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1

Surgical strategies in the management of ecthyma gangrenosum in paediatric oncology patients.  

PubMed

Clinical presentation and microbiology profiles of neutropenic paediatric oncology patients presenting with ecthyma gangrenosum (EG) were studied. Surgical strategies deployed for these critically ill children are reported. Between 1994 and 2005, all children with EG were identified. Case notes were reviewed. Hospital course and long-term outcome were documented. Ten patients were identified. Eight had acute lymphoblastic leukaemia, one child had acute myeloid leukaemia and another had rhabdomyosarcoma. Lesions occurred in the perineal region (n = 5), buttocks (n = 2), thigh (n = 2) and the face (n = 1). Seven children had positive blood cultures for Pseudomonas aeruginosa. Surgery included (1) radical debridement, and (2) debridement with covering colostomy for four of those with perianal lesions. Ecthyma gangrenosum is a rapidly spreading and potentially lethal condition. Paediatric oncology patients with neutropenia are at a high risk. Surgical excision is crucial for progressive lesions to prevent mortality. PMID:18427811

Khalil, B A; Baillie, C T; Kenny, S E; Lamont, G L; Turnock, R R; Pizer, B L; van Saene, H F K; Losty, P D

2008-07-01

2

Primary prevention of venous thromboembolism in medical and surgical oncology patients  

PubMed Central

Recent data suggest that patients with a malignancy have a seven-fold increased risk for venous thromboembolism (VTE) compared with those without cancer, suggesting that these patients may benefit from thromboprophylaxis. Mechanisms for the prevention of thromboembolism can be divided into two broad categories: mechanical and pharmacological. Although generally used in combination with pharmacotherapy, little evidence exists for the efficacy of mechanical modalities either in the broader population of patients at risk for VTE or for patients with cancer specifically. A recent study using graduated compression stockings (GCS) for thromboprophylaxis showed no support for the use of stockings in acute stroke patients. Established pharmacological modalities, including warfarin, unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), and the factor Xa inhibitor fondaparinux, have been shown to reduce risk for VTE in general medical and surgical populations. In medical cancer patients, only limited data are available for the efficacy of thromboprophylaxis. In contrast, considerable evidence indicates that thromboprophylaxis is warranted in patients undergoing cancer surgery. The most recent evidence suggests that catheter-related thrombosis is not prevented by current pharmacological modalities. On 22 May 2009, a group of clinicians based in the United Kingdom (UK) met in London, UK, to evaluate recent data on cancer thrombosis. This article (the second of four) briefly reviews key data on the prevention of VTE in medical and surgical oncology patients, providing context for a brief transcript of the surrounding discussion and a consensus statement, developed by meeting attendees, on the implications of this information for UK clinical practice.

Stanley, A; Young, A

2010-01-01

3

Pediatric surgical oncology  

SciTech Connect

This book contains 17 chapters. Some of the chapter titles are: Ethical Considerations in Pediatric Tumor Management; The Essentials of Radiotherapy for Solid Tumors in Pediatric Patients; Markers in Childhood Solid Tumors; Rhabdomyosarcoma; Neophroblastoma; and The Management of Pulmonary Metastatic Lesions in Pediatric Solid Tumors.

Hays, D.M.

1986-01-01

4

Recommended core curriculum for the specialist training in surgical oncology within Europe  

Microsoft Academic Search

Cancer incidence increases each year in Europe and the role of surgeons to diagnose and treat patients with cancer is pivotal. In Europe many cancer surgeons are organised in the European Society of Surgical Oncology (ESSO). Surgical oncology covers the treatment of solid tumours of the oro-eosophago-gastrointestinal tract, of parenchymal and endocrine organs and of skin, mesenchymal, neurogenic, bone and

Peter Naredi; Marjut Leidenius; Marko Hocevar; Felicitas Roelofesen; Cornelis van de Velde; Riccardo A. Audisio

2008-01-01

5

Repeat Partial Nephrectomy: Surgical, Functional and Oncological Outcomes  

PubMed Central

Purpose of Review The greater utilization of partial nephrectomy and ablative procedures has increased the incidence of patients presenting with local renal recurrence. The choice to either perform a partial or radical nephrectomy in these situations can be a challenging decision. Recent Findings Repeat and salvage partial nephrectomy, while challenging and potentially associated with increased complications, offers patients the ability to maintain excellent renal functional outcomes and promising oncologic outcomes at intermediate follow up. Summary Surgeons should be familiar with the surgical complications and the functional and oncologic outcomes of re-operative nephron-sparing surgery. Recent data and outcome analysis support utilization of these procedures in patients presenting with either local recurrence or de novo lesions in the ipsilateral kidney.

Shuch, Brian; Linehan, W. Marston; Bratslavsky, Gennady

2011-01-01

6

Why do we need a core curriculum in surgical oncology in Europe?  

Microsoft Academic Search

Patients with cancer are often treated by multidisciplinary collaboration between many specialities where thorough knowledge about cancer, and surgical expertise is necessary.Most European surgeons with an interest in surgical oncology were trained according to their local organisations and national regulations. Formal education as per a national training programme is rare and little collaborative effort has taken place within Europe to

Peter Naredi; Riccardo A. Audisio; Irving Taylor

2008-01-01

7

Oocyte cryopreservation in oncological patients.  

PubMed

The use of chemotherapy and radiotherapy in oncological patients may reduce their reproductive potential. Sperm cryopreservation has been already used in men affected by neoplastic disease. Oocyte cryopreservation might be an important solution for these patients at risk of losing ovarian function. A program of oocyte cryopreservation for oncological patients is also present in our center. From June 1996 to January 2000, 18 patients awaiting chemotherapy and radiotherapy for neoplastic disease were included in our oocyte cryopreservation program. Our experience documents that oocyte storage may be a concrete and pragmatic alternative for oncological patients. The duration of oocyte storage does not seem to interfere with oocyte survival as pregnancies occurred even after several years of gamete cryopreservation in liquid nitrogen. PMID:15041124

Porcu, Eleonora; Fabbri, Raffaella; Damiano, Giuseppe; Fratto, Rosita; Giunchi, Susanna; Venturoli, Stefano

2004-04-01

8

Using Patient-Reported Outcome Measures for Improved Decision-Making in Patients with Gastrointestinal Cancer - the Last Clinical Frontier in Surgical Oncology?  

PubMed Central

The genomic era has introduced concepts of “personalized medicine” and “targeted therapy” in the field of oncology. Medicine has become increasingly complex with a plethora of potential dilemmas in diagnosis, treatment, and management. The focus on classical outcomes for clinical decision-making is now increasingly being replaced by patient-reported outcome measures (PROMs). PROMs should increasingly now be in the center of patient-centered decision-making, based on valid, reliable, and clinically useful measures delivered directly by the patient to the caregiver. Surgeons’ ability to interpret and apply PROMs and quality of life results must improve by education and further research, and has an unreleased potential to contribute to a better understanding of the patients’ well-being. A number of caveats must be addressed before this can be brought to fruition; standardization for valid items; appropriate use of instruments; correct timing of the application; missing data handling, compliance, and respondent drop-outs are but a few issues to be addressed. Based on the apparent lack of use in both research and clinical work, it should call for an educational effort to address this among surgeons caring for patients with cancer.

S?reide, Kjetil; S?reide, Annbj?rg H.

2013-01-01

9

Clinical Outcome Analysis in 'High-Risk' Versus 'Low-Risk' Patients Eligible For National Surgical Adjuvant Breast and Bowel B-39/Radiation Therapy Oncology Group 0413 Trial: Five-Year Results  

SciTech Connect

Purpose: To report the local control and overall survival outcomes after lumpectomy followed by accelerated partial breast irradiation in high-risk patients as defined by the current inclusion criteria for the National Surgical Adjuvant Breast and Bowel B-39/Radiation Therapy Oncology Group 0413 Intergroup trial. Methods and Materials: Between 2000 and 2005, 273 women with early-stage breast cancer were treated using either multicatheter interstitial brachytherapy (n = 247) or MammoSite (n = 26). Patients received 32-34 Gy in 8-10 twice-daily fractions using high-dose-rate {sup 192}Ir brachytherapy. All patients met the initial inclusion criteria for the Intergroup trial and were separated into two groups: high-risk patients (representing the cohort that remained eligible for the Intergroup trial) who satisfied one or more of the 'high-risk' criteria (age <50 years, estrogen receptor negative, and/or positive lymph nodes; n = 90), and low-risk patients who comprised the remainder of the cohort (n = 183). The outcomes of the two cohorts were analyzed and compared. Results: The median follow-up of the entire cohort was 48.5 months. No significant difference was found in outcomes at 5 years between the low- and high-risk groups, with a local control rate of 97.8% vs. 93.6%, crude local recurrence rate of 2.2% (n = 4) vs. 4.4% (n = 4), and overall survival rate of 92.1% vs. 89.5%, respectively. Conclusion: At 5 years, no statistically significant difference was found in outcomes for patients deemed to be at greater risk in the current National Surgical Adjuvant Breast and Bowel B-39/Radiation Therapy Oncology Group 0413 Intergroup trial. These clinical data support the inclusion of this 'high-risk' population in this important ongoing study.

Patel, Rakesh R. [Department of Radiation Oncology, University of Wisconsin Hospital and Clinics, Madison, WI (United States)], E-mail: patel@humonc.wisc.edu; Christensen, Michael E.; Hodge, C. Wesley; Adkison, Jarrod B.; Das, Rupak K. [Department of Radiation Oncology, University of Wisconsin Hospital and Clinics, Madison, WI (United States)

2008-03-15

10

Evaluation of surgical risk factors in an elderly population undergoing major gynecologic surgery by a gynecologic oncology service  

Microsoft Academic Search

The purpose of the current study was to evaluate the incidence of coexisting medical risk factors in an elderly group of patients under-going major surgery by a university-based gynecologic oncology service. The impact of each risk factor was assessed to determine which ones significantly increased the surgical risk. We performed a retrospective chart review of 99 patients aged 70 or

Fidel A. Valea; Jennifer Sherwood; Eva Chalas; Michael L. Pearl

1997-01-01

11

Liver biopsy methods for pediatric oncology patients  

Microsoft Academic Search

Background. Liver biopsy is a high-risk procedure in oncology patients, and optimal methods for children have not been established.¶Objective. To assess the effectiveness and safety of two methods of performing liver biopsy in pediatric oncology patients.¶Materials and methods. Between May 1997 and July 1999, 51 liver biopsies (22 percutaneous and 29 transjugular) were performed. The 22 percutaneous\\u000a biopsies (13 focal

Fredric A. Hoffer

2000-01-01

12

[Current problems in surgical oncology: 1. Theoretical models in oncology and their implications in surgical therapy].  

PubMed

Cancer biology has proven to be far more complex than imagined twenty years ago. While current treatment strategies (i.e., surgery, chemotherapy, and radiation) are successful in many cancers, they all have limitations. In some types of solid tumors some survival progress has been recorded, such in the case of breast and colorectal cancer, but these improvements are probably mainly due to screening programmes and earlier detection than to more-effective treatment. In other tumor types the mortality certainly increased: the death rate from lung cancer rose from 43 to 53 per 100,000 people from 1975 to 2005, the death rate from melanoma has risen nearly 30 percent, and death rate from liver and bile-duct cancer almost doubled, from 2.8 to 5.3 per 100,000. Cancer is commonly viewed as minimally controlled by modern medicine, especially when compared with other major diseases (Sharon Begley, 2008). Either directly from the phenomenological observation or through the biological model, mathematicians and biologists can generate mathematical models aimed at describing the biological phenomenon. The analysis of the solution properties by mathematical methods will give a description of the dynamics resulting in a deeper insight into the problem. The models can be implemented numerically to give rise to in silico models. The quality of the modeling process can be tested, validating the results of the simulations with experiments and clinical data. The theoretical predictions generated from the models may optimize the experimental protocol by identifying the most promising candidates for further clinical investigation. The speed with which large numbers of simulations can be performed may reduce the number of animal experiments and identify new experimental programmes and optimal cancer therapy schedules. However, it is clear that surgical decisions in cancer therapy are strongly driven by the theoretical hypotheses of local tumor evolution and malignant cells dissemination. For 60 years cancer was seen as a disease that arose in one location and spread through the lymphatic system first to nearby lymph nodes and subsequently to other organs. This theory of "contiguous" development of metastases has become known as the Virchow-Halsted theory. After 1954 an alternative theory was formulated by B. Fisher stating "that breast cancer is a systemic disease". Following the therapeutic implications of this "systemic theory," the disease has been attacked in recent years by chemotherapy and hormone therapy to the whole body. In 1994 S. Hellman stated the case for what he calls the "spectrum theory." He observed that there are intermediate tumor states between purely localized lesions and widely metastatic. Such clinical circumstances are not accounted for by either the contiguous (Halsted theory) or the systemic (systemic theory) hypotheses and supports the idea that loco-regional therapies (surgery and radiotherapy) may be useful in some cases. So, it is obvious that the extent and the role of cancer surgery are direct consequences of our theoretical understanding of cancer natural history. The genetical, pathological and clinical heterogeneity of cancers suggest new theoretical approaches based on chaos and fractal theory. PMID:21523955

Vasilescu, C

2011-01-01

13

Doctor-patient interactions in oncology  

Microsoft Academic Search

Studies which apply content analysis techniques to the cancer consultation are few. This descriptive study examines the structure and content of the bad news cancer consultations of 117 outpatients newly referred to the Medical Oncology Department of a large London teaching hospital. From previous communication research three main hypotheses are formed: (i) the cancer consultation is clinician-dominated rather than patient-centred;

Sarah Ford; Lesley Fallowfield; Shôn Lewis

1996-01-01

14

Experience with and attitudes to chemotherapy among newly employed nurses in oncological and surgical departments  

Microsoft Academic Search

Based on questionnaires, attitudes to chemotherapy were compared between newly employed nurses in oncology departments and\\u000a surgical departments. Comparisons were made as they started in their new jobs and after 6 and 12 months. In total, 76 nurses\\u000a were included in the study; 41 were employed in oncology departments and 35 in surgical departments. The questionnaires presented\\u000a a hypothetical situation

Roy M. Bremnes

1999-01-01

15

Improving patient safety in radiation oncology.  

PubMed

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 oncology that grievously impacted patients. In response, the American Association of Physicists in Medicine and the American Society for 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 co-hosted by 14 organizations in the United States and Canada. The meeting yielded 20 recommendations that provided a pathway to reducing errors and improving patient safety in radiation therapy facilities everywhere. PMID:24673864

Hendee, William R; Herman, Michael G

2011-01-01

16

Improving patient safety in radiation oncology.  

PubMed

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. PMID:21361177

Hendee, William R; Herman, Michael G

2011-01-01

17

Oncological and Functional Outcome after Surgical Treatment of Early Glottic Carcinoma without Anterior Commissure Involvement  

PubMed Central

Introduction. Glottic carcinoma can be successfully diagnosed in its early stages and treated with high percentage of success. Organ preservation and optimal functional outcomes could be achieved with wide array of surgical techniques for early glottic cancer, including endoscopic approaches or open laryngeal preserving procedures, making surgery the preferred method of treatment of early glottic carcinoma in the last few years. Material and Methods. Prospective study was done on 59 patients treated for Tis and T1a glottic carcinoma over a one-year time period in a tertiary medical center. Patients were treated with endoscopic laser cordectomy (types II–IV cordectomies according to European Laryngological Society classification of endoscopic cordectomies) and open cordectomy through laryngofissure. Follow-up period was 60 months. Clinical and oncological results were followed postoperatively. Voice quality after the treatment was assessed using multidimensional voice analysis 12 months after the treatment. Results. There were no significant differences between oncological and functional results among two groups of patients, though complications were more frequent in patients treated with open cordectomy. Conclusion. Endoscopic laser surgery should be the first treatment of choice in treatment of early glottic carcinomas, though open approach through laryngofissure should be available for selected cases where anatomical factors present limiting adequate tumor removal.

Milovanovic, Jovica; Jotic, Ana; Djukic, Vojko; Pavlovic, Bojan; Trivic, Aleksandar; Krejovic-Trivic, Sanja; Milovanovic, Andjela; Milovanovic, Aleksandar; Artiko, Vera; Banko, Bojan

2014-01-01

18

[Oncology].  

PubMed

The American Society for Clinical Oncology (ASCO) determined that there were twelve major advances in medical oncology last year. Endocrine-responsive breast cancer benefits from tamoxifen or an aromatase inhibitor taken for more than five years. Zoledronic acid, a bisphosphonate, reduces the risk of breast cancer recurrence in premenopausal women undergoing hormonal-suppression therapy. Bevacizumab was for use in combination with paclitaxel in patients with metastatic breast cancer Cetuximab added to chemotherapy of non-small cell lung cancer patients increased survival by up to 21%. Adjuvant gemcitabine doubled disease-free survival in pancreas cancer. Adjuvant pegylated interferon cuts the risk of recurrent melanoma by 18%. Bendamustine abolishes signs of activity of chronic lymphocytic leukemia in 30% of patients. The HPV vaccine--now approved for prevention of cervical cancer--might have a role in preventing oral cancers and a review of 45 studies showed that oral contraceptives reduce the risk of ovarian cancer. PMID:19271650

Aapro, Matti S

2009-02-01

19

NCI-CCR Pediatric Oncology Branch: Neuro-Oncology Section: Patient Consultations  

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

20

Thoracic complications and emergencies in oncologic patients  

PubMed Central

Abstract Oncology patients often experience urgent or emergent medical complications that are a direct or indirect result of the underlying malignant condition and are first identified or clarified on radiologic imaging studies. The aim of this review is to identify, discuss, and illustrate some of the major thoracic complications in patients with primary intrathoracic or extrathoracic neoplasms; particular focus is placed on issues in which radiologic imaging may have a significant impact on patient management, including superior vena cava (SVC) syndrome, post-obstructive pneumonia, diaphragmatic paralysis, pleural effusions, pericardial disease, tracheo-esophageal fistula, deep venous thrombosis, and pulmonary embolism.

2009-01-01

21

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.

2014-01-01

22

The oncological patient in the palliative situation.  

PubMed

Palliative care approaches the patient and his or her suffering with a biopsychosocial-spiritual model. Thus, it is the strength of palliative care to complement the diagnosis driven approach of medical cancer care by a problem and resources-based assessment, participatory care plan, and patient-directed interventions. Interventions need to reflect timely prognosis, target population (the patient, the family carer, the professional), and level of trust and remaining energy. In palliative care the relevance of psycho-oncological aspects in the care of the terminally ill is considerable in the understanding of the overall suffering of patients approaching death and their loved ones and in their care and support. There is little evidence to date in terms of clinical benefit of specific psycho-oncological interventions in the last months or weeks of life, but there is evidence on effects of stress reduction and reduced anxiety if locus of control can stay within the patient as long as possible. One major difficulty in psychosocial research at the end-of-life, however, is defining patient relevant outcomes. PMID:24305769

Eychmueller, Steffen; Zwahlen, Diana; Fliedner, Monica

2014-01-01

23

Participation in surgical oncology clinical trials: gender-, race/ethnicity-, and age-based disparities. | accrualnet.cancer.gov  

Cancer.gov

Researchers determined the enrollment fraction (EF), defined as the number of trial enrollees in Cancer Therapeutics Evaluation Program (CTEP) studies divided by the estimated U.S. cancer cases in each demographic group from the period 2000-2002. Women comprised 83.95% of the participants in NCI-sponsored trials, due to the fact that 74.66% of enrollees to surgical oncology trials participated in large breast cancer studies. African-American and Hispanic patients were underrepresented in NCI-sponsored surgical trials relative to their proportion of cancer incidence.

24

Incorporating Fertility Preservation into the Care of Young Oncology Patients  

PubMed Central

As the number of cancer survivors continues to increase, oncologists are faced with the challenge of providing cancer therapy to patients who may one day want to have children. Yet gonadotoxic cancer treatments can compromise future fertility, either temporarily or permanently. There are established means of preserving fertility prior to cancer treatment, specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy, and thus patients’ wishes regarding future fertility and the available fertility preservation alternatives should be discussed prior to the initiation of therapy. This commentary provides an overview of the range of fertility preservation options currently available and under development, and utilizes case-based discussions to illustrate ways in which fertility preservation can be incorporated into oncology care. Cases involving breast cancer, testicular cancer, and rectal cancer are described to illustrate fertility issues experienced by male and female patients, as well as to provide examples of strategies for modifying surgical, medical, and radiation therapy in order to spare fertility. Current guidelines in oncology and reproductive medicine are also reviewed to underscore the importance of communicating fertility preservation options to young patients with cancer.

Redig, Amanda J.; Brannigan, Robert; Stryker, Steven J.; Woodruff, Teresa K.; Jeruss, Jacqueline S.

2010-01-01

25

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.

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

26

Incidental pelvic lesions in the oncology patient  

PubMed Central

Abstract The identification of an incidental (i.e. unexpected and asymptomatic) lesion can create a dilemma for the clinician and radiologist. The incidental abnormality may represent metastatic disease, a second primary malignancy or a benign lesion. The diagnosis and management of such incidental findings will depend in part on the clinical setting, the pathology and stage of underlying primary malignancy and the imaging features of the incidental abnormality. This article reviews the diagnosis and management of incidental pelvic lesions in the oncology patient.

Riddell, A.M.

2011-01-01

27

Protecting Pediatric Oncology Patients From Influenza  

PubMed Central

Influenza is a common respiratory pathogen. Its severity can be unpredictable, but people with chronic illness are at increased risk of severe infection, complications, and death from influenza. This review examines evidence to support various strategies to protect pediatric oncology patients from influenza-related morbidity. Influenza vaccination should be considered standard. Additional evidence-supported measures include antiviral treatment, antiviral prophylaxis, cohorting of patients, and hospital infection control measures. Data from other high-risk populations support the vaccination of family members, double-dose or high-dose vaccination, and the use of barrier methods. These measures have the potential to optimize patient outcomes because there will be fewer treatment interruptions for acute illness. These strategies can also protect patients from prolonged hospitalizations and morbidity related to influenza.

Kersun, Leslie S.; Reilly, Anne F.; Coffin, Susan E.

2013-01-01

28

A structured strategy to combine education for advanced MIS training in surgical oncology training programs  

Microsoft Academic Search

Changing realities in surgery and surgical technique have heightened the need for agile adaptation in training programs. Current guidelines reflect the growing acceptance and adoption of the use of minimally invasive surgery (MIS) in oncology. North American general surgery residents are often not adequately skilled in advanced laparoscopic surgery skills at the completion of their residency. Presently, advanced laparoscopic surgery

S. S. Brar; F. Wright; A. Okrainec; A. J. Smith

2011-01-01

29

Focus on invasive mucormycosis in paediatric haematology oncology patients: a series of 11 cases.  

PubMed

Mucormycosis has emerged as an increasingly important infection in oncology centres with high mortality, especially in severely immunocompromised patients. We carried out a retrospective study of 11 children with mucormycosis treated in seven French oncology-haematology paediatric wards during the period from 1991 to 2011. Lichtheimia corymbifera and Mucor spp. were the predominant pathogens. Treatment regimens included antifungal therapy, reversal of underlying predisposing risk factors and surgical debridement. Although mucormycosis is associated with high mortality, this infection could be cured in eight of our cases of severely immunocompromised paediatric cancer patients. PMID:23020159

Phulpin-Weibel, Aurélie; Rivier, Alexandre; Leblanc, Thierry; Bertrand, Yves; Chastagner, Pascal

2013-05-01

30

Randomized controlled trials in surgical oncology: where do we stand?  

PubMed

This article reviews the history of clinical trials in surgery using breast cancer surgery and rectal cancer surgery as examples. Trials in breast cancer have transformed the surgical management of this disease. Rectal cancer surgery has also changed greatly, but much of this evolution occurred outside the setting of clinical trials. This article highlights the strengths and limitations of surgical trials and suggests that future studies should include pretrial credentialing as a requirement for surgeon participation. More work needs to be done to bridge the gap from trial results to implementation of new techniques in clinical practice. PMID:22583993

Mathis, Kellie L; Nelson, Heidi

2012-07-01

31

Clinical evaluation of vancomycin dosage in pediatric oncology patients.  

PubMed

Vancomycin trough serum concentrations were below therapeutic range (8-15 mg/L) in 58% of 124 pediatric oncology patients receiving 60 mg/kg/d divided qid. Patients <6 and between 6 and 12 years had significantly lower trough concentrations than patients >12 years. A vancomycin dosage of 60 mg/kg/d is inadequate for pediatric oncology patients >12 years. PMID:24445830

Sanders, Stefan J W J; Bijleveld, Yuma A; Sinkeler, Fleur; Kemper, Elles M; Pajkrt, Dasja; van de Wetering, Marianne; van Eijkelenburg, Natasha K A; Mathôt, Ron A A

2014-07-01

32

[Role of the surgical pathologist for tissue management in oncology].  

PubMed

Currently, the increasing number of ancillary methods to be performed from tumoral tissues in a pathology laboratory determines the necessity to have an optimal strategy for tissue management. The size of tissue samples dedicated for a pathological examination becomes smaller and smaller, as the diagnosis can be made with non or less invasive methods. However, the samples should also allow to provide the prognosis as well as to realise biological molecular testing in order to found a genomic alteration. Thus, it is critical to think about how to share and to pool the different expertises and abilities in a pathology laboratory in order to optimize the achievement of the different ancillary methods. Thus, following the morphological study made in hematoxylin-eosin staining, it is necessary to preempt the number of immunohistochemical and in situ hybridization studies, which will be potentially done from the tissue samples. Moreover, since the genomic alteration detection in tumours is mainly performed from DNA extracted from tissues, it is necessary to take in account some numerous parameters, in particular the nature and the time of fixation, the percentage of tumour cells, the presence of necrotic area, the percentage of inflammatory cells and the sample size. The strategy for an optimal tissue management in an oncology-pathology laboratory is critical and takes part of the different steps allowing to get an accreditation according the ISO15189 norm. PMID:23985751

Long, Élodie; Ilie, Marius; Hofman, Véronique; Lassalle, Sandra; Butori, Catherine; Alsubaie, Saad; Hofman, Paul

2013-09-01

33

Sub-specialty training in head and neck surgical oncology in the European Union  

Microsoft Academic Search

Sub-specialty training in otorhinolaryngology and head and neck surgery (ORL-HNS) is not standardised across European Union\\u000a (EU) states and remains diverse. The objective of this study was to assess the current status of sub-specialty training programmes\\u000a in head and neck surgical oncology within the European Union (EU-15). A postal questionnaire was distributed to 41 representative\\u000a members of the European Federation

Argyris Manganaris; Myles Black; Alistair Balfour; Christopher Hartley; Jean-Pierre Jeannon; Ricard Simo

2009-01-01

34

Molecules, cancer, and the surgeon. A review of molecular biology and its implications for surgical oncology.  

PubMed Central

Interactions between molecules control intra- and intercellular physiology. Cancer is emerging as a disease in which individual molecules are either overproduced, mutated, expressed at inappropriate stages of development, or lost due to inheritance or aberrant mitotic division. The major players in this contest of cellular control are growth factors, growth factor receptors (GFRs), signal transducers, and dominant or suppressor/recessive oncogenes. The tumors most frequently removed by surgeons have been reported to have changes in one or another of these types of molecules. The concept of multistage carcinogenesis, whereby malignancy arises after a sequence of changes that are cumulative, and passed from progenitor to daughter cells, is also being defined as a sequence of molecular, genetic, and chromosomal alterations. Molecular antineoplastic therapy is in early stages of development at the laboratory bench. The future may see patients screened for cancer susceptibility, evaluated for adjuvant therapy, and chosen for particular treatment based on molecular analysis. The types of cancer operations and the scope of surgical resection may change as molecular techniques enhance oncologic treatment.

Arbeit, J M

1990-01-01

35

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.

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

2013-01-01

36

NCI-CCR Pediatric Oncology Branch - Patients and Families  

Cancer.gov

Investigators and physicians in the Pediatric Oncology Branch realize that many challenges remain in the treatment of childhood cancers and genetic tumor predisposition syndromes. We are committed to improving outcomes for children and young adults with cancer through cutting-edge basic science and clinical research. Patients with cancer, NF1, NF2, or other diseases under study in the Pediatric Oncology Branch who are enrolled on clinical trials may receive therapy at the NIH Clinical Center.

37

Clinical problem solving: utility of sonography in oncologic patients.  

PubMed

This review demonstrates the unique advantages of sonography in the oncologic setting. Although computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography are primary imaging modalities for evaluation of the oncologic patient, sonography is useful for evaluation of various conditions and clinical scenarios associated with cancer. The following article will illustrate the utility of sonography at a tertiary cancer center for diagnosis and problem solving. PMID:24371094

Cooley, Christine; Nishino, Mizuki; Jagannathan, Jyothi; Ramaiya, Nikhil; Di Salvo, Donald; Krajewski, Katherine M

2014-01-01

38

Gynecologic oncology patients' satisfaction and symptom severity during palliative chemotherapy  

Microsoft Academic Search

BACKGROUND: Research on quality and satisfaction with care during palliative chemotherapy in oncology patients has been limited. The objective was to assess the association between patient's satisfaction with care and symptom severity and to evaluate test-retest of a satisfaction survey in this study population. METHODS: A prospective cohort of patients with recurrent gynecologic malignancies receiving chemotherapy were enrolled after a

Vivian E von Gruenigen; Jessica R Hutchins; Anne Marie Reidy; Heidi E Gibbons; Barbara J Daly; Elisa M Eldermire; Nancy L Fusco

2006-01-01

39

The science of patient safety: implications for oncology nursing practice.  

PubMed

Patient safety is one of the most frequent terms used in health care today. Patients and their families are, first and foremost, focused on receiving effective and safe care, and oncology nurses strive to incorporate clinical evidence into day-to-day practice. This article provides a road map on how to incorporate emerging patient safety science into daily clinical practice to best serve patients and their families. PMID:24305480

Sheridan, Carol A

2013-12-01

40

Albumin synthesis in surgical patients.  

PubMed

Albumin plasma concentrations are being used as indicators of nutritional status and hepatic function based on the assumption that plasma levels reflect the rate of albumin synthesis. However, it has been shown that albumin levels are not reliable markers of albumin synthesis under a variety of clinical conditions including inflammation, malnutrition, diabetes mellitus, liver disease, and surgical tissue trauma. To date, only a few studies have measured albumin synthesis in surgical and critically ill patients. This review summarizes the findings from these studies, which used different tracer methodology in various surgical or critically ill patient populations. The results indicate that the fractional synthesis rate of albumin appears to decrease during surgery, followed by an increase during the postoperative phase. In the early postoperative phase, albumin fractional synthesis rate can be stimulated by perioperative nutrition, if enough amino acids are being provided and if nutrition is being initiated before the operation. The physiologic meaning of albumin synthesis after surgery, however, still needs to be further clarified. PMID:23333435

Hülshoff, Ansgar; Schricker, Thomas; Elgendy, Hamed; Hatzakorzian, Roupen; Lattermann, Ralph

2013-05-01

41

Cancer in older patients: an analysis of elderly oncology.  

PubMed

Is it possible to define when someone is elderly? The worldwide population is growing not only in number but also in age; it is estimated that the population will increase to around 750 million by 2021. Two thirds of cancer occurs in the over 65 age groups. With an increasing elderly population, it can be derived that cancer will become a more prevalent condition. The burden of cancer on the medical profession will be even more apparent than before. In addition the elderly age group has different needs compared with younger oncology patients; there can be no 'rule of thumb' with the management of elderly illness. Factors such as frailty are significant when treating cancer in the older patients. The assessment of quality of life in older patients with cancer is also an important factor. Is it best for a patient to enjoy life as it is with cancer or aim for increased life expectancy by undertaking treatment with the threat of morbidity however severe during that period? The volume of scientific evidence currently available to support all the issues in geriatric oncology is greatly limited; almost all treatments designed for oncology are being tested in randomized clinical trials preferentially using younger cohorts of patients. Changes need to be made in order to further this field of medicine. Geriatric oncology is no longer a palliative field, as a healthy active life can now be expected by some older patients. The burden of oncology in the elderly will need to take a modern approach regarding the management of these patients. PMID:22423250

Swaminathan, V; Audisio, Ra

2012-01-01

42

Cancer in older patients: an analysis of elderly oncology  

PubMed Central

Is it possible to define when someone is elderly? The worldwide population is growing not only in number but also in age; it is estimated that the population will increase to around 750 million by 2021. Two thirds of cancer occurs in the over 65 age groups. With an increasing elderly population, it can be derived that cancer will become a more prevalent condition. The burden of cancer on the medical profession will be even more apparent than before. In addition the elderly age group has different needs compared with younger oncology patients; there can be no ‘rule of thumb’ with the management of elderly illness. Factors such as frailty are significant when treating cancer in the older patients. The assessment of quality of life in older patients with cancer is also an important factor. Is it best for a patient to enjoy life as it is with cancer or aim for increased life expectancy by undertaking treatment with the threat of morbidity however severe during that period? The volume of scientific evidence currently available to support all the issues in geriatric oncology is greatly limited; almost all treatments designed for oncology are being tested in randomized clinical trials preferentially using younger cohorts of patients. Changes need to be made in order to further this field of medicine. Geriatric oncology is no longer a palliative field, as a healthy active life can now be expected by some older patients. The burden of oncology in the elderly will need to take a modern approach regarding the management of these patients.

Swaminathan, V; Audisio, RA

2012-01-01

43

Perioperative care of the surgical patient.  

PubMed

Efficient care of the surgical patient necessitates attention to key elements of preoperative patient preparation prior to the day of surgery, a standardized approach to patient monitoring and education on the day of surgery, and careful postoperative monitoring. Patient education is fundamental to all phases of surgical management so that patient expectations and concerns are practically addressed. Quality assurance endeavors must also be integrated into these preioperative phases so that optimal care of the surgical patient is ensured. PMID:15584686

Wilde, Joseph; Hauser, Debbie; Leshin, Barry

2004-09-01

44

Mindfulness Meditation for Oncology Patients: A Discussion and Critical Review  

Microsoft Academic Search

The purpose of this article is to (1) provide a comprehensive over view and discussion of mindfulness meditation and its clinical applicability in oncology and (2) report and critically evaluate the existing and emerging research on mindfulness meditation as an intervention for cancer patients. Using relevant keywords, a comprehensive search of MEDLINE, PsycInfo, and Ovid was completed along with a

Mary Jane Ott; Rebecca L. Norris; Susan M. Bauer-Wu

2006-01-01

45

Patient satisfaction with inpatient care provided by the Sydney Gynecological Oncology Group  

PubMed Central

Purpose: Patient satisfaction with the provision of hospital oncology services can have a significant impact on their overall treatment experience. Aims: To assess patient satisfaction with the inpatient hospital services in the gynecological oncology setting using the IN-PATSAT32 questionnaire developed by the European Organization for Research and Treatment of Cancer (EORTC). Methods: A modified version of the IN-PATSAT32 questionnaire with additional 16 items was administered to 52 adult surgical inpatients admitted with the Sydney Gynecological Oncology Group. All participants were provided with an information leaflet regarding the survey and written consent obtained. Results: A high response rate (100%) from patients with varied social, ethnic, and educational backgrounds confirmed the acceptability of the survey. Standard of medical care provided, frequency of doctors’ visits, exchange of information with doctors, friendliness of the staff, and state of the room ranked highly (>95%) on the patient satisfaction scales. Problems were identified with ease of access to and within the hospital, quality of food, and exchange of information with other hospital staff. Conclusions: Overall the satisfaction with inpatient care was rated very highly in most areas. Deficiencies in certain elements of provision of medical care to the patients were identified and steps have been taken to improve upon these shortcomings.

Arora, Vivek; Philp, Shannon; Nattress, Kathryn; Pather, Selvan; Dalrymple, Christopher; Atkinson, Kenneth; Smirnova, Sofia; Cotterell, Stephen; Carter, Jonathan

2010-01-01

46

Oncology clinical challenges: caring for patients with preexisting psychiatric illness.  

PubMed

People with severe mental disorders (SMDs) have a higher mortality rate and reduced life expectancy compared to the general population. Factors that contribute to higher mortality rates include a higher rate of smoking and increased incidence of obesity from lifestyle, diet, or medication side effects. Cancer treatment may exacerbate mood and psychotic symptoms in patients with SMD. Some of the medications used in cancer treatment or the medications used to alleviate the side effects of cancer treatment can have adverse reactions with psychotropic medications. This article examines problems that patients with SMD encounter with their cancer diagnosis and treatment. Oncology nurses in any clinical setting play a pivotal role in identifying the special needs of a patient with SMD and must become familiar with psychosocial issues, psychotropic medications, and SMD to educate and advocate for these patients and their families. Collaborating and coordinating care between oncology and psychiatry providers is needed for optimal patient outcomes. PMID:23022930

Thomson, Kate; Henry, Barb

2012-10-01

47

Oncology clinicians' accounts of discussing complementary and alternative medicine with their patients  

Microsoft Academic Search

The profile of complementary and alternative medicine (CAM) has risen dramatically over recent years, with cancer patients representing some of the highest users of any patient group. This article reports the results from a series of in-depth interviews with oncology consultants and oncology nurses in two hospitals in Australia. Analysis identifies a range of self-reported approaches with which oncology clinicians

Alex Broom; Jon Adams

2009-01-01

48

Enterocolic lymphocytic phlebitis: an oncologic surgical resection without a preoperative pathologic diagnosis.  

PubMed

A patient with complaints of an abdominal (mesenteric) mass is presented. Differential diagnosis included neoplastic processes, such as malignant lymphoma, desmoid tumour, a carcinoid or a gastro-intestinal stromal cell tumour. An oncological resection was performed. Despite the malignant appearance of the tumour no malignancy was found with histopathological examination. Vasculitic lesions were seen in venous structures, resembling veno-occlusive disease with signs of recanalization and with the presence of inflammatory cells, mainly lymphocytes. A diagnosis of enterocolic lymphocytic phlebitis was made. This benign condition can mimic malignancy, necessitating a wide excision, also because obtaining a pre-operative histopathological diagnosis is hardly possible. PMID:24876508

Huiberts, Astrid A M; Donkervoort, Sandra C; Blok, Willem L; Blaauwgeers, Hans L G

2014-01-01

49

Enterocolic lymphocytic phlebitis: an oncologic surgical resection without a preoperative pathologic diagnosis  

PubMed Central

A patient with complaints of an abdominal (mesenteric) mass is presented. Differential diagnosis included neoplastic processes, such as malignant lymphoma, desmoid tumour, a carcinoid or a gastro-intestinal stromal cell tumour. An oncological resection was performed. Despite the malignant appearance of the tumour no malignancy was found with histopathological examination. Vasculitic lesions were seen in venous structures, resembling veno-occlusive disease with signs of recanalization and with the presence of inflammatory cells, mainly lymphocytes. A diagnosis of enterocolic lymphocytic phlebitis was made. This benign condition can mimic malignancy, necessitating a wide excision, also because obtaining a pre-operative histopathological diagnosis is hardly possible.

Huiberts, Astrid A.M.; Donkervoort, Sandra C.; Blok, Willem L.; Blaauwgeers, Hans L.G.

2014-01-01

50

Proximal femoral reconstruction with a constrained acetabulum in oncologic patients.  

PubMed

Metallic endoprostheses are used for oncological reconstruction around the proximal femur and hip joint. Common modes of failure with hemiarthroplasty or standard hip arthroplasty after proximal femoral replacement include dislocation, late hip pain, and infection. The authors reviewed hospital records to identify patients undergoing constrained tripolar hip arthroplasty for oncological reasons between 2002 and 2012. Inclusion criterion was at least 12-cm proximal femoral resection, including patients with total femur reconstruction. A total of 33 patients were reviewed. Information regarding demographics, length of follow-up, treatment characteristics, and patient outcomes was extracted. Average follow-up for all patients was 912.33 days (30.4 months). Average follow-up was 1396.1 days for living patients and 428.6 days for deceased patients. Average estimated blood loss was 462.12 cc: an average of 1080 cc for patients undergoing total femoral resection and replacement and 315.8 cc for patients undergoing proximal femoral resection and replacement. Average operative time was 137.7 minutes: an average of 205 minutes for patients undergoing total femoral resection and replacement and 119.1 minutes for patients undergoing proximal femoral resection and replacement. Average Musculoskeletal Tumor Society score was 21.7. There were no dislocations in the cohort. A constrained tripolar device can be safely used for oncological proximal femoral reconstructions while minimizing the risk of dislocation. Positioning of the acetabular implant in neutral anatomic version in conjunction with a neutral-placed femoral component provides the greatest range of motion, reduction of liner impingement, and improved hip stability. PMID:24679207

Jawad, Muhammad Umar; Brien, Earl W

2014-02-01

51

Applying the American Pain Society's QA standards to evaluate the quality of pain management among surgical, oncology, and hospice inpatients in Taiwan.  

