Palliative care (pc) is a fundamental component of the cancer care trajectory. Its primary focus is on “the quality of life of people who have a life-threatening illness, and includes pain and symptom management, skilled psychosocial, emotional and spiritual support” to patients and loved ones. Palliative care includes, but is not limited to, end-of-life care. The benefits of early introduction of pc services in the care trajectory of patients with advanced cancer are well known, as indicated by improved quality of life, satisfaction with care, and a potential for increased survival. In turn, early referral of patients with advanced cancer to pc services is strongly recommended. So when, how, and why should patients with advanced cancer be referred to pc services? In this article, we summarize evidence to address these questions about early pc referral:■ What are the known benefits?■ What is the “ideal” pc referral timing?■ What are the barriers?■ Which strategies can optimize integration of pc into oncology care?■ Which communication tools can facilitate skillful introduction of pc to patients?

20 Background: Nearly 50% of cancer survivors (CS) experience psychosocial and physical treatment-related effects. CS are often afflicted with greater medical conditions than non-cancer patients: survivorship care is thus imperative. In addition to follow-up by specialists, 75% of CS also visit their primary care provider (PCP) during and after treatments. Despite their role in survivorship, insufficient knowledge and low confidence have been reported by PCPs, supporting the need to educate them. This study aimed to evaluate the educational benefit of a survivorship workshop (SW) targeting PCPs in Montreal, Canada. Methods: An accredited 60-minute SW based on common survivorship issues and recommended guidelines by recognized entities was developed and delivered to 167 PCPs at 6 sites. The same MD presented each SW. Brief matched pre, post and 3 month delayed post surveys were designed (Likert-scale and short-answer questions), and completed on a voluntary basis. Outcome measures targeted 3 levels of Kirkpatrick’s learning model: satisfaction, knowledge, and behavior. Data were analyzed with parametric (paired t-tests) and non-parametric (Wilcoxon Signed rank tests) comparisons as appropriate. Results: The pre and post survey response rate was 65.3% and the 3-month delayed post survey response rate was 56.9%. Immediately following the SW, participants were significantly more likely to be able to list standards of survivorship, t(108) = 10.50, p < .001, and to name late-effects of cancer treatment, t(108) = 5.52 , p < .001. High relevance and satisfaction of SW was reported (95%), and 99% expressed intent to incorporate survivorship information into practice. At 3 months post-SW, confidence remained significantly higher than pre-intervention levels for both knowledge of “late physical effects” ( Z = 6.08, p < .001, n = 60) and “adverse psychosocial outcomes” of cancer and treatments (Z = 4.26, p < .001, n = 62). Conclusions: Much literature has focused on determining PCP barriers to survivorship care, including limited topic proficiency, yet further initiatives are warranted to optimize PCP survivorship expertise. Our SW increased PCP survivorship knowledge, and confidence levels remained greater at 3 months post, indicating its educational merit.

A higher birthweight represented an independent risk factor for developing SCFN in asphyxiated newborns treated with hypothermia. When macrosomia is present, other risk factors related to haemodynamic instability during the initial hospitalisation may also increase the risk of developing SCFN.

A 35-year-old man presented with severe hypo-osmolar hyponatremia (serum sodium 99 mmol/L), profound nonoliguric renal failure (serum creatinine 1240 μmol/L), and nephrotic range proteinuria. Computed tomography of the abdomen revealed nephromegaly and no obstruction. The patient was admitted to the intensive care unit (ICU) and conventional hemodialysis was initiated. To avoid rapid sodium correction, we prescribed concurrent dialysate flow, a low dialysate sodium concentration, a small surface area dialyzer, and a low blood flow rate. We infused dextrose 5% water into the venous return line and adjusted the infusion rate according to hourly sodium concentration. The rate of sodium correction was 7.7 mmol/day over the first 3 days of admission. A subsequent renal biopsy revealed focal segmental glomerulosclerosis and interstitial infiltration with extranodal NK/T-cell lymphoma nasal type. The patient died of massive lower gastrointestinal bleeding secondary to lymphomatous involvement day 19 in the ICU. In the setting of acute kidney injury requiring renal replacement therapy and concomitant severe hyponatremia, it is challenging to avoid overcorrection of serum sodium. We describe several key prescription modifications to conventional hemodialysis, factors that affect sodium diffusion at the level of the dialyzer membrane, and the importance of frequent laboratory monitoring.

