Princess Margaret Hospital Research Articles

A modern era comparison of right versus left sided congenital diaphragmatic hernia outcomes

Background/purposeThis study aims to retrospectively review outcomes, including neurodevelopmental outcomes, of neonatal right sided congenital diaphragmatic hernias (RCDH) compared with left sided congenital diaphragmatic hernias (L-CDH) treated surgically at our institute. MethodsA retrospective review was undertaken of all cases of congenital diaphragmatic hernia (CDH) treated at Princess Margaret Hospital for Children (PMH), Perth, born between 1st January 2002 and 1st August 2012. The outcomes of R-CDH cases were compared with L-CDH cases. We examined duration of ventilatory support, use of patch versus primary closure, the CDH recurrence rates, the number of reoperations and neurodevelopmental follow-up at one year of age. ResultsForty-nine cases of CDH were operated on at PMH during the 10-year period. Of these, ten cases were R-CDH with 39 L-CDH cases. Of 49 cases, 34 were diagnosed antenatally, 5 R-CDH versus 29 L-CDH. Only 8/39 cases of L-CDH required patch repair for larger defects, while 5/10 R-CDH required patch repair. Postoperative mortality was 6/49 (1/10 right sided versus 5/39 left sided). Recurrence was observed in 5/10 R-CDH versus 6/39 L-CDH with p=0.03. Thirty-three of 43 surviving patients received one-year follow-up with Griffiths general quotient (GQ) assessment demonstrating a median score of 98 for L-CDH (IQR 86 to 104.25) and 91 for R-CDH (IQR 76.5 to 93). ConclusionsR-CDH required patch repair more commonly than L-CDH because of larger defect size or complete agenesis. The rate of recurrent herniation was the only morbidity significantly higher in the R-CDH group. Survivors of R-CDH did not have a significant difference in neurodevelopmental outcome compared to L-CDH cases, with both groups exhibiting normal median GQ scores at one year of age.

Perivascular epithelioid cell neoplasm: A case report and an overview of the current literature

Surgical PracticeVolume 20, Issue 2 p. 92-94 CASE REPORT Perivascular epithelioid cell neoplasm: A case report and an overview of the current literature Mina Cheng, Corresponding Author Mina Cheng Department of Surgery, Princess Margaret Hospital, Hong KongAuthor to whom all correspondence should be addressed. Email: minacheng0505@gmail.comSearch for more papers by this author Mina Cheng, Corresponding Author Mina Cheng Department of Surgery, Princess Margaret Hospital, Hong KongAuthor to whom all correspondence should be addressed. Email: minacheng0505@gmail.comSearch for more papers by this author First published: 05 February 2016 https://doi.org/10.1111/1744-1633.12171Citations: 1 This is to declare that the author has not published or submitted any related papers from the same study. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume20, Issue2May 2016Pages 92-94 RelatedInformation

Dental anomalies in children with cleft lip and palate in Western Australia.

Objective:The purpose of this paper was to describe the prevalence and type of dental anomalies in the primary and permanent dentition in children with a cleft condition at Princess Margaret Hospital in Perth, Western Australia.Materials and Methods:The details of 162 current dental patients extracted from the main dental database through their year of birth for the period 1998–2001 were selected consecutively. Dental records and X-rays were examined by one examiner (WN) and verified by a second examiner (RB) to determine dental development. The mean age of the subjects was 10.8 years with equal numbers of males and females. Subjects were further divided into cleft type; unilateral cleft lip (UCL) and palate, bilateral cleft lip (BCL) and palate, UCL, BCL, and cleft palate.Results:One hundred sixty-two subjects were grouped into 21 categories of anomaly or abnormality. Prevalence rates for the categories were calculated for the overall group and for gender and cleft type.Conclusion:Overall, 94% of patients were found to have at least one dental anomaly, with fifty-six (34%) patients having more than one anomaly or abnormality.

Patient monitoring with Google Glass: a pilot study of a novel monitoring technology.

