Publications by authors named "Gregg Nelson"
Enhanced Recovery Canada (ERC) Clinical Pathway for Cesarean Delivery.
J Obstet Gynaecol Can
December 2024
Enhanced recovery after surgery (ERAS) is a process to promote optimal recovery after a variety of operations utilized by many surgical specialities. This evidence- based series of interventions was developed to decrease the physiological stress and risks associated with surgery. In April of 2023, Enhanced Recovery Canada released its new Clinical Pathway for cesarean delivery.
View Article and Find Full Text PDFBackground: Administration of chemotherapy during pregnancy is often delayed, while preterm delivery is common. If in utero exposure to chemotherapy is associated with adverse pediatric outcomes, it is unknown whether that relationship is directly attributable to the chemotherapy or is mediated by preterm birth.
Methods: Cases were identified from Canadian cancer registries and administrative data in Alberta, British Columbia, and Ontario, 2003-2017, with follow-up until 2018.
Background: As perioperative care shifts to a more patient-centered model, understanding needs and experiences of patients is vital. Gaining such insight can enhance the alignment of care with patient priorities, encouraging adherence to recovery-oriented interventions. We aimed to explore patient-defined recovery and the elements that modify the recovery process for patients with colorectal disease under enhanced recovery after surgery (ERAS) care.
View Article and Find Full Text PDFBackground And Objectives: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) can be associated with prolonged hospital stays. A novel Enhanced Recovery After Surgery (ERAS) based on ERAS Society guidelines was designed and implemented. The primary outcome was ERAS compliance.
View Article and Find Full Text PDFObjective: Enhanced recovery after surgery (ERAS) pathways have demonstrated improvements in outcomes following benign gynecologic and gynecologic oncology surgery. However, there is limited data reporting the benefit of ERAS from the patient's perspective. This study aimed to explore patient knowledge of and experience with ERAS-guided surgery.
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- Cervical cancer screening participation among First Nations women in Canada is lower compared to non-First Nations women, with a significant 13.9% average participation gap.
- The study linked Alberta's Cervical Cancer Screening Program data with First Nations identifiers and analyzed trends in participation and retention rates from 2012 to 2018.
- Findings revealed First Nations women had a higher occurrence of high-risk abnormal cytology tests, highlighting the need to address screening inequities to lessen the impact of cervical cancer in this population.
Objective: To assess whether procedural-induced abortion or provider-initiated preterm delivery are associated with improved survival in pregnant people with cancer.
Design: Retrospective population-based cohort study.
Setting: Provinces of Alberta and Ontario, Canada, 2003-2016.
Objective: Abdominal Radical hysterectomy (ARH) with pelvic lymph node assessment is considered the standard treatment for early-stage cervical cancer. Accepted routes have previously included laparoscopic or robotic approaches (LRH). Laparoscopy-assisted vaginal or vaginal radical hysterectomy (LVRH) are performed in some centers.
View Article and Find Full Text PDFImportance: Neonates requiring surgery are often cared for in neonatal intensive care units (NICUs). Despite a breadth of surgical pathology, neonates share many perioperative priorities that allow for the development of unit-wide evidence-based Enhanced Recovery After Surgery (ERAS) recommendations.
Observations: The guideline development committee included pediatric surgeons, anesthesiologists, neonatal nurses, and neonatologists in addition to ERAS content and methodology experts.
Objective: This study aims to investigate the relationship between body mass index (BMI) and molecular subtypes of endometrial carcinoma using an immunohistochemistry (IHC)-based classification approach.
Methods: We analyzed a consecutive series of endometrial cancer cases undergoing surgical staging in southern Alberta (2019-2021). Molecular classification was determined through IHC-based molecular typing, incorporating p53 and mismatch repair (MMR), and further characterized with the addition of ER and PR.
On February 6th, 2024, and the Society of Gynecologic Oncology Education Committee co-hosted a webinar about ways to use social media for career enhancement and for dissemination of research. During the discussion, we reviewed:i.how to identify one's goals, target audience, and select a social media platform.
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- Mesonephric-type adenocarcinomas (MAs) are rare but aggressive ovarian tumors that can be difficult to diagnose due to their origin from Müllerian lesions.
- A study was conducted involving a four-marker immunohistochemical (IHC) panel to distinguish MAs from similar tumors like endometrioid carcinoma, significantly improving diagnostic accuracy among pathologists.
- The findings showed that MAs are linked to a higher risk of early death compared to endometrioid carcinoma, indicating that careful testing and diagnosis are crucial, especially in early-stage disease.
Objective: To investigate the prevalence and patterns of social media use among gynecologic oncologists for professional and academic purposes.
