Supportive care during treatment for breast cancer: Resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement

Breast cancer patients may have unmet supportive care needs during treatment, including symptom management of treatment-related toxicities, and educational, psychosocial, and spiritual needs. Delivery of supportive care is often a low priority in low- and middle-income settings, and is also dependent on resources available.This consensus statement describes twelve key recommendations for supportive care during treatment in low- and middle-income countries, identified by an expert international panel as part of the 5th Breast Health Global Initiative (BHGI) Global Summit for Supportive Care, which was held in October 2012, in Vienna, Austria. Panel recommendations are presented in a 4-tier resource-stratified table to illustrate how health systems can provide supportive care services during treatment to breast cancer patients, starting at a basic level of resource allocation and incrementally adding program resources as they become available. These recommendations include: health professional and patient and family education; management of treatment related toxicities, management of treatment-related symptoms of fatigue, insomnia and non-specific pain, and management of psychosocial and spiritual issues related to breast cancer treatment.Establishing supportive care during breast cancer treatment will help ensure that breast cancer patients receive comprehensive care that can help 1) improve adherence to treatment recommendations, 2) manage treatment-related toxicities and other treatment related symptoms, and 3) address the psychosocial and spiritual aspects of breast cancer and breast cancer treatments.     

Supportive care after curative treatment for breast cancer (survivorship care): Resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement

Breast cancer survivors may experience long-term treatment complications, must live with the risk of cancer recurrence, and often experience psychosocial complications that require supportive care services. In low- and middle-income settings, supportive care services are frequently limited, and program development for survivorship care and long-term follow-up has not been well addressed.As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert panel identified nine key resources recommended for appropriate survivorship care, and developed resource-stratified recommendations to illustrate how health systems can provide supportive care services for breast cancer survivors after curative treatment, using available resources.Key recommendations include health professional education that focuses on the management of physical and psychosocial long-term treatment complications. Patient education can help survivors transition from a provider-intense cancer treatment program to a post-treatment provider partnership and self-management program, and should include: education on recognizing disease recurrence or metastases; management of treatment-related sequelae, and psychosocial complications; and the importance of maintaining a healthy lifestyle. Increasing community awareness of survivorship issues was also identified as an important part of supportive care programs. Other recommendations include screening and management of psychosocial distress; management of long-term treatment-related complications including lymphedema, fatigue, insomnia, pain, and women's health issues; and monitoring survivors for recurrences or development of second primary malignancies. Where possible, breast cancer survivors should implement healthy lifestyle modifications, including physical activity, and maintain a healthy weight. Health professionals should provide well-documented patient care records that can follow a patient as they transition from active treatment to follow-up care.     

Supportive and palliative care for metastatic breast cancer: Resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement

Many women diagnosed with breast cancer in low- and middle-income countries (LMICs) present with advanced-stage disease. While cure is not a realistic outcome, site-specific interventions, supportive care, and palliative care can achieve meaningful outcomes and improve quality of life.As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert international panel identified thirteen key resource recommendations for supportive and palliative care for metastatic breast cancer. The recommendations are presented in three resource-stratified tables: health system resource allocations, resource allocations for organ-based metastatic breast cancer, and resource allocations for palliative care. These tables illustrate how health systems can provide supportive and palliative care services for patients at a basic level of available resources, and incrementally add services as more resources become available.The health systems table includes health professional education, patient and family education, palliative care models, and diagnostic testing. The metastatic disease management table provides recommendations for supportive care for bone, brain, liver, lung, and skin metastases as well as bowel obstruction. The third table includes the palliative care recommendations: pain management, and psychosocial and spiritual aspects of care.The panel considered pain management a priority at a basic level of resource allocation and emphasized the need for morphine to be easily available in LMICs. Regular pain assessments and the proper use of pharmacologic and non-pharmacologic interventions are recommended. Basic-level resources for psychosocial and spiritual aspects of care include health professional and patient and family education, as well as patient support, including community-based peer support.     

