How Can We Improve the Quality of Life of Dialysis Patients?

As medical advances are made in the care of persons with chronic illnesses including those with end‐stage renal disease (ESRD), patients are not only experiencing increasing life expectancy but also bearing the burden of illness and treatment for a longer duration of time. With this in mind, it is increasingly important for health care providers to pay close attention to their individual patient's perceptions of their health, fitness, life satisfaction, and well‐being. This assessment of Health‐Related Quality of Life (HRQOL) also includes an evaluation of the patient's level of satisfaction with treatment, outcome, and health status, also taking into account their perspective on future prospects. In addition to improving patient–provider communication by helping in the identification and prioritization of problems, it is important to note that high HRQOL has been shown to be associated with better medical outcomes, including reduction in hospitalizations and death. In this review, we outline several validated tools that are used to quantitatively measure HRQOL in the ESRD population and incorporate these instruments in a review of specific, evidence‐based measures by which we can measurably improve health‐related quality of life in dialysis patients.     

Patients’ Experiences of Weight Regain After Bariatric Surgery

Obesity Surgery - Bariatric surgery is a successful obesity treatment; however, an estimated 1/5 of patients have regained more than 15% of their body weight 5 years post-surgery. To...     

Is the Quality of Life Better in Patients with Colostomy than Patients with Fecal Incontience?

Background A colostomy offers definitive treatment for individuals with fecal incontinence (FI). Patients and physicians remain apprehensive regarding this option because the quality of life (QOL) with a colostomy is presumably worse than living with FI. The aim of this study, therefore, was to compare the QOL of colostomy patients to patients with FI. Methods A cross-sectional postal survey of patients with FI or an end colostomy was undertaken. QOL measures used included the Short Form 36 General Quality of Life Assessment (SF-36) and the Fecal Incontinence Quality of Life score (FIQOL). Results The colostomy group included 39 patients and the FI group included 71 patients. The average FI score for FI group was 12 ± 4.9 (0 = complete continence, 20 = severe incontinence). In the colostomy group the average colostomy function score was 12.9 ± 3.8 (7 = good function, 35 = poor function). Analysis of the SF-36 revealed higher social function score in the colostomy group compared to the FI group. Analysis of the FIQOL revealed higher scores in the coping, embarrassment, lifestyle scales, and depression scales in the colostomy group compared to the FI group. Conclusion A colostomy is a viable option for patients who suffer from FI and offers a definitive cure with improved QOL.     

Atherosclerosis in Hemodialysis Patients—the Role of Microinflammation

Introduction. Cardiovascular diseases (CVDs) are the most frequent cause of morbidity and mortality in patients with end-stage renal disease, and the risk for coronary heart disease is higher among the hemodialysis (HD) patients than in the general population. This excess risk for coronary heart disease is not entirely explained by traditional risk factors for CVDs. The aim of the study was to determine possible correlations between asymptomatic atherosclerosis and inflammatory markers (high sensitivity CRP [hsCRP], interleukin 6 [IL-6], tumor necrosis factor-alpha [TNF-α], interleukin 2 receptor [IL-2R], and selective adhesion molecules ICAM-1 and VCAM-1) in HD patients. Patients and methods. In our study, 95 HD patients, 56 (59%) male and 39 (41%) female, were included. The mean age was 60 ± 13 years, ranging from 22–81 years. Using B-mode ultrasonography (US), we measured intima-media thickness (IMT) and plaque occurrence (markers of asymptomatic atherosclerosis) in carotid arteries in these patients. In the 1–4 weeks after US examination, we took blood samples from patients to determine serum concentrations of inflammatory markers. Results. The mean IMT value was 0.83 ± 0.21 mm, ranging from 0.5 to 2 mm. The plaques were found in 63 (84%) of HD patients. Correlations between IMT values and serum concentrations of IL-2R (r = 0.269; p < 0.022) and VCAM-1 (r = 0.290; p < 0.014) were found. Multiple linear regression analysis showed relationship between IMT values and IL-2R (p = 0.049). No relationship between inflammatory markers and plaques was found. Conclusion. The results indicate that atherosclerosis in HD patients correlates with some nontraditional risk factors—the markers of inflammation.     

Patients’ experiences of laparoscopic fundoplication in day surgery

Previous research has concentrated mainly on surgical aspects and postoperative complication rates after day surgery laparoscopic fundoplications (LF), due to gastrooesophageal reflux (GERD) and less on patients'experiences and nursing care aspects. A qualitative study was conducted aimed at investigating patients’ experiences of day surgery LF. The very first patients who had day surgery LF (n=7) were interviewed. The findings demonstrate that patients with GERD experience limitations in their daily lives and feelings of social handicap. At discharge after day surgery, amnesia was experienced and the respondents did not recall important information about the operation given by the surgeon. Experience of postoperative pain varied greatly. All respondents experienced dysphagia, vomiting, distension and bloating. The need for additional pain medication, additional follow-ups by the Advanced Medical Home Care team and extended preoperative information was expressed. However, the great majority felt that returning home on the same day as the operation was positive.     

