Assessment Of Surgical Patients Research Articles

Comparison of the predictive validity of the Braden, Munro and 3S scales in surgical patients

Aim of the studyThis research is a descriptive and cross-sectional study aimed at examining the use of three different scales to assess the risk of pressure injury (PI) in surgical patients. Materials and methodsThis study was conducted between February 1 and July 1, 2022. The study included patients who had planned surgery in general surgery clinic. The sample size was 388 patients. Patients who agreed to participate in the study were asked to fill out the " Introductory Information Form " and perform a risk assessment using the Braden, Munro and 3S Scales. The statistics program IBM SPSS Statistics 25.0 packaged software was used in the analyses of data. ResultsIt is evident that the relationship between the scales and the diagnosis of PI, as well as the strength of this relationship, are statistically significant (p < 0.05). The Munro Scale exhibited the highest value of Phi value and validity coefficient c, indicating a stronger association with the diagnosis of PI, thus suggesting its greater effectiveness in discrimination. According to the validity coefficients found, it can be stated that the correct classification percentages for Munro, Braden, and 3S Scales were 91 %, 71 %, and 66 %, respectively. ConclusionThe findings of this study indicate that both the Braden, Munro, and 3S Scales can be used for PI risk assessment in surgical patients, but the Munro Scale exhibits superior predictive validity compared to the Braden and 3S Scales in terms of overall sensitivity and specificity.

A cross-sectional study to assess the barriers to teleconsultations among doctors in Chennai

Background: A doctor's communication and interpersonal skills encompass gathering information to facilitate accurate diagnosis, counsel appropriately, give therapeutic instructions, and establish caring relationships with patients. While face-to-face consultations have been the norm, tele-consultations and enrolment in telemedicine apps have become necessary. Tele-consultations have been on the rise significantly during the COVID-19 lockdown. This study aims to assess the barriers to tele-consultations among doctors in Chennai. Methodology: This study uses a cross-sectional design to assess the barriers to tele-consultations among doctors in Chennai using a convenience sampling technique. Data was entered in Microsoft Excel and analyzed using SPSS software version 23. Results: 81.6% of the participants feel that teleconsultations have reduced face-to-face consultations. Only about 6% of the study participants preferred teleconsultation in the future. About a third of the doctors in the study could not treat/manage chronically ill patients through teleconsultations. About 70% of the doctors could follow up with their patients through telecommunication, but 70% failed to follow up. Conclusion: From this study, we conclude that only about 6% of the study participants would prefer teleconsultation in the future. Treating medical emergencies and assessment of surgical patients were considered as top 2 important barriers in this study with about half of them facing this barrier during their telecommunication.

Impact of sarcopenia on outcomes in surgical patients: a systematic review and meta-analysis.

Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, the authors aimed to synthesize the available literature and investigate the impact of sarcopenia on perioperative and postoperative outcomes across all surgical specialties. The authors systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Their primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at 1, 3, and 5 years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population and on those of higher quality or prospective study design. A total of 294 studies comprising 97643 patients, of which 33070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes, including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P <0.00001). A significantly lower survival rate in patients with sarcopenia was noted at 1, 3, and 5 years (all P <0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P <0.00001), cardiovascular (both P <0.00001), and emergency ( P =0.03 and P =0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia ( P <0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients ( P =0.007). Sensitivity analysis based on higher quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P <0.00001). Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical subspecialties.

Venous thromboembolism risk assessment of surgical patients in Southwest China using real-world data: establishment and evaluation of an improved venous thromboembolism risk model

BackgroundVenous thromboembolism (VTE) risk assessment in surgical patients is important for the appropriate diagnosis and treatment of patients. The commonly used Caprini model is limited by its inadequate ability to discriminate between risk stratums on the surgical population in southwest China and lengthy risk factors. The purpose of this study was to establish an improved VTE risk assessment model that is accurate and simple.MethodsThis study is based on the clinical data from 81,505 surgical patients hospitalized in the Southwest Hospital of China between January 1, 2019 and June 18, 2021. Among the population, 559 patients developed VTE. An improved VTE risk assessment model, SW-model, was established through Logistic Regression, with comparisons to both Caprini and Random Forest.ResultsThe SW-model incorporated eight risk factors. The area under the curve (AUC) of SW-model (0.807 [0.758, 0.853], 0.804 [0.765, 0.840]), are significantly superior (p = 0.001 and p = 0.044) to those of the Caprini (0.705 [0.652, 0.757], 0.758 [0.719, 0795]) on two test sets, but inferior (p < 0.001 and p = 0.002) to Random Forest (0.854 [0.814, 0.890], 0.839 [0.806, 0.868]). In decision curve analysis, within threshold range from 0.015 to 0.04, the DCA curves of the SW-model are superior to Caprini and two default strategies.ConclusionsThe SW-model demonstrated a higher discriminative capability to distinguish VTE positive in surgical patients compared with the Caprini model. Compared to Random Forest, Logistic Regression based SW-model provided interpretability which is essential in guarantee the procedure of risk assessment transparent to clinicians.

