Can we improve transurethral resection of the bladder tumour for nonmuscle invasive bladder cancer?

NARCIS (Netherlands)

Liem, Esmee Iml; de Reijke, Theo M.

2017-01-01

Purpose of review The recurrence rate in patients with nonmuscle invasive bladder cancer is high, and the quality of transurethral resection of the bladder (TURB) tumour influences recurrence risk. We review new methods that aim to improve the effectiveness of TURB, and highlight studies of the past

DOES HYPOGONADISM ON RESULTS TRANSURETHRAL RESECTION OF BENIGN PROSTATIC HYPERPLASIA?

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A. V. Sigaev

2013-01-01

Full Text Available Influence of hypogonadism on the results of transurethral resection of the prostate (TURP in patients with benign prostatic hyperplasia (BPH remains unexplored. At the survey included 98 patients with benign prostatic hyperplasia who underwent TURP. Revealed that the postoperative period in patients characterized by a significant decrease in the level of performance testosteronemii in all cases, and against the background of hypogonadism accompanied by the development of more complications. Preoperative correction of hypogonadism for 2 weeks prior to surgery allows a 2-3 times lower risk of postoperative complications. 

Comparison of the efficacy and feasibility of laser enucleation of bladder tumor versus transurethral resection of bladder tumor: a meta-analysis.

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Yang, Huan; Wang, Ning; Han, Shanfu; Male, Musa; Zhao, Chenming; Yao, Daqiang; Chen, Zhiqiang

2017-12-01

The transurethral resection of bladder tumor (TURBT) remains the most widely used method in the surgical treatment of the non-muscle invasive bladder tumor (NMIBT). Despite its popularity, the laser technique has been widely used in urology as an alternative, via the application of transurethral laser enucleation of bladder tumor. The aim of the present study was to compare the efficacy and feasibility between transurethral laser enucleation and transurethral resection of bladder tumor. A systematic search of the following databases was conducted: PubMed, Wed of Science, Cochrane Library, EMBASE, Google scholar, and Medline. The search included studies up to the 1st of January 2017. The outcomes of interest that were used in order to assess the two techniques included operation time, catheterization time, hospitalization time, obturator nerve reflex, bladder perforation, bladder irritation, 24-month-recurrence rate, and the postoperative adjuvant intravesical chemotherapy. A total of 13 trials with 2012 participants were included, of which 975 and 1037 underwent transurethral laser enucleation and transurethral resection of bladder tumor, respectively. No significant difference was noted in the operation time between the two groups, although significant differences were reported for the variables catheterization time, hospitalization time, obturator nerve reflex, bladder perforation, bladder irritation, and 24-month-recurrence rate. In the mitomycin and epirubicin subgroups, no significant differences were observed in the laser enucleation and TURBT methods with regard to the 24-month-recurrence rate. The laser enucleation was superior to TURBT with regard to the parameters obturator nerve reflex, bladder perforation, catheterization time, hospitalization time, and 24-month-recurrence rate. Moreover, laser enucleation can offer a more accurate result of the tumor's pathological stage and grade.

[Perioperative stroke following transurethral resection of prostate: high index of suspicion and stabilization of physiological parameters can save lives].

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Nag, Deb Sanjay; Chatterjee, Abhishek; Samaddar, Devi Prasad; Agarwal, Ajay

2017-01-09

We report a case of a 72 year old hypertensive male who developed severe hypertension followed by neurological deterioration in the immediate postoperative period after transurethral resection of prostate. While arterial blood gas and laboratory tests excluded transurethral resection of prostate syndrome or any other metabolic cause, reduction of blood pressure failed to ameliorate the symptoms. A cranial CT done 4hours after the onset of neurological symptoms revealed bilateral gangliocapsular and right thalamic infarcts. Oral aspirin was advised to prevent early recurrent stroke. Supportive treatment and mechanical ventilation ensured physiological stability and the patient recovered completely over the next few days without any residual neurological deficit. Copyright © 2016. Publicado por Elsevier Editora Ltda.

Adjuvant chemotherapy for superficial transitional cell bladder carcinoma : Long-term results of a European organization for research and treatment of cancer randomized trial comparing doxorubicin, ethoglucid and transurethral resection alone

NARCIS (Netherlands)

Kurth, K; Tunn, U; Ay, R; Schroder, FH; PavoneMacaluso, M; Debruyne, F; TenKate, F; DePauw, M; Sylvester, R; Essed, E; Caubergh, RV; Hoekstra, JW; deVoogt, HJ; Newling, DWW; deReijke, TM; Mensink, HJA; Groen, JM; Jakse, G; Leisinger, HJ; Richards, B; Adib, RA; Robinson, M; Denis, L; Bouffioux, C; Schulman, C; Carpentier, PJ

Purpose: We compared the efficacy of transurethral resection alone or transurethral resection followed by bladder instillations of doxorubicin or ethoglucid for 1 year in patients with superficial bladder carcinoma, and followed them long term for the incidence of progression to muscle invasion.

Muscle invasive bladder cancer treated by transurethral resection, followed by external beam radiation and interstitial iridium-192

NARCIS (Netherlands)

A. Wijnmaalen (Arendjan); P.A. Helle (Peter); P.C.M. Koper (Peter); P.P. Jansen (Peter); P. Hanssens (Patrick); C.G.G. Boeken Kruger (Cornelis); W.L.J. van Putten (Wim)

1997-01-01

textabstractPurpose: To evaluate the results of transurethral resection (TUR), external beam radiotherapy (EBRT), and interstitial radiation (IRT) with iridium-192, using the afterloading technique in patients with muscle invasive bladder cancer. Methods and Materials: From May 1989 until September

Can immediate second resection be an alternative to standardized second transurethral resection of bladder tumors?

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Engin Doğantekin

2016-03-01

Full Text Available This study analyzed the impact of an immediate second transurethral resection of bladder tumor (TURBT protocol on residual tumor status at the initial TURBT session and the recurrence rate in the primary resection area. We prospectively evaluated and randomized 47 consecutive patients who underwent TURBT sessions for bladder cancer. In accordance with the inclusion criteria, of the 47 consecutive patients, 19 (Group I underwent immediate second resection of the tumor bed after complete TUR and 28 (Group II did not. After standard TURBT, Group I underwent a second cystoscopy and resection of the bed of the tumor or an ignored tumor, which was performed by a different urologist. After 4–6 weeks, delayed second TURB was performed, and all pathological results were evaluated. Tumors were detected in two patients during the immediate second resection. Of these, one was a misdiagnosed tumor, whereas the other was diagnosed at the bed of the tumor by pathological examination. Tumors were detected in nine patients at the delayed second TURB, of which only one was part of Group I, while the others were part of Group II (p = 0.04. The results of this study demonstrated that residual tumors may remain after initial TURB, either in the tumor bed or in a different location within the bladder. Although this was a pilot study enrolling only a small number of patients, our initial results supported the assertion that immediate second resection can be an alternative to standard second TURBT.

The role of succinylcholine in the prevention of the obturator nerve reflex during transurethral resection of bladder tumors

International Nuclear Information System (INIS)

Cesur, M.; Erdem, Ali F.; Alici, Haci A.; Yuksek, Mustafa S.; Yapanoglu, T.; Aksoy, Y.

2008-01-01

Objective was to present our 8 year experience in the prevention of the obturator nerve reflex during transurethral resection of bladder tumors. This study was performed in Ataturk University Hospital between 1999 and 2007. We retrospectively reviewed the records of 89 patients with inferolateral bladder tumors, who underwent transurethral resection under epidural or general anesthesia and requested obturator nerve reflex inhibition. Epidural anesthesia was administered to 57 patients, while the remaining 32 patients underwent general anesthesia via mask; and succinylcholine was administered prior to resection. Of the 57 patients received epidural anesthesia, 18 were diagnosed as inferolateral bladder tumors during endoscopy and had to undergo general anesthesia. Obturator nerve block was attempted preoperatively in 39 patients. However, a nerve identification failure, hematoma and 4 obturator nerve reflex events, despite the block, were observed and these patients were subjected to general anesthesia with succinylcholine. Fifty-six patients (32 patients initially had general anesthesia and 24 converted from epidural to general anesthesia) were all given succinylcholine prior to resection. Due to its mechanisms of action, succinylcholine is completely effective and represents a simple alternative to obturator nerve block. No contraction was observed in any patient given succinylcholine. (author)

Effects of transurethral resection of prostate on the quality of life of patients with benign prostatic hyperplasia.

LENUS (Irish Health Repository)

O'Sullivan, MartinJ

2012-02-03

BACKGROUND: This article investigated the effects of transurethral resection of prostate on quality of life (QOL) and urinary symptoms in patients with benign prostatic hyperplasia (BPH). STUDY DESIGN: In a prospective study, 30 patients without significant comorbidities undergoing transurethral resection of prostate for BPH were studied. Patients completed four validated questionnaires: the International Prostate Symptom Score and the associated QOL index because urinary symptoms, the Montgomery and Asberg Depression Rating Scale, the McGill Pain Questionnaire, and the QOL questionnaire Short Form-36. These were completed preoperatively, on the first postoperative day, on discharge from hospital, and at 1 and 3 months postoperatively. RESULTS: The QOL of patients who undergo transurethral resection of prostate for BPH had significantly improved at 3 months after their operation. The International Prostate Symptom Score scores at 1 month (9.3+\\/-4.6) and 3 months (5.4+\\/-5.6) were less than they were preoperatively (19.9+\\/-7.1). The QOL index because urinary symptoms was less at 1 month (2.4+\\/-1.9) and at 3 months postoperatively (1.5+\\/-1.4) in comparison with the preoperative scores (4.5+\\/-1.2). The Montgomery and Asberg Depression Rating Scale scores at 1 month (5.4+\\/-6.8) and 3 months (4.9+\\/-6.5) were less than they were preoperatively (9.2+\\/-8.3). The McGill Pain Questionnaire sensory and pain rating index scores were less at 3 months than they were preoperatively (p=0.02 and p<0.02 respectively). The McGill Pain Questionnaire affective score was less at 1 month than it was preoperatively (p<0.03). The McGill Pain Questionnaire evaluative scores were less than the preoperative score at all times postoperatively. The role physical (p=0.007), bodily pain (p=0.006), social function (p=0.007), and physical component summary (p=0.007) subsections of the Short Form-36 were greater at 3 months postoperatively when compared with the preoperative scores

Prostate stent is an option for selected patients who are unsuitable for transurethral resection of the prostate

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Skydsgaard Schou-Jensen, Katrine; Dahl, Claus; Azawi, Nessn Htum

2014-01-01

INTRODUCTION: Transurethral resection of the prostate (TUR-P) is the gold standard for treatment of severe lower urinary tract symptoms (LUTS) or urine retention. Some patients are unfit for surgery due to much co-morbidity and need alternative treatment. Intraprostatic stents are one example...

Can pretreatment ADC values predict recurrence of bladder cancer after transurethral resection?

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Funatsu, Hiroyuki, E-mail: hirofunatsu999@hotmail.com [Division of Diagnostic Imaging, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba 260-8717 (Japan); Imamura, Akihiro; Takano, Hideyuki [Division of Diagnostic Imaging, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba 260-8717 (Japan); Ueda, Takeshi [Division of Urology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba 260-8717 (Japan); Uno, Takashi [Department of Radiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670 (Japan)

2012-11-15

Objective: The aim of this retrospective study was to investigate the association between the pretreatment apparent diffusion coefficient (ADC) value and recurrence of bladder cancer after transurethral resection. Methods: Patients with superficial bladder cancer were identified. Mean ADC values of the tumors were compared between patients with and without recurrence following trans-urethral resection. A receiver-operator characteristic curve was used for determining the optimal cutoff ADC value. Univariate and multivariate analyses were used to determine the effect of ADC values and other factors. Results: With a mean follow-up period of 25 months, bladder cancer recurred in 14 of 44 patients (32%). The mean ADC value of tumors in patients with recurrence was lower than in those without recurrence (1.08 mm{sup 2}/s vs. 1.28 Multiplication-Sign 10{sup -3} mm{sup 2}/s; p = 0.003). The optimal cutoff ADC value for predicting recurrence was determined to be 1.12 Multiplication-Sign 10{sup -3} mm{sup 2}/s. A modest and significant negative correlation was observed between the ADC values and tumor size (r = -0.436, p = 0.008). After adjustment for size and risk groups, an ADC value equal to or less than the optimal cutoff remained a significant predictor of recurrence (odds ratio 6.3, 95% CI 1.23-32.2, p = 0.027). Conclusion: Pretreatment ADC values may be an independent predictor of bladder cancer recurrence.

Can pretreatment ADC values predict recurrence of bladder cancer after transurethral resection?

International Nuclear Information System (INIS)

Funatsu, Hiroyuki; Imamura, Akihiro; Takano, Hideyuki; Ueda, Takeshi; Uno, Takashi

2012-01-01

Objective: The aim of this retrospective study was to investigate the association between the pretreatment apparent diffusion coefficient (ADC) value and recurrence of bladder cancer after transurethral resection. Methods: Patients with superficial bladder cancer were identified. Mean ADC values of the tumors were compared between patients with and without recurrence following trans-urethral resection. A receiver–operator characteristic curve was used for determining the optimal cutoff ADC value. Univariate and multivariate analyses were used to determine the effect of ADC values and other factors. Results: With a mean follow-up period of 25 months, bladder cancer recurred in 14 of 44 patients (32%). The mean ADC value of tumors in patients with recurrence was lower than in those without recurrence (1.08 mm 2 /s vs. 1.28 × 10 −3 mm 2 /s; p = 0.003). The optimal cutoff ADC value for predicting recurrence was determined to be 1.12 × 10 −3 mm 2 /s. A modest and significant negative correlation was observed between the ADC values and tumor size (r = −0.436, p = 0.008). After adjustment for size and risk groups, an ADC value equal to or less than the optimal cutoff remained a significant predictor of recurrence (odds ratio 6.3, 95% CI 1.23–32.2, p = 0.027). Conclusion: Pretreatment ADC values may be an independent predictor of bladder cancer recurrence.

Effect of hydromorphone hydrochloride combined with ropivacaine for PCEA after transurethral resection of prostate on pain mediators and stress response

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Yu-Lin Ma

2017-08-01

Full Text Available Objective: To study the effect of hydromorphone hydrochloride combined with ropivacaine for patient-controlled epidural analgesia (PCEA after transurethral resection of prostate on pain mediators and stress response. Methods: A total of 138 patients who received transurethral resection of prostate in Ankang Central Hospital between May 2014 and October 2016 were selected and randomly divided into group A and group B, group A received postoperative hydromorphone hydrochloride combined with ropivacaine for PCEA, and group B received postoperative morphine hydrochloride combined with ropivacaine for PCEA. The serum contents of pain mediators, inflammatory response cytokines and stress hormones of the two groups were detected before surgery as well as 12 h, 24 h and 48 h after surgery. Results: 12 h, 24 h and 48 h after surgery, serum SP, BK, HIS, CX3CL1, CCL2, IL-1β, TNF-α, IL-10, ACTH, CORT, TSH, FT3, FT4 and GH levels of both groups of patients were significantly higher than those before surgery, and serum SP, BK, HIS, CX3CL1, CCL2, IL-1β, TNF-α, IL-10, ACTH, CORT, TSH, FT3, FT4 and GH levels of group A were significantly lower than those of group B. Conclusion: Hydromorphone hydrochloride combined with ropivacaine for PCEA can effectively reduce the pain and stress after transurethral resection of prostate.

Cost-effectiveness analysis at 2 years of surgical treatment of benign prostatic hyperplasia by photoselective vaporization of the prostate with GreenLight-Photo vaporization 120 W versus transurethral resection of the prostate.

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Benejam-Gual, J M; Sanz-Granda, A; García-Miralles Grávalos, R; Severa-Ruíz de Velasco, A; Pons-Viver, J

2014-05-01

Transurethral resection of the prostate is the gold standard of surgical treatment of lower urinary tract symptoms associated to benign prostate hyperplasia. The new Green Light Photovaporization has been shown to be an alternative that is as effective for this condition as the transurethral resection of the prostate. To compare the efficiency of Green Light Photovaporization 120 W versus transurethral resection of the prostate in the treatment of benign prostate hyperplasia (BPH) in a 2-year time horizon from the perspective of the Spanish health service perspective. A cost utility analysis was performed retrospectively with the data from 98 patients treated sequentially with transurethral resection of the prostate (n: 50) and Green Light Photovaporization 120 W (n: 48). A Markov model was designed to estimate the cost (2012€) and results (quality adjusted life years) in a 2-year time horizon. The total cost associated to Green Light Photovaporization 120 W treatment was less (3,377€; 95% CI: 3,228; 3,537) than that of the transurethral resection of the prostate (3,770€; 95% CI: 3,579; 3,945). The determining factor of the cost was the surgical phase (difference: -450€; 95% CI: -625; -158) because admission to hospital after surgery was not necessary with the GreenLight-PhotoVaporization. Surgical treatment of BPH patients with GreenLight-PhotoVaporization 120 W is more efficient than transurethral resection of the prostate in the surgical treatment of benign prostate hyperplasia as it has similar effectiveness and lower cost (-393€; 95% CI: -625; -158). Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

Combined endoscopic and laparoscopic approach for palliative resection of metastatic melanoma of the stomach

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Pritchard SA

2006-03-01

Full Text Available Abstract Background Metastatic tumours of the stomach present a clinical dilemma for the surgeon. Palliative surgical resection can alleviate symptoms and prolong survival in selected patients. However, previous studies have used open methods of surgical resection with potentially high morbidity and mortality. We describe the use of laparoscopic wedge resection of the stomach for palliative resection of metastatic melanoma to highlight the benefits of this technique. Case presentation A 58 year old male was investigated for iron deficiency anaemia while under treatment for pulmonary metastatic malignant melanoma. An upper gastrointestinal endoscopy revealed a 5 cm diameter ulcer on the anterior wall of the stomach, biopsies from the ulcer confirmed metastatic melanoma. Laparoscopic wedge resection of the stomach lesion was performed without complication. Conclusion Laparoscopic approach has many benefits and is useful for the palliative resection of rare tumours of the stomach in order to preserve the quality of life. Its use should be considered in selected patients.

Perspectives of transurethral robotic laser resection of the prostate: vaporization and coagulation effects with the Nd:YAG laser

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Ho, Gideon; Teo, Ming Y.; Kwoh, Chee K.; Ng, Wan S.; Cheng, Wai S.

2000-05-01

A longer operating time and steeper learning curve in mastering the techniques for transurethral laser resection of the prostate are the main problems faced by surgeons compared to standard transurethral resection of the prostate (TURP). However, these disadvantages can be solved with the introduction of a treatment modality designed and developed based on an integrated system of computer, robotics and laser technology. In vitro experiments were carried out to determine variables affecting the vaporization and coagulation lesions, in order to identify the parameters that could optimize this modality. Human cadaveric prostate and fresh chicken breast tissues were irradiated with different parameters using continuous wave Nd:YAG laser fiber in contact with the tissue. The effects of irrigant flowrate, fiber/tissue angle of inclination, number of passes, direction, speed and power of lase on the volume of tissue vaporized and coagulated, were assessed. A non-contact optical coordinate measuring machine was used to measure the depth and width of the vaporized and coagulated lesion. Results reveal that for each directional vaporization path (forward, clockwise and counter-clockwise), power and speed of lase are the most significant parameters influencing the volume of the vaporized and coagulated lesion. Optimized values of the power and speed of lase at 100 W and 1 - 3 mm/s respectively were obtained from the experiments when the tissues were irradiated in the forward, clockwise and counter-clockwise directions. It was concluded from our study to quantify tissue removal and damage, optimized values of irradiation power and speed could be obtained and implemented in the procedure of transurethral robotic laser resection of the prostate.

Reducing recurrence in non-muscle-invasive bladder cancer using photodynamic diagnosis and immediate post-transurethral resection of the bladder chemoprophylaxis

DEFF Research Database (Denmark)

Risager, Malene Bøg; Nielsen, Tommy Kjærgaard; Zieger, Karsten Egbert Arnold

2015-01-01

Abstract Objective. The aim of this study was to evaluate the effect of fluorescence cystoscopy and immediate post-transurethral resection of the bladder (TURB) chemoprophylaxis on the risk of recurrence of non-muscle-invasive bladder cancer (NMIBC) under routine clinical conditions. Materials...

Ergonomic assessment of the posture of surgeons performing endoscopic transurethral resections in urology

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Sökeland Jürgen

2009-10-01

Full Text Available Abstract Background During transurethral endoscopic prostate and bladder operations the influence of an ergonomic redesign of the arrangement of the operation equipment - including the introduction of a video-assisted resection method ('monitor endoscopy' instead of directly viewing onto the operation area via the endoscope ('direct endoscopy' - was studied with respect to the postures of the surgeons. Methods Postures were analysed on the basis of video recordings of the surgeons performed in the operation theatre during live operations and subsequent visual posture estimation executed by an observer. In particular, head, trunk and arm positions were assigned to posture categories according to a newly developed posture classification schema. 10 urological operations with direct endoscopy and 9 with monitor endoscopy were included. Results Application of direct endoscopy coincides with distinct lateral and sagittal trunk and head inclinations, trunk torsion and strong forearm and upper arm elevations of the surgeons whereas operations with monitor endoscopy were performed with an almost upright head and trunk and hanging arms. The disadvantageous postures observed during direct endoscopy are mainly caused by the necessity to hold the endoscope continuously in close contact with the eye. Conclusion From an ergonomic point of view, application of the video-assisted resection method should be preferred in transurethral endoscopic operations in order to prevent awkward postures of the surgeons and to limit muscular strain and fatigue. Furthermore, the application of the monitor method enables the use of a chair equipped with back support and armrests and benefits the reduction of postural stress.

Primary tumor location as a predictor of the benefit of palliative resection for colorectal cancer with unresectable metastasis.

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Zhang, Rong-Xin; Ma, Wen-Juan; Gu, Yu-Ting; Zhang, Tian-Qi; Huang, Zhi-Mei; Lu, Zhen-Hai; Gu, Yang-Kui

2017-07-27

It is still under debate that whether stage IV colorectal cancer patients with unresectable metastasis can benefit from primary tumor resection, especially for asymptomatic colorectal cancer patients. Retrospective studies have shown controversial results concerning the benefit from surgery. This retrospective study aims to evaluate whether the site of primary tumor is a predictor of palliative resection in asymptomatic stage IV colorectal cancer patients. One hundred ninety-four patients with unresectable metastatic colorectal cancer were selected from Sun Yat-sen University Cancer Center Database in the period between January 2007 and December 2013. All information was carefully reviewed and collected, including the treatment, age, sex, carcinoembryonic antigen, site of tumor, histology, cancer antigen 199, number of liver metastases, and largest diameter of liver metastasis. The univariate and multivariate analyses were used to detect the relationship between primary tumor resection and overall survival of unresectable stage IV colorectal cancer patients. One hundred twenty-five received palliative resection, and 69 received only chemotherapy. Multivariate analysis indicated that primary tumor site was one of the independent factors (RR 0.569, P = 0.007) that influenced overall survival. For left-side colon cancer patients, primary tumor resection prolonged the median overall survival time for 8 months (palliative resection vs. no palliative resection: 22 vs. 14 months, P = 0.009); however, for right-side colon cancer patients, palliative resection showed no benefit (12 vs. 10 months, P = 0.910). This study showed that left-side colon cancer patients might benefit from the primary tumor resection in terms of overall survival. This result should be further explored in a prospective study.

[Resection of juxtahilar bile duct carcinoma instead of palliative drainage of the biliary tract].

Science.gov (United States)

Pichlmayr, R; Lehr, L; Ziegler, H

1983-01-01

Instead of the widely recommended approach of treating hilar carcinoma of the bile ducts by simple palliative biliary drainage, step by step a policy of primarily aiming at resection for cure has been adopted. So far in 11 out of 22 patients excision of the tumor was possible by resection of the hepatic duct confluence; in 4 cases a left hemihepatectomy had to be added because of carcinomatous infiltration of the left liver lobe or the left hepatic artery. The multiple bile duct openings remaining after resection of such tumors were reconstructed to one or two orifices and a bi- or unilateral Roux-en-Y cholangiojejunal anastomosis performed. In further 3 cases orthotopic liver transplantation was necessary to remove all visibly infiltrated tissue. In the remaining 8 patients because of documented extrahepatic carcinomatous spread palliative biliary drainage by a percutaneous U-tube or an endoprothesis was indeed considered the only reasonable measure. Despite the relatively high resectional rate of 60% and the extensive operations performed early mortality was confined to one patient who succumbed to septic endocarditis 6 weeks after the operation. At present the longest postoperative interval without recurrence amounts to 3 1/2 years. Nine patients free of recurrent disease are in perfect health; in 3 patients in whom a recurrence was observed after 1/2, 1 1/2 and 2 years meanwhile palliation was perfect. In contrast all patients with unresected tumors but carrying draining stents suffered from cholangitis and after 1 1/2 years all but one had died. In conclusion resectional therapy for hilar carcinoma seems possible with acceptable risk. Since only resection can provide potential cure and also palliation was better than that achieved by draining tubes a more aggressive attitude to the treatment of these lesions is advocated from our experience.

Thermal balance during transurethral resection of the prostate. A comparison of general anaesthesia and epidural analgesia

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Stjernström, H; Henneberg, S; Eklund, A

1985-01-01

Heat loss during anaesthesia and surgery is a common problem. In patients with restricted cardio-pulmonary reserves this may endanger the postoperative outcome. In order to compare thermal balance we studied 25 men undergoing transurethral resection of the prostate (TURP), using either general...... of the prostate resulted in a peroperative heat loss which was not influenced by the anaesthetic technique used and averaged 370 kJ during the first hour of surgery. G.A. reduced heat production while this was uninfluenced by E.A. After termination of general anaesthesia, oxygen uptake and plasma catecholamines...

Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer: long-term results

International Nuclear Information System (INIS)

Prada, Pedro J.; Anchuelo, Javier; Blanco, Ana Garcia; Paya, Gema; Cardenal, Juan; Acuña, Enrique; Ferri, Maria; Vazquez, Andres; Pacheco, Maite; Sanchez, Jesica

2016-01-01

Objectives: We analyzed the long-term oncologic outcome for patients with prostate cancer and transurethral resection who were treated using low-dose-rate (LDR) prostate brachytherapy. Methods and Materials: From January 2001 to December 2005, 57 consecutive patients were treated with clinically localized prostate cancer. No patients received external beam radiation. All of them underwent LDR prostate brachytherapy. Biochemical failure was defined according to the 'Phoenix consensus'. Patients were stratified as low and intermediate risk based on The Memorial Sloan Kettering group definition. Results: The median follow-up time for these 57 patients was 104 months. The overall survival according to Kaplan-Meier estimates was 88% (±6%) at 5 years and 77% (±6%) at 12 years. The 5 and 10 years for failure in tumour-free survival (TFS) was 96% and respectively (±2%), whereas for biochemical control was 94% and respectively (±3%) at 5 and 10 years, 98% (±1%) of patients being free of local recurrence. A patient reported incontinence after treatment (1.7%). The chronic genitourinary complains grade I were 7% and grade II, 10%. At six months 94% of patients reported no change in bowel function. Conclusions: The excellent long-term results and low morbidity presented, as well as the many advantages of prostate brachytherapy over other treatments, demonstrates that brachytherapy is an effective treatment for patients with transurethral resection and clinical organ-confined prostate cancer. (author)

Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer: long-term results

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Prada, Pedro J.; Anchuelo, Javier; Blanco, Ana Garcia; Paya, Gema; Cardenal, Juan; Acuña, Enrique; Ferri, Maria [Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria (Spain); Vazquez, Andres; Pacheco, Maite; Sanchez, Jesica [Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria (Spain)

2016-01-15

Objectives: We analyzed the long-term oncologic outcome for patients with prostate cancer and transurethral resection who were treated using low-dose-rate (LDR) prostate brachytherapy. Methods and Materials: From January 2001 to December 2005, 57 consecutive patients were treated with clinically localized prostate cancer. No patients received external beam radiation. All of them underwent LDR prostate brachytherapy. Biochemical failure was defined according to the 'Phoenix consensus'. Patients were stratified as low and intermediate risk based on The Memorial Sloan Kettering group definition. Results: The median follow-up time for these 57 patients was 104 months. The overall survival according to Kaplan-Meier estimates was 88% (±6%) at 5 years and 77% (±6%) at 12 years. The 5 and 10 years for failure in tumour-free survival (TFS) was 96% and respectively (±2%), whereas for biochemical control was 94% and respectively (±3%) at 5 and 10 years, 98% (±1%) of patients being free of local recurrence. A patient reported incontinence after treatment (1.7%). The chronic genitourinary complains grade I were 7% and grade II, 10%. At six months 94% of patients reported no change in bowel function. Conclusions: The excellent long-term results and low morbidity presented, as well as the many advantages of prostate brachytherapy over other treatments, demonstrates that brachytherapy is an effective treatment for patients with transurethral resection and clinical organ-confined prostate cancer. (author)

Prospective, Randomized, Multinational Study of Prostatic Urethral Lift Versus Transurethral Resection of the Prostate

DEFF Research Database (Denmark)

Sønksen, Jens; Barber, Neil J; Speakman, Mark J

2015-01-01

BACKGROUND: Transurethral resection of the prostate (TURP) is considered the gold standard for male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, TURP may lead to sexual dysfunction and incontinence, and has a long recovery period. Prostatic urethral...... lift (PUL) is a treatment option that may overcome these limitations. OBJECTIVE: To compare PUL to TURP with regard to LUTS improvement, recovery, worsening of erectile and ejaculatory function, continence and safety (BPH6). DESIGN, SETTING, AND PARTICIPANTS: Prospective, randomized, controlled trial...... at 10 European centers involving 80 men with BPH LUTS. INTERVENTION: PUL or TURP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The BPH6 responder endpoint assesses symptom relief, quality of recovery, erectile function preservation, ejaculatory function preservation, continence preservation...

Current Indications for Transurethral Resection of the Prostate and Associated Complications

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Chia-Chu Liu

2003-02-01

Full Text Available Transurethral resection of the prostate (TURP is the most common surgical procedure for relieving symptoms of benign prostatic hyperplasia. Here, we report our experience of current indications for TURP and their associated outcomes at Kaohsiung Medical University Hospital (KMUH. A total of 111 patients who underwent TURP at KMUH between May 2000 and December 2001 were included in this retrospective review. For each patient, the surgical indication was categorized into acute urinary retention, chronic complications (including renal impairment, recurrent urinary infection, bladder stone/diverticulum, post-void residue, and recurrent hematuria, and symptomatic prostatism. Thirty-five patients (31% had acute urinary retention, 28 (27% had chronic complications, and 48 (42% had symptomatic prostatism. Most patients chose TURP only when medical treatment had failed to relieve symptoms, no matter what category they belonged to. Patients with acute urinary retention and chronic complications had larger prostates (p = 0.002 and more tissue resected (p = 0.05 than those with symptomatic prostatism. Patients with acute urinary retention seemed to be at greater risk of postoperative complications such as recurrent urinary retention and urinary tract infection. We suggest that urodynamic study may be necessary to rule out concomitant bladder dysfunction before surgery and that adequate prophylactic antibiotic treatment be used to decrease the risk of urinary tract infection during or after TURP, especially when pyuria is noted preoperatively in patients with acute urinary retention.

A head-mounted display-based personal integrated-image monitoring system for transurethral resection of the prostate.

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Yoshida, Soichiro; Kihara, Kazunori; Takeshita, Hideki; Fujii, Yasuhisa

2014-12-01

The head-mounted display (HMD) is a new image monitoring system. We developed the Personal Integrated-image Monitoring System (PIM System) using the HMD (HMZ-T2, Sony Corporation, Tokyo, Japan) in combination with video splitters and multiplexers as a surgical guide system for transurethral resection of the prostate (TURP). The imaging information obtained from the cystoscope, the transurethral ultrasonography (TRUS), the video camera attached to the HMD, and the patient's vital signs monitor were split and integrated by the PIM System and a composite image was displayed by the HMD using a four-split screen technique. Wearing the HMD, the lead surgeon and the assistant could simultaneously and continuously monitor the same information displayed by the HMD in an ergonomically efficient posture. Each participant could independently rearrange the images comprising the composite image depending on the engaging step. Two benign prostatic hyperplasia (BPH) patients underwent TURP performed by surgeons guided with this system. In both cases, the TURP procedure was successfully performed, and their postoperative clinical courses had no remarkable unfavorable events. During the procedure, none of the participants experienced any HMD-wear related adverse effects or reported any discomfort.

Radiofrequency assisted pancreaticoduodenectomy for palliative surgical resection of locally advanced pancreatic adenocarcinoma.

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Kumar, Jayant; Reccia, Isabella; Sodergren, Mikael H; Kusano, Tomokazu; Zanellato, Artur; Pai, Madhava; Spalding, Duncan; Zacharoulis, Dimitris; Habib, Nagy

2018-03-20

Despite careful patient selection and preoperative investigations curative resection rate (R0) in pancreaticoduodenectomy ranges from 15% to 87%. Here we describe a new palliative approach for pancreaticoduodenectomy using a radiofrequency energy device to ablate tumor in situ in patients undergoing R1/R2 resections for locally advanced pancreatic ductal adenocarcinoma where vascular reconstruction was not feasible. There was neither postoperative mortality nor significant morbidity. Each time the ablation lasted less than 15 minutes. Following radiofrequency ablation it was observed that the tumor remnant attached to the vessel had shrunk significantly. In four patients this allowed easier separation and dissection of the ablated tumor from the adherent vessel leading to R1 resection. In the other two patients, the ablated tumor did not separate from vessel due to true tumor invasion and patients had an R2 resection. The ablated remnant part of the tumor was left in situ. Whenever pancreaticoduodenectomy with R0 resection cannot be achieved, this new palliative procedure could be considered in order to facilitate resection and enable maximum destruction in remnant tumors. Six patients with suspected tumor infiltration and where vascular reconstruction was not warranted underwent radiofrequency-assisted pancreaticoduodenectomy for locally advanced pancreatic ductal adenocarcinoma. Radiofrequency was applied across the tumor vertically 5-10 mm from the edge of the mesenteric and portal veins. Following ablation, the duodenum and the head of pancreas were removed after knife excision along the ablated line. The remaining ablated tissue was left in situ attached to the vessel.

Intestinal obstruction: a rare complication of channeling Transurethral Resection of the Prostate (TURP: a case report

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Popoola AA

2008-01-01

Full Text Available Abstract Introduction Channeling transurethral resection of the prostate is a recognized form of adjunctive treatment in the treatment of patients with prostate cancer. Despite the fact that complications arising from the procedure have been on the decline, rare complications like intestinal obstruction may occur. Case presentation This is a case report of a 56 year old man who developed mechanical intestinal obstruction few days after a channeling TURP for advanced CaP. Conclusion The report highlights the possibility of intestinal obstruction as a secondary event following a silent urinary bladder perforation during channeling TURP. Early recognition and intervention were responsible for the good outcome in this patient.

Satisfactory spinal anesthesia with a total of 1.5 mg of bupivacaine for transurethral resection of bladder tumor in an elderly patient.

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Namba, Yoshimichi; Yamakage, Michiaki; Tanaka, Yoshinori

2016-01-01

Spinal anesthesia is popular for endoscopic urological surgery. Many patients undergoing urological surgery are elderly. It is important to limit the dose to reduce any resultant hemodynamic effect. We present a case in which incremental administration of 0.1 % bupivacaine up to 1.5 mg was sufficient to produce satisfactory spinal anesthesia for transurethral resection of bladder tumor (TURBT).

The changing practice of transurethral resection of the prostate.

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Young, M J; Elmussareh, M; Morrison, T; Wilson, J R

2018-04-01

Introduction Transurethral resection of the prostate (TURP) is considered the gold standard surgical treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The number of TURPs performed has declined significantly over the last three decades owing to pharmaceutical therapy. TURP data from a single institution for the years 1990, 2000 and 2010 were compared to assess the difference in performance. Methods A retrospective analysis was undertaken of all patients who underwent TURP between January and December 2010. These findings were compared with historical data for the years 1990 and 2000: 100 sets of case notes were selected randomly from each of these years. Results The number of TURPs performed fell from 326 in 1990 to 113 in 2010. The mean age of patients increased from 70.6 years to 74.0 years. There was also a significant increase in the mean ASA grade from 1.9 to 2.3. The most common indication for TURP shifted from LUTS to acute urinary retention. No significant change in operating time was observed. The mean resection weight remained constant (22.95g in 1990, 22.55g in 2000, 20.76g in 2010). A reduction in transfusion rates was observed but there were higher rates of secondary haematuria and bladder neck stenosis. There was an increase from 2% to 11.5% of patients with long-term failure to void following TURP. Conclusions The number of TURPs performed continues to decline, which could lead to potential training issues. Urinary retention is still by far the most common indication. However, there has been a significant rise in the percentage of men presenting for TURP with high pressure chronic retention. The number of patients with bladder dysfunction who either have persistent storage LUTS or eventually require long-term catheterisation or intermittent self-catheterisation has increased markedly, which raises the question of what the long-term real life impact of medical therapy is on men with LUTS secondary to benign

Thermal balance during transurethral resection of the prostate. A comparison of general anaesthesia and epidural analgesia

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Stjernström, H; Henneberg, S; Eklund, A

1985-01-01

of the prostate resulted in a peroperative heat loss which was not influenced by the anaesthetic technique used and averaged 370 kJ during the first hour of surgery. G.A. reduced heat production while this was uninfluenced by E.A. After termination of general anaesthesia, oxygen uptake and plasma catecholamines...... anaesthesia (G.A.) or epidural analgesia (E.A.). Oxygen uptake, catecholamines, peripheral and central temperatures were followed in the per- and postoperative period. Heat production and total body heat were calculated from oxygen uptake and temperature measurements, respectively. Transurethral resection...... increased, while no such changes could be detected using epidural analgesia. The ability to increase mean body temperature by increasing heat production was negatively correlated to age....

Sequential transurethral surgery, multiple drug chemotherapy and radiation therapy for invasive bladder carcinoma: Initial report

International Nuclear Information System (INIS)

Cervek, J.; Cufer, T.; Kragelj, B.; Zakotnik, B.; Stanonik, M.

1993-01-01

Forty-seven patients with muscle-invasive bladder cancer (T2--T4, Nx, MO) were treated by transurethral resection, followed by 3--4 cycles of combination chemotherapy (methothrexate 30 mg/m2 on days 1, 14; cis-platinum 100 mg/m2 on day 2; vinblastine 3 mg/m2 on days 1, 14; repeated every 21 days), and external beam irradiation (64--66 Gy to the bladder and 40 Gy to the pelvic lymphatics). Complete remission after transurethral resection and chemotherapy was achieved in 24 out of 45 patients (53%). Cystectomy was performed in patients without complete response to transurethral resection and chemotherapy. The therapy was completed as planned in 45/47 patients. After transurethral resection, chemotherapy, and radiation therapy, biopsy proven complete response was achieved in 62% (28/45); Stage T2T3 in 67% (23/24), Stage T4 in 45% (5/11) of patients. Among 19 patients with positive biopsy findings after transurethral resection and chemotherapy, 14 underwent cystectomy. After follow-up of 4--55 months (median 23 months) 75% (34/45) are alive, 68% (31/45) have had their bladders preserved, and 53% (24/45) are free of the primary tumor. The actuarial survival of all 45 patients is 73%. Moderate nausea and vomiting during treatment were common; severe leukopenia and mucositis were observed in five patients. Late side effects such as miction disorders and diarrhea were predominantly mild. Although the observation period has been too short to allow a definitive evaluation of treatment results, the authors feel both from the point of bladder preservation and disease-free survival that the presented treatment approach is successful in a majority of T2T3 patients, whereas a large tumor size (T4) renders this treatment less effective. 17 refs., 4 figs., 4 tabs

[CLINICAL BACKGROUND ANALYSIS ABOUT TRANSURETHRAL ELECTROCOAGULATION].

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Katsui, Masahiro; Kikuchi, Eiji; Yazawa, Satoshi; Hagiwara, Masayuki; Morita, Shinya; Shinoda, Kazunobu; Kosaka, Takeo; Mizuno, Ryuichi; Shinojima, Toshiaki; Asanuma, Hiroshi; Miyajima, Akira; Oya, Mototsugu

2015-10-01

Transurethral electrocoagulation (TUC) is a rare event but occurs in a constant manner with various causes or disorders and reduces patient quality of life. So far there have been no reports focusing on the details of TUC. We focused on the clinical background and related causes in cases of TUC in our institution. We identified 76 cases (65 patients) who underwent TUC at Keio University Hospital between April 2001 and March 2011. We focused on patient background, especially with respect to the primary disease, treatment modality, use of antiplatelet or anticoagulant agent, timing of TUC, type of electrosurgical device, and the incidence of transfusion. The primary disease for TUC included bladder tumor (BT) in 31 cases, benign prostate hyperplasia (BPH) in 13, prostate cancer (PCa) in 13, idiopathic bladder bleeding in 4, periarteritis nodosa in 3, uterine cervical cancer in 3, and others in 9. TUC after transurethral resection (TUR) was found in 38 cases, including transurethral resection of bladder tumor (TURBT) in 26 of 31 BT cases and transurethral resection of prostate (TURP) in 12 of 13 BPH cases. After TURBT, TUC was performed before removal of a urethral catheter in 7 cases, and after removal of a urethral catheter in 19 cases. With regard to TUC associated with TURP, the average estimated prostate volume in TUC cases before removal of the urethral catheter was 66.2 ml, which was significantly larger than that in TUC cases after removal of the urethral catheter (46.1 ml, p = 0.045). TUC after the radiation therapy was observed in 21 cases, and the average time from the radiation therapy to TUC was 3.4 years (7 months-10 years). TUC was caused by multiple causes or disorders, and 75% of our TUC was associated with BT, BPH or PCa. TUC associated with TURBT frequently occurred within 1 week after TURBT but was still observed after 1 month following the operation. All TUC associated with TURP occurred within 3 weeks after operation. The average period from

Herbal compound 'Songyou Yin' reinforced the ability of interferon-alfa to inhibit the enhanced metastatic potential induced by palliative resection of hepatocellular carcinoma in nude mice

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Huang, Xiu-Yan; Huang, Zi-Li; Wang, Lu; Xu, Yong-Hua; Huang, Xin-Yu; Ai, Kai-Xing; Zheng, Qi; Tang, Zhao-You

2010-01-01

Liver resection is a widely accepted treatment for hepatocellular carcinoma (HCC). Our previous clinical study showed that the rate of palliative resection was 34.0% (1958-2008, 2754 of 8107). However, the influence of palliative resection on tumor metastasis remains controversial. The present study was conducted to evaluate the effect of palliative resection on residual HCC and to explore interventional approaches. Palliative resection was done in an orthotopic nude mice model of HCC (MHCC97H) with high metastatic potential. Tumor growth, invasion, metastasis, lifespan, and some molecular alterations were examined in vivo and in vitro. Mice that underwent palliative resection were treated with the Chinese herbal compound 'Songyou Yin,' interferon-alfa-1b (IFN-α), or their combination to assess their effects. In the palliative resection group, the number of lung metastatic nodules increased markedly as compared to the sham operation group (14.3 ± 4.7 versus 8.7 ± 3.6, P < 0.05); tumor matrix metalloproteinase 2 (MMP2) activity was elevated by 1.4-fold, with up-regulation of vascular endothelial growth factor (VEGF) and down-regulation of tissue inhibitor of metalloproteinase 2 (TIMP2). The sera of mice undergoing palliative resection significantly enhanced cell invasiveness by 1.3-fold. After treatment, tumor volume was 1205.2 ± 581.3 mm 3 , 724.9 ± 337.6 mm 3 , 507.6 ± 367.0 mm 3 , and 245.3 ± 181.2 mm 3 in the control, 'Songyou Yin,' IFN-α, and combination groups, respectively. The combined therapy noticeably decreased the MMP2/TIMP2 ratio and prolonged the lifespan by 42.2%. Moreover, a significant (P < 0.001) reduction of microvessel density was found: 43.6 ± 8.5, 34.5 ± 5.9, 23.5 ± 5.6, and 18.2 ± 8.0 in the control and treatment groups, respectively. Palliative resection-stimulated HCC metastasis may occur, in part, by up-regulation of VEGF and MMP2/TIMP2. 'Songyou Yin' reinforced the ability of IFN-α to inhibit the

Open radical prostatectomy after transurethral resection: perioperative, functional, oncologic outcomes.

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Fragkoulis, Charalampos; Pappas, Athanasios; Theocharis, Georgios; Papadopoulos, Georgios; Stathouros, Georgios; Ntoumas, Konstantinos

2018-04-01

To demonstrate any differences in the perioperative, functional and oncologic outcomes after radical retropubic prostatectomy (RRP) among those patients having previously performed transurethral resection of prostate (TURP) and those not. A total of 35 patients were diagnosed with prostate cancer (T1a and T1b) after TURP, underwent RRP and completed a 1 year follow up (group A). They were matched with a cohort of another 35 men (group B) in terms of age, body mass index (BMI), prostatic specific antigen (PSA), Gleason score, prostate volume (before surgery), pathological stage and neurovascular bundle-sparing technique. That was a retrospective study completed between September 2011 and March 2014. Not a significant difference was demonstrated among the two groups of patients concerning the functional and oncologic results. On the other hand, previous prostate surgery made the operation procedure more demanding. Besides, operative time and blood loss (though not translated in transfusion rates) were higher among patients in group A. Besides, catheter removal in group A patients was performed later than their counterparts of group B. RRP after TURP is a relatively safe procedure and in the hands of experienced surgeons, a previously performed TURP, does not seem to compromise oncologic outcomes of the operation. Continence is preserved, though erectile function seems to be compromised compared with patients undergoing RRP without prior TURP. Moreover, defining the prostate and bladder neck margins can be challenging and the surgeon has to be aware of the difficulties that might confront.

New transurethral system for interstitial radiation of prostate cancer

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Baumgartner, G.; Callahan, D.; McKiel, C.F. Jr.; Zickgraf, E.; Forgione, H.

1988-01-01

Direct endoscopic implantation of radioactive materials for carcinoma of the prostate without an open operation was accomplished by the use of modified existing transurethral instrumentation and techniques. The closed approach seems applicable particularly to the geriatric population, which is afflicted more commonly but is frequently not treated because of concurrent diseases or because the patient had transurethral resection of the prostate as a diagnostic procedure. Eleven patients were implanted using the transurethral route. Implantations were accomplished successfully with extremely low morbidity. Along with more conventional dosimetry studies, computer tomography was used to assess the placement of seeds. The direct visualization of the method suggests a potential for greater precision of seed placement as illustrated by computer tomography. In addition, this new instrumentation and method offers a low-risk procedure for carcinoma of the prostate that can be performed on an outpatient basis for selected patients

Bladder preservation for locally advanced bladder cancer by transurethral resection, systemic chemotherapy and radiation

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Honda, Masahito; Satoh, Mototaka; Tujimoto, Yuichi; Takada, Tuyoshi; Matsumiya, Kiyomi; Fujioka, Hideki

2006-01-01

Twenty-three out of 31 patients with clinical T2-4a N0 M0 bladder cancer and given a trial of trimodality therapy including transurethral resection (TUR), systemic chemotherapy and radiation between 1991 and 2002 completed this therapy. The other 8 dropped out because of insufficient clinical effect. Local bladder recurrence was seen in 3 patients and the bladder preservation rate was 64.5%. Nineteen of the 23 patients showed a complete histological response on a subsequent TUR specimen, the other 4 were not examined for histological response. Thirteen of the 19 patients showed a complete histological response after maximal TUR and systemic chemotherapy, while 6 did after TUR, chemotherapy and radiotherapy. Bladder cancer was T2 in, 15, T3 in 1, and T4a in 3 patients. The CR rate for T2 cancer was significantly higher than that for T3-4a cancer. The 5-year disease-specific survival of the 23 patients treated with preservation therapy was 67.1%. Some of the patients with locally advanced bladder cancer may benefit from this preservation therapy. (author)

Clinical analysis of urinary tract infection in patients undergoing transurethral resection of the prostate.

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Li, Y-H; Li, G-Q; Guo, S-M; Che, Y-N; Wang, X; Cheng, F-T

2017-10-01

To analyze the related influencing factors of urinary tract infection in patients undergoing transurethral resection of the prostate (TURP). A total of 343 patients with benign prostatic hyperplasia admitted to this hospital from January 2013 to December 2016, were selected and treated by TURP. Patients were divided into infection group and non-infection group according to the occurrence of urinary tract infection after operation. The possible influencing factors were collected to perform univariate and multivariate logistic regression analysis. There were 53 cases with urinary tract infection after operation among 343 patients with benign prostatic hyperplasia, accounting for 15.5%. The univariate analysis displayed that the occurrence of urinary tract infection in patients undergoing TURP was closely associated with patient's age ≥ 65 years old, complicated diabetes, catheterization for urinary retention before operation, no use of antibiotics before operation and postoperative indwelling catheter duration ≥ 5 d (p urinary tract infection in patients receiving TURP (p urinary tract infection after TURP, while preoperative prophylactic utilization of anti-infective drugs can reduce the occurrence of postoperative urinary tract infection.

Day care monopolar transurethral resection of prostate: Is it feasible?

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Altaf Khan

2014-01-01

Full Text Available Introduction: Benign prostatic hyperplasia is a common disease accounting for 30% of our OPD cases and about 25% of our surgery cases. Various treatment options are now available for more efficient care and early return to work. We wanted to determine the safety and feasibility of day care monopolar transurethral resection of prostate (m-TURP, by admitting the patients on the day of surgery and discharging the patient without catheter on the same day. We also compared the morbidity associated with conventional TURP where in the catheter is removed after 24-48 h of surgery and day care TURP where in the catheter is removed on the day of surgery. Materials and Methods: A total of 120 patients who fulfilled the criteria were included in the study which was conducted between November 2008 and December 2010. A total of 60 patients were assigned for day care and 60 for conventional monopolar TURP. There was no significant difference in age, prostatic volume or IPSS score. Day care patients were admitted on day of surgery and discharged the same day after the removal of catheter. Results: Both the groups were comparable in outcome. Stricture rate was less with day care TURP. Mean catheterization time was similar to laser TURP. Conclusion: Monopolar TURP is still the gold standard of care for BPH. If cases are selected properly and surgery performed diligently it remains the option of choice for small and medium sized glands and patients can be back to routine work early.

Age as a prognostic variable in patients undergoing transurethral prostatectomy

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Krogh, J; Jensen, J S; Iversen, H G

1993-01-01

In a retrospective study the outcome of transurethral prostatectomy (TURP) for benign prostatic hyperplasia (BPH) in patients more than 80 years old was compared to a control group of patients with a mean age ten years younger. The elderly had significantly more tissue resected and presented...

A case of advanced gastric cancer resected for rebleeding after palliative radiotherapy for hemostasis

International Nuclear Information System (INIS)

Muneoka, Yusuke; Ichikawa, Hiroshi; Ishikawa, Takashi

2016-01-01

We report a case of advanced gastric cancer (AGC) that was resected for rebleeding after palliative radiotherapy for hemostasis. A 74-year-old man with Stage IV gastric cancer received chemotherapy and achieved stable disease. After 23 months, he experienced continuous bleeding from the tumor due to regrowth. Palliative radiotherapy was conducted to control the bleeding, and the tumor successfully achieved hemostasis. However, 6 weeks later, the patient experienced rebleeding and developed hemostatic shock. We then performed a successful emergency gastrectomy. Bleeding negatively affects quality of life in patients with AGC and is potentially lethal. Although palliative radiotherapy for bleeding of gastric cancer is a safe and useful treatment within a short time frame in cases of rebleeding, emergency gastrectomy may be necessary. Therefore, when we select this treatment, the possibility of subsequent surgical treatment must be considered. (author)

Impact of lymphovascular invasion on recurrence and progression rates in patients with pT1 urothelial carcinoma of bladder after transurethral resection

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Sha N

2015-11-01

Full Text Available Nan Sha,* Linguo Xie,* Tao Chen,* Chen Xing, Xiaoteng Liu, Yu Zhang, Zhonghua Shen, Hao Xu, Zhouliang Wu, Hailong Hu, Changli Wu Department of Urology, Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Tianjin, People’s Republic of China *These authors contributed equally to this work Objective: To evaluate the clinical significance of lymphovascular invasion (LVI on recurrence and progression rates in patients with pT1 urothelial carcinoma of bladder after transurethral resection.Methods: This retrospective study was performed with 155 patients with newly diagnosed pT1 urothelial carcinoma of bladder who were treated with transurethral resection of bladder tumor at our institution from January 2006 to January 2010. The presence or absence of LVI was examined by pathologists. Chi-square test was performed to identify the correlations between LVI and other clinical and pathological features. Kaplan–Meier method was used to estimate the recurrence-free survival (RFS and progression-free survival curves and difference was determined by the log-rank test. Univariate and multivariate analyses were performed to determine the predictive factors through a Cox proportional hazards analysis model.Results: LVI was detected in a total of 34 patients (21.9%. While LVI was associated with high-grade tumors (P<0.001 and intravesical therapy (P=0.009. Correlations with age (P=0.227, sex (P=0.376, tumor size (P=0.969, tumor multiplicity (P=0.196, carcinoma in situ (P=0.321, and smoking (P=0.438 were not statistically significant. There was a statistically significant tendency toward higher recurrence rate and shorter RFS time in LVI-positive patients. However, no statistically significant differences were observed in progression rate between the two groups. Moreover, multivariate Cox proportional hazards analysis revealed that LVI, tumor size, and smoking were independent prognostic predictors of

Low risk of urinary incontinence following prostate brachytherapy in patients with a prior transurethral prostate resection

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Wallner, Kent; Lee, Henry; Wasserman, Stuart; Dattoli, Michael

1997-01-01

Purpose: To review post implant morbidity in patients with prior transurethral prostate resection (TURP). Methods and Materials: Nineteen patients with stage T1-T2 prostatic carcinoma and prior TURP were treated with I-125 or Pd-103 implantation from 1991 through 1994. Follow-up ranged from 1 to 6 years (median: 3 years). The time from TURP to implantation ranged from 2 months to 15 years (median: 3 years). Results: Only one patient developed mild urinary stress incontinence, 6 months following his I-125 implant. The actuarial freedom from permanent urinary incontinence at 3 years after implantation was 94%. No patient required urethral dilatation for urethral stricture. Eleven patients were sexually potent prior to implantation. At 3 years after treatment, all patients had maintained potency. Conclusion: In our experience, there has been remarkably little adverse sequelae following I-125 or Pd-103 implantation in patients with a prior history of TURP

Risk factors associated with sexual dysfunction after transurethral resection of the prostate.

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Ibrahim, A I A; El-Malik, E M A; Ismail, G; Rashid, M; Al Zahrani, A B

2002-01-01

The effect of transurethral resection of prostate (TURP) for benign prostatic hyperplasia (BPH) on sexual function continues to be a controversial issue. The aim of this study was to evaluate sexual functions in Saudi patients suffering from BPH before and after TURP. The influence of TURP on libido, erection and ejaculation was prospectively studied in 179 patients undergoing TURP for BPH. The risk factors studied for erectile dysfunction (ED) were old age, polygamy, comorbidities, late presentation, intraoperative bleeding, intraoperative capsular perforation and bacteriuria. Patients reporting ED underwent intracavernosal injection (ICI) of 20-40 AA(1/4)g of prostaglandin E1 (PGE1) before and/or after surgery. Before surgery, ED was present in 33/179 patients (18%) and was significantly associated with old age and comorbidities but not with polygamy or late presentation. In the patients with normal erection before surgery, dry ejaculation, ED and diminished libido developed after TURP in 71/134 (53%), 20/137 (15%), and 22/137 (16%), respectively. Postoperative ED was significantly associated with diminished libido (P=0.001), but not with postoperative dry ejaculation. The only significant risk factor associated with ED following TURP was capsular perforation. The response to ICI before and after TURP was comparable. ED associated with TURP is most likely of neurogenic origin due to capsular perforation, or of psychogenic nature as suggested by the significant association with diminished libido.

Muscle invasive bladder cancer treated by transurethral resection, followed by external beam radiation and interstitial iridium-192

International Nuclear Information System (INIS)

Wijnmaalen, Arendjan; Helle, Peter A.; Koper, Peter C.M.; Jansen, Peter P.; Hanssens, Patrick E.J.; Boeken Kruger, Cornelis G.G.; Putten, Wim L.J. van

1996-01-01

Purpose: In our center interstitial radiation has played an important role in the treatment of bladder cancer patients for over 40 years. Radium needles, that were initially used, were replaced by caesium needles in 1983, whereas the afterloading iridium wire technique was adopted in 1989. Patients with solitary tumors (T1, T2 and T3) with a surface diameter of < 5 cm are considered for interstitial radiation. In this study we report on the results of the afterloading iridium wire technique in patients with muscle invasive bladder cancer. Materials and Methods: From May 1989 to September 1993 interstitial radiation using iridium wires was part of the treatment in 46 patients with muscle invasive bladder cancer (37 T2, 9 T3). The mean age was 67 years. After transurethral resection of all visible tumor (if possible), in most cases 40 Gy (20 x 2.0 Gy, midplane dose) external beam radiation was delivered to the true pelvis, followed by 30 Gy interstitial radiation using iridium-192 wires covering the tumor area in the bladder. Results: After a median follow-up of 26 months, bladder relapses occurred in 7 patients. In 5 of them the tumor relapsed in the initial area, in 1 patient elsewhere in the bladder and in 1 patient tumor recurred in and outside the initial site. Recurrence was superficial (T1) in 4 patients. A relapse in the urethra was found once. Metastases developed in 13 patients, in 8 without bladder relapse. During the observation period 17 patients died, 13 due to bladder cancer. The actuarial bladder relapse-free survival at 4 years was 74% and 82% for T2 and T3 tumors, respectively. The actuarial distant metastases-free survival was 65% for both categories. No serious toxicity was recorded. Conclusion: In a selected group of patients with muscle invasive bladder cancer transurethral resection in combination with external beam and interstitial radiation provides an excellent opportunity to preserve the bladder with a high chance of success. Development of

Multicenter study on costs associated with two surgical procedures: GreenLight XPS 180 W versus the gold standard transurethral resection of the prostate.

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Benejam-Gual, J M; Sanz-Granda, A; Budía, A; Extramiana, J; Capitán, C

2014-01-01

To analyze the costs associated with two surgical procedures for lower urinary tract symptoms secondary to benign prostatic hyperplasia: GreenLight XPS 180¦W versus the gold standard transurethral resection of the prostate. A multicenter, retrospective cost study was carried out from the National Health Service perspective, over a 3-month time period. Costs were broken down into pre-surgical, surgical and post-surgical phases. Data were extracted from records of patients operated sequentially, with IPSS=15, Qmax=15 mL/seg and a prostate volume of 40-80mL, adding only direct healthcare costs (€, 2013) associated with the procedure and management of complications. A total of 79 patients sequentially underwent GL XPS (n: 39) or TURP (n: 40) between July and October, 2013. Clinical outcomes were similar (94.9% and 92.5%, GL XPS and TURP, respectively) without significant differences (P=.67). The average direct cost per patient was reduced by €114 in GL XPS versus TURP patients; the cost was higher in the surgical phase with GL XPS (difference: €1,209; P<.001) but was lower in the post-surgical phase (difference: €-1,351; P<.001). The GreenLight XPS 180-W laser system is associated with a reduction in costs with respect to transurethral resection of prostate in the surgical treatment of LUTS secondary to PBH. This reduction is due to a shorter inpatient length of stay that offsets the cost of the new technology. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

Hospitalization for transurethral bladder resection reduces quality of life in Danish patients with non-muscle-invasive bladder tumour

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Mogensen, Karin; Christensen, Karl B.; Vrang, Marie-Louise

2016-01-01

Objective: The aim of the study was to evaluate the impact of transurethral resection of bladder tumour (TURBT) on patients’ quality of life (QoL) and to validate a tool to quantify problems associated with TURBT in a Danish population. Materials and methods: A prospective study was carried out...... using a combination of questionnaires and interviews. The study included 165 consecutive patients undergoing a TURBT owing to non-muscle-invasive bladder cancer (NMIBC) from 1 May 2011 to 30 April 2012. Seven patients were selected for interviews. The Danish translation of the QLQ-NMIBC24 Quality...... of Life Questionnaire for NMIBC, from the European Organisation for Research and Treatment of Cancer (EORTC), was used. The interviews were semi-structured. The reliability of the subscales quantifying QoL as defined by the EORTC was tested by computing Cronbach’s coefficient alpha and confirmatory factor...

Influence of alcoholism on morbidity after transurethral prostatectomy

DEFF Research Database (Denmark)

Tønnesen, H; Schütten, B T; Tollund, L

1988-01-01

Morbidity after transurethral resection of the prostate gland was retrospectively investigated by comparing 73 alcoholics with 73 controls (daily alcohol consumption greater than or equal to 60 g vs. less than 25 g). The compared groups derived from 1,172 patients and were matched for diagnosis......, age, weight, smoking habits, treatment for cardiovascular, pulmonary or endocrine diseases, anaesthesia and weight of resected tissue. The postoperative morbidity was significantly higher in the alcohol group than in the controls (62% vs. 20%). Follow-up at 1, 3 and 12 months revealed significantly...... more complications among the alcoholics and also more frequent requirement of supplementary procedures than in the controls....

Palliative resection with intraoperative radiotherapy for bile duct carcinoma at the liver hilus

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Iwasaki, Yoji; Okamura, Takao; Todoroki, Ken; Ohara, Kiyoshi

1984-01-01

In 10 patients undergoing palliative resection of the bile duct or both the bile duct and the liver, residual lesions (including the liver parenchyma, bile duct and major blood vessels) were given intraoperative irradiation of 20-35 Gy from a 25 MeV betatoron. Intraoperative radiotherapy was also performed in 3 patients without resection. Autopsy and clinical findings revealed severe liver damage as postoperative complications, suggesting the influence of irradiation. Therefore, exposure doses and the irradiated field have been reduced recently. An average duration of survival was 6.5 months in 8 patients excluding two who are alive (10 months and 8 months, respectively after operation). It was 8.3 months in 6 patients excluding two who died as a result of operative complications. (Namekawa, K.)

Analysis of the learning curve for transurethral resection of the prostate. Is there any influence of musical instrument and video game skills on surgical performance?

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Yamaçake, Kleiton Gabriel Ribeiro; Nakano, Elcio Tadashi; Soares, Iva Barbosa; Cordeiro, Paulo; Srougi, Miguel; Antunes, Alberto Azoubel

2015-09-01

To evaluate the learning curve for transurethral resection of the prostate (TURP) among urology residents and study the impact of video game and musical instrument playing abilities on its performance. A prospective study was performed from July 2009 to January 2013 with patients submitted to TURP for benign prostatic hyperplasia. Fourteen residents operated on 324 patients. The following parameters were analyzed: age, prostate-specific antigen levels, prostate weight on ultrasound, pre- and postoperative serum sodium and hemoglobin levels, weight of resected tissue, operation time, speed of resection, and incidence of capsular lesions. Gender, handedness, and prior musical instrument and video game playing experience were recorded using survey responses. The mean resection speed in the first 10 procedures was 0.36 g/min and reached a mean of 0.51 g/min after the 20(th) procedure. The incidence of capsular lesions decreased progressively. The operation time decreased progressively for each subgroup regardless of the difference in the weight of tissue resected. Those experienced in playing video games presented superior resection speed (0.45 g/min) when compared with the novice (0.35 g/min) and intermediate (0.38 g/min) groups (p=0.112). Musical instrument playing abilities did not affect the surgical performance. Speed of resection, weight of resected tissue, and percentage of resected tissue improve significantly and the incidence of capsular lesions reduces after the performance of 10 TURP procedures. Experience in playing video games or musical instruments does not have a significant effect on outcomes.

