RESUMO
In response to concern about lengthy waiting times for cancer treatment in the UK, the Department of Health introduced 'the colorectal cancer target referral scheme' to improve the referral process for suspected cancer. A user-centred web-based intranet software was developed reflecting the core work of the multi-disciplinary cancer team and the patient journey. The method used was primarily based on the concept of involving the end users (clinicians, nurses, administration staff) in the process of problem definition, software design, formative evaluation, development and implementation, from the very beginning, to ensure its relevance, functionality, and effectiveness. This software improved the interdisciplinary communication among doctors. All patients met the government waiting targets and proved to be a facilitative tool for audit, research and further prospective assessment of our service. Implementing a functional software design is mandatory for the management of target referral patients.
Assuntos
Neoplasias Colorretais/diagnóstico , Comunicação Interdisciplinar , Aplicações da Informática Médica , Encaminhamento e Consulta , Design de Software , Listas de Espera , Atitude do Pessoal de Saúde , Humanos , Internet , Aceitação pelo Paciente de Cuidados de Saúde , Guias de Prática Clínica como Assunto , Administração em Saúde Pública , Qualidade da Assistência à Saúde , Encaminhamento e Consulta/legislação & jurisprudência , Encaminhamento e Consulta/estatística & dados numéricos , Análise de Regressão , Reino Unido , Interface Usuário-ComputadorRESUMO
The study compared paper-based and electronic-based medical handover with respect to quality of information transfer during hospital out-of-hours shifts, and analysed the caseload burden of the hospital night team. The participants were 1645 hospital patients transferred from the day team to the out-of-hours team over four months in 2006. Quality of information transfer was determined by clinical data handed over within pre-set fields, and caseload burden by the frequency of tasks required at handover. Handover information fields comprised patient's demographics and location, primary diagnosis, current problem, plan of action and primary care team details. Electronic handover achieved a significantly higher number of completed fields than paper-based handover. Blood collection, checking blood and X-ray results, and adjusting fluid balance and intravenous cannulation account for most of the workload during the nightshift. Electronic handover provides better continuity of care than paper-based handover, and redistribution of tasks during working hours would benefit night staff.
Assuntos
Plantão Médico/normas , Sistemas de Informação Hospitalar/normas , Hospitais de Ensino/tendências , Sistemas Computadorizados de Registros Médicos , Qualidade da Assistência à Saúde/normas , Software , Sistemas de Informação Hospitalar/organização & administração , Humanos , Londres , Projetos Piloto , Estudos Prospectivos , Fatores de Tempo , Reino UnidoRESUMO
BACKGROUND: Innervation of blood vessels shows inter-species variability. There are few studies on the innervation of human vessels; thus, healthy mesenteric vessels were studied to identify the expression of immunomarkers and the morphology of sympathetic innervation as the basis for a study of mesenteric vessels in inflammatory bowel disease. METHODS AND RESULTS: Electron microscopy studies examined the relationships of nerves to smooth muscle cells. In veins, nerves were distributed throughout the medial smooth muscle coat, often in close apposition (50 nm) to smooth muscle cells. In arteries, nerves were located at the adventitial-medial border, few closer than 2,000 nm to smooth muscle cells, often with interposing connective tissue and Schwann cell processes. There was a significantly greater nerve density in veins than in arteries (227 vs. 41 mm(2); p = 0.03). Immunohistochemical studies revealed the presence of sympathetic and sensory-motor nerves in arteries and veins. CONCLUSIONS: It is suggested that in humans with an upright stance, the mesenteric venous system plays a particularly important role in controlling mesenteric capacitance, which is reflected by their dense innervation. It is speculated that transmitters released from perivascular nerves supplying the human mesenteric arteries may play a long-term (trophic) role in addition to short-term signalling roles.
Assuntos
Artérias Mesentéricas/inervação , Veias Mesentéricas/inervação , Sistema Nervoso Simpático/anatomia & histologia , Humanos , Imuno-Histoquímica , Artérias Mesentéricas/citologia , Veias Mesentéricas/citologia , Microscopia Eletrônica , Músculo Liso Vascular/inervação , Miócitos de Músculo Liso/citologiaRESUMO
BACKGROUND AND OBJECTIVES: Colorectal cancers (CRC) with high-level micro-satellite instability (MSI-H) show reduced metastatic potential and better prognosis compared to stage-matched stable (MSS) cancers. Angiogenesis/lymphangiogenesis, central to tumour growth and spread, is mediated by vascular endothelial growth factor (VEGF) cytokines, but little is known of their relationship to MSI. METHODS: In this study, 67 sporadic CRC with identified MSI status, and 8 samples of normal colon were analysed for VEGF-A soluble isoforms (VEGF-121/VEGF-165) and VEGF-C gene transcription (by RT-PCR and scanning densitometry), and blood vessel density (BVD; measuring angiogenesis) and VEGF-C protein expression (measuring lymphangiogenesis). RESULTS: Compared to normal colon, VEGF-165 transcription was reduced (P < 0.05), but VEGF-121 transcription was higher in MSS (P < 0.06) and MSI-L (P < 0.01) cancers (but similar in MSI-H). VEGF-165 transcription was unrelated to MSI, but VEGF-121 transcription was elevated in MSI-L (P < 0.06). There was a weak inverse correlation with VEGF-121 transcription and Dukes stage (P < 0.09), and with BVD and MSI (P < 0.09). With a singular di-nucleotide loci mutation (MSI-L), VEGF-121 (P < 0.03) and VEGF-C (P < 0.04) transcription was elevated. CONCLUSIONS: MSI-H cancers have reduced angiogenic/lymphangiogenic potential, and transcription of VEGF-121 may be important in early growth and spread of CRC. Elevated VEGF-121 and VEGF-C transcription with singular di-nucleotide mutations may aid in the identification of distinct MSI-L cancers.
