Premarin

Heather J. Frederick MD

• Assistant Professor
• Department of Anesthesiology
• Duke University Medical Center
• Durham, North Carolina

Draw the additional specimens at 2 hour and 3 hour intervals (3-hour gestational tolerance only) for the duration of the test breast cancer october purchase 0.625mg premarin otc. Draw blood in a grey-top (potassium oxalate/sodium fluoride) tube following an overnight (8-14 hour) fast menopause hot flashes relief generic 0.625 mg premarin mastercard. Unless the purpose of the measurement is drug monitoring houston women's health care center trusted 0.625 mg premarin, discontinue any epinephrine menstruation 21 days cycle 0.625mg premarin with amex, norepinephrine or dopamine injections or infusions at least 12 hours before specimen draw pregnancy implantation buy premarin without prescription. Discontinue drugs that release epinephrine menopause treatment options buy premarin once a day, norepinephrine, or dopamine or hinder their metabolism for at least 1 week before obtaining the specimen. If this is not possible for medical reasons, contact the laboratory and discuss whether a shorter drug withdrawal period may be possible in a particular case. Do not perform the test on patients withdrawing from legal or illegal drugs known to cause rebound plasma catecholamine release during withdrawal. The patient must refrain from eating, using tobacco, and drinking caffeinated beverages for at least 4 hours before the specimen is drawn. Calm the patient by giving complete instructions and reassurance regarding the procedure. At the end of the 30 minutes, withdraw and discard a minimum of 3 mL of blood to remove the saline out of the catheter. Specimens must remain at refrigerated temperature during processing and transport. Cautions: Catecholamines in plasma are chemically labile and the specimens must be handled carefully, both because of rapid specific metabolism and rapid oxidation on exposure to air. For example, plasma-free norepinephrine has a half-life of approximately 2 minutes. To enhance accuracy, one must pay careful attention to the circumstances of specimen collection and to the preparation of the patient (see Collection Required). Many alterations in physiologic and pathologic states can profoundly affect catecholamine concentrations. Any environmental factor that may increase endogenous catecholamine production should be avoided. These include noise, stress, discomfort, body position, and the consumption of food, caffeinated beverages, or nicotine. Substances that result in increased release or diminished metabolism of endogenous catecholamines. Catecholamine reuptake inhibitors including cocaine and synthetic cocaine derivatives, such as many local anesthetics, some of which are also antiarrhythmic drugs. Withdrawal from sedative drugs, medical or recreational, in particular alcohol, benzodiazepines. These drugs are converted to dopamine, and dopamine measurements in patients taking these drugs will artifactually elevated. Since isolated dopamine elevations are extremely rare, they should always be viewed with suspicion. On a careful review, the methodology usually, but not always, allows the identity of the unmetabolized parent drug, alongside dopamine. Historically, a third category of potentially interfering substances was represented by molecules that are either similar in chemical structure, antibody epitopes, or chromatographic migration pattern to the catecholamines, or have metabolites that can be mistaken for the catecholamines. On occasion, when interference cannot be resolved, an interference comment will be reported. Measure the total volume of the urine specimen and record the amount and collection time on the test requisition. Random Collections: For routine analysis and microscopic evaluation, have the patient void into a clean container. The specimen should be capped, labeled, and refrigerated until courier pickup time. Some of the urine should then be collected in a clean container before voiding is completed. Urinate the rest of the urine stream into a screw-capped, sterile urine container. Keep the labia separated, urinate a small amount into the toilet or bedpan, and stop. Work fresh urine down tubing and aspirate 1 20 mL into a screw-capped, sterile urine container. Submit measured aliquot(s) of a well-mixed specimen according to test requirements. Containers and Transport: Special containers and 100 mL white polypropylene aliquot containers for the collection and processing of fecal specimens are supplied by HealthEast Medical Laboratory. Instruct patient to not fill any container more than fi full (to the indicated line on the label). At the time the patient returns the container to you, complete the following information on the label: a. If timed duration is other than those listed, please list it on the line provided following fiOther. Indicate if the entire collection is contained in one container or in multiple containers. Label each container with the patient name, date of birth, and date of collection from the appropriate request form. B15 B16 B17 B18 B19 B20 Microbiology Culture Instructions: (Deliver all culture specimens promptly to the Laboratory) I. Using a syringe, draw 17 mL of blood for an adult, or 3 mL for pediatric patients 