Effect of multidisciplinary tumor conference on clinical management of rectal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 749-749 ◽  
Author(s):  
Georgios Karagkounis ◽  
Luca Stocchi ◽  
Ian C. Lavery ◽  
David Liska ◽  
Emre Gorgun ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Clinical Management ◽  
Clinical Decision Making ◽  
Care Center ◽  
Tertiary Care ◽  
Stage Iv ◽  
Clinical Decision ◽  
National Accreditation ◽  
Accreditation Program ◽  
Surgeon Experience

749 Background: Presentation of rectal cancer cases at a multidisciplinary tumor conference (MTC) is a required standard for the newly formed National Accreditation Program for Rectal Cancer. However, its impact on clinical decision-making remains incompletely defined. Our aim was to determine the frequency and manner in which MTC changed the management of patients with rectal cancer at a tertiary academic center. Methods: All rectal cancer cases presented at the weekly Colorectal Cancer MTC between July 2015 and June 2016 at a single institution were prospectively included. Patient demographics and clinical information were recorded. The presenting physician completed a uniform written questionnaire outlining their plan before and after the MTC discussion, and any changes in management as a result of the discussion. Imaging and pathology were reviewed for each case at MTC and consistency with prior interpretation was recorded. Results: 234 unique initial rectal cancer cases were included. Survey responses were obtained for 212 cases (90.6%). The mean patient age was 58.3 years. 37 patients (15.8%) presented with Stage IV disease and 20 (9.4%) had locally recurrent cancer. There was a documented change in plan as a result of the MTC discussion in 70 of 212 (33%) cases surveyed, including 22 cases (10.4%) in which the presenting physician had a “definitive plan” prior to the MTC. Changes in management included a change in therapy or change in therapy sequence in 45 cases (64%), and recommendation of further evaluation in 26 cases (37%). Change in management following MTC did not vary by surgeon experience: it occurred in 31.4%, 37.2% and 29.8% of cases presented by surgeons with < 10, 10-20, and ≥ 20 years of experience respectively (Chi-square p= 0.71). The imaging or pathology review at MTC resulted in a different interpretation than previously reported in 23% and 12% of cases, respectively. Conclusions: MTC changes clinical management for a significant portion of rectal cancer patients at a tertiary care center, independent of the presenting surgeons’ years of clinical experience. Our results highlight the utility of multidisciplinary rectal cancer care and support the MTC standard for the National Accreditation Program for Rectal Cancer.

DRIVERS OF THE DECISION TO BIOPSY AND FOLLOW-UP OF SMALL SUSPICIOUS THYROID NODULES

2020 ◽  
Vol 26 (8) ◽  
pp. 857-868 ◽  
Author(s):  
Natalia Genere ◽  
Maria Daniela Hurtado ◽  
Tiffany Cortes ◽  
Shobana Athimulam ◽  
Ruaa Al Ward ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Thyroid Nodules ◽  
Clinical Decision Making ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Decision ◽  
American Thyroid Association ◽  
Nodule Volume ◽  
Ultrasound Features

Objective: In 2015, the updated American Thyroid Association (ATA) guidelines recommended observation for suspicious subcentimeter thyroid nodules, based on their indolent course. We aimed to evaluate the frequency of biopsy in suspicious thyroid nodules since the introduction of these guidelines, including factors contributing to clinical decision-making in a tertiary care center. Methods: We conducted a retrospective study of patients in the Mayo Clinic, Rochester, Minnesota, with new, subcentimeter suspicious thyroid nodules (by report or by sonographic features) between March, 2015, and November, 2017, not previously biopsied. Results: We identified 141 nodules in 129 patients: mean age 58.1 ± 14.1 years, 74% female, 87% Caucasian. The frequency of biopsy in suspicious thyroid nodules was 39%. Ultrasound features that were the strongest predictors for biopsy on multivariate analysis included: nodule volume (odds ratio [OR] 37.3 [7.5–188.7]), radiology recommendation for biopsy (OR 2.6 [1.8–3.9]) and radiology report of the nodule as “suspicious” (OR 2.1 [1.4–3.2]). Patient’s age and degree of comorbidities did not change the likelihood for biopsy, nor did it vary by clinician type or how the nodule was initially found (incidentally or not incidentally). Among 86 nodules that were not biopsied, 41% had no specific follow-up recommendations. Conclusion: One third of suspicious thyroid nodules underwent biopsy since the release of updated ATA guidelines. Factors driving thyroid biopsy seem to be associated with nodule characteristics but not with patient factors including age and comorbidities. Further studies and development of decision aides may be helpful in providing individualized approaches for suspicious thyroid nodules. Abbreviations: ATA = American Thyroid Association; OR = odds ratio

