ChemInform Research Articles

Clinical Practice Guideline: Recommendations for the Perioperative Management of Pancreatic and Colorectal Cancer Patients.

Colorectal and pancreatic carcinoma are the most common cancers of the gastrointestinal tract. Their surgical treatment carries a high morbidity: Complications arise in 25% to 30% of cases, often prolonging recovery times and delaying the initiation of adjuvant therapy, leading, in turn, to worse oncological outcomes. The goal of multimodal perioperative management (mPOM) is to lower the postoperative complication rate through a combination of perioperative measures. This guideline on the perioperative management of gastrointestinal tumors (POMGAT) meets all requirements for an S3 guideline as specified by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). These include a systematic literature search, quality assessment of the included publications, an evaluation of the reliability of the evidence according to the GRADE approach, and a structured consensus process. Meta-analyses have shown that mPOM lowers the complication rates of both pancreatic and colorectal resections (RD 0.96 with 95% confidence interval [0.92; 0.99] and RR 0.66 [0.54; 0.80], respectively). This shortens the hospital stay after pancreatic resections by a median of 2.33 days [-2.98; -1.69] and after colorectal resections by a median of 2.59 days [-3.22; -1.97]. Adherence to the POMGAT-S3 guideline for pancreatic and colorectal cancer surgery is associated with improved recovery, which can lead to a faster return to intended oncological treatment (RIOT) and thus to better long-term outcomes. These recommendations are not restricted to gastrointestinal cancer surgery; they can also be applied to visceral surgery for benign conditions, as well as to gynecological and urological operations.

Brazilian Physicians’ Attitudes and Feelings Towards Palliative Care in Pediatrics

Brazilian Physicians’ Attitudes and Feelings Towards Palliative Care in Pediatrics

Integrating Simulation in Pediatric Health Care: Collaboration of Primary and Acute Care Pediatric Nurse Practitioners Across Settings

Pediatric nurse practitioner (PNP) education continues to evolve. Clinical placement availability significantly impacts student’s exposure to complex pediatric patients. The intricacy of pediatric health care demands innovative educational approaches, especially in managing high-risk, low-frequency emergencies. Simulation-based education is a vital tool to bridge learning gaps and enhance core competencies, particularly in diagnosing and managing pediatric patients across diverse health care settings. Here we explore a collaborative formative simulation experience for primary care PNPs and acute care PNPs, focusing on a single patient transitioning through primary care, emergency, and acute care settings. Results demonstrate enhanced student satisfaction and self-confidence, underscoring the efficacy of such simulations in preparing future pediatric health care providers. Opportunities for improvement and future directions are discussed, highlighting the significance of interprofessional collaboration and continuous innovation in PNP education.

Under- not over-nutrition is associated with adverse outcomes in cancer surgery

Under- not over-nutrition is associated with adverse outcomes in cancer surgery

Development and validation of a questionnaire (QSPC-Q) for assessment of quality and strengthening of primary care in Brazil.

The performance evaluation of services through instruments is relevant, as it can support thoughts, actions and political approaches to meet a social need. The objective of the article was to develop and validate the Quality and Strengthening of Primary Care Questionnaire (QSPC-Q) for professionals and users based on Starfield attributes and Donabedian pillars. A mixed sequential study was performed to develop the QSPC-Q. The test was applied to 149 doctors and 795 users of basic health units. Psychometric properties was assessed by testing internal consistency using Cronbach's alpha and exploratory factor analysis. Reproducibility od scale was assessed using intraclass cognitive and test-retest correlation. The final version of the follow-up consisted of 45 items aimed at physicians (Cronbach's alpha = 0.921) and 33 at users (Cronbach's alpha = 0.86); the intraclass respiratory capacity was 0.88. An exploratory factor analysis identified 13 factors associated with the pattern components. A short version with 29 items for professionals was also elaborated. Professional QSPC-Q (short and braided versions) and user QSPC-Q were valid.

Preoperative nutritional counseling and immuno-nutrition as part of prehabilitation leads to successful body weight preservation and or weight gain in patients undergoing surgery for gastrointestinal cancers

Preoperative nutritional counseling and immuno-nutrition as part of prehabilitation leads to successful body weight preservation and or weight gain in patients undergoing surgery for gastrointestinal cancers

Changes in body composition following curative surgery for colorectal cancer: Insights from InBody720 measurements

Changes in body composition following curative surgery for colorectal cancer: Insights from InBody720 measurements

Characteristics and Outcomes of Infants in Texas by Facility Children's Surgery Verification Status

IntroductionThe American College of Surgeons Children's Surgery Verification (CSV) status recognizes hospitals that deliver high-quality pediatric surgical care. Texas has 5 CSV centers in three cities, which may limit equitable access to care. We explored the characteristics and outcomes of infants admitted in Texas as a function of facility CSV status. Materials and methodsWe retrospectively reviewed a state-wide hospital discharge database (2013-2021). All patients <1 y of age were included. Patients transferred to an outside hospital were excluded to avoid double counting. Descriptive statistics and chi-square analysis were performed. ResultsWe analyzed 3,617,173 admissions, with 211,278 (6%) treated at CSV centers. CSV admissions were less likely to be inborn (46% versus 93%) and more likely to be transfers (16% versus 1%). CSV centers also had sicker patients (32% versus 13% extreme illness severity) with higher mortality rates (1% versus 0%), longer length of stay (9 ± 22 versus 4 ± 9), and higher operative rates (33% versus 20%). However, mortality was lower at CSV centers when matched for illness severity. Proportionately more patients from rural counties (9% versus 4%) and counties along the United States-Mexico border (13% versus 1%), as well as patients of Hispanic ethnicity (39% versus 33%), were treated at non-CSV centers. Meanwhile, proportionately more African Americans (21% versus 11%) were treated at CSV centers. ConclusionsCSV centers are associated with improved outcomes among patients with high illness severity. Population differences among patients treated at CSV centers compared to non-CSV centers may represent disparities in access to care and warrant further evaluation.