Effect of Preemptive Flurbiprofen Axetil and Tramadol on Transurethral Resection of the Prostate under Spinal Anesthesia

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Jinguo Wang

2016-01-01

Full Text Available Objective. To investigate the efficacy of preoperative intravenous flurbiprofen axetil and tramadol on spinal anesthesia for transurethral resection of the prostate (TURP. Methodology. In this prospective clinical study, we enrolled 60 patients undergoing TURP under spinal anesthesia with small-dose bupivacaine and sufentanil. Patients were randomly divided in two: group flurbiprofen axetil and tramadol (Group FT intravenously received 1 mg/kg flurbiprofen axetil and 1 mg/kg tramadol 20 min prior to the surgical procedures and group control (Group C was given normal saline. The characteristics of spinal anesthesia, blood pressure, heart rate, analgesic requirement, visual analogue scale (VAS, and overall satisfaction degree were collected. Results. Time to the first analgesic requirement was significantly longer in Group FT. Patients who needed postoperative analgesics were fewer in Group FT. VAS scores were lower in Group FT at postoperative time points of 1, 2, 6, and 12 h. The patients in Group FT were more satisfied than in Group C. Conclusions. Preoperative flurbiprofen axetil and tramadol can reduce and delay postoperative pain and then decrease analgesic consumption for TURP under spinal anesthesia without an increase of side effects.

The management of non-invasive bladder tumours with Doxorubicin intravesical instillation after transurethral resection.

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Al-Gallab, Musa I; Naddaf, Louai A; Kanan, Mohamad R

2009-04-01

Evaluation of the intravesical instillation of doxorubicin for its effect on disease recurrence for patients with non-invasive bladder tumour. The study was performed at Al Assad University Hospital in Lattakia, Syria and included patients with non-invasive bladder tumours who were managed with transurethral resection and induction and maintenance therapy with intravesical doxorubicin. They were followed up by cystoscopy every 3 months for 2 years and every 6 months thereafter with special emphasis on recurrence rates. The study included 85 patients with non-invasive bladder tumours: 23 with non-invasive papillary carcinoma (Stage Ta), 62 with tumour invading subepithelial connective tissue (Stage T1). Twelve patients had well differentiated tumours (Grade 1), 48 had moderately differentiated (Grade 2), 25 had poorly differentiated (Grade 3) tumours. The total recurrence rate was 23%. The rates of recurrence were 56% in Grade 3 and 0% in Grade 1. The recurrence rate was 41% in patients with large tumours versus 17% in those with small tumours; 44% in those with multiple tumours compared to 18% in those with solitary tumours; 30% of Stage Ta tumours recurred and 21% of Stage T1 tumours. In short term follow-up, our rate of recurrence was 23%. Adjuvant intravesical doxorubicin was shown to reduce the recurrence of superficial bladder cancer. Tumour grade, size and number were shown to be prognostic factors for recurrence.

Impact of virtual reality-simulated training on urology residents' performance of transurethral resection of the prostate.

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Källström, Reidar; Hjertberg, Hans; Svanvik, Joar

2010-09-01

There are virtual reality simulators for practicing the transurethral resection of prostate (TURP) procedure, but only few data on its effect on surgical performance are available. The purpose of this study was to test if practicing the TURP procedure in a virtual reality simulator (PelvicVision) increases the skills and dexterity of urology residents when performing the procedure on patients. Twenty-four urology residents attended a 5-day course on diagnosis and treatment of benign prostatic enlargement. Each of the residents performed three video-recorded TURP procedures. Between two of the procedures (on day 2 and 3, or 3 and 4) the residents underwent criterion-based practice using a simulator. The TURP procedure was evaluated using objective structured assessment of technical skills. Video-recordings of the procedures were analyzed on a minute-to-minute basis. Mean practice time in the simulator was 198 minutes before reaching the criterion level. Comparison of the first and last TURP procedures showed an increase in autonomous operation time and time spent on resection, and a tendency to decreased hemostasis time without increased blood loss. The proportion of residents believed to be able to perform a simple TURP procedure increased from 10% to about 75%. Objective structured assessment of technical skills scores and self-evaluations were significantly improved. The scores increased significantly more with than without simulator practice. The resident's self-evaluations showed increased knowledge about the procedure and the technical equipment used. Patient follow-up showed no increased risks. Practice in a simulator-based environment improves the skills and dexterity of urology residents when performing the procedure on patients, without increased risks for the patients.

Is palliative resection of the primary tumour, in the presence of advanced rectal cancer, a safe and useful technique for symptom control?

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Al-Sanea, N.; Isbister, W.H.

2004-01-01

Over an 8-year period 22 patients (average age 54 years) underwent rectal resectional surgery in the presence of metastatic disease. There were 13 men and nine women. The commonest complaint was rectal bleeding. All patients had chest radiographs. Pulmonary metastases were identified in four patients. Nineteen abdominal and pelvic computed tomography scans were performed and eight showed evidence of metastases. Skeletal radiographs in two patients showed evidence of bone metastasis. At operation, intraperitoneal metastases were found in 18 patients. Nine of these were not identified preoperatively. Six patients underwent abdomino-perineal resection, nine anterior resection and seven a Hartmann's procedure. Eight patients developed a significant postoperative complication and one died 42 days after surgery. The mean length of hospital stay was 18.6 days. Nine patients received preoperative radiotherapy. Four patients had palliative radiotherapy, two for bony, one for liver and one for peritoneal metastases. Patients were followed up for a mean of 1.1 years. During follow up, 11 returned to the emergency room on 24 occasions. Two patients required readmission. No patient had further rectal bleeding. The mean survival was 1.3 years. It is concluded that patients with rectal cancer and unresectable distant metastases can be successfully palliated by resection of the primary tumour with low morbidity and mortality. The early involvement of a palliative care team facilitates patient management and helps patients enjoy what remains of the rest of their lives at home, in comfort and with good symptom control. Copyright (2004) Blackwell Publishing

Learning Transurethral Resection of the Prostate: A Comparison of ...

African Journals Online (AJOL)

2018-01-30

Jan 30, 2018 ... benign prostate enlargement (BPE) are of limited use in the resource‑poor ... trans‑urethral resection of the prostate, resected weight, retropubic prostatectomy ..... digital rectal examination and total prostate specific antigen.

Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

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Assfalg, Volker; Hüser, Norbert; Michalski, Christoph; Gillen, Sonja; Kleeff, Jorg; Friess, Helmut

2011-01-01

Palliative treatment concepts are considered in patients with non-curatively resectable and/or metastasized pancreatic cancer. However, patients without metastases, but presented with marginally resectable or locally non-resectable tumors should not be treated by a palliative therapeutic approach. These patients should be enrolled in neoadjuvant radiochemotherapy trials because a potentially curative resection can be achieved in approximately one-third of them after finishing treatment and restaging. Within the scope of best possible palliative care, resection of the primary cancer together with excision of metastases represents a therapeutic option to be contemplated in selected cases. Comprehensive palliative therapy is based on treatment of bile duct or duodenal obstruction for certain locally unresectable or metastasized advanced pancreatic cancer. However, endoscopic or percutaneous stenting procedures and surgical bypass provide safe and highly effective therapeutic alternatives. In case of operative drainage of the biliary tract (biliodigestive anastomosis), the prophylactic creation of a gastro-intestinal bypass (double bypass) is recommended. The decision to perform a surgical versus an endoscopic procedure for palliation depends to a great extent on the tumor stage and the estimated prognosis, and should be determined by an interdisciplinary team for each patient individually

Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

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Assfalg, Volker; Hüser, Norbert; Michalski, Christoph; Gillen, Sonja; Kleeff, Jorg; Friess, Helmut, E-mail: friess@chir.med.tu-muenchen.de [Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, D-81675 Munich (Germany)

2011-02-14

Palliative treatment concepts are considered in patients with non-curatively resectable and/or metastasized pancreatic cancer. However, patients without metastases, but presented with marginally resectable or locally non-resectable tumors should not be treated by a palliative therapeutic approach. These patients should be enrolled in neoadjuvant radiochemotherapy trials because a potentially curative resection can be achieved in approximately one-third of them after finishing treatment and restaging. Within the scope of best possible palliative care, resection of the primary cancer together with excision of metastases represents a therapeutic option to be contemplated in selected cases. Comprehensive palliative therapy is based on treatment of bile duct or duodenal obstruction for certain locally unresectable or metastasized advanced pancreatic cancer. However, endoscopic or percutaneous stenting procedures and surgical bypass provide safe and highly effective therapeutic alternatives. In case of operative drainage of the biliary tract (biliodigestive anastomosis), the prophylactic creation of a gastro-intestinal bypass (double bypass) is recommended. The decision to perform a surgical versus an endoscopic procedure for palliation depends to a great extent on the tumor stage and the estimated prognosis, and should be determined by an interdisciplinary team for each patient individually.

[LUTS in BPH patients with histological prostatitis before and after transurethral resection of the prostate].

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Huang, Xiang-Hua; Qin, Bin; Liang, Yi-Wen; Wu, Qing-Guo; Li, Chang-Zan; Wei, Gang-Shan; Ji, Han-Chu; Liang, Yang-Bing; Chen, Hong-Qiu; Guan, Ting

2013-01-01

To investigate the effects of transurethral resection of the prostate (TURP) on lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) complicated by histological prostatitis. This study included 432 cases of BPH pathologically confirmed after TURP. Excluding those with LUTS-related factors before and after surgery and based on the international prostatitis histological classification of diagnostic criteria, the remaining 144 cases were divided into groups A (pure BPH, n = 30), B (mild inflammation, n = 55), C (moderate inflammation, n = 31), and D (severe inflammation, n = 28). Each group was evaluated for LUTS by IPSS before and a month after surgery. A total of 399 cases (92.4%) were diagnosed as BPH with histological prostatitis, 269 (67.4%) mild, 86 (21.6%) moderate and 44 (11.0%) severe. The preoperative IPSS was 21.43 +/- 6.09 in group A, 21.75 +/- 5.97 in B, 27.84 +/- 4.18 in C and 31.00 +/- 2.92 in D, with statistically significant differences among different groups (P BPH with histological prostatitis were lymphocytes. BPH is mostly complicated with histological chronic prostatitis. The severity of LUTS is higher in BPH patients with histological prostatitis than in those without before and after TURP, and positively correlated with the grade of inflammation. Those complicated with moderate or severe histological prostatitis should take medication for the management of LUTS.

Renin-Angiotensin Inhibitors Decrease Recurrence after Transurethral Resection of Bladder Tumor in Patients with Nonmuscle Invasive Bladder Cancer.

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Blute, Michael L; Rushmer, Timothy J; Shi, Fangfang; Fuller, Benjamin J; Abel, E Jason; Jarrard, David F; Downs, Tracy M

2015-11-01

Prior reports suggest that renin-angiotensin system inhibition may decrease nonmuscle invasive bladder cancer recurrence. We evaluated whether angiotensin converting enzyme inhibitor or angiotensin receptor blocker treatment at initial surgery was associated with decreased recurrence or progression in patients with nonmuscle invasive bladder cancer. Using an institutional bladder cancer database we identified 340 patients with data available on initial transurethral resection of bladder tumor. Progression was defined as an increase to stage T2. Cox proportional hazards models were used to evaluate associations with recurrence-free and progression-free survival. Median patient age was 69.6 years. During a median followup of 3 years (IQR 1.3-6.1) 200 patients (59%) had recurrence and 14 (4.1%) had stage progression. Of those patients 143 were receiving angiotensin converting enzyme inhibitor/angiotensin receptor blockers at the time of the first transurethral resection. On univariate analysis factors associated with improved recurrence-free survival included carcinoma in situ (p = 0.040), bacillus Calmette-Guérin therapy (p = 0.003) and angiotensin converting enzyme inhibitor/angiotensin receptor blocker therapy (p = 0.009). Multivariate analysis demonstrated that patients treated with bacillus Calmette-Guérin therapy (HR 0.68, 95% CI 0.47-0.87, p = 0.002) or angiotensin converting enzyme inhibitor/angiotensin receptor blocker therapy (HR 0.61, 95% CI 0.45-0.84, p = 0.005) were less likely to experience tumor recurrence. The 5-year recurrence-free survival rate was 45.6% for patients treated with angiotensin converting enzyme inhibitor/angiotensin receptor blockers and 28.1% in those not treated with angiotensin converting enzyme inhibitor/angiotensin receptor blockers (p = 0.009). Subgroup analysis was performed to evaluate nonmuscle invasive bladder cancer pathology (Ta, T1 and carcinoma in situ) in 85 patients on bacillus Calmette-Guérin therapy alone and in

Lymph node status as a prognostic factor after palliative resection of primary tumor for patients with metastatic colorectal cancer.

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Li, Qingguo; Wang, Changjian; Li, Yaqi; Li, Xinxiang; Xu, Ye; Cai, Guoxiang; Lian, Peng; Cai, Sanjun

2017-07-18

Lymph node (LN) status is one of the most important predictors for M0 colorectal cancer patients. However, its clinical impact on stage IV colorectal cancer remains unclear. The study aimed to explore the prognostic value of LN status after palliative resection of primary tumor for patients with metastatic colorectal cancer (mCRC). We combined analyses of mCRC patients in Surveillance, Epidemiology and End Results (SEER) database and Fudan University Shanghai Cancer Center (FUSCC).A total of 17,553 patients with mCRC were identified in SEER database. X-tile program was adopted to identify 2 and 10 as optimal cutoff values for negative lymph node (NLN) count to divide patients into 3 subgroups of high, middle and low risk of cancer related death. N stage and NLN count were verified as independent prognostic factors in multivariate analyses of patients in whole cohort and in subgroup analyses of each N stage (Pcolorectal cancer. Advanced N stage and small number of NLN were correlated with high risk of cancer related death after palliative resection of primary tumor.

Postoperative complications with glycine and sterile distilled water after transurethral resection of prostate

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Pesha, M.T.; Khan, M.A.; Jamal, Y.; Waahab, F.

2015-01-01

Transurethral resection of prostate (TURP) is considered the gold standard for the surgical treatment of BPH. Irrigant fluid absorption by the patient is a potentially serious complication of TURP and can lead to dilutional hyponatremia and TURP syndrome. Other common complications of TURP include urinary tract infection and secondary haemorrhage. The objective of this study was to compare the frequency of postoperative complications (Urinary Tract infection and dilutional hyponatremia) between 1.5% glycine and sterile distilled water used as irrigant in BPH patients after TURP. Methods: This randomized controlled trial was conducted in department of Urology, PIMS Islamabad, from August 2013 to February 2014. A total of 170 adult male patients between 50-80 years of age undergoing TURP with prostate volume more than 30cc on ultrasound. 85 patients each were randomly allocated to two groups. In group-A, glycine was used as irrigant solution during TURP while in group-B distilled water was used. Serum sodium levels were measured at 6th postoperative hour to look for dilutional hyponatremia. On the 15th postoperative day they were inquired about any clinical features of urinary tract infection. Also urine routine examination was performed to look for the presence of WBCs in the urine. Results: Post-operative dilutional hyponatremia was observed in 13 (15.3%) patients in Group A and in 10 (11.8%) patients in group-B. The difference between both the groups being non-significant (p-value=0.501).Frequency of postoperative urinary tract infection on 15th postoperative day in group-A was 23(27.1%) while in group-B it was 16 (18.8%), the difference among both the groups being insignificant (p-value=0.202). Conclusion: Although the frequency of postoperative complications like UTI and dilutional hyponatremia was less with sterile distilled water, yet, the difference was statistically not significant. (author)

Transurethral Resection of Bladder Tumors: Next-generation Virtual Reality Training for Surgeons.

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Neumann, Eva; Mayer, Julian; Russo, Giorgio Ivan; Amend, Bastian; Rausch, Steffen; Deininger, Susanne; Harland, Niklas; da Costa, Inês Anselmo; Hennenlotter, Jörg; Stenzl, Arnulf; Kruck, Stephan; Bedke, Jens

2018-05-22

The number of virtual reality (VR) simulators is increasing. The aim of this prospective trial was to determine the benefit of VR cystoscopy (UC) and transurethral bladder tumor resection (TURBT) training in students. Medical students without endoscopic experience (n=51, median age=25 yr, median 4th academic year) were prospectively randomized into groups A and B. After an initial VR-UC and VR-TURBT task, group A (n=25) underwent a video-based tutorial by a skilled expert. Group B (n=26) was trained using a VR training program (Uro-Trainer). Following the training, every participant performed a final VR-UC and VR-TURBT task. Performance indicators were recorded via the simulator. Data was analyzed by Mann-Whitney U test. VR cystoscopy and TURBT. No baseline and post-training differences were found for VR-UC between groups. During baseline, VR-TURBT group A showed higher inspected bladder surface than group B (56% vs 73%, p=0.03). Subgroup analysis detected differences related to sex before training (male: 31.2% decreased procedure time; 38.1% decreased resectoscope movement; p=0.02). After training, significant differences in procedure time (3.9min vs 2.7min, p=0.007), resectoscope movement (857mm vs 529mm, p=0.005), and accidental bladder injury (n=3.0 vs n=0.88, p=0.003) were found. Male participants showed reduced blood loss (males: 3.92ml vs females: 10.12ml; p=0.03) after training. Measuring endoscopic skills within a virtual environment can be done easily. Short training improved efficacy and safety of VR-TURBT. Nevertheless, transfer of improved VR performance into real world surgery needs further clarification. We investigated how students without endoscopic experience profit from simulation-based training. The safe environment and repeated simulations can improve the surgical training. It may be possible to enhance patient's safety and the training of surgeons in long term. Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All

Comparison of Surgical Outcomes Between Holmium Laser Enucleation and Transurethral Resection of the Prostate in Patients With Detrusor Underactivity

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Myeong Jin Woo

2017-03-01

Full Text Available Purpose Currently, holmium laser enucleation of the prostate (HoLEP and transurethral resection of the prostate (TURP are the standard surgical procedures used to treat benign prostatic hyperplasia (BPH. Several recent studies have demonstrated that the surgical management of BPH in patients with detrusor underactivity (DU can effectively improve voiding symptoms, but comparative data on the efficacy of HoLEP and TURP are insufficient. Therefore, we compared the short-term surgical outcomes of HoLEP and TURP in patients with DU. Methods From January 2010 to May 2015, 352 patients underwent HoLEP or TURP in procedures performed by a single surgeon. Of these patients, 56 patients with both BPH and DU were enrolled in this study (HoLEP, n=24; TURP, n=32. Surgical outcomes were retrospectively compared between the 2 groups. DU was defined as a detrusor pressure at maximal flow rate of <40 cm H2O as measured by a pressure flow study. Results The preoperative characteristics of patients and the presence of comorbidities were comparable between the 2 groups. The TURP group showed a significantly shorter operative time than the HoLEP group (P=0.033. The weight of the resected prostate was greater in the HoLEP group, and postoperative voiding parameters, including peak flow rate and postvoid residual urine volume were significantly better in the HoLEP group than in the TURP group. Conclusions HoLEP can be effectively and safely performed in patients with DU and can be expected to have better surgical outcomes than TURP in terms of the improvement in lower urinary tract symptoms.

A network meta-analysis of therapeutic outcomes after new image technology-assisted transurethral resection for non-muscle invasive bladder cancer: 5-aminolaevulinic acid fluorescence vs hexylaminolevulinate fluorescence vs narrow band imaging

International Nuclear Information System (INIS)

Lee, Joo Yong; Cho, Kang Su; Kang, Dong Hyuk; Jung, Hae Do; Kwon, Jong Kyou; Oh, Cheol Kyu; Ham, Won Sik; Choi, Young Deuk

2015-01-01

This study included a network meta-analysis of evidence from randomized controlled trials (RCTs) to assess the therapeutic outcome of transurethral resection (TUR) in patients with non-muscle-invasive bladder cancer assisted by photodynamic diagnosis (PDD) employing 5-aminolaevulinic acid (5-ALA) or hexylaminolevulinate (HAL) or by narrow band imaging (NBI). Relevant RCTs were identified from electronic databases. The proceedings of relevant congresses were also searched. Fifteen articles based on RCTs were included in the analysis, and the comparisons were made by qualitative and quantitative syntheses using pairwise and network meta-analyses. Seven of 15 RCTs were at moderate risk of bias for all quality criteria and two studies were classified as having a high risk of bias. The recurrence rate of cancers resected with 5-ALA-based PDD was lower than of those resected using HAL-based PDD (odds ratio (OR) = 0.48, 95 % confidence interval (CI) [0.26–0.95]) but was not significantly different than those resected with NBI (OR = 0.53, 95 % CI [0.26–1.09]). The recurrence rate of cancers resected using HAL-based PDD versus NBI did not significantly differ (OR = 1.11, 95 % CI [0.55–2.1]). All cancers resected using 5-ALA-based PDD, HAL-based PDD, or NBI recurred at a lower rate than those resected using white light cystoscopy (WLC). No difference in progression rate was observed between cancers resected by all methods investigated. The recurrence rate of some bladder cancers can be decreased by the implementation of either PDD- and NBI-assisted TUR; in real settings, clinicians should consider replacing WLC as the standard imaging technology to guide TUR

Surgical and Palliative Management and Outcome in 184 Patients With Hilar Cholangiocarcinoma

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Witzigmann, Helmut; Berr, Frieder; Ringel, Ulrike; Caca, Karel; Uhlmann, Dirk; Schoppmeyer, Konrad; Tannapfel, Andrea; Wittekind, Christian; Mossner, Joachim; Hauss, Johann; Wiedmann, Marcus

2006-01-01

Objective: First, to analyze the strategy for 184 patients with hilar cholangiocarcinoma seen and treated at a single interdisciplinary hepatobiliary center during a 10-year period. Second, to compare long-term outcome in patients undergoing surgical or palliative treatment, and third to evaluate the role of photodynamic therapy in this concept. Summary Background Data: Tumor resection is attainable in a minority of patients (<30%). When resection is not possible, radiotherapy and/or chemotherapy have been found to be an ineffective palliative option. Recently, photodynamic therapy (PDT) has been evaluated as a palliative and neoadjuvant modality. Methods: Treatment and outcome data of 184 patients with hilar cholangiocarcinoma were analyzed prospectively between 1994 and 2004. Sixty patients underwent resection (8 after neoadjuvant PDT); 68 had PDT in addition to stenting and 56 had stenting alone. Results: The 30-day death rate after resection was 8.3%. Major complications occurred in 52%. The overall 1-, 3-, and 5-year survival rates were 69%, 30%, and 22%, respectively. R0, R1, and R2 resection resulted in 5-year survival rates of 27%, 10%, and 0%, respectively. Multivariate analysis identified R0 resection (P < 0.01), grading (P < 0.05), and on the limit to significance venous invasion (P = 0.06) as independent prognostic factors for survival. PDT and stenting resulted in longer median survival (12 vs. 6.4 months, P < 0.01), lower serum bilirubin levels (P < 0.05), and higher Karnofsky performance status (P < 0.01) as compared with stenting alone. Median survival after PDT and stenting, but not after stenting alone, did not differ from that after both R1 and R2 resection. Conclusion: Only complete tumor resection, including hepatic resection, enables long-term survival for patients with hilar cholangiocarcinoma. Palliative PDT and subsequent stenting resulted in longer survival than stenting alone and has a similar survival time compared with incomplete R1 and

Regional anesthesia in transurethral resection of prostate (TURP surgery: A comparative study between saddle block and subarachnoid block

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Susmita Bhattacharyya

2015-01-01

Full Text Available Background: Spinal anesthesia is the technique of choice in transurethral resection of prostate (TURP. The major complication of spinal technique is risk of hypotension. Saddle block paralyzed pelvic muscles and sacral nerve roots and hemodynamic derangement is less. Aims and objectives: To compare the hemodynamic changes and adequate surgical condition between saddle block and subarachnoid block for TURP. Material and methods: Ninety patients of aged between 50 to 70 years of ASA-PS I, II scheduled for TURP were randomly allocated into 2 groups of 45 in each group. Group A patients were received spinal (2 ml of hyperbaric bupivacaine and Group B were received saddle block (2 ml of hyperbaric bupivacaine. Baseline systolic, diastolic and mean arterial pressure, heart rate, oxygen saturation were recorded and measured subsequently. The height of block was noted in both groups. Hypotension was corrected by administration of phenylephrine 50 mcg bolus and total requirement of vasopressor was noted. Complications (volume overload, TURP syndrome etc. were noted. Results: Incidence of hypotension and vasopressor requirement was less (P < 0.01 in Gr B patients.Adequate surgical condition was achieved in both groups. There was no incidence of volume overload, TURP syndrome, and bladder perforation. Conclusion: TURP can be safely performed under saddle block without hypotension and less vasopressor requirement.

Thulium laser enucleation (ThuLEP) versus transurethral resection of the prostate in saline (TURis): A randomized prospective trial to compare intra and early postoperative outcomes.

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Bozzini, G; Seveso, M; Melegari, S; de Francesco, O; Buffi, N M; Guazzoni, G; Provenzano, M; Mandressi, A; Taverna, G

2017-06-01

To compare clinical intra and early postoperative outcomes between thulium laser transurethral enucleation of the prostate (ThuLEP) and transurethral bipolar resection of the prostate (TURis) for treating benign prostatic hyperplasia (BPH) in a prospective randomized trial. The study randomized 208 consecutive patients with BPH to ThuLEP (n=102) or TURis (n=106). For all patients were evaluated preoperatively with regards to blood loss, catheterization time, irrigation volume, hospital stay and operative time. At 3 months after surgery they were also evaluated by International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual urine volume (PVR). The patients in each study arm each showed no significant difference in preoperative parameters. Compared with TURIS, ThuLEP had same operative time (53.69±31.44 vs 61.66±18.70minutes, P=.123) but resulted in less hemoglobin decrease (0.45 vs 2.83g/dL, P=.005). ThuLEP also needed less catheterization time (1.3 vs 4.8 days, P=.011), irrigation volume (29.4 vs 69.2 L, P=.002), and hospital stay (1.7 vs 5.2 days, P=.016). During the 3 months of follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS, PVR, and QOLS. ThuLEP and TURis both relieve lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP was statistically superior to TURis in blood loss, catheterization time, irrigation volume, and hospital stay. However, procedures did not differ significantly in Qmax, IPSS, PVR, and QOLS through 3 months of follow-up. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Gastric carcinoma: when is palliative gastrectomy justified?

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Hubert Scheidbach

2011-12-01

Full Text Available Gastric carcinoma is frequently diagnosed with an advanced stage of non-curable tumor growth characterized by infiltration of the gastric serosa, peritoneal tumor spread and/or metastases within lymph nodes and liver. Currently, there is a controversy on the value of palliative resection with regard to the safety and benefit to the patient outcome. Based on the available literature, this overview summarizes the various aspects and interprets the limited data on the palliative resection of gastric carcinoma. It turns out that the available study results may indicate potential for an improved quality of life and a prolongation of survival if an acceptable morbidity and mortality are present.

Impacted Anterior Urethral Calculus Complicated by a Stone-containing Diverticulum in an Elderly Man: Outcome of Transurethral Lithotripsy without Resection of the Diverticulum

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Tie Zhou

2013-09-01

Full Text Available Introduction The prevalence of lower urinary tract symptoms (LUTS is about 20% in men aged 40 or above. Other than benign prostatic hyperplasia (BPH, urethral diverticulum or calculus is not uncommon for LUTS in men. Surgical treatment is often recommended for urethral diverticulum or calculus, but treatment for an impacted urethral calculus complicated by a stone-containing diverticulum is challenging. Materials and Methods An 82-year-old man had the persistence of LUTS despite having undergone transurethral resection of prostate for BPH. Regardless of treatment with broad spectrum antibiotics and an α-blocker, LUTS and post-void residual urine volume (100 mL did not improve although repeated urinalysis showed reduction of WBCs from 100 to 10 per high power field. Further radiology revealed multiple urethral calculi and the stone configuration suggested the existence of a diverticulum. He was successfully treated without resecting the urethral diverticulum; and a new generation of ultrasound lithotripsy (EMS, Nyon, Switzerland through a 22F offset rigid Storz nephroscope (Karl Storz, Tuttingen, Germany was used to fragment the stones. Results The operative time was 30 minutes and the stones were cleanly removed. The patient was discharged after 48 hours with no immediate complications and free of LUTS during a 2 years follow-up. Conclusions When the diverticulum is the result of a dilatation behind a calculus, removal of the calculus is all that is necessary. Compared with open surgery, ultrasound lithotripsy is less invasive with little harm to urethral mucosa; and more efficient as it absorbs stone fragments while crushing stones.

Impacted anterior urethral calculus complicated by a stone-containing diverticulum in an elderly man: outcome of transurethral lithotripsy without resection of the diverticulum.

Science.gov (United States)

Zhou, Tie; Chen, Guanghua; Zhang, Wei; Peng, Yonghan; Xiao, Liang; Xu, Chuangliang; Sun, Yinghao

2013-01-01

The prevalence of lower urinary tract symptoms (LUTS) is about 20% in men aged 40 or above. Other than benign prostatic hyperplasia (BPH), urethral diverticulum or calculus is not uncommon for LUTS in men. Surgical treatment is often recommended for urethral diverticulum or calculus, but treatment for an impacted urethral calculus complicated by a stone-containing diverticulum is challenging. An 82-year-old man had the persistence of LUTS despite having undergone transurethral resection of prostate for BPH. Regardless of treatment with broad spectrum antibiotics and an α-blocker, LUTS and post-void residual urine volume (100 mL) did not improve although repeated urinalysis showed reduction of WBCs from 100 to 10 per high power field. Further radiology revealed multiple urethral calculi and the stone configuration suggested the existence of a diverticulum. He was successfully treated without resecting the urethral diverticulum; and a new generation of ultrasound lithotripsy (EMS, Nyon, Switzerland) through a 22F offset rigid Storz nephroscope (Karl Storz, Tuttingen, Germany) was used to fragment the stones. The operative time was 30 minutes and the stones were cleanly removed. The patient was discharged after 48 hours with no immediate complications and free of LUTS during a 2 years follow-up. When the diverticulum is the result of a dilatation behind a calculus, removal of the calculus is all that is necessary. Compared with open surgery, ultrasound lithotripsy is less invasive with little harm to urethral mucosa; and more efficient as it absorbs stone fragments while crushing stones.

Day care bipolar transurethral resection vs photoselective vaporisation under sedoanalgesia: A prospective, randomised study of the management of benign prostatic hyperplasia.

Science.gov (United States)

Sood, Rajeev; Manasa, T; Goel, Hemant; Singh, Ritesh Kumar; Singh, Rajpal; Khattar, Nikhil; Pandey, Praveen

2017-12-01

To conduct a prospective randomised study comparing the safety, effectiveness and treatment outcomes in patients undergoing bipolar transurethral resection of the prostate (bTURP) and photoselective vaporisation of the prostate (PVP) under sedoanalgesia, as sedoanalgesia is a safe and effective technique suitable for minimally invasive endourological procedures and although studies have confirmed that both TURP and PVP are feasible under sedoanalgesia there are none comparing the two. Between November 2014 and April 2016, all patients satisfying the eligibility criteria underwent either bTURP or PVP under sedoanalgesia after randomisation. The groups were compared for functional outcomes, visual analogue scale (VAS) pain scores (range 0-10), perioperative variables and complications, with a follow-up of 3 months. In all, 42 and 36 patients underwent bTURP and PVP under sedoanalgesia, respectively. The mean VAS pain score was operating time [mean (SD) 55.64 (12.8) vs 61.79 (14.2) min, P  = 0.035], shorter duration of hospitalisation [mean (SD) 14.58 (2.81) vs 19.21 (2.82) h, P  post-void residual urine volume at 3 months were similar in both groups. None of our patients required re-admission or re-operation. Both PVP and bTURP can be carried out safely under sedoanalgesia with excellent treatment outcomes.

Pathology outcomes in patients with transurethral bladder tumour resection in a Turkish population: A retrospective analysis

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Salih Budak

2018-03-01

Full Text Available Objectives: Transurethral bladder tumour resection (TURBT is the common surgical method used in the diagnosis, staging and treatment of patients with bladder tumour. Most of the rare tumours other than the urothelial carcinomas of the bladder are in advanced stage on diagnosis and necessitate aggressive treatment. In our study, we aimed to the histologic types of bladder cancer and to determine the regional incidence of rare bladder cancer types in our region. Materials and methods: We retrospectively evaluated 815 patients who underwent TURBT surgery between January 2010 and March 2016 in our clinic with a diagnosis of bladder cancer and at least 1 year follow-up. Patients with tumour histopathological examination including histological tumour type, grade and were reported. Thirty-nine patients with an unclear pathology report (neighboring organ invasion, cautery artifact, etc and 17 patients whose data could not be accessed were excluded from the study. The patients who had received chemotherapy or radiotherapy due to any type of malignancy (23 were also excluded from the study. Results: The outcomes of 736 patients operated in our clinics due to bladder tumour were evaluated. The mean age was 65.2 ± 8.4; 135 were female and 601 were male. Among them 711 patients with urothelial carcinoma were reported (94.2%. According to TNM classification, stage Ta was observed in 270 patients (37.9%, stage T1 in 297 (41.7%, and stage T2 in 144 (20.3%. Non-urothelial cancers were reported in 25 cases (3.3%. Conclusion: The incidence of bladder carcinoma varies between regions. The results of our study are similar to those of the western countries. Increased smoking and exposure to environmental carcinogenetic agents may lead to altered incidences and histological types of bladder tumours. Revision of regional tumour records may be useful to develop and evaluate future treatment strategies.

Age as a prognostic variable in patients undergoing transurethral prostatectomy

DEFF Research Database (Denmark)

Krogh, J; Jensen, J S; Iversen, H G

1993-01-01

In a retrospective study the outcome of transurethral prostatectomy (TURP) for benign prostatic hyperplasia (BPH) in patients more than 80 years old was compared to a control group of patients with a mean age ten years younger. The elderly had significantly more tissue resected and presented...... with a higher rate of preoperative urinary tract infection. More urological complications were seen among the elderly but these were generally short lived and had no influence on the morbidity, mortality and symptomatic outcome. The perioperative mortality was 3.2% among elderly and 0% in the younger age group....... A cardiorespiratory risk score could not predict patients at risk. In conclusion the age per se had no major influence on the outcome of TURP....

Hemolysis in Transurethral Resection of the Prostate Using Distilled Water as the Irrigant

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Shiou-Sheng Chen

2006-06-01

Conclusion: Using distilled water as an irrigant for TURP might cause hemolysis, especially in patients with larger prostates and longer resection times. It is necessary to carry out every effort to shorten resection time and avoid extravasation during surgery.

Prophylactic antibiotics in transurethral prostatectomy

DEFF Research Database (Denmark)

Qvist, N; Christiansen, H.M.; Ehlers, D

1984-01-01

The study included 88 patients with sterile urine prior to transurethral prostatectomy. Forty-five received a preoperative dose of 2 g of cefotaxime (Claforan) and the remaining 43 were given 10 ml of 0.9% NaCl. The two groups did not differ in frequency of postoperative urinary infection (greate...... of infection and the few side effects of the infections that did occur, prophylactic treatment with an antibiotic is not indicated for transurethral prostatectomy in patients with sterile urine....

Transurethral ventral buccal mucosa graft inlay urethroplasty for reconstruction of fossa navicularis and distal urethral strictures: surgical technique and preliminary results.

Science.gov (United States)

Nikolavsky, Dmitriy; Abouelleil, Mourad; Daneshvar, Michael

2016-11-01

To introduce a novel surgical technique for the reconstruction of distal urethral strictures using buccal mucosal graft (BMG) through a transurethral approach. A retrospective institution chart review was conducted of all the patients who underwent a transurethral ventral BMG inlay urethroplasty from March 2014 to March 2016. Patients with greater than one-year follow-up were included. Steps of the procedure: transurethral ventral wedge resection of the stenosed segment and transurethral delivery and spread fixation of appropriate BMG inlay into the resultant urethrotomy. The patients were followed for post-operative complications and stricture recurrence with uroflow, PVR, cystoscopy and outcome questionnaires. Three patients with a minimum of 12-month follow-up are included in this case series. The mean age of the patients was 42 years (35-53); mean stricture length was 2.1 cm (1-4). All patients had at least 2 previous failed procedures. Mean follow-up was 18 months (12-24). There were no stricture recurrences or fistula. Mean pre- and post-operative uroflow values were 4.3 (0-8) and 19 (16-26), respectively. Neither penile chordee nor changes in sexual function were noted in patients on follow-up. Transurethral ventral BMG inlay urethroplasty is a feasible option for treatment of fossa navicularis strictures. This single-stage technique allows for avoiding skin incision or urethral mobilization. It helps to prevent glans dehiscence, fistula formation and avoids the use of genital skin flaps in all patients, especially those affected with LS. This novel surgical technique is an effective treatment alternative for men with distal urethral strictures.

What factors are associated with unplanned return following transurethral resection of bladder tumor? An analysis of a large single institution's experience.

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Ghali, Fady; Moses, Rachel A; Raffin, Eric; Hyams, Elias S

2016-10-01

This study sought to evaluate factors associated with unplanned hospital return (UR) following transurethral resection of bladder tumor (TURBT), the largest source of readmission among ambulatory urological procedures. A retrospective review of TURBTs at a single academic institution between April 2011 and August 2014 was performed. Demographics, comorbidities, length of stay, tumor size and multiple other factors were recorded. UR was recorded within 30 days of surgery. Bivariate and multivariable analyses were performed to determine factors associated with UR. Among 708 patients undergoing TURBT, 23.9% were female with a mean age of 70 years. The rate of UR was 10.9%. The most common cause of UR was gross hematuria, accounting for 70%. On bivariate analysis, Foley catheter placement in the operating room, non-aspirin anticoagulation and index length of stay longer than 24 h were associated with hematuria-related UR (p hematuria-related UR (p  0.05). On multivariable analysis, only Foley placement in the operating room remained associated with higher rates of hematuria-related UR, while preoperative antibiotics, female gender and aspirin therapy remained associated with a lower likelihood of this event. UR following TURBT is common and typically results from gross hematuria. Patients with postoperative Foley catheterization in the operating room may require additional counseling or supervision before discharge, and should be considered for discharge with a Foley rather than having a prompt voiding trial.

Post-Transurethral Resection of the Prostate Inflation of Pressure-Controlled Endorectal Balloon-Impact on Postoperative Bleeding: A Preliminary Experimental Pilot Study.

Science.gov (United States)

Mohyelden, Khaled; Ibrahim, Hamdy; Abdel-Kader, Osman; Sherief, Mahmoud H; El-Nashar, Ahmed; Shaker, Hosam; Elkoushy, Mohamed A

2016-02-01

To evaluate the impact of rectal balloon (RB) inflation on post-transurethral resection of the prostate (TURP) bleeding in patients with symptomatic benign prostatic hyperplasia. After institutional review board approval, patients who were eligible for TURP were randomized into two equal groups, depending on whether they received postoperative endorectal balloon (RB) (GII) or not (GI). The tip of three-way Foley catheter was fixed to a balloon by a blaster strip to prepare air-tight RB. Postoperatively, the RB was inflated for 15 minutes by a pressure-controlled sphygmomanometer. Perioperative data were compared between both groups, including hemoglobin (Hb) deficit 24-hour postoperatively and at time of discharge. Functional outcomes, anorectal complaints, and adverse events were assessed perioperatively and after 1 and 3 months. Fifty patients were enrolled, including 13 (26%) patients who presented with indwelling urethral catheters. Baseline data and mean resected tissue weight were comparable between both groups, including preoperative Hb (p = 0.17). Immediate postoperative Hb deficit was, comparable between GI and GII patients (0.58 ± 0.18 vs 0.60 ± 0.2, p = 0.56) before RB inflation, respectively. However, compared to GI patients, mean Hb deficit significantly decreased in GII patients 24-hour postoperatively (0.2 ± 0.2 vs 0.7 ± 0.3 g, p = 0.002) and at time of discharge (0.8 ± 0.2 vs 1.3 ± 0.4 g, p = 0.003). GII patients needed significantly less postoperative irrigation (2.1 ± 1.6 vs 8.3 ± 1.8 L, p hematuria or clot retention in either group, while there were no anorectal complaints reported by GII patients. Post-TURP endorectal balloon inflation seems to be simple, safe, and an efficient procedure to reduce postoperative bleeding and irrigation volume. It is significantly associated with shorter catheterization time and hospital stay.

Transurethral resection of the prostate for patients with grade III urinary symptoms following transperineal implantation of the prostate

International Nuclear Information System (INIS)

Potters, L; Waldbaum, R; Bosworth, J; Ashley, R

1996-01-01

PURPOSE/OBJECTIVE: Patients (Pts) undergoing a I-125 or Pd-103 transperineal implant of the prostate (TPIP) experience urethritis of a varying degree. Most pts with mild to moderate symptoms can be treated with alpha blocking agents. Few pts will experience urethritis that does not respond to medical management, or persists beyond three half life's of the isotope. These pts will have significant quality of life complaints related to their symptoms. The purpose of this study is to present our results of Transurethral resection of the prostate (TURP) for patients with grade III urethritis. MATERIALS AND METHODS: Between November 1992 and January 1996, 378 patients underwent TPIP for clinically localized cancer. Treatment consisted of either a Pd-103 or I-125 implant either alone or in combination with external beam radiation and/or hormones. All the implants used a peripheral loading and urethral sparing technique. All pts were followed after the implant and assessed by DRE, PSA, and symptoms. The grading of urinary symptoms was as follows: Grade I-successful relief with pyridium or an equivalent medication, Grade II-pts requiring various doses of alpha blockers, Grade III-pts with persistent symptoms despite medical management. RESULTS: Of the 378 pts undergoing implant, 358 had sufficient follow-up to be included in this review. Forty two pts (12%) received hormone downsizing prior to implantation. Two hundred and two (56%) underwent a Pd-103 implant and 156 (44%) a I-125 implant; 15 underwent EBRT plus I-125 and 27 with EBRT and Pd-103. One hundred and fifty five (43%) pts experienced grade I urethritis during the first three half life's of the implant, while 116 (32%) experienced grade II urethritis. Twenty eight pts (8%) experienced grade III urethritis that persisted beyond three half life's of the implant. All grade III pts were offered TURP and 26 elected to undergo this procedure. Of the twenty six pts undergoing TURP, 100% experienced relief of their

Peripheral hepatojejunostomy as palliative treatment for irresectable malignant tumors of the liver hilum.

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Schlitt, H J; Weimann, A; Klempnauer, J; Oldhafer, K J; Nashan, B; Raab, R; Pichlmayr, R

1999-02-01

To evaluate the concept of surgical decompression of the biliary tree by peripheral hepatojejunostomy for palliative treatment of jaundice in patients with irresectable malignant tumors of the liver hilum. Jaundice, pruritus, and recurrent cholangitis are major clinical complications in patients with obstructive cholestasis resulting from malignant tumors of the liver hilum. Methods for palliative treatment include endoscopic stenting, percutaneous transhepatic drainage, and surgical decompression. The palliative treatment of choice should be safe, effective, and comfortable for the patient. In a retrospective study, surgical technique, perioperative complications, and efficacy of treatment were analyzed for 56 patients who had received a peripheral hepatojejunostomy between 1982 and 1997. Laparotomy in all of these patients had been performed as an attempt for curative resection. Hepatojejunostomy was exclusively palliative in 50 patients and was used for bridging to resection or transplantation in 7. Anastomosis was bilateral in 36 patients and unilateral in 20. The 1-month mortality in the study group was 9%; median survival was 6 months. In patients surviving >1 month, a marked and persistent decrease in cholestasis was achieved in 87%, although complete return to normal was rare. Among the patients with a marked decrease in cholestasis, 72% had no or only mild clinical symptoms such as fever or jaundice. Peripheral hepatojejunostomy is a feasible and reasonably effective palliative treatment for patients with irresectable tumors of the liver hilum. In patients undergoing exploratory laparotomy for attempted curative resection, this procedure frequently leads to persistent-although rarely complete-decompression of the biliary tree. In a few cases it may also be used for bridging to transplantation or liver resection after relief of cholestasis.

Ablative efficiency of lithium triborate laser vaporization and conventional transurethral resection of the prostate: a comparison using transrectal three-dimensional ultrasound volumetry

Science.gov (United States)

Gross, Oliver; Sulser, Tullio; Hefermehl, Lukas J.; Strebel, Daniel D.; Largo, Remo; Mortezavi, Ashkan; Poyet, Cédric; Eberli, Daniel; Zimmermann, Matthias; Müller, Alexander; Michel, Maurice S.; Müntener, Michael; Seifert, Hans-Helge; Hermanns, Thomas

2011-03-01

Introduction and objectives: It is unknown if tissue ablation following 120W lithium triborate (LBO) laser vaporization (LV) of the prostate is comparable to that following transurethral resection of the prostate (TURP). Therefore, transrectal 3D-ultrasound volumetry of the prostate was performed to compare the efficiency of tissue ablation between LBO-LV and TURP. Methods: Between 03/2008 and 03/2010 110 patients underwent routine LBO-LV (n=61) or TURP (n=49). Transrectal 3D-ultrasound with planimetric volumetry of the prostate was performed pre-operatively, after catheter removal, 6 weeks and 6 months. Results: Median prostate volume was 52.5ml in the LV group and 46.9ml in the TURP group. After catheter removal, median absolute volume reduction (LV: 7.05ml, TURP: 15.8ml) and relative volume reduction (15.9% vs. 34.2%) were significantly lower in the LV group (p<0.001). After 6 weeks/ 6 months, the relative volume reduction but not the absolute remained significantly lower in the LV group. Conclusions: LBO-LV is an efficient procedure evidenced by an absolute tissue ablation not significantly different to that after TURP. However, TURP seems to be superior due to a higher relative tissue ablation. The differences in tissue ablation had no impact on the early clinical outcome. Delayed volume reduction indicates that prostatic swelling occurs early after LV and then decreases subsequently.

Transurethral incision of urethral diverticulum in the female

DEFF Research Database (Denmark)

Miskowiak, J; Honnens de Lichtenberg, M

1989-01-01

A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time.......A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time....

Muscle invasive bladder cancer treated by transurethral resection, followed by external beam radiation and interstitial iridium-192

International Nuclear Information System (INIS)

Wijnmaalen, Arendjan; Helle, Peter A.; Koper, Peter C.M.; Jansen, Peter P.; Hanssen, Patrick E.; Kruger, Cornelis G.G. Boeken; Putten, Wim L.J. van

1997-01-01

Purpose: To evaluate the results of transurethral resection (TUR), external beam radiotherapy (EBRT), and interstitial radiation (IRT) with iridium-192, using the afterloading technique in patients with muscle invasive bladder cancer. Methods and Materials: From May 1989 until September 1995, 66 patients with primary, solitary muscle invasive bladder cancer were treated with TUR, EBRT, and IRT, aiming at bladder preservation. According to the protocol, in three patients low-dose EBRT was applied, whereas 63 patients received high-dose EBRT. Immediately prior to IRT, 42 patients underwent a lymphnode dissection, and in 16 cases a partial cystectomy was performed. For IRT, two to five catheters were used and IRT was started within 24 h after surgery. The majority of patients received 30 Gy of IRT, with a mean dose rate of .58 Gy/h. In three patients, additional EBRT was applied following IRT. Follow-up consisted of regular cystoscopies, mostly done during joint clinics of urologist and radiation oncologist, with urine cytology routinely performed. The median follow-up period was 26 months. The Kaplan-Meier method was used for the determination of survival rates. Results: In seven patients, a bladder relapse developed. The probability of remaining bladder relapse free at 5 years was 88%. The bladder was preserved in 98% of the surviving patients. Metastases developed in 16 patients, and the probability of remaining metastasis free at 5 years was 66%. The cumulative 5-year overall and bladder and distant relapse free survival were 48% and 69%, respectively. Acute toxicity was not serious in the majority of cases; surgical correction of a persisting vesicocutaneous fistula was necessary in two patients, whereas a wound toilet had to be performed in another patient. Serious late toxicity (bladder, RTOG Grade 3) was experienced by only one patient. Conclusions: Interstitial radiation preceded by TUR and EBRT, in a selected group of patients with muscle invasive bladder

Palliation: Hilar cholangiocarcinoma

Science.gov (United States)

Goenka, Mahesh Kr; Goenka, Usha

2014-01-01

Hilar cholangiocarcinomas are common tumors of the bile duct that are often unresectable at presentation. Palliation, therefore, remains the goal in the majority of these patients. Palliative treatment is particularly indicated in the presence of cholangitis and pruritus but is often also offered for high-grade jaundice and abdominal pain. Endoscopic drainage by placing stents at endoscopic retrograde cholangio-pancreatography (ERCP) is usually the preferred modality of palliation. However, for advanced disease, percutaneous stenting has been shown to be superior to endoscopic stenting. Endosonography-guided biliary drainage is emerging as an alternative technique, particularly when ERCP is not possible or fails. Metal stents are usually preferred over plastic stents, both for ERCP and for percutaneous biliary drainage. There is no consensus as to whether it is necessary to place multiple stents within advanced hilar blocks or whether unilateral stenting would suffice. However, recent data have suggested that, contrary to previous belief, it is useful to drain more than 50% of the liver volume for favorable long-term results. In the presence of cholangitis, it is beneficial to drain all of the obstructed biliary segments. Surgical bypass plays a limited role in palliation and is offered primarily as a segment III bypass if, during a laparotomy for resection, the tumor is found to be unresectable. Photodynamic therapy and, more recently, radiofrequency ablation have been used as adjuvant therapies to improve the results of biliary stenting. The exact technique to be used for palliation is guided by the extent of the biliary involvement (Bismuth class) and the availability of local expertise. PMID:25232449

Augmented Reality Using Transurethral Ultrasound for Laparoscopic Radical Prostatectomy: Preclinical Evaluation.

Science.gov (United States)

Lanchon, Cecilia; Custillon, Guillaume; Moreau-Gaudry, Alexandre; Descotes, Jean-Luc; Long, Jean-Alexandre; Fiard, Gaelle; Voros, Sandrine

2016-07-01

To guide the surgeon during laparoscopic or robot-assisted radical prostatectomy an innovative laparoscopic/ultrasound fusion platform was developed using a motorized 3-dimensional transurethral ultrasound probe. We present what is to our knowledge the first preclinical evaluation of 3-dimensional prostate visualization using transurethral ultrasound and the preliminary results of this new augmented reality. The transurethral probe and laparoscopic/ultrasound registration were tested on realistic prostate phantoms made of standard polyvinyl chloride. The quality of transurethral ultrasound images and the detection of passive markers placed on the prostate surface were evaluated on 2-dimensional dynamic views and 3-dimensional reconstructions. The feasibility, precision and reproducibility of laparoscopic/transurethral ultrasound registration was then determined using 4, 5, 6 and 7 markers to assess the optimal amount needed. The root mean square error was calculated for each registration and the median root mean square error and IQR were calculated according to the number of markers. The transurethral ultrasound probe was easy to manipulate and the prostatic capsule was well visualized in 2 and 3 dimensions. Passive markers could precisely be localized in the volume. Laparoscopic/transurethral ultrasound registration procedures were performed on 74 phantoms of various sizes and shapes. All were successful. The median root mean square error of 1.1 mm (IQR 0.8-1.4) was significantly associated with the number of landmarks (p = 0.001). The highest accuracy was achieved using 6 markers. However, prostate volume did not affect registration precision. Transurethral ultrasound provided high quality prostate reconstruction and easy marker detection. Laparoscopic/ultrasound registration was successful with acceptable mm precision. Further investigations are necessary to achieve sub mm accuracy and assess feasibility in a human model. Copyright © 2016 American Urological

Comparison of Sedation With Local Anesthesia and Regional Anesthesia in Transurethral Resection of Prostate (TURP

Directory of Open Access Journals (Sweden)

H Aghamohammadi

2008-12-01

Full Text Available ABSTRACT: Introduction & Objective: Transurethral Resection of Prostate (TURP is usually performed under regional or general anesthesia. An alternative to conventional anesthesia is performing of TURP under local anesthetic infiltration with sedation. The aim of this study was to evaluate the efficacy and complication of sedoanalgesia in TURP. Material & Methods: In a prospective clinical trial from September 2006 to December 2007, 60 patients (30 in each group with prostate hypertrophy, candidate for TURP, were randomly assigned into two groups. In the first group, standard spinal anesthesia was done. In the second group, five minutes before the operation, 25 mgs of diazepam plus 25-50 mgs of pethedine was intravenously administered followed by injection of 10 ml lidocaine 2% gel in the urethra and the skin in the suprapubic area was anesthetized with 2 ml of 1% lidocaine. Using a 22 gauge nephrostomy needle, the suprapubic skin was punctured and the needle was directed toward prostate apex and 10-20ml of 1% lidocaine was injected at the serosal aspect of the rectal wall. For dorsal nerve block, 5-10ml of 1% lidocaine was injected at penopubic junction, and then a standard TURP was performed. Patients were switched to another anesthetic technique if the selected technique failed. Severity of pain was assessed by visual analogue scale. Results: The average prostate size was 25 grs (range10-50grs in the local anesthetic group (group 1 and 27.5 grs (range 10-50 grs in the spinal group (group2. In the local anesthetic group, 82.3% had no or mild pain while moderate to severe pain was reported in 16, 7% of the patients. In the group with spinal anesthesia, these were 93.1% and 6.9% respectively. Intolerable pain was observed in 23.3% and 13.8% of groups 1 and 2 respectively (p>0.05. Two patients in spinal group and 5 in local anesthetic group (3 due to severe pain and 2 for unsatisfaction required conversion to general anesthesia or receiving

A novel automatic regulatory device for continuous bladder irrigation based on wireless sensor in patients after transurethral resection of the prostate: A prospective investigation.

Science.gov (United States)

Ding, Aimin; Cao, Huling; Wang, Lihua; Chen, Jiangang; Wang, Jian; He, Bosheng

2016-12-01

Benign prostatic hyperplasia is a common progressive disease in aging men, which leads to a significant impact on daily lives of patients. Continuous bladder irrigation (CBI) is a supplementary option for preventing the adverse events following transurethral resection of the prostate (TURP). Regulation of the flow rate based on the color of drainage bag is significant to prevent the clot formation and retention, which is controlled manually at present. To achieve a better control of flow rate and reduce inappropriate flow rate-related adverse effects, we designed an automatic flow rate controller for CBI applied with wireless sensor and evaluated its clinical efficacy. The therapeutic efficacy was evaluated in patients receiving the novel automatic bladder irrigation post-TURP in the experimental group compared with controls receiving traditional bladder irrigation in the control group. A total of 146 patients were randomly divided into 2 groups-the experimental group (n = 76) and the control group (n = 70). The mean irrigation volume of the experimental group (24.2 ± 3.8 L) was significantly lower than that of the controls (54.6 ± 5.4 L) (P sensor for CBI is safe and effective for patients after TURP. However, studies with a large population of patients and a long-term follow-up should be conducted to validate our findings.

Transurethral vaporesection of prostate: diode laser or thulium laser?

Science.gov (United States)

Tan, Xinji; Zhang, Xiaobo; Li, Dongjie; Chen, Xiong; Dai, Yuanqing; Gu, Jie; Chen, Mingquan; Hu, Sheng; Bai, Yao; Ning, Yu

2018-05-01

This study compared the safety and effectiveness of the diode laser and thulium laser during prostate transurethral vaporesection for treating benign prostate hyperplasia (BPH). We retrospectively analyzed 205 patients with BPH who underwent a diode laser or thulium laser technique for prostate transurethral vaporesection from June 2016 to June 2017 and who were followed up for 3 months. Baseline characteristics of the patients, perioperative data, postoperative outcomes, and complications were compared. We also assessed the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Q max ), average flow rate (AFR), and postvoid residual volume (PVR) at 1 and 3 months postoperatively to evaluate the functional improvement of each group. There were no significant differences between the diode laser and thulium laser groups related to age, prostate volume, operative time, postoperative hospital stays, hospitalization costs, or perioperative data. The catheterization time was 3.5 ± 0.8 days for the diode laser group and 4.7 ± 1.8 days for the thulium laser group (p diode laser and thulium laser contributes to safe, effective transurethral vaporesection in patients with symptomatic BPH. Diode laser, however, is better than thulium laser for prostate transurethral vaporesection because of its shorter catheterization time. The choice of surgical approach is more important than the choice of laser types during clinical decision making for transurethral laser prostatectomy.

Transurethral resection of the prostate among Medicare beneficiaries in the United States: time trends and outcomes. Prostate Patient Outcomes Research Team (PORT).

Science.gov (United States)

Lu-Yao, G L; Barry, M J; Chang, C H; Wasson, J H; Wennberg, J E

1994-11-01

The purpose of this study was to examine the epidemiology of transurethral resection of the prostate (TURP) and associated risks among Medicare beneficiaries during the period of 1984 to 1990. Medicare hospital claims for a 20% national sample of Medicare beneficiaries were used to identify TURPs performed during the study period. All reported rates were adjusted to the composition of the 1990 Medicare population. Risks of mortality and reoperation were evaluated using life-table methods. The age-adjusted rate of TURP reached a peak in 1987 and declined thereafter. Similar trends were observed for all age groups. In 1990, the rates of TURP (including all indications) were approximately 25, 19, and 13 per 1000 for men over the age of 75, 70 to 74, and 65 to 69, respectively. The 30-day mortality following TURP for the treatment of benign prostatic hyperplasia (BPH) decreased from 1.20% in 1984 to 0.77% in 1990 (linear trend, p = 0.0001). The cumulative incidence of a second TURP among men with BPH has likewise decreased steadily over time; in this study, the average was 7.2% over 7 years (5.5% when the indication for the second TURP was restricted to BPH only). The rate of TURP has been declining since 1987, conceivably due to increasing availability of alternative treatments or changes in treatment preferences of patients and physicians. Over the same period, the outcomes following TURPs have improved, perhaps due to improved surgical care and changes in patient selection.

Detection and recurrence rate of transurethral resection of bladder tumors by narrow-band imaging: Prospective, randomized comparison with white light cystoscopy

Directory of Open Access Journals (Sweden)

Seung Bin Kim

2018-03-01

Full Text Available Purpose: The purpose of this study was to evaluate the efficacy of narrow-band imaging (NBI as a diagnostic tool for detecting bladder tumors during cystoscopy compared with white light cystoscopy (WLC. Materials and Methods: From December 2013 to June 2017, a randomized prospective study was conducted on 198 patients underwent transurethral resection of bladder tumor by a single surgeon. The patients were divided into two groups according to diagnostic method. In Group I, WLC only was performed. In Group II, NBI was additionally performed after WLC. We analyzed the rate of detection of bladder tumors as a primary endpoint. In addition, we evaluated rates of recurrence in each group. Results: There were no significant differences between the two groups in characteristics except hypertension. In the analysis of rates of detection, the probability of diagnosing cancer was 80.9% (114/141 in the WLC group, and the probability of diagnosing cancer using WLC in the NBI group was 85.5% (159/186. After switching from WLC to NBI for second-look cystoscopy in the NBI group, NBI was shown to detect additional tumors with a detection rate of 35.1% (13/37 from the perspective of the patients and 42.2% (27/64 from the perspective of the tumors. The 1-year recurrence-free rate was 72.2% in the WLC group and 85.2% in the NBI group (p=0.3. Conclusions: NBI had benefits for detecting tumors overlooked by WLC. Although the difference in the 1-year recurrence-free rate was not statistically significant, our results showed a trend for higher recurrence in the NBI group.

Survivin Expression as a Predictive Marker for Local Control in Patients With High-Risk T1 Bladder Cancer Treated With Transurethral Resection and Radiochemotherapy

International Nuclear Information System (INIS)

Weiss, Christian; Roemer, Felix von; Capalbo, Gianni; Ott, Oliver J.; Wittlinger, Michael; Krause, Steffen F.; Sauer, Rolf; Roedel, Claus; Roedel, Franz

2009-01-01

Purpose: The objectives of this study were to investigate the expression of survivin in tumor samples from patients with high-risk T1 bladder cancer and to correlate its expression with clinicopathologic features as well as clinical outcomes after initial transurethral resection (TURBT) followed by radiotherapy (RT) or radiochemotherapy (RCT). Methods and Materials: Survivin protein expression was evaluated by immunohistochemistry on tumor specimen (n = 48) from the initial TURBT, and was correlated with clinical and histopathologic characteristics as well as with 5-year rates of local failure, tumor progression, and death from urothelial cancer after primary bladder sparring treatment with RT/RCT. Results: Survivin was not expressed in normal bladder urothelium but was overexpressed in 67% of T1 tumors. No association between survivin expression and clinicopathologic factors (age, gender, grading, multifocality, associated carcinoma in situ) could be shown. With a median follow-up of 27 months (range, 3-140 months), elevated survivin expression was significantly associated with an increased probability of local failure after TURBT and RCT/RT (p = 0.003). There was also a clear trend toward a higher risk of tumor progression (p = 0.07) and lower disease-specific survival (p = 0.10). Conclusions: High survivin expression is a marker of tumor aggressiveness and may help to identify a subgroup of patients with T1 bladder cancer at a high risk for recurrence when treated with primary organ-sparing approaches such as TURBT and RCT.

Efficacy and safety of tamsulosin hydrochloride 0.2 mg and combination of tamsulosin hydrochloride 0.2 mg plus solifenacin succinate 5 mg after transurethral resection of the prostate: a prospective, randomized controlled trial

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Shin YS

2016-09-01

Full Text Available Yu Seob Shin,1,* Li Tao Zhang,1,* Jae Hyung You,1 In Sung Choi,1 Chen Zhao,2 Jong Kwan Park1 1Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Medical Device Clinical Trial Center of Chonbuk National University, Jeonju, Republic of Korea; 2Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, and Shanghai Institute of Andrology, Shanghai, People’s Republic of China *These authors contributed equally to this work Objective: The objective of this study was to evaluate the safety and efficacy of tamsulosin hydrochloride 0.2 mg (TAM and its combination with solifenacin succinate 5 mg (SOL after transurethral resection of the prostate (TURP.Patients and methods: The patients were randomized into three groups: TURP (group 1, TURP plus TAM (group 2, and TURP plus TAM + SOL (group 3. Patients in group 2 and group 3 received medication for 4 weeks. The primary efficacy end points were the mean change in total International Prostate Symptom Score (IPSS and IPSS subscores. The secondary end points included quality-of-life score, Overactive Bladder Symptom Score, and short-form voiding and storage score of International Continence Society.Results: In total, 37 men (31.8% in group 1, 37 men (31.8% in group 2, and 42 men (36.2% in group 3 completed the study. In total IPSS, no significant improvement was seen from baseline to the end of treatment in groups 2 and 3 compared with group 1. However, in group 2, the decrement in the IPSS storage score was smaller than group 1 (P=0.02, and in group 3, the decrement in the IPSS voiding score was smaller than group 1 (P=0.05. In groups 2 and 3 compared with group 1, improvements in the quality of life score, total score of Overactive Bladder Symptom Score, and short-form voiding score and storage score of International Continence Society were not statistically

Hand-held transendoscopic robotic manipulators: A transurethral laser prostate surgery case study.

