Collaboration equals independence

Hospitals that don't want to merge or be acquired need certain kinds of partnerships to thrive in an age of collaborative health care. It's happening in Wyoming and Ohio.

Testing boundaries

The Christie hospital's clinical trials unit plays a major role in testing new cancer treatments. The clinical research nurses who work there are vital to its success.

Clinical challenges in the implementation of a tomotherapy service for head and neck cancer patients in a regional UK radiotherapy centre

OBJECTIVE

Intensity-modulated radiotherapy (IMRT) is increasingly being used to treat head and neck cancer cases.

METHODS

We discuss the clinical challenges associated with the setting up of an image guided intensity modulated radiotherapy service for a subset of head and neck cancer patients, using a recently commissioned helical tomotherapy (HT) Hi Art (Tomotherapy Inc, WI) machine in this article. We also discuss the clinical aspects of the tomotherapy planning process, treatment and image guidance experiences for the first 10 head and neck cancer cases. The concepts of geographical miss along with tomotherapy-specific effects, including that of field width and megavoltage CT (MVCT) imaging strategy, have been highlighted using the first 10 head and neck cases treated.

RESULTS

There is a need for effective streamlining of all aspects of the service to ensure compliance with cancer waiting time targets. We discuss how patient toxicity audits are crucial to guide refinement of the newly set-up planning dose constraints.

CONCLUSION

This article highlights the important clinical issues one must consider when setting up a head and neck IMRT, image-guided radiotherapy service. It shares some of the clinical challenges we have faced during the setting up of a tomotherapy service. Implementation of a clinical tomotherapy service requires a multidisciplinary team approach and relies heavily on good team working and effective communication between different staff groups.

[Introduction of a clinical protocol for extravasation at the National Institute of Oncology, Budapest, Hungary]

Extravasation of cytostatics occurs when an infusion containing a cytotoxic drug leaks into the surrounding perivascular and subcutaneous tissues. Incidence of cytostatic extravasation is found to be 0.1-6% according to the literature. Depending on the severity of complications, pain, loss of function in the extremities, or in extreme cases tissue necrosis necessitating an amputation may develop, drawing consequences like delay or interruption of the chemotherapy. Extent of complications is greatly influenced by the type of medication administered, general condition of the patient, and professional preparedness of staff providing the oncological health service. The protocol recently implemented in the National Institute of Oncology is a short, compact guidance for physicians and nurses providing oncological care, so by quick and adequate management of extravasation cases, severe complications could be prevented. More complex practical guidelines including algorithms could be created as a result of a wider collaboration, with the help of which oncological health professionals could easily cope with this rare problem. The authors describe in their review the implementation of the use of dry warm and cold packs, dymethylsulfoxide and hyaluronidase and their function within the algorithm of extravasation treatment.

Pediatric neuro-oncology in small centers--quality control of network support: the HIT-GBM experience

BACKGROUND

The quality of care for children with brain tumors might be higher in large medical centers; however, it may be possible to improve the quality of care received in smaller centers if they join an effective network.

AIM

This study used the HIT-GBM® database to compare the quality of care provided to pediatric high-grade glioma and diffuse intrinsic pontine glioma patients among various medical centers of differing sizes.

PATIENTS AND METHODS

Overall survival was used as a defining parameter. Indirect measures were the time intervals between the first clinical signs of cancer, initial diagnostic imaging, surgery, or chemotherapy and radiation.

RESULTS

From 1995 to 2003, 310 children (137 girls and 173 boys, aged 3 to 18 years old) were registered from 72 medical centers in Europe. Center sizes differed from 1 to 17 registered patients. Center size did not affect survival, nor any of the time intervals studied.

CONCLUSION

There was no evidence that the quality of care differed between smaller and larger centers.

Utilizing the Canadian Emergency Department Triage and Acuity Scale (CTAS) in an oncology urgent care clinic: the university health network experience

The Canadian Triage Acuity Score (CTAS) is a validated triage method used in Canadian emergency departments (ED) that groups patients according to severity of presenting illness (CIHI, 2005). According to Tanabe, Gimbel, Yarnold and Adams (2004), five-level triage systems can be utilized in order to benchmark with similar programs. CTAS, a five-level triage system, can also be used as an instrument to determine triage quality and to predict admission rates, hospital length of stay and diagnostic utilization (Jiminez et al., 2003). In June 2009, Princess Margaret Hospital launched REACH (Reducing Emergent and Acute Care Hospitalization), an oncology-specific urgent care clinic. In order to appropriately utilize resources, assist patients in a timely manner according to acuity, and compare and contrast data to that which is traditionally reported from our area EDs, we implemented the use of a validated triage methodology, CTAS, in this urgent care clinic. The following paper describes the University Health Network experience with utilizing CTAS in an oncology population.

Follow-up policies at Canadian head and neck cancer treatment centres

OBJECTIVE

to demonstrate the extent of the variation in follow-up policies in Canadian head and neck cancer treatment centres.

METHOD

telephone survey of head and neck surgeons.

RESULTS

there is a wide variation in both follow-up policies and beliefs about follow-up. The majority of centres saw patients every 2 to 3 months for the first 2 years, every 3 to 4 months in year 3, and every 6 months in years 4 and 5.

CONCLUSIONS

research is required to determine effective follow-up policies to maximize both patient outcomes and resource management as the numbers of patients in follow-up increase.

The quest for a "winning" breast center

This article focuses on the initiatives and first hand experiences in the establishment of a women's breast center at a not-for-profit, 305 bed, community hospital located in the highly affluent area of southern Connecticut. According to the National Consortium of Breast Centers (NCBC), a breast center organizes the screening, diagnosis, and treatment of breast services in a multidisciplinary approach. The services can be under one roof or at different locations, but the key is they must be under one unified leadership. Making a commitment to establish and maintain a viable breast center can be financially advantageous, as well as an outstanding service dedicated to women's breast health.