The Experts below are selected from a list of 291 Experts worldwide ranked by ideXlab platform
Bruce Ramshaw - One of the best experts on this subject based on the ideXlab platform.
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Evaluating effectiveness of cognitive behavioral therapy within multimodal treatment for chronic Groin pain after inguinal hernia repair
Surgical Endoscopy, 2019Co-Authors: Miles Landry, Rachel Lewis, Brandie Forman, Eric Heidel, Bruce RamshawAbstract:Introduction The development of chronic Groin pain after inguinal hernia repair is a complex problem with many potential factors contributing to its development. Surgical options for alleviation of symptoms are limited and only performed by a few centers dedicated to its treatment. Opportunities to apply the principles of a prehabilitation program, including Cognitive Behavioral Therapy (CBT), aim to improve the surgical outcomes for this condition. Methods and procedures A multi-disciplinary hernia team has implemented a clinical quality improvement (CQI) effort in an attempt to better measure and improve outcomes for patients suffering with chronic Groin pain after inguinal hernia repair. Between April 2011 and August 2018, 129 patients (157 Groins) underwent surgical treatment for chronic Groin pain after inguinal hernia repair. Data were collected to compare outcomes for those undergoing preoperative CBT and patients who did not have CBT prior to their operation. Results Of 129 total patients, baseline demographics were similar in terms of gender, age, and BMI. In total, 27 patients (32 Groins) underwent prehabilitation with CBT (20.93%). We found none of the patients who underwent preoperative CBT had new postoperative pain and all patient procedures were able to be performed on an outpatient basis. Overall, 15 (14.7%) patients had no improvement in symptoms after surgery from the non-CBT group, whereas there was improvement in chronic pain for all patients who underwent CBT. Conclusion This attempt at process improvement demonstrated beneficial effects for patients who had CBT as part of a prehabilitation program prior to a surgical procedure to attempt to relieve Groin pain after inguinal hernia repair. As with any CQI analysis, other factors may have contributed to these outcomes and these results may be different in another local environment.
J Van Der Velden - One of the best experts on this subject based on the ideXlab platform.
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Primary Groin irradiation vs primary Groin surgery for early vulvar cancer.
The Cochrane database of systematic reviews, 2020Co-Authors: J Van Der Velden, A AnsinkAbstract:Despite changes in technique, morbidity after surgical treatment for vulvar cancer is considerable and mainly related to the Groin dissection. Primary radiotherapy to the Groin is expected to result in lower morbidity. However, studies on the efficacy of primary radiotherapy for the Groins in terms of Groin recurrences and survival show conflicting results. To determine whether the effectiveness and safety of primary radiotherapy to the inguino-femoral lymph nodes is comparable with surgery The literature search was carried out using the criteria set by the Cochrane Gynaecological Cancer Group. A MEDLINE and EMBASE search using the Mesh Heading 'vulvar neoplasms' and textword 'vulva' was performed. Publications on the effectiveness of primary radiotherapy treatment of early squamous cell carcinoma of the vulva were selected. Randomized clinical trials, case-control and observational studies of primary radiotherapy of the Groin Type of participants: Patients with early squamous cell cancer of the vulva Type of interventions: inguino-femoral lymph node dissection and primary radiotherapy of the inguino-femoral lymph nodes. Type of outcome measurements: incidence of Groin recurrences, survival and morbidity Two reviewers independently assessed study quality and extracted results Out of nine reviewed papers only three met the selection criteria. From these studies, (one randomised controlled trial ¿RCT¿ one case-control and one observational study) it became clear from the RCT that the incidence of Groin recurrences after primary radiotherapy is higher compared with surgery. survival was also worse in the radiotherapy group. The other two studies showed a higher than expected number of Groin recurrences after primary radiotherapy. Morbidity after primary radiotherapy was lower compared with surgery. The conclusion of the RCT was criticized on the grounds of the depth of the radiotherapy administered. The depth of 3 cm used in the RCT, is too shallow to administer an optimal dose to the deeper Groin nodes. As shown in an RCT, primary radiotherapy to the Groin results in less morbidity but also in a higher number of Groin recurrences compared with surgery. Although the technique of radiotherapy in the RCT was criticized, other uncontrolled data do not give evidence for a similar or better Groin control for radiotherapy when compared to surgery. This means that surgery is still to be considered the cornerstone of therapy for the Groin nodes in women with vulvar cancer. Individual patients not fit enough to withstand surgery can be treated with primary radiotherapy.