Determinants of Patients’ Choice of Reconstruction with Mastectomy for Primary Breast Cancer

Background: The aim of the study was to measure womens decisions about breast reconstruction (BR) after mastectomy and to assess the factors contributing to their decisions, in a context involving shared decision-making and maximum patient autonomy.Methods: Women who were about to undergo mastectomy for primary breast cancer were systematically offered choices concerning BR and time of reconstruction (intervention always covered by the French National Insurance System). Self-administered questionnaires were used prior to the operation.Results: Among the 181 respondents, 81% opted for BR and 19% for mastectomy alone. In comparison with those who chose mastectomy alone, those opting for BR more frequently recognized the importance of discussing these matters with the surgeon and their partner (adjusted odds ratio [OR^adj] = 13.45 and 3.59, respectively; P < .05) and realized that their body image was important (OR^adj = 10.55, P < .01); fears about surgery prevented some of the women from opting for BR (OR^adj = 0.688, P < .05). Among the women opting for BR, 83% chose immediate breast reconstruction (IBR) and 17% chose delayed breast reconstruction (DBR). The preference for IBR was mainly attributable to the fact that these women had benefited more frequently from doctor–patient discussions (OR^adj = 3.49, P < .05) but was also attributable to the patients physical and functional characteristics: they were in a poorer state of health (P < .05). The surgeons predicted their patients preferences fairly accurately.Conclusions: In a context of maximum autonomy, the great majority of the women chose IBR. The patients choices were explained mainly by their psychosocial characteristics. The indication for BR should be properly discussed between patients and surgeons before mastectomy.     

Patients’ Experience of Surplus Skin After Laparoscopic Gastric Bypass

Background  

Previous studies have described that many obese patients who undergo bariatric surgery develop surplus skin. However, there is a lack of knowledge about where on the body the problems are located and to what extent surplus skin affects the person. The aim of this study was to examine whether and where patients develop surplus skin after laparoscopic gastric bypass and if there is any relation between surplus skin and the patient’s sex, age, weight loss, or activity level.     

Patients’ perceptions of day surgery: A literature review

Medical and pharmacological advances in surgery have contributed to the current and continued growth of day surgery. As the majority of adult UK elective surgery now takes place within day surgery facilities, these changes will inevitably have an impact upon nursing intervention. Past nursing practices may have to undergo a period of redevelopment in order to meet these changes and the logical first step towards any innovative change must involve acquiring the views of patients. The main themes to emerge related to nursing practice, information provision, experiences within day surgery and recovery at home. The overwhelming principle challenge was that of information provision followed closely by postoperative pain management.     

Patients’ preferred mode of travel to the orthopaedic theatre

AIM: To determine the preferred mode of travel to the operating theatre for elective orthopaedic patients.METHODS: Data was collected prospectively over a 2-wk period at an elective Orthopaedic Treatment Centre. Patients were asked to complete a patient satisfaction questionnaire following their surgery on their experience and subsequent preferred mode of transport to theatre. The data was then recorded in a tabulated format and analysed with percentages. Fisher’s exact test was used to determine if there was any statistical association between patients’ preference to walk and various groups; in-patient or day case procedures, and whether patients were < 60 years or > 60 years of age.RESULTS: Seventy patients (40 females and 30 males) fully completed the questionnaire. In total there were 33 d-cases and 37 in-patients. The spectrum of orthopaedic sub-specialties included was knee (41%), hip (17%), foot and ankle (24%), spine (13%) and upper limb (4%). Patient satisfaction for overall experience of travelling to theatre was either excellent (77%) or good (23%). Following their experience of travelling to theatre, 87% (95%CI: 79%-95%) of the total cohort would have preferred to walk to the operating theatre. There was a statistically significant association (P = 0.003) between patients’ preference to walk and whether they were day-case or in-patients. Similarly, there was a statistically significance association (P = 0.028) between patients’ preference to walk and whether they were < 60 years or > 60 years of age.CONCLUSION: This study confirms the majority of Orthopaedic elective patients would prefer to walk to theatre, when given the choice and if practically possible.     

Leucocyte-Depleted Blood Transfusion is an Independent Predictor of Surgical Morbidity in Patients Undergoing Elective Colon Cancer Surgery—A Single-Center Analysis of 531 Patients

Background

Leukocyte-depleted packed red blood cells (PRBC) were introduced to reduce potential immunomodulatory effects and transfusion-associated morbidity. It has, however, remained unclear, if leucocyte depletion prevents negative side effects of blood transfusion. The aim of this analysis was to examine the effects of leukocyte-depleted PRBC on surgical morbidity after elective colon cancer surgery.