Head-mounted devices (HMDs) are of significant interest for applications within medicine, including in anesthesia for patient monitoring. Previous devices trialed in anesthesia for this purpose were often bulky, involved cable tethers, or were otherwise ergonomically infeasible. Google Glass is a modern HMD that is lightweight and solves many of the issues identified with previous HMDs. To examine the acceptance of Google Glass as a patient monitoring device in a pediatric anesthesia context at Princess Margaret Hospital for Children, Perth, Australia. We developed a custom-designed software solution for integrating Google Glass into the anesthesia environment, which enabled the device user to continuously view patient monitoring parameters transmitted wirelessly from the anesthesia workstation. A total of 40 anesthetists were included in the study. Each anesthetist used the device for the duration of a theater list. We found 90% of anesthetists trialing the device agreed that it was comfortable to wear, 86% agreed the device was easy to read, and 82.5% agreed the device was not distracting. In 75% of cases, anesthetists reported unprompted that they were comfortable using the device in theater. Anesthetists reported that they would use the device again in 76% of cases, and indicated that they would recommend the device to a colleague in 58% of cases. Given the pilot nature of this study, we consider these results highly favorable. Anesthetists readily accepted Google Glass in the anesthetic environment, with further enhancements to device software, rather than hardware, now being the barrier to adoption. There are a number of applications for HMDs in pediatric anesthesia.

Mandibular changes on panoramic imaging after head and neck radiotherapy

Changes to the radiographic appearance of the jaws after head and neck radiotherapy have not been thoroughly characterized. This retrospective study examines changes to the appearance of the mandible on panoramic images following intensity-modulated radiotherapy (IMRT) and relates these changes to medical co-morbidities and radiation dose. The medical and dental charts, and panoramic images of 126 patients who received IMRT at the Princess Margaret Hospital between January 1, 2005, and December 31, 2008, were analyzed independently by three observers. Of the 126 patients, 75 (60%) had post-IMRT changes, as seen on panoramic images; most, 66 (88%), consisted of widened periodontal ligament space (WPLS). The median time to WPLS was 29months after IMRT. Female gender and radiation dose correlated with decreased time to WPLS. These results indicate that WPLS is a common radiographic sequela after head and neck radiotherapy, underscoring its clinical significance as a reliable marker of irradiated bone. Furthermore, this type of WPLS needs to be differentiated from odontogenic inflammatory disease and cancer recurrence to avoid unnecessary treatment that may precipitate osteoradionecrosis.

Exercise training improves vascular function in adolescents with type 2 diabetes.

The impact of exercise training on vascular health in adolescents with type 2 diabetes has not been previously studied. We hypothesized that exercise training would improve micro‐ and macrovascular health in adolescents with type 2 diabetes. Thirteen adolescents (13–21 years, 10F) with type 2 diabetes were recruited from Princess Margaret Hospital. Participants were randomized to receive either an exercise program along with standard clinical care (n = 8) or standard care alone (n = 5). Those in the intervention group received 12 weeks of gym‐based, personalized, and supervised exercise training. Those in the control group were instructed to maintain usual activity levels. Assessments were conducted at baseline and following week 12. The exercise group was also studied 12 weeks following the conclusion of their program. Assessments consisted of conduit artery endothelial function (flow‐mediated dilation, FMD) and microvascular function (cutaneous laser Doppler). Secondary outcomes included body composition (dual‐energy X‐ray absorptiometry, DXA), glycemic control (whole body insulin sensitivity, M) assessed using the euglycemic–hyperinsulinemic clamp protocol, cardiorespiratory fitness (V˙O2peak), and muscular strength (1RM). Exercise training increased FMD (P < 0.05), microvascular function (P < 0.05), total lean mass (P < 0.05), and muscle strength (P < 0.001). There were no changes in cardiorespiratory fitness, body weight, BMI, or M. In the control group, body weight (P < 0.01), BMI (P < 0.01), and total fat mass (P < 0.05) increased. At week 24, improvements in vascular function were reversed. This study indicates that exercise training can improve both conduit and microvascular endothelial function and health, independent of changes in insulin sensitivity in adolescents with type 2 diabetes.

