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1

Surgical emergencies in oncology.  

PubMed

An oncologic emergency is defined as an acute, potentially life threatening condition in a cancer patient that has developed as a result of the malignant disease or its treatment. Many oncologic emergencies are signs of advanced, end-stage malignant disease. Oncologic emergencies can be divided into medical or surgical. The literature was reviewed to construct a summary of potential surgical emergencies in oncology that any surgeon can be confronted with in daily practice, and to offer insight into the current approach for these wide ranged emergencies. Cancer patients can experience symptoms of obstruction of different structures and various causes. Obstruction of the gastrointestinal tract is the most frequent condition seen in surgical practice. Further surgical emergencies include infections due to immune deficiency, perforation of the gastrointestinal tract, bleeding events, and pathological fractures. For the institution of the appropriate treatment for any emergency, it is important to determine the underlying cause, since emergencies can be either benign or malignant of origin. Some emergencies are well managed with conservative or non-invasive treatment, whereas others require emergency surgery. The patient's performance status, cancer stage and prognosis, type and severity of the emergency, and the patient's wishes regarding invasiveness of treatment are essential during the decision making process for optimal management. PMID:24933674

Bosscher, M R F; van Leeuwen, B L; Hoekstra, H J

2014-09-01

2

Risk prediction tools in surgical oncology.  

PubMed

Healthcare has increasingly focused on patient engagement and shared decision-making. Decision aids can promote engagement and shared decision making by providing patients and their providers with care options and outcomes. This article discusses decision aids for surgical oncology patients. Topics include: short-term risk prediction following surgery, long-term risk prediction of survival and recurrence, the combination of short- and long-term risk prediction to help guide treatment choice, and decision aid usability, transparency, and accessibility. J. Surg. Oncol. 2014 110:500-508. © 2014 Wiley Periodicals, Inc. PMID:24975865

Kinnier, Christine V; Asare, Elliot A; Mohanty, Sanjay; Paruch, Jennifer L; Rajaram, Ravi; Bilimoria, Karl Y

2014-10-01

3

The Clinico-Oncologic Outcomes of Elderly Patients with Glioblastoma after Surgical Resection Followed by Concomitant Chemo-Radiotherapy  

PubMed Central

Background There have been controversies in the treatment of elderly patients with glioblastoma. We introduce the outcome of the treatment of elderly patients with glioblastoma comparing with younger patients. Methods The author's hospital database was used to identify patients with histologically confirmed glioblastoma after surgery between January 2006 and December 2013. Forty-eight patients (control group) were under age 65 and 16 patients (elderly group) were aged 65 years or over at the time of surgery. Results The median age of the elderly group was 71 years and control group was 50 years. Mean number of medical comorbidities was 1.8 in the elderly group vs. 0.5 in the control group. The median progression free survival (PFS) was 5.6 months and the median overall survival (OS) was 19.9 months in all patients. The elderly group had a median PFS of 4.2 months vs. 8 months for the control group (log-rank test, p=0.762). Median OS was 8.2 months in the elderly group vs. 20.9 months in the control group (log-rank test, p=0.457). Major complications occurred in 5 cases (7.8%) for all patients. The ratio of completion of concomitant chemo-radiotherapy (CCRT) was 81.3% and was the same between the two groups. In multivariable analysis, extent of resection (p=0.034) and completion of CCRT (p=0.023) were statistically significant, independent prognostic factors only for PFS in all patients by Cox proportional hazards model. Age was not an independent prognostic factor. As for OS, there was no significant factor. Conclusion Surgical resection and CCRT were well tolerated in elderly patients with glioblastoma, and maximal safe resection followed by timely CCRT could improve clinic-oncologic outcomes.

Park, Hee-Kwon; Song, Sang Woo

2014-01-01

4

Free Fibula Long Bone Reconstruction in Orthopedic Oncology: A Surgical Algorithm for Reconstructive Options  

Microsoft Academic Search

The fibula free flap became popular in orthopedic oncology for limb-sparing long bone tumor resection. It is particularly suitable for intercalary or resection arthro- desis options. In the present series, a surgical reconstruc- tion algorithm was used, enabling each patient to receive a personalized technique. During the years 1998 to 2002, 30 patients underwent limb-sparing surgery for long bone sarcoma.

Arik Zaretski; Aharon Amir; Isaac Meller; David Leshem; Yehuda Kollender; Yoav Barnea; Jacob Bickels; Thomas Shpitzer; Dean Ad-El; Eyal Gur

5

ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology.  

PubMed

Parenteral nutrition offers the possibility of increasing or ensuring nutrient intake in patients in whom normal food intake is inadequate and enteral nutrition is not feasible, is contraindicated or is not accepted by the patient. These guidelines are intended to provide evidence-based recommendations for the use of parenteral nutrition in cancer patients. They were developed by an interdisciplinary expert group in accordance with accepted standards, are based on the most relevant publications of the last 30 years and share many of the conclusions of the ESPEN guidelines on enteral nutrition in oncology. Under-nutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis and, per se, responsible for excess morbidity and mortality. Many indications for parenteral nutrition parallel those for enteral nutrition (weight loss or reduction in food intake for more than 7-10 days), but only those who, for whatever reason cannot be fed orally or enterally, are candidates to receive parenteral nutrition. A standard nutritional regimen may be recommended for short-term parenteral nutrition, while in cachectic patients receiving intravenous feeding for several weeks a high fat-to-glucose ratio may be advised because these patients maintain a high capacity to metabolize fats. The limited nutritional response to the parenteral nutrition reflects more the presence of metabolic derangements which are characteristic of the cachexia syndrome (or merely the short duration of the nutritional support) rather than the inadequacy of the nutritional regimen. Perioperative parenteral nutrition is only recommended in malnourished patients if enteral nutrition is not feasible. In non-surgical well-nourished oncologic patients routine parenteral nutrition is not recommended because it has proved to offer no advantage and is associated with increased morbidity. A benefit, however, is reported in patients undergoing hematopoietic stem cell transplantation. Short-term parenteral nutrition is however commonly accepted in patients with acute gastrointestinal complications from chemotherapy and radiotherapy, and long-term (home) parenteral nutrition will sometimes be a life-saving maneuver in patients with sub acute/chronic radiation enteropathy. In incurable cancer patients home parenteral nutrition may be recommended in hypophagic/(sub)obstructed patients (if there is an acceptable performance status) if they are expected to die from starvation/under nutrition prior to tumor spread. PMID:19477052

Bozzetti, F; Arends, J; Lundholm, K; Micklewright, A; Zurcher, G; Muscaritoli, M

2009-08-01

6

Robot-Assisted Radical Hysterectomy for Cervical Cancer: Review of Surgical and Oncological Outcomes  

PubMed Central

Robot-assisted procedures are being increasingly incorporated in gynaecologic oncology. Several studies have confirmed the feasibility and safety of robotic radical hysterectomy for selected patients with early-stage cervical cancer. It has been demonstrated that robotic radical hysterectomy offers an advantage over other surgical approaches with regard to operative time, blood loss, and hospital stay. Also initial evidences concerning oncological outcomes seem to confirm the equivalence to traditional open technique. Despite the fact that costs of robotic system are still high, they could be partially offset by several health-related and social benefits: less pain, faster dismissal, and return to full activity than other surgical approaches. The development of robotic technology may facilitate the spread of minimally invasive surgery in gynaecological oncology, overcoming some drawbacks of laparoscopic technique for challenging intervention such as radical hysterectomy. Further studies are needed to evaluate overall and disease-free survival of this technique and associated morbidity after adjuvant therapies. PMID:22111022

Renato, Seracchioli; Mohamed, Mabrouk; Serena, Solfrini; Giulia, Montanari; Giulia, Ferrini; Giulia, Giovanardi; Diego, Raimondo; Riccardo, Schiavina

2011-01-01

7

Palliative Techniques and Supportive Procedures in Surgical Oncology  

Microsoft Academic Search

In palliative treatment surgery plays an important role: the primary aim of any palliative surgery is the relief of symptoms,\\u000a with preservation or improvement in the quality of life [1]. In oncological practice, palliative surgery in the broadest sense refers to surgery that is by nature non curative. Palliative\\u000a surgery also involves surgical procedures that are aimed primarily at the

Patrizia Racca; Baudolino Mussa; Riccardo Ferracini; Dorico Righi; Lorenzo Repetto; Rosella Spadi

8

Quality assurance in surgical oncology. Colorectal cancer as an example.  

PubMed

Quality assurance in surgical oncology is a field of growing importance. National, regional and local systems have been built up in many countries. Often the quality assurance projects are linked to different registers. The advantage of such a link is the possibility of obtaining population-based data from unselected health care institutions. Few discussions of results from such projects have been published. Quality assurance of colorectal cancer surgery implies the development and use of systems for improvement all the way from detection of the cancer to the outcome as survival and patient satisfaction. To achieve this we must know what methods are being used and the outcome of our treatments. Designing processes for improvement necessitates careful planning, including decisions about end-points. Some crucial issues are discussed step-by-step in the present paper. In addition to auditing and providing collegial feedback, quality assurance is a tool for closing the gap between clinical practice and evidence based medicine and for creating new evidences as well as monitoring the introduction of new techniques and their effects. PMID:12559084

Gunnarsson, Ulf

2003-02-01

9

Does the number of exogenous infections increase in paediatric oncology patients when sterile surgical gloves are not worn for accessing central venous access devices?  

PubMed

The aim of this study was to determine whether the routine use of sterile gloves when accessing central venous catheters (CVCs) affects the incidence of exogenous septicaemia in paediatric oncology patients. The 36-month study period ran prospectively from September 2000 to August 2003. During this time the routine use of sterile gloves for accessing CVCs was suspended. Sterile gloves were only used when obtaining blood samples from the line or injecting substances that required direct entry into the lumen with removal of line cap. Surveillance cultures of throat and rectum were obtained to detect carriage of potential pathogens. Exogenous septicaemia was defined as a blood stream infection due to microorganisms not carried by the patient in throat and/or rectum. The incidence of exogenous septicaemia following a change of practice of not routinely using sterile gloves for accessing lines was compared to the incidence of exogenous septicaemia in a historical control group. The number of exogenous septicaemia episodes per inpatient days with gloves and without gloves was calculated for the total number of episodes and for the first episode for each child. The relative incidence and 95% confidence intervals was also calculated for first and total episodes. For both, all episodes and first episodes there was no statistically significant difference in the incidence of exogenous septicaemia comparing the control and study patients. In summary, this study does not support or approve the use of sterile gloves when accessing CVCs in respect of exogenous septicaemia. PMID:17584528

Hemsworth, Sue; Selwood, Karen; van Saene, Rick; Pizer, Barry

2007-12-01

10

Improving patient safety in radiation oncology  

SciTech Connect

Beginning in the 1990s, and emphasized in 2000 with the release of an Institute of Medicine report, healthcare providers and institutions have dedicated time and resources to reducing errors that impact the safety and well-being of patients. But in January 2010 the first of a series of articles appeared in the New York Times that described errors in radiation oncology that grievously impacted patients. In response, the American Association of Physicists in Medicine and the American Society of Radiation Oncology sponsored a working meeting entitled ''Safety in Radiation Therapy: A Call to Action''. The meeting attracted 400 attendees, including medical physicists, radiation oncologists, medical dosimetrists, radiation therapists, hospital administrators, regulators, and representatives of equipment manufacturers. The meeting was cohosted by 14 organizations in the United States and Canada. The meeting yielded 20 recommendations that provide a pathway to reducing errors and improving patient safety in radiation therapy facilities everywhere.

Hendee, William R.; Herman, Michael G. [Medical College of Wisconsin, P.O. Box 7319, Rochester, Minnesota 55901 (United States); Department of Radiation Oncology, Desk R, Mayo Clinic, 200 First St. SW Rochester, Minnesota 55905 (United States)

2011-01-15

11

Uncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception  

PubMed Central

Background Bowel intussusception represents an infrequent and challenging condition in adult patients. Preoperative diagnosis and treatment strategies often remain difficult especially in emergency patients. Primary reduction of intussusception before surgical resection is discussed controversially in adult patients and at the moment there is no consensus about the best treatment in literature. Case report We report the case of a 40-year-old male patient with a ten-day history of increasing colicky abdominal pain and constipation associated with nausea and vomiting. Clinical examination revealed acute abdomen with a palpable mass in the right upper abdomen. Ultrasonography and CT-scan showed typical signs of bowel intussusception. Emergency laparotomy and extended right hemicolectomy were performed. Histological examination detected an adenocarcinoma of the ileocecal valve as leading pathology. Conclusions In adults most cases of intussusception are caused by structural lesions. The high incidence of malignancies in adult patients, which require an optimal oncological treatment, should be the main reason for primary surgical resection without reduction. PMID:25083311

2014-01-01

12

Postdural puncture headache in paediatric oncology patients  

Microsoft Academic Search

Purpose  Previous studies have not determined the correlation between durai puncture and postural headache in paediatric patients.\\u000a Furthermore, no studies have evaluated the correlation between atypical headache and durai puncture in the paediatric population.\\u000a Therefore, we prospectively analyzed the incidence of typical postdural puncture headache (PDPHA) and atypical headache in\\u000a paediatric oncology patients following durai puncture.\\u000a \\u000a \\u000a \\u000a Methods  The study population consisted of

Napoleon Burt; B. Hugh Dorman; Scott T. Reeves; Philip F. Rust; Mark L. Pinosky; Miguel R. Abboud; Julio C. Barredo; Joseph H. Laver

1998-01-01

13

Comparison of laparoscopy and laparotomy for the management of early-stage ovarian cancer: surgical and oncological outcomes  

PubMed Central

Objective To investigate the surgical and oncological outcomes of laparoscopic surgery compared with laparotomy for the treatment of early-stage ovarian cancer. Methods Data from patients who underwent surgical management for early-stage ovarian cancer between 2006 and 2012 were retrospectively reviewed. All patients presented with stage I or II disease, and underwent comprehensive staging surgery consisting of a total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, omentectomy, and peritoneal cytology. Results Seventy-seven patients who underwent laparoscopic surgery (24 patients) or laparotomy (53 patients) were identified. Surgery for none of the patients was converted from laparoscopy to laparotomy. The mean operation time was shorter and the estimated blood loss was lower in the laparoscopy group than in the laparotomy group, though the differences were not statistically significant (193 min vs. 224 min, p=0.127; 698 mL vs. 973 mL, p=0.127). There were no differences in the intraoperative or postoperative complications. During a mean follow-up period of 31 months, tumor recurrence occurred in 4 patients: 2 (8.3%) in the laparoscopy group and 2 (3.8%) in the laparotomy group. The mean disease-free survival was 59 months after laparoscopy and 66 months after laparotomy (p=0.367). Conclusion Laparoscopic surgery seems to be adequate and feasible for the treatment of early-stage ovarian cancer with comparable results to laparotomy in terms of the surgical outcomes and oncological safety. PMID:24761214

Koo, Yu-Jin; Kim, Jung-Eun; Kim, Young-Hwa; Hahn, Ho-Suap; Lee, In-Ho; Kim, Tae-Jin; Lee, Ki-Heon; Shim, Jae-Uk

2014-01-01

14

The end of the beginning: society of surgical oncology 2013 presidential address.  

PubMed

In September 2011, the Society of Surgical Oncology (SSO) Executive Council voted to transition to self-management. The transition was successfully completed in October 2012. This article summarizes the infrastructure changes that have occurred to facilitate the transition, the SSO goals, selected results from the 2012 Membership Survey, and future directions for the SSO. PMID:24604588

Morrow, Monica

2014-05-01

15

Duplicate Submission and Scientific Fraud: The Annals of Surgical Oncology Perspective  

Microsoft Academic Search

Publication of original scientific articles in Annals of Surgical Oncology is based upon an “honor system” where authors have the obligation to submit manuscripts for publication with truly original content. That is, the substantive content and conclusions have not been published in other medical journals. Furthermore, any related or overlapping content published in other journals must be appropriately cross-referenced. To

Charles M. Balch

2001-01-01

16

A national survey of restorative consultants' treatment provision for head and neck oncology patients.  

PubMed

Aim To investigate current UK practices in the treatment of head and neck oncology patients by consultants in restorative dentistry.Method A postal questionnaire requesting details of surgical and restorative head and neck oncology care from diagnosis to oral rehabilitation was circulated to all 315 consultants in restorative dentistry in the UK. If a reply was not received within 12 weeks a follow up was sent.Results One hundred and thirty-two (43%) completed questionnaires were returned. On average 46% of respondents treated head and neck oncology patients, this varied with geographical location. Sixty percent of consultants' weekly workload was less than 25% oncology related, while 13% indicated more than 75%. Of the cohort providing oncology care only 12% thought there was always time for dental screening pre-radiotherapy, furthermore 67% had difficulty liaising with primary care. Within the UK great variety existed between attendance at multidisciplinary team meetings, dental care professional support, and provision of dental implant reconstruction including timing, manufacturer, operator, and funding.Conclusion Significant variation in dental input into head and neck oncology patients' pathways exists, most notably with pre-radiotherapy screening. This study highlights a change in trend for patient rehabilitation with dental implants, and an increase to 52% of restorative dentistry consultants' attendance during a multidisciplinary team meeting. PMID:25415039

Calvert, G; Barclay, S C; Owens, J S; Alani, A

2014-11-21

17

Nutritional support of the oncology patient.  

PubMed

This review focuses on the nutritional support of the non-surgical cancer patient. The following topics are reviewed: cancer cachexia (definition and staging, prevalence and impact on clinical outcome); nutritional screening to identify potential candidates for nutritional support; nutritional requirements in terms of macro-and micro-nutrients of the advanced cancer patient. Finally, the indications and results of nutritional support are presented with a special focus on the following issues: routes of delivering nutritional support, the use of standard or n-3 fatty acids-enriched oral nutritional supplements during radiation therapy and/or chemotherapy, tube feeding during RT (with/without chemotherapy), parenteral nutrition during chemotherapy, nutritional support during hematopoietic stem cell transplantation, (home) enteral or total and supplemental parenteral nutrition in the incurable patient. Lastly, the bioethical aspects of feeding patients with incurable disease are briefly reviewed. PMID:23746998

Bozzetti, Federico

2013-08-01

18

Barriers to recruitment for surgical trials in head and neck oncology: a survey of trial investigators  

PubMed Central

Objectives Many randomised trials in surgery suffer from recruitment rates that lag behind projected targets. We aim to identify perceived barriers to recruitment among these pioneering trials in the field of head and neck cancer surgery. Design Recruiting centres to all three trials (Selective Elective Neck Dissection (SEND), Positron Emission Tomography (PET)-Neck and Hyperbaric Oxygen in the Prevention of Osteoradionecrosis (HOPON)) were contacted by email by the chief investigators. Responders were asked to complete a web-based survey in order to identify the barriers to recruitment in their centre and grade each by severity. Setting Secondary care: 44 head and neck oncology regional referral centres. Participants Analysis was based on 85 responses evenly distributed between the three trials. Results The most commonly identified perceived barriers to recruitment (more than 50% of responders identified the item as a barrier in all the three trials) in the order of frequency were: patients consent refusal because of expressed treatment preference, patients consent refusal owing to aversion to randomisation, excess complexity/amount of information provided to patients and lack of time in clinic to accommodate research. The most severely rated of these problems was consent refusal because of the expressed treatment preference and lack of time in the clinic. Conclusions Our findings confirm others’ work in surgery that the most significant barrier to trial recruitment in head and neck cancer surgery is the patient's preference for one arm of the trial. It may be that additional training for those taking consent may be helpful in this regard. It is also important to adequately resource busy surgical clinics to support clinical trial recruitment. PMID:23585392

Kaur, Geetinder; Hutchison, Iain; Mehanna, Hisham; Williamson, Paula; Shaw, Richard; Tudur Smith, Catrin

2013-01-01

19

ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology.  

PubMed

Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where normal food intake is inadequate. These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in cancer patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards, are based on all relevant publications since 1985 and were discussed and accepted in a consensus conference. Undernutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis. EN should be started if undernutrition already exists or if food intake is markedly reduced for more than 7-10 days. Standard formulae are recommended for EN. Nutritional needs generally are comparable to non-cancer subjects. In cachectic patients metabolic modulators such as progestins, steroids and possibly eicosapentaenoic acid may help to improve nutritional status. EN is indicated preoperatively for 5-7 days in cancer patients undergoing major abdominal surgery. During radiotherapy of head/neck and gastrointestinal regions dietary counselling and ONS prevent weight loss and interruption of radiotherapy. Routine EN is not indicated during (high-dose) chemotherapy. PMID:16697500

Arends, J; Bodoky, G; Bozzetti, F; Fearon, K; Muscaritoli, M; Selga, G; van Bokhorst-de van der Schueren, M A E; von Meyenfeldt, M; Zürcher, G; Fietkau, R; Aulbert, E; Frick, B; Holm, M; Kneba, M; Mestrom, H J; Zander, A

2006-04-01

20

Ethical Aspects of Patient Information in Radiation Oncology  

Microsoft Academic Search

Background: While legal aspects of patient information in radiotherapy are often discussed in clinical literature, ethical aspects are mainly a topic of debate only in bioethical literature. Nevertheless, patient information about radiation oncology has many ethical implications which must be considered in order to provide an optimal patient care. Therefore, this publication describes these ethical aspects from a clinical perspective.

Christof Schäfer; Manfred Herbst

2003-01-01

21

http://www.hbuk.co.uk--the European Journal of Surgical Oncology and the Internet.  

PubMed

The popularization of the Internet through the World Wide Web heralds a new era in public and professional communication. The European Journal of Surgical Oncology is now represented on the Web at a site provided, developed and maintained by the publisher. We may expect to see rapid developments in electronic publishing, although the direction and general utility of these changes are not yet clear. This article introduces the EJSO Web site to the readership and considers the ways in which the Internet Revolution may bring benefits to the readership, the publisher, the editorial process and the Journal staff. PMID:9005139

Rew, D A

1996-12-01

22

ENDOSCOPIC ASSESSMENT OF BLADDER TUMOURS: Accuracy of Endoscopic Staging and Grading with Fiberoptic and Digital Cystoscopes Michael A.S. Jewett, Karen Hersey, Kamal Mattar, Mischel G. Neill, Ethan Grober, Raquel Lopez, Anushiya Sathiananthan, Gina Lockwood, Andrew Evans, Emily Seto and Neil Fleshner Department of Surgical Oncology/Urology, Pathology and Medical Engineering  

Cancer.gov

GENITOURINARY ONCOLOGY BIOMARKER RESEARCH Karen Chadwick1 , Ken Evans3, Andrew Evans2, Neil Fleshner1 The Departments of Surgical Oncology (Urology)1 and Pathology2, the University Health Network and the Ontario Cancer BioMarker Network3 ABSTRACT The genitourinary (GU) oncology division at Princess Margaret Hospital (PMH) has developed a site-specific BioBank to serve as a central repository for biospecimens obtained from patients attending out-patient clinics within the division.

23

A nurse practitioner patient care team: implications for pediatric oncology.  

PubMed

The role of the pediatric advanced practice registered nurse continues to evolve within the ever-changing field of health care. In response to increased demand for health care services and because of a variety of changes in the health care delivery system, nurse practitioner patient care teams are an emerging trend in acute care settings. Care provided by nurse practitioner teams has been shown to be effective, efficient, and comprehensive. In addition to shorter hospital stays and reduced costs, nurse practitioner teams offer increased quality and continuity of care, and improved patient satisfaction. Nurse practitioner patient care teams are well suited to the field of pediatric oncology, as patients would benefit from care provided by specialized clinicians with a holistic focus. This article provides health care professionals with information about the use of nurse practitioner patient care teams and implications for use in pediatric oncology. PMID:25013006

Golden, Julia Rose

2014-11-01

24

[A computerized database for managing otorhinolaryngologic oncology patients].  

PubMed

In recent years the management and interdisciplinary treatment of oncological patients has become extremely complex due to the progress made in diagnosis and therapy. As a result, the knowledge required to treat patients can no longer be simply memorized or manually filed. Computer technology provides the ideal instrument for organizing, saving and analyzing data from head and neck tumor patients. The authors have prepared a computerized database to meet the following needs: ease of use, even for non computer savvy users; minimal ambiguity for data entry; use for both clinical and scientific purposes; possibility to create a network with similar database at other Centers; possibility to expand to include image management. The archive is based on a personal computer with an INTEL 80486 microprocessor, 40 Mb RAM, DOS 6.0. and Windows 3.1. The software includes four main routines: a) formulation and management of tables where oncological data are gathered; b) entry and management of patient-related clinical data; c) statistical processing for epidemiological and oncological research and; d) management of basic computer services. In clinical practice the database allows the following: a) preparation of a monthly chart of check-ups, b) rapid tracking of patients lost to followup, c) printout of a summary of the clinical history of each patient at the time of check-up and rapid updating at the end of the examination, d) automatic production of forms such as discharge letters and reports to be shared with related services (i.e. medical oncology, radiotherapy). In addition, the database is a powerful, versatile research tool which can promptly provide all sorts of oncological data and can automatically prepare tables, diagrams, correlations, survival curves. The system was developed from 1993 to 1995 and has been operative, with a few minor modifications and updates, since 1995. Today the database contains more than 1200 oncological cases and the system is used daily by medical and paramedical personnel alike. Approximately 15 new cases are entered a month and 80 cases updated after follow-up. PMID:9926449

Mira, E; Lanza, L; Castelli, A; Benazzo, M; Tinelli, C

1998-06-01

25

Outcome of bacteremia and fungemia in paediatric oncology patients  

PubMed Central

OBJECTIVE: To determine the outcome of paediatric oncology patients with positive blood cultures. DESIGN: Retrospective chart review. SETTING: Tertiary care hospital. POPULATION STUDIED: Oncology patients up to 17 years of age with positive blood cultures from January 1, 1994 to March 31, 1999. MAIN RESULTS: There were 121 episodes of positive blood cultures in 76 patients. Seventeen episodes were excluded because blood cultures were contaminated. Of the organisms grown from the remaining episodes, 63% were Gram-positive organisms, 23% were Gram-negative organisms, 3% were fungal and 11% were mixed. There were 13 episodes with pure or mixed isolates of Staphylococcus aureus, of which nine occurred within 14 days of the placement of a new central venous tunnelled catheter. Central venous tunnelled catheters were retained in 76 of the 102 episodes when they were present. There were two relapses, and four children were admitted to the intensive care unit with septic shock, but all survived. CONCLUSIONS: The outcome was excellent with the current management of possible bacteremia in paediatric oncology patients, but the high incidence of S aureus bacteremia suggests that empirical antibiotics should be altered if sepsis is suspected within 14 days of the placement of a central venous catheter. PMID:18159414

Robinson, Joan L; Rennie, Robert P

2002-01-01

26

[Physical activity and sports for oncology patients].  

PubMed

Physical activity and sport are integrated into support care and their indication is officially recognised. The aim is to improve patients' physical capacities, restore social contact and help improve their psychological condition, by reinforcing in particular their self-esteem. However, patients are not sufficiently well-informed. PMID:24654328

Sauveplane, Dominique; Descotes, Jean-Marc; Renvoise, Nathalie; Dauchy, Sarah

2014-02-01

27

Robotic surgery in gynecologic oncology: evolution of a new surgical paradigm  

Microsoft Academic Search

Robotic surgical platforms were first developed with telesurgery in mind. Conceptualized by NASA and the military to provide\\u000a surgical expertise to remote locations, some telesurgical success has been documented, but progress has been held back by\\u000a communication bandwidth limitations. Telepresence surgery, where the surgeon is in proximity to the patient but is provided\\u000a with an ergonomic console equipped with three-dimensional

John F. Boggess

2007-01-01

28

Nutritional support of the medical oncology patient.  

PubMed

Our current ability to favorably influence the adverse consequences of malnutrition in adult patients with established cancer is quite limited. Nutrient provision alone has not been successful in this regard. In fact, the approach of managing cancer patients with weight loss by solely providing calories is almost entirely extrapolated from clinical situations in which the presence of cancer is not a confounding problem and, therefore, may well be seriously flawed. These conclusions may not apply to situations in which special considerations hold, such as childhood malignancies and bone marrow transplantation. Current clinical management strategies for the cancer patient with weight loss require appropriate attention to the potential influence of the selected intervention on more than one parameter. As illustrated in Figure 1, nutritional support, whether by nutrient provision, pharmacologic administration, or a combination approach, differentially influences several parameters including nutritional status, abnormal host metabolism, gastrointestinal symptoms, and/or tumor growth. Changes in these parameters will influence the true end points with clinical relevance, which are patient survival and quality of life. Increased survival of patients with metastatic cancer has been difficult to achieve, even using chemotherapeutic regimens targeted directly at cancer growth. Similarly, nutritional support for patients with advanced cancer has not demonstrated improvement in this refractory parameter. Therefore, at the present time, clinicians must judge whether a nutritional support modality will favorably or unfavorably influence patient quality of life. This end point is of emerging importance in studies of nutritional support in cancer populations. Potential interrelationships among parameters influenced by nutritional support and their effect on clinically relevant end points are conceptually outlined in Figure 1. It is likely that concurrent attention to both optimal provision of nutrients and reversal of abnormal metabolism will be required if successful nutritional support approaches are to be described. Currently emerging clinical results provide some optimism for the future, but they do not unequivocally support the present routine application of any one particular nutrition support strategy for the medical patient with cancer. PMID:1902828

Chlebowski, R T

1991-02-01

29

Improving patient safety in radiation oncology  

Microsoft Academic Search

Beginning in the 1990s, and emphasized in 2000 with the release of an Institute of Medicine report, health care providers and institutions have dedicated time and resources to reducing errors that impact the safety and well-being of patients. However, in January 2010, the first of a series of articles appeared in The New York Times that described errors in radiation

William R. Hendee; Michael G. Herman

2011-01-01

30

The role of the physiotherapy in the plastic surgery patients after oncological breast surgery  

PubMed Central

Introduction Breast cancer is the disease which causes the greatest concern among women worldwide, with an estimated 1,152,161 new cases each year. The improvement of surgical techniques, neoadjuvant and adjuvant treatment enhance the survival time and recovery of these patients. As surgery is the first choice for the treatment of breast neoplasms reconstructive surgery has become an important procedure helping to reconstruct the mutilation after radical or conservative breast surgery. The objective of this article is to review the scientific literature and examine the available data regarding the role of physiotherapy in patients who undergo plastic reconstruction after oncological breast surgery, including suggestions on how physiotherapy could be applied in that population. Materials and methods Our review was obtained by searching the PubMed (National Library of Medicine, USA) and LILACS (Latin American and Caribbean Health Sciences) databases. Terms applied concerned physiotherapy and breast reconstructive surgery. The time of limit for our search was from 1995 until the present date. Results Fourteen articles were included in our review that matched our search criteria. Conclusions Physiotherapy is a field that still needs evidence based on daily routine and studies in the oncological physiotherapy field. Evaluation should be standardized and rehabilitation techniques used are empirical and should be researched in patients who undergo plastic reconstruction after breast surgery. The lack of post-surgery exercise protocols makes it difficult to analyse the patient’s evolution and makes it a challenge to investigate the true role of physiotherapy in this population. PMID:25083493

Sandrin, Fabio

2014-01-01

31

Central Line Maintenance Bundles and CLABSIs in Ambulatory Oncology Patients  

PubMed Central

OBJECTIVE: Pediatric oncology patients are frequently managed with central lines as outpatients, and these lines confer significant morbidity in this immune-compromised population. We aimed to investigate whether a multidisciplinary, central line maintenance care bundle reduces central line–associated bloodstream infections (CLABSIs) and bacteremias in ambulatory pediatric oncology patients. METHODS: We conducted an interrupted time-series study of a maintenance bundle concerning all areas of central line care. Each of 3 target groups (clinic staff, homecare agency nurses, and patient families) (1) received training on the bundle and its importance, (2) had their practice audited, and (3) were shown CLABSI rates through graphs, in-service training, and bulletin boards. CLABSI and bacteremia person-time incidence rates were collected for 23 months before and 24 months after beginning the intervention and were compared by using a Poisson regression model. RESULTS: The mean CLABSI rate decreased by 48% from 0.63 CLABSIs per 1000 central line days at baseline to 0.32 CLABSIs per 1000 central line days during the intervention period (P = .005). The mean bacteremia rate decreased by 54% from 1.27 bacteremias per 1000 central line days at baseline to 0.59 bacteremias per 1000 central line days during the intervention period (P < .001). CONCLUSIONS: Implementation of a multidisciplinary, central line maintenance care bundle significantly reduced CLABSI and bacteremia person-time incidence rates in ambulatory pediatric oncology patients with central lines. Further research is needed to determine if maintenance care bundles reduce ambulatory CLABSIs and bacteremia in other adult and pediatric populations. PMID:24101764

Bundy, David G.; Chen, Allen R.; Milstone, Aaron M.; Colantuoni, Elizabeth; Pehar, Miriana; Herpst, Cynthia; Fratino, Lisa; Miller, Marlene R.

2013-01-01

32

Complementary and Alternative Medicine (CAM) use by Malaysian oncology patients.  

PubMed

The current study sought to evaluate Malaysian oncology patients' decision making about the use of Complementary and Alternative Medicine (CAM) for the management of their care. Patients were interviewed across three major Malaysian ethnic groups, Malay, Chinese and Indian. Thematic content analysis identified four central themes: Conceptualizing CAM, the decision making process; rationale given for selecting or rejecting CAM and barriers to CAM use. Participants generally used the term 'traditional medicine', referred to locally as 'ubat kampung', meaning medicine derived from 'local traditions'. Mixed reactions were shown concerning the effectiveness of CAM to cure cancer and the slow progression of CAM results and treatment costs were cited as major barriers to CAM use. Concerns regarding safety and efficacy of CAM in ameliorating cancer as well as potential interactions with conventional therapies highlighted the importance of patients' knowledge about cancer treatments. PMID:22500849

Farooqui, Maryam; Hassali, Mohamed Azmi; Abdul Shatar, Aishah Knight; Shafie, Asrul Akmal; Seang, Tan Boon; Farooqui, Muhammad Aslam

2012-05-01

33

Patient-reported Outcomes in End-of-Life Research in Pediatric Oncology  

Microsoft Academic Search

Objective The purpose of this review of published literature was to identify the number and focus of empirically based papers that included research methods used to directly solicit patient-reported outcomes (PRO) from pediatric oncology patients at end of life. Methods Key terms including ''pediatric or child and oncology or cancer and end of life or palliative or hospice or dying''

Pamela S. Hinds; Jennifer Brandon; Caitlin Allen; Nobuko Hijiya; Rachel Newsome; Javier R. Kane

2007-01-01

34

[Informed consent of the surgical patient].  

PubMed

The article analyses the consequences of the paradigm shift in the surgical practice in the last fifty years. The earlier, paternalistic physician-patient relationship has been replaced by an equal one, which is based on informing the patient and involving him or her in the treatment decisions. This shift did not happen uniformly in various medical subspecialties. In this respect, surgery is more conservative than general medicine. The article analyses the most frequent problems of informing patients, and examines the major elements of information, together with their technical conditions in surgery. It reflects on specifics of surgical information disclosure and conditions of refusing medical interventions. PMID:24566653

Kovács, József

2014-02-01

35

Development of an electronic radiation oncology patient information management system.  

PubMed

The quality of patient care is critically influenced by the availability of accurate information and its efficient management. Radiation oncology consists of many information components, for example there may be information related to the patient (e.g., profile, disease site, stage, etc.), to people (radiation oncologists, radiological physicists, technologists, etc.), and to equipment (diagnostic, planning, treatment, etc.). These different data must be integrated. A comprehensive information management system is essential for efficient storage and retrieval of the enormous amounts of information. A radiation therapy patient information system (RTPIS) has been developed using open source software. PHP and JAVA script was used as the programming languages, MySQL as the database, and HTML and CSF as the design tool. This system utilizes typical web browsing technology using a WAMP5 server. Any user having a unique user ID and password can access this RTPIS. The user ID and password is issued separately to each individual according to the person's job responsibilities and accountability, so that users will be able to only access data that is related to their job responsibilities. With this system authentic users will be able to use a simple web browsing procedure to gain instant access. All types of users in the radiation oncology department should find it user-friendly. The maintenance of the system will not require large human resources or space. The file storage and retrieval process would be be satisfactory, unique, uniform, and easily accessible with adequate data protection. There will be very little possibility of unauthorized handling with this system. There will also be minimal risk of loss or accidental destruction of information. PMID:19052391

Mandal, Abhijit; Asthana, Anupam Kumar; Aggarwal, Lalit Mohan

2008-01-01

36

Colorectal cancer in geriatric patients: Endoscopic diagnosis and surgical treatment  

PubMed Central

AIM: To investigate the prevalence of colorectal cancer in geriatric patients undergoing endoscopy and to analyze their outcome. METHODS: All consecutive patients older than 80 years who underwent lower gastrointestinal endoscopy between January 1995 and December 2002 at our institution were included. Patients with endoscopic diagnosis of colorectal cancer were evaluated with respect to indication, localization and stage of cancer, therapeutic consequences, and survival. RESULTS: Colorectal cancer was diagnosed in 88 patients (6% of all endoscopies, 55 women and 33 men, mean age 85.2 years). Frequent indications were lower gastrointestinal bleeding (25%), anemia (24%) or sonographic suspicion of tumor (10%). Localization of cancer was predominantly the sigmoid colon (27%), the rectum (26%), and the ascending colon (20%). Stage Dukes A was rare (1%), but Dukes D was diagnosed in 22% of cases. Curative surgery was performed in 54 patients (61.4%), in the remaining 34 patients (38.6%) surgical treatment was not feasible due to malnutrition and asthenia or cardiopulmonary comorbidity (15 patients), distant metastases (11 patients) or refusal of operation (8 patients). Patients undergoing surgery had a very low in-hospital mortality rate (2%). Operated patients had a one-year and three-year survival rate of 88% and 49%, and the survival rates for non-operated patients amounted to 46% and 13% respectively. CONCLUSION: Nearly two-thirds of 88 geriatric patients with endoscopic diagnosis of colorectal cancer underwent successful surgery at a very low perioperative mortality rate, resulting in significantly higher survival rates. Hence, the clinical relevance of lower gastrointestinal endoscopy and oncologic surgery in geriatric patients is demonstrated. PMID:15637734

Kirchgatterer, Andreas; Steiner, Pius; Hubner, Dietmar; Fritz, Eva; Aschl, Gerhard; Preisinger, Josef; Hinterreiter, Maximilian; Stadler, Bernhard; Knoflach, Peter

2005-01-01

37

Illness perception differences between Russian- and Hebrew-speaking Israeli oncology patients.  

PubMed

Illness perception influences health and illness behaviors. This study was designed to estimate illness perception differences between Russian-speaking and Hebrew-speaking Israeli oncology patients. Changes in illness perception associated with time spent in Israel among Russian-speaking patients were also evaluated. Additionally, we evaluated differences in illness perception of patients exposed to Chernobyl's consequences. A total of 144 oncology patients (77 Hebrew-speaking, 67 Russian-speaking) completed personal data questionnaires and The illness perception questionnaire revised, translated into Russian for this study. Significantly more Russian-speaking oncology patients perceived their illness as chronic and having negative consequences on life (p < .01). Russian-speaking oncology patients tend to have a more negative perception of cancer compared to Hebrew-speaking patients. Time spent in Israel may create more positive perceptions of cancer among these patients. No illness perception differences were found concerning Chernobyl consequences. PMID:24492913

Popov, Nadia; Heruti, Irit; Levy, Sigal; Lulav-Grinwald, Doron; Bar-Sela, Gil

2014-03-01

38

Guidelines on Vaccinations in Paediatric Haematology and Oncology Patients  

PubMed Central

Objective. Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children. Patients and Methods. A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed. Results and Conclusion. During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity. PMID:24868544

Cesaro, Simone; Giacchino, Mareva; Fioredda, Francesca; Barone, Angelica; Battisti, Laura; Bezzio, Stefania; Frenos, Stefano; De Santis, Raffaella; Livadiotti, Susanna; Marinello, Serena; Zanazzo, Andrea Giulio; Caselli, Desiree

2014-01-01

39

[Patients' Rights Act - Relevance for surgical disciplines].  

PubMed

The new Patients' Rights Act does not reflect rights of patients as professional obligations of physicians for the first time. It adopted common longtime jurisdiction, but in some respects it is going beyond. This law clearly extends the documentation requirements of physicians, especially concerning the extent of documentation. In surgical fields the requirements for enlightening physicians were more strongly worded than in previous jurisdiction. In medical facilities it is now mandatory to establish an internal quality management system. PMID:24390850

Haier, J

2014-01-01

40

NCI-CCR Pediatric Oncology Branch - Referring a Patient  

Cancer.gov

These pages are intended for informational purposes only and to foster potential collaboration between professionals in psycho-oncology services. While we tried to include potentially useful resources, this website is not exhaustive. New and additional resources may be available.

41

Safety of pull-type and introducer percutaneous endoscopic gastrostomy tubes in oncology patients: a retrospective analysis  

PubMed Central

Background Percutaneous endoscopic gastrostomy (PEG) allows long-term tube feeding. Safety of pull-type and introducer PEG placement in oncology patients with head/neck or oesophageal malignancies is unknown. Methods Retrospective analysis of 299 patients undergoing PEG tube placement between January 2006 and December 2008 revealed 57 oncology patients. All patients with head/neck or oesophageal malignancy were treated with chemo- and radiotherapy. In case of high-grade stenosis introducer Freka® Pexact PEG tube was placed (n = 24) and in all other patients (n = 33) conventional pull-type PEG tube. Short-term complications and mortality rates were compared. Results Patients' characteristics and clinical status were comparable in both groups. Short-term complications were encountered in 11/24 (48%) introducer PEG patients as compared to only 4/33 (12%) pull-type PEG patients (P < 0.05). Accidental removal of the introducer PEG tube occurred in 4/24 (17%) with need for surgical intervention in 1 vs. 0/33 (0%, P < 0.05). Wound infection occurred in 3/24 (12%) leading to septic shock and admission to intensive care unit (ICU) in 1 vs. 3/33 (9%, NS). Finally, 3/24 gastrointestinal perforations (12%) resulted from a difficult placement procedure vs. 1/33 (3%), leading to urgent surgical intervention and admission to ICU. Two introducer PEG patients died at ICU, resulting in an overall mortality rate of 8% vs. 0% (P = 0.091). Conclusion The introducer Freka® Pexact PEG procedure for long-term tube feeding may lead to significantly higher complication and mortality rates in patients with head/neck or oesophageal malignancies treated with chemo- and radiotherapy. It is suggested to use the conventional pull-type PEG tube placement in this group of patients, if possible. PMID:21410958

2011-01-01

42

Surgical Treatment of the Overweight Patient  

Microsoft Academic Search

Treatment of overweight patients with surgery is increasing at a rapid rate The Nationwide Inpatient Sample from 1998 to 2002 has provided one quantitative estimate of bariatric surgical procedures. Between 1998 and 2002 the number of operations increased from 13,365 to 72,177, a more than 5-fold increase. More than 80% of these were the so-called gastric bypass operation. Several other

George A. Bray

43

[Surgical treatment of patients, suffering Crohn's disease].  

PubMed

In surgical clinic of Zakarpattya's Regional Clinic n. a. Andriy Novak (City of Uzhgorod) 43 patients were observed for complicated Crohn's disease (CD), in whom 79 operations were performed, including in 1 patient--8 interventions, in 10--on 3, in 5--on 2, and in others--on one. Not depending, that the recurrence occurrence rate is definitely high, at average in every 10 yrs for the patients reoperation is indicated, the surgical treatment, conducted in accordance to absolute indications, is considered as highly effective and a sole correct approach for elimination of severe complications of CD, what provides the life span enhancement and its quality rising. Absolute indications for surgical treatment of acute complications of CD are following: perforation, peritonitis, ileus, phlegmon, abdominal and retroabdominal abscesses, profuse bleeding, toxic dilatation of large bowel. Chronic complications of CD--inflammatory infiltrates with the internal organs compression; internal and external fistulas; intestinal stricture with signs of obturation ileus; recurrent paraproctitis; extrasphincteric fistulas; destruction of muscular carcass of anal sphincter. PMID:25097967

Rusyn, V I; Chobe?, S M; Shkriba, I I; Filip, S S

2014-04-01

44

[Oncological and reconstructive management in a patient with multiple recurrences of basal cell carcinoma of the nose].  

PubMed

Basal cell carcinoma (BCC) grows by direct extension replacing local anatomical structure; it rarely metastasizes, however may cause severe injure expanding to contiguous tissues with a biological invasive behaviour. BCC of the nose is often a highly aggressive neoplasia with infiltrative growth pattern. Fast cancer extension to the adjacent facial structures requires wide resection for oncological management. In our study we present a 69-year-old male affected by BCC of the nose back and treated by surgical radical excision with free margin disease at histological examination. Patient, subsequently, developed a local relapse. Therefore, he underwent surgical excision of the recurrence and the histological evaluation pointed out a metatypical and infiltrative BCC pattern without margins involvement. Afterwards, the patient developed another local recurrence involving the left alar nose and the omolateral cheek. Histological examination still demonstrated a metatypical and infiltrative pattern, with disease free margins, but nasal vestibule involvement. Successively the patient had another local wide resection from the nasal wing to the maxillary bone without reconstructive procedure. Three years after, the patient developed another local relapse and underwent another surgical procedure, consisting in a very wide resection with concomitant selective left laterocervical node dissection. Histological evaluation demonstrated a metatypical solid infiltrative BCC pattern with disease free margins and lymph nodes. One year after, forehead flap was made to reconstruct the nose and left cheek deficit. At 16 months follow-up the patient remains disease free. PMID:18366887

Monarca, C; Chiummariello, S; Mazzana, P; Rizzo, M I; Alfano, C; Scuderi, N

2008-03-01

45

Healing the mind/body split: bringing the patient back into oncology.  

PubMed

The effect on oncology of the doctrine of Cartesian dualism is examined. It is argued that (1) this doctrine continues to exert a baneful (though unacknowledged) influence on the practice of oncology, (2) Descartes's doctrine of a mind/body split is mistaken, and (3) mind and body (brain) are inextricably interwoven. A biopsychosocial model of disease is advocated. The role of psychooncology in healing the mind/body split by focusing research attention on the patient is outlined. PMID:12941164

Greer, Steven

2003-03-01

46

Daptomycin Pharmacokinetics in Adult Oncology Patients with Neutropenic Fever ?  

PubMed Central

Daptomycin is the first antibacterial agent of the cyclic lipopeptides with in vitro bactericidal activity against gram-positive organisms, including vancomycin-resistant enterococci, methicillin-resistant staphylococci, and glycopeptide-resistant Staphylococcus aureus. The pharmacokinetics of daptomycin were determined in 29 adult oncology patients with neutropenic fever. Serial blood samples were drawn at 0, 0.5, 1, 2, 4, 8, 12, and 24 h after the initial intravenous infusion of 6 mg/kg of body weight daptomycin. Daptomycin total and free plasma concentrations were determined by high-pressure liquid chromatography. Concentration-time data were analyzed by noncompartmental methods. The results (presented as means ± standard deviations and ranges, unless indicated otherwise) were as follows: the maximum concentration of drug in plasma (Cmax) was 49.04 ± 12.42 ?g/ml (range, 21.54 to 75.20 ?g/ml), the 24-h plasma concentration was 6.48 ± 5.31 ?g/ml (range, 1.48 to 29.26 ?g/ml), the area under the concentration-time curve (AUC) from time zero to infinity was 521.37 ± 523.53 ?g·h/ml (range, 164.64 to 3155.11 ?g·h/ml), the volume of distribution at steady state was 0.18 ± 0.05 liters/kg (range, 0.13 to 0.36 liters/kg), the clearance was 15.04 ± 6.09 ml/h/kg (range, 1.90 to 34.76 ml/h/kg), the half-life was 11.34 ± 14.15 h (range, 5.17 to 83.92 h), the mean residence time was 15.67 ± 20.66 h (range, 7.00 to 121.73 h), and the median time to Cmax was 0.6 h (range, 0.5 to 2.5 h). The fraction unbound in the plasma was 0.06 ± 0.02. All patients achieved Cmax/MIC and AUC from time zero to 24 h (AUC0-24)/MIC ratios for a bacteriostatic effect against Streptococcus pneumoniae. Twenty-seven patients (93%) achieved a Cmax/MIC ratio for a bacteriostatic effect against S. aureus, and 28 patients (97%) achieved an AUC0-24/MIC ratio for a bacteriostatic effect against S. aureus. Free plasma daptomycin concentrations were above the MIC for 50 to 100% of the dosing interval in 100% of patients for S. pneumoniae and 90% of patients for S. aureus. The median time to defervescence was 3 days from the start of daptomycin therapy. In summary, a 6-mg/kg intravenous infusion of daptomycin every 24 h was effective and well tolerated in neutropenic cancer patients. PMID:19015332

Bubalo, Joseph S.; Munar, Myrna Y.; Cherala, Ganesh; Hayes-Lattin, Brandon; Maziarz, Richard

2009-01-01

47

Geriatric oncology: comparing health related quality of life in head and neck cancer patients  

PubMed Central

Background Population ageing is increasing the number of people annually diagnosed with cancer worldwide, once most types of tumours are age-dependent. High-quality healthcare in geriatric oncology requires a multimodal approach and should take into account stratified patient outcomes based on factors other than chronological age in order to develop interventions able to optimize oncology care. This study aims to evaluate the Health Related Quality of Life in head and neck cancer patients and compare the scores in geriatric and younger patients. Methods Two hundred and eighty nine head and neck cancer patients from the Oncology Portuguese Institute participated in the Health Related Quality of Life assessment. Two patient groups were considered: the geriatric (? 65 years old, n = 115) and the younger (45-60 years old, n= 174). The EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires were used. Results Head and neck cancer patients were mostly males, 77.4% within geriatric group and 91.4% among younger patients group. The most frequent tumour locations were similar in both groups: larynx, oral cavity and oropharynx - base of the tongue. At the time of diagnosis, most of younger male patients were at disease stage III/IV (55.9%) whereas the majority of younger female patients were at disease stage I/II (83.4%). The geriatric patient distribution was found to be similar in any of the four disease stages and no gender differences were observed. We found that age (geriatrics scored generally worse), gender (females scored generally worse), and tumour site (larynx tumours denounce more significant problems between age groups) clearly influences Health Related Quality of Life perceptions. Conclusions Geriatric oncology assessments signalize age-independent indicators that might guide oncologic geriatric care optimization. Decision-making in geriatric oncology must be based on tumour characteristics and chronological age but also on performance status evaluation, co-morbidity, and patient reported outcomes assessment. PMID:21232097

2011-01-01

48

Professional psychological support and psychotherapy methods for oncology patients. Basic concepts and issues  

PubMed Central

Background The essence of psychological support provided to oncology patients is to adjust its methods to the needs and expectations arising from the distressful experience of cancer and its treatment. Aim The aim of this study is to present methods of professional psychological support to be used in work with oncology patients during the treatment and follow-up stages. Materials and methods The article is a review of psychological and psychotherapy methods most often applied to oncology patients. Conclusion Methods of psychological support depend on the current condition of a patient. The support will be effective if provided in adequate time and place with the patient's express consent and in line with their individual needs and expectations. PMID:24416542

Cieslak, Katarzyna

2013-01-01

49

The Use of Art in the Medical Decision-Making Process of Oncology Patients  

ERIC Educational Resources Information Center

The introduction of written informed consent in the 1970s created expectations of shared decision making between doctors and patients that has led to decisional conflict for some patients. This study utilized a collaborative, intrinsic case study approach to the decision-making process of oncology patients who participated in an open art therapy…

Czamanski-Cohen, Johanna

2012-01-01

50

Surgical Management of the Pediatric Cochlear Implant Patient.  

ERIC Educational Resources Information Center

This article discusses the surgical management of children receiving cochlear implants. It identifies preoperative considerations to select patients likely to benefit, contraindications, some new surgical techniques, complications, special considerations (otitis media, meningitis, head growth, inner ear malformations, and cochlear obstruction).…

Cohen, Seth M.; Haynes, David S.

2003-01-01

51

Serotonin syndrome: take a closer look at the unwell surgical patient  

PubMed Central

This article describes the sequence of acute clinical deterioration seen in a head and neck oncology patient who developed serotonin syndrome perioperatively. It highlights the clinical dilemma that can be encountered when a septic picture masks the onset of serotonin syndrome and reinforces the importance of awareness of the potential interactions and side effects associated with drugs that surgeons prescribe. We discuss the pathophysiology, causal factors, clinical presentation and diagnosis of serotonin syndrome as well as highlighting some of the dilemmas that this condition presents in the surgical setting. PMID:22041229

Shaikh, ZS; Krueper, S; Malins, TJ

2011-01-01

52

Caring for head and neck oncology patients. Does social support lead to better quality of life?  