413kg. For adults: Using a blood transfer device, transfer 10 mL of blood to the Aerobic Vial and 7 ml of blood to the Anaerobic Vial. For pediatrics: Using a blood transfer device, transfer 3 mL of blood to the Peds Plus/F Vial (Pink Top) 7. In extreme cases <5 ml a volume of <3ml may be put in a Peds Plus/F vial (pink top). B21 Pediatric Blood Culture Volumes Pediatric Patient Blood Volume Drawn Blood Culture Vial(s) Weight <4 kg 1 ml Peds Plus/F (pink) 413 kg 3 ml Peds Plus/F (pink) Plus Aerobic/F 5 ml Optimum: 10 ml 13-25 kg Anaerobic/F 5ml 4-9 ml Plus Aerobic/F 1. Using a blood transfer device, inject 7 10 mL of blood to the aerobic bottle (blue cap) and 3 7 mL to the anaerobic bottle (yellow cap) bottle. Firmly sample the membrane by rotating the swab and leaving it in place for 10-15 seconds. Nasal Wash Collection Materials: Saline (sterile) or use a Nasal Wash Sterile tapered rubber bulb Collection set Sterile screw-top container (urine cup) Collection: Suction 1 3 mL saline into bulb. Squeeze bulb to instill saline into nostril; immediately release bulb to recover specimen. Insert mini-tip swab through cleaned nasal passages until it just meets resistance at the posterior nasopharynx, taking care not to touch anterior nares. Place a drop of mineral oil on the blade, apply scalpel to papule so mineral oil goes into papule surface. Instruct the patient to take a deep breath, hold it momentarily, and cough deeply and vigorously into a tightly sealing, screw-capped, sterile container or into suction trap. Depress the tongue with a tongue depressor so the swab does not touch the tongue, cheeks, or the lips. Swab behind the uvula and over any areas of inflammation, exudation, or ulceration and remove the swab. Place the cup under the stream and continue to urinate into the screw-capped, sterile urine container. Remove superficial flora by decontaminating the skin before collecting a specimen from advancing margin or base. Any questions/comments regarding this chart can be directed to Microbiology at 651-232-3680. Insert contoured end of plastic spatula into cervix and rotate 360 degrees around the entire exocervix (one entire rotation). Insert CytoBrush into the endocervix until only the bottom-most bristles are exposed at the os. Insert the SurePath Broom into the endocervix so that the tip of the broom is in the cervix and the bottom bristles are resting on the ectocervix. The dispatcher is in constant contact with all drivers and can keep you apprised of timeliness, especially in situations related to traffic delays and severe weather. Specimen Packaging Laboratory test results are dependent on the quality of the specimen submitted. It is important to fill out the test requisition legibly, accurately, and completely. Complete patient information is important to ensure proper billing and correct interpretation of laboratory test values. In addition, the identification on the labeled specimen must exactly match the identification provided on the requisition. To ensure the safety of all personnel who handle specimens, please submit specimens in the appropriate containers. Use large zip-lock bags to collect the individually-bagged specimens according to temperature requirements: one bag for room temperature, one bag for refrigerate, or one for frozen. A syringe may be submitted only if a syringe cap is used and the needle is removed. Label bag with the temperature for transport and storage on the small and large zip-lock bags [frozen, refrigerate, or room (ambient) temperature]. Some test requirements state that the specimen should be frozen if it will be stored for 24, 48, or 72 hours. Freezing is not required if the specimen will be submitted to our laboratory within the stated time period. When one test in a group of tests requires freezing, only freeze a part of the specimen and then send us two specimens, one frozen and one not frozen. Paracentesis of ascitic fluid may be carried out on an outpatient basis by the abdominal or transvaginal D route under ultrasound guidance. In a minority of women undergoing treatment, the ovarian response exceeds that aimed for and results in a clinical condition with a specific pathophysiology. Furthermore, the lack of an internationally agreed classification system makes it difficult to compare data from different units. Hence, care must be taken to exclude other serious conditions that may present in a similar manner but require very different management. Important differential diagnoses include pelvic infection, pelvic abscess, appendicitis, ovarian torsion or cyst rupture, bowel perforation15 and ectopic Evidence pregnancy. It is important for staff triaging women over the telephone to have a clear understanding of the women who will require face-to-face clinical review. Specific enquiry should be made for significant level 3 abdominal pain, shortness of breath or a subjective impression of reduced urine output. Although there are no Evidence trials on this subject, thromboprophylaxis should be provided for these women in view of the level 4 serious nature of this complication33 (see section 10. There is variability in the threshold for hospital admission between practitioners and it is not possible to be categorical about criteria for admission. Evidence However, each