Journal of oncology practice
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The treatment of stage I non-small-cell lung cancer has advanced markedly over the past century. The transition from therapeutic nihilism with ensured mortality to radical surgery with pneumonectomy to rational oncologic-based resection has resulted in dramatically improved outcomes and reduced morbidity. The superiority of anatomic resection with lobectomy over sublobar resection for fit patients with stage I disease, where more than one half of all patients should expect to be cured, is backed by level 1 evidence. ⋯ In particular, provocative results with stereotactic body radiotherapy have led to rapid adoption in clinical practice with a resultant decrease in the number of untreated patients. A comparison of outcomes across studies of competing modalities remains challenging given the potential impact of selection bias in single-arm trials, and attempts to conduct randomized studies have been largely unsuccessful. Given the uncertainty in defining optimal therapy, patients are best served by a multidisciplinary team of thoracic surgeons, radiation oncologists, pulmonologists, and chest and interventional radiologists to ensure that they receive the evaluation and treatment best suited not only to their tumor and medical challenges but also to their concerns, fears, and values.
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Multicenter Study
Mixed-Methods Study of the Impact of Chronic Patient Death on Oncologists' Personal and Professional Lives.
Although some research has found that health care professionals experience grief when their patients die, within the oncology context, few studies have examined the impact of this loss on oncology personnel. Given the paucity of empirical studies on this topic, this research explored the impact of patient death on oncologists. Methods and Materials This study used a mixed-methods design. The qualitative component used the grounded theory method of data collection and analysis. Twenty-two oncologists were recruited from three adult oncology centers. Purposive sampling was used to gain maximum variation in the sample. The quantitative component involved a convenience sample of 79 oncologists recruited through oncologist collaborators. ⋯ Frequent patient death has an impact on oncologists' lives, some of which negatively affect the quality of life for oncologists, their families, and their patients.
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Surgical site infections (SSIs) are associated with patient morbidity and increased health care costs. Although several national organizations including the University HealthSystem Consortium (UHC), the National Surgical Quality Improvement Program (NSQIP), and the National Healthcare Safety Network (NHSN) monitor SSI, there is no standard reporting methodology. ⋯ There is discordance among national reporting agencies tracking SSI. Adopting standardized metrics across agencies could improve consistency and accuracy in assessing SSI rates.
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Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs. ⋯ Given the high frequency of avoidable terminal ICU hospitalizations, health care leaders should develop strategies to prospectively identify patients at high risk and formulate interventions to improve end-of-life care.