Better Patient Quality Of Life Research Articles

Spirituality in advanced cancer: implications for care in oncologic emergencies.

Spirituality-defined as "the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred"-plays important roles in the setting of serious illnesses such as cancer. The nature of oncologic emergencies, with their attendant imminent threat to life and urgent medical decision-making, renders more salient the frequent role of spirituality in the context of coping, spiritual needs, and medical decisions. Furthermore, these roles highlight the importance of spiritual care: recognition of and attention to patients' and their family's spirituality within medical care. Extant palliative care quality guidelines include spiritual care as a core domain of palliative care provision. Generalist spiritual care requires spiritual history-taking by clinicians and respect and integration of spirituality and spiritual values into medical care. Specialty spiritual care involves the integration of professionally trained spiritual care providers into the care of patients facing oncologic emergencies. Spiritual care is associated with better patient quality of life and greater transitions to more comfort-focused care; among family caregivers, it is associated with greater care satisfaction. Spiritual care is always patient-centered, and hence can be provided by clinicians regardless of their spiritual backgrounds. The integration of spiritual care into the care of patients and their families holds promise to advance holistic care and improve well-being in this setting of oncologic emergencies.

LANGaware: biomarker workflows for classifying neurodegenerative and affective disorders across languages and severity levels

AbstractBackgroundA wide range of neurodegenerative disorders impair communication faculties, manifested as subtle changes in speech and language. Following trends in Machine Learning (ML), Text and Multimedia Analysis, recent works pursue classification of such disorders by developing biomarkers useful for cognitive status description. However, investigations that gauge biomarker applicability on cases of radically different impairment / symptom severity have been under‐investigated. In this work, we build upon previous research and evaluate LANGaware’s biomarker suite in the drastically different tasks of Dementia and Depression classification. For both cases, we use appropriate Healthy Controls and evaluate the proposed biomarker workflow under a multi‐language experimental investigation.MethodWe utilize audio recordings and transcripts from patient responses to verbal cognitive assessment tasks. These are analyzed with LANGaware’s multimodal biomarker pool, mapping raw data to biomarkers scores that quantify vocal, linguistic and grammatical usage proficiency, structure and patterns, by applying both statistical analysis and explainable template matching. Biomarkers activations are fed to ML workflows composed of gradient boosting learners that employ feature selection, filtering and ensemble‐based learning to arrive at configurations best suited for discriminating the disorder of interest. The pipeline is evaluated using a standard train‐test and cross‐validation setup.ResultExperimental results indicate that our method achieves weighted F1 test scores of 82.49% for Greek Dementia classification, using a train / test dataset of 1271 / 624 instances and 80.28% on 570 / 243 English data. We use the same pipeline and biomarker pool for Depression classification, reaching 74.03% and 71.36% performance scores, obtained from 73 / 31 and 652 / 42 available train‐test data, for Greek and English respectively.ConclusionThe above findings show that the proposed biomarker pool generalizes across neurodegenerative and affective disorders of radically different severity. As a result, they constitute valuable decision support tools for accurate, automatic and explainable early diagnosis, facilitating proactive care, improved symptom management and better patient quality of life. Future research efforts include extending our experimental evaluation of LANGaware biomarkers to additional disorders and diseases, as well as expanding the biomarker set to enable analysis of additional modalities.

Acellular Fish Skin for Tissue Replacement.

In modern practice, xenografts play a crucial role in wound management due to their regenerative properties. Of the various xenografts currently available on the market, acellular fish skin (AFS) grafts have emerged as a more effective alternative to existing xenografts and other standard of care (SOC) treatments for wound healing. Since AFS grafts require minimal processing, they maintain their structural integrity and natural properties, including an abundance of Omega-3 fatty acids, which is a distinctive, pro-regenerative feature. AFS grafts are also unique in that they are not derived from mammalian tissue, so there is no risk of viral transmission and no cultural or religious barriers to use. AFS grafts have been shown to be more cost-effective in the treatment of diabetic foot ulcers (DFUs) and result in a higher percentage of healed wounds, fewer amputations, and better patient quality of life. Several studies and case reports have highlighted the versatility of AFS in not only acute and chronic wound healing, but also for burn wound skin regeneration. Additionally, AFS may have promise as an implantable biologic matrix for suture line reinforcement in hernia repairs or breast and dura reconstruction.

