Cancer Care (cancer + care)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Cancer Care

  • breast cancer care


  • Selected Abstracts


    Development of three different neoplasias in a patient in an 18-year period of time

    EUROPEAN JOURNAL OF CANCER CARE, Issue 3 2010
    P. HERAS md
    HERAS P., GEORGOPOULOU A.P., HATZOPOULOS A. & KRITIKOS K. (2010) European Journal of Cancer Care 19, 413,416 Development of three different neoplasias in a patient in an 18-year period of time This study presents a rare case of a patient who developed three different types of neoplasia in an 18-year period of time. The case presents a 31-year-old man with a history of treated Hodgkin's lymphoma in the neck region at the age of 13 years. The patient was admitted at the General Hospital of Nafplio for differential diagnosis of pain in the right subcostal region initiated 1 month before his admission and normochromic, normocytic anaemia. The laboratory examinations lead to the diagnosis of a sarcoma in the cardioesophageal junction. The patient was subjected to total gastrectomy. Nine months later he is admitted with a palpable firm lump in the nipple of the right breast, which suggested a malignant neoplasia. The patient was subjected to modified radical mastectomy. The appearance of three different types of neoplasia in three different organ systems in the same patient and the infrequency of the specific neoplasias individually and in combination present a special interest considering the patient's genetic background and the uniqueness of the case in the international literature. [source]


    Supportive Cancer Care with Chinese Medicine

    FOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 3 2010
    BR Cassileth
    [source]


    Nursing Homes and Cancer Care

    HEALTH SERVICES RESEARCH, Issue 6 2009
    Mary L. Fennell
    First page of article [source]


    Cultural Perspectives of International Breast Health and Breast Cancer Education

    JOURNAL OF NURSING SCHOLARSHIP, Issue 2 2007
    Karen Dow Meneses
    Purpose: To (a) describe teaching,learning strategies to foster cultural exchange among participants in the Train-The-Trainer (TTT) International Breast Health Program; (b) describe participants' perceptions of cultural influences on breast health and breast cancer; and (c) explore lessons learned about cultural influences on breast health TTT educational programs. Organizing Construct: The TTT curriculum was grounded in the belief that nurses can effectively deliver breast health and breast cancer education, that educational programs must be culturally relevant and sensitive to the needs of the target population, and that an urgent need exists worldwide to reduce the burden of breast cancer. Methods: A total of 32 nurses from 20 countries participated in three TTT programs held before the biennial meetings of the International Society of Nurses in Cancer Care (ISNCC) since 2000, with follow-up by E-mail survey. Narrative descriptions of their perspectives and experiences are reported. Results: Teaching,learning strategies incorporated cultural values into a TTT program to engage participants in sharing their individual and collective experiences about women with breast cancer. Conclusions: Developing countries are increasingly multicultural. Developed countries have large immigrant populations that generally maintain the cultural values and practices about breast cancer from the country of origin. These "lessons learned" are important in planning other educational programs. [source]


    Implementing touch-screen technology to enhance recognition of distress

    PSYCHO-ONCOLOGY, Issue 8 2009
    K. Clark
    Abstract Objective: The University of California, San Diego, Moores Cancer Center implemented a systematic approach for patients to communicate with their health-care team in real-time regarding psychosocial problem-related distress using touch-screen technology. The purpose of this report is to describe our experience in implementing touch-screen problem-related distress screening as the standard of care for all outpatients in a health-care setting. Although early identification of distress has recently gained wide attention, the practical issues of implementing psychosocial screening with and without the use of technology have not been fully addressed or investigated. Methods: ,The How Can We Help You and Your Family?' screening instrument was used to identify and address patient problem-related distress for clinical services, program development, research and education. Using a HIPPA-compliant approach, the touch-screen technology also helped to identify patients interested in clinical trials and additional support services. Results: We found that the biggest barrier to implementing this technology was the attitude of the front desk staff (i.e. schedulers, clerks, administrative staff) who felt that the touch-screen would be burdensome. Our experience suggested that it was essential to actively involve these personnel from the beginning of the planning process. As specifically acknowledged in the recent 2007 Institute of Medicine report (Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. The National Academies Press: Washington, DC, 2007), use of this computerized version of the screening instrument was able to bridge the gap between the detection of problem-related distress and referrals for assessment or treatment. Conclusion: We found that it is feasible to implement a computerized problem-related distress screening program in a comprehensive cancer center. Copyright © 2008 John Wiley & Sons, Ltd. [source]