Science.gov (United States)

Hendrick, Richard J; Mitchell, Christopher R; Herrell, S Duke; Webster, Robert J

2015-11-01

Natural orifice endoscopic surgery can enable incisionless approaches, but a major challenge is the lack of small and dexterous instrumentation. Surgical robots have the potential to meet this need yet often disrupt the clinical workflow. Hand-held robots that combine thin manipulators and endoscopes have the potential to address this by integrating seamlessly into the clinical workflow and enhancing dexterity. As a case study illustrating the potential of this approach, we describe a hand-held robotic system that passes two concentric tube manipulators through a 5 mm port in a rigid endoscope for transurethral laser prostate surgery. This system is intended to catalyze the use of a clinically superior, yet rarely attempted, procedure for benign prostatic hyperplasia. This paper describes system design and experiments to evaluate the surgeon's functional workspace and accuracy using the robot. Phantom and cadaver experiments demonstrate successful completion of the target procedure via prostate lobe resection.

Long-term urinary toxicity after 3-dimensional conformal radiotherapy for prostate cancer in patients with prior history of transurethral resection

International Nuclear Information System (INIS)

Sandhu, Ajaypal S.; Zelefsky, Michael J.; Lee, Henry J.; Lombardi, Danna; Fuks, Zvi; Leibel, Steven A.

2000-01-01

Purpose: To report on the long-term urinary morbidity among prostate cancer patients with a prior history of a transurethral resection of the prostate (TURP) treated with high-dose 3-dimensional conformal radiotherapy (3D-CRT). Methods and Materials: Between 1988 and 1997, 1100 patients with clinically localized prostate cancer were treated with 3D-CRT. Of these, 120 patients (8%) were identified as having had a prior TURP and are the subjects of this analysis. The median age was 71 years (range: 49-83 years). The clinical stages of the patients were T1c: 33 (28%); T2a: 38 (32%); T2b: 15 (13%); and T3: 34 (27%). Neoadjuvant androgen ablation therapy was given to 39 (33%). The median radiation dose prescribed to the planning target volume was 75.6 Gy (range: 64.8-81 Gy). The median elapsed time from TURP to initiation of 3D-CRT was 69 months (range: 4-360 months). The median follow-up time was 51 months (range: 18-109 months). Results: Five patients of the 120 with a prior history of TURP (4%) developed a urethral stricture after 3D-CRT which was corrected with dilatation. The 5-year actuarial likelihood of ≥ Grade 2 late urinary toxicities was 9%. No Grade 4 urinary toxicities were observed in this group of patients. Among 110 patients who were completely continent of urine prior to 3D-CRT, 10 (9%) developed stress incontinence requiring 1 pad daily for protection or experienced occasional leakage (not requiring pad protection). The 5-year incidence of ≥ Grade 1 stress incontinence was 18% in patients who developed acute ≥ Grade 2 GU symptoms during the course of 3D-CRT compared to 7% for patients who experienced Grade 1 or no acute urinary symptoms (p = 0.05). The radiation dose (≥75.6 Gy vs. <75.6 Gy), the number of prior TURP procedures, or the volume of resected tissue at the time of TURP had no significant impact on the long-term urinary morbidity outcome. A multivariate analysis demonstrated that the presence of Grade 2 acute urinary symptoms was the

Stricture prophylaxis in transurethral prostatectomy

DEFF Research Database (Denmark)

Hansen, R I; Jensen, A R; Stage, P

1987-01-01

In a prospective study 317 patients with prostatic hypertrophy, admitted for transurethral prostatectomy (TUR P), were randomized into three different groups: (1) urethral dilation and TUR P; (2) urethrotomy according to Otis and TUR P, and (3) TUR P alone. The number of postoperative urethral...

Outcome of colorectal cancer resection in octogenarians

African Journals Online (AJOL)

Colorectal cancer is predominantly a disease of the elderly. It is the second most common cancer in the UK and the third most common cause of cancer-related death.[1] Surgical resection, either for cure or palliation, remains the mainstay of treatment.[1,2]. Long-term survival is related to the extent of disease at diagnosis.

Evaluation of transurethral ultrasonography and computed tomography in the staging of bladder tumors

International Nuclear Information System (INIS)

Yamakawa, Kensuke; Hoshina, Akira; Tochigi, Hiromi; Kawamura, Juichi

1987-01-01

A definitive pathologic diagnosis was made in 47 patients with bladder tumors from cystectomy specimens or by surgical exploration. The tumor was staged in 35 cases by transurethral ultrasonography and in 39 cases by computed tomography. We obtained the following results : the accuracy was 83 % using transurethral sonography, 77 % using computed tomography. Although transurethral ultrasonography is more advantageous than computed tomography in the low stage in regard to accuracy, computed tomography is excellent method to obtain information about the tumor invasion and/or metastases. Of 25 cases combind with computed tomography and transurethral sonography. tumors were correctly staged by both methods in 18 cases (72 %). Histopathological stage was consistent with neither ultrasonographic stage nor computed tomographic stage in 2 cases, and any of these tumors was correctly staged by either of these methods. Although transurethral ultrasonography and computed tomography improve the clinical stage of the bladder tumors separately, some limitations and problems was recognized on using together with these methods for staging the bladder tumors. (author)

Day care bipolar transurethral resection vs photoselective vaporisation under sedoanalgesia: A prospective, randomised study of the management of benign prostatic hyperplasia

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Rajeev Sood

2017-12-01

Full Text Available Objective: To conduct a prospective randomised study comparing the safety, effectiveness and treatment outcomes in patients undergoing bipolar transurethral resection of the prostate (bTURP and photoselective vaporisation of the prostate (PVP under sedoanalgesia, as sedoanalgesia is a safe and effective technique suitable for minimally invasive endourological procedures and although studies have confirmed that both TURP and PVP are feasible under sedoanalgesia there are none comparing the two. Patients and methods: Between November 2014 and April 2016, all patients satisfying the eligibility criteria underwent either bTURP or PVP under sedoanalgesia after randomisation. The groups were compared for functional outcomes, visual analogue scale (VAS pain scores (range 0–10, perioperative variables and complications, with a follow-up of 3 months. Results: In all, 42 and 36 patients underwent bTURP and PVP under sedoanalgesia, respectively. The mean VAS pain score was <2 at any time during the procedure, with no conversions to general anaesthesia. PVP patients had a shorter operating time [mean (SD 55.64 (12.8 vs 61.79 (14.2 min, P = 0.035], shorter duration of hospitalisation [mean (SD 14.58 (2.81 vs 19.21 (2.82 h, P < 0.001] and a higher dysuria rate when compared to bTURP patients. However, the catheterisation time was similar and both intraoperative and postoperative complications were minimal and comparable. Improvements in the International Prostate Symptom Score, quality of life, prostate volume, maximum urinary flow rate and post-void residual urine volume at 3 months were similar in both groups. None of our patients required re-admission or re-operation. Conclusion: Both PVP and bTURP can be carried out safely under sedoanalgesia with excellent treatment outcomes. Keywords: Photoselective vaporisation of prostate (PVP, Bipolar TURP, Day care bTURP, Day care PVP, Sedoanalgesia

Transurethral radiofrequency collagen denaturation for the treatment of women with urinary incontinence.

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Kang, Diana; Han, Julia; Neuberger, Molly M; Moy, M Louis; Wallace, Sheila A; Alonso-Coello, Pablo; Dahm, Philipp

2015-03-18

Transurethral radiofrequency collagen denaturation is a relatively novel, minimally invasive device-based intervention used to treat individuals with urinary incontinence (UI). No systematic review of the evidence supporting its use has been published to date. To evaluate the efficacy of transurethral radiofrequency collagen denaturation, compared with other interventions, in the treatment of women with UI.Review authors sought to compare the following.• Transurethral radiofrequency collagen denaturation versus no treatment/sham treatment.• Transurethral radiofrequency collagen denaturation versus conservative physical treatment.• Transurethral radiofrequency collagen denaturation versus mechanical devices (pessaries for UI).• Transurethral radiofrequency collagen denaturation versus drug treatment.• Transurethral radiofrequency collagen denaturation versus injectable treatment for UI.• Transurethral radiofrequency collagen denaturation versus other surgery for UI. We conducted a systematic search of the Cochrane Incontinence Group Specialised Register (searched 19 December 2014), EMBASE and EMBASE Classic (January 1947 to 2014 Week 50), Google Scholar and three trials registries in December 2014, along with reference checking. We sought to identify unpublished studies by handsearching abstracts of major gynaecology and urology meetings, and by contacting experts in the field and the device manufacturer. Randomised and quasi-randomised trials of transurethral radiofrequency collagen denaturation versus no treatment/sham treatment, conservative physical treatment, mechanical devices, drug treatment, injectable treatment for UI or other surgery for UI in women were eligible. We screened search results and selected eligible studies for inclusion. We assessed risk of bias and analysed dichotomous variables as risk ratios (RRs) with 95% confidence intervals (CIs) and continuous variables as mean differences (MDs) with 95% CIs. We rated the quality of

Influence of antiplatelet-anticoagulant drugs on the need of blood components transfusion after vesical transurethral resection

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Alvaro Julio Virseda-Rodríguez

2015-07-01

Full Text Available Aims: The effect of the antithrombotic preventive therapy on haemorrhage keeps uncertain. We investigate the influence of the antiplatelet and anticoagulant drugs (AP/AC drugs on the transfusion requirement after vesical transurethral resection (VTUR. We also describe the epidemiology of the blood components transfusion in our department. Materials and Methods: Retrospective observational study of a series of patients needing blood transfusion at the Urology Department between June 2010 and June 2013. Selection of 100 consecutive patients who were transfused after VTUR due to bladder transitional cell carcinoma (BTCC (group A = GA. Control group: 100 consecutive patients who underwent VTUR due to BTCC and were not transfused (group B = GB. Transfusion criteria: Haemoglobin < 8 g/dl + anaemia symptoms. Age, gender, associated AP/AC treatment, secondary diagnoses, toxics, tumour stage and grade were analysed. Results: 212 patients required transfusion of a blood component. 169 were men (79% and 43 women (21%. Median age 77.59 years (SD 9.42, range 50-92. Secondary diagnoses: Diabetes Mellitus 64%, high blood pressure 77%, dyslipidemia 52%. 60% of patients were previously treated with AP/AC drugs. Average Haemoglobin pre-transfusion values: 7.4 g/dl (DE ± 0.7. Average Haemoglobin post-transfusion values: 8.9 g/Dl (DE ± 0.72. Most frequent transfusion indications were bladder cancer (37%, kidney cancer (11%, prostate cancer (8%, benign prostatic hyperplasia (BHP (8%, other urological diagnoses (36%. Intraoperative transfusions indicated by the anaesthesiologist: kidney cancer (33%, BPH (28%. Patients who underwent VTUR due to BTCC were older in GA (77.59 years SD 9.42 than in GB (68.98 years SD 11.78 (p = 0.0001. Similar gender distribution (15 women in GA and 24 in GB. Less patients were asked to keep their treatment with ASA 100mg (AcetylSalicylicAcid in GA (25.64% than in GB (50% (p = 0.0330. More aggressive tumour grade in GA (p = 0.0003 and

Does ethamsylate reduce haemorrhage in transurethral prostatectomy?

Science.gov (United States)

Lyth, D R; Booth, C M

1990-12-01

A double-blind, randomised trial of 44 consecutive patients undergoing transurethral prostatectomy demonstrated that ethamsylate (Dicynene) did not reduce blood loss during either the operative or the post- operative periods.

Transurethral prostatectomy in human immunodeficiency virus ...

African Journals Online (AJOL)

Human immunodeficiency virus (HIV) infection is increasing world-wide and highly active antiretroviral treatment ... Hospital with urethral catheter in situ and having failed medical therapy, he opted for transurethral ... endoscopic visualization of operation field, the .... percutaneous exposure: Centers for Disease Control and.

[Results of surgical treatment in ampullary and pancreatic carcinoma and its prognostic parameters after R0-resection].

Science.gov (United States)

Ridwelski, K; Meyer, F; Schmidt, U; Lippert, H

2005-08-01

Resection is currently the only established reasonable therapeutic option with curative potential in pancreatic and ampullary carcinoma. The aim of the study was i) to analyze value and results of surgical therapy and ii) to detect the prognostic parameters, which determine significantly higher survival rates. Two-hundred-twenty patients with pancreatic and ampullary carcinoma (mean age, 61.4 years; 104 females/116 males) underwent surgery. Histologic investigation revealed 19 carcinomas of the papilla of Vater and 201 ductal pancreatic carcinomas. In 126 patients, stage IV a or b tumors were found, in addition, stage I (n =26), II (n = 17) and III (n = 51). Survival-rate was determined according to the method by Kaplan/Meier. Survival was compared using log-rank test. Association of several or multiple parameters with survival was tested using Cox model. Hundred-ten patients underwent tumor resection with primary curative intention (50 %): 96 resections of the pancreatic head, 2 total pancreatectomies and 12 left resections of the pancreas. R0-resection was achieved in 94 patients (42.7 %), whereas intervention was classified R1 in 10 and R2 in 6 cases. In addition, 60 palliative interventions (28 gastroenterostomies, 17 biliodigestive anastomoses, 15 anastomoses at both sites) and 50 explorative laparotomies were performed. In 42.3 % of patients, postoperative complications were found, but only 12/220 individuals died (overall letality, 5.4 %). Postoperative letality of curative pancreatic resections was 3.6 % (palliative intervention, 6.7 %; explorative laparotomy, 8.8 %). Five-year survival-rate of carcinoma of the papilla of Vater and pancreatic carcinoma was 73.3 % and 16.2 %, respectively (median survival time was 66.0 and 14.0 months, respectively). Taken together all other interventions, median survival time ranged between 4.0 (palliative intervention) to 10.0 months (R1-resection). No patient survived 5 years. Therefore, the most relevant prognostic

[En bloc resection and vaporization techniques for the treatment of bladder cancer].

Science.gov (United States)

Struck, J P; Karl, A; Schwentner, C; Herrmann, T R W; Kramer, M W

2018-04-12

Modifications in resection techniques may overcome obvious limitations of conventionally performed transurethral resection (e. g., tumor fragmentation) of bladder tumors or provide an easier patient treatment algorithm (e. g., tumor vaporization). The present review article summarizes the current literature in terms of en bloc resection techniques, histopathological quality, complication rates, and oncological outcomes. A separate data search was performed for en bloc resection (ERBT, n = 27) and vaporization (n = 15) of bladder tumors. In most cases, ERBT is performed in a circumferential fashion. Alternatively, ERBT may be performed by undermining the tumor base via antegrade application of short energy impulses. Based on high rates of detrusor in specimens of ERBT (90-100%), a better histopathological quality is assumed. Significant differences in perioperative complication rates have not been observed, although obturator-nerve-based bladder perforations are not seen when laser energy is used. There is a nonstatistically significant trend towards lower recurrence rates in ERBT groups. Tumor vaporization may provide a less invasive technique for older patients with recurrences of low-risk bladder cancer. It can be performed in an outpatient setting. ERBT may provide better histopathological quality. Tumor vaporization is performed in health care systems where reimbursement is adequate.

Transurethral resection of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: how much should be resected?

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Alberto A. Antunes

2009-12-01

Full Text Available Objective: To assess the impact of the percent of resected tissue on the improvement of urinary symptoms. Materials and methods: The study included a prospective analysis of 88 men with benign prostatic hyperplasia. Patients were divided in three groups according to the percent of resected tissue: Group 1 50%. Each patient was re-evaluated 3 months after surgery. We assessed the international prostatic symptom score, nocturia and serum prostate specific antigen levels. Results: All patients presented a significant decrease on mean International Prostate System Score (IPSS (23 to 5.9, Quality of Life (QoL (4.9 to 1.0 and nocturia (3.2 to 1.9. Variation in the IPSS was 16.7, 16.6 and 18.4 for patients from Group 1, 2 and 3 respectively (P = 0.504. Although the three groups presented a significant decrease in QoL, patients in Group 3 presented a significantly greater decrease when compared to Group 1. Variation in QoL was 3.1, 3.9 and 4.2 for patients from Group 1, 2 and 3 respectively (p = 0.046. There was no significant difference in nocturia variation according to the percent of resected tissue (p = 0.504. Median pre and postoperative PSA value was 3.7 and 1.9 ng/mL respectively. Patients from Group 1 did not show a significant variation (p = 0.694. Blood transfusions were not required in any group. Conclusions:Resection of less than 30% of prostatic tissue seems to be sufficient to alleviate lower urinary tract symptoms related to benign prostate hyperplasia. However, these patients may not show a significant decrease in serum PSA level.

Transurethral prostatectomy in human immunodeficiency virus ...

African Journals Online (AJOL)

A 63-year old man was admitted to our Hospital with urethral catheter in situ and having failed medical therapy, he opted for transurethral prostatectomy (TURP) which was done without any post-operative complication. He was known to be afflicted with human immunodeficiency virus and on treatment for 3 years. He also ...

Initial Results of Retrospective Study: Preoperative Transurethral Excision Plus Chemotherapy and Radiation Therapy and Trial of Bladder Preservation

International Nuclear Information System (INIS)

Gammal El-Deen, H.S.

2007-01-01

For patients with invasive bladder cancer the usual recommended treatment is radical cystectomy, although transurethral resection of the tumor, systemic chemotherapy, and radiotherapy are each effective in some patients. This retrospective study evaluated the experience of the Clinical Oncology Department, Tanta University Hospital with combined modality treatment and selective bladder preservation in patients with muscle-invading bladder cancer with assessment of its safety, tolerance, and efficacy to determine whether these treatments in combination might be as effective as radical cystectomy and thus might allow the bladder to be preserved and the cancer cured and to identify factors that may predict treatment response, risk of relapse and survival. Patients and Methods: Between January 2000 and January 2006, 55 consecutive patients with muscle invading bladder cancer (stages T2 through T4, NX M0) were treated with as complete transurethral surgery as possible, followed by induction combination chemotherapy, and irradiation with 4500 cGy with concurrent cisplatin administration. Urologic evaluation by cystoscopy, cytology, and re biopsy 2-3 weeks later of the tumor response directed further therapy: either radical cystectomy in the patients who had incomplete responses, or additional chemotherapy with the same drugs and doses and radiotherapy up to 6480 cGy in the patients who had complete responses. The median follow-up was 48 months. Results: In 37 patients (67.3%) the bladder was free of invasive tumor and functioning well, even though in 13(23.6%) a superficial tumor recurred and required further transurethral surgery and intravesical drug therapy. Of the 18 (32.7%) patients who still had detectable tumor after initial treatment, all of them underwent radical cystectomy. None of the patients had required a cystectomy for radiation toxicity. Of the 37 (67.3%) patients who had complete responses with no tumor detectable on urine cytology or re biopsy after

Transurethral resection of the prostate in Northern Nigeria, problems and prospects

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Mohammed AZ

2008-12-01

Full Text Available Abstract Background Benign prostatic hyperplasia (BPH is the commonest disease of the urinary tract afflicting the ageing male and is the commonest neoplastic disease in men aged 50 years and above. Transurethral prostatectomy (TURP is the ultimate treatment of choice for benign prostatic hyperplasia (BPH due mainly to the preference of minimally invasive surgery, long term relief of symptoms and cost effectiveness. It is however not available to the majority of Nigerians in need of prostatic surgery in Public Health Institutions. Methods The records of patients who underwent prostatectomy in Aminu Kano Teaching Hospital, over the period June 2001 to July 2007 were examined. The bio data of patients and laboratory investigations performed were retrieved. Results Five Hundred and forty two patients were operated upon, out of which 40 were excluded due to open prostatectomy (22 patients, bladder neck stenosis (16 patients or bladder tumour around the trigon (2 patients. The age range of the patients was 47–110 years with a mean of 67.2 years. 289 patients (80.1% had urethral catheter in situ at presentation and 11 (3% patients had suprapubic cystostomy of which only 3 (0.85% had combined urethral stricture and BPH. Only 131 (26% had their PSA measured which ranged from 2–100 ng/ml out of which 39(29.8% n = 131 patients had more than 4 ng/ml and cancer of the prostate and 1(0.8%, n = 131 patient had a PSA level of 4 ng/ml and malignant prostate. Hospital stay was 1–32 days (mean 7.9 and the mean follow up period was 5.6 months (range 0–60 and there were 17.5% complications comprising of urinary tract infection (UTI 7.2%, Orchitis 2.2%, urinary incontinence 0.6%, atonic bladder 1%, erectile dysfunction 0.6%, cerebrovascular accident 0.4%, myocardial infarction 0.4%, deep vein thrombosis 0.4% and disseminated intravascular coagulopathy (DIC 0.6% and 1.2% mortality. The cost of treatment inclusive of pre-admission investigations was US$ 615

Comparison between transurethral ultrasound and conventional urethrography in male urethral stricture

International Nuclear Information System (INIS)

Fernandez, G. C.; Rivas, C.; Rivas, B.; Perez, M.; Peasqueira, D.; Tardaguila, F.

2001-01-01

To define the role of transurethral ultrasound in the study of male urethral structure. A prospective study was carried out in 19 consecutive patients with male urethral structure, diagnosed by means of conventional urethrography, who subsequently underwent transurethral ultrasound. The latter study consisted of the introduction of a Foley catheter (8 or 10 F) and gradual inflation of the balloon within the navicular fossa. Sterile saline solution was then slowly and continuously infused while the ultrasound was carried out by placing the transducer on the ventral aspect of the penis and in the perineal region to identify the different portions of the urethra. The location and extension of the structure were determined by both radiological techniques, and adjacent areas of fibrosis (spongiofibrosis) were detected by ultrasound. The results correlated with the pathological findings in 10 case. There was good agreement between the two techniques in the localization of the structure (kappa=0.81). However, there were statistically significant differences in the measurements of the extension (p=0.01). Transurethral ultrasound revealed areas of spongiofibrosis adjacent to the structure that presented a different echogenicity. The results of the measurement of their extension were not significantly different from those found in the pathological study. Transurethral ultrasound is more effective than conventional urethrography in the study of urethral structure since it permits the precise measurement and localization of the structure and the visualization of the zone of spongiofibrosis, a determining factor in surgical planning. (Author) 11 refs

[Clinical value of "Kou mode of hepatic hilar anastomosis" in resection of type III or IV hepatic hilar cholangiocarcinoma].

Science.gov (United States)

He, Xiao-dong; Liu, Wei; Tao, Lian-yuan; Zhang, Zhen-huan; Cai, Lei; Zhang, Shuang-min

2009-08-01

To evaluate the surgical technique of "Kou mode of hepatic hilar anastomosis" in the treatment for type III or IV hilar cholangiocarcinoma. The clinical data of 89 patients with type III or IV hilar cholangiocarcinoma surgically treated in our department between Jan. 1990 and Jan. 2008 were retrospectively analyzed. Since January 2000, "Kou mode of hepatic hilar anastomosis" was performed for some patients with advanced hilar cholangiocarcinoma. The patients were divided into two groups: group A treated between 1990 and 1999, group B between 2000 and 2008. The rate of resection, therapeutic efficacy and complications in these two groups were compared, respectively. Of the 37 cases with hilar cholangiocarcinoma in group A, 4 were surgically treated (10.8%), with 1 (2.7%) radical resection and 3 (8.1%) palliative resection. Among the 52 cases with hilar cholangiocarcinoma in the group B, 35 (67.3%) received surgical resection, of them 15 (28.8%) underwent radical resection and 20 (38.5%) had palliative resection. Twenty-eight of these 35 cases underwent the "Kou mode of hepatic hilar anastomosis". The resection rate of advanced hilar cholangiocarcinoma in the group B was significantly higher than that in group A (P anastomosis" developed bile leakage to a varying degree and recovered after drainage and symptomatic treatment. The resection rate of type III or IV advanced hilar cholangiocarcinoma can be remarkably improved by using a novel alternative surgical technique called "Kou mode of hepatic hilar anastomosis". However, the long-term outcome still needs to be determined by close follow-up and further observation.

Transvaginal Resection of a Bladder Leiomyoma Misdiagnosed with a Vaginal Mass: A Case Report and Literature Review

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Fu-Fen Yin

2015-01-01

Full Text Available Bladder leiomyoma is a rare benign tumor and it could be easily misdiagnosed with many other pelvic diseases, especially obstetrical and gynecological diseases; abdominal, laparoscopic, and transurethral resection of bladder leiomyoma have been reported. Herein, we present a case of bladder leiomyoma misdiagnosed with a vaginal mass preoperatively; the mass was isolated, enucleated from the bladder neck, and removed transvaginally; to the best of our knowledge, this is the first case of intramural leiomyoma of bladder neck that has been enucleated transvaginally only without cystotomy.

Seizure outcomes in non-resective epilepsy surgery: An update

Science.gov (United States)

Englot, Dario J.; Birk, Harjus; Chang, Edward F.

2016-01-01

In approximately 30% of patients with epilepsy, seizures are refractory to medical therapy, leading to significant morbidity and increased mortality. Substantial evidence has demonstrated the benefit of surgical resection in patients with drug-resistant focal epilepsy, and in the present journal, we recently reviewed seizure outcomes in resective epilepsy surgery. However, not all patients are candidates for or amenable to open surgical resection for epilepsy. Fortunately, several non-resective surgical options are now available at various epilepsy centers, including novel therapies which have been pioneered in recent years. Ablative procedures such as stereotactic laser ablation and stereotactic radiosurgery offer minimally invasive alternatives to open surgery with relatively favorable seizure outcomes, particularly in patients with mesial temporal lobe epilepsy. For certain individuals who are not candidates for ablation or resection, palliative neuromodulation procedures such as vagus nerve stimulation, deep brain stimulation, or responsive neurostimulation may result in a significant decrease in seizure frequency and improved quality of life. Finally, disconnection procedures such as multiple subpial transections and corpus callosotomy continue to play a role in select patients with an eloquent epileptogenic zone or intractable atonic seizures, respectively. Overall, open surgical resection remains the gold standard treatment for drug-resistant epilepsy, although it is significantly under-utilized. While non-resective epilepsy procedures have not replaced the need for resection, there is hope that these additional surgical options will increase the number of patients who receive treatment for this devastating disorder - particularly individuals who are not candidates for or who have failed resection. PMID:27206422

Holmium laser enucleation versus transurethral resection in patients with benign prostate hyperplasia: an updated systematic review with meta-analysis and trial sequential analysis.

Directory of Open Access Journals (Sweden)

Sheng Li

Full Text Available BACKGROUND: Holmium laser enucleation (HoLEP in surgical treatment of benign prostate hyperplasia (BPH potentially offers advantages over transurethral resection of the prostate (TURP. METHODS: Published randomized controlled trials (RCTs were identified from PubMed, EMBASE, Science Citation Index, and the Cochrane Library up to October 10, 2013 (updated on February 5, 2014. After methodological quality assessment and data extraction, meta-analysis was performed using STATA 12.0 and Trial Sequential Analysis (TSA 0.9 software. RESULTS: Fifteen studies including 8 RCTs involving 855 patients met the criteria. The results of meta-analysis showed that: a efficacy indicators: there was no significant difference in quality of life between the two groups (P>0.05, but compared with the TURP group, Qmax was better at 3 months and 12 months, PVR was less at 6, 12 months, and IPSS was lower at 12 months in the HoLEP, b safety indicators: compared with the TURP, HoLEP had less blood transfusion (RR 0.17, 95% CI 0.06 to 0.47, but there was no significant difference in early and late postoperative complications (P>0.05, and c perioperative indicators: HoLEP was associated with longer operation time (WMD 14.19 min, 95% CI 6.30 to 22.08 min, shorter catheterization time (WMD -19.97 h, 95% CI -24.24 to -15.70 h and hospital stay (WMD -25.25 h, 95% CI -29.81 to -20.68 h. CONCLUSIONS: In conventional meta-analyses, there is no clinically relevant difference in early and late postoperative complications between the two techniques, but HoLEP is preferable due to advantage in the curative effect, less blood transfusion rate, shorter catheterization duration time and hospital stay. However, trial sequential analysis does not allow us to draw any solid conclusion in overall clinical benefit comparison between the two approaches. Further large, well-designed, multicentre/international RCTs with long-term data and the comparison between the two approaches remain open.

Aggressive palliative surgery in metastatic phyllodes tumor: Impact on quality of life

Directory of Open Access Journals (Sweden)

A S Kapali

2010-01-01

Full Text Available Metastatic phyllodes tumor has very few treatment options. Phyllodes tumor in metastatic setting has limited role of surgery, radiotherapy and chemotherapy or combined treatment. Most of the patients receive symptomatic management only. We present a case of metastatic phyllodes tumor managed with aggressive margin negative resection of primary tumor leading to palliation of almost all the symptoms, which eventually led to improved quality of life and probably to improved survival. The improved quality of life was objectively assessed with Hamilton depression rating scale. Surgery may be the only mode of palliation in selected patients that provides a better quality of life and directly or indirectly may lead to improved survival.

A cost-minimisation analysis comparing photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for the management of symptomatic benign prostatic hyperplasia (BPH) in Queensland, Australia.

Science.gov (United States)

Whitty, Jennifer A; Crosland, Paul; Hewson, Kaye; Narula, Rajan; Nathan, Timothy R; Campbell, Peter A; Keller, Andrew; Scuffham, Paul A

2014-03-01

To compare the costs of photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for management of symptomatic benign prostatic hyperplasia (BPH) from the perspective of a Queensland public hospital provider. A decision-analytic model was used to compare the costs of PVP and TURP. Cost inputs were sourced from an audit of patients undergoing PVP or TURP across three hospitals. The probability of re-intervention was obtained from secondary literature sources. Probabilistic and multi-way sensitivity analyses were used to account for uncertainty and test the impact of varying key assumptions. In the base case analysis, which included equipment, training and re-intervention costs, PVP was AU$ 739 (95% credible interval [CrI] -12 187 to 14 516) more costly per patient than TURP. The estimate was most sensitive to changes in procedural costs, fibre costs and the probability of re-intervention. Sensitivity analyses based on data from the most favourable site or excluding equipment and training costs reduced the point estimate to favour PVP (incremental cost AU$ -684, 95% CrI -8319 to 5796 and AU$ -100, 95% CrI -13 026 to 13 678, respectively). However, CrIs were wide for all analyses. In this cost minimisation analysis, there was no significant cost difference between PVP and TURP, after accounting for equipment, training and re-intervention costs. However, PVP was associated with a shorter length of stay and lower procedural costs during audit, indicating PVP potentially provides comparatively good value for money once the technology is established. © 2013 The Authors. BJU International © 2013 BJU International.

Transurethral deroofing of midline prostatic cyst for subfertile men

NARCIS (Netherlands)

E.B. Cornel (Erik); G.R. Dohle (Gert); E.J. Meuleman

1999-01-01

textabstractWe evaluated the efficacy of transurethral deroofing of a midline prostatic cyst in subfertile men with one or more of the following semen abnormalities: decreased ejaculatory volume, decreased sperm motility and oligo- or azoospermia. Results from treatment

Palliative surgery for pancreatic carcinoma

International Nuclear Information System (INIS)

Khan, I.M.; Aurangzeb, M.

2010-01-01

To evaluate the role of palliative surgical treatment in patients with advanced pancreatic carcinoma. Study Design: Case series. Place and Duration of Study: Surgical Ward of Khyber Teaching Hospital, Peshawar, from January 2005 to January 2009. Methodology: The study included patients with pancreatic carcinoma admitted with advanced, unresectable carcinoma of the pancreas. Patients with resectable tumours and with previous history of gastric or biliary surgery were excluded. Palliative procedures were performed after assessment of the tumour and its confirmation as unresectable on ultrasound and CT scan + ERCP. Postoperatively all patients were referred to oncologist. Complications and mortality were noted. Results: There were 40 patients, including 24 males and 16 females with mean age 58.72 +- 6.42 years. The most common procedure performed was triple bypass in 21 (52.50%) patients followed by choledocho-, cholecysto-, hepaticoand gastro-jejunostomy in various combinations. Wound infection occurred in 7 patients and was more common in patients with co-morbidities. Biliary leakage occurred in 03 patients. Postoperative cholangitis occurred in 3 patients while 7 patients had minor leak from the drain site. Four patients developed UTI, while 5 patients had signs of delayed gastric emptying. Two patients had upper gastrointestinal bleeding. Three patients died due to septicemia and multiple organs failure. Rest of the patients were discharged in stable state. The mean hospital stay was 8.40 +- 3.48 days and median survival was 7.72 +- 2.39 months. Conclusion: Surgical palliation for the advanced carcinoma pancreas can improve the quality of life of patients and is associated with minimum morbidity and mortality. (author)

Transumbilical laparoendoscopic single-site radical prostatectomy and cystectomy with the aid of a transurethral port: a feasibility study.

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Su, Jian; Zhu, Qingyi; Yuan, Lin; Zhang, Yang; Zhang, Qingling; Wei, Yunfei

2018-01-01

To describe the surgical technique and report early outcomes of transurethral assisted laparoendoscopic single-site (LESS) radical prostatectomy (RP) and LESS radical cystectomy (RC) in a single institution. Between December 2014 and March 2016, a total of 114 LESS RPs and RCs were performed, comprising 68 LESS RPs, 38 LESS RCs with cutaneous ureterostomy (CU) and eight LESS RCs with orthotopic ileal neobladder (OIN). Access was achieved via a single-port, with four channels placed through a transumblical incision. After the apex of prostate was separated from the urethra, a self-developed port ('Zhu's port') was inserted through the urethra to facilitate resection of prostate and urethrovesical anastomosis. The peri-operative and postoperative data were collected and analysed retrospectively. Patients were followed up postoperatively for evidence of long-term side effects. All the procedures were completed successfully. No conversion to conventional laparoscopic surgery was necessary. For LESS RP, the average operating time was 152 min. Estimated blood loss was 117 mL. The mean hospital stay was 16.4 days after surgery. For LESS RC with CU and LESS RC with OIN, the mean operating times were 215 and 328 min, mean estimated blood loss was 175 and 252 mL, and mean hospital stay was 9.4 and 18.2 days, respectively. Six patients required blood transfusion (5.26%). Intra-operative complications occurred in two patients (1.75%), and postoperative complications in nine (7.89%). Fourteen out of 68 (20.6%) patients who underwent LESS RP had positive surgical margins. Follow-up ranged from 10 to 30.6 months. In the prostate cancer cases, good urinary control was observed in 35.3%, 97.1% and 100% of patients at 1, 6 and 12 months after the operation, respectively, while biochemical recurrence was observed in 11.8% patients. In the bladder cancer cases, two patients had local recurrence and two patients had distant metastasis. Our results showed that LESS RP and LESS RC

Ultrasonic diagnosis and transurethral incision of ureterocele with hydronephrosis

DEFF Research Database (Denmark)

Waaddegaard, P; Miskowiak, J; Stage, P

1991-01-01

In a 65-year-old woman with right-sided loin pain, ultrasonography revealed a grossly dilated and obstructed right pyelogram due to a 50-mm ureterocele. After transurethral lateral incision of the ureterocele, there was complete recovery without vesicoureteric reflux. Ultrasonography is advantage...

Does resectoscope size play a role in formation of urethral stricture following transurethral prostate resection?

Directory of Open Access Journals (Sweden)

Mustafa Günes

2015-08-01

Full Text Available ABSTRACTBackground and aims:To investigate the possible effect of resectoscope size on urethral stricture rate after monopolar TURP.Materials and Methods:A retrospective study of 71 men undergoing TURP was conducted at two centers’ from November 2009 to May 2013. The patients were divided into one of two groups according to the resectoscope diameter used for TURP. Resectoscope diameter was 24 F in group 1 (n=35 or 26 F in group 2 (n=36. Urethral catheter type, catheter removal time and energy type were kept constant for all patients. Urethral stricture formation in different localizations after TURP was compared between groups.Results:There was no significant difference between the two groups in terms of age, pre-operative prostate gland volume (PV, prostate-specific antigen (PSA, maximal urinary flow rates (Qmax, International Prostate Symptom Score (IPSS and post-voiding residual urine volume (PVR. The resection time and weight of resected prostate tissue were similar for both groups (p>0.05. A statistically significant higher incidence of bulbar stricture was detected in group 2 compared to group1 (p=0.018.Conclusions:The use of small-diameter resectoscope shafts may cause a reduction in the incidence of uretral strictures in relation to urethral friction and mucosal damage.

Age and prostate volume are risk factors for transient urinary incontinence after transurethral enucleation with bipolar for benign prostatic hyperplasia.

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Hirasawa, Yosuke; Kato, Yuji; Fujita, Kiichiro

2018-01-01

To investigate the predictive factors for transient urinary incontinence after transurethral enucleation with bipolar. We retrospectively analyzed the data of 584 patients who underwent transurethral enucleation with bipolar between December 2011 and September 2016 operated by a single surgeon. Urinary incontinence after transurethral enucleation with bipolar was defined as involuntary leakage of urine that required the use of pads. It was evaluated at 1 week, and 1, 3, 6, 12 and 24 months after transurethral enucleation with bipolar. We defined transient urinary incontinence as urinary incontinence persisting up to 1 month after transurethral enucleation with bipolar. Based on independent risk factors identified by a multivariate stepwise logistic regression analysis, a nomogram to predict transient urinary incontinence was developed. Of the 584 patients, 17.3%, 13.5%, 3.1%, 0.41%, and 0% patients had urinary incontinence at 1 week, 1, 3, 6 and 12 months after transurethral enucleation with bipolar, respectively. The mean (±standard error) age was 69.6 ± 0.26 years, estimated prostate volume was 54.7 ± 0.91 cm 3 , operative time was 58.0 ± 1.1 min and the prostate specimen weight was 30.6 ± 0.69 g. On univariate analysis, age, prostate volume estimated by transrectal ultrasonography, prostate-specific antigen, prostate specimen weight, operative time, prostate specimen weight/prostate volume and prostate specimen weight/operative time were significant predictive factors for transient urinary incontinence after transurethral enucleation with bipolar. On multivariate analysis, age (hazard ratio 1.07, P-value = 0.0034) and prostate volume (hazard ratio 1.03, P-value bipolar. Age and prostate volume estimated by transrectal ultrasonography seem to represent significant independent risk factors for transient urinary incontinence after transurethral enucleation with bipolar. This should be well discussed with the patient before surgery. © 2017 The Japanese

Transurethral light delivery for prostate photoacoustic imaging

OpenAIRE

Lediju Bell, Muyinatu A.; Guo, Xiaoyu; Song, Danny Y.; Boctor, Emad M.

2015-01-01

Photoacoustic imaging has broad clinical potential to enhance prostate cancer detection and treatment, yet it is challenged by the lack of minimally invasive, deeply penetrating light delivery methods that provide sufficient visualization of targets (e.g., tumors, contrast agents, brachytherapy seeds). We constructed a side-firing fiber prototype for transurethral photoacoustic imaging of prostates with a dual-array (linear and curvilinear) transrectal ultrasound probe. A method to calculate ...

Elective hemi transurethral resection of prostate: a safe and effective method of treating huge benign prostatic hyperplasia

International Nuclear Information System (INIS)

Abidi, S.S.; Feroz, I.; Aslam, M.; Fawad, A.

2012-01-01

To evaluate the safety and efficacy of elective hemi-resection of prostate in patients with huge gland, weighing more than 120 grams. Study Design: Multi centric, analytical comparative study. Place and Duration of Study: Department of Urology, Karachi Medical and Dental College, Abbasi Shaheed Hospital and Dr. Ziauddin Hospital, Karachi, from August 2006 to July 2009. Methodology: All benign cases were included in this study and divided into two groups. In group A, patients having huge prostate (> 120 grams) were placed and hemi TURP was performed. In group B, patients having 60 to 100 grams prostate were placed and conventional Blandy's TURP was performed. Results of both groups were compared in terms of duration of surgery, amount of tissue resected, operative bleeding, postoperative complications, duration of postoperative catheterization, re-admission and re-operations. Effectiveness of procedure was assessed by a simple questionnaire filled by the patients at first month, first year and second year. Patients satisfaction in terms of their ability to void, control urination, frequency, urgency, urge incontinence, haematuria, recurrent UTI, re-admission and re-operations were also assessed. Fisher exact test was applied to compare the safety and efficacy of variables. Results: In group A and B, average age range was 72 and 69 years, average weight of prostate was 148 and 70 grams, average duration of surgery was 102 and 50 minutes respectively. Average weight of resected tissue was 84 and 54 grams and haemoglobin loss was two grams and one gram respectively. Total hospital stay was 5 and 4 days. Total duration of indwelling Foley's catheter (postoperative) was 5 days and 2 days. Patient satisfaction in term of urine flow, urinary control, improvement in frequency and nocturia were comparable in both groups. UTI and re-admission was more in hemi resection group. At the end of 2 years follow-up, there is no statistical difference between the safety and efficacy

The effects of indwelling transurethral catheterization and tube cystostomy on urethral anastomoses in dogs.

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Cooley, A J; Waldron, D R; Smith, M M; Saunders, G K; Troy, G C; Barber, D L

1999-01-01

The influence of urinary diversion procedures on urethral healing was studied in 15 male dogs following transection and anastomosis of the intrapelvic portions of their urethras. Dogs were randomly assigned to one of three treatment groups and had urine diverted from the surgical site by indwelling transurethral catheter, cystostomy catheter, or a combination of transurethral catheter and cystostomy catheter. There were no statistically significant differences in urethral healing when considering the different diversion methods, based on clinical, radiographic, and urodynamic parameters evaluated.

Branding Palliative Care Units by Avoiding the Terms "Palliative" and "Hospice".

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Dai, Ying-Xiu; Chen, Tzeng-Ji; Lin, Ming-Hwai

2017-01-01

The term "palliative care" has a negative connotation and may act as a barrier to early patient referrals. Rebranding has thus been proposed as a strategy to reduce the negative perceptions associated with palliative care. For example, using the term "supportive care" instead of "palliative care" in naming palliative care units has been proposed in several studies. In Taiwan, terms other than "palliative" and "hospice" are already widely used in the names of palliative care units. With this in mind, this study investigated the characteristics of palliative care unit names in order to better understand the role of naming in palliative care. Relevant data were collected from the Taiwan Academy of Hospice Palliative Medicine, the National Health Insurance Administration of the Ministry of Health and Welfare, and the open database maintained by the government of Taiwan. We found a clear phenomenon of avoiding use of the terms "palliative" and "hospice" in the naming of palliative care units, a phenomenon that reflects the stigma attached to the terms "palliative" and "hospice" in Taiwan. At the time of the study (September, 2016), there were 55 palliative care units in Taiwan. Only 20.0% (n = 11) of the palliative care unit names included the term "palliative," while 25.2% (n = 14) included the term "hospice." Religiously affiliated hospitals were less likely to use the terms "palliative" and "hospice" (χ 2 = 11.461, P = .001). There was also a lower prevalence of use of the terms "palliative" and "hospice" for naming palliative care units in private hospitals than in public hospitals (χ 2 = 4.61, P = .032). This finding highlights the strong stigma attached to the terms "palliative" and "hospice" in Taiwan. It is hypothesized that sociocultural and religious factors may partially account for this phenomenon.

Palliative treatment in patients with unresectable hilar cholangiocarcinoma: results of endoscopic drainage in patients with type III and IV hilar cholangiocarcinoma

NARCIS (Netherlands)

Gerhards, M. F.; den Hartog, D.; Rauws, E. A.; van Gulik, T. M.; González González, D.; Lameris, J. S.; de Wit, L. T.; Gouma, D. J.

2001-01-01

OBJECTIVE: To find out how patients fared after palliative endoscopic biliary drainage for inoperable hilar cholangiocarcinoma. DESIGN: Retrospective study. SETTING: University hospital, the Netherlands. SUBJECTS: Between 1992 and 1999, 41 patients who were referred for resection had tumours that

Severe hematuria after transurethral electrocoagulation in a patient with an arteriovesical fistula.

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Zheng, Xiangyi; Lin, Yiwei; Chen, Bin; Zhou, Xianyong; Zhou, Xiaofeng; Shen, Yuehong; Xie, Liping

2013-12-01

Arteriovesical fistulas are extremely rare. Only eleven cases were previously reported in the literature. They can occur iatrogenically, traumatically or spontaneously. We report an unusual case of a 62-year-old woman with arteriovesical fistula that developed fatal hematuria after transurethral electrocoagulation. Computed tomography (CT) and selective angiography revealed a pseudoaneurysm of the right superior vesical artery with arteriovesical fistula formation, which was managed by transarterial embolization. Contrast enhanced CT or CT angiography should be performed when a pulsatile hemorrhage is revealed during cystoscopy. Therapeutic vesical arterial embolization should be considered as a safe and effective procedure for arteriovesical fistulas. Transurethral electrocoagulation may cause severe hematuria for pulsatile bladder bleeding in patients with pelvic vascular malformation.

Referral patterns of patients with liver metastases due to colorectal cancer for resection.

LENUS (Irish Health Repository)

Al-Sahaf, O

2012-02-01

INTRODUCTION: Colorectal carcinoma accounts for 10% of cancer deaths in the Western World, with the liver being the most common site of distant metastases. Resection of liver metastases is the treatment of choice, with a 5-year survival rate of 35%. However, only 5-10% of patients are suitable for resection at presentation. AIMS: To examine the referral pattern of patients with liver metastases to a specialist hepatic unit for resection. METHODOLOGY: Retrospective review of patient\\'s charts diagnosed with colorectal liver metastases over a 10-year period. RESULTS: One hundred nine (38 women, 71 men) patients with liver metastases were included, mean age 61 years; 79 and 30 patients had synchronous and metachronus metastases, respectively. Ten criteria for referral were identified; the referral rate was 8.25%, with a resection rate of 0.9%. Forty two percent of the patients had palliative chemotherapy; 42% had symptomatic treatment. CONCLUSION: This study highlights the advanced stage of colorectal cancer at presentation; in light of modern evidence-based, centre-oriented therapy of liver metastasis, we conclude that criteria of referral for resection should be based on the availability of treatment modalities.

[Clinical application of combined hepatic artery resection and reconstruction in surgical treatment for hilar cholangiocarcinoma].

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Dai, H S; Bie, P; Wang, S G; He, Y; Li, D J; Tian, F; Zhao, X; Chen, Z Y

2018-01-01

Objective: To clarify whether the surgical treatment for hilar cholangiocarcinoma combined with artery reconstruction is optimistic to the patients with hilar cholangiocarcinoma with hepatic artery invasion. Methods: There were 384 patients who received treatment in the First Affiliated Hospital to Army Medical University from January 2008 to January 2016 analyzed retrospectively. There were 27 patients underwent palliative operation, 245 patients underwent radical operation, radical resection account for 63.8%. Patients were divided into four groups according to different operation method: routine radical resection group( n =174), portal vein reconstruction group ( n =47), hepatic artery reconstruction group ( n =24), palliative group( n =27). General information of patients who underwent radical operation treatment was analyzed by chi-square test and analysis of variance. The period of operation time, blood loss, the length of hospital stay and hospitalization expenses of the radical operation patients were analyzed by one-way ANOVA. Comparison among groups was analyzed by LSD- t test. Results: The follow-up ended up in June first, 2016. Each of patients followed for 6 to 60 months, the median follow-up period was 24 months. 1-, 3-, and 5-year survival rates were 81.3%, 44.9% and 13.5% of routine radical operation group, and were 83.0%, 44.7% and 15.1% of portal vein reconstruction group, and were 70.8%, 27.7% and 6.9% of hepatic artery reconstruction group, respectively. And 1-, 3-, and 5-year survival rates of hepatic artery reconstruction group was lower than routine radical group and portal vein reconstruction group significantly ( P 0.05). The data shows that the ratio of lymphatic metastasis in hepatic artery reconstruction group (70.8%) is much higher than them in routine radical operation group (20.1%) and portal vein reconstruction group (19.1%) significantly ( P hilar cholangiocarcinoma. Cox regression analysis indicate that hepatic artery resection and

Reduced estimated glomerular filtration rate (eGFR 73 m2 ) at first transurethral resection of bladder tumour is a significant predictor of subsequent recurrence and progression.

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Blute, Michael L; Kucherov, Victor; Rushmer, Timothy J; Damodaran, Shivashankar; Shi, Fangfang; Abel, E Jason; Jarrard, David F; Richards, Kyle A; Messing, Edward M; Downs, Tracy M

2017-09-01

To evaluate if moderate chronic kidney disease [CKD; estimated glomerular filtration rate (eGFR) 73 m 2 ] is associated with high rates of non-muscle-invasive bladder cancer (NMIBC) recurrence or progression. A multi-institutional database identified patients with serum creatinine values prior to first transurethral resection of bladder tumour (TURBT). The CKD-epidemiology collaboration formula calculated patient eGFR. Cox proportional hazards models evaluated associations with recurrence-free (RFS) and progression-free survival (PFS). In all, 727 patients were identified with a median (interquartile range [IQR]) patient age of 69.8 (60.1-77.6) years. Data for eGFR were available for 632 patients. During a median (IQR) follow-up of 3.7 (1.5-6.5) years, 400 (55%) patients had recurrence and 145 (19.9%) patients had progression of tumour stage or grade. Moderate or severe CKD was identified in 183 patients according to eGFR. Multivariable analysis identified an eGFR of 73 m 2 (hazard ratio [HR] 1.5, 95% confidence interval [CI]: 1.2-1.9; P = 0.002) as a predictor of tumour recurrence. The 5-year RFS rate was 46% for patients with an eGFR of ≥60 mL/min/1.73 m 2 and 27% for patients with an eGFR of 73 m 2 (P 73 m 2 (HR 3.7, 95% CI: 1.75-7.94; P = 0.001) was associated with progression to muscle-invasive disease. The 5-year PFS rate was 83% for patients with an eGFR of ≥60 mL/min/1.73 m 2 and 71% for patients with an eGFR of 73 m 2 (P = 0.01). Moderate CKD at first TURBT is associated with reduced RFS and PFS. Patients with reduced renal function should be considered for increased surveillance. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Palliative Care in Romania.

Science.gov (United States)

Mosoiu, Daniela; Mitrea, Nicoleta; Dumitrescu, Malina

2018-02-01

HOSPICE Casa Sperantei has been pioneering palliative care development in Romania since 1992. The have developed specialist palliative care services in home-based settings, inpatient units, day care centers, and as hospital support teams. They have provided national and international education programs for professionals in the palliative care field, as well as promoting palliative care integration in the health care system. Legislative improvements were adopted, including funding mechanisms for the reimbursement of palliative care services through the health insurance funds, review of opioid policy, and quality standards of care. By the end of 2015, Romania had 115 specialist palliative care services (78 palliative care inpatient units, 24 home-based palliative care services, five outpatient palliative care clinics, four day care centers, and four hospital support teams). A palliative care subspecialty for doctors was recognized as early as 2000, and a multidisciplinary master's degree program has been available at Transilvania University since 2010, when the first palliative care academic position was established. Nursing education includes mandatory palliative care modules in nursing schools. For coordinated development of palliative care at the national level, a national strategy was proposed defining three levels of palliative care provision, local, district, and national. The implementation of the palliative care strategy is partially funded through a World Bank loan. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

[Transurethral electroresection--an alternative to the indwelling catheter of old patients with prostatic hypertrophy].

Science.gov (United States)

Thiel, U; Krebs, W

1978-01-01

The people become elder in this time, everywhere. The number of patients with adenoma of the prostate is increasing. Most of them have other diseases, too. A retrospective study (2646 cases in 8 years, exactly specially analysed 469 cases from 1975/1976) was done, comparing the results of TUR and open surgery. Well known is the lower risk of TUR, the lower blood loss, the lower discomfort, the lower nursing in the postoperative period ect. There are not news in this study. But it is important, to recall some things, because it's more and more difficult, to classify an old man as an "inoperable case". Nobody knows, where he should stay. The family does not like him at home (his "dripping", his incontinence etc.) In the veterans house it's the same problem, and from the hospital he is removed, because he is an "inoperable case". The situation of this old man is very bad, because he feels there isn't a place for him and nobody likes him. Each man, also if it's the strongest one, will be broken psychically and physically after a short time. Concerning these aspects, must be enlarged the indication of removal the bladder neck obstruction per transurethral resection, more and more.

When palliative treatment achieves more than palliation: Instances of long-term survival after palliative radiotherapy

Directory of Open Access Journals (Sweden)

Madhup Rastogi

2012-01-01

Full Text Available Context: Palliative radiotherapy aims at symptom alleviation and improvement of quality of life. It may be effective in conferring a reasonable quantum of local control, as well as possibly prolonging survival on the short term. However, there can be rare instances where long-term survival, or even cure, results from palliative radiotherapy, which mostly uses sub-therapeutic doses. Aim: To categorize and characterize the patients with long-term survival and/or cure after palliative radiotherapy. Materials and Methods: This study is a retrospective analysis of hospital records of patients treated with palliative radiotherapy from 2001 to 2006 at the Regional Cancer Centre, Shimla. Results: Of the analyzed 963 patients who received palliative radiotherapy, 2.4% (n = 23 survived at least 5 years, with a large majority of these surviving patients (73.9%, n = 17 being free of disease. Conclusions: In addition to providing valuable symptom relief, palliative radiotherapy utilizing sub-therapeutic doses may, in a small proportion of patients, bestow long-term survival, and possibly cure. Rationally, such a favorable, but rare outcome cannot be expected with supportive care alone.

Asymptomatic primary tumour in incurable metastatic colorectal cancer: is there a role for surgical resection prior to systematic therapy or not?

Science.gov (United States)

Samalavicius, Narimantas E; Dulskas, Audrius; Baltruskeviciene, Edita; Smailyte, Giedre; Skuciene, Marija; Mikelenaite, Rasa; Venslovaite, Rasa; Aleknavicius, Eduardas; Samalavicius, Almantas; Lunevicius, Raimundas

2016-01-01

The role of the resection of asymptomatic primary colorectal cancer in patients with incurable disease is questionable. To evaluate the impact of the resection of asymptomatic primary tumour on overall survival in patients with unresectable distant metastases. Patients treated in the National Cancer Institute, Lithuania, in the period 2008-2012, were selected retrospectively. The main inclusion criteria were: metastatic colorectal cancer (mCRC), endoscopically and histologically confirmed adenocarcinoma, without any symptoms for urgent operation, and at least one cycle of palliative chemotherapy administered. Information on patients' age, gender, tumour histology, localization of the tumour, regional lymph node involvement, number of metastatic sites, surgery and systemic treatment was collected prospectively. Eligible patients for the study were divided into two groups according to the initial treatment - surgery (patients who underwent primary tumour resection) and chemotherapy (patients who received chemotherapy without surgery). The impact of initial treatment strategy, tumour size and site, regional lymph nodes, grade of differentiation of adenocarcinoma and application of biotherapy on overall cumulative survival was estimated using the Kaplan-Meier method. To compare survival between groups the log-rank test was used. Cox regression analysis was employed to assess the effects of variables on patient survival. The study group consisted of 183 patients: 103 men and 80 women. The median age was 66 years (range: 37-91). There were no notable imbalances with regard to age, gender, number of metastatic sites, metastases (such as pulmonary, peritoneal, liver, metastases into non-regional lymph nodes and other metastases), the number of received cycles of chemotherapy, first line chemotherapy type or biological therapy. Only 27 (14.8%) patients received biological therapy and the majority of them (n = 25, 92.6%) were treated with bevacizumab. For surgically treated

Transurethral resection of the prostate

Science.gov (United States)

... and Treatment in Prostate Pathology . San Diego, CA: Elsevier Academic Press; 2016:chap 2. Han M, Partin ... eds. Campbell-Walsh Urology . 11th ed. Philadelphia, PA: Elsevier; 2016:chap 106. Kaplan SA. Benign prostatic hyperplasia ...

Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians.

Science.gov (United States)

Koper, Ian; van der Heide, Agnes; Janssens, Rien; Swart, Siebe; Perez, Roberto; Rietjens, Judith

2014-01-01

Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services. Fifty-four physicians were interviewed on their most recent case of palliative sedation. Reasons to consult were a lack of expertise and the view that consultation was generally supportive. Reasons not to consult were sufficient expertise, the view that palliative sedation is a normal medical procedure, time pressure, fear of disagreement with the service and regarding consultation as having little added value. Arguments in favour of mandatory consultation were that many physicians lack expertise and that palliative sedation is an exceptional intervention. Arguments against mandatory consultation were practical obstacles that may preclude fulfilling such an obligation (i.e. lack of time), palliative sedation being a standard medical procedure, corroding a physician's responsibility and deterring physicians from applying palliative sedation. Consultation about palliative sedation with specialist palliative care services is regarded as supportive and helpful when physicians lack expertise. However, Dutch physicians have both practical and theoretical objections against mandatory consultation. Based on the findings in this study, there seems to be little support among Dutch physicians for the EAPC recommendations on obligatory consultation.

Nonsurgical Transurethral Radiofrequency Collagen Denaturation: Results at Three Years after Treatment

Directory of Open Access Journals (Sweden)

Denise M. Elser

2011-01-01

Full Text Available Objective. To assess treatment efficacy and quality of life in women with stress urinary incontinence 3 years after treatment with nonsurgical transurethral radiofrequency collagen denaturation. Methods. This prospective study included 139 women with stress urinary incontinence due to bladder outlet hypermobility. Radiofrequency collagen denaturation was performed using local anesthesia in an office setting. Assessments included incontinence quality of life (I-QOL and urogenital distress inventory (UDI-6 instruments. Results. In total, 139 women were enrolled and 136 women were treated (mean age, 47 years. At 36 months, intent-to-treat analysis (n=139 revealed significant improvements in quality of life. Mean I-QOL score improved 17 points from baseline (P=.0004, while mean UDI-6 score improved (decreased 19 points (P=.0005. Conclusions. Transurethral collagen denaturation is a low-risk, office-based procedure that results in durable quality-of-life improvements in a significant proportion of women for as long as 3 years.

Management of stage IV rectal cancer: Palliative options

Science.gov (United States)

Ronnekleiv-Kelly, Sean M; Kennedy, Gregory D

2011-01-01

Approximately 30% of patients with rectal cancer present with metastatic disease. Many of these patients have symptoms of bleeding or obstruction. Several treatment options are available to deal with the various complications that may afflict these patients. Endorectal stenting, laser ablation, and operative resection are a few of the options available to the patient with a malignant large bowel obstruction. A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity. In this review, we describe various options for palliation of symptoms in patients with metastatic rectal cancer. Additionally, we briefly discuss treatment for asymptomatic patients with metastatic disease. PMID:21412493

Flemish palliative-care nurses' attitudes to palliative sedation: a quantitative study.

Science.gov (United States)

Gielen, Joris; Van den Branden, Stef; Van Iersel, Trudie; Broeckaert, Bert

2012-09-01

Palliative sedation is an option of last resort to control refractory suffering. In order to better understand palliative-care nurses' attitudes to palliative sedation, an anonymous questionnaire was sent to all nurses (589) employed in palliative care in Flanders (Belgium). In all, 70.5% of the nurses (n = 415) responded. A large majority did not agree that euthanasia is preferable to palliative sedation, were against non-voluntary euthanasia in the case of a deeply and continuously sedated patient and considered it generally better not to administer artificial floods or fluids to such a patient. Two clusters were found: 58.5% belonged to the cluster of advocates of deep and continuous sedation and 41.5% belonged to the cluster of nurses restricting the application of deep and continuous sedation. These differences notwithstanding, overall the attitudes of the nurses are in accordance with the practice and policy of palliative sedation in Flemish palliative-care units.

Tumor-Associated Macrophages Provide Significant Prognostic Information in Urothelial Bladder Cancer.

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Minna M Boström

Full Text Available Inflammation is an important feature of carcinogenesis. Tumor-associated macrophages (TAMs can be associated with either poor or improved prognosis, depending on their properties and polarization. Current knowledge of the prognostic significance of TAMs in bladder cancer is limited and was investigated in this study. We analyzed 184 urothelial bladder cancer patients undergoing transurethral resection of a bladder tumor or radical cystectomy. CD68 (pan-macrophage marker, MAC387 (polarized towards type 1 macrophages, and CLEVER-1/Stabilin-1 (type 2 macrophages and lymphatic/blood vessels were detected immunohistochemically. The median follow-up time was 6.0 years. High macrophage counts associated with a higher pT category and grade. Among patients undergoing transurethral resection, all studied markers apart from CLEVER-1/Stabilin-1 were associated with increased risk of progression and poorer disease-specific and overall survival in univariate analyses. High levels of two macrophage markers (CD68/MAC387+/+ or CD68/CLEVER-1+/+ groups had an independent prognostic role after transurethral resection in multivariate analyses. In the cystectomy cohort, MAC387, alone and in combination with CD68, was associated with poorer survival in univariate analyses, but none of the markers were independent predictors of outcome in multivariate analyses. In conclusion, this study demonstrates that macrophage phenotypes provide significant independent prognostic information, particularly in bladder cancers undergoing transurethral resection.

Transurethral cystolithotripsy with a ureteroscope under local urethral anaesthesia and sedoanalgesia

International Nuclear Information System (INIS)

Uzun, H.; Tomak, Y.; Zorba, O.U.; Bostan, H.; Kalkan, M.

2013-01-01

Objective: To investigate if transurethral cystolithotripsy with a ureteroscope is feasible under local urethral anaesthesia, intravenous sedation and analgesia (sedoanalgesia). Methods: The prospective study was conducted from December 2009 to October 2010 and comprised 18 male patients with bladder calculi over 10mm in widest diameter regardless of etiology. The patients underwent transurethral holmium laser cystolithotripsy with a 9.5f semi-rigid ureteroscope. All patients received 2% idocaine gel local urethral anaesthesia, intravenous 0.03mg/kg midazolam and 7 micro g/kg alfentanil before the start of lithotripsy. Patients were discharged 1-3 hours after removal of the urethral foley catheter. Patients were asked to scale the discomfort and/or pain level by using visual analogue pain scale. Patients were followed up for at least 6 months. Results: The overall success rate was 89% (n=16). The mean stone diameter and total number of stones in the 16 patients was 21,48 +-6.7 (12-35) mm and 21 stones, respectively. The average age of the 16 patients was 52.3+-17.6 (45-78) years and mean operative time from begin ing of intravenous sedoanalgesia until urethral foley catheter insertion was 19.2+-18.9 (4-60) minutes. Mean pain score of the 16 patients after ureteroscopic cystolithotripsy was 1.75+-0.6cm (1-6 ). No anaesthesia-related serious complications occurred. After a follow-up of 18 months, recurrent stone formation and urethral stricture was not located in any patient. Conclusions: Transurethral cystolithotripsy with a ureteroscope under local urethral anaesthesia and sedoanalgesia for stones less than 30mm might offer patients safer anaesthesia and shorter operative time with favourable results. (author)

Palliative care and neurology

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Boersma, Isabel; Miyasaki, Janis; Kutner, Jean

2014-01-01

Palliative care is an approach to the care of patients and families facing progressive and chronic illnesses that focuses on the relief of suffering due to physical symptoms, psychosocial issues, and spiritual distress. As neurologists care for patients with chronic, progressive, life-limiting, and disabling conditions, it is important that they understand and learn to apply the principles of palliative medicine. In this article, we aim to provide a practical starting point in palliative medicine for neurologists by answering the following questions: (1) What is palliative care and what is hospice care? (2) What are the palliative care needs of neurology patients? (3) Do neurology patients have unique palliative care needs? and (4) How can palliative care be integrated into neurology practice? We cover several fundamental palliative care skills relevant to neurologists, including communication of bad news, symptom assessment and management, advance care planning, caregiver assessment, and appropriate referral to hospice and other palliative care services. We conclude by suggesting areas for future educational efforts and research. PMID:24991027

Palliative Care Development in Mongolia.

