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1.
Alexandre Chan Deren Soh Yu Ko Yu-Chu Huang Joen Chiang 《Supportive care in cancer》2014,22(7):1875-1881
Background
Studies have examined drug-related problems (DRPs) that have led to hospital admissions in the general population. However, there is a lack of information on the characteristics of DRPs in the cancer population.Objective
The objective of this study was to investigate the type, causality, severity, and preventability of DRPs that result in unplanned hospitalizations among cancer patients.Methods
This was a prospective, cohort study conducted in two oncology wards between July and December 2012. All patients who were diagnosed with solid tumor or lymphoma and required unplanned hospitalization were included. The incidence of DRPs among hospital admissions was captured, and the nature of the DRPs (causality, severity, and preventability) was characterized.Results
There were 1,299 admissions and 1,275 were eligible for analysis. Among the 1,275 eligible admissions, 158 (12.4 %) were considered to be associated with a DRP. In the 158 admissions associated with DRPs, 164 DRPs were found. The majority of the DRP-related admissions were adverse drug reactions (ADRs) (n?=?155/164, 94.5 %), probable (n?=?98, 59.8 %), moderately severe (n?=?155, 94.5 %), and probably or definitely preventable (n?=?86, 52.4 %). Most patients with DRPs recovered and were discharged. Febrile neutropenia was the most common adverse drug reaction, and drug combinations involving antihypertensives and long-term corticosteroids raised the risks for potential drug-drug interactions among patients with cancer.Conclusion
The incidence of DRP-induced unplanned hospital admissions was 12.4 % among cancer patients. Approximately half of these were preventable events. 相似文献2.
3.
Purpose
Despite the recognized relevance of symptom burden in breast cancer, there has been limited exploration of whether an individual patient's assessment of the overall quality of care received might influence outcome. We therefore evaluated the relationship between patient-reported satisfaction with service quality and survival in breast cancer.Methods
A random sample of 1,521 breast cancer patients treated at Cancer Treatment Centers of America. A questionnaire which covered several dimensions of patient satisfaction was administered. Items were measured on a seven-point Likert scale ranging from “completely dissatisfied” to “completely satisfied”. Univariate and multivariate Cox regression was used to evaluate the association between patient satisfaction and survival.Results
Of 1,521 patients, 836 were newly diagnosed, and 685 had previously been treated. A number of 409, 611, 323, and 178 patients had stage I, II, III, and IV disease, respectively. A total of 1,106 (72.7 %) patients were completely satisfied with the overall service quality, while 415 (27.3 %) were not. On univariate analysis, completely satisfied patients had a significantly lower risk of mortality compared to those not completely satisfied (HR?=?0.62; 95 % CI 0.50–0.76; p?<?0.001). On multivariate analysis, completely satisfied patients demonstrated significantly lower mortality (HR?=?0.71; 95 % CI 0.57–0.87; p?=?0.001) compared to those not completely satisfied.Conclusions
Patient satisfaction with service quality was an independent predictor of survival in breast cancer. Further exploration of a possible meaningful relationship between patient satisfaction with the care they receive and outcomes in breast cancer is indicated. 相似文献4.
5.
Irene P. Jongerden Arjen J. Slooter Linda M. Peelen Hester Wessels Colette M. Ram Jozef Kesecioglu Margriet M. Schneider Diederik van Dijk 《Intensive care medicine》2013,39(9):1626-1634
Purpose
To determine to what extent intensive care unit environment affects family and patient satisfaction.Methods
A before–after study was performed in one university hospital in The Netherlands, 2 months before and 2 months after the migration of an intensive care unit (ICU) with multiple beds on a ward to a newly built ICU with all single rooms. Family and patient satisfaction were determined by two surveys: family satisfaction with care in the ICU and patient satisfaction with care in the ICU, respectively.Results
From 387 of 617 (63 %) discharged patients at least one survey (patient and/or family) was returned. Both family and patients were more satisfied with their overall ICU experience in the new ICU as compared with the old ICU. Mean scores for family satisfaction increased from 69.5 [standard deviation (SD) 16.6] to 74.1 (SD 15.2) for old and new ICU, respectively (p = 0.02). For patients, satisfaction rates increased from 63.6 (SD 18.9) to 69.6 (SD 18.3) for old and new ICU, respectively (p = 0.02). The largest differences on single items of the surveys were noted on environmental aspects.Conclusions
This is the first study to quantify the effect of ICU environment on family and patient satisfaction. Family and patient satisfaction with ICU experience increased by 6 % in the new ICU environment with noise-reduced, single rooms with daylight, adapted colouring and improved family facilities. 相似文献6.