case should be considered on its merits with reference to the clinical features, level 4 social factors and the expertise available. Body weight, abdominal girth, and fluid intake and output should be measured on a daily basis, along with full blood count, haematocrit, serum electrolytes, osmolality and liver function tests. Women with persistent haemoconcentration despite volume replacement with intravenous colloids D may need invasive monitoring and this should be managed with anaesthetic input. Diuretics should be avoided as they further deplete intravascular volume, but they may have a role in P a multidisciplinary setting if oliguria persists despite adequate fluid replacement and drainage of ascites. Vigorous intravenous fluid therapy with crystalloids has the potential of worsening ascites in Evidence the presence of increased capillary permeability. Acutely dehydrated women may need intravenous fluid therapy to correct fluid balance, followed by oral fluids to maintain hydration. There are theoretical advantages to using colloids rather than crystalloids for initial rehydration. In these cases, continuous urine output measurement and invasive haemodynamic monitoring may help guide fluid management more accurately. Oliguria despite adequate fluid replacement may in some cases respond to paracentesis. It is not possible to be categorical about the value of these interventions in the absence of adequate trials and they should only be undertaken in the multidisciplinary setting under close monitoring.

Site Pathology Extremities of the limbs women's health zucchini recipe discount premarin 0.625mg visa, but almost always the feet Cause of most cases unknown menstruation 24 order 0.625mg premarin with amex. Burning pain which comes in attacks and affects the foot-sole or palm of the hand menstruation questions and answers order generic premarin, closely related to objecMain Features tive increased local skin temperature breast cancer journal buy on line premarin. Reduction of pain Primary form rare and more often bilateral than the secby elevating or cooling the affected extremity menstrual questions answered 0.625 mg premarin with mastercard. Men in the middle-age group are more often Code involved womens health 15 minute workout dvd order premarin 0.625 mg, but women and children may also be affected. X8d Hands Note: add code for secondary Characterized by severe, burning pain and red discolora624. The skin temperature is often raised, the skin flushed with venous engorgement, and the surface hyReferences peresthetic. Pain in the fingers or hands or small digits of the feet, usually in males who smoke; associated with ulceration Complications of fingertips and margins of nails; related initially to Gangrene and infection of digits. Osteoporosis of bones segmental inflammation of walls of medium and small of extremities. Pathology Site Ulnar, palmar, and digital arteries affected early with Fingers and hands, more often toes and feet, rarely the segmental inflammation initially. System Acute stage: granulation tissue in all layers of affected Cardiovascular system. Chronic Main Features stage: sclerotic thrombus, dense fibrous tissue encloses Prevalence: a rare disease with a possible preponderance arteries, veins, and nerves. Sex Ratio: Summary of Essential Features and Diagnostic Crimales more than females-ratio above 9:1. Pain QualOrganic arterial disease of one or more digits, almost ity, Time Pattern, Intensity: usual onset is sharp pain in always in a male under 40 with a history of migrating fingers or hands or more often in the foot or calf. Intensity: may be unbearable, often aggravated by Arteriosclerosis (larger vessels and more widespread), elevation. X3b Legs Signs Coldness and sensitivity to cold, sensations of numbReferences ness, paresthesias, sometimes superficial thrombophlebiJuergens, J. Saunders, Philadelvenous obstruction; edema present if there is venous phia, 1977. Absent ulnar or tibial artery pulsation and positive Allen test in cases affecting the arms (see ThoHaimovici, M. Definition Skin plethysmography shows reduced blood flow in one Dull, aching pain in limbs, especially legs, characterized or more digits, indicating local arterial disease. Vigorous muscle contraction of the digit may result in sufficient pressure to Site overcome intravascular pressure with cessation of blood Limbs, usually the legs; especially the distal portions. Page 134 Main Features Prevalence: about 15% of adult population, severe in Social and Physical Disability only 1%. Additional pain often due to Chronic venous insufficiency is the late consequence of thrombosis and/or thrombophlebitis acutely. The aching pain is associAssociated Symptoms ated with edema largely of the subcutaneous tissues. Previous more epicritic pain of ulcers and indurative cellulitis is thrombophlebitis in a vein of the extremity, orthostasis usually due to secondary inflammation rather than conwith edema, developing during the day and disappearing gestion. After edema has been present for some time, areas of brown pigmenEtiology tation (hemosiderin and melanin) may appear. Eczema is Hereditary factors, blockage by thrombosis or other disa common feature. Edema, dilated superficial veins, varicosities, corona phlebectatica, hyperand