Introduction: Continued smoking by cancer patients causes adverse cancer treatment outcomes, but few patients receive evidence-based smoking cessation as a standard of care.

Aim: To evaluate practical strategies to promote wide-scale dissemination and implementation of evidence-based tobacco cessation services within state cancer centers.

Methods: A Collaborative Learning Model (CLM) for Quality Improvement was evaluated with three community oncology practices to identify barriers and facilitate practice change to deliver evidence-based smoking cessation treatments to cancer patients using standardized assessments and referrals to statewide smoking cessation resources. Patients were enrolled and tracked through an automated data system and received follow-up cessation support post-enrollment. Monthly quantitative reports and qualitative data gathered through interviews and collaborative learning sessions were used to evaluate meaningful quality improvement changes in each cancer center.

Results: Baseline practice evaluation for the CLM identified the lack of tobacco use documentation, awareness of cessation guidelines, and awareness of services for patients as common barriers. Implementation of a structured assessment and referral process demonstrated that of 1,632 newly registered cancer patients,1,581 (97%) were screened for tobacco use. Among those screened, 283 (18%) were found to be tobacco users. Of identified tobacco users, 207 (73%) were advised to quit. Referral of new patients who reported using tobacco to an evidence-based cessation program increased from 0% at baseline across all three cancer centers to 64% (range = 30%–89%) during the project period.

Conclusions: Implementation of quality improvement learning collaborative models can dramatically improve delivery of guideline-based tobacco cessation treatments to cancer patients.

Snake farming in Asia has increased over the past decade, and conservationists have expressed concerns that farms may foster overexploitation of wild populations and create legal conduits for illegally harvested wild individuals. We conducted face-to-face interviews with snake farmers in Viet Nam and China, with the aim of describing the basic models under which snakes are farmed for meat. We synthesized this information to assess the feasibility of farming snakes for human consumption, drawing conclusions about the impact of this industry on the conservation of wild snake populations. The most commonly farmed snakes include the monocled cobra Naja kaouthia, the Chinese cobra Naja atra, the oriental rat snake Ptyas mucosus and the king cobra Ophiophagus hannah. These species have life histories that are compatible with the demands of intensive livestock production, including early maturity, rapid growth rates, high reproductive output, efficient food assimilation rates and undemanding space requirements. Snake farmers appear to be capitalizing on the unique energy-efficiency of snakes to produce meat for human consumption. We conclude that the ease and profitability of farming snakes in China and Viet Nam make farming a viable substitute for harvesting wild snakes, with apparently minimal threat to wild populations. Snake farming offers a range of novel agricultural opportunities and has the potential to play a pivotal role in sustainable development.

Collaboration is used by the US National Security Council as a means to integrate inter-federal government agencies during planning and execution of common goals towards unified, national security. The concept of collaboration has benefits in the healthcare system by building trust, sharing resources, and reducing costs. The current terrorist threats have made collaborative medical training between military and civilian agencies crucial.

This review summarizes the long and rich history of collaboration between civilians and the military in various countries and provides support for the continuation and improvement of collaborative efforts. Through collaboration, advances in the treatment of injuries have been realized, deaths have been reduced, and significant strides in the betterment of the Emergency Medical System have been achieved. This review promotes collaborative medical training between military and civilian medical professionals and provides recommendations for the future based on medical collaboration.