Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature

Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The aim of this umbrella review was to identify, critically appraise, synthesize, and present the best available evidence to inform policy and planning regarding patient navigation across the cancer continuum. Systematic reviews examining navigation in cancer care were identified in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), Epistemonikos, and Prospective Register of Systematic Reviews (PROSPERO) databases and in the gray literature from January 1, 2012, to April 19, 2022. Data were screened, extracted, and appraised independently by two authors. The JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used for quality appraisal. Emerging literature up to May 25, 2022, was also explored to capture primary research published beyond the coverage of included systematic reviews. Of the 2062 unique records identified, 61 systematic reviews were included. Fifty-four reviews were quantitative or mixed-methods reviews, reporting on the effectiveness of cancer patient navigation, including 12 reviews reporting costs or cost-effectiveness outcomes. Seven qualitative reviews explored navigation needs, barriers, and experiences. In addition, 53 primary studies published since 2021 were included. Patient navigation is effective in improving participation in cancer screening and reducing the time from screening to diagnosis and from diagnosis to treatment initiation. Emerging evidence suggests that patient navigation improves quality of life and patient satisfaction with care in the survivorship phase and reduces hospital readmission in the active treatment and survivorship care phases. Palliative care data were extremely limited. Economic evaluations from the United States suggest the potential cost-effectiveness of navigation in screening programs.     

A retrospective analysis of gunshot injuries to the maxillo-facial region.

This study analysed the prevalence, demography, soft- and hard-tissue injury patterns, management and complications of gunshot injuries to the maxillo-facial region in 301 patients treated at Groote Schuur Hospital, Cape Town. The number of patients presenting with maxillo-facial injuries caused by gunshot increased over the 15-year study period. The majority were caused by civilian type low-velocity hand-guns and were purposefully and intentionally inflicted by others. Males in their third decade of life and of low socioeconomic status were most often the victims. The wounding effects of these low-velocity injuries were characteristic--small rounded entrance wounds, causing fragmentation of teeth and comminution of the underlying bone, usually without any exit wounds. A comminuted displaced type of fracture pattern was most frequently observed. Special investigations included plain film radiographs with more sophisticated investigations being requested where indicated. Definitive surgical management was initiated by early soft-tissue debridement. Both the mandibular and maxillary fractures had more open than closed reductions. Bone continuity defects as a result of the initial injury were usually reconstructed secondarily using free autogenous bone grafts. All the patients received anti-tetanus toxoid on admission and the majority received antibiotic treatment. The most common complications were sepsis, ocular and neurological complications and limitation of mouth opening. The postoperative sepsis rate was high (19%). The wounding effects of these low-velocity missile injuries are devastating and pose a treatment challenge to the maxillo-facial surgeon.     

Pre-teenage children's strategies for avoiding situations in which they might be exposed to drugs

This paper explores the ways in which pre-teenage children try to avoid coming into contact with illegal drugs and then examines the factors and circumstances that facilitate or impede their efforts to achieve this. Their main strategy of avoiding certain groups or individuals was complicated by the fluid nature of young people's social groups and the unpredictable nature of their activities. Children who lived in areas in which illegal drugs were prevalent found it especially difficult to avoid coming into contact with them. While it was relatively easy for a child to avoid making friends with someone who was using drugs, the situation in which an existing friend started to use illegal drugs was much more difficult to deal with. The paper concludes that, while children should be encouraged to avoid certain groups and situations as their first line of defence, the problematic nature of this activity means that it is also essential that they continue to be provided with the skills necessary to deal effectively with situations in which illegal drugs are available.