Effectiveness of a National Transitional Care Program in Reducing Acute Care Use

This study evaluated the effectiveness of a national transitional care program for elderly adults with complex care needs and limited social support. The Aged Care Transition (ACTION) Program was designed to improve coordination and continuity of care and reduce rehospitalizations and visits to emergency departments (EDs). Dedicated care coordinators provided coaching to help individuals and families understand the individuals' conditions, effectively articulate their preferences, and enable self‐management and care planning. Participants were individuals aged 65 and older hospitalized and enrolled from five public general hospitals in Singapore between February 2009 and July 2010 (N = 4,132). The coordinators worked with participants during hospitalization and followed up with telephone calls and home visits for 1 to 2 months after discharge and coordinated placements with appropriate community service providers. Unplanned rehospitalization and ED visit (up to 6 months after discharge) rates were compared with those of a comparator group of individuals who did not receive care coordination using propensity score‐based weighting. Participant and caregiver surveys on quality of life and self‐rated health were also administered. Recipients of the ACTION program had fewer unplanned rehospitalizations and ED visits after discharge. Propensity score–adjusted odds ratios of participants versus control for number of unplanned rehospitalization and ED visits were 0.5 (95% confidence interval (CI) = 0.5–0.6) and 0.81 (95% CI = 0.72–0.90) 30 days after discharge and 0.6 (95% CI = 0.6–0.7) and 0.90 (95% CI = 0.82–0.99) 180 days after discharge. Quality of life and self‐rated health were better 4 to 6 weeks after discharge than 1 week after discharge. These findings confirm the effectiveness of the ACTION program in improving the transition of vulnerable older adults from hospital to community. Such transitional care should be considered as an integral part of care integration.     

A Systematic Review and Meta-Analysis Comparing Laparoscopic Versus Open Gastric Resections for Gastrointestinal Stromal Tumors of the Stomach

Background

This study is a systematic review and meta-analysis that compares the short- and long-term outcomes of laparoscopic gastric resection (LR) versus open gastric resection (OR) for gastric gastrointestinal stromal tumors (GISTs).

Methods

Comparative studies reporting the outcomes of LR and OR for GIST were reviewed.

Results

A total of 11 nonrandomized studies reviewed 765 patients: 381 LR and 384 OR. A higher proportion of high-risk tumors and gastrectomies were in the OR compared with LR (odds ratio, 3.348; 95 % CI, 1.248–8.983; p = .016) and (odds ratio, .169; 95 % CI, .090–.315; p < .001), respectively. Intraoperative blood loss was significantly lower in the LR group [weighted mean difference (WMD), ?86.508 ml; 95 % CI, ?141.184 to ?31.831 ml; p < .002]. The LR group was associated with a significantly lower risk of minor complications (odds ratio, .517; 95 % CI, .277–.965; p = .038), a decreased postoperative hospital stay (WMD, ?3.421 days; 95 % CI, ?4.737 to ?2.104 days; p < .001), a shorter time to first flatus (WMD, ?1.395 days; 95 % CI, ?1.655 to ?1.135 days; p < .001), and shorter time for resumption of oral intake (WMD, ?1.887 days; 95 % CI, ?2.785 to ?.989 days; p < .001). There was no statistically significant difference between the two groups with regard to operation time (WMD, 5.731 min; 95 % CI, ?15.354–26.815 min; p = .594), rate of major complications (odds ratio, .631; 95 % CI, .202–1.969; p = .428), margin positivity (odds ratio, .501; 95 % CI, .157–1.603; p = .244), local recurrence rate (odds ratio, .629; 95 % CI, .208–1.903; p = .412), recurrence-free survival (RFS) (odds ratio, 1.28; 95 % CI, .705–2.325; p = .417), and overall survival (OS) (odds ratio, 1.879; 95 % CI, .591–5.979; p = .285).

Conclusions

LR results in superior short-term postoperative outcomes without compromising oncological safety and long-term oncological outcomes compared with OR.     

Impact of MammaPrint on Clinical Decision‐Making in South African Patients with Early‐Stage Breast Cancer

The aim of the study was to evaluate the impact of MammaPrint on treatment decision‐making in patients with breast cancer. Clinicopathologic information of all breast cancer patients referred for MammaPrint testing in South Africa was collected from 2007 until 2014. A total of 107 patients (109 tumors) with estrogen receptor/progesterone receptor positive and human epidermal growth factor receptor‐2 negative tumors were selected with tumors ≥10 mm, or when 1–3 nodes were involved without extra‐nodal extension. None of the clinical indicators correlated significantly with the MammaPrint risk classification, which changed the decision for adjuvant chemotherapy in 52% of patients. Of 60 patients who were clinically high risk, 62% had a low‐risk MammaPrint result and of the 47 clinically low ‐risk patients 40% had a high‐risk MammaPrint result. This study indicates that MammaPrint could reduce the need for adjuvant chemotherapy by 17% using the selection criteria stipulated. The significant impact on treatment decisions confirmed the clinical utility of MammaPrint independent of standard clinicopathologic risk factors as supported by long‐term clinical outcome studies.