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Janczewski LM, Chandrasekaran A, Abahuje E, Ko B, Slocum JD, Tesorero K, Nguyen MLT, Yang S, Strong EA, Bhakta K, Huml JP, Kruser JM, Johnson JK, Stey AM. Barriers and Facilitators to End-of-Life Care Delivery in ICUs: A Qualitative Study. Crit Care Med 2024:00003246-990000000-00295. [PMID: 38372629 DOI: 10.1097/ccm.0000000000006235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVES To understand frontline ICU clinician's perceptions of end-of-life care delivery in the ICU. DESIGN Qualitative observational cross-sectional study. SETTING Seven ICUs across three hospitals in an integrated academic health system. SUBJECTS ICU clinicians (physicians [critical care, palliative care], advanced practice providers, nurses, social workers, chaplains). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In total, 27 semi-structured interviews were conducted, recorded, and transcribed. The research team reviewed all transcripts inductively to develop a codebook. Thematic analysis was conducted through coding, category formulation, and sorting for data reduction to identify central themes. Deductive reasoning facilitated data category formulation and thematic structuring anchored on the Systems Engineering Initiative for Patient Safety model identified that work systems (people, environment, tools, tasks) lead to processes and outcomes. Four themes were barriers or facilitators to end-of-life care. First, work system barriers delayed end-of-life care communication among clinicians as well as between clinicians and families. For example, over-reliance on palliative care people in handling end-of-life discussions prevented timely end-of-life care discussions with families. Second, clinician-level variability existed in end-of-life communication tasks. For example, end-of-life care discussions varied greatly in process and outcomes depending on the clinician leading the conversation. Third, clinician-family-patient priorities or treatment goals were misaligned. Conversely, regular discussion and joint decisions facilitated higher familial confidence in end-of-life care delivery process. These detailed discussions between care teams aligned priorities and led to fewer situations where patients/families received conflicting information. Fourth, clinician moral distress occurred from providing nonbeneficial care. Interviewees reported standardized end-of-life care discussion process incorporated by the people in the work system including patient, family, and clinicians were foundational to delivering end-of-life care that reduced both patient and family suffering, as well as clinician moral distress. CONCLUSIONS Standardized work system communication tasks may improve end-of life discussion processes between clinicians and families.
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Affiliation(s)
- Lauren M Janczewski
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Adithya Chandrasekaran
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL
- Department of Hospital Medicine, Division of Hospice and Palliative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medicine, Division of Critical Care Medicine, Northwestern Medicine Central DuPage Hospital, Winfield, IL
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Egide Abahuje
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Bona Ko
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - John D Slocum
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kaithlyn Tesorero
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - My L T Nguyen
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sohae Yang
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Erin A Strong
- Department of Hospital Medicine, Division of Hospice and Palliative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kunjan Bhakta
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jeffrey P Huml
- Department of Medicine, Division of Critical Care Medicine, Northwestern Medicine Central DuPage Hospital, Winfield, IL
| | - Jacqueline M Kruser
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Julie K Johnson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Northwestern Quality Improvement, Research, and Education in Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Kopecky KE, Strong EA, Pellizzeri KF. Nomenclature in Palliative Surgery. Am Surg 2023:31348231161667. [PMID: 36951226 DOI: 10.1177/00031348231161667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Surgical palliative care, palliative care interventions, and palliative surgery all reference a blend of these 2 sub-specialty fields. Despite prior published definitions, use of these phrases both clinically and in the literature is varied and can lead to confusion and misunderstanding. Herein, we proposed the adoption of standardized nomenclature to guide the consistent use of these phrases.
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Affiliation(s)
| | - Erin A Strong
- Department of Hospital Medicine, Division of Hospice and Palliative Medicine, 12244Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine F Pellizzeri
- Department of Surgery, Division of Trauma and Critical Care, Clinical Assistant Professor of Surgery, 3626University of South Carolina School of Medicine Affiliate Faculty, Prisma Health, Greenville, SC, USA
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Strong EA, Lilley EJ. What Are the Priorities in Surgical Palliative Care Research? Am Surg 2023:31348231157824. [PMID: 36797660 DOI: 10.1177/00031348231157824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
In the 20 years since the American College of Surgeons outlined the first research agenda for surgical palliative care, there has been immense growth in the evidence. In this article, we briefly review the state of the science and priority research areas in surgical palliative care.
