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Watch and wait for Rectal Cancer: A 9 year Experience. 观察和等待直肠癌:一个9年的经验。
Q3 Medicine Pub Date : 2022-09-01
C Cosgrove, Raj Spence, L Convie, D Beattie, K McCallion, I McAllister

Background: Neoadjuvant long course chemoradiotherapy has become the standard treatment for locally advanced rectal cancer. It can reduce tumour bulk, downstage, reduce the risk of local recurrence, and increase the possibility of clear resection margins. The aim of our study is to evaluate all patients over a 9 year period who underwent neoadjuvant chemoradiotherapy for rectal cancer and entered our watch and wait programme.

Methods: Data were analysed from a prospective database for all patients diagnosed with rectal cancer over a 9 year period (2011-2019 inclusive).

Findings: Over a 9 year period, 532 patients were treated for rectal cancer, with 180 patients receiving long course chemoradiotherapy. 61 (11%) patients entered a watch and programme as they had a complete clinical and radiological response following chemoradiotherapy. Within this programme, 40 patients (65%) remain disease free over the follow-up period (mean 38 months); 12 (20%) patients had regrowth and proceeded to surgery; and 9 (15%) proceeded to palliation due to being unfit for surgery or had distant metastatic disease. Overall (all cause) mortality was 18% during follow-up period in the watch and wait group.

Conclusions: Neoadjuvant long course chemoradiotherapy is the standard treatment for locally advanced rectal cancer. 34% of our patient group who received long course chemoradiotherapy entered a watch and wait programme with the majority avoiding major rectal surgery.

背景:新辅助长疗程放化疗已成为局部晚期直肠癌的标准治疗方法。它可以减少肿瘤体积,降低分期,降低局部复发的风险,并增加切除边缘清晰的可能性。我们研究的目的是评估所有接受直肠癌新辅助放化疗并进入我们的观察和等待计划的9年以上的患者。方法:从前瞻性数据库中分析9年(2011-2019年包括在内)所有诊断为直肠癌的患者的数据。结果:在9年的时间里,532例直肠癌患者接受了治疗,其中180例接受了长疗程的放化疗。61例(11%)患者在放化疗后有完全的临床和放射反应,因此进入了观察和计划。在该方案中,40名患者(65%)在随访期间(平均38个月)保持无病状态;12例(20%)患者再生并进行手术;9例(15%)由于不适合手术或有远处转移性疾病而得到缓解。观察和等待组在随访期间的总(全因)死亡率为18%。结论:新辅助长疗程放化疗是局部晚期直肠癌的标准治疗方法。在接受长期放化疗的患者中,有34%的人进入了观察和等待计划,大多数人避免了大的直肠手术。
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引用次数: 0
Could the Emergency Department Facilitate the Start of a Holistic Follow-Up Pathway for Patients Recovering from COVID-19? 急诊科能否为COVID-19康复患者提供全面的随访途径?
Q3 Medicine Pub Date : 2022-09-01
Patrick Cook, Emma Allde, Flynn Griffith, Reza Khorasanee, Calum Luke, Benjamin Ridley, Thomas Simpson

Background: For many patients suffering from COVID-19, Emergency Departments (ED) facilitate the first contact with clinicians. There is a high rate of psychiatric symptoms in COVID-19 survivors, including anxiety, depression, fatigue and sleep disturbance, which persist months after the acute phase.

Aims: To investigate if COVID-19 patients discharged from ED have a higher prevalence of mental health symptoms than those admitted.In addition, this study will investigate if discharged ED patients who now require COVID-19 follow-up with the respiratory team had a higher prevalence of mental health symptoms than admitted patients requiring follow-up.

Methods: This was a retrospective cohort study (n = 472) with the PHQ2 and GAD-2 scoring systems to quantify current anxiety and depression symptoms via a telephone consultation.

Results: The PHQ-2 and GAD-2 scores were significantly higher for discharged ED patients than the admitted patients. There was a higher proportion of females with a positive PHQ2 or GAD-2 score. Of the patients requiring respiratory follow-up, discharged ED patients were more likely to have a positive PHQ-2 or GAD-2 score than those admitted.

Conclusions: Clinicians should maintain a low threshold for referring patients with psychiatric complaints post-COVID alongside respiratory symptoms irrespective of admission. It is imperative that available psychological services, crisis lines and other avenues of support post-COVID-19 are signposted to patients before discharge to facilitate earlier intervention.

背景:对于许多COVID-19患者,急诊科(ED)促进了与临床医生的第一次接触。COVID-19幸存者中出现精神症状的比例很高,包括焦虑、抑郁、疲劳和睡眠障碍,这些症状在急性期后持续数月。目的:探讨COVID-19急诊科出院患者的心理健康症状是否高于入院患者。此外,本研究将调查现在需要与呼吸团队进行COVID-19随访的出院急诊科患者是否比需要随访的住院患者具有更高的心理健康症状患病率。方法:这是一项回顾性队列研究(n = 472),采用PHQ2和GAD-2评分系统,通过电话咨询量化当前的焦虑和抑郁症状。结果:出院ED患者PHQ-2和GAD-2评分明显高于入院患者。PHQ2或GAD-2评分阳性的女性比例较高。在需要呼吸系统随访的患者中,出院的ED患者比入院的患者更有可能有PHQ-2或GAD-2阳性评分。结论:无论入院与否,临床医生都应保持较低的转诊门槛。必须在患者出院前为他们提供可用的心理服务、危机热线和其他支持途径,以促进早期干预。
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引用次数: 0
RESPONSE TIMES FOR ACUTE NON-INVASIVE VENTILATION SET-UPS. 急性无创通气装置的反应时间。
Q3 Medicine Pub Date : 2022-09-01
A Watson, H Barnard, A Shanmugarajah, P Antoine-Pitterson, R Mukherjee
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引用次数: 0
Straight to test reduces time to investigation and treatment. 直接检测减少了调查和治疗的时间。
Q3 Medicine Pub Date : 2022-09-01
R S Wilson, D B Johnston, D McKay, D Mark

