Improving surgical outcomes in pancreatic surgery with preoperative nutrition.

The purposes of this study were (1) to describe the relationship between preoperative physical status and postoperative outcomes in patients undergoing Whipple resection, and (2) to determine if the use of specialized immunonutrition with IMPACT Advanced Recovery supplementation improved postoperative outcomes (pancreatic leak rate, length of stay, and postoperative complications) in patients undergoing Whipple resection. The trial was a case-controlled prospective pilot study that took place in an outpatient gastrointestinal surgical oncology office in an urban community hospital in the northeast United States. The study population consisted of nine patients undergoing Whipple surgery. Patients were given IMPACT Advanced Recovery supplementation 4 days prior to Whipple surgery. Prospective data were collected on all patients and then compared to national averages in terms of outcomes. Study approval was obtained from the Fairfield University Institutional Review Board (IRB), though IRB approval was not required by the study facility due to the fact that this was a pilot study. Consent was also not required for retrospective chart review. Patients with lower scores according to the American Society of Anesthesiologists Physical Status Classification System have a shorter operating time in the setting of preoperative nutrition. Patients in this study who received preoperative nutrition with IMPACT Advanced Recovery supplementation had outcomes comparable to the national average. This pilot study suggests that there is a need for a multi-institutional randomized study powered to further evaluate the effectiveness of preoperative nutrition in pancreatic surgery. The literature supports the fact that preoperative nutritional supplementation should be offered to patients undergoing Whipple surgery. Optimization of nutritional status can translate to decreased length of stay and cost savings.

Psychosocial trajectories of men monitoring prostate-specific antigen levels following surgery for prostate cancer.

PURPOSE/OBJECTIVES: To describe the psychosocial trajectories of men treated surgically for prostate cancer after monitoring their prostate-specific antigen (PSA) levels until 24 months post-treatment. DESIGN: Descriptive longitudinal study. SETTING: Urology clinic at Duke University Health System. SAMPLE: 12 men diagnosed and treated for prostate cancer. METHODS: Men were interviewed in their homes at baseline and at 24 months and via telephone at 6, 12, and 18 months. Scores from the Profile of Mood States, Mishel Uncertainty in Illness Scale, Self-Control Schedule, and Cantril's Ladder were entered into a database for analysis. Graphs of individual participants' scores were plotted. MAIN RESEARCH VARIABLES: PSA values, mood state, cognitive reframing, impact of event, quality of life, illness uncertainty, and growth through uncertainty were measured. FINDINGS: Three trajectories were identified (i.e., stable, unstable, and mixed) and graphed using a typological or health pattern approach. CONCLUSIONS: Monitoring PSA levels is critical for men treated for prostate cancer. This study provides preliminary data on the psychological trajectories of men during the first 24 months postprostatectomy. IMPLICATIONS FOR NURSING: Rising PSA levels that are associated with the recurrence of disease can cause psychosocial distress among men with prostate cancer.

Transforming doctoral education through the clinical electronic portfolio.

The DNP is a terminal degree focusing on the preparation of expert clinicians with advanced leadership, evidence-based practice, and systems management skills. An electronic clinical portfolio (e-portfolio) allows students to showcase their individual experiences, provides an objective measure of their achievement, and demonstrates integration of the core doctoral competencies within each specialty. The purpose of this article was to describe the development of an e-portfolio and provide general guidelines for successful implementation and evaluation.

Radical prostatectomy versus watchful waiting for prostate cancer.

BACKGROUND: The lack of evidence regarding the effectiveness of treatment options for clinically localised prostate cancer continues to impact on clinical decision-making. Two such options are radical prostatectomy (RP) and watchful waiting (WW). WW involves providing no initial treatment and monitoring the patient with the intention of providing palliative treatment if there is evidence of disease progression. OBJECTIVES: To compare the beneficial and harmful effects of RP versus WW for the treatment of localised prostate cancer. SEARCH STRATEGY: MEDLINE, EMBASE, The Cochrane Library, ISI Science Citation Index, DARE and LILACS were searched through 30 July 2010. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials comparing the effects of RP versus WW for clinically localised prostate cancer. DATA COLLECTION AND ANALYSIS: Data extraction and quality assessment were carried out independently by two authors. MAIN RESULTS: Two trials met the inclusion criteria. Both trials commenced prior to the widespread availability of prostate-specific antigen (PSA) screening; hence the results may not be applicable to men with PSA-detected disease.One trial (N = 142), conducted in the US, was judged to be of poor quality. All cause (overall) mortality was not significantly different between RP and WW groups after fifteen years of follow up (Hazard Ratio (HR) 0.9 (95% Confidence Interval (CI) 0.56 to 1.43).The second trial (N = 695), conducted in Scandinavia, was judged to be of good quality. After 12 years of follow up, the trial results were compatible with a beneficial effect of RP on the risks of overall mortality, prostate cancer mortality and distant metastases compared with WW but the precise magnitude of the effect is uncertain as indicated by the width of the confidence intervals for all estimates (risk difference (RD) -7.1% (95% CI -14.7 to 0.5); RD -5.4% (95% CI -11.1 to 0.2); RD -6.7% (95% CI -13.2 to -0.2), respectively).        Compared to WW, RP increased the absolute risks of erectile dysfunction (RD 35% (95% CI 25 to 45)) and urinary leakage (RD 27% (95% CI 17 to 37)). These estimates must be interpreted cautiously as they are derived from data obtained from a self-administered questionnaire survey of a sample of the trial participants (N = 326), no baseline quality of life data were obtained and nerve-sparing surgery was not routinely performed on trial participants undergoing RP. AUTHORS' CONCLUSIONS: The existing trials provide insufficient evidence to allow confident statements to be made about the relative beneficial and harmful effects of RP and WW for patients with localised prostate cancer. The results of ongoing trials should help to inform treatment decisions for men with screen-detected localised prostate cancer.