scholarly journals P-OGC86 Textbook Outcome following Oesophagectomy for Oesophageal Cancer: An International Cohort Study

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Keyword(s):  
Oesophageal Cancer ◽  
Negative Impact ◽  
Multivariable Analysis ◽  
Surgical Care ◽  
High Volume ◽  
Future Research ◽  
Resected Specimen ◽  
Tumour Resection ◽  
Binary Logistic Regression Model ◽  
Lymph Node Yield

Abstract Background Although textbook outcome (TO) has been proposed as a tool for the assessment of oncological surgical care, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess TO in an international setting. Methods Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 - December 2018. TO was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with TO, and results are presented as odds ratio (OR) and 95% confidence intervals (CI95%). Results This study included 2,159 patients with oesophageal cancer, of whom 39.7% achieved a TO. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a TO for patients with oesophageal cancer, compared to other TO parameters. Multivariable analysis identified male gender, increasing Charlson comorbidity index, and higher AJCC T and N staging to be associated with a significantly lower likelihood of TO. After accounting for these factors, high volume centres (>50 cases/year; OR: 1.36, CI95%: 1.06 - 1.75, p = 0.015), presence of 24-hour on-call rota for oesophageal surgeons (OR: 2.11, CI95%: 1.33 - 3.35, p = 0.001) and radiology (OR: 1.56, CI95%: 1.08 - 2.26, p = 0.019), total minimally invasive esophagectomies (OR: 1.60, CI95%: 1.25 - 2.05, p < 0.001), and chest anastomosis above azygous (OR: 2.17, CI95%: 1.58 - 2.98, p < 0.001) were independently associated with a significantly increased likelihood of TO.  Conclusions TO is achieved in less than 40% of patients having oesophagectomy for cancer. Improvements in centralisation, hospital resources (i.e. daily 24-hour on-call esophagogastric surgeons and radiologists), access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve TO. Understanding how these individual parameters help improve quality of patient care should be the focus of future research.

Primary Uterine Cancer in Maryland: Impact of Distance on Access to Surgical Care at High-Volume Hospitals

2013 ◽  
Vol 23 (7) ◽  
pp. 1244-1251 ◽  
Author(s):  
Camille C. Gunderson ◽  
Ana I. Tergas ◽  
Aimee C. Fleury ◽  
Teresa P. Diaz-Montes ◽  
Robert L. Giuntoli
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Uterine Cancer ◽  
Multivariable Analysis ◽  
Community Setting ◽  
Surgical Care ◽  
High Volume ◽  
High Volume Hospital ◽  
To Receive ◽  
Zip Code

ObjectiveTo evaluate the influence of distance on access to high-volume surgical treatment for patients with uterine cancer in Maryland.MethodsThe Maryland Health Services Cost Review Commission database was retrospectively searched to identify primary uterine cancer surgical cases from 1994 to 2010. Race, type of insurance, year of surgery, community setting, and both surgeon and hospital volume were collected. Geographical coordinates of hospital and patient’s zip code were used to calculate primary independent outcomes of distance traveled and distance from nearest high-volume hospital (HVH). Logistic regression was used to calculate odds ratios and confidence intervals.ResultsFrom 1994 to 2010, 8529 women underwent primary surgical management of uterine cancer in Maryland. Multivariable analysis demonstrated white race, rural residence, surgery by a high-volume surgeon and surgery from 2003 to 2010 to be associated with both travel 50 miles or more to the treating hospital and residence 50 miles or more from the nearest HVH (allP< 0.05). Patients who travel 50 miles or more to the treating hospital are more likely to have surgery at a HVH (odds ratio, 6.03; 95% confidence interval, 4.67–7.79) In contrast, patients, who reside ≥50 miles from a HVH, are less likely to have their surgery at an HVH. (odds ratio, 0.37; 95% confidence interval, 0.32–0.42).ConclusionIn Maryland, 50 miles or more from residence to the nearest HVH is a barrier to high-volume care. However, patients who travel 50 miles or more seem to do so to receive care by a high-volume surgeon at an HVH. In Maryland, Nonwhites are more likely to live closer to an HVH and more likely to use these services.

