1
|
Chen BL, Lien HC, Yang SS, Wu SC, Chiang HH, Lin LC. Impact of Mobile Apps in Conjunction With Percutaneous Endoscopic Gastrostomy on Patients' Complications, Quality of Life, and Health-Related Self-Care Behaviors: Randomized Clinical Trial. JMIR Mhealth Uhealth 2023; 11:e48970. [PMID: 37862072 PMCID: PMC10625096 DOI: 10.2196/48970] [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: 05/13/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is commonly chosen for long-term enteral nutrition support. However, common complications of PEG include wound infection, leakage, obstruction, bleeding, dislodgement, pneumonia, peritonitis, and more. The anticipation of these complications by both patients and their family caregivers underscores the essential requirement of ongoing technical guidance for the daily care of PEG and the adoption of preventative strategies. OBJECTIVE This study aimed to establish and compare a health education program utilizing a tracking system for PEG using a mobile app (PEG app) and instant messaging software versus a paper-based health education program with instant messaging software. Their effectiveness in preventing complications, avoiding hospital readmissions, improving self-care practices, and enhancing quality of life outcomes was assessed. METHODS A randomized controlled trial design was used, and the study sample consisted of patients from a medical center in central Taiwan who underwent thoracic surgery or gastroenterology procedures. Inclusion criteria were being a new case undergoing his or her first gastric tube insertion and having the ability to operate a smartphone. Exclusion criteria were cases requiring tube replacement or nasogastric tubes. A total of 74 participants were enrolled, with 37 participants in the experimental group and 37 participants in the control group. Data collection took place from hospitalization until 1 month after discharge. The experimental group received care using the gastric tube tracking system (PEG app) and the Line app that included phone, text, and photo capture capabilities, while the control group received routine nursing care and used the Line app. RESULTS The experimental group demonstrated a significant reduction in the occurrence of complications compared with the control group (χ21=12.087, P=.001). Specifically, the occurrence of leakage events was significantly lower in the experimental group than in the control group (χ21=12.906, P=.001). However, the experimental group exhibited superior self-care ability compared with the control group (t72=2.203, P=.03). There was no significant difference in overall quality of life scores between the experimental and control groups (t72=1.603, P=.11). However, the experimental group showed better social aspects of quality of life than the control group (t72=2.164, P=.03). CONCLUSIONS Integration of the PEG app with instant messaging can enhance self-care ability, improve social aspects of quality of life, and reduce complications. The study results suggest that the PEG app could be used as an adjunct tool to promote patients' self-directed management of their gastric tube at home, particularly for patients who have undergone their first PEG placement and are being discharged from the hospital. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300071271; https://tinyurl.com/4vvy584e.
Collapse
Affiliation(s)
- Bi-Lian Chen
- Department of Nursing, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Han-Chung Lien
- Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shyh-Sheng Yang
- The Division of Thoracic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Hsien-Hsien Chiang
- Department of Nursing, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Li-Chan Lin
- Department of Nursing, Asia University, Taichung, Taiwan
| |
Collapse
|
2
|
Cohen JT, Beard RE, Cioffi WG, Miner TJ. Was It Worth It? Critical Evaluation of a Novel Outcomes Measure in Oncologic Palliative Surgery. J Am Coll Surg 2023; 236:1156-1162. [PMID: 36786475 DOI: 10.1097/xcs.0000000000000649] [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] [Indexed: 02/15/2023]
Abstract
BACKGROUND Patient selection for palliative surgery is complex, and appropriate outcomes measures are incompletely defined. We explored the usefulness of a specific outcomes measure "was it worth it" in patients after palliative-intent operations for advanced malignancy. STUDY DESIGN A retrospective review of a comprehensive longitudinal palliative surgery database was performed at an academic tertiary care center. All patients who underwent palliative-intent operation for advanced cancer from 2003 to 2022 were included. Patient satisfaction ("was it worth it") was reported within 30 days of operation after palliative-intent surgery. RESULTS A total of 180 patients were identified, and 81.7% self-reported that their palliative surgery was "worth it." Patients who reported that their surgery was "not worth it" were significantly older and were more likely to have recurrent symptoms and to need reoperation. There was no significant difference in overall, recurrence-free, and reoperation-free survival for patients when comparing "worth it" with "not worth it." Initial symptom improvement was not significantly different between groups. Age older than 65 years (hazard ratio 0.25, 95% CI 0.07 to 0.80, p = 0.03), family engagement (hazard ratio 6.71, 95% CI 1.49 to 31.8, p = 0.01), and need for reoperation (hazard ratio 0.042, 95% CI 0.01 to 0.16, p < 0.0001) were all independently associated with patients reporting that their operation was "worth it." CONCLUSIONS Here we demonstrate that simply asking a patient "was it worth it" after a palliative-intent operation identifies a distinct cohort of patients that traditional outcomes measures fail to distinguish. Family engagement and durability of an intervention are critical factors in determining patient satisfaction after palliative intervention. These data highlight the need for highly individualized care with special attention paid to patients self-reporting that their operation was "not worth it."