Waterlow score for risk assessment in surgical patients: a systematic review.

The Waterlow score (WS) is used routinely in clinical practice to assess risk of pressure sore development. Recent studies have also suggested its use in preoperative risk stratification. The primary aim of this systematic review was to evaluate the current evidence on the WS in predicting morbidity and mortality in surgical patients. A systematic review was carried out in accordance with PRISMA and SWiM guidelines. A search strategy was conducted on the MEDLINE and EMBASE databases. Quality was assessed using the Newcastle-Ottawa scale. Overall, 72 papers were identified, of which 7 met inclusion criteria for full text review, and 4 were included for analysis. All studies were cohort in nature and published between 2013 and 2016, encompassing a total of 505 surgical patients. The studies included general, vascular, transplant and orthopaedic surgery. A high WS was demonstrated to have statistically significant association with increased morbidity and mortality as well as need for intensive care unit admission and length of stay. Furthermore, this was a more accurate predictor compared with the P-POSSUM and ASA scoring systems used currently in routine practice. The WS is a promising tool for risk stratification of surgical patients. It is already collected routinely by nursing staff throughout hospitals in the UK and would therefore be easy to implement. However, further large prospective studies are required in order to validate these findings prior to its establishment for this role in everyday surgical practice.

Pain Assessment: Benefits of Using Pain Scales for Surgical Patients in South Bohemian Hospitals.

Pain is a medical and nursing problem that is common in surgical departments. Inadequate pain management can lead to patient distress, as well as extending the period in which the patient’s quality of life is reduced. The standardized SF-MPQ-2 questionnaire provides nurses with the opportunity to assess pain within a broader context. The aim of this descriptive and exploratory study was to describe the state of pain assessment in surgical patients in the South Bohemian Region and to highlight the benefits of using a standardized tool for proper pain assessment. The research was carried out using a quantitative survey within the South Bohemian Region (Czech Republic). The participants in the study were nurses working in surgical departments in hospitals in the region as well as hospitalized patients. The results show that nurses pay slightly more attention to pain assessments than doctors. We know that, generally, pain decreases with time after surgery. Nonetheless, returning pain, as well as continuous pain, can occur, both of which have an emotional component. The results of this study are directed at nurses and include a call for more effective pain management through improved assessment.

Venous Thromboembolism Risk and Thromboprophylaxis Assessment in Surgical Patients Based on Caprini Risk Assessment Model.

PurposeVenous thromboembolism (VTE) is the most common preventable cause of hospitalization-associated mortality. In the absence of optimal prophylaxis and depending on the type of surgery and patient-related factors, the risk of developing VTE increases by 10% to 50%. We aimed to assess VTE risk and thromboprophylaxis among surgical patients hospitalized at surgical wards of Tikur Anbessa Specialized Hospital (TASH). Addis Ababa, Ethiopia.Materials and MethodsA retrospective cross-sectional study was conducted from September 1, 2018 to February 28, 2019. Data were collected using a pretested observational checklist which is prepared based on the VTE Caprini risk assessment model. Then, the collected data were checked for completeness and finally entered and analyzed using Statistical Package for Social Sciences (SPSS) version 25.ResultsOut of 155 admitted patients, almost equal numbers of males (49.68%) and females (50.32%) participated in the study with a mean age of 41.87±16.84 and an age range of 13 to 89 years. Undergoing major surgery, resting in bed for more than 3 days and having acute infections (including pneumonia) were the most frequently seen VTE risk factors. Most of the study participants (135, 87.10%) were at risk of developing VTE (>1 Caprini risk score), and 47.11% were in the highest risk category (≥5 Caprini score). The maximum and minimum total risk scores were 19 and 1, respectively with a mean score of 4.53±2.31. Among patients who were at risk of developing VTE and eligible for thromboprophylaxis, only 17.78% received thromboprophylaxis and two ineligible patients received prophylaxis. Parental unfractionated heparin twice or three times per day was the most widely used thromboprophylaxis regimen. A total of 29 (18.71%) patients had one or more contraindication(s) for thromboprophylaxis and three of them took prophylaxis despite the contraindications. Only 3 (1.93%) patients admitted to surgical wards developed VTE during hospitalization.ConclusionAs per the Caprini risk assessment model, the majority of surgical patients treated at TASH were at risk of developing VTE. However, thromboprophylaxis was underutilized. The incidence of VTE was 1.93% in our study.

