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1

Complementary and alternative medicine use among general surgery, hepatobiliary surgery and surgical oncology patients  

PubMed Central

Background The use of complementary and alternative medicine (CAM) is becoming more common, particularly among cancer patients. We sought to define the frequency of CAM use among general surgery, hepatobiliary and surgical oncology patients and to define some of the determinants of CAM use in patients with benign and malignant disease. Methods We asked all patients attending the clinics of 3 hepatobiliary/surgical oncology surgeons from 2002 to 2005 to voluntarily respond on first and subsequent visits to a questionnaire related to the use of CAM. We randomly selected patients for review. Results We reviewed a total of 490 surveys from 357 patients. Overall CAM use was 27%. There was significantly more CAM use among cancer (34%) versus noncancer patients (21%; p = 0.008), and the use of CAM was more common in patients with unresectable cancer (51%) than resectable cancer (22%; p < 0.001). There was no significant difference in use between men and women. There did not appear to be a change in CAM use with progression of cancer. The most common CAM was herbs or supplements (58% of all users), which were most frequently used by patients with malignant disease. Among the 27 herbs reported to be ingested, 10 are associated with bleeding and hepatotoxicity, as described in the literature. Conclusion Prospective studies evaluating surgical outcomes related to CAM use are needed.

Schieman, Colin; Rudmik, Luke R.; Dixon, Elijah; Sutherland, Francis; Bathe, Oliver F.

2009-01-01

2

Palliative care outcomes in surgical oncology patients with advanced malignancies: a mixed methods approach  

PubMed Central

Purpose To prospectively compare outcomes and processes of hospital-based early palliative care with standard care in surgical oncology patients (N = 152). Methods A randomized, mixed methods, longitudinal study evaluated the effectiveness of a hospital-based Pain and Palliative Care Service (PPCS). Interviews were conducted presurgically and at follow-up visits up to 1 year. Primary outcome measures included the Gracely Pain Intensity and Unpleasantness Scales and the Symptom Distress Scale. Qualitative interviews assessed social support, satisfaction with care, and communication with providers. Survival analysis methods explored factors related to treatment crossover and study discontinuation. Models for repeated measures within subjects over time explored treatment and covariate effects on patient-reported pain and symptom distress. Results None of the estimated differences achieved statistical significance; however, for those who remained on study for 12 months, the PPCS group performed better than their standard of care counterparts. Patients identified consistent communication, emotional support, and pain and symptom management as positive contributions delivered by the PPCS. Conclusions It is unclear whether lower pain perceptions despite greater symptom distress were clinically meaningful; however, when coupled with the patients’ perceptions of their increased resources and alternatives for pain control, one begins to see the value of an integrated PPCS.

Baker, Karen; Stolar, Marilyn; Miller-Davis, Claiborne; Ames, Nancy; Yates, Jan; Bolle, Jacques; Pereira, Donna; St. Germain, Diane; Handel, Daniel; Berger, Ann

2012-01-01

3

[New surgical technologies in oncology].  

PubMed

Despite new efficient methods of pharmaco- and radiotherapy, surgery is still applied to most patients with malignant tumors as the main treatment. Rational definition of indications to a surgical intervention based upon precise morphological verification of the diagnosis and correct staging is half a battle of surgical success. When planning the time and volume of surgery, its aim (whether it is radical, palliative, or reconstructive intervention) should be understood very clearly. The ideology of oncosurgery has changed to a great extent. On the one hand, wide clinical application of contemporary imaging techniques (CT, MRI, and PET) has resulted in more frequent detection of non-advanced tumors. Another aspect of present-day big oncosurgery is the application of advanced surgical techniques as well as the development of broad resection techniques and methods of en bloc removal of locally advanced tumors from different locations. By examples of thoracoabdominal tumors (neoblastomas of the bronchi, mediastinum, stomach, and kidney) and bone tumors the author considers the main aspects of modern operative strategy in oncology. PMID:18050674

Davydov, M I

2007-01-01

4

Nanotechnology Applications in Surgical Oncology  

PubMed Central

Surgery is currently the most effective and widely used procedure in treating human cancers, and the single most important predictor of patient survival is a complete surgical resection. Major opportunities exist to develop new and innovative technologies that could help the surgeon to delineate tumor margins, to identify residual tumor cells and micrometastases, and to determine if the tumor has been completely removed. Here we discuss recent advances in nanotechnology and optical instrumentation, and how these advances can be integrated for applications in surgical oncology. A fundamental rationale is that nanometer-sized particles such as quantum dots and colloidal gold have functional and structural properties that are not available from either discrete molecules or bulk materials. When conjugated with targeting ligands such as monoclonal antibodies, peptides, or small molecules, these nanoparticles can be used to target malignant tumor cells and tumor microenvironments with high specificity and affinity. In the “mesoscopic” size range of 10–100 nm, nanoparticles also have large surface areas for conjugating to multiple diagnostic and therapeutic agents, opening new possibilities in integrated cancer imaging and therapy.

Singhal, Sunil; Nie, Shuming; Wang, May D.

2010-01-01

5

Prostate cancer patients' support and psychological care needs: Survey from a non-surgical oncology clinic.  

PubMed

While there are numerous uncertainties surrounding prostate cancer's detection and treatment, more research focusing on the psychological needs of prostate patients is required. This study investigated the support and psychological care needs of men with prostate cancer. Patients were approached during urological oncology clinics and asked to complete the: Support Care Needs Survey (SCNS), Support Care Preferences Questionnaire, EORTC QLQ-C30 (Version 3) Measure plus Prostate Module, and the Hospital Anxiety and Depression Scale (HADS). Of the 249 patients meeting study entry criteria, there was an 89% response rate resulting in a cohort of 210 patients. The data showed that significant unmet need exists across a number of domains in the areas of psychological and health system/information. The more commonly reported needs were 'fears about cancer spreading (44%),' 'concerns about the worries of those close to you (43%),' and 'changes in sexual feelings (41%).' Half of all patients reported some need in the domain of sexuality, especially men younger than 65 years. Needs were being well met in the domain of patient care and support. A significant number of patients reported having used or desiring support services, such as information about their illness, brochures about services and benefits for patients with cancer (55%), a series of talks by staff members about aspects of prostate cancer (44%), and one-on-one counselling (48%). Quality of life (QoL) was most negatively impacted in those who: were < or =65 years old, had been diagnosed within one year, or had metastatic disease. Men < or =65 had decreased social functioning, greater pain, increased sleep disturbance, and were more likely to be uncomfortable about being sexually intimate. Patients recently diagnosed had increased fatigue, more frequent urination, greater disturbance of sleep, and were more likely to have hot flushes. Those with advanced disease scored lower on 12 out of 15 QoL categories. PSA level had no effect on QoL or anxiety/depression scores. Men with advanced disease had greater levels of depression and those < or =65 years old were more likely to be anxious. Although most men with prostate cancer seem to function quite well, a substantial minority report areas of unmet need that may be targets for improving care. PMID:14681951

Lintz, Kathleen; Moynihan, Clare; Steginga, Suzanne; Norman, Andy; Eeles, Ros; Huddart, Robert; Dearnaley, David; Watson, Maggie

2003-12-01

6

Principles of surgical oncology in the elderly.  

PubMed

Elderly patients constitute the largest group in oncologic medical practice, despite the fact that in solid cancers treated operatively, many patients are denied standard therapies and where such decision making is based solely on age. The “natural” assumptions that we have are often misleading; namely, that the elderly cannot tolerate complex or difficult procedures, chemotherapy, or radiation schedules; that their overall predictable medical health determines survival (and not the malignancy); or that older patients typically have less aggressive tumors. Clearly, patient selection and a comprehensive geriatric assessment is key where well-selected cases have the same cancer-specific survival as younger cohorts in a range of tumors as outlined including upper and lower gastrointestinal malignancy, head and neck cancer, and breast cancer. The assessment of patient fitness for surgery and adjuvant therapies is therefore critical to outcomes, where studies have clearly shown that fit older patients experience the same benefits and toxicities of chemotherapy as do younger patients and that when normalized for preexisting medical conditions,that older patients tolerate major operative procedures designed with curative oncological intent. At present, our problem is the lack of true evidence-based medicine specifically designed with age in mind, which effectively limits surgical decision making in disease-based strategies. This can only be achieved by the utilization of more standardized, comprehensive geriatric assessments to identify vulnerable older patients, aggressive pre-habilitation with amelioration of vulnerability causation, improvement of patient-centered longitudinal outcomes, and an improved surgical and medical understanding of relatively subtle decreases in organ functioning, social support mechanisms and impairments of health-related quality of life as a feature specifically of advanced age. PMID:22326035

Zbar, Andrew P; Gravitz, Aviad; Audisio, Riccardo A

2011-12-03

7

Endocarditis in Oncology Patients  

Microsoft Academic Search

\\u000a Although relatively uncommon in the general population with an incidence of 2–7 cases per 100,000 person-years, infective\\u000a endocarditis (IE) is associated with significant morbidity and mortality. Recent studies suggest that the incidence of IE\\u000a in oncology patients overall has increased and that it is reasonable to maintain a baseline suspicion in patients who present\\u000a with the appropriate clinical scenario. An

Sara E. Cosgrove; Aruna Subramanian

8

Surgical outcome of patients considered to have “inoperable” tumors by specialized pediatric neuro-oncological multidisciplinary teams  

Microsoft Academic Search

Purpose  Despite the lack of evidence in literature, it is widely felt that patient outcomes will be improved by adopting a multidisciplinary\\u000a team (MDT) approach to children with brain tumors. This study focuses on a series of pediatric patients treated surgically\\u000a despite a MDT recommendation against surgery.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A retrospective study was conducted on all pediatric brain and spinal cord tumor patients

Teo Charles; Broggi Morgan

2010-01-01

9

Failure to Rescue in the Surgical Oncology Population  

PubMed Central

Purpose/Objectives To analyze the frequency, type, and correlates of postoperative complications for surgical patients with cancer to illustrate practical application of the failure to rescue concept in oncology nursing practice. Design Secondary analysis of inpatient claims. Setting Data obtained from the Pennsylvania Health Care Cost Containment Council were linked with data from the Pennsylvania Cancer Registry. Sample 24,618 patients with solid tumors hospitalized for tumor-directed surgery in 164 acute care hospitals from 1998-1999. Methods Frequency distributions examined the incidence of each complication, the proportion of patients who died with the complication, and complication frequency by tumor type. Chi-square tests compared the frequency of complications for patients who were admitted routinely or via the emergency department. Main Research Variables 30-day mortality, postoperative complications, and tumor type. Findings The most frequent complication in the sample was gastrointestinal bleeding (13.2%); however, 37.1% of patients who died had respiratory compromise as a complication. Admission through the emergency department was significantly associated with experiencing a complication (71.9% versus 43.9%). Conclusions Treatable but serious postoperative complications are frequent and can be fatal in the surgical oncology population. Complication frequency and fatality vary significantly by cancer type. Implications for Nursing The complications studied are detectable by nurses and can be managed successfully with timely intervention. Recognition of complications at an early stage and evidence-based management may assist nurses in patient rescue and, ultimately, improve quality of care.

Friese, Christopher R.; Aiken, Linda H.

2008-01-01

10

Video Endoscopic Inguinal Lymphadenectomy: Surgical and oncological results.  

PubMed

INTRODUCTION: We evaluated the reproducibility of video endoscopic inguinal lymphadenectomy (VEIL) and we report our initial experience in the treatment of penile cancer with palpable inguinal lymph nodes. MATERIAL AND METHODS: From July 2006 to November 2010 were conducted 33 VEIL in 20 patients as complementary treatment for penile cancer in two referral hospitals in Latin America. We analyzed the epidemiological and clinical characteristics of patients and surgical and oncologic outcomes. RESULTS: Fifty-five percent of the patients included were clinical stage N0 and 45% were N +. Thirteen patients underwent bilateral VEIL and the remaining seven underwent VEIL unilateral and conventional open surgery in the contralateral limb. The average operative time for VEIL was 119minutes and mean resected lymph nodes was 8 per lymphadenectomy. The overall complication rate was 33.2%. No patient had skin necrosis. The lymphatic complication rate was 27.2%. Of the 6 cases in which the saphenous vein was preserved (18.2%) there were no lymphatic complications (P=,2). The overall survival rate was 80% and cancer-specific survival was 90%. Mean follow-up was 20 months. CONCLUSIONS: VEIL in the adjunctive treatment of penile cancer is safe, reproducible and may be an alternative to conventional lymphadenectomy. Patients with palpable lymphadenopathy also may benefit from this technique. Oncological results seem to be adequate however require longer follow-up to be confirmed. PMID:23433745

Romanelli, P; Nishimoto, R; Suarez, R; Decia, R; Abreu, D; Machado, M; Arroyo, C; Campolo, H; Campos, E; Carlos, A S; Tobias-Machado, M

2013-02-20

11

Principles and guidelines for surgeons--management of symptomatic breast cancer. European Society of Surgical Oncology.  

PubMed

The European Society of Surgical Oncology is actively involved in the promotion of a high standard of surgical oncology throughout Europe. Such an ambition involves recognition of Centres of Excellence in the management of cancer patients throughout Europe. These centres have a multi-disciplinary system involved in the total care of patients with cancer and are concerned with the delivery of care to the highest available standards. It is accepted that not all patients with cancer can, nor should, necessarily be treated in such highly specialized centres. Yet all cancer patients should be guaranteed a high standard of care. High surgical standards can be ensured if surgeons treating cancer are trained in specialist centres and, when in independent practice, follow established guidelines or protocols of treatment. In common with many national surgical oncology societies, the European Society of Surgical Oncology is in the process of establishing good practice guidelines in the treatment of solid tumours. This document on the management of symptomatic breast cancer is the first of a series of guidelines to be proposed by ESSO. It draws heavily on excellent documents already in existence from the British Association of Surgical Oncology and from the Danish Breast Cancer Co-Operative Group. It is hoped that this document will be sufficiently clear and purposeful to be of help to the individual surgeon and yet sufficiently flexible to allow it to be adopted in the different medical systems throughout Europe. PMID:9158182

Blichert-Toft, M; Smola, M G; Cataliotti, L; O'Higgins, N

1997-04-01

12

Quality assurance in surgical oncology. Colorectal cancer as an example  

Microsoft Academic Search

Quality assurance in surgical oncology is a field of growing importance. National, regional and local systems have been built up in many countries. Often the quality assurance projects are linked to different registers. The advantage of such a link is the possibility of obtaining population-based data from unselected health care institutions. Few discussions of results from such projects have been

Ulf Gunnarsson

2003-01-01

13

Principles and guidelines for surgeons--management of symptomatic breast cancer. On behalf of the European Society of Surgical Oncology.  

PubMed

The European Society of Surgical Oncology is actively involved in the promotion of a high standard of surgical oncology throughout Europe. Such an ambition involves recognition of Centres of Excellence in the management of cancer patients throughout Europe. These centres have a multi-disciplinary system involved in the total care of patients with cancer and are concerned with the delivery of care to the highest available standards. It is accepted that not all patients with cancer can, nor should, necessarily be treated in such highly specialized centres. Yet all cancer patients should be guaranteed a high standard of care. High surgical standards can be ensured if surgeons treating cancer are trained in specialist centres and, when in independent practice, follow established guidelines or protocols of treatment. In common with many national surgical oncology societies, the European Society of Surgical Oncology is in the process of establishing good practice guidelines in the treatment of solid tumours. This document on the management of symptomatic breast cancer is the first of a series of guidelines to be proposed by ESSO. It draws heavily on excellent documents already in existence from the British Association of Surgical Oncology and from the Danish Breast Cancer Co-Operative Group. It is hoped that this document will be sufficiently clear and purposeful to be of help to the individual surgeon and yet sufficiently flexible to allow it to be adopted in the different medical systems throughout Europe. PMID:9598248

Blichert-Toft, M; Smola, M G; Cataliotti, L; O'Higgins, N

1998-01-01

14

Patient Care Coordination of Adult Oncology Patients in Home Health  

Microsoft Academic Search

This article illustrates several key components regarding caring for adult oncology patients at home, such as focusing on the oncology nurse as the patient care coordinator (PCC) instead of utilizing today's terminology as the case manager. Oncology nurses are of a rare breed. They must have extensive skill, knowledge, compassion, and insight to manage patients with devastating diseases, which sets

Rita R. Callahan

1999-01-01

15

Assessing medical students' and surgery residents' clinical competence in problem solving in surgical oncology  

Microsoft Academic Search

Background: We sought to determine the competence of medical students and surgery residents in evaluating clinical problems (using both real and simulated patients) in surgical oncology.\\u000aMethods: Forty-five third-year medical students, 23 first postgraduate year (PGY-1) residents, and seven second postgraduate year (PGY-2) residents were presented with the same four clinical problems (breast evaluation, prostate nodule, colon cancer, and mole

David A. Sloan; Michael B. Donnelly; Richard W. Schwartz; Larry C. Munch; Mark D. Wells; Steven B. Johnson; William E. Strodel

1994-01-01

16

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

17

[New approach to the analysis of surgical activities of oncological establishments].  

PubMed

A new approach to analysis of surgical activity in surgical oncological establishments is suggested which is based on work measurement in surgeon/hours. The unit of measurement is "a unit operation" which is, in turn, an equivalent of six surgeon/hours. The surgical activity of seven oncological departments was analysed. The new method was compared to those available and its advantage was shown. The procedure is applicable in any surgical activity assessment situation. PMID:2532802

Saga?dak, V N; Gusev, L I; Akhmetov, M Sh

1989-01-01

18

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

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

A Career in Surgical Oncology: Finding Meaning, Balance, and Personal Satisfaction  

PubMed Central

The practice of surgical oncology provides opportunities for both personal distress as well as personal satisfaction. While many surgical oncologists experience career burnout, others derive great meaning and satisfaction from their work. In this article, we review the literature on surgeon burnout, discuss potential personal and professional consequences, and consider steps individual surgeons can take to promote personal and professional satisfaction.

2007-01-01

21

Competing in the New Health Care Environment: Strategies for Surgical Oncology  

Microsoft Academic Search

Driven largely by pressures to reduce expenditures, the American health-care industry is in the midst of a major transformation. 1 These issues are critical to surgical oncologists, and they have clear, measurable impacts (Table 1). Surgical oncology procedures performed at university hospitals account for a substantial portion of hospital profits and professional collections, and these revenues historically have been used

Wiley W. Souba; John Mahon

1999-01-01

22

EDUCATIONAL SECTION: risk analysis in surgical oncology-part I: concepts and tools.  

PubMed

All clinical procedures invoke risk. Many interventions in cancer management carry a particularly high element of risk, expressed through morbidity and premature death. Formal risk analysis is a discipline which is fundamental to engineering, to finance, to the airline industry and many other sectors of public life. Clinical risk analysis involves risk prediction, risk management and risk avoidance. Risk analysis is rarely invoked or taught in the clinical sciences, and management appraisals on individual patients almost never include a formal estimate of risk. Clinical decisions tend to be guided by qualitative judgements, and by the personality interactions of patients and clinicians. A formal evaluation of risk on a case by case and procedural basis might reduce morbidity and cost in surgical oncology practice. This article introduces the concepts, the spectrum and history of risk analysis and the tools for risk prediction. PMID:11034813

Rew, D A

2000-09-01

23

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

24

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

25

[Gastric stump carcinoma--a surgical and oncological challenge].  

PubMed

Gastric stump carcinoma after gastric surgery for benign disease is now widely recognized as a distinct clinical entity. An electronic literature search was performed in the MEDLINE database to identify relevant studies concerning epidemiology, prognosis, treatment, aetiology and pathology of gastric stump carcinoma. The references reported in these studies were used to complete the literature search. It can be assumed that approximately 10 % of patients who had undergone a distal gastric resection for benign disease will develop a carcinoma in the gastric remnant about 15 to 20 years after the primary procedure. The incidence is reported to be higher in males and following Billroth II resection. The site of tumour growth is predominantly in the anastomotic area, but may occur anywhere in the stump. Enterogastric reflux, achlorhydria, bacterial overgrowth, and genetic factors appear to be the major factors involved in the aetiopathogenesis of the gastric stump cancer. Unfortunately, a significant proportion of patients presents with synchronous metastases. Clinical symptoms are mainly attributed to locally advanced tumour growth. Surgical therapy comprises total removal of the gastric remnant and the jejunal segment including modified lymphadenectomy (D2 lymphadenectomy and jejunal mesentery). Surveillance of patients with endoscopy and multiple biopsies should be initiated from the tenth postoperative year and may provide the means to diagnose tumours at an early stage. PMID:21887665

Meyer, F; Benedix, F; Garlipp, B; Lippert, H; Meyer, L

2011-09-01

26

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

27

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

2012-10-01

28

Robotic technologies in surgical oncology training and practice  

Microsoft Academic Search

The modern-day surgeon is frequently exposed to new technologies and instrumentation. Robotic surgery (RS) has evolved as a minimally invasive technique aimed to improve clinical outcomes. RS has the potential to alleviate the inherent limitations of laparoscopic surgery such as two dimensional imaging, limited instrument movement and intrinsic human tremor. Since the first reported robot-assisted surgical procedure performed in 1985,

Marcelo A. Orvieto; Pablo Marchetti; Octavio A. Castillo; Rafael F. Coelho; Sanket Chauhan; Bernardo Rocco; Bobby Ardila; Mary Mathe; Vipul R. Patel

2011-01-01

29

Optimising surgical management of elderly cancer patients  

PubMed Central

Background Elderly population is on rise. It is an ethical dilemma how aggressive one should be when it comes to treat cancer in elderly. Presumed fear of increased postoperative morbidity and mortality has resulted in delivery of sub-optimal cancer surgery. Methods In this review article we visit physiology of the aged, tools available to assess surgical risks in oncogeriatric patients, and current practice in the management of common cancers encountered in surgical oncology, with the view of increasing awareness on optimising surgical management of senior patients with cancer. A pubmed search for cancer, surgery, elderly, was carried out. Results Cancer is on rise with increasing age predominantly affecting breast, gastrointestinal tract and lung. Increasingly more surgeons are offering surgery to elderly cancer patient but selection bias is prevalent. Available data reflect short and long-term outcome of cancer surgery in elderly is not greatly different to that of younger patient. Declining physiological reserve along with inability to respond adequately to physiological stress are salient age related changes. Comprehensive Geriatric Assessment (CGA) is not tested in surgical patient. There is need for a tool to define individualised operative risk. Preoperative assessment of cancer in elderly is designed to offer this information based on functional status of an individual utilising currently available tools of risk assessment. Conclusion All elderly cancer patients should be offered optimal treatment depending on their functional status not on chronological age. Oncogeriatric patient would benefit from dedicated multidisciplinary approach. Recruitment of elderly cancer patients to more clinical trials is needed to enhance our knowledge and to offer optimum treatment to this unique subgroup.

Ramesh, Hodigere Sripathy Jois; Pope, Daniel; Gennari, Roberto; Audisio, Riccardo A

2005-01-01

30

GNOSIS: Guidelines for Neuro-Oncology: Standards for Investigational Studies — reporting of surgically based therapeutic clinical trials  

Microsoft Academic Search

We present guidelines to standardize the reporting of surgically based neuro-oncology trials. The guidelines are summarized\\u000a in a checklist format that can be used as a framework from which to construct a surgically based trial. This manuscript follows and is taken in part from GNOSIS: Guidelines for neuro-oncology: Standards for investigational studies?reporting\\u000a of phase 1 and phase 2 clinical trials

Susan Chang; Michael Vogelbaum; Frederick F. Lang; Stephen Haines; Sandeep Kunwar; E. Antonio Chiocca; Alessandro Olivi; Alfredo Quinones-Hinojosa; Andrew Parsa; Ronald Warnick

2007-01-01

31

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

32

The learning curve for surgical margins after open radical prostatectomy: implications for the use of margin status as an oncologic endpoint  

PubMed Central

Purpose Surgical margin status is commonly used as an endpoint for surgical learning. In this study, we examine the learning curve for surgical margins and investigate whether surgical margins are good marker for oncologic outcome. Materials and Methods The study cohort included 7765 prostate cancer patients who were treated with radical prostatectomy by one of 72 surgeons at four major U.S. academic medical centers. We calculated the learning curve for surgical margins and a concordance probability between the surgeon's rates of positive surgical margins and 5-year biochemical recurrence. Results A positive surgical margin was identified in 2059 patients (27%). On multivariable analysis, surgeon experience was strongly associated with surgical margin status (p=0.017). The probability of a positive surgical margin was 40% for a surgeon with 10 prior cases, and decreased to 25% for a surgeon with 250 prior cases (absolute difference 15%, 95% CI 11% to 18%). Learning curves differed dramatically between surgeons. For pairs of surgeons, the surgeon with the superior positive surgical margin rate also had the better biochemical recurrence rate only 58% of the time. Conclusions We have demonstrated a learning curve for surgical margins after open radical prostatectomy. The poor concordance between a surgeon's margin and recurrence rates suggests that, while margins clearly matter, and efforts should be made to reduce positive margin rates, surgical margin status is not a strong surrogate for cancer control. These results have implications for the use of margin rates to evaluate changes in surgical technique and as feedback for surgeons.

AJ, Vickers; FJ, Bianco; AM, Cronin; JA, Eastham; EA, Klein; MW, Kattan; PT, Scardino

2010-01-01

33

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

34

A generation of laparoscopic nephrectomy: stage-specific surgical and oncologic outcomes for laparoscopic nephrectomy in a single center.  

PubMed

Abstract Purpose: To determine the stage-specific operative, postoperative and oncologic outcomes, for patients undergoing a laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) in a single center and assess changes over a generation of practice. Patients and Methods: From December 1992 to July 2011, data were collected prospectively for 854 consecutive simple laparoscopic necphrectomies (LNs) and LRNs, 397 of which were LRNs for RCC. The first LRN was performed in December 1997. Stage-specific surgical and oncologic outcomes were assessed across the study period. Patients were then grouped into three equal consecutive cohorts. Case mix and surgical outcomes were compared to assess changes with departmental experience. Results: There were 206, 71, 118, and 2 patients across stages pT1, pT2, pT3, and pT4, respectively. Median operative time was significantly shorter for pT1 tumors (125, 150 and 150?min for pT1-3, P<0.021), while median estimated blood loss (EBL) was greater for pT3 tumors (50, 50, 100?mL, for pT1-3, P<0.001). Median follow-up time was 31, 30, and 18 months, respectively, across pT1-pT3. There was a significant difference in 5-year overall survival (82.4%, 68.4%, 58.9%), cancer-specific survival (99.5%, 83.6%, 66.5%) and progression free survival (86.5%, 66.3%, 47.5%) across these stage-specific subgroups. Over the three cohorts, there was an increase in LRN performed for locally advanced disease and cytoreduction. With greater surgical experience, there was improvement in median operative time and median EBL in localized disease over the three periods, but no significant changes for locally advanced disease. Conclusion: This is the largest reported series of LRN in the United Kingdom. Departmental experience has resulted in improved surgical outcomes for localized RCC, with expansion of practice in more complex advanced disease. Laparoscopic nephrectomy is both operatively and oncologically safe in T1 and T2 disease, and although technically more demanding, it is also safe in selected T3 disease. PMID:23634886

Laird, Alexander; Stewart, Grant D; Zhong, Jim; Ang, W J Jensen; Cutress, Mark L; Riddick, Antony C P; McNeill, S Alan; Tolley, David A

2013-08-01

35

Candida infection in surgical patients  

Microsoft Academic Search

Candida infections have become a common and serious problem in non-neutropenic general surgical patients. This paper reviews the\\u000a etiologic factors, pathogenesis of systemic candidiasis, and the more common syndromes of infection in surgical patients.\\u000a Prophylactic and systemic therapy is detailed. The most significant factor inCandida infections is depression of host immune function. Significant abnormalities of T-cells, monocytes, and neutrophils have

Joseph S. Solomkin; Richard L. Simmons

1980-01-01

36

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

37

[Thromboprophylaxis in surgical patients].  

PubMed

The thromboprophylaxis strategy varies across the surgery type and the patient characteristics. The thromboembolic risk depends on the surgery and the patient's characteristics. The bleeding risk depends on the surgery, the anticoagulant drug and the patient's characteristics. The low molecular weight heparins remain the main drugs used for thromboprophylaxis in surgery, except in major orthopaedic surgery, a situation in which some of the new oral anticoagulants may be preferred. PMID:23910563

Godier, Anne; Rosencher, Nadia; Samama, Charles-Marc

2013-08-01

38

Outcome of oncology patients in the pediatric intensive care unit  

Microsoft Academic Search

We evaluated the outcome of oncology patients in the Pediatric Intensive Care Unit (PICU) from a total of 72 consecutive admissions. Severity of illness and quantity of care were measured by the Physiologic Stability Index (PSI) and the Therapeutic Intervention Scoring System (TISS), respectively. The overall mortality was 51% and was especially high in patients admitted for acute organ system

Y. Sivan; P. H. Schwartz; T. Schonfeld; I. J. Cohen; C. J. L. Newth

1991-01-01

39

Candida infections in surgical patients.  

PubMed Central

Serious Candida infections were seen in 55 surgical patients from January 1977 through December 1980. Most of the patients had compromising underlying conditions and many were elderly. Broad-spectrum antibiotics and total parenteral nutrition (TPN) appeared to predispose patients to Candida infections. Mortality rate from Candida was 38%. A high percentage of patients with positive blood or bile cultures died as a result of Candida infection. Therapy with intravenous amphotericin B was highly effective if given in adequate dosage. No patient receiving more than 200 mg of amphotericin B died, but the mortality rate was 56% in those receiving lower doses.

Marsh, P K; Tally, F P; Kellum, J; Callow, A; Gorbach, S L

1983-01-01

40

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

41

Ericksonian Hypnosis and Approaches with Pediatric Hematology Oncology Patients  

Microsoft Academic Search

This paper describes the applicability of Ericksonian hypnosis and hypnotherapy approaches with Pediatric Hematology\\/Oncology patients. Ericksonian hypnotherapy enable the clinician to intervene creatively and informally with the utilization approach. Interspersed suggestions in daily conversations weave in hypnotherapeutic strategies of pacing, leading, reframing, relaxation, imagery, storytelling and hypnoanalgesic techniques. These approaches are highly effective with children and easily adapted to the

Ellen Jacobs; Elsa Pelier; Dorothy Larkin

1998-01-01

42

Possibly Impossible Patients: Management of Difficult Behavior in Oncology Outpatients  

PubMed Central

Angry, threatening, or otherwise disruptive behavior by patients can interfere with necessary oncologic treatment, sometimes to the point of rendering continued care impossible. We offer oncology clinicians guidance in dealing with difficult outpatients by discussing the differential diagnosis and multidisciplinary management of treatment-disrupting behavior in the ambulatory oncology setting. We review the existing literature on dealing with difficult patients and present clinical experience at a comprehensive cancer center where a formalized, institutional process for responding to disruptive outpatients has been developed. A structured, multidisciplinary approach to deal with difficult behavior in oncology outpatients can improve care and staff morale. Staff using this approach can identify causes of treatment-disrupting behavior, develop and implement appropriate behavior plans, facilitate communication, address mental health issues, and ensure that decisions to terminate a relationship with a patient are ethical, clinically justified, and supported by due process. In the future, clinical recommendations and institutional guidelines for dealing with difficult patients should be evaluated with more structured, quantitative research.

Peteet, John R.; Meyer, Fremonta L.; Miovic, Michael K.

2011-01-01

43

Enteral Nutrition in Surgical Patients  

Microsoft Academic Search

.\\u000a Abstract.  \\u000a \\u000a \\u000a Purpose:   Malnutrition is well-recognized as a potential cause of increased morbidity and mortality in surgical patients; however,\\u000a enteral and parenteral nutritional support given pre- and postoperatively have been shown to decrease these rates. We conducted\\u000a a prospective study to assess the short-term efficacy of oral dietary supplementation in malnourished patients undergoing\\u000a major abdominal surgery.\\u000a \\u000a \\u000a \\u000a Methods:   Sixty patients undergoing

Sundeep Singh Saluja; Navneet Kaur; Upendra Kumar Shrivastava

2002-01-01

44

Epithelial tumours of the lacrimal gland: a clinical, histopathological, surgical and oncological survey.  

PubMed

Epithelial tumours of the lacrimal gland represent a large spectrum of lesions with similarities in clinical signs and symptoms but with different biological behaviour and prognosis. They are rare, but with aggressive malignant potential. Tumours of the lacrimal gland may present with swelling of the lacrimal gland, displacement of the eyeball, reduced eye motility and diplopia. Pain and symptoms of short duration before the first ophthalmic consultation are characteristic of malignant tumours. The histological diagnosis determines the subsequent treatment regimen and provides important clues regarding the prognosis. The purpose of this paper is to describe the various primary epithelial tumours of the lacrimal gland. In the first part of the review, the frequency, demographics, clinical presentation and diagnostic features are described. In the second part, primarily tumour-specific histological characteristics are given. Finally, treatment modalities including surgical procedures and medical oncology as well as prognosis are discussed. PMID:22471335

von Holstein, Sarah Linéa; Coupland, Sarah E; Briscoe, Daniel; Le Tourneau, Christophe; Heegaard, Steffen

2012-04-04

45

Outcome of bacteremia and fungemia in paediatric oncology patients  

PubMed Central

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

Robinson, Joan L; Rennie, Robert P

2002-01-01

46

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

47

[Complementary medicine use in oncology patients].  

PubMed

Through an anonymized questionnaire we assessed the prevalence of complementary and alternative medicine (CAM) use in a series of cancer patients treated at the Geneva University Hospitals. 152 among the 300 sollicitated patients responded and 39 (26.5%) recognized to use CAM, particularly young, and moderate to highly educated patients. Patients justify their use of CAM to maximize caring ressources, to achieve physical or psychic relief. Most of them recognize to share these therapeutic options with their doctor. Satisfaction with traditional medicine as well as ignorance of CAM are the main arguments provided by non users. The specificity of our hospital context in which results were collected and the lack of a common and popular definition of CAM remain the main limitations of our enquiry. PMID:18616209

Inglin, S; Amsler, S; Arigoni, F; Burton-Jeangros, C; Pargoux-Vallade, C; Sappino, A-P

2008-05-21

48

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

Microsoft Academic Search

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

John F. Boggess

2007-01-01

49

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

50

Improving patient safety in radiation oncology  

Microsoft Academic Search

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

William R. Hendee; Michael G. Herman

2011-01-01

51

Opioid misuse in oncology pain patients.  

PubMed

The problem of therapeutic opioid misuse largely affects patients who need opioids to treat chronic pain conditions. Opioid misuse is rarely an overt clinical problem during end of life or acute pain treatment. Misuse attaches a stigma to opioid use, and makes many patients and prescribers reluctant to use these uniquely effective drugs, even when misuse is unlikely. Cancer was once an explosive, typically terminal disease and became the prototype for end-of-life opioid pain treatment. However, cancer is no longer such an explosive disease, and many cancer sufferers can now expect to have a prolonged, even normal, lifespan. They may need pain treatment, but this treatment should not be modeled on palliative care paradigms. This article describes the underlying mechanisms of opioid dependence and its progression to addiction, and suggests a cautious approach to opioid treatment of chronic cancer pain that aims to minimize the problem of misuse. PMID:17686391

Ballantyne, Jane C

2007-08-01

52

Nutrition in oncologic patients during antiblastic treatment.  

PubMed

Cancer may induce weight loss and cachexia, and cancer treatment may contribute to nutritional impairment. Here, we review the literature on the mechanisms of cancer cachexia and the pharmacological interventions both in use in clinical practice and currently under development. Based on this analysis, several nutritional proposals for cancer patients are suggested and the importance of good nutritional status in candidates for hematopoietic stem cell transplantation is highlighted. PMID:23276913

Berretta, Massimiliano; Michieli, Mariagrazia; Di Francia, Raffaele; Cappellani, Alessandro; Rupolo, Maurizio; Galvano, Fabio; Fisichella, Rossella; Berretta, Salvatore; Tirelli, Umberto

2013-01-01

53

[Psychology and ethics of care of oncology patients].  