PubMed Central

OBJECTIVE: To determine whether social support contributes to better quality of life and psychological state of head and neck oncology patients. DESIGN: A structured questionnaire, administered orally to patients face-to-face, with specific questions about demographic and medical information and social support and two standardized scales; a cancer-specific quality of life scale and a depression scale. SETTING: Head and Neck Oncology Clinic, an institutional referral centre providing ambulatory care at the Camp Hill Medical Centre in Halifax, NS. PARTICIPANTS: Forty-five head and neck oncology patients (33 men, 12 women) who came for follow-up appointments at the clinic. One person did not complete the interview. Fifty patients were approached, but five were not included: one died before the interview, and four agreed to participate but were prevented by transportation or timing problems. MAIN OUTCOME MEASURES: Scores on the Functional Living Index-Cancer Scale and the Center for Epidemiologic Studies Depression scale. RESULTS: Four main factors predicted quality of life: satisfaction with family physician support, severity of cancer, sex of patient, and type of cancer. Three important predictors of psychological state were loss of appetite, family physician support, and sex of patient. CONCLUSION: Social support, particularly from family physicians, contributes greatly to better quality of life and psychological state for head and neck oncology patients. PMID:8828874

Mathieson, C. M.; Logan-Smith, L. L.; Phillips, J.; MacPhee, M.; Attia, E. L.

1996-01-01

53

The physical and psycho-social experiences of patients attending an outpatient medical oncology department: a cross-sectional study  

Microsoft Academic Search

The aim of this study was to assess the prevalence and predictors of physical symptoms, anxiety, depression and perceived needs among patients receiving treatment at an outpatient medical oncology department using a cross-sectional survey. It was carried out at the outpatient clinic of an academic medical oncology department, which sees around 150–180 outpatients each week; 201 patients were selected. These

Sallie Newell; Rob William Sanson-Fisher; Afaf Girgis; Stephen Ackland

1999-01-01

54

Cooling in Surgical Patients: Two Case Reports  

PubMed Central

Moderate induced hypothermia has become standard of care for children with peripartum hypoxic ischaemic encephalopathy. However, children with congenital abnormalities and conditions requiring surgical intervention have been excluded from randomised controlled trials investigating this, in view of concerns regarding the potential side effects of cooling that can affect surgery. We report two cases of children, born with congenital conditions requiring surgery, who were successfully cooled and stabilised medically before undergoing surgery. Our first patient was diagnosed after birth with duodenal atresia after prolonged resuscitation, while the second had an antenatal diagnosis of left-sided congenital diaphragmatic hernia and suffered an episode of hypoxia at birth. They both met the criteria for cooling and after weighing the pros and cons, this was initiated. Both patients were medically stabilised and successfully underwent therapeutic hypothermia. Potential complications were investigated for and treated as required before they both underwent surgery successfully. We review the potential side effects of cooling, especially regarding coagulation defects. We conclude that newborns with conditions requiring surgery need not be excluded from therapeutic hypothermia if they might benefit from it. PMID:24551469

Gurreebun, Bibi F.; Zipitis, Christos S.; Edi-Osagie, Ngozi E.; Dady, Ian M.; Sylvan, Axel

2014-01-01

55

Oncologic Safety of Skin-Sparing Mastectomy  

Microsoft Academic Search

Skin-sparing mastectomy consists of a standard mastectomy that preserves as much of the patient’s skin as is safe in preparation for immediate breast reconstruction. Aside from this preserving the skin, the mastectomy technique is the same as that for a standard total mastectomy with removal of all breast tissue. In this issue of the Annals of Surgical Oncology , two

S. Eva Singletary; Geoffrey L. Robb

2003-01-01

56

Improving quality of patient care by improving daily practice in radiation oncology.  

PubMed

Radiation oncology is an ever-advancing, complex, technologically based specialty that has been thrust into the public spotlight because of recent reports of serious treatment delivery errors that have impacted the quality of patient care. Although quality assurance (QA) initiatives are already common place in radiation oncology, the continued complex technology and automation-based advances in radiotherapy have created new safety challenges. The ongoing evolution of safety challenges in radiation oncology requires corresponding evolution in workflow and QA programs to ensure the quality of patient care. We believe that the incorporation of QA themes into our daily practice will help to create safer patient environments. Practical QA approaches that can be readily incorporated and applied in the daily practice of radiation oncology include process engineering and human factors engineering, medical peer review, "safety rounds," and software QA tools. Most importantly, we need to develop a culture of safety in which all team members work together to maximize the quality of our patient care. PMID:22177881

Chera, Bhishamjit S; Jackson, Marianne; Mazur, Lukasz M; Adams, Robert; Chang, Sha; Deschesne, Kathy; Cullip, Timothy; Marks, Lawrence B

2012-01-01

57

NCI-CCR Pediatric Oncology Branch - Patients and Families, Support Services  

Cancer.gov

As part of the comprehensive care provided at the Pediatric Oncology Branch of the National Cancer Institute, we provide a wide range of psychosocial support services to address the social, psychological, emotional, and practical facets of pediatric cancer and to support patients and families while they are enrolled in clinical research protocols.

58

Etiology and Incidence of Pressure Ulcers in Surgical Patients  

Microsoft Academic Search

This experimental study was designed to identify the etiology of pressure ulcers in a surgical sample and to evaluate a special OR mattress overlay in preventing pressure ulcer development. Surgical patients (N = 413) were randomized to receive “usual perioperative care” or the new mattress overlay. Over six postoperative days, 89 patients (21.5%) developed pressure ulcers, primarily stage I. Only

Alyce A. Schultz; Maureen Bien; Karen Dumond; Kathleen Brown; Amanda Myers

1999-01-01

59

An investigation into the spiritual needs of neuro-oncology patients from a nurse perspective  

PubMed Central

Background Spiritual needs of cancer patients should be assessed and discussed by healthcare professionals. Neurosurgical nurses need to be able to assess and support neuro-oncology patients with their spiritual needs from diagnosis and throughout their hospital stay. Methods Data were collected through questionnaires using a Critical Incident Technique (CIT) from neurosurgical nurses, findings were analysed using thematic analysis. Results Nurses reported some awareness of their patients’ spiritual needs during their stay on neurosurgical units although some used expressions approximating what could be described as spiritual needs. Patients’ spiritual needs were identified as: need to talk about spiritual concerns, showing sensitivity to patients’ emotions, responding to religious needs; and relatives’ spiritual needs included: supporting them with end of life decisions, supporting them when feeling being lost and unbalanced, encouraging exploration of meaning of life, and providing space, time and privacy to talk. Participants appeared largely to be in tune with their patients’ spiritual needs and reported that they recognised effective strategies to meet their patients’ and relatives’ spiritual needs. However, the findings also suggest that they don’t always feel prepared to offer spiritual support for neuro-oncology patients. Conclusions There is a need for healthcare professionals to provide spiritual care for neuro-oncology patients and their relatives. Although strategies were identified that nurses can use to support patients with spiritual needs further research is required to explore how effective nurses are at delivering spiritual care and if nurses are the most appropriate professionals to support neuro-oncology patients with spiritual care. PMID:23374999

2013-01-01

60

Surgical and oncology trials for rectal cancer: who will participate? | accrualnet.cancer.gov  

Cancer.gov

Patients, surgeons, and oncologists were asked whether they would be willing to enter one of five randomized controlled trials for rectal cancer. Patients’ willingness to participate was consistently low (19%-32%). Colorectal surgeons and medical and radiation oncologists also reported low levels of potential participation. The overwhelming reason for refusing to enter each trial was a dislike of the randomization process, followed by the effect of treatment on quality of life.

61

Current and Future Status of Laparoscopy in Gynecologic Oncology  

PubMed Central

Laparoscopy is playing an increasingly important role in gynecologic oncology. The benefits of minimally invasive surgery for oncology patients and the quality of this treatment are well documented. Outcomes and quality of minimally invasive surgical procedures to treat cervical cancer were evaluated based on retrospective and case-control studies; outcomes and quality after minimally invasive treatment für early-stage low-risk endometrial cancer were also assessed in prospective randomized studies. If indicated, laparoscopic lymphadenectomy is both technically feasible and oncologically safe. Adipose patients in particular benefit from minimally invasive procedures, where feasible. The potential role of laparoscopy in neoadjuvant therapy for ovarian cancer and in surgery for early-stage ovarian carcinoma is still controversially discussed and is currently being assessed in further studies. Using a minimally invasive approach in gynecologic oncology procedures demands strict adherence to oncological principles and requires considerable surgical skill.

Rimbach, S.; Neis, K.; Solomayer, E.; Ulrich, U.; Wallwiener, D.

2014-01-01

62

Are Circulating Adhesion Molecules Specifically Changed in Cardiac Surgical Patients?  

Microsoft Academic Search

Background. Soluble adhesion molecules are considered to be markers of inflammation, endothelial activation, or damage. This study was designed to assess whether adhesion molecules are specifically altered in patients undergoing cardiac surgical procedures.Methods. Three groups of 20 patients each were prospectively studied: patients undergoing elective coronary artery bypass grafting; patients scheduled for a Whipple pancreatoduodenectomy; and patients undergoing elective pneumonectomy

Joachim Boldt; Bernd Kumle; Michael Papsdorf; Gunter Hempelmann

1998-01-01

63

Use of an electronic patient-reported outcome measurement system to improve distress management in oncology  

PubMed Central

Objective Management of patient distress is a critical task in cancer nursing and cancer practice. Here we describe two examples of how an electronic patient-reported outcome (ePRO) measurement system implemented into routine oncology care can practically aid clinical and research tasks related to distress management. Methods Tablet personal computers were used to routinely complete a standardized ePRO review of systems surveys at point of care during every encounter in the Duke Oncology outpatient clinics. Two cases of use implementation are explored: (1) triaging distressed patients for optimal care, and (2) psychosocial program evaluation research. Results Between 2009 and 2011, the ePRO system was used to collect information during 17,338 Duke Oncology patient encounters. The system was used to monitor patients for psychosocial distress employing an electronic clinical decision support algorithm, with 1,952 (11.3%) referrals generated for supportive services. The system was utilized to examine the efficacy of a psychosocial care intervention documenting statistically significant improvements in distress, despair, fatigue, and quality of life (QOL) in 50 breast cancer patients. Significance of results ePRO solutions can guide best practice management of cancer patient distress. Nurses play a key role in implementation and utilization. PMID:24128592

Smith, Sophia K.; Rowe, Krista; Abernethy, Amy P.

2014-01-01

64

Percentage of Surgical Patients Receiving Recommended Care  

MedlinePLUS

... measure is calculated by the Oklahoma Foundation for Medical Quality using data from the Medicare Quality Improvement Organization Clinical Data Warehouse. National Summary {dataset.metadata.custom_fields.ASPE.Chart Title} Percentage of Surgical ...

65

Patient relevant endpoints in oncology: current issues in the context of early benefit assessment in Germany  

PubMed Central

The German AMNOG healthcare reform includes a mandatory early-benefit-assessment (EBA) at launch. As per German social code, EBA is based on registration trials and includes evaluation of the patient-relevant effect of the new medicines compared to an appropriate comparator as defined by the Federal Joint Committee (G-BA). Current EBA decisions released have unveiled issues regarding the acceptance of some patient-relevant endpoints as G-BA and IQWiG are grading the endpoints, focusing on overall survival as the preferred endpoint in oncology. A taskforce of experienced German outcomes research, medical, health-technology assessment and biostatistics researchers in industry was appointed. After agreement on core assumptions, a draft position was prepared. Input on iterative versions was solicited from a panel of reviewers from industry and external stakeholders. Distinctive features of registration trials in oncology need to be considered when these studies form basis for EBA, especially in cancer-indications with long post-progression survival; and with several consecutive therapeutic options available post-progression. Ethical committees, caregivers and patients often demand cross-over-designs diluting the treatment-effect on overall survival. Regulatory authorities require evaluation of morbidity-related study endpoints including survival of patients without their disease getting worse (i.e., progression-free survival). Also, progression requires treatment-changes, another strong indicator for its relevance to patients. Based on specific guidelines and clinical trial programs that were developed to be consistent with regulatory guidance, endpoints in oncology are thoroughly evaluated in terms of their patient-relevance. This extensive knowledge and experience should be fully acknowledged during EBA when assessing the patient-relevant benefit of innovative medicines in oncology. JEL codes D61; H51; I18. PMID:24460706

2014-01-01

66

Provision of palliative care and pain management services for oncology patients.  

PubMed

Early initiation of palliative care to address pain and other symptoms offers the potential to improve quality of life for patients with cancer. The approaches to implementing and delivering palliative care and pain management services vary depending on patient needs, available resources, provider training, and clinical setting. This article describes the experiences in developing programs in which the need for early palliative care or pain management services for patients with cancer was recognized. In each case, collaborative efforts, careful planning, administrative support, and ample time were needed to implement such services. To tailor services based on the available resources, different approaches were taken, including structuring of services within oncology units; creation of an integrated partnership between oncology and palliative care departments; establishment of a multidisciplinary comprehensive service; and incorporation of nurse-based pain services to address acute, chronic, and cancer pain. These examples offer insights into how to optimize delivery of services in a variety of settings with varying resources. PMID:23520182

Marchetti, Paolo; Voltz, Raymond; Rubio, Carmen; Mayeur, Didier; Kopf, Andreas

2013-03-01

67

The WHO surgical safety checklist: survey of patients' views  

PubMed Central

Background Evidence suggests that full implementation of the WHO surgical safety checklist across NHS operating theatres is still proving a challenge for many surgical teams. The aim of the current study was to assess patients’ views of the checklist, which have yet to be considered and could inform its appropriate use, and influence clinical buy-in. Method Postoperative patients were sampled from surgical wards at two large London teaching hospitals. Patients were shown two professionally produced videos, one demonstrating use of the WHO surgical safety checklist, and one demonstrating the equivalent periods of their operation before its introduction. Patients’ views of the checklist, its use in practice, and their involvement in safety improvement more generally were captured using a bespoke 19-item questionnaire. Results 141 patients participated. Patients were positive towards the checklist, strongly agreeing that it would impact positively on their safety and on surgical team performance. Those worried about coming to harm in hospital were particularly supportive. Views were divided regarding hearing discussions around blood loss/airway before their procedure, supporting appropriate modifications to the tool. Patients did not feel they had a strong role to play in safety improvement more broadly. Conclusions It is feasible and instructive to capture patients’ views of the delivery of safety improvements like the checklist. We have demonstrated strong support for the checklist in a sample of surgical patients, presenting a challenge to those resistant to its use. PMID:25038036

Russ, Stephanie Jane; Rout, Shantanu; Caris, Jochem; Moorthy, Krishna; Mayer, Erik; Darzi, Ara; Sevdalis, Nick; Vincent, Charles

2014-01-01

68

Oral-dental concerns of the pediatric oncology patient  

SciTech Connect

One of the main concerns of all disciplines in health care today is maintaining the patient's quality of life and comfort during cancer therapy. Oral complications resulting from radiation or chemotherapy can be expected in a large percentage of patients. Conducting a dental evaluation and performing treatment before therapy can help prevent or lessen potential complications. With preventive care and fewer infections, the patient will be able to communicate with friends and family, and optimum care and comfort can be provided.

Lawson, K.

1989-01-01

69

SURGICAL RECONSTRUCTION OF A TREACHER-COLLINS SYNDROME PATIENT  

Microsoft Academic Search

Objective To discuss the possibility of developing a surgical treatment plan for patients with some of the noted characteristics of Treacher-Collins syndrome, mainly mandibular ankylosis in a way that would give lasting, predictable results.

CRAYTON R. WALKER

70

Physical Fitness TrainingOutcomes for Adult Oncology Patients  

Microsoft Academic Search

Physical activity and exercise participation are important considerations in the study and management of acute and long-term care for cancer patients. Although excessive rest and lack of physical activity are related to diminished physical fitness, reduced functional status, impaired cognition, and diminished quality of life, exercise prescription is not a standard treatment support for patients or survivors of cancer. In

Diane Drake; Paul Falzer; Deanna Xistris; Garret Robinson; Michael Roberge

2004-01-01

71

Surgical Management of Patients with Chiari I Malformation  

PubMed Central

Chiari malformations (CMs) constitute a variety of four mainly syndromes (I, II, III, and IV), which describe the protrusion of brain tissue into the spinal canal through the foramen magnum. These malformations frequently occur in combination with other pathological entities such as myelomeningocele, hydrocephalus, and/or hydrosyringomyelia. The recent improvement of imaging techniques has increased not only the rate of CM diagnosis but also the necessity for its early treatment. Several different surgical techniques have been employed in the treatment of patients with symptomatic CM-I. In our current study, a systematic and critical review of the pertinent literature was made for identifying the most commonly employed surgical procedures in the management of these patients. Emphasis was given in outlining the advantages and disadvantages of each surgical approach. Moreover, an attempt was made for defining those parameters that may be prognostic factors for their surgical outcome. There is a consensus that surgical treatment is reserved only for symptomatic patients with CM-I. It has also been postulated that early surgically intervention is usually associated with better outcome. Despite the large number of previously published clinical series, further clinical research with large-scale studies is necessary for defining surgical treatment guidelines in these patients. PMID:22811732

Siasios, John; Kapsalaki, Eftychia Z.; Fountas, Kostas N.

2012-01-01

72

“Breaking Bad News”: Standardized Patient Intervention improves communication skills for hematology-oncology fellows and advanced practice nurses  

Microsoft Academic Search

Background. Breaking bad news is 1 of cancer specialists’ most common and difficult duties, yet hematology-oncology fellowship programs\\u000a typically offer little formal preparation for this daunting task. We designed the Breaking Bad News Standardized Patient Intervention\\u000a (BBNSPI) as a standardized patient educational intervention to improve the communication skills of hematology-oncology fellows\\u000a (HOFs) and advanced practice nurses (APNs) in breaking bad

Ahmed Eid; Michael Petty; Laura Hutchins; Reed Thompson

2009-01-01

73

Internal Qualification and Credentialing of Radiation Oncology Physicists to Perform Patient Special Procedures  

PubMed Central

In the arena of radiation oncology special procedures, medical physicists are often the focus professionals for implementation and administration of advanced and complex technologies. One of the most vexing and challenging aspects of managing complexity concerns the ongoing internal qualification and credentialing of radiation oncology physicists to perform patient special procedures. To demonstrate ongoing qualification, a physicist must: (a) document initial training and successful completion of competencies to implement and perform this procedure, (b) demonstrate familiarity with all aspects of the commissioning and quality assurance process, (c) demonstrate continuing education respecting this procedure, (d) demonstrate the peer-reviewed completion of a minimum number of patient special procedures during a specified time span, and (e) demonstrate satisfactory overall progress toward maintenance of specialty board certification. In many respects, this information complement is similar to that required by an accredited residency program in therapy physics. In this investigation, we report on the design of a management tool to qualify staff radiation oncology physicists to deliver patient procedures. PMID:24427742

Mills, Michael D.

2014-01-01

74

Effect of Opiates, Anesthetic Techniques, and Other Perioperative Factors on Surgical Cancer Patients  

PubMed Central

Background Opioid pharmacotherapy is often used to treat cancer pain. However, morphine and other opioid-like substance use in patients with cancer may have significant adverse consequences, including the suppression of both innate and acquired immune responses. Although studies have examined the possibility that regional anesthesia attenuates the immunosuppressive response of surgery, the effects of morphine and other opioid-related substances on tumor progression remain unknown. Methods This article presents an evidence-based review of the influence of opioids and anesthetic technique on the immune system in the context of cancer recurrence. The review focuses on the field of regional anesthesia and the setting of surgical oncologic procedures. The method for perioperative pain management and the technique of anesthesia chosen for patients in cancer surgery were explored. Results General anesthetics have been indicated to suppress both cell-mediated immunity and humoral immunity. Evidence suggests that intravenous opioids suppress the immune system. However, the mechanisms by which anesthetics and analgesics inhibit the immune system are not understood. Compared with the alternatives, regional analgesia offers reduced blood loss and superior postoperative analgesia. Because of these advantages, the use of regional analgesia has increased in oncologic surgeries. Conclusion Immune responses from all components of the immune system, including both the humoral and cell-mediated components, appear to be suppressed by anesthetics and analgesics. The clinical anesthesiologist should consider these factors in the application of technique, especially in cancer surgery. PMID:24940132

Kaye, Alan David; Patel, Nayan; Bueno, Franklin Rivera; Hymel, Brad; Vadivelu, Nalini; Kodumudi, Gopal; Urman, Richard D.

2014-01-01

75

Surgical Management of Infiltrating Bladder Cancer in Elderly Patients  

Microsoft Academic Search

Objectives: To review the surgical therapeutic options in elderly patients with infiltrating bladder cancer.Methods: A review of the literature relevant to cystectomy and transurethral resection for infiltrating bladder cancer in elderly patients was conducted using Medline Services.Results: Thanks to progress in anaesthesia, intensive care and surgery, cystectomy now forms part of the classical treatments for bladder cancer in elderly patients,

Michaël Peyromaure; Florent Guerin; Bernard Debre; Marc Zerbib

2004-01-01

76

Rehabilitation in Patients after Cardio-Surgical Interventions  

Microsoft Academic Search

The purpose of the present study was to verify the hypothesis: the use of exercises and physical therapy helps patients after cardio-surgical inter- ventions in early return to normal life. The research was based on the di- agnosis of physical fitness of cardiological patients. The data was ana- lyzed for 421 cardiological patients: 245 men and 176 women, aged 27-

Alicja Wolynska-Slezynska; Jan Slezynski

77

Patient navigation in oncology nursing: an innovative blended learning model.  

PubMed

Nurses are ideally suited to assume professional patient navigation roles in cancer care. Continuing education and staff development are essential for nurses to implement their roles to the fullest potential. This article describes an innovative patient navigation course that was developed to meet the educational needs of nurses who work with patients who have been diagnosed with cancer or are undergoing evaluation for cancer. Adult learning principles and interactive teaching strategies facilitated learning that was relevant and applicable to all nurses. Of the 200 participants, 77.5% completed questionnaires before and after the course. The questionnaire administered after the course showed a statistically significant increase in average total confidence scores on knowledge and skills in the seven domains examined (p < .00 to .03). This change reflected improvements in overall confidence in key principles and role functions of patient navigation. The course provided an opportunity for nurses to enhance their individual practice in patient navigation in the following areas: meeting patient needs for emotional and supportive care; providing information and education; and facilitating coordination and continuity of care. PMID:24024504

Crawford, Joanne; Brudnoy, Liat; Soong, Tracy; Graham, Thomas

2013-10-01

78

Patient Oncology Research Tracking System (PORTS) | accrualnet.cancer.gov  

Cancer.gov

This tracking system is intended for small to medium clinical research sites and organizations that participate in NCI or NIH- sponsored clinical research trials. The tool addresses patient enrollment information management and NCI report forms completion. It can also be used for in-house research.

79

Radiation oncology: An Irish hospitals approach to supporting patients  

Microsoft Academic Search

Despite advances in medical technology, cancer is still one of the leading causes of death globally, leaving many patients to deal with the emotional and psychological aspects associated with cancer and its treatment [Department of Health and Children. A strategy for cancer control in Ireland. National Cancer Forum. Dublin; 2006].The recognition and management of psychological conditions are an integral part

Caragh Miller

2009-01-01

80

Use of psychosocial services increases after a social worker-mediated intervention in gynecology oncology patients.  

PubMed

The purpose of this study was to determine whether the introduction of psychosocial services to gynecologic oncology outpatients by a social worker increases service use. During the initial six weeks (phase I), patients were referred for psychosocial services by clinic staff. During the second six weeks (phase II), a nurse introduced available services to each patient with a brochure. During the final 12 weeks (phase III), a social worker introduced services to each patient. The authors then compared psychosocial service referral rates. The sample included 196 patients. During phase III, the probability of a patient-initiated referral increased 3.4-fold (95 percent confidence interval [CI] [1.1, 10.4], p = .04) compared with baseline; the probability of any referral rose 2.7-fold (95 percent CI [1.1, 6.3], p = .03). The mean time to referral decreased from 79.4 days at baseline to 3.9 days during phase III (p < .001). The phase III intervention was accomplished only in 34 patients (39 percent) because of scheduling conflicts. Of these, eight requested referral, resulting in a 24 percent patient-initiated referral rate after meeting with a social worker. The introduction of psychosocial services by a social worker to gynecologic oncology outpatients increases referral rates and expedites evaluation. PMID:23865288

Abbott, Yuko; Shah, Nina R; Ward, Kristy K; McHale, Michael T; Alvarez, Edwin A; Saenz, Cheryl C; Plaxe, Steven C

2013-05-01

81

Toward strategies for cost containment in surgical patients.  

PubMed Central

The University of Rochester, Department of Surgery, in response to an experimental community-wide limit on hospital budgets, studied high-cost general surgical patients as a potential source of leverage for containment of hospital costs. It was found that a small number of patients impact significantly on hospital costs. In 1980, 3935 patients at Strong Memorial Hospital (SMH) had at least one contact with a general surgical patient care or intensive care unit; 261 patients (6.6%) had total 1980 charges of more than $20,000 each. They contributed 32% of the total of both general surgical charges and patient days. A subset of 2021 patients was selected to represent more precisely the general surgical patient. The 85 high-cost patients (4.2%) of this subset were chosen for intensive study. These patients generated a significant and disproportionate per cent of total (2021) general surgical charges (26.8%) and hospital days (27.6%). Average total charges were more than 8 times those of the complementary general surgical subset (1936). Nineteen of the 85 patients (22.3%) died in the hospital and 42 patients (49.4%) were dead within 2 1/2 years. Forty patients (of the 85) were then further identified as "complex", based on multiple, usually unrelated, illnesses and multiple annual admissions. Tending to be elderly with poor prognoses, 60% of them had died by April 1983. The major criterion of complexity was the lack of a well-focused medical problem; the cure for one problem simply relinquished primacy to another. A parallel study of hospital ancillary procedures disclosed a similar high-cost pattern. Of approximately 4000 ancillary procedures, 100 (2.5%) had annual charges of $100,000 or over, accounting for two-thirds of total 1980 ancillary charges. Roughly 20% of a single patient's ordered procedures accounted for 80% of the patient's ancillary charges, thus allowing concentrated study of a relatively small number of charges. Means for cost containment may be applied logically to the high-cost patient and particularly toward the complex patient. The complex patient is especially suited for consideration, since it is postulated that these patients are endemic to all general hospitals and to all clinical services. Strategies to be developed should include: 1) a managerial system in which physicians have an incentive to contain costs, 2) an online data system, 3) an accurate, efficient way to identify prospective high-cost and complex patients and, 4) awareness by physicians, patients, and society that less expensive modes of diagnosis and therapy are an appropriate response to rationed health resources. PMID:6412640

Drucker, W R; Gavett, J W; Kirshner, R; Messick, W J; Ingersoll, G

1983-01-01

82

Complementary and alternative medicine use in oncology: A questionnaire survey of patients and health care professionals  

PubMed Central

Background We aimed to investigate the prevalence and predictors of Complementary and Alternative Medicine (CAM) use among cancer patients and non-cancer volunteers, and to assess the knowledge of and attitudes toward CAM use in oncology among health care professionals. Methods This is a cross-sectional questionnaire survey conducted in a single institution in Ireland. Survey was performed in outpatient and inpatient settings involving cancer patients and non-cancer volunteers. Clinicians and allied health care professionals were asked to complete a different questionnaire. Results In 676 participants including 219 cancer patients; 301 non-cancer volunteers and 156 health care professionals, the overall prevalence of CAM use was 32.5% (29.1%, 30.9% and 39.7% respectively in the three study cohorts). Female gender (p < 0.001), younger age (p = 0.004), higher educational background (p < 0.001), higher annual household income (p = 0.001), private health insurance (p = 0.001) and non-Christian (p < 0.001) were factors associated with more likely CAM use. Multivariate analysis identified female gender (p < 0.001), non-Christian (p = 0.001) and private health insurance (p = 0.015) as independent predictors of CAM use. Most health care professionals thought they did not have adequate knowledge (58.8%) nor were up to date with the best evidence (79.2%) on CAM use in oncology. Health care professionals who used CAM were more likely to recommend it to patients (p < 0.001). Conclusions This study demonstrates a similarly high prevalence of CAM use among oncology health care professionals, cancer and non cancer patients. Patients are more likely to disclose CAM usage if they are specifically asked. Health care professionals are interested to learn more about various CAM therapies and have poor evidence-based knowledge on specific oncology treatments. There is a need for further training to meet to the escalation of CAM use among patients and to raise awareness of potential benefits and risks associated with these therapies. PMID:21609461

2011-01-01

83

[The HIV patient in the surgical emergency unit].  

PubMed

At the emergency station of the Surgical Department of the University Hospital in Zurich, 90% of the group with high risk of infection with the human immunodeficiency virus are intravenous drug abusers and 10% are promiscuous homosexuals. When compared with the group of i.v. drug addicts, the group of homosexual patients is small, as homosexual behaviour is not recognised and drug consumption and surgical emergency cases occur more often with i.v. drug addicts than with homosexuals. Surgical illnesses of i.v. drug abusers are directly connected with drug addiction (needle abscesses, injuries by accident or violence). Homosexual patients have no characteristic surgical problems outside of anal difficulties. I.v. drug abusers are running a very high risk of viral infections: 75% have antibodies against the human immunodeficiency virus. 77% have antibodies against the hepatitis-B virus and 50% have antibodies against the hepatitis-A virus. At the surgical emergency station of the University Hospital in Zurich, the problem of i.v. drug consumption patients with risk of viral infection is permanently increasing. The surgical emergency station can be considered as an ideal place for the prevention from HIV-infection and for taking care of i.v. drug abusers. PMID:2704921

Bessler, S C; Joller-Jemelka, H I

1989-03-01

84

Internet-based neuro-oncology patient recruitment.  

PubMed

THE PRIVACY RULE, as part of the Health Insurance Portability and Accountability Act, was implemented in 2003 as a response to public concern over potential abuses of private health information. Although the Privacy Rule was not intended to place limits on clinical research, its complexity has caused much confusion throughout the academic medicine and research communities. Many clinical and translational researchers have created clinical databases or human tissue banks to facilitate future research. Maintenance of such databases is considered a research activity under the Privacy Rule, and researchers are, therefore, subject to its regulations. We present a novel Internet-based method to generate and maintain a neurooncology patient registry and human tissue bank. Through our web site, we secure both Health Insurance Portability and Accountability Act research authorization and informed consent, enabling us to contact the treating physician for clinical data and pathological specimens. Considering the importance of continued use of clinical databases and tissue banks in the genetic era of medicine, our method offers one way for researchers to adapt to the changing world of clinical research. PMID:16639336

Komotar, Ricardo J; Zacharia, Brad E; Mocco, J; Ransom, Evan R; Davis, Jeffrey P; Gasparis, George; Bruce, Jeffrey N; Anderson, Richard C E

2006-05-01

85

Establishing an anemia clinic for optimal erythropoietic-stimulating agent use in hematology-oncology patients.  

PubMed

Erythropoietic-stimulating agent (ESA) therapy has significantly impacted the management of chemotherapy-induced anemia (CIA) by decreasing the number of red blood cell transfusions required by patients with cancer. However, managing these patients with ESA therapy has become increasingly difficult since the release of the Centers for Medicare & Medicaid Services' new National Coverage Determination document because of the disparities between this document and recommendations from expert-reviewed national clinical guidelines on the treatment of anemia. This article describes a collaborative practice agreement between pharmacists and physicians as one approach to managing CIA in hematology-oncology patients in an anemia clinic. The goal of the pharmacist-managed anemia clinic is to improve patient satisfaction and clinical outcomes associated with the treatment of CIA. This article describes the rationale for the clinic and discusses its design and implementation in managing ESA, iron, folate, and vitamin B12 therapy for CIA in hematology-oncology patients. The pharmacist's role is justified in this clinic model through increased adherence to evidence-based practice guidelines and decreased costs associated with ESA therapy. PMID:18597711

Gilreath, Jeffrey A; Sageser, Daniel S; Jorgenson, James A; Rodgers, George M

2008-07-01

86

Overcoming Complications Through Pre-patient Surgical Training in Otolaryngology.  

PubMed

Planning a balanced academic and practical surgical curriculum that is parallel to the constant innovations in surgical fields is the cornerstone of surgical education. Current training methods have coinciding benefits and drawbacks. In this study, we compare the efficacy of two learning models: pre-patient training outside the operating room versus step-by-step training on real patients in the operating room. Facial nerve preservation in superficial parotidectomy is the surgical model used in the study. Five otolaryngology residents in the third year of their residency participated in this study. They were divided into two groups: a treatment group which underwent a pre-patient training program by cadaver dissection and a control group which followed a step-by-step training model. At the end of the study, significant differences were apparent between two groups in the ability to find facial nerve trunk, microdissection of facial nerve branches, and the mean duration of total operating time. Pre-patient training programs outside the operating room provide surgical residents the opportunity to learn by trial and error without fear of complications. PMID:24605292

Mostaan, Leila Vazifeh; Poursadegh, Mahdi; Pourhamze, Mojgan; Roknabadi, Koorush; Shakeri, Mohammad Taghi

2014-01-01

87

Psychosocial adaptation in surgically treated patients for laryngeal cancer  

Microsoft Academic Search

The objective of the study was to assess the psychosocial adaptation in 62 patients surgically treated for head and neck cancer. Forty-one patients were grouped as having had radical surgery (total laringectomy), and twenty-one as having had functional surgery (horizontal supraglottic laryngectomy or partial vertical surgery). The Psychosocial Adjustment to Illness Scale Self-Report (PAIS-SR) was used for the evaluation. Patients

M Carrasco Llatas; M. J Ferrer Ram??rez; E Estellés Ferriol; F Guallart Doménech; M Morales Suárez-Varela; R López Mart??nez

2003-01-01

88

[Meaning of premature discharge in surgical patients].  

PubMed

In the last years, there have been some changes in our society related to the organization of the health system to optimize resources and serve the population. Because of the gradual aging of the population and increasing chronic pluripathologies, there is an increased health care demand, leading to the introduction of new technologies and minimally invasive surgery, helping quick reintegration of the patient in their daily activity. There is no agreed definition of early discharge but the patient is discharged from hospital sooner than indicated by the standards, provided that the medical condition, personal, social and family allows. The aim of our work is to know in depth the meaning of the experience of patients in relation to early discharge and home care associated and, knowing the deficiencies and needs perceived by patients during recovery in their midst. This will allow us to have a realistic and humanist view that will help us understand and improve the processes of care, planning and evaluation of different health complex situations. PMID:24547630

Lacambra Montanuy, Lucía; Carrasco Aranda, M Teresa; Castro Milán, Patricia; Melchor Gómez, Magdalena

2013-12-01

89

Patients' Reflections on Communication in the Second-Opinion Hematology-Oncology Consultation  

PubMed Central

OBJECTIVE The nature of communication between patients and their second-opinion hematology consultants may be very different in these one-time consultations than for those that are within long-term relationships. This study explored patients’ perceptions of their second-opinion hematology oncology consultation to investigate physician-patient communication in malignant disease at a critical juncture in cancer patients’ care and decision-making. METHODS In-depth telephone interviews with a subset of 20 patients from a larger study, following their subspecialty hematology consultations. RESULTS Most patients wanted to contribute to the consultation agenda, but were unable to do so. Patients sought expert and honest advice delivered with empathy, though most did not expect the consultant to directly address their emotions. They wanted the physician to apply his/her knowledge to the specifics of their individual cases, and were disappointed and distrustful when physicians cited only general prognostic statistics. In contrast, physicians’ consideration of the unique elements of patients’ cases, and demonstrations of empathy and respect made patients’ feel positively about the encounter, regardless of the prognosis. CONCLUSIONS Patients provided concrete recommendations for physician and patient behaviors to enhance the consultation. PRACTICE IMPLICATIONS Consideration of these recommendations may result in more effective communication and increased patient satisfaction with medical visits. PMID:19135824

Goldman, Roberta E.; Sullivan, Amy; Back, Anthony L.; Alexander, Stewart C.; Matsuyama, Robin K.; Lee, Stephanie J.

2010-01-01

90

[Ambulatory surgical interventions in patients with proctological diseases].  

PubMed

The results of 629 operations for the most frequent proctological diseases (hemorrhoid, anal scissure, rectal fistula, acute paraproctitis) were analyzed. 134 operations were performed in outpatient clinic, 225--in one-day hospital and 270 (control group)--in coloproctology department. The place of operation did not influence postoperative period and temporary disability time. The mean stay of patient in outpatient department and hospital surgical unit was 3.8 and 324 hours, respectively. Since the second day after operation in specialized department it is possible to perform therapeutic manipulations outpatient in coloproctology room without negative sequences for patient's health. Cost of the ambulatory operation constituted 28.4% of hospital stay for patients with similar interventions. Surgical treatment of the above diseases could be performed in outpatients setfing in more than 50% patients. The bed resources must be used for patients who need long-term and intensive treatment in specialized department. PMID:11210321

Vorob'ev, G I; Turutin, A D; Za?tsev, V G

2001-01-01

91

Evaluation and management of patients with heart disease and cancer: cardio-oncology.  

PubMed

The care for patients with cancer has advanced greatly over the past decades. A combination of earlier cancer diagnosis and greater use of traditional and new systemic treatments has decreased cancer-related mortality. Effective cancer therapies, however, can result in short- and long-term comorbidities that can decrease the net clinical gain by affecting quality of life and survival. In particular, cardiovascular complications of cancer treatments can have a profound effect on the health of patients with cancer and are more common among those with recognized or unrecognized underlying cardiovascular diseases. A new discipline termed cardio-oncology has thus evolved to address the cardiovascular needs of patients with cancer and optimize their care in a multidisciplinary approach. This review provides a brief introduction and background on this emerging field and then focuses on its practical aspects including cardiovascular risk assessment and prevention before cancer treatment, cardiovascular surveillance and therapy during cancer treatment, and cardiovascular monitoring and management after cancer therapy. The content of this review is based on a literature search of PubMed between January 1, 1960, and February 1, 2014, using the search terms cancer, cardiomyopathy, cardiotoxicity, cardio-oncology, chemotherapy, heart failure, and radiation. PMID:25192616

Herrmann, Joerg; Lerman, Amir; Sandhu, Nicole P; Villarraga, Hector R; Mulvagh, Sharon L; Kohli, Manish

2014-09-01

92

Management of Post-Operative Maxillofacial Oncology Patients Without the Routine Use of an Intensive Care Unit  

Microsoft Academic Search

Aim  To assess the safety and efficacy of immediate postoperative management of major maxillofacial oncology patients in a High\\u000a Dependency Unit (HDU).\\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods  All operated maxillofacial oncology patients were included. Detailed records and clinical parameters were assessed for diagnosis,\\u000a procedure, diagnosis, American Society of Anaesthiologists (ASA) grade, procedure, type of reconstruction, duration of surgery,\\u000a post operative location, days of hospitalization

Seema Alice Mathew; P. Senthilnathan; Vinod Narayanan

2010-01-01

93

The Post-surgical Treatment of the Bariatric Patient: Helping the Patient Succeed  

Microsoft Academic Search

Background: A psychological profile of the average bariatric patient demonstrates psychopathology that may contribute to patient\\u000a noncompliance with post-surgical treatment guidelines. Methods and results: Patient psychopathology is analysed with regard\\u000a to noncompliance and its contribution to poor surgical outcome. The interpersonal process approach is reviewed as a psychotherapeutic\\u000a framework that provides interventions to patient psychopathology. Conclusions: Treatment of patient psychopathology

Gaye Andrews

1996-01-01

94

Aspirin increases the risk of venous thromboembolism in surgical patients.  

PubMed

The risk of venous thromboembolism (VTE) for patients taking an antiplatelet agent is largely unknown. This study aimed to investigate the association between antiplatelet agent use before admission with the risk of in-hospital VTE in surgical intensive care unit (ICU) patients. A retrospective review of all patients admitted to the surgical ICU at a Level I trauma center over 30 months was performed. Patients who underwent diagnostic imaging for VTE were selected. Patients were divided based on whether or not antiplatelet agents were used before admission (APTA vs NAPTA). The primary outcome was VTE occurrence. A forward logistic regression model was used to identify factors independently associated with the primary outcome. During the study period, 461 (24%) patients met inclusion criteria: 70 (15%) APTA and 391 (85%) NAPTA. After adjusting for confounding factors, APTA patients were at a significantly higher risk for developing VTE (59 vs 40%; adjusted odds ratio, 1.8; 95% confidence interval, 1.0 to 3.0; adjusted P = 0.04). Whether or not antiplatelet agents were resumed during the hospital stay and the day on which they were resumed did not affect VTE risk. In conclusion, surgical ICU patients receiving antiplatelet agents before admission are at a significantly higher risk for development of VTE. PMID:25264630

Barmparas, Galinos; Jain, Monica; Mehrzadi, Devorah; Melo, Nicolas; Chung, Rex; Bloom, Matthew; Ley, Eric J; Margulies, Daniel R

2014-10-01

95

76 FR 65885 - Medicare Program; Changes to the Ambulatory Surgical Centers Patient Rights Conditions for Coverage  

Federal Register 2010, 2011, 2012, 2013

...the Ambulatory Surgical Centers Patient Rights Conditions for Coverage; Reform of Hospital...the Ambulatory Surgical Centers Patient Rights Conditions for Coverage AGENCY: Centers...for coverage (CfC) to allow patient rights information to be provided to the...

2011-10-24

96

Surgically induced miosis during phacoemulsification in patients with diabetes mellitus  

Microsoft Academic Search

Purpose To assess the incidence of surgically induced miosis during phacoemulsification in diabetic patients.Methods A total of 76 patients with diabetes mellitus were compared to 76 age- and race-matched controls. A combination of cyclopentolate 1%, phenylephrine 2.5% and diclofenac sodium 0.1% was applied topically 60, 45 and 30 min before surgery. Adrenaline mixed with buffered saline solution was used for

S A Mirza; A Alexandridou; T Marshall; P Stavrou

2003-01-01

97

A Comparison of Eating Disorders among Patients Receiving Surgical vs Non-surgical Weight-loss Treatments  

Microsoft Academic Search

Background  Little is known about differences between patients in surgical and non-surgical weight-loss treatments (WLT) regarding eating\\u000a disorders, level of general psychopathology, and health-related quality of life (HRQL). Such differences could indicate different\\u000a clinical needs in the management of surgical compared to non-surgical WLT patients.\\u000a \\u000a \\u000a \\u000a Methods  Participants were a subset of 100 patients from a Swedish study investigating the long-term effects of

Joakim de Man Lapidoth; Ata Ghaderi; Claes Norring

2008-01-01

98

Surgical Management of Urolithiasis in Patients after Urinary Diversion  

PubMed Central

Objective To present our experience in surgical management of urolithiasis in patients after urinary diversion. Patients and Methods Twenty patients with urolithiasis after urinary diversion received intervention. Percutaneous nephrolithotomy, percutaneous based antegrade ureteroscopy with semi-rigid or flexible ureteroscope, transurethral reservoir lithotripsy, percutaneous pouch lithotripsy and open operation were performed in 8, 3, 2, 6, and 1 patients, respectively. The operative finding and complications were retrospectively collected and analyzed. Results The mean stone size was 4.5±3.1 (range 1.5–11.2) cm. The mean operation time was 82.0±11.5 (range 55–120) min. Eighteen patients were rendered stone free with a clearance of 90%. Complications occurred in 3 patients (15%). Two patients (10%) had postoperative fever greater than 38.5°C, and one patient (5%) suffered urine extravasations from percutaneous tract. Conclusions The percutaneous based procedures, including percutaneous nephrolithotomy, antegrade ureteroscopy with semi-rigid ureteroscope or flexible ureteroscope from percutaneous tract, and percutaneous pouch lithotripsy, provides a direct and safe access to the target stones in patients after urinary diversion, and with high stone free rate and minor complications. The surgical management of urolithiasis in patients after urinary diversion requires comprehensive evaluation and individualized consideration depending upon the urinary diversion type, stone location, stone burden, available resource and surgeon experience. PMID:25360621

Zhong, Wen; Yang, Bicheng; He, Fang; Wang, Liang; Swami, Sunil; Zeng, Guohua

2014-01-01

99

Psychosocial well-being of prospective orthognathic-surgical patients.  

PubMed

Abstract Objective. To compare the psychosocial well-being of prospective orthognathic-surgical patients and controls. Materials and methods. Sixty patients referred for assessment of orthognathic-surgical treatment need and 29 controls participated. All participants filled in the modified version of Secord and Jourard's Body Image Questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem scale, the Acceptance and Action Questionnaire II and a structured diary developed by the authors. Patients also filled in the Symptom Checklist 90. Patients assessed their dental appearance on a visual analogue scale modified from the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need. Professional assessment was made from study models with the AC. Results. Patients rating their dental appearance as AC grades 5-10 suffered from lower orthognathic quality-of-life and poorer body image than the controls, while those with AC grades of 1-4 only had poorer oral function. Self-perceived dental appearance was more important to orthognathic quality-of-life and body image than an orthodontist's assessment. Patients and controls had equal psychological flexibility and self-esteem. In all, 23-57% of patients had significant psychiatric symptoms, which explained the adverse emotions patients felt during the day. Fifteen per cent of the patients had been bullied. Conclusions. Many orthognathic-surgical patients cope well with their dentofacial deformities, despite functional masticatory problems. It seems that a subjective view of dental appearance may be a key factor in finding patients with psychosocial problems. It should be a major issue when considering psychosocial support and other treatment options. PMID:24850504

Alanko, Outi M E; Svedström-Oristo, Anna-Liisa; Peltomäki, Timo; Kauko, Tommi; Tuomisto, Martti T

2014-11-01

100

Surgical errors and risks - the head and neck cancer patient  

PubMed Central

Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. It can lead to functional impairment and has impact in future chances for disease related survival. There are many risks for head and neck surgeons that can cause errors and malpractice. To avoid surgical mistakes, thorough preoperative management of patients is mandatory. As there are ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of the medical studies and data as well as qualification in modern surgical techniques and the surgeons ability for critical self assessment are basic and important prerequisites for head and neck surgeons in order to make out risks and to prevent from mistakes. Additionally it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and to be able to deal with complications, when they occur. Despite all precaution and surgical care, errors and mistakes cannot always be avoided. For that it is important to be able to deal with mistakes and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery. PMID:24403972

Harreus, Ulrich

2013-01-01

101

Implementation of a Central Line Maintenance Care Bundle in Hospitalized Pediatric Oncology Patients  

PubMed Central

OBJECTIVE: To investigate whether a multidisciplinary, best-practice central line maintenance care bundle reduces central line-associated blood stream infection (CLABSI) rates in hospitalized pediatric oncology patients and to further delineate the epidemiology of CLABSIs in this population. METHODS: We performed a prospective, interrupted time series study of a best-practice bundle addressing all areas of central line care: reduction of entries, aseptic entries, and aseptic procedures when changing components. Based on a continuous quality improvement model, targeted interventions were instituted to improve compliance with each of the bundle elements. CLABSI rates and epidemiological data were collected for 10 months before and 24 months after implementation of the bundle and compared in a Poisson regression model. RESULTS: CLABSI rates decreased from 2.25 CLABSIs per 1000 central line days at baseline to 1.79 CLABSIs per 1000 central line days during the intervention period (incidence rate ratio [IRR]: 0.80, P = .58). Secondary analyses indicated CLABSI rates were reduced to 0.81 CLABSIs per 1000 central line days in the second 12 months of the intervention (IRR: 0.36, P = .091). Fifty-nine percent of infections resulted from Gram-positive pathogens, 37% of patients with a CLABSI required central line removal, and patients with Hickman catheters were more likely to have a CLABSI than patients with Infusaports (IRR: 4.62, P = .02). CONCLUSIONS: A best-practice central line maintenance care bundle can be implemented in hospitalized pediatric oncology patients, although long ramp-up times may be necessary to reap maximal benefits. Further research is needed to determine if this CLABSI rate reduction can be sustained and spread. PMID:22945408

Chen, Allen R.; Bundy, David G.; Colantuoni, Elizabeth; Fratino, Lisa; Drucis, Kim M.; Panton, Stephanie Y.; Kokoszka, Michelle; Budd, Alicia P.; Milstone, Aaron M.; Miller, Marlene R.

2012-01-01

102

Bacterial bloodstream infections and antimicrobial susceptibility pattern in pediatric hematology/oncology patients after anticancer chemotherapy  

PubMed Central

Purpose Bloodstream infections in pediatric hematology and oncology represent a major problem worldwide, but this has not been studied in Qatar. In this study, we investigated the burden of infection and the resistance pattern in the bacterial etiology, in the only tertiary pediatric hematology and oncology center in Qatar. Methods All pediatric cancer patients (n=185) were evaluated retrospectively during the period 2004–2011; a total of 70 (38%) patients were diagnosed with bloodstream infections. Bacterial etiology was determined, along with their susceptibility patterns. Neutropenia, duration of neutropenia, fever, duration of fever, and C-reactive protein (CRP) were evaluated throughout the study. Results A total of 70 patients (38%) were diagnosed with acute leukemias, lymphomas, solid tumors, or brain tumors; those patients experienced 111 episodes of bacteremia. The most common Gram-positive (n=64 [55%]) isolates were Staphylococcus epidermidis (n=26), Staphylococcus hominis (n=9), and Staphylococcus haemolyticus (n=7), and the common Gram-negative (n=52 [45%]) isolates were Klebsiella pneumoniae (n=14), Pseudomonas aeruginosa (n=10), and Escherichia coli (n=7). There was a significant association observed between fever with positive blood culture and different types of cancer (P=0.035). The majority of bacteremia (n=68 [61.3%]) occurred in nonneutropenic episodes. Elevated values of CRP (?5 mg/L) were detected in 82 (95.3%) episodes and were negatively correlated with absolute neutrophil count (ANC) (r=?0.18; P=0.248) among all cases. However, the infection-related fatality rate was 2.2% (n=4), with three caused by Gram-negative pathogens. Multidrug resistant organisms were implicated in 33 (28.4%) cases and caused three of the mortality cases. Conclusion Multidrug resistant organisms cause mortality in pediatric cancer patients. Investigation of antimicrobial susceptibility of these organisms may guide successful antimicrobial therapy and improve the surveillance and quality of pediatric malignancy care.

Al-Mulla, Naima A; Taj-Aldeen, Saad J; El Shafie, Sittana; Janahi, Mohammed; Al-Nasser, Abdullah A; Chandra, Prem

2014-01-01

103

An integrative review of pressure relief in surgical patients.  

PubMed

Effective patient positioning has been an important issue throughout the history of the nursing profession. Pressure ulcers result from prolonged pressure, which causes skin, tissue, or muscle damage. Surgical patients present a unique challenge in preventing pressure ulcers because they are immobile and unable to perceive the discomfort of prolonged pressure. The purpose of this integrative review is to examine risk factors associated with pressure ulcer development in surgical patients and to examine pressure-relieving support surfaces to determine if they significantly reduce intraoperative tissue pressure and result in a lower incidence of postoperative pressure ulcers. Most of the research focuses on long-term care units, with little attention given to the acute care setting. Although the pathophysiology and etiology of pressure ulcers are well documented by years of research, the OR as an etiologic factor is largely undefined. PMID:11253620

Armstrong, D; Bortz, P

2001-03-01

104

Pneumatosis Intestinalis: Can We Avoid Surgical Intervention in Nonsurgical Patients?  