Intravenous iron infusion as an alternative to minimize blood transfusion in peri-operative patients

Despite the reported benefits of intravenous iron therapy (IVIT) for correcting iron deficiency anemia (IDA) before any major surgery and the evidence thereof, perioperative allogenic blood transfusion (ABT) practice is still considered as the only viable option by some clinicians worldwide. As ABT increases the likelihood of infections, cardiac complications, longer hospital stays and mortality among the patients, the practice of ABT should only be reserved for critical cases (Hb level < 7 g/dl). Timely iron studies and iron replenishment (oral/IV) of prospective surgical patients could help decrease the ABT practice, and prove beneficial from both the clinical and economic standpoint. Evidence based patient blood management guidelines should be developed and standardized for use by clinicians worldwide. These guidelines should include specific instructions on timely assessment of surgical patients for correction of their IDA by either oral iron supplementation, if time permits, or by using IVIT such as ferric carboxymaltose (FCM) in emergency surgeries and in patients with functional ID. This study was conducted to explore the clinical benefits of the timely administration of IV-FCM in iron-deficient preoperative patients during 2017–2018 and compare the results thereof with that of the ABT. Based on the IDA treatment plan of 2953 patients, 11.14% cases were administered IV FCM (Group 1), 11.58% cases received ABT (Group 2), while the remaining 77.27% of anemic cases received neither ABT nor IV FCM (Group 3). The results indicate that the IV FCM administration reduces the need for ABT and thus minimizes its associated side effects. The findings of our study concur with the favorable outcomes reported by the other similar studies.

Pain assessment in surgical patients in the South Bohemia region

Aim: The aim of the study was to describe the current state of pain assessment in surgical patients in the South Bohemia region. Design: A quantitative descriptive study. Methods: Two sets of questionnaires were used to determine the state of pain assessment. The sample included 253 nurses and 205 patients from the South Bohemia region. Results: Nurses use visual analog scales (129) and verbal pain assessment (89) to assess pain. A more precise verbal description of pain assessment would be appreciated by 44 of the respondents, and 42 would appreciate confirmation of assessments by doctors. According to nurses, the main pain manifestations in patients are: limited mobility (156), verbal expressions (134), lack of cooperation (129) and limited independence (128). Direct physical manifestations of pain mentioned by patients include: limited mobility (140), limited independence (97), and mimic manifestation (46). Patients would like pain assessments complemented by more accurate verbal assessments (84), use of pictures to illustrate pain (40), and increased frequency of assessment by doctors (29). Conclusion: The data obtained suggest some shortcomings in pain assessment, and indicate the spheres in which provision of care could be improved.

Defining the Minimal Clinically Important Difference and Patient-acceptable Symptom State Score for Disability Assessment in Surgical Patients.

The World Health Organization Disability Assessment Schedule 2.0 has been used to measure postoperative disability in several clinical trials and cohort studies. It is uncertain what the minimal clinically important difference or patient-acceptable symptom state scores are for this scale in patients recovering from surgery. The authors analyzed prospectively collected data from three studies that measured disability 3 and 6 months after surgery. Three distribution-based methods (0.3 multiplied by SD, standard error of the measurement, and 5% range) and two anchor-based methods (anchored to two patient-rated health status questions and separately to unplanned hospital readmission) were averaged to estimate the minimal clinically important difference for the World Health Organization Disability Assessment Schedule 2.0 score converted to a percentage scale. Scores consistent with a patient-acceptable symptom state and clinically significant disability were determined by an anchored 75th centile method. Data from 4,361 patients were analyzed. The average minimal clinically important difference estimate for the World Health Organization Disability Assessment Schedule 2.0 was 5%, with similar estimates in patients with or without preoperative disability. The patient-acceptable symptom state score was 16%, and the score consistent with at least moderate clinically significant disability was 35%. Using these estimates, between baseline and 6 months after surgery, 21% of patients had a significant increase in disability, and 73% achieved a patient-acceptable symptom state. A change in World Health Organization Disability Assessment Schedule 2.0 score of 5% or more after surgery is consistent with a clinically important change in disability. Patients with a score less than 16% after surgery have an acceptable symptom state and can be considered as disability-free, whereas patients with a score of 35% or more can be considered as having at least moderate clinically significant disability.