PubMed

The author discusses the necessity of perception of the uniqueness of oncological patients and the necessity to treat all their dimensions (physical, social, mental and spiritual). She analyzes the concept of total pain according to Cecilia Saunders who discusses the mentioned dimensions of man. Total pain is made up of mutually linked components which are difficult to separate: physical pain, social pain, emotional pain, and spiritual pain. Contemporary alarming statistics provide evidence that in many patients suffering is not alleviated correctly. One of the important reasons of failure is also failure of health workers as regards knowledge of the complexity of suffering. PMID:15633401

Munzarová, M

2001-08-01

54

Geriatric evaluation of oncological elderly patients.  

PubMed

Cancer has a high prevalence in older age. The management of cancer in the older aged person is an increasingly common problem. Age may be construed as a progressive loss of stress tolerance, due to decline in functional reserve of multiple organ systems, high prevalence of comorbid conditions, limited socioeconomic support, reduced cognition, and higher prevalence of depression. In the elderly, the comorbidities and physiological changes in the pharmacokinetics reduce the prospective for therapy and suggest the importance of a multidimensional assessment of cancer patients as well as the formulation of predictive models of risk, in order to estimate the life expectancy and tolerance to treatment. The pharmacological changes of age include decreased renal excretion of drugs and increased susceptibility to myelosuppression, mucositis, cardio toxicity and neurotoxicity. The chemotherapy in patients older than 75 years is very limited. The geriatric assessment is considered a valid tool in geriatric medical. It is important for two main reasons: first of all, for the need to distinguish the features linked to the geriatric syndromes from those ones which are strictly connected to the cancer pathology; secondly, for its potential prognostic value. PMID:24102283

Malaguarnera, Michele; Frazzetto, Paola Mariangela; Erdogan, Ozyalcn; Cappellani, Alessandro; Cataudella, Emanuela; Berretta, Massimiliano

2013-11-01

55

An Observational Study of Oncology Patients' Utilization of Breakthrough Pain Medication  

Microsoft Academic Search

The aim of this study was to determine utilization of breakthrough pain medication among a community-dwelling group of oncology patients. The subjects were recruited from patients attending the oncology outpatient department and oncology day unit. The protocol involved completion of a study-specific proforma: the information collected included demographic information (i.e., age, gender), cancer diagnosis, background cancer pain management, breakthrough pain

Andrew N. Davies; Joanna Vriens; Alison Kennett; Michelle McTaggart

2008-01-01

56

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

2012-07-18

57

Implanted Cardiac Defibrillator Care in Radiation Oncology Patient Population  

SciTech Connect

Purpose: To review the experience of a large cancer center with radiotherapy (RT) patients bearing implantable cardiac defibrillators (ICDs) to propose some preliminary care guidelines as we learn more about the devices and their interaction with the therapeutic radiation environment. Methods and Materials: We collected data on patients with implanted ICDs treated with RT during a 2.5-year period at any of the five Memorial Sloan-Kettering clinical campuses. Information regarding the model, location, and dose detected from the device, as well as the treatment fields, fraction size, and treatment energy was collected. During this time, a new management policy for these patients had been implemented requiring treatment with low-energy beams (6 MV) and close surveillance of the patients in partnership with their electrophysiologist, as they received RT. Results: During the study period, 33 patients were treated with an ICD in place. One patient experienced a default of the device to its initial factory setting that was detected by the patient hearing an auditory signal from the device. This patient had initially been treated with a 15-MV beam. After this episode, his treatment was replanned to be completed with 6-MV photons, and he experienced no further events. Conclusion: Patients with ICDs and other implanted computer-controlled devices will be encountered more frequently in the RT department, and proper management is important. We present a policy for the safe treatment of these patients in the radiation oncology environment.

Gelblum, Daphna Y. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)], E-mail: dgelblum@mskcc.org; Amols, Howard [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

2009-04-01

58

Information and communication technology (ICT) in oncology. Patients' and relatives' experiences and suggestions  

Microsoft Academic Search

Cancer patients and relatives worldwide are turning more and more to the internet to obtain health information. The goal of this survey was to clarify their experiences and suggestions on the implementation of information and communication technology (ICT) in oncology. A total of 127 patients and 60 relatives visiting the outpatient clinic at the Department of Oncology, University of North

Jan Norum; Anne Grev; Mari-Ann Moen; Lise Balteskard; Kari Holthe

2003-01-01

59

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

60

Oncology patients pose challenge in choosing birth control method.  

PubMed

Available information on the impact of radiation and chemotherapy on the fertility and pregnancy outcomes of oncology patients was briefly reviewed, and some suggestions for the contraceptive counseling of oncology patients were provided. Pregnancy generally has no adverse effect on nonhormonal dependent tumors, but the therapy used to treat the tumors may have an adverse effect on the patient's fertility and on the fetus. Studies indicate that radiation therapy can interfere with ovarian function. For example, in a study of 208 patients, under 18 years of age and with various types of cancers, 52% received radiation therapy and 47% received chemotherapy. None of the chemotherapy patients developed ovarian failure. Among radiated patients, ovarian failure developed in 68% of the women when the ovaries were in the treatment field, in 14% of those whose ovaries were at the border of the treatment field, and in none of the women whose ovaries were outside the treatment field. Other studies indicate that chemotherapy can destroy ovarian primordial follicles. The damage seems to be caused by the alkylating agents. Combination chemotherapy is especially damaging to the ovaries. 1 investigator found that among 35 leukemia patients who received chemotherapy, 1 of the 17 prepubertal women and 6 of the 18 pubertal or post pubertal women experienced either ovarian failure or hypothalamic pituitary dysfunction. Radiation therapy during the 1st trimester and radiation therapy which exposes the fetus to 10 or more rad increases the risk of fetal wastage and fetal malformation. The risk of these adverse effects for the fetus can be reduced by using a pelvis shield and by moving the ovaries to midline at staging laparotomy. There is considerable evidence that chemotherapy during the 1st trimester can produce abortion and fetal malformation. Most experts recommend avoiding chemotherapy during the 1st trimester, whenever possible, and many recommend therapuetic abortion for women who are treated with either chemotherapy or radiation during the 1st trimester. Cancer patients should be provided with appropriate contraceptive counseling. Some patients are instructed by their physicians to avoid pregnancy for 1 year following chemotherapy. Pregnancies may also need to be timed so as not to interfere with the disease's management schedule. Counselors should help patients select an effective method, avoid oral contraceptives if the disease is hormonal dependent, and chose a method appropriate to the severity and prognosis of the disease. Consideration should be given to the risk of IUD failure if the patient is being treated with steroids. In addition, counselors should advise patients who received chemotherapy or radiation therapy during the 1st trimester to consider abortion. PMID:12313869

Neinstein, L S; Katz, B

1985-04-01

61

Oncology nurse communication barriers to patient-centered care.  

PubMed

Although quality communication has been identified as a necessary component to cancer care, communication skills training programs have yet to focus on the unique role of nurses. This study explored communication barriers as reported by seven nurse managers to better identify communication skills needed for oncology nurses to practice patient-centered care. Thematic analysis of transcripts was used to identify barriers to patient and family communication and desirable patient-centered nursing communication skills. Overall, the nurse managers reported that nurses experience patient and family communication difficulties as a result of inconsistent messages to patients and family from other healthcare staff. Physician assumptions about nursing left nurses feeling uncomfortable asking for clarification, creating a barrier to team communication processes. Patient-centered communication and care cannot be actualized for nurses unless team roles are clarified and nurses receive training in how to communicate with physicians, patients, and family. Therefore, the authors of this article created the COMFORT communication training protocol, and key concepts and resources for nurse communication training through COMFORT are detailed in this article. PMID:23538250

Wittenberg-Lyles, Elaine; Goldsmith, Joy; Ferrell, Betty

2013-04-01

62

Surgical Resection of High-Risk Hepatocellular Carcinoma: Patient Selection, Preoperative Considerations, and Operative Technique  

Microsoft Academic Search

Hepatocellular carcinoma remains a leading cause of cancer death worldwide. There are an increasing number of patients that\\u000a do not meet traditional criteria for surgical resection as a result of historically poor outcomes. We define these oncologically\\u000a high-risk patients as those with either one of these risk factors or a combination of them: large (>5 cm) primary tumors,\\u000a multinodular disease, and\\/or

Mark J. Truty; Jean-Nicolas Vauthey

2010-01-01

63

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

64

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

Microsoft Academic Search

BACKGROUND: Population ageing is increasing the number of people annually diagnosed with cancer worldwide, once most types of tumours are age-dependent. High-quality healthcare in geriatric oncology requires a multimodal approach and should take into account stratified patient outcomes based on factors other than chronological age in order to develop interventions able to optimize oncology care. This study aims to evaluate

Augusta P Silveira; Joaquim Gonçalves; Teresa Sequeira; Cláudia Ribeiro; Carlos Lopes; Eurico Monteiro; Francisco L Pimentel

2011-01-01

65

Perfecting patient flow in the surgical setting.  

PubMed

Reduced surgical efficiency and productivity, delayed patient discharges, and prolonged use of hospital resources are the results of an OR that is unable to move patients to the postanesthesia care unit or other patient units. A primary reason for perioperative patient flow delay is the lack of hospital beds to accommodate surgical patients, which consequently causes backups of patients currently in the surgical suite. In one facility, implementing Six Sigma methodology helped to improve OR patient flow by identifying ways that frontline staff members could work more intelligently and more efficiently, and with less stress to streamline workflow and eliminate redundancy and waste in ways that did not necessitate reducing the number of employees. The results were improved employee morale, job satisfaction and safety, and an enhanced patient experience. PMID:22742751

Amato-Vealey, Elaine J; Fountain, Patricia; Coppola, Deborah

2012-07-01

66

Fat grafting and stem cell enhanced fat grafting to the breast under oncological aspects - Recommendations for patient selection.  

PubMed

Reconstructive and aesthetic fat grafting has been introduced to the breast level over the last years. The safety of such procedures has so far not been completely clarified. The concept has now been refined to stem cell enhanced fat grafting. However beside the promise of using adult stem cells in terms of tissue rejuvenation and augmentation, scar treatment and reconstruction, the variance of adipose stem cell function - including angiogenetic, antiapoptotic, immunomodulatory, chemotactic and anti-scarring potential - raises new scepsis about oncological safety. Herein we reviewed experimental and clinical data on fat grafting and stem cell enhanced fat grafting addressing surgical promise and oncological concerns. Based on these data we suggest clinical criteria for patient selection undergoing fat grafting for aesthetic or reconstructive reasons based on their individual breast cancer risk. PMID:23769661

Krumboeck, Anna; Giovanoli, Pietro; Plock, Jan A

2013-06-13

67

Specific Surgical Problems in Marfan Patients  

Microsoft Academic Search

\\u000a Marfan patients constitute a very special category within a cardiovascular surgical practice: they are very young, often present\\u000a themselves with acute aortic syndromes or even aortic catastrophes, frequently have already breathtaking surgical histories\\u000a at first presentation, and demand the close attention of a complete team including geneticists. They remain patients for life\\u000a due to the frequent recurrence of aortic problems

Marc Schepens; Willem Ranschaert

68

Surgical management of oncogeriatric patients.  

PubMed

Major changes are taking place at a great pace in modern medicine, and surgical oncologists are at the forefront when new skills are to be tested and implemented. Perhaps the most significant change we are facing relates to the aging of our population, with most solid tumors presenting at age 70 years (+/- 5 years). The demographics and epidemiological details are covered in the appropriate sections of this special issue, but it is important to realize how such a shift influences our day-to-day practice. These principally are occurring in improved anesthetic care, minimally invasive surgery, nonoperative therapies, risk assessment, and quality-of-life estimates. PMID:17488992

Audisio, Riccardo A; Zbar, Andrew P; Jaklitsch, Michael T

2007-05-10

69

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.

70

Oncology Nursing Minimum Data Set (ONMDS): can we hypothesize a set of prevalent Nursing Sensitive Outcomes (NSO) in cancer patients?  

PubMed Central

Background The nursing minimum data set (NMDS) was created in 1977 in the United States to collect uniform standardised data that could be comparable among different nursing areas or patients. So far, in the literature, an NMDS in an oncology setting has not yet been described. Considering an oncology nursing minimum data set (ONMDS), which data could be chosen to define this tool regarding cancer patient care? Material and methods At the European Institute of Oncology (IEO), 20 experienced oncology nurses representing surgical, medical, and critical areas participated in a nursing record working group. All nurses followed an educational course on NMDS, and they shared clinical experiences to find which data common among different areas could be useful to care. To identify these data, nurses considered three issues: what is nursing care for nurses in the IEO? What is the nurses’ responsibility in the IEO? What is the organisational nursing model in the IEO? Nurses in the IEO are autonomous in decision making and recognised by patients and by a multi-professional team; the organisational nursing model is primary nursing with patient-centred care. Nursing data must therefore show the quality and results of this care. With this in mind, the working group decided to orient the ONMDS toward nursing-sensitive outcomes (NSOs), meeting also with psychologists, physiotherapists, and dieticians. Nurses analysed Oncology Nursing Society outcomes, and through focus groups, experiential meetings, role playing, and case studies, they integrated them with other NSOs. Results The ONMDS is composed of 49 NSOs recognised as the most common and frequent oncologic outcomes regardless of the treatment that the patient undergoes. These outcomes were clustered into 15 categories. The categories are: gastrointestinal outcomes, genitourinary outcomes, respiratory outcomes, skin outcomes, fluid and electrolyte balance outcomes, neurological outcomes, security, functional status, vascular access outcomes, nutritional status, pain, psychosocial discomfort, activities of daily living (ADL), instrumental activities daily living (IADL), and self-care outcomes. Conclusions Efforts to identify an ONMDS based on NSOs allow us to develop an tool that can standardise language, assessment, and intervention, but overall could be used to measure nursing care. To evaluate these potentialities, the ONMDS was introduced into nursing records, and it was tested with a pre–post research study.

Milani, A; Mauri, S; Gandini, S; Magon, G

2013-01-01

71

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

72

The impact of PET scanning on management of paediatric oncology patients  

Microsoft Academic Search

Purpose Limited information is available on the use of positron emission tomography (PET) in paediatric oncology. The aim of this study was to review the impact of PET on the management of paediatric patients scanned over a 10-year period. Methods One hundred and sixty-five consecutive oncology patients aged 11 months to 17 years were included. Two hundred and thirty-seven scans

E. A. Wegner; S. F. Barrington; J. E. Kingston; R. O. Robinson; R. E. Ferner; M. Taj; M. A. Smith; M. J. O’Doherty

2005-01-01

73

Does Exercise Reduce Cancer-Related Fatigue in Hospitalised Oncology Patients? A Systematic Review  

Microsoft Academic Search

SummaryThe primary aim was to find out if exercise reduces cancer-related fatigue in hospitalised oncology patients. Controlled trials of fatigue outcomes after exercise in hospitalised oncology patients were obtained by searching electronic databases. Two reviewers completed data extraction and quality assessment independently. Standardised mean differences and 95% confidence intervals (CI) were determined and a meta-analysis completed. Five relevant trials evaluated

Meaghan Arnold; Nicholas F. Taylor

2010-01-01

74

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

75

Positive Surgical Margins in Robotic-Assisted Radical Prostatectomy: Impact of Learning Curve on Oncologic Outcomes  

Microsoft Academic Search

ObjectiveThe presence of positive surgical margins following radical prostatectomy is a known risk factor for disease recurrence and may lead to adjuvant treatment. Our goal was to assess the incidence of positive surgical margins in our series of robotic-assisted radical prostatectomy (RARP) and its relationship to our learning curve.

Fatih Atug; Erik P. Castle; Sudesh K. Srivastav; Scott V. Burgess; Raju Thomas; Rodney Davis

2006-01-01

76

Innate immunity in surgical patients.  

PubMed

The innate immune system is the first line of defence against pathogens that acts immediately in order to prevent, control and eliminate infections. This paper reviews some important aspects of innate immune sensing, namely the LPS-TLR signalling pathway and endotoxin tolerance (ET) as a host protective mechanism against uncontrolled immune activation. The fine-tuning of the innate immune response is enabled by miRNAs which constitute an additional level of gene expression regulation between messenger RNA (mRNA) and protein translation. Finally clinical relevance of this complex and dynamic process is pointed out: acute phase reaction, sepsis and the particular case of the splenectomised patient are discussed. PMID:23464764

Lacatus, M

77

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

78

Fungal Septicemia in Surgical Patients  

PubMed Central

Opportunistic systemic fungal infections are more frequent than generally realized. Increased awareness and a high index of suspicion of fungal super-infection in the presence of sepsis is required to bring about recognition and therapy. The intravenous catheter is an important portal of entry or may act as a foreign body favoring localization of a septic process. In its presence, fungemia must be guarded against. Whenever an intravenous catheter is removed, its tip should be cultured. Removal alone may be a critical item in therapy. In febrile patients, in whom the course of fever is not established, frequent blood cultures with attention directed specifically at fungi should be obtained. Fungi are not easily isolated and identified and only by requesting special attention from the microbiologist can the diagnosis be established in the average institutional laboratory in time to permit appropriate therapy. Since available therapeutic measures are strikingly effective when instituted early, awareness and alertness on the part of the clinician constitute the key to cure.

Rodrigues, Roberto J.; Wolff, William I.

1974-01-01

79

Occult adrenal insufficiency in surgical patients.  

PubMed Central

Eight patients admitted to a University hospital with acute surgical problems and related adrenal insufficiency were reviewed and three are presented in detail. Surgical stress and continued sepsis played major roles in the lack of responsiveness to usual modes of therapy until the adrenal insufficiency was corrected. The patients fell into three major clinical categories of adrenal insufficiency. Chronic illness and sepsis are shown to affect steroid production and metabolism, as well as adrenal responsiveness to ACTH. Pharmacologic amounts of steroids are often needed in patients with shock, gram negative sepsis and prolonged illnesses, even if normal or elevated serum cortisols are present. Therapeutic trials of cortisol administration are shown to be confusing when not accompanied by easily performed diagnostic tests of adrenal function. It is emphasized that a pretreatment serum cortisol should be obtained whenever possible. The evaluation of adrenal function is of lifelong importance to the patient.

Hubay, C A; Weckesser, E C; Levy, R P

1975-01-01

80

Clinical assessment and management of the oral environment in the oncology patient.  

PubMed

The dental care of oncology patients is an important component of general dental practice. Oncology patients have additional requirements for their outpatient care in the dental office. Intense involvement of the general dental practitioner in the patient's overall plan of care is essential so that appropriate preventive and therapeutic strategies are followed prior to chemotherapy, radiation and other medical treatments. This paper provides an overview of the role of the dental practitioner in the pre-treatment workup and post-treatment maintenance of oncology patients, and discusses the complications which occur during the intensive and in-hospital phases of care, in the context of approaches that show promise for reducing or preventing these. The role of the general dental practitioner in the maintenance of oral health for the remainder of the patient's life is stressed, with evidence-based recommendations given for optimal use of home care products which support oral health and improve quality-of-life. PMID:20553247

Walsh, L J

2010-06-01

81

Prevention of VTE in Nonorthopedic Surgical Patients  

PubMed Central

Background: VTE is a common cause of preventable death in surgical patients. Methods: We developed recommendations for thromboprophylaxis in nonorthopedic surgical patients by using systematic methods as described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: We describe several alternatives for stratifying the risk of VTE in general and abdominal-pelvic surgical patients. When the risk for VTE is very low (< 0.5%), we recommend that no specific pharmacologic (Grade 1B) or mechanical (Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE (?1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE (?3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE (?6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava filter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients.

Garcia, David A.; Wren, Sherry M.; Karanicolas, Paul J.; Arcelus, Juan I.; Heit, John A.; Samama, Charles M.

2012-01-01

82

Young patients', parents', and survivors' communication preferences in paediatric oncology: Results of online focus groups  

Microsoft Academic Search

BACKGROUND: Guidelines in paediatric oncology encourage health care providers to share relevant information with young patients and parents to enable their active participation in decision making. It is not clear to what extent this mirrors patients' and parents' preferences. This study investigated communication preferences of childhood cancer patients, parents, and survivors of childhood cancer. METHODS: Communication preferences were examined by

Marieke Zwaanswijk; Kiek Tates; Sandra van Dulmen; Peter M Hoogerbrugge; Willem A Kamps; Jozien M Bensing

2007-01-01

83

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

84

Tumor thrombus of inferior vena cava in patients with renal cell carcinoma - clinical and oncological outcome of 50 patients after surgery  

PubMed Central

Background To evaluate oncological and clinical outcome in patients with renal cell carcinoma (RCC) and tumor thrombus involving inferior vena cava (IVC) treated with nephrectomy and thrombectomy. Methods We identified 50 patients with a median age of 65?years, who underwent radical surgical treatment for RCC and tumor thrombus of the IVC between 1997 and 2010. The charts were reviewed for pathological and surgical parameters, as well as complications and oncological outcome. Results The median follow-up was 26?months. In 21 patients (42%) distant metastases were already present at the time of surgery. All patients underwent radical nephrectomy, thrombectomy and lymph node dissection through a flank (15 patients/30%), thoracoabdominal (14 patients/28%) or midline abdominal approach (21 patients/42%), depending upon surgeon preference and upon the characteristics of tumor and associated thrombus. Extracorporal circulation with cardiopulmonary bypass (CPB) was performed in 10 patients (20%) with supradiaphragmal thrombus of IVC. Cancer-specific survival for the whole cohort at 5?years was 33.1%. Survival for the patients without distant metastasis at 5?years was 50.7%, whereas survival rate in the metastatic group at 5?years was 7.4%. Median survival of patients with metastatic disease was 16.4?months. On multivariate analysis lymph node invasion, distant metastasis and grading were independent prognostic factors. There was no statistically significant influence of level of the tumor thrombus on survival rate. Indeed, patients with supradiaphragmal tumor thrombus (n?=?10) even had a better outcome (overall survival at 5?years of 58.33%) than the entire cohort. Conclusions An aggressive surgical approach is the most effective therapeutic option in patients with RCC and any level of tumor thrombus and offers a reasonable longterm survival. Due to good clinical and oncological outcome we prefer the use of CPB with extracorporal circulation in patients with supradiaphragmal tumor thrombus. Cytoreductive surgery appears to be beneficial for patients with metastatic disease, especially when consecutive therapy is performed. Although sample size of our study cohort is limited consistent with some other studies lymph node invasion, distant metastasis and grading seem to have prognostic value.

2012-01-01

85

Free Microsurgical and Pedicled Flaps for Oncological Mandibular Reconstruction: Technical Aspects and Evaluation of Patient Comorbidities  

PubMed Central

Oncologic mandibular reconstruction has changed significantly over the years and continues to evolve with the introduction of newer technologies and techniques. Patient demographic, reconstructive, and complication data were obtained from a prospectively maintained clinical database of patients who underwent head and neck reconstruction at our institution. The free fibular flap is now considered the gold standard for mandibular reconstruction. However, in patients with multiple comorbidities, lengthy procedures may be less optimal and pedicled flaps, with specific modifications, can yield reasonable outcomes. Technical aspects and comorbidity profiles are examined in the oncological mandibular reconstruction cohort.

Hassid, Victor J.; Maqusi, Suhair; Culligan, Emmett; Cohen, Mimis N.; Antony, Anuja K.

2012-01-01

86

Pediatric Surgical Neuro-Oncology: Current Best Care Practices and Strategies  

Microsoft Academic Search

Significant advances have been made in the diagnosis and treatment of childhood brain tumors. Gross total surgical resection combined with appropriate adjuvant therapies can achieve a high rate of disease control for low grade gliomas, ependymomas and medulloblastomas. High grade gliomas, tumors involving the optic apparatus or diencepahalic structures, diffuse brainstem lesions, and recurrent or metastatic disease still pose considerable

James T. Rutka; John S. Kuo

2004-01-01

87

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

88

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

89

In their own words: Oncology nurses respond to patient requests for assisted suicide and euthanasia  

Microsoft Academic Search

Little is currently known about the context, nature, or frequency of nurses' responses to patient requests for help in dying. Only two empirical studies have surveyed American nurses about their actual responses to such requests. In one of those studies, 441 New England oncology nurses described how often patients ask them for help in ending their lives and also indicated

Marianne LaPorte Matzo; Judith Kennedy Schwarz

2001-01-01

90

Characterization of incidental cardiac masses in oncological patients using a new CT-based tumor volume perfusion technique.  

PubMed

Cardiac masses are challenging for non-invasive diagnostic procedures and therapy, respectively. In tumor patients differentiation between primary or secondary cardiac neoplasm and thrombus is a frequent and knowingly difficult task to manage. To avoid complex and unnecessary surgical diagnostic procedures non-invasive methods are in favor. For initiation of adequate therapy and evaluation of prognosis, however, early and reliable diagnosis is mandatory. So far, echocardiography and magnetic resonance imaging represent the mainstay for cardiac imaging diagnosis. Recently, the new technique of CT-based tumor volume perfusion (VPCT) measurement has advanced to a potent, reliable, and easy to perform alternative for cardiac imaging. The purpose of this study was to review the existing spectrum of diagnostic modalities for characterization of cardiac masses in an oncologic patient cohort with emphasis on their strengths and limitations and to present the benefit from using the novel technique called VPCT for this purpose. PMID:23828946

Schulze, M; Spira, D; Claussen, Cd; Sauter, A; Mayer, F; Horger, M

2013-07-04

91

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

PubMed Central

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

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

1996-01-01

92

Surgical guides (patient-specific instruments) for pediatric tibial bone sarcoma resection and allograft reconstruction.  

PubMed

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. PMID:23533326

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

2013-03-04

93

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

94

[Education of oncology specialists--towards a high standard of oncology in Japan].  

PubMed

Major advances in cancer research, remarkable progress in cancer management and the rapid increase of cancer incidence force public attention upon the unsetted education system of oncology specialists, in Japan. Despite the well-recognized importance of education, very few formal training programs have been established due to little collaboration among many specialties. Cancer patients and their families require the best care and support through the entire process, and optimal treatment for patients cannot be provided without an oncology health care team that includes various specialists such as medical-, radiation-, and surgical oncologists, among other professionals. The increasing demands of oncology experts promote the establishment of a nationwide education system of various oncology subspecialties, and the urgent requirement for rapid improvement has brought about a unique primary certification system for oncology, Gann-chiryou Ninnteii: This system provides education for candidates in basic principles common to management and treatment of malignant diseases, which can enhance the quality of oncology care. Educational programs for various oncology subspecialties such as drug and radiation, and palliative medicine, are also rapidly developing in Japan, but many obstacles remain. A wide variation is still found among the different oncology subspecialties regarding the requirements of such training programs including admission requirements to the programs and the training duration. For clinical oncology disciplines in Japan, the final destination and the most effective way to the goal were discussed by introducing the special circumstances and latest status. PMID:20087025

Nishiyama, Masahiko

2010-01-01

95

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

96

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

PubMed

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

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

2012-01-01

97

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

98

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

99

[The experience of the "oncologic patient": (re)conceptualizing the informative act].  

PubMed

The adaptation of the patient to the conditions of chronic illness makes the information given to the patient one of the most powerful strategies, capable of contributing to a change in the social representation of the patient, from that of a mere clinical case to that of a holistic being. The objective of this study was to investigate the scientific work published in periodicals indexed by the Medline and Lilacs databases between 1990 and 2006 as to the informative act and the different forms in which information is provided to oncology patients. This analysis of the literature led to the conclusion that there has been an increase in the volume of publications, underlining the role of the oncology patient as a catalyst for new strategies for psychosocial adjustment and revealing her key role through her status as a 'professional patient'. PMID:18472547

Laranjeira, Carlos António

100

Evaluation of Medical Nutrition Therapy by Radiation Oncology Out-Patients  

Microsoft Academic Search

An outcome study was designed to measure radiation oncology out-patients perceptions of the value of medical nutrition therapy provided by a Registered Dietitian during their treatment. A patient satisfaction survey addressing specific nutrition problems was given to 143 patients with a diagnosis of cancer of the brain, head and neck, lung, colon\\/rectal, lymphoma, as well as metastatic breast\\/prostate cancer, who

B. Cress

1999-01-01

101

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

102

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

103

Surgical Management of the Pediatric Cochlear Implant Patient.  

ERIC Educational Resources Information Center

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

Cohen, Seth M.; Haynes, David S.

2003-01-01

104

Surgical Management of the Pediatric Cochlear Implant Patient.  

ERIC Educational Resources Information Center

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

Cohen, Seth M.; Haynes, David S.

2003-01-01

105

Outbreak of Vancomycin-Resistant Enterococcus Colonization Among Pediatric Oncology Patients  

PubMed Central

OBJECTIVE To detect the burden of vancomycin-resistant Enterococcus (VRE) colonization among pediatric oncology patients and to determine risk factors for VRE acquisition. DESIGN Retrospective case-control study. SETTING The Children’s Hospital of Philadelphia. PATIENTS Pediatric oncology patients hospitalized from June 2006 through December 2007. METHODS Prevalence surveys revealed an increased VRE burden among pediatric oncology patients. For the case-control study, the 16 case patients were pediatric oncology patients who had 1 stool sample negative for VRE at screening before having a stool sample positive for VRE at screening; the 62 control patients had 2 consecutive screenings in which stool samples were negative for VRE. Case and control patients were matched on the duration of the interval between screens. Analyses were performed to determine the association between multiple exposures and VRE acquisition. RESULTS The prevalence survey revealed that 5 (9.6%) of 52 patients had unsuspected VRE colonization at the time of hospitalization. Multivariate analysis identified a lack of empirical contact precautions (odds ratio [OR], 17.16 [95% confidence interval {CI}, 1.49–198.21]; P = .02) and the presence of a gastrointestinal device (OR, 4.03 [95% CI, 1.04–15.56]; P = .04) as significant risk factors for acquisition of VRE. Observations in the interventional radiology department revealed that staff could not access the portions of the electronic medical record in which isolation precautions were documented. Simple interventions that granted access and that trained interventional radiology staff to review the need for precautions, coupled with enhanced infection control practices, interrupted ongoing transmission and reduced the proportion of VRE screens that were positive to 15 (1.2%) of 1,270. CONCLUSIONS Inadequate communication with regard to infection control precautions can increase the risk of transmission of epidemiologically important organisms, particularly when patients receive care at multiple clinic locations. Adherence to infection control practices across the spectrum of care may limit the spread of resistant organisms.

Nolan, Sheila M.; Gerber, Jeffrey S.; Zaoutis, Theoklis; Prasad, Priya; Rettig, Susan; Gross, Kimberly; McGowan, Karin L.; Reilly, Anne F.; Coffin, Susan E.

2010-01-01

106

Surgical treatment of extraluminal pelvic recurrence from rectal cancer: oncological management and resection techniques.  

PubMed

Local recurrence (LR) after curative surgery for rectal cancer occurs in 4 to 33% of cases especially with suboptimal surgery (non-TME). For numerous patients, diagnosis of LR is done at late stage of the disease because of the high rate of asymptomatic patients. MRI and PET-scan are the most performing exams to assess the local and general extension, with high diagnostic accuracy (sensibility 85% and specificity 92%). For extraluminal pelvic recurrences from rectal cancer, pelvic exenterations alone or with irradiation (preoperative and/or intraoperative) can afford a R0 resection rate ranging from 30% to 45% with acceptable morbidity. Morbidity and mortality rates are high for total exenteration and abdominosacral resection. After curative surgery, 5-year global survival from 30% to 40% is observed. Careful selection of patients with better preoperative status before resection is needed to achieve more curative resections and increase long-term survivor rates. PMID:23623561

Pereira, P; Ghouti, L; Blanche, J

2013-04-23

107

Young patients', parents', and survivors' communication preferences in paediatric oncology: Results of online focus groups  

PubMed Central

Background Guidelines in paediatric oncology encourage health care providers to share relevant information with young patients and parents to enable their active participation in decision making. It is not clear to what extent this mirrors patients' and parents' preferences. This study investigated communication preferences of childhood cancer patients, parents, and survivors of childhood cancer. Methods Communication preferences were examined by means of online focus groups. Seven patients (aged 8–17), 11 parents, and 18 survivors (aged 8–17 at diagnosis) participated. Recruitment took place by consecutive inclusion in two Dutch university oncological wards. Questions concerned preferences regarding interpersonal relationships, information exchange and participation in decision making. Results Participants expressed detailed and multi-faceted views regarding their needs and preferences in communication in paediatric oncology. They agreed on the importance of several interpersonal and informational aspects of communication, such as honesty, support, and the need to be fully informed. Participants generally preferred a collaborative role in medical decision making. Differences in views were found regarding the desirability of the patient's presence during consultations. Patients differed in their satisfaction with their parents' role as managers of the communication. Conclusion Young patients' preferences mainly concur with current guidelines of providing them with medical information and enabling their participation in medical decision making. Still, some variation in preferences was found, which faces health care providers with the task of balancing between the sometimes conflicting preferences of young cancer patients and their parents.

Zwaanswijk, Marieke; Tates, Kiek; van Dulmen, Sandra; Hoogerbrugge, Peter M; Kamps, Willem A; Bensing, Jozien M

2007-01-01

108

A randomized controlled trial of early oral analgesia in gynecologic oncology patients undergoing intra-abdominal surgery  

Microsoft Academic Search

OBJECTIVE:To evaluate the safety and efficacy of early oral analgesia after intra-abdominal surgery in gynecologic oncology patients.METHODS:Over a 2.5-year period, 227 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a randomized controlled trial of early oral versus traditional parenteral analgesia. All patients initially received parenteral morphine via a patient-controlled analgesia (PCA) pump with a basal dose of 0.5 mg\\/h

Michael L Pearl; Dayna L McCauley; Jill Thompson; Linda Mahler; Fidel A Valea; Eva Chalas

2002-01-01

109

[Assessment of phonation in patients after oncologic surgery of the oral cavity].  

PubMed

The authors evaluated word articulation ability in 33 patients undergoing integrated (chemo-radio-surgical) treatment for carcinoma of the oral cavity. Speech was intelligible in 22 patients. Severe language distortion was observed in 11 patients. PMID:7991178

Pomatto, E; Falco, V; Ruchawa, E; Miletto, A

110

Bacillus cereus infections among oncology patients at a children’s hospital  

Microsoft Academic Search

Background:Bacillus cereus can cause severe infections in immunocompromised persons. Methods: We report 3 cases of bacteremia\\/septicemia (1 fatal) among oncology patients in a children’s hospital. Because all cases occurred during a 10-day period, a common source outbreak was suspected. An epidemiologic investigation was performed. Molecular comparison of patient and environmental isolates was performed by using pulsed-field gel electrophoresis. Results: After

John C. Christenson; Carrie Byington; E. Kent Korgenski; Elisabeth E. Adderson; Carol Bruggers; Roberta H. Adams; Eileen Jenkins; Sheri Hohmann; Karen Carroll; Judy A. Daly; Andrew T. Pavia

1999-01-01

111

Tumour necrosis factor: implications for surgical patients.  

PubMed

Tumour necrosis factor alpha (TNF-alpha) is an inflammatory cytokine primarily produced by macrophages. It is a unique protein with contradictive properties; it has the ability to induce cellular death by apoptosis and oncosis, but can also induce cellular regeneration and growth. Genetic polymorphisms in TNFA have been associated with poor outcome in some surgical patients and this may provide a useful tool to screen for high-risk patients. Manipulating TNF-alpha levels in vivo may influence the progression of several pathological conditions. TNF-alpha has anti-cancer properties and has been used to treat cancer patients. Treatment with anti-TNF-alpha drugs and antibodies has been successful in rheumatoid arthritis and other autoimmune diseases, but disappointing in the management of patients with sepsis. This review article focuses on the biological activities, genetic polymorphism of TNFA and the role of TNF-alpha and anti-TNF-alpha treatments, based on animal experiments and clinical trials. PMID:17054552

Khalil, Alizan A; Hall, John C; Aziz, Farah A; Price, Patricia

2006-11-01

112

[Surgical approach to posthepatitic cirrhotic patient today].  

