Predictors of early retirement after cancer rehabilitation-a longitudinal study.

This longitudinal study was designed to assess patients' desire for early retirement and investigate which cancer-related and psychosocial characteristics are associated with early retirement. We assessed 750 cancer patients at the beginning (t0 ) and end (t1 ) of, and 12 months after (t2 ) inpatient cancer rehabilitation. At t0 , 22% had a desire to retire early. These patients reported significantly longer sick leave periods, less favourable workplace environments, lower work ability, higher psychological distress and lower quality of life than other patients. At t2 , 12.5% of patients received temporary or permanent early retirement pensions. Of all patients with a desire for early retirement at t0 , 43% had returned to work at t2 . This subgroup had a significantly lower physical quality of life than other patients returning to work. The most influential predictors of early retirement were being on sick leave (OR = 6.50, 95% CI = 1.97-21.47) and a desire for early retirement (OR = 5.61, 95% CI = 2.73-11.52). Inverse predictors of early retirement were cancer remission (OR = 0.23, 95% CI = 0.10-0.53), perceived productivity (OR = 0.38, 95% CI = 0.18-0.83), work satisfaction (OR = 0.36, 95% CI = 0.17-0.77) and mental quality of life (OR = 0.94, 95% CI = 0.91-0.98). This underlines the need for cancer-specific multi-professional rehabilitation and occupational therapy programmes.

[Transapical approach for aortic stented valve implantation: experimental results]. / Implantation transapicale d'une valve stentée aortique: résultats expérimentaux.

OBJECTIVE: Percutaneous aortic valve replacement has been performed in humans mainly for non-surgical candidates. We evaluated on animals a transapical approach to deliver an aortic stented valve without cardiopulmonary bypass. METHODS: A tubular pericardial valve fixed within a cobalt-nickel stent (Medtronic, Inc.) was implanted using a transapical approach in five adult sheep. A left thoracotomy was used to access the apex of the heart. The crimped valve was deployed in orthotopic position with a valvuloplasty balloon catheter on the beating heart after decreasing the left ventricular pressure by using either drugs or inferior vena cava occlusion. Deployments were performed under fluoroscopy and epicardial 2D Doppler echocardiography. Exact positioning of the valve into the target area was confirmed by autopsy at the end of the procedures. RESULTS: Valves were unsuccessfully deployed at the target site in all cases but one. Three valves were implanted in a supra-annular position with two of them in supracoronary position. One valve was implanted below the native annulus in the outflow tract. Valvular leak was noted in all but one implants. Coronary obstruction occurred twice and early valve retrograde migration once. Ventricular fibrillation or diastolic cardiac arrest occurred less than 20 minutes after stent deployment in all cases. CONCLUSION: In our experience the transapical approach does not facilitate delivery of a stented valve. Despite its technically feasibility, advanced stent design and improvements in delivery system are required before to continue experimental studies in transapical approach for aortic stented valve.