Understanding the needs and preferences for cancer care among First Nations people: An integrative review.

AIM: This systematic review aimed to identify the needs and preferences for cancer care services among Australian First Nations people. DESIGN: Integrative review. DATA SOURCES: An integrative review was conducted. A wide range of search terms were used to increase the sensitivity and specificity of the searches in electronic databases. Methodological quality assessment, data extraction, was conducted independently by two reviewers, and a narrative synthesis was conducted. RESULTS: Forty-two studies were included. A total of 2965 Australian First Nations adults, both men and women of various ages across the lifespan, were represented; no First Nations children affected by cancer were represented in the studies. Three themes emerged which included: (1) discrimination, racism and trauma, resulting from colonization, directly impacted First National people's cancer care experience; (2) cultural ways of knowing, being and doing are fundamental to how First Nations people engage with cancer care services; and (3) First Nations people need culturally safe person-centred cancer care services that address practical needs. CONCLUSION: Most participants represented in this review experienced discrimination, racism and trauma, resulting from colonization, which directly negatively impacted Aboriginal peoples' cancer care experience. While the Optimal Cancer Pathway (OCP) was launched in Australia several years ago, people with cancer may continue to experience distressing unmet care needs. PATIENT OR PUBLIC CONTRIBUTION: Our team includes both First Nations people, non-First Nations researchers and healthcare professionals with expertise in cancer care. The researchers employed decolonizing restorative approaches to ensure voice, respect, accountability and reciprocity in this review work. IMPLICATIONS FOR NURSING PRACTICE: Members of the multidisciplinary team including nurses and policymakers should reflect on these findings, ensure that they have up-to-date cultural safety training and stand together with Indigenous and non-Indigenous cancer leaders to take proactive steps to stamp out and dismantle oppression in health, and safely implement the OCP.

Is The Consent Process Appropriate - The Interns' Perspective?

Aims Consent is an integral component to any medical procedure involving a competent patient, a communicating doctor, and transfer of information about the procedure. The aim of this study was to assess interns' experience of the consent process. Methods An online questionnaire was distributed to interns in Ireland questioning their role in the consent process within six months of starting as an intern. Results One hundred and seventy-one interns (89.1%) had consented a patient for a procedure during their first intern rotation. One hundred and forty-three (83.6%) reported their supervisors did not explain the procedure to the intern prior to consent. One hundred and fifty-eight (92.4%) respondents consented for a procedure which they had not witnessed before. Sixty (35.1%) of interns reported that they have obtained signed consent without fully discussing the procedure and the associated risks. Conclusion The most junior members of a team are independently consenting patients on a regular basis without the appropriate level of knowledge.

A novel phase assignment protocol and driving system for a high-density focused ultrasound array.

Currently, most phased-array systems intended for therapy are one-dimensional (1-D) and use between 5 and 200 elements, with a few two-dimensional (2-D) systems using several hundred elements. The move toward lambda/2 interelement spacing, which provides complete 3-D beam steering, would require a large number of closely spaced elements (0.15 mm to 3 mm). A solution to the resulting problem of cost and cable assembly size, which this study examines, is to quantize the phases available at the array input. By connecting elements with similar phases to a single wire, a significant reduction in the number of incoming lines can be achieved while maintaining focusing and beam steering capability. This study has explored the feasibility of such an approach using computer simulations and experiments with a test circuit driving a 100-element linear array. Simulation results demonstrated that adequate focusing can be obtained with only four phase signals without large increases in the grating lobes or the dimensions of the focus. Experiments showed that the method can be implemented in practice, and adequate focusing can be achieved with four phase signals with a reduction of 20% in the peak pressure amplitude squared when compared with the infinite-phase resolution case. Results indicate that the use of this technique would make it possible to drive more than 10,000 elements with 33 input lines. The implementation of this method could have a large impact on ultrasound therapy and diagnostic devices.

Extraskeletal Ewing's sarcoma: a case report and review of the literature.

STUDY DESIGN: Case report. OBJECTIVES: To report on the diagnosis and current treatment of a rare tumor about the cervical spine. SUMMARY OF BACKGROUND DATA: Extraskeletal Ewing's sarcoma (EES) is rare and has not been previously described about the cervical spine. We present a case of a 24-year-old man with a large mass in the posterior triangle of the neck extending through the vertebral foramens of the cervical vertebrae. This was identified as an extraskeletal Ewing's sarcoma. Traditional treatment paradigms have been associated with a poor prognosis. Since the recommendations of the Intergroup Rhabdomyosarcoma Study II study of multimodal chemotherapy and radiotherapy, this tumor has a significantly better prognosis. METHOD: Surgical debulking of the tumor was necessary to relieve cord compression. Histologic analysis was used to confirm both magnetic resonance imaging and computed tomography diagnosis. A chemoradiation therapy program was commenced in accordance with Intergroup Rhabdomyosarcoma Study II recommendations. RESULTS: Computed tomography and magnetic resonance imaging demonstrated a large lobulated mass extending through the exit foramens of C2/C3 and C3/C4. The mass was entirely extraskeletal and extradural. Histologic examination of the excised mass showed microscopy consistent with extraskeletal Ewing's sarcoma. After surgical debulking and chemoradiation, the patient made a complete recovery. CONCLUSION: A review of the literature confirms that extraskeletal Ewing's sarcoma is a rare tumor and particularly so in the region of the cervical spine. Early diagnosis and surgical debulking combined with current multimodality chemoradiation programs can produce a favorable outcome.

Salvage of total loss of DIEP and skin envelope in breast reconstruction with tissue expansion.

We present two cases of breast reconstruction using abdominal tissue expansion as a salvage procedure for those patients who have had multiple sequential complications using the traditional free flap techniques yet still request some form of reliable breast reconstruction.

The factors considered by editors of plastic surgery journals in evaluating submitted manuscripts.

The publication of clinical- or laboratory-based research in peer-reviewed journals is seen as the final end point rewarding many months of detailed work. For both trainees and established consultants alike, having a submitted manuscript rejected is both frustrating and disheartening. All journals publish details regarding manuscript structure and preparation. However these "in-house" guidelines tell little about what editors are looking for in their journals, and indeed what can be done to ensure acceptance of any work that researchers submit. The authors surveyed the editors of 40 peer-reviewed plastic surgery and related subspeciality journals regarding factors that influence their decision to accept or reject a manuscript. The aim was to establish factors that influence editors' decisions regarding submitted papers, which then would enable aspects to be highlighted that authors could address to expedite publication and produce relevant guidelines to facilitate this process. The results demonstrate that editors value an original, rigorously designed manuscript with valid methodology and appropriate conclusions. Adherence to the philosophy and aims of the journal and the journal's target audience will further improve the likelihood of successful publication for the submitting authors.

Comparison of zones 1 to 4 flexor tendon repairs using absorbable and unabsorbable four-strand core sutures.

Absorbable sutures behave favourably in vitro and in an animal model. We report the outcome of flexor tendon injuries in a series of 272 consecutive patients treated over 45 months with a mean follow-up of 4 (range 3-12) months. Five hundred and seventy-six tendons were repaired in 416 digits. The patients were not randomised and all repairs were performed using a Strickland four-strand core technique. In 191 (73%) patients an absorbable core suture was used (Group 1) and in 81 (27%) a non-absorbable material was used (Group 2). There were six ruptures (2%) in Group 1 and two (2%) in Group 2. Using the original Strickland criteria, there were 72% excellent/good and 28% fair/poor results in the absorbable core suture group, and 73% and 27%, respectively, in the non-absorbable core suture group. This study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repair.