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  1. Article ; Online: Late and Long-term Symptom Management in Colorectal Cancer Survivorship.

    Shaw, Robert D / Ivatury, Srinivas J

    Diseases of the colon and rectum

    2021  Volume 64, Issue 12, Page(s) 1447–1450

    Abstract: Case summary: A 59-year-old previously healthy, asymptomatic man initially presented for his first screening colonoscopy. At this time, a friable, partially obstructing tumor was encountered in his proximal rectum. Final workup demonstrated a mrT2N1M0 ... ...

    Abstract Case summary: A 59-year-old previously healthy, asymptomatic man initially presented for his first screening colonoscopy. At this time, a friable, partially obstructing tumor was encountered in his proximal rectum. Final workup demonstrated a mrT2N1M0 upper rectal cancer. The patient went on to successfully complete total neoadjuvant chemoradiation therapy and was taken to the operating room for an uncomplicated robotic-assisted low anterior resection with primary anastomosis. His final pathology revealed an ypT2N1M0 rectal cancer, and he was subsequently followed in surveillance per National Comprehensive Cancer Network guidelines. At long-term follow-up visits he continued to report significant depressive symptoms and functional impairment. Despite aggressive medical management with fiber supplementation and antidiarrheal medications, the patient continued to struggle with bowel movement frequency and urgency. He reported having 4 to 6 clustered bowel movements during the day and 1 to 2 stools at night that significantly limited his ability to perform normal day-to-day activities.
    MeSH term(s) Aftercare ; Anastomosis, Surgical ; Cancer Survivors/psychology ; Colonoscopy/standards ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy/methods ; Neoplasm Staging ; Proctectomy/adverse effects ; Proctectomy/methods ; Quality of Life/psychology ; Rectal Neoplasms/drug therapy ; Rectal Neoplasms/pathology ; Rectal Neoplasms/radiotherapy ; Rectal Neoplasms/surgery ; Robotic Surgical Procedures/instrumentation
    Language English
    Publishing date 2021-09-27
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000002262
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  2. Article ; Online: Minimally Invasive Surgery Approach is Not Associated With Differences in Long-Term Bowel Function Patient-Reported Outcomes After Elective Sigmoid Colectomy.

    Shaw, Robert D / Eid, Mark A / Ramkumar, Niveditta / Ivatury, Srinivas J

    The Journal of surgical research

    2022  Volume 274, Page(s) 85–93

    Abstract: Background: Postoperative bowel function is a common concern for patients undergoing a sigmoidectomy. We have previously demonstrated that patients with symptomatic bowel function preoperatively have substantial improvement at long-term follow-up. ... ...

    Abstract Background: Postoperative bowel function is a common concern for patients undergoing a sigmoidectomy. We have previously demonstrated that patients with symptomatic bowel function preoperatively have substantial improvement at long-term follow-up. However, the effect of the operative approach on patient-reported bowel function is largely unknown. We aimed to evaluate the differences in long-term patient-reported bowel function after robotic or laparoscopic sigmoid colectomies for benign and malignant disease.
    Materials and methods: A retrospective analysis of a prospectively collected institutional database from July 2015 to July 2020. Patients included underwent a sigmoid colectomy for benign or malignant disease and completed the Colorectal Functional Outcome (COREFO) questionnaire at preoperative presentation, postoperatively, and long-term follow-up. Differences between preoperative and postoperative scores, as well as differences between the robotic and laparoscopic cohorts, were compared using paired t-tests.
    Results: A total of 169 patients met inclusion criteria with a median age of 61 y, and 55% of the patients underwent robotic sigmoid colectomy, with the most common diagnosis being diverticular disease (62%). There was no significant difference between the presentation, short-term, or long-term follow-up total COREFO scores or subdomains based on the surgical technique. Patients that present asymptomatic remain asymptomatic, while those that are symptomatic demonstrate improvements for both the robotic and laparoscopic groups.
    Conclusions: Patient-reported long-term global bowel function does not appear to differ between patients who underwent elective robotic or laparoscopic sigmoid colectomy for benign or malignant disease. Patients that present asymptomatic remain asymptomatic, while those that are symptomatic demonstrate improvements, regardless of surgical technique.
    MeSH term(s) Colectomy/methods ; Colon, Sigmoid/surgery ; Humans ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Patient Reported Outcome Measures ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Retrospective Studies ; Robotic Surgical Procedures/adverse effects ; Robotic Surgical Procedures/methods ; Treatment Outcome
    Language English
    Publishing date 2022-02-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2021.12.044
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  3. Article ; Online: Long-term bowel function patient-reported outcomes after successful chemoradiation for carcinoma of the anal canal.

