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Context: Cancer and chronic disease prevention and screening (CCDPS) guidelines are not consistently applied in primary care. Furthermore, while most patients have multiple risks and conditions, guidelines are focused on a specific disease or organ system. The BETTER program (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) involves an evidence-based intervention provided by an allied health professional within a primary care practice who acquires advanced skills in CCDPS and takes on the role of Prevention Practitioner (PP). Using the BETTER toolkit, created through a rigorous process of knowledge synthesis and harmonization of recommendations, the PP meets with patients for a personalized prevention visit. Objective: To describe the: 1) evidence review process used to identify high-quality clinical practice guidelines (CPGs), 2) harmonization of primary prevention and screening recommendations, and 3) identification, development, and refinement of resources and tools for inclusion in the BETTER toolkit. The BETTER toolkit will be used to inform CCDPS in rural, remote, and urban primary care settings across Canada. Methods: In 2017, the BETTER Program conducted a literature review of evidence-based CPGs published between 2010 and 2016. For this update, high-quality international, Canadian, and Provincial CPGs published between 2016 and 2021, focusing on primary prevention and screening of cancer and chronic disease, and applicable to patients 40-69 years of age were identified. A Clinical Working Group consisting of decision-makers, researchers, clinicians, and a patient representative across Canada was split up into 3 topic review teams. A total of 19 CCDPS topics within scope for BETTER were identified. Topic teams reviewed the literature and synthesized guidelines based on evidence for their topic and updated the toolkits to inform the PP role. Results: Development of an updated care map that considers family history and risk factor assessment that is tailored to the patient and adaptable to diverse practice settings. Conclusions: Synthesized and evidence-based integrated care plans can be used to assess patients' CCDPS risk and preferences in diverse populations in Canada. The updated toolkit will facilitate the application of recommendations for the primary prevention of cancer and chronic disease in patients 40-69 years of age., Presenters Donna Manca, MD, MCLSC, Denise Campbell-Scherer, MD, PhD, Carolina Fernandes, MA, MSc, Eva Grunfeld, MD, PhD, FCFP, Kris Aubrey-Bassler, MD, FCFP, MSc, Aisha Lofters, MD, Katherine Latko, CDE, RD, [...]

Introduction/Goal: As a research-intensive facility located within a cancer care environment, library services provided at the Holy Cross Site closely adhere to an embedded librarian mandate, one where the librarian "actively engages in activities, possesses extensive knowledge of the researcher's work, and offers assistance above and beyond common library service expectations" (Strain, 2011). The Guideline Utilization Resource Unit (GURU) is composed of knowledge management specialists (KMS) and nurse facilitators (NF) who support multidisciplinary teams in developing, implementing, and evaluating provincial clinical practice guidelines (CPGs) for the diagnosis, staging, treatment and follow-up of cancer. These CPGs are evidence-based documents with consensus recommendations; they are freely available on a public website for access by practitioners and patients, and are a form of grey literature. Team members at GURU consult regularly with the librarian to ensure that the most accurate and comprehensive search strategy is used to develop CPGs. The goal of this paper is to describe the process of organizing and evaluating a journal club involving a unique collaboration between guideline developers and a librarian. Procedure: The journal club is comprised of three KMSs, two NFs, the GURU Manager and an embedded librarian. The group has been meeting once per month since April 2012. Each member takes turns selecting two articles related to CPG development or implementation, and is responsible for leading an informal discussion. To evaluate the usefulness of the journal club and the impact of grey literature on CPG development in Alberta, all members of the journal club (n=7) were interviewed in a focus group setting or a semi-structured interview. Transcripts of audio-recorded interviews will be qualitatively analyzed for repeated themes related to knowledge gained from, and perceived benefits of journal club meetings. Results: First, we hypothesize that monthly participation in the journal club will increase members' knowledge of development, evaluation, and implementation of guidelines. Second, we believe that participants will have acquired a better understanding of the research process and how to critique current guideline research. Finally, we expect that members will report that the journal club provided the opportunity to facilitate discussions around topics that are less familiar to them. It is anticipated that this collaborative venture will further enhance the importance of grey literature and its usefulness for cancer care clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Importance: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking., Objective: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction., Evidence Review: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included "head and neck surgery," "pharyngectomy," "laryngectomy," "laryngopharyngectomy," "neck dissection," "parotid lymphadenectomy," "thyroidectomy," "oral cavity resection," "glossectomy," and "head and neck." The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel., Findings: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting., Conclusions and Relevance: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.