Palliative care (pc) is a fundamental component of the cancer care trajectory. Its primary focus is on “the quality of life of people who have a life-threatening illness, and includes pain and symptom management, skilled psychosocial, emotional and spiritual support” to patients and loved ones. Palliative care includes, but is not limited to, end-of-life care. The benefits of early introduction of pc services in the care trajectory of patients with advanced cancer are well known, as indicated by improved quality of life, satisfaction with care, and a potential for increased survival. In turn, early referral of patients with advanced cancer to pc services is strongly recommended. So when, how, and why should patients with advanced cancer be referred to pc services? In this article, we summarize evidence to address these questions about early pc referral:■ What are the known benefits?■ What is the “ideal” pc referral timing?■ What are the barriers?■ Which strategies can optimize integration of pc into oncology care?■ Which communication tools can facilitate skillful introduction of pc to patients?

20 Background: Nearly 50% of cancer survivors (CS) experience psychosocial and physical treatment-related effects. CS are often afflicted with greater medical conditions than non-cancer patients: survivorship care is thus imperative. In addition to follow-up by specialists, 75% of CS also visit their primary care provider (PCP) during and after treatments. Despite their role in survivorship, insufficient knowledge and low confidence have been reported by PCPs, supporting the need to educate them. This study aimed to evaluate the educational benefit of a survivorship workshop (SW) targeting PCPs in Montreal, Canada. Methods: An accredited 60-minute SW based on common survivorship issues and recommended guidelines by recognized entities was developed and delivered to 167 PCPs at 6 sites. The same MD presented each SW. Brief matched pre, post and 3 month delayed post surveys were designed (Likert-scale and short-answer questions), and completed on a voluntary basis. Outcome measures targeted 3 levels of Kirkpatrick’s learning model: satisfaction, knowledge, and behavior. Data were analyzed with parametric (paired t-tests) and non-parametric (Wilcoxon Signed rank tests) comparisons as appropriate. Results: The pre and post survey response rate was 65.3% and the 3-month delayed post survey response rate was 56.9%. Immediately following the SW, participants were significantly more likely to be able to list standards of survivorship, t(108) = 10.50, p < .001, and to name late-effects of cancer treatment, t(108) = 5.52 , p < .001. High relevance and satisfaction of SW was reported (95%), and 99% expressed intent to incorporate survivorship information into practice. At 3 months post-SW, confidence remained significantly higher than pre-intervention levels for both knowledge of “late physical effects” ( Z = 6.08, p < .001, n = 60) and “adverse psychosocial outcomes” of cancer and treatments (Z = 4.26, p < .001, n = 62). Conclusions: Much literature has focused on determining PCP barriers to survivorship care, including limited topic proficiency, yet further initiatives are warranted to optimize PCP survivorship expertise. Our SW increased PCP survivorship knowledge, and confidence levels remained greater at 3 months post, indicating its educational merit.

A higher birthweight represented an independent risk factor for developing SCFN in asphyxiated newborns treated with hypothermia. When macrosomia is present, other risk factors related to haemodynamic instability during the initial hospitalisation may also increase the risk of developing SCFN.

A 35-year-old man presented with severe hypo-osmolar hyponatremia (serum sodium 99 mmol/L), profound nonoliguric renal failure (serum creatinine 1240 μmol/L), and nephrotic range proteinuria. Computed tomography of the abdomen revealed nephromegaly and no obstruction. The patient was admitted to the intensive care unit (ICU) and conventional hemodialysis was initiated. To avoid rapid sodium correction, we prescribed concurrent dialysate flow, a low dialysate sodium concentration, a small surface area dialyzer, and a low blood flow rate. We infused dextrose 5% water into the venous return line and adjusted the infusion rate according to hourly sodium concentration. The rate of sodium correction was 7.7 mmol/day over the first 3 days of admission. A subsequent renal biopsy revealed focal segmental glomerulosclerosis and interstitial infiltration with extranodal NK/T-cell lymphoma nasal type. The patient died of massive lower gastrointestinal bleeding secondary to lymphomatous involvement day 19 in the ICU. In the setting of acute kidney injury requiring renal replacement therapy and concomitant severe hyponatremia, it is challenging to avoid overcorrection of serum sodium. We describe several key prescription modifications to conventional hemodialysis, factors that affect sodium diffusion at the level of the dialyzer membrane, and the importance of frequent laboratory monitoring.

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