scholarly journals Glove and instrument changing to prevent tumour seeding in cancer surgery: a survey of surgeons’ beliefs and practices

2018 ◽  
Vol 25 (3) ◽  
pp. 200 ◽  
Author(s):  
D. Berger-Richardson ◽  
R.S. Xu ◽  
R.A. Gladdy ◽  
J.A. McCart ◽  
A. Govindarajan ◽  
...  
Keyword(s):  
Clinical Training ◽  
Cancer Recurrence ◽  
Potential Effect ◽  
Cancer Surgery ◽  
Free Text ◽  
Chi Square ◽  
Predictive Variables ◽  
Free Text Response ◽  
Surgeon Training ◽  
Tumour Seeding

Background Some surgeons change gloves and instruments after the extirpative phase of cancer surgery with the intent of reducing the risk of local and wound recurrence. Although this practice is conceptually appealing, the evidence that gloves or instruments act as vectors of cancer-cell seeding in the clinical setting is weak. To determine the potential effect of further investigation of this question, we surveyed the practices and beliefs of a broad spectrum of surgeons who operate on cancer patients.Methods Using a modified Dillman approach, a survey was mailed to all 945 general surgeons listed in the College of Physicians and Surgeons of Ontario public registry. The survey consisted of multiple-choice and free-text response questions. Responses were tabulated and grouped into themes, including specific intraoperative events and surgeon training. Predictive variables were analyzed by chi-square test.ResultsOf 459 surveys returned (adjusted response rate: 46%), 351 met the inclusion criteria for retention. Of those respondents, 52% reported that they change gloves during cancer resections with the intent of decreasing the risk of tumour seeding, and 40%, that they change instruments for that purpose. The proportion of respondents indicating that they take measures to protect the wound was 73% for laparoscopic cancer resections and 31% for open resections. Training and years in practice predicted some of the foregoing behaviours. The most commonly cited basis for adopting specific strategies to prevent tumour seeding was “gut feeling,” followed by clinical training. Most respondents believe that it is possible or probable that surgical gloves or instruments harbour malignant cells, but that a cancer recurrence proceeding from that situation is unlikely.Conclusions There is no consensus on how gloves and instruments should be handled in cancer operations. Further investigation is warranted.

Understanding Clinician Perspectives and Actions to Address Caregiver Burden in Caregivers of Adults

2021 ◽  
pp. 1-18
Author(s):  
Crystal Chen ◽  
Samantha Shune ◽  
Ashwini Namasivayam-MacDonald
Keyword(s):  
United States ◽  
Caregiver Burden ◽  
Professional Associations ◽  
The United States ◽  
Education And Training ◽  
Free Text ◽  
Physical Strain ◽  
Chi Square ◽  
Free Text Response ◽  
And Training

Purpose: The purpose of this study was to determine how speech-language pathologists (SLPs) perceive and address caregiver burden. Method: A 29-question survey was distributed virtually via relevant Facebook pages and professional associations. Ninety-three responses from English-speaking SLPs working with adults in the United States or Canada were analyzed descriptively. Other analyses included one-way analysis of variance and chi-square tests to assess relationships between years of experiences, primary work setting, and other relevant variables, as well as a thematic analysis of one free-text response detailing how respondents defined caregiver burden. Results: Respondents associated caregiver burden with physical, psychological, financial, and social strain, loss of personal time, and the COVID-19 pandemic. The most described theme (80%) was physical strain. Almost all respondents (92%) believed that caregiver burden is a prominent issue and reported using strategies such as education and training to reduce burden. Most respondents (86%) would consider adopting a standardized tool to identify caregiver burden. Common barriers to addressing caregiver burden were lack of tools, time, and expertise. Additionally, less than half of respondents reported being confident in their ability to appropriately refer caregivers for support (45%). Conclusions: Most SLPs interacted with caregivers and used strategies such as education and training within their areas of expertise to try and address caregiver burden. Further research into the resources SLPs need to address caregiver burden is required. This study provides a preliminary understanding of current SLP perspectives and the strategies currently used to address caregiver burden in the United States and Canada.

