Patients at the centre after a health care incident:A scoping review of hospital strategies targeting communication and nonmaterial restoration

OBJECTIVE: This study aimed to provide an overview of the strategies adopted by hospitals that target effective communication and nonmaterial restoration (i.e., without a financial or material focus) after health care incidents, and to formulate elements in hospital strategies that patients consider essential by analysing how patients have evaluated these strategies. BACKGROUND: In the aftermath of a health care incident, hospitals are tasked with responding to the patients' material and nonmaterial needs, mainly restoration and communication. Currently, an overview of these strategies is lacking. In particular, a gap exists concerning how patients evaluate these strategies. SEARCH STRATEGY AND INCLUSION CRITERIA: To identify studies in this scoping review, and following the methodological framework set out by Arksey and O'Malley, seven subject‐relevant electronic databases were used (PubMed, Medline, Embase, CINAHL, PsycARTICLES, PsycINFO and Psychology & Behavioral Sciences Collection). Reference lists of included studies were also checked for relevant studies. Studies were included if published in English, after 2000 and as peer‐reviewed articles. MAIN RESULTS AND SYNTHESIS: The search yielded 13,989 hits. The review has a final inclusion of 16 studies. The inclusion led to an analysis of five different hospital strategies: open disclosure processes, communication‐and‐resolution programmes, complaints procedures, patients‐as‐partners in learning from health care incidents and subsequent disclosure, and mediation. The analysis showed three main domains that patients considered essential: interpersonal communication, organisation around disclosure and support, and desired outcomes. PATIENT CONTRIBUTION: This scoping review specifically takes the patient perspective in its methodological design and analysis. Studies were included if they contained an evaluation by patients, and the included studies were analysed on the essential elements for patients

Three-year outcome after transanal versus laparoscopic total mesorectal excision in locally advanced rectal cancer : a multicenter comparative analysis

Altres ajuts: This work has been funded by the Resident Award "Emili Letang," granted by Hospital Clinic of Barcelona, Research, Innovation, and Education Departments (Grant number: 25_delacyoliverb_250709_cgicm_pfr2018). The funder of this study supported the data collection and database management.For patients with mid and distal rectal cancer, robust evidence on long-term outcome and causal treatment effects of transanal total mesorectal excision (TaTME) is lacking. This multicentre retrospective cohort study aimed to assess whether TaTME reduces locoregional recurrence rate compared to laparoscopic total mesorectal excision (LapTME). Consecutive patients with rectal cancer within 12 cm from the anal verge and clinical stage II-III were selected from three institutional databases. Outcome after TaTME (Nov 2011 - Feb 2018) was compared to a historical cohort of patients treated with LapTME (Jan 2000 - Feb 2018) using the inverse probability of treatment weights method. The primary endpoint was three-year locoregional recurrence. A total of 710 patients were analysed, 344 in the TaTME group and 366 in the LapTME group. At 3 years, cumulative locoregional recurrence rates were 3.6% (95% CI, 1.1-6.1) in the TaTME group and 9.6% (95% CI, 6.5-12.7) in the LapTME group (HR = 0.4; 95% CI, 0.23-0.69; p = 0.001). Three-year cumulative disease-free survival rates were 74.3% (95% CI, 68.8-79.8) and 68.6% (95% CI, 63.7-73.5) (HR = 0.82; 95% CI, 0.65-1.02; p = 0.078) and three-year overall survival 87.2% (95% CI, 82.7-91.7) and 82.2% (95% CI, 78.0-86.2) (HR = 0.74; 95% CI, 0.53-1.03; p = 0.077), respectively. In patients who underwent sphincter preservation procedures, TaTME was associated with a significantly better disease-free survival (HR = 0.78; 95% CI, 0.62-0.98; p = 0.033). These findings suggest that TaTME may improve locoregional recurrence and disease-free survival rates among patients with mid and distal locally advanced rectal cancer