Straight to test (STT) is a recognised pathway for improving the waiting time for red flag referrals. Electronic patient care records (ECR) provide clinicians with a greater volume of clinical information allowing virtual triage and STT. We aimed to assess if using ECR and STT can reduce delays in diagnosis and treatment. A review of 300 colorectal referrals between 2018-2019 was performed. Patients awaiting an appointment were reviewed electronically, by a single colorectal surgeon and re-triaged STT if appropriate. The delay in time from referral to initial review was removed, creating a second group for statistical comparison to demonstrate time saved if the strategy was adopted at the point of original triage. 91.3% (n= 274) were red flag referrals. 94% (n=282) were sent STT. Patients processed via traditional referral and clinic had a median time to scope of 36 days compared with 22.5 days, p < 0.001 if triaged STT via virtual clinic. Median time to management was 59 days for traditional and 35 days for STT, p < 0.001.

直接测试(STT)是公认的改善红旗转介等待时间的途径。电子患者护理记录(ECR)为临床医生提供了更大量的临床信息,允许虚拟分诊和STT。我们的目的是评估使用ECR和STT是否可以减少诊断和治疗的延误。对2018-2019年间300例结直肠转诊进行了回顾。等待预约的患者由一名结直肠外科医生进行电子检查,并在适当的情况下对STT进行重新分类。从转诊到初步审查的时间延迟已被消除,创建了第二组进行统计比较,以证明如果在最初分诊时采用该策略所节省的时间。91.3% (n= 274)为危险信号转诊。94% (n=282)接受STT治疗。通过传统转诊和诊所处理的患者的中位时间为36天,而通过虚拟诊所进行STT分类的患者为22.5天,p < 0.001。到治疗的中位时间为传统治疗59天,STT治疗35天,p < 0.001。
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引用次数: 0
Pestilence, Plague and Pandemics: A Troubled History. 瘟疫、瘟疫和流行病:一段混乱的历史。
Q3 Medicine Pub Date : 2022-09-01
Mwd Wren, D Petts, G Guthrie, S Clarke, B R Nation, L Peters, S Mortlock, I Sturdgess, M Wright, C Burt

Humankind has lived with the danger of endemic, epidemic and pandemic disease for thousands of years. The effects of these outbreaks have often devastated human populations. Sixteen pandemic events causing an estimated 147 million deaths have occurred since the eighth century, The Black Death and the influenza pandemic of 1918-1920 probably having the greatest impact. Animal populations, both wild and domestic, have similarly suffered devastating outbreaks of disease which, on occasions, have translated into serious effects on human health. The deliberate or accidental introduction of animals into virgin areas has given rise to unforeseen disease events occasionally leading to extinction. Similarly, human intent or negligence and the vagaries of nature itself has resulted in ill health and loss of life. This paper describes the history of pandemics, epidemics and disasters, and the attempts to bring them under control.

几千年来,人类一直生活在地方病、流行病和大流行病的危险之中。这些疫情的影响往往使人口遭受重创。自8世纪以来,共发生了16次大流行事件,估计造成1.47亿人死亡,其中黑死病和1918-1920年的流感大流行可能影响最大。野生和家养动物种群同样遭受毁灭性疾病的爆发,有时对人类健康造成严重影响。有意或无意将动物引入未开发地区会引起无法预料的疾病事件,有时会导致灭绝。同样,人类的意图或疏忽以及自然本身的变幻莫测也造成了健康不良和生命损失。本文描述了流行病、流行病和灾难的历史,以及控制它们的努力。
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引用次数: 0
Ulster Medical Society Lecture Programme 2022-2023. 阿尔斯特医学会2022-2023年讲座计划。
Q3 Medicine Pub Date : 2022-09-01
Nigel Hart
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引用次数: 0
HAART, THE HEART AND THE POTENTIAL FOR INTERACTION. 心脏和潜在的相互作用。
Q3 Medicine Pub Date : 2022-09-01
Liam Coyle, Niall Herity
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引用次数: 0
A secular age. 一个世俗的时代。
Q3 Medicine Pub Date : 2022-09-01
Michael Trimble
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引用次数: 0
The Launch of William Whitla's Medical Institute: Concept and Commissioning. 威廉·惠特拉医学研究所的启动:概念和调试。
Q3 Medicine Pub Date : 2022-09-01
Alun Evans
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引用次数: 0
REACTIVE NON-REGIONAL LYMPHADENOPATHY FROM THE COVID-19 mRNA VACCINE: A NOVEL SIDE-EFFECT. COVID-19 mRNA 疫苗引起的反应性非区域性淋巴腺病变:一种新的副作用。
Q3 Medicine Pub Date : 2022-09-01 Epub Date: 2022-12-05
Rithvik Gidwani, Salman Siddiqui, Siddhesh Prabhavalkar
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引用次数: 0
期刊
Ulster Medical Journal
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