Science.gov (United States)

Davaasuren, Odontuya; Ferris, Frank D

2018-02-01

Since the year 2000, Mongolia has established the foundation measures for a national palliative care program and has made several significant achievements. Systematic reviews and observational studies on palliative care development in Mongolia have taken place over the past 16 years. Mongolia began palliative care development in 2000 with the creation of the Mongolian Palliative Care Society and the Palliative Care Department. Palliative care is included in the Mongolia's Health Law, Health Insurance Law, Social Welfare Law, National Cancer Control Program, and the National Program for Non-Communicable Diseases, and has approved Palliative Care Standards and Pain Management Guidelines. Palliative care education is included in the undergraduate and postgraduate curriculum in all medical universities. Six hospice units in Ulaanbaatar have 50 beds; each of the nine districts and all 21 provinces have up to four to five palliative beds, and there are 36 palliative care units, for a total 190 beds for three million people. In 2014, a pediatric palliative care inpatient unit was established with five beds. Essential drugs for palliative care have been available in Mongolia since 2015. The pharmaceutical company IVCO produces morphine, codeine, pethidine, and oxycodone in Ulaanbaatar. Mongolia has made real progress in integrating palliative care into the health system. Copyright © 2017. Published by Elsevier Inc.

Specialist palliative care nursing and the philosophy of palliative care: a critical discussion.

Science.gov (United States)

Robinson, Jackie; Gott, Merryn; Gardiner, Clare; Ingleton, Christine

2017-07-02

Nursing is the largest regulated health professional workforce providing palliative care across a range of clinical settings. Historically, palliative care nursing has been informed by a strong philosophy of care which is soundly articulated in palliative care policy, research and practice. Indeed, palliative care is now considered to be an integral component of nursing practice regardless of the specialty or clinical setting. However, there has been a change in the way palliative care is provided. Upstreaming and mainstreaming of palliative care and the dominance of a biomedical model with increasing medicalisation and specialisation are key factors in the evolution of contemporary palliative care and are likely to impact on nursing practice. Using a critical reflection of the authors own experiences and supported by literature and theory from seminal texts and contemporary academic, policy and clinical literature, this discussion paper will explore the influence of philosophy on nursing knowledge and theory in the context of an evolving model of palliative care.

A Survey of Hospice and Palliative Care Physicians Regarding Palliative Sedation Practices.

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Lux, Michael R; Protus, Bridget McCrate; Kimbrel, Jason; Grauer, Phyllis

2017-04-01

Patients nearing the end of life may experience symptoms that are refractory to standard therapeutic options. Physicians may consider palliative sedation to relieve intolerable suffering. There is limited clinical literature regarding preferred medications for palliative sedation. To determine the preferred medications physicians use when implementing palliative sedation. An Internet-based, cross-sectional survey of hospice and palliative care physicians in the United States. A link to the survey was e-mailed to 3130 physician members of the American Academy of Hospice and Palliative Medicine, of which 381 physicians completed the survey. Physicians were not required to answer all questions. Nearly all (n = 335, 99%) respondents indicated that palliative sedation may be used (acceptable by 73% [n = 248] for refractory symptoms and acceptable by 26% [n = 87] only for imminently dying patients). Seventy-nine percent (n = 252) believed that opioids should not be used to induce palliative sedation but should be continued to provide pain control. Midazolam was the most commonly selected first-line choice for palliative sedation (n = 155, 42%). The most commonly reported second-line agents for the induction of palliative sedation were lorazepam, midazolam (for those who did not select midazolam as first-line agent), and phenobarbital with a reported preference of 20% (n = 49), 19% (n = 46), and 17% (n = 40), respectively. Of the physicians surveyed, 99% (n = 335) felt that palliative sedation is a reasonable treatment modality. Midazolam was considered a drug of choice for inducing and maintaining sedation, and opioids were continued for pain control.

Tanshinone IIA inhibits metastasis after palliative resection of hepatocellular carcinoma and prolongs survival in part via vascular normalization

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Wang Wen-Quan

2012-11-01

Full Text Available Abstract Background Promotion of endothelial normalization restores tumor oxygenation and obstructs tumor cells invasion, intravasation, and metastasis. We therefore investigated whether a vasoactive drug, tanshinone IIA, could inhibit metastasis by inducing vascular normalization after palliative resection (PR of hepatocellular carcinoma (HCC. Methods A liver orthotopic double-tumor xenograft model in nude mouse was established by implantation of HCCLM3 (high metastatic potential and HepG2 tumor cells. After removal of one tumor by PR, the effects of tanshinone IIA administration on metastasis, tumor vascularization, and survival were evaluated. Tube formation was examined in mouse tumor-derived endothelial cells (TECs treated with tanshinone IIA. Results PR significantly accelerated residual hepatoma metastases. Tanshinone IIA did not inhibit growth of single-xenotransplanted tumors, but it did reduce the occurrence of metastases. Moreover, it inhibited PR-enhanced metastases and, more importantly, prolonged host survival. Tanshinone IIA alleviated residual tumor hypoxia and suppressed epithelial-mesenchymal transition (EMT in vivo; however, it did not downregulate hypoxia-inducible factor 1α (HIF-1α or reverse EMT of tumor cells under hypoxic conditions in vitro. Tanshinone IIA directly strengthened tube formation of TECs, associated with vascular endothelial cell growth factor receptor 1/platelet derived growth factor receptor (VEGFR1/PDGFR upregulation. Although the microvessel density (MVD of residual tumor tissue increased after PR, the microvessel integrity (MVI was still low. While tanshinone IIA did not inhibit MVD, it did dramatically increase MVI, leading to vascular normalization. Conclusions Our results demonstrate that tanshinone IIA can inhibit the enhanced HCC metastasis associated with PR. Inhibition results from promoting VEGFR1/PDGFR-related vascular normalization. This application demonstrates the potential clinical

Inter-Professional Palliative Care

DEFF Research Database (Denmark)

Madsen, Kirsten Halskov; Henriksen, Jette; Meldgaard, Anette

2013-01-01

Chapter 11 by Kirsten Halskov Madsen, Anette Meldgaard and Jette Henriksen deals with the development of palliative care programmes aimed at the basic level of palliative care practice. The need to develop educational opportunities at particularly this level – described as ‘the basic inter......-professional level of palliative care’ – has been increasing for many years where palliative care has conventionally and primarily been associated with specialist training. As the authors show – based on a mapping out of existing educational initiatives in a region of Denmark, a reading of the curriculum...... and a description of the organization of palliative care – there is a need for such inter-professional palliative care that raises the level of competences at the basic level and the sharing of knowledge as well as securing the continuous qualifying of healthcare staff working with palliative care....

Efficacy and safety of tamsulosin hydrochloride 0.2 mg and combination of tamsulosin hydrochloride 0.2 mg plus solifenacin succinate 5 mg after transurethral resection of the prostate: a prospective, randomized controlled trial

Science.gov (United States)

Shin, Yu Seob; Zhang, Li Tao; You, Jae Hyung; Choi, In Sung; Zhao, Chen; Park, Jong Kwan

2016-01-01

Objective The objective of this study was to evaluate the safety and efficacy of tamsulosin hydrochloride 0.2 mg (TAM) and its combination with solifenacin succinate 5 mg (SOL) after transurethral resection of the prostate (TURP). Patients and methods The patients were randomized into three groups: TURP (group 1), TURP plus TAM (group 2), and TURP plus TAM + SOL (group 3). Patients in group 2 and group 3 received medication for 4 weeks. The primary efficacy end points were the mean change in total International Prostate Symptom Score (IPSS) and IPSS subscores. The secondary end points included quality-of-life score, Overactive Bladder Symptom Score, and short-form voiding and storage score of International Continence Society. Results In total, 37 men (31.8%) in group 1, 37 men (31.8%) in group 2, and 42 men (36.2%) in group 3 completed the study. In total IPSS, no significant improvement was seen from baseline to the end of treatment in groups 2 and 3 compared with group 1. However, in group 2, the decrement in the IPSS storage score was smaller than group 1 (P=0.02), and in group 3, the decrement in the IPSS voiding score was smaller than group 1 (P=0.05). In groups 2 and 3 compared with group 1, improvements in the quality of life score, total score of Overactive Bladder Symptom Score, and short-form voiding score and storage score of International Continence Society were not statistically significant. Conclusion Treatment with TAM and combination of TAM and SOL did not have significant additional benefits for lower urinary tract symptoms during the early recovery period after TURP. PMID:27698559

Flemish Palliative-Care Nurses’ Attitudes to Palliative Sedation: Results of a Quantitative Study

OpenAIRE

Gielen, Joris; Van den Branden, Stef; van Iersel, Trudie; Broeckaert, Bert

2012-01-01

Palliative sedation is an option of last resort to control refractory suffering. In order to better understand palliative-care nurses’ attitudes to palliative sedation, an anonymous questionnaire was sent to all nurses (589) employed in palliative care in Flanders (Belgium). In all, 70.5% of the nurses (n=415) responded. A large majority did not agree that euthanasia is preferable to palliative sedation, were against non-voluntary euthanasia in the case of a deeply and continuously sedated pa...

The preventive role of transurethral antibiotic delivery in a rat model

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Ozok HU

2012-07-01

Full Text Available Hakki U Ozok,1 Okan Ekim,2 Hakan Saltas,3 Ata T Arikok,4 Orkun Babacan,5 Levent Sagnak,1 Hikmet Topaloglu,1 Hamit Ersoy11Department of Urology, 3Department of Microbiology, 4Department of Pathology, Diskapi Yildirim Beyazit Training and Research Hospital, Ministry of Health, Ankara, Turkey; 2Department of Anatomy, 5Department of Microbiology, Ankara University Faculty of Veterinary Medicine, Ankara, TurkeyPurpose: There is currently an emerging need for developing improved approaches for preventing urinary tract infections (UTIs occurring during diagnostic or interventional procedures of the lower urinary tract. We aimed to establish a rat model to assess the use of transurethral antibiotic administration and to provide evidence that this could be used as a preventive therapy.Methods: Animals received fosfomycin trometamol (FOF either urethrally or orally prior to the procedure. A third group was generated as treatment controls and did not receive any medication. Urethral dilation was conducted to recapitulate an interventional procedure prior to intravesical Escherichia coli administration in all three groups. Finally, sham-operated animals were introduced as a fourth group which did not receive antibiotics or E. coli. Colony counts of urine and tissue cultures for the identification of E. coli and histopathological examinations of the bladder and prostate were conducted.Results: Evaluation of infection intensities in cultures as well as histopathological examination of the bladder and prostate demonstrated a preventative role of transurethral FOF administration. In terms of efficiency, local administration of FOF was similar to oral administration.Conclusions: These results suggest that transurethral antibiotic administration is a promising alternative for preventing UTIs occurring during diagnostic or interventional procedures of the lower urinary tract.Keywords: cystitis, fosfomycin, infection, prostatitis, urinary tract

Muslim physicians and palliative care: attitudes towards the use of palliative sedation.

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Muishout, George; van Laarhoven, Hanneke W M; Wiegers, Gerard; Popp-Baier, Ulrike

2018-05-08

Muslim norms concerning palliative sedation can differ from secular and non-Muslim perceptions. Muslim physicians working in a Western environment are expected to administer palliative sedation when medically indicated. Therefore, they can experience tension between religious and medical norms. To gain insight into the professional experiences of Muslim physicians with palliative sedation in terms of religious and professional norms. Interpretative phenomenological study using semi-structured interviews to take a closer look at the experiences of Muslim physicians with palliative sedation. Data were recorded, transcribed and analysed by means of interpretative phenomenological analysis (IPA). Ten Muslim physicians, working in the Netherlands, with professional experience of palliative sedation. Two main themes were identified: professional self-concept and attitudes towards death and dying. Participants emphasized their professional responsibility when making treatment decisions, even when these contravened the prevalent views of Islamic scholars. Almost all of them expressed the moral obligation to fight their patients' pain in the final stage of life. Absence of acceleration of death was considered a prerequisite for using palliative sedation by most participants. Although the application of palliative sedation caused friction with their personal religious conceptions on a good death, participants followed a comfort-oriented care approach corresponding to professional medical standards. All of them adopted efficient strategies for handling of palliative sedation morally and professionally. The results of this research can contribute to and provide a basis for the emergence of new, applied Islamic ethics regarding palliative sedation.

Comparison of the effects of two intrathecal anaesthetic techniques for transurethral prostatectomy on haemodynamic and pulmonary function.

LENUS (Irish Health Repository)

Walsh, K H

2012-02-03

BACKGROUND AND OBJECTIVE: Transurethral prostatectomy is routinely performed under spinal anaesthesia. This technique can cause hypotension, which is particularly undesirable in the elderly. The objective was to compare spinal anaesthesia for transurethral prostatectomy using hyperbaric bupivacaine 15 mg (control group) and hyperbaric bupivacaine 10 mg (limiting spread by maintaining the upright position for 15 min) and fentanyl 25 microg (fentanyl group) in terms of haemodynamic and pulmonary function. METHODS: Thirty ASA I-III patients were randomly selected and underwent spinal anaesthesia with either hyperbaric bupivacaine 15 mg (immediately positioned supine) or hyperbaric bupivacaine 10 mg (upright for 15 min) and fentanyl 25 microg. RESULTS: The greatest changes in mean arterial pressure (P = 0.9), ephedrine requirements (P = 0.8) and mean maximum change in forced vital capacity (P = 0.5) were similar in both groups. CONCLUSIONS: The addition of fentanyl 25 microg to bupivacaine 10 mg and limiting the spread of the block does not improve either haemodynamic or pulmonary function compared with bupivacaine 15 mg in patients undergoing transurethral prostatectomy.

Retrograde transurethral balloon dilation of the prostate

International Nuclear Information System (INIS)

Castaneda, F.; Reddy, P.; Wasserman, N.F.; Lund, G.; Hulbert, J.; Hunter, D.; Castaneda-Zuniga, W.R.; Amplatz, K.

1986-01-01

A series of patients with documented benign prostatic hypertrophy evaluated by urodynamic studies, voiding cystourethrography, retrograde urethrography, and MR imaging underwent dilation performed using a retrograde transurethral approach with 25-mm balloon dilators inflated at a pressure of 3-4 atm for 10 minutes. Immediately after the procedure, retrograde and voiding cystourethrography as well as MR imaging were performed. A Foley catheter was left in place for 24 hours. Complete relief of symptoms has occurred in all of the patients during the follow-up period. No significant complications other than transient hematuria resulted from the procedure. Results of the comparison studies and of MR imaging are discussed

Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer.

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Kleespies, Axel; Füessl, Kathrin E; Seeliger, Hendrik; Eichhorn, Martin E; Müller, Mario H; Rentsch, Markus; Thasler, Wolfgang E; Angele, Martin K; Kreis, Martin E; Jauch, Karl-Walter

2009-09-01

The benefit of elective primary tumor resection for non-curable stage IV colorectal cancer (CRC) remains largely undefined. We wanted to identify risk factors for postoperative complications and short survival. Using a prospective database, we analyzed potential risk factors in 233 patients, who were electively operated for non-curable stage IV CRC between 1996 and 2002. Patients with recurrent tumors, resectable metastases, emergency operations, and non-resective surgery were excluded. Risk factors for increased postoperative morbidity and limited postoperative survival were identified by multivariate analyses. Patients with colon cancer (CC = 156) and rectal cancer (RC = 77) were comparable with regard to age, sex, comorbidity, American Society of Anesthesiologists score, carcinoembryonic antigen levels, hepatic spread, tumor grade, resection margins, 30-day mortality (CC 5.1%, RC 3.9%) and postoperative chemotherapy. pT4 tumors, carcinomatosis, and non-anatomical resections were more common in colon cancer patients, whereas enterostomies (CC 1.3%, RC 67.5%, p 50%, and comorbidity >1 organ. Prognostic factors for limited postoperative survival were hepatic tumor load >50%, pT4 tumors, lymphatic spread, R1-2 resection, and lack of chemotherapy. Palliative resection is associated with a particularly unfavorable outcome in rectal cancer patients presenting with a locally advanced tumor (pT4, expected R2 resection) or an extensive comorbidity, and in all CRC patients who show a hepatic tumor load >50%. For such patients, surgery might be contraindicated unless the tumor is immediately life-threatening.

Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis

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Carnevale, Francisco C., E-mail: fcarnevale@uol.com.br [University of Sao Paulo Medical School, Interventional Radiology Unit (Brazil); Iscaife, Alexandre, E-mail: iscaifeboni@yahoo.com.br; Yoshinaga, Eduardo M., E-mail: dumuracca@ig.com.br [University of Sao Paulo Medical School, Division of Urology (Brazil); Moreira, Airton Mota, E-mail: motamoreira@gmail.com [University of Sao Paulo Medical School, Interventional Radiology Unit (Brazil); Antunes, Alberto A., E-mail: antunesuro@uol.com.br; Srougi, Miguel, E-mail: srougi@uol.com.br [University of Sao Paulo Medical School, Division of Urology (Brazil)

2016-01-15

PurposeTo compare clinical and urodynamic results of transurethral resection of the prostate (TURP) to original and PErFecTED prostate artery embolization (PAE) methods for benign prostatic hyperplasia.MethodsWe prospectively randomized 30 patients to receive TURP or original PAE (oPAE) and compared them to a cohort of patients treated by PErFecTED PAE, with a minimum of 1-year follow-up. Patients were assessed for urodynamic parameters, prostate volume, international prostate symptom score (IPSS), and quality of life (QoL).ResultsAll groups were comparable for all pre-treatment parameters except bladder contractility and peak urine flow rate (Q{sub max}), both of which were significantly better in the TURP group, and IIEF score, which was significantly higher among PErFecTED PAE patients than TURP patients. All groups experienced significant improvement in IPSS, QoL, prostate volume, and Q{sub max}. TURP and PErFecTED PAE both resulted in significantly lower IPSS than oPAE but were not significantly different from one another. TURP resulted in significantly higher Q{sub max} and significantly smaller prostate volume than either original or PErFecTED PAE but required spinal anesthesia and hospitalization. Two patients in the oPAE group with hypocontractile bladders experienced recurrence of symptoms and were treated with TURP. In the TURP group, urinary incontinence occurred in 4/15 patients (26.7 %), rupture of the prostatic capsule in 1/15 (6.7 %), retrograde ejaculation in all patients (100 %), and one patient was readmitted for temporary bladder irrigation due to hematuria.ConclusionsTURP and PAE are both safe and effective treatments. TURP and PErFecTED PAE yield similar symptom improvement, but TURP is associated with both better urodynamic results and more adverse events.

Quality of life assessment in patients treated with lower energy thermotherapy (Prostasoft 2.0): results of a randomized transurethral microwave thermotherapy versus sham study

NARCIS (Netherlands)

Francisca, E. A.; D'Ancona, F. C.; Hendriks, J. C.; Kiemeney, L. A.; Debruyne, F. M.; de la Rosette, J. J.

1997-01-01

We evaluated the impact of lower energy transurethral microwave thermotherapy on quality of life and quality of sexual function in patients with benign prostatic hyperplasia (BPH). A total of 50 patients with BPH were randomized to receive either lower energy transurethral microwave thermotherapy

Palliative sedation for intolerable suffering.

Science.gov (United States)

Maltoni, Marco; Scarpi, Emanuela; Nanni, Oriana

2014-07-01

The purpose of this review is to provide an update on palliative sedation in palliative and end-of-life care. Palliative sedation is the medical procedure used to deal with refractory symptoms in advanced cancer patients when all other specific approaches have failed. Palliative sedation, in the strictest sense of the term, is a proportionate (proportionate palliative sedation, PPS) and intrinsically variable procedure used on an individual basis to relieve refractory symptoms in terminally ill patients, without the intention of hastening death. Completely separate from any other end-of-life decision and not intended to hasten death, palliative sedation has been shown not to have a detrimental impact on survival. To maintain palliative sedation as a legitimate clinical procedure from any ethical or clinical point of view, it must be limited to the restricted area for which it was conceived, that is, relief from refractory suffering as deemed necessary by a patient and by an experienced palliative care team. In this way, there is no risk of associating palliative sedation with other end-of-life decisions. Close collaboration is needed between oncologists and palliative care physicians for this clinical procedure.

Factors influencing treatment results of definitive radiotherapy following transurethral surgery for muscle-invasive bladder cancer

International Nuclear Information System (INIS)

Abe, Tatsuyuki; Kanehira Chihiro

1999-01-01

To determine the prognostic factors influencing the outcome of bladder cancer patients treated with definitive radiotherapy following transurethral tumor resection (TURBT). From March 1977 through August 1991, 83 patients with muscle-invasive bladder cancer were treated with TURBT (as thoroughly as possible) and definitive radiotherapy (median total dose: 64 Gy, median fractional dose: 2 Gy). Cystectomy was performed when possible for the residual or recurrent invasive cancer following radiotherapy. The median follow-up period was 76 months. The overall survival (OS) and bladder-preserving survival (BPS) rates at 5 years were 38% and 28%, respectively. Univariate analysis indicated that depth of invasion (T2 vs T3), tumor diameter (<3 cm vs. ≥3 cm), and visible (R1) or not visible (R0) residual tumor after TURBT influenced both OS and BPS. In multivariate analysis, absence of visible residual tumor after TURBT was the only significant prognostic factor related to OS (p<0.001) and BPS (p=0.002). Five-year OS and BPS were 54% and 43% in T2-3R0 and 14% and 7% in T2-3R1, respectively. Absence of visible residual tumor after TURBT was significantly associated with better overall survival and bladder-preserving survival for muscle-invasive bladder cancer patients treated with definitive radiotherapy following TURBT. (author)

Palliative or Comfort Care

Science.gov (United States)

... is not under control Need help understanding your situation and coordinating care PALLIATIVE CARE Often a team of specialists provides palliative care. The team usually includes: Palliative care doctors and nurses Social workers and chaplains Pharmacists and nutritionists Counselors and others ...

Palliative Care

Science.gov (United States)

... for Patients and Families What Is Palliative Care? Definition Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to ...

The Attitudes of Indian Palliative-care Nurses and Physicians to Pain Control and Palliative Sedation.

Science.gov (United States)

Gielen, Joris; Gupta, Harmala; Rajvanshi, Ambika; Bhatnagar, Sushma; Mishra, Seema; Chaturvedi, Arvind K; den Branden, Stef Van; Broeckaert, Bert

2011-01-01

We wanted to assess Indian palliative-care nurses and physicians' attitudes toward pain control and palliative sedation. From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programs in New Delhi, using a semi-structured questionnaire, and following grounded-theory methodology (Glaser and Strauss). The interviewees did not consider administration of painkillers in large doses an ethical problem, provided the pain killers are properly titrated. Mild palliative sedation was considered acceptable. The interviewees disagreed whether palliative sedation can also be deep and continuous. Arguments mentioned against deep continuous palliative sedation were the conviction that it may cause unacceptable side effects, and impedes basic daily activities and social contacts. A few interviewees said that palliative sedation may hasten death. Due to fears and doubts regarding deep continuous palliative sedation, it may sometimes be too easily discarded as a treatment option for refractory symptoms.

[General practitioner and palliative sedation].

Science.gov (United States)

Schweitzer, Bart

2014-01-01

Recent publications in Dutch national newspapers on palliative sedation have raised concerns about its use in general practice. There is now evidence that there is no significant increase in the incidence of palliative sedation. Euthanasia requests were pending in 20.8% of the cases in which palliative sedation was performed, but the general practitioners could clearly justify why they made this choice. This is important because it indicates that they are aware of a sharp distinction between euthanasia and palliative sedation. Although the decision to perform palliative sedation was discussed with almost all cancer patients, patient involvement was less present in non-cancer conditions. This may be related to different disease trajectories, but it also indicates that attention should be devoted to earlier identification of patients in need of palliative care. The findings confirm that the practice of palliative sedation by general practitioners largely reflects the recommendations of the Dutch National Guideline on Palliative Sedation.

Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians

NARCIS (Netherlands)

Koper, I.; Heide, A.; Janssens, M.J.P.A.; Swart, S.; Perez, R.S.G.M.; Rietjens, J.A.C.

2014-01-01

Purpose: Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it

Pediatric Palliative Care at a Glance

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® ™ ® Pediatric Palliative Care at a Glance A child’s serious illness affects the entire family. Pediatric palliative (pal-lee-uh-tiv) care can support ... extra support, palliative care can help. What is pediatric palliative care? Pediatric palliative care is supportive care ...

The Attitudes of Indian Palliative-care Nurses and Physicians to Pain Control and Palliative Sedation

Science.gov (United States)

Gielen, Joris; Gupta, Harmala; Rajvanshi, Ambika; Bhatnagar, Sushma; Mishra, Seema; Chaturvedi, Arvind K; den Branden, Stef Van; Broeckaert, Bert

2011-01-01

Aim: We wanted to assess Indian palliative-care nurses and physicians’ attitudes toward pain control and palliative sedation. Materials and Methods: From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programs in New Delhi, using a semi-structured questionnaire, and following grounded-theory methodology (Glaser and Strauss). Results: The interviewees did not consider administration of painkillers in large doses an ethical problem, provided the pain killers are properly titrated. Mild palliative sedation was considered acceptable. The interviewees disagreed whether palliative sedation can also be deep and continuous. Arguments mentioned against deep continuous palliative sedation were the conviction that it may cause unacceptable side effects, and impedes basic daily activities and social contacts. A few interviewees said that palliative sedation may hasten death. Conclusion: Due to fears and doubts regarding deep continuous palliative sedation, it may sometimes be too easily discarded as a treatment option for refractory symptoms. PMID:21633619

Palliative Care Leadership Centers Are Key To The Diffusion Of Palliative Care Innovation.

Science.gov (United States)

Cassel, J Brian; Bowman, Brynn; Rogers, Maggie; Spragens, Lynn H; Meier, Diane E

2018-02-01

Between 2000 and 2015 the proportion of US hospitals with more than fifty beds that had palliative care programs tripled, from 25 percent to 75 percent. The rapid adoption of this high-value program, which is voluntary and runs counter to the dominant culture in US hospitals, was catalyzed by tens of millions of dollars in philanthropic support for innovation, dissemination, and professionalization in the palliative care field. We describe the dissemination strategies of the Center to Advance Palliative Care in the context of the principles of social entrepreneurship, and we provide an in-depth look at its hallmark training initiative, Palliative Care Leadership Centers. Over 1,240 hospital palliative care teams have trained at the Leadership Centers to date, with 80 percent of them instituting palliative care services within two years. We conclude with lessons learned about the role of purposeful technical assistance in promoting the rapid diffusion of high-value health care innovation.

Comparison of abdominoperineal resection and low anterior resection in lower and middle rectal cancer.

Science.gov (United States)

Omidvari, Shapour; Hamedi, Sayed Hasan; Mohammadianpanah, Mohammad; Razzaghi, Samira; Mosalaei, Ahmad; Ahmadloo, Niloofar; Ansari, Mansour; Pourahmad, Saeideh

2013-09-01

This study aimed to investigate local control and survival rates following abdominoperineal resection (APR) compared with low anterior resection (LAR) in lower and middle rectal cancer. In this retrospective study, 153 patients with newly histologically proven rectal adenocarcinoma located at low and middle third that were treated between 2004 and 2010 at a tertiary hospital. The tumors were pathologically staged according to the 7th edition of the American Joint Committee on Cancer (AJCC) staging system. Surgery was applied for 138 (90%) of the patients, of which 96 (70%) underwent LAR and 42 were (30%) treated with APR. Total mesorectal excision was performed for all patients. In addition, 125 patients (82%) received concurrent (neoadjuvant, adjuvant or palliative) pelvic chemoradiation, and 134 patients (88%) received neoadjuvant, adjuvant or concurrent chemotherapy. Patients' follow-up ranged from 4 to 156 (median 37) months. Of 153 patients, 89 were men and 64 were women with a median age of 57 years. One patient (0.7%) was stage 0, 15 (9.8%) stage I, 63 (41.2%) stage II, 51 (33.3%) stage III and 23 (15%) stage IV. There was a significant difference between LAR and APR in terms of tumor distance from anal verge, disease stage and combined modality therapy used. However, there was no significant difference regarding 5-year local control, disease free and overall survival rates between LAR and APR. LAR can provide comparable local control, disease free and overall survival rates compared with APR in eligible patients with lower and middle rectal cancer. Copyright © 2013. Production and hosting by Elsevier B.V.

Comparison of abdominoperineal resection and low anterior resection in lower and middle rectal cancer

International Nuclear Information System (INIS)

Omidvari, Sh.; Ahmadloo, N.; Ansari, M.; Hamedi, S.H.; Razzaghi, S.; Mohammadianpanah, M.; Mosalaei, A.; Pourahmad, S.

2013-01-01

Introduction: This study aimed to investigate local control and survival rates following abdominoperineal resection (APR) compared with low anterior resection (LAR) in lower and middle rectal cancer. Methods: In this retrospective study, 153 patients with newly histologically proven rectal adenocarcinoma located at low and middle third that were treated between 2004 and 2010 at a tertiary hospital. The tumors were pathologically staged according to the 7th edition of the American Joint Committee on Cancer (AJCC) staging system. Surgery was applied for 138 (90%) of the patients, of which 96 (70%) underwent LAR and 42 were (30%) treated with APR. Total meso rectal excision was performed for all patients. In addition, 125 patients (82%) received concurrent (neoadjuvant, adjuvant or palliative) pelvic chemo radiation, and 134 patients (88%) received neoadjuvant, adjuvant or concurrent chemotherapy. Patients follow-up ranged from 4 to 156 (median 37) months. Results: Of 153 patients, 89 were men and 64 were women with a median age of 57 years. One patient (o.7%) was stage 0, 15 (9.8%) stage I, 63 (41.2%) stage II, 51 (33.3%) stage III and 23 (15%) stage IV. There was a significant difference between LAR and APR in terms of tumor distance from anal verge, disease stage and combined modality therapy used. However, there was no significant difference regarding 5-year local control, disease free and overall survival rates between LAR and APR. Conclusion: LAR can provide comparable local control, disease free and overall survival rates compared with APR in eligible patients with lower and middle rectal cancer

192Ir Intraluminal brachytherapy for the prevention of urethral re-stricture

International Nuclear Information System (INIS)

Ma Changuo; Guo Hui; Du Chun; Yang Keqiang

2008-01-01

Objective: To evaluate the safety and efficacy of 192 Ir intraluminal brachytherapy for the prevention of urethral restricture after transurethral incision or transurethral resection of scar. Methods: From Mar. 2004 to Jun. 2006, 48 patients aging 18-81 years were treated by 192 Ir intraluminal brachytherapy. The length of stricture(0.5-5.5 cm) was ≤3.0 cm in 90% of the patients. The stricture was caused by trauma in 23 patients and prostate hyperplasia operation in 19 patients. The cause of remaining 6 patients was unclear. All patients were diagnosed by urethra photograph or endoscopy. Radiotherapy was the initial treatment in 26 patients and the second time treatment in 22. The irradiation dose was from 14 Gy to 18 Gy. Results: The median follow up was 10 months, and the total response rate was 98%. Only one patient recurred and received transurethral incision again. The uresis was fluency in 47 patients and the maximum flow rate was 13.9-36.4 (19.2 ± 10.3) ml/s. No secondary urethral bleeding or urethral cancer was observed. Conclusions: Being a safe and feasible treatment, 192 Ir intraluminal brachytherapy following transurethral incision or transurethral resection of scar can effectively prevent urethral re-stricture. (authors)

Adenocarcinoma of the pancreatic head: preoperative helical CT. Criteria of resectability

International Nuclear Information System (INIS)

Kozima, Shigeru; Szelagowski, Carlos; Tisserand, Guy L.; Ocampo, Carlos; Zandalazini, Hugo; Silva, Walter; Oria, Alejandro; Vidovic, Gustavo; Varas, Pablo

2001-01-01

Objective: The purpose of this study is to determine the accuracy of biphasic helical CT scanning in predicting resectability of adenocarcinoma of the head of the pancreas by staying tumor involvement of the portal and superior mesenteric veins. Material and methods: 46 patients with proven adenocarcinoma of the head of the pancreas who underwent curative or palliative surgery were studied with preoperative biphasic helical CT scanning. Tumor involvement of the portal and mesenteric veins was graduated on a 1-3 scale based on circumferential contiguity of the tumor vessel. Grade 1: without contact; grade 2: tumor involvement of less than 50% of the vessel; grade 3: tumor involvement of more than 50%. Results: The total number of vessels evaluated was 92. In our series the preoperative biphasic helical CT was accurate in 77% for resectability and unresectability. Conclusion: Our experience of staging in 3 grades with biphasic helical CT, vessel involvement the portal and superior mesenteric veins of adenocarcinoma of the head of the pancreas is highly specific for unresectable tumor in patients who were graded 2 and 3. (author)

Palliative Care.

Science.gov (United States)

Swetz, Keith M; Kamal, Arif H

2018-03-06

Palliative care prioritizes symptom management and quality of life throughout the course of serious illness. Regardless of whether care is inpatient or outpatient, primary or subspecialty, a solid understanding of the basics of effective communication, symptom management, and end-of-life care is crucial. This article reviews these essentials and provides an overview of current evidence to support patient-centered palliative care.

What is Pediatric Palliative Care?

Science.gov (United States)

... FAQ Handout for Patients and Families What Is Pediatric Palliative Care? Pediatric Palliative care (pronounced pal-lee-uh-tiv) is ... life for both the child and the family. Pediatric palliative care is provided by a team of ...

Baseline prostatic specific antigen does not predict the outcome of high energy transurethral microwave thermotherapy

NARCIS (Netherlands)

Laguna, M. Pilar; Kiemeney, Lambertus A.; Debruyne, Frans M. J.; de La Rosette, Jean J. M. C. H.

2002-01-01

PURPOSE: We assessed the prognostic value of baseline prostate specific antigen (PSA) for outcome after high energy transurethral thermotherapy in patients with lower urinary tract symptoms. MATERIAL AND METHODS: Data were collected prospectively in 404 consecutive patients treated with high energy

Comparison of urine and bladder or urethral mucosal biopsy culture obtained by transurethral cystoscopy in dogs with chronic lower urinary tract disease: 41 cases (2002 to 2011).

Science.gov (United States)

Sycamore, K F; Poorbaugh, V R; Pullin, S S; Ward, C R

2014-07-01

To compare aerobic bacterial culture of urine to cystoscopically obtained mucosal biopsies of the lower urinary tract in dogs. Retrospective review of case records from dogs that had transurethral cystoscopy at a veterinary teaching hospital between 2002 and 2011. Dogs that had culture results from cystocentesis obtained urine and transurethral cystoscopically obtained mucosal samples were included in the study. Pathogens identified were compared between sampling methods. Forty dogs underwent transurethral cystoscopy for lower urinary tract disease on 41 occasions. There was significant (P = 0 · 0003) agreement between urine and mucosal biopsy cultures. Both cultures were negative in 66% and positive in 17% of dogs. There was a 17% disagreement between the sampling methods. Although not statistically significant, more mucosal samples than urine cultures were positive for Escherichia coli. There was a good agreement between pathogen identification from urine and lower urinary tract mucosal cultures. These results do not support the utilisation of transurethral cystoscopy to obtain biopsy samples for culture in dogs with urinary tract infection and positive urine culture. Individual cases with possible chronic urinary tract infection and negative urine culture may benefit from transurethral cystoscopy to obtain biopsies for culture. © 2014 British Small Animal Veterinary Association.

Palliative care content on cancer center websites.

Science.gov (United States)

Vater, Laura B; Rebesco, Gina; Schenker, Yael; Torke, Alexia M; Gramelspacher, Gregory

2018-03-01

Professional guidelines recommend that palliative care begin early in advanced cancer management, yet integration of palliative and cancer care remains suboptimal. Cancer centers may miss opportunities to provide palliative care information online. In this study, we described the palliative care content on cancer center websites. We conducted a systematic content analysis of 62 National Cancer Institute- (NCI) designated cancer center websites. We assessed the content of center homepages and analyzed search results using the terms palliative care, supportive care, and hospice. For palliative and supportive care webpages, we assessed services offered and language used to describe care. Two researchers analyzed all websites using a standardized coding manual. Kappa values ranged from 0.78 to 1. NCI-designated cancer center homepages presented information about cancer-directed therapy (61%) more frequently than palliative care (5%). Ten percent of cancer centers had no webpage with palliative care information for patients. Among centers with information for patients, the majority (96%) defined palliative or supportive care, but 30% did not discuss delivery of palliative care alongside curative treatment, and 14% did not mention provision of care early in the disease process. Cancer center homepages rarely mention palliative care services. While the majority of centers have webpages with palliative care content, they sometimes omit information about early use of care. Improving accessibility of palliative care information and increasing emphasis on early provision of services may improve integration of palliative and cancer care.

European Association for Palliative Care (EAPC) framework for palliative sedation: an ethical discussion.

Science.gov (United States)

Juth, Niklas; Lindblad, Anna; Lynöe, Niels; Sjöstrand, Manne; Helgesson, Gert

2010-09-13

The aim of this paper is to critically discuss some of the ethically controversial issues regarding continuous deep palliative sedation at the end of life that are addressed in the EAPC recommended framework for the use of sedation in palliative care. We argue that the EAPC framework would have benefited from taking a clearer stand on the ethically controversial issues regarding intolerable suffering and refractory symptoms and regarding the relation between continuous deep palliative sedation at the end of life and euthanasia. It is unclear what constitutes refractory symptoms and what the relationship is between refractory symptoms and intolerable suffering, which in turn makes it difficult to determine what are necessary and sufficient criteria for palliative sedation at the end of life, and why. As regards the difference between palliative sedation at the end of life and so-called slow euthanasia, the rationale behind stressing the difference is insufficiently demonstrated, e.g. due to an overlooked ambiguity in the concept of intention. It is therefore unclear when palliative sedation at the end of life amounts to abuse and why. The EAPC framework would have benefited from taking a clearer stand on some ethically controversial issues regarding intolerable suffering and refractory symptoms and regarding the relation between continuous deep palliative sedation at the end of life and euthanasia. In this text, we identify and discuss these issues in the hope that an ensuing discussion will clarify the EAPC's standpoint.

European Association for Palliative Care (EAPC framework for palliative sedation: an ethical discussion

Directory of Open Access Journals (Sweden)

Juth Niklas

2010-09-01

Full Text Available Abstract Background The aim of this paper is to critically discuss some of the ethically controversial issues regarding continuous deep palliative sedation at the end of life that are addressed in the EAPC recommended framework for the use of sedation in palliative care. Discussion We argue that the EAPC framework would have benefited from taking a clearer stand on the ethically controversial issues regarding intolerable suffering and refractory symptoms and regarding the relation between continuous deep palliative sedation at the end of life and euthanasia. It is unclear what constitutes refractory symptoms and what the relationship is between refractory symptoms and intolerable suffering, which in turn makes it difficult to determine what are necessary and sufficient criteria for palliative sedation at the end of life, and why. As regards the difference between palliative sedation at the end of life and so-called slow euthanasia, the rationale behind stressing the difference is insufficiently demonstrated, e.g. due to an overlooked ambiguity in the concept of intention. It is therefore unclear when palliative sedation at the end of life amounts to abuse and why. Conclusions The EAPC framework would have benefited from taking a clearer stand on some ethically controversial issues regarding intolerable suffering and refractory symptoms and regarding the relation between continuous deep palliative sedation at the end of life and euthanasia. In this text, we identify and discuss these issues in the hope that an ensuing discussion will clarify the EAPC's standpoint.

Palliative Radiotherapy

International Nuclear Information System (INIS)

Salinas, J.

2003-01-01

Palliative care does not attempt to prolong survival but to the achieve the highest quality of life both for the patient and their family covering their physical, psychological, social and spiritual needs. Radiotherapy (RT), one of the most important therapeutic modalities, has a great significance in palliative medicine for cancer since it attempts to reduce as much as possible the acute reaction associated with the treatment for the patient. (Author)

[Palliative sedation at a university palliative care unit--a descriptive analysis].

Science.gov (United States)

Hopprich, A; Günther, L D; Laufenberg-Feldmann, R; Reinholz, U; Weber, M

2016-04-01

Palliative sedation (pS) is indicated in the presence of end-stage disease with treatment-refractory symptoms not tolerable for the patient. We investigated the practice of pS at a university palliative care unit. Before starting pS the following data were documented: indication and decision making, type of sedation, life expectancy evaluated by the physician using the palliative prognostic index. Over the time of pS communication skills, depth of sedation, relief in symptoms, substitution of fluid and nutrition and used medications were collected. During evaluation time 99 patients died. 34 patients received pS (34 %). All patients suffered from cancer. Indications for palliative sedation were: terminal restlessness (56 %), dyspnea (39 %), pain (32 %), psychological distress (15 %), agitated delir (9 %), vomiting (3 %) and bleeding (3 %) (multiple nominations possible). In 31 cases (91 %) nurses were included for decision making. In 33 cases continuous sedation were initiated immediately (median duration 27.5 hours). The most applied medication was midazolam (94 %), sometimes combined with neuroleptics (44 %) and propofol (15 %). 91 % of the patients additionally received opioids. Artificial fluid was substituted in two cases. Palliative sedation started in the median 27.5 hours before death. The final physician assessment revealed complete symptom relief in 12 patients (35 %), very strong symptom relief in 20 patients (59 %) and moderate symptom relief in 2 patients (6 %). pS was successfully used as last resort for relief of treatment-refractory symptoms in one third of decedents at the investigated palliative care unit. © Georg Thieme Verlag KG Stuttgart · New York.

Palliative sedation in nursing anesthesia.

Science.gov (United States)

Wolf, Michael T

2013-04-01

Palliative sedation is a technique of providing a sedative for end-of-life care to patients with intractable pain. The literature discusses the techniques and use of palliative sedation. Numerous articles have been written regarding the issues surrounding its use, but no literature has discussed the prescription or administration of palliative sedation by a nurse anesthetist. By understanding the concept and ethics involved in its use and providing nursing care that is theory based, the author argues that the involvement of nursing anesthesia is appropriate and within the scope of practice. Few other healthcare disciplines can provide the patient care and empirical knowledge that is imperative in the care of the dying patient. This article discusses the concept and ethics of palliative sedation and presents a case of providing palliative sedation to a terminally ill patient by an experienced nurse anesthetist. Palliative sedation should be understood, embraced, and utilized as an area of expertise suited for nursing anesthesia.

SINGLE-DOSE VERSUS 3-DAY PROPHYLAXIS WITH CIPROFLOXACIN IN TRANSURETHRAL SURGERY - A CLINICAL-TRIAL

NARCIS (Netherlands)

BIJL, W; JANKNEGT, RA

1993-01-01

in 235 patients who underwent transurethral surgery, perioperative oral ciprofloxacin prophylaxis was given as a single dose 500 mg versus a 3-day regimen. Out of 180 evaluable patients, 84 received a single dose and 96 received a 3-day course. In the single dose prophylaxis group there were 5

Intravenous chemotherapy combined with intravesical chemotherapy to treat T1G3 bladder urothelial carcinoma after transurethral resection of bladder tumor: results of a retrospective study

Directory of Open Access Journals (Sweden)

Zhang Y

2016-01-01

Full Text Available Yu Zhang,1,* Linguo Xie,1,* Tao Chen,1,* Wanqin Xie,2 Zhouliang Wu,1 Hao Xu,1 Chen Xing,1 Nan Sha,1 Zhonghua Shen,1 Yunkai Qie,1 Xiaoteng Liu,1 Hailong Hu,1 Changli Wu1 1Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, 2Key Laboratory of Genetics and Birth Health of Hunan Province, The Family Planning Research Institute of Hunan Province, Changsha, People’s Republic of China *These authors contributed equally to this work Objective: The management of stage 1 and grade 3 (T1G3 bladder cancer continues to be controversial. Although the transurethral resection of bladder tumor (TURBT followed by intravesical chemotherapy is a conservative strategy for treatment of T1G3 bladder cancer, a relatively high risk of tumor recurrence and progression remains regarding the therapy. This study aimed to compare the efficacy of intravenous chemotherapy combined with intravesical chemotherapy versus intravesical chemotherapy alone for T1G3 bladder cancer after TURBT surgery. Methods: We retrospectively reviewed the cases of 457 patients who were newly diagnosed with T1G3 bladder urothelial carcinoma between January 2009 and March 2014. After TURBT, 281 patients received intravesical chemotherapy alone, whereas 176 patients underwent intravesical chemotherapy in combination with intravenous chemotherapy. Tumor recurrence and progression were monitored periodically by urine cytology and cystoscopy in follow-up. Recurrence-free survival and progression-free survival of the two chemotherapy strategies following TURBT were analyzed. Univariable and multivariable Cox hazards analyses were performed to predict the prognostic factors for tumor recurrence and progression. Results: The tumor recurrence rate was 36.7% for patients who received intravesical chemotherapy alone after TURBT, compared with 19.9% for patients who received intravenous chemotherapy combined with intravesical chemotherapy after

Kenya Hospices and Palliative Care Association: integrating palliative care in public hospitals in Kenya.

Science.gov (United States)

Ali, Zipporah

2016-01-01

In Kenya, cancers as a disease group rank third as a cause of death after infectious and cardiovascular diseases. It is estimated that the annual incidence of cancer is about 37,000 new cases with an annual mortality of 28,000 cases (Kenya National Cancer Control Strategy 2010). The incidence of non-communicable diseases accounts for more than 50% of total hospital admissions and over 55% of hospital deaths (Kenya National Strategy for the Prevention and Control of Non Communicable Diseases 2015-2020). The prevalence of HIV is 6.8 (KIAS 2014). Most of these patients will benefit from palliative care services, hence the need to integrate palliative care services in the public healthcare system. The process of integrating palliative care in public hospitals involved advocacy both at the national level and at the institutional level, training of healthcare professionals, and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed. Eleven provincial hospitals across the country have now integrated palliative care services (Palliative Care Units) and are now centres of excellence. Over 220 healthcare providers have been trained, and approximately, over 30,000 patients have benefited from these services. Oral morphine is now available in the hospital palliative care units. As a success of the pilot project, Kenya Hospices and Palliative Care Association (KEHPCA) is now working with the Ministry of Health Kenya to integrate palliative care services in 30 other county hospitals across the country, thus ensuring more availability and access to more patients. Other developing countries can learn from Kenya's successful experience.

Palliative Care in Cancer

Science.gov (United States)

... care is usually provided by palliative care specialists, health care practitioners who have received special training and/or certification in palliative care. They provide holistic care to the patient and family or caregiver ...

Factors related to recurrence of bladder transitional cell carcinoma after transurethral resection of bladder tumor (TUR-BT)

International Nuclear Information System (INIS)

Nam, Ki Dong; Koo, Bong Sik; Yoon, Seong Kuk; Park, Byung Ho; Nam, Kyung Jin; Choi, Jong Cheol; Lee, Ki Nam; Lee, Young Il; Chung, Duck Hwan

1998-01-01

The purpose of this study is to evaluate factors related to the recurrence of TCC (transitional cell carcinoma) in the urinary bladder after transurethal resection of bladder tumor (TUR-BT). We retrospectively reviewed 54 patients in whom TCC (transitional cell carcinoma) after TUR-BT had been confirmed. Recurrence was evaluated by US, CT, cystoscopy and urine smear during the follow-up period of 6 months. The multiplicity, shape, size, and calcification of TCC, as revealed by radiologic studies, were evaluated retrospectively before TUR-BT. After TUR-BT, the histologic grade and pathologic stage of TCC were evaluated. Radiologically, multiple and/or sessile type TCC had a higher recurrence rate than the single and/or pedunculated type. Pathologically, when the grade and stage of bladder tumor were higher, recurrent rates were higher. (author). 17 refs., 3 tabs., 3 figs

Transurethral microwave thermotherapy: The gold standard for minimally invasive therapies for patients with benign prostatic hyperplasia?

NARCIS (Netherlands)

de La Rosette, Jean J. M. C. H.; Laguna, M. Pilar; Gravas, Stavros; de Wildt, Michel J. A. M.

2003-01-01

From all available minimally invasive methods for the treatment of symptomatic benign prostatic hyperplasia (BPH), transurethral microwave thermotherapy (TUMT) has gained a firm position as the most attractive option. Recent research has produced innovations in high-energy TUMT, including new

Danish Palliative Care Database

DEFF Research Database (Denmark)

Grønvold, Mogens; Adsersen, Mathilde; Hansen, Maiken Bang

2016-01-01

Aims: The aim of the Danish Palliative Care Database (DPD) is to monitor, evaluate, and improve the clinical quality of specialized palliative care (SPC) (ie, the activity of hospital-based palliative care teams/departments and hospices) in Denmark. Study population: The study population is all...... patients were registered in DPD during the 5 years 2010–2014. Of those registered, 96% had cancer. Conclusion: DPD is a national clinical quality database for SPC having clinically relevant variables and high data and patient completeness....

Factors Affecting the Improvement of the Initial Peak Urinary Flow Rate after Transurethral Resection of the Prostate or Photoselective Vaporization of the Prostate for Treating Benign Prostatic Hyperplasia

Directory of Open Access Journals (Sweden)

Hwa Sub Choi

2011-03-01

Full Text Available Purpose We evaluated the factors that affect the improvement of the initial peak flow rate after transurethral resection of the prostate (TURP or photoselective vaporization of the prostate (PVP for benign prostatic hyperplasia (BPH patients by using noninvasive tools. Methods One hundred and twenty seven BPH patients who had undergone TURP or PVP between January 2005 and May 2009 were evaluated. They were divided into 2 groups: the postoperative initial peak urinary flow rate (Qmax was less than 10 mL/sec (Group 1; n=37, TURP=11, PVP=26 and more than 10 mL/sec (Group 2; n=90, TURP=41, PVP=49. We confirmed the patients' preoperative check lists. The check list were the international prostate symptom score (IPSS, the quality of life score, a past history of acute urinary retention (AUR, body mass index and/or pyuria, the serum prostate-specific antigen (PSA level and the prostate volume, the prostate transitional zone volume and prostatic calcification. The initial Qmax was measured at the outpatient clinic one week after discharge. Results The improvement rate was not significant difference between the TURP group (78.8% and the PVP group (65.3%. The efficacy parameters were the IPSS-storage symptom score, the prostate volume, the PSA level and a past history of AUR. The IPSS-storage symptom scores of Group 1 (12.3±3.3 was higher than those of Group 2 (10.5±1.7. The prostate volume of Group 2 (42.3±16.6 g was bigger than that of Group 1 (36.6±7.8 g. The PSA level of Group 2 (3.8±2.6 ng/mL was higher than that of Group 1 (2.6±2.6 ng/mL. A past history of AUR in Group 1 (35.1% was more prevalent than that of Group 2 (15.6%. Conclusions The non-invasive factors affecting the initial Qmax after TURP or PVP were the IPSS-storage symptom score, the prostate volume and a past history of AUR. Accordingly, in patients who have a higher IPSS-storage symptom score, a smaller prostate volume and a history of AUR, there might be a detrimental effect on

Psychosocial issues in palliative care

African Journals Online (AJOL)

Repro

work of all involved in palliative care and understanding this will ... palliative care. The quality of life for patients and the manner of ... In palliative care, the creation of a safe space for families to talk is important. Communication ... family finds balance only with, and in your ... those relationships that are signifi- cant for the ...

Who to include in palliative care research? Consequences of different population definitions in palliative care epidemiology.

NARCIS (Netherlands)

Borgsteede, S.D.; Deliens, L.; Francke, A.L.; Stalman, W.A.B.; Willems, D.L.; Eijk, T.T.M. van; Wal, G. van der

2003-01-01

Object of the study: Epidemiological research into palliative care faces the problem of defining an adequate research population. Subjects in studies are alternately defined as patients receiving 'palliative care' , 'palliative treatment' or 'end of life care'. So far, it is not known how

Endoscopic extraperitoneal radical prostatectomy after radical resection of pT1-pT2 rectal cancer: a report of thirty cases.

Science.gov (United States)

Liu, Zhuo; Li, Dechuan; Chen, Yinbo

2017-01-01

Endoscopic extraperitoneal radical prostatectomy (EERPE) has gained popularity for the treatment of localized prostate cancer. However, prior complex lower abdominal or pelvic surgery can complicate subsequent EERPE. To date, there have been few reports on patients who underwent EERPE after radical resection of pT1-pT2 rectal cancer. To present our experience with EERPE in patients after radical resection of pT1-pT2 rectal carcinoma and introduce a simple and effective way to create an extraperitoneal working space. Thirty patients after radical resection of pT1-pT2 rectal carcinoma were treated with EERPE for biopsy-proven localized prostate cancer. Operation time, estimated blood loss, conversion to open surgery rate, transfusion rate and transurethral catheter time were recorded. Meanwhile, functional outcome (continence and potency) and oncological outcome were reviewed. The average operative time was 168 min. Mean blood loss was 195 ml. There was no need for conversion to open surgery or transfusion. The catheter was removed on postoperative day (POD) 7.8. After a mean follow-up time of 53.1 months, 3 patients had a prostate-specific antigen level relapse over 0.1 ng/ml. At the follow-up time, 26 patients were completely continent, and 4 needed 1-2 pads/day. Of the 6 patients who underwent neurovascular bundle preservation, none have experienced return of erections at the last follow-up time. Endoscopic extraperitoneal radical prostatectomy after radical resection of rectal carcinoma appears promising, with feasibility in experienced hands. The operative data, postoperative urinary incontinence and oncological outcomes appear encouraging, but the rate of erectile dysfunction seems to be disappointing.

Palliative Care: Delivering Comprehensive Oncology Nursing Care.

Science.gov (United States)

Dahlin, Constance

2015-11-01

To describe palliative care as part of comprehensive oncology nursing care. A review of the palliative care, oncology, and nursing literature over the past 10 years. Palliative care is mandated as part of comprehensive cancer care. A cancer diagnosis often results in distress in the physical, psychosocial, spiritual, and emotional domains of care. Oncology nurses are essential in providing palliative care from diagnosis to death to patients with cancer. They address the myriad aspects of cancer. With palliative care skills and knowledge, oncology nurses can provide quality cancer care. There are many opportunities in which oncology nurses can promote palliative care. Oncology nurses must obtain knowledge and skills in primary palliative care to provide comprehensive cancer care. Copyright © 2015 Elsevier Inc. All rights reserved.

Pediatric Palliative Care: A Personal Story

Medline Plus

Full Text Available ... The story demonstrates how palliative care can positively influence a patient's and family's experience with illness. Category ... Cancer: Palliative Care - Duration: 3:29. American Cancer Society 4,364 views 3:29 Perinatal Palliative Care - ...

A case grafted with polyglycolic acid sheets and fibrin glue for protection after temporary resection of a metastatic cervical skin tumor.

Science.gov (United States)

Matsuzuka, Takashi; Suzuki, Masahiro; Ikeda, Masakazu; Sato, Kaoru; Fujimoto, Junko; Hosaka, Rumi; Tanji, Yuko; Soeda, Shu; Murono, Shigeyuki

2018-04-01

The aim of this case report was to evaluate the usefulness of a grafting with polyglycolic acid sheet and a fibrin glue spray (PGA sheet grafting) after resection of a cervical skin tumor. A 61-year-old woman presented with left cervical skin tumor resistance to chemo-radiotherapy. She had been undergoing multimodal therapy for ovarian serous papillary adenocarcinoma for the previous six years. Although she had a poor general condition and a cervical skin tumor of 9cm in diameter, which was painful and easy bleeding, had offensive smell, she hoped to return to her job. Under local anesthesia, resection was performed, and PGA sheet grafting were used to shield the skin defect. After resection, she was relieved from pain, and could stay home without daily wound treatment. One and half months after resection, the wound was almost epithelialized. The PGA sheets consist of soft, elastic, nonwoven fabric made of PGA. In recent years, PGA sheet grafting has been widely used in the reconstruction and was chosen to shield the skin defect for this case. PGA sheet grafting after resection of cervical skin tumor can be an acceptable method for palliative care to relieve pain, bleeding, offensive smell, and ugly appearance. Copyright © 2017 Elsevier B.V. All rights reserved.

High energy transurethral thermotherapy in the treatment of benign prostatic hyperplasia: criteria to predict treatment outcome

NARCIS (Netherlands)

D'Ancona, F. C. H.; Francisca, E. A. E.; Hendriks, J. C. M.; Debruyne, F. M. J.; de la Rosette, J. J. M. C. H.

1999-01-01

In this study we analyzed the individual value of baseline parameters to predict the outcome of high energy transurethral microwave thermotherapy in the treatment of patients with lower urinary tract symptoms and benign prostatic hyperplasia. Two hundred and forty-seven patients with symptomatic

Endoscopic therapy of neoplasia related to Barrett's esophagus and endoscopic palliation of esophageal cancer.

Science.gov (United States)

Vignesh, Shivakumar; Hoffe, Sarah E; Meredith, Kenneth L; Shridhar, Ravi; Almhanna, Khaldoun; Gupta, Akshay K

2013-04-01

Barrett's esophagus (BE) is the most important identifiable risk factor for the progression to esophageal adenocarcinoma. This article reviews the current endoscopic therapies for BE with high-grade dysplasia and intramucosal cancer and briefly discusses the endoscopic palliation of advanced esophageal cancer. The diagnosis of low-grade or high-grade dysplasia (HGD) is based on several cytologic criteria that suggest neoplastic transformation of the columnar epithelium. HGD and carcinoma in situ are regarded as equivalent. The presence of dysplasia, particularly HGD, is also a risk factor for synchronous and metachronous adenocarcinoma. Dysplasia is a marker of adenocarcinoma and also has been shown to be the preinvasive lesion. Esophagectomy has been the conventional treatment for T1 esophageal cancer and, although debated, is an appropriate option in some patients with HGD due to the presence of occult cancer in over one-third of patients. Endoscopic ablative modalities (eg, photodynamic therapy and cryoablation) and endoscopic resection techniques (eg, endoscopic mucosal resection) have demonstrated promising results. The significant morbidity and mortality of esophagectomy makes endoscopic treatment an attractive potential option.

Palliative sedation in end-of-life care.

Science.gov (United States)

Maltoni, Marco; Scarpi, Emanuela; Nanni, Oriana

2013-07-01

The aim of this review was to present and comment on recent data published on palliative sedation in palliative and end-of-life care. Palliative sedation is a medical procedure used to deal with the refractory symptoms occurring in the advanced stages of cancer. It has clinical, nursing, relational and ethical implications, making it a highly sensitive issue. Over the last 12 months, a number of authors have published interesting new findings on different areas of palliative sedation, that is prevalence, indications, monitoring, duration and choice of drugs. In particular, a clear definition of palliative sedation and of its more pronounced form, deep continuous sedation (DCS), has emerged. It has been confirmed that, when performed in the correct way and with the right aims, palliative sedation does not have a detrimental impact on survival. Recent findings confirm that palliative sedation is an integral part of a medical palliative care approach and is needed in certain clinical situations. It is a legitimate clinical practice from any ethical point of view. While oncologists should have a basic knowledge of the procedure, its in depth study is a core competency for palliative care physicians.

A Review of Palliative Sedation.

Science.gov (United States)

Bobb, Barton

2016-09-01

Palliative sedation has become a standard practice to treat refractory symptoms at end-of-life. Dyspnea and delirium are the two most commonly treated symptoms. The medications used in palliative sedation are usually benzodiazepines, barbiturates, antipsychotics, and/or anesthetics. Some ethical considerations remain, especially surrounding the use of palliative sedation in psychological distress and existential suffering. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparison of Urinary Tract Infection Rates Associated with Transurethral Catheterization, Suprapubic Tube and Clean Intermittent Catheterization in the Postoperative Setting: A Network Meta-Analysis.

Science.gov (United States)

Han, Christopher S; Kim, Sinae; Radadia, Kushan D; Zhao, Philip T; Elsamra, Sammy E; Olweny, Ephrem O; Weiss, Robert E

2017-12-01

We performed a network meta-analysis of available randomized, controlled trials to elucidate the risks of urinary tract infection associated with transurethral catheterization, suprapubic tubes and intermittent catheterization in the postoperative setting. PubMed®, EMBASE® and Google Scholar™ searches were performed for eligible randomized, controlled trials from January 1980 to July 2015 that included patients who underwent transurethral catheterization, suprapubic tube placement or intermittent catheterization at the time of surgery and catheterization lasting up to postoperative day 30. The primary outcome of comparison was the urinary tract infection rate via a network meta-analysis with random effects model using the netmeta package in R 3.2 (www.r-project.org/). Included in analysis were 14 randomized, controlled trials in a total of 1,391 patients. Intermittent catheterization and suprapubic tubes showed no evidence of decreased urinary tract infection rates compared to transurethral catheterization. Suprapubic tubes and intermittent catheterization had comparable urinary tract infection rates (OR 0.903, 95% CI 0.479-2.555). On subgroup analysis of 10 randomized, controlled trials with available mean catheterization duration data in a total of 928 patients intermittent catheterization and suprapubic tube were associated with significantly decreased risk of urinary tract infection compared to transurethral catheterization when catheterization duration was greater than 5 days (OR 0.173, 95% CI 0.073-0.412 and OR 0.142, 95% CI 0.073-0.276, respectively). Transurethral catheterization is not associated with an increased urinary tract infection risk compared to suprapubic tubes and intermittent catheterization if catheterization duration is 5 days or less. However, a suprapubic tube or intermittent catheterization is associated with a lower rate of urinary tract infection if longer term catheterization is expected in the postoperative period. Copyright �

Outcome of Transurethral Plasmakinetic Vaporization for Benign Prostatic Hyperplasia

Directory of Open Access Journals (Sweden)

Magdy El-Tabey

2015-04-01

Full Text Available Purpose To assess the outcome of transurethral plasmakinetic vaporization (PKVP in the management of benign prostatic hyperplasia (BPH. Patients and methods From August 2010 to May 2012, 60 patients with obstructive LUTS due to BPH were included in the study. All patients were evaluated by International Prostate Symptom Score (IPSS, general examination, digital rectal examination, PSA, routine laboratory examinations, pelvi-abdominal ultrasound, trans-rectal ultrasound, and uroflowmetry. Patients with Qmax of 8 and a prostate volume of >40 mL underwent transurethral PKVP. Results Mean age of the patients was 66.8±4.5 years. The mean times of the operation, post-operative bladder irrigation, and post-operative catheterization were 63.8±13.9 minutes, 15.2±5.7 hours, and 23.9±5.2 hours, respectively. At 3 months of follow-up, there were significant reductions in the mean IPSS from 23.4±3.5 to 9.2±3.7 (P=0.4, mean PSA from 3.03±2.2 ng/mL to 1.2±1.04 ng/mL (P value=0.02, mean post voiding residual urine from 149.8±59.5 mL to 46.9±24.1 mL (P value <0.01, and mean prostate volume from 72.8±10.3 mL to 22.7±6.1 mL (P value <0.01. Also, there was a statistically significant increase in the mean Q max. from 8.7±2.4 mL/s to 19.5±3.5 mL/s (P value <0.01. Conclusion PKVP is an effective and safe treatment option in the management of symptomatic BPH.