Verkenning standaardisering van het programma ‘Fris Verder’:Een behandelprogramma voor ouderen met alcoholproblemen

Dit rapport bevat het verslag van een onderzoek naar Nederlandse behandelprogramma’s voor ouderen met alcoholproblematiek, gebaseerd op Cognitieve Gedrags-Therapie. Deze programma’s zijn gebaseerd op het programma Fris Verder, oorspronkelijk ontwikkeld door Victas (nu De Jellinek) en geadopteerd door Brijder, locatie Den Haag. De naam Fris Verder werd door de deelnemers zelf gekozen. In dit rapport wordt ‘Fris Verder’ als gemeenschappelijke naam gebezigd voor de onderzochte programma’s, ook al wordt deze naam niet in alle huidige bestaande programma’s gebruikt en zijn er in de loop der tijd verschillen tussen de programma’s ontstaan. Doel van het onderzoek was de mogelijkheden tot standaardisering te onderzoeken, zodat op basis hiervan een valideringstraject gestart zou kunnen worden. Hieraan ligt ten grondslag de wens van de werkgroep alcohol en ouderen binnen Verslavingskunde Nederland (VKN) om het behandelaanbod voor ouderen met alcoholproblematiek te vergroten gezien de groei van deze problematiek in onze samenleving. In dit onderzoek is gebruik gemaakt van literatuuronderzoek, documentanalyse en interviews met uitvoerders van bestaande programma’s. De resultaten van dit onderzoek zijn aansluitend getoetst in een bijeenkomst van de werkgroep alcohol en ouderen.ConclusieEr zijn voldoende overeenkomsten tussen de programma’s en deze bevatten ook de elementen die in de onderzoeksliteratuur als werkzaam worden beschouwd. Tevens bestaat er bij de uitvoerende instellingen voldoende draagvlak om een valideringstraject in te gaan, waarbij voor dat doel ook aanpassingen aan het eigen onderscheiden groepsaanbod kunnen worden gedaan (zoals een nazorgaanbod). Daarnaast wordt door de geïnterviewden en door de werkgroep alcohol en ouderen binnen VKN de wens geuit de mogelijkheden te onderzoeken tot haalbaarheid en financiering van een voortraject (‘voorzorggroep’) en tot uitbreiding van het aanbod voor ouderen met (beginnende) alcoholproblematiek in eerdere fasen van de zorgketen.<br/

Three-year outcome after transanal versus laparoscopic total mesorectal excision in locally advanced rectal cancer : a multicenter comparative analysis

Altres ajuts: This work has been funded by the Resident Award "Emili Letang," granted by Hospital Clinic of Barcelona, Research, Innovation, and Education Departments (Grant number: 25_delacyoliverb_250709_cgicm_pfr2018). The funder of this study supported the data collection and database management.For patients with mid and distal rectal cancer, robust evidence on long-term outcome and causal treatment effects of transanal total mesorectal excision (TaTME) is lacking. This multicentre retrospective cohort study aimed to assess whether TaTME reduces locoregional recurrence rate compared to laparoscopic total mesorectal excision (LapTME). Consecutive patients with rectal cancer within 12 cm from the anal verge and clinical stage II-III were selected from three institutional databases. Outcome after TaTME (Nov 2011 - Feb 2018) was compared to a historical cohort of patients treated with LapTME (Jan 2000 - Feb 2018) using the inverse probability of treatment weights method. The primary endpoint was three-year locoregional recurrence. A total of 710 patients were analysed, 344 in the TaTME group and 366 in the LapTME group. At 3 years, cumulative locoregional recurrence rates were 3.6% (95% CI, 1.1-6.1) in the TaTME group and 9.6% (95% CI, 6.5-12.7) in the LapTME group (HR = 0.4; 95% CI, 0.23-0.69; p = 0.001). Three-year cumulative disease-free survival rates were 74.3% (95% CI, 68.8-79.8) and 68.6% (95% CI, 63.7-73.5) (HR = 0.82; 95% CI, 0.65-1.02; p = 0.078) and three-year overall survival 87.2% (95% CI, 82.7-91.7) and 82.2% (95% CI, 78.0-86.2) (HR = 0.74; 95% CI, 0.53-1.03; p = 0.077), respectively. In patients who underwent sphincter preservation procedures, TaTME was associated with a significantly better disease-free survival (HR = 0.78; 95% CI, 0.62-0.98; p = 0.033). These findings suggest that TaTME may improve locoregional recurrence and disease-free survival rates among patients with mid and distal locally advanced rectal cancer

