Establishing an Integrative Oncology Service: Essential Aspects of Program Development.

PURPOSE OF REVIEW: Over the last 2 decades, integrative oncology (IO) has seen exponential growth within cancer care. It aims to combine evidence-based complementary therapies with conventional treatments to improve the well-being and quality of life for individuals dealing with cancer. The proliferation of integrative medicine programs in major cancer centers globally reflects varying approaches shaped by cultural, demographic, and resource-based factors. RECENT FINDINGS: Drawing upon the expertise of leaders in IO from the Society for Integrative Oncology (SIO) Clinical Practice Committee, this manuscript serves as a practical guide for establishing an IO practice. Collating insights from diverse professionals, including oncologists, integrative oncologists, supportive care physicians, researchers, and clinicians, the paper aims to provide a comprehensive roadmap for initiating and advancing IO services. The primary objective is to bridge the gap between conventional cancer care and complementary therapies, fostering a patient-centric approach to address the multifaceted challenges encountered by individuals with cancer. This paper delineates several key sections elucidating different aspects of IO practice. It delves into the core components necessary for an IO service's foundation, outlines the initial medical consultation process, and presents crucial tools essential for successful consultations. By consolidating insights and expertise, this manuscript seeks to facilitate the integration of IO into mainstream cancer care, ultimately enhancing patient outcomes and experiences.

Framework for pediatric robotic surgery program development.

Pediatric robotic surgery has seen increasing implementation for its many benefits over the past two decades. As more pediatric surgeons gain exposure to robotic surgery, the interest in utilizing this technology is growing. However, there are no guidelines or existing framework for developing pediatric general surgery robotic programs. Programmatic development can be challenging, requiring institutional support, a minimum 12-month multistep process in partnership with the robot manufacturer, and organization of a local dedicated team. A cornerstone to all program building is collaboration and communication with key stakeholders who are committed to establishing a robotic surgery program. In this manuscript, we detail numerous best practices for implementation, followed by three variations of programmatic development, each drawing lessons from one of three practice settings: (i) A children's hospital in a large medical center associated with an adult hospital, (ii) a free-standing children's hospital, and (iii) a community-based practice. We aim for this article to provide a framework that can serve as a guide for those beginning this process, consolidating the key resources and strategies used to develop a robust pediatric robotic surgery program.

Designing viable, durable physical activity programs for cancer survivors: reflections from program participants and organizational leaders.

PURPOSE: Despite recommendations for cancer survivors to participate in routine physical activity (PA), offering programs that fit both survivors' needs and sponsoring organizations' resources remains a challenge. The purpose of this study is to explore the perspectives of cancer survivors and organizational stakeholders with the intent of developing PA peer-led programs that organizations can implement into their programming. METHODS: This study explored cancer survivors' (n = 11) and cancer care organizational stakeholders' (n = 27) perspectives on the design and feasibility of PA programs targeted for cancer survivors. Semi-structured interview guides were developed for survivors and stakeholders; interviews lasted approximately 30 min. Two analysts used a thematic analysis approach and independently conducted a line-by-line coding of each transcript. With guidance from a senior analyst, the codes were collapsed into themes and subthemes. RESULTS: The qualitative analysis of the interview data resulted in seven major themes relating to PA program development and success. Survivor-related themes included the following: (1) developing PA programs based on cancer survivors' characteristics and experiences; (2) perceived value and importance of accessible, face-to-face instruction; (3) ensuring success based on physical abilities and limitations of the survivor; and (4) the value of physician recommendation for PA participation. Organization-related themes included the following: (1) incorporating participant and community input into program offerings; (2) program feasibility and sustainability; (3) incorporating organizational experience when adopting new program initiatives. CONCLUSION: These findings highlight the challenges of developing viable PA programs for cancer survivors and may guide organizations in future program development and implementation.

Development and Implementation of a Telemental Health Program for Caregivers in a Children's Hospital Setting.