Collapse
Affiliation(s)
- Joshua T Cohen
- From the Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | | | | | | |
Collapse
|
3
|
Roche KF, Bower KL, Collier B, Neel D, Esry L. When Should the Appropriateness of PEG be Questioned? Curr Gastroenterol Rep 2023; 25:13-19. [PMID: 36480136 DOI: 10.1007/s11894-022-00857-2] [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] [Accepted: 08/28/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review aims to analyze the evidence regarding the appropriateness of PEG placement in the following clinical situations: short bowel syndrome, head and neck cancer, dementia and palliative use in malignant bowel obstruction. RECENT FINDINGS Percutaneous endoscopic gastrostomy (PEG) tubes are placed for a variety of clinical indications by numerous different specialties. First described in 1980, PEG tubes are now the dominant method of enteral access. Typically, PEG tubes are technically feasible procedures that can come with significant risk for both minor and major complications. Therefore, it is important to perform an in-depth, patient specific risk-benefit analysis when considering insertion. By analyzing the current evidence regarding benefits in these situations, superimposed by the lens of biomedical ethics, we make recommendations that are accessible to any provider who may be a consultant or proceduralist, helping to provide informed care that is in the patient's best interest.
Collapse
Affiliation(s)
- Keelin Flannery Roche
- Department of Surgery (Trauma Surgery, Critical Care & Acute Care Surgery), East Tennessee State University, Johnson City, TN, USA
| | - Katie L Bower
- Department of Surgery (Trauma Surgery, Critical Care & Acute Care Surgery), Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Bryan Collier
- Department of Surgery (Trauma Surgery, Critical Care & Acute Care Surgery), Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Dustin Neel
- Department of Surgery (Trauma Surgery, Critical Care & Acute Care Surgery), University of Missouri-Kansas City, Kansas City, MO, USA
| | - Laura Esry
- Department of Surgery (Trauma Surgery, Critical Care & Acute Care Surgery), University of Missouri-Kansas City, Kansas City, MO, USA
| |
Collapse
|
4
|
Liang J, Jiang Y, Abboud Y, Gaddam S. Role of Endoscopy in Management of Upper Gastrointestinal Cancers. Diseases 2022; 11:diseases11010003. [PMID: 36648868 PMCID: PMC9844461 DOI: 10.3390/diseases11010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Upper gastrointestinal (GI) malignancy is a leading cause of cancer-related morbidity and mortality. Upper endoscopy has an established role in diagnosing and staging upper GI cancers, screening for pre-malignant lesions, and providing palliation in cases of advanced malignancy. New advances in endoscopic techniques and technology have improved diagnostic accuracy and increased the therapeutic potential of upper endoscopy. We aim to describe the different types of endoscopic technology used in cancer diagnosis, summarize the current guidelines for endoscopic diagnosis and treatment of malignant and pre-malignant lesions, and explore new potential roles for endoscopy in cancer therapy.
Collapse
|
5
|
Khatib SE, Khoder A, Moghrabi D, Rabah M, Tabbah SA. Nurses' knowledge about palliative care services in North Lebanon. Int J Palliat Nurs 2022; 28:474-481. [DOI: 10.12968/ijpn.2022.28.10.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: The surge in number of people needing palliative care services along with the deficit in nursing knowledge in in this field are challenges to be addressed in order to ensure higher quality end of life life care. Aim: The aim of this cross-sectional, exploratory pilot study was to assess nurses' knowledge in palliative care using the palliative care knowledge test (PCKT). Method: Descriptive analysis and correlations were carried out. Findings: Nurses showed insufficient knowledge in palliative care; 52% had a poor level (≤18 points) and 48% a fair level (19–28) of knowledge. No participants scored more than 73% in the total PCKT score. Nurses scored poorest in the management of dyspnoea and psychiatric problems. Conclusion: This pilot study demonstrated that promoting continuous education in palliative care is needed to provide quality care to terminally ill patients.