Targeted Epigenetic Interventions in Cancer with an Emphasis on Pediatric Malignancies.

Over the past two decades, novel hallmarks of cancer have been described, including the altered epigenetic landscape of malignant diseases. In addition to the methylation and hyd-roxymethylation of DNA, numerous novel forms of histone modifications and nucleosome remodeling have been discovered, giving rise to a wide variety of targeted therapeutic interventions. DNA hypomethylating drugs, histone deacetylase inhibitors and agents targeting histone methylation machinery are of distinguished clinical significance. The major focus of this review is placed on targeted epigenetic interventions in the most common pediatric malignancies, including acute leukemias, brain and kidney tumors, neuroblastoma and soft tissue sarcomas. Upcoming novel challenges include specificity and potential undesirable side effects. Different epigenetic patterns of pediatric and adult cancers should be noted. Biological significance of epigenetic alterations highly depends on the tissue microenvironment and widespread interactions. An individualized treatment approach requires detailed genetic, epigenetic and metabolomic evaluation of cancer. Advances in molecular technologies and clinical translation may contribute to the development of novel pediatric anticancer treatment strategies, aiming for improved survival and better patient quality of life.

Comparison of laparoscopic adnexal mass extraction via the transumbilical and transvaginal routes

This study was performed to compare the transumbilical (TU) and transvaginal (TV) routes for adnexal mass removal from the abdominal cavity. Data from 93 women who underwent laparoscopic (LS) surgery for the removal of benign adnexal masses at three centres between January 2016 and December 2020 were examined retrospectively. The specimen retrieval times in the TU and TV groups were 9.0 ± 2.0 and 9.8 ± 2.5 min, respectively (p = .373). Additional analgesic was required in 13.8% and 14.3% of cases in the TU and TV groups, respectively. The mean 3-month (2–4 months) postoperative visual analogue scale (VAS) score was lower in the TV group than in the TU group. The postoperative vaginal length did not differ between the TU and TV groups (8.9 (8.7–9.1) vs. 8.7 (8.4–9.1) cm; p = .465). Oophorectomy and the TU route were found to be independent risk factors for the worsening of the VAS score. Sexual function index scores were similar in the two groups. The TV method for specimen removal in LS surgery may cause less pain in the early postoperative period and less dyspareunia in the later period without shortening the length of the vagina. Impact Statement What is already known on this subject? Compared with open procedures, minimally invasive surgery (MIS) is associated with faster recovery times, better patient quality of life and lower postoperative complication rates. The removal of an adnexal mass from the abdominal cavity is performed most commonly using the suprapubic, transumbilical (TU) or transvaginal (TV) route. What do the results of this study add? The specimen retrieval times in the TU and TV groups were 9.0 ± 2.0 and 9.8 ± 2.5 min, respectively (p = .373). The mean 3-month (2–4 months) postoperative visual analogue scale (VAS) score was lower in the TV group than in the TU group. Oophorectomy and the TU route were found to be independent risk factors for the worsening of the VAS score. Sexual function index scores were similar in the two groups. What are the implications of these findings for clinical practice and/or further research? In conclusion, specimen removal via the TV route in LS surgery may cause less pain in the early postoperative period and less dyspareunia in the later period without reducing the length of the vagina.

Priority levels in cancer patients admitted to medical intensive care at a safety net hospital.

