Prognostic factors in mucoepidermoid carcinoma of the salivary glands

BACKGROUND:

Mucoepidermoid carcinoma (MEC) is the most common malignancy of the major salivary glands. Prior reports noted histological grade and tumor stage as consistently important prognostic factors. This study reviewed the experience of patients with MEC at the University of Texas MD Anderson Cancer Center to determine the impact of clinical and pathologic findings on disease outcomes.

METHODS:

A retrospective clinical review was performed of patients with salivary gland MEC treated at a tertiary cancer center from 1990 to 2007.

RESULTS:

A total of 125 patients were included. The 5‐year overall survival and disease‐free survival of all patients were 79.3% and 76.5%, respectively. Patients with low‐ and intermediate‐grade disease had significantly better overall survival and disease‐free survival than patients with high‐grade disease, but no difference in survival rates was found between low‐ and intermediate‐grade disease. Pathologic results of positive lymph nodes, extracapsular lymph node spread, and perineural invasion were all found to be poor prognostic indicators. On multivariate analysis, advanced disease stage and perineural invasion were found to be the most significant prognostic factors.

CONCLUSIONS:

Patients with either low‐ or intermediate‐grade tumors uniformly have favorable local control and survival. High histological grade, advanced stage, perineural invasion, positive surgical margins, and submandibular location all portend for poor outcomes in MEC. Further advances in therapy are needed to improve outcomes for high‐grade and advanced‐stage disease. Cancer 2012. © 2011 American Cancer Society.     

Evaluation of acceptance and commitment therapy for drug refractory epilepsy: a randomized controlled trial in South Africa--a pilot study

PURPOSE: Psychological interventions in the treatment of epilepsy have been developed and evaluated for many years but the amount of research has hardly made an impact on how epilepsy is treated. The purpose of this study was to develop and evaluate a psychological treatment program consisting of acceptance and commitment therapy (ACT) together with some behavioral seizure control technology shown to be successful in earlier research. METHODS: The method consisted of a randomized controlled trial group design with repeated measures (n=27). All participants had an EEG verified epilepsy diagnosis with drug refractory seizures. Participants were randomized into one of two conditions, ACT or supportive therapy (ST). Therapeutic effects were measured by examining changes in quality of life (SWLS and WHOQOL) and seizure index (frequency x duration). Both treatment conditions consisted of only nine hours of professional therapy distributed in two individual and two group sessions during a four-week period. RESULTS: The results showed significant effects over all of the dependent variables for the ACT group as compared to the ST group at six- and twelve-month follow-ups. CONCLUSIONS: The results from this study suggest that a short-term psychotherapy program combined with anticonvulsant drugs may help to prevent the long-term disability that occurs from drug refractory seizures.     

Mental, physical and social components in leisure activities equally contribute to decrease dementia risk

BACKGROUND: There is accumulating evidence in the literature that leisure engagement has a beneficial effect on dementia. Most studies have grouped activities according to whether they were predominantly mental, physical or social. Since many activities contain more than one component, we aimed to verify the effect of all three major components on the dementia risk, as well as their combined effect. METHODS: A mental, social and physical component score was estimated for each activity by the researchers and a sample of elderly persons. The correlation between the ratings of the authors and the means of the elderly subjects' ratings was 0.86. The study population consisted of 776 nondemented subjects, aged 75 years and above, living in Stockholm, Sweden, who were still nondemented after 3 years and were followed for 3 more years to detect incident dementia cases. RESULTS: Multi-adjusted relative risks (RRs) of dementia for subjects with higher mental, physical and social component score sums were 0.71 (95% CI: 0.49-1.03), 0.61 (95% CI: 0.42-0.87) and 0.68 (95% CI: 0.47-0.99), respectively. The most beneficial effect was present for subjects with high scores in all or in two of the components (RR of dementia = 0.53; 95% CI: 0.36-0.78). CONCLUSIONS: These findings suggest that a broad spectrum of activities containing more than one of the components seems to be more beneficial than to be engaged in only one type of activity.     

LV Mass Independently Predicts Mortality and Need for Future Revascularization in Patients Undergoing Diagnostic Coronary Angiography

Objectives

The goal of this study was to assess associations between left ventricular (LV) mass, all-cause mortality, and need for revascularization in patients undergoing coronary angiography.

