Outcome of Colonic Surgery in Elderly Patients with Colon Cancer

Introduction. Colonic cancer is one of the most commonly diagnosed malignancies and most often occurs in patients aged 65 years or older. Aim. To evaluate the outcome of colonic surgery in the elderly in our hospital and to compare five-year survival rates between the younger and elderly patients. Methods. 207 consecutive patients underwent surgery for colon cancer. Patients were separated in patients younger than 75 and older than 75 years. Results. Elderly patients presented significantly more (P < .05) as a surgical emergency, had a longer duration of admission and were more often admitted to the ICU (P < .01). Also, elderly patients had significant more co-morbidities, especially cardiovascular pathology (P < .01). Post-operative complications were seen more often in the elderly, although no significant difference was seen in anastomotic leakage. The five-year survival rate in the younger group was 62% compared with 36% in the elderly (P < .05). DFS was 61% in the younger patients compared with 32% in the elderly (P < .05). Conclusion. Curative resection of colonic carcinoma in the elderly is well tolerated and age alone should not be an indication for less aggressive therapy. However, the type and number of co-morbidities influence post-operative mortality and morbidity

Het geriatrisch model als inspiratiebron

Inleiding Met het dichterbij komen van het moment waarop de vergrijzing in ons land haar hoogtepunt gaat bereiken, neemt ook de belangstelling voor de toekomstige vormgeving van de medische ouderenzorg snel toe. Illustratief in dit opzicht is bijvoorbeeld de scenariostudie die recentelijk in opdracht van het Capaciteitsorgaan is uitgevoerd.1 Eveneens illustratief is het voornemen van de KNMG om de medische zorg voor ouderen in 2008 prominent op de agenda te zetten.2 Algemeen wordt aangenomen dat ouderen steeds langer en zo actief en zelfstandig mogelijk thuis zullen willen blijven wonen. Voorspelbaar is echter ook dat het aantal kwetsbare ouderen met complexe zorgvragen de komende jaren aanzienlijk zal toenemen. Daarbij worden in veel toekomstbeschouwingen vooral de regie en de coördinatie van de medische zorg voor de risicogroepen onder ouderen als een belangrijk knelpunt aangemerkt. Alle reden dus voor de betrokken beroepsgroepen om samenwerkingsvormen te ontwikkelen waarmee adequaat op de voorziene kwalitatieve en kwantitatieve problemen kan worden ingespeeld. Alle reden ook om daarbij optimaal gebruik te maken van de op ervaringen gefundeerde inzichten die de oorspronkelijke pioniers op dit terrein, te weten de klinisch geriaters, de afgelopen halve eeuw hebben ontwikkeld

Bespreken van het reanimatiebeleid op een afdeling geriatrie: de ervaring van patiënt en familie

Doel: Achterhalen van de ervaring van het gesprek over het reanimatiebeleid dat standaard bij iedere opname wordt gevoerd bij geriatrische patiënten of hun vertegenwoordigers. Opzet: Prospectief, observationeel, exploratief survey-onderzoek Methode: Gedurende 10 weken werd aan alle nieuw opgenomen patiënten of vertegenwoordigers van wilsonbekwame patiënten op een afdeling geriatrie van een algemeen ziekenhuis, met een semi-gestructureerd interview gevraagd naar hun ervaring van het gesprek over het reanimatiebeleid. Ook werd er gevraagd naar factoren die mogelijk invloed hebben op deze ervaring, en naar verbeterpunten van het gesprek. De primaire uitkomst was het cijfer op een schaal van 1 t/m 10 met betrekking tot de tevredenheid over het reanimatiegesprek. Resultaten: Er werden 76 deelnemers, waarvan 29 wilsbekwame patiënten en 47 vertegenwoordigers, geïncludeerd. Het reanimatiegesprek duurde gemiddeld 4,5 minuut (SD 3,2) en in 70% (n=53) werd een niet-reanimatiebesluit genomen. De beoordeling van het reanimatiegesprek op een schaal van 1 t/m 10 was gemiddeld 7,8 (SD 1,5). In totaal werden er 121 positieve opmerkingen gemaakt tegenover 70 negatieve. Als belangrijkste verbeterpunten worden genoemd: beter inleiden van het gesprek (17%), meer uitleg geven over reanimatie en de kans op succes (17%) en het geven van informatie voorafgaand aan de opname, zodat patiënt en vertegenwoordiger al op de hoogte zijn dat er gesproken gaat worden over het reanimatiebeleid (12%). Conclusie: Patiënten en vertegenwoordigers van wilsonbekwame patiënten staan positief tegenover het standaard bespreken van het reanimatiebeleid met de arts tijdens het opnamegesprek op een afdeling geriatrie, en beoordelen dit gesprek met een 7,8/10. Ter verbetering wordt voorbereiding van de patiënt en vertegenwoordiger voor het reanimatiegesprek en uitgebreidere communicatie tijdens het gesprek aanbevolen

