Applying systematic review search methods to the grey literature: a review of education and training courses on breastfeeding support for health professionals

BACKGROUND

Currently, lactation training courses aimed at health professionals are important for informing and supporting mothers who are breastfeeding. In this review, we seek to analyze similarities and/or variations in course content, modes of delivery, costs, teaching style and learning strategies among courses. To our knowledge, a review of lactation training courses available worldwide is lacking. Thus, the aim of this review is to describe course models aimed at training health professionals in lactation support for mothers.

METHODS

Through searching grey literature, training courses were obtained from several directories, including the Alaska Breastfeeding Coalition, International Board of Lactation Consultant Examiners (IBLCE), International Lactation Consultant Association (ILCA), Lactation Education Accreditation Association and Approval Review Committee (LEAARC), World Alliance for Breastfeeding Action (WABA), World Health Organization (WHO), and United Nations Children's Fund (UNICEF).

RESULTS

Descriptions of ten training programs were included in the final review. Our group found variations in costs, modes of delivery and duration among courses.

CONCLUSIONS

Certified training for health professionals in lactation is a promising approach for increasing and protecting breastfeeding. Breastfeeding mothers might also benefit from specifically trained health professionals, yet, well-conducted research on such training courses is still required. The variability in the mode of teaching, tuition costs and course content in breastfeeding education programs around the globe must be kept in mind when considering providing training on the optimal competency for health professionals.

Abstract P2-12-03: A pilot study evaluating the benefits and feasibility of an exercise program for breast cancer patients receiving adjuvant chemotherapy

BACKGROUND: Breast cancer chemotherapy is frequently associated with a decline in general physical condition, exercise tolerance, muscle strength and quality of life (QOL). Evidence suggests that physical activity and exercise interventions during chemotherapy treatment may contribute to maintaining QOL, cardiorespiratory fitness and strength, however the results of studies conducted to date have not been consistent.

OBJECTIVES: This study aimed to determine the effect of a structured, tailored exercise program involving both aerobic and resistance training, on QOL, physical function, and body composition in breast cancer patients undergoing adjuvant chemotherapy.

METHODS: Women who were within 4–12 weeks of surgery for stage I-III breast cancer and undergoing adjuvant chemotherapy, were randomized to either a structured exercise program (6 months) or to usual oncology care. Functional assessment of cancer therapy-breast cancer (FACT-B), and Short Form Survey (SF-36), weight, waist circumference, waist hip ratio, percent body fat, peak oxygen, strength and arm volume were performed at baseline, and 3-month intervals through 12 months. One-way analysis of variance (ANOVA) was performed at baseline, 3, 6 and 12 months for all endpoints. The Wilcoxon Rank-sum Nonparametric test was applied for all Primary and Secondary endpoints with changing scores at each follow-up visit, p-value < 0.05 was considered as statistical significance.

RESULTS: Of the recruited 62 women, 51 completed all 12 months. One patient developed metastatic disease and 10 others withdrew (4 in the exercise arm and 6 in the standard arm). Median age was 48 (24–75) years. There was a general trend of improvement from baseline for most components of the FACT-B and SF-36 for the exercise group but only the FACT-B social wellbeing was statistically significant at 3 months with a p = 0.0164. Changes in other FACT-B and SF-36 scores were not significantly different between exercise and usual care groups. There were significant improvements at 6 months in weight (p = 0.0192), % body fat (p = 0.0337), max strength (p = 0.0029), and waist circumference (0.0359) and at 12 months in weight (p = 0.0293), % body fat (p = 0.0481), max strength (p = 0.0097) and endurance (p = 0.0037) in the exercise group compared to usual care.

CONCLUSIONS: This randomized prospective study suggests benefit of exercise during chemotherapy. This benefit continued 6 months beyond the completion of the exercise program with significant improvement in physical function, body composition, strength and endurance with no decline in quality of life. Regular moderate exercise may play an important role in improving function during adjuvant chemotherapy and should be further studied in a large randomized trial.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-12-03.

Coexistence of central diabetes insipidus and salt wasting: the difficulties in diagnosis, changes in natremia, and treatment

Both central diabetes insipidus (DI) and a high rate of excretion of sodium (Na) and chloride (Cl) contributed to the development of polyuria and dysnatremia in two patients during the acute postoperative period after neurosurgery. To minimize difficulties in diagnosis and projections for therapy, two available (but not often used) clinical tools were helpful. First, the osmole excretion rate early on revealed the co-existence of central DI and an osmotic diuresis. The osmoles excreted were largely Na salts; after antidiuretic hormone acted, this electrolyte diuresis caused the urine flow rate to be much higher than otherwise anticipated. Interestingly, part of this saline diuresis occurred when the extracellular fluid volume was contracted. The tool to explain the basis for the dysnatremias was a tonicity balance. Hypernatremia, which developed before treatment of central DI, was primarily a result of a positive balance for Na rather than a large negative balance for water. Moreover, hyponatremia that developed once antidiuretic hormone acted was primarily a result of a negative balance for Na; the urine volume was large and its Na concentration was hypertonic. To prevent a further decline in the plasma Na concentration, either the Na concentration in the urine should be decreased by provision of urea or a loop diuretic while replacing all unwanted water and electrolyte losses; alternatively, the fluid infused should have a similar Na concentration and volume as the urine (infuse hypertonic saline).