Application of the replicating effective programs framework to design a COPD training program

BackgroundChronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and a common cause of hospital readmissions in the United States. While best practices exist in COPD management, incorporation of such approaches into routine clinical care remains a challenge.ObjectivesThis evaluation applied principles from the field of dissemination and implementation (D&I) science to design a training package integrating best practice for COPD management. The D&I field promotes evidence-based implementation strategies, frameworks, and assessment approaches that can be considered by clinicians to promote adoption of best practices.MethodsThis prospective mixed-methods evaluation applied a D&I science model to develop, implement, and evaluate an interprofessional training program for COPD management originally piloted in 2016. The authors provide a contextual example of how a guiding D&I framework, replicating effective programs, was applied to design and implement a Web-based training program for clinicians preparing to implement the COPD service. A questionnaire and profession-specific focus group sessions were conducted to evaluate trainee confidence and enactment of critical service components.ResultsA total of 41 of the 50 interprofessional trainees responded to the pre- and postquestionnaire including primary care clinical pharmacists (n = 15), primary care registered nurses (n = 9), triage registered nurses (n = 12), and respiratory therapists (n = 5). Statistically significant improvements in trainee confidence and enactment were observed in 31 of the 40 total survey items (77%). Pooled focus group data provided attestation that the training enhanced practitioners’ confidence in their role within the service. Opportunities for further improvement were also identified, such as incorporating a video modeling clinic example and accompanying written materials.ConclusionThis evaluation provides a case-study example of how D&I science can be used to design, implement, and evaluate a training package for trainees to spread a promising best practice. Clinicians can consider similar applications of D&I science to enhance training and spread novel services across health systems.     

Recent Temporal Trends and Geographic Distribution of Cardiac Procedures in Alberta

Background

Prior Canadian studies of cardiac procedure rates showed changes over time and regional variability, but more recent Canadian cardiac procedure rates are unknown.

Methods

We performed a study using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease registry to evaluate the temporal trends and geographic distribution of cardiac procedures in Alberta from April 1, 2003 through March 31, 2010. Rates were age- and sex-standardized by means of the 1996 Canadian census.

Results

While the raw number of cardiac catheterizations in Alberta was nearly uniform through the study period, age- and sex-standardized cardiac catheterizations declined from a rate of 480 per 100,000 in 2003 to a rate of 430 per 100,000 in 2010. The percutaneous coronary intervention (PCI) rates also declined, from a rate of 186 per 100,000 in 2003 to 170 per 100,000 in 2010. The rates for coronary artery bypass grafts declined from 84 per 100,000 in 2003 to 42 per 100,000 in 2010. There was geographic variability, with northern regions characterized by rates that were higher than the provincial average rates, and southern regions characterized by rates lower than the provincial average.

Conclusion

During the study period, age- and sex-standardized rates of cardiac catheterization and PCI in Alberta declined, reversing previous trends of increasing PCI rates. The rates of coronary artery bypass grafts in Alberta declined significantly, suggesting a change in practice consistent with that seen elsewhere. There are geographic differences in rates of cardiac procedures. These data have implications for other regions of Canada, for which registry data may not be available.     

Redo ileal pouch–anal anastomosis for malfunctioning pouches–acceptable alternative to permanent ileostomy?

Background: Pouch complications after ileal pouch–anal anastomosis (IPAA) can result in morbidity and pouch loss. Recent reports describe success with redo IPAA. This study was conducted to assess the outcome of malfunctioning pouches treated by redo IPAA.Methods: All patients undergoing redo IPAA between 1983 and 1999 were identified and clinical records studied. Redo IPAA was defined as an operation for malfunctioning pouch with pelvic dissection and disconnection, pouch revision, and reanastomosis. Analyzed were etiology, presentation, diagnostic modalities, surgical management, pouch loss, and outcome. Follow-up was obtained by telephone or mailed survey.Results: Between 1983 and 1999, 650 IPAA procedures were performed, 6 (0.9%) of which required redo IPAA. Ten referred patients required redo IPAA. These 16 cases included 7 anastomotic disruptions, 3 pouch-vaginal fistulae, 2 recurrent polyps after stapled IPAA, 2 megapouches, 1 cuff abscess, and 1 straight pullthrough. All patients underwent redo IPAA with pouch salvage 100% in this series. Twelve had the original pouch repaired and 4 new pouches. Six patients (37%) had complications and outcome was acceptable with 7.8 stools per day and nighttime incontinence “rarely” or “never” in 7 patients. Eight described results as “good,” 6 as “fair.”Conclusions: Redo IPAA can be performed with few complications, an acceptable outcome, and should result in low pouch loss.