Collapse
Affiliation(s)
- Sarah El Khatib
- Assistant Professor, Faculty of Public Health, Lebanese University, Lebanon; Center for Epidemiology and Research in Population Health (CERPOP), Université de Toulouse, Inserm, Université Paul Sabatier, France
| | - Ansar Khoder
- Registered Nurse, Faculty of Public Health, Lebanese University; Al Youssef Hospital Center, Lebanon
| | - Dalal Moghrabi
- Registered Nurse, Faculty of Public Health, Lebanese University; Al Youssef Hospital Center, Lebanon
| | - Mohamad Rabah
- Registered Nurse, Faculty of Public Health, Lebanese University; Nini Hospital, Lebanon
| | - Samaa Al Tabbah
- Clinical Pharmacist, Faculty of Health Sciences, American University of Beirut; School of Pharmacy, Lebanese American University, Lebanon
| |
Collapse
|
6
|
The Outcomes of Nutritional Support Techniques in Patients with Gastrointestinal Cancers. GASTROENTEROLOGY INSIGHTS 2022. [DOI: 10.3390/gastroent13030025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Gastrointestinal cancers represent a major cause of morbidity and mortality worldwide. A significant issue regarding the therapeutic management of these patients consists of metabolic disturbances and malnutrition. Nutritional deficiencies have a negative impact on both the death rates of these patients and the results of surgical or oncological treatments. Thus, current guidelines recommend the inclusion of a nutritional profile in the therapeutic management of patients with gastrointestinal cancers. The development of digestive endoscopy techniques has led to the possibility of ensuring the enteral nutrition of cancer patients without oral feeding through minimally invasive techniques and the avoidance of surgeries, which involve more risks. The enteral nutrition modalities consist of endoscopy-guided nasoenteric tube (ENET), percutaneous endoscopic gastrostomy (PEG), percutaneous endoscopic gastrostomy with jejunal tube extension (PEG-J), direct percutaneous endoscopic jejunostomy (DPEJ) or endoscopic ultrasound (EUS)-guided gastroenterostomy.
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW Nonoperating room anesthesia for digestive tract endoscopy has its own specificities and requires practical training. Monitoring devices, anesthetic drugs, understanding of procedures and management of complications are critical aspects. RECENT FINDINGS New data are available regarding risk factors for intra- and postoperative complications (based on anesthesia registries), airway management, new anesthetic drugs, techniques of administration and management of advances in interventional endoscopy procedures. SUMMARY Digestive tract endoscopy is a common procedure that takes place outside the operating room most of the time and has become more and more complex due to advanced invasive procedures. Prior evaluation of the patient's comorbidities and a good understanding of the objectives and constraints of the endoscopic procedures are required. Assessing the risk of gastric content aspiration is critical for determining appropriate anesthetic protocols. The availability of adequate monitoring (capnographs adapted to spontaneous ventilation, bispectral index), devices for administration of anesthetic/sedative agents (target-controlled infusion) and oxygenation (high flow nasal oxygenation) guarantees the quality of sedation and patient' safety during endoscopic procedures. Knowledge of the specificities of each interventional endoscopic procedure (endoscopic retrograde cholangiopancreatography, submucosal dissection) allows preventing complications during anesthesia.
Collapse
Affiliation(s)
- Emmanuel Pardo
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine and Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris
| | - Marine Camus
- Sorbonne University, INSERM, Centre de Recherche Saint-Antoine (CRSA) & Endoscopy Center, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Franck Verdonk
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine and Sorbonne University, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris
| |
Collapse
|
8
|
Cohen JT, Fallon EA, Charpentier KP, Cioffi WG, Miner TJ. Improving the value of palliative surgery by optimizing patient selection: The role of long-term survival on high impact palliative intent operations. Am J Surg 2020; 221:1018-1023. [PMID: 32980077 DOI: 10.1016/j.amjsurg.2020.08.034] [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: 06/19/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In order to better characterize outcomes of palliative surgery (PS), we evaluated patients that experienced top quartile survival to elucidate predictors of high impact PS. METHODS All PS performed on advanced cancer patients from 2003 to 2017 were identified from a PS database. RESULTS 167 patients were identified. Multivariate analysis demonstrated the ability to rise from a chair was independently associated with top quartile survival (HR 7.61, 95% CI 2.12-48.82, p=0.008) as was the need for re-operation (HR 2.81, 95% CI 1.26-6.30, p=0.0012). Patients who were able to rise from a chair had significantly prolonged overall survival (320 vs 87 days, p < 0.001). CONCLUSIONS Although not the primary goal, long-term survival can be achieved following PS and is associated with re-operation and the ability to rise from a chair. These patients experience the benefits of PS for a longer period of time, which in turn maximizes value and positive impact. SUMMARY Long-term survival and symptom control can be achieved in highly selected advanced cancer patients following palliative surgery. The ability of the patient to independently rise from a chair and the provider to offer a re-operation when indicated are associated with long-term survival following a palliative operation.