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Affiliation(s)
- Erin A Strong
- Division of Hospice & Palliative Medicine, 12244Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth J Lilley
- Department of Surgical Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Strong EA, Livingston A, Gracz M, Peltier W, Tsai S, Christians K, Gamblin TC, Kersting K, Clarke CN. Palliative Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis: Is It Safe and Effective? J Surg Res 2022; 278:31-38. [PMID: 35588572 DOI: 10.1016/j.jss.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/19/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Palliation is a controversial indication for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Patients with peritoneal carcinomatosis (PC) are living longer, and the roles of palliative CRS and HIPEC are increasingly challenged. The purpose of this study is to evaluate indications, morbidity, and symptom improvement from CRS/HIPEC in advanced PC. METHODS A retrospective review of patients undergoing CRS and/or HIPEC with a palliative intent at a single institution from February 2008 to February 2018 was performed. Main end points included symptom improvement, symptom-free interval, and overall survival. RESULTS Two hundred and seventy seven patients were referred for CRS/HIPEC during the study period and 17 underwent 20 palliative procedures. Appendiceal (n = 6) and colorectal cancers (n = 6) were the most common malignancies. Ascites (n = 8) and bowel obstruction (n = 8) were the most common indications for intervention. The postoperative complication rate was 50% and major complication rate was 20%. Partial symptom improvement or resolution of symptoms was achieved in 18 (90%) cases. A durable symptom control at 90 d was achieved in 13 (65%) cases. The median time to symptom recurrence was 5.1 mo (interquartile range: 2-11.4), and the median overall survival was 11.6 mo (interquartile range: 3.8-28.5). CONCLUSIONS Palliative CRS and/or HIPEC achieve symptom improvement in patients with advanced PC. Risk assessment and expected time to recovery from surgery remain paramount for patient selection.
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Affiliation(s)
- Erin A Strong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Austin Livingston
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Maciej Gracz
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wendy Peltier
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Susan Tsai
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathleen Christians
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karen Kersting
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Callisia N Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Braun EJ, Singh S, Penlesky AC, Strong EA, Holt JM, Fletcher KE, Stadler ME, Nattinger AB, Crotty BH. Nursing implications of an early warning system implemented to reduce adverse events: a qualitative study. BMJ Qual Saf 2022; 31:716-724. [PMID: 35428684 DOI: 10.1136/bmjqs-2021-014498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/23/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Unrecognised changes in a hospitalised patient's clinical course may lead to a preventable adverse event. Early warning systems (EWS) use patient data, such as vital signs, nursing assessments and laboratory values, to aid in the detection of early clinical deterioration. In 2018, an EWS programme was deployed at an academic hospital that consisted of a commercially available EWS algorithm and a centralised virtual nurse team to monitor alerts. Our objective was to understand the nursing perspective on the use of an EWS programme with centralised monitoring. METHODS We conducted and audio-recorded semistructured focus groups during nurse staff meetings on six inpatient units, stratified by alert frequency (high: >100 alerts/month; medium: 50-100 alerts/month; low: <50 alerts/month). Discussion topics included EWS programme experiences, perception of EWS programme utility and EWS programme implementation. Investigators analysed the focus group transcripts using a grounded theory approach. RESULTS We conducted 28 focus groups with 227 bedside nurses across all shifts. We identified six principal themes: (1) Alert timeliness, nurses reported being aware of the patient's deterioration before the EWS alert, (2) Lack of accuracy, nurses perceived most alerts as false positives, (3) Workflow interruptions caused by EWS alerts, (4) Questions of actionability of alerts, nurses were often uncertain about next steps, (5) Concerns around an underappreciation of core nursing skills via reliance on the EWS programme and (6) The opportunity cost of deploying the EWS programme. CONCLUSION This qualitative study of nurses demonstrates the importance of earning user trust, ensuring timeliness and outlining actionable next steps when implementing an EWS. Careful attention to user workflow is required to maximise EWS impact on improving hospital quality and patient safety.