Baseline neutrophil to lymphocyte ratio as a prognostic marker for patients with muscle-invasive bladder cancer being treated with neoadjuvant chemotherapy.

468 Background: The neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, has been associated with a poor prognosis in several solid malignancies. In muscle-invasive bladder cancer (MIBC), an elevated pre-cystectomy NLR has been shown to predict for poor survival; however, its role in prognostication for patients being treated with neoadjuvant chemotherapy (NAC) is unknown. We evaluated the baseline NLR as an independent prognostic factor in patients with MIBC treated with NAC. Methods: Patients with MIBC treated with NAC in Alberta from 2005 to 2015, and at the Princess Margaret Hospital in Ontario from 2005 to 2013 were evaluated. All 290 patients treated with NAC were included; 272 were evaluable for NLR and outcomes. Patient, disease, and treatment-related factors were evaluated. NLR was examined prior to initiation of preoperative chemotherapy. The prognostic role of NLR on overall survival (OS) and progression-free survival (PFS) was determined using Cox proportional hazard regression analysis. Results: The median age of patients was 66 years (range 36-87). The majority of patients (77%) were male. Median baseline NLR at diagnosis was 2.9. NLR &gt; 3.0 at baseline was independently associated with PFS and OS after adjustment for age, gender and stage (Table). Patients with an NLR &gt; 3 had a median PFS of 14.1 months compared to 25.1 months in those patients with a baseline NLR ≤ 3 (HR 0.63, p = 0.01). Similarly, OS was 19.4 months in patients with a baseline NLR &gt; 3 compared to 33.4 months in those with a baseline NLR ≤ 3 (HR 0.65, p = 0.04). Conclusions: NLR is an independent prognostic factor for patients with MIBC undergoing NAC. [Table: see text]

Consultation-liaison psychiatry in the Princess Margaret Hospital at Nassau, Bahamas

Consultation-liaison psychiatry in the Princess Margaret Hospital at Nassau, Bahamas

Real-world efficacy, toxicity and clinical management of ipilimumab treatment in metastatic melanoma

Approved by the Food and Drug Administration in 2011, the anti-cytotoxic T-lymphocyte-associated protein 4 checkpoint inhibitor ipilimumab has delivered a survival benefit of ≥3 years in a subset of metastatic melanoma patients. After participating in the registration trial, patients were treated with this agent in routine practice. Toxicity and efficacy of agents in "real world" settings may differ from trials. The present study aimed to evaluate, with respect to toxicity and outcome, all patients treated with ipilimumab to date at the Princess Margaret Hospital (Toronto, Canada). Patients treated with ipilimumab between 2008 and 2013 were identified, and patient characteristics (age, gender, tumour burden, oncogenic mutation status, number of treatments received and toxicities from treatment) were collected. Progression-free survival (PFS) and overall survival (OS) were calculated from the commencement of ipilimumab treatment. Associations between clinical characteristics and outcome or toxicity were assessed. Between 2008 and 2013, 129 patients with metastatic cutaneous melanoma were treated. Since, during this period, ipilimumab was approved in the second line setting, ipilimumab was delivered in the second or subsequent line in all patients, and 70% did not receive any further anticancer therapy. Immune-related toxicities were observed, the onset of which varied from 1 to 162 days. The majority resolved within 6 weeks of the final treatment, with the exception of endocrinopathies and bowel related toxicity. The median PFS and OS were 2.83 and 8.44 months, respectively. No pre-treatment factor independently predicted toxicity. The number of infusions (4 vs. ≤3) and presence of toxicity were significantly associated with superior survival. The onset of toxicity secondary to ipilimumab could occur later than previously reported. Toxicities were manageable, but required long-term vigilance.