PubMed

A posthepatitic cirrhotic patient may undergo elective or urgent abdominal operation for an extra-hepatic or hepatic disease. According to the high postoperative morbidity (61%), surgery is indicated only for symptomatic or complicated cholelithiasis. A surgical procedure for refractory ascites has been devised to create a permanent peritoneo-venous shunt by a one way pressure-sensitive valve (Leveen). The procedure is simple and brings a long lasting relief with recovery in strength and nutrition and improved kidney function. Sclerotherapy is widely used to treat acute variceal bleeding while repeated sclerotherapy is used in the long-term management to eradicate varices. When indicated, liver transplantation is the best treatment to prevent variceal bleeding recurrence. Also portosystemic shunts effectively prevent recurrent variceal bleeding. They are, however, major operations with an important morbidity and mortality, particularly in poor risk patients. The most advocated shunts today are the Warren distal splenorenal shunt and the Sarfeh portacaval shunt using a small diameter prosthetic H-graft. The transjugular intrahepatic portosystemic stent-shunt (TIPSS) is a new treatment for portal hypertension and its complications. From a haemodynamic point of view it allows balanced hepatic perfusion. Postoperative mortality is rare; further bleeding and encephalopathy are reasonably acceptable. The most relevant complications concern dislocation of the prosthesis, stenosis and thrombosis of the shunt, which can be corrected by non-invasive dilatation. Encephalopathy is the main complication of surgical portosystemic shunts. It is usually controlled by protein diet restriction, and administration of lactulose or oral antibiotics. In severe forms the patients may be treated by an oesophageal transection with oesophagogastric devascularization, and by a postoperative suppression of the portosystemic shunt using external maneuvers. Posthepatitic liver cirrhosis is frequently complicated by the onset of an hepatocellular carcinoma. Early detection (aFP, DCP, Echography) and curative resection are the best ways to improve long term prognosis. Segmentectomy achieves a good balance between liver function preservation and radical exeresis for tumours less than 5 cm in diameter. Liver transplantation may be considered for the treatment of long-staging cirrhotic patients in whom hepatocarcinoma development has been recognized at an early presymptomatic stage. Hepatic arterial chemoembolization (gelfoam, lipiodol, mitomycin C or doxorubicin) may improve the survival of patients with unresectable malignant disease of the liver. A marked reduction in liver size may occur in the weeks following an effective chemoembolization with objective (CT scan) and subjective improvement (amelioration of specific symptoms). Liver chemoembolization is absolutely contraindicated in the presence of jaundice disordered liver function (Child C) or complete portal venous obstruction. In the last years, the number of patients treated by liver transplantation has greatly increased. Surgical technique, postoperative management, and immunosuppressive therapy account for the dramatic improvement of the results. However, indications for selection of patients and the timing for liver transplantation are still not well defined. PMID:9272983

Meriggi, F; Forni, E

113

Risk of surgical site infection in patients undergoing orthopedic surgery.  

PubMed

This study aimed to identify risk factors associated with surgical site infections in orthopedic surgical patients at a public hospital in Minas Gerais, Brazil, between 2005 and 2007. A historical cohort of 3,543 patients submitted to orthopedic surgical procedures. A descriptive analysis was conducted and surgical site infection incidence rates were estimated. To verify the association between infection and risk factors, the Chi-square Test was used. The strength of association of the event with the independent variables was estimated using Relative Risk, with a 95% confidence interval and p<0.05. The incidence of surgical site infection was 1.8%. Potential surgical wound contamination, clinical conditions, time and type of surgical procedure were statistically associated with infection. Identifying the association between surgical site infection and these risk factors is important and contributes to nurses' clinical practice. PMID:22249670

Ercole, Flávia Falci; Franco, Lúcia Maciel Castro; Macieira, Tamara Gonçalves Rezende; Wenceslau, Luísa Cristina Crespo; de Resende, Helena Isabel Nascimento; Chianca, Tânia Couto Machado

114

[Ethical aspects of treatment in patients with advanced oncologic diseases].  

PubMed

Ethical aspects of treatment are discussed from the aspect of medical objectives and the doctor-patient relationship. The authors draws attention to various dangers of incorrect approaches which may ensue for the patient: unnecessary and excessively burdening antitumourous treatment, inadequate treatment--in particular of pain, queer views on palliative treatment, a paternalistic approach of the physician with insufficient respect for the patient's wishes, inadequate information provided to the patient, "abuse" of patients for different experimental treatments etc. The author discusses in detail the double effect principle and draws attention to classification of means into ordinary and extraordinary with regard to the patient's own evaluation. PMID:12197401

Munzarová, M

2002-07-01

115

The Sleep Experience of Medical and Surgical Patients  

Microsoft Academic Search

This study described and compared the sleep experience of medical and surgical patients during a hospital stay. During 3 consecutive nights, patients (n = 110) self-reported sleep quality using the Verran and Snyder Sleep Scale (VSH) and potentially disruptive factors using items from the Factors Influencing Sleep Questionnaire (FISQ). Surgical patients, on the first night, received more procedural care (p

Joan E. Tranmer; Janice Minard; Lee Ann Fox; L. Rebelo

2003-01-01

116

Surgical considerations in the emergent small animal patient.  

PubMed

To ensure a successful outcome when performing emergency surgery, the clinician must have the knowledge to be able to assess the patient to determine that surgical intervention is necessary, and to determine the urgency of the procedure. The clinician must have the skills to manage common surgical emergency procedures and the equipment necessary to perform the surgery. This article discusses surgical considerations for the emergent patient, including preoperative patient assessment, readiness, surgical instrumentation, and patient preparation. An overview of the trauma triad of death, options for providing effective hemostasis, damage control surgery, peritoneal lavage and drainage, and wound management are reviewed. PMID:23747265

Devey, Jennifer J

2013-04-19

117

Antibacterial honey (Medihoney®) for wound care of immunocompromised pediatric oncology patients  

PubMed Central

The physiologic process of wound healing is impaired and prolonged in paediatic patients receiving chemotherapy. Due to profound immunosuppression, wound infection can easily spread and act as the source of sepsis. Referring to in vitro studies, which confirmed the antibacterial potency of special honey preparations against typical isolates of nosocomially acquired wound infections (including MRSA and VRE) and considering the encouraging reports from other groups, Medihoney™ has now been used in wound care at the Department of Pediatric Oncology, Children's Hospital, University of Bonn for three years. Supplemented with exemplary clinical data from pediatric oncology patients, this presentation reviews the scientific background and our promising experience with Medihoney™ in wound care issues at our institution.

Simon, Arne; Sofka, Kai; Wieszniewsky, Gertrud; Blaser, Gisela

2006-01-01

118

Procalcitonin: a useful discriminator between febrile conditions of different origin in hemato-oncological patients?  

Microsoft Academic Search

Plasma concentrations of procalcitonin (PCT) have been shown to be elevated in bacterial and fungal infections. In contrast to C-reactive protein (CRP), PCT is not elevated in inflammations of noninfectious origin. Febrile inflammatory conditions are frequent in patients with hemato-oncological diseases. A reliable marker to discriminate infectious inflammations from drug-related and tumor-associated fever is still lacking. To evaluate the impact

S. Schüttrumpf; L. Binder; T. Hagemann; D. Berkovic; L. Trümper; C. Binder

2003-01-01

119

Multiple malignancies in a single patient : a glimpse into 30 years of interdisciplinary oncology.  

PubMed

We report on an 83-year-old woman who suffered from seven manifestations of at least five different nonmetastasizing malignancies during a period spanning more than three decades. Although suspected, an inherited genetic tumor syndrome could not be detected. This patient history exemplifies the development of interdisciplinary oncology and specifies the success but also the risks of intensified locoregional treatments. In particular, radiation oncologists routinely have to perform a risk-benefit analysis, rendering their work both challenging and fascinating. PMID:23283588

Berger, B; Bamberg, M; Zips, D; Schlunk, T

2012-12-21

120

Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study  

PubMed Central

Background The management of early breast cancer (BC) with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on level-1 evidence. In this study, the oncological outcome, post-operative morbidity and patients' satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis is evaluated. Methods 137 SSMs with IBR (10 bilateral) were undertaken in 127 consecutive women, using the LD flap plus implant (n = 85), LD flap alone (n = 1) or implant alone (n = 51), for early BC (n = 130) or prophylaxis (n = 7). Nipple reconstruction was performed in 69 patients, using the trefoil local flap technique (n = 61), nipple sharing (n = 6), skin graft (n = 1) and Monocryl mesh (n = 1). Thirty patients underwent contra-lateral procedures to enhance symmetry, including 19 augmentations and 11 mastopexy/reduction mammoplasties. A linear visual analogue scale was used to assess patient satisfaction with surgical outcome, ranging from 0 (not satisfied) to 10 (most satisfied). Results After a median follow-up of 36 months (range = 6-101 months) there were no local recurrences. Overall breast cancer specific survival was 99.2%, 8 patients developed distant disease and 1 died of metastatic BC. There were no cases of partial or total LD flap loss. Morbidities included infection, requiring implant removal in 2 patients and 1 patient developed marginal ischaemia of the skin envelope. Chemotherapy was delayed in 1 patient due to infection. Significant capsule formation, requiring capsulotomy, was observed in 85% of patients who had either post-mastectomy radiotherapy (PMR) or prior radiotherapy (RT) compared with 13% for those who had not received RT. The outcome questionnaire was completed by 82 (64.6%) of 127 patients with a median satisfaction score of 9 (range = 5-10). Conclusion SSM with IBR is associated with low morbidity, high levels of patient satisfaction and is oncologically safe for T(is), T1 and T2 tumours without extensive skin involvement.

2010-01-01

121

“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

122

Neuro-Oncology Branch: Patient Care at NOB  

Cancer.gov

The diagnosis of a brain tumor can bring about a mixture of emotions for a patient and their loved ones. Reactions to such overwhelming news can range from denial and shock to anger and confusion. Many patients and families do not even know where to start.

123

Oral-dental concerns of the pediatric oncology patient  

Microsoft Academic Search

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

Kathy Lawson

1989-01-01

124

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

125

Satisfaction with oncology care among patients with advanced cancer and their caregivers.  

PubMed

PURPOSE: Satisfaction with care is important for quality assurance in oncology, but may differ between patients and caregivers. We aimed to assess satisfaction with cancer care in paired analyses of these groups, examine differences between them, and identify areas for potential intervention. METHODS: Patients with advanced cancer and their caregivers were recruited from 24 medical oncology outpatient clinics. Satisfaction with care was measured using the FAMCARE (caregivers) and FAMCARE-Patient (patients) scales. Quality of life (QOL) was measured with the Caregiver QOL Index-Cancer (caregivers) and FACIT-Sp (patients). The paired t test assessed differences in overall satisfaction and individual scores. In addition, scores were dichotomized into satisfied versus not satisfied, and McNemar's test was used to assess differences. Multivariable linear regression analyses assessed predictors of patient and caregiver satisfaction, respectively. RESULTS: Satisfaction ratings in the 191 patient-caregiver pairs were high, but patients were more satisfied (p = 0.02). Both groups were least satisfied with information regarding prognosis and pain management. Caregivers were significantly less satisfied than patients regarding coordination of care (p = 0.001) and family inclusion in treatment/care decisions (p < 0.0001). In both groups, higher education was associated with lower satisfaction (p ? 0.01), while better QOL predicted greater satisfaction (p < 0.0001). CONCLUSIONS: Communication regarding pain control and prognosis were identified as key areas for improvement. Caregivers seem to desire greater involvement in treatment decisions, though this must be balanced with patient autonomy. PMID:23435667

Hannon, Breffni; Swami, Nadia; Krzyzanowska, Monika K; Leighl, Natasha; Rodin, Gary; Le, Lisa W; Zimmermann, Camilla

2013-02-23

126

[Second tumors in pediatric oncologic patients. Report of 5 cases].  

PubMed

The dramatic progress observed in the survival of children treated for cancer in the last two decades due to the use of aggressive chemotherapy and radiotherapy has brought an increased incidence of second malignant tumors. Five clinical cases of second malignant neoplasms after a period of six months to seventeen years after diagnosis are presented. The second tumors observed were: one patient with malignant fibrous histiocytoma of the orbit after treatment bilateral retinoblastoma; one patient with multifocal osteosarcoma after cerebelli medullo-blastoma; one patient with Ewing's sarcoma of the fibula after neuroblastoma of the adrenal gland; one case of carcinoma of the thyroid gland after osteosarcoma of the femur and one patient with acute lymphoblastic leukemia after been treated of osteosarcoma of the femur. The genetic, immunologic and therapeutic risk factors are reviewed and analyzed. PMID:7569549

Jiménez, M; León, P; Castro, L; Azcona, C; Sierrasesúmaga, L

127

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

128

Percutaneous gastrostomy in oncologic patients: analysis of results and expansion of the indications  

Microsoft Academic Search

Background: Percutaneous gastrostomy is generally performed for permanent enteral nutrition or gastric decompression.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: In our series of oncologic patients, percutaneous gastrostomy was also used temporarily in some patients for enteral nutrition\\u000a while awaiting functional recovery of swallowing, in preparation for surgery, or for the treatment of fistulas in the upper\\u000a digestive tract. Fifty-one procedures were performed in 50 patients:

G. Cozzi; C. Gavazzi; E. Civelli; M. Milella; M. Salvetti; G. Scaperrotta; F. Bozzetti; A. Severini

2000-01-01

129

Evaluation of a tablet PC technology to screen and educate oncology patients  

Microsoft Academic Search

Study Goal  The aim of the study was to evaluate The Patient Assessment, Care and Education (PACE) System™—an electronic patient symptom\\u000a screening and reporting system for oncology. Specifically, the study determined provider and patient opinions of The PACE\\u000a System™ and documented evidence as to whether symptom assessment rates increased after this system was implemented.\\u000a \\u000a \\u000a \\u000a Materials and methods  Ninety-two providers (i.e., physicians, nurse

Tami L. Mark; Barry Fortner; Gina Johnson

2008-01-01

130

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. J Contin Educ Nurs 2013;44(10):461-469. PMID:24024504

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

2013-09-10

131

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

PubMed Central

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 prioritizing important behaviors. This paper reports a study that aimed at determining the caring behaviors which oncology patients and oncology nurses perceive to be the most important. Methods This study is a comparative descriptive design that was conducted in an Iranian oncology centre. Convenience sampling was used to recruit 200 patients and 40 nurses to take part in the study. Data were collected over a period of 4 months in 2009 using the Caring Assessment Questionnaire, developed by Larson. Caring behaviors (n = 57) were ranked on a 5-point Likert-type scale and ordered in six subscales: "Being accessible", "Explains and facilitates", "Comforts", "Anticipates", "Trusting relationship", "Monitors and follows through". The data were analyzed using SPSS software version 13.0. The overall mean was calculated for each subscale to determine the rank distribution of the subscales. The nonparametric Mann-Whitney U test analysis of variables was used to compare patients' and nurses' scores on subscales. Results The results demonstrate that both groups considered the same order of importance of caring, the high ranking of "Monitors and Follows through and "Being Accessible" and the low ranking of "Comforts" and "Trusting Relationships". Also, Patients only ranked "Being accessible" (p = 0.04) and "Explains and facilitates" (p = 0.03) higher than nurses. Conclusions The oncology patients and nurses perceived highly physical aspects of caring and the results provide for nurses to be aware of the need, during their interactions with patients, to validate the effect their intended caring has upon patients. By so doing and with further refinement of the concept of caring for nursing in studies such as this, the practical aim of making patients feel cared for can be achieved.

2010-01-01

132

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

133

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

134

Results of surgical treatment for patients with a spinal angioma  

PubMed Central

The clinical, angiographic, and operative findings in 16 patients with a spinal angioma are reviewed, and the results of surgery are assessed. The surgical procedure employed in 15 patients consisted of excision of the fistulous portion of the malformation, achieved by intradural ligation of its feeding vessels and excision of its draining veins throughout the limits of the exposure. In 14 patients, a previously progressive deterioration in their clinical condition was arrested by surgical correction of the malformation and in 12 of these patients there was worthwhile improvement in functional capacity. The optimal time for surgical treatment is considered and suggestions are made for the manner in which patients should be investigated. Images

Logue, Valentine; Aminoff, M. J.; Kendall, B. E.

1974-01-01

135

Integrative oncology for breast cancer patients: introduction of an expert-based model  

PubMed Central

Background Malignant breast neoplasms are among the most frequent forms of cancer in the Western world. Conventional treatment of breast cancer may include surgery, hormonal therapy, chemotherapy, radiation and/or immunotherapy, all of which are often accompanied by severe side effects. Complementary and alternative medicine (CAM) treatments have been shown to be effective in alleviating those symptoms. Furthermore, with patient survival rates increasing, oncologists, psychologists and other therapists have to become more sensitive to the needs of cancer survivors that go beyond than the mere alleviation of symptoms. Many CAM methods are geared to treat the patient in a holistic manner and thus are also concerned with the patient’s psychological and spiritual needs. Discussion The use of certain CAM methods may become problematic when, as frequently occurs, patients use them indiscriminately and without informing their oncologists. Herbal medicines and dietary supplements, especially, may interfere with primary cancer treatments or have other detrimental effects. Thus, expertise in this highly specialized field of integrative medicine should be available to patients so that they can be advised about the benefits and negative effects of such preparations and practices. Being a beneficial combination of conventional and CAM care, integrative oncology makes possible the holistic approach to cancer care. The concept of integrative oncology for breast cancer is jointly practiced by the Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, academic teaching hospital of the University of Duisburg-Essen, and the Breast Center at Kliniken Essen-Mitte in Germany. This model is introduced here; its scope is reviewed, and its possible implications for the practice of integrative medicine are discussed. Summary Evidence-based integrative care is crucial to the field of oncology in establishing state-of-the-art care for breast cancer patients.

2012-01-01

136

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

137

Gene therapy imaging in patients for oncological applications  

Microsoft Academic Search

Thus far, traditional methods for evaluating gene transfer and expression have been shown to be of limited value in the clinical arena. Consequently there is a real need to develop new methods that could be repeatedly and safely performed in patients for such purposes. Molecular imaging techniques for gene expression monitoring have been developed and successfully used in animal models,

Iván Peñuelas; Uwe Haberkorn; Shahriar Yaghoubi; Sanjiv S. Gambhir

2005-01-01

138

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

139

[Optimization of surgical treatment of patients with chronic hemorrhoids].  

PubMed

The results of surgical treatment, performed in 1028 patients, suffering chronic hemorrhoids (CHH) stages I-IV, are presented. The patients were divided on three groups in accordance to the disease stage. Comparison of the treatment results was conducted in groups of the patients in accordance to the intervention methods used. Basing on the obtained results analysis, the diagnostic-treatment algorithm was elaborated for differentiated approach to surgical treatment in patients, suffering CHH. PMID:23718025

Shudrak, A A; Necha?, V S; Paliienko, R K

2013-03-01

140

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

141

Surgical Castration in Hormone-Refractory Metastatic Prostate Cancer Patients Can Be an Alternative for Medical Castration  

PubMed Central

Background. Most patients with metastatic prostate cancer are endocrinologically treated with LHRH agonist, but finally castration-refractory and hormone-refractory cancers occur. Serum testosterone levels get low to “the castration level” by LHRH agonists but may not get low enough against castration-refractory prostate cancer. Methods. As case series, twelve patients suffering from hormone-refractory prostate cancer continuously on LHRH agonist underwent surgical castration. Additionally, one hundred and thirty-nine prostate cancer patients on LHRH agonist or surgical castration were tested for serum total testosterone levels. Results. Surgical castration caused decrease in serum PSA in one out of 12 hormone-refractory prostate cancer patients with PSA reduction rate 74%. Serum total testosterone levels were below the sensitivity threshold (0.05?ng/mL) in 40 of 89 (44.9%) medically castrated patients and 33 of 50 (66.0%) surgically castrated patients (P = .20). Conclusion. Even hormone-refractory prostate cancer patients are candidates for surgical castration because of endocrinological, oncological, and economical reasons.

Zaitsu, Masayoshi; Yamanoi, Mariko; Mikami, Koji; Takeshima, Yuta; Okamoto, Naohiko; Imao, Sadao; Tonooka, Akiko; Takeuchi, Takumi

2012-01-01

142

[Systemic enzymotherapy as a method of prophylaxis of postradiation complications in oncological patients].  

PubMed

Set out in the paper are results of treatment of those patients with carcinoma of the lung, uterine cervix, hysterocarcinoma, breast cancer, malignant thymomas, malignant non-Hodgkin's lymphomas, and lymphogranulematosis having been administered combined, chemoradiation or radiation treatments against the background of a complex of accompanying therapy involving systemic enzymotherapy. Polyenzymic drugs were found to be capable of improving results of treatment of acute radiation reactions and preventing postradiation fibrous changes in the lungs, skin, fatty tissue, soft tissue, liver, kidneys. Thus, systemic enzymotherapy is capable of improving the quality of life and results of treatment of oncological patients. PMID:16786662

Hubarieva, H O; Kindzel's'ky?, L P; Ponomar'ova, O V; Udatova, T V; Shpil'ova, S I; Smolanka, I I; Korovin, S I; Ivankin, V S

143

Oncology nurses' experiences with prognosis-related communication with patients who have advanced cancer.  

PubMed

BACKGROUND: Oncology nurses have opportunities to engage in prognosis-related communication with patients who have advanced cancer but encounter barriers that impede the patient's understanding of prognosis, delay transitions to end-of-life care, and contribute to nonbeneficial treatments. PURPOSE: To describe nurses' experiences with prognosis-related communication with patients who have advanced cancer. METHOD: Thematic analysis of audio-recorded interviews with oncology nurses (n = 27). After data coding, themes were identified, and a thematic map was developed. Methods to ensure trustworthiness of the findings were used. RESULTS: Six themes were identified: being in the middle, assessing the situation, barriers to prognosis communication, nurse actions, benefits of prognosis understanding, and negative outcomes. Nurses managed barriers through facilitation, collaboration, or independent actions to help patients with prognosis understanding. CONCLUSIONS: Shortcomings in prognosis-related communication with patients who have advanced cancer may contribute to negative outcomes for patients and nurses. Interventions that empower nurses to engage in prognosis communications are needed. Interprofessional communication skills education also may be beneficial. PMID:23402782

McLennon, Susan M; Lasiter, Sue; Miller, Wendy R; Amlin, Kathryn; Chamness, Amy R; Helft, Paul R

2013-02-01

144

Surgical Therapy for Pulmonary Aspergillosis in Immunocompromised Patients  

Microsoft Academic Search

Background. Medical management for invasive pulmonary aspergillosis (IPA) is often unsatisfactory. Antifungal therapy may be unable to eradicate IPA in the immunocompromised or neutropenic patient.Methods. We retrospectively reviewed the surgical management of IPA in 13 immunocompromised patients at our institution. Twelve patients underwent perioperative bone marrow transplantation (4 autologous, 8 allogenic). All 13 patients received antifungal therapy. Eleven patients were

Christopher T. Salerno; David W. Ouyang; Timothy S. Pederson; David M. Larson; Jay P. Shake; Eric M. Johnson; Michael A. Maddaus

1998-01-01

145

[Protein malnutrition in pediatric patients with oncologic diseases].  

PubMed

To study the frequency of protein-caloric malnutrition in children (n = 16) with malignant diseases, we measured serum-albumin, -transferrin, -prealbumin and -retinol-binding protein (Radial immunodiffusion) before treatment was started. In 9 children at least 3 of the 4 rapid-turnover proteins were below the age-specific reference values. 7 patients (44%) with low rapid turnover proteins were free from infection, liver and renal dysfunction and thus, diagnosis of protein-caloric malnutrition was established. Anthropometric parameters as weight for age and the weight/height ratio did not predict protein-caloric malnutrition. Nutritional therapy (enteral, parenteral) during a period of 2 weeks resulted in significant increase of albumin (p less than 0.05), prealbumin (p less than 0.01) and retinol-binding protein (p less than 0.01). Rapid turnover proteins can be easily measured in each laboratory and are useful in diagnosis and treatment of protein-caloric malnutrition of children with malignant diseases as long as the limitations of this method are not neglected. PMID:3108568

Howanietz, H; Thun-Hohenstein, L; Haschke, F; Pietschnig, B; Bruckner, R; Camaya, Z; Jürgenssen, O A

146

Internet-based neuro-oncology patient recruitment.  

PubMed

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

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

2006-05-01

147

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

Microsoft Academic Search

Background  Percutaneous endoscopic gastrostomy (PEG) allows long-term tube feeding. Safety of pull-type and introducer PEG placement\\u000a in oncology patients with head\\/neck or oesophageal malignancies is unknown.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Retrospective analysis of 299 patients undergoing PEG tube placement between January 2006 and December 2008 revealed 57 oncology\\u000a patients. All patients with head\\/neck or oesophageal malignancy were treated with chemo- and radiotherapy. In case of

Evi Van Dyck; Elisabeth J Macken; Bernard Roth; Paul A Pelckmans; Tom G Moreels

2011-01-01

148

[Outpatient psycho-oncological care for family members and patients: access, psychological distress and supportive care needs].  

PubMed

Supportive care needs of family members of cancer patients are often overlooked within psychosocial care. A screening measure was sent to 132 family members and 362 cancer patients (response rate > 95 %) after telephone registration at a specialized outpatient clinic for psycho-oncology at the University Medical Center Hamburg-Eppendorf. The majority of participants was informed about the outpatient clinic for psycho-oncology through advice by third parties. More than 90 % of family members and cancer patients show high levels of distress; 49 % of family members and 59 % of patients had moderate to high levels of depression; 58 % of family members and 61 % of patients had moderate to high levels of anxiety. No gender differences were observed in both groups. Most frequent supportive care needs in both groups refer to fear of recurrence, dealing with uncertainty, sadness and keeping a positive outlook. Our findings emphasize the need for specific psycho-oncological interventions. PMID:22565336

Rosenberger, Christina; Höcker, Anja; Cartus, Michaela; Schulz-Kindermann, Frank; Härter, Martin; Mehnert, Anja

2012-05-07

149

[Surgical treatment of the patients, suffering alimentary--constitutional obesity].  

PubMed

The results of surgical treatment of 105 patients, suffering alimentary-constitutional obesity, using intragastric balloon placement. operative procedures of regulated gastric banding, longitudinal gastric resection, gastric and biliopancreatic shunting, were analyzed. The changes dynamics in the carbohydrate and lipid metabolism indices was estimated. Algorithm of the obesity surgical treatment, depending on the body mass index and concomitant diseases presence, was elaborated. PMID:22432191

Ioffe, O Iu; Tarasiuk, T V; Stetsenko, O P

2011-12-01

150

Morbidity risk assessment in the surgically anemic patient  

Microsoft Academic Search

Clinicians have few data on which to base a decision to transfuse a surgical patient. We reviewed animal and human data to evaluate the effects that anemia and comorbidity have on surgical outcome. Experimental evidence consistently demonstrates increased cardiac output, decreased peripheral vascular resistance, and increased release of oxygen by red blood cells in response to anemia. Normal animals tolerate

Jeffrey L. Carson

1995-01-01

151

Clinical hypnosis in the alleviation of procedure-related pain in pediatric oncology patients.  

PubMed

This prospective controlled trial investigated the efficacy of a manual-based clinical hypnosis intervention in alleviating pain in 80 pediatric cancer patients (6-16 years of age) undergoing regular lumbar punctures. Patients were randomly assigned to 1 of 4 groups: direct hypnosis with standard medical treatment, indirect hypnosis with standard medical treatment, attention control with standard medical treatment, and standard medical treatment alone. Patients in the hypnosis groups reported less pain and anxiety and were rated as demonstrating less behavioral distress than those in the control groups. Direct and indirect suggestions were equally effective, and the level of hypnotizability was significantly associated with treatment benefit in the hypnosis groups. Therapeutic benefit degraded when patients were switched to self-hypnosis. The study indicates that hypnosis is effective in preparing pediatric oncology patients for lumbar puncture, but the presence of the therapist may be critical. PMID:12825916

Liossi, Christina; Hatira, Popi

2003-01-01

152

Efficacy of multifaceted interventions in reducing complications of peripherally inserted central catheter in adult oncology patients  

Microsoft Academic Search

Purpose  To evaluate the efficacy of multifaceted interventions in reducing complications of peripherally inserted central venous catheter\\u000a (PICC) in adult oncology patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Multifaceted interventions were implemented in our department in December 2006. These interventions include: (1) A mandatory\\u000a nurse reeducation was developed by a multidisciplinary task force; (2) Modification of peripherally inserted central catheter\\u000a insertion: take a chest X-ray before removal

Geng Tian; Yan Zhu; Li Qi; Fengqin Guo; Haidan Xu

2010-01-01

153

Evaluation of an oral patient-controlled analgesia device for pain management in oncology inpatients.  

PubMed

An oral, patient-controlled analgesia (PCA) device uses radiofrequency identification technology to allow patients direct, controlled access to medication at the bedside. Twenty oncology inpatients participated in a pilot study to evaluate the device's design function and patient, nursing, and pharmacy satisfaction. The referring oncology physicians ordered oral pain tablets or capsules on an as-needed basis; the drugs were dispensed by the device with a specified lockout time interval and with a provision for administration of an immediate dose, if desired. In all, 95% of the patients reported that use of the device provided better pain control, since it allowed them to receive medication directly without delay. Further, 100% of the patients preferred using the device to calling a nurse for each dose of as-needed medication. All patients desired to use the device again during future hospitalizations if they required oral breakthrough pain medications. More than 80% of nurses surveyed stated that the device was reliable and easy both to program and to query about medication-dispensing data. In addition, more than 90% of nurses reported that patients' pain appeared to be better controlled when the device was used; they also indicated that the device saved them nursing time. Pharmacy staff agreed that the device's disposable medication tray was easy to fill; however, it did not save them time. The results of a Cronbach's-alpha statistic calculated for patient and nursing questionnaires showed these surveys to be reliable tools that featured consistent responses. The overall conclusion from this pilot study was that the oral PCA device was a useful, functional device that should improve pain management in selected patients in the acute care setting. PMID:18019852

Rosati, Jane; Gallagher, Mary; Shook, Beverly; Luwisch, Edward; Favis, Gregory; Deveras, Ruby; Sorathia, Abdul; Conley, Sharon

2007-10-01

154

Spinal meningiomas: critical review of 131 surgically treated patients.  

PubMed

This study was undertaken to analyze the functional outcome of surgically treated spinal meningiomas and to determine factors for surgical morbidity. Between January 1990 and December 2006 a total of 131 patients underwent surgical resection of a spinal menigioma. There were 114 (87%) female and 17 (13%) male patients. Age ranged from 17 to 88 years (mean 69 years). The mean follow-up period was 61 months (range 1-116 months) including a complete neurological examination and postoperative MRI studies. The pre- and postoperative neurological state was graded according to the Frankel Scale. Surgery was performed under standard microsurgical conditions with neurophysiological monitoring. In 73% the lesion was located in the thoracic region, in 16% in the cervical region, in 5% at the cervico-thoracic junction, in 4.5% at the thoraco-lumbar junction and in 1.5% in the lumbar region. Surgical resection was complete in 127 patients (97%) and incomplete in 4 patients (3%). At the last follow-up the neurological state was improved or unchanged in 126 patients (96.2%) and worse in 4 patients (3%). Permanent operative morbidity and mortality rates were 3 and 0.8%, respectively. Extensive tumour calcification proved to be a significant factor for surgical morbidity (P < 0.0001). Radical resection of spinal meningiomas can be performed with good functional results. Extensive tumor calcification, especially in elderly patients proved to harbor an increased risk for surgical morbidity. PMID:18481118

Sandalcioglu, I Erol; Hunold, Anja; Müller, Oliver; Bassiouni, Hischam; Stolke, Dietmar; Asgari, Siamak

2008-05-15

155

Maximizing Patient Thermoregulation in US Army Forward Surgical Teams.  

National Technical Information Service (NTIS)

Creating universal minimal thermoregulation standards for all Forward Surgical Teams (FST) may decrease morbidity and mortality of combat damage control patients. These standards will also decrease blood and IV fluid requirements for each individual patie...

B. Eastridge K. W. Grathwohl L. H. Blackbourne P. Barras

2008-01-01

156

Surgical outcome in patients with epilepsy and dual pathology  

Microsoft Academic Search

Summary High-resolution MRI can detect dual pathology (an extrahippocampal lesion plus hippocampal atrophy) in about 5-20% of patients with refractory partial epilepsy referred for surgical evaluation. We report the results of 41 surgical interventions in 38 adults (mean age 31 years, range 14-63 years) with dual pathology. Three patients had two operations. The mean postoperative follow-up was 37 months (range

L. M. Li; F. Cendes; F. Andermann; C. Watson; M. J. Cook; F. Dubeau; J. S. Duncan; S. D. Shorvon; S. F. Berkovic; A. Olivier; W. Harkness; D. L. Arnold

1999-01-01

157

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

158

Cor triatriatum: clinical presentation and surgical results in 12 patients.  

PubMed

Twelve patients with cor triatriatum have been seen at our institution since 1979. The clinical presentation, diagnostic evaluation, and surgical results are outlined in this retrospective review. Operation is the treatment of choice for this rare congenital cardiac defect. One patient died 1 day before scheduled operation, and 2 patients died postoperatively, yielding a surgical mortality rate of 17% and an overall mortality rate of 25%. Resection of the obstructing atrial membrane was performed using hypothermic cardiopulmonary bypass in all cases. Left atriotomy was performed in 6 patients, and right atriotomy was performed in 7. The two postoperative deaths occurred in patients who had serious associated cardiac defects. Associated anomalies include atrial septal defect, persistent left superior vena cava, and partial anomalous pulmonary venous return. The postoperative course has been excellent in all 9 surviving patients; all remain asymptomatic. Cor triatriatum is amenable to surgical repair with excellent results when diagnosed early and when not complicated by other severe cardiac anomalies. PMID:2222044

Rodefeld, M D; Brown, J W; Heimansohn, D A; King, H; Girod, D A; Hurwitz, R A; Caldwell, R L

1990-10-01

159

Providing internet lessons to oncology patients and family members: a shared project.  

PubMed

The paper describes the steps in a pilot study taken to develop and evaluate an Internet intervention for cancer patients and family members. The intervention was a shared project of two hospital departments; a volunteer oncology support service, Hope & Cope, and the Health Services Library. Forty subjects were surveyed on their computer use and interest, and of these, half used the Internet to access health and medical information. Of the 40 subjects, 28 participated in an innovative, one-to-one teaching session with a medical librarian where they learned to access Internet sites to find information specific to their needs and subsequently be more confident in their perceived ability to evaluate the information received. Follow up interviews found that the sessions were well received and at two months follow-up the participants attributed their positive well being in large part to the intervention. Internet use by oncology patients and family members in conjunction with skilled help has the potential to contribute in a timely fashion to the well being of those with cancer. PMID:12228877

Edgar, Linda; Greenberg, Arlene; Remmer, Jean

160

The care of elderly, terminally ill oncological patients in caregiving sanitary residences.  

