74 research outputs found
Nutrition interventions in patients with gynecological cancers requiring surgery
No full textObjective Including developing countries, between 20 and 88% of gynecological oncology patients may present with at least mild malnutrition at diagnosis. Significant morbidity and mortality is attributed to malnutrition. Here we reviewed randomized clinical trials of nutritional interventions used to achieve early return to oral diet, enhance recovery from surgery and reduce adverse events in gynecological cancer patients undergoing surgery. Methods Ebscohost (CINAHL\ua0+\ua0Medline\ua0+\ua0PsycINFO), Cochrane, Embase, PubMed and Scopus databases were searched for articles published from 2000 onwards. Potentially eligible articles were screened by two reviewers. Length of hospital stay (LOS), postoperative complications, recovery of intestinal function, quality of life (QOL), hematological and immunological parameters were outcome measures of the nutritional interventions. Results Seven randomized clinical trials were included in the review. Early clear liquid diet, semiliquid diet, regular diet or immune-enhanced enteral diets were all found to be safe as nutritional interventions. In five of the seven trials significantly better outcomes were observed in the intervention group compared to usual care for one of more of the outcomes intestinal recovery time, LOS, postoperative complications and immunological parameters. However, the nutritional interventions varied greatly between the trials, making it difficult to directly compare their findings. Trial quality was low to moderate. Recommended malnutrition screening and assessment tools and guidelines for treatment are reviewed. Conclusions From the limited findings it would appear that nutritional interventions of early oral feeding and enteral feeding are safe. Receiving nutritional interventions seems to reduce LOS, intestinal recovery time and postoperative complications for some patients. Increasing use of neoadjuvant treatment may reduce the prevalence of patients presenting malnourished for surgery in the future
A population-level evaluation of barriers and facilitators to referral in Cytoreduction/Hyperthermic Intraperitoneal Chemotherapy using knowledge translation methodology.
No full textIntroduction: Referral for CS/HIPEC is variable, and barriers encountered by referring physicians are unknown. Identification of such barriers is useful for the creation of tailored knowledge translation (KT) strategies.
Methods: Interviews of 20 medical oncologists and surgeons in the New York (NY) area were completed to identify barrier topics, using the Pathman framework of uptake of innovations (awareness, agreement, adoption, adherence) at the various levels of the individual, practice group, and organization. Barriers were used to structure a survey for evaluation of prevalence at the population level of medical oncologists and surgeons in NY State.
Results: Barrier topics of awareness included training at a CS/HIPEC center, and availability of multidisciplinary cancer conferences. Agreement barriers centered mainly on quality of published literature, and the paradigm shift of carcinomatosis as a systemic to locoregional disease process. Adoption barriers included knowledge of outcomes of a CS/HIPEC surgeon, and concerns with morbidity/mortality rates. Adherence barriers included the lack of reflection of CS/HIPEC in current CPGs, financial/resource and logistic concerns of referrals, and lack of quality measures for the procedure. For the survey, 119 responded (12% response rate), including 42 medical oncologist and 77 surgeons. The majority were aware of CS/HIPEC (n=113, 95%). Medical oncologists were less likely than surgeons to agree with CS/HIPEC related to published evidence (76% vs 92 %, p = 0.02). Surgeons were more likely to be aware of where to refer patients for the procedure, and were less likely to have concerns regarding morbidity/mortality, compared with medical oncologists (p = 0.05, p = 0.04). Representation of CS/HIPEC in CPGs and quality measures/outcomes data was felt to result in adherence to a regular referral practice.