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The Cochrane Library - Primary Groin irradiation versus primary Groin surgery for early vulvar cancer.
Cochrane Database of Systematic Reviews, 2011Co-Authors: J Van Der Velden, Guus Fons, Theresa A LawrieAbstract:BACKGROUND: Despite changes in technique, morbidity after surgical treatment for vulvar cancer is considerable and mainly related to the Groin dissection. Primary radiotherapy to the Groin is expected to result in lower morbidity. However, studies on the efficacy of primary radiotherapy for the Groins in terms of Groin recurrences and survival show conflicting results. OBJECTIVES: To determine whether the effectiveness and safety of primary radiotherapy to the inguino-femoral lymph nodes is comparable with surgery SEARCH STRATEGY: The literature search was carried out using the criteria set by the Cochrane Gynaecological Cancer Group. A MEDLINE and EMBASE search using the Mesh Heading 'vulvar neoplasms' and textword 'vulva' was performed. Publications on the effectiveness of primary radiotherapy treatment of early squamous cell carcinoma of the vulva were selected. TYPE OF STUDY: Randomized clinical trials, case-control and observational studies of primary radiotherapy of the Groin Type of participants: Patients with early squamous cell cancer of the vulva Type of interventions: inguino-femoral lymph node dissection and primary radiotherapy of the inguino-femoral lymph nodes. Type of outcome measurements: incidence of Groin recurrences, survival and morbidity DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed study quality and extracted results MAIN RESULTS: Out of nine reviewed papers only three met the selection criteria. From these studies, (one randomised controlled trial ?RCT? one case-control and one observational study) it became clear from the RCT that the incidence of Groin recurrences after primary radiotherapy is higher compared with surgery. survival was also worse in the radiotherapy group. The other two studies showed a higher than expected number of Groin recurrences after primary radiotherapy. Morbidity after primary radiotherapy was lower compared with surgery. The conclusion of the RCT was criticized on the grounds of the depth of the radiotherapy administered. The depth of 3 cm used in the RCT, is too shallow to administer an optimal dose to the deeper Groin nodes. REVIEWER'S CONCLUSIONS: As shown in an RCT, primary radiotherapy to the Groin results in less morbidity but also in a higher number of Groin recurrences compared with surgery. Although the technique of radiotherapy in the RCT was criticized, other uncontrolled data do not give evidence for a similar or better Groin control for radiotherapy when compared to surgery. This means that surgery is still to be considered the cornerstone of therapy for the Groin nodes in women with vulvar cancer. Individual patients not fit enough to withstand surgery can be treated with primary radiotherapy.
Miles Landry - One of the best experts on this subject based on the ideXlab platform.
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Evaluating effectiveness of cognitive behavioral therapy within multimodal treatment for chronic Groin pain after inguinal hernia repair
Surgical Endoscopy, 2019Co-Authors: Miles Landry, Rachel Lewis, Brandie Forman, Eric Heidel, Bruce RamshawAbstract:Introduction The development of chronic Groin pain after inguinal hernia repair is a complex problem with many potential factors contributing to its development. Surgical options for alleviation of symptoms are limited and only performed by a few centers dedicated to its treatment. Opportunities to apply the principles of a prehabilitation program, including Cognitive Behavioral Therapy (CBT), aim to improve the surgical outcomes for this condition. Methods and procedures A multi-disciplinary hernia team has implemented a clinical quality improvement (CQI) effort in an attempt to better measure and improve outcomes for patients suffering with chronic Groin pain after inguinal hernia repair. Between April 2011 and August 2018, 129 patients (157 Groins) underwent surgical treatment for chronic Groin pain after inguinal hernia repair. Data were collected to compare outcomes for those undergoing preoperative CBT and patients who did not have CBT prior to their operation. Results Of 129 total patients, baseline demographics were similar in terms of gender, age, and BMI. In total, 27 patients (32 Groins) underwent prehabilitation with CBT (20.93%). We found none of the patients who underwent preoperative CBT had new postoperative pain and all patient procedures were able to be performed on an outpatient basis. Overall, 15 (14.7%) patients had no improvement in symptoms after surgery from the non-CBT group, whereas there was improvement in chronic pain for all patients who underwent CBT. Conclusion This attempt at process improvement demonstrated beneficial effects for patients who had CBT as part of a prehabilitation program prior to a surgical procedure to attempt to relieve Groin pain after inguinal hernia repair. As with any CQI analysis, other factors may have contributed to these outcomes and these results may be different in another local environment.