PubMed

A panoramic survey is outlined regarding the care system of terminally ill oncologic patients with particular regard to the elderly. National and international experiences are considered offering a caregiving service out of hospital, in small dwelling centers being able to relieve the sufferings of the last days of life. The caregiving sanitary residences and hospices are inserted in a network of services for the elderly oncological patients, representing an adequate answer for the problems. In those structures there is a need of proper professional sanitary figures and standardized lodgings, which may be of importance in the maintenance of a good quality of life. In addition, this study emphasizes the caregiving activity of the family and the needs of the caregivers, as well as the proper instruction of them through courses of specialization. New figures should be inserted in the hospices, like the volunteers, the animators and spiritual assistants; their help is inevitably necessary to assure a better care during the last days of life. PMID:10989167

Di Mauro S; Scalia; Leotta; Giuffrida; Di Stefano A; Malaguarnera

2000-08-01

161

Oral surgical management of patients with mechanical circulatory support  

Microsoft Academic Search

After the introduction of mechanical circulatory support (MCS) for treatment of patients with severe cardiogenic shock, the survival rate of these patients increased significantly. Temporary MCS may be applied over a period of several days up to months prior to heart transplantation (HTx). Oral surgical management of patients with MCS is seriously complicated by a combination of anticoagulant and antiaggregant

J.-P. Lund; T. Drews; R. Hetzer; P. A. Reichart

2002-01-01

162

Rehabilitation in Patients after Cardio-Surgical Interventions  

Microsoft Academic Search

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

Alicja Wolynska-Slezynska; Jan Slezynski

163

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

164

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

Microsoft Academic Search

The effects of video games on the adverse corollaries of chemotherapy were assessed in 3 pediatric oncology patients using a combined multiple-baseline and ABAB design. Patients were three males, 11, 16, and 17 years old, who reported and exhibited distress both prior to and following chemotherapy. Self-report measures of the presence of several anticipatory distress and anxiety symptoms and the

David J. Kolko; Jorge L. Rickard-Figueroa

1985-01-01

165

Noninfectious causes of elevated procalcitonin and C-reactive protein serum levels in pediatric patients with hematologic and oncologic disorders  

Microsoft Academic Search

Background  Procalcitonin (PCT) is considered a sensitive and specific diagnostic and prognostic marker of systemic bacterial infection,\\u000a but its value is questionable in certain clinical conditions, particularly in hemato-oncological patients.\\u000a \\u000a \\u000a \\u000a Materials and methods  We analyzed PCT and C-reactive protein (CRP) levels in 56 patients of a pediatric hematology–oncology unit during 110 consecutive\\u000a non-infectious febrile episodes related to administration of T-cell antibodies (group

Hans Jürgen Dornbusch; Volker Strenger; Petra Sovinz; Herwig Lackner; Wolfgang Schwinger; Reinhold Kerbl; Christian Urban

2008-01-01

166

[Value of radical oncological surgery in bilateral synchronous renal cell cancer and coincidental simultaneous prostate cancer].  

PubMed

To date, the current literature does not report on oncological surgery in bilateral renal cell cancer and coincidental simultaneous prostate cancer. We present the case of a 66-year-old patient presenting as a challenge due to this oncological-surgical constellation. Based on the present case study and the postoperative follow-up, we discuss possible surgical strategies and demonstrate that, even in the case of multiple tumour locations, a satisfying oncological and functional long-term result is achievable. PMID:19603378

Rud, Oleg; Krause, F S; Engehausen, D G; May, M; Gilfrich, C

2009-07-14

167

Adverse drug events in surgical patients: an observational multicentre study.  

PubMed

Background Errors occurring during different steps of the medication process can lead to adverse drug events (ADEs). Surgical patients are expected to have an increased risk for ADEs during hospitalization. However, detailed information about ADEs in the surgical patient is lacking. Objective In this study, we aim to measure the incidence and nature of (preventable) ADEs, potential risk factors for and outcome parameters of (preventable) ADEs in surgical patients. Setting Observational multicentre cohort study in which eight surgical wards participated from three Dutch hospitals, all using computerized physician order entry (CPOE) systems with clinical decision support. Methods Electively admitted surgical patients of the participating wards were included from March until June 2009. ADEs were measured using a standardized method with expert judgment. Incidence, severity, preventability and accountable medication were assessed. Poisson regression analysis was applied to determine the associations between possible risk factors and the occurrence of ADEs, expressed as incidence rate ratio (IRR). Also outcomes of ADEs in surgical patients were measured. Main outcome measure The incidence and nature of (preventable) ADEs in surgical patients. Results A total of 567 surgical patients were included. We found an incidence of 27.5 ADEs and 4.2 preventable ADEs (pADEs) per 100 admissions (15.4 %). A quarter of the pADEs were severe or life-threatening. Opioids and anti-coagulation medication play a major role in the occurrence of ADEs and pADEs respectively. Univariate analysis revealed an American Society of Anesthesiologists classification of III or more as a risk factor for ADEs. Patients older than 65 years [IRR 2.77 (1.14-6.72)], with cardiovascular comorbidity [IRR 2.87 (1.13-7.28)], or undergoing vascular surgery [IRR 2.32 (1.01-5.32)] were at risk for pADEs. Patients experiencing an ADE had a significant longer duration of admission than patients without an ADE. Conclusions Surgical patients are at considerable risk of experiencing one or more ADEs during their admission, also in CPOE-hospitals. Risk factors for pADEs are age older than 65 years, cardiovascular comorbidity, and vascular surgery. Intensified monitoring may be needed in patients with a higher than average risk for pADEs. PMID:23722455

de Boer, Monica; Boeker, Eveline B; Ramrattan, Maya A; Kiewiet, Jordy J S; Dijkgraaf, Marcel G W; Boermeester, Marja A; Lie-A-Huen, Loraine

2013-05-31

168

Information for Patients on Surgical Fires  

Center for Drug Evaluation (CDER)

... in dental offices, so ask about safety precautions. ... head and neck surgeries and for patients with beards ... ROOM AIR: If possible, the patient should be ... More results from www.fda.gov/drugs/drugsafety/safeuseinitiative

169

Surgical treatment of intracranial arachnoid cyst in adult patients.  

PubMed

Background: Intracranial arachnoid cyst (IAC) is a benign cystic lesion filled with cerebrospinal fluid (CSF). Different surgical treatments were evaluated to determine the most effective technique among several. Materials and Methods: A consecutive series of 68 adult patients (43 males, mean age 30.3 years, range 18-42 years) with IAC were surgically treated between January 2004 and January 2011. The cysts were supratentorial in location in 53 and infratentorial in 15 patients. Symptoms at presentation, location of the IAC, surgical treatment modalities, and postoperative complications were evaluated. Results: Of the 51 patients with headache, 44 (86.27%) patients had complete relief of the headache, five (9.80%) patients had significant improvement, and two (3.92%) had no worthwhile change. Three of the four patients with hydrocephalus and gait disturbances had relief of the symptoms and one patient had significant improvement. Of the five patients with cognitive decline and weakness, three (60.00%) patients showed improvement, and two (40.00%) patients had no significant change. Five (62.50%) of the eight patients with epilepsy had seizure remission, two (25.00%) patients had non-disabling seizures, and one had no change. Follow-up computed tomography (CT) scans showed variable change in the mass effect of IAC in 68 patients; cystic size was significantly reduced in 51 patients, no significant change in two patients of supratentorial arachnoid cysts. Cystic size was reduced in seven patients, but no significant change was observed in eight patients of infratentorial cysts. Three patients with enlarged head circumference had no further increase in the head circumference. Conclusion: Adult patients with IAC symptoms should be treated efficiently. Surgical treatment is associated with significant improvement in the symptoms and signs. PMID:23466842

Wang, Chao; Liu, Chuangxi; Xiong, Yunbiao; Han, Guoqiang; Yang, Hen; Yin, Hao; Wang, Jun; You, Chao

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

Sleep-Wake Circadian Activity Rhythms and Fatigue in Family Caregivers of Oncology Patients  

PubMed Central

Background Little is known about the relationships between sleep/wake circadian activity rhythms and fatigue in family caregivers (FCs) of oncology patients. Objectives In a sample of FCs of oncology patients, to describe values for nocturnal sleep/rest, daytime wake/activity, and circadian activity rhythm parameters measured using actigraphy and to evaluate the relationships between these subjective and objective measures of sleep disturbance and self-reported fatigue severity. Methods FCs (n=103) completed self-report measures for sleep disturbance (i.e., Pittsburgh Sleep Quality Index, General Sleep Disturbance Scale) and fatigue (Lee Fatigue Scale) and wore wrist actigraphs for 48 hours prior to beginning radiation therapy. Spearman rank correlations were calculated between variables. Results Approximately 40% to 60% of FCs experienced sleep disturbance depending on whether clinically significant cutoffs for the subjective or objective measures were used to calculate occurrence rates. In addition, these FCs reported moderate levels of fatigue. Only a limited number of significant correlations were found between the subjective and objective measures of sleep disturbance. Significant positive correlations were found between fatigue and subjective, but not objective measures of sleep disturbance. The amplitude of circadian activity rhythm was not related to any objective sleep measure but was correlated with self-report of longer sleep onset latency. Conclusions A significant percentage of FCs experience clinically meaningful disturbances in sleep-wake circadian activity rhythms. These disturbances occur primarily in sleep maintenance. Implications for Practice: FCs need to be assessed, along with patients, for sleep disturbance and appropriate interventions initiated for them and for the patient.

Dhruva, Anand; Lee, Kathryn; Paul, Steven M.; West, Claudia; Dunn, Laura; Dodd, Marylin; Aouizerat, Bradley E.; Cooper, Bruce; Swift, Patrick; Miaskowski, Christine

2011-01-01

172

Effects of oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders.  

PubMed

Pretherapy sperm cryopreservation in young men is currently included in good clinical practice guidelines for cancer patients. The aim of this paper is to outline the effects of different oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders, based on an 8-year experience of the Cryopreservation Centre of a large public hospital. Two hundred and sixty-one patients with testicular neoplasia and 219 patients with lymphoproliferative disorders who underwent chemotherapy and/or radiotherapy and pretherapy semen cryopreservation were evaluated. Sperm and hormonal parameters (follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, inhibin B levels) were assessed prior to and 6, 12, 18, 24 and 36 months after the end of cancer treatment. At the time of sperm collection, baseline FSH level and sperm concentration were impaired to a greater extent in patients with malignant testicular neoplasias than in patients with lymphoproliferative disorders. Toxic effects on spermatogenesis were still evident at 6 and 12 months after the end of cancer therapies, while an improvement of seminal parameters was observed after 18 months. In conclusion, an overall increase in sperm concentration was recorded about 18 months after the end of cancer treatments in the majority of patients, even if it was not possible to predict the evolution of each single case 'a priori'. For this reason, pretherapy semen cryopreservation should be considered in all young cancer patients. PMID:23542137

Di Bisceglie, Cataldo; Bertagna, Angela; Composto, Emanuela R; Lanfranco, Fabio; Baldi, Matteo; Motta, Giovanna; Barberis, Anna M; Napolitano, Emanuela; Castellano, Elena; Manieri, Chiara

2013-04-01

173

Effects of oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders  

PubMed Central

Pretherapy sperm cryopreservation in young men is currently included in good clinical practice guidelines for cancer patients. The aim of this paper is to outline the effects of different oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders, based on an 8-year experience of the Cryopreservation Centre of a large public hospital. Two hundred and sixty-one patients with testicular neoplasia and 219 patients with lymphoproliferative disorders who underwent chemotherapy and/or radiotherapy and pretherapy semen cryopreservation were evaluated. Sperm and hormonal parameters (follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, inhibin B levels) were assessed prior to and 6, 12, 18, 24 and 36 months after the end of cancer treatment. At the time of sperm collection, baseline FSH level and sperm concentration were impaired to a greater extent in patients with malignant testicular neoplasias than in patients with lymphoproliferative disorders. Toxic effects on spermatogenesis were still evident at 6 and 12 months after the end of cancer therapies, while an improvement of seminal parameters was observed after 18 months. In conclusion, an overall increase in sperm concentration was recorded about 18 months after the end of cancer treatments in the majority of patients, even if it was not possible to predict the evolution of each single case ‘a priori'. For this reason, pretherapy semen cryopreservation should be considered in all young cancer patients.

Di Bisceglie, Cataldo; Bertagna, Angela; Composto, Emanuela R; Lanfranco, Fabio; Baldi, Matteo; Motta, Giovanna; Barberis, Anna M; Napolitano, Emanuela; Castellano, Elena; Manieri, Chiara

2013-01-01

174

Comparison Between Patient-Reported and Clinician-Observed Symptoms in Oncology.  

PubMed

BACKGROUND:: Symptom assessment is critical to understand the effectiveness of cancer treatment. Traditionally, clinicians have provided the information about cancer patients' symptoms. However, current research has shown that there are discrepancies on symptom assessment results reported by patients themselves and clinicians. OBJECTIVE:: The objective of this study was to present an integrative review on studies comparing patient-reported symptoms and clinician-observed symptoms in patients with a diagnosis of cancer. METHODS:: This was a review of published articles from PubMed, CINAHL, and the Cochrane Database, using the key words symptom or toxicity, and patient-reported, patient-rated, patient-assessed or patient-evaluated, which were combined with cancer, oncology, neoplasm, or tumor. RESULTS:: Clinicians have the propensity to underestimate the incidence, severity, or distress of symptoms experienced by cancer patients. These discrepancies appear to be consistently demonstrated over time and become even more apparent when symptoms are more severe and distressing to patients. In addition, patients report both symptom frequency and severity earlier than clinicians do; patients' symptom assessments are more predictable for daily health status, whereas clinicians' symptom measurements are more related to clinical outcomes. CONCLUSIONS:: Healthcare professionals must appreciate that there can be discordance between what they perceive and what patients experience and report. Further research needs to address methodological limitations and weaknesses of existing literature. IMPLICATIONS FOR PRACTICE:: Symptoms reported by patients themselves provide the necessary and different insight into cancer and its treatment, compared with those observed by clinicians. The use of patient-reported symptoms should be incorporated into routine clinical practice and not just research studies. PMID:23047799

Xiao, Canhua; Polomano, Rosemary; Bruner, Deborah Watkins

2012-10-01

175

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

176

A Nomogram for Predicting Surgical Complications in Bariatric Surgery Patients  

Microsoft Academic Search

Background  To minimize morbidity and mortality associated with surgery risks in the obese patient, algorithms offer planning operative\\u000a strategy. Because these algorithms often classify patients based on inadequate category granularity, outcomes may not be predicted\\u000a accurately. We reviewed patient factors and patient outcomes for those who had undergone bariatric surgical procedures to\\u000a determine relationships and developed a nomogram to calculate individualized

Patricia L. Turner; Leif Saager; Jarrod Dalton; Alaa Abd-Elsayed; Dmitry Roberman; Pamela Melara; Andrea Kurz; Alparslan Turan

2011-01-01

177

Surgical outcomes of elderly patients with cervical spondylotic myelopathy  

Microsoft Academic Search

BackgroundCervical spondylotic myelopathy is a potentially serious neurologic disorder that commonly presents with gait difficulty and hand dysfunction. Because the development of CSM is in large part related to advanced spondylosis and degenerative disk disease, elderly patients appear to be at an increased risk to develop this condition. The surgical outcomes of this patient population have been understudied; the authors

Langston T. Holly; Parham Moftakhar; Larry T. Khoo; A. Nick Shamie; Jeffrey C. Wang

2008-01-01

178

Surgical Treatment of Canalicular Stenosis in Patients Receiving Docetaxel Weekly  

Microsoft Academic Search

Objective: To describe the surgical treatment and out- comes in patients with metastatic breast cancer and cana- licular stenosis caused by weekly treatment with doce- taxel. Methods: This case series included 10 patients with per- sistent epiphora due to weekly docetaxel treatment, who were evaluated by probing and irrigation of the tear drain- age apparatus and were found to have

M. Amir Ahmadi; Bita Esmaeli

2001-01-01

179

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

180

[Clinicopathological experiences in oncologic diseases].  

PubMed

Authors on the base of the study of clinical history and autopsy protocols of 260 patients died in 1974 in the Institute of Oncology of Hungary from oncological diseases established, that the proportion of decised younger 30 years and the number of those older 70 years increased in comparison with 1964. In the autopsy material the most frequent were tumours of the lymphoid-myeloid system, then followed the frequency of the tumours of the breast and urogenital tract, the least frequent were the tumours of the gastrointestinal tract. Number of the primary multiplex tumours during the last 10 years increased from 1,5 per cent to 5,5 per cent. In 23,5 per cent of the cases medica negligence or that of the patient itself could be proved. The clinical and the pathological diagnosis did not correlate in 35,9 per cent of the cases studied. The most common unrecognized complication was pneumonia. Surgical treatment appeared to be most effective in cases of the cancer of the breast. The average age of the patients suriving for a longer period after the operation was 62,8 years, which seems to evidence, that prognosis of oncological diseases in older ages is better than in younger. In comparison with the data in 1964 number of cases with five year surviving increased by 3,7 per cent. This was striking first of all in cases of lymphoid-myeloid tumours. PMID:927448

Tóth, J; Szentirmay, Z; Döbrössy, L

1977-07-01

181

Surgical palliation of unresectable pancreatic head cancer in elderly patients  

PubMed Central

AIM: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer. METHODS: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS: Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively). The median hospital-free survival period and the median overall survival were also significantly longer in Group A (P = 0.001 and P < 0.001, respectively). CONCLUSION: Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.

Hwang, Sang Il; Kim, Hyung Ook; Son, Byung Ho; Yoo, Chang Hak; Kim, Hungdai; Shin, Jun Ho

2009-01-01

182

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

183

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

184

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

185

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

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

Promoting parental use of distraction and relaxation in pediatric oncology patients during invasive procedures.  

PubMed

Treatment of children with cancer involves many painful procedures. Invasive procedures such as bone marrow aspiration and lumbar punctures can be very traumatic, painful, and anxiety-producing for both parents and child. The use of distraction and relaxation techniques is a nonpharmacologic strategy to promote comfort and decrease anxiety and procedural pain. This article describes the development of a parent education booklet that promotes the use of distraction and relaxation techniques during invasive procedures across pediatric oncology inpatient and outpatient settings. Promoting parents' use of these techniques with their child can add to the parent and child's repertoire of coping skills that can be used throughout the course of their treatment or during other painful procedures. These techniques in combination with traditional methods of practice enhance quality patient care and significantly decrease the cost and risk associated with performing these procedures under general anesthesia. PMID:12203192

Christensen, Joy; Fatchett, Debora

188

Frailty in the older surgical patient: a review.  

PubMed

The rate of surgical procedures in the older population is rising. Despite surgical, anaesthetic and medical advances, older surgical patients continue to suffer from adverse postoperative outcomes. Comorbidities and reduction in physiological reserve are consistently identified as major predictors of poor postoperative outcome in this population. Frailty can be defined as a lack of physiological reserve seen across multiple organ systems and is an independent predictor of mortality, morbidity and institutionalisation after surgery. Despite this identification of frailty as a significant predictor of adverse postoperative outcome, there is not yet a consensus on the definition of frailty or how best to assess and diagnose it. This review describes our current definitions of frailty and discusses the available methods of assessing frailty, the impact on the older surgical population and the emerging potential for modification of this important syndrome. PMID:22345294

Partridge, Judith S L; Harari, Danielle; Dhesi, Jugdeep K

2012-03-01

189

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

190

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

191

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

192

Surgical options for patients with shoulder pain  

Microsoft Academic Search

Shoulder pain is a common musculoskeletal complaint in the community, which can arise from diverse causes. Regardless of the cause, mild cases can often be effectively treated conservatively, with options including rest, physiotherapy, pain relief and glucocorticoid injections. If conservative strategies fail after a 3–6 month period then surgery might be considered. Generally, the proportion of patients with shoulder pain

Salma Chaudhury; Stephen E. Gwilym; Jane Moser; Andrew J. Carr

2010-01-01

193

Computer-enhanced robotic surgery in gynecologic oncology  

Microsoft Academic Search

Background  This study aimed to report the computer-enhanced robotic surgery experience of the authors’ gynecologic oncology division.\\u000a \\u000a \\u000a \\u000a Methods  From January 2001 to August 2006, 41 patients underwent laparoscopic surgery by our gynecologic oncology service using a computer-enhanced\\u000a surgical robot. This report describes a retrospective review of these patients.\\u000a \\u000a \\u000a \\u000a Results  The patients ranged in age from 27 to 77 years (mean, 44.2 years), in

Jayson B. Field; Michelle F. Benoit; Tri A. Dinh; Concepcion Diaz-Arrastia

2007-01-01

194

Does an oral analgesic protocol improve pain control for patients with cancer? An intergroup study coordinated by the Eastern Cooperative Oncology Group  

Microsoft Academic Search

Background: Cancer pain is highly prevalent and commonly undertreated. This study was designed to determine whether dissemination of a clinical protocol for pain management would improve outcomes in community oncology practices. Patients and methods: A pain management protocol was developed based on accepted guidelines. After baseline assessment, oncology practices were randomly assigned to 'analgesic protocol' (AP) sites, where oncologists implemented

C. S. Cleeland; R. K. Portenoy; M. Rue; T. R. Mendoza; E. Weller; R. Payne; J. Kirshner; J. N. Atkins; P. A. Johnson; A. Marcus

2005-01-01

195

Incidental cancer in patients surgically treated for benign thyroid disease. Our experience at a single institution.  

PubMed

Increased incidence of incidental cancer in patients operated for benign thyroid disease has been reported. We report our experience about incidental thyroid cancer (ITC) in order to better characterize this nosologic entity. Between 2001 and 2009 a total of 568 patients underwent surgery for benign thyroid disease. Patients with preoperative cytology undetermined or positive for malignancy were excluded. The most frequent indication for surgery was multinodular or diffuse nontoxic goiter. We performed total thyroidectomy in 499 cases and emithyroidectomy in 69 cases. Final histology revealed ITC in 53 patients (9.3%): 44 had papillary carcinoma (20 classic variant and 24 follicular variant), 4 follicular carcinoma, 4 medullary carcinoma and 1 primitive thyroid paraganglioma. The preoperative diagnosis was multinodular or diffuse goiter in 45 cases of ITC and uninodular goiter in 8 cases. We performed total thyroidectomy in 46 case, emithyroidectomy in 4 patients with past history of lobectomy, emithyroidectomy in 3 patients with following radicalization and central neck dissection. In 14 patients the tumor was multifocal and in 12 of these patients the tumor foci were bilateral. The lesion was a microcarcinoma in 34 cases. Mean diameter of the ITC was 1.14 cm. We retrospectively reconsidered the results of preoperative ultrasound examinations in relation to the exact position of the tumor in the specimens and we found a statistically significant association between echogenicity and papillary histotype. Twenty-six patients were followed up at our Hospital. The mean follow-up period was 38.2 months. A relapse was observed in 3/26 patients. Incidental thyroid cancer in patients operated for benign disease has its own surgical and oncological relevance. A correct preoperative assessment, with a careful selection of nodules for fine-needle aspiration cytology on the basis of ultrasound pattern, could better address the choice of surgical procedure. The non irrelevant incidence of incidental thyroid cancer, the eventuality of multifocality and bilaterality and the possible occurrence of relapse, support that total thyroidectomy without residuum is a valuable option for treating benign thyroid conditions such as multinodular goitre. When an incidental cancer is diagnosed after emithyroidectomy, a radicalization with central neck dissection could be considered. We suggest that natural history of papillary microtumors and the correct surgical approach for these lesions could be better defined with a more extensive use of "Porto proposal" criteria. PMID:23463928

Costamagna, D; Pagano, L; Caputo, M; Leutner, M; Mercalli, F; Alonzo, A

196

Surgical outcome of hepatocellular carcinoma patients with biliary tumor thrombi  

PubMed Central

Background To investigate the surgical outcome of hepatocellular carcinoma (HCC) patients with biliary tumor thrombi (BTT). Methods Surgical outcome of 27 HCC patients with BTT (group I) were compared with randomly selected HCC patients without BTT (group II; n = 270). Results One patient in group I died of hepatic failure within 30 days after resection. The 1-, 3- and 5-year cumulative survival rates of group I were 70.3%, 25.9%, and 7.4%, respectively; these were significantly lower than those of group II (90.6%, 54.0%, and 37.7%) (P <0.001). The rates of early recurrence (? 1 year) after resection were significantly higher in group I than group II (70.3% vs. 34.8%) (P < 0.001). Conclusion HCC patients with BTT had a worse prognosis after resection than those without BTT. Resection should be considered for these tumors given the lack of effective alternative therapies.

2011-01-01

197

Postoperative Arrhythmias in General Surgical Patients  

PubMed Central

INTRODUCTION New-onset arrhythmias are a common problem in cardiothoracic surgery. They are also common following major non-cardiac surgery. This review examines the available literature to establish the incidence and significance of new-onset arrhythmias following major non-cardiothoracic surgery. MATERIALS AND METHODS A literature search was performed using the Medline and Pubmed databases using the terms ‘postoperative arrhythmia’, ‘peri-operative arrhythmia’, ‘atrial fibrillation/flutter’, ‘supraventricular arrhythmia/tachycardia’, ‘cardiac complications’ and ‘non-cardiothoracic surgery’. Articles were cross-referenced for additional relevant publications and reviewed for data regarding new-onset arrhythmias following major non-cardiothoracic surgery. RESULTS There was considerable heterogeneity in the literature regarding cardiac monitoring, types of arrhythmias considered and potential associations investigated, thus hindering interpretation. The available data suggest that new-onset arrhythmias affect about 7% of patients following major non-cardiothoracic surgery. These arrhythmias are often associated with other underlying complications.

Walsh, Stewart R; Tang, Tjun; Wijewardena, Chandana; Yarham, Sahah I; Boyle, Jonathan R; Gaunt, Michael E

2007-01-01

198

Surgical outcome of 21 patients with congenital upper eyelid coloboma  

PubMed Central

AIM To evaluate the surgical outcome of congenital upper eyelid coloboma repair. METHODS All patients underwent complete ophthalmic and general examination before going to surgery, and then examination under anesthesia was performed to assess the site and size of eyelid defect, conjunctival involvement. The status of cornea and ocular motility with forced duction test was also being noted. The surgical procedure was performed according to the size of defect. RESULTS Out of 21 cases of congenital upper eyelid coloboma, 18 occurred in isolation with upper eyelid medial defect, 13 were bilateral and 5 were unilateral. Others were associated with Goldenhar syndrome and CHARGE syndrome with bilateral upper lid medial defects. All patients were presented for surgical corrections during age of 2.5-4.0 years except one that presented at 25 years of age. Cosmetically surgical results were acceptable, except one that was already presented with opaque corneal. CONCLUSION In this study, overall surgical results were satisfactory except one that was presented late with compromised cornea.

Lodhi, Arshad Ali; Junejo, Sameen Afzal; Khanzada, Mahtab Alam; Sahaf, Imran Akram; Siddique, Zahid Kamal

2010-01-01

199

Medical and surgical advances in the radical prostatectomy patient  

Microsoft Academic Search

Maintaining the quality of life after surgery in the radical prostatectomy patient is of paramount importance. One of the major dilemmas in surgical management of radical retropubic prostatectomy (RRP) is preservation of the neurovascular bundle and, hence, erectile function and the continence mechanism. This manuscript addresses anatomical considerations for the surgeon and discusses the following issues with regard to medical

A Nehra

2000-01-01

200

Surgical treatment of supraventricular arrhythmias. Results in 67 patients.  

PubMed Central

Over 6 years, recurrent drug-refractory supraventricular arrhythmias were treated by electrophysiologically guided surgical procedures in 67 patients. There were 57 patients, age 10-72 years, with accessory pathways who had 61 operations. The perioperative mortality rate was 3.5%, with deaths occurring in two patients with complex problems. Four patients with multiple but one or more silent accessory pathways had successful reoperation, and modified surgical technique has eliminated this problem. All patients are free of arrhythmias 2-70 months after operation. The survival and primary cure rates were 100% for 36 patients with solitary accessory pathways. Eight patients, age 10-53 years, were operated on for atrial focal tachycardia. Right atrial cryothermic lesions without excision or cardiopulmonary bypass were used in four patients: local excision was used in two patients and combined procedures were used in two patients. Because of recurrence in two of four patients treated by isolated cryoablation, a new technique was applied subsequently to one of these patients and two other patients: wide atrial excision and PTFE patch replacement during cardiopulmonary bypass. All patients are free of arrhythmias at a follow-up of 9-72 months. Intractable atrial flutter or fibrillation occurred in 11 patients who had 15 attempts at transvenous A-V node electroshock ablation. In three patients in whom this failed, subsequent open cryoablation of the A-V node during cardiopulmonary bypass and epicardial pacemaker implantation were performed successfully. Two patients had A-V nodal modification for control of A-V nodal re-entry tachycardia: one patient with cryothermia at the time of ablation of atrial focal tachycardia and the other patient with sharp dissection at the time of accessory pathway division. Of the initial 67 patients, 65 (97%) survived operation and all were cured of their presenting arrhythmia. Surgery for drug-refractory supraventricular arrhythmias is safe and effective in selected cases.

Lawrie, G M; Lin, H T; Wyndham, C R; DeBakey, M E

1987-01-01

201

Anesthetic implications of obesity in the surgical patient.  

PubMed

The obese patient presents many challenges to both anesthesiologist and surgeon. A good understanding of the pathophysiologic effects of obesity and its anesthetic implications in the surgical setting is critical. The anesthesiologist must recognize increased risks and comorbidities inherent to the obese patient and manage accordingly, optimizing multisystem function in the perioperative period that leads to successful outcomes. Addressed from an organ systems approach, the purpose of this review is to provide surgical specialists with an overview of the anesthetic considerations of obesity. Minimally invasive surgery for the obese patient affords improved analgesia, postoperative pulmonary function, and shorter recovery times at the expense of a more challenging intraoperative anesthetic course. The physiologic effects of laparoscopy are discussed in detail. Although laparoscopy's physiologic effects on various organ systems are well recognized, techniques provide means for compensation and reversing such effects, thereby preserving good patient outcomes. PMID:23204937

Dority, Jeremy; Hassan, Zaki-Udin; Chau, Destiny

2011-12-01

202

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

Microsoft Academic Search

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

Joakim de Man Lapidoth; Ata Ghaderi; Claes Norring

2008-01-01

203

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

204

Oncoplastic surgery and cancer relapses: Cosmetic and oncological results in 489 patients.  

PubMed

During the past 20 years, breast conservation has become the preferred treatment modality for breast carcinoma, and in recent times there is an increased expectation from breast cancer patients to retain their "normal breast appearance". For large tumor-to-breast ratio excision, the subspecialty of oncoplastic surgery is born, helping to achieve a good oncologic and esthetic result. In our study we have considered 767 patients undergone a mastectomy or quadrantectomy, and especially 489 undergone quadrantectomy. We have used our protocol for breast reshaping and analyzed our data in terms of oncologic safety and esthetic results. Considering the lesions, they were placed like this: 214 (44%) in the SEQ, 58 lesions (12%) in the SIQ, 54 lesions (11%) in the IEQ, 24 lesions (5%) in the IIQ, 45 lesions (9%) respectively in the CQ and between the SQ, 39 lesions (8%) between the EQ, 5 lesions (1%) respectively between the internal quadrants and between the inferior quadrants. We have chosen simple breast reshapings in case of operations on the superior quadrants, while, in case of operations on the inferior quadrants, we have chosen complex techniques, like reshapings according to a "key hole" reductive mammaplasty, which requires also a contralateral reshaping. We have done simple and monolateral reshapings respectively in 372 (76%) and 296 (60.5%) cases. We have had early complications in 98 (20%) cases: 12 infections (2.4%), 10 hematomas (2%), 11 seromas (2.2%), 65 liponecrosis. As late complications, we have found scar retractions and minus areas in 20 cases (4.08%), while we have found asymmetries and bigger deformities in 34 cases (6.95%). We have not found any cancer relapse after one year of follow up, while we have had 3 cases of relapse (0.6%) after 5 years of follow up, respectively after 5, 4 and 2 years. This result has to be attributed to our preoperatory project of surgery derived from many factors, among which stands out the MRI done in all the cases. We think that an immediate breast reshaping following quadrantectomy is the best esthetic and psychologic option for breast cancer patients. PMID:23849934

Semprini, G; Cattin, F; Vaienti, L; Brizzolari, M; Cedolini, C; Parodi, P C

2013-07-09

205

Therapeutic Hypothermia after Perioperative Cardiac Arrest in Cardiac Surgical Patients  

PubMed Central

BACKGROUND Therapeutic hypothermia (TH) has been established as an effective treatment for preserving neurological function after out of hospital cardiac arrest (CA). Use of TH has been limited in cardiac surgery patients in particular because of concern about adverse effects such as hemorrhage and dysrhythmia. Little published data describe efficacy or safety of TH in cardiac surgical patients who suffer unintentional CA. However, the benefits of TH are such as may suggest clinical equipoise, even in this high risk patient population. OBJECTIVE To report a series of three patients in our institution’s cardiac surgery intensive care unit who suffered unintentional CA within 48 hours of cardiac surgery and were treated with TH. METHODS After institutional review board approval, study patients were identified by diagnosis of undesired intraoperative CA or arrest on ICU days 1–2, as well as having documented TH. The institution’s electronic medical record and the Society of Thoracic Surgeons database were retrospectively reviewed for demographic information, comorbid diagnoses, surgical procedure, and outcomes including hemorrhage, re-warming dysrhythmias, infection, in-hospital mortality, and neurologic outcome were assessed. TH was initiated and monitored using active cooling pads according to written institutional protocol. RESULTS Four patients received TH after perioperative arrest. One patient was inadequately cooled and had massive surgical bleeding, and was therefore excluded from this review. The remaining three patients had a predicted mortality of 14.6% (±13.3) based on Euroscore calculation, and were cooled for 17.6±4.0 hours after CA. Coagulopathy, hypovolemia, severe electrolyte abnormalities, and re-warming dysrhythmias were not identified in any patient. 2 patients were discharged home and 1 was discharged to a long-term care facility. CONCLUSION Herein we report the safe and successful use of TH after unintentional perioperative CA in 3 cardiac surgery patients. These data suggest that further investigation of this therapy may be warranted given the potential benefit and apparent safety in a small series.

Rinehart, Thomas W.; Merkel, Matthias J.; Schulman, Peter M.; Hutchens, Michael P.

2013-01-01

206

Therapeutic Hypothermia after Perioperative Cardiac Arrest in Cardiac Surgical Patients.  

PubMed

BACKGROUND: Therapeutic hypothermia (TH) has been established as an effective treatment for preserving neurological function after out of hospital cardiac arrest (CA). Use of TH has been limited in cardiac surgery patients in particular because of concern about adverse effects such as hemorrhage and dysrhythmia. Little published data describe efficacy or safety of TH in cardiac surgical patients who suffer unintentional CA. However, the benefits of TH are such as may suggest clinical equipoise, even in this high risk patient population. OBJECTIVE: To report a series of three patients in our institution's cardiac surgery intensive care unit who suffered unintentional CA within 48 hours of cardiac surgery and were treated with TH. METHODS: After institutional review board approval, study patients were identified by diagnosis of undesired intraoperative CA or arrest on ICU days 1-2, as well as having documented TH. The institution's electronic medical record and the Society of Thoracic Surgeons database were retrospectively reviewed for demographic information, comorbid diagnoses, surgical procedure, and outcomes including hemorrhage, re-warming dysrhythmias, infection, in-hospital mortality, and neurologic outcome were assessed. TH was initiated and monitored using active cooling pads according to written institutional protocol. RESULTS: Four patients received TH after perioperative arrest. One patient was inadequately cooled and had massive surgical bleeding, and was therefore excluded from this review. The remaining three patients had a predicted mortality of 14.6% (±13.3) based on Euroscore calculation, and were cooled for 17.6±4.0 hours after CA. Coagulopathy, hypovolemia, severe electrolyte abnormalities, and re-warming dysrhythmias were not identified in any patient. 2 patients were discharged home and 1 was discharged to a long-term care facility. CONCLUSION: Herein we report the safe and successful use of TH after unintentional perioperative CA in 3 cardiac surgery patients. These data suggest that further investigation of this therapy may be warranted given the potential benefit and apparent safety in a small series. PMID:23420469

Rinehart, Thomas W; Merkel, Matthias J; Schulman, Peter M; Hutchens, Michael P

2012-11-01

207

Oncologic imaging  

SciTech Connect

This book presents papers on nuclear medicine. Topics considered include the classification of cancers, oncologic diagnosis, brain and spinal cord neoplasms, lymph node metastases, the larynx and hypopharynx, thyroid cancer, breast cancer, esophageal cancer, bladder cancer, tumors of the skeletal system, pediatric oncology, computed tomography and radiation therapy treatment planning, and the impact of future technology on oncologic diagnosis.

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

1985-01-01

208

A multiplex cytokine score for the prediction of disease severity in pediatric hematology/oncology patients with septic shock.  