Risk Assessment in Surgical Patients: American Society of Anesthesiologist’s (ASA) Classification vs Intraoperative Therapeutic and Diagnostic Interventions (I-ITS)

Background: In this prospective study of 859 surgical patients in a tertiary research hospital, we examined the association between ASA physical status classification and Intraoperative Therapeutic Intervention Score (I-TIS). Methodology: All patients were assigned by ASA classification before the operation and received a value of 1-4 points for I-TIS score during surgical procedures. Surgical complexity was also classified and correlation with I-TIS was examined. Results: The correlation coefficient of the ASA with I-TIS was r=0.55 (p25 and surgical complexity of major plus were admitted to the intensive care unit. Two of them were followed up six hours and the other three stayed more than 24 hours in the intensive care unit. Conclusions: It’s concluded that I-TIS score may be validated for our surgical patients but this assessment may show variability among institutions. The ASA classification is the most valued and widely used scoring system for evaluation of perioperative risk in surgical patients. It is simple, easy and also a useful tool to assist descriptions of workload and ‘anesthetic risk’ for analysis and research purposes.

A prospective study of Mannheim peritonitis index as a prognostic scale in analysis of outcome in hollow viscus perforation

Background: MPI as a prognostic index helps in analysis of prognosis in peritonitis in hollow viscus perforation. The factors that are considered in MPI index are routinely used in assessment of surgical patients, they are easily available, routinely performed, and helps in arrival at a prognosis in fast and effective way.Methods: A prospective survey of patients with acute generalized peritonitis due to hollow viscus perforation was carried out in general surgical wards of our institute during the period starting from January 2014 to December 2015. Study population consisted of 150 consecutive patients with performative peritonitis, which confirmed on emergency laparotomy.Results: The Mannheim peritonitis index emerged as a reliable marker for assessing the severity and prognosis of intra-abdominal infection with sensitivity and specificity comparable to APACHE II score which has been adopted as the gold standard by Surgical Infection Society. The score designed specifically for peritonitis, combines preoperative and operative data and is easy to apply. MPI scores were consistent with low scores among survivors and higher scores among non-survivors.Conclusions: MPI scores in the analysis were sharp predictor of mortality.

Health-related quality-of-life assessment in surgical patients with papillary thyroid carcinoma: A single-center analysis from Mainland China.

Even with a favorable prognosis, the health-related quality of life (HRQoL) of papillary thyroid carcinoma (PTC) patients remains unclear and conflicting. Thus, in the present study, we compared the HRQoL of PTC patients with that of the general population (GP).The study was performed in our thyroid and parathyroid surgery department, and 186 PTC patients who had undergone thyroidectomy were included. The exclusion criteria were an age < 18 years, no follow-up, and the presence of other malignant neoplasms. The control group included 186 volunteers who were matched by age, gender, and socioeconomic status. The survivor and control groups were asked to complete the Chinese version of the SF-36 questionnaire.The 186 volunteers from the GP were well matched to PTC patients with respect to the baseline demographic characteristics. PTC patients showed significantly lower scores than those of the control group in 7 domains of the HRQoL: role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE), and mental health (MH). PTC was a risk factor for a low Physical Component Summary (PCS) score and a low Mental Component Summary (MCS) score (all P values were less than .05). Significant reductions in the scores of all 8 domains were observed at 1 month after the operation, and obvious recovery was noted at 6 months according to the PCS and MCS scores (all P values were less than .05). However, even 2 years after surgery, few domain scores had recovered to levels found in the GP, including the PCS and MCS scores (all P values were less than .05).Due to the decreased preoperative and postoperative HRQoL scores, much attention should be given to and more long-term observation should be performed for PTC patients, even those who have undergone surgery.

