RESUMO
AIM: Patient-reported outcome (PRO) measures (PROMs) are standard measures in the assessment of colorectal cancer (CRC) treatment, but the range and complexity of available PROMs may be hindering the synthesis of evidence. This systematic review aimed to: (i) summarize PROMs in studies of CRC surgery and (ii) categorize PRO content to inform the future development of an agreed minimum 'core' outcome set to be measured in all trials. METHOD: All PROMs were identified from a systematic review of prospective CRC surgical studies. The type and frequency of PROMs in each study were summarized, and the number of items documented. All items were extracted and independently categorized by content by two researchers into 'health domains', and discrepancies were discussed with a patient and expert. Domain popularity and the distribution of items were summarized. RESULTS: Fifty-eight different PROMs were identified from the 104 included studies. There were 23 generic, four cancer-specific, 11 disease-specific and 16 symptom-specific questionnaires, and three ad hoc measures. The most frequently used PROM was the EORTC QLQ-C30 (50 studies), and most PROMs (n = 40, 69%) were used in only one study. Detailed examination of the 50 available measures identified 917 items, which were categorized into 51 domains. The domains comprising the most items were 'anxiety' (n = 85, 9.2%), 'fatigue' (n = 67, 7.3%) and 'physical function' (n = 63, 6.9%). No domains were included in all PROMs. CONCLUSION: There is major heterogeneity of PRO measurement and a wide variation in content assessed in the PROMs available for CRC. A core outcome set will improve PRO outcome measurement and reporting in CRC trials.
Assuntos
Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/métodos , Avaliação de Resultados da Assistência ao Paciente , Autorrelato , Inquéritos e Questionários , HumanosRESUMO
OBJECTIVE: The colorectal fast track (FT) referral system was set up to ensure patients with suspected cases of colorectal cancer (CRC) received prompt access to specialized services. The aim of this study was to ascertain the association between referral source and the time it took to be seen by a colorectal surgeon to establish whether referral source had any association with the stage of disease at presentation in patients with CRC. METHOD: Consecutive patients with newly diagnosed CRC presenting between October 2002 and September 2004 were identified retrospectively. Mode of presentation, symptoms, treatment and histopathology data were analysed. RESULTS: Data for 193 patients were analysed. Ninety seven patients (50%) presented via the FT system, 43 (22.5%) from nonfast track outpatient sources (NFT) and 53 (27.5%) as emergencies. NFT patients took significantly longer to be seen by a colorectal specialist than FT patients (median 69 vs 31 days; P < 0.001) and to initiation of treatment (median 57.5 vs 42.5 days; P = 0.001). Overall 152 patients (79%) presented with symptoms that met the FT criteria. A significantly lower number of NFT (P = 0.001) and emergency patients (P < 0.001) presented with FT symptoms compared with patients referred through the FT system. There was no significant difference between referral groups in patients undergoing surgery with potentially curative intent or stage of disease. CONCLUSION: Nonfast track referral leads to a significant delay in being seen by a specialist and in initiation of treatment but no association with more advanced stage of disease or a reduction in potentially curative surgery was found.
Assuntos
Agendamento de Consultas , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Encaminhamento e Consulta/normas , Colectomia/efeitos adversos , Colectomia/métodos , Neoplasias Colorretais/mortalidade , Tratamento de Emergência , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia/mortalidade , Estadiamento de Neoplasias , Probabilidade , Prognóstico , Encaminhamento e Consulta/tendências , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Reino UnidoRESUMO
OBJECTIVES: To meet the introduction of the two-week wait (TWW) rule for patients with suspected colorectal cancer, a fast-track barium enema (FTBE) service was set up. This study was conducted to evaluate the success of this approach in preparation for meeting the forthcoming targets on waiting times to treatment from referral and diagnosis. METHODS: All patients were offered a double-contrast barium enema within two-weeks, except those with a palpable rectal mass. FTBE were double-reported by specialist gastrointestinal radiologists. Patients with a suspected malignancy were booked for an urgent staging CT and outpatient appointment, whilst the remaining patients were referred back to their general practitioner with a report. Prospective data were collected and two 16-month periods analysed. RESULTS: Three hundred and nine patients had a FTBE over the first 16-month period and 277 (89.6%) were seen within two-weeks. Mean times from initial referral to staging CT and first outpatient appointment were 30.7 and 36.0 days, respectively. Cancer was confirmed histologically in 32 (10.4%) patients. Of 267 patients without a malignancy, 46 (17.2%) were referred back to the colorectal outpatient or endoscopy service within 6-months. The number of referrals increased with time from a mean of 19.3 per month in the first period to 27.8 in the second, but the percentage with a suspected malignancy remained similar at 13.6% and 10.1%, respectively. CONCLUSION: FTBE diagnosed malignancy accurately and facilitated rapid staging. The TWW target was met in almost 90% of patients, whilst the impact on the colorectal outpatient and endoscopy service was minimized.
Assuntos
Sulfato de Bário , Neoplasias Colorretais/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Enema/métodos , Tomografia Computadorizada por Raios X/métodos , Listas de Espera , Idoso , Sulfato de Bário/administração & dosagem , Esquema de Medicação , Seguimentos , Humanos , Estadiamento de Neoplasias/métodos , Pacientes Ambulatoriais , Estudos Prospectivos , Encaminhamento e Consulta , Reprodutibilidade dos Testes , Fatores de TempoRESUMO
The diversity, frequency, and scale of human impacts on coral reefs are increasing to the extent that reefs are threatened globally. Projected increases in carbon dioxide and temperature over the next 50 years exceed the conditions under which coral reefs have flourished over the past half-million years. However, reefs will change rather than disappear entirely, with some species already showing far greater tolerance to climate change and coral bleaching than others. International integration of management strategies that support reef resilience need to be vigorously implemented, and complemented by strong policy decisions to reduce the rate of global warming.
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Adaptação Biológica , Antozoários/fisiologia , Clima , Conservação dos Recursos Naturais , Ecossistema , Animais , Antozoários/crescimento & desenvolvimento , Meio Ambiente , Peixes , Efeito Estufa , HumanosRESUMO
This article explores the use of a cognitive information-processing structure, mental models, to assess an organizational management change to shared leadership (SL). The purpose of this study was to describe the mental models of critical care nurses after the implementation of an SL management model. Scenarios based on daily clinical situations and measuring three SL concepts (empowerment, accountability, and partnership in decision making) were posed to critical care nurses in personal interviews. By using this evaluation methodology, nurse administrators can determine to what extent a new management change has been incorporated into daily nursing practice and in what areas to target further education and resources.
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Cuidados Críticos , Liderança , Especialidades de Enfermagem , Tomada de Decisões , Estudos de Avaliação como Assunto , Humanos , Modelos de Enfermagem , Pesquisa Metodológica em EnfermagemRESUMO
Surveillance of 101 hemodialysis patients for Staphylococcus aureus positive nasal cultures was performed by monthly nasal swabs over a 27-month period. All positive cultures were treated with a prophylactic antibiotic regimen. Forty-seven (46.5%) patients had one or more positive cultures. The surveillance period was longer in the S. aureus nasal carriers (p = 0.004). The frequency of positive cultures correlated with the duration of surveillance (p = 0.029). The incidence of S. aureus bacteremia was greater in patients with two or more positive cultures (p = 0.030). This study suggests that continuous surveillance for S. aureus nasal colonization is essential to properly identify all patients at risk of developing S. aureus bacteremias.