de-pigmentation, induration, Code open or healed ulcus cruris. X6 Legs Chronic, but dependent on stage of insufficience and reaction on causal therapy. Age of Onset: over 30, increasing in later middle age and deSite creasing in the aged. Pain Quality: the intermittent pain is cramping and severe and arises, usually, after fixed Page 135 and consistent amounts of exercise. The pain is relieved by May be due to (a) arteriosclerosis, characterized by local the dependent position, which initially causes the limb to deposition of fat under and within the intima of arteries, flush red and then become cyanotic. Elevation of the most commonly the aorta, coronary, cerebral arteries; (b) limb causes blanching and increased pain. Changes confined to muscular media of mediumwith hypertension of long duration, ulceration of skin sized arteries. Intermittent claudication and rest pain are more usually in skin of legs but sometimes in the upper limbs. Signs Essential Features A systolic murmur may be heard over the abdominal Exercise-induced pain which passes off very quickly by aorta or iliac arteries. Arterial or arteriopulses, reduced skin temperature, and coldness of the lar vascular insufficiency by other conditions like enlimb are characteristic. Laboratory Finding Arteriography demonstrates the level of arterial obstrucCode tion or obstructions. Recurrent or chronic limb pain due to inappropriate use of muscle groups whether or not for References psychological reasons may be quite common. In chronic cases bad body mechanics, lordosis or scoliosis, trauma, and arthritis are the most common Code causes. Xla Post-traumatic gia are similar in all regions and are normally unilateral and limited to one or two dermatomal segments. Definition Paroxysmal pain in the distribution of an intercostal Site nerve commonly associated with cutaneous tenderness Pain classically is in the precordium, although radiation in the affected dermatome. Pain may also radiate up Site into the sides of the neck or jaw or into the back or epiIn the distribution of spinal nerve roots or trunks (if gastrium. Main Features System Prevalence: common in middle and older age groups, Peripheral nervous system. It is freMain Features quently precipitated by stress, either physical or psychoPain Quality: sharp or burning pain, usually intermittent, logical. It usually lasts a few minutes but can be often precipitated by lateral movements of trunk or verprolonged or intermittent, lasting hours or occasionally tebral column. Post-traumatic Associated Symptoms intercostal neuralgia often has continuous pain with exAs noted, pain is aggravated by stress and relieved acerbation. Frequently patients also experience breathlessness, sweating, nausea, and Etiology belching. Neuralgic pains may be due to postinfectious radiculitis, osteoarthritic spurs, other spinal lesions, trauma, toxic Signs and Laboratory Findings and metabolic lesions, etc. In acute cases they are most Frequently there are no objective findings but patients Page 138 may at the time demonstrate a tachycardia, a mitral reSite gurgitant murmur of papillary muscle dysfunction, an S3 Retrosternal area with radiation to arms, neck, jaw, epior S4, and reversed splitting of the second heart sound. Coronary angiograMain Features phy may show typical atherosclerotic narrowing of the Prevalence: common in middle and older age groups, coronary arteries. Usually it is very Usual Course severe and lasts several hours or until relieved by morAnginal pain typically is brief and intermittent, brought phine. Complications Signs and Laboratory Findings Arrhythmia and myocardial infarction may occur. Physical examination may be normal but may show hypertension, S3 or S4 gallop rhythm, and papillary muscle Social and Physical Disability dysfunction with a mitral regurgitant murmur, as well as If angina is brought on by little extra stress, there is serisigns of forward or backward cardiac failure. If the patient is particularly fearful, angina can cause interruption of normal Laboratory abnormalities include elevation of cardiac psychological function as well. Usual Course In patients surviving myocardial infarction the severe Pathology pain tends to diminish and disappear over several hours A list of risk factors predisposing individuals to atheroto a day or two. Often the patient is then pain free, alsclerotic heart disease continues to develop but includes though recurrent pain may represent angina or reinfarcage, sex, hypertension, smoking, family history, hypertion. Superimposed on atherosclerotic coronary artery narComplications rowing, such factors as increased cardiac oxygen deSudden cardiac death, arrhythmias, congestive heart mand, decreased flow related to coronary artery spasm, failure, cardiogenic shock, post-myocardial infarction or arrhythmias may be contributory. Recovery frequently takes several months, and physical and psychological complications may prolong Code recovery and affect not only the patient but family mem324. X6 If mostly in the arms heart as the source of life makes interpretation of this type of pain particularly threatening. Other factors such as coronary artery Definition spasm or arrhythmias, or decreased blood volume, or Pain, usually crushing, from myocardial necrosis