In 2002 the Breast Health Global Initiative (BHGI) convened a panel of breast cancer experts and patient advocates to develop consensus recommendations for diagnosing breast cancer in countries with limited resources. The panel agreed on the need for a pathologic diagnosis, based on microscopic evaluation of tissue specimens, before initiating breast cancer treatment. The panel discussed options for pathologic diagnosis (fine-needle aspiration biopsy, core needle biopsy, and surgical biopsy) and concluded that the choice among these methods should be based on available tools and expertise. Correlation of pathology, clinical, and imaging findings was emphasized. A 2005 BHGI panel reaffirmed these recommendations and additionally stratified diagnostic and pathology methods into four levels--basic, limited, enhanced, and maximal--from lowest to highest resources. The minimal requirements (basic level) include a history, clinical breast examination, tissue diagnosis, and medical record keeping. Fine-needle aspiration biopsy was recognized as the least expensive reliable method of tissue sampling, and the need for comparing its clinical usefulness with that of core needle biopsy in the limited-resource setting was emphasized. Increasing resources (limited level) may enable diagnostic breast imaging (ultrasound +/- mammography), use of tests to evaluate for metastases, limited image-guided sampling, and hormone receptor testing. With more resources (enhanced level), diagnostic mammography, bone scanning, and an onsite cytologist may be possible. Mass screening mammography is introduced at the maximal-resource level. At all levels, increasing breast cancer awareness, diagnosing breast cancer at an early stage, training individuals to perform and interpret breast biopsies, and collecting statistics about breast cancer, resources, and competing priorities may improve breast cancer outcomes in countries with limited resources. Expertise in pathology was reaffirmed to be a key requirement for ensuring reliable diagnostic findings. Several approaches were again proposed for improving breast pathology, including training pathologists, establishing pathology services in centralized facilities, and organizing international pathology services.

The last decade has been marked by rapid growth in the breast cancer advocacy movement around the world. Today such movements are well established in North America and western Europe, and are emerging and gaining momentum in regions of the world with limited resources--Africa, Asia, eastern Europe, and Latin America. Internationally breast cancer advocates have faced the challenges of dealing with many languages, cultures, countries, and health systems. Because of these differences, existing models of breast cancer advocacy are not always appropriate or reproducible across countries. At the second biennial Global Summit Consensus Conference on International Breast Health Care, 12 breast cancer survivor-advocates and advocates from around the world gave statements describing the experiences of women with breast cancer and with advocacy in their countries, and attended a roundtable meeting to discuss breast cancer advocacy from a global perspective. We used the "long table" method to analyze their comments and identify common experiences. Although participants came from diverse settings, the analysis revealed five common experiences that were consistent across cultures: 1) the experiences and fears of breast cancer survivors, 2) beliefs and taboos about breast cancer that hinder awareness programs and treatment, 3) the need for public education and breast cancer awareness programs in countries with limited resources, 4) difficulty in translating the concept and ethos of advocacy into many languages, and 5) the experiences in establishing and maintaining advocacy groups to promote breast cancer awareness and to inform public policy. These themes constitute an action agenda for breast cancer advocacy groups in countries with limited resources. In addition, they provide invaluable insight for policymakers, program planners, and others undertaking efforts to improve breast cancer outcomes in low-resource settings.

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Purpose To explore the patient and process factors associated with all‐cause 30‐day readmission after heart failure (HF) hospitalization and develop recommendations to reduce readmissions of patients with HF. Data sources A retrospective, cohort study of 239 patients ages 18 years and older was performed using electronic medical chart review. All patients were discharged from the medical center between July 1, 2009 and June 30, 2010 with a principal diagnosis of HF. Patient and process factors were compared in readmitted and nonreadmitted groups. Conclusions Renal failure/insufficiency was the only factor significantly associated with all‐cause 30‐day readmission among patients with HF. Implications for practice Assessment of renal function during hospitalization will help identify patients with HF at high risk for all‐cause 30‐day readmission. Give careful consideration to the timing of discharge of patients who appear otherwise ready for discharge but still have creatinine levels above their baseline. Careful follow‐up is needed for patients with impaired renal function.