Maryam Mousavi Alireza Hayatshahi Amir Sarayani Molouk Hadjibabaie Mohammadreza Javadi Hassan Torkamandi Kheirollah Gholami Ardeshir Ghavamzadeh 《Supportive care in cancer》2013,21(12):3441-3448
Purpose
Parenteral nutrition (PN) is a well-documented supportive care which maintains the nutritional status of patients. Clinical pharmacists are often involved in providing PN services; however, few studies have investigated the effect of a clinical pharmacy-based PN service in resource-limited settings.Methods
We designed a randomized clinical trial to compare the clinical pharmacist-based PN service (intervention group) with the conventional method (control group) for adult patients undergoing hematopoietic stem cell transplantation in Shariati Hospital, Tehran, Iran (2011–2012). In the intervention group, the clinical pharmacists implemented standard guidelines of nutrition support. The conventional method was a routine nutrition support protocol which was pursued for all patients in the bone marrow transplantation wards. Main study outcomes included nutritional status (weight, albumin, total protein, pre-albumin, and nitrogen balance), length of hospital stay, time to engraftment, rate of graft versus host disease, and mortality rate. Patients were followed for 3 months.Results
Fifty-nine patients were randomly allocated to a study group. The overall intake (oral and parenteral) in the control group was significantly lower than standard daily needed calories (P?<?0.01). Patients in the intervention group received fewer days of PN (10.7?±?4.2 vs. 18.4?±?5.5 days, P?<?0.01). All nutritional outcomes were either preserved or improved in the intervention group while the nutritional status in the control group was deteriorated (P values?<?0.01). Length of hospital stay was significantly shorter in the intervention group (P?<?0.01). Regarding PN complications, hyperglycemia was observed more frequently in the intervention group (34.5 %, P?=?0.01). Two patients in the control group expired due to graft versus host disease at the 3-month follow-up.Conclusion
A clinical pharmacist-based nutrition support service significantly improved nutritional status and clinical outcomes in comparison with the suboptimal conventional method. Future studies should assess the cost effectiveness of clinical pharmacists’ PN services. 相似文献7.
Sinem Sag Mustafa Serdar Sag Ibrahim Tekeoglu Ayhan Kamanlı Kemal Nas 《Journal of Medical Ultrasonics》2018,45(1):121-127
Background
Musculoskeletal findings in Sjögren’s syndrome are arthralgia, arthritis, myalgia, myositis, fibromyalgia, and chronic fatigue. Enthesis zones are important in the formation of pain in the musculoskeletal system. Musculoskeletal ultrasound (US) may show subclinical enthesitis in the synovial joints and in the axial skeleton before joint swelling in inflammatory diseases characterized by arthritis.Objective
In this study, we aimed to determine the presence of enthesopathy using the Madrid sonographic enthesitis index (MASEI) in patients with primary Sjögren’s syndrome (PSS).Patients and methods
Consecutive patients with PSS and age-matched healthy controls were included in this study. All the patients met the 2002 American College of Rheumatology/European League against Rheumatism classification criteria for PSS. The demographic characteristics of the patients were recorded. Six enthesis sites were evaluated using gray-scale and Doppler US with a linear transducer, and they were scored using the MASEI. They were assessed by the EULAR Sjögren’s syndrome disease activity index (ESSDAI).Results
We evaluated 40 patients with PSS (average age 48.67 ± 11.23 years) and 30 healthy controls (average age 45.40 ± 8.24 years). Patients with PSS had significantly higher MASEI scores than the healthy controls. Plantar fascia, Achilles tendon, and distal patellar tendons were significantly thicker in the PSS group than in the healthy controls. The MASEI total score had a positive correlation with age. There was no correlation between MASEI total score and BMI and ESSDAI.Conclusion
In this study, it was shown that the MASEI scores assessed by US were significantly higher in patients with PSS than in healthy controls. Plantar fascia, Achilles tendon, and distal patellar tendon were significantly thicker in the PSS group than in the healthy controls. This result suggests that PSS may be one of the causes of musculoskeletal pain that can be seen in patients with PSS. Our study was the first study to use an enthesis index ultrasonographically in patients with PSS. In addition, it is the first study to investigate the relationship between the presence of enthesopathy and disease activity by means of US.8.
