Annals of surgery
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Randomized Controlled Trial Multicenter Study
Functional performance and quality of life in patients with squamous esophageal carcinoma receiving surgery or chemoradiation: results from a randomized trial.
The aim of this study was to compare the 2-year functional performance and quality of life in patients with operable squamous cell carcinoma of the esophagus, who have received either surgery or definitive chemoradiation (CRT). ⋯ Neither surgery nor definitive CRT significantly impaired the global health status of patients. Surgery was associated with a short-term negative impact in some aspects of health related quality of life assessments but these changes became insignificant 2 years after treatment. However, CRT was associated with progressive deteriorations in pulmonary function in the longer term.
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The elderly injured have been identified as a population with unique needs compared with nonelderly trauma patients. We sought to determine whether trauma center (TC) performance is consistent across age groups and to assess whether aggregate evaluations of TC performance capture quality of care among the elderly. ⋯ The use of outcome-based benchmarking harbors significant potential for trauma quality improvement. Evaluations of aggregate TC performance may not adequately reflect the care provided to the elderly injured. Elderly trauma patients may warrant special attention in the context of ongoing quality improvement programs.
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Comparative Study
The effect of an organized trauma system on mortality in major trauma involving serious head injury: a comparison of the United kingdom and victoria, australia.
To compare outcomes following major trauma involving serious head injury managed in an inclusive trauma system (Victoria, Australia) and a setting where rationalization of trauma services is absent (England/Wales). ⋯ Management of the severely injured patient with an associated head injury in England and Wales, where an organized trauma system is absent, was associated with increased risk-adjusted mortality compared with management of these patients in the inclusive trauma system of Victoria, Australia. This study provides further evidence to support efforts to implement such systems.
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Liberal acceptance criteria are used when offering liver transplantation (LTx) for treatment of hepatocellular carcinoma (HCC) at our center. This provides a unique opportunity to assess outcomes in a large North American series of patients with advanced tumors. ⋯ Cross-sectional imaging did not reliably stage patients with HCC for LTx. A protocol using a biopsy to exclude poorly differentiated tumors and aggressive bridging therapy achieved excellent survival rates with LTx for otherwise incurable advanced HCC, irrespective of tumor size and number.
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To compare the health-related quality of life (HRQOL) of disease-free breast cancer survivors at the time of diagnosis and 1 year later with that of the general population (GP) and to examine the predictors of HRQOL change. ⋯ Immediately after the diagnosis of breast cancer, patients reported a lower HRQOL than the GP, and they continued to do so a year later. Increased levels of fatigue, pain, and insomnia were the main symptoms responsible.