PubMed

The purpose of this study was two-fold: first, to apply the American Pain Society (APS) outcome questionnaire to examine and compare the quality of pain management provided in surgical, oncology, and hospice inpatient units in the Taipei area of Taiwan, and second, to provide baseline data of pain management quality in advance of the implementation of national guidelines for cancer pain management. Data revealed that hospice patients had significantly lower levels of pain severity and higher satisfaction with pain management than did oncology or surgical patients. A majority of patients reported that they received pain medication within 15 min after they complained of pain. However, a large number of patients never asked for pain medication during hospitalization. Moreover, most of the patients never requested medication changes even when their perception was that their medication were not effective. The findings of this study may provide support for the effectiveness of hospices in Taiwan in pain management and provide important information on the validity of the APS quality standards. PMID:10863044

Lin, C C

2000-07-01

52

Osteointegration in oncologic patients: a case report  

PubMed Central

Summary Objective the present case report aims at illustrating how implant-prosthetic rehabilitation in patients with oral cancer resection aids to improve their quality of life. Material and methods a patient with verrucous squamous cell carcinoma of the mandible was treated with surgery and rehabilitation with three interforaminal dental implants and Toronto bridge. Three years after treatment, because of cancer recurrence, a segment of jaw and one of the three mandibular implants were removed. The histological examination showed healthy bone contact to implant surface, despite proximity to the neoplastic area. Results the case shows the maintainance of the osseointegration implants despite the cancer recurrence in the same area. Conclusions endosseous implants represent a useful and valid tool for the prosthetic rehabilitation of cancer patients. Long-term effects of implant-prosthetic rehabilitation in patients with cancer still need to be verified. It would be interesting to confirm the data obtained by numerical studies of representative samples.

Carini, Fabrizio; Bucalo, Concetta; Saggese, Vito; Monai, Dario; Porcaro, Gianluca

2012-01-01

53

[Intensive care management of hematological and oncological patients].  

PubMed

Management of critically ill cancer patients warrants stringent admission criteria and clear concepts concerning duration and limits of intensive care. Recent developments in mechanical ventilation and sepsis therapy can easily be used to improve the outcome of critically ill cancer patients. The incidence and overall prognosis of cancer is constantly growing and, thus, the number of critically ill cancer patients is increasing. Furthermore, novel oncology drugs-in particular immune modulators-produce unexpected and substantial side effects. Therefore, the development of an interdisciplinary algorithm by oncologists and intensivists remains an important and dynamic challenge. PMID:23963277

von Bergwelt-Baildon, M; Shimabukuro-Vornhagen, A; Hallek, M; Kochanek, M

2013-09-01

54

Oncology patient-reported claims: maximising the chance for success  

PubMed Central

Objectives/purpose: To review Patient Reported Outcome (PRO) labelling claims achieved in oncology in Europe and in the United States and consider the benefits, and challenges faced. Methods: PROLabels database was searched to identify oncology products with PRO labelling approved in Europe since 1995 or in the United States since 1998. The US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) websites and guidance documents were reviewed. PUBMED was searched for articles on PRO claims in oncology. Results: Among all oncology products approved, 22 were identified with PRO claims; 10 in the United States, 7 in Europe, and 5 in both. The language used in the labelling was limited to benefit (e.g. “…resulted in symptom benefits by significantly prolonging time to deterioration in cough, dyspnoea, and pain, versus placebo”) and equivalence (e.g. “no statistical differences were observed between treatment groups for global QoL”). Seven products used a validated HRQoL tool; two used symptom tools; two used both; seven used single-item symptom measures (one was unknown). The following emerged as likely reasons for success: ensuring systematic PRO data collection; clear rationale for pre-specified endpoints; adequately powered trials to detect differences and clinically significant changes; adjusting for multiplicity; developing an a priori statistical analysis plan including primary and subgroup analyses, dealing with missing data, pooling multiple-site data; establishing clinical versus statistical significance; interpreting failure to detect change. End-stage patient drop-out rates and cessation of trials due to exceptional therapeutic benefit pose significant challenges to demonstrating treatment PRO improvement. Conclusions: PRO labelling claims demonstrate treatment impact and the trade-off between efficacy and side effects ultimately facilitating product differentiation. Reliable and valid instruments specific to the desired language, claim, and target population are required. Practical considerations include rationale for study endpoints, transparency in assumptions, and attention to subtle variations in data.

Kitchen, H; Rofail, D; Caron, M; Emery, M-P

2011-01-01

55

Surgical fires: a patient safety perspective.  

PubMed

A surgical fire is a fire that occurs on or in a surgical patient. Such fires are rare--they occur in only an extremely small percentage of surgical cases. Nevertheless, the actual number of incidents that occur each year may surprise many healthcare professionals. ECRI estimates that 50 to 100 or more surgical fires occur each year in the United States alone. And such fires can have devastating consequences, not only for the patient, but also for the surgical staff and for the healthcare facility. Fortunately, through awareness of the hazards-and with emphasis placed on following safe practices-virtually all surgical fires can be prevented. Thus, it's important that surgical fire safety be incorporated into formal patient safety initiatives. In this article, we describe a few surgical fire patient safety initiatives that have been instituted in recent years. In addition, we describe in detail the causes of surgical fires and the preventive measures that are available for healthcare personnel to follow. In addition, we review how staff should respond in the event of a surgical fire. PMID:16541832

2006-02-01

56

Immunonutrition in the surgical patient.  

PubMed

Both malnutrition and the physical injury related to trauma and surgery increase the expression of T-helper 2 (Th2) lymphocytes which cause impaired cell mediated immunity. Activation of the hypothalamic-pituitary-adrenal axis and sympathoadrenal system with the release of cortisol and catecholamines drive the development of Th2 cells. Th2 cytokines result in the accumulation of arginase-1 expressing myeloid-derived suppressor cells in lymphoid tissue. The myeloid-derived suppressor cells cause an arginine deficient state resulting in impaired lymphocyte function. Prostaglandin-E2 released following trauma plays a synergetic role with cortisol and catecholamines in driving these pathways. There is now increasing evidence that immunomodulating enteral formulas supplemented with arginine and omega-3 fatty acids can reverse many of the immune mediated changes and decrease the number of adverse outcomes after major surgery and trauma. These immunomodulating enteral formulas should be strongly considered in surgical patients undergoing major surgery and following severe trauma. PMID:22240611

Marik, P E; Flemmer, M

2012-03-01

57

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.

Sandrin, Fabio

2014-01-01

58

[Laparoscopic jejunostomy in malnourished surgical patients: indications and technique].  

PubMed

Laparoscopic jejunostomy (LJ) represents a new way of enteral nutrition (EN) for surgical malnourished patients. LJ is an alternative form of therapy, with restricted indications to the few cases when classical way for EN (nosogastroenteral tube feeding, PEG/PEJ, surgical gastrostomy), are contraindicated or can not be used, and the patient is unable to eat. This technique is also preferred to the open surgical jejunostomy. The paper describes our LJ technique, indications and contraindications. We used JL in two surgical severely malnourished patients, within 11 and 14 days, before the elective, open, curative operations. In this period the patients where exclusively nourished with special feeding solutions through the LJ catheter. The main pathologic lesions were: extrinsec antral obstruction from a perforated transverse colon carcinoma in the omental pouch, in the first case, and proximal inflammatory stenosis of efferent loop, after gastric resection with Billroth II anastomosis for duodenal ulcer, in the second case. LJ gives the opportunity for the exploration of the whole abdominal cavity, and for the direct imaging of the pathological lesions. With EN being delivered before the open, elective operations, we get an amelioration of serum albumin values, and we have no morbidity related to the LJ or open, curative operation. EN was administrated after open surgery in the same way, and in the first case, during chemotherapy. LJ is an efficient, miniinvasive way for EN, in selected surgical severe malnourished patients with proximal digestive obstructions, especially oncologic ones, the aim being an amelioration of the nutritional status and a reduction of postoperative morbidity. A continuous study on a larger number of cases is imperative necessary. PMID:14997843

Nicolau, A E; Beuran, M; Veste, V; Grecu, Irina; Vasilescu, Cleopatra; Grin?escu, Ioana

2003-01-01

59

Quality of Pharmaceutical Care in Surgical Patients  

PubMed Central

Background Surgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements. Objective To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements. Methods For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients. Results Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and ‘sensitivity to change’. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%). Conclusions This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.

de Boer, Monica; Ramrattan, Maya A.; Boeker, Eveline B.; Kuks, Paul F. M.; Boermeester, Marja A.; Lie-A-Huen, Loraine

2014-01-01

60

Electronic patient-reported outcome systems in oncology clinical practice.  

PubMed

Patient-reported outcome (PRO) questionnaires assess topics a patient can report about his or her own health. This includes symptoms (eg, nausea, fatigue, diarrhea, pain, or frequent urination), physical functioning (eg, difficulty climbing stairs or difficulty fastening buttons), and mental health (eg, anxiety, fear, or worry). Electronic PRO (ePRO) systems are used in oncology clinical care because of 1) their ability to enhance clinical care by flagging important symptoms and saving clinicians time; 2) the availability of standardized methods for creating and implementing PROs in clinics; and 3) the existence of user-friendly platforms for patient self-reporting like tablet computers and automated telephone surveys. Many ePRO systems can provide actionable links to clinical care such as summary reports in a patient's electronic medical record and real-time e-mail alerts to providers when patients report acute needs. This review presents 5 examples of ePRO systems currently in use in oncology practice. These systems support multiple clinical activities, including assessment of symptoms and toxicities related to chemotherapy and radiation, postoperative surveillance, and symptom management during palliative care and hospice. Patient self-reporting is possible both at clinical visits and between visits over the Internet or by telephone. The implementation of an ePRO system requires significant resources and expertise, as well as user training. ePRO systems enable regular monitoring of patient symptoms, function, and needs, and can enhance the efficiency and quality of care as well as communication with patients. PMID:22811342

Bennett, Antonia V; Jensen, Roxanne E; Basch, Ethan

2012-01-01

61

Surgical Volume Matters: Helping Patients Pick Hospitals.  

National Technical Information Service (NTIS)

The purpose of this project was to (1) learn how Medicare patients currently choose hospitals for surgery and (2) determine how best to inform Medicare beneficiaries about the relative quality of surgical providers. We conducted telephone interviews with ...

J. D. Birkmeyer L. Schwartz S. Woloshin

2004-01-01

62

The 2013 Society of Surgical Oncology Susan G. Komen for the Cure Symposium: MRI in breast cancer: where are we now?  

PubMed

Magnetic resonance imaging (MRI) has been widely applied in the contemporary management of patients with breast cancer and as a screening tool for those at increased risk; however, prospective evidence that the use of breast MRI improves patient outcomes remains limited to screening of known BRCA mutation carriers or women at increased risk based on a strong family history. Despite this, the role of MRI in the routine evaluation of the newly diagnosed breast cancer patient remains a subject of much debate, with widely divergent views on the value of MRI in selecting local therapy. The application of MRI in patients undergoing neoadjuvant therapy is an area of active investigation, with several potential benefits, including predicting response to therapy. We review the current state of the literature on the topics of MRI for screening, MRI and short-term surgical outcomes, MRI and long-term surgical outcomes, and MRI and neoadjuvant chemotherapy as presented at the 2013 Society of Surgical Oncology Susan G. Komen for the Cure Symposium, 9 March 2013. PMID:24145992

McLaughlin, Sarah; Mittendorf, Elizabeth A; Bleicher, Richard J; McCready, David R; King, Tari A

2014-01-01

63

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

64

Oncological patterns of care and outcome for 952 patients with newly diagnosed glioblastoma in 2004  

PubMed Central

This report, an audit requested by the French government, describes oncological patterns of care, prognostic factors, and survival for patients with newly diagnosed and histologically confirmed glioblastoma multiforme (GBM) in France. The French Brain Tumor DataBase, which is a national multidisciplinary (neurosurgeons, neuropathologists, radiotherapists, neurooncologists, epidemiologists, and biostatisticians) network, prospectively collected initial data for the cases of GBM in 2004, and a specific data card was used to retrospectively collect data on the management and follow-up care of these patients between January 1, 2004, and December 1, 2006. We recorded 952 cases of GBM (male/female ratio 1.6, median age 63.9 years, mean preoperative Karnofsky performance status [KPS] 79). Surgery consisted of resection (RS; n = 541) and biopsy (n = 411); 180 patients did not have subsequent oncological treatment. After surgery, first-line treatment (n = 772) consisted of radiotherapy (RT) and temozolomide (TMZ) concomitant +/? adjuvant in 314 patients, RT alone in 236 patients, chemotherapy (CT) alone in 157 patients, and other treatment modalities in 65 patients. Median overall survival was 286 days (95% CI, 266–314) and was significantly affected by age, KPS, and tumor location. Median survival (days, 95% CI) associated with these main strategies, when analyzed by a surgical group, were as follows: RS + RT-TMZ(n=224): 476 (441–506), biopsy + RT-TMZ(n=90): 329 (301–413), RS + RT(n=147): 363 (331–431), biopsy + RT(n=89): 178 (153–237), RS + CT(n=61): 245 (190–361), biopsy + CT(n=96): 244 (198–280), and biopsy only(n=118): 55 (46–71). This study illustrates the usefulness of a national brain tumor database. To our knowledge, this work is the largest report of recent GBM management in Europe.

Bauchet, Luc; Mathieu-Daude, Helene; Fabbro-Peray, Pascale; Rigau, Valerie; Fabbro, Michel; Chinot, Olivier; Pallusseau, Lorelei; Carnin, Charlotte; Laine, Karl; Schlama, Aline; Thiebaut, Agnes; Patru, Maria Cristina; Bauchet, Fabienne; Lionnet, Martine; Wager, Michel; Faillot, Thierry; Taillandier, Luc; Figarella-Branger, Dominique; Capelle, Laurent; Loiseau, Hugues; Frappaz, Didier; Campello, Chantal; Kerr, Christine; Duffau, Hugues; Reme-Saumon, Monique; Tretarre, Brigitte; Daures, Jean-Pierre; Henin, Dominique; Labrousse, Francois; Menei, Philippe; Honnorat, Jerome

2010-01-01

65

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

66

[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

67

Chronic post-treatment symptoms in patients with breast cancer operated in different surgical units  

Microsoft Academic Search

AimsThis study was designed to find out whether women operated in high volume surgical units have less chronic symptoms than women operated in smaller volume units.MethodsA questionnaire was sent to 265 consecutive women treated at the Department of Oncology, Helsinki University Central Hospital, from January to June 1996. Of the patients, 129 were operated in hospitals experienced in breast cancer

T. Tasmuth; C. Blomqvist; E. Kalso

1999-01-01

68

[FDG PET and its impact on patient's management in oncology].  

PubMed

FDG, a radioactive glucose analog for PET imaging, requires some precautions: it should be used only in patients with glycemia < 7mmol/L, fasting for at least 6 h but well hydrated, and after pregnancy is ruled out. FDG-PET has many indications in oncology. Its clinical utility has been documented in some circumstances, listed as routine indications in the European Principal Characteristics Summary and the French Standards, Options, and Recommendations. The European "Points to Consider" define as a principal criterion of clinical utility the impact of the imaging results on patient management. The original results presented here evaluate the clinical impact of FDG-PET among patients at Tenon Hospital by the rate of modifications in patient' management, determined with the same questionnaire as that used in two California studies of 2044 patients. Our response rate was lower than in our previous retrospective study in 2000 (34% versus 73%), probably because a prospective evaluation requires more work by the referring physician (who had to respond to two separate letters). On the other hand, the modification rate rose significantly (54% versus 46%, p<0.001), especially for colorectal cancer (58% versus 44%, p<0.02). The California studies had similar response rates (31%-48%, depending on the indication). Their modification rates were also similar, although higher for lymphoma (68%), colorectal (65%) and breast (58%) cancers. PMID:16969330

Talbot, Jean-Noël; Montravers, Françoise; Grahek, Dany; Kerrou, Khaldoun; Gutman, Fabrice; Cailleux, Nathalie

2006-09-01

69

How has acute oncology improved care for patients?  

PubMed

A United Kingdom-wide appreciation of the systemic failings of emergency cancer care led to the creation of a new subspecialty, acute oncology. It was meant to bridge the gap between admitting teams, oncology, and palliative care, providing support to manage the symptoms of cancer, the side effects of cancer treatment, and people presenting with cancer of unknown primary origin. This article identifies the reasons for the creation of acute oncology and explores various models for this aspect of cancer care worldwide. With health care budgets static and demand increasing, the article also identifies ways in which acute oncology can contribute to an efficient and caring health system. PMID:24940096

Navani, V

2014-06-01

70

How has acute oncology improved care for patients?  

PubMed Central

A United Kingdom–wide appreciation of the systemic failings of emergency cancer care led to the creation of a new subspecialty, acute oncology. It was meant to bridge the gap between admitting teams, oncology, and palliative care, providing support to manage the symptoms of cancer, the side effects of cancer treatment, and people presenting with cancer of unknown primary origin. This article identifies the reasons for the creation of acute oncology and explores various models for this aspect of cancer care worldwide. With health care budgets static and demand increasing, the article also identifies ways in which acute oncology can contribute to an efficient and caring health system.

Navani, V.

2014-01-01

71

Positive patient experiences in an Australian integrative oncology centre  

PubMed Central

Background The purpose of this study was to explore the experiences of cancer patients’ utilising complementary and integrative therapies (CIT) within integrative oncology centres across Western Australia. Methods Across four locations 135 patients accessed CIT services whilst undergoing outpatient medical treatment for cancer. Of the 135 patients, 66 (61?±?12 y; female n?=?45; male n?=?21) agreed to complete a personal accounts questionnaire consisting of open-ended questions designed to explore patients’ perceptions of CIT. All results were transcribed into nVivo (v9) and using thematic analysis, key themes were identified. Results Of the 66 participants, 100% indicated they would “recommend complementary therapies to other patients” and 92% stated “CIT would play a significant role in their future lifestyle”. A mean score of 8?±?1 indicated an improvement in participants’ perception of wellbeing following a CIT session. Three central themes were identified: empowerment, support and relaxation. Fourteen sub-themes were identified, with all themes clustered into a framework of multifaceted views held by cancer patients in relation to wellbeing, role of significant others and control. Conclusions Exploration of patients’ experiences reveals uniformly positive results. One of the key merits of the environment created within the centres is patients are able to work through their cancer journey with an increased sense of empowerment, without placing them in opposition to conventional medical treatment. In order to effectively target integrative support services it is crucial to explore the experiences of patients in their own words and use those forms of expression to drive service delivery.

2014-01-01

72

Oncologic Outcomes of Patients With Gleason Score 7 and Tertiary Gleason Pattern 5 After Radical Prostatectomy  

PubMed Central

Purpose We evaluated oncologic outcomes following radical prostatectomy (RP) in patients with a Gleason score (GS) of 7 with tertiary Gleason pattern 5 (TGP5). Materials and Methods We retrospectively reviewed the medical records of 310 patients who underwent RP from 2005 to 2010. Twenty-four patients who received neoadjuvant or adjuvant antiandrogen deprivation or radiation therapy were excluded. Just 239 (GS 6 to 8) of the remaining 286 patients were included in the study. Patients were classified into four groups: GS 6, GS 7 without TGP5, GS 7 with TGP5, and GS 8. We analyzed preoperative clinical factors, postoperative pathological outcomes, and biochemical recurrence (BCR). Results TGP5 in GS 7 was an independent predictor of primary Gleason pattern 4, tumor volume larger than 10%, positive surgical margin, and lymphovascular invasion. The presence of TGP5 in GS 7 was not associated with BCR-free survival. Subgroup analyses revealed that BCR-free survival did not differ significantly between patients with GS 7 with TGP5 and those with GS 8 (p=0.120). In addition, time to BCR in patients with a higher percentage of TGP5 was shorter than that in patients with a lower percentage of TGP5. TGP5 in GS 7 was not a significant predictive factor for BCR, whereas prostate-specific antigen density and a positive surgical margin were shown to be independent predictors of BCR. Conclusions TGP5 in GS 7 was an independent predictor of unfavorable pathologic outcomes. The rate of BCR was similar in GS 7 disease with TGP5 and in GS 8 disease, even though TGP5 was not a significant predictive factor for BCR in Cox proportional hazards models.

Leng, Yi-Hsueh; Lee, Won Jun; Yang, Seung Ok; Lee, Jeong Ki; Jung, Tae Young

2013-01-01

73

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.

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

74

Adverse events in surgical patients in Australia  

Microsoft Academic Search

Objective. To determine the adverse event (AE) rate for surgical patients in Australia. Design. A two-stage retrospective medical record review was conducted to determine the occurrence of AEs in hospital admissions. Medical records were screened for 18 criteria and positive records were reviewed by two medical officers using a structured questionnaire. Setting. Admissions in 1992 to 28 randomly selected hospitals

A. K. KABLE; R. W. GIBBERD; A. D. SPIGELMAN

2002-01-01

75

Gynecologic oncology patients' satisfaction and symptom severity during palliative chemotherapy  

PubMed Central

Background Research on quality and satisfaction with care during palliative chemotherapy in oncology patients has been limited. The objective was to assess the association between patient's satisfaction with care and symptom severity and to evaluate test-retest of a satisfaction survey in this study population. Methods A prospective cohort of patients with recurrent gynecologic malignancies receiving chemotherapy were enrolled after a diagnosis of recurrent cancer. Patients completed the Quality of End-of-Life care and satisfaction with treatment scale (QUEST) once upon enrollment in an outpatient setting and again a week later. Patients also completed the Mini-Mental Status Exam, the Hospital Anxiety/Depression Scale, a symptom severity scale and a demographic survey. Student's t-test, correlation statistics and percent agreement were used for analysis. Results Data from 39 patients were analyzed. Mean (SD) quality of care summary score was 41.95 (2.75) for physicians and 42.23 (5.42) for nurses (maximum score was 45; p = 0.76 for difference in score between providers). Mean (SD) satisfaction of care summary score was 29.03 (1.92) for physicians and 29.28 (1.70) for nurses (maximum score was 30; p = 0.49 for difference between providers). Test-retest for 33 patients who completed both QUEST surveys had high percent agreement (74–100%), with the exception of the question regarding the provider arriving late (45 and 53%). There was no correlation between quality and satisfaction of care and symptom severity. Weakness was the most common symptom reported. Symptom severity correlated with depression (r = 0.577 p < 0.01). There was a trend towards a larger proportion of patients reporting pain who had three or more prior chemotherapy regimens (p = 0.075). Prior number of chemotherapy regimens or time since diagnosis was not correlated with symptom severity score. Anxiety and depression were correlated with each other (r = 0.711, p < 0.01). There was no difference in symptom severity score at enrollment between those patients who have since died (n = 19) versus those who are still alive. Conclusion The QUEST Survey has test-retest reliability when used as a written instrument in an outpatient setting. However, there was no correlation between this measure and symptom severity. Patient evaluation of care may be more closely related to the interpersonal aspects of the health care provider relationship than it is to physical symptoms.

von Gruenigen, Vivian E; Hutchins, Jessica R; Reidy, Anne Marie; Gibbons, Heidi E; Daly, Barbara J; Eldermire, Elisa M; Fusco, Nancy L

2006-01-01

76

Chylous ascites after oncological abdominal surgery: incidence and treatment  

Microsoft Academic Search

Aims Chylous ascites can be a problem after oncological abdominal surgery. The aim of this study was to report the incidence and the management of the problem. Methods A retrospective study over a 2-year period of all oncological patients undergoing abdominal surgical procedures was carried out. Patients with resections in the upper abdomen and retroperitoneum were studied in more detail.

R. Kaas; L. D. Rustman; F. A. N. Zoetmulder

2001-01-01

77

Relationship between Spirituality and the Use of Self-Regulation Strategies by Hospitalized Adult Oncology Patients.  

National Technical Information Service (NTIS)

The purpose of this descriptive-correlational study was to examine the relationship between spirituality and the use of self-regulation strategies (SRSs) by hospitalized adult oncology patients. SRSs are any behaviors that individuals perform to make them...

C. R. Salvatore

1991-01-01

78

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.

79

Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public  

Microsoft Academic Search

SummaryBackground Euthanasia and physician-assisted suicide are pressing public issues. We aimed to collect empirical data on these controversial interventions, particularly on the attitudes and experiences of oncology patients.Methods We interviewed, by telephone with vignette-style questions, 155 oncology patients, 355 oncologists, and 193 members of the public to assess their attitudes and experiences in relation to euthanasia and physician-assisted suicide.Findings About

E. J Emanuel; E. R Daniels; D. L Fairclough; B. R Clarridge

1996-01-01

80

Oral sequelae of chemotherapy: an important teaching opportunity for oncology health care providers and their patients  

Microsoft Academic Search

The object of this work was to conduct a rapid assessment of a teaching hospital's promotion of optimal oral health among\\u000a its chemotherapy patients. A pilot study was undertaken, which included focus interviews with oncology clinic staff, a review\\u000a of the fellowship training curriculum, and unobtrusive observations in the clinic setting. Charts were also audited for oncology\\u000a patients who were

Georgia Robins Sadler; Loree Oberle-Edwards; Arvina Farooqi; William M. Hryniuk

2000-01-01

81

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.

2011-01-01

82

Applying the American Pain Society's QA standards to evaluate the quality of pain management among surgical, oncology, and hospice inpatients in Taiwan  

Microsoft Academic Search

The purpose of this study was two-fold: first, to apply the American Pain Society (APS) outcome questionnaire to examine and compare the quality of pain management provided in surgical, oncology, and hospice inpatient units in the Taipei area of Taiwan, and second, to provide baseline data of pain management quality in advance of the implementation of national guidelines for cancer

Chia-Chin Lin

2000-01-01

83

Oncology Nurses' Teaching and Support for Suicidal Patients  

Microsoft Academic Search

Although the nursing literature contains many references to the nurses' teaching, support, and advocacy functions, the consumer and other health care professional literature suggests that the potential importance of nurses in these roles is not widely accepted. In a secondary analysis, we examined nurses' interventions for teaching and support in survey of a random sample of oncology nurses in a

Sharon M. Valente

2007-01-01

84

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.

Cieslak, Katarzyna

2013-01-01

85

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

86

Management of Gynecologic Oncology Patients with a Preoperative Deep Vein Thrombosis  

Microsoft Academic Search

Our experience with gynecologic oncology patients presenting preoperatively with a deep vein femoral thrombosis is reported. Over a 3-year period data were collected on all patients at the University of South Florida (USF) requiring surgery for a known or suspected gynecologic cancer and having a concomitant active femoral venous thrombosis. Twelve such patients were managed. Management was divided among three

Mitchel S. Hoffman; Steven DeCesare; James V. Fiorica; William S. Roberts; Denis Cavanagh

1997-01-01

87

High Colonization Rate and Prolonged Shedding of Clostridium difficile in Pediatric Oncology Patients.  

PubMed

Surveillance testing for Clostridium difficile among pediatric oncology patients identified stool colonization in 29% of patients without gastrointestinal symptoms and in 55% of patients with prior C. difficile infection (CDI). A high prevalence of C. difficile colonization and diarrhea complicates the diagnosis of CDI in this population. PMID:24785235

Dominguez, Samuel R; Dolan, Susan A; West, Kelly; Dantes, Raymund B; Epson, Erin; Friedman, Deborah; Littlehorn, Cynthia A; Arms, Lesley E; Walton, Karen; Servetar, Ellen; Frank, Daniel N; Kotter, Cassandra V; Dowell, Elaine; Gould, Carolyn V; Hilden, Joanne M; Todd, James K

2014-08-01

88

Guide to Surgical Specialists  

MedlinePLUS

... the surgical care and prevention of traumatic injuries); pediatric surgical oncology (knowledge of the diagnosis and surgical care of ... and disorders of the cranial and spinal nerves. Pediatric neurosurgeons manage ... care, oncology care, and primary health care for women. Specialty ...

89

Surgical Guides (Patient-Specific Instruments) for Pediatric Tibial Bone Sarcoma Resection and Allograft Reconstruction  

PubMed Central

To achieve local control of malignant pediatric bone tumors and to provide satisfactory oncological results, adequate resection margins are mandatory. The local recurrence rate is directly related to inappropriate excision margins. The present study describes a method for decreasing the resection margin width and ensuring that the margins are adequate. This method was developed in the tibia, which is a common site for the most frequent primary bone sarcomas in children. Magnetic resonance imaging (MRI) and computerized tomography (CT) were used for preoperative planning to define the cutting planes for the tumors: each tumor was segmented on MRI, and the volume of the tumor was coregistered with CT. After preoperative planning, a surgical guide (patient-specific instrument) that was fitted to a unique position on the tibia was manufactured by rapid prototyping. A second instrument was manufactured to adjust the bone allograft to fit the resection gap accurately. Pathologic evaluation of the resected specimens showed tumor-free resection margins in all four cases. The technologies described in this paper may improve the surgical accuracy and patient safety in surgical oncology. In addition, these techniques may decrease operating time and allow for reconstruction with a well-matched allograft to obtain stable osteosynthesis.

Bellanova, Laura; Paul, Laurent; Docquier, Pierre-Louis

2013-01-01

90

Current Oncological Treatment of Patients with Pancreatic Cancer in Germany: Results from a National Survey on behalf of the Arbeitsgemeinschaft Internistische Onkologie and the Chirurgische Arbeitsgemeinschaft Onkologie of the Germany Cancer Society  

Microsoft Academic Search

Background: No data have previously been available regarding the current treatment of patients with pancreatic cancer (PC) in German hospitals and medical practices. Methods: Between February 2007 and March 2008 we conducted a national survey [on behalf of the Arbeitsgemeinschaft Internistische Onkologie (AIO) and the Chirurgische Arbeitsgemeinschaft Onkologie (CAO)] regarding the current surgical and oncological treatment of PC in Germany.

Stefan Boeck; Christiane J. Bruns; Mirja Sargent; Claus Schäfer; Thomas Seufferlein; Karl-Walter Jauch; Volker Heinemann

2009-01-01

91

Monitoring the critically ill surgical patient.  

PubMed Central

Critically ill surgical patients account for approximately half the patients in an active multidisciplinary critical care unit. Hypovolemia and sepsis are common in such patients and affect a number of organ systems. Monitoring these systems provides therapeutically relevant information that may decrease morbidity and improve patient survival. Circulatory hemodynamics may be assessed by direct measurement of the arterial blood pressure, central venous and pulmonary artery pressure monitoring and cardiac output determination; the data thus obtained are valuable in guiding fluid replacement in the hypovolemic individual. The respiratory status may be assessed by bedside spirometry and measurement of arterial blood gas tensions to gauge pulmonary function and the need for assisted ventilation. Renal dysfunction is common in such patients; careful analysis of both urine and blood may identify prerenal as opposed to renal and postrenal factors. Monitoring of the gastrointestinal tract, especially for hemorrhage, is important. Finally, careful attention to nutritional status and provision of adequate protein and energy intake by mouth or by vein is a vital component of the optimal care of these patients.

Holliday, R L; Doris, P J

1979-01-01

92

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.

Shaikh, ZS; Krueper, S; Malins, TJ

2011-01-01

93

Group Therapy with Patients in the Waiting Room of an Oncology Clinic.  

ERIC Educational Resources Information Center

Describes a therapy group for cancer patients, conducted by cotherapists in an oncology waiting room. Group members provided mutual support and shared concerns and coping methods. Medical staff members became more involved and were more able to address the affective needs of the patients and their families. (JAC)

Arnowitz, Edward; And Others

1983-01-01

94

Trajectories of anxiety in oncology patients and family caregivers during and after radiation therapy  

Microsoft Academic Search

PurposeAnxiety is common in patients undergoing radiation therapy (RT) and in their family caregivers (FCs). Little is known about individual differences in anxiety trajectories during and after RT. This study aimed to identify distinct latent classes of oncology patients and their FCs based on self-reported anxiety symptoms from the beginning to four months after the completion of RT.

Laura B. Dunn; Bradley E. Aouizerat; Bruce A. Cooper; Marylin Dodd; Kathryn Lee; Claudia West; Steven M. Paul; William Wara; Patrick Swift; Christine Miaskowski

95

Managing distress in oncology patients: description of an innovative online educational program for nurses.  

PubMed

The American Psychosocial Oncology Society and the Individual Cancer Assistance Network have launched the online continuing education accredited program "ICAN: Distress Management for Oncology Nursing" to address the ability of oncology nurses to assess, treat, and refer patients with a range of psychosocial problems. An important goal of the program is to reduce traditional barriers to psychosocial oncology education by providing the oncology nursing community with easy access to information from experts in the field. There are 4 Internet webcasts: Nurse's Role in Recognizing Distress in Patients and Caregivers; Assessment Recommendations; Treatment Strategies; and Principles and Guidelines for Psychotherapy and Referral. The program examines the prevalence and dimensions of patient distress and offers instruction on how to effectively integrate screening tools, such as the Distress Thermometer and Problem Check List, into clinical practice. It provides details on relevant interventions and referral algorithms based on the National Comprehensive Cancer Network Guidelines for Distress Management. It explores the devastating impact of psychological distress on quality of life, and the unique position of nurses in busy inpatient settings, outpatient clinics, and offices to detect, intervene, and refer to appropriate services. Providing information over the Internet addresses common barriers to learning, including schedule and time constraints. PMID:18987517

Pasacreta, Jeannie V; Kenefick, Amy L; McCorkle, Ruth

2008-01-01

96

Occult trauma mimicking metastases on bone scans in pediatric oncology patients  

Microsoft Academic Search

Background  Tracer-avid osseous lesions are usually considered to represent metastases in pediatric oncology patients. However, sites\\u000a of minor, clinically occult, skeletal trauma may be mistaken for osseous metastases.\\u000a \\u000a \\u000a \\u000a Objective  The objective of this study was to review our experience with skeletal scintigraphy in pediatrie oncology patients to determine\\u000a specificity for metastatic disease.\\u000a \\u000a \\u000a \\u000a Materials and methods  We reviewed 164 bone scans performed on 96

Patricia A. Lowry; M. Cristie Carstens

1997-01-01

97

Cancer patient expectations of and communication with oncologists and oncology nurses: the experience of an integrated oncology and palliative care service  

Microsoft Academic Search

The purpose of this study was to evaluate ambulatory cancer patients' knowledge of their diagnosis and stage, their expectations of medical and nursing staff, and issues related to communication with the professional staff. A structured interview was conducted with each of 103 consecutive cancer patients attending the Oncology Day Hospital of the Shaare Zedek Medical Center. There were 77 women

Rama Sapir; Raphael Catane; Bella Kaufman; Ruti Isacson; Amiel Segal; Simon Wein; Nathan I. Cherny

2000-01-01

98

Seroprevalence of Hepatitis B and C among Oncology Patients in Turkey  

PubMed Central

Hepatitis B virus (HBV) is one of the public-health issues worldwide. Approximately two billion people are infected with HBV, and about 350 million people are chronic carriers globally. About 3% of the world population is infected with hepatitis C virus (HCV). Oncology patients receiving packed red blood cell suspensions and other blood products usually are in the high-risk group for infections due to these viruses. The aim of the study was to detect the seroprevalence of hepatitis B and hepatitis C among chemotherapy patients at the Oncology Department of the Tepecik Education and Research Hospital. HBsAg, anti-HBs, anti-HBcIgM, anti-HBc total and anti-HCV assays were studied by enzyme immunoassay method (Diasorin, Italy) in serum samples of patients (n=448) referred to the Department of Oncology of the Tepecik Education and Research Hospital during 1 June 2006–1 January 2007. Of the 448 patients, 19 (4.2%) were HBsAg-positive, and three (0.7%) had anti-HCV positivity. In this study, the seroprevalence of HBV was similar to previous data in Turkey. This could be due to widespread vaccination programmes. The seroprevalence of low anti-HCV may be because of controlled blood transfusion. Oncology patients should be monitored for their protective antibody levels against HBV, and they must be included in the vaccination programme. Their anti-HCV status should also be checked as well.

Kose, Sukran; Olmezoglu, Ali; Gozaydin, Ayhan

2011-01-01

99

A prospective study assessing patient satisfaction at a large tertiary gynecologic oncology/dysplasia unit  

PubMed Central

Background: Patient satisfaction is an important quality assurance measure in the delivery of health care. We conducted a prospective study to assess patient satisfaction at a large tertiary oncology/dysplasia unit. Aims: To assess current patient satisfaction at a large tertiary oncology/dysplasia unit and identify potential areas for improvement. Methods: This was a prospective study of patients attending a tertiary oncology/dysplasia unit. Patients were invited to participate and, if they agreed, were given a validated questionnaire to complete at the end of their consultation. Descriptive statistics were then used to analyze the data and identify potential areas of improvement. Results: One hundred eighty-seven patients were recruited, and 96% of patients were satisfied with the overall level of care received. Significant positive features of the service included helpfulness of the staff, cleanliness of the facility, and measures implemented to respect patient privacy. Lack of patient parking, waiting times in the clinic, difficulties in contacting the service, and locating the building were identified as areas for improvement. Conclusion: Patients attending our facility were largely satisfied with the overall level of care received. Nonclinical factors including parking, waiting times, and access to the service were identified as areas for improvement.

Pather, Selvan; Tai, Davina; Philp, Shannon; Nattress, Kathryn; Carter, Jonathan; Dalrymple, Christopher; Atkinson, Ken

2010-01-01

100

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.

101

Use of Psychosocial Services Increases after a Social Worker-Mediated Intervention in Gynecology Oncology Patients  

ERIC Educational Resources Information Center

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…

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

2013-01-01

102

Pediatric Oncology Nurses' Attitudes Related to Discussing Fertility Preservation With Pediatric Cancer Patients and Their Families  

Microsoft Academic Search

This study explores nurses' attitudes toward the dis- cussion of fertility preservation (FP) with pediatric cancer patients and their families. A cross- sectional survey was administered to attendees of a pediatric oncology conference. Of the 115 nurses who responded and comprised the study sample, most reported discussing risks of infertility or FP ? 50% of the time. The 3 attitudinal

Susan T. Vadaparampil; Heather Clayton; Gwendolyn P. Quinn; Lindsey M. King; BA Michael Nieder; Crystal Wilson

103

Current concepts in the surgical management of glioma patients.  

PubMed

The scientific basis for the surgical management of patients with glioma is rapidly evolving. The infiltrative nature of these cancers precludes a surgical cure, but despite this, cytoreductive surgery remains central to high-quality patient care. In addition to tissue sampling for accurate histopathological diagnosis and molecular genetic characterisation, clinical benefit from decompression of space-occupying lesions and microsurgical cytoreduction has been reported in patients with different grades of glioma. By integrating advanced surgical techniques with molecular genetic characterisation of the disease and targeted radiotherapy and chemotherapy, it is possible to construct a programme of personalised surgical therapy throughout the patient journey. The goal of therapeutic packages tailored to each patient is to optimise patient safety and clinical outcome and must be delivered in a multidisciplinary setting. Here we review the current concepts that underlie surgical subspecialisation in the management of patients with glioma. PMID:24882149

Watts, C; Price, S J; Santarius, T

2014-07-01

104

Pelvic colorectal recurrence: crucial role of radiologists in oncologic and surgical treatment options  

PubMed Central

Abstract Radical resection is the only potential cure for patients with locally advanced primary and recurrent rectal cancer and is considered curative only when the histologic margins are clear of tumour. Early diagnosis of the disease is essential as it increases the likelihood of a potentially curative resection and prevention of dissemination. Clinical examination, tumour markers and radiologic modalities such as ultrasonography, computed tomography, magnetic resonance imaging and positron emission tomography are routinely used in an effort to accurately stage these patients and provide useful information for the selection of patients for further treatment/management. This review describes the methods of staging patients with locally advanced primary and recurrent rectal cancer prior to surgery emphasizing the role that radiologists have in this process.