Litteraturstudie: akupunktur og palliation

DEFF Research Database (Denmark)

Larsen, Anne Bolt

2013-01-01

af systematiske søgninger fra 2002-2012 i Pubmed, Cochrane, Cinahl og PsykInfo med søgeordene acupuncture and palliation, acupuncture and cancer, acupuncture and placebo, acupuncture and neurophysiology, acupuncture and palliation and nursing. RCT-forskning viser ikke overbevisende effekt af...

Future of palliative medicine

Directory of Open Access Journals (Sweden)

Sushma Bhatnagar

2015-01-01

Full Text Available A ′need-supply′ and ′requirement-distribution mismatch′ along with a continuingneed explosion are the biggest hurdles faced by palliative medicine today. It is the need of the hour to provide an unbiased, equitable and evidence-based palliative care to those in need irrespective of the diagnosis, prognosis, social and economic status or geographical location. Palliative care as a fundamental human right, ensuring provision throughout the illness spectrum, global as well as region-specific capacity building, uniform availability of essential drugs at an affordable price, a multidisciplinary team approachand caregiver-support are some of the achievable goals for the future. This supplanted with a strong political commitment, professional dedication and ′public-private partnerships′ are necessaryto tackle the existing hurdles and the exponentially increasing future need. For effectively going ahead it is of utmost importance to integrate palliative medicine into medical education, healthcare system and societal framework.

Palliative Sedation in Patients With Cancer.

Science.gov (United States)

Maltoni, Marco; Setola, Elisabetta

2015-10-01

Palliative sedation involves the use of sedative medication to relieve refractory symptoms in patients by reducing their level of consciousness. Although it is considered an acceptable clinical practice from most ethical points of view, palliative sedation is still a widely debated procedure and merits better understanding. The relevant medical literature pertaining to palliative sedation was analyzed and reviewed from various technical, relational, and bioethical perspectives. Proportionate palliative sedation is considered to be the most clinically appropriate modality for performing palliative sedation. However, guidelines must be followed to ensure that it is performed correctly. Benzodiazepines represent the first therapeutic option and careful monitoring of dosages is essential to avoid oversedation or undersedation. Proportionate palliative sedation is used to manage and relieve refractory symptoms in patients with cancer during their last days or hours of life. Evidence suggests that its use has no detrimental effect on survival. A different decision-making process is used to manage the withdrawal of hydration than the process used to determine whether proportionate palliative sedation is appropriate. Communication between patients, their relatives, and the health care staff is important during this medical intervention.

TUR and postoperative megavolt inrradiation in urinary bladder cancer

International Nuclear Information System (INIS)

Haschek, H.; Kaercher, K.H.; Studler, G.

1984-01-01

100 patients suffering from infiltrating urinary bladder cancer underwent transurethral resection followed by external megavolt irradiation (Betatron) are presented. The value of irradiation and its role in the actual therapeutic concept is discussed. The results of the combined therapy in infiltrative urinary bladder cancer using transurethral resection and megavolt irradiation are demonstrated according to stage (T 2 , T 3 ) and histological grading (G 2 , G 3 ). The 5-years survival rate amounts around 80%, in deep infiltrating bladder cancer about 50%. The morbidity of postoperative megavolt therapy was negligible. The results are superior to megavolt therapy alone and approach the one achieved by radical surgery; in addition the possibility of salvage-cystectomy remains open. (Author)

Radiochemotherapy With Cisplatin and 5-Fluorouracil After Transurethral Surgery in Patients With Bladder Cancer

International Nuclear Information System (INIS)

Weiss, Christian; Engehausen, Dirk G.; Krause, Frens S.; Papadopoulos, Thomas; Dunst, Juergen; Sauer, Rolf; Roedel, Claus

2007-01-01

Purpose: To give an update on the long-term outcome of an intensified protocol of combined radiochemotherapy (RCT) with 5-fluorouracil (5-FU) and cisplatin after initial transurethral resection of bladder tumor (TURBT) with selective organ preservation in bladder cancer. Methods and Materials: One hundred twelve patients with muscle-invading or high-risk T1 (G3, associated Tis, multifocality, diameter >5 cm) bladder cancer were enrolled in a protocol of TURBT followed by concurrent cisplatin (20 mg/m 2 /day as 30-min infusion) and 5-FU (600 mg/m 2 /day as 120-h continuous infusion), administered on Days 1-5 and 29-33 of radiotherapy. Response to treatment was evaluated by restaging TURBT 4-6 weeks after RCT. In case of invasive residual tumor or recurrence, salvage cystectomy was recommended. Results: Ninety-nine patients (88.4%) had no detectable tumor at restaging TURBT; 71 patients (72%) have been continuously free from local recurrence or distant metastasis. Superficial relapse occurred in 13 patients and muscle-invasive recurrence in 11 patients. Overall and cause-specific survival rates for all patients were 74% and 82% at 5 years, respectively. Of all surviving patients, 82% maintained their own bladder, 79% of whom were delighted or pleased with their urinary condition. Hematologic Grade 3/4 toxicity occurred in 23%/6% and Grade 3 diarrhea in 21% of patients. One patient required salvage cystectomy due to a shrinking bladder. Conclusion: Concurrent RCT with 5-FU/cisplatin has been associated with acceptable acute and long-term toxicity. Overall and cause-specific survival rates are encouraging. More than 80% of patients preserved their well-functioning bladder

Palliative care and palliative radiation therapy education in radiation oncology: A survey of US radiation oncology program directors.

Science.gov (United States)

Wei, Randy L; Colbert, Lauren E; Jones, Joshua; Racsa, Margarita; Kane, Gabrielle; Lutz, Steve; Vapiwala, Neha; Dharmarajan, Kavita V

The purpose of this study was to assess the state of palliative and supportive care (PSC) and palliative radiation therapy (RT) educational curricula in radiation oncology residency programs in the United States. We surveyed 87 program directors of radiation oncology residency programs in the United States between September 2015 and November 2015. An electronic survey on PSC and palliative RT education during residency was sent to all program directors. The survey consisted of questions on (1) perceived relevance of PSC and palliative RT to radiation oncology training, (2) formal didactic sessions on domains of PSC and palliative RT, (3) effective teaching formats for PSC and palliative RT education, and (4) perceived barriers for integrating PSC and palliative RT into the residency curriculum. A total of 57 responses (63%) was received. Most program directors agreed or strongly agreed that PSC (93%) and palliative radiation therapy (99%) are important competencies for radiation oncology residents and fellows; however, only 67% of residency programs had formal educational activities in principles and practice of PSC. Most programs had 1 or more hours of formal didactics on management of pain (67%), management of neuropathic pain (65%), and management of nausea and vomiting (63%); however, only 35%, 33%, and 30% had dedicated lectures on initial management of fatigue, assessing role of spirituality, and discussing advance care directives, respectively. Last, 85% of programs reported having a formal curriculum on palliative RT. Programs were most likely to have education on palliative radiation to brain, bone, and spine, but less likely on visceral, or skin, metastasis. Residency program directors believe that PSC and palliative RT are important competencies for their trainees and support increasing education in these 2 educational domains. Many residency programs have structured curricula on PSC and palliative radiation education, but room for improvement exists in

Palliative care in Romania

NARCIS (Netherlands)

Dumitrescu, Luminita

2006-01-01

Palliative care concentrates on supporting and helping people with an incurable disease and aims to improve patient’s quality of life by reducing or eliminating pain and other physical symptoms. Palliative care is a new phenomenon in Romania . PhD student Luminita Dumitrescu describes the

PALLIATIVE CARE IN SLOVENIA AND FUTURE CHALLENGES

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Urška Lunder

2003-11-01

Full Text Available Background. Palliative care in Slovene health care system isn’t developed. Comparison with other countries is not possible in many aspects. There is no complete or appropriately educated palliative care team in hospitals or in primary care. Palliative care departments in hospitals and nursing homes do not exist. Holistic palliative home care is offered only by Slovene association of hospice. The pressure on nursing homes and nursing service departments is getting stronger. Standards and norms for staff, for living conditions and medical equipment do not allow any more admittances of patients with the needs of high category of care in these institutions.Conclusions. Indirect indicators of level of palliative care (e.g. morphine consumption, palliative care departments, home care network, undergraduate education, specialisation and research put Slovenia at the bade of the Europe. Statistics predict aging of population and more patients are also living with consequences of progressive chronic diseases and cancer.In the new healthcare reform there is an opportunity for palliative care to get an equal place in healthcare system. With coordinated implementation of palliative care departments, consultant teams and mobile specialistic teams, palliative care could reach a better level of quality. At the same time, quality permanent education is essential.

Developing a costing framework for palliative care services.

Science.gov (United States)

Mosoiu, Daniela; Dumitrescu, Malina; Connor, Stephen R

2014-10-01

Palliative care services have been reported to be a less expensive alternative to traditional treatment; however, little is known about how to measure the cost of delivering quality palliative care. The purpose of this project was to develop a standardized method for measuring the cost of palliative care delivery that could potentially be replicated in multiple settings. The project was implemented in three stages. First, an interdisciplinary group of palliative care experts identified standards of quality palliative care delivery in the inpatient and home care services. Surveys were conducted of government agencies and palliative care providers to identify payment practices and budgets for palliative care services. In the second phase, unit costs were defined and a costing framework was designed to measure inpatient and home-based palliative care unit costs. The final phase was advocacy for inclusion of calculated costs into the national funding system. In this project, a reliable framework for determining the cost of inpatient and home-based palliative care services was developed. Inpatient palliative care cost in Romania was calculated at $96.58 per day. Home-based palliative care was calculated at $30.37 per visit, $723.60 per month, and $1367.71 per episode of care, which averaged 45 visits. A standardized methodology and framework for costing palliative care are presented. The framework allows a country or provider of care to substitute their own local costs to generate cost information relevant to the health-care system. In Romania, this allowed the palliative care provider community to advocate for a consistent payment system. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Diagnostic radiology in paediatric palliative care

International Nuclear Information System (INIS)

Patel, Preena; Koh, Michelle; Carr, Lucinda; McHugh, Kieran

2014-01-01

Palliative care is an expanding specialty within paediatrics, which has attracted little attention in the paediatric radiological literature. Paediatric patients under a palliative care team will have numerous radiological tests which we traditionally categorise under organ systems rather than under the umbrella of palliative medicine. The prevalence of children with life-limiting illness is significant. It has been estimated to be one per thousand, and this may be an underestimate. In this review, we will focus on our experience at one institution, where radiology has proven to be an invaluable partner to palliative care. We will discuss examples of conditions commonly referred to our palliative care team and delineate the crucial role of diagnostic radiology in determining treatment options. (orig.)

Diagnostic radiology in paediatric palliative care

Energy Technology Data Exchange (ETDEWEB)

Patel, Preena; Koh, Michelle; Carr, Lucinda; McHugh, Kieran [Great Ormond Street Hospital, Radiology Department, London (United Kingdom)

2014-01-15

Palliative care is an expanding specialty within paediatrics, which has attracted little attention in the paediatric radiological literature. Paediatric patients under a palliative care team will have numerous radiological tests which we traditionally categorise under organ systems rather than under the umbrella of palliative medicine. The prevalence of children with life-limiting illness is significant. It has been estimated to be one per thousand, and this may be an underestimate. In this review, we will focus on our experience at one institution, where radiology has proven to be an invaluable partner to palliative care. We will discuss examples of conditions commonly referred to our palliative care team and delineate the crucial role of diagnostic radiology in determining treatment options. (orig.)

The Attitudes of Indian Palliative-Care Nurses and Physicians toward Pain Control and Palliative Sedation

OpenAIRE

Gielen, Joris; Gupta, Harmala; Rajvanshi, Ambika; Bhatnagar, Sushma; Mishra, Seema; Chaturvedi, Arvind K.; Van den Branden, Stef; Broeckaert, Bert

2011-01-01

Aim: We wanted to assess Indian palliative-care nurses and physicians’ attitudes toward pain control and palliative sedation. Materials and Methods: From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programs in New Delhi, using a semi-structured questionnaire, and following grounded-theory methodology (Glaser and Strauss). Results: The interviewees did not consider administration of painkillers in large doses an ethical problem, ...

The attitudes of Indian palliative-care nurses and physicians to pain control and palliative sedation

OpenAIRE

Joris Gielen; Harmala Gupta; Ambika Rajvanshi; Sushma Bhatnagar; Seema Mishra; Arvind K Chaturvedi; Stef Van den Branden; Bert Broeckaert

2011-01-01

Aim: We wanted to assess Indian palliative-care nurses and physicians′ attitudes toward pain control and palliative sedation. Materials and Methods: From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programs in New Delhi, using a semi-structured questionnaire, and following grounded-theory methodology (Glaser and Strauss). Results: The interviewees did not consider administration of painkillers in large doses an ethical problem...

Comparison between transurethral ultrasound and conventional urethrography in male urethral stricture; Uretrosonografia. Comparacion con la uretrografia convenctional en la estenosis de uretra masculina

Energy Technology Data Exchange (ETDEWEB)

Fernandez, G. C.; Rivas, C.; Rivas, B.; Perez, M.; Peasqueira, D.; Tardaguila, F. [Hospital Povisa. Vigo. Pontevedra (Spain)

2001-07-01

To define the role of transurethral ultrasound in the study of male urethral structure. A prospective study was carried out in 19 consecutive patients with male urethral structure, diagnosed by means of conventional urethrography, who subsequently underwent transurethral ultrasound. The latter study consisted of the introduction of a Foley catheter (8 or 10 F) and gradual inflation of the balloon within the navicular fossa. Sterile saline solution was then slowly and continuously infused while the ultrasound was carried out by placing the transducer on the ventral aspect of the penis and in the perineal region to identify the different portions of the urethra. The location and extension of the structure were determined by both radiological techniques, and adjacent areas of fibrosis (spongiofibrosis) were detected by ultrasound. The results correlated with the pathological findings in 10 case. There was good agreement between the two techniques in the localization of the structure (kappa=0.81). However, there were statistically significant differences in the measurements of the extension (p=0.01). Transurethral ultrasound revealed areas of spongiofibrosis adjacent to the structure that presented a different echogenicity. The results of the measurement of their extension were not significantly different from those found in the pathological study. Transurethral ultrasound is more effective than conventional urethrography in the study of urethral structure since it permits the precise measurement and localization of the structure and the visualization of the zone of spongiofibrosis, a determining factor in surgical planning. (Author) 11 refs.

Pediatric Palliative Care Initiative in Cambodia

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Mahmut Yaşar Çeliker

2017-07-01

Full Text Available Cancer care with curative intent remains difficult to manage in many resource-limited settings such as Cambodia. Cambodia has a small workforce with limited financial and health-care resources resulting in delayed diagnoses and availability of limited therapeutic tools. Thus, palliative care becomes the primary form of care in most cases. Although palliative care is becoming an integral part of medical care in developed countries, this concept remains poorly understood and utilized in developing countries. Angkor Hospital for Children serves a relatively large pediatric population in northern Cambodia. According to the modern definition of palliative care, approximately two-thirds of the patients admitted to the hospital were deemed candidates to receive palliative care. In an effort to develop a pediatric palliative care team utilizing existing resources and intensive training, our focus group recruited already existing teams with different health-care expertise and other motivated members of the hospital. During this process, we have also formed a palliative care training team of local experts to maintain ongoing palliative care education. Feedback from patients and health-care providers confirmed the effectiveness of these efforts. In conclusion, palliative and sustainable care was offered effectively in a resource-limited setting with adequately trained and motivated local providers. In this article, the steps and systems used to overcome challenges in Cambodia are summarized in the hope that our experience urges governmental and non-governmental agencies to support similar initiatives.

Pediatric Palliative Care Initiative in Cambodia

Science.gov (United States)

Çeliker, Mahmut Yaşar; Pagnarith, Yos; Akao, Kazumi; Sophearin, Dim; Sorn, Sokchea

2017-01-01

Cancer care with curative intent remains difficult to manage in many resource-limited settings such as Cambodia. Cambodia has a small workforce with limited financial and health-care resources resulting in delayed diagnoses and availability of limited therapeutic tools. Thus, palliative care becomes the primary form of care in most cases. Although palliative care is becoming an integral part of medical care in developed countries, this concept remains poorly understood and utilized in developing countries. Angkor Hospital for Children serves a relatively large pediatric population in northern Cambodia. According to the modern definition of palliative care, approximately two-thirds of the patients admitted to the hospital were deemed candidates to receive palliative care. In an effort to develop a pediatric palliative care team utilizing existing resources and intensive training, our focus group recruited already existing teams with different health-care expertise and other motivated members of the hospital. During this process, we have also formed a palliative care training team of local experts to maintain ongoing palliative care education. Feedback from patients and health-care providers confirmed the effectiveness of these efforts. In conclusion, palliative and sustainable care was offered effectively in a resource-limited setting with adequately trained and motivated local providers. In this article, the steps and systems used to overcome challenges in Cambodia are summarized in the hope that our experience urges governmental and non-governmental agencies to support similar initiatives. PMID:28804708

Palliative sedation: not just normal medical practice. Ethical reflections on the Royal Dutch Medical Association's guideline on palliative sedation.

Science.gov (United States)

Janssens, Rien; van Delden, Johannes J M; Widdershoven, Guy A M

2012-11-01

The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline.

TRANSURETHRAL RADIOFREQUENCY HEATING OR THERMOTHERAPY FOR BENIGN PROSTATIC HYPERTROPHY - A PROSPECTIVE TRIAL ON 65 CONSECUTIVE CASES

NARCIS (Netherlands)

MEIER, AHP; WEIL, EHJ; VANDOORN, ESCV; VERHAEGH, GTCM; JANKNEGT, RA

1992-01-01

65 consecutive cases with symptomatic benign prostate hypertrophy were treated with transurethral radiowave thermotherapy (TURF) using the Thermex-II at a temperature of 44.5-degrees-C. We report uroflowmetry and symptom scores after a follow-up of 6 months. The mean age was 63 years, the mean

Urinary diversion in hypospadias repair: suprapubic cystostomy versus transurethral catheterization

International Nuclear Information System (INIS)

Qamar, S.A.; Pansota, M.S.; Rasool, M.; Ali, S.; Shahzad, M.

2013-01-01

Objective: To compare the results of suprapubic with transurethral urinary diversion in hypospadias repair. Data Source: Patients admitted to the Department of Urology and Renal Transplantation with distal or middle hypospadias. Design of Study: Randomized Controlled Trials. Setting: Department of Urology and Renal Transplantation, Quaid-I-Azam Medical College /Bahawal Victoria Hospital, Bahawalpur. Period: From June 2010 to December 2011. Materials and Methods: A total of sixty patients, 1 to 10 years of age with distal or middle hypospadias were included in the study. Patients with history of previous hypospadias repair were excluded. Patients were divided in two groups by using random numbers table, 30 patients in each group. Group I had suprapubic and Group II had transurethral urinary diversion. Tubularized Incised Plate urethroplasty and Mathieu's repair were commonly used techniques. Stent was kept for 7-14 days. Patient discharged from hospital at 72 hours post-operatively with urethral catheter or suprapubic cystostomy intact. Patients were followed for subsequent outcome. Follow up was initially fortnightly and then at 1 month intervals. Minimum follow up period was 3 months and maximum 18 months for these particular patients. Results: Only two patients of Group I had complications as compared to seven patients of Group II. Moreover, patient discomfort and voiding problems was more with group II than group I. Nursing care was easy in group I patients. Complication rate was significantly 10 where in group I as compared to group II. Conclusion: The overall complication rate and patient discomfort were significantly lower with suprapubic urinary diversion in hypospadias repair, which also had a better cosmetic outcome. (author)

Palliative sedation versus euthanasia: an ethical assessment.

Science.gov (United States)

ten Have, Henk; Welie, Jos V M

2014-01-01

The aim of this article was to review the ethical debate concerning palliative sedation. Although recent guidelines articulate the differences between palliative sedation and euthanasia, the ethical controversies remain. The dominant view is that euthanasia and palliative sedation are morally distinct practices. However, ambiguous moral experiences and considerable practice variation call this view into question. When heterogeneous sedative practices are all labeled as palliative sedation, there is the risk that palliative sedation is expanded to include practices that are actually intended to bring about the patients' death. This troublesome expansion is fostered by an expansive use of the concept of intention such that this decisive ethical concept is no longer restricted to signify the aim in guiding the action. In this article, it is argued that intention should be used in a restricted way. The significance of intention is related to other ethical parameters to demarcate the practice of palliative sedation: terminality, refractory symptoms, proportionality, and separation from other end-of-life decisions. These additional parameters, although not without ethical and practical problems, together formulate a framework to ethically distinguish a more narrowly defined practice of palliative sedation from practices that are tantamount to euthanasia. Finally, the article raises the question as to what impact palliative sedation might have on the practice of palliative care itself. The increasing interest in palliative sedation may reemphasize characteristics of health care that initially encouraged the emergence of palliative care in the first place: the focus on therapy rather than care, the physical dimension rather than the whole person, the individual rather than the community, and the primacy of intervention rather than receptiveness and presence. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Reporting of pediatric palliative care: A systematic review and quantitative analysis of research publications in palliative care journals

Directory of Open Access Journals (Sweden)

Senthil P Kumar

2011-01-01

Conclusions: The overall reporting rate for pediatric palliative care articles in palliative care journals was very low and there were no randomized clinical trials and systematic reviews found. The study findings indicate a lack of adequate evidence base for pediatric palliative care.

Palliative radiotherapy in developing countries

International Nuclear Information System (INIS)

Allen, B.J.

2010-01-01

Full text: The International Agency for Research on Cancer predicts that cancer incidence in developing countries will increase dramatically in the first two decades of this millennium. Already some 80% of cancer patients in developing countries present with incurable disease. [n many cases pain is a severe problem and palliation is needed to improve quality of life as well as extending survival. This paper will consider the physical and clinical aspects of palliative radiotherapy (PRT), choice of radiation modality, alternative approaches to imaging and therapy and cost-benefit considerations. The potential benefits of a dedicated palliative centre include lower cost and therefore more centres, enabling more patients access to regional palliative care. Whilst there is an obvious need for palliative radiotherapy, simple curative treatments could also be managed. C060 radiotherapy has important advantages in developing countries, because of the higher initial cost of a linear accelerator, as well as the need for reliable power supply and the level of skill required by linac technicians and physicists. The beam characteristics of both C060 units and low energy linacs are compared and both are found to be acceptable for palliation. The concept of telemedicine is also discussed, using mobile phones and internet communication to allow rural clinics to receive support from specialists based in the cities, to send images for remote diagnosis and remote dose planning for radiotherapy. (author)

Creation of minimum standard tool for palliative care in India and self-evaluation of palliative care programs using it

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M R Rajagopal

2014-01-01

Full Text Available Background: It is important to ensure that minimum standards for palliative care based on available resources are clearly defined and achieved. Aims: (1 Creation of minimum National Standards for Palliative Care for India. (2 Development of a tool for self-evaluation of palliative care organizations. (3 Evaluation of the tool in India. In 2006, Pallium India assembled a working group at the national level to develop minimum standards. The standards were to be evaluated by palliative care services in the country. Materials and Methods: The working group prepared a "standards" document, which had two parts - the first composed of eight "essential" components and the second, 22 "desirable" components. The working group sent the document to 86 hospice and palliative care providers nationwide, requesting them to self-evaluate their palliative care services based on the standards document, on a modified Likert scale. Results: Forty-nine (57% palliative care organizations responded, and their self-evaluation of services based on the standards tool was analyzed. The majority of the palliative care providers met most of the standards identified as essential by the working group. A variable percentage of organizations had satisfied the desirable components of the standards. Conclusions: We demonstrated that the "standards tool" could be applied effectively in practice for self-evaluation of quality of palliative care services.

Center to Advance Palliative Care palliative care clinical care and customer satisfaction metrics consensus recommendations.

Science.gov (United States)

Weissman, David E; Morrison, R Sean; Meier, Diane E

2010-02-01

Data collection and analysis are vital for strategic planning, quality improvement, and demonstration of palliative care program impact to hospital administrators, private funders and policymakers. Since 2000, the Center to Advance Palliative Care (CAPC) has provided technical assistance to hospitals, health systems and hospices working to start, sustain, and grow nonhospice palliative care programs. CAPC convened a consensus panel in 2008 to develop recommendations for specific clinical and customer metrics that programs should track. The panel agreed on four key domains of clinical metrics and two domains of customer metrics. Clinical metrics include: daily assessment of physical/psychological/spiritual symptoms by a symptom assessment tool; establishment of patient-centered goals of care; support to patient/family caregivers; and management of transitions across care sites. For customer metrics, consensus was reached on two domains that should be tracked to assess satisfaction: patient/family satisfaction, and referring clinician satisfaction. In an effort to ensure access to reliably high-quality palliative care data throughout the nation, hospital palliative care programs are encouraged to collect and report outcomes for each of the metric domains described here.

Community Palliative Care Nurses' Challenges and Coping Strategies on Delivering Home-Based Pediatric Palliative Care.

Science.gov (United States)

Chong, LeeAi; Abdullah, Adina

2017-03-01

The aim of this study was to explore the experience of community palliative care nurses providing home care to children. A qualitative study was conducted at the 3 community palliative care provider organizations in greater Kuala Lumpur from August to October 2014. Data were collected with semistructured interviews with 16 nurses who have provided care to children and was analyzed using thematic analysis. Two categories were identified: (1) challenges nurses faced and (2) coping strategies. The themes identified from the categories are (1) communication challenges, (2) inadequate training and knowledge, (3) personal suffering, (4) challenges of the system, (5) intrapersonal coping skills, (6) interpersonal coping strategies, and (7) systemic supports. These results reinforces the need for integration of pediatric palliative care teaching and communication skills training into all undergraduate health care programs. Provider organizational support to meet the specific needs of the nurses in the community can help retain them in their role. It will also be important to develop standards for current and new palliative care services to ensure delivery of quality pediatric palliative care.

The process of palliative sedation as viewed by physicians and nurses working in palliative care in Brazil.

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Spineli, Vívian Marina Calixto Damasceno; Kurashima, Andrea Yamaguchi; De Gutiérrez, Maria Gaby Rivero

2015-10-01

Our aim was to describe the process of palliative sedation from the point of view of physicians and nurses working in palliative care in Brazil. Ours was a descriptive study conducted between May and December of 2011, with purposeful snowball sampling of 32 physicians and 29 nurses working in facilities in Brazil that have adopted the practice of palliative care. The symptoms prioritized for an indication of palliative sedation were dyspnea, delirium, and pain. Some 65.6% of respondents believed that the survival time of a patient in the final phase was not a determining factor for the indication of this measure, and that the patient, family, and healthcare team should participate in the decision-making process. For 42.6% of these professionals, the opinion of the family was the main barrier to an indication of this therapy. The opinion of the physicians and nurses who participated in this study converged with the principal national and international guidelines on palliative sedation. However, even though it is a therapy that has been adopted in palliative care, it remains a controversial practice.

[Multiprofessional team working in palliative medicine].

Science.gov (United States)

Osaka, Iwao

2013-04-01

Now, more than ever, palliative medicine has been gaining recognition for its essential role in cancer treatment. Since its beginning, it has emphasized the importance of collaboration among multidisciplinary professionals, valuing a comprehensive and holistic philosophy, addressing a wide range of hopes and suffering that patients and families experience. There are three models (approaches) for the medical teams: multidisciplinary, interdisciplinary, and transdisciplinary. Palliative care teams often choose the interdisciplinary team model, and the teams in the palliative care units may often choose the transdisciplinary team model. Recently, accumulating research has shown the clinical benefits of the interdisciplinary/transdisciplinary approach in palliative care settings. Clarifying appropriate functions and ideal features of physicians in the health care team, and enforcing the suitable team approach will contribute to improve the quality of whole medical practice beyond the framework of "palliative medicine".

[Repeat hepatic resections].

Science.gov (United States)

Popescu, I; Ciurea, S; Braşoveanu, V; Pietrăreanu, D; Tulbure, D; Georgescu, S; Stănescu, D; Herlea, V

1998-01-01

Five cases of iterative liver resections are presented, out of a total of 150 hepatectomies performed between 1.01.1995-1.01.1998. The resections were carried out for recurrent adenoma (one case), cholangiocarcinoma (two cases), hepatocellular carcinoma (one case), colo-rectal cancer metastasis (one case). Only cases with at least one major hepatic resection were included. Re-resections were more difficult than the primary resection due, first of all, to the modified vascular anatomy. Intraoperative ultrasound permitted localization of intrahepatic recurrences. Iterative liver resection appears to be the best therapeutical choice for patients with recurrent liver tumors.

Continuous Palliative Sedation for Existential Distress? A Survey of Canadian Palliative Care Physicians' Views.

Science.gov (United States)

Voeuk, Anna; Nekolaichuk, Cheryl; Fainsinger, Robin; Huot, Ann

2017-01-01

Palliative sedation can be used for refractory symptoms during end-of-life care. However, continuous palliative sedation (CPS) for existential distress remains controversial due to difficulty determining when this distress is refractory. The aim was to determine the opinions and practices of Canadian palliative care physicians regarding CPS for existential distress. A survey focusing on experience and views regarding CPS for existential distress was sent to 322 members of the Canadian Society of Palliative Care Physicians. Eighty-one surveys returned (accessible target, 314), resulting in a response rate of 26%. One third (31%) of the respondents reported providing CPS for existential distress. On a 5-point Likert-type scale, 40% of participants disagreed, while 43% agreed that CPS could be used for existential distress alone. Differing opinions exist regarding this complex and potentially controversial issue, necessitating the education of health-care professionals and increased awareness within the general public.

[Austrian guideline for palliative sedation therapy (long version) : Results of a Delphi process of the Austrian Palliative Society (OPG)].

Science.gov (United States)

Weixler, Dietmar; Roider-Schur, Sophie; Likar, Rudolf; Bozzaro, Claudia; Daniczek, Thomas; Feichtner, Angelika; Gabl, Christoph; Hammerl-Ferrari, Bernhard; Kletecka-Pulker, Maria; Körtner, Ulrich H J; Kössler, Hilde; Meran, Johannes G; Miksovsky, Aurelia; Pusswald, Bettina; Wienerroither, Thomas; Watzke, Herbert

2017-02-01

Palliative sedation therapy (PST) is an important and ethically accepted therapy in the care of selected palliative care patients with otherwise unbearable suffering from refractory distress. PST is increasingly used in end-of-life care. Austria does not have a standardized ethical guideline for this exceptional practice near end of life, but there is evidence that practice varies throughout the country. The Austrian Palliative Society (OPG) nominated a multidisciplinary working group of 16 palliative care experts and ethicists who established the national guideline on the basis of recent review work with the aim to adhere to the Europeans Association of Palliative Care's (EAPC) framework on palliative sedation therapy respecting Austrians legal, structural and cultural background. Consensus was achieved by a four-step sequential Delphi process. The Delphi-process was strictly orientated to the recently published EUROIMPACT-sedation-study-checklist and to the AGREE-2-tool. Additionally national stakeholders participated in the reflection of the results. As a result of a rigorous consensus process the long version of the Austrian National Palliative Sedation Guideline contains 112 statements within eleven domains and is supplemented by a philosophers excursus on suffering. By establishing a national guideline for palliative sedation therapy using the Delphi technique for consensus and stakeholder involvement the Austrian Palliative Society aims to ensure nationwide good practice of palliative sedation therapy. Screening for the practicability and efficacy of this guideline will be a future task.

A role of multimodality bladder-preserving therapy in patients with muscle-invasive bladder cancer plus hydronephrosis with or without pelvic nodal involvement

Directory of Open Access Journals (Sweden)

Yun Chiang

2017-09-01

Conclusion: With trimodality treatment involving visually complete transurethral resection of bladder tumor, cisplatin-based induction chemotherapy, and CCRT, patients with unfavorable factors maintained satisfactory bladder preservation but not systemic control.

Advancing palliative care as a human right.

Science.gov (United States)

Gwyther, Liz; Brennan, Frank; Harding, Richard

2009-11-01

The international palliative care community has articulated a simple but challenging proposition that palliative care is an international human right. International human rights covenants and the discipline of palliative care have, as common themes, the inherent dignity of the individual and the principles of universality and nondiscrimination. However, when we consider the evidence for the effectiveness of palliative care, the lack of palliative care provision for those who may benefit from it is of grave concern. Three disciplines (palliative care, public health, and human rights) are now interacting with a growing resonance. The maturing of palliative care as a clinical specialty and academic discipline has coincided with the development of a public health approach to global and community-wide health problems. The care of the dying is a public health issue. Given that death is both inevitable and universal, the care of people with life-limiting illness stands equal to all other public health issues. The International Covenant on Economic, Social and Cultural Rights (ICESCR) includes the right to health care and General Comment 14 (paragraph 34) CESCR stipulates that "States are under the obligation to respect the right to health by, inter alia, refraining from denying or limiting equal access for all persons, ... to preventive, curative and palliative health services." However, these rights are seen to be aspirational-rights to be achieved progressively over time by each signatory nation to the maximum capacity of their available resources. Although a government may use insufficient resources as a justification for inadequacies of its response to palliative care and pain management, General Comment 14 set out "core obligations" and "obligations of comparable priority" in the provision of health care and placed the burden on governments to justify "that every effort has nevertheless been made to use all available resources at its disposal in order to satisfy, as

PALLIATIVE BRONCHOSCOPIC TREATMENT OF TUMOUR CENTRAL AIRWAYS STENOSIS

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Andrej Debeljak

2003-07-01

Full Text Available Background. This article presents our three year experience with bronchoscopic management of central bronchial tumours stenosis.Methods. In the years 2000, 2001, and 2002, 52 patients (43 men, 9 women, aged 62.3 ± 10.8 years with central airway obstruction because of primary or secondary malignant tumours in 47 cases (90% and benign diseases in 5 (10% were treated. Topical anaesthesia with Lidocaine in all 52 patients where flexible bronchoscopes Olympus were applied was used. Additionally, Fentanyl or Diprivane were used in 25 patients where rigid bronchoscopy (Storz was performed. Mechanical removal and electrocautery resection (Olympus were used for tumour resection. In 2 patients Polyflex stent (Rüsch was introduced into the trachea.Results. We treated 17 (33% tumours in the trachea, 14 (27% in the right, 15 (29% in the left main bronchi and 6 (11% in more peripheral bronchi. The combination of mechanical removal and electrocautery was applied in 32 (61%, mechanical removal alone in 4 (8% and electrocautery alone in 16 (31% of patients. Symptomatic relief was achieved in 41 (79% patients. In 47 patients with malignant tumours bronchoscopic intervention was applied during the first diagnostic procedure 28 times (60%, after additional surgery, radiotherapy or chemotherapy 14 times (30% and between additional therapeutic interventions 5 times (10%. The procedure had to be terminated in one patient due to hypoxemia. There was no immediate mortality.Conclusions. Mechanical desobstruction in combination with electrocautery through the flexible and/or rigid bronchoscopes and stent introduction in patients with central airways tumours are efficient and rather safe palliative procedures.

Rawlsian Justice and Palliative Care

DEFF Research Database (Denmark)

Knight, Carl; Albertsen, Andreas

2015-01-01

Palliative care serves both as an integrated part of treatment and as a last effort to care for those we cannot cure. The extent to which palliative care should be provided and our reasons for doing so have been curiously overlooked in the debate about distributive justice in health and healthcar...... to provide pain relief to those who need it as a supplement to treatment and, without justice-based reasons to provide palliative care to those whose opportunities cannot be restored. We conclude that this makes Daniels' framework much less attractive.......Palliative care serves both as an integrated part of treatment and as a last effort to care for those we cannot cure. The extent to which palliative care should be provided and our reasons for doing so have been curiously overlooked in the debate about distributive justice in health and healthcare....... We argue that one prominent approach, the Rawlsian approach developed by Norman Daniels, is unable to provide such reasons and such care. This is because of a central feature in Daniels' account, namely that care should be provided to restore people's opportunities. Daniels' view is both unable...

Danish Prostate Cancer Registry

DEFF Research Database (Denmark)

Helgstrand, J Thomas; Klemann, Nina; Røder, Martin Andreas

2016-01-01

of SNOMED codes were identified. A computer algorithm was developed to transcode SNOMED codes into an analyzable format including procedure (eg, biopsy, transurethral resection, etc), diagnosis, and date of diagnosis. For validation, ~55,000 pathological reports were manually reviewed. Prostate-specific...... antigen, vital status, causes of death, and tumor-node-metastasis classification were integrated from national registries. RESULTS: Of the 161,525 specimens from 113,801 males identified, 83,379 (51.6%) were sets of prostate biopsies, 56,118 (34.7%) were transurethral/transvesical resections......BACKGROUND: Systematized Nomenclature of Medicine (SNOMED) codes are computer-processable medical terms used to describe histopathological evaluations. SNOMED codes are not readily usable for analysis. We invented an algorithm that converts prostate SNOMED codes into an analyzable format. We...

[Laparoscopic liver resection: lessons learned after 132 resections].

Science.gov (United States)

Robles Campos, Ricardo; Marín Hernández, Caridad; Lopez-Conesa, Asunción; Olivares Ripoll, Vicente; Paredes Quiles, Miriam; Parrilla Paricio, Pascual

2013-10-01

After 20 years of experience in laparoscopic liver surgery there is still no clear definition of the best approach (totally laparoscopic [TLS] or hand-assisted [HAS]), the indications for surgery, position, instrumentation, immediate and long-term postoperative results, etc. To report our experience in laparoscopic liver resections (LLRs). Over a period of 10 years we performed 132 LLRs in 129 patients: 112 malignant tumours (90 hepatic metastases; 22 primary malignant tumours) and 20 benign lesions (18 benign tumours; 2 hydatid cysts). Twenty-eight cases received TLS and 104 had HAS. 6 right hepatectomies (2 as the second stage of a two-stage liver resection); 6 left hepatectomies; 9 resections of 3 segments; 42 resections of 2 segments; 64 resections of one segment; and 5 cases of local resections. There was no perioperative mortality, and morbidity was 3%. With TLS the resection was completed in 23/28 cases, whereas with HAS it was completed in all 104 cases. Transfusion: 4,5%; operating time: 150min; and mean length of stay: 3,5 days. The 1-, 3- and 5-year survival rates for the primary malignant tumours were 100, 86 and 62%, and for colorectal metastases 92, 82 and 52%, respectively. LLR via both TLS and HAS in selected cases are similar to the results of open surgery (similar 5-year morbidity, mortality and survival rates) but with the advantages of minimally invasive surgery. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

Extended Resection of Chest Wall Tumors with Reconstruction Using Poly Methyl Methacrylate-Mesh Prosthesis

International Nuclear Information System (INIS)

Abo Sedira, M.; Nassar, O.; Al-Ariny, A.

2003-01-01

irrigation and antibiotics was sufficient to keep infection under control. Prostheses were removed without functional respiratory disturbance. Follow-up was carried out for a mean period of 18 months (6-43). Ten patients (27%) suffered relapses including 4 cases (10.8%) with local chest wall recurrence and 6 (16.2%) with distant metastases. Actuarial two year relapse free survival rate was 65% and survival rate was better for primary chest tumors than secondary tumors (78.5% for primary tumors and 65.2% for chest wall lesions secondary to breast cancer). This type of reconstruction obviated the need for postoperative ventilatory support and/or tracheostomy for such a major chest wall resection. It enabled to resect large tumors with acceptable morbidity and mortality. Chest wall resection should be attempted aggressively in primary tumors. However, resection for secondary lesions should be selective and limited to palliation mainly

Palliative Care: Improving Nursing Knowledge, Attitudes, and Behaviors
.

Science.gov (United States)

Harden, Karen; Price, Deborah; Duffy, Elizabeth; Galunas, Laura; Rodgers, Cheryl

2017-10-01

Oncology nurses affect patient care at every point along the cancer journey. This creates the perfect opportunity to educate patients and caregivers about palliative care early and often throughout treatment. However, healthcare providers frequently do not have the knowledge and confidence to engage in meaningful conversations about palliative care.
. The specific aims were to improve oncology nurses' palliative care knowledge, attitudes, and behaviors by providing a palliative care nursing education program. An additional aim was to increase the number of conversations with patients and families about palliative care.
. This project had a pre-/post-test design to assess knowledge, attitudes, and behaviors at baseline and one month after implementation of an established education curriculum. The teaching strategy included one four-hour class for oncology RNs with topics about the definition of palliative care, pain and symptom management, and how to have palliative care conversations.
. Results showed a statistically significant difference after the educational intervention for knowledge, attitudes, and behaviors. The number of conversations with patients and caregivers about palliative and end-of-life care increased significantly.

ISSN 2073-9990 East Cent Afr J Surg

African Journals Online (AJOL)

transurethral resection of the prostate, and ureteroscopy + lithotripsy. Fifty-two ... nephropathy can be initially managed with nephrostomy, ureteric stent insertion, .... the patients were not fit for definitive surgery, radiotherapy or chemotherapy.

Mapping the scope of occupational therapy practice in palliative care: A European Association for Palliative Care cross-sectional survey.

Science.gov (United States)

Eva, Gail; Morgan, Deidre

2018-05-01

Occupational therapists play an integral role in the care of people with life-limiting illnesses. However, little is known about the scope of occupational therapy service provision in palliative care across Europe and factors influencing service delivery. This study aimed to map the scope of occupational therapy palliative care interventions across Europe and to explore occupational therapists' perceptions of opportunities and challenges when delivering and developing palliative care services. A 49-item online cross-sectional survey comprised of fixed and free text responses was securely hosted via the European Association for Palliative Care website. Survey design, content and recruitment processes were reviewed and formally approved by the European Association for Palliative Care Board of Directors. Descriptive statistics and thematic analysis were used to analyse data. Setting/respondents: Respondents were European occupational therapists whose caseload included palliative care recipients (full-time or part-time). In total, 237 valid responses were analysed. Findings demonstrated a consistency in occupational therapy practice in palliative care between European countries. Clinician time was prioritised towards indirect patient care, with limited involvement in service development, leadership and research. A need for undergraduate and postgraduate education was identified. Organisational expectations and understanding of the scope of the occupational therapy role constrain the delivery of services to support patients and carers. Further development of occupational therapy in palliative care, particularly capacity building in leadership and research activities, is warranted. There is a need for continuing education and awareness raising of the role of occupational therapy in palliative care.

Risk of Prostate Cancer after Trans Urethral Resection of BPH: A Cohort and Nested Case-Control Study

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Beatrice Melin

2011-11-01

Full Text Available Epidemiological and experimental evidence suggests that inflammation plays a role in both prostate cancer (PCa and benign prostate hyperplasia (BPH. This study evaluates the risk of PC after transurethral resection (TURP for BPH and estimates the PCa risk related to presence of inflammation in the resected material. The Pathology Department at the University Hospital of Umeå (Umeå, Sweden identified BPH cases (n = 7,901 that underwent TURP between 1982 and 1997. Using these pathological specimens, we compared the incidence of PCa in the cohort to the population and calculated the standardized incidence and mortality ratios (SIR and SMR. Inflammation, the androgen receptor (AR, and p53 were evaluated in a nested case-control study of 201 cases and controls. Inflammation was graded severe or mild-moderate. In the follow-up period after TURP, cases developed prostate cancer and the controls did not. After TURP, SIR for prostate cancer increased [1.26, CI 95% (1.17–1.35], whereas SMR decreased [0.59, CI 95% (0.47–0.73]. Presence of inflammation at the time of TURP did not differ between cases and controls nor were there differences in p53 or AR staining. The data suggest a small increased risk of PCa after TURP and decreased PCa mortality. Inflammation at the time of TURP is not associated with PCa risk in this material. The increased PCa risk may be attributed to increased surveillance and PSA screening.

Risk of Prostate Cancer after Trans Urethral Resection of BPH: A Cohort and Nested Case-Control Study

International Nuclear Information System (INIS)

Karlsson, Camilla T.; Wiklund, Fredrik; Grönberg, Henrik; Bergh, Anders; Melin, Beatrice

2011-01-01

Epidemiological and experimental evidence suggests that inflammation plays a role in both prostate cancer (PCa) and benign prostate hyperplasia (BPH). This study evaluates the risk of PC after transurethral resection (TURP) for BPH and estimates the PCa risk related to presence of inflammation in the resected material. The Pathology Department at the University Hospital of Umeå (Umeå, Sweden) identified BPH cases (n = 7,901) that underwent TURP between 1982 and 1997. Using these pathological specimens, we compared the incidence of PCa in the cohort to the population and calculated the standardized incidence and mortality ratios (SIR and SMR). Inflammation, the androgen receptor (AR), and p53 were evaluated in a nested case-control study of 201 cases and controls. Inflammation was graded severe or mild-moderate. In the follow-up period after TURP, cases developed prostate cancer and the controls did not. After TURP, SIR for prostate cancer increased [1.26, CI 95% (1.17–1.35) ], whereas SMR decreased [0.59, CI 95% (0.47–0.73) ]. Presence of inflammation at the time of TURP did not differ between cases and controls nor were there differences in p53 or AR staining. The data suggest a small increased risk of PCa after TURP and decreased PCa mortality. Inflammation at the time of TURP is not associated with PCa risk in this material. The increased PCa risk may be attributed to increased surveillance and PSA screening

Risk of Prostate Cancer after Trans Urethral Resection of BPH: A Cohort and Nested Case-Control Study

Energy Technology Data Exchange (ETDEWEB)

Karlsson, Camilla T., E-mail: Camilla.thellenberg@onkologi.umu.se [Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå (Sweden); Wiklund, Fredrik; Grönberg, Henrik [Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm SE-171 77 (Sweden); Bergh, Anders [Department of Medical Biosciences, Pathology, Umeå University, SE-901 87 Umeå (Sweden); Melin, Beatrice [Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå (Sweden)

2011-11-08

Epidemiological and experimental evidence suggests that inflammation plays a role in both prostate cancer (PCa) and benign prostate hyperplasia (BPH). This study evaluates the risk of PC after transurethral resection (TURP) for BPH and estimates the PCa risk related to presence of inflammation in the resected material. The Pathology Department at the University Hospital of Umeå (Umeå, Sweden) identified BPH cases (n = 7,901) that underwent TURP between 1982 and 1997. Using these pathological specimens, we compared the incidence of PCa in the cohort to the population and calculated the standardized incidence and mortality ratios (SIR and SMR). Inflammation, the androgen receptor (AR), and p53 were evaluated in a nested case-control study of 201 cases and controls. Inflammation was graded severe or mild-moderate. In the follow-up period after TURP, cases developed prostate cancer and the controls did not. After TURP, SIR for prostate cancer increased [1.26, CI 95% (1.17–1.35) ], whereas SMR decreased [0.59, CI 95% (0.47–0.73) ]. Presence of inflammation at the time of TURP did not differ between cases and controls nor were there differences in p53 or AR staining. The data suggest a small increased risk of PCa after TURP and decreased PCa mortality. Inflammation at the time of TURP is not associated with PCa risk in this material. The increased PCa risk may be attributed to increased surveillance and PSA screening.

Undergraduate curricula in palliative medicine: a systematic analysis based on the palliative education assessment tool.

LENUS (Irish Health Repository)

Schiessi, C

2013-01-01

By law in 2013, palliative medicine will be integrated into the undergraduate curriculum as part of a mandatory training program and examinations at German medical schools. For this reason a national curriculum in palliative medicine has to be developed.

When there are no good choices: illuminating the borderland between proportionate palliative sedation and palliative sedation to unconsciousness.

Science.gov (United States)

Reid, Thomas T; Demme, Richard A; Quill, Timothy E

2011-01-01

Despite state-of-the-art palliative care, some patients will require proportionate palliative sedation as a last-resort option to relieve intolerable suffering at the end of life. In this practice, progressively increasing amounts of sedation are provided until the target suffering is sufficiently relieved. Uncertainty and debate arise when this practice approaches palliative sedation to unconsciousness (PSU), especially when unconsciousness is specifically intended or when the target symptoms are more existential than physical. We constructed a case series designed to highlight some of the common approaches and challenges associated with PSU and the more aggressive end of the spectrum of proportionate palliative sedation as retrospectively identified by palliative care consultants over the past 5 years from a busy inpatient palliative care service at a tertiary medical center in Rochester (NY, USA). Ten cases were identified as challenging by the palliative care attendings, of which four were selected for presentation for illustrative purposes because they touched on central issues including loss of capacity, the role of existential suffering, the complexity of clinical intention, the role of an institutional policy and use of anesthetics as sedative agents. Two other cases were selected focusing on responses to two special situations: a request for PSU that was rejected; and anticipatory planning for total sedation in the future. Although relatively rare, PSU and more aggressive end-of-the-spectrum proportionate palliative sedation represent responses to some of the most challenging cases faced by palliative care clinicians. These complex cases clearly require open communication and collaboration among caregivers, patients and family. Knowing how to identify these circumstances, and how to approach these interventions of last resort are critical skills for practitioners who take care of patients at the end of life.

Palliation of Dysphagia in Carcinoma Esophagus

OpenAIRE

Ramakrishnaiah, Vishnu Prasad Nelamangala; Malage, Somanath; Sreenath, G.S.; Kotlapati, Sudhakar; Cyriac, Sunu

2016-01-01

Esophageal carcinoma has a special place in gastrointestinal carcinomas because it contains two main types, namely, squamous cell carcinoma and adenocarcinoma. Carcinoma esophagus patients require some form of palliation because of locally advanced stage or distant metastasis, where it cannot be subjected to curable treatment with surgery and chemoradiation. Many modalities of palliation of dysphagia are available, but the procedure with least morbidity, mortality, and long-term palliation of...

Therapeutic efficacy of narrow band imaging-assisted transurethral electrocoagulation for ulcer-type interstitial cystitis/painful bladder syndrome.

Science.gov (United States)

Kajiwara, Mitsuru; Inoue, Shougo; Kobayashi, Kanao; Ohara, Shinya; Teishima, Jun; Matsubara, Akio

2014-04-01

Narrow band imaging cystoscopy can increase the visualization and detection of Hunner's lesions. A single-center, prospective clinical trial was carried out aiming to show the effectiveness of narrow band imaging-assisted transurethral electrocoagulation for ulcer-type interstitial cystitis/painful bladder syndrome. A total of 23 patients (19 women and 4 men) diagnosed as having ulcer-type interstitial cystitis/painful bladder syndrome were included. All typical Hunner's lesions and suspected areas identified by narrow band imaging were electrocoagulated endoscopically after the biopsy of those lesions. Therapeutic efficacy was assessed prospectively by using visual analog scale score of pain, O'Leary-Sant's symptom index, O'Leary-Sant's problem index and overactive bladder symptom score. The mean follow-up period was 22 months. All patients (100%) experienced a substantial improvement in pain. The average visual analog scale pain scores significantly decreased from 7.3 preoperatively to 1.2 1 month postoperatively. A total of 21 patients (91.3%) who reported improvement had at least a 50% reduction in bladder pain, and five reported complete resolution. Daytime frequency was significantly decreased postoperatively. O'Leary-Sant's symptom index, O'Leary-Sant's problem index and overactive bladder symptom score were significantly decreased postoperatively. However, during the follow-up period, a total of six patients had recurrence, and repeat narrow band imaging-assisted transurethral electrocoagulation of the recurrent lesions was carried out for five of the six patients, with good response in relieving bladder pain. Our results showed that narrow band imaging-assisted transurethral electrocoagulation could be a valuable therapeutic alternative in patients with ulcer-type interstitial cystitis/painful bladder syndrome, with good efficacy and reduction of recurrence rate. © 2014 The Japanese Urological Association.

Palliative nursing care for children and adolescents with cancer

Directory of Open Access Journals (Sweden)

Gilmer MJ

2012-06-01

Full Text Available Terrah L Foster,1,2 Cynthia J Bell,1 Carey F McDonald,2 Joy S Harris,3 Mary Jo Gilmer,1,21Vanderbilt University School of Nursing, Nashville, 2Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, 3Vanderbilt University, Nashville, TN, USAAbstract: Pediatric palliative care aims to enhance life and decrease suffering of children and adolescents living with life-threatening conditions and their loved ones. Oncology nurses are instrumental in providing palliative care to pediatric oncology populations. This paper describes pediatric palliative care and provides an overview of literature related to the physical, psychological, social, and spiritual domains of palliative nursing care for children and adolescents with cancer. Nurses can provide optimal palliative care by accounting for children's understanding of death, encouraging early initiation of palliative care services, and improving utilization of pediatric palliative care in cancer settings. Specific roles of registered nurses and advanced practice nurses in pediatric palliative care will be addressed. Recommendations for future research are made to further advance the science of pediatric palliative care and decrease suffering for children and teens with cancer.Keywords: pediatric palliative care, pediatric cancer, oncology, child, suffering

Need for palliative care for neurological diseases.

Science.gov (United States)

Provinciali, Leandro; Carlini, Giulia; Tarquini, Daniela; Defanti, Carlo Alberto; Veronese, Simone; Pucci, Eugenio

2016-10-01

The new concept of palliative care supports the idea of palliation as an early approach to patients affected by disabling and life-limiting disease which focuses on the patient's quality of life along the entire course of disease. This model moves beyond the traditional concept of palliation as an approach restricted to the final stage of disease and widens the fields of intervention. There is a growing awareness of the importance of palliative care not only in oncological diseases but also in many other branches of medicine, and it appears particularly evident in the approach to many of the most frequent neurological diseases that are chronic, incurable and autonomy-impairing illnesses. The definition and implementation of palliative goals and procedures in neurology must take into account the specific features of these conditions in terms of the complexity and variability of symptoms, clinical course, disability and prognosis. The realization of an effective palliative approach to neurological diseases requires specific skills and expertise to adapt the concept of palliation to the peculiarities of these diseases; this approach should be realized through the cooperation of different services and the action of a multidisciplinary team in which the neurologist should play a central role to identify and face the patient's needs. In this view, it is paramount for the neurologist to be trained in these issues to promote the integration of palliative care in the care of neurological patients.

Radiotherapy for advanced carcinoma of the gallbladder

International Nuclear Information System (INIS)

Shimizu, Teppei; Tanaka, Yoshiaki; Iijima, Mitsuharu; Matsuda, Tadayoshi

1994-01-01

The results of radiotherapy in 37 patients who were treated for carcinoma of the gallbladder from April 1975 to April 1992 are presented. To analyze the treatment results, patients were divided into four groups depending on treatment modality: intraoperative radiotherapy (IORT) with surgical resection in 9 (resection group), IORT with palliative surgery in 5 (palliative surgery group), hyperthermo-chemo-radiotherapy for inoperable cases in 11 (HCR group), external irradiation for inoperable cases in 12 (ExRT alone group). Most of the patients in the resection group received ExRT. The HCR group showed better local response than the groups treated with palliative surgery and ExRT alone. The mean length of survival in the resection, palliative surgery, HCR and ExRT alone groups was 315 days, 144 days, 246 days and 74 days, respectively. Although no statistically significant difference in survival was observed between the resection and HCR groups, the relapse-free interval of the resection group was significantly longer than that of the other groups. The application of IORT for surgically resectable tumors contributed to improved prognosis and better quality of life. Although IORT for patients with unresectable tumors had little effect on survival, it was considered to play a palliative role in improving the quality of life. The HCR group had a significantly longer survival time and relapse-free interval than the palliative surgery and ExRT alone groups. In conclusion, the application of HCR for inoperable carcinoma of the gallbladder contributed to the improvement of prognosis and quality of life. (author)

External and intraoperative radiotherapy for resectable and unresectable pancreatic cancer: analysis of survival rates and complications

International Nuclear Information System (INIS)

Nishimura, Yasumasa; Hosotani, Ryo; Shibamoto, Yuta; Kokubo, Masaki; Kanamori, Shuichi; Sasai, Keisuke; Hiraoka, Masahiro; Ohshio, Gakuji; Imamura, Masayuki; Takahashi, Masaji; Abe, Mitsuyuki

1997-01-01

Purpose: Clinical results of intraoperative radiotherapy (IORT) and/or external beam radiotherapy (EBRT) for both resectable and unresectable pancreatic cancer were analyzed. Methods and Materials: Between 1980 and 1995, 332 patients with pancreatic cancer were treated with surgery and/or radiation therapy (RT). Of the 332 patients, 157 patients were treated with surgical resection of pancreatic tumor, and the remaining 175 patients had unresectable pancreatic tumors. Among the 157 patients with resected pancreatic cancer, 62 patients were not treated with RT, while 40 patients were treated with EBRT alone (mean RT dose; 46.3 Gy) and 55 patients with IORT (25.2 Gy) ± EBRT (44.0 Gy). On the other hand, among the 175 patients with unresectable pancreatic cancer, 58 patients were not treated with RT, 46 patients were treated with EBRT alone (39.2 Gy), and the remaining 71 patients with IORT (29.3 Gy) ± EBRT (41.2 Gy). Results: For 87 patients with curative resection, the median survival times (MSTs) of the no-RT, the EBRT, and the IORT ± EBRT groups were 10.4, 13.0, and 15.5 months, respectively, without significant difference. For 70 patients with non curative resection, the MSTs of the no-RT, the EBRT, and the IORT ± EBRT groups were 5.3, 8.7, and 6.5 months, respectively. When the EBRT and the IORT ± EBRT groups were combined, the survival rate was significantly higher than that of the no RT group for non curatively resected pancreatic cancers (log rank test; p = 0.028). The 2-year survival probability of the IORT ± EBRT group (16%) was higher than that of the EBRT group (0%). For unresectable pancreatic cancer, the MSTs of 52 patients without distant metastases were 6.7 months for palliative surgery alone, 7.6 months for EBRT alone, and 8.2 months for IORT ± EBRT. The survival curve of the IORT ± EBRT group was significantly better than that of the no-RT group (p 2 years) were obtained by IORT ± EBRT for non curatively resected and unresectable pancreatic

The effect of suprapubic catheterization versus transurethral catheterization after abdominal surgery on urinary tract infection: A randomized controlled trial

NARCIS (Netherlands)

Baan, A. H.; Vermeulen, H.; van der Meulen, J.; Bossuyt, P.; Olszyna, D.; Gouma, D. J.

2003-01-01

Background/Aim: Transurethral catheterization is generally associated with a higher incidence of urinary tract infections than suprapubic catheterization; however, suprapubic catheterization is associated with other disadvantages such as higher costs and a more difficult technique, and at the moment

Suboptimal palliative sedation in primary care: an exploration.

Science.gov (United States)

Pype, Peter; Teuwen, Inge; Mertens, Fien; Sercu, Marij; De Sutter, An

2018-02-01

Palliative sedation is a therapeutic option to control refractory symptoms in terminal palliative patients. This study aims at describing the occurrence and characteristics of suboptimal palliative sedations in primary care and at exploring the way general practitioners (GPs) experience suboptimal palliative sedation in their practice. We conducted a mixed methods study with a quantitative prospective survey in primary care and qualitative semi-structured interviews with GPs. The research team defined suboptimal palliative sedation as a time interval until deep sleep >1.5 h and/ or >2 awakenings after the start of the unconsciousness. Descriptive statistics were calculated on the quantitative data. Thematic analysis was used to analyse interview transcripts. We registered 63 palliative sedations in 1181 home deaths, 27 forms were completed. Eleven palliative sedations were suboptimal: eight due to the long time span until deep sleep; three due the number of unintended awakenings. GPs' interview analysis revealed two major themes: the shifting perception of failure and the burden of responsibility. Suboptimal palliative sedation occurs frequently in primary palliative care. Efficient communication towards family members is needed to prevent them from having unrealistic expectations and to prevent putting pressure on the GP to hasten the procedure. Sharing the burden of decision-making during the procedure with other health care professionals might diminish the heavy responsibility as perceived by GPs.

3D conformal MRI-controlled transurethral ultrasound prostate therapy: validation of numerical simulations and demonstration in tissue-mimicking gel phantoms.

Science.gov (United States)

Burtnyk, Mathieu; N'Djin, William Apoutou; Kobelevskiy, Ilya; Bronskill, Michael; Chopra, Rajiv

2010-11-21

MRI-controlled transurethral ultrasound therapy uses a linear array of transducer elements and active temperature feedback to create volumes of thermal coagulation shaped to predefined prostate geometries in 3D. The specific aims of this work were to demonstrate the accuracy and repeatability of producing large volumes of thermal coagulation (>10 cc) that conform to 3D human prostate shapes in a tissue-mimicking gel phantom, and to evaluate quantitatively the accuracy with which numerical simulations predict these 3D heating volumes under carefully controlled conditions. Eleven conformal 3D experiments were performed in a tissue-mimicking phantom within a 1.5T MR imager to obtain non-invasive temperature measurements during heating. Temperature feedback was used to control the rotation rate and ultrasound power of transurethral devices with up to five 3.5 × 5 mm active transducer elements. Heating patterns shaped to human prostate geometries were generated using devices operating at 4.7 or 8.0 MHz with surface acoustic intensities of up to 10 W cm(-2). Simulations were informed by transducer surface velocity measurements acquired with a scanning laser vibrometer enabling improved calculations of the acoustic pressure distribution in a gel phantom. Temperature dynamics were determined according to a FDTD solution to Pennes' BHTE. The 3D heating patterns produced in vitro were shaped very accurately to the prostate target volumes, within the spatial resolution of the MRI thermometry images. The volume of the treatment difference falling outside ± 1 mm of the target boundary was, on average, 0.21 cc or 1.5% of the prostate volume. The numerical simulations predicted the extent and shape of the coagulation boundary produced in gel to within (mean ± stdev [min, max]): 0.5 ± 0.4 [-1.0, 2.1] and -0.05 ± 0.4 [-1.2, 1.4] mm for the treatments at 4.7 and 8.0 MHz, respectively. The temperatures across all MRI thermometry images were predicted within -0.3 ± 1.6 °C and 0

OUTCOMES OF PALLIATIVE ORTHOPEDIC SURGERY FOR HIP DISLOCATION IN PATIENTS WITH CEREBRAL PALSY

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R. R. Bidyamshin

2016-01-01

Full Text Available Introduction. Hip dislocation is the key problem in patients with severe cerebral palsy (GMFCS IV, V older than 10 years that affects life quality and limits functional capabilities. In the present study the authors evaluated the efficiency of the proximal femoral resection arthroplasty (pfra and valgus proximal osteotomy of the femur (VPOF associated with femoral head resection for pain control, improvement of postural management, hygiene and verticalization with total weight-bearing and correction of accompanying orthopaedic deformities. Material and мethods. A retrospective study compared two groups of patients where PFRA (7 cases, 13 hips or VPOF (14 patients, 23 hips were performed. Level V of GMFCS was reported in 10 patients, and level IV of GMFCS – in 11 patients. The mean age at time of surgery was 15.3±3.9 y.o. PFRA was performed in 7 cases (13 joints and VPOF – in 14 patients (23 joints. Results. The authors did not observe any difference between the methods in respect of pain control, postural management, comfortable sitting position and hygiene. The verticalization with total weight-bearing and life quality improvement was achieved only after PVOF with femoral head resection associated with simultaneous knee and foot deformity correction performed according to the principles of Single-Event Multilevel Orthopedic Surgery. Conclusion. Both palliative methods allow to control pain syndrome, to achieve satisfactory postural management, comfortable sitting position and hygiene. But only VPOF with simultaneous knee and foot deformity correction provides possibility to verticalize the patient with weight-bearing using different orthopedic devices.

