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2023 Canadian Surgery Forum: Sept. 20-23, 2023. Can J Surg 2023; 66:S54-S136. [PMID: 38173057 PMCID: PMC10718225 DOI: 10.1503/cjs.014223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
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Radiosurgical Thalamotomy for Essential Tremor: A Prospective Study with Blinded Assessment by a Movement Disorder Neurologist. Int J Radiat Oncol Biol Phys 2023; 117:e191-e192. [PMID: 37784829 DOI: 10.1016/j.ijrobp.2023.06.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To prospectively evaluate the effectiveness and safety of radiosurgical thalamotomy in patients with Essential Tremor (ET). MATERIALS/METHODS Patients underwent stereotactic radiation VIM thalamotomy by a dedicated Cobalt 60 intracranial radiosurgery platform in a fixed headframe. 130 Gy was prescribed to the 100% isodose point with single 4mm collimator. Effectiveness was evaluated using validated tremor rating scale: upper limb CRST Part B ratings (CRST) in comparison to baseline. To be eligible minimal CRST score of 2 in writing or drawing was required. Writing and drawing score assessments were conducted by a single movement disorder neurologist in a blinded fashion. Mean writing and drawing scores were statistically compared with paired t-test. RESULTS A total of 213 cases (203 patients) were enrolled in the study, 7 cases (and individual patients) withdrew prior to treatment. The total number of thalamotomies performed was 206. Ten patients had right and left thalamotomies on study. Eleven patients underwent a contralateral thalamotomy but their initial thalamotomy was not a case in this study. 30 patients withdrew or were lost to follow-up, 2 patients were withdrawn due to not meeting medication criteria after treatment, 12 patients were withdrawn not meeting CRST rating criteria. Two patients were lost to follow-up immediately following the procedure (one of whom was a patient who underwent right and left staged procedures - no follow-up was obtained after the second procedure). 177 cases completed 6-month follow-up; 169 cases completed 1 year follow-up; 113 cases completed 2-year follow-up. For 189 total evaluable cases pre-treatment, drawing score mean was 2.86 +/- 0.84, pre-treatment writing score mean was 2.96 +/- 0.86. WRITING At one year: 143 cases (writing side targeted) mean writing score 1.28 +/-1.11 P<.01. 77% of cases improved by 1 point or greater. At two years: 102 cases 1.48+/-1.11, P<.01. 78% of cases improved by 1 point or greater. DRAWING At one year: 169 cases mean drawing score 1.42 +/-0.97, P<.01. 71% of cases improved by 1 point or greater. At two years: 113 cases mean drawing score 1.49+/-0.98, P<.01. 71% of cases improved by 1 point or greater. Cumulative side effects at 6 months and 1 year were seen in 17 of 175 of patients. 12 mild, 3 moderate and 2 severe. Mild side effects included numbness of the fingers, lip or hand and mild dysarthria. Severe side effects were 1 thalamic hemorrhage resulting in contralateral weakness. 1 patient developed foot drop and slurring of speech. Cumulative 2-year side effects were 15 mild, 3 moderate and 3 severe (1 additional thalamic hemorrhage). CONCLUSION Stereotactic radiosurgical thalamotomy provided a significant reduction in tremor at 1 and 2 years. The treatment is an effective noninvasive treatment option worthy of consideration in many patients. The treatment has a low but non-zero risk of significant SEs.
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Fragilité osseuse due au traitement du cancer du sein : rôle essentiel des infirmières dans l’élaboration, la mise en œuvre et l’évaluation d’un programme pour la santé des os. Can Oncol Nurs J 2022. [DOI: 10.5737/23688076323408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Le traitement du cancer du sein modifie les taux d’œstrogène et entraîne une importante perte osseuse, de l’ostéoporose et des risques de fracture. Bien qu’il existe des lignes directrices sur les soins des os soient, les personnes à risque ne bénéficient pas systématiquement des interventions en ce sens. Le présent article fait état du processus de conception et de mise en œuvre d’un Programme Santé seins et os (PSSO) bilingue et dirigé par des infirmières, offert en personne et en ligne dans un centre de cancérologie de Montréal, dans la province de Québec (https://santeseinsetos.ca/). Le PSSO propose des interventions personnalisées pour préserver la santé des os : évaluation des risques, information sur la réadaptation, prescription d’exercices, conseils nutritionnels et accompagnement pour l’adoption d’un mode de vie sain. Pendant 2 ans, des femmes traitées pour un cancer du sein (N = 430) ont pris part au programme. De ce nombre, 40 % (n = 97) ont dit au départ ignorer que certains traitements anticancéreux pouvaient fragiliser considérablement les os. À la suite de la première séance d’information avec l’infirmière responsable du PSSO, leurs connaissances autoévaluées à ce sujet se sont grandement améliorées, et 96 % ont dit en savoir suffisamment pour gérer leur santé osseuse. Le PSSO a été créé à l’intention des professionnels de la santé et des femmes atteintes de cancer du sein. Il offre une évaluation du risque en ligne et en personne ainsi que des activités et des outils visant à promouvoir la bonne santé des os. Le présent article décrit le contexte ayant mené à l’élaboration et à la mise en œuvre du PSSO, de même que l’évaluation préliminaire du programme.