Paediatric nutritional care after hospital discharge: A systematic review

Paediatric nutritional care after hospital discharge: A systematic review

Validation of a laser visual feedback and core stability exercise programme to improve lateropulsion reduction and pushing intensity in stroke patients with pusher syndrome: A Delphi study.

The patient with pusher syndrome (PS) is characterized by showing postural control alterations due to a lack of perception of his own body in the space. It appears when the patient actively pushes with his unaffected limbs towards the injured side, reacting with resistance to passive straightening towards the midline. Between 10% and 50% of strokes present PS. Nowadays, there is no clearly defined treatment for PS. To design and validate an exercise program using visual feedback and specific core stability exercises (FeViCoS) for the treatment of patients with PS. Validation was conducted by expert consensus using the Delphi method. Thirteen neurorehabilitation experts participated in the process. An online questionnaire with 18 Likert-type questions was used to evaluate the designed program. Consensus was considered reached if there was convergence between the quartile 1 and 3 values (RIQ=Q1-Q3) or if the relative interquartile range (RIR) was less than 20%. The degree of agreement between experts was measured by calculating the Fleiss' kappa coefficient. A total of 2 rounds were required to achieve 97.44% consensus with 100% participation. The RIR was less than or equal to 20% for all questions. The Fleiss' kappa index (0.831) showed that the degree of agreement between experts was excellent. Neurorehabilitation experts considered FeViCoS valid for the therapeutic approach to patients with PS. Expert consensus suggests a novel strategy in physical therapy clinical practice to improve balance and postural orientation in patients with subacute stroke and PS.

A nationwide survey of changes in nutritional management after gastrointestinal cancer surgery over a 12-year period using medical claims database

A nationwide survey of changes in nutritional management after gastrointestinal cancer surgery over a 12-year period using medical claims database

A propensity-matched cohort study of pre-operative immunonutrition in patient undergoing major gastrointestinal cancer surgery in Hong kong

A propensity-matched cohort study of pre-operative immunonutrition in patient undergoing major gastrointestinal cancer surgery in Hong kong

Long-term results using nutritional indicators in colorectal cancer surgery: Cachexia and modified glasgow prognostic score (MGPS)

Long-term results using nutritional indicators in colorectal cancer surgery: Cachexia and modified glasgow prognostic score (MGPS)

Functional outcomes of prehabilitation programme for sarcopenic patients undergoing major colorectal cancer surgery

Functional outcomes of prehabilitation programme for sarcopenic patients undergoing major colorectal cancer surgery

The role of malnutrition assessment tools in estimating postoperative outcomes after upper gastrointestinal cancer surgery: A bi-center cohort study

The role of malnutrition assessment tools in estimating postoperative outcomes after upper gastrointestinal cancer surgery: A bi-center cohort study

Could malnutrition screening tools help in preoperative assessment of patients undergoing HPB cancer surgery in terms of postoperative complications? A bi-center observational study

Could malnutrition screening tools help in preoperative assessment of patients undergoing HPB cancer surgery in terms of postoperative complications? A bi-center observational study

Nutritional support after hospital discharge reduces long-term mortality in patients after gastric cancer surgery: Secondary analysis of a prospective randomized trial

Nutritional support after hospital discharge reduces long-term mortality in patients after gastric cancer surgery: Secondary analysis of a prospective randomized trial

Impact of glim criteria defined malnutrition on short- and long-term clinical outcomes in patients after gastrointestinal cancer surgery

Impact of glim criteria defined malnutrition on short- and long-term clinical outcomes in patients after gastrointestinal cancer surgery

Nutritional evaluation in cancer surgery pre-admission: A protocol for identifying patients in need of perioperative nutritional intervention

Nutritional evaluation in cancer surgery pre-admission: A protocol for identifying patients in need of perioperative nutritional intervention

Artificial intelligence in action: Improving breast disease management through surgical robotics and remote monitoring

ObjectivesThis article aims to discuss the transformative impact of artificial intelligence (AI) on the identification and management of breast diseases, with a specific focus on breast cancer. Materials and methodsHealthcare providers have integrated AI technologies such as surgical robots and remote monitoring systems to improve the accuracy and efficiency of breast disease diagnosis and treatment. ResultsSurgical robots equipped with AI algorithms provide real-time guidance to surgeons, analyze imaging data, and ensure precise procedures for better outcomes in breast cancer surgeries. AI-driven remote monitoring systems allow for close monitoring of patient health data, disease progression prediction, and personalized treatment recommendations. ConclusionsThe incorporation of AI technology into healthcare practices for breast diseases has revolutionized patient care delivery, enhancing outcomes, promoting patient engagement, and improving overall quality of care. These advancements offer personalized and tailored healthcare strategies that meet the unique needs of each patient, reshaping the healthcare industry.