    Shaw, Robert D / Eid, Mark A / Milanese, Eric D / Ivatury, Srinivas J

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2021  Volume 23, Issue 6, Page(s) 1480–1486

    Abstract: Aim: We aimed to evaluate long-term changes in patient-reported bowel function from presentation of anal canal squamous cell carcinoma (SCC) successfully treated with the modified Nigro protocol using a patient-reported outcome measure for bowel ... ...

    Abstract Aim: We aimed to evaluate long-term changes in patient-reported bowel function from presentation of anal canal squamous cell carcinoma (SCC) successfully treated with the modified Nigro protocol using a patient-reported outcome measure for bowel function.
    Method: This is a retrospective study of prospectively collected patient-reported outcomes for bowel function. We included patients that were successfully treated with the modified Nigro protocol for anal SCC and had completed the Colorectal Functional Outcomes (COREFO) questionnaire at presentation, following the modified Nigro treatment (post-Nigro), and at subsequent surveillance visits (medium and long term). We compared the differences in mean domain and total COREFO scores using a paired t test for each paired time point.
    Results: Twenty-seven patients met inclusion criteria. Time from completion of the modified Nigro was post-Nigro at 3-6 months, medium-length follow-up at 8-12 months and long-term follow-up at 12-18 months. There was significant improvement in the stool-related aspects domain (pain, bleeding and anal skin irritation) from presentation to our short- and medium-length follow-up (42.5 to 23.7, P = 0.01). There was worsening in the frequency domain in the medium term (7.23 to 14.5, P = 0.02). There were no differences in any other domain or time point.
    Conclusion: Global bowel function does not appear to change following successful treatment of anal canal SCC with the modified Nigro protocol in the long term. There are some improvements in stool-related aspects and worsening in bowel movement frequency at medium-length follow-up. These findings should help surgeons counsel patients with regard to bowel function expectations for those with anal canal SCC in the long term.
    MeSH term(s) Anal Canal ; Anus Neoplasms/therapy ; Carcinoma, Squamous Cell/therapy ; Humans ; Patient Reported Outcome Measures ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2021-03-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15590
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    Zs.A 5799: Show issues Location:
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  4. Article ; Online: Mental health diagnosis, not patient-reported outcomes, is predictive of failing to meet the expected outcomes after successful implementation of an Enhanced Recovery After Surgery Protocol after elective colon resection.

    Shaw, Robert D / Read, Jackson T / Eid, Mark A / Wilson, Matthew Z / Ivatury, Srinivas J

    Surgery

    2022  Volume 172, Issue 3, Page(s) 878–884

    Abstract: Background: Enhanced Recovery After Surgery protocols have demonstrated decreased complication rates and length of stay. However, the influence of mental health on Enhanced Recovery After Surgery success is unknown.: Method: A retrospective study of ... ...