secondecreased total peripheral resistance may also be signifidary to ischemia. Differential Diagnosis Social and Physical Disabilities Angina pectoris, dissecting aneurysm, pulmonary emboProbably only significant in chronic cases where weight lism, esophageal spasm, hiatus hernia, and pericarditis. Summary of Essential Features and Diagnostic Etiology Criteria A wide range of etiologies can cause pericarditis and its Crushing retrosternal chest pain with myocardial necrosubsequent pain. Differential Diagnosis Site Angina, myocardial infarction, pulmonary embolism, the pain is classically in the precordium but may radiate hiatus hernia, and esophageal spasm, etc. X5 Toxic Main Features Most cases are acute, and this is particularly true of pericarditis causing pain. Associated Symptoms Weight loss, fatigue, and fever are common especially in Site chronic cases. If dissection occurs, sudden and on chest X-ray if there is an effusion, as well as changes severe pain occurs, maximal at onset. Usual Course the course varies depending on the etiology and may range from being acute to chronic. Page 140 Signs and Laboratory Findings Site A discrepancy may develop between pulses or blood Diaphragmatic pain is deep and difficult to localize. A new aortic regurgitant Noxious stimulation may affect phrenic nerve sensory murmur may develop. A neurological impairment may fibers C3, C4, and C5 and therefore is often felt at the develop. Chest X-ray may show widening of the supeshoulder tips and along the upper border of the trapezius rior mediastinum. Aortography may demonstrate a false muscle, or it may affect the intercostal nerves T6, T7, lumen. T8, and T9 with radiation of pain into the anterior chest, the upper abdomen, and the corresponding region of the Usual Course back. If there is a large aortic aneurysm, there can be chronic dull, central chest aching. If dissection occurs, an acute System medical and surgical emergency has developed. The system is musculoskeletal, cardiac, pulmonary, or intestinal depending upon the disease. Acute Main Features complications include acute aortic valvular incompethe pain is deep, dull, poorly localized, and non-specific tence, occlusion of major vessels, hypotension, and if it involves only the central chest and upper abdomen death. Social and Physical Disability the main problems with aortic aneurysms are life and Associated Symptoms death considerations. Hiccoughs may aneurysm consists only of adventitia and/or perivascular be present. Cystic medial Frequently there are no physical findings, but if there necrosis is a major cause of dissection. Arteriosclerosis are, the most classic would be elevation of a hemidiais a major cause. Usual Course Differential Diagnosis There is usually a specific therapy once the etiology is Angina, pulmonary diseases, and thoracic disk disease. Chronic aneurysm If the pain assumes a thoracic spinal pattern (although of Social and Physical Disability visceral origin), code according to X-7. These relate partly to the underlying disease process and partly to the vagueness of understanding of the cause of pain. Definition Etiology Pain from the diaphragm related to irritation of the diaAlthough a wide range of causes can cause disease afphragmatic nerves by a disease process above the diafecting the diaphragm, the most important are infections phragm, in the diaphragm (rare), or below the diaphragm. Page 141 Summary of Essential Features and Diagnostic Complications Criteria Esophageal obstruction, erosion into a bronchus, Abdominal pain in epigastrium with radiation to central bronchoesophageal stricture, erosion into aorta with chest, posterior midthorax and shoulder tip(s), with evicatastrophic hemorrhage. Social and Physical Disability If the tumor is inoperable and the patient cannot eat, a Differential Diagnosis plastic tube can be passed through the tumor or a feeding Involves a wide range of cardiac, pulmonary, muscujejunostomy performed. X2 Infection: chest or pulmonary source Smoking-chronic disorders of esophagus. X2 Infection: gastrointestinal source Summary of Essential Features and Diagnostic 453. Pain due to malignant disease of the esophagus resulting Code from malignant transformation of either the squamous 353. Definition Chronic pain at the costal margin which may mimic visMain Features ceral pain. This is a relatively uncommon tumor in the Western World but has localized areas of high incidence, espeSite cially in Iraq and Iran among the Kurds. Pain is not usuEighth, ninth, or tenth rib cartilages, one or more rib ally a prominent feature. The condition may be bilatusually dysphagia without pain, which usually occurs eral. At that point dysphagia and retrosternal pain may become Main Features continuous and radiate through the back. Quality: a Associated Symptoms constant dull ache or a sharp stabbing pain which may Dysphagia is the major symptom; others include regurgiitself be followed by a dull ache. Signs and Laboratory Findings Aggravating Factors Evidence of weight loss and cervical lymphadenopathy, Movement, especially lateral flexion and rotation of the particularly deep to the sternomastoid. Rising from a sitting position in an armchair is show a dilated esophagus; barium swallow, a narrowing often a particularly painful stimulus.