Georgiou, P.A.; Tekkis, P.P.

2011-01-01

105

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.

106

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.

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

2014-01-01

107

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.

2013-01-01

108

From patient-specific mathematical neuro-oncology to precision medicine.  

PubMed

Gliomas are notoriously aggressive, malignant brain tumors that have variable response to treatment. These patients often have poor prognosis, informed primarily by histopathology. Mathematical neuro-oncology (MNO) is a young and burgeoning field that leverages mathematical models to predict and quantify response to therapies. These mathematical models can form the basis of modern "precision medicine" approaches to tailor therapy in a patient-specific manner. Patient-specific models (PSMs) can be used to overcome imaging limitations, improve prognostic predictions, stratify patients, and assess treatment response in silico. The information gleaned from such models can aid in the construction and efficacy of clinical trials and treatment protocols, accelerating the pace of clinical research in the war on cancer. This review focuses on the growing translation of PSM to clinical neuro-oncology. It will also provide a forward-looking view on a new era of patient-specific MNO. PMID:23565501

Baldock, A L; Rockne, R C; Boone, A D; Neal, M L; Hawkins-Daarud, A; Corwin, D M; Bridge, C A; Guyman, L A; Trister, A D; Mrugala, M M; Rockhill, J K; Swanson, K R

2013-01-01

109

Practical Issues in the Surgical Care of the Obese Patient  

PubMed Central

The incidence of obesity has steadily climbed to epidemic proportions in the United States. To provide optimal surgical care for the growing number of obese surgical patients, surgeons and other healthcare personnel must often modify routine procedures and standard treatment protocols. Psychological support of obese patients is an additional factor that frequently must be addressed during the perioperative period.

Hammond, Kerry L.

2013-01-01

110

Surgical Treatment of 26 Patients with Necrotizing Pneumonia  

Microsoft Academic Search

Background: This study aimed to review the outcome of patients treated with surgical resection for necrotizing lung infection with various co-morbidities and complications. Methods: The records of 26 patients treated with pulmonary resection for necrotizing pneumonia between July 2004 and January 2010 were retrospectively reviewed. Surgical procedures included large wedge resection (n = 1), lobectomy (n = 19) and bilobectomy

Y.-F. Tsai; Y.-T. Tsai; Y.-H. Ku

2011-01-01

111

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.

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

2014-01-01

112

"Il Corpo Ritrovato": Dermocosmetological Skin Care Project for the Oncologic Patient  

PubMed Central

Neoplastic disease and its therapeutic options have a huge impact on the patient's quality of life from both the emotional and the working point of view. The project “Il Corpo Ritrovato” aims at creating an interdisciplinary network of physicians to improve the quality of life of the oncologic patient, focusing on such important aspects as dermocosmetological skin care but also on the evaluation of new therapeutic and diagnostic algorithms in order to make further progress in the field of prevention.

Fabbrocini, G.; Romano, M. C.; Cameli, N.; Mariano, M.; Pastore, F.; Annunziata, M. C.; Mazzella, C.; De Vita, Valerio; Mauriello, Maria Chiara; Monfrecola, G.

2011-01-01

113

NCI-CCR Pediatric Oncology Branch - Referring a Patient  

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 Clinical Programs Clinical

114

Oncologic imaging  

SciTech Connect

This text is devoted to the goal of integrating medical imaging into the field of oncology. This book serves as a guide to the appropriate selection and sequencing of the vast array of imaging techniques currently available. Contents: Staging and classification of cancers; Imaging strategies for oncologic diagnosis and staging; Brain and spinal cord neoplasms; The upper aerodigestive tract: cervical lymph node metastases; Thoracic neoplasms; Esophageal cancer; Malignant neoplasms of the pancreas, the liver, and biliary tract; Prostate cancer; Gynecological neoplasms; Hodgkin's disease and the non-Hodgkin's lymphomas; Tumors of the skeletal system; Pediatric oncology; Computed tomography and radiation therapy treatment planning; Contributions of interventional radiology to diagnosis and management of the cancer patient; The impact of future technology on oncologic diagnosis.

Bragg, D.G.; Rubin, P.; Youker, J.E.

1985-01-01

115

Prediction of pathological and oncological outcomes based on extended prostate biopsy results in patients with prostate cancer receiving radical prostatectomy: a single institution study  

PubMed Central

Background The prediction of pathological outcomes prior to surgery remains a challenging problem for the appropriate surgical indication of prostate cancer. This study was performed to identify preoperative values predictive of pathological and oncological outcomes based on standardized extended prostate biopsies with core histological results diagrammed/mapped in patients receiving radical prostatectomy for prostate cancer clinically diagnosed as localized or locally advanced disease. Methods In 124 patients with clinically localized or locally advanced prostate cancer (cT1c–cT3a) without prior treatment, pathological outcomes on the surgical specimen including seminal vesicle involvement (SVI), positive surgical margin (PSM), and perineural invasion (PNI) were studied in comparison with clinical parameters based on the results of 14-core prostate biopsies comprising sextant, laterally-directed sextant, and bilateral transition zone (TZ) sampling. Results Concerning the association of pathological outcomes with oncological outcomes, patients with PSM and PNI on surgical specimens had poorer biochemical-progression-free survival than those without PSM (logrank p?=?0.002) and PNI (p?=?0.003); it was also poorer concerning SVI, although the difference was not significant (p?=?0.120). Concerning the impact of clinical parameters on these pathological outcomes, positive TZ and multiple positive biopsy cores in the prostatic middle were independent values predictive of SVI with multivariate analyses (p?=?0.020 and p?=?0.025, respectively); both positive TZ and multiple positive prostatic middle biopsies were associated with larger tumor volume (p?oncological outcomes. When diagramming biopsy-core results, extended biopsy may provide additional information for predicting oncological and pathological outcomes including SVI in patients clinically diagnosed as having localized or locally advanced disease. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8790262771042628

2012-01-01

116

Psychological functioning of morbidly obese patients after surgical treatment  

Microsoft Academic Search

OBJECTIVE: To investigate the long-term effects of surgically induced weight loss on the psychological functioning of morbidly obese patients.DESIGN: Comparison between preoperative and postoperative psychometric test results in a cross-sectional study.PATIENTS AND METHODS: Three psychometric tests were administered to 62 morbidly obese patients before and after surgery.RESULTS: The mean follow-up was 85.9±48.1 months. Surgical treatment resulted in a mean weight

WG van Gemert; RM Severeijns; JWM Greve; N Groenman; PB Soeters

1998-01-01

117

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

118

Epidemic Pseudomonas aeruginosa serotype O16 bacteremia in hematology-oncology patients.  

PubMed Central

From 1 August 1978 through 31 December 1982, 98 hematology-oncology patients had positive cultures for Pseudomonas aeruginosa serotype O16; 22 of these patients developed bacteremia, and this bacteremia was associated with the occurrence of extensive perineal cellulitis in 10 patients (45.5%). Seventeen bacteremic patients died. The epidemic strain differed from other P. aeruginosa organisms isolated at the hospital by its resistance to all antibiotics available at that time (ticarcillin, piperacillin, azlocillin, tobramycin, ceftizoxime, ceftriaxone, moxalactam, ceftazidime, and fosfomycin). Univariate analysis showed the following factors to be significantly associated with P. aeruginosa O16 bacteremia: the severity of granulocytopenia at the time of the bacteremia, more days with fever, the administration of ticarcillin or an aminoglycoside, the receipt of a greater number of antimicrobial agents for a longer period of time before documentation of the bacteremia, and the occurrence of cellulitis. Logistic regression analysis showed that duration of fever, duration of bacteremia, and the number of antimicrobial agents administered before documentation of the bacteremia were the best predictors of P. aeruginosa O16 bacteremia. In a prospective study of the acquisition of P. aeruginosa by hematology-oncology patients, 1,149 specimens (throat and rectal swabs) from 270 patients and 201 specimens from their washbasin drains were collected. On only three occasions was the epidemic strain isolated from both the patient and his or her washbasin, but in each case the colonization of the patient preceded the isolation of the strain from the washbasin. The transmission of any P. aeruginosa organism from washbasin drain to patient could not be documented. Contact isolation precautions from the Centers for Disease Control were used for all hematology-oncology patients colonized or infected with P. aeruginosa after 7 January 1983. No case of P. aeruginosa O16 bacteremia has occurred at Hotel Dieu since July 1984. Images

Richet, H; Escande, M C; Marie, J P; Zittoun, R; Lagrange, P H

1989-01-01

119

Cancerous patients and outbreak of Escherichia coli: an important issue in oncology  

PubMed Central

The widespread of the Escherichia coli outbreak in Europe becomes an important public concern at global level. The infection can be serious and might result in death. The retrospective literature review on this specific topic is performed. In this specific brief article, the author presented and discussed on the problem of Escherichia coli infection in the cancerous patients. This is an actual important issue in medical oncology for the scenario of Escherichia coli epidemic.

Joob, Beuy; Wiwanitkit, Viroj

2014-01-01

120

Home administration of medications in pediatric oncology patients: use of the Travenol infusor.  

PubMed

Administration of chemotherapy and other medications with an infusor can facilitate home care of the pediatric oncology patient. An infusor that is reliable, lightweight, disposable, and delivers an infusion at a constant rate is described in two case studies. Use of this device has allowed children to receive most of their chemotherapy as outpatients thus decreasing the cost of care and facilitating the child's return to more normal daily activities. PMID:2604937

Pasut, B

1989-10-01

121

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

122

“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

123

Herbaspirillum Species Bacteremia in a Pediatric Oncology Patient?  

PubMed Central

Herbaspirillum species, an organism commonly found in soil, has only recently been linked to disease in humans. We report Herbaspirillum bacteremia in a 2-year-old female patient following a hematopoietic stem cell transplant for relapsed acute lymphoblastic leukemia.

Ziga, Edward D.; Druley, Todd; Burnham, Carey-Ann D.

2010-01-01

124

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

125

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.

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

2014-01-01

126

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.

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

2012-01-01

127

Patients' experience of important factors in the healthcare environment in oncology care  

PubMed Central

Background and objective The aim of this study was to describe what factors of the healthcare environment are perceived as being important to patients in oncology care. Design A qualitative design was adopted using focus group interviews. Setting and participants The sample was 11 patients with different cancer diagnoses in an oncology ward at a university hospital in west Sweden. Results Analysis of the patients’ perceptions of the environment indicated a complex entity comprising several aspects. These came together in a structure consisting of three main categories: safety, partnership with the staff, and physical space. The care environment is perceived as a complex entity, made up of several physical and psychosocial aspects, where the physical factors are subordinated by the psychosocial factors. It is clearly demonstrated that the patients’ primary desire was a psychosocial environment where they were seen as a unique person; the patients wanted opportunities for good encounters with staff, fellow patients, and family members, supported by a good physical environment; and the patients valued highly a place to withdraw and rest. Conclusions This study presents those attributes that are valued by cancer patients as crucial and important for the support of their well-being and functioning. The results show that physical aspects were subordinate to psychosocial factors, which emerged strongly as being the most important in a caring environment.

Browall, Maria; Koinberg, Ingalill; Falk, Hanna; Wijk, Helle

2013-01-01

128

Modified supracricoid laryngectomy: oncological and functional outcomes in the elderly  

PubMed Central

Background Supracricoid laryngectomy is an organ preservation surgical technique for early-stage glottic tumors. Modified supracricoid laryngectomy using sternohyoid muscles for neoglottis reconstruction is a new surgical technique. This report evaluates oncological and functional outcomes of this new technique and its feasibility in elderly patients. Methods Clinical records from 21 consecutive patients affected by glottic cancer and treated by modified SCL between 2004 and 2009 were retrospectively reviewed. Postoperative parameters and quality of voice after modified SCL were retrospectively reviewed. Actuarial overall survival, disease-specific survival rates, and recurrence-free survival rates were assessed. The functional and oncological outcomes of patients over 65 years were compared with those of patients younger than 65 years of age. Results There were no postoperative complications and all of the patients had complete swallowing rehabilitation. Twenty of the 21 patients had decannulation. Two patients received total laryngectomy for locoregional relapse. Overall survival and disease-specific survival rates were 100%. Recurrence-free survival rates were 90.1% and 90% in patients younger and older than 65 years of age, respectively. The larynx preservation index was lower in patients who were older than 65 years of age. The postoperative courses with regard to functional outcome and voice quality in elderly patients were similar to those of patients younger than 65 years of age. Conclusion Modified SCL is a new open organ preservation surgical technique that is oncologically safe. The positive functional and oncological outcomes of this surgical procedure allow it to be performed in elderly patients.

Allegra, Eugenia; Franco, Teresa; Trapasso, Serena; Domanico, Rossana; La Boria, Alessandro; Garozzo, Aldo

2012-01-01

129

Massachusetts general hospital: improving patient access to the breast oncology clinic.  

PubMed

As part of Massachusetts General Hospital's overall quality improvement program, the Massachusetts General Hospital Breast Oncology Program participated in the NCCN Breast Cancer Outcomes Database Opportunities for Improvement Program. A review of concordance to breast oncology quality measures revealed that a small proportion of patients with breast cancer started chemotherapy more than 120 days after diagnosis. Therefore, the research team designed a quality improvement project to increase the percentage of concordance with the ASCO quality measure that requires time to treatment of less than 120 days and to decrease the number weeks from last definitive surgery to first adjuvant chemotherapy by 2014. A multipronged approach of improvements was used: to systems and infrastructure, communication among providers, and recruitment of additional staff as needed. This article describes the project and future initiatives to further improve the quality of breast cancer care at the institution. PMID:24614048

Lennes, Inga T; Bloom, Mara; Bohlen, Nie; Moy, Beverly

2014-02-01

130

Moving CLABSI Prevention Beyond the ICU: Risk Factors in Pediatric Oncology Patients  

PubMed Central

Background and Objective Central line-associated bloodstream infections (CLABSIs) frequently complicate the use of central venous catheters (CVCs) among pediatric patients with cancer. Our objectives were to describe the microbiology and identify risk factors for hospital-onset CLABSI in this patient population. Design Retrospective case-control study. Setting Oncology and stem cell transplant units of a freestanding, 396-bed quaternary care pediatric hospital. Participants Case subjects (N=54) were patients with a diagnosis of malignancy and/or stem cell transplant recipients with CLABSI occurring during admission. Controls (N=108) were identified using risk set sampling of hospitalizations among patients with a CVC, matched on date of admission. Methods Multivariate conditional logistic regression was used to identify independent predictors of CLABSI. Results The majority of CLABSI isolates were Gram-positive bacteria (58%). The most frequently isolated organism was Enterococcus faecium, and 6 of 9 isolates were resistant to vancomycin. In multivariate analyses, independent risk factors for CLABSI included platelet transfusion within the prior week (odds ratio [OR], 10.90 [95% confidence interval {CI}, 3.02–39.38], P<0.001) and CVC placement within the previous month (<1 week vs. ?1 month: OR, 11.71 [95% CI, 1.98–69.20], P=0.02; ?1 week and <1 month vs. ?1 month: OR, 7.37 [95% CI, 1.85–29.36], P=0.004). Conclusions Adjunctive measures to prevent CLABSI among pediatric oncology patients may be most beneficial in the month following CVC insertion and in patients requiring frequent platelet transfusions. Vancomycin-resistant enterococci may be an emerging cause of CLABSI in hospitalized pediatric oncology patients and are unlikely to be treated by typical empiric antimicrobial regimens.

Kelly, Matthew; Conway, Margaret; Wirth, Kathleen; Potter-Bynoe, Gail; Billett, Amy L.; Sandora, Thomas J.

2014-01-01

131

An Occupational Analysis of Counselors Working with Oncology Patients.  

ERIC Educational Resources Information Center

Empirically examined counselors' (n=2) work behaviors with cancer patients and families in hospital setting. Results indicated most of work behaviors performed by the counselors were specialized to a hospital setting, and within this domain, most common work behavior observed was in clinical supervision of volunteers, the second-most in the…

Vacc, Nicholas A.

1989-01-01

132

Nutrient Intakes of Hospitalized Pediatric Patients on Oncology Services  

Microsoft Academic Search

Design Subjects were randomized into one of two dining arms for three consecutive days, each with strata based on diagnosis and age. Subjects in the first arm dined with caregivers through room service, while subjects in the second arm dined independently.Subjects\\/Setting Fifty patients, ages 3 to 18 years, who were hospitalized in a pediatric research hospital in the midsouth with

S Gurley; MA Smith; R Williams; Crase

1998-01-01

133

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.

134

[Treatment of postoperative pain in elderly oncology patients with intravenous administration of a 50% glucose solution].  

PubMed

Postoperative pain is the most important factor od so called "tumor-promotive effect of surgery" i.e. of endocrine-metabolic changes having the consequence drop in immune, antiinfective and antitumor defense. Due to presence of organic involutive changes, old people (= 65 years), often have serious side effects during application of usual analgetics. Since hypertonic glucose (33%) given i.v. or per os, works analgesically in small children there is assumption that it can be used in treatment of postoperative pain in old oncology patients. We tested the hypothesis that postoperative pain in old oncology patients can be treated with i.v. application of 50% of glucose solution. 37 oncology patients over 65 years, 26 females and 11 males, operated for breast cancer and soft tissue cancer, were investigated. Average age of the patients was 72 +/- 4 years. 50% Glucose solution was given in two boluses of 20 ml each: the first bolus was given to all patients at the end of anesthesia, and the other bolus was given individually after appearance of post-operative pain. Pain intensity (in coefficients of the visual analogue scale VAK = 1-100) and its characteristics were tested by oral testing of operated patients; after weakening from anesthesia, after the first appearance of the pain and 15 minutes after giving of the second glucose bolus. None patient had pain weakening from anesthesia. All tested patients experienced pain during the first 70 minutes and it could be categorized as very strong pain (= 82 VAK). The pain was decreased with another glucose bolus by approximately (= 56% VAK) so it was classifies in category of bearable pains (= 36 VAK). In 9 patients (24.3%) the pain had neuropathic component (filing of "burning") which could not be eliminated by hypertonic glucose, but only with application of tramadol. Activation of the central cholinergic transmission is the most significant mechanism of analgesic glucose effect, but, probably there is another one: facilitation of entrance of formerly given analgesics in the brain cells. As energetic substrate, entering all organism cells, glucose could make easier intracell breakthrough of any other analgesic drug, of the peripheral or central action, and final antipain effect could be potential or additional one. It was concluded that 40 ml of 50% glucose solution given in two identical boluses, has good analgesic effect in treatment of postoperative pain in old oncology patient: the pain was not completely eliminated, but it was significantly decreased and became tolerable. Hypertonic glucose neither eliminates, nor decreases neuropathic component of the pain, so, when the pain appears the therapy should be supplemented with other drugs, which may completely eliminate all pain components. PMID:14608864

Jovanovi?, Nikola C; Dzodi?, Radan; Celebi?, Aleksandar; Zegarac, Milan; Djurisi?, Igor; Stojiljkovi?, Dejan

2003-01-01

135

Patient-Reported Outcomes Are Changing the Landscape in Oncology Care: Challenges and Opportunities for Payers  

PubMed Central

Background A patient-reported outcome (PRO) is a subjective report that comes from a patient without interpretation by a clinician. Because of the increasingly significant role of PROs in the development and evaluation of new medicines, the US Food and Drug Administration (FDA) issued a formal guidance to describe how PRO instruments will be reviewed and evaluated with respect to claims in approved medical product labeling. Meanwhile, PROs continue to appear in oncology clinical trials more frequently; however, it is unclear how payers and policymakers can use PRO data in the context of decision-making for cancer treatments. Objective The objective of this article is to discuss the challenges and opportunities of incorporating oncology-related PRO data into payer decision-making. Discussion Payer concerns with PRO instruments are often related to issues regarding measurement, relevance, quality, and interpretability of PROs. Payers may dismiss PROs that do not independently predict improved outcomes. The FDA guidance released in 2009 demonstrates, as evidenced by the case of ruxolitinib, how PRO questionnaires can be generated in a relevant, trustworthy, and meaningful way, which provides an opportunity for payers and policy decision makers to focus on how to use PRO data in their decision-making. This is particularly relevant in oncology, where a recent and sizable number of clinical trials include PRO measures. Conclusion As an increasing number of oncology medications enter the market with product labeling claims that contain PRO data, payers will need to better familiarize themselves with the opportunities associated with PRO questionnaires when making coverage decisions. PRO measures will continue to provide valuable information regarding the risk–benefit profile of novel agents. As such, PRO measures may provide evidence that should be considered in payers' decisions and discussions; however, the formal role of PROs and the pertinence of PROs in decision-making has yet to be understood.

Zagadailov, Erin; Fine, Michael; Shields, Alan

2013-01-01

136

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

137

Oocyte Cryostorage to Preserve Fertility in Oncological Patients  

PubMed Central

Thanks to the progress in oncostatic treatments, young women affected by cancer have a fairly good chance of surviving the disease and leading a normal post-cancer life. Quite often, however, polychemiotherapy and/or radiotherapy can induce ovarian damage and significantly reduce the content of follicles and oocytes inside the ovary, thus predisposing the patient to menstrual disorders, infertility, and precocious menopause. Several techniques have been proposed to preserve fertility in these patients; among them oocyte collection and cryopreservation prior to the oncostatic treatment has been widely applied in the last decade. The proper indications, the permitting conditions, the available hormonal stimulation protocols, as well as the effectiveness and limits of this option will be discussed herein, with a comprehensive and up-to-date review of the two techniques commonly used to cryostore oocytes, the slow-freezing technique and the vitrification technique.

Revelli, Alberto; Molinari, Emanuela; Salvagno, Francesca; Delle Piane, Luisa; Dolfin, Elisabetta; Ochetti, Simona

2012-01-01

138

Dapsone-induced methemoglobinemia in pediatric oncology patients: Case examples  

Microsoft Academic Search

Over the last 25 years, significant advances have been made in supportive care of the immunocompromised patient. One significant advance is the use of trimethoprim-sulfamethoxazole (TMP-SMZ) in the prevention of Pneumocystic carinii pneumonia (PCP). Although TMP-SMZ remains the drug of choice for PCP prophylaxis, children who develop or have a history of adverse reactions must be prescribed an alternative treatment.

Belinda N. Mandrell; John N. McCormick

2001-01-01

139

[Hepatosplenic candidiasis in patients treated for hemato-oncological disorders].  

PubMed

Hepatosplenic candidiasis is increasingly observed in patients with a haematological malignancy who have received chemotherapy. A case history is described of a male aged 45 who developed symptoms of hepatosplenic candidiasis caused by Candida tropicalis after treatment for acute myeloid leukaemia. The disease is characterized by persistent fever after recovery of the leukopenia induced by the chemotherapy. Echographic and computer-tomographic examination may reveal abscess patterns specific of Candida in the liver. Treatment consists of amphotericin B intravenously or fluconazole orally. Protracted treatment is frequently required. PMID:8289957

Zweegman, S; Sibinga, L; Huijgens, P C

1994-01-01

140

Case management process improvement protocol: transcribing an initial summary for the oncology geriatric patient in a rural satellite office.  

PubMed

This case management improvement project involved the provision of a transcribed summary of an initial clinic visit for elderly oncology patients at a rural satellite clinic. The aim of this project was to provide elderly patients at a rural satellite oncology clinic with a transcription of their encounter with the doctor and case manager when their diagnosis and treatment options were discussed. This project was introduced to improve communication and enhance satisfaction of the patients with their case management services. This low-cost intervention was implemented with 25 patients. Results demonstrated that the patient did express a high degree of satisfaction with this intervention. PMID:16205205

Henry, Regina A; Stanton, Marietta P

2005-01-01

141

Surgical management in patient with uveitis  

PubMed Central

Surgery in the management of uveitis can be divided based on indication: either for therapeutic or can be for diagnostic purposes or to manage complications. The commonest indications include: Visual rehabilitation: surgery for removal of cataract, band keratopathy, corneal scars, pupillary membranes, removal of dense vitreous membranes, management of complications: anti-glaucoma surgery, vitreous hemorrhage, retinal detachment and chronic hypotony and diagnostic: aqueous tap, vitreous biopsy, tissue biopsy (iris, choroid). In this review, we shall describe the surgical technique for visual rehabilitation and for management of complications.

Murthy, Somasheila I; Pappuru, Rajeev Reddy; Latha, K Madhavi; Kamat, Sripathi; Sangwan, Virender S

2013-01-01

142

Tuberculosis in pediatric oncology and bone marrow transplantation patients.  

PubMed

Five children with malignancies (3 hematologic, 1 medulloblastoma, 1 hepatoblastoma) and one bone marrow transplant patient were treated for tuberculosis over a 30-year period. Three had pulmonary disease, 3 disseminated tuberculosis, and 1 had scrofula. Four of five had positive tuberculin skin tests, cultures were positive in 5/6 children. One child died of disseminated TB after engraftment, and one child had hepatotoxicity likely related to tuberculosis therapy. All cases were potentially preventable had they been screened due to established risk factors of foreign birth (4/6) or parental foreign birth (2/6). All children should be screened for latent tuberculosis before chemotherapy. Pediatr Blood Cancer 2014; 61:1484-1485. © 2014 Wiley Periodicals, Inc. PMID:24623644

Cruz, Andrea T; Airewele, Gladstone; Starke, Jeffrey R

2014-08-01

143

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.

2011-01-01

144

Surgical team behaviors and patient outcomes  

Microsoft Academic Search

BackgroundLittle evidence exists that links teamwork to patient outcomes. We conducted this study to determine if patients of teams with good teamwork had better outcomes than those with poor teamwork.

Karen Mazzocco; Diana B. Petitti; Kenneth T. Fong; Doug Bonacum; John Brookey; Suzanne Graham; Robert E. Lasky; J. Bryan Sexton; Eric J. Thomas

2009-01-01

145

Patient participation in the medical decision-making process in haemato-oncology--a qualitative study.  

PubMed

Cancer patients are showing increased interest in shared decision-making. Patients with haematological illnesses, however, express considerably less desire for shared decision-making as compared with other oncological patient groups. The goal of the current project was to identify the reasons for the lower desire for shared decision-making among patients with haematological illness. We conducted qualitative, semi-structured interviews with 11 haematological patients (39-70 years old) after the beginning of therapy concerning the course and evaluation of medical shared decision-making. The patients were often overwhelmed by the complexity of the illness and the therapy and did not want to assume any responsibility in medical decision-making. They reported a great deal of distress and very traditional paternalistic role expectations with regards to their health care providers, which limited the patients' ability to partake in the decision-making process. In contrast to the socio-cultural support for many other oncological diseases, haematological diseases are not as well supported, e.g. there is a lack of self-help materials, systematic provision of information and support groups for patients, which may be related to a lower empowerment of this patient population. Results show the limits of patient participation in the context of highly complicated medical conditions. In addition to already researched preferences of the physicians and patients for shared decision-making, future research should pay greater attention to the process and other variables relevant to this aspect of the doctor-patient relationship. PMID:23731258

Ernst, J; Berger, S; Weißflog, G; Schröder, C; Körner, A; Niederwieser, D; Brähler, E; Singer, S

2013-09-01

146

Is the clinical use of cannabis by oncology patients advisable?  

PubMed

The use of the cannabis plant for various medical indications by cancer patients has been rising significantly in the past few years in several European countries, the US and Israel. The increase in use comes from public demand for the most part, and not due to a scientific basis. Cannabis chemistry is complex, and the isolation and extraction of the active ingredient remain difficult. The active agent in cannabis is unique among psychoactive plant materials, as it contains no nitrogen and, thus, is not an alkaloid. Alongside inconclusive evidence of increased risks of lung and head and neck cancers from prolonged smoking of the plant produce, laboratory evidence of the anti-cancer effects of plant components exists, but with no clinical research in this direction. The beneficial effects of treatment with the plant, or treatment with medicine produced from its components, are related to symptoms of the disease: pain, nausea and vomiting, loss of appetite and weight loss. The clinical evidence of the efficacy of cannabis for these indications is only partial. However, recent scientific data from studies with THC and cannabidiol combinations report the first clinical indication of cancer-related pain relief. The difficulties of performing research into products that are not medicinal, such as cannabis, have not allowed a true study of the cannabis plant extract although, from the public point of view, such studies are greatly desirable. PMID:24606496

Bar-Sela, Gil; Avisar, Adva; Batash, Ron; Schaffer, Moshe

2014-06-01

147

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.

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

1983-01-01

148

Alcohol abuse in cancer patients: a shadow side in the oncological field and research.  

PubMed

This article aims to foreground alcohol abuse by cancer patients and explore how alcohol abuse functions as a biographic master motive and at the same time is a shadow side in the oncological field and research. The research is based on a single case study which draws on empirical material from interviews, field notes and staff policy, with analysis using Bourdieu's concepts of trajectory of life and habitus. The findings show that the cancer patient's alcohol abuse is an important part of the trajectory of his private life and spare time. In social life with family and friends alcohol is given and normal and acts as a socialisator. Alcohol abuse provides both stability and instability in the cancer patient's life. When cancer results in work breaks and retirement, and spare time often is used as drinking time, then all daily life becomes drinking time for the cancer patient. Alcohol is often a hidden abuse at the working place and in the oncological field. In meetings with healthcare professionals, the patient chooses not to speak about his alcohol abuse to avoid further medicalisation. The challenge for the healthcare professionals is to see and accept alcohol abusers with cancer and their social lives without always trying to change their 'unhealthy' lifestyles. PMID:24368516

Glasdam, Stinne; Oye, Christine

2014-08-01

149

[POSSUM scoring system for predicting mortality in surgical patients].  

PubMed

This study evaluated the use of the POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) score for predicting mortality in surgical practice. In this study, 416 surgical patients admitted into ICUs for post-surgical care were analyzed. Both predicted and actual mortality rates were compared, according to four risk groups: 0-4%, 5-14%, 15-49%, 50% and over, and the area under the ROC curve of the POSSUM and APACHE II for mortality. The POSSUM and APACHE II scores overestimated the risk of death. The area under the ROC curve of the POSSUM was 0.762, and under APACHE II was 0.737, suggesting the use of POSSUM as an auxiliary tool to predict the risk of death in surgical patients. PMID:19437850

Elías, Adriana Cristina Galbiatti Parminondi; Matsuo, Tiemi; Grion, Cíntia Magalhães Carvalho; Cardoso, Lucienne Tibery Queiroz; Verri, Paulo Henrique

2009-03-01

150

Practice and Effectiveness of Outpatient Psycho-Oncological Counseling for Cancer Patients  

PubMed Central

Objective: Because of various types of psychological distress, cancer patients are encouraged to attend outpatient psycho-oncological and psychosocial counseling. The aim of this prospective study was an analysis of the impact and success of existing counseling resources. Methods: All cancer patients who had applied at a central counseling center were given a standardized questionnaire (FBK-R23), designed to assess the type and degree of cancer patients' difficulties prior to their first counseling session. Additionally, the psychological condition of the patients was assessed psycho-oncologically by a third party (PO-Bado). After at least 2 and no more than 5 sessions, patients underwent both self-evaluation and third-party assessment, using the same instruments. Results: During the period from September 2008 and August 2009, we looked at a total of 447 people seeking counseling, including 186 family members (42%), 33 professional caregivers (7%), and 228 patients (51%). Out of the 228 patients, 48 attended our counseling sessions personally and 20 of these additionally completed the second questionnaire. Counseling led to only a tendency toward improvement, on average, of total psychological distress (p=0.08). In individual areas - for example, “Social Distress” and “Everyday Limitations”- no change could be measured. Only the problem area identified as “Information Deficit” was improved, on average, after 3 counseling sessions (p=0.008). Conclusion: Our results indicate that while short-term counseling has no concrete effect on the improvement of a patient's psychological well-being, these support sessions do serve to decrease the patient's so-called “Information Deficit”, thereby bringing about an indirect improvement in the sufferer's psychological state. The course of treatment offered should be determined according to the patient's needs. In order to ensure that even the very sickest of the tumor patient group seek outreach groups, we must target this particular group with additional evaluative questions. Further studies must determine whether short-term counseling or other counseling strategies are most effective.

Goerling, Ute; Tagmat, Deniz; Muffler, Elvira; Schramm, Nancy; Wernecke, Klaus-Dieter; Schlag, Peter M.

2010-01-01

151

Urinary tract infections in the surgical patient.  

PubMed

Urinary tract infection (UTI) continues to be a common nosocomial infection. From a 2-year city-county hospital experience, 212 nosocomial UTI were identified in 153 patients from 3747 admissions. Mean age was 54 years; 102 were men. Foley catheterization was an associated factor in 129 patients (84%). UTI was caused by 40 different species of bacteria. In 28 infections (13%), the UTI was polymicrobial. Only nine patients had bacteremia. The bacteriology of the UTI depended on whether the patient had received systemic antibiotics previously during the hospitalization. Prior antibiotic administration increased the probability of Pseudomonas and Serratia as pathogens. Thus, patients that have had antibiotic therapy demonstrate a distribution of pathogens that are different from patients not receiving antibiotics, and a distribution different from the community-acquired UTI. Continued emphasis on the shorter duration and more judicious use of systemic antibiotics for both prophylaxis and therapy is warranted. PMID:3389599

Asher, E F; Oliver, B G; Fry, D E

1988-07-01

152

Surgical Patients Need Their Family Doctors  

PubMed Central

The author addresses the reasons family doctors should be involved in the treatment of their patients who are hospitalized. The author was hospitalized while her family doctor was on holidays. The physician's locum did not see her presence as necessary because the patient already had two surgeons in attendance. The author missed the presence of her family doctor, so she discussed the situation with the nurses and other patients. Her observations led to the writing of this article.

Lynn, Kathy

1990-01-01

153

Lactoferrin Regulates the Immune Responses in Post-Surgical Patients  

Microsoft Academic Search

A bstract. The effect of oral administration of lactoferrin (LF) was studied to determine if it could modify post-surgical immune response. The action of LF was evaluated in 18 LF-treated patients vs 28 placebo counter- p arts. Patients (women and men, mean age 50 years) were given daily oral doses (20 mg each) of LF for 5 consecutive days prior

M. Zimecki

154

Patients’ perception of sound levels in the surgical suite  

Microsoft Academic Search

Study Objectives: To measure sound levels that our patients are exposed to in the surgical suite and their perception of these sound levels.Design: Sound levels experienced by 100 patients undergoing general anesthesia for elective surgery during three phases: induction and maintenance of anesthesia in the operating room (OR), and recovery from anesthesia in the recovery room, were measured using a

Eugene H. C Liu; Su-Meng Tan

2000-01-01

155

[Surgical treatment of patients with cholestatic hepatitis].  

PubMed

The experience with treatment of 86 patients with cholestatic form of hepatitis has been summarized. The operative intervention included drainage of the extrahepatic bile ducts, denervation of the hepatoduodenal ligament, marginal hepatic resection. In ineffective conservative therapy, the patients should be operated on at the early period. When establishing the indications for the operation, the functional state of hepatocytes should be considered. PMID:8301944

Vecherko, V N; Sidorov, S A; Matar, Kh; Sabadash, I E

1993-01-01

156

Transesophageal Echocardiography for the Noncardiac Surgical Patient  

PubMed Central

Transesophageal echocardiography (TEE) has been established as a very valuable asset for patient monitoring during cardiac surgery. The value of perioperative TEE for patients undergoing noncardiac surgery is less clear. This article reviews the technical aspects of TEE and comments on the potential benefit of using TEE as a monitoring modality apart from cardiac surgery. Based on patient's comorbidities and/or injury pattern, TEE is a fast and minimally invasive approach to obtain important hemodynamic information, especially useful in a hemodynamically unstable patient. However, certain requirements for the use of the technique are necessary, most important the development of sufficient echocardiographic skills by the anesthesiologists. Indications, skill requirements, and possible complications of the technique are reviewed.

Rebel, Annette; Klimkina, Oksana; Hassan, Zaki-Udin

2012-01-01

157

Long-Term Surgical Complications in the Oral Cancer Patient: a Comprehensive Review. Part II  

PubMed Central

ABSTRACT Objectives Surgery remains the preferred treatment for the majority of oral cancers. The aim of the present article was to provide a comprehensive review of complications associated with surgical treatment of oral cancer including hardware failure; complications associated with choice of reconstruction, donor site morbidity as well as functional and aesthetic issues that impact on the quality of life. Material and Methods The available English language literature relevant to complications associated with surgical treatment of oral cancer was reviewed. Complications associated with potential for disfigurement, choice of reconstruction, donor site morbidity as well as functional and aesthetic issues that impact on the quality of life are summarized. Results In total 35 literature sources were obtained and reviewed. The topics covered in the second part of this review series include hardware failure, scars and fistula formation; complications associated with choice of reconstruction, donor site morbidity as well as functional and aesthetic issues. Conclusions Cancer resection should be planned around two very important concepts. First and foremost is the eradication of disease. This should be the ultimate goal of the ablative team and all potential complications that may be the result of appropriately executed oncologic resection should be discussed in details with the patient. Adequate reconstruction of the defects with restoration of form and function is the second, but not of less importance, goal for the successful care of the head and neck cancer patient.

2010-01-01

158

[Surveillance study of vancomycin resistant enterococci in pediatric haematology and oncology patients].  

PubMed

In this study, the prevalence and risk factors of fecal carriage of vancomycin resistant enterococci (VRE) among patients in Ondokuz Mayis University Pediatric Hematology and Oncology Clinics have been investigated. During two months, rectal swab samples were collected weekly from all of the patients hospitalized in Pediatric Hematology and Oncology Clinics, for the surveillance cultures. During the study a total of 85 rectal swabs were obtained from 34 patients who had been hospitalized in the inpatient clinic with 20 bed capacity. The number of samples obtained from the patients varied between 1-6 cultures. All of the patients (100%) had peripheral venous catheters and 27(79%) of patients had used antibiotics. All of the samples were inoculated onto 8 microg/ mL gentamicin containing blood agar media, and enterococci were identified by Gram staining, catalase test and at species level by VITEK 2 (bioMérieux, France) automated system. Vancomycin resistance was screened by using 6 microg/mL vancomycin containing brain-heart infusion agar according to CLSI guidelines. The vancomycin MIC values of the strains grown in this medium were determined by microdilution test proposed by CLSI. As a result, a total of 50 samples (59%) belonging to 24 patients yielded enterococci, and the species distribution was as follows; E. faecium (in 16 cases), E. faecalis (in 8 cases), E. casseliflavus (in 6 cases), E. avium (in 3 cases) and E. durans (in 1 case). In our study no vancomycin resistance nor VRE colonization was detected in the patients. PMID:17001854

Ta?delen Fi?gin, Nuriye; Darka, Ozge; Fi?gin, Tunç; Hepsert, Serkan; Coban, Ahmet Yilmaz; Elli, Murat

2006-07-01

159

Keeping patients safe: an interventional hand hygiene study at an oncology center.  