    Toward Optimized Breast Cancer Care with East/West-Linked Wisdom

    THE BREAST JOURNAL, Issue 2006
    Tomoo Tajima MD
    No abstract is available for this article. [source]


    Prostate Cancer Care Down Under

    BJU INTERNATIONAL, Issue 2 2010
    An interview with Prof Anthony Costello
    First page of article [source]


    Institute of Medicine's 10-Point Plan for More Comprehensive Cancer Care

    CA: A CANCER JOURNAL FOR CLINICIANS, Issue 2 2008
    Article first published online: 31 DEC 200
    No abstract is available for this article. [source]


    Survivorship in cancer care

    EUROPEAN JOURNAL OF CANCER CARE, Issue 3 2010
    N. DOYLE msc, nurse consultant
    DOYLE N. (2010) European Journal of Cancer Care19, 284 Survivorship in cancer care An increasing number of people are living with and beyond a cancer diagnosis. Health professionals need to understand the complexity of cancer survivorship and develop skills to help support people living with cancer. [source]


    Breaking bad news , whose responsibility is it?

    EUROPEAN JOURNAL OF CANCER CARE, Issue 4 2009
    B. KALBER msc, onc. cert. matron for neurology
    This module considers different aspects of communicating a cancer diagnosis to the patient. Using a UK study, it looks at who breaks bad news in cancer care, frameworks for breaking bad news and the role of nurses. [source]


    Developing practice in cancer rehabilitation

    EUROPEAN JOURNAL OF CANCER CARE, Issue 3 2009
    S. ACREMAN msc, consultant practitioner
    This module explores the concept of rehabilitation and supportive care in a cancer context. It examines policy and practice that inform rehabilitation in cancer care in England and considers how rehabilitation and supportive care issues can be addressed in clinical practice. [source]


    Spirituality in cancer care

    EUROPEAN JOURNAL OF CANCER CARE, Issue 5 2008
    B. QUINN
    Abstract Spirituality affects us all, although it takes many different forms. The spiritual needs of patients and families may not always be obvious to health professionals and this module will consider the theoretical and practical skills required to address them. [source]


    A retrospective audit exploring the use of relaxation as an intervention in oncology and palliative care

    EUROPEAN JOURNAL OF CANCER CARE, Issue 5 2008
    J. MILLER
    The benefits of relaxation in cancer care have been well documented within the literature, with the majority of research being undertaken by nursing professionals. However, evidence of the effectiveness of relaxation interventions by occupational therapists is lacking. Occupational therapists are in an ideal situation to provide information and practical relaxation sessions. Athough in numerical terms, the outcome of relaxation interventions is small, functional outcome related to quality of life and independence in activities of daily living is immeasurable. This article reports the findings of a retrospective audit exploring relaxation-specific referrals to occupational therapy, and identifies effectiveness of a variety of different techniques currently employed within this specific programme. Patients with a primary diagnosis of breast cancer were the most frequently seen, and this prevalence is reflected in current national statistics. Similarly, those between 50 and 59 years of age comprised the largest group. Guided visualization was the most commonly used technique, although there appeared to be very little change in perceived tension between all the techniques. Further study of the impact relaxation has on occupational performance would be worthwhile. [source]


    Information and communications technology in cancer care

    EUROPEAN JOURNAL OF CANCER CARE, Issue 3 2008
    P. WILSON phd, director Article first published online: 16 APR 200
    No abstract is available for this article. [source]


    Traditional Chinese medicine in cancer care: perspectives and experiences of patients and professionals in China