Evolving Treatment Modality of Hand Enchondroma in a Local Hospital: From Autograft to Artificial Bone Substitutes: 一所地區性醫院治療手部內生軟骨瘤- 由自體骨移植術到使用人工合成骨的發展

Background/PurposeCurettage followed by the application of iliac crest autograft was the traditional treatment of hand enchondroma in Princess Margaret Hospital, Hong Kong. MethodsWe reviewed the results of 13 patients with hand enchondroma who were operated on in the past 15 years (1999–2013). Eight patients (1999–2009) received iliac crest autograft after curettage, whereas the other five patients (2009–2013) received artificial bone substitutes. ResultsBoth groups of patients had good functional outcome and bone graft incorporation. There was no recurrence. One patient in the autograft group had mild residual finger stiffness. One patient receiving artificial bone substitutes had a gouty attack, early wound infection, and finger stiffness. The use of artificial bone substitutes eliminated donor site morbidities, decreased operation time and, hospital stay. They took a longer time for radiological incorporation than autograft, but it did not translate into adverse clinical effects. ConclusionArtificial bone substitute is a good alternative to iliac crest autograft in the treatment of hand enchondroma.

Comparison of Rhinovirus Antibody Titers in Children With Asthma Exacerbations and Species-Specific Rhinovirus Infection

J Iwasaki, WA Smith, SK Khoo. J Allergy Clin Immunol. 2014;134(1):25–32 Human rhinovirus C (HRV-C), compared with HRV-A and HRV-B, has been associated with more severe asthma attacks in children presenting to the hospital. The purpose of this study was to compare the antibody response to each HRV in asthmatic children who had a known HRV infection. Ninety-six children who presented with acute asthma exacerbations to the emergency department of Princess Margaret Hospital for Children (Australia) and 47 nonasthmatic control children were included in the …

Retrospective assessment of patterns of recurrence relative to radiotherapy volumes for adjuvant conformal chemoradiotherapy in gastric cancer.

Since the Intergroup 0116 study was published in 2000, adjuvant postoperative chemoradiotherapy using CT-planned and 3D conformal/intensity-modulated radiotherapy has been offered routinely to fit patients with resected gastric cancer at Princess Margaret Hospital .The objective of this study was to analyze patterns of disease recurrence with respect to the radiotherapy volumes. For the date and site (local, locoregional, or distant) of the first recurrence, medical records were reviewed for all patients treated at Princess Margaret Hospital with adjuvant chemoradiotherapy for resected gastric adenocarcinoma (January 1, 2000 to November 30, 2009). Patients whose recurrences were limited to local and/or regional sites were selected for further analysis. Available diagnostic imaging of the recurrence site was registered to the original planning radiotherapy dataset for contouring. If necessary to respect changes in anatomy, the contour was translocated on the basis of anatomic descriptors. The center of mass for each recurrence was identified as a point and its location was categorized according to the isodose encompassing it; in field (90% or more), marginal (50-89%), or out of field (less than 50%). Of all 197 patients, 14 (7%) had isolated locoregional failure, constituting 20% of all 71 patients with a recurrence. Successful fusions were feasible in five cases. Of these recurrences, four were in field and one was marginal. In a further four cases, visual inspection was used, showing one in-field recurrence, one marginal recurrence, and two out-of-field recurrences. In five patients, either a useable original dataset or diagnostic imaging of the recurrence was not available. The rates of isolated local/locoregional tumor recurrence in this study were low. Of the small number of recurrences available for analysis, most (five of nine) were in field. Further studies involving a larger cohort of patients might allow a more meaningful analysis of trends in the recurrence site with evolving radiotherapy techniques.

