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PURPOSE: Prior studies have described complications of radiofrequency ablation (RFA) of liver tumours. The aim of this study was to identify risk factors for hospitalization duration longer than 24 hours following RFA of liver tumours. METHODS: This retrospective, single-centre study included patients with liver tumours undergoing RFA between October 2017 and July 2020. Medical records were reviewed to collect patient, tumours, and procedure characteristics for each RFA session. The association between potential risk factors and duration of hospitalization (less than or more than 24 hours) was analyzed using univariate and multivariate logistic regressions. RESULTS: Our study included 291 patients (mean age: 65.2 ± 11.2 [standard deviation]; 201 men) undergoing 324 RFA sessions. Sixty-eight sessions (21.0%) resulted in hospitalization of more than 24 hours. Multivariate analysis identified each additional needle insertion per session (OR 1.4; 95% CI [1.1-1.9]; P = .02), RFA performed in segment V (OR 2.8; 95% CI [1.4-5.7]; P = .004), and use of artificial pneumothorax (OR 14.5; 95% CI [1.4-146.0]; P = .02) as potential risk factors. A history of hepatic encephalopathy (OR 2.6; 95% CI [1.1-6.0]; P = .03) was only significant in univariate analysis. Post-hoc, subgroup analysis of patients with hepatocellular carcinoma (69.8%) did not identify other risk factors. CONCLUSION: Risk factors for a hospitalization duration longer than 24 hours include a higher number of needle insertions per session, radiofrequency ablation in segment V, and use of an artificial pneumothorax.
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Introduction: A large proportion of patients undergoing hip or knee replacement surgery experience preoperative anxiety, a predictor of postoperative pain. Objective: To evaluate the preliminary effects of a preoperative nursing consultation incorporating therapeutic education with relaxation on pre- and postoperative anxiety and postoperative pain in patients undergoing hip or knee replacement surgery. Method: Pre-experimental study conducted with a single group and several measurement times: before and after the consultation with a nurse; the day before surgery; and during the hospital stay. Results: A total of 92 people participated in the study. There was a significant and progressive decrease in levels of pain and anxiety. The reduction in anxiety levels before/after the consultation (T0-T1) correlated with anxiety levels the day before surgery (T2), anxiety levels during the hospital stay (T3), and postoperative pain. Discussion: This preoperative nursing consultation appears to have been effective in reducing levels of pre- and postoperative anxiety, as well as postoperative pain, in the patients studied. Conclusion: This randomized clinical trial demonstrates the relevance of continuing to study this combined therapeutic approach in the management of pre- and postoperative anxiety and pain.
Introduction: Une grande proportion de personnes devant subir une arthroplastie de la hanche ou du genou éprouvent de l'anxiété préopératoire, prédictive de douleur postopératoire. Objectif: Évaluer les effets préliminaires d'une consultation infirmière préopératoire intégrant de l'éducation thérapeutique avec de la relaxation sur l'anxiété pré- et postopératoire et la douleur postopératoire dans cette population. Méthode: Devis préexpérimental avec un seul groupe en plusieurs temps de mesure, avant et après la consultation infirmière, la veille de la chirurgie et durant le séjour hospitalier. Résultats: Au total, 92 personnes ont participé à l'étude. Il y a une diminution significative et progressive de l'anxiété et de la douleur. La diminution de l'anxiété avant/après la consultation (T0-T1) est corrélée à l'anxiété la veille de la chirurgie (T2), l'anxiété pendant le séjour (T3) et la douleur postopératoire. Discussion: Cette consultation infirmière en préopératoire semble efficace pour diminuer l'anxiété pré- et postopératoire et la douleur postopératoire dans cette population. Conclusion: Cette étude démontre la pertinence de continuer à étudier cette combinaison thérapeutique dans la gestion de l'anxiété et la douleur pré- et postopératoire dans un essai clinique à répartition aléatoire.