e18599 Background: Admissions of cancer patients to intensive care units (ICU) are increasing with improved mortality. While ICU care can be lifesaving, its higher cost does not always result in reduced mortality. Moreover, timely goals of care (GOC) discussions correlate with less ICU use in those with certain cancers. We investigate if hospital mortality and disposition outcomes for cancer patients correlate to triage by ICU providers. Methods: This subgroup analysis of a prospective cohort of 808 patients admitted to the ICU from 1 July 2015- 15 June 2016 at an academic safety net hospital included 106 patients diagnosed with cancer. Medical records were reviewed by ICU physicians, who assigned priority ranks using Society of Critical Care Medicine guidelines: 1: critically ill, needing treatment/monitoring not provided outside of ICU, 2: not critically ill, but requiring close monitoring/potentially immediate intervention, 3: critically ill patients with reduced likelihood of recovery, 4: not appropriate for ICU, equivalent outcomes achieved with non-ICU care. We did a chart review for factors like prior therapy and documentation of GOC discussions. Statistical tests were conducted to examine if priority levels correlate with disposition, mortality, and length of stay (LOS). Results: χ2-tests revealed priority rank correlated with disposition after hospitalization (p<.05) with group 3 having the highest proportion of deaths and lowest proportion of discharges home. It revealed that mortality rate differed by group (p<.05) with logistic regression showing that priority 3 predicted increased mortality (p<.05). ANCOVA indicated ICU LOS differed by priority group (p<.05), with priority 3 averaging the longest LOS. While priority 3 had the most in-hospital GOC discussions, relatively few were documented pre-hospitalization. Conclusions: Overall, our patients were accurately triaged, with worse mortality and discharge outcomes among priority 3 and a dearth of pre-hospitalization GOC documentation for all groups. Our data show the importance of triaging patients and having early, frequent GOC discussions to minimize ICU admission given increasing demand and costs. GOC discussions are associated with less aggressive medical care near death and better patient quality of life. Thus, holding these talks with our sickest patients prior to potential ICU admission is an area to improve cost-effective high quality care.[Table: see text]

Stronger therapeutic alliance is associated with better quality of life among patients with advanced cancer.

Patient-oncologist therapeutic alliance is a foundation of quality cancer care, although there is limited research demonstrating its relationship with patient outcomes. We investigated the relationship between therapeutic alliance and patient quality of life with a secondary goal of determining whether the association varied by patients' baseline level of psychological distress. Cross-sectional analysis of baseline data from a randomized clinical trial of 672 patients with advanced cancer participating in a primary palliative care intervention trial. Patients completed baseline self-reported measures of therapeutic alliance (The Human Connection Scale, range: 16-64), overall quality of life (Functional Assessment of Cancer Therapy-Palliative Care, range: 0-184), and psychological distress (Hospital Anxiety and Depression Scale, range: 0-42). First, we determined the relationship between therapeutic alliance and quality of life using multivariable regression adjusting for confounders. We then examined if psychological distress was an effect modifier in this relationship by adding interaction effects of depression and anxiety symptoms on therapeutic alliance into the regression model. Patients reported high levels of therapeutic alliance (56.4±7.4) and moderate quality of life (130.3±25.5). Stronger therapeutic alliance was associated with better quality of life after adjusting for other confounding factors (β=3.7, 95% confidence interval=2.1, 5.3, p<0.01). The relationship between therapeutic alliance and quality of life was generally consistent regardless of psychological distress. Collaborative, trusting relationships between patients with advanced cancer and their oncologists are associated with better patient quality of life. Future research should investigate the causal, longitudinal nature of these relationships.

Comparison of the short-term efficacy and serum markers between lobaplatin/paclitaxel- And carboplatin/paclitaxel-based adjuvant chemotherapy in patient with ovarian cancer.

To compare short-term therapeutic efficacies and related changes of serum markers from two chemotherapeutic regimes using lobaplatin or carboplatin in combination with paclitaxel in ovarian cancer patients after cytoreductive surgery. 120 patients were recruited with pathologically confirmed ovarian cancer. Patients were equally and randomly divided into two groups receiving paclitaxel (PTX) with lobaplatin (LBP) or carboplatin (CBP, as control), respectively, 21days as a cycle for 6 cycles. Follow-up was performed for 6months post-treatment. The therapeutic efficacy, serum levels of CA125 (cancer antigen 125/ mucin 16) and HE4 (Human epididymis protein 4) as well as the quality of life were assessment before and after treatment. No significant difference in therapeutic efficacy was observed between the groups (P>.05). The response rates at 1, 3 and 6months were 76.7%, 66.7% and 46.7% in the LBP group and 73.3%, 63.3% and 36.7% in the CPB group, respectively. At the end of chemotherapy, serum levels of HE4 and CA125 in both groups returned to normal. However, patients in the LBP group had significantly lower HE4 and CA125 levels than those in the CPB group when examined at 3 or 6months after chemotherapy (P<.05). Moreover, at the end of follow-up, the quality-of-life score (QLQ-C30) of the LBP group was better than that of the CBP group with statistical significance (P<.05). Both lobaplatin and carboplatin have decent anti-tumour efficacy to be involved in the standard platinum/paclitaxel-based chemotherapy against ovarian cancer. Lobaplatin, on the other hand, has demonstrated higher efficacy to control the progress of the disease yet less toxicity to warrant better patient quality of life.

