Coordination Of Multidisciplinary Team Research Articles

Impact of specialized renal technologists on optimizing delivery of continuous kidney replacement therapy in critical care areas a retrospective study.

Continuous renal replacement therapy (CKRT) is delivered to some of the most critically ill patients in hospitals. This therapy is expensive and requires coordination of multidisciplinary teams to ensure the prescribed dose is delivered. With increased demands on the critical care nursing staff and increased complexities of patients admitted to critical care units, we evaluated the role of specialized renal technologists in ensuring the prescribed dose is delivered. Therefore, the aim of this study is to investigate the impact of supporting intensive care unit nurses with specialized renal technologists on optimizing efficiency of CKRT sessions in the United Arab Emirates. This is a retrospective study that compared critically ill patients on CKRT overseen by specialized renal technologists versus who are non-covered in the year 2021. A total of 331 sessions on 158 patients were included in the study. The mean filter life was longer in specialized renal technologists-covered patients compared to the non-covered group (66 vs. 59 h, p = 0.019). After adjustment by multiple regression analysis for risk factors (i.e., age, gender, mechanical ventilation, sepsis, mean arterial pressure, vasopressors, and SOFA) that may affect CKRT machines' filter life, presence of a specialized renal technologists resulted in significantly longer filter life (co-efficient 0.129; CI 95% 1.080, 11.970; p-value: 0.019). Our study suggests that specialized renal technologists play a vital role in prolonging CKRT machine's filter life span and optimizing CKRT machine's efficiency. Further research should focus on other potential benefits of having specialized renal technologists performing CKRT sessions, and to confirm the finding of this study. Additionally, a cost-benefit analysis could be conducted to determine the economic impact of having specialized teams performing CKRT.

Perioperative strategies and management of giant anterior mediastinal tumors: a narrative review.

Giant anterior mediastinal tumors sometimes may cause circulatory collapse and respiratory failure, known as mediastinal mass syndrome (MMS). The prediction and prevention of MMS is challenging. The aim of this study is to summarize the evaluation methods for MMS and formulate treatment strategies for giant anterior mediastinal tumors. We performed a thorough analysis of recent international literature on giant anterior mediastinal tumors (>10 cm in diameter) and MMS published in the PubMed database. The search spanned the duration of the preceding 10 years from August 19, 2023, and only studies published in English were included. Mature teratomas and liposarcomas are the most common giant anterior mediastinal tumors and MMS develops most frequently in case of malignant lymphomas. Here, we propose a new treatment strategy for giant anterior mediastinal tumors. Based on imaging findings, giant anterior mediastinal tumors can be classified as cystic or solid and further blood investigation data are useful for a definitive diagnosis. When malignant lymphoma or malignant germ cell tumor is highly suspected, the first choice of treatment is not surgery but chemotherapy and radiotherapy. Moreover, image-guided drainage may be effective if giant cystic anterior tumors develop into MMS. The risk classification of MMS is important for treating giant anterior mediastinal tumors. If the MMS risk classification is 'unsafe' or 'uncertain', the intraoperative management deserves special attention. The surgical approach should however be based on tumor localization and invasion of surrounding tissues. Multidisciplinary team coordination is indispensable in the treatment of giant anterior mediastinal tumors. When giant anterior mediastinal tumors are encountered, it is important to follow the appropriate treatment strategy, focusing on the development of MMS based on imaging findings and symptoms.

Association between Antenatal Vaginal Bleeding and Adverse Perinatal Outcomes in Placenta Accreta Spectrum.

Background and Objectives: Placenta accreta spectrum (PAS) disorders are placental conditions associated with significant maternal morbidity and mortality. While antenatal vaginal bleeding in the setting of PAS is common, the implications of this on overall outcomes remain unknown. Our primary objective was to identify the implications of antenatal vaginal bleeding in the setting of suspected PAS on both maternal and fetal outcomes. Materials and Methods: We performed a case-control study of patients referred to our PAS center of excellence delivered by cesarean hysterectomy from 2012 to 2022. Subsequently, antenatal vaginal bleeding episodes were quantified, and components of maternal morbidity were assessed. A maternal composite of surgical morbidity was utilized, comprised of blood loss ≥ 2 L, transfusion ≥ 4 units of blood, intensive care unit (ICU) admission, and post-operative length of stay ≥ 4 days. Results: During the time period, 135 cases of confirmed PAS were managed by cesarean hysterectomy. A total of 61/135 (45.2%) had at least one episode of bleeding antenatally, and 36 (59%) of these had two or more bleeding episodes. Increasing episodes of antenatal vaginal bleeding were associated with emergent delivery (p < 0.01), delivery at an earlier gestational age (35 vs. 34 vs. 33 weeks, p < 0.01), and increased composite maternal morbidity (76, 84, and 94%, p = 0.03). Conclusions: Antenatal vaginal bleeding in the setting of PAS is associated with increased emergent deliveries, earlier gestational ages, and maternal composite morbidity. This important antenatal event may aid in not only counseling patients but also in the coordination of multidisciplinary teams caring for these complex patients.

