Recurrences after transanal excision or transanal endoscopic microsurgery of T1 rectal cancer

Local excision for T1 rectal cancer is increasingly applied, in a strive to avoid the morbidity associated with radical surgery, despite limited evidence. One of the issues is the high rate of local recurrence following local excision (LE). In this article we focus on this item and review the literature articles concerning local excision and transanal endoscopic microsurgery (TEM), recurrence, and salvage surgery. Local recurrence rates after LE or TEM are unacceptably high. As outcome of this subgroup is limited, future studies should focus on proper tumor selection and adjuvant treatment strategies following salvage surgery.

An educational intervention to improve the quality of care of diabetic patients

OBJECTIVE

As few studies have addressed intervention for in-hospital care of diabetes mellitus (DM) patients, we set out to investigate whether an educational intervention targeting doctors could improve the quality of care for diabetic patients.

DESIGN

An observational interventional study conducted at Pretoria Academic Hospital, a tertiary care hospital.

SUBJECTS

Doctors working in the Department of Internal Medicine were the subjects of two interventional sessions on diabetic care, and all diabetic patients admitted to the wards in the above Department were evaluated.

OUTCOME MEASURES

A Diabetes Attitude Scale (DAS-3) and a Diabetes Practice Scale (DPS) were completed by each doctor before and after the interventional educational sessions. Data from diabetic patients in the wards were collected for 5 weeks before and 5 weeks after the interventional training, and these two sets of data were compared to measure the effect of the interventional training.

RESULTS

Subscales of the DAS-3 showed an improvement, with a statistically significant improvement in attitude regarding seriousness of DM (P = 0.03), and a trend towards improvement in attitude regarding need for special training and patient autonomy. Most of the items on the DPS improved significantly (P < 0.05).

CONCLUSIONS

A short educational intervention resulted in an improvement in attitude, knowledge and clinical management of diabetic patients.