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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. PMID:19865579

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

2009-01-01

2

Nutrition support in surgical oncology.  

PubMed

This review article, the second in a series of articles to examine the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients, evaluates the evidence related to the use of nutrition support in surgical oncology patients. Cancer patients develop complex nutrition issues. Nutrition support may be indicated in malnourished cancer patients undergoing surgery, depending on individual patient characteristics. As with the first article in this series, this article provides background concerning nutrition issues in cancer patients, as well as discusses the role of nutrition support in the care of surgical cancer patients. The goal of this review is to enrich the discussion contained in the clinical guidelines as they relate to recommendations made for surgical patients, cite the primary literature more completely, and suggest updates to the guideline statements in light of subsequently published studies. PMID:19605805

Huhmann, Maureen B; August, David A

2009-01-01

3

Primary prevention of venous thromboembolism in medical and surgical oncology patients  

PubMed Central

Recent data suggest that patients with a malignancy have a seven-fold increased risk for venous thromboembolism (VTE) compared with those without cancer, suggesting that these patients may benefit from thromboprophylaxis. Mechanisms for the prevention of thromboembolism can be divided into two broad categories: mechanical and pharmacological. Although generally used in combination with pharmacotherapy, little evidence exists for the efficacy of mechanical modalities either in the broader population of patients at risk for VTE or for patients with cancer specifically. A recent study using graduated compression stockings (GCS) for thromboprophylaxis showed no support for the use of stockings in acute stroke patients. Established pharmacological modalities, including warfarin, unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), and the factor Xa inhibitor fondaparinux, have been shown to reduce risk for VTE in general medical and surgical populations. In medical cancer patients, only limited data are available for the efficacy of thromboprophylaxis. In contrast, considerable evidence indicates that thromboprophylaxis is warranted in patients undergoing cancer surgery. The most recent evidence suggests that catheter-related thrombosis is not prevented by current pharmacological modalities. On 22 May 2009, a group of clinicians based in the United Kingdom (UK) met in London, UK, to evaluate recent data on cancer thrombosis. This article (the second of four) briefly reviews key data on the prevention of VTE in medical and surgical oncology patients, providing context for a brief transcript of the surrounding discussion and a consensus statement, developed by meeting attendees, on the implications of this information for UK clinical practice. PMID:20386544

Stanley, A; Young, A

2010-01-01

4

The impact of short-term psycho-oncological interventions on the psychological outcome of cancer patients of a surgical-oncology department – A randomised controlled study  

Microsoft Academic Search

BackgroundAnxiety and depression are the two most frequent comorbidities of tumour patients. At present, it is unclear to which degree a patient’s psychological condition can be altered during the treatment period and if psycho-oncological support positively affects a patient’s psychological condition.

Ute Goerling; Anna Foerg; Steffen Sander; Nancy Schramm; Peter Michael Schlag

2011-01-01

5

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

PubMed Central

Background There have been controversies in the treatment of elderly patients with glioblastoma. We introduce the outcome of the treatment of elderly patients with glioblastoma comparing with younger patients. Methods The author's hospital database was used to identify patients with histologically confirmed glioblastoma after surgery between January 2006 and December 2013. Forty-eight patients (control group) were under age 65 and 16 patients (elderly group) were aged 65 years or over at the time of surgery. Results The median age of the elderly group was 71 years and control group was 50 years. Mean number of medical comorbidities was 1.8 in the elderly group vs. 0.5 in the control group. The median progression free survival (PFS) was 5.6 months and the median overall survival (OS) was 19.9 months in all patients. The elderly group had a median PFS of 4.2 months vs. 8 months for the control group (log-rank test, p=0.762). Median OS was 8.2 months in the elderly group vs. 20.9 months in the control group (log-rank test, p=0.457). Major complications occurred in 5 cases (7.8%) for all patients. The ratio of completion of concomitant chemo-radiotherapy (CCRT) was 81.3% and was the same between the two groups. In multivariable analysis, extent of resection (p=0.034) and completion of CCRT (p=0.023) were statistically significant, independent prognostic factors only for PFS in all patients by Cox proportional hazards model. Age was not an independent prognostic factor. As for OS, there was no significant factor. Conclusion Surgical resection and CCRT were well tolerated in elderly patients with glioblastoma, and maximal safe resection followed by timely CCRT could improve clinic-oncologic outcomes. PMID:25408928

Park, Hee-Kwon; Song, Sang Woo

2014-01-01

6

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. PMID:18765323

Friese, Christopher R.; Aiken, Linda H.

2008-01-01

7

Protocol of an expertise based randomized trial comparing surgical Venae Sectio versus radiological Puncture of Vena Subclavia for insertion of Totally Implantable Access Port in oncological patients  

PubMed Central

Background Totally Implantable Access Ports (TIAP) are being extensively used world-wide and can be expected to gain further importance with the introduction of new neoadjuvant and adjuvant treatments in oncology. Two different techniques for the implantation can be selected: A direct puncture of a central vein and the utilization of a Seldinger device or the surgical Venae sectio. It is still unclear which technique has the optimal benefit/risk ratio for the patient. Design A single-center, expertise based randomized, controlled superiority trial to compare two different TIAP implantation techniques. 100 patients will be included and randomized pre-operatively. All patients aged 18 years or older scheduled for primary elective implantation of a TIAP under local anesthesia who signed the informed consent will be included. The primary endpoint is the primary success rate of the randomized technique. Control Intervention: Venae Sectio will be employed to insert a TIAP by a surgeon; Experimental intervention: Punction of V. Subclavia will be used to place a TIAP by a radiologist. Duration of study: Approximately 10 months, follow up time: 90 days. Organisation/Responsibility The PORTAS 2 – Trial will be conducted in accordance with the protocol and in compliance with the moral, ethical, and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989) and Good Clinical Practice (GCP). The Center of Clinical Trials at the Department of Surgery, University Hospital Heidelberg is responsible for design and conduct of the trial including randomization and documentation of patients' data. Data management and statistical analysis will be performed by the independent Institute for Medical Biometry and Informatics (IMBI), University of Heidelberg. Trial Registration The trial is registered at ClinicalTrials.gov (NCT00600444). PMID:18950491

Knebel, Philip; Fischer, Lars; Cremonese, Eva; Lopez-Benitez, Ruben; Stampfl, Ulrike; Radeleff, Boris; Kauczor, Hans-Ulrich; Büchler, Markus W; Seiler, Christoph M

2008-01-01

8

ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology.  

PubMed

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

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

2009-08-01

9

Non-surgical oncology – Guidelines on Parenteral Nutrition, Chapter 19  

PubMed Central

Reduced nutritional state is associated with unfavourable outcomes and a lower quality of life in patients with malignancies. Patients with active tumour disease frequently have insufficient food intake. The resting energy expenditure in cancer patients can be increased, decreased, or remain unchanged compared to predicted values. Tumours may result in varying degrees of systemic pro-inflammatory processes with secondary effects on all significant metabolic pathways. Therapeutic objectives are to stabilise nutritional state with oral/enteral nutrition and parenteral nutrition (PN) and thus to prevent or reduce progressive weight loss. The maintenance or improvement of quality of life, and the increase in the effectiveness and a reduction in the side-effects of antitumor therapy are further objectives. Indications for PN in tumour patients are essentially identical to those in patients with benign illnesses, with preference given to oral or enteral nutrition when feasible. A combined nutritional concept is preferred if oral or enteral nutrition are possible but not sufficient. There are generally no accepted standards for ideal energy and nutrient intakes in oncological patients, particularly when exclusive artificial nutrition is administered. The use of PN as a general accompaniment to radiotherapy or chemotherapy is not indicated, but PN is indicated in chronic severe radiogenic enteritis or after allogenic transplantation with pronounced mucositis or GvH-related gastrointestinal damage for prolonged periods, with particular attention to increased risk of bleeding and infection. No PN is necessary in the terminal phase. PMID:20049066

Arends, J.; Zuercher, G.; Dossett, A.; Fietkau, R.; Hug, M.; Schmid, I.; Shang, E.; Zander, A.

2009-01-01

10

Comparison of surgical, functional, and oncological outcomes of open and robot-assisted partial nephrectomy  

PubMed Central

BACKGROUND: We aimed to compare the surgical, oncological, and functional outcomes of robot-assisted partial nephrectomy (RAPN) with open partial nephrectomy (OPN) in the management of small renal masses. MATERIALS AND METHODS: Between 2009 and 2013, a total of 46 RAPN patients and 20 OPN patients was included in this study. Patients’ demographics, mean operative time, estimated blood loss (EBL), warm ischemia time (WIT), length of hospital stay, pre- and post-operative renal functions, complications and oncological outcomes were recorded, prospectively. RESULTS: Mean tumor size was 4.04 cm in OPN group and 3.56 cm in RAPN group (P = 0.27). Mean R.E.N.A.L nephrometry score was 6.35 in OPN group and 5.35 in RAPN group (P = 0.02). The mean operative time was 152 min in OPN group and 225 min in RAPN group (P = 0.006). The mean EBL in OPN and RAPN groups were 417 ml and 268 ml, respectively (P = 0.001). WIT in OPN group was significantly shorter than RAPN group (18.02 min vs. 23.33 min, P = 0.003). The mean drain removal time and the length of hospital stay were longer in OPN group. There were no significant differences in terms of renal functional outcomes and postoperative complications between groups. CONCLUSION: Minimally invasive surgical management of renal masses with RAPN offers better outcomes in terms of EBL and length of stay. However, the mean operative time and WIT were significantly shorter in OPN group. RAPN is a safe and effective minimally invasive alternative to OPN in terms of oncological and functional outcomes. PMID:25598603

Boylu, Ugur; Basatac, Cem; Yildirim, Umit; Onol, Fikret F.; Gumus, Eyup

2015-01-01

11

Plastic Surgery for the Oncological Patient  

PubMed Central

The therapy of oncological patients has seen tremendous progress in the last decades. For most entities, it has been possible to improve the survival as well as the quality of life of the affected patients. To supply optimal cancer care, a multidisciplinary approach is vital. Together with oncologists, radiotherapists and other physicians, plastic surgeons can contribute to providing such care in all stages of treatment. From biopsies to the resection of advanced tumors, the coverage of the resulting defects and even palliative care, plastic surgery techniques can help to improve survival and quality of life as well as mitigate negative effects of radiation or the problems arising from exulcerating tumors in a palliative setting. This article aims to present the mentioned possibilities by illustrating selected cases and reviewing the literature. Especially in oncological patients, restoring their quality of life with the highest patient safety possible is of utmost importance. PMID:25593966

Daigeler, Adrien; Harati, Kamran; Kapalschinski, Nicolai; Goertz, Ole; Hirsch, Tobias; Lehnhardt, Marcus; Kolbenschlag, Jonas

2014-01-01

12

Critical evaluation of nutrition screening tools recommended for oncology patients.  

PubMed

Malnutrition ranges from 20% to 80% in oncology patients. Malnutrition has been associated with reduced response to treatment, survival, and quality of life. Therefore, screening for malnutrition in patients with cancer is recommended by clinical practice groups including the Oncology Nursing Society. Nurses are in an ideal position to carry out nutrition screening. Three nutrition screening tools that have been recommended for use with oncology patients by the Oncology Nursing Society are critically evaluated. The Patient Generated-Subjective Global Assessment has demonstrated diagnostic value in oncology patients at risk of malnutrition or who are malnourished. PMID:17876173

Kubrak, Catherine; Jensen, Louise

2007-01-01

13

Improving patient safety in radiation oncology  

SciTech Connect

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

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

2011-01-15

14

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

PubMed Central

Introduction. Glottic carcinoma can be successfully diagnosed in its early stages and treated with high percentage of success. Organ preservation and optimal functional outcomes could be achieved with wide array of surgical techniques for early glottic cancer, including endoscopic approaches or open laryngeal preserving procedures, making surgery the preferred method of treatment of early glottic carcinoma in the last few years. Material and Methods. Prospective study was done on 59 patients treated for Tis and T1a glottic carcinoma over a one-year time period in a tertiary medical center. Patients were treated with endoscopic laser cordectomy (types II–IV cordectomies according to European Laryngological Society classification of endoscopic cordectomies) and open cordectomy through laryngofissure. Follow-up period was 60 months. Clinical and oncological results were followed postoperatively. Voice quality after the treatment was assessed using multidimensional voice analysis 12 months after the treatment. Results. There were no significant differences between oncological and functional results among two groups of patients, though complications were more frequent in patients treated with open cordectomy. Conclusion. Endoscopic laser surgery should be the first treatment of choice in treatment of early glottic carcinomas, though open approach through laryngofissure should be available for selected cases where anatomical factors present limiting adequate tumor removal. PMID:24991554

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

2014-01-01

15

A career in surgical oncology: finding meaning, balance, and personal satisfaction.  

PubMed

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. PMID:18071823

Shanafelt, Tait

2008-02-01

16

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

17

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

Cancer.gov

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

18

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

PubMed Central

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

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

2014-01-01

19

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. PMID:22186028

Riddell, A.M.

2011-01-01

20

Oncological and functional results after the surgical treatment of parotid cancer.  

PubMed

The objective of this study was to analyze the oncological and functional outcomes after the surgical treatment of parotid cancer. We reviewed 80 primary parotid carcinomas retrospectively. A superficial parotidectomy was performed in 10 patients; 27 patients underwent total parotidectomy and 43 patients underwent radical parotidectomy. A facial-facial nerve anastomosis was chosen for the facial nerve reconstruction in eight patients, while an interpositional graft was selected in 24 patients. The overall N-positive rate of pathology was 21.3%. The rate of occult metastasis was 8.1%. High-grade carcinoma and lymphovascular emboli were independent factors for nodal metastasis. The 5-year disease-free survival and overall survival rates were 79.7% and 78.8%, respectively. Preoperative facial nerve palsy and extraparenchymal invasion were the independent factors associated with poor disease-free survival. Of the 41 patients in the facial nerve preservation group, 13 (31.7%) had transient facial nerve paresis. In the facial nerve sacrifice group of 39 cases, (sub)total recovery (House-Brackmann grade I/II) occurred in 14 (35.9%), partial recovery (House-Brackmann grade III/IV) in 13 (33.3%), and no recovery (House-Brackmann grade V) in 12 (30.8%). Facial nerve palsy upon presentation and extraparenchymal invasion indicate a grave prognosis. Facial nerve function after proper reconstruction is tolerable. PMID:25444479

Chung, E-J; Lee, S-H; Baek, S-H; Kwon, K-H; Chang, Y-J; Rho, Y-S

2015-01-01

21

Predictive Value of Benign Percutaneous Adrenal Biopsies in Oncology Patients  

Microsoft Academic Search

PURPOSE: Percutaneous CT guided biopsy is accepted as a safe procedure for the diagnosis of indeterminate adrenal masses in oncologic patients. The purpose of this study was to evaluate the accuracy of a ‘negative for tumour’ adrenal biopsy in the oncologic patient population by assessing subsequent outcome including clinical course, size and imaging characteristics of the adrenal lesions on follow-up

M. G Harisinghani; M. M Maher; P. F Hahn; D. A Gervais; K Jhaveri; J Varghese; P. R Mueller

2002-01-01

22

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

PubMed

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

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

2013-09-01

23

Participation in Surgical Oncology Clinical Trials: Gender, Race\\/Ethnicity, and Age-based Disparities  

Microsoft Academic Search

Objective  To characterize the representation of racial\\/ethnic minorities, women, and older persons among participants in surgical trials\\u000a sponsored by the National Cancer Institute (NCI).\\u000a \\u000a \\u000a \\u000a Methods  The NCI Clinical Trial Cooperative Group surgical oncology trials database was queried for breast, colorectal, lung, and prostate\\u000a cancers treated during the period 2000–2002 (n=13,991). Data from the SEER program and the Census were used to estimate

John H. Stewart; Alain G. Bertoni; Jennifer L. Staten; Edward A. Levine; Cary P. Gross

2007-01-01

24

Albumin synthesis in surgical patients.  

PubMed

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

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

2013-05-01

25

Sport and oxidative stress in oncological patients.  

PubMed

Oxidative stress is thought to be an important factor in the onset, progression and recurrence of cancer. In order to investigate how it is influenced by physical activity, we measured oxidative stress and antioxidative capacity (aoC) in 12 women with breast cancer and 6 men with prostate cancer, before and after long hiking trips. Before the hike, the men had a ROS-concentration of 1.8±0.6 mM H2O2 and an aoC of 0.7±0.6 mM Trolox-equivalent (Tro), while the women had a ROS-concentration of 3.1±0.7 mM H2O2 and an aoC of 1.2±0.2 mM Tro. After the hike, women showed no significant change in ROS and a significant increase in aoC (1.3±0.2 mM Tro), while the ROS concentration in men increased significantly (2.1±0.3 mM H2O2) and their aoC decreased (0.25±0.1 mM Tro). After a regenerative phase, the ROS concentration of the men decreased to 1.7±0.4 mM H2O2 and their aoC recovered significantly (1.2±0.4 mM Tro), while the women presented no significant change in the concentration of H2O2 but showed an ulterior increase in antioxidant capacity (2.05±0.43 mM Tro). From this data we conclude that physical training programs as for example long distance hiking trips can improve the aoC in the blood of oncological patients. PMID:22095321

Knop, K; Schwan, R; Bongartz, M; Bloch, W; Brixius, K; Baumann, F

2011-12-01

26

Ethical Aspects of Patient Information in Radiation Oncology  

Microsoft Academic Search

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

Christof Schäfer; Manfred Herbst

2003-01-01

27

Use of Parentkral Nutrition in Oncology Patients  

Microsoft Academic Search

Most members of the health care team are concerned about the appropriateness of PN use-especially when risk, morbidity, mortality and cost issues are examined. Now more than ever, it's important to evaluate the cost of nutrition treatments. The purpose of this study was to examine current practices with PN use on a busy oncology floor of a tertiary care hospital

P. M. Freed

1995-01-01

28

Thrombelastography in the surgical patient.  

PubMed

Coagulopathy in surgical patients is an important factor in triggering major perioperative complications, i.e., intra- or postoperative bleeding and thrombo-embolic events associated with an increased mortality and morbidity. Different methods exist to assess the coagulation status of patients before, during and after surgery. Routine coagulation tests have long been considered to be the clinical standard. However, these tests have considerable limitations. Information regarding the kinetics of clot formation, clot strength, interaction of the coagulation components, platelet function and fibrinolysis is not available. Moreover, there is an important delay in obtaining test results. In contrast, thrombelastography and thrombelastometry, which both measure the visco-elastic properties of whole blood, allow the dynamic assessment of a developing clot, from fibrin formation to clot strengthening and clot lysis. Both techniques are increasingly being used in daily clinical practice in order to detect perioperative coagulopathy and to guide predominantly pro-coagulant therapy in different settings. This article provides an overview of both techniques, thrombelastography (TEG) and thrombelastometry (ROTEM), and their field of perioperative application considering of recently published data. PMID:20150854

Bischof, D; Dalbert, S; Zollinger, A; Ganter, M T; Gantner, M T; Hofer, C K

2010-02-01

29

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

30

Early postoperative feeding in resectional gastrointestinal surgical cancer patients  

PubMed Central

Malnutrition is present in the majority of patients presenting for surgical management of gastrointestinal malignancies, due to the effects of the tumour and preoperative anti-neoplastic treatments. The traditional practice of fasting patients until the resumption of bowel function threatens to further contribute to the malnutrition experienced by these patients. Furthermore, the rationale behind this traditional practice has been rendered obsolete through developments in anaesthetic agents and changes to postoperative analgesia practices. Conversely, there is a growing body of literature that consistently demonstrates that providing oral or tube feeding proximal to the anastomosis within 24 h postoperatively, is not only safe, but might be associated with significant benefits to the postoperative course. Early post operative feeding should therefore be adopted as a standard of care in oncology patients undergoing gastrointestinal resections. PMID:21160596

Osland, Emma J; Memon, Muhammed Ashraf

2010-01-01

31

Nutritional support in oncologic patients: where we are and where we are going.  

PubMed

The use of nutritional support in cancer patients has evolved since its introduction in the clinical practice 40 years ago. Both parenteral and enteral nutrition are now increasingly integrated within the main oncologic strategy with the aim of making surgery, chemotherapy and radiation therapy more safe and effective. This requires a better awareness of the inherent risk of starvation and undernutrition by the surgeons, medical oncologists and radiologists, the ability to implement a policy of nutritional screening of cancer patients and to propose them the nutritional support in a single bundle together with the oncologic drugs. Four different areas of nutritional intervention are now recognized which parallel the evolutionary trajectory of patients with tumour: the perioperative nutrition in surgical patients, the permissive nutrition in patients receiving chemotherapy and/or radiation therapy and the home parenteral nutrition which may be total (in aphagic-obstructed-incurable patients) or supplemental (in advanced weight-losing anorectic patients). Since cancer is a common disease and the continuous progress in medical therapy is changing its natural history, with more and more patients entering in a chronic and finally incurable phase where nutrition is determinant for survival, we can expect an increased demand for nutritional support in the next future. PMID:21802801

Bozzetti, Federico

2011-12-01

32

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

2013-05-01

33

Patient Appreciation Day in radiation oncology.  

PubMed

Patients undergoing radiation therapy struggle with many physical and emotional stressors. Many ways to help patients cope with stressors and improve the treatment experience are found in the literature, including humor, art, entertainment, and hospitality. At H. Lee Moffitt Cancer Center, the radiation therapy nurses and staff members use entertainment in an annual patient appreciation day event as one way to give back to the patients. PMID:25095305

Cirillo, Dianne

2014-08-01

34

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

35

[Patient information duties in radiation oncology].  

PubMed

Patient information duties are a basic task of radiation oncologists in their daily practice. This article is essentially a factsheet on legal obligations, the value of written informed consent and information documents that ought to be given to patient. PMID:25201635

Pourel, N; Py, B; Safran, D

2014-10-01

36

Surgical indications for patients with hyperammonemia  

Microsoft Academic Search

Background\\/Purpose: The authors surgically treated seven of eight patients with congenital portosystemic shunt and hyperammonemia. This entity is uncommon in children.Methods: The patients included five boys and three girls with a mean age of 8 years (range, 7 months to 24 years). Preoperative symptoms included hyperammonemia. Hepatic encephalopathy was evident in five patients. Diagnosis and assessment were made by ultrasound

Shinji Ikeda; Yoshihisa Sera; Hajime Ohshiro; Shinichiro Uchino; Takako Uchino; Fumio Endo

1999-01-01

37

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

38

Interventional Radiology and the Care of the Oncology Patient  

PubMed Central

Interventional Radiology (IR) is occupying an increasingly prominent role in the care of patients with cancer, with involvement from initial diagnosis, right through to minimally invasive treatment of the malignancy and its complications. Adequate diagnostic samples can be obtained under image guidance by percutaneous biopsy and needle aspiration in an accurate and minimally invasive manner. IR techniques may be used to place central venous access devices with well-established safety and efficacy. Therapeutic applications of IR in the oncology patient include local tumour treatments such as transarterial chemo-embolisation and radiofrequency ablation, as well as management of complications of malignancy such as pain, organ obstruction, and venous thrombosis. PMID:22091374

O'Neill, Siobhan B.; O'Connor, Owen J.; Ryan, Max F.; Maher, Michael M.

2011-01-01

39

Follow-up of patients after resection for colorectal cancer: a position paper of the Canadian Society of Surgical Oncology and the Canadian Society of Colon and Rectal Surgeons  

PubMed Central

Objective To provide recommendations for postoperative follow-up of patients with colorectal carcinoma. Options Postoperative follow-up surveillance versus no surveillance. Evidence A MEDLINE search for articles published between 1966 and February 1996 with the terms “colorectal neoplasm” and “follow-up studies.” Pertinent citations from references of reviewed articles were also retrieved. Methodology With the evidence-based methodology of the Canadian Task Force on the Periodic Health Examination, a thorough review of the value of postoperative follow-up for colorectal cancer patients was performed. Studies were categorized according to their study design and submitted to critical appraisal. Randomized trials, cohort studies and descriptive studies were assessed. A benefit of follow-up was defined as an overall increase in survival. Recommendation To date, there is insufficient evidence to make a recommendation on the benefit of postoperative surveillance in colorectal cancer patients. Further clinical trials are needed to clarify the role of postoperative follow-up for patients after resection for colorectal cancer. PMID:9126121

Richard, Carole S.; McLeod, Robin S.

1997-01-01

40

Human rhinovirus C infections in pediatric hematology and oncology patients.  

PubMed

Children with cancer and HSCT recipients are at high risk for common viral infections. We sought to define the viral etiology of ARI and identify risk factors. Nasal wash samples were collected from pediatric hematology-oncology patients and HSCT recipients with ARI during the 2003-2005 winter seasons. Real-time RT-PCR was performed to detect Flu A, influenza B, RSV, PIV 1-3, human MPV, and HRV. HRV specimens were sequenced and genotyped. Seventy-eight samples from 62 children were included. Viruses were detected in 31 of 78 samples (40%). HRV were detected most frequently, in 16 (52%) including five HRVC; followed by seven (22%) RSV, five (16%) Flu A, four (13%) MPV, and two (6%) PIV2. There was a trend toward higher risk of viral infection for children in day care. Only 8% of the study children had received influenza vaccine. HRV, including the recently discovered HRVC, are an important cause of infection in pediatric oncology and HSCT patients. Molecular testing is superior to conventional methods and should be standard of care, as HRV are not detected by conventional methods. PMID:25377237

Loria, Carolina; Domm, Jennifer A; Halasa, Natasha B; Heitman, Elizabeth; Miller, E Kathryn; Xu, Meng; Saville, Benjamin R; Frangoul, Haydar; Williams, John V

2015-02-01

41

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

PubMed

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

Haier, J

2014-01-01

42

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. PMID:22315263

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

2012-01-01

43

Role of culture of postoperative drainage fluid in the prediction of infection of the surgical site after major oncological operations of the head and neck.  

PubMed

Infection of the surgical site after major oncological operations of the head and neck increases mortality and morbidity. The aim of this prospective pilot study was to assess the efficacy of culturing the exudate from the drain after cervical neck dissection to see if it predicted such infection. We studied 40/112 patients with squamous cell cancer of the head and neck who were treated during the last two years and met our inclusion criteria. Six patients developed infections (15%). Reconstruction with pedicled rather than local or microvascular flaps, duration of operation of over 7hours, the presence of a tracheostomy, and bilateral neck dissection were considered risk factors (p=0.01). Culture of drainage fluid on postoperative day 3 that grew no pathogens predicted that the site would not become infected, with a negative predictive value of 96%. PMID:25534399

Candau-Alvarez, A; Linares-Sicilia, M J; Dean-Ferrer, A; Pérez-Navero, J L

2015-02-01

44

Development of an electronic radiation oncology patient information management system.  

PubMed

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

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

2008-01-01

45

Ethics and genomic medicine, how to navigate decisions in surgical oncology.  

PubMed

Using genetic information to make medical decisions and tailor treatments to individuals will likely provide major benefits and become an important part of health care. Surgical oncologists must ethically apply scientific genetic information in a complex and evolving environment to the benefit of their patients. In this review we address ethical issues associated with: indications for genetic testing, informed consent for testing and therapy, confidentiality, targeted therapy, prophylactic surgery, and genetic testing in children. J. Surg. Oncol. 2015 111:18-23. © 2014 Wiley Periodicals, Inc. PMID:25183289

Devon, Karen M; Lerner-Ellis, Jordan P; Ganai, Sabha; Angelos, Peter

2015-01-01

46

Quality of laparoscopic radical hysterectomy in developing countries: a comparison of surgical and oncologic outcomes between a comprehensive cancer center in the United States and a cancer center in Colombia  

PubMed Central

Objective To help determine whether global collaborations for prospective gynecologic surgery trials should include hospitals in developing countries, we compared surgical and oncologic outcomes of patients undergoing laparoscopic radical hysterectomy at a large comprehensive cancer center in the United States and a cancer center in Colombia. Methods Records of the first 50 consecutive patients who underwent laparoscopic radical hysterectomy at The University of Texas MD Anderson Cancer Center in Houston (between April 2004 and July 2007) and the first 50 consecutive patients who underwent the same procedure at the Instituto de Cancerología–Clínica las Américas in Medellín (between December 2008 and October 2010) were retrospectively reviewed. Surgical and oncologic outcomes were compared between the 2 groups. Results There was no significant difference in median patient age (US 41.9 years [range 23-73] vs. Colombia 44.5 years [range 24-75], P=0.09). Patients in Colombia had a lower median body mass index than patients in the US (24.4 kg/m2 vs. 28.7 kg/m2, P=0.002). Compared to patients treated in Colombia, patients who underwent surgery in the US had a greater median estimated blood loss (200 mL vs. 79 mL, P<0.001), longer median operative time (328.5 min vs. 235 min, P<0.001), and longer postoperative hospital stay (2 days vs. 1 day, P<0.001). Conclusions Surgical and oncologic outcomes of laparoscopic radical hysterectomy were not worse at a cancer center in a developing country than at a large comprehensive cancer center in the United States. These results support consideration of developing countries for inclusion in collaborations for prospective surgical studies. PMID:22261300

Pareja, Rene; Nick, Alpa M.; Schmeler, Kathleen M.; Frumovitz, Michael; Soliman, Pamela T.; Buitrago, Carlos A; Borrero, Mauricio; Angel, Gonzalo; dos Reis, Ricardo; Ramirez, Pedro T.

2014-01-01

47

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

PubMed

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

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

2014-03-01

48

Surgical Treatment of the Overweight Patient  

Microsoft Academic Search

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

George A. Bray

49

Feasibility of robot-assisted radical prostatectomy for very-high risk prostate cancer: surgical and oncological outcomes in men aged ?70 years  

PubMed Central

Purpose Robot-assisted radical prostatectomy with pelvic lymph node dissection (RALP-PLND) is a feasible treatment option for high-risk prostate cancer (HPCa), but remains controversial for very high-risk prostate cancer (VHPCa). We aimed to assess the feasibility of RALP-PLND in men ?70 years with VHPCa features by comparing outcomes to those of HPCa. Methods Among patients aged ?70 years who underwent RALP-PLND between 2005 and 2012, 101 HPCa patients (31%) (PSA?20 ng/mL or biopsy Gleason 8–10 or cT3a) and 53 VHPCa patients (16%) (?cT3b or cN1) were identified. Perioperative, functional, and oncological outcomes were compared between groups. Results Perioperative outcomes including operative time (P=0.917), estimated blood loss (P=0.181), and complications (P=0.239) were comparable. Due to Gleason score downgrading, 19% of HPCa and 4% of VHPCa were actually of intermediate risk. VHPCa revealed higher LN involvements (P=0.002). Discrepancy between clinical and pathological nodal status was more frequent in VHPCa (36% vs. 7%, P<0.01). Nodal metastasis would have been missed in 23% patients without PLND, while 13% of cN1 patients were shown to be metastasis-free by PLND. Continence rates were lower for VHPCa (32% vs. 56%, P=0.013). Although biochemical recurrence-free survival rates were comparable (P=0.648), risk for later adjuvant treatments was higher for VHPCa patients (14% vs. 34%, P<0.01). Conclusions RALP-PLND is a feasible option for VHPCa in elderly patients with satisfactory oncologic outcomes; however, functional outcomes were not as favorable. Patients who are unable to accept the risk of adjuvant therapy and its side effects or incontinence should be deterred from surgical treatment, and other options such as radiation therapy could be an alternative. PMID:25325024

Koo, Kyo Chul; Jung, Dae Chul; Lee, Seung Hwan; Choi, Young Deuk; Chung, Byung Ha; Hong, Sung Joon; Rha, Koon Ho

2014-01-01

50

Outbreak of Pseudomonas fluorescens bacteremia among oncology patients.  

PubMed

From 7 to 24 March 1997, four patients developed Pseudomonas fluorescens bacteremia at the hospital; one on the oncology ward and the other three in the chemotherapy room. These patients all had underlying malignancies and had the Port-A-Cath (Smiths Industries Medical Systems, Deltec, Inc., St. Paul, Minn.) implants. Three patients had primary bacteremia, and one had Port-A-Cath-related infection. None of these patients had received a blood transfusion before the episodes of bacteremia. All patients recovered: two received antimicrobial agents with in vitro activity against the isolates, and the other two did not have any antibiotic treatment. A total of eight blood isolates were recovered from these patients during the febrile episodes that occurred several minutes after the infusion of chemotherapeutic agents via the Port-A-Cath. These isolates were initially identified as P. fluorescens or Pseudomonas putida (four), Burkholderia (Ralstonia) pickettii (three), and a non-glucose-fermenting gram-negative bacillus (one) by routine biochemical methods and the Vitek GNI card. These isolates were later identified as P. fluorescens on the basis of the characteristic cellular fatty acid chromatogram and the results of supplemental biochemical tests. The identification of identical antibiotypes by the E test and the random amplified polymorphic DNA patterns generated by arbitrarily primed PCR of the isolates showed that the outbreak was caused by a single clone of P. fluorescens. Surveillance cultures of the possibly contaminated infusion fluids and disinfectants, which were performed 7 days after recognition of the last infected patient, failed to isolate P. fluorescens. This report of a small outbreak caused by P. fluorescens suggests that timely, accurate identification of unusual nosocomial pathogens is crucial for early initiation of an epidemiological investigation and timely control of an outbreak. PMID:9738043

Hsueh, P R; Teng, L J; Pan, H J; Chen, Y C; Sun, C C; Ho, S W; Luh, K T

1998-10-01

51

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

PubMed Central

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

2011-01-01

52

Radical Hysterectomy: A comparison of surgical approaches after adoption of robotic surgery in gynecologic oncology  

PubMed Central

Objective To compare intra-operative, postoperative and pathologic outcomes of three surgical approaches to radical hysterectomy and bilateral pelvic lymph node dissection over a three year time period during which all three approaches were used. Methods We reviewed all patients who underwent radical hysterectomy with pelvic lymph node dissection between 1/2007 and 11/2010. Comparison was made between robotic, laparoscopic and open procedures in regard to surgical times, complication rates, and pathologic findings. Results A total of 95 radical hysterectomy procedures were performed during the study period: 30 open (RAH), 31 laparoscopic (LRH) and 34 robotic (RRH). There were no differences in age, body mass index or other demographic factors between the groups. Operative time was significantly shorter in the RAH compared to LRH and RRH (265 vs 338 vs 328 min, p=0.002). Estimated blood loss was significantly lower in LRH and RRH compared with RAH (100 vs 100 vs 350 mL, p<0.001). Thirteen (24%) of RAH required blood transfusion. Conversion rates were higher in the LRH (16%) compared to RRH (3%) although not significant (p=0.10). Median length of stay was significantly shorter in RRH (1 days) vs LRH or RAH (2 vs 4 days, p<0.01). Pathologic findings were similar among all groups. Conclusion Minimally invasive surgery has made a significant impact on patients undergoing radical hysterectomy including decrease in blood loss and transfusion rates however; operative times were significantly longer compared to open radical hysterectomy. Our findings suggest that the robotic approach may have the added benefit of even shorter length of stay compared to traditional laparoscopy. PMID:21872911

Soliman, Pamela T.; Frumovitz, Michael; Sun, Charlotte C.; dos Reis, Ricardo; Schmeler, Kathleen M.; Nick, Alpa M.; Westin, Shannon N.; Brown, Jubilee; Levenback, Charles F.; Ramirez, Pedro T.

2014-01-01

53

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. PMID:24009644

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

2013-01-01

54

Monitoring the critically ill surgical patient.  

PubMed Central

Critically ill surgical patients account for approximately half the patients in an active multidisciplinary critical care unit. Hypovolemia and sepsis are common in such patients and affect a number of organ systems. Monitoring these systems provides therapeutically relevant information that may decrease morbidity and improve patient survival. Circulatory hemodynamics may be assessed by direct measurement of the arterial blood pressure, central venous and pulmonary artery pressure monitoring and cardiac output determination; the data thus obtained are valuable in guiding fluid replacement in the hypovolemic individual. The respiratory status may be assessed by bedside spirometry and measurement of arterial blood gas tensions to gauge pulmonary function and the need for assisted ventilation. Renal dysfunction is common in such patients; careful analysis of both urine and blood may identify prerenal as opposed to renal and postrenal factors. Monitoring of the gastrointestinal tract, especially for hemorrhage, is important. Finally, careful attention to nutritional status and provision of adequate protein and energy intake by mouth or by vein is a vital component of the optimal care of these patients. PMID:115566

Holliday, R L; Doris, P J

1979-01-01

55

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

Microsoft Academic Search

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

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

1996-01-01

56

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. PMID:23533326

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

2013-01-01

57

Surgical Approach to Complicated Intestinal Failure for Benign Disease in Adult Patients: Transplantation or Surgical Rehabilitation?  

Microsoft Academic Search

Surgical approaches to complicated benign intestinal failure are gaining acceptance, especially in the pediatric population. Less international experience has been obtained in adult patients, who are usually treated with total parenteral nutrition (TPN). An intestinal rehabilitation program was started in our institution with comprehensive medical rehabilitation, surgical bowel rescue, and transplantation. Among 38 adult patients referred by our gastroenterologists for

A. Lauro; C. Zanfi; A. Dazzi; L. Golfieri; A. Amaduzzi; G. Ercolani; M. Cescon; A. Siniscalchi; G. L. Grazi; M. Vivarelli; G. Varotti; M. Ravaioli; M. Del Gaudio; F. Di Benedetto; A. Cucchetti; G. La Barba; G. Vetrone; M. Zanello; L. Pironi; S. Faenza; A. D. Pinna

2006-01-01

58

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

2011-01-01

59

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

60

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

Microsoft Academic Search

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 group. Narrative analysis of art and interview data revealed

Johanna Czamanski-Cohen

2012-01-01

61

Prospective evaluation of 2009 H1N1 influenza A in patients admitted with fever to an oncology unit.  

