Identification of clinical outcome measures for recovery of gastrointestinal motility in postoperative ileus.

OBJECTIVE: To identify clinical hallmarks associated with recovery of gastrointestinal transit. BACKGROUND: Impaired gastrointestinal transit or postoperative ileus largely determines clinical recovery after abdominal surgery. However, validated clinical hallmarks of gastrointestinal recovery to evaluate new treatments and readiness for discharge from the hospital are lacking. METHODS: Gastric emptying and colonic transit were scintigraphically assessed from postoperative day 1 to 3 in 84 patients requiring elective colonic surgery and were compared with clinical parameters. The clinical hallmark that best reflected recovery of gastrointestinal transit was validated using data from a multicenter trial of 320 segmental colectomy patients. RESULTS: Seven of 84 patients developed a major complication with paralytic ileus characterized by total inhibition of gastrointestinal motility and were excluded from further analysis. In the remaining patients, recovery of colonic transit (defined as geometric center of radioactivity ≥2 on day 3), but not gastric emptying, was significantly correlated with clinical recovery (ρ = -0.59, P < 0.001). Conversely, the combined outcome measure of tolerance of solid food and having had defecation (SF + D) (area under the curve = 0.9, SE = 0.04, 95% CI = 0.79-0.95, P < 0.001), but not time to first flatus, best indicated recovery of gastrointestinal transit with a positive predictive value of 93% (95% CI = 78-99). Also in the main clinical trial, multiple regression analysis revealed that SF + D best predicted the duration of hospital stay. CONCLUSIONS: Our data indicate that the time to SF + D best reflects recovery of gastrointestinal transit and therefore should be considered as primary outcome measure in future clinical trials on postoperative ileus.(Netherlands National Trial Register, number NTR1884 and NTR222).

[Trust of Turkish and Arabic ethnic minority patients in their Dutch oncologist]. / Vertrouwen van Turkse en Arabische allochtonen in hun oncoloog.

OBJECTIVE: To examine the nature of the trust that Turkish and Arabic ethnic minority patients suffering from cancer have in their oncologist, and to explore how this trust is established. DESIGN: We interviewed 9 cancer patients with Turkish and Arabic backgrounds about the trust they have in their oncologist. Semi-structured qualitative interviews. METHOD: We interviewed 9 cancer patients with Turkish and Arabic backgrounds about the trust they have in their oncologist. RESULTS: The trust that these patients have in their oncologist seemed to evolve gradually over time. According to the patients, three specific elements seemed to promote trust. Firstly, patients attached importance to a strongly proactive physician approach, even in the palliative phase when treatment was no longer indicated. A wait-and-see attitude was perceived by patients as a lack of willingness to help, and was detrimental to their trust. Secondly, patients indicated that they needed their oncologist to reassure them and avoided discussing depressing topics, so that they would not give up hope. Finally, the oncologist's non-verbal communication, particularly his or her facial expression, contributed to patients' trust. CONCLUSION: Among these Turkish and Arabic ethnic minority cancer patients, trust in the physician appeared not to be self-evident, and might to some extent need to be 'earned' by oncologists. Because of these patients' great need for a proactive attitude, it is desirable that oncologists clearly explain their motivation when choosing for a possibly less active approach. In order to preserve hope, it is important that oncologists discover exactly what their patients' information needs are. The results of this explorative, small-scale study may help physicians to optimise the trust that Turkish and Arabic ethnic minority patients have in them.