scholarly journals Surgery for constipation in patients with prior spinal cord injury: The Department of Veterans Affairs experience

2013 ◽  
Vol 36 (3) ◽  
pp. 207-212 ◽  
Author(s):  
Jason R. West ◽  
Shoeb A. Mohiuddin ◽  
William R. Hand ◽  
Erik M. Grossmann ◽  
Katherine S. Virgo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Cord Injury

Curative-intent resection for bronchogenic carcinoma in patients with prior spinal cord injury: The Department of Veterans Affairs experience

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17127-17127
Author(s):  
L. S. Brunworth ◽  
D. Dharmasena ◽  
K. S. Virgo ◽  
F. E. Johnson
Keyword(s):  
Lung Cancer ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mortality Rate ◽  
Bronchogenic Carcinoma ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Curative Intent ◽  
Cord Injury ◽  
Morbid Conditions

17127 Background: There are approximately 250,000 people with spinal cord injury (SCI) in the US, and they have a high prevalence of smoking. A literature search yielded no published information concerning the clinical course of SCI patients who subsequently develop bronchogenic carcinoma and undergo pulmonary resection for this condition. We hypothesized that poorer outcomes of surgery would be observed in this population, as compared to neurally-intact patients. Methods: We conducted a study of all veterans at Department of Veterans Affairs (DVA) Medical Centers during fiscal years 1993–2002 who were diagnosed with SCI, subsequently developed non-small cell lung cancer and were then surgically treated with curative intent. Inclusion criteria included American Spinal Injury Association type A injury (complete loss of neural function distal to the injury site) and traumatic etiology. Data were compiled from national DVA datasets and supplemented by operative reports, pathology reports, progress notes, and discharge summaries. Results: Of 12,634 patients who underwent surgery for bronchogenic carcinoma, 55 also had codes for prior SCI; 7 were evaluable. The mean age was 64. Five (71%) had one or more co-morbid conditions in addition to their spinal cord injuries. All 7 underwent pulmonary lobectomy. Post-operative complications occurred in 4 patients (57%). Two patients died post-operatively on days 29 and 499, yielding a 30-day mortality rate of 14% and an in-hospital mortality rate of 29%. Conclusions: We believe this isthe only report in the English language literature on this topic. SCI patients with resectable bronchogenic carcinoma have a high incidence of co-morbid conditions. Those who undergo curative-intent surgery have high morbidity and mortality rates. This evidence suggests that SCI should be considered a risk factor for adverse outcomes of surgery for primary lung cancer, strengthening the case for alternative treatments. No significant financial relationships to disclose.

Optimal Colostomy Placement in Spinal Cord Injury Patients

2016 ◽  
Vol 82 (3) ◽  
pp. 278-280
Author(s):  
Jiashou Xu ◽  
Sekhar Dharmarajan ◽  
Frank E. Johnson
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Veterans Affairs ◽  
Long Term Results ◽  
Department Of Veterans Affairs ◽  
Care Providers ◽  
Cord Injury ◽  
Primary Disorder ◽  
Operative Notes ◽  
Sigmoid Colostomy

Barring unusual circumstances, sigmoid colostomy is the optimal technique for management of defecation in spinal cord injury (SCI) patients. We sought to provide evidence that a sigmoid colostomy is not difficult to perform in SCI patients and has better long-term results. The St. Louis Department of Veterans Affairs has a Commission on Accreditation of Rehabilitation Facilities (CARF)–approved SCI Unit. We reviewed the operative notes on all SCI patients who received a colostomy for fecal management by three ASCRS-certified colorectal surgeons at the St. Louis Department of Veterans Affairs from January 1,2007 to November 26, 2012. There were 27 operations for which the recorded indication for surgery suggested that the primary disorder was SCI. Fourteen had traumatic SCI of the thoracic and/or lumbar spine and were evaluable. Of these 14 patients, 12 had laparoscopic sigmoid colostomy and two had open sigmoid colostomy. We encountered one evaluable patient with a remarkably large amount of retroperitoneal bony debris who successfully underwent laparoscopic sigmoid colostomy. In conclusion, sigmoid colostomy is the consensus optimal procedure for fecal management in SCI patients. Laparoscopic procedures are preferred. Care providers should specify sigmoid colostomy when contacting a surgeon.

scholarly journals Surgery For Constipation In Patients With Prior Spinal Cord Injury: The Department Of Veterans Affairs Experience

2011 ◽  
Vol 165 (2) ◽  
pp. 176
Author(s):  
J.R. West ◽  
S.A. Mohiuddin ◽  
W.R. Hand ◽  
K.S. Virgo ◽  
E.M. Grossman ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Cord Injury

scholarly journals Evaluating the roll-out of environmental control units in Veterans Affairs Spinal Cord Injury Centers: Workflow observations

2017 ◽  
Vol 3 (2) ◽  
pp. 57
Author(s):  
Balmatee Bidassie ◽  
Marissa A. Vallette ◽  
Theadora James ◽  
Rachael Martinez ◽  
Bella Etingen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Environmental Control ◽  
Veterans Affairs ◽  
Comfort Level ◽  
Staff Satisfaction ◽  
Time In Bed ◽  
Control Units ◽  
Cord Injury ◽  
Roll Out

Objective: Evaluate the value of providing environmental control units (ECUs) to Veterans with spinal cord injuries and/or disorders (SCI/D) in Veterans Affairs Medical Centers (VAMCs).Design: Industrial engineers observed SCI/D staff (support) and Veterans (use) with ECUs at four participating VAMC Spinal Cord Injury (SCI) Centers.Measure(s)/Analysis: Standardized data collection efforts included: 1) time study (trend analysis) and 2) open-ended, semistructured interviews on Strengths-Weaknesses-Opportunities-Threats (SWOT) feedback (qualitative analysis).Results: From 59 interactions, reasons for ECU downtime were troubleshooting (n = 30, 51%), repairs/replacements (n = 10, 17%), and 29% combined for patient education (n = 8), set-up (n = 5), and admission (n = 4). ECU strengths were functionality (n = 23, 70%) and 30% (n = 10) combined for patient independence and staff satisfaction. Functionality was both a weakness (n = 43, 78%) and opportunity (n = 29, 66%). Threats were functionality (n = 8, 50%), staff satisfaction (n = 3, 19%), and maintenance (n = 5, 31%). When ECUs were functioning properly, Veterans participated in leisurely activities (e.g., games, television), had increased control of their environment (e.g., bed, lights), and clinicians spent less time troubleshooting the ECU, hence, increasing clinical care availability.Conclusions: ECUs minimized physical limitation challenges, and may improve safety, comfort level, and general satisfaction with care of Veterans with SCI/D who often spend much of their time in bed when hospitalized. Veterans and staff reported that the ECUs added value by increasing patient independence and social support including communication with loved ones. Functionality strengths and weaknesses influenced the Veterans’/staff’s perceptions of ECU value. Therefore, ECU training/maintenance education and dedicated non-clinical support staff are recommended prior to future ECU roll-out.

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