A Review and Comparative Analysis of Information Targeted to the General Public on the Websites of Breast Screening Programs in Canada.

Organized breast screening programs in Canada recommend that women, usually 50-74 years of age, are screened regularly with mammography to reduce their risk of breast cancer death. There is increasing evidence that estimates of mortality reduction are overestimated and harms under-reported. This article will report on a review of the websites of 12 breast screening programs in Canada. The primary goal is to determine what information is provided to enable women to make an informed decision about mammography and whether choice is emphasized. All publicly available English language information was extracted from the 12 websites by two independent reviewers, using a data extraction sheet. Information extracted included eligible age, screening interval and potential benefits and harms. This review is relevant to policy makers and breast screening program staff so they can determine what additional or alternative information is required on their websites to enable women to make informed decisions.

Impact of the Relocation of a Long-term Residential Care Facility on Staff.

This article describes the relocation of residents and staff of a long-term residential care facility into a new state-of-the-art building in a Canadian province. All staff were surveyed about their perceptions of the moving process 2 months after the move occurred using a newly created 51-item questionnaire containing both open-ended and closed questions (5-point Likert scale). The results were positive for the 3 subscales of the survey, with average scores for premove, midmove, and postmove items of 3.67, 3.94, and 3.66, respectively. There was no significant difference in the means when comparing staff position, years of employment, or assignment to 1 or more units. Staff were very positive about the move itself, the orientation provided and overall planning, and support from coworkers and management. Some concerns were raised about staffing shortages, involvement of residents, and preparedness of the units and building. In addition, it is evident that relocation is an ongoing process, with many supports required in the months after the move. This article describes a very well planned and executed relocation of a long-term residential care facility and can provide guidance and lessons learned to assist other administrators who are planning a similar endeavor.

Viewpoint: It is time to reconsider policy for population-based mammography screening.

Breast cancer in women is an important cause of morbidity and mortality. Many countries in the Western world have widely promoted early detection through mammography screening and established population-based screening programs. Over the past 15 years, there has been growing debate about the benefits and harms of universal mammography screening. This article presents findings from the latest systematic review conducted by the Cochrane Collaboration and from the Canadian National Breast Screening Study 25-year follow up. The authors of both reports conclude there is no reliable evidence that population-based mammography screening reduces mortality, but there is good evidence of harm in the form of false positive findings, over-diagnosis and unnecessary treatment, and associated psychological distress. It is time for policymakers to discontinue universal population-based mammography screening and shift to a more selective approach to early detection.

Quality of work life of novice nurses: a qualitative exploration.

This qualitative research study examines factors influencing the quality of work life of novice nurses (less than 2 years' experience) in the Eastern Regional Health Authority in St. John's, Newfoundland and Labrador, Canada. Although novice nurses are highly motivated to provide quality patient care, they encounter many sources of stress, including "difficult personalities," inadequate orientation and mentoring, and horizontal violence from nursing and medical colleagues. These stressors are compounded by staffing shortages and heavy workloads. Supportive mentoring and adequate orientation are key factors to successful transition.

Breast cancer screening recommendations: is mammography the only answer?

Early detection of breast cancer is important to reduce mortality and morbidity. Traditionally, three methods of breast screening were recommended: mammography, clinical breast examination (CBE), and breast self-examination (BSE). At present, BSE and CBE are no longer widely recommended, while mammography is still broadly promoted in the Western world. The primary intent of this article is to examine whether current health policy recommendations related to breast cancer screening are informed by evidence. The issue of whether women are adequately aware of the potential benefits and risks of breast screening methods to make informed decisions is also discussed. It is argued that it is premature to caution women against BSE and CBE because the current evidence is inconclusive or incomplete. Moreover, women should be better informed about the potential harms associated with mammography screening. Recommendations for research and health policy are also discussed.

Facilitating interprofessional education and practice.

Collaborative patient-centred care has the potential to address serious issues in the Canadian health-care system such as those related to increasing complexity of care; patient safety and access; and recruitment and retention of health human resources. This approach involves teams of health professionals working together to provide more coordinated and comprehensive care to clients. It places priority on the preferences of the patient and fosters respect for the skills and perspectives of all health-care providers. Interprofessional education at the undergraduate, graduate and practice levels is essential for facilitating the transition to team-based care. The author presents the rationale for collaborative care and describes an interprofessional education project at Memorial University of Newfoundland that is preparing students and health professionals for this groundbreaking change in practice.

University collaboration in delivering applied health and nursing services research training.

In 2001-2002, the Canadian Health Services Research Foundation (CHSRF) and the Canadian Institutes of Health Research (CIHR) committed 10 years of funding for the creation and implementation of three Regional Training Centres to build capacity in health services and policy research in the Atlantic, Ontario and Western regions of Canada and one training centre in Quebec to focus on the development of nursing services researchers. Each RTC comprises several universities that collaborate to deliver the graduate training. The authors of this paper describe the consortium-related features of the RTCs, including approval processes, formal agreements, governance, communication, students, curriculum, administration and use of educational technology. The discussion outlines the benefits and challenges of university collaboration for participating students, faculty and universities and summarizes lessons learned.

Evidence against breast self examination is not conclusive: what policymakers and health professionals need to know.

Breast cancer is a serious health concern and a disease that is not well understood. Early detection remains the best way to prevent debilitation and death. Traditionally, mammography, clinical breast examination (CBE), and breast self examination (BSE) have been accepted as legitimate breast screening modalities. Over the past 5 years, academics, health professionals, and policymakers have seriously questioned the usefulness of BSE after influential organizations such as the Canadian Task Force on Preventive Health Care downgraded their BSE recommendation citing fair evidence of no benefit and good evidence of harm. We briefly review the three large BSE trials, highlighting methodological weaknesses limiting their ability to evaluate its effectiveness, as well as critique the 2001 Canadian Task Force on Preventive Health Care report on BSE. We argue that it is premature to conclude that BSE is ineffective. Given that most women find their own breast cancer, this article cautions policymakers and health professionals that a prudent approach to BSE promotion should be taken.

Increasing our understanding of breast self-examination: women talk about cancer, the health care system, and being women.

The author engaged 13 women, aged 30 to 59, in a collaborative research project over several months to explore the meaning of breast self-examination (BSE) to them. Through a series of 11 group discussions, the women developed a critical consciousness of the commonality of their personal experiences in relation to BSE. Although these women valued BSE, their reluctance to perform it was influenced by their perceptions of breast cancer as a lethal disease, the perceived threat it posed to their femininity, and their ability to negotiate an increasingly medical and technological health care system. This study provides insight into the importance of the social environment and shared understandings in influencing women's individual behavioral choices for BSE. It also illustrates the particular value of collaborative health research.