Organizational guidance for the care of patients with head-and-neck cancer in Ontario.

Background: At the request of the Head and Neck Cancers Advisory Committee of Ontario Health (Cancer Care Ontario), a working group and expert panel of clinicians with expertise in the management of head-and-neck cancer developed the present guideline. The purpose of the guideline is to provide advice about the organization and delivery of health care services for adult patients with head-and-neck cancer. Methods: This document updates the recommendations published in the Ontario Health (Cancer Care Ontario) 2009 organizational guideline The Management of Head and Neck Cancer in Ontario. The guideline development methods included an updated literature search, internal review by content and methodology experts, and external review by relevant health care providers and potential users. Results: To ensure that all patients have access to the highest standard of care available in Ontario, the guideline establishes the minimum requirements to maintain a head-and-neck disease site program. Recommendations are made about the membership of core and extended provider teams, minimum skill sets and experience of practitioners, cancer centre-specific and practitioner-specific volumes, multidisciplinary care requirements, and unique infrastructure demands. Conclusions: The recommendations contained in this document offer guidance for clinicians and institutions providing care for patients with head-and-neck cancer in Ontario, and for policymakers and other stakeholders involved in the delivery of health care services for head-and-neck cancer.

A review of brainstem strokes.

Stroke is the fifth leading cause of death and a common serious neurological problem. The location of a presumed ischemic lesion can be inferred by relating the observed signs and symptoms to the functional anatomy of the cerebral vessels. It is essential to be able to determine whether a lesion lies in the distribution of either the carotid or the vertebrobasilar arterial systems. The focus of this paper will be limited to a discussion of strokes occurring within the distribution of the vertebrobasilar system. Although nursing does not make medical diagnoses, a clear understanding of the clinical presentation and potential problems will enhance the nurse's ability to develop a comprehensive plan of care for the patient.