Objective
The aim of this study was to explore the association between baseline social support, functional status, and change in health‐related quality of life (HRQoL) in colorectal cancer patients ...and change in anxiety and depression measured by Hospital Anxiety and Depression Scale (HADS) at 1 year after surgery.
Methods
Consecutive patients who were due to undergo therapeutic surgery for the first time for colon or rectal cancer in 9 hospitals in Spain were eligible for the study. Patients completed the following questionnaires before surgery and 12 months afterward: 1 HRQoL instrument, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire; a social support questionnaire, the Duke‐UNC Functional Social Support Questionnaire; the Barthel Index, to assess functional status; the HADS, to assess anxiety and depression; and questions about sociodemographic information. General linear models were built to explore the association between social support, functional status, and change in HRQoL and changes in anxiety and depression 12 months after surgery.
Results
A total of 947 colorectal cancer patients took part in the study. Patients' functional status, social support, and change in HRQoL were associated with changes in anxiety and depression. Greater social support and improvements in physical, cognitive, and social functioning and in insomnia resulted in improvements in anxiety and depression. No functionally independent patients were associated with lesser improvements in anxiety and depression.
Conclusions
Colorectal cancer patients who have more social support, are functionally independent and have higher improvements in HRQoL may have better results in anxiety and depression at 1 year after surgery, adjusting for age, gender, location, occupation, and baseline HADS scores.
Summary Objective To provide new data on minimally clinical important difference (MCID) and percentages of responders on pain and functional dimensions of Western Ontario and McMaster Osteoarthritis ...Index (WOMAC) in patients who have undergone total knee replacement (TKR). Methods 1-year prospective multicentre study with two different cohorts. Consecutive patients on the waiting list were recruited. There were 415 and 497 patients included. Pain and function were collected by the reverse scoring option of the WOMAC (0–100, worst to best). Transition items (five point scale) were collected at 1-year and MCID was calculated through mean change in patients somewhat better, Receiver Operating Characteristic (ROC) and two other questions about satisfaction. Analysis was performed in the whole sample and by tertiles of baseline severity. Likewise were calculated the percentages of patients who attained cut-off values. Results Global MCID for pain were about 30 in both cohorts and 32 for. By ROC these values were about 20 and 24 respectively. According to the other two transitional questions these values were for pain 27 and 20 for function. By tertiles the worst the baseline score the higher the cut-off values. Percentage of responders does not change when comparing responders to the global MCID with their own tertile MCID and were about 61% for pain and 50% for function. Conclusion Due to the wide variations, MCID estimates should be calculated and used according to the baseline severity score.
The rate of eradication of Helicobacter pylori with standard triple therapy using omeprazole, amoxicillin and clarithromycin (OAC) is unacceptable in populations with high rates of clarithromycin ...resistance (15–20%). The aim of this study was to compare the efficacy of 10-day OAC therapy as the first-line treatment in patients diagnosed by culture with antimicrobial susceptibility or diagnosed by a 13C-labelled urea breath test (UBT) without antimicrobial susceptibility in an area where the clarithromycin resistance rate was 15–20%. This was a retrospective cohort study of 266 patients, recruited consecutively throughout 2008. A total of 247 H. pylori-infected patients received antibiotic therapy (221 received the 10-day OAC therapy and 26 received other regimens) of which 134 patients were diagnosed by culture of gastric samples followed by antimicrobial susceptibility testing and 113 were diagnosed by UBT. In all patients, the eradication of H. pylori was checked by UBT. The cost of eradication by 10-day OAC treatment was assessed in each patient. The success rate of 10-day OAC therapy in patients diagnosed by culture and by UBT was 88% (103/117) and 49% (51/104), respectively (p <0.0005). The treatment was also more cost-effective in the former of these two groups (€571 versus €666). To perform culture and antimicrobial susceptibility of the H. pylori isolates was a more successful and cost effective strategy than empirical 10-day OAC treatment in populations with high rates of resistance to clarithromycin.