Palliative care and neurology: time for a paradigm shift.

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Boersma, Isabel; Miyasaki, Janis; Kutner, Jean; Kluger, Benzi

2014-08-05

Palliative care is an approach to the care of patients and families facing progressive and chronic illnesses that focuses on the relief of suffering due to physical symptoms, psychosocial issues, and spiritual distress. As neurologists care for patients with chronic, progressive, life-limiting, and disabling conditions, it is important that they understand and learn to apply the principles of palliative medicine. In this article, we aim to provide a practical starting point in palliative medicine for neurologists by answering the following questions: (1) What is palliative care and what is hospice care? (2) What are the palliative care needs of neurology patients? (3) Do neurology patients have unique palliative care needs? and (4) How can palliative care be integrated into neurology practice? We cover several fundamental palliative care skills relevant to neurologists, including communication of bad news, symptom assessment and management, advance care planning, caregiver assessment, and appropriate referral to hospice and other palliative care services. We conclude by suggesting areas for future educational efforts and research. © 2014 American Academy of Neurology.

Pediatric Palliative Care: A Personal Story

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Full Text Available ... The Keeney Family discuss pediatric palliative care - Duration: 12:07. Hospice of the Western Reserve 12,073 views 12:07 Perinatal Palliative Care - The Zimmer Family Story - ...

Biliopancreatic tumors: patient survival and quality of life after palliative treatment Tumores biliopancreáticos: supervivencia y calidad de vida de los pacientes sometidos a tratamiento paliativo

Directory of Open Access Journals (Sweden)

M. V. García Sánchez

2004-05-01

Full Text Available Objectives: to analyse survival and quality of life of patients with malignant obstructive jaundice after palliative treatment, comparing endoscopic stent insertion and palliative surgical (pallative resection and bypass surgical. Patients and method: eighty and seven patients were included in a trial. They were distributed to endoscopic stent (50 and palliative surgical (37. It analysed survival, quality of life and comfort index of jaundiced patients. The good quality of life was defined by absence of jaundice, pruritus and cholangitis after the initial treatment. Results: the median survival of the patients treated to endoscopic stent was 9,6 months whereas the patients to surgical treatment survived a median of 17 months. The time free of disease was 4 months in stented patients and 10,5 months in surgical patients. There was no significant difference in comfort index between the two groups (stented 34%, surgical 42,5%. Neither was there significant difference in survival and quality of life between palliative resection and bypass surgery. Conclusions: despite the survival and time free of disease being better in surgical patients, there was no significant difference in overall quality of life between the two groups. The survival and quality of life are the same after palliative resection as after bypass surgery, for this should not be performed routinely or to justify resection as a debulking procedure.Objetivos: analizar la supervivencia y calidad de vida de los pacientes con ictericia obstructiva maligna sometidos a tratamiento paliativo, y comparar estos resultados en función de la alternativa terapéutica aplicada (prótesis biliar endoscópica frente a cirugía paliativa de resección o derivación biliodigestiva. Pacientes y método: ochenta y siete pacientes fueron incluidos en el estudio que se distribuyeron en dos grupos: a 50 sometidos a drenaje biliar endoscópico con colocación de endoprótesis; y b 37 intervenidos quir

Defining palliative care in cystic fibrosis: A Delphi study.

Science.gov (United States)

Dellon, E P; Goggin, J; Chen, E; Sabadosa, K; Hempstead, S E; Faro, A; Homa, K

2018-05-01

The goal of palliative care is to improve quality of life for people with serious illness. We aimed to create a cystic fibrosis (CF)-specific definition of palliative care. A working group of 36 CF care providers, researchers, palliative care providers, quality improvement experts, individuals with CF, and CF caregivers completed a series of questionnaires to rate the value of each of 22 attributes of palliative care, rank top attributes to construct definitions of palliative care, and then rate proposed definitions. An average of 28 participants completed each of four questionnaires, with consistent distribution of stakeholder roles across questionnaires. Many identified overlaps in routine CF care and palliative care and highlighted the importance of a definition that feels relevant across the lifespan. Modified Delphi methodology was used to define palliative care in CF. The definition will be used as the foundation for development of CF-specific palliative care guidelines. Copyright © 2017 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Palliative sedation, not slow euthanasia: a prospective, longitudinal study of sedation in Flemish palliative care units.

Science.gov (United States)

Claessens, Patricia; Menten, Johan; Schotsmans, Paul; Broeckaert, Bert

2011-01-01

Palliative sedation remains a much debated and controversial issue. The limited literature on the topic often fails to answer ethical questions concerning this practice. The aim of this study was to describe the characteristics of patients who are being sedated for refractory symptoms in palliative care units (PCUs) from the time of admission until the day of death. A prospective, longitudinal, descriptive design was used to assess data in eight PCUs. The total sample consisted of 266 patients. Information on demographics, medication, food and fluid intake, decision making, level of consciousness, and symptom experience were gathered by nurses and researchers three times a week. If patients received palliative sedation, extra information was gathered. Of all included patients (n=266), 7.5% received palliative sedation. Sedation started, on average, 2.5 days before death and for half of these patients, the form of sedation changed over time. At the start of sedation, patients were in the end stage of their illness and needed total care. Patients were fully conscious and had very limited oral food or fluid intake. Only three patients received artificial fluids at the start of sedation. Patients reported, on average, two refractory symptoms, the most important ones being pain, fatigue, depression, drowsiness, and loss of feeling of well-being. In all cases, the patient gave consent to start palliative sedation because of increased suffering. This study revealed that palliative sedation is only administered in exceptional cases where refractory suffering is evident and for those patients who are close to the ends of their lives. Moreover, this study supports the argument that palliative sedation has no life-shortening effect. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Pediatric Palliative Care: A Personal Story

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Full Text Available ... and Legacy through Pediatric Palliative Care - Duration: 5:39. Northeast Ohio Medical University (NEOMED) 26,045 views 5:39 Little Stars – Paediatric Palliative Care – Charlie's Story - Duration: ...

Clinicodemographic aspect of resectable pancreatic cancer and prognostic factors for resectable cancer

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Chiang Kun-Chun

2012-05-01

Full Text Available Abstract Background Pancreatic adenocarcinoma (PCA is one of the most lethal human malignancies, and radical surgery remains the cornerstone of treatment. After resection, the overall 5-year survival rate is only 10% to 29%. At the time of presentation, however, about 40% of patients generally have distant metastases and another 40% are usually diagnosed with locally advanced cancers. The remaining 20% of patients are indicated for surgery on the basis of the results of preoperative imaging studies; however, about half of these patients are found to be unsuitable for resection during surgical exploration. In the current study, we aimed to determine the clinicopathological characteristics that predict the resectability of PCA and to conduct a prognostic analysis of PCA after resection to identify favorable survival factors. Methods We retrospectively reviewed the medical files of 688 patients (422 men and 266 women who had undergone surgery for histopathologically proven PCA in the Department of Surgery at Chang Gung Memorial Hospital in Taiwan from 1981 to 2006. We compared the clinical characteristics of patients who underwent resection and patients who did not undergo resection in order to identify the predictive factors for successful resectability of PCA, and we conducted prognostic analysis for PCA after resection. Results A carbohydrate antigen 19–9 (CA 19–9 level of 37 U/ml or greater and a tumor size of 3 cm or more independently predicted resectability of PCA. In terms of survival after resection, PCA patients with better nutritional status (measured as having an albumin level greater than 3.5 g/dl, radical resection, early tumor stage and better-differentiated tumors were associated with favorable survival. Conclusions Besides traditional imaging studies, preoperative CA 19–9 levels and tumor size can also be used to determine the resectability of PCA. Better nutritional status, curative resection, early tumor stage and well

Team networking in palliative care

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Odette Spruyt

2011-01-01

Full Text Available "If you want to travel quickly, go alone. But if you want to travel far, you must go together". African proverb. The delivery of palliative care is often complex and always involves a group of people, the team, gathered around the patient and those who are close to them. Effective communication and functional responsive systems of care are essential if palliative care is to be delivered in a timely and competent way. Creating and fostering an effective team is one of the greatest challenges for providers of palliative care. Teams are organic and can be life giving or life sapping for their members.

Team Networking in Palliative Care

Science.gov (United States)

Spruyt, Odette

2011-01-01

“If you want to travel quickly, go alone. But if you want to travel far, you must go together”. African proverb. The delivery of palliative care is often complex and always involves a group of people, the team, gathered around the patient and those who are close to them. Effective communication and functional responsive systems of care are essential if palliative care is to be delivered in a timely and competent way. Creating and fostering an effective team is one of the greatest challenges for providers of palliative care. Teams are organic and can be life giving or life sapping for their members. PMID:21811361

Strategies for Introducing Outpatient Specialty Palliative Care in Gynecologic Oncology.

Science.gov (United States)

Hay, Casey M; Lefkowits, Carolyn; Crowley-Matoka, Megan; Bakitas, Marie A; Clark, Leslie H; Duska, Linda R; Urban, Renata R; Creasy, Stephanie L; Schenker, Yael

2017-09-01

Concern that patients will react negatively to the idea of palliative care is cited as a barrier to timely referral. Strategies to successfully introduce specialty palliative care to patients have not been well described. We sought to understand how gynecologic oncologists introduce outpatient specialty palliative care. We conducted a national qualitative interview study at six geographically diverse academic cancer centers with well-established palliative care clinics between September 2015 and March 2016. Thirty-four gynecologic oncologists participated in semistructured telephone interviews focusing on attitudes, experiences, and practices related to outpatient palliative care. A multidisciplinary team analyzed interview transcripts using constant comparative methods to inductively develop and refine a coding framework. This analysis focuses on practices for introducing palliative care. Mean participant age was 47 years (standard deviation, 10 years). Mean interview length was 25 minutes (standard deviation, 7 minutes). Gynecologic oncologists described the following three main strategies for introducing outpatient specialty palliative care: focus initial palliative care referral on symptom management to dissociate palliative care from end-of-life care and facilitate early relationship building with palliative care clinicians; use a strong physician-patient relationship and patient trust to increase acceptance of referral; and explain and normalize palliative care referral to address negative associations and decrease patient fear of abandonment. These strategies aim to decrease negative patient associations and encourage acceptance of early referral to palliative care specialists. Gynecologic oncologists have developed strategies for introducing palliative care services to alleviate patient concerns. These strategies provide groundwork for developing system-wide best practice approaches to the presentation of palliative care referral.

Pain palliation therapy of bone metastases: palliative or curative?

International Nuclear Information System (INIS)

Fischer, M.

2007-01-01

In Germany the incidence of breast cancer is about 85 and of prostate cancer about 50 new patients per 100.000 inhabitants/year. In about 80% of prostate cancer patients and 75% of breast cancer patients bone metastases are observed in autopsy. Most of these patients develop severe pain syndrome from bone metastases reducing quality of life during life time. Therapy of these patients should aim at adding life to the years not years to their life. The knowledge of metastatic cell biology, of cell-cell interaction and of tumor-cell, tumor cell-skeleton interaction may modify the therapeutic procedure. Already in 1940/41, Pecher treated a patient suffering from painful prostate cancer bone metastases administering 296 MBq 89 Strontium chloride. About 10 years later, Friedell introduced 32 Phosphorus for treatment of bone metastases from breast cancer. Today in Europe 3 radionuclides are approved for pain palliation therapy as shown in Table.1. Indication: - pain palliation therapy of bone metastases from prostate cancer ( 89 Sr and 186 Re); - pain palliation of all osteoblastic metastases independent from primary tumors ( 153 Sm). Contraindications: - pregnant and lactating females - myelosuppression ( 3 granulocytes; 3 platelets); - impaired renal function (urea >12 mmol/l; creatinine > 150 mmol/l) - incontinence; - acute or chronic spinal cord compression and/or brain metastases causing neurological symptoms; - disseminated intravascular coagulopathy. The recommended activities per treatment are: 89 Sr 150 MBq, 186 Re 1.295 MBq, and 153 Sm 37 MBq/kg BW. Shortly (6-8 weeks) prior to radionuclide therapy for pain palliation no high dose chemotherapy or large field radiation therapy should be performed. Stopping unlabelled bisphosphonate therapy prior to pain palliation therapy is not necessary. This radionuclide therapy may be repeated several time, the interval between tracer administration depends on blood cell count rate. The recommended intervals are for 89 Sr

Proof of Concept for Systematic Collection of Optimal Molecular Quality Anatomically Oriented Normal Prostate from Diverse Age and Race Transplant Donors

National Research Council Canada - National Science Library

Bova, G. S

2006-01-01

... (transurethral resection of the prostate) samples from men with benign prostatic hyperplasia, cystoprostatectomy specimens in men with bladder cancer, or rarely from autopsy samples collected no sooner than 12-24 hours after death, although...

Failure of bacillus calmette guerin (bcg) therapy for the treatment of ...

African Journals Online (AJOL)

BCG) instillation following complete transurethral resection of superficial transitional cell carcinoma (TCC) of the urinary bladder at the Urology Department, Al-Azhar University, Cairo, Egypt. Patients and Methods: A prospective analysis of 160 ...

Radiotherapy in Palliative Cancer Care: Development and Implementation

International Nuclear Information System (INIS)

2012-01-01

It is estimated that in 2008 there were over 12 million new cancer diagnoses and 7 million cancer deaths worldwide. The World Health Organisation (WHO) predicts that cancer rates will increase from 10 million to 24 million in the next 50 years. More than half of cancer cases will be diagnosed in low income nations, where 80% or more of patients will have incurable disease at diagnosis. In situations where most patients are diagnosed with incurable disease or where curative treatment is logistically unavailable, as is the case in many low income countries, the allocation of limited health care resources should reflect a greater emphasis on palliative care. Ironically, access to palliative care is greater in health care systems with well developed infrastructures and facilities for prevention, early detection, and curative treatment of cancer. To provide comprehensive cancer care, a multidisciplinary approach is needed. This maximizes the available treatments and interventions, whilst ensuring a cost effective and ethically sound approach to the treatment of patients at each stage of the disease. Barriers to palliative care may result from its low prioritization in health care policy and education. The WHO expert committee on cancer pain and palliative care report of 1990 called for the integration of efforts directed at maintaining patient quality of life through all stages of cancer treatment. As a result supportive interventions aimed at improving quality of life are needed for patients undergoing both curative and palliative cancer treatment. The International Atomic Energy Agency is currently collaborating with the Open Society Institute to develop palliative care programmes in Eastern Europe, Africa and India, as well as supporting programmes in other regions of the world, through the International Palliative Care Initiative. OSI partners with the IAEA's Programme of Action for Cancer Therapy, the World Health Organization, the International Agency for Research

The African Palliative Care Association (APCA Atlas of Palliative Care Development in Africa: a comparative analysis

Directory of Open Access Journals (Sweden)

John Y Rhee

2018-03-01

Funding: Arnhold Institute of Global Health at the Icahn School of Medicine at Mount Sinai, the African Palliative Care Association, the International Association for Hospice and Palliative Care, and the Institute for Culture and Society at the University of Navarra.

At-home palliative sedation for end-of-life cancer patients.

Science.gov (United States)

Alonso-Babarro, Alberto; Varela-Cerdeira, Maria; Torres-Vigil, Isabel; Rodríguez-Barrientos, Ricardo; Bruera, Eduardo

2010-07-01

Using a decision-making and treatment checklist developed to facilitate the at-home palliative sedation process, we assessed the incidence and efficacy of palliative sedation for end-of-life cancer patients with intractable symptoms who died at home. We retrospectively reviewed the medical records of 370 patients who were followed by a palliative home care team. Twenty-nine of 245 patients (12%) who died at home had received palliative sedation. The mean age of the patients who received palliative sedation was 58 +/- 17 years, and the mean age of the patients who did not receive palliative sedation was 69 +/- 15 years (p = 0.002). No other differences were detected between patients who did or did not receive palliative sedation. The most common indications for palliative sedation were delirium (62%) and dyspnea (14%). Twenty-seven patients (93%) received midazolam for palliative sedation (final mean dose of 74 mg), and two (7%) received levomepromazine (final mean dose of 125 mg). The mean time between palliative sedation initiation and time of death was 2.6 days. In 13 of the cases (45%), the palliative sedation decision was made with the patient and his or her family members, and in another 13 patients (45%), the palliative sedation decision was made only with the patient's family members. We concluded that palliative sedation may be used safely and efficaciously to treat dying cancer patients with refractory symptoms at home.

Hope in palliative care: A longitudinal qualitative study

NARCIS (Netherlands)

Olsman, E.

2015-01-01

This thesis describes hope in palliative care patients, their family members and their healthcare professionals. An interpretative synthesis of the literature (chapter 2) and a metaphor analysis of semi-structured interviews with palliative care professionals (chapter 3) highlight palliative care

Assessment of a Statewide Palliative Care Team Training Course: COMFORT Communication for Palliative Care Teams.

Science.gov (United States)

Wittenberg, Elaine; Ferrell, Betty; Goldsmith, Joy; Ragan, Sandra L; Paice, Judith

2016-07-01

Despite increased attention to communication skill training in palliative care, few interprofessional training programs are available and little is known about the impact of such training. This study evaluated a communication curriculum offered to interprofessional palliative care teams and examined the longitudinal impact of training. Interprofessional, hospital-based palliative care team members were competitively selected to participate in a two-day training using the COMFORT(TM SM) (Communication, Orientation and options, Mindful communication, Family, Openings, Relating, Team) Communication for Palliative Care Teams curriculum. Course evaluation and goal assessment were tracked at six and nine months postcourse. Interprofessional palliative care team members (n = 58) representing 29 teams attended the course and completed course goals. Participants included 28 nurses, 16 social workers, 8 physicians, 5 chaplains, and one psychologist. Precourse surveys assessed participants' perceptions of institution-wide communication performance across the continuum of care and resources supporting optimum communication. Postcourse evaluations and goal progress monitoring were used to assess training effectiveness. Participants reported moderate communication effectiveness in their institutions, with the weakest areas being during bereavement and survivorship care. Mean response to course evaluation across all participants was greater than 4 (scale of 1 = low to 5 = high). Participants taught an additional 962 providers and initiated institution-wide training for clinical staff, new hires, and volunteers. Team member training improved communication processes and increased attention to communication with family caregivers. Barriers to goal implementation included a lack of institutional support as evidenced in clinical caseloads and an absence of leadership and funding. The COMFORT(TM SM) communication curriculum is effective palliative care communication

CEA monitoring of palliative treatment for colorectal carcinoma.

Science.gov (United States)

Herrera, M A; Chu, T M; Holyoke, E D; Mittelman, A

1977-01-01

Palliative treatment was applied to 131 cases of unresectable or palliatively resected colorectal carcinoma being monitored with serial CEA determinations. There were 84 instances of disease progression with 67 (80%) of them showing an increase in CEA above pretreatment levels or maintaining high levels, and 17 (20%) showing a fall when compared to pretreatment values or maintaining low initial values. There was a clear-cut regression of the disease in only 9 instances. In all 9, the CEA clearly dropped or maintained low valles throughout the period of regression. No patient in regression had a rise or maintained an elevated CEA level. These changes in CEA followed closely the clinical response of our patient to the use of a particular agent, although for the Nitrosourea compounds there may be a tendency to lower the CEA regardless of the patient's tumor response to the drug. This could be due to the fact that the Nitrosoureas produce a diffuse block of cellular activity, both at the nucleous and cytoplasm; while other compounds act as alkylating agents or by inhibition of enzymes involved in the metabolism of nucleic acids (i.e., 5-FU inhibiting thymidylate synthetase). In general, longer survival was found in those patients who had initially lower levels of CEA as compared to those with high initial levels. The patients with a favorable CEA response to the treatment (falling CEA or maintained low value), even in many who did not show a clinical response had a longer survival than the group with rising or stable high levels. The main value in CEA monitoring of patients resides in its correlation with the amount of disease present and then its ability to detect progression of tumor mass which is not clinically measurable. PMID:64132

Transurethral laser therapy of tumours of the bladder

International Nuclear Information System (INIS)

Noeske, H.D.; Rothauge, C.F.; Kraushaar, J.

1979-01-01

Surgical treatment of tumours of the bladder is still not generally accepted, and its results are unsatisfactory. To ameliorate this situation, the new energy source of laser is now being tested in transurethral treatment. There are several groups of scientists who study the use of lasers suited for human medicine: CO 2 laser (Tel Aviv), YAG neodymium laser (Munich), and argon laser (Giessen). In the urological university hospital at Giessen, where a human bladder carcinoma received laser treatment for the first time in the world in 1976, 45 argon laser operations on 38 patients are investigated. There were 37 bladder tumours of different stages and one haemangioma. Laser monotherapy was applied in 11 cases. The bulk of the cases, however, was treated by combined electro-laser-surgical treatment where the tumour bed and its immediate neighbourhood were irradiated after TUR. The results do not give a satisfactory answer as to the therapeutic value of laser. Advantages over TUR will probably be purely technical. (orig.) [de

Commissioning of specialist palliative care services in England.

Science.gov (United States)

Lancaster, Harriet; Finlay, Ilora; Downman, Maxwell; Dumas, James

2018-03-01

Some failures in end-of-life care have been attributed to inconsistent provision of palliative care across England. We aimed to explore the variation in commissioning of services by Clinical Commissioning Groups (CCGs) using a data collection exercise. We sent a Freedom of Information request in the form of an open questionnaire to all 209 CCGs in England to assess their commissioning of palliative and end-of-life care services, mainly focused on the provision of specialist palliative care services. 29 CCGs provided information about the number of patients with some form of palliative care needs in their population. For specialist palliative care services, CCGs allocated budgets ranging from £51.83 to £2329.19 per patient per annum. 163 CCGs (77.90%) currently commission 7-day admission to their specialist palliative care beds. 82.84% of CCGs commission 7-day specialist palliative care services in patients' own homes and out-of-hours services rely heavily on hospice provision. 64 CCGs (31.37%) commission pain control teams, the majority of whom only operate in regular working hours. 68.14% of CCGs reported commissioning palliative care education of any sort for healthcare professionals and 44.85% of CCGs had no plans to update or review their palliative care services. The most important finding from this exercise is that the information CCGs hold about their population and services is not standardised. However, information based on data that are more objective, for example, population and total budget for palliative care, demonstrate wide variations in commissioning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Palliative care in Africa: a global challenge.

Science.gov (United States)

Ntizimira, Christian R; Nkurikiyimfura, Jean Luc; Mukeshimana, Olive; Ngizwenayo, Scholastique; Mukasahaha, Diane; Clancy, Clare

2014-01-01

We are often asked what challenges Rwanda has faced in the development of palliative care and its integration into the healthcare system. In the past, patients have been barred from accessing strong analgesics to treat moderate to severe pain, but thanks to health initiatives, this is slowly changing. Rwanda is an example of a country where only a few years ago, access to morphine was almost impossible. Albert Einsten said 'in the middle of difficulty lies opportunity' and this sentiment could not be more relevant to the development of palliative care programmes. Through advocacy, policy, and staunch commitment to compassion, Rwandan healthcare workers are proving how palliative care can be successfully integrated into a healthcare system. As a global healthcare community, we should be asking what opportunities exist to do this across the African continent. Champions of palliative care have a chance to forge lasting collaborations between international experts and African healthcare workers. This global network could not only advocate for palliative care programmes but it would also help to create a culture where palliative care is viewed as a necessary part of all healthcare systems.

Pediatric Palliative Care: A Personal Story

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Full Text Available ... report inappropriate content. Sign in Transcript Add translations 4,609 views Like this video? Sign in to ... Palliative Care - Duration: 3:29. American Cancer Society 4,363 views 3:29 Pediatric Palliative Care and ...

Pediatric Palliative Care: A Personal Story

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Full Text Available ... it free Find out why Close Pediatric Palliative Care: A Personal Story NINRnews Loading... Unsubscribe from NINRnews? ... and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience ...

Results of high-energy transurethral microwave thermotherapy in patients categorized according to the American Society of Anesthesiologists operative risk classification

NARCIS (Netherlands)

D'Ancona, F. C.; van der Bij, A. K.; Francisca, E. A.; Kho, H.; Debruyne, F. M.; Kiemeney, L. A.; de la Rosette, J. J.

1999-01-01

To evaluate the relation between the American Society of Anesthesiologists (ASA) classification and response to transurethral microwave thermotherapy (TUMT) in patients with lower urinary tract symptoms and benign prostatic hyperplasia (BPH). Two hundred forty-seven patients with symptomatic BPH

A randomised, multicentre clinical trial of specialised palliative care plus standard treatment versus standard treatment alone for cancer patients with palliative care needs: the Danish palliative care trial (DanPaCT) protocol

DEFF Research Database (Denmark)

Johnsen, Anna Thit; Damkier, Anette; Vejlgaard, Tove Bahn

2013-01-01

Advanced cancer patients experience considerable symptoms, problems, and needs. Early referral of these patients to specialised palliative care (SPC) could improve their symptoms and problems.The Danish Palliative Care Trial (DanPaCT) investigates whether patients with metastatic cancer, who report...... palliative needs in a screening, will benefit from being referred to 'early SPC'....

Can elearning be used to teach palliative care? - medical students' acceptance, knowledge, and self-estimation of competence in palliative care after elearning.

Science.gov (United States)

Schulz-Quach, Christian; Wenzel-Meyburg, Ursula; Fetz, Katharina

2018-04-27

Undergraduate palliative care education (UPCE) was mandatorily incorporated in medical education in Germany in 2009. Implementation of the new cross-sectional examination subject of palliative care (QB13) continues to be a major challenge for medical schools. It is clear that there is a need among students for more UPCE. On the other hand, there is a lack of teaching resources and patient availabilities for the practical lessons. Digital media and elearning might be one solution to this problem. The primary objective of this study is to evaluate the elearning course Palliative Care Basics, with regard to students' acceptance of this teaching method and their performance in the written examination on the topic of palliative care. In addition, students' self-estimation in competence in palliative care was assessed. To investigate students' acceptance of the elearning course Palliative Care Basics, we conducted a cross-sectional study that is appropriate for proof-of-concept evaluation. The sample consisted of three cohorts of medical students of Heinrich Heine University Dusseldorf (N = 670). The acceptance of the elearning approach was investigated by means of the standard evaluation of Heinrich Heine University. The effect of elearning on students' self-estimation in palliative care competencies was measured by means of the German revised version of the Program in Palliative Care Education and Practice Questionnaire (PCEP-GR). The elearning course Palliative Care Basics was well-received by medical students. The data yielded no significant effects of the elearning course on students' self-estimation in palliative care competencies. There was a trend of the elearning course having a positive effect on the mark in written exam. Elearning is a promising approach in UPCE and well-accepted by medical students. It may be able to increase students' knowledge in palliative care. However, it is likely that there are other approaches needed to change students' self

Policy analysis: palliative care in Ireland.

LENUS (Irish Health Repository)

Larkin, P

2014-03-01

Palliative care for patients with advanced illness is a subject of growing importance in health services, policy and research. In 2001 Ireland became one of the first nations to publish a dedicated national palliative care policy. This paper uses the \\'policy analysis triangle\\' as a framework to examine what the policy entailed, where the key ideas originated, why the policy process was activated, who were the key actors, and what were the main consequences. Although palliative care provision expanded following publication, priorities that were unaddressed or not fully embraced on the national policy agenda are identified. The factors underlying areas of non-fulfilment of policy are then discussed. In particular, the analysis highlights that policy initiatives in a relatively new field of healthcare face a trade-off between ambition and feasibility. Key policy goals could not be realised given the large resource commitments required; the competition for resources from other, better-established healthcare sectors; and challenges in expanding workforce and capacity. Additionally, the inherently cross-sectoral nature of palliative care complicated the co-ordination of support for the policy. Policy initiatives in emerging fields such as palliative care should address carefully feasibility and support in their conception and implementation.

Continuous Palliative Sedation for Cancer and Noncancer Patients

NARCIS (Netherlands)

Swart, S.J.; Rietjens, J.A.C.; van Zuylen, L.; Zuurmond, W.W.A.; Perez, R.S.G.M.; van der Maas, P.J.; van Delden, J.J.M.; van der Heide, A.

2012-01-01

Context: Palliative care is often focused on cancer patients. Palliative sedation at the end of life is an intervention to address severe suffering in the last stage of life. Objectives: To study the practice of continuous palliative sedation for both cancer and noncancer patients. Methods: In 2008,

An Innovative Role for Faith Community Nursing: Palliative Care Ministry.

Science.gov (United States)

Lentz, Judy C

Although the specialty of palliative nursing and palliative care continues to grow in hospital and outpatient settings, a paucity of home-based palliative services remains. This article discusses a new paradigm of faith-based palliative care ministry using faith community nurses (FCNs). Under the leadership of a palliative care doula (a nurse expert in palliative care), nurses in the faith community can offer critical support to those with serious illness. Models such as this provide stimulating content for FCN practice and opportunity to broaden health ministry within faith communities.

Pediatric Palliative Care: A Personal Story

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Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 014 views 6:28 Seasons Hospice & Palliative Care Music Therapy & Alzheimer's - Duration: 6:24. Seasons Hospice & Palliative ...

Pediatric Palliative Care: A Personal Story

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Full Text Available ... Queue __count__/__total__ It’s YouTube. Uninterrupted. Loading... Want music and videos with zero ads? Get YouTube Red. ... 010 views 1:55 Seasons Hospice & Palliative Care Music Therapy & Alzheimer's - Duration: 6:24. Seasons Hospice & Palliative ...

Palliative care and spirituality

Directory of Open Access Journals (Sweden)

Narayanasamy Aru

2007-01-01

Full Text Available Critical junctures in patients′ lives such as chronic illnesses and advanced diseases may leave the persons in a state of imbalance or disharmony of body, mind and spirit. With regard to spirituality and healing, there is a consensus in literature about the influence of spirituality on recovery and the ability to cope with and adjust to the varying and demanding states of health and illness. Empirical evidence suggests that spiritual support may act as an adjunct to the palliative care of those facing advanced diseases and end of life. In this article, the author draws from his empirical work on spirituality and culture to develop a discourse on palliative care and spirituality in both secular and non-secular settings. In doing so, this paper offers some understanding into the concept of spirituality, spiritual needs and spiritual care interventions in palliative care in terms of empirical evidence. Responding to spiritual needs could be challenging, but at the same time it could be rewarding to both healthcare practitioner (HCP and patient in that they may experience spiritual growth and development. Patients may derive great health benefits with improvements in their quality of life, resolutions and meaning and purpose in life. It is hoped that the strategies for spiritual support outlined in this paper serve as practical guidelines to HCPs for development of palliative care in South Asia.

Healing ministry and palliative care in Christianity.

Science.gov (United States)

Jayard, S Stephen; Irudayadason, Nishant A; Davis, J Charles

2017-01-01

Death is inevitable, but that does not mean it can be planned or imposed. It is an ethical imperative that we attend to the unbearable pain and suffering of patients with incurable and terminal illnesses. This is where palliative care plays a vital role. Palliative care has been growing faster in the world of medicine since its emergence as a specialty in the last decade. Palliative care helps to reduce physical pain while affirming the aspect of human suffering and dying as a normal process. The goal of palliative care is to improve the quality of life both of the patient and the family. Palliative care resonates with the healing ministry of Christianity that affirms the sanctity and dignity of human life from the moment of conception to natural death. Christianity is convinced that patients at the very end of their lives, with all their ailments and agonies, are still people who have been created in the image and likeness of God. The human person is always precious, even when marked by age and sickness. This is one of the basic convictions that motivate Christians to take care of the sick and the dying. Palliative care is a great opportunity for Christians to manifest God's unfailing love for the terminally ill and the dying.

Palliative Care

Science.gov (United States)

Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

Case report

African Journals Online (AJOL)

abp

2013-01-09

Jan 9, 2013 ... transurethral resection of the prostate under spinal anesthesia. 30 minutes after the end of the surgery, the patient presented signs of TURP syndrome with ... abdomen and lung auscultation were normal. He was intubated ...

PALLIATIVE CARE IN GERIATRICS: CURRENT ISSUES AND PROSPECTS

Directory of Open Access Journals (Sweden)

I. P. Рonomareva

2016-01-01

Full Text Available The purpose of the study is to identify the main problems and prospects of development of palliative care in geriatrics at the present stage. Method of research was to analyze the printed and electronic databases that meet the stated issues. The results of the study highlight the problems of the development of palliative care in geriatric practice: the lack of a developed procedure of rendering palliative care and adequate elderly patient selection criteria, the lack of trained professional staff. The main prospects-association of palliative practices and concepts of modern geriatrics required specialized geriatric assessment and the provision of clinical, medical, social and socio-psychological geriatric syndromes. While promising option for the development of palliative care geriatrics is the integration into the existing health care system, acceptance of the fact that it is a part of the specialized geriatric care. This requires the involvement and training of not only specialists with medical education, but also persons without medical training from among social workers and volunteers working in palliative care. Therefore, the obtained data allowed to conclude that topical is the development of palliative care in geriatrics, taking into account not only clinical but medico-social, socio-psychological features.

PROGRAM OF PALLIATIVE CANCER CARE – OUR EXPERIENCE

Directory of Open Access Journals (Sweden)

Iva Slánská

2013-01-01

Full Text Available Introduction: Annually more than 27,000 persons die of cancer in the Czech Republic and the overall incidence of malignancies is still increasing. These data shows the need for affordable and good follow-up care especially for patients without any cancer treatment due to irreversible progression of tumor. Currently the outpatient palliative cancer care gets more into the forefront. Prerequisite for a well working outpatient palliative care is cooperation with general practitioners and home health care agencies. The purpose of the so called program of palliative cancer care is to guide a patient in palliative cancer care and to improve the cooperation among health care providers. Methods: During the period from January 2008 to October 2010 we evaluated in patient without any oncology treatment due to irreversible progression of tumor. Results: In palliative outpatient clinic we treated 446 patients, 119 of them received home care services with average length of 27.8 days. 77 patients died at home, 51 in health facilities and 41 in inpatient hospice care. Conclusion: We present pilot study focusing on outpatient palliative cancer care which shows the real benefit from early indication of palliative cancer care. This type of care allows patients to stay as long as possible at home among their close relatives.

Is Palliative Care Right for You?

Science.gov (United States)

... to you, need help with: Coping with the stress of a serious illness Emotional support Spiritual or religious support Talking with your family about your illness and what is important to ... What Is Palliative Care Definition Pediatric Palliative Care Disease Types FAQ Handout for ...

Prevalence of hyponatremia in palliative care patients

Directory of Open Access Journals (Sweden)

Shoba Nair

2016-01-01

Conclusions: Prevalence of hyponatremia is significant in palliative care patients. A prospective study looking at the causes and clinical outcomes associated with hyponatremia in palliative care patients is needed.

Improving communication on hope in palliative care. A qualitative study of palliative care professionals' metaphors of hope: grip, source, tune, and vision

NARCIS (Netherlands)

Olsman, Erik; Duggleby, Wendy; Nekolaichuk, Cheryl; Willems, Dick; Gagnon, Judith; Kruizinga, Renske; Leget, Carlo

2014-01-01

Hope is important in palliative care. However, palliative care professionals' perspectives on hope are not well understood. Metaphors of hope are a way of better understanding these perspectives. To describe palliative care professionals' perspectives on hope by examining the hope metaphors they

Morphometrical differences between resectable and non-resectable pancreatic cancer: a fractal analysis.

Science.gov (United States)

Vasilescu, Catalin; Giza, Dana Elena; Petrisor, Petre; Dobrescu, Radu; Popescu, Irinel; Herlea, Vlad

2012-01-01

Pancreatic cancer is a highly aggressive cancer with a rising incidence and poor prognosis despite active surgical treatment. Candidates for surgical resection should be carefully selected. In order to avoid unnecessary laparotomy it is useful to identify reliable factors that may predict resectability. Nuclear morphometry and fractal dimension of pancreatic nuclear features could provide important preoperative information in assessing pancreas resectability. Sixty-one patients diagnosed with pancreatic cancer were enrolled in this retrospective study between 2003 and 2005. Patients were divided into two groups: one resectable cancer group and one with non-resectable pancreatic cancer. Morphometric parameters measured were: nuclear area, length of minor axis and length of major axis. Nuclear shape and chromatin distribution of the pancreatic tumor cells were both estimated using fractal dimension. Morphometric measurements have shown significant differences between the nuclear area of the resectable group and the non-resectable group (61.9 ± 19.8µm vs. 42.2 ± 15.6µm). Fractal dimension of the nuclear outlines and chromatin distribution was found to have a higher value in the non-resectable group (p<0.05). Objective measurements should be performed to improve risk assessment and therapeutic decisions in pancreatic cancer. Nuclear morphometry of the pancreatic nuclear features can provide important pre-operative information in resectability assessment. The fractal dimension of the nuclear shape and chromatin distribution may be considered a new promising adjunctive tool for conventional pathological analysis.

[eLearning service for home palliative care].

Science.gov (United States)

Sakuyama, Toshikazu; Komatsu, Kazuhiro; Inoue, Daisuke; Fukushima, Osamu

2008-12-01

In order to support the home palliative care learning, we made the eLearning service for home palliative care (beta version) and tried to teach the palliative care to the medical staffs in the community. The various learners (such as nurses, pharmacists and the like) accessed to the online learning and used this eLearning service. After the learners finished eLearning for home palliative care, some questionnaires were distributed to the learners and analyzed by us. The analysis of questionnaires revealed that almost all were satisfied with our eLearning services. Especially the learners were not only interested in using the skills of opioids and the management of pain control, but they had a good cognition for the usage of opioids.

Palliative care in India: Current progress and future needs

Directory of Open Access Journals (Sweden)

Divya Khosla

2012-01-01

Full Text Available Despite its limited coverage, palliative care has been present in India for about 20 years. Obstacles in the growth of palliative care in India are too many and not only include factors like population density, poverty, geographical diversity, restrictive policies regarding opioid prescription, workforce development at base level, but also limited national palliative care policy and lack of institutional interest in palliative care. Nonetheless we have reasons to be proud in that we have overcome several hurdles and last two decades have seen palpable changes in the mindset of health care providers and policy makers with respect to need of palliative care in India. Systematic and continuous education for medical staff is mandatory, and a major break-through for achieving this purpose would be to increase the number of courses and faculties in palliative medicine at most universities.

Prostate resection - minimally invasive

Science.gov (United States)

... thermotherapy; TUMT; Urolift; BPH - resection; Benign prostatic hyperplasia (hypertrophy) - resection; Prostate - enlarged - resection ... passing an instrument through the opening in your penis (meatus). You will be given general anesthesia (asleep ...

An instrument to measure nurses' knowledge in palliative care: Validation of the Spanish version of Palliative Care Quiz for Nurses.

Directory of Open Access Journals (Sweden)

Elena Chover-Sierra

Full Text Available Palliative care is nowadays essential in nursing care, due to the increasing number of patients who require attention in final stages of their life. Nurses need to acquire specific knowledge and abilities to provide quality palliative care. Palliative Care Quiz for Nurses is a questionnaire that evaluates their basic knowledge about palliative care. The Palliative Care Quiz for Nurses (PCQN is useful to evaluate basic knowledge about palliative care, but its adaptation into the Spanish language and the analysis of its effectiveness and utility for Spanish culture is lacking.To report the adaptation into the Spanish language and the psychometric analysis of the Palliative Care Quiz for Nurses.The Palliative Care Quiz for Nurses-Spanish Version (PCQN-SV was obtained from a process including translation, back-translation, comparison with versions in other languages, revision by experts, and pilot study. Content validity and reliability of questionnaire were analyzed. Difficulty and discrimination indexes of each item were also calculated according to Item Response Theory (IRT.Adequate internal consistency was found (S-CVI = 0.83; Cronbach's alpha coefficient of 0.67 and KR-20 test result of 0,72 reflected the reliability of PCQN-SV. The questionnaire had a global difficulty index of 0,55, with six items which could be considered as difficult or very difficult, and five items with could be considered easy or very easy. The discrimination indexes of the 20 items, show us that eight items are good or very good while six items are bad to discriminate between good and bad respondents.Although in shows internal consistency, reliability and difficulty indexes similar to those obtained by versions of PCQN in other languages, a reformulation of the items with lowest content validity or discrimination indexes and those showing difficulties with their comprehension is an aspect to take into account in order to improve the PCQN-SV.The PCQN-SV is a useful

Defining High-Quality Palliative Care in Oncology Practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement.

Science.gov (United States)

Bickel, Kathleen E; McNiff, Kristen; Buss, Mary K; Kamal, Arif; Lupu, Dale; Abernethy, Amy P; Broder, Michael S; Shapiro, Charles L; Acheson, Anupama Kurup; Malin, Jennifer; Evans, Tracey; Krzyzanowska, Monika K

2016-09-01

Integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to specialist palliative medicine. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. An expert steering committee outlined 966 palliative care service items, in nine domains, each describing a candidate element of primary palliative care delivery for patients with advanced cancer or high symptom burden. Using modified Delphi methodology, 31 multidisciplinary panelists rated each service item on three constructs: importance, feasibility, and scope within medical oncology practice. Panelists endorsed the highest proportion of palliative care service items in the domains of End-of-Life Care (81%); Communication and Shared Decision Making (79%); and Advance Care Planning (78%). The lowest proportions were in Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level, with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea, and pain. Within the Appropriate Palliative Care and Hospice Referral domain, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients appropriately. This statement describes the elements comprising high-quality primary palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find this information useful to inform operational changes and quality improvement efforts. Copyright © 2016 by American Society of Clinical Oncology.

Endoscopic Palliation for Pancreatic Cancer

Directory of Open Access Journals (Sweden)

Mihir Bakhru

2011-04-01

Full Text Available Pancreatic cancer is devastating due to its poor prognosis. Patients require a multidisciplinary approach to guide available options, mostly palliative because of advanced disease at presentation. Palliation including relief of biliary obstruction, gastric outlet obstruction, and cancer-related pain has become the focus in patients whose cancer is determined to be unresectable. Endoscopic stenting for biliary obstruction is an option for drainage to avoid the complications including jaundice, pruritus, infection, liver dysfunction and eventually failure. Enteral stents can relieve gastric obstruction and allow patients to resume oral intake. Pain is difficult to treat in cancer patients and endoscopic procedures such as pancreatic stenting and celiac plexus neurolysis can provide relief. The objective of endoscopic palliation is to primarily address symptoms as well improve quality of life.

Palliative care in Pakistan.

Science.gov (United States)

Khan, Robyna Irshad

2017-01-01

Pakistan is a developing country of South East Asia, with all the incumbent difficulties currently being faced by the region. Insufficient public healthcare facilities, poorly regulated private health sector, low budgetary allocation for health, improper priority setting while allocating limited resources, have resulted essentially in an absence of palliative care from the healthcare scene. Almost 90% of healthcare expenditure is out of the patient's pocket with more than 45% of population living below the poverty line. All these factors have a collective potential to translate into an end-of-life care disaster as a large percentage of population is suffering from chronic debilitating/terminal diseases. So far, such a disaster has not materialised, the reason being a family based culture emphasising the care of the sick and old at home, supported by religious teachings. This culture is not limited to Pakistan but subsists in the entire sub-continent, where looking after the sick/elderly at home is considered to be the duty of the younger generation. With effects of globalisation, more and more older people are living alone and an increasing need for palliative care is being realised. However, there does not seem to be any plan on the part of the public or private sectors to initiate palliative care services. This paper seeks to trace the social and cultural perspectives in Pakistan with regards to accessing palliative care in the context of healthcare facilities available.

Music therapy for palliative care: A realist review.

Science.gov (United States)

McConnell, Tracey; Porter, Sam

2017-08-01

Music therapy has experienced a rising demand as an adjunct therapy for symptom management among palliative care patients. We conducted a realist review of the literature to develop a greater understanding of how music therapy might benefit palliative care patients and the contextual mechanisms that promote or inhibit its successful implementation. We searched electronic databases (CINAHL, Embase, Medline, and PsychINFO) for literature containing information on music therapy for palliative care. In keeping with the realist approach, we examined all relevant literature to develop theories that could explain how music therapy works. A total of 51 articles were included in the review. Music therapy was found to have a therapeutic effect on the physical, psychological, emotional, and spiritual suffering of palliative care patients. We also identified program mechanisms that help explain music therapy's therapeutic effects, along with facilitating contexts for implementation. Music therapy may be an effective nonpharmacological approach to managing distressing symptoms in palliative care patients. The findings also suggest that group music therapy may be a cost-efficient and effective way to support staff caring for palliative care patients. We encourage others to continue developing the evidence base in order to expand our understanding of how music therapy works, with the aim of informing and improving the provision of music therapy for palliative care patients.

Palliative care nurses' views on euthanasia.

Science.gov (United States)

Verpoort, Charlotte; Gastmans, Chris; Dierckx de Casterlé, Bernadette

2004-09-01

In debates on euthanasia legalization in Belgium, the voices of nurses were scarcely heard. Yet studies have shown that nurses are involved in the caring process surrounding euthanasia. Consequently, they are in a position to offer valuable ideas about this problem. For this reason, the views of these nurses are important because of their palliative expertise and their daily confrontation with dying patients. The aim of this paper is to report a study of the views of palliative care nurses about euthanasia. A grounded theory approach was chosen, and interviews were carried out with a convenience sample of 12 palliative care nurses in Flanders (Belgium). The data were collected between December 2001 and April 2002. The majority of the nurses were not a priori for or against euthanasia, and their views were largely dependent on the situation. What counted was the degree of suffering and available palliative options. Depending on the situation, we noted both resistance and acceptance towards euthanasia. The underlying arguments for resistance included respect for life and belief in the capabilities of palliative care; arguments underlying acceptance included the quality of life and respect for patient autonomy. The nurses commented that working in palliative care had a considerable influence on one's opinion about euthanasia. In light of the worldwide debate on euthanasia, it is essential to know how nurses, who are confronted with terminally ill patients every day, think about it. Knowledge of these views can also contribute to a realistic and qualified view on euthanasia itself. This can be enlightening to the personal views of caregivers working in a diverse range of care settings.

Factors affecting rural volunteering in palliative care - an integrated review.

Science.gov (United States)

Whittall, Dawn; Lee, Susan; O'Connor, Margaret

2016-12-01

To review factors shaping volunteering in palliative care in Australian rural communities using Australian and International literature. Identify gaps in the palliative care literature and make recommendations for future research. A comprehensive literature search was conducted using Proquest, Scopus, Sage Premier, Wiley online, Ovid, Cochran, Google Scholar, CINAHL and Informit Health Collection. The literature was synthesised and presented in an integrated thematic narrative. Australian Rural communities. While Australia, Canada, the United States (US) and the United Kingdom (UK) are leaders in palliative care volunteer research, limited research specifically focuses on volunteers in rural communities with the least occurring in Australia. Several interrelated factors influence rural palliative care provision, in particular an increasingly ageing population which includes an ageing volunteer and health professional workforce. Also current and models of palliative care practice fail to recognise the innumerable variables between and within rural communities such as distance, isolation, lack of privacy, limited health care services and infrastructure, and workforce shortages. These issues impact palliative care provision and are significant for health professionals, volunteers, patients and caregivers. The three key themes of this integrated review include: (i) Geography, ageing rural populations in palliative care practice, (ii) Psychosocial impact of end-end-of life care in rural communities and (iii) Palliative care models of practice and volunteering in rural communities. The invisibility of volunteers in rural palliative care research is a concern in understanding the issues affecting the sustainability of quality palliative care provision in rural communities. Recommendations for future Australian research includes examination of the suitability of current models of palliative care practice in addressing the needs of rural communities; the recruitment

Self-assessment in cancer patients referred to palliative care

DEFF Research Database (Denmark)

Strömgren, Annette S; Goldschmidt, Dorthe; Groenvold, Mogens

2002-01-01

the symptomatology of participating patients and examines differences in symptomatology between patients in three palliative care functions: inpatient, outpatient, and palliative home care. RESULTS: Of 267 eligible patients who were referred to a department of palliative medicine, initial self......-based study of symptomatology in consecutive cancer patients in palliative care, achieving rather complete data from the participants. The symptomatology in these patients was very pronounced. The questionnaires were able to detect clinically important differences between places of service....

American Academy of Hospice and Palliative Medicine

Science.gov (United States)

... Getting Involved Communities Advanced Lung Disease Forum Psychiatry, Psychology, Mental Health Forum Social Work Forum SIG Instructions ... MOC/OCC Workforce Study Global Palliative Care About History Position Statements Access to Palliative Care and Hospice ...

Cooperating with a palliative home-care team

DEFF Research Database (Denmark)

Goldschmidt, Dorthe; Groenvold, Mogens; Johnsen, Anna Thit

2005-01-01

BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one...... month later. Questions focussed on benefits to patients, training issues for professionals and cooperation between the home-care team and the GP/ district nurse. A combination of closed- and open-ended questions was used. RESULTS: Response rate was 84% (467/553). Benefits to patients were experienced...... by 91 %, mainly due to improvement in symptom management, 'security', and accessibility of specialists in palliative care. After one month, 57% of the participants reported to have learnt aspects of palliative care, primarily symptom control, and 89% of them found cooperation satisfactory...

Flemish palliative care nurses' attitudes toward euthanasia: a quantitative study.

Science.gov (United States)

Gielen, Joris; van den Branden, Stef; van Iersel, Trudie; Broeckaert, Bert

2009-10-01

To adequately measure the attitudes of Flemish palliative care nurses toward euthanasia, and assess the relationship between these attitudes and demographic factors and the (perceived) influence of experience in palliative care on death anxiety. An anonymous questionnaire was sent to all nurses (n=589) employed in palliative care in Flanders, Belgium: 70.5% of the nurses (n=415) responded. A majority of the nurses supported the Belgian law regulating euthanasia but also believed that most euthanasia requests disappear as soon as a patient experiences the benefits of good palliative care. Three clusters were discovered: staunch advocates of euthanasia (150 nurses, 41.1%); moderate advocates of euthanasia (135 nurses, 37%); and (moderate) opponents of euthanasia (80 nurses, 21.9%). An absolute opposition between advocates and opponents of euthanasia was not observed. A statistically significant relationship was found between the euthanasia clusters and years of experience in palliative care, and (perceived) influence of experience in palliative care on anxiety when a patient dies. Flemish palliative care nurses' attitudes toward euthanasia are nuanced and contextual. By indicating that most euthanasia requests disappear as soon as a patient experiences the benefits of good palliative care, the nurses applied a 'palliative filter' a standard procedure in the case of a euthanasia request.

Palliative and end-of-life care in South Dakota.

Science.gov (United States)

Minton, Mary E; Kerkvliet, Jennifer L; Mitchell, Amanda; Fahrenwald, Nancy L

2014-05-01

Geographical disparities play a significant role in palliative and end-of-life care access. This study assessed availability of palliative and end of life (hospice) care in South Dakota. Grounded in a conceptual model of advance care planning, this assessment explored whether South Dakota health care facilities had contact persons for palliative care, hospice services, and advance directives; health care providers with specialized training in palliative and hospice care; and a process for advance directives and advance care planning. Trained research assistants conducted a brief telephone survey. Of 668 health care eligible facilities, 455 completed the survey for a response rate of 68 percent (455 out of 668). Over one-half of facilities had no specific contact person for palliative care, hospice services and advance directives. Nursing homes reported the highest percentage of contacts for palliative care, hospice services and advance directives. Despite a lack of a specific contact person, nearly 75 percent of facilities reported having a process in place for addressing advance directives with patients; slightly over one-half (53 percent) reported having a process in place for advance care planning. Of participating facilities, 80 percent had no staff members with palliative care training, and 73 percent identified lack of staff members with end-of-life care training. Palliative care training was most commonly reported among hospice/home health facilities (45 percent). The results of this study demonstrate a clear need for a health care and allied health care workforce with specialized training in palliative and end-of-life care.

Palliative care in home care: perceptions of occupational therapists

Directory of Open Access Journals (Sweden)

Séfora Gomez Portela

2015-03-01

Full Text Available This research aimed at understanding and reflecting on the perceptions of occupational therapists regarding the implementation of palliative care in home care. This is an exploratory, qualitative study, through semi-structured interviews, conducted in the second semester of 2012 with eight occupational therapists with experience in palliative care in the city of São Paulo. Content analysis identified four themes: characterization and professional trajectory in the field, understanding the concepts of palliative care, home care and palliative care, and occupational therapy and palliative care in home care. The results suggest that the role of the occupational therapist in this field has taken place at different levels of health care, being addressed to people with varying needs. The use of the concept of palliative care by the interviewees exceeds the notion of end of life, following the changes in the epidemiological transition. They understand that professional services follow the trend of national palliative care services with focus on specialized levels, but manifest the importance of its implementation in primary and home care. Among the barriers to practice, they identified the complexity of “being at home “, peculiarities of palliative care with high cost demands, lack of infrastructure and implementation of the current policy. Professional training and scientific roduction in the area were viewed as inadequate, although they identified a call for change. The interviewees recognized palliative care in home care as a strong professional field, but one still requiring study and discussions regarding its limits and conditions of implementation, especially in the Unified Health System.

Qualitative Research in Palliative Care: Applications to Clinical Trials Work.

Science.gov (United States)

Lim, Christopher T; Tadmor, Avia; Fujisawa, Daisuke; MacDonald, James J; Gallagher, Emily R; Eusebio, Justin; Jackson, Vicki A; Temel, Jennifer S; Greer, Joseph A; Hagan, Teresa; Park, Elyse R

2017-08-01

While vast opportunities for using qualitative methods exist within palliative care research, few studies provide practical advice for researchers and clinicians as a roadmap to identify and utilize such opportunities. To provide palliative care clinicians and researchers descriptions of qualitative methodology applied to innovative research questions relative to palliative care research and define basic concepts in qualitative research. Body: We describe three qualitative projects as exemplars to describe major concepts in qualitative analysis of early palliative care: (1) a descriptive analysis of clinician documentation in the electronic health record, (2) a thematic content analysis of palliative care clinician focus groups, and (3) a framework analysis of audio-recorded encounters between patients and clinicians as part of a clinical trial. This study provides a foundation for undertaking qualitative research within palliative care and serves as a framework for use by other palliative care researchers interested in qualitative methodologies.

Leadership Development Initiative: Growing Global Leaders… Advancing Palliative Care.

Science.gov (United States)

Ferris, Frank D; Moore, Shannon Y; Callaway, Mary V; Foley, Kathleen M

2018-02-01

The International Palliative Care Leadership Development Initiative (LDI) was a model demonstration project that aimed to expand the global network of palliative care leaders in low- and moderate-resource countries who are well positioned to apply their new leadership skills. Thirty-nine palliative medicine physicians from 25 countries successfully completed the two-year curriculum that included three thematic residential courses, mentorship, and site visits by senior global palliative care leaders and personal projects to apply their new leadership skills. The focus on self-reflection, leadership behaviors and practices, strategic planning, high-level communication, and teaching skills led to significant personal and professional transformation among the participants, mentors, and the LDI team. The resulting residential course curriculum and the personal leadership stories and biosketches of the leaders are now available open access at IPCRC.net. Already, within their first-year postgraduation, the leaders are using their new leadership skills to grow palliative care capacity through significant changes in policy, improved opioid/other medication availability, new and enhanced educational curricula and continuing education activities, and development/expansion of palliative care programs in their organizations and regions. We are not aware of another palliative care initiative that achieves the global reach and ripple effect that LDI has produced. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Awareness of palliative care among diploma nursing students

Directory of Open Access Journals (Sweden)

Suja Karkada

2011-01-01

Full Text Available Background: The goal of palliative care is not to cure, but to provide comfort and maintain the highest possible quality of life for as long as life remains. The knowledge of nurses influences the quality of care provided to these patients. The present study aimed at identifying the level of knowledge and attitude of nursing students who are the future caretakers of patients, which helps to make recommendations in incorporating palliative care concepts in the nursing curriculum. Objectives: (1 To assess the level of knowledge of nursing students on palliative care; (2 To identify the attitude of nursing students towards palliative care; (3 To find the correlation between the knowledge and attitude of nursing students; (4 To find the association between nursing students′ knowledge, attitude and selected demographic variables. Materials and Methods: A correlative survey was carried out among 83 third-year Diploma Nursing students by using cluster sampling method from selected nursing schools of Udupi district. Results: The data analyzed showed that the majority (51% of them was in the age group of 21years and 92% of them were females. Only 43.4% of them were aware of the term palliative care and it was during their training period. The data showed that 79.5% of students had poor knowledge (6.4± 1.64 on palliative care and 92.8% of them had favorable attitude (56.7± 8.5 towards palliative care. The chi-square showed a significant association between knowledge and age (χ2 =18.52,P<0.01 of the nursing students. Conclusion: Palliative care aspects should be incorporated in the diploma nursing curriculum.

Palliative sedation in advanced cancer patients hospitalized in a specialized palliative care unit.

Science.gov (United States)

Parra Palacio, Santiago; Giraldo Hoyos, Clara Elisa; Arias Rodríguez, Camilo; Mejía Arrieta, Daniel; Vargas Gómez, John Jairo; Krikorian, Alicia

2018-03-29

To describe the practice of palliative sedation (PS) in patients with advanced cancer in a specialized palliative care (PC) unit in Colombia. Descriptive prospective study including all adults with cancer hospitalized under PS in a cancer institute between January and July 2015 in Colombia. Variables examined were diagnosis, physical functioning, symptoms at the start of sedation, medications and dosages used, and type, level, and time of sedation. Descriptive and correlational statistics were obtained. Sixty-six patients were included, 70% of which were women. The patients had an average age of 61 years (range 24-87), and 74% had a Karnofsky Index (KI) of 50% or less. The most frequent diagnosis was breast cancer (22%), and 82% had metastatic cancer. The prevalence of palliative sedation was 2% and the most common symptoms indicating it were dyspnea (59%), delirium (45%), and pain (32%). All patients received midazolam as a sedative. The average time between the interval start and culmination of sedation was 44 h. There was a significant and inverse relationship between functionality and time under sedation. Palliative sedation is a valid therapeutic option for refractory symptoms causing suffering. The results correspond to international reports and guidelines, which suggests that PS is tailored to the needs of the individual patient while maintaining a high scientific standard, even in a context where PC is under development. However, further development of strategies and clear indications towards the use of PS in Colombia are needed, given its still scarce use.

Palliative Sedation: An Analysis of International Guidelines and Position Statements.

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Gurschick, Lauren; Mayer, Deborah K; Hanson, Laura C

2015-09-01

To describe the suggested clinical practice of palliative sedation as it is presented in the literature and discuss available guidelines for its use. CINAHL, PubMed, and Web of Science were searched for publications since 1997 for recommended guidelines and position statements on palliative sedation as well as data on its provision. Keywords included palliative sedation, terminal sedation, guidelines, United States, and end of life. Inclusion criteria were palliative sedation policies, frameworks, guidelines, or discussion of its practice, general or oncology patient population, performance of the intervention in an inpatient unit, for humans, and in English. Exclusion criteria were palliative sedation in children, acute illness, procedural, or burns, and predominantly ethical discussions. Guidelines were published by American College of Physicians-American Society of Internal Medicine (2000), Hospice and Palliative Nurses Association (2003), American Academy of Hospice and Palliative Medicine (2006), American Medical Association (2008), Royal Dutch Medical Association (2009), European Association for Palliative Care (2009), National Hospice and Palliative Care Organization (2010), and National Comprehensive Cancer Network (2012). Variances throughout guidelines include definitions of the practice, indications for its use, continuation of life-prolonging therapies, medications used, and timing/prognosis. The development and implementation of institutional-based guidelines with clear stance on the discussed variances is necessary for consistency in practice. Data on provision of palliative sedation after implementation of guidelines needs to be collected and disseminated for a better understanding of the current practice in the United States. © The Author(s) 2014.

Poverty Reduction in India through Palliative Care: A Pilot Project.

Science.gov (United States)

Ratcliff, Cathy; Thyle, Ann; Duomai, Savita; Manak, Manju

2017-01-01

EMMS International and Emmanuel Hospital Association (EHA) implemented a pilot project, poverty reduction in India through palliative care (PRIPCare). A total of 129 interviews with patients and family enrolled in palliative care at three EHA hospitals (in Fatehpur, Lalitpur and Utraula) and staff discussions established that 66% of palliative care patients had lost livelihoods due to illness, 26% of patients' families had members who had lost livelihoods due to the illness, 98% of enrolled households had debts, 59% had loans for which they had sold assets, 69% of households took out debt after their family member fell ill, many patients do not know about government benefits and lack necessary documents, many village headmen require bribes to give people access to benefits, and many bereaved women and children lose everything. Palliative care enabled 85% of patients and families to spend less on medicines, 31% of patients received free medicines, all patients reduced use of out-patient departments (OPDs), 20% reduced use of inpatient departments (IPDs), and therefore spent less on travel, 8% of patients had started earning again due to improved health, members of 10% of families started earning again, and one hospital educated 171 village headmen and increased by 5% the number of patients and their families receiving government benefits. If only 0.7% of needy adults are receiving palliative care, these benefits could be delivered to 143 times more families, targeted effectively at poverty reduction. Palliative care has great scope to reduce that most desperate poverty in India caused by chronic illness. This article concerns a study by the UK NGO EMMS International and Indian NGO EHA, to assess whether palliative care reduces household poverty. EHA staff had noticed that many patients spend a lot on ineffective treatment before joining palliative care, many families do not know their entitlement to government healthcare subsidies or government pensions, and many

[Endoscopic full-thickness resection].

Science.gov (United States)

Meier, B; Schmidt, A; Caca, K

2016-08-01

Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) are powerful tools for the treatment of gastrointestinal (GI) neoplasms. However, those techniques are limited to the superficial layers of the GI wall (mucosa and submucosa). Lesions without lifting sign (usually arising from deeper layers) or lesions in difficult anatomic positions (appendix, diverticulum) are difficult - if not impossible - to resect using conventional techniques, due to the increased risk of complications. For larger lesions (>2 cm), ESD appears to be superior to the conventional techniques because of the en bloc resection, but the procedure is technically challenging, time consuming, and associated with complications even in experienced hands. Since the development of the over-the-scope clips (OTSC), complications like bleeding or perforation can be endoscopically better managed. In recent years, different endoscopic full-thickness resection techniques came to the focus of interventional endoscopy. Since September 2014, the full-thickness resection device (FTRD) has the CE marking in Europe for full-thickness resection in the lower GI tract. Technically the device is based on the OTSC system and combines OTSC application and snare polypectomy in one step. This study shows all full-thickness resection techniques currently available, but clearly focuses on the experience with the FTRD in the lower GI tract.

Bladder Cancer Treatment (PDQ®)—Patient Version

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Treatment of bladder cancer depends on the stage of the cancer. Treatment options include different types of surgery (transurethral resection, radical and partial cystectomy, and urinary diversion), radiation therapy, chemotherapy, and immunotherapy. Learn more about how bladder cancer is treated.

Effects of intrathecal bupivacaine and bupivacaine plus sufentanil in ...

African Journals Online (AJOL)

Introduction: The present study compared the effect of bupivacaine and bupivacaine + sufentanil on hemodynamic parameters and characteristics of spinal anesthesia in elderly patients undergoing transurethral resection of the prostate (TURP) under spinal anesthesia. Technical Considerations: The study included 40 ...

Photodynamic diagnosis of bladder cancer:Initial experience of a ...

African Journals Online (AJOL)

Objectives: To describe the introduction and evaluate efficacy of photodynamic diagnosis with Hexvix fordetecting tumours and abnormal mucosal lesions during transurethral resection of bladder tumour (TURBT). Subjects and methods: Prospective study of consecutive eligible patients who underwent TURBT with aidof ...

