Part Of Overall Care Research Articles

Gynecological management of the breast cancer survivor.

Survival from breast cancer has continued to increase since the 1990's, and quality of life and gynecologic issues have been an increasingly important part of overall care. Common women's health issues such as contraception, pregnancy, menopause, and sexual functioning are uniquely affected by breast cancer diagnosis and treatment. Two-thirds of breast cancers are hormone-sensitive and adjuvant hormonal therapies like tamoxifen or aromatase inhibitors have substantially decreased the disease recurrence and contralateral breast cancer. These hormonal therapies can cause menopausal and sexual side effects, and women's healthcare providers need to understand safe and effective treatment options to manage them. Providingcounseling and evidence-based education is important for primary care providers and gynecologists who care for those women who have or previously had breast cancer. This review will focus on specific women's health issues pertaining to breast cancer and treatment.

EP.FRI.508 Improving Antibiotic Stewardship on General Surgical Wards

Abstract Aims Good antibiotic stewardship is a core part of patient care. It has been shown to reduce antibiotic resistance and improve overall patient outcomes. The primary aim was to improve compliance with national antibiotic prescribing guidance. In doing so, we sought to improve documentation of antibiotic duration; reduce the duration of intravenous antibiotics and gentamicin courses; and length of stay in hospital. Methods 50 general surgery inpatients at a district general hospital over a 2-week period were included in cycle 1. All eligible patients on antibiotics were included. Patients were excluded if under 18 years; discharged within 24 hours; or on antibiotics for prophylaxis. Intervention was a poster and education sessions with prescribers. Cycle 2 gathered data from a further 50 patients from the same wards over 10 days. Results There were improvements in documentation of antibiotic duration (from 1% to 52%, p = 0.001); prescription of antibiotics in line with guidance (from 74% to 90%, p = 0.0376) and number of patients on intravenous antibiotics (reduced from 89% to 72%, p = 0.0307). Duration of gentamicin courses also improved: from 23% patients getting more than 72 hours of gentamicin, to 0% post intervention. Length of stay was also reduced, however was not statistically significant (4.98 days to 4.10 days, p = 0.259). Conclusions This simple audit intervention improved antibiotic stewardship on surgical wards, which is an essential part of overall care for patients. Future work could be done to further improve on this, including a prompt via electronic prescribing and targeted interventions in other clinical areas, e.g. ICU.

Podiatry care in rheumatoid arthritis: differences between current and ideal service provision

Background Foot and ankle involvement in rheumatoid arthritis (RA) is common, impacting negatively on quality of life. Stakeholder perceptions of podiatric service provision are unknown. Given the importance of specialist podiatry care, this knowledge would be beneficial. This study explored opinions of people with RA and podiatrists regarding current and ideal podiatry care in NHS Scotland. Methods Two focus groups were conducted with participants from five NHS Health Boards in Scotland. One focus group involved people with RA who previously received podiatry care, and the other, podiatrists who treat people with RA. The Framework approach was used to identify core concepts and associated themes. Results Five people with RA (all female) with mean ± SD age of 53.6 ± 6.6 years and disease duration 15 ± 11 years participated in the first focus group. The average duration of podiatry care was 7 years (range 3-15). Six rheumatology specialist podiatrists participated in the second focus group. Both groups identified similar issues with current care and steps that could be taken to achieve ideal service provision. ‘Access to health care services’ (core concept one) had associated themes of ‘access facilitated’ and ‘access inhibited’. ‘Tailored podiatry service for the complex needs of people with RA’ (core concept two) had associated themes of ‘podiatry service location’, ‘profile of podiatry’, ‘foot health interventions’, ‘podiatrist skills’ ,a nd‘service review’. ‘Tailored service’ also emerged from the podiatrist focus group. Conclusions Podiatry care was regarded as a positive and important part of overall care for people with RA. However, more integrated specialist services with moves towards a national model of care may be beneficial. Participating podiatrists widely endorsed these themes. Greater concurrence between stakeholders could lead to more flexible and accessible services better meeting patient need.

Fertility after high-dose chemotherapy for testicular cancer

Objectives To describe long-term gonadal function after high-dose chemotherapy (HDC). HDC for testicular cancer was recently developed. The evaluation of testicular function after chemotherapy for testicular cancer is an important part of overall care, especially in young patients. Methods Between 1994 and 2001, 27 patients underwent HDC (1250 mg/m 2 carboplatin, 1500 mg/m 2 etoposide, and 7.5 g/m 2 ifosfamide) at Kobe University Hospital. Information on gonadal function during follow-up was available for 10 of these patients. The mean patient age ± SD at treatment was 32.2 ± 8.4 years. The relationships among age at treatment, semen analysis, serum hormone levels (follicle-stimulating hormone, luteinizing hormone, testosterone, prolactin, and estradiol), cumulative dose of cisplatin and carboplatin, and length of follow-up were determined. Results Spermatogenesis recovered after cessation of HDC in 5 of 10 patients. Semen analysis in these patients showed the mean sperm concentration and motility at 42.4 ± 10.4 million/mL and 67.2% ± 17.0%, respectively. The patients were divided into azoospermic and nonazoospermic groups. The age of the nonazoospermic and azoospermic patients was 28.2 ± 8.7 and 36.2 ± 6.5 years, respectively. Follicle-stimulating hormone levels in the nonazoospermic group (11.7 ± 3.4 mIU/mL) were significantly lower than in the azoospermic group (32.8 ± 14.4 mIU/mL; P = 0.0472). No other statistically significant difference was observed in the other hormone levels or the cumulative dose of cisplatin and carboplatin between the azoospermic and nonazoospermic groups. Conclusions Spermatogenesis recovers after HDC in some patients. Patients should be informed that they may or may not be fertile after HDC.