    Abstract Background: Enhanced Recovery After Surgery protocols have demonstrated decreased complication rates and length of stay. However, the influence of mental health on Enhanced Recovery After Surgery success is unknown.
    Method: A retrospective study of patient-reported outcomes for physical and mental health. We included patients who underwent elective minimally invasive colon resections, who completed the Patient-Reported Outcomes Measurement Information System 10 questionnaire preoperatively, and who had successful implementation of perioperative Enhanced Recovery After Surgery components. We evaluated the predictors of having successful expected Enhanced Recovery After Surgery outcomes using a multiple logistic regression, controlling for baseline patient characteristics, history of a mental health diagnosis, inpatient opiate use, and preoperative Patient-Reported Outcomes Measurement Information System 10 scores.
    Results: In total, 163 patients met inclusion criteria, with 23% failing Enhanced Recovery After Surgery, and 32% having a preoperative mental health diagnosis. The most common reason for failure of expected Enhanced Recovery After Surgery outcomes was length of stay (55.3%) followed by postoperative ileus (31.6%). Age, sex, the American Society of Anesthesiologists physical status classification, and preoperative Patient-Reported Outcomes Measurement Information System 10 scores were not significantly different between those who failed or succeeded, whereas length of stay was typically longer for those who failed Enhanced Recovery After Surgery (5.7 days failure vs 2.2 days success, P < .001). Patients with a previous mental health diagnosis, where depression and anxiety were most common, had significantly lower odds of successfully meeting expected Enhanced Recovery After Surgery outcomes (odds ratio of 0.23, 95% confidence interval: 0.09-0.55, P = .001).
    Conclusion: Patients with a mental health diagnosis have a lower likelihood of successfully meeting expected Enhanced Recovery After Surgery outcomes. The majority of these patients self-report normal mental and physical health preoperatively, indicating that even well-controlled mental health diagnoses have a negative impact on Enhanced Recovery After Surgery success.
    MeSH term(s) Colon ; Enhanced Recovery After Surgery ; Humans ; Length of Stay ; Mental Health ; Patient Reported Outcome Measures ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Retrospective Studies
    Language English
    Publishing date 2022-05-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2022.03.040
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    Uk I Zs.129: Show issues Location:
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  5. Article ; Online: Physicians perceive that ostomates have decreased quality of life but not overall health: An international survey of physicians.

    Eid, Mark A / Goldwag, Jenaya L / Gray, Philip P / Shaw, Robert D / Ivatury, Srinivas J

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2022  

    Abstract: Aim: The aim of this work was to evaluate physicians' perceptions of ostomates' quality of life (QoL) and comfort of care among an international sample of physicians caring for ostomates.: Method: This was a cross-sectional survey study. We conducted ...

    Abstract Aim: The aim of this work was to evaluate physicians' perceptions of ostomates' quality of life (QoL) and comfort of care among an international sample of physicians caring for ostomates.
    Method: This was a cross-sectional survey study. We conducted a survey of primary care physicians (PCP), gastroenterologists (GI), and general surgeons (GS) from three continents using the SERMO online physician platform. We piloted the survey for content, clarity and domain development using a pilot sample of physicians from each speciality before use. We summarized responses to questions related to physician comfort of ostomate care with descriptive statistics. We conducted multiple logistic regression with the primary outcome of physician perception of ostomate QoL.
    Results: A total of 617 physicians (PCP 264, GI 176, GS 177) completed the survey representing North America, Europe and Australia similarly. The average age was 46 years and 21% were women. Ninety per cent of physicians care for an ostomate at least once per month. Eighty eight per cent had access to enterostomal nurses. Eighty two per cent of physicians believed that ostomates have decreased QoL. Forty seven per cent believed that ostomates have decreased overall health. Almost half of respondents answered incorrectly to a 'bogus question' citing fake clinical evidence supporting a negative impact of ostomies on social relationships. Increased physician comfort in ostomy care (OR 1.30, p = 0.04) and US-based physicians (OR 1.75, p = 0.01) were associated with increased odds of answering that ostomates have no decreased QoL.
    Conclusion: Among a diverse international sample, most physicians believe that ostomates have decreased QoL but not overall health. Physician implicit bias, physician comfort and geographical variability account for these findings. Targeted efforts to increase physician comfort in ostomate care and establish universal best practices is needed.
    Language English
    Publishing date 2022-07-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16289
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    Zs.A 5799: Show issues Location:
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  6. Article ; Online: Implementation of a Standardized Sub-Intern Curriculum Improves Confidence for those Entering a Surgical Residency.

    Shaw, Robert D / Lamb, Casey R / Carroll, Matthew C / Wong, Sandra L / Rosenkranz, Kari M

    Journal of surgical education

    2022  Volume 79, Issue 6, Page(s) 1402–1412

    Abstract: Objective: Medical students often feel underprepared entering surgical residency. We have previously reported the results of a sub-intern needs assessment (SINA) which informed the creation of a standardized sub-internship curriculum. We aimed to ... ...

