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Patients Suitable (patient + suitable)
Selected AbstractsBilateral thoracoscopy, mediastinoscopy and laparoscopy, in addition to CT, MRI and PET imaging, are essential to correctly stage and treat patients with mesothelioma prior to trimodality therapy,ANZ JOURNAL OF SURGERY, Issue 10 2009John M. Alvarez Abstract Background:, Trimodality therapy (TMT; extrapleural pneumonectomy (EPP), chemotherapy and radiation therapy) offers the potential of optimal survival in selected patients with Brigham stage I,II epitheliod mesothelioma based on CT, MRI and PET scanning. We hypothesized that these scanning modalities were inadequate to accurately stage these patients. Methods:, Patients suitable for TMT, in addition to CT, MRI and PET scanning, prior to EPP, underwent bilateral thoracoscopy, mediastinoscopy and laparoscopy (surgical staging). Follow-up CT scans were performed, six monthly, quality of life assessments yearly. Results:, From 1 June 2004 to 28 February 2007, 34 patients were referred; mean age was 66 years (range: 44,69). Surgical staging was performed in 30 patients; 24 patients were confirmed as Brigham Stage I,II. However, six were upstaged, five as stage IV disease (one contralateral chest, two contralateral chest and abdomen, two abdomen) and one as mediastinal node positive; two further patients were reclassified histologically (one sarcomatoid, one biphasic). These eight patients fared poorly, 50% dying within 1 year from mesothelioma. Following surgical staging, 3 patients declined further surgery; thus, 19 patients proceeded to surgery, 3 were unresectable and 16 received EPP. Follow-up of all 34 patients is complete. Conclusion:, Surgical staging identified 26% of patients who would have received no benefit from TMT. [source] Selective use of embolic protection devices during saphenous vein grafts interventions: A single-center experience,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2010Shahar Lavi MD Abstract Objectives: To report on outcomes with selective use of embolic protection devices (EPD) during percutaneous coronary intervention (PCI) to saphenous vein grafts (SVG). Background: PCI to SVG is associated with increased risk and the use of EPD is recommended in this setting. Methods: Angiographic and clinical outcomes were prospectively obtained from 534 consecutive patients who underwent PCI to SVG with or without EPD at a tertiary cardiac centre. Long-term outcomes were obtained by linkage to a provincial registry. Results: EPD, deployed in 198 of 373 SVGs (53%) suitable for deployment of a distal EPD, were used more often in ectatic (33% vs. 19%, P = 0.003), ulcerated (17% vs. 9%, P = 0.03), thrombotic (26% vs. 10%, P < 0.0001) vein grafts, with longer degenerated segments (P = 0.002), and in lesions involving the body of the graft (85% vs. 66%, P < 0.0001), and less with lesions involving the graft ostium (29% vs. 44%, P = 0.003). Patients suitable for but not receiving EPD tended to be more likely to have a periprocedural myocardial infarction. During 3 years of follow-up, 49% of the patients had a cardiovascular event. Cumulative mortality was 8.4%, 18.8% and 14.7% in patients unsuitable for distal EPD, suitable but without EPD, and with EPD (p = 0.11). Nonuse of EPD was an independent predictor of MACE at 3 years. (P = 0.02). Conclusions: Selective use of EPD is associated with low in-hospital cardiovascular event rates. Long-term outcomes are manifested by a high rate of events, especially in patients with SVG's suitable for but not receiving EPD. This suggests that routine use of distal EPD may be warranted in unselected patients with suitable SVG anatomy. © 2010 Wiley-Liss, Inc. [source] Accuracy of triage nurses in predicting patient dispositionEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2007Anna Holdgate Abstract Objective:, Increasing demand to reduce patient waiting times and improve patient flow has led to the introduction of a number of strategies such as fast track and patient streaming. The triage nurse is primarily responsible for identifying suitable patients, based on prediction of likely admission or discharge. The aim of the present study was to explore the accuracy with which triage nurses predict patient disposition. Methods:, Over two separate 1-week periods, triage nurses at two urban tertiary hospitals electronically recorded in real time whether they thought each patient would be admitted or discharged. The patient's ultimate disposition (admission or discharge), age, sex, diagnostic group, triage category and time of arrival were also recorded. Results:, In total, 1342 patients were included in the study, of which 36.0% were subsequently admitted. Overall, the triage nurse correctly predicted the disposition in 75.7% of patients (95% CI: 73.2,78.0). Nurses were more accurate at predicting discharge than admission (83.3%,vs 65.1%,,P = 0.04). Triage nurses were most accurate at predicting admission in patients with higher triage categories and most accurate at predicting discharge in patients with injuries and febrile illnesses (89.6%, 95% CI: 85.6,92.6). Predicted discharge was least accurate for patients with cardiovascular disease, with 41.1% (95% CI: 26.4,57.8) of predicted discharges in this category subsequently requiring admission. Conclusion:, Triage nurses can accurately predict likely discharge in specific subgroups of ED patients. This supports the role of triage nurses in appropriately identifying patients suitable for ,fast track' or streaming. [source] Literature