Impacto do Isolamento Social na Saúde Mental de Trabalhadores num Instituto de Oncologia durante a Pandemia COVID-19

ABSTRACT Introduction The COVID-19 pandemic had a major impact on the mental health of workers, in particular healthcare professionals. The social isolation used as a mitigation measure against infection contributed to a reduction in sleep quality, and an increase in depressive symptoms, anxiety, and burnout. Objectives The aims of this study are to assess the impact of isolation and quarantine on the mental health and sleep quality of healthcare professionals in a Portuguese Oncology Institute. Material and Methods An online form was distributed to all healthcare professionals who were in isolation or quarantine during the year 2020 in the IPO-Porto, consisting of three instruments- sociodemographic survey, Mental Health Inventory (MHI) and Basic Insomnia and Sleep Quality Scale (BaSIQS). Data were collected in two moments, from July 25 to December 25, 2020, and in December 2021. Results A total of 359 healthcare professionals were identified (151 by isolation and 208 by quarantine). In the 2020 analysis, 115 responses were obtained (54 by isolation and 61 by quarantine), resulting in a response rate of 32.0%. In the 2021 analysis, 76 responses were obtained with a response rate of 21.1%. Regarding the healthcare professionals in our study, the dimensions that make up the psychological stress of the MHI, show an improvement after the first year of the pandemic, as well as an improvement in the mean total MHI value from 2020 to 2021. Sleep quality (assessed by the BaSIQS) is in the poor-to-intermediate category in the 2020 assessment. Although the 2021 assessment shows a slightly better mean, there is no statistically significant difference between the two. In this sample of health professionals, mental health and sleep quality correlated for the instruments used. Discussion and conclusions Insomnia and sleep quality are a modifiable factor of mental health, with an impact on the quality of life and productivity of healthcare professionals. Social isolation as a disruptor of sleep, daily routine and healthy interaction in work teams may be a factor that aggravates psychological distress. The investment in mental health promotion programs, as well as the coordination of multidisciplinary teams composed of Psychology, Medicine and Occupational Nursing are essential in the monitoring and surveillance of these workers’ health. KEY WORDS: Mental Health, Healthcare Professionals, Occupational Psychology, COVID-19, Occupational Medicine, Occupational Health.

Certification program of Addiction Centres for hepatitis C virus elimination in Spain. HepCelentes Project.

Microelimination strategies for the hepatitis C virus (HCV) in vulnerable populations, such as users of Addiction Centres (AC), are key for the elimination of hepatitis C. The aim of the HepCelentes project was to design a certification program for AC from the generation of a guide with the criteria to favour the prevention, diagnosis, control, and treatment of HCV in Spain. The project was structured in 4 phases: normalisation, implementation, certification, and communication. In the first phase, developed between July and December 2020, a Steering Committee was created (formed by representatives of scientific societies, healthcare professionals from AC, primary care centres and hospital units, and patient associations) that, from of an exhaustive bibliographic review, generated by consensus an accreditation guide for AC. The guide consists of 22 criteria (15 mandatory and 7 recommended) structured based on the requirements to be met by AC, justification for the selection, level of action (management, prevention, diagnosis and treatment/follow-up), measurement of the indicator, objective level to be achieved, evidence of compliance, clarifications to improve understanding, and mandatory / recommendation (depending on their relevance to achieve HCV elimination and its feasibility for implementation in real practice). The development of a certification system for the AC, based on consensus and coordination of multidisciplinary teams, is intended to favour the management of hepatitis C and its elimination in AC users, supporting the international, national, and regional elimination strategies.

Effect of a patient education video and prehabilitation on the quality of preoperative person-centred coordinated care experience: protocol for a randomised controlled trial

IntroductionMultimodal prehabilitation, an emerging field within the Perioperative Medicine specialty, requires close multidisciplinary team coordination. The goal is to optimise the patient’s health status in the 4–8 weeks before elective...

