Patients undergoing oncologic liver operations who participated in an enhanced recovery programme returned sooner to their normal life function and adjuvant cancer therapies than patients who were treated with a traditional approach to perioperative care, according to a new study.
‘What really matters is life function. Until now, we have been trying to add up a patient’s pain, nausea, and fatigue, but what we really needed to look at is how those symptoms actually impact a patient’s life function, because as it turns out, each patient experiences symptoms differently,’ said lead investigator Thomas A. Aloia, MD, FACS, associate professor, department of surgical oncology, The University of Texas MD Anderson Cancer Center, Houston. ‘We found that you could have very symptomatic people who were quite functional, and you could have mildly symptomatic people who were completely disabled.’
This single-centre study involved 118 patients undergoing both open and laparoscopic hepatectomy (surgical resection of the liver). In addition to traditional quality metrics like complications and length of stay, researchers collected data from a patient-reported outcomes tool called the MD Anderson Symptom Inventory (MDASI). All patients rated symptom severity and life interference using this validated survey, first preoperatively and again at every outpatient visit until 31 days after their operations.
Typically, surgeons counsel patients that they are not going to feel better for a month after the operation, and that their full recovery will take about six to eight weeks. ‘Enhanced recovery,’ however, is a multicomponent perioperative care protocol created to speed patients’ recovery and return to normal life functions such as working and driving.
This type of fast-track care plan involves preoperative patient education, fewer narcotic painkillers used during and after an operation (which have side effects that can lengthen the hospital stay), and a quicker return to eating and walking as soon as possible after the operation.
In this study, 75 patients in the enhanced recovery group were compared with 43 patients in the traditional care group. All preoperative and postoperative care was the same for both groups, except the enhanced recovery part of it. The aim was to compare the difference between patients’ functional outcomes.
The researchers found that patients treated in the enhanced recovery group were 2.6 times more likely to achieve their baseline functional status within 31 days than those who were treated with the traditional protocol.
‘The only independent factor that correlated to faster return to baseline functional status, both in terms of absolute value and short time to recovery, was being on an enhanced recovery protocol,’ Dr. Aloia said. ‘It wasn’t the size of the liver resection, the approach [laparoscopic versus open operation], or whether we used an epidural catheter for pain control or not.’
In this study, enhanced recovery patients reported lower postoperative pain scores and experienced fewer complications and decreased length of stay. The breakthrough from this study is that most enhanced recovery studies stop measuring their outcome at length of hospital stay, with the sole purpose of shortening the hospital visit.
‘At a cancer centre, length of stay is pretty low on our list of importance; our true metric of success is getting people after cancer surgery back to cancer therapy,’ Dr. Aloia said.
The researchers also found that patients in the enhanced recovery group were more likely to return to chemotherapy (a measure researchers at this centre created and call Return to Intended Oncologic Therapy or RIOT), (95 percent vs. 87 percent), and at a shorter time interval compared with patients in the traditional group (44.7 days vs. 60.2 days). Because some of the patients were not indicated to receive further cancer treatment in this part of the analysis, these results aren’t statistically significant. Still, the researchers have no doubt that the trend is clear.
‘With this study, we may have got one step closer to a scientific definition of recovery that could be used in other disease sites,’ Dr. Aloia said. ‘As enhanced recovery strategies evolve we may now have a tool to compare one approach with another to find out which one is better.’

American College of Surgeonshttp://tinyurl.com/h9yz499

Researchers at the University of Warwick have worked with Coventry-based Medherant, a Warwick spinout company, to produce and patent the world’s first ever ibuprofen patch delivering the drug directly through skin to exactly where it is needed at a consistent dose rate.
They have invented a transparent adhesive patch that can consistently deliver a prolonged high dose of the painkiller ibuprofen directly through the skin. The University of Warwick researchers and Medherant have found a way to incoporate significant amounts of the drug (up to 30% weight) into the polymer matrix that sticks the patch to the patient’s skin with the drug then being delivered at a steady rate over up to 12 hours. This opens the way for the development of a range of novel long-acting over-the-counter pain relief products which can be used to treat common painful conditions like chronic back pain, neuralgia and arthritis without the need to take potentially damaging doses of the drug orally. Although there are a number of popular ibuprofen gels available these make it difficult to control dosage and are inconvenient to apply.
This novel patch incorporates polymer technology developed by the global adhesive company Bostik and exclusively licensed for transdermal use to Medherant.
The key features of Medherant’s new patch technology are:
The patch remains highly tacky and thus adheres well to skin even when the drug load reaches levels as high as 30% of the weight/volume of the patch. The drug load made possible by this new technology can be 5 -10 times than that found in some currently used medical patches and gels.
High drug load and a consistent drug release profile means the Medherant patches out-perform other patches and gels in their ability to deliver a consistent and significant dose of drug over a prolonged time from a small patch.
It is a cosmetically pleasing transparent design with stronger adhesion than other commercial products – remaining stuck over its time of action but easy and comfortable to remove.
University of Warwick research chemist Professor David Haddleton said:
‘Many commercial patches surprisingly don’t contain any pain relief agents at all, they simply soothe the body by a warming effect. Our technology now means that we can for the first time produce patches that contain effective doses of active ingredients such as ibuprofen for which no patches currently exist. Also, we can improve the drug loading and stickiness of patches containing other active ingredients to improve patient comfort and outcome.’

