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BackgroundColorectal cancer is a significant issue internationally, with over 1.3 million people diagnosed annually. Survival rates are increasing as treatments improve, although physical symptoms can persist despite eradication of the tumour. In order to optimize survivorship care, further research is warranted in relation to symptom burden. Therefore, the objectives of this study are to (i) investigate frequency of physical symptoms in colorectal cancer survivors (ii) identify which symptoms occur together (iii) examine the associations between demographic and clinical variables, and symptoms.MethodsParticipants nine months to three years post diagnosis were identified from the population-based National Cancer Registry Ireland. Respondents completed the EORTC QLQ-C30 and EORTC QLQ-CR29. Reported physical symptom frequencies were transformed into continuous scale variables, which were then analysed using one way analysis of variance, general linear modelling and Spearman rank correlations.ResultsThere were 496 participants. Fatigue, insomnia and flatulence were the most frequent symptoms, with ≥20% of respondents reporting these to be often present in the previous week. Eight other symptoms were experienced often by 10–20% of respondents. At least one of these eleven most common symptoms was experienced frequently by almost every respondent (99%). 66% of respondents experienced at least two of these symptoms together, and 16% experienced five or more together. Current stoma was the single most common variable associated with increased symptom scores, although statistically significant relationships (p ≤ 0.05) between symptom frequency scores and clinical/demographic variables were generally weak (R-sq value ≤0.08).ConclusionFindings may inform targeted interventions during the nine month to three year post diagnosis timeframe, which would enable supported self-management of symptoms.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4923-3) contains supplementary material, which is available to authorized users.

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SETTING: Alberta is a prairie province located in western Canada, with a population of approximately 4.3 million. In 2016, 363 Albertans died from apparent drug overdoses related to fentanyl, an opioid 50-100 times more toxic than morphine. This surpassed the number of deaths from motor vehicle collisions and homicides combined.INTERVENTION: Naloxone is a safe, effective, opioid antagonist that may quickly reverse an opioid overdose. In July 2015, a committee of communitybased harm reduction programs in Alberta implemented a geographically restricted take-home naloxone (THN) program. The successes and limitations of this program demonstrated the need for an expanded, multi-sectoral, multi-jurisdictional response. The provincial health authority, Alberta Health Services (AHS), used previously established incident command system processes to coordinate implementation of a provincial THN program.OUTCOMES: Alberta's provincial THN program was implemented on December 23, 2015. This collaborative program resulted in a coordinated response across jurisdictional levels with wide geographical reach. Between December 2015 and December 2016, 953 locations, including many community pharmacies, registered to dispense THN kits, 9572 kits were distributed, and 472 reversals were reported. The provincial supply of THN kits more than tripled from 3000 to 10 000. IMPLICATIONS:Alberta was uniquely poised to deliver a large, province-wide, multi-sectoral and multi-jurisdictional THN program as part of a comprehensive response to increasing opioid-related morbidity and mortality. The speed at which AHS was able to roll out the program was made possible by work done previously and the willingness of multiple jurisdictions to work together to build on and expand the program.KEY WORDS: Fentanyl; take-home naloxone; harm reduction; opioid overdose La traduction du résumé se trouve à la fin de l'article.

Aims and objectives To review published literature pertaining to the management of sialorrhoea while also highlighting the significance of the multidisciplinary approach. Background Sialorrhoea is a common and troublesome problem among certain neurological patients. It is distressing for patients and caregivers, and can be challenging for healthcare professionals. Various sialorrhoea management approaches have been documented. However, there is no clear consensus on best management practices. Therefore, it is necessary to systematically review and synthesise various approaches so as to provide an understanding of the efficacy of management approaches. Design Systematic literature review using PRISMA checklist (see Appendix S1). Method Five databases (ScienceDirect, Wiley Online Library, CINAHL, Cochrane Library and PubMed) were searched (years 2001–2018) following inclusion criteria. Out of 1,294 identified records, 29 studies met the inclusion criteria. Results Various management approaches identified, ranging from noninvasive, such as speech therapy aiming to enhance swallowing behaviour, to invasive treatment including anticholinergic medication, botulinum toxin injection and surgical techniques. However, in the majority of cases, there is no scientific evidence‐based management protocol leading to favourable results, and the evidence base for intervention effectiveness remains weak. Conclusions The multifactor nature of sialorrhoea and its associated complications presents challenges for the medical care team. None of the management strategies stand alone as the best modality; therefore, it is proposed that management strategies follow a multidisciplinary approach to meet the diverse needs of patients. Relevance to clinical practice A comprehensive understanding of different sialorrhoea management approaches will enable healthcare professionals to identify the signs and symptoms regarding sialorrhoea, and to assist in effective management implementation. This will help to improve the management of sialorrhoea, hence, to improve quality of life of patients and provide formative scope to the development of an integrated care pathway.

Awareness of the prevalence and severity of the acute side effects of preoperative radiotherapy will enable nurses to thoroughly assess these symptoms, plan and implement appropriate interventions and evaluate outcomes. This will assist in optimising the quality of life of patients with rectal cancer and may hasten postoperative recovery times.

Assessment of patients receiving radiotherapy for cancer is essential, with the ability to identify those who may be more likely to experience radiotherapy-related side effects noted as an important issue for nurses. Body mass, age, and radiation dose may be predictive factors for the development of such side effects. This review considers these factors and how nurses can use this evidence to inform their care, with results indicating that the dose of radiation, the site treated, and body mass index are predictive of toxicities that may develop. Increased awareness of these predictive factors will aid nurses in identifying patients at greater risk of developing radiation-related side effects. This will assist in guiding nursing interventions, as well as enabling the individualization of patient education, by placing greater emphasis on preventive measures for patients who are more vulnerable to the development of radiation-related toxicities.

he Canadian incarceration rate of 116 per 100,000 people reveals a relatively high rate of incarceration compared to Western European countries. 1 Although the absolute number of Canadians with incarceration experience is relatively small, they experience many health inequities and are among the most underserved populations in Canada. 2-5 Furthermore, there is increasing evidence that the determinants of criminality and recidivism are similar to the determinants of health. For example, criminal behaviour patterns are associated with substance dependence which is often an expression of trauma and unmet health and social needs, including inaccessible health care services. 6 Imprisonment itself also negatively impacts health for several reasons, including separation from family, unhygienic facilities, and poor self-care as a reaction to imprisonment. 7 Selfreported health problems are also found to increase with inmates' duration of incarceration. 8 Upon release from prison, individuals face many challenges to reintegration, including social exclusion, which is often underpinned by the stigma of incarceration. 5,9,10 Although health-seeking behaviours of prisoners can improve when appropriate prison health services are provided, barriers persist to accessing health services in the community. 11 As health care provision often focuses finite resources on the most pressing health needs, individuals with incarceration experience in particular have little access to preventive health programs. Indeed, the authors of the current article were unable to locate any Canadian-based preventive health promotion programs targeted to individuals with incarceration experience living in the community. The Collaborating Centre for Prison Health and Education (CCPHE) at the University of British Columbia is committed to using participatory processes of engagement in order to