Opiophobia in Cancer Biology- Justified? - The Role of Perioperative Use of Opioids in Cancer Recurrence

2019 ◽  
Vol 25 (28) ◽  
pp. 3020-3027 ◽  
Author(s):  
Mir W. Sekandarzad ◽  
Chris Doornebal ◽  
Markus W. Hollmann
Keyword(s):  
Pain Management ◽  
Cancer Biology ◽  
Tumor Biology ◽  
Cancer Recurrence ◽  
Standard Of Care ◽  
Cancer Surgery ◽  
Perioperative Pain Management ◽  
Tumor Growth And Metastasis

: Opioids remain the standard of care in the provision of analgesia in the patient undergoing cancer surgery preoperatively. : The effects of opioids on tumor growth and metastasis have been discussed for many years. In recent years their use as part of the perioperative pain management bundle in the patients undergoing cancer surgery has been thought to promote cancer recurrence and metastasis. : This narrative review highlights earlier and more recent in vitro, in vivo and human retrospective studies that yield conflicting results as to the immune-modulatory effects of morphine on tumor biology. The article examines and explains the discrepancies with regards to the seemingly opposite results of morphine in the tumor milieu. The results of both, earlier studies that demonstrated procarcinogenic effects versus the data of more recent refined rodent studies that yielded neutral or even anti-carcinogenic effects are presented here. : Until the results of prospective randomized controlled trials are available to clarify this important question, it is currently not warranted to support opiophobia and opioids continue to constitute a pivotal role in the pain management of cancer patients.

scholarly journals Perceptions of Seasonal Influenza Vaccine Among U.S. Army Civilians and Dependents in the Kaiserslautern Military Community: A Mixed-Methods Survey

2021 ◽  
Author(s):  
Veronica M Burns ◽  
Fritz M Castillo ◽  
Rodney L Coldren ◽  
Trisha Prosser ◽  
Renee L Howell ◽  
...  
Keyword(s):  
Online Survey ◽  
Seasonal Influenza ◽  
Medical Center ◽  
Vaccine Uptake ◽  
Free Text ◽  
Chi Square ◽  
Military Health ◽  
Influenza Outbreak ◽  
Flu Vaccination ◽  
Flu Vaccine

ABSTRACT Introduction Influenza is a globally occurring viral respiratory infection that can lead to hospitalizations and death. An influenza outbreak can interfere with combat readiness in a military setting, as the infection can incapacitate soldiers. Vaccination remains the most effective tool to prevent and mitigate seasonal influenza. Although influenza vaccinations for U.S. Army soldiers can be monitored through military health systems, those systems cannot capture DoD civilians and Army dependents who may not use military health services. This study aims to gauge flu vaccine uptake and perceptions in U.S. Army civilians and dependents. Materials and Methods An online survey was e-mailed to civilian and dependent enrollees of Landstuhl Regional Medical Center. The survey contained 24 questions pertaining to demographics, vaccine history, history of the flu, and beliefs toward vaccines. Chi-square tests, t-tests, and logistic regressions were performed to investigate the association between demographic, behavior, and belief factors with vaccine uptake. Free-text answers were coded and categorized by themes. Results Over 70% of respondents were vaccinated for the flu. There were differences between vaccinated and unvaccinated respondents regarding their perceptions of barriers to vaccination, benefits of the flu vaccine, severity of flu symptoms, and personal risk of getting ill with the flu. After controlling for confounders, flu vaccination in the previous season and healthcare worker status were associated with increased vaccine uptake, while perceived barriers to influenza vaccination were associated with decreased vaccine uptake. Conclusions Flu vaccine uptake may be increased by increasing access to vaccination, promoting vaccination and addressing concerns at the provider level, and engaging positively framed public messaging. Increasing flu vaccine uptake is of particular importance as the flu season approaches during the COVID-19 (Coronavirus disease 2019) pandemic.