Introduction: Caregivers of children with chronic illness, such as hematology-oncology conditions, face numerous stressors, and a subset experience persistent distress and poor psychological outcomes. Many logistical and ethical barriers complicate the provision of mental health care to caregivers in children's hospital settings. Telemental health (TMH) is one method to increase access and reduce barriers. Methods: A partnership was established with an outside TMH agency to provide mental health care to caregivers of children with hematology-oncology conditions. Development and implementation strategies are described, and feasibility was measured on four dimensions. Results: One hundred twenty-seven (n = 127) caregivers were referred for TMH services in the first 28 months of program implementation. Of the total, 63/127 (49%) received TMH services for at least one session. Most caregivers had a child in active medical treatment (89%). A small portion (11%) of caregivers were bereaved or had a child in hospice care. Program feasibility was enhanced by hospital leadership support and availability of staffing, financial, and technology resources. Available resources also contributed to the practicality of program development and swift implementation and integration within the defined hospital system. Discussion: Partnership with an outside TMH agency increased access to care and reduced barriers to treating caregivers in a children's hospital setting. Offering mental health interventions to caregivers aligns with evidence-based standards of care. Future research will elucidate caregiver satisfaction with this modality of treatment and whether use of TMH reduces disparities in caregiver receipt of mental health care in children's hospital settings.

The Integration of Community Voice in the Implementation of a Mobile Health Program.

BACKGROUND: Health care access is vital to advancing health equity. The purpose of this paper was to use a community-based participatory research approach to engage underserved communities in the development of a new mobile health clinic (MHC) program and to discuss the lessons learned from the conversations. Community conversations helped identify barriers to access to health care, community strengths, and health concerns. They also helped the MHC leaders develop programming. METHODS: The community-based participatory research approach guided five community conversations conducted (N = 51 participants) from 2018 to 2019. Participants provided input on their personal experiences with a) existing facilitators and barriers to health, b) priority health issues and needs, and c) recommendations for MHC program development. RESULTS: Barriers to health care access were identified, as were many community strengths. Recommendations directly informed MHC program development and implementation, including availability of services at no cost, mammogram referrals, mental health screening, eye exams, and nutrition counseling. CONCLUSIONS: This project highlights the importance of collaboration between academic partners and communities to inform health care programs and the implementation of a MHC based on community voice and input.

Integrated Care for Comprehensive Management of Patients with Osteoarthritis: Program Development and Implementation.

Treatment of symptomatic osteoarthritis (OA) is often complicated by comorbidities, which put patients at potentially higher risks following operative interventions. Management of these comorbidities is usually separate from orthopaedic care, with patients invited to return to their orthopaedic surgeon once surgical risk factors are better controlled. However, this practice can lead to disjointed care, resulting in uncertainty, mistrust, unmanaged pain, and dissatisfaction for patients. Integrated care teams provide an effective option for coordinated comprehensive nonoperative and preoperative management of patients with knee OA and medical comorbidities. The objective of this article is to summarize the process for implementation of an integrated program to manage patients with symptomatic knee OA and the initial outcomes at our institution as an example of the effects of integrated patient management in orthopaedics. At the author's institution, an integrated program was implemented, successfully addressing the unmet need for coordinated care for patients with bone and joint health problems and medical comorbidities. Patients who completed the full program experienced significant improvements in both pain and function. Potential applications for knee surgeons considering implementing integrated care models could include pre- and postoperative management programs, nonoperative management program, and programs seeking to meet key metrics such as improved readmission rates, patient satisfaction, or value-based care. For effective program implementation, careful planning with convenient referral mechanisms, leadership buy-in, and patient-centered communication protocols are required.

A peer-led, school-based social network intervention for young people in the UK, promoting sexual health via social media and conversations with friends: intervention development and optimisation of STASH.