PubMed

We prospectively evaluated all oncology inpatients for 2009 H1N1 influenza virus. All patients recovered completely. Evaluating all oncology patients with fever for influenza involved overtreatment of influenza-negative patients and involved a significant infection control burden. However, early antiviral intervention could have contributed to a favorable outcome. PMID:21768767

Seiter, Karen; Shah, Dhaval; Sandoval, Claudio; Liu, Delong; Nadelman, Robert B; Sinaki, Banafsheh; Cuffari, Cristina; Shi, Qiuhu; Abid, Syed; Montecalvo, Marisa

2011-08-01

62

Etiology and Incidence of Pressure Ulcers in Surgical Patients  

Microsoft Academic Search

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

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

1999-01-01

63

Personality Characteristics of the Cosmetic Surgical Insatiable Patient  

Microsoft Academic Search

It is argued that the personality of the cosmetic surgical patient is undisturbed. Furthermore it is argued that a vast majority of these patients are very pleased with the results of the cosmetic correction. A very small percentage however is dissatisfied (although no surgical-technical mistake was made) and is urging again and again for a repetition of the procedure. The

N. H. Groenman; H. C. Sauër

1983-01-01

64

Clinical features and complications of viridans streptococci bloodstream infection in pediatric hemato-oncology patients  

Microsoft Academic Search

Background and Purpose: Viridans streptococci (VS) are part of the normal flora of humans, but are fast emerging as pathogens causing bacteremia in neutropenic patients. The clinical features, outcomes, and antibiotic sus- ceptibilities of VS bloodstream infections in children with hemato-oncological diseases are reported in this study. Methods: A retrospective chart review of pediatric patients (?18 years) diagnosed with VS

Wan-Ting Huang; Luan-Yin Chang; Po-Ren Hsueh; Chun-Yi Lu; Pei-Lan Shao; Fu-Yuan Huang; Ping-Ing Lee; Chun-Ming Chen; Chin-Yun Lee; Li-Min Huang

65

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

66

Nutritional Status and Information Needs of Medical Oncology Patients Receiving Treatment at an Australian Public Hospital  

Microsoft Academic Search

This study aimed to identify 1) the prevalence of malnutrition according to the scored Patient Generated-Subjective Global Assessment (PG-SGA), 2) utilization of available nutrition resources, 3) patient nutrition information needs, and 4) external sources of nutrition information. An observational, cross-sectional study was undertaken at an Australian public hospital on 191 patients receiving oncology services. According to PG-SGA, 49% of patients

Elisabeth Isenring; Giordana Cross; Elizabeth Kellett; Bogda Koczwara; Lynne Daniels

2010-01-01

67

Vitamin D Deficiency Is Widespread in Cancer Patients and Correlates With Advanced Stage Disease: A Community Oncology Experience  

Microsoft Academic Search

The purpose of this study was to correlate serum vitamin D levels with potential clinical variables and to determine the extent of vitamin D deficiency in a large, outpatient oncology practice. One hundred ninety-five consecutive patients referred for consultation at a community radiation oncology center from October 8, 2008 to March 17, 2010 had vitamin D levels ordered. Patients who

Thomas M. Churilla; Harmar D. Brereton; Mary Klem; Christopher A. Peters

2012-01-01

68

The WHO surgical safety checklist: survey of patients’ views  

PubMed Central

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

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

2014-01-01

69

Seroprevalence of Hepatitis B and C among Oncology Patients in Turkey  

PubMed Central

Hepatitis B virus (HBV) is one of the public-health issues worldwide. Approximately two billion people are infected with HBV, and about 350 million people are chronic carriers globally. About 3% of the world population is infected with hepatitis C virus (HCV). Oncology patients receiving packed red blood cell suspensions and other blood products usually are in the high-risk group for infections due to these viruses. The aim of the study was to detect the seroprevalence of hepatitis B and hepatitis C among chemotherapy patients at the Oncology Department of the Tepecik Education and Research Hospital. HBsAg, anti-HBs, anti-HBcIgM, anti-HBc total and anti-HCV assays were studied by enzyme immunoassay method (Diasorin, Italy) in serum samples of patients (n=448) referred to the Department of Oncology of the Tepecik Education and Research Hospital during 1 June 2006–1 January 2007. Of the 448 patients, 19 (4.2%) were HBsAg-positive, and three (0.7%) had anti-HCV positivity. In this study, the seroprevalence of HBV was similar to previous data in Turkey. This could be due to widespread vaccination programmes. The seroprevalence of low anti-HCV may be because of controlled blood transfusion. Oncology patients should be monitored for their protective antibody levels against HBV, and they must be included in the vaccination programme. Their anti-HCV status should also be checked as well. PMID:22283040

Kose, Sukran; Olmezoglu, Ali; Gozaydin, Ayhan

2011-01-01

70

[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

2007-01-01

71

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

72

Scope and limitations of minimal invasive surgery in practice of pediatric surgical oncology  

PubMed Central

Management of Solid tumors in children needs a comprehensive multimodality protocol based treatment plan. Open surgical removal of the tumors occurring in any of the sites such as abdomen, thorax, chest wall, HFN (head, face, neck), brain and extremities, is the option which has been traditionally practiced even in the present era and in most of the centers. Nevertheless with the advances in science and technology and with ever increasing usage and expertise of laparoscopy in children, it’s application has extended to treatment of solid tumors in children. A review of the scope of such intervention as well as the limitations of minimal invasive surgery in this specialized field of pediatric surgery has been attempted in this article. PMID:21584219

Bhatnagar, Sushmita; Sarin, Yogesh Kumar

2010-01-01

73

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

PubMed Central

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

2013-01-01

74

End-of-Life Care of the Geriatric Surgical Patient.  

PubMed

Providing end-of-life care is a necessity for nearly all health care providers and especially those in surgical fields. Most surgical practices will involve caring for geriatric patients and those with life-threatening or terminal illnesses where discussions about end-of-life decision making and goals of care are essential. Understanding the differences between do not resuscitate (DNR), palliative care, hospice care, and symptom management in patients at the end of life is a critical skill set. PMID:25459551

Peschman, Jacob; Brasel, Karen J

2015-02-01

75

From Patient-Specific Mathematical Neuro-Oncology to Precision Medicine  

PubMed Central

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

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

2013-01-01

76

Preoperative trans-jugular porto-systemic shunt for oncological gastric surgery in a cirrhotic patient  

PubMed Central

Abdominal surgery in cirrhotic patients with portal hypertension is associated with high incidence of disease and mortality. In these patients, oncological gastric procedures with lymph-nodes dissection show much higher complication rates than in normotensive portal vein patients. Thus, normalization of portal vein pressure may be a favorable determinant factor to reduce complications. We report a case of a patient with hepatitis C virus-related hepatic cirrhosis, esophageal varices, portal hypertension and gastric cancer. We demonstrated the efficacy of a preoperative trans-jugular porto-systemic shunt to perform oncological radical resection more safely. We retained preoperative the trans-jugular porto-systemic shunt in the patients with elevated portal pressure and gastric cancer to perform a gastrectomy more safely and to decrease morbidity and mortality of these cases. PMID:25624736

Liverani, Andrea; Solinas, Luigi; Di Cesare, Tatiana; Velari, Luca; Neri, Tiziano; Cilurso, Francesco; Favi, Francesco; Bizzarri, Giancarlo

2015-01-01

77

Preoperative trans-jugular porto-systemic shunt for oncological gastric surgery in a cirrhotic patient.  

PubMed

Abdominal surgery in cirrhotic patients with portal hypertension is associated with high incidence of disease and mortality. In these patients, oncological gastric procedures with lymph-nodes dissection show much higher complication rates than in normotensive portal vein patients. Thus, normalization of portal vein pressure may be a favorable determinant factor to reduce complications. We report a case of a patient with hepatitis C virus-related hepatic cirrhosis, esophageal varices, portal hypertension and gastric cancer. We demonstrated the efficacy of a preoperative trans-jugular porto-systemic shunt to perform oncological radical resection more safely. We retained preoperative the trans-jugular porto-systemic shunt in the patients with elevated portal pressure and gastric cancer to perform a gastrectomy more safely and to decrease morbidity and mortality of these cases. PMID:25624736

Liverani, Andrea; Solinas, Luigi; Di Cesare, Tatiana; Velari, Luca; Neri, Tiziano; Cilurso, Francesco; Favi, Francesco; Bizzarri, Giancarlo

2015-01-21

78

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. PMID:22186112

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

2011-01-01

79

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

Cancer.gov

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

80

Salvage Pelvic Lymph Node Dissection in Recurrent Prostate Cancer: Surgical and Early Oncological Outcome  

PubMed Central

Methodology. Seventeen patients with prostate-specific antigen (PSA) rise following local treatment for prostate cancer with curative intent underwent open or minimally invasive salvage pelvic lymph node dissection (SLND) for oligometastatic disease (<4 synchronous metastases) or as staging prior to salvage radiotherapy. Biochemical recurrence after complete biochemical response (cBR) was defined as 2 consecutive PSA increases >0,2?ng/mL; and after incomplete biochemical response as 2 consecutive PSA rises. Newly found metastasis on imaging defined clinical progression (CP). Palliative androgen deprivation therapy (ADT) was initiated if >3 metastases were detected or if patients became symptomatic. Kaplan-Meier statistics were applied. Results. Clavien-Dindo grade 1, 2, 3a, and 3b complications were seen in 6, 1, 1, and 2 patients, respectively. Median follow-up time was 22 months. Among 13 patients treated for oligometastatic disease, 8 (67%) had a PSA decline, with 3 patients showing cBR. Median PSA progression-free survival (FS) was 4.1 months and median CP-FS 7 months. Three patients started ADT, resulting in a 2-year ADT-FS rate of 79.5%. Conclusion. SLND is feasible, but postoperative complication rate seems higher than that for primary LND. Biochemical and clinical response duration is limited, but as part of an oligometastatic treatment regime it can defer palliative ADT.

Van Praet, Charles; Lumen, Nicolaas; Ost, Piet; Fonteyne, Valérie; De Meerleer, Gert; Lambert, Bieke; Delrue, Louke; De Visschere, Pieter; Villeirs, Geert; Decaestecker, Karel

2015-01-01

81

NCI-CCR Pediatric Oncology Branch - Referring a Patient  

Cancer.gov

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

82

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

PubMed Central

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

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

2014-01-01

83

[The disorders of hemostasis and their prevention with low-molecular heparins in oncological patients].  

PubMed

The patients with malignant neoplasms are subjected to high risk of development of venous and arterial thromboembolic disease. The development of thrombosis complicates treatment and deteriorates indicators of survival. The alterations in the system of hemostasis brought on by both tumor and methods of treatment play the main role in pathogenesis of thrombotic complications in oncological patients. The application of low-molecular heparins (Klexan and Fraxiparine) prior to operation and during post-operative period decreases activation of pro-coagulant (prolongation of activated partial thromboplastin time, pro-prothrombin activity and concentration of fibrinogen) and platelet-derived components of system of hemostasis, level of markers of intravascular coagulation of blood, von Willebrand factor. The low-molecular heparins favor preservation of natural inhibitors of thrombin and support protective function of fibrinolytic system. In the group of patients with tumors of locomotor apparatus receiving no pharmaceutical prevention thrombotic complications developed in 13% of cases and in the group of patients receiving Klexan complications developed in 2% of cases. In the group of patients with oncological gynecological patients receiving no pharmaceutical prevention thrombotic complications developed in 13% of cases and in the group of these patients receiving Fraxiparine thrombotic complications developed in 6% of cases and in the group of patients receiving Klexan thrombotic complications developed in 5% of cases. In oncological patients during the period of anti-tumor treatment the intensity of intravascular coagulation of blood is increased. The application of low-molecular heparins against the background of antitumor therapy decreases activation of intravascular coagulation of blood and rate of thrombotic complications. In the group of patients receiving no pharmaceutical prevention the thrombotic complications developed in 21% of patients and in the group of patients receiving low-molecular heparins the complications developed in 4% of patients. PMID:25346984

Somonova, O V; Kushlinski?, N E

2014-07-01

84

Perioperative Glucose Control and Infection Risk in Older Surgical Patients.  

PubMed

The aging of the U.S. population is leading to an increasing number of surgical procedures performed on older adults. At the same time, the quality of medical care is being more closely scrutinized. Surgical site infection is a widely-assessed outcome. Evidence suggests that strict perioperative serum glucose control among patients with or without diabetes can lower the risk of these infections, but it is unclear whether this control should be applied to older surgical patients. In this clinical review, we discuss current research on perioperative serum glucose management for cardiothoracic, orthopedic, and general/colorectal surgery. In addition, we summarize clinical recommendations and quality-of-care process indicators provided by surgical, diabetes, and geriatric medical organizations. PMID:25431751

Lee, Pearl; Min, Lillian; Mody, Lona

2014-03-01

85

Patient-centered care in cancer treatment programs: the future of integrative oncology through psychoeducation.  

PubMed

ABSTRACT? The reciprocal relationship between the mind and body has been a neglected process for improving the psychosocial care of cancer patients. Emotions form an important link between the mind and body. They play a fundamental role in the cognitive functions of decision-making and symptom control. Recognizing this relationship is important for integrative oncology. We define psychoeducation as the teaching of self-evaluation and self-regulation of the mind-body process. A gap exists between research evidence and implementation into clinical practice. The patients' search for self-empowerment through the pursuit of complementary therapies may be a surrogate for inadequate psychoeducation. Integrative oncology programs should implement psychoeducation that helps patients to improve both emotional and cognitive intelligence, enabling them to better negotiate cancer treatment systems. PMID:25531048

Garchinski, Christina M; DiBiase, Ann-Marie; Wong, Raimond K; Sagar, Stephen M

2014-12-01

86

[Surgical treatment of patients with drug abuse and mandible necrosis].  

PubMed

The article describes clinical and radiological classification of osteonecrosis of the mandible in patients with drug dependence, surgical options presented on the basis of classification proposed. Clinical case of simultaneous application of individual plate of nikelid titanium in patient with osteonecrosis of the mandible is presented. PMID:25588339

Medvedev, Iu A; Basin, E M; Korshunova, A V

2014-01-01

87

Adrenal Insufficiency in High-Risk Surgical ICU Patients  

Microsoft Academic Search

Study objectives: To examine the incidence and response to treatment of adrenal insufficiency (AI) in high-risk postoperative patients. Design: Prospective observational case series. Setting: Large urban tertiary-care surgical ICU (SICU). Participants: Adults > 55 years of age who required vasopressor therapy after adequate volume resuscitation in the immediate postoperative period. Interventions: Each patient underwent a cosyntropin (ACTH) stimulation test; at

Emanuel P. Rivers; Mario Gaspari; George Abi Saad; Mark Mlynarek; John Fath; H. Matilda Horst; Jacobo Wortsman

2001-01-01

88

Overcoming Complications Through Pre-patient Surgical Training in Otolaryngology.  

PubMed

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

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

2014-01-01

89

Oral-dental concerns of the pediatric oncology patient  

SciTech Connect

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

Lawson, K.

1989-01-01

90

[The quality of life of patients with oncological gynecological pathology during period of involution].  

PubMed

The representative group of women older than 40 years with oncological gynecological pathology during involution period was examined. Quality of life of these patients and their attitude to their health as well was studied during various rehabilitation periods of the course of this disease. Survey was applied using questionnaire MOS-SF 36 Health Survey 2.0 with subsequent statistical data processing. The results can be applied to enhance effectiveness of preventive activities in gynecology and practical and research medicine. PMID:17036458

Kulikova, N G; Minaev, A B; Simonova, L P

2006-01-01

91

Pharmacology for the geriatric surgical patient.  

PubMed

Alterations in pharmacokinetics and pharmacodynamics place geriatric patients at an increased risk of experiencing an adverse drug event. The incidence of medication-related adverse events can be decreased with careful selection of agents and appropriate dosage adjustments. PMID:25459548

Then, Janine; Tisherman, Samuel A

2015-02-01

92

Increasing Patient Safety and Surgical Team Communication by Using a Count\\/Time Out Board  

Microsoft Academic Search

Communication and collaboration in patient care settings is vital for promoting the best possible patient outcomes. The counting of sponges, sharps, and instruments, and the surgical time out before the start of any surgical procedure are opportunities for the surgical team to address patient safety risks. Personnel in the surgical services department at St Luke's Episcopal Hospital, Houston, Texas, implemented

Elizabeth Morell Edel

2010-01-01

93

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

PubMed Central

ABSTRACT Objectives Surgery remains the preferred treatment for the majority of oral cancers. The aim of the present article was to provide a comprehensive review of complications associated with surgical treatment of oral cancer including hardware failure; complications associated with choice of reconstruction, donor site morbidity as well as functional and aesthetic issues that impact on the quality of life. Material and Methods The available English language literature relevant to complications associated with surgical treatment of oral cancer was reviewed. Complications associated with potential for disfigurement, choice of reconstruction, donor site morbidity as well as functional and aesthetic issues that impact on the quality of life are summarized. Results In total 35 literature sources were obtained and reviewed. The topics covered in the second part of this review series include hardware failure, scars and fistula formation; complications associated with choice of reconstruction, donor site morbidity as well as functional and aesthetic issues. Conclusions Cancer resection should be planned around two very important concepts. First and foremost is the eradication of disease. This should be the ultimate goal of the ablative team and all potential complications that may be the result of appropriately executed oncologic resection should be discussed in details with the patient. Adequate reconstruction of the defects with restoration of form and function is the second, but not of less importance, goal for the successful care of the head and neck cancer patient. PMID:24421972

2010-01-01

94

Surgical indications and optimization of patients for resectable esophageal malignancies  

PubMed Central

Esophageal cancer is a devastating diagnosis with very dire long-term survival rates. This is largely due to its rather insidious progression, which leads to most patients being diagnosed with advanced disease. Recently, however, a greater understanding of the pathogenesis of esophageal malignancies has afforded surgeons and oncologists with new opportunities for intervention and management. Coupled with improvements in imaging, staging, and medical therapies, surgeons have continued to enhance their knowledge of the nuances of esophageal resection, which has resulted in the development of minimally invasive approaches with similar overall oncologic outcomes. This marriage of more efficacious induction therapy and diminished morbidity after esophagectomy offers new promise to patients diagnosed with this aggressive form of cancer. The following review will highlight these most recent advances and will offer insight into our own approach to patients with resectable esophageal malignancy. PMID:24624289

Grimm, Joshua C.; Valero, Vicente

2014-01-01

95

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

PubMed Central

Background and objective The aim of this study was to describe what factors of the healthcare environment are perceived as being important to patients in oncology care. Design A qualitative design was adopted using focus group interviews. Setting and participants The sample was 11 patients with different cancer diagnoses in an oncology ward at a university hospital in west Sweden. Results Analysis of the patients’ perceptions of the environment indicated a complex entity comprising several aspects. These came together in a structure consisting of three main categories: safety, partnership with the staff, and physical space. The care environment is perceived as a complex entity, made up of several physical and psychosocial aspects, where the physical factors are subordinated by the psychosocial factors. It is clearly demonstrated that the patients’ primary desire was a psychosocial environment where they were seen as a unique person; the patients wanted opportunities for good encounters with staff, fellow patients, and family members, supported by a good physical environment; and the patients valued highly a place to withdraw and rest. Conclusions This study presents those attributes that are valued by cancer patients as crucial and important for the support of their well-being and functioning. The results show that physical aspects were subordinate to psychosocial factors, which emerged strongly as being the most important in a caring environment. PMID:23924604

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

2013-01-01

96

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. PMID:23170989

2012-01-01

97

[Salvage cryotherapy for recurrent prostate cancer after radiotherapy failure: Principles, indications, patient selection, oncological results and morbidity].  

PubMed

Potentially curative salvage options for biochemical failure after primary prostatic radiotherapy include salvage radical prostatectomy, brachytherapy, high-intensity focused ultrasound and cryotherapy. Salvage cryoablation for recurrent prostate cancer after irradiation failure is currently a well-established therapeutic option, since technical improvements have permitted better oncologic outcomes and lower complications rates over the years. This article reviews surgical technique, oncologic and functional outcomes, as well as morbidity and complications of salvage cryotherapy for local recurrence after external beam radiotherapy or brachytherapy for prostate cancer. PMID:24910288

Hétet, J-F; Colls, P; Pocholle, P; Chauveau, P; Barré, C; Hallouin, P

2014-11-01

98

Medication Usage in Older Cardiothoracic Surgical Patients  

Microsoft Academic Search

\\u000a Older individuals in general take more medications than other age groups and are more susceptible to potential adverse effects.\\u000a This chapter reviews the changes that occur with aging and that underlie this increased susceptibility and offers suggestions\\u000a to minimize adverse effects. Specific medication categories are highlighted that pose particular risk of adverse effects in\\u000a older cardiothoracic surgery patients. The vast

Richard A. Marottoli; Sean M. Jeffery; Roshini C. Pinto-Powell

99

Evidence-based management of constipation in the oncology patient  

Microsoft Academic Search

Constipation is suffered by over 50% of cancer patients and is regarded as one of the most distressing symptoms causing both physical and emotional distress. A need to treat constipation is often due to a failure to prevent it. There is little literature in this area and research based on clinical trials as to best treatment is virtually non-existent. It

Sam Smith

2001-01-01

100

Antiemetic effect of ginger in gynecologic oncology patients receiving cisplatin.  

PubMed

To determine whether ginger had antiemetic effect in cisplatin-induced emesis, we conducted a randomized, double-blinded crossover study in 48 gynecologic cancer patients receiving cisplatin-based chemotherapy. Subjects were randomly allocated to regimen A or regimen B in their first cycle of the study. All patients received standard antiemetics in the first day of cisplatin administration. In regimen A, capsules of ginger root powder were given orally 1 g /day for 5 days, starting on the first day of chemotherapy. In regimen B, placebo was given on the first day and metoclopramide was given orally thereafter for 4 days. The patients were then crossed over to receive the other antiemetic regimen in their next cycle of chemotherapy. Among 43 evaluable patients who received both cycles of treatment, success in controls of nausea and emesis were not significantly different between the two regimens in both acute and delayed phases. Restlessness, as a side effect, occurred more often in metoclopramide arm compared to ginger arm (P=0.109). In conclusion, addition of ginger to standard antiemetic regimen has no advantage in reducing nausea or vomiting in acute phase of cisplatin-induced emesis. In delayed phase, ginger and metoclopramide have no statistically significant difference in efficacy. PMID:15571611

Manusirivithaya, S; Sripramote, M; Tangjitgamol, S; Sheanakul, C; Leelahakorn, S; Thavaramara, T; Tangcharoenpanich, K

2004-01-01

101

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

102

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

Cancer.gov

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

103

[Croatian guidelines for perioperative enteral nutrition of surgical patients].  

PubMed

Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals. PMID:25327004

Zeli?, Marko; Bender, Darija Vranesi?; Keleci?, Dina Ljubas; Zupan, Zeljko; Cicvari?, Tedi; Maldini, Branka; Durut, Iva; Raheli?, Velimir; Skegro, Mate; Majerovi?, Mate; Perko, Zdravko; Susti?, Alan; Madzar, Tomislav; Kovaci?, Borna; Kekez, Tihomir; Krznari?, Zeljko

2014-01-01

104

Surgical treatment for severe visual compromised patients after pituitary apoplexy  

Microsoft Academic Search

Background  Pituitary apoplexy is a rare neurovascular insult. Early surgical decompression is the most effective treatment, especially for rapid deterioration of visual acuity or for altered consciousness. The timing of rapidly expanded mass was strongly related to the treatment outcome.Methods  Thirteen patients who presented with severe visual defect after pituitary apoplexy were enrolled retrospectively. Six patients without severe underlying diseases were considered

Chi-Cheng Chuang; Chen-Nen Chang; Kuo-Chen Wei; Cheng-Chih Liao; Peng-Wei Hsu; Ying-Cheng Huang; Yao-Liang Chen; Li-Ju Lai; Ping-Ching Pai

2006-01-01

105

Surgical Management of Urolithiasis in Patients after Urinary Diversion  

PubMed Central

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

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

2014-01-01

106

TRAJECTORIES OF ANXIETY IN ONCOLOGY PATIENTS AND FAMILY CAREGIVERS DURING AND AFTER RADIATION THERAPY  

PubMed Central

Purpose Anxiety is common in patients undergoing radiation therapy (RT) and in their family caregivers (FCs). Little is known about individual differences in anxiety trajectories during and after RT. This study aimed to identify distinct latent classes of oncology patients and their FCs based on self-reported anxiety symptoms from the beginning to four months after the completion of RT. Method Using growth mixture modeling (GMM), longitudinal changes in Spielberger State Anxiety Inventory (STAI-S) scores among 167 oncology outpatients with breast, prostate, lung, or brain cancer and 85 FCs were evaluated to determine distinct anxiety symptom profiles. STAI-S scores were assessed just prior to, throughout the course of, and for four months following RT (total of 7 assessments). Baseline trait anxiety and depressive symptoms (during and after RT) were also assessed. Results The GMM analysis identified three latent classes of oncology patients and FCs with distinct trajectories of state anxiety: Low Stable (n=93, 36.9%), Intermediate Decelerating (n=82, 32.5%), and High (n=77, 30.6%) classes. Younger participants, women, ethnic minorities, and those with children at home were more likely to be classified in the High anxiety class. Higher levels of trait anxiety and depressive symptoms, at the initiation of RT, were associated with being in the High anxiety class. Conclusions Subgroups of patients and FCs with high, intermediate, and low mean levels of anxiety during and after RT were identified with GMM. Additional research is needed to better understand the heterogeneity of symptom experiences as well as comorbid symptoms in patients and FCs. PMID:21324418

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

2011-01-01

107

Surgical errors and risks – the head and neck cancer patient  

PubMed Central

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

Harréus, Ulrich

2013-01-01

108

Delivering care to oncology patients in the community: an innovative integrated approach.  

PubMed

A community oncology nursing programme was developed in Ireland between the hospital and community health services for patients receiving systemic cancer therapy, in response to a service need. A robust evaluation of the pilot programme was undertaken, which found that defined clinical procedures traditionally undertaken in hospitals were safely undertaken in the patient's home with no adverse effects. There was a dramatic decrease in hospital attendances for these defined clinical procedures, and hospital capacity was consequently freed up. Patients valued having aspects of their care delivered at home and reported that it improved their quality of life, including reduced hospital visits and travel time. Community nurses expanded their scope of practice and became partners with oncology day-ward nurses in caring for these patients. Community nurses developed the competence and confidence to safely deliver cancer care in the community. This initiative shows that defined elements of acute cancer care can be safely delivered in the community so long as the training and support are provided. The findings and recommendations of the evaluation resulted in university accreditation and approval for national roll-out of the programme. Integration of services between primary and secondary care is a key priority. This innovative programme is a good example of shared integrated care that benefits both patients and health-care providers. PMID:25089749

Hanan, Terry; Mullen, Louise; Laffoy, Marie; O'Toole, Eve; Richmond, Janice; Wynne, Mary

2014-08-01

109

Information seeking during "bad news" oncology interactions: Question asking by patients and their companions.  

PubMed

Previous research has investigated patient question asking in clinical settings as a strategy of information seeking and as an indicator of the level of active patient participation in the interaction. This study investigates questions asked by patients and their companions during stressful encounters in the oncology setting in the USA. We transcribed all questions patients and companions asked the oncologist during 28 outpatient interactions in which "bad news" was discussed (n = 705) and analyzed them for frequency and topic. Additionally, we analyzed the extent to which personal and demographic characteristics and independently obtained ratings of the oncologist-patient/companion relationships were related to question asking. Findings demonstrated that at least one companion was present in 24 (86%) of the 28 interactions and companions asked significantly more questions than patients. The most frequently occurring topics for both patients and companions were treatment, diagnostic testing, diagnosis, and prognosis. In general, personal and demographic characteristics were unrelated to question asking, but older patients asked fewer questions, while more educated patients asked more questions. With regard to ratings of the quality of the dyadic relationships, results showed that "trust" between the physician and companions was positively correlated and "conversational dominance by physician" was negatively correlated with the frequency of companion questions. Additionally, positive ratings of the relationship between physicians and companions were correlated with fewer patient questions. This study demonstrates that companions are active participants in stressful oncology interactions. Future research and physician training in communication would benefit from expanding the focus beyond the patient-physician dyad to the roles and influence of multiple participants in medical interactions. PMID:16962218

Eggly, Susan; Penner, Louis A; Greene, Meredith; Harper, Felicity W K; Ruckdeschel, John C; Albrecht, Terrance L

2006-12-01

110

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

2008-10-01

111

Are Preoperative Depressive Symptoms Associated With Postoperative Delirium in Geriatric Surgical Patients?  

Microsoft Academic Search

Background. Delirium is common in older surgical patients and predicts negative health outcomes. Whether depressive symptoms are prevalent and predict the development of postoperative delirium in elderly surgical patients has not been investigated. Our study aimed to examine the prevalence and prognostic importance of preoperative depressive symptoms in older surgical patients. Methods. Patients at least 65 years of age who

Jacqueline M. Leung; Laura P. Sands; E. Ann Mullen; Yun Wang; Linnea Vaurio

2005-01-01

112

Longitudinal Assessments of Quality of Life in Endometrial Cancer Patients: Effect of Surgical Approach and Adjuvant Radiotherapy  

SciTech Connect

Purpose: Adjuvant radiotherapy (RT) is often considered for endometrial cancer. We studied the effect of RT and surgical treatment on patients' quality of life (QOL). Methods and Materials: All patients referred to the gynecologic oncology clinics with biopsy findings showing endometrial cancer were recruited. QOL assessments were performed using the European Organization for Research and Treatment of Cancer QOL questionnaire-C30, version 3. Assessments were obtained at study entry and at regular 3-month intervals for a maximum of 2 years. Open-ended telephone interviews were done every 6 months. Linear mixed regression models were built using QOL domain scores as dependent variables, with the predictors of surgical treatment and adjuvant RT type. Results: A total of 40 patients were recruited; 80% of the surgeries were performed by laparotomy. Significant improvements were seen in most QOL domains with increased time from treatment. Adjuvant RT resulted in significantly more severe bowel symptoms and improvement in insomnia compared with conservative follow-up. No significant adverse effect from adjuvant RT was seen on the overall QOL. Bowel symptoms were significantly increased in patients treated with laparotomy compared with laparoscopy in the patients treated with whole pelvic RT. Qualitatively, about one-half of the patients noted improvements in their overall QOL during follow-up, with easy fatigability the most prevalent. Conclusion: No significant adverse effect was seen on patients' overall QOL with adjuvant pelvic RT after the recovery period. The acute adverse effects on patients' QOL significantly improved with an increasing interval from diagnosis.

Le, Tien, E-mail: tle@ottawahospital.on.c [Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Ottawa, Ottawa, Ontario (Canada); Menard, Chantal [Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Ottawa, Ottawa, Ontario (Canada); Samant, Rajiv; Choan, E. [Department of Radiation Oncology, University of Ottawa, Ottawa, Ontario (Canada); Hopkins, Laura; Faught, Wylam; Fung-Kee-Fung, Michael [Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Ottawa, Ottawa, Ontario (Canada)

2009-11-01

113

Surgical treatment of liver metastases in patients with neuroendocrine tumors  

PubMed Central

Liver metastases occur in 75% to 80% of patients with neuroendocrine tumors (NETs), and are considered significant adverse prognostic indicators. Management of NETs liver metastases is challenging and requires aggressive therapy. Currently, there are many therapeutic options for metastatic NETs. However, there is considerable controversy regarding the optimal management. Although complete surgical resection remains the optimal therapy, a variety of other minimally invasive surgical and medical options are available, this includes thermal ablative techniques (e.g., radiofrequency ablation, microwave ablation, cryotherapy), embolization using transcatheter embolization, chemoembolization, or radioembolization, and medical therapy (e.g., chemotherapy, biotherapy with somatostatin analogues and interferon). Currently there is no evidence-based data directly comparing surgical versus alternative liver-directed treatment options. An aggressive surgical approach, coupled with additional liver-directed procedures is often recommended as it extends the overall survival. Optimal patient care should be directed by a multidisciplinary team to assure that all treatment options are explored for decision-making while treating this aggressive disease. PMID:25332951

Saeed, Ahmad; Buell, Joseph F

2013-01-01

114

Surgical treatment of patients with unruptured intracranial aneurysms.  

PubMed

We present our experience with elective microsurgical clipping of unruptured intracranial aneurysms (UIA) and analyze this management. A total of 150 patients with UIA were reviewed and data were collected with regard to age, sex, presence of symptoms, location and size of the aneurysms, surgical complications and postoperative 1year outcomes. Aneurysm size was assessed either by three-dimensional CT angiography or digital subtraction angiogram. Glasgow Outcome Scale was used to assess clinical outcomes. One hundred and fifty patients with 165 aneurysms were treated in this series. The mean size of the UIA was 5.6mm. Eighty aneurysms (48.5%) were less than 5mm in size, and 73 (44.2%) were from 5 to 10mm. Ten (6.1%) of the aneurysms were large and two (1.2%) were giant. One hundred and forty-three were asymptomatic and seven were symptomatic before surgery. The outcome was good in 147 patients (98%), and only three patients (2%) had a treatment-related unfavorable outcome. Five patients experienced transient neurological deficits and one patient experienced permanent neurological deficits. Overall 98.7% of the treated aneurysms were satisfactorily obliterated. Wound complications were seen only in three patients. In conclusion, UIA pose a significant challenge for neurosurgeons, where a delicate balance between benefits and possible risks must be weighed. If the requisite expertise is available, they can be treated surgically with low morbidity and a good outcome at specialized neurovascular centers. PMID:25443084

Chen, S F; Kato, Y; Sinha, R; Kumar, A; Watabe, T; Imizu, S; Oda, J; Oguri, D; Sano, H; Hirose, Y

2015-01-01

115

Robotic-assisted surgery in gynecologic oncology.  

PubMed

The quest for improved patient outcomes has been a driving force for adoption of novel surgical innovations across surgical subspecialties. Gynecologic oncology is one such surgical discipline in which minimally invasive surgery has had a robust and evolving role in defining standards of care. Robotic-assisted surgery has developed during the past two decades as a more technologically advanced form of minimally invasive surgery in an effort to mitigate the limitations of conventional laparoscopy and improved patient outcomes. Robotically assisted technology offers potential advantages that include improved three-dimensional stereoscopic vision, wristed instruments that improve surgeon dexterity, and tremor canceling software that improves surgical precision. These technological advances may allow the gynecologic oncology surgeon to perform increasingly radical oncologic surgeries in complex patients. However, the platform is not without limitations, including high cost, lack of haptic feedback, and the requirement for additional training to achieve competence. This review describes the role of robotic-assisted surgery in the management of endometrial, cervical, and ovarian cancer, with an emphasis on comparison with laparotomy and conventional laparoscopy. The literature on novel robotic innovations, special patient populations, cost effectiveness, and fellowship training is also appraised critically in this regard. PMID:25274485

Sinno, Abdulrahman K; Fader, Amanda N

2014-10-01

116

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

PubMed Central

Objective To study practical guidelines and strategies in the treatment of cervical osteomyelitis. Methods We retrospectively reviewed 14 patients who underwent surgical treatment for cervical osteomyelitis from May 2000 to July 2008. We investigated their clinical course, antibiotic regimen, surgical methods, and laboratory and radiologic findings including X-ray, CT and MRI. Results 5 patients had primary spondylodiscitis, 5 patients had post operative spondylodiscitis and 4 patients had tuberculosis in cervical spine. The causative microorganisms were MRSA (5), P. aeruginosa (1), Methicillin resistant coagulase negative streptococcus (1), P. aeruginosa changed to MRSA (1), and 2 patients showed no growth on culture studies. Patients were treated 13.8 weeks (range, 5.4-25.8) with IV antibiotics and then treated for 58.2 days (range, 13-106) with oral antibiotics. Antituberculotic medications were used for a mean of 383.8 days. Patients were treated with anterior debridement and fusion (5), irrigation and debridement (5), simultaneous cervical anterior interbody and transthoracic thoracic interbody fusion (1). 3 patients underwent the planned 2-staged operation, which included an anterior debridement with or without fusion for the 1st operation and posterior instrumentation for 2nd operation. 10 patients (71.4%) had neurologic deficits at the time of diagnosis and 7 patients (70%) among them improved post-operatively. Conclusion Anterior cervical spine surgery is the preferable treatment option in patients with neurological deterioration, extensive bony destruction with expected kyphotic deformity, and uncontrolled infection being managed only with antibiotics. Antibiotics are also important for thorough treatment. PMID:25346763

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

2014-01-01

117

Recommendations for incorporating patient-reported outcomes into clinical comparative effectiveness research in adult oncology.  

