scholarly journals Caregiver–provider communication after resection of pediatric brain tumors

2020 ◽  
Vol 26 (3) ◽  
pp. 295-301
Author(s):  
Alexandra Cutillo ◽  
Kathrin Zimmerman ◽  
Susan Davies ◽  
Avi Madan-Swain ◽  
Wendy Landier ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Tumor Resection ◽  
Pediatric Brain Tumors ◽  
Support Network ◽  
Communication Styles ◽  
Provider Communication ◽  
Semistructured Interview ◽  
Team Members

OBJECTIVEBecause caregivers are a crucial part of a child’s medical care, it is important to understand how to best communicate with them during hospitalization. Qualitative research can elucidate the best strategies for effective parent–provider communication. This study aims to reveal communication styles of neurosurgery team members, and to identify areas for improvement in the future.METHODSCaregivers of children with a newly diagnosed brain tumor requiring neurosurgery were enrolled during their child’s hospitalization. During routine follow-up clinic visits within 3 months after diagnosis and tumor resection, caregivers participated in a semistructured interview, which assessed the quality of communication with the neurosurgery and oncology teams during hospitalization. Interviews were audio-recorded, transcribed, and coded for common themes until thematic saturation was reached.RESULTSDuring caregiver interviews (N = 22), several domains were discussed including communicating the diagnosis to the patient and siblings, to the rest of the family/support network, and with the neurosurgery team. Regarding parent–neurosurgeon communication, 82% of caregivers identified at least one positive aspect and 55% identified at least one negative aspect of communication. Caregivers who provided positive feedback appreciated that their neurosurgeon was thorough (73%), direct (27%), or compassionate (14%). They also valued when providers would speak “on my level” (18%) and would speak directly to the patient (27%). In terms of negative feedback, caregivers identified miscommunications (32%), discussing the diagnosis in front of the child before feeling prepared to do so (14%), and a lack of clarity about expectations, medications, or treatment (32%).CONCLUSIONSThese data provide specific ways in which neurosurgery providers have communicated effectively with caregivers and identify areas for improvement. Results have been used to develop a navigator-led intervention geared toward improving parent–provider communication during hospitalization for resection of a brain tumor.

scholarly journals RONC-19. TWO CASES OF RE-IRRADIATION FOR LATE RECURRENT OR RADIATION-INDUCED TUMOR AFTER RADIATION THERAPY FOR PEDIATRIC BRAIN TUMORS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii459-iii459
Author(s):  
Takashi Mori ◽  
Shigeru Yamaguchi ◽  
Rikiya Onimaru ◽  
Takayuki Hashimoto ◽  
Hidefumi Aoyama
Keyword(s):  
Radiation Therapy ◽  
Brain Tumors ◽  
Tumor Resection ◽  
Intensity Modulated Radiation Therapy ◽  
Late Recurrence ◽  
Pediatric Brain Tumors ◽  
Suprasellar Region ◽  
Radiation Induced ◽  
Pediatric Brain

Abstract BACKGROUND As the outcome of pediatric brain tumors improves, late recurrence and radiation-induced tumor cases are more likely to occur, and the number of cases requiring re-irradiation is expected to increase. Here we report two cases performed intracranial re-irradiation after radiotherapy for pediatric brain tumors. CASE 1: 21-year-old male. He was diagnosed with craniopharyngioma at eight years old and underwent a tumor resection. At 10 years old, the local recurrence of suprasellar region was treated with 50.4 Gy/28 fr of stereotactic radiotherapy (SRT). After that, other recurrent lesions appeared in the left cerebellopontine angle, and he received surgery three times. The tumor was gross totally resected and re-irradiation with 40 Gy/20 fr of SRT was performed. We have found no recurrence or late effects during the one year follow-up. CASE 2: 15-year-old female. At three years old, she received 18 Gy/10 fr of craniospinal irradiation and 36 Gy/20 fr of boost to the posterior fossa as postoperative irradiation for anaplastic ependymoma and cured. However, a anaplastic meningioma appeared on the left side of the skull base at the age of 15, and 50 Gy/25 fr of postoperative intensity-modulated radiation therapy was performed. Two years later, another meningioma developed in the right cerebellar tent, and 54 Gy/27 fr of SRT was performed. Thirty-three months after re-irradiation, MRI showed a slight increase of the lesion, but no late toxicities are observed. CONCLUSION The follow-up periods are short, however intracranial re-irradiation after radiotherapy for pediatric brain tumors were feasible and effective.