Non-muscle-invasive bladder cancer

DEFF Research Database (Denmark)

Malmström, Per-Uno; Agrawal, Sachin; Bläckberg, Mats

2017-01-01

The management of non-muscle-invasive bladder cancer (NMIBC) has evolved from the first reports on bladder endoscopy and transurethral resection to the introduction of adjuvant intravesical treatment. However, disease recurrence and progression remain an ongoing risk, placing a heavy burden...

European Association for Palliative Care: Forging a Vision of Excellence in Palliative Care in Central and Eastern European and Former Soviet Union Countries.

Science.gov (United States)

Radbruch, Lukas; Ling, Julie; Hegedus, Katalin; Larkin, Philip

2018-02-01

The European Association for Palliative Care (EAPC) represents many thousands of health care workers and volunteers working in or with an interest in palliative care. In 2016, the EAPC has individual members from 48 nations across the world, and collective members from 57 national palliative care associations in 32 European countries. Throughout its history, the EAPC has produced guidance on a range of palliative care issues. The biennial congresses and research congresses and the comprehensive Web site (www.eapcnet.eu) are renowned and well utilized platforms for dissemination and exchange of palliative care information. The EAPC has also published a newsletter specifically for Eastern European and Central Asian countries that has been available in both English and Russian from 2005 to 2012. In addition, for a period of time, a Russian Web site (www.eapcspeaksrussian.eu) was also available. A survey of palliative care in Central and Eastern European nations sponsored by Open Society Foundation's International Palliative Care Initiative found that in most countries, the national language is preferred rather than using English or Russian for the provision of information. Accordingly, the EAPC Web site provides translations of white papers, position papers, and blog posts in a number of languages. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Bladder cancer: The combination of chemotherapy and irradiation in the treatment of patients with muscle-invading tumors

International Nuclear Information System (INIS)

Shipley, William U.; Zietman, Anthony L.

1996-01-01

In the USA the recommended treatment for patients with muscle-invading transitional cell cancer of the bladder is usually radical cystectomy. Conservative surgery irradiation, and cisplatin-based systemic chemotherapy are, however, each effective for some patients. Although they provide the opportunity for bladder preservation, each modality, when used alone, is inferior to radical cystectomy in terms of local control and, perhaps, survival. Many recent publications have now documented the efficacy of combined modality treatment protocols employing all three of these modalities together. All employ a selective approach in which the patients only receive full-dose radiation if they have had a complete response to induction CMT. Overall survival data for T2-T3a patients are certainly as good as any reported cystectomy series of similarly clinically staged and similar aged patients. Radiation adds very significantly to the transurethral resection and systemic chemotherapy to maintain the bladder free of tumor. Substantially higher rates of pathologic confirmation of complete response are found following transurethral surgery and chemoradiation when compared with transurethral surgery and chemotherapy omitting the radiation. Overall survival is as good as cystectomy based approaches at 48-54% and over 80% of these long-term survivors keep their bladders. Following such therapies, 20-30% will subsequently develop superficial tumors. These patients may still be well treated by standard methods using transurethral resection and intravesical drugs. The concern of urologists that the conserved irradiated bladder functions poorly has also been answered by recent reports using modern radiation techniques. The instance of cystectomy for bladder shrinkage is repeatedly below 2%. Furthermore, sexual function is commonly preserved. The systemic morbidity of the chemotherapy is relatively high, but new approached using anti-emetics and GCSF now allow this to be reduced. In many

Integration of palliative care in the context of rapid response: a report from the Improving Palliative Care in the ICU advisory board.

Science.gov (United States)

Nelson, Judith E; Mathews, Kusum S; Weissman, David E; Brasel, Karen J; Campbell, Margaret; Curtis, J Randall; Frontera, Jennifer A; Gabriel, Michelle; Hays, Ross M; Mosenthal, Anne C; Mulkerin, Colleen; Puntillo, Kathleen A; Ray, Daniel E; Weiss, Stefanie P; Bassett, Rick; Boss, Renee D; Lustbader, Dana R

2015-02-01

Rapid response teams (RRTs) can effectively foster discussions about appropriate goals of care and address other emergent palliative care needs of patients and families facing life-threatening illness on hospital wards. In this article, The Improving Palliative Care in the ICU (IPAL-ICU) Project brings together interdisciplinary expertise and existing data to address the following: special challenges for providing palliative care in the rapid response setting, knowledge and skills needed by RRTs for delivery of high-quality palliative care, and strategies for improving the integration of palliative care with rapid response critical care. We discuss key components of communication with patients, families, and primary clinicians to develop a goal-directed treatment approach during a rapid response event. We also highlight the need for RRT expertise to initiate symptom relief. Strategies including specific clinician training and system initiatives are then recommended for RRT care improvement. We conclude by suggesting that as evaluation of their impact on other outcomes continues, performance by RRTs in meeting palliative care needs of patients and families should also be measured and improved.

[Providing regular relief; considerations for palliative care in the Netherlands].

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Crul, B J; van Weel, C

2001-10-20

Over the last few decades the attention devoted to the palliative aspects of medicine, particularly those in hospital care, has declined due to the emphasis on medical technology. In Anglo-Saxon countries a review of this development resulted in structured palliative care that benefited terminally ill patients with a progressive fatal disease, especially cancer patients. Due to increasing national and international criticism of both the practice of euthanasia (assumed to be too liberal) and the lack of attention devoted to structured palliative care in the Netherlands, the Dutch government decided to improve the structure of palliative care. The government's viewpoint is based on the assumption that good palliative care that includes adequate pain control benefits patient care and might eventually lead to fewer requests for euthanasia. The improvements to palliative care should be realised by means of improvements in the structure, training and knowledge. Six academic medical clusters have been designated as Centres for the Development of Palliative Care (Dutch acronym: COPZ) for a 5-year period. Each COPZ must develop the various aspects needed to improve palliative care within the region it serves and ensure that its activities are carefully coordinated with those in the other centres. Research will focus on measuring the efficacy of palliative care as well as ethical and epidemiological aspects. A government committee will assess the appropriateness of the activities undertaken by each of the centres.

Safety and efficacy of transurethral pneumatic lithotripsy for bladder calculi in children

International Nuclear Information System (INIS)

Khosa, A.S.; Hussain, M.; Hussain, M.

2012-01-01

Objective: To determine the safety and efficacy of transurethral pneumatic lithotripsy for bladder calculi in children. Method: The study included 100 children up to 15 years of age undergoing pneumatic cystolithoclast for bladder stones. The descriptive study was conducted from September 2006 to February 2007 at the Sindh Institute of Urology and Transplantation, Karachi. The inclusion criteria was children up to 15 years of age with a bladder stone of up to 3 cm, pre-operative negative urine culture, no coagulopathy and fit for general anaesthesia. An X-ray and ultrasound of Kidney and Urinary Bladder (KUB) was mandatory. The procedure was done under general anaesthesia with a single dose of pre-operative antibiotic. A mini-scope of 4 FR or a semi-rigid ureteroscope of 7/8.5 FR with pneumatic wolf lithoclast was used for the fragmentation of stones. Duration of procedure, any per-operative and post-operative complications and the duration of hospital stay were recorded. Post-operatively, the patient underwent ultrasound Kidney and Urinary Bladder at the first follow-up to assess stone clearance after one week. Result: Mean patients age was 4.95+-3.3 years. The male-to-female ratio was 11.5: 1 The mean hospital stay was 9.2 +- 2.5 hours. The mean operating time was 25 (10 -65) minutes. Ten (10%) patients developed minor complications out of which 5 (5%) developed haematuria and 4 (4%) developed difficulty in passing urine. One (1%) of the patients developed post-operative retention of urine. All the patients were stone free after the procedure. Conclusion: The transurethral pneumatic lithoclast is very effective and safe in children with bladder stones up to 3 cm. (author)

Integrated palliative care is about professional networking rather than standardisation of care: A qualitative study with healthcare professionals in 19 integrated palliative care initiatives in five European countries.

Science.gov (United States)

den Herder-van der Eerden, Marlieke; van Wijngaarden, Jeroen; Payne, Sheila; Preston, Nancy; Linge-Dahl, Lisa; Radbruch, Lukas; Van Beek, Karen; Menten, Johan; Busa, Csilla; Csikos, Agnes; Vissers, Kris; van Gurp, Jelle; Hasselaar, Jeroen

2018-06-01

Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of integrated care (content of care, patient flow, information logistics and availability of (human) resources and material) are lacking. To examine how integrated palliative care takes shape in practice across abovementioned key domains within several integrated palliative care initiatives in Europe. Qualitative group interview design. A total of 19 group interviews were conducted (2 in Belgium, 4 in the Netherlands, 4 in the United Kingdom, 4 in Germany and 5 in Hungary) with 142 healthcare professionals from several integrated palliative care initiatives in five European countries. The majority were nurses ( n = 66; 46%) and physicians ( n = 50; 35%). The dominant strategy for fostering integrated palliative care is building core teams of palliative care specialists and extended professional networks based on personal relationships, shared norms, values and mutual trust, rather than developing standardised information exchange and referral pathways. Providing integrated palliative care with healthcare professionals in the wider professional community appears difficult, as a shared proactive multidisciplinary palliative care approach is lacking, and healthcare professionals often do not know palliative care professionals or services. Achieving better palliative care integration into regular healthcare and convincing the wider professional community is a difficult task that will take time and effort. Enhancing standardisation of palliative care into education, referral pathways and guidelines and standardised information exchange may be necessary. External authority (policy makers, insurance companies and professional bodies) may be needed to support integrated palliative care practices across settings.

Bypass laparoscopic procedure for palliation of esophageal cancer.

Science.gov (United States)

Siosaki, Marcos Duarte; Lacerda, Croider Franco; Bertulucci, Paulo Anderson; da Costa Filho, José Orlando; de Oliveira, Antônio Talvane Torres

2013-03-26

Esophageal cancer is a devastating disease with rapidly increasing incidence in Western countries. Dysphagia is the most common complication, causing severe malnutrition and reduced quality of life. A 69-year-old male with persistent esophageal cancer after radiation therapy was subjected to palliative by-pass surgery using a laparoscopic approach. Due to the advanced stage at diagnosis, palliative treatment was a more realistic option. Dysphagia is a most distressing symptom of this disease, causing malnutrition and reducing quality of life. The goal of palliation is to improve swallowing. The most common methods applied are endoscopic stenting, radiation therapy (external or brachytherapy), chemotherapy, yttrium-aluminum-garnet laser rechanneling or endoscopic dilatation. Palliative surgery is rarely proposed due to morbidity and complications. This paper demonstrates an update in the technique proposed by Postlethwait in 1979 for palliation of esophageal cancer. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2013.

Attitudes of palliative home care physicians towards palliative sedation at home in Italy.

Science.gov (United States)

Mercadante, Sebastiano; Masedu, Francesco; Mercadante, Alessandro; Marinangeli, Franco; Aielli, Federica

2017-05-01

Information about the attitudes towards palliative sedation (PS) at home is limited. The aim of this survey was to assess the attitudes of palliative care physicians in Italy regarding PS at home. A questionnaire was submitted to a sample of palliative care physicians, asking information about their activity and attitudes towards PS at home. This is a survey of home care physicians in Italy who were involved in end-of-life care decisions at home. One hundred and fifty participants responded. A large heterogeneity of home care organizations that generate some problems was found. Indications, intention and monitoring of PS seem to be appropriate, although some cultural and logistic conditions were limiting the use of PS. Specialized home care physicians are almost involved to start PS at home. Midazolam was seldom available at home and opioids were more frequently used. These data should prompt health care agencies to make a minimal set of drugs easily available for home care. Further research is necessary to compare attitudes in countries with different sociocultural profiles.

[Transit-slowing anastomosis by 180 degree axial rotation of the upper intestinal segment after massive resection of the small intestine. Preliminary note on an experimental study in the adult dog].

Science.gov (United States)

Salomao, J; Bosgiraud, F; Vayre, P

1976-01-01

After massive resection of 85 p. cent of the small intestine in the dog, there occurs diarrhoea and malabsorption. These consequences may be palliated by an oblique end-to-end anastomosis with 180 rotation on the intestinal axis of the jejunal sugment above in relation to the ileal segment below. The authors noted slowing of the transit in the 10 operated dogs. The experimental conditions and the results obtained suggest that the technic may be applicable in man.

Palliative Care: A Partnership Across the Continuum of Care.

Science.gov (United States)

Spaulding, Aaron; Harrison, Debra A; Harrison, Jeffrey P

2016-01-01

Palliative care services are becoming more prevalent in the United States as greater portions of the population are requiring end-of-life services. Furthermore, recent policy changes and service foci have promoted more continuity and encompassing care. This study evaluates characteristics that distinguish hospitals with a palliative care program from hospitals without such a program in order to better define the markets and environments that promote the creation and usage of these programs. This study demonstrates that palliative care programs are more likely in communities with favorable economic factors and higher Medicare populations. Large hospitals with high occupancy rates and a high case mix index use palliative care programs to better meet patient needs and improve hospital efficiency. Managerial, nursing, and policy implications are discussed relating to further usage and implementation of palliative care programs.

Palliative Care in Heart Failure

Directory of Open Access Journals (Sweden)

Hatice Mert

2012-04-01

Full Text Available Heart failure is an important health problem since its incidence and prevalence is increasing year by year. Since symptom burden and mortality are high in heart failure, supportive and palliative care should be provided. However, very few patients are referred to palliative care services. In comparison with cancer patients, it is difficult to identify end of life care for patients with heart failure, because these patients are hospitalized when the signs of acute decompensation appear, and their symptoms decrease and functional status improve before they are discharged. Therefore, palliative care, which is a holistic approach aiming to improve patients’ quality of life, to detect and treat the attacks of the disease before they become severe, and to deal with patients’ physical, psychological, social, and mental health altogether during their care, should be integrated into heart failure patients’ care. [TAF Prev Med Bull 2012; 11(2.000: 217-222

COMPARATIVE STUDY OF CONSERVATIVE RESECTION AND ...

African Journals Online (AJOL)

1999-05-05

May 5, 1999 ... Depmment of Surgery, University Teaching Hospital, PMB 2076. Jos, Nigeria ... Design: A retrospective study of patients with thyroid cancers that were managed during an ... This logical basis for either cure or palliation of a .... palliative purposes. A mixed ... Pulmonary metastasis are usually of the classical.

Evaluating palliative care needs in Middle Eastern countries.

Science.gov (United States)

Silbermann, Michael; Fink, Regina M; Min, Sung-Joon; Mancuso, Mary P; Brant, Jeannine; Hajjar, Ramzi; Al-Alfi, Nesreen; Baider, Lea; Turker, Ibrahim; ElShamy, Karima; Ghrayeb, Ibtisam; Al-Jadiry, Mazin; Khader, Khaled; Kav, Sultan; Charalambous, Haris; Uslu, Ruchan; Kebudi, Rejin; Barsela, Gil; Kuruku, Nilgün; Mutafoglu, Kamer; Ozalp-Senel, Gulsin; Oberman, Amitai; Kislev, Livia; Khleif, Mohammad; Keoppi, Neophyta; Nestoros, Sophia; Abdalla, Rasha Fahmi; Rassouli, Maryam; Morag, Amira; Sabar, Ron; Nimri, Omar; Al-Qadire, Mohammad; Al-Khalaileh, Murad; Tayyem, Mona; Doumit, Myrna; Punjwani, Rehana; Rasheed, Osaid; Fallatah, Fatimah; Can, Gulbeyaz; Ahmed, Jamila; Strode, Debbie

2015-01-01

Cancer incidence in Middle Eastern countries, most categorized as low- and middle-income, is predicted to double in the next 10 years, greater than in any other part of the world. While progress has been made in cancer diagnosis/treatment, much remains to be done to improve palliative care for the majority of patients with cancer who present with advanced disease. To determine knowledge, beliefs, barriers, and resources regarding palliative care services in Middle Eastern countries and use findings to inform future educational and training activities. Descriptive survey. Fifteen Middle Eastern countries; convenience sample of 776 nurses (44.3%), physicians (38.3%) and psychosocial, academic, and other health care professionals (17.4%) employed in varied settings. Palliative care needs assessment. Improved pain management services are key facilitators. Top barriers include lack of designated palliative care beds/services, community awareness, staff training, access to hospice services, and personnel/time. The nonexistence of functioning home-based and hospice services leaves families/providers unable to honor patient wishes. Respondents were least satisfied with discussions around advance directives and wish to learn more about palliative care focusing on communication techniques. Populations requiring special consideration comprise: patients with ethnic diversity, language barriers, and low literacy; pediatric and young adults; and the elderly. The majority of Middle Eastern patients with cancer are treated in outlying regions; the community is pivotal and must be incorporated into future plans for developing palliative care services. Promoting palliative care education and certification for physicians and nurses is crucial; home-based and hospice services must be sustained.

Effects of extradural bupivacaine on the haemostatic system

NARCIS (Netherlands)

Henny, C. P.; Odoom, J. A.; ten Cate, H.; ten Cate, J. W.; Oosterhoff, R. J.; Dabhoiwala, N. F.; Sih, I. L.

1986-01-01

Twenty consecutive patients undergoing elective transurethral resection of the prostate were allocated randomly to one of two groups. Group I (n = 10) received lumbar extradural analgesia with 0.5% bupivacaine. Group II (n = 10) received general anaesthesia with spontaneous respiration, using 60%

Participation of radiotherapy in interdisciplinary palliative care units. Challenge and chance

International Nuclear Information System (INIS)

Momm, F.; Frommhold, H.; Becker, G.; Ewald, H.; Baumgartner, J.; Adamietz, I.A.

2004-01-01

Background: in Germany, a sufficient system of palliative care does not exist. Possibilities for participation of radiooncologists in the further development of this promising part of medical action are reported. Material and methods: experiences from interdisciplinary work in the field of palliative care are described. This experience is communicated for use in the actual discussion about the future of palliative care in Germany, especially in the field of radiooncology. Results: a palliative care unit can only work in a team of different professions, which means different physicians, but also nurses, social workers, psychologists or pastors. A palliative care unit will benefit from working with radiooncologists as well as radiooncologists will do from working in the field of palliative care. Conclusion: in times of growing interest in and need for palliative care, radiooncologists should actively participate in the development of palliative care units in Germany. The aim of this participation should be to reasonably arrange the treatment of incurably ill patients with the chances of modern radiotherapy. Another aim should be to improve the treatment of ''classic'' radiation oncology patients by ideas of pallative care. The further development of palliative care in Germany should not take place without the participation of radiooncologists. This will meet the interests of palliative care and radiotherapy and - most importantly - the patients' interests. (orig.) [de

Current status of palliative care--clinical implementation, education, and research.

Science.gov (United States)

Grant, Marcia; Elk, Ronit; Ferrell, Betty; Morrison, R Sean; von Gunten, Charles F

2009-01-01

Palliative and end-of-life care is changing in the United States. This dynamic field is improving care for patients with serious and life-threatening cancer through creation of national guidelines for quality care, multidisciplinary educational offerings, research endeavors, and resources made available to clinicians. Barriers to implementing quality palliative care across cancer populations include a rapidly expanding population of older adults who will need cancer care and a decrease in the workforce available to give care. Methods of integrating current palliative care knowledge into care of patients include multidisciplinary national education and research endeavors, and clinician resources. Acceptance of palliative care as a recognized medical specialty provides a valuable resource for improvement of care. Although compilation of evidence for the importance of palliative care specialities is in its initial stages, national research grants have provided support to build the knowledge necessary for appropriate palliative care. Opportunities are available to clinicians for understanding and applying appropriate palliative and end-of-life care to patients with serious and life-threatening cancers. (c) 2009 American Cancer Society, Inc.

Dental expression and role in palliative treatment

Directory of Open Access Journals (Sweden)

Rajiv Saini

2009-01-01

Full Text Available World Health Organization defines palliative care as the active total care of patients whose disease is not responding to curative treatment. Palliative care for the terminally ill is based on a multidimensional approach to provide whole-person comfort care while maintaining optimal function; dental care plays an important role in this multidisciplinary approach. The aim of the present study is to review significance of dentist′s role to determine whether mouth care was effectively assessed and implemented in the palliative care setting. The oral problems experienced by the hospice head and neck patient clearly affect the quality of his or her remaining life. Dentist plays an essential role in palliative care by the maintenance of oral hygiene; dental examination may identify and cure opportunistic infections and dental disease like caries, periodontal disease, oral mucosal problems or prosthetic requirement. Oral care may reduce not only the microbial load of the mouth but the risk for pain and oral infection as well. This multidisciplinary approach to palliative care, including a dentist, may reduce the oral debilities that influence the patient′s ability to speak, eat or swallow. This review highlighted that without effective assessment of the mouth, the appropriate implementation of care will not be delivered. Palliative dental care has been fundamental in management of patients with active, progressive, far-advanced disease in which the oral cavity has been compromised either by the disease directly or by its treatment; the focus of care is quality of life.

Palliative care in Argentina: perspectives from a country in crisis.

Science.gov (United States)

De Simone, Gustavo G

2003-01-01

Argentina is a large South American country with a high prevalence of chronic disease-related mortality and a clear need for implementation of palliative care. Primary concerns related to palliative care are cultural, socio-economic and educational. Increasing poverty, patients and families receiving inadequate information about their diagnosis or prognosis, drug availability and costs, and insufficient knowledge by health care providers are obstacles to palliative care. Palliative care programs are developing throughout the country and methods by which they are meeting their needs are described. Several Argentinean palliative care initiatives are described and the role of the Pallium Latinomérica training program is discussed.

Invasive bladder cancer: treatment strategies using transurethral surgery, chemotherapy and radiation therapy with selection for bladder conservation

International Nuclear Information System (INIS)

Shipley, William U.; Zietman, Anthony L.; Kaufman, Donald S.; Althausen, Alex F.; Heney, Niall M.

1997-01-01

Purpose: Combined modality therapy has become the standard oncologic approach to achieve organ preservation in many malignancies. Methods and Materials: Although radical cystectomy has been considered as standard treatment for invasive bladder carcinoma in the United States, good results have been recently reported from several centers using multimodality treatment, particularly in patients with clinical T2 and T3a disease who do not have a ureter obstructed by tumor. Results: The components of the combined treatment are usually transurethral resection of the bladder tumor (TURBT) followed by concurrent chemotherapy and radiation therapy. Following an induction course of therapy a histologic response is evaluated by cystoscopy and rebiopsy. Clinical 'complete responders' (tumor site rebiopsy negative and urine cytology with no tumor cells present) continue with a consolidation course of concurrent chemotherapy and radiation. Those patients not achieving a clinical complete response are recommended to have an immediate cystectomy. Individually the local monotherapies of radiation, TURBT, or multidrug chemotherapy each achieve a local control rate of the primary tumor of from 20 to 40%. When these are combined, clinical complete response rates of from 65 to 80% can be achieved. Seventy-five to 85% of the clinical complete responders will remain with bladders free of recurrence of an invasive tumor. Conclusions: Bladder conservation trials using combined modality treatment approaches with selection for organ conservation by response of the tumor to initial treatment report overall 5-year survival rates of approximately 50%, and a 40-45% 5-year survival rate with the bladder intact. These modern multimodality bladder conservation approaches offer survival rates similar to radical cystectomy for patients of similar clinical stage and age. Bladder-conserving therapy should be offered to patients with invasive bladder carcinoma as a realistic alternative to radical

Management of malignant left colonic obstruction: is an initial temporary colostomy followed by surgical resection a better option?

Science.gov (United States)

Chéreau, N; Lefevre, J H; Lefrancois, M; Chafai, N; Parc, Y; Tiret, E

2013-11-01

The surgical management of obstructed left colorectal cancer (OLCC) is still a matter of debate, and current guidelines recommend Hartmann's procedure (HP). The study evaluated the results of the surgical management with a focus on a strategy of initial colostomy (IC) followed by elective resection. All patients operated on for OLCC were reviewed. Clinical, surgical, histological, morbidity and long-term results were noted. From 2000-11, 83 patients (48 men) with a mean age of 70.3 ± 15.1 years underwent surgery for OLCC. Eleven (13.3%) had a subtotal colectomy owing to a laceration of the caecal wall. Eleven had a HP for tumour perforation (n = 6) or as palliation in a severely ill patient (n = 5). The remaining 61 (73.5%) patients had an IC, with the intention of performing an elective resection shortly after recovery. Postoperative complications occurred in six (9.8%) and there were two (3.3%) deaths. Fifty-nine operation survivors had a colonoscopy shortly afterwards which showed a synchronous cancer in two (3.4%). Twelve of the 59 patients had synchronous metastases. The subsequent elective resection including the colostomy site could be performed in 45 (74%) patients during the same admission at a median interval of 11 (7-17) days. The overall median length of hospital stay was 20 days and the 30-day mortality was 3/61 (5%). IC followed by surgical resection is a technically simple strategy, allowing initial abdominal exploration with a short period of having a colostomy, and permitting elective surgery with a low morbidity and full oncological lymphadenectomy. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals: A Qualitative Study.

Science.gov (United States)

Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki

2016-07-01

To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.

Attitude to Euthanasia of Workers in Palliative Care

OpenAIRE

Poštová, Lenka

2015-01-01

This bsachelor thesis is devided into two parts, theoretical and practical. The work focuses on opinions of workers in palliative care on euthanasia. The theoretical part deals with the definition of palliative care, its goals and principles. Futhermore, it also introduced quality of palliative care in Czech Republic. Second chapter explains the term euthanasia and its forms. It also contains opinions of citizens of the Czech Republic on euthanasia. Third chapter is dedicated to terms such as...

Palliative care guidelines in oncology

International Nuclear Information System (INIS)

Krizanova, K.

2006-01-01

Palliative care has its roots in hospice movement arising in the 1970s in Europe and later also in America. From its beginning it has had connection with patients in terminal phase of cancer disease who suffered from many serious symptoms. Nowadays palliative care is also being provided to patients in terminal phase of certain neurological disorders, AIDS, exceptionally for patients with heart, lung or kidney failure. It has become part of modern medicine and of good clinical practice. (author)

Patient preferences for clean intermittent catheterisation and transurethral indwelling catheterisation for treatment of abnormal post-void residual bladder volume after vaginal prolapse surgery

NARCIS (Netherlands)

Hakvoort, R. A.; Nieuwkerk, P. T.; Burger, M. P.; Emanuel, M. H.; Roovers, J. P.

2011-01-01

To determine patient preferences for clean intermittent catheterisation (CIC) relative to transurethral indwelling catheterisation (TIC) as the treatment of abnormal post-void residual bladder volume (PVR) following vaginal prolapse surgery. Scenario-based preference assessment during face-to-face

PALLIATIVE CARE – ITS ROLE IN HEALTHCARE SYSTEMS

Directory of Open Access Journals (Sweden)

Urška Lunder

2003-11-01

Full Text Available Background. In the last decades a palliative care has been well established in the majority of West European countries. However, majority of these countries are not able to follow needs for palliative care because of demographic changes (older population, changes of morbidity pattern (increase of chronic progressive diseases and social changes (disability of families to care for their relatives at their homes. Research is showing evidence on palliative care effectiveness at end of life and in bereavement. There is still a great need for healthcare professionals’ change in their attitudes, knowledge and skills. In many National strategic plans (United Kingdom, Ireland, Sweden, Australia, New Zealand and Canada palliative care becomes a priority in the national public health. New organizational planning supports establishement of palliative care departments in hospitals and other healthcare settings and consultant teams at all levels of healthcare system. Hospices, caritative and independent organizations, will remain as a source of good clinical practice and philosophy of care at the end of life also in the future.

Launching a palliative care homepage: the Edmonton experience.

Science.gov (United States)

Pereira, J; Macmillan, A; Bruera, E

1997-11-01

The Internet, with its graphical subdivision, the World Wide Web (WWW). has become a powerful tool for the dissemination of information and for communication. This paper discusses the authors' experiences with creating, launching and maintaining an official publication on the Internet by the Edmonton Regional Palliative Care Program and the Division of Palliative Medicine, University of Alberta, Canada. It describes the content and format of the homepage and the process of publication. Over a six-month period there were 892 visits to the site and 84 separate items of correspondence to the site's editors. Of these correspondence items, 36 were requesting further information regarding clinical and other programme information. Sixty-nine of the 84 communications came from North America and Europe. The pattern of readership is briefly discussed as are some of the potential advantages and challenges when utilizing this electronic medium. To promote the dissemination of reliable information on the Internet, the authors encourage other palliative care groups and organizations to publish on the WWW. The URL is http:/(/)www.palliative.org (previously http:/(/)www.caritas.ab.ca/approximately palliate).

Palliative radiotherapy for multiple myeloma

International Nuclear Information System (INIS)

Furusawa, Mitsuhiro; Baba, Yuji; Murakami, Ryuji; Yokoyama, Toshimi; Nishimura, Ryuichi; Uozumi, Hideaki; Takada, Chitose; Takahashi, Mutsumasa

1995-01-01

This study reviews the experience of palliative radiotherapy to patients with multiple myeloma to define the optimal dose for pain relief. The records of 31 patients (66 sites) with multiple myeloma irradiated for palliation at Kumamoto University hospital between 1985 and 1994 were reviewed. Total dose ranged from 8 to 50 Gy, with a mean of 32.2 Gy. Symptoms included pain (78.1%), neurological abnormalities (28.1%), and palpable masses (34.3%). Symptomatic remission was obtained in 45 of 46 evaluable sites (97.8%). Complete remission of symptoms were obtained in 28.3%, and partial remission in 69.6%. According to fraction size, there was no significant difference between 3-5 Gy and 1.8-2 Gy. The incidence of complete remission increased when a total dose of more than 20 Gy was given. When the quality of life is considered, hypofractionation was recommended for the palliative radiation therapy of multiple myeloma. (author)

Multifocal epilepsy: the role of palliative resection - intractable frontal and occipital lobe epilepsy secondary to radiotherapy for acute lymphoblastic leukaemia.

Science.gov (United States)

Radhakrishnan, Ashalatha; Sithinamsuwan, Pasiri; Harvey, A Simon; Flanagan, Danny; Fitt, Gregory; Berlangieri, Sam; Jackson, Graeme D; Berkovic, Samuel F; Scheffer, Ingrid E

2008-12-01

Patients with multifocal epilepsy are often considered unsuitable for epilepsy surgery. We report an adolescent with intractable frontal and occipital lobe seizures, secondary to complications of treatment for acute lymphoblastic leukaemia as a young child. Chemotherapy and radiotherapy were complicated by bilateral, posterior leukoencephalopathy and later an acquired frontal cerebral cavernous malformation (CCM). Detailed electro-clinical and imaging studies showed multiple, frontal lobe seizures per day with less frequent and non-debilitating, simple, occipital lobe seizures. Focal resection of the frontal CCM abolished the socially-disabling seizures with resultant marked improvement in the patient's quality of life at 12 months. Careful analysis of the type and impact of focal seizures in the setting of multifocal epilepsy may demonstrate that one seizure type is more deleterious to quality of life and may be amenable to surgery. In this situation, the patient may benefit significantly from surgery to resect the more active epileptic focus.

Augmented reality in bone tumour resection

Science.gov (United States)

Park, Y. K.; Gupta, S.; Yoon, C.; Han, I.; Kim, H-S.; Choi, H.; Hong, J.

2017-01-01

Objectives We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model. Methods We developed an AR-based navigation system for bone tumour resection, which could be used on a tablet PC. To simulate a bone tumour in the pig femur, a cortical window was made in the diaphysis and bone cement was inserted. A total of 133 pig femurs were used and tumour resection was simulated with AR-assisted resection (164 resection in 82 femurs, half by an orthropaedic oncology expert and half by an orthopaedic resident) and resection with the conventional method (82 resection in 41 femurs). In the conventional group, resection was performed after measuring the distance from the edge of the condyle to the expected resection margin with a ruler as per routine clinical practice. Results The mean error of 164 resections in 82 femurs in the AR group was 1.71 mm (0 to 6). The mean error of 82 resections in 41 femurs in the conventional resection group was 2.64 mm (0 to 11) (p Augmented reality in bone tumour resection: An experimental study. Bone Joint Res 2017;6:137–143. PMID:28258117

Improving aspects of palliative care for children

NARCIS (Netherlands)

Jagt, C.T.

2017-01-01

This thesis is about improving aspects of palliative care for children, and covers three different areas of quality of care. First of all, palliative care should be anticipating. To be able to deliver this anticipating care, caregivers should know what to expect. The first two chapters of the thesis

Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.

Science.gov (United States)

Hoek, Patrick; Grandjean, Ilse; Verhagen, Constans A H H V M; Jansen-Landheer, Marlies L E A; Schers, Henk J; Galesloot, Cilia; Vissers, Kris C P; Engels, Yvonne; Hasselaar, Jeroen G J

2015-01-01

Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation. We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations). We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations. Of the 44,443 initial consultations, most were requested by general practitioners (73%) and most concerned patients with cancer (86%). Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51-2.12) or COPD (OR 1.39; 95% CI: 1.15-1.69) than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22-1.40), agitation/delirium (OR 1.57; 95% CI: 1.47-1.68), exhaustion (OR 2.89; 95% CI: 2.61-3.20), euthanasia-related questions (OR 2.65; 95% CI: 2.37-2.96) or existential issues (OR 1.55; 95% CI: 1.31-1.83). In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.

Directory of Open Access Journals (Sweden)

Patrick Hoek

Full Text Available Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations. We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.Of the 44,443 initial consultations, most were requested by general practitioners (73% and most concerned patients with cancer (86%. Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51-2.12 or COPD (OR 1.39; 95% CI: 1.15-1.69 than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22-1.40, agitation/delirium (OR 1.57; 95% CI: 1.47-1.68, exhaustion (OR 2.89; 95% CI: 2.61-3.20, euthanasia-related questions (OR 2.65; 95% CI: 2.37-2.96 or existential issues (OR 1.55; 95% CI: 1.31-1.83.In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

Efficacy of intrathecal midazolam versus fentanyl for endoscopic

African Journals Online (AJOL)

intrathecal midazolam versus fentanyl as an adjunct to bupivacaine for endoscopic urology surgery. Methods: Sixty adult ASA grade I–II patients undergoing transurethral resection of prostate or bladder tumor under spinal block. Postoperative analgesia was provided with intravenous diclofenac. The onset and duration of ...

Low dose intravesical heparin as prophylaxis against recurrent noninvasive (stage Ta) bladder cancer

DEFF Research Database (Denmark)

Bitsch, M; Hermann, G G; Andersen, J P

1990-01-01

A controlled randomized clinical trial was conducted to examine the efficacy of topical low dose heparin (0.125 gm./l., 25,000 units per l.) as prophylaxis against recurrent noninvasive (stage Ta) transitional cell bladder cancer. Transurethral tumor resection was done with irrigation fluid conta...

Perioperative management of nonmuscle-invasive bladder cancer

NARCIS (Netherlands)

Falke, J.; Witjes, J.A.

2011-01-01

PURPOSE OF REVIEW: The management of nonmuscle-invasive bladder cancer is a challenge. Despite current guidelines, the treatment is suboptimal as illustrated by the high risk of recurrence and progression. Transurethral resection plays a pivotal role in the management of bladder cancer, but the

Download this PDF file

African Journals Online (AJOL)

Background: The pain fibers from the pelvic viscera including the prostate gland, the urinary bladder ... Method: Ten selected patients with obstructing benign prostatic enlargement on urethral ... assessment, were subjected to transurethral resection of the prostate gland (TURP) .... patients needed to come back before the.

Estrogen receptors in the human male bladder, prostatic urethra, and prostate. An immunohistochemical and biochemical study

DEFF Research Database (Denmark)

Bødker, A; Balslev, E; Juul, B R

1995-01-01

The distribution and quantity of estrogen receptors (ERs) in the human male bladder, prostatic urethra and the prostate were studied in eight males with recurrent papillomas of the bladder or monosymptomatic hematuria (median age 61 years), 14 men undergoing transurethral resection due to benign...

Endoscopic palliation in gastric cancer

International Nuclear Information System (INIS)

Valdivieso, Eduardo

2010-01-01

The integral search for improved living conditions for those patients with gastric cancer who have not received curative surgical treatment continues to challenge the knowledge, dexterity and ethical foundations of medical teams. The justification for palliative treatment must be based on a thorough consideration of the available options and the particular situation in each case. This article reviews endoscopic therapy with auto expandable prosthetics for palliative treatment of gastric cancer, as well as the scientific evidence that supports its use and the factors that determine its indication.

[Palliative home care in Westfalia-Lippe--baseline study 12 and 36 months after coming into effect of the "agreement to the implementation of ambulant home palliative careforterminally ill patients"].

Science.gov (United States)

Lux, E A; Althaus, A; Classen, B; Hilscher, H; Hofmeister, U; Holtappels, P; Mansfeld-Nies, R; Weller, H U

2013-07-25

On 2009-04-01 the Association of Statutory Health Insurance Physicians Westfalia-Lippe and health insurance organizations made an agreement to implement palliative home care for terminally ill patients. Based on this agreement, family doctors and palliativecardoctorscooperate,supported by coordinators. 12 and 36 months after coming into effect of the agreement a questionnaire was sent to the regional palliative care networks to collect data about supply structure, number of patients and their place of death. In the year 2011 85,410 people died in Westfalia-Lippe, 9.0% of them were included in palliative care structures. 69.5% of the included patients died at home, 9.9% in hospital (in 2010: 68.7% at home, 14.7% in hospital). A correlation between the population density or the number of included patients per palliative networkcould not be detected. Low-threshold access to palliative care networks(bothfamilydoctorand patientcancontact the palliative care team at any time) improves ambulant palliative care. Non-bureaucratic change from general home palliative care (German abbreviation: AAPV) to specialized home palliative care (SAPV) has proven successful in Westfalia-Lippe. Well-trained and experienced coordinators guarantee multidisciplinary and multiprofessional working of palliative care teams. In order to enhance palliative care in Westfalia-Lippe, data for quality assurance should be defined, periodically collected and evaluated in the future.

Paediatric palliative medicine

African Journals Online (AJOL)

of health workers to prescribe and/or administer morphine despite the availability of essential ... doses are complex, largely weight related, and side-effect profiles can differ from those of ... psychological, and social distress. • Effective palliative ...

PALLIATIVE CARE IN ROMANIA : NEEDS AND RIGHTS

NARCIS (Netherlands)

van den Heuvel, Wim J. A.; Olaroiu, Marinela

2008-01-01

Palliative care is directed to maintenance of quality of life and to prevent and to relief suffering of those with a life-threatening disease. Palliative care does not only concern the patient, but also the quality of life of family members and it deals with physical symptoms as well as with

[Knowledge and experience of palliative medicine among general practitioners in Germany].

Science.gov (United States)

Papke, J; Freier, W

2007-12-01

Levels of experience and competence in palliative medicine vary considerably among physicians. The aim of the study was to collect information from specially interested general practitioners on education, pivotal lectures and experience regarding the delivery of palliative care. 92 general practitioners (41 women and 22 men) attending a basic course in palliative medicine were asked to fill in a standardized questionnaire relating to their knowledge and experience of palliative medicine. 63 responded (68%), 54 in general private practice, nine worked in a hospital. The same number worked in urban and in rural health care facilities. The majority of those questioned (53%) gained their first experience in palliative medicine as junior hospital doctors about a quarter (26%) only after starting in private practice. Many of the doctors (31%) admitted to taking more interest in palliative medicine only after having made mistakes, a significant percentage (20%) after the death of a relative. 28% expressed the view that practical courses were an important part in learning about palliative medicine. The implementation of practice-based c tuition of medical students and of continuing education of established general practitioners and hospital physicians in palliative medicine is indispensable.

Significance of prostatic weight in prostatism

DEFF Research Database (Denmark)

Jensen, K M; Bruskewitz, R C; Iversen, P

1983-01-01

In addition to routine evaluation, 68 patients with prostatism underwent blinded urodynamic testing prior to transurethral prostatectomy and were reexamined symptomatologically and urodynamically at 3 and 12 months after surgery to determine if prostatic weight could predict postoperative outcome....... Resected prostatic weight correlated with estimated weight at cystoscopy and with obstructive symptoms, but not with urodynamic variables of infravesical obstruction. Patients with small prostates improved symptomatologically to the same degree as patients with larger glands, although they did not improve...... to the same degree urodynamically. Prostatic weight, therefore, could not be used to predict the outcome of transurethral surgery....

The views of patients with brain cancer about palliative care: a qualitative study.

Science.gov (United States)

Vierhout, M; Daniels, M; Mazzotta, P; Vlahos, J; Mason, W P; Bernstein, M

2017-12-01

Palliative care, a specialty aimed at providing optimal care to patients with life-limiting and chronic conditions, has several benefits. Although palliative care is appropriate for neurosurgical conditions, including brain cancer, few studies have examined the views of brain cancer patients about palliative care. We aimed to explore the thoughts of brain cancer patients about palliative care, their opinions about early palliative care, and their preferred care setting. Semi-structured interviews and the qualitative research methodologies of grounded theory were used to explore perceptions of palliative care on the part of 39 brain cancer outpatients. Seven overarching actions emerged: ■Patients would prefer to receive palliative care in the home.■Increased time with caregivers and family are the main appeals of home care.■Patients express dissatisfaction with brief and superficial interactions with health care providers.■Patients believe that palliative care can contribute to their emotional well-being.■Patients are open to palliative care if they believe that it will not diminish optimism.■There is a preconceived idea that palliative care is directly linked to active dying, and that supposed link generates fear in some patients.■Patients prefer to be educated about palliative care as an option early in their illness, even if they are fearful of it. Overall, when educated about the true meaning of palliative care, most patients express interest in accessing palliative care services. Although the level of fear concerning palliative care varies in patients, most recognize the associated benefits.

Improving communication on hope in palliative care. A qualitative study of palliative care professionals' metaphors of hope: grip, source, tune, and vision.

Science.gov (United States)

Olsman, Erik; Duggleby, Wendy; Nekolaichuk, Cheryl; Willems, Dick; Gagnon, Judith; Kruizinga, Renske; Leget, Carlo

2014-11-01

Hope is important in palliative care. However, palliative care professionals' perspectives on hope are not well understood. Metaphors of hope are a way of better understanding these perspectives. To describe palliative care professionals' perspectives on hope by examining the hope metaphors they spontaneously used to describe their own hope and their perspectives on the hope of patients and their families. Semistructured interviews with palliative care professionals were recorded, transcribed, and analyzed using a narrative approach. Results were discussed until the researchers reached consensus and reinforced by other health-care professionals and by observing several palliative care settings. The 64 participants (mean (SD) age, 48.42 (9.27) years and 72% female) were physicians (41%), nurses (34%), chaplains (20%), or other professionals (5%), working in Canada (19%) or The Netherlands (81%). Participants described the hope of patients, their families, or themselves as a 1) grip, which implied safety; 2) source, which implied strength; 3) tune, which implied harmony; and 4) vision, which implied a positive perspective. Compared with Dutch participants, Canadian participants generally put more emphasis on spirituality and letting go of their own hope as a grip (safety). Compared with other included professionals, physicians used hope as a grip (safety) most often, whereas chaplains used hope as a tune (harmony) most often. Our findings help to increase the understanding of hope and contribute to improving communication skills in palliative care professionals. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Pediatric Palliative Care Resources for You | NIH MedlinePlus the Magazine

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... Pediatric Palliative Care Resources for You Follow us Pediatric Palliative Care Resources for You Dealing with a ... The National Institute of Nursing Research (NINR) offers pediatric palliative care resources to help you, your family, ...

Organisation and Evaluation of General Palliative Care in a Danish Hospital

DEFF Research Database (Denmark)

Bergenholtz, Heidi; Hølge-Hazelton, Bibi; Jarlbæk, Lene

2015-01-01

and evaluation of generalist palliative care in hospitals. Therefore the aim of the study was to investigate the organization and evaluation of generalist palliative care in a large regional hospital by comparing results from existing evaluations. Methods: Results from three different data sets, all aiming...... of palliative care in order to identify concordances and/or discrepancies. Results: The triangulation indicated poor validity of the results from existing methods used to evaluate palliativecare in hospitals. When the datasets were compared, several discrepancies occurred with regard to the organizationand...... the performance of generalist palliative care. Five types of discrepancies were found in 35 out of 56 sections inthe fulfilment of the national accreditation standard for palliative care. Responses from the hospital management and the department managements indicated that generalist palliative care was organized...

Continuous palliative sedation for cancer and noncancer patients.

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Swart, Siebe J; Rietjens, Judith A C; van Zuylen, Lia; Zuurmond, Wouter W A; Perez, Roberto S G M; van der Maas, Paul J; van Delden, Johannes J M; van der Heide, Agnes

2012-02-01

Palliative care is often focused on cancer patients. Palliative sedation at the end of life is an intervention to address severe suffering in the last stage of life. To study the practice of continuous palliative sedation for both cancer and noncancer patients. In 2008, a structured questionnaire was sent to 1580 physicians regarding their last patient receiving continuous sedation until death. A total of 606 physicians (38%) filled out the questionnaire, of whom 370 (61%) reported on their last case of continuous sedation (cancer patients: n=282 [76%] and noncancer patients: n=88 [24%]). More often, noncancer patients were older, female, and not fully competent. Dyspnea (odds ratio [OR]=2.13; 95% confidence interval [CI]: 1.22, 3.72) and psychological exhaustion (OR=2.64; 95% CI: 1.26, 5.55) were more often a decisive indication for continuous sedation for these patients. A palliative care team was consulted less often for noncancer patients (OR=0.45; 95% CI: 0.21, 0.96). Also, preceding sedation, euthanasia was discussed less often with noncancer patients (OR=0.42; 95% CI: 0.24, 0.73), whereas their relatives more often initiated discussion about euthanasia than relatives of cancer patients (OR=3.75; 95% CI: 1.26, 11.20). The practice of continuous palliative sedation in patients dying of cancer differs from patients dying of other diseases. These differences seem to be related to the less predictable course of noncancer diseases, which may reduce physicians' awareness of the imminence of death. Increased attention to noncancer diseases in palliative care practice and research is, therefore, crucial as is more attention to the potential benefits of palliative care consultation. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Development and Implementation of a Pediatric Palliative Care Program in a Developing Country

Directory of Open Access Journals (Sweden)

Megan Doherty

2018-04-01

Full Text Available BackgroundPalliative care is recognized as an important component of care for children with cancer and other life-limiting conditions. In resource limited settings, palliative care is a key component of care for children with cancer and other life-limiting conditions. Globally, 98% of children who need palliative care live in low- or middle-income countries, where there are very few palliative care services available. There is limited evidence describing the practical considerations for the development and implementation of sustainable and cost-effective palliative care services in developing countries.ObjectivesOur aim is to describe the key considerations and initiatives that were successful in planning and implementing a hospital-based pediatric palliative care service specifically designed for a resource-limited setting.SettingBangabandu Sheikh Mujib Medical University (BSMMU is a tertiary referral hospital in Bangladesh. Local palliative care services are very limited and focused on adult patients. In partnership with World Child Cancer, a project establishing a pediatric palliative care service was developed for children with cancer at BSMMU.ResultsWe describe four key elements which were crucial for the success of this program: (1 raising awareness and sensitizing hospital administrators and clinical staff about pediatric palliative care; (2 providing education and training on pediatric palliative care for clinical staff; (3 forming a pediatric palliative care team; and (4 collecting data to characterize the need for pediatric palliative care.ConclusionThis model of a hospital-based pediatric palliative care service can be replicated in other resource-limited settings and can be expanded to include children with other life-limiting conditions. The development of pilot programs can generate interest among local physicians to become trained in pediatric palliative care and can be used to advocate for the palliative care needs of children.

Palliative and low cost radiotherapy in developing countries

International Nuclear Information System (INIS)

Allen, Barry; Hussein, S.M.A.

2011-01-01

Full text: The International Agency for Research on Cancer predicts that cancer incidence in developing countries will increase dramatically in the first two decades of this millennium. Already some 80% of cancer patients in developing countries present with incurable disease. In many cases pain is a severe problem and palliation is needed to improve quality of life as well as extending survival. This paper will consider the physical and clinical aspects of palliative radiotherapy (PRT), choice of radiation modality, alternative approaches to imaging and therapy and cost-benefit considerations. The potential benefits of a dedicated palliative care centre include lower cost and therefore more centres, enabling more patients access to regional palliative care. Simple curative treatments could also be managed. Co60 radiotherapy has important advantages in developing countries, because of the higher initial cost of a linear accelerator, as well as the need for reliable power supply and the level of skill required by linac technicians and physicists. The beam characteristics of both Co60 units and low energy linacs are compared and both are found to be acceptable for palliation. The role of palliative and low cost radiotherapy in Bangladesh is reviewed. The concept of telemedicine is also discussed, using mobile phones and internet communication to allow rural clinics to receive support from specialists based in the cities, to send images for remote diagnosis and remote dose planning for radiotherapy.

Overcoming recruitment challenges in palliative care clinical trials.

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LeBlanc, Thomas W; Lodato, Jordan E; Currow, David C; Abernethy, Amy P

2013-11-01

Palliative care is increasingly viewed as a necessary component of cancer care, especially for patients with advanced disease. Rigorous clinical trials are thus needed to build the palliative care evidence base, but clinical research-especially participant recruitment-is difficult. Major barriers include (1) patient factors, (2) "gatekeeping," and (3) ethical concerns. Here we discuss an approach to overcoming these barriers, using the Palliative Care Trial (PCT) as a case study. The PCT was a 2 × 2 × 2 factorial randomized controlled trial (RCT) of different service delivery models to improve pain control in the palliative setting. It used a recruitment protocol that fused evidence-based strategies with principles of "social marketing," an approach involving the systematic application of marketing techniques. Main components included (1) an inclusive triage algorithm, (2) information booklets targeting particular stakeholders, (3) a specialized recruitment nurse, and (4) standardization of wording across all study communications. From an eligible pool of 607 patients, the PCT enrolled 461 patients over 26 months. Twenty percent of patients referred to the palliative care service were enrolled (76% of those eligible after screening). Several common barriers were minimized; among those who declined participation, family disinterest was uncommon (5%), as was the perception of burden imposed (4%). Challenges to clinical trial recruitment in palliative care are significant but not insurmountable. A carefully crafted recruitment and retention protocol can be effective. Our experience with designing and deploying a social-marketing-based protocol shows the benefits of such an approach.

A team approach in palliative care: enhancing outcomes.

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Schrader, Susan L; Horner, Arlene; Eidsness, LuAnn; Young, Sandy; Wright, Chris; Robinson, Michael

2002-07-01

While most Americans envision a "good death" as one occurring quickly and painlessly at home surrounded by loved ones, many people do not die in this fashion. Palliative care focuses on holistic treatment of patients whose disease is not responsive to curative treatment, and strives to improve quality of life for patients and families at end-of-life (EOL). This hospital-based study examines the extent to which a palliative care consultant team makes a difference in EOL for patients and families. Data were collected from a convenience sample of 50 hospitalized patients referred to an interdisciplinary palliative care consulting team at a South Dakota tertiary hospital during 2001. Various palliative care interventions were introduced during the course of hospitalization, and data were collected two days later to see if quality of life had improved. Statistically significant improvements were found in pain levels, non-pain symptom management, numerous psychosocial measures of quality of life, change in code status, and perceptions of communication and treatment during hospitalization. The study demonstrates that consultations with a palliative care team are beneficial and enhance the EOL experience for patients and families.

Physician Perspectives on Palliative Care for Children With Neuroblastoma: An International Context.

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Balkin, Emily M; Thompson, Daria; Colson, K Ellicott; Lam, Catherine G; Matthay, Katherine K

2016-05-01

Studies have shown that children with cancer globally lack access to palliative care. Little is known regarding physicians' perceptions of palliative care, treatment access, and self-reported competence in providing palliative care. Members of the Global Neuroblastoma Network (online tumor board) were surveyed. Eighty-three respondents met inclusion criteria; 53 (64%) completed the survey. Most respondents trained in high-income countries (HIC) but practice in low- and middle-income countries (LMIC), and care for more than five patients with neuroblastoma annually. WHO Essential Medicines in palliative care varied in availability, with incomplete access across LMIC centers. Nonpharmacologic therapies were inconsistently available. Contrary to international definitions, 17% of respondents inappropriately considered palliative care as that initiated only after curative therapy is stopped. Mean physician competence composite score (Likert scale 1-5, 5 = very competent) in providing symptomatic relief and palliative care across phases of care was 2.93 (95% CI 2.71-3.22). Physicians reported significantly greater competence in symptom management during cure-directed therapy than during end-of-life (P = 0.02) or when patients are actively dying (P = 0.007). Practicing in HIC, prior palliative care training, having access to radiotherapy, and not having to turn patients away due to bed shortages were significantly predictive of perceived competence in providing palliative care at end of life. An international sample identified gaps in treatment and palliative care service availability, in understanding the definition of palliative care, and in self-reported competence in providing palliative care. Increased perceived competence was associated with training, which supports the need for increased palliative care education and advocacy, especially in LMIC. © 2016 Wiley Periodicals, Inc.

Right trisectionectomy with principle en bloc portal vein resection for right-sided hilar cholangiocarcinoma: no-touch technique.

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Machado, Marcel Autran; Makdissi, Fabio F; Surjan, Rodrigo C

2012-04-01

The most favorable long-term survival rate for hilar cholangiocarcinoma is achieved by a R0 resection. A surgical concept involving a no-touch technique, with extended right hepatic resections and principle en bloc portal vein resection was described by Neuhaus et al. According to Neuhaus et al., their technique may increase the chance of R0, because the right branch of the portal vein and hepatic artery is in close contact with the tumor and is frequently infiltrated. The left artery runs on the left margin of the hilum and often is free. The 5-year survival rate for their patients is 61% but 60-day mortality rate is 8%. Given the increased morbidity, some authors do not agree with routine resection of portal vein and may perform the resection of portal vein only on demand, after intraoperative assessment and confirmation of portal vein invasion. This video shows en bloc resection of extrahepatic bile ducts, portal vein bifurcation, and right hepatic artery, together with extended right trisectionectomy (removal of segments 1, 4, 5, 6, 7, and 8). A 75-year-old man with progressive jaundice due to right-sided hilar cholangiocarcinoma underwent percutaneous biliary drainage with metallic stents for palliation. The patient was referred for a second opinion. Serum bilirubin levels were normal, and CT scan showed a resectable tumor, but volumetry showed a small left liver remnant. Right portal vein embolization was then performed, and CT scan performed after 4 weeks showed adequate compensatory hypertrophy of the future liver remnant (segments 2 and 3). Surgical decision was to perform a right trisectionectomy with en bloc portal vein and bile duct resection using the no-touch technique. The operation began with hilar lymphadenectomy. The common bile duct is sectioned. Right hepatic artery is ligated. Left hepatic artery is encircled. Portal vein is dissected and encircled. Right liver is mobilized and detached from retrohepatic vena cava. Right and middle hepatic

Downsizing Treatment with Tyrosine Kinase Inhibitors in Patients with Advanced Gastrointestinal Stromal Tumors Improved Resectability

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Sjölund, Katarina; Andersson, Anna; Nilsson, Erik; Nilsson, Ola; Ahlman, Håkan

2010-01-01

Background Gastrointestinal stromal tumors (GISTs) express the receptor tyrosine kinase KIT. Most GISTs have mutations in the KIT or PDGFRA gene, causing activation of tyrosine kinase. Imatinib, a tyrosine kinase inhibitor (TKI), is the first-line palliative treatment for advanced GISTs. Sunitinib was introduced for patients with mutations not responsive to imatinib. The aim was to compare the survival of patients with high-risk resected GISTs treated with TKI prior to surgery with historical controls and to determine if organ-preserving surgery was facilitated. Methods Ten high-risk GIST-patients had downsizing/adjuvant TKI treatment: nine with imatinib and one with sunitinib. The patients were matched with historical controls (n = 89) treated with surgery alone, from our population-based series (n = 259). Mutational analysis of KIT and PDGFRA was performed in all cases. The progression-free survival was calculated. Results The primary tumors decreased in mean diameter from 20.4 cm to 10.5 cm on downsizing imatinib. Four patients with R0 resection and a period of adjuvant imatinib had no recurrences versus 67% in the historical control group. Four patients with residual liver metastases have stable disease on continuous imatinib treatment after surgery. One patient has undergone reoperation with liver resection. The downsizing treatment led to organ-preserving surgery in nine patients and improved preoperative nutritional status in one patient. Conclusions Downsizing TKI is recommended for patients with bulky tumors with invasion of adjacent organs. Sunitinib can be used for patients in case of imatinib resistance (e.g., wild-type GISTs), underlining the importance of mutational analysis for optimal surgical planning. PMID:20512492

The proportionate value of proportionality in palliative sedation.

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Berger, Jeffrey T

2014-01-01

Proportionality, as it pertains to palliative sedation, is the notion that sedation should be induced at the lowest degree effective for symptom control, so that the patient's consciousness may be preserved. The pursuit of proportionality in palliative sedation is a widely accepted imperative advocated in position statements and guidelines on this treatment. The priority assigned to the pursuit of proportionality, and the extent to which it is relevant for patients who qualify for palliative sedation, have been overstated. Copyright 2014 The Journal of Clinical Ethics. All rights reserved.

Palliative care for Parkinson's disease: Patient and carer's perspectives explored through qualitative interview.

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Fox, Siobhan; Cashell, Alison; Kernohan, W George; Lynch, Marie; McGlade, Ciara; O'Brien, Tony; O'Sullivan, Sean S; Foley, Mary J; Timmons, Suzanne

2017-07-01

Palliative care is recommended for non-malignant illnesses, including Parkinson's disease. However, past research with healthcare workers highlights unmet palliative needs in this population and referral rates to Specialist Palliative Care are low. Some healthcare workers perceive a 'fear' in their patients about introducing palliative care. However, less is known about the views of people with Parkinson's disease and their carers about palliative care. (1) To explore the palliative care and related issues most affecting people with Parkinson's disease and their families and (2) to examine perceptions about/understanding of palliative care. This was a qualitative study; semi-structured interviews were conducted, transcribed and analysed using thematic analysis. A total of 31 people participated, both people with Parkinson's disease ( n = 19) and carers ( n = 12), across three Movement Disorder Clinics in the Republic of Ireland. People with Parkinson's disease and their carers were unfamiliar with the term palliative care. When informed of the role of palliative care, most felt that they would benefit from this input. People with Parkinson's disease and carers experienced a high illness burden and wanted extra support. Crises requiring Specialist Palliative Care involvement may occur at diagnosis and later, with advancing illness. Participants wanted more information about palliative care and especially further supports to address their psychosocial needs. A holistic palliative care approach could address the complex physical and psychosocial symptoms experienced by people with Parkinson's disease and their carers, and people with Parkinson's disease and their carers are open to palliative care. Further research needs to explore how palliative care can be introduced into the routine care for people with Parkinson's disease.

Establishment and preliminary outcomes of a palliative care research network.

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Hudson, Peter; Street, Annette; Graham, Suzanne; Aranda, Sanchia; O'Connor, Margaret; Thomas, Kristina; Jackson, Kate; Spruyt, Odette; Ugalde, Anna; Philip, Jennifer

2016-02-01

The difficulties in conducting palliative care research have been widely acknowledged. In order to generate the evidence needed to underpin palliative care provision, collaborative research is considered essential. Prior to formalizing the development of a research network for the state of Victoria, Australia, a preliminary study was undertaken to ascertain interest and recommendations for the design of such a collaboration. Three data-collection strategies were used: a cross-sectional questionnaire, interviews, and workshops. The questionnaire was completed by multidisciplinary palliative care specialists from across the state (n = 61); interviews were conducted with senior clinicians and academics (n = 21) followed by two stakeholder workshops (n = 29). The questionnaire was constructed specifically for this study, measuring involvement of and perceptions of palliative care research. Both the interview and the questionnaire data demonstrated strong support for a palliative care research network and aided in establishing a research agenda. The stakeholder workshops assisted with strategies for the formation of the Palliative Care Research Network Victoria (PCRNV) and guided the development of the mission and strategic plan. The research and efforts to date to establish the PCRNV are encouraging and provide optimism for the evolution of palliative care research in Australia. The international implications are highlighted.

Core attitudes of professionals in palliative care: a qualitative study.

Science.gov (United States)

Simon, Steffen T; Ramsenthaler, Christina; Bausewein, Claudia; Krischke, Norbert; Geiss, Gerlinde

2009-08-01

Self-awareness of one's own reactions towards patients and their relatives is of paramount importance for all professionals in palliative care. 'Core attitude' describes the way in which a person perceives himself and the world, and forms the basis for his actions and thoughts. The aim of this study is to explore what core attitude means for palliative care professionals and whether there is a specific core attitude in palliative care. Qualitative study with 10 face-to-face in-depth interviews with experts in palliative care (nurses, physicians, social workers, psychologists, chaplain) in Germany. Core attitude in palliative care can be best described with the following three domains: 1) personal characteristics; 2) experience of care; and 3) competence in care. Authenticity is the most important characteristic of professionals, along with honesty and mindfulness. Core attitude primarily becomes apparent in the relationship with the patient. Perception and listening are key competences. The experts emphasized the universality of the core attitude in the care of ill people. They stressed the importance and relevance of teaching core attitudes in palliative care education. In the field of palliative care, core attitude consists predominately of authenticity, manifests itself in relationships, and requires a high degree of perceptiveness.

Smarter palliative care for cancer: Use of smartphone applications

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Nisha Rani Jamwal

2016-01-01

Full Text Available Smartphones are technologically advanced mobile phone devices which use software similar to computer-based devices as a user-friendly interface. This review article is aimed to inform the palliative care professionals, cancer patients and their caregivers about the role of smartphone applications (apps in the delivery of palliative care services, through a brief review of existing literature on the development, feasibility, analysis, and effectiveness of such apps. There is a dearth need for sincere palliative care clinicians to work together with software professionals to develop the suitable smartphone apps in accordance with the family/caregivers' necessities and patients' biopsychosocial characteristics that influence the technology driven evidence informed palliative cancer care.

Palliative sedation: from the family perspective.

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Vayne-Bossert, Petra; Zulian, Gilbert B

2013-12-01

Palliative sedation (PS) is a treatment option in case of refractory symptoms at the end of life. The emotional impact on nurses and doctors has been widely studied. We explore the experience of family members during a PS procedure. An anonymous questionnaire was sent to the closest family members (n = 17) of patients who died while receiving palliative sedation. The response rate was 59% (10 of 17). Nine relatives were sufficiently informed about PS. In all, 70% evaluated the chosen moment for initiation of PS as adequate. All the relatives noticed a significant improvement in the refractory symptom with a mean reduction in the estimated suffering of 6.25 points on a visual analog scale. Palliative sedation should be performed in the best possible way for the patient and his family in order to efficiently reduce a refractory symptom.

Optimizing the diagnosis and treatment of bladder cancer using fluorescence cystoscopy and Raman spectroscopy

NARCIS (Netherlands)

Draga, R.O.P.

2013-01-01

The gold standard for the diagnosis and treatment of bladder cancer is transurethral resection of bladder tumors (TURBT). A relative high recurrence rate and the need for repeated treatments make bladder cancer one the most expensive cancers from diagnosis till death of the patient. The TURBT

Post TURP obliterative urethral stricture: Unusual presentation and ...