Review and suggested protocol for managing ultrasound soft markers for Down syndrome: Thickened nuchal fold, echogenic bowel, shortened femur, shortened humerus, pyelectasis and absent or hypoplastic nasal boneJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2007Article first published online: 10 MAY 200, M Bethune Summary Mid-trimester soft markers have been linked with Down syndrome and other aneuploidies. There are many other prenatal screening tests available with better detection rates for Down syndrome than the mid-trimester ultrasound. Many patients confronted with the diagnosis of a soft marker become anxious and may request a diagnostic test (amniocentesis) despite the associated risk of miscarriage. This is also despite the fact that most fetuses with an isolated soft marker are chromosomally normal. The management of a pregnancy with a soft marker must therefore be planned in a manner designed to minimize patient anxiety. Likelihood ratios can be used to modify a patient's ,prior risk' (based on age or prior screening tests) and create a new risk. This calculation may help identify a subset of patients suitable for further investigation. It has been proposed that ,negative' likelihood ratios can be used to reduce a patient's risk if no soft marker is found at a mid-trimester ultrasound. There remain concerns about this approach and further research is required before this approach enters common practice. The published work surrounding the management of thickened nuchal fold, echogenic bowel, shortened femur, shortened humerus, pyelectasis (renal pelvis dilatation) and hypoplastic nasal bone is reviewed. Each soft marker has different associations and individual management plans for each of these soft markers are presented. Although isolated single umbilical artery is not usually considered a soft marker of aneuploidy, a management plan for this common finding is also included. [source] Guidelines for patient selection and performance of carotid artery stentingANZ JOURNAL OF SURGERY, Issue 6 2010The Carotid Stenting Guidelines Committee Abstract Background:, The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy remains the benchmark in terms of procedural mortality and morbidity. At present, there are no consensus Australasian guidelines for the safe performance of CAS. Methods:, We applied a modified Delphi consensus method of iterative consultation between the College representatives on the Carotid Stenting Guidelines Committee (CSGC). Results:, Selection of patients suitable for CAS needs careful consideration of clinical and patho-anatomical criteria and cannot be directly extrapolated from clinical indicators for carotid endarterectomy (CEA). Randomized controlled trials (including pooled analyses of results) comparing CAS with CEA for treatment of symptomatic stenosis have demonstrated that CAS is more hazardous than CEA. On current evidence, the CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. The evidence for CAS in patients with symptomatic severe carotid stenosis who are considered medically high risk is weak, and there is currently no evidence to support CAS as a treatment for asymptomatic carotid stenosis. The use of distal protection devices during CAS remains controversial with increased risk of clinically silent stroke. The knowledge requirements for the safe performance of CAS include an understanding of the evidence base from randomized controlled trials, carotid and aortic arch anatomy and pathology, clinical stroke syndromes, the differing treatment options for stroke and carotid atherosclerosis, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre-procedural neuro-imaging and an independent, standardized neurological assessment before and after the procedure. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and continuing medical education programs. These standards should apply in the public and private health care settings. Conclusion:, These guidelines represent the consensus of an inter-collegiate committee in order to direct appropriate patient selection and the range of cognitive and technical requirements to perform CAS. Advances in endovascular technologies and the results of randomized controlled trials will guide future revisions of these guidelines. [source] A preliminary report on a patient-preference study to compare treatment options in early prostate cancerBJU INTERNATIONAL, Issue 3 2002The North West Uro-oncology Group Objectives,To prospectively record prognostic factors, quality-of-life and outcome data in a patient-preference controlled study comparing radical prostatectomy with radical radiotherapy for the treatment of early prostate cancer. Patients and methods,All patients suitable for radical treatment of early prostate cancer were identified and provided with information from a urologist, oncologist and nurse to allow them to choose a treatment option. Prognostic and demographic data were recorded for all patients and patients followed up uniformly, with the additional collection of quality-of-life data. Results,In a 38-month period, 196 patients were recruited to the trial; of these, 81 chose surgery, 81 radiotherapy, 30 brachytherapy and four ,watchful waiting'. The distribution of acknowledged prognostic factors was similar between the groups. Conclusion,If patient preference continues to divide this population into roughly equal and comparable arms, it should be possible to answer the underlying questions on the treatment of early prostate cancer using this study design. [source] | ||||||||||