scholarly journals Brain Tumor Resection in Elderly Patients: Potential Factors of Postoperative Worsening in a Predictive Outcome Model

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2320
Author(s):  
Paolo Ferroli ◽  
Ignazio Gaspare Vetrano ◽  
Silvia Schiavolin ◽  
Francesco Acerbi ◽  
Costanza Maria Zattra ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Performance Status ◽  
Tumor Resection ◽  
Patient Specific ◽  
Invasive Treatment ◽  
Tertiary Referral Center ◽  
Surgical Complexity

The decision of whether to operate on elderly patients with brain tumors is complex, and influenced by pathology-related and patient-specific factors. This retrospective cohort study, based on a prospectively collected surgical database, aims at identifying possible factors predicting clinical worsening after elective neuro-oncological surgery in elderly patients. Therefore, all patients ≥65 years old who underwent BT resection at a tertiary referral center between 01/2018 and 12/2019 were included. Age, smoking, previous radiotherapy, hypertension, preoperative functional status, complications occurrence, surgical complexity and the presence of comorbidities were prospectively collected and analyzed at discharge and the 3-month follow-up. The series included 143 patients (mean 71 years, range 65–86). Sixty-five patients (46%) had at least one neurosurgical complication, whereas 48/65 (74%) complications did not require invasive treatment. Forty-two patients (29.4%) worsened at discharge; these patients had a greater number of complications compared to patients with unchanged/improved performance status. A persistent worsening at three months of follow-up was noted in 20.3% of patients; again, this subgroup presented more complications than patients who remained equal or improved. Therefore, postoperative complications and surgical complexity seem to influence significantly the early outcome in elderly patients undergoing brain tumor surgery. In contrast, postoperative complications alone are the only factor with an impact on the 3-month follow-up.

scholarly journals Vulva Cancer Treatment with Cryosurgery

2018 ◽  
Vol 4 (1) ◽  
pp. 1-10
Author(s):  
Mauro JE ◽  
Storino C ◽  
Bianconi MI ◽  
Farah C ◽  
D’Atri FJ
Keyword(s):  
Quality Of Life ◽  
Genital Tract ◽  
Vulvar Cancer ◽  
Tumor Resection ◽  
Safety Margin ◽  
Previous Treatment ◽  
Complete Healing ◽  
High Morbidity

Vulvar cancer represents 4% to 5% of Low Genital Tract Tumors (LGTT) and 1% of all cancers in women. Treatment depends on stage, and when possible surgery is preferable. Advanced cancers require large resections (with needs grafts and-or rotating flaps), radio and/or chemotherapy, all of which can lead to high morbidity and quality of life impairment. To minimize these effects, in 1994, we developed a cryosurgery prospective protocol to manage vulvar cancer in patients with comorbid conditions.Patients and Methods: Between 1994 and 2019 we treated n=41 patients: FIGO stages I: n=2 (4.88%) II: n=9 (21.95%), III: n=28 (68.29%), IV: n=2 (4.88%). Median age 64.3 (28 to 90 years old), and 70% were 70 years old or older, 59% had severe comorbidities (diabetes, autoimmune diseases, immunosuppressive user).Cryosurgery Protocol:Firstly, tumor resection, hemostasis, and 2 rapid freezing- slow thawing cycles with Liquid Nitrogen (LN) spray. The cycles should include the logde and a 1.5 cm safety margin. After complete healing (between 45 and 95 days after cryosurgery), nodes are treated according to FIGO stages. Result:All patients after the effects of the anesthesia were able to urinate spontaneously, walk, had minimal analgesic requirements, with good postoperative. The patients remained in the hospital for one or two days, and with rare exceptions, were discharged the following day with controls twice a week at the hospital. None of the patients required flaps or grafts to repair the treated areas. After complete healing they maintained the vulvar sensitivity and considerably improved their quality of life. Some of them, who had a partner, were able to resume their sexual intercourse.Mean follow-up: 55.39 (3 months to 258 months). Five patients had local recurrences between 12 and 72 months after treatment, and were controlled with a new cryosurgery. Six patients had HPV related lesions located in other areas of the lower genital tract, which were also controlled with cryosurgery. Twenty five of them died 19 due to an unrelated cause of death, and 6 due to disease progression in the nodes without vulvar recurrence, 9 patients survived and were free of disease with a mean follow-up of 53 months. Seven patients, after a disease free follow up of 17.2 months, weren ́t able to be controlled, as they lived more than 400 km way from the hospital. Local control was achieved in all patients.Comments: Cryosurgery can be done after any previous treatment, and can be repeated to control recurrences.Conclusion: Given the simplicity of the technique, its low cost, the possibility of being used in patients with multiple co-morbidities, the absence of major complications, and the anatomical and functional results obtained, we believe that cryosurgery can be considered among the best options to control of vulvar cancer, even large or advanced cases, in elderly patients and-or with severe comorbidities.

