Endoscopic treatment of patients with early forms of gastric cancer

Leningrad regional oncological dispensary, Russia, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaBackground: Currently, most patients with gastric tumors are detected in late stages. Early diagnosis is a major factor in improving treatment outcomes. On the other hand, patients who are diagnosed on early stages often receive aggressive treatment and are not subjects to less invasive interventions. Material and Methods: In our clinic we have been using endoscopic surgery for early gastric cancer since 2009. Japanese colleagues are the most experienced in this kind of treatment that is why we follow the recommendations of Japanese Gastric Cancer Association (JGCA). The main criterion provided that endoscopic removal is possible is the depth of tumor invasion. We evaluate the depth of invasion primarily by endoscopic ultrasonography. According to our data the accuracy of this method is 94%. The main operation used for the treatment of early gastric cancer is endoscopic submucosal dissection (ESD). Its main advantages are single block resection within healthy tissues and adequate morphological assessment of the removed tumor. In the last ten years we have performed 148 ESD (145 patients) for early forms of gastric cancer. Surgeries were radical in 95% of cases. Results:There were no cases of postoperative mortality. Progression of the disease was noted only in one patient. These endoscopic surgeries have proved to be effective, safe and reasonable in treating early gastric cancer. Conclusions: Thus, endoscopic surgery significantly reduces the cost of treatment and hospital stay (average - 3.7 days), facilitates rehabilitation and improves the quality of patients’ life

The effectiveness of strategies to change organisational culture to improve healthcare performance: a systematic review

<p>Abstract</p> <p>Background</p> <p>Organisational culture is an anthropological metaphor used to inform research and consultancy and to explain organisational environments. In recent years, increasing emphasis has been placed on the need to change organisational culture in order to improve healthcare performance. However, the precise function of organisational culture in healthcare policy often remains underspecified and the desirability and feasibility of strategies to be adopted have been called into question. The objective of this review was to determine the effectiveness of strategies to change organisational culture in order to improve healthcare performance.</p> <p>Methods</p> <p>We searched the following electronic databases: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Sociological Abstracts, Web of Knowledge, PsycINFO, Business and Management, EThOS, Index to Theses, Intute, HMIC, SIGLE, and Scopus until October 2009. The Database of Abstracts of Reviews of Effectiveness (DARE) was searched for related reviews. We also searched the reference lists of all papers and relevant reviews identified, and we contacted experts in the field for advice on further potential studies. We considered randomised controlled trials (RCTs) or well designed quasi-experimental studies (controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series (ITS) analyses). Studies could be set in any type of healthcare organisation in which strategies to change organisational culture in order to improve healthcare performance were applied. Our main outcomes were objective measures of professional performance and patient outcome.</p> <p>Results</p> <p>The search strategy yielded 4,239 records. After the full text assessment, two CBA studies were included in the review. They both assessed the impact of interventions aimed at changing organisational culture, but one evaluated the impact on work-related and personal outcomes while the other measured clinical outcomes. Both were at high risk of bias. Both reported positive results.</p> <p>Conclusions</p> <p>Current available evidence does not identify any effective, generalisable strategies to change organisational culture. Healthcare organisations considering implementing interventions aimed at changing culture should seriously consider conducting an evaluation (using a robust design, <it>e.g.</it>, ITS) to strengthen the evidence about this topic.</p

Workplace Spirituality Facilitation: A Comprehensive Model

workplace spirituality, spirituality, workplace spirituality facilitation, model,