Clinical guidelines for managing menopausal symptoms in women with (a history of) breast cancer.

Background: One in eight women will be diagnosed with breast cancer. At the time of diagnosis, 75% of patients are postmenopausal. Many will receive anti-hormone therapy, which often induces menopausal symptoms. Premenopausal breast cancer patients frequently become postmenopausal as a result of the treatment and often experience menopausal symptoms. The increased incidence of breast cancer, combined with longer survival, has led to an increase in the number of women experiencing menopausal symptoms. Therefore, the management of menopausal symptoms in women with a history or current breast cancer is a relevant and common clinical problem. Objectives: To provide a clinically useful overview of the steps in the management of menopausal symptoms in women with (a history of) breast cancer. Materials and Methods: A comprehensive literature review was conducted by authors JS and WT using the PubMed and Medline databases. Abstracts were critically appraised and, where appropriate, the full text was analysed. Main Outcome Measures: Not applicable. Results: Depending on the condition, either meta-analyses, randomised controlled trials or retrospective cohorts were identified. No evidence was found for some proposed treatments. Conclusions: Menopausal symptoms in women with (a history of) breast cancer require a patient-tailored approach. Shared decision making is paramount and adequate up-to-date knowledge can help the breast cancer specialist to advise and guide patients accordingly. What is new?: A comprehensive, clinically-based overview of evidence-based treatment options for menopausal symptoms in women with (a history of) breast cancer.

Do victims of an out-of-hospital cardiac arrest benefit from a training program for emergency medical dispatchers?

In this paper, we assessed the effects of a training course for emergency medical dispatchers on the handling of out-of-hospital cardiac arrest cases in the dispatch center of a two-tiered emergency medical services system. A total of 112 cardiac arrest cases were studied; 64 before and 48 after the training course. Before the course, all relevant information was obtained in 36% of cases, only partial information in 56% and no useful medical information in 8%. The corresponding figures after the training program were 62, 38 and 0%, respectively (2 x 3 chi2 test, P = 0.01). Trends towards an increase in the percentage of cases in which a second-tier team was sent immediately after the initial call (58 vs 75%; chi2 test, P = 0.06) and towards shorter overall intervals between receipt of the call and dispatch of the second-tier team (logrank test, P = 0.10) were noticed. Similarly, the survival rate increased from 2% before, to 8% after the training course (chi2 test with Yates' correction, P = 0.24). We conclude that our training program for emergency medical dispatchers produced some beneficial effects.

How to evaluate an emergency medical dispatch system: a Belgian perspective.

In order to evaluate the local emergency medical dispatch centre, 4601 calls were analysed. Information was obtained from the tape recordings of the dispatch centre and standardized reports from the basic life support (BLS) teams, advanced life support (ALS) teams and the emergency departments of all receiving hospitals in the study area. The need for prehospital ALS care was assessed 'post hoc', based on the clinical findings at the scene and in the emergency department. The accuracy of the medical dispatch was evaluated by comparing the level of care actually sent with the real medical needs of the patient. The 4601 medical problems reported led to 4446 interventions: a BLS team only in 82% (n = 3627), an ALS team and BLS team simultaneously in 14% (n = 623), and a BLS team followed somewhat later by an ALS team in 4% (n = 196). In the 633 cases judged 'post hoc' to require prehospital ALS care, an ALS team was not sent in 260 (41%) or sent with some delay in 112 (18%). Of the 819 interventions of the ALS teams, 446 (54%) dealt with cases not requiring that level of care. With regard to the role of the dispatchers in the mismatches between the medical needs of the patients and the level of care sent, underestimation and overestimation of the severity of the emergency by the dispatchers was found in 31% and 22% cases respectively.

The 'early access' link in the chain of survival for cardiac arrest victims in Ghent, Belgium.

Without early access to the emergency medical services (EMS) system, the chances of surviving an out-of-hospital cardiopulmonary arrest (CPA) are poor. The aim of this study was to evaluate this first link in the chain of survival in Ghent. Therefore, we reviewed the data from the registry on all CPA cases treated by our mobile intensive care unit (MICU) and the tape recordings from the local EMS dispatch centre of 100 consecutive non-traumatic CPA cases that occurred after January 1, 1993. Alarm signs before the collapse were recorded in 39 cases. In only 54% (21 out of 39) a pre-arrest call to the EMS system was made. In only four cases (10%) was the MICU at the patient's side when the collapse occurred. The delay between collapse and call in the 79 cases in which no call to the EMS system was made before the collapse was estimated to be 3 min or less for only 49% (39 out of 79). To evaluate the processing of the call in the EMS dispatch centre, we examined all 100 cases with regard to whether or not the first tier (emergency medical technicians) and the second tier (MICU) were dispatched simultaneously upon the first call. We found that in 41 cases the MICU was not sent immediately. The most important reasons were minimal information available for the EMS system (n = 8), underestimation of the emergency of the call by the dispatcher (n = 10) and underestimation of the pre-alarm signs by a general practitioner (n = 7). This analysis shows that all aspects of the first link of the chain of survival need improvement.