Report of the House of Representatives Select Committee on Mental Health and Suicide Prevention: Commentary on an expanded psychologist role and decreased GP/psychiatrist leadership in private multidisciplinary primary mental healthcare.

This opinion paper discusses certain recommendations of the House of Representatives Select Committee on Mental Health and Suicide Prevention pertaining to psychology, GP and psychiatric professions. The Committee's recommendations may compromise patient care by undermining the ability of private sector medical specialists in providing direct clinical treatment and their role in the coordination of multidisciplinary teams. Expanding private psychological therapies without GP and private psychiatry support might increase the reliance on public hospital emergency departments and public sector mental health services for severe disorders and suicidal crises. Psychiatrists and GPs need to engage in more effective policy advocacy with the Australian Government, in order to maintain their roles in leading private sector collaborative multidisciplinary care.

Sinonasal cancer in Denmark 2008–2015: a population-based phase-4 cohort study from DAHANCA

Background Sinonasal cancer is considered a rare disease with poor survival. Its treatment has changed profoundly in recent years, primarily following the introduction of intensity-modulated radiation therapy (IMRT) and minimally invasive endoscopic surgery. Danish national guidelines on treatment of patients diagnosed with sinonasal carcinoma were introduced in 2007. The aim of this phase-4 study was to assess the effect of the implementation of guidelines by describing treatment outcomes in a consecutive nationwide cohort. Methods All patients diagnosed with sinonasal carcinoma in Denmark from 2008 to 2015 were identified in the nationwide clinical database, DAHANCA, and were followed until May 2020. Overall survival (OS) was analysed using Kaplan–Meier estimator. Cumulative incidence of locoregional failure (LRF) and disease-specific mortality (DSM) were analysed using the Aalen–Johansen estimator. Competing risks were death from other causes (DSM) and distant failure and death (LRF). Analysis of prognostic factors was performed using Cox proportional hazard analysis. Start of follow-up was time of diagnosis. The results are presented as estimates with 95% confidence intervals (95% CIs). Results A total of 331 patients were identified. Curatively intended treatment was performed in 264 patients (80%). Non-compliance with treatment guidelines was registered in 24 patients (9%). Non-compliance was associated with LRF (hazard ratio [HR], 2.0 [95% CI: 1.1–3.5]). Among patients qualified for curative treatment, failure occurred in 109 patients (41%), primarily at the primary tumour site (81%). Anatomical tumour site and disease stage were independent prognostic factors. The 5-year OS was 56% in patients treated with curative intent, and a combined treatment strategy showed reduced LRF (HR, 0.53 [95% CI: 0.30–0.92]) in a multivariate analysis. Conclusions Guideline compliance and a combined treatment approach reduced the incidence of LRF and thereby increased OS. Our results confirm those of international studies. Treatment of sinonasal carcinoma remains a challenge that requires multidisciplinary team coordination.

Brief Cognitive-Behavioral Therapy for Suicidal Inpatients

Suicide risk is elevated in psychiatric patients following discharge from inpatient care. Despite this vulnerability, there has been limited research investigating suicide prevention protocols that take into account the unique system characteristics of this setting (e.g., short lengths of stay, crisis stabilization treatment model, multidisciplinary team coordination). Cognitive-behavioral therapy (CBT) has demonstrated efficacy for improving suicide risk in outpatients, but has not been validated with inpatients. The current study was a treatment development and pilot feasibility open trial that modified brief cognitive-behavioral therapy (BCBT) for an inpatient setting (BCBT-I). Key treatment modifications included administering up to 10 sessions (depending on patient length of stay), daily, and in a standardized order, with core crisis management skills introduced during the first three sessions. In addition, coordination with the inpatient treatment team was included in BCBT-I implementation. Six adult inpatients with a recent suicide attempt enrolled and completed an average of 4.67 BCBT-I sessions (SD = 1.36). The treatment was highly acceptable (Client Satisfaction Questionnaire total score M = 3.49, SD = 0.73). Pre- to posttreatment effect sizes demonstrated improvements in suicidal ideation (d = 0.97), depression (d = 1.33), and suicidal implicit associations (d = 1.28). All but one of the participants (83%) completed follow-up assessments 1-, 2-, and 3-months postdischarge. Over follow-up, two participants reported suicidal ideation (both without intent), and none reported suicide attempts, preparatory acts or behaviors, or nonsuicidal self-injury. This study provided preliminary evidence supporting the feasibility of CBT to treat suicidal inpatients. Future research is needed to validate BCBT-I in a larger, randomized controlled trial to determine whether BCBT-I reduces suicide risk beyond that afforded by inpatient treatment alone.