scholarly journals Quality of Patient-Provider Communication Among Cancer Survivors: Findings From a Nationally Representative Sample

2016 ◽  
Vol 12 (12) ◽  
pp. e964-e973 ◽  
Author(s):  
Neetu Chawla ◽  
Danielle Blanch-Hartigan ◽  
Katherine S. Virgo ◽  
Donatus U. Ekwueme ◽  
Xuesong Han ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Social Needs ◽  
Provider Communication ◽  
Communication Quality ◽  
Follow Up Care ◽  
Patient Provider Communication ◽  
Lifestyle Recommendations

Purpose: Although patient-provider communication is an essential component of health care delivery, little is known about the quality of these discussions among patients with cancer. Methods: Data are from the 2011 Medical Expenditure Panel Survey Experiences with Cancer survey among 1,202 adult cancer survivors. We evaluated discussions with any provider after a cancer diagnosis about: (1) follow-up care; (2) late or long-term treatment effects; (3) lifestyle recommendations, such as diet, exercise, and quitting smoking; and (4) emotional or social needs. Using a response scale ranging from “did not discuss” to “discussed in detail,” a summary score was constructed to define communication quality as high, medium, or low. Patient factors associated with the quality of provider discussions were examined using multivariable polytomous logistic regression analyses. Results: At the time of the survey, approximately one half of the patients (46%) were either within 1 year (24.1%) or between 1 and 5 years (22.0%) of treatment. More than one third of cancer survivors reported that they did not receive detailed communication about follow-up care, and more than one half reported that they did not receive detailed communication regarding late or long-term effects, lifestyle recommendations, or emotional and social needs. Only 24% reported high-quality communication for all four elements, indicating that the vast majority experienced suboptimal communication. In multivariable analysis, survivors reporting a high communication quality with providers included those who were within 1 year of treatment, between the ages of 18 and 64 years, non-Hispanic black or other ethnicity, and married. Conclusion: Study findings demonstrate gaps in the communication quality experienced by cancer survivors in the United States and help identify survivors for targeted interventions.

scholarly journals Functional and structural biomarkers of cognitive outcomes after brain tumor resection

2020 ◽  
Author(s):  
Meritxell Garcia ◽  
Jose Aguasvivas ◽  
Santiago Gil-Robles ◽  
Iñigo Pomposo ◽  
Lucia Amorouso ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Working Memory ◽  
Brain Tumor ◽  
White Matter ◽  
Decision Tree ◽  
Executive Control ◽  
Outcome Prediction ◽  
Naive Bayes ◽  
Tumor Resection