Radiation therapy for advanced canine nasal planum squamous cell carcinoma: case report

ABSTRACT This case report describes the outcome of treatment of dogs with advanced (deeply invasive) nasal planum squamous cell carcinomas with palliative or definitive radiation therapy. All dogs were diagnosed with nasal planum squamous cell carcinoma by histopathology, and their owners declined aggressive surgery. Dogs were treated with a cobalt-60 unit, definitive-intent radiation protocol consisting of 15 daily fractions (Monday-Friday) of 2.8 Gy, and palliative radiation protocol consisting of 4 fractions of 8 Gy performed once a week. Three dogs had T3 tumors and three had T4 tumors according to the WHO staging system. Two dogs had tumor complete remission and four had tumor partial remission. Survival time of dogs submitted to radiation therapy was 95-417 days. Radiation acute side effects involved only mild epilation and cutaneous erythema in palliative protocols, and moist desquamation, epilation, mild rhinitis and oral mucositis in definitive-intent RT. Radiation therapy, especially palliative protocols, can be a treatment option for nasal planum squamous cell carcinoma in dogs, when the owner declines aggressive surgery. It may contribute to partial or complete tumor remission and better patient quality of life, even at advanced stages, leading to mild side effects.

Incorporating 4DCT-Based Elasticity Information As a Regional Physiological Representation for Function Preserving Lung SBRT Treatment Planning

Recent advancements in radiotherapy treatment delivery techniques have led to the ability to develop treatment plans that can intelligently spare the most functional normal tissue. Specifically, for lungs, such a treatment plan can greatly improve patient’s quality of life. There is a need for a CT-based lung functional biomarker that can be used for function-preserving treatment planning to reduce lung toxicity after radiation therapy. Lung tissue elasticity has been shown to correlate with overall lung tissue function. The purpose of this study is to investigate the feasibility of avoiding functional lung regions characterized by 4DCT-derived lung tissue elasticity to minimize functional lung dose during stereotactic body radiotherapy (SBRT) treatment planning. 4DCT-based lung elastography was used to retrospectively derive elasticity information for 7 lung cancer patients treated with SBRT. All patients had early and late stage COPD as classified by GOLD 2017. Functional lung tissue was empirically determined to be the lung parenchymal tissue with elastic moduli between 4 and 8 kPa. Clinical and functional avoidance SBRT plans were developed, with the latter having additional constraints in order to preferentially spare the functional lung tissue. Plans were accepted once they met all TG-101 normal tissue constraints. The plan quality was evaluated for both clinical and functional plans by comparing target coverage and max OAR dose. Dose-volume and dose-function metrics were also investigated. Functional-avoidance plans were able to evade functional lung regions while maintaining target coverage and strict normal tissue constraints. While the plan quality was similar between functional and clinical plans, dose volume and dose function metrics illustrated a decrease in dose to functional and total lung volumes. More improvements in the planned dose distributions were seen in patients with mild stage COPD as compared to late stage COPD patients. With lung tissue elasticity providing patient-specific maps of spatial function and physiology, clinically relevant function-preserving SBRT plans were developed for 7 patients. This study has shown that is feasible to develop functional-tissue sparing SBRT plans that preferentially spare the functional lung tissue while maintaining clinically acceptable plan quality. The avoidance of elasticity-defined functional lung tissue in radiotherapy has the potential to lead to less radiation-induced toxicity after radiotherapy treatment, and better patient quality of life.

Heparosan-coated liposomes for drug delivery.

