Patient-reported outcomes of prostate high-dose-rate brachytherapy boost comparing an outpatient and inpatient protocol: a two-center chronologic cohort study

Purpose

To determine patients’ self-reported experiences of outpatient high-dose-rate prostate brachytherapy boost, and compare with previous cohort treated as inpatients.

Methods and Materials

Using the Prostate Brachytherapy Questionnaire, we previously examined patients’ subjective experience of the brachytherapy procedure when it involved one implant and hospitalization with the template in situ for 2 days (Group 1). The protocol was subsequently changed to two implants, 2 weeks apart as outpatients. Fifty-eight patients treated with the new protocol (Group 2) completed the same questionnaire. We compared the self-reported experiences between Groups 1 and 2 and also between the first and second implant for those in Group 2. Our hypothesis was that the worst rated issues in Group 1 might be reduced with the new approach.

Results

Group 2 patients were less troubled overall by the procedure (mean scores 2.3 vs. 3.2, p = 0.0293). Specifically, they were less troubled by “discomfort” (2.8 vs. 3.8, p = 0.0254); “being stuck in bed” (1.7 vs. 4.2 p < 0.0001); “feeling helpless” (1.3 vs. 2.8, p = 0.0009); “fear of opening my bowels” (2.1 vs. 3.3, p = 0.0055); and “fear of coping with the implant” (1.3 vs. 2.5, p = 0.0004). There was no significant increase in “thought of implant” or “fear of implant” before the second implant. However, more patients rated worse than expected “fear of passing urine” during the second implant.

Conclusions

Patients rated high-dose-rate brachytherapy less troublesome when delivered as outpatient with two implants, 2 weeks apart than as inpatient over 3 days, despite the additional invasive procedure and anesthesia.     

The psychological impact of arthritis: the effects of illness perception and coping

Background  

Coping and illness perception are considered to be important contributors in the relationship between physical and psychological factors in rheumatoid arthritis (RA).     

Fatal neutropenic enterocolitis due to clostridium septicum

We describe a case of Clostridium septicum enterocolitis in a patient with pre-B acute lymphoblastic leukaemia undergoing autologous stem cell transplant. In the setting of neutropenia, Clostridium septicum should be suspected in patients who develop signs and symptoms of acute abdomen.     

Medicare in the USA: a review of 45 years of health provision

From a review of the experience and history of Medicare in the US over these 45 years, politics and economics played a large role in its introduction, in the direction it took in its initial years, and more recently in the introduction of "donut hole" drug coverage. However, health planning and policy processes in federal and state agencies have grown, and by using data collected over the years on the Medicare programme specifically, and the health system more broadly, trial programmes to control costs and introduce efficiencies into healthcare have been and will continue to be undertaken. Those identified as workable and effective are then introduced as policy. For at least two generations now, in the US, the burden of health costs in old age, the period of greatest vulnerability to disease and chronic conditions, has been lifted, as foreseen by President Johnson in 1966.