[Implementation of a nurse practitioner role in inpatient surgery: A mixed-methods study in a pre-post design]. / Implementierung einer "Nurse Practitioner"-Rolle in der stationären Chirurgie.

Implementation of a nurse practitioner role in inpatient surgery: A mixed-methods study in a pre-post design Abstract: Background: The study describes the introduction and testing of a Nurse Practitioner role in acute inpatient surgery in a Swiss hospital over a year. Using a Nurse Practitioner can improve continuity of care, quality of care and patient safety. Aim: The short-term outcome of such a role in the field of inpatient surgery is shown after one year. The target variables included nine measurement criteria. Method: The evaluation was carried out using a mixed-method approach, partly in a pre-post comparison. Quantitatively, the number of patients being looked after, the discharge time, interprofessional cooperation, the duration of stay, disruptions to everyday life and the availability of the discharge documents were recorded. The qualitative recording included the experience of the participants. Results: The results of the evaluation indicate an added value of the new role. Indications can be found in the continuity of care and amenability in medical issues of the participants, as well as in the optimization of patient processes. The legally undefined situation in Switzerland proved to be difficult. Conclusions: The strengths of this role were increasing continuity of care, improving responsiveness in medical issues for patients and caregivers, as well as optimizing patient processes and patient safety. The legal requirements regarding competencies currently make it difficult to use NPs in the inpatient sector.

Sentinel lymph node procedure leads to upstaging of patients with resectable colon cancer: results of the Swiss prospective, multicenter study sentinel lymph node procedure in colon cancer.

BACKGROUND: The value of the sentinel lymph node (SLN) procedure in colon cancer patients remains a matter of debate. The objective of this prospective, multicenter trial was 3-fold: to determine the identification rate and accuracy of the SLN procedure in patients with resectable colon cancer; to evaluate the learning curve of the SLN procedure; and to assess the extent of upstaging due to the SLN procedure. METHODS: One hundred seventy-four consecutive colon cancer patients were enrolled onto this prospective trial. They underwent an intraoperative SLN procedure with isosulfan blue 1% injected peritumorally followed by open standard colon resection with oncologic lymphadenectomy. Three levels of each SLN were stained with hematoxylin and eosin (H&E) and immunostained with the pancytokeratin marker AE1/AE3 if H&E was negative. RESULTS: SLN identification rate and accuracy were 89.1% and 83.9%, respectively. SLN were significantly more likely to contain tumor infiltrates than non-SLN (P < 0.001). Both SLN identification rate (P = 0.021) and the sensitivity of the procedure (P = 0.043) significantly improved with experience. The use of immunohistochemistry in SLN resulted in an upstaging of 15.4% (16 of 104) stage I and II patients considered node-negative in initial H&E analysis. CONCLUSIONS: The SLN procedure for colon cancer has good identification and accuracy rates, which further improve with increasing experience. Most importantly, the SLN procedure results in upstaging of >15% of node-negative patients. The potential advantage of performing the SLN procedure appears to be particularly important in these patients because they may potentially benefit from adjuvant therapy.

Inadequate quality of surveillance after curative surgery for colon cancer.

BACKGROUND: Colon cancer patients are at risk for recurrence. Recurrent disease might be curable if detected early by surveillance. However, data on the quality of surveillance are scarce. The objective of this study is to analyze the quality of surveillance after curative surgery for colon cancer among a cohort of Swiss patients. PATIENTS AND METHODS: After curative surgery, 129 stage I-III colon cancer patients were followed by chart review, questionnaires, and phone interviews. National surveillance guidelines mandate periodic measurement of carcinoembryonic antigen (CEA) levels, abdominal ultrasound or computed tomography (US/CT), and colonoscopy. However, surveillance was left to the discretion of the treating physicians. Actual surveillance was compared with the recommendations in the guidelines. RESULTS: Datasets of all 129 patients were available. Median follow-up was 33.5 months (range 5.6-74.7 months). Eighteen patients (14.0%) recurred during follow-up. Three-year overall and disease-free survival were 94.7% and 83.5%, respectively. Periodic CEA measurements, US/CT, and colonoscopies as recommended by the guidelines were performed in 32.8%, 31.7%, and 23.8% of patients, respectively. Forty-four patients (34.1%) received adjuvant chemotherapy. For these patients there was a trend towards better compliance with national surveillance guidelines than for patients without adjuvant chemotherapy. CONCLUSIONS: The quality of surveillance after curative surgery for colon cancer among a cohort of Swiss patients is inadequate. Further education of health care professionals and patients regarding the potential life-saving benefits of surveillance is imperative. It is cardinal that quality of surveillance is critically analyzed in other countries with different health care systems as well.