PubMed

Healthcare-associated infections (HCIs) continue to affect patient morbidity and mortality and contribute to the rising cost of health care. Factors associated with the rise of HCIs in patients with cancer may include an increase in antimicrobial resistance and treatment effects of radiation and chemotherapeutic agents. Infection control and prevention practices can decrease infection rates among patients with cancer. In an effort to reduce HCIs and increase awareness, an interventional study was conducted at an oncology center to investigate hand hygiene compliance of healthcare professionals before and after the introduction of a handheld sanitizer spray. Although healthcare professionals had a positive response to the spray, it did not improve compliance rates. PMID:17962172

Siegel, Jeanne H; Korniewicz, Denise M

2007-10-01

160

Distribution and determinants of patient satisfaction in oncology with a focus on health related quality of life  

Microsoft Academic Search

BACKGROUND: Cancer patients usually undergo extensive and debilitating treatments, which make quality of life (QoL) and patient satisfaction important health care assessment measures. However, very few studies have evaluated the relationship between QoL and patient satisfaction in oncology. We investigated the clinical, demographic and QoL factors associated with patient satisfaction in a large heterogeneous sample of cancer patients. METHODS: A

Christopher G Lis; Mark Rodeghier; James F Grutsch; Digant Gupta

2009-01-01

161

The development and pilot testing of a teaching booklet for oncology patients' self-assessment and perineal skin care  

Microsoft Academic Search

Oncology patients often experience skin breakdown as a result of chemotherapy. Often the loss of skin integrity is neither identified nor treated until it becomes severe and painful. If patients were taught to identify early signs of breakdown and to report these symptoms to a health care provider, treatment for these conditions could begin at an early stage. Nursing staff

Mary Ellen Haisfield-Wolfe; Cecilia Rund

2002-01-01

162

Surgical management of bilateral bronchiectases: results in 29 patients.  

PubMed

Bronchiectasis is a major cause of morbidity and mortality in developing countries. Staged bilateral segmental resection of the lungs is performed in selected patients. Our experience of surgical removal of 87 bilateral bronchiectases in 29 patients during an 11-year period was reviewed retrospectively. High-resolution computed tomography was performed preoperatively in all patients to locate the anatomic sites of bronchiectasis. The mortality and morbidity of the surgical procedure, clinical symptoms, age distribution, etiology, bacteriology, and operative procedures were analyzed. There were 22 males (76%) and 7 females (24%), aged 5 to 60 years, with a mean age of 30 years. Complications developed in 11 patients (38%); atelectasia was the most common (14%). There was one hospital death. Clinical symptoms disappeared in 19 (66%) patients, improved in 5 (17%), and were unchanged in 4 (14%). Staged bilateral resection for bronchiectases can be performed at any age with acceptable morbidity and mortality. PMID:16714699

Aghajanzadeh, Manucher; Sarshad, Ali; Amani, Hosin; Alavy, Ali

2006-06-01

163

Sources and pathways of spread of vancomycin-resistant enterococci in hemato-oncological patients.  

PubMed

The presented study aims at analyzing an increasing prevalence of vancomycin-resistant enterococci (VRE) isolated from various kinds of clinical material obtained from patients in the Department of Hemato-oncology (DHO), University Hospital in Olomouc, Czech Republic. Between January 1 and March 31, 2005, enterococci were isolated by standard microbiological procedures using both clinical material obtained from hospitalized patients and samples from the department environment. Resistance to vancomycin and teicoplanin was determined by a standardized microdilution method. Phenotype determination of resistance to vancomycin was verified by PCR detection of vanA and vanB genes. In VanA Enterococcus faecium, macrorestriction analysis was performed by pulsed-field gel electrophoresis. During the monitored period, a total of 128 Enterococcus sp. strains were isolated, of which 38 (30 %) isolates from 22 different patients were determined as VRE. Dominating were Enterococcus faecium VanA (63 %) and Enterococcus casseliflavus VanC (16 %) strains. At the same time, one Enterococcus faecium VanA strain was acquired from a bed-side table used by a patient in whom a similar strain had been isolated repeatedly from various clinical materials including a rectal swab taken in 2004. Based on the macrorestriction analysis of genome DNA in 24 vancomycin-resistant Enterococcus faecium VanA strains isolated from the patients' clinical material, one strain from the bed-side table surface and one strain isolated from stools in 2004, 8 unique restriction profiles with similarity ranging from 90 % to 100 % were identified, which could be classified into 3 clonal types. Thus, we can assume not only the endogenous origin of the VRE in hemato-oncological patients and their potential selection caused by therapy with broad-spectrum antibiotics but also the ability of the strains to survive in a hospital setting and, subsequently, to be spread clonally by various vectors. PMID:16936913

Vagnerova, Iva; Sauer, Pavel; Kolar, Milan; Slepickova, Sabina; Hubacek, Jaromir; Faber, Edgar; Raida, Ludek; Papajik, Tomas

2006-07-01

164

Surgical Correction of Gynecomastia in Thin Patients  

Microsoft Academic Search

Background  Gynecomastia refers to a benign enlargement of the male breast. This article describes the authors’ method of using power-assisted\\u000a liposuction and gland removal through a subareolar incision for thin patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Power-assisted liposuction is performed for removal of fatty breast tissue in the chest area to allow skin retraction. The\\u000a subareolar incision is used to remove glandular tissue from a male

Emanuele Cigna; Mauro Tarallo; Pasquale Fino; Liliana De Santo; Nicolò Scuderi

165

Smart CO2 laser surgical system based on autodyne monitoring of laser-evaporated biotissues: first results in oncology  

NASA Astrophysics Data System (ADS)

New method based on techniques of self-induced autodyne effect for diagnostics and control of laser-tissue evaporation by radiation of high-frequency pumped waveguide CO2 laser is developed. This method is used for creation of feed-back for smart CO2 laser surgical system of "Lancet" series. The results of medical testing of the smart laser surgical system are presented.

Dmitriev, A. K.; Varev, G. A.; Konovalov, A. N.; Kortunov, V. N.; Panchenko, V. Y.; Reshetov, I. V.; Matorin, O. V.; Maiboroda, V. F.; Ul'yanov, V. A.

2005-08-01

166

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.

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

167

The critically-ill pediatric hemato-oncology patient: epidemiology, management, and strategy of transfer to the pediatric intensive care unit  

PubMed Central

Cancer is a leading cause of death in children. In the past decades, there has been a marked increase in overall survival of children with cancer. However, children whose treatment includes hematopoietic stem cell transplantation still represent a subpopulation with a higher risk of mortality. These improvements in mortality are accompanied by an increase in complications, such as respiratory and cardiovascular insufficiencies as well as neurological problems that may require an admission to the pediatric intensive care unit where most supportive therapies can be provided. It has been shown that ventilatory and cardiovascular support along with renal replacement therapy can benefit pediatric hemato-oncology patients if promptly established. Even if admissions of these patients are not considered futile anymore, they still raise sensitive questions, including ethical issues. To support the discussion and potentially facilitate the decision-making process, we propose an algorithm that takes into account the reason for admission (surgical versus medical) and the hemato-oncological prognosis. The algorithm then leads to different types of admission: full-support admission, “pediatric intensive care unit trial” admission, intensive care with adapted level of support, and palliative intensive care. Throughout the process, maintaining a dialogue between the treating physicians, the paramedical staff, the child, and his parents is of paramount importance to optimize the care of these children with complex disease and evolving medical status.

2012-01-01

168

Evaluation and surgical treatment of patients with penile curvature  

Microsoft Academic Search

In patients with adult penile curvatures the aim of treatment is to have a penis straight enough and firm enough to allow\\u000a satisfactory sexual function. Several operative approaches have been used to correct this condition. Herein, we describe our\\u000a experience with the evaluation and surgical treatment of 37 patients with penile curvature. When we have decided on surgery,\\u000a we either

Y. Z. Müftüo?lu; K. Aydos; Ö. Yaman; K. Anafarta; Y. Bedük

1996-01-01

169

Providing care for the "whole patient" in the cancer setting: the psycho-oncology consultation model of patient care.  

PubMed

This paper describes a psycho-oncology consultation model of care (POCM) that provides a framework for psychosocial clinical work with cancer patients. Goals for care are addressed that follow the recommendations of the Institute of Medicine report advocating care for the "whole patient." Specific goals include reducing distress and symptoms, building on the patient's existing strengths, enhancing self-efficacy, expanding the patient's repertoire of healthy coping strategies, and addressing informational needs. Specific interventions are described that clinicians can implement in order to address the above goals. The paper also addresses the unique challenges encountered in working with cancer patients, as well as programmatic difficulties that are inherent in providing mental health care in a medical setting. PMID:20799056

Deshields, Teresa L; Nanna, Shannon K

2010-09-01

170

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.

Harris, Eric A.

2010-01-01

171

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

PubMed

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

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

2012-01-01

172

Effects of an intervention aimed at improving nurse-patient communication in an oncology outpatient clinic.  

PubMed

In an ever more burdened healthcare system, there is an urgent need to investigate whether patients benefit from the resources allocated to nurses' communication skills training in terms of improved patient outcomes. This study aimed to evaluate a standardized two 2-day (33 hours) communication skills training program in nursing cancer care. Twenty-four nurses in an oncology outpatient clinic participated and were randomly assigned to the intervention program or a control group. A total of 413 patients treated in the clinic during 2 recruitment periods (before and after the communication skills training) completed a questionnaire package assessing the nurse-patient relationship, psychological well-being, and cancer-related self-efficacy. Nurse group differences in change scores between time points (baseline, 1 week, and 3 months after the communication skills training) on measures related to communication and work-related stress were all nonsignificant. Time-by-group analyses of patient data showed no training effect on patient perception of nurse empathy and attentiveness, and we found no training effect on patients' anxious/depressed, angry, or positive mood, as well as no effect on cancer-related self-efficacy. The results were unable to support the hypotheses that nurse communication skills training would be associated with improved nurse and patient outcomes. PMID:19104193

Rask, Mette Trøllund; Jensen, Mette Lund; Andersen, Jørn; Zachariae, Robert

2009-01-01

173

Surgical treatment of infectious spondylitis in patients undergoing hemodialysis therapy  

PubMed Central

Treatment of infectious spondylitis in hemodialysis patients remains a challenge because of comorbidities. This study aimed to evaluate the impact of end-stage renal disease (ESRD) on the clinical manifestations and surgical outcomes of patients with spinal infection. Sixteen patients who underwent surgical intervention were included. There were 3 thoracic and 13 lumbar lesions. All patients presented with intractable back pain at the start of treatment. Six patients had a fever, nine had inflammation at the hemodialysis access site, and six of them had concomitant bacteremia. Ten patients had an elevated leukocyte count. Serological tests indicated an elevation of the C-reactive protein and erythrocyte sedimentation rate level in all patients. Five patients had a neurological compromise. Postoperative complications included two mortalities, two iliac bone graft and implant dislodgement, and one retroperitoneal wound dehiscence. The preoperative mean visual analog scale score was 7.7 (range, 6–9), which improved to 3.4 (range, 2–5) at the final follow-up for 14 surviving patients. Neurological improvement was obtained by at least one grade in four Frankel C category patients. The radiographs revealed a good bony fusion in 12 cases although with a variable bone graft subsidence. In conclusion, early diagnosis of infectious spondylitis is difficult due to latent symptoms. A spine infection should be suspected in hemodialysis patients with severe back pain, even when they are afebrile. Surgical intervention for infectious spondylitis in ESRD patients undergoing hemodialysis can be performed with acceptable outcomes; however, the complication and mortality rates are relative high.

Fu, Tsai-Sheng; Kao, Yu-Hsein; Tsai, Tsung-Ting; Lai, Po-Liang; Niu, Chi-Chieh; Chen, Wen-Jer

2010-01-01

174

Laparoscopy and Robotics Robotic Radical Prostatectomy in Overweight and Obese Patients: Oncological and Validated-Functional Outcomes  

Microsoft Academic Search

OBJECTIVES To determine the impact of body mass index (BMI) on perioperative functional and oncological outcomes in patients undergoing robotic laparoscopic radical prostatectomy (RLRP) when stratified by BMI. METHODS Data were collected prospectively for 945 consecutive patients undergoing RLRP. Patients were evaluated with the UCLA-PCI-SF36v2 validated-quality-of-life questionnaire preoperatively and postoperatively to 24 months. Patients were stratified by BMI as normal

Aimee L. Wiltz; Sergey Shikanov; Scott E. Eggener; Mark H. Katz; Alan E. Thong; Gary D. Steinberg; Arieh L. Shalhav; Gregory P. Zagaja; Kevin C. Zorn

175

LONG-TERM OUTCOMES IN ELDERLY SURGICAL PATIENTS  

PubMed Central

Anesthesia has developed to the point where long term outcomes are important endpoints. Elderly patients are becoming an increasingly large part of most surgical practices, consistent with demographic shifts. Long term outcomes are particularly important for this group. In this review, we discuss functional outcomes in the elderly. We describe the areas of cognitive change and frailty, both of which are specific to the elderly. We also discuss prevention of surgical infections and emerging evidence around hemodynamic alterations in the operating room and their impact on long term outcomes.

Deiner, Stacie; Silverstein, Jeffrey H.

2011-01-01

176

Interferon-alpha in oncology patients: fewer psychiatric side effects than anticipated.  

PubMed

Interferon-alpha (IFN-alpha) treatment in both oncological and hepatological settings is associated with depression. If IFN-alpha treatment induces depression in high numbers, it could serve as a model for studying the pathophysiology of depression, in general. The authors therefore studied 43 oncology patients treated with standard or pegylated IFN-alpha with baseline psychiatric assessment and at regular time-points in the first 6 months of treatment. Apart from a severe depression because of brain metastases, authors observed only two clinically relevant depressive states. Contrary to findings in most of the literature, most depressive episodes in this study were self-limiting and short-lasting and were associated with either episodes of flu-like symptoms common at the start of the treatment or with concurrent psychosocial events. In the group as a whole, scores on both observer-based and self-report rating scales did not show clinically relevant changes. The results of this study indicate that IFN-alpha treatment is not suitable as a study model for depression in general. PMID:18212177

Bannink, Marjolein; Kruit, Wim H J; Van Gool, Arthur R; Sleijfer, Stefan; van der Holt, Bronno; Eggermont, Alexander M M; Stoter, Gerrit; Hengeveld, Michiel W

2008-01-01

177

Zygomycosis originating from an odontogenic infection in a pediatric oncology patient  

PubMed Central

The Zygomyces are an increasingly frequent cause of invasive mould infection in immunocompromised patients. Here we describe the first well-documented case of Rhizopus infection of odontogenic origin, which presented as a rapidly progressive soft tissue infection in a neutropenic child. The infection resolved with limited surgical debridement and antifungal therapy.

Adderson, Elisabeth E.; Rowland, Christopher; McGregor, Lisa M.; Santana, Victor M.

2011-01-01

178

The Patient Protection and Affordable Care Act: what every provider of gynecologic oncology care should know.  

PubMed

The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in 2010. While initial implementation of the law began shortly thereafter, the full implementation will take place over the next few years. With respect to cancer care, the act was intended to make care more accessible, affordable, and comprehensive across different parts of the country. For our cancer patients and our practices, the ACA has implications that are both positive and negative. The Medicaid expansion and access to insurance exchanges are intended to increase the number of insured patients and thus improve access to care, but many states have decided to opt out of the Medicaid program and in these states access problems will persist. Screening programs will be put in place for insured patients but may supplant federally funded programs that are currently in place for uninsured patients and may not follow current screening guidelines. Both hospice and home health providers will be asked to provide more services with less funding, and quality measures, including readmission rates, will factor into reimbursement. Insured patients will have access to all phases of clinical trial research. There is a need for us as providers of Gynecologic Oncology care to be active in the implementation of the ACA in order to ensure that our patients and our practices can survive and benefit from the changes in health care reimbursement, with the ultimate goals of improving access to care and quality while reducing unsustainable costs. PMID:23500090

Duska, Linda R; Engelhard, Carolyn L

2013-06-01

179

Lateral transport osteogenesis in maxillofacial oncology patients for rehabilitation with dental implants: a retrospective case series  

PubMed Central

Objectives: To report on the use of lateral transport osteogenesis in cancer patients after maxillo/mandibular resections and on the implant survival rate in the generated bone Material and Methods: Four patients treated using lateral transport osteogenesis entered this descriptive study and were retrospectively studied (mean age 55; range 41-62). Results: Reconstruction of segmentary defects after surgical and radiological cancer treatment on maxilla and mandible was achieved. No relevant intra- or post-operative complications occurred. No differences on implant survival were observed between patients who had received radiotherapy and those who had not. Conclusions: This approach can be considered a recommendable reconstructive option after oral cancer treatment –including radiotherapy- particularly for high-surgical-risk, collaborative patients. Key words:Distraction osteogenesis, oral cancer, radiotherapy, reconstruction, dental implants.

Bilbao-Alonso, Arturo; Garcia-Rielo, Jose M.; Varela-Centelles, Pablo

2013-01-01

180

Regulating surgical oncotaxis to improve the outcomes in cancer patients.  

PubMed

Excessive surgical stress and postoperative complications cause a storm of perioperative cytokine release, which has been shown to enhance tumor metastasis in experimental models. We have named this phenomenon "surgical oncotaxis". The mechanisms that underpin this process are thought to be excessive corticosteroid secretion, coagulopathy in the peripheral vasculature, immune suppression and excessive production of reactive oxygen species. Nuclear factor-kappa B (NFkB) activation plays a key role in these mechanisms. Minimally invasive surgical techniques should be used, and postoperative complications should be avoided whenever possible to lessen the impact of surgical oncotaxis. Furthermore, there may be a role for a small preoperative dose of corticosteroid or the use of free radical scavengers in the perioperative period. Recently, there has been a great deal of interest in omega-3 fatty acid, because it regulates NFkB activation. The use of multimodal treatments that regulate surgical oncotaxis may be as important as chemotherapy for determining the outcome of patients with cancer undergoing surgery. PMID:23736890

Hirai, Toshihiro; Matsumoto, Hideo; Kubota, Hisako; Yamaguchi, Yoshiyuki

2014-05-01

181

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.

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

182

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

SciTech Connect

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.

Ge Jin [Perelman School of Medicine at University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States)] [Perelman School of Medicine at University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Fishman, Jessica [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States) [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Annenberg School for Communication at University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Vapiwala, Neha [Abramson Comprehensive Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States) [Abramson Comprehensive Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Li, Susan Q.; Desai, Krupali [Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States)] [Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Xie, Sharon X. [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States)] [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Mao, Jun J., E-mail: maoj@uphs.upenn.edu [Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Abramson Comprehensive Cancer Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States); Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania (United States)

2013-01-01

183

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.

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

2009-01-01

184

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

185

Attitudes of Oncologists, Oncology Nurses, and Patients from a Women's Clinic Regarding Medical Decision Making for Older and Younger Breast Cancer Patients.  

ERIC Educational Resources Information Center

Administered Beisecker Locus of Authority in Decision Making: Breast Cancer survey to 67 oncologists, 94 oncology nurses, and 288 patients from women's clinic. All groups believed that physicians should have dominant role in decision making. Nurses felt that patients should have more input than patients or physicians felt they should. Physicians…

Beisecker, Analee E.; And Others

1994-01-01

186

[Understanding positon emission tomography (PET) with [18F]-FDG in clinical oncology. Informations dedicated to patients and relatives].  

PubMed

In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives, the SOR SAVOIR PATIENT program (SSP). The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information, developed in this program, is based on clinical practice guidelines produced by the FNCLCC and the twenty French regional cancer centres, the National League against Cancer, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals, the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The guidelines, "Standards, Options: Recommendations" (SOR) are used as primary information sources. The handbook SOR SAVOIR PATIENT Understanding positron emission tomography (PET) with [18F]-FDG in clinical oncology, integrally published in this issue of the Bulletin du Cancer, is an adapted version of the clinical practice guidelines (CPG) Standards, Options and Recommendations for positron emission tomography (PET) with [18F]-FDG in clinical oncology. The main objectives of this article are to allow persons affected by cancer and their close relatives to better understand this medical imaging technique and its implementation. This document also offers health professionals a synthetic evidence-based patient information source that should help them communicate that information during the physician-patient encounter. Positron emission tomography (PET) is a scintigraphy technique using a radiotracer, [18F]-fluorodeoxyglucose (abbreviated [18F]-FDG), administered intravenously into the patient's arm. This tracer, similar to glucose (sugar), binds to cancer cells and temporarily emits radiations that can be recorded by a special camera in the PET scanner. PET scanning can be used to obtain complementary information at different stages of the disease, whether for assessing diagnosis, treatment evolution or follow-up. By 2007, in the framework of the government plan against cancer, about seventy-five PET scanners are expected to be installed in France. Twenty-four are currently in use; a similar number is under installation. At the end of this process, all French regions should have at least one PET imaging equipment. The SOR SAVOIR PATIENT guide: Understanding positron emission tomography (PET) with [18F]-FDG in clinical oncology and the integral report of CPG SOR 2003: Standards, Options and Recommendations for positron emission tomography (PET) with [18F]-FDG in clinical oncology can be downloaded from the FNCLCC website: http:\\\\www.fnclcc.fr. PMID:16123010

Bourguet, Patrick; Brusco, Sylvie; Corone, Corinne; Devillers, Anne; Foehrenbach, Hervé; Lumbroso, Jean-Daniel; Maszelin, Philippe; Montravers, Françoise; Moretti, Jean-Luc; Rain, Jean-Didier; Talbot, Jean-Noël; Carretier, Julien; Leichtnam-Dugarin, Line; Delavigne, Valérie; Philip, Thierry; Fervers, Béatrice

2005-07-01

187

Effects of Video Games on the Adverse Corollaries of Chemotherapy in Pediatric Oncology Patients: A Single-Case Analysis.  

ERIC Educational Resources Information Center

Assessed effects of video games on adverse corollaries of chemotherapy in three pediatric oncology patients. Results indicated that access to video games resulted in reduction in the number of anticipatory symptoms experienced and observed, as well as a diminution in the aversiveness of chemotherapy side effects. (Author/NRB)

Kolko, David J.; Rickard-Figueroa, Jorge L.

1985-01-01

188

Making the System WorkTraining Pediatric Oncology Patients to Cope and Their Parents to Coach them during BMAILP Procedures  

Microsoft Academic Search

Three 4-to 7-year-old pediatric oncology patients were taught to engage in distraction prior to painful bone marrow asporations and limber puncture and to use party blowers as a breathing technique during the painful procedures. Parents were taught to coach their children to use these coping behavior. Using a multiple baseline across subjects design, results indicated that all of the parents

Ronald L. Blount; Scort W. Powers; Melanie W. Cotter; Suzanne Swan; Kay Free

1994-01-01

189

Clinical-pharmacological aspects, application and effectiveness of total parenteral nutrition in surgical patients.  

PubMed

The term "total parenteral nutrition" (TPN) refers to the maintenance of an adequate nutritional status, normal body weight and positive nitrogen balance solely by intravenous means. It requires solutions providing calories, amino acids and other nutrients in amounts much greater than those indicated for maintenance of normal body weight. Nutrient solutions have been studied, selected and prepared in our Hospital Pharmacological Service utilizing a sterile closed system, which allows large-volume filtering, sterilizing and bottling devices. For maintenance of weight gain in adults, a basic formula is employed, which provides 1,100 Kcal/1 with pure crystalline amino acids mixed with 50% anhydrous dextrose in water in a ratio of 5.8:1 (160 Kcal:1 g nitrogen). Minerals and vitamins are added to the base solution prior to use and may be increased or decreased by simple addition or omission depending on the patient's condition. This paper is based on 192 surgical patients who received TPN and have been followed in strict cooperation between the Hospital Pharmacological Service and the Surgical Department. The patients, ranging from 23 to 79 years of age, with life threatening diseases and unable to maintain adequate nutrition by the oral route, received TPN through a central catheter inserted via subclavian puncture (146 cases) or through a surgically created internal A-V fistula (46 cases). The condition of the patients generally improved within a few days after starting TPN; and weight gain, wound healing, general improvement and a shorter period of hospitalization were observed. TPN could be efficiently combined with oncologic treatment, and a significant improvement of the patients' performance status and decrease of toxic side-effects due to chemotherapeutic agents were observed. TPN has been successfully applied also in patients with fistulas of the alimentary tract obtaining spontaneous closure and in patients with ulcerative colitis, showing its beneficial effect in allowing complete bowel rest for healing. No major complications or deaths could be attributed to TPN or to the route of administration. PMID:107127

Dionigi, R; Guaglio, R; Bonera, A; Cerri, M; Rondanelli, R; Campani, M

1979-03-01

190

The use of herbal therapies in pediatric oncology patients: treating symptoms of cancer and side effects of standard therapies.  

PubMed

Complementary and alternative medicine is increasing in use in the pediatric oncology population. Although there is a multitude of herbal therapies used, the focus of this article is a review of the literature addressing some herbal therapies used to treat the symptoms of cancer and side effects of traditional methods of treatment. Ginger is used in the treatment of nausea and vomiting. St. John's wort is successful in treating depression and anxiety. Echinacea is used as an immunostimulant. Herbal therapies in the pediatric oncology population are usually initiated and managed by parents. Many herbal therapies are beneficial, but some potential herb-drug interactions should be considered. This poses a challenge to the oncology nurse because herbal treatments are managed by the parents and pharmaceuticals are managed by the practitioner. Educating the patient, family, and practitioner is important in ensuring a thorough health history assessment and, subsequently, safe and effective herbal and pharmacological therapies. PMID:17185400

Quimby, Erin L

2007-01-01

191

Incorporating Patient-Specific Variability in the Simulation of Realistic Whole-Body Distributions for Oncology Applications  

Microsoft Academic Search

The purpose of the work described in this paper was the development of a framework for the creation of a realistic positron emission tomography (PET) simulated database incorporating patient-specific variability. The ground truth used was therefore based on clinical PET\\/computed tomography (CT) data of oncology patients. In the first step, the NURBS-based cardiac-torso phantom was adapted to the patient's CT

Amandine Le Maitre; William Paul Segars; Simon Marache; Anthonin Reilhac; Mathieu Hatt; Sandrine Tomei; Carole Lartizien; Dimitris Visvikis

2009-01-01

192

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.

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

2010-01-01

193

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.

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

194

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.

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

2008-01-01

195

Dental Approach in the Pediatric Oncology Patient: Characteristics of the Population Treated at the Dentistry Unit in a Pediatric Oncology Brazilian Teaching Hospital  

PubMed Central

OBJECTIVES: The objective of this paper was to characterize the population seen at the dentistry unit of the hematology-oncology service of the Oncology-Hematology Service, Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Oral problems resulting from cancer therapy increase the risk of infection, length of hospital stay, treatment cost and negative impact on the course and prognosis of the disease. METHOD: Of the 367 medical records of cancer patients seen from November 2007 until December 2008: 186 with a cancer diagnosis and complete clinical data were selected, while 20 with a cancer diagnosis and incomplete records were excluded; 161 medical records with only hematological diagnosis were also excluded. The following characteristics were assessed: ethnicity, gender, age, diagnosis and characteristics of the neoplasm, cancer therapy status and performed dental procedures. RESULTS: Review of 1,236 visits indicated that 54% (n=100) of the patients had blood cancers, 46% (n=86) had solid tumors and 63% were undergoing anticancer therapy. The proportion of males (52.7%) in the study population was slightly greater. The most common cancer was acute lymphocytic leukemia (32.2%). Cancer occurred more often among those patients aged 5 to 9 years. The most common dental procedures were restorative treatment, preventive treatment and removal of infectious foci. CONCLUSION: The characteristics of the studied population were similar to those of the general Brazilian and global populations, especially regarding gender and diagnosis distributions. The aim of implementation of the dentistry unit was to maintain good oral health and patients’ quality of life, which is critical to provide oral care and prevent future oral problems.

Carrillo, Camila; Vizeu, Heloisa; Soares-Junior, Luis Alberto; Fava, Marcelo; Filho, Vicente Odone

2010-01-01

196

Surgical management of urolithiasis in spinal cord injury patients.  

PubMed

Urolithiasis is a common condition in patients with spinal cord injury (SCI). Surgical management of stones in this population is more challenging and associated with lower clearance rates than the general population. The rate of complications - specifically infectious complications - is also high due to the chronic bacterial colonization. Shock wave lithotripsy (SWL) has a low clearance rate of 44-73 %. Percutaneous nephrolithotripsy is indicated for larger nephrolithiasis, but multiple procedures may be required to clear the stones. Ureteroscopy has been associated with low success rates because of difficulty in obtaining ureteral access. Historically, bladder stones were managed with open surgery or SWL. Recently, good results have been reported with the combination of endoscopic and laparoscopic techniques. Surgical management of urolithiasis in patients with SCI should be performed in high-volume centers in light of the technical challenges and higher rate of perioperative complications. PMID:24740271

Nabbout, Philippe; Slobodov, Gennady; Culkin, Daniel J

2014-06-01

197

The Management of Surgical Patients with Obstructive Sleep Apnea  

Microsoft Academic Search

Obstructive sleep apnea (OSA) is a leading public health problem in both developed and developing nations. However, awareness\\u000a regarding diagnostic options, management, and consequences of untreated OSA remains inadequate in the perioperative period.\\u000a Adverse surgical outcomes appear to be more frequent in OSA patients. Immediate postoperative complications may be partially\\u000a attributed to the negative effects of sedative, analgesic, and anesthetic

Jahan Porhomayon; Ali El-Solh; Sanjeev Chhangani; Nader D. Nader

198

A new staging system for multiple myeloma patients based on the Southwest Oncology Group (SWOG) experience.  

PubMed

We aimed to develop and evaluate a staging system for multiple myeloma (MM) based on easily obtained laboratory measures. The Durie-Salmon stage is most commonly used and is an effective system of patient stratification for clinical trial research. However, the criteria are complex and many laboratory parameters are required to properly stage patients. In this analysis, we focused on two common measures with prognostic importance in MM: serum beta2 microglobulin (beta2m) and serum albumin. Pre-study data on 1555 previously untreated MM patients enrolled on four recent South-west Oncology Group (SWOG) phase III trials were used in the analysis. Staging models were developed and validated using regression tree methods for survival outcomes. SWOG stages were defined as: stage 1, beta2m < 2.5 mg/l (14% of patients, median overall survival of 55 months); stage 2, 2.5 patients, median overall survival of 40 months); stage 3, beta2m >/= 5.5 and albumin >/= 30 g/l (32% of patients, median overall survival of 24 months); and stage 4, beta2m >/= 5.5 and albumin < 30 g/l (11% of patients and median overall survival of 16 months). This staging scheme was also predictive of event-free survival, first-year mortality and long-term (>/= 5 years) event-free survival. We conclude that although the SWOG stage does not represent a new prognostic marker for MM (cytogenetics, FISH), it could provide a simple alternative to the Durie-Salmon stage for patients with previously untreated MM. Additional evaluation in other MM patient populations is needed to confirm results. PMID:12877671

Jacobson, Joth L; Hussein, Mohamad A; Barlogie, Bart; Durie, Brian G M; Crowley, John J

2003-08-01

199

A retrospective review of three antibiotic prophylaxis regimens for pediatric cardiac surgical patients  

Microsoft Academic Search

BackgroundOptimal antimicrobial prophylaxis for the pediatric cardiac surgical patient is unknown. We have reviewed our experience with more than 4,000 pediatric cardiac surgical patients at the University of Michigan to evaluate antibiotic prophylaxis regimens.

Kevin O Maher; Kristen VanDerElzen; Edward L Bove; Ralph S Mosca; Carol E Chenoweth; Thomas J Kulik

2002-01-01

200

Assessment of oral mucositis in adult and pediatric oncology patients: an evidence-based approach.  

PubMed

Oral mucositis is a frequent side effect of cancer treatment and can lead to delayed treatment, reduced treatment dosage, altered nutrition, dehydration, infections, xerostomia, pain, and higher healthcare costs. Mucositis is defined as "inflammatory lesions of the oral and/or gastrointestinal tract caused by high-dose cancer therapies. Alimentary tract mucositis refers to the expression of mucosal injury across the continuum of oral and gastrointestinal mucosa, from the mouth to the anus" (Peterson, Bensadoun, & Roila, 2008, p. ii122). Evidence demonstrates that oral mucositis is quite distressing for patients. In addition, the majority of oncology nurses are unaware of available guidelines related to the care of oral mucositis. A multidisciplinary Oral Mucositis Committee was formed by the University of Iowa Hospitals and Clinics to develop evidence-based prevention and treatment strategies for adult and pediatric oncology patients experiencing oral mucositis. The first step was implementing an evidence-based nursing oral assessment. The Iowa Model was used to guide this evidence-based practice initiative. The Oral Assessment Guide (OAG) is reliable and valid, feasible, and sensitive to changing conditions. The OAG was piloted on an Adult Leukemia and Bone Marrow Transplant Unit leading to modification and adaptation. The pilot evaluation found 87% of patients had an abnormal oral assessment involving all categories in the tool. Nursing questionnaires showed that staff (8/23; 35% response) felt they were able to identify at risk patients using the OAG (3.3; 1-4 scale), and the tool accurately identifies mucosal changes (2.9; 1-4 scale). A knowledge assessment found nurses correctly identified OAG components 63% of the time. Unlike results from a national survey, most University of Iowa Hospitals and Clinics nurses (63%) were aware of national guidelines for prevention and treatment of oral mucositis. Developing an evidence-based nursing policy and updating documentation systems was done before implementation occurred. Computer-based and printed educational materials were developed for nursing staff caring for oncology patients. Team members were responsible for facilitating adoption in clinical areas. After organizational roll out, the nursing assessment was documented in all patients 87% of the time, and 99% for inpatients. The highest risk population, head and neck cancer patients receiving radiation, had documentation in 88% of audited visits. Other clinics required further work. Changing the system to the electronic medical record created an additional need for integration of the evidence-based practice with housewide documentation of oral assessment being completed 60.9% of the time. Use of an evidence-based assessment is the first step in a comprehensive program to reduce a common and highly distressing side effect of cancer treatment. Nursing documentation of oral assessment is well integrated on inpatient units. Opportunities for improvement remain in ambulatory care. Multidisciplinary team collaborations to expand evidence-based assessment and research questions generated from this work will be shared. PMID:20863028

Farrington, Michele; Cullen, Laura; Dawson, Cindy

2010-01-01

201

Multidetector computed tomography findings of dense pulmonary emboli in oncologic patients.  

PubMed

Pulmonary embolism is a frequent condition for which multidetector computed tomography (MDCT) plays an important role in its detection. Occasionally, on MDCT studies, dense linear branching opacities may be found within the pulmonary vessels. They represent dense emboli within the pulmonary arteries (DEPA). These may occur in oncologic patients that undergo specific treatments or interventional procedures, such as cement embolus from vertebroplasty, catheter or coil migration after embolization procedures, radioactive seed embolus in patients treated with local brachytherapy for prostate, lung, or liver cancer, and also in chronic pulmonary embolism. Usually DEPA does not have any clinical significance but may be fatal when massive or when in patients with impaired cardiopulmonary function. Being familiar with their radiologic appearance and knowing about the good clinical outcome of these patients will avoid unnecessary imaging testing. In this article, we describe some examples of DEPA. Based on the MDCT imaging findings, these emboli have very few or no side effects on the underlying lung parenchyma. We would like to stress the need for using bone window values for identifying these emboli. We provide examples of dense linear nonvascular images (pulmonary calcification secondary to tuberculosis (TBC) or radiotherapy, calcified mucous plugs, lung sutures, etc) that may mimic DEPA. PMID:19778659

Villanueva, Alberto; Díaz, Maria Lourdes; Sánchez, Armando; Castañer, Eva; Bastarrika, Gorka; Broncano, Jordi; del Barrio, Loreto Garcia

2009-01-01

202

[Prevention of respiratory infection in patients following surgical intervention].  

PubMed

The objective of the present study was to estimate the efficacy of therapy with hexetedine for the prevention of the respiratory infection in the patients undergoing surgical intervention. The study included 64 patients (28 adults and 36 children) ranging in the age from 3 to 55 years who were examined before and after surgery (radiosurgical tonsillectomy and radiosurgical uvulopalatoplasty). Complete clinical examination was supplemented by a microbiological study of cultivated mucosal swab samples obtained from the pharynx before and after the treatment. 41 patients of the study group received hexetedine (hexoral) for the 4 days preceding the operation and during 3 days of the postoperative period. It was shown that the patients treated with hexetedine both in the pre- and postoperative periods experienced a substantial decrease in microbial infestation of pharyngeal mucosa and accelerated elimination of the inflammatory process. Moreover, the general therapeutic effect on day 5 after surgery was more pronounced in the hexetedine-treated patients compared with controls. PMID:22433703

2011-01-01

203

Electronic Patient Data Confidentiality Practices Among Surgical Trainees: Questionnaire Study  

PubMed Central

INTRODUCTION The objective of this work was to evaluate the safeguards implemented by surgical trainees to protect the confidentiality of electronic patient data through a structured questionnaire sent to Northern Ireland surgical trainees. PARTICIPANTS AND METHODS A group of 32 basic and higher surgical trainees attending a meeting of the Northern Ireland Association of Surgeons-in-Training were invited to complete a questionnaire regarding their computer use, UK Data Protection Act, 1988 registration and electronic data confidentiality practices. RESULTS Of these 32 trainees, 29 returned completed questionnaires of whom 26 trainees regularly stored sensitive patient data for audit or research purposes on a computer. Only one person was registered under the Data Protection Act, 1988. Of the computers used to store and analyse sensitive data, only 3 of 14 desktops, 8 of 19 laptops and 3 of 14 hand-held computers forced a password logon. Of the 29 trainees, 16 used the same password for all machines, and 25 of 27 passwords were less than 8 characters long. Two respondents declined to reveal details of their secure passwords. Half of all trainees had never adjusted their internet security settings, despite all 14 desktops, 16 of 19 laptops and 5 of 14 hand-helds being routinely connected to the internet. Of the 29 trainees, 28 never encrypted their sensitive data files. Ten trainees had sent unencrypted sensitive patient data over the internet, using a non-secure server. CONCLUSIONS Electronic data confidentiality practices amongst Northern Ireland surgical trainees are unsafe. Simple practical measures to safeguard confidentiality are recommended.

Mole, Damian J; Fox, Colin; Napolitano, Giulio

2006-01-01

204

Aspergillus infections in transplant and non-transplant surgical patients.  

PubMed

Background: Aspergillus infections are associated commonly with immunocompromised states, such as transplantation and hematologic malignant disease. Although Aspergillus infections among patients having surgery occur primarily in transplant recipients, they are found in non-recipients of transplants, and have a mortality rate similar to that seen among transplant recipients. Methods: We conducted a retrospective analysis of a prospective data base collected from 1996 to 2010, in which we identified patients with Aspergillus infections. We compared demographic data, co-morbidities, and outcomes in non-transplant patients with those in abdominal transplant recipients. Continuous data were evaluated with the Student t-test, and categorical data were evaluated through ?(2) analysis. Results: Twenty-three patients (11 transplant patients and 12 non-transplant patients) were identified as having had Aspergillus infections. The two groups were similar with regard to their demographics and co-morbidities, with the exceptions of their scores on the Acute Physiology and Chronic Health Evaluation II (APACHE II), of 23.6±8.1 points for transplant patients vs. 16.8±6.1 points for non-transplant patients (p=0.03); Simplified Acute Physiology Score (SAPS) of 16.6±8.3 points vs. 9.2±4.1 points, respectively (p=0.02); steroid use 91.0% vs. 25.0%, respectively (p=0.003); and percentage of infections acquired in the intensive care unit (ICU) 27.3% vs. 83.3%, respectively (p=0.01). The most common site of infection in both patient groups was the lung. The two groups showed no significant difference in the number of days from admission to treatment, hospital length of stay following treatment, or mortality. Conclusions: Although Aspergillus infections among surgical patients have been associated historically with solid-organ transplantation, our data suggest that other patients may also be susceptible to such infections, especially those in an ICU who are deemed to be critically ill. This supports the idea that critically ill surgical patients exist in an immunocompromised state. Surgical intensivists should be familiar with the diagnosis and treatment of Aspergillus infections even in the absence of an active transplant program. PMID:24799182

Davies, Stephen; Guidry, Christopher; Politano, Amani; Rosenberger, Laura; McLeod, Matthew; Hranjec, Tjasa; Sawyer, Robert

2014-06-01

205

The influence of race on the attitudes of radiation oncology patients towards clinical trial enrollment. | accrualnet.cancer.gov  

Cancer.gov

In this study of radiation oncology patients, whites and non-whites had similar rates of enrollment in clinical trials and expressed similar levels of interest in clinical trials. However, significant differences in attitudes towards clinical trials between whites and nonwhites were found. These differences reflect findings in other studies that there is a lack of trust of the medical establishment by nonwhite patients and this lack of trust affects enrollment.