BACKGROUND: The quality of school-based sex and relationships education (SRE) is variable in the UK. Digitally-based interventions can usefully supplement teacher-delivered lessons and positively impact sexual health knowledge. Designed to address gaps in core SRE knowledge, STASH (Sexually Transmitted infections And Sexual Health) is a peer-led social network intervention adapted from the successful ASSIST (A Stop Smoking in Schools Trial) model, and based on Diffusion of Innovation theory. This paper describes how the STASH intervention was developed and refined. METHODS: Drawing on the Six Steps in Quality Intervention Development (6SQuID) framework, we tested a provisional programme theory through three iterative stages -: 1) evidence synthesis; 2) intervention co-production; and 3) adaptation - which incorporated evidence review, stakeholder consultation, and website co-development and piloting with young people, sexual health specialists, and educators. Multi-method results were analysed in a matrix of commonalities and differences. RESULTS: Over 21 months, intervention development comprised 20 activities within the three stages. 1) We identified gaps in SRE provision and online resources (e.g. around sexual consent, pleasure, digital literacy), and confirmed critical components including the core ASSIST peer nomination process, the support of schools, and alignment to the national curriculum. We reviewed candidate social media platforms, ruling out all except Facebook on basis of functionality restrictions which precluded their use for our purposes. 2) Drawing on these findings, as well as relevant behaviour change theories and core elements of the ASSIST model, we co-developed new content with young people and other stakeholders, tailored to sexual health and to delivery via closed Facebook groups, as well as face-to-face conversations. 3) A pilot in one school highlighted practical considerations, including around peer nomination, recruitment, awareness raising, and boundaries to message sharing. From this, a revised STASH intervention and programme theory were co-developed with stakeholders. CONCLUSIONS: STASH intervention development required extensive adaptation from the ASSIST model. Although labour intensive, our robust co-development approach ensured that an optimised intervention was taken forward for feasibility testing. Evidencing a rigorous approach to operationalising existing intervention development guidance, this paper also highlights the significance of balancing competing stakeholder concerns, resource availability, and an ever-changing landscape for implementation. TRIAL REGISTRATION: ISRCTN97369178.

The past, present and future of ACS NSQIP-Pediatric: Evolution from a quality registry to a comparative quality performance platform.

Quality and process improvement (QI/PI) in children's surgical care require reliable data across the care continuum. Since 2012, the American College of Surgeons' (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIP-Pediatric) has supported QI/PI by providing participating hospitals with risk-adjusted, comparative data regarding postoperative outcomes for multiple surgical specialties. To advance this goal over the past decade, iterative changes have been introduced to case inclusion and data collection, analysis and reporting. New datasets for specific procedures, such as appendectomy, spinal fusion for scoliosis, vesicoureteral reflux procedures, and tracheostomy in children less than 2 years old, have incorporated additional risk factors and outcomes to enhance the clinical relevance of data, and resource utilization to consider healthcare value. Recently, process measures for urgent surgical diagnoses and surgical antibiotic prophylaxis variables have been developed to promote timely and appropriate care. While a mature program, NSQIP-Pediatric remains dynamic and responsive to meet the needs of the surgical community. Future directions include introduction of variables and analyses to address patient-centered care and healthcare equity.

Multi-State Implementation of Go NAPSACC to Support Healthy Practices in the Early Care and Education Setting.

Childhood obesity in the United States is a serious problem that puts children at risk for poor health. Effective state-wide interventions are needed to address childhood obesity risk factors. Embedding evidence-based initiatives into state-level Early Care and Education (ECE) systems has the potential to improve health environments and promote healthy habits for the 12.5 million children attending ECE programs. Go NAPSACC, an online program that was adapted from an earlier paper version of Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC or NAP SACC), provides an evidence-based approach that aligns with national guidance from Caring for Our Children and the Centers for Disease Control and Prevention. This study describes approaches undertaken across 22 states from May 2017 to May 2022 to implement and integrate Go NAPSACC into state-level systems. This study describes challenges encountered, strategies employed, and lessoned learned while implementing Go NAPSACC state-wide. To date, 22 states have successfully trained 1,324 Go NAPSACC consultants, enrolled 7,152 ECE programs, and aimed to impact 344,750 children in care. By implementing evidence-based programs, such as Go NAPSACC, ECE programs state-wide can make changes and monitor progress on meeting healthy best practice standards, increasing opportunities for all children to have a healthy start.

Building a Cardiac Palliative Care Program: A Qualitative Study of the Experiences of Ten Program Leaders From Across the United States.