scholarly journals Recurrence pattern of rectal cancer after surgical treatment. Analysis of 122 patients in a tertiary care center

2018 ◽  
Vol 38 (1) ◽  
pp. 18-23
Author(s):  
Gustavo Sevá-Pereira ◽  
Roberta Nascimento Cypreste ◽  
Joaquim José Oliveira Filho ◽  
Sandra Pedroso de Moraes ◽  
Paula Buozzi Tarabay
Keyword(s):  
Rectal Cancer ◽  
Surgical Treatment ◽  
Care Center ◽  
Tertiary Care ◽  
Recurrence Pattern ◽  
Tertiary Care Center ◽  
Treatment Analysis

scholarly journals Structured Reporting of Rectal Cancer Staging and Restaging: A Consensus Proposal

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2135
Author(s):  
Vincenza Granata ◽  
Damiano Caruso ◽  
Roberto Grassi ◽  
Salvatore Cappabianca ◽  
Alfonso Reginelli ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Correlation Coefficient ◽  
Clinical Decision Making ◽  
Intraclass Correlation ◽  
Clinical Decision ◽  
Cancer Staging ◽  
Structured Reporting ◽  
Quality Analysis ◽  
Promising Tool ◽  
Structured Reports

Background: Structured reporting (SR) in oncologic imaging is becoming necessary and has recently been recognized by major scientific societies. The aim of this study was to build MRI-based structured reports for rectal cancer (RC) staging and restaging in order to provide clinicians all critical tumor information. Materials and Methods: A panel of radiologist experts in abdominal imaging, called the members of the Italian Society of Medical and Interventional Radiology, was established. The modified Delphi process was used to build the SR and to assess the level of agreement in all sections. The Cronbach’s alpha (Cα) correlation coefficient was used to assess the internal consistency of each section and to measure the quality analysis according to the average inter-item correlation. The intraclass correlation coefficient (ICC) was also evaluated. Results: After the second Delphi round of the SR RC staging, the panelists’ single scores and sum of scores were 3.8 (range 2–4) and 169, and the SR RC restaging panelists’ single scores and sum of scores were 3.7 (range 2–4) and 148, respectively. The Cα correlation coefficient was 0.79 for SR staging and 0.81 for SR restaging. The ICCs for the SR RC staging and restaging were 0.78 (p < 0.01) and 0.82 (p < 0.01), respectively. The final SR version was built and included 53 items for RC staging and 50 items for RC restaging. Conclusions: The final version of the structured reports of MRI-based RC staging and restaging should be a helpful and promising tool for clinicians in managing cancer patients properly. Structured reports collect all Patient Clinical Data, Clinical Evaluations and relevant key findings of Rectal Cancer, both in staging and restaging, and can facilitate clinical decision-making.

