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Background: The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews. Methods: We first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method. Results: Thirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals. Conclusions: Residents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention. Trial registration: #NCT03052959, 10/02/2017. [ABSTRACT FROM AUTHOR]

Background: Studies have shown an association between socioeconomic status and breast cancer treatment. We examined the relation between socioeconomic status and the treatment of breast cancer (surgical, systemic and radiation) in a universal health care system. Method: Data from a single urban Canadian centre were collected for consecutive patients who received a diagnosis of breast cancer from January 2010 to December 2011. Variables included patient and disease factors, surgery type, systemic and radiation treatment, and breast reconstruction. Socioeconomic variables were obtained from 2006 Canadian census data. We used multivariable logistic regression to identify predictors of breast cancer treatment. Results: A total of 721 patients were treated for breast cancer during the study period. Socioeconomic variables were not related to type of breast surgery for breast cancer. Age less than 50 years, having a first-degree relative with breast cancer and income status were predictors of breast reconstruction. Employment status was a consistent predictor of systemic and radiation treatment. Conclusion: Employment consistently predicted systemic and radiation treatment, and age and income were predictors of breast reconstruction in a universal health care system. Further research is required to determine precisely how socioeconomic factors affect care and to minimize possible disparities in delivery of health care services. Contexte: Des etudes ont montre un lien entre la situation socio-economique et le traitement du cancer du sein. Nous avons analyse ce lien entre la situation socio-economique et le traitement (chirurgie, chimiotherapie, radiotherapie) du cancer du sein dans un systeme de sante universel. Methodes: Les donnees d'un seul centre urbain canadien ont ete compilees pour les patientes consecutives ayant recu un diagnostic de cancer du sein entre janvier 2010 et decembre 2011. Les variables incluaient des facteurs propres aux patientes et a la maladie, le type de chirurgie, la chimiotherapie, la radiotherapie et la reconstruction mammaire. Les variables socio-economiques proviennent des donnees du recensement canadien de 2006. Nous avons utilise la regression logistique multivariee pour identifier les predicteurs du traitement du cancer du sein. Resultats: En tout, 721 patientes ont ete traitees pour un cancer du sein durant la periode de l'etude. Les variables socio-economiques n'ont pas influe sur le type de chirurgie mammaire pour cancer du sein. L'age inferieur a 50 ans, un cancer du sein chez une parente au premier degre et le revenu ont ete des predicteurs de la reconstruction mammaire. La situation professionnelle a ete un predicteur fiable du traitement systemique et de la radiotherapie. Conclusion: L'emploi a ete un predicteur fiable du traitement systemique et de la radiotherapie, et l'age et le revenu ont ete des predicteurs de la reconstruction mammaire, dans un systeme de sante universel. Il faudra approfondir la recherche pour determiner plus precisement l'influence des facteurs socio-economiques sur les soins et pour reduire les possibles disparites dans leur prestation., Breast cancer is the most commonly diagnosed cancer and the second-leading cause of cancer mortality in North American women. (1) Breast cancer is treated with a multidisciplinary approach involving surgery, [...]

CLINICAL SCENARIO You are a young general surgeon in a community practice. A new consultation is scheduled in your clinic: a 60-year-old woman presenting with chronic venous ulcers on both [...]

The use of surveys is expanding in all domains of society. Frequently surgeons are presented with hard-copy or email surveys asking for information about their knowledge, beliefs, attitudes and practice [...]