PubMed

Examining the patient's subjective experience in prospective clinical comparative effectiveness research (CER) of oncology treatments or process interventions is essential for informing decision making. Patient-reported outcome (PRO) measures are the standard tools for directly eliciting the patient experience. There are currently no widely accepted standards for developing or implementing PRO measures in CER. Recommendations for the design and implementation of PRO measures in CER were developed via a standardized process including multistakeholder interviews, a technical working group, and public comments. Key recommendations are to include assessment of patient-reported symptoms as well as health-related quality of life in all prospective clinical CER studies in adult oncology; to identify symptoms relevant to a particular study population and context based on literature review and/or qualitative and quantitative methods; to assure that PRO measures used are valid, reliable, and sensitive in a comparable population (measures particularly recommended include EORTC QLQ-C30, FACT, MDASI, PRO-CTCAE, and PROMIS); to collect PRO data electronically whenever possible; to employ methods that minimize missing patient reports and include a plan for analyzing and reporting missing PRO data; to report the proportion of responders and cumulative distribution of responses in addition to mean changes in scores; and to publish results of PRO analyses simultaneously with other clinical outcomes. Twelve core symptoms are recommended for consideration in studies in advanced or metastatic cancers. Adherence to methodologic standards for the selection, implementation, and analysis/reporting of PRO measures will lead to an understanding of the patient experience that informs better decisions by patients, providers, regulators, and payers. PMID:23071244

Basch, Ethan; Abernethy, Amy P; Mullins, C Daniel; Reeve, Bryce B; Smith, Mary Lou; Coons, Stephen Joel; Sloan, Jeff; Wenzel, Keith; Chauhan, Cynthia; Eppard, Wayland; Frank, Elizabeth S; Lipscomb, Joseph; Raymond, Stephen A; Spencer, Merianne; Tunis, Sean

2012-12-01

118

Surgical Management of Patients with Synchronous Colorectal Liver Metastasis: A Multicenter International Analysis  

PubMed Central

BACKGROUND The goal of this study was to investigate the surgical management and outcomes of patients with primary colorectal cancer (CRC) and synchronous liver metastasis (sCRLM). STUDY DESIGN Using a multi-institutional database, we identified 1,004 patients treated for sCRLM between 1982 and 2011. Clinicopathologic and outcomes data were evaluated with uni- and multivariable analyses. RESULTS A simultaneous CRC and liver operation was performed in 329 (33%) patients; 675 (67%) underwent a staged approach (“classic” staged approach, n = 647; liver-first strategy, n = 28). Patients managed with the liver-first approach had more hepatic lesions and were more likely to have bilateral disease than those in the other 2 groups (p < 0.05). The use of staged operative strategies increased over the time of the study from 58% to 75% (p < 0.001). Liver-directed therapy included hepatectomy (90%) or combined resection + ablation (10%). A major resection (>3 segments) was more common with a staged approach (39% vs 24%; p < 0.001). Overall, 509 patients (50%) received chemotherapy in either the preoperative (22%) or adjuvant (28%) settings, with 11% of patients having both. There were 197 patients (20%) who had a complication in the postoperative period, with no difference in morbidity between staged and simultaneous groups or major vs minor hepatectomies (p > 0.05). Ninety-day postoperative mortality was 3.0%, with no difference between simultaneous and staged approaches (p = 0.94). The overall median and 5-year survivals were 50.9 months and 44%, respectively; long-term survival was the same regardless of the operative approach (p > 0.05). CONCLUSIONS Simultaneous and staged resections for sCRLM can be performed with comparable morbidity, mortality, and long-term oncologic outcomes. PMID:23433970

Mayo, Skye C; Pulitano, Carlo; Marques, Hugo; Lamelas, Jorge; Wolfgang, Christopher L; de Saussure, Wassila; Choti, Michael A; Gindrat, Isabelle; Aldrighetti, Luca; Barrosso, Eduardo; Mentha, Gilles; Pawlik, Timothy M

2014-01-01

119

Practice Patterns and Perceptions of Thoracic Oncology Providers on Tobacco Use and Cessation in Cancer Patients  

PubMed Central

Introduction Tobacco use is associated with poor outcomes in cancer patients, but there is little information on the practice patterns or perceptions of tobacco use and smoking cessation by oncology providers. Methods An online survey of practices, perceptions, and barriers to tobacco assessment and cessation in cancer patients was conducted in members of the International Association for the Study of Lung Cancer (IASLC). Responses of physician level respondents were analyzed and reported. Results Responses from 1,507 IASLC members who completed the survey are reported representing 40.5% of IASLC members. Over 90% of physician respondents believe current smoking affects outcome and that cessation should be a standard part of clinical care. At the initial patient visit, 90% ask patients about tobacco use, 79% ask patients if they will quit, 81% advise patients to stop tobacco use, but only 40% discuss medication options, 39% actively provide cessation assistance, and fewer yet address tobacco at follow-up. Dominant barriers to physician cessation effort are pessimism regarding their ability to help patients stop using tobacco (58%) and concerns about patient resistance to treatment (67%). Only 33% report themselves adequately trained to provide cessation interventions. Discussion Physicians who care for lung cancer patients recognize the importance of tobacco cessation as a necessary part of clinical care, but many still do not routinely provide assistance to their patients. Increasing tobacco cessation will require increased assessment and cessation at diagnosis and during follow-up, increased clinician education, and improved tobacco cessation methods. PMID:23529191

Warren, Graham W.; Marshall, James R.; Cummings, K. Michael; Toll, Benjamin; Gritz, Ellen R.; Hutson, Alan; Dibaj, Seyedeh; Herbst, Roy; Dresler, Carolyn

2013-01-01

120

Factors Influencing Communication Between the Patients with Cancer and their Nurses in Oncology Wards  

PubMed Central

Aims: The purpose of this study was to demonstrate the factors influencing nurse-patient communication in cancer care in Iran. Materials and Methods: This study was conducted with a qualitative conventional content analysis approach in oncology wards of hospitals in Tabriz. Data was collected through purposive sampling by semi-structured deep interviews with nine patients, three family members and five nurses and analyzed simultaneously. Robustness of data analysis was evaluated by the participants and external control. Results: The main theme of the research emerged as “three-factor effects” that demonstrates all the factors related to the patient, nurse, and the organization and includes three categories of “Patient as the center of communication”, “Nurse as a human factor”, and “Organizational structures”. The first category consists of two sub-categories of “Imposed changes by the disease” and the “patient's particular characteristics”. The second category includes sub-categories of “sense of vulnerability” and “perception of professional self: Pre-requisite of patient-centered communication”. The third category consists of the sub-categories of “workload and time imbalance”, “lack of supervision”, and “impose duties in context of neglecting nurse and patient needs”. Characteristics of the patients, nurses, and care environment seemed to be the influential factors on the communication. Conclusions: In order to communicate with cancer patients effectively, changes in philosophy and culture of the care environment are essential. Nurses must receive proper trainings which meet their needs and which focus on holistic and patient-centered approach. PMID:24600177

Zamanzadeh, Vahid; Rassouli, Maryam; Abbaszadeh, Abbas; Nikanfar, Alireza; Alavi-Majd, Hamid; Ghahramanian, Akram

2014-01-01

121

Evaluating the Total Costs of Chemotherapy-Induced Febrile Neutropenia: Results from a Pilot Study with Community Oncology Cancer Patients  

Microsoft Academic Search

Purpose. While cancer chemotherapy-related febrile neutropenia affects patients' activities and medical ex- penditures, few studies have reported on the total costs of this condition. Here, we evaluate the feasibility of ob- taining detailed and comprehensive cost information on patientswhoexperiencefebrileneutropeniaduringcan- cer chemotherapy treatment. Methods. Community oncology cancer patients who experienced chemotherapy-associated febrile neutrope- nia recorded information about use of medical care,

CHARLES L. BENNETT; ELIZABETH A. CALHOUNb; Robert H. Lurie

122

Palliative care in pediatric hematological oncology patients: experience of a tertiary hospital  

PubMed Central

Objective To evaluate the approach to palliative care for hematological oncology patients in the pediatric ward of a tertiary hospital. Methods This was a retrospective, descriptive study of 29 hematological oncology patients who died between 2009 and 2011. Data regarding the approach and prevalence of pain, prevalence of other symptoms, multidisciplinary team participation, communication between staff and family and limited invasive therapy were collected from the medical records. Results Twenty-seven (93.1%) patients displayed disease progression unresponsive to curative treatment. The median age at death was ten years old. Pain was the most prevalent symptom with all patients who reported pain receiving analgesic medications. The majority took weak (55.2%) and/or strong (65.5%) opioids. The patients were followed by pediatricians and a pediatric hematologist/oncologist. Participation of other professionals was also documented: 86.2% were followed by social services and 69% by psychologists, among others. There were explicit descriptions of limitation of invasive therapy in the medical records of 26 patients who died with disease progression. All these decisions were shared with the families. Conclusion Although the hospital where this study was conducted does not have a specialized team in pediatric palliative care, it meets all the requirements for developing a specific program. The importance of approaching pain and other prevalent symptoms in children with cancer involving a comprehensive multidisciplinary team is evident. Discussions were had with most of the families on limiting invasive therapy, but no record of a well-defined and coordinated treatment plan for palliative care was found. PMID:25453649

Valadares, Maria Thereza Macedo; Mota, Joaquim Antônio César; de Oliveira, Benigna Maria

2014-01-01

123

Percutaneous Dilatational Tracheostomy and Surgically Created Thracheostomy in ICU Patients  

PubMed Central

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

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

2014-01-01

124

Addressing Tobacco Use in Patients With Cancer: A Survey of American Society of Clinical Oncology Members  

PubMed Central

Purpose: Assessing tobacco use and providing cessation support is recommended by the American Society for Clinical Oncology (ASCO). The purpose of this study was to evaluate practice patterns and perceptions of tobacco use and barriers to providing cessation support for patients with cancer. Methods: In 2012, an online survey was sent to 18,502 full ASCO members asking about their practice patterns regarding tobacco assessment, cessation support, perceptions of tobacco use, and barriers to providing cessation support for patients with cancer. Responses from 1,197 ASCO members are reported. Results: At initial visit, most respondents routinely ask patients about tobacco use (90%), ask patients to quit (80%), and advise patients to stop using tobacco (84%). However, only 44% routinely discuss medication options with patients, and only 39% provide cessation support. Tobacco assessments decrease at follow-up assessments. Most respondents (87%) agree or strongly agree that smoking affects cancer outcomes, and 86% believe cessation should be a standard part of clinical cancer care. However, only 29% report adequate training in tobacco cessation interventions. Inability to get patients to quit (72%) and patient resistance to treatment (74%) are dominant barriers to cessation intervention, but only 8% describe cessation as a waste of time. Conclusion: Among ASCO members who responded to an online survey about their practice patterns regarding tobacco, most believe that tobacco cessation is important and frequently assess tobacco at initial visit, but few provide cessation support. Interventions are needed to increase access to tobacco cessation support for patients with cancer. PMID:23943904

Warren, Graham W.; Marshall, James R.; Cummings, K. Michael; Toll, Benjamin A.; Gritz, Ellen R.; Hutson, Alan; Dibaj, Seyedeh; Herbst, Roy; Mulshine, James L.; Hanna, Nasser; Dresler, Carolyn A.

2013-01-01

125

Surgical options for patients with Lennox-Gastaut syndrome.  

PubMed

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

Douglass, Laurie M; Salpekar, Jay

2014-09-01

126

Principles of surgical risk assessment of the elderly patient.  

PubMed

Treatment of the elderly will comprise increasingly higher proportions of practice time in the future, and issues regarding this treatment are more salient now than ever before. Because more elders are seeking treatment, surgeons need to be comfortable with assessing the potential risks associated with surgical procedures in their elderly patients, many of whom have multiple chronic diseases. Risks that need to be considered are those physiologic changes normal for aging, pathologic changes due to disease, and psychosocial changes that may occur with aging. This article assesses the contribution each of these changes makes to surgical risk, and discusses the principles of gerontology and geriatric medicine that are relevant to risk assessment. PMID:2203886

Gilbert, G H; Minaker, K L

1990-09-01

127

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

PubMed Central

Purpose Bloodstream infections in pediatric hematology and oncology represent a major problem worldwide, but this has not been studied in Qatar. In this study, we investigated the burden of infection and the resistance pattern in the bacterial etiology, in the only tertiary pediatric hematology and oncology center in Qatar. Methods All pediatric cancer patients (n=185) were evaluated retrospectively during the period 2004–2011; a total of 70 (38%) patients were diagnosed with bloodstream infections. Bacterial etiology was determined, along with their susceptibility patterns. Neutropenia, duration of neutropenia, fever, duration of fever, and C-reactive protein (CRP) were evaluated throughout the study. Results A total of 70 patients (38%) were diagnosed with acute leukemias, lymphomas, solid tumors, or brain tumors; those patients experienced 111 episodes of bacteremia. The most common Gram-positive (n=64 [55%]) isolates were Staphylococcus epidermidis (n=26), Staphylococcus hominis (n=9), and Staphylococcus haemolyticus (n=7), and the common Gram-negative (n=52 [45%]) isolates were Klebsiella pneumoniae (n=14), Pseudomonas aeruginosa (n=10), and Escherichia coli (n=7). There was a significant association observed between fever with positive blood culture and different types of cancer (P=0.035). The majority of bacteremia (n=68 [61.3%]) occurred in nonneutropenic episodes. Elevated values of CRP (?5 mg/L) were detected in 82 (95.3%) episodes and were negatively correlated with absolute neutrophil count (ANC) (r=?0.18; P=0.248) among all cases. However, the infection-related fatality rate was 2.2% (n=4), with three caused by Gram-negative pathogens. Multidrug resistant organisms were implicated in 33 (28.4%) cases and caused three of the mortality cases. Conclusion Multidrug resistant organisms cause mortality in pediatric cancer patients. Investigation of antimicrobial susceptibility of these organisms may guide successful antimicrobial therapy and improve the surveillance and quality of pediatric malignancy care. PMID:25395866

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

2014-01-01

128

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

PubMed Central

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

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

2012-01-01

129

The effectiveness of a participatory program on fall prevention in oncology patients.  

PubMed

Falls are known to be one of the most common in patient adverse events. A high incidence of falls was reported on patients with cancer. The purpose of this study was to explore the effect of a participatory program on patient's knowledge and self-efficacy of fall prevention and fall incidence in an oncology ward. In this quasi-experimental study, 68 participants were recruited at a medical centre in Taiwan. A 20-min fall prevention program was given to patients. A questionnaire was used to evaluate the effectiveness of program after on day 3 of intervention. The data of fall incidence rates were collected from hospital record. Fall incidences with and without the program were used to compare the effectiveness of intervention. The patients' knowledge and self-efficacy of fall prevention are better than after intervention. A statistically significant difference in fall incidence rate was observed with (0.0%) and without (19.3%) the program. Our findings suggest that the fact of the bedside is that the most risk for falling in hospital must be communicated to the hospitalized patients. Educating patients about fall prevention and activities associated with falling increases their awareness of the potential of falling and promoting patient safety. PMID:25492057

Huang, Li-Chi; Ma, Wei-Fen; Li, Tsai-Chung; Liang, Yia-Wun; Tsai, Li-Yun; Chang, Fy-Uan

2014-12-01

130

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

PubMed Central

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

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

2012-01-01

131

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

NASA Astrophysics Data System (ADS)

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

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

2005-08-01

132

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

133

Risk group criteria for tailoring adjuvant treatment in patients with endometrial cancer: a validation study of the Gynecologic Oncology Group criteria  

PubMed Central

Objective The purpose of this study is to validate the Gynecologic Oncology Group (GOG) criteria for adjuvant treatment in a different cohort of patients and to evaluate the simplified risk criteria predicting the prognosis and tailoring adjuvant treatment in patients with surgically staged endometrial cancer. Methods We performed a retrospective analysis of 261 consecutive patients with surgically staged endometrial cancer between January 2000 and February 2013. All patients had complete staging procedures and were surgically staged according to the 2009 International Federation of Gynecology and Obstetrics staging system. Clinical and pathologic data were obtained from medical records. We designed the simplified risk criteria for adjuvant treatment according to the risk factors associated with survival. The patients were divided into low and low-intermediate, high-intermediate, and high-risk groups according to the GOG criteria and simplified criteria and their survivals were compared. Receiver-operating characteristic curve analysis was used to evaluate the prognostic significance of both criteria. Results Median follow-up time was 48 months (range, 10 to 122 months). According to the GOG criteria, we identified 197 low and low-intermediate risk patients, 20 high-intermediate risk patients, and 44 high-risk patients. There were significant differences in disease-free (p<0.001) and overall survival (p<0.001) among the three groups. Using the simplified risk criteria, we identified 189 low and low-intermediate risk patients, 28 high-intermediate risk patients, and 44 high-risk patients. There were significant differences in disease-free (p<0.001) and overall survival (p<0.001) among the three groups. The performance of the simplified criteria (area under the curve [AUC]=0.829 and 0.916 for disease recurrences and deaths, respectively) was as good as the GOG criteria (AUC=0.836 and 0.921 for disease recurrences and deaths, respectively). Conclusion The simplified criteria may be easily applicable and offer useful information for planning strategy of adjuvant treatment in patients with surgically staged endometrial cancer as the GOG criteria. PMID:25376915

Kong, Tae Wook; Paek, Jiheum; Lee, Yonghee; Chun, Mison; Ryu, Hee-Sug

2015-01-01

134

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

SciTech Connect

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

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

2013-01-01

135

Orthotopic kidney transplant: a valid surgical alternative for complex patients.  

PubMed

Kidney transplant is the best alternative of treatment for patients with end-stage renal disease (ESRD). At present, a significant part of patients admitted to waiting list are older and have previous transplants or severe vascular atheromatosis. In these cases, orthotopic kidney transplant (OKT) could be an option. The aim of the study is to present our results with this technique in terms of surgical steps, complications, and outcomes. Between January 1977 and August 2014, 1549 kidney transplants were performed in our transplant unit. Nine of them were OKT and were performed according to principles described by Gil-Vernet. All data were reviewed retrospectively. Nine OKTs were performed in seven males and two females, with a mean age of 49.3 years (range 24-67). Donor mean age was 40.5 (18.5-62.5) and the follow-up mean time was of 91.8 months (8-226). Seven cases were first transplants and two were third transplants, all of them from deceased donors. Indication for the OKT was an unsuitable iliac region in six (66.6%) and abnormalities in the low urinary tract or urinary diversions in three (33.3%). Delayed graft function (DGF) was present in 22.2% (2/9). Three patients (33.3%) developed early surgical complications: one bleeding (Clavien IIIb), one arterial thrombosis (IIIb), and one pancreatic leak (IIIb). Two patients (25%) had late complications: one ureteral stricture (IIIb) and one reflux nephropathy (IIIa). Mean serum creatinine after OKT was 1.7, 1.5, and 1.8 mg/dl at 1 month, 1 year, and 5 years, respectively. Mean graft survival was 80.7 months (range 0-226). At present, three patients are alive with functioning graft, three patients died with functioning graft, two patients returned to dialysis many years after the transplant, and one lost the graft due to an arterial thrombosis in the early postoperative course. OKT is a valid option for patients with unsuitable iliac regions such as those with third transplants, severe atheromatosis, or vena cava thrombosis. It is also an option for those patients with urinary diversions. Functional results are good, although it is a technique not exempted from complications. Two thirds of the patients have a long-term survival of the graft, and a third of the patients die with functioning graft. PMID:25404184

Hevia, Vital; Gómez, Victoria; Álvarez, Sara; Díez-Nicolás, Víctor; Fernández, Ana; Burgos, Francisco Javier

2015-01-01

136

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

PubMed Central

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

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

2014-01-01

137

Factors influencing the diagnostic accuracy and management in acute surgical patients  

PubMed Central

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

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

2014-01-01

138

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

139

Radical cystectomy for bladder cancer: oncologic outcome in 271 Chinese patients  

PubMed Central

Few large scale studies have reported the oncologic outcome of radical cystectomy for treating bladder cancer in China; hence, we lack long-term prognostic information. The aim of the current study was to determine the survival rate and prognostic factors of patients who underwent radical cystectomy for bladder cancer in a Chinese medical center. We retrospectively analyzed clinicopathologic data from 271 bladder cancer patients who underwent radical cystectomy between 2000 and 2011. Univariate and multivariate analyses were conducted to identify independent prognostic predictors for this cohort. Median follow-up was 31.7 months (range, 0.2–139.1 months). Thirty-day mortality was (1.4%). The 5-year recurrence-free survival, cancer-specific survival (CSS), and overall survival rates were 61.6%, 72.9%, and 68.0%, respectively. The 5-year CSS rates of patients with T1–T4 disease were 90.7%, 85.0%, 51.0%, and 18.0%, respectively. Patients with organ-confined disease had a higher 5-year CSS rate than those with extravesical disease (81.4% vs. 34.9%, P < 0.001). For the 38 patients (14%) with lymph node involvement, the 5-year CSS rate was 27.7%—significantly lower than that of patients without lymph node metastasis (P < 0.001). The 5-year CSS rate was much higher in patients with low grade tumor than in those with high grade tumor (98.1% vs. 68.1%, P < 0.001). Multivariate Cox regression showed that patient age (hazard ratio, 2.045; P = 0.013) and T category (hazard ratio, 2.213; P < 0.001) were independent predictors for CSS. These results suggest that radical cystectomy is a safe and effective method for treating bladder cancer in Chinese patients. Old age and high T category were associated with poor prognosis in bladder cancer patients who underwent radical cystectomy. PMID:23958053

Zhang, Zhi-Ling; Dong, Pei; Li, Yong-Hong; Liu, Zhuo-Wei; Yao, Kai; Han, Hui; Qin, Zi-Ke; Zhou, Fang-Jian

2014-01-01

140

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

PubMed

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

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

2012-06-01

141

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

142

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

143

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

PubMed

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

Farrington, Michele; Cullen, Laura; Dawson, Cindy

2010-01-01

144

Global radiation oncology waybill  

PubMed Central

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

Muñoz-Garzón, Victor; Rovirosa, Ángeles; Ramos, Alfredo

2013-01-01

145

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

Cancer.gov

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

146

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

Federal Register 2010, 2011, 2012, 2013, 2014

...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

147

Evaluation of Distress and Stress in Cancer Patients in AMIR Oncology Hospital in Shiraz  

PubMed Central

Background Routine screening for distress is internationally recommended as a necessary standard for good cancer care given its high prevalence and negative consequences on quality of life. This study attempts to support validation of Distress Thermometer (DT) in Shiraz, Iran and in the second step to investigate privilege/priority of DT over other referent criterion measures. Material and methods In total, 58 outpatients with cancer were recruited from AMIR Oncology hospital in Shiraz, Iran. Each participant completed the DT and a list of 34 possible cancer-related problems (the Problem List), the Hospital Anxiety and Depression Scale (HADS), the 18-item Brief Symptom Inventory (BSI-18), and a short visual analog scale to determine the understandability of the tools. Results Characteristic analysis revealed that DT cutoff scores ?4 and ?5 had optimal sensitivity and specificity relative to both HADS and BSI-18 cutoff scores for general caseness and more severe psychological distress, respectively. Patients with DT scores ?4 (cases) were more likely to be women suffering from psychological problems in the past experience stressful events in the 3 years ago and encounter more family, emotional, and physical issue related to cancer or cancer treatment (p=0.02). Conclusion Patients indicated that the DT was easier to fill out and to understand than the HADS, but not the BSI-18. The DT was identified as a simple and effective screening instrument for detecting distress in Iranian cancer patients as a first step toward more properly referring those in need to psychosocial intervention. PMID:25598953

Mansourabadi, A; Moogooei, M; Nozari, S

2014-01-01

148

Age-related toxicity in patients with rhabdomyosarcoma: a report from the children's oncology group.  

PubMed

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

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

2014-11-01

149

Nutrition support in surgical patients with colorectal cancer  

PubMed Central

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

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

2011-01-01

150

Impact of a patient care pathway protocol on surgical site infection rates in cardiothoracic surgery patients  

Microsoft Academic Search

BackgroundWe hypothesized that implementing a quality care initiative, including peri-incisional antibiotic administration, tight blood glucose control, and hair removal with clippers would reduce surgical site infection (SSI) rates in patients undergoing coronary artery bypass grafting (CABG), with or without valve replacement.

Joshua Trussell; Richard Gerkin; Brian Coates; Jared Brandenberger; Pierre Tibi; Jennifer Keuth; Kerry Montefour; Helen Salisbury; John Ferrara

2008-01-01

151

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

PubMed Central

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

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

2012-01-01

152

Early Initiation of Enteral Feeding in Oncology Patients after Outpatient Percutaneous Fluoroscopic-Guided Gastrostomy Catheter Placement  

PubMed Central

Purpose To report the results of early enteral feeding in oncology patients following outpatient percutaneous fluoroscopic-guided gastrostomy (PFG) placement. Materials and Methods From January 2008 through December 2008, 121 consecutive outpatient oncology patients underwent PFG placement for nutrition. 113 patients met criteria and were fed early (after at least 3 hours). Of these patients, 5 had insufficient follow up for further analysis leaving 108 patients for outcomes analysis. After PFG placement, patients were put on low-wall suction via the PFG for one hour followed by feeding via PFG at least three hours after placement. Follow-up was obtained on the next business day. The medical records were reviewed for the outcomes of early feeding, technical aspects of the procedures, and complications. Results Following PFG placement, 93% (113/121) of patients met criteria for early feeding and 91% (103/113) of these patients were fed within 5 hours of PFG insertion. The median time between the end of procedure and initiation of feeding was 4 hours (range 3-6.5 hours). The 30-day minor complication rate was 14% (15/108) and major complication rate was 0.9% (1/108). No complications were directly attributable to early feeding. Conclusion Early initiation of tube feedings following outpatient PFG placement was well tolerated in oncology patients and carried no additional risk compared with previously reported results using traditional delayed feeding protocols. Early feeding provided our patients with prompt enteral nutrition and eliminated the need for post-procedural hospital admission. PMID:24674218

Sabir, Sharjeel H.; Armstrong, Ryan; Elting, Linda S.; Wallace, Michael J.; Gupta, Sanjay; Tam, Alda L.

2015-01-01

153

Management of the Gastrointestinal Tract and Nutrition in the Geriatric Surgical Patient.  

PubMed

Aging is associated with physiological changes in the gut and with physical and psychosocial risk factors that predispose to malnutrition, particularly in the presence of disease states. The geriatric faction of the surgical population is increasing, and malnourished, critically ill geriatric surgical patients have worse outcomes. The authors discuss the assessment of nutritional risk, recognition of risk factors, statement of dietary goals, and appropriate nutritional interventions in critically ill geriatric surgical patients. PMID:25459544

Nohra, Eden; Bochicchio, Grant V

2015-02-01

154

Review of current best practice and priorities for research in radiation oncology for elderly patients with cancer: the International Society of Geriatric Oncology (SIOG) task force.  

PubMed

Radiotherapy (RT) is a key component of the management of older cancer patients. Level I evidence in older patients is limited. The International Society of Geriatric Oncology (SIOG) established a task force to make recommendations for curative RT in older patients and to identify future research priorities. Evidence-based guidelines are provided for breast, lung, endometrial, prostate, rectal, pancreatic, oesophageal, head and neck, central nervous system malignancies and lymphomas. Patient selection should include comorbidity and geriatric evaluation. Advances in radiation planning and delivery improve target coverage, reduce toxicity and widen eligibility for treatment. Shorter courses of hypofractionated whole breast RT are safe and effective. Conformal RT and involved-field techniques without elective nodal irradiation have improved outcomes in non-small-cell lung cancer (NSCLC) without increasing toxicity. Where comorbidities preclude surgery, stereotactic body radiotherapy (SBRT) is an option for early-stage NSCLC and pancreatic cancer. Modern involved-field RT for lymphoma based on pre-treatment positron emission tomography data has reduced toxicity. Significant comorbidity is a relative contraindication to aggressive treatment in low-risk prostate cancer (PC). For intermediate-risk disease, 4-6 months of hormones are combined with external beam radiotherapy (EBRT). For high-risk PC, combined modality therapy (CMT) is advised. For high-intermediate risk, endometrial cancer vaginal brachytherapy is recommended. Short-course EBRT is an alternative to CMT in older patients with rectal cancer without significant comorbidities. Endorectal RT may be an option for early disease. For primary brain tumours, shorter courses of postoperative RT following maximal debulking provide equivalent survival to longer schedules. MGMT methylation status may help select older patients for temozolomide alone. Stereotactic RT provides an alternative to whole-brain RT in patients with limited brain metastases. Intensity-modulated radiation therapy provides an excellent technique to reduce dose to the carotids in head and neck cancer and improves locoregional control in oesophageal cancer. Best practice and research priorities are summarised. PMID:24625455

Kunkler, I H; Audisio, R; Belkacemi, Y; Betz, M; Gore, E; Hoffe, S; Kirova, Y; Koper, P; Lagrange, J-L; Markouizou, A; Pfeffer, R; Villa, S

2014-11-01

155

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

Cancer.gov

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

156

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

157

Transfusion related iron overload in pediatric oncology patients treated at a tertiary care centre and treatment with chelation therapy.  

PubMed

We conducted a retrospective chart review to determine prevalence of, risk factors for, and liver toxicity associated with Transfusion Related Iron Overload (TRIO) in pediatric cancer patients, and report our experience with Iron Chelation Therapy (ICT). Total number of transfusions was identified as the major risk factor, with a prevalence of 37% in patients receiving ?10 transfusions. Four patients with TRIO and abnormal liver function tests (LFT) received ICT. Significant decrease in serum ferritin and improvement in LFT were observed, with no serious adverse effects from ICT noted. Guidelines for screening and treatment of TRIO in pediatric oncology are needed. PMID:25154390

Sait, Sameer; Zaghloul, Nibal; Patel, Ashish; Shah, Tishi; Iacobas, Ionela; Calderwood, Stanley

2014-12-01

158

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

PubMed Central

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

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

2014-01-01

159

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

PubMed Central

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

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

2014-01-01

160

Investigation of the effects of planned mouth care education on the degree of oral mucositis in pediatric oncology patients.  

PubMed

This study was designed as a longitudinal study with the purpose of investigating the effects of providing mouth care education to pediatric oncology patients on the degree of oral mucositis. The study sample included 16 children aged 8 to 18 years who were hospitalized in the pediatric oncology and hematology clinics at a university hospital. The results revealed a statistically significant difference between the degree of mucositis before and after the education given to children undergoing chemotherapy (P < .05). The median pain values were significantly different before and after the education (P < .05) as well. It was also found that there was a strong positive statistically significant correlation between the degree of mucositis and mean pain score both before and after the education (P < .001). Consequently, it is reported that both the degree of mucositis and pain levels decreased when children were given planned mouth care education before chemotherapy and when they regularly performed mouth care. PMID:25416516

Yavuz, Betül; Bal Y?lmaz, Hatice

2015-01-01

161

The 2014 society of surgical oncology susan g. Komen for the cure symposium: triple-negative breast cancer.  

PubMed

Triple-negative breast cancer (TNBC) is an operational term that refers to a heterogeneous collection of breast cancers lacking expression of estrogen receptor (ER), progesterone receptor, and HER2. These tumors account for 12-17 % of all breast cancers, preferentially affect young women, are more frequent in women of African and Hispanic descent, and are enriched in the population of patients diagnosed with "interval cancers." TNBCs account for the majority of breast cancers arising in BRCA1 germline mutation carriers (approximately 80 %), and approximately 11-16 % of all TNBCs harbor BRCA1 or BRCA2 germline mutations. Well-known risk factors for ER-positive cancers, such as reproductive history and hormonal factors, do not appear to have the same correlations for TNBC, and histologic risk factors for TNBC have not been identified. Patients with TNBC have a higher risk of both local and distant recurrence, but this is not mitigated by bigger surgery, and standard criteria should be used to select the approach to local therapy in these patients. Although platinum drugs have shown promise in the treatment of TNBC, standard chemotherapy remains the standard of care outside of a clinical trial. PMID:25527230

Newman, Lisa A; Reis-Filho, Jorge S; Morrow, Monica; Carey, Lisa A; King, Tari A

2015-03-01

162

INvolvement of breast CAncer patients during oncological consultations: a multicentre randomised controlled trial—the INCA study protocol  

PubMed Central

Introduction Studies on patient involvement show that physicians make few attempts to involve their patients who ask few questions if not facilitated. On the other hand, the patients who participate in the decision-making process show greater treatment adherence and have better health outcomes. Different methods to encourage the active participation during oncological consultation have been described; however, similar studies in Italy are lacking. The aims of the present study are to (1) assess the effects of a preconsultation intervention to increase the involvement of breast cancer patients during the consultation, and (2) explore the role of the attending companions in the information exchange during consultation. Methods and analysis All female patients with breast cancer who attend the Oncology Out-patient Services for the first time will provide an informed consent to participate in the study. They are randomly assigned to the intervention or to the control group. The intervention consists of the presentation of a list of relevant illness-related questions, called a question prompt sheet. The primary outcome measure of the efficacy of the intervention is the number of questions asked by patients during the consultation. Secondary outcomes are the involvement of the patient by the oncologist; the patient's perceived achievement of her information needs; the patient's satisfaction and ability to cope; the quality of the doctor–patient relationship in terms of patient-centeredness; and the number of questions asked by the patient's companions and their involvement during the consultation. All outcome measures are supposed to significantly increase in the intervention group. Ethics and dissemination The study was approved by the local Ethics Committee of the Hospital Trust of Verona. Study findings will be disseminated through peer-reviewed publications and conference presentations. Trial registration ClinicalTrials.gov identifier: NCT01510964 PMID:23645911

Goss, Claudia; Ghilardi, Alberto; Deledda, Giuseppe; Buizza, Chiara; Bottacini, Alessandro; Del Piccolo, Lidia; Rimondini, Michela; Chiodera, Federica; Mazzi, Maria Angela; Ballarin, Mario; Bighelli, Irene; Strepparava, Maria Grazia; Molino, Annamaria; Fiorio, Elena; Nortilli, Rolando; Caliolo, Chiara; Zuliani, Serena; Auriemma, Alessandra; Maspero, Federica; Simoncini, Edda Lucia; Ragni, Fulvio; Brown, Richard; Zimmermann, Christa

2013-01-01

163

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

PubMed

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

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

2014-12-01

164

Assessment of changes in body water by bioimpedance in acutely ill surgical patients  

Microsoft Academic Search

Objective: To evaluate the relationship between changes in body bioelectrical impedance (BI) at 0.5, 50 and kHz and the changes in body weight, as an index of total body water changes, in acutely ill surgical patients during the rapid infusion of isotonic saline solution.Design: Prospective clinical study.Setting: Multidisciplinary surgical ICU in a university hospital.Patients: Twelve male patients treated for acute

R. L. Chioléro; L. J. Gay; J. Cotting; C. Gurtner; Y. Schutz

1992-01-01

165

Non-surgical treatment of early breast cancer: techniques on the way  

PubMed Central

Trials are still on the way to evaluate different non-surgical techniques to treat early breast cancer with achieving maximum oncological control and aesthetic outcome. Also these techniques can help old patients to bypass surgical and radiation complications and facilitate the treatment of early breast cancer with minimum side effects. PMID:25207205

Elrefaey, Shymaa

2014-01-01

166

Evaluating the usefulness of patient education materials on surgical site infection: A systematic assessment.  

PubMed

Patient education is important for the prevention of surgical site infections (SSIs). The usefulness of available patient education materials is unclear. Using a validated evaluation tool, the Patient Education Materials Assessment Tool, we systematically assessed patient education materials for SSI. We found that available materials performed poorly, and further research is needed in this area. PMID:25541334

Zellmer, Caroline; Zimdars, Peggy; Parker, Sarah; Safdar, Nasia

2015-02-01

167

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

PubMed

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

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

2014-06-01

168

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

169

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

PubMed Central

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

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

2012-01-01

170

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

PubMed Central

Background To compare survival of patients with non-small cell lung cancer (NSCLC) who underwent surgical resection and lymph node sampling based on guidelines proposed by the American College of Surgeons Oncology Group (ACOSOG), National Comprehensive Cancer Network (NCCN), the OSI Pharmaceutical RADIANT trial, and the International Association for the Study of Lung Cancer (IASLC). Methods Medical records of patients with NSCLC who underwent surgical resection from 2001 to 2008 at our hospital were reviewed. Staging was according to the 7th edition of the AJCC TNM classification of lung cancer. Patients who received surgical resection following the IASLC, ACOSOG, RADIANT or NCCN resection criteria were identified. Results A total of 2,711 patients (1803 males, 908 females; mean age, 59.6?±?9.6 years) were included. Multivariate Cox proportional hazards regression analysis indicated that increasing age, adenosquamous histology, and TNM stage II or III were associated with decreased overall survival (OS). Univariate analysis and log-rank test showed that surgical resection following the guidelines proposed by the IASLC, NCCN, ACOSOG, or RADIANT trial was associated with higher cumulative OS rates (relative to resection not following the guidelines). Multivariate analysis revealed that there was a significant improvement in OS only when IASLC resection guidelines (complete resection) were followed (hazard ratio?=?0.84, 95% confidence interval 0.716 to 0.985, P?=?0.032). Conclusions Surgical resection following the criteria proposed by IASLC, NCCN, ACOSOG, or the RADIANT trial was associated with a higher cumulative OS rate. However, significant improvement in OS only occurred when IASLC resection guidelines were followed. PMID:24915848

2014-01-01

171

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

E-print Network

Using the Statecharts paradigm for simulation of patient flow in surgical care Boris Sobolev of surgical care. However, little research is available on the utility of existing modeling techniques in one activity according to transitions that occur in another activity. Combined with hierarchy

Harel, David

172

Astrocytomas of the cerebral peduncle in children: surgical experience in seven patients  

Microsoft Academic Search

Objects. Cerebral peduncle tumors are rare in childhood but often consist of benign astrocytomas. Surgical resection, however, is considered to be detrimental because of the highly sensitive neural structures. These tumors are often treated by radiation therapy (RT). We resected such tumors in seven patients, whom we then followed up without adjuvant therapy. The surgical approach and postoperative course are

Tadanori Tomita; Ricardo F. Cortes

2002-01-01

173

Nonadherence in Adolescent Oncology Patients: Preliminary Data on Psychological Risk Factors and Relationships to Outcome  

Microsoft Academic Search

Published nonadherence rates in the adolescent oncology population range from 33 to 60% though little is known about the psychological factors that contribute to adherence and the relationship between outcome and nonadherence. Our study was designed to investigate psychological and family factors related to adherence and the relationship between adherence and survival in this population. We evaluated 44 (27 males,

Beth D. Kennard; Sunita M. Stewart; Rebecca Olvera; Roger E. Bawdon; Ann O hAilin; Charles P. Lewis; Naomi J. Winick

2004-01-01

174

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. PMID:22754118

Edgerton, Zachary J.

2012-01-01

175

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

PubMed

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

Edgerton, Zachary J; Edgerton, James R

2012-07-01

176

Surgical strategy for intracranial dermoid and epidermoid tumors: An experience with 33 Patients  

PubMed Central

Background: The aim of this paper is to report on our surgical strategy and technique and to identify the best management for intracranial dermoids and epidermoids tumors (IDETs). Methods: We retrospectively reviewed 33 consecutive patients (14 males and 19 females; mean age at surgery, 37.9 years) with pathologically confirmed IDETs who underwent surgical resection, with mean follow-up of 7.2 years. Results: Gross total tumor removal was achieved in 24 cases (72.7%) with zero surgical mortality and a recurrence rate of 9%. Conclusions: The surgical strategies used in this group of patients enabled total removal of most tumors without surgical mortality and with low morbidity and recurrence rates, proving to be safe and effective.

Lynch, Jose Carlos; Aversa, Antônio; Pereira, Celestino; Nogueira, Jânio; Gonçalves, Mariangela; Lopes, Hélio

2014-01-01

177

[Enterosorption in the treatment of chronic kidney failure in patients with surgical diseases of the kidneys].  

PubMed

Enterosgel was used in 89 patients with different stages of renal failure treated surgically and medically. It is concluded that isolated or complex detoxication using enterosgel is a perspective approach in the treatment of patients with surgical renal diseases complicated by chronic renal failure. The use of enterosorption in the preoperative period allows to perform operative intervention in situations when infusion treatment by traditional methods was not sufficient. PMID:1441347

Vozianov, A F; Kolesnik, N A; Samodumova, I M

1992-02-01

178

Pacific Partnership 2008: the surgical mission, surgical screening process, and the anesthetic management of uncontrolled, untreated hypertensive patients.  

