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Patient-centered developments in colon-and rectal cancer with a multidisciplinary international team:From translational research to national guidelines

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1597-1614页

作者： Karl-Heinrich Link Marko Kornmann Ludger Staib Ernst-Dietrich Kreuser Wilhelm Gaus Erwin Röttinger Peter Suhr Catharina Maulbecker-Armstrong Peter Danenberg Kathleen Danenberg Miriam Schatz Silvia Sander Zhen-Ling Ji Jiang-Tao Li Shu-You Peng Reinhard Bittner Hans Günther Beger Benno Traub Asklepios Tumor Center(ATC)and Surgical Center Asklepios Paulinen KlinikWiesbaden 65197Germany FOGT(Multidisciplinary Study Group on Oncology of Gastrointestinal Tumors) University of UlmUlm 89081Germany Department of General and Visceral Surgery University of UlmUlm 89081Germany Department of Biometry and Medical Documentation University of UlmUlm 89081Germany Department of Radiotherapy University of UlmUlm 89081Germany Fachbereich Gesundheit Medizinisches ManagementSozialversicherungssystemeInternationales Versorgungsmanagemente-HealthTechnische Hochschule MittelhessenGiessen 35390Germany Department of Biochemistry and Molecular Medicine Keck-USC School of MedicineLos AngelesCA 90033United States Norris Comprehensive Cancer Center Keck-USC School of MedicineLos AngelesCA 90033United States Private Practice for Psychology Adelsdorf 91325Germany Department of General Surgery Southeast UniversityNanjing 210009Jiangsu ProvinceChina Department of Surgery The Second Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310009Zhejiang ProvinceChina Surgical Clinic MarienhospitalStuttgart 70177Germany

Rarely,scientific developments centered around the patient as a whole *** multidisciplinary group,headed by gastrointestinal surgeons,applied this research philosophy considering the most important aspects of thediseases“colon-and rectal cancer”in the long-term *** expertcooperation/knowledge at the Comprehensive Cancer Center Ulm(CCCU)wereapplied in several phase III trials for multimodal treatments of primary tumors(MMT)and metastatic diseases(involving nearly 2000 patients and 64 centers),fortreatment individualization of MMT and of metastatic disease,for psychooncology/quality of life involving the patients’wishes,and for disease *** of the targets initially were heavily rejected/discussed in thescientific communities,but now have become standards in treatments andnational guidelines or are topics in modern translational research protocolsinvolving molecular biology for e.g.,“patient centered individualized treatment”.In this context we also describe the paths we had to tread in order to realize ournew goals,which at the end were highly beneficial for the patients from manypoints of *** description is also important for students and youngresearchers who,with an actual view on our recent developments,might want toknow how medical progress was achieved.

关键词： Colon-and rectal cancer Translational research Interdisciplinary treatment Personalized treatment national guidelines

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Are Tuberculosis Patients Managed According to the national guidelines in Lagos State Nigeria?

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International Journal of Clinical Medicine 2016年第1期7卷 16-24页

作者： Olusola Adedeji Adejumo Olusoji James Daniel Mustapha Gidado Andrew Folarin Otesanya Esther Ngozi Adejumo Ebunoluwa O. Jaiyesimi Oluwatoyin Esther Idowu Olumuyiwa O. Odusanya Department of Community Health and Primary Health Care Lagos State University Teaching Hospital Ikeja Lagos Nigeria Department of Community Medicine and Primary Care Olabisi Onabanjo University Teaching Hospital Sagamu Nigeria KNCV Tuberculosis Foundation/TB CARE I Project Abuja Nigeria Medical Services Department Central Bank of Nigeria Lagos Nigeria Department of Medical Laboratory Science Babcock University Ilisan-Remo Nigeria Department of Community Health and Primary Health Care College of Medicine Lagos Lagos State University Lagos Nigeria

Setting: Private and public tuberculosis (TB) treatment centers in Lagos State, Nigeria. Objective: To compare adherence of private and public providers of directly observed treatment short course (DOTS) in the Lagos State TB control program, Nigeria (LSTBLCP) with the national TB guidelines. Design: A retrospective review of treatment cards of TB patients managed within the first and second quarter of 2012 in 34 DOTS facilities {23 public, 7 private for profit (PFP), and 4 private not for profit (PNFP)} involved in the private public mix of the LSTBLCP. Results: Of the 1896 treatment cards reviewed, 1524 (80.4%), 132 (7.0%) and 240 (12.6%) were from public, PFP and PNFP DOTS facilities, respectively. About 19%, 25% and none of the patients managed at the public, PNFP, and PFP DOTS facilities were treated in full adherence with the national guidelines respectively. A significantly higher proportion of adults and sputum smear positive TB patients were treated in full adherence with the national guidelines (p national guidelines. Conclusion: There is a need to reorient health care providers in public and private health facilities in Lagos State Nigeria to ensure full adherence with the national TB guidelines.

关键词： Adherence national guidelines Health Workers DOTS Facilities

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Problems faced by evidence-based medicine in evaluating lymphadenectomy for gastric cancer

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World Journal of Gastroenterology 2014年第36期20卷 12883-12891页

作者： Giuseppe Verlato Simone Giacopuzzi Maria Bencivenga Paolo Morgagni Giovanni De Manzoni Unit of Epidemiology and Medical Statistics Department of Public Health and Community Medicine University of Verona 37134 Verona Italy Unit of Upper GI Surgery University of Verona 37126 Verona Italy Gastrointestinal and General Surgery Unit Morgagni-Pierantoni Hospital 47121 Forlì Italy

Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy (D2) is the standard of care in Japan and South Korea since decades, while the majority of United States patients receive at most a limited lymphadenectomy (D1). United States and Northern Europe are considered the scientific leaders in medicine and evidence-based procedures are the cornerstone of their clinical practice. However, surgeons in Eastern Asia are more experienced, as there are more new cases of gastric cancer in Japan (107898 in 2012) than in the entire European Union (81592), or in South Korea (31269) than in the entire United States (21155). For quite a long time evidence-based medicine (EBM) did not solve the question whether D2 improves long-term prognosis with respect to D1. Indeed, eastern surgeons were reluctant to perform D1 even in the frame of a clinical trial, as their patients had a very good prognosis after D2. Evidence-based surgical indications provided by Western trials were questioned, as surgical procedures could not be properly standardized. In the present study we analyzed indications about the optimal extension of lymphadenectomy in gastric cancer according to current scientific literature (2008-2012) and surgical guidelines. We searched PubMed for papers using the key words “lymphadenectomy or D1 or D2” AND “gastric cancer” from 2008 to 2012. Moreover, we reviewed national guidelines for gastric cancer management. The support to D2 lymphadenectomy increased progressively from 2008 to 2012: since 2010 papers supporting D2 have achieved a higher overall impact factor than the other papers. Till 2011, D2 was the procedure of choice according to experts’ opinion, while three meta-analyses found no survival advantage after D2 with respect to D1. In 2012-2013, however, two meta-analyses reported that D2 improves prognosis with respect to D1. D2 lymphadenectomy was proposed as the standard

关键词： Gastric cancer Surgical quality Lymphadenectomy Evidence-based medicine national guidelines Eastern Asia United States

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