Liposomal encapsulation is a useful drug delivery strategy for small molecules, especially chemotherapeutic agents such as doxorubicin. Doxil® is a doxorubicin-containing liposome ("dox-liposome") that passively targets drug to tumors while reducing side effects caused by free drug permeating and poisoning healthy tissues. Polyethylene glycol (PEG) is the hydrophilic coating of Doxil® that protects the formulation from triggering the mononuclear phagocyte system (MPS). Evading the MPS prolongs dox-liposome circulation time thus increasing drug deposition at the tumor site. However, multiple doses of Doxil® sometimes activate an anti-PEG immune response that enhances liposome clearance from circulation and causes hypersensitivity, further limiting its effectiveness against disease. These side effects constrain the utility of PEG-coated liposomes in certain populations, justifying the need for investigation into alternative coatings that could improve drug delivery for better patient quality of life and outcome. We hypothesized that heparosan (HEP; [-4-GlcA-β1-4-GlcNAc-α1-]n) may serve as a PEG alternative for coating liposomes. HEP is a natural precursor to heparin biosynthesis in mammals. Also, bacteria expressing an HEP extracellular capsule during infection escape detection and are recognized as "self," not a foreign threat. By analogy, coating drug-carrying liposomes with HEP should camouflage the delivery vehicle from the MPS, extending circulation time and potentially avoiding immune-mediated clearance. In this study, we characterize the postmodification insertion of HEP-lipids into liposomes by dynamic light scattering and coarse-grain computer modeling, test HEP-lipid immunogenicity in rats, and compare the efficacy of drug delivered by HEP-coated liposomes to PEG-coated liposomes in a human breast cancer xenograft mouse model.

PET/CT with 18F–choline: Physiological whole bio-distribution in male and female subjects and diagnostic pitfalls on 1000 prostate cancer patients: 18F–choline PET/CT bio-distribution and pitfalls. A southern Italian experience

IntroductionThe 11C/18F–choline is a PET/CT radiopharmaceutical useful in detecting tumors with high lipogenesis. 11C/18F–choline uptake can occur in physiological conditions or tumors. The knowledge of its bio-distribution is essential to recognize physiologic variants or diagnostic pitfalls. Moreover, few information are available on the bio-distribution of this tracer in female patients. Our aim was to discuss some documented 18F–choline PET/CT pitfalls in prostate cancer patients. Our secondary aim was to describe the 18F–choline bio-distribution in the female body. MethodsWe collected diagnostic pitfalls in three PET centers examining 1000 prostate cancer by 18F–choline PET/CT. All pitfalls were ensured by follow-up, imaging and/or histology. We also performed whole body 18F–choline PET/CT in 5 female patients. Results169/1000 (16.9%) patients showed pitfalls not owing to prostate cancer. These findings were due to inflammation, benign tumors while, in 1% of examined patients, a concomitant neoplasm was found. In the female body, the breast showed low physiological uptake. ConclusionsThe accurate knowledge of 18F–choline PET/CT bio-distribution and diagnostic pitfalls is essential. Correlative imaging and histological exam are often necessary to depict pitfalls. In women, the uptake in the breast is due to the physiological gradient of 18F–choline uptake in the exocrine glands. Advances in knowledgeOur results confirm the possibility of 18F–choline uptake in several diseases other than prostate cancer. However, our experience was acquired on a large population and shows that a conspicuous amount of 18F–choline diagnostic pitfalls are easily recognizable and attributable to inflammation. A new advance in knowledge is the minimal difference in terms of physiological tracer bio-distribution between male and female patients. Implications for patient careThe knowledge of the physiological bio-distribution and of the potential pitfalls linked of a tracer could help physicians to choose the best diagnostic and therapeutic approaches for a better patient quality of life.

Panhysterectomies-A Comparison of Perioperative Care of Abdominal and Laparoscopic

Background: To explore the curative effects of laparosopic panhysterectomies and summarize perioperative care experience.Methods: Forty cases of perioperative hysterectomy, twenty laparoscopic hysterectomies and twenty abdominal hysterectomies were selected for a controlled analysis of treatment efficacies of different nursing measures.Results: Laparoscope surgery durations were longer than abdominal surgery durations. Laparoscopic surgery had lesser bleeding, quicker postoperative ambulation times, shorter intestinal bowel function recovery times, lower patient stress, better patient quality of life, shorter hospitalization stays, and reduced patient economic burdens. Laparoscopic surgery resulted in fewer postoperative complications, reduced nursing care, which improved care effectiveness, and significantly increased patient satisfaction with nursing care.Conclusion: Laparoscopic panhysterectomies have advantages, including smaller abdominal incisions, shorter hospital stays, improved bed turnover rates, low infection rates, and fast recovery. Its curative effect is superior to the abdominal hysterectomy and it is more suitable clinically. Increased patient supervision and care given during the perioperative period facilitates post-operative healing.