CONTEXT: Palliative care is guideline-recommended for patients with advanced heart failure (HF). However, studies on how cardiac palliative care is provided in the United States are lacking. OBJECTIVES: To study how cardiac palliative care programs provide services, and to identify challenges and facilitators they encountered in program development. METHODS: In this qualitative descriptive study, we used purposive and snowball sampling approaches to identify cardiac palliative care program leaders across the United States, administered a survey and conducted semi-structured interviews. Interview transcripts were coded and evaluated using thematic analysis. RESULTS: While cardiac palliative care programs vary in their organizational setup, they all provide comprehensive interdisciplinary palliative care services, ideally across the care continuum. They predominantly serve HF patients who are evaluated for advanced therapies or have complex needs. The challenges which cardiac palliative care programs face include reaching those cardiac patients who need palliative care the most and collaborating with cardiologists who do not see value added from palliative care for their patients. Facilitators of cardiac palliative care program development include building personal relationships with cardiology providers, proactively assessing local institution needs, and tailoring palliative care services to meet patient and provider needs. CONCLUSION: Cardiac palliative care programs vary in their organizational setup but provide similar services and face similar challenges. The challenges and facilitators we identified can inform the development of future cardiac palliative care programs.

Perceptions of Palliative Care Program Viability During the Pandemic: Qualitative Results From a National Survey.

Background: Palliative care programs have played a significant role during the COVID-19 pandemic. However, the financial impact of the pandemic and operational challenges for palliative care programs have raised concerns for their future viability. Objectives: To explore palliative care program leaders' perceptions of the future viability of their programs in the context of the pandemic and inform future educational and program development. Methods: Surveys were sent to 1430 specialist palliative care program leaders, identified through the Center to Advance Palliative Care's contact lists, via email in May 2020 and January 2021. Leaders were asked why they were or were not concerned about the viability of their palliative care programs. Qualitative content analysis was applied to determine themes. Results: We received 440 responses. Most programs served hospital settings and were geographically located across all US regions. We identified four themes: 1) The importance of being valued by organizational leadership and peers, 2) The importance of adequate and supported palliative care staff, 3) The pandemic validated and accelerated the need for palliative care, and 4) The pandemic perpetuated organizational financial concerns. Conclusion: Findings provide insights about palliative care program viability from the perspective of program leaders during a global pandemic. Technical assistance to support palliative care teams and their relationships with stakeholders, methods to measure the impact of peer support, efforts to educate administrators about the value of palliative care, and efforts to reduce burnout are needed to sustain palliative care programs into the future.

Influence of the size of the cities of birth and residence in the sports career: an analysis through the bolsa-atleta program / Influência do tamanho das cidades de nascimento e residência na carreira desportiva: uma análise por meio do programa bolsa-atleta

ABSTRACT This study aimed to verify whether the size of municipalities in which Brazilian high-performance athletes are born or live influences the federal government subsidy, in addition to pointing out whether factors such as human development index, demographic density and municipal investment in sports also exert influence. The sample consisted of 2,033 Brazilian municipalities that had athletes, born or resident, receiving the Brazilian incentive Bolsa-Atleta program. The size of municipalities influences the amount and level of grant obtained, demonstrating that the smaller the population size, the lower the chance of obtaining a higher grant level. In addition, factors such as human development index, demographic density and investment in sport influence the acquisition of grants by athletes, mainly by resident athletes, which shows an internal sports migration in the country as a result.

RESUMO O presente estudo teve por objetivo verificar se o tamanho dos municípios em que os atletas brasileiros de rendimento nascem ou residem gera influência na obtenção de subsídio pelo governo federal, além de apontar se fatores como índices de desenvolvimento humano, densidade demográfica e investimento municipal no esporte também exercem influência. A amostra consistiu em 2033 municípios brasileiros que apresentaram atletas nascidos ou residentes contemplados pelo programa de incentivo brasileiro Bolsa-Atleta. Por meio da análise, pode-se verificar que o tamanho dos municípios influência na quantidade e no nível de bolsa obtido, demonstrando que quanto menor o tamanho da população, menor a chance de se obter um nível mais alto de bolsa. Além disto, pode-se notar que fatores como índices de desenvolvimento humano, densidade demográfica e investimento no esporte exercem influência na aquisição de bolsas pelos atletas, principalmente, por parte de atletas residentes, o que evidencia uma migração esportiva interna no país.