Characterization of the Soluble Nanoparticles Formed through Coulombic Interaction of Bovine Serum Albumin with Anionic Graft Copolymers at Low pH

A static light scattering (SLS) study of bovine serum albumin (BSA) mixtures with two anionic graft copolymers of poly (sodium acrylate-co-sodium 2-acrylamido-2-methyl-1-propanesulphonate)-graft-poly (N, N-dimethylacrylamide), with a high composition in poly (N, N-dimethylacrylamide) (PDMAM) side chains, revealed the formation of oppositely charged complexes, at pH lower than 4.9, the isoelectric point of BSA. The core-corona nanoparticles formed at pH = 3.00, were characterized. Their molecular weight and radius of gyration were determined by SLS, while their hydrodynamic radius was determined by dynamic light scattering. Small angle neutron scattering measurements were used to determine the radius of the insoluble complexes, comprising the core of the particles. The values obtained indicated that their size and aggregation number of the nanoparticles, were smaller when the content of the graft copolymers in neutral PDMAM side chains was higher. Such particles should be interesting drug delivery candidates, if the gastrointestinal tract was to be used

Interventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis.

OBJECTIVE To compare the effectiveness of single, multiple, and multifactorial interventions to prevent falls and fall-related fractures in community-dwelling older persons. METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) evaluating the effectiveness of fall prevention interventions in community-dwelling adults aged ≥65 years, from inception until February 27, 2019. Two large RCTs (published in 2020 after the search closed) were included in post hoc analyses. Pairwise meta-analysis and network meta-analysis (NMA) were conducted. RESULTS NMA including 192 studies revealed that the following single interventions, compared with usual care, were associated with reductions in number of fallers: exercise (risk ratio [RR] 0.83; 95% confidence interval [CI] 0.77-0.89) and quality improvement strategies (e.g., patient education) (RR 0.90; 95% CI 0.83-0.98). Exercise as a single intervention was associated with a reduction in falls rate (RR 0.79; 95% CI 0.73-0.86). Common components of multiple interventions significantly associated with a reduction in number of fallers and falls rate were exercise, assistive technology, environmental assessment and modifications, quality improvement strategies, and basic falls risk assessment (e.g., medication review). Multifactorial interventions were associated with a reduction in falls rate (RR 0.87; 95% CI 0.80-0.95), but not with a reduction in number of fallers (RR 0.95; 95% CI 0.89-1.01). The following single interventions, compared with usual care, were associated with reductions in number of fall-related fractures: basic falls risk assessment (RR 0.60; 95% CI 0.39-0.94) and exercise (RR 0.62; 95% CI 0.42-0.90). CONCLUSIONS In keeping with Tricco et al. (2017), several single and multiple fall prevention interventions are associated with fewer falls. In addition to Tricco, we observe a benefit at the NMA-level of some single interventions on preventing fall-related fractures

A pilot study of rivastigmine in the treatment of delirium after stroke: A safe alternative

<p>Abstract</p> <p>Background</p> <p>Delirium is a common disorder in the early phase of stroke. Given the presumed cholinergic deficiency in delirium, we tested treatment with the acetylcholinesterase inhibitor rivastigmine.</p> <p>Methods</p> <p>This pilot study was performed within an epidemiological study. In 527 consecutive stroke patients presence of delirium was assessed during the first week with the confusion assessment method. Severity was scored with the delirium rating scale (DRS). Sixty-two patients developed a delirium in the acute phase of stroke. Only patients with a severe and persistent delirium (defined as a DRS of 12 or more for more than 24 hours) were enrolled in the present study. In total 26 fulfilled these criteria of whom 17 were treated with orally administered rivastigmine with a total dose between 3 and 12 mg a day. Eight patients could not be treated because of dysphagia and one because of early discharge.</p> <p>Results</p> <p>No major side effects were recorded. In 16 patients there was a considerable decrease in severity of delirium. The mean DRS declined from 14.8 on day one to 8.5 after therapy and 5.6 after tapering. The mean duration of delirium was 6.7 days (range; 2–17).</p> <p>Conclusion</p> <p>Rivastigmine is safe in stroke patients with delirium even after rapid titration. In the majority of patients the delirium improved after treatment. A randomized controlled trial is needed to establish the usefulness of rivastigmine in delirium after stroke.</p> <p>Trial registration</p> <p>Nederlands Trial Register NTR1395</p

