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Treatment of pancreatic and periampullary cancers at a community hospital: successful application of tertiary care treatment standards.

ABSTRACT: Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers. There is very little published data from low volume community cancer programs in regards to the treatment of periampullary cancer. In this study, a review of comprehensive periampullary cancer care at two low volume hospitals with comparison to national standards is presented. Methods. This is a retrospective review of 70 consecutive patients with periampullary neoplasms who underwent surgery over a 5-year period (2006-2010) at two community hospitals. Results. There were 51 successful resections of 70 explorations (73%) including 34 Whipple procedures. Mortality rate was 2.9%. Comparison of these patients to national standards was made in terms of operative mortality, resectability rate, administration of adjuvant therapy, clinical trial participation and overall survival. The results in these patients were comparable to national standards. Conclusions. With adequate commitment of resources and experienced surgical and oncologic practitioners, community cancer centers can meet national tertiary care standards in terms of pancreatic and periampullary cancer care.

SUBMITTER: Moesinger RC

PROVIDER: S-EPMC3263692 | biostudies-other | 2011

REPOSITORIES: biostudies-other

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Treatment of pancreatic and periampullary cancers at a community hospital: successful application of tertiary care treatment standards.

Moesinger Robert C RC Davis Jan W JW Hill Britani B Johnston W Cory WC Gray Carl C Johnson Harold H Ingersoll Leslye L Whipple Gary G Reilly Mark M Harris Robert R Hansen Vincent V

International journal of surgical oncology 20111219

Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers. There is very little published data from low volume community cancer programs in regards to the treatment of periampullary cancer. In this study, a review of comprehensive periampullary cancer care at two low ...[more]

PMID: 22312532

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Project description:BackgroundMalnutrition is very common in elderly patients admitted to the hospital. The aim of our study is to assess the nutritional status of elderly patients and the use of nutritional support in a tertiary care hospital in China and to analyze the impacts of nutritional status and nutritional support on clinical outcomes.MethodsStatistical analysis was performed on a sample of 745 elderly patients in the geriatric medicine department of Qilu Hospital of Shandong University from March 2012 to March 2015. The Nutrition Risk Screening 2002 (NRS 2002) and Mini Nutritional Assessment-short forms (MNA-SF) were utilized for the nutritional risk screening at admission. Personal information, anthropometric measurements, laboratory tests, nutritional support and clinical outcomes were recorded. Comparisons were carried out to analyze impacts on clinical outcomes and prognosis based on incidence rate of nutritional risk, nutritional support rate, and different methods of support.ResultsNRS 2002 and MNA-SF were utilized to screen for nutritional risk at admission. The results of this screening were 39.81% and 44.10%, respectively. Based on the results of the MNA-SF, 33.38% of elderly patients were at risk of malnutrition and 5.5% were malnourished. The incidence of nutritional risk in the departments of Gastroenterology, Hematology, and Respiratory were 51.72%, 46.88%, 43.33%, respectively, higher than in other departments. Patients with nutritional risk were more likely to have a longer hospital stay compared to those without (P < 0.05). The nutritional support rate of patients overall was 16.49%, and the ratio of Parenteral nutrition (PN):Enteral nutrition (EN) was 5.13:1. Patients at nutritional risk had an in-hospital support rate of 29.63% and 28.57%, respectively, identified via screening by NRS 2002 and MNA-SF. Nutritional support rate of patients without nutritional risk was 7.8%(35/449) and 6.96%(29/417), respectively. Patients in the departments of Gastroenterology and Hematology had higher rates of nutritional support than patients in other departments. In addition, results showed that in patients with nutritional risk and malnutrition, nutritional support decreased the length of hospital stay (P<0.05). The patients that received nutritional support also had a lower incidence of infectious complications than the patients without nutritional support (NRS 2002 was 6.82%:18.18% and MNA-SF was 9.57%:20.23%)(P<0.05).ConclusionsUndernourishment and nutritional risk in elderly patients at hospital admission is a common occurrence. In the current study, the nutritional risk rate in the Gastroenterology department was higher than in other departments. Patients with normal nutritional status were still receiving nutritional support. Overall, there is a need to better apply nutritional support in the clinical treatment of elderly patients. In elderly patients with nutritional risk and malnutrition, nutritional support reduced the length of hospital stay and the incidence of infectious complications.

Project description:The rising global incidence of cervical cancer is estimated to have affected more than 600,000 women, and nearly 350,000 women are predicted to have died from the disease in 2020 alone. Novel advances in cancer prevention, screening, diagnosis and treatment have all but reduced the burden of cervical cancer in developed nations. Unfortunately, cervical cancer is still the number one gynecological cancer globally. A limiting factor in managing cervical cancer globally is access to healthcare systems and trained medical personnel. Any methodology or procedure that may simplify or assist cervical cancer screening is desirable. Herein, we assess the use of artificial intelligence (AI)-assisted colposcopy in a tertiary hospital cervical diagnostic pathology unit. The study group consisted of 48 women (mean age 34) who were referred to the clinic for a routine colposcopy by their gynecologist. Cervical images were taken by an EVA-Visualcheck TM colposcope and run through an AI algorithm that gave real-time binary results of the cervical images as being either normal or abnormal. The primary endpoint of the study assessed the AI algorithm's ability to correctly identify histopathology results of CIN2+ as being abnormal. A secondary endpoint was a comparison between the AI algorithm and the clinical assessment results. Overall, we saw lower sensitivity of AI (66.7%; 12/18) compared with the clinical assessment (100%; 18/18), and histopathology results as the gold standard. The positive predictive value (PPV) was comparable between AI (42.9%; 12/28) and the clinical assessment (41.8%; 18/43). The specificity, however, was higher in the AI algorithm (46.7%; 14/30) compared to the clinical assessment (16.7%; 5/30). Comparing the congruence between the AI algorithm and histopathology results showed agreement 54.2% of the time and disagreement 45.8% of the time. A trained colposcopist was in agreement 47.9% and disagreement 52.1% of the time. Assessing these results, there is currently no added benefit of using the AI algorithm as a tool of speeding up diagnosis. However, given the steady improvements in the AI field, we believe that AI-assisted colposcopy may be of use in the future.

Dataset Information

Treatment of pancreatic and periampullary cancers at a community hospital: successful application of tertiary care treatment standards.

Publications

Treatment of pancreatic and periampullary cancers at a community hospital: successful application of tertiary care treatment standards.

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