Cognitive explorations have demonstrated the activation of plastic mechanisms in slow-growing brain lesions, generating structural and functional changes. Due to its incidence, it is essential to investigate the reorganization of functional areas in brain tumor patients as well as formulating new approaches for predicting patient quality of life after tumor resection. Following this perspective, we formulated an efficient methodology for postsurgical prognosis prediction, not only in terms of the structural damage but also to measure the neuroplastic changes associated with tumor appearence. Of note, most of previous studies employed a limited number of neuropsychological and clinical features for predicting patient prognosis. Our objective is to optimize the traditional model and to develop a method that can predict outcomes with high accuracy and identify the most significant features for cognitive impairment, working memory, executive control and language outcomes. Our approach is based on the inclusion of a large battery of neuropsychological tests as well as the introduction of grey and white matter morphological measures for model optimization. We employed Support Vector Machine (SVM), Decision Tree, and Naïve Bayes algorithms for testing the models and outcomes. Overall, SVM performance showed to be more accurate as compared to Decision Tree and Naïve Bayes. Specifically, we found that, by introducing connectivity variables (e.g., grey and white matter measures) Cognitive Status and Working Memory exhibited a predictive improvement. However, Language and Executive Control outcomes were not significantly predicted in none of the models. The importance of the present study resides in the employment of structural and functional variables for postsurgical outcome prediction. We found that connectivity variables are sensitive for predicting the postsurgical quality of life. Keywords: glioma, resection, postoperative outcome, prediction, neuropsychological test, mapping

scholarly journals Quality of life following surgical treatment of lesions within the pineal region

2018 ◽  
Vol 130 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Stepan Fedorko ◽  
Klaus Zweckberger ◽  
Andreas W. Unterberg
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Neurological Outcome ◽  
Tumor Resection ◽  
Pineal Region ◽  
Subtotal Resection ◽  
Modified Rankin Scale ◽  
Tumor Patients

OBJECTIVEPineal region tumors are a rare and heterogeneous group of lesions. The optimal therapeutic approach is currently a topic of controversy, particularly in light of the potential operative risks and complications. The potential beneficial effects of surgery have already been described, but information about neurological outcome and, in particular, health-related quality of life (HRQOL) is still lacking in the literature. The aim of this study was to assess the therapeutic effect of resection of pineal region lesions, emphasizing grade of tumor resection, neurological outcome, quality of life, and the necessity of additional shunt procedures.METHODSThe authors performed a prospective study of HRQOL in 32 patients who had undergone surgical treatment of lesions in the pineal region (20 tumors and 12 cysts) between 2008 and 2014. All patients had at least 6 months of follow-up, with reexamination including standardized neurological assessment, an evaluation of dependency using the modified Rankin Scale, and an evaluation of HRQOL. The authors retrospectively examined patient charts and collected information regarding imaging studies, neurological status prior to surgery, surgical strategies used, any complications, and histological diagnoses.RESULTSIn this study, there was no surgery-associated mortality or major morbidity. Permanent minor morbidity was reported for 4 patients (13%). Comparing pre- and postoperative neurological symptoms, 75% of tumor patients had either complete resolution or improvement of preoperative symptoms; symptoms were unchanged in 10% of tumor patients and deteriorated in 15%. In patients with pineal cysts, long-term follow-up showed that 42% of patients were free of any symptoms and 58% experienced improvement of their preoperative symptoms. These outcomes were also reflected in the modified Rankin Scale scores, which demonstrated significant improvement following resection of pineal region lesions. Furthermore, significant improvements in HRQOL scores occurred in global health status, in all functional scales, and in pain, nausea and vomiting, fatigue, and insomnia (p < 0.0001). Moreover, a significant reduction in the necessity for permanent shunt procedures was observed after gross-total tumor resection compared with subtotal resection (p = 0.035) of pineal cysts.CONCLUSIONSDespite potential risks, (radical) surgery is a highly effective and safe treatment option for pineal region lesions and should be considered for the majority of patients.

scholarly journals 2405

2017 ◽  
Vol 1 (S1) ◽  
pp. 77-77
Author(s):  
Alexandra Cutillo ◽  
Susan Davies ◽  
Avi Madan-Swain ◽  
Wendy Landier ◽  
Anastasia Arynchyna ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Coping Strategies ◽  
Medical Information ◽  
Tumor Resection ◽  
Active Coping ◽  
Coping Mechanisms ◽  
Code Word ◽  
Surgical Removal ◽  
Semistructured Interview ◽  
Avoidance Coping