    Abstract Objective: Medical students often feel underprepared entering surgical residency. We have previously reported the results of a sub-intern needs assessment (SINA) which informed the creation of a standardized sub-internship curriculum. We aimed to determine if implementation of this curriculum into students' scheduled rotations would improve student confidence in their abilities related to the AAMC Core Entrustable Professional Activities for Entering Residency (CEPAERs).
    Design: We surveyed 4th year medical students during their surgery sub-internship. Sub-interns participated in a weekly series of 2-hour didactic sessions. We utilized interactive lectures and case scenarios addressing the pertinent topics identified in our previous needs assessment. The surveys were administered before and after the rotation and linked using unique identifiers. The surveys assessed confidence in each of the CEPAERs as well as the top 25 topics prioritized by our needs assessment. Self-reported confidence in each of the topics was measured using Likert scales (CEPAER scale 1-5, SINA scale 1-6). Pre- and post-curriculum confidence on a variety of topics were compared using paired t-tests.
    Setting: Geisel School of Medicine at Dartmouth/Dartmouth-Hitchcock Medical Center, a tertiary-care academic medical center.
    Participants: Fourth year medical students participating in their general surgery sub-internship.
    Results: Twelve medical students participated in general and thoracic surgery sub-internships over the course of the study period. Ten (83%) participated in the didactic curriculum and they all completed both the pre- and postsurvey. 100% of the respondents agreed that the curriculum provided a useful supplement to their clinical experience. With respect to the CEPAERs, students reported improved confidence in 77% of the areas, with statistically significant increases occurring in the following areas: ability to prioritize a differential diagnosis (average Likert rating improved from 3.7 to 4.1, p = 0.04), comfort entering and discussing orders (2.9-3.8, p = 0.007), and overall preparedness to be a surgical intern (3.2-3.8, p = 0.02). Students also reported improvement in confidence in 92% of the basic intern responsibility topics, with statistically significant increases in maintenance fluid calculations (Likert rating 3.5-4.5, p = 0.001), repleting electrolytes (3.8-4.6, p = 0.01), interpretation of chest and abdominal x-rays (4-5, p = 0.02; 3.6-4.5, p=0.004, respectively), management of oliguria (3.2-3.8, p = 0.02), and time management/organization skills (4.5-5.4, p = 0.04).
    Conclusions: Implementation of a standardized sub-intern curriculum improved student confidence in 33 of the 38 basic intern responsibilities, core Entrustable Professional Activities, and overall preparedness to be a surgical intern. While limited by a single institution design, we believe these results offer a new avenue for educating and preparing medical students for residency within their existing sub-internships.
    MeSH term(s) Humans ; Internship and Residency ; Clinical Competence ; Curriculum ; Students, Medical ; Academic Medical Centers
    Language English
    Publishing date 2022-07-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2277538-9
    ISSN 1878-7452 ; 1931-7204
    ISSN (online) 1878-7452
    ISSN 1931-7204
    DOI 10.1016/j.jsurg.2022.07.002
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  7. Article ; Online: A Targeted Needs Assessment for the Development of a Surgical Sub-internship Curriculum.

    Lamb, Casey R / Shaw, Robert D / Hilty, Bailey K / Wong, Sandra L / Rosenkranz, Kari M

    Journal of surgical education

    2021  Volume 78, Issue 6, Page(s) e121–e128

    Abstract: Objective: Medical students often feel inadequately prepared for the responsibilities of surgical internship because of insufficient exposure to resident responsibilities prior to starting residency. This lack of preparation may contribute to burnout ... ...