scholarly journals Ensuring Quality in Thyroid Cancer Surgery

2017 ◽  
Vol 13 (01) ◽  
pp. 22
Author(s):  
Maria F Bates ◽  
Kristin L Long ◽  
Rebecca S Sippel ◽  
◽  
◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Survival Rates ◽  
Surgical Care ◽  
High Volume ◽  
Term Survival ◽  
Lymph Node Yield ◽  
Ultrasound Evaluation

Thyroid cancer incidence is increasing worldwide. Though long-term survival rates are excellent, recurrence remains a significant problem, which highlights potential areas of needed improvement, including the surgical care of these patients. This review paper identifies tools and markers that can be used to improve surgical quality in thyroid cancer. Preoperative surgical planning starts with an adequate ultrasound evaluation of the cervical lymph node basins. Postoperatively, thyroglobulin and radioactive iodine uptake scans can track adequacy of resection. In addition, lymph node yield and lymph node ratios serve as indirect markers for assessing the quality of lymph node dissections. Current research also suggests that high-volume surgeons have improved oncological outcomes. Surgeons can use these tools and information to follow and potentially improve the care provided to patients.

Applying personalized medicine to adult severe asthma

2021 ◽  
Vol 42 (1) ◽  
pp. e8-e16 ◽  
Author(s):  
Angelica Tiotiu
Keyword(s):  
Personalized Medicine ◽  
Severe Asthma ◽  
Negative Impact ◽  
Target Therapy ◽  
Asthma Management ◽  
Future Research ◽  
Biologic Therapies ◽  
Eosinophilic Asthma ◽  
Definition Of ◽  
Structured Approach

Background: Severe asthma is a heterogeneous disease that consists of various phenotypes driven by different pathways. Associated with significant morbidity, an important negative impact on the quality of life of patients, and increased health care costs, severe asthma represents a challenge for the clinician. With the introduction of various antibodies that target type 2 inflammation (T2) pathways, severe asthma therapy is gradually moving to a personalized medicine approach. Objective: The purpose of this review was to emphasize the important role of personalized medicine in adult severe asthma management. Methods: An extensive research was conducted in medical literature data bases by applying terms such as “severe asthma” associated with “structured approach,” “comorbidities,” “biomarkers,” “phenotypes/endotypes,” and “biologic therapies.” Results: The management of severe asthma starts with a structured approach to confirm the diagnosis, assess the adherence to medications and identify confounding factors and comorbidities. The definition of phenotypes or endotypes (phenotypes defined by mechanisms and identified through biomarkers) is an important step toward the use of personalized medicine in asthma. Severe allergic and nonallergic eosinophilic asthma are two defined T2 phenotypes for which there are efficacious targeted biologic therapies currently available. Non-T2 phenotype remains to be characterized, and less efficient target therapy exists. Conclusion: Despite important progress in applying personalized medicine to severe asthma, especially in T2 inflammatory phenotypes, future research is needed to find valid biomarkers predictive for the response to available biologic therapies to develop more effective therapies in non-T2 phenotype.

Employees' Perceptions of the Effects of Retrenchment on Job Stress and Organisational Commitment in a Mining Company

2019 ◽  
Vol 43 ◽  
Author(s):  
Landiswa Seteni ◽  
Pierre Joubert ◽  
Manilall Dhurup
Keyword(s):  
Job Stress ◽  
Quantitative Research ◽  
Negative Impact ◽  
Surface Mining ◽  
Future Research ◽  
Global Changes ◽  
Organisational Commitment ◽  
Consultation Process ◽  
Mining Company ◽  
Time Stress

Over the past decade, South African organisations have had to cope with an ever-increasing rate of local and global changes. There have been considerable and ongoing socio-political changes, resulting from new government regulations. Most organisations have experienced some type of downturn, whether due to external business factors or poor internal performance. A typical response to organisational decline is retrenchment. Our study sought to explore employees’ perceptions of the effects of retrenchment on job stress and organisational commitment in a mining company. The study was located within a quantitative research paradigm. Four research hypotheses were posited and data was collected in one region from a sample of 400 surface mining employees, including management, administrators, engineers and artisans. The results showed that the effects of retrenchment did not have a negative impact on job stress (time stress and anxiety). This may be due to the fact that the mining company in question had a planning and consultation process in place for the employees prior to the retrenchment process. The results also showed that job stress (time stress and anxiety) was negatively associated with organisational commitment. To conclude this article we discuss the implications of our findings, outline the limitations of our study and make recommendations for future research.