PubMed

Although many inflammatory cytokines are prognostic in sepsis, the utility of cytokines in evaluating disease severity in pediatric hematology/oncology patients with septic shock was rarely studied. On the other hand, a single particular cytokine is far from ideal in guiding therapeutic intervention, but combination of multiple biomarkers improves the accuracy. In this prospective observational study, 111 episodes of septic shock in pediatric hematology/oncology patients were enrolled from 2006 through 2012. Blood samples were taken for inflammatory cytokine measurement by cytometric bead array (CBA) technology at the initial onset of septic shock. Interleukin (IL)-6 and IL-10 were significantly elevated in majority of patients, while tumor necrosis factor (TNF)-? and interferon (IFN)-? were markedly increased in patients with high pediatric index of mortality 2 (PIM2) score and non-survivors. All the four cytokines paralleled the PIM2 score and differentially correlated with hemodynamic disorder and fatal outcomes. The pediatric multiplex cytokine score (PMCS), which integrated the four cytokines into one score system, was related to hemodynamic disorder and mortality as well, but showed more powerful prediction ability than each of the four cytokines. PMCS was an independent predictive factor for fatal outcome, presenting similar discriminative power with PIM2, with accuracy of 0.83 (95% CI, 0.71-0.94). In conclusion, this study develops a cytokine scoring system based on CBA technique, which performs well in disease severity and fatality prediction in pediatric hematology/oncology patients with septic shock. PMID:24051223

Xu, Xiao-Jun; Tang, Yong-Min; Song, Hua; Yang, Shi-Long; Xu, Wei-Qun; Shi, Shu-Wen; Zhao, Ning; Liao, Chan

2013-09-16

209

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

2013-06-01

210

[Latex Allergy in Patients Who Underwent Surgical Treatment. Case series].  

PubMed

Latex allergy is an underdiagnosed condition, and it is the second cause of perioperative anaphylaxis. This condition represents a clinical challenge due to the severity of reactions caused by the exposure to latex in allergic individuals. It is necessary to know the risk factors in order to suspect the diagnosis of latex allergy, and to apply the preventive measures in the medical care of patients allergic to latex. Other safety measures and pre-medication, as avoiding objects and medical equipment made of latex, should be taken since they can cause anaphylaxis. We present six cases of patients with latex allergy, who underwent surgical procedures. In five of them with positive skin test with latex, we used preventive measures and pre-medication 72 hours before and 48 hours after surgery. Only one patient, a sixty year old woman, with urticaria related to kiwi, avocado and potatoes, who was surgically intervened without pre-medication, presented grade IV anaphylaxis. PMID:24007963

Campos-Romero, Freya Helena; Mendoza-Reyna, Laura Dafne; Guillen-Rocha, Nelva Lizbeth; Segura-Mèndez, Nora Hilda

211

[Surgical treatment of patients with disseminated and progressing pulmonary tuberculosis].  

PubMed

The results of surgical treatment have been summarized for 97 patients with disseminated progressive and complicated tuberculosis associated with respiratory disorders. Of them, 89 (91.8%) had fibrous-cavernous disease and empyema, 72.2% exhibited bilateral advanced process. Noticeable disturbances of ventilation capacity were registered in 47 patients, grave ones in 22 cases. Restrictive and obstructive types predominated. External respiration was impaired most seriously when the process was disseminated and progressive. Respiratory failure increased with growing rates of the disease progression. Pulmonectomy was performed in 58, primary and staged trans-sternal transpericardial occlusions of the main bronchi in 25 cases. The effect was reached in 83.5%, 16.5% of patients died. Lethal outcomes occurred due to bronchopleural complications in 43.8%, pulmonary artery thromboembolism in 18.7% of surgical cases. It is inferred that pulmonary dysfunction cannot be a principal criterion for rejecting operative treatment in progressive and complicated pulmonary tuberculosis. PMID:8295880

Naumov, V N; Karaeva, G B

1993-01-01

212

Mitral Valve Disease Presentation and Surgical Outcome in African-American Patients Compared With White Patients  

Microsoft Academic Search

Background. Disparities associated with race, particu- larly African-American race, in access to medical and surgical care for patients with cardiac disease have pre- viously been documented. The purpose of this study was to determine the presentation, etiology, and hospital outcome differences between African-American patients and white patients with regard to surgically corrected mitral valve disease. Methods. All 1,425 adult patients

Paul L. DiGiorgi; F. Gregory Baumann; Anne M. O'Leary; Charles F. Schwartz; Eugene A. Grossi; Greg H. Ribakove; Stephen B. Colvin; Aubrey C. Galloway; Juan B. Grau

2010-01-01

213

Clinical Outcomes of 54 Pelvic Osteosarcomas Registered by Japanese Musculoskeletal Oncology Group  

Microsoft Academic Search

Background: To determine the clinical outcomes in patients with pelvic osteosarcoma, we reviewed the experience with 54 pelvic osteosarcoma patients. Methods: Thirty-five patients underwent surgical treatment with 30 undergoing limb salvage procedures and 5 requiring hemipelvectomies. Results: Oncological outcome was continuously disease free in 12 cases, no evidence of disease in 3, alive with disease in 3, died of disease

Toshihiro Matsuo; Takashi Sugita; Keiji Sato; Tetsuo Hotta; Hiroyuki Tsuchiya; Shoji Shimose; Tadahiko Kubo; Mitsuo Ochi

2005-01-01

214

The importance and provision of oral hygiene in surgical patients.  

PubMed

The provision of mouth care on the general surgical ward and intensive care setting has recently gained momentum as an important aspect of patient care. Oropharyngeal morbidity can cause pain and disordered swallowing leading to reluctance in commencing or maintaining an adequate dietary intake. On the intensive care unit, aside from patient discomfort and general well-being, oral hygiene is integral to the prevention of ventilator-associated pneumonia. Chlorhexidine (0.2%) is widely used to decrease oral bacterial loading, dental bacterial plaque and gingivitis. Pineapple juice has gained favour as a salivary stimulant in those with a dry mouth or coated tongue. Tooth brushing is the ideal method of promoting oral hygiene. Brushing is feasible in the vast majority, although access is problematic in ventilated patients. Surgical patients undergoing palliative treatment are particularly prone to oral morbidity that may require specific but simple remedies. Neglect of basic aspects of patient care, typified by poor oral hygiene, can be detrimental to surgical outcome. PMID:18947816

Ford, Samuel J

2007-01-13

215

Development of a respite care program for caregivers of pediatric oncology patients and their siblings.  

PubMed

Children with chronic health care needs, including those with cancer, require complex care under direct caregiver supervision. This intensive care management may result in increased stress and psychological distress for the caregiver and family. Respite care services are needed in providing alleviation of caregiver stress among families of children with complex health care needs. This report describes the feasibility of a pilot hospital-based respite care program for caregivers of pediatric oncology patients and their siblings and development of a permanent, expanded service to include both inpatient and outpatient units under the supervision of hospital volunteer services. During the feasibility pilot, 39 respite care requests were made by caregivers for care of patients, with 67% of these requests for care of infants and toddlers. The respite care providers were hospital volunteers. Reasons for the caregiver respite care request included a need to leave the hospital for running an errand, eating a meal, taking a mental break, or talking with the medical team. At the completion of the pilot, caregivers and staff were surveyed and expressed a strong desire for continuation of the service. The success of the pilot led to the implementation of a formal respite care program, Helping Hands, which provides services 7 days a week for inpatients, outpatients, and their siblings. Although this respite care service is specific to children with cancer, the program model is feasible within most pediatric care facilities. PMID:23358697

Carter, Kathryn Berry; Mandrell, Belinda N

2013-01-28

216

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

217

Surgical correction of blepharoptosis in patients with myasthenia gravis.  

PubMed Central

PURPOSE: To describe the results of surgical correction of blepharoptosis in a series of patients with myasthenia gravis. METHODS: We reviewed the medical records of all patients with myasthenia gravis who underwent surgical correction for blepharoptosis at the Mayo Clinic between 1985 and 1999. The primary outcome measure was change in interpalpebral eyelid fissure height. RESULTS: Eighteen blepharoptosis procedures were performed on 11 patients with myasthenia gravis. Eight of the 11 patients had ocular myasthenia gravis, and 3 had systemic myasthenia gravis. Of the 18 procedures performed, 11 were external levator advancements (ELA), 6 were frontalis slings, and 1 was a tarsomyectomy. Patients were followed up postoperatively for an average of 34 months (range, 9 to 126 months). The amount of ptosis was quantified preoperatively and postoperatively for 9 of the 11 eyelids that underwent ELA. For these eyelids, there was a statistically significant improvement in the mean interpalpebral eyelid fissure height, from 4.2 mm preoperatively to 8.1 mm postoperatively, with a mean difference of 3.9 mm (95% confidence interval, 2.3 to 5.5 mm; P = .0005). Postoperative complications included worsened diplopia in 1 patient who underwent ELA and exposure keratopathy in 1 patient who underwent a frontalis sling procedure. Two of the eyelids that underwent ELA developed recurrent ptosis, requiring additional surgery more than 2 years after the initial procedure. CONCLUSION: Surgical correction of blepharoptosis is an appropriate treatment option in patients with myasthenia gravis who fail medical therapy. Potential complications include worsened diplopia and exposure keratopathy. Images FIGURE 1A FIGURE 1B FIGURE 2A FIGURE 2B FIGURE 3A FIGURE 3B FIGURE 3C FIGURE 3D FIGURE 3E FIGURE 3F FIGURE 3G FIGURE 3H FIGURE 4A FIGURE 4B FIGURE 4C FIGURE 4D FIGURE 1A,B FIGURE 2A,B

Bradley, E A; Bartley, G B; Chapman, K L; Waller, R R

2000-01-01

218

International society of geriatric oncology (SIOG) clinical practice recommendations for the use of bisphosphonates in elderly patients  

Microsoft Academic Search

A society of geriatric oncology (SIOG) task force reviewed information from the literature (in PubMed) on bisphosphonates in elderly patients with bone metastases until December 2005. Additional pertinent data were obtained from the manufacturers.Bisphosphonates are recommended in the elderly with bone metastases to prevent skeletal-related events. Intravenous formulations are preferred for the treatment of hypercalcaemia. It has been recognised that

Jean-Jacques Body; Rob Coleman; Philippe Clezardin; Carla Ripamonti; Rene Rizzoli; Matti Aapro

2007-01-01

219

"Renal dose" dopamine in surgical patients: dogma or science?  

PubMed Central

OBJECTIVE: "Renal dose" dopamine is widely used in the perioperative period to provide renal protection. A comprehensive review of the literature was performed to determine whether dopamine does in fact confer protection on the kidneys of surgical patients. SUMMARY BACKGROUND DATA: Studies in healthy animals and human volunteers reveal that dopamine causes diuresis and natriuresis, as well as some degree of renal vasodilatation. RESULTS: Studies of the perioperative use of dopamine fail to demonstrate any benefit of dopamine in preventing renal failure. Studies in congestive heart failure, critical illness, and sepsis also fail to show any benefit of dopamine other than diuresis. Further, dopamine administration is not completely without risk, because of dopamine's catecholamine and neuroendocrine functions. CONCLUSIONS: Routine use of prophylactic "renal dose" dopamine in surgical patients is not recommended.

Perdue, P W; Balser, J R; Lipsett, P A; Breslow, M J

1998-01-01

220

Translational oncology toward benefiting cancer patients: the Sun Yat-sen University Cancer Center experience.  

PubMed

Sun Yat-sen University Cancer Center (SYSUCC) is currently conducting many translational studies to improve cancer patients' condition through early diagnosis, discovering new treatments, improving treatment outcomes, and better classification and prognosis of cancer. SYSUCC is a leading institution for treating nasopharyngeal carcinoma (NPC) and carrying out research into the disease. The center has performed several large-scale studies that have produced new insights, such as a genome-wide analysis study, which has allowed researchers to identify new genetic risk factors for NPC; the findings are significant toward building a risk prediction model for NPC. Other researchers are using molecular biological methods to identify new biomarkers, which will allow a better classification and prognosis of this disease. Drug discovery, especially for molecular targeted therapy, is also an active field of research at SYSUCC, not only for NPC treatment, but also for, among others, cancers of the head, neck, and liver. As an alternative to Western medicine, scientists also use derivatives of natural products from Traditional Chinese Medicine to develop new compounds. The tumor biobank at SYSUCC, one of the largest in China, play an essential role in producing clinical applications from research findings. Translational oncology is a promising field, and scientists and clinicians from SYSUCC will continue to work in synergy to develop new anticancer therapies. PMID:23132500

Guerin, Mathilde; Qian, Chaonan; Zhong, Qian; Cui, Qian; Guo, Yunmiao; Bei, Jinxin; Shao, Jianyong; Zhu, Xiaofeng; Huang, Wenlin; Wu, Jiangxue; Liu, Ranyi; Liu, Qiang; Wang, Jing; Jia, Weihua; Zheng, Xiaohui; Zeng, Yixin

2012-11-01

221

The use of probiotics in the surgical patient  

Microsoft Academic Search

Summary  BACKGROUND: The intestinal microflora is thought to be the origin for many infectious complications seen in surgical conditions,\\u000a due to dysfunction of the intestinal barrier and bacterial translocation. Probiotics may produce beneficial effects on the\\u000a intestinal barrier function and help reduce the incidence of infectious complications in this group of patients. METHODS:\\u000a Medical databases were searched for randomised controlled studies

C. P. Moran; S. A. Musa; T. M. Rahman

222

Vitamin D and the Bariatric Surgical Patient: A Review  

Microsoft Academic Search

Objective  Adiposity has been inversely associated with vitamin D concentration across a range of body mass index values and cultural\\u000a groups. As obesity has increased markedly worldwide, a greater number of patients with severe obesity have been treated with\\u000a gastric restrictive and\\/or malabsorptive surgical procedures. The purpose of this review was to describe current knowledge\\u000a about vitamin D and severe obesity,

Charlene W. Compher; Karen O. Badellino; Joseph I. Boullata

2008-01-01

223

Should Patients and Family be Involved in "Do Not Resuscitate" Decisions? Views of Oncology and Palliative Care Doctors and Nurses  

PubMed Central

Background: “Do not resuscitate” (DNR) orders are put in place where cardiopulmonary resuscitation is inappropriate. However, it is unclear who should be involved in discussions and decisions around DNR orders. Aim: The aim was to determine the views of oncology and palliative care doctors and nurses on DNR orders. Materials and Methods: A questionnaire survey was conducted on 146 doctors and nurses in oncology and palliative care working within a tertiary specialist cancer center in Singapore. Results: Perceived care differences as a result of DNR determinations led to 50.7% of respondents reporting concerns that a DNR order would mean that the patient received a substandard level of care. On the matter of DNR discussions, majority thought that patients (78.8%) and the next of kin (78.1%) should be involved though with whom the ultimate decision lay differed. There was also a wide range of views on the most appropriate time to have a DNR discussion. Conclusions: From the viewpoint of oncology and palliative care healthcare professionals, patients should be involved at least in discussing if not in the determination of DNR orders, challenging the norm of familial determination in the Asian context. The varied responses highlight the complexity of decision making on issues relating to the end of life. Thus, it is important to take into account the innumerable bio-psychosocial, practical, and ethical factors that are involved within such deliberations.

Yang, Grace M; Kwee, Ann K; Krishna, Lalit

2012-01-01

224

Racial Disparities in Cancer Survival Among Randomized Clinical Trials Patients of the Southwest Oncology Group  

PubMed Central

Background Racial disparities in cancer outcomes have been observed in several malignancies. However, it is unclear if survival differences persist after adjusting for clinical, demographic, and treatment variables. Our objective was to determine whether racial disparities in survival exist among patients enrolled in consecutive trials conducted by the Southwest Oncology Group (SWOG). Methods We identified 19?457 adult cancer patients (6676 with breast, 2699 with lung, 1244 with colon, 1429 with ovarian, and 1843 with prostate cancers; 1291 with lymphoma; 2067 with leukemia; and 2208 with multiple myeloma) who were treated on 35 SWOG randomized phase III clinical trials from October 1, 1974, through November 29, 2001. Patients were grouped according to studies of diseases with similar histology and stage. Cox regression was used to evaluate the association between race and overall survival within each disease site grouping, controlling for available prognostic factors plus education and income, which are surrogates for socioeconomic status. Median and ten-year overall survival estimates were derived by the Kaplan–Meier method. All statistical tests were two-sided. Results Of 19?457 patients registered, 2308 (11.9%, range = 3.9%–21.6%) were African American. After adjustment for prognostic factors, African American race was associated with increased mortality in patients with early-stage premenopausal breast cancer (hazard ratio [HR] for death = 1.41, 95% confidence interval [CI] = 1.10 to 1.82; P = .007), early-stage postmenopausal breast cancer (HR for death = 1.49, 95% CI = 1.28 to 1.73; P < .001), advanced-stage ovarian cancer (HR for death = 1.61, 95% CI = 1.18 to 2.18; P = .002), and advanced-stage prostate cancer (HR for death = 1.21, 95% CI = 1.08 to 1.37; P = .001). No statistically significant association between race and survival for lung cancer, colon cancer, lymphoma, leukemia, or myeloma was observed. Additional adjustments for socioeconomic status did not substantially change these observations. Ten-year (and median) overall survival rates for African American vs all other patients were 68% (not reached) vs 77% (not reached), respectively, for early-stage, premenopausal breast cancer; 52% (10.2 years) vs 62% (13.5 years) for early-stage, postmenopausal breast cancer; 13% (1.3 years) vs 17% (2.3 years) for advanced ovarian cancer; and 6% (2.2 years) vs 9% (2.7 years) for advanced prostate cancer. Conclusions African American patients with sex-specific cancers had worse survival than white patients, despite enrollment on phase III SWOG trials with uniform stage, treatment, and follow-up.

Unger, Joseph M.; Crowley, John J.; Coltman, Charles A.; Hershman, Dawn L.

2009-01-01

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

Fiberoptic colonoscopic examination in surgical patients with colorectal cancer.  

PubMed

A diagnostic and surveillance program using colonscopy in patients with colorectal cancer was established at North Carolina Memorial Hospital. The records of all patients who had preoperative or postoperative colonoscopic examination between 1976 and 1979 were reviewed. Fifty-five patients had colonscopic examination preoperatively. No additional disease was found in 39. In 15 patients, unsuspected additional disease was detected, and one patient had a suspected polyp ruled out by colonoscopic examination. One of these patients was found to have a synchronous primary cancer, not demonstrated by barium enema. Surgical treatment was modified in nine (16%) of these 55 patients by the preoperative colonoscopic findings. Sixty patients had colonoscopy six months to six years postoperatively. No additional disease was found in 47. Adenomatous polyps were found in eight. Two patients had recurrent cancer proved by colonoscopy, and three had a second primary cancer detected only by colonoscopy. Treatment was directly influenced by colonoscopy in eight (13.3%) of these 60 patients. These studies had a favorable cost/benefit ratio in patients with colorectal cancer and support a program of preoperative colonoscopy in patients with colorectal cancer and reexamination within two to three years after operation. PMID:6769165

Herbst, C A; Sessions, J T; Lapis, J L

1980-05-01

227

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

228

Surgical management in patients with pancreatic cancer: a Queensland perspective.  

PubMed

BACKGROUND: Little has been published regarding presenting symptoms, investigations and outcomes for patients with pancreatic cancer in Australia. Data from a series of patients undergoing attempted resection in Queensland, Australia, are presented with the aim of assisting development of consistent strategies in disease management. METHODS: We reviewed the medical records of 121 patients who underwent attempted surgical resection and who took part in a case-control study between 2007 and 2009. Information relating to symptoms, investigations, surgical procedures and outcomes was captured. RESULTS: The mean age was 63 years and 60% were men. The most common presenting symptoms were jaundice (64%) and pain (63%). Over 80% of patients had multiple imaging investigations or laparoscopy prior to surgery. Seventy-eight patients (64%) had a completed resection and 23% of these had involved margins. The presence of metastases and/or involvement of vessels or adjacent structures precluded resection in the remaining patients. The 1-year survival for patients whose resections were completed was 77% compared with 51% for those whose tumours were not resectable (P?=?0.004). There was no 30-day mortality and 68% of patients were alive 1 year after diagnosis. Resections were performed in 11 different hospitals but over 90% of patients underwent their surgery in one of five high-volume centres. CONCLUSION: The Queensland experience is consistent with that reported internationally. A significant proportion of attempted resections was not completed because preoperative staging underestimated disease extent. Most patients with potentially resectable disease are being treated in high-volume centres. PMID:23095039

Wylie, Neil; Adib, Reza; Barbour, Andrew P; Fawcett, Jonathan; Hill, Alexander; Lynch, Stephen; Martin, Ian; O'Rourke, Thomas R; Puhalla, Harald; Rutherford, Leigh; Slater, Kellee; Whiteman, David C; Neale, Rachel E

2012-10-24

229

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

PubMed Central

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

Sternick, Edward S.

2011-01-01

230

Amino acid metabolism and inflammatory burden in ovarian cancer patients undergoing intense oncological therapy  

PubMed Central

Background & Aims Cancer and oncological therapy are associated with a progressive physical deterioration, malnutrition, and enhanced inflammatory burden. Our considerable data showing the strong anabolic potential of amino acids led us to test whether amino acids can acutely stimulate muscle protein synthesis in cancer patients (CA) undergoing intense chemotherapy. Methods Mixed muscle fractional synthesis rate (FSR), rates of phenylalanine appearance and disappearance (Ra and Rd), and net phenylalanine balance (NB) were measured during a primed constant infusion of L-[ring-2H5]phenylalanine. Blood and muscle tissue samples were collected in the basal state and following ingestion of 40 g of amino acids (AA) given in 30 mL boluses every 10 minutes for 3 hours. Serum and tissue cytokines and NF-?B expression in skeletal muscle were measured and compared to normative, healthy older controls (OC). Results Skeletal muscle TNF-?, IL-6, and NF-?B were elevated in CA. FSR and model-derived protein synthesis (Rd) increased significantly from basal to AA (FSR: 0.052 ± 0.009 vs. 0.120 ± 0.008 %•h-1, P<0.001; Rd: 23.1 ± 4.1 vs. 36.4 ± 5.0 nmol•min-1•100mL leg-1, P?0.05). Model-derived protein breakdown (Ra) remained unchanged from basal to AA.. Phenylalanine NB improved from a negative basal value (-16 ± 2) to zero (0.8 ± 6 nmol•min-1•100 ml leg-1, P?0.05) following AA. Conclusion Despite advanced cancer, ongoing therapy, and an enhanced inflammatory burden, amino acids were capable of acutely stimulating muscle protein synthesis in these patients.

Lichar Dillon, E.; Volpi, Elena; Wolfe, Robert R.; Sinha, Sandeep; Sanford, Arthur P.; Arrastia, Concepcion D.; Urban, Randall J.; Casperson, Shanon L.; Paddon-Jones, Douglas; Sheffield-Moore, Melinda

2007-01-01

231

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

PubMed

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

Shannahoff-Khalsa, David S

2005-03-01

232

Thoracic wall defects: surgical management of 205 consecutive patients  

SciTech Connect

In this article, we review our experience during the past 9 years with 205 consecutive thoracic wall reconstructions. The 100 female and 105 male patients ranged in age from 12 to 85 years (mean, 53.4 years). One hundred fourteen patients had thoracic wall tumors, 56 had radiation necrosis, 56 had infected median sternotomy wounds, and 8 had costochondritis. Twenty-nine of these patients had combinations of the aforementioned conditions. One hundred seventy-eight patients underwent skeletal resection. A mean of 5.4 ribs were resected in 142 patients. Total or partial sternectomies were performed in 60. Skeletal defects were closed with prosthetic material in 66 patients and with autogenous ribs in 12. One hundred sixty-eight patients underwent 244 muscle flap procedures: 149 pectoralis major, 56 latissimus dorsi, 14 rectus abdominis, 13 serratus anterior, 8 external oblique, 2 trapezius, and 2 advancement of diaphragm. The omentum was transposed in 20 patients. The mean number of operations per patient was 1.9 (range, 1 to 8). The mean duration of hospitalization was 16.5 days. One perioperative death occurred (at 29 days). Four patients required tracheostomy. During a mean follow-up of 32.4 months, there were 49 late deaths, predominantly due to malignant disease. All 204 patients who were alive 30 days after operation had excellent surgical results at last follow-up examination or at the time of death due to causes unrelated to the reconstructive procedure.

Pairolero, P.C.; Arnold, P.G.

1986-07-01

233

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

234

Pulmonary hypertension in mitral valve disease: 56 surgical patients reviewed.  

PubMed Central

A total of 392 patients have undergone prosthetic valve surgery including the mitral valve over a four-year period (1972-76). Of these patients 56 (14%) had a pulmonary artery systolic pressure of 70 mmHg or more during preoperative cardiac catheterisation and the hospital mortality of this group was 5.4%. Similarly, the hospital mortality of the remaining 336 patients with a pulmonary artery pressure below 70 mmHg was 5.4%. The presence of pulmonary hypertension in patients with valve disease including the mitral valve does not therefore indicate that the risk of dying in hospital as a consequence of corrective surgery is increased. The absence of a raised hospital mortality in this recent series may be attributed to improved surgical techniques and materials, while the use of droperidol and pentolinium which may reduce pulmonary vascular resistance as well as systemic resistance during surgery could be contributory.

Manners, J M; Monro, J L; Ross, J K

1977-01-01

235

Nosocomial infections in an oncology intensive care unit  

Microsoft Academic Search

Introduction: Treatment of cancer has contributed to a growing number of immunocompromised patients with life-threatening nosocomial infections (NI). High mortality with considerable cost is observed when they are admitted to the intensive care unit (ICU). Few studies on infection control and surveillance have been undertaken in this population group.Methods: All patients treated at a six-bed medical-surgical oncology ICU for >48

Eduardo Velasco; Luiz Claudio Santos Thuler; Carlos Alberto de S. Martins; Leda Maria de Castro Dias; Vania Maria da S. e C. Gonçalves

1997-01-01

236

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

PubMed

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

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

2012-11-08

237

Low-grade mucosa-associated lymphoid tissue lymphoma: a retrospective analysis of 97 patients by the Hellenic Cooperative Oncology Group (HeCOG)  

Microsoft Academic Search

Background: The aim was to examine characteristics and treatment results of patients with mucosa-associated lymphoid tissue (MALT) non-Hodgkin's lymphomas. Patients and methods: Epidemiological and clinical features of 97 patients with MALT lymphoma from the Hellenic Cooperative Oncology Group registry were analysed retrospectively for their prognostic significance in progression- free survival (PFS) and overall survival (OS). Comparisons were made between patients

G. Papaxoinis; G. Fountzilas; D. Rontogianni; M. A. Dimopoulos; N. Pavlidis; C. Tsatalas; D. Pectasides; N. Xiros; T. Economopoulos

2008-01-01

238

Impact of Dedicated Brain PET on Intended Patient Management in Participants of the National Oncologic PET Registry  

Microsoft Academic Search

Purpose  This study seeks to assess the impact of dedicated brain positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-d-glucose on intended management of patients with primary and metastatic brain tumors.\\u000a \\u000a \\u000a \\u000a \\u000a Procedures  We analyzed demographic characteristics and evaluated change in intended management after PET, using previously described\\u000a metrics, for patients in the National Oncologic PET Registry (NOPR) undergoing dedicated brain PET. For cases of primary

Bruce E. Hillner; Barry A. Siegel; Anthony F. Shields; Fenghai Duan; Ilana F. Gareen; Lucy Hanna; R. Edward Coleman

2011-01-01

239

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

240

Intestinal mucosal injury in critically ill surgical patients: preliminary observations.  

PubMed

This was a prospective study designed to evaluate the extent to which intestinal mucosal compromise occurs in adult critical care patients with and without systemic inflammatory response syndrome (SIRS) and to correlate the degree of intestinal injury with outcome. Ten patients from a university hospital surgical intensive care unit were identified who manifested SIRS at the time of admission to the intensive care unit. Five other critical care patients without SIRS were also evaluated. The Acute Physiology and Chronic Health Evaluation II score was determined. Intestinal mucosal viability was assessed by serial measurement of serum and urine iFABP intestinal fatty acid binding protein (iFABP), a sensitive and specific marker for mucosal injury. Outcome in terms of the development of multiorgan dysfunction syndrome, adult respiratory distress syndrome, and survival was determined. iFABP was detectable in the serum or urine in 8 out of 10 patients with SIRS. Among the 4 patients with detectable serum iFABP, 2 died and 1 developed severe adult respiratory distress syndrome. Nine of 11 patients without detectable serum iFABP recovered without major morbidity. iFABP was detectable in most patients with SIRS, suggesting that subclinical intestinal mucosal compromise is a frequent component of this syndrome. When iFABP was detectable, particularly in the serum, the prognosis was poor, even in the absence of SIRS, indicating that iFABP may be a relevant and independent predictor of outcome in critical care patients. PMID:9915525

Gollin, G; Zieg, P M; Cohn, S M; Lieberman, J M; Marks, W H

1999-01-01

241

Surgical management of cleft lip in pedo-patients.  

PubMed

The Present article describes in short etiology of cleft lip and cleft palate. With this in-born defect, patient develops crucial problems with feeding, phonation, overall growth and development of affected and allied soft and hard tissue structures. This in turn results in deformity and asymmetry which is going to affect functional requirements as well as aesthetic outlook. Hence it really becomes mandatory to correct this defect surgically as early as possible, at stipulated timings so as to avoid present and future anticipated problems. PMID:1820390

Taware, C P; Kulkarni, S R

1991-01-01

242

Surgical outcome after spinal fractures in patients with ankylosing spondylitis  

PubMed Central

Background Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine. The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned. Methods Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge. Results Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries. Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement due to the operation performed. Conclusion The operative treatment of these injuries is useful and effective. It usually succeeds the improvement of the patients' neurological status. Taking into consideration the cardiovascular problems that these patients have, anterior and posterior stabilization aren't always possible. In these cases, posterior approach can be performed and give excellent results, while total operation time, blood loss and other possible complications are decreased.

Sapkas, George; Kateros, Konstantinos; Papadakis, Stamatios A; Galanakos, Spyros; Brilakis, Emmanuel; Machairas, George; Katonis, Pavlos

2009-01-01

243

The outcome of surgical fixation of mid shaft clavicle fractures; looking at patient satisfaction and comparing surgical approaches  

PubMed Central

Introduction: Clavicle fractures represent 2.5% of fractures in adults and almost 44% of shoulder injuries. The treatment is usually non-surgical with good results; however, significantly displaced fractures can be associated with high non-union rate and therefore many would advocate surgical fixation. This is traditionally carried out by direct approach over the clavicle but an infraclavicular approach has also been used for clavicular fixation. The aim of this study was to identify the main indications for surgical intervention at our unit and patient satisfaction following surgery. We also wanted to compare the direct and the infraclavicular surgical approaches in relation to the outcome of surgical intervention. Materials and Methods: Retrospective study looking at all the clavicle fractures managed surgically over 5 years at our department. Information relating to surgical indication, surgical approach, complications, outcome, patient satisfaction, and oxford shoulder score were collected. Results: A total of 35 patients were identified, the majority were males (n = 25) and most (n = 29) were working at the time of injury. The commonest indication for surgery was displacement with shortening (n = 16). The infraclavicular approach was used in the majority of patients (n = 21), the rest (n = 14) had direct incision. Evidence of radiological and union was achieved in all patients after an average of 13 (8-24) weeks. There were no major complications but minor complications were reported in 28% and 19% of cases with direct and infraclavicular approaches, respectively. Plates were removed from six symptomatic patients; infraclavicular (n = 2) and direct approach (n = 4). Four asymptomatic plates were removed on patients’ requests. All patients returned to work (after an average 2.6 months), had good oxford shoulder score between 12-20, regardless of the surgical approach used. All patients except one would recommend it to a friend. Conclusion: Our study showed excellent surgical outcome for displaced clavicle fractures supported by the high union rate, good oxford shoulder score, high return to work rate, and good patient's satisfaction. The number of minor complications and symptomatic metal work removal was less in the infraclavicular approach.

Alshameeri, Zeiad A.; Katam, Krishnaiah; Alsamaq, Mohammed; Sonsale, Paresh

2012-01-01

244

Cavernous angiomas: an uncontrolled clinical study of 87 surgically treated patients  

Microsoft Academic Search

Summary. Background. Cerebral cavernous angiomas remain as one of the most negotiable and controversial topics in neurological and neurosurgical practice. We present statistical evaluation of initial presentation, preoperative neurological findings, surgical complications, and outcome of surgically treated patients with intracerebral cavernous angiomas. Methods. During 1997 to 2004, 87 patients (41 men, 46 women) with intracerebral cavernous angiomas underwent surgical treatment

Giedrimantas Bernotas; Vytenis Deltuva

245

Late Status of Fontan Patients with Persistent Surgical Fenestration  

PubMed Central

Objective To determine the effects of creation of a systemic to pulmonary venous atrial level communication (fenestration) at the time of the Fontan procedure on late outcomes. Background Fenestrations are frequently performed during Fontan procedures but late consequences are not well described. Methods Patient characteristics were compared between those with and without surgical fenestration among 536 subjects (mean 11.9 years) enrolled in the Pediatric Heart Network Fontan Cross-sectional Study. The status of the fenestration and the association of a currently patent fenestration with health status and measures of ventricular performance were investigated. Results Fenestration was performed in 361 patients (67%) and frequency differed by year and center (p<0.001 for each). After adjustment for center, age at Fontan, year of Fontan and prior superior cavopulmonary surgery, the fenestrated group had shorter length of Fontan hospital stay. At time of cross-sectional testing 8±3 years after Fontan, the fenestration remained open in 19% of subjects. Among those with confirmed fenestration closure, 59% were by catheter intervention, 1% by surgical intervention, and 40% had apparent spontaneous closure. Compared to those without evidence of a fenestration, subjects with a current fenestration were taking more medications (p=0.02) and had lower resting oxygen saturation (median 89 vs. 95%, p<.001). Functional health status, exercise performance, echocardiographic variables, prevalence of post Fontan stroke or thrombosis, and growth did not differ by current fenestration status. Discussion Surgical fenestration is associated with well demonstrated early postoperative benefits. This cross-sectional study found few associations between a persistent fenestration and deleterious later outcomes.

Atz, Andrew M.; Travison, Thomas G.; McCrindle, Brian W.; Mahony, Lynn; Quartermain, Michael; Williams, Richard V.; Breitbart, Roger E.; Lu, Minmin; Radojewski, Elizabeth; Margossian, Renee; Covitz, Wesley; Gersony, Welton M.

2011-01-01

246

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

247

[Psycho-social and religious impact of cancer diagnosis on Moroccan patients: experience from the National Oncology Center of Rabat].  

PubMed

The impact cancer occurrence is variable according to the sociocultural issue, specific to each context and each area. In order to determine the psychosocial profile of Moroccan patients that have developed cancers, four studies were performed at the National institute of oncology (INO) in Rabat. These studies were prospective, included between 125 and 1,600 patients and were based on questionnaires developed by a medical oncologist, a psychologist and a sociologist. These studies were focused on the psychosocial characteristics of the Moroccan cancer occurrence on patients, the impact of cancer on the religious practice as well as the impact of cancer and its treatments on patients' sexuality. In this article, we will develop the particular characteristics of moroccan patients that were specific to their sociocultural context. PMID:20385518

Errihani, H; Mrabti, H; Sbitti, Y; Kaikani, W; El Ghissassi, I; Afqir, S; Boutayeb, S; Farik, M; Riadi, A; Hammoudi, M; Chergui, H

2010-04-01

248

Incidence of surgical site infections in pediatric patients: a 3-month prospective study in an academic pediatric surgical unit  

Microsoft Academic Search

During a 3-month period 259 pediatric surgical procedures in 236 patients were followed for the development of surgical site\\u000a infections (SSI): 17 sites became infected, an overall infection rate of 6.6%. The incidence in our study was therefore higher\\u000a than expected. As expected, the infection rate increased according to wound contamination: dirty sites had a SSI rate of 30%.\\u000a Emergency

Ö. Uludag; P. Rieu; M. Niessen; A. Voss

2000-01-01

249

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

250

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

2011-04-29

251

Patient perception of physician reimbursement for common hand surgical procedures.  

PubMed

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

Fowler, John R; Buterbaugh, Glenn A

2013-09-01

252

[Psychology of patient management: evaluation and quality assurance of psychosocial management in pediatric oncology].  

