ObjectiveTo summarize the development of surgical treatment of rectal cancer.MethodReviewed the domestic and foreign literatures on surgical methods for rectal cancer.ResultsThe first real surgery for rectal cancer was performed by LisFrance in 1826. Because the early understanding of rectal cancer and its development was not clear, the operation effect was poor, and the postoperative recurrence rate was high. It was not until 1908, when Dr. Miles proposed the classic abdominoperineal resection (APR), that the recurrence of rectal cancer improved significantly. In the 20th century, there also appeared Hartmann, Dixon, Bacon, Parks, and other sphincter-preserving operations, among which Dixon surgery was the most influential. Dixon surgery had changed the focus of rectal cancer treatment from radical APR to more sphincter-preserving surgery. With the emergence of stapler, the introduction of concepts such as total mesorectal excision (TME) and circumferric resection margins (CRM), and the promotion of laparoscopic technology, resection and anastomosis of rectal cancer had a lower location, less surgical trauma, better postoperative quality of life, and higher survival rate. Modern rectal cancer surgery was gradually developing to precision and minimally invasive. Following TME, transanal total mesorectal excision (taTME) and natural orifice specimen extraction surgery (NOSES) had given a new meaning to the operation of rectal cancer.ConclusionsWith the in-depth understanding of the occurrence, development, recurrence, and metastasis of rectal cancer, surgical methods of rectal cancer are constantly developing and improving. The introduction of new concepts and surgical procedures is accompanied by controversy and doubt, which promotes the improvement of the treatment level of rectal cancer.
Objective To explore the application effect of a nursing management mode based on Swiss cheese model in safe medication for chemotherapy patients in daytime wards. Methods The study included chemotherapy patients in the Department of Day Care Ward of Tianjin Medical University Cancer Institute & Hospital between February and March 2023 (before improvement) and between June and July 2023 (after improvement). Before the improvement, a conventional nursing management mode was adopted, and after the improvement, a nursing management mode based on the Swiss cheese model was adopted. The medication safety ability of nurses, adverse drug events, and patients’ satisfaction of nursing before and after improvement were compared. Results Finally 150 patients were included before and after improvement, respectively. There was no statistically significant difference in age, gender, educational level, per capita monthly household income, tumor staging, and disease diagnosis between the two groups of patients (P>0.05). The total score of patients’ satisfaction of nursing after improvement was higher than before improvement (22.99±1.52 vs. 20.45±2.14, P<0.05), but there was no statistically significant difference in the dimensions of treatment environment and service attitude (P>0.05). There was no change in the nursing staff before and after the improvement, and a total of 34 nurses were included in the Department of Day Care Ward. The total score of the nurses’ medication safety ability was higher than before improvement [162.00 (160.75, 166.25) vs. 136.00 (135.00, 138.00), P<0.05], but there was no statistically significant difference in the dimensions of improving medication safety issues, multidisciplinary collaboration ability, and nursing professional responsibility (P>0.05). The incidences of adverse events during daytime chemotherapy after improvement were lower than before improvement (P<0.05). Conclusion The nursing management mode based on Swiss cheese model can improve the safety medication ability of nurses, reduce adverse events of chemotherapy medication in daytime wards, and improve patient satisfaction, which can be promoted in clinical practice.
ObjectiveTo explore the current situation of financial toxicity (FT) of breast cancer patients undergoing daytime chemotherapy under the background of diagnosis intervention packet (DIP) and its influencing factors, and to build a risk early warning model.Methods Convenient sampling method was used to select breast cancer patients undergoing chemotherapy in the daytime ward of Tianjin Medical University Cancer Institute & Hospital between April and May 2022. The general data questionnaire and FT comprehensive score scale were used to investigate them, and the influencing factors of patients’ FT were discussed through single factor analysis and logistic regression analysis, and the risk early warning model was established. Hosmer-Lemeshow fitting effect test was used to evaluate the prediction effect of the model.Results A total of 278 patients were included. The median (lower quartile, upper quartile) of FT score was 14.00 (8.75, 23.00), of which 195 patients (70.14%) had FT score≤22; 83 patients (29.86%) had FT scores>22. Logistic regression analysis showed that age, per capita monthly income of families, commercial health insurance, chemotherapy cycle, tumor stage, neoadjuvant chemotherapy were the influencing factors for high-risk FT of breast cancer patients undergoing daytime chemotherapy. The results of Hosmer-Lemeshow goodness of fit test showed that the model-predicted FT of breast cancer patients undergoing daytime chemotherapy was in good agreement with the actual observation value (χ2=10.685, P=0.220). The area under the curve of the model was 0.931 [95% confidence interval (0.900, 0.962)], the sensitivity was 0.807, and the specificity was 0.913.Conclusions The FT of breast cancer patients undergoing daytime chemotherapy is at a high level. Older age, purchase of commercial health insurance, and high per capita monthly income of families are protective factors for high-risk FT. The wind with chemotherapy cycle≤4 weeks, tumor stage Ⅱ, neoadjuvant chemotherapy are high-risk FT risk factors. The final warning model has been tested to have a good prediction effect, which can provide a reference for clinical medical staff to identify high-risk FT patients early and make preventive strategies as soon as possible.