Giovanna Franchi Francesco Bulli Maria Grazia Muraca Alice Maruelli Elisa Grechi Guido Miccinesi 《Supportive care in cancer》2013,21(9):2381-2386
Background
Combining medical and psychological knowledge and accompanying patients in an individualised path, the Oncological Rehabilitation Centre of Florence (CeRiOn) aims at offering effective integrated rehabilitation interventions and at reducing psychological distress in cancer patients. In the present observational study, we measured the psychological distress at baseline and at the end of the completed rehabilitation processes.Methods
A total number of 627 cancer patients were treated by the psycho-oncological service at CeRiOn in 2007–2010. Among them, 99 (all women) participated in more than or equal to three sessions, were followed up for clinical and life status for at least 1 year and had a formal conclusion of their psychological rehabilitation process. For 98 cases, both a baseline and a follow-up measure of distress, by the Psychological Distress Inventory (PDI) and the Distress Thermometer (DT), were available.Results
Relevant before–after amelioration in this selected group of psychologically, highly suffering cancer patients has been shown. Almost all the patients (except 20 %) received both group and individual psychological support. The average rehabilitation process lasted 1.7 years. Average distress evaluation decreased from a baseline of 34.7 to 26.4 (P?<?0.001) according to PDI and from 5.9 to 2.2 according to DT (P?<?0.001).Conclusions
On average, quite a long psychological support time was necessary to complete the rehabilitation process. During this period, patients who had a formal conclusion of the psychological support received at CeRiOn showed a significant reduction of their distress. 相似文献9.
Objectives
This observational study investigated the value of drug-coated balloons (DCB) only strategy in bifurcation lesions in a consecutive series of all comer percutaneous coronary intervention.Background
Local application of paclitaxcel by DCB has clinical benefits in various settings including coronary bifurcations. While so far most bifurcation studies investigated sequential application of DCBs to the main (MB) and side branch (SB) with stenting of the MB, we report first results after DCB intervention without additional stenting of the MB or SB.Methods
We performed 39 consecutive DCB only interventions in de novo bifurcation lesions with SB ≥2 mm and scheduled follow-up angiography after 4 months. Patients refusing angiography had telephone follow-up.Results
Follow-up angiograms were obtained in 30 out of 39 DCB only interventions. 33.3 % were located in the left main (LM) bifurcation, 28.2 % in left anterior descending (LAD), 20.5 % in left circumflex (LCX) and 17.9 % in the right coronary artery. Four months after index procedure no patient had died, experienced myocardial infarction or stroke. Follow-up angiograms showed restenosis in 3 out of 30 interventions (10 %), 2 developing in the distal main (6.7 %) and 1 in the SB (3.3 %). All three patients had been treated for LM/LAD/LCX bifurcations and suffered from most severe coronary artery disease, but had not been eligible for CABG for various reasons. Target lesion revascularization was performed in 3 out of 39 patients consistent with a MACE rate of 7.7 %.Conclusion
Treatment of de novo bifurcation lesions with DCB only intervention without additional stenting is a safe therapy with low rates of restenosis and TLR. 相似文献10.