Collapse
Affiliation(s)
- Joshua T Cohen
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Eleanor A Fallon
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kevin P Charpentier
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - William G Cioffi
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Thomas J Miner
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| |
Collapse
|
9
|
Abstract
Surgeons are often asked to perform tracheostomies and percutaneous endoscopic gastrostomies for a wide variety of patients. As consultants, surgeons are tasked with honoring the relationship between the referring provider and the patient while also assessing whether the consult is appropriate given the patient's prognosis and goals of care. This article discusses the most common conditions for which these procedures are requested and reviews the evidence supporting either the placement or avoidance of these tubes in each condition. It provides a framework for surgeons to use when discussing these procedures in the context of goals of care.
Collapse
|
10
|
Albrecht H, Hagel AF, Schlechtweg P, Foertsch T, Neurath MF, Mudter J. Computed Tomography-Guided Percutaneous Gastrostomy/Jejunostomy for Feeding and Decompression. Nutr Clin Pract 2016; 32:212-218. [PMID: 27329861 DOI: 10.1177/0884533616653806] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND An effective method for long-term enteral feeding or stomach decompression is the use of a percutaneous gastrostomy (PEG) or sometimes jejunostomy (PEJ). Under certain circumstances (eg, inadequate transillumination), endoscopic placement of PEG/PEJ tubes is impossible. In these cases, computed tomography (CT)-guided PEG/PEJ may represent an alternative technique. In this study, we evaluate indications, results, and complications of CT-guided PEG/PEJ. MATERIALS AND METHODS A total of 102 consecutive referred patients were enrolled in the study. Patients came to the endoscopy unit of our department to undergo a CT-guided PEG/PEJ for long-term intragastric/intrajejunal feeding (n = 57) or decompression (n = 45). The majority (n = 98) received a pull-through PEG/PEJ with simultaneous gastroscopy/jejunoscopy. Dose length product and the effective dose for every patient were calculated. RESULTS PEG/PEJ tube placement was successful in 87.3% (89 of 102). Feeding PEG/PEJ tube placement was successfully completed in 91.2% (52 of 57); decompressive PEG/PEJ tube placement was likewise successfully completed in 82.2% (37 of 45). No procedure-related mortality was observed. Minor complications (eg, tube dysfunction, local bleeding, minimal leakage, local skin infection) were observed in 13 patients. The complication rate was similar between the feeding and decompression groups ( P = .9). CONCLUSIONS CT-guided PEG/PEJ is a feasible and safe method with a low procedure-related morbidity rate for patients where endoscopic placement via transillumination is not successful. Thus, the procedure is an attractive alternative to surgical tube placement. Long-term complications, mainly tube disturbances, can be treated easily.
Collapse
Affiliation(s)
- Heinz Albrecht
- 1 Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander F Hagel
- 1 Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Philipp Schlechtweg
- 2 Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Foertsch
- 3 Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Markus F Neurath
- 1 Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jonas Mudter
- 1 Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany.,4 Sana Clinic Ostholstein, Department of Gastroenterology, Eutin, Germany
| |
Collapse
|
11
|
Athanasiou A, Spartalis E, Alexandrou A, Liakakos T. Comment on "Laparo-Endoscopic Gastrostomy (LEG) Decompression: a Novel One-time Method of Management of Gastric Leaks Following Sleeve Gastrectomy". Obes Surg 2015; 26:620-1. [PMID: 26694211 DOI: 10.1007/s11695-015-2015-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Antonios Athanasiou
- 1st Surgery Department, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece.
| | - Eleftherios Spartalis
- 1st Surgery Department, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece.
| | - Andreas Alexandrou
- 1st Surgery Department, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece.
| | - Theodoros Liakakos
- 1st Surgery Department, Laikon General Hospital, 17 Agiou Thoma str., 115 27, Athens, Greece.
| |
Collapse
|