Objective To establish a machine learning-based risk prediction model of combined chronic obstructive pulmonary disease (COPD) with lung cancer, so as to explore the high risk factors for COPD patients with lung cancer and to lay the foundation for early detection of lung cancer risk in COPD patients. Methods A total of 154 patients from the Second Hospital of Dalian Medical University from 2010 to 2021 were retrospectively analyzed, including 99 patients in the COPD group and 55 patients in the COPD with lung cancer group. the chest high resolution computed tomography (HRCT) scans and pulmonary function test of each patient were acquired. The main analyses were as follow: (1) to valid the statistically differences of the basic information (such as age, body mass index, smoking index), laboratory test results, pulmonary function parameters and quantitative parameters of chest HRCT between the two groups; (2) to analyze the indicators of high risk factors for lung cancer in COPD patients using univariate and binary logistic regression (LR) methods; and (3) to establish the machine learning model (such as LR and Gaussian process) for COPD with lung cancer patients. Results Based on the statistical analysis and LR methods, decreased BMI, increased whole lung emphysema index, increased whole lung mean density, and increased percentage activity of exertional spirometry and prothrombin time were risk factors for COPD with lung cancer patients. Based on the machine learning prediction model for COPD with lung cancer patients, the area under the receiver operating characteristic curve for LR and Gaussian process were obtained as 0.88 using the soluble fragments of prothrombin time percentage activity, whole lung emphysema index, whole lung mean density, and forced vital capacity combined with neuron-specific enolase and cytokeratin 19 as features. Conclusion The prediction model of COPD with lung cancer patients using a machine learning approach can be used for early detection of lung cancer risk in COPD patients.
Neurofeedback (NF) technology based on electroencephalogram (EEG) data or functional magnetic resonance imaging (fMRI) has been widely studied and applied. In contrast, functional near infrared spectroscopy (fNIRS) has become a new technique in NF research in recent years. fNIRS is a neuroimaging technology based on hemodynamics, which has the advantages of low cost, good portability and high spatial resolution, and is more suitable for use in natural environments. At present, there is a lack of comprehensive review on fNIRS-NF technology (fNIRS-NF) in China. In order to provide a reference for the research of fNIRS-NF technology, this paper first describes the principle, key technologies and applications of fNIRS-NF, and focuses on the application of fNIRS-NF. Finally, the future development trend of fNIRS-NF is prospected and summarized. In conclusion, this paper summarizes fNIRS-NF technology and its application, and concludes that fNIRS-NF technology has potential practicability in neurological diseases and related fields. fNIRS can be used as a good method for NF training. This paper is expected to provide reference information for the development of fNIRS-NF technology.
Objective To clarify the views of healthcare providers on the current vascular access shared decision-making model under the daytime chemotherapy mode, and to determine improvement measures to promote the conventional implementation of the daytime chemotherapy vascular access shared decision-making model. Methods Based on the SWOT model, an interview outline was developed. Using purposive sampling method, 7 doctors and 6 intravenous therapy nurses working at Tianjin Medical University Cancer Institute & Hospital from April to June 2023 were selected for semi-structured interviews, and content analysis method was used for data analysis. Results Four themes were extracted for internal advantages: alleviating the pressure of diagnosis and treatment and decision-making for doctors, ability and willingness of specialized intravenous therapy nurses to implement, promoting the rational selection of vascular pathways, enhancing the recognition of vascular pathways in daytime chemotherapy patients, and enhancing communication stickiness between nurses and patients. Four themes were extracted for internal weaknesses: increased workload, impractical decision support tools, unsmooth implementation processes, and incomplete informatization. Three themes were extracted for external opportunities: national policy support, willingness of daytime chemotherapy patients to participate in decision-making, and sufficient evidence-based evidence. Three themes were extracted for external threats: poor communication between healthcare providers under daytime chemotherapy mode, cognitive differences related to intravenous therapy among healthcare providers, and insufficient confidence in nurse leadership. Conclusions The vascular pathway shared decision-making led by intravenous therapy nurses has certain advantages in the daytime chemotherapy mode. In the future, we should seize existing opportunities, avoid our own weaknesses, face external threats, and develop a standardized vascular access shared decision-making model led by intravenous therapy nurses under the daytime chemotherapy mode, promoting the best evidence-based practice for vascular access decision-making during daytime chemotherapy.