Background: For patients with breast cancer, a negative surgical margin at first breast-conserving surgery (BCS) minimizes the need for reoperation and likely reduces postoperative anxiety. We assessed technical factors, surgeon and hospital case volume and margin status after BCS in early-stage breast cancer. Methods: We performed a retrospective cohort study using a regional cancer centre database of patients who underwent BCS for breast cancer from 2000 to 2002. We considered the influence of patient, tumour and technical factors (e.g., size of specimen and preoperative diagnosis of cancer available) and surgeon and hospital case volume on margin status at first and final operation. We performed univariate and multivariate regression analyses. Results: We reviewed 489 cases. There were no differences in patient or tumour characteristics among the low-, medium- and high-volume surgeon groups. Highvolume surgeons were significantly more likely than other surgeons to operate with a confirmed preoperative diagnosis and to resect a larger volume of tissue. In our univariate analysis and at first operation, the rates of positive margins were 16.4%, 32.9% and 29.1% for high-, medium- and low-volume surgeons, respectively (p = 0.002). In the multivariate analysis, tumour factors (palpability, size, histology), presence of a confirmed preoperative diagnosis and size of resection specimen significantly predicted negative margins. However, when we controlled for these and other factors, high surgeon volume was not a predictor of negative margins at first surgery (odds ratio 1.8, 95% confidence interval 0.9-3.8, p = 0.09). Increased hospital volume was not associated with a lower rate of positive margins at first surgery. Conclusion: Various tumour and technical factors were associated with negative margins at first BCS, whereas surgeon and hospital volume status were not. Technical steps that are under the control of the operating surgeon are likely effective targets for quality initiatives in breast cancer surgery. Contexte : Chez les personnes atteintes de cancer du sein, une marge chirurgicale negative au cours de la premiere chirurgie mammaire conservatrice (CMC) reduit au minimum la necessite de reoperer et attenue probablement l'anxiete postoperatoire. Nous avons evalue des facteurs techniques, le chirurgien et le volume de cas de l'hopital, ainsi que l'etat de la marge apres la CMC dans le cas du cancer du sein au stade precoce. Methodes : Nous avons effectue une etude de cohorte retrospective en utilisant la base de donnees d'un centre regional de cancerologie portant sur des patientes qui ont subi une CMC pour traiter un cancer du sein entre 2000 et 2002. Nous avons tenu compte de l'influence des facteurs lies a la patiente et a la tumeur, des facteurs techniques (p. ex., grosseur du specimen et diagnostic preoperatoire de cancer disponibles), du chirurgien et du volume de cas de l'hopital sur l'etat des marges au cours de la premiere intervention et de l'intervention finale. Nous avons procede a des analyses de regression unidimensionnelle et multidimensionnelle. Resultats : Nous avons analyse 489 cas. Il n'y avait pas de differences au niveau des caracteristiques des patientes et des tumeurs et entre les groupes de chirurgiens traitant un volume faible, moyen et eleve de patientes. Les chirurgiens qui traitaient des volumes eleves de patientes etaient beaucoup plus susceptibles que les autres d'operer en se basant sur un diagnostic preoperatoire confirme et de resequer un volume plus important de tissu. Dans notre analyse unidimensionnelle et a la premiere intervention, les frequences des marges positives se sont etablies a 16,4 %, 32,9 % et 29,1 % chez les chirurgiens qui traitaient des volumes eleves, moyens et faibles respectivement (p = 0,002). Au cours de l'analyse multidimensionnelle, les facteurs tumoraux (palpabilite, taille, histologie), l'existence d'un diagnostic preoperatoire confirme et la grosseur du specimen reseque constituaient des predicteurs importants de marge negative. Cependant, lorsque nous avons tenu compte de ces facteurs et de certains autres, le volume eleve chez les chirurgiens ne constituait pas un predicteur de marge negative au cours de la premiere intervention chirurgicale (rapport de cotes, 1,8; intervalle de confiance a 95 %, 0,9-3,8;p = 0,09). Il n'y avait pas de lien entre le volume plus important de l'hopital et un taux plus faible de marges positives a la premiere intervention chirurgicale. Conclusion : Divers facteurs tumoraux et facteurs techniques ont ete associes a des marges negatives a la premiere CMC, mais non au volume de patientes traitees par le chirurgien et l'hopital. Les etapes techniques controlees par le chirurgien executant constituent probablement des cibles efficaces pour des initiatives portant sur la qualite des interventions chirurgicales contre le cancer du sein., Most early-stage breast cancers are managed with breast-conserving surgery (BCS) followed by radiation therapy. The goal of BCS is to completely remove the identified cancer while preserving adequate breast tissue [...]

Classically, prognosis is defined as a forecast or prediction. Medically, prognosis may be defined as the prospect of recovering from injury or disease, or a prediction or forecast of the [...]

In addition to relieving clinical symptoms and prolonging survival, the primary objective of any health care intervention is to enhance quality of life (QOL) and well-being. (1) The broader term [...]