PubMed Central

Pneumatosis intestinalis (PI) is the presence of gas within the wall of the gastrointestinal tract and represents a tremendous spectrum of conditions and outcomes, ranging from benign diseases to abdominal sepsis and death. It is seen with increased frequency in patients who are immunocompromised because of steroids, chemotherapy, radiation therapy, or AIDS. PI may result from intraluminal bacterial gas entering the bowel wall due to increased mucosal permeability caused by defects in bowel wall lymphoid tissue. We present a case of PI who was treated conservatively and in whom PI resolved completely and we present a literature review of conservative management. It is not difficult to make a precise diagnosis of PI and to prevent unnecessary surgical intervention, especially when PI presents without clinical evidence of peritonitis. Conservative treatment is possible and safe for selected patients. Awareness of these rare causes of PI and close observation of selected patients without peritonitis may prevent unnecessary invasive surgical explorations. PMID:21103243

Al-Talib, Ayman; Al-Ghtani, Fahd; Munk, Roni

2009-01-01

105

Patient-derived tumour xenografts as models for oncology drug development  

PubMed Central

Progress in oncology drug development has been hampered by a lack of preclinical models that reliably predict clinical activity of novel compounds in cancer patients. In an effort to address these shortcomings, there has been a recent increase in the use of patient-derived tumour xenografts (PDTX) engrafted into immune-compromised rodents such as athymic nude or NOD/SCID mice for preclinical modelling. Numerous tumour-specific PDTX models have been established and, importantly, they are biologically stable when passaged in mice in terms of global gene-expression patterns, mutational status, metastatic potential, drug responsiveness and tumour architecture. These characteristics might provide significant improvements over standard cell-line xenograft models. This Review will discuss specific PDTX disease examples illustrating an overview of the opportunities and limitations of these models in cancer drug development, and describe concepts regarding predictive biomarker development and future applications. PMID:22508028

Tentler, John J.; Tan, Aik Choon; Weekes, Colin D.; Jimeno, Antonio; Leong, Stephen; Pitts, Todd M.; Arcaroli, John J.; Messersmith, Wells A.; Eckhardt, S. Gail

2014-01-01

106

Sedation and Anesthesia Options for Pediatric Patients in the Radiation Oncology Suite  

PubMed Central

External beam radiation therapy (XRT) has become one of the cornerstones in the management of pediatric oncology cases. While the procedure itself is painless, the anxiety it causes may necessitate the provision of sedation or anesthesia for the patient. This review paper will briefly review the XRT procedure itself so that the anesthesia provider has an understanding of what is occurring during the simulation and treatment phases. We will then examine several currently used regimens for the provision of pediatric sedation in the XRT suite as well as a discussion of when and how general anesthesia should be performed if deemed necessary. Standards of care with respect to patient monitoring will be addressed. We will conclude with a survey of the developing field of radiation-based therapy administered outside of the XRT suite. PMID:20490268

Harris, Eric A.

2010-01-01

107

That liver lesion on MDCT in the oncology patient: is it important?  

PubMed Central

Abstract Multidetector-row computed tomography (MDCT) has become the primary imaging test for the staging and follow-up of most malignancies that originate outside of the central nervous system. Technical advances in this imaging technique have led to significant improvement in the detection of metastatic disease to the liver. An unintended by-product of this improving diagnostic acumen is the discovery of incidental hepatic lesions in oncology patients that in the past remained undetected. These ubiquitous, incidentally identified hepatic lesions have created a management dilemma for both clinicians and radiologists: are these lesions benign or do they represent metastases? Naturally, the answer to this question has profound prognostic and therapeutic implications. In this review, guidelines concerning the diagnosis and management of some of the more common hepatic incidental lesions detected in patients with extrahepatic malignancies are presented. PMID:23023318

Thakrar, Kiran H.; Wenzke, Daniel R.; Newmark, Geraldine M.; Mehta, Uday K.; Berlin, Jonathan W.

2012-01-01

108

Perioperative use of antibiotics in elective surgical patients: timing of administration.  

PubMed

The practice of perioperative antibiotics administration in relation to surgical incision was analyzed in 525 elective surgical patients at St Vincent University Hospital, Dublin. 82.86 % (435) patients received the perioperative antibiotics before surgical incision was made and 17.14 % (90) patients received it after the surgical incision was made. The issue of timely administration of perioperative antibiotic should be included in the surgical time out to improve compliance in this regard. PMID:19743679

Zaidi, Nadeem; Tariq, Muhammad; Breslin, Dara

2009-07-01

109

Surgical treatment of liver metastases in patients with neuroendocrine tumors  

PubMed Central

Liver metastases occur in 75% to 80% of patients with neuroendocrine tumors (NETs), and are considered significant adverse prognostic indicators. Management of NETs liver metastases is challenging and requires aggressive therapy. Currently, there are many therapeutic options for metastatic NETs. However, there is considerable controversy regarding the optimal management. Although complete surgical resection remains the optimal therapy, a variety of other minimally invasive surgical and medical options are available, this includes thermal ablative techniques (e.g., radiofrequency ablation, microwave ablation, cryotherapy), embolization using transcatheter embolization, chemoembolization, or radioembolization, and medical therapy (e.g., chemotherapy, biotherapy with somatostatin analogues and interferon). Currently there is no evidence-based data directly comparing surgical versus alternative liver-directed treatment options. An aggressive surgical approach, coupled with additional liver-directed procedures is often recommended as it extends the overall survival. Optimal patient care should be directed by a multidisciplinary team to assure that all treatment options are explored for decision-making while treating this aggressive disease.

Saeed, Ahmad; Buell, Joseph F

2013-01-01

110

Surgical Options for Drug-Refractory Overactive Bladder Patients  

PubMed Central

Overactive bladder (OAB) is a symptom complex of urinary frequency, urinary urgency, and nocturia, with or without urgency incontinence. This syndrome is idiopathic in most instances without clearly defined pathophysiology. Studies clearly show that OAB negatively impacts health-related quality of life and impairs daily functioning in a large proportion of patients. Despite recent advances in drug delivery and improved tolerability of antimuscarinic drug class, a large percentage of patients remain refractory to conventional pharmacological therapy for this chronic condition. There are several unique and effective treatments that are available for this difficult population. We review the various surgical options within the urological armamentarium to treat patients with refractory OAB. PMID:20811558

Starkman, Jonathan S; Smith, Christopher P; Staskin, David R

2010-01-01

111

Quality of life in patients with ulcerative colitis treated surgically  

PubMed Central

Introduction Ulcerative colitis belongs to the group of inflammatory bowel diseases. The specific symptoms and chronic nature of the disease significantly affect the quality of patients’ lives. Quality-of-life assessment helps to define its determining factors as well as the efficiency of surgical procedures. Aim Quality-of-life evaluation of patients with ulcerative colitis treated surgically. Material and methods A retrospective review was carried out on 35 patients with ulcerative colitis, who were treated surgically in the Clinic of General and Colorectal Surgery, University of Medical Sciences in Poznan. The research tools used to assess the quality of life consisted of: the Inflammatory Bowel Disease Questionnaire, a Polish version of the Short Form Health Survey-36, and a questionnaire. Results The mean of the IBDQ scale was 152.51, and the median was 161. In this scale, a higher score indicates better quality of life. The situation in the subjective SF-36 scale is reversed: a lower score indicates better quality of life. The mean of the SF-36 was 115.94, and the median was 58. Many discrepancies in the field (e.g. the influence of determining factors) create a niche for further studies. Conclusions Moreover, quality-of-life evaluation may lead to better patient care, understanding their problems or treatment modifications, and finally may become a kind of therapy efficiency parameter.

Kozlowska, Katarzyna A.; Krokowicz, Piotr

2014-01-01

112

Patient-Physician Communication About Complementary and Alternative Medicine in a Radiation Oncology Setting  

PubMed Central

Purpose Despite the extensive use of complementary and alternative medicine (CAM) among cancer patients, patient-physician communication regarding CAM therapies remains limited. This study quantified the extent of patient-physician communication about CAM and identified factors associated with its discussion in radiation therapy (RT) settings. Methods and Materials We conducted a cross-sectional survey of 305 RT patients at an urban academic cancer center. Patients with different cancer types were recruited in their last week of RT. Participants self-reported their demographic characteristics, health status, CAM use, patient-physician communication regarding CAM, and rationale for/against discussing CAM therapies with physicians. Multivariate logistic regression was used to identify relationships between demographic/clinical variables and patients’ discussion of CAM with radiation oncologists. Results Among the 305 participants, 133 (43.6%) reported using CAM, and only 37 (12.1%) reported discussing CAM therapies with their radiation oncologists. In multivariate analyses, female patients (adjusted odds ratio [AOR] 0.45, 95% confidence interval [CI] 0.21-0.98) and patients with full-time employment (AOR 0.32, 95% CI 0.12-0.81) were less likely to discuss CAM with their radiation oncologists. CAM users (AOR 4.28, 95% CI 1.93-9.53) were more likely to discuss CAM with their radiation oncologists than were non-CAM users. Conclusions Despite the common use of CAM among oncology patients, discussions regarding these treatments occur rarely in the RT setting, particularly among female and full-time employed patients. Clinicians and patients should incorporate discussions of CAM to guide its appropriate use and to maximize possible benefit while minimizing potential harm. PMID:23040545

Ge, Jin; Fishman, Jessica; Vapiwala, Neha; Li, Susan Q.; Desai, Krupali; Xie, Sharon X.; Mao, Jun J.

2012-01-01

113

Cytokine Gene Variation is Associated with Depressive Symptom Trajectories in Oncology Patients and Family Caregivers  

PubMed Central

Purpose Depressive symptoms are common in cancer patients and their family caregivers (FCs). While these symptoms are characterized by substantial interindividual variability, the factors that predict this variability remain largely unknown. This study sought to confirm latent classes of oncology patients and FCs with distinct depressive symptom trajectories and to examine differences in phenotypic and genotypic characteristics among these classes. Method Among 167 oncology outpatients with breast, prostate, lung, or brain cancer and 85 of their FCs, growth mixture modeling (GMM) was used to identify latent classes of individuals based on Center for Epidemiological Studies-Depression (CES-D) scores obtained prior to, during, and for four months following completion of radiation therapy. One hundred four single nucleotide polymorphisms (SNPs) and haplotypes in 15 candidate cytokine genes were interrogated for differences between the two largest latent classes. Multivariate logistic regression analyses assessed effects of phenotypic and genotypic characteristics on class membership. Results Four latent classes were confirmed: Resilient (56.3%), Subsyndromal (32.5%), Delayed (5.2%), and Peak (6.0%). Participants who were younger, female, non-white, and who reported higher baseline trait and state anxiety were more likely to be in the Subsyndromal, Delayed, or Peak groups. Variation in three cytokine genes (i.e., interleukin 1 receptor 2 [IL1R2], IL10, tumor necrosis factor alpha [TNFA]), age,and performance status predicted membership in the Resilient versus Subsyndromal classes. Conclusions Findings confirm the four latent classes of depressive symptom trajectories previously identified in a sample of breast cancer patients. Variations in cytokine genes may influence variability in depressive symptom trajectories. PMID:23187335

Dunn, Laura B.; Aouizerat, Bradley E.; Langford, Dale J.; Cooper, Bruce A.; Dhruva, Anand; Cataldo, Janine K.; Baggott, Christina R.; Merriman, John D.; Dodd, Marylin; West, Claudia; Paul, Steven M.; Miaskowski, Christine

2014-01-01

114

Psychosocial and legal aspects of oncological treatment in patients with cognitive impairment.  

PubMed

With society getting older and affected by many diseases, more and more people suffer from severe cognitive disorders. As practice shows, the legal situations of such people is often problematic. This is due to a number of factors, such as short time since the deterioration of patient's condition, initial symptoms ignored, social prejudice towards the idea of incapacitation or taking decisions for a patient, complicated procedures and, sometimes, insufficient knowledge of legal regulations. Cognitive disorders also occur in patients treated for cancer. To be effective, oncological treatment needs to be started as early as possible. This, however, does not meet the criteria of sudden threat to life. The present article relates to both the psychosocial and legal aspects of care of people suffering from intense disorders of memory, attention, problem solving, executive functions, and other. Surely, physicians know how to handle patients with the above dysfunctions. However, legal procedures aimed to protect patients' rights are often unclear and time consuming. In practice, this often amounts to a dilemma whether to treat or follow the applicable law. Certainly, solutions in this regard should be clearer and better adapted to the needs arising from specific treatment needs of particular groups of patients. PMID:24936334

Ku?nierkiewicz, Maria; K?dziora, Justyna; Jaroszyk-Pawlukiewicz, Joanna; Nowak-Jaroszyk, Monika

2014-05-01

115

Distribution and determinants of patient satisfaction in oncology: A review of the literature  

PubMed Central

Cancer is one of the leading causes of morbidity and mortality in the United States. It places considerable mental, physical, and emotional stress on patients and requires them to make major adjustments in many key areas of their lives. As a consequence, the demands on health care providers to satisfy the complex care needs of cancer patients increase manifold. Of late, patient satisfaction has been recognized as one of the key indicators of health care quality and is now being used by health care institutions for monitoring health care improvement programs, gaining accreditation, and marketing strategies. The patient satisfaction information is also being used to compare and benchmark hospitals, identify best-performance institutions, and discover areas in need of improvement. However, the existing literature on patient satisfaction with the quality of cancer care they receive is inconsistent and heterogeneous because of differences in study designs, questionnaires, study populations, and sample sizes. The aim of this review was therefore to systematically evaluate the available information on the distribution and determinants of patient satisfaction in oncology. PMID:19936172

Lis, Christopher G; Rodeghier, Mark; Gupta, Digant

2009-01-01

116

The approaches in the care for terminal cancer patients in radiotherapy and oncology clinic, Rijeka University Hospital Center.  

PubMed

We sought to determine the proportion of our admitted patients in terminal phase of ilness who recieved some kind of active oncological therapy. We conducted a pilot study on the records of patients who died in the University Hospital. We assessed the percentage of mortality, a therapeutic approach in terms of treating the underlying disease, and access to palliative treatment. Of 2097 patients hospitalized in the UHC Rijeka Department of Radiation Therapy and Oncology during 2010 and 2011, 44 pts died which accounts for 2.1%. The most common primary sites of cancer in patients who died in our Department were the lungs and then the breast. Ten (22.7%) patients were admitted exclusively to receive palliative care, while others (34-77.3%) were admitted for planned active chemo- and/or radiotherapy administration. Within three months before death, 18 (40.9%) patients underwent chemotherapy treatment. The number of patients hospitalized due to providing palliative care is extremely low, which could indicate a good supply of out-patient treatment of cancer patients in the terminal stage of the disease. However, concerned about the high percentage of patients who tried to provide oncology treatments in the three months before his death. The percentages referred to in their daily work is still guided by the principles of healing "to the end" and thus we plunge into the realm disthanasia. PMID:23837258

Dobrila-Dintinjana, Renata; Redzovi?, Arnela; Peri?, Jana; Petranovi?, Duska

2013-04-01

117

Oncology clinicians' defenses and adherence to communication skills training with simulated patients: an exploratory study.  

PubMed

The aim of this exploratory study was to assess the impact of clinicians' defense mechanisms-defined as self-protective psychological mechanisms triggered by the affective load of the encounter with the patient-on adherence to a communication skills training (CST). The population consisted of oncology clinicians (N=31) who participated in a CST. An interview with simulated cancer patients was recorded prior and 6 months after CST. Defenses were measured before and after CST and correlated with a prototype of an ideally conducted interview based on the criteria of CST-teachers. Clinicians who used more adaptive defense mechanisms showed better adherence to communication skills after CST than clinicians with less adaptive defenses (F(1, 29)?=5.26, p=0.03, d=0.42). Improvement in communication skills after CST seems to depend on the initial levels of defenses of the clinician prior to CST. Implications for practice and training are discussed. Communication has been recognized as a central element of cancer care [1]. Ineffective communication may contribute to patients' confusion, uncertainty, and increased difficulty in asking questions, expressing feelings, and understanding information [2, 3], and may also contribute to clinicians' lack of job satisfaction and emotional burnout [4]. Therefore, communication skills trainings (CST) for oncology clinicians have been widely developed over the last decade. These trainings should increase the skills of clinicians to respond to the patient's needs, and enhance an adequate encounter with the patient with efficient exchange of information [5]. While CSTs show a great diversity with regard to their pedagogic approaches [6, 7], the main elements of CST consist of (1) role play between participants, (2) analysis of videotaped interviews with simulated patients, and (3) interactive case discussion provided by participants. As recently stated in a consensus paper [8], CSTs need to be taught in small groups (up to 10-12 participants) and have a minimal duration of at least 3 days in order to be effective. Several systematic reviews evaluated the impact of CST on clinicians' communication skills [9-11]. Effectiveness of CST can be assessed by two main approaches: participant-based and patient-based outcomes. Measures can be self-reported, but, according to Gysels et al. [10], behavioral assessment of patient-physician interviews [12] is the most objective and reliable method for measuring change after training. Based on 22 studies on participants' outcomes, Merckaert et al. [9] reported an increase of communication skills and participants' satisfaction with training and changes in attitudes and beliefs. The evaluation of CST remains a challenging task and variables mediating skills improvement remain unidentified. We recently thus conducted a study evaluating the impact of CST on clinicians' defenses by comparing the evolution of defenses of clinicians participating in CST with defenses of a control group without training [13]. Defenses are unconscious psychological processes which protect from anxiety or distress. Therefore, they contribute to the individual's adaptation to stress [14]. Perry refers to the term "defensive functioning" to indicate the degree of adaptation linked to the use of a range of specific defenses by an individual, ranging from low defensive functioning when he or she tends to use generally less adaptive defenses (such as projection, denial, or acting out) to high defensive functioning when he or she tends to use generally more adaptive defenses (such as altruism, intellectualization, or introspection) [15, 16]. Although several authors have addressed the emotional difficulties of oncology clinicians when facing patients and their need to preserve themselves [7, 17, 18], no research has yet been conducted on the defenses of clinicians. For example, repeated use of less adaptive defenses, such as denial, may allow the clinician to avoid or reduce distress, but it also diminishes his ability to respond to the patient's emotions, to identify and to respon

Bernard, Mathieu; de Roten, Yves; Despland, Jean-Nicolas; Stiefel, Friedrich

2012-06-01

118

Surgical Treatment in Patients with Cervical Osteomyelitis: Single Institute's Experiences  

PubMed Central

Objective To study practical guidelines and strategies in the treatment of cervical osteomyelitis. Methods We retrospectively reviewed 14 patients who underwent surgical treatment for cervical osteomyelitis from May 2000 to July 2008. We investigated their clinical course, antibiotic regimen, surgical methods, and laboratory and radiologic findings including X-ray, CT and MRI. Results 5 patients had primary spondylodiscitis, 5 patients had post operative spondylodiscitis and 4 patients had tuberculosis in cervical spine. The causative microorganisms were MRSA (5), P. aeruginosa (1), Methicillin resistant coagulase negative streptococcus (1), P. aeruginosa changed to MRSA (1), and 2 patients showed no growth on culture studies. Patients were treated 13.8 weeks (range, 5.4-25.8) with IV antibiotics and then treated for 58.2 days (range, 13-106) with oral antibiotics. Antituberculotic medications were used for a mean of 383.8 days. Patients were treated with anterior debridement and fusion (5), irrigation and debridement (5), simultaneous cervical anterior interbody and transthoracic thoracic interbody fusion (1). 3 patients underwent the planned 2-staged operation, which included an anterior debridement with or without fusion for the 1st operation and posterior instrumentation for 2nd operation. 10 patients (71.4%) had neurologic deficits at the time of diagnosis and 7 patients (70%) among them improved post-operatively. Conclusion Anterior cervical spine surgery is the preferable treatment option in patients with neurological deterioration, extensive bony destruction with expected kyphotic deformity, and uncontrolled infection being managed only with antibiotics. Antibiotics are also important for thorough treatment.

Hahn, Bang Sang; Kim, Kyung-Hyun; Park, Jung Yoon; Chin, Dong-Kyu; Kim, Keun-Su; Cho, Yong-Eun

2014-01-01

119

Global radiation oncology waybill  

PubMed Central

Background/aim Radiation oncology covers many different fields of knowledge and skills. Indeed, this medical specialty links physics, biology, research, and formation as well as surgical and clinical procedures and even rehabilitation and aesthetics. The current socio-economic situation and professional competences affect the development and future or this specialty. The aim of this article was to analyze and highlight the underlying pillars and foundations of radiation oncology, indicating the steps implicated in the future developments or competences of each. Methods This study has collected data from the literature and includes highlights from discussions carried out during the XVII Congress of the Spanish Society of Radiation Oncology (SEOR) held in Vigo in June, 2013. Most of the aspects and domains of radiation oncology were analyzed, achieving recommendations for the many skills and knowledge related to physics, biology, research, and formation as well as surgical and clinical procedures and even supportive care and management. Results Considering the data from the literature and the discussions of the XVII SEOR Meeting, the “waybill” for the forthcoming years has been described in this article including all the aspects related to the needs of radiation oncology. Conclusions Professional competences affect the development and future of this specialty. All the types of radio-modulation are competences of radiation oncologists. On the other hand, the pillars of Radiation Oncology are based on experience and research in every area of Radiation Oncology. PMID:24416572

Munoz-Garzon, Victor; Rovirosa, Angeles; Ramos, Alfredo

2013-01-01

120

Patient-oriented Functional Results of Total Femoral Endoprosthetic Reconstruction Following Oncologic Resection  

PubMed Central

Background and Objectives Functional outcomes following oncologic total femoral endoprosthetic reconstruction (TFR) are lacking. We compared patient-oriented functional results of TFRs to proximal femur and distal femur reconstructions (PFR and DFR). We also compared function and complications with regard to knee and hip componentry. Methods 54 TFR patients were identified from 3 institutional prospective databases. 41 had fixed- and 13 had rotating-hinge knees, 37 hemiarthroplasty and 17 total hip arthroplasty componentry. Toronto Extremity Salvage Scores (TESS) for n=27 were compared between groups and to cohorts of PFR (n=31) and DFR (n=85) patients using the Mann-Whitney U test. Results Follow-up averaged 4 years. Mechanical complications included 5 hip dislocations and 1 femoral malrotation. Four dislocations were in fixed-hinge implants, all in those lacking abductor reattachment. TESS averaged 69.3±17.8, statistically decreased from DFR (p=0.002) and PFR patients (p=0.036). No significant differences were detected between patients in the fixed-hinge (n=18) and rotating-hinge (n=9) groups (p = 0.944), or total hip (n=8) and hemiarthroplasty (n=19) groups (p=0.633). Conclusions TFR is reserved for extreme cases of limb salvage, portending a poor prognosis overall. Function reflects additive impairments from PFR and DFR. TFR outcomes differ little with rotating- or fixed-hinge, total hip or hemiarthroplasty implants. PMID:21695701

Jones, Kevin B.; Griffin, Anthony M.; Chandrasekar, Coonoor R.; Biau, David; Babinet, Antoine; Deheshi, Benjamin; Bell, Robert S.; Grimer, Robert J.; Wunder, Jay S.; Ferguson, Peter C.

2011-01-01

121

Clinical factors associated with fatigue over time in paediatric oncology patients receiving chemotherapy  

PubMed Central

The purpose of this study was to investigate the relationships between clinical factors (including haemoglobin value, chemotherapeutic agents, and corticosteroid use) and changing patterns of fatigue before and for the next 10 days following the start of a new round of chemotherapy in children with cancer. A prospective longitudinal design was used to collect data from 48 paediatric oncology patients who were about to begin a new round of chemotherapy and their parents. Fatigue levels were assessed using multidomain questionnaires with three categories of patient self-report (including ‘General Fatigue', ‘Sleep/Rest Fatigue', and ‘Cognitive Fatigue') and four categories of parent proxy-report (including ‘Lack of Energy', ‘Unable to Function', ‘Altered Sleep', and ‘Altered Mood'). The findings suggest that fatigue from both patient self-report and parent proxy-report changed significantly over time. The major findings from this study are that patients have more problems with fatigue in the first few days after the start of a cycle of chemotherapy. Corticosteroid use and haemoglobin value were associated with significant increases in fatigue that were sustained for several days and reached the highest level of fatigue at day 5 for those receiving concurrent steroids. The association of chemotherapeutic agents with fatigue varied between patient self-report and parent report, but the type of chemotherapeutic agents used was not associated with most changes in fatigue. PMID:18577992

Yeh, C-H; Chiang, Y-C; Lin, L; Yang, C-P; Chien, L-C; Weaver, M A; Chuang, H-L

2008-01-01

122

Reciprocal empathy and working alliance in terminal oncological illness: the crucial role of patients' attachment style.  

PubMed

Security of attachment is described as an inner resource that may also facilitate the adaptation of individuals during critical life adversity, even when facing end-stage illness and death. This study assessed the relation between attachment styles, patient-caregiver reciprocal empathy, and patient-physician working alliance, in the terminal phase of an oncological disease. We hypothesized that the attachment security of patients, as measured by the Relationship Questionnaire (RQ), is related to the reciprocal empathy with the caregiver, as measured by the Perception of Partner Empathy (PPE) questionnaire, and to the working alliance with the physician, as measured by the Working Alliance Inventory-Short Form (WAI-S). Thirty-seven end-stage cancer patients, their caregivers, and physicians participated in the study. The PPE and WAI-S were administered twice: immediately after the hospice recovery and a week later. Results showed a significant improvement in patient-caregiver empathy and in patient-physician alliance after a week at the hospice. Findings indicated that the patients' attachment style influenced their perception of reciprocal empathy with the caregiver and the working alliance with the physician. Patients with a secure attachment had a greater capacity to show empathic closeness with their caregivers and enjoyed a better working alliance with their physicians. Caregivers' attachment security, otherwise, did not show the same influence on empathy and alliance. Findings support the hypothesis that patients' attachment security plays a crucial role in the relation with their own caregiver and with the physician, even at the terminal phase. Theoretical and clinical implications of these findings are explored in the discussion. PMID:24988462

Calvo, Vincenzo; Palmieri, Arianna; Marinelli, Sara; Bianco, Francesca; Kleinbub, Johann R

2014-01-01

123

Surgical treatment and prognosis of gastric cancer in 2 613 patients  

Microsoft Academic Search

AIM: To analyze the factors influencing the prognosis of patients with gastric cancer after surgical treatment, in order to optimize the surgical procedures. METHODS: A retrospective study of 2 613 consecutive patients with gastric cancer was performed. Of these patients, 2 301 (88.1%) received operations; 196 explorative laparotomy (EL), 130 by-pass procedure (BPP), and 1 975 surgical resection of the

Xiang-Fu Zhang; Chang-Ming Huang; Hui-Shan Lu; Xing-Yuan Wu; Chuang Wang; Guo-Xian Guang; Jian-Zhong Zhang; Chao-Hui Zheng

124

Percutaneous Dilatational Tracheostomy and Surgically Created Thracheostomy in ICU Patients  

PubMed Central

Introduction: Following advances of Intensive Care medicine and widespread administration of mechanical ventilation, tracheostomy has become one of the indispensable surgical procedures. During this research we tried to assess and compare two main strategies for doing tracheostomy: Surgically Created Tracheostomy (SCT) and Percutaneous Dilatational Tracheostomy (PDT). Methods: In a randomized clinical trial, 60 cases of patients who were admitted in Intensive Care Unit (ICU) and needed tracheostomy during their stay were enrolled. Patients were randomly divided into two groups. SCT technique was considered for the first group and PDT for the second one. Demographic characteristics, associated and underlying diseases, type and duration of procedure, duration of receiving mechanical ventilation and ICU stay, expenses and complications of tracheostomy including bleeding, subcutaneous emphysema, pneumothorax, stomal infection and airway loss were all recorded during study and compared between both groups. Results: There were significant differences between two groups of patients in terms of duration of receiving mechanical ventilation (P=0.04), duration of tracheostomy procedure (P=0.001) and procedure expenses (P=0.04). There was no significant difference between two groups in terms of age and gender of patients, duration of ICU stay and complications of tracheostomy including copious bleeding, stomal infection, subcutaneous emphysema and airway. Conclusion: According to the results of our study and similar researches, it can be concluded that PDT can be considered as the preferred procedure in cautiously selected patients during their ICU stay. PMID:24753831

Valizade Hasanloei, Mohammad Amin; Mahoori, Alireza; Bazzazi, Amir Mohammad; Golzari, Samad EJ; Karami, Tohid

2014-01-01

125

Surgical Management of Rhinosinusitis in Onco-Hematological Patients  

PubMed Central

Objectives In onco-hematological diseases, the incidence of paranasal sinuses infection dramatically increase and requires a combination of medical and surgical therapy. Balloon dilatation surgery (DS) is a minimally invasive, tissue preserving procedure. The study evaluates the results of DS for rhinosinusitis in immunocompromised patients. Methods A retrospective chart review was conducted in 110 hematologic patients with rhinosinusitis. Twenty-five patients were treated with DS technique and 85 patients with endoscopic sinus surgery (ESS). We considered the type of anesthesia and the extent of intra- and postoperative bleeding. Patients underwent Sino-Nasal Outcome Test (SNOT-20) to evaluate changes in subjective symptoms and global patient assessment (GPA) questionnaire to value patient satisfaction. Results Local anesthesia was employed in 8 cases of DS and in 15 of ESS. In 50 ESS patients, an anterior nasal packing was placed and in 12 cases a repacking was necessary. In the DS group, nasal packing was required in 8 cases and in 2 cases a repacking was placed (P=0.019 and P=0.422, respectively). The SNOT-20 change score showed significant improvement of health status in both groups. However the DS group showed a major improvement in 3 voices: need to blow nose, runny nose, and facial pain/pressure. The 3-month follow-up GPA questionnaire showed an higher satisfaction of DS group. Conclusion Balloon DS represents a potentially low aggressive treatment and appears to be relatively safe and effective in onco-hematologic patients. All these remarks may lead the surgeon to consider a larger number of candidates for surgical procedure.

Di Girolamo, Stefano; Di Mauro, Roberta; Giacomini, Piergiorgio; Cantonetti, Maria

2014-01-01

126

Optimizing the use of inferior vena cava filters in oncology patients: are all filters created equally?  

PubMed

Many studies have supported the efficacy of inferior vena cava filters (IVCF) in the setting of venous thromboembolic disease, particularly in oncologic patients who are at increased risk. The advent of retrievable IVCF designs has prompted dramatically expanded use for patients with widely accepted indications but also disproportionately so in patients with so-called extended indications. At the same time, an alarming increase in filter-related complications has been reported both in the literature and through regulatory agencies, leading to government agency-issued warnings. The synergistic effect of these two interconnected phenomena is explained through a careful review of the evolution of IVCF device design. Critical differences exist when comparing retrievable IVCF and permanent IVCF. IVCF utilization can be optimized by prospectively identifying which patients are best served by a specific IVCF device. Careful follow-up strategies are also needed to ensure that all IVCFs are removed as soon as they are no longer needed. Finally, adjunctive techniques for removing "difficult" filters help maximize the number of IVCF removed and minimize IVCF left implanted needlessly. PMID:24610401

Ryu, Robert K; Lewandowski, Robert J

2014-04-01

127

Surgical options for patients with Lennox-Gastaut syndrome.  

PubMed

Despite ongoing investigation into pharmacologic treatments for Lennox-Gastaut syndrome (LGS), outcomes for chronic administration of medications remain disappointing. In many instances LGS is treatment refractory, resulting in poor prognoses that include intellectual disability, persisting seizures, and psychiatric conditions. For patients with treatment resistance to other modalities for LGS, a further option is surgical intervention. Evaluation for surgery should involve interictal electroencephalogram (EEG), magnetic resonance imaging (MRI) analysis, and age-appropriate neuropsychological/developmental assessment. Resective surgery, where seizure foci are removed, successfully controls seizures in many cases, particularly where lesionectomy or lobar resections are appropriate. Recent studies of resective surgery on individuals with LGS show promising results, with a high percentage of patients having improved seizure control. Corpus callosotomy is a palliative surgical approach that aims at controlling potentially injurious seizures, for example, atonic or drop seizures, by preventing the bilateral spread of epileptic activity. Once associated with a high risk for morbidity and mortality, microsurgical techniques and surgery limited to the anterior region of the callosum have greatly diminished complications of corpus callosotomy surgery. Vagus nerve stimulation, another palliative procedure, offers rates of seizure improvement similar to those of corpus callosotomy, with the exception of atonic seizure for which corpus callosotomy may lead to a greater reduction. Recent advances in surgical techniques offer encouraging options for treatment of LGS. PMID:25284034

Douglass, Laurie M; Salpekar, Jay

2014-09-01

128

Surgical patents and patients--the ethical dilemmas.  

PubMed

It is obvious that every inventor should be rewarded for the intellectual effort, and at the same time be encouraged to successively improve his or her discovery and to work on subsequent innovations. Patents also ensure that patent owners are officially protected against intellectual piracy, but protection of intellectual property may be difficult to accomplish. Nevertheless, it all comes down to this basic question: Does a contradiction exist between medical ethics and the "Medical and Surgical Procedure Patents" system? It may well turn out that medical-procedure patents can have a negative influence on the standard of medical care. Medical-method patents may also interfere with the physician-patient relationship. At present, physicians do not question the usefulness of patent protection for medicines, biotechnology, equipment and devices, but they strongly oppose it for surgical procedures. PMID:15727000

To??oczko, Tadeusz

2005-01-01

129

Hospital nurses' views of the signs and symptoms that herald the onset of the dying phase in oncology patients.  

PubMed

Determining the onset of the dying phase is important, because care aims and interventions change once this phase begins. In the dying phase, maximising comfort is paramount, even if doing so causes a deterioration of cognitive functions. In this delicate context, it is necessary to give special attention to the patient's personal wishes, spiritual guidance, and rituals, and to the emotional support of relatives. To initiate a care plan for the dying, health professionals must recognise and acknowledge when a patient enters the dying phase. This article describes hospital nurses' perspectives on the signs and symptoms that herald the onset of the dying phase in oncology patients, obtained via three focus group discussions. A broad range of signs and symptoms were reported and are presented here as a conceptual model. Further research is needed to determine whether the signs and symptoms that mark the onset of the dying phase in oncology patients may be tumour-specific. PMID:22584315

van der Werff, Gertruud F M; Paans, Wolter; Nieweg, Roos M B

2012-03-01

130

Meaningful patient representation informing Canada's cancer drug funding decisions: views of patient representatives on the Pan-Canadian Oncology Drug Review.  

PubMed

In this interview with the patient representatives on the Expert Review Committee (perc) of the Pan-Canadian Oncology Drug Review (pcodr), those representatives offer their views about how to be a valuable contributing member of Canada's national cancer drug funding recommendation committee. The article seeks to inform readers, and especially clinicians, about pcodr from the perspective of the patient representatives. PMID:25302034

Hoch, J S; Brown, M B; McMahon, C; Nanson, J; Rozmovits, L

2014-10-01

131

Prognostic factors of overall survival in renal cancer patients - single oncological center study  

PubMed Central

Introduction The clinical course of renal cancer remains difficult to predict. Attempts to appoint new independent prognostic factors (IPFs) and comparisons of already identified ones among populations are inevitable to develop more effective prognostic instruments. The aim of this study was to evaluate IPFs of overall survival in a given population of patients with renal cancer. Materials and methods Retrospective analysis of 148 patients with renal cancer treated at the Oncological Institute in Cracow from 2000 to 2007 was performed. Mean follow–up was 51 months. Using the log–rang test, a group of clinicopathological and biochemical features was analyzed in respect to their influence on overall survival. Results were presented as Kaplan–Meier curves. Final identification of IPFs was made by multivariate Cox regression analysis. Results Overall survival rate at 1, 2, and 5–year follow–up was 58.8%, 38.2%, and 21.4%, respectively. The set of identified IPFs consisted of performance status, smoking history, hemoglobin concentration, anatomical staging, tumor grade, and the presence of microvascular invasion. It was confirmed that only nephrectomy increases significantly overall survival. Conclusions Apart from smoking history, the role of all other IPFs identified in our study is well documented in the literature. Smoking history seems to be a new IPF with strong negative impact on survival in patients with RCC. PMID:24707365

Sandheim, Marek; Jakubowski, Jacek; Juszczak, Kajetan; Stelmach, Andrzej Wojciech

2013-01-01

132

Age-related Toxicity in Patients With Rhabdomyosarcoma: A Report From the Children's Oncology Group.  

PubMed

On the Fourth Intergroup Rhabdomyosarcoma study, older children experienced excessive neurotoxicity, whereas younger children had increased myelosuppression. The purpose of this study was to determine whether the same pattern of toxicity was seen on the successor study when use of growth factor was required and dosing of chemotherapy was different by performing a retrospective cohort analysis on patients treated on Children's Oncology Group protocol D9803. Toxicity data were analyzed by stratifying children into 4 age groups. The frequency of grade 3/4 neurotoxicity, myelosuppression, infection, and mucositis was predicted for each age group. The cumulative doses of vincristine and cyclophosphamide administered were measured as percent of protocol-prescribed dose. Adolescents (aged 15+) were more likely to experience neurotoxicity compared with younger patients (odds ratio, 3.6; P<0.0001). There was no difference in myelosuppression, infection, or mucositis. The mean percent protocol-prescribed doses administered for vincristine and cyclophosphamide did not differ much by age group. Adolescents experienced more neurotoxicity with vincristine compared with younger patients. No differences in other toxicities were observed between age groups. As adolescents received at least 85% of protocol-prescribed doses of vincristine, it is difficult to attribute the poorer survival in this age group to inadequate protocol-delivered therapy. PMID:24936741

Altaf, Sadaf; Enders, Felicity; Lyden, Elizabeth; Donaldson, Sarah S; Rodeberg, David; Arndt, Carola

2014-11-01

133

A telematic system for oncology based on electronic health and patient records  

Microsoft Academic Search

The NHS in the UK recognizes six levels of IT adoption in healthcare systems. Most current healthcare systems are at Level 1 (clinical administrative data), with some notable specialized exceptions. The telematic system for oncology is at Level 6 (advanced multimedia and telematics). Oncology is a particularly complicated area, as it draws on most of the other diagnostic systems and

A. James; Y. Wilcox; Raouf N. Gorgui-naguib

2001-01-01

134

Healing the Mind\\/Body Split: Bringing the Patient Back Into Oncology  

Microsoft Academic Search

The effect on oncology of the doctrine of Cartesian dualism is examined. It is argued that (1) this doctrine continues to exert a baneful (though unacknowledged) influence on the practice of oncology, (2) Descartes's doctrine of a mind\\/ body split is mistaken, and (3) mind and body (brain) are inextricably interwoven. A biopsychosocial model of disease is advocated. The role

Steven Greer

2003-01-01

135

Malnutrition and Obesity in Pediatric Oncology Patients: Causes, Consequences, and Interventions  

PubMed Central

In children with cancer, suboptimal nutrition states are common consequences of the disease and its treatment. These nutrition states have been attributed to a number of etiologies dependent on the patient’s tumor type and treatment, and are associated with increased morbidity and mortality. Interventions vary from psychosocial to pharmacological and surgical management. Further research is necessary to understand the epidemiology and etiology of these nutrition states. Of great importance is the development and implementation of effective interventions to optimize nutritional status among children with cancer during and after therapy. PMID:22948929

Co-Reyes, Erica; Li, Rhea; Huh, Winston; Chandra, Joya

2012-01-01

136

Surgical management of giant intracranial aneurysms: experience with 171 patients.  

PubMed

Patients with untreated giant intracranial aneurysms have a dismal prognosis as a result of hemorrhage, cerebral compression, and thromboembolism. Therefore, giant aneurysms should be treated. The operative approach is chosen to maximize exposure of the aneurysm. Direct clipping of the aneurysm neck, with preservation of the parent and branch vessels, is the preferred method of occlusion. Hypothermic circulatory arrest may facilitate clipping in selected patients. Alternative techniques for unclippable aneurysms can be utilized, but they compromise parent arteries and require revascularization to maintain CBF. Because mass effect is an important cause of patient morbidity, giant aneurysms are usually debulked after they have been eliminated completely from the circulation. Giant aneurysms are complex lesions that demand thorough surgical planning, individualized strategies, and a multidisciplinary effort. PMID:8846596

Lawton, M T; Spetzler, R F

1995-01-01

137

Barriers to recruitment for surgical trials in head and neck oncology: A survey of trial investigators. | accrualnet.cancer.gov  

Cancer.gov

Three head and neck cancers trials in the United Kingdom were examined to identify barriers to recruitment at the planned rate. The primary barriers were patient preference for one study arm and aversion to randomization. The complexity of patient information, which often was not appropriate to socioeconomic status and English proficiency of the targeted patients, also served as a barrier.

138

Coronary artery disease in surgical patients. Perioperative management.  

PubMed

With effective communication, optimal use of perioperative therapeutic techniques, and postoperative follow-up, the medical, surgical, and anesthetic teams can prevent or minimize cardiac complications that occur during the postoperative period. Up to 50% of postoperative myocardial infarctions may be silent, or they may present as congestive heart failure, hypotension, or arrhythmia. Dyspnea is a common finding. All high-risk patients should be monitored in the intensive care unit during the first 7 days after surgery, when adverse cardiac events are most common. PMID:1409176

Corapi, M J; Della Ratta, R K

1992-10-01

139

Reproductive Health in the Adolescent and Young Adult Cancer Patient: An Innovative Training Program for Oncology Nurses  

PubMed Central

In 2008, approximately 69,200 AYAs were diagnosed with cancer, second only to heart disease for males in this age group. Despite recent guidelines from professional organizations and clinical research that AYA oncology patients want information about reproductive health topics and physician support for nurses to address these issues with patients, existing research finds few oncology nurses discuss this topic with patients due to barriers such as lack of training. This article describes an innovative eLearning training program, entitled Educating Nurses about Reproductive Issues in Cancer Healthcare (ENRICH). The threefold purpose of this article is to: (1) highlight major reproductive health concerns relevant to cancer patients, (2) describe the current status of reproductive health and oncology communication and the target audience for the training, and (3) present a systematic approach to curriculum development, including the content analysis and design stages as well as the utilization of feedback from a panel of experts. The resulting 10-week curriculum contains a broad-based approach to reproductive health communication aimed at creating individual- and practice-level change. PMID:23225072

Vadaparampil, Susan T.; Hutchins, Nicole M.; Quinn, Gwendolyn P.

2012-01-01

140

Factors influencing the diagnostic accuracy and management in acute surgical patients  

PubMed Central

AIM: To evaluate the diagnostic accuracy (DA) in acute surgical patients admitted to a District General Hospital. METHODS: The case notes of all acute surgical patients admitted under the surgical team for a period of two weeks were reviewed for the data pertaining to the admission diagnoses, relevant investigations and final diagnoses confirmed by either surgery or various other diagnostic modalities. The diagnostic pathway was recorded from the source of referral [general practitioner (GP), A and E, in-patient] to the correct final diagnosis by the surgical team. RESULTS: Forty-one patients (23 males) with acute surgical admissions during two weeks of study period were evaluated. The mean age of study group was 61.05 ± 23.24 years. There were 111 patient-doctor encounters. Final correct diagnosis was achieved in 85.4% patients. The DA was 46%, 44%, 50%, 33%, 61%, 61%, and 75% by GP, A and E, in-patient referral, surgical foundation year-1, surgical senior house officer (SHO), surgical registrar, and surgical consultant respectively. The percentage of clinical consensus diagnosis was 12%. Surgery was performed in 48.8% of patients. Sixty-seven percent of GP-referred patients, 31% of A and E-referred, and 25% of the in-patient referrals underwent surgery. Surgical SHO made the most contributions to the primary diagnostic pathway. CONCLUSION: Approximately 85% of acute surgical patients can be diagnosed accurately along the diagnostic pathway. Patients referred by a GP are more likely to require surgery as compared to other referral sources. Surgical consultant was more likely to make correct surgical diagnosis, however it is the surgical SHO that contributes the most correct diagnoses along the diagnostic pathway. PMID:25429324

Sajid, Muhammad Shafique; Hollingsworth, Thaddeus; McGlue, Mike; Miles, William FA

2014-01-01

141

Measurement of Cardiac Index by Transpulmonary Thermodilution Using an Implanted Central Venous Access Port: A Prospective Study in Patients Scheduled for Oncologic High-Risk Surgery  

PubMed Central

Background Transpulmonary thermodilution allows the measurement of cardiac index for high risk surgical patients. Oncologic patients often have a central venous access (port-a-catheter) for chronic treatment. The validity of the measurement by a port-a-catheter of the absolute cardiac index and the detection of changes in cardiac index induced by fluid challenge are unknown. Methods We conducted a monocentric prospective study. 27 patients were enrolled. 250 ml colloid volume expansions for fluid challenge were performed during ovarian cytoreductive surgery. The volume expansion-induced changes in cardiac index measured by transpulmonary thermodilution by a central venous access (CIcvc) and by a port-a-catheter (CIport) were recorded. Results 23 patients were analyzed with 123 pairs of measurements. Using a Bland and Altman for repeated measurements, the bias (lower and upper limits of agreement) between CIport and CIcvc was 0.14 (?0.59 to 0.88) L/min/m2. The percentage error was 22%. The concordance between the changes in CIport and CIcvc observed during volume expansion was 92% with an r?=?0.7 (with exclusion zone). No complications (included sepsis) were observed during the follow up period. Conclusions The transpulmonary thermodilution by a port-a-catheter is reliable for absolute values estimation of cardiac index and for measurement of the variation after fluid challenge. Trial Registration clinicaltrials.gov NCT02063009 PMID:25136951

Suria, Stephanie; Wyniecki, Anne; Eghiaian, Alexandre; Monnet, Xavier; Weil, Gregoire

2014-01-01

142

Pediatric hospitalist comanagement of surgical patients: Structural, quality, and financial considerations.  

PubMed

Comanagement of surgical patients is occurring more commonly among adult and pediatric patients. These systems of care can vary according to institution type, comanagement structure, and type of patient. Comanagement can impact quality, safety, and costs of care. We review these implications for pediatric surgical patients. Journal of Hospital Medicine 2014;9:737-742. © 2014 Society of Hospital Medicine. PMID:25283766

Rappaport, David I; Rosenberg, Rebecca E; Shaughnessy, Erin E; Schaffzin, Joshua K; O'Connor, Katherine M; Melwani, Anjna; McLeod, Lisa M

2014-11-01

143

A national survey on patients’ enrollment rate in oncology clinical trials: The French experience. | accrualnet.cancer.gov  

Cancer.gov

To help increase enrollment in cancer clinical trials, France has provided financial support to university hospitals, comprehensive cancer centers, and community hospitals. Substantial portions of this support have been targeted at increasing the number of clinical research associates in these settings. Surveys were conducted to obtain a national overview of clinical oncology research in France, including numbers of trials conducted and numbers of patients enrolled. Between 2002 and 2011, trial accrual increased by 47%.

144

Patient perception of physician reimbursement for common hand surgical procedures.  

PubMed

Health care-related costs have been the focus of intense scrutiny in politics and in the media. However, public perception of physician reimbursement is poorly understood. The purpose of this study was to determine patient perception of physician reimbursement for 2 common hand surgery procedures: carpal tunnel release and open reduction and internal fixation of a distal radius fracture. Anonymous surveys were completed by 132 patients in an outpatient hand and upper-extremity practice. The surveys asked patients to estimate reasonable surgeon fees and actual Medicare reimbursement for 2 common hand surgery procedures (carpal tunnel release and internal fixation of a distal radius fracture) and 2 common surgical procedures (coronary artery bypass and appendectomy). On average, patients estimated that a reasonable surgeon fee for carpal tunnel release and 90 days of postoperative care was $2629 and that actual Medicare reimbursement was $1891. Patients estimated that a reasonable surgeon fee for internal fixation of an extra-articular distal radius fracture and 90 days of postoperative care was $3874 and that actual Medicare reimbursement was $2671. Higher level of education, annual household income, and insurance status had no statistically significant effect on patient estimates of reimbursement. Patients in an outpatient hand and upper extremity practice believe that surgeons are reimbursed at a rate 3.6 to 4.7 times greater than actual reimbursement. These misperceptions highlight the lack of understanding and transparency in health care costs and may interfere with the ability of patients to make well-informed decisions about health care. PMID:24025005

Fowler, John R; Buterbaugh, Glenn A

2013-09-01

145

Satisfaction of orthognathic surgical patients in a Malaysian population.  

PubMed

Thirty-one patients treated at the Faculty of Dentistry, University of Malaya, were assessed for their satisfaction following orthognathic surgery. The female to male ratio was 22:9 with an age range of 17 to 36. Almost all patients (97%) listed appearance as one of their rationales for surgery. More males (78%) than females (59%) wanted functional improvement, while more females (91%) than males (33%) hoped for improvement in self-confidence. All patients reported esthetic improvement while 68% each reported improvement in mastication and self-confidence. Slightly more than half (52%) chose esthetic improvement as the single most important factor resulting in satisfaction. Almost ninety percent of male patients claimed satisfaction with functional improvement, while 68% of those who found satisfaction in improved self-confidence were females. Eighty-seven percent rated their post-surgical changes as being well accepted by their family. The impact of these findings on the success of the surgery and the need to reinforce verbal communication with printed pamphlets are emphasized. PMID:12613507

Siow, K K; Ong, S T; Lian, C B; Ngeow, W C

2002-12-01

146

Abdominal Aortic Aneurysms in "High-Risk" Surgical Patients  

PubMed Central

Objective To evaluate the early results of endovascular grafting for high-risk surgical candidates in the treatment of abdominal aortic aneurysms (AAA). Summary Background Data Since the approval of endoluminal grafts for treatment of AAA, endovascular repair of AAA (EVAR) has expanded to include patients originally considered too ill for open AAA repair. However, some concern has been expressed regarding technical failure and the durability of endovascular grafts. Methods The University of Alabama at Birmingham (UAB) Computerized Vascular Registry identified all patients who underwent abdominal aneurysm repair between January 1, 2000, and June 12, 2002. Patients were stratified by type of repair (open AAA vs. EVAR) and were classified as low risk or high risk. Patients with at least one of the following classifications were classified as high risk: age more than 80 years, chronic renal failure (creatinine > 2.0), compromised cardiac function (diminished ventricular function or severe coronary artery disease), poor pulmonary function, reoperative aortic procedure, a “hostile” abdomen, or an emergency operation. Death, systemic complications, and length of stay were tabulated for each group. Results During this 28-month period, 404 patients underwent AAA repair at UAB. Eighteen patients (4.5%) died within 30 days of their repair or during the same hospitalization. Two hundred seventeen patients (53%) were classified as high risk. Two hundred fifty-nine patients (64%) underwent EVAR repair, and 130 (50%) of these were considered high-risk patients (including four emergency procedures). One hundred forty-five patients (36%) underwent open AAA repair, including 15 emergency operations. All deaths occurred in the high-risk group: 12 (8.3%) died after open AAA repair and 6 (2.3%) died after EVAR repair. Postoperative length of stay was shorter for EVAR repair compared to open AAA. Conclusions High-risk and low-risk patients can undergo EVAR repair with a lower rate of short-term systemic complications and a shorter length of stay compared to open AAA. Despite concern regarding the durability of EVAR, high-risk patients should be evaluated for EVAR repair before committing to open AAA repair. PMID:12724628

Jordan, William D.; Alcocer, Francisco; Wirthlin, Douglas J.; Westfall, Andrew O.; Whitley, David

2003-01-01

147

Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines.  

PubMed

Cholecystectomy has been widely performed in the treatment of acute cholecystitis, and laparoscopic cholecystectomy has been increasingly adopted as the method of surgery over the past 15 years. Despite the success of laparoscopic cholecystectomy as an elective treatment for symptomatic gallstones, acute cholecystitis was initially considered a contraindication for laparoscopic cholecystectomy. The reasons for it being considered a contraindication were the technical difficulty of performing it in acute cholecystitis and the development of complications, including bile duct injury, bowel injury, and hepatic injury. However, laparoscopic cholecystectomy is now accepted as being safe for acute cholecystitis, when surgeons who are expert at the laparoscopic technique perform it. Laparoscopic cholecystectomy has been found to be superior to open cholecystectomy as a treatment for acute cholecystitis because of a lower incidence of complications, shorter length of postoperative hospital stay, quicker recuperation, and earlier return to work. However, laparoscopic cholecystectomy for acute cholecystitis has not become routine, because the timing and approach to the surgical management in patients with acute cholecystitis is still a matter of controversy. These Guidelines describe the timing of and the optimal surgical treatment of acute cholecystitis in a question-and-answer format. PMID:17252302

Yamashita, Yuichi; Takada, Tadahiro; Kawarada, Yoshifumi; Nimura, Yuji; Hirota, Masahiko; Miura, Fumihiko; Mayumi, Toshihiko; Yoshida, Masahiro; Strasberg, Steven; Pitt, Henry A; de Santibanes, Eduardo; Belghiti, Jacques; Büchler, Markus W; Gouma, Dirk J; Fan, Sheung-Tat; Hilvano, Serafin C; Lau, Joseph W Y; Kim, Sun-Whe; Belli, Giulio; Windsor, John A; Liau, Kui-Hin; Sachakul, Vibul

2007-01-01

148

Totally implantable central venous access devices in pediatric oncology--our experience in 46 patients.  

