Health Professionals Perception of Enhanced Recovery After Surgery: A Scoping Review.

PURPOSE: The Enhanced Recovery After Surgery (ERAS) program is currently poorly implemented by healthcare workers. Furthermore, several inhibiting and supporting factors for this implementation have been discovered to influence healthcare workers' perception of the program. This study aims to investigate the perception of healthcare workers regarding the ERAS program. DESIGN: A scoping review in a systematic manner. METHODS: A systematic search was performed using six databases: PubMed, ScienceDirect, SCOPUS, EBSCO, Proquest, and Sage Journals, from August 2011 to August 2021. The data was extracted using an excel worksheet, and the results obtained were presented descriptively. FINDINGS: This study selected a total of 10 articles, where both qualitative and quantitative methods were used to discuss the perceptions of healthcare workers about ERAS. CONCLUSIONS: Based on this study's findings, not all healthcare workers have a good perception of ERAS. The implementation of ERAS is often hindered by several factors, including resistance to change and lack of knowledge about the program. However, good teamwork and support from hospital management can support the program's implementation.

Anti-Mullerian hormone and puberty development in girls and adolescents who underwent cancer treatment.

BACKGROUND: High survival rates of children diagnosed with cancer have led to a growing population of women with premature ovarian failure (POF) due to chemotherapy and radiotherapy. The POF process occurs due to the disruption of the hypothalamic-pituitary and gonadal axis followed by the delay of puberty development. Evaluation of reproductive function in children with cancer is essential to determine the fertility preservation plan. This study aimed to describe reproductive functions in children and adolescents with cancer who received chemotherapy based on Tanner stage evaluation, menstrual cycle, and anti-Mullerian hormone (AMH) examination using electro-chemiluminescence immunoassay kit. RESULTS: Twenty-three girls aged 12-18 years old and had menarche who underwent cancer therapy in January-August 2019 in Dr. Sardjito General Hospital were included in the study. Among them, 61% had low AMH levels and were defined as diminished ovarian reserve (DOR). Two subjects with DOR experienced delayed puberty. Regular menstrual cycle was reported in 65.2% of subjects and irregular menstrual cycle in 34.8%, while 21.7% with irregular menstrual cycle encountered secondary amenorrhea. CONCLUSION: Chemotherapy exposure affected DOR occurrence in 60.9% of patients with childhood and adolescence cancer. Moreover, it also altered menstrual regularity in 34.8% and delayed puberty development in 8.7% subjects.

Current Awareness and Attitude toward Fertility Preservation in Indonesia: A Nationwide Survey Among Health-care Providers.

CONTEXT: Fertility preservation (FP) is necessary for cancer patients who develop infertility due to chemotherapy and radiotherapy. In Indonesia, many systematic steps and long-term continued actions must be taken to establish FP units since there has been an increasing incidence of cancer among people under 45 years old. AIMS: This study aimed at a comprehensive evaluation on the awareness and practices of health-care providers (HCPs) toward FP. SETTINGS AND DESIGN: This was a descriptive cross-sectional study. SUBJECTS AND METHODS: A validated nationwide online survey was completed by 160 HCPs as a representative sample from 11 provinces in 2017 that provide medical care to cancer patients at hospitals or clinics. STATISTICAL ANALYSIS USED: Descriptive statistics, analysis of variance, logistic regression, and Pearson correlation tests were used for the statistical analysis. RESULTS: Respondents were specialists (59.4%) and other HCPs (40.6%). Around 60% of the HCPs who performed cancer therapies already discussed the fertility issues with their patients. Meanwhile, the HCPs (60.7%) also tended not to consult and refer their patients to fertility experts (P < 0.05). However, those who discussed the risk of infertility with patients tended to consult with and refer them to a fertility consultant for further FP procedure as the follow-up for their discussions (odds ratio = 8.98, confidence interval 95%, P < 0.05). CONCLUSIONS: In Indonesia, FP awareness of the HCPs who performed cancer therapy was high. Nevertheless, attitudes to refer patients to fertility experts for possible FP management still need to be improved.

The Attitude of Health Care Workers on Enhanced Recovery After Surgery for Cesarean Delivery: A Scoping Review.

OBJECTIVE: Previous systematic reviews have found that the enhanced recovery after surgery (ERAS) protocol for cesarean delivery can vary from one study to another, and the attitudes of health care professionals regarding ERAS methods and the implementation of the ERAS for cesarean delivery remain unclear. We aimed to identify the attitudes of health professionals toward ERAS in the context of cesarean delivery. DATA SOURCES: Systematic searches were conducted in 6 databases: PubMed, ScienceDirect, EBSCO, Scopus, the Cochrane Library, and Sage Journals from September 2010 to September 2020. STUDY SELECTION: A total of 4 articles were selected for analysis. All articles use survey methods and present health professional attitudes toward ERAS for cesarean delivery. DATA EXTRACTION AND SYNTHESIS: Data were extracted using Excel spreadsheets. The results obtained are presented descriptively. CONCLUSION: This review illustrates that there are many ERAS protocols that health care professionals have not yet implemented for cesarean delivery. Policymakers can use this knowledge to inform the promotion of the ERAS protocol for cesarean delivery.

Localization of TrkB and p75 receptors in peritoneal and deep infiltrating endometriosis: an immunohistochemical study.

BACKGROUND: The roles of the neurotrophins NGF (Neurotrophic growth factor) and BDNF (brain-derived neurotrophic factor) in neuronal growth and development are already known. Meanwhile, the neurotrophin receptors TrkA (tropomyosin related kinase A), TrkB, and p75 are important for determining the fate of cells. In endometriosis, this complex system has not been fully elucidated yet. The aim of this study was to evaluate the expression and location of these neurotrophins and their receptors in peritoneal (PE) and deep infiltrating endometriotic (DIE) tissues and to measure and compare the density of nerve fibers in the disease subtypes. METHODS: PE lesions (n = 20) and DIE lesions (n = 22) were immunostained and analyzed on serial slides with anti-BDNF, -NGF, -TrkA, -TrkB, -p75,-protein gene product 9.5 (PGP9.5, intact nerve fibers) and -tyrosine hydroxylase (TH, sympathetic nerve fibers) antibodies. RESULT: There was an equally high percentage (greater than 75 %) of BDNF-positive immunostaining cells in both PE and DIE. TrkB (major BDNF receptor) and p75 showed a higher percentage of immunostaining cells in DIE compared to in PE in stroma only (p < 0.014, p < 0.027, respectively). Both gland and stroma of DIE lesions had a lower percentage of NGF-positive immunostaining cells compared to those in PE lesions (p < 0.01 and p < 0.01, respectively), but there was no significant reduction in immunostaining of TrkA in DIE lesions. There was no difference in the mean density of nerve fibers stained with PGP9.5 between PE (26.27 ± 17.32) and DIE (28.19 ± 33.15, p = 0.8). When we performed sub-group analysis, the density of nerves was significantly higher in the bowel DIE (mean 57.33 ± 43.9) than in PE (mean 26.27 ± 17.32, p < 0.01) and non-bowel DIE (mean 14.6. ± 8.6 p < 0.002). CONCLUSIONS: While the neurotrophin BDNF is equally present in PE and DIE, its receptors TrkB and p75 are more highly expressed in DIE and may have a potential role in the pathophysiology of DIE, especially in promotion of cell growth. BDNF has a stronger binding affinity than NGF to the p75 receptor, likely inducing sympathetic nerve axonal pruning in DIE, resulting in the lower nerve fiber density seen.