scholarly journals Protocol for a systematic review on the experience of informal caregivers for people with a moderate to advanced dementia within a domestic home setting

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Charles James ◽  
Catherine Walshe ◽  
Katherine Froggatt
Keyword(s):  
Systematic Review ◽  
Negative Impact ◽  
Current Knowledge ◽  
Informal Caregivers ◽  
Informal Caregiving ◽  
Bibliographic Databases ◽  
Future Research ◽  
Advanced Dementia ◽  
Home Setting ◽  
Search Terms

Abstract Background The knowledge about the experience of informal caregivers who provide care to people with moderate to advanced dementia in a domestic home setting is limited. A consequence of long hours of caregiving in addition to dealing with normal challenges of daily living is their experience of a poor quality of life. Some of their experiences may be described in terms of a feeling of powerlessness to make changes during care provision. This feeling may also suggest an experience of moral distress. The aim of this systematic review is to synthesise qualitative evidence relating to these experiences. Methods This review adopts a narrative synthesis approach. A search will be conducted for studies written in the English language in the bibliographic databases MEDLINE Complete, CINAHL, EMBASE, PsycINFO, Web of Science and Academic Search Complete covering periods from 1984 to present. Included studies will be qualitative or mixed-methods designs. The search terms will be related to dementia and caregivers, and the process will be focused on dementia at the moderate to the advanced stages within the domestic home setting. Reference lists of included papers will also be searched for additional relevant citations. Search terms and strategies will be checked by two independent reviewers. The identification of abstracts and full texts of studies will be done by the author, while the quality and the risk of bias will also be checked by the two independent reviewers. Discussion Psychological distress is cited as an experience reported within informal caregiving. For the caregiver, it is associated with a negative impact on general health. To date, no synthesis exists on the specific experience of informal caregiving for people with moderate to advanced dementia within the domestic home setting. This review considers that variation of accounts contributes to how the informal caregivers’ general experience is explored in future research. This may enable gaps in current knowledge to be highlighted within the wider context of caregiving in the domestic home setting. Systematic review registration This review is registered with PROSPERO (CRD42020183649).

scholarly journals SAT0623-HPR THE LIVED EXPERIENCES OF COGNITIVE DYSFUNCTION IN ADULTS WITH FIBROMYALGIA: A QUALITATIVE SYSTEMATIC REVIEW

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1271.1-1272
Author(s):  
S. Derham ◽  
J. Lewis ◽  
E. Dures ◽  
F. Cramp
Keyword(s):  
Clinical Practice ◽  
Cognitive Function ◽  
Cognitive Dysfunction ◽  
Lived Experiences ◽  
Critical Appraisal ◽  
Negative Impact ◽  
Practice Research ◽  
Future Research ◽  
Poor Sleep ◽  
Cognitive Changes

