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McLaughlin P, Brady P, Carabellese F, Carabellese F, Parente L, Uhrskov Sorensen L, Jeandarme I, Habets P, Simpson AIF, Davoren M, Kennedy HG. Excellence in forensic psychiatry services: international survey of qualities and correlates. BJPsych Open 2023; 9:e193. [PMID: 37828908 PMCID: PMC10594163 DOI: 10.1192/bjo.2023.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development. AIMS To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security. METHOD A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire. RESULTS Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score. CONCLUSIONS Larger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.
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Affiliation(s)
- Patrick McLaughlin
- National Forensic Mental Health Service, Central Mental Hospital, Portrane, Dublin, Ireland; and DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Philip Brady
- National Forensic Mental Health Service, Central Mental Hospital, Portrane, Dublin, Ireland; and DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Felice Carabellese
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy
| | - Fulvio Carabellese
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy
| | - Lia Parente
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy
| | - Lisbeth Uhrskov Sorensen
- Department for Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark; and Institute of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Ingeborg Jeandarme
- Knowledge Centre for Forensic Psychiatric Care (KeFor), OPZC Rekem, Rekem, Belgium; and KU Leuven, Leuven, Belgium
| | - Petra Habets
- Knowledge Centre for Forensic Psychiatric Care (KeFor), OPZC Rekem, Rekem, Belgium; and Tilburg University, Tilburg, The Netherlands
| | - Alexander I. F. Simpson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty School of Medicine, University of Toronto, Toronto, Canada
| | - Mary Davoren
- National Forensic Mental Health Service, Central Mental Hospital, Portrane, Dublin, Ireland; DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland; and Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy
| | - Harry G. Kennedy
- DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland; Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy; and Institute of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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Breitkopf D, Banks E, Chelmow D, Lara-Torre E, McCue K, Ogburn T, Pfeifer S, Anderson T, Valea FA. Levels of Gynecologic Care: A Task Force Consensus Statement. Obstet Gynecol 2023; 141:1036-1045. [PMID: 37486649 DOI: 10.1097/aog.0000000000005173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/16/2023] [Indexed: 07/25/2023]
Abstract
Systems of care have been established for obstetrics, trauma, and neonatology. An American College of Obstetricians and Gynecologists Presidential Task Force was established to develop a care system for gynecologic surgery. A group of experts who represent diverse perspectives in gynecologic practice proposed definitions of levels of gynecologic care using the Delphi method. The goal is to improve the quality of gynecologic surgical care performed in the United States by providing a framework of minimal institutional requirements for each level. Subgroups developed draft criteria for each level of care. The entire Task Force then met to reach consensus regarding the levels of care final definitions and parameters. The levels of gynecologic care framework focuses on systems of care by considering institutional resources and expertise, providing guidance on the provision of care in appropriate level facilities. These levels were defined by the ability to care for patients of increasing risk, complexity, and comorbidities, organizing gynecologic care around hospital capability. This framework can also be used to inform the escalation of care to appropriate facilities by identifying patients at risk and guiding them to facilities with the skills, expertise, and capabilities to safely and effectively meet their needs. The levels of gynecologic care framework is intended for use by patients, hospitals, and clinicians in the United States to guide where elective surgery can be done most safely and effectively by specialists and subspecialists in obstetrics and gynecology. The key features of the levels of gynecologic care include ensuring provision of risk-appropriate care and regionalization of care by facility capabilities.
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Affiliation(s)
- Daniel Breitkopf
- Departments of Obstetrics and Gynecology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, New York University Long Island School of Medicine, Mineola, New York, Virginia Commonwealth University School of Medicine, Richmond, Virginia, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia, Kaiser Permanente Medical Center, Sacramento, California, University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, Weill-Cornell School of Medicine, New York, New York, Vanderbilt School of Medicine, Nashville, Tennessee, and Zucker School of Medicine/Northwell Health Cancer Institute, New Hyde Park, New York
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Abiri A, Pang JC, Roman K, Goshtasbi K, Birkenbeuel JL, Kuan EC, Tjoa T, Haidar YM. Facility Volume as a Prognosticator of Survival in Locally Advanced Papillary Thyroid Cancer. Laryngoscope 2023; 133:443-450. [PMID: 35822421 PMCID: PMC9837308 DOI: 10.1002/lary.30280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/26/2022] [Accepted: 06/13/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the influence of facility case-volume on survival in patients with locally advanced papillary thyroid cancer (PTC), and to identify prognostic case-volume thresholds for facilities managing this patient population. STUDY DESIGN Retrospective database study. METHODS The 2004-2017 National Cancer Database was queried for patients receiving definitive surgery for locally advanced PTC. Using K-means clustering and multivariable Cox proportional-hazards (CPH) regression, two groups with distinct spectrums of facility case-volumes were generated. Multivariable CPH regression and Kaplan-Meier analysis assessed for the influence of facility case-volume and the prognostic value of its stratification on overall survival (OS). RESULTS Of 48,899 patients treated at 1304 facilities, there were 34,312 (70.2%) females and the mean age was 48.0 ± 16.0 years. Increased facility volume was significantly associated with reduced all-cause mortality (HR 0.996; 95% CI, 0.992-0.999; p = 0.008). Five facility clusters were generated, from which two distinct cohorts were identified: low (LVF; <27 cases/year) and high (HVF; ≥27 cases/year) facility case-volume. Patients at HVFs were associated with reduced mortality compared to those at LVFs (HR 0.791; 95% CI, 0.678-0.923, p = 0.003). Kaplan-Meier analysis of propensity score-matched N0 and N1 patients demonstrated higher OS in HVF cohorts (all p < 0.001). CONCLUSIONS Facility case-volume was an independent predictor of improved OS in locally advanced PTC, indicating a possible survival benefit at high-volume medical centers. Specifically, independent of a number of sociodemographic and clinical factors, facilities that treated ≥27 cases per year were associated with increased OS. Patients with locally advanced PTC may, therefore, benefit from referrals to higher-volume facilities. LEVEL OF EVIDENCE 4 Laryngoscope, 133:443-450, 2023.