    EUROPEAN JOURNAL OF CANCER CARE, Issue 4 2006
    W. XU md, msc
    Although traditional Chinese medicine (TCM) is widely used in Chinese cancer centres, it is a brand new area for formal scientific evaluation. As the first step of developing a research programme on clinical evaluation of TCM for cancer patients, we conducted a qualitative study to explore the perspectives and experiences of Chinese cancer patients and TCM professionals. Twenty-eight persons participated in two cancer patient focus groups and one professional focus group. Semi-structured interviews were audiotaped, transcribed and translated. Textual transcripts and field notes underwent inductive thematic analysis. We found that patients' decision to use TCM for cancer is a self-help process with a deep cultural grounding, which is related to the traditional Chinese philosophy of life. Participants perceived TCM to be an effective and harmless therapy. They highly valued the fact that TCM is tailored to patients, and believed it was the basis of an optimal and safe treatment. Participants also highlighted the long-term positive effects, the benefit of group interventions and the low cost as important features of TCM. Subjects believed that conducting clinical research would be crucial for the recognition and dissemination of TCM in Western countries. The findings of this study are expected to contribute to the knowledge base on the current TCM use for cancer in China, and to provide useful information for developing future clinical research in this area in Western countries. [source]


    Provision of oncology services in remote rural areas: a Scottish perspective

    EUROPEAN JOURNAL OF CANCER CARE, Issue 2 2004
    S.M. SMITH research assistant
    There is a paucity of research into rural health care services. In particular little is known about the provision of specialist cancer services for patients who live in remote rural areas of the UK. This study set out to investigate current models of medical and clinical oncology care in Scotland. A national survey with key health professionals was conducted to identify rural oncology schemes currently in operation. Detailed quantitative data about the schemes together with qualitative data on how health professionals view current models of care were collected by a computer-assisted telephone survey. Schemes that currently provide outpatient and chemotherapy oncology services for remote rural patients fell into three categories: central clinics (5); shared care outreach clinics with chemotherapy provision (11); and shared care outreach clinics without chemotherapy provision (7). All radiotherapy was conducted at central clinics (5). Widely varying practices in delivery of cancer care were found across the country. The main issues for professionals about current models of care involved expertise, travelling and accessibility (for patients), communication and expansion of the rural service. Nation-wide consistency in cancer care has still to be achieved. Travelling for treatment was seen to take its toll on all patients but particularly for the very remote, elderly and poor. Most professionals believe that an expansion of rural services would be of benefit to these patients. It is clear, however, that the proper infrastructure needs to be in place in terms of local expertise, ensured quality of care, and good communication links with cancer centres before this could happen. [source]


    Group mediation of complementary and alternative medicine in cancer care in the UK and Pakistan

    EUROPEAN JOURNAL OF CANCER CARE, Issue 4 2003
    P. TOVEY
    No abstract is available for this article. [source]


    Quantitative and qualitative methods in UK health research: then, now and . . . ?

    EUROPEAN JOURNAL OF CANCER CARE, Issue 3 2002
    K. Mcpherson phd
    Quantitative and qualitative methods in UK health research: then, now and . . . ? This paper examines the current status of qualitative and quantitative research in the context of UK (public) health research in cancer. It is proposed that barren competition between qualitative and quantitative methods is inevitable, but that effective synergy between them continues to be essential to research excellence. The perceived methodological utility, with respect to understanding residual uncertainties, can account for the status accorded various research techniques and these will help to explain shifts witnessed in recent years and contribute towards an understanding of what can be realistically expected in terms of future progress. It is argued that the methodological debate, though familiar to many, is worthy of rearticulation in the context of cancer research where the psychosocial aspects of living with a cancer and the related complexity of providing appropriate cancer care are being addressed across Europe, as evidenced in recent directions in policy and research. [source]


    High-touch cancer care associated with improved symptom control

    FOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 1 2005
    Article first published online: 14 JUN 2010
    [source]


    Evaluating the impact of a cancer supportive care project in the community: patient and professional configurations of need

    HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2007
    Kristian Pollock PhD MA PGCHE
    Abstract Advances in cancer care and treatment have created a new and somewhat anomalous category of patients with a diagnosis of non-curative disease who still have a considerable period of life remaining. During much of this time they may remain relatively well, without manifest need for clinical care. The responses of patients to this challenging situation are largely unknown. However, it has been assumed that because they confront a difficult experience they will need, or can benefit from, professional intervention. The implementation of pre-emptive support measures is anticipated to improve patients' resilience in coping with their illness and approaching death. This study aimed to investigate the impact of the keyworker role in a 3-year cancer supportive community care project to identify and provide for the needs of patients with a diagnosis of non-curative cancer. It was a qualitative study incorporating face-to-face interviews and focus groups with 19 healthcare professionals and 25 patients and carers from an urban East Midlands locality and a thematic analysis of qualitative interview and focus group transcripts. The project was positively evaluated by patients, carers and professionals. However, the findings raised questions about the different configuration of ,need' within the lay and professional perspectives and how this should most appropriately be addressed. In contrast to widespread professional assumptions about patients' need for counselling, many patients preferred to turn to their friends and families for support, and to adopt a stance of emotional and personal self-reliance as a strategy for coping with their predicament. The study highlights the continuing orientation of services around professional, rather than patient, agendas and the momentum towards increasing specialisation of professional roles and the medicalisation of everyday life that flows from this. [source]


    The impact of detection and treatment on lifetime medical costs for patients with precancerous polyps and colorectal cancer

    HEALTH ECONOMICS, Issue 12 2009
    David H. Howard
    Abstract Understanding the costs associated with early detection of disease is important for determining the fiscal implications of government-funded screening programs. We estimate the lifetime medical costs for patients with screen-detected versus undetected polyps and early-stage colorectal cancer. Typically, cost,effectiveness studies of screening account only for the direct costs of screening and cancer care. Our estimates include costs for unrelated conditions. We applied the Kaplan,Meier Smoothing Estimator to estimate lifetime costs for beneficiaries with screen-detected polyps and cancer. Phase-specific costs and survival probabilities were calculated from the Surveillance, Epidemiology, and End Results-Medicare database for Medicare beneficiaries aged ,65. We estimate costs from the point of detection onward; therefore, our results do not include the costs associated with screening. We used a modified version of the model to estimate what lifetime costs for these patients would have been if the polyps or cancer remained undetected, based on assumptions about the ,lead time' for polyps and early-stage cancer. For younger patients, polyp removal is cost saving. Treatment of early-stage cancer is cost increasing. Copyright © 2009 John Wiley & Sons, Ltd. [source]


    Are guidelines on use of colony-stimulating factors in solid cancers flawed?

    INTERNAL MEDICINE JOURNAL, Issue 4 2009
    I. E. Haines
    Abstract In cancer care in Australia, we are very reliant on an array of expensive pharmaceuticals. Our use of these treatments is often based on multinational or foreign clinical studies. Oncologists are, to varying degrees, reliant on how the studies are interpreted by the writers of journal editorials, clinical guidelines and opinion pieces. Therefore it is important that these guidelines are balanced and evidence based. We have examined in detail one of the most influential and wide ranging clinical guidelines used in oncology, The American Society of Clinical Oncology (ASCO) 2006 Update of Recommendations for the use of White Blood Cell Factors: An Evidence-Based Clinical Practice Guideline. We have discussed in detail some of the controversial recommendations in this guideline and have exposed what we believe are some flaws in these recommendations. We would urge that we continue to be rigorous in our oversight of international research agendas and international clinical guidelines in the future. [source]


    Diagnosing cancer: changing patterns of care

    INTERNAL MEDICINE JOURNAL, Issue 2 2007
    E. Lim
    Abstract We prospectively assessed 100 consecutive inpatient referrals made to the Medical Oncology Unit. The major end-point was the time to diagnostic biopsy. Referral trends and treatment outcomes were also recorded. Our results show that the referring units undertook the diagnostic process in the vast majority and the time to inpatient diagnostic biopsy has fallen from 10 to 4.6 days, compared with a similar study 13 years ago. This emphasizes the changing role of the oncologist in current day multidisciplinary cancer care. [source]


    Screening for mental disorders in cancer patients , discriminant validity of HADS and GHQ-12 assessed by standardized clinical interview

    INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2001
    Katrin Reuter
    Abstract The detection and classification of comorbid mental disorders has major implications in cancer care. Valid screening instruments for different diagnostic specifications are therefore needed. This study investigated the discriminant validity of the German versions of the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire (GHQ-12). A total of 188 cancer patients participated in the examination, consisting first of the assessment of psychological distress and, second, of the diagnosis of mental disorders according to DSM-IV by clinical standardized interview (CIDI). Discriminant validity of the two instruments regarding the diagnosis of any mental disorder, anxiety, depression and multiple mental disorders was compared using ROC analysis. Overall, the total HADS scale shows a better screening performance than the GHQ-12, especially for the detection of depressive and anxiety disorders. Best results are achieved for depressive disorders with an area under the curve (AUC) of 0.80, a sensitivity of 79% and a specificity of 76% (cut-off point = 17). For the ability of the instruments to detect patients with mental disorders in general, the GHQ-12 (AUC: 0.68) shows a similar overall accuracy to the HADS (AUC: 0.70). The screening performance of both scales for comorbid mental disorders is comparable. The HADS is a valid screening instrument for depressive and anxiety disorders in cancer care. The GHQ-12 can be considered as an alternative to the HADS when diagnostic specifications are less detailed and the goal of screening procedures is to detect patients with single or multiple mental disorders in general. Limitations of conventional screening instruments are given through the differing methodological approaches of screening tests (dimensional approach) and diagnosis according to DSM-IV (categorical approach). Copyright © 2001 Whurr Publishers Ltd. [source]


    Factors underlying the inclination to donate to particular types of charity

    INTERNATIONAL JOURNAL OF NONPROFIT & VOLUNTARY SECTOR MARKETING, Issue 1 2003
    Roger Bennett
    Two hundred and fifty members of the general public were interviewed in central London and asked to assume that they had been given a certain sum of money, all of which they had to donate to a single good cause. The interviewees were presented with the names of three organisations in different fields (cancer care, animal welfare and human rights) and asked to make a selection. Respondents were then questioned about their personal values, inclinations and other characteristics potentially relevant to the choice. It emerged that personal values and inclinations exerted powerful influences on selections. Moreover, the possession of certain personal values and inclinations correlated significantly with specific organisational values that the respondents most admired. Copyright © 2003 Henry Stewart Publications [source]


    Is nurse,patient agreement of importance to cancer nurses' satisfaction with care?

    JOURNAL OF ADVANCED NURSING, Issue 3 2010
    Gunilla Mårtensson
    mårtensson g., carlsson m. & lampic c. (2010) Is nurse,patient agreement of importance to cancer nurses' satisfaction with care? Journal of Advanced Nursing66(3), 573,582. Abstract Aim., This paper is a report of a study of situational (nurse,patient agreement), personal and occupational factors of potential importance to oncology nurses' satisfaction with care provided and general work satisfaction. Background., Nurses have a general tendency to attribute to patients with cancer more problems and suffering than patients themselves report. However, little is known about whether dis/agreement between oncology nurses and patients with cancer concerning perceptions of patients' situation is of importance to nurses' satisfaction with their work. Methods., The study had a comparative and prospective design. Data were collected in 2005 using self-administrated questionnaires with 81 consecutively recruited nurse,patient pairs. Data were analysed with non-parametric tests (for comparison between subgroups) and with multiple regression analyses (for identifying predictors). Results., Initial nurse,patient agreement concerning patients' emotional distress, coping resources and quality of life did not appear to be important to nurses' subsequent satisfaction with the care directed at a specific patient. However, higher satisfaction with care provided as well as general work satisfaction was reported by nurses with more experience of cancer care and with a lower workload. Conclusion., To improve oncology nurses' opportunities to provide high quality cancer care, novice nurses and advanced beginners in particular should receive support and nurses' working conditions must be improved. Further research is needed to examine whether there are other aspects of the nurse,patient relationship that contribute to oncology nurses' satisfaction with the care provided to specific patients. [source]


    Patient perceptions of helpful communication in the context of advanced cancer

    JOURNAL OF CLINICAL NURSING, Issue 13-14 2010
    Kelli I Stajduhar
    Aims and objectives., Based on a secondary analysis of data from a large qualitative study on cancer care communication, we address the question: what do patients with advanced cancer identify as helpful in their communication encounters with health care providers? Background., Communication is of critical importance to the care of patients with advanced cancer. A better understanding of what such patients identify as helpful in their communication encounters with nurses and other health care providers seems critical to creating evidence-informed recommendations for best practices. Design., Secondary analysis of qualitative interview data. Methods., Data from 18 participants interviewed individually and 16 focus group participants, with advanced cancer in the palliative phase of care. Interpretive description methodology informed data collection and analysis. Results., Findings suggest four key elements are critically important to consider in communications with patients in an advanced or palliative phase , respecting the importance of time, demonstrating caring, acknowledging fear and balancing hope and honesty in the provision of information. Conclusions., Communication is an important element in the provision of advanced cancer care. Relevance to clinical practice., Findings emphasise the complex meanings inherent in cancer care communication and identify central themes that are fundamental to effective cancer care communication. [source]