Practice Guidelines for the Diagnosis of COVID-19-Associated Pulmonary Aspergillosis in an Intensive Care Setting

2021 ◽  
pp. 088506662110471
Author(s):  
Zia Hashim ◽  
Zafar Neyaz ◽  
Rungmei S.K. Marak ◽  
Alok Nath ◽  
Soniya Nityanand ◽  
...  
Keyword(s):  
Intensive Care ◽  
Practice Guidelines ◽  
Clinical Management ◽  
Care Setting ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Third Wave ◽  
Intensive Care Setting ◽  
Pulmonary Aspergillosis

Coronavirus disease-2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a new disease characterized by secondary Aspergillus mold infection in patients with COVID-19. It primarily affects patients with COVID-19 in critical state with acute respiratory distress syndrome, requiring intensive care and mechanical ventilation. CAPA has a higher mortality rate than COVID-19, posing a serious threat to affected individuals. COVID-19 is a potential risk factor for CAPA and has already claimed a massive death toll worldwide since its outbreak in December 2019. Its second wave is currently progressing towards a peak, while the third wave of this devastating pandemic is expected to follow. Therefore, an early and accurate diagnosis of CAPA is of utmost importance for effective clinical management of this highly fatal disease. However, there are no uniform criteria for diagnosing CAPA in an intensive care setting. Therefore, based on a review of existing information and our own experience, we have proposed new criteria in the form of practice guidelines for diagnosing CAPA, focusing on the points relevant for intensivists and pulmonary and critical care physicians. The main highlights of these guidelines include the role of CAPA-appropriate test specimens, clinical risk factors, computed tomography of the thorax, and non-culture-based indirect and direct mycological evidence for diagnosing CAPA in the intensive care unit. These guidelines classify the diagnosis of CAPA into suspected, possible, and probable categories to facilitate clinical decision-making. We hope that these practice guidelines will adequately address the diagnostic challenges of CAPA, providing an easy-to-use and practical algorithm to clinicians for rapid diagnosis and clinical management of the disease.

scholarly journals The Role of Micro-RNAs and Circulating Tumor Markers as Predictors of Response to Neoadjuvant Therapy in Locally Advanced Rectal Cancer

2020 ◽  
Vol 21 (19) ◽  
pp. 7040 ◽  
Author(s):  
Fatima Domenica Elisa De Palma ◽  
Gaetano Luglio ◽  
Francesca Paola Tropeano ◽  
Gianluca Pagano ◽  
Maria D’Armiento ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Clinical Decision Making ◽  
Locally Advanced ◽  
Therapy Response ◽  
Predictive Biomarkers ◽  
Advanced Rectal Cancer ◽  
Clinical Decision ◽  
Locally Advanced Rectal Cancer ◽  
Specific Expression ◽  
Micro Rnas

The response to neoadjuvant chemoradiation (nCRT) is a critical step in the management of locally advanced rectal cancer (LARC) patients. Only a minority of LARC patients responds completely to neoadjuvant treatments, thus avoiding invasive radical surgical resection. Moreover, toxic side effects can adversely affect patients’ survival. The difficulty in separating in advances responder from non-responder patients affected by LARC highlights the need for valid biomarkers that guide clinical decision-making. In this context, microRNAs (miRNAs) seem to be promising candidates for predicting LARC prognosis and/or therapy response, particularly due to their stability, facile detection, and disease-specific expression in human tissues, blood, serum, or urine. Although a considerable number of studies involving potential miRNA predictors to nCRT have been conducted over the years, to date, the identification of the perfect miRNA signatures or single miRNA, as well as their use in the clinical practice, is still representing a challenge for the management of LARC patients. In this review, we will first introduce LARC and its difficult management. Then, we will trace the scientific history and the key obstacles for the identification of specific miRNAs that predict responsiveness to nCRT. There is a high potential to identify non-invasive biomarkers that circulate in the human bloodstream and that might indicate the LARC patients who benefit from the watch-and-wait approach. For this, we will critically evaluate recent advances dealing with cell-free nucleic acids including miRNAs and circulating tumor cells as prognostic or predictive biomarkers.