African Journals Online (AJOL)

A. Bhageria

on combination drug treatment (Tamsulosin + Dutasteride) since 9 months with no symptomatic improvement. Patient was diagnosed as a case of benign enlargement of the prostate with failed med- ical management and underwent monopolar TURP (transurethral resection of the prostate). Duration of TURP was 45 min ...

Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode laser system: results of an evolving technology

NARCIS (Netherlands)

Mårtenson, A. C.; de la Rosette, J. J. M. C. H.

1999-01-01

Interstitial laser coagulation (ILC) treatment is a recent technique in the treatment of BPH that is evolving rapidly. The results of a prospective randomised study vs transurethral resection of the prostate (TURP) is presented as well as results of patients treated with a temperature sensing laser

Relieving existential suffering through palliative sedation: discussion of an uneasy practice.

Science.gov (United States)

Bruce, Anne; Boston, Patricia

2011-12-01

This article presents a discussion of the use of palliative sedation in response to intractable (not responsive to treatment) existential suffering. Patients suffering from a terminal illness are often faced with severe symptoms at the end of life. Although palliative sedation is sometimes used when no other options are effective in relieving unbearable pain or suffering, its use in response to intractable existential suffering in terminal illness remains controversial. A literature search was conducted for published articles addressing the use of palliative sedation between 1996 and 2009 using established databases. Palliative sedation remains an uneasy practice. The debates have centred on ethical issues surrounding decisions to use sedation and on separating the intent of palliative sedation (relief of intolerable symptoms) from the intent of euthanasia (hastening death). There is lack of consensus in defining existential suffering. Consequently, there is limited understanding of how decisions are being made when using palliative sedation to treat intractable existential suffering. Given the confusion and uncertainty about ethical and clinical justifications for palliative sedation in treating existential suffering, we argue that a better understanding of the controversies and decision-making process is needed. Greater understanding is required to prevent palliative sedation from becoming a substitute for intensive treatment of this kind of suffering. © 2011 Blackwell Publishing Ltd.

Palliative Care To The Elderly Patient With Cancer: Speech Of Nurses

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Irany Carvalho da Silva

2017-02-01

Full Text Available Palliative care is aimed at people with diseases without perspective of cure or terminally, aiming to provide a better quality of life. This study aims to investigating the discourse of nurses about their understanding of palliative care to elderly patient with cancer and identify strategies used by nurses to promote palliative care to the elderly cancer patient. It is an exploratory research of a qualitative nature, carried out with thirteen nurses from a philanthropic institution in the city of João Pessoa, through a questionnaire. The empirical material was subjected to thematic content analysis, resulting in three categories: design of nurses to assist the elderly in Palliative Care: promoting comfort and minimizing the suffering, the importance of palliative care in humanized care to the elderly with cancer and strategies for the Promotion of Care of the Elderly with Cancer. Participants highlighted the palliative care as essential in the humanization of care, ensuring the dignity and quality of life among the elderly with cancer without possibilities of cure, adding such assistance, the family. Keywords: Palliative Care; Nurse; Elderly; Cancer.

Knowledge in palliative care of nursing professionals at a Spanish hospital

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Elena Chover-Sierra

2017-10-01

Full Text Available Resume Objective: to determine the level of knowledge in palliative care of nursing staff at a Spanish tertiary care hospital. Method: descriptive, cross-sectional study. Data were collected about the results of the Spanish version of the Palliative Care Quiz for Nurses (PCQN, sociodemographic aspects, education level and experience in the field of palliative care. Univariate and bivariate descriptive analysis was applied. Statistical significance was set at p < 0.05 in all cases. Results: 159 professionals participated (mean age 39.51 years ± 10.25, with 13.96 years ± 10.79 of professional experience 54.7% possessed experience in palliative care and 64.2% educational background (mainly basic education. The mean percentage of hits on the quiz was 54%, with statistically significant differences in function of the participants’ education and experience in palliative care. Conclusions: although the participants show sufficient knowledge on palliative care, they would benefit from a specific training program, in function of the mistaken concepts identified through the quiz, which showed to be a useful tool to diagnose professionals’ educational needs in palliative care.

Histiocytic sarcoma with bladder involvement: Case report and literature review.

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Fernández-Aceñero, Mª Jesús; Pérez Alonso, Pablo; Díaz Del Arco, Cristina

We report an unusual case of histiocytic sarcoma with bladder involvement. An 80 year-old man with a previous history of diffuse large B-cell malignant lymphoma presented with hematuria and back pain. Serial urine cytologies revealed no urothelial malignant cells, but cystoscopy showed a large intravesical mass. The patient underwent transurethral resection (TUR) of the tumor. The bladder TUR specimen showed a widely infiltrating epithelioid neoplasm, with intense immunohistochemical positivity for CD45 and histiocytic markers (CD68, lysozime and fascin). Histopathological diagnosis was histiocytic sarcoma. As the patient's condition was progressively deteriorating, only palliative care was indicated and he died one month after TUR. Although histiocytic sarcoma can often be widespread at the time of diagnosis, to our knowledge, this is the first report of a case presenting with urinary symptoms. Histiocytic sarcoma can mimic many other malignant lesions, and only immunohistochemistry can define the tumor cells, allowing correct therapy. We discuss the differential diagnosis and possible associations. Copyright © 2017 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.

Highly directional transurethral ultrasound applicators with rotational control for MRI-guided prostatic thermal therapy

Energy Technology Data Exchange (ETDEWEB)

Ross, Anthony B [Thermal Therapy Research Group, UCSF Radiation Oncology, San Francisco, CA (United States); Diederich, Chris J [Thermal Therapy Research Group, UCSF Radiation Oncology, San Francisco, CA (United States); Nau, William H [Thermal Therapy Research Group, UCSF Radiation Oncology, San Francisco, CA (United States); Gill, Harcharan [Department of Urology, Stanford University, Stanford, CA (United States); Bouley, Donna M [Department of Comparative Medicine, Stanford University, Stanford, CA (United States); Daniel, Bruce [Department of Radiology, Stanford University, Stanford, CA (United States); Rieke, Viola [Department of Radiology, Stanford University, Stanford, CA (United States); Butts, R Kim [Department of Radiology, Stanford University, Stanford, CA (United States); Sommer, Graham [Department of Radiology, Stanford University, Stanford, CA (United States)

2004-01-21

Transurethral ultrasound applicators with highly directional energy deposition and rotational control were investigated for precise treatment of benign prostatic hyperplasia (BPH) and adenocarcinoma of the prostate (CaP). Two types of catheter-based applicators were fabricated, using either sectored tubular (3.5 mm OD x 10 mm) or planar transducers (3.5 mm x 10 mm). They were constructed to be MRI compatible, minimally invasive and allow for manual rotation of the transducer array within a 10 mm cooling balloon. In vivo evaluations of the applicators were performed in canine prostates (n 3) using MRI guidance (0.5 T interventional magnet). MR temperature imaging (MRTI) utilizing the proton resonance frequency shift method was used to acquire multiple-slice temperature overlays in real time for monitoring and guiding the thermal treatments. Post-treatment T1-weighted contrast-enhanced imaging and triphenyl tetrazolium chloride stained tissue sections were used to define regions of tissue coagulation. Single sonications with the tubular applicator ) produced coagulated zones covering a wedge of the prostate extending from 1-2 mm outside the urethra to the outer boundary of the gland (16 mm radial coagulation). Single sonications with the planar applicator (15-20 W, 10 min, {approx}8 MHz) generated thermal lesions of {approx}30 extending to the prostate boundary. Multiple sequential sonications (sweeping) of a planar applicator (12 W with eight rotations of 30 each) demonstrated controllable coagulation of a 270 contiguous section of the prostate extending to the capsule boundary. The feasibility of using highly directional transurethral ultrasound applicators with rotational capabilities to selectively coagulate regions of the prostate while monitoring and controlling the treatments with MRTI was demonstrated in this study.

Internship report on palliative care at St Catherine's hospice

OpenAIRE

Monteiro, Andreia Marlene da Silva

2016-01-01

This report, performed in the context of the completion of the masters in Palliative Care, presents the activities and learning experiences that I have acquired during the months of training in the different settings of palliative care. This internship was performed at St Catherine’s Hospice (Inpatient unit, Day hospice and Community team) and with the National Health Service of East Surrey Hospital Specialist Palliative Care Team. Alongside the institutional involvement, internship activitie...

Practice Patterns, Attitudes, and Barriers to Palliative Care Consultation by Gynecologic Oncologists.

Science.gov (United States)

Buckley de Meritens, Alexandre; Margolis, Benjamin; Blinderman, Craig; Prigerson, Holly G; Maciejewski, Paul K; Shen, Megan J; Hou, June Y; Burke, William M; Wright, Jason D; Tergas, Ana I

2017-09-01

We sought to describe practice patterns, attitudes, and barriers to the integration of palliative care services by gynecologic oncologists. Members of the Society of Gynecologic Oncology were electronically surveyed regarding their practice of incorporating palliative care services and to identify barriers for consultation. Descriptive statistics were used, and two-sample z-tests of proportions were performed to compare responses to related questions. Of the 145 respondents, 71% were attending physicians and 58% worked at an academic medical center. The vast majority (92%) had palliative care services available for consultation at their hospital; 48% thought that palliative care services were appropriately used, 51% thought they were underused, and 1% thought they were overused. Thirty percent of respondents thought that palliative care services should be incorporated at first recurrence, whereas 42% thought palliative care should be incorporated when prognosis for life expectancy is ≤ 6 months. Most participants (75%) responded that palliative care consultation is reasonable for symptom control at any stage of disease. Respondents were most likely to consult palliative care services for pain control (53%) and other symptoms (63%). Eighty-three percent of respondents thought that communicating prognosis is the primary team's responsibility, whereas the responsibilities for pain and symptom control, resuscitation status, and goals of care discussions were split between the primary team only and both teams. The main barrier for consulting palliative care services was the concern that patients and families would feel abandoned by the primary oncologist (73%). Ninety-seven percent of respondents answered that palliative care services are useful to improve patient care. The majority of gynecologic oncologists perceived palliative care as a useful collaboration that is underused. Fear of perceived abandonment by the patient and family members was identified as a

Function of local networks in palliative care: a Dutch view.

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Nikbakht-Van de Sande, C V M Vahedi; van der Rijt, C C D; Visser, A Ph; ten Voorde, M A; Pruyn, J F A

2005-08-01

Although network formation is considered an effective method of stimulating the integrated delivery of palliative care, scientific evidence on the usefulness of network formation is scarce. In 1998 the Ministry of Health of The Netherlands started a 5-year stimulation program on palliative care by founding and funding six regional Centres for the Development of Palliative Care. These centers were structured around pivotal organizations such as university hospitals and comprehensive cancer centers. As part of the stimulation program a locoregional network model was introduced within each center for the Development of Palliative Care to integrate palliative care services in the Dutch health care system. We performed a study on network formation in the southwestern area of The Netherlands with 2.4 million inhabitants. The study aimed to answer the following questions: (1) how do networks in palliative care develop, which care providers participate and how do they function? (2) which are the achievements of the palliative care networks as perceived by their participants? (3) which are the success factors of the palliative care networks according to their participants and which factors predict the achievements? Between September 2000 and January 2004 eight local palliative care networks in the region of the Center for Development of Palliative Care-Rotterdam (southwestern area of The Netherlands) were closely followed to gain information on their characteristics and developmental course. At the start of the study semistructured interviews were held with the coordinators of the eight networks. The information from these interviews and from the network documents were used to constitute a questionnaire to assess the opinions and experiences of the network participants. According to the vast majority of responders, the most important reason to install the networks was the lack of integration between the existing local health care services. The networks were initiated to

The role of dentist in palliative care team

Directory of Open Access Journals (Sweden)

Rani P Mol

2010-01-01

Full Text Available The palliative doctor gives the ′touch of God′ as he/she takes care of the terminally ill patient. The oncologist encounters great difficulties in managing oral cavity problems of these patients. A trained dental doctor can help other doctors in dealing with these situations. But the general dental surgeon does not have enough idea about his part in these treatments. The community is also unaware of the role that a nearby dentist can play. Adequate training programs have to be conducted and awareness has to be created. A trained dentist will be a good team mate for the oncologist or radiotherapist or other doctors of the palliative care team. In this paper, a brief attempt is made to list a few areas in which a palliative care dentist can help other members of the palliative care team and also the patient in leading a better life.

Differential Family Experience of Palliative Sedation Therapy in Specialized Palliative or Critical Care Units.

Science.gov (United States)

Shen, Hui-Shan; Chen, Szu-Yin; Cheung, Denise Shuk Ting; Wang, Shu-Yi; Lee, Jung Jae; Lin, Chia-Chin

2018-02-21

No study has examined the varying family experience of palliative sedation therapy (PST) for terminally ill patients in different settings. To examine and compare family concerns about PST use and its effect on the grief suffered by terminally ill patients' families in palliative care units (PCUs) or intensive care units (ICUs). A total of 154 family members of such patients were recruited in Taiwan, of whom 143 completed the study, with 81 from the PCU and 62 from the ICU. Data were collected on their concerns regarding PST during recruitment. Grief levels were assessed at three days and one month after the patient's death with the Texas Revised Inventory of Grief. Families' major concern about sedated patients in the PCU was that "there might be other ways to relieve symptoms" (90.2%), whereas families of ICU sedated patients gave the highest ratings to "feeling they still had something more to do" (93.55%), and "the patient's sleeping condition was not dignified" (93.55%). Family members recruited from the ICU tended to experience more grief than those from the PCU (P = 0.005 at Day 3 and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Satisfaction with palliative care after stroke: a prospective cohort study.

Science.gov (United States)

Blacquiere, Dylan; Bhimji, Khadija; Meggison, Hilary; Sinclair, John; Sharma, Michael

2013-09-01

The determinants of satisfaction for families of acute stroke patients receiving palliative care have not been extensively studied. We surveyed families to determine how they perceived palliative care after stroke. Families of patients palliated after ischemic stroke, intracerebral, or subarachnoid hemorrhage were approached. Four weeks after the patient's death, families were administered the After-Death Bereaved Family Member Interview to determine satisfaction with the care provided. Fifteen families participated. Families were most satisfied with participation in decision making and least satisfied with attention to emotional needs. In stroke-specific domains, families had less satisfaction with artificial feeding, hydration, and communication. Overall satisfaction was high (9.04 out of 10). Families of patients receiving palliative care at our institution showed generally high satisfaction with palliation after stroke; specific domains were identified for improvement. Further study in larger populations is required.

Age Disparity in Palliative Radiation Therapy Among Patients With Advanced Cancer

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Wong, Jonathan [University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii (United States); Xu, Beibei [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Yeung, Heidi N.; Roeland, Eric J. [Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Division of Palliative Medicine, Department of Internal Medicine, University of California San Diego, La Jolla, California (United States); Martinez, Maria Elena [Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California (United States); Le, Quynh-Thu [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Mell, Loren K. [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Moores Cancer Center, University of California San Diego, La Jolla, California (United States); Murphy, James D., E-mail: j2murphy@ucsd.edu [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States); Moores Cancer Center, University of California San Diego, La Jolla, California (United States)

2014-09-01

Purpose/Objective: Palliative radiation therapy represents an important treatment option among patients with advanced cancer, although research shows decreased use among older patients. This study evaluated age-related patterns of palliative radiation use among an elderly Medicare population. Methods and Materials: We identified 63,221 patients with metastatic lung, breast, prostate, or colorectal cancer diagnosed between 2000 and 2007 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Receipt of palliative radiation therapy was extracted from Medicare claims. Multivariate Poisson regression analysis determined residual age-related disparity in the receipt of palliative radiation therapy after controlling for confounding covariates including age-related differences in patient and demographic covariates, length of life, and patient preferences for aggressive cancer therapy. Results: The use of radiation decreased steadily with increasing patient age. Forty-two percent of patients aged 66 to 69 received palliative radiation therapy. Rates of palliative radiation decreased to 38%, 32%, 24%, and 14% among patients aged 70 to 74, 75 to 79, 80 to 84, and over 85, respectively. Multivariate analysis found that confounding covariates attenuated these findings, although the decreased relative rate of palliative radiation therapy among the elderly remained clinically and statistically significant. On multivariate analysis, compared to patients 66 to 69 years old, those aged 70 to 74, 75 to 79, 80 to 84, and over 85 had a 7%, 15%, 25%, and 44% decreased rate of receiving palliative radiation, respectively (all P<.0001). Conclusions: Age disparity with palliative radiation therapy exists among older cancer patients. Further research should strive to identify barriers to palliative radiation among the elderly, and extra effort should be made to give older patients the opportunity to receive this quality of life-enhancing treatment at the end

An Australian casemix classification for palliative care: technical development and results.

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Eagar, Kathy; Green, Janette; Gordon, Robert

2004-04-01

To develop a palliative care casemix classification for use in all settings including hospital, hospice and home-based care. 3866 palliative care patients who, in a three-month period, had 4596 episodes of care provided by 58 palliative care services in Australia and New Zealand. A detailed clinical and service utilization profile was collected on each patient with staff time and other resources measured on a daily basis. Each day of care was costed using actual cost data from each study site. Regression tree analysis was used to group episodes of care with similar costs and clinical characteristics. In the resulting classification, the Australian National Sub-acute and Non-acute Patient (AN-SNAP) Classification Version 1, the branch for classifying inpatient palliative care episodes (including hospice care) has 11 classes and explains 20.98% of the variance in inpatient palliative care phase costs using trimmed data. There are 22 classes in the ambulatory palliative care branch that explains 17.14% variation in ambulatory phase cost using trimmed data. The term 'subacute' is used in Australia to describe health care in which the goal--a change in functional status or improvement in quality of life--is a better predictor of the need for, and the cost of, care than the patient's underlying diagnosis. The results suggest that phase of care (stage of illness) is the best predictor of the cost of Australian palliative care. Other predictors of cost are functional status and age. In the ambulatory setting, symptom severity and the model of palliative care are also predictive of cost. These variables are used in the AN-SNAP Version 1 classification to create 33 palliative care classes. The classification has clinical meaning but the overall statistical performance is only moderate. The structure of the classification allows for it to be improved over time as models of palliative care service delivery develop.

World Health Organization Public Health Model: A Roadmap for Palliative Care Development.

Science.gov (United States)

Callaway, Mary V; Connor, Stephen R; Foley, Kathleen M

2018-02-01

The Open Society Foundation's International Palliative Care Initiative (IPCI) began to support palliative care development in Central and Eastern Europe and the Former Soviet Union in 1999. Twenty-five country representatives were invited to discuss the need for palliative care in their countries and to identify key areas that should be addressed to improve the care of adults and children with life-limiting illnesses. As a public health concern, progress in palliative care requires integration into health policy, education and training of health care professionals, availability of essential pain relieving medications, and health care services. IPCI created the Palliative Care Roadmap to serve as a model for government and/or nongovernment organizations to use to frame the necessary elements and steps for palliative care integration. The roadmap includes the creation of multiple Ministry of Health-approved working groups to address: palliative care inclusion in national health policy, legislation, and finance; availability of essential palliative care medications, especially oral opioids; education and training of health care professionals; and the implementation of palliative care services at home or in inpatient settings for adults and children. Each working group is tasked with developing a pathway with multiple signposts as indicators of progress made. The roadmap may be entered at different signposts depending upon the state of palliative care development in the country. The progress of the working groups often takes place simultaneously but at variable rates. Based on our experience, the IPCI Roadmap is one possible framework for palliative care development in resource constrained countries but requires both health care professional engagement and political will for progress to be made. Copyright © 2017. Published by Elsevier Inc.

Pediatrician Ambiguity in Understanding Palliative Sedation at the End of Life.

Science.gov (United States)

Henderson, Carrie M; FitzGerald, Michael; Hoehn, K Sarah; Weidner, Norbert

2017-02-01

Palliative sedation is a means of relieving intractable symptoms at the end of life, however, guidelines about its use lack consistency. In addition, ethical concerns persist around the practice. There are reports of palliative sedation in the pediatric literature, which highlight various institutional perspectives. This survey of 4786 pediatric providers sought to describe their knowledge of and current practices around pediatric palliative sedation. Our survey was administered to pediatricians who care for children at the end of life. The survey assessed agreement with a definition of palliative sedation, as well as thoughts about its alignment with aggressive symptom management. Bivariate analyses using χ 2 and analysis of variance were calculated to determine the relationship between responses to closed-ended questions. Open-ended responses were thematically coded by the investigators and reviewed for agreement. Nearly half (48.6%) of the respondents indicated that the stated definition of palliative sedation "completely" reflected their own views. Respondents were split when asked if they viewed any difference between palliative sedation and aggressive symptom management: Yes (46%) versus No (54%). Open-ended responses revealed specifics about the nature of variation in interpretation. Responses point to ambiguity surrounding the concept of palliative sedation. Pediatricians were concerned with a decreased level of consciousness as the goal of palliative sedation. Respondents were split on whether they view palliative sedation as a distinct entity or as one broad continuum of care, equivalent to aggressive symptom management. Institutional-based policies are essential to clarify acceptable practice, enable open communication, and promote further research.

A survey of palliative medicine education in Japan's undergraduate medical curriculum.

Science.gov (United States)

Nakamura, Yoichi; Takamiya, Yusuke; Saito, Mari; Kuroko, Koichi; Shiratsuchi, Tatsuko; Oshima, Kenzaburo; Ito, Yuko; Miyake, Satoshi

2017-06-07

This study aimed to examine the status of undergraduate palliative care education among Japanese medical students using data from a survey conducted in 2015. A questionnaire was originally developed, and the survey forms were sent to universities. The study's objectives, methods, disclosure of results, and anonymity were explained to participating universities in writing. Responses returned by the universities were considered to indicate consent to participate. Descriptive statistical methodology was employed. The response rate was 82.5% (66 of 80 medical faculties and colleges). Palliative care lectures were implemented in 98.5% of the institutions. Regarding lecture titles, "palliative medicine," "palliative care," and "terminal care" accounted for 42.4, 30.3, and 9.1% of the lectures, respectively. Teachers from the Department of Anesthesia, Palliative Care, and Psychiatry administered 51.5, 47.0, and 28.8% of lectures, respectively. Subjects of lectures included general palliative care (81.8%), pain management (87.9%), and symptom management (63.6%). Clinical clerkship on palliative care was a compulsory and non-compulsory course in 43.9 and 25.8% of the schools, respectively; 30.3% had no clinical clerkship curriculum. Undergraduate palliative care education is implemented in many Japanese universities. Clinical clerkship combined with participation in actual medical practice should be further improved by establishing a medical education certification system in compliance with the international standards.

[For the betterment of home palliative care].

Science.gov (United States)

Midorikawa, Yasuhiko; Iiduka, Masashi

2010-12-01

The problems we have identified to overcome for a betterment of home palliative care were as follows:(1) Staffs' low level of knowledge and a lack of interest in home care, (2) Lack of cooperation between hospital and clinic, (3) Hard to keep the medical and caregiver staffs employed in the home care settings and a technical training is behind, (4) Insufficient cooperative networks for elderly care and welfare in the region, and (5) Misunderstanding of home palliative care by patient, family and people in the region. It is important to solve these problems one by one for a betterment of home palliative care. In this paper, we reported these problems through actual activities of our hospital and Iwaki city, and we propose to deal with them.

Transvesical prostatectomy in the management of benign prostatic ...

African Journals Online (AJOL)

2014-06-02

Jun 2, 2014 ... only occurred in 76 patients (25.7%); acute urinary retention was seen in 106 patients (35.7%). Chronic ... prostatic hyperplasia (BPH) is a common problem in the ... of the drugs, open prostatectomy or transurethral resection .... Storage LUTS. 37 ... there was paucity of data about prostatectomy specimen.

Palliative care for homeless people: a systematic review of the concerns, care needs and preferences, and the barriers and facilitators for providing palliative care.

Science.gov (United States)

Klop, Hanna T; de Veer, Anke J E; van Dongen, Sophie I; Francke, Anneke L; Rietjens, Judith A C; Onwuteaka-Philipsen, Bregje D

2018-04-24

Homeless people often suffer from complex and chronic comorbidities, have high rates of morbidity and die at much younger ages than the general population. Due to a complex combination of physical, psychosocial and addiction problems at the end of life, they often have limited access to palliative care. Both the homeless and healthcare providers experience a lot of barriers. Therefore, providing palliative care that fits the needs and concerns of the homeless is a challenge to healthcare providers. This systematic review aims to summarize evidence about the concerns, palliative care needs and preferences of homeless people, as well as barriers and facilitators for delivering high quality palliative care. PubMed, Embase, PsycINFO, CINAHL and Web of Science were searched up to 10 May 2016. Included were studies about homeless people with a short life expectancy, their palliative care needs and the palliative care provided, that were conducted in Western countries. Data were independently extracted by two researchers using a predefined extraction form. Quality was assessed using a Critical Appraisal instrument. The systematic literature review was based on the PRISMA statement. Twenty-seven publications from 23 different studies met the inclusion criteria; 15 studies were qualitative and eight were quantitative. Concerns of the homeless often related to end-of-life care not being a priority, drug dependence hindering adequate care, limited insight into their condition and little support from family and relatives. Barriers and facilitators often concerned the attitude of healthcare professionals towards homeless people. A respectful approach and respect for dignity proved to be important in good quality palliative care. A patient-centred, flexible and low-threshold approach embodying awareness of the concerns of homeless people is needed so that appropriate palliative care can be provided timely. Training, education and experience of professionals can help to

A Survey of Hospice and Palliative Care Clinicians' Experiences and Attitudes Regarding the Use of Palliative Sedation.

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Maiser, Samuel; Estrada-Stephen, Karen; Sahr, Natasha; Gully, Jonathan; Marks, Sean

2017-09-01

A variety of terms and attitudes surround palliative sedation (PS) with little research devoted to hospice and palliative care (HPC) clinicians' perceptions and experiences with PS. These factors may contribute to the wide variability in the reported prevalence of PS. This study was designed to better identify hospice and palliative care (HPC) clinician attitudes toward, and clinical experiences with palliative sedation (PS). A 32-question survey was distributed to members of the American Academy of Hospice and Palliative Medicine (n = 4678). The questions explored the language clinicians use for PS, and their experiences with PS. Nine hundred thirty-six (20% response rate) responded to the survey. About 83.21% preferred the terminology of PS compared with other terms. A majority felt that PS is a bioethically appropriate treatment for refractory physical and nonphysical symptoms in dying patients. Most felt PS was not an appropriate term in clinical scenarios when sedation occurred as an unintended side effect from standard treatments. Hospice clinicians use PS more consistently and with less distress than nonhospice clinician respondents. Benzodiazepines (63.1%) and barbiturates (18.9%) are most commonly prescribed for PS. PS is the preferred term among HPC clinicians for the proportionate use of pharmacotherapies to intentionally lower awareness for refractory symptoms in dying patients. PS is a bioethically appropriate treatment for refractory symptoms in dying patients. However, there is a lack of clear agreement about what is included in PS and how the practice of PS should be best delivered in different clinical scenarios. Future efforts to investigate PS should focus on describing the clinical scenarios in which PS is utilized and on the level of intended sedation necessary, in an effort to better unify the practice of PS.

Review of palliative sedation and its distinction from euthanasia and lethal injection.

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Hahn, Michael P

2012-01-01

Palliative sedation evolved from within the practice of palliative medicine and has become adopted by other areas of medicine, such as within intensive care practice. Clinician's usually come across this practice for dying patients who are foregoing or having life support terminated. A number of intolerable and intractable symptom burdens can occur during the end of life period that may require the use of palliative sedation. Furthermore, when patients receive palliative sedation, the continued use of hydration and nutrition becomes an issue of consideration and there are contentious bioethical issues involved in using or withholding these life-sustaining provisions. A general understanding of biomedical ethics helps prevent abuse in the practice of palliative sedation. Various sedative drugs can be employed in the provision of palliative sedation that can produce any desired effect, from light sedation to complete unconsciousness. Although there are some similarities in the pharmacotherapy of palliative sedation, euthanasia, physician-assisted suicide, and lethal injection, there is a difference in how the drugs are administered with each practice. There are some published guidelines about how palliative sedation should be practiced, but currently there is not any universally accepted standard of practice.

Palliative sedation at home in the Netherlands: a nationwide survey among nurses.

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Brinkkemper, Tijn; Klinkenberg, Marianne; Deliens, Luc; Eliel, Miriam; Rietjens, Judith A C; Zuurmond, Wouter W A; Perez, Roberto S G M

2011-08-01

This paper is a report of a nationwide study conducted to assess experiences of nurses involved in palliative sedation at home after introduction of a physicians' guideline for palliative sedation. Most studies investigating the practice of palliative sedation focus on physicians' practices and attitudes. However, little is known about experiences and attitudes of nurses. A web-based structured questionnaire was offered to 387 nurses providing medical technical care in 2007, assessing their experiences concerning decision-making, treatment policy and communication, focussing on the last patient receiving palliative sedation. The questionnaire was filled out by 201 nurses (response rate 52%). The majority of respondents agreed with the indication for palliative sedation. However, 21% reported to have refused carrying out a palliative sedation in the preceding year. The general practitioner was not present at the start of palliative sedation in a third of the cases, but was available when needed. The sedation was considered insufficiently effective by 42% of the respondents. According to a third of the respondents, the level of sedation was not related to the required level of symptom relief nor were changes in dosage based on the severity of symptoms. Although the guideline for palliative sedation appears to be followed adequately in the majority of cases with respect to indication for palliative sedation and reportage. The survey findings revealed shortcomings in medication policy, communication, medical control over the start and continued monitoring of palliative sedation. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

Palliative Care Training in Cardiology Fellowship: A National Survey of the Fellows.

Science.gov (United States)

Dabbouseh, Noura M; Kaushal, Shivtej; Peltier, Wendy; Johnston, Fabian M

2018-02-01

To address perspectives of cardiology fellows on the current state of palliative education and palliative and hospice resource utilization within their fellowship experiences. We conducted an online national survey of cardiology fellows during the 2015 to 2016 academic year. Survey questions aimed to assess perceived importance of palliative care education, level of palliative care education during fellowship, and the structure of palliative care support at respondent institutions. Responses were collected anonymously. A total of 519 programs, including subspecialty programs, were contacted. We received 365 responses, a number that represents roughly 14% of all cardiology fellows nationwide during the 2015 to 2016 academic year. Fellows reported discordance in the quality of education between general cardiology and palliative care principles as it relates to care of the patient approaching the end of life. Fellows infrequently received explicit training nor were observed or mentored in delivering end-of-life discussions. Respondents reported an underutilization of palliative care and hospice resources during fellowship training and also a perception that attending faculty were not routinely addressing goals of care. Our survey results highlight a need for enhanced palliative care and end-of-life training experiences for cardiology fellows and also suggest underutilization of hospice and palliative care resources for patients with advanced cardiac diseases. These findings create a platform for future work that might: (1) confirm this training deficit, (2) lead to exploration of educational models that could reconcile this deficit, and (3) potentially help improve palliative care support for patients and families facing advanced heart disease.

Assessing palliative care needs: views of patients, informal carers and healthcare professionals.

Science.gov (United States)

McIlfatrick, Sonja

2007-01-01

This paper reports a study to assess the palliative care needs of the adult population served by a healthcare provider organization in Northern Ireland from the perspectives of patients, informal carers and healthcare providers. Assessing palliative care need is a key factor for health service planning. Traditionally, palliative care has been associated with end-of-life care and cancer. More recently, the concept has been extended to include care for both cancer and non-cancer populations. Various approaches have been advocated for assessing need, including the exploration of professional provider and user perspectives of need. Semi-structured qualitative interviews were undertaken with a purposive sample of patients and lay carers receiving palliative care services (n = 24). Focus groups were also conducted with multi-professional palliative care providers (n = 52 participants) and face to face interviews were undertaken with key managerial stakeholders in the area (n = 7). The focus groups and interviews concentrated on assessment of palliative care need. All the interviews were transcribed verbatim and analysed using Burnard's framework. Professional providers experienced difficulty in defining the term palliative care. Difficulties in communication and information exchange, and fragmented co-ordination between services were identified. The main areas of need identified by all participants were social and psychological support; financial concerns; and the need for choice and information. All participants considered that there was inequity between palliative care service provision for patients with cancer and non-cancer diseases. All patients, regardless of diagnosis, should be able to access palliative care appropriate to their individual needs. For this to happen in practice, an integrated approach to palliative care is essential. The study methodology confirms the value of developing a comprehensive approach to assessing palliative care need.

Ideology and Palliative Care: Moral Hazards at the Bedside.

Science.gov (United States)

Rhodes, Rosamond; Strain, James J

2018-01-01

Palliative care has had a long-standing commitment to teaching medical students and other medical professionals about pain management, communication, supporting patients in their decisions, and providing compassionate end-of-life care. Palliative care programs also have a critical role in helping patients understand medical conditions, and in supporting them in dealing with pain, fear of dying, and the experiences of the terminal phase of their lives. We applaud their efforts to provide that critical training and fully support their continued important work in meeting the needs of patients and families. Although we appreciate the contributions of palliative care services, we have noted a problem involving some palliative care professionals' attitudes, methods of decisionmaking, and use of language. In this article we explain these problems by discussing two cases that we encountered.

The perceived impact of public involvement in palliative care in a provincial palliative care network in the Netherlands : a qualitative study

NARCIS (Netherlands)

Henk van Rijswijk; Esther Stoffers; Anna Beurskens; M. Beckers; F.A. Haarsma; Albine Moser

2015-01-01

Background and objective Public involvement in palliative care is challenging and difficult, because people in need of palliative care are often not capable of speaking up for themselves. Patient representatives advocate for their common interests. The aim of our study was to examine in depth the

Coverage and development of specialist palliative care services across the World Health Organization European Region (2005-2012): Results from a European Association for Palliative Care Task Force survey of 53 Countries.

Science.gov (United States)

Centeno, Carlos; Lynch, Thomas; Garralda, Eduardo; Carrasco, José Miguel; Guillen-Grima, Francisco; Clark, David

2016-04-01

The evolution of the provision of palliative care specialised services is important for planning and evaluation. To examine the development between 2005 and 2012 of three specialised palliative care services across the World Health Organization European Region - home care teams, hospital support teams and inpatient palliative care services. Data were extracted and analysed from two editions of the European Association for Palliative Care Atlas of Palliative Care in Europe. Significant development of each type of services was demonstrated by adjusted residual analysis, ratio of services per population and 2012 coverage (relationship between provision of available services and demand services estimated to meet the palliative care needs of a population). For the measurement of palliative care coverage, we used European Association for Palliative Care White Paper recommendations: one home care team per 100,000 inhabitants, one hospital support team per 200,000 inhabitants and one inpatient palliative care service per 200,000 inhabitants. To estimate evolution at the supranational level, mean comparison between years and European sub-regions is presented. Of 53 countries, 46 (87%) provided data. Europe has developed significant home care team, inpatient palliative care service and hospital support team in 2005-2012. The improvement was statistically significant for Western European countries, but not for Central and Eastern countries. Significant development in at least a type of services was in 21 of 46 (46%) countries. The estimations of 2012 coverage for inpatient palliative care service, home care team and hospital support team are 62%, 52% and 31% for Western European and 20%, 14% and 3% for Central and Eastern, respectively. Although there has been a positive development in overall palliative care coverage in Europe between 2005 and 2012, the services available in most countries are still insufficient to meet the palliative care needs of the population. © The

Postgraduate palliative care education: Evaluation of a South ...

African Journals Online (AJOL)

Aim. We aimed to assess the postgraduate palliative care distance education programme of the University of Cape Town (UCT) in terms of its perceived ability to influence palliative care delivery. Methods. A mixed-methods approach, consisting of two surveys using open-ended and multiple-choice options, was conducted ...

Palliative care awareness amongst religious leaders and seminarians

African Journals Online (AJOL)

Introduction: There exists scanty literature on the awareness of Nigerians towards palliative care. This study was conducted to determine the level of awareness of religious leaders and seminarians in Ibadan, Nigeria, on palliative care. Methods: Data obtained from a cross-section of 302 religious leaders and seminarians in ...

Improved knowledge of and difficulties in palliative care among physicians during 2008 and 2015 in Japan: Association with a nationwide palliative care education program.

Science.gov (United States)

Nakazawa, Yoko; Yamamoto, Ryo; Kato, Masashi; Miyashita, Mitsunori; Kizawa, Yoshiyuki; Morita, Tatsuya

2018-02-01

Palliative care education for health care professionals is a key element in improving access to quality palliative care. The Palliative Care Emphasis Program on Symptom Management and Assessment for Continuous Medical Education (PEACE) was designed to provide educational opportunities for all physicians in Japan. As of 2015, 57,764 physicians had completed it. The objective of this study was to estimate the effects of the program. This study was an analysis of 2 nationwide observational studies from 2008 and 2015. We conducted 2 questionnaire surveys for representative samples of physicians. The measurements used were the Palliative Care Knowledge Test (range, 0-100) and the Palliative Care Difficulties Scale (range, 1-4). Comparisons were made with the unpaired Student t test and with a multivariate linear regression model using 2 cohorts and a propensity score-matched sample. This study analyzed a total of 48,487 physicians in 2008 and a total of 2720 physicians in 2015. Between 2008 and 2015, physicians' knowledge and difficulties significantly improved on the Palliative Care Knowledge Test with total scores of 68 and 78, respectively (P PEACE program had a higher knowledge score (74 vs 86; P PEACE program may have contributed to these improvements. Cancer 2018;124:626-35. © 2017 American Cancer Society. © 2017 American Cancer Society.

'Palliative sedation'? A retrospective cohort study on the use and labelling of continuously administered sedatives on a palliative care unit.

Science.gov (United States)

Schildmann, Eva; Pörnbacher, Sebastian; Kalies, Helen; Bausewein, Claudia

2018-03-01

Sedatives are frequently used towards the end of life. However, there is scarce information when their use is labelled as 'palliative sedation'. To assess the use and labelling of 'continuous administration of sedatives within the last 7 days of life', based on objective operational criteria, on a palliative care unit. Retrospective cohort study, using medical records. Explorative statistical analysis (SPSS 23). Patients who died on a palliative care unit from August 2014 to July 2015. Sedatives recorded were benzodiazepines, levomepromazine, haloperidol ⩾5 mg/day and propofol. Of the 192 patients, 149 (78%) patients received continuous sedatives within the last week of life. The prevalence of delirium/agitation was significantly higher in patients with continuous sedatives compared to those without continuous sedatives at admission to the unit (35% vs 16%, p = 0.02) and on the day before death (58% vs 40%, p = 0.04). The term '(palliative) sedation' was used in the records for 22 of 149 (15%) patients with continuous sedatives. These patients had significantly higher total daily midazolam doses 2 days before death (median (range), 15.0 (6.0-185.0) mg vs 11.5 (1.0-70.0) mg, p = 0.04) and on the day of death (median (range), 19.5 (7.5-240.0) mg vs 12.5 (2.0-65.0) mg, p = 0.01). The dose range was large in both groups. The prevalence of delirium/agitation was associated with the administration of continuous sedatives. There was no consistent pattern regarding labelling the use of continuous sedatives as '(palliative) sedation'. Multicentre mixed-methods research is needed for a better characterization of sedation practices in palliative care.

Radiotherapy for brain metastases: defining palliative response

International Nuclear Information System (INIS)

Bezjak, Andrea; Adam, Janice; Panzarella, Tony; Levin, Wilfred; Barton, Rachael; Kirkbride, Peter; McLean, Michael; Mason, Warren; Wong, Chong Shun; Laperriere, Normand

2001-01-01

Background and purpose: Most patients with brain metastases are treated with palliative whole brain radiotherapy (WBRT). There is no established definition of palliative response. The aim of this study was to develop and test clinically useful criteria for response following palliative WBRT. Materials and methods: A prospective study was conducted of patients with symptomatic brain metastases treated with WBRT (20 Gy/5 fractions) and standardised steroid tapering. Assessments included observer rating of neurological symptoms, patient-completed symptom checklist and performance status (PS). Response criteria were operationally defined based on a combination of neurological symptoms, PS and steroid dose. Results: Seventy-five patients were accrued. At 1 month, presenting neurological symptoms were improved in 14 patients, stable in 17, and worse in 21; 23 patients were not assessed, mainly due to death or frailty. Using response criteria defined a priori, 15% (95% CI 7-23%) of patients were classified as having a response to RT, 25% no response, and 29% progression; 27% were deceased at or soon after 1 month. A revised set of criteria was tested, with less emphasis on complete tapering of steroids: they increased the proportion of patients responding to 39% (95% CI 27-50%) but didn't change the large proportion who did not benefit (44%). Conclusions: Clinical response to RT of patients with brain metastases is multifactorial, comprising symptoms, PS and other factors. Assessment of degree of palliation depend on the exact definition used. More research is needed in this important area, to help validate criteria for assessing palliation after WBRT

Experiences of Family Members of Dying Patients Receiving Palliative Sedation.

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Tursunov, Olga; Cherny, Nathan I; Ganz, Freda DeKeyser

2016-11-01

To describe the experience of family members of patients receiving palliative sedation at the initiation of treatment and after the patient has died and to compare these experiences over time.
. Descriptive comparative study.
. Oncology ward at Shaare Zedek Medical Center in Jerusalem, Israel.
. A convenience sample of 34 family members of dying patients receiving palliative sedation. 
. A modified version of a questionnaire describing experiences of family members with palliative sedation was administered during palliative sedation and one to four months after the patient died. Descriptive statistics were used to describe the results of the questionnaire, and appropriate statistical analyses were conducted for comparisons over time.
. Experiences of family members and time.
. Most relatives were satisfied with the sedation and staff support. Palliative sedation was experienced as an ethical way to relieve suffering. However, one-third felt that it shortened the patient's life. An explanation of the treatment was given less than half of the time and was usually given on the same day treatment was started. This explanation was given by physicians and nurses. Many felt that they were not ready for changes in the patient's condition and wanted increased opportunities to discuss the treatment with oncology care providers. No statistically significant differences in experiences were found over time. 
. Relatives' experiences of palliative sedation were generally positive and stable over time. Important experiences included timing of the initiation of sedation, timing and quality of explanations, and communication.
. Nurses should attempt to initiate discussions of the possible role of sedation in the event of refractory symptoms and follow through with continued discussions. The management of refractory symptoms at the end of life, the role of sedation, and communication skills associated with decision making related to palliative sedation should be a

Why we need more poetry in palliative care.

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Davies, Elizabeth A

2018-03-23

Although many well-known poems consider illness, loss and bereavement, medicine tends to view poetry more as an extracurricular than as a mainstream pursuit. Within palliative care, however, there has been a long-standing interest in how poetry may help patients and health professionals find meaning, solace and enjoyment. The objective of this paper is to identify the different ways in which poetry has been used in palliative care and reflect on their further potential for education, practice and research. A narrative review approach was used, drawing on searches of the academic literature through Medline and on professional, policy and poetry websites to identify themes for using poetry in palliative care. I identified four themes for using poetry in palliative care. These concerned (1) leadership, (2) developing organisational culture, (3) the training of health professionals and (4) the support of people with serious illness or nearing the end of life. The academic literature was mostly made up of practitioner perspectives, case examples or conceptual pieces on poetry therapy. Patients' accounts were rare but suggested poetry can help some people express powerful thoughts and emotions, create something new and feel part of a community. Poetry is one way in which many people, including patients and palliative care professionals, may seek meaning from and make sense of serious illnesses and losses towards the end of life. It may have untapped potential for developing person-centred organisations, training health professionals, supporting patients and for promoting public engagement in palliative care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Pelvic reconstructions after bone tumor resection].

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Anract, Philippe; Biau, David; Babinet, Antoine; Tomeno, Bernard

2014-02-01

The three more frequent primitive malignant bone tumour which concerned the iliac bone are chondrosarcoma, following Ewing sarcoma and osteosarcoma. Wide resection remains the most important part of the treatment associated with chemotherapy for osteosarcoma and the Ewing sarcoma. Iliac wing resections and obdurate ring don't required reconstruction. However, acetabular resections and iliac wing resection with disruption of the pelvic ring required reconstruction to provide acceptable functional result. Acetabular reconstruction remains high technical demanding challenge. After isolated acetabular resection or associated to obdurate ring, our usual method of reconstruction is homolateral proximal femoral autograft and total hip prosthesis but it is possible to also used : saddle prosthesis, Mac Minn prosthesis with auto or allograft, modular prosthesis or custom made prosthesis, massive allograft with or without prosthesis and femoro-ilac arthrodesis. After resection of the iliac wing plus acetabulum, reconstruction can be performed by femoro-obturatrice and femora-sacral arthrodesis, homolateral proximal femoral autograft and prosthesis, femoral medialisation, massive allograft and massive allograft. Carcinological results are lesser than resection for distal limb tumor, local recurrence rate range 17 to 45%. Functional results after Iliac wing and obdurate ring are good. However, acetabular reconstruction provide uncertain functional results. The lesser results arrive after hemipelvic or acetabular and iliac wing resection-reconstruction, especially when gluteus muscles were also resected. The most favourable results arrive after isolated acetabular or acetabular plus obturateur ring resection-reconstruction.

Humor Assessment and Interventions in Palliative Care: A Systematic Review

Directory of Open Access Journals (Sweden)

Lisa M. Linge-Dahl

2018-06-01

Full Text Available Background: The central goal of palliative care is to optimize the quality of life of patients suffering from life-limiting illnesses, which includes psychosocial and spiritual wellbeing. Research has demonstrated positive correlations between humor and laughter with life satisfaction and other aspects of wellbeing, and physiological symptoms can be improved by humorous stimuli.Objectives: The aim of this review is to evaluate humor interventions and assessments that have been applied in palliative care and to derive implications for future research.Methods: A systematic review of four databases identified 13 included studies. Criteria for inclusion were peer-reviewed English-language studies on humor interventions or assessments in a palliative care context.Results: Two studies on humor interventions and 11 studies on humor assessment were included in the systematic review. Most of these studies were about the patients' perspective on humor in palliative care. Findings showed that humor had a positive effect on patients, their relatives, and professional caregivers. Humor was widely perceived as appropriate and seen as beneficial to care in all studies.Conclusions: Even though humor interventions seem to be potentially useful in palliative care, descriptions evaluating their use are scarce. Overall, research on humor assessment and interventions in palliative care has remained limited in terms of quantity and quality. More research activities are needed to build a solid empirical foundation for implementing humor and laughter as part of regular palliative care activities.

Pancreatic Cancer: What the Oncologist Can Offer for Palliation

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Malcolm J Moore

2002-01-01

Full Text Available Because pancreatic cancer has a poor survival rate and only 20% of patients present with potentially resectable disease, a key goal of therapy is to provide palliation. The poor medical condition of many patients interferes with their ability to tolerate traditional chemotherapy. Recently, however, a nucleoside analogue, gemcitabine, has been developed. This drug is more effective than 5-fluorouracil (5-FU, can be used in patients who fail to respond to 5-FU and has only modest toxicity. Combination therapies including gemcitabine and other agents are being tested. Local radiotherapy seems to provide pain relief, but gastrointestinal toxicity is significant. The effect of combined modality therapy (5-FU with radiotherapy on survival is unclear, and it does not prevent local disease progression. Some novel biological agents, including angiogenesis inhibitors, matrix metalloproteinase inhibitors, antisense compounds, inhibitors of cell signalling such as epidermal growth factor and vascular endothelial growth factor, and inhibitors of oncogene activation, are undergoing phase II and III trials in patients with pancreatic cancer. Among the most promising are farnesyl protein transferase inhibitors, which modulate K-ras function. Such an approach is promising for the treatment of pancreatic cancer because this tumour frequently exhibits mutation of the ras gene.

Endoscopic resection of subepithelial tumors.

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Schmidt, Arthur; Bauder, Markus; Riecken, Bettina; Caca, Karel

2014-12-16

Management of subepithelial tumors (SETs) remains challenging. Endoscopic ultrasound (EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the minority of cases. Complete endoscopic resection may provide a reasonable approach for tissue acquisition and may also be therapeutic in case of malignant lesions. Small SET restricted to the submucosa can be removed with established basic resection techniques. However, resection of SET arising from deeper layers of the gastrointestinal wall requires advanced endoscopic methods and harbours the risk of perforation. Innovative techniques such as submucosal tunneling and full thickness resection have expanded the frontiers of endoscopic therapy in the past years. This review will give an overview about endoscopic resection techniques of SET with a focus on novel methods.

Palliative sedation: a focus group study on the experiences of relatives.

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Bruinsma, Sophie; Rietjens, Judith; van der Heide, Agnes

2013-04-01

Most studies that have investigated the practice of palliative sedation have focused on physicians' practices and attitudes. The aim of this study was to explore relatives' experiences with palliative sedation and to gain more insight in positive and negative elements in their evaluation of palliative sedation. Focus groups and individual interviews. Various care settings in the Netherlands. A total of 14 relatives of patients who received palliative sedation until death participated. Most relatives evaluated the provision of palliative sedation of their dying family member positively. Positive experiences were related to: the beneficial impact of palliative sedation on the patient's suffering, the opportunity that was offered to prepare for the patient's death, their involvement in the decision-making and care for the patient, and the pleasant care environment. However, the majority of the relatives were unsatisfied with one or more aspects of how information was being provided for. Some relatives were frustrated about the fact that nurses were not authorized to make decisions about the care for the patient and about the absence of physicians during weekends. None of the relatives mentioned the loss of the ability to communicate with the patient during the sedation and the possibility of "hastening death" as disadvantages of palliative sedation. Relatives tend to evaluate the provision of palliative sedation to their severely suffering family member positively because it contributes to a peaceful dying process. However, relatives indicated discontent with how information was being provided and with the communication in general.

Palliative Care and Human Rights: A Decade of Evolution in Standards.

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Ezer, Tamar; Lohman, Diederik; de Luca, Gabriela B

2018-02-01

Human rights standards to address palliative care have developed over the last decade. This article aims to examine key milestones in the evolution of human rights standards to address palliative care, relevant advocacy efforts, and areas for further growth. The article provides an analysis of human rights standards in the context of palliative care through the lens of the right to health, freedom from torture and ill treatment, and the rights of older persons and children. Significant developments include the following: 1) the first human rights treaty to explicitly recognize the right to palliative care, the Inter-American Convention on the Rights of Older Persons; 2) the first World Health Assembly resolution on palliative care; 3) a report by the UN Special Rapporteur on Torture with a focus on denial of pain treatment; 4) addressing the availability of controlled medicines at the UN General Assembly Special Session on the World Drug Problem. Development of human rights standards in relation to palliative care has been most notable in the context of the right to health, freedom from torture and ill treatment, and the rights of older persons. More work is needed in the context of the rights of children, and human rights treaty bodies are still not consistently addressing state obligations with regards to palliative care. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Progress in surgical palliative treatment for malignant obstructive jaundice

Directory of Open Access Journals (Sweden)

LIANG Zhang

2013-06-01

Full Text Available Obstructive jaundice, also known as surgical jaundice, is divided into benign and malignant types. Most of the patients newly diagnosed with malignant obstructive jaundice have lost the opportunity of receiving radical surgery due to its insidious onset, so surgical palliative treatment is very important for patients with advanced malignant obstructive jaundice. This paper elaborates on various current modalities of surgical palliative treatment for malignant obstructive jaundice. Appropriate modality of surgical palliative treatment is of great significance for patients with advanced malignant obstructive jaundice.

Education, implementation, and policy barriers to greater integration of palliative care: A literature review.

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Aldridge, Melissa D; Hasselaar, Jeroen; Garralda, Eduardo; van der Eerden, Marlieke; Stevenson, David; McKendrick, Karen; Centeno, Carlos; Meier, Diane E

2016-03-01

Early integration of palliative care into the management of patients with serious disease has the potential to both improve quality of life of patients and families and reduce healthcare costs. Despite these benefits, significant barriers exist in the United States to the early integration of palliative care in the disease trajectory of individuals with serious illness. To provide an overview of the barriers to more widespread palliative care integration in the United States. A literature review using PubMed from 2005 to March 2015 augmented by primary data collected from 405 hospitals included in the Center to Advance Palliative Care's National Palliative Care Registry for years 2012 and 2013. We use the World Health Organization's Public Health Strategy for Palliative Care as a framework for analyzing barriers to palliative care integration. We identified key barriers to palliative care integration across three World Health Organization domains: (1) education domain: lack of adequate education/training and perception of palliative care as end-of-life care; (2) implementation domain: inadequate size of palliative medicine-trained workforce, challenge of identifying patients appropriate for palliative care referral, and need for culture change across settings; (3) policy domain: fragmented healthcare system, need for greater funding for research, lack of adequate reimbursement for palliative care, and regulatory barriers. We describe the key policy and educational opportunities in the United States to address and potentially overcome the barriers to greater integration of palliative care into the healthcare of Americans with serious illness. © The Author(s) 2015.

Endoscopic Transsphenoidal Resection of Craniopharyngioma.

Science.gov (United States)

Liew, Kong Yew; Narayanan, Prepageran; Waran, Vicknes

2018-02-01

Objectives  To demonstrate, step-by-step, the technique and efficacy of endoscopic transsphenoidal approach in resection of a suprasellar craniopharyngioma. Design  The video shows a step-by-step approach to the resection, covering the exposure, access, resection, and confirmation of resection and reconstruction. Setting  The surgery was performed in the University of Malaya Medical Centre, a tertiary referral center in the capital of Malaysia. Participants  Surgery was performed jointly by Professor Prepageran from the department of otorhinolaryngology and Professor Vicknes Waran from the division of neurosurgery. Both surgeons are from the University of Malaya. Video compilation, editing, and voice narration was done by Dr. Kong Yew Liew. Main Outcome Measures  Completeness of resection and avoidance of intra- and postoperative complications. Results  Based on intraoperative views and MRI findings, the tumor was completely resected with the patient suffering only transient diabetes insipidus. Conclusion  Central suprasellar tumors can be removed completely via an endoscopic transsphenoidal approach with minimal morbidity to the patient. The link to the video can be found at: https://youtu.be/ZNIHfk12cYg .

Palliative Care Edema: Patient Population, Causal Factors, and Types of Edema Referred to a Specialist Palliative Care Edema Service.

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Real, Shirley; Cobbe, Sinead; Slattery, Sinead

2016-07-01

Edema in palliative care patients is a common symptom, however, the research base for all aspects of its care is extremely poor. To evaluate a specialist palliative care edema service in order to report on the patient population referred, the types of edema encountered, and the causes of edema. Prior to study, three different edema types were described for evaluation: lymphedema, nonlymphatic edema, and a combination of the two. Retrospective chart evaluation was completed from August 2013 through January 2014. Patients with edema assessed by the specialist palliative care physiotherapy edema service. Sixty-three cases were included, comprising 10.5% of all new palliative care referrals during the study period. Ninety-two percent (n = 58) had a diagnosis of cancer and 57% (n = 36) were female. Age ranged from 45-97 years. The most common edema type was a mixed edema (46%, n = 29), followed by lymphedema (27%, n = 18) and nonlymphatic edema (16%, n = 10). Lymphorrhea occurred in 9.5% of cases. The most common reasons for edema, based on clinical opinion, were blocked lymphatics (33%) and dependency from immobility (27%). The most common site for edema was in the lower limbs (89%, n = 56). The time lapse from the last treatment to death ranged from 1-225 days. Having a mixed edema type or lymphorrhea was a relatively poor prognostic sign. This is the first study to describe in detail the occurrence of edema in palliative care patients. Edema may be present for many months prior to death making the search for effective treatments imperative.

Intention, procedure, outcome and personhood in palliative sedation and euthanasia.

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Materstvedt, Lars Johan

2012-03-01

Palliative sedation at the end of life has become an important last-resort treatment strategy for managing refractory symptoms as well as a topic of controversy within palliative care. Furthermore, palliative sedation is prominent in the public debate about the possible legalisation of voluntary assisted dying (physician-assisted suicide and euthanasia). This article attempts to demonstrate that palliative sedation is fundamentally different from euthanasia when it comes to intention, procedure, outcome and the status of the person. Nonetheless, palliative sedation in its most radical form of terminal deep sedation parallels euthanasia in one respect: both end the experience of suffering. However, only the latter intentionally ends life and also has this as its goal. There is the danger that deep sedation could bring death forward in time due to particular side effects of the treatment. Still that would, if it happens, not be intended, and accordingly is defensible in view of the doctrine of double effect.

Palliative Workforce Development and a Regional Training Program.

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O'Mahony, Sean; Levine, Stacie; Baron, Aliza; Johnson, Tricia J; Ansari, Aziz; Leyva, Ileana; Marschke, Michael; Szmuilowicz, Eytan; Deamant, Catherine

2018-01-01

Our primary aims were to assess growth in the local hospital based workforce, changes in the composition of the workforce and use of an interdisciplinary team, and sources of support for palliative medicine teams in hospitals participating in a regional palliative training program in Chicago. PC program directors and administrators at 16 sites were sent an electronic survey on institutional and PC program characteristics such as: hospital type, number of beds, PC staffing composition, PC programs offered, start-up years, PC service utilization and sources of financial support for fiscal years 2012 and 2014. The median number of consultations reported for existing programs in 2012 was 345 (IQR 109 - 2168) compared with 840 (IQR 320 - 4268) in 2014. At the same time there were small increases in the overall team size from a median of 3.2 full time equivalent positions (FTE) in 2012 to 3.3 FTE in 2013, with a median increase of 0.4 (IQR 0-1.0). Discharge to hospice was more common than deaths in the acute care setting in hospitals with palliative medicine teams that included both social workers and advanced practice nurses ( p < .0001). Given the shortage of palliative medicine specialist providers more emphasis should be placed on training other clinicians to provide primary level palliative care while addressing the need to hire sufficient workforce to care for seriously ill patients.

Knife-assisted snare resection: a novel technique for resection of scarred polyps in the colon.

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Chedgy, Fergus J Q; Bhattacharyya, Rupam; Kandiah, Kesavan; Longcroft-Wheaton, Gaius; Bhandari, Pradeep

2016-03-01

There have been significant advances in the management of complex colorectal polyps. Previous failed resection or polyp recurrence is associated with significant fibrosis, making endoscopic resection extremely challenging; the traditional approach to these lesions is surgery. The aim of this study was to evaluate the efficacy of a novel, knife-assisted snare resection (KAR) technique in the resection of scarred colonic polyps. This was a prospective cohort study of patients, in whom the KAR technique was used to resect scarred colonic polyps > 2  cm in size. Patients had previously undergone endoscopic mucosal resection (EMR) and developed recurrence, or EMR had been attempted but was aborted as a result of technical difficulty. A total of 42 patients underwent KAR of large (median 40  mm) scarred polyps. Surgery for benign disease was avoided in 38 of 41 patients (93 %). No life-threatening complications occurred. Recurrence was seen in six patients (16 %), five of whom underwent further endoscopic resection. The overall cure rate for KAR in complex scarred colonic polyps was 90 %. KAR of scarred colonic polyps by an expert endoscopist was an effective and safe technique with low recurrence rates. © Georg Thieme Verlag KG Stuttgart · New York.

PALLIATIVE CARE ELDERLY PATIENTS WITH SLEEPING DISORDERS ARE POORLY TREATED

OpenAIRE

Bellido-Estevez, Inmaculada

2015-01-01

Background: Sleep disorders are frequent in patients with advanced cancer receiving palliative-care, especially in elderly patients (1). Sleep disorders during palliative-care may be related with anxiety, opioids related central-sleep apnoea or corticoids therapy between others (2). Our aim was to quantify the effectiveness of hypnotic medication in the sleep quality in advanced cancer receiving palliative-care elderly patients. Material and methods: A descriptive cross-sectional study was...

Funding models in palliative care: Lessons from international experience

Science.gov (United States)

Groeneveld, E Iris; Cassel, J Brian; Bausewein, Claudia; Csikós, Ágnes; Krajnik, Malgorzata; Ryan, Karen; Haugen, Dagny Faksvåg; Eychmueller, Steffen; Gudat Keller, Heike; Allan, Simon; Hasselaar, Jeroen; García-Baquero Merino, Teresa; Swetenham, Kate; Piper, Kym; Fürst, Carl Johan; Murtagh, Fliss EM

2017-01-01

Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest. PMID:28156188

Funding models in palliative care: Lessons from international experience.

Science.gov (United States)

Groeneveld, E Iris; Cassel, J Brian; Bausewein, Claudia; Csikós, Ágnes; Krajnik, Malgorzata; Ryan, Karen; Haugen, Dagny Faksvåg; Eychmueller, Steffen; Gudat Keller, Heike; Allan, Simon; Hasselaar, Jeroen; García-Baquero Merino, Teresa; Swetenham, Kate; Piper, Kym; Fürst, Carl Johan; Murtagh, Fliss Em

2017-04-01

Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. To assess national models and methods for financing and reimbursing palliative care. Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest.

Evaluating Palliative Care Resources Available to the Public Using the Internet and Social Media.

Science.gov (United States)

Claudio, Celeste H; Dizon, Zoelle B; October, Tessie W

2018-01-01

Accessible information about palliative care available to the public on the Internet is growing. We do not know whether this information is consistent with the current accepted definition of palliative care. To identify resources on the Internet and social media regarding palliative care and evaluate the information conveyed. A cross-sectional study of "palliative care" search results. Top 10 Google websites, top 10 most viewed YouTube videos, and social media platforms, Facebook and Twitter, were searched. The most popular Google websites were mostly from national organizations promoting palliative care, whose definitions of palliative care consistently mention "quality of life" and "relief from symptoms and stress." None of the websites mentioned children, and 77% cited palliative care as treatment for cancer with less focus on other diseases. No personal stories were included in Google websites, while 60% of YouTube videos included personal stories. Five main themes were generated from 266 YouTube video comments analyzed. The most common theme was emotionality, of which 91% were positive statements. Facebook and Twitter were mostly used by health-care professionals and not the public. Palliative care resources are mostly positive and consistent with the current definition of palliative care. Major Internet search engines such as Google and YouTube provide valuable insight into information the public receives about palliative care. Future development of Internet resources on palliative care should consider including children and emphasizing palliative care for all life-limiting illnesses.

Internal Medicine Residents' Beliefs, Attitudes, and Experiences Relating to Palliative Care: A Qualitative Study.

Science.gov (United States)

Kawaguchi, S; Mirza, R; Nissim, R; Ridley, J

2017-05-01

Internal medicine residents are frequently called upon to provide palliative care to hospitalized patients, but report feeling unprepared to do so effectively. Curricular development to enhance residents' palliative care skills and competencies requires an understanding of current beliefs, attitudes and learning priorities. We conducted a qualitative study consisting of semi-structured interviews with ten internal medicine residents to explore their understanding of and experiences with palliative care. All of the residents interviewed had a sound theoretical understanding of palliative care, but faced many challenges in being able to provide care in practice. The challenges described by residents were system-related, patient-related and provider-related. They identified several priority areas for further learning, and discussed ways in which their current education in palliative care could be enhanced. Our findings provide important insights to guide curricular development for internal medicine trainees. The top five learning priorities in palliative care that residents identified in our study were: 1) knowing how and when to initiate a palliative approach, 2) improving communication skills, 3) improving symptom management skills, 4) identifying available resources, and 5) understanding the importance of palliative care. Residents felt that their education in palliative care could be improved by having a mandatory rotation in palliative care, more frequent didactic teaching sessions, more case-based teaching from palliative care providers, opportunities to be directly observed, and increased support from palliative care providers after-hours.