Abstract 198: Public Perceptions on Why Women Receive Less Bystander CPR Than Men in Out of Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Sarah M Perman ◽  
Shelby K Shelton ◽  
Christopher Knoepke ◽  
Kathryn Rappaprt ◽  
Daniel D Matlock ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
National Sample ◽  
Public Perceptions ◽  
Free Text ◽  
Pilot Survey ◽  
Adequate Knowledge ◽  
Free Text Response ◽  
Bystander Cpr ◽  
To Receive ◽  
Hospital Cardiac Arrest

Introduction: Women who suffer an out of hospital cardiac arrest have been observed to receive less bystander cardiopulmonary resuscitation (CPR) than men. Potential reasons for why women receive less bystander CPR than men are largely unknown. Methods: Mechanical Turk (MTurk), Amazon’s crowdsourcing platform, was used to pilot a national survey asking participants why they believe women receive less bystander CPR than men. Eligible participants were adults (18 years or over) located in the US. Participants were reimbursed $1 for their participation. To ensure adequate knowledge on the subject, survey responses were excluded if they incorrectly defined CPR. Participant demographics as well as familiarity with CPR were queried. Participants were asked to answer the following free-text question “Do you have any ideas on why women may be less likely to receive CPR than men when they collapse in public?” Descriptive statistics were used to define the cohort. The free text response was coded using thematic analysis and major themes were identified via classical content analysis. Results: Within 55 minutes of deploying the pilot survey, 54 individuals responded. All respondents answered the knowledge question correctly, and none were excluded. Mean age was 36.9 ±9.6 years and 38.9% were female. Participants were geographically distributed as follows: 13% West, 13% Southwest, 16.7% Midwest, 27.8% Southeast, 29.6% Northeast. Predominant themes identified for why women might receive less bystander CPR than men are identified in Table 1. Within this cohort, 27.8% were trained in CPR, and only 5.6% of respondents had actually performed CPR on a person. Conclusions: In this pilot survey, public perceptions identified social norms regarding fear of inappropriate touching and hurting women as significant contributors to reasons for why women receive less bystander CPR than men. Additional work using a larger national sample to confirm and expand on these findings is ongoing.

scholarly journals Lessons Learned and New Challenges: Re-evaluation of End-User Assessment of a Skills-Based Training Program for Urology Trainees

2019 ◽  
Vol 6 ◽  
pp. 238212051983455 ◽  
Author(s):  
Damian Flanders ◽  
Athina Pirpiris ◽  
Niall Corcoran ◽  
Robert Forsyth ◽  
Richard Grills
Keyword(s):  
Training Program ◽  
User Satisfaction ◽  
Skills Training ◽  
Lessons Learned ◽  
Free Text ◽  
End User ◽  
Reading Material ◽  
Free Text Response ◽  
Assessment Period ◽  
Potential Improvement

Objectives: To re-assess the perceived benefit and relevance of simulation sessions to Victorian urology trainees and to identify areas for potential improvement. Subjects and methods: All trainees attending skills training sessions between 2011 and 2016 were asked to complete a structured questionnaire at the completion of the session. The questionnaire included 11 topic areas ranging from the year of surgical training to degree of usefulness of the session, including several sections for free-text response to offer more detailed feedback. Sessions were examined both individually and collectively to assess end-user satisfaction with the structure and content of the program. Results: In total, 24 individual skills sessions were held over the 6-year period, with a total of 355 attendees. Of these, 331 attendees completed the majority of the questionnaire, a response rate of over 93%. Overall 88% of the surveyed attendees stated that they had both the support of their supervising consultant and the flexibility of workload to attend the session; 90% of trainees felt that there was adequate reading material provided prior to the skills session, an improvement from 76% in the previous study period; and 97% of those surveyed felt that the existing session structure was appropriate and the same proportion found the sessions both useful and interesting, compared with just 63% in the previous study period. Analysis of individual topics demonstrates some variability in outcome measures, but for nearly every assessed parameter, greater than 90% of participants agreed that the session fulfilled the expected criteria. New topics developed since the 2011 analysis, including renal transplant and vascular repair, also had high levels of satisfaction. The practical models used have been refined and achieved higher scores than those in the previous assessment period. Conclusion: The urology skills-based training program has been well received by the surveyed trainees and is now embedded and accepted as part of the Victorian training program. The format of the sessions has matured and the overall rating, both individually and collectively, was high. There has been a clear increase in satisfaction across most areas assessed when compared with previous feedback. Despite this, there remain areas that can be improved, such as the amount and quality of available equipment and the inclusion of video demonstrations of operative techniques.

