Readability, suitability and comprehensibility in patient education materials for Swedish patients with colorectal cancer undergoing elective surgery: a mixed method design.

Objective: To characterize education materials provided to patients undergoing colorectal cancer surgery to gain a better understanding of how to design readable, suitable, comprehensible materials.

Method: Mixed method design. Deductive quantitative analysis using a validated suitability and comprehensibility assessment instrument (SAM+CAM) was applied to patient education materials from 27 Swedish hospitals, supplemented by language technology analysis and deductive and inductive analysis of data from focus groups involving 15 former patients.

Feelings of rewards among family caregivers during ongoing palliative care.

Objectives: Palliative family caregivers appear to experience the rewards of caregiving concurrent with burdens and negative feelings. Relatively few studies have attended to the positive and rewarding aspects in palliative family caregiving. In addition, most studies on rewards are retrospective and examine the experiences of bereaved family caregivers.

Autophagic-lysosomal pathway is the main proteolytic system modified in the skeletal muscle of esophageal cancer patients.

Background: In cancer cachexia, muscle depletion is related to morbidity and mortality. Muscle-wasting mechanisms in cancer patients are not fully understood.

Objective: We investigated the involvement of the proteolytic systems (proteasome, autophagic-lysosomal, calpain, and caspase) in muscle wasting during cancer cachexia.

Relationship between preoperative symptoms and improvement of quality of life in patients undergoing elective inguinal herniorrhaphy.

Background: Improvement of quality of life (QoL) is the ultimate goal for inguinal hernia repair. Data on QoL before surgery are scarce, and it is not known whether postoperative improvement of QoL relates to preoperative symptoms.

Methods: Symptoms and self-reported QoL were evaluated and compared with matched control patients from a normal population in 309 male subjects before and 1 year after unilateral open inguinal hernia repair.

Preoperative sexual function in women with rectal cancer.

Background: Even though sexual dysfunction has been reported after rectal cancer treatment, information on preoperative sexual function is scarce, particularly in female patients.

Aims: To describe preoperative sexual function in women with rectal cancer, and to analyse potential sources of bias.

Methods: The Female Sexual Function Index (FSFI) was administered to women with newly diagnosed non-metastatic rectal cancer, irrespective of whether they were sexually active or not.

Waist circumference to assess reversal of insulin resistance following weight reduction after bariatric surgery: cohort and cross-sectional studies.

Objective: To validate the use of waist circumference to assess reversal of insulin resistance after weight loss induced by bariatric surgery.

Design: In cross-sectional studies, threshold values for insulin resistance were determined with homeostasis model assessment of insulin resistance (HOMA-IR) (algorithm based on fasting plasma glucose and insulin) in 1018 lean subjects and by hyperinsulinemic euglycemic clamp (clamp) in 26 lean women. In a cohort study on 211 patients scheduled for bariatric surgery, HOMA-IR and waist circumference were measured before and 1.

Exploring factors and caregiver outcomes associated with feelings of preparedness for caregiving in family caregivers in palliative care: a correlational, cross-sectional study.

Background: Family caregivers in palliative care often report feeling insufficiently prepared to handle the caregiver role. Preparedness has been confirmed as a variable that may actually protect family caregiver well-being. Preparedness refers to how ready family caregivers perceive they are for the tasks and demands in the caregiving role.

Local recurrence after prone vs supine abdominoperineal excision for low rectal cancer.

Aim: Tumour-involved circumferential resection margins (CRMs) and intra-operative perforation (IOP) are well known risk factors for local recurrence after surgery for low rectal cancer. In conventional abdominoperineal excision (APE) the patient remains in the supine position for the perineal part of the procedure. However, turning the patient to the prone position may improve visualization which potentially might reduce the risk of involved CRMs and IOP and thus improve local control.

Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations.

Background: This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidenced-based enhanced perioperative protocol.

Methods: Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded.

Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations.

Background: This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery, and to provide graded recommendations for items for an evidenced-based enhanced recovery protocol.

Methods: Studies were selected with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded.

Laparoscopic-assisted and open high anterior resection within an ERAS protocol.

Background: Due to potentially superior short-term outcomes compared with open colorectal surgery, laparoscopic surgery is currently being implemented in clinical practice worldwide. In parallel, enhanced recovery after surgery (ERAS) programs are shown to improve postoperative recovery in open colorectal surgery. This study reports outcomes in laparoscopic versus open surgery in conjunction with compliance to the ERAS protocol.

Perioperative nutritional management in digestive tract surgery.

Purpose Of Review: This article reviews the recent research on perioperative nutrition in digestive tract surgery in the light of modern perioperative care principles, that is, enhanced recovery after surgery (ERAS). Four major directions of research emerge: detecting malnutrition, perioperative hyperglycemia/insulin resistance, enteral/parenteral nutrition and immunonutrition.

Recent Findings: For preoperative nutritional screening/assessment, current data cannot single out superiority for SGA questionnaire, nutritional risk score, Reilly's nutritional risk score or nutritional risk index in the ability to predict nutrition-related complications.

The effects of short-course preoperative irradiation on local recurrence rate and survival in rectal cancer: a population-based nationwide study.

Background: Preoperative irradiation with 5 × 5 Gy in randomized trials reduces local recurrence rate and may improve survival in patients with resectable rectal cancer.

Objective: The aim of this study was to determine whether the same favorable effects could be observed in a population-based study.

Design: This study was conducted via a retrospective analysis of prospectively collected data from the Swedish Rectal Cancer Registry.

Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery.

