Critical path analysis in head and neck cancer: a management technique for surgical oncology

Interventions to reduce times to diagnosis and treatment of head and neck cancer: A systematic review and narrative synthesis

BACKGROUND

We systematically reviewed evidence of health system interventions to reduce diagnostic and treatment intervals for people with head and neck cancer (HNC).

METHODS

Electronic databases were searched from inception to 30 April 2020 for controlled or uncontrolled comparative studies. Primary outcome was any time interval between first clinical presentation and treatment onset.

RESULTS

Thirty-seven studies were included. Four types of interventions were identified: single clinic-based (N = 4), multidisciplinary clinic-based (N = 15), hospital or service re-design (N = 12), and health system re-design (N = 6). There was some evidence that multidisciplinary interventions improve timeliness of diagnosis and treatment; however, evidence of long-term effectiveness was lacking. Study quality was assessed as either low or moderate.

CONCLUSIONS

Interventions to reduce times to diagnosis and treatment of HNC are heterogeneous, with limited evidence of effectiveness. Future interventions should account for the complex and dynamic nature of health systems and adhere to best-practice principles for early-diagnosis research.

New estimate of chemical weathering rate in Xijiang River Basin based on multi-model

Hydrochemistry and Sr isotope compositions were measured in water samples collected during high- and low-water periods from the main stream and tributaries of the Xijiang River Basin in southern China. The primary weathering end-members were analyzed and calculated using the multi-model combination and classic hydrogeochemical method. During the high-water period, structural factors were found to be the main factors controlling chemical weathering in the basin, whereas anthropogenic activity and other random factors had a negligible influence. During the low-water period, both structural and random factors controlled chemical weathering. Through path-model and semi-variance analyses, we determined and quantified the relationship between the main weathering sources, whose results were stable; this is consistent with the inversion model. The total dissolved substances were mainly derived from carbonate weathering, which was approximately 76% (0–96%) while silicate weathering accounted for only 14% (5–19%). The inversion model results showed that the optimum silicate weathering rate was 7.264–35.551 × 10³ mol/km²/year, where carbonic acid was the main factor that induces weathering. The CO₂ flux consumed by rock weathering in the basin during the study period was 150.69 × 10⁹ mol/year, while the CO₂ flux consumed by carbonic acid weathering of carbonate (CCW) and silicate rocks (CSW) was 144.47 and 29.45 × 10⁹ mol/year, respectively. The CO₂ flux produced by H₂SO₄ weathered carbonate (SCW) was 23.23 × 10⁹ mol/year.

Teamwork in skull base surgery: An avenue for improvement in patient care

BACKGROUND

During the past several decades, numerous centers have acquired significant expertise in the treatment of skull base pathologies. Favorable outcomes are not only due to meticulous surgical planning and execution, but they are also related to the collaborative efforts of multiple disciplines. We review the impact of teamwork on patient care, elaborate on the key processes for successful teamwork, and discuss its challenges.

METHODS

Pubmed and Medline databases were searched for publications from 1970 to 2012 using the following keywords: "teamwork", "multidisciplinary", "interdisciplinary", "surgery", "skull base", "neurosurgery", "tumor", and "outcome".

RESULTS

Current literature testifies to the complexity of establishing and maintaining teamwork. To date, few reports on the impact of teamwork in the management of skull base pathologies have been published. This lack of literature is somewhat surprising given that most patients with skull base pathology receive care from multiple specialists. Common factors for success include a cohesive and well-integrated team structure with well-defined procedural organization. Although a multidisciplinary work force has clear advantages for improving today's quality of care and propelling research efforts for tomorrow's cure, teamwork is not intuitive and requires training, guidance, and executive support.

CONCLUSIONS

Teamwork is recommended to improve quality over the full cycle of care and consequently patient outcomes. Increased recognition of the value of an integrated team approach for skull base pathologies will hopefully encourage centers, physicians, allied health caregivers, and scientists devoted to treating these patients and advancing the field of knowledge to invest the time, effort, and resources to optimize and organize their collective expertise.

Tumour boards/multidisciplinary head and neck cancer meetings: are they of value to patients, treating staff or a political additional drain on healthcare resources?

PURPOSE OF REVIEW

This article reviews the literature on the management of head and neck cancer using multidisciplinary team meetings as well as addressing the question of whether or not this organization is of benefit to the patients and treating staff and if it is cost efficient.

RECENT FINDINGS

The multidisciplinary team has developed because of the complexity of clinical workup and treatment of head and neck cancer for which no single physician can claim to master all the training and skills necessary to treat the patients. The multidisciplinary team ensures that the professional efforts are coordinated and timely, thus ensuring the best results for patients. The multidisciplinary team usually involves a centralization of care with specialization, which benefits the outcome of treatment as well as enabling the development of clinical pathways to minimize complications, and improving on cost effectiveness.

SUMMARY

The multidisciplinary team has become more and more an integral part of the clinical pathway for a patient with head and neck cancer in many European countries. This is cost effective and benefits patient outcomes.

Effect of process standards on survival of patients with head and neck cancer in the south and west of England

The aim of the study was to compare standards for the process of care and 2-year survival between two cohorts of patients with head and neck cancer in the south and west of England. A total of 566 and 727 patients presented in 1996–97 and 1999–2000, respectively. The median number of cases treated per surgeon was 4 (1997, range 1–26) and 4 (2000, 1–23) and per radiotherapist was 10 (1–51) and 19 (1–70). For all ‘nontemporal’ standards, the overall standard increased, without reaching minimum high targets, while most ‘waiting times’ increased. Overall 2-year survival was 64.1% in 1997 and 65.1% in 2000. There was no difference in survival between networks (range 56–68, 1997, log-rank test 4.1, P=0.4; 62–69, 2000, log-rank test 1.26, P=0.69). Patients assessed by a multidisciplinary clinic exhibited improved survival (1997: P=0.1; 2000: hazard ratio 0.7, P=0.02), as did those with a pretreatment chest X-ray (hazard ratio 0.7, P=0.03). Despite an increased incidence, standards for the process of care for patients with head and neck cancer improved between 1996 and 2000, while waiting times increased and 2-year survival rates remained unaltered. Two out of five networks demonstrated centralisation of services between audits. Being seen in a multidisciplinary clinic correlated strongly with patient survival.