Patient management after primary rectal cancer diagnosis. Special focus on surgical treatment for non-metastatic disease.

Background: Rectal cancer is a public health priority. Primary objectives of this study were to evaluate the quality of care for non-metastatic rectal cancer using process and outcome indicators. Delay of management, length of stay and readmission rate, sphincter preservation, morbidity, number of examined lymph nodes, mortality, overall and disease-free survivals were evaluated. Secondary objectives were to estimate the relationship between possible predictive parameters for (1) anastomotic leakage (logistic regression), (2) overall or disease-free survivals (cox regression).Methods: We performed a retrospective study on 312 consecutive patients diagnosed with primary rectal cancer between 2016 and 2019. We focused on the 163 patients treated by surgery for non-metastatic cancer.Results: The treatment began within 33 days (range 0-264) after incidence, resection rate was 67%. Digestive continuity rate in lower, middle and upper rectum was 30%, 87% and 96%. Median of 14 lymph nodes (range 1-46) was analyzed. Length of stay and readmission rate were 11 days (range 3-56) and 4%, respectively. Within 90 postoperative days, clinical anastomotic leakage occurred in 9.2% of cases, major morbidity rate was 17%, mortality 1.2%. Multivariate analysis revealed that stoma decreased the risk of anastomotic leakage [hazard ratio: 0.16; 95% confidence intervals: 0.04-0.63; p = 0.008]. The 5-year overall survival after surgery was 85 ± 4%, disease-free survival 83 ± 4%. Patients with major complications, male gender and R1/R2 resection margin had a poorer prognosis.Conclusion: This work showed encouraging results in rectal cancer treatment in our institution, our results were in line with recommendations at the time.

[Utilisation of immunosuppressants in the prevention of a graft versus host reaction: report by the SFGM-TC]. / Immunosuppresseurs dans la prévention de la réaction du greffon contre l'hôte : rapport de la SFGM-TC.

In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the fourth annual series of workshops which brought together practitioners from all member centers and took place in September 2013 in Lille. Here we report our recommendations regarding the use of immunosuppressive treatment in the prevention of graft versus host disease: report by the SFGM-TC.

[A report of the SFGM-TC on the interactions between national transplant coordination and local coordinators in allogeneic stem cell transplantation activity]. / Interactions entre coordination nationale de greffe et coordinateurs locaux.

In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. The main aim of this session was to describe the relations between the national transplant coordination office of the French registry and local stem cell transplantation coordinators throughout France.

Vertebral compression fracture during stereotactic body radiotherapy for spinal metastasis: A rare case of tracking failure.

Spinal metastasis are a daily challenge in clinical practice. Stereotactic body radiotherapy (SBRT) allows delivery of definitive treatment with excellent long-term control rates. Its implementation needs dedicated devices and day-to-day image-guided radiotherapy (IGRT). The XSight™ spine tracking system, integrates with the CyberKnife® (Accuray™), provides a fiducial-free tracking system for spinal SBRT. We report a rare case of tracking failure during treatment due to the occurrence of a vertebral compression fracture (VCF).

Assessment of primary lymphedema and post-thrombotic lower limb edema patient's pathway.

OBJECTIVES: To assess: (1) lower limb primary lymphedema or post-thrombotic syndrome patient's pathway in terms of health care professional use and (2) if aetiology of edema has an impact on this pathway. METHODS: Ancillary survey of the transversal prospective CHROEDEM pilot study. Forty patients with either lower limb primary lymphedema or post-thrombotic syndrome were invited to participate. RESULTS: Seventy-five percent of primary lymphedema patients and 50% of post-thrombotic patients benefited from a multidisciplinary management (P=0.10) including the general practitioner, the vascular medicine physician and either a physiotherapist (particularly in case of primary lymphedema), a registered nurse (particularly in case of post-thrombotic syndrome). Main ambulatory health care professionals' correspondent of hospital-based vascular medicine physicians were general practitioners (80%) in post-thrombotic patients, and general practitioners (60%) and physiotherapists (45%) in primary lymphedema patients. Pharmacists were also involved in patient education. CONCLUSION: Management of primary lymphedema and post-thrombotic related chronic edema is usually multidisciplinary. General practitioners and vascular medicine physicians are the cornerstones of this management, that also involves the physiotherapist in case of primary lymphedema and in a lesser extent the registered nurse and the pharmacist. This suggests that these five healthcare professional should play a key role in case of development of standardized patient pathways for primary lymphedema and post-thrombotic syndrome.