What was learned: In our experience menstrual cycle 0-5 days discount premarin 0.625mg with visa, liquid biopsy repositories can augment goodandisadaptableandapplicabletodiversecontextsandhealthcareenvironments pregnancy estimated due date cheap premarin online visa. Whatwaslearned:Whileitisimportantto and retrospectively annotated biobanks can be a cost-efficient resource in a global cancer describe the various elements required for cancer care delivery breast cancer prognosis buy premarin without a prescription, it is critical to consider healthcare delivery system and a useful tool for scientific and economic opportunities and and address the integration and interdependencies of these various elements breast cancer 2a prognosis purchase 0.625 mg premarin. The program was designed to train only 18 patient navigatorsforAbujaonly menstrual like cramps after hysterectomy safe premarin 0.625 mg,however menstruation 5 weeks postpartum 0.625 mg premarin free shipping,wetrained44patientnavigatorsfromNationalHospitalAbuja,Enugu not-for-profit organization Partners for World Health. Aim: To empower women at risk for, or living with advanced breast cancer and oncologists, nurses and allied health professionals who were trained. Strategy/Tactics:Theprogramusedtrainingof partnership is currently for 5 years starting from October of 2017. The plan is to have 2nurses, cancer survivors and nurses to become patient navigators at National Hospital Abuja and week vocational and skills transfer session every 6 months. Whatwaslearned:Metastaticbreastcancerpatientneededmoresupporttoliveaqualitylife, 100 radiation oncologists were trained on March of 2018. Empowering Patients and Care Givers 245s Empowering patients and cancer caregivers with information and training Fig 1. Opara4,5 1The Dorcas Cancer Foundation, Surulere, Nigeria; 2Lagos University Teaching Hospital, Mushin, Nigeria; 3The Dorcas Cancer Foundation, Research, Surulere, Nigeria; 4The Dorcas Cancer Foundation, Communications, Surulere, Nigeria; 5Lagos University Teaching Hospital, Surulere, Nigeria Background and context: When a child has cancer, the entire family is affected. Many parents blame themselves and wonder if some action or decision of theirs contributed to; or caused the cancer. In addition, and especially for families falling within the low socioeconomic demographic groups, there maybepoorunderstandingofthetreatmentprocessandexpectationsfromtreatment. Aim:To assess the most common challenges or concerns faced by parents, family members, or caregivers of a child living with cancer in Nigeria. Strategy/Tactics: A series of 10 focus group sessions were held with different groups of parents, family members, or other caregivers of children being treated for cancer at 2 teaching hospitals in Nigeria. Atthebeginningof every session, participants were asked to submit 2 most pressing questions. Open-ended questions were also used with every attendee given a turn to give their answer. Thesingle most prevalent concern raised in every focus group was lack of information or understanding. The questions and concerns the attendee raised; and the degree of understanding they had regarding the Fig 2. This data were collatedandateamofexpertsincludingoncologists,nurses,andhealthworkersincancerwere brought together to answer the questions. This culminated in the publishing of a free childhood cancer handbook;thefirstofitskindinNigeria;withplanstotranslatethehandbookintothecommon colloquial and vernacular languages in Nigeria. Outcomes: Participants of the focus groups were given a handbook, including some whose child had passed on since the sessions were held. Theywere assessed to see if the handbook provided information that could have eased their cancer journey. The most appreciated information in the handbook was contact details of an organization dedicated to supporting them financially to pay treatment fees. What was learned: Many Nigerian families go through the entire childhood cancer journey completely in the dark. Many parent and caregiver questions remain unanswered, and concerns remain unresolved. Empowering Patients and Care Givers Local interventions in tobacco control Patient and family support Implementation of a Comprehensive Hospital-Based Smoking-Cessation From Diagnosis toSurvivorship: Using CancerSupport Group asanAdvocacy Program in Cancer and Support Platform for Cancer Care in Nigeria N. Princess Margaret Cancer Centre, Cancer Strategy Stewardship, Toronto, 2 Okenwa6,G. Background and context: Quitting smoking after a cancer diagnosis minimizes 3 3 10 11 12 treatment-related effects, improves prognosis and enhances quality of life. It is a huge burden to the 5) Analysis and clinical integration patient, family, and community; subjecting them to financial