Thyroid abnormalities in patients with Hodgkin lymphoma: The importance of close surveillance.

INTRODUCTION: Survival in paediatric patients with Hodgkin lymphoma (HL) has increased over the last decades. However, these patients are at increased risk of developing late thyroid sequelae due to the treatment with irradiation and alkylating agents. METHODS: We conducted an observational and retrospective study in patients with a diagnosis of HL between 2007 and 2022, in a hospital that is a paediatric oncology reference centre, through the review of electronic health records. We collected data on demographic (age, sex), clinical, radiological and histopathological variables, the dosage of alkylating agents and radiotherapy (RT) and on thyroid disorders using Microsoft Excel. The data analysis was conducted with SPSS version 17, using the Fisher exact test for qualitative data, a nonparametric test for quantitative data and Kaplan-Meier curves. RESULTS: Sixty patients received a diagnosis of HL from 2007 to 2022. The median duration of follow-up was 78.5 months. There were 4 detected cases of hypothyroidism, 5 of thyroid nodules and 1 of subclinical hyperthyroidism. Treatment with RT was significantly associated with the development of hypothyroidism (P= .026), thyroid nodules (P= .01) and thyroid disease overall (P= .003). We estimated that the risk of thyroid disease increased 8-fold with each additional Grey received (hazard ratio, 1.081; 95% CI, 1.014-1.152; P= .017). CONCLUSION: Hodgkin lymphoma patients treated with RT are at increased risk of late thyroid disorders, mainly hypothyroidism and malignancy. This risk is greater the higher the RT dosage and the longer the follow-up. We did not find evidence of an association between the use of alkylating agents and an increase in the risk of thyroid disease.

[The acute orthogeriatric unit. Assessment of its effect on the clinical course of patients with hip fractures and an estimate of its financial impact]. / La unidad de ortogeriatría de agudos. Evaluación de su efecto en el curso clínico de los pacientes con fractura de cadera y estimación de su impacto económico.

OBJECTIVE: To study the effects of the management of hip fracture patients in an acute orthogeriatric unit shared between the departments of Orthopedic Surgery and Geriatrics compared with the usual hospital care, and to analyse financial differences in both systems of care. METHOD: Prospective quasy-experimental randomized intervention study in 506 patients admitted to a terciary hospital with an osteoporotic hip fracture. The usual model of care was the admission to the orthopedic ward with a request to Geriatrics (RC) and the study model consisted of the admission to an orthogeriatric unit (OGU) for the shared co-management between orthopaedic surgeons and geriatricians. This model included the appointment of one spokesperson from each department, the specialist geriatric nurse management, early geriatric assessment, shared daily clinical care, weekly joint ward round and coordinated planning of the surgery schedule, the start of the ambulation and the time and setting of patient discharge. RESULTS: Two hundred fifty five consecutive patients admitted to the OGU and 251 patients managed simultaneously by the RC model were included. Except for a mean age slightly lower in the OGU group, there were no differences neither in the baseline patients characteristics nor in the surgical rates between the two groups. Among the OGU patients group it was more frequent to receive rehabilitation in the acute setting, to be able to walk at discharge and to be referred to a geriatric rehabilitation unit (all with P < .05). The OGU patients received geriatric assessment and were operated on earlier than the RC patients (P < .001). The length of stay in the acute ward was 34% shorter in the OGU patients (mean 12.48 ± 5 vs 18.9 ± 8.6 days, P < .001) (median 12 [9-14] vs 17 [13-23] days, P < .001). The whole hospital length of stay, including the days spent in the geriatric rehabilitation units, was 11% shorter in the OGU patients (mean 21.16 ± 14.7 vs 23.9 ± 13.8 days, P < 0.05) (median 14 [10-31] vs 20 [14-30] days, P < .001). The OGU saved 1,207 € to 1,633 € per patient when estimated by the costs for process model, and 3,741 € when estimated by the costs for stay model. CONCLUSIONS: The OGU is a hospital setting that provides an improvement in the patients functional outcome and a reduction in the hospital length of stay. Therefore it saves health care resources. These findings show the OGU as an advisable setting for the acute care of hip fracture patients.

The orthogeriatric unit for acute patients: a new model of care that improves efficiency in the management of patients with hip fracture.

We performed a prospective, quasi-experimental, randomised, interventional study comparing two models of care for patients admitted with osteoporotic hip fractures between February and August 2007 in a tertiary university hospital. The usual model of care was treatment of patients admitted to the orthopaedics ward, with consultation by the geriatrician (CG model). The study model involved admission to an acute orthogeriatric unit (OGU model), with joint care provided by geriatricians and orthopaedic surgeons which included immediate geriatric assessment, coordinated daily clinical care, weekly combined ward rounds, and joint planning of the surgical schedule, initial mobilisation, discharge date and destination. No differences were found between CG patients (123) and OGU patients (101) in terms of previous characteristics, number of patients surgically treated, functional level obtained, or discharge destination. OGU patients had earlier geriatric assessment (median 1 day, P25-P75: 1-2) than CG patients (median 4 days, P25-P75: 3-8), earlier surgery (median 5 days from admission to OGU, P25-P75: 3-6, versus 6 days in the CG group, P25-P75: 5-9), and had a shorter acute hospital stay (33% reduction, median 12 days in OGU, P25-P75: 9-14, versus 18 days, P25-P75: 13-23 in the CG group) and total (acute and subacute) hospital stay (30% reduction, median 14 days in OGU, P25-P75: 10-31, versus 20 days, P25-P75: 14-30 in the CG group). All these comparisons were statistically significant (p<0.01). The organization of an OGU in a tertiary hospital allowed hip fracture patients to receive earlier geriatric assessment and surgical treatment. Acute hospital stay was reduced by 33%, and total hospital stay was reduced by 30% with no differences at discharge in clinical and functional outcomes.

Impact of a clinical pathway in patient care following surgery on laparoscopic radical prostatectomy.

PURPOSE: The aim of this study was to evaluate the impact of clinical pathway (CP) implementation in laparoscopic radical prostatectomy (LRP) has had on patient care and clinical evolution after discharge. MATERIALS AND METHODS: Eighty-six patients were included in 2 groups: first group was composed of patients operated since the new technique (LRP) was used until the CP was implemented (26 patients operated in 2002) and, second group, with 60 patients, followed the CP during 2004 and 2005. RESULTS: The operative time was reduced from 377.7 to 172.3 minutes after the CP implementation. The duration of bladder catheterization decreased by more than 10 days (from 26.17 to 15.85 days) and that of thromboprophylaxis was reduced from 6.44 to 3.38 days. No difference was found in the rate of complications in the first month after surgery, nor was there any difference in the rate of occurrence of erectile dysfunction, incontinence, and biochemical recurrence during the first year after surgery. CONCLUSION: After the implementation of the CP, there have been better results in patient care, such as reduction in the duration of catheterization and thromboprophylaxis. In comparison with other studies, we observed a clear reduction in length of stay and operative time. However, there is still room for improvement in reducing the duration of catheterization.