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Affiliation(s)
- Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Jonathan C Pang
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Kelsey Roman
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
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Roman KM, Torabi SJ, Bitner BF, Goshtasbi K, Haidar YM, Tjoa T, Kuan EC. The Impact of Facility Type and Volume on Outcomes in Head and Neck Mucosal Melanoma. Otolaryngol Head Neck Surg 2023; 168:1079-1088. [PMID: 36939581 DOI: 10.1002/ohn.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate differences in treatment outcomes for head and neck mucosal melanoma (HNMM) patients seen at academic versus nonacademic centers and high versus low volume facilities. STUDY DESIGN Retrospective cohort study. SETTING National Cancer Database. METHODS Differences in treatment course and overall survival (OS) by facility type and volume were assessed for 2772 HNMM cases reported by the 2004 to 2017 National Cancer Database. A subgroup analysis was performed with a smaller cohort containing staging data. The analysis employed Kaplan-Meier and Cox proportional hazards models. RESULTS A higher proportion of patients treated at academic centers within the HNMM cohort waited longer for surgery after diagnosis (p < .001), had negative surgical margins (p < .001), and were readmitted to the hospital within 30 days of surgery (p = .001); these relationships remained significant when controlling for cancer stage. Kaplan-Meier analysis demonstrated higher 5-year OS for patients treated at academic versus nonacademic facilities within the main cohort (32.5% ± 1.3% vs 27.3% ± 1.5%; p = .006) and within the stage-controlled subgroup (34.8% ± 2.1% vs 27.2% ± 2.6%; p = .003). Treatment at high volume versus low volume facilities was associated with improved 5-year OS for main cohort patients (33.5% ± 1.7% vs 28.8% ± 1.2%; p = .016) but not for subgroup patients (35.3% ± 2.7% vs 30.1% ± 2.1%; p = .100). Upon multivariate analysis controlling for demographic and oncologic factors, there was no significant difference in OS by facility type (main cohort: odds ratio [OR] = 1.07, 95% confidence interval [CI] = 1.01-1.21; subgroup: OR = 1.13, 95% CI = 0.97-1.32). CONCLUSION Neither facility type nor surgical volume predicts overall survival in HNMM.
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Affiliation(s)
- Kelsey M Roman
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Benjamin F Bitner
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
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Bizzarri N, Dostálek L, van Lonkhuijzen LRCW, Giannarelli D, Lopez A, Falconer H, Querleu D, Ayhan A, Kim SH, Ortiz DI, Klat J, Landoni F, Rodriguez J, Manchanda R, Kosťun J, Ramirez PT, Meydanli MM, Odetto D, Laky R, Zapardiel I, Weinberger V, Reis RD, Anchora LP, Amaro K, Salehi S, Akilli H, Abu-Rustum NR, Salcedo-Hernández RA, Javůrková V, Mom CH, Scambia G, Cibula D. Association of Hospital Surgical Volume With Survival in Early-Stage Cervical Cancer Treated With Radical Hysterectomy. Obstet Gynecol 2023; 141:207-214. [PMID: 36701621 PMCID: PMC10445691 DOI: 10.1097/aog.0000000000005026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/22/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the association of number of radical hysterectomies performed per year in each center with disease-free survival and overall survival. METHODS We conducted an international, multicenter, retrospective study of patients previously included in the Surveillance in Cervical Cancer collaborative studies. Individuals with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1-IIA1 cervical cancer who underwent radical hysterectomy and had negative lymph nodes at final histology were included. Patients were treated at referral centers for gynecologic oncology according to updated national and international guidelines. Optimal cutoffs for surgical volume were identified using an unadjusted Cox proportional hazard model, with disease-free survival as the outcome and defined as the value that minimizes the P-value of the split in groups in terms of disease-free survival. Propensity score matching was used to create statistically similar cohorts at baseline. RESULTS A total of 2,157 patients were initially included. The two most significant cutoffs for surgical volume were identified at seven and 17 surgical procedures, dividing the entire cohort into low-volume, middle-volume, and high-volume centers. After propensity score matching, 1,238 patients were analyzed-619 (50.0%) in the high-volume group, 523 (42.2%) in the middle-volume group, and 96 (7.8%) in the low-volume group. Patients who underwent surgery in higher-volume institutions had progressively better 5-year disease-free survival than those who underwent surgery in lower-volume centers (92.3% vs 88.9% vs 83.8%, P=.029). No difference was noted in 5-year overall survival (95.9% vs 97.2% vs 95.2%, P=.70). Cox multivariable regression analysis showed that FIGO stage greater than IB1, presence of lymphovascular space invasion, grade greater than 1, tumor diameter greater than 20 mm, minimally invasive surgical approach, nonsquamous cell carcinoma histology, and lower-volume centers represented independent risk factors for recurrence. CONCLUSION Surgical volume of centers represented an independent prognostic factor affecting disease-free survival. Increasing number of radical hysterectomies performed in each center every year was associated with improved disease-free survival.