crisis, emotional distress, dearth of self6) Monitoring and evaluation of program performance metrics. Cancer patientsareconstantlyseekingsolace, peopleto advice on quitting, and generate an electronic referral to cessation programs. Studies have shown that peer cancer support group results in psychological benefit and improve relationships. The Patient and provider education was developed to address the unique knowledge gaps, cancer support was primarily founded for only breast cancer patient, survivor, caregivers and for peer beliefsandstigmaassociatedwithsmokingandacancerdiagnosis. Outcomes:Program support;asattodaythegrouphastransitedfrombeingpatientgrouptoalsobeinganadvocacygroupwith metricsindicatethatof11,366newpatientseligibleforscreeningbetweenApril2017 a number of activities and programs aimed at propelling all cancer patients from diagnosis to survito March 2018, 62% (n 5 6629) were screened with 10% (n 5 655) identifying as vorship. Aim:TodisseminateimpactofestablishingabreastcancersupportgroupinAbujaandhowithas helpedcancerpatients/survivorsinspireeachotherwhileengagingpolicymakerstomakecancercontrol current smokers and 4% (n 5 261) as recent quitters (6 months or less). Future become a point of networking and inspiration for several patients and survivors; hence, more cancer directions include assessing strategies to increase screening and referral rates, colpatientsarebeginningtocomeoutfromtheirclosesttoidentifywiththesupportandmaketheirdiagnosis public. What was learned: There is an improvement in psychological states of patients and their lection of long-term outcomes, and integration into the patient portal. Our qualitativefinding also showed that cancer patients needs platformsto speak out, to advocateandtochangethecourseofcancercareifprovidedwithallthenecessarytrainingandsupport. Ndiaye2 1 2 Breast Care International, Kumasi, Ghana; Peace and Love Hospital, 1University Hospital A. Despite the lack of a national cancer registry, it is esadvanced stages of disease. Their large tumors, as well as the side effects of chemotimated that 2260 women were newly diagnosed with breast cancer. Doctors donfit prescribe morphine due to shortages; but few women according to the Ghana Breast Health Study is 43 years while white American prescriptions also lead to limited orders. To address the alarming rate by which women Hearing children in painwasagonizingfor everyone:patients, caregiversandhealthcare present late for diagnosis, several advocacy groups have implemented education and practitioners. Aim: this advocacy narrative illustrates how the fight for access to morawareness programs in the country. However, despite aggressive campaigns to improve phine in pediatric oncology has led to both positive and negative externalities. We will earlydetection,therearestillarecordnumberoflatepresentationsindicatingthatthere highlightwaysinwhichthisfightformorphinehasprovokedpoliticaltensionsmovingthe is still aneed for a more aggressive approach. ThePeaceand LoveSurvivors Association issue forward, but has also affected the careers of health workers involved. Aim: To help Breast Tactics: Morphine is a cheap drug, yet it is extremely regulated by international laws. This advocacy strategy was cancer and eradicate the stigma, myths and misconceptions surrounding the disease. Not Strategy/Tactics: Speak out and share our stories to encourage and empower newly providing morphine in oncology goes against international standards of care. Program/Policy process: Some members have dedicated themselves righttolive-andalsodie-indignity. Postmastectomy survivors among us show their artificial powerlessness before their suffering child. Interviews with key informants (doctor and breastsinpublicforwomentoknowtheyhave1breastwhichishelpingalot. Wedohomevisits medical and political causes to morphine supply shortages, as well as its psychological and phone calls to assist andcheck on patients asthey gothrough treatment. We tell them the sequently, meetings were held between the Ministry of Health, the National Supply numberofyearswehavesurvivedandthatmakesthemmorerelaxed. Outcomes: Morphine orders were multiplied by been able to navigate quite a number of patients through their treatment journey to also 10, leading to much improved pain management for patients. However, Senegal was become members of our association and that has increased our membership to . Threeof us have been used by the Peace and Love Hospitals and gone the consequences were incurred by the health workers who contributed to the inthrough training to help counsel newly diagnosed patients. What was learned: Health practices can inform policy relaxed and comfortable with us. They even sometimes call us to discuss their problems just like policy can inform health