PubMed

United States Armed Forces and nongovernmental agencies on board the USNS Mercy provided humanitarian and civic assistance to over 68,000 patients in five southeastern Asian nations during Pacific Partnership 2008. A commitment to improving the health and well-being of the citizens of these countries along with strengthening diplomatic relationships between the United States and the host nations visited was paramount. This article focuses on surgical mission planning and perioperative anesthetic considerations of providing care for patients with uncontrolled untreated hypertension. Special consideration was required when providing anesthetic care to our patient population. The anesthesia team developed perioperative guidelines for these patients and experienced minimal complications for over 900 surgeries. The purpose herein is to provide guidance for future humanitarian missions regarding management of this clinical problem and to improve mission planning. PMID:20108840

King, Heather Cuniff; Baker, William

2010-01-01

179

Preoperative Prevalence of Staphylococcus aureus in Cardiothoracic and Neurological Surgical Patients  

PubMed Central

Methicillin-resistant Staphylococcus aureus (MRSA) is a global cause of both hospital and community-acquired infection. This retrospective, observational study determined the prevalence of MRSA carriers in cardiothoracic and neurological surgical patients presenting to an outpatient preoperative assessment center in Columbus, OH. Aggressive skin and soft-tissue infection may be caused by MRSA with potentially fatal complications. Cardiothoracic and neurological surgical patients are at high risk for surgical-site infection. Results indicated that 4.25% of the sample carried MRSA and 25.25% carried methicillin-sensitive S. aureus. PMID:25405147

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

2014-01-01

180

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

PubMed Central

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

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

2011-01-01

181

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

182

Results of high-risk neutropenia therapy of hematology–oncology patients in a university hospital in Uruguay  

PubMed Central

Background Febrile neutropenia is an important cause of mortality and morbidity in hematology–oncology patients undergoing chemotherapy. The management of febrile neutropenia is typically algorithm-driven. The aim of this study was to assess the results of a standardized protocol for the treatment of febrile neutropenia. Methods A retrospective cohort study (2011–2012) was conducted of patients with high-risk neutropenia in a hematology–oncology service. Results Forty-four episodes of 17 patients with a median age of 48 years (range: 18–78 years) were included. The incidence of febrile neutropenia was 61.4%. The presence of febrile neutropenia was associated with both the duration and severity of neutropenia. Microbiological agents were isolated from different sources in 59.3% of the episodes with bacteremia isolated from blood being the most prevalent (81.3%). Multiple drug-resistant gram-negative bacilli were isolated in 62.5% of all microbiologically documented infections. Treatment of 63% of the episodes in which the initial treatment was piperacillin/tazobactam needed to be escalated to meropenem. The mortality rate due to febrile neutropenia episodes was 18.5%. Conclusion The high rate of gram-negative bacilli resistant to piperacillin/tazobactam (front-line antibiotics in our protocol) and the early need to escalate to carbapenems raises the question as to whether it is necessary to change the current protocol. PMID:25638764

Boada Burutaran, Matilde; Guadagna, Regina; Grille, Sofia; Stevenazzi, Mariana; Guillermo, Cecilia; Diaz, Lilian

2014-01-01

183

Assessment of presurgical clefts and predicted surgical outcome in patients treated with and without nasoalveolar molding.  

PubMed

Obtaining an esthetic and functional primary surgical repair in patients with complete cleft lip and palate (CLP) can be challenging because of tissue deficiencies and alveolar ridge displacement. This study aimed to describe surgeons' assessments of presurgical deformity and predicted surgical outcomes in patients with complete unilateral and bilateral CLP (UCLP and BCLP, respectively) treated with and without nasoalveolar molding (NAM). Cleft surgeon members of the American Cleft Palate-Craniofacial Association completed online surveys to evaluate 20 presurgical photograph sets (frontal and basal views) of patients with UCLP (n = 10) and BCLP (n = 10) for severity of cleft deformity, quality of predicted surgical outcome, and likelihood of early surgical revision. Five patients in each group (UCLP and BCLP) received NAM, and 5 patients did not receive NAM. Surgeons were masked to patient group. Twenty-four percent (176/731) of surgeons with valid e-mail addresses responded to the survey. For patients with UCLP, surgeons reported that, for NAM-prepared patients, 53.3% had minimum severity clefts, 58.9% were anticipated to be among their best surgical outcomes, and 82.9% were unlikely to need revision surgery. For patients with BCLP, these percentages were 29.8%, 38.6%, and 59.9%, respectively. Comparing NAM-prepared with non-NAM-prepared patients showed statistically significant differences (P < 0.001), favoring NAM-prepared patients. This study suggests that cleft surgeons assess NAM-prepared patients as more likely to have less severe clefts, to be among the best of their surgical outcomes, and to be less likely to need revision surgery when compared with patients not prepared with NAM. PMID:25534051

Rubin, Marcie S; Clouston, Sean; Ahmed, Mohammad M; M Lowe, Kristen; Shetye, Pradip R; Broder, Hillary L; Warren, Stephen M; Grayson, Barry H

2015-01-01

184

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

E-print Network

resource and patient management. Keywords: WiFi, Tracking, Location, Positioning, Safety, HealthcareThe Digital Patient Push ­ Using Location to Streamline the Surgical Journey S. Mukherjee1 , K-h.peng@aston.ac.uk Abstract: This paper introduces a patient information management system that uses location tracking of Wi

Peng, Xiaohong

185

Surgical correction of obstructive sleep apnea in the complicated pediatric patient documented by polysomnography  

Microsoft Academic Search

Objective: Evaluate the effectiveness of surgical treatment of obstructive sleep apnea in a diverse population of children. Design: A retrospective case series of pre and post operative polysomnograms (PSG) of pediatric patients with obstructive sleep apnea (OSA). Setting: Tertiary care children's hospital. Patients: 48 patients in whom sleep studies were performed pre-operatively for either an unclear history and\\/or physical findings

Gregory J. Wiet; Charles Bower; Robert Seibert; May Griebel

1997-01-01

186

Recurrence and Survival After Random Assignment to Laparoscopy Versus Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group LAP2 Study  

PubMed Central

Purpose The primary objective was to establish noninferiority of laparoscopy compared with laparotomy for recurrence after surgical staging of uterine cancer. Patients and Methods Patients with clinical stages I to IIA disease were randomly allocated (two to one) to laparoscopy (n = 1,696) versus laparotomy (n = 920) for hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The primary study end point was noninferiority of recurrence-free interval defined as no more than a 40% increase in the risk of recurrence with laparoscopy compared with laparotomy. Results With a median follow-up time of 59 months for 2,181 patients still alive, there were 309 recurrences (210 laparoscopy; 99 laparotomy) and 350 deaths (229 laparoscopy; 121 laparotomy). The estimated hazard ratio for laparoscopy relative to laparotomy was 1.14 (90% lower bound, 0.92; 95% upper bound, 1.46), falling short of the protocol-specified definition of noninferiority. However, the actual recurrence rates were substantially lower than anticipated, resulting in an estimated 3-year recurrence rate of 11.4% with laparoscopy and 10.2% with laparotomy, or a difference of 1.14% (90% lower bound, ?1.28; 95% upper bound, 4.0). The estimated 5-year overall survival was almost identical in both arms at 89.8%. Conclusion This study previously reported that laparoscopic surgical management of uterine cancer is superior for short-term safety and length-of-stay end points. The potential for increased risk of cancer recurrence with laparoscopy versus laparotomy was quantified and found to be small, providing accurate information for decision making for women with uterine cancer. PMID:22291074

Walker, Joan L.; Piedmonte, Marion R.; Spirtos, Nick M.; Eisenkop, Scott M.; Schlaerth, John B.; Mannel, Robert S.; Barakat, Richard; Pearl, Michael L.; Sharma, Sudarshan K.

2012-01-01

187

Validation and Predictive Power of Radiation Therapy Oncology Group (RTOG) Recursive Partitioning Analysis Classes for Malignant Glioma Patients: A Report Using RTOG 90-06  

Microsoft Academic Search

Purpose: The recursive partitioning analysis (RPA) classes for malignant glioma patients were previously established using data on over 1500 patients entered on Radiation Therapy Oncology Group (RTOG) clinical trials. The purpose of the current analysis was to validate the RPA classes with a new dataset (RTOG 90-06), determine the predictive power of the RPA classes, and establish the usefulness of

Charles B Scott; Charles Scarantino; Raul Urtasun; Benjamin Movsas; Christopher U Jones; Joseph R Simpson; A. Jennifer Fischbach; Walter J Curran

1998-01-01

188

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

189

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

190

Different Clinical Utility of Oropharyngeal Bacterial Screening prior to Percutaneous Endoscopic Gastrostomy in Oncological and Neurological Patients  

PubMed Central

Background. The aim of this study was to monitor oropharyngeal bacterial colonization in patients indicated for percutaneous endoscopic gastronomy (PEG). Methods. Oropharyngeal swabs were obtained from patients prior to PEG placement. A development of peristomal infection was evaluated. The analysis of oropharyngeal and peristomal site pathogens was done. Results. Consecutive 274 patients referred for PEG due to neurological disorder or cancer completed the study. Oropharyngeal colonization with pathogens was observed in 69% (190/274), dominantly in the neurologic subgroup of patients (P < 0.001). Peristomal infection occurred in 30 (10.9%) of patients and in 57% of them the correlation between oropharyngeal and peristomal agents was present. The presence of oropharyngeal pathogens was assessed as an important risk factor for the development of peristomal infection only in oncological patients (OR = 8.33, 95% CI: 1.66–41.76). Despite a high prevalence of pathogens in neurological patients, it did not influence the risk of peristomal infection with the exception for methicillin resistant Staphylococcus aureus (MRSA) carriers (OR 4.5, 95% CI: 1.08–18.76). Conclusion. During oropharyngeal microbial screening prior to the PEG insertion, the detection of pathogens may be a marker of the increased risk of peristomal infection in cancer patients only. In neurological patients the benefit of the screening is limited to the detection of MRSA carriers. PMID:25243153

Dastych, Milan; Senkyrik, Michal; Pavlik, Tomas; Prokesova, Jitka; Jecmenova, Marketa; Dolina, Jiri; Hep, Ales

2014-01-01

191

[Clinical study on intraoperative hyperketonemia in non-diabetic surgical patients under general anesthesia].  

PubMed

We measured plasma 3-hydroxybutyrate (3-OHBA) concentrations in 925 non-diabetic surgical patients who underwent various surgical procedures under various types of general anesthesia. Lactated Ringer's solution only was used as an intraoperative fluid. Among them, 46 patients (4.9%) developed high 3-OHBA levels of over 500 microM.l-1 during surgery. The causes of observed hyperketonemia would be surgical stress and preoperative fasting irrespective of 8 types of general anesthesia. Blood glucose, lactic acid, base excess and pH were not influenced by hyperketonemia. Prolonged recovery from anesthesia was not observed in any patients with hyperketonemia. Without any specific treatments, plasma 3-OHBA levels were unchanged or rather decreased in 70% of the patients whose 3-OHBA levels were over 500 microM. The results suggest that hyperketonemia below 500 microM.l-1 is not always disadvantageous in nondiabetic patients under general anesthesia. PMID:8301829

Ohkawa, H; Iwakawa, T; Ohtomo, N; Kitayama, M; Miyahara, A; Ishihara, H; Matsuki, A

1993-12-01

192

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

PubMed Central

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

2014-01-01

193

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

SciTech Connect

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

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

2006-07-01

194

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

PubMed Central

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

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

2014-01-01

195

Surgical results in patients with hepatitis virus-related hepatocellular carcinoma in Taiwan  

Microsoft Academic Search

To investigate the surgical results of hepatectomy for hepatocellular carcinoma in relation to hepatitis virus status in Taiwan,\\u000a 252 patients (196 men and 56 women; March 1992 to August 1998) were reviewed. The patients were divided into four groups:\\u000a 30 patients (11.9%) seronegative for both hepatitis B surface antigen (HBsAg) and antihepatitis C antibody (HCVAb) (N-HCC\\u000a group); 133 patients (52.8%)

Miin-Fu Chen; Long-Bin Jeng; Wei-Chen Lee

2002-01-01

196

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

PubMed

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

Türker, ?brahim; Kömürcü, ?eref; Ar?can, Ali; Doruk, Hatice; Özy?lkan, Özgür; Co?kun, Hasan ?enol; Colak, Dil?en; Üçgül Çavu?o?lu, Emel; Ata, Alper; Sezer, Ahmet; Ye?il Ç?nk?r, Havva; ?enler, Filiz Cay; Arpac?, Fikret

2014-12-01

197

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. PMID:19672432

Roth, Kirk; Izard, Jason; Beiko, Darren

2009-01-01

198

Patterns of Care in Elderly Head-and-Neck Cancer Radiation Oncology Patients: A Single-Center Cohort Study  

SciTech Connect

Purpose: To compare the patterns of care for elderly head-and-neck cancer patients with those of younger patients. Methods and Materials: A retrospective review was conducted of all new mucosal head-and-neck cancer referrals to radiation oncology between July 1, 2003 and December 31, 2007 at our institution. The clinical characteristics, treatment pattern, tolerance, and outcomes were compared between the elderly (aged {>=}75 years) and younger (aged <75 years) cohorts. Results: A total of 2,312 patients, including 452 (20%) elderly and 1,860 (80%) younger patients, were studied. The elderly patients were more likely to be women (36% vs. 27%, p <.01) and to have other malignancies (23% vs. 13%, p <.01), Stage I or II disease (38% vs. 32%, p <.01), and N0 status (56% vs. 42%, p <.01). Treatment was less often curative in intent (79% vs. 93%, p <.01). For the 1,487 patients who received definitive radiotherapy (RT), no differences were found between the elderly (n = 238) and younger (n = 1,249) patients in treatment interruption, completion, or treatment-related death. Within the subset of 760 patients who received intensified treatment (concurrent chemoradiotherapy or hyperfractionated accelerated RT), no difference was seen between the elderly (n = 46) and younger (n = 714) patients in treatment interruption, completion, or treatment-related death. After a median follow-up of 2.5 years, the 2-year cause-specific survival rate after definitive RT was 72% (range, 65-78%) for the elderly vs. 86% (range, 84-88%) for the younger patients (p <.01). Conclusion: Elderly head-and-neck cancer patients exhibited different clinical characteristics and experienced different patterns of care from younger patients. Although age itself was an adverse predictor of cause-specific survival, its effect was modest. Elderly patients selected for definitive RT or intensified RT showed no evidence of impaired treatment tolerance.

Huang Shaohui [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); O'Sullivan, Brian; Waldron, John [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON (Canada); Lockwood, Gina [Department of Biostatistics, Princess Margaret Hospital, Toronto, ON (Canada); Bayley, Andrew; Kim, John [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Cummings, Bernard [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON (Canada); Dawson, Laura A.; Hope, Andrew; Cho, John [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Witterick, Ian [Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON (Canada); Department of Surgical Oncology, Princess Margaret Hospital, Toronto, ON (Canada); Chen, Eric X. [Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON (Canada); Ringash, Jolie, E-mail: Jolie.Ringash@rmp.uhn.on.c [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada)

2011-01-01

199

Self-reported functional outcome after surgical intervention in patients with idiopathic normal pressure hydrocephalus  

Microsoft Academic Search

The goal of this study was to characterize long-term social and functional outcomes in adults treated for idiopathic normal pressure hydrocephalus (NPH). Data for 252 patients treated medically or surgically for idiopathic NPH were obtained through the Hydrocephalus Association Database Project. Data on post-surgical outcomes including improvement in symptoms, the need for in-home care, ability to drive, and employment status

T. A. Cage; K. I. Auguste; M. Wrensch; Y. W. Wu; N. Gupta

2011-01-01

200

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

201

Impact of total activity variation in 18F-FDG injected with the overall PET image quality in oncology patients  

NASA Astrophysics Data System (ADS)

The preliminary study aims to investigate whether variation on dose activity 18F-FDG will influence the overall PET image quality in oncology patients. This is a retrospective analysis of 10 oncology patients who were injected with an average of 337.40 ± 38.43 MBq of 18F-FDG for PET/CT whole body examination. Patients were divided into 2 groups based on total activity of 18F-FDG injected: less than 333 MBq (302.96±12.65 MBq) (group 1) and more than 333 MBq (371.85±14.00 MBq) (group 2). Multiple Image Projection (MIP) PET images were scored visually by two qualified nuclear radiologists using a two-point scoring scale (poor and excellent). The agreement between radiologists was analysed using kappa measure of agreement (K). The prediction on poor-to-excellent PET image by the total activity of 18F-FDG injected was analysed using a Chi-squared test (x2). A p value of < 0.05 was considered significant. Agreement on PET image scoring was substantial, with a kappa value of 0.737. However, the prediction of the PET image quality by the total activity injected has been found to be insignificant (p > 0.05). Therefore, there is no strong evidence suggest that the dose injected will influence the PET image quality. Hence, it is recommended to use low-dosed of 18F-FDG technique as it also potentially yields a comparable PET image and reduces radiation burden to the patients.

Hishar, H.; Fathinul Fikri, A. S.; Salasiah, M.; Noramaliza, M. N.; Abdul Jalil, N.

2013-05-01

202

SPECIAL ISSUE -ORIGINAL ARTICLE Patient-specific surgical planning and hemodynamic  

E-print Network

fluid dynamics optimization through free-form haptic anatomy editing tool (SURGEM) Kerem Pekkan Ã? Brian version of an anatomy editing/surgical planning tool (SURGEM) targeting anatomical complexity and patient- tion'' at the surgery planning phase for patients with congenital heart defects, these tools

Rossignac, Jarek

203

Knowledge expectations of surgical orthopaedic patients: A European survey.  

PubMed

Ageing population entails a growing international problem of osteoarthritis. Best practices for education of these patients are lacking. This study focused on empowering education in Northern (Finland, Iceland, Lithuania and Sweden) and Southern Europe (Cyprus, Greece and Spain). The aim was to analyse associations between expected knowledge and background factors. The data were collected from European arthroplasty patients with the Knowledge Expectations of hospital patients- scale, (KEhp - scale), including bio-physiological, functional, experiential, ethical, social and financial dimensions. Patients had essential bio-physiological and functional knowledge expectations. Women expected more than men, employed less than retired, unemployed or who worked at home. Generally, patients in Northern countries expected more than in Southern countries. However, highest expectations were found in Sweden and Greece, lowest in Spain and Cyprus. There are differences in knowledge expectations based on patients' backgrounds. Development of common standards in European patient education needs further research. PMID:24118436

Valkeapää, Kirsi; Klemetti, Seija; Cabrera, Esther; Cano, Sara; Charalambous, Andreas; Copanitsanou, Panagiota; Ingadottir, Brynja; Istomina, Natalja; Johansson Stark, Åsa; Katajisto, Jouko; Lemonidou, Chryssoula; Papastavrou, Evridiki; Sigurdardottir, Arun K; Sourtzi, Panayota; Unosson, Mitra; Zabalegui, Adelaida; Leino-Kilpi, Helena

2014-12-01

204

Outcomes of early physiotherapy in patients with cerebral aneurysms treated by surgical clipping or endovascular embolization?  

PubMed Central

Early physiotherapy was given to 124 patients with ruptured or unruptured cerebral aneurysms who were treated by surgical clipping or endovascular embolization. Patients were divided into four groups according to their Hunt and Hess grade at admission and aneurysm treatment modality: Group 1, Hunt and Hess grade ? II and surgical clipping; Group 2, Hunt and Hess grade ? II and endovascular embolization; Group 3, Hunt and Hess grade ? III and surgical clipping; Group 4, Hunt and Hess grade ? III and endovascular embolization. Level of consciousness was evaluated using the Glasgow Coma Scale, functional status using the Glasgow Outcome Scale, level of the mobility using the Mobility Scale for acute stroke patients, and independence in activities of daily living using the Barthel Index. After early physiotherapy, the level of consciousness and functional status improved significantly in Groups 1, 3, and 4; mobility improved significantly in all groups; and independence in activities of daily living improved significantly in Groups 1 and 3. At discharge, Groups 1 and 2 had better functional status than Groups 3 and 4. Level of consciousness, functional status, mobility and independence in activities of daily living improved after early physiotherapy. These findings suggest that early physiotherapy improved the prognosis of patients with cerebral aneurysms who were treated by surgical clipping or endovascular embolization. Patients with a worse clinical status at presentation had a poorer functional status at discharge. The outcome of physiotherapy was not affected by whether surgical clipping or endovascular embolization was chosen for treatment of the aneurysm.

Guclu-Gunduz, Arzu; Bilgin, Sevil; Köse, Nezire; Oruckaptan, Hakan

2012-01-01

205

Increasing patient safety and surgical team communication by using a count/time out board.  

PubMed

Communication and collaboration in patient care settings is vital for promoting the best possible patient outcomes. The counting of sponges, sharps, and instruments, and the surgical time out before the start of any surgical procedure are opportunities for the surgical team to address patient safety risks. Personnel in the surgical services department at St Luke's Episcopal Hospital, Houston, Texas, implemented the use of a hanging, magnetic, dry-erase board that includes the elements of a time out (eg, patient name and identifiers, procedure, site, allergies) and provides a means to document countable items. The board promotes team awareness of this time out and count information at all times during a procedure. Specific magnets on the count board identify items intentionally packed inside the patient to remind the team of the location of these items when the count is reconciled at the end of the procedure. In addition, a process of obtaining an radiograph of items similar to any missing items assists radiologists in identifying the location of retained surgical items. As a result of implementing both changes, our ability to locate missing items has significantly increased. PMID:20888944

Edel, Elizabeth Morell

2010-10-01

206

American Society for Radiation Oncology  

MedlinePLUS

... Webinars Virtual Meetings Practice Quality Improvement (PQI) ABMS Patient Safety Foundations Module Ethics and Professionalism Modules Meetings and ... Symposium in Thoracic Oncology Advocacy Day Clinical Practice Patient Safety Choosing Wisely Guidelines Best Practices White Papers Research ...

207

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

208

Surgical Treatment for Lung Cancer Patients with Poor Pulmonary Function  

Microsoft Academic Search

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

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

2005-01-01

209

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

2010-12-01

210

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

211

Prolonged nasogastric tube feeding in critically ill and surgical patients  

Microsoft Academic Search

Fifteen patients with varying diagnoses were fed via nasogastric tubes for between 7 and 41 days using a feed consisting of Caloreen (a glucose polymer) and Albumaid (a beef serum hydrolysate) with vitamin and mineral supplements. The feed proved nutritionally adequate and relatively free of complications. Diarrhoea was seen only in those patients receiving antibiotics by the nasogastric route. Codeine

A. M. Woolfson; J. N. Saour; C. R. Ricketts; B. J. Pollard; S. M. Hardy; S. P. Allison

1976-01-01

212

Preoperative Assessment of Surgical Risk in Oncogeriatric Patients  

Microsoft Academic Search

Cancer is a prevalent disease in our aging population; however, few oncologists are familiar with caring for oncogeriatric patients. Surgery is presently the treat- ment of choice for most solid tumors, but it is frequently delivered in a suboptimal way in this patient subsetting. Undertreatment is often justified with the concern of an unsustainable toxicity, while overtreatment can be related

RICCARDO A. AUDISIO; WALTER E. LONGO; ANDREW P. Z BAR; DANIEL POPE

213

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. PMID:2945517

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

1986-01-01

214

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

PubMed Central

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

2013-01-01

215

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

PubMed Central

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

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

2011-01-01

216

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

2012-08-01

217

Treatment by specialist surgical neurooncologists improves survival times for patients with malignant glioma.  

PubMed

OBJECT Surgeries for CNS tumors are frequently performed by general neurosurgeons and by those who specialize in surgical neurooncology. Subspecialization in neurosurgical practice has become common and may improve patient morbidity and mortality rates. However, the potential benefits for patients of having their surgeries performed by surgical neurooncologists remain unclear. Recently, a shift in patient care to those who practice predominantly surgical neurooncology has been promoted. Evidence for this practice is lacking and therefore requires fundamental investigation. METHODS The authors conducted a case-control study of neurooncology patients who underwent surgery for glioblastoma and anaplastic astrocytoma during 2006-2009. Outcomes were compared for patients whose surgery was performed by general neurosurgeons (generalists) or by specialist neurooncology neurosurgeons (specialists). An electronic record database and a picture archiving and communication system were used to collect data and assess the extent of tumor resection. Mortality rates and survival times were compared. Patient comorbidity and postoperative morbidity were assessed by using the Waterlow, patient handling, and falls risk assessment scores. Effects of case mix were adjusted for by using Cox regression and a hazards model. RESULTS Outcomes for 135 patients (65 treated by generalists and 70 by specialists) were analyzed. Survival times were longer for patients whose surgery was performed by specialists (p = 0.026) and after correction for case mix (p = 0.019). Extent of tumor resection was greater when performed by specialists (p = 0.005) and correlated with increased survival times (p = 0.004). There was a trend toward reduced surgical deaths when surgery was performed by specialists (2.8%) versus generalists (7%) (p = 0.102), and inpatient stays were significantly shorter when surgery was performed by specialists (p = 0.008). CONCLUSIONS The prognosis for glioblastoma multiforme remains dire, and improved treatments are urgently needed. This study provides evidence for a survival benefit when surgery is performed by specialist neurooncology neurosurgeons. The benefit might be attributable to increased tumor resection. Furthermore, specialist neurooncology surgical care may reduce the number of surgical patient deaths and length of inpatient stay. These findings support the recommendations for subspecialization within surgical neurooncology and advocate for care of these patients by specialists. PMID:25415070

Khan, Ursalan A; Bhavsar, Amar; Asif, Hasan; Karabatsou, Konstantina; Leggate, James R S; Sofat, Ajit; Kamaly-Asl, Ian D

2015-02-01

218

Low Paraoxonase 1 Activity Predicts Mortality in Surgical Patients with Sepsis  

PubMed Central

Introduction. State of severe oxidative stress is encountered in sepsis. Paraoxonase 1 (PON1) protects against oxidative stress but also undergoes inactivation upon that condition. We investigated PON1 activity in surgical patients with sepsis in relation to oxidative stress status, inflammation, disease severity, and survival. Methods. Prospective observational study. Sixty-nine surgical patients with sepsis were compared to 69 age/sex matched healthy controls. PON1 paraoxonase and diazoxonase activities, selected biochemical, hematological and oxidative stress parameters were measured on admission to ICU and 24, 48, 72, and 96 hours later. Disease severity scores were calculated daily. Results. Septic patients had significantly lower PON1 activities compared to control group at all time points. PON1 activities had good capacity to differentiate septic patients from healthy controls. Low PON1 activities were associated with higher disease severity scores and higher risk of death. Correlation between PON1 activity and markers of inflammation failed to reach significance. Decrease in PON1 activity was correlated with an increase in reducing components in plasma. Conclusion. Our study demonstrated lower PON1 activity in surgical patients with sepsis compared to healthy controls. PON1 activity also reflected severity of the disease. Low PON1 activity was associated with higher mortality of surgical patients with sepsis. PMID:24665146

Jelic-Ivanovic, Zorana; Stefanovic, Aleksandra; Palibrk, Ivan; Kalaba, Zdravko; Stojanovic, Marina; Simic-Ogrizovic, Sanja

2014-01-01

219

Endoscopic Ultrasound after Preoperative Chemoradiation Can Help Identify Patients Who Benefit Maximally after Surgical Esophageal Resection  

Microsoft Academic Search

BACKGROUND:We investigated whether differences in postoperative survival exist based on the presence and site of residual tumor (esophagus vs regional lymph nodes) after preoperative chemoXRT in patients with esophageal cancer. Based on these data, we reevaluated the role of EUS in identifying patients who maximally benefit from surgical esophageal resection after preoperative chemoXRT.METHODS:We studied 97 consecutive esophageal cancer patients treated

Banke Agarwal; Stephen Swisher; Jaffer Ajani; Kaitlyn Kelly; Christina Fanning; Ritsuko R. Komaki; Joe B. Putnam; Emad Abu-Hamda; Kimber L. Molke; Garrett L. Walsh; Arlene M. Correa; Linus Ho; Zhongxing Liao; Patrick M. Lynch; David C. Rice; W. Roy Smythe; Craig W. Stevens; Ara A. Vaporciyan; James Yao; Jack A. Roth

2004-01-01

220

Surgical Site Infection Following Surgery for Inflammatory Bowel Disease in Patients with Clean-Contaminated Wounds  

Microsoft Academic Search

Background  It is generally believed that the accompanying conditions in patients with inflammatory bowel disease (IBD) are associated\\u000a with a high incidence of surgical site infection (SSI), and sometimes these patients are classified as compromised hosts without\\u000a definitive clinical evidence. The aim of this study was to clarify the impact of IBD on the occurrence and features of SSI\\u000a in patients

Motoi Uchino; Hiroki Ikeuchi; Toshie Tsuchida; Kazuhiko Nakajima; Naohiro Tomita; Yoshio Takesue

2009-01-01

221

Improving surgical patient flow in a congested recovery area  

E-print Network

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

Schwartz, Trevor A

2012-01-01

222

Nursing Practice Environment and Outcomes for Oncology Nursing  

PubMed Central

Background It is commonly assumed that oncology nurses experience high job-related burnout and high turnover because their work involves inherent stressors such as caring for patients with serious and often life-threatening illness. Objectives The objectives of this study were to examine the differences in outcomes such as job dissatisfaction and burnout between oncology nurses and medical-surgical nurses, and to identify factors that affect oncology nurse outcomes. Methods A secondary analysis of nurse survey data collected in 2006 including 4047 nurses from 282 hospitals in 3 states was performed; t test and ?2 test compared differences between oncology nurses and medical-surgical nurses in nurse outcomes and their assessments of nurse practice environment, as measured by the Practice Environment Scale of the Nursing Work Index. Logistic regression models estimated the effect of nurse practice environment on 4 nurse-reported outcomes: burnout, job dissatisfaction, intention to leave the current position, and perceived quality of care. Results Oncology nurses reported favorable practice environments and better outcomes than did medical-surgical nurses. All 4 subscales of the Practice Environment Scale of the Nursing Work Index studied were significantly associated with outcomes. Specifically, nurses who reported favorable nursing foundations for quality of care (eg, active in-service or preceptorship programs) were less likely to report burnout and leave their current position. Conclusions Better practice environments, including nurse foundations for quality care, can help to achieve optimal nurse outcomes. Implications for Practice Improving hospital practice environments holds significant potential to improve nurse well-being, retention, and quality of care. Specifically, hospitals should consider preceptor programs and continuing education and increase nurses’ participation in hospital decision making. PMID:22751101

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

2012-01-01

223

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

PubMed Central

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

2014-01-01

224

Pre: Surgical orthopedic pre-maxillary alignment in bilateral cleft lip and palate patient  

PubMed Central

Pre-surgical orthopedic appliances are mainly used to retract and align the protruded and deviated pre-maxilla and to facilitate initial lip repair. This article presents a case report of a five year old male child patient with bilateral cleft lip and palate in whom a special custom made pre-surgical orthopedic appliance was delivered. Use of a special custom made presurgical orthopedic appliance for repositioning pre-maxilla in bilateral cleft lip and palate patient is discussed in this article. PMID:23293501

Ellore, Vijaya Prasad Kamavaram; Ramagoni, Naveen Kumar; Taranatha, Mahantesha; Nara, Asha; Gunjalli, Gururaj; Bhat, Ashwin Devasya

2012-01-01

225

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. PMID:16170071

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

2005-01-01

226

A web-based system for clinical decision support and knowledge maintenance for deterioration monitoring of hemato-oncological patients.  

PubMed

We introduce a web-based clinical decision support system (CDSS) and knowledge maintenance based on rules and a set covering method focusing on the problem of detecting serious comorbidities in hemato-oncological patients who are at high risk of developing serious infections and life threatening complications. We experienced that diagnostic problems which are characterized by fuzzy, uncertain knowledge and overlapping signs, still reveal some kind of patterns that can be transferred into a computer-based decision model. We applied a multi-stage evaluation process to assess the system's diagnostic performance. Depending on how system behavior was compared to presumably correct judgment of a case the correctness rate for closed cases with all data available varied between 58% and 71%, the overall rate after critical review was 84%. However, the real time behavior of our approach which data becoming available as time passes still has to be evaluated and observational studies need to be conducted. PMID:23522434

Wicht, Andreas; Wetter, Thomas; Klein, Ulrike

2013-07-01

227

Preoperative Nutritional Status of the Surgical Patients in Jeju  

PubMed Central

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

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

2014-01-01

228

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

SciTech Connect

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

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

2008-02-01

229

Malignant melanoma in elderly patients: biological, surgical and medical issues.  

PubMed

Malignant melanoma is an aggressive tumor with a poor prognosis for patients with advanced disease. Over the last decades, its incidence and mortality has increased in elderly population, impacting significantly on healthcare costs, considering the increase in average age of the world population. Older age is recognized as an independent poor prognostic factor for melanoma, but the scientific community now is wondering if elderly melanoma patients have worse outcome because they are not receiving the same treatment as their younger counterparts. This article summarizes current data on elderly melanoma prevention and early detection and its subsequent management, underling the differences observed between older and younger patients. It also describes age-associated alterations in immunity and how these may impact on anti-melanoma response. PMID:25248282

Russo, Alessia E; Ferraù, Francesco; Antonelli, Giovanna; Priolo, Domenico; McCubrey, James A; Libra, Massimo

2015-01-01

230

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

PubMed Central

Purpose The aim of this study was to evaluate outcomes of a total colectomy with ileorectal anastomosis in patients with slow transit constipation. Methods A retrospective review of 37 consecutive patients with slow transit constipation who underwent a total colectomy between 1994 and 2008 was undertaken. Preoperative and postoperative Wexner's constipation scores were collected and used to evaluate the outcomes after surgical treatment. Also patients' postoperative satisfaction scores were collected using a 4-point scale. Results The 37 patients consisted of 31 women and 6 men, with a median age of 41 years (range, 17 to 71 years). Pre- and post-operative Wexner's scores were collected from 33 patients (89.1%), and the mean preoperative Wexner's score was 19.3 (range, 11 to 24), which decreased to an average post-operative score of 2.3 (range, 0 to 8). Neither intraoperative complications nor postoperative mortalities were noted. Five patients (13.5%) had early postoperative complications, and the most common complication was postoperative ileus (10.8%). Seven patients (18.9%) had late postoperative complications, and postoperative ileus (10.8%) was also the most common. Twenty seven of 33 patients were satisfied with their surgical outcome (81.8%). Conclusion A total colectomy with ileorectal anastomosis might be an effective surgical procedure with acceptable morbidity to treat medically intractable slow transit constipation. PMID:21980588

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

2011-01-01

231

Personalized Oncology in Interventional Radiology  

PubMed Central

As personalized medicine becomes more applicable to oncologic practice, image-guided biopsies will be integral for enabling predictive and pharmacodynamic molecular pathology. Interventional radiology has a key role in defining patient-specific management. Advances in diagnostic techniques, genomics, and proteomics enable a window into subcellular mechanisms driving hyperproliferation, metastatic capabilities, and tumor angiogenesis. A new era of personalized medicine has evolved whereby clinical decisions are adjusted according to a patient’s molecular profile. Several mutations and key markers already have been introduced into standard oncologic practice. A broader understanding of personalized oncology will help interventionalists play a greater role in therapy selection and discovery. PMID:23885909

Abi-Jaoudeh, Nadine; Duffy, Austin G.; Greten, Tim F.; Kohn, Elise C.; Clark, Timothy W.I.; Wood, Bradford J.

2013-01-01

232

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

PubMed Central

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

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

2011-01-01

233

Surgical approach for cardiac surgery in a patient with tracheostoma  

Microsoft Academic Search

The thoracic approach for cardiac surgery in a patient with a tracheostoma can result in difficult problems, such as mediastinitis, stoma necrosis or inadequate operative exposure. We present a distinct approach consisting of an incision at the second intercostal space, transverse sternum transection and longitudinal median sternotomy to the xiphoid process, performed for coronary artery bypass grafting and aortic valve

Juan José Legarra; José Aurelio Sarralde; José Luis López Coronado; Alejandro Mart??n Trenor

1998-01-01

234

Surgical-orthodontic management of bilateral multiple impactions in non-syndromic patient.  

PubMed

Several surgical and orthodontic treatment options are available to disimpact the impacted teeth. But the closed eruption technique has the best long-term prognosis. The tooth is surgically exposed, an attachment is bonded to it, flap is resutured over it and an orthodontic extrusive force is delivered to bring the tooth into occlusion. This case report presents a case with multiple impacted teeth in which no syndrome or systemic conditions were detected. A 20-year-old female patient reported for orthodontic treatment with chief complaint of multiple unerupted permanent teeth and retained primary teeth. Radiographic examination revealed impacted 14, 15, 24, 25, 33, 34, 43 and 44. Surgical exposure of the impacted teeth was done after extraction of retained primary teeth. Forced eruption of these teeth was done by applying traction with closed eruption technique. After careful treatment planning followed by guided eruption of impacted teeth, patient finished with a significantly improved functional and aesthetic result. PMID:23329714

Agrawal, Jiwanasha Manish; Agrawal, Manish Suresh; Nanjannawar, Lalita Girish

2013-01-01

235

Surgical-orthodontic management of bilateral multiple impactions in non-syndromic patient  

PubMed Central

Several surgical and orthodontic treatment options are available to disimpact the impacted teeth. But the closed eruption technique has the best long-term prognosis. The tooth is surgically exposed, an attachment is bonded to it, flap is resutured over it and an orthodontic extrusive force is delivered to bring the tooth into occlusion. This case report presents a case with multiple impacted teeth in which no syndrome or systemic conditions were detected. A 20-year-old female patient reported for orthodontic treatment with chief complaint of multiple unerupted permanent teeth and retained primary teeth. Radiographic examination revealed impacted 14, 15, 24, 25, 33, 34, 43 and 44. Surgical exposure of the impacted teeth was done after extraction of retained primary teeth. Forced eruption of these teeth was done by applying traction with closed eruption technique. After careful treatment planning followed by guided eruption of impacted teeth, patient finished with a significantly improved functional and aesthetic result. PMID:23329714

Agrawal, Jiwanasha Manish; Agrawal, Manish Suresh; Nanjannawar, Lalita Girish

2013-01-01

236

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

PubMed Central

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

2012-01-01

237

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

238

Improving pain management in orthopedic surgical patients with opioid tolerance.  