Pre-hospital trauma care resources for road traffic injuries in a middle-income country—A province based study on need and access in Iran

Background

Access to pre-hospital trauma care can help minimize many of traffic related mortality and morbidity in low- and middle-income countries with high rate of traffic deaths such as Iran. The aim of this study was to assess if the distribution of pre-hospital trauma care facilities reflect the burden of road traffic injury and mortality in different provinces in Iran.

Methods

This national cross-sectional study is based on ecological data on road traffic mortality (RTM), road traffic injuries (RTIs) and pre-hospital trauma facilities for all 30 provinces in Iran in 2006. Lorenz curves and Gini coefficients were used to describe the distributions of RTM/RTIs and pre-hospital trauma care facilities across provinces. Spearman rank-order correlation was performed to assess the relationship between RTM/RTI and pre-hospital trauma care facilities.

Results

RTM and RTIs as well as pre-hospital trauma care facilities were distributed unequally between different provinces. There was no significant association between the rate of RTM and RTIs and the number of pre-hospital trauma care facilities across the country.

Conclusions

The distribution of pre-hospital trauma care facilities does not reflect the needs in terms of RTM and RTIs for different provinces. These results suggest that traffic related mortality and morbidity could be reduced if the needs in terms of RTM and RTIs were taken into consideration when distributing pre-hospital trauma care facilities between the provinces.     

Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology,care seeking behavior,and outcomes across four countries

Purpose

Low-and middle-income (LMIC) countries account for 90% of all reported burns, nevertheless there is a paucity of providers to treat burns. Current studies on burns in LMICs have not evaluated the gap between care seeking and receiving. This study explores this gap across socioeconomically similar populations in a multi-country population based assessment to inform burn care strategies.

Chiropractors and collaborative care: An overview illustrated with a case report

Although not typical, there appears to be a growing trend of chiropractors working within collaborative care settings. We use a case report to highlight features of patient care and education related to chiropractic practice within a collaborative care model. This paper hopes to offer some insight into how a chiropractor might fit into a collaborative setting and what training might help them to function effectively. The case report used is an example where a chiropractor provided a secondary diagnosis and complementary care not previously considered by the allied team resulting in symptom control and return to work by the patient. By the nature of a chiropractor’s ability to provide a primary or secondary musculoskeletal diagnosis, they have the capacity to offer an additive approach to patient care within collaborative care models. However, chiropractors wishing to work in these environments, such as a family health team, would benefit from further education.     

Learning by (video) example: a randomized study of communication skills training for end-of-life and error disclosure family care conferences

Background

Teaching residents to lead end of life (EOL) and error disclosure (ED) conferences is important.

Methods

We developed and tested an intervention using videotapes of EOL and error disclosure encounters from previous Objective Structured Clinical Exams. Residents (n = 72) from general and orthopedic surgery programs at 2 sites were enrolled. Using a prospective, pre-post, block group design with stratified randomization, we hypothesized the treatment group would outperform the control on EOL and ED cases. We also hypothesized that online course usage would correlate positively with post-test scores.

Results

All residents improved (pre-post). At the group level, treatment effects were insignificant, and post-test performance was unrelated to course usage. At the subgroup level for EOL, low performers assigned to treatment scored higher than controls at post-test; and within the treatment group, post graduate year 3 residents outperformed post graduate year ?1 residents.

Conclusions

To be effective, online curricula illustrating communication behaviors need face-to-face interaction, individual role play with feedback and discussion.     

Reduced length of stay and convalescence in laparoscopic vs open sigmoid resection with traditional care: a double blinded randomized clinical trial