Economic evaluations of comprehensive geriatric assessment in surgical patients: a systematic review

BackgroundSeniors presenting with surgical disease face increased risk of postoperative morbidity and mortality and have increased treatment costs. Comprehensive Geriatric Assessment (CGA) is proposed to reduce morbidity, mortality, and the cost after surgery. MethodsA systematic review of CGA in emergency surgical patients was conducted. The primary outcome was cost-effectiveness; secondary outcomes were length of stay, return of function, and mortality. Inclusion and exclusion criteria were predefined. Systematic searches of MEDLINE, Embase, Cochrane, and National Health Service Economic Evaluation Database were performed. Text screening, bias assessment, and data extraction were performed by two authors. ResultsThere were 560 articles identified; abstract review excluded 499 articles and full-text review excluded 53 articles. Eight studies were included; one nonorthopedic trauma and seven orthopedic trauma studies. Bias assessment revealed moderate to high risk of bias for all studies. Economic evaluation assessment identified two high-quality studies and six moderate or low quality studies. Pooled analysis from four studies assessed loss of function; loss of function decreased in the experimental arm (odds ratio 0.92, 95% confidence interval [CI]: 0.88-0.97). Pooled results for length of stay from five studies found a significant decrease (mean difference: −1.17, 95% CI: −1.63 to −0.71) after excluding the nonorthopedic trauma study. Pooled mortality was significantly decreased in seven studies (risk ratio: 0.78, 95% CI: 0.67-0.90). All studies decreased cost and improved health outcomes in a cost-effective manner. ConclusionsCGA improved return of function and mortality with reduced cost or improved utility. Our review suggests that CGA is economically dominant and the most cost-effective care model for orthogeriatric patients. Further research should examine other surgical fields.

Frailty syndrome: an overview

Frailty is a common and important geriatric syndrome characterized by age-associated declines in physiologic reserve and function across multiorgan systems, leading to increased vulnerability for adverse health outcomes. Two major frailty models have been described in the literature. The frailty phenotype defines frailty as a distinct clinical syndrome meeting three or more of five phenotypic criteria: weakness, slowness, low level of physical activity, self-reported exhaustion, and unintentional weight loss. The frailty index defines frailty as cumulative deficits identified in a comprehensive geriatric assessment. Significant progress has recently been made in understanding the pathogenesis of frailty. Chronic inflammation is likely a key pathophysiologic process that contributes to the frailty syndrome directly and indirectly through other intermediate physiologic systems, such as the musculoskeletal, endocrine, and hematologic systems. The complex multifactorial etiologies of frailty also include obesity and specific diseases. Major clinical applications include risk assessment and stratification. This can be applied to the elderly population in the community and in a variety of care settings. Frailty may also be useful for risk assessment in surgical patients and those with cardiovascular diseases, cancer, or human immunodeficiency virus infection, as well as for assessment of vaccine effectiveness in older adults. Currently, exercise and comprehensive geriatric interdisciplinary assessment and treatment are key interventions for frailty. As understanding of the biologic basis and complexity of frailty further improves, more effective and targeted interventional strategies and innovative geriatric-care models will likely be developed.

The Waterlow score for risk assessment in surgical patients

IntroductionPerioperative scoring systems aim to predict outcome following surgery and are used in preoperative counselling to guide management and to facilitate internal or external audit. The Waterlow score is used prospectively in many UK hospitals to stratify the risk of decubitus ulcer development. The primary aim of this study was to assess the potential value of this existing scoring system in the prediction of mortality and morbidity in a general surgical and vascular cohort.MethodsA total of 101 consecutive moderate to high risk emergency and elective surgical patients were identified through a single institution database. The preoperative Waterlow score and outcome data pertaining to that admission were collected. The discriminatory power of the Waterlow score was compared against that of the American Society of Anesthesiologists (ASA) grade and the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM).ResultsThe inpatient mortality rate was 17% and the 30-day morbidity rate was 29%. A statistically significant association was demonstrated between the preoperative Waterlow score and inpatient mortality (p<0.0001) and 30-day morbidity (p=0.0002). Using a threshold Waterlow score of 20 to dichotomise risk, accuracies of 0.84 and 0.76 for prediction of mortality and morbidity were demonstrated. In comparison with P-POSSUM, the preoperative Waterlow score performed well on receiver operating characteristic analysis. With respect to mortality, the area under the curve was 0.81 (0.80–0.85) and for morbidity it was 0.72 (0.69–0.76). The ASA grade achieved a similar level of discrimination.ConclusionsThe Waterlow score is collected routinely by nursing staff in many hospitals and might therefore be an attractive means of predicting postoperative morbidity and mortality. It might also function to stratify perioperative risk for comparison of surgical outcome data. A prospective study comparing these risk prediction scores is required to support these findings.