PubMed

As increasing numbers of the baby boomer generation seek health care, nursing staff educated in the evidence-based practice process can make significant contributions to successful patient outcomes. Health care providers who anticipate the approaching perfect storm in health care and thoughtfully plan, collaborate, and incorporate evidence-based practice methods will be well prepared to improve the quality of care, realize cost savings, and meet the challenges ahead. PMID:25155539

Doi, Kathleen; Shimoda, Rosanne; Gibbons, Gregory

2014-09-01

239

Fate of patients with fixed subaortic stenosis after surgical removal.  

PubMed Central

Thirty-nine consecutive patients, aged 5 to 57 years, were followed for two to 15 years with serial haemodynamic studies after removal of fixed subaortic stenosis, which was never a "membrane". Two late deaths occurred, one sudden and one in congestive failure. Of 37 survivors, 25 were asymptomatic and could be classified as good or excellent if judged by well-being. Seven were symptomatic, two having had reoperation for fixed subaortic stenosis, and four needed long-term pacing. Evaluation, including the effect of isoprenaline, showed important dynamic obstruction in 17, five of whom redeveloped fixed obstruction. Seven had congestive features without outflow gradients, and 14 had neither congestion nor outflow obstruction. Complete assessment therefore confirmed that only 14 (36%) were haemodynamically satisfactory; two of them had permanent pacing, and four had had aortic valve surgery. Fixed subaortic stenosis should be removed early, when diagnosed, and completely before secondary myocardial changes occur. Patients however "well" need regular supervision and early haemodynamic assessment. The aortic valve, whether repaired, replaced, or untouched, remains a site for infective endocarditis for life. The fixed subaortic stenosis removed at operation may not be present in that form at birth, but acquired secondary to other congenital abnormalities which remain in the patient. Images PMID:7191709

Somerville, J; Stone, S; Ross, D

1980-01-01

240

[Short-stay in patients surgically treated for thyroid disease].  

PubMed

The improvement in anesthesiology and greater experience of medical staff have permitted short-stay surgery. The authors in this pages report their knowledge of thyroid short-stay surgery. Their series numbers twenty-two lobectomies for uninodular the thyroid disease and one enucleoresection for a nodule of pyramidal lobe. Short-stay surgery has been proposed to euthyroid patients, selected according to age, residence and health (lack of associated pathologies such as cardiopathy, bronchopathy, hepatopathy, nephropathy, allergy, calcemic disorders and dysphony) and confirmed in the presence of histological extemporary diagnosis of "adenoma" (21 cases). The histological extemporary diagnosis of "carcinoma" has lengthened hospital stay. Among the lobectomies, 21 were executed in general anaesthesia and 1 in acupuncture. The enucleoresection was executed in local anaesthesia. Only in eighteen cases was a "Penrose" deainage used, removed after 24 hours. The choice of thyroid short-stay surgery, particularly in day-hospital, must arise from a careful selection of patients. Besides, this surgery requires an administrative and sanitary structure which permits a constant patient's check at hare too. PMID:8152563

Cannizzaro, M A; De Maria, A; Fazzi, C; Mazzone, G; Veroux, P F; Terminella, A; Tumminelli, M G

1993-11-01

241

Sleep-Wake Circadian Activity Rhythm Parameters and Fatigue in Oncology Patients Prior to the Initiation of Radiation Therapy  

PubMed Central

Background Little is known about the relationships between sleep parameters and fatigue in patients at the initiation of radiation therapy (RT). Objectives In a sample of patients at the initiation of RT, 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 objective parameters and subjective ratings of sleep disturbance and fatigue severity. Methods Patients (n=185) with breast, prostate, lung, or brain cancer 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 a total of 48 hours prior to beginning RT. Actigraphy data were analyzed using the Cole-Kripke algorithm. Spearman rank correlations were calculated between variables. Results Approximately 30% to 50% of patients experienced sleep disturbance depending on whether clinically significant cutoffs for the subjective or objective measures were used to calculate occurrence rates. In addition, these patients 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 the subjective, but not the objective measures of sleep disturbance and fatigue. Conclusions A significant percentage of oncology patients experience significant disturbances in sleep-wake circadian activity rhythms at the initiation of RT. The disturbances occur in both sleep initiation and sleep maintenance. Implications for Practice Patients need to be assessed at the initiation of RT for sleep disturbance and appropriate treatment initiated. PMID:21252646

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

2010-01-01

242

Surgical treatment of temporal lobe epilepsy: clinical, radiological, and histopathological findings in 178 patients.  

PubMed Central

The surgical treatment of pharmacoresistant temporal lobe epilepsy is increasing rapidly. The correlation of preoperative MRI, histopathological findings, and postoperative seizure control is reported for 178 patients with chronic medically intractable temporal lobe epilepsy who were operated on between November 1987 and January 1993. Histopathologically there were distinct structural abnormalities in 97.2% of the surgical specimens. Signal abnormalities on MRI were present in 98.7% of patients with neoplastic lesions (n = 79), 76.6% of patients with non-neoplastic focal lesions (n = 55), and 69.2% of patients with Ammon's horn sclerosis (n = 39). Overall, structural abnormalities were detected by MRI in 82.7% of all patients. The mean postoperative follow up period was three years. Some 92% of the patients benefited from surgery: 103 patients (61.7%) were seizure free, 26 (15.5%) had no more than two seizures a year, and 24 (14.4%) showed a reduction of seizure frequency of at least 75%. Fourteen patients (8.4%) had a < 75% reduction of seizure frequency. The percentage of patients who were completely free of seizures after operation was 68.5% for patients with neoplastic lesions, 66.7% for Ammon's horn sclerosis, and 54.0% for patients with non-neoplastic focal lesions. By contrast, none of the patients in whom histopathological findings were normal became seizure free postoperatively. The data show that the presence of focal lesions or Ammon's horn sclerosis as determined by histopathological examination is associated with improved postoperative seizure control compared with patients without specific pathological findings. Brain MRI was very sensitive in detecting neoplasms; however, its sensitivity and specificity were limited with respect to non-neoplastic focal lesions and Ammon's horn sclerosis. Improvement of imaging techniques may provide a more precise definition of structural lesions in these cases and facilitate limited surgical resections of the epileptogenic area rather than standardised anatomical resections. Images PMID:7608662

Zentner, J; Hufnagel, A; Wolf, H K; Ostertun, B; Behrens, E; Campos, M G; Solymosi, L; Elger, C E; Wiestler, O D; Schramm, J

1995-01-01

243

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

Microsoft Academic Search

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

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

2002-01-01

244

Surgical variables affecting swallowing in patients treated for oral\\/oropharyngeal cancer  

Microsoft Academic Search

Background. Postoperative swallowing function may be influenced by a number of treatment variables; this study examines the relationship of various treatment factors to measures of swallow function. Methods. Swallowing was examined with the modified barium swallow procedure in 144 patients surgically treated for oral or oropharyngeal cancer 3 months after healing. Univariate and multivariate correlations were used to examine the

Barbara Roa Pauloski; Alfred W. Rademaker; Jerilyn A. Logemann; Fred M. S. McConnel; Mary Anne Heiser; Salvatore Cardinale; Cathy L. Lazarus; Harold Pelzer; David Stein; Quinter Beery

2004-01-01

245

Cost of Opioid-Related Adverse Drug Events in Surgical Patients  

Microsoft Academic Search

Opioids have demonstrated efficacy and often are drugs of choice in the management of postoperative pain. However, their use is often limited by adverse drug events (ADEs). The objective of this study was to determine the ADE rate in adult surgical patients who received opioids and the impact of opioid ADEs on length of stay (LOS), costs, and mortality. A

Gary M Oderda; R. Scott Evans; James Lloyd; Arthur Lipman; Connie Chen; Michael Ashburn; John Burke; Matthew Samore

2003-01-01

246

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

Microsoft Academic Search

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

Pallavi Daram Annambhotla

2010-01-01

247

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

PubMed

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

Uygur, Safak; Tuncer, Serhan

2014-12-01

248

Surgical Outcomes and Prognostic Factors of T4 Gastric Cancer Patients without Distant Metastasis  

PubMed Central

Objective To evaluate surgical outcomes and prognostic factors for T4 gastric cancer treated with curative resection. Methods Between January 1994 and December 2008, 94 patients diagnosed with histological T4 gastric carcinoma and treated with curative resection were recruited. Patient characteristics, surgical complications, survival, and prognostic factors were analyzed. Results Postoperative morbidity and mortality were 18.1% and 2.1%, respectively. Multivariate analysis indicated lymph node metastasis (hazard ratio, 2.496; 95% confidence interval, 1.218–5.115; p?=?0.012) was independent prognostic factor. Conclusions For patients with T4 gastric cancer, lymph node metastasis was associated with poorer survival. Neoadjuvant chemotherapy or aggressive adjuvant chemotherapy after radical resection was strongly recommended for these patients. PMID:25211331

Xiao, Long-bin; Wu, Wen-hui; Yang, Shi-bin; Li, Wen-feng

2014-01-01

249

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

Microsoft Academic Search

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

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

250

Coronary haemo-dynamics and myocardial metabolism during weaning from mechanical ventilation in cardiac surgical patients  

Microsoft Academic Search

The present clinical study was undertaken to assess the alterations in myocardial metabolism and coronary haemodynamics during\\u000a weaning from mechanical ventilation in postoperative cardiac surgical patients. Global and regional myocardial blood flow\\u000a and metabolism were assessed using a dual port coronary sinus-great cardiac vein thermodilution catheter in 17 patients who\\u000a had undergone coronary revascularization and who were being weaned from

Steven Elia; Peter Liu; Alan Hilgenberg; Charrisios Skourtis; Demetrios Lappas

1991-01-01

251

Surgical treatment of pulmonary hydatid cysts in pediatric patients.  

PubMed

Hydatid cyst is a zoonotic infection that is caused by Echinococcus granulosus and alveolaris, and that can result in endemics in rural regions. Infections caused by Echinococcus granulosus are more commonly seen in our country. In this retrospective study, we aimed at discussing the experience we have accumulated on pediatric pulmonary hydatid cyst cases over the last 6 years. Between 1995-2001, in the Department of Thoracic and Cardiovascular Surgery in Gaziantep University, 38 cases underwent 39 operations due to pulmonary and hepatic hydatid cysts. Of these, 24 were males and 14 were females, with an age range of 2-16 years. Operations were frequently performed via thoracotomy. Nineteen cysts were intact, and 26 were perforated. One case had sternotomy, another had sequential thoracotomy, and the rest of the cases underwent thoracotomy, which resulted in cystotomy-capitonnage. In the postoperative period, 2 patients had sustained air leakage, and 2 other cases developed skin infections. Average hospital stay was 5 days. After the operation, the patients received chemotherapy (albendazole 10 mg/kg/day) for 1.5 months. Early or late deaths or recurrences were not observed. We conclude that cystotomy-capitonnage is a successful treatment for pediatric pulmonary hydatid cysts, as it preserves the parenchyma. Chemotherapy in the postoperative period is beneficial in preventing the recurrences. PMID:12526068

Sivrikoz, M Cumhur; Tunçözgür, Bülent; Nacak, Ibrahim; Elbeyli, Levent

2003-02-01

252

Oral Health Status of Chinese Paediatric and Adolescent Oncology Patients with Chemotherapy in Hong Kong: a Pilot Study  

PubMed Central

Aim: To study the oral health status of Chinese children and adolescents undergoing chemotherapy in Hong Kong. Method: All Chinese children and adolescent oncology patients aged 18 or below attending the Children's Centre for Cancer and Blood Disease at a hospital for chemotherapy were invited and parental consent was sought before they were accepted into the study. The study comprised of 1) a parental questionnaire, 2) the collection of medical history and 3) a clinical examination for tooth decay (caries) and mucosal status. Results: A total of 69 patients were invited, and they all participated in this study. Their mean age was 9.2±5.0 and 44 (64%) were males. Twenty-six patients (38%) had no caries experience (DMFT and/or dmft = 0). Higher caries experience was detected in participants that were not born in Hong Kong, had completed active chemotherapy, participated in school dental care service and whose parents had low educational levels. There were 41 patients with active chemotherapy, 24 of whom were diagnosed with acute leukaemia, 5 with haematological malignancies other than leukaemia and 11 with solid tumours. Antimetabolites, cytotoxic antibiotics, alkylating agents and plant alkaloids were administered in 49%, 32%, 24% and 22% of them, respectively. Twenty-six (63%) patients showed no mucosal complications. The most common oral complication was oral mucositis (24%) followed by petechiae (10%). Conclusion: About two-thirds of paediatric and adolescent cancer patients had caries experience, which was more common among those who had completed chemotherapy. Oral mucositis followed by petechiae were the two most common complications of receiving chemotherapy. PMID:25674168

Kung, A.Y.H; Zhang, S; Zheng, L.W; Wong, G.H.M; Chu, C.H

2015-01-01

253

Best practices for preventing hospital-acquired pressure injuries in surgical patients.  

PubMed

Hospital-acquired pressure ulcers (HAPUs) and deep tissue injuries (DTIs), while considered to be preventable in most cases continue to affect many patients in acute care facilities. Surgical patients have an especially high risk of developing HAPUs for several reasons, including immobility during the intraoperative and immediate postoperative periods. HAPUs are responsible for significant patient harm in the form of pain, increased susceptibility to infection, and delayed recovery. Perioperative nurses must take a proactive and comprehensive approach to protecting their patients from pressure injuries, including HAPUS and DTIs. PMID:21434513

Cherry, Cecile; Moss, Jacqueline

2011-03-01

254

Lived experiences and challenges of older surgical patients during hospitalization for cancer: An ethnographic fieldwork  

PubMed Central

This paper explores the lived experiences of older surgical patients’ (aged 74 years and older) experienced challenges during a brief admission to hospital. Age, gender, polypharmacy, and the severity of illness are also factors known to affect the hospitalization process. For an ethnographic study using participant observation and interviews, surgical cancer patients (n = 9, aged 74 years and older) were recruited during admission to a Danish teaching hospital. Using ethnographic strategies of participant observation and interviews, each patient was followed through the course of 1 day during their stay at the hospital. Interviews were carried out with all patients during this time. Three areas of concern were identified as prominent in the patients’ experiences and challenges during their short hospital stay: teeth and oral cavity, eating in a hospital setting, and medication during hospitalization. Short-term hospitalization requires focused collaboration between staff and patient concerning individual challenges from their teeth and oral cavity as support of nutritional needs during surgical treatment for cancer. PMID:24559546

Høybye, Mette Terp

2014-01-01

255

Clinical effect of a positive surgical margin after hepatectomy on survival of patients with intrahepatic cholangiocarcinoma  

PubMed Central

Background Several unfavorable prognostic factors have been proposed for peripheral cholangiocarcinoma (PCC) in patients undergoing hepatectomy, including gross type of tumor, vascular invasion, lymph node metastasis, a high carbohydrate antigen 19-9 level, and a positive resection margin. However, the clinical effect of a positive surgical margin on the survival of patients with PCC after hepatectomy still needs to be clarified due to conflicting results. Methods A total of 224 PCC patients who underwent hepatic resection with curative intent between 1977 and 2007 were retrospectively reviewed. Eighty-nine patients had a positive resection margin, with 62 having a microscopically positive margin and 27 a grossly positive margin (R2). The clinicopathological features, outcomes, and recurrence pattern were compared with patients with curative hepatectomy. Results PCC patients with hepatolithiasis, periductal infiltrative or periductal infiltrative mixed with mass-forming growth, higher T stage, and more advanced stage tended to have higher positive resection margin rates after hepatectomy. PCC patients who underwent curative hepatectomy had a significantly higher survival rate than did those with a positive surgical margin. When PCC patients underwent hepatectomy with a positive resection margin, the histological grade of the tumor, nodal positivity, and chemotherapy significantly affected overall survival. Locoregional recurrence was the most common pattern of recurrence. Conclusion A positive resection margin had an unfavorable effect on overall survival in PCC patients undergoing hepatectomy. In these patients, the prognosis was determined by the biology of the tumor, including differentiation and nodal positivity, and chemotherapy increased overall survival. PMID:25552905

Yeh, Chun-Nan; Hsieh, Feng-Jen; Chiang, Kun-Chun; Chen, Jen-Shi; Yeh, Ta-Sen; Jan, Yi-Yin; Chen, Miin-Fu

2015-01-01

256

Protocol in managing oral surgical patients taking dabigatran.  

PubMed

New anticoagulants are being introduced into the market. These drugs are orally administered, have predictable pharmacokinetics and dose response, do not require monitoring and have an acceptable safety profile when used appropriately, and so avoid many of the disadvantages and possible complications of warfarin and heparin. Dabigatran is the most widely used, and has been approved by the Therapeutic Goods Administration. The use of dabigatran will likely increase in the coming years, and so it is important for dentists to be aware of its mechanism of action, the possible complications, and how to reverse the bleeding if it occurs. This review discusses dabigatran and reports on our experience of five cases, and provides practical clinical advice on how to manage patients on dabigatran who require dental treatment, particularly extractions. PMID:24889878

Breik, O; Cheng, A; Sambrook, Pj; Goss, An

2014-09-01

257

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

PubMed

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

Usmanova, T É

2014-06-01

258

[Experience of 10 years with the surgical treatment of lung cancer in elderly patients].  

PubMed

The surgical treatment of lung cancer in elderly patients is correlated with a lot of complications that in most cases are cardiopulmonary type; for this reason, in past times these patients were left out of the surgical treatment. Today, the progress of surgical, diagnostic and anesthetic techniques permit to execute pulmonary resections in patients older than 70 years too. The aim of this study is to evaluate postoperative complications and long-term and long-term survival in patients under and over the age 70. Between January 1990 and June 2000 we have assessed 172 patients with lung neoplasm. We have divided patients in two groups: those younger than 70 years of age (group 1, n = 119) and those older than 70 years of age (group 2, n = 53). Postoperative mortality for group 2 was 7.5% and for group 5.1%. The overall postoperative complication rate for group 2 was 30.2% and for group 1 10.9%. Within group 1 main complications have been of surgical type (61.5%) while in group 2 medical type (cardiopulmonary), with higher frequency in patients ASA 3 or ASA 4. The mortality at 12 months for non-neoplastic causes was 10.2% for group 2 and 2.5% for group 1. On the contrary, the mortality at 12 months for neoplastic causes was 8.2% for group 2 and 6.7% for group 1. We haven't noticed an important correlation between the extension of the resection and the recurrence of disease. The survival at 3 years was 46.5% for group 1 and 41% for group 2 and associated with neoplastic causes. PMID:11396063

Filippetti, M; Crucitti, G; Andreetti, C; Mastropietro, T; Santoro, R; Lepiane, P; Graziano, F; Santoro, E

2001-01-01

259

The relationship between direct-care RN specialty certification and surgical patient outcomes.  

PubMed

Specialty certification enhances patient safety in health care by validating that practice is consistent with standards of excellence. The purpose of this research was to explore the relationship between direct-care, specialty-certified nurses employed in perioperative units, surgical intensive care units (SICUs), and surgical units and nursing-sensitive patient outcomes in SICUs and surgical units. Lower rates of central-line-associated bloodstream infections in SICUs were significantly associated with higher rates of CPAN (certified postanesthesia nurse) (? = -0.09, P = .05) and CNOR/CRNFA (certified nurse operating room/certified RN first assistant) (? = -0.17, P = .00) certifications in perioperative units. Unexpectedly, higher rates of CNOR/CRNFA certification in perioperative units were associated with higher rates of hospital-acquired pressure ulcers (? = 0.08, P = .03) and unit-acquired pressure ulcers (? = 0.13, P = .00), possibly because of a higher risk of pressure ulcers in the patient population. Additional research is needed to clarify this relationship. Our findings lend credence to perioperative, SICU, and surgical nurses participating in lifelong learning and continuous professional development, including achievement of specialty certification. PMID:25443121

Boyle, Diane K; Cramer, Emily; Potter, Catima; Gatua, Mary W; Stobinski, James X

2014-11-01

260

Personalized oncology in interventional radiology.  

PubMed

As personalized medicine becomes more applicable to oncologic practice, image-guided biopsies will be integral for enabling predictive and pharmacodynamic molecular pathology. Interventional radiology has a key role in defining patient-specific management. Advances in diagnostic techniques, genomics, and proteomics enable a window into subcellular mechanisms driving hyperproliferation, metastatic capabilities, and tumor angiogenesis. A new era of personalized medicine has evolved whereby clinical decisions are adjusted according to a patient's molecular profile. Several mutations and key markers already have been introduced into standard oncologic practice. A broader understanding of personalized oncology will help interventionalists play a greater role in therapy selection and discovery. PMID:23885909

Abi-Jaoudeh, Nadine; Duffy, Austin G; Greten, Tim F; Kohn, Elise C; Clark, Timothy W I; Wood, Bradford J

2013-08-01

261

Chronobiology, cognitive function and depressive symptoms in surgical patients.  

PubMed

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

Hansen, Melissa Voigt

2014-09-01

262

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

PubMed

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

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

2014-08-01

263

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

PubMed Central

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

2014-01-01

264

Can cone-beam computed tomography superimposition help orthodontists better understand relapse in surgical patients?  

PubMed

This case report describes the interdisciplinary treatment of a 19-year-old Brazilian man with a Class I malocclusion, a hyperdivergent profile, an anterior open bite, and signs of temporomandibular joint internal derangement. The treatment plan included evaluation with a temporomandibular joint specialist and a rheumatologist, orthodontic appliances, and maxillomandibular surgical advancement with counterclockwise rotation. Cone-beam computed tomography images were taken before and after surgery at different times and superimposed at the cranial base to assess the changes after orthognathic surgery and to monitor quantitatively the internal derangement of the temporomandibular joints and surgical relapse. Our protocol can improve the orthodontist's understanding of surgical instability, demonstrate the clinical value of cone-beam computed tomography analysis beyond the multiplanar reconstruction, and guide patient management for the best outcome possible. PMID:25439215

Porciúncula, Guilherme Machado; Koerich, Leonardo; Eidson, Lindsey; Gandini Junior, Luiz Gonzaga; Gonçalves, João Roberto

2014-11-01

265

Recovery profile of patients undergoing nasal surgical procedures: a comparison between sevoflurane and propofol  

Microsoft Academic Search

Objectives  To compare the recovery profile of sevoflurane and propofol in nasal surgical procedures.\\u000a \\u000a \\u000a \\u000a Design  A prospective, double blind, randomized study\\u000a \\u000a \\u000a \\u000a Setting  King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, a tertiary care teaching hospital, attached with King Saud University,\\u000a Riyadh Saudi Arabia.\\u000a \\u000a \\u000a \\u000a Patients  60 ASA I–II patients age between 18–35 years, and weighing 50-80 kg, scheduled for nasal surgical procedures.\\u000a \\u000a \\u000a \\u000a Methods  Patients were assigned

Aziz Ul Haq; Mansoor Aqil; Amjad Rasheed; Rana Altaf Ahmed

2008-01-01

266

Modeling Plus MRI Data Characterize Brain Tumors in Patients | Physical Sciences in Oncology  

Cancer.gov

Patients diagnosed with glioblastoma, the most aggressive form of brain cancer, routinely undergo MRI scanning prior to receiving treatment. Now, an international team of investigators has developed a mathematical modeling technique that can translate the data from pretreatment MRI scans into patient-specific rates of tumor growth and metastasis that may find use in tailoring therapy to meet the needs of each patient.

267

Computer-based quality of life questionnaires may contribute to doctor–patient interactions in oncology  

Microsoft Academic Search

It is well recognized that oncologists should consider patients' quality of life and functioning when planning and delivering anticancer treatment, but a comprehensive assessment of how a patient feels requires a thorough inquiry. A standardized measurement of patients' quality of life may support clinicians in identifying important problems for discussion during the limited time of the medical consultations. The aim

G Velikova; J M Brown; A B Smith; P J Selby

2002-01-01

268

[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

269

Incidence of oral mucositis, its treatment and pain management in patients receiving cancer treatment at Radiation Oncology Departments in Spanish hospitals (MUCODOL Study)  

Microsoft Academic Search

Objective  To estimate the incidence of oral mucositis (OM) in patients receiving radiotherapy, describe the treatments used to manage\\u000a pain in OM grades 3 and 4 and assess relief of pain and patient satisfaction.\\u000a \\u000a \\u000a \\u000a Patients and methods  All patients older than 18 years consecutively attending a Radiation Oncology Department over 5 working days were included\\u000a in a cross-sectional study. The data recorded

Ana Mañas; Amalia Palacios; Jorge Contreras; Isabel Sánchez-Magro; Pilar Blanco; Cristina Fernández-Pérez

2009-01-01

270

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

NASA Astrophysics Data System (ADS)

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

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

2013-06-01

271

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

PubMed Central

Emotional distress (ED) is greater for oncology patients in comparison with the general population, and this has implications for the quality of life of the patient and his/her family, adherence to the treatment, and eventually, survivorship. In general, the detection of these symptoms is low, which explains the need for detection systems appropriate to the clinical reality of the oncology team. The objective of this study is to evaluate for the first time the usefulness of an ultra-brief screening instrument [distress thermometer (DT)], in a group of Chilean oncology patients. A total of 166 outpatients were evaluated at the Cancer Center of the Pontificia Universidad Católica de Chile, before starting chemotherapy. Two screening instruments were applied: Hospital Anxiety and Depression Scale (HADS) and DT. The application of HADS resulted in a prevalence of 32.7% of anxiety symptoms (HADS-A ? 8), 15.7% of depression symptoms (HADS-D ? 8), and 39.8% had a total score of HADS-T ? 11. The DT resulted in the prevalence of 32.5% of distress or ED (DT ? 5). The validity of the DT was evaluated as a screening tool in comparison with HADS, observing, in relation to the anxiety scale (HADS-A), a sensitivity of 88.9% and specificity of 78.4% (DT ? 4); depression (HADS-D), a sensitivity of 69.2% and specificity of 74.3% (DT ? 5); and in relation to the total scale (HADS-T), a sensitivity of 68.2% and specificity of 73.0% (DT ? 4). This study demonstrates the elevated prevalence of emotional symptoms in Chilean oncology patients, before the start of chemotherapy, and confirms the potential of the DT as a brief screening instrument with easy application. The DT will allow the clinician to increase the detection threshold in the Chilean oncology population, intervene in a timely manner, and contribute to the comprehensive handling of the oncology patient without affecting the time needed for assistance. PMID:24966889

Calderón, Jorge; Campla, Cristóbal; D’Aguzan, Nicole; Barraza, Soledad; Padilla, Oslando; Sánchez, Cesar; Palma, Silvia; González, Matías

2014-01-01

272

Interprofessional patient-centred practice in oncology teams: utopia or reality?  

PubMed

Abstract Studies on interprofessional practice usually report professionals' viewpoints and document organizational, procedural and relational factors influencing that practice. Considering the importance of interprofessional patient-centred (IPPC) practice, it seems necessary to describe it in detail in an actual context of care, from the perspective of patients, their families and health-care professionals. The goal of this study was to describe IPPC practice throughout the continuum of cancer care. A qualitative multiple case study was completed with two interprofessional teams from a Canadian teaching hospital. Interviews were conducted with patients, their families and professionals, and observation was carried out. Three themes were illustrated by current team practice: welcoming the person as a unique individual, but still requiring the patient to comply; the paradoxical coexistence of patient-centred discourse and professional-centred practice; and triggering team collaboration with the culmination of the patient's situation. Several influential factors were described, including the way the team works; the physical environment; professionals' and patients'/family members' stance on the collaboration; professionals' stance on patients and their families; and patients' stance on professionals. Finally, themes describing the desired IPPC practice reflect the wish of most participants to be more involved. They were: providing support in line with the patient's experience and involvement; respecting patients by not imposing professionals' values and goals; and consistency and regularity in the collaboration of all members. PMID:25070427

Bilodeau, Karine; Dubois, Sylvie; Pepin, Jacinthe

2015-03-01

273

Impact of medical therapy on patients with Crohn’s disease requiring surgical resection  

PubMed Central

AIM: To evaluate the impact of medical therapy on Crohn’s disease patients undergoing their first surgical resection. METHODS: We retrospectively evaluated all patients with Crohn’s disease undergoing their first surgical resection between years 1995 to 2000 and 2005 to 2010 at a tertiary academic hospital (St. Paul’s Hospital, Vancouver, Canada). Patients were identified from hospital administrative database using the International Classification of Diseases 9 codes. Patients’ hospital and available outpatient clinic records were independently reviewed and pertinent data were extracted. We explored relationships among time from disease diagnosis to surgery, patient phenotypes, medication usage, length of small bowel resected, surgical complications, and duration of hospital stay. RESULTS: Total of 199 patients were included; 85 from years 1995 to 2000 (cohort A) and 114 from years 2005 to 2010 (cohort B). Compared to cohort A, cohort B had more patients on immunomodulators (cohort A vs cohort B: 21.4% vs 56.1%, P < 0.0001) and less patients on 5-aminosalysilic acid (53.6% vs 29.8%, P = 0.001). There was a shift from inflammatory to stricturing and penetrating phenotypes (B1/B2/B3 38.8% vs 12.3%, 31.8% vs 45.6%, 29.4% vs 42.1%, P < 0.0001). Both groups had similar median time to surgery. Within cohort B, 38 patients (33.3%) received anti-tumor necrosis factor (TNF) agent. No patient in cohort A was exposed to anti-TNF agent. Compared to patients not on anti-TNF agent, ones exposed were younger at diagnosis (anti-TNF vs without anti-TNF: A1/A2/A3 39.5% vs 11.8%, 50% vs 73.7%, 10.5% vs 14.5%, P = 0.003) and had longer median time to surgery (90 mo vs 48 mo, P = 0.02). Combination therapy further extended median time to surgery. Using time-dependent multivariate Cox proportional hazard model, patients who were treated with anti-TNF agents had a significantly higher risk to surgery (adjusted hazard ratio 3.57, 95%CI: 1.98-6.44, P < 0.0001) compared to those without while controlling for gender, disease phenotype, smoking status, and immunomodulator use. CONCLUSION: Significant changes in patient phenotypes and medication exposures were observed between the two surgical cohorts separated by a decade. PMID:25206286

Fu, YT Nancy; Hong, Thomas; Round, Andrew; Bressler, Brian

2014-01-01

274

Changes in patient's quality of life comparing conservative and surgical treatment of venous leg ulcers.  

PubMed

Leg ulcers of different etiology disable up to 1% of total population, and up to 15% individuals over 70 years old. It is an old disease, which troubles the patients and medical personnel and is hard to cure. It might take several years to cure the ulcer fully. Most of the patients with leg ulcers are being treated at home, not in the outpatient departments or hospitals; therefore there is not much information on how the ulcer affects the patient's everyday life and its quality. The researchers often analyze only the financial part of this disorder forgetting its human part: pain, social isolation, and decreased mobility. There are many questionnaires and methods to analyze the quality of life of the patients with leg ulceration. It is often unclear if we should treat the ulcer conservatively for a long time or if part of resources should be used for operation (skin grafting) and the time of treatment should be shortened. To see the advantage of both methods and the influence of the ulcer treatment to the quality of life we decided to estimate the functionality of surgical and conservative treatment. We have analyzed the case histories and the data of special questionnaires of 44 patients, which were treated in Department of Plastic Surgery and Burns of Kaunas University of Medicine Hospital in the period of 2001 January-2004 February and had large trophic leg ulcers (m=254 cm2) for 6 months or more. Ten patients were treated conservatively and 34 patients were treated by skin grafting. All of them were interviewed after 3-6 months. We found that the pain in the place of the ulcers has decreased for the patients, who were treated surgically. By making the differences of the pain more exact we found out, that the patients have been feeling pain before the operation and when interviewing them the second time they told that they felt discomfort, not pain. The intensity of pain remained the same for the patients treated conservatively. The regression of pain also proves the decreased usage of painkillers in the group of the patients with the surgical treatment. All the patients (n=44) have had sleep disorders because of the ulcers. In the group of surgically treated patients, ulcers did not disturb the sleep after more than 3 months, and in the group, treated conservatively, the problem remained. We also found that after surgical treatment the patients were more optimistic and cried less. That shows the recovery of their emotional status. We have also found that the patients knew from the surgeon first than from the family doctor or other medical personnel about this disorder. We have made conclusions, that with the reduction of the ulcer area the pain is also reduced. Surgical treatment of ulcers (autodermoplasty) reveals a statistically reliable positive effect on patient life quality (sleep and emotions), but even 50% of patients are unaware of the real leg ulceration causes. PMID:15299989

Jank?nas, Vytautas; Rimdeika, Rytis; Jasenas, Marius; Samsanavicius, Donatas

2004-01-01

275

Oncology nurse navigator.  

PubMed

The purpose of this integrative review is to explore the presence of the oncology nurse as navigator on measurable patient outcomes. Eighteen primary nursing research studies were found using combinations of the following key words: advocate, cancer, case manager, coach, certification, guide, navigator, nurse, oncology, patient navigator, pivot nurse, and continuity of care. Nurse researchers identified nursing-sensitive patient outcomes related to the time to diagnosis and appropriate treatment, effect on mood states, satisfaction, support, continuity of care, and cost outcomes. Navigator roles are expanding globally, and nurses should continue to embrace opportunities to ensure the safe passage of patients with cancer along the entire trajectory of illness and to evaluate the implications for educational preparation, research, and practice of navigators of all kinds. PMID:21278039

Case, Mary Ann B

2011-02-01

276

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. PMID:21921793

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

2011-01-01

277

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

PubMed

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

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

2011-07-01

278

Surgical treatment outcomes of patients with bilateral warthin tumors in the parotid gland.  

PubMed

We describe the treatment outcomes of patients with bilateral Warthin tumors in the parotid gland according to surgical methods. The medical records of ten patients with bilateral Warthin tumors in the parotid gland who underwent surgery between 2004 and 2011 were retrospectively reviewed. Ten patients were included in the study and 13 parotidectomies were performed. Patients with bilateral Warthin tumors in the parotid gland were divided into three groups according to the surgical methods used to treat these individuals. In group 1, the patients were closely observed without undergoing contralateral parotidectomy after unilateral parotidectomy. In group 2, the patients underwent concurrent bilateral parotidectomies. In group 3, the patient underwent contralateral parotidectomy 2 months after unilateral parotidectomy was performed. The overall rate of transient facial nerve dysfunction was 31%. Our findings suggest that concurrent superficial parotidectomy may be an appropriate method for treating bilateral Warthin tumors in the parotid gland, at least for desired patients. The symptoms of this type of tumor and physical examination findings are frequently non-specific and present in the unilateral parotid gland. Therefore, a high degree of discernment is needed and imaging techniques are essential for the determining the correct pre-operative diagnosis. PMID:24533403

Lee, Dong Hoon; Yoon, Tae Mi; Lee, Joon Kyoo; Lim, Sang Chul

2014-01-01

279

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

ERIC Educational Resources Information Center

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

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

2010-01-01

280

Patient-specific model of a scoliotic torso for surgical planning  

NASA Astrophysics Data System (ADS)

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

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

2013-03-01

281

Apolipoproteins A-I and B as predictors of complications in gallbladder lithiasis surgical patients.  

PubMed

Specific serum proteins have been traditionally used in the assessment of protein-energy malnutrition. Some short half-life serum proteins have been related to the appearance of postoperative complications in surgical patients with low-risk pathologies that, far from undernutrition, showed a trend toward overweight and obesity. Apolipoproteins have been proposed as potential tools to assess protein status and nutritional recovery, so we investigated apolipoproteins A-I and B as new tools with prognostic value to detect postoperative complications. We analyzed the interrelation between apolipoproteins level and the appearance of complications after programed surgical procedures of gallbladder lithiasis. Assessment was performed, and postoperative complications were recorded in 52 patients (39 women and 13 men, age range = 21-69 y). Assessment included measurements of weight and height and determinations of apolipoprotein A-I and B by quantitative radial immunodiffusion on gel layers. Apolipoproteins levels showed no statistical differences between complicated and uncomplicated patients. The apolipoproteins included in this study did not predict surgical complications because abnormal values were not associated with the presence of complications in this kind of patient. PMID:12620528

Zago, Liliana B; Slobodianik, Nora H; Gasali, Fernando; Torino, Francisco; Río, María Esther

2003-03-01

282

The unfunded costs incurred by patients accessing plastic surgical care in Northern Saskatchewan.  

PubMed

The Canadian health care system was designed to ensure that all Canadian citizens would receive equal access to health care. However, in rural areas of Canada, patients are required to travel long distances and pay significant out-of-pocket expenses to access health care. The present study attempted to quantify the added out-of-pocket costs that rural Saskatchewan residents must pay to receive plastic surgical specialist care compared with urban residents of Saskatoon. A cost analysis was performed to generate a numerical value that would represent a minimum cost for patients travelling from three different locations within the province. The cost analysis performed in the present study approximated that the unfunded costs for common plastic surgical procedures are, at a minimum, 30 times greater for rural patients in La Ronge compared with their urban counterparts in Saskatoon. The fundamental principle of the Canadian health care system is equal access to necessary health care for all Canadians. Despite this, inequalities persist. The present cost-analysis study demonstrated that the unfunded (out-of-pocket) expenses for rural Saskatchewan patients seeking plastic surgical treatment is significantly higher than for their urban counterparts. These unfunded costs represent a significant barrier to health care access in Canada and serve to propagate inequalities in the nation's heath care system. PMID:25114619

Robb, Jessica L; Clapson, Brian J

2014-01-01

283

Comparison of surgical and endovascular approach in management of spinal dural arteriovenous fistulas: A single center experience of 27 patients  

PubMed Central

Background: Spinal dural arteriovenous fistula (SDAVF) is a rare spinal vascular malformation with an annual incidence of 5-10 cases per million. The data on efficacy, recurrence rates and complications of endovascular versus surgical treatment of SDAVF is limited. Methods: We conducted a retrospective chart review of 27 adult patients with a diagnosis of SDAVF and who underwent treatment at Duke University Hospital between January 1, 1993 and December 31, 2012. We compared the outcome measures by Aminoff–Logue score (ALS) in patients who underwent treatment with endovascular embolization versus surgical ligation of fistula. We compared complication rates, recurrence rates as well as data on long-term follow up in these patients. Results: Out of 27 patients in the study, 10 patients underwent endovascular embolization (Onyx was used in 5 patients and NBCA in 5 patients) as the first line therapy. Seventeen patients underwent surgical ligation as initial therapeutic modality. Patients in both groups showed significant improvement in clinical status (ALS) after treatment. One patient in endovascular group developed spinal infarction due to accidental embolization of medullary artery. Three patients in embolization group had recurrence of fistula during the course of follow up requiring surgical ligation. Two patients in surgical group developed local wound infection. None of the patients in surgical group had recurrence of fistula during the course of follow up. Conclusions: Endovascular embolization and surgical ligation are effective treatment strategies for SDAVF. Our observations show that surgical ligation may offer permanent cure without any recurrence. Endovascular approach is associated with higher incidence of recurrence, especially with use of onyx. PMID:24575322

Gokhale, Sankalp; Khan, Shariq A.; McDonagh, David L.; Britz, Gavin

2014-01-01

284

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

Cancer.gov

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

285

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

PubMed Central

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

2013-01-01

286

Patient specific surgical simulator for the evaluation of the movability of bimanual robotic arms.  