A computational study of liposome logic: towards cellular computing from the bottom up

In this paper we propose a new bottom-up approach to cellular computing, in which computational chemical processes are encapsulated within liposomes. This “liposome logic” approach (also called vesicle computing) makes use of supra-molecular chemistry constructs, e.g. protocells, chells, etc. as minimal cellular platforms to which logical functionality can be added. Modeling and simulations feature prominently in “top-down” synthetic biology, particularly in the specification, design and implementation of logic circuits through bacterial genome reengineering. The second contribution in this paper is the demonstration of a novel set of tools for the specification, modelling and analysis of “bottom-up” liposome logic. In particular, simulation and modelling techniques are used to analyse some example liposome logic designs, ranging from relatively simple NOT gates and NAND gates to SR-Latches, D Flip-Flops all the way to 3 bit ripple counters. The approach we propose consists of specifying, by means of P systems, gene regulatory network-like systems operating inside proto-membranes. This P systems specification can be automatically translated and executed through a multiscaled pipeline composed of dissipative particle dynamics (DPD) simulator and Gillespie’s stochastic simulation algorithm (SSA). Finally, model selection and analysis can be performed through a model checking phase. This is the first paper we are aware of that brings to bear formal specifications, DPD, SSA and model checking to the problem of modeling target computational functionality in protocells. Potential chemical routes for the laboratory implementation of these simulations are also discussed thus for the first time suggesting a potentially realistic physiochemical implementation for membrane computing from the bottom-up

Does oncological outcome differ between restorative and nonrestorative low anterior resection in patients with primary rectal cancer?

Aim: Nonrestorative low anterior resection (n-rLAR) (also known as low Hartmann’s) is performed for rectal cancer when a poor functional outcome is anticipated or there have been problems when constructing the anastomosis. Compared with restorative LAR (rLAR), little oncological outcome data are available for n-rLAR. The aim of this study was to compare oncological outcomes between rLAR and n-rLAR for primary rectal cancer. Method: This was a nationwide cross-sectional comparative study including all elective sphincter-saving LAR procedures for nonmetastatic primary rectal cancer performed in 2011 in 71 Dutch hospitals. Oncological outcomes of patients undergoing rLAR and n-rLAR were collected in 2015; the data were evaluated using Kaplan–Meier survival analysis and the results compared using log-rank testing. Uni- and multivariable Cox regression analysis was used to evaluate the association between the type of LAR and oncological outcome measures. Results: A total of 1197 patients were analysed, of whom 892 (75%) underwent rLAR and 305 (25%) underwent n-rLAR. The 3-year local recurrence (LR) rate was 3% after rLAR and 8% after n-rLAR (P < 0.001). The 3-year disease-free survival and overall survival rates were 77% (rLAR) vs 62% (n-rLAR) (P < 0.001) and 90% (rLAR) vs 75% (n-rLAR) (P < 0.001), respectively. In multivariable Cox analysis, n-rLAR was independently associated with a higher risk of LR (OR = 2.95) and worse overall survival (OR = 1.72). Conclusion: This nationwide study revealed that n-rLAR for rectal cancer was associated with poorer oncological outcome than r-LAR. This is probably a noncausal relationship, and might reflect technical difficulties during low pelvic dissection in a subset of those patients, with oncological implications