A Comparison of Peritoneal Equilibration Tests Performed 1 and 4 Weeks after PD Commencement

2004 ◽  
Vol 24 (5) ◽  
pp. 460-465 ◽  
Author(s):  
David W. Johnson ◽  
David W. Mudge ◽  
Sophie Blizzard ◽  
Mary Arndt ◽  
Amanda O'Shea ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Clinical Decision Making ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Glucose Measurement ◽  
Altman Analysis ◽  
Princess Alexandra Hospital ◽  
Peritoneal Equilibration Test ◽  
Bland Altman Analysis ◽  
Peritoneal Transport

Objective The aim of this study was to prospectively evaluate the ability of a peritoneal equilibration test (PET) performed in the first week of peritoneal dialysis (PD) to predict subsequent transport status, as determined by a PET at 4 weeks and >1 year after PD commencement. Design Prospective observational study of an incident PD cohort at a single center. Setting Tertiary-care institutional dialysis center. Participants The study included 50 consecutive patients commencing PD at the Princess Alexandra Hospital between 25/2/2001 and 14/5/2003 (mean age 60.9 ± 12.2 years, 54% male, 92% Caucasian, 38% diabetic). All patients were initially prescribed continuous ambulatory PD. Main Measurements Measurements performed during paired PETs included dialysate-to-plasma ratios of urea (D/P urea) and creatinine (D/P creatinine) at 4 hours, the ratio of dialysate glucose concentrations at 0 and 4 hours (D/D0 glucose), and drain volumes at 4 hours. Results When paired 1-week and 1-month PET data were analyzed, significant changes were observed in measured D/P urea (0.91 ± 0.07 vs 0.94 ± 0.07 respectively; p < 0.05), D/P creatinine (0.55 ± 0.12 vs 0.66 ± 0.11, p < 0.001), and D/D0 glucose (0.38 ± 0.08 vs 0.36 ± 0.10, p < 0.05). Using Bland–Altman analysis, the repeatability coefficients were 0.17, 0.20, and 0.13, respectively. Agreement between 1-week and 1-month PET measurements with respect to peritoneal transport category was moderate for D/D0 glucose (weighted κ 0.52), but poor for D/P urea (0.30), D/P creatinine (0.35), and drain volumes (0.20). The PET measurements performed more than 1 year following PD commencement ( n = 28) generally agreed closely with 1-month measurements, and poorly with 1-week measurements. Conclusions Peritoneal transport characteristics change significantly within the first month of PD. PETs carried out during this time should be considered preliminary and should be confirmed by a PET 4 weeks later. Nevertheless, performing an early D/D0 glucose measurement at 1 week predicted ultimate transport status sufficiently well to facilitate early clinical decision-making about optimal PD modality while patients were still receiving PD training. On the other hand, the widespread practice of using measured drain volumes in the first week to predict ultimate transport category is highly inaccurate and not recommended.

Comparison of clinical and economic outcomes between robotic, laparoscopic, and open rectal cancer surgery: early experience at a tertiary care center

2015 ◽  
Vol 30 (4) ◽  
pp. 1337-1343 ◽  
Author(s):  
Karim M. Ramji ◽  
Michelle C. Cleghorn ◽  
Jonathan M. Josse ◽  
Andrea MacNeill ◽  
Catherine O’Brien ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Care Center ◽  
Tertiary Care ◽  
Early Experience ◽  
Cancer Surgery ◽  
Economic Outcomes ◽  
Rectal Cancer Surgery ◽  
Tertiary Care Center

scholarly journals Sarcopenia as a Prognostic Factor for 90-Day and Overall Mortality in Patients Undergoing Spine Surgery for Metastatic Tumors: A Multicenter Retrospective Cohort Study

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 1025-1036 ◽  
Author(s):  
Hesham Mostafa Zakaria ◽  
Brandon Michael Wilkinson ◽  
Zach Pennington ◽  
Yamaan S Saadeh ◽  
Darryl Lau ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Spinal Metastasis ◽  
Tertiary Care ◽  
Spinal Metastases ◽  
Psoas Muscle ◽  
Clinical Decision ◽  
Tokuhashi Score ◽  
Tomita Score ◽  
Overall Mortality