PubMed

This work presents a simulator based on patient specific data for bimanual surgical robots. Given a bimanual robot with a particular geometry and kinematics, and a patient specific virtual anatomy, the aim of this simulator was to evaluate if a dexterous movability was obtainable to avoid collisions with the surrounding virtual anatomy in order to prevent potential damages to the tissues during the real surgical procedure. In addition, it could help surgeons to find the optimal positioning of the robot before entering the operative room. This application was tested using a haptic device to reproduce the interactions of the robot with deformable organs. The results showed good performances in terms of frame rate for the graphic, haptic, and dynamic processes. PMID:21335823

Moglia, Andrea; Turini, Giuseppe; Ferrari, Vincenzo; Ferrari, Mauro; Mosca, Franco

2011-01-01

287

Robust design for acetabular cup stability accounting for patient and surgical variability.  

PubMed

The stability of cementless acetabular cups depends on a close fit between the components and reamed acetabular cavities to promote bone ingrowth. Cup performance and stability are affected by both design and environmental (patient-dependent and surgical) factors. This study used a statistically based metamodel to determine the relative influences of design and environmental factors on acetabular cup stability by incorporating a comprehensive set of patient-dependent and surgical variables. Cup designs with 2 mm or 3 mm intended equatorial bone-implant interferences appeared to perform the best, improving implant stability with smaller mean and variability in cup relative motions and greater mean and smaller variability in ingrowth areas. Cup eccentricity was found to have no effect on implant performance. Design variables did not contribute as much to the variation in performance measures compared to the environmental variables, except for potential ingrowth areas. PMID:18532850

Ong, Kevin L; Santner, Thomas J; Bartel, Donald L

2008-06-01

288

A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting  

PubMed Central

Background Despite growing interest and urges by leading experts for the routine collection of patient reported outcome (PRO) measures in all general care patients, and in particular cancer patients, there has not been an updated comprehensive review of the evidence regarding the impact of adopting such a strategy on patients, service providers and organisations in an oncologic setting. Methods Based on a critical analysis of the three most recent systematic reviews, the current systematic review developed a six-method strategy in searching and reviewing the most relevant quantitative studies between January 2000 and October 2011 using a set of pre-determined inclusion criteria and theory-based outcome indicators. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to rate the quality and importance of the identified publications, and the synthesis of the evidence was conducted. Results The 27 identified studies showed strong evidence that the well-implemented PROs improved patient-provider communication and patient satisfaction. There was also growing evidence that it improved the monitoring of treatment response and the detection of unrecognised problems. However, there was a weak or non-existent evidence-base regarding the impact on changes to patient management and improved health outcomes, changes to patient health behaviour, the effectiveness of quality improvement of organisations, and on transparency, accountability, public reporting activities, and performance of the health care system. Conclusions Despite the existence of significant gaps in the evidence-base, there is growing evidence in support of routine PRO collection in enabling better and patient-centred care in cancer settings. PMID:23758898

2013-01-01

289

An Automatic Control System of the Blood Pressure of Patients Under Surgical Operation  

Microsoft Academic Search

We developed an automatic blood pressure control system to maintain the blood pressure of patients at a substantially low level during a surgical operation. The developed system discharges two functions, continuous feedback control of the mean arterial pressure (MAP) by a state-predictive servo controller and risk control based on the inference by fuzzy-like logics and rules using measured data. Twenty-eight

Eiko Furutani; Mituhiko Araki; Shugen Kan; Tun Aung; Hisashi Onodera; Masayuki Imamura; Gotaro Shirakami; Shunzo Maetani

2004-01-01

290

Surgical treatment for paediatric patients with moyamoya disease by indirect revascularization procedures (EDAS, EMS, EMAS)  

Microsoft Academic Search

Summary Surgical results of paediatric patients with Moyamoya disease who were treated by indirect revascularization procedures are reported. Encephalo-duro-arterio-synangiosis (EDAS), encephalomyo-arterio-synangiosis (EMAS), and\\/or encephalo-myo-synangiosis (EMS) were performed on 47 sides of 29 children with Moyamoya disease. The results of those non-anastomotic EC-IC bypass procedures were evaluated clinically, angiographically, and by computed tomography (CT). Postoperative external carotid angiograms showed a good

T. Matsushima; S. Fujiwara; S. Nagata; K. Fujii; M. Fukui; K. Kitamura; K. Hasuo

1989-01-01

291

Patient safety in surgery: non-technical aspects of safe surgical performance  

PubMed Central

The performance of operative surgery has an understandable focus placed on dexterity, technical precision, as well as the choice of procedure. There is less appreciation of the cognitive and social skills of the individual surgeon and the effect that these have on the surgical team and on patient outcome. This article highlights that impact and explores the contribution of non-technical skills to safe practice within the operating room. PMID:20298538

2010-01-01

292

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. PMID:19488604

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

2009-01-01

293

Patient Experiences of Continuity of Cancer Care: Development of a New Medical Care Questionnaire (MCQ) for Oncology Outpatients  

Microsoft Academic Search

ObjectivesTo adapt the Components of Primary Care Index (CPCI) to be applicable to oncology outpatients and to assess the reliability and validity of the adapted instrument (renamed the Medical Care Questionnaire [MCQ]).

Clare Harley; Jacqui Adams; Laura Booth; Peter Selby; Julia Brown; Galina Velikova

2009-01-01

294

Surgical Decision Making for the Elderly Patients in Severe Head Injuries  

PubMed Central

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

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

2014-01-01

295

The ultimate constant of head and neck oncology-the physician-patient relationship.  

PubMed

Head and neck surgeons have the unique opportunity to engage with humans in life and death situations. We are confronting cancer, cure, failure, self-image, and most of all, a bond with the patient and family. We would like to view our expertise in head and neck surgery and the world of caring for our patients much like a Brigadoon. However, we daily are confronted with ever-changing and evolving approaches to health care that do not involve the physician or the patient. What kind of world is healthcare without a physician-patient interaction? Yes, there is the government-supported electronic medical record, which is here to stay (until our electrical and/or wired network fails). Yes, there is new technology, including robotic surgery and telemedicine and efforts to link these to our cell phones and applications, making care and expertise more available across long distances. And yes, there exist goals to extend care beyond the physician to other health care professions as the buffer between the physician and the patient, sometimes to reduce cost and sometimes to make care more ubiquitous. However, an Internet search will show that most say that the only constant in healthcare is change. I propose that the ultimate constant in healthcare is the physician-patient relationship. PMID:25068431

Day, Terry A

2014-12-01

296

Surgical Techniques for Personalized Oncoplastic Surgery in Breast Cancer Patients with Small- to Moderate-Sized Breasts (Part 1): Volume Displacement  

PubMed Central

Despite the popularity of breast-conserving surgery (BCS), which constitutes 50-60% of all breast cancer surgeries, discussions regarding cosmetic results after BCS are not specifically conducted. The simple conservation of breast tissue is no longer adequate to qualify for BCS completion. The incorporation of oncological and plastic surgery techniques allows for the complete resection of local disease while achieving superior cosmetic outcome. Oncoplastic BCS can be performed in one of the following two ways: 1) volume displacement techniques and 2) volume replacement techniques. This study reports volume displacement surgical techniques, which allow the use of remaining breast tissue after BCS by glandular reshaping or reduction techniques for better cosmetic results. Thorough understanding of these procedures and careful consideration of the patient's breast size, tumor location, excised volume, and volume of the remaining breast tissue during the surgery in choosing appropriate patient and surgical techniques will result in good cosmetic results. Surgery of the contralateral breast may be requested to improve symmetry and may take the form of a reduction mammoplasty or mastopexy. The timing of such surgery and the merits of synchronous versus delayed approaches should be discussed in full with the patients. Because Korean women have relatively small breast sizes compared to Western women, it is not very easy to apply the oncoplastic volume displacement technique to cover defects. However, we have performed various types of oncoplastic volume displacement techniques on Korean women, and based on our experience, we report a number of oncoplastic volume displacement techniques that are applicable to Korean women with small- to moderate-sized breasts. PMID:22493622

Yang, Jung Dug; Lee, Jeong Woo; Cho, Young Kyoo; Kim, Wan Wook; Hwang, Seung Ook; Jung, Jin Hyang

2012-01-01

297

Self-reported functional outcome after surgical intervention in patients with idiopathic normal pressure hydrocephalus.  

PubMed

The goal of this study was to characterize long-term social and functional outcomes in adults treated for idiopathic normal pressure hydrocephalus (NPH). Data for 252 patients treated medically or surgically for idiopathic NPH were obtained through the Hydrocephalus Association Database Project. Data on post-surgical outcomes including improvement in symptoms, the need for in-home care, ability to drive, and employment status were analyzed. Most patients (73.7%) surveyed were treated with a shunt, an endoscopic third ventriculostomy (ETV), or both. More patients who underwent surgery reported driving and being employed compared to those who did not have surgery. Most shunt patients had improvements in gait (81.1%), urinary incontinence (55.9%), and dementia (64.4%). Overall, shunt patients reported more dramatic improvements in quality of life as compared to ETV patients (72.2% versus 55.6%). Treating idiopathic NPH with cerebrospinal fluid diversion facilitates a return to independence through improved functional and social outcomes. PMID:21371890

Cage, T A; Auguste, K I; Wrensch, M; Wu, Y W; Gupta, N

2011-05-01

298

Surgical Treatment Options for the Young and Active Middle-Aged Patient with Glenohumeral Arthritis  

PubMed Central

The diagnosis and treatment of symptomatic chondral lesions in young and active middle-aged patients continues to be a challenging issue. Surgeons must differentiate between incidental chondral lesions from symptomatic pathology that is responsible for the patient's pain. A thorough history, physical examination, and imaging work up is necessary and often results in a diagnosis of exclusion that is verified on arthroscopy. Treatment of symptomatic glenohumeral chondral lesions depends on several factors including the patient's age, occupation, comorbidities, activity level, degree of injury and concomitant shoulder pathology. Furthermore, the size, depth, and location of symptomatic cartilaginous injury should be carefully considered. Patients with lower functional demands may experience success with nonoperative measures such as injection or anti-inflammatory pharmacotherapy. When conservative management fails, surgical options are broadly classified into palliative, reparative, restorative, and reconstructive techniques. Patients with lower functional demands and smaller lesions are best suited for simpler, lower morbidity palliative procedures such as debridement (chondroplasty) and cartilage reparative techniques (microfracture). Those with higher functional demands and large glenohumeral defects will usually benefit more from restorative techniques including autograft or allograft osteochondral transfers and autologous chondrocyte implantation (ACI). Reconstructive surgical options are best suited for patients with bipolar lesions. PMID:22536515

Bhatia, Sanjeev; Hsu, Andrew; Lin, Emery C.; Chalmers, Peter; Ellman, Michael; Cole, Brian J.; Verma, Nikhil N.

2012-01-01

299

[Prolonged intra-arterial therapy in surgical treatment of patients with critical lower limb ischemia].  

PubMed

In vascular surgery department of V.V. Vakhidov Research Center of Surgery prolonged intraarterial catheter therapy (PIACT) was applied in the treatment of 97 patients with critical lower limbs ischemia. Both routine and special methods of examination were used. Isolated PIACT was performed in 29 patients, PIACT in combination with other operations--in 68 patients (lumbar sympathectomy--51, microsurgical transplantation of greater omentum--9, arterialisation of venous system--8). Good and satisfactory results were achieved in 82.4% patients, limb amputations were performed in 17.6% patients. PIACT is most effective only in combination with other surgical methods. Use of PIACT in acute limb ischemia is not recommended. PMID:11810940

Karimov, Z Z; Bakhritdinov, F Sh; Trynkin, A V

2001-01-01

300

Surgical treatment of lumbar vertebral collapse in a patient with Parkinson's disease: a case report.  

PubMed

Parkinson's disease (PD) frequently develops postural abnormalities including extreme neck flexion and trunk flexion. Patients with PD sometimes have osteopenia and vertebral deformity due to the destruction of fragile bone can be also associated with the spinal deformity. Surgical treatment for these patients is very difficult. We encountered a patient with PD presenting severe trunk sagittal and frontal deformity. The patient had cauda equina syndrome due to progressive vertebral collapse of the lumbar spine. We performed anterior reconstruction surgery at first in order to achieve improved lordotic alignment of the lumbar spine. Then, we performed 2 posterior surgeries, resulting in total long fusion from T4 to S1. The clinical findings of this patient were presented, and the treatment options were discussed. PMID:23412270

Kawaguchi, Yoshiharu; Nakano, Masato; Seki, Shoji; Yasuda, Taketoshi; Hori, Takeshi; Tanaka, Kortarou; Kimura, Tomoatsu

2013-11-01

301

A targeted e-learning program for surgical trainees to enhance patient safety in preventing surgical infection  

Microsoft Academic Search

INTRODUCTION: Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty.\\u000aMETHODS: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An educational Web site was developed targeting deficiencies highlighted in the

Seamus M McHugh; Mark Corrigan; Borislav D Dimitrov; Seamus Cowman; Sean Tierney; Hilary Humphreys; Arnold DK Hill

2010-01-01

302

Intracranial aneurysms: a review of endovascular and surgical treatment in 248 patients.  

PubMed

We reviewed the medium-term results of endovascular treatment of intracranial aneurysms and compared patient selection and results with those of open surgery. Between January 1992 and December 1995, a total of 248 consecutive patients were treated for 297 aneurysms (61 unruptured and 236 ruptured). 162 aneurysms in 142 patients (mean age, 48.5 years) were treated microsurgically and 134 aneurysms in 106 patients (mean age, 54.2 years) were treated by endovascular embolization with Guglielmi detachable coils (GDC). The mean follow-up was 2.6 years (range, 1.5 to 4.5 years). There was no significant difference in patient population and selection in terms of age, sex or location of aneurysms between both methods. Both modalities achieved excellent results (defined as no neurological deficit) in patients with unruptured aneurysms and with no or minor deficits after subarachnoid hemorrhage (SAH) between 71% and 88%. Patients with moderate deficits after SAH had excellent outcomes in 49% after open surgery, and 47% after embolization. Poor grade patients had, equally, as well an acceptable as a pour outcome, between 0% and 50%. There was no significant difference between the outcome of surgical or endovascular patients. We conclude that GDC embolization is not associated with a higher risk of morbidity and mortality than open surgery. This risk may even be lower for lesions in surgically unfavorable locations. The GDC technique is a less invasive, effective option to prevent re-bleeding in early stage, even in poor-grade patients. However, these encouraging medium-term results have to be confirmed by a longer observation period. PMID:9651916

Leber, K A; Klein, G E; Trummer, M; Eder, H G

1998-06-01

303

Prevention and treatment of surgical site infection in HIV-infected patients  

PubMed Central

Background Surgical site infection (SSI) are the third most frequently reported nosocomial infection, and the most common on surgical wards. HIV-infected patients may increase the possibility of developing SSI after surgery. There are few reported date on incidence and the preventive measures of SSI in HIV-infected patients. This study was to determine the incidence and the associated risk factors for SSI in HIV-infected patients. And we also explored the preventive measures. Methods A retrospective study of SSI was conducted in 242 HIV-infected patients including 17 patients who combined with hemophilia from October 2008 to September 2011 in Shanghai Public Health Clinical Center. SSI were classified according to Centers for Disease Control and Prevention (CDC) criteria and identified by bedside surveillance and post-discharge follow-up. Data were analyzed using SPSS 16.0 statistical software (SPSS Inc., Chicago, IL). Results The SSI incidence rate was 47.5% (115 of 242); 38.4% incisional SSIs, 5.4% deep incisional SSIs and 3.7% organ/space SSIs. The SSI incidence rate was 37.9% in HIV-infected patients undergoing abdominal operation. Patients undergoing abdominal surgery with lower preoperative CD4 counts were more likely to develop SSIs. The incidence increased from 2.6% in clean wounds to 100% in dirty wounds. In the HIV-infected patients combined with hemophilia, the mean preoperative albumin and postoperative hemoglobin were found significantly lower than those in no-SSIs group (P<0.05). Conclusions SSI is frequent in HIV-infected patients. And suitable perioperative management may decrease the SSIs incidence rate of HIV-infected patients. PMID:22583551

2012-01-01

304

Surgical biopsies in patients with central diabetes insipidus and thickened pituitary stalks.  

PubMed

Thickened pituitary stalks (TPSs) on magnetic resonance imaging (MRI) result from diverse pathologies; therefore, it is essential to make specific diagnoses for clinical decision-making. The diagnoses and indications for surgical biopsies in patients with central diabetes insipidus (CDI) and TPSs are thoroughly discussed in this paper. Thirty-seven patients with CDI and TPSs were retrospectively reviewed. The mean age at the diagnosis of CDI was 29.0 ± 15.9 years (range 8.0-63.3), and the median duration of follow-up was 5.5 ± 2.8 years (range 0.7-13.0). Anterior pituitary hormone deficiencies were documented in 26 (70.3 %) patients. All patients had a TPS on MRI at the diagnosis of CDI, and 21 (56.8 %) patients exhibited radiological changes during the follow-up. Of these 21 patients, 11 exhibited increases in the thickness of the stalk, and two patients exhibited reversals of the TPSs. Involvements of the hypothalamus, pituitary gland, basal ganglia or supersellar, and pineal gland were found in four, three, one, and 1 patient, respectively. Ultimately, clear diagnoses were established in 17 patients who underwent biopsies, nine of whom had germinomas, six of whom had Langerhans cell histiocytosis, one of whom had a granular cell tumor, and one of whom had Erdheim-Chester disease. Patients with CDI and TPSs should submit to periodic clinic follow-ups with serial MRI assessments to establish anterior pituitary deficiencies and to detect radiological progressions that are appropriate for surgical biopsies. Endoscopic-assisted microsurgery via the supraorbital keyhole approach is a good choice for the biopsy of pituitary stalk lesions. PMID:24532100

Jian, Fangfang; Bian, Liuguan; Sun, Shouyue; Yang, Jun; Chen, Xiao; Chen, Yufan; Ma, Qinyun; Miao, Fei; Wang, Weiqing; Ning, Guang; Sun, Qingfang

2014-09-01

305

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

PubMed Central

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

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

2013-01-01

306

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

PubMed Central

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

Matoušková, Ivanka

2012-01-01

307

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

PubMed Central

Objectives. Bisphosphonates related osteonecrosis of the jaw (BRONJ) is a pathological condition characterized by bone exposure or latent infection in patients treated with the drug. The aim of the study is to monitor the BRONJ level of risk health in patients with cancer, according to a preventive clinical protocol, which is firstly aimed at reducing risk factors such as the periodontal infections. Materials and Methods. 10 patients participated in the protocol and were evaluated at baseline and after 3 and 18 months of treatment with bisphosphonates, through full mouth plaque and bleeding scores (FMPS and FMBS), clinical attachment level (CAL) measurement, and the occurrence of osteonecrosis. Results. The mean plaque and bleeding were reduced and the CAL has not shown significant changes and in no cases was there manifestation of BRONJ. Conclusion. The protocol proved crucial for the maintenance of good oral health conditions by eliminating the risk of BRONJ during the observation period. PMID:25258628

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

2014-01-01

308

Postoperative intubation time is associated with acute kidney injury in cardiac surgical patients.  

PubMed

IntroductionAcute kidney injury (AKI) is a frequent complication after cardiac surgery and is associated with a poor prognosis. Mechanical ventilation is an important risk factor for developing AKI in critically ill patients. Ventilation with high tidal volumes has been associated with postoperative organ dysfunction in cardiac surgical patients. No data are available about the effects of the duration of postoperative respiratory support in the immediate postoperative period on the incidence of AKI in patients after cardiac surgery.MethodWe performed a secondary analysis of 584 elective cardiac surgical patients enrolled in an observational trial on the association between preoperative cerebral oxygen saturation and postoperative organ dysfunction and analyzed the incidence of AKI in patients with different times to extubation. The latter variable was graded in 4 h intervals (if below 16 h) or equal to or greater than 16 h. AKI was staged according to the AKI-network criteria.ResultsOverall, 165 (28.3%) patients developed AKI (any stage), 43 (7.4%) patients needed renal replacement therapy. Patients developing AKI had a significantly (P <0.001) lower renal perfusion pressure (RPP) in the first 8 hours after surgery (57.4 mmHg (95%CI: 56.0 to 59.0 mmHg)) than patients with a postoperatively preserved renal function (60.5 mmHg ((95%CI: 59.9 to 61.4 mmHg). The rate of AKI increased from 17.0% in patients extubated within 4 h postoperatively to 62.3% in patients ventilated for more than 16 h (P <0.001). Multivariate logistic regression analysis of variables significantly associated with AKI in the univariate analysis revealed that the time to the first extubation (OR: 1.024/hour, 95%CI:1.011 to 1.044/hour; P <0.001) and RPP (OR: 0.963/mmHg; 95%CI: 0.934 to 0.992; P <0.001) were independently associated with AKI.ConclusionWithout taking into account potentially unmeasured confounders, these findings are suggestive that the duration of postoperative positive pressure ventilation is an important and previously unrecognized risk factor for AKI in cardiac surgical patients, independent from low RPP as an established AKI ¿ trigger, and that even a moderate delay of extubation increases AKI risk. If replicated independently, these findings may have relevant implications for clinical care and for further studies aiming at the prevention of cardiac surgery. PMID:25277725

Heringlake, Matthias; Nowak, Yvonne; Schön, Julika; Trautmann, Jens; Berggreen, Astrid; Charitos, Efstratios I; Paarmann, Hauke

2014-10-01

309

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

Microsoft Academic Search

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

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

2001-01-01

310

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. PMID:24137321

IBRAHIM, TONI; MERCATALI, LAURA; AMADORI, DINO

2013-01-01

311

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

312

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

Cancer.gov

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

313

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

314

Post-discharge care planning and rehabilitation of the elderly surgical patient.  

PubMed

Successful discharge planning, home care, and rehabilitation for surgical patients can be very satisfying. However, everyone involved should be aware that it can also be frustrating when, despite careful plans and organization, everything falls apart, often because the patient's disease course is different from that expected or the patient or family are not satisfied with the services. There are multiple other reasons for plans to fail, but with experience the failures should become less frequent. All too often in life we take success for granted and weigh failures twice as much. The danger of this type of thinking becomes especially important in discharge planning--successfully discharged patients may be "invisible" but the failures are back very quickly. Everyone involved in discharge planning should be made aware of the successes in order to prevent "burn out." Certain predictable complications can often be prevented or rapidly reversed, and rehabilitation is achieved by a team of varied health care providers. A home visit is often very helpful before discharge of an elderly surgical patient. PMID:2199024

Suter-Gut, D; Metcalf, A M; Donnelly, M A; Smith, I M

1990-08-01

315

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

PubMed Central

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

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

2013-01-01

316

A systematic review of patient reported nasal obstruction scores: Defining normative and symptomatic ranges in surgical patients  

PubMed Central

Importance A gold standard objective measure of nasal airway obstruction (NAO) does not currently exist, so patient-reported measures are commonly used, particularly the Nasal Obstruction Symptom Evaluation (NOSE) and the visual analog scale (VAS). However, questions remain regarding how best to utilize these instruments. Objectives The goal of this study is to systematically review studies on NOSE and VAS scores in NAO patients and compile and standardize the data to (1) define symptomatic and normative values for (a) pre and post-surgical NAO patients, (b) asymptomatic individuals, and (c) the general population, (2) determine if post-surgery scores are comparable to asymptomatic scores, and (3) determine if there is a clinically useful pre-operative and post-operative score change. Evidence Review A systematic review of the literature was performed through PubMed for studies assessing NOSE and VAS scores in patients with chronic NAO. Strict inclusion criteria were applied to focus on anatomic obstruction only. For statistical analysis, the patients were divided into asymptomatic, pre- and post-surgery NAO, and the general population. Findings The average NOSE and VAS scores for a patient with NAO were 65 ± 22 and 6.9 ± 2.3 respectively. The average post-surgery NOSE score was 23 ± 20 and VAS score was 2.1 ± 2.2. The average asymptomatic individual NOSE score was 15 ± 17, and VAS score was 2.1 ± 1.6. The average NOSE and VAS scores for the general population were 42 ± 27 and 4.6 ± 2.6 respectively. The average pre- to post-surgical change was > 40 for NOSE and > 4 for VAS. Conclusions and Relevance We have shown that normative and abnormal value ranges for NOSE and VAS can be established for clinical use. Given the consistency of both scales, we conclude that these measures should be used as a clinically meaningful measure of successful surgical outcomes. PMID:24604253

Rhee, John S.; Sullivan, Corbin D.; Frank, Dennis O.; Kimbell, Julia S.; Garcia, Guilherme J.M.

2014-01-01

317

Scoliosis in patients with Prader Willi Syndrome – comparisons of conservative and surgical treatment  

PubMed Central

In children with Prader Willi syndrome (PWS), besides growth hormone (GH) therapy, control of the food environment and regular exercise, surgical treatment of scoliosis deformities seems the treatment of choice, even though the risks of spinal surgery in this specific population is very high. Therefore the question arises as to whether the risks of spinal surgery outweigh the benefits in a condition, which bears significant risks per se. The purpose of this systematic review of the Pub Med literature was to find mid or long-term results of spinal fusion surgery in patients with PWS, and to present the conservative treatment in a case study of nine patients with this condition. Types of studies included; all kinds of studies; retrospective and prospective ones, which reported upon the outcome of scoliosis surgery in patients with PWS. Types of participants included: patients with scoliosis and PWS. Type of intervention: surgery. Search strategy for identification of the studies; Pub Med; limited to English language and bibliographies of all reviewed articles. Nine patients with PWS from our data-base treated conservatively have been found, being 19 years or over at the time this study has been performed. The results of conservative management are described and related to the natural history and treatment results found in the Pub Med review. From 2210 titles displayed in the Pub Med database with the key word being "Prader Willi syndrome", 5 different papers were displayed at the date of the search containing some information on the outcome of surgery and none appeared to contain a mid or long-term follow-up. The PWS patients treated conservatively from our series all stayed below 70° and some of which improved. If the curve of scoliosis patients with PWS can be kept within certain limits (usually below 70 degrees) conservatively, this treatment seems to have fewer complications than surgical treatments. The results of our retrospective study of nine patients demonstrate that scoliosis in this entity plays only a minor role and surgery is unnecessary when high quality conservative management exists. There is lack of the long follow-up studies in post-surgical cases in patients with PWS and scoliosis. The rate of complications of spinal fusion in patients with PWS and scoliosis is very high and the death rates have been found to be higher than in patients with Adolescent Idiopathic Scoliosis (AIS). The long-term side-effects of the intervention are detrimental, so that the risk-benefit ratio favours the conservative approaches over spinal fusion surgery. PMID:19419581

Weiss, Hans-Rudolf; Goodall, Deborah

2009-01-01

318

Transsphenoidal surgical treatment of pituitary adenomas in patients aged 80 years or older.  

PubMed

To know the clinical characteristics of pituitary adenomas in the elderly patients aged 80 years or older who were surgically treated. From 1995 through 2012, 907 patients underwent surgery for the pituitary adenomas at Kagoshima- and Hiroshima University hospitals in Japan. Ten (1.1%) patients were aged 80 years or older. We retrospectively assessed the clinical characteristics including preoperative comorbidities, manifestations, neuroimaging findings, and endocrinologic features of these ten patients. The subjects included eight males and two females. Their ages ranged from 80 to 86 with mean of 83.1 years. Of these, besides one case of growth hormone-producing adenoma, others were clinically nonfunctioning adenoma. Six patients had modest comorbidities such as hypertension, cardiovascular diseases, diabetes mellitus, or chronic kidney dysfunction, and all patients were classified into grade 2-3 on American Society of Anesthesiologists' Physical Status grading. Transsphenoidal surgery was performed in all due to visual disturbance in eight, diabetes mellitus as an intercurrent illness of acromegaly in one, and for the purpose of preventing visual disturbance in one patient who had an adenoma impinging optic chiasm but still had normal visual field. The surgeries provided sufficient decompression of the optic pathways and improved visual disorder in all. In an acromegalic male, his comorbidities considerably improved. No permanent surgical morbidity ensued. More than three axes of anterior pituitary hormones were preoperatively impaired in all, which were rarely recovered. Transsphenoidal surgery is safe and efficient treatment way for patients aged 80 years or older with pituitary adenomas with chiasmatic symptoms when the patients' general condition is well preserved and pituitary hormonal deficiency is adequately replaced. PMID:24233259

Yunoue, Shunji; Tokimura, Hiroshi; Tominaga, Atsushi; Fujio, Shingo; Karki, Prasanna; Usui, Satoshi; Kinoshita, Yasuyuki; Habu, Mika; Moinuddin, F M; Hirano, Hirofumi; Arita, Kazunori

2014-04-01

319

Surgical Approach for Long-term Survival of Patients With Intrahepatic Cholangiocarcinoma: A Multi-institutional Analysis of 434 Patients.  

PubMed

OBJECTIVES To examine the outcomes of a hepatectomy for intrahepatic cholangiocarcinoma (IHC) and to clarify the prognostic impact of a lymphadenectomy and the surgical margin. Large series of patients who were surgically treated for IHC are scarce. Thus, prognostic factors and long-term survival after resection of IHC remain uncertain. DESIGN Prospective study of patients who were surgically treated for IHC. Clinicopathologic, operative, and long-term survival data were analyzed. SETTING Prospectively collected data of all consecutive patients with pathologically confirmed IHC who had undergone liver resection with a curative intent at 1 of 16 tertiary referral centers were entered into a multi-institutional registry. PATIENTS All consecutive patients who underwent a hepatectomy with a curative intent for IHC (1990-2008) were identified from a multi-institutional registry. RESULTS A total of 434 patients were included in the analysis. Most patients underwent a major or extended hepatectomy (70.0%) and a systematic lymphadenectomy (62.2%). The incidence of lymph node metastases (overall, 36.9%) increased with increased tumor size, with 24.4% of patients with a small IHC (diameter ?3 cm) having N1 disease. Almost one-third of patients required an additional major procedure to obtain a R0 resection in 84.6% of the cases. In these patients, the median time of survival was 39 months, and the 5-year survival rate was 39.8%. Lymph node metastases (hazard ratio, 2.21; P < .001), multiple tumors (hazard ratio, 1.50; P = .009), and an elevated preoperative cancer antigen 19.9 level (hazard ratio, 1.62; P = .006) independently predicted an adverse prognosis. Conversely, survival was not influenced by the width of a negative resection margin (P = .61). The potential survival benefit of a lymphadenectomy was assessed with the therapeutic value index, which was calculated to be 5.9 points. CONCLUSIONS Survival rates after a hepatectomy with a curative intent for IHC at tertiary referral centers exceed the survival rates reported in most study series in single institutions, which strengthens the value of an aggressive approach to radical resection. Lymph node metastases and multiple tumors are associated with decreased survival rates, but they should not be considered selection criteria that prevent other patients from undergoing a potentially curative resection. Lymphadenectomy should be considered for all patients. PMID:22910846

Ribero, Dario; Pinna, Antonio Daniele; Guglielmi, Alfredo; Ponti, Antonio; Nuzzo, Gennaro; Giulini, Stefano Maria; Aldrighetti, Luca; Calise, Fulvio; Gerunda, Giorgio Enrico; Tomatis, Mariano; Amisano, Marco; Berloco, Pasquale; Torzilli, Guido; Capussotti, Lorenzo

2012-12-01

320

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

321

Assessment tools for the evaluation of pain in the oncology patient  

Microsoft Academic Search

The control of cancer pain is an essential goal in the care of patients with cancer. Inadequate pain assessment by health\\u000a care providers is a major risk factor for undertreatment of pain. Repeated and accurate pain assessment is required for optimal\\u000a pain management. Pain assessment tools such as simple rating scales and short pain questionnaires can facilitate routine measurement\\u000a of

Karen O. Anderson; Holcombe Boulevard

2007-01-01

322

Oncology Staff Recognition of Depressive Symptoms on Videotaped Interviews of Depressed Cancer Patients  

Microsoft Academic Search

We examined oncologists' and nurses' ability to recognize depressive symptoms in two cancer patients who were interviewed on videotape. The study was conducted in a rural community, hospital-based outreach network. Staff were given a one-hour in-service on the use of the Mini International Neuropsychiatric Interview (MINI)—a brief diagnostic interview—to provide a differential diagnosis (no psychiatric diagnosis, major depressive disorder, or

Steven D Passik; Kathleen B Donaghy; Dale E Theobald; Jeremy C Lundberg; Elizabeth Holtsclaw; William M Dugan

2000-01-01

323

Toxocarosis and putative DRESS syndrome in an oncological patient: a case report.  

PubMed

Toxocarosis is a parasitic infection caused by Toxocara canis or Toxocara cati. Their definite hosts are the domestic dog and cat, where their adult forms live within the lumen of the small intestine. In humans, infective larvae hatch after ingestion of eggs, but the juvenile stages fail to develop into mature adult worms. Instead, they migrate through the body with the potential to affect virtually every body site. DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) is a serious cutaneous drug reaction, which also involves other organ systems. We report on a 45-year-old man who was admitted with fever up to 40?°C, skin rash and pruritus not responding to amoxicillin/clavulanic acid. Laboratory results showed a slightly elevated white blood cell count, with 62?% eosinophils. History revealed contact to roaming cats. Travel history was unremarkable. Extensive diagnostic workup was performed, and the patient was finally diagnosed with DRESS syndrome, responded to systemic corticosteroid therapy and was discharged. Serology for Toxocara came back positive a few days later. Stool was again sent for microscopy and was found positive for Giardia lamblia, which was treated with a 5-day course of metronidazole. The patient had again developed rash and eosinophilia (62?%). Total immunoglobulin (Ig)E was 1,689 U/l (normal limit: patient had no further complaints. Although generalized exanthema due to Toxocara has not yet been described in literature, toxocarosis is known to cause a wide spectrum of cutaneous manifestations. Whether our patient had both, a drug reaction with eosinophilia and systemic symptoms and a parasitic infection, or whether a hypersensitivity reaction to Toxocara antigen was mimicking a DRESS syndrome remains unclear. PMID:24249317

Wutte, Nora; Palfner, Michael; Auer, Herbert; Ruckenbauer, Gerald; Valentin, Thomas; Seeber, Katharina; Aberer, Werner; Krause, Robert; Hoenigl, Martin

2014-04-01

324

[Characteristics of anesthesia in patients with osteogenesis imperfecta undergoing orthopedic surgical procedures].  

PubMed

The aim is to show our experience in anesthesia of patients with osteogenesis imperfecta (OI) who have undergone orthopedic surgical procedures. This is a retrospective analysis of OI patients treated at our Department from 1980 to 2012. We analyzed demographics, comorbidities, preoperative characteristics, anesthesia types, anesthetics and intraoperative and postoperative complications. In the given period, 26 OI patients were treated, using 103 surgeries, and 103 anesthesia procedures. Most procedures, a total of 68, were used in children aged 0-10 years. According to the diagnosis, OI type III was mostly encountered. The rating of the American Society of Anesthesiologist (ASA) physical status was II in most cases, a total of 99. General anesthesia was used in 89 cases, and regional anesthesia in 14. Fourteen intraoperative complications were seen, mostly difficult intubation, and six postoperative cardiovascular instability cases. With careful preparation, and knowledge of pitfalls, anesthesia in these patients should be a safe procedure. PMID:25632774

Tripkovi?, Branko; Anti?evi?, Darko; Buljan, Melita; Jakovina-Blažekovi?, Sanja; Oreškovi?, Zrinka; Kubat, Ozren

2014-01-01

325

Primary hyperparathyroidism in patients with multiple endocrine neoplasia syndromes. Surgical experience.  

PubMed

Forty-five patients with biochemically documented primary hyperparathyroidism as part of multiple endocrine neoplasia syndrome types 1 or 2 were surgically treated from 1960 through 1980. Hyperplasia occurred in 69% of the patients, single adenoma in 27%, and double adenomas in 4%. All but two patients with hyperplasia underwent subtotal parathyroidectomy. In this group, the cure rate was 93% and the incidence of permanent postoperative hypoparathyroidism 23%. In the adenoma group, treatment included excision of the adenoma and biopsy of at least one other gland. The cure rate was 76%, with no postoperative hypoparathyroidism. Analysis of patients with persistent hyperparathyroidism suggested that failure to recognize multiple gland disease was the principal cause of postoperative hypercalcemia. In view of the high incidence of hypocalcemia after subtotal parathyroidectomy, approximately 500 mg of tissue should be cryopreserved to allow transplantation should hypocalcemia ensue postoperatively. PMID:6132593

van Heerden, J A; Kent, R B; Sizemore, G W; Grant, C S; ReMine, W H

1983-05-01

326

[Surgical technique of aortic valve replacement for small aortic annulus in elderly patients].  

PubMed

Recent reports have shown that aortic valve replacement in elderly patients over 65 years with atherosclerotic aortic stenosis and a small aortic annulus is possible by using a small sized bioprosthesis (Carpentier-Edwards pericardial valve). Here we present out surgical technique. Firstly, the native calcified aortic valve was removed completely to gain total exposure of the surrounding aortic root and sinus of Valsalva like Bentall procedure. Secondly, a small sized bioprosthesis was implanted with intermittent noneverting mattress 2-0 sutures with spaghetti and small polytetrafluoroethylene (PTFE) felt. Aortic annulus is the dilated by inserting Hegar dilator sizing from 25 to 27 mm. Therefore, aortic valve replacement for small aortic annulus in intra- or supra-annular position should be easily accomplished. Good surgical results and hemodynamic state were achieved in 25 consecutive cases using this technique. PMID:16613145

Hata, T; Fujiwara, K; Furukawa, H; Tsushima, Y; Yoshitaka, H; Kuinose, M; Minami, H; Ishida, A; Tamura, K; Totsugawa, T; Kanemitsu, H; Ozawa, M

2006-04-01

327

Electroclinical, MRI and neuropathological study of 10 patients with nodular heterotopia, with surgical outcomes.  

