Faculty Opinions recommendation of Surveillance CT scans are a source of anxiety and fear of recurrence in long-term lymphoma survivors.

Abstract Background Repair of a ventral hernia is increasingly being performed by a laparoscopic approach despite lack of good long term follow up data on outcomes. The aim of this study was to examine the long term performance of a polyester mesh and to assess its elastic properties in patients undergoing laparoscopic ventral hernia repair. Methods All patients being assessed for a ventral hernia repair between August 2011 and November 2013 were placed on a prospective database. Those undergoing laparoscopic repair with a polyester mesh were seen at clinic at one month and one year, while their electronic records were assessed at 34 months (range 24–48 months) and 104 months (range 92–116 months). In addition, CT scans of the abdomen and pelvis performed for any reason on these patients during the follow up period were reviewed by a consultant gastrointestinal radiologist. Mechanical failure testing of the mesh was also performed. Results Thirty-two of the 100 patients assessed for ventral hernia repair had a laparoscopic repair with a polyester mesh. Nineteen (59%) had CT scans performed during the follow-up period. No recurrence was recorded at 34 months, while three (9.4%) had a recurrence at 104 months. Two had central breakdown of the mesh at 81 and 90 months, while 1 presented acutely at 116 months after operation. Mesh had stretched across the defect by an average of 21% (range 5.7–40%) in nine patients. Mechanical testing showed that this mesh lost its elasticity at low forces ranging between 1.8 and 3.2 N/cm. Conclusion This study shows that late recurrence is a problem following laparoscopic ventral hernia repair with polyester mesh. The mesh loses it elasticity at a low force. This combined with degradation of mesh seems the most likely cause of failure. This is unlikely to be a unique problem of polyester mesh and further long-term studies are required to better assess this operative approach to ventral hernia repair.

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Cognitive function in long-term lymphoma survivors: relationship between subjective reports and objective assessments and with quality of life

Psychology Health & Medicine ◽

10.1080/13548506.2020.1770815 ◽

2020 ◽

pp. 1-12

Author(s):

Barbara Muzzatti ◽

Nicoletta Cattaruzza ◽

Marika Piccinin ◽

Cristiana Flaiban ◽

Giulia Agostinelli ◽

...

Keyword(s):

Quality Of Life ◽

Cognitive Function ◽

Subjective Reports ◽

Lymphoma Survivors

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Persistent fatigue among long-term non-Hodgkin lymphoma survivors

Leukemia & Lymphoma ◽

10.1080/10428194.2021.1984450 ◽

2021 ◽

pp. 1-9

Author(s):

Matthew R. LeBlanc ◽

Sheryl Zimmerman ◽

Thomas W. LeBlanc ◽

Ashley Leak Bryant ◽

Kathryn E. Hudson ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Non Hodgkin Lymphoma ◽

Persistent Fatigue ◽

Lymphoma Survivors

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Concerns and Quality of Life of Cancer Survivors Across the Survivorship Trajectory: A Singapore Perspective

10.21203/rs.2.14780/v1 ◽

2019 ◽

Author(s):

Gek Phin Chua ◽

Quan Sing Ng ◽

Hiang Khoon Tan ◽

Whee Sze Ong

Keyword(s):

Quality Of Life ◽

Cancer Survivors ◽

Cancer Treatment ◽

Cancer Survivorship ◽

Recurrence Risk ◽

Term Treatment ◽

Fear Of Recurrence ◽

Long Term Treatment

Abstract Background The aim of this study is to determine the main concerns of survivors at various stages of the cancer survivorship of the cancer survivorship trajectory and to assess whether these concerns have any effect on their quality of life (QOL). The overall goal was to use the insights from the study to guide practice on patient care. Methods A cross-sectional survey of 1107 cancer survivors diagnosed with colorectal, breast, lung, gynaecological, prostate or liver cancers from a cancer centre in Singapore. Eligible patients self-completed a questionnaire adapted from the Mayo Clinic Cancer Centre’s Cancer Survivors Survey of Needs. Results The top 5 concerns among all survivors were cancer treatment and recurrence risk (51%), followed by long-term treatment effects (49%), fear of recurrence (47%), financial concerns (37%) and fatigue (37%). Cancer treatment and recurrence risk, long-term treatment effects and fear of recurrence were amongst the top concerns across the survivorship trajectory. Mean QOL was 7.3 on a scale of 0 – 10. Completed treatment patients had higher QOL score than the newly diagnosed and on treatment patients and the patients dealing with recurrence or second cancer patients. Predictors for QOL included the economic status and housing type of patients and whether patients were concerned with pain and fatigue Conclusion This study confirms that cancer survivors in Singapore face multiple challenges and had various concerns at various stages of cancer survivorship, some of which negatively affect their QOL It is critical to design patient care delivery that appropriately address the various concerns of cancer survivors in order for them to cope and improve their QOL.