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Bone fragility related to breast cancer treatment: The pivotal role of nurses in bone health program development, implementation, and testing. Can Oncol Nurs J 2022. [DOI: 10.5737/23688076323401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast cancer treatment can affect estrogen levels leading to significant bone loss, osteoporosis, and risks for fracture. Although bone care guidelines are published, bone health interventions are often not routinely offered to at-risk individuals. This paper reports on the process of developing and implementing a nurse-led bilingual Breast and Bone Health Program (BBHP) in-person and online at a cancer centre in Montreal, Quebec (www.breastandbonehealth.ca, www.santeseinsetos.ca). The BBHP offers tailored bone health interventions (e.g., risk screening, information, rehabilitation, exercise prescriptions, nutritional counselling, and support for a health-promoting lifestyle). Over a two-year period, women treated for breast cancer (N = 430) took part in the program. Forty percent of surveyed participants (n = 97) initally reported being unaware that some breast cancer treatment could significantly affect bone health. Following the initial informational session with the BBHP nurse, self-reported bone health knowledge significantly increased, with 96% reporting sufficient information to manage their bone health. The BBHP offers both online and in-person risk assessment and bone health promotion activities and tools to both health care professionals and women with breast cancer. Herein, we review the background, BBHP development and implementation as well as preliminary program evaluation.
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Comparing Perspectives of Canadian Men Diagnosed With Prostate Cancer and Health Care Professionals About Active Surveillance. J Patient Exp 2020; 7:1122-1129. [PMID: 33457554 PMCID: PMC7786672 DOI: 10.1177/2374373520932735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Active surveillance (AS) has gained acceptance as a primary management approach for patients diagnosed with low-risk prostate cancer (PC). In this qualitative study, we compared perspectives between patients and health care professionals (HCP) to identify what may contribute to patient-provider discordance, influence patient decision-making, and interfere with the uptake of AS. We performed a systematic comparison of perspectives about AS reported from focus groups with men eligible for AS (7 groups, N = 52) and HCP (5 groups, N = 48) who engaged in conversations about AS with patient. We used conventional content analysis to scrutinize separately focus group transcripts and reached a consensus on similar or divergent viewpoints between them. Patients and clinicians agreed that AS was appropriate for low grade PC and understood the low-risk nature of the disease. They shared the perspective that disease status was a critical factor to pursue or discontinue AS. However, men expressed a greater emphasis on quality of life in their decisions related to AS. Patients and clinicians differed in their perspectives on the clarity, availability, and volume of information needed and offered; clinicians acknowledged variations between HCP when presenting AS, while patients were often compelled to seek additional information beyond what was provided by physicians and experienced difficulty in finding or interpreting information applicable to their situation. A greater understanding of discordant perspectives about AS between patients and HCP can help improve patient engagement and education, inform development of knowledge-based tools or aids for decision-making, and identify areas that require standardization across the clinical practice.
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Abstract
PURPOSE To offer a better understanding of the experiences, preferences, and needs of patients with thyroid cancer. PARTICIPANTS & SETTING 17 patients with thyroid cancer receiving treatment at a university-affiliated hospital in Montreal, Québec, Canada. METHODOLOGIC APPROACH Interviews were conducted with patients, and descriptive phenomenology was used to explore patients' lived experience. FINDINGS Coping with uncertainty was a major theme that emerged from interviews, with some of the main concerns being difficult treatment decisions, long surgery wait times, and fears about surgical complications, potential metastases, and death. Study participants reported that without a nurse and an interprofessional team, they would be lost in a system they believed minimized their illness and offered few resources to support them in a time of crisis. IMPLICATIONS FOR NURSING Nurses must understand how the needs of individuals with thyroid cancer are often overlooked because of the good prognosis associated with the disease and should work to meet these information and support needs.