[Quality standards for ultrasonographic assessment of peripheral vascular malformations and vascular tumors. Report of the french society for vascular medicine. 2018 Update]. / Standards de qualité pour la pratique de l'examen écho-Doppler dans l'étude des malformations et tumeurs vasculaires. Rapport de la Société française de médecine vasculaire (SFMV) : actualisation 2018.

The quality standards of the French Society of Vascular Medicine for the ultrasonographic assessment of vascular malformations are based on the two following requirements: (1) technical know-how: mastering the use of ultrasound devices and the method of examination; (2) medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. AIMS OF THE QUALITY STANDARDS: To describe an optimal method of examination in relation to the clinical question and hypothesis. To homogenize practice, methods, glossary, and reporting. To provide good practice reference points, and promote a quality process. ITEMS OF THE QUALITY STANDARDS: The 3 levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Setting and use of ultrasound devices. Here, we discuss ultrasonography methods of using of ultrasonography for the assessment of peripheral vascular malformations and tumors (limbs, face, trunk).

Effect of lenograstim on the cost of autologous bone marrow transplantation. A preliminary communication.

High dose chemotherapy and autologous bone marrow transplantation (BMT) can produce prolonged remission in patients with malignant lymphoma or solid tumours. However, neutropenia is a serious complication of treatment in patients with these diseases. In this study, we investigated the costs and effects of using lenograstim, a recombinant human granulocyte colony-stimulating factor, to treat neutropenia in 16 patients with lymphoma or solid tumours. The cost of lenograstim was not included in the calculations. The duration of neutropenia and hospitalisation were both lower in patients who received lenograstim compared with no treatment. The mean cost of autologous BMT was FF142,000 in patients who received lenograstim, compared with FF166,000 in patients who did not. Savings were largely attributable to decreased expenditure on hospitalisation in the lenograstim-treated group. The cost of 14 days' treatment with lenograstim was estimated at FF10,500, based on a daily dosage of 150 micrograms/m2/day.

Project LEAP of New Jersey: lower extremity amputation prevention in persons with type 2 diabetes.

OBJECTIVE: To reduce type 2 diabetes-related lower extremity amputations (LEAs) in New Jersey through a statewide training program for primary care providers at healthcare agencies in high-risk areas. STUDY DESIGN: Project LEAP provided 27 1-day training workshops to 560 healthcare professionals representing 85 organizations. The effect of training was evaluated based on a multiple-choice knowledge test, self-reported practice behaviors, and a medical records audit of practice behaviors, and pre- and postprogram LEA rates. PATIENTS AND METHODS: We evaluated statistically significant differences in pre- and postprogram knowledge scores using Student's t-tests. We also evaluated providers' intentions to change clinical foot-care practices and compared them with actual practices documented in medical records. We used analysis of variance to determine any statistically significant differences in pre- and postprogram LEA rates at various types of institutions. In addition, we assisted facilities in the development of self-education programs containing specific foot-care modules. RESULTS: Participating providers were: 70.6% nurses, 7.8% physicians, 4.5% podiatrists, 4.2% dietitians, and 12.9% all others. Pre- and postprogram knowledge scores increased by 12% (T = 13.29; P < 0.0001) and were maintained for 9 months (T = 7.58; P < 0.05). Provider intentions to change clinical practice behaviors correlated with self-reported practice changes 9 months postprogram (r = .51; P < 0.001). Medical record audits 1 year before and 9 months after training demonstrated marked improvement in foot-care practices in the following areas: (1) foot-care education given to patients by primary care providers; 2) documentation of peripheral vascular disease; 3) documentation of patient preventive care practices; and 4) referrals to diabetes educators, orthopedists, podiatrists, and diabetologists. Education programs with specific foot-care components increased 10%. The overall incidence of pre- and posttraining LEAs did not change significantly but differed depending on institution type. Hospitals and community healthcare centers were more likely to show postprogram reductions in LEAs than nursing homes and rehabilitation centers. CONCLUSION: Institutionalization of a LEAP program resulted in improved provider knowledge and certain clinical practice behaviors. There was a trend toward an overall reduction in the number of LEAs at participating institutions.