    Abstract Objective: Medical students often feel inadequately prepared for the responsibilities of surgical internship because of insufficient exposure to resident responsibilities prior to starting residency. This lack of preparation may contribute to burnout and attrition early in residency. Sub-internships should provide these experiences. Significant variation, however, exists in the structure of these rotations. We conducted a targeted needs assessment to inform the development of a didactic curriculum to address gaps in the surgical sub-internship experience and better prepare students for general surgery residency.
    Design: A 25-item needs assessment survey was developed and distributed to senior medical students in their surgical sub-internship, current junior residents, and prior students (alumni) from the past 4 years who matched into general surgery residencies at other institutions.
    Setting: Geisel School of Medicine at Dartmouth/Dartmouth-Hitchcock Medical Center, a tertiary-care academic medical center.
    Participants: Nine senior medical students; 12 current residents and 14 alumni, including 9 PGY-1, 13 PGY-2, and 4 PGY-3 residents.
    Results: The topics rated most important by medical students were floor management topics, specifically lines, tubes, and drains, hypotension, post-operative fever, chest pain, oliguria, and post-operative pain. In contrast, there was a wider variety of topics rated highly by residents. Residents emphasized non-technical communication and documentation skills. Residents at every training level rated presenting patients on rounds as the most important skill for incoming interns to acquire, whereas only one-third of medical students considered this to be an essential topic.
    Conclusions: Medical students rank management of common clinical problems as the most critical aspect in their preparation for residency. Residents recognized these topics as important, but also placed high emphasis on non-technical communication and documentation skills. The findings from this need's assessment can be used to guide content structure for a sub-intern curriculum.
    MeSH term(s) Clinical Competence ; Curriculum ; General Surgery/education ; Humans ; Internship and Residency ; Needs Assessment ; Students, Medical
    Language English
    Publishing date 2021-08-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2277538-9
    ISSN 1878-7452 ; 1931-7204
    ISSN (online) 1878-7452
    ISSN 1931-7204
    DOI 10.1016/j.jsurg.2021.06.017
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  8. Article ; Online: Reducing New Ileostomy Readmissions in a Rural Health Care Setting: A Quality Improvement Initiative.

    Eid, Mark A / Oliver, Brant J / Goldwag, Jenaya L / Gray, Philip J / Shaw, Robert D / Henkin, Jessica R / Wilson, Matthew Z / Ivatury, Srinivas Joga

    Diseases of the colon and rectum

    2022  Volume 65, Issue 7, Page(s) 928–935

    Abstract: Background: Readmission after ileostomy creation continues to be a major cause of morbidity with rates ranging from 15% to 30% due to dehydration and obstruction. Rural environments pose an added risk of readmission due to larger travel distances and ... ...

