some idea of the problem you wish to investigate. On the other hand, the literature review can play an extremely important role in shaping your research problem because the process of reviewing the literature helps you to understand the subject area better and thus helps you to conceptualise your research problem clearly and precisely and makes it more relevant and pertinent to your field of enquiry. When reviewing the literature you learn what aspects of your subject area have been examined by others, what they have found out about these aspects, what gaps they have identified and what suggestions they have made for further research. All these will help you gain a greater insight into your own research questions and provide you with clarity and focus which are central to a relevant and valid study. In addition, it will help you to focus your study on areas where there are gaps in the existing body of knowledge, thereby enhancing its relevance. Improving your research methodology Going through the literature acquaints you with the methodologies that have been used by others to find answers to research questions similar to the one you are investigating. A literature review tells you if others have used procedures and methods similar to the ones that you are proposing, which procedures and methods have worked well for them and what problems they have faced with them. By becoming aware of any problems and pitfalls, you will be better positioned to select a methodology that is capable of providing valid answers to your research question. This will increase your confidence in the methodology you plan to use and will equip you to defend its use. Broadening your knowledge base in your research area the most important function of the literature review is to ensure you read widely around the subject area in which you intend to conduct your research study. It is important that you know what other researchers have found in regard to the same or similar questions, what theories have been put forward and what gaps exist in the relevant body of knowledge. Another important reason for doing a literature review is that it helps you to understand how the findings of your study fit into the existing body of knowledge (Martin 1985: 30). Enabling you to contextualise your findings Obtaining answers to your research questions is comparatively easy: the difficult part is examining how your findings fit into the existing body of knowledge. Undertaking a literature review will enable you to compare your findings with those of others and answer these questions. It is important to place your findings in the context of what is already known in your field of enquiry. How to review the literature If you do not have a specific research problem, you should review the literature in your broad area of interest with the aim of gradually narrowing it down to what you want to find out about. There is a danger in reviewing the literature without having a reasonably specific idea of what you want to study. It can condition your thinking about your study and the methodology you might use, resulting in a less innovative choice of research problem and methodology than otherwise would have been the case. Hence, you should try broadly to conceptualise your research problem before undertaking your major literature review. Developing theoretical and conceptual frameworks is more difficult than the other tasks. Searching for the existing literature To search effectively for the literature in your field of enquiry, it is imperative that you have at least some idea of the broad subject area and of the problem you wish to investigate, in order to set parameters for your search. There are three sources that you can use to prepare a bibliography: (a) books; (b) journals; (c) the Internet. Books Though books are a central part of any bibliography, they have their disadvantages as well as advantages. The main advantage is that the material published in books is usually important and of good quality, and the findings are ‘integrated with other research to form a coherent body of knowledge’ (Martin 1985: 33). The main disadvantage is that the material is not completely up to date, as it can take a few years between the completion of a work and its publication in the form of a book. When librarians catalogue a book they also assign to it subject headings that are usually based on Library of Congress Subject Headings. If you are not sure, ask your librarian to help you find the best subject heading for your area. Use the subject catalogue or keywords option to search for books in your area of interest. Look through these titles carefully and identify the books you think are likely to be of interest to you. If you think the titles seem appropriate to your topic, print them out (if this facility is available), as this will save you time, or note them down on a piece of paper. Be aware that sometimes a title does not provide enough information to help you decide if a book is going to be of use so you may have to examine its contents too. When you have selected 10–15 books that you think are appropriate for your topic, examine the bibliography of each one. Go through these bibliographies carefully to identify the books common to several of them. If a book has been referenced by a number of authors, you should include it in your reading list. Having prepared your reading list, locate these books in your library or borrow them from other sources. Examine their contents to double-check that they really are relevant to your topic. If you find that a book is not relevant to your research, delete it from your reading list. If you find that something in a book’s contents is relevant to your topic, make an annotated bibliography. An annotated bibliography contains a brief abstract of the aspects covered in a book and your own notes of its relevance. To do this you can prepare your own card index or use a computer program such as Endnotes or Pro-Cite.