6 research outputs found
Eight-year experience in esophageal cancer surgery
Aim: Esophageal cancer remains a major and lethal health problem. In
Nepal, not much has been explored about its management. The aim of this
study was to conduct a retrospective review of esophageal cancer
patients undergoing surgery or combined modality treatment at a cancer
hospital in Nepal. Materials and Methods: Resectable cases were treated
primarily with surgery. Locally advanced cases with doubtful or
obviously unresectability underwent preoperative chemo/radiation or
chemoradiation followed by surgery. Results: Among 900 patients, 103
were treated with curative intent. Mean age of patients was 54 years,
and 100% of the patients presented with complaint of dysphagia. Surgery
as a single modality of treatment was done in 57% of cases, and the
remaining underwent combined modality treatment. Transthoracic and
transhiatal approaches were used in 95% and 5% of cases, respectively.
Nodal sampling, two-field (2-FD), and three-field lymphadenectomy
(3-FD) were done in 18%, 59%, and 20% of cases, respectively. A
majority of patients had pathological stage III disease (46.6%).
In-hospitality mortality was 5%, and anastomotic leakage rate was 14%.
In 87% of patients, R0 resection was achieved. Overall, 4-year survival
was 20%. A R0 resection, early-stage disease and 3-FD favored the
survival advantage (P < 0.05). Conclusion: The mortality,
complication, and survival results were in the acceptable range. R0
resection and radical nodal dissection should be standard practice
Eight-year experience in esophageal cancer surgery
Aim: Esophageal cancer remains a major and lethal health problem. In
Nepal, not much has been explored about its management. The aim of this
study was to conduct a retrospective review of esophageal cancer
patients undergoing surgery or combined modality treatment at a cancer
hospital in Nepal. Materials and Methods: Resectable cases were treated
primarily with surgery. Locally advanced cases with doubtful or
obviously unresectability underwent preoperative chemo/radiation or
chemoradiation followed by surgery. Results: Among 900 patients, 103
were treated with curative intent. Mean age of patients was 54 years,
and 100% of the patients presented with complaint of dysphagia. Surgery
as a single modality of treatment was done in 57% of cases, and the
remaining underwent combined modality treatment. Transthoracic and
transhiatal approaches were used in 95% and 5% of cases, respectively.
Nodal sampling, two-field (2-FD), and three-field lymphadenectomy
(3-FD) were done in 18%, 59%, and 20% of cases, respectively. A
majority of patients had pathological stage III disease (46.6%).
In-hospitality mortality was 5%, and anastomotic leakage rate was 14%.
In 87% of patients, R0 resection was achieved. Overall, 4-year survival
was 20%. A R0 resection, early-stage disease and 3-FD favored the
survival advantage (P < 0.05). Conclusion: The mortality,
complication, and survival results were in the acceptable range. R0
resection and radical nodal dissection should be standard practice
Need for Improvement of Medical Records
Introduction: A medical record is a systematic documentation of a patient’s medical history and care for legal and future use. A poor quality medical record can negatively affect patient care and safety. The study aims to assess the adequacy of medical records in Bir Hospital, a central hospital.
Methods:A cross-sectional study was conducted by analyzing consecutive discharge summaries of patients admitted during a 6 month period in a single unit of a tertiary care center. The discharge summary format of the hospital was taken as the standard and evaluation for adequacy of data entered was assessed. Descriptive statistics were used to analyze various statistical discrepancies.
Results: Patient’s condition at discharge was missing in 86 (66.15%). Patient’s address was missing in 21 (16.1%) cases. Almost all the discharge sheets lacked mailing address. Total 96 (73.8%) had use of abbreviations diagnosis. Age and sex were missing in 1 (0.76%). Doctor’s signature was illegible in 103 (79.3%) and missing in 2 (1.5%) summaries. Doctor’s name and their level/position were missing in 118 (90.76%) and 125 (96.1%) respectively. Total 126 patients (96.9%) were not given any instructions on discharge.
Conclusions: The discharge summaries analyzed were seen to be inadequate especially in documenting course during the hospital stay, condition at discharge, appropriate instructions and the treating physician’s details. These can probably be addressed by introducing electronic medical records if feasible. Otherwise, the discharge summary should be standardized and doctors should be trained to write legible, complete discharge summaries.
Key Words: discharge, hospital, records, summarie