PubMed

Since the introduction of health-care reform in Germany, quality assurance of inpatient care is required. In paediatric oncology this also includes quality assurance measures of psycho-social care. Care Psychology deals with the development, testing and continual improvement of high-quality psycho-social care. Based on clinical experience, scientific knowledge and ascertained requirements a handbook and manual of service delivery of psycho-social care is formulated and tested in everyday practice. Service performance analyses are carried out, and verified improvements are re-tested in practice. This, as well as additional attempts, should lead to total quality management (TQM) of psycho-social care in paediatric oncology according to the criteria of the European Foundation of Quality Management (EFQM). PMID:9156631

Kusch, M; Labouvie, H; Jäger, R S; Bode, U

1997-02-01

253

Surgically Managed Gastrointestinal Stromal Tumors: A Comparative and Prognostic Analysis  

Microsoft Academic Search

Background  Tyrosine kinase inhibitors have been shown to have marked clinical efficacy in patients with unresectable or metastatic gastrointestinal\\u000a stromal tumors (GIST). We performed a comparative and prognostic analysis of our experience with surgically managed GIST to\\u000a determine factors associated with adverse oncologic outcomes.\\u000a \\u000a \\u000a \\u000a Methods  Oncologic outcomes of 191 patients with primary GIST surgically managed between 1978 and 2004 at a single

Imran Hassan; Y. Nancy You; Roman Shyyan; Eric J. Dozois; Thomas C. Smyrk; Scott H. Okuno; Cathy D. Schleck; David O. Hodge; John H. Donohue

2008-01-01

254

Treatment of invasive fungal infections in cancer patients--recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).  

PubMed

Invasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. Early antifungal treatment is mandatory to improve survival. Today, a number of effective and better-tolerated but more expensive antifungal agents compared to the former gold standard amphotericin B deoxycholate are available. Clinical decision-making must consider results from numerous studies and published guidelines, as well as licensing status and cost pressure. New developments in antifungal prophylaxis improving survival rates result in a continuous need for actualization. The treatment options for invasive Candida infections include fluconazole, voriconazole, and amphotericin B and its lipid formulations, as well as echinocandins. Voriconazole, amphotericin B, amphotericin B lipid formulations, caspofungin, itraconazole, and posaconazole are available for the treatment of invasive aspergillosis. Additional procedures, such as surgical interventions, immunoregulatory therapy, and granulocyte transfusions, have to be considered. The Infectious Diseases Working Party of the German Society of Hematology and Oncology here presents its 2008 recommendations discussing the dos and do-nots, as well as the problems and possible solutions, of evidence criteria selection. PMID:18853161

Böhme, Angelika; Ruhnke, Markus; Buchheidt, Dieter; Cornely, Oliver A; Einsele, Herrmann; Enzensberger, Ruxandra; Hebart, Holger; Heinz, Werner; Junghanss, Christian; Karthaus, Meinolf; Krüger, William; Krug, Utz; Kubin, Thomas; Penack, Olaf; Reichert, Dietmar; Reuter, Stefan; Silling, Gerda; Südhoff, Thomas; Ullmann, Andrew J; Maschmeyer, Georg

2008-10-14

255

Positron emission tomography as a diagnostic tool in oncology  

Microsoft Academic Search

.   Early diagnosis in oncology is important for treatment by surgical intervention, which generally has the highest curative\\u000a potential. For higher stages of disease involvement, initiation of rapid treatment is indicated to provide the patient with\\u000a the optimal therapy regimen. Although this may not improve the prognosis, it will maintain the quality of life. Anatomic imaging\\u000a modalities, such as CT,

C. Schiepers; C. K. Hoh

1998-01-01

256

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

257

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

Microsoft Academic Search

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

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

2011-01-01

258

Outcomes of elderly patients with proximal femoral fractures according to positive criteria for surgical treatment.  

PubMed

Proximal femoral fractures in elderly patients are a serious problem in the aging society. Recently, surgical indications have changed due to advancements in medical technology. The purpose of this study was to investigate the outcome of elderly patients with displaced proximal hip fractures according to our positive criteria for surgical treatment. Exclusion criteria included (1) terminal-stage malignancy; (2) a combination of an inability to walk, a severe mental disorder, and caregiver refusal of surgery; and (3) nonapproval of the anesthesiologist for surgery. The study group comprised 666 elderly patients. They were categorized into surgically and nonsurgically treated groups, and their treatment outcomes were retrospectively analyzed. The majority of patients were treated surgically (97.0% vs 3.0%). One-year survival rate was higher among surgically treated patients (82.2%-91.8%) than non-surgically treated patients (55%). The major cause of death in nonsurgically treated patients was deterioration of comorbidities (66.7%), whereas this was the cause of death in 18.9% of surgically treated patients. One-year survival rates were worse in both groups with a lower American Society of Anesthesiologists grade. The 1-year survival rate of our patients suggests that our surgical criteria offer a reasonable outcome in surgically and nonsurgically treated patients. American Society of Anesthesiologists grade and preexisting comorbidities were strongly correlated with patient outcome. PMID:22385446

Ishimaru, Daichi; Ogawa, Hiroyasu; Maeda, Masato; Shimizu, Katsuji

2012-03-07

259

American Society for Radiation Oncology  

MedlinePLUS

... Journal SA-CME Webinars Virtual Meetings PAAROT ABMS Patient Safety Foundations Module Ethics and Professionalism Modules Meetings and ... Symposium in Thoracic Oncology Advocacy Day Clinical Practice Patient Safety Guidelines Best Practices White Papers Research Funding Opportunities ...

260

Primary Prophylaxis of Venous Thromboembolism in Surgical Patients  

Microsoft Academic Search

The following article is the first in a series addressing the important topic of improving the quality and safety of surgical care. To promote awareness, Hospital Physician is publishing a series of clinical review articles focused on recent evidence-based recom- mendations for lowering the incidence of perioperative complications and general approaches to improving surgical quality of care. Some surgical complications

Eric K. Peden; Peter H. Lin

261

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

262

Pediatric Intensive Care Unit admission criteria for haemato-oncological patients: a basis for clinical guidelines implementation  

PubMed Central

Recent advances in supportive care and progress in the development and use of chemotherapy have considerably improved the prognosis of many children with malignancy, thus the need for intensive care admission and management is increasing, reaching about 40% of patients throughout the disease course. Cancer remains a major death cause in children, though outcomes have considerably improved over the past decades. Prediction of outcome for children with cancer in Pediatric Intensive Care Unit (PICU) obviously requires clinical guidelines, and these are not well defined, as well as admission criteria. Major determinants of negative outcomes remain severe sepsis/septic shock association and respiratory failure, deserving specific approach in children with cancer, particularly those receiving a bone marrow transplantation. A nationwide consensus should be achieved among pediatric intensivists and oncologists regarding the threshold clinical conditions requiring Intensive Care Unit (ICU) admission as well as specific critical care protocols. As demonstrated for the critically ill non-oncologic child, it appears unreasonable that pediatric patients with malignancy can be admitted to an adult Intensive Care Unit ICU. On a national basis a pool of refecence institutions should be identified and early referral to an oncologic PICU is warranted.

Piastra, Marco; Fognani, Giuliana; Franceschi, Alessia

2011-01-01

263

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

264

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

265

Timing of Salvage Hormonal Therapy in Prostate Cancer Patients With Unfavorable Prognosis Treated With Radiotherapy: A Secondary Analysis of Radiation Therapy Oncology Group 85-31  

Microsoft Academic Search

Purpose: Radiation Therapy Oncology Group 85-31 was a randomized trial comparing radiotherapy (RT) alone vs. RT plus adjuvant androgen suppression for life in unfavorable-prognosis carcinoma of the prostate. We examined the impact of early initiation of salvage hormonal therapy (HT) in relapsing patients randomized to RT alone arm. Methods and Materials: Patients were divided into two groups: early salvage HT

Luis Souhami; Kyounghwa Bae; Miljenko Pilepich; Howard Sandler

2010-01-01

266

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

267

Impact of Obesity on Surgical Outcomes following Open Radical Prostatectomy  

Microsoft Academic Search

Objective: The increasing incidence of both obesity and prostate cancer (PCa) detection will confront the urologist more often with obese men having PCa. It is unknown whether obesity affects the surgical and oncological outcomes following open radical retropubic prostatectomy (RRP). Knowledge concerning this issue is relevant when counselling obese patients with PCa for RRP. Patients and Methods: A single institution

Joep G. H. van Roermund; Jean-Paul A. van Basten; Lambertus A. Kiemeney; Herbert F. M. Karthaus; J. Alfred Witjes

2009-01-01

268

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

Microsoft Academic Search

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

Eefje N de Vries; Lucia Dijkstra; Susanne M Smorenburg; R Peter Meijer; Marja A Boermeester

2010-01-01

269

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

PubMed Central

Background Cancer diseases and their therapies have negative effects on the quality of life. The aim of this study is to assess the effectiveness of case management in a sample of oncological outpatients with the intent of rehabilitation after cancer treatment. Case management wants to support the complex information needs of the patients in addition to the segmented structure of the health care system. Emphasis is put on support for self-management in order to enhance health - conscious behaviour, learning to deal with the burden of the illness and providing the opportunity for regular contacts with care providers. We present a study protocol to investigate the efficacy of a case management in patients following oncology rehabilitation after cancer treatment. Methods The trial is a multicentre, two-arm randomised controlled study. Patients are randomised parallel in either 'usual care' plus case management or 'usual care' alone. Patients with all types of cancer can be included in the study, if they have completed the therapy with chemo- and/or radiotherapy/surgery with curative intention and are expected to have a survival time >1 year. To determine the health-related quality of life the general questionnaire FACT G is used. The direct correlation between self-management and perceived self-efficacy is measured with the Jerusalem & Schwarzer questionnaire. Patients satisfaction with the care received is measured using the Patient Assessment of Chronic Illness Care 5 As (PACIC-5A). Data are collected at the beginning of the trial and after 3, 6 and 12 months. The power analysis revealed a sample size of 102 patients. The recruitment of the centres began in 2009. The inclusion of patients began in May 2010. Discussion Case management has proved to be effective regarding quality of life of patients with chronic diseases. When it comes to oncology, case management is mainly used in cancer treatment, but it is not yet common in the rehabilitation of cancer patients. Case management in oncology rehabilitation is not well-established in Switzerland. A major challenge of the study will therefore probably be the recruitment of the patients due to the physicians' and patients' scarcely existing awareness of this issue. Trial registration ISRCTN41474586

2011-01-01

270

77 FR 25179 - Patient Safety Organizations: Voluntary Relinquishment From Surgical Safety Institute  

Federal Register 2010, 2011, 2012, 2013

...Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment...Surgical Safety Institute of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005...

2012-04-27

271

Estimation of increased hospital stay due to nosocomial infections in surgical patients: comparison of matched groups  

Microsoft Academic Search

An investigation, using a prospective cohort study, was performed to estimate the prolongation of hospital stay caused by nosocomial infections in surgical patients. An evaluation of the one-to-one matching method, as a model for similar studies was also undertaken. Between 1992 and 1994, 225 of 1482 surgical patients (15%) developed infection. Of these, 223 evaluable patients were compared with 1256

S. Erbaydar; A. Akgün; A. Eksik; T. Erbaydar; O. Bilge; A. Bulut

1995-01-01

272

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

273

Guidelines for surgical treatment of hepatoblastoma in the modern era – Recommendations from the Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL)  

Microsoft Academic Search

Cisplatin-containing chemotherapy and complete surgical resection are both crucial in the cure of hepatoblastoma. Radical resection can be obtained either conventionally by partial hepatectomy or with orthotopic liver transplant, but the surgical approach to hepatoblastoma differs considerably across the world. Our main aim in this paper is to present the surgical recommendations of the Childhood Liver Tumour Strategy Group of

Piotr Czauderna; Jean Bernard Otte; Daniel C. Aronson; Frederic Gauthier; Gordon Mackinlay; Derek Roebuck; Jack Plaschkes; Giorgio Perilongo

2005-01-01

274

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

275

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

PubMed Central

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

2012-01-01

276

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

2012-05-01

277

[Gann-chiryou Ninnteii--education of a fundamental (junior) oncology specialist].  

PubMed

The development of new active agents, along with rapid progress in biomedical technology in recent decades, has resulted in major progress in cancer treatment, but at the same time it has made cancer management much more complex: Medical treatment must now be supplemented by various other types of care. Cancer patients and their families require the best care and support through the entire process, and optimal treatment for patients cannot be provided without an oncology health care team that includes various specialists such as medical-, radiation-, and surgical oncologists, and other professionals. The oncology education system in Japan, however, is unable to comply with this demand at present, although educational programs for highly trained and dedicated oncology experts are rapidly developing. Oncologists, whether subspecialized in medical, pediatric, radiation, or surgical oncology, must comprehend a formidable knowledge base and then effectively interact with medical colleagues in a wide range of disciplines in cancer care. Since the rapid improvement of this poor oncology environment is urgently required, the Japanese Board of Cancer Therapy has made a proposal to develop a primary certification system for oncology, Gannchiryou Ninnteii: This system provides education for candidates in basic principles common to management and treatment of malignant diseases, which can enhance the quality of oncology care and also maintain the standards for certification of various oncology specialists who are now developing in Japan. Candidates are required to pass the certifying examination after satisfactory completion of graduate education in a specialty and the following training programs as a fundamental oncologist. The first certifying examination is scheduled in January, 2008. The details for certification were reviewed. PMID:18408424

Nishiyama, Masahiko

2008-04-01

278

[Definition and outline on geriatric oncology].  

PubMed

Geriatric oncology is the concept for management of elderly cancer patients. It is an equal approach of the health status problems and of cancer in a patient considered as a whole. Therefore it is not a subspecialty but a practice which can be translated in the elderly cancer patient's care. The treatment of cancer is based on the same principles than this of younger patients; recommendations used are those of the scientific oncological societies. Health problems of elderly patients are screened by specific tools. Patients without major health problems are managed by the oncological team in the routine; those for whom screening have demonstrated problems are first evaluated in the geriatrics setting and then oncological decisions are adapted to the patient situation. Decisions are made in specific geriatric oncology conferences. Specific clinical trials are required to build an Evidence Based Medicine background. Geriatric oncology teaching programs are warranted. PMID:20123506

Terret, C; Droz, J-P

2009-11-01

279

Surgical complications associated with primary closure in patients with diabetic foot osteomyelitis  

PubMed Central

Background The aim of this study was to determine the incidence of complications associated with primary closure in surgical procedures performed for diabetic foot osteomyelitis compared to those healed by secondary intention. In addition, further evaluation of the surgical digital debridement for osteomyelitis with primary closure as an alternative to patients with digital amputation was also examined in our study. Methods Comparative study that included 46 patients with diabetic foot ulcerations. Surgical debridement of the infected bone was performed on all patients. Depending on the surgical technique used, primary surgical closure was performed on 34 patients (73.9%, Group 1) while the rest of the 12 patients were allowed to heal by secondary intention (26.1%, Group 2). During surgical intervention, bone samples were collected for both microbiological and histopathological analyses. Post-surgical complications were recorded in both groups during the recovery period. Results The average healing time was 9.9±SD 8.4 weeks in Group 1 and 19.1±SD 16.9 weeks in Group 2 (p=0.008). The percentage of complications was 61.8% in Group 1 and 58.3% in Group 2 (p=0.834). In all patients with digital ulcerations that were necessary for an amputation, a primary surgical closure was performed with successful outcomes. Discussion Primary surgical closure was not associated with a greater number of complications. Patients who received primary surgical closure had faster healing rates and experienced a lower percentage of exudation (p=0.05), edema (p<0.001) and reinfection, factors that determine the delay in wound healing and affect the prognosis of the surgical outcome. Further research with a greater number of patients is required to better define the cases for which primary surgical closure may be indicated at different levels of the diabetic foot.

Garcia-Morales, Esther; Lazaro-Martinez, Jose Luis; Aragon-Sanchez, Javier; Cecilia-Matilla, Almudena; Garcia-Alvarez, Yolanda; Beneit-Montesinos, Juan Vicente

2012-01-01

280

Surgical Reinforcement of Gender Identity in Adolescent Intersex Patients  

Microsoft Academic Search

The presentation of phenotypic gender ambiguity at the time of adolescence is uncommon. Surgical reinforcement of gender, or reassignment is often complex and multistage. We present 2 cases of children who developed secondary sexual characteristics contrary to their chromosome status who, because of their late presentation, required significant surgical intervention to reinforce the gender assigned to them. We review some

S. A. V. Holmes; J. M. W. Kirk; S. Liu; M. O. Savage; R. S. Kirby

1992-01-01

281

Evaluation of the pediatric surgical patient with congenital heart disease.  

PubMed

Children with cardiac disease who undergo noncardiac surgical procedures may encounter risks beyond those usually associated with surgical procedures. In this article, several complicating factors seen in children with heart disease are discussed, including arrhythmias, cyanosis, congestive heart failure, pulmonary hypertension, and subacute bacterial endocarditis. PMID:6356416

Werner, J C; Fripp, R R; Whitman, V

1983-10-01

282

Nutrition Support Using the American Dietetic Association Medical Nutrition Therapy Protocol for Radiation Oncology Patients Improves Dietary Intake Compared with Standard Practice  

Microsoft Academic Search

BackgroundA randomized controlled trial previously conducted in radiation oncology patients demonstrated that nutrition intervention had a beneficial impact on body weight, nutritional status, and quality of life compared with standard practice, but it did not report on dietary intake data.

Elisabeth A. Isenring; Judith D. Bauer; Sandra Capra

2007-01-01

283

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

Microsoft Academic Search

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

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

1999-01-01

284

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

PubMed

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

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

2013-01-22

285

Identifying health literacy and health system navigation needs among rural cancer patients: findings from the Rural Oncology Literacy Enhancement Study (ROLES).  

PubMed

Rural residence is associated with disparities in cancer-related outcomes. Guided by the Chronic Care Model (CCM), the Rural Oncology Literacy Enhancement Study (ROLES) assessed health literacy and patient navigation needs among rural cancer patients. A mixed methods (qualitative and quantitative) approach was used, including: in-depth interviews, health literacy assessments, and phone surveys with cancer patients (N = 53) from 5 oncology clinics in rural Wisconsin; focus groups and self-administered surveys with staff (N = 41) in these clinics. Within four dimensions of the CCM (community resources, self-management support, delivery system design, and decision support), this study uncovered multiple unmet navigation needs, health literacy limitations, and barriers to quality cancer care. System-level implementation of patient navigation and health literacy best practices could contribute to improved cancer care and patient outcomes among rural populations. Further research identifying effective interventions that reduce cancer disparities among rural cancer patients is necessary. PMID:23813542

Martinez-Donate, Ana P; Halverson, Julie; Simon, Norma-Jean; Strickland, Jeanne Schaaf; Trentham-Dietz, Amy; Smith, Paul D; Linskens, Rebecca; Wang, Xinyi

2013-09-01

286

How to provide care for patients suffering from terminal non-oncological diseases: barriers to a palliative care approach.  

PubMed

Despite the seemingly evident pertinence of palliative care for patients suffering from non-oncological long-term life-threatening diseases, everyday clinical practice is far from that assumption. This study aims to explore palliative care service provision for these patients in Spain. Patients, family caregivers and healthcare professionals were interviewed, individually or in a group, aiming at identifying barriers in the provision of care and strategies to overcome them. Ritchie and Spencer's framework was used for data analysis. The barriers identified were as follows: lack of clarity about prognosis, the hegemony of the curative approach, avoiding words and the desire to cheat death. Provision of palliative care services for these patients should be guided by the characteristic trajectory of each type of disease. Even if healthcare systems were capable of providing specialized palliative care services to this large group of patients, other barriers should not be overlooked. It would then seem appropriate to provide therapeutic and palliative care simultaneously, thus facilitating adaptation processes for both patients and relatives. PMID:20817747

Mahtani-Chugani, Vinita; González-Castro, Inmaculada; de Ormijana-Hernández, Amaia Sáenz; Martín-Fernández, Roberto; de la Vega, Enrique Fernández

2010-09-03

287

Stress in pediatric oncology nurses.  

PubMed

Although the onset of physiological and emotional stress can greatly affect outcomes for a child with cancer, the focus of this review targets pediatric oncology nurses and their daily occupation-related stress. Literature currently exists that discusses the etiology of stress in the oncology work environment as well as coping strategies and their effects on pediatric oncology nurses' stress levels. To date, however, no literature review has been assembled to comprehensively address practice implications and provide recommendations for pediatric oncology staff nurses. This review of literature seeks to provide a general overview of stress experienced in the pediatric oncology work environment and supportive interventions to decrease negative outcomes such as compassion fatigue and burnout. Recommendations and conclusions are made based on existing interventions, thus creating a framework for future research to be conducted to compare the effectiveness of these measures and optimize patient experiences through caregiver well-being. PMID:23087251

Hecktman, Hillary Michelle

288

Quality of Care Differs by Patient Characteristics: Outcome Disparities After Ambulatory Surgical Procedures  

Microsoft Academic Search

The surgery literature is filled with reports on racial or gender disparities in quality. However, whether patient demographics are risk factors for complications or death from ambulatory surgical procedures is unknown. This study explores whether racial, age, and gender outcome disparities exist after ambulatory surgeries. Patients studied included adults (>18 years) receiving common ambulatory surgical procedures (N = 3 174

Nir Menachemi; Askar Chukmaitov; L. Steven Brown; Charles Saunders; Robert G. Brooks

2007-01-01

289

Economic impact of untimely surgical intervention for acute plastic surgery patients  

Microsoft Academic Search

Aims (1) To identify and quantify the causes of delay in surgical intervention for plastic surgery patients presenting acutely to the public hospital; (2) to assess the resultant economic impact; and (3) to propose strategies that may improve the efficiency of acute surgical care. Method All patients presenting acutely to the Wellington Regional Plastic, Maxillofacial & Burns Unit at Hutt

Lawrence Kim; Swee T Tan

290

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

Microsoft Academic Search

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

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

2000-01-01

291

The availability of circulating blood volume values alters fluid management in critically ill surgical patients  

Microsoft Academic Search

BACKGROUND: This study evaluated whether commercially available blood volume measurements in critically ill surgical patients altered fluid management. METHODS: Patients admitted to the surgical intensive care unit of a tertiary care teaching hospital were prospectively evaluated. The frequency of changes in fluid management when results of blood volume measurements were available was determined. RESULTS: In a pilot study, the frequency

Danny M. Takanishi Jr; Elisabeth N. Biuk-Aghai; Mihae Yu; Fedor Lurie; Hideko Yamauchi; Hao C. Ho; Alyssa D. Chapital; Wega Koss

2009-01-01

292

Acute Surgical Emergencies in Patients at or Near the End of Life  

PubMed Central

Patients with advanced or incurable preexisting illnesses often develop acute surgical emergencies. The decision to proceed with aggressive surgical intervention or provide comfort measures and symptomatic relief is often difficult. This article provides an organized overview of the multiple considerations required to produce optimal patient outcome.

Townsend, Michael C

2011-01-01

293

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

294

Patient-controlled Epidural Analgesia with Ropivacaine and Fentanyl: Experience with 2,276 Surgical Patients  

PubMed Central

Background Good postoperative pain control is an important part of adequate postoperative care. Patient-controlled epidural analgesia (PCEA) provided better postoperative analgesia compared to other conventional analgesic methods, but several risks have been observed as well. We therefore surveyed the efficacy and safety of PCEA in this retrospective observational study. Methods We analyzed collected data on 2,276 elective surgical patients who received PCEA with ropivacaine and fentanyl. Patients were assessed by a PCA service team in the post-anesthesia care unit (PACU), at 1-6 h, 6-24 h, and 24-48 h postoperatively for adequate pain control. The presence of PCEA-related adverse events was also assessed. Results Numerical pain score (median [interquartile range]) were 3 [1-4], 5 [4-7], 4 [3-5], and 3 [3-5] in the PACU, at 1-6 h, 6-24 h, and 24-48 h postoperatively. Median pain scores in patients underwent major abdominal or thoracic surgery were higher than other surgical procedure in the PACU, at 1-6 h after surgery. Nausea and vomiting (20%) and numbness and motor weakness (15%) were revealed as major PCEA-related adverse events during the postoperative 48 h period. There were 329 patients (14%) for whom PCEA was ceased within 48 h following surgery. Conclusions Our data suggest that the use of PCEA provides proper analgesia in the postoperative 48 h period after a wide variety of surgical procedures and that is associated with few serious complications. However, more careful pain management and sustainable PCEA monitoring considering the type of surgical procedure undergone is needed in patients with PCEA.

Kim, Shin Hyung; Yoon, Kyung Bong; Yoon, Duck Mi; Kim, Chan Mi

2013-01-01

295

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

Microsoft Academic Search

BackgroundIntellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients.MethodsA nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly

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

2011-01-01

296

Surgical Implements Too Often Left Behind in Patients  

MedlinePLUS

... the problem of "retained surgical items." "Leaving a foreign object after surgery is a well-known problem, but one that can be prevented," Dr. Ana McKee, the commission's executive vice president and chief medical officer, said during ...

297

Longitudinal Evaluation of Thyroid Function in Critically Ill Surgical Patients.  

National Technical Information Service (NTIS)

Thyroid hormone alterations (known as the sick-euthyroid syndrome) are common following major surgery, but the time course for appearance and recovery from these alterations has not previously been longitudinally studied in a large group of surgical patie...

G. P. Zaloga B. Chernow R. C. Smallridge R. Zajtchuk K. Hall-Boyer

1985-01-01

298

Mixed Incontinence: Comparing Definitions in Non-Surgical Patients  

PubMed Central

Purpose We aimed to explore operational definitions of mixed urinary incontinence (MUI) for use in incontinence outcomes research for non-surgical patient populations. Methods A secondary analysis of women with urge incontinence or urge predominant MUI enrolled in the Urinary Incontinence Treatment Network BE-DRI randomized clinical trial was performed. Subjects were characterized at baseline for urinary incontinence severity and incontinence subtype (stress or urge) using the Medical, Epidemiologic and Social Aspects of Aging (MESA) questionnaire, the Urogenital Distress Inventory, and a 7-day urinary diary. Various different definitions of MUI, ranging from low to high threshold, were created using a combination of these baseline incontinence measures. Prevalence of MUI based on each definition was described and compared to treatment response. Logistic regression analysis was used to estimate the association between the study outcomes and the different definitions of MUI. Results The 307 participants in the BE-DRI study had a mean age of 56.9 (± 13.9) years with a mean total MESA score of 21.7 (± 8.9) and a mean total UDI score of 120.5 (± 49.6). The proportion of women diagnosed with MUI varied significantly by definition ranging from (63.5%) to (96.4%). Low threshold symptom-based definitions resulted in nearly universal diagnosis of MUI. No strict cut-off value for these baseline measures was identified to predict clinical outcomes. Conclusions Current MUI definitions do not adequately categorize clinically relevant UI subgroups. For research purposes we believe it necessary to describe the severity of each incontinence subtype separately in subjects with MUI.

Brubaker, Linda; Lukacz, Emily S.; Burgio, Kathryn; Zimmern, Philippe; Norton, Peggy; Leng, Wendy; Johnson, Harry; Kraus, Stephen; Stoddard, Anne

2013-01-01

299

Symptom Cluster Analyses Based on Symptom Occurrence and Severity Ratings Among Pediatric Oncology Patients During Myelosuppressive Chemotherapy  

PubMed Central

Background Symptom cluster research is an emerging field in symptom management. The ability to identify symptom clusters that are specific to pediatric oncology patients may lead to improved understanding of symptoms’ underlying mechanisms among patients of all ages. Objective The purpose of this study, in a sample of children and adolescents with cancer who underwent a cycle of myelosuppressive chemotherapy, was to compare the number and types of symptom clusters identified using patients’ ratings of symptom occurrence and symptom severity. Interventions/Methods Children and adolescents with cancer (10 to 18 years of age; N=131) completed the Memorial Symptom Assessment Scale 10–18 on the day they started a cycle of myelosuppressive chemotherapy, using a one week recall of experiences. Symptom data based on occurrence and severity ratings were examined using Exploratory Factor Analysis (EFA). The defined measurement model suggested by the best EFA model was then examined with a latent variable analysis. Results Three clusters were identified when symptom occurrence ratings were evaluated which were classified as a chemotherapy sequelae cluster, mood disturbance cluster, and a neuropsychological discomforts cluster. Analysis of symptom severity ratings yielded similar cluster configurations. Conclusions Cluster configurations remained relatively stable between symptom occurrence and severity ratings. The evaluation of patients at a common point in the chemotherapy cycle may have contributed to these findings. Implications for Practice Additional uniformity in symptom clusters investigations is needed to allow appropriate comparisons among studies. The dissemination of symptom clusters research methodology through publication and presentation may promote uniformity in this field.

Baggott, Christina; Cooper, Bruce A.; Marina, Neyssa; Matthay, Katherine K.; Miaskowski, Christine

2011-01-01

300

Uterine Papillary Serous Carcinoma: Evaluation of Long-Term Survival in Surgically Staged Patients  

Microsoft Academic Search

Objective.Earlier studies have demonstrated that the uterine papillary serous carcinoma (UPSC) variant of endometrial carcinoma has a high recurrence rate, even when disease is apparently confined to the uterus. The current study evaluated survival in patients with surgically staged UPSC.Methods.Patients with UPSC were identified from surgical pathology files and charts were retrospectively reviewed. Only patients who had undergone a TAH–BSO,

Jeffrey Grice; Marit Ek; Benjamin Greer; Wui-Jin Koh; Howard G. Muntz; Joanna Cain; Hisham Tamimi; Keith Stelzer; David Figge; Barbara A. Goff

1998-01-01

301

Perioperative thrombocytopenia in cardiac surgical patients — incidence of heparin-induced thrombocytopenia, morbidities and mortality  

Microsoft Academic Search

Objectives: Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of heparin therapy. At our institution, postoperative cardiac surgical patients are screened for HIT antibodies, when platelet counts persist to be less than 50% of the baseline level or less than 50000nl?1. In the present study, we compared the outcomes in HIT-antibody-positive and HIT-antibody-negative patients. Methods: Patients who underwent a cardiac surgical

Matthias Thielmann; Marlene Bunschkowski; Paschalis Tossios; Sixten Selleng; Günter Marggraf; Andreas Greinacher; Heinz Jakob; Parwis Massoudy

2010-01-01

302

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

303

Factors affecting surgical risk in elderly patients with inflammatory bowel disease  

Microsoft Academic Search

The operative treatment of elderly patients with inflammatory bowel disease (IBD) has often been avoided in favor of medical\\u000a management because of a perceived increase in surgical risk. This study sought to define the following in the elderly IBD\\u000a patient population: (1) the risk of surgical management and (2) those factors affecting risk. Thirty patients with IBD, aged\\u000a 60 years

Michael J. Page; Lisa S. Poritz; Susan J. Kunselman; Walter A. Koltun

2002-01-01

304

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

305

A medical oncologist's perspective on communication skills and burnout syndrome with psycho-oncological approach (to die with each patient one more time: the fate of the oncologists).  

PubMed

The increasing incidence of cancer is at the same time one of the leading causes of death all over the world. Many clinical studies show that the psychological disorders are more frequent in cancer patients than the normal population. That is the reason why "psycho-oncology" is getting popular each day. On the other hand, clinical studies about psychological status of the oncologists who are in contact with cancer patients ceaselessly and who are mostly responsible to give the "bad news" to the cancer patients are very limited. In fact, if the clinical studies which show that the frequency of depression and burnout syndrome are increasing among physicians are taken into consideration, one can say that psycho-oncology must cover all the medical personnel who are dealing with cancer patients. It is determined that the rate of depression and burnout syndrome is high among oncologists when referred to the literature. Several solutions are proposed for the psychological conditions of the oncologists and other related personnel who empathize with the patients and deliver "bad news" and also try to adopt ideal "patient-physician" communication model. The knowledge on the psychological conditions of oncology professionals and their behaviour and the results of the clinical studies on this subject will be discussed and the personal opinion will also be presented in this paper. PMID:23494668

Tanriverdi, Ozgur

2013-03-15

306

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

307

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

308

Two Surgically Treated Patients With Severe Symptoms of Takayasu Arteritis  

PubMed

Takayasu arteritis, also known as the aortitis syndrome, is a panarteritis that affects the arcus aorta and its major branches, seen usually in young women. As Takayasu arteritis has a progressive nature, surgery is usually indicated only in complications of the arteritis. In this report we present two surgically treated cases with severe complications of Takayasu arteritis. We also review the syndrome. PMID:9585454

Sarigül; Mercan; Koramaz; Demirtürk; Böke

1998-05-01

309

Helping Surgical Patients Quit Smoking: Why, When, and How  

Microsoft Academic Search

Millions of cigarette smokers undergo elective surgery each year. Efforts to help them quit smoking could im- prove immediate perioperative outcomes, such as those related to the cardiac and respiratory systems, and the healing of surgical wounds. Perhaps more im- portantly, the scheduling of elective surgery represents an excellent opportunity for smokers to permanently quit, with great benefit to their

David O. Warner

2005-01-01

310

[Using arts therapies in psycho-oncology: evaluation of an exploratory study implemented in an out-patient setting].  

PubMed

According to the state-of-the-art in health psychology and psycho-oncology, a cancerous disease, as well as the accompanying medical treatments, is a source ofintense emotional stress. As feelings of insecurity and anxiety are likely to induce negative effects on immune defences, those effects may overlap with the cancerous disease and complicate its evolution. As arts therapies tend to favour the imaginary and symbolic elaboration of the tensions of daily life, as well as the re appropriation of one's body and personal history, different artistic mediations may occupy an important function in the psychological follow-up of the patient. Following an exploratory study in a hospital, we carried out an action-research in an out-patient setting during six moths. The arts therapeutic treatment comprehended alternatively drawing and writing sessions while listening to music, opening tracks for a thorough verbal elaboration. The evaluation was based on psychometric scales (HADS and MDBF), rating scales for the pictorial and literary production and a semi-structured interview. According to the results of the quantitative analyses, based on non parametric statistical procedures for small groups and non metric data, as well as to the qualitative content analyses, arts therapies could become a valuable treating measure within a multidisciplinary bio-psycho-social approach. PMID:23808110

Schiltz, L; Zimoch, A

2013-01-01

311

Minimally invasive surgery in gynecologic oncology.  

PubMed

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

Mori, Kristina M; Neubauer, Nikki L

2013-08-12

312

Predictors of Surgical Candidacy in 414 Epilepsy Patients Admitted to the EMU.  

PubMed

Objectives: Admission to an Epilepsy Monitoring Unit (EMU) is essential for pre-surgical evaluation of patients with medically-refractory epilepsy; however, prolonged referral times and resource limitations are significant access barriers. Therefore, identification of pre-EMU variables that predict potential surgical candidates can assist in the triage of patient admissions to the EMU. Methods: In this hypothesis-generating study, a retrospective analysis of patients admitted for pre-surgical evaluation to the Toronto Western Hospital EMU (2004-2011) was performed. Univariate and multivariate logistic regression was used to identify variables that could independently predict subsequent surgical candidacy following EMU evaluation. Results: Four hundred and fourteen patients were admitted to the EMU. Overall, 259 patients (62.5%) were identified as potential surgical candidates. One hundred and seven patients (25.8%) required invasive electroencephalogram (iEEG) implantations; of 75 patients consenting to iEEG analysis 39 underwent a subsequent resective procedure. Male patients and those with a lesion on MRI were 1.9 times more likely to be surgical candidates (95% CI 1.18-2.98 and 0.94-3.80, respectively), while patients with non-localizable seizures were seven times less likely (95% CI 0.02-1.25). Conclusion: In this retrospective, hypothesis-generating study male gender, presence of a lesion on MRI and localizable seizures on routine outpatient EEG analysis independently predicted subsequent resective epilepsy surgical candidacy in EMU patients. Upon validation by other studies, these variables may be considered by clinicians referring patients to the EMU in order to improve wait times and optimize patient care. PMID:23603174

Mansouri, Alireza; Fallah, Aria; Ibrahim, George M; Valiante, Taufik A

2013-05-01

313

Surgical Options  

MedlinePLUS

... have significant memory problems and patients who have unstable medical conditions that would increase surgical risk are ... to patients with severe tremor who because of unstable medical conditions are not candidates for DBS. Surgical ...