Background:Adults with fibromyalgia frequently report symptoms of cognitive dysfunction, often referred to as fibrofog. However primary research exploring cognitive dysfunction in the lives of adults with fibromyalgia is very limited (Kravitz and Katz, 2015).Objectives:The aim of this review was to (i) synthesise the qualitative literature on the lived experiences of cognitive dysfunction in adults with fibromyalgia, (ii) develop common themes through thematic analysis and (iii) identify knowledge gaps to inform future research and clinical practice in this area.Methods:Seven electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, Amed, Scopus and OpenGrey), reference lists of key articles and two high impact qualitative journals were searched from 1990 to November 2018. Articles were eligible for inclusion if they reported primary qualitative data exploring the experiences of cognitive dysfunction in adults with fibromyalgia. Included studies were appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist and extracted data analysed using narrative synthesis. SD conducted critical appraisal and data extraction on all included studies. FC, JL and ED reviewed five papers each. All papers were reviewed by two co-authors. Of the 1413 records identified, 15 studies were selected for inclusion.Results:These studies included 208 women and 22 men with fibromyalgia, aged 18 to 72 years and representing seven different countries. Duration of diagnosis was four months to 34 years. Fourteen studies used interviews and one used focus groups. None of the included studies focussed exclusively on cognitive function in adults with fibromyalgia. Three studies identified themes specific to cognitive dysfunction and fibromyalgia symptoms. The remaining 12 studies presented relevant data intertwined with the overall lived experiences of fibromyalgia.Cognitive dysfunction, as a part of fibromyalgia, was often unpredictable. Problems with memory and concentration that were most commonly reported were emotionally distressing and affected functional and vocational activities. Participants found communication effortful, with a negative impact on work, leisure and social activities. Stress, fear and worry around perceived cognitive changes were commonly expressed. Lost employment or changed work roles and relationships, due to cognitive difficulties, had negative impacts for many participants. The terms cognitive dysfunction and fibrofog were used interchangeably within the studies, but lacked common definition. This introduced uncertainty around whether participants and authors were describing the same phenomenon.Conclusion:Adults with fibromyalgia experience unpredictable and emotionally impactful difficulties related to cognitive dysfunction. Functional impact was broad-reaching, particularly around work ability and lost employment opportunities. It is unclear how cognitive symptoms in fibromyalgia related to co-morbid symptoms such as pain, fatigue and poor sleep. Further research focusing on the full impact of cognitive function on the lives of adults with fibromyalgia is recommended to inform clinical practice. Research to establish clarity of definition of the terms cognitive dysfunction and fibrofog within fibromyalgia is highly recommended.References:[1]Kravitz H, Katz R. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatology International. 2015;35(7):1115-25.Acknowledgments:This work is supported by the National Institute for Heath Research [ICA-PCAF-2018-01-078 to SD]Disclosure of Interests:Sandra Derham: None declared, Jenny Lewis: None declared, Emma Dures Grant/research support from: Independent Learning Grant from Pfizer, combined funding for a research fellow from Celgene, Abbvie and Novartis, Paid instructor for: A fee from Novartis to deliver training to nurses., Fiona Cramp: None declared

Focal Concerns and Intimate Partner Violence Case Processing: Predicting Arrest Using a Stratified Random Sample of Police Case File Data

2021 ◽  
pp. 001112872110104
Author(s):  
Cortney A. Franklin ◽  
Leana A. Bouffard ◽  
Alondra D. Garza ◽  
Amanda Goodson
Keyword(s):  
Intimate Partner Violence ◽  
Random Sample ◽  
Partner Violence ◽  
Police Department ◽  
Intimate Partner ◽  
Criminal History ◽  
Future Research ◽  
Binary Logistic Regression Model ◽  
Case File ◽  
Focal Concerns

Focal concerns has utility for explaining criminal justice decisions, including among police. At present, there is no research that has examined focal concerns and arrest decisions in non-sexual, intimate partner violence (IPV) cases. This study used a stratified random sample of 776 IPV incidents from an urban police department in one of the five largest and most diverse US cities to assess the effect of focal concerns on arrest. A multivariate binary logistic regression model demonstrated victim injury, suspect IPV and general criminal history, evidence, witnesses, victim preference for formal intervention, women victims, and intoxicated suspects predicted arrest. When the suspect was on scene, this was the strongest predictor of arrest. Implications and future research are discussed.

Relationship of hospital volume on outcomes in patients with acute pulmonary embolism: Analysis of a 70,000 patient database

2020 ◽  
pp. 1358863X2097026
Author(s):  
Mark Finkelstein ◽  
Mario A Cedillo ◽  
David C Kestenbaum ◽  
Obaib S Shoaib ◽  
Aaron M Fischman ◽  
...  
Keyword(s):  
New York ◽  
Pulmonary Embolism ◽  
Length Of Stay ◽  
New York State ◽  
Multivariable Analysis ◽  
High Volume ◽  
Categorical Variables ◽  
Patient Database ◽  
Very High ◽  
Total Charges

Positive relationships between volume and outcome have been seen in several surgical and medical conditions, resulting in more centralized and specialized care structures. Currently, there is a scarcity of literature involving the volume–outcome relationship in pulmonary embolism (PE). Using a state-wide dataset that encapsulates all non-federal admissions in New York State, we performed a retrospective cohort study on admitted patients with a diagnosis of PE. A total of 70,443 cases were separated into volume groups stratified by hospital quartile. Continuous and categorical variables were compared between cohorts. Multivariable regression analysis was conducted to assess predictors of 1-year mortality, 30-day all-cause readmission, 30-day PE-related readmission, length of stay, and total charges. Of the 205 facilities that were included, 128 (62%) were labeled low volume, 39 (19%) medium volume, 23 (11%) high volume, and 15 (7%) very high volume. Multivariable analysis showed that very high volume was associated with decreased 30-day PE-related readmission (OR 0.64; 95% CI, 0.55 to 0.73), decreased 30-day all-cause readmission (OR 0.84; 95% CI, 0.79 to 0.89), decreased 1-year mortality (OR 0.85; 95% CI, 0.80 to 0.91), decreased total charges (OR 0.96; 95% CI, 0.94 to 0.98), and decreased length of stay (OR 0.94; 95% CI, 0.92 to 0.96). In summary, facilities with higher volumes of acute PE were found to have less 30-day PE-related readmissions, less all-cause readmissions, shorter length of stay, decreased 1-year mortality, and decreased total charges.

