No abstract

Adjuvant chemotherapy causes cognitive dysfunction, fatigue, and menopausal symptoms in women with breast cancer. Priority should be given to the study of strategies that might reduce these toxic effects.

Fatigue, menopausal symptoms, and cognitive dysfunction are important adverse effects of chemotherapy that improve in most patients. Hormonal treatment has minimal impact on them.

Foreword I n July 2019, a panel of wound care experts, educators and researchers met in the UK to review the literature on medical adhesive-related skin injury and discuss best practice for its assessment and prevention. e two-day meeting resulted in this consensus document, which is intended for anyone who uses adhesive medical devices. e document aims to raise awareness of the widespread occurrence of medical adhesive-related skin injury and the burden it imposes on patients, health professionals and the health service. It seeks to encourage a change in culture, whereby risk assessment and prevention of medical adhesive-related skin injury are considered an integral part of patient care. e document, therefore, provides recommendations for the assessment and prevention of this type of injury, with a view to standardising care across all healthcare settings. It also highlights the need for education on this form of skin damage, which needs to become a core topic in skin care and wound management. Until this happens, there is scope for multidisciplinary teams to provide local training on this subject. In the light of the panel's concern that many health professionals are not only unaware of this avoidable harm but also its abbreviation, MARSI, the term is written in full throughout the document. e panel hopes that implementation of the guidance in this document will reduce avoidable patient su ering and promote better outcomes. Sian Fumarola, Senior Clinical Nurse Specialist, Tissue Viability and Continence, University Hospitals of North Midlands NHS Trust, UK Overview of medical adhesive-related skin injury  'Medical adhesive-related skin injury' is a term used to defi ne any skin damage related to the use of medical adhesive products or devices such as tapes, wound dressings, stoma products, electrodes, medication patches and wound closure strips. This type of injury is largely avoidable

Women receiving adjuvant chemotherapy for breast cancer have substantial problems with fatigue, menopausal symptoms and cognitive changes. Formal tests such as the HSCS may fail to adequately capture the perceived impact of symptoms.

The Cognitive Scale for Functional Bowel Disorders is a valid and reliable scale that can be used as an outcome measure in evaluating the efficacy of different forms of psychotherapeutic intervention for FBD, and can also serve as a helpful assessment tool for health professionals working with patients diagnosed with FBD.

BackgroundPhysiotherapists are currently working in primary care as first contact practitioners (FCP), assessing and managing patients with musculoskeletal conditions instead of GPs. There are no published data on these types of services.AimTo evaluate a new service presenting the first 2 years of data.Design and settingAnalysis of 2 years’ data of patient outcomes and a patient experience questionnaire from two GP practices in Forth Valley NHS, UK. The service was launched in November 2015 in response to GP shortages.MethodData were collected from every patient contact in the first 2 years. This included outcomes of appointments, GP support, capacity of the service, referral rates to physiotherapy and orthopaedics, numbers of steroid injections, and outcomes from orthopaedic referrals. A patient experience questionnaire was also conducted.ResultsA total of 8417 patient contacts were made, with the majority managed within primary care (n = 7348; 87.3%) and 60.4% (n = 5083) requiring self-management alone. Referrals to orthopaedics were substantially reduced in both practices. Practice A from 1.1 to 0.7 per 1000 patients; practice B from 2.4 to 0.8 per 1000 patients. Of referrals to orthopaedics, 86% were considered ‘appropriate’. Extended scope physiotherapists (ESPs) asked for a GP review in 1% of patients.ConclusionThe results suggest that patients with musculoskeletal conditions may be assessed and managed independently and effectively by physiotherapists instead of GPs. This has the potential to significantly reduce workload for GPs as the service requires minimal GP support. The majority of patients were managed within primary care, with low referral rates and highly appropriate referrals to orthopaedics. Patients reported positive views regarding the service.

Community photo-triage improved referral management of patients with suspected skin cancer, improving the delivery of definitive care at first visit and achieved an increased service capacity. Cost comparison found that the photo-triage model described was marginally cheaper than conventional care, and reduced hospital visits. An integrated primary-secondary care referral pathway that includes photo-triage facilitates a more efficient specialist service while ensuring that all suspicious lesions are viewed by an experienced dermatologist.