Aim The effect of a laparoscopic technique without a multi‐modal rehabilitation programme but with traditional postoperative care was studied in a blinded randomized trial regarding nursing time, hospital stay, pain, fatigue, need for sleep and return to normal daily activities. Method Eighteen patients with sigmoid cancer were randomly assigned to laparoscopic (n = 10) and open (n = 8) colonic resection in a double blinded trial. Length of hospital stay, fulfilment of discharge criteria, need for nursing care (information given to the patient, physical care and indirect care) and postoperative pain were recorded. Furthermore, the patients filled out a questionnaire regarding fatigue, need for sleep and return to daily activities 14 and 30 days postoperatively. Results The laparoscopic technique reduced length of hospital stay from 7 to 4.5 days (P = 0.006), although both groups met the discharge criteria on the third postoperative day. There were no significant differences in total need for nursing time during hospitalization between the two groups (P = 0.328). The laparoscopic group had less pain 24 hours after operation (P = 0.040), and reported less fatigue and reduced need for sleep during the day 30 days after surgery when compared with open surgery (P = 0.033 and P = 0.036, respectively). Furthermore, the laparoscopic group returned significantly faster to normal daily activities after surgery (P = 0.023). Conclusion Laparoscopic surgery per se reduced hospital stay, pain and convalescence compared with open surgery in patients undergoing colonic resection.These effects were obtained without a fast track programme and without an increase in nursing staff on the general surgical ward.     

State-of-the-Science on Postacute Rehabilitation: Setting a Research Agenda and Developing an Evidence Base for Practice and Public Policy. An Introduction

Abstract

The Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness, along with academic, professional, provider, accreditor, and other organizations, sponsored a 2-day State-of-the-Science of Postacute Rehabilitation Symposium in February 2007. The aim of this symposium was to serve as a catalyst for expanded research on postacute care (PAC) rehabilitation so that health policy is founded on a solid evidence base. The goals were to (a) describe the state of our knowledge regarding utilization, organization, and outcomes of postacute rehabilitation settings, (b) identify methodologic and measurement challenges to conducting research, (c) foster the exchange of ideas among researchers, policy makers, industry representatives, funding agency staff, consumers, and advocacy groups, and (d) identify critical questions related to setting, delivery, payment, and effectiveness of rehabilitation services. Plenary presentation and state-of-the-science summaries were organized around 4 themes: (a) the need for improved measurement of key rehabilitation variables and methods to collect and analyze this information, (b) factors that influence access to postacute rehabilitation care, (c) similarities and differences in quality and quantity of services across PAC settings, and (d) effectiveness of postacute rehabilitation services. The full set of symposium articles, including recommendations for future research, appear in Archives of Physical Medicine and Rehabilitation.     

State-of-the-science on postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy. An introduction

The Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness, along with academic, professional, provider, accreditor, and other organizations, sponsored a 2-day State-of-the-Science of Postacute Rehabilitation Symposium in February 2007. The aim of this symposium was to serve as a catalyst for expanded research on postacute care (PAC) rehabilitation so that health policy is founded on a solid evidence base. The goals were to (a) describe the state of our knowledge regarding utilization, organization, and outcomes of postacute rehabilitation settings, (b) identify methodologic and measurement challenges to conducting research, (c) foster the exchange of ideas among researchers, policy makers, industry representatives, funding agency staff, consumers, and advocacy groups, and (d) identify critical questions related to setting, delivery, payment, and effectiveness of rehabilitation services. Plenary presentation and state-of-the-science summaries were organized around 4 themes: (a) the need for improved measurement of key rehabilitation variables and methods to collect and analyze this information, (b) factors that influence access to postacute rehabilitation care, (c) similarities and differences in quality and quantity of services across PAC settings, and (d) effectiveness of postacute rehabilitation services. The full set of symposium articles, including recommendations for future research, appear in Archives of Physical Medicine and Rehabilitation.     

Quality of integrated care for patients with head and neck cancer: Development and measurement of clinical indicators

BACKGROUND: To improve the quality of integrated care, we developed indicators for assessing current practice in a large reference center for head and neck oncology. METHODS: We defined a set of indicators based on integrated care literature, national evidence-based guidelines for patients with head and neck cancer, and the opinions of professionals and patients. We tested this set regarding assessment of current practice and clinimetric characteristics. RESULTS: The final set consisted of 8 integrated care indicators and 23 specific indicators for patients with head and neck cancer. Current practice assessment produced high scores for the integrated care indicators, but the specific indicators showed room for improvement. The practice test showed that 9 indicators had good applicability. CONCLUSIONS: The indicators, while based on evidence-based guidelines and the principles of integrated care, should incorporate patients' opinions and include a practice test. Our results show that the quality of integrated care for patients with head and neck cancer could be improved.