PubMed

Between 1986 and 1990, 50 venous access devices have been implanted in 45 children with various types of cancer and in one patient with Langerhans cell histiocytosis. Twenty-five devices were of the so-called "pediatric" type (Port-A-Cath: 24, Vascuport: 1) and 25 were "adult" ports (Port-A-Cath: 8, Vascuport: 6, Infuse-A-Port: 6, Theraport: 5). The catheters (in silicone elastomer or polyurethane) were inserted percutaneously or surgically. Cumulative total venous access was 15024 patient-days (mean: 290 days per patient, range 2-900 days). Occlusion of the system, the most frequent complication, was encountered in 5 patients (11%). Rarer complications were catheter-related infection (2 pts), pneumothorax (1 pt), skin necrosis (1 pt), catheter leakage (1 pt) and port-catheter disconnection (1 pt). No serious complication ever occurred in 35 patients (76%). Seven of the 11 complications, including all 3 port occlusions, were encountered with "pediatric" systems. All the adult access devices tested were safe and allowed long-standing access to the central venous system in this series of pediatric cancer patients. With proper placement technique and adequate nursing care, they represent a definite improvement in child cancer therapy. PMID:8323914

De Backer, A; Vanhulle, A; Otten, J; Deconinck, P

1993-04-01

149

Patient perspectives: Kundalini yoga meditation techniques for psycho-oncology and as potential therapies for cancer.  

PubMed

The ancient system of Kundalini Yoga (KY) includes a vast array of meditation techniques. Some were discovered to be specific for treating psychiatric disorders and others are supposedly beneficial for treating cancers. To date, 2 clinical trials have been conducted for treating obsessive-compulsive disorder (OCD). The first was an open uncontrolled trial and the second a single-blinded randomized controlled trial (RCT) comparing a KY protocol against the Relaxation Response and Mindfulness Meditation (RRMM) techniques combined. Both trials showed efficacy on all psychological scales using the KY protocol; however, the RCT showed no efficacy on any scale with the RRMM control group. The KY protocol employed an OCD-specific meditation technique combined with other techniques that are individually specific for anxiety, low energy, fear, anger, meeting mental challenges, and turning negative thoughts into positive thoughts. In addition to OCD symptoms, other symptoms, including anxiety and depression, were also significantly reduced. Elements of the KY protocol other than the OCD-specific technique also may have applications for psycho-oncology patients and are described here. Two depression-specific KY techniques are described that also help combat mental fatigue and low energy. A 7-part protocol is described that would be used in KY practice to affect the full spectrum of emotions and distress that complicate a cancer diagnosis. In addition, there are KY techniques that practitioners have used in treating cancer. These techniques have not yet been subjected to formal clinical trials but are described here as potential adjunctive therapies. A case history demonstrating rapid onset of acute relief of intense fear in a terminal breast cancer patient using a KY technique specific for fear is presented. A second case history is reported for a surviving male diagnosed in 1988 with terminal prostate cancer who has used KY therapy long term as part of a self-directed integrative care approach. PMID:15695478

Shannahoff-Khalsa, David S

2005-03-01

150

Nutrition support in surgical patients with colorectal cancer  

PubMed Central

AIM: To review the application of nutrition support in patients after surgery for colorectal cancer, and to propose appropriate nutrition strategies. METHODS: A total of 202 consecutive surgical patients admitted to our hospital with a diagnosis of colon cancer or rectal cancer from January 2010 to July 2010, meeting the requirements of Nutrition Risk Screening 2002, were enrolled in our study. Laboratory tests were performed to analyze the nutrition status of each patient, and the clinical outcome variables, including postoperative complications, hospital stay, cost of hospitalization and postoperative outcome, were analyzed. RESULTS: The “non-risk” patients who did not receive postoperative nutrition support had a higher rate of postoperative complications than patients who received postoperative nutrition support (2.40 ± 1.51 vs 1.23 ± 0.60, P = 0.000), and had a longer postoperative hospital stay (23.00 ± 15.84 d vs 15.27 ± 5.89 d, P = 0.009). There was higher cost of hospitalization for patients who received preoperative total parenteral nutrition (TPN) than for patients who did not receive preoperative TPN (62 713.50 ± 5070.66 RMB Yuan vs 43178.00 ± 3596.68 RMB Yuan, P = 0.014). Applying postoperative enteral nutrition significantly shortened postoperative fasting time (5.16 ± 1.21 d vs 6.40 ± 1.84 d, P = 0.001) and postoperative hospital stay (11.92 ± 4.34 d vs 15.77 ± 6.03 d, P = 0.002). The patients who received postoperative TPN for no less than 7 d had increased serum glucose levels (7.59 ± 3.57 mmol/L vs 6.48 ± 1.32 mmol/L, P = 0.006) and cost of hospitalization (47 724.14 ± 16 945.17 Yuan vs 38 598.73 ± 8349.79 Yuan, P = 0.000). The patients who received postoperative omega-3 fatty acids had a higher rate of postoperative complications than the patients who did not (1.33 ± 0.64 vs 1.13 ± 0.49, P = 0.041). High level of serum glucose was associated with a high risk of postoperative complications of infection. CONCLUSION: Appropriate and moderate nutritional intervention can improve the postoperative outcome of colorectal cancer patients. PMID:21483641

Chen, Yang; Liu, Bao-Lin; Shang, Bin; Chen, Ai-Shan; Liu, Shi-Qing; Sun, Wei; Yin, Hong-Zhuan; Yin, Jian-Qiao; Su, Qi

2011-01-01

151

Using Baldrige Performance Excellence Program Approaches in the Pursuit of Radiation Oncology Quality Care, Patient Satisfaction, and Workforce Commitment  

PubMed Central

The Malcolm Baldrige National Quality Improvement Act was signed into law in 1987 to advance US business competitiveness and economic growth. Administered by the National Institute of Standards and Technology, the Act created the Baldrige National Quality Program, recently renamed the Baldrige Performance Excellence Program. The comprehensive analytical approaches referred to as the Baldrige Healthcare Criteria, are very well-suited for the evaluation and sustainable improvement of radiation oncology management and operations. A multidisciplinary self-assessment approach is used for radiotherapy program evaluation and development in order to generate a fact-based, knowledge-driven system for improving quality of care, increasing patient satisfaction, enhancing leadership effectiveness, building employee engagement, and boosting organizational innovation. This methodology also provides a valuable framework for benchmarking an individual radiation oncology practice's operations and results against guidelines defined by accreditation and professional organizations and regulatory agencies. PMID:22655229

Sternick, Edward S.

2011-01-01

152

Using the Statecharts paradigm for simulation of patient flow in surgical care  

E-print Network

chronology of events, conditions, and actions. Keywords Health care . Hospitals . Surgical services . Patient are not feasible because of ethical, safety, economic, or other reasons [2]. Other work has shown that patientUsing the Statecharts paradigm for simulation of patient flow in surgical care Boris Sobolev

Harel, David

153

Measured dose rate constant from oncology patients administered 18F for positron emission tomography  

SciTech Connect

Purpose: Patient exposure rate measurements verify published patient dose rate data and characterize dose rates near 2-18-fluorodeoxyglucose ({sup 18}F-FDG) patients. A specific dose rate constant based on patient exposure rate measurements is a convenient quantity that can be applied to the desired distance, injection activity, and time postinjection to obtain an accurate calculation of cumulative external radiation dose. This study reports exposure rates measured at various locations near positron emission tomography (PET) {sup 18}F-FDG patients prior to PET scanning. These measurements are normalized for the amount of administered activity, measurement distance, and time postinjection and are compared with other published data. Methods: Exposure rates were measured using a calibrated ionization chamber at various body locations from 152 adult oncology patients postvoid after a mean uptake time of 76 min following injection with a mean activity of 490 MBq {sup 18}F-FDG. Data were obtained at nine measurement locations for each patient: three near the head, four near the chest, and two near the feet. Results: On contact with, 30 cm superior to and 30 cm lateral to the head, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.482 (0.511), 0.135 (0.155), and 0.193 (0.223) {mu}Sv/MBq h, respectively. On contact with, 30 cm anterior to, 30 cm lateral to and 1 m anterior to the chest, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.623 (0.709), 0.254 (0.283), 0.190 (0.218), and 0.067 (0.081) {mu}Sv/MBq h respectively. 30 cm inferior and 30 cm lateral to the feet, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.024 (0.022) and 0.039 (0.044) {mu}Sv/MBq h, respectively. Conclusions: The measurements for this study support the use of 0.092 {mu}Sv m{sup 2}/MBq h as a reasonable representation of the dose rate anterior from the chest of patients immediately following injection. This value can then be reliably scaled to the desired time and distance for planning and staff dose evaluation purposes. At distances closer than 1 m, a distance-specific dose rate constant of 0.367 {mu}Sv/MBq h at 30 cm is recommended for accurate calculations. An accurate patient-specific dose rate constant that accounts for patient-specific variables (e.g., distribution and attenuation) will allow an accurate evaluation of the dose rate from a patient injected with an isotope rather than simply utilizing a physical constant.

Quinn, Brian; Holahan, Brian; Aime, Jean; Humm, John; St Germain, Jean; Dauer, Lawrence T. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (United States); Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (United States); Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (United States) and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (United States); Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (United States); Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (United States) and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (United States)

2012-10-15

154

Impact of proton beam availability on patient treatment schedule in radiation oncology.  

PubMed

Proton beam therapy offers unique physical properties with potential for reduced toxicity and better patient care. There is an increased interest in radiation oncology centers to acquire proton therapy capabilities. The operation of a proton treatment center is quite different than a photon-based clinic because of the more complex technology involved, as well as the single proton beam source serving multiple treatment rooms with no backup source available. There is limited published data which investigates metrics that can be used to determine the performance of a proton facility. The purpose of this study is to evaluate performance metrics of Indiana University Cyclotron Operations (IUCO), including availability, mean time between failures, and mean time to repair, and to determine how changes in these metrics impact patient treatments. We utilized a computerized maintenance management system to log all downtime occurrences and servicing operations for the facility. These data were then used to calculate the availability as well as the mean time between failures and mean time to repair. Impact on patient treatments was determined by analyzing delayed and missed treatments, which were recorded in an electronic medical record and database maintained by the therapists. The availability of the IUCO proton beam has been increasing since beginning of operation in 2003 and averaged 96.9% for 2009 through 2011. The mean time between failures and mean time to repair were also determined and correlated with improvements in the maintenance and operating procedures of the facility, as well as environmental factors. It was found that events less than 15 minutes in duration have minimal impact on treatment delays, while events lasting longer than one hour may result in missed treatments. The availability of the proton beam was more closely correlated with delayed than with missed treatments, demonstrating the utility and limitations of the availability metric. In conclusion, we suggest that the availability metric and other performance parameters, such as the mean time between failures and the mean time to repair, should be used in combination with downtime impact on patient treatments in order to adequately evaluate the operational success of a proton therapy facility. PMID:23149788

Miller, Eric D; Derenchuk, Vladimir; Das, Indra J; Johnstone, Peter A S

2012-01-01

155

Meaningful patient representation informing Canada's cancer drug funding decisions: views of patient representatives on the Pan-Canadian Oncology Drug Review  

PubMed Central

In this interview with the patient representatives on the Expert Review Committee (perc) of the Pan-Canadian Oncology Drug Review (pcodr), those representatives offer their views about how to be a valuable contributing member of Canada’s national cancer drug funding recommendation committee. The article seeks to inform readers, and especially clinicians, about pcodr from the perspective of the patient representatives. PMID:25302034

Hoch, J.S.; Brown, M.B.; McMahon, C.; Nanson, J.; Rozmovits, L.

2014-01-01

156

Clinical Oncology Society of Australia position statement on the use of complementary and alternative medicine by cancer patients.  

PubMed

Health professionals involved in the clinical management of cancer are becoming increasingly aware that their patients use complementary and alternative medicine (CAM). As cancer incidence and survival rates increase, use of CAM is also likely to increase. This paper outlines the position of the Clinical Oncology Society of Australia (COSA) on the use of CAM by cancer patients and provides guidance for health professionals involved with the treatment of cancer patients who are using or wish to use CAM. Key definitions and common communication scenarios are presented along with evidence-based recommended steps for health professionals when discussing CAM use. COSA encourages health professionals to focus on open discussion with their patients regarding CAM, to become familiar with reputable resources for CAM information, to discuss with patients the concept of evidence-based medicine, to recognize limitations to their knowledge of CAM and seek further advice when necessary, and to be respectful of the patients' right to autonomy. PMID:25244342

Braun, Lesley; Harris, Jessica; Katris, Paul; Cain, Michael; Dhillon, Haryana; Koczwara, Bogda; Olver, Ian; Robotin, Monica

2014-12-01

157

U.S. survey of surgical capabilities and experience with surgical procedures in patients with congenital haemophilia with inhibitors.  

PubMed

General guidelines exist for the use of recombinant activated factor VII (rFVIIa) to maintain haemostasis during surgery in congenital haemophilia A and B patients with high responding inhibitors (CHwI). Individual surgical plans are required and based upon historical therapy response, adverse events and anticipated procedure. Surgical interventions are feasible, yet it remains unclear how many US hemophilia treatment centres (HTCs) perform procedures in this fragile population. To better understand the US HTC surgical experience in CHwI patients and the number/types of procedures performed, a 21-question survey was sent to 133 US HTCs, with follow-up for response clarification and to non-responders. 98/133 HTCs (74%) responded, with 87 currently treating CHwI patients. In the last decade, 76/85 HTCs performed 994 surgeries on CHwI patients. Sites were experienced in the following procedures: central line insertion/removal (73 HTCs), dental (58), orthopaedic (52), abdominal (23), cardiovascular (14) and otolaryngologic (11). Experience with orthopaedic surgeries included synovectomies - arthroscopic (23 HTCs), radioisotopic (22), and open (7); joint replacement (18); fracture repair (14); and arthrodesis (8). Treatment modalities included rFVIIa bolus (83 HTCs) or continuous infusions (9), plasma-derived activated prothrombin complex concentrate (pd-aPCC) (55), antifibrinolytics (51), topical haemostatic agents (29), factor VIII (16) and fibrin sealants (14). Protocols for bypassing agents were used by 31/92 (33%) HTCs. Most US HTCs surveyed care for CHwI patients (74%) and have experience in minor surgery; fewer HTCs reported complex orthopaedic surgical experience. Identification of best practices and surgical barriers is required to guide future initiatives to support these patients. PMID:22168829

Shapiro, A; Cooper, D L

2012-05-01

158

NCI-CCR Pediatric Oncology Branch: Molecular Oncology Section - Staff  

Cancer.gov

Skip to Main Content CCR Home | About CCR | CCR Intranet Main Navigation Referrals For Patients For Physicians For Prospective Trainees For Scientists News Quick Links Home Referring a Patient Patients and Families Scientific Programs - Molecular Oncology

159

2009 Pandemic Influenza A (H1N1) Virus Infection in Pediatric Oncology and Hematopoietic Stem Cell Transplantation Patients  

PubMed Central

Background Pediatric oncology and hematopoietic stem cell transplantation (HSCT) patients are at high risk for influenza infection and its associated complications. Little is known about infection with novel 2009 influenza A (H1N1) in this population. Procedure Prospective laboratory surveillance identified all children with positive influenza test results from 4/27/09-12/5/09. 2009 H1N1 infection was confirmed by PCR subtyping; cases in which subtyping was not performed were considered probable. Medical records of all pediatric oncology and HSCT cases were reviewed. Results Thirty children with cancer or HSCT had laboratory-confirmed influenza A. Patients with ALL (18), CNS tumors (4), CML (1), Ewing sarcoma (1), Hodgkin lymphoma (1), LCH (1), severe aplastic anemia (1), and HSCT (3), had confirmed (5) and probable (25) H1N1 by rapid (22; 73%), DFA (4; 13%), or RVP (4; 13%) assays. Most frequent presenting signs and symptoms were fever (93%; median 38.6°C), cough (97%), and rhinorrhea (83%). Ten patients required hospitalization for a median of 5 days, most commonly for fever and neutropenia (8). Imaging demonstrated lower respiratory tract involvement in 3 patients. There were no concomitant bacteremias; one patient had rhinovirus co-infection. Three patients required ICU care; 1 developed ARDS, multi-organ failure, and died after 5 days. Chemotherapy was delayed in 5 patients. Oseltamivir was administered to 28 patients; 1 patient developed an oseltamivir-resistant strain and was treated with zanamivir. Conclusions 2009 influenza A H1N1 infection in children with cancer and HSCT is mild in most patients, but can lead to serious complications. PMID:20973099

Cost, Carrye; Brock, Evangeline; Adams-Huet, Beverley; Siegel, Jane D.; Ardura, Monica I.

2010-01-01

160

A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients  

Microsoft Academic Search

BACKGROUNDPatients who undergo surgery are at risk of malnutrition due to periods of starvation, the stress of surgery, and subsequent increase in metabolic rate. There are limited data on nutritional outcome of surgical patients.AIMSTo investigate changes in nutritional status and the influence of oral supplements on nutritional status, morbidity, and quality of life in postoperative surgical patients.METHODSEntry was determined by

A H Beattie; A T Prach; J P Baxter; C R Pennington

2000-01-01

161

Spine deformities in patients with Ehlers-Danlos syndrome, type IV - late results of surgical treatment  

Microsoft Academic Search

BACKGROUND: Spinal deformities in Ehlers-Danlos syndrome are usually progressive and may require operative treatment. There is limited number of studies describing late results of surgery in this disease. METHODS: This is a retrospective study of the records of 11 patients with Ehlers-Danlos syndrome type IV, treated surgically between 1990 and 2007. All patients underwent surgical treatment for spinal deformity. Duration

Barbara Jasiewicz; Tomasz Potaczek; Maciej Tesiorowski; Krzysztof Lokas

2010-01-01

162

Surgical Treatment of Patients with Open Tibial Fractures  

Microsoft Academic Search

Open tibial fractures are true surgical emergencies because of the risk of extensive infection to bone and devitalized soft tissue. The most serious consequence of open tibial fractures is osteomyelitisf-which usually can be prevented by prompt surgical intervention within six to eight hours after injuries occur. Open tibial fractures often are the result of trauma from motor vehicle collisions, farm

Chris Brown; Shirley Henderson; Shirley Moore

1996-01-01

163

Therapeutic scrapbooking: a technique to promote positive coping and emotional strength in parents of pediatric oncology patients.  

PubMed

Therapeutic scrapbooking is an intervention being used with parents and caregivers of children with cancer. The purpose of the group is to promote hopefulness, mobilize internal strengths, and thereby enhance the parents' and caregivers' coping abilities to benefit pediatric oncology patients. Facilitators, licensed in medical social work, provide a safe environment for participants to verbalize their stories and share their distress. Scrapbooking is a "normal" activity without the negative stigma that a "support group" may carry, minimizing the reluctance to attend this supportive group. Outcome measurements indicate this therapeutic intervention achieves positive results. PMID:21391072

McCarthy, Paula G; Sebaugh, Jill Genone

2011-01-01

164

Cancer patients' experiences of the early phase of individual counseling in an outpatient psycho-oncology setting.  

PubMed

Distress is a common and substantive problem associated with the invasive nature of cancer. Psychosocial interventions can alleviate distress and enhance quality of life, with a wealth of research demonstrating benefits of group interventions. Less is known, however, about the value of individual psychological counseling for cancer patients. The goal of our study was to understand patients' experiences of attending an individual psycho-oncology counseling service in a comprehensive cancer center in Canada. We conducted six focus groups to ask patients about their perceived benefits of the early phase of counseling. The 23 participants were predominantly women living in urban areas who sought counseling for emotional and coping difficulties. Using inductive analysis, we identified four interrelated themes: distress and need for support, challenges to service access, service benefits, and the therapeutic encounter. The therapeutic encounter formed a core component of patients' experiences, highlighting the benefits of specific therapeutic interventions and processes. PMID:23264535

Nekolaichuk, Cheryl L; Turner, Jill; Collie, Kate; Cumming, Ceinwen; Stevenson, Audrey

2013-05-01

165

Multiscale modeling and surgical planning for single ventricle heart patients  

NASA Astrophysics Data System (ADS)

Single ventricle heart patients are among the most challenging for pediatric cardiologists to treat, and typically undergo a palliative course of three open-heart surgeries starting immediately after birth. We will present recent tools for modeling blood flow in single ventricle heart patients using a multiscale approach that couples a 3D Navier-Stokes domain to a 0D closed loop lumped parameter network comprised of circuit elements. This coupling allows us to capture the effect of changes in local geometry, such as shunt sizes, on global circulatory dynamics, such as cardiac output. A semi-implicit numerical method is formulated to solve the coupled system in which flow and pressure information is passed between the two domains at the inlets and outlets of the model. A finite element method with outflow stabilization is applied in the 3D Navier-Stokes domain, and the LPN system of ordinary differential equations is solved numerically using a Runge-Kutta method. These tools are coupled via automated scripts to a derivative-free optimization method. Optimization is used to systematically explore surgical designs using clinically relevant cost functions for two stages of single ventricle repair. First, we will present results from optimization of the first stage Blalock Taussig Shunt. Second, we will present results from optimization of a new Y-graft design for the third stage of single ventricle repair called the Fontan surgery. The Y-graft is shown, in simulations, to successfully improve hepatic flow distribution, a known clinical problem. Preliminary clinical experience with the Y-graft will be discussed.

Marsden, Alison

2011-11-01

166

Surgical Approaches to the Oral Cavity Primary and Neck  

SciTech Connect

Purpose: A variety of surgical approaches used to treat primary oral cavity tumors are described to delineate the technique and rationale behind each treatment choice. Methods and Materials: Size, location, proximity to bone, lymph node status, histology, and prior treatment considerations are employed to determine the most appropriate surgical approach for primary oral cavity tumors. Results: Oncologic outcomes and physical function show the best results from surgical treatment of many primary oral cavity, but necessitates careful selection of surgical approach. Conclusion: Each surgical approach must be selected based upon relevant tumor, patient and physician factors.

Shah, Jatin P. [Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)], E-mail: shahj@mskcc.org

2007-10-01

167

Preoperative telemedicine evaluation of surgical mission patients: should we use it routinely?  

PubMed

Low-cost telemedicine is a viable and secure tool for preoperative evaluation of surgical mission patients. It increases efficiency and optimizes the use of existing resources. More specifically, it helps ensure an accurate assessment of patients before the surgical team arrives, reduces on-site prescreening time, and decreases the number of surgical candidates on the waiting list. Routine use of telemedicine in surgical missions most likely would reduce preoperative times and the number of operations canceled at the last minute. Moreover, it may be effectively used for long-term follow-up care, including the management of any postoperative complications. PMID:24552027

Latifi, Rifat; Mora, Francisco; Bekteshi, Flamur; Rivera, Renato

2014-01-01

168

Surgical strategies for treating patients with pineal region tumors.  

PubMed

Optimal management of pineal region tumors depends on securing an accurate histologic diagnosis to facilitate management customized to the nuances of specific pathologies. As an initial step, surgical intervention by either stereotactic biopsy or open surgery is necessary to obtain tissue for pathologic examination. Stereotactic biopsy has the benefit of relative ease and minimal morbidity but is associated with greater likelihood of diagnostic inaccuracy compared to open surgery where more extensive tissue sampling is possible. The role of surgical debulking in the management of pineal tumors is clearly defined for some tumors but is less evident for others. Among the one third of pineal tumors that are benign or low grade, complete surgical resection is achievable and constitutes optimal management with excellent long-term recurrence-free survival. The benefits of aggressive surgical resection among malignant tumors are less clear but several studies have correlated degree of tumor removal with improved outcome. Advances in technology, surgical technique, and post-operative care have minimized surgical complications, however all surgical procedures in the pineal region, including both stereotactic biopsy and open surgery, are potentially hazardous. Advanced judgment, experience, and expertise are necessary to achieve rates of success sufficient to justify aggressive management. Management strategies using stereotactic biopsy, endoscopy, and radiosurgery can also provide favorable outcomes in some cases. Selective incorporation of these innovations can be expected to improve the already highly favorable outcome for all pineal region tumors. PMID:15527093

Bruce, Jeffrey N; Ogden, Alfred T

2004-01-01

169

Evaluation of psychosocial distress in patients treated in a community-based oncology group practice in Germany  

PubMed Central

Background: Systematic evaluation of psychosocial distress in oncology outpatients is an important issue. We assessed feasibility and benefit of standardized routine screening using the Distress Thermometer (DT) and Problem List (PL) in all patients of our community-based hematooncology group practice. Patients and methods: One thousand four hundred forty-six patients were screened between July 2008 and September 2008. Five hundred randomly selected patients were sent a feedback form. Results: The average distress level was 4.7, with 37% indicating a distress level >5. Patients with nonmalignant diseases (81% autoimmune diseases or hereditary hemochromatosis) showed the highest distress level of 5.2. Most distressed were patients who just learned about relapse or metastases (6.4), patients receiving best supportive care (5.4) and patients receiving adjuvant antihormonal therapy (5.4). Ninety-seven percent of patients appreciated to speak to their doctor about their distress. Fifty-six percent felt better than usual after this consultation. Conclusion: DT and PL are feasible instruments to measure distress in hematooncology outpatients receiving routine care. DT and PL are able to improve doctor–patient communication and thus should be implemented in routine patient care. The study shows that distress is distributed differently between individuals, disease groups and treatment phases. PMID:20926545

Mergenthaler, U.; Heymanns, J.; Köppler, H.; Thomalla, J.; van Roye, C.; Schenk, J.; Weide, R.

2011-01-01

170

Impact of a surgical intensivist on the clinical outcomes of patients admitted to a surgical intensive care unit  

PubMed Central

Purpose An intensivist is a key factor in the mortality of patients admitted to the intensive care unit (ICU). The aim of this study was to evaluate the effect of an intensivist on clinical outcomes of patients admitted to a surgical ICU. Methods During the study period, the surgical ICU was converted from an open ICU to an intensivist-directed ICU managed by an intensivist who was board certified in both general surgery and critical care medicine. We compared consecutive patients admitted to the surgical ICU before and after implementing the intensivist-directed care. The primary outcome was ICU mortality, and secondary outcomes were hospital mortality, 90-day mortality, length of hospital stay, ICU-free days, ventilator-free days, and ICU readmission rate. Results A total of 441 patients were included in this study: 188 before implementation of the intensivist and 253 after implementation. Clinical characteristics were not different between the two groups. ICU mortality decreased from 11.7% to 6.3% (P = 0.047) after implementation, and 90-day mortality also decreased significantly (P = 0.008). The adjusted hazard ratio of the intensivist for ICU mortality was 0.43 (95% confidence interval, 0.22-0.87; P = 0.020). ICU-free days (P = 0.013) and the hospital length of stay (P = 0.032) were significantly improved after implementing the intensivist-directed care. Before implementation period, 16.0% of patients were readmitted, compared with only 9.9% after implementation (P = 0.05). Conclusion Implementing intensivist-directed care in the surgical ICU was associated with significant improvements in ICU mortality and significant clinical outcomes. PMID:24949324

Park, Chi-Min; Lee, Dae-Sang; Jeon, Kyeongman; Suh, Gee Young; Jeong, Jin Cheol

2014-01-01

171

Using an educational presentation to evaluate staffs' attitudes\\/perceptions regarding the use of mind\\/body interventions during serial MRIs for pediatric neuro-oncology patients  

Microsoft Academic Search

Pediatric neuro-oncology patients require serial MRI scans for years after diagnosis and medical treatment to monitor disease status. Managing anxiety and distress associated with MRI procedures is essential to improving the quality of the patient's repeated experience in radiology and ensuring the quality of the scan. Mind\\/body interventions such as relaxation, guided imagery, and hypnosis can be useful tools to

S. E Bates; E. A Meyer; E Dean-Clover; M. J Ott; W Wornham

2004-01-01

172

Thromboembolism prophylaxis. Choosing the proper method for surgical patients.  

PubMed

The primary care physician can play a major role in preoperative consultation in terms of assisting the surgical team to reduce the risk of thromboembolism. A preoperative risk assessment takes into account the type and duration of surgery as well as the existence of risk factors such as age and underlying medical conditions. With careful communication, the consulting physician and surgical team can together select a method of preventing thromboembolism that will prove both safe and effective. PMID:1862045

Corapi, M J; Della Ratta, R K

1991-08-01

173

Patient attitudes toward the use of surgical scrubs in a military hospital clinic  

PubMed Central

Objective To determine whether obstetrics and gynecology (ob/gyn) patients in a large military teaching hospital have a negative attitude toward the wearing of surgical scrubs by ob/gyn providers. Methods A convenience sample questionnaire on patient preferences, including two questions relating independently to military and civilian staff attire, was offered to clinic patients over a 2 month period. Univariate and multiple logistic regression analyses were used to identify patient groups less accepting of the surgical scrubs in clinics. Results Over ninety-one percent of respondents viewed surgical scrubs with a white coat to be acceptable clinical attire for military or civilian providers. Eight percent preferred the more formal uniform or business dress. Non-white and Hispanic patients had higher rates of preference for more formal dress. Conclusions The majority of ob/gyn patients surveyed did not view the use of surgical scrubs with a white coat negatively. PMID:19920961

Lund, Jon D; Rohrer, James E; Goldfarb, Susana

2008-01-01

174

Case management in oncology rehabilitation (CAMON): The effect of case management on the quality of life in patients with cancer after one year of ambulant rehabilitation. A study protocol for a randomized controlled clinical trial in oncology rehabilitation  

Microsoft Academic Search

Background  Cancer diseases and their therapies have negative effects on the quality of life. The aim of this study is to assess the effectiveness\\u000a of case management in a sample of oncological outpatients with the intent of rehabilitation after cancer treatment. Case management\\u000a wants to support the complex information needs of the patients in addition to the segmented structure of the

Irene Bachmann-Mettler; Claudia Steurer-Stey; Oliver Senn; Mathyas Wang; Katarina Bardheci; Thomas Rosemann

2011-01-01

175

Evaluating the effects of increasing surgical volume on emergency department patient access  

Microsoft Academic Search

AimTo determine how increases in surgical patient volume will affect emergency department (ED) access to inpatient cardiac services. To compare how strategies to increase cardiology inpatient throughput can either accommodate increases in surgical volume or improve ED patient access.MethodsA stochastic discrete event simulation was created to model patient flow through a cardiology inpatient system within a US, urban, academic hospital.

S Levin; R Dittus; D Aronsky; M Weinger

2011-01-01

176

BCL2, p53 and HLA-DR antigen expression in surgically treated parotid cancer patients  

Microsoft Academic Search

Our objective was to investigate the prognostic significance of bcl-2 protein, p53 protein and HLA-DR antigen expression in\\u000a a group of surgically treated parotid cancer patients. We studied bcl-2, p53 and HLA-DR immunohistochemical expression in\\u000a paraffin-embedded surgically removed tissue specimens derived from 26 patients with parotid cancer and 9 patients with Warthin\\u000a parotid tumors operated between 2000 and 2006 at

Michael Genetzakis; Ilias P. Gomatos; Anastasia N. Georgiou; John Giotakis; Leonidas Manolopoulos; ?onstantina Papadimitriou; Helen Chra; Emmanuel Leandros; Christos Tsigris; Eleutherios A. Ferekidis

2009-01-01

177

Anesthesia and perioperative management of colorectal surgical patients - specific issues (part 2)  

PubMed Central

Colorectal surgery carries significant morbidity and mortality, which is associated with an enormous use of healthcare resources. Patients with pre-existing morbidities, and those undergoing emergency colorectal surgery due to complications such as perforation, obstruction, or ischemia / infarction are at an increased risk for adverse outcomes. Fluid therapy in emergency colorectal surgical patients can be challenging as hypovolemic and septic shock may coexist. Abdominal sepsis is a serious complication and may be diagnosed during pre-, intra-, or postoperative periods. Early suspicion and recognition of medical and / or surgical complications are essential. The critical care management of complicated colorectal surgical patients require collaborative and multidisciplinary efforts. PMID:22869934

Patel, Santosh; Lutz, Jan M.; Panchagnula, Umakanth; Bansal, Sujesh

2012-01-01

178

[Radical surgical treatment of patients with complicated forms of acute paraproctitis].  

PubMed

The authors discuss the results of surgical treatment of 412 patients with complicated forms of acute paraproctitis. They found that one-stage radical surgical treatment may be performed in most patients. With strict observance of indications for each type of operative measures, careful surgical techniques, and effective treatment of the purulent operative wound, not only may the period of treatment be shortened but, which is most important, the incidence of postoperative complications may be considerably reduced and the best end results of the management of this most serious group of patients be achieved. But the authors also do not exclude the tactics of two-stage treatment. PMID:7897941

Koplatadze, A M; Bondarev, Iu A; Nosov, V A

1994-12-01

179

Prospective Comparison of Stereotactic Core Biopsy and Surgical Excision as Diagnostic Procedures for Breast Cancer Patients  

PubMed Central

Objective To determine whether stereotactic core biopsy (SCNB) is the diagnostic method of choice for all mammographic abnormalities requiring tissue sampling. Summary Background Data Stereotactic core needle biopsy decreases the cost of diagnosis, but its impact on the number of surgical procedures needed to complete local therapy has not been studied in a large, unselected patient population. Methods A total of 1,852 mammographic abnormalities in 1,550 consecutive patients were prospectively categorized for level of cancer risk and underwent SCNB or diagnostic needle localization and surgical excision. Diagnosis, type of cancer surgery, and number of surgical procedures to complete local therapy were obtained from surgical and pathology databases. Results The malignancy rate was 24%. Surgical biopsy patients were older, more likely to have cancer, and more likely to be treated with breast-conserving therapy than those in the SCNB group. For all types of lesions, regardless of degree of suspicion, patients diagnosed by SCNB were almost three times more likely to have one surgical procedure. However, for patients treated with lumpectomy alone, the number of surgical procedures and the rate of negative margins did not differ between groups. Conclusions Stereotactic core needle biopsy is the diagnostic procedure of choice for most mammographic abnormalities. However, for patients undergoing lumpectomy without axillary surgery, it is an extra invasive procedure that does not facilitate obtaining negative margins. PMID:11303136

Morrow, Monica; Venta, Luz; Stinson, Tamy; Bennett, Charles

2001-01-01

180

Treatment modalities in primary gastric lymphoma: the effect of rituximab and surgical treatment. A study by the Anatolian Society of Medical Oncology  

PubMed Central

Aim of the study Gastrointestinal lymphoma is the most common type of extranodal lymphoma and commonly involved site is the stomach. We have compared the superiority between treatment modalities for primary gastric lymphoma and we want to investigate efficacy of rituximab in gastric lymphoma. Material and methods Between April 2002 and December 2011, 146 patients with a histologically confirmed primary gastric lymphoma, initially diagnosed at eight different Cancer Centers within Turkey were evaluated retrospectively. According to the treatment modality, the patients were divided into chemotherapy (CT) alone, chemotherapy and radiotherapy (CRT), surgery and chemotherapy (SCT), surgery along with chemotherapy and radiotherapy (SCRT), and surgery (S) alone groups. Results Median follow-up period was 25.5 months. The 5-year EFS (event free survival) and OS (overall survival) rates for the patients were 55% and 62.3% respectively. In Log rank analysis of OS and EFS, we have identified levels of albumin and hemoglobine, IPI score, stage at diagnosis as factors influencing survival. In multivariate analysis of OS and EFS, only albumin and stage at diagnosis were factors independently contributing to survival. There was no statistically significant difference in terms of survival between different treatment modalities (p = 0.707 in EFS and p = 0.124 in OS). In analysis of patients treated with chemotherapy alone, there was no a statistically significant difference in terms of EFS and OS between chemotherapy regimens with or without rituximab in localized and advanced stage groups (p = 0.264 and p = 0.639). There was no statistical difference in survival rate (EFS and OS) between surgical or non-surgical treatment modalities for localized/advanced stage gastric lymphoma groups (p = 0.519 / p = 0.165). Conclusions There are several treatment options due to similar results in different treatment modalities. Also benefit of rituximab treatment in gastric lymphoma is still a controversial subject. Additional prospective trials are definitely required in order to clarify use of rituximab in treatment of extranodal gastric lymphoma. PMID:25258586

Sener, Cihan; Uyeturk, Ummugul; Seker, Mesut; Tastekin, Didem; Tonyali, Onder; Balakan, Ozan; Yazici, Omer Kemal; Urakci, Zuhat; Isikdogan, Abdurrahman; Ozdemir, Nuriye; Inal, Ali; Kaplan, Muhammed Ali; Suner, Ali; Dal, Sinan; Uncu, Dogan; Gumus, Mahmut; Boruban, Melih Cem; Oksuzoglu, Berna; Ayyildiz, Orhan; Benekli, Mustafa

2014-01-01

181

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands  

PubMed Central

Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient’s perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients’ perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well. PMID:23176563

2012-01-01

182

Investigational tests and treatments performed in terminal stage cancer patients in two weeks before death: Turkish oncology group (TOG) study.  

PubMed

Although more palliative care is necessary for terminally ill cancer patients, excess investigational tests, invasive procedures, and treatments are given instead. Between November 2009 and December 2013, six hundred and twenty-four patients with end-stage cancer who were died at inpatient setting evaluated retrospectively. Patients' characteristics, sites of tumor and metastasis, tests and invasive procedures, treatments performed in the last 2 weeks before death were collected from the hospital files and analyzed. Median age of 624 patients was 58 (range 16-96) years. More than half of the patients (370, 59.3 %) were men. The most frequent cancer sites were gastrointestinal (GI) system (32.2 %), lung (24.0 %), and breast (11.1 %). Frequent metastatic sites were liver (34.8 %), bone (31.5 %), lung (23.3 %), and/or brain (16.9 %). Causes of death were respiratory failure, infections, and/or liver failure in 49.9, 23.9, and 19.4 % of patients, respectively. Radiological tests performed in the last 2 weeks before death were ultrasonography, computed tomography, magnetic resonance imaging, bone scan in 25.6, 16.3, 11.4, and 3.8 % of patients, respectively. Treatments received were intravenous (i.v) serum infusion, blood transfusion, total parenteral nutrition (TPN), human albumin infusion in 55.9, 44.1, 34.9, and 9.5 % of patients, respectively. Invasive procedures such as invasive pain relief, terminal sedation, and chemotherapy performed in 12.6, 4.4, and 10.0 % of patients, respectively. Central venous catheter application, paracentesis, thoracentesis, and GI endoscopy were applied in 41.7, 9.8, 5.6, and 3.4 % of the patients, respectively. Radiological tests, invasive procedures, TPN, and human albumin transfusion were used excessively in terminal stage cancer patients in our medical oncology inpatient clinics. Invasive pain relief and terminal sedation were still underused in our cancer clinics. There is an urgent need in developing national palliative care program to improve the understanding of end-of-life care in our medical oncology clinics. PMID:25412940

Türker, Ibrahim; Kömürcü, Seref; Ar?can, Ali; Doruk, Hatice; Ozy?lkan, Ozgür; Co?kun, Hasan Senol; Colak, Dil?en; Uçgül Çavu?o?lu, Emel; Ata, Alper; Sezer, Ahmet; Ye?il Ç?nk?r, Havva; Senler, Filiz Cay; Arpac?, Fikret

2014-12-01

183

The Effect of Residual Osteomyelitis at the Resection Margin in Patients with Surgically Treated Diabetic Foot Infection  

Microsoft Academic Search

The appropriate antibiotic treatment of surgically resected diabetic foot osteomyelitis is controversial. We conducted a retrospective cohort study to evaluate the prognostic impact of residual osteomyelitis at the surgical margin of surgically resected diabetic foot osteomyelitis, and to assess the effectiveness of postoperative antibiotic therapy for residual osteomyelitis after surgical resection of infected bone. Of the 111 patients included in

Todd J. Kowalski; Miki Matsuda; Matthew D. Sorenson; Jacob D. Gundrum; William A. Agger

2011-01-01

184

Imatinib (Gleevec®) Reduces Cancer Recurrence in Patients with Surgically Removed GIST  

Cancer.gov

Patients with localized gastrointestinal stromal tumors (GIST) who took imatinib (Gleevec®) after surgical removal of the primary tumor were less likely to have a recurrence of their cancer, according to findings presented at the 2007 ASCO meeting in Chicago.

185

Functional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients  

Microsoft Academic Search

Objective:To analyze factors with impact on the functional outcome for patients with surgically treated intramedullary spinal cord tumors (IMSCT) and to point out characteristics of the different histological entities.Setting:Neurosurgical Department, University of Essen, Germany.Methods:Between 1990 and 2000, a consecutive series of 78 patients were referred to our institution and underwent surgical treatment. There were 46 (59%) male and 32 (41%)

I E Sandalcioglu; T Gasser; S Asgari; A Lazorisak; T Engelhorn; T Egelhof; D Stolke; H Wiedemayer

2005-01-01

186

Preoperative Prevalence of Staphylococcus aureus in Cardiothoracic and Neurological Surgical Patients  

PubMed Central

Methicillin-resistant Staphylococcus aureus (MRSA) is a global cause of both hospital and community-acquired infection. This retrospective, observational study determined the prevalence of MRSA carriers in cardiothoracic and neurological surgical patients presenting to an outpatient preoperative assessment center in Columbus, OH. Aggressive skin and soft-tissue infection may be caused by MRSA with potentially fatal complications. Cardiothoracic and neurological surgical patients are at high risk for surgical-site infection. Results indicated that 4.25% of the sample carried MRSA and 25.25% carried methicillin-sensitive S. aureus.

Kapoor, Ritu; Barnett, Christopher J.; Gutmann, Rebecca M.; Yildiz, Vedat O.; Joseph, Nicholas C.; Stoicea, Nicoleta; Reyes, Stephan; Rogers, Barbara M.

2014-01-01

187

Emotional Distress and Occupational Burnout in Health Care Professionals Serving HIV-Infected Patients: A Comparison with Oncology and Internal Medicine Services  

Microsoft Academic Search

Background: The present paper examines the levels of emotional distress and professional burnout among health care professionals working with HIV patients in two different settings, Infectious Disease (ID) Units and a Haemophilia (H) Unit, and compares them with those of professionals working in Oncology (O) or General Internal Medicine (IM) Units, all at public hospitals. Methods: Cross-sectional anonymous survey assessing

J. López-Castillo; M. Gurpegui; J. L. Ayuso-Mateos; J. D. Luna; J. Catalan

1999-01-01

188

Surveillance of hospital-acquired central line-associated bloodstream infections in pediatric hematology-oncology patients: lessons learned, challenges ahead.  

PubMed

Across 36 US pediatric oncology centers, 576 central line-associated bloodstream infections (CLABSIs) were reported over a 21-month period. Most infections occurred in those with leukemia and/or profound neutropenia. The contribution of viridans streptococci infections was striking. Study findings depict the contemporary epidemiology of CLABSIs in hospitalized pediatric cancer patients. PMID:23388370

Gaur, Aditya H; Bundy, David G; Gao, Cuilan; Werner, Eric J; Billett, Amy L; Hord, Jeff D; Siegel, Jane D; Dickens, David; Winkle, Cindi; Miller, Marlene R

2013-03-01

189

Assessment of protein-calorie malnutrition in surgical patients from plasma proteins and anthropometricmeasurements1  

Microsoft Academic Search

Six plasma proteins, two anthropometric measurements, hemoglobin and total lymphocytes were determined in 54 surgical patients and 19 normal individuals. Preopera- tive patients had how mean values for prealbumin, retinol binding protein, and arm muscle circumference. In postoperative patients, plasma transferrin, albumin, hemoglobin, total lym- phocytes and body weight were also how and complement C3 was higher than normal. A

Gerald A. Young; Graham L. Hill

190

Preliminary experience with 18f-fluoro-deoxy-glucose positron emission tomography/computed tomography in pediatric oncology patients.  

PubMed

The aim of this study was to present preliminary experience with FDG PET/CT in pediatric oncology patients in National PET Center, Clinical Center of Serbia and to asses its impact on management of malignancies in children. 33 FDG PET/CT scans were performed on 30 pediatric patients. PET/CT imaging was performed for staging the disease, assessing therapy efficacy and diagnosing recurrent or metastatic disease. FDG PET/CT changed the stage of the disease in 60.6% (20/33) of the cases. 14 patients were down-staged after PET/CT, mostly patients with Hodgkin's disease, were in 7/10 cases PET/CT showed no activity in residual masses. Six scans led to upstage of the disease. In three cases PET/CT did not change the stage of disease, but has showed new distant metastases. In conclusion, FDG PET/CT showed important role in managing pediatric patients with different malignancies and was useful complementary diagnostic tool to conventional imaging methods. PMID:22519195

Odalovi?, Strahinja; Sobi?-Saranovi?, Dragana; Pavlovi?, Smiljana; Grozdi?, Isidora; Saranovi?, Djordjije; Petrovi?, Milorad; Milovanovi?, Aleksandar; Petrasinovi?, Zorica; Djuri?-Stefanovi?, Aleksandra; Obradovi?, Vladimir

2011-01-01

191

Cultural differences in spiritual care: findings of an Israeli oncologic questionnaire examining patient interest in spiritual care  

PubMed Central

Background As professional spiritual care (chaplaincy) is introduced to new cultures worldwide, it bears examining which elements of screening and care are universal and, for those elements showing cultural difference, to study them in each culture. No quantitative spiritual care patient study had previously been done in Israel. Our objectives were twofold: 1) to examine who wants spiritual care in Israel, including demographic and clinical variables, and to compare against other results worldwide to further develop universal screening protocols 2) to see what patients want from spiritual care specifically in the Israeli setting. Methods Self-administered patient questionnaire examining spirituality/religiosity, interest in spiritual care (subdivided by type of care), and key demographic, social, and clinical data. The study setting was an Israeli oncology center at which spiritual care had been recently introduced. Results Data from 364 oncology patient questionnaires found 41% interest in spiritual care, as compared to 35%-54% in American studies. Having previously been visited by a spiritual caregiver predicted patient interest in further spiritual care (AOR 2.4, 95% CI 1.2-4.6), suggesting that the new service is being well-received. Multivariate stepwise logistic regression analysis identified additional predictors of openness to receiving spiritual care: self-describing as somewhat/very spiritual vs. not spiritual (adjusted odds ratio [AOR] 3.9 and 6.3, 95% CI 1.8-8.6 and 2.6-15.1) or traditional/religious vs. secular (AOR 2.2 and 2.1, 95% CI 1.3-3.6 and 1.1-4.0); and receiving one visit a week or less from family and friends (AOR 5.6, 95% CI 2.1-15.1). These findings are in line with previous American studies, suggesting universality across cultures that could be utilized in screening. Differences in demographic data and medical condition were not significant predictors of patient interest, suggesting a cultural difference, where age and education were predictors in the American context. Levels of interest in explicitly religious or spiritual support such as prayer or addressing religious/spiritual questions were much lower than in other cultures. Conclusions Results illustrate the demand for and satisfaction with the new Israeli service. The cross-cultural comparison found both culture-dependent and possibly universal predictors of patient interest, and found lower interest in Israel for explicitly religious/spiritual types of support. PMID:24708816

2014-01-01

192

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques.  

PubMed

Nipple-sparing mastectomy (NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon and careful preoperative and intraoperative management. In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon's experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon's experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM. PMID:25114861

Munhoz, Alexandre Mendonça; Montag, Eduardo; Filassi, José Roberto; Gemperli, Rolf

2014-08-10

193

Facial aesthetic surgical goals in patients of different cultures.  

PubMed

The purpose of facial aesthetic surgery is to improve the patient's psychological well-being. To achieve this, the surgeon must understand the patient's body image and their aesthetic and psychological expectations. These factors must be judged in the context of their cultural background. The patient's cultural values must also be understood to optimize the doctor-patient relationship. PMID:25049120

Rowe-Jones, Julian M

2014-08-01

194

Pretreatment Quality of Life Predicts for Locoregional Control in Head and Neck Cancer Patients: A Radiation Therapy Oncology Group Analysis  

SciTech Connect

Purpose: To analyze the prospectively collected health-related quality-of-life (HRQOL) data from patients enrolled in two Radiation Therapy Oncology Group randomized Phase III head and neck cancer trials (90-03 and 91-11) to assess their value as an independent prognostic factor for locoregional control (LRC) and/or overall survival (OS). Methods and Materials: HRQOL questionnaires, using a validated instrument, the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H and N), version 2, were completed by patients before the start of treatment. OS and LRC were the outcome measures analyzed using a multivariate Cox proportional hazard model. Results: Baseline FACT-H and N data were available for 1,093 patients and missing for 417 patients. No significant difference in outcome was found between the patients with and without baseline FACT-H and N data (p = 0.58). The median follow-up time was 27.2 months for all patients and 49 months for surviving patients. Multivariate analyses were performed for both OS and LRC. Beyond tumor and nodal stage, Karnofsky performance status, primary site, cigarette use, use of concurrent chemotherapy, and altered fractionation schedules, the FACT-H and N score was independently predictive of LRC (but not OS), with p = 0.0038. The functional well-being component of the FACT-H and N predicted most significantly for LRC (p = 0.0004). Conclusions: This study represents, to our knowledge, the largest analysis of HRQOL as a prognostic factor in locally advanced head and neck cancer patients. The results of this study have demonstrated the importance of baseline HRQOL as a significant and independent predictor of LRC in patients with locally advanced head and neck cancer.

Siddiqui, Farzan [Department of Radiation Oncology, Henry Ford Health System, Detroit, MI (United States); Pajak, Thomas F. [Statistical Headquarters, Radiation Therapy Oncology Group, Philadelphia, PA (United States); Watkins-Bruner, Deborah [University of Pennsylvania School of Nursing, Philadelphia, PA (United States); Konski, Andre A. [Fox Chase Cancer Center, Philadelphia, PA (United States); Coyne, James C. [Abramson Family Cancer Research Institute, Philadelphia, PA (United States); Gwede, Clement K. [H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (United States); Garden, Adam S. [University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Spencer, Sharon A. [Department of Radiation Oncology, Wallace Tumor Institute, Birmingham, AL (United States); Jones, Christopher [Radiological Associates of Sacramento, Sacramento, CA (United States); Movsas, Benjamin [Department of Radiation Oncology, Henry Ford Health System, Detroit, MI (United States)], E-mail: bmovsas1@hfhs.org

2008-02-01

195

Rare multiple primary malignancies among surgical patients--a single surgical unit experience  

PubMed Central

Background A remarkable number of patients presents with multiple primary malignancies (MPM) over their lifetimes. In most cases inherited syndromes, iatrogenic, or viral factors are implicated, while in some cases it is not possible to ascertain a clear aetiopathogenesis. Methods Starting from a series of 315 patients with MPM, we focused our attention on those with extremely infrequent combinations of tumours. We retrospectively analysed patients’ characteristics, type of first and second tumour and the interval between the two tumours. We made a comparison between our own data and data from surveillance, epidemiology, and end results cancer registries, the largest global series on this topic. Results Six patients presented with unusual associations, namely, central nervous system (CNS)/colon, testis/stomach, colon/CNS, CNS/kidney, uterus/soft tissue, and bone/breast. The median age was 50.5 years at the diagnosis of second neoplasm and the male:female ratio was 1:1. All six patients underwent surgery for both tumours. The median interval between the first and the second tumour was 11.3 years (range 1–36 years). Five patients were given chemotherapy as adjuvant systemic treatment, and two of them with CNS tumours also received radiotherapy. Discussion We analysed the behaviour of these rare tumours as first and second neoplasms. More frequent combinations and possible aetiological factors were evaluated. Conclusions Follow-up for patients recovering from a first tumour must be strict, as there is the risk of developing MPM, even after a long time period. Advancement in biomolecular knowledge and cooperation among different specialists are strongly needed to reduce mortality related to MPM and to foresee their occurrence. PMID:24966890

Carlomagno, Nicola; Santangelo, Michele L; Mastromarino, Rossella; Calogero, Armando; Dodaro, Concetta; Renda, Andrea

2014-01-01

196

Gynecologic Oncologic Surgery in the Elderly: A Retrospective Analysis of 213 Patients  

Microsoft Academic Search

Objectives. The aims of the study were (1) to analyze morbidity and mortality for elderly women (?70 years) operated on for gynecological malignancies at our department between 1985 and 1996; and (2) to compare two periods of time (years 1985–1990 versus years 1991–1996) to investigate whether new expedients in the surgical technique as well as in the perioperative management introduced

Tommaso Susini; Giovanni Scambia; Pasquale A. Margariti; Raffaella Giannice; Piero Signorile; Pierluigi Benedetti Panici; Salvatore Mancuso

1999-01-01

197

Assessment of serologic immunity to diphtheria-tetanus-pertussis after treatment of Korean pediatric hematology and oncology patients.  