Ozone differential absorption lidar algorithm intercomparison.

An intercomparison of ozone differential absorption lidar algorithms was performed in 1996 within the framework of the Network for the Detection of Stratospheric Changes (NDSC) lidar working group. The objective of this research was mainly to test the differentiating techniques used by the various lidar teams involved in the NDSC for the calculation of the ozone number density from the lidar signals. The exercise consisted of processing synthetic lidar signals computed from simple Rayleigh scattering and three initial ozone profiles. Two of these profiles contained perturbations in the low and the high stratosphere to test the vertical resolution of the various algorithms. For the unperturbed profiles the results of the simulations show the correct behavior of the lidar processing methods in the low and the middle stratosphere with biases of less than 1% with respect to the initial profile to as high as 30 km in most cases. In the upper stratosphere, significant biases reaching 10% at 45 km for most of the algorithms are obtained. This bias is due to the decrease in the signal-to-noise ratio with altitude, which makes it necessary to increase the number of points of the derivative low-pass filter used for data processing. As a consequence the response of the various retrieval algorithms to perturbations in the ozone profile is much better in the lower stratosphere than in the higher range. These results show the necessity of limiting the vertical smoothing in the ozone lidar retrieval algorithm and questions the ability of current lidar systems to detect long-term ozone trends above 40 km. Otherwise the simulations show in general a correct estimation of the ozone profile random error and, as shown by the tests involving the perturbed ozone profiles, some inconsistency in the estimation of the vertical resolution among the lidar teams involved in this experiment.

The aftermath of youth suicide--providing postvention services for the school and community.

Suicide is one of the leading causes of death in adolescence. Due to the risk of contagion and maladaptive coping responses in the aftermath of suicide, clinicians have responded by developing postvention services. Based on a considerable amount of experience in this field, target groups of individuals have been identified to receive such assistance. These groups include school administrators, staff, students, families, and community members at large. In addition, it has become clear that the local media response to suicide is of critical importance, and that school administrators and local mental health officials should work effectively with reporters so that news stories do not contribute to suicide contagion.

[SOPHOCLE (Ophthalmologic Simulator of Laser PHOtocoagulation): contribution to virtual reality]. / SOPHOCLE (Simulateur Ophtalmologique de PHOtoCoagulation LaSer): contribution de la réalité virtuelle.

PURPOSE: This study was undertaken to teach laser retinal photocoagulation in different disorders using a "virtual eye". Most ophthalmologists routinely use laser photocoagulator. Both indications and laser effects are well-known. However, in various diseases (diabetic retinopathy, age-related-macular degeneration, myopia...) complications rate increase or at least does not decrease. The main reasons are: - ignorance of risk factors, - misuse of the instrument. METHODS: We developed a new automated device stimulating a real laser photocoagulator. Only slit-lamp exists. The three-mirror lens, the fundus and the retinal photocoagulation impacts are "virtual". CONCLUSION: The aim of the simulator is to help practitioners to recognize various pathologies almost as in real conditions and to be familiar with different technics of photocoagulation. By using computer assisted learning, a constant evaluation determines the level and the progress of practitioners.

[Influence of the granulocyte growth factor on the cost of bone marrow autografts in oncologic hematology]. / Influence du facteur de croissance granulocytaire sur le coût des autogreffes de moelle en onco-hématologie.

OBJECTIVE: It is now possible to achieve prolonged remission of malignant lymphoma and certain cancers with high-dose chemotherapy followed by autograft with haematopoietic stem cells. We tested such a protocol, evaluating haematologic recovery, in order to determine the total cost of hospitalization. METHODS: Sixteen patients were included in the study, 7 had severe or relapsing lymphoma, 7 had breast cancer or cancer of the ovary and 2 had cancer of the testicule. Mean age was 34 years, 14 patients reached complete remission and relapse occurred in 2. Ten patients were given granulocyte growth factor and 6 were given a placebo. RESULTS: The duration of aplasia (number of days with a white cell count below 1 x 10(9)1) ranged from 10 to 32 days. In patients treated with granulocyte growth factor, it was shorter (16 vs 22 days) as was hospitalization time (27 vs 33 days). The cost of the autograft ranged from 100,000 FF to 250,000 FF and the average cost for the 16 patients was 149,500 FF including: 83,600 FF (56.4%) for hospitalization itself, 33,200 FF (22%) for drugs, mostly antibiotics, and 19,000 FF (13%) for laboratory examinations and 14,000 FF (9%) for blood transfusions. Total cost was lower in patients given granulocyte growth factor, 142,000 FF vs 166,000 FF for those given placebo. CONCLUSION: In order to shorten the duration of the aplasia period, haematopoietic growth factors are widely used in autograft protocols. Our findings give an evaluation of the cost in 16 patients and show that cost decreases in patients given granulocyte growth factor. This reduction is cost is related to a lower hospitalization cost and not a reduction in the number of drugs and transfusions required.