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Affiliation(s)
- Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Lukáš Dostálek
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group, CEEGOG), Prague, Czech Republic
| | - Luc R C W van Lonkhuijzen
- Center for Gynaecologic Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Aldo Lopez
- Department of Gynecological Surgery, National Institute of Neoplastic Diseases, Lima, Peru
| | - Henrik Falconer
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Denis Querleu
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Ali Ayhan
- Baskent University School of Medicine, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Ankara, Turkey
| | - Sarah H Kim
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - David Isla Ortiz
- Gynecology Oncology Center, National Institute of Cancerology Mexico, Mexico City, Mexico
| | - Jaroslav Klat
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital and University of Ostrava, Ostrava, Czech Republic
| | - Fabio Landoni
- University of Milano-Bicocca, Department of Obstetrics and Gynecology, Gynaecologic Oncology Surgical Unit, ASST-Monza, San Gerardo Hospital, Monza, Italy
| | - Juliana Rodriguez
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Ranjit Manchanda
- Wolfson Institute of Preventive Medicine, Barts Cancer Centre, Queen Mary University of London, & Barts Health NHS Trust, London, UK
| | - Jan Kosťun
- Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Prague, Czech Republic
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mehmet M Meydanli
- Department of Gynecologic Oncology, Zekai Tahir Burak Women’s Health and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Diego Odetto
- Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
| | - Rene Laky
- Gynecology, Medical University of Graz, Graz, Austria
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Vit Weinberger
- University Hospital Brno, Medical Faculty of Masaryk University, Czech
| | - Ricardo Dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - Luigi Pedone Anchora
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Karina Amaro
- Department of Gynecological Surgery, National Institute of Neoplastic Diseases, Lima, Peru
| | - Sahar Salehi
- Department of Pelvic Cancer, Karolinska University Hospital and Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Huseyin Akilli
- Baskent University School of Medicine, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Ankara, Turkey
| | | | | | - Veronika Javůrková
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital and University of Ostrava, Ostrava, Czech Republic
| | - Constantijne H Mom
- Center for Gynaecologic Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group, CEEGOG), Prague, Czech Republic
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Roman KM, Torabi SJ, Goshtasbi K, Kuan EC, Tjoa T, Haidar YM. Case volume regionalization and volume-based outcome differences in cutaneous head and neck melanoma. Head Neck 2022; 44:2428-2436. [PMID: 35903986 DOI: 10.1002/hed.27150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Hospital volume has emerged as a prognostic factor in oncology but is not currently known whether volume is associated with improved outcomes for cutaneous head and neck (HN) melanoma. METHODS A total of 556 079 cutaneous melanoma cases reported by the 2004-2016 National Cancer Database were separated into two cohorts (HN and non-HN) and facilities within each cohort were classified by case volume. Analysis employed chi-square, analysis of variance, Kaplan-Meier, and Cox proportional hazards models. RESULTS Only 41 facilities (3.1% of 1326) treating HN melanoma and 50 facilities (3.7% of 1344) treating non-HN melanoma were classified as high-volume facilities (HVFs). The estimated 5-year overall survival (OS) was 62.7% (standard error [SE]: 0.4%) for patients with HN at low-volume facilities (LVFs), 69.3% (SE: 0.4%) at IVFs, and 71.8% (SE 0.4%) at HVFs (p < 0.001). Differences in OS remained significant between HVFs versus LVFs after adjusting for confounders. CONCLUSION Volume is independently associated with OS and improved surgical outcomes for HN melanoma.
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Affiliation(s)
- Kelsey M Roman
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
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Yakar MN, Polat C, Akkılıç M, Yeşildal K, Yakar ND, Turgut N. Use of a modified surgical APGAR score for prediction of postoperative complications in emergency surgery: An observational retrospective study. ULUS TRAVMA ACIL CER 2022; 28:615-625. [PMID: 35485468 PMCID: PMC10442991 DOI: 10.14744/tjtes.2021.34732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/06/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The surgical Apgar score (SAS) was defined by Gawande et al. in 2007. It has been shown that this scoring system was highly effective for predicting the incidence of post-operative complications and mortality. In this study, we aimed to define a new, modified SAS (mSAS) for predicting the incidence of post-operative complications and mortality in emergency surgery. We also wanted to quantify the effectiveness of this modified scoring system, comprising of the duration of the operation in addition to the three intraoperative parameters of the SAS score. METHODS Five hundred and seventy-nine patients who underwent emergency surgery were enrolled in this retrospective obser-vational study. At the end of the operation, the SAS was calculated from the data obtained from the examination of the patients and the mSAS was calculated by adding the duration of the operation to data used in the calculation of the SAS (Surgical duration >8 h; -4 points; 7.01-8 h; -3 points; 5.01-7 h; -2 points; 3.01-5 h; -1 points; 0-3 h; 0 points added). RESULTS There was a statistically significant relationship between the mSAS and the total number of complications (as operative time [OT] increased, the number of complications increased) (r=0.360; p=0.001). The compliance levels of the SAS and mSAS were 98.4% and they have been found as statistically significant (ICC: 0.984; p=0.001; p<0.01). CONCLUSION We suggest that the OT should be included as a simple, objective and practical indication of the SAS risk score in major operations. The mSAS was an independent predictor of post-operative mortality and complications. With the widespread use of electronic medical record systems and the effective use of pre-operative medical data, the mSAS can be used as an easy and new scoring system to predict prognosis.
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Affiliation(s)
- Mehmet Nuri Yakar
- Department of Anesthesiology and Reanimation, University of Health Seciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul-Turkey
| | - Cengiz Polat
- Department of Anesthesiology and Reanimation, University of Health Seciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul-Turkey
| | - Müslüm Akkılıç
- Department of Anesthesiology and Reanimation, University of Health Seciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul-Turkey
| | - Kadir Yeşildal
- Department of Anesthesiology and Reanimation, University of Health Seciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul-Turkey
| | - Nagihan Duran Yakar
- Department of Anesthesiology and Reanimation, University of Health Seciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul-Turkey
| | - Namigar Turgut
- Department of Anesthesiology and Reanimation, University of Health Seciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul-Turkey
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Study on the Risk Factors of Pulmonary Infection after Laparoscopic Surgery and Analysis of the Detection Results of Drug-Resistant Bacteria. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6510068. [PMID: 35340242 PMCID: PMC8956428 DOI: 10.1155/2022/6510068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 12/24/2022]
Abstract
This study aimed to investigate and analyze the risk of pulmonary infection after laparoscopic surgery and the detection results of drug-resistant bacteria. With the laparoscopic technology developing rapidly in recent years and people's minimally invasive concept improving continuously, laparoscopic radical surgery has been widely used in the treatment of a variety of diseases. Laparoscopic surgery has the probability of causing complications. In order to avoid this, the risk factors after surgery were analyzed, and the drug-resistant bacteria were analyzed for accurate prevention and treatment. A total of 600 patients who underwent elective laparoscopic surgery in our hospital from January 2017 to September 2021 were included in the study. The risk factors and pathogen distribution of pulmonary infection were analyzed. The risk factors of pulmonary infection after laparoscopic surgery were hypoproteinemia, diabetes mellitus, pulmonary disease history, and perioperative blood transfusion. The main pathogens were Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Streptococcus pneumoniae. In clinical work, relevant nursing intervention measures can be developed for the above factors, so as to reduce the incidence of pulmonary infection. This study finds the risk factors for pulmonary infection after surgery, and the common drug-resistant bacteria has an indicative and guiding effect on the formulation of nursing management measures.