PubMed

The aim of this study was to investigate the diphtheria-tetanus-pertussis antibody titers after antineoplastic treatment and to suggest an appropriate vaccination approach for pediatric hemato-oncologic patients. A total of 146 children with either malignancy in remission after cessation of therapy or bone marrow failure were recruited. All children had received routine immunization including diphtheria-tetanus-acellular pertussis vaccination before diagnosis of cancer. The serologic immunity to diphtheria, tetanus and pertussis was classified as: completely protective, partially protective, or non-protective. Non-protective serum antibody titer for diphtheria, tetanus and pertussis was detected in 6.2%, 11.6%, and 62.3% of patients, respectively, and partial protective serum antibody titer for diphtheria, tetanus and pertussis was seen in 37%, 28.1%, and 8.9% of patients. There was no significant correlation between the severity of immune defect and age, gender or underlying disease. Revaccination after antineoplastic therapy showed significantly higher levels of antibody for each vaccine antigen. Our data indicates that a large proportion of children lacked protective serum concentrations of antibodies against diphtheria, tetanus, and pertussis. This suggests that reimmunization of these patients is necessary after completion of antineoplastic treatment. Also, prospective studies should be undertaken with the aim of devising a common strategy of revaccination. PMID:22219618

Kwon, Hyo Jin; Lee, Jae-Wook; Chung, Nak-Gyun; Cho, Bin; Kim, Hack-Ki; Kang, Jin Han

2012-01-01

198

Improving neuro-oncological patients care: basic and practical concepts for nurse specialist in neuro-rehabilitation  

PubMed Central

Background Neuro-oncological population well expresses the complexity of neurological disability due to the multiple neurological deficits that affect these patients. Moreover, due to the therapeutical opportunities survival times for patients with brain tumor have increased and more of these patients require rehabilitation care. The figure of nurse in the interdisciplinary specialty of neurorehabilitation is not clearly defined, even if their role in this setting is recognized as being critical and is expanding. The purpose of the study is to identify the standard competencies for neurorehabilitation nurses that could be taught by means of a specialization course. Methods A literature review was conducted with preference given to works published between January 2000 and December 2008 in English. The search strategy identified 523 non-duplicated references of which 271 titles were considered relevant. After reviewing the abstracts, 147 papers were selected and made available to a group of healthcare professionals who were requested to classify them in few conceptual main areas defining the relative topics. Results The following five main areas were identified: clinical aspects of nursing; nursing techniques; nursing methodology; relational and organisational models; legal aspects of nursing. The relative topics were included within each area. As educational method a structured course based on lectures and practical sessions was designed. Also multi-choices questions were developed in order to evaluate the participants’ level of knowledge, while a semi-structured interview was prepared to investigate students’ satisfaction. Conclusions Literature shows that the development of rehabilitation depends on the improvement of scientific and practical knowledge of health care professionals. This structured training course could be incorporated into undergraduate nursing education programmes and also be inserted into continuing education programmes for graduate nurses. Developing expertise in neuro-rehabilitation for nurses, will be critical to improve overall care and care management of patients with highly complex disabilities as patients affected by brain tumors. The next step will be to start discussing, at the level of scientific societies linked to the field of neurorehabilitation and oncology, the development of a specialisation course in neurorehabilitation nursing. PMID:23031446

2012-01-01

199

Applicability of the Clavien-Dindo classification to emergency surgical procedures: a retrospective cohort study on 444 consecutive patients  

PubMed Central

Background Patients undergoing emergency surgery have a high risk for surgical complications and death. The Clavien-Dindo classification has been developed and validated in elective general surgical patients, but has not been validated in emergency surgical patients. The aim of the current study was to evaluate the Clavien-Dindo classification of surgical complications in emergency surgical patients and to study preoperative factors for risk stratification that should be included into a database of surgical complications. Methods A cohort of 444 consecutive patients having emergency general surgery during a three-month period was retrospectively analyzed. Surgical complications were classified according to the Clavien-Dindo classification. Preoperative risk factors for complications were studied using logistic regression analysis. Results Preoperatively 37 (8.3%) patients had organ dysfunctions. Emergency surgical patients required a new definition for Grade IV complications (organ dysfunctions). Only new onset organ dysfunctions or complications that significantly contributed to worsening of pre-operative organ dysfunctions were classified as grade IV complications. Postoperative complications developed in 115 (25.9%) patients, and 14 (3.2%) patients developed grade IV complication. Charlson comorbidity index, preoperative organ dysfunction and the type of surgery predicted postoperative complications. Conclusions The Clavien-Dindo classification of surgical complications can be used in emergency surgical patients but preoperative organ dysfunctions should be taken into account when defining postoperative grade IV complications. For risk stratification patients’ comorbidities, preoperative organ dysfunctions and the type of surgery should be taken into consideration. PMID:25075222

2014-01-01

200

NCI-CCR Pediatric Oncology Branch - Patients and Families, Driving Directions  

Cancer.gov

Skip to Main Content CCR Home | About CCR | CCR Intranet Main Navigation Referrals For Patients For Physicians For Prospective Trainees For Scientists News Quick Links Home Referring a Patient Patients and Families Support Services Clinical Programs

201

Promoting sleep in the adult surgical intensive care unit patients to prevent delirium.  

PubMed

Ensuring adequate sleep for hospitalized patients is important for reducing stress, improving healing, and decreasing episodes of delirium. The purpose of this project was to implement a Sleep Program for stable patients in the surgical intensive care unit, thereby changing sleep management practices and ensuring quality of care using an evidence-based practice approach. Improving patient satisfaction with sleep by 28 percentage points may be attributed to a standardized process of providing a healing environment for patients to sleep. PMID:25155537

Hata, Rose K L; Han, Lois; Slade, Jill; Miyahira, Asa; Passion, ChristyAnne; Ghows, Maimona; Izumi, Kara; Yu, Mihae

2014-09-01

202

Disparities in Oncologic Surgery  

PubMed Central

Surgical oncology is one of the most frequently studied surgical specialties with regard to disparities in quality of care. There is variation in the care received according to nonclinical factors such as age, race and ethnicity, education, income, and even geographic region. Differences exist with regard to who gets treatment, what treatment is received, and the outcomes of those treatments. Although the existence of such disparities is no longer in doubt, the etiology is still being investigated. Ongoing research and quality improvement initiatives move beyond the mere description of existing disparities in one of three ways: (1) identifying and understanding the factors that lead to disparities; (2) advancing available methods to measure and track disparities; and (3) developing an approach to improvement. In this article, we start out by offering a framework to describe potential factors that lead to disparities, using examples from surgical oncology. We then describe the approaches to measuring and tracking disparities that are being used in research and quality improvement. Finally, we attempt to illustrate how all of these factors interact and offer some potential strategies to close the gap and alleviate disparities within the discipline. PMID:18197450

Weeks, Jane C.; Stain, Steven C.

2014-01-01

203

[Organization of an out-patient surgical aid and ways of it's improvement].  

PubMed

The organization of an out-patient surgical aid is analysed. The results of 2363 surgical operations performed in the outpatients clinics in 1990-1992 are analysed. 277 (11.7%) of these operations are usually done in hospital. 348 roentgen-contrast examinations (including iliacography, arteriography, retroe femoral and popliteal phlebography) were performed in the Roentgenological division of clinics for outpatients. PMID:9297028

Mikheev, N M; Miroshnikov, A M; Dudkin, B P; Gradusov, E G; Belan, L A; Buldakov, G P; Epanchintsev, F F; Stovba, S I; Kukes, A I; Trifonov, K V

1997-01-01

204

Traumeel S in preventing and treating mucositis in young patients undergoing SCT: a report of the Children's Oncology Group  

PubMed Central

Mucositis can be a serious complication of hematopoietic SCT (HSCT). A previous phase II trial in 32 children undergoing HSCT reported a beneficial effect of the homeopathic remedy Traumeel S. The Children’s Oncology Group sought to replicate the results in a multi-institutional trial. The study was an international multi-center, double-blind, randomized trial comparing Traumeel with placebo in patients aged 3–25 years undergoing myeloablative HSCT. Traumeel/placebo was started on Day ?1 as a five-time daily mouth rinse. Efficacy of the treatment was assessed using the modified Walsh scale for mucositis, scored daily from Day ?1 to 20 days after HCST. The main outcome was the sum of Walsh scale scores (area-under-the-curve (AUC)) over this period. Other outcomes included narcotic use, days of total parenteral feeding, days of nasogastric feeding and adverse events. In 181 evaluable patients, there was no statistical difference in mucositis (AUC) in the Traumeel group (76.7) compared with placebo (67.3) (P = 0.13). There was a trend towards less narcotic usage in the Traumeel patients. No statistically beneficial effect from Traumeel was demonstrated for mucositis. We could not confirm that Traumeel is an effective treatment for mucositis in children undergoing HSCT. PMID:22504933

Sencer, SF; Zhou, T; Freedman, LS; Ives, JA; Chen, Z; Wall, D; Nieder, ML; Grupp, SA; Yu, LC; Sahdev, I; Jonas, WB; Wallace, JD; Oberbaum, M

2012-01-01

205

[Galen's oncology].  

PubMed

"Claudius Galenus" is the Author of "De tumoribus praeter naturam". The book was studied on the original Greek text with Latin version edited by K.G. Kühn ("Opera omnia Claudii Galeni": VII, 705-732). This Galen's clinical and pathological oncology was examined as far as categorization, classification, morphology, etiology, pathogenesis, morphogenesis, topography, behaviour (with related therapeutic and prognostic implications) and terminology are concerned. Problems, aspects and concepts, more or less clarified by Galen, were extensively discussed with special reference to the Galen's scientific knowledge and compared with the modern oncology. PMID:8868190

Vigliani, R

1995-10-01

206

Coronary artery disease in surgical patients. Preoperative evaluation.  

PubMed

Primary care physicians play a major role in the risk stratification of patients with coronary artery disease (CAD) preparing for noncardiac surgery. Preoperative risk assessment takes into account the type and urgency of surgery and the extent of underlying CAD. With this approach, patients can be categorized as being at high, intermediate, or low risk for postoperative cardiac complications. Judicious use of preoperative noninvasive cardiac testing may help identify those patients at particularly high risk for such complications. PMID:1409175

Corapi, M J; Della Ratta, R K

1992-10-01

207

Surgical Treatment for Lung Cancer Patients with Poor Pulmonary Function  

Microsoft Academic Search

This retrospective study was aimed to review the risk factors of postoperative hospital death in lung cancer patients with poor pulmonary reserves. We performed surgery on 30 lung cancer patients (average age: 71 years) with less than 1.0L of preoperative forced expiratory volume in one second (FEV1.0<1.0L) between 1982 and 2003. The preoperative FEV1.0 of these 30 patients was 0.81±0.1L

Kiyoshi Koizumi; Shuji Haraguchi; Tomomi Hirata; Kyoji Hirai; Iwao Mikami; Daisuke Okada; Shigeki Yamagishi; Tetsuo Kawashima; Hiroyasu Kinoshita; Yutaka Enomoto; Yuki Nakajima; Kazuo Shimizu

2005-01-01

208

Impact of age on in-hospital mortality of surgical patients in a German university hospital  

Microsoft Academic Search

Although the frequency of major surgical procedures in elderly patients is increasing, the impact of age as an independent factor on in-hospital mortality and capacity planning is uncertain. Therefore, we analyzed how age, gender, number of diagnoses, and number of operations per patient are reflecting the demographic changes going on in the last decade. Furthermore, we analyzed the influence of

Andrej Udelnow; Steffen Leinung; Dierk Schreiter; Manfred Schönfelder; Peter Würl

2005-01-01

209

The Digital Patient Push Using Location to Streamline the Surgical Journey S. Mukherjee1  

E-print Network

was designed to avoid medical errors and improve hospital efficiency by automating surgical patient management clinical sessions. Such a system could eliminate human error in patient identification (saving lives prevents mistakes such as administering the wrong drugs, accessing incorrect records or operating

Peng, Xiaohong

210

Surgical Outcome of Synchronous Second Primary Cancer in Patients with Gastric Cancer  

E-print Network

Purpose: In order to improve the likelihood of curative and safe gastric surgery, this study investigated the clinical features and surgical outcomes of gastric cancer with a synchronous cancer. Patients and Methods: The clinicopathological data of 10,090 gastric cancer patients at Samsung

Tae Kyung Ha; Ji Yeong An; Ho Geun Youn; Jae Hyung Noh; Tae Sung Sohn; Sung Kim

2007-01-01

211

Colloquial descriptions of body image in older surgical patients  

Microsoft Academic Search

Major surgery and associated experiences in critical care settings affect patients’ perceptions of their body images. This paper discusses several colloquial terms related to body image used in interviews by elderly patients following major surgery for abdominal aortic aneurysm. The terms ‘badly failed, and well mended’, and ‘out of sorts’, and ‘in tune with my body’ recurred. These referred to

Pat Deeny; Michael Kirk-Smith

2000-01-01

212

Dacryocystectomy: surgical indications and results in 25 patients.  

PubMed

The main indication for dacryocystectomy (DCT) is excision of lacrimal sac tumors. DCT may be considered less invasive than dacryocystorhinostomy (DCR) because lacrimal bone and nasal mucosa are not violated. To determine other indications for DCT, we performed a retrospective review of all patients who underwent DCT from the Oculoplastics Division, Department of Ophthalmology, UMD-New Jersey Medical School from July 1983 through July 1994. Patients with lacrimal sac tumors were excluded from the study. All 25 patients in the study demonstrated complete nasolacrimal duct obstruction (NLDO) and dry eye with minimal preoperative complaints of tearing. Nine of 25 patients also had systemic medical problems making them at medical risk for local anesthesia with monitored sedation. Four of 25 patients had underlying medical conditions (ocular cicatricial pemphigoid [OCP], Crohn's disease, and systemic lupus erythematosus) that might predispose them to nasal scarring after standard DCR. None of the 25 patients required secondary hospital admission and no patient demonstrated or complained of significant tearing that affected daily function after DCT. Although DCR is the standard for improving lacrimal outflow, we conclude that DCT is a useful alternative to it in selected patients with underlying dry eye and other medical conditions. PMID:9306443

Mauriello, J A; Vadehra, V K

1997-09-01

213

The non-operative care of the vascular surgical patient.  

PubMed

It is as important to recognize that some patients will not improve by operative surgery for vascular disease. When a decision is made for nonoperative management, responsibility dictates that the patient be given a regimen of measures designed for stabilization of his present condition and reversal of lifestyle trends which caused it. These include cessation of smoking, appropriate exercise and nutrition, excellent skin care, attention to clothing and shoes, management of prostheses, control of pain, and control of stress. A careful analysis of the patient's medications and his work environment must be made and tailored to his needs. Finally, the patient should be studiously educated as to his disease process and its relationship to his lifestyle. Only through understanding of the reasons for taking good care of himself can patients be effective in following their physician's advice. PMID:2724932

Bradham, G B

1989-05-01

214

External Dacryocystorhinostomy: Characteristics and Surgical Outcomes in Patients with and without Previous Dacryocystitis  

PubMed Central

Objective. To compare pre- and postoperative characteristics and surgical success rates of patients with and without previous episodes of dacryocystitis, who underwent external dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction (NLDO). Methods. The medical files of all patients who underwent external DCR between 2006 and 2011 in our institution were reviewed. The retrieved data of patients with and without previous episodes of dacryocystitis were compared. Surgical success was determined by postoperative followup of at least 6 months. Results. A total of 185 patients with NLDO underwent external DCR of whom 152 (100 females and 52 males, mean age 67 ± 15 years) met the inclusion criteria. Sixty had previous episodes of dacryocystitis and 92 did not. Left-side obstruction was more common than right-side obstruction among patients with previous episodes of dacryocystitis (48.3% versus 31.7%, resp., P = 0.031). Glaucoma patients were significantly more likely to develop dacryocystitis than patients without glaucoma (P = 0.002). The success rate of external DCR was 94.4% for patients with previous episodes of dacryocystitis and 86.7% for patients without (P = 0.337). Conclusions. The surgical outcomes of external DCR in patients with or without a previous episode of dacryocystitis were similar. Patients with glaucoma and NLDO had a significantly higher risk of developing dacryocystitis. PMID:24455195

Rabina, Gilad; Golan, Shani; Neudorfer, Meira; Leibovitch, Igal

2013-01-01

215

Daily baseline skin care in the prevention, treatment, and supportive care of skin toxicity in oncology patients: recommendations from a multinational expert panel  

PubMed Central

Skin reactions due to radiotherapy and chemotherapy are a significant problem for an important number of cancer patients. While effective for treating cancer, they disturb cutaneous barrier function, causing a reaction soon after initiation of treatment that impacts patient quality of life. Managing these symptoms with cosmetics and nonpharmaceutical skin care products for camouflage or personal hygiene may be important for increasing patient self-esteem. However, inappropriate product choice or use could worsen side effects. Although recommendations exist for the pharmaceutical treatment of skin reactions, there are no recommendations for the choice or use of dermatologic skin care products for oncology patients. The present guidelines were developed by a board of European experts in dermatology and oncology to provide cancer care professionals with guidance for the appropriate use of non-pharmaceutical, dermocosmetic skin care management of cutaneous toxicities associated with radiotherapy and systemic chemotherapy, including epidermal growth factor inhibitors and monoclonal antibodies. The experts hope that these recommendations will improve the management of cutaneous side effects and hence quality of life for oncology patients. PMID:24353440

Bensadoun, Rene-Jean; Humbert, Phillipe; Krutman, Jean; Luger, Thomas; Triller, Raoul; Rougier, Andre; Seite, Sophie; Dreno, Brigitte

2013-01-01

216

Improving surgical patient flow in a congested recovery area  

E-print Network

The recent movement in healthcare reform requires hospitals to care for more patients while simultaneously reducing costs. Medical institutions can no longer afford to simply add beds and hire staff to increase capacity. ...

Schwartz, Trevor A

2012-01-01

217

Clinical-surgical treatment of temporomandibular joint disorder in a psoriatic arthritis patient  

PubMed Central

Introduction Condylotomy is a surgical procedure that has been used as an option to treat temporomandibular disorder (TMD) patients. This technique has the advantage of avoiding intra-capsular alterations that might be found involving other surgical procedures. Its use, even when unilateral, has positive effect on treatment of both joints. Methods In order to better evaluate the benefits of a clinical-surgical treatment for TMD, the present report describes the case of a psoriatic arthritis patient. The case was clinically characterized by dental malloclusion, and imaging exams showed joint degeneration of the right mandibular condyle. The patient was treated by condylotomy technique after a prosthetic oral rehabilitation. Results No clinical-radiological signs or symptoms of progression of articular disease were observed within a period of 16 months after surgery. Furthermore, there was functional stability of the temporomandibular joint, total absence of local pain and improvement of mouth opening. Conclusion The present study suggests that condylotomy can be considered as a valid option for the management of TMD, since it has low surgical morbidity and favorable clinical outcomes. In this case, the patient had a medical diagnosis of systemic disease presenting general pain and pain at the temporomandibular joint (TMJ), in addition of causal agent of TMD (dental malloclusion). The difficulty of finding a single etiology (malocclusion vs. systemic disease) did not exclude the indication of a clinical-surgical treatment to re-establish the balance of TMJ. PMID:23556553

2013-01-01

218

Psychological modulation in patients surgically intervened for gastroesophageal reflux disease.  

PubMed

Gastroesophageal reflux disease (GERD) has been related with certain psychological dimensions. The influence of mood, emotional intelligence, and perceived quality of life on clinical symptoms and outcome of antireflux surgery was evaluated in GERD patients with and without hiatal hernia. The study included 61 patients who were diagnosed with GERD between 2003 and 2008: 16 of them without hiatal hernia (group A) and 45 of them with hiatal hernia (group B). All of these patients had undergone laparoscopic antireflux surgery. Patients were clinically examined and evaluated with the following instruments: Short Form (SF)-36 Health Survey, Gastrointestinal Quality of Life Index, Hospital Anxiety and Depression (HAD) Scale, and Trait Meta-Mood Scale (TMMS)-24. Proportions were compared by using the chi-squared test; averages were compared by using the Student's t-test (with Bonferroni's correction). In general, our patients intervened for GERD showed results lower than normal or close to the lower limit of normal in the administered tests. Patients in the group without hernia were younger (P < 0.001) and with lower American Society of Anaesthesiologists risk. They showed higher scores in the SF-36 dimensions: Physical Functioning, Physical Role and Emotional Role, and lower scores in the Social Role (P < 0.001). They showed lower scores in the Emotional dimension of Gastrointestinal Quality of Life Index (P = 0.0068) and worse results in the Hospital Anxiety and Depression subscales of Anxiety (P < 0.001) and Depression (not significant). Men in the group without hernia showed higher scores than men in the group with hernia in the TMMS subscales corresponding to Emotional Clarity and Emotional Repair (P < 0.001). Women in the group with hernia showed higher scores than women in the group without hernia regarding Emotional Clarity (P = 0.0012). GERD patients showed poor results in all the tests, and patients without hiatal hernia compared with patients with hernia showed higher levels of anxiety, which interfered with their social life. Moreover, they showed lower tolerance to stress and higher frustration, fear, and worry. On the basis of such unfavorable phychoemotional results observed with GERD patients (especially those without hernia) in the different tests, we propose that improving our knowledge of the psychological profile of GERD patients - particularly those without hiatal hernia - could help in designing individualized medical and psychological therapies and increase success rates. PMID:23121479

Lara, F J Pérez; Carranque, G; Oehling, H; Hernández, J M; Oliva, H

2014-08-01

219

Predicting and preventing pressure ulcers in surgical patients  

Microsoft Academic Search

•PRESSURE ULCERS, regardless of their origin, represent negative outcomes for patients, including pain, additional treatments and surgery, longer hospital stays, disfigurement or scarring, increased morbidity, and increased costs.•THE OR IS A HIGH-RISK environment for the development of pressure ulcers. Preoperative identification of patients at risk for pressure ulcer development is imperative if cost-effective, evidence-based preventive measures are to be implemented.•THIS

Alyce Schultz

2005-01-01

220

The decisional conflict scale: further validation in two samples of Dutch oncology patients  

Microsoft Academic Search

The importance of patient involvement in medical decision making is indisputable. Yet, decision making concerning medical treatment options is a difficult task for most patients. In order to study decision-making processes in health care, O’Connor developed the decisional conflict scale (DCS). The DCS assesses the level of ‘decisional conflict’ that patients experience while making health care decisions, and encompasses the

Nelleke Koedoot; Sjaak Molenaar; Paul Oosterveld; Piet Bakker; Alexander de Graeff; Marianne Nooy; Inge Varekamp; Hanneke de Haes

2001-01-01

221

Pelvic exenteration for colorectal cancer: oncologic outcome in 59 patients at a single institution  

PubMed Central

Background Pelvic exenteration (PE) continues to be the only curative option in selected patients with advanced or recurrent pelvic neoplasms. A current debate exists concerning the appropriate selection of patients for PE, with the most important factor being the absence of extrapelvic disease. Aim To evaluate the outcome of patients submitted to exenterative surgery. Patients and methods A review of the clinical charts of patients with colorectal cancer who underwent PE between January 1994 and June 2010 at the Institute National of Cancerología in Mexico City was performed. Results We selected 59 patients, 53 of whom were females (90%), and six of whom were males (10%). Mean age at the time of diagnosis was 50 years (range, 21–77 years). A total of 51 patients underwent posterior PE (86%), and eight patients underwent total PE (14%). Operative mortality occurred in two cases (3%), and 29 patients developed complications (49%). Overall, 11 patients (19%) experienced local failure with mean disease-free survival time of 10.2 months. After a mean follow-up of 28.3 months, nine patients are still alive without evidence of the disease (15%). Conclusions PE should be considered in advanced colorectal cancer without extrapelvic metastatic disease. PE is accompanied by considerable morbidity (49%) and mortality (3%), but local control is desirable. Overall survival justifies the use of this procedure in patients with primary or recurrent locally advanced rectal cancer. PMID:23091398

López-Basave, Horacio N; Morales-Vásquez, Flavia; Herrera-Gómez, Ángel; Rosciano, Alejandro Padilla; Meneses-García, Abelardo; Ruiz-Molina, Juan M

2012-01-01

222

Preoperative Nutritional Status of the Surgical Patients in Jeju  

PubMed Central

Background To assess the preoperative nutritional status of patients with various disorders and to provide data for pre- and postoperative patient management plans, particularly in the elderly. There is no published information on age-matched and disease-matched preoperative nutritional/immunologic status for orthopedic patients, especially in the elderly, in Jeju. Methods In total, 331 patients with four categories of orthopedic conditions were assessed: 92 elective surgery patients, 59 arthroplasty patients, 145 patients with fractures, and 35 infection patients. Malnutrition was defined as body mass index (BMI) below 18 kg/m2 of expected body weight (below 20% of normal), serum albumin/globulin ratio below 1.5 (normal range, 1.5 to 2.3), albumin level below 3.5 g/dL, total lymphocyte count below 1,500 cells/mm3, and lymphocyte/monocyte ratio below 5 versus 1. Results In 92 elective surgery patients, the average BMI was 23 kg/m2, hemoglobin was 15 g/dL, lymphocytes (2,486 cells)/monocytes (465 cells) ratio was 6.1, and the albumin (4.4 g/dL)/globulin (2.5 g/dL) ratio as a protein quotient was 1.7. Among the 59 hip and knee arthroplasty patients, the average BMI was 25 kg/m2, hemoglobin was 12 g/dL, lymphocytes (2,038 cells)/monocytes (391 cells) ratio was 6.6, and albumin (4.1 g/dL)/globulin (2.4 g/dL) ratio was 1.6. No subject showed malnutrition. Among the 145 fracture patients, the average BMI was 23 kg/m2. The hemoglobin level was 13 g/dL, monocytes (495 cells)/lymphocytes (1,905 cells) ratio was 1 versus 4.6, and albumin (4.1 d/gL)/globulin (2.5 d/gL) ratio was 1.6. However, both ratios decreased after 70 years of age. Among the 17 of 35 infection patients, albumin levels were below 3.5 g/dL, the average BMI was 22 kg/m2, lymphocytes (1,532 cells)/monocytes (545 cells) ratio was 2.4 versus 1, and albumin (3.0 g/dL)/globulin (3.3 g/dL) ratio was 0.9, while in 18 patients albumin levels were over 3.5 g/dL, the average BMI was 22 kg/m2, hemoglobin was 12 g/dL, lymphocytes (1,998 cells)/monocytes (583 cells) ratio was 3 versus 1, and albumin/globulin ratio was 1.4. Thus, in the infection group, approximately 50% of the patients showed poor nutrition and immunosuppression. Conclusions It was found that nutritional and immune condition deteriorated gradually to some degree in elderly patients over 60 years of age. PMID:25177463

Moon, Myung-Sang; Lee, Sang-Yup; Jeon, Dal-Jae; Yoon, Min-Geun; Kim, Sung-Sim; Moon, Hanlim

2014-01-01

223

Postoperative Adverse Outcomes in Intellectually Disabled Surgical Patients: A Nationwide Population-Based Study  

PubMed Central

Background Intellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients. Methods A nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact. Results Controls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37), pneumonia (odds ratio 2.01, 1.61 to 2.49), postoperative bleeding (odds ratio 1.35, 1.09 to 1.68) and septicemia (odds ratio 2.43, 1.85 to 3.21) without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability. Conclusion Intellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients. PMID:22046425

Lin, Jui-An; Liao, Chien-Chang; Chang, Chuen-Chau; Chang, Hang; Chen, Ta-Liang

2011-01-01

224

[Experience in the surgical treatment of patients with cancer of the proximal stomach].  

PubMed

The results of surgical treatment of 116 patients with cancer of the proximal part of the stomach are analysed; in 63 of the patients the tumor had spread to the esophagus. Combined gastrectomy was performed in 87 patients, combined proximal resection of the stomach--in 2 patients. In 73 patients the operation was carried out through a transperitoneal approach. The authors describe an original method of compression esophago-intestinal anastomosis established through a transperitoneal approach with a suturing apparatus of their design. The operation was performed on 14 patients. Comparative analysis of the results of surgical treatment with the use of different methods for creating the anastomosis allows the suggested method to be recommended when a transpleural approach is contraindicated. PMID:2687136

Kochegarov, A A; Prokudina, T N; Alimnazarov, Sh A

1989-01-01

225

Ophthalmologic Findings in Patients with Non-Surgically Treated Blowout Fractures  

PubMed Central

We evaluated the ocular and visual status in a group of patients with a non-surgically treated blowout fracture. Clinical examination with refraction, test of binocular function, and tear film evaluation was performed in 23 patients. These values were statistically correlated with the orbital volume measurements and ocular finding from the patient records at presentation. About 50% of the study group was symptomatic due to low visual acuity from refractive errors and decompensated phorias as a consequence of the blowout fracture. Several patients displayed changes in tear film production. There was no strong correlation between the measured parameters and orbital volume measurements. Patients with a non-surgically treated blowout fracture often display ocular and visual changes after discharge. A routine visual exam is advocated in all patients after the ocular status has stabilized after a blowout fracture. PMID:23449855

Pansell, Tony; Alinasab, Babak; Westermark, Anders; Beckman, Mats; Abdi, Saber

2012-01-01

226

Southwest Oncology Group: two decades of experience in non-small cell lung cancer.  

PubMed

Over the past two decades, studies of the Southwest Oncology Group have consistently reported stable esophagitis rates despite changing scales with concurrent chest radiotherapy and cisplatin/etoposide regimens. Patient selection has perhaps contributed to increased survival over this period. The Southwest Oncology Group has incorporated surgical questions and advanced the field with a steady use of consistent therapies (ie, cisplatin/etoposide plus radiotherapy of 45 Gy [induction therapy] and cisplatin/etoposide plus at least 61 Gy) in potentially operable or unresectable disease. Further studies examining the addition of either docetaxel or novel agents to such regimens are underway. PMID:16015548

Turrisi, Andrew T; Crowley, John; Albain, Kathy; Gaspar, Laurie; Gandara, David

2005-04-01

227

[Surgical therapy and critical care medicine in severely burned patients - Part 1: the first 24 ours].  

PubMed

Critical care medicine in severely burned patients should be adapted to the different pathophysiological phases. Accordingly, surgical and non-surgical therapy must be coordinated adequately. Initial wound care comprises topical treatment of less severely injured skin and surgical debridement of severely burned areas. The first 24 hours of intensive care are focused on calculated fluid delivery to provide stable hemodynamics and avoid progression of local edema formation. In the further course wound treatment with split-thickness skin grafts is the major aim of surgical therapy. Critical care is focused on the avoidance of complications like infections and ventilator associated lung injury. Therefore, lung-protective ventilation strategies, weaning and sedation protocols, and early enteral nutrition are important cornerstones of the treatment. PMID:22968982

Dembinski, Rolf; Kauczok, Jens; Deisz, Robert; Pallua, Norbert; Marx, Gernot

2012-09-01

228

Patient fears of tumor cell dissemination secondary to surgical interventions-part II.  

PubMed

Patient fears are an ever-present factor of patient care, and addressing those fears is a responsibility of the healthcare provider. One such fear may be of tumor cell dissemination secondary to surgical interventions. Preparing for such discussions will allow the healthcare provider to speak with authority on the topic of tumor dissemination secondary to breast biopsy or surgery, even in a situation where a patient has underlying fears. PMID:24476734

McClelland, Stacy; Weiss, Patricia

2014-02-01

229

Effect of surgical treatment on physical activity and bone resorption in patients with neurogenic intermittent claudication  

Microsoft Academic Search

.   The effect of surgical treatment on physical activity and bone resorption was examined in patients with neurogenic intermittent\\u000a claudication. Nineteen patients, 50–77 years of age, with neurogenic intermittent claudication (mean, 162 m; range, 20–400\\u000a m) caused by degenerative lumbar disease were included in the study. Decompressive laminectomy alone was performed for 7 patients\\u000a with lumbar spinal stenosis (LSS) and

Jun Iwamoto; Tsuyoshi Takeda

2002-01-01

230

How Closely Should We Follow Gastric Cancer Patients Following Surgical Resection?  

Microsoft Academic Search

The utility of intensive follow-up of patients with gastrointestinal malignancies following surgical resection has been a source of persistent debate. Most of the studies on this topic have been performed for patients with colorectal cancer, and the conclusions are mixed. In a meta-analysis of 8 randomized trials with 2923 colorectal cancer patients, more intensive follow-up was found to detect recurrences

Sam S. Yoon

2011-01-01

231

Surgical treatment of multiple knee ligament injuries in 44 patients: 2–8 years follow-up results  

Microsoft Academic Search

The purpose of the study was to evaluate the mid-term results of surgical treatment in different groups of patients with multiple knee ligament injuries. Review of our patients’ records revealed that 48 acute and chronic patients were surgically treated for combined knee injury. Due to severe capsular damage in these injuries, open techniques were used. In our treatment protocol, avulsed

Matheus Tzurbakis; Andreas Diamantopoulos; Theodoros Xenakis; Anastasios Georgoulis

2006-01-01

232

Patient and carer unmet needs: a survey of the British association of head and neck oncology nurses.  

PubMed

The aim of this survey was to ask members of the British Association of Head and Neck Oncology Nurses (BAHNON) about the identification of patients and carers unmet needs in the routine out-patient review clinic and the support services available during consultation. A national postal survey was sent out to the 210 current members of BAHNON in November 2009. Reminders were sent to non-responders in February 2010. The response rate was 61% (129/210). The vast majority (80%) were Clinical Nurse Specialists (CNS). The questionnaire data support the strong belief in attempts to identify unmet needs with over three-quarters feeling strongly about themselves being personally involved in attempting to identify unmet needs. Most of the responders used counselling and communication methods to elicit unmet concerns rather than specific tools such as questionnaires. The vast majority clearly felt that identifying unmet needs in clinic improves patients' perception of outcome post-treatment. Support services' readily' available at the time of consultation were as follows: H&N CNS (99%), Speech and Language (86%), Oncologist (84%), Dietician/Nutritionist (84%), Dentist (44%), Oral Rehabilitation consultant (27%), Dental Hygienist (26%), Physiotherapist (21%), Chaplain (20%), Emotional Support therapist (15%), Psychologist (15%), Occupational therapist (13%), Social worker (8%), other (11%). Although responders felt it very important to identify unmet needs in follow-up clinics, there is reliance on one to one discussion with the patient and carer. Hence in a busy clinic, needs might be easily missed and further research is required into ways to facilitate their identification. PMID:20674109

Rogers, S N; Clifford, N; Lowe, D

2011-07-01

233

Surgical bypass of symptomatic central venous obstruction for arteriovenous fistula salvage in hemodialysis patients.  

PubMed

Venous hypertension due to proximal central venous outflow obstruction coexisting with a functioning arteriovenous fistula in the ipsilateral arm presents with a complex management problem in hemodialysis patients. Ligation of the arteriovenous communication is the simplest procedure to relieve symptoms; however, this sacrifices the patient's hemodialysis access, which may be the only available access in that patient. Surgical bypass of the occlusion is a potential option as it obviates the symptoms of venous hypertension while preserving dialysis access. Our objective was to evaluate our experience and outcome with dialysis patients undergoing surgical bypass for symptomatic central venous obstruction and dialysis access salvage. There were three hemodialysis patients with severe venous hypertension secondary to subclavian vein obstruction who had functioning ipsilateral arteriovenous fistulae. All underwent cephalic vein (n = 2) or axillary vein (n = 1) to internal jugular vein bypass of the obstructed subclavian segment via an 8-mm polytetrafluoroethylene bridge graft. All patients had unsuccessful percutaneous transluminal angioplasty (PTA) attempts prior to surgical bypass. In two patients, a wire could not be passed through the occlusion; in the third, PTA was only transiently successful despite four repeated procedures. All patients had complete resolution of symptoms without operative mortality. The bypass grafts remained patent, allowing the arteriovenous fistulae to provide functional access for the entire duration of follow-up after surgery (3-8 months). Surgical bypass of a central vein obstruction relieves the symptoms of venous hypertension and prolongs the use of the existing hemodialysis access. This surgical option should be well recognized within the dialysis community. PMID:18346573

Suliman, Ahmed; Greenberg, Joshua I; Angle, Niren

2008-03-01

234

Flow Simulation to Enable Patient Specific Virtual Surgical Planning  

NASA Astrophysics Data System (ADS)

The current paradigm for interventional and surgery planning for the treatment of cardiovascular disease relies exclusively on diagnostic imaging data to define the present state of the patient, empirical data to evaluate the efficacy of prior treatments for similar patients, and the judgement of the surgeon to decide on a preferred treatment. The individual variability and inherent complexity of human biological systems is such that diagnostic imaging and empirical data alone are insufficient to predict the outcome of a given treatment for an individual patient. We have proposed a new paradigm of predictive medicine in which the physician utilizes computational tools to construct and evaluate a combined anatomic/physiologic model to predict differential changes in blood flow for alternative treatment plans for an individual patient. Ideally, these systems would provide an integrated set of image segmentation, geometric solid modeling, automatic finite element mesh generation, computational mechanics and scientific visualization tools accessible through an intuitive human-computer interface. In this talk we focus on the flow simulation aspects of this project. Error estimators for transient flow analyses have been developed and implemented to focus computational resources on the areas where they may have provide the greatest improvement. We will describe these error estimators and apply them to adaptive as well as uniform refinement simulations and compare the accuracy and performance to available experimental data in porcine bypass models that have been carried out specifically for this purpose.

Jansen, Kenneth; Taylor, Charles; Mueller, Jens

2003-11-01

235

Nerve sheath catheter analgesia for forequarter amputation in paediatric oncology patients.  

PubMed

In a single centre over two years, four children (7 to 10 years old) with upper limb osteosarcoma underwent chemotherapy followed by forequarter amputation. All patients had preoperative pain and were treated with gabapentin. Nerve sheath catheters were placed in the brachial plexus intraoperatively and left in situ for five to 14 days. After surgery, all patients received local anaesthetic infused via nerve sheath catheters as part of a multimodal analgesia technique. Three of the four patients were successfully treated as outpatients with the nerve sheath catheters in situ. All four children experienced phantom limb pain; however, it did not persist beyond four weeks in any patient. PMID:23977919

Kaddoum, R N; Burgoyne, L L; Pereiras, J A; Germain, M; Neel, M; Anghelescu, D L

2013-09-01

236

Minimally Invasive Surgery in Gynecologic Oncology  

PubMed Central

Minimally invasive surgery has been utilized in the field of obstetrics and gynecology as far back as the 1940s when culdoscopy was first introduced as a visualization tool. Gynecologists then began to employ minimally invasive surgery for adhesiolysis and obtaining biopsies but then expanded its use to include procedures such as tubal sterilization (Clyman (1963), L. E. Smale and M. L. Smale (1973), Thompson and Wheeless (1971), Peterson and Behrman (1971)). With advances in instrumentation, the first laparoscopic hysterectomy was successfully performed in 1989 by Reich et al. At the same time, minimally invasive surgery in gynecologic oncology was being developed alongside its benign counterpart. In the 1975s, Rosenoff et al. reported using peritoneoscopy for pretreatment evaluation in ovarian cancer, and Spinelli et al. reported on using laparoscopy for the staging of ovarian cancer. In 1993, Nichols used operative laparoscopy to perform pelvic lymphadenectomy in cervical cancer patients. The initial goals of minimally invasive surgery, not dissimilar to those of modern medicine, were to decrease the morbidity and mortality associated with surgery and therefore improve patient outcomes and patient satisfaction. This review will summarize the history and use of minimally invasive surgery in gynecologic oncology and also highlight new minimally invasive surgical approaches currently in development. PMID:23997959

Mori, Kristina M.; Neubauer, Nikki L.

2013-01-01

237

BK viremia in critically ill surgical patients with hemorrhagic or septic shock  

PubMed Central

Background Infections with polyomavirus BK virus (BKV) are a common cause of renal dysfunction after renal transplantation and may also be harmful in surgical patients with shock. The aim of the present study was to determine the frequency of BKV viremia in critically ill surgical patients with septic or hemorrhagic shock, and, if viremia is detectable, whether viremia may be associated with renal dysfunction. Findings A total of 125 plasma samples from 44 critically ill surgical patients with septic or hemorrhagic shock were tested by real-time polymerase chain reaction (PCR) for BKV DNA during their stay on the intensive care unit (ICU). BKV viremia occurred in four patients, i.e. in three of the septic and in one of the hemorrhagic shock group. There was no association between viremia and renal dysfunction. All positive samples contained a low viral load (< 500 copies/ml). Conclusions Since BK viremia was rarely found and with low viral load only in critically ill surgical patients with shock, it is very unlikely that BK viremia results in BK nephropathy later on. PMID:22339896

2012-01-01

238

Use of Complementary and Alternative Medicine in Paediatric Oncology Patients in Singapore  

Microsoft Academic Search

Introduction: Complementary and alternative medicine (CAM) is garnering increasing interest and acceptance among the general population. Although usage is thought to be widespread among paediatric cancer patients, local studies have not been done. We aimed to investigate the prevalence and predictors of CAM usage in paediatric cancer patients in a single institution. Materials and Methods: Parents of 73 paediatric cancer

M Y Chan

239

Improving the outcomes in oncological colorectal surgery.  

PubMed

During the last several decades, colorectal cancer surgery has experienced some major perioperative improvements. Preoperative risk-assessment of nutrition, frailty, and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy, contributed to improved postoperative outcomes. Enhanced recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient safety. After an initially indecisive start due to uncertainty about oncological safety, the most significant improvement in intraoperative care was the introduction of laparoscopy. Laparoscopic surgery for colon and rectal cancer is associated with better short-term outcomes, whereas long-term outcomes regarding survival and recurrence rates are comparable. Nevertheless, long-term results in rectal surgery remain to be seen. Early recognition of anastomotic leakage remains a challenge, though multiple improvements have allowed better management of this complication. PMID:25253944

van Vugt, Jeroen L A; Reisinger, Kostan W; Derikx, Joep P M; Boerma, Djamila; Stoot, Jan H M B

2014-09-21

240

Improving the outcomes in oncological colorectal surgery  

PubMed Central

During the last several decades, colorectal cancer surgery has experienced some major perioperative improvements. Preoperative risk-assessment of nutrition, frailty, and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy, contributed to improved postoperative outcomes. Enhanced recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient safety. After an initially indecisive start due to uncertainty about oncological safety, the most significant improvement in intraoperative care was the introduction of laparoscopy. Laparoscopic surgery for colon and rectal cancer is associated with better short-term outcomes, whereas long-term outcomes regarding survival and recurrence rates are comparable. Nevertheless, long-term results in rectal surgery remain to be seen. Early recognition of anastomotic leakage remains a challenge, though multiple improvements have allowed better management of this complication.

van Vugt, Jeroen LA; Reisinger, Kostan W; Derikx, Joep PM; Boerma, Djamila; Stoot, Jan HMB

2014-01-01

241

Investigation of realistic PET simulations incorporating tumor patient's specificity using anthropomorphic models: Creation of an oncology database  

SciTech Connect

Purpose: The GATE Monte Carlo simulation toolkit is used for the implementation of realistic PET simulations incorporating tumor heterogeneous activity distributions. The reconstructed patient images include noise from the acquisition process, imaging system's performance restrictions and have limited spatial resolution. For those reasons, the measured intensity cannot be simply introduced in GATE simulations, to reproduce clinical data. Investigation of the heterogeneity distribution within tumors applying partial volume correction (PVC) algorithms was assessed. The purpose of the present study was to create a simulated oncology database based on clinical data with realistic intratumor uptake heterogeneity properties.Methods: PET/CT data of seven oncology patients were used in order to create a realistic tumor database investigating the heterogeneity activity distribution of the simulated tumors. The anthropomorphic models (NURBS based cardiac torso and Zubal phantoms) were adapted to the CT data of each patient, and the activity distribution was extracted from the respective PET data. The patient-specific models were simulated with the Monte Carlo Geant4 application for tomography emission (GATE) in three different levels for each case: (a) using homogeneous activity within the tumor, (b) using heterogeneous activity distribution in every voxel within the tumor as it was extracted from the PET image, and (c) using heterogeneous activity distribution corresponding to the clinical image following PVC. The three different types of simulated data in each case were reconstructed with two iterations and filtered with a 3D Gaussian postfilter, in order to simulate the intratumor heterogeneous uptake. Heterogeneity in all generated images was quantified using textural feature derived parameters in 3D according to the ground truth of the simulation, and compared to clinical measurements. Finally, profiles were plotted in central slices of the tumors, across lines with heterogeneous activity distribution for visual assessment.Results: The accuracy of the simulated database was assessed against the original clinical images. The PVC simulated images matched the clinical ones best. Local, regional, and global features extracted from the PVC simulated images were closest to the clinical measurements, with the exception of the size zone variability and the mean intensity values, where heterogeneous tumors showed better reproducibility. The profiles on PVC simulated tumors after postfiltering seemed to represent the more realistic heterogeneous regions with respect to the clinical reference.Conclusions: In this study, the authors investigated the input activity map heterogeneity in the GATE simulations of tumors with heterogeneous activity distribution. The most realistic heterogeneous tumors were obtained by inserting PVC activity distributions from the clinical image into the activity map of the simulation. Partial volume effect (PVE) can play a crucial role in the quantification of heterogeneity within tumors and have an important impact on applications such as patient follow-up during treatment and assessment of tumor response to therapy. The development of such a database incorporating patient anatomical and functional variability can be used to evaluate new image processing or analysis algorithms, while providing control of the ground truth, which is not available when dealing with clinical datasets. The database includes all images used and generated in this study, as well as the sinograms and the attenuation phantoms for further investigation. It is freely available to the interested reader of the journal at http://www.med.upatras.gr/oncobase/.

Papadimitroulas, Panagiotis; Efthimiou, Nikos; Nikiforidis, George C.; Kagadis, George C. [Department of Medical Physics, School of Medicine, University of Patras, Rion, GR 265 04 (Greece)] [Department of Medical Physics, School of Medicine, University of Patras, Rion, GR 265 04 (Greece); Loudos, George [Department of Biomedical Engineering, Technological Educational Institute of Athens, Ag. Spyridonos Street, Egaleo GR 122 10, Athens (Greece)] [Department of Biomedical Engineering, Technological Educational Institute of Athens, Ag. Spyridonos Street, Egaleo GR 122 10, Athens (Greece); Le Maitre, Amandine; Hatt, Mathieu; Tixier, Florent; Visvikis, Dimitris [Medical Information Processing Laboratory (LaTIM), National Institute of Health and Medical Research (INSERM), 29609 Brest (France)] [Medical Information Processing Laboratory (LaTIM), National Institute of Health and Medical Research (INSERM), 29609 Brest (France)

2013-11-15

242

Recruiting minority cancer patients into cancer clinical trials: a pilot project involving the Eastern Cooperative Oncology Group and the National Medical Association. | accrualnet.cancer.gov  

Cancer.gov

This paper may be useful for researchers interested in enhancing their interactions with community physicians and increasing the number of minority patients referred to clinical trials. It describes a study conducted by the Eastern Cooperative Oncology Group (ECOG) in collaboration with the National Medical Association (NMA) to better understand barriers and solutions to African-American (AA) accrual and to test several recommended low-cost strategies.

243

Cancer-related neuropathic pain in out-patient oncology clinics: a European survey  

PubMed Central

Background Although pain is frequently experienced by patients with cancer, it remains under-treated. The primary aim of this study was to estimate the prevalence of cancer-related neuropathic pain (CRNP) in patients with chronic pain who attended an outpatient clinic for standard care in Europe (irrespective of the reason or stage of the cancer). The secondary aims of this study were to characterise pain and cancer in patients with CRNP (including treatment) and to evaluate the usefulness of the painDETECT (PD-Q) screening tool to help physicians identify a potential neuropathic component of cancer-related pain. Methods An observational, non-interventional, cross-sectional, multi-centre study of adult patients with cancer using patient and physician case report forms (CRFs). Patients with CRNP were identified by physicians’ clinical assessments after examining the completed PD-Q. Results A total of 951 patients visiting outpatient clinics across Europe were enrolled in this study between August 2010 and July 2011. Of these, 310 patients (32.60%; 95% confidence interval 29.62, 35.58) were identified as having CRNP. Twenty-nine of 39 (74.4%) physicians who completed the CRF relating to the PD-Q considered it a useful tool to help detect CRNP in daily practice and 28 of 39 (71.8%) indicated that they would use this tool in the future for most or some of their patients. Data from physicians before and after review of the completed PD-Qs showed a shift in clinical opinion (either to positive CRNP diagnosis [yes] or negative CRNP diagnosis [no]) in respect of 142 patients; about half of which (74) were categorised with an initial diagnosis of unknown. Opinions also shifted from a no to a yes diagnosis in 10 patients and from a yes to a no diagnosis in 51 patients. Conclusions Approximately one-third of adults with cancer experiencing chronic pain attending outpatient clinics as part of routine care were considered to have CRNP in the opinion of the physicians after considering scores on the PD-Q. While physicians did not consider the PD-Q to be a useful tool for all patients, shifts in diagnosis before and after the use of this tool indicate that it may help physicians identify CRNP, especially where there is initial uncertainty. PMID:24200014

2013-01-01

244

Double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients  

PubMed Central

AIM: To evaluate double balloon enteroscopy (DBE) in post-surgical patients to perform endoscopic retrograde cholangiopancreatography (ERCP) and interventions. METHODS: In 37 post-surgical patients, a stepwise approach was performed to reach normal papilla or enteral anastomoses of the biliary tract/pancreas. When conventional endoscopy failed, DBE-based ERCP was performed and standard parameters for DBE, ERCP and interventions were recorded. RESULTS: Push-enteroscopy (overall, 16 procedures) reached enteral anastomoses only in six out of 37 post-surgical patients (16.2%). DBE achieved a high rate of luminal access to the biliary tract in 23 of the remaining 31 patients (74.1%) and to the pancreatic duct (three patients). Among all DBE-based ERCPs (86 procedures), 21/23 patients (91.3%) were successfully treated. Interventions included ostium incision or papillotomy in 6/23 (26%) and 7/23 patients (30.4%), respectively. Biliary endoprosthesis insertion and regular exchange was achieved in 17/23 (73.9%) and 7/23 patients (30.4%), respectively. Furthermore, bile duct stone extraction as well as ostium and papillary dilation were performed in 5/23 (21.7%) and 3/23 patients (13.0%), respectively. Complications during DBE-based procedures were bleeding (1.1%), perforation (2.3%) and pancreatitis (2.3%), and minor complications occurred in up to 19.1%. CONCLUSION: The appropriate use of DBE yields a high rate of luminal access to papilla or enteral anastomoses in more than two-thirds of post-surgical patients, allowing important successful endoscopic therapeutic interventions. PMID:21633596

Raithel, Martin; Dormann, Harald; Naegel, Andreas; Boxberger, Frank; Hahn, Eckhart G; Neurath, Markus F; Maiss, Juergen

2011-01-01

245

Catheter-associated bloodstream infections in pediatric hematology-oncology patients: factors associated with catheter removal and recurrence.  