206

Rapid Reduction of Central Line Infections in Hospitalized Pediatric Oncology Patients Through Simple Quality Improvement Methods  

PubMed Central

Background Pediatric hematology-oncology (PHO) patients are at significant risk for developing central line-associated bloodstream infections (CLA-BSIs) due to their prolonged dependence on such catheters. Effective strategies to eliminate these preventable infections are urgently needed. In this study, we investigated the implementation of bundled central line maintenance practices and their effect on hospital-acquired CLA-BSIs. Materials and Methods CLA-BSI rates were analyzed within a single-institution’s PHO unit between January 2005 and June 2011. In May 2008, a multidisciplinary quality improvement team developed techniques to improve the PHO unit’s safety culture and implemented the use of catheter maintenance practices tailored to PHO patients. Data analysis was performed using time-series methods to evaluate the pre- and post-intervention effect of the practice changes. Results The pre-intervention CLA-BSI incidence was 2.92 per 1000-patient days (PD) and coagulase-negative Staphylococcus was the most prevalent pathogen (29%). In the post-intervention period, the CLA-BSI rate decreased substantially (45%) to 1.61 per 1000-PD (p<0.004). Early on, blood and marrow transplant (BMT) patients had a three-fold higher CLA-BSI rate compared to non-BMT patients (p<0.033). With additional infection control countermeasures added to the bundled practices, BMT patients experienced a larger CLA-BSI rate reduction such that BMT and non-BMT CLA-BSI rates were not significantly different post-intervention. Conclusions By adopting and effectively implementing uniform maintenance catheter care practices, learning multidisciplinary teamwork, and promoting a culture of patient safety, the CLA-BSI incidence in our study population was significantly reduced and maintained.

Choi, Sung W.; Chang, Lawrence; Hanauer, David A.; Shaffer-Hartman, Jackie; Teitelbaum, Daniel; Lewis, Ian; Blackwood, Alex; Akcasu, Nur; Steel, Janell; Christensen, Joy; Niedner, Matthew F.

2013-01-01

207

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.

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

2014-01-01

208

Use of serum drug concentrations in surgical patients.  

PubMed

Surgical patients frequently require drug treatments that can be assessed with serum drug concentrations. Of the agents for which serum drug concentrations are routinely available, the aminoglycosides theophylline, vancomycin, digoxin, and phenytoin are used most frequently in surgical patients. When using serum drug concentrations, the clinician should have an understanding of the relationships (or lack of) between drug concentrations and therapeutic or toxic effects. When blood is collected for serum concentration determinations, the exact timing of the sample in relation to the dose must be considered. For some drugs, (such as the aminoglycosides, it is necessary to determine peak and trough concentrations, whereas for other agents, like theophylline, the average or mid-dose level may be more important to consider. There are many factors that affect serum drug concentrations. Among these are various disease states, obesity, fluid imbalances, the drug dosage form used, and concurrent drug use. Not all patients require serum drug concentration monitoring; however, with each drug there are high-risk patients who may benefit. When used properly, serum drug concentrations may be helpful in maximizing therapeutic benefits, minimizing or diagnosing drug toxicity, and assessing patient compliance with drug regimens. PMID:3293477

Connors, J E; DiPiro, J T; Sisley, J F

1988-07-01

209

Advances in the molecular and serological diagnosis of invasive fungal infection in haemato-oncology patients.  

PubMed

Current laboratory diagnostic methods for invasive fungal infection (IFI) in haemato-oncology patients are insensitive, resulting in late diagnosis and contributing to high mortality. In recent years, progress has been made in the development and evaluation of sensitive sero-diagnostic assays, including detection of genomic DNA sequences and fungal antigens, which aid in a rapid, early diagnosis of IFI. The sensitivity and specificity of the assays vary considerably between studies, highlighting the need to correlate serological results with conventional laboratory tests and clinical or radiological findings. As part of management protocols, these assays may help to confirm the diagnosis of suspected IFI; however, the impact on mortality from IFI may be greatest when they are used to screen high-risk patients. Persistently positive screening results could direct early aggressive antifungal therapy, guided further by radiological and microbiological findings combined with regular clinical review, while the excellent negative predictive value may allow treatment to be withheld in patients with antibiotic resistant neutropenic fever but no other signs of IFI. However, this pre-emptive approach requires evaluation in prospective randomized trials. PMID:15257700

McLintock, Lorna A; Jones, Brian L

2004-08-01

210

Recommendations from the Spanish Oncology Genitourinary Group for the treatment of patients with renal cell carcinoma.  

PubMed

Clear-cell renal cell carcinoma (RCC) is the most common kidney cancer. New treatment options of localized RCC recently incorporated include laparoscopic surgery, nephron-sparing surgery, ablative techniques and active surveillance. But 50 % of patients may develop disease recurrence attributable to subclinical metastases. In these cases, and considering the low benefits of chemotherapy, new targeted therapies such as tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin (mTOR) inhibitors have been developed as first- and second-line treatment. Both sunitinib and pazopanib are TKIs that constitute the first-line treatment option in patients with metastatic RCC. As second-line treatment, sequential therapy with a second TKI or a mTOR inhibitor is recommended. This review has collected together a series of recommendations issued by the Spanish Oncology Genitourinary Group with the aim of facilitating the treatment of these patients. Each recommendation is accompanied by the level of evidence and grade of recommendation on the basis of the available data. PMID:24531612

García Del Muro, Xavier; Gallardo, Enrique; García Carbonero, Iciar; Laínez, Nuria; José Méndez, María; Maroto, Pablo; Ochoa de Olza, María; Puente, Javier; Reynes, Gaspar; Rubio, José; Santander, Carmen; Suárez, Cristina; Vázquez Estévez, Sergio; Castellano, Daniel

2014-06-01

211

Educational Levels of Hospital Nurses and Surgical Patient Mortality  

PubMed Central

Context Growing evidence suggests that nurse staffing affects the quality of care in hospitals, but little is known about whether the educational composition of registered nurses (RNs) in hospitals is related to patient outcomes. Objective To examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications). Design, Setting, and Population Cross-sectional analyses of outcomes data for 232–342 general, orthopedic, and vascular surgery patients discharged from 168 nonfederal adult general Pennsylvania hospitals between April 1, 1998, and November 30,1999, linked to administrative and survey data providing information on educational composition, staffing, and other characteristics. Main Outcome Measures Risk-adjusted patient mortality and failure to rescue within 30 days of admission associated with nurse educational level. Results The proportion of hospital RNs holding a bachelor’s degree or higher ranged from 0% to 77% across the hospitals. After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patient’s surgeon was board certified, a 10% increase in the proportion of nurses holding a bachelor’s degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue (odds ratio, 0.95; 95% confidence interval, 0.91–0.99 in both cases). Conclusion In hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.

Aiken, Linda H.; Clarke, Sean P.; Cheung, Robyn B.; Sloane, Douglas M.; Silber, Jeffrey H.

2010-01-01

212

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.

213

Oncology Healthcare Providers' Implementation of the 5 A's Model of Brief Intervention for Smoking Cessation: Patients' Perceptions  

PubMed Central

Objective Health care providers (HCPs) can play an important role in promoting smoking cessation and preventing relapse. Public Health Service guidelines recommend the “5A’s” model of brief intervention. The goal of the current study was to examine cancer patients’ perceptions of 5A’s model implementation by their oncology HCPs. Methods This study included 81 thoracic and 87 head and neck cancer patients at a large NCI-designated comprehensive cancer center. Patients completed questionnaires assessing perceptions of their oncology HCPs’ implementation of the 5A’s model of brief intervention. Results Results indicate partial implementation of the 5A’s model. The majority of patients reported that their providers had asked about smoking and advised them to quit, however; only half reported that their interest in quitting had been assessed, and few reported assistance in quitting or follow-up. Delivery of the 5A’s was greater among patients who requested cessation advice from their HCPs. Conclusion The current findings suggest a need to increase adherence to the 5A’s in the oncology setting. Practical Implications Efforts to increase smoking cessation treatment provision by HCPs may improve the rate of cessation among cancer patients, and ultimately translate into better long-term cancer treatment outcomes.

Simmons, Vani Nath; Litvin, Erika B.; Unrod, Marina; Brandon, Thomas H.

2011-01-01

214

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

215

Risk assessment in surgical patients: balancing iatrogenic risks and benefits.  

PubMed

Cutaneous procedures are associated with a wide variety of potential risks. This contribution discusses risk-related considerations in the preoperative, intraoperative, and postoperative management of dermatologic surgery patients. In the preoperative setting, major considerations include bleeding risks, the presence of pacemakers or defibrillators, risks of local and systemic infection, and the possibility of adverse reactions to local anesthetics and topical agents used for dermatologic procedures. Risk is minimized intraoperatively through careful attention to sterile technique, maintaining adequate hemostasis, skillful management of emerging complications, and effective closure of surgical defects. To optimize outcomes, postoperative priorities include effective management of postoperative bleeding, appropriate wound care, and prevention and treatment of hypertrophic scars and keloids. Reducing the likelihood of adverse surgical outcomes requires identification of potential risk factors and case-specific approaches to minimize risks while simultaneously preparing for the possibility of complications. PMID:22014989

Pomerantz, Rebecca G; Lee, David A; Siegel, Daniel M

2011-01-01

216

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.

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

2012-01-01

217

Selected surgical managements in snoring and obstructive sleep apnea patients  

PubMed Central

Summary Background The diagnostic process and the surgical procedures in patients with snoring and obstructive sleep apnea syndrome (OSAS) are crucial. The aim of this study was to assess the efficacy of surgical treatment in snoring and OSAS patients. Material/Methods A precise laryngological examination and screening polysomnography (Poly-Mesam) were performed in all patients with mild, moderate and severe OSAS before and 6 months after surgery. The patients completed questionnaires concerning their complaints. We included patients qualified to septoplasty, laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP) and radiofrequency-induced thermotherapy of the tongue base (RITT). Outcome evaluation of surgery was performed on the basis of data received from follow-up laryngological examinations, selected parameters obtained from the Poly-Mesam test and follow-up questionnaires. Results In most cases we observed improvement, defined as decreasing some sleep parameters, such as a respiratory disturbance index (RDI), by more than 50%, decreasing the loudness of snoring, decreasing the number of hypopneas, and obtaining better blood saturation values. After UPPP we noticed changes in retropalatal space, soft palate dimensions and uvula-posterior pharyngeal wall distance. In the postoperative period we did not observe severe complications. In some cases we found short-lived palatal deficiency after UPPP. Patients after RITT experienced discomfort and throat pain lasting from 2 to 4 days. In 2 patients we observed swelling of the tongue base, which decreased after few days. Conclusions Surgery in OSAS contributes to normalization of some sleep parameters. The majority of patients experienced improvement after surgery.

Olszewska, Ewa; Rutkowska, Justyna; Czajkowska, Aneta; Rogowski, Marek

2012-01-01

218

Surgical management of musculoskeletal involvement in hemophilic patients.  

PubMed

Since the establishment of a Hemophilic Center at the National Taiwan University Hospital in 1984, all hemophilic patients have been registered. They have received regular follow-ups by specialists in appropriate fields. Orthopedic surgeons are assigned to evaluate and handle the complications of the musculoskeletal system. From January 1984 to April 1988, 20 of these patients were referred for various reconstructive procedures. Seventeen had a moderate to severe depletion of factor VIII and 2 had a severe factor IX deficiency. The indications for surgery include pain, swelling, frequent bleeding, and flexion contracture of the involved joints. Knee joints outnumbered the others. The operative procedures included: synovectomy in 7 patients, total knee replacement in 3 patients, total hip replacement in 1 patient, tendon reconstruction and supracondylar osteotomy of the femur in 3 patients, excision of a pseudotumor or cyst in 4 patients and amputation in 2 patients. Postoperatively, joint pain was relieved greatly, recurrent bleeding became rare and walking ability was significantly improved. To prevent a decrease in the arc of motion of the operated knee joint, exercise was initiated early using a continuous passive motion machine with promising results. Postoperative complications were minimal. Indications for various surgical procedures, and the details of hematological handling are discussed. PMID:2621433

Chen, P Q; Shen, M C; Tsai, Y C; Liu, T K

1989-09-01

219

Reproductive health in the adolescent and young adult cancer patient: an innovative training program for oncology nurses.  

PubMed

In 2008, approximately 69,200 adolescents and young adults (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. 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

2013-03-01

220

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.

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

2012-01-01

221

Non invasive ventilation in cardio-surgical patients.  

PubMed

Non invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic respiratory failure, has also found a wide application in the postoperative period. The expanding indications to the transcatheter treatment of diseased left heart valves have led to an increase in cardiac interventional and diagnostic procedures in severely fragile cardiac patients. As an essential part of post cardiac surgery care is ventilatory support, NIV use has expanded to cardiosurgical patients. The objective of this study was to investigate the application and the results of preventive and curative NIV in patients after cardiac surgery. Despite limited data and the necessity of randomized trials, the NIV should be considered in selected patients with postoperative acute respiratory failure as a tool to both prevent and treat acute respiratory failure following patient weaning from mechanical ventilation and tracheal extubation. The knowledge and the real time assessment of the possible effects of positive pressure ventilation on cardiopulmonary interactions in the clinical scenario of cardiac surgery will prompt the intensivists to tailor the respiratory support by non invasive ventilation to the individual patient. The influence on the cardiovascular system of positive pressure and volume delivered through the airways, which can be highly favorable on the impaired left heart and less favorable on the diseased right heart, should be considered when applying NIV in a cardio-surgical patient. As a consequence, the application of NIV in this setting requires an expertly skilled team, continuous hemodynamic monitoring and echocardiographic assessment. PMID:21709660

Guarracino, F; Ambrosino, N

2011-07-01

222

Successful surgical treatment of two patients with eosinophilic endomyocardial disease.  

PubMed Central

Cardiac surgery to treat severe heart failure was of benefit to two patients with endomyocardial disease and hypereosinophilia-eosinophilic endomyocardial disease. Both patients had severe biventricular fibrosis with mitral and tricuspid regurgitation. One had predominant right ventricular disease and was treated by right ventricular endocardectomy with tricuspid and mitral xenograft valve replacement. The second patient's main haemodynamic problem was considered to be mitral regurgitation. His mitral valve was replaced by a Starr-Edwards prosthesis; endocardectomy was not performed. Though both patients had toxic confusional states for several weeks postoperatively there was distinct symptomatic and objective evidence of improvement which has been maintained for over 16 months. Previous reports of surgical treatment of 22 patients without eosinophilia (all of whom had endomyocardial resection) and three other patients with eosinophilia have shown equally encouraging results. There has been no evidence of recurrence or progression of heart damage in follow-up periods of up to seven years. It is concluded that cardiac surgery is an important advance in the treatment of endomyocardial disease in patients with or without an eosinophilia. Images

Davies, J; Sapsford, R; Brooksby, I; Olsen, E G; Spry, C J; Oakley, C M; Goodwin, J F

1981-01-01

223

NCI-CCR Pediatric Oncology Branch - Patients and Families, New to NIH: Frequently Asked Questions  

Cancer.gov

Traveling to a new hospital can be stressful. We hope the information provided here will answer your questions before your first visit to the Pediatric Oncology Branch, located within the NIH Clinical Center.

224

[Mri and surgical indications in perforating ulcer in diabetic patients].  

PubMed

The authors report a series of thirty-six perforating ulcers of the foot in diabetic patients, evaluated using M.R.I. M.R.I. showed osteomyelitis in 16 cases, cellulitis in 15 cases, osteoarthropathies in 21 cases, tenosynovitis of flexor tendons in 2 cases, oedema in 2 cases and abscess in one case. In 19 cases, M.R.I. was used to improve diagnostic accuracy. The medical treatment made use of thermo-moulded soles allowing for the recovery of walking, with a hole facing the perforating ulcer of the foot. The application of insulin-soaked sponges in the event of clean perforating ulcer of the foot and iodized solution in the event of infected perforating ulcer of the foot promoted healing. The treatment was only conservative, when the lesions were limited to the soft tissues. Surgical treatment was performed in 19 cases due to a global involvement of soft and osteoarticular tissues. In fourteen cases the surgical treatment was limited and was performed through the perforating ulcer. Resection of metatarsal heads or metatarso-phalangeal joints was performed in 10 cases, with resection of surrounding pathologic tissue. The surgical treatment was limited to the soft tissues in 6 cases. In 4 cases, M.R.I. findings resulted into a transmetatarsal amputation because the vascular plexus was of poor quality and infection spread from the perforating ulcer to the dorsal aspect of the foot. In our opinion, dorsal infectious involvement in a perforating ulcer of the foot, is a factor of poor prognosis. A below-knee amputation has been performed in one patient. PMID:9441558

Jarde, O; Filloux, V; Filloux, J F; Remond, A; Vives, P

1997-09-01

225

Analysis of non-clonal chromosome abnormalities observed in hematologic malignancies among Southwest Oncology Group patients  

SciTech Connect

From 1987-1994, the Southwest Oncology Group Cytogenetics Committee reviewed 1571 studies in 590 adult patient cases with ALL, AML, CML or CLL. These were analyzed for the presence of clinically important non-clonal abnormalities (NCA). Abnormalities were defined as non-clonal if one metaphase had a structural abnormality or an extra chromosome. Chromosome loss was not analyzed due to the possibility of random loss. In 72 cases (12%) comprising 136 studies, at least one NCA was observed. In 21 of these cases (29%), NCAs consisted of obvious clonal evolution or instability, and thus were not included in the analysis. At least one structural NCA was observed in which the abnormality differed from the mainline in 36 (50%) patients. Seventeen of the 36 cases had a normal mode. Nineteen of the 36 patients had an abnormal or normal/abnormal mode. At least one numerical NCA was found in 15 cases (21%). Fifteen cases (21%) contained at least one marker chromosome. Several cases involved NCA in more than one of the above divisions. NCAs could be classified into several categories: (1){open_quotes}the clone to come{close_quotes}, (2) evolving clones which then disappeared, (3) NCAs with putative clinical importance that never became clonal, (4) NCAs during remission identical to the preceding clonal abnormality, (5) NCAs which indicated clonal evolution or instability. Examples include one metaphase with t(9;22) or del(20q) or inv(16) or +8 which either preceded or followed clonal findings of the same aberration. Such findings should be communicated to the clinician.

McConnell, T.S. [Univ. of New Mexico, Albuquerque, NM (United States); Dobin, S.M. [Oregon Health Sciences Univ., Portland, OR (United States)

1994-09-01

226

Alexithymia in severely obese patients seeking surgical treatment.  

PubMed

The purpose of the study was to examine the rate of alexithymia as measured by the Toronto Alexithymia Scale in a sample of severely obese subjects, as well as the relationships between this dimension and five other dimensions found in obesity: depression, anhedonia, external locus of control, impulsivity, and interpersonal dependency. A second purpose was to test the hypothesis that alexithymia could be a prognosis factor in severely obese subjects seeking bariatric surgery. 49 severely obese and 40 psychiatric patients presenting mood, neurotic, or personality disorders participated. Analyses showed a significantly lower rate of alexithymia in severely obese (42.9%) than in psychiatric patients (67.5%). Interpersonal dependency was the main predictor of alexithymia in the two samples and impulsivity as well as anhedonia were independent predictors of alexithymia only in the severely obese sample. Preoperative Body Mass Index was the sole predictor of 1-yr. postoperative Body Mass Index in severely obese subjects receiving surgical treatment. PMID:20099557

Marechal, Virginie; Loas, Gwenolé; Legrand, Alain; Corcos, Maurice

2009-12-01

227

Patient Participation in Surgical Treatment Decision Making from the Patients' Perspective: Validation of an Instrument  

PubMed Central

The aim of this paper is to describe the development of a new, brief, easy-to-administer self-reported instrument designed to assess patient participation in decision making in surgical treatment. We describe item generation, psychometric testing, and validity of the instrument. The final scale consisted of four factors: information dissemination (5 items), formulation of options (4 items), integration of information (4 items), and control (3 items). The analysis demonstrated a reasonable level of construct validity and reliability. The instrument applies to patients in surgical wards and can be used to identify the health services that are being provided and the areas that could strengthen patient participation.

Heggland, Liv-Helen; ?gaard, Torvald; Mikkelsen, Aslaug; Hausken, Kjell

2012-01-01

228

Lower vitamin D levels in surgical hyperparathyroidism versus thyroid patients.  

PubMed

Low vitamin D levels have been shown to be associated with primary hyperparathyroidism, but it is unclear whether vitamin D deficiency may be an etiologic factor in the development of primary hyperparathyroidism. To investigate this, we compared preoperative vitamin D levels of patients undergoing surgery for primary hyperparathyroidism with those of patients undergoing surgery for benign thyroid disease. With Institutional Review Board approval, data were collected prospectively on patients undergoing parathyroidectomy or thyroidectomy by one surgeon between March 2006 and July 2011. Patients were excluded if they underwent simultaneous thyroid and parathyroid surgery, had secondary or tertiary hyperparathyroidism, if no preoperative vitamin D level was measured, or if they took vitamin D supplements. Inclusion criteria were met by 219 patients who underwent parathyroidectomy and 186 patients who underwent thyroid surgery. Patient age, sex, race, and preoperative vitamin D levels (vitamin D 25-OH; normal, 32 to 100 pg/mL) were collected. Statistical analysis was performed using linear regression. Vitamin D levels were significantly lower in the parathyroid group compared with the thyroid group (23.8 vs 28.5 pg/mL; P < 0.001). This difference was also observed after adjustment for age, sex, and race with a mean difference of 4.87 pg/mL (P < 0.001). Statistically significant associations between lower vitamin D levels and patients younger than 50 years (P = 0.048), male sex (P = 0.03), and nonwhite race were identified (P < 0.001). Patients with primary hyperparathyroidism are more likely to have lower vitamin D levels than a control surgical population. Further study is needed to determine whether low vitamin D levels may be an etiologic factor associated with the development of hyperparathyroidism. PMID:24887732

Lindeman, Brenessa M; Pesce, Catherine E; Tsai, Hua-Ling; Somervell, Helina; Umbricht, Christopher B; Kowalski, Jeanne; Zeiger, Martha A

2014-05-01

229

A Systematic Review of Risk Factors Associated with Surgical Site Infections among Surgical Patients  

PubMed Central

Importance Surgical site infection (SSI) complicates 2-5% of surgeries in the United States. Severity of SSI ranges from superficial skin infection to life-threatening conditions such as severe sepsis, and SSIs are responsible for increased morbidity, mortality, and economic burden associated with surgery. Staphylococcus aureus (S. aureus) is a commonly-isolated organism for SSI, and methicillin-resistant S. aureus SSI incidence is increasing globally. Objective The objective of this systematic review was to characterize risk factors for SSI within observational studies describing incidence of SSI in a real-world setting. Evidence Review An initial search identified 328 titles published in 2002-2012; 57 were identified as relevant for data extraction. Extracted information included study design and methodology, reported cumulative incidence and post-surgical time until onset of SSI, and odds ratios and associated variability for all factors considered in univariate and/or multivariable analyses. Findings Median SSI incidence was 3.7%, ranging from 0.1% to 50.4%. Incidence of overall SSI and S. aureus SSI were both highest in tumor-related and transplant surgeries. Median time until SSI onset was 17.0 days, with longer time-to-onset for orthopedic and transplant surgeries. Risk factors consistently identified as associated with SSI included co-morbidities, advanced age, risk indices, patient frailty, and surgery complexity. Thirteen studies considered diabetes as a risk factor in multivariable analysis; 85% found a significant association with SSI, with odds ratios ranging from 1.5-24.3. Longer surgeries were associated with increased SSI risk, with a median odds ratio of 2.3 across 11 studies reporting significant results. Conclusions and Relevance In a broad review of published literature, risk factors for SSI were characterized as describing reduced fitness, patient frailty, surgery duration, and complexity. Recognition of risk factors frequently associated with SSI allows for identification of such patients with the greatest need for optimal preventive measures to be identified and pre-treatment prior to surgery.

Korol, Ellen; Johnston, Karissa; Waser, Nathalie; Sifakis, Frangiscos; Jafri, Hasan S.; Lo, Mathew; Kyaw, Moe H.

2013-01-01

230

[Specificity of the psychological undertaking of a patient in thoracic oncology].  

PubMed

The question raised by the title calls for a balanced answer. As a matter of fact, like in many clinical situations in which an illness threatens the patient's survival, the singularity of each case makes any attempt of generalization simplistic. Writing about the speficity of the psychological undertaking in thoracic oncology has to avoid two pitfalls: denying any psychosociological specificity of thoracic cancerology, and thus not providing the reader's understanding with anything which could help them read the most frequent problematics. And secondly turn clinical qualitative data into generalities stuck on each case, and rejecting the singularity of the sick person as a subject. As we attempt to avoid both traps, the three next points will be tackled: the announcement of cancer is prototypical of a trauma, and calls up an intense affect of anguish. This affect can be read through social representations, which intervene within the exchange doctor - sick person. The subjectivation of this relation cannot be understood without taking the environment into account, and especially what the affected person knows about cancer owing to their belonging to a socius. In the traumatic atmosphere thus created, the rereading of the phenomenons - cropping up between a somatic symptom experienced by the patient and a traumatic language revolving around the compulsory term "cancer" - is achieved according recurrent thematic lines. As we do not wish to reach the exhaustiveness of the significant unities, neither their reassembly, we will limit ourselves to the development of one main line: that of the relation to time, to temporality, and to presentism. PMID:23664288

Pujol, J-L

2013-04-01

231

The Waterlow score for risk assessment in surgical patients  

PubMed Central

Introduction Perioperative scoring systems aim to predict outcome following surgery and are used in preoperative counselling to guide management and to facilitate internal or external audit. The Waterlow score is used prospectively in many UK hospitals to stratify the risk of decubitus ulcer development. The primary aim of this study was to assess the potential value of this existing scoring system in the prediction of mortality and morbidity in a general surgical and vascular cohort. Methods A total of 101 consecutive moderate to high risk emergency and elective surgical patients were identified through a single institution database. The preoperative Waterlow score and outcome data pertaining to that admission were collected. The discriminatory power of the Waterlow score was compared against that of the American Society of Anesthesiologists (ASA) grade and the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM). Results The inpatient mortality rate was 17% and the 30-day morbidity rate was 29%. A statistically significant association was demonstrated between the preoperative Waterlow score and inpatient mortality (p<0.0001) and 30-day morbidity (p=0.0002). Using a threshold Waterlow score of 20 to dichotomise risk, accuracies of 0.84 and 0.76 for prediction of mortality and morbidity were demonstrated. In comparison with P-POSSUM, the preoperative Waterlow score performed well on receiver operating characteristic analysis. With respect to mortality, the area under the curve was 0.81 (0.80–0.85) and for morbidity it was 0.72 (0.69–0.76). The ASA grade achieved a similar level of discrimination. Conclusions The Waterlow score is collected routinely by nursing staff in many hospitals and might therefore be an attractive means of predicting postoperative morbidity and mortality. It might also function to stratify perioperative risk for comparison of surgical outcome data. A prospective study comparing these risk prediction scores is required to support these findings.

Thorn, CC; Smith, M; Aziz, O

2013-01-01

232

Using baldrige performance excellence program approaches in the pursuit of radiation oncology quality care, patient satisfaction, and workforce commitment.  

PubMed

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

233

Pre-surgical evaluation and surgical outcome of 41 patients with non-lesional neocortical epilepsy  

Microsoft Academic Search

Pre-surgical evaluation and the surgical treatment of non-lesional neocortical epilepsy is one of the most challenging areas in epilepsy surgery. The aim of this study was to evaluate the surgical outcome and the diagnostic role of ictal scalp electroencephalography (EEG), interictal 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET), and ictal technetium-99m hexamethylpropyleneamine oxime single photon emission tomography (99m Tc-HMPAO SPECT). In 41 non-lesional

Chun-Kee Chung

2002-01-01

234

Laparoscopic radical prostatectomy: oncological and functional results of 126 patients with a minimum 3-year follow-up at a single Chinese institute  

PubMed Central

In this study we evaluate the oncological and functional results of the largest cohort of patients in China treated by laparoscopic radical prostatectomy (LRP) and with at least 3 years of follow-up. 126 inconsecutive patients (range 56–78 years, median 62.5) who had an LRP were retrospectively analyzed. The mean prostate specific antigen level and Gleason score was 13.4 ng mL?1 and 6.4, respectively. Twenty-seven patients had unilateral or bilateral nerve preservation and 29 had pelvic lymphadenectomy. Multivariate analysis was used to adjust for differences in clinical and pathological features when comparing the risk for biochemical progression-free survival (bPFS). Urinary continence was assessed by incontinence questionnaire and erectile function by the Sexual Health Inventory for Men score. The mean operative duration was 250 min and blood loss 354 mL. Five patients received blood transfusion and nine had complications, including rectal injury (two), ureteral injury (one), active bleeding (one), bladder neck stenosis (two), paralytic ileus (one), subcutaneous hematoma (one) and port-site hernia (one). The overall positive surgical margin rate was 20.6% and correlated with pathological stage and Gleason score respectively (P = 0.03, P < 0.001 respectively). All patients had ? 3 years of follow-up (range 3–6.75 years, mean 4.6, median 4.75). At 3 years of follow-up, the overall survival rate was 100% and the bPFS was 81.0% in all patients; 124 patients (98.4%) were continent; 22 of 27 patients (81.5%) who underwent nerve preservation retained erectile function. Our series confirms that LRP is an effective, safe and precise technique at Chinese institution.

Gao, Xin; Zhou, Jian-Hua; Li, Liao-Yuan; Qiu, Jian-Guang; Pu, Xiao-Yong

2009-01-01

235

Different anticoagulants and platelet reactivity in cardiac surgical patients.  

PubMed

A technique for assessing platelet reactivity to shear stress from nonanticoagulated blood samples was employed to compare the relative effects of an unfractionated heparin, a low-molecular-weight heparin, and hirudin. The in vitro platelet effect of unfractionated heparin (5 U/mL) was measured in 290, the effect of a low-molecular-weight heparin (1 anti-Xa unit/mL) in 74, and the effect of hirudin (8 micrograms/mL) in 50 cardiac surgical patients. The relative proportions of patients exhibiting an enhanced platelet reactivity, a mild to moderate inhibition, and a severe inhibition were, respectively: 8.6%, 58.6%, and 32.8% for unfractionated heparin; 22%, 66%, and 12% for the low-molecular-weight heparin; and 6%, 66%, and 28% for hirudin. At the concentrations examined, a significantly greater proportion (p < 0.01) of the patients exhibited enhanced platelet reactivity and a significantly smaller proportion (p < 0.01) showed severely inhibited platelet reactivity associated with the low-molecular-weight heparin versus the unfractionated heparin, whereas there was no significant difference between the patients treated with hirudin and unfractionated heparin. Although the relevance of this study is limited because the clinically appropriate concentration of the alternative anticoagulants and comparative doses are unknown, it can be inferred that low-molecular-weight heparin may reduce the blood loss associated with cardiopulmonary bypass. PMID:8215666

John, L C; Rees, G M; Kovacs, I B

1993-10-01

236

Clinical predictors of surgical outcome in patients with thoracic outlet syndrome operated on via transaxillary approach  

Microsoft Academic Search

Objectives: Although the transaxillary route appears to be the optimal approach in patients with thoracic outlet syndrome (TOS), the effect of clinical features on surgical outcome remains unclear. We conducted a study to determine the clinical predictors of surgical outcome in patients with TOS. Methods: We examined the data charts of patients with TOS who underwent operation via transaxillary approach.

?inasi Yavuzer; Cansel Atinkaya; Osman Tokat

2004-01-01

237

Cumulative radiation dose estimates from medical imaging in paediatric patients with non-oncologic chronic illnesses. A systematic review.  

PubMed

Paediatric patients with non-oncologic chronic illnesses often require ongoing care that may result in repeated imaging and exposure to ionizing radiation from both diagnostic and interventional procedures. In this study the scientific literature on cumulative effective dose (CED) of radiation accrued from medical imaging among specific cohorts of paediatric, non-oncologic chronic patients (inflammatory bowel disease, cystic fibrosis, congenital heart disease, shunt-treated hydrocephalus, hemophilia, spinal dysraphism) was systematically reviewed. We conducted PubMed/Medline, Scopus and EMBASE searches of peer-reviewed papers on CED from diagnostic and therapeutic radiological examinations. No time restriction was introduced in the search. Only studies reporting CEDs accrued for a period >1 year were included. We found that the annual CED was relatively low (<3 mSv/year) in cystic fibrosis, congenital heart disease, patients with cerebrospinal fluid shunts and hemophilia, while being moderate (>3-20 mSv/year) in Crohn's patients. This extra yearly radiation exposure accrues over the lifetime and can reach high values (>100 mSv) in selected cohorts of paediatric chronic patients. PMID:24440537

Brambilla, Marco; De Mauri, Andreana; Lizio, Domenico; Leva, Lucia; Carriero, Alessandro; Carpeggiani, Clara; Picano, Eugenio

2014-06-01

238

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

239

Internet-Based Survey Evaluating Use of Pain Medications and Attitudes of Radiation Oncology Patients Toward Pain Intervention  

SciTech Connect

Purpose: Pain is a common symptom among cancer patients, yet many patients do not receive adequate pain management. Few data exist quantifying analgesic use by radiation oncology patients. This study evaluated the causes of pain in cancer patients and investigated the reasons patients fail to receive optimal analgesic therapy. Methods and Materials: An institutional review board-approved, Internet-based questionnaire assessing analgesic use and pain control was posted on the OncoLink (available at (www.oncolink.org)) Website. Between November 2005 and April 2006, 243 patients responded. They were predominantly women (73%), white (71%), and educated beyond high school (67%) and had breast (38%), lung (6%), or ovarian (6%) cancer. This analysis evaluated the 106 patients (44%) who underwent radiotherapy. Results: Of the 106 patients, 58% reported pain from their cancer treatment, and 46% reported pain directly from their cancer. The pain was chronic in 51% and intermittent in 33%. Most (80%) did not use medication to manage their pain. Analgesic use was significantly less in patients with greater education levels (11% vs. 36%, p = 0.002), with a trend toward lower use by whites (16% vs. 32%, p 0.082) and women (17% vs. 29%, p = 0.178). The reasons for not taking analgesics included healthcare provider not recommending medication (87%), fear of addiction or dependence (79%), and inability to pay (79%). Participants experiencing pain, but not taking analgesics, pursued alternative therapies for relief. Conclusions: Many radiation oncology patients experience pain from their disease and cancer treatment. Most study participants did not use analgesics because of concerns of addiction, cost, or failure of the radiation oncologist to recommend medication. Healthcare providers should have open discussions with their patients regarding pain symptoms and treatment.

Simone, Charles B. [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States); Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (United States)], E-mail: simonec@mail.nih.gov; Vapiwala, Neha; Hampshire, Margaret K.; Metz, James M. [Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States)

2008-09-01

240

Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome  

Microsoft Academic Search

Osteoarthritis is one of the most common causes of pain originating from the acromioclavicular (AC) joint. An awareness of\\u000a appropriate diagnostic techniques is necessary in order to localize clinical symptoms to the AC joint. Initial treatments\\u000a for AC joint osteoarthritis, which include non-steroidal anti-inflammatory drugs (NSAIDS) and corticosteroids, are recommended\\u000a prior to surgical interventions. Distal clavicle excision, the main surgical

Salvatore Docimo Jr; Dellene Kornitsky; Bennett Futterman; David E. Elkowitz

2008-01-01

241

Early postoperative and long-term oncological outcomes of laparoscopic treatment for patients with familial adenomatous polyposis  

PubMed Central

Purpose We evaluated the short- and long-term outcomes of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis (TPC/IPAA) for treatment of familial adenomatous polyposis (FAP). Also, we assessed the oncologic outcomes in FAP patients with coexisting malignancy. Methods From August 1999 to September 2010, 43 FAP patients with or without coexisting malignancy underwent TPC/IPAA by a laparoscopic-assisted or hand-assisted laparoscopic surgery. Results The median age was 33 years (range, 18 to 58 years) at the time of operation. IPAA was performed by a hand-sewn method in 21 patients (48.8%). The median operative time was 300 minutes (range, 135 to 610 minutes), which reached a plateau after 22 operations. Early postoperative complications within 30 days occurred in 7 patients (16.3%) and long-term morbidity occurred in 15 patients (34.9%) including 6 (14.0%) with desmoid tumors and 3 (7.0%) who required operative treatment. Twenty-two patients (51.2%) were diagnosed with coexisting colorectal malignancy. The median follow-up was 58.5 months (range, 7.9 to 97.8 months). There was only 1 case of local recurrence in the pelvic cavity. No cases of adenocarcinoma at the residual rectal mucosa developed. 5-year disease-free survival rate for 22 patients who had coexisting malignancy was 86.5% and 5-year overall survival rate was 92.6%. Three patients died from pulmonary or hepatic metastasis. Conclusion Laparoscopic TPC/IPAA in patients with FAP is feasible and offers favorable postoperative outcomes. It also delivered acceptable oncological outcomes in patients with coexisting malignancy. Therefore, laparoscopic TPC/IPAA may be a favorable treatment option for FAP.

Kim, Hye Jin; Park, Jun Seok; Park, Soo Yeun; Choi, Wohn Ho; Ryuk, Jong Pil

2012-01-01

242

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.

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

2010-01-01

243

Impact of a real-time peer review audit on patient management in a radiation oncology department.  

PubMed

In September 2006, the Royal Australian and New Zealand College of Radiologists (RANZCR) endorsed the modified Peer Review Audit Tool (PRAT). We aimed to assess the feasibility of using this tool in a busy radiation oncology department using an electronic medical record (EMR) system, identify areas of compliance and assess the impact of the audit process on patient management. Fortnightly random clinical audit was undertaken by using the revised RANZCR PRAT in the departments of radiation oncology at Liverpool and Macarthur Cancer Therapy Centres (LCTC and MCTC). Following audit of the EMR, treatment plans were audited by peer review. Data were collected prospectively from June 2007 to June 2008. Audits were carried out on 208 patients. Behaviour criteria were well documented in the EMR, but scanning of histology and medical imaging reports did not occur in up to a third of cases. With electronic prescriptions, treatment prescription errors were rare. In total, 8 (3.8%) out of 208 patients had a change to management recommended. Variability in interpretation of PRAT 'protocol/study' criteria was identified. We found that real-time audit is feasible and effective in detecting both issues with documentation in the EMR, and a small number of patients in whom a change to management is recommended. Recommendations have been made in order to continue to improve the audit process including documentation of any changes recommended and whether the recommended change occurred. PMID:19695048

Boxer, M; Forstner, D; Kneebone, A; Delaney, G; Koh, E-S; Fuller, M; Kaadan, N

2009-08-01

244

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

245

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

246

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

247

Length of stay in surgical patients: nutritional predictive parameters revisited.  

PubMed

Nutritional evaluation may predict clinical outcomes, such as hospital length of stay (LOS). We aimed to assess the value of nutritional risk and status methods, and to test standard anthropometry percentiles v. the 50th percentile threshold in predicting LOS, and to determine nutritional status changes during hospitalisation and their relation with LOS. In this longitudinal prospective study, 298 surgical patients were evaluated at admission and discharge. At admission, nutritional risk was assessed by Nutritional Risk Screening-2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST) and nutritional status by Subjective Global Assessment (SGA), involuntary % weight loss in the previous 6 months and anthropometric parameters; % weight loss and anthropometry were reassessed at discharge. At admission, risk/undernutrition results by NRS-2002 (P< 0.001), MUST (P< 0.001), % weight loss (P< 0.001) and SGA (P< 0.001) were predictive of longer LOS. A mid-arm circumference (MAC) or a mid-arm muscle circumference (MAMA) under the 15th and the 50th percentile, which was considered indicative of undernutrition, did predict longer LOS (P< 0.001); conversely, there was no association between depleted triceps skinfold (TSF) and longer LOS. In-hospital, there was a high prevalence of weight, muscle and fat losses, associated with longer LOS. At discharge, patients with a simultaneous negative variation in TSF+MAC+MAMA (n 158, 53 %) had longer LOS than patients with a TSF+MAC+MAMA positive variation (11 (8-15) v. 8 (7-12) d, P< 0.001). We concluded that at risk or undernutrition evaluated by all methods, except TSF and BMI, predicted a longer LOS. Moreover, MAC and MAMA measurements and their classification according to the 50th percentile threshold seem reliable undernutrition indicators. PMID:22717003

Almeida, Ana Isabel; Correia, Marta; Camilo, Maria; Ravasco, Paula

2013-01-28

248

Pathology turnaround time in pediatric oncology: a tool to prepare patients and families for the diagnostic waiting period.  