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Perspectives of prostate cancer patients about active surveillance. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
82 Background: In prostate cancer (PC), men diagnosed with low risk disease may be monitored through an active surveillance (AS) approach that runs counter to the traditional message of undergoing treatment as soon as possible following a cancer diagnosis. This research explored the perspectives of men with PC regarding their decision-making process for AS to identify the factors that influenced their decision and assisted health care professionals in discussing AS as an option. Methods: Focus group interviews (n = 7) were held in several Canadian cities with men (n = 52) diagnosed with PC and eligible for AS. The men’s viewpoints were captured regarding their understanding of AS, the factors that influenced their decision to engage in AS, and their experience with the approach. A content and theme analysis was performed on the verbatim transcripts from the interviews. Results: All patients described the perception that their disease was not “large enough” to require treatment. They understood that the waiting process avoided the side effects associated with treatments, and they were comfortable about postponing treatment while undergoing close monitoring. Conversations with their doctor and how AS was described were cited as key influences in their decision. Other influences included availability of information on treatment options, distrust in the health system, personality, experiences and opinions of others, and personal perspectives on quality of life. Conclusions: AS is a relatively new approach for the care of men with low risk PC. Men require a thorough explanation on AS as a safe and valid option, as well as guidance towards supportive resources in their decision-making.
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Thyroid cancer patients receiving an interdisciplinary team-based care approach (ITCA-ThyCa) appear to display better outcomes: Program evaluation results indicating a need for further integrated care and support. Psychooncology 2018; 27:937-945. [PMID: 29178318 DOI: 10.1002/pon.4590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/18/2017] [Accepted: 11/14/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Thyroid cancer (ThyCa) is generally associated with a favorable prognosis and excellent surgical outcomes. Consequently, its treatment is medically focused and current guidelines recommend interdisciplinary care including access to a nurse for complex cases alone. To date, no studies have evaluated the need for and impact of an Interdisciplinary Team-based Care Approach (ITCA-ThyCa) for general thyroid cancer patients, including a dedicated nurse as part of a larger interdisciplinary team, as well as patient-reported outcomes, as is recommended worldwide in cancer care. Our aim was to evaluate such a program. METHODS The ITCA-ThyCa was evaluated within a quasi-experimental design using the Centers for Disease Control Framework for Program Evaluation, including process and outcome measures. Patients eligible were adults with a biopsy indicating confirmed or highly suspicious ThyCa (TNM-Classification + Bethesda score of V/VI). The intervention group (IG) received ITCA-ThyCa and the comparison group (CG), usual care alone. RESULTS In our sample comprised of 200 participants (122 IG; 78 CG), ITCA-ThyCa patients appeared to show significantly better outcomes than CG patients, namely, higher levels of overall well-being (P = .001) and fewer physical (P = .003) and practical (P = .003) issues and concerns. More satisfied with their overall care (P = .028), including care coordination (P = .049), they reported their health care provider as more approachable (P = .007), respectful (P = .005), and trustworthy (P = .077; trend) and were more likely to recommend their hospital (P = .02). Ninety-eight percent of IG patients recommended ITCA-ThyCa. CONCLUSION Data from our program illustrates that hospital resources should not be allocated based on medical trajectory alone and challenges the idea that ThyCa is "straightforward." ThyCa patients seem to experience symptom distress at a level comparable to-or exceeding-that of general oncological patients despite their promising medical outcomes, indicating that better integrated care and support are in order.
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Canadian Men's perspectives about active surveillance in prostate cancer: need for guidance and resources. BMC Urol 2017; 17:98. [PMID: 29078772 PMCID: PMC5658971 DOI: 10.1186/s12894-017-0290-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 10/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background In prostate cancer, men diagnosed with low risk disease may be monitored through an active surveillance. This research explored the perspectives of men with prostate cancer regarding their decision-making process for active surveillance to identify factors that influence their decision and assist health professionals in having conversations about this option. Methods Focus group interviews (n = 7) were held in several Canadian cities with men (N = 52) diagnosed with prostate cancer and eligible for active surveillance. The men’s viewpoints were captured regarding their understanding of active surveillance, the factors that influenced their decision, and their experience with the approach. A content and theme analysis was performed on the verbatim transcripts from the sessions. Results Patients described their concerns of living with their disease without intervention, but were reassured by the close monitoring under AS while avoiding harmful side effects associated with treatments. Conversations with their doctor and how AS was described were cited as key influences in their decision, in addition to availability of information on treatment options, distrust in the health system, personality, experiences and opinions of others, and personal perspectives on quality of life. Conclusions Men require a thorough explanation on AS as a safe and valid option, as well as guidance towards supportive resources in their decision-making.