Objectives: To study the impact of different adherence levels to the enhanced recovery after surgery (ERAS) protocol and the effect of various ERAS elements on outcomes following major surgery.

Design: Single-center prospective cohort study before and after reinforcement of an ERAS protocol. Comparisons were made both between and across periods using multivariate logistic regression.

Ten-year follow-up after autologous stem cell transplantation of a patient with immunoglobulin light-chain (AL) amyloidosis with deposits in the heart, liver and gastrointestinal tract.

The prognosis in amyloid light chain (AL)-amyloidosis and multiorgan involvement is poor, with a high-treatment-related mortality after high-dose melphalan and autologous stem cell transplantation (HDM/SCT). Some patients, however, might benefit from the therapy. We report a case of cardiac AL-amyloidosis with multiorgan involvement where the progressive cardiomyopathy was halted after successful treatment with HDM/SCT in 2001.

Learning to live with irritabel bowel syndrome. The influence of a group-based patient education programme on peoples' ability to manage illness in everyday life.

Background: Living with chronic irritable bowel syndrome sets limitations in peoples' everyday lives. This is due to bad health and the difficulty to find strategies that will manage their problem. In encounters with health care providers, these people feel that they are not getting the appropriate support to manage their illness-related troubles, and they perceive themselves to be insufficiently informed about the disease.

Factors influencing local failure in rectal cancer: analysis of 2315 patients from a population-based series.

Purpose: This study aimed to identify risk factors for local failure in an effort to optimize treatment for rectal cancer.

Methods: A total of 154 patients with local failure after abdominal resection were identified from a population-based consecutive series of 2315 patients who underwent operations for rectal cancer in the Stockholm region between January 1995 and December 2004. Surgeons trained in total mesorectal excision performed the surgery, and preoperative radiotherapy was given according to defined protocols.

Liver transplantation of patients with cryptogenic cirrhosis: clinical characteristics and outcome.

Objectives: Non-alcoholic fatty liver disease (NAFLD), autoimmune hepatitis (AIH) and unapparent alcohol abuse may be underlying causes of cryptogenic cirrhosis, but the frequencies of these underlying factors differ between studies. Also, previous studies have shown various outcomes after orthotopic liver transplantation (OLT) for cryptogenic cirrhosis. The aims of this study were (1) to evaluate the presence of NAFLD in patients with cryptogenic cirrhosis evaluated for OLT and (2) to compare the severity of liver disease and patient survival in OLT candidates with cryptogenic cirrhosis and those with cirrhosis of another known origin.

Tumour budding correlates with local recurrence of rectal cancer.

Aim: Predictive tools for local recurrence (LR) of rectal cancer are needed. This study assessed the predictive value of tumour budding detected by MNF-116 and laminin-5 γ2 chain (Ln-5 γ2).

Method: In a case-control study, the surgical specimens of 48 patients with LR after from primary resection of rectal carcinoma and 82 control patients matched for gender and preoperative radiation from a population of 1180 patients operated with total mesorectal excision were studied.

Haemoglobin A1c as a predictor of postoperative hyperglycaemia and complications after major colorectal surgery.

Background: Hyperglycaemia following major surgery increases morbidity, but may be improved by use of enhanced-recovery protocols. It is not known whether preoperative haemoglobin (Hb) A1c could predict hyperglycaemia and/or adverse outcome after colorectal surgery.

Methods: Some 120 patients without known diabetes underwent major colorectal surgery within an enhanced-recovery protocol.

The impact of hospital volume on surgical outcome in patients with rectal cancer.

Purpose: This study was designed to investigate, in a population-based setting, the surgical outcome in patients with rectal cancer according to the hospital volume.

Methods: Since 1995 all patients with rectal cancer have been registered in the Swedish Rectal Cancer Registry. Hospitals were classified, according to number treated per year, as low-volume, intermediate-volume, or high-volume hospitals (<11, 11-25, or >25 procedures per year).

An enhanced-recovery protocol improves outcome after colorectal resection already during the first year: a single-center experience in 168 consecutive patients.

Purpose: This study was designed to investigate the clinical outcome and recovery before and immediately after implementation of the enhanced recovery after surgery enhanced recovery after surgery protocol in colonic and rectal resection.

Methods: One hundred and sixty-eight consecutive patients in a single center underwent colorectal surgery before (traditional, n = 69) and immediately after implementing enhanced recovery after surgery (n = 99). Rectal surgery was performed in 77 patients.

Inflammatory bowel disease-related lesions in the duodenal and gastric mucosa.

Objective: In 10-15% of patients with colorectal inflammatory bowel disease it is not possible to determine whether they have Crohn's disease or ulcerative colitis and they are therefore classified as having inflammatory bowel disease unclassified (IBDU) (formerly referred to as "indeterminate colitis"). The aim of this study was to determine whether upper endoscopy with biopsies could be a useful tool for diagnosing patients with colorectal inflammatory disease.

Material And Methods: Fifty-two patients (14 colorectal Crohn's disease, 19 ulcerative colitis, 6 IBDU, 8 microscopic colitis and 5 without IBD) were examined by upper endoscopy.

Comparison of wireless 48-h (Bravo) versus traditional ambulatory 24-h esophageal pH monitoring.

Objective: To compare wireless with catheter-based esophageal pH recordings.

Material And Methods: Forty-five patients with symptoms suggestive of gastroesophageal reflux disease and 47 healthy volunteers were investigated in a university-affiliated hospital; 48-h wireless esophageal pH recording was performed. During the first 24 h, simultaneous traditional pH recording by catheter was undertaken.