Ablative margins in percutaneous thermal ablation of hepatic tumors: a systematic review.

INTRODUCTION: This study aims to systematically review current evidence on ablative margins and correlation to local tumor progression (LTP) after thermal ablation of hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM). METHODS: A systematic search was performed in PubMed (MEDLINE) and Web of Science to identify all studies that reported on ablative margins (AM) and related LTP rates. Studies were assessed for risk of bias and synthesized separately per tumor type. Where possible, results were pooled to calculate risk differences (RD) as function of AM. RESULTS: In total, 2910 articles were identified of which 43 articles were eligible for final analysis. There was high variability in AM measurement methodology across studies in terms of measurement technique, imaging modalities, and timing. Most common margin stratification was < 5 mm and > 5 mm, for which data were available in 25/43 studies (58%). Of these, all studies favored AM > 5 mm to reduce the risk of LTP, with absolute RD of 16% points for HCC and 47% points for CRLM as compared to AM < 5 mm. CONCLUSIONS: Current evidence supports AM > 5 mm to reduce the risk of LTP after thermal ablation of HCC and CRLM. However, standardization of AM measurement and reporting is critical to allow future meta-analyses and improved identification of optimal threshold value for clinical use.

Liaison nursing for stroke patients: results of a Dutch evaluation study.

Liaison nurses, employed by a home care organization, were introduced into two Dutch hospitals to improve discharge planning for stroke patients. The main aim of the study presented was to gain insight into the effects of liaison nursing on the quality of the discharge process and related outcomes. After the introduction of liaison nursing, hospital nurses completed a questionnaire on satisfaction with the liaison nurse. In addition, both before and after the introduction of liaison nursing, two groups of discharged stroke patients were interviewed by telephone. The records of these patients were also studied with respect to background characteristics and duration of hospital stays. The hospital nurses were, generally, positive about the liaison nurse and the job she did (e.g. they found that home care was better organized). Further, after the introduction of liaison nursing, more patients stated that their post-discharge needs had been discussed not later than 48 hours prior to discharge, and more patients said their aftercare had been discussed with community nurses. However, the number of patients whose medication had arrived at home on time had decreased. The results also indicated that there was no significant difference in the duration of stay between the before and after group. The overall conclusion is that the liaison nurses have been moderately successful in their jobs. However, since the study was conducted in only two Dutch hospitals, findings may not be representative of other settings. Future research on liaison nursing is therefore recommended.

Workload, capacity for coping and psychological and physical outcomes amongst home helps in the Netherlands.

Owing to many developments and changes in home care in the Netherlands, a national study was carried out. One of the aims was to examine the differences between the six categories of home help in the Netherlands regarding workload, pressure of work and capacity for coping. A total of 474 home helps from six categories participated in the study. A structured questionnaire, based on the components of the research model, was used, which consisted of existing scales regarding workload (organizational and job characteristics, working conditions), psychological and physical outcomes (job satisfaction, burnout, health) and capacity for coping (social support, leadership style, coping strategies). Workload, specifically organizational and job characteristics are scored low by alpha helps and, to a lesser degree, by A home helps. The higher categories of home help experienced relatively bad working conditions. Home helps, except for alpha helps, are, on the whole, quite satisfied with their work, which is one of the psychological and physical outcomes. The higher categories of home help (C, D and E carers) experienced high feelings of emotional exhaustion. Health, absenteeism and back problems did not differ significantly amongst home helps. When looking at capacity for coping, traditional home helps (A to E) received more social support. The subordinate categories of home help dealt less actively with their problems and sought less social support than the other categories. Alpha helps are not employed by the organization and this might cause low organizational and job characteristics, and little social support. Their satisfaction scores suggest that they would like to see their low organizational involvement changed. The higher categories of home help, who carry out many psychosocial tasks, have higher emotional and mental workload and high burnout scores. B, C and D carers, who perform personal care and have to adhere to strict planning, experience extreme time pressure and a high physical workload.

A job profile of home helps in the Netherlands.

Owing to many developments and changes in home care in the Netherlands, a national study on home help services was carried out. One of the aims was to examine the job content of the six new categories of home help, the differences in their work and the correspondence of daily practice with formal job descriptions. Six home help categories were examined: alpha helps; A home helps; B caring helps; C and D carers; and specialized E carers - self-registration forms and weekly reports were used for data-collection. For a period of 4 weeks, 458 home helps recorded on these forms all the activities they carried out during and outside home visits. The daily work of alpha helps, A home helps and B caring helps mainly involves housework and psycho-social/supportive activities, whilst B caring helps also carry out some personal care and C carers do some housework, personal care and psycho-social or supportive activities. The main work of D carers consists of personal care and psycho-social activities. Psycho-social activities are mainly carried out by specialized E carers, who also do housework, mostly together with the client. In daily practice, the four subordinate categories of home help carry out more psycho-social and reporting activities, and the three highest categories do more housework compared with their formal job descriptions. There also appears to be an overlap in the work of A home helps and B caring helps and in the work of C and D caters. An adjustment to formal job descriptions relating to the daily practice of home helpers is required, as well as more time for the extra activities home helps have to carry out. Finally, the overlap between various categories of home helps needs to be resolved whereby instead of six categories of home help, four new categories should be created.

Age-related response to lidocaine-prilocaine (EMLA) emulsion and effect of music distraction on the pain of intravenous cannulation.

OBJECTIVE: To compare the efficacy of a local anesthetic cream and music distraction in reducing or preventing pain from needle puncture (intravenous cannulation) in children. A secondary aim was to examine the influence of age on the pain report and behavior and on the therapeutic outcome. METHODOLOGY: Children aged 4 to 16 years (N = 180) who were to undergo surgery under general anesthesia via intravenous cannulation were randomly allocated to one of three interventions. The comparison of lidocaine-prilocaine emulsion (EMLA, Astra) and a placebo emulsion was double-blind. Stratification by age group (4 to 6, 7 to 11, 12 to 16) ensured an equal number of children (20) in each intervention/age group category. A global assessment of the behavioral reaction to the procedure was made by the principal investigator, taking into account vocal, verbal, facial, and motor responses. The child was asked to assess pain severity on the Faces Pain Scale (FPS) and a visual analogue toy (VAT). The scales were applied conservatively as ordinal scales: FPS 0 to 6; VAT 0 to 10. RESULTS: Children who received lidocaine-prilocaine emulsion reported less pain (mean FPS score = 1.42) compared with placebo emulsion (mean FPS score = 2.58) and with music distraction (mean FPS = 2.62). There was a highly significant therapeutic effect (P < .001) on the self-report and behavioral scores. Younger children, regardless of intervention, reported significantly more pain than the older children (mean FPS scores: 2.85, 2.33, 1.43 for age groups 4 to 6, 7 to 11, and 12 to 16 respectively; P < .001). The superiority of the local anesthetic emulsion was maximal in the youngest age group (4 to 6) almost eliminating pain-related behavior, and multiple regression analysis confirmed significant age and treatment effects and revealed interaction between therapeutic effect and age. Although a trend favoring the active emulsion was evident in the older children (7 to 11, 12 to 16) the differences were not significant. The pain scores were influenced by the type (gauge) of cannula, but this did not affect the conclusion regarding therapeutic and age effects. There was no influence of sex, experience with venipuncture, or whether the child was anxious on arrival in the operating room. CONCLUSIONS: The results show that lidocaine-prilocaine emulsion is highly effective in preventing pain from venipunctures in young children, the group in most need of prevention.