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Epstein–Barr virus load is higher in long‐term Hodgkin lymphoma survivors compared to their unaffected twins and unrelated controls

British Journal of Haematology ◽

10.1111/bjh.15522 ◽

2018 ◽

Vol 185 (2) ◽

pp. 377-380 ◽

Cited By ~ 1

Author(s):

Amie E. Hwang ◽

Vickie Marshall ◽

David V. Conti ◽

Bharat N. Nathwani ◽

Thomas M. Mack ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Epstein Barr Virus ◽

Virus Load ◽

Barr Virus ◽

Epstein Barr ◽

Lymphoma Survivors

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Coping with Pressure

Oxford Assess and Progress: Situational Judgement Test ◽

10.1093/oso/9780198805809.003.0021 ◽

2018 ◽

Author(s):

David Metcalfe ◽

Harveer Dev

Keyword(s):

Computed Tomography ◽

Ward Round ◽

Ct Scans ◽

Junior Doctors ◽

Good Medical Practice ◽

Foundation Programme ◽

Competing Priorities ◽

First Time ◽

Affect Patient Care

The Foundation Programme is tough. New doctors have to cope with taking responsibility for patients for the first time and managing the logistical difficulties that inevitably face those working in a complex environment. They often have to balance multiple competing priorities. Perhaps computed tomography (CT) scans need to be requested by 9.30 a.m. if they are to be scheduled for the same day, Mrs A has chest pain, Mr B is an outlier on a distant ward and has become acutely short of breath, and Mr C’s relatives are angry because they have been waiting to speak to a doctor for an hour. You are part- way through taking blood and have three bleeps to answer (all potentially important but conferring new tasks), and your consultant needs to complete the ward round before her clinic starts . . . This would not be a remarkable day by any means. It can be difficult to balance these responsibilities and do so without cutting corners. Criticism is inevitable as it is rarely possible to keep everyone happy all of the time. Questions within this section will explore your resilience and ability to work under pressure. Through your responses, you will need to demonstrate a willingness to remain flexible, manage ambiguity, and adapt to changing circumstances. The ability to remain calm while handling stressful situations arising with patients, relatives, and colleagues is of the utmost importance. Problems must be resolved directly but may require a diplomatic approach to avoid conflict. It is therefore important to speak to others respectfully, seek help early on, and remain aware of your own limitations. There is growing recognition that such pressures can have long- term health implications for junior doctors. You must be aware of threats to your own health, and the British Medical Association (BMA) has reiterated that you have a duty to ensure that your ‘health problems do not affect patient care’. Informal (so- called ‘corridor’) consultations are discouraged, and Good Medical Practice (2013) is clear that ‘you must, wherever possible avoid providing medical care to yourself ’.

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Use of CT Scans for Abdominal Pain in the ED: Factors in Choice

The American Surgeon ◽

10.1177/000313482008600428 ◽

2020 ◽

Vol 86 (4) ◽

pp. 324-333 ◽

Cited By ~ 1

Author(s):

Aubrey A. Mwinyogle ◽

Astha Bhatt ◽

Onyebuchi U. Ogbuagu ◽

Neer Dhillon ◽

Anne Sill ◽

...

Keyword(s):

Abdominal Pain ◽

Ct Scan ◽

Primary Diagnosis ◽

Socioeconomic Disparities ◽

Ct Scans ◽

Utilization Rate ◽

Rebound Tenderness ◽

High Index Of Suspicion ◽

Ct Finding

Overutilization of healthcare resources is a threat to long-term healthcare sustainability and patient outcomes. CTis a costly but efficient means of assessing abdominal pain; however, 97 per cent of ED physicians acknowledge its overutilization. This study sought to understand factors that influence ED providers’ decision regarding CT use in the evaluation of abdominal pain. After evaluating a patient for acute abdominal pain, ED providers filled in a form in which the primary diagnosis and index of suspicion were recorded. Bivariate and multivariate analyses were used to identify predictors of outcomes. The CT scan utilization rate was 54.82 per cent. Whereas 34.11 per cent of CT scans were normal, 30 per cent yielded an acute abdominal pathology. Tenderness and rebound tenderness were positive predictors of high index of suspicion [odds ratio (OR) 2.09 and 2.54, respectively]. These variables were also predictive of obtaining a CT scan [OR 2.64 and 3.41, respectively]. Compared with whites, the index of suspicion was 26 per cent and 56 per cent less likely to be high when patients were black [OR 0.73] or Hispanic [OR 0.44] respectively. Blacks and Hispanics were less likely to have CT scans performed than whites [OR 0.58 and 0.48, respectively]. Leukocytosis significantly affected the index of suspicion for acute abdominal pathology, obtaining a CTscan and the acuity of CTscan diagnosis on multivariate analysis. Patients aged ≥60 years had 2.03 odds of acute CT finding compared with those aged <60 years. There is a need for committed efforts to optimize CT scan utilization and eliminate socioeconomic disparities in health care.

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