PubMed

There is little data on the amount of time patients and families typically wait for pathology results when pediatric malignancy is suspected. The purpose of this study was to determine the average waiting period after diagnostic intervention for pediatric cancer. Pathology reports were reviewed for pediatric patients who had their initial diagnosis and were followed in the Division of Hematology/Oncology from 2007 through 2010. The average turnaround time (TAT) for all pathology (n=266) was 6.9 days. The TAT for pathology results according to diagnosis was 10.1 days for CNS tumors (n=59), 9.7 days for sarcomas (n=40), 5.4 days for lymphomas (n=31), 5.4 days for neuroblastoma (n=13), 7.3 days for kidney tumors (n=11), 7.2 days for thyroid tumors (n=7), 9.4 days for ovarian tumors (n=7), 7.0 days for schwannomas/neurofibromas (n=5), 5.7 days for testicular tumors (n=3), 5.0 days for hepatoblastoma (n=3), and 7.0 days for nasopharyngeal carcinomas (n=2). Overall the TAT for leukemia was 3.1 days (n=76), with diagnosis by flow cytometry taking 1.2 days and results by bone marrow biopsy taking 4.0 days. The TAT for pediatric oncology pathology after diagnostic intervention varies according to diagnosis. The hope is that this information will better prepare patients and families for the agonizing waiting period associated with diagnosis. PMID:23823114

Forlenza, Christopher J; Levy, Adam S

2013-10-01

249

Practical tips for surgical research: how to optimize patient recruitment. | accrualnet.cancer.gov  

Cancer.gov

Surgeons are often patients’ initial point of contact about surgical studies. Surgeons conducting clinical research need to consider the issues involved in patient recruitment and plan strategies to minimize and avoid recruitment difficulties. In this article, strategies are suggested to avoid common pitfalls in recruitment to surgical trials.

250

Surgical Decompression of Supratentorial Arachnoid Cysts in Pediatric Patients Younger than One Year  

Microsoft Academic Search

Background: There has been much debate about the optimal surgical management of arachnoid cysts in infants younger than 1 year of age. The authors present the clinical and neuroimaging findings in pediatric patients with supratentorial arachnoid cysts treated by surgical decompression. Methods: A retrospective chart review was conducted to identify all pediatric patients who had been diagnosed with arachnoid cysts

Seung-Ho Yang; Kwan-Sung Lee; Jae Hoon Sung; Byung Chul Son; Sin-Soo Jeun; Joon-Ki Kang

2008-01-01

251

Computer control of physiological states of patients under and after surgical operation  

Microsoft Academic Search

We have been engaged in developments of computer control systems to regulate various physiological states of patients under or after surgical operation. We started the research in 1991 in cooperation with surgeons and anesthesiologists. We first tried hypotensive control of the blood pressure of patients under surgical operation. The system was clinically applied to 34 cases since 1995 with the

Mituhiko Araki; Eiko Furutani

2005-01-01

252

A Retrospective Review of Three Antibiotic Prophylaxis Regimens for Pediatric Cardiac Surgical Patients  

Microsoft Academic Search

Background. Optimal antimicrobial prophylaxis for the pediatric cardiac surgical patient is unknown. We have reviewed our experience with more than 4,000 pediatric cardiac surgical patients at the University of Michigan to evaluate antibiotic prophylaxis regimens. Methods. Three antibiotic prophylaxis protocols were serially used during a 6-year period: Protocol 1 (n 786): cefazolin was administered before operation and contin- ued as

Kevin O. Maher; Edward L. Bove; Ralph S. Mosca; Carol E. Chenoweth; Thomas J. Kulik

2010-01-01

253

ABDOMINAL COMPARTMENT SYNDROME AMONG CRITICALLY ILL SURGICAL AND TRAUMATISED PATIENTS: EXPERIENCE AT PIMS, ISLAMABAD  

Microsoft Academic Search

Background: Raised intra-abdominal pressure (IAP) accompanied by evidence of organ dysfunction constitutes abdominal compartment syndrome (ACS). The ACS is now becoming an increasingly recognised fatal entity in the critically ill surgical and traumatized patients receiving critical care. The objectives were to determine the frequency of abdominal compartment syndrome (ACS) in critically ill surgical and traumatised patients and to identify the

Muhammad Saaiq; Syed Aslam Shah; Tanwir Khaliq

2009-01-01

254

Financial Quality Control of In-Patient Chemotherapy in Germany: Are Additional Payments Cost-Covering for Pharmaco-Oncological Expenses?  

PubMed

SUMMARY: BACKGROUND: Cost-covering in-patient care is increasingly important for hospital providers in Germany, especially with regard to expensive oncological pharmaceuticals. Additional payments (Zusatzentgelte; ZE) on top of flat rate diagnose-related group (DRG) reimbursement can be claimed by hospitals for in-patient use of selected medications. To verify cost coverage of in-patient chemotherapies, the costs of medication were compared to their revenues. METHOD: From January to June 2010, a retrospective cost-revenue study was performed at a German obstetrics/gynecology university clinic. The hospital's pharmacy list of inpatient oncological therapies for breast and gynecological cancer was checked for accuracy and compared with the documented ZEs and the costs and revenues for each oncological application. RESULTS: N = 45 in-patient oncological therapies were identified in n = 18 patients, as well as n = 7 bisphosphonate applications; n = 11 ZEs were documented. Costs for oncological medication were € 33,752. The corresponding ZE revenues amounted to only € 13,980, resulting in a loss of € 19,772. All in-patient oncological therapies performed were not cost-covering. Data discrepancy, incorrect documentation and cost attribution, and process aborts were identified. CONCLUSIONS: Routine financial quality control at the medicine-pharmacy administration interface is implemented, with monthly comparison of costs and revenues, as well as admission status. Non-cost-covering therapies for in-patients should be converted to out-patient therapies. Necessary adjustments of clinic processes are made according to these results, to avoid future losses. PMID:21673822

Jacobs, Volker R; Mallmann, Peter

2011-01-01

255

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

256

Surgical stabilization of the spine in the osteoporotic patient.  

PubMed

Osteoporosis affects millions of US citizens, and millions more are at risk for developing the disease. Several operative techniques are available to the spine surgeon to provide care for those affected by osteoporosis. The types of osteoporosis, common surgical complications, medical optimization, and surgical techniques in the osteoporotic spine are reviewed, with an emphasis on preoperative planning. PMID:23544827

Dodwad, Shah-Nawaz M; Khan, Safdar N

2013-04-01

257

Efficacy of Seprafilm for reducing reoperative risk in pediatric surgical patients undergoing abdominal surgery  

Microsoft Academic Search

BackgroundThe safety and efficacy of Seprafilm (Genzyme Corporation, Cambridge, Mass) in adult surgery patients have been established. The aim of this study was to evaluate the safety and efficacy of Seprafilm in pediatric surgical patients.

Mikihiro Inoue; Keiichi Uchida; Chikao Miki; Masato Kusunoki

2005-01-01

258

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

259

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.

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

2011-01-01

260

One-year assessment of surgical outcomes in Class III patients using cone beam computed tomography  

PubMed Central

The purpose of this study was to apply a novel method to evaluate surgical outcomes at 1 year after orthognathic surgery for Class III patients undergoing two different surgical protocols. Fifty patients divided equally into two groups (maxillary advancement only and combined with mandibular setback) had cone beam computed tomography (CBCT) scans taken pre-surgery, at splint removal, and at 1-year post-surgery. An automatic cranial base superimposition method was used to register, and shape correspondence was applied to assess, the overall changes between pre-surgery and splint removal (surgical changes) and between splint removal and 1-year post-surgery at the end of orthodontic treatment (post-surgical adaptations). Post-surgical maxillary adaptations were exactly the same for both groups, with 52% of the patients having changes >2 mm. Approximately half of the post-surgical changes in the maxilla for both groups were vertical. The two-jaw group showed significantly greater surgical and post-surgical changes in the ramus, chin, and most of the condylar surfaces (P < 0.05). Post-surgical adaptation on the anterior part of the chin was also more significant in the two-jaw group (P < 0.05). Regardless of the type of surgery, marked post-surgical adaptations were observed in the regions evaluated, which explain the adequate maxillary–mandibular relationship at 1-year post-surgery on average, with individual variability.

de Paula, L.K.; de Oliveira Ruellas, A.C.; Paniagua, B.; Styner, M.; Turvey, T.; Zhu, H.; Wang, J.; Cevidanes, L.H.S.

2014-01-01

261

One-year assessment of surgical outcomes in Class III patients using cone beam computed tomography.  

PubMed

The purpose of this study was to apply a novel method to evaluate surgical outcomes at 1 year after orthognathic surgery for Class III patients undergoing two different surgical protocols. Fifty patients divided equally into two groups (maxillary advancement only and combined with mandibular setback) had cone beam computed tomography (CBCT) scans taken pre-surgery, at splint removal, and at 1-year post-surgery. An automatic cranial base superimposition method was used to register, and shape correspondence was applied to assess, the overall changes between pre-surgery and splint removal (surgical changes) and between splint removal and 1-year post-surgery at the end of orthodontic treatment (post-surgical adaptations). Post-surgical maxillary adaptations were exactly the same for both groups, with 52% of the patients having changes >2mm. Approximately half of the post-surgical changes in the maxilla for both groups were vertical. The two-jaw group showed significantly greater surgical and post-surgical changes in the ramus, chin, and most of the condylar surfaces (P<0.05). Post-surgical adaptation on the anterior part of the chin was also more significant in the two-jaw group (P<0.05). Regardless of the type of surgery, marked post-surgical adaptations were observed in the regions evaluated, which explain the adequate maxillary-mandibular relationship at 1-year post-surgery on average, with individual variability. PMID:23403336

de Paula, L K; Ruellas, A C O; Paniagua, B; Styner, M; Turvey, T; Zhu, H; Wang, J; Cevidanes, L H S

2013-06-01

262

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

263

Foreign body reactions in lymph nodes of oncology patients with joint prostheses--light-, electron microscopic and immunohistological investigations.  

PubMed

Foreign body reactions in lymph nodes caused by wear particles from joint prostheses can mimic different lymphadenopathies, including metastatic cancer. The knowledge of these alterations is particularly important for pathologists performing frozen section diagnosis for oncology patients. As recent investigations of pseudocapsules have revealed that most of the wear particles are submicron-sized, transmission electron microscopic investigations were additionally performed. The histological investigation of the pelvic lymph nodes of 22 oncology patients with joint prostheses showed that the bone cement wear prevailed. At least small amounts of polyethylene wear particles were also found in all cases. Metallic wear particles were detected in 90% of the cases. The wear particles induce a macrophage-rich foreign body reaction that can cause an architectural effacement of the lymph nodes. The electron microscopic investigations showed that submicron-sized wear particles prevail. Some of them form conglomerates in size ranges detectable by light microscopy. The immunohistochemical studies showed that the foreign body reactions comprised mature CD163- and PGM1-positive macrophages and few lymphocytes, predominantly T-lymphocytes. The knowledge of the characteristic alterations of regional lymph nodes seems important in order to avoid misinterpretations. Therefore, in particular the detection of intracytoplasmatic wear particles is helpful in this respect. PMID:15200270

Bos, Ingeborg; Johannisson, Reiner

2004-01-01

264

Prevalence and antibiotic sensitivity of Danish versus other European bacterial isolates from intensive care and hematology\\/oncology units  

Microsoft Academic Search

The prevalence and antibiotic sensitivity patterns of bacteria collected consecutively from medical and surgical intensive care units (ICUs) and from hematology\\/oncology units in nine hospitals in Denmark were determined and compared to data collected simultaneously in 12 other European countries. Bacterial isolates from 794 Danish patients were tested and compared to 8,625 isolates from European patients. The minimal inhibitory concentrations

A. Fomsgaard; N. Høiby; H. M. Friis; B. Gahrn-Hansen; H. J. J. Kolmos; P. Schouenborg; B. Korsager; M. Tvede; E. Gutschik; A. Bremmelgaard

1995-01-01

265

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.

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

2014-01-01

266

Clinical Oncology Assistantship Program for Medical Students.  

ERIC Educational Resources Information Center

The Clinical Oncology Assistantship Program at the University of Arkansas for Medical Sciences is described, along with student reactions to the program. The summer elective program involves cancer lectures (one week) and clinical exposure (nine weeks) in medical, surgical, and pediatric oncology services, as well as self-directed learning…

Neilan, Barbara A.; And Others

1985-01-01

267

Distribution and determinants of patient satisfaction in oncology with a focus on health related quality of life  

PubMed Central

Background Cancer patients usually undergo extensive and debilitating treatments, which make quality of life (QoL) and patient satisfaction important health care assessment measures. However, very few studies have evaluated the relationship between QoL and patient satisfaction in oncology. We investigated the clinical, demographic and QoL factors associated with patient satisfaction in a large heterogeneous sample of cancer patients. Methods A cohort of 538 cancer patients treated at Cancer Treatment Centers of America® (CTCA) was assessed. A patient satisfaction questionnaire developed in-house by CTCA was used. It covered the following dimensions of patient satisfaction: hospital operations and services, physicians and staff, and patient endorsements for themselves and others. QoL was assessed using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30). The clinical, demographic and QoL factors were evaluated for predictive significance using univariate and multivariate logistic regression. Results The mean age of our patient population was 54.1 years (SD = 10.5, range 17-86), with a slight preponderance of females (57.2%). Breast cancer (n = 124) and lung cancer (n = 101) were the most frequent cancer types. 481 (89.4%) patients were "very satisfied" with their overall experience. Age and several QoL function and symptom scales were predictive of overall patient satisfaction upon univariate analysis. In the multivariate modeling, only those with a score above the median on the fatigue measure (i.e. worse fatigue) had reduced odds of 0.28 of being very satisfied (p = 0.03). Conclusion Patient fatigue, as reported by the QoL fatigue scale, was an independent significant predictor of overall patient satisfaction. This finding argues for special attention and programs for cancer patients who report higher levels of fatigue given that fatigue is the most frequently reported symptom in cancer patients.

Lis, Christopher G; Rodeghier, Mark; Grutsch, James F; Gupta, Digant

2009-01-01

268

The third Symptom Management Research Trial in Oncology (SMaRT Oncology3): a randomised trial to determine the efficacy of adding a complex intervention for major depressive disorder (Depression Care for People with Lung Cancer) to usual care, compared to usual care alone in patients with lung cancer  

Microsoft Academic Search

BACKGROUND: Depression Care for People with Lung Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3 Trial) will test its

Jane Walker; Jim Cassidy; Michael Sharpe

2009-01-01

269

Patient-Specific Surgical Outcomes Assessment Using Population-Based Data Analysis for Risk Model Development  

PubMed Central

Optimal surgical planning and decision making surrounding surgical interventions requires patient-specific risk assessment which incorporates patient pre-operative clinical assessment and clinical literature. In this paper, we utilized population-based data analysis to construct surgical outcome predictive models for spinal fusion surgery using hospital, patient and admission characteristics. We analyzed population data from the Nationwide Inpatient Sample (NIS) –a nationally representative database– to identify data elements affecting inpatient mortality, length of stay, and disposition status for patients receiving spinal fusion surgery in the years 2004–2008. In addition to outcomes assessment, we want to make the analytic model results available to clinicians and researchers for pre-operative surgical risk assessment, hospital resource allocation, and hypothesis generation for future research without an individual patient data management burden. Spinal fusion was the selected prototype procedure due to it being a high volume and typically inpatient procedure where patient risk factors will likely affect clinical outcomes.

AbuSalah, Ahmad M.; Melton, Genevieve B.; Adam, Terrence J.

2012-01-01

270

Survival analysis of patients with non-small cell lung cancer who underwent surgical resection following 4 lung cancer resection guidelines  

PubMed Central

Background To compare survival of patients with non-small cell lung cancer (NSCLC) who underwent surgical resection and lymph node sampling based on guidelines proposed by the American College of Surgeons Oncology Group (ACOSOG), National Comprehensive Cancer Network (NCCN), the OSI Pharmaceutical RADIANT trial, and the International Association for the Study of Lung Cancer (IASLC). Methods Medical records of patients with NSCLC who underwent surgical resection from 2001 to 2008 at our hospital were reviewed. Staging was according to the 7th edition of the AJCC TNM classification of lung cancer. Patients who received surgical resection following the IASLC, ACOSOG, RADIANT or NCCN resection criteria were identified. Results A total of 2,711 patients (1803 males, 908 females; mean age, 59.6?±?9.6 years) were included. Multivariate Cox proportional hazards regression analysis indicated that increasing age, adenosquamous histology, and TNM stage II or III were associated with decreased overall survival (OS). Univariate analysis and log-rank test showed that surgical resection following the guidelines proposed by the IASLC, NCCN, ACOSOG, or RADIANT trial was associated with higher cumulative OS rates (relative to resection not following the guidelines). Multivariate analysis revealed that there was a significant improvement in OS only when IASLC resection guidelines (complete resection) were followed (hazard ratio?=?0.84, 95% confidence interval 0.716 to 0.985, P?=?0.032). Conclusions Surgical resection following the criteria proposed by IASLC, NCCN, ACOSOG, or the RADIANT trial was associated with a higher cumulative OS rate. However, significant improvement in OS only occurred when IASLC resection guidelines were followed.

2014-01-01

271

Oncology Nursing.  

National Technical Information Service (NTIS)

Oncology Overviews are a service of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute, intended to facilitate and promote the exchange of information between cancer scientists by keeping them aware of literature ...

1983-01-01

272

Pretreatment factors significantly influence quality of life in cancer patients: A Radiation Therapy Oncology Group (RTOG) analysis  

SciTech Connect

Purpose The purpose of this analysis was to assess the impact of pretreatment factors on quality of life (QOL) in cancer patients. Methods and Materials Pretreatment QOL (via Functional Assessment of Cancer Therapy [FACT], version 2) was obtained in 1,428 patients in several prospective Radiation Therapy Oncology Group (RTOG) trials including nonmetastatic head-and-neck (n = 1139), esophageal (n = 174), lung (n = 51), rectal (n = 47), and prostate (n = 17) cancer patients. Clinically meaningful differences between groups were defined as a difference of 1 standard error of measurement (SEM). Results The mean FACT score for all patients was 86 (20.7-112) with SEM of 5.3. Statistically significant differences in QOL were observed based on age, race, Karnofsky Performance Status, marital status, education level, income level, and employment status, but not by gender or primary site. Using the SEM, there were clinically meaningful differences between patients {<=}50 years vs. {>=}65 years. Hispanics had worse QOL than whites. FACT increased linearly with higher Karnofsky Performance Status and income levels. Married patients (or live-in relationships) had a better QOL than single, divorced, or widowed patients. College graduates had better QOL than those with less education. Conclusion Most pretreatment factors meaningfully influenced baseline QOL. The potentially devastating impact of a cancer diagnosis, particularly in young and minority patients, must be addressed.

Movsas, Benjamin [Radiation Oncology, Henry Ford Health System, Detroit, MI (United States)]. E-mail: bmovsas1@hfhs.org; Scott, Charles [RTOG Headquarters, Philadelphia, PA (United States); Watkins-Bruner, Deborah [Fox Chase Cancer Center, Philadelphia, PA (United States)

2006-07-01

273

Prospective evaluation of the epidemiology, microbiology, and outcome of bloodstream infections in adult surgical cancer patients  

Microsoft Academic Search

The aim of this study was to describe the epidemiology and microbiology of bloodstream infections (BSIs) among adult surgical cancer patients and to determine independent factors that influence in-hospital mortality. The study enrolled 112 consecutive episodes of BSIs in adult surgical cancer patients during a 26-month period. The median age of the patients was 64.5 years, and crude in-hospital mortality

E. Velasco; M. Soares; R. Byington; C. A. S. Martins; M. Schirmer; L. M. C. Dias; V. M. S. Gonçalves

2004-01-01

274

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.

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

2012-01-01

275

Successful Surgical Treatment of Congenital Aortopulmonary Window in an Adult Patient  

PubMed Central

Congenital aortopulmonary window is a rare inborn cardiac malformation that should be surgically treated as soon as the diagnosis is made usually during infancy. We report a successful surgical treatment of a 23-year-old male patient with a big type III aortopulmonary window.

Giamberti, Alessandro; Abella, Raul; Consuegra Llapur, Eduardo; Raweh, Abdallah; Cirri, Silvia; Frigiola, Alessandro

2011-01-01

276

Development of a patient-specific surgical simulator for pediatric laparoscopic procedures.  

PubMed

The purpose of this study is to develop and evaluate a pediatric patient-specific surgical simulator for the planning, practice, and validation of laparoscopic surgical procedures prior to intervention, initially focusing on the choledochal cyst resection and reconstruction scenario. The simulator is comprised of software elements including a deformable body physics engine, virtual surgical tools, and abdominal organs. Hardware components such as haptics-enabled hand controllers and a representative endoscopic tool have also been integrated. The prototype is able to perform a number of surgical tasks and further development work is under way to simulate the complete procedure with acceptable fidelity and accuracy. PMID:24732536

Saber, Nikoo R; Menon, Vinay; St-Pierre, Jean C; Looi, Thomas; Drake, James M; Cyril, Xavier

2014-01-01

277

Surgical treatment of stress urinary incontinence and severe pelvic organ relaxation in the medically compromised elderly patient using local anesthesia  

Microsoft Academic Search

Objective: To describe the technique and complications of vaginal repair of advanced pelvic organ prolapse and the use of tension-free vaginal tape (TVT) using intravenous sedation and local anesthesia for patients with concomitant severe vaginal prolapse and stress urinary incontinence.Methods: A retrospective review of the surgical records of 15 patients was performed. Patient demographics, surgical procedure, surgical time, estimated blood

Robert D. Moore; Stephen Speights; John R. Miklos

2000-01-01

278

Nursing Practice Environment and Outcomes for Oncology Nursing  

PubMed Central

Background It is commonly assumed that oncology nurses experience high job-related burnout and high turnover because their work involves inherent stressors such as caring for patients with serious and often life-threatening illness. Objectives The objectives of this study were to examine the differences in outcomes such as job dissatisfaction and burnout between oncology nurses and medical-surgical nurses, and to identify factors that affect oncology nurse outcomes. Methods A secondary analysis of nurse survey data collected in 2006 including 4047 nurses from 282 hospitals in 3 states was performed; t test and ?2 test compared differences between oncology nurses and medical-surgical nurses in nurse outcomes and their assessments of nurse practice environment, as measured by the Practice Environment Scale of the Nursing Work Index. Logistic regression models estimated the effect of nurse practice environment on 4 nurse-reported outcomes: burnout, job dissatisfaction, intention to leave the current position, and perceived quality of care. Results Oncology nurses reported favorable practice environments and better outcomes than did medical-surgical nurses. All 4 subscales of the Practice Environment Scale of the Nursing Work Index studied were significantly associated with outcomes. Specifically, nurses who reported favorable nursing foundations for quality of care (eg, active in-service or preceptorship programs) were less likely to report burnout and leave their current position. Conclusions Better practice environments, including nurse foundations for quality care, can help to achieve optimal nurse outcomes. Implications for Practice Improving hospital practice environments holds significant potential to improve nurse well-being, retention, and quality of care. Specifically, hospitals should consider preceptor programs and continuing education and increase nurses’ participation in hospital decision making.

Shang, Jingjing; Friese, Christopher R.; Wu, Evan; Aiken, Linda H.

2012-01-01

279

How nonverbal communication shapes the doctor-patient relationship: from paternalism to the ethics of care in oncology.  

PubMed

The purpose of this research, led in the wake of years of pressure to reject paternalism, was to study whether controlled practice of nonverbal communication by doctors inheres a continued risk of paternalistic attitudes in oncology clinic interviews (chosen to illustrate the doctor-patient relationship). This study involved qualitative descriptive research based on interview observations and questionnaires and mobilized recognized theory borrowed from sociology and anthropology. We found that the legislative framework governing the doctor-patient relationship has simply shifted the paternalism issue from verbal communication over to a new area that doctors have not yet mastered and patients have not yet understood, i.e., nonverbal communication. This study shows that all the laws framing the doctor-patient relationship can be circumvented, and that by controlling nonverbal communication, the doctor can fall back into paternalism. The rejection of paternalism therefore needs to lead to an appropriate reading of the patient's story, which in ethical terms can only happen if hospital structures are made non-paternalizing by design, if doctors learn to understand the patient's different chronemic timeframe, and if doctors committedly engage in the Hippocratic Oath codified through the ethics of care. PMID:24558741

Bommier, C; Mamzer, M F; Desmarchelier, D; Hervé, C

2013-12-01

280

Nutritional and treatment-related characteristics of pediatric oncology patients referred or not referred for nutritional support.  

PubMed

Nutritional problems often result from malignancies and aggressive multimodal treatment. Early identification of reliable risk factors associated with malnutrition and need for nutritional support is necessary for development of preventative approaches. Nutritional and treatment-related characteristics were examined for 173 pediatric oncology patients referred for nutritional support and a comparison sample of 43 patients matched on treatment protocol and/or diagnosis who had never been referred for nutritional support. Abnormally low serum albumin levels, poor oral intake, mucositis, prior radiation therapy, and increased gastrointestinal toxicity were significantly more frequent among referred than non-referred patients. A discriminant function analysis indicated that poor oral intake was the single best predictor of need for nutritional support. Patients with solid tumors were more nutritionally depleted at the time of referral; all bone marrow transplant patients received nutritional support. Patients with central nervous system (CNS) tumors required nutritional support for longer time periods. We conclude that routine documentation of poor oral intake (i.e., observation of change in a child's eating patterns) is the most reliable indicator of children who eventually require nutritional support and who may benefit from interventions that could delay or prevent nutritional problems. Prophylactic interventions should be tailored to meet the specific needs of individual diagnostic groups. PMID:7674995

Tyc, V L; Vallelunga, L; Mahoney, S; Smith, B F; Mulhern, R K

1995-11-01

281

A review of current surgical treatment of patients with atrial fibrillation.  

PubMed

Surgical therapy for patients with atrial fibrillation has undergone significant advances over the past 30 years. The Cox Maze III technique is currently the gold standard of care for these patients. However, Maze IV, a less complex procedure using alternative energy sources, is rapidly replacing the Cox Maze III in clinical practice. The use of alternative energy sources such as cryothermy and radiofrequency eliminates some of the "cut and sew" lesions of the Maze III, resulting in an easier and faster procedure with less morbidity. Video-assisted technology and hybrid procedures have further ushered in the future of surgical therapy. This article presents the latest surgical therapeutic options for patients with atrial fibrillation. The history of these procedures is presented, followed by a discussion of modern-era techniques, including concomitant ablation and standalone (also referred to as "lone") procedures. Finally, the article explores breaking developments and future directions for the surgical treatment of patients with atrial fibrillation. PMID:22754118

Edgerton, Zachary J; Edgerton, James R

2012-07-01

282

Surgical correction of hypertrophic obstructive cardiomyopathy in a patient with severe hypertrophy and septal myocardial fibrosis  

PubMed Central

In patients with hypertrophic cardiomyopathy, myocardial fibrosis is an independent predictor of an adverse outcome. A new technique of hypertrophic obstructive cardiomyopathy (HOCM) surgical correction in patients with severe hypertrophy and septal myocardial fibrosis has been proposed. This approach avoids mechanical damage to the heart conduction system, and for the surgeon it improves visual inspection of the area to be resected. We present a case report of a 33-year old female patient with biventricular obstruction, extreme hypertrophy, septal myocardial fibrosis and episodes of ventricular tachycardia who underwent surgical correction according to this novel procedure. The advantage of the approach is an effective surgical treatment of HOCM in patients with severe hypertrophy and septal myocardial fibrosis who cannot be treated with the current surgical techniques.

Borisov, Konstantin Valentinovitch

2012-01-01

283

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.

284

A review of current surgical treatment of patients with atrial fibrillation  

PubMed Central

Surgical therapy for patients with atrial fibrillation has undergone significant advances over the past 30 years. The Cox Maze III technique is currently the gold standard of care for these patients. However, Maze IV, a less complex procedure using alternative energy sources, is rapidly replacing the Cox Maze III in clinical practice. The use of alternative energy sources such as cryothermy and radiofrequency eliminates some of the “cut and sew” lesions of the Maze III, resulting in an easier and faster procedure with less morbidity. Video-assisted technology and hybrid procedures have further ushered in the future of surgical therapy. This article presents the latest surgical therapeutic options for patients with atrial fibrillation. The history of these procedures is presented, followed by a discussion of modern-era techniques, including concomitant ablation and standalone (also referred to as “lone”) procedures. Finally, the article explores breaking developments and future directions for the surgical treatment of patients with atrial fibrillation.

Edgerton, Zachary J.

2012-01-01

285

Costs Associated with Capecitabine or 5Fluorouracil Monotherapy after Surgical Resection in Patients with Colorectal Cancer  

Microsoft Academic Search

Objective: To compare chemotherapy-related and total medical costs among patients with colorectal cancer (CRC) receiving capecitabine or 5-fluorouracil (5-FU) monotherapy after surgical resection. Methods: This retrospective, claim-based study utilized the Thomson Reuters Market Scan® databases to identify 1,396 CRC patients who received capecitabine or 5-FU monotherapy within 90 days of surgical resection from 2003 through 2006. Propensity score matching addressed

Edward Chu; Nianwen Shi; Wenhui Wei; Johanna C. Bendell; Thomas Cartwright

2009-01-01

286

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.

2014-01-01

287

Rates of symptomatic venous thromboembolism in US surgical patients: a retrospective administrative database study  

Microsoft Academic Search

US national performance measures may reduce the burden of venous thromboembolism (VTE) in surgical patients. To characterize\\u000a the VTE rate in US surgical patients, and identify real-world independent VTE risk-factors, a national managed-care database\\u000a was analyzed. 172,320 eligible surgical discharges (23.9% orthopedic, 76.1% abdominal surgery) from the PharMetrics database\\u000a (January 2001–December 2005) were evaluated. The rate of thromboprophylaxis was low

Alex C. Spyropoulos; Mohammed Hussein; Jay Lin; David Battleman

2009-01-01

288

Management of the elderly patient with gynecologic cancer: report of the 2011 workshop in geriatric gynecologic oncology.  

PubMed

Reflecting the worldwide aging trend and close association of aging with cancer, geriatric oncology is now growing beyond its pioneer years. Nevertheless, geriatric oncology in the gynecologic field is in the beginning stage; indeed, there is no geriatric specialist who is trained in this particular field of gynecologic oncology. Therefore, we held the first workshop in geriatric gynecologic oncology. In this review, we summarize what we discussed at the workshop and provide evidence-based recommendations for the diagnosis and treatment of gynecologic cancer in elderly individuals. PMID:22080887

Suh, Dong Hoon; Kang, Sokbom; Lim, Myong Cheol; Lee, Taek Sang; Park, Jeong-Yeol; Kim, Tae-Joong; Kim, Jee Hyun; Lee, Kwang-Beom; Park, Dong Choon; Chung, Hyun Hoon; Kim, Kidong; Seo, Sang-Soo; Kim, Hak Jae; Kim, Mi-Kyung; Ju, Woong; Kim, Jae Weon; Lichtman, Stuart M; Park, Sang-Yoon

2012-01-01

289

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

290

[Combined surgical treatment of patients with multifocal atherosclerosis].  

PubMed

Multifocal manifestation of atherosclerosis (ATS) is common for this pathology and demands special diagnostic and therapeutic approaches. The need of active screening of basic clinical forms of multifocal ATS--carotid, peripheral arterial disease (PAD), aortic abdominal aneurysms(AAA) and coronary (IHD) is mandatory along with precise indications of therapeutical strategy and operative tactics in cases when surgical treatment is needed. The aim of this study is the evaluation of our results in operative treatment of combined forms of ATS and proper indication for simultaneous or two staged surgical approach. Our experience dictates simultaneous operative strategy only in cases of: 1. Carotid stenosis > 70% even asympthomatic, or > 50% sympthomatic stenosis (group A) combined with coronary artery disease in III-IV stage and 2-3 main vessel disease and unstable angina. 2. AAA > 7 cm. (group B) associated with IHD. 3. PAD with critical limb ischemia associated with unstable IHD. The absence of this specific indications allows not so aggressive surgical approach--two staged procedures (coronary artery bypass surgery first and several months later arterial reconstructive surgery of carotid or abdominal aortic lesions. PMID:12024651

Zakhariev, T; Grozdinski, L; Stankev, M; Nachev, G; Chirkov, A

2001-01-01

291

Auditory Function in Patients with Surgically Treated Superior Semicircular Canal Dehiscence  

Microsoft Academic Search

Objective: To characterize preoperative and postoperative au- diologic findings in patients with superior semicircular canal dehiscence syndrome. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Patients with documented superior semicircular canal dehiscence syndrome (according to history, vestibular testing, and high-resolution computed tomography imaging) who underwent surgical repair of their dehiscence. Intervention: Middle fossa craniotomy for superior semicir- cular

Charles J. Limb; John P. Carey; Sharmila Srireddy; Lloyd B. Minor

2006-01-01

292

A Model for Primary Care Psychology With General Thoracic Surgical Patients  

Microsoft Academic Search

This study examined a model for brief psychological assessment for providing primary psychological care to patients within a surgical, specialty outpatient clinic to provide early and accurate detection of psychological distress in patients to increase compassionate care. Questionnaires were completed by 351 outpatients and 227 of these outpatients were provided a model of primary care (brief psychological intervention). Patients were

Jeff Baker; Lisa A. Keenan; Joseph Zwischenberger

2005-01-01

293

Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging  

Microsoft Academic Search

BACKGROUND. Breast magnetic resonance imaging (MRI) is a developing technique for the evaluation of patients with primary breast carcinoma. The authors assessed the impact of preoperative breast MRI on surgical management. METHODS. The current study was a retrospective review of 267 patients with primary breast tumors who had MRI studies prior to undergoing definitive surgery. RESULTS. Two hundred sixty-seven patients

Isabelle Bedrosian; Rosemarie Mick; Susan G. Orel; Mitchell Schnall; Carol Reynolds; Francis R. Spitz; Linda S. Callans; Gordon P. Buzby; Ernest F. Rosato; Douglas L. Fraker; Brian J. Czerniecki

2003-01-01

294

Efficacy and outcome of surgical intervention in patients with nephrolithiasis and chronic renal failure  

Microsoft Academic Search

Aim: To prospectively evaluate the efficacy and outcome of surgical intervention in patients with renal stones and chronic renal insufficiency.Methods: The study was carried out from January 1999 till January 2001. Only patients with chronic renal failure without medical renal disease were taken up for study. All patients were subjected to an ultrasound assessment of the kidney, ureter and bladder.

Iqbal Singh; N. P. Gupta; A. K. Hemal; M. Aron; P. N. Dogra; A. Seth

2001-01-01

295

Access to Cancer Services for Rural Colorectal Cancer Patients  

ERIC Educational Resources Information Center

Context: Cancer care requires specialty surgical and medical resources that are less likely to be found in rural areas. Purpose: To examine the travel patterns and distances of rural and urban colorectal cancer (CRC) patients to 3 types of specialty cancer care services--surgery, medical oncology consultation, and radiation oncology consultation.…

Baldwin, Laura-Mae; Cai, Yong; Larson, Eric H.; Dobie, Sharon A.; Wright, George E.; Goodman, David C.; Matthews, Barbara; Hart, L. Gary

2008-01-01

296

Using an age-specific nursing model to tailor care to the adolescent surgical patient.  

PubMed

A surgical experience can be stressful for any patient. When the patient is an adolescent, however, the surgical experience can create significant stress, which is related to normal adolescent development. Perioperative nursing care should address what adolescent patients perceive as stressful and should provide a safe environment so that a successful surgical outcome can be achieved. To accomplish this, a nursing model specific to perioperative nursing practice should be developed to guide nurses when providing care to adolescents. The Adolescent Perioperative System Stability Model based on the Neuman Systems Model provides a framework for defining scope of practice and organizing nursing care that is appropriate for the adolescent during a surgical experience. In addition to guiding nursing practice, this model provides direction and guidance for future studies of adolescents in the perioperative setting. PMID:24875209

Monahan, Janean Carter

2014-06-01

297

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.

2012-01-01

298

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.

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

2014-01-01

299

Cooperative group clinical trials in general thoracic surgery: report from the 2012 Robert Ginsberg Clinical Trials Meeting of the General Thoracic Surgical Club.  

PubMed

At the 25th Annual General Thoracic Surgical Club meeting in March 2012, the major cooperative groups presented updates on clinical trials at the Robert Ginsberg Clinical Trials Meeting. There were 57 members in attendance. Representatives from the Radiation Treatment Oncology Group (RTOG), American College of Surgeons Oncology Group (ACOSOG), Cancer and Leukemia Group B (CALGB), Southwest Oncology Group (SWOG), National Cancer Institute of Canada Clinical Trials Group (NCIC), and the Eastern Cooperative Oncology Group (ECOG) presented an overview of trials currently accruing or in development. These include oncologic trials that thoracic surgeons are currently accruing patients to in North America. The purpose of this review is to centralize the information to assist surgeons enrolling patients into oncologic clinical trials in thoracic surgery. PMID:23336898

Allen, Mark S; Wigle, Dennis A

2013-02-01

300

Will emergency and surgical patients participate in and complete alcohol interventions? A systematic review  

PubMed Central

Background In the everyday surgical life, staff may experience that patients with Alcohol Use Disorders (AUDs) seem reluctant to participate in alcohol intervention programs. The objective was therefore to assess acceptance of screening and intervention as well as adherence to the intervention program among emergency department (ED) and surgical patients with AUDs. Methods A systematic literature search was followed by extraction of acceptance and adherence rates in ED and surgical patients. Numbers needed to screen (NNS) were calculated. Subgroup analyses were carried out based on different study characteristics. Results The literature search revealed 33 relevant studies. Of these, 31 were randomized trials, 28 were conducted in EDs and 31 evaluated the effect of brief alcohol intervention. Follow-up was mainly conducted after six and/or twelve months. Four in five ED patients accepted alcohol screening and two in three accepted participation in intervention. In surgical patients, two in three accepted screening and the intervention acceptance rate was almost 100%. The adherence rate was above 60% for up to twelve months in both ED and surgical patients. The NNS to identify one eligible AUD patient and to get one eligible patient to accept participation in alcohol intervention varied from a few up to 70 patients. The rates did not differ between randomized and non-randomized trials, brief and intensive interventions or validated and self-reported alcohol consumption. Adherence rates were not affected by patients' group allocation and type of follow-up. Conclusions Most emergency and surgical patients with AUD accept participation in alcohol screening and interventions and complete the intervention program.

2011-01-01

301

A prospective study of real-time panfungal PCR for the early diagnosis of invasive fungal infection in haemato-oncology patients  

Microsoft Academic Search

A blinded prospective study was performed to determine whether screening of whole blood using a real-time, panfungal polymerase chain reaction (PCR) technique could predict the development of invasive fungal infection (IFI) in immunocompromised haemato-oncology patients. In all, 78 patients (125 treatment episodes) were screened twice weekly by real-time panfungal PCR using LightCycler™ technology. IFI was documented in 19 treatment episodes

N E Jordanides; E K Allan; L A McLintock; M Copland; M Devaney; K Stewart; A N Parker; P R E Johnson; T L Holyoake; B L Jones

2005-01-01

302

Allergic reaction to a red plastic allergy alert patient identification bracelet: implications for surgical patient safety.  