Discussion: This prospective study of stakeholders for CS/HIPEC is the first to evaluate and characterize barriers to referral for this complex and controversial surgical innovation, with prevalence at the population level.ThesisMaster of Health Sciences (MSc)This thesis identifies problems encountered with referring patients to a specialist surgeon for a procedure that involves both surgical removal of tumors and treatment of the abdominal cavity with chemotherapy. These problems are evaluated from interviews with specialists in the field, and then evaluated at a higher level of all practicing referring specialists through a survey. The results will be used to improve patient outcomes in the future
Scoping clinicians’ perspectives on pre-treatment multidisciplinary care for young women with breast cancer
No full textArden L Corter,1 May Lynn Quan,2 Frances L Wright,3 Erin D Kennedy,4 Marko RI Simunovic,5 Juliet Shao,1 Nancy N Baxter1,6 1Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada; 2Department of Surgery and Oncology, University of Calgary, Calgary, Canada; 3Department of Surgery, University of Toronto, Toronto, Canada; 4Division of General Surgery, University Health Network, Mount Sinai Hospital, Toronto, Canada; 5Department of Surgery, McMaster University, Hamilton, Canada; 6Dalla Lana School of Public Health, University of Toronto, Toronto, Canada Background: Young women with breast cancer (YWBC) experience worse medical and psychosocial outcomes than their older counterparts. Early input from a multidisciplinary team via pre-treatment multidisciplinary cancer conferences (pMCCs) may be important for addressing the complex needs of YWBC. However, pMCCs are not common. This study has two parts: a survey and workshop aimed at assessing clinicians’ perspectives on pMCCs, including the importance of pMCCs in the care of YWBC, as well as barriers to, and strategies for supporting their implementation.Methods: Survey results highlight variability across sites in the delivery of multidisciplinary care in general. However, both survey and workshop results emphasize clinicians’ agreement on the importance of pMCCs and suggest that numerous practical and systems levels barriers be addressed before pMCCs can be implemented.Conclusions: pMCCs have the potential to improve surgical treatment and psychosocial outcomes for YWBC. A combined practical and policy approach to their implementation, which sees extension of existing standards to include pMCCs, may support their adoption and subsequent audit practices to assess the effect of pMCCs on outcomes for YWBC. Keywords: multidisciplinary care, pre-treatment, cancer conference, breast cancer, young wome
Enhanced Recovery After Surgery in Autologous Breast Reconstruction: A Pilot Randomized Controlled Trial
No full textBackground: Enhanced recovery after surgery (ERAS) is an approach to perioperative care shown to shorten hospital length of stay (LoS) and decrease opioid use after colorectal surgery. There is increasing interest in applying ERAS to breast reconstruction, but the supporting evidence is limited. In this pilot study we evaluated the feasibility of conducting a randomized controlled trial (RCT) comparing ERAS to standard perioperative care among patients undergoing abdominal-based autologous breast reconstruction (AABR) for breast cancer.
Methods: We conducted a parallel two-arm pilot RCT of adult patients undergoing AABR between November 2019 and April 2020. Patients were randomly assigned to ERAS or standard perioperative care. Feasibility outcomes included patient rates of eligibility, recruitment, retention, and adherence to study protocol. The primary clinical outcome was median hospital length of stay. Secondary clinical outcomes included in-hospital opioid use, adverse events at 30-days, and quality of life questionnaires including BREAST-Q and EQ-5D-5L at 30-days.
Results: Of 22 screened patients, 21 (95.4%) were eligible for the study and 20 patients (95.2% of eligible) consented to study enrollment. Two patients did not undergo surgery due to COVID-19 related cancellations. Among the 18 randomized patients (90%) 10 received the study intervention and 8 received standard care. All patients undergoing surgery completed the trial with 30-day follow-up. There was 85.8% adherence to study protocol items in the ERAS group. The ERAS group had a slightly shorter median hospital length of stay (ERAS 4 days, IQR 3-5; Standard care 4.5 days, IQR 3.25-5.75) and lower mean total oral morphine equivalent consumed (ERAS 82.3mg, SD 66.5; Standard care 408.1mg, SD 368.6).
Conclusions: This pilot study supports the feasibility of a larger RCT evaluating effectiveness of ERAS, as demonstrated by high rates of patient recruitment, study completion, and adherence to study protocols. Effectiveness outcomes also encourage a larger RCT.ThesisMaster of Science (MSc)Many women with breast cancer need surgical removal of their breast. Reconstructing the breast after such surgery improves patient quality of life. The breast can be reconstructed using implants or tissue from another part of the patient’s body such as the abdomen. Patients undergoing breast reconstruction using their abdominal tissue experience longer recovery and use more pain medications compared to reconstruction using implants. We would like to test if a new approach to surgical care can improve recovery for patients having breast reconstruction using their abdominal tissue. As a first step, we would conduct a small pilot study to test if patients are willing to participate in this research, and if this approach can be delivered by the healthcare team. The results of this study will help decide if a larger study should be organized to test if we can improve recovery for patients having breast reconstruction using abdominal tissue
Literature review on thunderstorm asthma and its implications for public health advice: Final report
No full textThis report, written by the Queensland University of Technology for the Department of Health and Human Services and published in May 2017, explores and details published reports on thunderstorm asthma. It will inform part of the Victorian Government’s response to the thunderstorm asthma outbreak that occurred on 21 November 2016. This review and evaluation of literature is designed to help better understand the factors leading to thunderstorm asthma, and highlight knowledge gaps that need to be filled to better predict and prevent the impact of future episodes
Explosive Remnants of War in the Republic of Croatia
No full textExplosive remnants of war represent a constant threat to normal life and activities of the population living in mine-affected areas in the Republic of Croatia. The author considers the extent and impact of unexploded ordnance and other ERW contaminating the country as a consequence of military operations between 1991 and 1995
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