314

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

PubMed

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. PMID:22761117

Borisov, Konstantin Valentinovitch

2012-07-03

315

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

316

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

317

New Applications of Radioguided Surgery in Oncology  

PubMed Central

OBJECTIVE: To report oncological cases (excluding those related to breast cancer) for which radioguided surgery has been used in combination with the Radioguided Occult Lesion Localization technique. INTRODUCTION: Radioguided surgery enables a surgeon to identify lesions or tissues that have been preoperatively marked with radioactive substances. The Radioguided Occult Lesion Localization technique has been widely used to identify the sentinel lymph node and occult lesions in patients with breast cancer. However, few studies have reported the use of this technique for non-breast cancer pathologies. METHODOLOGY: In all cases, injection of Technecium-99m sulfur colloid was performed, directly inside or near by the suspicious lesion, guided by ultrasound or computed tomography, up to 36 hours prior to the surgical procedure. Intraoperative lesion detection was carried out using a gamma-probe. RESULTS: We report five oncology cases in which preoperative markings of the lesions were carried out using the Radioguided Occult Lesion Localization technique. The patients presented with the following: recurrence of renal cell carcinoma, cervical recurrence of papillary carcinoma of the thyroid, recurrence of retroperitoneal sarcoma, lesions of the popliteal fossa, and recurrence of rhabdomyosarcoma of a thigh. In each case, the lesions that were marked preoperatively were ultimately successfully excised. CONCLUSIONS: Radioguided surgery has proven to be a safe and effective alternative for the management of oncology patients. The Radioguided Occult Lesion Localization technique can be useful in selected cases where suspect lesions may be difficult to identify intraoperatively, due to their dimensions or anatomical location. The procedure allows for more conservative excisions and reduces the surgery-related morbidity.

Bitencourt, Almir Galvao Vieira; Lima, Eduardo Nobrega Pereira; Pinto, Paula Nicole Vieira; Martins, Eduardo Bruno Lobato; Chojniak, Rubens

2009-01-01

318

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

319

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

PubMed Central

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

Lopez-Basave, Horacio N; Morales-Vasquez, Flavia; Herrera-Gomez, Angel; Rosciano, Alejandro Padilla; Meneses-Garcia, Abelardo; Ruiz-Molina, Juan M

2012-01-01

320

Surgical Treatment of Retinal Detachment Following Acute Retinal Necrosis Syndrome: Surgical Results in Four Patients  

Microsoft Academic Search

Background: Acute retinal necrosis (ARN) syndrome is an uncommon but severe ocular disease that typically affects otherwise healthy individuals. It is frequently complicated with retinal detachment and the visual prognosis in such patients is usually poor. Methods: We operated on four eyes in four patients from 1999 through 2001. Three ophthalmologists in our hospital did these operations, respectively. The sur-

Chiun-Ho Hou; San-Ni Chen; Jau-Der Ho; Cheng-Lien Ho

321

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

322

Use of the WHO surgical safety checklist in trauma and orthopaedic patients  

Microsoft Academic Search

The World Health Organisation (WHO) recommends routine use of a surgical safety checklist prior to all surgical operations.\\u000a The aim of this study was to prospectively audit checklist use in orthopaedic patients before and after implementation of\\u000a an educational programme designed to increase use and correlate this with early complications, mortality and staff perceptions.\\u000a Data was collected on 480 patients

Mathew Sewell; Miriam Adebibe; Prakash Jayakumar; Charlie Jowett; Kin Kong; Krishna Vemulapalli; Brian Levack

2011-01-01

323

Degenerative spondylolisthesis does not influence surgical results of laminoplasty in elderly cervical spondylotic myelopathy patients  

Microsoft Academic Search

The objective of the study was to investigate the comorbidity of degenerative spondylolisthesis (DS), in elderly cervical\\u000a spondylotic myelopathy (CSM) patients in our hospital, and the correlation between surgical results and preoperative DS. There\\u000a are few studies on the outcome of laminoplasty for CSM with DS. A total of 49 elderly patients (>65 years old) who eventually\\u000a had surgical treatment for

Hideki Shigematsu

2010-01-01

324

Surgical results of anterior corpectomy in the aged patients with cervical myelopathy  

Microsoft Academic Search

Retrospective study on the results of anterior corpectomy for the treatment of cervical myelopathy in patients over 70 years\\u000a old. To evaluate the surgical results of anterior corpectomy in aged patients with multilevel cervical myelopathy and to investigate\\u000a the probable pathomechanism by radiographic study. There are few data focused on the surgical results and post-operative complications\\u000a of anterior corpectomy in aged

Jun Lu; Xiaotao Wu; Yonggang Li; Xiangfei Kong

2008-01-01

325

Management of asymptomatic carotid stenosis in patients undergoing general and vascular surgical procedures  

PubMed Central

Current available data do not seem to support the strategy for carotid endarterectomy prior to surgical intervention in patients with asymptomatic carotid stenosis. However, in patients with coronary artery disease, synchronous carotid endarterectomy and coronary artery bypass grafting should be considered where there is a proven surgical risk of <3% with unilateral asymptomatic stenosis >60% or bilateral carotid stenosis >75% on the same side as the most severe stenosis. Clarification of the optimal strategy requires an adequately powered, multicentre, randomised clinical trial.

Paciaroni, M; Caso, V; Acciarresi, M; Baumgartner, R; Agnelli, G

2005-01-01

326

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

Microsoft Academic Search

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

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

2005-01-01

327

Managing Micronutrient Deficiencies in the Bariatric Surgical Patient  

Microsoft Academic Search

Bariatric surgery is associated with development of several micronutrient deficiencies that are predictable based on the surgically\\u000a altered anatomy and the imposed dietary changes. The three restrictive malabsorptive procedures—Roux-en-Y gastric bypass (RYGB),\\u000a biliopancreatic diversion (BPD), and biliopancreatic diversion with duodenal switch (BPD\\/DS) — pose a greater risk for micronutrient\\u000a malabsorption and deficiency than the purely restrictive laparoscopic adjustable silicone gastric

Robert F. Kushner

328

Efficacy of desmopressin as surgical prophylaxis in patients with acquired von Willebrand disease undergoing thyroid surgery.  

PubMed

Coagulation abnormalities may occur in patients with thyroid diseases. We report on 14 patients undergoing thyroid surgery for a thyroid disease with an alteration of coagulation parameters resembling von Willebrand disease. Subcutaneous desmopressin was first tested and then used successfully in these patients as surgical prophylaxis, with no side-effects or bleeding complications during or after surgery. This study highlights the need for coagulation studies in patients with thyroid diseases undergoing thyroid surgery. Subcutaneous desmopressin may be used in these patients in order to prevent a surgically related bleeding risk. PMID:11952850

Franchini, M; de Gironcoli, M; Lippi, G; Manzato, F; Brazzarola, P; Bottura, D; Aprili, G; Gandini, G

2002-03-01

329

Surgical site infections in HIV-infected patients: Results from an Italian prospective multicenter observational study  

Microsoft Academic Search

\\u000a Abstract\\u000a \\u000a \\u000a Background:\\u000a   The quality of life of the HIV-infected population in developed countries has substantially improved over the years. Accordingly,\\u000a the clinical limitations in the surgical treatment of the HIV-infected patients are becoming fewer, and the number of HIV-infected\\u000a patients undergoing surgical interventions of all types is increasing. However, available data on the incidence and risk factors\\u000a for post-surgical complications,

C. M. J. Drapeau; A. Pan; C. Bellacosa; G. Cassola; M. P. Crisalli; M. De Gennaro; S. Di Cesare; F. Dodi; G. Gattuso; L. Irato; P. Maggi; M. Pantaleoni; P. Piselli; L. Soavi; E. Rastrelli; E. Tacconelli; N. Petrosillo

2009-01-01

330

Surgical Treatment for Skeletal Metastases From Soft Tissue Sarcomas: Experience With 23 Lesions in 20 Patients  

PubMed Central

Purpose. This paper reports the procedures and the clinical results of a series of surgical treatments for skeletal metastases from soft tissue sarcomas. Subjects and methods. Surgical treatment of metastatic bony lesions from soft tissue sarcomas has been carried out over a 20 year period (1975–1996). Thirty-two patients developed skeletal metastases from soft tissue sarcomas, and 20 of these cases received surgical treatment. The 23 metastatic bony lesions in these 20 patients were treated using the following surgical approaches: wide resection with prosthetic replacement in five lesions, wide or marginal resection without reconstruction in four lesions, intramedullarly nailing with curettage and methylmethacrylate cementation in four lesions, marginal resection of vertebral body with replacement by a ceramic prosthesis in three lesions, laminectomy in three lesions, intramedullarly nailing in two lesions, and curettage in two lesions. Results. Relief of pain was achieved in 17 of the 20 patients. The ambulatory status of the patients with metastasis in the lower extremity or periacetabular region was significantly improved in nine of 10 cases. Seventeen patients died of disease, with a mean survival period of 17.9 months after surgery for metastasis. Discussion. Although surgical treatment for skeletal metastases from soft tissue sarcomas cannot save the life of the patient, it can be of value in improving their well-being and overall quality of life. In these cases, surgical intervention may be more frequently indicated than in tumors with an osteoblastic or mixed pattern.

Ueda, Takafumi; Kudawara, Ikuo; Araki, Nobuhito; Yonenobu, Kazuo; Ochi, Takahiro; Uchida, Atsumasa

1998-01-01

331

Cisplatin-Based Therapy for Elderly Patients With Advanced Non-Small-Cell Lung Cancer: Implications of Eastern Cooperative Oncology Group 5592, a Randomized Trial  

Microsoft Academic Search

Background: Older patients, even if fit, are often considered incapable of tolerating platinum-based systemic therapy. We performed a retrospective analysis of Eastern Cooperative Oncology Group (ECOG) 5592, a phase III randomized trial of platinum-based chemotherapy regimens for non-small- cell lung cancer (NSCLC), and compared outcomes in en- rollees 70 years of age and older with those in younger pa- tients.

Corey J. Langer; Judith Manola; Patricia Bernardo; John W. Kugler; David Cella; David H. Johnson

332

Safety of surgical treatment for patients with scoliosis and surgically corrected congenital cardiac malformations: a comparison with patients with scoliosis and normal hearts.  

PubMed

Object The safety of spinal fusion has been poorly studied in children with surgically corrected congenital cardiac malformations (CCMs). The objective of this study was to evaluate the safety of spinal fusion in patients with CCMs following cardiac surgery. Methods A retrospective study was conducted on 32 patients with scoliosis who received surgical treatment for their CCMs (CCM group). Sixty-four age- and sex-matched patients with scoliosis and normal hearts who received spinal fusion served as the control group. These 2 groups were compared for demographic distribution, blood loss, transfusion requirements, and incidence of postoperative complications. Results The ages, curve pattern distributions, and number of levels fused were similar between the 2 groups before spinal fusion. Overall, a total of 7 patients in the CCM group (21.9%) and 5 (7.8%) in the control group had documented postoperative complications. The perioperative allogenic blood transfusion rate and mean red blood cell transfusion requirement in the CCM group were significantly higher than those found in patients in the control group (68.7% vs 28.1%, respectively, p = 0.000; and 2.68 ± 2.76 units/patient vs 0.76 ± 1.07 units/patient, respectively, p = 0.011). In the CCM group, a preoperative major curve magnitude ? 80° was the most accurate indicator of an increased risk for a major complication (p = 0.019), whereas no statistically significant correlation was noted between postoperative complications and age, type of congenital heart disease, operative duration, and estimated blood loss during the operation and transfusion. Conclusions Spinal fusion subsequent to prior cardiac surgery is relatively safe and effective in correcting the spinal deformity for patients with scoliosis and surgically corrected CCMs. A preoperative major curve magnitude ? 80° may be a risk factor in predicting postoperative complications in scoliotic patients with surgically corrected CCMs. PMID:24032989

Liang, Jinqian; Ding, Ran; Chua, Sooyong; Li, Zheng; Shen, Jianxiong

2013-09-13

333

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

334

A Performance Study of Multimedia Patient Education: A Case of Surgical Wound Care  

Microsoft Academic Search

Wound care skills are essential for patients in stable condition after surgery. A nurse must teach wound care skills and explain infection symptoms and signs to patients or their families before discharge to help wound healing. The purpose of this study is to investigate the influence of group teaching with multimedia materials on wound care skills of surgical patients. This

Shu-Ling Tu; Yue-Der Lin; I-Chen Chiu; Yaw-Jen Lin

2012-01-01

335

Oral dietary supplements in pre- and postoperative surgical patients: a prospective and randomized clinical trial  

Microsoft Academic Search

It has been suggested that the routine provision of oral dietary supplements (ODS) in postoperative surgical patients is of benefit in terms of morbidity and length of hospital stay. The aim of this study was to evaluate the effects of both pre- and postoperative ODS in patients undergoing an elective laparotomy. Patients requiring elective major gastrointestinal surgery were prospectively randomized

John MacFie; N. P Woodcock; M. D Palmer; A Walker; S Townsend; C. J Mitchell

2000-01-01

336

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

Microsoft Academic Search

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

Gerald A. Young; Graham L. Hill

337

On the Way to New Horizons: Telemedicine in Oncology.  

PubMed

Breathtaking insights into carcinogenesis and tumor biology have been gained mainly by recent technical advances in molecular-biological and genetic techniques. Thus, dimensions of earlier diagnosis and the development of new concepts in therapy arise, which were previously unavailable. There is no doubt that through these techniques the future role and tasks of surgical oncology will change. New indications will result, for example, in the context of prophylactic therapy of hereditary malignant disease or the removal of tissue predisposed to tumors. However, modes of therapy orientated toward molecular biology will still be dependent on specialist surgical interventions in the future. Examples are such innovative concepts of therapy as transport of a therapeutic device to or into tumor cells (e.g., gene gun), or even simply obtaining the necessary tumor tissue for therapy (vaccination with transfected autologous tumor cells). Therefore, the future of surgical oncology will be influenced quantitatively as well as conceptually by new qualitative requirements. Improving precision of the surgical intervention will have to go hand-in-hand with a further reduction in surgical trauma. The consistent use of laser, video, computer and communication technology can be seen as an important predeterminant here for optimizing diagnostic and therapeutic procedures. If correctly guided, the professional experience of the individual surgeon and his personal efficiency can also be positively influenced by the swift conversion of society to multimedia and information technology. Major advances in interdisciplinary communication, as one important factor in the choice and the course of suitable complex therapies in oncology, will have to target and help to overcome former weak spots. Communication in and outside one department or hospital, as well as external communication between different medical disciplines and specialists, is being developed further and increasingly refined. The possibilities of modern technology in addition to verbal exchange include visual and interactive "tele"-communication. This renders a new option to the physician, as without direct patient contact he is able to observe, counsel and actively interact - the latter even more so in the future. In oncology the increase of knowledge thus far has gone hand-in-hand with further specialization. This explains the difficulties one encounters in the correct evaluation of relevant data of one specific patient. Telemedicine will help to focus on the advantages of specialist knowledge by rendering access to all available data. These possibilities should furthermore be accessible during a consultation, an examination or in the course of a surgical intervention. Real-time modalities are referred to as telepresence and exceed by far a mere electronic version of the patient's medical folder. Especially in oncology, interdisciplinary collaboration is immensely important for successful therapy. Preoperative diagnostic data are still to be evaluated according to the intraoperative findings. At this decisive moment, it is necessary to involve specialists of other oncological disciplines. Real-time communication devices have to be present in order to transfer image data and clinical observations and ensure the best possible transmission quality to resident and geographically distant experts. With further technological perfection and widespread availability of interactive consultation, other applications include the "second opinion" in the daily routine. Another fascinating option in oncology is offered by visual computer simulation in virtual reality (VR). Medical data are visualized according to the human perception by the means of scenic simulation. From that point of view, VR technologies represent a practicable user interface between computer technology and the individual human being. Through VR, three-dimensional worlds containing virtual objects, which consist of computer-generated data, are created, which the user may explore and liberally interact with. The

Schlag

1997-01-01

338

Observation of nurse–patient interaction in oncology: review of assessment instruments  

Microsoft Academic Search

The aim of this review is to identify assessment instruments that can be used for analyzing sequences and can be applied to research into nurse–patient communication in cancer care. A systematic search of the literature revealed a variety of methods and instruments applicable to studies recording nurse–patient interaction. The studies that were qualitative in nature offered valuable information on observational

Wilma Caris-Verhallen; Liesbeth Timmermans; Sandra van Dulmen

2004-01-01

339

The natural history of postoperative venous thromboemboli in gynecologic oncology: a prospective study of 382 patients  

SciTech Connect

Three hundred eighty-two patients who underwent major operations for gynecologic malignancy were studied prospectively to determine the natural history of postoperative venous thromboemboli. Iodine 125-labeled fibrinogen leg counting, to diagnose deep venous thrombosis, was performed daily. Sixty-three patients (17%) developed postoperative venous thromboembolic complications. Deep venous thrombosis initially arose in the calf veins in 52 patients. Twenty-seven percent of these thrombi lysed spontaneously. Four percent of thrombi in the calf veins progressed to deep venous thrombosis in the femoral vein, and 4% resulted in pulmonary emboli. Nine other patients developed proximal deep venous thrombosis without prior thrombosis in the calf veins. One patient with proximal deep venous thrombosis also had a pulmonary embolus. Two patients with no evidence of deep venous thrombosis on prospective /sup 125/I-labeled fibrinogen leg counting developed pulmonary emboli, including one fatal pulmonary embolus that was found at autopsy to have arisen from the internal iliac veins. Fifty percent of all venous thromboemboli were detected within 48 hours of operation, although two patients developed significant deep venous thrombosis and pulmonary emboli after discharge from the hospital. These results add important information to our understanding of this disease process, and raise issues related to appropriate treatment and prophylaxis of venous thromboembolism in patients after gynecologic operations.

Clarke-Pearson, D.L.; Synan, I.S.; Colemen, R.E.; Hinshaw, W.; Creasman, W.T.

1984-04-15

340

Impact of Diabetes on Oncologic Outcome of Colorectal Cancer Patients: Colon vs. Rectal Cancer  

PubMed Central

Background To evaluate the impact of diabetes on outcomes in colorectal cancer patients and to examine whether this association varies by the location of tumor (colon vs. rectum). Patients and methods This study includes 4,131 stage I-III colorectal cancer patients, treated between 1995 and 2007 (12.5% diabetic, 53% colon, 47% rectal) in South Korea. Cox proportional hazards modeling was used to determine the prognostic influence of DM on survival endpoints. Results Colorectal cancer patients with DM had significantly worse disease-free survival (DFS) [hazard ratio (HR) 1.17, 95% confidence interval (CI): 1.00–1.37] compared with patients without DM. When considering colon and rectal cancer independently, DM was significantly associated with worse overall survival (OS) (HR: 1.46, 95% CI: 1.11–1.92), DFS (HR: 1.45, 95% CI: 1.15–1.84) and recurrence-free survival (RFS) (HR: 1.32, 95% CI: 0.98–1.76) in colon cancer patients. No association for OS, DFS or RFS was observed in rectal cancer patients. There was significant interaction of location of tumor (colon vs. rectal cancer) with DM on OS (P?=?0.009) and DFS (P?=?0.007). Conclusions This study suggests that DM negatively impacts survival outcomes of patients with colon cancer but not rectal cancer.

Park, Min Geun; Lee, Ji-Won; Chu, Sang Hui; Park, Ji-Hye; Lee, Mi Kyung; Sato, Kaori; Ligibel, Jennifer A.; Meyerhardt, Jeffrey A.; Kim, Nam Kyu

2013-01-01

341

Adjunctive use of monthly physician questionnaires for surveillance of surgical site infections after hospital discharge and in ambulatory surgical patients: Report of a seven-year experience  

Microsoft Academic Search

We report our experience with the use of monthly physician questionnaires, in conjunction with traditional in-house monitoring, for surveillance of surgical site infections (SSIs) in inpatients after hospital discharge and in ambulatory surgical patients (i.e., those not requiring perioperative hospitalization) over a 7-year period (July 1988 to June 1995) involving 156,977 surgical procedures. The mean annual response rate was 73%

Farrin A. Manian; Lynn Meyer

1997-01-01

342

Hypertrophic obstructive cardiomyopathy in pediatric patients: Results of surgical treatment  

Microsoft Academic Search

Between April 1975 and May 1995, 25 pediatric patients on one hospital service underwent extended left ventricular septal myectomy because of hypertrophic obstructive cardiomyopathy. Ages ranged from 2 months to 20 years (mean, 11.2 years). Seventeen patients had moderate to severe mitral valve insufficiency. Medical therapy had failed in all patients and one patient had undergone dual-chamber pacemaker implantation without

David A. Theodoro; Gordon K. Danielson; Robert H. Feldt; Betty J. Anderson

1996-01-01

343

Oncologic outcomes for lymph node-positive urothelial carcinoma patients treated with robot assisted radical cystectomy: With mean follow-up of 3.5 years.  

PubMed

PURPOSE: Previous studies have shown robot assisted radical cystectomy (RARC) to have comparable perioperative outcomes to open radical cystectomy. There are few reports that have examined the oncologic results of RARC, specifically with respect to lymph node-positive patients. We report the outcomes of pathologic node-positive patients who have undergone RARC with medium-term follow-up. MATERIALS AND METHODS: A total of 275 patients underwent RARC at 2 institutions for invasive bladder cancer between April 2005 and June 2009. We examined the 50 patients with lymph node-positive disease. Oncologic outcomes, overall, and recurrence-free survival were analyzed and compared with the open literature. RESULTS: Mean (median) clinical follow-up in this cohort was 42 (39.5) months (range 16-75 months). The mean (median) number of lymph nodes (LN) removed was 18 (17.5) (range 5-35), and mean (median) number of positive LN was 3 (2) (range 1-12). Mean lymph node density was 18%. Seventeen (34%) patients had ? pT(2) disease and 33 (66%) pT(3)/T(4) disease. At this follow-up, 29 patients have recurred, and 22 patients have died of disease. Mean (median) time to recurrence was 10 (9) months. The estimated overall survival at 36 and 60 months was 55%, and 45%, respectively. The recurrence-free survival at 36 and 60 months was 43%, and 39%, respectively. Thirty-three (66%) patients had an LN density <20%. The estimated overall survival at 36 months of patients with a lymph node density of <20% was higher than those with a lymph node density >20%, though the difference was not statistically significant. A total of 58% of patients received chemotherapy in this cohort. The use of chemotherapy was associated with a statistically significant (P = 0.033) improvement in overall survival, with an overall survival of 68% at 36 months compared with 36% for the patients who did not receive any chemotherapy. CONCLUSIONS: The oncologic outcomes of patients with lymph node-positive bladder cancer treated with robot assisted radical cystectomy (RARC) compare favorably to previous published studies of open radical cystectomy at medium-term (mean follow-up of 42 months). As our follow-up increases, we expect to continue to accurately define the long-term clinical suitability and oncologic success of this procedure in this high-risk population. PMID:22534088

Mmeje, Chinedu O; Nunez-Nateras, Rafael; Nielsen, Matthew E; Pruthi, Raj S; Smith, Angela; Wallen, Eric M; Humphreys, Mitchell R; Woods, Michael E; Castle, Erik P

2012-04-23

344

Do Elderly Cancer Patients Care about Cure? Attitudes to Radical Gynecologic Oncology Surgery in the Elderly  

Microsoft Academic Search

Objective. The aim of this study was to address the hypothesis of no difference between elderly and younger patients' desire for optimal surgery and disease cure.Methods. The new ARGOSE questionnaire with established instruments was administered to 189 gynecologic cancer patients (95 aged <65, 57 aged 65–74, and 37 aged 75+ years).Results. Disease diagnosis differed between the <65 years and 65+

A. J. Nordin; D. J. Chinn; I. Moloney; R. Naik; A. de Barros Lopes; J. M. Monaghan

2001-01-01

345

Multidisciplinary panel discussion of a gynecologic oncology patient: preventing wound complications.  

PubMed

At the 39th meeting of the Society of Gynecologic Oncologists, a multidisciplinary panel presented and discussed the current management strategies for the treatment of complex wounds. After the presentations, the panel discussed the management options for a morbidly obese endometrial cancer patient with a focus toward the complex wound that may delay discharge, healing, or the start of adjuvant treatment. This article highlights the clinical considerations discussed for these types of patients. PMID:18786719

Carlson, Jay W; Stojadinovic, Alexander; Ennis, William; Diegelmann, Robert; Attinger, Christopher

2008-09-10

346

Neoantigen response in patients successfully treated for lymphoma. A Southwest Oncology Group study.  

PubMed

To ascertain the cellular immune function of patients successfully treated for lymphoma, we measured skin-test reactivity to a battery of recall antigens, phytohemmagglutinin (PHA), and the neoantigens keyhole limpet hemocyanin (KLH) and dinitrochlorobenzene (DNCB). Seventy-four patients with Hodgkin's disease and 31 patients with non-Hodgkin's lymphoma were studied from 3 to 186 months after cessation of therapy for lymphoma. Although reactivity to recall antigens and PHA was normal, the number of patients responding to the neoantigens was significantly (P less than 0.01) lower than normal (KLH, 35%; and DNCB, 34%). This impairment in reactivity to neoantigens could not be correlated with specific diagnosis, stage of disease, or type of treatment. Reactivity to DNCB was significantly (P less than 0.01) improved in those patients studied more than 3 years after treatment, but the number who reacted was still markedly abnormal (17 of 33). Thus, successfully treated patients with lymphoma seem to have difficulty in responding to new foreign antigens. PMID:375792

King, G W; Grozea, P C; Eyre, H J; LoBuglio, A F

1979-06-01

347

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

348

[Surgical treatment of coronary heart disease in elderly patients].  

PubMed

Current approaches to the provision of effective medical aid to elderly patients with cardiovascular diseases are discussed. Clinical characteristics of such patients, concomitant pathologies, the strategy and extent of cardiosurgical treatment and postoperative therapy are described The original observations are compared with literature data concerning the immediate postoperative outcomes, clinical features, and peculiarities ofsurgical intervention in the patients of this age group. PMID:23718067

Borisov, I A; Rudakov, A S; Bletkin, A N; U?manova, M Iu; Novosel'tsev, O S; Dalinin, V V; Dulin, A P

2013-01-01

349

Surgical Management of Patients with Severe Head Injuries  

Microsoft Academic Search

Minutes can make the difference between life and death when patients with severe head injuries require surgery. Subdural, epidural, and intracerebral hematomas and cerebral contusions and gunshot wounds are the pathologic entities encountered most frequently during emergency surgery in patients with severe head injuries. Neurosurgical team members frequently use hyperventilation, mannitol and barbiturates, and sophisticated monitoring modalities to manage patients

Daniel R. Pieper; Alex B. Valadka; Cheryi Marsh

1996-01-01

350

[The role of cefepime, a 4th-generation cephalosporin, in treating patients with surgical sepsis].  

PubMed

Cefepime (Maxipime) was used in the management of 22 patients at the age of 18 to 73 years with the surgical sepsis syndrome (SAPS > 15). In 16 patients surgical sepsis was due to pancreatitis, appendititis, abdominal wound or trauma or complications after planned surgical interventions on the organs of the abdominal cavity. In the other 6 patients surgical sepsis was due to inflammatory processes in soft tissues after minor trauma. In 10 patients (group 1) cefepime was used after the pathogen verification and antibioticogram examination. In 12 patients (group 2) the antibiotic was used in the empirical therapy as the first line drug after the patients acceptance from another unit when the pathogen nature was obscure. Cefepime was administered intravenously in a dose of 2.0 g twice daily for 7 to 10 days in combination with metronidazole in a dose of 0.5 g thrice daily. After 5-6 days of the treatment the patients of group 1 were switched to the cefepime intramuscular regimen. The lethality totaled 18 per cent (4 patients). Three of them were from group 2. The patients died of progressive polyorgan insufficiency. It is characteristic that in no cases cefepime induced septic shock due to the endotoxin escape. No septicopyemia was as well observed even in the patients with verified bacteremia due to Staphylococcus aureus. PMID:10629740

Shliapnikov, S A; Rybkin, A K

1999-01-01

351

[Acute surgical diseases and injuries of the abdominal organs in mentally ill patients].  

PubMed

The work analyses the results of treatment of acute surgical diseases and traumas of the abdominal organs in 84 patients 18 to 81 years of age suffering from various mental disorders. Schizophrenia was encountered in 47 patients, the manic-depressive syndrome in 16, epilepsy in 8, reactive psychosis in 8, and senile psychosis in 5 patients. Among 66 patients who were admitted for suspected acute surgical disease of the abdominal organs, in 54 the diagnosis was confirmed. Operation was conducted on 59 of them. Eighteen patients had an abdominal trauma. Fourteen patients were operated on for closed (2) and open (12) abdominal injury. All in all 73 patients were treated by operation. Eight patients died. The causes of death were peritonitis and intoxication (4), thromboembolism of the pulmonary artery (1), acute cardiovascular insufficiency (2), and pulmonary edema (1). The peculiarities of the diagnosis and postoperative management of these patients are discussed. PMID:2811134

Mamedov, I M; Aliev, S A

1989-08-01

352

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

353

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

354

Venous access ports: frequency and management of complications in oncology patients.  

PubMed

Totally implantable venous access ports have been in use now for over 20 years. They are valuable instruments for long-term intravenous treatment of patients with cancer. Apart from perioperative difficulties, the typical complications associated with venous access ports are venous thrombosis, port infection, extravasation, pinch off syndrome, dislocation, occlusion and catheter leakages. The vast majority of these complications are avoidable, or at least the complication rate can be reduced with health care personnel training and education of patients. This review will give a broad overview on the frequency and possible complications related to port devices. Furthermore, this review suggests strategies for management including proposals to avoid such complications. PMID:18596390

Jordan, Karin; Behlendorf, Timo; Surov, Alexey; Kegel, Thomas; Maher, Gita; Wolf, Hans-Heinrich

2008-06-20

355

Surgical considerations in patients receiving neoadjuvant systemic therapy.  

PubMed

Neoadjuvant chemotherapy is being increasingly used in the treatment of patients presenting with early-stage, operable breast cancer. Neoadjuvant chemotherapy downsizes most tumors, allowing appropriately selected patients to undergo breast-conserving therapy. Management of the axilla in patients receiving neoadjuvant chemotherapy is dictated by whether patients present with clinically node-negative or node-positive disease. Patients with clinically node-negative disease can undergo sentinel lymph node dissection after neoadjuvant chemotherapy, with axillary lymph node dissection reserved for patients with a positive sentinel lymph node. For patients with clinically node-positive disease at presentation, the current standard of care is axillary lymph node dissection. An ongoing cooperative group trial is investigating the utility of sentinel lymph node surgery in the clinically node-positive population. PMID:22409461

Chawla, Akhil; Hunt, Kelly K; Mittendorf, Elizabeth A

2012-03-01

356

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

357

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

358

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

359

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

360

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

361

Thrombocytopenia following peritonitis in surgical patients. A prospective study.  

PubMed Central

Thrombocytopenia is commonly found in patients with serious infection. To investigate this phenomenon, 14 consecutive patients (68 +/- 10 years) who underwent laparotomy for bowel perforation and culture-proven peritonitis were prospectively studied. Ten noninfected laparotomy patients served as a control group. None of the 10 control patients developed thrombocytopenia. Of the infected group, 12 of 14 patients (85%) developed thrombocytopenia (less than 100,000/mm3). One patient (9%) developed disseminated intravascular coagulation (DIC). Of the remaining 11 patients with thrombocytopenia, platelet counts fell from preoperative level of 350,000 +/- 166,000 to 54,000 +/- 30,000 (p less than 0.001) and reached this nadir 4.3 +/- 2 days after surgery. There was no statistically significant difference in prothrombin time, partial thromboplastin time, or fibrinogen levels before versus after operation in this group. Bleeding times in seven patients were 5.5 +/- 2 minutes, and bone marrow examination in five patients with platelet counts of less than 50,000/mm3 revealed normal or increased megakaryocytes. No patient in this group bled, had medications held, or received platelet transfusions. Platelet counts increased greater than 100,000/mm3 at a mean of 8.9 +/- 4.1 days after operation. It is concluded that thrombocytopenia is common following surgery for intra-abdominal infection, is not usually associated with DIC, clinical bleeding, or coagulation abnormalities, does not commonly result from bone marrow suppression, and is transient and does not require routine platelet transfusions.

Iberti, T J; Rand, J H; Benjamin, E; Gentili, D R; Gabrielson, G V; Berger, S R; Aufses, A H

1986-01-01

362

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

363

Patient mortality in the 12 years following enrolment into a pre-surgical cardiac rehabilitation programme  

Microsoft Academic Search

Objective: This study examined whether involvement in a pre-surgical cardiac rehabilitation programme conferred a long-term survival benefit.Design: Patients randomly allocated to a pre-surgical cardiac rehabilitation programme intervention or a control group were tracked through national databases at a point approximately 12 years later, and all causes of mortality were identified from death records. Kaplan–Meier survival analyses based on involvement in

Andrew Rideout; Grace Lindsay; Jon Godwin

2012-01-01

364

Macular translocation for surgical management of subfoveal choroidal neovascularizations in patients with AMD: first results  

Microsoft Academic Search

·   Background: At present no satisfying treatment for subfoveal choroidal neovascularization (CNV) secondary to age-related\\u000a macular degeneration (AMD) is available. Visual results after successful surgical removal of subfoveal CNV are disappointing.\\u000a This has been explained by a primary dysfunction of the retinal pigment epithelium (RPE) in the macular region and the surgical\\u000a trauma to the RPE in patients with AMD.

Sebastian Wolf; Alexandra Lappas; Andreas W. A. Weinberger; Bernd Kirchhof

1999-01-01

365

Surgical effects of focus resection for patients with intractable epilepsy.  

PubMed

Postoperative seizure-free outcome, psychiatric condition, intellectual function, and employment status were reviewed to demonstrate the usefulness of focus resection in 71 patients who underwent resective epilepsy surgery between 2000 and 2010 for the treatment of medication-resistant epilepsy. The psychiatric problems were assumed to be present only if the patient received psychotropic drug therapy. Seizure-free outcome was obtained in 53 (75%) patients. The patients were followed up for 2.0-12.0 years (mean 7.2 years) after surgery. Temporal lobe epilepsy (TLE), late seizure onset, short seizure duration, and magnetic resonance imaging lesions were all significantly associated with cessation of seizures. Psychotropic drug therapy was performed in 3 (4.2%) patients before surgery and in 12 (17.0%) patients at 2 years or later after surgery. TLE and preoperative psychotropic drugs were significantly associated with postoperative psychiatric problems. Among the 71 patients, 65 underwent full Wechsler Adult Intelligence Scale-Revised (WAIS-R) examinations both before and after surgery. The mean WAIS-R score was 82.5 ± 18.7 points for total intelligence quotient (IQ) preoperatively and 89.6 ± 20.3 points for total IQ postoperatively. Before surgery, 19 (27%) patients were engaged in full-time employment. After surgery, 2 patients lost and 9 patients newly entered full-time employment, so a total of 26 (37%) patients were engaged in full-time employment after surgery. Resective epilepsy surgery resulted in overall improvements in seizure control, intellectual functions, and employment status. However, patients with TLE had some risk of postoperative psychiatric disorder. PMID:23708217

Maehara, Taketoshi; Inaji, Motoki; Matsuura, Masato

2013-01-01

366

Surveillance of Pancreatic Cancer Patients Following Surgical Resection  

PubMed Central

Background There are no clear recommendations to guide post-treatment surveillance in patients with pancreatic cancer. Our goal was to describe the post-treatment surveillance patterns in patients undergoing curative-intent resection for pancreatic cancer. Methods We used SEER-Medicare linked data (1992-2005) to identify CT scans and physician visits in patients with pancreatic cancer who underwent curative resection (n= 2,393). Surveillance began 90 days after surgery and patients were followed for 2 years in 6-month periods. Patients were censored if they died, recurred, or entered hospice. Chi-square tests were two-sided. Results 2,045 patients survived uncensored to the beginning of the surveillance period. CT scan use decreased from 20.9% of patients in month 4 to 6.4% in month 27. There was no temporal pattern in CT use to suggest regular surveillance. 23% of patients did not receive a CT scan in the year after surgery, increasing to 42% the second year. Patients who underwent adjuvant therapy and patients diagnosed in later years had higher CT scan use over the surveillance periods. Most patients visited both a primary care physician and a cancer specialist in each 6-month surveillance period. Patients who visited cancer specialists were more likely to have any CT scan and to be scanned more frequently. Conclusions Current surveillance patterns after resection for pancreatic cancer reflect the lack of established guidelines, implying a need for evaluation and standardization of surveillance protocols. The lack of a temporal pattern in CT testing suggests that most were obtained to evaluate symptoms rather than for routine surveillance.