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Affiliation(s)
- Emilie J Braun
- Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Siddhartha Singh
- Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Annie C Penlesky
- Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Erin A Strong
- Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jeana M Holt
- Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,School of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Kathlyn E Fletcher
- Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Internal Medicine, Clement J. Zablocki VAMC, Milwaukee, Wisconsin, USA
| | - Michael E Stadler
- Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ann B Nattinger
- Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bradley H Crotty
- Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Strong EA, Park SH, Ethun CG, Chow B, King D, Bedi M, Charlson J, Mogal H, Tsai S, Christians K, Tran TB, Poultsides G, Grignol V, Howard JH, Tseng J, Roggin KK, Chouliaras K, Votanopoulos K, Cullinan D, Fields RC, Gamblin TC, Cardona K, Clarke CN. High neutrophil-lymphocyte ratio is not independently associated with worse survival or recurrence in patients with extremity soft tissue sarcoma. Surgery 2020; 168:760-767. [PMID: 32736869 DOI: 10.1016/j.surg.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/21/2020] [Accepted: 06/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Soft tissue sarcomas are a heterogenous group of neoplasms without well-validated biomarkers. Cancer-related inflammation is a known driver of tumor growth and progression. Recent studies have implicated a high circulating neutrophil-lymphocyte ratio as a surrogate marker for the inflammatory tumor microenvironment and a poor prognosticator in multiple solid tumors, including colorectal and pancreatic cancers. The impact of circulating neutrophil-lymphocyte ratio in soft tissue sarcomas has yet to be elucidated. METHODS We performed a retrospective analysis of patients undergoing curative resection for primary or recurrent extremity soft tissue sarcomas at academic centers within the US Sarcoma Collaborative. Neutrophil-lymphocyte ratio was calculated retrospectively in treatment-naïve patients using blood counts at or near diagnosis. RESULTS A high neutrophil-lymphocyte ratio (≥4.5) was associated with worse survival on univariable analysis in patients with extremity soft tissue sarcomas (hazard ratio 2.07; 95% confidence interval, 1.54-2.8; P < .001). On multivariable analysis, increasing age (hazard ratio 1.03; 95% confidence interval, 1.02-1.04; P < .001), American Joint Committee on Cancer T3 (hazard ratio 1.89; 95% confidence interval, 1.16-3.09; P = .011), American Joint Committee on Cancer T4 (hazard ratio 2.36; 95% confidence interval, 1.42-3.92; P = .001), high tumor grade (hazard ratio 4.56; 95% confidence interval, 2.2-9.45; P < .001), and radiotherapy (hazard ratio 0.58; 95% confidence interval, 0.41-0.82; P = .002) were independently predictive of overall survival, but a high neutrophil-lymphocyte ratio was not predictive of survival (hazard ratio 1.26; 95% confidence interval, 0.87-1.82; P = .22). CONCLUSION Tumor inflammation as measured by high pretreatment neutrophil-lymphocyte ratio was not independently associated with overall survival in patients undergoing resection for extremity soft tissue sarcomas.
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Affiliation(s)
- Erin A Strong
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Cecilia G Ethun
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Bonnie Chow
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - David King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - John Charlson
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Harveshp Mogal
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Susan Tsai
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Thuy B Tran
- Department of Surgery, Stanford University, Palo Alto, CA
| | | | - Valerie Grignol
- Department of Surgery, The Ohio State University, Columbus, OH
| | | | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Kevin K Roggin
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | | | | | | | - Ryan C Fields
- Department of Surgery, Washington University, St. Louis, MO
| | - T Clark Gamblin
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Kenneth Cardona
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
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Geurts JL, Strong EA, Wang TS, Evans DB, Clarke CN. Screening guidelines and recommendations for patients at high risk of developing endocrine cancers. J Surg Oncol 2020; 121:975-983. [DOI: 10.1002/jso.25869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/09/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Jennifer L. Geurts
- Graduate School of Biomedical SciencesMedical College of WisconsinMilwaukee Wisconsin
| | - Erin A. Strong
- Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukee Wisconsin
| | - Tracy S. Wang
- Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukee Wisconsin
| | - Douglas B. Evans
- Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukee Wisconsin
| | - Callisia N. Clarke
- Division of Surgical Oncology, Department of SurgeryMedical College of WisconsinMilwaukee Wisconsin
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Morgan Z, Chow BE, Strong EA, Tsai S, Christians K, Mogal H, Gamblin TC, Clarke CN. RAS Mutation Status Confers Prognostic Relevance in Patients Treated With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Cancer. J Surg Res 2019; 240:130-135. [PMID: 30928770 DOI: 10.1016/j.jss.2019.02.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/12/2019] [Accepted: 02/22/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Metastatic colorectal cancer (mCRC) with peritoneal carcinomatosis is an increasingly prevalent disease that carries significant mortality if left untreated. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in this patient population is associated with improved outcomes but high morbidity. We sought to study the prognostic significance of the known genomic driver, RAS, in patients with mCRC undergoing CRS/HIPEC to allow for improved assessment of risk-benefit ratio in this patient population. METHODS Patients undergoing CRS/HIPEC for mCRC between 2010 and 2017 at our institution were identified. Patient demographics, RAS mutation status, perioperative morbidity, overall survival (OS), and relapse-free survival (RFS) were evaluated. RESULTS Forty-seven patients met inclusion criteria. RAS mutant versus RAS wild-type groups were well matched with no difference in the clinicopathologic factors between groups. RAS mutation was associated with decreased RFS but no difference in OS. CONCLUSIONS RAS mutation is an independent marker of early recurrence in patients undergoing CRS/HIPEC for mCRC and may identify patients who do not derive benefit from this high-risk procedure.