Corinna C. Winter Carsten Müller Jendrik Hardes Georg Gosheger Joachim Boos Dieter Rosenbaum 《Supportive care in cancer》2013,21(6):1629-1636
Background
While research on exercise interventions during anticancer treatment is well-established in adults, only very few studies exist in children. However, pediatric patients experience great limitations to being physically active, and appropriate interventions are desired.Procedure
The present study aimed at investigating the effects of individualized exercise interventions during inpatient stays on pediatric patients with a malignant bone tumor. The parameter of interest was physical activity (PA). Patients’ PA during home stays was assessed 6 weeks as well as 3, 6, 12, and 18 months post-surgery. Patients were distinguished into an intervention group and a control group. All patients received endoprosthetic replacement of the affected bone in the same institution.Results
A constant increase in all PA parameters was observed during follow-up. Exercise interventions were possible and appeared worthwhile. The intervention group showed better PA results at all measurements; however, no significant differences between groups were found. Furthermore, differences decreased especially after the cessation of the intervention. General problems in reaching appropriate power and compliance were observed.Conclusions
Individualized exercise interventions in pediatric bone tumor patients are possible and appear to be beneficial. Such interventions should be implemented in adjuvant care; however, future research is needed to understand more about the effects of different interventions. 相似文献11.
Ralf Zahn Thomas Ischinger Uwe Zeymer Johannes Brachmann Jens Jung Hartwig Haase Karl Eugen Hauptmann Hubert Seggewiß Ilse Janicke Matthias Leschke Harald Mudra 《Clinical research in cardiology》2010,99(12):809-815
Objective
To compare characteristics and outcome of patients with re-stenoses after prior carotid artery stenting (CAS) treated with repeat carotid interventions (Re-CI) with CAS for de novo lesions.Background
The treatment of re-stenosis is a major problem in vascular interventions. Patients with re-stenoses after prior CAS treated with Re-CI are not well defined.Methods
We analyzed data from the prospective ALKK CAS Registry.Results
Out of 3,817 CAS procedures 95 were intended in 93 patients (2.5%) for a restenosis after prior CAS and 3,722 CAS in 3,655 patients (97.5%) for a de novo stenosis. There was no difference in age (p = 0.302) or distribution of gender (p = 0.545) between the two groups. Patients treated for a restenosis after CAS were less likely to be treated for a symptomatic lesion (22.7 vs. 40.1%, p = 0.001). Coronary heart disease (p = 0.017), peripheral arterial disease (p < 0.001) as well as diabetes mellitus (p = 0.004) were more prevalent in the restenosis group. Lesions were less complicated in restenosis patients, with less ulcers (7.4 vs. 19.9%, p = 0.003) and less severe calcifications (7.4 vs. 23.6%, p < 0.001). The intended interventions were more often not performed in the Re-CI group (9.5 vs. 3.3%; p = 0.001). In-hospital, the stroke or death rate was 0% in the Re-CI group as compared to 3.1% in the de novo group (p = 0.115).Conclusions
Patients treated with Re-CI for repeat stenoses after prior CAS represent 2.5% of current CAS patients. Although representing a subgroup with more concomitant diseases, Re-CI seems to be associated with lower event rates as compared to CAS for de novo lesions. 相似文献12.
V. Anantharaman 《International journal of emergency medicine》2008,1(1):11-20
Background
Public emergency departments (EDs) in Singapore were facing increasing attendances (visits) with frequent overcrowding in the 10 years from 1975 to 1985. Over the next 12 years a series of social interventions were carried out to minimize “unnecessary” attendances at these EDs.Aims
This paper reviews the various interventions carried out on ED utilization to determine their impact and usefulness.Methods
Emergency and non-emergency attendances at the six main public EDs were analysed over the 32 years of the review and especially just before and soon after the application of four major interventions relating to use of EDs, including: (1) public education campaigns, (2) financial disincentives, (3) redirection to primary health care centres and (4) use of alternative clinics.Results
The 12-year period of social interventions resulted in a fall in the proportion of non-emergency patients using the EDs from 57% to 18%. Public education campaigns each resulted in a fall in inappropriate attendances of 27% to 67%. Financial disincentives were able to demonstrate an impact if they were significant and resulted in a heavier fiscal cost to the patient than if available primary health clinics were used. Redirection of non-emergencies away from EDs resulted in significant public relations issues with only mild decreases in non-emergency attendances. Alternative clinics may provide some respite if actively promoted by ED staff, but are able to generate their own separate patient clientele.Conclusions
Public education and financial measures that seek to change the pattern of ED utilization in a community must go hand in hand with an easily accessible primary health care system for best effect. Co-ordination of such efforts requires active support from all levels of the health service and political leadership. An active feedback loop is needed for better outcomes management. 相似文献13.