University of Warwick http://tinyurl.com/h9jqsyh

Sepsis, commonly called blood poisoning, is a common affliction that can affect people of all ages. A series of simple measures tested at a Norwegian hospital can make a difference in successfully treating sepsis.
Researchers were able to cut the number of patients who died from sepsis, or infections that spread to the bloodstream, by 40percent (from 12.5percent to 7.1percent) after the introduction of relatively simple steps at the wards at Levanger Hospital in Nord-Trondelag, Norway.
The steps, which included increased training and a special observation chart, were introduced as part of a research project carried out by Nord University, Levanger Hospital, and the Mid-Norway Centre for Sepsis Research at NTNU and St. Olavs Hospital in Trondheim, Norway.
‘This study suggests that ward nurses have a key function in increasing the survival for patients with serious infection. The use of cost-effective and clear tools for the identification of sepsis and the scoring of severity in patients as well as a standardized treatment course can achieve this,’ says Erik Solligard, the senior author of the study and head of the Mid-Norway Centre for Sepsis Research. ‘These simple steps should be implemented in all Norwegian hospitals.’
According to the Global Sepsis Alliance, a worldwide alliance of healthcare providers working to increase knowledge about the problem, the majority of sepsis cases are caused by common infections. Pneumonia, urinary tract infections, skin infections like cellulitis and infections in the abdomen (such as appendicitis) can cause sepsis, as well as invasive medical procedures like the insertion of a catheter into a blood vessel. The Alliance says sepsis is the primary cause of death from infection, despite advances in modern medicine like vaccines, antibiotics, and intensive care.
‘Sepsis is a very common and serious condition that many people die from,’ Solligard says. ‘Patients with lifestyle diseases such as diabetes or cancer are particularly at risk. However, sepsis doesn’t attract nearly as much attention.’
Solligard said rates of sepsis are expected to increase in the future, fuelled by the double problem of increasing incidences of lifestyle diseases and antibiotic-resistant bacteria. For that reason, hospitals should have a standardized observation regime so sepsis can be diagnosed early in its progression, and should create clear treatment plans for addressing sepsis, he said.
‘We need much more research on sepsis, especially on how the illness can be prevented,’ he said.
In their study, the researchers created a flow-chart for the identification of sepsis and an observation chart with a severity score that nurses at Levanger Hospital could use at the ward (for triage). Doctors who worked in the ward were given written information, whereas nurses and nursing students were given a 4-hour training course, and the treatment course was standardized with clear guidelines for doctors and nurses.
In addition to increasing survival, the use of these measures reduced the development of serious sepsis during hospital stays by 30percent and the number of days in intensive care was reduced by an average of 3.7 days per patient, thus making the methods not only life-saving, but simple and cost effective.

Gemini http://tinyurl.com/hh3dtvt

The 32nd Korea International Medical & Hospital Equipment Show held in Seoul from 17 to 20 March showcased Korea’s important medical equipment industry.

Over the years, KIMES has grown into one of the major trade shows in Asia. This year, the event gathered more than 73,000 visitors over 38,808 square meters of exhibition space. One of its main advantages is that it acts as a showcase for Korea’s particularly strong medical equipment industry. Indeed, out of the 1,152 companies from 37 countries who were exhibiting this year, 548 were Korean manufacturers and the show provided an ideal setting for highlighting the increasingly important role played by leading Korean companies such as Samsung, Listem, JW Medical, DK Medical, BIT Computer and Alpinion to name but a few.
As a platform enabling Korea’s medical device industry to show its latest equipment and technology alongside leading global players like GE, Fuji, Shimadzu and Hitachi, KIMES has succeeded in attracting numerous contingents of foreign visitors especially from the Asia region who have a strong purchasing power, including officials in medical institutions and hospitals, radiologists, medical laboratory specialists, pharmacists and emergency medical personnel. The number of foreign visitors has increased significantly this year, reaching 3563 medical professionals from 86 countries, a growth of 17.2% versus 2015. Over the last 5 years, the total of foreign visitors has grown by 184% compared with 19% for domestic visitors. Unsurprisingly, China is top of the list accounting for more than 30% of the total of foreign visitors, followed by South East Asia with nearly 20% and Japan.
A post show survey of exhibitors conducted by the organizers showed a majority of them satisfied with the results of their participation and over 70% committing to exhibit again in 2017.