    Abstract Background: Readmission after ileostomy creation continues to be a major cause of morbidity with rates ranging from 15% to 30% due to dehydration and obstruction. Rural environments pose an added risk of readmission due to larger travel distances and lack of consistent home health services.
    Objective: This study aimed to reduce ileostomy-related readmission rates in a rural academic medical center.
    Design: This is a rapid cycle quality improvement study.
    Setting: This single-center study was conducted in a rural academic medical center.
    Patients: Colorectal surgery patients receiving a new ileostomy were included in this study.
    Interventions: Improvement initiatives were identified through Plan-Do-Study-Act cycles (enhanced team continuity, standardized rehydration, nursing/staff education).
    Main outcome measures: Thirty-day readmission, average length of stay, and average time to readmission served as main outcome measures.
    Results: Roughly equal rates of ileostomy were created in each time point, consistent with a tertiary care colorectal practice. The preimplementation readmission rate was 29%. Over the course of the entire quality improvement initiative, re-admission rates decreased by more than 50% (29% to 14%). PDSA cycle 1, which involved integrating a service-specific physician assistant to the team, allowed for greater continuity of care and had the most dramatic effect, decreasing rates by 27.5% (29% to 21%). Standardization of oral rehydration therapy and the implementation of a patient-directed intake/output sheet during PDSA cycle 2 resulted in further improvement in readmission rates (21% to 15%). Finally, implementation of nurse and physician assistant (PA)-driven patient education on fiber supplementation resulted in an additional yet nominal decrease in readmissions (15% to 14%). Latency to readmission also significantly increased throughout the study period.
    Limitations: This study was limited by its small sample size in a single-center study.
    Conclusion: Implementation of initiatives targeting enhanced team continuity, the standardization of rehydration therapies, and improved patient education decreased readmission rates in patients with new ileostomies. Rural centers, where outpatient resources are not as readily available or accessible, stand to benefit the most from these types of targeted interventions to decrease readmission rates. See Video Abstract at http://links.lww.com/DCR/B771.
    Reduccin en las readmisiones por ileostomas ne medios de atencin mdica rural iniciativa de mejora en la calidad: ANTECEDENTES:La readmisión después de la creación de una ileostomía sigue siendo una de las principales causas de morbilidad con tasas que oscilan entre el 15% y el 30% debido a la deshidratación y la oclusión. Un entorno rurale presenta un riesgo adicional de readmisión debido a las mayores distancias de viaje y la falta de servicios de salud domiciliarios adecuados.OBJETIVO:Reducir las tasas de reingreso por ileostomía en un centro médico académico rural.DISEÑO:Estudio de mejoría de la calidad de ciclo rápido.AJUSTE:Estudio unicéntrico en una unidad de servicio médico académico rural.PACIENTES:Pacientes de cirugía colorrectal a quienes se les confeccionó una ileostomía.INTERVENCIONES:Iniciativas de mejoría identificadas a través de los ciclos Planificar-Hacer-Estudiar-Actuar (Continuidad del equipo mejorada, rehidratación estandarizada, educación de enfermería / personal).PRINCIPALES MEDIDAS DE RESULTADO:30 días de readmisión, duración media de la estadía hospitalaria, tiempo medio de reingreso.RESULTADOS:Se crearon tasas aproximadamente iguales de ileostomías un momento dado de tiempo, subsecuentes en la práctica colorrectal de atención terciaria. La tasa de readmisión previa a la implementación del estudio fue del 29%. En el transcurso de toda la iniciativa de mejoría en la calidad, las tasas de readmisión disminuyeron en más del 50% (29% a 14%). El ciclo 1 de PDSA, que implicó la integración en el equipo de un asistente médico específico, lo que permitió una mayor continuidad en la atención y tuvo el mayor efecto disminuyendo las tasas en un 27,5% (29% a 21%). La estandarización de una terapia de rehidratación oral y la implementación de una hoja de ingresos / perdidas dirigida al paciente durante el ciclo 2 de PDSA resultó en una mejoría adicional en las tasas de readmisión (21% a 15%). Finalmente, la implementación de la educación del paciente impulsada por enfermeras y AF sobre el consumo suplementario de dietas con fibra dio como resultado una disminución adicional, aunque nominal, de las readmisiones (15% a 14%). La latencia hasta la readmisión también aumentó significativamente durante el período de estudio.LIMITACIONES:Estudio de un solo centro con un muestreo de pequeño tamaño.CONCLUSIONES:La implementación de iniciativas dirigidas a mejorar la continuidad en el equipo, la estandarización de las terapias de rehidratación y la mejoría en la información de los pacientes disminuyeron las tasas de readmisión en todos aquellas personas con nuevas ileostomías. Los centros rurales, donde los recursos para pacientes ambulatorios no están tan fácilmente disponibles o accesibles, son los que más beneficiaron de este tipo de intervenciones específicas para reducir las tasas de readmisión. Consulte Video Resumen en http://links.lww.com/DCR/B771. (Traducción-Dr. Xavier Delgadillo).
    MeSH term(s) Humans ; Ileostomy ; Patient Readmission ; Quality Improvement ; Retrospective Studies ; Rural Health
    Language English
    Publishing date 2022-10-29
    Publishing country United States
    Document type Journal Article ; Video-Audio Media
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000002142
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  9. Article ; Online: Deep sleep and beeps II: Sleep quality improvement project in general surgery patients.

    Allen, Robert W / Shaw, Robert D / Burney, Charles P / Newton, Laura E / Lee, Andrew Y / Judd, Brooke G / Ivatury, Srinivas Joga

    Surgery

    2022  Volume 172, Issue 6, Page(s) 1697–1703

    Abstract: Background: Poor sleep leads to poor health outcomes. Phase I of our sleep quality improvement project showed severe sleep disturbance in the ward setting. We implemented a novel PostOp Pack to improve sleep quality.: Methods: Patients underwent ... ...