Thierry Lebret Jean-Loup Mouysset Alain Lortholary Claude El Kouri Laurent Bastit Meryem Ktiouet Khemaies Slimane Xavier Murraciole Stéphane Guérif 《Supportive care in cancer》2013,21(6):1613-1620
Purpose
This study aimed to explore patient and nurse satisfaction, compliance with best practice, technical feasibility and safety of home infusion of the bisphosphonate zoledronic acid (ZOL).Methods
This was a prospective 1-year survey of home ZOL therapy (4 mg Zometa®, 15-min i.v., every 3–4 weeks) in patients with bone metastases secondary to a solid malignancy. A physician questionnaire, nurse satisfaction/feasibility questionnaire and patient satisfaction questionnaire were administered at several time-points.Results
Physician participation rate was 56.5 % (87/154). Physicians enrolled 818 patients visited by 381 predominantly community nurses. Of the 788 case report forms received, 763 met inclusion criteria. Patient characteristics were as follows: median age, 68 years (30–95); M/F, 40/60; ECOG-PS 0 or 1, 78.6 %;and primary tumour site, breast (55.2 %), prostate (28.4 %), lung (7.2 %) or other (9.4 %). Nurse satisfaction rates were high: organisation of home ZOL therapy, 90.9 %; ease of infusion, 96.7 %; patient–nurse relationship, 97.5 %; and relationship with hospital staff, 73 %. Patient satisfaction was also very high (95.3 %). The main reasons were quality of the nurse–patient relationship (57.6 %), less travel/waiting (68.8 %), home environment (52.9 %) and less disruption to daily routine (36.6 %). ZOL therapy was well tolerated, the discontinuation rate due to adverse events (including deaths whether related to diseases progression or not) was 33.6 %. The incidence of osteonecrosis of the jaw was 0.6 % and of fractures, 0.2 %. Practitioner compliance with best practice was 76.7–83.7 % for recommended and/or tolerated dosage, 73 % for dental hygiene checks at inclusion and 48–56 % thereafter, 66 % for pre-infusion hydration, and often undocumented for calcium/vitamin D supplementation.Conclusions
Home ZOL therapy was well tolerated. Both patient and nurse satisfaction were very high. However, better compliance with best practice should be encouraged. 相似文献14.
Lale Atahan Ferah Yıldız Mustafa Cengiz Bunyamin Kaplan Metin Özkan Gozde Yazici Mete Gündoğ Ayfer Haydaroğlu Aylin F. Korcum Meriç Şengöz Maktav Dinçer Müge Akmansu Kayıhan Engin Mutlu Hayran 《Supportive care in cancer》2010,18(6):691-698
Introduction
In this prospective study, the efficacy and safety of radiotherapy combined with zoledronic acid was evaluated.Materials and methods
Breast cancer patients with painful bone metastases were randomized to either high- or reduced-dose radiotherapy. All patients received zoledronic acid (4 mg) every 28 days from the beginning of radiotherapy. Analgesic and pain scores in addition to visual analog score (VAS) for treatment satisfaction and whole-body bone scintigraphy were evaluated.Results and conclusion
No significant differences could be found in analgesic or pain scores and bone scintigraphy results between the groups. Our results suggest that reduced-dose radiotherapy produces similar response rates and response durations when used concomitantly with zoledronic acid. 相似文献15.
Ruth Chieng John Coutsouvelis Susan Poole Michael J. Dooley Diana Booth Andrew Wei 《Supportive care in cancer》2013,21(12):3491-3495
Purpose
Patients having undergone allogeneic stem cell transplantation (SCT) require complex medication regimens. To ensure the safe and effective management of this patient group, specialised care in a centre with a dedicated and experienced healthcare team is essential. The aim of this study was to evaluate the effectiveness of a specialty clinical pharmacist working in an ambulatory SCT clinic.Methods
A prospective cohort study was conducted on patients post SCT and discharged to the ambulatory setting. Patients were reviewed by a clinical pharmacist weekly for six visits. At these visits a medication review was undertaken. Interventions from these reviews were recorded. Interventions were then assigned a risk rating by a multidisciplinary panel. Adherence was also assessed by a Morisky questionnaire and review of dose administration aids. Comparison of data over the six-visit period was undertaken.Results
In total 23 patients were enrolled in the study. All six visits were completed in 17 patients and 161 interventions were recorded at an average of 1.4 interventions per patient visit. The panel rated 40 % of interventions as high risk, 46 % as medium risk and 14 % as low risk. At all visit points high- and medium-risk interventions constituted >80 % of the total. Morisky scores improved by an average of 1.53 (p?<?0.0001) between visits 1 and 6. All patients were scored as highly adherent by visit 6.Conclusions
A specialist clinical pharmacist in the SCT outpatient clinic resulted in regular and effective intervention contributing to improved medication management and adherence. 相似文献16.
