One-third of patients fail to return to work 1 year after surgery for colorectal cancer

Background Achieving full recovery after colorectal cancer surgery means a return to normal physical and psychological health and to a normal social life. Recovery data focusses on time to discharge rather than longer term functionality including return to work (RTW). We aim to assess return to normal holistic function at 1 year after colorectal cancer surgery. Method Questionnaires were created and dispatched to 204 patients who had undergone surgery with curative intent for colorectal cancer, in 2011–2012, in a single teaching hospital. Results Response rate was 75 % (153/204), 82 % (129/157) for open surgery (OS) and 51 % (24/47) for laparoscopic surgery (LS). Median age was 68 (48–91) years for OS and 65 (36–84) for LS. Eighty-four per cent of patients felt ‘ready’ and 95 % had adequate pain control upon discharge (no difference between groups). LS reported earlier ‘return to full fitness’ (1–3 months) than OS (>6 months; Mann–Whitney U, p < 0.05). Recovery from LS was ‘better than expected’ compared to OS ‘worse than expected’ (Mann–Whitney U test, p < 0.05). Forty-nine patients were employed preoperatively and 61 % (n = 30) returned to work. RTW was more frequent after LS (Chi-square test, p < 0.05). Length of time to RTW was significantly less after LS [44 (6–84) days] than OS [71 (14–252) days] (t test, p < 0.05). Levels of self-employment were equal between groups. Conclusions One-third of patients failed to RTW at 1 year post-surgery. Patients having LS returned to full fitness faster, felt recovery was shorter and returned to work earlier than OS. We must invest more in managing expectations and provide better post-discharge support to improve RTW

Markov Properties of Electrical Discharge Current Fluctuations in Plasma

Using the Markovian method, we study the stochastic nature of electrical discharge current fluctuations in the Helium plasma. Sinusoidal trends are extracted from the data set by the Fourier-Detrended Fluctuation analysis and consequently cleaned data is retrieved. We determine the Markov time scale of the detrended data set by using likelihood analysis. We also estimate the Kramers-Moyal's coefficients of the discharge current fluctuations and derive the corresponding Fokker-Planck equation. In addition, the obtained Langevin equation enables us to reconstruct discharge time series with similar statistical properties compared with the observed in the experiment. We also provide an exact decomposition of temporal correlation function by using Kramers-Moyal's coefficients. We show that for the stationary time series, the two point temporal correlation function has an exponential decaying behavior with a characteristic correlation time scale. Our results confirm that, there is no definite relation between correlation and Markov time scales. However both of them behave as monotonic increasing function of discharge current intensity. Finally to complete our analysis, the multifractal behavior of reconstructed time series using its Keramers-Moyal's coefficients and original data set are investigated. Extended self similarity analysis demonstrates that fluctuations in our experimental setup deviates from Kolmogorov (K41) theory for fully developed turbulence regime.Comment: 25 pages, 9 figures and 4 tables. V3: Added comments, references, figures and major correction

Day-case closure of ileostomy: feasible, safe and efficient

Aim Over 5000 loop ileostomy closures were performed in the UK in 2013 with a median inpatient stay of 5 days. Previously we have successfully implemented a 23-h protocol for loop ileostomy closure which was modified for same-day discharge. We present our early experience of day-case loop ileostomy closure. Method A specific patient pathway for day-case discharge following loop ileostomy closure was implemented with inclusion criteria to conform with British Association of Day Surgery guidelines. Exclusion criteria included postoperative chemoradiotherapy, multiple comorbidities and social care needs. Follow-up consisted of telephone contact (24 and 72 h after discharge) and a routine outpatient appointment. Patients were provided with a 24-h contact point in case of emergency. Results Fifteen (12 male) patients were enrolled of median age 67 (39–80) years. The median operating time was 41 (23–80) min. The indication for ileostomy formation was to cover a low anterior resection for adenocarcinoma (13), reversal of Hartmann's procedure (1) and functional bowel disorder (1). The median interval from the primary procedure to day-case loop ileostomy closure was 8 (3–14) months. Every patient was discharged on the day of surgery. There were no complications related to the surgery and there was one readmission due to a urinary tract infection. The median length of follow-up was 4 (2–16) months. Conclusion Our early experience shows that day-case loop ileostomy closure is feasible, safe and efficient. This protocol will become standard within our institution for suitable patients, saving on average five inpatient bed days per patient