Compact Polyelectrolyte Complexes: “Saloplastic” Candidates for Biomaterials

Precipitates of polyelectrolyte complexes were transformed into rugged shapes suitable for bioimplants by ultracentrifugation in the presence of high salt concentration. Salt ions dope the complex, creating a softer material with viscous fluid-like properties. Complexes that were compacted under the centrifugal field (CoPECs) were made from poly(diallyldimethyl ammonium), PDADMA, as polycation, and poly(styrene sulfonate), PSS, or poly(methacrylic acid), PMAA, as polyanion. Dynamic mechanical testing revealed a rubbery plateau at lower frequencies for PSS/PDADMA with moduli that decreased with increasing salt concentration, as internal ion pair cross-links were broken. CoPECs had significantly lower modulii compared to similar polyelectrolyte complexes prepared by the “multilayering ” method. The difference in mechanical properties was ascribed to higher water content (located in micropores) for the former and, more importantly, to their nonstoichiometric polymer composition. The modulus of PMAA/PDADMA CoPECs, under physiological conditions, demonstrated dynamic mechanical properties that were close to those of the nucleus pulposus in an intervertebral disk

Which factors explain variation in intention to disclose a diagnosis of dementia? A theory-based survey of mental health professionals

Background: For people with dementia, patient-centred care should involve timely explanation of the diagnosis and its implications. However, this is not routine. Theoretical models of behaviour change offer a generalisable framework for understanding professional practice and identifying modifiable factors to target with an intervention. Theoretical models and empirical work indicate that behavioural intention represents a modifiable predictor of actual professional behaviour. We identified factors that predict the intentions of members of older people's mental health teams (MHTs) to perform key behaviours involved in the disclosure of dementia. Design: Postal questionnaire survey. Participants: Professionals from MHTs in the English National Health Service. Methods: We selected three behaviours: Determining what patients already know or suspect about their diagnosis; using explicit terminology when talking to patients; and exploring what the diagnosis means to patients. The questionnaire was based upon the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), and exploratory team variables. Main outcomes: Behavioural intentions. Results: Out of 1,269 professionals working in 85 MHTs, 399 (31.4%) returned completed questionnaires. Overall, the TPB best explained behavioural intention. For determining what patients already know, the TPB variables of subjective norm, perceived behavioural control and attitude explained 29.4% of the variance in intention. For the use of explicit terminology, the same variables explained 53.7% of intention. For exploring what the diagnosis means to patients, subjective norm and perceived behavioural control explained 48.6% of intention. Conclusion: These psychological models can explain up to half of the variation in intention to perform key disclosure behaviours. This provides an empirically- supported, theoretical basis for the design of interventions to improve disclosure practice by targeting relevant predictive factors. Trial Registration: ISRCTN15871014

Non-small-cell lung cancer in a French department, (1982–1997): management and outcome

Addition of chemotherapy to the treatment of non-small-cell lung cancer (NSCLC) resulted in a modest but clear improvement in the survival of selected patients. To ascertain if this translates to improved survival in the whole population of patients, we conducted a retrospective population-based study of a sample of 1738 patients diagnosed with primary NSCLC in a French department between 1982 and 1997. The proportion of women, metastatic cases and adenocarcinoma changed significantly over time, as did their management: use of chemotherapy alone increased from 9.7 to 28.1% (P<0.0001), while the use of radiotherapy alone decreased from 32.2 to 9.4% (P<0.0001). The 5-year survival probability was 15.7 % for all patients and 32.6% for those with resectable disease. The 1- and 2-year survival probabilities were 38.2 and 15.6% in locally advanced disease, and were, respectively, 16.8 and 5.2% in metastatic disease. Disease extent and histological subtype were significant independent prognostic factors. Survival of resectable disease was longer among patients treated with surgery or surgery plus chemotherapy, while better outcomes for locally advanced disease were associated with radiation plus chemotherapy. In metastastic disease, patients treated by classical agent without platin or palliative care only had the shortest survival. Despite changes in treatment in accordance with the state-of-the-art, overall survival did not improve over time. It is not unlikely that more patients with bad PS were diagnosed during the latter end of the study period. This could at least partially explain the absence of detection of an overall improvement in survival