PubMed

We present a case of allergy to a hospital thermally-printed red plastic allergy alert bracelet in a 48 year old lady admitted to the day surgery unit. Two hours postoperatively, an intensely itchy area of erythema and oedema was seen extending from her left wrist distally to the fingers. The bracelet was removed and the rash resolved overnight without further complication. A diagnosis of contact dermatitis was made, secondary to exposure to an agent within the bracelet. We discuss the safety implications for surgical patients unable to wear an identification bracelet and the steps that may be taken to minimise the risk of harm from misidentification. We believe this to be the first documented case of an allergy to a patient identification bracelet in the medical literature. PMID:24245062

Colbert, Serryth; Williams, John V; Mackenzie, Neil; Brennan, Peter A

2013-01-01

303

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

304

Principles and New Approaches in Surgical Reconstruction  

Microsoft Academic Search

\\u000a The reconstruction of oncologic defects remains a critical element in the surgical treatment of head and neck cancer. Goals\\u000a of reconstruction are wound healing, vital structure protection, function, and cosmesis. In this chapter, we discuss the reconstructive\\u000a ladder as it applies to defects of the oral cavity, oropharynx, nose, orbit, midface, hypopharynx, larynx, and cervical esophagus.\\u000a Patient cases are shown

Christina Kenney Magill; Bruce H. Haughey

305

DRUGSURV: a resource for repositioning of approved and experimental drugs in oncology based on patient survival information.  

PubMed

The use of existing drugs for new therapeutic applications, commonly referred to as drug repositioning, is a way for fast and cost-efficient drug discovery. Drug repositioning in oncology is commonly initiated by in vitro experimental evidence that a drug exhibits anticancer cytotoxicity. Any independent verification that the observed effects in vitro may be valid in a clinical setting, and that the drug could potentially affect patient survival in vivo is of paramount importance. Despite considerable recent efforts in computational drug repositioning, none of the studies have considered patient survival information in modelling the potential of existing/new drugs in the management of cancer. Therefore, we have developed DRUGSURV; this is the first computational tool to estimate the potential effects of a drug using patient survival information derived from clinical cancer expression data sets. DRUGSURV provides statistical evidence that a drug can affect survival outcome in particular clinical conditions to justify further investigation of the drug anticancer potential and to guide clinical trial design. DRUGSURV covers both approved drugs (?1700) as well as experimental drugs (?5000) and is freely available at http://www.bioprofiling.de/drugsurv. PMID:24503543

Amelio, I; Gostev, M; Knight, R A; Willis, A E; Melino, G; Antonov, A V

2014-01-01

306

Factors influencing patients seeking oral health care in the oncology dental support clinic at an urban university dental school setting.  

PubMed

The purpose of this study was to identify predictors and/or factors associated with medically compromised patients seeking dental care in the oncology dental support clinic (ODSC) at the University of Missouri-Kansas City (UMKC) School of Dentistry. An 18-item survey was mailed to 2,541 patients who were new patients to the clinic from 2006 to 2011. The response rate was approximately 18% (n = 450). Analyses included descriptive statistics of percentages/frequencies as well as predictors based on correlations. Fifty percent of participants, 100 females and 119 males, identified their primary medical diagnosis as cancer. Total household income (p < .001) and the importance of receiving dental care (p < .001) were significant factors in relation to self-rated dental health. Perceived overall health (p < .001) also had a significant association with cancer status and the need for organ transplants. This study provided the ODSC at UMKC and other specialty clinics with vital information that can contribute to future planning efforts. PMID:24712504

Corrigan, Dale M; Walker, Mary P; Liu, Ying; Mitchell, Tanya Villalpando

2014-01-01

307

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.

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

308

A prospective comparison of antibiotic usage in pediatric surgical patients: The safety, advantage, and effectiveness of the Surgical Infection Society guidelines versus a common practice  

Microsoft Academic Search

Background: The Surgical Infection Society (SIS) guidelines for antibiotic (Ab) usage minimally changed the surgical practice. The authors believed that clinical evidence of the safety, advantage, and effectiveness of SIS guidelines may improve inappropriate usage of Ab. Methods: A group of dedicated surgeons attempted to use Ab appropriately to SIS guidelines in their patients (group A). A comparison was made

Elzbieta Grochowska; Miroslaw Krysta; Piotr Wojciechowski; Anna Taczanowska; Beata Stanek

2002-01-01

309

GERD in elderly patients: surgical treatment with Nissen-Rossetti laparoscopic technique, outcome  

PubMed Central

Background The gastro-esophageal reflux disease (GERD) is one of the most frequent disease of the upper gastro-entheric tract. Surgical treatment is reserved to selected patients, affected by severe forms of disease and/or without compliance to medical therapy. In 95%-60% of the patients submitted to surgical antireflux intervention, a notable improvement of the quality of life is observed. Functional evaluations performed on pre and post – surgical pHmetric and manometric examination have provided new acquisitions about improvements in the restoration of anatomical and functional integrity of the esophagus-gastric antireflux barrier. Methods 45 elderly patients with GERD were recruited in a 27 months period. All patients were subjected to laparoscopic Nissen-Rossetti 360° fundoplication. The subjects had a pre-surgical evaluation with: • 24 hours pHmetry, • esophageal manometry, The same evaluation was repeated 1 month and 6 months after surgical intervention. Results In our series all patients get benefit from surgical treatment, with an improvement of pHmetric and manometric parameters and a regression of complications of GERD such as Barrett's metaplasia. In 8.33% of patients a PPI therapy was necessary, after the surgical intervention, to control symptoms. Conclusions The role of surgery in GERD concerns selected patients. Nissen-Rossetti mini-invasive approach is performed with an acceptable percentage of complications (3%-10%). This technique is associated with a good control of GERD symptoms in a short and middle term and with an improvement of functional parameters, such as pHmetric and manometric.

2012-01-01

310

[Objective assessment of symptoms and informing patients of surgical risks].  

PubMed

Genital prolapse is a functional pathology presenting with numerous urinary, genito-sexual, and anorectal symptoms. These symptoms are responsible for an alteration of the quality of life, sometimes associated to a real anxiety-depressive syndrome. Because of these complex intricacies, the management of these disorders became multidisciplinary. Tools to measure the impact of prolapse symptoms on the quality of life became a necessity. Such instruments should allow a correlation of the functional symptomatology at the anatomic stage, raise a surgical indication based on the functional disturbance and evaluate the effectiveness and tolerance of the various therapeutic procedures. Two validated self-questionnaires in French (short versions of the Pelvic Floor Distress Inventory [PFDI-20] and the Pelvic Floor Impact Questionnaire [PFIQ-7]) are presently available. Moreover, the physician has the legal obligation to provide detailed presurgical information on frequent and severe hazards, expected benefits, functional consequences, therapeutic alternatives and the consequences of nonintervention. Before surgery takes place, the surgical approach, the benefit of using synthetic prostheses, the possibility of uterine and/or ovarian conservation, and some risky conditions such as smoking, obesity and estrogen deficiency should be discussed. PMID:24260838

de Tayrac, Renaud; Letouzey, Vincent; Marès, Pierre

2013-01-01

311

Surgical Preplanning and Patient Outcomes. Executive Summary and Final Report.  

National Technical Information Service (NTIS)

Preoperative male coronary-bypass surgery patients on average preferred a roommate who was likewise preoperative compared to postoperative and who was likewise cardiac compared to noncardiac. Patients ambulated more after surgery and had significantly sho...

J. A. Kulik

1993-01-01

312

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.

2014-01-01

313

Feedback on Quality: : Patients’ Experience of Surgical Care  

Microsoft Academic Search

There is a growing consensus within the NHS of the importance of obtaining feedback from patients in order to improve the quality of health care; consequently, many patient satisfaction surveys are now undertaken. However, much research is based on provider-held assumptions about service quality. This study focuses on patient satisfaction with coronary bypass surgery, starting with the concerns expressed by

Emilie Roberts; Ralph Leavey; David Allen; Graham Gibbs

1994-01-01

314

Multimodal intraoperative monitoring (MIOM) during surgical decompression of thoracic spinal stenosis in 36 patients  

PubMed Central

A prospective study of 36 patients who received multimodal intraoperative monitoring (MIOM) during decompression of thoracic spinal stenosis between March 2000 and December 2005 was chosen as the study design. The objective was to determine the sensitivity and specificity of MIOM techniques used for monitoring spinal cord during surgical thoracic decompression. The background data revealed that the surgical decompression for thoracic spinal stenosis is less frequent than in other regions of the spine. However, due to the relative narrow spinal canal, neurological complications could be severe. The combination of monitoring ascending and descending pathways may provide an early alert to the surgeon in order to alter the surgical procedure, and avoid neurological complications. The methods involved evaluation of intraoperative somatosensory spinal and cerebral evoked potentials and motor evoked potentials of the spinal cord and muscles that were compared with post operative clinical neurological changes. 36 consecutive patients with thoracic spinal stenosis of different aetiologies were monitored by the means of MIOM during the surgical procedure. 31 patients had true negative while one patient had false positive findings. Three patients had true positive and one patient had false negative findings. This indicates a sensitivity of 75% and a specificity of 97%. The one case of false negative findings recovered completely within 3 months. In conclusion, the MIOM is an effective method of monitoring the spinal cord during surgical decompression of the thoracic spine.

Sutter, Martin A.; Grob, Dieter; Porchet, F.; Jeszenszky, Dezso; Dvorak, Jiri

2007-01-01

315

Does a Geriatric Oncology Consultation Modify the Cancer Treatment Plan for Elderly Patients?  

Microsoft Academic Search

Results. Patient characteristics included a median age of 79 years and a predominance of women with breast cancer. About one half of patients had an independent functional status. Nearly 15% presented severe undernourishment. Depression was suspected in 53.1% of cases. One third of these patients had .2 chronic diseases, and 74% of patients took ? 3 medications. Of the 93

Veronique Girre; Marie-Christine Falcou; Mathilde Gisselbrecht; Genevieve Gridel; Veronique Mosseri; Carole Bouleuc; Rollon Poinsot; Lionel Vedrine; Liliane Ollivier; Valerie Garabige; Jean-Yves Pierga; Veronique Dieras; Laurent Mignot

2008-01-01

316

The utility of surgical lung biopsy in cancer patients with acute respiratory distress syndrome.  

PubMed

BACKGROUND: This retrospective study evaluated the utility and safety of surgical lung biopsy (SLB) in cancer patients with acute respiratory distress syndrome (ARDS). METHODS: All cases of critically ill patients with cancer and diagnosed with ARDS who underwent SLB in a tertiary care hospital from January 2002 to July 2009 were reviewed. Clinical data including patient baseline characteristics, surgical complications, pathological findings, treatment alterations, and survival outcomes were retrospectively collected and analyzed. RESULTS: A total of 16 critically ill patients with cancer diagnosed with ARDS who underwent SLB were enrolled. The meantime from ARDS onset to SLB was 3.0 +/- 1.5 days. All SLB specimens offered a pathological diagnosis, and specific diagnoses were made in 9 of 16 patients. Biopsy findings resulted in a change in therapy in 11 of 16 patients. Overall, the SLB surgical complication rate was 19% (3/16). SLB did not directly cause the observed operative mortality. The ICU mortality rate was 38% (6/16). Patients who switched therapies after SLB had a trend toward decreased mortality than patients without a change in therapy (27% versus 60%; P = 0.299). CONCLUSIONS: In selected critically ill cancer patients with ARDS, SLB had a high diagnostic yield rate and an acceptable surgical complication rate. PMID:23680446

Chang, Chih-Hao; Kao, Kuo-Chin; Hu, Han-Chung; Hung, Chen-Yiu; Li, Li-Fu; Wu, Ching-Yang; Wang, Chih-Wei; Fu, Jui-Ying; Huang, Chung-Chi; Chen, Ning-Hung; Yang, Cheng-Ta; Tsai, Ying-Huang

2013-05-16

317

Comparison of surgical septal myectomy to medical therapy alone in patients with hypertrophic cardiomyopathy and syncope.  

PubMed

The presence of syncope despite medical therapy in patients with hypertrophic cardiomyopathy (HC) is considered an indication for surgical myectomy; however, no study has examined the long-term effects on recurrent syncope and survival after surgery in these patients. We examined 239 patients with HC and a history of syncope who had undergone surgical myectomy (mean age 48 ± 17 years; 56% men). The patients were age- and gender-matched to patients with HC and syncope who were treated medically without myectomy (mean age 51 ± 16 years; 59% men). The median follow-up period was 4.7 years (0.8, 11.3). The recurrence rate of syncope was 11% in the myectomy patients and 40% in the medical group (p <0.0001). Multiple episodes of syncope, left ventricular outflow tract obstruction, and recent syncope were identified as baseline predictors of recurrent syncope. Survival free of all-cause mortality was greater for patients who had undergone surgical myectomy than for the medically treated patients (10-year estimate 82 ± 4% vs 69 ± 4%; p = 0.01). In conclusion, surgical myectomy in patients with HC and a history of syncope was associated with a reduction in recurrent syncope and increased survival. PMID:23168291

Orme, Nicholas M; Sorajja, Paul; Dearani, Joseph A; Schaff, Hartzell V; Gersh, Bernard J; Ommen, Steve R

2013-02-01

318

Surgical Face Masks Worn by Patients with Multidrug-Resistant Tuberculosis  

PubMed Central

Rationale: Drug-resistant tuberculosis transmission in hospitals threatens staff and patient health. Surgical face masks used by patients with tuberculosis (TB) are believed to reduce transmission but have not been rigorously tested. Objectives: We sought to quantify the efficacy of surgical face masks when worn by patients with multidrug-resistant TB (MDR-TB). Methods: Over 3 months, 17 patients with pulmonary MDR-TB occupied an MDR-TB ward in South Africa and wore face masks on alternate days. Ward air was exhausted to two identical chambers, each housing 90 pathogen-free guinea pigs that breathed ward air either when patients wore surgical face masks (intervention group) or when patients did not wear masks (control group). Efficacy was based on differences in guinea pig infections in each chamber. Measurements and Main Results: Sixty-nine of 90 control guinea pigs (76.6%; 95% confidence interval [CI], 68–85%) became infected, compared with 36 of 90 intervention guinea pigs (40%; 95% CI, 31–51%), representing a 56% (95% CI, 33–70.5%) decreased risk of TB transmission when patients used masks. Conclusions: Surgical face masks on patients with MDR-TB significantly reduced transmission and offer an adjunct measure for reducing TB transmission from infectious patients.

Mphahlele, Matsie; Stoltz, Anton; Venter, Kobus; Mathebula, Rirhandzu; Masotla, Thabiso; Lubbe, Willem; Pagano, Marcello; First, Melvin; Jensen, Paul A.; van der Walt, Martie; Nardell, Edward A.

2012-01-01

319

The utility of surgical lung biopsy in cancer patients with acute respiratory distress syndrome  

PubMed Central

Background This retrospective study evaluated the utility and safety of surgical lung biopsy (SLB) in cancer patients with acute respiratory distress syndrome (ARDS). Methods All cases of critically ill patients with cancer and diagnosed with ARDS who underwent SLB in a tertiary care hospital from January 2002 to July 2009 were reviewed. Clinical data including patient baseline characteristics, surgical complications, pathological findings, treatment alterations, and survival outcomes were retrospectively collected and analyzed. Results A total of 16 critically ill patients with cancer diagnosed with ARDS who underwent SLB were enrolled. The meantime from ARDS onset to SLB was 3.0?±?1.5 days. All SLB specimens offered a pathological diagnosis, and specific diagnoses were made in 9 of 16 patients. Biopsy findings resulted in a change in therapy in 11 of 16 patients. Overall, the SLB surgical complication rate was 19% (3/16). SLB did not directly cause the observed operative mortality. The ICU mortality rate was 38% (6/16). Patients who switched therapies after SLB had a trend toward decreased mortality than patients without a change in therapy (27% versus 60%; P?=?0.299). Conclusions In selected critically ill cancer patients with ARDS, SLB had a high diagnostic yield rate and an acceptable surgical complication rate.

2013-01-01

320

Surgical treatment of orbital cavernomas: clinical and functional outcome in a series of 20 patients  

Microsoft Academic Search

Purpose  The aim of this study is to assess the efficacy and safety of surgical treatment of orbital cavernomas in terms of clinical\\u000a and functional results.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twenty consecutive patients underwent surgical removal of a unilateral orbital cavernoma between 1999 and 2009. Indications\\u000a for surgical treatment were: visual impairment, diplopia due to ocular movement impairment, progressive and disfiguring unilateral\\u000a proptosis, severe retroorbital

Nicola Boari; Filippo Gagliardi; Paola Castellazzi; Pietro Mortini

2011-01-01

321

Successful Outcome of Refractory Chronic Constipation by Surgical Treatment: A Series of 34 Patients  

PubMed Central

Background/Aims Chronic constipation is commonly managed medically, and surgical options have been advocated in patients with refractory symptoms. We aimed to study the role of surgical procedures in patients with constipation, refractory to medical therapy. Methods Data on 34 surgically managed patients with refractory chronic constipation during a 6-year period (March 2003 to May 2009) were retrospectively analyzed. Results All the 34 patients (24 males and 10 females, median age of 45 years [range, 18-77 years]) had symptoms for a long period (median 96 months [range, 12-360 months]) without response to medical treatment including biofeedback. Preopertive investigations included barium enema, colonoscopy, colonic transit study, defecography and anorectal manometry as indicated. Eight patients (23.5%) had slow transit constipation, 4 (11.8%) had Hirschsprung's disease and 22 (64.7%) had rectal prolapse. Total colectomy and ileo-rectal anastomosis, anterior resection, Delorme's procedure, resection rectopexy and Duhamel's operation were the surgical procedures performed. Though 7 (20.6%) patients had post operative complications, there was no mortality. One patient whose symptoms recurred following anterior resection was successfully treated by total colectomy and ileo-rectal anastomosis. Median spontaneous bowel movements increased following surgical treatment compared to that while on medical treatment (1 per week [range, 0 to 3 per week] vs. 14 per week [range, 7-28 per week], P < 0.00001). Patients remained well during 3-60 months follow-up (n = 27). Conclusions Spontaneous bowel movements significantly increased following surgical operation for refractory chronic constipation, nature of which is dependent on underlying etiology and the expertise available. Careful preoperative work-up and selection of patients are critical for obtaining good functional results.

Lokesh, HM; Ghoshal, Uday C

2013-01-01

322

[A rare case of surgical management of a patient with thoracic aortic aneurysm].  

PubMed

Described in the article is a clinical case of successful surgical management of a male patient diagnosed with a syphilitic-origin aneurysm of the thoracic aorta isthmus, complicated by an aortopulmonary fistula. Also presented herein are the clinical pattern, findings of examination, and treatment policy. This is followed by a detailed description of both the course of the surgical intervention and outcomes obtained. PMID:22929686

Kospanov, N A; Mierbekov, E M; Eshmuratov, T Sh; Kodasbaev, A T; Kirgizbaev, S Zh

2012-01-01

323

VAC therapy for wound management in patients with contraindications to surgical treatment.  

PubMed

The treatment of complex wounds often requires multiple surgical debridement and eventually reconstruction with skin grafts or flaps, under local or general anesthesia. When the patient's general conditions contraindicate surgical procedures, topical negative pressure with vacuum assisted closure (VAC)) device can achieve wound healing with reduction of healing time and simpler management. We treated with VAC device four patients with complex wounds and important contraindications to surgery. In all the patients, we used VAC device with common protocol of topical negative pressure. The healing was obtained in a period variable between 18 and 40 days; the results were satisfactory in three cases, one patient developed an aesthetically unpleasant scar. We present our experience to propose VAC when surgical procedures are contraindicated. PMID:22913447

Negosanti, Luca; Sgarzani, Rossella; Nejad, Parissa; Pinto, Valentina; Tavaniello, Beatrice; Palo, Stefano; Oranges, Carlo Maria; Fabbri, Erich; Michelina, Veronica Vietti; Zannetti, Guido; Morselli, Paolo Giovanni; Cipriani, Riccardo

2012-01-01

324

Self-performed glansectomy and surgical repair by a nonpsychotic patient on androgen replacement therapy  

PubMed Central

Genital self-amputation in men is a rare condition. We report an interesting case of penile self-amputation that was performed and surgically repaired by a nonpsychotic patient who was enrolled in a clinical trial for androgen replacement therapy. Using sterile technique for amputation of the glans penis and using cotton thread to suture the wound, the patient was able to avoid hemorrhage and infection. This is the first reported case of androgen therapy–induced penile self-amputation with patient-performed surgical reconstruction using primitive instruments.

Roth, Kirk; Izard, Jason; Beiko, Darren

2009-01-01

325

Early results of the surgical treatment of patients with traumatic injuries to the cervical spine.  

PubMed

In the period 1997-1999, 51 patients were surgically treated for injury to the cervical spine at the Rzeszów Voivodeship Hospital. There were 46 men and 5 women, with the majority in the age group 15-20 years. The most common causes of injury were diving and automobile accidents. Most of these patients were referred to our Department for treatment 1-3 days after the injury was incurred. The treatment method of choice was surgery. The majority of the patients were referred to the Department or Rehabilitation at our hospital as soon as their surgical wounds had healed. PMID:18034111

Surmacz, L; Sklepowicz, A; Gamracki, B; Kusibab, M; Szuber, J

2000-06-30

326

Self-performed glansectomy and surgical repair by a nonpsychotic patient on androgen replacement therapy.  

PubMed

Genital self-amputation in men is a rare condition. We report an interesting case of penile self-amputation that was performed and surgically repaired by a nonpsychotic patient who was enrolled in a clinical trial for androgen replacement therapy. Using sterile technique for amputation of the glans penis and using cotton thread to suture the wound, the patient was able to avoid hemorrhage and infection. This is the first reported case of androgen therapy-induced penile self-amputation with patient-performed surgical reconstruction using primitive instruments. PMID:19672432

Roth, Kirk; Izard, Jason; Beiko, Darren

2009-08-01

327

The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO).  

PubMed

The number of cancer patients in Europe is rising and significant advances in basic and applied cancer research are making the provision of optimal care more challenging. The concept of cancer as a systemic, highly heterogeneous and complex disease has increased the awareness that quality cancer care should be provided by a multidisciplinary team (MDT) of highly qualified healthcare professionals. Cancer patients also have the right to benefit from medical progress by receiving optimal treatment from adequately trained and highly skilled medical professionals. Built on the highest standards of professional training and continuing medical education, medical oncology is recognised as an independent medical specialty in many European countries. Medical oncology is a core member of the MDT and offers cancer patients a comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire 'cancer journey'. Medical oncologists are also engaged in clinical and translational research to promote innovation and new therapies and they contribute to cancer diagnosis, prevention and research, making a difference for patients in a dynamic, stimulating professional environment. Medical oncologists play an important role in shaping the future of healthcare through innovation and are also actively involved at the political level to ensure a maximum contribution of the profession to Society and to tackle future challenges. This position paper summarises the multifarious and vital contributions of medical oncology and medical oncologists to today's and tomorrow's professional cancer care. PMID:24335854

Popescu, R A; Schäfer, R; Califano, R; Eckert, R; Coleman, R; Douillard, J-Y; Cervantes, A; Casali, P G; Sessa, C; Van Cutsem, E; de Vries, E; Pavlidis, N; Fumasoli, K; Wörmann, B; Samonigg, H; Cascinu, S; Cruz Hernández, J J; Howard, A J; Ciardiello, F; Stahel, R A; Piccart, M

2014-01-01

328

Usefulness of magnetic motor evoked potentials in the surgical treatment of hemiplegic patients with intractable epilepsy  

Microsoft Academic Search

Five hemiplegic patients with intractable epilepsy were studied with transcranial magnetic stimulation (TMS) before and after various surgical treatments. These patients had unilateral widespread cerebral lesions acquired at various times, including congenital, infantile and childhood injury. Motor evoked potentials (MEPs) of the abductor pollicis brevis (APB) muscles were simultaneously recorded on both sides following TMS of the motor cortex in

TOHRU KAMIDA; HIROSHI BABA; KENJI ONO; MASATO YONEKURA; MINORU FUJIKI; HIDENORI KOBAYASHI

2003-01-01

329

Surgical Repair of Chronic Complete Hamstring Tendon Rupture in the Adult Patient  

Microsoft Academic Search

Complete rupture of the hamstring tendons in the adult is a rare injury. This report discusses complete rupture of the hamstring tendons in nine patients treated by late operative repair. All patients were referred from outside centers for a second opinion after failed non-operative treatment. The diagnosis was made quite easily on clinical grounds and was confirmed at surgery. Surgical

Mervyn J. Cross; Ronald Vandersluis; David Wood; Margaret Banff

1998-01-01

330

[Surgical rehabilitation in patients with zygomatic orbital fractures and orbital floor fractures].  

PubMed

The study presents the results of surgical management of 65 patients with zygomatico-orbital complex and orbital floor fractures according to a self-designed technique using polymer implants Reperen. Being a method of choice the technique reduces treatment time, promotes good esthetic results, reduces complication rate, and contributes to a patient's quality life improvement. PMID:24429787

2013-01-01

331

The elderly patient with surgically resected non-small cell lung cancer--a distinct situation?  

PubMed

The worldwide population shift towards older ages will inevitably lead to more elderly patients being diagnosed with cancer. Lung cancer is the number one cause for cancer mortality and surgical resection is the treatment of choice whenever possible. This study investigates whether elderly patients with non-small cell lung cancer (NSCLC) are characterized by distinct clinical and pathologic features and different clinical course after resection. Special emphasis is placed on disease recurrence, which is an important, but rarely described parameter for biological tumor behavior. Sex, stage, histology, differentiation grade, smoking status, performance status, hemoglobin, C-reactive protein, lactate dehydrogenase, Ki-67 index, recurrent disease and overall survival were analyzed in 383 surgically resected NSCLC patients. Calculations were performed comparing patients <70 to ?70 years. A postoperative follow-up period of 15 years enabled detailed correlations. Rate of disease recurrence and disease-free survival did not differ between any age groups and was not influenced by clinico-pathologic parameters. Elderly patients with a Ki-67 index of >3% were associated with significantly decreased overall survival time when compared to younger patients (36.3 and 47.3 months respectively, p=0.029). The biological behavior of NSCLC as reflected by characteristics of disease recurrence is similar for surgically resected patients among different age groups and does not warrant specific recommendations for the elderly surgical patient. The Ki-67 index offers prognostic information for overall survival in the elderly. PMID:22226625

Sterlacci, William; Stockinger, Richard; Schmid, Thomas; Bodner, Johannes; Hilbe, Wolfgang; Waldthaler, Christian; Oberaigner, Wilhelm; Tzankov, Alexandar; Fiegl, Michael

2012-03-01

332

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

333

[General surgical procedures in patients with electrical pacemaker].  

PubMed

Work of the implanted electric pacemaker (EP) was assessed in 99 patients, aged 62.4±9.6 years, during non-cardiological surgery. Inhibition of the EP stimuli was registered in 9 (9.1%) patients, short episodes of uneffective stimulation with synchronization disturbation--in 2 (2%) patients and change of stimulation regimen was registered in the same number of patients by electocoagulation. Episodes of myopotential inhibition not assotiated with electrocoagulation was registered in 4 cases. The ascertained rhythm disturbances require a thorough preoperative check-up, intraoperative ECG control and short use of monopolar electrocoagulation. PMID:21164416

Sazhin, A V; Tiagunov, A E; Pervova, E V; Aleksandrov, A N; Rogov, K A; Zlotnikova, A D; Zhdanov, A M

2010-01-01

334

Managing surgical pain in long-term opioid patients.  

PubMed

The number of patients taking long-term opioid therapy for pain is increasing, with opioid use no longer being confined to advanced cancer patients. Challenges to peri- and postoperative pain management in chronic pain patients include complex existing drug regimens and problems arising from tolerance to opioid analgesia. Postoperatively, individualized, multimodal pain therapy involving a round-the-clock regimen of nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, paracetamol, and regional blocks should be used. Other considerations may include patients receiving opioids by intrathecal drug delivery systems, spinal cord stimulator (SCS), and potential substance abusers. PMID:23688513

Brill, Silviu

2013-06-01

335

Evidence based development of bedside clinical drug rules for surgical patients.  

PubMed

Background Surgical adverse events constitute a considerable problem. More than half of in-hospital adverse events are related to a surgical procedure. Medication related events are frequent and partly preventable. Due to the complexity and multidisciplinary nature of the surgical process, patients are at risk for drug related problems. Consistent drug management throughout the process is needed. Objective The aim of this study was to develop an evidence-based bedside tool for drug management decisions during the pre- and postoperative phase of the surgical pathway. Setting Tool development study performed in an academic medical centre in the Netherlands involving an expert panel consisting of a surgeon, a clinical pharmacist and a pharmacologist, all experienced in quality improvement. Method Relevant medication related problems and critical pharmacotherapeutic decision steps in the surgical process were identified and prioritised by a team of experts. The final selection comprised undesirable effects or unintended outcomes related to surgery (e.g. pain, infection) and comorbidity related hazards (e.g. diabetes, cardiovascular diseases). To guide patient management, a list of bedside surgical drug rules was developed using international evidence-based guidelines. Main outcome measure 55 bedside drug rules on 6 drug categories, specifically important for surgical practice, were developed: pain, respiration, infection, diabetes, cardiovascular diseases and anticoagulation. Results A total of 29 evidence-based guidelines were used to develop the Bedside Surgical Drug Rules tool. This tool consist of practical tables covering management regarding (1) the most commonly used drug categories during surgery, (2) comorbidities that require dosing adjustments and, (3) contra-indicated drugs in the perioperative period. Conclusion An evidence-based approach provides a practical basis for the development of a bedside tool to alert and assist the care providers in their drug management decisions along the surgical pathway. PMID:24748507

Ramrattan, Maya A; Boeker, Eveline B; Ram, Kim; Burgers, Desiree M T; de Boer, Monica; Lie-A-Huen, Loraine; Mulder, Wilhelmina M C; Boermeester, Marja A

2014-06-01

336

Prevalence of emotional symptoms in Chilean oncology patients before the start of chemotherapy: potential of the distress thermometer as an ultra-brief screening instrument  

PubMed Central

Emotional distress (ED) is greater for oncology patients in comparison with the general population, and this has implications for the quality of life of the patient and his/her family, adherence to the treatment, and eventually, survivorship. In general, the detection of these symptoms is low, which explains the need for detection systems appropriate to the clinical reality of the oncology team. The objective of this study is to evaluate for the first time the usefulness of an ultra-brief screening instrument [distress thermometer (DT)], in a group of Chilean oncology patients. A total of 166 outpatients were evaluated at the Cancer Center of the Pontificia Universidad Católica de Chile, before starting chemotherapy. Two screening instruments were applied: Hospital Anxiety and Depression Scale (HADS) and DT. The application of HADS resulted in a prevalence of 32.7% of anxiety symptoms (HADS-A ? 8), 15.7% of depression symptoms (HADS-D ? 8), and 39.8% had a total score of HADS-T ? 11. The DT resulted in the prevalence of 32.5% of distress or ED (DT ? 5). The validity of the DT was evaluated as a screening tool in comparison with HADS, observing, in relation to the anxiety scale (HADS-A), a sensitivity of 88.9% and specificity of 78.4% (DT ? 4); depression (HADS-D), a sensitivity of 69.2% and specificity of 74.3% (DT ? 5); and in relation to the total scale (HADS-T), a sensitivity of 68.2% and specificity of 73.0% (DT ? 4). This study demonstrates the elevated prevalence of emotional symptoms in Chilean oncology patients, before the start of chemotherapy, and confirms the potential of the DT as a brief screening instrument with easy application. The DT will allow the clinician to increase the detection threshold in the Chilean oncology population, intervene in a timely manner, and contribute to the comprehensive handling of the oncology patient without affecting the time needed for assistance.

Calderon, Jorge; Campla, Cristobal; D'Aguzan, Nicole; Barraza, Soledad; Padilla, Oslando; Sanchez, Cesar; Palma, Silvia; Gonzalez, Matias

2014-01-01

337

Oncology out-patients nursing: a challenge within the changing face of cancer care  

Microsoft Academic Search

Eighty to 90% of cancer care is delivered in the out-patient setting, and thus the out-patient nurse's role is pivotal to patient care. A report published in 1990 (NHS Management Executive) suggested that there had been no change in the traditional ‘handmaiden’ role of the out-patient nurse over the previous 20 years. This study was designed using the conceptual framework

Julia Downing

2001-01-01

338

The Impact of Specialized Oncology Nursing on Patient Supportive Care Outcomes  

Microsoft Academic Search

Meeting the supportive care needs of cancer patients remains a challenge to cancer care systems around the world. Despite significant improvements in the organization of medical care of patients with cancer, numerous surveys of cancer populations demonstrate that significant proportions of patients fail to have their supportive care needs met. One possible solution is the introduction of a care coordinator

Jonathan Sussman; Doris Howell; Daryl Bainbridge; Kevin Brazil; Nancy Pyette; Saqib Abbasi; Timothy Whelan

2011-01-01

339

The role of the oncology nurse in prechemotherapy neutropenic risk assessment and patient outcomes  

Microsoft Academic Search

The 88 patients studied during the first 6 months after implementation of the tool were a mean of 62 years of age (86% male); patients had cancer of the lungs (27%), head and neck (22%), colorectum (22%), gastrointestinal tract or esophagus (8%), or prostate (6%), or had lymphoma (7%) or other malignancy (8%). The 101 patients studied during the second

Anne Doyle; Kathryn Keegan; Kristin Mullen; Gabrielle Zecha; Charles A. Boyd; Janice Hutson

340

Oncology patients' and professional nurses' perceptions of important nurse caring behaviors  

Microsoft Academic Search

BACKGROUND: Caring is the essence of nursing. Caring to be meaningful needs to be based on mutual agreement between nurses and patients as to what constitutes nurse caring behaviors. As a result, healthcare professional can enhance patients' satisfaction of care by providing appropriate caring behavior. However, previous research that combined multiple types of patients, nurses and institutions demonstrated disagreement in

Vahid Zamanzadeh; Roghaieh Azimzadeh; Azad Rahmani; Leila Valizadeh

2010-01-01

341

Utilitarian prioritization of radiation oncology patients based on maximization of population tumour control  

NASA Astrophysics Data System (ADS)

An objective method for establishing patient prioritization in the context of a radiotherapy waiting list is investigated. This is based on a utilitarian objective, being the greatest probability of local tumour control in the population of patients. A numerical simulation is developed and a clinical patient case-mix is used to determine the influence of the characteristics of the patient population on resulting optimal patient scheduling. With the utilitarian objective, large gains in tumour control probability (TCP) can be achieved for individuals or cohorts by prioritizing patients for that fraction of the patient population with relatively small sacrifices in TCP for a smaller fraction of the population. For a waiting list in steady state with five patients per day commencing treatment and leaving the list (and so with five patients per day entering the list), and a mean wait time of 35 days and a maximum of 90 days, optimized wait times ranged from a mean of one day for patients with tumour types with short effective doubling times to a mean of 66.9 days for prostate cancer patients. It is found that, when seeking the optimal daily order of patients on the waiting list in a constrained simulation, the relative rather than absolute value of TCP is the determinant of the resulting optimal waiting times. An increase in the mean waiting time mostly influences (increases) the optimal waiting times of patients with fast-growing tumours. The proportional representation of groups (separated by tumour type) in the patient population has an influence on the resulting distribution of optimal waiting times for patients in those groups, though has only a minor influence on the optimal mean waiting time for each group.

Ebert, M. A.; Li, W.; Jennings, L.; Kearvell, R.; Bydder, S.

2013-06-01

342

Psychological evaluation and management of pediatric oncology patients in protected environments.  

PubMed

Specific aspects of psychological investigation and management of pediatric patients with widely disseminated solid tumors treated in semiportable, laminar airflow patient isolators are discussed. Information was obtained prospectively from a psychosocial study c-ordinated with a medical investigation of the use of protected environments (PE) employing barrier isolation as an adjunct to intensive anticancer therapy. Included are description of the development of psychological criteria for patient eligibility, psychometric evaluation, longitudinal behavioral observation, pre-entry and predischarge orientation techniques, as well as approaches to the ongoing management of patients and families. No debilitating psychological disturbance has been observed in these patients, and no patients have had to be removed for psychological reasons. Specific transitory psychological changes are noted as are the problems encountered by staff members functioning in such a setting. The adoption of a well-coordinated psychosocial program of investigation and clinical intervention has proved useful in maximizing patient adjustment to prolonged treatment in protected environments. PMID:979916

Kellerman, J; Rigler, D; Siegel, S E; McCue, K; Pospisil, J; Uno, R

1976-01-01

343

Impact of medical and surgical intervention on survival in patients with cholangiocarcinoma  

PubMed Central

AIM: To examine surgical and medical outcomes for patients with cholangiocarcinoma using a population-based cancer registry. METHODS: Using the California Cancer Registry’s Cancer Surveillance Program, patients with intrahepatic cholangiocarcinoma treated in Los Angeles County from 1988 to 2006 were identified and evaluated for clinical and pathologic factors and therapies received (surgery, radiation, and chemotherapy). The surgical cohort was further categorized into three treatment groups: patients who received adjuvant chemotherapy, adjuvant chemoradiation, or underwent surgery alone (no chemotherapy or radiation administered). Survival was assessed by Kaplan-Meier method; and Cox proportional hazard modeling was used in multivariate analysis. RESULTS: Of 825 patients, 60.2% received no treatment. Of the remaining 328 patients, 18.5% chemotherapy only, 7.4% chemoradiation, and 13.8% underwent surgery. More male patients underwent surgical resection (P = 0.004). Surgical patients were younger than the patients receiving chemotherapy or chemoradiation (P < 0.001). Of the surgical cohort (n = 114), 60.5% underwent surgery alone while 39.5% underwent surgery plus adjuvant therapy (chemotherapy, n = 20; chemoradiation, n = 21) (P < 0.001). Median survival for all patients in the study was 6.6 mo. Median survival was highest for patients who underwent surgery (23 mo), whereas both chemotherapy (9 mo) and chemoradiation (8 mo) alone were each less effective (P < 0.001). By multivariate analysis, extent of disease, receipt of surgery, and administration of chemotherapy (with/without surgery) were independent predictors of overall survival. CONCLUSION: This study demonstrates that surgery is a critical treatment modality. Multimodality treatment has yet to be standardized, but play a role in optimal therapy for cholangiocarcinoma.

Arrington, Amanda K; Nelson, Rebecca A; Falor, Ann; Luu, Carrie; Wiatrek, Rebecca L; Fakih, Marwan; Singh, Gagandeep; Kim, Joseph

2013-01-01

344

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

PubMed Central

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 Medical Center from September 1994 to December 2006 were retrospectively analyzed. Of them, 90 patients with gastric cancer and a synchronous second primary cancer underwent simultaneous surgery for gastric cancer and second primary cancer. The clinicopathological characteristics of the patients, surgical outcome, and prognosis were examined. Results The most common synchronous second primary cancer was colorectal cancer (37 patients), followed by hepatocellular carcinoma (13 patients), renal cell carcinoma (11 patients), and pancreatic carcinoma (5 patients). The incidence of a second primary cancer in the gastric cancer patients was higher than the incidence in the general population. Stage I gastric cancer patients had more synchronous cancers than stage II patients (59 vs. 31). Postoperative complications were encountered in 7 patients. Four patients underwent reoperation. Two patients died from hepatic failure and leakage of esophagojejunal anastomosis. The 5-year survival rate of stage I and II gastric cancer was 61% and 39%, respectively. Conclusion Since gastric cancer patients with a synchronous second primary cancer are not rare, the possibility of synchronous cancers in gastric cancer patients should be considered. The prognosis of early stage gastric cancer patients with a synchronous second primary cancer was influenced more by the presence of the second primary cancer than by the gastric cancer itself.