Methods: A prospective online survey between November and December 2022 targeted gynecologic oncology practitioners (gynecologic oncologists, surgical oncologists, medical oncologists, radiation/clinical oncologists, and onco-pathologists/pathologists). The survey, distributed via various social media platforms, included 40 questions to capture qualitative and quantitative data on social media use.
Article Synopsis
- A study investigated how various cancer risk factors impact the likelihood of developing second primary cancers (SPC) in 533 endometrial cancer survivors over a follow-up period of 16.7 years.
- Key findings revealed that higher dietary glycemic load, older age, and increased alcohol intake were linked to a greater risk of SPC, with breast, colorectal, and lung cancers being the most commonly observed second cancers.
- Notably, reducing alcohol consumption from prediagnosis to early survivorship significantly lowered SPC risk, indicating that dietary changes and lifestyle modifications could be crucial for improving long-term health in endometrial cancer survivors.
Importance: A comprehensive review of the evidence exploring the outcomes of enhanced recovery after surgery (ERAS) guidelines has not been completed.
Objective: To evaluate if ERAS guidelines are associated with improved hospital length of stay, hospital readmission, complications, and mortality compared with usual surgical care, and to understand differences in estimates based on study and patient factors.
Data Sources: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central were searched from inception until June 2021.
Purpose: The purpose of this study was to evaluate RB1 expression and survival across ovarian carcinoma histotypes and how co-occurrence of BRCA1 or BRCA2 (BRCA) alterations and RB1 loss influences survival in tubo-ovarian high-grade serous carcinoma (HGSC).
Experimental Design: RB1 protein expression was classified by immunohistochemistry in ovarian carcinomas of 7,436 patients from the Ovarian Tumor Tissue Analysis consortium. We examined RB1 expression and germline BRCA status in a subset of 1,134 HGSC, and related genotype to overall survival (OS), tumor-infiltrating CD8+ lymphocytes, and transcriptomic subtypes.
Objective: To evaluate the clinical outcomes pre- and post-implementation of an evidence-informed surgical site infection prevention bundle (SSIPB) in gynecologic oncology patients within an Enhanced Recovery After Surgery (ERAS) care pathway.
Methods: Patients undergoing laparotomy for a gynecologic oncology surgery between January-June 2017 (pre-SSIPB) and between January 2018-December 2020 (post-SSIPB) were compared using t-tests and chi-square. Patient characteristics, surgical factors, and ERAS process measures and outcomes were abstracted from the ERAS® Interactive Audit System (EIAS).
Objectives: The objectives of our quality improvement (QI) initiative were (1) to increase the rate of same-day discharge (SDD) in eligible gynecologic oncology (GO) patients to 70% and (2) to evaluate the ease with which QI methods demonstrated in one study could be applied at another center.
Design: A pre-/postintervention design was used (50 patients/group).
Setting: SDD in patients undergoing minimally invasive GO surgery is a recent trend aligned with Enhanced Recovery After Surgery (ERAS) principles.
Introduction: Fragmentation in immunisation reporting systems pose challenges in measuring vaccine coverage for First Nations children in Canada. Some Nations have entered into data-sharing agreements with the province of Alberta's health ministry, enabling novel opportunities to calculate coverage.
Methods: Partnering with a First Nations community in Alberta, this retrospective cohort study calculated routine childhood vaccine coverage.
Background: Of all the care provided in health care systems, major surgical interventions are the costliest and can carry significant risks. Enhanced Recovery After Surgery (ERAS) is a bundle of interventions that help improve patient outcomes and experience along their surgical journey. However, given that patients can be overwhelmed by the multiple tasks that they are expected to follow, a digital application, the ERAS app, was developed to help improve the implementation of ERAS.
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- Researchers studied a common genetic change that happens in a type of ovarian cancer called high-grade serous carcinoma (HGSC), looking at how it affects patient survival.
- They found that losing the RB1 protein was linked to longer survival in patients with HGSC, but it was the opposite for a different type of ovarian cancer called endometrioid cancer.
- Patients with both RB1 loss and certain inherited genetic changes had much better survival rates compared to those with just one of these problems or none at all.
Introduction: Iron-deficiency anaemia is common in gynaecological oncology patients. Blood transfusions are immunosuppressive and carry immediate and long-term risks. Oral iron replacement remains the standard of care but requires prolonged treatment courses associated with gastrointestinal side effects, poor compliance and variable absorption in cancer patients.
View Article and Find Full Text PDFEnhanced recovery after surgery (ERAS) has established benefits in open gynecologic oncology surgery. However, the benefits for gynecologic oncology patients undergoing minimally invasive surgery (MIS) are less well defined. We conducted a review of this topic after a comprehensive search of the peer-reviewed literature using MEDLINE and PubMed databases.
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