practices. Creating advocacy with us and we help them to sort it out with the hospital especially when it is financial. Whatwaslearned:Womenareimportanttoourhusbands,children,familyandsocietyas However, in the political arena, health workers need more than commitment to human a whole and we should not die needlessly. Even in democratic republics, systems can penalise outspoken preventionandtogetherwecanmakeanimpact. We have learned that health care practitioners (especially working in public save a lot of women in very diverse ways. Internationalpartners willreturn to their homecountries,but local actors will pay understand the disease and report early to the hospital for treatment. Program on Prevention and Early Detection of Head 1 1 1 1 and Neck Cancers in Poland in the Years 2017-2019 C. Aim: To implement in 5 Polish voivodeships pilot prophylactic shareandthisistheeraofonlinecontent. Strategy/Tactics: the main objective will be achieved for merit-making and good luck. Program process: Maria Sklodowska-Curie Institute Oncology exercise and collect money. The cost of whole program was 1,500,000 Bht, Center successfully applied for funds for the implementation of the created project. What was learned: this campaign has sucProgram is cofinanced by European Union, from European Social Funds within the Operational Program Knowledge Education Development 2014-2020, V. Priority axis: Supcessfully engage many people to start exercise, using donation as motivation. Nowadays project team conducts procedures aiming among the others rethe cancer in 1 way or another. Aim:Howdowe move the above personalized integrative approach to the cancer across the global communityfi Create a personalized integrative healing approaches to cancer patients across the world. Strategy/Tactics: Strategyis precare (before cancer behavioral) and postcare (palliative, pain relief approach). Lyonga4, Background and context: With the rapid economic growth and aging population, 5 3 Chinaisnowfacingthechallengeofcancerburden. Lung, gastrointestinal, breast cancers are the top 3 most commoncausedcancerdiseases forChinesepeople. Thetotalcancercosthasbeenraised 5University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria 4 times more than in 2003, which was estimated to . Background and context: Nigeria has been rated the 1st nation in Africa and 5th in the world From 1970s, Chinese government attached importance to cancer control and withhighestcervicalcancerdeathswith. Breastcancerincidenceis conducted cancer prevention and control planning and strategy, but the medical higherwith90newcasesper100,000womenannuallyinsomewesterncountries,compared resource allocation for cancer is still inequality in the country. Late diagnosis of canceris possibly encouraged due to low awareness and velopment. Strategy/Tactics: Through collecting the data from 55 cancer hospitals sporadic screenings across Nigeria. To mitigate this system-wide gap, huge resources are across the country from 2013 to 2015 to analyze. Program/Policy process: the required from the government, corporate organizations and nonprofits engaged in cancer results show that oncology doctors and nurses slightly increase in consecutive awarenessandprograms. With impact awareness events engaging thousands of people and professional is constituted by clinical surgery, internal medical doctor, radiation raisingsupportsforcancerpatientswhileadvocatingforpolicychange. Clinical surgery is estimated to account for 40% of all use volunteers has propelled the nonprofit organization to reach millions in,5 years while professionals in cancer hospitals. The oncology professionals have higher eduspending less on human resource compared with her impact. Whatwaslearned:Qualitativeresponsesshowedthatthevolunteersneededto treatment,andformulatingstandardizedandprecisioncancertreatmentguideline, be more engaged in series of cancer activities. During the event, healthy selfappreciated the importance of integrity, professionalism, innovativeness and transmade ice creams were sold. Background and context: fundraise to support awareness, human resource development and breast cancer Malnutritionisacommonproblemamongcancerpatientsandlikelytodeveloporworsen screening. Strategy/Tactics:Privatepublicpartnershipafterneedsassessmentforeachof during specific cancer treatments especially when early and appropriate nutritional our projects with full transparency and innovation.

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Diseases

• Herpes viridae disease
• Chromosome 1q, duplication 1q12 q21
• Vitiligo
• Aniridia mental retardation syndrome
• Lymphangiectasies lymphoedema type Hennekam type
• Trimethylaminuria
• 5p minus syndrome
• Argininosuccinate synthetase deficiency
• Muscular phosphorylase kinase deficiency