The efficacy, challenges, and facilitators of telemedicine in post-treatment cancer survivorship care: an overview of systematic reviews.

BACKGROUND: Telemedicine services have been increasingly used to facilitate post-treatment cancer survivorship care, including improving access; monitoring health status, health behaviors, and symptom management; enhancing information exchange; and mitigating the costs of care delivery, especially since the COVID-19 pandemic. To inform guidance for the use of telemedicine in the post-COVID era, the aim of this overview of systematic reviews (SRs) was to evaluate the efficacy of, and survivor engagement in, telemedicine interventions in the post-treatment survivorship phase, and to consider implementation barriers and facilitators. METHODS: PubMed, Cochrane CENTRAL, CINAHL, Embase, and Web of Science databases were searched. SRs that examined the use of telemedicine in the post-treatment phase of cancer survivorship, published between January 2010 and April 2021, were included. Efficacy data were synthesized narratively. Implementation barriers and facilitators were synthesized using the Consolidated Framework for Implementation Research. RESULTS: Twenty-nine SRs were included. A substantive body of evidence found telemedicine to benefit the management of psychosocial and physical effects, particularly for improving fatigue and cognitive function. There was a lack of evidence on the use of telemedicine in the prevention and surveillance for recurrences and new cancers as well as management of chronic medical conditions. This overview highlights a range of diverse barriers and facilitators at the patient, health service, and system levels. CONCLUSIONS: This review highlights the benefits of telemedicine in addressing psychosocial and physical effects, but not in other areas of post-treatment cancer survivorship care. This large review provides practical guidance for use of telemedicine in post-treatment survivorship care.

Anaesthesia and surgical aspects of thyroid swelling: the Ibadan experience.

Seventy-five cases of thyroid swelling operated on at the University College Hospital, Ibadan over a period of two years and three months (March 1990 - May 1993) were reviewed. The male-female ratio was 1:8.6, and the highest incidence was in the fourth decade (34.7%). Benign nodular and multinodular goitre constituted 80%, solitary adenoma constituted 6.7%, papillary carcinoma constituted 4% and toxic goitre 9.3%. Approximately 20% presented with a duration of over 5 years, and 22.7% of the glands removed weighed over 100 gms. Eighteen of the cases (24%) showed tracheal deviation, but this did not cause preoperative respiratory problems although there were difficulties in endotracheal incubation during anaesthesia. The non-toxic benign goitres were totally asymptomatic regardless of their size, and the indication for surgery was for cosmetic reasons. We did not routinely search for the recurrent laryngeal nerve and we did not routinely dissect out the inferior thyroid artery for ligation at its main trunk.