Assuntos
Neoplasias Colorretais/genética , Neoplasias Colorretais/metabolismo , Repetições de Microssatélites , Fator A de Crescimento do Endotélio Vascular/genética , Fator C de Crescimento do Endotélio Vascular/genética , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Humanos , Imuno-Histoquímica , Linfangiogênese/genética , Neovascularização Patológica/genética , Neovascularização Patológica/metabolismo , Isoformas de Proteínas/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transcrição Gênica , Fator A de Crescimento do Endotélio Vascular/biossíntese , Fator C de Crescimento do Endotélio Vascular/biossínteseRESUMO
PURPOSE: Multislice CT colonography is an alternative to colonoscopy. The purpose of this study was to compare multislice CT colonography with colonoscopy in the detection of colorectal polyps and cancers. METHODS: Between June 2000 and December 2001, 45 males and 35 females (median age, 68 (29-83) years) with symptoms of colorectal disease were studied prospectively. All patients underwent multislice CT colonography and colonoscopy, and the findings were compared. RESULTS: Colonoscopy was incomplete in 18 (22 percent) patients because of obstructing lesions or technical difficulty, and multislice CT colonography was unsuccessful in 4 (5 percent) because of fecal residue. Colonoscopy was normal in 26 patients and detected 29 colorectal cancers and 33 polyps in 35 patients, diverticulosis in 16 patients, and colitis in 3 patients. Multislice CT colonography identified 28 of 29 colorectal cancers with one false negative and one false positive (sensitivity, 97 percent; specificity, 98 percent; positive predictive value, 96 percent; negative predictive value, 98 percent). Multislice CT colonography identified all 12 polyps measuring >or=10 mm in diameter (sensitivity, 100 percent), 5 of 6 measuring 6 to 9 mm in diameter (sensitivity, 83 percent), 8 of 15 polyps
Assuntos
Pólipos do Colo/diagnóstico , Colonografia Tomográfica Computadorizada , Colonoscopia , Neoplasias Colorretais/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Pólipos do Colo/diagnóstico por imagem , Neoplasias Colorretais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: The effect of pelvic radiotherapy on anorectal function is not clearly documented and is investigated in this prospective study. METHODS: Thirty-one males (median age, 70 years) with carcinoma of the prostate (n = 28) and bladder (n = 3) completed proctitis/incontinence symptom score questionnaires and anorectal physiology studies before and six weeks after pelvic radiotherapy. At six months after completion of radiotherapy, 25 of these patients were studied again. The results were expressed as medians and ranges and compared by the Mann-Whitney U test (2-tailed). RESULTS: Six weeks and six months after treatment, respectively, the proctitis symptom scores (0 (0-4) vs. 2 (0-7) (P < 0.001) vs. 2 (0-5) (P < 0.001)) and the incontinence symptom scores (0 (0-5) vs. 4 (0-11) (P < 0.001) vs. 3 (0-14) (P < 0.001)) increased. Urgency, frequency of defecation, anorectal pain, incontinence to liquid stool and to flatus, and alteration in lifestyle were significant symptoms after treatment. The following measurements decreased: anal canal resting pressure (83 (35-137) vs. 79 (26-152) (P = NS) vs. 71 (29-97) (P < 0.01) cm H2O), the squeeze increment (152 (51-135) vs. 162 (63-321) (P = NS) vs. 108 (45-296) (P < 0.042) cm H2O), and the maximum tolerated rectal volume (245 (115-450) vs. 194 (112-344) (P < 0.05) vs. 200 (109-350) (P < 0.138) ml). The rectal electrosensory threshold increased (20 (5.4-44) vs. 22 (9-50.5) (P < 0.134) vs. 31.5 (13.6-76) (P < 0.001) mA). CONCLUSIONS: Anorectal symptoms at six weeks after pelvic radiotherapy are related to reduced rectal capacity and compounded at six months by diminished internal and external sphincter function and rectal mucosal sensitivity.