PubMed

We present the results of a retrospective study on 10 patients operated on for intractable epilepsy associated with nodular heterotopia as identified by high resolution MRI. Seven patients had unilateral heterotopia, one patient had symmetric bilateral heterotopia and two patients had asymmetric bilateral heterotopia. By stereo-electroencephalogram (SEEG) (nine patients) interictal activity within nodules was similar in all cases, and ictal activity never started from nodules alone but from the overlying cortex or simultaneously in nodules and cortex. Excellent outcomes (Engel class Ia, 1987) were achieved in the seven patients with unilateral heterotopia, showing that surgery can be highly beneficial in such cases when the epileptogenic zone is carefully located prior to surgery by MRI and particularly SEEG. For the bilateral cases surgical outcomes were Engel IIa (one patient) or Engel IIIa (two patients). Histological/immunohistochemical studies of resected specimens showed that all nodules had similar microscopic organization, even though their extent and location varied markedly. The overlying cortex was dysplastic in nine patients, but of normal thickness. We suggest that nodule formation may be the result of a dual mechanism: (i) failure of a stop signal in the germinal periventricular region leading to cell overproduction; and (ii) early transformation of radial glial cells into astrocytes resulting in defective neuronal migration. The intrinsic interictal epileptiform activity of nodules may be due to an impaired intranodular GABAergic system. PMID:15618282

Tassi, L; Colombo, N; Cossu, M; Mai, R; Francione, S; Lo Russo, G; Galli, C; Bramerio, M; Battaglia, G; Garbelli, R; Meroni, A; Spreafico, R

2005-02-01

328

Central and peripheral venous lines-associated blood stream infections in the critically ill surgical patients  

PubMed Central

Critically ill surgical patients are always at increased risk of actual or potentially life-threatening health complications. Central/peripheral venous lines form a key part of their care. We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention. An extensive systematic electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonisation and catheter-related bloodstream infection. Two independent reviewers engaged in selecting the appropriate articles in line with our protocol retrieved 8 articles published from 1999 to 2011. Outcomes on CVC colonisation and infections were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomised trial. We identified only one study that compared CVC- and PICC-related complications in surgical intensive care units. Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature, namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations. In summary, the diverse definitions for the diagnosis of central and peripheral venous catheter-related bloodstream infections along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance remains inconclusive. PMID:22947496

2012-01-01

329

Risk factors affecting the survival rate in patients with symptomatic pericardial effusion undergoing surgical intervention  

PubMed Central

OBJECTIVES The optimal management and treatment of pericardial effusion are still controversial. There is limited data related to the risk factors affecting survival in these patients. The aim of this study was to determine the risk factors affecting the survival rate of patients with symptomatic pericardial effusion who underwent surgical interventions. METHODS From 2004 to 2011, we retrospectively analysed 153 patients who underwent subxiphoid pericardial window as their surgical intervention to drain pericardial effusions at the National Research Institute of Tuberculosis and Lung diseases (NRITLD). To determine the effects of risk factors on survival rate, demographic data, clinical records, echocardiographic data, computed tomographic and cytopathological findings and also operative information of patients were recorded. Patients were followed annually until the last clinical follow-up (August 2011). To determine the prognostic factors affecting survival, both univariate analysis and multivariate Cox proportional hazards model were utilized. RESULTS There were 89 men and 64 women with a mean age of 50.3 ± 15.5 years. The most prevalent symptom was dyspnoea. Concurrent malignancies were present in 66 patients. Lungs were the most prevalent primary site for malignancy. The median duration of follow-up was 15 (range 1–85 months). Six-month, 1-year and 18-month survival rates were 85.6, 61.4 and 36.6%, respectively. In a multivariate analysis, positive history of lung cancer (hazard ratio [HR] 2.894, 95% confidence interval [CI] 1.362–6.147, P = 0.006) or other organ cancers (HR 2.315, 95% CI 1.009–50311, P = 0.048), presence of a mass in the computed tomography (HR 1.985, 95% CI 1.100–3.581, P = 0.023), and echocardiographic findings compatible with tamponade (HR 1.745, 95% CI 1.048–2.90 P = 0.032) were the three independent predictors of postoperative death. CONCLUSIONS In the surgical management of pericardial effusion, patients with underlying malignant disease, especially with lung cancer, patients with a detectable invasion of thorax in computed tomography and those with positive echocardiographic findings compatible with tamponade have a poor survival. Therefore, minimally invasive therapies could be considered as a more acceptable alternative for these high-risk patients. PMID:23250960

Mirhosseini, Seyed Mohsen; Fakhri, Mohammad; Mozaffary, Amirhossein; Lotfaliany, Mojtaba; Behzadnia, Neda; Ansari Aval, Zahra; Ghiasi, Seyed Mohammad Saeed; Boloursaz, Mohammad Reza; Masjedi, Mohammad Reza

2013-01-01

330

Geographic and socioeconomic determinants of participation by elderly patients in surgical oncology trials | accrualnet.cancer.gov  

Cancer.gov

Stewart JH, Russell GB, Howard-McNatt MM, Petro RM, Levine EA, Bell RA. Wake Forest School of Medicine, Winston-Salem, NC; Wake Forest University Baptist Medical Center, Winston-Salem, NC; Wake Forest School of Medicine, Maya Angelou Center for Health Equity, Winston-Salem, NC.. 2012 ASCO Annual Meeting, J Clin Oncol 30, 2012 (suppl abstr 6127). 2012 Jun 01. 2012 Jun 05. Chicago, IL.

331

A two-stage patient enrichment adaptive design in phase II oncology trials.  

PubMed

Illustrated is the use of a patient enrichment adaptive design in a randomized phase II trial which allows the evaluation of treatment benefits by the biomarker expression level and makes interim adjustment according to the pre-specified rules. The design was applied to an actual phase II metastatic hepatocellular carcinoma (HCC) trial in which progression-free survival (PFS) in two biomarker-defined populations is evaluated at both interim and final analyses. As an extension, a short-term biomarker is used to predict the long-term PFS in a Bayesian model in order to improve the precision of hazard ratio (HR) estimate at the interim analysis. The characteristics of the extended design are examined in a number of scenarios via simulations. The recommended adaptive design is shown to be useful in a phase II setting. When a short-term maker which correlates with the long-term PFS is available, the design can be applied in smaller early phase trials in which PFS requires longer follow-up. In summary, the adaptive design offers flexibility in randomized phase II patient enrichment trials and should be considered in an overall personalized healthcare (PHC) strategy. PMID:24342820

Song, James X

2014-01-01

332

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

PubMed

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

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

2014-07-01

333

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

PubMed Central

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

2014-01-01

334

Efficacy of Surgical Treatment for Brain Metastasis in Patients with Non-Small Cell Lung Cancer  

PubMed Central

Purpose Patients with non-small cell lung cancer (NSCLC) and simultaneously having brain metastases at the initial diagnosis, presenting symptoms related brain metastasis, survived shorter duration and showed poor quality of life. We analyzed our experiences on surgical treatment of brain metastasis in patients with NSCLC. Materials and Methods We performed a single-center, retrospective review of 36 patients with NSCLC and synchronous brain metastases between April 2006 and December 2011. Patients were categorized according to the presence of neurological symptoms and having a brain surgery. As a result, 14 patients did not show neurological symptoms and 22 patients presented neurological symptoms. Symptomatic 22 patients were divided into two groups according to undergoing brain surgery (neurosurgery group; n=11, non-neurosurgery group; n=11). We analyzed overall surgery (OS), intracranial progression-free survival (PFS), and quality of life. Results Survival analysis showed there was no difference between patients with neurosurgery (OS, 12.1 months) and non-neurosurgery (OS, 10.2 months; p=0.550). Likewise for intracranial PFS, there was no significant difference between patients with neurosurgery (PFS, 6.3 months) and non-neurosurgery (PFS, 5.3 months; p=0.666). Reliable neurological one month follow up by the Medical Research Council neurological function evaluation scale were performed in symptomatic 22 patients. The scale improved in eight (73%) patients in the neurosurgery group, but only in three (27%) patients in the non-neurosurgery group (p=0.0495). Conclusion Patients with NSCLC and synchronous brain metastases, presenting neurological symptoms showed no survival benefit from neurosurgical resection, although quality of life was improved due to early control of neurological symptoms. PMID:25510753

Kim, Sang Young; Hong, Chang Ki; Kim, Tae Hoon; Hong, Je Beom; Park, Chul Hwan; Chang, Yoon Soo; Kim, Hyung Jung; Ahn, Chul Min

2015-01-01

335

Impact of Cosmetic Result on Selection of Surgical Treatment in Patients With Localized Prostate Cancer  

PubMed Central

Objectives: To analyze the effect of cosmetic outcome as an isolated variable in patients undergoing surgical treatment based on the incision used in the 3 variants of radical prostatectomy: open (infraumbilical incision and Pfannestiel incision) and laparoscopic, or robotic (6 ports) surgery. Patients and methods: 612 male patients 40 to 70 years of age with a negative history of prostate disease were invited to participate. Each patient was evaluated by questionnaire accompanied by a set of 6 photographs showing the cosmetic appearance of the 3 approaches, with and without undergarments. Participants ranked the approaches according to preference, on the basis of cosmesis. We also recorded demographic variables: age, body mass index, marital status, education level, and physical activity. Results: Of the 577 patients who completed the questionnaries, the 6-port minimally invasive approach represents the option preferred by 52% of the participants, followed by the Pfannestiel incision (46%), and the infraumbilical incision (11%), respectively. The univariate and multivariate analyses did not show statistically significant differences when comparing the approach preferred by the patients and the sub-analyses for demographic variables, except for patients who exercised who preferred the Pfannestiel incision (58%) instead of minimally invasive approach (42%) with statistically significant differences. Conclusion: The minimally invasive approach was the approach of choice for the majority of patients in the treatment of prostate cancer. The Pfannestiel incision represents an acceptable alternative. More research and investment may be necesary to improve cosmetic outcomes. PMID:25516703

Martinez-Salamanca, Juan Ignacio; Maestro, Mario Alvarez; Galarza, Ignacio Sola; Rodriguez, Joaquin Carballido

2014-01-01

336

Confidentiality and the physician-patient relationship -- ethical reflections from a surgical waiting room.  

PubMed

The physician-patient relationship is the primary focus of ethics in medicine. It is both a personal and a professional relationship that is founded on trust, confidence, dignity and mutual respect. Trust is the bridge to the physician-patient relationship, and the burden is on the physician not only to expect the patient's trust but also to build a solid foundation upon which the patient can place his or her trust. Great strides have been made by physicians in refining the physician-patient relationship especially in understanding and respecting the patients' right of self-determination regarding medical decision-making and protecting their rights of privacy and confidentiality. However, further refinements are needed on both sides regarding this relationship. Breaches of confidentiality are occurring in places like surgical waiting rooms and as a result, the physician-patient relationship is being damaged. This article identifies some legitimate concerns and offers some concrete solutions so that the physician-patient relationship can be further refined and the virtues and rights that support it can be reinforced. PMID:12444393

Clark, Peter A

2002-11-01

337

Patient-centering approaches for the surgical oncologist: palliative care, patient navigation, and distress screening.  

PubMed

Surgeons can more effectively meet the public's increased expectation of patient-centered care by directing attention to pain, non-pain symptoms, including depression and anxiety, in addition to the patient's personal preferences, resources, and support needs. Patient navigation and palliative care, both pioneered by surgeons, provide complementary frameworks for the screening, assessment and intervention needed to achieve enhanced patient outcomes including adherence to care, improved quality of life and patient satisfaction. PMID:24995436

Dunn, Geoffrey P; Miller, Nina

2014-10-01

338

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

PubMed

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

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

2014-11-01

339

Anesthesia and perioperative management of colorectal surgical patients – A clinical review (Part 1)  

PubMed Central

Colorectal surgery is commonly performed for colorectal cancer and other pathology such as diverticular and inflammatory bowel disease. Despite significant advances, such as laparoscopic techniques and multidisciplinary recovery programs, morbidity and mortality remain high and vary among surgical centers. The use of scoring systems and assessment of functional capacity may help in identifying high-risk patients and predicting complications. An understanding of perioperative factors affecting colon blood flow and oxygenation, suppression of stress response, optimal fluid therapy, and multimodal pain management are essential. These fundamental principles are more important than any specific choice of anesthetic agents. Anesthesiologists can significantly contribute to enhance recovery and improve the quality of perioperative care. PMID:22557737

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

2012-01-01

340

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

Microsoft Academic Search

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

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

2008-01-01

341

Do statins have a role in the promotion of postoperative wound healing in cardiac surgical patients?  

PubMed

Cardiac surgical patients often have associated comorbidities that can impede normal wound healing; however, statin therapy has the potential to improve this process through augmentation of the normal inflammatory response. Outcomes included a 30% earlier rate of wound epithelialization and an 80% greater wound-breaking strength combined with faster wound healing rates (13.0 days vs 18.7 days, p<0.0001). Inhibition of farnesyl pyrophosphate may hold a key role in the mediation of such advantageous effects. This systematic review suggests that there is sufficient evidence to warrant completion of a human trial to assess the effects of statins on wound healing. PMID:24980602

Fitzmaurice, Gerard J; McWilliams, Billy; Nölke, Lars; Redmond, J Mark; McGuinness, Jonathan G; O'Donnell, Mark E

2014-08-01

342

Internal carotid artery surgical revascularization in a pediatric patient with Schimke immuno-osseous dysplasia.  

PubMed

Schimke immuno-osseous dysplasia (SIOD) is a rare autosomal recessive disorder characterized by spondyloepiphyseal dysplasia, episodic lymphopenia, renal failure, and cerebrovascular disease secondary to arteriosclerosis and myointimal hyperplasia. In this paper the authors report the first known application of internal carotid artery (ICA) surgical revascularization to relieve a high-grade focal stenosis of the ICA in a pediatric patient, a 6-year-old boy with SIOD. The clinical presentation, imaging features, operative technique, and postoperative course are described and the molecular genetics, pathophysiology, and treatment considerations in SIOD are discussed. PMID:25431900

Westbroek, Erick M; Mukerji, Nitin; Kalanithi, Paul; Steinberg, Gary K

2015-02-01

343

Rehabilitation of the Geriatric Surgical Patient: Predicting Needs and Optimizing Outcomes.  

PubMed

Geriatric surgical and trauma patients often require institutionalization following acute hospitalization, generally related to frailty. The potential need for rehabilitation can be assessed using various tools. Once the likelihood of rehabilitation needs is established, early involvement of the rehabilitation team is warranted. Rehabilitation interventions can be initiated during acute hospitalization, and even in the intensive care unit. The rehabilitation team addresses a tremendous spectrum of issues, and targeted interventions are carried out by various team members. There are many gaps in current knowledge of the benefits of rehabilitation interventions. Understanding common standardized assessment tools is important to assess the literature and advance the field. PMID:25459550

Biffl, Walter L; Biffl, Susan E

2015-02-01

344

Immediate surgical coronary revascularisation in patients presenting with acute myocardial infarction  

PubMed Central

Background The number of patients presenting with acute myocardial infarction (AMI) and being untreatable by interventional cardiologists increased during the last years. Previous experience in emergency coronary artery bypass grafting (CABG) in these patients spurred us towards a more liberal acceptance for surgery. Following a prospective protocol, patients were operated on and further analysed. Methods Within a two year interval, 127 patients (38 female, age 68±12 years, EuroScore (ES) II 6.7±7.2%) presenting with AMI (86 non-ST-elevated myocardial infarction (NSTEMI), 41 STEMI) were immediately accepted for emergency CABG and operated on within six hours after cardiac catheterisation (77% three-vessel-disease, 47% left main stem stenosis, 11% cardiogenic shock, 21% preoperative intraaortic balloon pump (IABP), left ventricular ejection fraction 48±15%). Results 30-day-mortality was 6% (8 patients, 2 NSTEMI (2%) 6 STEMI (15%), p=0.014). Complete revascularisation could be achieved in 80% of the patients using 2±1 grafts and 3±1 distal anastomoses. In total, 66% were supported by IABP, extracorporal life support (ECLS) systems were implanted in two patients. Logistic regression analysis revealed the ES II as an independent risk factor for mortality (p<0.001, HR 1.216, 95%-CI-Intervall 1.082-1.366). Conclusions Quo ad vitam, results of emergency CABG for patients presenting with NSTEMI can be compared with those of elective revascularisation. Complete revascularisation obviously offers a clear benefit for the patients. Mortality in patients presenting with STEMI and cardiogenic shock is substantially high. For these patients, other concepts regarding timing of surgical revascularisation and bridging until surgery need to be taken into consideration. PMID:23819483

2013-01-01

345

Is there a role for transplantation in gynecologic oncology? Autotransplantation and other lessons.  

PubMed

We describe an exciting and novel surgical option, which may be used to treat formerly unresectable masses. This process is commonly referred to as autotransplantation (AuTn), and it combines the advances in transplant medicine and applies them to surgical oncology. The idea behind AuTn is the removal of the cancerous organ(s) to allow complete anatomic resection of the tumor mass, with consequent anastomotic reimplantation or AuTn of the now macroscopically tumor-free organ back into the patient. Autotransplantation has been used to remove large fibromatosis and desmoid tumors as well as malignant tumors. Our belief is that using lessons learned from the field of transplantation, AuTn can be applied in gynecologic oncology. PMID:23429484

Saso, Srdjan; Hamed, Ali Hassan; Doctor, Cyrus; Thum, Meen-Yau; Naji, Osama; Smith, James Richard; Vianna, Rodrigo; Del Priore, Giuseppe

2013-03-01

346

Persistent pain in postmastectomy patients: Comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain  

PubMed Central

Persistent postmastectomy pain (PPMP) is a major individual and public health problem. Increasingly, psychosocial factors such as anxiety and catastrophizing are being revealed as crucial contributors to individual differences in pain processing and outcomes. Furthermore, differences in patients’ responses to standardized quantitative sensory testing (QST) may aid in the discernment of who is at risk for acute and chronic pain after surgery. However, characterization of the variables that differentiate those with PPMP from those whose acute postoperative pain resolves is currently incomplete. The purpose of this study was to investigate important surgical, treatment-related, demographic, psychophysical, and psychosocial factors associated with PPMP by comparing PPMP cases with PPMP-free controls. Pain was assessed using the breast cancer pain questionnaire to determine the presence and extent of PPMP. Psychosocial and demographic information were gathered via phone interview, and women underwent a QST session. Consistent with most prior research, surgical and disease-related variables did not differ significantly between cases and controls. Furthermore, treatment with radiation, chemotherapy, or hormone therapy was also not more common among those with PPMP. In contrast, women with PPMP did show elevated levels of distress-related psychosocial factors such as anxiety, depression, catastrophizing, and somatization. Finally, QST in nonsurgical body areas revealed increased sensitivity to mechanical stimulation among PPMP cases, while thermal pain responses were not different between the groups. These findings suggest that an individual’s psychophysical and psychosocial profile may be more strongly related to PPMP than their surgical treatment. PMID:23290256

Schreiber, Kristin L.; Martel, Marc O.; Shnol, Helen; Shaffer, John R.; Greco, Carol; Viray, Nicole; Taylor, Lauren N.; McLaughlin, Meghan; Brufsky, Adam; Ahrendt, Gretchen; Bovbjerg, Dana; Edwards, Robert R.; Belfer, Inna

2013-01-01

347

Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support  

PubMed Central

Background Veno-arterial extracorporeal membrane oxygenation (ECMO) is a common modality of circulatory assist device used in children. We assessed the outcome of children who had ECMO following repair of congenital cardiac defects (CCD) and identified the risk factors associated with hospital mortality. Methods From April 1990 to December 2003, 53 patients required ECMO following surgical correction of CCD. Retrospectively collected data was analyzed with univariate and multivariate logistic regression analysis. Results Median age and weight of the patients were 150 days and 5.4 kgs respectively. The indications for ECMO were low cardiac output in 16, failure to wean cardiopulmonary bypass in 13, cardiac arrest in 10 and cardio-respiratory failure in 14 patients. The mean duration of ECMO was 143 hours. Weaning off from ECMO was successful in 66% and of these 83% were survival to hospital-discharge. 37.7% of patients were alive for the mean follow-up period of 75 months. On univariate analysis, arrhythmias, ECMO duration >168 hours, bleeding complications, renal replacement therapy on ECMO, arrhythmias and cardiac arrest after ECMO were associated with hospital mortality. On multivariate analysis, abnormal neurology, bleeding complications and arrhythmias after ECMO were associated with hospital mortality. Extra and intra-thoracic cannulations were used in 79% and 21% of patients respectively and extra-thoracic cannulation had significantly less bleeding complications (p = 0.031). Conclusion ECMO provides an effective circulatory support following surgical repair of CCD in children. Extra-thoracic cannulation is associated with less bleeding complications. Abnormal neurology, bleeding complications on ECMO and arrhythmias after ECMO are poor prognostic indicators for hospital survival. PMID:17217529

Balasubramanian, Sendhil K; Tiruvoipati, Ravindranath; Amin, Mohammed; Aabideen, Kanakkande K; Peek, Giles J; Sosnowski, Andrew W; Firmin, Richard K

2007-01-01

348

Evaluation of prognostic value of selected biochemical markers in surgically treated patients with acute mediastinitis  

PubMed Central

Summary Background Monitoring of biochemical markers of inflammation in acute mediastinitis (AM) can be useful in the modification of treatment. This study was a retrospective evaluation of selected biochemical parameters with negative impact on the prognosis in surgically treated patients. Material/Methods There were 44 consecutive patients treated surgically due to AM of differentiated etiology. Selected biochemical markers (WBC, RBC, HGB, HCT, PLT, CRP, PCT, ionogram, protein and albumins) were assessed before surgery and on the 3rd day after surgery. ANOVA was applied to find factors influencing observations. Numerical data [laboratory parameters] were compared by means of medians. Results The overall hospital mortality rate was 31.82%. In the group of dead patients, there were observed statistically significant lower mean preoperative values of RBC [p=0.0090], HGB [p=0.0286], HCT [p=0.0354], protein [p= 0.0037], albumins [p=0.0003] and sodium [p<0.0001] and elevated values of CRP [P=0.0107] and PCT p<0.0001]. High level of inflammatory markers on day 3 after surgery was found to increase the risk of death – for WBC (by 67%), for CRP (by 88%) and for PCT (by 100%). Conclusions Poor prognosis was more frequent in patients with preoperative high levels of CRP, PCT, anemia, hypoproteinemia and hyponatremia. The risk of death increases significantly if in the immediate postoperative period no distinct decrease in WBC count and of the CRP and PCT level is observed. In such a situation the patients should be qualified earlier for broadened diagnostic workup and for reoperation. PMID:22534711

Jab?o?ski, S?awomir; Brocki, Marian; Krzysztof, Kujawski; Wawrzycki, Marcin; Santorek-Strumi??o, Edyta; ?obos, Marek; Kozakiewicz, Marcin

2012-01-01

349

Controversial issues of optimal surgical timing and patient selection in the treatment planning of otosclerosis.  

PubMed

The aim of this study was to analyze the impact of clinical factors on the outcomes of otosclerosis surgery and support patients' access to evidence-based information in pre-operative counseling to optimize their choices. A total of 109 ears in 93 patients undergoing stapes surgery in a tertiary referral center were included. Variables with a potential impact on hearing outcomes were recorded, with an emphasis on factors that were readily available pre-operatively. Hearing success was defined as a post-operative air-bone gap ?10 dB. Logistic regression analysis was used to determine the factors independently contributing to the prediction of hearing success. The mean follow-up period was 18.0 months. Univariate and multivariate analyses indicated that none of the pre-operative factors (piston type, age, sex, affected side, tinnitus, vertigo, and pre-operative hearing thresholds) affected hearing success significantly (all p > 0.05). In conclusion, self-crimping Nitinol piston provides comparable hearing outcomes with conventional manual-crimping prostheses. However, Nitinol piston offers a technical simplification of a surgical procedure and an easier surgical choice for patients. In addition, age is not a detriment to hearing gain and instead might result in better use of hearing aids in older adults, thus facilitating social hearing recovery. Finally, hearing success does not depend on the extent of pre-operative hearing loss. Hence, patients with poor cochlear function should not be considered poor candidates for surgery. The predictive model has established recommendations for otologists for better case selection, and factors that are readily available pre-operatively may inform patients more explicitly about expected post-operative audiometric results. PMID:23632874

Shiao, An-Suey; Kuo, Chin-Lung; Cheng, Hsiu-Lien; Wang, Mao-Che; Chu, Chia-Huei

2014-05-01

350

Are the American Society for Radiation Oncology Guidelines Accurate Predictors of Recurrence in Early Stage Breast Cancer Patients Treated with Balloon-Based Brachytherapy?  

PubMed Central

The American Society for Radiation Oncology (ASTRO) consensus statement (CS) provides guidelines for patient selection for accelerated partial breast irradiation (APBI) following breast conserving surgery. The purpose of this study was to evaluate recurrence rates based on ASTRO CS groupings. A single institution review of 238 early stage breast cancer patients treated with balloon-based APBI via balloon based brachytherapy demonstrated a 4-year actuarial ipsilateral breast tumor recurrence (IBTR) rate of 5.1%. There were no significant differences in the 4-year actuarial IBTR rates between the “suitable,” “cautionary,” and “unsuitable” ASTRO categories (0%, 7.2%, and 4.3%, resp., P = 0.28). ER negative tumors had higher rates of IBTR than ER positive tumors. The ASTRO groupings are poor predictors of patient outcomes. Further studies evaluating individual clinicopathologic features are needed to determine the safety of APBI in higher risk patients. PMID:24382996

Christoudias, Moira K.; Collett, Abigail E.; Stull, Tari S.; Gracely, Edward J.; Frazier, Thomas G.; Barrio, Andrea V.

2013-01-01

351

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

352

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

353

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

354

Use of Complementary and Alternative Medicine by Patients Admitted to a Surgical Unit in Scotland  

PubMed Central

INTRODUCTION Within the UK there are 50,000 practitioners of complementary medicine. Five million people have consulted such practitioners in one year. The aim of this study was to explore the use of complementary and alternative medicine (CAM) in patients attending general, vascular and cardiothoracic units at a regional Scottish centre. PATIENTS AND METHODS A questionnaire was administered to 450 patients attending the units over an 8-week period. The questionnaire consisted of demographic sections, a listing of 48 herbal preparations and alternative therapies, reasons for use and opinions on efficacy. RESULTS A total of 430 patients completed questionnaires (95%); age and sex were equally distributed over the sample. Of respondents, 68% (291 patients) had ever used CAM; 46% had used CAM in the preceding year. Half had used herbal preparations only, 13% non-herbal treatments and 35% both types of therapy. Only 10% were using CAM for the condition that led to their hospital admission. Two-thirds failed to inform their family physician about their use of CAM. CONCLUSIONS Despite concerns regarding the efficacy, safety and cost-effectiveness of complementary medicine, use amongst surgical patients is common. PMID:18701007

Shakeel, Muhammad; Bruce, Julie; Jehan, Shah; McAdam, Timothy K; Bruce, Duff M

2008-01-01

355

Low dose heparin: bleeding and wound complications in the surgical patient. A prospective randomized study.  

PubMed Central

A randomized prospective study of low dose heparin was performed in 175 surgical patients to determine the frequency of bleeding and wound complications. The patients were divided into three groups: (1) low dose heparin (5000 units two hours before operation and 5000 units every 12 hours following operation for five days); (2) low dose heparin postoperatively only; and (3) a control group. The frequency of bleeding and wound complications was 27% in group I, 7.5% in group II, and 1.4% in group III. The difference between the control patients and those heparinized pre- and postoperatively is statistically significant (p less than 0.005). None of the patients in any of the three groups had a pulmonary embolus, but the number of patients involved is too small to assess the significance of this finding. However, a bleeding and wound complication rate of 27% is significant. These findings indicate that perhaps the routine use of low dose heparin should be reserved for those patients with preoperative factors indicating an increased risk from thromboembolism. PMID:603271

Pachter, H L; Riles, T S

1977-01-01

356

[Roentgen-surgical interventions in combined treatment of patients, suffering hepatic metastases of noncolorectal cancer].  

PubMed

Results of combined treatment, using roentgen-surgical interventions, of 58 patients, suffering noncolorectal metastatic affection of the liver, complicated in 20 (34.5%) of them by obturation jaundice, were analyzed. While resectability of the metastases, preoperatively chemotherapy (CHT) or chemoembolization of hepatic artery (CHEHA) in 1 - 2 courses were performed, and then - hepatic resection of various volume, adjuvant regional CHEHA or systemic CHT. Median survival of the patients have constituted 31.2 mo. While presence of nonresectable metastases a regional chemoinfusion via hepatic arteries or CHEHA (2 - 3 courses) were performed. Median survival of this group of patients have constituted 15.3 mo. Application of cytostatics for regional therapy have permitted in 4 (6.9%) patients, in whom partial tumor regression was achieved, to perform radical hepatic resection. Complete answer on the treatment was not achieved in any patient, partial answer was noted in 16 (33.3%), the process stabilization - in 20 (41.7%), the tumor progress - in 12 (25.0%). In total 170 endovascular and 41 transcutaneous transhepatic endobiliary interventions were performed. After operation 1 (12.5%) patient died. PMID:25509430

2014-09-01

357

Surgical strategy for low rectal cancers.  

PubMed

The two goals of surgery for lower rectal cancer surgery are to obtain clear "curative" margins and to limit post-surgical functional disorders. The question of whether or not to preserve the anal sphincter lies at the center of the therapeutic choice. Histologically, tumor-free distal and circumferential margins of>1mm allow a favorable oncologic outcome. Whether such margins can be obtained depends of TNM staging, tumor location, response to chemoradiotherapy and type of surgical procedure. The technique of intersphincteric resection relies on these narrow margins to spare the sphincter. This procedure provides satisfactory oncologic outcome with a rate of circumferential margin involvement ranging from 5% to 11%, while good continence is maintained in half of the patients. The extralevator abdominoperineal resection provides good oncologic results, however this procedure requires a permanent colostomy. A permanent colostomy alters several domains of quality of life when located at the classical abdominal site but not when brought out at the perineal site as a perineal colostomy. PMID:25455959

Dumont, F; Mariani, A; Elias, D; Goéré, D

2014-11-20

358

Systematic Review of Quality of Life and Patient Reported Outcomes in Patients with Oncologic Related Lower Extremity Lymphedema  

PubMed Central

Abstract Background Lower limb lymphedema (LLL) is a common complication of cancer treatment. The disease is chronic and progressive with no cure. Although a common and significant source of morbidity, the impact of this condition on health-related quality of life (HRQOL) has only recently been addressed. In effort to identify valid treatment strategies for LLL, we performed a systematic review, identifying studies describing HRQOL outcomes in patients with LLL secondary to cancer. Methods and Results Seven medical databases were searched to identify reports using validated Patient Reported Outcome (PRO) instruments on patients with cancer-related LLL. Studies were classified by levels of evidence set by the Agency for Healthcare Research and Quality (AHRQ) and evaluated using the Efficace criteria. 25 studies were identified, 6 met inclusion criteria. Levels of evidence included: no level I studies, level II (n=3), level III (n=1), and level 4 (n=2). 50% of studies were compliant with the Efficace criteria. 5 PRO HRQOL instruments were used, but only 1 was specific to cancer-related lymphedema. Treatment strategies assessed included complete decongestive physiotherapy (CDP), exercise, and compression bandaging. CDP yielded significant enhancements in HRQOL. Conclusions There is a deficit in high quality studies for HRQOL in patients with LLL secondary to cancer. Furthermore, of the studies present, most did not conform to guidelines set for assessment of HRQOL, nor did they use lymphedema condition specific PRO instruments. New measures specific to assessing LLL are necessary to gain more accurate evaluation of how this debilitating disorder affects HRQOL. PMID:23531180

Cemal, Yeliz; Jewell, Sarah; Albornoz, Claudia R.; Pusic, Andrea

2013-01-01

359

Multidisciplinary approach to a nonsyndromic oligodontia patient using advanced surgical techniques.  

PubMed

Treatment of a woman suffering from oligodontia and multiple diastemata with insufficient alveolar ridges in both the maxilla and mandible is described in this clinical report. The total number of missing teeth was 11 (excluding the wisdom teeth). The treatment strategy consisted of an interdisciplinary team approach of orthodontic, surgical, and prosthodontic phases. Sinus floor augmentation, alveolar ridge augmentation via vertical alveolar distraction, and lateral augmentation with ramus graft procedures were performed after fixed orthodontic treatment and prior to dental implant placement. Oral rehabilitation of the patient was completed with the placement of fixed prostheses in the maxillary and mandibular posterior edentulous areas. Early dental intervention improved the patient's appearance and minimized the onset of emotional and psychosocial problems. PMID:21556386

Gunbay, Tayfun; Koyuncu, Banu Ozveri; Sipahi, Aylin; Bulut, Hakan; Dundar, Mine

2011-06-01

360

Surgical treatment of chronic pancreatitis and its complications. Comparative analysis of results in 91 patients.  

PubMed

There is a large variety of proposed conservative, invasive, endoscopic and surgical methods for treatment of chronic pancreatitis and its complications. This study presents a comparative analysis of the results from each group of patients subjected to drainage, resection, denervation and other operative techniques for a total of 91 patients with chronic pancreatitis and its complications. Drainage and resection operative techniques yield comparable results in terms of postoperative pain control 93.1% and 100%, perioperative mortality--3.17% and 5.8%, perioperative morbidity--7.9% and 11.7%, respectively. There is a significant increase in the instances of diabetes in the resection group. Right-side semilunar ganglionectomy is a good method for pain control as an accompanying procedure in the course of another main operative technique. PMID:24800314

Marinov, V; Draganov, K; Gaydarski, R; Katev, N N

2013-01-01

361

Surgical management of melanoma brain metastases in patients treated with immunotherapy  

PubMed Central

Object Despite the increasing use of immunotherapy in the treatment of metastatic melanoma, the effects of this therapy on the management of patients with associated brain metastases are not completely defined. The authors undertook this study to determine the effectiveness of resection and the effects of immunotherapy on brain metastasis management. Methods The authors analyzed data pertaining to consecutive patients with metastatic melanoma treated with immunotherapy within 3 months of discovery of brain metastases that were surgically resected. Results Forty-one patients (median age 44.4 years, range 19.2–63.1 years) underwent resection of 53 brain metastases (median number of metastases 1, range 1–4). The median metastasis volume was 2.5 cm3. Fifteen patients underwent whole-brain radiation therapy (WBRT) and 26 patients did not. Duration of survival from brain metastasis diagnosis was not significantly different between patients who received WBRT (mean 24.9 months) and those who did not (mean 23.3 months) (p > 0.05). Local and distant brain recurrence rates were not statistically different between the WBRT (7.1% and 28.6%, respectively) and non-WBRT (7.7% and 41.0%) groups for the duration of follow-up (p > 0.05). An objective systemic response to immunotherapy was associated with increased duration of survival (p < 0.05). Conclusions Resection of melanoma brain metastases in patients treated with immunotherapy provides excellent local control with low morbidity. An objective response to systemic immunotherapy is associated with a prolonged survival in patients who have undergone resection of melanoma brain metastases. Moreover, adjuvant WBRT in melanoma immunotherapy patients with limited metastatic disease to the brain does not appear to provide a significant survival benefit. PMID:21476810

Lonser, Russell R.; Song, Debbie K.; Klapper, Jacob; Hagan, Marygrace; Auh, Sungyoung; Kerr, P. Benjamin; Citrin, Deborah E.; Heiss, John D.; Camphausen, Kevin; Rosenberg, Steven A.

2014-01-01

362

Hospital type- and volume-outcome relationships in esophageal cancer patients receiving non-surgical treatments  

PubMed Central

AIM: To study the “hospital type-outcome” and “volume-outcome” relationships in patients with esophageal cancer who receive non-surgical treatments. METHODS: A total of 6106 patients with esophageal cancer diagnosed between 2008 and 2011 were identified from a national population-based cancer registry in Taiwan. The hospital types were defined as medical center and non-medical center. The threshold for high-volume hospitals was based on a median volume of 225 cases between 2008 and 2011 (annual volume, > 56 cases) or an upper quartile (> 75%) volume of 377 cases (annual volume > 94 cases). Cox regression analyses were used to determine the effects of hospital type and volume outcome on patient survival. RESULTS: A total of 3955 non-surgically treated patients were included in the survival analysis. In the unadjusted analysis, the significant prognostic factors included cT, cN, cM stage, hospital type and hospital volume (annual volume, > 94 vs ? 94). The 1- and 3-year overall survival rates in the non-medical centers (36.2% and 13.2%, respectively) were significantly higher than those in the medical centers (33.5% and 11.3%, respectively; P = 0.027). The 1- and 3-year overall survival rates in hospitals with an annual volume of ? 94 (35.3% and 12.6%, respectively) were significantly higher than those with an annual volume of > 94 (31.1% and 9.4%, respectively; P = 0.001). However, in the multivariate analysis, the hospital type was not statistically significant. Only cT, cN, and cM stages and hospital volume (annual volume > 94 vs ? 94) were independent prognostic factors. CONCLUSION: Whether the treatment occurs in medical centers is not a significant prognostic factor. High-volume hospitals were not associated with better survival rates compared with low-volume hospitals.

Hsu, Po-Kuei; Chen, Hui-Shan; Wang, Bing-Yen; Wu, Shiao-Chi; Liu, Chao-Yu; Shih, Chih-Hsun; Liu, Chia-Chuan

2015-01-01

363

Orthopaedic and surgical features in the management of patients with haemophilia.  