François Lellouche Pierre-Alexandre Bouchard Serge Simard Erwan L’Her Marc Wysocki 《Intensive care medicine》2013,39(3):463-471
Purpose
Discrepancies between the demand and availability of clinicians to care for mechanically ventilated patients can be anticipated due to an aging population and to increasing severity of illness. The use of closed-loop ventilation provides a potential solution. The aim of the study was to evaluate the safety of a fully automated ventilator.Methods
We conducted a randomized controlled trial comparing automated ventilation (AV) and protocolized ventilation (PV) in 60 ICU patients after cardiac surgery. In the PV group, tidal volume, respiratory rate, FiO2 and positive end-expiratory pressure (PEEP) were set according to the local hospital protocol based on currently available guidelines. In the AV group, only sex, patient height and a maximum PEEP level of 10 cmH2O were set. The primary endpoint was the duration of ventilation within a “not acceptable” range of tidal volume. Zones of optimal, acceptable and not acceptable ventilation were based on several respiratory parameters and defined a priori.Results
The patients were assigned equally to each group, 30 to PV and 30 to AV. The percentage of time within the predefined zones of optimal, acceptable and not acceptable ventilation were 12 %, 81 %, and 7 % respectively with PV, and 89.5 %, 10 % and 0.5 % with AV (P < 0.001). There were 148 interventions required during PV compared to only 5 interventions with AV (P < 0.001).Conclusion
Fully AV was safe in hemodynamically stable patients immediately following cardiac surgery. In addition to a reduction in the number of interventions, the AV system maintained patients within a predefined target range of optimal ventilation. 相似文献17.
Ann C. Long Erin K. Kross Ruth A. Engelberg Lois Downey Elizabeth L. Nielsen Anthony L. Back J. Randall Curtis 《Intensive care medicine》2014,40(11):1688-1697
Objective
Although most intensive care unit (ICU) admissions originate in the emergency department (ED), a substantial number of admissions arrive from hospital wards. Patients transferred from the hospital ward often share clinical characteristics with those admitted from the ED, but family expectations may differ. An understanding of the impact of ICU admission source on family perceptions of end-of-life care may help improve patient and family outcomes by identifying those at risk for poor outcomes.Design and setting
This was a cohort study of patients with chronic illness and acute respiratory failure requiring mechanical ventilation who died after admission to an ICU in any of the 14 participating hospitals in the Seattle-Tacoma area between 2003 and 2008 (n = 1,500).Measurements
Using regression models adjusted for hospital site and patient-, nurse- and family-level characteristics, we examined associations between ICU admission source (hospital ward vs. ED) and (1) family ratings of satisfaction with ICU care; (2) family and nurse ratings of quality of dying; (3) chart-based indicators of palliative care.Main results
Admission from the hospital ward was associated with lower family ratings of quality of dying [β ?0.90, 95 % confidence interval (CI) ?1.54, ?0.26, p = 0.006] and satisfaction (total score β ?3.97, 95 % CI ?7.89, ?0.05, p = 0.047; satisfaction with care domain score β ?5.40, 95 % CI ?9.44, ?1.36, p = 0.009). Nurses did not report differences in quality of dying. Patients from hospital wards were less likely to have family conferences [odds ratio (OR) 0.68, 95 % CI 0.52, 0.88, p = 0.004] or discussion of prognosis in the first 72 h after ICU admission (OR 0.72, 95 % CI 0.56, 0.91, p = 0.007) but were more likely to receive spiritual care (OR 1.48, 95 % CI 1.14, 1.93, p = 0.003) or have life support withdrawn (OR 1.38, 95 % CI 1.04, 1.82, p = 0.025).Conclusion
Admission from the hospital ward is associated with family perceptions of a lower quality of dying and less satisfaction with ICU care. Differences in receipt of palliative care suggest that family of patients from the hospital ward receive less communication. Nurse ratings of quality of dying did not significantly differ by ICU admission source, suggesting dissimilarities between family and nurse perspectives. This study identifies a patient population at risk for poor quality palliative and end-of-life care. Future studies are needed to identify interventions to improve care for patients who deteriorate on the wards following hospital admission. 相似文献18.