Ten years of experience with intravesical and intrasphincteric onabotulinumtoxinA in children

To review 10 years of experience with both intravesical and intrasphincteric onabotulinumtoxinA (Botox(®)) injections in children. Fifty three children aged between 1 and 18 years at first injection had a combined total of 134 injections (106 intravesical, 23 intrasphincteric and five combined) between January 2004 and December 2013 at Princess Margaret Hospital. Follow-up occurred 3 months post procedure, and then 3-6 monthly. Response to Botox was graded according to the International Children's Continence Society (ICCS) response to treatment scale. Response time was the time that the injection remained effective before symptoms relapsed to the ICCS 'no response' category Nevéus etal., 2006. Median response times to Botox by pathology are summarised in Table 1. For detrusor overactivity (DO), the response after each Botox injection was in the ICCS '>90% symptom reduction' category Nevéus etal., 2006. Two children had sustained responses to Botox for a tenth and eleventh injection, respectively. A total of 45% of children receiving intrasphincteric Botox for chronic dysfunctional voiding (DV) or detrusor sphincter dyssynergia (DSD) had no symptom recurrence. Intravesical Botox was effective for treating new-onset hydronephrosis secondary to neurogenic bladder in one child. Intravesical Botox had a sustained effect over five injections in eliminating trigonal hypersensitivity and pain with CIC in one child. Episodes of severe autonomic dysreflexia in one child with a high cord transection were effectively eliminated by intravesical Botox, and were sustained over three injections. Thirteen of the 134 Botox injections (9.7%) had a symptomatic culture-positive urinary tract infection (UTI) in the 2 weeks following injection. All had a history of previous UTI. Three children (2.8%) developed urinary retention after intravesical injection. Intravesical Botox remained effective after up to eleven injections. In children with DV or DSD, the response to Botox was more variable, but 45% experienced symptom resolution with no recurrence. Trigonal hypersensitivity with CIC improved in a child after Botox. Botox may confer long-term bladder and upper tract protection in the neurogenic patient group. Severe episodes of autonomic dysreflexia triggered by bladder fill in a child with high cord lesion were eliminated by intravesical Botox. This study demonstrated that intravesical Botox remained effective in response quality and response time in children up to an eleventh injection. This is one of the longer follow-up studies in children published to date. Botox was effective in numbing trigonal hypersensitivity, treating new-onset hydronephrosis secondary to neurogenic bladder, and eliminating episodes of autonomic dysreflexia in one patient each.

Patients of all ages with advanced non-small cell lung cancer are not receiving chemotherapy.

Patients of all ages with advanced non-small cell lung cancer are not receiving chemotherapy.

How Accurate are Emergency Department Medical Staff in the Interpretation of Head Injury Related Computed Tomography?

Introduction Computed tomography (CT) brain has become a popular modality to detect head injury related problems for patients seen at the Emergency Departments (ED) in Hong Kong. This study aims to assess the diagnostic accuracy of local ED medical staff in interpretation of head injury related CT and to assess the association between years of working experience of ED medical staff and the diagnostic accuracy of CT brain interpretation. Methods This is a retrospective cohort study reviewing all patients attending the ED of Princess Margaret Hospital in three years (from 2008 to 2010) with head injuries requiring CT brain during ED stay. The findings of CT brain by ED medical staff were compared with those by radiologists, the reference standard. Results A total of 1716 cases were assessed. The overall sensitivity and specificity for detecting an abnormal CT were 0.66 (95% confidence interval [CI] 0.60-0.71) and 0.96 (95% CI 0.95-0.97), respectively. The sensitivity showed an increasing trend from 0.63 (95% CI 0.54-0.72) in ED staff with 0-3 years of working experience, to 0.71 (95% CI 0.59-0.84) with 4-6 years of experience and 0.75 (95% CI 0.63-0.86) with 7-10 years of experience. It dropped to 0.59 (95% CI 0.47-0.71) with more than 10 years of experience. Conclusions The head injury related CT interpretation skill by ED medical staff is suboptimal. More training is necessary. (Hong Kong j.emerg.med. 2015;22:241-247)

Effectiveness of the risk of malignancy index and the risk of ovarian malignancy algorithm in a cohort of women with ovarian cancer: does histotype and stage matter?

