Hospital characteristics associated with better ‘quality of surgery’ and survival following oesophagogastric cancer surgery in Queensland: a population‐level study

2020 ◽  
Author(s):  
Aaditya Narendra ◽  
Peter D. Baade ◽  
Joanne F. Aitken ◽  
Jonathan Fawcett ◽  
Brandon Leggett ◽  
...  
Keyword(s):  
Population Level ◽  
Cancer Surgery ◽  
Quality Of Surgery ◽  
Oesophagogastric Cancer ◽  
Hospital Characteristics

Using textbook outcome as a measure of quality of care in oesophagogastric cancer surgery

2018 ◽  
Vol 105 (5) ◽  
pp. 561-569 ◽  
Author(s):  
R. T. van der Kaaij ◽  
M. V. de Rooij ◽  
F. van Coevorden ◽  
F. E. M. Voncken ◽  
P. Snaebjornsson ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Cancer Surgery ◽  
Oesophagogastric Cancer

Improving the quality of surgery for gastric cancer—Are surgeons aware of the relevant quality indicators?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4048-4048
Author(s):  
L. K. Helyer ◽  
C. O Brien ◽  
N. G. Coburn ◽  
C. J. Swallow
Keyword(s):  
Gastric Cancer ◽  
Quality Indicators ◽  
Frozen Section ◽  
Tumor Biology ◽  
Young Patients ◽  
Cancer Surgery ◽  
Proximal Margin ◽  
Gastric Cancer Surgery ◽  
Quality Of Surgery

4048 Background: Gastric cancer survival in the West is inferior to that achieved in Asian centers. While differences in tumor biology may play a role, poor quality surgery contributes to understaging. In our evaluation, adequate lymph node (LN) assessment (≥15) was achieved in only one third of patients and independently predicted survival across Surveillance, Epidemiology and End Results (SEER) regions (ASCO 2005, Abstract # 4004). The standard proximal margin of resection is recommended to be ≥5 cm; revision based on intraoperative frozen section is of benefit. We hypothesize that the majority of surgeons performing gastric cancer surgery in a North American setting are unaware of the recommended standards. Methods: Using the Ontario College of Physicians and Surgeons registry, surgeons who potentially include gastric cancer surgery in their scope of practice were identified. A questionnaire was mailed to 559, 55% responded. 203surgeons reported managing gastric cancer. Results were evaluated by chi-square and logistic regression; p<0.05 was considered significant. Results: 86% of respondents were male; 59% in urban non-academic practice, and 30% in academic. 42% of surgeons operate on 2–5 cases/yr and 18 % on >5. One third of surgeons identified ≤ 4 cm to be the desired proximal margin. Frozen section is used by 52% to evaluate proximal margin status. 20% were unsure of the number of LN needed to accuratly stage, the median number reported by the remainder was 10 (range 0 - 30). 99% refer for adjuvant therapy. This was less likely for patients in poor medical condition, poor nutritional status, or age >70 years. Young patients, those with bulky LN or positive margins were more likely to be referred. Overall, only 16 of 203identified the need for both a ≥5 cm proximal margin and ≥15LN; this was too small a group to analyze for demographic associations. Surgeons who do >5 gastric resections/yr were more likely to report performing a D2 resection (p = 0.008). Conclusions: The majority of surgeons operating on gastric cancer in Ontario did not identify standard quality indicators of gastric cancer surgery. A continuing medical education program should be designed to address the knowledge gap, aiming to improve the quality of surgery and outcome of multidisciplinary management. No significant financial relationships to disclose.

scholarly journals Population-Level Prevalence, Bother, and Treatment Behavior for Urinary Incontinence in an Eastern European Country: Findings from the LUTS POLAND Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2314
Author(s):  
Mikolaj Przydacz ◽  
Marcin Chlosta ◽  
Piotr Chlosta
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Rural Areas ◽  
Eastern European Country ◽  
Population Level ◽  
Eastern European ◽  
Level Data ◽  
Urban And Rural Areas ◽  
Eastern European Countries

Objectives: Population-level data are lacking for urinary incontinence (UI) in Central and Eastern European countries. Therefore, the objective of this study was to estimate the prevalence, bother, and behavior regarding treatment for UI in a population-representative group of Polish adults aged ≥ 40 years. Methods: Data for this epidemiological study were derived from the larger LUTS POLAND project, in which a group of adults that typified the Polish population were surveyed, by telephone, about lower urinary tract symptoms. Respondents were classified by age, sex, and place of residence. UI was assessed with a standard protocol and established International Continence Society definitions. Results: The LUTS POLAND survey included 6005 completed interviews. The prevalence of UI was 14.6–25.4%; women reported a greater occurrence compared with men (p < 0.001). For both sexes, UI prevalence increased with age. Stress UI was the most common type of UI in women, and urgency UI was the most prevalent in men. We did not find a difference in prevalence between urban and rural areas. Individuals were greatly bothered by UI. For women, mixed UI was the most bothersome, whereas for men, leak for no reason was most annoying. More than half of respondents (51.4–62.3%) who reported UI expressed anxiety about the effect of UI on their quality of life. Nevertheless, only around one third (29.2–38.1%) of respondents with UI sought treatment, most of whom received treatment. Persons from urban and rural areas did not differ in the degrees of treatment seeking and treatment receiving. Conclusion: Urinary incontinence was prevalent and greatly bothersome among Polish adults aged ≥ 40 years. Consequently, UI had detrimental effects on quality of life. Nonetheless, most affected persons did not seek treatment. Therefore, we need to increase population awareness in Poland about UI and available treatment methods, and we need to ensure adequate allocation of government and healthcare system resources.

