Coping strategies and considerations regarding low anterior resection syndrome and quality of life among patients with rectal cancer; a qualitative interview study

INTRODUCTION: Low anterior resection syndrome (LARS) is defined as disordered bowel function following rectal resection, which is detrimental to quality of life (QoL). A recent international consensus definition of LARS stresses the importance of focusing on both the symptoms and the consequences that the symptoms have for the individual patient as studies indicate that LARS has a negative impact on patients’ QoL. However, an ongoing PROM study investigating late sequelae after rectal cancer finds that a minor proportion of patients scoring major LARS experience none or only little impact on quality of life AIM: The aim of this study was to identify patients’ considerations and coping strategies to establish why the burden caused by major LARS had little or no influence on their QoL. MATERIALS AND METHODS: This was a qualitative interview study based on 21 semi-structured individual telephone interviews with patients treated for rectal cancer. Data were analysed using a hermeneutic inspired thematic analysis. RESULTS AND CONCLUSION: Three themes emerged from the analysis; Adapting new life situation, Altering life perception and the Importance of relationships. Major LARS and its consequences following rectal cancer may be managed or altered by adopting problem-focused and emotion-focused coping strategies. Maintaining a positive attitude and having a good network of family and friends constitute a surplus, allowing patients to cope with the need for changed behaviour and appreciate the life that they have been given. Accepting that major LARS and its consequences cause limitations in life allowed patients to change their normality threshold over time

Validation of low anterior resection syndrome score in Brazil with Portuguese

Purpose This study was performed to investigate the convergent validity, discriminative validity, and reliability of the Brazilian version of the low anterior resection syndrome (LARS) score in a population with low educational and socioeconomic levels. Methods The LARS score was translated into the Portuguese language by forward- and back-translation procedures. In total, 127 patients from a public hospital in Brazil completed the questionnaires. The convergent validity was tested by comparing the LARS score with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core Module 30 (QLQ-C30) and with patients’ self-reported quality of life. For the discriminative validity, we tested the ability of the score to differentiate among subgroups of patients regarding neoadjuvant radiotherapy, type of surgery, and tumor distance from the anal verge. The test-retest reliability was investigated in a subgroup of 36 patients who responded to the survey twice in 2 weeks. Results The LARS score demonstrated a strong correlation with 5 of 6 items from the EORTC QLQ-C30 (P<0.05) and good concordance with patients’ self-reported quality of life (95.3%), confirming the convergent validity. The score was able to discriminate between subgroups of patients with different clinical characteristics related to LARS (P<0.001). The agreement between the test and retest showed that 86.1% of the patients remained in the same LARS category, and there was no significant difference between the LARS score numerical values (P=0.80), indicating good reliability overall. Conclusion The Brazilian version of the LARS score is a valid and reliable instrument to assess postoperative bowel function in a population with low educational and socioeconomic levels

Computer work and musculoskeletal disorders of the neck and upper extremity: A systematic review

<p>Abstract</p> <p>Background</p> <p>This review examines the evidence for an association between computer work and neck and upper extremity disorders (except carpal tunnel syndrome).</p> <p>Methods</p> <p>A systematic critical review of studies of computer work and musculoskeletal disorders verified by a physical examination was performed.</p> <p>Results</p> <p>A total of 22 studies (26 articles) fulfilled the inclusion criteria. Results show limited evidence for a causal relationship between computer work per se, computer mouse and keyboard time related to a diagnosis of wrist tendonitis, and for an association between computer mouse time and forearm disorders. Limited evidence was also found for a causal relationship between computer work per se and computer mouse time related to tension neck syndrome, but the evidence for keyboard time was insufficient. Insufficient evidence was found for an association between other musculoskeletal diagnoses of the neck and upper extremities, including shoulder tendonitis and epicondylitis, and any aspect of computer work.</p> <p>Conclusions</p> <p>There is limited epidemiological evidence for an association between aspects of computer work and some of the clinical diagnoses studied. None of the evidence was considered as moderate or strong and there is a need for more and better documentation.</p