Abstract BACKGROUND Novel methods in predicting survival in patients with spinal metastases may help guide clinical decision-making and stratify treatments regarding surgery vs palliative care. OBJECTIVE To evaluate whether the frailty/sarcopenia paradigm is predictive of survival and morbidity in patients undergoing surgery for spinal metastasis. METHODS A total of 271 patients from 4 tertiary care centers who had undergone surgery for spinal metastasis were identified. Frailty/sarcopenia was defined by psoas muscle size. Survival hazard ratios were calculated using multivariate analysis, with variables from demographic, functional, oncological, and surgical factors. Secondary outcomes included improvement of neurological function and postoperative morbidity. RESULTS Patients in the smallest psoas tertile had shorter overall survival compared to the middle and largest tertile. Psoas size (PS) predicted overall mortality more strongly than Tokuhashi score, Tomita score, and Karnofsky Performance Status (KPS). PS predicted 90-d mortality more strongly than Tokuhashi score, Tomita score, and KPS. Patients with a larger PS were more likely to have an improvement in deficit compared to the middle tertile. PS was not predictive of 30-d morbidity. CONCLUSION In patients undergoing surgery for spine metastases, PS as a surrogate for frailty/sarcopenia predicts 90-d and overall mortality, independent of demographic, functional, oncological, and surgical characteristics. The frailty/sarcopenia paradigm is a stronger predictor of survival at these time points than other standards. PS can be used in clinical decision-making to select which patients with metastatic spine tumors are appropriate surgical candidates.

scholarly journals Viennese risk prediction score for Advanced Gastroesophageal carcinoma based on Alarm Symptoms (VAGAS score): characterisation of alarm symptoms in advanced gastro-oesophageal cancer and its correlation with outcome

ESMO Open ◽  
2020 ◽  
Vol 5 (2) ◽  
pp. e000623
Author(s):  
Hannah Christina Puhr ◽  
Eleonore Pablik ◽  
Anna Sophie Berghoff ◽  
Gerd Jomrich ◽  
Sebastian Friedrich Schoppmann ◽  
...  
Keyword(s):  
Risk Prediction ◽  
Oesophageal Cancer ◽  
Clinical Decision Making ◽  
Stage Iv ◽  
Clinical Decision ◽  
Prediction Score ◽  
Prognostic Information ◽  
Initial Symptoms ◽  
The Impact ◽  
Her2 Positivity

IntroductionThe prognostic value of symptoms at disease presentation of advanced gastro-oesophageal cancer is unknown. Thus, the aim of this study was to characterise these symptoms and correlate them with the outcome, so new prognostic markers can be defined.MethodsWe analysed clinical data including symptoms, therapies and survival of patients with stage IV gastro-oesophageal cancer treated between 2002 and 2018 at the Vienna General Hospital, Austria. Initial symptoms as well as stenosis in endoscopy and HER2 positivity were evaluated in a cross-validation model to ascertain the impact of each variable on patient survival.ResultsIn total, 258 patients were evaluated. Five factors (stenosis in endoscopy, weight loss, HER2 positivity, dyspepsia, ulcer or active bleeding) have proven to be statistically relevant prognostic factors and were given a count of +1 and −1, if applicable. The resulting score ranges between −3 and +2. The survival probability for 180 days with a score of −3/–2, −1, 0, +1 and +2 is 90%, 80%, 73%, 72% and 42%, whereas for 2 years, it is 30%, 30%, 8%, 7% and 3%, respectively. The median overall survival of a score of −3/–2, −1, 0, +1 and +2 was 579 (95% CI 274 to not measurable), 481 (95% CI 358 to 637), 297 (95% CI 240 to 346), 284 (95% CI 205 to 371), 146 (95% CI 120 to 229) days, respectively.ConclusionThe data from this retrospective study indicate that the Viennese risk prediction score for Advanced Gastroesophageal carcinoma based on Alarm Symptoms score provides independent prognostic information that may support clinical decision making at diagnosis of advanced gastro-oesophageal cancer. Our findings should be evaluated in prospective studies.

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