PubMed

Haemophilia is a hereditary disease due to a defect of the X chromosome, which determines a faulty production of coagulation factor VIII in haemophilia A (85% of cases) and factor IX in haemophilia B. Three degrees of severity can be distinguished: low, with a deficient factor concentration greater than 5% of normal values, medium, with a concentration between 1 and 5%, and severe, comprising more than half of haemophilia cases, with a concentration of factor VIII or factor IX under 1% of normal. The evolution of haemophilic arthropathy is almost always from haemarthrosis to chronic synovitis and extended erosions of the articular surface, culminating in the final stage of articular destruction-chronic haemophilic arthropathy. This paper analyses the results of the treatment applied to a lot of one hundred and ten patients operated inside the our country's sole Compartment of Osteo-Articular Surgery of haemophiliac patients within the Clinic No. 2 of Orthopaedics and Traumatology between 2001 and 2013. This compartment was founded in 2001, being included in the Romanian Health Ministry's programme for financing the treatment for haemophilia. Within the aforementioned time period, a total of 158 patients from the entire country were consulted. From these, 110 patients underwent a series of surgical procedures, 112 in total. The age interval of the studied lot was between 9 and 45 years, with a maximum between 11 and 20 years. With replacement therapy and correct surgical indication, osteoarticular surgery in haemophiliacs, performed in a specialized centre by a multidisciplinary team, can give good results with acceptable risks. PMID:24297373

Poenaru, Dan V; P?tra?cu, J M; Andor, Bogdan Corneliu; Popa, Iulian

2014-07-01

364

Regional citrate anticoagulation for high volume continuous venovenous hemodialysis in surgical patients with high bleeding risk.  

PubMed

Acute kidney injury requiring renal replacement therapy occurs in up to 10% of all intensive care unit patients. Those who are hemodynamically unstable are often treated with continuous renal replacement therapy requiring continuous anticoagulation of the extracorporeal circuit. This is usually achieved by infusion of unfractionated heparin, which subsequently increases the risk of bleeding. To avoid systemic anticoagulation for continuous renal replacement therapy, regional anticoagulation with citrate has been introduced. We studied safety and efficacy of regional citrate anticoagulation for continuous venovenous hemodialysis in surgical patients requiring high dialysis doses. This was an observational prospective study in a 40-bed surgical intensive care unit at a university hospital. During a 12-month study period, all consecutive critically ill patients with high risk of bleeding requiring continuous renal replacement therapy continuous renal replacement therapy were treated with citrate anticoagulation for continuous venovenous hemodialysis. Prescribed dialysis dose was 45 mL/kg per h with a 10% increase for expected downtime. We studied filter lifetime, delivered dialysis dose, control of acid-base status, bleeding episodes, and adverse effects, that is, citrate intolerance. The total number of filters analyzed in 75 patients was 100. Mean (± standard deviation) filter running time was 78 ± 25 h. Fifty-one circuits had to be renewed because of extended filter running time (96 ± 18 h), 33 discontinued for reasons not related to renal replacement therapy (62 ± 19 h), and 13 due to filter clotting (58 ± 18 h). The mean dialysis dose during the first 72 h was 49 ± 14 mL/kg per h. Overall, acid-base status after 72 h was well controlled in 62% of patients, metabolic alkalosis (pH > 7.45) occurred in 29%, and metabolic acidosis (pH < 7.35) in 9%. In one patient, treatment was stopped because of citrate accumulation. Citrate intoxication or overt bleeding episodes were not observed. Regional citrate anticoagulation for continuous venovenous hemodialysis is a safe and effective method to deliver a high dialysis dose in critically ill patients with a high risk of bleeding. Filter patency was excellent, acid-base status was well controlled, and clinically relevant adverse effects were not observed. Therefore, citrate anticoagulated continuous venovenous hemodialysis is a useful treatment option for patients with acute kidney injury requiring high dialysis doses and at risk of bleeding. PMID:23551677

Kalb, Robert; Kram, Rainer; Morgera, Stanislao; Slowinski, Torsten; Kindgen-Milles, Detlef

2013-04-01

365

Surgical site infections in patients undergoing major operations in a university hospital: Using standardized infection ratio as a benchmarking tool  

Microsoft Academic Search

Background: Because patterns of infection acquired in patients undergoing operation are ever changing, it is an essential part of nosocomial infection surveillance programs to periodically document the epidemiologic features of infection in these patients. This study was conducted with the primary intention of describing the incidence and risk factors of the surgical site infection (SSI). Methods: We performed a prospective

Montha Na Narong; Somchit Thongpiyapoom; Nonglak Thaikul; Silom Jamulitrat; Nongyao Kasatpibal

2003-01-01

366

Surgical stress and transient postoperative psychiatric disturbances in aged patients studied using the Yamaguchi University Mental Disorder Scale  

Microsoft Academic Search

Psychiatric disturbances often occur in aged patients after surgery, but there is no easy or precise method of predicting their occurrence. We devised an easy mental test, the Yamaguchi University Mental Disorder Scale (YDS), based on the surgical perspective. Using both this new method and the Hasegawa mental disorder scale (HDS), we examined 106 patients who had undergone general anesthesia.

Hiroto Hayashi; Yoshitaka Maeda; Hiroshi Morichika; Toshimune Miyama; Takashi Suzuki

1996-01-01

367

Prevalence and Predictors of Adverse Events in Older Surgical Patients: Impact of the Present on Admission Indicator  

ERIC Educational Resources Information Center

Purpose of the Study: To examine the effects of the present on admission (POA) indicator on the prevalence of and factors associated with postsurgical adverse events in older patients. Design and Methods: This is a secondary data analysis of 82,898 surgical patients aged 65 years or older in 252 acute care hospitals in California in 2004. Four…

Kim, Hongsoo; Capezuti, Elizabeth; Kovner, Christine; Zhao, Zhonglin; Boockvar, Kenneth

2010-01-01

368

An Examination of the Effects of Pre-Surgical Education on Patient Expectations in Total Knee Arthroplasties  

ERIC Educational Resources Information Center

As patients prepare for total-knee arthroplasty surgery, they have numerous expectations related to their long-term recovery and function. This research discerned whether the use of a pre-surgical patient education class with an additional long-term expectation module addressing recovery during the first 12 months after surgery was more effective…

Montez-Ray, Natasha Dawn

2011-01-01

369

A Simple Novel Model to Predict Hospital Mortality, Surgical Site Infection, and Pneumonia in Elderly Patients Undergoing Operation  

Microsoft Academic Search

Background\\/Aims: Predicting models of operative morbidity and mortality in the geriatric population are important in the prevention of adverse surgical outcomes. Methods: A retrospective review of medical records was performed for patients over 80 years of age who underwent gastrointestinal surgery from 1998 to 2008. Results: 215 patients were identified with a mean age of 83.7 years. Overall morbidity and

Ting-Shuo Huang; Fu-Chang Hu; Chung-Wei Fan; Chun-Hui Lee; Shyh-Chuan Jwo; Huang-Yang Chen

2010-01-01

370

Efficacy of micafungin in empirical therapy of deep mycosis in surgically ill patients.  

PubMed

Micafungin (MCFG), an echinocandin antifungal agent, exhibits antifungal activity against Candida albicans and non-albicans Candida. The fungicidal activity of MCFG against clinical isolates of Candida species was investigated, and the clinical efficacy of MCFG in therapy of deep mycosis in surgery was studied using the AKOTT algorithm. The minimum inhibitory concentration and minimum fungicidal concentration values of fluconazole were ?0.06-4 and >64 ?g/ml, respectively, for each strain, whereas these values of MCFG were 0.008-0.5 and 0.016-1 ?g/ml, suggesting that MCFG provided superior fungicidal ability against Candida albicans and non-albicans Candida. The subjects were separated into two groups: group A consisted of 20 subjects with both persisting fever refractory to broad-spectrum antibiotics and positive reaction to ?-D-glucan test, and group B consisted of 20 subjects with either of those conditions. The overall response was evaluated as "effective" in 17 patients (85%) and 20 patients (100%) in groups A and B, respectively. In total, response was evaluated as "effective" in 37 patients (92.5%) and "ineffective" in 3 patients (7.5%). These findings suggest that MCFG administration should be used as empirical therapy for deep mycosis in surgically ill patients as it was shown to be an effective antifungal drug lacking serious adverse effects. PMID:22450876

Okamoto, Kohji; Katsuki, Takefumi; Tamura, Toshihisa; Kanemitsu, Shuichi; Minagawa, Noritaka; Torigoe, Takayuki; Shibao, Kazunori; Higure, Aiichirou; Yamaguchi, Koji

2012-10-01

371

Postoperative Pain Management among Surgically Treated Patients in an Ethiopian Hospital  

PubMed Central

Background Incidence of postoperative pain has been reported to be between 47–100%. Ineffective postoperative pain management results in tangible and intangible costs. The purpose of this study was to assess the processes and outcomes of pain management in the surgical wards of Jimma University Specialized Hospital, Ethiopia. Methods and Findings A prospective cross sectional study was conducted among 252 postoperative patients during February 13 to April 30, 2012. A contextually modified and validated (Cronbach’s ? coefficient of 0.78) American Pain Society Patient Outcome Questionnaire was used to assess pain experience of patients. Patients’ charts were reviewed to assess the pattern of analgesic use. Incidence of postoperative pain was 91.4%, and remained high over 3 measurements (McNemar’s; p<0.05), and 80.1% of the patients were undertreated. The mean pain intensity, and pain interference on functional status were 6.72±1.44 and 5.61±1.13 on a 10 point Numerical rating scale respectively; both being strongly correlated(r?=?0.86: p<0.001). Pain intensity was varied by ethnicity, education and preoperative information (ANOVA; P<0.05). Only 50% of the patients were adequately satisfied with their pain management. As needed (prn), solo analgesic, null analgesic, and intramuscular orders were noted for 31.3%, 89.29%, 9.7% and 20.1% of the prescription orders respectively. Though under dose, diclofenac and tramadol were the top prescribed medications, and only 57% of their dose was administered. Linear regression model showed that the predictors of satisfaction were sex of an individual and pain interference with functional status. Conclusion Despite patients’ paradoxical high satisfaction with pain management, the majority of patients were inadequately and inappropriately treated. Thus, further research is needed to determine how best to break down current barriers to effective pain management. PMID:25033399

Woldehaimanot, Tewodros Eyob; Eshetie, Tesfahun Chanie; Kerie, Mirkuzie Woldie

2014-01-01

372

Comparison of different surgical approaches of functional endoscopic sinus surgery on patients with chronic rhinosinusitis.  

PubMed

Chronic rhinosinusitis (CRS) is not a life-threatening disorder but may have a great impact on the patients. This study intended to evaluate the impact of functional endoscopic sinus surgery (FESS), and compare the effect and quality of life (QOL) after two different surgical approaches on patients with CRS. Sixty patients of CRS were analyzed before and after FESS. The extent of disease was evaluated by the Lund-Mackay scoring system using computed tomography (CT) and endoscopy. Subjective patient QOL scores were assessed by SF-36 questionnaire and symptom scores were recorded using the SNOT-20 questionnaire. Forty patients of multiunit CRS were randomly allocated to two groups in order to be taken radical FESS (RFESS) and conservative FESS (CFESS), respectively. The Lund-Mackay score and degree of preoperative polyps did not differ statistically between the two groups. In the 1 months follow-up settings, such domains as role physical, mental health, role emotional and general health of SF-36, and total of the SNOT-20 items scores and the most important 5-item scores of SNOT-20 all began to get better markedly (P<0.05); in the 6-12 months follow-up settings, the indices of QOL and symptoms status entirely improved from the baseline, and CFESS scope surgery is no significantly difference with RFESS in improving the QOL and symptoms of patients. The results of this study suggesting that nasal polyps have a significant negative impact on the patients with CRS. FESS is a reliable and effective method for improving a patient's QOL and symptoms after 6 months of surgery, regardless of approaches. PMID:25035783

Shen, Bin; Liu, Li-Ting; Liu, Dan; Guo, Qi-Yun; Dong, Pin

2014-01-01

373

Surgical treatment of double-orifice mitral valve in atrioventricular canal defects. Experience in 25 patients.  

PubMed

Double-orifice mitral valve is an uncommon but surgically important condition. The experience in 25 cases of double-orifice mitral valve associated with atrioventricular canal defects was reviewed. This constituted 4.3% of the 581 cases of atrioventricular canal defects operated upon between 1961 and July, 1984. The combined mitral orifice area ranged from 85% to 91% of normal in those patients whose valves were sized intraoperatively. Ten associated cardiac defects were repaired in six patients. Of 23 patients having cleft mitral valve, 21 had partial closure of the cleft. There was one operative death (4.0%), which occurred early in the series in a patient in whom the tissue bridge was severed and massive mitral regurgitation resulted. In the remaining 24 patients the tissue bridge was left intact, and all survived operation. No patient had clinically significant mitral stenosis during a follow-up of 1 to 14 years (mean 4.9 years). Two patients (8%) developed progressive mitral regurgitation and required mitral valve replacement 3 and 11 years postoperatively. One of these patients died and a second death occurred suddenly 2 years following operation. All survivors are in Functional Class I or II. The noncleft orifice of a double-orifice mitral valve usually is competent and rarely requires closure. The cleft, because it constitutes a type of parachute (single papillary muscle) valve, should be closed partially so as to relieve valve incompetence without causing undue stenosis. The incidence of late development of mitral regurgitation is similar to that of atrioventricular canal without double-orifice mitral valve. Repair of atrioventricular canal associated with double-orifice mitral valve can be achieved with a low operative mortality and excellent late results. PMID:4058042

Lee, C N; Danielson, G K; Schaff, H V; Puga, F J; Mair, D D

1985-11-01

374

The occurrence of postoperative atrial fibrillation according to different surgical settings in cardiac surgery patients  

PubMed Central

OBJECTIVES Atrial fibrillation is the most common arrhythmia after cardiac surgery. The pathogenesis of postoperative atrial fibrillation is multifactorial. The aim of the study was to analyse preoperative, intraoperative and postoperative factors and their relationships with the occurrence and duration of atrial fibrillation. METHODS One hundred and ninety-six patients with coronary heart disease (152 men, age 62.7 ± 10.1 years) underwent surgical revascularization. Extracorporeal circulation was used in 64 patients and minimal extracorporeal circulation was used in 75 patients. Fifty-seven patients underwent surgery without extracorporeal circulation. During the first three postoperative days, subjects were monitored for the duration and incidence of atrial fibrillation, laboratory markers of inflammation (C-reactive protein, leucocytes) and serum potassium. RESULTS Demographic data and associated cardiovascular diseases in the groups were not statistically different. The overall incidence of atrial fibrillation was 56% (110 patients). The highest incidence of atrial fibrillation was found in the extracorporeal circulation subgroup, with a significantly lower incidence using minimal extracorporeal circulation, and in patients operated on without extracorporeal circulation (75 vs 47 vs 46%, P <0.001). The longest duration of atrial fibrillation was found in patients operated on with extracorporeal circulation compared with minimal extracorporeal circulation, and without extracorporeal circulation (9.7 ± 11.6 vs 4.9 ± 8.3 vs 3.1 ± 5.2, P ?0.001). The incidence of postoperative atrial fibrillation significantly correlated with elevation of inflammatory markers (C-reactive protein, leucocytes) compared with patients who were free of atrial fibrillation (P ?0.001, P ?0.05). The values of serum potassium were not significantly different. The relationship between postoperative atrial fibrillation and echocardiographic parameters was not confirmed. CONCLUSIONS The use of extracorporeal circulation leads to a higher incidence of postoperative atrial fibrillation compared with the use of minimal extracorporeal circulation or with surgery without extracorporeal circulation, probably due to enhanced systemic inflammatory response. PMID:22927177

Jakubová, Marta; Mitro, Peter; Stan?ák, Branislav; Sabol, František; Kolesár, Adrián; Cisarik, Paul; Nagy, Vincent

2012-01-01

375

Management of elderly patients with NSCLC; updated expert's opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology.  

PubMed

Non-small-cell lung cancer (NSCLC) is a very common disease in the elderly population and its incidence in this particular population is expected to increase further, because of the ageing of the Western population. Despite this, limited data are available for the treatment of these patients and, therefore, the development of evidence-based treatment recommendations is challenging. In 2010, European Organization for Research and Treatment of Cancer (EORTC) took an initiative in collaboration with International Society of Geriatric Oncology (SIOG) and created an experts panel that provided an experts' opinion consensus paper for the management of elderly NSCLC patients. Since this publication, important new data are available and EORTC and SIOG recommended to update the 2010 recommendations. Besides recommendations for surgery, adjuvant chemotherapy and radiotherapy, treatment of locally advanced and metastatic disease, recommendations were expanded, to include data on patient preferences and geriatric assessment. PMID:24638905

Pallis, A G; Gridelli, C; Wedding, U; Faivre-Finn, C; Veronesi, G; Jaklitsch, M; Luciani, A; O'Brien, M

2014-07-01

376

Validation of the Surgical Fear Questionnaire in Adult Patients Waiting for Elective Surgery  

PubMed Central

Objectives Because existing instruments for assessing surgical fear seem either too general or too limited, the Surgical Fear Questionnaire (SFQ) was developed. The aim of this study is to assess the validity and reliability of the SFQ. Methods Based on existing literature and expert consultation the ten-item SFQ was composed. Data on the SFQ were obtained from 5 prospective studies (N?=?3233) in inpatient or day surgery patients. These data were used for exploratory factor analysis (EFA), confirmatory factor analysis (CFA), reliability analysis and validity analysis. Results EFA in Study 1 and 2 revealed a two-factor structure with one factor associated with fear of the short-term consequences of surgery (SFQ-s, item 1–4) and the other factor with fear of the long-term consequences of surgery (SFQ-l, item 5–10). However, in both studies two items of the SFQ-l had low factor loadings. Therefore in Study 3 and 4 the 2-factor structure was tested and confirmed by CFA in an eight-item version of the SFQ. Across all studies significant correlations of the SFQ with pain catastrophizing, state anxiety, and preoperative pain intensity indicated good convergent validity. Internal consistency (Cronbach's alpha) was between 0.765–0.920 (SFQ-total), 0.766–0.877 (SFQ-s), and 0.628–0.899 (SFQ-l). The SFQ proved to be sensitive to detect differences based on age, sex, education level, employment status and preoperative pain intensity. Discussion The SFQ is a valid and reliable eight-item index of surgical fear consisting of two subscales: fear of the short-term consequences of surgery and fear of the long-term consequences. PMID:24960025

Theunissen, Maurice; Peters, Madelon L.; Schouten, Erik G. W.; Fiddelers, Audrey A. A.; Willemsen, Mark G. A.; Pinto, Patrícia R.; Gramke, Hans-Fritz; Marcus, Marco A. E.

2014-01-01

377

Comparative analysis of autologous blood transfusion and allogeneic blood transfusion in surgical patients  

PubMed Central

Objective: To investigate application effects of autologous blood transfusion and allogeneic blood transfusion in surgically treated patients receiving spine surgery, abdomen surgery and ectopic pregnancy surgery. Methods: 130 patients who would undergo selective operations were divided into autologous transfusion group and allogeneic transfusion group. Both groups received the same anesthesia, and there was no significant difference in transfusion volume or fluid infusion volume. Results: The serum TNF-? level in autologous transfusion group after operation showed a clear upward trend and had significant difference compared with that before operation (P < 0.05). Meanwhile, after operation, the serum TNF-? level in autologous transfusion group was all significantly higher than that allogeneic transfusion group and the comparative difference was statistically significant (P < 0.05). IgG level in treatment group did not significantly fluctuate during perioperative period, but IgG level in allogeneic transfusion group after operation was all significantly lower than that before operation, and there was statistically significant difference between both groups (P < 0.05). At the same time, complement C3 level in treatment group after operation was significantly higher than that before operation (P < 0.05), but complement C3 level in allogeneic transfusion group did not significantly change. After operation, there was statistically significant difference in complement C3 level between both groups (P < 0.05). Conclusion: Autologous transfusion is already a widely accepted transfusion method at present, and it can increase TNF-? and complement C3 levels in the body of surgically treated patients to strengthen immune ability against infection. PMID:25356154

Long, Miao-Yun; Liu, Zhong-Han; Zhu, Jian-Guang

2014-01-01

378

Image-Guided Radiotherapy for Breast Cancer Patients: Surgical Clips as Surrogate for Breast Excision Cavity  

SciTech Connect

Purpose: To determine the use of surgical clips as a surrogate for localization of the excision cavity and to quantify the stability of the clips' positions during the course of external beam radiotherapy for breast cancer patients, using cone beam computed tomography (CBCT) scans. Methods and Materials: Twenty-one breast cancer patients with surgical clips placed in the breast excision cavity were treated in a supine position with 28 daily fractions. CBCT scans were regularly acquired for a setup correction protocol. Retrospectively, the CBCT scans were registered to the planning CT scans, using gray-value registration of the excision cavity region and chamfer matching of the clips. Subsequently, residual setup errors (systematic [{Sigma}] and random [{sigma}]) of the excision cavity were estimated relative to the clips' registration. Finally, the stability of the clips' positions were quantified as the movement of each separate clip according to the center of gravity of the excision cavity. Results: When clips were used for online setup corrections, the residual errors of the excision cavity were {Sigma}{sub left-right} = 1.2, {sigma}{sub left-right} = 1.0; {Sigma}{sub cranial-caudal} = 1.3, {sigma}{sub cranial-caudal} = 1.2; and {Sigma}{sub anterior-posterior} = 0.7, {sigma}{sub anterior-posterior} = 0.9 mm. Furthermore, the average distance (over all patients) between the clips and centers of gravity of the excision cavities was 18.8 mm (on the planning CT) and was reduced to 17.4 mm (measured on the last CBCT scan). Conclusion: Clips move in the direction of the center of gravity of the excision cavity, on average, 1.4 mm. The clips are good surrogates for locating the excision cavity and providing small residual errors.

Topolnjak, Rajko; Ruiter, Peter de; Remeijer, Peter; Vliet-Vroegindeweij, Corine van; Rasch, Coen [Radiotherapy Department, Netherlands Cancer Institute/Antoni van Leeuwenhoek Huis, Amsterdam (Netherlands); Sonke, Jan-Jakob, E-mail: j.sonke@nki.nl [Radiotherapy Department, Netherlands Cancer Institute/Antoni van Leeuwenhoek Huis, Amsterdam (Netherlands)

2011-11-01

379

Incidence of Nocturnal Leg Cramps in Patients with Lumbar Spinal Stenosis before and after Conservative and Surgical Treatment  

PubMed Central

Purpose To examine the effects of conservative and surgical treatments for nocturnal leg cramps in patients with lumbar spinal stenosis (LSS). Nocturnal leg cramps is frequently observed in patients with peripheral neuropathy. However, there have been few reports on the relationship between nocturnal leg cramps and LSS, and it remains unknown whether conservative or surgical intervention has an impact on leg cramps in patients with LSS. Materials and Methods The subjects were 130 LSS patients with low back and leg pain. Conservative treatment such as exercise, medication, and epidural block was used in 66 patients and surgical treatment such as decompression or decompression and fusion was performed in 64 patients. Pain scores and frequency of nocturnal leg cramps were evaluated based on self-reported questionnaires completed before and 3 months after treatment. Results The severity of low back and leg pain was higher and the incidence of nocturnal leg cramps was significantly higher before treatment in the surgically treated group compared with the conservatively treated group. Pain scores improved in both groups after the intervention. The incidence of nocturnal leg cramps was significantly improved by surgical treatment (p=0.027), but not by conservative treatment (p=0.122). Conclusion The findings of this prospective study indicate that the prevalence of nocturnal leg cramps is associated with LSS and severity of symptoms. Pain symptoms were improved by conservative or surgical treatment, but only surgery improved nocturnal leg cramps in patients with LSS. Thus, these results indicate that the prevalence of nocturnal leg cramps is associated with spinal nerve compression by LSS. PMID:24719148

Yamashita, Masaomi; Murata, Yasuaki; Eguchi, Yawara; Aoki, Yasuchika; Ataka, Hiromi; Hirayama, Jiro; Ozawa, Tomoyuki; Morinaga, Tatsuo; Arai, Hajime; Mimura, Masaya; Kamoda, Hiroto; Orita, Sumihisa; Miyagi, Masayuki; Miyashita, Tomohiro; Okamoto, Yuzuru; Ishikawa, Tetsuhiro; Sameda, Hiroaki; Kinoshita, Tomoaki; Hanaoka, Eiji; Suzuki, Miyako; Suzuki, Munetaka; Aihara, Takato; Ito, Toshinori; Inoue, Gen; Yamagata, Masatsune; Toyone, Tomoaki; Kubota, Gou; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Yamauchi, Kazuyo; Takahashi, Kazuhisa

2014-01-01

380

Anticoagulation in the management of venous thromboembolism in the cancer patient  

Microsoft Academic Search

Cancer is associated with a four to sevenfold increased risk of venous thromboembolism (VTE). This risk is influenced by the\\u000a site and extent of cancer and its treatment. Despite its availability, effective VTE prophylaxis is used in less than 50%\\u000a of oncology patients. Pharmacologic VTE prophylaxis should be administered to all hospitalized medical and surgical oncology\\u000a patients for the duration

Michael B. Streiff

2011-01-01

381

Preventing transmission of infectious agents in the pediatric in-patients hematology-oncology setting: what is the role for non-pharmacological prophylaxis?  

PubMed Central

The most intensive chemotherapy regimens were used in the past for leukemia patients who were the main focus of trials on infections; today there are increasing numbers of children with solid cancer and considerable risk of infection who do receive intensive standard-dose chemotherapy. Despite a continuous will to protect the immune-compromised child from infections, evidence-based indications for intervention by non-pharmacological tools is still lacking in the pediatric hematology-oncology literature. Guidelines on standard precautions as well as precautions to avoid transmission of specific infectious agents are available. As a result of a consensus discussion, the Italian Association for Pediatric Hematology-Oncology (AIEOP) Cooperative Group centers agree that for children treated with chemotherapy both of these approaches should be implemented and vigorously enforced, while additional policies, including strict environmental isolation, should be restricted to patients with selected clinical conditions or complications. We present here a study by the working group on infectious diseases of AIEOP. PMID:21647282

Caselli, Désirée; Cesaro, Simone; Livadiotti, Susanna; Ziino, Ottavio; Paolicchi, Olivia; Zanazzo, Giulio; Milano, Giuseppe M.; Licciardello, Maria; Barone, Angelica; Cellini, Monica; Raffaella, De Santis; Giacchino, Mareva; Rossi, Mario Renato; Aricò, Maurizio; Castagnola, Elio

2011-01-01

382

Preoperative Platelet Count Associates with Survival and Distant Metastasis in Surgically Resected Colorectal Cancer Patients  

PubMed Central

Objective Platelets have been implicated in cancer metastasis and prognosis. No population-based study has been reported as to whether preoperative platelet count directly predicts metastatic recurrence of colorectal cancer (CRC) patients. Design Using a well-characterized cohort of 1,513 surgically resected CRC patients, we assessed the predictive roles of preoperative platelet count in overall survival, overall recurrence, as well as locoregional and distant metastatic recurrences. Results Patients with clinically high platelet count (?400× 109/L) measured within 1 month before surgery had a significantly unfavorable survival (hazard ratio [HR]=1.66, 95 % confidence interval [CI] 1.34–2.05, P=2.6×10?6, Plog rank= 1.1×10?11) and recurrence (HR=1.90, 1.24–2.93, P=0.003, Plog rank=0.003). The association of platelet count with recurrence was evident only in patients with metastatic (HR=2.81, 1.67–4.74, P=1.1×10?4, Plog rank =2.6×10?6) but not locoregional recurrence (HR=0.59, 95 % CI 0.21–1.68, P= 0.325, Plog rank=0.152). The findings were internally validated through bootstrap resampling (P<0.01 at 98.6 % of resampling). Consistently, platelet count was significantly higher in deceased than living patients (P<0.0001) and in patients with metastatic recurrence than locoregional (P= 0.004) or nonrecurrent patients (P<0.0001). Time-dependent modeling indicated that the increased risks for death and metastasis associated with elevated preoperative platelet counts persisted up to 5 years after surgery. Conclusion Our data demonstrated that clinically high level of preoperative platelets was an independent predictor of CRC survival and metastasis. As an important component of the routinely tested complete blood count panel, platelet count may be a cost-effective and noninvasive marker for CRC prognosis and a potential intervention target to prevent metastatic recurrence. PMID:23549858

Wan, Shaogui; Lai, Yinzhi; Myers, Ronald E.; Li, Bingshan; Hyslop, Terry; London, Jack; Chatterjee, Devjani; Palazzo, Juan P.; Burkart, Ashlie L.; Zhang, Kejin; Xing, Jinliang

2013-01-01

383

A good surgical option for ischemic mitral regurgitation in co-morbid patients: semicircular reduction annuloplasty  

PubMed Central

Background Ring annuloplasty is the standard treatment of ischemic mitral regurgitation (MR), however, it has been associated with some drawbacks. It abolishes normal annular dynamics and freezes the posterior leaflet. In the present study, we evaluated Paneth suture annuloplasty in chronic ischemic MR and both early and mid-term outcomes of the technique on a selected population. Methods The study period was from June 2010 to June 2012. We operated on 21 patients who had the diagnosis of coronary artery disease and MR of grade 3 or 4. The patients had both a coronary artery bypass operation and the mitral semicircular reduction annuloplasty described by Paneth-Burr. The data on the patients were retrospectively collected. Patients were contacted by outpatient clinic controls for mid-term results. Results The male/female ratio was 10/11. The mean age of the patients was 71.0 ± 6.4 years. Preoperative and postoperative left ventricular ejection fraction was statistically similar (P = 0.973). Early postoperative MR grade (mean, 0.57 ± 0.51) was statistically lower than the preoperative MR grades (mean, 3.38 ± 0.50) (P < 0.001). There was no revision for excess bleeding. Two patients had prolonged hospitalization, one for sternal infection and the other for severe chronic obstructive pulmonary disease. No hospital or late postoperative deaths occurred. The mean late postoperative MR grade was 0.66 ± 0.97 degrees. One patient had progression of MR in the later follow-up, which was treated by mitral valve replacement. Conclusion Semicircular reduction annuloplasty is an effective, inexpensive and easy surgical annuloplasty technique with low mortality and morbidity in severe symptomatic ischemic MR. PMID:23888173

Emrecan, Bilgin; Onem, Gokhan; Ozdemir, Ahmet Coskun; K?l?ç, ?smail Do?u; Alihano?lu, Yusuf ?zzettin

2013-01-01

384

[A study on a postoperative change of beta-2-microglobulin in surgical patients].  

PubMed

Various renal tubular functions were monitored perioperatively in 42 surgical patients and the validity of beta-2-microglobulin (BMG) was evaluated. NAG index (urine NAG titer/urine creatinine), the absolute value of free water clearance and fractional excretion of sodium were worse at 3 to 5 hours after the beginning of operation, indicating the latent renal tubular damage took place during operation. On the other hand, fractional excretion of BMG (FE-BMG; BMG clearance/creatinine clearance) slowly elevated after operation and reached a peak on the 2nd postoperative day. The postoperative change of C-reactive protein (CRP), was similar with that of FE-BMG, showing a significant correlation (r = 0.716, p less than 0.001). The close relationship between CRP and FE BMG was confirmed in 26 patients with or without abnormal liver function who underwent abdominal operation. The peak value of FE BMG was significantly (p less than 0.01) lower in 5 patients with ICG 15' greater than 25% than in 21 patients with ICG 15' less than 20%. Similarly, the peak value of CRP tended to be lower in the former group. In conclusion, FE BMG can not be employed as an indicator of renal tubular function during postoperative period. It reacts as an acute phase reactant like CRP and is probably produced in the liver. PMID:1614390

Homma, T; Tsujinaka, T; Kido, Y; Hayashida, Y; Ishida, H; Iijima, S; Mori, T

1992-05-01

385

Surgical treatment of large substernal thyroid goiter: analysis of 12 patients  

PubMed Central

This study was carried out to evaluate the clinical presentation, surgical treatment, complications, and risk of malignancy for large substernal goiter. From March 2010 to December 2012, 12 patients with large substernal thyroid goiter who underwent surgery in our Department were enrolled in the study. Their medical records were retrospectively analyzed. Collar-shaped incision was adequate for resection of the lesions in 10 (83%) patients, while two (17%) patients required combined cervical-thoracic incision. In addition, one case was subjected to postoperative tracheotomy. Transient hypocalcaemia occurred in one case. The incidence of transient hoarseness, tracheomalacia and hypothyroidism was 8.3%. There was no perioperative bleeding, thyroid storm as well as other serious complications. All patients were clinically cured. Therefore, cervical collar incision is nearly always adequate for most cases of larger substernal goiter, and sternotomy can be avoided. Furthermore, the application of intraoperative ultrasonic knife can effectively reduce intraoperative and postoperative complications. Aggressive perioperative management is crucial for the successful removal of large substernal goiter. PMID:23936586

Gao, Bo; Jiang, Yan; Zhang, Xiaohua; Zhao, Jianjie; He, Yujun; Wen, Yayuan; Zhang, Shu; Luo, Donglin

2013-01-01

386

Comparison of surgically induced astigmatism in patients with horizontal rectus muscle recession  

PubMed Central

AIM To compare surgically induced astigmatism (SIA) following horizontal rectus muscle recession surgery between suspension recession with both the “hang-back” technique and conventional recession technique. METHODS Totally, 48 eyes of 24 patients who had undergone horizontal rectus muscle recession surgery were reviewed retrospectively. The patients were divided into two groups. Twelve patients were operated on by the hang-back technique (Group 1), and 12 by the conventional recession technique (Group 2). SIA was calculated on the 1st wk, 1st and in the 3rd mo after surgery using the SIA calculator. RESULTS SIA was statistically higher in the Group 1 all postoperative follow-up. SIA was the highest in the 1st wk, and decreased gradually in both groups. CONCLUSION The suspension recession technique induced much more SIA than the conventional recession technique. This difference also continued in the following visits. Therefore, the refractive power should be checked postoperatively in order to avoid refractive amblyopia. Conventional recession surgery should be the preferred method so as to minimize the postoperative refractive changes in patients with amblyopia. PMID:25161948

Çakmak, Harun; Kocatürk, Tolga; Dündar, Sema Oruç

2014-01-01

387

Management and surgical resection for tracheobronchial tumors institutional experience with 12 patients.  

PubMed

We reviewed the records of 12 patients with primary tracheobronchial tumors and various clinical characteristics treated at our institution to investigate our overall management experience with disease. Over a 21-year period, we treated 1405 cases of primary pulmonary neoplasms, of which 12 (0.9%) patients had primary tracheobronchial tumors with eight different histological types, including three adenoid cystic carcinomas, two bronchial carcinoids, two papillomas, one squamous cell carcinoma, one mucous gland adenoma, one inflammatory pseudotumor, one schwannoma, and one mucoepidermoid carcinoma. Eleven of the patients had symptoms of airway obstruction and/or secondary infection or bleeding. A complete resection was performed in ten, which included a sleeve lobectomy in seven, sleeve pneumonectomy in one, tracheal resection in one, and left main stem resection without lung resection in one. Median survival following complete resection was 91 months. When possible, a complete resection provides the best potential benefits and symptomatic relief for patients with tracheo-endobronchial tumors. Further, various options related to tracheobronchoplasty including conservative resection can be applied for surgical intervention. PMID:17669912

Takeda, Shin-Ichi; Hashimoto, Taikichi; Kusu, Takashi; Kawamura, Tomohiro; Nojiri, Takashi; Funakoshi, Yasunobu; Kadota, Yoshihisa; Maeda, Hajime

2007-08-01

388

Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study  

PubMed Central

Objectives Despite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore VTE and subsequent mortality rates, trends and variations across Australian acute public hospitals. Setting A large retrospective cohort study using all elective surgical patients in 82 acute public hospitals during 2002–2009 in New South Wales, Australia. Participants Patients underwent elective surgery within 2?days of admission, aged between 18 and 90?years, and who were not transferred to another acute care facility; 4?362?624 patients were included. Outcome measures VTE incidents were identified by secondary diagnostic codes. Poisson mixed models were used to derive adjusted incidence rates and rate ratios (IRR). Results 2/1000 patients developed postoperative VTE. VTE increased by 30% (IRR=1.30, CI 1.19 to 1.42) over the study period. Differences in the VTE rates, trends between hospital peer groups and between hospitals with the highest and those with the lowest rates were significant (between-hospital variation). Smaller hospitals, accommodated in two peer groups, had the lowest overall VTE rates (IRR=0.56:0.33 to 0.95; IRR=0.37:0.23 to 0.61) and exhibited a greater increase (64% and 237% vs 19%) overtime and greater between-hospital variations compared to larger hospitals (IRR=8.64:6.23 to 11.98; IRR=8.92:5.49 to 14.49 vs IRR=3.70:3.32 to 4.12). Mortality among patients with postoperative VTE was 8% and remained stable overtime. No differences in post-VTE death rates and trends were seen between hospital groups; however, larger hospitals exhibited less between-hospital variations (IRR=1.78:1.30 to 2.44) compared to small hospitals (IRR>23). Hospitals performed differently in prevention versus treatment of postoperative VTE. Conclusions VTE incidence is increasing and there is large variation between-hospital and within-hospital peer groups suggesting a varied compliance with VTE preventative strategies and the potential for targeted interventions and quality improvement opportunities. PMID:25280806

Assareh, Hassan; Chen, Jack; Ou, Lixin; Hollis, Stephanie J; Hillman, Kenneth; Flabouris, Arthas

2014-01-01

389

Effects of Degree of Surgical Correction for Flatfoot Deformity in Patient-Specific Computational Models.  

PubMed

A cohort of adult acquired flatfoot deformity rigid-body models was developed to investigate the effects of isolated tendon transfer with successive levels of medializing calcaneal osteotomy (MCO). Following IRB approval, six diagnosed flatfoot sufferers were subjected to magnetic resonance imaging (MRI) and their scans used to derive patient-specific models. Single-leg stance was modeled, constrained solely through physiologic joint contact, passive soft-tissue tension, extrinsic muscle force, body weight, and without assumptions of idealized mechanical joints. Surgical effect was quantified using simulated mediolateral (ML) and anteroposterior (AP) X-rays, pedobarography, soft-tissue strains, and joint contact force. Radiographic changes varied across states with the largest average improvements for the tendon transfer (TT) + 10 mm MCO state evidenced through ML and AP talo-1st metatarsal angles. Interestingly, 12 of 14 measures showed increased deformity following TT-only, though all increases disappeared with inclusion of MCO. Plantar force distributions showed medial forefoot offloading concomitant with increases laterally such that the most corrected state had 9.0% greater lateral load. Predicted alterations in spring, deltoid, and plantar fascia soft-tissue st