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The Impact of Cobalt-60 Source Age on Biologically Effective Dose in Stereotactic Radiosurgery Thalamotomy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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SU-E-J-06: Necessity of 4D Cone-Beam CT Imaging in Patient Setup for Gated Stereotactic Body Radiation Therapy of Lung Cancer. Med Phys 2013. [DOI: 10.1118/1.4814218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Four levels of outcomes of information-seeking: A mixed methods study in primary health care. ACTA ACUST UNITED AC 2012. [DOI: 10.1002/asi.22793] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Determination of Optimal Operating Point in ROC Curve using Probabilistic Model of Radiation Therapy. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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A Dynamic Contrast Enhanced MRI Kinetic Parameter Indicating Lymph Node Extracapsular Extension. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Predictors of the duration of exclusive breastfeeding among first-time mothers. Res Nurs Health 2008; 31:428-41. [PMID: 18324667 DOI: 10.1002/nur.20275] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Few women currently meet revised WHO recommendations to breastfeed exclusively for 6 months postpartum. In this prospective study we aimed to determine the influence of socio-demographic, psychosocial, and perinatal factors on the length of exclusive breastfeeding among 189 Canadian primiparous mothers. A majority of the participants did not meet their exclusive breastfeeding goals, and only 5% breastfed exclusively for a full 6 months. Breastfeeding self-efficacy, in-hospital formula supplementation, prenatal class attendance, and type of delivery independently predicted exclusive breastfeeding duration. Findings underscore the complex interplay of factors influencing breastfeeding, highlight the early postpartum weeks as a critical period for the establishment of exclusive breastfeeding, and suggest the need for a continuum of pre- and postnatal strategies for prolonging the exclusive breastfeeding period.
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Understanding the role of cancer informational support in relation to health care service use among newly diagnosed individuals. Can Oncol Nurs J 2008; 18:193-205. [DOI: 10.5737/1181912x184193198] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Comprendre le rôle du soutien informationnel sur le cancer dans l’utilisation des services de santé chez les personnes nouvellement diagnostiquées. Can Oncol Nurs J 2008. [DOI: 10.5737/1181912x184199205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
OBJECTIVE The aim of this pilot/feasibility study was to describe the experience of women presenting with a suspicious mammogram who are waiting for a breast biopsy and to identify those at risk for distress. METHODS Participants (n=25) were interviewed at two time points: immediately after being put on the waiting list (T1) and again immediately before their biopsy approximately 6 weeks later (T2). Self-report measures of distress and coping were used. Perceived personal risk of a positive biopsy finding and information needs were assessed through open-ended questions. RESULTS Distress levels were high in this sample. Using cognitive-avoidant coping strategies, being employed, history of previous biopsies, and having a family history of breast cancer were associated with greater distress. Perceived personal risk of a positive biopsy finding was overestimated in one half of the cases and was correlated with greater distress. CONCLUSION Waiting period between suspicious mammogram and breast biopsy may be a time of high distress for many women.
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[Uncertainty, coping and hope in spinal injured patients]. L'INFIRMIERE DU QUEBEC : REVUE OFFICIELLE DE L'ORDRE DES INFIRMIERES ET INFIRMIERS DU QUEBEC 2003; 10:16-24. [PMID: 12703257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Abstract
Oncology patients requiring outpatient services have expectations that must be addressed to ensure continuous and improved quality of care. A convenience sample of 96 patients recruited from an oncology outpatient center completed a 26-item patient satisfaction questionnaire (SEQUS). Overall satisfaction ratings indicate that patients are satisfied with their care. Patients' perception of waiting time and lack of questioning regarding their medications by the pharmacist were identified as two areas needing improvement. Findings suggest that by identifying what is most important to patients, nurses can readily modify the care environment to enhance patient satisfaction and quality of care.
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Abstract
The Toronto Alexithymia Scale (TAS) is a self-report measure of the alexithymia construct. In previous studies with college students, the TAS demonstrated excellent psychometric properties including a 4-factor structure theoretically congruent with the alexithymia construct. The present study attempted to cross-validate the factor structure of the TAS with samples of normal adults, psychiatric outpatients and college students. Congruence coefficients comparing the similarity of the factor structures for these three samples indicated good congruence for all four factors. The results provide further support for the validity of both the TAS and the alexithymia construct. In addition, the results provide evidence of the applicability of the scale to normal adult and clinical samples.
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Yes--occupational therapy can be dynamic in a chronic care setting. Can J Occup Ther 1981; 48:19-26. [PMID: 10309340 DOI: 10.1177/000841748104800104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article described the Occupational Therapy programs at Bloorview Children's Hospital. The Hospital itself and the structure within which Occupational Therapy operates are outlined. The numerous group programs are detailed, including objectives, target populations, activities and approach used.
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