PubMed

The aims of this study were to analyze the factors associated with antibiotic failure leading to tunneled central venous catheter (CVC) removal during catheter-associated bloodstream infections (CABSIs) and with recurrence and reinfection in children with cancer. All cases of CABSI in patients attending the Department of Pediatric Hematology-Oncology between November 2000 and November 2003 were reviewed. A total of 207 episodes of CABSI, including multiple episodes involving the same catheter, were identified in 146 of 410 tunneled CVCs (167 Hickman, 243 implantable ports). The most common organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in 96 (46%) episodes. Hypotension, persistent bacteremia, previous stem cell transplantation, multiple CABSIs in the same CVC, exit-site infection, inappropriate empiric antibiotic therapy, and Candida infection were all significantly associated with increased risk of catheter removal (P < 0.05, odds ratios 7.81, 1.14, 2.22, 1.93, 3.04, 2.04 and 24.53, respectively). There were 12 episodes of recurrent infection, all except 1 caused by CONS (odds ratio 20.5, P = 0.006). Inappropriate empiric therapy, especially in implantable ports, was the only mutable risk factor for antibiotic failure. Because CONS was the predominant isolate in these devices, adding glycopeptides to the empiric therapy for suspected implantable-port CABSI might decrease the removal rate. This issue should be explored in future controlled trials. PMID:16394888

Adler, Amos; Yaniv, Isaac; Solter, Ester; Freud, Enrique; Samra, Zmira; Stein, Jerry; Fisher, Salvador; Levy, Itzhak

2006-01-01

246

Surgical approach in patients with hyperparathyroidism in multiple endocrine neoplasia type 1: total versus partial parathyroidectomy  

PubMed Central

Usually, primary hyperparathyroidism is the first endocrinopathy to be diagnosed in patients with multiple endocrine neoplasia type 1, and is also the most common one. The timing of the surgery and strategy in multiple endocrine neoplasia type 1/hyperparathyroidism are still under debate. The aims of surgery are to: 1) correct hypercalcemia, thus preventing persistent or recurrent hyperparathyroidism; 2) avoid persistent hypoparathyroidism; and 3) facilitate the surgical treatment of possible recurrences. Currently, two types of surgical approach are indicated: 1) subtotal parathyroidectomy with removal of at least 3–3½ glands; and 2) total parathyroidectomy with grafting of autologous parathyroid tissue. Transcervical thymectomy must be performed with both of these procedures. Unsuccessful surgical treatment of hyperparathyroidism is more frequently observed in multiple endocrine neoplasia type 1 than in sporadic hyperparathyroidism. The recurrence rate is strongly influenced by: 1) the lack of a pre-operative multiple endocrine neoplasia type 1 diagnosis; 2) the surgeon's experience; 3) the timing of surgery; 4) the possibility of performing intra-operative confirmation (histologic examination, rapid parathyroid hormone assay) of the curative potential of the surgical procedure; and, 5) the surgical strategy. Persistent hyperparathyroidism seems to be more frequent after subtotal parathyroidectomy than after total parathyroidectomy with autologous graft of parathyroid tissue. Conversely, recurrent hyperparathyroidism has a similar frequency in the two surgical strategies. To plan further operations, it is very helpful to know all the available data about previous surgery and to undertake accurate identification of the site of recurrence. PMID:22584722

Tonelli, Francesco; Giudici, Francesco; Cavalli, Tiziana; Brandi, Maria Luisa

2012-01-01

247

Surgical approach in patients with hyperparathyroidism in multiple endocrine neoplasia type 1: total versus partial parathyroidectomy.  

PubMed

Usually, primary hyperparathyroidism is the first endocrinopathy to be diagnosed in patients with multiple endocrine neoplasia type 1, and is also the most common one. The timing of the surgery and strategy in multiple endocrine neoplasia type 1/hyperparathyroidism are still under debate. The aims of surgery are to: 1) correct hypercalcemia, thus preventing persistent or recurrent hyperparathyroidism; 2) avoid persistent hypoparathyroidism; and 3) facilitate the surgical treatment of possible recurrences. Currently, two types of surgical approach are indicated: 1) subtotal parathyroidectomy with removal of at least 3-3 K glands; and 2) total parathyroidectomy with grafting of autologous parathyroid tissue. Transcervical thymectomy must be performed with both of these procedures. Unsuccessful surgical treatment of hyperparathyroidism is more frequently observed in multiple endocrine neoplasia type 1 than in sporadic hyperparathyroidism. The recurrence rate is strongly influenced by: 1) the lack of a pre-operative multiple endocrine neoplasia type 1 diagnosis; 2) the surgeon's experience; 3) the timing of surgery; 4) the possibility of performing intra-operative confirmation (histologic examination, rapid parathyroid hormone assay) of the curative potential of the surgical procedure; and, 5) the surgical strategy. Persistent hyperparathyroidism seems to be more frequent after subtotal parathyroidectomy than after total parathyroidectomy with autologous graft of parathyroid tissue. Conversely, recurrent hyperparathyroidism has a similar frequency in the two surgical strategies. To plan further operations, it is very helpful to know all the available data about previous surgery and to undertake accurate identification of the site of recurrence. PMID:22584722

Tonelli, Francesco; Giudici, Francesco; Cavalli, Tiziana; Brandi, Maria Luisa

2012-01-01

248

Factors Influencing Adjustment of Patients Suffering from Nasopharynx Carcinoma—Implications for Oncology Social Work  

Microsoft Academic Search

A longitudinal study has been conducted in Hong Kong to identify important factors that affect short-term adjustment of patients suffering from nasopharynx carcinoma (NPC). A total of 125 newly diagnosed NPC patients were interviewed in the diagnostic phase, the number dropping to 119 in the treatment phase, and 111 in the post-treatment phase. Data were gathered by a pre-tested structured

Joyce L. C. Ma

1997-01-01

249

Using the Values-Based History to Fine-Tune Advance Care Planning for Oncology Patients  

Microsoft Academic Search

There is no standardized approach to the discussion of advanced care planning. One approach to discussing advanced care planning\\u000a involves the use of a values history. The values history focuses on questions related to overall health, personal relationships,\\u000a and independence, as well as symptoms. The values history facilitates communication with the patient and allows the patient\\u000a to express their view.

Eric E. Prommer

2010-01-01

250

[Breast cancer as a social problem and common aspects with other oncologic patients].  

PubMed

Problems of peculiar relationships between oncologists, society and general public, on the one hand, and cancer patients, on the other, are discussed with respect to breast cancer. It is suggested that if one's right to take care of one's life is to be honored, cancer patients are to have access to more information on their disease must doctor should be prepared to give away more of it in their conversations. Once one is aware of responsibility for one's health, the advantages of an earlier visit to a doctor and, conversely, the tragedy of a belated call become quite apparent. Such awareness is not feasible unless society becomes the patients ally in every-day activities of cancer control. This approach calls for a revision of somewhat out-dated deontological principles as well as measures aimed at getting the public to change their attitudes towards cancer patients. Simultaneously, the medical profession must receive an education in dealing healthy people and cancer patients. The engagement of former cancer patients, who have an experience of a program of social rehabilitation, will make the efforts to cure those who are still sick more meaningful and boost their morale. PMID:9615837

Demin, E V

1998-01-01

251

Adverse events in emergency oncological spine surgery: a prospective analysis.  

PubMed

Object Most descriptions of spine surgery morbidity and mortality in the literature are retrospective. Emerging prospective analyses of adverse events (AEs) demonstrate significantly higher rates, suggesting underreporting in retrospective and prospective studies that do not include AEs as a targeted outcome. Emergency oncological spine surgeries are generally palliative to reduce pain and improve patients' neurology and health-related quality of life. In individuals with limited life expectancy, AEs can have catastrophic implications; therefore, an accurate AE incidence must be considered in the surgical decision-making process. The purpose of this study was to determine the true incidence of AEs associated with emergency oncological spine surgery. Methods The authors carried out a prospective cohort study in a quaternary care referral center that included consecutive patients admitted between January 1, 2009, and December 31, 2012. Inclusion criteria were all patients undergoing emergency surgery for metastatic spine disease. AE data were reported and collected on standardized AE forms (Spine AdVerse Events Severity System, version 2 [SAVES V2] forms) at weekly dedicated morbidity and mortality rounds attended by attending surgeons, residents, fellows, and nursing staff. Results A total of 101 patients (50 males, 51 females) met the inclusion criteria and had complete data. Seventysix patients (76.2%) had at least 1 AE, and 11 patients (10.9%) died during their admission. Intraoperative surgical AEs were observed in 32% of patients (9.9% incidental durotomy, 16.8% blood loss > 2 L). Transient neurological deterioration occurred in 6 patients (5.9%). Infectious complications in this patient population were significant (surgical site 6%, other 50.5%). Delirium complicated the postoperative period in 20.8% of cases. Conclusions When evaluated in a rigorous prospective manner, metastatic spine surgery is associated with a higher morbidity rate than previously reported. This AE incidence must be considered by the patient, oncologist, and surgeon to determine appropriate management and preventative strategies to reduce AEs in this fragile patient population. PMID:25147976

Dea, Nicolas; Versteeg, Anne; Fisher, Charles; Kelly, Adrienne; Hartig, Dennis; Boyd, Michael; Paquette, Scott; Kwon, Brian K; Dvorak, Marcel; Street, John

2014-11-01

252

[Structural and clinical characteristics of elderly and senile patients' treatment in regional surgical hospital].  

PubMed

Treatment results of 1219 patients of elderly and senile age, hospitalized in surgical departments of Turkestan during 2001-2008 were analyzed. Demographic characteristics, spectrum of profile pathology as well as concurrent diseases were given. Operative activity and average hospital stay, hospital lethality and complication rates were defined. PMID:21716221

Gavrilov, A O; Se?dinov, Sh M; Iusupov, A A

2011-01-01

253

Surgical Technique in Cadaveric Donors for Partial Hand Allotransplant in Patients With Rheumatoid Arthritis  

Microsoft Academic Search

For patients with severe hand deformities due to rheumatoid arthritis, we propose an allotransplantation of an osteomyotendinose structure (OMTS), preserving the recipient's skin and sensory nerves. Our objective was to develop the surgical technique in a 10 cadavers, five as donors and five as recipients. The donor's hand was 10% to 15% smaller than the recipient's. Dissections were performed by

M. Iglesias; P. Butrón; S. Santander-Flores; D. Ricaño-Enciso; J. P. Negrete-Najar; M. F. Pérez-Monzó; A. González-Chávez; M. González-Chávez; B. de Rienzo-Madero; N. Hamdan-Pérez

2010-01-01

254

Partial fingertip necrosis following a digital surgical procedure in a patient with primary Raynaud's phenomenon.  

PubMed

Raynaud's phenomenon is a common clinical disorder consisting of recurrent, long-lasting and episodic vasospasm of the fingers and toes often associated with exposure to cold. In this article, we present a case of partial fingertip necrosis following digital surgical procedure in a patient with primary Raynaud's phenomenon. PMID:25200107

Uygur, Safak; Tuncer, Serhan

2014-12-01

255

The relationship between surgical residents' perception of leadership and patient safety culture  

Microsoft Academic Search

Introduction. Patient safety culture is the integration of interrelated practices that once developed is supported by both the culture and leadership of the organization (Sagan, 1993). The purpose of this study is to describe and examine the relationship between surgical residents’ perception of their leadership and the resulting organizational safety culture within their clinical setting. This assessment is important to

Pallavi Daram Annambhotla

2010-01-01

256

The Effectiveness of Adjunctive Hypnosis with Surgical Patients: A Meta-Analysis  

Microsoft Academic Search

Hypnosis is a nonpharmacologic means for managing adverse surgical side effects. Typically, reviews of the hypnosis literature have been narrative in nature, fo- cused on specific outcome domains (e.g., patients' self- reported pain), and rarely address the impact of differ- ent modes of the hypnosis administration. Therefore, it is important to take a quantitative approach to assess- ing the beneficial

Guy H. Montgomery; Daniel David; Gary Winkel; Jeffrey H. Silverstein; Dana H. Bovbjerg

2002-01-01

257

Hospital-acquired infections among surgical patients in a Brazilian hospital  

Microsoft Academic Search

A historical cohort study was conducted among surgical patients in a large general hospital in Porto Alegre, Brazil between March 1992 and May 1993. Data were collected by means of a retrospective chart review, which followed a standardized method based on the systematic review of all clinical and laboratory information available in the hospital records. The criteria for diagnosis of

M. B. Wagner; N. B. da Silva; A. R. Vinciprova; A. B. Becker; L. M. Burtet; A. J. Hall

1997-01-01

258

Surgical intensive care unit clinician estimates of the adequacy of communication regarding patient prognosis  

Microsoft Academic Search

INTRODUCTION: Intensive care unit (ICU) patients and family members repeatedly note accurate and timely communication from health care providers to be crucial to high-quality ICU care. Practice guidelines recommend improving communication. However, few data, particularly in surgical ICUs, exist on health care provider opinions regarding whether communication is effective. METHODS: To evaluate ICU clinician perceptions regarding adequacy of communication regarding

Rebecca A Aslakson; Rhonda Wyskiel; Dauryne Shaeffer; Marylou Zyra; Nita Ahuja; Judith E Nelson; Peter J Pronovost

2010-01-01

259

[Surgical procedures in selected proctological patients with local anesthesia. Study of 150 cases].  

PubMed

Experience in the treatment of 150 patients with anorectal disorders and disorders of the sacrococcygeal region who were operated on with local anesthesia at the University Hospital, ABC Medical School, São Bernardo do Campo, SP, Brazil, from March 1995 to March 1998. The anesthesia technique, the operations carried out and the tolerance to the procedure are reported. Intraoperative morbidity was 10.6% (16 patients), and postoperative morbidity was 6% (nine patients). The age of patients was between 15 and 92 years old, with mean age 42 years old; 58% of patients were male and 42% female. Surgical mean time was 45 minutes and the patients remained in the hospital for a mean time of 8 hours. All of patients was instructed about the anesthesia technique, their advantages and disadvantages, and only with their permit the surgery was programmed. Hospitalization was required in five patients (3.3%). The anesthesia technique employed was the same for all patients. Upon survey, 96.7% of the patients stated they did not feel pain during the surgery and that they would go through the procedure again. The authors conclude the surgical treatment of anorectal disorders and disorders of the sacrococcygeal region with local anesthesia is viable and safe, and in addition, is well accepted by the patients. PMID:11245158

Henriques, A C; Horta, S H; Pezzolo, S; Waisberg, J; Boratto, S F; Helal, S; Gomes, M; Speranzini, M B

2000-01-01

260

Elective surgical patients' narratives of hospitalization: the co-construction of safety.  

PubMed

This research explores how elective surgical patients make sense of their hospitalization experiences. We explore sensemaking using longitudinal narrative interviews (n=72) with 38 patients undergoing elective surgical procedures between June 2010 and February 2011. We consider patients' narratives, the stories they tell of their prior expectations, and subsequent post-surgery experiences of their care in a United Kingdom (UK) hospital. An emergent pre-surgery theme is that of a paradoxical position in which they choose to make themselves vulnerable by agreeing to surgery to enhance their health, this necessitating trust of clinicians (doctors and nurses). To make sense of their situation, patients draw on technical (doctors' expert knowledge and skills), bureaucratic (National Health Service as a revered institution) and ideological (hospitals as places of safety), discourses. Post-operatively, themes of 'chaos' and 'suffering' emerge from the narratives of patients whose pre-surgery expectations (and trust) have been violated. Their stories tell of unmet expectations and of inability to make shared sense of experiences with clinicians who are responsible for their care. We add to knowledge of how patients play a critical part in the co-construction of safety by demonstrating how patient-clinician intersubjectivity contributes to the type of harm that patients describe. Our results suggest that approaches to enhancing patients' safety will be limited if they fail to reflect patients' involvement in the negotiated process of healthcare. We also provide further evidence of the contribution narrative inquiry can make to patient safety. PMID:24331879

Doherty, Carole; Saunders, Mark N K

2013-12-01

261

Unresolved problems in optimal therapy of pubertal disorders in oncological and bone marrow transplanted patients.  

PubMed

Specialised clinics for the long-term follow-up of survivors from childhood cancer have developed over recent years. The problems encountered among patients who received multiple chemotherapy and radiotherapy can be challenging and require high expertise and close collaboration among different professionals (e.g. oncologists, endocrinologists, radiotherapists, psychologists). Endocrine disorders are often seen, particularly among those who received cranial radiotherapy or gonadotoxic chemotherapy; puberty can be affected and the spectrum of disorders may range from precocious or accelerated puberty to delayed, arrested or even absent pubertal development. Growth impairment can be multifactorial and growth hormone deficiency is an important but probably not the only factor involved. Many questions remain about the optimal management of this group of young patients. In the consensus guidelines that follow the overview an attempt is made to help optimise patients' growth and puberty by suggesting practical clinical approaches to some of the most challenging issues. PMID:11529406

Bozzola, M; Albanese, A; Butler, G E; Cherubini, V; Cicognani, A; Caruso-Nicoletti, M; Crowne, E; De Sanctis, V; Di Battista, E; Hokken-Koelega, A C; Severi, F; Wonke, B; Cavallo, L

2001-07-01

262

The importance of cleanrooms for the treatment of haemato-oncological patients  

PubMed Central

The main purpose of cleanrooms in health care centres is to prevent hospital infections or leakage of a highly infectious agent (the source of haemorrhagic fevers, SARS, etc.) into the ambient environment and subsequently possibly threatening other individuals. Patients with haematological malignancies or after autologous or allogeneic haematopoietic stem cell transplantation (HSCT) rank among immunosuppressed individuals. Prolonged and deep neutropenia is considered a key risk factor of the occurrence of an exogenous infection. One of the possibilities of preventing an exogenous infection in these patients is to place them in a “cleanroom” for the crucial period of time. Cleanrooms are intensive care units with reverse isolation. The final part of the general article below provides an overview of the technology and types of cleanrooms for immunosuppressed patients in compliance with the current recommendations and technical standards. PMID:23788892

Matouskova, Ivanka

2012-01-01

263

Risk Assessment of BRONJ in Oncologic Patients Treated with Bisphosphonates: Follow-Up to 18 Months  

PubMed Central

Objectives. Bisphosphonates related osteonecrosis of the jaw (BRONJ) is a pathological condition characterized by bone exposure or latent infection in patients treated with the drug. The aim of the study is to monitor the BRONJ level of risk health in patients with cancer, according to a preventive clinical protocol, which is firstly aimed at reducing risk factors such as the periodontal infections. Materials and Methods. 10 patients participated in the protocol and were evaluated at baseline and after 3 and 18 months of treatment with bisphosphonates, through full mouth plaque and bleeding scores (FMPS and FMBS), clinical attachment level (CAL) measurement, and the occurrence of osteonecrosis. Results. The mean plaque and bleeding were reduced and the CAL has not shown significant changes and in no cases was there manifestation of BRONJ. Conclusion. The protocol proved crucial for the maintenance of good oral health conditions by eliminating the risk of BRONJ during the observation period.

Vitali, Lucia; Nori, Alessandra; Berlin, Ricarda Sara; Mazur, Marta; Orsini, Giovanna; Putignano, Angelo

2014-01-01

264

A decision support system for quality of life in head and neck oncology patients  

PubMed Central

Background The assessment of Quality of Life (QoL) is a Medical goal; it is used in clinical research, medical practice, health-related economic studies and in planning health management measures and strategies. The objective of this project is to develop an informational platform to achieve a patient self-assessment with standardized QoL measuring instruments, through friendly software, easy for the user to adapt, which should aid the study of QoL, by promoting the creation of databases and accelerating its statistical treatment and yet generating subsequent useful results in graphical format for the physician analyzes in an appointment immediately after the answers collection. Methods First, a software platform was designed and developed in an action-research process with patients, physicians and nurses. The computerized patient self-assessment with standardized QoL measuring instruments was compared with traditional one, to verify if its use did not influence the patient's answers. For that, the Wilcoxon and t-Student tests were applied. After, we adopted and adapted the mathematic Rash model to make possible the use of QoL measure in the routine appointments. Results The results show that the computerized patient self-assessment does not influence the patient's answers and can be used as a suitable tool in the routine appointment, because indicates problems which are more difficult to identify in a traditional appointment, improving thus the physician's decisions. Conclusions The possibility of representing graphically useful results that physician needs to analyze in the appointment, immediately after the answer collection, in an useful time, makes this QoL assessment platform a diagnosis instrument ready to be used routinely in clinical practice. PMID:22340746

2012-01-01

265

Surgem: Next Generation CAD Tools for Interactive Patient Specific Surgical Planning and Hemodynamic Analysis  

Microsoft Academic Search

The first version of an anatomy editing\\/surgical planning tool targeting anatomical complexity and patient-specific computational fluid dynamics (CFD) analysis is presented. Novel shape editing concepts and human-shape interaction (HSI) technologies have been combined to facilitate interactive shape alterations and grid generation. At a surgery planning phase, these tools are applied to design and evaluate possible modifications of patient-specific anatomies of

Jarek Rossignac; Kerem Pekkan; Brian Whited; Kirk Kanter; Ajit Yoganathan; Wallace H. Coulter

266

Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care  

Microsoft Academic Search

The incidence of systemic Candida infections in patients requiring intensive care has increased substantially in recent years as a result of a combination\\u000a of factors. More patients with severe underlying disease or immunosuppression from anti-neoplastic or anti-rejection chemotherapy\\u000a and at risk from fungal infection are now admitted to the ICU. Improvements in supportive medical and surgical care have led\\u000a to

J. L. Vincent; E. Anaissie; H. Bruining; W. Demajo; M. El-Ebiary; J. Haber; Y. Hiramatsu; G. Nitenberg; P. O. Nyström; D. Pittet; T. Rogers; P. Sandven; G. Sganga; M. D. Schaller; J. Solomkin

1998-01-01

267

Chronobiology, cognitive function and depressive symptoms in surgical patients.  

PubMed

Biological rhythms are essential for the regulation of many life processes. Disturbances of the circadian rhythm are known to affect human health, performance and well-being and the negative consequences are numerous and widespread. Cognitive dysfunction, fatigue, pain, sleep disturbances and mood disorders, such as anxiety and depression, are common problems arising around the time of surgery or in the course of a cancer diagnosis and subsequent treatment period. The importance of investigating prevention or treatment possibilities in these populations is significant due to the extent of the problems and the derived consequences on morbidity and mortality. Genetic predisposition to these problems is also an issue in focus. In this thesis we initially investigated whether the specific clock gene genotype PER(5/5) was associated with the development of postoperative cognitive dysfunction one week after non-cardiac surgery. We did not find any association, although this could have been due to the size of the study. Yet, if PER3(5/5) is associated with a higher incidence of postoperative cognitive dysfunction, the risk seems to be only modestly increased and by less than 10%. Melatonin is a hormone with well-known chronobiotic and hypnotic effects. In addition, exogenous melatonin is also known to have anxiolytic, analgesic, antidepressant and positive cognitive effects. Based on the lack of studies investigating these effects of melatonin, we conducted the MELODY trial in which we investigated the effect of 6 mg oral melatonin on depressive symptoms, anxiety, sleep, cognitive function and fatigue in patients with breast cancer in a three month time period after surgery. Melatonin had an effect on reducing the risk of developing depressive symptoms and also increased sleep efficiency perioperatively and total sleep time postoperatively. No effect was found on anxiety, sleep quality, sleepiness, general well-being or pain, however melatonin seemed to positively influence the ability to complete trial participation compared to placebo. Postoperative cognitive dysfunction was not a problem in this limited population. With regard to safety in our study, melatonin treatment for three months did not cause any serious adverse effects. Finally, we systematically reviewed the literature on the prophylactic or therapeutic effect of melatonin for depression or depressive symptoms in adult patients and assessed the safety of melatonin in these studies. The quantity, size and quality of trials investigating this question were not high and there was no clear evidence of an effect, although some studies were positive. In conclusion, further research is warranted with regard to the prophylactic effect and treatment effect of melatonin in depression, depressive symptoms, cognitive disturbances and symptom clusters of cancer patients in general. In addition, more hypothesis-generating studies with regard to the genetic heritability of POCD are needed. PMID:25186550

Hansen, Melissa Voigt

2014-09-01

268

Introduction to pediatric oncology  

SciTech Connect

This book covers the varied and complex aspects of management in pediatric oncology. Emphasis is placed on a team approach and on establishing and maintaining an individualized, humanistic relationships with the patient. Numerous illustrations show modern imaging techniques that are proving most valuable in the investigation of suspected or confirmed childhood cancer. Physical and psychological side effects of short-term and long-term treatment are also discussed.

McWhirter, W.R.; Masel, J.P.

1987-01-01

269

Violent Behavior in Cancer Patients--A Rarely Addressed Phenomenon in Oncological Treatment  

ERIC Educational Resources Information Center

Dealing with violent cancer patients can be particularly challenging. The purpose of this study was to collect data on the frequency, quality, and underlying variables affecting violent behavior as well as to examine the role played by this behavior in the premature interruption of treatment. A total of 388 cancer inpatients were examined by…

Grube, Michael

2012-01-01

270

Psychosocial Support for Patients in Pediatric Oncology: The Influences of Parents Schools Peers and Technology  

Microsoft Academic Search

Abstract The diagnosis and treatment of pediatric cancer can be associated with profound psychosocial changes in the life of young patients. While nurses, physicians, and other healthcare professionals are important sources of support, psychosocial support is also available through parents, schools, and peers. This article presents a review of the literature on how parents, schools, and peers affect the coping

Lalita K. Suzuki; Pamela M. Kato

2010-01-01

271

NCI-CCR Pediatric Oncology Branch - Patients and Families, Other Resources  

Cancer.gov

The NIH Children’s School was established in 1953 to instruct school-age patients of the Clinical Center. The School’s goal is to maintain the continuity of education between the student’s home school and the NIH children’s school.

272

Controversies in the surgical management of thyroid follicular neoplasms. Retrospective analysis of 721 patients.  

PubMed

The most appropriate surgical management of "follicular neoplasm/suspicious for follicular neoplasm" lesions, is still controversial. Analysing and comparing the experience of two units for endocrine surgery, we retrospectively evaluated 721 patients, surgically treated after a follicular neoplasm diagnosis. Total thyroidectomy was routinely performed in one Institution, while in the other one it was selectively carried out. The main criteria leading to hemythyroidectomy were a single nodule, the age ?45 years, the absence of thyroiditis or clinical/intraoperative suspicion of malignancy. Total thyroidectomy was performed in 402/721 patients (55.7%), hemythyroidectomy in 319/721 cases (44.2%) and a completion thyroidectomy in 51/319 cases (15.9%). The overall malignancy rate was 24% (176/721 patients), respectively 16% (51/319 patients) following hemythyroidectomy, and 31% (125/402 patients) following total thyroidectomy. Definitive recurrent laryngeal nerve paralysis and permanent hypoparathyroidism were not reported in hemythyroidectomy patients in which lower mean hospitalization and costs were observed. Considering the low-risk of follicular neoplasm solitary lesions, hemythyroidectomy is still the safest standard of care with lower hospitalization and costs. In case of multiglandular disease or thyroiditis, that might be associated with a higher risk of cancer, total thyroidectomy should be recommended. Further investigation is warranted to achieve a better preoperative follicular neoplasm diagnostic accuracy in order to reduce the amount of unnecessary surgical operations with a diagnostic aim. PMID:24859409

Conzo, Giovanni; Calò, Pietro Giorgio; Gambardella, Claudio; Tartaglia, Ernesto; Mauriello, Claudio; Della Pietra, Cristina; Medas, Fabio; Santa Cruz, Rosa; Podda, Francesco; Santini, Luigi; Troncone, Giancarlo

2014-01-01

273

Surgical treatment of a chronically fixed lateral patella dislocation in an adolescent patient.  

PubMed

Acute patellar dislocation or subluxation is a common cause for knee injuries in the United States and accounts for 2% to 3% of all injuries. Up to 49% of patients will have recurrent subluxations or dislocations. Importance of both soft tissue (predominantly, the medial patellofemoral ligament, MPFL, which is responsible for 60% of the resistance to lateral dislocation) and bony constraint of femoral trochlea in preventing subluxation and dislocation is well documented. Acute patella dislocation will require closed reduction and management typically consist of conservative or surgical treatment depending on the symptoms and recurrence of instability. Most patients are diagnosed and treated in a timely manner. We present a 15 years old male with a missed traumatic lateral patella dislocation during childhood. The patient presented as an adolescent with a chronically fixed lateral patella dislocation and was management with surgery. The key steps in the surgical reconstruction of this patient required first mobilizing the patella with a lateral retinacular release and V-Y lengthening of the shortened or contracted quadriceps tendon. Then a combination of MPFL reconstruction using the semitendinosis autograft, tibial tubercle osteotomy with anterio-medialization, and lateral facetectomy was performed. At the one-year follow-up, our patient had improved knee range of motion and decrease in pain. Chronically fixed lateral dislocated patella is a rare and complex problem to manage in older patients that will require a thorough work-up and appropriate surgical planning along with reconstruction. PMID:23888199

Li, Xinning; Nielsen, Natalie M; Zhou, Hanbing; Stein, Beth Shubin; Shelton, Yvonne A; Busconi, Brian D

2013-06-01

274

Epidemiological characteristics of 778 patients who underwent surgical drainage of chronic subdural hematomas in Brasília, Brazil  

PubMed Central

Background Chronic subdural hematomas (CSDHs) are common in neurosurgical practice. There are no publications that report large series of the epidemiological characteristics of this pathology in Brazil. The purpose is to describe a large series of surgical cases and analyze the epidemiological and clinical characteristics. Methods We retrospectively analyzed patients with CSDH admitted into Neurosurgical Services at the Hospital de Base do Distrito Federal, Brasília, Brazil from 2006 to 2011. Age, sex, clinical feature, etiology, surgical procedure, side, clinical outcome, and recurrence were reviewed. Statistical tests were used to analyze data, and P < 0.05 was considered statistically significant. Results The series included 778 patients. There were 643 (82.6%) male patients with a mean age of 64.3 ± 15.9 (range, 14–93) years. The principal symptom was headache (58.9%). The most frequent origin was a fall (282 cases, 36.2%), but the origin remained unclear in 281 (36.1%) patients. Mild head injury occurred in 540 (69.4%) cases. Burr holes with drainage were used as the surgical procedure in 96.5% patients, and 687 (88.3%) patients had a positive outcome. Mortality was 0%. Recurrence was observed in 42 cases. Conclusions The occurrence of CSDHs is more common in elderly men. Treatment with burr holes and drainage is a simple and safe method for treatment. In our experience, CSDH presents decreased morbidity and mortality. PMID:23452673

2013-01-01

275

Risk Factors for Cisplatin-Associated Ototoxicity in Pediatric Oncology Patients  

PubMed Central

Background Cisplatin is an effective chemotherapy agent against several pediatric malignancies. One of its side effects is irreversible sensorineural hearing damage that is highly variable with a reported incidence of 22–70%. The aim of this study was to evaluate the incidence and identify clinical predictors of cisplatin-related ototoxicity. Procedures We performed a retrospective chart review of 102 pediatric patients who had completed cisplatin therapy for osteosarcoma, neuroblastoma, hepatoblastoma, or germ cell tumor. Patients were diagnosed at Riley Hospital for Children between January 1995 and June 2008, were less than 18 years old at diagnosis, and had normal hearing prior to therapy. Audiograms were scored using the Brock scale (0–4), a validated grading system for cisplatin-related hearing loss. Results Forty-two percent of the patients experienced hearing loss and 28% had moderate to severe ototoxicity (Brock score ?2). Males were at significantly greater risk for developing hearing loss than were females (P = 0.005, OR 4.812). Age at cancer diagnosis was inversely related to severity of ototoxicity. Patients who suffered Brock grade 3 ototoxicity had a mean age of 4.5 years versus 11.5 years and 7.2 years for grades 1 and 2, respectively (P = 0.02). Cumulative cisplatin dose was also identified as a risk factor for development of ototoxicity (P = 0.03). Conclusions Gender and cumulative dose are important clinical biomarkers of cisplatin ototoxicity. Severity of ototoxicity may be inversely related to age at time of exposure, with very young patients exhibiting higher grades of hearing loss following cisplatin therapy. PMID:22431292

Yancey, Allison; Harris, Michael S.; Egbelakin, Akinbode; Gilbert, Jaimie; Pisoni, David B.; Renbarger, Jamie

2013-01-01

276

Factors Associated with Disease Survival after Surgical Resection in Chinese Patients with Hepatocellular Carcinoma  

Microsoft Academic Search

Objective  The aim of this cohort study was to investigate clinical outcome and prognostic factors after surgical resection for hepatocellular\\u000a carcinoma (HCC).\\u000a \\u000a \\u000a \\u000a Materials and Methods  A total of 1,157 HCC patients undergoing hepatic resection between 1998 and 2003 were included in this study. Univariate and\\u000a multivariate analyses were performed to examine factors affecting clinical outcome and recurrence.\\u000a \\u000a \\u000a \\u000a Results  Surgical procedures consisted of 1,011

Li Qiang; Li Huikai; Kelly Butt; P. Peter Wang; Xishan Hao

2006-01-01

277

[Optimization of approaches to the surgical treatment of patients with benign breast gland tumors].  

PubMed

The results of 95 patients treatment with benign brest gland tumours (BBGT) were studied. For improve the results of treatment the introduction of surgical techniques that reduce the invasiveness of operations were applied. The performance of preoperative ultrasound (US) marking BB GT, cosmetically non-traumatic incisions, US dissector, combined cosmetic suture applay for the glandular tissue after sectoral resection of brest gland contribute to improving the results of surgical treatment, which is confirmed by the auspicious course of the early postoperative period. PMID:25252558

Usmanova, T É

2014-06-01

278

High Mortality Rate for Patients Requiring Intensive Care After Surgical Revision Following Bariatric Surgery  

Microsoft Academic Search

Background  To report the prognosis and management of patients reoperated for severe intraabdominal sepsis (IAS) after bariatric surgery\\u000a (S0) and admitted to the surgical intensive care unit (ICU) for organ failure.\\u000a \\u000a \\u000a \\u000a Methods  A French observational study in a 12-bed adult surgical intensive care unit in a 1,200-bed teaching hospital with expertise\\u000a in bariatric surgery. From January 2001 to August 2006, 27 morbidly

Nathalie Kermarrec; Jean-Pierre Marmuse; Judith Faivre; Sigismond Lasocki; Philippe Mognol; Denis Chosidow; Claudette Muller; Jean-Marie Desmonts; Philippe Montravers

2008-01-01

279

Detection of the Echinococcus granulosus diagnostic arc 5 in sera from patients with surgically-confirmed E. multilocularis infection  

Microsoft Academic Search

Summary The Echinococcus granulosus diagnostic arc 5 was revealed by sera from an Alaskan and a Swiss patient with surgically confirmed E. multilocularis infections. The possibility of each patient harboring a concurrent infection with both parasites may be disregarded on the basis of radiologic, scintillographic and surgical data. This conclusion is compatible with ecologic and epidemiologic considerations. These observations suggest

V. M. Varela-Díaz; J. Eckert; R. L. Rausch; E. A. Coltorti; U. Hess

1977-01-01

280

Best practice management of CINV in oncology patients: II. Antiemetic guidelines and rationale for use.  

PubMed

Antiemetic guidelines for chemotherapy-induced nausea and vomiting (CINV) are important to provide a framework for evidence-based care. Attention and adherence to guidelines can help to close the gap between practitioner prediction and patient experience of CINV. Recent updated recommendations have provided guidance on appropriate use of standard-of-care antiemetics--aprepitant, palonosetron, and other serotonin (5-hydroxytryptamine) type 3 (5-HT3) receptor antagonists and dexamethasone. Guidelines are also important, in that their use is often tied to Medicare or other third-party payment. Limitations of guidelines include an absence of provisions for moving patients up the risk ladder for CINV when they have a poor response to recommended antiemetic treatment, as well as an absence of recommendations for treatment beyond the first cycle of antiemetic therapy. Further work is needed to improve evidence-based care in CINV, including studies focusing on delayed CINV and studies in the palliative-care setting. PMID:20629453

Wickham, Rita

2010-01-01

281

Therapeutic options for the treatment of infections with multiresistant grampositive bacteria in oncological patients  

Microsoft Academic Search

Summary  Infections with highly resistant grampositive bacteria are a major threat to the patients with underlying malignant diseases\\u000a and due to more aggressive treatment strategies the incidence of these infections increased over the past years. For many\\u000a years, glycopeptides such as vancomycin, have been the standard treatment for methicillin-resistant S. aureus (MRSA) and ampicillin-resistant\\u000a enterococci. However, the clinical use of vancomycin

G. Fritsche; G. Weiss

2008-01-01

282

Can Robotic Thyroidectomy Be Performed Safely in Thyroid Carcinoma Patients?  

PubMed Central

Since the adoption of the Da Vinci robotic system for remote access thyroid surgery, robotic thyroidectomy (RT) has become a popular surgical option for patients who want to avoid neck scars. Surgeons in South Korea pioneered this surgical technique and have reported successful outcomes. Although many studies have reported that RT is a feasible and safe therapeutic alternative, concerns over the surgical and oncological safety of RT remain. This article reviews the advantages and disadvantages of RT and compares the surgical safety and oncological completeness of RT with conventional open thyroidectomy.

Chai, Young Jun; Youn, Yeo-Kyu

2014-01-01

283

Results of Surgical Treatment on Benign Anal Diseases in Korean HIV-Positive Patients.  

PubMed

Perianal diseases are the most common reasons for surgery in HIV-positive patients. This study aimed to evaluate the outcomes of these surgical procedures in Korean patients, focusing on wound healing and postoperative complications. Retrospective analysis was performed on 72 HIV-positive patients who underwent surgery by a single surgeon for benign anal disease between 1998 and 2011. Of these, 68.1% (49/72) of patients received surgery for condyloma acuminata, 19.4% (14/72) for anal fistulas, 6.9% (5/72) for hemorrhoids, and 5.6% (4/72) for perianal abscesses. Patients with condyloma acuminata received surgical excision with electrical coagulation, and all wounds healed completely within 3 months, though 16.3% (8/49) of these patients experienced recurrence. Twelve of the 49 patients (24.5%) who were treated for condyloma acuminata underwent simultaneous operations for concomitant anal fistulas (n = 6), hemorrhoids (n = 4), and perianal abscesses (n = 2). Overall, 3 postoperative complications developed following a total of 94 procedures, and there was no significant increase in complication rate for patients with a low CD4+ T-cell count ( < 200/µL) compared to those with a higher count. The results demonstrate favorable results following perianal surgery in HIV-positive Korean patients. PMID:25246745

Oh, Heung-Kwon; Moon, Sang-Hui; Ryoo, Seungbum; Choe, Eun Kyung; Park, Kyu Joo

2014-09-01

284

Results of Surgical Treatment on Benign Anal Diseases in Korean HIV-Positive Patients  

PubMed Central

Perianal diseases are the most common reasons for surgery in HIV-positive patients. This study aimed to evaluate the outcomes of these surgical procedures in Korean patients, focusing on wound healing and postoperative complications. Retrospective analysis was performed on 72 HIV-positive patients who underwent surgery by a single surgeon for benign anal disease between 1998 and 2011. Of these, 68.1% (49/72) of patients received surgery for condyloma acuminata, 19.4% (14/72) for anal fistulas, 6.9% (5/72) for hemorrhoids, and 5.6% (4/72) for perianal abscesses. Patients with condyloma acuminata received surgical excision with electrical coagulation, and all wounds healed completely within 3 months, though 16.3% (8/49) of these patients experienced recurrence. Twelve of the 49 patients (24.5%) who were treated for condyloma acuminata underwent simultaneous operations for concomitant anal fistulas (n = 6), hemorrhoids (n = 4), and perianal abscesses (n = 2). Overall, 3 postoperative complications developed following a total of 94 procedures, and there was no significant increase in complication rate for patients with a low CD4+ T-cell count ( < 200/µL) compared to those with a higher count. The results demonstrate favorable results following perianal surgery in HIV-positive Korean patients. PMID:25246745

2014-01-01

285

Individual and social concerns in American surgical education: paying patients, prepaid health insurance, Medicare and Medicaid.  

PubMed

The education of the U.S. surgeon was traditionally based on a system in which surgeons-in-training cared for a population of largely indigent patients in a setting of graded responsibility. To ensure an ethically appropriate bargain, senior surgeons served as mentors, assumed ultimate responsibility for the patient, and supervised the surgical care of the ward patient by the surgical trainee. During the 20th century, changes in health care financing challenged this comfortable accommodation between charity care and medical education. As others have also written, the introduction of prepaid health insurance plans such as Blue Cross/Blue Shield in the early third of the century, the rapid expansion of employment-based health benefits during World War II, and the enactment of the Medicare and Medicaid legislation under Titles XVIII and XIX of the Social Security Act all contributed to a dramatic reduction in hospital ward (i.e., service) populations. The tension between education and patient care remains incompletely resolved; the proper balance between supervision and graded responsibility for the resident is ultimately worked out on an individual basis. Newer issues facing U.S. surgical education, including the justifiable demand for greater transparency, are likely to upset this suspended truce and lead to renewed discussions about such fundamental concepts as the definition of the resident and the role of the patient in the education of future surgeons. PMID:20520042

O'Shea, John S

2010-05-01

286

Value of PCR in surgically treated patients with staphylococcal infective endocarditis: a 4-year retrospective study.  

PubMed

The aim of the study was to establish a diagnostic value for broad-range polymerase chain reaction (br-PCR) and staphylococci-specific multiplex PCR (ssm-PCR) performed on surgical material from patients with staphylococcal infective endocarditis (IE). Data were analysed retrospectively from 60 patients with suspected staphylococcal IE and 59 controls who were surgically treated at three cardiosurgery centres over 4 years. Both PCR tests showed high agreement and could be aggregated. In patients with definite and rejected IE, the clinical sensitivity and specificity of PCR reached 89 and 95%, respectively. Tissue culture (TC) and PCR agreed with blood culture (BC) in 29% and 67% of IE cases. TC helped to determine aetiology in five BC negative cases while PCR aided in nine cases. Out of 52 patients with conclusive staphylococcal IE, 40 were diagnosed with S. aureus and 12 with coagulase-negative staphylococci. PCR was shown to be highly superior to TC in confirming preoperative diagnosis of IE. In addition to aid in culture negative patients, PCR helped to establish or refine aetiology in inconclusive cases. We suggest that simultaneous br-PCR and ssm-PCR performed on surgical material together with histopathology could significantly increase the performance of current Duke criteria. PMID:21964590

Zaloudíková, B; N?mcová, E; Pol, J; Sorm, Z; Wurmová, S; Novotná, K; Van?rková, M; Holá, V; R?ži?ka, F; Dušek, L; N?mec, P; Freiberger, T

2012-06-01

287

A Targeted E-Learning Program for Surgical Trainees to Enhance Patient Safety in Preventing Surgical Infection  

ERIC Educational Resources Information Center

Introduction: Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty. Methods: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An…

McHugh, Seamus Mark; Corrigan, Mark; Dimitrov, Borislav; Cowman, Seamus; Tierney, Sean; Humphreys, Hilary; Hill, Arnold

2010-01-01

288

Results of the American College of Surgeons Oncology Group Z0050 trial: the utility of positron emission tomography in staging potentially operable non–small cell lung cancer  

Microsoft Academic Search

ObjectivesThe American College of Surgeons Oncology Group undertook a trial to ascertain whether positron emission tomography with 18F-fluorodeoxyglucose could detect lesions that would preclude pulmonary resection in a group of patients with documented or suspected non–small cell lung cancer found to be surgical candidates by routine staging procedures.

Carolyn E Reed; David H Harpole; Katherine E Posther; Sandra L Woolson; Robert J Downey; Bryan F Meyers; Robert T Heelan; Homer A MacApinlac; Sin-Ho Jung; Gerard A Silvestri; Barry A Siegel; Valerie W Rusch

2003-01-01

289

Antibiotic Prophylaxis and Incisional Surgical Site Infection Following Colorectal Cancer Surgery: An Analysis of 330 Cases  

Microsoft Academic Search

Objective: To evaluate the rate of incisional surgical site infection (SSI) following colorectal cancer surgery in a university hospital and to determine whether duration of prophylactic antibiotic administration can affect the development of this complication. Material and Method: The medical records of 330 patients with colorectal cancer undergoing elective oncological resection between 2003 and 2006 at Siriraj Hospital were reviewed.

Varut Lohsiriwat; Darin Lohsiriwat

2009-01-01

290

[Surgical treatment of degenerative cervical spine diseases: analyses of 90 patients clinical study].  

PubMed

The effect of degenerative cervical spine surgery depends on good understanding of the pathogenesis and clinical course of disease with a detailed neurological and neuroradiological examination. Surgical approach should be considered separately for each pathological substrate in order to avoid additional morbidity. The aim of our study is to present the results of treatment through analysis of large clinical series focusing on anterior surgical approach with iliac crest graft fusion without cervical plating. The retrospective analysis of 90 patients operated on Neurosurgery of CHC Zemun, from 2008 to 2011, was done. In 81 patients cervical disc herniation was found in one or two levels, and 9 patients had spinal canal stenosis with polydiscopathy. Preoperatively 50 patients had cervical myelopathy, and 40 patients had radiculopathy as dominating clinical sign. Anterior cervical approach was performed in 79 patients, and 11 patients were operated by posterior approach. The treatment outcome was as follows: good outcome 16 (16.8%) patients, improved condition 65 (72.2%), without improvement 6 (6.7%), bad outcome 3 (4.3%). The anterior cervical approach with iliac crest autologous graft fusion, and without additional cervical plating, is reliable treatment option with results comparable to reported clinical series with sintetic graft placement and anterior cervical plate stabilisation. PMID:23654008

Markovi?, M; Zivkovi?, N; Stojanovi?, D; Samardzi?, M

2012-01-01

291

Patient-specific model of a scoliotic torso for surgical planning  

NASA Astrophysics Data System (ADS)

A method for the construction of a patient-specific model of a scoliotic torso for surgical planning via inter-patient registration is presented. Magnetic Resonance Images (MRI) of a generic model are registered to surface topography (TP) and X-ray data of a test patient. A partial model is first obtained via thin-plate spline registration between TP and X-ray data of the test patient. The MRIs from the generic model are then fit into the test patient using articulated model registration between the vertebrae of the generic model's MRIs in prone position and the test patient's X-rays in standing position. A non-rigid deformation of the soft tissues is performed using a modified thin-plate spline constrained to maintain bone rigidity and to fit in the space between the vertebrae and the surface of the torso. Results show average Dice values of 0:975 +/- 0:012 between the MRIs following inter-patient registration and the surface topography of the test patient, which is comparable to the average value of 0:976 +/- 0:009 previously obtained following intra-patient registration. The results also show a significant improvement compared to rigid inter-patient registration. Future work includes validating the method on a larger cohort of patients and incorporating soft tissue stiffness constraints. The method developed can be used to obtain a geometric model of a patient including bone structures, soft tissues and the surface of the torso which can be incorporated in a surgical simulator in order to better predict the outcome of scoliosis surgery, even if MRI data cannot be acquired for the patient.

Harmouche, Rola; Cheriet, Farida; Labelle, Hubert; Dansereau, Jean

2013-03-01

292

The quality of life and psychological status of mothers of hospitalized pediatric oncology patients.  

PubMed

This study compares the quality of life (QoL) and psychological status of mothers of children with cancer with those of mothers of children without cancer. One hundred hospitalized children and their mothers, as primary caregivers, were included in this study. Fifty mothers with healthy children were enrolled as the control group. A children and mother query form was used to obtain demographical data. The disease histories were extracted from patient records. QoL was measured with the Medical Outcomes Study 36-item Short Form Survey (SF-36) and the State-Trait Anxiety Inventory (STAI) in order to assess the psychological symptoms of the mothers in the study and in the control groups. The mean age of the caregivers was 35.93 ± 8.27 years, whereas the mean age of the mothers in the control group was 39.72 ± 6.88 years. The general health, vitality, social functioning, and mental health scores from the SF-36 and the STAI-trait scores were significantly poorer among the mothers of children with cancer as compared with the scores of the mothers of children without cancer (P < .05). Significant negative correlations were found between the age of the children, the age at diagnosis, and the SF-36 subscores for physical functioning, physical role, and pain (P < .05). The mothers of children with cancer, who require hospital care, have poorer QoL and psychological health than the mothers of healthy children. These results suggest that the current system for treating cancer in Turkish children should also include close monitoring of the care-giving mothers' QoL and psychological health. PMID:21707473

Eyigor, Sibel; Karapolat, Hale; Yesil, Hilal; Kantar, Mehmet

2011-08-01

293

Percutaneous Cholecystostomy for Patients with Acute Cholecystitis and an Increased Surgical Risk  

SciTech Connect

Purpose: To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk. Methods: Thirty-three patients with acute cholecystitis (calculous, n= 22; acalculous, n= 11) underwent percutaneous cholecystostomy by means of a transhepatic (n= 21) or transperitoneal (n= 12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy. Results: All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decrease in body temperature (n= 13), normalization of the white blood cell count (n= 3), or both (n= 6). There were 6 (18%) minor/moderate complications (transhepatic access, n= 3; transperitoneal access, n= 3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n= 9) and percutaneous and endoscopic stone removal (n= 8). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n= 2) and gallbladder ablation (n= 2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related. Conclusions: Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary.

Overhagen, Hans van; Meyers, Hjalmar [Department of Radiology, University Hospital Dijkzigt, Dr. Molewaterplein 40, NL-3015 GD Rotterdam (Netherlands); Tilanus, Hugo W.; Jeekel, Johannes [Department of Surgery, University Hospital Dijkzigt, Dr. Molewaterplein 40, NL-3015 Rotterdam (Netherlands); Lameris, Johan S. [Department of Radiology, University Hospital Dijkzigt, Dr. Molewaterplein 40, NL-3015 GD Rotterdam (Netherlands)

1996-03-15

294

Surgical Treatments on Patients with Anterior Cervical Hyperostosis-Derived Dysphagia  

PubMed Central

Anterior cervical hyperostosis may be a cause of dysphagia. For anterior cervical hyperostosis, medical or surgical treatments can be adhibited in view of the causative mechanisms and intensities of dysphagia. We report 3 cases of cervical hyperostosis-derived progressive dysphagia that underwent operation. Radiologic diagnosis and Video Fluoroscopic Swallowing Study were performed on the three patients for evaluation. One had history of recurrent aspiration pneumonia accompanied by weight loss, another complained of dysphagia only when swallowing pills, and the third experienced recurrence symptom with reossification. All patients reported gradual improvement of dysphagia immediately after their cervical osteophytes were resected through the anterior approach. In relation to postoperative improvement, however, they expressed different degrees of satisfaction according to severity of symptoms. Surgical treatment, performed for the anterior cervical hyperostosis-derived dysphagia, can immediately relieve symptoms of difficulty in swallowing. This might especially be considered as an appropriate treatment option for severe dysphagia. PMID:23185741

Song, Ah Rom; Byun, Eunjin; Kim, Youngbae; Park, Kwan Ho; Kim, Kyung Lyul

2012-01-01

295

Should Perioperative Supplemental Oxygen Be Routinely Recommended for Surgical Patients? A Bayesian Meta-analysis  

PubMed Central

Objective The purpose of this study is to use updated data and Bayesian methods to evaluate the effectiveness of hyperoxia to reduce surgical site infections (SSIs) and/or mortality in both colorectal and all surgical patients. Because few trials assessed potential harms of hyperoxia, hazards were not included. Background Use of hyperoxia to reduce SSIs is controversial. Three recent meta-analyses have had conflicting conclusions. Methods A systematic literature search and review were performed. Traditional fixed-effect and random-effects meta-analyses and Bayesian meta-analysis were performed to evaluate SSIs and mortality. Results Traditional meta-analysis yielded a relative risk of an SSI with hyperoxia among all surgery patients of 0.84 (95% confidence interval, CI, 0.73–0.97) and 0.84 (95% CI 0.61–1.16) for the fixed-effect and random effects models respectively. The probabilities of any risk reduction in SSIs among all surgery patients were 77%, 81%, and 83% for skeptical, neutral, and enthusiastic priors. Subset analysis of colorectal surgery patients increased the probabilities to 86%, 89%, and 92%. The probabilities of at least a 10% reduction were 57%, 62%, and 68% for all surgical patients and 71%, 75%, and 80% among the colorectal surgery subset. Conclusions There is a moderately high probability of a benefit to hyperoxia in reducing SSIs in colorectal surgery patients; however, the magnitude of benefit is relatively small and might not exceed treatment hazards. Further studies should focus on generalizability to other patient populations or on treatment hazards and other outcomes. PMID:23160100

Kao, Lillian S.; Millas, Stefanos G.; Pedroza, Claudia; Tyson, Jon E.; Lally, Kevin P.

2012-01-01

296

The effects of early rehabilitation in patients with surgically treated colorectal cancer.  