Michael Hwang Rosene Pirrello Minya Pu Karen Messer Eric Roeland 《Supportive care in cancer》2013,21(10):2817-2824
Background
Medical management is the cornerstone of malignant bowel obstruction (MBO) therapy and may include antisecretory agents such as octreotide. Currently, no data exist regarding octreotide prescribing patterns in US academic hospitals in the palliation of inoperable MBO. The aim of this study is to collect octreotide prescribing data to shape future prospective studies.Methods
This retrospective chart review evaluated inpatient inoperable MBO admissions at a single academic US hospital between 2008 and 2011. The prescribing primary service (medical vs. surgical), inpatient day initiated, average octreotide daily dose, cumulative octreotide dose, days receiving octreotide, length of stay (LOS), subject age, cancer stage, lines of chemotherapy, cancer type, and overall survival were analyzed utilizing a Wilcoxon rank sum test, Spearman rank correlation test, Kaplan–Meier curves, log rank test, and multiple linear regression analysis when appropriate.Results
A total of 767 patients received octreotide. A cancer diagnosis was documented in 134 patients and 37 of these (24 females and 13 males; mean age, 56.7 years) had a confirmed inoperable MBO. Statistical significance was not achieved for variables analyzed. However, octreotide prescribing trends were observed for several variables: the mean LOS was equivalent on both services (16.8 vs. 17 days), mean octreotide dose was higher on the medical service (201.2 μg vs. 119 μg surgical), cumulative octreotide dose was higher on the medical service (3,558 vs. 1,884 mcg), mean day of octreotide initiation was roughly equivalent (7.9 days medical vs. 8.8 days surgical), subjects on the medical service had a decreased overall survival, and earlier octreotide initiation (defined as <7 days) was associated with a decreased overall survival.Limitation
The data were collected retrospectively, with a limited population distribution at a specific time.Conclusions
These data possibly suggest that the MBO patients on the medical vs. surgical services are distinct patient populations. MBO patients on the medical service trended to receive higher cumulative doses and have a decreased overall survival compared with surgical patients. Consequently, future studies should possibly consider these distinct study groups. 相似文献19.
Prevalence of sporadic renal angiomyolipoma: a retrospective analysis of 61,389 in- and out-patients
Astrid Fittschen Inka Wendlik Suemeyra Oeztuerk Wolfgang Kratzer Atilla S. Akinli Mark M. Haenle Tilmann Graeter 《Abdominal imaging》2014,39(5):1009-1013
Purpose
To calculate the prevalence, localization, and growth of sporadic angiomyolipomas and to identify the predominant sex in the largest patient population reviewed to date.Methods
Abdominal ultrasound analyses of 61,389 patients (49.7% women; 50.3% men) were consecutively collected using a PC-based, standardized documentation system from September 1999 to December 2012. The present study evaluates and presents this data.Results
The population studied includes 270 cases of sporadic angiomyolipoma (184 females; 86 males). This represents an overall prevalence of 0.44%, with 0.60% in the female and 0.28% in the male subpopulations. Mean tumor size was 10.8 ± 5.8 mm. Fifty-seven percent of cases involved the right kidney and 43.0% the left kidney. Only 14 of the 270 patients presented with multiple angiomyolipomas, four of which were bilateral. Sixty-one cases were followed over a mean period of 25 months (range: 1–105 months) and showed no significant increase in tumor size during the period of observation.Conclusion
The analysis of 61,389 patients revealed a higher prevalence of sporadic angiomyolipoma than previously observed in smaller studies. There was a significantly higher prevalence in females than in males. Multiple and bilateral angiomyolipomas were rare, and tumor growth was marginal. 相似文献20.