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

2007-01-01

345

The challenge of recruiting patients into a placebo-controlled surgical trial  

PubMed Central

Background Randomized placebo-controlled trials represent the gold standard in evaluating healthcare interventions but are rarely performed within orthopedics. Ethical concerns or well-known challenges in recruiting patients for surgical trials in general have been expressed and adding a placebo component only adds to this complexity. The purpose of this study was to report the challenges of recruiting patients into an orthopedic placebo-controlled surgical trial, to determine the number of patients needed to be screened and allocated in order to include one participant into the trial, and to identify reasons associated with participation in a placebo-controlled randomized surgical trial. Methods Data were extracted from an ongoing placebo-controlled randomized controlled trial (RCT) on meniscectomy versus placebo surgery. We calculated the number of patients needed to be screened in order to include the required number of participants into the RCT. Participating patients were asked about their rationale for joining the study and which type of information was most useful for deciding upon participation. Results A total of 476 patients entered the screening group, of which 190 patients fulfilled the inclusion and exclusion criteria. 102 patients declined to participate in the study due to various reasons and 46 were later excluded (no meniscus lesion on the magnetic resonance imaging scan or withdrawn consent). A total of 40 patients were finally included in the RCT. To include one patient into the RCT, 11.9 individuals needed to be screened. A total of 69% of participating patients considered the oral information to be the most important and the most common reason for participating was the contribution to research (90%). Conclusions Patients are willing to participate in an orthopedic placebo-controlled surgical trial. Oral information given by the surgeon to the patient and the contribution to research are important aspects to enhance patient recruitment. Trial registration ClinicalTrials.gov NCT01264991, registered 21 December 2010.

2014-01-01

346

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

347

Cancer patient-centered home care: a new model for health care in oncology  

PubMed Central

Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients’ needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients’ needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective.

Tralongo, Paolo; Ferrau, Francesco; Borsellino, Nicolo; Verderame, Francesco; Caruso, Michele; Giuffrida, Dario; Butera, Alfredo; Gebbia, Vittorio

2011-01-01

348

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.

2013-01-01

349

The SURgical PAtient Safety System (SURPASS) checklist optimizes timing of antibiotic prophylaxis  

PubMed Central

Background Surgical site infection (SSI) is an adverse event in which a close relation between process of care and outcome has been demonstrated: administration of antibiotic prophylaxis decreases the risk of SSI. In our tertiary referral centre, a SURgical PAtient Safety System (SURPASS) checklist was developed and implemented. This multidisciplinary checklist covers the entire surgical pathway and includes, among other items, administration of antibiotic prophylaxis before induction of anaesthesia. The aim of this study was to determine the effect of SURPASS implementation on timing of antibiotic prophylaxis. Methods A retrospective analysis was performed on two cohorts of patients: one cohort of surgical patients that underwent surgery before implementation of the checklist and a comparable cohort after implementation. The interval between administration of antibiotic prophylaxis and incision was compared between the two cohorts. Results A total of 772 surgical procedures were included. More than half of procedures were gastro-intestinal; others were vascular, trauma and hernia repair procedures. After implementation, the checklist was used in 81.4% of procedures. The interval between administration of antibiotic prophylaxis and incision increased from 23.9 minutes before implementation of SURPASS to 29.9 minutes after implementation (p = 0.047). In procedures where the checklist was used, the interval increased to 32.9 minutes (p = 0.004). The proportion of patients that did not receive antibiotics until after the incision decreased significantly. Conclusion The use of the SURPASS checklist leads to better compliance with regard to the timing of antibiotic prophylaxis administration.

2010-01-01

350

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

351

Patient Race and Surgical Outcomes after Total Knee Arthroplasty: An analysis of a large regional database  

PubMed Central

Objective To examine racial differences in surgical complications, mortality and revision rates after total knee arthroplasty. Methods We studied patients undergoing primary total knee arthroplasty using 2001–2007 Pennsylvania Health Care Cost Containment Council data. We conducted bivariate analyses to assess the risk of complications: myocardial infarction, venous thromboembolism, wound infections, and failure of prosthesis, and 30-day and one year overall mortality after elective total knee arthroplasty between racial groups. We estimated Kaplan-Meier one and five year surgical revision rates, and fit multivariable Cox proportional hazard models to compare surgical revision by race, incorporating 5 years of follow up. We adjusted for patient age, sex, length of hospital stay, surgical risk of death, type of health insurance, hospital surgical volume and hospital teaching status. Results In unadjusted analyses, there were no significant differences by racial group for either overall 30-day or in hospital complication rates, or 30-day and one year mortality rates. Adjusted Cox models incorporating five years of follow up showed an increased risk of revisions for black patients [hazard ratios (95% confidence intervals)]: [1.39 (1.08–1.80)], younger patients [2.30 (1.96–2.69)], and lower risk for female patients [0.81 (0.71–0.92)]. Conclusions In this sample of patients who underwent knee arthroplasty, we found no significant racial differences in major complication rates or mortality. However, black patients, younger patients, and male patients all had significantly higher rates of revision based on five years of follow up.

Blum, Marissa A.; Singh, Jasvinder A.; Lee, Gwo-Chin; Richardson, Diane; Chen, Wei; Ibrahim, Said A.

2012-01-01

352

Implementation of the american college of surgeons oncology group z1071 trial data in clinical practice: is there a way forward for sentinel lymph node dissection in clinically node-positive breast cancer patients treated with neoadjuvant chemotherapy?  

PubMed

For clinically node-positive breast cancer patients receiving neoadjuvant chemotherapy, approximately 40 % will be found to be pathologically node negative. The American College of Surgeons Oncology Group Z1071 trial was therefore conducted to evaluate sentinel lymph node dissection (SLND) in these patients. The trial's primary end point was to determine the false-negative rate (FNR) among patients with clinical N1 disease in whom at least 2 sentinel lymph nodes (SLNs) were identified. The FNR was 12.6 %, which exceeded the prespecified end point of 10.0 %. After data publication, our multidisciplinary team discussed the trial results and how we may incorporate the findings into clinical practice. Patient selection and surgical technique are critical. As an example, when dual tracer technique was used, the FNR was 10.8 %. Data from the trial presented at the San Antonio Breast Cancer Symposium suggested that the FNR could be improved if a clip was placed in the biopsy-proven positive lymph node and removal of that node during SLND was confirmed. Taking this into consideration, we have proposed an approach to surgical management of the axilla in clinically node-positive patients receiving neoadjuvant chemotherapy termed targeted axillary dissection (TAD). TAD involves placing a clip at the time a lymph node is determined to be positive. After completion of neoadjuvant chemotherapy, the clipped node is localized by using a wire or radioactive seed, and during the SLND procedure, all SLNs and the clipped node are removed. We are currently evaluating the efficacy of TAD in axillary staging after neoadjuvant chemotherapy. PMID:24841348

Mittendorf, Elizabeth A; Caudle, Abigail S; Yang, Wei; Krishnamurthy, Savitri; Shaitelman, Simona; Chavez-MacGregor, Mariana; Woodward, Wendy A; Bedrosian, Isabelle; Kuerer, Henry M; Hunt, Kelly K

2014-08-01

353

The surgical management of stage I and stage II lung cancer.  

PubMed

There have been recent advances in the treatment of non-small cell lung cancer (NSCLC). Surgical resection remains the cornerstone in the treatment of patients with stages I and II NSCLC. Anatomic lobectomy combined with hilar and mediastinal lymphadenectomy constitutes the oncologic basis of surgical resection. The surgical data favor video-assisted thoracic surgery (VATS) lobectomy over open lobectomy and have established VATS lobectomy as a gold standard in the surgical resection of early-stage NSCLC. However, the role of sublobar pulmonary resection, either anatomic segmentectomy or nonanatomic wedge resection, in patients with subcentimeter nodules may become important. PMID:21986267

Gorenstein, Lyall A; Sonett, Joshua R

2011-10-01

354

Screening for Distress in Routine Oncological Care--A Survey in 520 Melanoma Patients  

PubMed Central

Introduction Despite the increasing incidence of melanoma little is known about patients' emotional distress associated with this disease. Supplemented by the problem list (PL), the distress thermometer (DT) is a recommended screening instrument to measure psychosocial distress in cancer patients. Our objective was to explore the acceptance and the feasibility of the DT and PL as a concise screening tool in an ambulatory setting for routine care and to elucidate determinants of distress in melanoma patients with regard to sociodemographic and clinical variables. Methods Consecutive melanoma outpatients were asked to complete the DT with the PL prior to their scheduled consultation. Demographic and clinical data were obtained from the patients' charts. Clinical data included melanoma stage, time since diagnosis, previous treatment, current treatment, and other cancer disease. Results Out of 734 patients recruited into the study, 520 patients (71%) completed both the DT and the PL. Forty-seven percent met the ?5 cut-off score for distress. Younger and employed patients reported higher distress than older and retired patients. A cut-off score of ?5 was closely associated with self-reported emotional sources of distress, with practical problems, especially at work, family problems (dealing with the partner), and physical problems like pain, appearance, getting around, and nausea. Apart from higher distress under current systemic treatment, no associations were found between distress and clinical data. Conclusion The DT together with the PL seems to be an economically reasonable screening tool to measure psychosocial distress in melanoma patients. In particular, younger melanoma patients who are currently employed are prone to experience distress at some point after diagnosis, but there appears to be almost no association between clinical data and the extent of distress. To characterize the impact of distress on disease outcome and quality of life in melanoma patients, further research is needed.

Loquai, Carmen; Scheurich, Vera; Syring, Nils; Schmidtmann, Irene; Rietz, Stephan; Werner, Andreas; Grabbe, Stephan; Beutel, Manfred E.

2013-01-01

355

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.

356

Age as an independent prognostic factor in patients with glioblastoma: a radiation therapy oncology group and American College of Surgeons National Cancer Data Base comparison  

Microsoft Academic Search

Glioblastoma (GBM) is rare in early adulthood and little information is available on this subgroup. We investigated whether\\u000a young age (18–30 years) had an independent effect on survival. We retrospectively reviewed patients from two large databases:\\u000a Radiation Therapy Oncology Group (RTOG) and American College of Surgeons National Cancer Data Base (NCDB). In the RTOG evaluation,\\u000a we analyzed all eligible GBM cases

Malika L. Siker; Meihua Wang; Kimberly Porter; Diana F. Nelson; Walter J. Curran; Jeff M. Michalski; Luis Souhami; Arnab Chakravarti; W. K. Alfred Yung; John DelRowe; Christopher T. Coughlin; Minesh P. Mehta

357

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

358

Telerobotic-assisted laparoscopic hysterectomy for benign and oncologic pathologies: initial clinical experience with 30 patients  

Microsoft Academic Search

Background: Telerobotic-assisted laparoscopic attempts to provide technological solutions to the inherent limitations of traditional laparoscopic surgery. The aim of this study is to report the first experience of two teams concerning telerobotic-assisted laparoscopic hysterectomy for benign and malignant pathologies. Methods: This study included 14 patients at the University Hospital Saint Pierre of Brussels (Belgium) and 16 patients at the Cancer

F. Marchal; P. Rauch; J. Vandromme; I. Laurent; A. Lobontiu; B. Ahcel; J. L. Verhaeghe; C. Meistelman; M. Degueldre; J. P. Villemot; F. Guillemin

2005-01-01

359

Surgical Treatment of Patients with Lennox-Gastaut Syndrome Phenotype  

PubMed Central

Lennox-Gastaut syndrome (LGS) is a devastating and refractory generalized epilepsy affecting children and adolescents. In this study we report the results of resective surgery in 18 patients with LGS phenotype who underwent single-lobe/lesionectomy or multilobe resection plus multiple subpial transection and/or callosotomy. After surgery, seven patients became completely seizure-free (Engel Class I) and five almost seizure-free (Engel Class II). Additional four had significant seizure control (Engel Class III), and two had no change in seizure frequency (Engel Class IV). Of the 4 patients without any lesion on brain MRI, 2 ended with Engel Class II, 1 with III and the other with IV in Engels' classification. Mean intelligence quotient (IQ) increased from 56.1?±?8.1 (mean?±?SD) before operation to 67.4?±?8.2 (mean?±?SD) after operation, a significant improvement (P = 0.001). Results also indicated that the younger the patient at surgery, or the shorter the interval between onset of seizure and resective operation, the better the intellectual outcome. Our data suggest that resective epilepsy surgery can be successful in patients with LGS phenotype as long as the EEG shows dominance of discharges in one hemisphere and corresponding ipsilateral imaging findings, even with contralateral ictal discharges.

Liu, Shi-Yong; An, Ning; Fang, Xiang; Singh, Prabhdeep; Oommen, Joseph; Yin, Qing; Yang, Mei-Hua; Liu, Yong; Liao, Wei; Gao, Chang-Qing; Yang, Hui

2012-01-01

360

Plasma gonadotropins and androgens in surgically treated cryptorchid patients.  

PubMed

Plasma LH, FSH, and total 17betaOH androgen levels were measured in a group of 40 adult patients who underwent orchiopexy for either unilateral or bilateral cryptorchism during childhood. Gonadotropin abnormalities were found in 15 of 40 patients and thereby appeared to be a much more sensitive indicator of testicular malfunction than the androgens which were abnormal in only four patients. In the postpubertal phase, the estimation of gonadotropins and androgens appeared valuable, first, as an additional help in the prognosis of fertility, where combined raised levels of LH and FSH were found to indicate a poor prognosis; second, to detect in infertile patients gonadotropin deficiency which, if previously missed, can still be expected to respond to gonadotropin therapy; third, for the detection of the subclinically hypogonad group who may require follow-up, and finally for the detection of the low-androgen group who may require some form of hormonal therapy. As several patients in this study were found to have low gonadotropins, it is postulated that low levels of gonadotropin may play a role in the production of cryptorchism. The finding of high gonadotropin levels in another group may indicate a feedback mechanism sensitive to a damaged testis, but alternatively it is possible that there might be a primary resistance to the action of gonadotropins and it is postulated that such a resistance may be an additional factor of the causation of cryptorchism in some cases. PMID:235016

Atkinson, P M; Epstein, M T; Rippon, A E

1975-02-01

361

The effect of patient body mass index on surgical difficulty in gynaecological laparoscopy  

Microsoft Academic Search

The objective of this pilot study was to evaluate the extent to which laparoscopic gynaecological surgery could be completed\\u000a as planned in overweight and obese patients versus patients of normal weight. A prospective surgical audit was conducted of\\u000a 64 women undergoing laparoscopy for benign gynaecological conditions. Patients were grouped according to their body mass index\\u000a (BMI). The number of attempts

Kate McIlwaine; M. Cameron; E. Readman; J. Manwaring; P. Maher

2011-01-01

362

Results of Surgical Resection of Patients With Primary Lung Cancer: A Retrospective Analysis of 1,905 Cases  

Microsoft Academic Search

Background. Surgical resection, combined therapies, and lymphadenectomy are extensively utilized in the treatment of patients with lung cancer. In the present study, we summarized the clinical data of patients with primary lung cancer after surgical resection alone or combined with adjuvant therapy, and evaluate the main factors influencing long-term survival. Methods. A retrospective review of 1,905 consecutive patients with primary

Dekang Fang; Dawei Zhang; Guojun Huang; Rugang Zhang; Liangjun Wang; Dechao Zhang

2010-01-01

363

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.

2013-01-01

364

Surgical treatment of substernal goiter: An analysis of 59 patients  

Microsoft Academic Search

Purpose  Substernal goiter is defined as a thyroid mass of which more than 50% is located below the thoracic inlet. In this article\\u000a we report the diagnosis, symptoms, thyroid function, treatment, and postoperative complications of 59 patients with substernal\\u000a goiter.\\u000a \\u000a \\u000a \\u000a Methods  Between 1992 and 2005, 59 patients underwent surgery for substernal goiter at our institution. The indications for surgery\\u000a were multinodular goiter

Ayman Agha; Gabriel Glockzin; Nabil Ghali; Igors Iesalnieks; Hans J. Schlitt

2008-01-01

365

Radiation oncology outpatient perceptions of patient-centred care: a cross-sectional survey  

PubMed Central

Objectives We aimed to describe the proportion and characteristics of cancer patients who perceived that better care would have greatly improved their well-being in (1) specific and (2) multiple domains of patient-centred care. Design Cross-sectional touchscreen computer survey. Setting Four Australian radiation therapy departments located within major urban public hospitals. Participants Radiation therapy outpatients were invited to participate in a touchscreen computer survey. Eligible patients were at least 18 years old, diagnosed with cancer and had sufficient English to complete the survey. Primary outcome measure Participants were asked whether their well-being could have been greatly improved if better care had been provided across eight domains of patient-centred care. Characteristics of those respondents who identified (1) specific and (2) multiple domains where it was perceived that better care would have greatly improved their well-being were examined. Results Of 508 eligible radiation therapy patients, 344 (68%) completed the survey. Patients most frequently perceived that better care in the following domains could have improved their well-being: information and communication about their cancer (22%; 95% CI 18% to 27%); emotional and spiritual support (22%; 95% CI 18% to 27%); management of physical symptoms (21%; 95% CI 17% to 26%) and involvement of friends and family (21%; 95% CI 17% to 26%). Just under one-third of respondents (31%; 95% CI 26% to 36%) indicated that their well-being could have been improved by better care across two or more domains of care. Patients in younger age groups and migrants to Australia had higher odds of endorsing multiple domains where better care would have improved their well-being. Conclusions Further investigation of patients’ perceptions of how their perceived quality of care might be improved is warranted, particularly among patients in younger age groups and migrants to Australia.

Mackenzie, Lisa J; Sanson-Fisher, Rob W; Carey, Mariko L; D'Este, Catherine A

2013-01-01

366

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

367

SURgical interventions with FEIBA (SURF): international registry of surgery in haemophilia patients with inhibitory antibodies.  

PubMed

Factor VIII Inhibitor Bypassing Activity (FEIBA) can effectively achieve haemostasis in haemophilia patients with inhibitors. Further evaluation of FEIBA in surgical settings is of significant interest considering the relatively limited prospective data published to date. The aim of the study is to evaluate the perioperative efficacy and safety of FEIBA in haemophilia patients with inhibitors. Haemophilia patients with inhibitors who underwent surgical procedures and received FEIBA for perioperative haemostatic control were prospectively enrolled in an open-label, noninterventional, postauthorization study [SURgical interventions with FEIBA (SURF)]. Outcome measures included haemostatic efficacy, safety, FEIBA exposure and blood loss associated with the perioperative use of FEIBA. Thirty-five surgical procedures were performed at 19 centres worldwide in patients with congenital haemophilia A, congenital haemophilia B, or acquired haemophilia A. Haemorrhagic risk was severe in 37.1% (13 of 35) of the procedures, moderate in 25.7% (9 of 35) and mild in 37.1% (13 of 35). One moderate risk surgery was excluded from the efficacy analyses because it did not meet all protocol requirements. Haemostasis was judged to be 'good' or 'excellent' in 91.2% (31 of 34) of surgical procedures and 'fair' in 8.8% (3 of 34). Among the 12 adverse events, three were serious adverse events (SAEs), two of which were unrelated to FEIBA therapy; one SAE, a clot in an arteriovenous fistula, was deemed to be possibly related to therapy. This prospective investigation confirms that FEIBA can be safely and effectively used when performing surgical procedures in haemophilia patients with inhibitors. PMID:23282031

Négrier, C; Lienhart, A; Numerof, R; Stephens, D; Wong, W Y; Baghaei, F; Yee, T T

2013-05-01

368

Obstructive Sleep Apnea Syndrome in Ambulatory Surgical Patients  

Microsoft Academic Search

Obstructive sleep apnea in the ambulatory surgery setting has become a more significant concern in recent years because its identification and recognition are a critical part of preoperative patients' risk assessment. The types of surgeries that can be performed on an outpatient basis have increased and include many specialty procedures that previously were performed on an inpatient basis only. Ambulatory

Yvonne Mull; Marshall Bedder

2002-01-01

369

Surgical Management of the Patient with an Implanted Cardiac Device  

PubMed Central

Objective To identify the sources of electromagnetic interference (EMI) that may alter the performance of implanted cardiac devices and develop strategies to minimize their effects on patient hemodynamic status. Summary Background Data Since the development of the sensing demand pacemaker, EMI in the clinical setting has concerned physicians treating patients with such devices. Implanted cardiovertor defibrillators (ICDs) and ventricular assist devices (VADs) can also be affected by EMI. Methods All known sources of interference to pacemakers, ICDs, and VADs were evaluated and preventative strategies were devised. Results All devices should be thoroughly evaluated before and after surgery to make sure that its function has not been permanently damaged or changed. If electrocautery is to be used, pacemakers should be placed in a triggered or asynchronous mode; ICDs should have arrhythmia detection suspended before surgery. If defibrillation is to be used, the current flow between the paddles should be kept as far away from and perpendicular to the lead system as possible. Both pacemakers and ICDs should be properly shielded if magnetic resonance imaging, positron emission tomography, or radiation therapy is to be used. The effect of EMI on VADs depends on the model. Magnetic resonance imaging adversely affects all VADs except the Abiomed VAD, and therefore its use should be avoided in this population of patients. Conclusions The patient with an implanted cardiac device can safely undergo surgery as long as certain precautions are taken.

Madigan, John D.; Choudhri, Asim F.; Chen, Jonathan; Spotnitz, Henry M.; Oz, Mehmet C.; Edwards, Niloo

1999-01-01

370

Impact of erythropoietin treatment on the quality of life of oncologic patients  

Microsoft Academic Search

Anaemia has a high incidence in cancer patients, especially when it is a consequence of myelosuppressive treatments. The incidence\\u000a and prevalence of this condition is influenced by the type and extension of the tumour, type and intensity of the myelosuppressive\\u000a treatment that patients receive, and previous surgery or intercurrent infections. Clinical manifestations of anaemia, overlapped\\u000a by tumour symptomatology, depend on

A. Pelegrí

2007-01-01

371

Surgical resection of malignant gliomas-role in optimizing patient outcome.  

PubMed

Malignant gliomas represent one of the most devastating human diseases. Primary treatment of these tumours involves surgery to achieve tumour debulking, followed by a multimodal regimen of radiotherapy and chemotherapy. Survival time in patients with malignant glioma has modestly increased in recent years owing to advances in surgical and intraoperative imaging techniques, as well as the systematic implementation of randomized trial-based protocols and biomarker-based stratification of patients. The role and importance of several clinical and molecular factors-such as age, Karnofsky score, and genetic and epigenetic status-that have predictive value with regard to postsurgical outcome has also been identified. By contrast, the effect of the extent of glioma resection on patient outcome has received little attention, with an 'all or nothing' approach to tumour removal still taken in surgical practice. Recent studies, however, reveal that maximal possible cytoreduction without incurring neurological deficits has critical prognostic value for patient outcome and survival. Here, we evaluate state-of-the-art surgical procedures that are used in management of malignant glioma, with a focus on assessment criteria and value of tumour reduction. We highlight key surgical factors that enable optimization of adjuvant treatment to enhance patient quality of life and improve life expectancy. PMID:23358480

Eyüpoglu, Ilker Y; Buchfelder, Michael; Savaskan, Nic E

2013-03-01

372

Pharmacoeconomics in oncology.  

PubMed

Healthcare costs in the USA continue to rise faster than the consumer price index. Nothing demonstrates this more vividly than the double-digit increases posted for the cost of the drug treatment of the oncology patient. A factor that will compound this cost is the expansion in the oncology patient population that will occur as the population ages. Pharmacoeconomics is a discipline that evaluates the relationship between clinical, economic and humanistic outcomes to determine the products and services that maximize the value for each dollar spent. Research in this area is evolving to meet the needs of the individual patient and decision-makers within a payer group, healthcare system, or society. Healthcare interests in countries in Europe, Canada and Australia have already adopted analytical tools and incorporated them into guidelines for drug use. The USA is also moving in this direction now that the Food and Drug Administration is considering requiring studies in pharmacoeconomics in addition to the standard studies of the safety and efficacy of drugs. The importance of this approach to oncology will be seen as policy-makers apply research findings to practice decisions. PMID:19807417

Arbuckle, Rebecca B; Adamus, Andrea T; King, Krista M

2002-06-01

373

[Results of surgical treatment of patients with solid malignant chest tumours and superior vena cava syndrome].  

PubMed

Superior vena cava syndrome results from blood flow disturbances caused by compression or tumour invasion of the superior vena cava and its tributaries. In most cases, malignant lung tumours are responsible for its development. In 1995-2010, we performed surgical treatment of 55 patients with malignant chest neoplasms and superior vena cave syndrome. Vertical sternotomy was employed most frequently. Some patients additionally underwent antero-lateral thoracotomy to facilitate the surgical approach. Polytetrafluoroethylene prostheses 18-20 mm in diameter (Russia) were used to superior vena cava. Radical and cytoreductive surgery was the method of choice in 60 and 40% of the patients respectively. The signs of obstruction disappeared in all patients immediately after surgery. 21.8% of the patients died during the early postoperative period, 5 ones survived without signs of relapses. Median survival was 21 months. PMID:23516849

Tarasov, V A; Bogdanovich, A S; Litvinov, A Iu; Larin, I A

2012-01-01

374

Art Therapy with an Oncology Care Team  

ERIC Educational Resources Information Center

Oncology nurses are particularly vulnerable to "burnout" syndrome due to the intensity of their work and the ongoing losses they experience while providing oncology care to their patients. High levels of stress in the workplace left untended lead to high job turnover, poor productivity, and diminished quality of care for patients. Attention to…

Nainis, Nancy A.

2005-01-01

375

Haemodynamic stability with midazolamsufentanil analgesia in cardiac surgical patients  

Microsoft Academic Search

Since the administration of both diazepam and midazolam are claimed to cause adverse haemodynamic effects following fentanyl\\u000a or sufentanil intravenous injection, we evaluated the effectiveness and safety of the reverse sequence, (midazolamsufentanil)\\u000a on haemodynamic variables, adequacy of analgesia, amnesia and recovery in 15 adult patients undergoing coronary artery surgery\\u000a (with a mean ± SEM ejection fraction of 0.41 ± 0.03),

Syed M. A. Raza; Robert W. Masters; Appa R. Vasireddy; Elemer K. Zsigmond

1988-01-01

376

A review of rapid prototyped surgical guides for patient-specific total knee replacement.  

PubMed

Improvements in the surgical technique of total knee replacement (TKR) are continually being sought. There has recently been interest in three-dimensional (3D) pre-operative planning using magnetic resonance imaging (MRI) and CT. The 3D images are increasingly used for the production of patient-specific models, surgical guides and custom-made implants for TKR. The users of patient-specific instrumentation (PSI) claim that they allow the optimum balance of technology and conventional surgery by reducing the complexity of conventional alignment and sizing tools. In this way the advantages of accuracy and precision claimed by computer navigation techniques are achieved without the disadvantages of additional intra-operative inventory, new skills or surgical time. This review describes the terminology used in this area and debates the advantages and disadvantages of PSI. PMID:23109622

Krishnan, S P; Dawood, A; Richards, R; Henckel, J; Hart, A J

2012-11-01

377

Surgical Outcomes after Total Colectomy with Ileorectal Anastomosis in Patients with Medically Intractable Slow Transit Constipation  

PubMed Central

Purpose The aim of this study was to evaluate outcomes of a total colectomy with ileorectal anastomosis in patients with slow transit constipation. Methods A retrospective review of 37 consecutive patients with slow transit constipation who underwent a total colectomy between 1994 and 2008 was undertaken. Preoperative and postoperative Wexner's constipation scores were collected and used to evaluate the outcomes after surgical treatment. Also patients' postoperative satisfaction scores were collected using a 4-point scale. Results The 37 patients consisted of 31 women and 6 men, with a median age of 41 years (range, 17 to 71 years). Pre- and post-operative Wexner's scores were collected from 33 patients (89.1%), and the mean preoperative Wexner's score was 19.3 (range, 11 to 24), which decreased to an average post-operative score of 2.3 (range, 0 to 8). Neither intraoperative complications nor postoperative mortalities were noted. Five patients (13.5%) had early postoperative complications, and the most common complication was postoperative ileus (10.8%). Seven patients (18.9%) had late postoperative complications, and postoperative ileus (10.8%) was also the most common. Twenty seven of 33 patients were satisfied with their surgical outcome (81.8%). Conclusion A total colectomy with ileorectal anastomosis might be an effective surgical procedure with acceptable morbidity to treat medically intractable slow transit constipation.

Sohn, Guiyun; Kim, Chan Wook; Kwak, Jae Young; Jang, Tae Young; Kim, Kyung Ho; Yang, Song Soo; Yoon, Yong Sik; Lim, Seok-Byung; Kim, Jin Cheon

2011-01-01

378

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

PubMed

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

Holý, Ond?ej; Matoušková, Ivanka

2012-01-01

379

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.

Matouskova, Ivanka

2012-01-01

380

Complications from supervised mask use in post-operative surgical patients during the Gulf War.  

PubMed

This is a report of three patients in a surgical ward of a hospital who developed complications seemingly related to the use of full-face-fitting masks associated with the first Scud Missile attack on Israel during the Gulf War. Patient 1 developed atrial fibrillation with an uncontrolled ventricular rate; Patient 2 redeveloped a gastrointestinal hemorrhage; and Patient 3 developed a severe anxiety attack. Each of the three was severely ill prior to the event. Special attention should be given to severely ill patients during such events. PMID:10558314

Rivkind, A I; Eid, A; Weingart, E; Izhar, U; Barach, P; Richter, E D; Belzberg, H

1999-01-01

381

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.

2012-01-01

382

Interventional radiology in oncology: clinical management of patients undergoing transarterial chemoembolization for hepatic malignancies.  

PubMed

Interventional radiology procedures treat a variety of solid tumor malignancies. Transarterial chemoembolization (TACE) is a minimally invasive procedure performed under fluoroscopic guidance that is used in treatment of hepatic malignancies because of hepatocellular carcinoma or malignancy that has metastasized to the liver. Patients undergoing a TACE procedure may manifest postembolization symptoms such as fever, nausea, vomiting, and abdominal pain, which may persist after discharge. Patients need to be educated on the importance of compliance with prescribed medications, clinical symptoms to be expected, and signs of potential complications that need to be reported. PMID:22297011

Perez-Rojas, Evelyn

2012-02-01

383

Oncology Nursing Education: Nursing Students' Commitment of "Presence" with the Dying Patient and the Family.  

ERIC Educational Resources Information Center

Following a chaplain's lecture on the end of life, nursing students wrote reaction papers on appropriate ways to support dying patients and their families. Six processes emerged, including the core concept of the nurse's presence at the bedside. (Contains 23 references.) (SK)

Walsh, Sandra M.; Hogan, Nancy S.

2003-01-01

384

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.

385

A new emergency in oncology: Bone metastases in breast cancer patients (Review)  

PubMed Central

Breast cancer (BC) is the most common tumour in females and as a result, the management of such patients is a major public health issue. A high percentage of BC patients develop bone metastases (BMs), occasionally even several years following the initial diagnosis. BMs are responsible for high morbidity and a reduced quality of life with the onset of various clinical complications defined as skeletal-related events (SREs), including pathological fractures, spinal cord compression, hypercalcaemia, bone marrow infiltration and severe bone pain, requiring palliative radiotherapy. Such complications reduce functional independence and quality of life, decrease survival rates and increase healthcare costs. The current treatment for metastatic BC aims to achieve meaningful clinical responses, an improved quality of life, long-term remission, prolonged survival and in a small percentage of cases, a complete cure. The treatment of this malignancy has become progressively complex, including well-known antitumour agents or bone-targeted molecules aimed at preventing bone complications and improving patient quality of life and the treatment outcome of a multidisciplinary programme. The importance of a multi disciplinary approach in the management of BMs is also widely accepted. The major complication of BMs are SREs which are responsible for reducing prognoses and patient quality of life and are correlated with high rates of hospitalisation with the subsequent social and economic consequences. For these reasons, it is crucial to prevent where possible or to identify and treat SREs promptly in an attempt to mitigate the ever-increasing clinical and economic burden.

IBRAHIM, TONI; MERCATALI, LAURA; AMADORI, DINO

2013-01-01

386

Using research to change practice: Enteral feedings for pediatric oncology patients  

Microsoft Academic Search

This report details a study whose purpose was to show the safety of and describe the clinical and financial outcomes of nasogastric (NG) and nasojejeunal (NJ) tube feedings for nutritional support during and after intensive treatment for cancer. During a 17-month period, NG or NJ tubes were inserted in 25 patients who experienced, or were anticipated to experience, suboptimal nutrition

Joetta DeSwarte-Wallace; Shahin Firouzbakhsh; Jerry Z. Finklestein

2001-01-01

387

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

388

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.

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

2013-01-01

389

Impact of a Surgical Technique Allowing Early Discharge of Cholecystectomy Patients.  

National Technical Information Service (NTIS)

With about 442,000 cholecystectomies (gall bladder removals) performed annually in the United States, and an average LOS of 11.0 days, a surgical technique that reduces patient discomfort and disability while reducing LOS to 2-4 days is very attractive to...

L. K. Lichtig M. E. Regal

1984-01-01

390

Surgical treatment of hemangioblastomas of the central nervous system in pediatric patients  

Microsoft Academic Search

Objective  Hemangioblastomas are histologically benign lesions that occur sporadically or as a manifestation of von Hippel–Lindau disease (VHL). The treatment strategy of these neoplasms is complicated by their unpredictable growth patterns and the often irreversible neurological deficits they may cause. This study aims to outline the neurosurgical treatment options and to address the ongoing debate of surgical timing in pediatric patients

Vassilios I. Vougioukas; Sven Gläsker; Ulrich Hubbe; Ansgar Berlis; Heymut Omran; Hartmut P. H. Neumann; Vera Van Velthoven

2006-01-01

391

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

392

Should physicians routinely be involved in the care of elderly surgical patients? Yes  

Microsoft Academic Search

Standards of care for elderly people in hospital have come under the spotlight. Kathy Wilkinson and Helen Wilson believe that geriatricians can help improve the management of surgical patients, but Barbara Herd (doi:10.1136\\/bmj.d1072) is concerned that the dilution of resources will harm those who most need specialist attention

Kathy Wilkinson; Helen Wilson

2011-01-01

393

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

394

Outcome of surgical resection of pelvic osteosarcoma  

PubMed Central

Background: The aim of the following study is to evaluate the morbidity, oncologic results and functional outcome in nonmetastatic patients with primary osteosarcoma of the pelvis treated with surgical resection. Materials and Methods: Twelve cases of nonmetastatic osteosarcoma of pelvis were operated as part of their multimodality treatment regime between November 2003 and May 2011. There were 5 males and 7 females with a median age of 22 years (range 8-39 years). Ten patients underwent limb sparing resections while 2 had a hindquarter amputation. All 10 cases of limb sparing surgery included resection of the acetabulum. A pseudarthrosis was carried out in 7 cases. Extracorporeal radiation therapy and reimplantation of the bone followed by fixation with plates was used in 1 case and an ischiofemoral arthrodesis was carried out in 2 cases. Results: Surgical margins were free in 11 patients. Seven patients had a poor histological response to chemotherapy while 4 patients had a good response to chemotherapy. In the patient reconstructed with radiated auto bone graft, the histological response to chemotherapy could not be assessed. Surgery related complications were seen in 8 out of 12 patients (67%). Three of these patients (25%) required additional surgical intervention for their complications. All patients were available for followup. The median followup of survivors was 56 months (range 24-102 months). Four patients (33%) developed a local recurrence. At 5 years, overall survival was 67%. Patients with a good response to chemotherapy had a better overall survival when compared with patients with a poor response to chemotherapy. The mean Musculoskeletal Tumor Society functional score was 22 (range12-27). Conclusions: Though complex and challenging, surgery provides good local control and oncologic outcomes with acceptable function in patients with osteosarcoma of the pelvis treated with appropriate surgical resection as part of their multimodality treatment.

Puri, Ajay; Gulia, Ashish; Pruthi, Manish

2014-01-01

395

[The olfactory function in the patients with the curved nasal septum before and after surgical treatment].  

PubMed

The authors compared the frequency of subjective complains of hyposmia and results of objective study (olfactometry) in the patients with the curved nasal septum. In addition, the influence of septoplastic surgery on the olfactory function in such patients was estimated. The study included 40 patients aged from 18 to 59 years who examined by olfactometry with the use of the Sniffing sticks test. Subjective evaluation of the olfactory function was performed based on the 10-point visual analog scale. All the patients underwent septoplasty; olfactometry was repeated within 1 and 4 months after surgery. Sixty percent of the patients interviewed prior to the surgical treatment complained of compromised sense of smell. Olfactometry revealed this condition in 75% of the patients of whom 52.5% presented with hyposmia of the mixed type. Significant improvement of all parameters of the olfactory function was documented within 1 month after the surgical treatment. The results of estimation of certain parameters (differentiation, identification, overall olfactory index) suggest further recovery of the olfactory function during the next 4 months. It is concluded that normalization of the nasal breathing improves the function of the olfactory analyzer even though the complete recovery of the olfactory function is hardly possible in the patients presenting with the curved nasal septum prior to surgical treatment. PMID:22334918

Savvateeva, D M; Chuchueva, N D; Kochetkov, P A; Lopatin, A S

2011-01-01

396

Establishing the surgical nurse liaison role to improve patient and family member communication.  

PubMed

Having clear personal communication with a surgical patient's family members decreases the anxiety and increases patient and family member satisfaction. Perioperative team members at one East Coast community hospital implemented a new approach to communication in the perioperative area to address patient satisfaction after patient survey scores declined in the areas of communication and calming fears. An additional consideration was the facility's plan to move to a new facility in which the surgical department would be split across two floors. A literature review revealed that adding a surgical nurse liaison can increase patient, family member, and staff member satisfaction. The administration approved creation of the position, with duties that included managing the waiting area, facilitating interaction between physicians and patients' family members, and assisting with family visits to the perianesthesia unit. After implementation of this position, results of surveys showed increases in patient satisfaction. One year after the position was established, staff members reported they were happy with the position as well. PMID:24766921

Herd, Hope A; Rieben, Melissa A

2014-05-01

397

Patient reported outcomes in pediatric oncology practice: Suggestions for future usage by parents and pediatric oncologists.  

PubMed

Several studies in adults have shown patient reported outcomes (PROs) to be effective in enhancing patient-physician communication and discussion of Health Related Quality of Life outcomes. Although less studied, positive results have been demonstrated in children. A PRO-intervention needs to be feasible in clinical practice to be successful. In the current study, 74 parents of children who successfully completed their cancer treatment and 21 pediatric oncologists (POs) evaluated a PRO-intervention and gave recommendations for future use in their practice. Most parents and POs suggested PROs to be an important part of standard care, starting during treatment, with an assessment frequency of every 3 months. Pediatr Blood Cancer 2014;61:1707-1710. © 2014 Wiley Periodicals, Inc. PMID:24648289

Schepers, S A; Engelen, V E; Haverman, L; Caron, H N; Hoogerbrugge, P M; Kaspers, G J L; Egeler, R M; Grootenhuis, M A

2014-09-01

398

[Dialogues with nurses about oncologic pain assessment of patients under palliative care].  

PubMed

It is an experience report developed next to nurses of a public hospital of Florianópolis-SC, about pain measurement of cancer patient in palliative cares. A total of six nurses had participated of six meeting distributed at three educative moments of this practical. The analysis of undertaken dialogue evidenced that, for the nurses, measurable and objective data are not only enough to measure pain. According to them, it is imperative consider biopsicosociais aspects, valuing integrally the pain that the patient relates. The concluding nurses detach that she has necessity to construct a pain measurement systematization to allow strengthens the importance of pain control to base the practical one, make possible the register of information and the continued education. PMID:20521010

Waterkemper, Roberta; Reibnitz, Kenya Schmidt; Monticelli, Marisa

2010-01-01

399

Losartan vs. amlodipine treatment in elderly oncologic hypertensive patients: a randomized clinical trial.  

PubMed

Elderly neoplastic patients frequently may show hypertension and hyperuricemia, before and after chemotherapeutic treatments. The purpose of this study was to evaluate the efficacy of losartan which is an antihypertensive drug with uricosuric properties vs. amlodipine in hypertensive neoplastic elderly patients. This was an open-labeled, randomized, comparative trial. The study was performed as a 30-day study. Seventy patients with cancer were randomly assigned to receive losartan or amlodipine. Blood pressure (BP), blood urea nitrogen (BUN) levels, creatinine, serum and urinary uric acid,