scholarly journals Regional differences in quality of care for heart failure: the role of patient, physician, and hospital characteristics

2002 ◽  
Vol 39 ◽  
pp. 452-453
Author(s):  
Edward P. Havranek ◽  
Pam Wolfe ◽  
Frederick A. Masoudi ◽  
Harlan M. Krumholz ◽  
Saif S. Rathore ◽  
...  
Keyword(s):  
Heart Failure ◽  
Quality Of Care ◽  
Regional Differences ◽  
Hospital Characteristics

A Prospective Study in Detection of Lower-Limb Lymphedema and Evaluation of Quality of Life After Vulvar Cancer Surgery

2012 ◽  
Vol 22 (6) ◽  
pp. 1081-1088 ◽  
Author(s):  
Marta Novackova ◽  
Michael J. Halaska ◽  
Helena Robova ◽  
Ivana Mala ◽  
Marek Pluta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lower Limb ◽  
Bioelectrical Impedance Analysis ◽  
Vulvar Cancer ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Cancer Surgery ◽  
Control Group ◽  
Inguinofemoral Lymphadenectomy

BackgroundLower-limb lymphedema is one of the most disabling adverse effects of vulvar cancer surgery. Multifrequency Bioelectrical Impedance Analysis (MFBIA) is a modern noninvasive method to detect lymphedema. The first aim of this study was to prospectively determine the prevalence of secondary lower-limb lymphedema after surgical treatment for vulvar cancer using objective methods, circumference measurements and MFBIA technique. The second aim was to compare quality of life (QoL) before and 6 months after vulvar surgery.MethodsTwenty-nine patients underwent vulvar cancer surgery in our study: 17 underwent inguinofemoral lymphadenectomy (RAD), and 12 underwent sentinel lymph node biopsy (CONS). Patients were examined before and 6 months after vulvar surgery by measuring the circumference of the lower limbs and with MFBIA. A control group of 27 healthy women was also measured. To evaluate QoL, the European Organisation for Research and Treatment of Cancer (EORTC) QoL questionnaires (QLQ-C30 and QLQ-CX24) were administered to patients before and 6 months after surgery.ResultsUsing circumference measurement, 9 lymphedemas (31%) were diagnosed: 3 (25%) in the CONS and 6 (37.5%) in the RAD group (P= 0.69). After vulvar surgery, patients in the RAD group reported more fatigue and worsening of physical and role functioning. When comparing both groups, the RAD group had significantly worse parameters in social functioning, fatigue, and dyspnea.ConclusionsLower radicality in inguinofemoral lymphadenectomy shows a trend toward lower morbidity and significantly improves QoL. Multifrequency Bioelectrical Impedance Analysis was tested in these patients as a noninvasive, objective method for lymphedema detection. Detection of lymphedema based on subjective evaluations proved to have an unsatisfactory sensitivity. Less radical surgery showed objectively better results in QoL.

scholarly journals Marginal mandibular nerve — a wandering enigma and ways to tackle it

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Adarsh Kudva ◽  
Kiruthika Babu ◽  
Mehul Saha ◽  
Smriti Puri ◽  
Lakshmi Pandey ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
Mandibular Nerve ◽  
Surgical Approaches ◽  
Main Body ◽  
Branching Pattern ◽  
Marginal Mandibular Nerve ◽  
Critical Measure ◽  
Quality Of Surgery

Abstract Background This study aims to propose surgical approaches intended to localize and preserve the marginal mandibular nerve (MMN) during routinely performed head and neck surgical procedures. Main body of abstract Preservation of the functional integrity of the MMN is a critical measure in the success of orofacial surgeries involving the submandibular triangle. This study systematically reviews the anatomical description of the nerve including origin, course relative to fascial planes, relation to the parotid gland and facial pedicle, branching pattern and anastomosis of nerve and consolidate the findings of several significant studies to determine the “surgically safe” approaches to avoid iatrogenic injury to MMN. Short conclusion The systematic approaches described in this study have helped the authors precisely determine which particular MMN preserving approach to be adopted for each aspect of head and neck surgery. This has definitely enhanced the quality of surgery performed and the postoperative satisfaction of the patients.

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