Desenvolvimento e implementação de sistema de gerenciamento de cirurgias voltado a um hospital universitário / Development and implementation of a surgery management system aimed at a university hospital / Desarrollo e implementación de um sistema de gestión de cirugías dirigido a un hospital universitario

Objetivo: desenvolver e implementar o sistema de gerenciamento de cirurgias contendo a Lista Cirúrgica e Mapa Cirúrgico. Método: este estudo é de natureza exploratória e descritiva do tipo pesquisa metodológica aplicada. A metodologia utilizada baseia-se no processo de desenvolvimento de software fundamentada no modelo de ciclo de vida de desenvolvimento de sistemas de Pressman. Resultados: o sistema foi desenvolvido e disponibilizado em todos os computadores do hospital em sua rede interna. Implementado em todos as áreas cirúrgicas e Centro Cirúrgico. Conclusão: o sistema de gerenciamento de cirurgias disponibiliza informações em tempo real de informações dos pacientes cirúrgicos a todos setores envolvidos com pacientes cirúrgicos

Objectives: to develop and implement the surgical management system containing the Surgical List and Surgical Map. Method: this study is of exploratory and descriptive nature of the applied methodological research type. The methodology used is based on the software development process based on the Pressman system development life cycle model. Results: the system was developed and made available on all hospital computers on its internal network. Implemented in all surgical areas and Surgical Center. Conclusion: the surgical management system provides real-time information on surgical patient information to all departments involved with surgical patients

Objetivos: desarrollar e implementar el sistema de gestión de cirugías que contenga la Lista Quirúrgica y el Mapa Quirúrgico. Método: este estudio es de naturaleza exploratoria y descriptiva del tipo investigación metodológica aplicada. La metodología utilizada se basa en el proceso de desarrollo de software fundamentada en el modelo de ciclo de vida de desarrollo de sistemas de Pressman. Resultados: el sistema fue desarrollado y puesto a disposición en todas las computadoras del hospital en su red interna. Implementado en todas las áreas quirúrgicas y el Centro Quirúrgico. Conclusión: el sistema de gestión de cirugías proporciona información en tiempo real de los pacientes quirúrgicos a todos los sectores involucrados con pacientes quirúrgicos

ESMO Designated Centres of Integrated Oncology and Palliative Care (ESMO DCs): education, research and programme development survey.

BACKGROUND: The European Society for Medical Oncology (ESMO) Designated Centres (DCs) of Integrated Oncology and Palliative Care is an incentive programme established in 2003 aiming to improve the integration of oncology and palliative care services provided by oncologists and oncology centres worldwide. Currently, the ESMO DCs programme has over 250 centres accredited from 54 countries worldwide, in all six world regions. MATERIALS AND METHODS: To evaluate how ESMO can support centres to improve programme development, education and research and vice versa what each single centre can do to improve in these areas, we developed a survey which was shared with all active centres. Two hundred and seven ESMO DCs representing 44 countries were invited to participate. We used content analysis to identify response categories using a stepwise approach. After reviewing and coding all responses to each question separately, they were placed into categories, counted and labelled. RESULTS: Of the 207 centres that were invited to participate, 146 centres started the survey, representing 43 countries. Five overarching topics were identified. They included (i) joint events and educational activities; (ii) sharing of materials and defining common standards; (iii) sharing of experiences, scientific knowledge and expertise; (iv) research collaboration; and (v) ESMO support. Respondents were willing to support the ESMO DC community group in all topics and were also asking ESMO to support their centres in these issues in the future. CONCLUSION: The study showed that the ESMO DCs are willing to provide support to improve education, research and programme development. They are also eager to contribute and collaborate amongst each other, but also request ESMO to offer advice and help to improve these issues in the DCs. In the future, facilitation of joint research projects and development of arenas to share experiences, educational and programme developments, and other resources are to be explored and could be offered to the DCs worldwide.

Alternativas de controle do diabetes / Alternatives for diabetes control / Alternativas para el control de la diabetes