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Jing H, Yang Y, Liu Y, Zou P, Li Z. Trends in Surgical Morbidity and Survival Outcomes for Radical Hysterectomy in West China: An 11-Year Retrospective Cohort Study. Front Oncol 2022; 12:836481. [PMID: 35223516 PMCID: PMC8866646 DOI: 10.3389/fonc.2022.836481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To vertically analyze the trend of surgical approaches, demographics, surgical morbidity, and long-term survival outcomes of early-stage cervical cancer over the past 11 years and to determine whether there have been any significant changes. Methods A total of 851 patients with consecutive International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA–IIA cervical cancer diagnosed between January 2008 and June 2018 at a single center in China were included in this retrospective study. Trends in the rate of minimally invasive surgery (MIS), demographics, surgical morbidities, and long-term survival outcomes were determined. We categorized patients into two groups according to their year of operation. The demographics, pathological factors, surgical morbidity, and long-term survival outcomes were compared between these two groups. Results Regarding the surgical approach, there was a significant increase in the rate of laparoscopic radical hysterectomy (LRH) performed over the study period, from 7.8% in 2008 to 72.5% in 2018 (p < 0.0001). The mean age of patients who underwent abdominal radical hysterectomy (ARH) has increased slightly from 2008 to 2018, and those who underwent ARH in the second half of the study period (2014–2018) were significantly older (45.01 vs. 47.50 years; p = 0.001). The most impressive changes over the past 11 years have occurred in the surgical morbidity in both the ARH and LRH groups. The overall surgical morbidity decreased from 29.2% in 2008 to 11.9% in 2018, with an annual rate of 1.57%. The median estimated blood loss volume of the ARH group was 500 ml (range 50–2,000) in the first few years compared to 400 ml (30–2500) in the last few years of the study period (p < 0.0001), which in the LRH group was 350 ml (range 150–800) and 150 ml (range 5–1,000), respectively (p < 0.0001). Similarly, allogeneic blood transfusions and hospital stay have all decreased dramatically over time in both approaches. On the other hand, our study did not reveal any significant statistical changes in long-term survival outcomes over the follow-up period in either group. Conclusions The findings of our study demonstrate that great progress in surgically managed cervical cancer has been made over the last decade in West China. Our retrospective study demonstrated that the year of operation does not appear to influence the long-term survival, but the surgical morbidity impressively decreased over the study period in both the ARH and LRH groups, which reflects that the higher hospital surgical volume for radical hysterectomy (RH) was not associated with lower survival outcomes but related to the reduction of surgical morbidity.
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Affiliation(s)
- Huining Jing
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Ying Yang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yinxia Liu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Peijun Zou
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
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10
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Ding Y, Zhang X, Qiu J, Zhang J, Hua K. Assessment of ESGO Quality Indicators in Cervical Cancer Surgery: A Real-World Study in a High-Volume Chinese Hospital. Front Oncol 2022; 12:802433. [PMID: 35145915 PMCID: PMC8821940 DOI: 10.3389/fonc.2022.802433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
The ESGO developed a list of fifteen quality indicators for cervical cancer surgery in order to audit and improve clinical practice in 2020. However, data from the developing countries with high incidence rates of cervical cancer is still lacking. Therefore, we conducted a retrospective study of 7081 cases diagnosed as cervical cancer between 2014 and 2019 in a Chinese single center according to the quality indicators proposed by ESGO. A total of 5952 patients underwent radical procedures, with an average of 992.0 per year. All surgeries were performed or supervised by a certified gynecologic oncologist as surgical qualification grading system has been established. Compared with the low-volume group, patients in the high-volume group (≥15 cases/year) had a shorter hospital stay (P<0.001), more free surgical margins (P=0.031), and less complications (P<0.001), but the 5-year recurrence-free survival and overall survival rates were similar (P>0.05). Treatment was not planned at a multidisciplinary team meeting but with the consultation system. The required preoperative workup was incomplete in 19.7% of patients with pelvic MRI and 45.7% of patients with PET-CT. A total of 1459 (20.6%) patients experienced at least one complication after surgery. The CDC grade IIIb or higher complications occurred in 80 patients, accounting for 5.5% complications. The urological fistula rate within 30 postoperative days were 0.3%. After primary surgical treatment, 97.4% patients had clear vaginal and parametrial margins. After restaging FIGO 2009 to FIGO 2018 system, 14.7% patients with a stage T1b disease were T-upstaged. After a median follow-up of 42 months, recurrence occurred in 448 patients, and 82.1% patients recurred within 2 years. The 2-year RFS rate of patients with pT1b1N0 was 97.3% in 2009 FIGO staging system. Lymph node staging was performed in 99.0% patients with a stage T1 disease. After a primary surgical treatment for a stage pT1b1N0 disease, 28.3% patients received adjuvant chemoradiotherapy. Above all, most of quality indicators reached the targets, except four quality indicators. The quality indicators of ESGO should be popularized and applied in China to guarantee quality of surgery.
