Biomedical subjects

Raoul Nap

Publications and source records attributed to Raoul Nap.

4 recordsLinked to original sources

PubMed2005

Increased incidence of brain metastases in cutaneous head and neck melanoma.

The incidence of cutaneous melanoma is increasing, and 10-20% of these melanomas are located in the head and neck region. The incidence of brain metastases, risk factors and outcome were analysed for melanomas originating in the head and neck region. During the period 1965-2000, 324 patients [152 females (47%), 172 males (53%)] were treated for cutaneous melanoma of the head and neck. The patients were staged according to the 2002 American Joint Committee on Cancer (AJCC) melanoma staging system. A matched control analysis was performed in order to identify the risk factors for the occurrence of brain metastases. The analysis was performed using cross-tabulations, chi-squared test and the logistic regression method. Twenty six (8%) head and neck patients, compared with 5.2% of extremity/truncal patients, developed brain metastases (confidence interval, 0.058-0.108; P<0.05). The 26 head and neck patients (four Stage I, 10 Stage II and 12 Stage III) had a median age of 46 years (range, 16-79 years) and developed brain metastases after a median follow-up of 24 months (range, 4-75 months). The median Breslow thickness was 3.3 mm (range, 0.7-12 mm). The patients were treated with steroids, surgery, radiation, chemotherapy, or a combination of these. The median survival after the development of brain metastases was 2.4 months (range, 0.2-64.3 months), with a 1-year overall survival of 15%. Risk factors identified for the development of brain metastases from head and neck melanoma were a younger age, male gender, Breslow thickness greater than 4 mm and increased mitotic rate. The incidence of brain metastases is significantly higher in patients with cutaneous melanoma of the head and neck (8%) compared with those with extremity/truncal melanoma (5.2%). The prognosis is still extremely poor with current therapies.

Adolescent↗

PubMed2004

Prognostic role of cyclooxygenase-2 expression in esophageal carcinoma.

Cyclooxygenase-2 (COX-2) is involved in esophageal carcinogenesis, but its clinical significance is not clarified yet. The association of several clinicopathological parameters with the immunohistochemical expression of COX-2 was analyzed in paraffin-embedded esophageal cancer specimens. In adenocarcinomas, COX-2 upregulation showed to be a late event and in a multivariate analysis it was associated independently with a reduced survival after surgery compared with low COX-2 expressed tumors (P=0.02). Although, the expression was extensively high in well-differentiated parts of squamous cell carcinoma, it was not related with a poor outcome. This study supports further investigation of selective COX-2 inhibitors in these tumors.

Barrett Esophagus↗

PubMed2004

The effect of a managerial-based intervention on the occurrence of out-of-range-measurements and mortality in intensive care units.

PURPOSE: To evaluate the effect of an organization-based managerial intervention on performance of intensive care units (ICUs). METHODS AND PARTICIPANTS: Prospective multicentre cluster-randomized study with an intervention at the level of ICU staff was carried out. The intervention comprised a set of managerial changes, concerning the nurses' level of skill discretion and participation in decision-making introduced during a period of six months. The ICU-performance was monitored before, during and after the intervention, in terms of mortality and occurrence of out-of-range-measurements (ORMs). The ORMs were defined as a derangement of systolic blood pressure (BP), heart rate (HR), oxygen saturation (SaO2) and urine output (Diur). Data were statistically analyzed by logistic regression with random effects due to ICUs. RESULTS: The overall ICU and hospital mortalities were 14% and 20%, the incidence of BP, HR, O2 and Diur ORM was respectively 46%, 38%, 28% and 48%. After adjusting for SAPSII, admission type and age the regression analyses revealed a positive effect of the intervention for all the six outcome variables. CONCLUSIONS: The intervention reduced both the ICU and hospital mortalities and the incidences of the out-of-range measurements. Registering ORMs provides a feasible method for evaluating ICU performance and could help to optimize individual patient care.

Adult↗

PubMed2003

Nursing activities score.

OBJECTIVES: The instruments used for measuring nursing workload in the intensive care unit (e.g., Therapeutic Intervention Scoring System-28) are based on therapeutic interventions related to severity of illness. Many nursing activities are not necessarily related to severity of illness, and cost-effectiveness studies require the accurate evaluation of nursing activities. The aim of the study was to determine the nursing activities that best describe workload in the intensive care unit and to attribute weights to these activities so that the score describes average time consumption instead of severity of illness. DESIGN: To define by consensus a list of nursing activities, to determine the average time consumption of these activities by use of a 1-wk observational cross-sectional study, and to compare these results with those of the Therapeutic Intervention Scoring System-28. SETTING: A total of 99 intensive care units in 15 countries. PATIENTS: Consecutive admissions to the intensive care units. INTERVENTION: Daily recording of nursing activities at a patient level and random multimoment recording of these activities. RESULTS: A total of five new items and 14 subitems describing nursing activities in the intensive care unit (e.g., monitoring, care of relatives, administrative tasks) were added to the list of therapeutic interventions in Therapeutic Intervention Scoring System-28. Data from 2,041 patients (6,451 nursing days and 127,951 multimoment recordings) were analyzed. The new activities accounted for 60% of the average nursing time; the new scoring system (Nursing Activities Score) explained 81% of the nursing time (vs. 43% in Therapeutic Intervention Scoring System-28). The weights in the Therapeutic Intervention Scoring System-28 are not derived from the use of nursing time. CONCLUSIONS: Our study suggests that the Nursing Activities Score measures the consumption of nursing time in the intensive care unit. These results should be validated in independent databases.

Critical Care↗