Validation of Portuguese version of the low anterior resection syndrome score

Objective: The authors aim to perform a thorough translation with cultural adaptation of the patient reported outcome tool, Low Anterior Resection Syndrome (LARS) Score, to the Portuguese language (LARS-PT) in the Portuguese population with rectal cancer, after proctectomy with anastomosis. Methods: According to the current international recommendations, we designed this study encompassing three main phases: (i) cultural and linguistic validation to European Portuguese; (ii) feasibility and reliability tests of the version obtained in the previous phase; and (iii) validity tests to produce a final version. The questionnaire was completed by 154 patients from six Portuguese Colorectal Cancer Units, and 58 completed it twice. Results: Portuguese version of LARS score showed high construct validity. Regarding the test-retest, the global Intraclass Correlation showed very strong test-retest reliability. Looking at all five items, only items 3 and 5 present a moderate correlation. LARS score was able to discriminate symptoms showing worse quality of life, in patients submitted to preoperative radio and chemotherapy. Conclusions: LARS questionnaire has been properly translated into European Portuguese, demonstrating high construct validity and reliability. This is a precise, reproducible, simple, clear and user-friendly tool for evaluating bowel function in rectal cancer patients after sphincter saving operation. Resumo: Objetivo: Os autores pretendem fazer uma tradução minuciosa e culturalmente adaptada para a língua portuguesa do escore da Síndrome de Ressecção Anterior Baixa (Low Anterior Resection Syndrome [LARS]), um instrumento de desfecho relatado pelo paciente, na população portuguesa com câncer retal após proctectomia com anastomose. Métodos: De acordo com as recomendações internacionais atuais, o estudo foi projetado abrangendo três fases principais: (i) validação cultural e linguística para o português europeu; (ii) testes de viabilidade e confiabilidade da versão obtida na fase anterior; e (iii) testes de validade para produzir a versão final. O questionário foi preenchido por 154 pacientes de seis unidades portuguesas de câncer colorretal e 58 pacientes completaram duas vezes. Resultados: A versão em português do escore LARS mostrou alta validade de construto. A correlação intra-classe global apresentou confiabilidade muito forte no teste-reteste. Considerando-se todos os cinco itens, apenas os itens 3 e 5 apresentam uma correlação moderada. O escore LARS foi capaz de discriminar sintomas com pior qualidade de vida em pacientes submetidos a radio- e quimioterapia pré-operatória. Conclusões: O questionário LARS foi traduzido corretamente para o português europeu, demonstrando alta validade de construto e confiabilidade. Trata-se de uma ferramenta precisa, reproduzível, simples, clara e fácil de usar para avaliar a função intestinal em pacientes com câncer retal após operações poupando o esfíncter. Keywords: Rectal neoplasms, Bowel dysfunction, Low anterior resection syndrome score, Quality of life, Validation, Palavras-chave: Neoplasias retais, Disfunção intestinal, Escore da síndrome da ressecção anterior baixa, Qualidade de vida, Validaçã

Validação da versão em português do escore da síndrome da ressecção anterior baixa

Objective: The authorsaimtoperformathoroughtranslationwithculturaladaptationof the patientreportedoutcometool,LowAnteriorResectionSyndrome(LARS)Score,tothe Portugueselanguage(LARS-PT)inthePortuguesepopulationwithrectalcancer,afterproc- tectomywithanastomosis. Methods: Accordingtothecurrentinternationalrecommendations,wedesignedthisstudy encompassing threemainphases:(i)culturalandlinguisticvalidationtoEuropeanPor- tuguese; (ii)feasibilityandreliabilitytestsoftheversionobtainedinthepreviousphase; and (iii)validityteststoproduceafinalversion.Thequestionnairewascompletedby154 patients fromsixPortugueseColorectalCancerUnits,and58completedittwice. Results: PortugueseversionofLARSscoreshowedhighconstructvalidity.Regardingthetest- retest,theglobalIntraclassCorrelationshowedverystrongtest-retestreliability.Lookingat all fiveitems,onlyitems3and5presentamoderatecorrelation.LARSscorewasableto discriminate symptomsshowingworsequalityoflife,inpatientssubmittedtopreoperative radioandchemotherapy. Conclusions: LARS questionnairehasbeenproperlytranslatedintoEuropeanPortuguese, demonstratinghighconstructvalidityandreliability.Thisisaprecise,reproducible,simple, clear anduser-friendlytoolforevaluatingbowelfunctioninrectalcancerpatientsafter sphincter savingoperation.Objetivo: Os autorespretendemfazerumatraduc¸ãominuciosaeculturalmenteadaptada paraalínguaportuguesadoescoredaSíndromedeRessecc¸ãoAnteriorBaixa(Low Ante- rior ResectionSyndrome [LARS]), uminstrumentodedesfechorelatadopelopaciente,na populac¸ãoportuguesacomcâncerretalapósproctectomiacomanastomose. Métodos: De acordocomasrecomendac¸õesinternacionaisatuais,oestudofoiproje- tado abrangendotrêsfasesprincipais:(i)validac¸ãoculturalelinguísticaparaoportuguês europeu;(ii)testesdeviabilidadeeconfiabilidadedaversãoobtidanafaseanterior;e(iii) testes devalidadeparaproduziraversãofinal.Oquestionáriofoipreenchidopor154 pacientes deseisunidadesportuguesasdecâncercolorretale58pacientescompletaram duas vezes. Resultados: A versãoemportuguêsdoescoreLARSmostroualtavalidadedeconstruto. A correlac¸ãointra-classeglobalapresentouconfiabilidademuitofortenoteste-reteste. Considerando-setodososcincoitens,apenasositens 3 e 5 apresentam umacorrelac¸ão moderada.OescoreLARSfoicapazdediscriminarsintomascompiorqualidadedevidaem pacientes submetidosaradio-equimioterapiapré-operatória. Conclusões: O questionárioLARSfoitraduzidocorretamenteparaoportuguêseuropeu, demonstrandoaltavalidadedeconstrutoeconfiabilidade.Trata-sedeumaferramentapre- cisa, reproduzível,simples,claraefácildeusarparaavaliarafunc¸ãointestinalempacientes com câncerretalapósoperac¸õespoupandooesfíncter