    Abstract Background: Poor sleep leads to poor health outcomes. Phase I of our sleep quality improvement project showed severe sleep disturbance in the ward setting. We implemented a novel PostOp Pack to improve sleep quality.
    Methods: Patients underwent elective, general surgery procedures. Fitbit trackers measured total sleep time. Patients completed the inpatient Richards-Campbell Sleep Questionnaire, which combines 5 domains into a cumulative score (0-100). Patients completed the outpatient Pittsburgh Sleep Quality Index preoperatively and postoperatively. Patients received the PostOp Pack, which included physical items and a sleep-protective order set to reduce nighttime awakenings. Patients from phase I served as the historical control. The primary outcome was the percentage of patients with Richards-Campbell Sleep Questionnaire total sleep score ≥50. The secondary outcomes included the mean Richards-Campbell Sleep Questionnaire domain scores and Fitbit total sleep time.
    Results: A total of 49 patients were compared with 64 historical controls. The percentage of patients with a total sleep score ≥50 was significantly higher in patients receiving a PostOp Pack versus historical control (69% vs. 44%, difference 26%, 95% confidence interval 6.1-45%, P = .01). The mean Richards-Campbell Sleep Questionnaire Total Sleep Score was significantly higher in patients with a PostOp Pack (62 vs 49, mean difference 13, 95% confidence interval 6-21, P ≤ .01). The PostOp Pack Richards-Campbell Sleep Questionnaire domain scores were significantly higher in various areas: Sleep Latency (68 vs 49, P ≤ .01), Awakenings (56 vs 40, P = .01), Sleep Quality (61 vs 49, P = .02), and Noise Disturbance (70 vs 59, P = .04). Of all patients, 92% would use PostOp Pack again in a future hospitalization. No patients had a failure to rescue event with PostOp Pack. The mean total sleep time was significantly improved with PostOp Pack on night 1 (6.4 vs 4.7 hours, P = .03).
    Conclusion: The PostOp Pack improves inpatient sleep quality and is safe.
    MeSH term(s) Humans ; Sleep Quality ; Quality Improvement ; Sleep, Slow-Wave ; Intensive Care Units ; Sleep ; Surveys and Questionnaires
    Language English
    Publishing date 2022-10-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2022.09.013
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  10. Article ; Online: Update on colon cancer screening: recent advances and observations in colorectal cancer screening.

    Anderson, Joseph C / Shaw, Robert D

    Current gastroenterology reports

    2014  Volume 16, Issue 9, Page(s) 403

    Abstract: There have been many recent advances and observations regarding colorectal cancer (CRC) screening. New CRC surveillance guidelines have been published to help endoscopists with the management of important clinical issues such as serrated polyps. There ... ...

    Abstract There have been many recent advances and observations regarding colorectal cancer (CRC) screening. New CRC surveillance guidelines have been published to help endoscopists with the management of important clinical issues such as serrated polyps. There have been several important large studies examining the impact of endoscopic process measures such as bowel prep, withdrawal time, and adenoma detection rate on CRC screening. In addition, there have been technical advances in CT colonography including the development of exams that do not require a bowel preparation. Other new technology such as colon capsule endoscopy may aid endoscopists in the challenge of completing the evaluation of the colon in those patients with an incomplete colonoscopy. Finally, there have been large studies which examine the performance characteristics of the so-called non-invasive CRC screening tests such as fecal immunochemical test (FIT) and fecal DNA.
    MeSH term(s) Adenoma/diagnosis ; Capsule Endoscopy ; Carcinoma/diagnosis ; Colonography, Computed Tomographic ; Colonoscopy ; Colorectal Neoplasms/diagnosis ; Early Detection of Cancer/methods ; Humans
    Language English
    Publishing date 2014-08-07
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2041376-2
    ISSN 1534-312X ; 1522-8037
    ISSN (online) 1534-312X
    ISSN 1522-8037
    DOI 10.1007/s11894-014-0403-3
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