Canadian integrative oncology research priorities: results of a consensus-building process.

BACKGROUND: In Canada, many diverse models of integrative oncology care have emerged in response to the growing number of cancer patients who combine complementary therapies with their conventional medical treatments. The increasing interest in integrative oncology emphasizes the need to engage stakeholders and to work toward consensus on research priorities and a collaborative research agenda. The Integrative Canadian Oncology Research Initiative initiated a consensus-building process to meet that need and to develop an action plan that will implement a Canadian research agenda. METHODS: A two-day consensus workshop was held after completion of a Delphi survey and stakeholder interviews. RESULTS: FIVE INTERRELATED PRIORITY RESEARCH AREAS WERE IDENTIFIED AS THE FOUNDATION FOR A CANADIAN RESEARCH AGENDA: EffectivenessSafetyResource and health services utilizationKnowledge translationDeveloping integrative oncology models Research is needed within each priority area from a range of different perspectives (for example, patient, practitioner, health system) and in a way that reflects a continuum of integration from the addition of a single complementary intervention within conventional cancer care to systemic change. Strategies to implement a Canadian integrative oncology research agenda were identified, and working groups are actively developing projects in line with those strategic areas. Of note is the intention to develop a national network for integrative oncology research and knowledge translation. CONCLUSIONS: The identified research priorities reflect the needs and perspectives of a spectrum of integrative oncology stakeholders. Ongoing stakeholder consultation, including engagement from new stakeholders, is needed to ensure appropriate uptake and implementation of a Canadian research agenda.

A systematic review of integrative oncology programs.

OBJECTIVE: This systematic review set out to summarize the research literature describing integrative oncology programs. METHODS: Searches were conducted of 9 electronic databases, relevant journals (hand searched), and conference abstracts, and experts were contacted. Two investigators independently screened titles and abstracts for reports describing examples of programs that combine complementary and conventional cancer care. English-, French-, and German-language articles were included, with no date restriction. From the articles located, descriptive data were extracted according to 6 concepts: description of article, description of clinic, components of care, administrative structure, process of care, and measurable outcomes used. RESULTS: Of the 29 programs included, most were situated in the United States (n = 12, 41%) and England (n = 10, 34%). More than half (n = 16, 55%) operate within a hospital, and 7 (24%) are community-based. Clients come through patient self-referral (n = 15, 52%) and by referral from conventional health care providers (n = 9, 31%) and from cancer agencies (n = 7, 24%). In 12 programs (41%), conventional care is provided onsite; 7 programs (24%) collaborate with conventional centres to provide integrative care. Programs are supported financially through donations (n = 10, 34%), cancer agencies or hospitals (n = 7, 24%), private foundations (n = 6, 21%), and public funds (n = 3, 10%). Nearly two thirds of the programs maintain a research (n = 18, 62%) or evaluation (n = 15, 52%) program. CONCLUSIONS: The research literature documents a growing number of integrative oncology programs. These programs share a common vision to provide whole-person, patient-centred care, but each program is unique in terms of its structure and operational model.

Principles to guide integrative oncology and the development of an evidence base.

BACKGROUND: Integrative oncology uses both conventional and complementary medicine to meet the needs of individual patients and to focus on the whole person. The core principles of integrative oncology include individualization, holism, dynamism, synergism, and collaboration, but the nature of the evidence to guide the development of integrative oncology has been given little attention. OBJECTIVES: To discuss the need for evidence to support the integration of complementary therapies for integrative oncology care. To emphasize that the evidence base must be valid and respect the underlying principles of individual complementary therapies and integrative oncology practice. To suggest ways to begin developing the evidence base. REVIEW AND DISCUSSION: Although the evidence for safety and efficacy seems paramount for supporting the integration of an individual complementary therapy into mainstream cancer care, the need for evidence to support the overall practice of integrative oncology has to be considered as well. We argue that developing an evidence base for integrative oncology requires a contextual and comprehensive research approach that assesses a range of outcomes over a suitable period of time that the patient and the patient's family, in addition to the health care providers, deem important. CONCLUSION: A whole-systems framework to the development of the evidence base for integrative oncology can guide the development of evidence that respects the complex nature of many complementary and integrative practices and their underlying principles of care delivery.

Hospital nursing education. Dispelling the doomsday prophesies.

Productivity is uppermost in the minds of most nurse executives. To protect patient caregivers, nurse educator and clinical specialist positions are being cut. Thus, for hospital nursing educational departments to survive, it is essential that the educational process be defined and include the expectations of the organization and employee as well as the means by which these outcomes can be measured. This article briefly analyzes the factors that have helped to create the current crisis, and then reviews the methods by which nurse administrators can provide some solutions without decimating their educational support services.

Effect of altrenogest on pregnancy maintenance in unsynchronized equine embryo recipients.

Non-surgical embryo recovery attempts were done on Day 7 after ovulation. Embryo recovery rate from mares of varied reproductive histories was 57% (38/67). Non-surgical transfer of these embryos into altrenogest-treated recipient mares that ovulated between 3 days before and 3 days after the donor resulted in a 30-day pregnancy rate of 77% (10/13). Transfer of embryos into altrenogest-treated recipients that ovulated between 4 days before and 6 days after the donor resulted in an overall pregnancy rate of 64% (16/25) at Day 30 of gestation. No recipients that were in oestrus at the start of treatment, nor recipients that ovulated 5 or more days before the donor, maintained pregnancy. Mean plasma progesterone concentrations of pregnant, altrenogest-treated, embryo-recipient mares; pregnant, altrenogest-treated, untransferred mares; and pregnant, untreated, untransferred mares were comparable (P greater than 0.05). Treatment of embryo-recipient mares with altrenogest appears to be beneficial in extending the degree of donor-recipient synchrony required for successful embryo transfer. Altrenogest treatment also seems to be conductive to pregnancy maintenance in recipients experiencing luteal dysfunction.

The documentation dilemma. A practical solution.

Few nursing divisions can withstand the continuation of practices known to be ineffective and costly, and of questioned benefit. Our hospital's critical survey of policies and procedures regarding nursing documentation has resulted in significant cost savings and improvement in satisfaction and quality.

Primary nursing. Teamwork is the answer.

Eight years of experience with primary nursing in a 750-bed acute care teaching hospital revealed several persistent problems: isolationism among nurses, communication problems between nurses and physicians, inadequate documentation, and insufficient time for patient and staff education, resulting in frustration for the nursing staff. By combining the basic elements of primary and team nursing, a 3-month pilot in one unit resulted in improved job satisfaction for professional staff, improved quality assurance scores, and increased physician-nurse communication.

PACE: a unique career development program.

Career development programs are increasingly recognized as the answer to retaining nurses in nursing, and more important, at the bedside. In the face of economic constraints facing health care, it is imperative that such programs benefit both the nurse and the hospital so that the ultimate goal of improved patient care delivery can be met in a cost-effective and creative way. PACE, Practice Alternatives for Career Expansion, a successful career development program designed to achieve these results, is described in this article. It has some unique features which benefit both the nurse and the hospital.