[Ocular redness in general medicine]. / L'oeil rouge en médecine générale.

Ocular redness is analysed within the framework of the practice in general medicine. The stress of this work is laid on the development of clinical and anamnestic criteria (pain and diminution of visual acuity) which allow to suspect a serious pathology of the eye. The systematic examination of each entity is described under field conditions, using a simple light and fluorescein. The attitude of the general practitioner is detailed according to the degree of severity of the affection, while insisting on the clinical situations to refer to a specialist.

The feasibility and desirability of public health credentialing: a survey of public health leaders.

OBJECTIVES: The goal of this study was to provide insight concerning the potential of credentialing public health workers through an exploratory examination of public health leaders' perceptions. METHODS: Qualitative and quantitative procedures were used. Credentialing issues were identified through the literature and through open-ended interviews with leaders and experts. A 74-item Likert-type survey was used to quantify perceptions. Key informants and survey participants were identified through pertinent organizations. RESULTS: The public health leaders leaned toward consensus on some benefits of and concerns about credentialing. There was no consensus related to a specific form of desired credentialing, although national certification was supported by a plurality. State licensing and an emphasis on the master's in public health (MPH) degree were opposed by large margins. Public health leadership survey results were similar to results of a survey of credentialing experts. CONCLUSIONS: The lack of consensus and the vehemence of some opposing positions indicate that movements toward credentialing should proceed cautiously. However, many of the response patterns indicate that the issue merits further exploration.

Ground-based laser DIAL system for long-term measurements of stratospheric ozone.

A ground-based differential absorption lidar system has been implemented to make long-term, precise measurements of stratospheric ozone concentration profiles from ~20 to 50 km altitude. This lidar is located at an elevation of 2300 m in the San Gabriel Mountains, Southern California, and has been in operation since Jan.1988. A high power (100-W) excimer laser system and a 90-cm diam telescope are used to achieve the desired performance levels. This paper describes the implementation of the system and its operation including the procedures for data analysis. Examples of ozone profiles measured, and intercomparisons with measurements made by other instruments, are presented which show that the lidar, in its present configuration, is capable of producing high quality ozone measurements from 20 km up to at least 45 km.

Lidar measurements of stratospheric ozone and intercomparisons and validation.

A ground-based, high power differential absorption lidar (DIAL) system has been implemented to make long term, precise measurements of stratospheric ozone concentration profiles from ~20- to 50-km altitude. This lidar is located at an elevation of 2300 m in the San Gabriel Mountains, Southern California, and has been in operation since January 1988. Evaluation of the results obtained from this system has been provided through an inter-comparison campaign, carried out during October/November 1988, and through long term comparison with SAGE II satellite measurements. This paper describes the implementation of the system and its operation, including the procedures for data analysis. Examples of ozone profiles measured and inter-comparisons with measurements made by other instruments are presented which show that the lidar is capable of producing high quality ozone measurements up to at least 45-km altitude.

Measurement intercomparison of the JPL and GSFC stratospheric ozone lidar systems.

For approximately one month during October and November 1988 the NASA Goddard Space Flight Center mobile lidar system was brought to the Jet Propulsion Laboratory, Table Mountain Facility, to make side-byside measurements with the JPL lidar of stratospheric ozone concentration profiles. Measurements were made by both excimer laser DIAL systems on fifteen nights during this period. The results showed good agreement of the ozone profiles measured between 20- and 40-km altitude. This is the first (to the best of our knowledge) reported side-by-side measurement intercomparison of two stratospheric ozone lidar systems.