PubMed

Colorectal cancer is one of the most common cancer. Caught early, it is often curable. The important role in functional recovery of these patients, have enhanced recovery after surgery (ERAS) clinical care protocol and early rehabilitation. The goal of this research is the objective evaluation of the effects of early rehabilitation in patients after surgical treatment of colorectal cancer, respecting their functional recovery and quality of life, before and after rehabilitation. Tis study was made as experimental, randomized, controlled clinical trial, opened type.The examination included 58 patients (39 males and 19 females), age from 36 to 85 years, average 63.3, with surgically treated colorectal cancer. All patients had appropriate early multimodal accelerated rehabilitation program.The mean value of this program was 7,24 days. As observing parameter was used short form, 36 items health related questionnaire (SF-36), with two summary measures-Physical component summary (PCS) and Mental component summary (MCS), for the evaluation of quality of life, before and after treatment. For the statistical analysis of the aquired data, before and after therapy, was used Student's t-test. Afer therapy, the quality of life of patients was significantly improved, physical health (p< 0.01), as well as mental health (p<0,01). SF36 score after rehabilitation, show important improvement of quality of life in early treated patients. These results show exellent therapeutic possibilities of enhaced recovery clinical care protocol and early rehabilitation procedures. Acording to the results of this study, it can be concluded that early rehabilitation accelerated program is very effective in treatment of patients with surgically treated colorectal cancer. PMID:23654014

Djurasi?, Ljubomir; Pavlovi?, Aleksandar; Zari?, Nemanja; Palibrk, Ivan; Basari?, Dragan; Djordjevi?, Vladimir R

2012-01-01

297

Evaluation of a Model for Glycemic Prediction in Critically Ill Surgical Patients  

PubMed Central

We evaluated a neural network model for prediction of glucose in critically ill trauma and post-operative cardiothoracic surgical patients. A prospective, feasibility trial evaluating a continuous glucose-monitoring device was performed. After institutional review board approval, clinical data from all consenting surgical intensive care unit patients were converted to an electronic format using novel software. This data was utilized to develop and train a neural network model for real-time prediction of serum glucose concentration implementing a prediction horizon of 75 minutes. Glycemic data from 19 patients were used to “train” the neural network model. Subsequent real-time simulated testing was performed in 5 patients to whom the neural network model was naive. Performance of the model was evaluated by calculating the mean absolute difference percent (MAD%), Clarke Error Grid Analysis, and calculation of the percent of hypoglycemic (?70 mg/dL), normoglycemic (>70 and <150 mg/dL), and hyperglycemic (?150 mg/dL) values accurately predicted by the model; 9,405 data points were analyzed. The models successfully predicted trends in glucose in the 5 test patients. Clark Error Grid Analysis indicated that 100.0% of predictions were clinically acceptable with 87.3% and 12.7% of predicted values falling within regions A and B of the error grid respectively. Overall model error (MAD%) was 9.0% with respect to actual continuous glucose modeling data. Our model successfully predicted 96.7% and 53.6% of the normo- and hyperglycemic values respectively. No hypoglycemic events occurred in these patients. Use of neural network models for real-time prediction of glucose in the surgical intensive care unit setting offers healthcare providers potentially useful information which could facilitate optimization of glycemic control, patient safety, and improved care. Similar models can be implemented across a wider scale of biomedical variables to offer real-time optimization, training, and adaptation that increase predictive accuracy and performance of therapies. PMID:23894489

Pappada, Scott M.; Cameron, Brent D.; Tulman, David B.; Bourey, Raymond E.; Borst, Marilyn J.; Olorunto, William; Bergese, Sergio D.; Evans, David C.; Stawicki, Stanislaw P. A.; Papadimos, Thomas J.

2013-01-01

298

Time trends of surgical treatment and the prognosis for Japanese patients with gastric cancer  

PubMed Central

The incidence of gastric cancer is much higher in Japan than in other countries even though diagnostics and treatments of such patients have improved. The objective of this study was to present an overview of the past, present and future of surgical treatment for our patients with gastric cancer. We analysed data on 2152 Japanese men and women with gastric cancer who underwent surgical resection from 1965 to 1995 at Kyushu University in Fukuoka, Japan, based on a univariate and the multivariate analysis. We focused on time trends of surgical treatment and the postoperative outcome. Over the years, there have been favourable changes in the numbers of patients with early gastric cancer. In all cases of gastric cancer, the rate of 18% in the first six year period (group 1) was 57% in the last 5 year period (group 6). Size of the tumour was smaller, well-differentiated tumour tissue was more common, and lymphatic involvement was less frequent. Lymph node metastasis, liver metastasis and peritoneal dissemination all decreased. Extensive lymph node dissection was more frequently done and the rate of curative resection (curability A and B) increased. With increases in identifying the early stage of cancer and better perioperative care, mortality rates 30 days after the surgery greatly decreased. Multivariate analysis revealed that the 10 factors of depth of invasion, lymph node metastasis, lymph node dissection, tumour size, liver metastasis, peritoneal dissemination, lymphatic invasion, vascular invasion, lesion in the whole stomach and lesion in the middle stomach were independent factors for determining the prognosis. Detection of the tumour in an early stage, standardized surgical treatment, including routine lymph node dissection, close follow-up schedules and better perioperative management are expected to increase survival time for patients with this malignancy. © 2000 Cancer Research Campaign PMID:10993643

Maehara, Y; Kakeji, Y; Oda, S; Takahashi, I; Akazawa, K; Sugimachi, K

2000-01-01

299

Contractile function of the myocardium with prolonged hypokinesia in patients with surgical tuberculosis  

NASA Technical Reports Server (NTRS)

The changes in the myocardial contractile function with hypokinesia in surgical tuberculosis patients are discussed. The phase nature of the changes is noted, specifically the changes in the various systoles, diastole, and other parts of the cardiac cycle. The data compare these changes during confinement in bed with no motor activity to and with a return to motor activity after leaving the in-bed regimen.

Zakutayeva, V. P.; Matiks, N. I.

1978-01-01

300

Regional anaesthesia to improve pain outcomes in paediatric surgical patients: a qualitative systematic review of randomized controlled trials.  

PubMed

Summary The development of analgesic interventions in paediatric surgical patients is often limited by the inherent difficulties of conducting large randomized clinical trials to test interventions in those patients. Regional anaesthesia is a valid strategy to improve postoperative pain in the adult surgical population, but the effects of regional anaesthesia on postoperative pain outcomes in paediatric patients are currently not well defined. The main objective of the current review was to systematically evaluate the use of regional anaesthesia techniques to minimize postoperative pain in paediatric patients. A systematic search was performed to identify randomized controlled trials that evaluated the effects of the regional anaesthesia techniques on postoperative pain outcomes in paediatric surgical patients' procedures. Seventy-three studies on 5125 paediatric patients were evaluated. Only few surgical procedures had more than one small randomized controlled trial favouring the use of regional anaesthesia to minimize postoperative pain (ophthalmological surgery, cleft lip repair, inguinal hernia, and urological procedures). Additional evidence is required to support the use of specific regional anaesthesia techniques to improve postoperative pain for several surgical procedures (craniectomy, adenotonsillectomy, appendectomy, cardiac surgery, umbilical hernia repair, upper and lower extremity) in paediatric patients. Currently, only a very limited number of regional anaesthesia techniques have demonstrated significant improvement on postoperative pain outcomes for a restricted number of surgical procedures. More studies are needed in order to establish regional anaesthesia as a valid strategy to improve analgesia in the paediatric surgical population. PMID:24907283

Suresh, S; Schaldenbrand, K; Wallis, B; De Oliveira, G S

2014-09-01

301

Short- and long-term surgical follow-up of the postbariatric surgery patient.  

PubMed

Follow-up of the large numbers of patients undergoing bariatric surgery poses problems for surgical programs and for internists who care for morbidly obese patients. Early surgical follow up is concentrated on the perioperative period to ensure healing and care for any surgical complications. It is especially important to treat persistent vomiting to avoid thiamine deficiency. Subsequently, monitoring weight loss and resolution of comorbidities assumes more importance. Identification and management of nutritional deficiencies and other unwanted consequences of surgery may become the responsibility of internists if the patient no longer attends the office of the operating surgeon. The long-term goal is to avoid weight regain and deficiencies, especially of protein, iron and vitamin B12, and calcium and vitamin D. Abdominal pain and gastrointestinal dysfunction should be investigated promptly to exclude or confirm such conditions as small bowel obstruction or gallstones. Good communication between bariatric surgeons and internal medicine specialists is essential for early and accurate identification of problems arising from bariatric surgery. PMID:20202586

Frank, Paul; Crookes, Peter F

2010-03-01

302

Surgical Decision Making for the Elderly Patients in Severe Head Injuries  

PubMed Central

Objective Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. Methods We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3-8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. Results Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. Conclusion Ethical training and developing decision-making skills are necessary including shared decision making. PMID:25024822

Shim, Jae-Jun; Yoon, Seok-Man; Oh, Jae-Sang; Bae, Hack-Gun; Doh, Jae-Won

2014-01-01

303

Nuclear and cytoplasmic expression of survivin in 67 surgically resected pancreatic cancer patients  

PubMed Central

Pancreatic cancer is one of the most aggressive gastrointestinal cancer with less than 10% long-term survivors. The apoptotic pathway deregulation is a postulated mechanism of carcinogenesis of this tumour. The present study investigated the prognostic role of apoptosis and apoptosis-involved proteins in a series of surgically resected pancreatic cancer patients. All patients affected by pancreatic adenocarcinoma and treated with surgical resection from 1988 to 2003 were considered for the study. Patients' clinical data and pathological tumour features were recorded. Survivin and Cox-2 expression were evaluated by immunohistochemical staining. Apoptotic cells were identified using the TUNEL method. Tumour specimen of 67 resected patients was included in the study. By univariate analysis, survival was influenced by Survivin overexpression. The nuclear Survivin overexpression was associated with better prognosis (P=0.0009), while its cytoplasmic overexpression resulted a negative prognostic factor (P=0.0127). Also, the apoptotic index was a statistically significant prognostic factor in a univariate model (P=0.0142). By a multivariate Cox regression analysis, both the nuclear (P=0.002) and cytoplasmic (P=0.040) Survivin overexpression maintained the prognostic statistical value. This is the first study reporting a statistical significant prognostic relevance of nuclear and cytoplasmic Survivin overexpression in pancreatic cancer. In particular, patients with high nuclear Survivin staining showed a longer survival, whereas patients with high cytoplasmic Survivin staining had a shorter overall survival. PMID:15928668

Tonini, G; Vincenzi, B; Santini, D; Scarpa, S; Vasaturo, T; Malacrino, C; Coppola, R; Magistrelli, P; Borzomati, D; Baldi, A; Antinori, A; Caricato, M; Nuzzo, G; Picciocchi, A

2005-01-01

304

Surgical management of pleomorphic adenoma of parotid gland in elderly patients: Role of morphological features.  

PubMed

The neoplasms of the salivary glands account for 2% of head and neck tumors and the most common form is the Pleomorphic adenoma (PA). Parotid gland is affected from 80% to 90% of cases. In elderly these tumors occur mostly in females. These benign tumors are composed of epithelial and myoepithelial cells that are arranged with various morphological patterns and subtypes. The classification of these tumors is also based on the amount and nature of the stroma. In literature there is an almost complete consensus that, in the major salivary glands, PAs are enclosed by a layer of fibrous tissue often called "capsule" but there is disagreement about the form, extension and thickness of this layer. The treatment is surgical and there are two main different surgical approaches: an enucleation (local dissection) or so-called subtotal superficial parotidectomy and lateral or superficial total parotidectomy. Histopathological characteristics of PAs especially of capsular alterations such as thin capsule areas, capsule-free regions, capsule penetration, satellite nodules and pseudopodia in the different subtypes are important for the choice of surgical treatment and the first explanation for tumor recurrence. In our study we describe a morphological features of 84 cases of pleomorphic adenoma of parotid gland from elderly patients treated by a surgical "enucleation like" method called nucleoresection. PMID:25159550

Guerra, Germano; Testa, Domenico; Montagnani, Stefania; Tafuri, Domenico; Salzano, Francesco Antonio; Rocca, Aldo; Amato, Bruno; Salzano, Giovanni; Dell'Aversana Orabona, Giovanni; Piombino, Pasquale; Motta, Gaetano

2014-10-01

305

Risks and complications of neuraxial anesthesia and the use of anticoagulation in the surgical patient  

PubMed Central

Recognition of the risk of thromboembolic phenomena to patients in the postsurgical period has resulted in the practice of administering prophylactic anticoagulant agents to those patients who are at high risk for this complication. Institution of a perioperative anticoagulant or antithrombotic protocol needs to be considered when a regional anesthetic is proposed as part of, or as the total, anesthetic management of the patient. This article reviews current data on the risks involved in the use of neuraxial regional anesthesia in the care of surgical patients in whom prophylactic thromboembolic anticoagulant therapy is planned. Guidelines are established to help the physician minimize the risks of a neuraxial hematoma forming, monitor the patient for this complication, and optimally treat him or her if a hematoma were to occur. PMID:16333466

2002-01-01

306

Orbital and Maxillofacial Computer Aided Surgery: Patient-Specific Finite Element Models To Predict Surgical Outcomes  

E-print Network

This paper addresses an important issue raised for the clinical relevance of Computer-Assisted Surgical applications, namely the methodology used to automatically build patient-specific Finite Element (FE) models of anatomical structures. From this perspective, a method is proposed, based on a technique called the Mesh-Matching method, followed by a process that corrects mesh irregularities. The Mesh-Matching algorithm generates patient-specific volume meshes from an existing generic model. The mesh regularization process is based on the Jacobian matrix transform related to the FE reference element and the current element. This method for generating patient-specific FE models is first applied to Computer-Assisted maxillofacial surgery, and more precisely to the FE elastic modelling of patient facial soft tissues. For each patient, the planned bone osteotomies (mandible, maxilla, chin) are used as boundary conditions to deform the FE face model, in order to predict the aesthetic outcome of the surgery. Seven F...

Luboz, V; Swider, P; Payan, Y; Luboz, Vincent; Chabanas, Matthieu; Swider, Pascal; Payan, Yohan

2005-01-01

307

NCI-CCR Pediatric Oncology Branch: Molecular Oncology Section - Clinical Trials  

Cancer.gov

Skip to Main Content CCR Home | About CCR | CCR Intranet Main Navigation Referrals For Patients For Physicians For Prospective Trainees For Scientists News Quick Links Home Referring a Patient Patients and Families Scientific Programs - Molecular Oncology

308

NCI-CCR Pediatric Oncology Branch: Neuro-Oncology Section Staff  

Cancer.gov

Skip to Main Content CCR Home | About CCR | CCR Intranet Main Navigation Referrals For Patients For Physicians For Prospective Trainees For Scientists News Quick Links Home Referring a Patient Patients and Families Scientific Programs - Neuro-Oncology

309

Penoscrotal extramammary Paget's disease: surgical techniques and follow-up experiences with thirty patients.  

PubMed

To report the surgical management, complications and prognosis of patients with penoscrotal extramammary Paget's disease (EMPD) at different clinical stages. Between 2003 and 2008, a total of 30 male patients with penoscrotal EMPD were enrolled and evaluated. All enrolled subjects received frozen biopsy-guided local wide resection and immediate reconstruction. Patients were followed every 3 months postoperatively. Among the 30 patients who accepted and underwent frozen biopsy-guided local wide resection treatment and reconstruction, two (6.7%) cases exhibited positive margins, verified by pathological examination, and underwent re-excision after surgery. The technique of primary closure or an adjacent flap was used in 10 (33.3%) cases, split-thickness skin grafts were used in 15 (50%), and an anterolateral thigh perforator flap was used in five cases (16.7%). The postoperative complications were acceptable. The mean follow-up time was 64.9 ± 29.6 months. Of all 30 cases, 22 patients (73.3%) survived with no evidence of recurrence, four patients (13.3%) exhibited local recurrence, two patients (6.7%) exhibited both local recurrence and distant metastasis and the remaining two patients (6.7%) exhibited distant metastasis. Five patients died from metastasis or cachexia. Current surgical techniques, including primary closure, adjacent flaps, split-thickness skin flaps and anterolateral thigh perforator flaps are able to reconstruct all types of defects with acceptable complications. Some patients with negative margins went on to exhibit local recurrence, potentially due to adnexal carcinoma or internal malignancy. PMID:23685910

Chen, Qi; Chen, Yan-Bo; Wang, Zhong; Cai, Zhi-Kang; Peng, Yu-Bing; Zheng, Da-Chao; Ma, Li-Ming; Yao, Hai-Jun; Zhou, Juan

2013-07-01

310

[Hematologic indicators in patients with morbid obesity after surgical creation of the miniature stomach].  

PubMed

Surgical establishment of miniature stomach was conducted in 28 patients with severe alimentary-constitutional obesity (mean body weight 155.7 kg). After a 18-36-month follow-up the patients underwent hematological examination. It was found that a 134% excess of body weight registered preoperatively dropped to 54%. Reduced levels of blood red cells, hemoglobin, serum iron were not registered. Neither was anemia. This shows that physiological function of the whole gastrointestinal tract was not damaged, the blood loss appeared insignificant. Substitution therapy with hemostimulants during the following two years may be avoided. PMID:2811242

Romanov, M M; Markov, V K; Kuzin, N M; Andreev, A V

1989-08-01

311

Surgical Factors Influencing Outcomes in Patients Resected for Cancer of the Esophagus or Gastric Cardia  

Microsoft Academic Search

Background  Surgery is the treatment of choice for localized esophageal and gastric cardia cancer. Our aim was to evaluate factors influencing\\u000a postoperative short-term morbidity, 30-day mortality, and long-term prognosis.\\u000a \\u000a \\u000a \\u000a Methods  We identified 232 patients who had undergone surgical resection from a Swedish nationwide case control study of cancer of\\u000a the esophagus and cardia between December 1, 1994 and December 31, 1997. Patients

Martin Sundelöf; Jesper Lagergren; Weimin Ye

2008-01-01

312

Aneurysm of the tibial-saphenous fistula in hemodialysis patient: the results of surgical treatment.  

PubMed

Arteriovenous fistulas are widely used for hemodialysis patients with end-stage renal failure. Due to the lack of suitable veins because of the arteriovenous fistulas previously opened in the upper extremity, alternative access routes are being tested. Few complications of long-term alternative arteriovenous fistulas have been reported in the literature. We report the results of surgical repairs of aneurysms that occurred on anterior tibial-saphenous arteriovenous fistulas (along the vein) in patients with end-stage renal disease after 5 years on hemodialysis. PMID:22140315

Günday, Murat

2011-01-01

313

Pediatric hospital medicine role in the comanagement of the hospitalized surgical patient.  

PubMed

Medical comanagement of surgical patients by pediatric hospital medicine providers has become increasingly common. Subjectively, the comanagement model is superior to more traditional consultative models because of the anticipatory preventive care and coordination hospitalists provide to patients and hospital colleagues. Although some studies have demonstrated the value of the comanagement model in adults and children, others have failed to do so. The coming years are both exciting and challenging for this emerging field as it attempts to sustain its early progress and define its future in pediatric hospital medicine. PMID:25084714

Schaffzin, Joshua K; Simon, Tamara D

2014-08-01

314

Geriatric oncology in the Netherlands: a survey of medical oncology specialists and oncology nursing specialists.  

PubMed

To identify ways to improve cancer care for older patients, we set out to examine how older patients in the Netherlands are currently being evaluated prior to oncological treatment and to explore the potential obstacles in the incorporation of a geriatric evaluation, using a web-based survey sent to Dutch medical oncology specialists and oncology nursing specialists. The response rate was 34% (183 out of 544). Two-thirds of respondents reported that a geriatric evaluation was being used, although primarily on an ad hoc basis only. Most respondents expressed a desire for a routine evaluation or more intensive collaboration with the geriatrician and 86% of respondents who were not using a geriatric evaluation expressed their interest to do so. The most important obstacles were a lack of time or personnel and insufficient availability of a geriatrician to perform the assessment. Thus, over 30% of oncology professionals in the Netherlands express an interest in geriatric oncology. Important obstacles to a routine implementation of a geriatric evaluation are a lack of time, or insufficient availability of geriatricians; this could be overcome with policies that acknowledge that quality cancer care for older patients requires the investment of time and personnel. PMID:24702775

Jonker, J M; Smorenburg, C H; Schiphorst, A H; van Rixtel, B; Portielje, J E A; Hamaker, M E

2014-11-01

315

Two surgical procedures for esophagogastric variceal bleeding in patients with portal hypertension  

PubMed Central

AIM: To determine the clinical value of a splenorenal shunt plus pericardial devascularization (PCVD) in portal hypertension (PHT) patients with variceal bleeding. METHODS: From January 2008 to November 2012, 290 patients with cirrhotic portal hypertension were treated surgically in our department for the prevention of gastroesophageal variceal bleeding: 207 patients received a routine PCVD procedure (PCVD group), and 83 patients received a PCVD plus a splenorenal shunt procedure (combined group). Changes in hemodynamic parameters, rebleeding, encephalopathy, portal vein thrombosis, and mortality were analyzed. RESULTS: The free portal pressure decreased to 21.43 ± 4.35 mmHg in the combined group compared with 24.61 ± 5.42 mmHg in the PCVD group (P < 0.05). The changes in hemodynamic parameters were more significant in the combined group (P < 0.05). The long-term rebleeding rate was 7.22% in the combined group, which was lower than that in the PCVD group (14.93%), (P < 0.05). CONCLUSION: Devascularization plus splenorenal shunt is an effective and safe strategy to control esophagogastric variceal bleeding in PHT. It should be recommended as a first-line treatment for preventing bleeding in PHT patients when surgical interventions are considered. PMID:24409071

Yang, Lin; Yuan, Li-Juan; Dong, Rui; Yin, Ji-Kai; Wang, Qing; Li, Tao; Li, Jiang-Bin; Du, Xi-Lin; Lu, Jian-Guo

2013-01-01

316

Effect of surgical incision management on wound infections in a poststernotomy patient population.  

PubMed

Skin breakdown and infiltration of skin flora are key causative elements in poststernotomy wound infections. We hypothesised that surgical incision management (SIM) using negative pressure wound therapy over closed surgical incisions for 6-7?days would reduce wound infections in a comprehensive poststernotomy patient population. 'All comers' undergoing median sternotomy at our institution were analysed prospectively from 1 September to 15 October 2013 (study group, n?=?237) and retrospectively from January 2008 to December 2009 (historical control group, n?=?3508). The study group had SIM (Prevena™ Therapy) placed immediately after skin suturing and applied at -125 mmHg for 6-7?days, whereas control group received conventional sterile wound tape dressings. Primary endpoint was wound infection within 30 days. Study group had a significantly lower infection rate than control group: 1·3% (3 patients) versus 3·4% (119 patients), respectively (P?patients (98·7%). SIM over clean, closed incisions for the first 6-7 postoperative days significantly reduced the incidence of wound infection after median sternotomy. Based on these data SIM may be cost-effective in patients undergoing cardiac surgery. PMID:24851729

Grauhan, Onnen; Navasardyan, Artashes; Tutkun, Baris; Hennig, Felix; Müller, Peter; Hummel, Manfred; Hetzer, Roland

2014-06-01

317

Quality of Life in Patients with Knee Osteoarthritis: A Commentary on Nonsurgical and Surgical Treatments  

PubMed Central

Knee osteoarthritis (OA) has a significant negative impact on health-related quality of life (HRQoL). Identification of therapies that improve HRQoL in patients with knee OA may mitigate the clinical, economic, and social burden of this disease. The purpose of this commentary is to report the impact of knee OA on HRQoL, describe the change in HRQoL attributable to common knee OA interventions, and summarize findings from clinical trials of a promising therapy. Nonsurgical therapies do not reliably modify HRQoL in knee OA patients given their general inability to alleviate physical manifestations of OA. Surgical knee OA interventions generally result in good to excellent patient outcomes. However, there are significant barriers to considering surgery, which limits clinical utility. Therapies that most effectively control OA-related pain with a low risk: benefit ratio will likely have the greatest benefit on HRQoL with greater rates of patient adoption. Initial clinical trial findings suggest that less invasive joint unloading implants hold promise in bridging the therapeutic gap between nonsurgical and surgical treatments for the knee OA patient. PMID:24285987

Farr II, Jack; Miller, Larry E.; Block, Jon E.

2013-01-01

318

Ethical issues in integrative oncology.  

PubMed

Integrative oncology relates to an emerging dialog between complementary and alternative medicine (CAM) scholars, oncologists, family practitioners, and other health care providers who envision an extended and holistic patient-centered approach to oncology care. The multiple commitments of integrative oncology to a medical humanistic approach and to a strong evidence-based foundation may impose considerable ethical concerns and dilemmas. The authors use narrative ethics to present a case study that exemplifies the ethical challenges confronting physicians and health care providers who wish to provide an integrative approach for their patients. An ethical analysis of the narrative is provided to help clarify the ethical issues and conflicts within it. Finally, a framework that may transform ethical constraints to a communication tool is proposed. PMID:18638699

Ben-Arye, Eran; Schiff, Elad; Golan, Ofra

2008-08-01

319

[Perception of night-time sleep by the surgical patients in an intensive care unit].  

PubMed

Night-time rest of the patients hospitalized in Intensive Care is a very important feature within the health/disease process since it has a direct repercussion on their adequate recovery. The objectives of this investigation are: 1) describe how the surgical patients perceive their night-time sleep in the Polyvalent Intensive Care Unit: 2) compare the subjective perception of the patients with the nursing record in the care plan and analyze the degree of agreement between both assessments. Night-time sleep has been studied in 104 patients; surgery patients from emergencies, patients who are intubated, with previous psychiatric treatment, sleep apnea, drinking habit or impossibility of adequate communication were not included. To measure the patient's perception, the five item sleep questionnaire of Richards-Campbell and the assessment of sleep by the nurse, as well as the remaining variables included in a computerized care plan, were used. The total mean score of the sleep on the first post-operative night was 51.42 mm. When the scores obtained in each one of the questionnaire items are analyzed, it is seen that the sleep profile of these patients has been characterized by being light sleep, with frequent wakenings and generally with little difficulty to go back to sleep when woke op or were awakened. The assessment of the night-time sleep performed by the nurse coincides with the perception of the patients on many occasions, and when there is discrepancy, the nurse has overestimated the patient's sleep. PMID:12356376

Nicolás, A; Aizpitarte, E; Iruarrizaga, A; Vázquez, M; Margall, M A; Asiain, M C

2002-01-01

320

Preoperative analysis of the stability of fit of a patient-specific surgical guide.  

PubMed

Although the use of patient-specific surgical guides has gained popularity over the past decade, little research has been done to examine in an objective and qualitative way the fit of such instruments. In this study, we have developed a model to predict the stability of a guide designed to fit on a supporting bone surface, thereby providing feedback on the translational and rotational stability of the device. The method was validated by comparing different guide designs with respect to their stability on the contact surface and comparing these results to those measured with a set of experiments. This validation experiment indicates that our stability model can be used to predict the stability of the fit of a surgical guide during the preoperative design process. PMID:23627973

Van den Broeck, Joyce; Wirix-Speetjens, Roel; Vander Sloten, Jos

2015-01-01

321

Invasive pulmonary aspergillosis: role of early diagnosis and surgical treatment in patients with acute leukemia  

PubMed Central

Background Aspergillus is a ubiquitous soil-dwelling fungus known to cause significant pulmonary infection in immunocompromised patients. The incidence of aspergillosis has increased during the past two decades and is a frequently lethal complication of acute leukemia patients that occurs following both chemotherapy and bone marrow transplantation. The diagnosis of invasive pulmonary aspergillosis (IPA) according to the criteria that are established by European Organization for the Research and Treatment of Cancer and Mycoses Study Group raise difficulties in severely ill patients. Despite established improvements in field of diagnosis (galactomannan antigen, quantitative PCR, real-time PCR for Aspergillus spp., and findings of computed tomography) and treatment with new antifungals, it is still a major problem in patients with acute leukemia. However, prompt and effective treatment of IPA is crucial because most patients will need subsequent chemotherapy for underlying hematologic disease as soon as possible. Case presentation We report a 33-year-old male patient with acute promyelocytic leukemia diagnosed in 1993 that developed invasive pulmonary aspergillosis due to A. flavus at relapse in 2003. The patient was successfully treated with liposomal amphotericin B and underwent surgical pulmonary resection. The operative course was uneventful. Conclusion This report emphasizes the clinical picture, applicability of recent advances in diagnostic and therapeutic approaches for IPA. For early identification of a patient infected with IPA, a high index of suspicion and careful clinical and radiological examinations with serial screening for galactomannan should be established. If aspergillosis is suspected, anti-aspergillosis drug should be administered immediately, and if a unique pulmonary lesion remains, surgical resection should be considered to prevent reactivation during consecutive chemotherapy courses and to improve the outcome. PMID:16872530

Ali, Ridvan; Ozkalemkas, Fahir; Ozcelik, Tulay; Ozkocaman, Vildan; Ozkan, Atilla; Bayram, Sami; Ener, Beyza; Ursavas, Ahmet; Ozal, Guze; Tunali, Ahmet

2006-01-01

322

Chronic rhinosinusitis in patients requiring surgical repair of a midface fracture.  

PubMed

Midface fractures commonly occur following trauma to the face and may cause changes in the normal sinus outflow system. To the best of our knowledge, no study has examined the incidence of rhinosinusitis following midface fractures. We report the incidence of chronic rhinosinusitis in patients who underwent surgical repair of a midface fracture. Our evaluation tool was the 20-item Sino-Nasal Outcome Test quality-of-life survey (SNOT-20). We mailed a demographic survey and the SNOT-20 questionnaire to 486 eligible patients who had undergone surgical repair of either a midface (n = 234) or mandible (n = 252) fracture; we had intended to use the latter cohort as a control group. Of the 234 midface patients, 34 (14.5%) returned a usable survey, but only 7 of the 252 mandibular patients (2.8%) did so, which was not a sufficient number for analysis; therefore we used normative data obtained from another study for comparison purposes. The mean SNOT-20 score in our cohort was 24.15, which was similar to the 28.7 mean score in the control cohort of patients with rhinosinusitis. The highest mean scores for the individual components of the SNOT-20 were for "Wake up at night," "Lack of a good night's sleep," "Wake up tired," and "Frustrated/restless/irritable." The components that the most patients found bothersome were "Facial pain/pressure," "Need to blow nose," "Runny nose," and "Lack of a good night's sleep." We conclude that patients who experience a midface fracture have a much higher risk of developing chronic rhinosinusitis that negatively affects their long-term quality of life. These patients should be monitored with long-term follow-up and treated appropriately. PMID:25255355

Yelverton, Joshua C; Jackson, Peter; Schmidt, Robert S

2014-09-01

323

Category-Specific Naming and Recognition Deficits in Temporal Lobe Epilepsy Surgical Patients  

PubMed Central

Objective Based upon Damasio's “Convergence Zone” model of semantic memory, we predicted that epilepsy surgical patients with anterior temporal lobe (TL) seizure onset would exhibit a pattern of category-specific naming and recognition deficits not observed in patients with seizures arising elsewhere. Methods We assessed epilepsy patients with unilateral seizure onset of anterior TL or other origin (n = 22), pre- or postoperatively, using a set of category-specific items and a conventional measure of visual naming (Boston Naming Test: BNT). Results Category-specific naming deficits were exhibited by patients with dominant anterior TL seizure onset/resection for famous faces and animals, while category-specific recognition deficits for these same categories were exhibited by patients with nondominant anterior TL onset/resection. Patients with other seizure onset did not exhibit category-specific deficits. Naming and recognition deficits were frequently not detected by the BNT, which samples only a limited range of stimuli. Interpretation Consistent with the “convergence zone” framework, results suggest that the nondominant anterior TL plays a major role in binding sensory information into conceptual percepts for certain stimuli, while dominant TL regions function to provide a link to verbal labels for these percepts. Although observed category-specific deficits were striking, they were often missed by the BNT, suggesting that they are more prevalent than recognized in both pre- and postsurgical epilepsy patients. Systematic investigation of these deficits could lead to more refined models of semantic memory, aid in the localization of seizures, and contribute to modifications in surgical technique and patient selection in epilepsy surgery to improve neurocognitive outcome. PMID:18206185

Drane, Daniel L.; Ojemann, George A.; Aylward, Elizabeth; Ojemann, Jeffrey G.; Johnson, L. Clark; Silbergeld, Daniel L.; Miller, John W.; Tranel, Daniel

2008-01-01

324

Surgical Outcomes after Traumatic Vertebral Fractures in Patients with Ankylosing Spondylitis  

PubMed Central

Objective Ankylosing spondylitis is an inflammatory rheumatic disease mainly affecting the axial skeleton. The rigid spine may secondarily develop osteoporosis, further increasing the risk of spinal fracture. In this study, we reviewed fractures in patients with ankylosing spondylitis that had been clinically diagnosed to better define the mechanism of injury, associated neurological deficit, predisposing factors, and management strategies. Methods Between January 2003 and December 2013, 12 patients with 13 fractures with neurological complications were treated. Neuroimaging evaluation was obtained in all patients by using plain radiography, CT scan, and MR imaging. The ASIA Impairment Scale was used in order to evaluate the neurologic status of the patients. Management was based on the presence or absence of spinal instability. Results A total of 9 cervical and 4 thoracolumbar fractures were identified in a review of patients in whom ankylosing spondylitis had been diagnosed. Of these, 7 fractures were associated with a hyperextension mechanism. 10 cases resulted in a fracture by minor trauma. Posttraumatic neurological deficits were demonstrated in 11 cases and neurological improvement after surgery was observed in 5 of these cases. Conclusions Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status. PMID:25328647

An, Seong-Bae; Kim, Keung-Nyun; Chin, Dong-Kyu; Kim, Keun-Su; Cho, Yong-Eun

2014-01-01

325

Surgical Approach and Laser Applications in BRONJ Osteoporotic and Cancer Patients  

PubMed Central

Bisphosphonates-related Osteonecrosis of the Jaw (BRONJ) has been reported with increasing frequency in literature over last years, but its therapy is still a dilemma. One hundred ninety patients affected by BRONJ were observed between January 2004 and November 2011 and 166 treated sites were subdivided in five groups on the basis of the therapeutical approach (medical or surgical, traditional or laser-assisted approach, with or without Low Level Laser Therapy (LLLT)). Clinical success has been defined for each treatment performed as clinical improvement or complete mucosal healing. Combination of antibiotic therapy, conservative surgery performed with Er:YAG laser and LLLT applications showed best results for cancer and noncancer patients. Nonsurgical approach performed on 69 sites induced an improvement in 35 sites (50.7%) and the complete healing in 19 sites (27.5%), while surgical approach on 97 sites induced an improvement in 84 sites (86.6%) and the complete healing in 78 sites (80.41%). Improvement and healing were recorded in 31 (81.5%) and 27 (71.5%) out of the 38 BRONJ sites treated in noncancer patients and in 88 (68.75%) and in 69 (53.9%) out of the 128 in cancer patients. PMID:22645701

Vescovi, Paolo; Merigo, Elisabetta; Meleti, Marco; Manfredi, Maddalena; Fornaini, Carlo; Nammour, Samir

2012-01-01

326

Efficacy of a new quinolone, levofloxacin in patients with surgical infections.  

PubMed

The pharmacokinetics and clinical efficacy of levofloxacin (LVFX, DR-3355), an optically pure S(-)-enantiomer of ofloxacin, were studied in patients after surgery. In the pharmacokinetic study, 4 patients undergoing bile drainage were given 2 100-mg tablets by mouth. Peak levels of LVFX were from 2.22 to 4.02 micrograms/ml of plasma at 2-4 hours after the oral administration, and from 7.5 to 11.3 micrograms/ml of bile at 2-6 hours. Forty-three patients with surgical infections, including 16 skin and soft-tissue infections and 12 wound infections, were treated with LVFX. Twenty-eight (70%) of the 40 patients whose results could be evaluated had excellent or good results; 42 (93%) of the 45 causative organisms identified were eradicated. An episode of diarrhea with chills and fever occurred in a 38-year-old man. The results suggested that LVFX has satisfactory antimicrobial effects in surgical infections. PMID:1512922

Morimoto, K; Kinoshita, H; Nakatani, S; Sakai, K; Fujimoto, M; Ohno, K; Ueda, T; Ohmori, K; Yamazaki, O; Doi, S

1992-03-01

327

Surgical treatment of patients with refractory migraine headaches and intranasal contact points.  

PubMed

Contact point headaches have been attributed to intranasal contact between opposing mucosal surfaces, resulting in referred pain in the distribution of the trigeminal nerve. In subjects with primary headaches, contact points may be associated with treatment refractoriness. We aimed to assess the benefits of surgical correction in patients with refractory migraine or transformed migraine, and radiographic evidence of contact points in the sinonasal area. We reviewed charts of patients who underwent endoscopic sinus surgery and septoplasty for contact point in the same surgical facility, from October 1998 through August 2003. Subjects eligible for surgery had: (i) refractory migraine (failed to standard pharmacological headache treatments) or refractory transformed migraine; (ii) contact points demonstrated by computed tomography scan; (iii) reported significant headache improvement after topical anaesthesia to the contact area. Headache characteristics were assessed preoperatively and at follow-up (6-62 months after surgery) using a standardized questionnaire. A total of 21 subjects (72.5% women) were assessed. Mean headache frequency was reduced from 17.7 to 7.7 headache days per month (P = 0.003). Mean headache severity was reduced from 7.8 to 3.6 on a 0-10 scale (P = 0.0001). Headache-related disability was reduced from 5.6 (10-point scale) to 1.8 (P < 0.0001). A total of 16 subjects (76.2%) had their headache scores improved by 50% or more; nine (42.9%) were pain free at the last follow-up. A total of 18 (95.8%) had at least a 25% reduction in their headache scores. Two patients (9.5%) had increase in their headache score by less than 25%. For selected patients with refractory headaches, demonstrable contact points, and positive response after topical anaesthesia, surgical approach toward the triggering factor may be useful. Prospective studies are necessary to confirm our results. PMID:15910568

Behin, F; Behin, B; Bigal, M E; Lipton, R B

2005-06-01

328

Prevalence of deep vein thrombosis in acutely admitted ambulatory non-surgical intensive care unit patients  

PubMed Central

Background Data on prevalence rates of venous thromboembolism (VTE) in different patient populations are scarce. Most studies on this topic focus on older patients or patients with malignancies, immobilization or thrombophilia. Less is known about the VTE risk profile of non-surgical patients presenting with a variety of medical diseases of differing severity. Aim of the present study was to investigate VTE prevalence in a pospective cohort study of ambulatory medical intensive care unit patients within 24 h after acute admission. Methods Prospective cohort study of 102 consecutive patients after acute admission to medical intensive care unit. Ultrasound compression sonography, APACHE-II-Scoring and laboratory examination was performed within 24 hours after admission.Possible determinants of a high risk of VTE were examined. In all patients with a confirmed diagnosis of DVT or suspicion of PE thoracic computer tomography (CT) was performed. Results VTE was found in 7.8% out of 102 of patients, mean APACHE-II-Score was 14 (mortality risk of about 15%). Thrombus location was femoropopliteal in 5 patients, iliacal in 2 and peroneal in 1 patient. Five VTE patients had concomitant PE (62.5% of VTE, 4.9% of all patients). No predictors of prevalent VTE were identified from univariable regression analysis although relative risk was high in patients with a history of smoking (RR 3.40), immobility (RR 2.50), and elevated D-Dimer levels (RR 3.49). Conclusions Prevalent VTE and concomitant PE were frequent in acutely admitted ICU patients. PMID:24996222

2014-01-01

329

The correlation among patients and health care professionals in assessing functional status using the karnofsky and eastern cooperative oncology group performance status scales.  

PubMed

This study evaluated the correlation between Karnofsky performance status (KPS) and Eastern Cooperative Oncology Group (ECOG) performance status (PS) scores assigned by doctors (MDs), nurses (RNs), radiation therapist (RTT), radiation therapy student (RTS), and patients (PTs) in assessing functional status of patients with cancer. Patients admitted to the general oncology and palliative care wards at our institution participated in the study. Data were gathered from survey forms completed by MDs, RNs, RTT, RTS, and PTs. The Spearman rank correlation coefficient was used to determine the extent of correlation between paired assessments. Thirty-six patients were enrolled in the study, 27 of whom were evaluable (17 men and 10 women), with a mean age of 57.7 years (range, 32-76 years). The correlation for ECOG PS scores were MD/RTS = 0.81; MD/RN = 0.77; MD/RTT = 0.57; MD/PT = 0.64; PT/RN = 0.51; PT/RTT = 0.60; and PT/RTS = 0.64. The correlations for KPS scores were MD/RTS = 0.81; MD/RN = 0.74; MD/RTT = 0.67; MD/PT = 0.70; PT/RN = 0.60; PT/RTT = 0.79; and PT/RTS = 0.60. The findings demonstrate that patients can make valuable and reliable self-assessments as evidenced from the moderate to good degree of correlation of patient-assigned scores with those of health care professionals. PMID:18628160

de Borja, Maria-Theresa; Chow, Edward; Bovett, Geoff; Davis, Lori; Gillies, Carol

2004-10-01

330

Is Postoperative Pain a Self-Fulfilling Prophecy? Expectancy Effects on Postoperative Pain and Patient-Controlled Analgesia Use Among Adolescent Surgical Patients  

Microsoft Academic Search

Objective To explore relationships among anxiety, anticipated pain, coping styles, postoperative pain, and patient-controlled analgesia (PCA) use among adolescent surgical patients and their parents. Methods Sixty-five 12- to 18-year-old surgical patients undergoing surgery with postoperative PCA pain management were included. Before surgery, adolescents and parents reported anxiety and expected levels of postoperative pain. Pain catastrophizing and coping style were assessed

Deirdre E. Logan; John B. Rose

2005-01-01

331

Rationale for the design of an oncology trial using a generic targeted therapy multi-drug regimen for NSCLC patients without treatment options (Review)  

PubMed Central

Despite more than 70 years of research concerning medication for cancer treatment, the disease still remains one of the leading causes of mortality worldwide. Many cancer types lead to death within a period of months to years. The original class of chemotherapeutics is not selective for tumor cells and often has limited efficacy, while treated patients suffer from adverse side-effects. To date, the concept of tumor-specific targeted therapy drugs has not fulfilled its expectation to provide a key for a cure. Today, many oncology trials are designed using a combination of chemotherapeutics with targeted therapy drugs. However, these approaches have limited outcomes in most cancer indications. This perspective review provides a rationale to combine targeted therapy drugs for cancer treatment based on observations of evolutionary principles of tumor development and HIV infections. In both diseases, the mechanisms of immune evasion and drug resistance can be compared to some extent. However, only for HIV is a breakthrough treatment available, which is the highly active antiretroviral therapy (HAART). The principles of HAART and recent findings from cancer research were employed to construct a hypothetical model for cancer treatment with a multi-drug regimen of targeted therapy drugs. As an example of this hypothesis, it is proposed to combine already marketed targeted therapy drugs against VEGFRs, EGFR, CXCR4 and COX2 in an oncology trial for non-small cell lung cancer patients without further treatment options. PMID:23877481

LANGHAMMER, STEFAN

2013-01-01

332

Low plasma renalase concentration in hypertensive patients after surgical repair of coarctation of aorta.  

PubMed

The study aimed to evaluate plasma renalase level, a recently discovered kidney-derived catecholamine-metabolizing enzyme in patients after successful repair of aortic coarctation, with special consideration of arterial hypertension in the context of underlying process of arterial remodeling. This case-control study covered 50 consecutive patients after Dacron patch repair of aortic coarctation (31 men; median age 33 [26; 40]; age at surgery 10 [5; 16] years), matched in terms of age and gender with 50 controls. Both groups were stratified depending on the presence of hypertension and assessed in terms of renalase, C-reactive protein, and carotid intima-media thickness. Additionally ultrasound and tonometric markers of vascular remodeling were obtained in the study group. Hypertension was found in 21 patients (42%) in the study group and 29 (58%) in the control group (P = .11). Renalase level was significantly lower in patients in the study than control group (5825.1 vs. 6592.7 ng/mL; P = .041). Significant difference in terms of renalase concentration between hypertensive and normotensive patients was confirmed both in subjects with coarctation of aorta (P = .027) and in control group (P < .0001). Renalase level inversely correlated with serum creatinine (r = -0.36) and arterial blood pressure in the whole population, and with central systolic (r = -0.29) and diastolic pressure (r = -0.35) in study group. Multivariate regression revealed that serum creatinine and pulse pressure were independent predictors of renalase. Surgical intervention >7 years was linked to lower renalase (P = .018) and unfavorable vascular parameters. Renalase level <4958 ng/mL accurately predicted presence of hypertension in patients after coarctation of aorta repair (odds ratio, 3.8; P = .032). Renalase deficiency is associated with the presence of hypertension in both patients after surgical repair of aortic coarctation and the control group. In coarctation of aorta, its action is probably parallel to underlying arterial remodeling. PMID:25064768

Wybraniec, Maciej T; Mizia-Stec, Katarzyna; Trojnarska, Olga; Chudek, Jerzy; Czerwie?ska, Beata; Wikarek, Maria; Wi?cek, Andrzej

2014-07-01

333

Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum  

PubMed Central

This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric?=?0–21; adult 17–99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), outcome ratings, complications, and percentage requiring reoperations. Adult implant patients (18.8%) had higher reoperation rates than adult Nuss or Ravitch patients (5.3% and 3.3% respectively). Adult Nuss patients had longer LOS (7.3 days), more strut/bar displacement (6.1%), and more epidural analgesia (3 days) than adult Ravitch patients (2.9 days, 0%, 0 days). Excluding pectus bar and strut displacements, pediatric and adult Nuss patients tended to have higher complication rates (pediatric - 38%; adult - 21%) compared to pediatric and adult Ravitch patients (12.5%; 8%). Pediatric Ravitch patients clearly had more strut displacements than adult Ravitch patients (0% and 6.4% respectively). These results suggest significantly better results in common PEx surgical repair techniques (i.e. Nuss and Ravitch) than uncommon techniques (i.e. Implants and Robicsek). The results suggest slightly better outcomes in pediatric Nuss procedure patients as compared with all other groups. We recommend that symptomatic pediatric patients with uncomplicated PEx receive the Nuss procedure. We suggest that adult patients receive the Nuss or Ravitch procedure, even though the long-term complication rates of the adult Nuss procedure require more investigation. PMID:24506826

2014-01-01

334

Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum.  

PubMed

This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric=0-21; adult 17-99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), outcome ratings, complications, and percentage requiring reoperations. Adult implant patients (18.8%) had higher reoperation rates than adult Nuss or Ravitch patients (5.3% and 3.3% respectively). Adult Nuss patients had longer LOS (7.3 days), more strut/bar displacement (6.1%), and more epidural analgesia (3 days) than adult Ravitch patients (2.9 days, 0%, 0 days). Excluding pectus bar and strut displacements, pediatric and adult Nuss patients tended to have higher complication rates (pediatric - 38%; adult - 21%) compared to pediatric and adult Ravitch patients (12.5%; 8%). Pediatric Ravitch patients clearly had more strut displacements than adult Ravitch patients (0% and 6.4% respectively). These results suggest significantly better results in common PEx surgical repair techniques (i.e. Nuss and Ravitch) than uncommon techniques (i.e. Implants and Robicsek). The results suggest slightly better outcomes in pediatric Nuss procedure patients as compared with all other groups. We recommend that symptomatic pediatric patients with uncomplicated PEx receive the Nuss procedure. We suggest that adult patients receive the Nuss or Ravitch procedure, even though the long-term complication rates of the adult Nuss procedure require more investigation. PMID:24506826

Johnson, William Rainey; Fedor, David; Singhal, Sunil

2014-01-01

335

Surgical and conservative treatment of patients with congenital scoliosis: ? search for long-term results  

PubMed Central

Background In view of the limited data available on the conservative treatment of patients with congenital scoliosis (CS), early surgery is suggested in mild cases with formation failures. Patients with segmentation failures will not benefit from conservative treatment. The purpose of this review is to identify the mid- or long-term results of spinal fusion surgery in patients with congenital scoliosis. Methods Retrospective and prospective studies were included, reporting on the outcome of surgery in patients with congenital scoliosis. Studies concerning a small numbers of cases treated conservatively were included too. We analyzed mid-term (5 to 7 years) and long-term results (7 years or more), both as regards the maintenance of the correction of scoliosis and the safety of instrumentation, the early and late complications of surgery and their effect on quality of life. Results A small number of studies of surgically treated patients were found, contained follow-up periods of 4-6 years that in the most cases, skeletal maturity was not yet reached, and few with follow-up of 36-44 years. The results of bracing in children with congenital scoliosis, mainly in cases with failure of formation, were also studied. Discussion Spinal surgery in patients with congenital scoliosis is regarded in short as a safe procedure and should be performed. On the other hand, early and late complications are also described, concerning not only intraoperative and immediate postoperative problems, but also the safety and efficacy of the spinal instrumentation and the possibility of developing neurological disorders and the long-term effect these may have on both lung function and the quality of life of children. Conclusions Few cases indicate the long-term results of surgical techniques, in the natural progression of scoliosis. Similarly, few cases have been reported on the influence of conservative treatment. In conclusion, patients with segmentation failures should be treated surgically early, according to the rate of deformity formation and certainly before the pubertal growth spurt to try to avoid cor- pulmonale, even though there is lack of evidence for that in the long-term. Furthermore, in patients with formation failures, further investigation is needed to document where a conservative approach would be necessary. PMID:21639924

2011-01-01

336

Misdiagnosis and Quality of Management in Paediatric Surgical Patients Referred to a Tertiary Care Hospital  

PubMed Central

Background: The literature on diagnosis and management prior to transfer paediatric surgical patients to a tertiary care center is scarce. In referral centers, it is common to receive patients previously subjected to inadequate or inappropriate health care. Aim: Analyze the prevalence of misdiagnosis and quality of management in patients before being referred and factors related to misdiagnosis and inadequate management. Design: Prospective, longitudinal, comparative study between patients with appropriate and inappropriate submission diagnosis and between patients with adequate or inadequate treatment. Setting: Third level care hospital, Mexico City. Participants: Newborn to adolescents referred to Paediatric Surgery Department. Intervention(s): None. Main Outcome Measure(s): Misdiagnosis and quality of management prior to being referred. Result: Two hundred patients were evaluated. Correlation between submission diagnosis and final diagnosis showed that 70% were correct and 30% incorrect; 48.5% were properly managed and 51.5% inappropriately managed. Incorrect diagnosis was more frequent when referred from first-or second-level hospitals and in inflammatory conditions. Patients referred by paediatricians had a higher rate of adequate management. Conclusion: We present the frequency of incorrect diagnosis and inadequate patient management in a highly selected population. Sample size should be increased as well as performing these studies in other hospital settings in order to determine whether the results are reproducible. PMID:24959495

Cazares-Rangel, Joel; Zalles-Vidal, Cristian; Davila-Perez, Roberto

2014-01-01

337

Surgical correction of microstomia in a patient with antilaminin 332 mucous membrane pemphigoid.  

PubMed

Microstomia is a term used to describe a small oral aperture. Most of the reported cases are caused by scar contracture after facial trauma, burn injury, and tumor excision. We experienced a rare case of microstomia in a patient with antilaminin 332 mucous membrane pemphigoid, which was an acquired autoimmune disease and showed blisters and erosive lesions mainly on the mucous membranes. The patient had recurrent aphthous stomatitis and presented microstomia caused by scar contracture of oral mucosa. We surgically corrected microstomia by 5-flap Z-plasty for commissuroplasty and 2 Z-plasty of both upper and lower lips for an enlargement of oral aperture. The patient could achieve an enough oral aperture and was satisfied with the result. There was no recurrence of microstomia for 2 years. PMID:23486114

Sato, Hideyoshi; Toriyama, Kazuhiro; Yagi, Shunjiro; Takanari, Keisuke; Takama, Hiroyuki; Sawada, Masaki; Hashimoto, Takashi; Kamei, Yuzuru

2014-05-01

338

Management of patients with psoriasis treated with biological drugs needing a surgical treatment.  

PubMed

Postmarketing Phase IV Tumor necrosis factor alpha (TNF-?) is a cytokine that plays a critical role in inflammatory and immune processes and in the control of infections and sepsis. Data on the perioperative management of patients treated with biologic drugs are limited and mainly in patients with rheumatoid arthritis (RA) and inflammatory bowel disease (IBD). This retrospective study assesses variations in the incidence of side effects between psoriatic patients who temporarily discontinue or continue biological therapy before surgical treatment. Despite the immunosuppressive risk, our results suggest that postoperative complications are not influenced by the suspension of biologic therapies. As TNF-? plays a role in promoting collagen synthesis and wound healing, we suggest that anti-TNFs should be discontinued before major surgery, whereas for minor surgery, the lower rates of infections favor anti-TNF-? continuation, particularly since suspending anti-TNF therapy is known to induce psoriasis relapse. PMID:25381969

Fabiano, Antonella; De Simone, Clara; Gisondi, Paolo; Piaserico, Stefano; Lasagni, Claudia; Pellacani, Giovanni; Conti, Andrea

2014-11-01

339

Surgical Treatment of a Mixed Pineocytoma\\/Pineoblastoma in a 72YearOld Patient  

Microsoft Academic Search

Summary.\\u000a Summary.  \\u000a ?\\u000a \\u000a \\u000a \\u000a \\u000a Background:   Although pineal parenchymal tumours are very rare in elderly patients, we recently successfully treated a 72-year-old male\\u000a patient. Interestingly, the histology of his pineal parenchymal tumour was mixed pineocytoma\\/pineoblastoma, which is reported\\u000a to be extremely rare in aged patients. We present his clinical manifestations, follow-up MRI, surgical treatment, pathological\\u000a findings, and review the literature.\\u000a \\u000a ?\\u000a \\u000a \\u000a \\u000a \\u000a Clinical

R. Saito; R. Shirane; T. Oku; M. Watanabe; T. Kumabe; C.-C. Su; H. Higuchi

2002-01-01

340

REVIEW Obesity in Pediatric Oncology  

Microsoft Academic Search

Today's obesity pandemic began in the United States, spread to Western Europe and other developed regions, and is emerging in devel- oping countries. Its influences on outcomes of childhood cancer are unknown. A recent Children's Oncology Group symposium con- sidered epidemiology of obesity, pharmacology of chemotherapy and outcomes in obese adults with cancer, excess mortality in obese pediatric patients with

Paul C. Rogers; Lillian R. Meacham; Kevin C. Oeffinger; David W. Henry; Beverly J. Lange

341

Using the Statecharts paradigm for simulation of patient flow in surgical care.  