O Diabetes desde a antiguidade tem sido uma das maiores causas de morte entre as populações do globo, e segundo a Organização Mundial da Saúde continua assolando nos nossos dias. Apesar das descobertas de tratamentos mais eficazes, a doença vem avançando em progressões assustadoras atualmente, com projeções preocupantes para a saúde pública. Como estratégia de acompanhamento terapêutico, estatístico direcionado a portadores de diabetes, o Governo Federal lançou o programa HIPERDIA (Hipertensos e Diabéticos), que faz o acompanhamento da evolução da doença e das complicações dos pacientes. E neste sentido, também são utilizadas terapêuticas mais acessíveis como as plantas medicinais. O objetivo desta pesquisa consiste em realizar uma revisão bibliográfica abordando as opções de terapias de controle do diabetes oferecidas no Sistema Único de Saúde e pesquisar fitoterápicos com potencial hipoglicêmico aprovados pela Anvisa. Através de levantamento bibliográfico, foram identificadas oito espécies vegetais utilizadas pela medicina popular no controle do diabetes, sendo estas: Bauhinia Forficata, Syzygium Cumini, Annona Muricata, Cynara Scolymus, Momordica Charantia, Eugenia Uniflora e Baccharis Trimera. Essas plantas do programa, embora tenham comprovação de seu efeito hipoglicêmico e redutores dos sintomas diabéticos, pelas suas propriedades antioxidantes e antiinflamatórias, colabora para uma melhor qualidade de vida aos pacientes.

Since antiquity, Diabetes has been one of the biggest causes of death amon-g populations around the globe, and according to the World Health Organization, it continues to plague our days. Despite discoveries of more effective treatments, the disease is currently advancing in frightening progressions, with worrying projections for public health. As a therapeutic, statistical follow-up strategy aimed at people with diabetes, the Federal Government launched the HIPERDIA (Hypertensive and Diabetic) program, which monitors the evolution of the disease and the complications of patients. And in this sense, more accessible therapies such as medicinal plants are also used. The objective of this research is to carry out a literature review addressing the options for diabetes control therapies offered in the Unified Health System and to search for herbal medicines with hypoglycemic potential approved by Anvisa. Through a bibliographical survey, eight plant species used by folk medicine to control diabetes were identified, namely: Bauhinia Forficata, Syzygium Cumini, Annona Muricata, Cynara Scolymus, Momordica Charantia, Eugenia Uniflora and Bacharis Trimera. These plants in the program, although they have evidence of their hypoglycemic effect and reduce diabetic symptoms, due to their antioxidant and anti-inflammatory properties, contribute to a better quality of life for patients.

La diabetes ha sido desde la antigüedad una de las principales causas de muerte entre las poblaciones del planeta, y según la Organización Mundial de la Salud sigue haciendo estragos en nuestros días. A pesar de los descubrimientos de tratamientos más eficaces, la enfermedad avanza actualmente con una progresión aterradora, con proyecciones preocupantes para la salud pública. Como estrategia de seguimiento terapéutico, estadísticamente dirigida a las personas con diabetes, el Gobierno Federal puso en marcha el programa HIPERDIA (Hipertensión y Diabetes), que controla la evolución de la enfermedad y las complicaciones de los pacientes. En este sentido, también se utilizan terapias más accesibles, como las plantas medicinales. El objetivo de esta investigación es realizar una revisión bibliográfica que aborde las opciones de terapias para el control de la diabetes ofrecidas en el Sistema Único de Salud y buscar fitoterapias con potencial hipoglucemiante aprobadas por Anvisa. Mediante un estudio bibliográfico, se identificaron ocho especies vegetales utilizadas por la medicina popular en el control de la diabetes, a saber: Bauhinia Forficata, Syzygium Cumini, Annona Muricata, Cynara Scolymus, Momordica Charantia, Eugenia Uniflora y Baccharis Trimera. Estas plantas del programa, aunque han demostrado su efecto hipoglucemiante y reductor de los síntomas diabéticos, por sus propiedades antioxidantes y antiinflamatorias, colaboran a una mejor calidad de vida para los pacientes.

Apoyo social, soledad, vulnerabilidad y satisfacción con la vida en personas mayores de México / Social Support, Loneliness, Vulnerability and Satisfaction with Life in Elderly People in Mexico / Apoio social, solidão, vulnerabilidade e satisfação com a vida em idosos no México

La presente investigación tuvo como objetivo analizar los efectos directos e indirectos del apoyo social, la soledad y la vulnerabilidad percibida en la satisfacción de vida (sv) de dos grupos de personas mayores en México, uno de 60 a 69 años de edad y el otro de 70 a 99. Se contó con una muestra no probabilística de 4.433 personas mayores, 61.8 % fueron mujeres y 38.2 % hombres. Se utilizaron los siguientes instrumentos: la escala de soledad de la Universidad de California; la escala de Red Social de Lubben (lsns-6) para evaluar el apoyo social percibido; la Escala de Vulnerabilidad Percibida de Myall et al.; la escala de Satisfacción con la Vida de Diener et al., así como un cuestionario sociodemográfico. Los resultados mostraron un buen ajuste de los modelos, en los que se aprecia que para ambos grupos es mayor la varianza explicada de sv al relacionar apoyo social con soledad y vulnerabilidad, que si se mide el efecto directo del apoyo sobre sv. Esta investigación aporta elementos para el desarrollo de programas y políticas públicas que contribuyan al bienestar de personas mayores.