To examine the performance of the Risk of Malignancy Index (RMI) and Risk of Ovarian Malignancy Algorithm (ROMA) by histologic subtype and stage of disease in a cohort of women with ovarian cancer. All patients with confirmed ovarian cancer at the Princess Margaret Hospital between February 2011 and January 2013 were eligible for study inclusion. Preoperative cancer antigen 125, human epididymis protein 4, and ultrasound findings were reviewed, and the sensitivity and false-negative rates of the RMI and ROMA were determined by stage of disease and tumor histology. A total of 131 patients with ovarian cancer were identified. High-grade serous (HGS) histology was most frequently associated with stage III/IV disease (n = 46 [72% of stage III/IV]) vs stage I (n = 5 [11% of stage I]; P < 0.0001). Clear cell (CC) and endometrioid (EC) histology presented most commonly with stage I disease (n = 9 [20%] and n = 13 [29% of stage I cases], respectively). Median cancer antigen 125 and human epididymis protein 4 values were significantly higher for HGS than for EC or CC histology. Risk of Malignancy Index II demonstrated the highest sensitivity of the 3 RMI algorithms. All RMIs and ROMA were significantly more sensitive in predicting malignancy in patients with HGS than EC or CC histology. Risk of Malignancy Index II (n = 38) and ROMA (n = 35) exhibited sensitivities of 68% and 54% and false-negative rates of 32% and 46%, respectively, for patients with stage I disease vs sensitivities of 94% and 93% and false-negative rates of 6% and 7% for patients with stage III/IV disease. Both RMI and ROMA performed well for the detection of advanced ovarian cancer and HGS histology. These triaging algorithms do not perform well in patients with stage I disease where EC and CC histologies predominate. Clinicians should be cautious using RMI or ROMA scoring tools to triage isolated adnexal masses because many patients with stage I malignancies would be missed.

SU‐E‐T‐675: Remote Dosimetry with a Novel PRESAGE Formulation

Purpose:3D‐gel dosimetry provides high‐resolution treatment validation; however, scanners aren't widely available. In remote dosimetry, dosimeters are shipped out from a central base institution to a remote site for irradiation, then shipped back for scanning and analysis, affording a convenient service for treatment validation to institutions lacking the necessary equipment and resources. Previous works demonstrated the high‐resolution performance and temporal stability of PRESAGE. Here the newest formulation is investigated for remote dosimetry use.Methods:A new formulation of PRESAGE was created with the aim of improved color stability post irradiation. Dose sensitivity was determined by irradiating cuvettes on a Varian Linac (6MV) from 0–15Gy and measuring change in optical density at 633nm. Sensitivity readings were tracked over time in a temperature control study to determine long‐term stability. A large volume study was performed to evaluate the accuracy for remote dosimetry. A 1kg dosimeter was pre‐scanned, irradiated on‐site with an 8Gy 4field box treatment, post‐scanned and shipped to Princess Margaret Hospital for remote reading on an identical scanner.Results:Dose sensitivities ranged from 0.0194–0.0295 ΔOD/(Gy*cm)—similar to previous formulations. Post‐irradiated cuvettes stored at 10°C retained 100% initial sensitivity over 5 days and 98.6% over 10 weeks while cuvettes stored at room temperature fell to 95.8% after 5 days and 37.4% after 10 weeks. The immediate and 5‐day scans of the 4field box dosimeter data was reconstructed, registered to the corresponding eclipse dose‐distribution, and compared with analytical tools in CERR. Immediate and 5‐day scans looked visually similar. Line profiles revealed close agreement aside from a slight elevation in dose at the edge in the 5‐day readout.Conclusion:The remote dosimetry formulation exhibits excellent temporal stability in small volumes. While immediate and 5‐day readout scans of large volume dosimeters show promising agreement, further development is required to reduce an apparent time dependent edge elevation.

Clinical setting influences off-label and unlicensed prescribing in a paediatric teaching hospital.