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Affiliation(s)
- Yan Ding
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xuyin Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Junjun Qiu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jianfeng Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Gynecology Quality Control Center, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Gynecology Quality Control Center, Shanghai, China
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11
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Fernandez-Gonzalez S, Ponce J, Martínez-Maestre MÁ, Barahona M, Gómez-Hidalgo NR, Díaz-Feijoo B, Casajuana A, Gracia M, Frias-Gomez J, Benavente Y, Costas L, Martí L, Melero L, Silvan JM, Beiro E, Lobo I, De la Rosa J, Coronado PJ, Gil-Moreno A. The Impact of Surgical Practice on Oncological Outcomes in Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer, Spanish National Registry. Cancers (Basel) 2022; 14:cancers14030698. [PMID: 35158966 PMCID: PMC8833333 DOI: 10.3390/cancers14030698] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/20/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Minimal invasive surgery (MIS) has been associated with lower disease-free survival than open surgery among women who underwent radical hysterectomy for early-stage cervical cancer. However, the mechanisms by which MIS increases mortality in cervical cancer remain uncertain. We aimed to determine if surgical practice among centers using robotic surgery has an impact on oncological outcomes. We evaluated 215 women with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) who underwent robot-assisted radical hysterectomy in five Spanish tertiary centers between 2009 and 2018. A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed for the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes in all surgical approaches. Abstract This study aimed to assess whether surgical practice had a significant impact on oncological outcomes among women who underwent robot-assisted radical hysterectomy for early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009). The secondary objective was to audit the pre-surgical quality indicators (QI) proposed by the European Society of Gynaecological Oncology (ESGO). The top 5 of 10 centers in Spain and Portugal were included in the analysis. The hospitals were divided into group A (n = 118) and group B (n = 97), with recurrence rates of <10% and >10%, respectively. After balancing both groups using the propensity score, the ORs for all events were higher and statistically significant for group B (recurrences OR = 1.23, 95% CI = 1.13–1.15, p-value = 0.001; death OR = 1.10, 95% CI = 1.02–1.18, p-value = 0.012; disease-specific mortality ORr = 1.11, 95% CI = 1.04–1.19, p-value = 0.002). A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed among the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes not only after robot-assisted surgery, but also after laparoscopies and open surgeries in the treatment of cervical cancer.
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Affiliation(s)
- Sergi Fernandez-Gonzalez
- Department of Gynecology, Bellvitge University Hospital, IDIBELL, L’Hospitalet de Llobregat, Universitat de Barcelona, 08907 Barcelona, Spain; (M.B.); (L.M.)
- Correspondence: (S.F.-G.); (J.P.)
| | - Jordi Ponce
- Department of Gynecology, Bellvitge University Hospital, IDIBELL, L’Hospitalet de Llobregat, Universitat de Barcelona, 08907 Barcelona, Spain; (M.B.); (L.M.)
- Correspondence: (S.F.-G.); (J.P.)
| | | | - Marc Barahona
- Department of Gynecology, Bellvitge University Hospital, IDIBELL, L’Hospitalet de Llobregat, Universitat de Barcelona, 08907 Barcelona, Spain; (M.B.); (L.M.)
| | - Natalia R. Gómez-Hidalgo
- Department of Gynecologic Oncology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (N.R.G.-H.); (A.G.-M.)
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatotlogy, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Andrea Casajuana
- Instituto de Salud de la Mujer (IdISSC), Hospital Clínico San Carlos, Universidad Complutense Madrid, 28040 Madrid, Spain; (A.C.); (M.G.); (P.J.C.)
| | - Myriam Gracia
- Instituto de Salud de la Mujer (IdISSC), Hospital Clínico San Carlos, Universidad Complutense Madrid, 28040 Madrid, Spain; (A.C.); (M.G.); (P.J.C.)
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.F.-G.); (Y.B.); (L.C.)
| | - Yolanda Benavente
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.F.-G.); (Y.B.); (L.C.)
| | - Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.F.-G.); (Y.B.); (L.C.)
| | - Lola Martí
- Department of Gynecology, Bellvitge University Hospital, IDIBELL, L’Hospitalet de Llobregat, Universitat de Barcelona, 08907 Barcelona, Spain; (M.B.); (L.M.)
| | - Lidia Melero
- Department of Gynecology, Hospital Universitario Virgen del Rocio, 41001 Sevilla, Spain; (M.Á.M.-M.); (L.M.); (J.M.S.)
| | - Jose Manuel Silvan
- Department of Gynecology, Hospital Universitario Virgen del Rocio, 41001 Sevilla, Spain; (M.Á.M.-M.); (L.M.); (J.M.S.)
| | - Eva Beiro
- Department of Gynecology, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (E.B.); (I.L.); (J.D.l.R.)
| | - Ignacio Lobo
- Department of Gynecology, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (E.B.); (I.L.); (J.D.l.R.)
| | - Jesús De la Rosa
- Department of Gynecology, Hospital Universitario de Basurto, 48013 Bilbao, Spain; (E.B.); (I.L.); (J.D.l.R.)
| | - Pluvio J. Coronado
- Instituto de Salud de la Mujer (IdISSC), Hospital Clínico San Carlos, Universidad Complutense Madrid, 28040 Madrid, Spain; (A.C.); (M.G.); (P.J.C.)
| | - Antonio Gil-Moreno
- Department of Gynecologic Oncology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (N.R.G.-H.); (A.G.-M.)