Summary Objective To identify new cut-off values beyond which patients can be considered as satisfied or as responders through patient acceptable symptom state (PASS) and OMERACT–OARSI (Outcome ...Measures in Rheumatology–Osteoarthritis Research Society International) set of responder criteria in total joint replacement. Methods Secondary analysis of a 1-year prospective multicenter study of 861 patients, 510 with total knee replacement (TKR) and 351 with total hip prosthesis (THR). Pain and function data were collected by the reverse scoring option of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). PASS values were identified with the 25th centile estimation using an anchoring question about satisfaction with actual symptoms. OMERACT–OARSI set of responder criteria was based on a combination of absolute and relative change of pain, function and global patient’s assessment. Receiver operating characteristic (ROC) analysis was used as a complementary approach. Results The values for PASS were about 80 and 69 for pain and function in THR, while these values were 80 and 68 when using OMERACT–OARSI criteria. Regarding TKR, PASS values were about 75 and 67 in pain and function with both criteria. ROC values were slightly lower in all cases. PASS and OMERACT–OARSI values varied moderately across tertiles of baseline severity. Conclusion With the provided data we can establish when a patient can be considered as satisfied/responder in joint replacement. The scores achieved at 1 year were very similar according to both criteria.
Many older patients don't receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in ...patients with colorectal cancer.
A prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics.
In colon cancer 92% of patients aged under 65 years, 77% of those aged 65 to 80 years and 27% of those aged over 80 years received adjuvant chemotherapy (χ
< 0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65 years, 60% of those aged 65 to 80 years, and 42% of those aged over 80 years (χ
< 0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1-0.6) and 0.04 (0.02-0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6-1.4) and 0.5 (0.3-0.8) compared with those under 65 years of age.
The probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors' attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies.
We aimed to evaluate whether oral anticoagulants (OACs) alter faecal immunochemical test (FIT) performance in average-risk colorectal cancer (CRC) screening.
Individuals aged 50-69 years were invited ...to receive one FIT sample (cutoff 75 ng ml(-1)) between November 2008 and June 2011.
Faecal immunochemical test was positive in 9.3% (21 out of 224) of users of OAC and 6.2% (365 out of 5821) of non-users (P-trend=0.07). The positive predictive value (PPV) for advanced neoplasia (AN) in non-users was 50.4% vs 47.6% in users (odds ratio, 0.70; 95% CI, 0.3-1.8; P=0.5). The PPV for AN in OAC more antiplatelets (aspirin or clopidogrel) was 75% (odds ratio, 2; 95% CI, 0.4-10.8; P=0.4).
Oral anticoagulant did not significantly modify the PPV for AN in this population-based colorectal screening program. The detection rate of advanced adenoma was higher in the combination OAC more antiplatelets.
To cite this article: Arroabarren E, Lasa EM, Olaciregui I, Sarasqueta C, Muñoz JA, Pérez‐Yarza EG. Improving anaphylaxis management in a pediatric emergency department. Pediatric Allergy Immunology ...2011; 22: 708–714.
Background: The management of anaphylaxis in pediatric emergency units (PEU) is sometimes deficient in terms of diagnosis, treatment, and subsequent follow‐up. The aims of this study were to assess the efficiency of an updated protocol to improve medical performance, and to describe the incidence of anaphylaxis and the safety of epinephrine use in a PEU in a tertiary hospital.
Methods: We performed a before–after comparative study with independent samples through review of the clinical histories of children aged <14 years old diagnosed with anaphylaxis in the PEU according to the criteria of the European Academy of Allergy and Clinical Immunology (EAACI). Two allergists and a pediatrician reviewed the discharge summaries codified according to the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD‐9‐CM) as urticaria, acute urticaria, angioedema, angioneurotic edema, unspecified allergy, and anaphylactic shock. Patients were divided into two groups according to the date of implantation of the protocol (2008): group A (2006–2007; the period before the introduction of the protocol) and group B (2008–2009; after the introduction of the protocol). We evaluated the incidence of anaphylaxis, epinephrine administration, prescription of self‐injecting epinephrine (SIE), other drugs administered, the percentage of admissions and length of stay in the pediatric emergency observation area (PEOA), referrals to the allergy department, and the safety of epinephrine use.