Risk assessment in surgical patients: balancing iatrogenic risks and benefits

Cutaneous procedures are associated with a wide variety of potential risks. This contribution discusses risk-related considerations in the preoperative, intraoperative, and postoperative management of dermatologic surgery patients. In the preoperative setting, major considerations include bleeding risks, the presence of pacemakers or defibrillators, risks of local and systemic infection, and the possibility of adverse reactions to local anesthetics and topical agents used for dermatologic procedures. Risk is minimized intraoperatively through careful attention to sterile technique, maintaining adequate hemostasis, skillful management of emerging complications, and effective closure of surgical defects. To optimize outcomes, postoperative priorities include effective management of postoperative bleeding, appropriate wound care, and prevention and treatment of hypertrophic scars and keloids. Reducing the likelihood of adverse surgical outcomes requires identification of potential risk factors and case-specific approaches to minimize risks while simultaneously preparing for the possibility of complications.

Agreement and association between the phase angle and parameters of nutritional status assessment in surgical patients.

To assess the agreement and the association between phase angle (PA) and parameters of nutritional status in surgical patients. This was a cross-sectional study that involved 98 patients admitted for elective gastrointestinal or hernia repair surgery. The risk and nutritional status were evaluated through Nutritional Risk Screening 2002 (NRS 2002), Subjective Global Assessment (SGA), Body Mass Index (BMI) and Total Lymphocytes Count (TLC). These assessments were compared with the mean standardized PA (SPA), obtained by Bioelectrical Impedance Analysis (BIA). Statistical analysis included kappa coefficient, Student's t-test, Mann-Whitney test, and the construction of a ROC Curve. The highest kappa agreement was obtained between the SPA and the SGA (0.27; CI95% 0.06-0.48). Malnourished patients diagnosed by NRS 2002, SGA and TLC had a significantly lower mean SPA as compared to those who were well-nourished. A cut-off point of 0.8 for SPA showed 82.6% (CI95% 65.0-100.0%) sensitivity and 40.6% (CI95% 23.0-58.2%) specificity. The SPA presented weak agreement with the methods of nutritional assessment, as well as low specificity, and could not be recommended as a marker of nutritional status, despite the fact that the lowest values for SPA were found in malnourished patients.

Education of Medical and Nursing Staff Regarding Pain Assessment in Surgical Patients Results in Improved Documentation and Treatment

PURPOSE: Evidence based documentation of improved outcomes with Education of Medical and Nursing staff regarding pain assessment and treatment is lacking. We hypothesized that such education would result in better documentation by medical staff and increased treatment of pain by nursing staff on surgical patients at an urban community hospital.

Validation of the BCLC Prognostic System in Surgical Hepatocellular Cancer Patients

Background/Aim Prognosis assessment in surgical patients with hepatocellular carcinoma (HCC) remains controversial. The most widely used HCC prognostic tool is the Barcelona Clinic Liver Cancer (BCLC) classification, but its prognostic ability in surgical patients has not been yet validated. The aim of this study was to investigate the value of known prognostic systems in 400 Italian HCC patients treated with radical surgical therapies. Methods We analyzed a prospective database collection (400 surgical, 315 nonsurgical patients) observed at a single institution from 2000 and 2007. By using survival times as the only outcome measure (Kaplan–Meier method and Cox regression), the performance of the BCLC classification was compared with that of Okuda, Cancer of the Liver Italian Program, United Network for Organ sharing TNM, and Japan Integrated Staging Score staging systems. Results Two hundred twenty-five patients underwent laparotomy resection; 55, laparoscopic procedures (ablation and/or resection); and 120, liver transplantations. In the surgical group, BCLC proved the best HCC prognostic system. Three-year survival rates of patients in BCLC Stages A, B, and C were 81%, 56%, and 44% respectively, ( P < .01); whereas all other tested staging systems did not show significant stratification ability. When all 715 HCC patients were considered, surgery proved to be a significant survival predictor in each BCLC stage (A, B, and C). Conclusions BCLC staging showed the best interpretation of the survival distribution in a surgical HCC population. The BCLC treatment algorithm should consider the role of surgery also for intermediate-advanced stages of liver disease.