scholarly journals Physiotherapists’ views on the Australian Physiotherapy Association’s Choosing Wisely recommendations: a content analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e031360 ◽  
Author(s):  
Joshua Zadro ◽  
Aimie L Peek ◽  
Rachael H Dodd ◽  
Kirsten McCaffery ◽  
Christopher Maher
Keyword(s):  
Content Analysis ◽  
Decision Rules ◽  
Choosing Wisely ◽  
Secondary Outcome ◽  
Free Text ◽  
Similar Response ◽  
Physiotherapy Practice ◽  
Free Text Response ◽  
Key Terms ◽  
The Impact

ObjectivesChoosing Wisely holds promise for increasing awareness of low-value care in physiotherapy. However, it is unclear how physiotherapists’ view Choosing Wisely recommendations. The aim of this study was to evaluate physiotherapists’ feedback on Choosing Wisely recommendations and investigate agreement with each recommendation.SettingThe Australian Physiotherapy Association emailed a survey to all 20 029 physiotherapist members in 2015 seeking feedback on a list of Choosing Wisely recommendations.ParticipantsA total of 9764 physiotherapists opened the email invitation (49%) and 543 completed the survey (response rate 5.6%). Participants were asked about the acceptability of the wording of recommendations using a closed (Yes/No) and free-text response option (section 1). Then using a similar response format, participants were asked whether they agreed with each Choosing Wisely recommendation (sections 2–6).Primary and secondary outcomesWe performed a content analysis of free-text responses (primary outcome) and used descriptive statistics to report agreement and disagreement with each recommendation (secondary outcome).ResultsThere were 872 free-text responses across the six sections. A total of 347 physiotherapists (63.9%) agreed with the ‘don’t’ style of wording. Agreement with recommendations ranged from 52.3% (electrotherapy for back pain) to 76.6% (validated decision rules for imaging). The content analysis revealed that physiotherapists felt that blanket rules were inappropriate (range across recommendations: 13.9%–30.1% of responses), clinical experience is more valuable than evidence (11.7%–28.3%) and recommendations would benefit from further refining or better defining key terms (7.3%–22.4%).ConclusionsAlthough most physiotherapists agreed with both the style of wording for Choosing Wisely recommendations and with the recommendations, their feedback highlighted a number of areas of disagreement and suggestions for improvement. These findings will support the development of future recommendations and are the first step towards increasing the impact Choosing Wisely has on physiotherapy practice.

Perioperative blood transfusions and cancer recurrence.

1988 ◽  
Vol 6 (8) ◽  
pp. 1348-1354 ◽  
Author(s):  
H S Wu ◽  
A G Little
Keyword(s):  
Natural Killer Cells ◽  
Acquired Immunodeficiency Syndrome ◽  
Cancer Recurrence ◽  
Cancer Surgery ◽  
The Other ◽  
Blood Transfusions ◽  
Suppressor T Lymphocytes ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Worse Prognosis

This collective review addresses the issue of transfusion-induced immunosuppression as it relates to patients undergoing cancer surgery. Patients receiving perioperative blood transfusions have a significantly worse prognosis than patients undergoing cancer surgery without a perioperative transfusion. It is thought that this is because transfusions produce a nonspecific immunosuppression by increasing the number and/or activity of suppressor T lymphocytes, decreasing the number of natural killer cells, and inducing anti-idiotypic antibodies. This risk, particularly when considered with the other risks of transfusion such as hepatitis or the acquired immunodeficiency syndrome (AIDS), suggests that criteria for transfusion of these patients should be stringent and related to an unequivocal need for replenishment of RBCs.