    Parents' experiences of a Family Support Program when a parent has incurable cancer

    JOURNAL OF CLINICAL NURSING, Issue 24 2009
    Kari E Bugge
    Aims and objectives., The Family Support Program was created to support children and parenting when one of the parents has incurable cancer. We chose a family-based approach to support parent's coping and to help families pull together, identify strengths in the family and learn how to seek help. Background., Cancer is usually a new experience for young families. In most cases, parents do not have the necessary knowledge about their children's need for information and support about their parent's serious illness and impending death. Design., A qualitative evaluation study based on data collected through in-depth interviews focusing on parent's experiences with the Family Support Program. Methods., Participants were patients with incurable cancer and their partners and ex-partners with children aged between 5,18 years. Thirteen parents were in-depth interviewed. Results., Parents described how the Family Support Program helped them gain greater insight into their children's thoughts and reactions and into how the situation affected their daily living. Parents reported that conflicts were reduced, they could talk more openly about the situation in the family and that they were shown how to support their children's coping. Conclusion., The Family Support Program met the parents in the study's needs for more information and support about how to cope with their children during the patient's terminal illness. Relevance to clinical practice., The Family Support Program is described in detail in a manual that makes it easy for other health workers to use the same programme. The Family Support program was in use in outpatient clinics, oncology wards and palliative care units and was provided both from nurses and social workers trained in cancer care. Parent's in the study would like the Family Support Program to be available to all patients who receive the poor prognosis that their cancer cannot be cured. [source]


    A systematic review of honey uses and its potential value within oncology care

    JOURNAL OF CLINICAL NURSING, Issue 19 2008
    Joy Bardy
    Aim., To synthesise the evidence regarding honey's role in health care and to identify whether this evidence applies more specifically to cancer care. Design., Systematic review. Methods., The inclusion and exclusion criteria were agreed by two reviewers and a keyword strategy was developed. EMBASE, CINAHL, AMED, MEDLINE, COCHRANE and PUBMED databases were screened to identify suitable articles. The citation list from each included study was also screened for potentially suitable papers. The key findings from each study were entered onto a data extraction sheet. Results., In total, 43 studies were included in the systematic review, which included studies in relation to wounds (n = 19), burns (n = 11), skin (n = 3), cancer (n = 5) and others (n = 5). In addition, a systematic review regarding honey use in wound care was also included. While the majority of studies noted the efficacy of honey in clinical use, five studies found honey to be equally as effective as the comparator and three found honey to be less effective than the comparator treatment. Other research did not illustrate any significant difference between standard treatment regimes vs. honey treatment. Studies were generally poor in quality because of small sample sizes, lack of randomisation and absence of blinding. Conclusions., Honey was found to be a suitable alternative for wound healing, burns and various skin conditions and to potentially have a role within cancer care. Relevance to clinical practice., In the cancer setting, honey may be used for radiation-induced mucositis, radiotherapy-induced skin reactions, hand and foot skin reactions in chemotherapy patients and for oral cavity and external surgical wounds. [source]


    Role boundaries , research nurse or clinical nurse specialist?

    JOURNAL OF CLINICAL NURSING, Issue 4 2002
    A literature review
    ,,This paper focuses on issues relating to the role components of clinical nurse specialists and clinical research nurses working in breast cancer care. ,,Identified issues relate to the lack of agreement as to the role and definition of clinical nurse specialists. At the same time there has been an increase and emergence of clinical research nurses, both within the NHS and university departments. ,,The review fails to reveal the relationship between these two specialist groups in terms of role overlap and role boundaries. ,,The lack of knowledge in this area substantiates the need for further research to be carried out. [source]