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Affiliation(s)
- Zoe Morgan
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bonnie E Chow
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Erin A Strong
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Susan Tsai
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathleen Christians
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Harveshp Mogal
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Thomas Clark Gamblin
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Callisia N Clarke
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Bliss LA, Strong EA, Gamblin TC. Surgical resectability of multisite metastatic colorectal cancer: Pushing the limits while appropriately selecting patients. J Surg Oncol 2019; 119:623-628. [PMID: 30802312 DOI: 10.1002/jso.25419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 01/26/2023]
Abstract
Management of multisite colorectal metastases is expanding to make curative resection possible for more patients who present with advanced disease. Patient selection, tumor biology, meticulous surgical technique, and thoughtful perioperative care are essential to extending the benefit to patients previously treated with palliative goals of care.
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Affiliation(s)
- Lindsay A Bliss
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Erin A Strong
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - T Clark Gamblin
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Strong EA, De Castro R, Sambuco D, Stewart A, Ubel PA, Griffith KA, Jagsi R. Work-life balance in academic medicine: narratives of physician-researchers and their mentors. J Gen Intern Med 2013; 28:1596-603. [PMID: 23765289 PMCID: PMC3832709 DOI: 10.1007/s11606-013-2521-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 05/13/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Leaders in academic medicine are often selected from the ranks of physician-researchers, whose demanding careers involve multiple professional commitments that must also be balanced with demands at home. OBJECTIVE To gain a more nuanced understanding of work-life balance issues from the perspective of a large and diverse group of faculty clinician-researchers and their mentors. DESIGN A qualitative study with semi-structured, in-depth interviews conducted from 2010 to 2011, using inductive analysis and purposive sampling. PARTICIPANTS One hundred former recipients of U.S. National Institutes of Health (NIH) K08 or K23 career development awards and 28 of their mentors. APPROACH Three researchers with graduate training in qualitative methods conducted the interviews and thematically coded verbatim transcripts. KEY RESULTS Five themes emerged related to work-life balance: (1) the challenge and importance of work-life balance for contemporary physician-researchers, (2) how gender roles and spousal dynamics make these issues more challenging for women, (3) the role of mentoring in this area, (4) the impact of institutional policies and practices intended to improve work-life balance, and (5) perceptions of stereotype and stigma associated with utilization of these programs. CONCLUSIONS In academic medicine, in contrast to other fields in which a lack of affordable childcare may be the principal challenge, barriers to work-life balance appear to be deeply rooted within professional culture. A combination of mentorship, interventions that target institutional and professional culture, and efforts to destigmatize reliance on flexibility (with regard to timing and location of work) are most likely to promote the satisfaction and success of the new generation of clinician-researchers who desire work-life balance.
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Affiliation(s)
- Erin A Strong
- University of Michigan Medical School, 1301 Catherine Road, Ann Arbor, MI, 48109, USA
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Gilpin JE, Strong EA. Scientific Journals. Science 1898; 7:323-4. [PMID: 17730449 DOI: 10.1126/science.7.166.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Strong EA. Preparation of Teachers of Science as Carried forward in the Michigan State Normal School. Science 1892; 20:185-7. [PMID: 17731770 DOI: 10.1126/science.ns-20.504.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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