Riktig håndtering av pasienter med gjennomgått TIA i allmennpraksis- Forbedret etterlevelse av gjeldende kunnskapsgrunnlag for god håndtering og risikovurdering ved gjennomgått transitorisk iskemisk anfall (TIA)

Tema/problemstilling: Sykdomstilstanden transitorisk iskemisk anfall (TIA) er betegnet som en forbigående episode med sentralnevrologiske utfall. TIA er forbundet med en økt risiko for hjerneslag de første en til to ukene etter anfallet. Derfor haster det med utredning og behandling. TIA- pasientene håndteres på en usystematisk måte i primærhelsetjenesten i dag, også ved vårt mikrosystem, som er et legesenter i Lørenskog. Vi ønsker å iverksette tiltak for å gi pasienter med gjennomgått TIA en evidensbasert håndtering i allmennpraksis. Kunnskapsgrunnlag: Vi baserte oss hovedsaklig på den nasjonale faglige retningslinjen for behandling og rehabilitering av hjerneslag. I tillegg søkte vi oppdatert kunnskap om prehospital behandling av pasienter med gjennomgått TIA og benyttet et oppdatert kunnskapsgrunnlag for risikovurderingsverktøyet ABCD2 , ved hjelp av PICO-spørsmål i søkemotoren McMaster Plus. Vi fant en oppdatert artikkel om prehospital evaluering av TIA-pasienter i UpToDate og fire systematiske oversiktsartikler om validiteten til ABCD2. Tiltak/kvalitetsindikator: Vårt hovedtiltak er å innføre en algoritme for den beste håndtering av pasienter med gjennomgått TIA i allmennpraksis, basert på den nasjonale retningslinjen og UpToDate. I tillegg foreslår vi støttetiltak for å implementere algoritmen, slik som opplæring av helsesekretærer og leger, samt pasienter og pårørende. Hensikten er å sikre at alle pasienter med gjennomgått TIA får en evidensbasert vurdering og behandling. Som mål på effekten av tiltaket valgte vi følgende prosessindikator: Alle pasienter med TIA, funnet ved søk etter diagnosekode i journalsystemet, skal ha blitt vurdert i henhold til vår algoritme. Ledelse/organisering: Kvalitetsforbedringsarbeidet skal ledes av en gruppe bestående av både leger og helsesekretærer. Innføringen av algoritmen og støttetiltakene kan skje over fire uker, dernest skal prosjekte evalueres og korrigeres halvårlig. Prosjektets mål om at alle pasienter med diagnosen TIA skal ha blitt vurdert i henhold til vår algoritme skal evalueres etter to år. Konklusjon: TIA er en diagnose med betydelig økt risiko for hjerneslag, derfor er det viktig at disse pasientene får god og rask utredning og behandling. Kunnskapsgrunnlaget for akkurat hvordan dette bør foregå er ikke spesielt sterkt, men inntil nye studier foreligger velger vi å følge nasjonale retningslinjer og UpToDate sine anbefalinger. Tiltaket vårt er lite kostbart og relativt enkelt å gjennomføre i praksis og vi mener det bør gjennomføres i vårt mikrosystem