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Background:In the last half century, literature has been increasingly recognized as beneficial to medical trainees in terms of teaching empathy, cultural competence, listening and interpretation skills, and reflecting on moral issues (Jones, A. H., 2013). Following the success of a McGill medical students reading club, a reading module was tentatively added to the McGill Physician Apprenticeship (PA) Course curriculum in 2016. This was based on the idea that literature could be used a springboard towards discussion and reflection upon issues related to health, illness and medical care. Methodology:PA groups are composed of six medical students, two senior students and a physician mentor, whose regular meetings throughout medical school are structured around suggested modules. As part of the reading module, all PA groups were encouraged to choose a novel, essay, short story or poem by the end of their academic first year. A discussion on the reading was to be held in early second year, with specific questions to be addressed in order to reflect on course objectives (e.g., patient-centered clinical approach, reflective practice, healer role). The students anonymously completed pre and post-module questionnaires to assess the module's learning and reflective value. Students’ opinions on the pertinence of renewing this pilot project in the future were also accumulated. Results:The first student cohort has completed the pre-questionnaires in spring 2017 and will be completing the post-module questionnaires in fall 2017.Therefore, at the moment of the abstract submission, we do not have preliminary results.  

As Dr. Rita Charon, pioneer of the field of narrative medicine, said “Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people” but also “enable physicians to recognize the power and implications of what they do” (Charon et al, 1995).Through various narrative medicine exercises, we have explored the benefits of narrative medicine for health care professionals. More specifically, we have created a reading club for medical students and developed a reading module as part of the Physician Apprenticeship Course for medical students at McGill University. Moreover, we led short writing workshops based on prompts from short stories and poems for health care professionals at Anna-Laberge Hospital.During our workshop, we will briefly review our narrative medicine initiatives and then dive into a narrative medicine exercise with the group to demonstrate its potential benefits among health care professionals. We hope that by providing concrete examples of narrative medicine projects we have developed and implemented, we will facilitate the integration of narrative medicine into participants’ own practices. 

22 Background: In North America, increasing evidence supports including patients’ in managing their own health as a strategy to improve health-related outcomes. Moreover, publications have emphasized the merit of supportive interventions during the survivorship phase, given their association with improvements in overall quality of life. Breast cancer survivors (BCS) are integral stakeholders of their own health, and ensuring their educational needs are met may positively influence them to become actively involved in their survivorship care. This study’s aimed to evaluate BCS activation levels in their care following an end of treatment educational group intervention (EOT) on what to expect after treatment, including self-management tips. Increased activation levels are consistently associated with improved self-management behaviors and utilization of services. Methods: The Patient Activation Measure (PAM), which evaluates one’s knowledge, skills, beliefs, and confidence for managing health and health care, was voluntarily self-administered to BCS shortly before and immediately following the EOT, and interviewer administered by telephone at 1 and 6 months post EOT, respectively. Data were analyzed with parametric (paired t-tests) and non-parametric (Wilcoxon Signed rank tests) comparisons as appropriate to assess EOT impact on BCS’ activation levels. Floor and ceiling effects were considered present if more than 40% of BCS achieved the highest score possible. Results: The pre and post survey response rate was 92.8%, the 1 month and 6 months delayed post survey response rate were 72.4% and 46.4%, respectively (n = 69). Post EOT, BCS significantly increased their activation levels: t(64) = 4.291, p ≤ 0.001, t(50) = 5.982, p ≤ 0.001 to t(32) = 4.664, p ≤ 0.001 for the post, 1 month and 6-month post surveys, respectively. The effect size of the BCS’ increased activation level in their own health increased incrementally with time from small (d = 0.40), medium (d = 0.65) to large (d = 0.84), for the post, 1 month and 6 month surveys, respectively. Conclusions: Our results indicate a large effect size in BCS activation levels at 6 month post EOT, suggesting a significant increase in BCS’s engagement to take part in their survivorship care and overall health.