This research analyzed the direct and indirect effects of social support, loneliness and perceived vulnerability on life satisfaction (lf) of two groups of elderly adults in Mexico, one aged 60 to 69 years and the other from 70 to 99. There was a non-probabilistic sample of 4.433 older adults ­61.8 % were women, and 38.2 % were men­. The following instruments were used: the Loneliness Scale of the University of California; the Lubben Social Network scale (lsns-6) to assess perceived social support; the Perceived Vulnerability Scale (pvs) of Myall et al.; the Satisfaction with Life scale of Diener et al., and a sociodemographic questionnaire. The results showed a good fit of the models, which show that the explained variance for both groups of lf is more significant when relating social support with loneliness and vulnerability than if the direct effect of support on lf is measured. This research provides elements for developing programs and public policies that contribute to the wellbeing of the elderly.

O objetivo desta pesquisa foi analisar os efeitos diretos e indiretos do apoio social, solidão e vulnerabilidade percebida na satisfação com a vida (sv) de dois grupos de idosos no México, um grupo entre 60 e 69 anos e outro entre 70 e 99 anos. Contouse com uma amostra não probabilística de 4.433 idosos, sendo 61.8 % mulheres e 38.2 % homens. Foram utilizados os seguintes instrumentos: a escala de solidão da Universidade da Califórnia; a Escala de Rede Social de Lubben (lsns-6) para avaliar o suporte social percebido; a Escala de Vulnerabilidade Percebida (pvs) de Myall et al.; a escala Satisfação com a Vida de Diener et al., bem como um questionário sociodemográfico. Os resultados mostra-ram um bom ajuste dos modelos, onde pode-se observar que para ambos os grupos a variância explicada da své maior quando se relaciona apoio social com solidão e vulnerabilidade do que quando se mede o efeito direto do apoio na sv. Esta pesquisa fornece elementos para o desenvolvimento de programas e políticas públicas que contribuam para o bem-estar dos idosos.

Advanced breast cancer education for cancer nurses: A systematic review.

BACKGROUND: Access to comprehensive, integrated, multidisciplinary care is one of the most urgent and actionable recommendations of the Advanced Breast Cancer Global Alliance. However, access to specialist breast care units, and specialist breast cancer nurses is variable, influenced by access to specialist education and role recognition. To date, there has not been a synthesis of evidence regarding educational programmes related to advanced breast cancer education for nurses. OBJECTIVES: The aim of this review was to determine the content, mode of delivery, assessment and outcomes of education programmes related to advanced breast cancer for nurses. REVIEW METHODS: A systematic review was undertaken, according to the Joanna Briggs Institute's mixed methods review methodology. DATA SOURCES: MEDLINE, PUBMED, CINAHL, Scopus, PsycInfo, Joanna Briggs Institute, Web of Science and grey literature sources were systematically searched. Eleven publications met the inclusion criteria. Data relating to programme content, mode of delivery, assessment and outcomes were extracted and analysed. RESULTS: This review identifies a limited number of educational programmes within this specialist area of nursing practice. Shortcomings in the development, implementation and evaluation of advanced breast cancer education programmes included limited use of educational standards, theoretical frameworks and patient and public involvement to inform programme development. Evaluation of education programmes related to advanced breast cancer relied predominantly on self-reported learning, with limited consideration of the impacts of education on service delivery, patient experience or quality of care. CONCLUSIONS: Future development of advanced breast cancer education programmes must consider the alignment of programme content and learning outcomes with existing educational and competency standards. Evaluation of educational programmes in this field must endeavour to enhance rigour of methods, incorporating standardised questionnaires, and multiple methods and sources of data to evaluate the broader impacts of advanced breast cancer education for nurses.