Sheffield, Kristin M.; Crowell, Kristen T.; Lin, Yu-Li; Djukom, Clarisse; Goodwin, James S.; Riall, Taylor S.

2012-01-01

367

Medicinal cannabis in oncology.  

PubMed

In The Netherlands, since September 2003, a legal medicinal cannabis product, constituting the whole range of cannabinoids, is available for clinical research, drug development strategies, and on prescription for patients. To date, this policy, initiated by the Dutch Government, has not yet led to the desired outcome; the amount of initiated clinical research is less than expected and only a minority of patients resorts to the legal product. This review aims to discuss the background for the introduction of legal medicinal cannabis in The Netherlands, the past years of Dutch clinical experience in oncology practice, possible reasons underlying the current outcome, and future perspectives. PMID:17976975

Engels, Frederike K; de Jong, Floris A; Mathijssen, Ron H J; Erkens, Joëlle A; Herings, Ron M; Verweij, Jaap

2007-10-31

368

The trans-sphenoidal resection of pituitary adenomas in elderly patients and surgical risk.  

PubMed

In western countries, the process of "ageing of the population" is increasingly forcing clinical medicine to find answers for pathologies affecting the elder segments of our community. In this respect, pituitary adenomas often raise difficult questions on surgical indications, since little is known about postoperative morbidity and mortality in elderly patients. The transsphenoidal endonasal approach (TNS), which is considered the gold standard for surgical resection of the majority of functioning and non-functioning pituitary adenomas, is supposed to be a low morbidity and mortality procedure in adult patients. However, only a few contradicting data are available in the literature about elderly patients. In this paper we retrospectively analyze a cohort of 43 consecutive patients aged more than 65 years, operated on for pituitary adenomas at our Institution in the years 1998-2007. These patients were treated by transsphenoidal endonasal approach (TNS) for resection of non-functioning pituitary adenomas (n = 31), GH-secreting adenomas (n = 4) and ACTH-secreting adenomas (n = 8). Clinical records reported a macroadenoma with tumour-related mass symptoms in about 80 % of patients; single or multiple pituitary deficits were present in 44 % of patients. Regarding comorbidities, cardiac disease was the most frequently observed (86 %); assessment of anaesthesiological risk indicated a moderate to severe ASA score in most patients, 11 % showing a 4-5 score. On the basis of current criteria, our retrospective analysis revealed that cure was achieved in 54 % of patients. The outcome was similar to that observed in the general population of patients undergoing transphenoidal surgery in our centre, without differences in the rate of surgical and endocrinological cure, minor and major surgical complications and hospitalization duration. In particular, no significant anaesthesiological complications were observed and no patient developed either permanent diabetes insipidus or cerebrospinal fluid rhinorrhea. In conclusion, in specialized centres the surgical treatment of pituitary adenomas via the transsphenoidal route can be a safe and effective procedure even in elderly patients. PMID:22488370

Locatelli, M; Bertani, G; Carrabba, G; Rampini, P; Zavanone, M; Caroli, M; Sala, E; Ferrante, E; Gaini, S M; Spada, A; Mantovani, G; Lania, A

2013-06-01

369

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

370

Surgical treatment of the sleep-disordered breathing patient; a consensus report.  

PubMed

Sleep disordered breathing patients may undergo surgical treatment after history, clinical examination and polysomnographic study if they demonstrate upper airway obstruction. This article focus on the surgical treatment designed for these patients. Sino-nasal surgery, rhinopharyngeal procedure, velopharyngeal procedures (Uvulopalato-pharyngoplasty, Laser assisted uvulopalatoplasty, Radiofrequency tissue volume reduction) as well as base of the tongue procedures were discussed among a panel of Belgian ENT specialists offering their experience in this field. Algorithm on corrective surgery as well as guidelines for postoperative management are proposed in the management of sleep disordered breathing patients. PMID:12092330

Rombaux, Ph; Leysen, J; Bertrand, B; Boudewyns, A; Deron, Ph; Goffart, Y; Hamoir, M; Hassid, S; Liistro, G; Mariën, S; Moerman, M; Remacle, M

2002-01-01

371

Dislodgement of port-A catheters in pediatric oncology patients: 11 years of experience  

PubMed Central

Background Port-A catheters are frequently used in pediatric cancer patients. Their dislodgement is potentially seriously risky although the incidence is not high. We analyzed our 11 years of data to address this important problem. Methods From January 2001 to December 2011, 330 port-A catheters of different brands were implanted in pediatric cancer patients. In total, eight children suffered a dislodgement of their catheter. Their ages ranged from four to thirteen years, with a median age of ten. Five patients presented with catheter dysfunction, two presented with a cough and one was identified incidentally during surgery to remove his port. Results The downstream ends of the dislodged catheters were located in the right atrium (three patients), left pulmonary artery (three) and inferior vena cava (two). Six of the eight catheters were broken at the site of anastomosis to the port and the other two were broken halfway in between. All episodes of dislodgement happened after the chemotherapy regimen was completed. The dislodged catheters were successfully retrieved without complications by transcatheter retrieval using a gooseneck snare. Conclusions The dislodgment rate of port-A catheter in our series was 2.4%. Chest X-rays can rapidly detect the problem. Most of the catheters were broken at the site of anastomosis. Earlier explantation of port-A catheters after completing chemotherapy may be considered to avoid the dislodgement of catheters, but this needs to be weighed against the possibility of underlying disease recurrence. However, we should re-examine how long port-A catheters need to be retained after chemotherapy considering the improved cure rate of pediatric cancer.

2013-01-01

372

Prediction of normal tissue toxicity as part of the individualized treatment with radiotherapy in oncology patients.  

PubMed

Normal tissue toxicity caused by radiotherapy conditions the success of the treatment and the quality of life of patients. Radiotherapy is combined with surgery in both the preoperative or postoperative setting for the treatment of most localized solid tumour types. Furthermore, radical radiotherapy is an alternative to surgery in several tumour locations. The possibility of predicting such radiation-induced toxicity would make possible a better treatment schedule for the individual patient. Radiation-induced toxicity is, at least in part, genetically determined. From decades, several predictive tests have been proposed to know the individual sensitivity of patients to the radiotherapy schedules. Among them, initial DNA damage, radiation-induced apoptosis, gene expression profiles, and gene polymorphisms have been proposed. We report here an overview of the main studies regarding to this field. Radiation-induced apoptosis in peripheral blood lymphocytes seem to be the most promising assay tested in prospective clinical trials, although they have to be validated in large clinical studies. Other promising assays, as those related with single nucleotide polymorphisms, need to be validated as well. PMID:22209348

Henríquez-Hernández, Luis Alberto; Bordón, Elisa; Pinar, Beatriz; Lloret, Marta; Rodríguez-Gallego, Carlos; Lara, Pedro C

2011-12-29

373

Safety and efficacy of StarClose SE Vascular Closure System in high-risk liver interventional oncology patients.  

PubMed

Purpose: To assess the safety and efficacy of the StarClose SE Vascular Closure System (Abbott Vascular, Abbott Park IL, USA) in high-risk thrombocytopenic and coagulopathic interventional oncology (IO) patients.Methods: In this single institution retrospective study, 63 high-risk thrombocytopenic or coagulopathic IO patients (M:F=51:12, mean age 58 years, range 31-88 years) who underwent 83 common femoral arteriotomy closures using the StarClose device were identified among all IO patients (n=131) undergoing StarClose closure (n=177) between 2008-2011. High-risk thrombocytopenia and coagulopathy were defined as platelet count =100 103/mL and international normalized ratio (INR) =1.5. Procedures included chemoembolization (n=67), radioembolization (n=8), and hepatic arterial mapping with technetium-99m macroaggrated albumin administration (n=8) for treatment of hepatocellular carcinoma (n=79) or liver metastases (n=4). Measured outcomes included technical success of arterial closure and closure-related adverse events, graded according to the Society of Interventional Radiology classification. Results: In all cases, 5 French common femoral arterial access was used. Platelet count was =100 103/mL in 80/83 (96.4%) cases and INR was =1.5 in 35/83 (42.2%) cases. Mean pre-procedure platelet count was 71 (range 26-347) 103/mL and mean INR was 1.4 (range 1.0-2.1). The StarClose device effectively sealed the arteriotomy in 83/83 (100%) cases, 60/83 (72.3%) cases were first-time closures, and 20/83 (24.1%) cases were repeat closures. Small groin hematomas, graded as class A minor complications, developed in 3/83 (3.6%) cases. No other complications were encountered. Conclusions: The StarClose SE Vascular Closure System confers high technical success and safety in common femoral arteriotomy closure in high-risk IO patients.

PMID:22467152

Gaba, Ron C; Parvinian, Ahmad; Trinos, Estrellita M; Padayao, Suzanne V; Francisco, Rechel M; Yap, Felix Y; Knuttinen, M Grace; Owens, Charles A; Bui, James T

2012-10-01

374

Colloquial descriptions of body image in older surgical patients  

Microsoft Academic Search

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

Pat Deeny; Michael Kirk-Smith

2000-01-01

375

Results of surgical treatment in patients with arachnoid cysts  

Microsoft Academic Search

Summary A retrospective study of 35 patients operated upon for arachnoid cysts during the last 10 years was carried out. In 19 patients treated by craniotomy, membrane resection and drainage into the basal cisterns, clinical improvement could be noted in 13 cases. Correspondingly on the CT-controls the cysts were found to have disappeared in two cases and were reduced in

M. Lange; R. Oeckler

1987-01-01

376

Continuous cardiac output measurement: pulse contour analysis vs thermodilution technique in cardiac surgical patients  

Microsoft Academic Search

We have analysed the clinical agreement between two methods of continuous cardiac output measurement: pulse contour analysis (PCCO) and a continuous thermodilution technique (CCO), were both compared with the intermittent bolus thermodilution technique (BCO). Measurements were performed in 26 cardiac surgical patients (groups 1 and 2, 13 patients each, with an ejection fraction .45% and ,45%, respectively) at 12 selected

G. Rodig; C. Prasser; C. Keyl; A. Liebold; J. Hobbhahn

1999-01-01

377

[Treatment and rehabilitation of patients with pain syndrome in surgical clinic].  

PubMed

Though the progress of modern medicine in understanding the mechanisms of pain and its treatment is significant, the problem of organizing help to the patients with pain syndrome is still actual and undecided. The issue highlights the general types of pain among surgical patients, as well as the integrative approach to the treatment and rehabilitation. PMID:23612343

Samo?lova, N V; Zagorul'ko, O I; Gnezdilov, A V; Medvedeva, L A

2013-01-01

378

Risks and risk-analysis for the development of pressure ulcers in surgical patients  

Microsoft Academic Search

With prevalence figures of 13% for university hospitals and 23% for general hospitals, pressure ulcers are a major health care issue in The Netherlands. Pressure ulcers in surgical patients are frequently encountered, as is illustrated by reported incidence rates up to 66%. The number of patients at risk will probably also grow, due to an ageing population. In an extensive

Bastiaan Paul Johan Aart Keller

2006-01-01

379

Better Surgical Prognosis for Patients With Complete Atrioventricular Septal Defect and Down's Syndrome  

Microsoft Academic Search

Background. Several studies have shown that Down's syndrome is not a risk factor for biventricular repair of complete atrioventricular septal defects. However, few data are available about the comprehensive outcome of all the cardiac surgical procedures in patients with tri- somy 21, including palliative surgery. Methods. This is a retrospective study of 206 consecu- tive patients who underwent cardiac surgery

Roberto Formigari; Roberto M. Di Donato; Gaetano Gargiulo

2010-01-01

380

The Prevalence of Preoperative Diastolic Filling Abnormalities in Geriatric Surgical Patients  

Microsoft Academic Search

Preoperative assessment of heart function has typically focused on evaluating left ventricular ejection fraction (LVEF). Recent evidence suggests that diastolic heart failure is common and may cause substantial morbidity and mortality. We designed this study to examine the prevalence and potential clinical correlates of diastolic filling abnormalities as measured by echocardiography in geriatric surgical patients. Patients 65 yr of age

Bridget Phillip; Darwin Pastor; Wayne Bellows; Jacqueline M. Leung

2003-01-01

381

Prevention of Infectious Complications in Surgical Patients: Potential Role of Probiotics  

Microsoft Academic Search

Infectious complications in surgical patients often originate from the intestinal microflora. In the critically ill patient, small bowel motility is disturbed, leading to bacterial overgrowth and subsequent bacterial translocation due to dysfunction of the gut mucosal barrier. The optimal prophylactic strategy should act on all these factors, but such a strategy is not yet available. For several decades, antibiotic prophylaxis

Marc G. H. Besselink; Harro M. Timmerman; L. Paul van Minnen; Louis M. A. Akkermans; Hein G. Gooszen

2005-01-01

382

Nutritional support in the management of critically ill patients in surgical intensive care  

Microsoft Academic Search

Nutritional support is given to many patients in surgical intensive care after major trauma and serious sepsis but rarely after major elective surgery. We have quantified the changes in body composition that occur in these patients and have found that serious losses of body protein still occur after trauma and sepsis despite nutritional support. Correct nutritional management of critically ill

Stephen J. Streat; Graham L. Hill

1987-01-01

383

Surgical Experience of Neglected Lower Cervical Spine Fracture in Patient with Ankylosing Spondylitis  

PubMed Central

The management of lower cervical fractures in patients with ankylosing spondylitis (AS) differs from normal cervical fractures. Patients with AS are highly susceptible to extensive neurologic injuries and spinal deformities after cervical fractures from even minor traumatic forces. These injuries are uniquely complex, require careful imaging assessment, and aggressive surgical management to optimize spinal stability and functional outcomes.

Kim, Sung-Min; Kim, Ki-Tack; Seo, Eun-Min

2010-01-01

384

Surgical treatment of hepatocellular carcinoma: Experience with liver resection and transplantation in 198 patients  

Microsoft Academic Search

Surgical therapy offers the only chance for long-term cure of patients with hepatocellular carcinoma. The role of partial and total hepatectomy with subsequent liver replacement was analyzed in a consecutive series of 198 patients. It was the aim of this study to compare both treatment modalities on the basis of various clinicopathological prognostic factors including the TNM system of pathological

Burckhardt Ringe; Rudolf Pichlmayr; Christian Wittekind; Günter Tusch

1991-01-01

385

Surgical strategies in patients at high risk for stroke undergoing coronary artery bypass grafting  

Microsoft Academic Search

Background. Perioperative stroke represents one of the major complications following coronary artery bypass grafting (CABG). The present study was designed to evaluate the use of an individualized surgical approach for reducing neurological injury in patients undergoing CABG at high risk of stroke from aortic atherosclerosis or carotid disease.Methods. Between January 1993 and June 1999, 6,138 patients undergoing elective CABG were

Naresh Trehan; Manisha Mishra; Ravi R Kasliwal; Anil Mishra

2000-01-01

386

Oncological results, functional outcomes and health-related quality-of-life in men who received a radical prostatectomy or external beam radiation therapy for localized prostate cancer: a study on long-term patient outcome with risk stratification  

Microsoft Academic Search

Health-related quality-of-life (HRQOL) after a radical prostatectomy (RP) or external beam radiation therapy (EBRT) has not been studied in conjunction with oncological outcomes in relation to disease risk stratification. Moreover, the long-term outcomes of these treatment approaches have not been studied. We retrospectively analyzed oncological outcomes between consecutive patients receiving RP (n = 86) and EBRT (n = 76) for

Itsuhiro Takizawa; Noboru Hara; Tsutomu Nishiyama; Masaaki Kaneko; Tatsuhiko Hoshii; Emiko Tsuchida; Kota Takahashi

2009-01-01

387

Must we really fear toxicity of conventional amphotericin B in oncological patients?  

PubMed

Fungal infections are an important cause of morbidity and mortality in patients with malignancies. Therefore, the use of amphotericin B (AmB) is essential for these patients. Results from the literature to date show that renal toxicity is the most serious adverse effect of AmB. Renal impairment manifests as a decrease in glomerular filtration and damage to tubular function. Currently, there is no reliable method of preventing nephrotoxicity. We have observed that sodium supplementation alone may not prevent nephrotoxicity. We noted that a large decrease in serum potassium and magnesium was followed by a significant reduction in creatinine clearance and an increase in both serum urea and creatinine. Therefore, we surmised that potassium and magnesium supplements corresponding to the amounts lost by the kidneys, as well as sufficient hydration, are necessary to prevent renal function damage. We decided to test our hypothesis in 32 cancer patients. During AmB therapy, serum electrolyte concentrations and biochemical parameters of renal function and fluid balance were monitored frequently. The daily ion supplementation corresponded to the amount lost through the kidneys. The total duration of administration ranged from 4 to 39 days, with a mean of 13.7 days (median 11.0 days). The mean daily AmB dose was 0.89 mg/kg (median 0.88 mg/kg). The average diuresis was 3863 ml/day, and the median 4000 ml/day. The daily mean i.v.-administered sodium dose was 195.9 mmol, the daily mean dose of i.v. potassium was 103.7 mmol, and the daily mean dose of i.v. magnesium was 9.0 mmol. The frequency of infusion-related side-effects was only 10.0%. These reactions were treated with hydrocortisone. We observed a significant increase in potassium and magnesium lost through the kidneys, and a significant increase in fractional sodium and potassium excretion through the renal tubuli. We did not observe a significant increase in serum creatinine and ion imbalances. Interestingly, the average creatinine clearance did not decrease, but actually increased slightly, though to a statistically insignificant degree, from 1.425 ml/s at the beginning of treatment to 1.589 ml/s on the 20th day of AmB use. Sufficient hydration of patients and ion supplementation corresponding to the amount lost by the kidneys is an effective prophylaxis for prevention of AmB-induced decrease in renal function and for countering imbalances of serum electrolyte concentrations during use of AmB. The frequency of infusion-related side-effects is minimal relative to other reports. PMID:9926976

Mayer, J; Doubek, M; Vorlìcek, J

1999-01-01

388

Institutional report - Thoracic non-oncologic Extended videoscopic robotic thymectomy with the da Vinci telemanipulator for the treatment of myasthenia gravis: the Vienna experience  

Microsoft Academic Search

Surgical treatment of myasthenia gravis should include the complete resection of the thymus with the whole fatty tissue adherent to the pericardium for immunologic as well as oncologic reasons. The aim of the current study was to investigate the efficacy and safety of robotic approach. A total of 18 patients with myasthenia gravis (mean age 44 years) have been operated

Tatjana Fleck; Michael Fleck; Michael Muller; Helmut Hager; Walter Klepetko; Ernst Wolner; Wilfried Wisser

389

Does robot-assisted laparoscopic radical prostatectomy enable to obtain adequate oncological and functional outcomes during the learning curve? From the Korean experience  

Microsoft Academic Search

To estimate the short-term results of robot-assisted laparoscopic radical prostatectomy (RALRP) during the learning curve, in terms of surgical, oncological and functional outcomes, we conducted a prospective survey on RALRP. From July 2007, a single surgeon performed 63 robotic prostatectomies using the same operative technique. Perioperative data, including pathological and early functional results of the patient, were collected prospectively and

Young Hwii Ko; Jeong Hyeon Ban; Seok Ho Kang; Hong Seok Park; Jeong Gu Lee; Duck Ki Yoon; Je Jong Kim; Jun Cheon; Vipul R Patel

2009-01-01

390

Patient satisfaction with nursing care in a colorectal surgical population.  

PubMed

This paper describes one arm of a much larger, multi-site study whose hypothesis was that evidence-based nursing practice is more effective than routine nursing care in improving patient outcomes and health gain. This arm of the study investigated patient satisfaction as an outcome measure for those patients undergoing colorectal surgery. The study's relevance for nurses is in the potential feedback for reviewing nursing practice and health care delivery. Patient satisfaction with nursing care was measured through a validated questionnaire, the SERVQUAL, followed by interviews with a percentage of the study population. The results of this arm of the study confirm the importance of measuring patient satisfaction through a triangulated method which investigates thoroughly, providing feedback for continuous quality improvement. The in-depth interviews provided greater insight into the results of the questionnaire, enabling clear feedback to nursing staff at the different sites of the study. Results of the questionnaire revealed age, sex and education levels of patients as major influences on individual perceptions of nursing care. Patients whose surgery resulted in stomas were also less satisfied with health-care delivery. PMID:11249412

Lumby, J; England, K

2000-06-01

391

Influence of irradiation and oncologic surgery on head and neck microsurgical reconstructions.  

PubMed

Despite the refinement of microsurgical techniques, microsurgical free flap transfer in patients with a history of previous radiotherapy, neck dissection or free flaps remains a challenge in oncologic reconstructive surgery. Previous studies on the prognostic factors for postoperative complications have been largely retrospective and shown conflicting results. Our aim was to design a prospective study to identify negative outcome predictors of free flap surgery in previously treated oral cancer patients. Prospective study including all patients who required microsurgical free flap transfer for reconstruction of the oral cavity between July of 2007 and June of 2010 with subset analysis of those cases in whom previous surgical or nonsurgical oncological treatment for head and neck cancer had been carried out. A total of 360 free flaps were performed in 358 patients, of whom 61 had previous neck dissection and 58 had undergone radiation therapy. Operation time was significantly found to be longer in irradiated patients. The need for microsurgical revision, postoperative wound infection and free flap loss were significantly associated with the ASA score and a previous neck dissection. Wound infection was seen significantly more often after radiotherapy. Previous neck dissections and radiotherapy as well as the ASA score are significant negative predictors for success in free flap transfer. For patients with prior oncologic treatments in their medical history, we recommend detailed preoperative assessment of the vascular status and an intensified postoperative care to reduce complication rates to improve outcome in oncologic reconstructive surgery. PMID:22155256

Mücke, Thomas; Rau, Andrea; Weitz, Jochen; Ljubic, Andreas; Rohleder, Nils; Wolff, Klaus-Dietrich; Mitchell, David A; Kesting, Marco R

2011-12-11

392

[Results of the surgical treatment of patients with primary tuberculosis].  

PubMed

The analysis of treatment of 163 patients with primary forms of tuberculosis in the Southern Crimea sanatorium (1967-1987) is given. Along with the operation techniques used for a removal of the affected intrathoracic and peripheric lymph nodes, the details of the patients' preoperative management, occurred complications and their treatment as well as immediate outcomes of these efforts are illustrated. The analysis was made in accordance with forms of the disease, age distribution and types of intervention. During preoperative period and afterwards, the involvement of climatic factors favourably influenced the course of the postoperative stage. The management of patients with tuberculosis of the mesenteric lymph nodes is presented also. PMID:2388894

Zharkov, E S; Bazanov, V P; Ba?ramov, V Ia; Kopytchuk, K K; Lomakina, N N; Tatarski?, E N

1990-01-01

393

Distress screening: Experiences of Oncology Social Workers  

Microsoft Academic Search

The purpose of this pilot study was to explore oncology social workers experiences with the introduction and use of distress screening tools with patients who are diagnosed with cancer. Focus groups were conducted with 15 oncology social workers, who were primarilyemployed in large hospitals or cancer centers. The results fell into three broad areas: initiating distress screening, adapting distress screening

Julianne S. Oktay; Frances R. Nedjat-Haiem; Cindy Davis; Kathleen C. Kern

2012-01-01

394

Is surgical management compromised in elderly patients with breast cancer?  

PubMed Central

OBJECTIVE: The suggestion that breast cancer management is compromised in elderly patients had prompted our review of the results of policies regarding screening and early detection of breast cancer and the adequacy of primary treatment in older women (> or = 65 years of age) compared to younger women (40 to 64 years of age). SUMMARY BACKGROUND DATA: Although breast cancer in elderly patients is considered biologically less aggressive than similar staged cancer in younger counterparts, outcome still is a matter of stage and adequate treatment of primary cancer. For many reasons, physicians appear reluctant to treat elderly patients according to the same standards used for younger patients. There is even government-mandated alterations in early detection programs. Thus, since 1993, Medicare has mandated screening mammography on a biennial basis for women older than 65 year of age compared to the current accepted standard of yearly mammograms for women older than 50 years of age. Using State Health Department and tumor registry data, the authors reviewed screening practice and management of elderly patients with primary breast cancer to determine the effects of age on screening, detection policies (as reflected in stage at diagnosis), treatment strategies, and outcome. METHODS: Data were analyzed from 5962 patients with breast cancer recorded in the state-wide Tumor Registry of the Hospital Association of Rhoda Island between 1987 and 1995. The focus of the data collection was nine institutions with established tumor registries using AJCC classified tumor data. Additional data were provided by the State Health Department on screening mammography practice in 2536 women during the years 1987, 1989, and 1995. RESULTS: The frequency of mammographic screening for all averaged 40% in 1987, 52% in 1987, and 63% in 1995. In the 65-year-old and older patients, the frequency of screening was 34% in 1987, 45% in 1989, and 48% in 1995, whereas in the 40- to 49-year-old age group, the frequency of mammography was 47% in 1987, 61% in 1989, and 74% in 1995 (p < 0.001). There was a lower detection rate of preinvasive cancer in the 65-year-old and older patients, 8.8% versus 13.7% in patients within the 40- to 64-year-old age group (p < 0.001). There was a higher percentage of treatment by limited surgery among elderly patients with highly curable Stage IA and IB cancer with 26.6% having lumpectomy alone versus 9.4% in the younger patients. Five-year survival in that group was significantly worse (63%) than in patients treated by mastectomy (80%) or lumpectomy with axillary dissection and radiation (95%, < 0.001). A similar effect was seen in patients with Stage II cancer. CONCLUSIONS: Breast cancer management appears compromised in elderly patients (older than 65 years of age). Frequency of mammography screening is significantly less in elderly women older than 65 years of age. Early detection of preinvasive (curative cancers) is significantly less than in younger patients. The recent requirement by Medicare of mammography every other year may further reduce the opportunity to detect potentially curable cancers. Approximately 20% of patients had inferior treatment of favorable stage early primary cancer with worsened survival. Detection and treatment strategy changes are needed to remedy these deficiencies.

Wanebo, H J; Cole, B; Chung, M; Vezeridis, M; Schepps, B; Fulton, J; Bland, K

1997-01-01

395

Prognostic impact of positive surgical margins in surgically treated prostate cancer: Multi-institutional assessment of 5831 patients  

Microsoft Academic Search

ObjectivesTo assess the prognostic significance of a positive surgical margin in the radical prostatectomy specimen, and to test for the presence of statistically significant interactions between surgical margin status and select pathologic stage variables.

Pierre I. Karakiewicz; James A. Eastham; Markus Graefen; Ilias Cagiannos; Phillip D. Stricker; Eric Klein; Thomas Cangiano; Fritz H. Schröder; Peter T. Scardino; Michael W. Kattan

2005-01-01

396

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

397

The role of patient, surgical, and implant design variation in total knee replacement performance.  

PubMed

Clinical studies demonstrate substantial variation in kinematic and functional performance within the total knee replacement (TKR) patient population. Some of this variation is due to differences in implant design, surgical technique and component alignment, while some is due to subject-specific differences in joint loading and anatomy that are inherently present within the population. Combined finite element and probabilistic methods were employed to assess the relative contributions of implant design, surgical, and subject-specific factors to overall tibiofemoral (TF) and patellofemoral (PF) joint mechanics, including kinematics, contact mechanics, joint loads, and ligament and quadriceps force during simulated squat, stance-phase gait and stepdown activities. The most influential design, surgical and subject-specific factors were femoral condyle sagittal plane radii, tibial insert superior-inferior (joint line) position and coronal plane alignment, and vertical hip load, respectively. Design factors were the primary contributors to condylar contact mechanics and TF anterior-posterior kinematics; TF ligament forces were dependent on surgical factors; and joint loads and quadriceps force were dependent on subject-specific factors. Understanding which design and surgical factors are most influential to TKR mechanics during activities of daily living, and how robust implant designs and surgical techniques must be in order to adequately accommodate subject-specific variation, will aid in directing design and surgical decisions towards optimal TKR mechanics for the population as a whole. PMID:22727219

Fitzpatrick, Clare K; Clary, Chadd W; Rullkoetter, Paul J

2012-06-20

398

Economies of scale, physician volume for orthopedic surgical patients, and the DRG prospective payment system.  

PubMed

American hospitals face increasing constraints due to a variety of factors. Federal and state diagnostic-related group (DRG) prospective hospital pricing has caused tremendous fiscal pressure on hospitals; many face substantial financial deficits. We analyzed the volume of orthopedic surgical procedures performed by an individual orthopedic surgeon for all patients (N = 2,134) treated for a 3-year period at a large academic medical center; these surgeons were arbitrarily divided into low volume or high volume. Patients of low volume surgeons had a longer hospital length of stay and hospital cost (after correction for DRG case mix and severity of illness), greater financial risk under DRGs, and a poorer outcome, compared with patients of higher volume orthopedic surgeons. Pearson correlation showed an inverse relationship between cost per patient and physician volume for nonemergency patients -0.201 (P less than .0001), and emergency patients, -0.321 (P less than .0001). Although the reasons for these findings appeared multifactoral, they raise important issues related to orthopedic surgical hospital costs, access, and quality of care. In addition, they suggest that hospital cost for these patients (and perhaps outcome) may be related to orthopedic surgical volume, and that DRG hospital payment (on the margin) may affect future orthopedic surgical practice opportunities. PMID:2105484

Munoz, E; Boiardo, R; Mulloy, K; Goldstein, J; Brewster, J G; Tenenbaum, N; Wise, L

1990-01-01

399

Surgical treatment of femoroacetabular impingement in patients with slipped capital femoral epiphysis: A review of current surgical techniques.  

PubMed

Slipped capital femoral epiphysis (SCFE) is relatively common in adolescents and results in a complex deformity of the hip that can lead to femoroacetabular impingement (FAI). FAI may be symptomatic and lead to the premature development of osteoarthritis (OA) of the hip. Current techniques for managing the deformity include arthroscopic femoral neck osteochondroplasty, an arthroscopically assisted limited anterior approach to the hip, surgical dislocation, and proximal femoral osteotomy. Although not a routine procedure to treat FAI secondary to SCFE deformity, peri-acetabular osteotomy has been successfully used to treat FAI caused by acetabular over-coverage. These procedures should be considered for patients with symptoms due to a deformity of the hip secondary to SCFE. PMID:23539694

Azegami, S; Kosuge, D; Ramachandran, M

2013-04-01

400

Percutaneous dilatational versus conventional surgical tracheostomy in intensive care patients  

PubMed Central

Background: Tracheostomy is usually performed in patients with difficult weaning from mechanical ventilation or some catastrophic neurologic insult. Conventional tracheostomy involves dissection of the pretracheal tissues and insertion of the tracheostomy tube into the trachea under direct vision. Percutaneous dilatational tracheostomy is increasingly popular and has gained widespread acceptance in many intensive care unit and trauma centers. Aim: Aim of the study was to compare percutaneous dilatational tracheostomy versus conventional tracheostomy in intensive care patients. Patients and Methods: 64 critically ill patients admitted to intensive care unit subjected to tracheostomy and randomly divided into two groups; percutaneous dilatational tracheostomy and conventional tracheostomy. Results: Mean duration of the procedure was similar between the two procedures while the mean size of tracheostomy tube was smaller in percutaneous technique. In addition, the Lowest SpO2 during procedure, PaCO2 after operation and intra-operative bleeding for both groups were nearly similar without any statistically difference. Postoperative infection after 7 days seen to be statistically lowered and the length of scar tend to be smaller among PDT patients. Conclusion: PDT technique is effective and safe as CST with low incidence of post operative complication.

Youssef, Tarek F.; Ahmed, Mohamed Rifaat; Saber, Aly

2011-01-01

401

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

402

[Surgical strategies in patients with inflammatory bowel disease].  

PubMed

Crohn's disease and ulcerative colitis are specific inflammatory bowel diseases. Quality of life can be considerably limited. It does not depend on the form of therapy that Crohn's disease is highly recurrent, whereas colitis ulcerosa is curable by proctocolectomy. For both forms of disease surgery is an important option. It has to be included early in the therapy concept and not as last choice. Quality of life in patients with Crohn's disease can be raised significantly by surgery. Meticulous selection of the patients are essential to the policy of surgery as well as a regular aftercare. Best profit for those patients are treatment with an interdisciplinary team, consisting of gastroenterologists, nutrition advisers, psychologists, surgeons and radiologists. PMID:12693320

von Flüe, M; Ott, K

2003-03-01

403

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

PubMed Central

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

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

2011-01-01

404

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

PubMed

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

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

2011-06-28

405

Consensus statements: ambulatory pediatric oncology nursing practice.  

PubMed

The pre-conference workshop at the 32nd Annual Conference of the Association of Pediatric Hematology/Oncology Nursing, held in September 2008, focused on issues faced by pediatric oncology nurses in the ambulatory setting. The workshop was developed after several years of intense discussions at several forums. Therefore the need for an extended discussion period with ambulatory pediatric oncology nurses across the country to address these concerns was evident. There has been a major shift over the past ten years from inpatient to outpatient treatment in oncology (Chabot & Fox, 2005). This shift has resulted in numerous unique challenges for the pediatric oncology nurse. Challenges include lack of staffing resources for fluctuating patient volume and acuity, telephone triage volume and management, home care patient issues, scheduling systems, patient flow and wait time, and multi-institutional communication. This article reports the results of the APHON workshop which utilized the evidence from adult ambulatory oncology literature and standards and the recommendations of the expert pediatric oncology nurse participants to develop global statements about pediatric oncology ambulatory practice standards. The energy and productivity of the group was evidence of a common theme and demand for attention to the ambulatory nursing staff and practice. The ability to identify common threads and reach consensus with powerful statements of practice supports the continued use of such forums to move practice forward. PMID:19897837

Conley, Susanne B; O'Hanlon Curry, Joan; Hines, Melissa; Baker, Kelley; Schmidt, Kaye; Zwier, Kathy; Siever, Beth; Mirisola, Therese; Burke, Susie; Thom, Bridgette; Kline, Nancy E

2009-11-06

406

NCI-CCR Pediatric Oncology Branch: Molecular Oncology Section - Choh Yeung, BS, Biologist  

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

407

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

Cancer.gov

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

408

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

Cancer.gov

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

409

Flow Simulation to Enable Patient Specific Virtual Surgical Planning  

NASA Astrophysics Data System (ADS)

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

Jansen, Kenneth; Taylor, Charles; Mueller, Jens

2003-11-01

410

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

411

Necrotizing fasciitis in gynecologic and obstetric patients: A surgical emergency  

Microsoft Academic Search

Objective: We reviewed the cases of 23 patients who were admitted to the hospital with a primary diagnosis of histopathologically confirmed necrotizing fasciitis in the lower abdomen or pelvis. Rapid demise of a healthy postpartum women piqued our interest in trying to identify the early signs and symptoms that may lead to earlier diagnosis and treatment of this often fatal

Donald G. Gallup; Murray A. Freedman; Ramon V. Meguiar; Sandra N. Freedman; Thomas E. Nolan

2002-01-01

412

The qualities of a compassionate nurse according to the perceptions of medical-surgical patients.  

PubMed

Compassion is thought of as a nursing quality that impacts patient care. Research to describe compassion among nurses is nonexistent. In this study, the complexities of compassion, its effect on patient care, and the historical roots of compassion are explored. Attempts are made to measure levels of compassion rendered by the health care team, including physicians, physician's assistants, and nurses. This descriptive study is designed to explore the qualities of compassionate nurses as perceived by patients in medical-surgical units. PMID:21446292

Kret, Diane Domine