Purpose: To evaluate patient satisfaction (with emphasis on preoperative education) with radical cystectomy for bladder cancer at our institution, the University of Missouri Hospital, qualitatively in order to identify specific areas where improvements can be made. Materials and Methods: We developed a patient survey that used open-ended questions to identify positive and negative experiences that contributed to patient satisfaction. We administered the survey to radical cystectomy patients who met inclusion criteria and agreed to participate. We recorded, transcribed and qualitatively coded the responses. We identified four themes under which both positive and negative responses were placed, and constructed two diagrams to better illustrate contributors to patient experience and satisfaction. Results: We identified 25 patients who met inclusion criteria. Of those, 13 participated in the survey. Regarding overall experience, 92.3% of patients rated their care as excellent or good. Regarding preoperative education, 76.9% of patients reported they definitely or somewhat received enough information on what to expect after surgery, and 76.9% definitely received enough guidance on how to care for themselves after surgery. From qualitative coding of patient responses to open-ended questions, we identified preoperative preparation, delivery of care, caregiver availability, and patient-centered care as themes that contributed positively and negatively to patient experience. Conclusion: Although the overall patient satisfaction could be perceived as high (92.3%), qualitative analysis revealed several areas where improvements can be made to improve patient experience with radical cystectomy at our institution. As previously expected, preoperative preparation was a contributor.
VEP (25.4% vs. 20.7%, p<0.04). Laparoscopic approach was more frequent in the VEP (43.2% vs. 37%, p<0.04). Partial nephrectomy and lymphadenectomy were performed less frequently in the older group (p<0.01, and p<0.02, respectively); there were no differences in surgical time, surgical margins, estimated blood loss (EBL), blood transfusions or complication rates. Length of stay was slightly longer in the VEP (4AE4 vs. 4AE3 days, p<0.01). On multivariate regression analysis, EBL!500cc (OR 2.06, CI 95% 1.36-3.11, p<0.00) was independently associated with perioperative complications.CONCLUSIONS: Despite VEP having more comorbidities, worse performance status and more pT3-4 tumors, surgical resection of RCC is a safe and successful intervention in this subgroup. Perioperative outcomes are similar to their younger counterparts. Age alone should not guide decision making in these patients and treatment must be tailored according to performance status and severity of other comorbidities.
The identification of relevant frame sequences in an endoscopy video is labor-intensive and complicated by the poor data integrity of endoscopic information. We designed a surgeon-guided framework to efficiently manage the visual data from commonly performed bladder endoscopy (cystoscopy) videos. Screenshots of bladder lesions were captured during cystoscopy during transurethral resection of bladder tumor, then manually labeled according to case identification, date, lesion location, imaging modality, and pathology. The framework used the screenshot to search for and extract a corresponding 10-second video clip. Each video clip included a one-second space holder with a QR barcode informing the video content. The success of the framework was measured by the secondary use of these short clips and the reduction of storage volume required for video materials. From 86 cases, the framework successfully generated 249 video clips from 230 screenshots, with 14 erroneous video clips from 8 screenshots excluded. The HIPPA-compliant barcodes provided information of video contents with a 100% data completeness. A web-based educational gallery was curated with various diagnostic categories and annotated frame sequences. Compared with the unedited videos, the informative short video clips reduced the storage volume by 99.5%. In conclusion, our framework expedites the generation of visual contents with surgeon’s instruction for cystoscopy and potential incorporation of video data towards applications including clinical documentation, education, and research.
Introduction: Conflicting reports exist regarding characteristics and outcomes of patients with only invasive lobular carcinoma (ILC) and mixed invasive lobular and ductal carcinoma (ILC/IDC). The purpose of this project is to report experience of 20 year cohort at one institution. Methods: Patients diagnosed with ILC between 1990 and 2010 were divided into two groups: ILC alone and ILC/IDC. Patient demographics, history, diagnosis and treatment modalities, and outcomes were captured. Chi-square, log-rank, and Wilcoxon rank sums tests were utilized for statistical analysis. P < 0.05 was considered significant. Results: In 189 AJCC Stage I-III patients, ILC was identified in 149 (79%) and ILC/IDC in 39 (21%). ILC stage was I, II, III in 46 (31%), 57 (41%), 32 (21%) ILC, and ILC/IDC was 17 (44%), 16 (41%), 4 (10%). Median age (range) at diagnosis was 64 (31-88) for ILC and 64 (35-84) years for ILC/IDC (p = 0.78). Median largest tumor diameter was 22 (range 1-100) in ILC, and 20 (range 2-110) mm in ILC/IDC (p = 0.97). Seventy-eight (52%) and 20 (51%) were diagnosed with ILC and ILC/IDC clinically, and 58 (39%) and 15 (38%) were diagnosed with ILC and ILC/IDC radiographically (p = 0.96). Treatment modalities were mastectomy and breast conservation therapy in 82(55%) and 67(45%) of patients with ILC, 18 (46%) and 21 (54%) of patients with ILC/IDC (p = 0.32). In 136 (91%) ILC and 33 (85%) ILC/IDC patients who had nodal evaluation/excision, 59 (43%) ILC and 12 (36%) ILC/IDC patients presented with positive nodal status. ER, PR, and HER2 status were positive in 132 (89%), 104 (70%), 7 (5%) ILC, and 29 (74%), 26 (67%), 3 (8%) ILC/IDC patients respectively (p = 0.02, p = 0.85, p = 0.17). Median (range) follow-up for ILC was 6.1 (< 1-22.3), and 8.0 (1.72-17.7) years for ILC/IDC (p = 0.03). At the time of analysis, 43(29%) patients with ILC, and 11(28%) patients with ILC/IDC had expired (p = 0.94). Median (range) follow-up for patients who were alive at time of analysis was 6.8 (<1-20.7) years for ILC, and10.1 (2.3-17.7) years for ILC/IDC (p = 0.06). Time to first recurrence was 3.23 (0.8-17.0) years in ILC, and 5.2 (2.9-9.3) years in ILC/IDC (p = 0.20). Recurrence was identified in 33(22%) ILC: 15(46%) locoregional and18 (54%) distant disease. Similarly, recurrence was found in 7 (20%) ILC/IDC patients: 4 locoregional and 3 distant. Most locoregional recurrences, 12/15 (80%), occurred in the ipsilateral breast in ILC, and 3/4 (75%) in ILC/IDC (p = 0.82). Five years disease free survival rates were 76% ILC and 85% for ILC/IDC, and 10 years rates were 63% for ILC and 67% for ILC/IDC (p = 0.4941). Overall survival estimates at 5 years were 84% for ILC and 92% for ILC/IDC, and at 10 years were 65% for ILC and 74% for ILC/IDC (p = 0.52). Conclusion: While basic demographics and survival patterns did not differ statistically between ILC and ILC/IDC, pure ILC histology tends to carry a higher risk of recurrence, as well as worse disease free and overall survival compared to ILC/IDC. ILC histology was more likely to be ER positive, present with advanced stage, and recur in the ipsilateral breast than the contralateral breast. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-35.
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