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12
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Concin N, Planchamp F, Abu-Rustum NR, Ataseven B, Cibula D, Fagotti A, Fotopoulou C, Knapp P, Marth C, Morice P, Querleu D, Sehouli J, Stepanyan A, Taskiran C, Vergote I, Wimberger P, Zapardiel I, Persson J. European Society of Gynaecological Oncology quality indicators for the surgical treatment of endometrial carcinoma. Int J Gynecol Cancer 2021; 31:1508-1529. [PMID: 34795020 DOI: 10.1136/ijgc-2021-003178] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Quality of surgical care as a crucial component of a comprehensive multi-disciplinary management improves outcomes in patients with endometrial carcinoma, notably helping to avoid suboptimal surgical treatment. Quality indicators (QIs) enable healthcare professionals to measure their clinical management with regard to ideal standards of care. OBJECTIVE In order to complete its set of QIs for the surgical management of gynecological cancers, the European Society of Gynaecological Oncology (ESGO) initiated the development of QIs for the surgical treatment of endometrial carcinoma. METHODS QIs were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for the identification of potential QIs and documentation of the scientific evidence, two consensus meetings of a group of international experts, an internal validation process, and external review by a large international panel of clinicians and patient representatives. QIs were defined using a structured format comprising metrics specifications, and targets. A scoring system was then developed to ensure applicability and feasibility of a future ESGO accreditation process based on these QIs for endometrial carcinoma surgery and support any institutional or governmental quality assurance programs. RESULTS Twenty-nine structural, process and outcome indicators were defined. QIs 1-5 are general indicators related to center case load, training, experience of the surgeon, structured multi-disciplinarity of the team and active participation in clinical research. QIs 6 and 7 are related to the adequate pre-operative investigations. QIs 8-22 are related to peri-operative standards of care. QI 23 is related to molecular markers for endometrial carcinoma diagnosis and as determinants for treatment decisions. QI 24 addresses the compliance of management of patients after primary surgical treatment with the standards of care. QIs 25-29 highlight the need for a systematic assessment of surgical morbidity and oncologic outcome as well as standardized and comprehensive documentation of surgical and pathological elements. Each QI was associated with a score. An assessment form including a scoring system was built as basis for ESGO accreditation of centers for endometrial cancer surgery.
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Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics; Innsbruck Medical Univeristy, Innsbruck, Austria .,Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | | | - Nadeem R Abu-Rustum
- Department of Obstetrics and Gynecology, Memorial Sloann Kettering Cancer Center, New York, New York, USA
| | - Beyhan Ataseven
- Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany.,Department of Obstetrics and Gynaecology, University Hospital Munich (LMU), Munich, Germany
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | - Pawel Knapp
- Department of Gynaecology and Gynaecologic Oncology, University Oncology Center of Bialystok, Medical University of Bialystok, Bialystok, Poland
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospitals Strasbourg, Strasbourg, Alsace, France
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitätzu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Artem Stepanyan
- Department of Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, Koç University School of Medicine, Ankara, Turkey.,Department of Gynecologic Oncology, VKV American Hospital, Istambul, Turkey
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Jan Persson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden.,Lund University, Faculty of Medicine, Clinical Sciences, Lund, Sweden
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13
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Minimal-invasive or open approach for surgery of early cervical cancer: the treatment center matters. Arch Gynecol Obstet 2021; 304:503-510. [PMID: 33483846 DOI: 10.1007/s00404-020-05947-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of the study was to compare recurrence-free survival (RFS) and overall survival (OS) of patients with early stage cervical cancer in dependence of surgical approach and treatment center. PATIENTS AND METHODS A population-based cohort study including women with early stage IA1-IIB2 cervical cancer treated by radical hysterectomy between January 2010 and December 2015 was performed. RESULTS The median follow-up time was 5.6 years. After exclusions, 413 patients were eligible for analysis: 111 (26.9%) underwent minimal-invasive surgery (MIS) and 302 (73.1%) open surgery. Both treatment groups were well balanced regarding the clinical and pathological characteristics. The mean age of the patients was 51.0 years. MIS was associated with improved RFS and OS compared with the open surgery. The 5-year RFS rates were 89.2% in the MIS group and 73.4% in the open surgery group (p = 0.004). The 5-year OS rates were 93.7% in the MIS group and 81.8% in the open surgery group (p = 0.016). After adjustment for other prognostic covariates, the MIS was further associated with improved RFS (HR = 0.45, 95% CI 0.24-0.86; p = 0.015) but not with OS. Nevertheless, after adjustment for treatment center, the surgical approach was not associated with significant difference in RFS (HR = 0.61, 95% CI 0.31-1.19; p = 0.143). Overall survival of patients treated in university cancer centers was significantly increased compared to patients treated in non-university cancer centers. The treatment center remains a strong prognostic factor regarding RFS (HR = 0.49, 95% CI 0.28-0.83; p = 0.009) and OS (HR = 0.50, 95% CI 0.26-0.94; p = 0.031). CONCLUSIONS The treatment center but not the surgical approach was associated with the survival of patients treated with radical hysterectomy for early stage cervical cancer.