Setting Priorities for a Provincial Adolescent and Young Adult Oncology Program.

Adolescent and young adult (AYA, ages 15-39 years) oncology patients are an underserved population with specialized needs. AYA programs are absent from most Canadian centers. We identified a priority list and sequence for new programs to address. Program goals, priorities, and activities were developed through literature review, national consensus documents, and expert opinion. Health care providers (HCPs) involved in AYA cancer care, administrators, and patient and family representatives were engaged to co-develop program goals and activities. A modified Delphi technique was used through two iterations followed by an in-person meeting to prioritize program implementation. Consensus was defined as a mean score of less than 2.0 (not important) or 4.0 or greater (important). Items without consensus (scored between 2.0 and 3.99) were discussed at the in-person meeting. Sixty provincial stakeholders completed the Delphi survey across multiple disciplines. Twenty-seven stakeholders attended the in-person meeting. All goals were deemed important, except development of a research program. Patient implementation tasks ranked highest. Priority sequence of implementation was: patient care first, followed by HCP education; patient and family education; program sustainability plan; evaluation; research; then a model for multidisciplinary tumor board review. These represent key goals for new AYA oncology programs and a priority sequence of implementation.

Meaningful patient and public involvement in digital health innovation, implementation and evaluation: A systematic review.

INTRODUCTION: The importance of meaningfully involving patients and the public in digital health innovation is widely acknowledged, but often poorly understood. This review, therefore, sought to explore how patients and the public are involved in digital health innovation and to identify factors that support and inhibit meaningful patient and public involvement (PPI) in digital health innovation, implementation and evaluation. METHODS: Searches were undertaken from 2010 to July 2020 in the electronic databases MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus and ACM Digital Library. Grey literature searches were also undertaken using the Patient Experience Library database and Google Scholar. RESULTS: Of the 10,540 articles identified, 433 were included. The majority of included articles were published in the United States, United Kingdom, Canada and Australia, with representation from 42 countries highlighting the international relevance of PPI in digital health. 112 topic areas where PPI had reportedly taken place were identified. Areas most often described included cancer (n = 50), mental health (n = 43), diabetes (n = 26) and long-term conditions (n = 19). Interestingly, over 133 terms were used to describe PPI; few were explicitly defined. Patients were often most involved in the final, passive stages of an innovation journey, for example, usability testing, where the ability to proactively influence change was severely limited. Common barriers to achieving meaningful PPI included data privacy and security concerns, not involving patients early enough and lack of trust. Suggested enablers were often designed to counteract such challenges. CONCLUSIONS: PPI is largely viewed as valuable and essential in digital health innovation, but rarely practised. Several barriers exist for both innovators and patients, which currently limits the quality, frequency and duration of PPI in digital health innovation, although improvements have been made in the past decade. Some reported barriers and enablers such as the importance of data privacy and security appear to be unique to PPI in digital innovation. Greater efforts should be made to support innovators and patients to become meaningfully involved in digital health innovations from the outset, given its reported benefits and impacts. Stakeholder consensus on the principles that underpin meaningful PPI in digital health innovation would be helpful in providing evidence-based guidance on how to achieve this. PATIENT OR PUBLIC CONTRIBUTION: This review has received extensive patient and public contributions with a representative from the Patient Experience Library involved throughout the review's conception, from design (including suggested revisions to the search strategy) through to article production and dissemination. Other areas of patient and public contributor involvement include contributing to the inductive thematic analysis process, refining the thematic framework and finalizing theme wording, helping to ensure relevance, value and meaning from a patient perspective. Findings from this review have also been presented to a variety of stakeholders including patients, patient advocates and clinicians through a series of focus groups and webinars. Given their extensive involvement, the representative from the Patient Experience Library is rightly included as an author of this review.

Development and Implementation of an Oncology Clinical Research Nursing Residency Program for Newly Licensed Nurses.

ABSTRACT: A paucity of nurses trained in clinical research prompted the development and implementation of a newly licensed nurse residency program in oncology research. The components of the program, funding, curriculum development, preceptor model, and partnerships, are described. Formal evaluation to quantify success in creating a pipeline for the future, increasing retention, and reducing costs is underway and will be reported in a future publication.