Predictors of Severe Intimate Partner Violence Among Antisocial and Family-Only Perpetrators: Victims’ and Offenders’ Characteristics

2020 ◽  
pp. 088626052094371
Author(s):  
Raúl Aguilar Ruiz ◽  
María José González-Calderón
Keyword(s):  
Risk Assessment ◽  
Intimate Partner Violence ◽  
Partner Violence ◽  
Intimate Partner ◽  
Assessment Tools ◽  
Chi Square ◽  
Predictive Variables ◽  
Risk Assessment Tools ◽  
Chi Square Test ◽  
Estimated Risk

The objective of this study was to determine the variables that predict severe intimate partner violence (S-IPV) according to the typology of abusers. The data were derived from 1,610 police reports on intimate partner violence (IPV) in Catalonia (Spain) between 2016 and 2017 obtained through the Police Risk Assessment Questionnaire. The study has compared a group of antisocial aggressors ( n = 613) with a group of family-only perpetrators ( n = 997). The chi-square test shows significant differences between antisocial and family-only groups for most of the variables analyzed. To determine the predictive variables of S-IPV in both groups, binary regression analyses were performed. In the antisocial group, death threats and degrading treatment by the aggressor significantly increased the probability of S-IPV, as did the victim’s minimization or justification of the abuse, living together with the aggressor, isolation, and drug or alcohol abuse. In the family-only group, an increase in the severity of the abuse and death threats against partners significantly increased the likelihood of perpetrating S-IPV. For the victims, being abused by a previous partner and fear for her physical integrity were found to increase the probability of suffering S-IPV. On the other hand, having filed a prior complaint appears to protect women from S-IPV, but only when the victims have antisocial perpetrators. The findings show that S-IPV risk factors are common regardless of the sociocultural context. Modifying the weighting of the factors that make up the risk assessment tools according to the typology of the abuser is suggested, as well as improving knowledge of these factors to increase the accuracy of the estimated risk. Finally, adapting supervision and monitoring measures according to the type of aggressor and taking into consideration the woman’s own perception of the danger she is in are also suggested.

Can Anaesthetic and Analgesic Techniques for Cancer Surgery Affect Cancer Recurrence and Metastasis?

2015 ◽  
Vol 5 (2) ◽  
pp. 190-202 ◽  
Author(s):  
Laura Marshall ◽  
Abdul Hameed Khan ◽  
Donal J. Buggy
Keyword(s):  
Cancer Recurrence ◽  
Cancer Surgery

scholarly journals Depression and quality of life of hemodialysis patients living in a poor region of Brazil

2011 ◽  
Vol 33 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Paulo Roberto Santos
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Chi Square ◽  
Depressed Patients ◽  
Role Emotional ◽  
Predictive Variables ◽  
Student’S T

OBJECTIVE: To determine the correlation between depression and quality of life (QOL) of patients in hemodialysis (HD). METHOD: One hundred and sixty six patients over 18 years of age who had been in HD for at least three months and had no history of transplant. QOL was assessed using the SF-36. To categorize depression, a score > 10 was used on the 10-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). Comparisons between depressed and nondepressed patients were performed using the chi-square test, Student's t-test, and Mann-Whitney test. Multiple regression was performed to assess the predictive variables of patients' QOL. RESULTS: Symptoms of depression were found in 13 (7.8%) patients. The only variable that differed among depressed patients was QOL. Depressed patients presented lower scores in vitality (40.7 vs. 57.3; p = 0.010), role-emotional (25.6 vs. 62.5; p = 0.006), and mental health (50.1 vs. 65.4; p = 0.023). Regression analysis demonstrated that depression was a predictor of role-emotional (OR = 0.981, CI = 0.967-0.996; p = 0.010) and mental health (OR = 0.970, CI = 0.946-0.996; p = 0.022). CONCLUSION: Depressed patients experience a poor QOL because, in addition to their chronically affected physical aspects, they also feel limited in the mental dimensions, which usually have the highest score among non-depressed HD patients.

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