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14
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Matsuo K, Matsuzaki S, Mandelbaum RS, Chang EJ, Klar M, Matsushima K, Grubbs BH, Roman LD, Wright JD. Minimally invasive radical hysterectomy for early-stage cervical cancer: Volume-outcome relationship in the early experience period. Gynecol Oncol 2020; 158:390-396. [PMID: 32473728 DOI: 10.1016/j.ygyno.2020.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/06/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Minimally invasive radical hysterectomy (MIS-RH) for early-stage cervical cancer is a relatively new surgical procedure with increased utilization in the mid-/late-2000s. This study examined the association between hospital surgical volume for MIS-RH and perioperative outcomes for early-stage cervical cancer in the period of early adoption. METHODS This population-based retrospective study queried the National Inpatient Sample from 2007 to 2011. Cervical cancer cases treated with MIS-RH were examined (n = 2202 from 163 hospitals). Annualized hospital surgical volume was defined as the average number of procedures performed per year in which at least one case was performed. Characteristics and outcomes related to MIS-RH use were assessed. The comparator cohort included RH by laparotomy (Open-RH; n = 11,187 from 405 hospitals). RESULTS Among MIS-RH-offering centers, 42.3% had average 1 case/year and surgical volume of >4 cases/year represented the top decile. When stratified by MIS-RH types, on average 31.3 centers performed robotic-assisted approach per year versus 11.5 centers for the traditional approach. Small bed capacity centers were most likely to perform robotic-assisted RH (adjusted-odds ratio 4.07, P < 0.001). In the traditional MIS-RH group, higher hospital surgical volume was associated with lower surgical morbidity (P = 0.025) whereas in the robotic-assisted approach higher hospital surgical volume was associated with higher surgical morbidity (P < 0.001). In the Open-RH cohort, higher hospital surgical volume was significantly associated with decreased surgical morbidity and mortality (both, P < 0.001). CONCLUSION In the mid-/late-2000s, MIS-RH surgical volume was modest in the United States. Small bed capacity centers adopted robotic-assisted MIS-RH more frequently, and there was a statistically significant association of increased perioperative complications among higher volume centers. In contrast, higher surgical volume was associated with improved perioperative outcomes with the traditional MIS-RH and open-RH approaches.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Erica J Chang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Brendan H Grubbs
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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15
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Cibula D, Planchamp F, Fischerova D, Fotopoulou C, Kohler C, Landoni F, Mathevet P, Naik R, Ponce J, Raspagliesi F, Rodolakis A, Tamussino K, Taskiran C, Vergote I, Wimberger P, Zahl Eriksson AG, Querleu D. European Society of Gynaecological Oncology quality indicators for surgical treatment of cervical cancer. Int J Gynecol Cancer 2020; 30:3-14. [PMID: 31900285 DOI: 10.1136/ijgc-2019-000878] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Optimizing and ensuring the quality of surgical care is essential to improve the management and outcome of patients with cervical cancer.To develop a list of quality indicators for surgical treatment of cervical cancer that can be used to audit and improve clinical practice. METHODS Quality indicators were developed using a four-step evaluation process that included a systematic literature search to identify potential quality indicators, in-person meetings of an ad hoc group of international experts, an internal validation process, and external review by a large panel of European clinicians and patient representatives. RESULTS Fifteen structural, process, and outcome indicators were selected. Using a structured format, each quality indicator has a description specifying what the indicator is measuring. Measurability specifications are also detailed to define how the indicator will be measured in practice. Each indicator has a target which gives practitioners and health administrators a quantitative basis for improving care and organizational processes. DISCUSSION Implementation of institutional quality assurance programs can improve quality of care, even in high-volume centers. This set of quality indicators from the European Society of Gynaecological Cancer may be a major instrument to improve the quality of surgical treatment of cervical cancer.
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Affiliation(s)
- David Cibula
- Gynecologic Oncology Center First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Daniela Fischerova
- Gynecologic Oncology Center First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | - Christhardt Kohler
- Asklepios Hambourg Altona and Department of Gynecology, University of Cologne, Koln, Germany
| | - Fabio Landoni
- Gynaecology, Universita degli Studi di Milano-Bicocca, Monza, Italy
| | - Patrice Mathevet
- Centre Hospitalier Universitaire Vaudois Departement de gynecologie-obstetrique et genetique medicale, Lausanne, Switzerland
| | - Raj Naik
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK
| | - Jordi Ponce
- University Hospital of Bellvitge (IDIBELL), LHospitalet de Llobregat, Spain
| | | | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athinon, Greece
| | | | - Cagatay Taskiran
- Department of Obstetrics and Gynecology; Division of Gynecologic Oncology, Gazi University, Ankara, Turkey
| | - Ignace Vergote
- Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universitat Dresden Medizinische Fakultat Carl Gustav Carus, Dresden, Germany
| | | | - Denis Querleu
- Clinical Research Unit, Institut Bergonie, Bordeaux, France
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Cervical cancer survivors' attitudes and understanding of menopause and hormone therapy. ACTA ACUST UNITED AC 2020; 27:701-705. [PMID: 32108734 DOI: 10.1097/gme.0000000000001520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We designed a survey study to assess the presence and severity of climacteric symptoms, in addition to better understand patients' knowledge and understanding of hormone therapy (HT). METHODS We administered a 23-question survey during a patient's clinic visit or over the phone. Study enrollment spanned from March, 2019 to May, 2019. The primary outcomes were severity of menopausal symptoms and willingness to try HT, calculated as a summarized overall score. Chi-square and logistic regression were used for analysis. RESULTS Our response rate was 38% (n = 34). Our participants were diverse-67% women were black and 21% women were Hispanic. Stage 1 and 2 disease was reported in 32% and 41% of women. Also, 82% and 94% of women reported ever receiving any chemotherapy or radiation therapy. There was no association between willingness to try HT for relief of menopausal symptoms and income (χ [1, 29] = 0.56, P = 0.81) or education level (χ [1, 29] = 2.78, P = 0.10). The most common climacteric symptoms experienced were hot flushes (85%) and decreased libido (77%). Neither symptom severity (odds ratio [OR] 1.31, 95% confidence interval [CI] 0.89-1.94) nor concern for side effects (OR 1.06, 95% CI 0.82-1.36) of HT significantly predicted willingness to try HT. CONCLUSIONS Menopausal symptoms were prevalent in this population. Our data indicate that women are experiencing climacteric symptoms, but are overall unmotivated to address symptoms using HT. Factors such as symptom severity, fear of side effects, income level, or education level were not associated with acceptability of HT for premature menopause.