Advancements in medical and surgical treatments of Takayasu arteritis-induced renal arteritis: a systematic review.

BackgroundTakayasu arteritis-induced renal arteritis (TARA), commonly seen in Takayasu arteritis (TA), has become one of the main causes of poor prognosis and early mortality in patients with TA. TARA progressing into Takayasu arteritis-induced renal artery stenosis (TARAS), could lead to severe complications including malignant hypertension, cardiac-cerebral vascular disease, and ischemic nephropathy. Since there existed no guidelines on treatments, this study aimed to review the comprehensive treatments for TARA.MethodsWe searched systematically in databases including PubMed, Ovid-Medline, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and SinoMed, from inception to May 2018. Literature selection, data extraction, and statistical analysis were performed.ResultsEighty-two literatures were recruited focusing on medical treatments (n = 34) and surgical treatments (n = 48). We found that combined medical treatments of glucocorticoids and conventional synthetic disease-modifying anti-rheumatic drugs could reach high rates of remission in patients with TARA, and biological disease-modifying anti-rheumatic drugs were preferred for refractory patients. After remission induction, surgical treatment could help reconstruct renal artery and recover renal function partly. Percutaneous transluminal angioplasty was the first choice for patients with TARAS, while open surgery showed a good long-term survival.ConclusionsPatients with TARA should benefit both from medical treatments and from surgical treatments comprehensively and sequentially. Multidisciplinary team coordination is recommended especially in patients with severe complications.

Call center performance to drive patient access.

135 Background: Access to oncology care through a specialty call center within a large academic institution was analyzed to determine service levels necessary to schedule patient consults within 7 days of contact. The specialty call center is the primary resource for ambulatory appointment scheduling, and staffed by 1 licensed provider and 6 agents who administratively coordinate patient care. Hours of operation are 8AM-5PM. Methods: Data was analyzed between a period of 1/1/2018 and 9/30/2018 (P1), providing call statistics (S1): inbound &amp; outbound calls, calls not answered, average speed of answer, agent availability. Observations of agents identified key processes, staffing analysis, and productivity levels. A dependency map was developed to identify key inputs and outputs for all call center activities. The number of dependencies were identified for each activity. Results: A dependency map identified 22 unique agent activities, categorized by administrative tasks (n = 9), multi-disciplinary team coordination (n = 7), direct patient interaction (n = 5), and patient benefit processing (n = 3). Average number of inputs per activity yielded 2.4 (Range = 0 to 8), while outputs were 2.0 (Range = 0 to 6). Inbound and outbound calls spanned multiple categories, with 28,730 calls received or placed during P1. 77% of inbound calls were answered, and remaining calls were directed to voicemail. 89% of all calls occurred between 9AM and 4PM, with slight variation each hour. Staffing Analysis revealed 91.3% availability rate equivalent to 5.48 agents available per day. Average call hours (inbound and outbound) per agent ranged from 2.45hrs/day to 5.18 hours/day, with variation attributed to the unique activities. An algorithm was created to determine appropriate staffing levels to ensure S1 requirements and timely coordination of care. Conclusions: A specialty call center requires a detailed understanding of dependencies that contribute to timely scheduling, while maximizing customer service. Dependency mapping provides visibility to clinical and non-clinical teams of necessary activities to coordinate appointments. Staffing models can assist in understanding the variables that influence S1, and provide support for staffing decisions in periods of high/low demand.

A Pilot Project Using Pediatricians as Initial Diagnosticians in Multidisciplinary Autism Evaluations for Young Children.

Wait times for autism spectrum disorder (ASD) evaluations are long, thereby delaying access to ASD-specific services. We asked how our traditional care model (requiring all patients to see psychologists for ASD diagnostic decisions) compared to an alternative model that better utilizes the available clinicians, including initial evaluation by speech, audiology, and pediatrics (trained in Level 2 autism screening tools). Pediatricians could diagnose immediately if certain about diagnosis but could refer uncertain cases to psychology. Accuracy and time to diagnosis, charges, and parent satisfaction were our main outcome measures. Data were gathered through record extraction (n = 244) and parent questionnaire (n = 57). We compared time to diagnosis, charges, and parent satisfaction between traditional and alternative models. Agreement between pediatrician and psychologist diagnoses was examined for a subset (n = 18). The alternative model's time to diagnosis was 44% faster (85 vs 152 d) and 33% less costly overall. Diagnostic agreement was 93% for children with ASD diagnoses and 100% for children without ASD diagnoses. Pediatricians expressed higher diagnostic certainty about children with higher levels of ASD symptoms. Parents reported no differences in high satisfaction with experiences, family-centered care, and shared decision making. Efficient use of available clinicians with additional training in Level 2 autism screening resulted in improvements in time to diagnosis and reduced charges for families. Coordination of multidisciplinary teams makes this possible, with strategic sequencing of patients through workflow. Flexibility was key to not only allowing pediatricians to refer uncertain cases to psychology for diagnosis but also allowing for diagnosis by a pediatrician when symptomatic presentation clearly met diagnostic criteria.