IP169. Revascularization of Smokers With Claudication Is Associated With Better Patient Quality of Life Despite Higher Failure Risk

IP169. Revascularization of Smokers With Claudication Is Associated With Better Patient Quality of Life Despite Higher Failure Risk

The Antidepressant Effect of Hospice: Need for a More Potent Prescription.

The Antidepressant Effect of Hospice: Need for a More Potent Prescription.

Ipsilateral Versus Contralateral Hamstring Grafts in Anterior Cruciate Ligament Reconstruction

Background: Benefits of graft harvest from the side contralateral to the anterior cruciate ligament (ACL)–deficient leg have been identified when using bone–patellar tendon–bone autografts in ACL reconstruction (ACLR). As hamstring tendon autografts are becoming more commonly used, a study examining the effect of contralateral graft harvest of semitendinosus gracilis (STG) tendons on patient quality of life was conducted. Purpose: To evaluate if ACLR using a hamstring tendon autograft results in better patient quality of life if the graft is harvested from the leg contralateral to the ACL rupture compared with the ipsilateral leg. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 100 participants between 16 and 50 years of age with a complete ACL tear were randomly assigned to undergo ACLR using either the ipsilateral or contralateral leg as the STG graft donor. Primary outcome measures were the ACL Quality of Life questionnaire (ACL-QOL), concentric knee flexion and extension strength at 60 and 240 deg/s, International Knee Documentation Committee (IKDC) knee assessment form, early postoperative pain and diary of analgesic use, and rate of reruptures. Outcome measures were evaluated before surgery and at 3, 6, 12, and 24 months after surgery. Results: The ACL-QOL score improved over time for both groups (P < .001), and there were no significant differences between groups at any time point (P = .528). Significant differences in knee flexion and extension strength were found at 3 months after surgery. There were no differences between groups in IKDC knee assessment scores or rerupture rates. Conclusion: There does not appear to be any measurable benefit or drawback in quality of life to the use of an STG graft from the unaffected limb. In light of this finding, further research to examine other possible effects on agility and balance as well as time and ability to return to sport should be conducted. Longer term follow-up beyond 2 years would allow for a more thorough evaluation of the risk of reruptures or contralateral reruptures using this novel approach.

Antiretroviral therapy in HIV-infected patients: a proposal to assess the economic value of the single-tablet regimen

BackgroundThe aim of this study was to assess the economic value of a reduced number of pills in patients infected with the immunodeficiency virus (HIV) and on highly active antiretroviral therapy by a cost-effectiveness model.MethodsAn incremental cost-effectiveness analysis of efavirenz, tenofovir, and emtricitabine (TDF-FTC-EFV) as a single-tablet regimen versus a multipill regimen, with reference to untreated HIV-infected patients, was carried out from the perspective of the Italian National Health Service. The comparisons were performed with the help of a Markov decision model over a 10-year time horizon. Based on the ADONE (ADherence to ONE pill) study, it was then possible to identify the utility score increment in patients switching from a multipill regimen of TDF-FTC + EFV therapy to a single-tablet regimen.ResultsThe single-tablet regimen (0.755 quality-adjusted life-years [QALYs]/year) resulted in better patient quality of life, with a higher number of QALYs than for the TDF-FTC + EFV multipill regimen (0.716 QALYs/year). The single-tablet regimen was the most cost-effective treatment strategy, with an incremental cost-effectiveness ratio of €22,017.00 versus €26,558.00 for the multipill regimen. A 24% decrease in cost of the multipill regimen determined equivalence with the single-tablet regimen in terms of the incremental cost-effectiveness ratio. Univariate sensitivity and probabilistic analysis carried out on the main variables did not highlight significant variations with respect to the base case scenario.ConclusionThe single-tablet regimen resulted in better adherence, and therefore better quality of life as perceived by patients, corresponding to a €4541.00 lower cost-effectiveness ratio per QALY versus the multipill regimen, with a 17% lower cost in favor of the single-tablet regimen. The value determined could be used to identify a maximum potential “premium price” of 29% to be assigned to therapeutic regimens proposing a single-tablet regimen for HIV-infected patients.

