New Primary Vs True Recurrence In Relapsed Retroperitoneal Liposarcoma: An Analysis of Clinicopatholgical Characteristic Differences And Relapse-Free Survival

Background This study aimed to classify relapsed retroperitoneal liposarcoma (RLS) as new primary (NP) or true recurrence (TR) and to assess the implications for therapeutic management of these classifications. Methods Patients with recurrent RLS were classified as NP if the relapse was different from the former tumor’s pathology subtype and anatomical location. Kaplan-Meier curves were adapted to estimate relapse-free survival (RFS), and logistic regression analysis was used to explore the factors related to NP.Results Total 177 patients with relapsed RLS were included in this study. The median tumor sizes were 16 cm (IQR, 13-22 cm, NP) and 18 cm (IQR, 12-25 cm, TR) (P=0.003). Multifocal tumors (89.2% vs 73.8%, P=0.011) and multiple pathology subtypes (52.7% vs 31.1%, P=0.004) were more common in the NP group and tended to invade wider anatomical areas (85.1% vs 71.8%, P=0.037). The median RFS was 17 months (IQR, 7-35 months) in the NP group and 12 months (IQR, 5-23 months) in the TR group, and NP patients showed a longer RFS than TR patients (P=0.004). When the log-rank test was conducted, low-grade pathology, tumor growth rate ≤ 1.25 cm/month and tumor size ≤ 16.5 cm had a significant influence on the NP phenomenon (P=0.015, 0.019, and 0.028, respectively). Logistic regression analysis illustrated that current surgeries, pathology subtype varieties and pathology grade were independent risk factors for NP (P=0.017, 0.019, and 0.025, respectively).Conclusion NP patients have longer RFS than TR patients, and their tumors tend to have multiple pathology subtypes and tumors and are more likely to invade wider anatomical areas. This classification contributes to a better understanding of RLS and provides new evidence for different therapeutic management of relapsed tumors.

Willingness to work in assisted living facilities: The Ghanaian nurses perspectives

ObjectiveThis study explored nurses willingness to work in assisted living institutions for the aged.BackgroundAssisted living institutions are multifunctional facilities that provide clinical and ambulatory (day hospital) care for somatic and psychogeriatric elderly with multiple pathology, disability, and handicaps.MethodsThe study used a mixed-methods approach in which qualitative data was collected first before the quantitative data. Data was collected through focused group discussions (FGDs) and questionnaires from 248 respondents with age ranging from 20 to 58 years from October 2016 to January 2017 with 8 missing from the quantitative data. Four pertinent questions were sked both in the study. Sampling was convenient and purposive from 4 different health institutions in the metropolis. Data from the FGDs were digitally recorded and transcribed verbatim. Quantitative data was entered in SPSS version 23 and cleaned. Both sets of data were coded and analysed.ResultThe nurses appreciate the increase in the number of the aged in their communities; they think community members prepare towards their ageing by using their children as security, and the idea of assisted living was enthusiastically supported, but with the proviso that it would need to be ran by a private entrepreneur. Almost all the 240 respondents said that government should establish an institution for the aged and they would be willing to work in such an institution, if only it will run by a private entrepreneur.ConclusionThe nurses also think that families are now becoming more nuclear; that is why caring for the aged has become a problem, thus creating a need for assisted living facilities.

Clinical assessment of older people

This chapter provides information on consultation skills, multiple pathology and frailty, taking a history, other sources of information, problem lists, general physical examination, investigations, common blood test abnormalities, and comprehensive geriatric assessment.

Multiple Pathologies are Common in Alzheimer Patients in Clinical Trials

Objective:To determine the frequency of multiple pathology [Alzheimer Disease (AD) plus Vascular Dementia and/or Dementia with Lewy Bodies] in patients enrolled in clinical trials of AD therapy, and to compare the cognitive and functional assessments between patients with pure AD and AD with multiple pathology.Methods:We conducted a retrospective analysis of patients with a clinical diagnosis of AD who were enrolled in AD therapy clinical trials and subsequently received an autopsy for confirmation of their diagnosis from 2000 to 2009. Performance on cognitive screening tests, namely Modified Mini Mental state (3MS) exam, Mini Mental state Exam (MMSE) and Functional Rating Scale (FRS) were compared between patients with pure AD and multiple pathology.Results:Autopsy reports were available for 16/47 (34%) of deceased patients. Of these 16 patients, 5 (31%) had pure AD pathology, 10 (63%) had AD with other pathology, and 1 (6%) had non-AD pathology. Compared to patients with pure AD, patients with AD mixed with other pathology had poorer baseline FRS in problem-solving (p<0.01) and community affairs (p<0.02).Conclusion:While the strict enrollment criteria for clinical trials identified the presence of AD pathology in the majority of cases (15/16), multiple pathology was more common than pure AD in our series of autopsied patients. Premortem biomarkers that can distinguish between pure AD and AD with multiple pathology will be beneficial in future clinical trials and dementia patient management.