Results: During the 4 years of the study, 133,591 children were attended in the PEU, 1673 discharge summaries were reviewed, and 64 cases of anaphylaxis were identified. The incidence of anaphylaxis was 4.8 per 10,000 cases/year. After the introduction of the protocol, significant increases were observed in epinephrine administration (27% in group A and 57.6% in group B) (p = 0.012), in prescription of SIE (6.7% in group A and 54.5% in group B) (p = 0.005) and in the number of admissions to the PEOA (p = 0.003) and their duration (p = 0.005). Reductions were observed in the use of corticosteroid monotherapy (29% in group A, 3% in group B) (p = 0.005), and in patients discharged without follow‐up instructions (69% in group A, 22% in group B) (p = 0.001). Thirty‐three epinephrine doses were administered. Precordial palpitations were observed in one patient.
Conclusion: The application of the anaphylaxis protocol substantially improved the physicians’ skills to manage this emergency in the PEU. Epinephrine administration showed no significant adverse effects.
We hypothesized that patients undergoing surgery for colorectal cancer (CRC) with COPD as a comorbidity would consume more resources and have worse in-hospital outcomes than similar patients without ...COPD. Therefore, we compared different aspects of the care process and short-term outcomes in patients undergoing surgery for CRC, with and without COPD.
This was a prospective study and it included patients from 22 hospitals located in Spain - 472 patients with COPD and 2,276 patients without COPD undergoing surgery for CRC. Clinical variables, postintervention intensive care unit (ICU) admission, use of invasive mechanical ventilation, and postintervention antibiotic treatment or blood transfusion were compared between the two groups. The reintervention rate, presence and type of complications, length of stay, and in-hospital mortality were also estimated. Hazard ratio (HR) for hospital mortality was estimated by Cox regression models.
COPD was associated with higher rates of in-hospital complications, ICU admission, antibiotic treatment, reinterventions, and mortality. Moreover, after adjusting for other factors, COPD remained clearly associated with higher and earlier in-hospital mortality.
To reduce in-hospital morbidity and mortality in patients undergoing surgery for CRC and with COPD as a comorbidity, several aspects of perioperative management should be optimized and attention should be given to the usual comorbidities in these patients.
Background
There is conflicting evidence about what factors influence outcomes after total knee replacement (TKR). The objective is to identify baseline factors that differentiate patients who ...achieve both, minimal clinically important difference (MCID) and a patient acceptable symptom state (PASS) in pain and function, measured by WOMAC, after TKR from those who do not attain scores above the cutoff in either of these dimensions.
Methods
One‐year prospective multicentre study. Patients completed WOMAC, SF‐12, EQ‐5D, expectations, other joint problems and sociodemographic data while in the waiting list, and 1‐year post‐TKR. Dependent variable was a combination of MCID and PASS in both dimensions (yes/no). Univariate analysis was performed to identify variables associated. Exploratory factor analysis (EFA) was performed to study how these variables grouped into different factors.
Results
Total sample comprised 492 patients. Mean (SD) age was 71.3 (6.9), and there were a 69.7% of women. Of the total, 106 patients did not attain either MCID or PASS in either dimension, and 230 exceeded both thresholds in both dimensions. In the univariate analysis, 13 variables were associated with belonging to one group or another. These 13 variables were included in EFA; 3 factors were extracted: expectations, mental health, and other joints problems. The percentage of variance explained by the 3 factors was 80.4%.
Conclusion
We have found 2 modifiable baseline factors, expectations and mental health, that should be properly managed by different specialist. Indication of TKR should take into account these modifiable factors for improving outcomes after TKR.
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