Cost utility of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

Early laparoscopic cholecystectomy for acute cholecystitis is safe and effective. However, the potential cost savings of this management strategy have not been well studied in a North American context. This study aimed to estimate the cost effectiveness of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy in Canada. A decision analytic model estimating and comparing costs from a Canadian providing institution after either early or delayed laparoscopic cholecystectomy was used. The health care resources consumed were calculated using local hospital data, and outcomes were measured in quality-adjusted life years (QALYs) gained during 1 year. Uncertainty was investigated with one-way sensitivity analyses, varying the probabilities of the events and utilities. Early laparoscopic cholecystectomy was estimated to cost approximately $2,000 (Canadian dollars) less than delayed laparoscopic cholecystectomy per patient, with an incremental gain of approximately 0.03 QALYs. Sensitivity analysis showed that only extreme values of bile duct injury or bile leak altered the direction of incremental gain. Adoption of a policy in favor of early laparoscopic cholecystectomy will result in better patient quality of life and substantial savings to the Canadian health care system.

Smoking affects quality of life in patients with oral squamous cell carcinomas

Smoking is a causative factor in oral squamous cell carcinomas (SCC). Unfortunately, only poor data exist regarding the quality of life of smokers vs non-smokers with SCC. The purpose of this study is to show a correlation between variables for comprehensive interdisciplinary rehabilitation and better patient quality of life (LQ). A total collective of 1,761 patients from 38 hospitals within the German-language area of Germany, Austria and Switzerland (DÖSAK-REHAB-STUDIE) yielding 1,652 patients' questionnaires containing 147 items were evaluated. They refer to the periods before (t1) and immediately after surgery (t2), as well as at least 6months later (t3). LQ was determined by the patient and ranges from 0% to 100%. Significant differences were found between smokers (80%) and non-smokers (20%) with respect to diagnosis, therapy and rehabilitation. Disabilities and impairments in speech, appearance, chewing/swallowing, pain and LQ were examined. Smokers were more often and more severely affected. Differences were found in the size of the tumour, scar tissue, ingestion, functionality of the facial muscles and a numb feeling in the head and shoulder area. Smoking has a severe effect on the oral cavity. Non-smokers suffer far less from the effects of SCC and the ensuing therapy. During therapy and rehabilitation, the LQ is much higher in non-smokers. This supports the importance of enhanced efforts to inform people about the consequences of smoking so as to prevent them from smoking. Moreover, psychological support might be helpful to give up smoking.

Die Hartmann-Operation bei perforierter Divertikulitis und maligner linksseitiger kolorektaler Obstruktion und Perforation

This review comments on the question whether laparoscopic techniques and interventional strategies have in the last ten years changed the emergency management of perforated diverticulitis and malignant colorectal obstruction or perforation with regard to the broad spectrum of indications for Hartmann's procedure (HP). Colon resection with primary anastomosis and defunctioning stoma is the optimal strategy for patients with perforated diverticulitis. HP should be considered for older patients with multiple comorbidities, realising that restoration of bowel continuity is no longer an issue. Laparoscopic peritoneal lavage is an alter-native to HP in Hinchey-III diverticulitis with promising results in experienced centers which should be further evaluated. OBSTRUCTIVE / PERFORATED LEFT-SIDED COLORECTAL CANCER: In perforated left-sided colorectal cancer HP may be generously indicated. In malignant obstruction, however, a temporary colostomy or -colonic stenting in case of appropriate expertise has been suggested as preoperative treatment -before elective surgery, allowing higher rates of RPA. HP remains relevant, especially in high-risk patients and after hours and during the weekend, when the most experienced surgeon is not always available. However, subspecialised colorectal surgeons obtain with single-stage resection in this situation at least comparable results with respect to morbidity and mortality, but better patient quality of life.