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Wright CH, Wright J, Cioffi G, Hdeib A, Kasliwal MK, Kruchko C, Barnholtz-Sloan JS, Sloan AE. Association of cancer center type with treatment patterns and overall survival for patients with sacral and spinal chordomas: an analysis of the National Cancer Database from 2004 to 2015. J Neurosurg Spine 2020; 32:311-320. [DOI: 10.3171/2019.7.spine19566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEChordomas of the spine and sacrum are a rare but debilitating cancer and require complex multidisciplinary care. Studies of other such rare cancers have demonstrated an association of high-volume and/or multidisciplinary centers with improved outcomes and survival. Such an association has been proposed for chordomas, but evidence to support this claim is lacking. The authors performed a study to investigate if treatment facility type is associated with patterns of care and survival for patients with spinal and sacral chordomas by assessing records from a US-based cancer database.METHODSIn this observational retrospective cohort study, the authors identified 1266 patients from the National Cancer Database with vertebral column or sacral chordomas diagnosed between 2004 and 2015. The primary study outcome was overall survival, and secondary outcomes included odds of receiving treatment and time to treatment, defined as radiation therapy, surgery, and/or any treatment, including surgery, radiation therapy, chemotherapy, or participation in clinical trials. The results were adjusted for age, sex, race/ethnicity, level of education, income, and Charlson/Deyo score.RESULTSOf the 1266 patients identified, the mean age at diagnosis was 59.70 years (SD 16.2 years), and the patients were predominantly male (n = 791 [62.50%]). Patients treated at community cancer programs demonstrated an increased risk of death (HR 1.98, 95% CI 1.13–3.47, p = 0.018) when compared to patients treated at academic/research programs (ARPs). The median survival was longest for those treated at ARPs (131.45 months) compared to community cancer programs (79.34 months, 95% CI 48.99–123.17) and comprehensive community cancer programs (CCCPs) (109.34 months, 95% CI 84.76–131.45); 5-year survival rates were 76.08%, 52.71%, and 61.57%, respectively. Patients treated at community cancer programs and CCCPs were less likely to receive any treatment compared to those treated at ARPs (OR 6.05, 95% CI 2.62–13.95, p < 0.0001; OR 3.74, 95% CI 2.23–6.28, p < 0.0001, respectively). Patients treated at CCCPs and community cancer programs were less likely to receive surgery than those treated at ARPs (OR 2.69, 95% CI 1.82–3.97, p = 0.010; OR = 2.64, 95% CI 1.22–5.71, p = 0.014, respectively). Patients were more likely to receive any treatment (OR 0.59, 95% CI 0.40–0.87, p = 0.007) and surgery (OR 0.58, 95% CI 0.38–0.88, p < 0.0001) within 30 days at a CCCP compared to an ARP. There were no differences in odds of receiving radiation therapy or time to radiation by facility type.CONCLUSIONSClinical care at an ARP is associated with increased odds of receiving treatment that is associated with improved overall survival for patients with spinal and sacral chordomas, suggesting that ARPs provide the most comprehensive specialized care for patients with this rare and devastating oncological disease.
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Affiliation(s)
- Christina Huang Wright
- 1Department of Neurological Surgery, University Hospitals Cleveland Medical Center
- 2Department of Neurosurgery, Case Western Reserve University
| | - James Wright
- 1Department of Neurological Surgery, University Hospitals Cleveland Medical Center
- 2Department of Neurosurgery, Case Western Reserve University
| | - Gino Cioffi
- 4Case Comprehensive Cancer Center and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio; and
- 5Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Alia Hdeib
- 1Department of Neurological Surgery, University Hospitals Cleveland Medical Center
- 2Department of Neurosurgery, Case Western Reserve University
- 3Seidman Cancer Center and Case Comprehensive Cancer Center
| | - Manish K. Kasliwal
- 1Department of Neurological Surgery, University Hospitals Cleveland Medical Center
- 2Department of Neurosurgery, Case Western Reserve University
| | - Carol Kruchko
- 5Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Jill S. Barnholtz-Sloan
- 4Case Comprehensive Cancer Center and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio; and
- 5Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Andrew E. Sloan
- 1Department of Neurological Surgery, University Hospitals Cleveland Medical Center
- 2Department of Neurosurgery, Case Western Reserve University
- 3Seidman Cancer Center and Case Comprehensive Cancer Center
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Kennedy HG, Simpson A, Haque Q. Perspective On Excellence in Forensic Mental Health Services: What We Can Learn From Oncology and Other Medical Services. Front Psychiatry 2019; 10:733. [PMID: 31681042 PMCID: PMC6813277 DOI: 10.3389/fpsyt.2019.00733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/12/2019] [Indexed: 12/11/2022] Open
Abstract
We propose that excellence in forensic and other mental health services can be recognized by the abilities necessary to conduct randomized controlled trials (RCTs) and equivalent forms of rigorous quantitative research to continuously improve the outcomes of treatment as usual (TAU). Forensic mental health services (FMHSs) are growing, are high cost, and increasingly provide the main access route to more intensive, organized, and sustained pathways through care and treatment. A patient newly diagnosed with a cancer can expect to be enrolled in RCTs comparing innovations with the current best TAU. The same should be provided for patients newly diagnosed with severe mental illnesses and particularly those detained and at risk of prolonged periods in a secure hospital. We describe FMHSs in four levels 1 to 4, basic to excellent, according to seven domains: values or qualities, clinical organization, consistency, timescale, specialization, routine outcome measures, and research. Excellence is not elitism. Not all centers need to achieve excellence, though all should be of high quality. Services can provide each population with a network of centers with access to one center of excellence. Excellence is the standard needed to drive the virtuous circle of research and development that is necessary for teaching, training, and the pursuit of new knowledge and better outcomes. Substantial advances in treatment of severe mental disorders require a drive at a national and international level to create services that meet these standards of excellence and are focused, active, and productive to drive better functional outcomes for service users.
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Affiliation(s)
- Harry G Kennedy
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland.,National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Alexander Simpson
- Division for Forensic Psychiatry-University of Toronto Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Quazi Haque
- Elysium Healthcare, London, United Kingdom.,Division for Forensic Psychiatry-University of Toronto Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health-University of Toronto, Toronto, ON, Canada
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