PurposeTo estimate the prevalence of off-label and unlicensed prescribing during 2008 at a major paediatric teaching hospital in Western Australia.MethodsA 12-month retrospective study was conducted at Princess Margaret Hospital using medication chart records randomly selected from 145,550 patient encounters from the Emergency Department, Inpatient Wards and Outpatient Clinics. Patient and prescribing data were collected. Drugs were classified as off-label or unlicensed based on Australian registration data. A hierarchical system of age, indication, route of administration and dosage was used. Drugs were classified according to the Anatomical Therapeutic Chemical Code.ResultsA total of 1,037 paediatric patients were selected where 2,654 prescriptions for 330 different drugs were prescribed to 699 patients (67.4%). Most off-label drugs (n = 295; 43.3%) were from the nervous system; a majority of unlicensed drugs were systemic hormonal preparations excluding sex hormones (n = 22, 32.4%). Inpatients were prescribed more off-label drugs than outpatients or Emergency Department patients (p < 0.0001). Most off-label prescribing occurred in infants and children (31.7% and 35.9% respectively) and the highest percentage of unlicensed prescribing (7.2%) occurred in infants (p < 0.0001). There were 25.7% of off-label and 2.6% of unlicensed medications prescribed across all three settings. Common reasons for off-label prescribing were dosage (47.4%) and age (43.2%).ConclusionThis study confirmed off-label and unlicensed use of drugs remains common. Further, that prevalence of both is influenced by the clinical setting, which has implications in regards to medication misadventure, and the need to have systems in place to minimise medication errors. Further, there remains a need for changes in the regulatory system in Australia to ensure that manufacturers incorporate, as it becomes available, evidence regarding efficacy and safety of their drugs in children in the official product information.

Reliability and Validity of the Korean Version of the Modified Adult Attachment Scale for the Use of Medically Ill Patients.

ObjectiveThe Modified Experiences in Close Relationships (ECR-M36) scale was developed for medically ill, older individuals in 2008 (Toronto, Canada, department of psychosocial oncology and palliative care, Princess Margaret Hospital). The scale has displayed satisfactory reliability and validity. This study aimed to test the reliability and validity of the Korean version of Modified Experiences in Close Relationships (K-ECR-M36) questionnaire in female patients with breast cancer.MethodsA total of 199 post-operative breast cancer patients completed the K-ECR-M36 as well as other psychological measures including the Revised Adult Attachment Scale (RAAS), World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF), and Hospital Anxiety and Depression Scale (HADS). The reliability and validity of the K-ECR-M36 were evaluated. Explorative factor analysis was conducted to identify the factor structure of the K-ECR-M36.ResultsThe K-ECR-M36 showed good internal consistency (Cronbach's α=0.87) and reasonable test-retest reliability (r=0.752, p<0.001). The total as well as avoidance and anxiety subscales demonstrated construct validity with the RAAS, the HADS, and the WHOQOL-BREF. Factor analysis revealed four-factor structure which was originally proposed by Brennan, Clark, and Shaver (1998).ConclusionThese findings support that the K-ECR-M36 has satisfactory reliability, validity and factor structure among patients with breast cancer.

The Body Esteem Program: inspiring freedom from an eating disorder

WOMENS Healthworks developed the Body Esteem program (BEP) in 2005 to respond to consumer need for accessible and community-based services for women living with an eating disorder. Core services include: -20 week facilitated self-help groups for women over the age of 18 with Anorexia/Bulimia Nervosa or Binge Eating Disorder - An Education and Support Workshop for family members or loved ones - Positive Body Image presentations, projects and events. - A Referral Directory The unique aspect of the BEP is that all facilitators have lived experience and can bring their personal stories, recovery strategies and a sense of hope to the participants. Evaluations report that participants of the BEP feel less ashamed, less isolated and more confident and hopeful about the future. They are supported to set their own goals, make changes at their own pace and take responsibility for their own recovery process. Viewed as a compliment to other treatment approaches, and funded by the WA Mental Health Commission, the BEP is involved in eating disorder sector development, regularly working alongside clinicians and services to provide valuable holistic support for recovery. Recently the BEP was invited to collaborate with Princess Margaret Hospital in order to develop, implement and evaluate eating disorder specific peer mentoring groups. The BEP staff would like to share our program outcomes, ethos and management strategies at the 2014 ANZAED Conference. This abstract was presented in the Peer Support stream of the 2014 ANZAED Conference.