PubMed

Computer simulation of patient flow has been used extensively to assess the impacts of changes in the management of surgical care. However, little research is available on the utility of existing modeling techniques. The purpose of this paper is to examine the capacity of Statecharts, a system of graphical specification, for constructing a discrete-event simulation model of the perioperative process. The Statecharts specification paradigm was originally developed for representing reactive systems by extending the formalism of finite-state machines through notions of hierarchy, parallelism, and event broadcasting. Hierarchy permits subordination between states so that one state may contain other states. Parallelism permits more than one state to be active at any given time. Broadcasting of events allows one state to detect changes in another state. In the context of the peri-operative process, hierarchy provides the means to describe steps within activities and to cluster related activities, parallelism provides the means to specify concurrent activities, and event broadcasting provides the means to trigger a series of actions in one activity according to transitions that occur in another activity. Combined with hierarchy and parallelism, event broadcasting offers a convenient way to describe the interaction of concurrent activities. We applied the Statecharts formalism to describe the progress of individual patients through surgical care as a series of asynchronous updates in patient records generated in reaction to events produced by parallel finite-state machines representing concurrent clinical and managerial activities. We conclude that Statecharts capture successfully the behavioral aspects of surgical care delivery by specifying permissible chronology of events, conditions, and actions. PMID:18390170

Sobolev, Boris; Harel, David; Vasilakis, Christos; Levy, Adrian

2008-03-01

342

[Surgical resection for elderly patient with skin invasion of breast cancer].  

PubMed

We report a locally advanced elderly breast carcinoma with skin invasion. The patient was a 96-year-old woman who had a breast lump. The palpable tumor was 3 .5 cm in diameter. Ultrasonography revealed a low echoic mass. A core needle biopsy for the breast tumor led to a diagnosis of an invasive ductal carcinoma positive for estrogen receptor and progesteron receptor, and negative for HER2/neu protein expression. She underwent a tumorectomy including the cancer invasive skin by local anesthesia. Because her respiratory function was unbearable to perform a muscle-preserving mastectomy with general anesthesia. The surgical margins of the resected specimen were negative. The clinicopathological stage, according to the UICC-pTNM classification, was Stage III C (T4b, N0, M0). After the operation, she was administered aromatase inhibitor. The patient has been well and remained disease-free during a follow-up period of 3 years. The surgical excision with local anesthesia was useful for locally advanced super senior breast cancer patients who were impossible to perform general anesthesia by various kinds of factors. PMID:22202268

Suzuki, Shuhei; Sakurai, Kenichi; Nagashima, Saki; Fujisaki, Shigeru; Shibata, Masahiko; Tomita, Ryouichi; Hara, Yukiko; Matsumoto, Kyoko; Enomoto, Katsuhisa; Amano, Sadao

2011-11-01

343

Clinical Characteristics and Surgical Safety in Patients with Acute Appendicitis Aged over 80  

PubMed Central

Purpose The aim of this study was to evaluate the clinical characteristics and treatment outcomes, including surgical safety, in patients over 80 years of age who underwent an appendectomy. Methods This study involved 160 elderly patients who underwent an appendectomy for acute appendicitis: 28 patients over 80 years old and 132 patients between 65 and 79 years old. Results The rate of positive rebound tenderness was significantly higher in the over 80 group (P = 0.002). Comparisons of comorbidity, diagnostic tool and delay in surgical treatment between the two groups were not statistically different. American Society of Anesthesiologists score was significantly higher in the over 80 group than in the 65 to 79 group (2.4 ± 0.5 vs. 1.6 ± 0.5; P < 0.00005). Comparisons of operative times and use of drainage between the two groups were not statistically different. In the pathologic findings, periappendiceal abscess was more frequent in the over 80 group (P = 0.011). No significant differences existed between the two groups when comparing the results of gas out and the time to liquid diet, but the postoperative hospital stay was significantly longer in the over 80 group (P = 0.001). Among the postoperative complications, pulmonary complication was significantly higher in the over 80 group (P = 0.005). However, operative mortality was zero in each group. Conclusion In case of suspicious appendicitis in elderly patients, efforts should be made to use aggressive diagnostic intervention, do appropriate surgery and prevent pulmonary complications especially in patients over 80 years of age. PMID:22606649

Moon, Kwon Sang; Jung, Yong Hwan; Lee, Eun Hun

2012-01-01

344

Patient safety in surgical environments: Cross-countries comparison of psychometric properties and results of the Norwegian version of the Hospital Survey on Patient Safety  

Microsoft Academic Search

BACKGROUND: How hospital health care personnel perceive safety climate has been assessed in several countries by using the Hospital Survey on Patient Safety (HSOPS). Few studies have examined safety climate factors in surgical departments per se. This study examined the psychometric properties of a Norwegian translation of the HSOPS and also compared safety climate factors from a surgical setting to

Arvid S Haugen; Eirik Søfteland; Geir E Eide; Monica W Nortvedt; Karina Aase; Stig Harthug

2010-01-01

345

Implementation of Quality Measures to Reduce Surgical Site Infection in Colorectal Patients  

Microsoft Academic Search

Purpose  The goal of this study was to determine the rate of surgical site infection and compliance with process measures designed\\u000a to prevent infection in a defined population of patients undergoing colorectal operations.\\u000a \\u000a \\u000a \\u000a Methods  A task-force consisting of surgeons, hospital infection control personnel, anesthesiologists, and nurses was convened to enforce\\u000a the use of process measures to prevent infections. We monitored antibiotic selection,

Elizabeth C. Wick; Laurel Gibbs; Lois Ann Indorf; Madhulika G. Varma; Julio Garcia-Aguilar

2008-01-01

346

Adverse Clinical and Economic Outcomes Attributable to Methicillin Resistance among Patients with Staphylococcus aureus Surgical Site Infection  

Microsoft Academic Search

Data for 479 patients were analyzed to assess the impact of methicillin resistance on the outcomes of patients with Staphylococcus aureus surgical site infections (SSIs). Patients infected with methicillin-resistant S. aureus (MRSA) had a greater 90-day mortality rate than did patients infected with methicillin-susceptible S. aureus (MSSA; adjusted odds ratio, 3.4; 95% confidence interval, 1.5-7.2). Patients infected with MRSA had

John J. Engemann; Yehuda Carmeli; Sara E. Cosgrove; Vance G. Fowler; Melissa Z. Bronstein; Sharon L. Trivette; Jane P. Briggs; Daniel J. Sexton; Keith S. Kaye

2003-01-01

347

Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk  

PubMed Central

Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than typical spinal procedures. Previous research has identified risk factors for SSI in spinal surgery, but few studies have looked at adult deformity surgeries. We retrospectively performed a large case cohort analysis of all adult patients who underwent surgery for kyphosis or scoliosis, between June 1996 and December 2005, by our adult spine division in an academic institution to asses the incidence and identify risk factors for SSI. We reviewed the electronic patient records of 830 adult patients. SSI was classified as deep or superficial to the fascia. 46 (5.5%) patients were found to have a SSI with 29 patients (3.5%) having deep infections. Obesity was found to be an independent risk factor for all SSI and superficial SSI (P = 0.014 and P = 0.013). As well, a history of prior SSI was also found to be a risk factor for SSI (P = 0.041). Patient obesity and history of prior SSI lead to increased risk of infection. Since obesity was related to an increased risk of both superficial and deep SSI, counseling and treatment for obesity should be considered before elective deformity surgery. PMID:20066445

van Laarhoven, C. J. H. M.; Cohen, David B.

2010-01-01

348

Inpatient surgical treatment patterns for patients with uterine fibroids in the United States, 1998-2002.  

PubMed Central

OBJECTIVE: To analyze the impact of patient and organizational characteristics on surgical treatment patterns for patients with uterine fibroids. METHODS: Unadjusted means and percentages were calculated from a population-based inpatient sample (HCUPNIS). Multiple logistic regression analysis was used to estimate the prevalence odds ratios for the association of uterine fibroid treatments and covariates of interest. RESULTS: More than 1.2 million patients with a primary diagnosis of uterine fibroids were treated from 1998 to 2002. Of these, 84.4% received a hysterectomy and 12.3% received a myomectomy. Total abdominal hysterectomy was the most common procedure. The number of supracervical hysterectomies increased 18.1% over the five-year period. Black women and Asians/Pacific Islanders were more likely than white women to receive a myomectomy. All types of hysterectomies were more common in Medicaid patients compared with private/HMO patients. With the exception of patients in ZIP codes with a median income of <$25,000 per year, an inverse relationship was identified between income and hysterectomy rates. CONCLUSIONS: The management of uterine fibroids appears to differ across a variety of socioeconomic factors and institutional characteristics. This study suggests that additional research should be conducted to assess the impact of nonclinical factors on treatment decisions for patients with uterine fibroids. PMID:16353655

Becker, Edmund R.; Spalding, James; DuChane, Janeen; Horowitz, Ira R.

2005-01-01

349

Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review  

PubMed Central

Background The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience. Findings Over three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%). Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained. Discussion This demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption. PMID:21884604

2011-01-01

350

Use of the modified early warning score and serum lactate to prevent cardiopulmonary arrest in hematology-oncology patients: a quality improvement study.  

PubMed

This process improvement project aimed to improve the early identification of clinically deteriorating hematology-oncology patients in order to prevent the development of critical illness and to facilitate timely intensive care unit (ICU) transfers. Using failure modes and effects analysis, a protocol employing the Modified Early Warning Score and serum lactate level was implemented to identify deteriorating patients who required the attention of the rapid response team. Control charts revealed a significant decrease in codes and preventable codes, while ICU transfers remained stable. A retrospective analysis to control for age, sex, race, severity of illness, and do not resuscitate status was performed, yielding a codes odds ratio of 0.51 (95% confidence interval = 0.31-0.85) and a preventable codes odds ratio of 0.25 (95% confidence interval = 0.07-0.82). At the study team's institution, implementation of this protocol reduced codes and preventable codes without an associated increase in ICU transfers. PMID:24202295

Young, Robert S; Gobel, Barbara H; Schumacher, Mark; Lee, Jungwha; Weaver, Charlotta; Weitzman, Sigmund

2014-11-01

351

Anterior Cranial Fossa Traumas: Clinical Value, Surgical Indications, and Results--A Retrospective Study on a Series of 223 Patients  

PubMed Central

Objective?Frontobasal fractures are relatively common traumas but surgical indications are still discussed. The authors report their results on patients showing anterior cranial fossa fractures; clinical data, surgical indications, and results are reported and critically analyzed. Methods?From 1991 to 2010, 223 patients were admitted in our institution with diagnosis of anterior cranial fossa fracture. Fractures were classified as type A—fracture of the anterior wall of the frontal sinus; type B—fracture of the posterior wall of the frontal sinus; and type C—frontobasal traumas without involvement of the frontal sinus. All patients entered a follow-up program consisting in periodic controls. Results?A total of 105 patients were conservatively treated, while 118 patients underwent surgical intervention. The presence of pneumocephalus (p?surgical indication. In the fractures of group B with signs of pneumocephalus and or rhinoliquorrhea, full sinus cranialization represents the variable mainly influencing the outcome (p?Patients with frontobasal traumas should be carefully evaluated to choose the best treatment option. Clinical and radiological data suggest that patients with frontobasal fractures with massive pneumocephalus and/or rhinoliquorrhea should be always surgically treated. PMID:23905003

Piccirilli, Manolo; Anichini, Giulio; Cassoni, Andrea; Ramieri, Valerio; Valentini, Valentino; Santoro, Antonio

2012-01-01

352

Current oncologic applications of radiofrequency ablation therapies  

PubMed Central

Radiofrequency ablation (RFA) uses high frequency alternating current to heat a volume of tissue around a needle electrode to induce focal coagulative necrosis with minimal injury to surrounding tissues. RFA can be performed via an open, laparoscopic, or image guided percutaneous approach and be performed under general or local anesthesia. Advances in delivery mechanisms, electrode designs, and higher power generators have increased the maximum volume that can be ablated, while maximizing oncological outcomes. In general, RFA is used to control local tumor growth, prevent recurrence, palliate symptoms, and improve survival in a subset of patients that are not candidates for surgical resection. It’s equivalence to surgical resection has yet to be proven in large randomized control trials. Currently, the use of RFA has been well described as a primary or adjuvant treatment modality of limited but unresectable hepatocellular carcinoma, liver metastasis, especially colorectal cancer metastases, primary lung tumors, renal cell carcinoma, boney metastasis and osteoid osteomas. The role of RFA in the primary treatment of early stage breast cancer is still evolving. This review will discuss the general features of RFA and outline its role in commonly encountered solid tumors. PMID:23671734

Shah, Dhruvil R; Green, Sari; Elliot, Angelina; McGahan, John P; Khatri, Vijay P

2013-01-01

353

Factors Affecting Outcomes in Patients Treated Surgically for Upper Extremity Tumors and Tumor-Like Lesions  

PubMed Central

There is little data available regarding outcomes of patients who have undergone surgery for tumors of the upper extremity. Functional data after surgery for upper extremity tumors would aid in guiding patient expectations in the peri-operative period. The purpose of this study was to identify patient, tumor, and surgery-related characteristics associated with patient-reported physical and emo-tional function before and after surgery for tumors of the upper extremity. Pre- and post-operative mental and physical Medical Outcomes Study Short Form 36 (SF-36) scores were collected from 79 patients with benign and malignant neoplasms of the upper extremity. A retrospective chart review was performed to ascertain whether tumor behavior, type, location, patient sex, age, surgical specimen size, or type of surgery were correlated with differing outcomes. Our outcome measure was patient-reported physi-cal and mental score (SF-36) at less than one year, one to two years, and greater than two years post-operatively. We found that patients with tumors proximal to the elbow and patients with right-sided tumors had statistically significantly lower post-operative physical scores at minimum two-year follow-up (p=0.02). Additionally, lower physical scores were associated with age greater than 50 (p=0.03) and tumor resection rather than curettage (p=0.01). The subset of patients with hereditary multiple exostoses had significantly lower post-operative physical scores than other patient sub-populations. There was no difference in physical function after surgery between patients with benign and malig-nant tumors, patients with tumors larger than 5 cm and less than 5 cm in greatest dimension, and patients with bone versus soft tissue tumors. Inter-estingly, we found that there was no difference in mental function scores between any comparisons. Our results suggest that patient age, tumor location, and type of surgery are correlated with patient-reported physical function following sur-gery. These findings could be helpful in counsel-ing patients undergoing surgery for tumors of the upper extremity. PMID:24027471

Otero, Jesse E; Graves, Christopher M; TeKippe, Ashley; Buckwalter, Joseph A; Miller, Benjamin J

2013-01-01

354

Prognostic Factors and Survival in Patients Treated Surgically for Recurrent Metastatic Uterine Leiomyosarcoma  

PubMed Central

Background. Uterine leiomyosarcoma (LMS) is a rare diagnosis, which is seldom cured when it recurs with metastatic disease. We evaluated patients who present with first time recurrence treated surgically to determine prognostic factors associated with long-term survival. Methods. Over a 16-year period, 41 patients were operated on for recurrent uterine sarcoma. Data examined included patient age, date of initial diagnosis, tumor histology, grade at the initial diagnosis, cytopathology changes in tumor activity from the initial diagnosis, residual tumor after all operations, use of adjuvant therapy, dates and sites of all recurrences, and disease status at last followup. Results. 24 patients were operated for first recurrence of metastatic uterine LMS. Complete tumor resection with histologic negative margins was achieved in 16 (67%) patients. Overall survival was significantly affected by the FIGO stage at the time of the initial diagnosis, the ability to obtain complete tumor resection at the time of surgery for first time recurrent disease, single tumor recurrence, and recurrence greater than 12 months from the time of the initial diagnosis. Median disease-free survival was 14 months and overall survival was 27 months. Conclusion. Our findings suggest that stage 1 at the time of initial diagnosis, recurrence greater than 12 months, isolated tumor recurrence, and the ability to remove ability to perform complete tumor resection at the time of the first recurrence can afford improved survival in selected patientsat the time of the first recurrence can afford improved survival in selected patients. PMID:25045534

Hoang, Han L. T.; Ensor, Kelsey; Rosen, Gerald; Leon Pachter, H.; Raccuia, Joseph S.

2014-01-01

355

The animal as surgical patient: a historical perspective in the 20th century.  

PubMed

Current veterinary history has not engaged significantly with patient histories. In many historical accounts of veterinary medicine, animal patients are backgrounded or completely invisible. Yet modern veterinary medicine, in its dominant form of companion animal practice, has become increasingly patient-centred. The modern animal patient is accorded something near full subject status in many veterinary clinical interactions. Embracing this raises issues of how to handle animals in veterinary history. Animals are the recipients of veterinary medicine, they exert agency in the clinic and field, yet they have remained problematical for the historian and sociologist, who have remained anthropocentric in orientation. This paper explores different constructions of the veterinary surgical patient in the 20th century in an attempt to begin examination of veterinary history as an animal-patient history "from below." In doing so, a trajectory of the development of British 20th-century veterinary medicine is presented which suggests the value of minding animals in historical accounts. Further interdisciplinary studies of veterinary procedures and practices are needed in order to foreground animals more and evaluate their subject status within historical and contemporary veterinary medicine. PMID:20586137

Gardiner, Andrew

2009-01-01

356

Outcomes for combined anterior and posterior surgical approaches for patients with multisegmental cervical spondylotic myelopathy.  

PubMed

Corpectomy is widely used to treat cervical spondylotic myelopathy (CSM). However, when this technique alone is performed at 1 or 2 levels for a multisegmental involvement (3 or more vertebrae), the incidence of post-operative complications is high. The optimal treatment for multisegmental CSM is still debatable. The aim of this study was to assess clinical and radiological outcomes for patients with multisegmental CSM who underwent combined anterior and posterior (AP) surgical approaches. Forty adults (17 women and 23 men; age range, 41-76 y) treated at our center between 2004 and 2007 were reviewed retrospectively. Their neurological function was assessed at different times using the Nurick classification (Grades 0 [root symptoms only] to 5 [wheelchair- or bed-bound]). Patients' satisfaction with the surgery was evaluated using Odom's criteria (poor, fair, good, or excellent). Pre-operatively, 20% of patients were assessed as Nurick Grade 0, 60% as Grade 1, and 20% as Grade 2. At the 1-year follow-up, only 10% of patients were assessed as Grade 1. At 1 year after surgery, 85% of patients rated their satisfaction with the operation as "excellent" and 15% rated it as "good". These outcomes suggest that, when surgery is indicated and patients with multisegmental CSM are carefully selected, the combined AP approach yields symptom relief comparable to that of corpectomy alone and a lower incidence of post-operative complications. PMID:19153044

Konya, Deniz; Ozgen, Serdar; Gercek, Arzu; Pamir, M Necmettin

2009-03-01

357

Changes in Demographic Features of Gallstone Disease: 30 Years of Surgically Treated Patients  

PubMed Central

Background/Aims The aim of this study was to investigate changes in the clinical and demographical characteristics of gallstone disease in Korea, based on 30 years of surgically treated patients at a single institute. Methods In total, 7,949 gallstone patients who underwent surgery between 1981 and 2010 were analyzed. Patients were divided into six time periods: period I (1981 to 1985, n=831), period II (1986 to 1990, n=888), period III (1991 to 1995, n=1,040), period IV (1996 to 2000, n=1,261), period V (2001 to 2005, n=1,651) and period VI (2006 to 2010, n=2,278). Results The total number and mean age of the patients gradually increased, and the male/female ratio decreased. The proportion of gallbladder (GB)-stone cases increased, whereas the proportions of common bile duct (CBD)- and intrahepatic duct (IHD)-stone cases decreased. Differences in patient geographical origins also decreased. Based on the relationship between changes in the prevalence of gallstone disease and socioeconomic status, the prevalence of CBD stones showed a strong correlation with Engel's coefficient (p<0.001). Conclusions Our study indicates that although the total number of cases and the mean age of gallstone patients have continuously increased, there are trends of increasing GB-stone cases and decreasing CBD- and IHD-stone cases. PMID:24312714

Chang, Ye Rim; Jang, Jin-Young; Kwon, Wooil; Park, Jae Woo; Kang, Mee Joo; Ryu, Ji Kon; Kim, Yong Tae; Yun, Young-Beum

2013-01-01

358

Oncological and functional outcome of periosteal osteosarcoma  

PubMed Central

Background: Periosteal osteosarcoma is an uncommon variant of osteosarcoma which constitutes less than 2% of all osteosarcomas. Whereas adequate surgical excision remains the cornerstone of treatment, the role of chemotherapy in this tumor is still unclear. Existing literature contains very few single center studies on the outcomes for periosteal osteosarcomas and any additional information will help in better understanding of these uncommon lesions. This study aims to evaluate the oncologic and functional outcomes of treatment of periosteal osteosarcoma treated at our institute. Materials and Methods: A retrospective analysis of 18 cases of periosteal osteosarcoma treated between January 2001 and December 2010 was carried out. There were 12 males and 6 females. The mean age at presentation was 16.3 years (range 5-26 years). Tibia and femur were the most common sites (n = 8). 16 of 18 patients received chemotherapy, 16 had limb sparing resection, one had an amputation and one had rotationplasty. Of the 16 patients with limb salvage, conventional wide excision was done in 11 cases. In 5 cases tumor was excised with hemicortical excision. Of the 11 cases treated with wide excisions, 4 patients underwent an osteoarticular resection and in 7 patients a joint preserving segmental intercalary resection was done. Results: All patients were available for followup. Surgical margins were free in all patients. A good response to chemotherapy was seen in 4/11 cases and poor in 6/11 cases. In one case the histological response was not discernible due to predominant chondromyxoid nature of the tumor. The median followup was 61 months (range: 18-130 months). There were two local recurrences (11%) at 9 and 18 months postsurgery. Pulmonary metastasis subsequently occurred in 4 cases (22%). Fourteen patients are currently alive and continuously disease free. Disease free survival at 5 years was 77.8% and overall survival (OVS) was 83.3%. Patients without marrow involvement had a better OVS at 5 years when compared with patients with marrow involvement (90% vs. 75%) (P = 0.23). Conclusion: Surgical excision remains the mainstay of treatment. Intramedullary involvement may suggest aggressive disease biology. The role of chemotherapy is still debatable and multicenter studies are needed to provide guidelines. PMID:24932034

Gulia, Ashish; Puri, Ajay; Pruthi, Manish; Desai, Saral

2014-01-01

359

[Surgical possibilities in the treatment of advanced and locally recurrent breast cancers].  

PubMed

Stage IV breast cancer is an incurable but treatable condition. Therapy of distant metastatic disease consists primarily of systemic and symptomatic treatments, while the role of surgery is subordinate. Conventional medical treatments result in 18-24 months average overall survival, and about 5-20% 5-year overall survival. However, it seems that in selected cases with solitary or oligometastases, mainly in those which respond well to drug therapy, the aggressive surgical removal of both the primary tumour and visceral metastases results in a survival advantage. After accurate evaluation of the patients, the indication for surgical treatment should be established through a biological and multidisciplinary approach. Other possible indications for surgical treatment are ulceration, bleeding, hygienic conditions undignified of human life, central nervous system metastases, acute neurological disorders, hydro- and pneumothorax greatly reducing respiratory surface and impending fractures. Surgical procedures include simple pleural drainage, minimal invasive techniques, large body cavity surgeries, extensive resection of soft tissue and chest wall due to the primary tumor, and plastic surgical reconstruction as well. Scientific assessment of the oncological value of surgical oncological interventions in stage IV. breast cancer require further multicentric prospective comparative studies. The present paper provides a broad review of the literature on surgical interventions and results in patients with breast cancer and remote metastases, and the surgical options of locally recurrent tumours. Orv. Hetil., 2014, 155(37), 1461-1468. PMID:25194868

Mátrai, Zoltán; Rényi Vámos, Ferenc

2014-09-01

360

A Review of Surgically Treated Patients with Obstruction after Stenting in the Femoropopliteal Artery Region  

PubMed Central

In this study, we retrospectively reviewed 36 cases that required surgical treatment in the femoropopliteal regions (46 regions) because of the development of obstructions after stent placement in these patients. Of the 46, stents were placed in 37 involved regions (80.4%) that included the common femoral and popliteal arteries; such as the common femoral, entire length of superficial femoral, or popliteal arteries, and the anastomosis site created during femoropopliteal (prosthetic graft) bypass surgeries (Group A). In contrast, 9 involved regions (19.6%) did not include the common femoral or popliteal arteries; the stents were primarily localized in the superficial femoral artery (Group B). Symptoms of stent occlusion were more severe in the former group of patients, who subsequently required peripheral artery bypass surgery. These results indicate that placement of stents in the common femoral artery and popliteal arteries should be avoided. (*English translation of J Jpn Coll Angiol 2012; 52: 19-23) PMID:24130611

2013-01-01

361

Surgical treatment of chronic pancreatitis and its complications. Comparative analysis of results in 91 patients.  

PubMed

There is a large variety of proposed conservative, invasive, endoscopic and surgical methods for treatment of chronic pancreatitis and its complications. This study presents a comparative analysis of the results from each group of patients subjected to drainage, resection, denervation and other operative techniques for a total of 91 patients with chronic pancreatitis and its complications. Drainage and resection operative techniques yield comparable results in terms of postoperative pain control 93.1% and 100%, perioperative mortality--3.17% and 5.8%, perioperative morbidity--7.9% and 11.7%, respectively. There is a significant increase in the instances of diabetes in the resection group. Right-side semilunar ganglionectomy is a good method for pain control as an accompanying procedure in the course of another main operative technique. PMID:24800314

Marinov, V; Draganov, K; Gaydarski, R; Katev, N N

2013-01-01

362

Developing a weekly patient safety and quality meeting in a medium-sized GI surgical unit in the United Kingdom  

PubMed Central

Background Morbidity and Mortality (M&M) meetings are advocated as part of good surgical practice, but have been criticised as a method of improving patient outcomes. Several groups have re-designed the format of M&M meetings to improve reporting of complications, near misses and maximise learning points. As a medium sized department of 8 GI surgeons in the UK, we wished to explore and discuss the complications encountered in our clinical practice in more detail than currently available in our monthly M&M/audit meeting, in order to try and improve the quality of care we deliver to our patients. This article describes the practicalities of introducing a weekly meeting and reports on the initial data generated from the patients discussed. Methods Four groups of general surgical patients (both elective and acute) are discussed in depth at the weekly meeting- a) patients whose length of in-patient stay is greater than 7 days (as a surrogate marker of a complicated surgical episode), b) unplanned patient readmissions to our hospital (under any specialty) within 30 days of a previous discharge from the GI surgical service, c) all GI surgical inpatient deaths and d) returns to theatre within the same admission (either planned or unplanned). Results The initial data generated from the meeting first six months of the meeting are presented e.g.– 302 length of stay greater than 7 days patient episodes (attributable to complications in 26%, normal variant of disease in 59% and social reasons delaying discharge in 15%). Conclusions We feel that these weekly meetings can be helpful in addressing both patient safety and quality issues in more depth than the traditional M&M format, as well as being a valuable training resource for both surgical trainees and consultants alike. PMID:24461339

2014-01-01

363

Interpersonal influences on patients' surgical decision making: the role of close others  

PubMed Central

Patients make medical decisions in consultation with their partner, family, and friends. However, little is known about the ways in which these close others influence their decisions, particularly with respect to discrete decisions such as those related to medical treatments. This cross-sectional study investigated their influence on the surgical decisions of inflammatory bowel disease patients referred for surgery to remove their colon (N = 91). Guided by research on social control and classic research on power and influence in close relationships, we identified four types of close other decision influence: persuasion, assistance with understanding, indirect influence, and negative influence. Linear logistic and regression analyses showed that patients were more likely to have surgery when their close other used persuasion, and they reported lower decisional conflict when their close other helped them understand the decision. Patients were less likely to have surgery and reported greater decisional conflict when their close other used negative influence tactics. Findings demonstrate the importance of considering social context when investigating patient decision making. PMID:21308408

Rini, Christine; Jandorf, Lina; Goldsmith, Rachel E.; Manne, Sharon L.; Harpaz, Noam; Itzkowitz, Steven H.

2011-01-01

364

Patient-specific surgical planning and hemodynamic computational fluid dynamics optimization through free-form haptic anatomy editing tool (SURGEM)  

Microsoft Academic Search

The first version of an anatomy editing\\/surgical planning tool (SURGEM) targeting anatomical complexity and patient-specific computational fluid dynamics (CFD) analysis is presented. Novel three-dimensional (3D) shape editing concepts and human-shape interaction technolo- gies have been integrated to facilitate interactive surgical morphology alterations, grid generation and CFD analysis. In order to implement ''manual hemodynamic optimiza- tion'' at the surgery planning phase

Kerem Pekkan; Brian Whited; Kirk Kanter; Shiva Sharma; Diane de Zelicourt; Kartik Sundareswaran; David H. Frakes; Jarek Rossignac; Ajit P. Yoganathan

2008-01-01

365

Recent advances in Oral Oncology.  

PubMed

This paper reviews the main papers related to oral squamous cell carcinoma published in 2006 in oral oncology - an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, and all other scientific articles relating to the aetiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck, and orofacial disease in patients with malignant disease. PMID:17275742

Scully, Crispian; Bagan, Jose V

2007-02-01

366

Clinical and Endoscopic Recurrence after Surgical Resection in Patients with Crohn's Disease  

PubMed Central

Background/Aims The natural history of Crohn's disease (CD) is characterized by a remitting and relapsing course and a considerable number of patients ultimately require bowel resection. Moreover, postoperative recurrence is very common. Relatively few studies have investigated the postoperative recurrence of CD in Korea. The aim of the current study was to assess postoperative recurrence rates - both clinical and endoscopic - in CD as well as factors influencing postoperative recurrence. Methods Electronic medical records of patients who underwent surgery due to CD were reviewed and analyzed. Patients with incomplete surgical resection, a follow-up period of less than a year, and a history of strictureplasty or perianal surgery were excluded. Results Of 112 CD patients, 39 patients had history of bowel resection, and 34 patients met the inclusion criteria. Among them, 26 were male (76%) and the mean age of onset was 32.8 years. The mean follow-up period after operation was 65.4 months. Cumulative clinical recurrence rates were 8.8%, 12.5%, and 33.5% at 12, 24, and 48 months, respectively. Use of immunomodulators for prophylaxis was the only predictor of clinical recurrence in univariate analysis (P=0.042). Of 21 patients who had undergone follow-up colonoscopy after surgery, cumulative endoscopic recurrence rates were 33.3%, 42.9%, and 66.1% at 6, 12, and 24 months, respectively. No significant predicting factor for endoscopic recurrence was detected. Conclusions Postoperative recurrence rates in Korean patients with CD are high, and endoscopic recurrence rates are comparable to those reported from Western studies. Appropriate medical prophylaxis seems to be important for preventing postoperative recurrence in CD. PMID:25349578

Lee, Yang Woon; Chung, Woo Chul; Paik, Chang Nyol; Sung, Hea Jung; Oh, You Suk

2014-01-01

367

Prevalence and Predictors of Adverse Events in Older Surgical Patients: Impact of the Present on Admission Indicator  

ERIC Educational Resources Information Center

Purpose of the Study: To examine the effects of the present on admission (POA) indicator on the prevalence of and factors associated with postsurgical adverse events in older patients. Design and Methods: This is a secondary data analysis of 82,898 surgical patients aged 65 years or older in 252 acute care hospitals in California in 2004. Four…

Kim, Hongsoo; Capezuti, Elizabeth; Kovner, Christine; Zhao, Zhonglin; Boockvar, Kenneth

2010-01-01

368

Nanotechnology in radiation oncology.  

PubMed

Nanotechnology, the manipulation of matter on atomic and molecular scales, is a relatively new branch of science. It has already made a significant impact on clinical medicine, especially in oncology. Nanomaterial has several characteristics that are ideal for oncology applications, including preferential accumulation in tumors, low distribution in normal tissues, biodistribution, pharmacokinetics, and clearance, that differ from those of small molecules. Because these properties are also well suited for applications in radiation oncology, nanomaterials have been used in many different areas of radiation oncology for imaging and treatment planning, as well as for radiosensitization to improve the therapeutic ratio. In this article, we review the unique properties of nanomaterials that are favorable for oncology applications and examine the various applications of nanotechnology in radiation oncology. We also discuss the future directions of nanotechnology within the context of radiation oncology. PMID:25113769

Wang, Andrew Z; Tepper, Joel E

2014-09-10

369

Validation of the Surgical Fear Questionnaire in Adult Patients Waiting for Elective Surgery  

PubMed Central

Objectives Because existing instruments for assessing surgical fear seem either too general or too limited, the Surgical Fear Questionnaire (SFQ) was developed. The aim of this study is to assess the validity and reliability of the SFQ. Methods Based on existing literature and expert consultation the ten-item SFQ was composed. Data on the SFQ were obtained from 5 prospective studies (N?=?3233) in inpatient or day surgery patients. These data were used for exploratory factor analysis (EFA), confirmatory factor analysis (CFA), reliability analysis and validity analysis. Results EFA in Study 1 and 2 revealed a two-factor structure with one factor associated with fear of the short-term consequences of surgery (SFQ-s, item 1–4) and the other factor with fear of the long-term consequences of surgery (SFQ-l, item 5–10). However, in both studies two items of the SFQ-l had low factor loadings. Therefore in Study 3 and 4 the 2-factor structure was tested and confirmed by CFA in an eight-item version of the SFQ. Across all studies significant correlations of the SFQ with pain catastrophizing, state anxiety, and preoperative pain intensity indicated good convergent validity. Internal consistency (Cronbach's alpha) was between 0.765–0.920 (SFQ-total), 0.766–0.877 (SFQ-s), and 0.628–0.899 (SFQ-l). The SFQ proved to be sensitive to detect differences based on age, sex, education level, employment status and preoperative pain intensity. Discussion The SFQ is a valid and reliable eight-item index of surgical fear consisting of two subscales: fear of the short-term consequences of surgery and fear of the long-term consequences. PMID:24960025

Theunissen, Maurice; Peters, Madelon L.; Schouten, Erik G. W.; Fiddelers, Audrey A. A.; Willemsen, Mark G. A.; Pinto, Patricia R.; Gramke, Hans-Fritz; Marcus, Marco A. E.

2014-01-01

370

Surgical stapling device-tissue interactions: what surgeons need to know to improve patient outcomes  

PubMed Central

The introduction of both new surgical devices and reengineered existing devices leads to modifications in the way traditional tasks are carried out and allows for the development of new surgical techniques. Each new device has benefits and limitations in regards to tissue interactions that, if known, allow for optimal use. However, most surgeons are unaware of these attributes and, therefore, new device introduction creates a “knowledge gap” that is potentially dangerous. The goal of this review is to present a framework for the study of device– tissue interactions and to initiate the process of “filling in” the knowledge gap via the available literature. Surgical staplers, which are continually being developed, are the focus of this piece. The integrity of the staple line, which depends on adequate tissue compression, is the primary factor in creating a stable anastomosis. This review focuses on published studies that evaluated the creation of stable anastomoses in bariatric, thoracic, and colorectal procedures. Understanding how staplers interact with target tissues is key to improving patient outcomes. It is clear from this review that each tissue type presents unique challenges. The thickness of each tissue varies as do the intrinsic biomechanical properties that determine the ideal compressive force and prefiring compression time for each tissue type. The correct staple height will vary depending on these tissue-specific properties and the tissue pathology. These studies reinforce the universal theme that compression, staple height, tissue thickness, tissue compressibility, and tissue type must all be considered by the surgeon prior to choosing a stapler and cartridge. The surgeon’s experience, therefore, is a critical factor. Educational programs need to be established to inform and update surgeons on the characteristics of each stapler. It is hoped that the framework presented in this review will facilitate this process. PMID:25246812

Chekan, Edward; Whelan, Richard L

2014-01-01

371

Surgical Simulation  

PubMed Central

Objective: To evaluate the effectiveness of surgical simulation compared with other methods of surgical training. Summary Background Data: Surgical simulation (with or without computers) is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before they operate on humans. Methods: Studies were identified through searches of MEDLINE, EMBASE, the Cochrane Library, and other databases until April 2005. Included studies must have been randomized controlled trials (RCTs) assessing any training technique using at least some elements of surgical simulation, which reported measures of surgical task performance. Results: Thirty RCTs with 760 participants were able to be included, although the quality of the RCTs was often poor. Computer simulation generally showed better results than no training at all (and than physical trainer/model training in one RCT), but was not convincingly superior to standard training (such as surgical drills) or video simulation (particularly when assessed by operative performance). Video simulation did not show consistently better results than groups with no training at all, and there were not enough data to determine if video simulation was better than standard training or the use of models. Model simulation may have been better than standard training, and cadaver training may have been better than model training. Conclusions: While there may be compelling reasons to reduce reliance on patients, cadavers, and animals for surgical training, none of the methods of simulated training has yet been shown to be better than other forms of surgical training. PMID:16495690

Sutherland, Leanne M.; Middleton, Philippa F.; Anthony, Adrian; Hamdorf, Jeffrey; Cregan, Patrick; Scott, David; Maddern, Guy J.

2006-01-01

372

Measuring patient-based outcomes in a plastic surgery service: breast reduction surgical patients  

Microsoft Academic Search

On admission for breast reduction surgery, 110 patients completed a preoperative assessment pack containing: 1) Personal and demographic questions; 2) Condition-specific questions including physical symptoms and areas of life affected by their condition; 3) The SF-36 Health Survey Questionnaire; and 4) The Rosenberg Self-esteem Scale. At 3 months and again at 6 months after surgery, these same patients were sent

V. Shakespeare; R. P. Cole

1997-01-01

373

Image-Guided Radiotherapy for Breast Cancer Patients: Surgical Clips as Surrogate for Breast Excision Cavity  

SciTech Connect

Purpose: To determine the use of surgical clips as a surrogate for localization of the excision cavity and to quantify the stability of the clips' positions during the course of external beam radiotherapy for breast cancer patients, using cone beam computed tomography (CBCT) scans. Methods and Materials: Twenty-one breast cancer patients with surgical clips placed in the breast excision cavity were treated in a supine position with 28 daily fractions. CBCT scans were regularly acquired for a setup correction protocol. Retrospectively, the CBCT scans were registered to the planning CT scans, using gray-value registration of the excision cavity region and chamfer matching of the clips. Subsequently, residual setup errors (systematic [{Sigma}] and random [{sigma}]) of the excision cavity were estimated relative to the clips' registration. Finally, the stability of the clips' positions were quantified as the movement of each separate clip according to the center of gravity of the excision cavity. Results: When clips were used for online setup corrections, the residual errors of the excision cavity were {Sigma}{sub left-right} = 1.2, {sigma}{sub left-right} = 1.0; {Sigma}{sub cranial-caudal} = 1.3, {sigma}{sub cranial-caudal} = 1.2; and {Sigma}{sub anterior-posterior} = 0.7, {sigma}{sub anterior-posterior} = 0.9 mm. Furthermore, the average distance (over all patients) between the clips and centers of gravity of the excision cavities was 18.8 mm (on the planning CT) and was reduced to 17.4 mm (measured on the last CBCT scan). Conclusion: Clips move in the direction of the center of gravity of the excision cavity, on average, 1.4 mm. The clips are good surrogates for locating the excision cavity and providing small residual errors.

Topolnjak, Rajko; Ruiter, Peter de; Remeijer, Peter; Vliet-Vroegindeweij, Corine van; Rasch, Coen [Radiotherapy Department, Netherlands Cancer Institute/Antoni van Leeuwenhoek Huis, Amsterdam (Netherlands); Sonke, Jan-Jakob, E-mail: j.sonke@nki.nl [Radiotherapy Department, Netherlands Cancer Institute/Antoni van Leeuwenhoek Huis, Amsterdam (Netherlands)

2011-11-01

374

Effect of surgical delay on early mortality in patients with femoral neck fracture  

PubMed Central

The aim of this study was to investigate the relationship between the delay between surgical treatment and mortality occurring within 30 days post-injury in patients aged 60 or older with femoral neck fracture. Data derive from the nationwide database of the National Health Insurance Fund Administration. Logistic regression analysis was performed to analyse the relationship between 30-day mortality and surgical delay in four groups of patients operated on within 12 h, between 12–24 h, 24–48 h or over 48 h post-injury. There were 3,777 patients involved in the study. Mortality rates in the four groups were 7.7%, 10.5%, 10.5% and 9.4%, respectively. Univariate logistic regression analysis revealed a statistically significant increase in the mortality risk in the 12–24-h treatment group compared to the group treated within 12 h (odds ratio, OR12–24h?=?1.413, confidence interval, CI12–24h: 1.032–1.935; p?=?0.031). According to multiple regression analysis, all three groups (12–24 h, 24–48 h and over 48 h) showed a trend to increased mortality risks, but this was not statistically significant (OR12–24h?=?1.301, CI12–24h: 0.945–1.791, p?=?0.106; OR24–48h?=?1.384, CI24–48h: 0.932–2.056, p?=?0.108; OR>48h?=?1.246, CI>48h: 0.950–1.635, p?=?0.113). We can conclude that sex, age and accompanying diseases significantly influenced early mortality, while early post-operative complications did not have a significant impact on the mortality risks. PMID:17323093

Boncz, Imre; Sandor, Janos; Nyarady, Jozsef

2007-01-01

375

Comparative analysis of autologous blood transfusion and allogeneic blood transfusion in surgical patients  

PubMed Central

Objective: To investigate application effects of autologous blood transfusion and allogeneic blood transfusion in surgically treated patients receiving spine surgery, abdomen surgery and ectopic pregnancy surgery. Methods: 130 patients who would undergo selective operations were divided into autologous transfusion group and allogeneic transfusion group. Both groups received the same anesthesia, and there was no significant difference in transfusion volume or fluid infusion volume. Results: The serum TNF-? level in autologous transfusion group after operation showed a clear upward trend and had significant difference compared with that before operation (P < 0.05). Meanwhile, after operation, the serum TNF-? level in autologous transfusion group was all significantly higher than that allogeneic transfusion group and the comparative difference was statistically significant (P < 0.05). IgG level in treatment group did not significantly fluctuate during perioperative period, but IgG level in allogeneic transfusion group after operation was all significantly lower than that before operation, and there was statistically significant difference between both groups (P < 0.05). At the same time, complement C3 level in treatment group after operation was significantly higher than that before operation (P < 0.05), but complement C3 level in allogeneic transfusion group did not significantly change. After operation, there was statistically significant difference in complement C3 level between both groups (P < 0.05). Conclusion: Autologous transfusion is already a widely accepted transfusion method at present, and it can increase TNF-? and complement C3 levels in the body of surgically treated patients to strengthen immune ability against infection.

Long, Miao-Yun; Liu, Zhong-Han; Zhu, Jian-Guang

2014-01-01

376

MGH RADIATION ONCOLOGY REDUCED RATE MULTI-VISIT  

E-print Network

MGH RADIATION ONCOLOGY REDUCED RATE MULTI-VISIT PARKING PROGRAM MGH Radiation Oncology Parking Programs enable patients undergoing radiation therapy to either self-park as close to the hospital patients currently in a treatment program; radiation therapy patients must have a minimum of two scheduled

Mootha, Vamsi K.

377

Comparison of different warfarin reversal protocols on surgical delay and complication rate in hip fracture patients.  

PubMed

PURPOSE. To compare the effects of different warfarin reversal protocols on surgical delay and complication rate in hip fracture patients. METHODS. Records of 7 men and 17 women aged 68 to 93 (mean, 82) years who were on warfarin and underwent surgery for femoral neck fractures were reviewed. The time to surgery, complication rate, and mortality were recorded, as were the International Normalised Ratio (INR) on admission and the day of operation, as well as the dose, route, and time of administration of vitamin K for reversing the anticoagulation effect of warfarin. Patients were divided into 4 groups based on the warfarin reversal treatment. Group 1 (n=4) included patients who did not receive reversal treatment, as their admission INR was 1.5 or less. Group 2 (n=6) included patients who did not receive reversal treatment even though their INR was >1.6. Group 3 (n=5) included patients who received inappropriate reversal treatment (late or low-dose oral administration). Group 4 (n=9) included patients who received appropriate reversal treatment in terms of dose, route, and time of administration. RESULTS. Among the 4 groups, the mean INR was 2.2 (range, 1.3-4.6) on admission and 1.4 (range, 1.0-1.6) on the day of surgery. Group 1 was excluded from further analysis. Respectively in groups 2, 3, and 4, the mean times to surgery were 2.3, 2.6, and 1.2 days, and the complication rates were 67%, 20%, and 11%. CONCLUSION. Early administration of intravenous vitamin K for hip fracture patients on warfarin is recommended to ensure early operative management and avoid postoperative complications. PMID:24014771

Leonidou, Andreas; Rallan, Rishi; Cox, Nancy; Pagkalos, Joseph; Luscombe, Jonathan

2013-08-01

378

Surgical Outcomes for Primary Rhegmatogenous Retinal Detachments in Patients with Pseudophakia after Phacoemulsification  

PubMed Central

Purpose To evaluate the clinical features and surgical outcomes for primary rhegmatogenous retinal detachments (RDs) in patients with pseudophakia after phacoemulsification. Methods The medical records of patients with pseudophakia after phacoemulsification and intraocular lens implantation who had undergone surgery for primary rhegmatogenous RDs with a minimum duration of follow-up of 12 months were reviewed retrospectively. Results A total of 104 patients were enrolled in this study and 106 eyes were analyzed. Post-operative retinal attachment was achieved in 87 of the eyes (82.1%) and the final visual acuities (logarithm of the minimum angle of resolution) were improved to 0.65 ± 0.49 from the baseline measurement of 1.51 ± 1.14 (p < 0.001). Re-operations were performed in 24 of the eyes (22.6%) and there were no visible retinal breaks in 30 of the eyes (28.3%). The failure to identify a retinal break during surgery was associated with a lower rate of retinal reattachment, worse final visual acuity, and a higher rate of re-operation (p = 0.002, p = 0.02, and p = 0.002, respectively). The location of the identified retinal break was more common in the superotemporal quadrant than in the other quadrants. Conclusions The inability to identify a retinal break during surgery was associated with a poor final outcome. Other factors were less important for the functional and anatomic success in patients with pseudophakic RDs. PMID:22131776

Ryu, Soo Jeong

2011-01-01

379

Severe bleeding in surgical and trauma patients: the role of fibrinogen replacement therapy.  

PubMed

Fibrinogen is in a central position in the coagulation system, playing an important role in platelet aggregation and establishing the fibrin network. Fibrinogen is also the first coagulation factor to become critically low during surgery and after major trauma. Hemostatic support has traditionally involved using transfusion of allogeneic blood products, including fresh frozen plasma; however, there is a lack of conclusive evidence supporting the clinical effectiveness of fresh frozen plasma in these situations. Early, targeted fibrinogen substitution may be preferable in terms of speed of administration and clinical effectiveness, with recent studies adding to the weight of evidence demonstrating the potential to significantly reduce blood loss and transfusion requirements in surgical and severe trauma patients with this approach. The availability of point-of-care testing using viscoelastic techniques to guide fibrinogen substitution has enabled the development of transfusion algorithms that lead to individualized, goal-directed, and targeted use of fibrinogen concentrates to improve clinical outcomes. Fibrinogen replacement has become the standard-of-care in several major surgical centers in Europe and is recommended in current European trauma treatment guidelines. Future prospective studies will help to establish the critical threshold and target levels for fibrinogen substitution in different acute-care situations and should encourage more widespread use of this rational and effective approach to the treatment of bleeding-induced coagulopathies. PMID:23439002

Spahn, Donat R

2012-12-01

380

Surgical techniques for smile restoration in patients with M?bius syndrome  

PubMed Central

Möbius syndrome is a congenital condition, the etiology when is not associated with misoprostol is not well defined. Signs and symptoms include difficulty swallowing, speech problems, drooling, strabismus, limitation of eye movement and more importantly, the facial blankness that these individuals have, result of the facial paralysis, due to atrophy of the cranial nerves that are involved in this condition. The ability to express emotions is affected and are considered “children without a smile.” There is currently no treatment to solvent the birth defects, the treatment options for reduce these alterations is the surgical option that has as main objective to restore muscle function through various techniques, used as required, the possibilities of applying them, is taking into consideration the outcome of the procedure to execute. Among the surgical techniques used mainly: the lengthening myoplasty of the temporal muscle,muscle transfers, cross-facial grafting, neurorrhaphy and nerve transposition, of which latter are the best performers, giving the patient a more natural, in as far as regards expression and function. Key words:Möbius syndrome, surgery, smile, facial nerve, muscle transfer, transfer nerve, temporalis muscle. PMID:24455082

Ortiz-Rincones, Maria A.; Suarez-Gorrin, Fabiola

2013-01-01

381

Preventable errors with nonopioid analgesics and antiemetic drugs may increase burden in surgical pediatric patients.  

PubMed

Introduction?Many hospitalized patients are affected by medication errors (MEs) that may cause discomfort, harm, and even death. Especially, children are considered to be at high risk of experiencing harm due to MEs. More insight into the prevalence, type, and severity of harm caused by MEs could help reduce the frequency of these harmful events. The primary objectives of our study were to establish the prevalence of different types of MEs and the severity of harm caused by MEs in hospitalized children from birth to 18 years of age. In addition, we investigated correlations between harmful MEs and characteristics of the collected data from 426 hospitalized children admitted, and the medication process. Methods?In this cross-sectional study, we identified MEs by reviewing clinical records, making direct observations, monitoring pharmacy logs, and reviewing voluntary incident reports. Subsequently, the MEs were classified according to type of error, medication group and stage of the medication process. Pediatricians rated the severity of the observed harm. Results?We collected data from 426 hospitalized children admitted during August to October 2011. A total of 322 MEs were identified, of which 39 caused patient harm. Harmful events were mainly because of wrong time (41%). Pediatricians rated the observed harm as minor in 77% of the incidents and significant in 23%. None of the harmful MEs resulted in permanent harm or was considered life-threatening or fatal. Patients admitted for a surgical procedure were at higher risk for a harmful event compared with patients admitted for nonsurgical reasons (adjusted odds ratio 2.79, 95% confidence interval; 1.35-5.80). Nonopioid analgesics and antiemetic drugs accounted for 67% of the harmful MEs. Harmful MEs occurred most frequently during medication prescription (28%) and administration (62%). Conclusion?Surgical pediatric patients seem to be at high risk for harmful MEs. Although the harm was considered minor in most cases, it still caused discomfort for the patients, and the high prevalence is a source of concern. Interventions to prevent the MEs should focus on the prescription and administration of nonopioid analgesics and antiemetic drugs. PMID:23966177

Maaskant, Jolanda; Bosman, Diederik; van Rijn-Bikker, Petra; van Aalderen, Wim; Vermeulen, Hester

2014-10-01

382

Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study  

PubMed Central

Objectives Despite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore VTE and subsequent mortality rates, trends and variations across Australian acute public hospitals. Setting A large retrospective cohort study using all elective surgical patients in 82 acute public hospitals during 2002–2009 in New South Wales, Australia. Participants Patients underwent elective surgery within 2?days of admission, aged between 18 and 90?years, and who were not transferred to another acute care facility; 4?362?624 patients were included. Outcome measures VTE incidents were identified by secondary diagnostic codes. Poisson mixed models were used to derive adjusted incidence rates and rate ratios (IRR). Results 2/1000 patients developed postoperative VTE. VTE increased by 30% (IRR=1.30, CI 1.19 to 1.42) over the study period. Differences in the VTE rates, trends between hospital peer groups and between hospitals with the highest and those with the lowest rates were significant (between-hospital variation). Smaller hospitals, accommodated in two peer groups, had the lowest overall VTE rates (IRR=0.56:0.33 to 0.95; IRR=0.37:0.23 to 0.61) and exhibited a greater increase (64% and 237% vs 19%) overtime and greater between