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Artroplastia do Joelho , Humanos , Artroplastia do Joelho/efeitos adversos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/tratamento farmacológico , Ansiedade/diagnóstico , Ansiedade/etiologiaRESUMO
PURPOSE: Results of surgical or endovascular treatment of intracranial aneurysms are often assessed using angiography. A reliable method to report results irrespective of treatment modality is needed to enable comparisons. Our goals were to systematically review existing classification systems, and to propose a 3-point classification applicable to both treatments and assess its reliability. METHODS: We conducted two systematic reviews on classification systems of angiographic results after clipping or coiling to select a simple 3-category scale that could apply to both treatments. We then circulated an electronic portfolio of angiograms of clipped (n=30) or coiled (n=30) aneurysms, and asked raters to evaluate the degree of occlusion using this scale. Raters were also asked to choose an appropriate follow-up management for each patient based on the degree of occlusion. Agreement was assessed using Krippendorff's α statistics (αK), and relationship between occlusion grade and clinical management was analyzed using Fisher's exact and Cramer's V tests. RESULTS: The systematic reviews found 70 different grading scales with heterogeneous reliability (kappa values from 0.12 to 1.00). The 60-patient portfolio was independently evaluated by 19 raters of diverse backgrounds (neurosurgery, radiology, and neurology) and experience. There was substantial agreement (αK=0.76, 95%CI, 0.67-0.83) between raters, regardless of background, experience, or treatment used. Intra-rater agreement ranged from moderate to almost perfect. A strong relationship was found between angiographic grades and management decisions (Cramer's V: 0.80±0.12). CONCLUSION: A simple 3-point scale demonstrated sufficient reliability to be used in reporting aneurysm treatments or in evaluating treatment results in comparative randomized trials.
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Aneurisma Intracraniano , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos , Variações Dependentes do Observador , Reprodutibilidade dos TestesRESUMO
With the advent of new cellular and targeted therapies, treatment options for relapsed and refractory (r/R) lymphomas have multiplied, and the optimal approach offering the best outcomes remains a matter of passionate debate. High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is still considered a treatment option for patients with chemosensitive lymphoma when cure is the expected goal. The myeloablative conditioning regimen preceding the stem cell infusion is considered the effective component of this approach. Carmustine (BCNU)-based preparative regimens, such as BEAM and BEAC, are considered the standard of care and have shown efficacy and low nonrelapse mortality (NRM). Comparative studies between conditioning regimens have failed to identify a better option. After a BCNU drug shortage in Canada followed by a steep increase in price, we elected to substitute BCNU for bendamustine (benda) in the preparative regimen. The purpose of this substitution was to improve response while preserving safety and controlling costs. From May 2015 to May 2018, a total of 131 consecutive lymphoma patients received benda-EAM conditioning. These patients were compared with 96 consecutive patients who received BCNU-based conditioning from January 2012 to May 2015. Apart from conditioning, supportive care measures were the same in the 2 groups. Patients receiving benda were older (55.7 years versus 51.1 years; P = .002). The development of grade ≥3 mucositis was more frequent with benda conditioning (39.5% versus 7.8%; P < .001) leading to a greater requirement for parenteral nutrition (48.9% versus 21.9%; P < .001). A transient creatinine increase >1.5 times the upper limit of normal (15.3% versus 4.2%; P < .008) and intensive care unit admission (6.9% versus 1.1%; P < .029) were more frequent with benda; however, there were no between-group differences in cardiac, pulmonary, or liver toxicity and NRM. With a median follow-up of 48 months for the benda group and 60 months for the BCNU group, benda was associated with significantly better progression-free survival (71% versus 61%; P = .040; hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.0 to 2.7) and overall survival (86% vs 71%; P = .0066; HR, 2.6; 95% CI, 1.3 to 5.4) compared with BCNU-based conditioning regimens. While novel therapies emerge, our study demonstrates that benda-EAM is safe and effective and should be considered a valid alternative to BCNU conditioning to improve outcomes of patients with chemosensitive r/R lymphomas undergoing ASCT.