201 Validation of the Elderly Risk Assessment Index in the Emergency Department

The Elderly Risk Assessment (ERA) score is a validated index that predicts hospitalizations, mortality, and emergency department (ED) visits in adults older than age 60 presenting to primary care. The index is composed of age, sex, number of hospital days in the prior 2 years, marital status, and selected medical conditions (diabetes, coronary artery disease, congestive heart failure, stroke, chronic obstructive pulmonary disease and dementia). The aim of this study was to validate the ERA score in a cohort of ED patients, including need for hospitalization, mortality and return ED visits. This was an observational cohort study of consecutive patients age 60 years and older who presented to the ED from Jan-Dec 2017. This study was approved by the Institutional Review Board. The ERA score uses demographic and clinical data and is automatically calculated and displayed in the electronic medical record. It ranges from -1 to 34 points. Medians with interquartile range (IQR), and odds ratios (OR) with 95% confidence intervals (CI) were calculated. Chi-square and Wilcoxon test were used for statistical analysis. There were 29,991 ED visits in 2017 by patients age 60 and older; this represents 39% of all ED visits at our hospital. Of these, 9% did not consent for medical record review and were excluded. The final cohort included 27,397 visits among 18,607 patients. The median age was 74 years (IQR 66 to 82), 48% were female and 59% were married. The median ERA score was 7 (IQR 2 to 14). A total of 53.7% patients were admitted to the hospital; those with higher ERA scores were more likely to be admitted with a median of 10 (4 to 16) versus 5 (1 to 11). A total of 15.1% of the patients returned to the ED within 30 days; those with a higher ERA score were more likely to return to the ED, with a median of 11 (5 to 17) versus 7 (2 to 13), p<0.0001. Despite being younger, male patients were more likely to return to the ED within 30 days (OR 1.16, CI 1.1-1.2), p<0.001. A total of 15.1% of the patients died within a year; those with a higher ERA score were more likely to die, with a median score of 14 (8 to 19) versus 6 (2 to 13), p<0.0001. When using a cutoff of ERA>=16, those with >=16 were more likely to be admitted to the hospital OR 2.19 (CI 2.06-2.33), more likely to return within 30 days OR 2.05 (CI 1.91-2.21), and to die within the year follow-up, OR 3.45 (CI 3.21-3.70). The ERA score can be automatically calculated into the medical record and can help identify ED patients at higher risk of death, hospitalization and return ED visits. This score could help clinicians identify patients who may benefit from additional resources like advanced care planning, multi-disciplinary team coordination in the ED and even palliative care. Identifying this high risk population has to target patients who could benefit from geriatric referral, social work evaluation for home resources amongst others. Ultimately, this score may be used to identify patients who can be targeted for goals of care discussion while in the ED.

Interprofessional Collaboration between General Physicians and Emergency Department Teams in Belgium: A Qualitative Study.

This study aimed to assess interprofessional collaboration between general physicians and emergency departments in the French speaking regions of Belgium. Eight group interviews were conducted both in rural and urban areas, including in Brussels.Findings showed that the relational components of collaboration, which are highly valued by individuals involved, comprise mutual acquaintanceship and trust, shared power and objectives. The organizational components of collaboration included out-of-hours services, role clarification, leadership and overall environment. Communication and patient’s role were also found to be key elements in enhancing or hindering collaboration across these two levels of care.Relationships between general physicians and emergency departments’ teams were tightly linked to organizational factors and the general macro-environment. Health system regulation did not appear to play a significant role in promoting collaboration between actors. A better role clarification is needed in order to foster multidisciplinary team coordination for a more efficient patient management. Finally, economic power and private practice impeded interprofessional collaboration between the care teams.In conclusion, many challenges need to be addressed for achievement of a better collaboration and more efficient integration. Not only should integration policies aim at reinforcing the role of general physicians as gatekeepers, also they should target patients’ awareness and empowerment.

Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

PA01.03 Establishing a Paradigm for High Quality Lung Cancer Treatment

PA01.03 Establishing a Paradigm for High Quality Lung Cancer Treatment

The implementation of the Mais Médicos (More Doctors) Program and comprehensiveness of care in the Family Health Strategy.

The Mais Médicos (More Doctors) Program is a Brazilian government program that aims to expand access to medical care and thus improve the quality of primary healthcare delivery. This study aims to analyze the perceptions of nondoctor members of the Family Health Strategy teams regarding comprehensiveness of care after the inclusion of doctors from the program. The study encompassed 32 poor municipalities in Brazil's five geographical regions. A total of 78 health workers were interviewed. The interviews were transcribed and analyzed using content analysis and the software Atlas.ti Version 1.0.36. The study found that the program led to: an increase in access to and accessibility of services provided under the Family Health Strategy; humanized care and the establishment of bonds - understanding, partnership, friendship and respect; going back to clinical approaches - dedicated time, listening attentively, and detailed physical examination; the desire and willingness to resolve problems; continuity of care; guarenteeing home visits; and coordination of multidisciplinary teams in networks. It was concluded that the Mais Médicos Program contributed to the enhancement of comprehensiveness, thus leading to improvements in primary health care delivery.

Editorial: Advances in the Prevention and Treatment of Inflammation-Associated Preterm Birth.

Editorial: Advances in the Prevention and Treatment of Inflammation-Associated Preterm Birth.

Evolution of Sports-medical Team Management in the Program of Posture Correction in Children.

Goals:The goal of this study was to determine the effectiveness of the organization and coordination of multidisciplinary team consisted of health and kinesiology professionals at the correction of posture among girls in the period of the second phase of intense growth and development.Material and methods:Testing was conducted on a sample of 70 girls, aged 11.9±2.3 years, in which by the expert evaluation is recorded weakness of individual muscle groups, but also of the whole musculature. For the assessment of posture we applied the method of Napoleon Wolanski. Used are 9 variables that included the observed region of the body and an overall assessment of posture. The subjects were included in the program of kinesiology treatment with duration of 28 weeks. For all the parameters have been applied statistical procedures at univariate and multivariate level.Results:Data on subjects were obtained by measuring the same variables at two time points, i.e. before and after the application of kinesiology treatments. Analyses of differences arithmetic mean and mean values were done with the t-test for paired samples. In order to determine global quantitative differences of tested variables tested discriminant analysis was applied. The results showed that the models which complement the experience and practical application of expert health professionals and kinesiology knowledge is a very effective tool for improving posture of girls in the second phase of intensive growth and development. In this way can be prevented health problems that might arise later in life.

Most practice nurses are aged over 50

Nurses specialising in lung cancer care are overstretched, with a ratio of only one nurse to every 122 patients in England, according to an expert review. A report by the United Kingdom Lung Cancer Coalition (UKLCC), made up of charities, senior NHS professionals and healthcare companies, points out more people die of the disease than any other type of cancer, yet lung cancer has the second lowest ratio of nurse specialists to patients. In comparison, it states there is one nurse specialist to every 79 breast cancer patients. The report contains 30 recommendations, including four that affect nurses directly: All lung cancer patients should be able to access nurse specialist support and advocacy. Lung cancer nurse specialists should be involved with pre-diagnosis care of suspected lung cancer patients. Lung cancer nurse specialists need to work closely with multidisciplinary team co-ordinators, trackers and audit staff to ensure they are not taking on unnecessary administrative roles. Despite the financial pressures facing the NHS, the role of the lung cancer nurse specialist must be protected. National Lung Cancer Forum for Nurses chair and nurse specialist John White said the report’s findings echo the results of a snapshot survey of forum members last year. This revealed that all believed their specialist role was under pressure. ‘Our members said they had been asked to work on the wards to relieve winter pressures,’ he added. ‘We are hoping that the UKLCC report will confirm to commissioners how vital we are.’ He added that the National Patient Experience Survey 2011/12 found that patients who had seen a cancer nurse specialist were more likely to report a good experience of care than those who had not. Macmillan Cancer Support head of policy Duleep Allirajah said the charity welcomed the report. ‘For too long lung cancer has been one of the most overlooked cancers, despite being the UK’s biggest cancer killer.’ To read the UKLCC report go to tiny.cc/Dream_MDT WORLD IN BRIEF