The psychological impact of active surveillance in men with prostate cancer: implications for nursing care

2021 ◽  
Vol 30 (10) ◽  
pp. S30-S37
Author(s):  
Sophie Biddle
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Negative Impact ◽  
Psychological Impact ◽  
Future Research ◽  
Management Approach ◽  
Close Monitoring ◽  
Illness Uncertainty ◽  
Quantitative Studies ◽  
Positive Treatment

Introduction: Active surveillance is a conservative management approach to treating prostate cancer involving regular testing and close monitoring by the health professional. The aim of this literature review is to establish whether men experience a psychological impact of active surveillance and what the prevalent effects might be. Method: The search was carried out in three databases: CINAHL, Medline and PsycINFO. Articles published in English, from October 2015 to March 2018, which focused on the psychological impact of active surveillance, were included. Findings: A total of eight quantitative studies were included in this report. The review identified key psychological impacts of active surveillance, including anxiety, sub-clinical depression, illness uncertainty and hopelessness. Active surveillance was seen by some patients as a positive treatment approach that limited the side effects associated with active treatment. Conclusion: The evidence found a negative impact of active surveillance might be felt by men at any stage during treatment and at differing levels of severity. The article highlights key demographic areas, including ethnicity and age, for future research and recommends more qualitative studies are conducted.

scholarly journals Natural Dyeing of Cellulose and Protein Fibers with the Flower Extract of Spartium junceum L. Plant

Materials ◽  
2021 ◽  
Vol 14 (15) ◽  
pp. 4091
Author(s):  
Zorana Kovačević ◽  
Ana Sutlović ◽  
Ana Matin ◽  
Sandra Bischof
Keyword(s):  
Negative Impact ◽  
Environmentally Friendly ◽  
Future Research ◽  
Wool Fabric ◽  
Dyeing Process ◽  
Protein Fibers ◽  
Wool Sample ◽  
C Value ◽  
Total Difference ◽  
Spartium Junceum

In this study, the natural dye was extracted from Spartium junceum L. (SJL) flowers and applied on cellulose (cotton) and protein (wool) fabric. Fabrics were pre-mordant with alum prior to the dyeing process. Considering the global requirements on zero waste and green policy, the dyeing process was intended to be as much as possible environmentally friendly but still effective. Therefore, mordant concentration was optimized due to the reduction of the negative impact. The efficiency of the dyeing process was investigated by examination of fabrics’ color characteristics and colorfastness to washing properties. In this paper, we have proved that the extracted dye from Spartium junceum L. is an acidic dye (mordant dye) which is more applicable for the treatment of wool fabrics. In this paper, it was proved that phytochemicals responsible for coloring are part of the flavonoids group. The UV absorption spectra of extracted dye show 4 bands in the region of λmax 224, 268, 308 and 346 nm which are ascribed to bands characteristic for flavonoids. Wool fabric pre-mordant with 3% alum and dyed shows great chromatic (C*) properties where C* value is in a range from 47.76 for unwashed samples to 47.50 for samples after 5 washing cycles and color hue (h°) is in a range 82.13 for unwashed samples to 81.52 for samples after 5 washing cycles. The best result regarding the colorfastness properties is shown by the wool sample treated with 3% alum after 5 washing cycles (total difference in color (Delta E*) = 0.87). These results confirm that metal (Al) from alum mordant make strong chemical bonds with wool substrate and dye since Delta E* values decrease in comparison to Delta E* values of the cotton samples treated the same way. The results revealed it is possible to reduce the concentration of mordant up to 3% and obtain satisfactory results regarding the colorfastness. Nevertheless, future research will go in the direction of replacing synthetic mordant with a more environmentally friendly one.

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