OBJECTIVES/SPECIFIC AIMS: The goal of this study is to use patient-centered qualitative techniques to determine what strategies caregivers use to cope with the stress of a child having recently (ie, within the past month) undergone surgical removal of a brain tumor. Results will eventually be evaluated and compared with results of quantitative measures of psychosocial risk and distress as well as demographic and medical characteristics. METHODS/STUDY POPULATION: All caregivers of patients with a newly diagnosed brain tumor requiring neurosurgery admitted to Children’s of Alabama (with English or Spanish-speaking parents) are eligible for enrollment. Participants are enrolled during their child’s initial hospitalization for surgical removal of a brain tumor. Approximately 1 month after hospital discharge, during a routine follow-up clinic visit, caregivers participate in a semistructured interview with a research assistant. Interview questions are used to obtain information about parent and family coping by asking first broadly about stress management over the previous month and then specifically about individual coping strategies. Semistructured interviews are audio recorded, transcribed, and coded for common themes. Interviews are coded by using specific words or phrases to describe various domains of the experience from the caregiver’s perspective. Each participant is given a study ID and study IDs are logged with each code word or phrase endorsed during the interview. RESULTS/ANTICIPATED RESULTS: To date, 22 caregivers have been enrolled and 15 have completed interviews. The most common coping mechanisms fall into the domains of active, avoidance, emotion-focused, and spiritual coping. Active coping consists of information seeking (eg, taking notes, internet research, asking questions), openly communicating emotions, celebrating small victories (eg, focusing on a good scan or test result, thinking that the diagnosis or treatment could have been worse), planning (eg, focusing on 1 d at a time), and maintaining normalcy (eg, maintaining extracurricular activities, returning to school if possible, continuing to see family and friends). Avoidance coping consists of evading discussions about emotions, withdrawal from family members, denial (eg, keeping a cancer diagnosis from the child), and avoiding seeing people or participating in activities. Emotion-focused coping consists of crying, laughing, and staying strong in front of the patient. In general, those who self-identify as coping poorly tend to be those who utilized more avoidance-focused coping strategies. Further, caregivers tended to identify active coping strategies (eg, taking notes, focusing on 1 appointment or treatment at a time) as the most helpful. DISCUSSION/SIGNIFICANCE OF IMPACT: It will be helpful for providers to more deeply understand the experience of caregivers whose children have recently undergone brain tumor resection and the strategies used to cope with the stress of the first month postsurgery. This information can be used to create standardized interventions for use during posthospitalization clinic visits. For example, if families continue to endorse that active coping mechanisms are the most helpful, providers can assist caregivers in developing these strategies (eg, uniformly provide notebooks and encourage caregivers to keep track of questions and appointment information, pair caregivers who are struggling with others who use more active coping strategies). Those utilizing more avoidance coping strategies may need more coaching and recommendations. A brief assessment could potentially be developed for caregivers dealing with this diagnosis, in order to quickly assess coping strategies and provide appropriate recommendations. Future analyses will determine whether initial coping strategies and adjustment are predicted by child age or medical information.

Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas Based on Preoperative Imaging

2021 ◽  
Author(s):  
Yang Li ◽  
Xingshu Zhang ◽  
Chaoying Qin ◽  
Jun Su ◽  
Xiangyu Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cerebral Artery ◽  
Cerebral Arteries ◽  
Tumor Resection ◽  
Preoperative Imaging ◽  
Karnofsky Performance Scale ◽  
Simpson Grade ◽  
Protection Strategies

Abstract OBJECTIVE Parasellar meningiomas represent a cohort of skull base tumors localize to parasellar region. Those meningiomas tend to compress, encase or even invade cerebral arteries and their perforating branches. Surgical resection of PMs is a challenging operation without damaging perforating arteries. The study aimed to analyze functional outcomes in a series of patients who underwent surgery with individualized cerebral arteries protection strategy based on preoperative imaging. METHODS A retrospective review of a single surgeon’s experience with microsurgical removal of PMs in 163 patients between January 2012 to March 2020. Individualized approaches with bidirectional dissection strategy were used. Cerebral Artery invasion classification, neurological outcomes, MRC Scale Muscle Strength Grading, and Karnofsky Performance Scale were used to assess the tumor vascular invasion, functional outcome, and patient quality-of-life outcomes, respectively. RESULTS Total resection (Simpson Grade I or II) was achieved in 114 (69.9%) patients in our series. Vision improved in 44.7% of patients with consecutive follow-up, was stable in 51.1% and deteriorated in 3.8%. Improvement in cranial nerve IIII, IV, and VI was observed in 41.1%, 36.2%, and 44.8%, respectively. The mean follow-up time was (38.8±27.9) months and KPS at the last follow-up was (89.6±8.5). Recurrence was observed in 8 (13.8%) patients with CSMs while the rate was only 3.8% and 2.8% in ACMs and MSWMs. CONCLUSIONS Preoperative imaging is of great significance in the selection of surgical approach. Maximum tumor resection and cerebral artery protection can be achieved concurrently utilizing bidirectional dissection. Those Individualized cerebral artery protection strategies not only are of great utility to neurosurgeons but also can improve patient’s quality of life.