Methods

Data were prospectively collected from 531 consecutive patients undergoing elective colon cancer surgery at a single high-volume center (University Hospital) from 2002 to 2008. Potentially predictive factors for surgical morbidity were tested on univariate and multivariate analysis.

Results

A total of 531 patients with colon cancer were included. A curative (R0) resection was performed in 497 patients (94%). The mortality rate, overall morbidity rate, and surgical morbidity rate were 1.1, 33, and 21%, respectively. Some 135 patients (25%) received perioperative transfusion of PRBCs. On multivariate analysis age (odds ratio [OR] 1.04, 95% confidence interval [95% CI] 1.02–1.06; P = 0.001), BMI (OR 1.08, 95% CI 1.03–1.13; P = 0.003), and PRBC transfusion (2.4, 1.41–4.11; P = 0.001) were revealed as independent predictors of surgical morbidity. The risk of surgical complications increased continuously with the amount of transfused PRBCs. The adverse impact of PRBC transfusion was neither restricted to the timepoint of transfusion (intraoperative or postoperative), nor to the kind of complication (infectious vs noninfectious complication).

Conclusion

Perioperative transfusion of leukocyte-depleted PRBCs has a significantly negative effect on surgical morbidity of patients undergoing elective colon cancer surgery. The use of perioperative blood transfusions in these patients should be avoided, whenever possible.     

The Surgical Treatment of Breast Cancer in the Elderly: A Single Institution Comparative Review of 5235 Patients with 1028 Patients ≥70 years

Abstract: As the wave of the baby boomers shifts the age demographic of patients, the current surgical management of breast cancer in elderly women (≥70 years of age) becomes relevant because deviation from standard treatment often occurs in this group. The purpose of this study was to determine the operative mortality when treated with standard surgical procedures and to investigate trends in the surgical management of breast cancer in the elderly. A total of 5,235 patients undergoing either mastectomy or breast conservation surgery (BCS) for invasive and ductal carcinoma in situ (DCIS) were identified in a retrospective review of a prospectively accrued data base between the years of 1994 and 2007 at the Moffitt Cancer Center. Of the 5,235 patients, 1,028 (20%) patients were ≥70 years of age. The 30‐day and 90‐day mortality in the elderly group (age ≥70 years) was 0.2% (95% CI 0.02–0.7%) and 0.7% (95% CI 0.3–1.4%), respectively. The 30‐day and 90‐day mortality among patients <70 years was 0 and 0.05% (2 of 4,207 patients) (95% CI 0.005–0.2), respectively. BCS rates for invasive carcinomas were the highest for patients between 40 and 70 years of age, whereas the mastectomy rates were higher among patients <40 years of age (53%). Elderly women were as likely as women <40 years to have BCS for invasive carcinoma (OR 1.1, 95% CI 0.8–1.5), but more likely to have BCS for DCIS (OR 1.9, 95% CI 1.1–3.3). Surgical mortality in elderly women treated for breast cancer was extremely low and was related to the extent of surgery performed. Breast cancer treatment differed by age groups.     

Accuracy of a New Algorithm to Identify Asthma–COPD Overlap (ACO) Patients in a Cohort of Patients with Chronic Obstructive Airway Disease

Objectives

We aimed to characterize the clinical, functional and inflammatory features of patients diagnosed diagnosed with ACO according to a new algorithm and to compare them with those of other chronic obstructive airway disease (COAD) categories (asthma and COPD).

Results of Laparoscopic Gastric Bypass in Patients ≥55 Years Old

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a commonly performed surgical intervention for morbid obesity. Some authors considered age ≥55 years as a relative contraindication to bariatric surgery. We examined the operative outcomes, weight loss, hospital stay and resolution of co-morbidities in patients ≥55 years old compared with those <55 years old undergoing LRYGBP. Methods: From Jan 2000 to Feb 2005, 350 LRYGBPs were performed. 48 patients ≥55 years old (13.7%) were compared to the remaining patients. Results: Analysis of the 48 patients ≥55 years old compared with 302 patients <55 revealed no difference in complication rate, although the older patients had a significantly greater percentage of serious complications. Younger patients lost more weight than older patients. Both groups demonstrated resolution of comorbidities, although the difference was not significant. Conclusions: LRYGBP is safe and well tolerated in morbidly obese patients ≥55 years. The older patients had more serious complications and lost less weight; however, their weight loss and resolution of co-morbidities improved their quality of life. Age should not be a contraindication to bariatric surgery.