scholarly journals Improved patient quality of life following intradural extramedullary spinal tumor resection

2016 ◽  
Vol 25 (5) ◽  
pp. 640-645 ◽  
Author(s):  
Matthew J. Viereck ◽  
George M. Ghobrial ◽  
Sara Beygi ◽  
James S. Harrop
Keyword(s):  
Quality Of Life ◽  
Clinical Symptoms ◽  
Tumor Resection ◽  
Spinal Tumor ◽  
Administrative Database ◽  
Spinal Tumors ◽  
Descriptive System ◽  
Intradural Extramedullary

OBJECTIVE Resection significantly improves the clinical symptoms and functional outcomes of patients with intradural extramedullary tumors. However, patient quality of life following resection has not been adequately investigated. The aim in this retrospective analysis of prospectively collected quality of life outcomes is to analyze the efficacy of resection of intradural extramedullary spinal tumors in terms of quality of life markers. METHODS A retrospective review of a single institutional neurosurgical administrative database was conducted to analyze clinical data. The Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and the EQ-5D-3 L descriptive system were used to analyze quality of life preoperatively, less than 1 month postoperatively, 1–3 months postoperatively, 3–12 months postoperatively, and more than 12 months postoperatively. RESULTS The ODI scores increased perioperatively at the < 1-month follow-up from 36 preoperatively to 47. Relative to preoperative values, the ODI score decreased significantly at 1–3, 3–12, and > 12 months to 23, 17, and 20, respectively. VAS scores significantly decreased from 6.1 to 3.5, 2.4, 2.0, and 2.9 at the < 1-month, 1- to 3-, 3- to 12-, and > 12-month follow-ups, respectively. EQ-5D mobility significantly worsened at the < 1-month follow-up but improved at the 3- to 12-and > 12-month follow-ups. EQ-5D self-care significantly worsened at the < 1-month follow-up but significantly improved by the 3- to 12-month follow-up. EQ-5D usual activities improved at the 1- to 3-, 3- to 12-, and > 12-month follow-ups. EQ-5D pain and discomfort significantly improved at all follow-up points. EQ-5D anxiety and depression significantly improved at 1- to 3-month and 3- to 12-month follow-ups. CONCLUSIONS Resection of intradural extramedullary spine tumors appears to significantly improve patient quality of life by decreasing patient disability and pain and by improving each of the EQ-5D domains.

Interdisciplinary Approach to the Management of Intestinal Transplant Recipients: Evaluation, Discharge, and Lifetime Management

2005 ◽  
Vol 15 (1) ◽  
pp. 54-59
Author(s):  
Kate Samela ◽  
Erin Fennelly ◽  
Mary Brosnan ◽  
Jill Robinson
Keyword(s):  
Intestinal Failure ◽  
Interdisciplinary Approach ◽  
Open Communication ◽  
Optimal Care ◽  
Team Members ◽  
Close Relationship ◽  
Transplant Team ◽  
Intestinal Transplant

Patients suffering from intestinal failure present unique and difficult challenges to the transplant team. Augmenting the need for interdisciplinary teamwork is the higher incidence of death on the intestinal transplant waiting list. Successful management of this population requires an interdisciplinary approach at each stage of care, beginning with evaluation and continuing through discharge and lifetime management. A close relationship between patients, their caregivers, and all members of the transplant team is an essential component to successful lifetime management. Open communication between team members and unlimited accessibility to each other enables work flow to be managed efficiently, and enables the provision of optimal care. In this article, we describe the functions of the nonphysician clinical personnel needed to manage the intestinal transplant patient—beginning at the evaluation through lifetime follow-up care. The goal of each professional is the same: to restore the patient to the best quality of life possible.

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