A Ansink - One of the best experts on this subject based on the ideXlab platform.
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Primary Groin irradiation vs primary Groin surgery for early vulvar cancer.
The Cochrane database of systematic reviews, 2020Co-Authors: J Van Der Velden, A AnsinkAbstract:Despite changes in technique, morbidity after surgical treatment for vulvar cancer is considerable and mainly related to the Groin dissection. Primary radiotherapy to the Groin is expected to result in lower morbidity. However, studies on the efficacy of primary radiotherapy for the Groins in terms of Groin recurrences and survival show conflicting results. To determine whether the effectiveness and safety of primary radiotherapy to the inguino-femoral lymph nodes is comparable with surgery The literature search was carried out using the criteria set by the Cochrane Gynaecological Cancer Group. A MEDLINE and EMBASE search using the Mesh Heading 'vulvar neoplasms' and textword 'vulva' was performed. Publications on the effectiveness of primary radiotherapy treatment of early squamous cell carcinoma of the vulva were selected. Randomized clinical trials, case-control and observational studies of primary radiotherapy of the Groin Type of participants: Patients with early squamous cell cancer of the vulva Type of interventions: inguino-femoral lymph node dissection and primary radiotherapy of the inguino-femoral lymph nodes. Type of outcome measurements: incidence of Groin recurrences, survival and morbidity Two reviewers independently assessed study quality and extracted results Out of nine reviewed papers only three met the selection criteria. From these studies, (one randomised controlled trial ¿RCT¿ one case-control and one observational study) it became clear from the RCT that the incidence of Groin recurrences after primary radiotherapy is higher compared with surgery. survival was also worse in the radiotherapy group. The other two studies showed a higher than expected number of Groin recurrences after primary radiotherapy. Morbidity after primary radiotherapy was lower compared with surgery. The conclusion of the RCT was criticized on the grounds of the depth of the radiotherapy administered. The depth of 3 cm used in the RCT, is too shallow to administer an optimal dose to the deeper Groin nodes. As shown in an RCT, primary radiotherapy to the Groin results in less morbidity but also in a higher number of Groin recurrences compared with surgery. Although the technique of radiotherapy in the RCT was criticized, other uncontrolled data do not give evidence for a similar or better Groin control for radiotherapy when compared to surgery. This means that surgery is still to be considered the cornerstone of therapy for the Groin nodes in women with vulvar cancer. Individual patients not fit enough to withstand surgery can be treated with primary radiotherapy.
Theresa A Lawrie - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Primary Groin irradiation versus primary Groin surgery for early vulvar cancer.
Cochrane Database of Systematic Reviews, 2011Co-Authors: J Van Der Velden, Guus Fons, Theresa A LawrieAbstract:BACKGROUND: Despite changes in technique, morbidity after surgical treatment for vulvar cancer is considerable and mainly related to the Groin dissection. Primary radiotherapy to the Groin is expected to result in lower morbidity. However, studies on the efficacy of primary radiotherapy for the Groins in terms of Groin recurrences and survival show conflicting results. OBJECTIVES: To determine whether the effectiveness and safety of primary radiotherapy to the inguino-femoral lymph nodes is comparable with surgery SEARCH STRATEGY: The literature search was carried out using the criteria set by the Cochrane Gynaecological Cancer Group. A MEDLINE and EMBASE search using the Mesh Heading 'vulvar neoplasms' and textword 'vulva' was performed. Publications on the effectiveness of primary radiotherapy treatment of early squamous cell carcinoma of the vulva were selected. TYPE OF STUDY: Randomized clinical trials, case-control and observational studies of primary radiotherapy of the Groin Type of participants: Patients with early squamous cell cancer of the vulva Type of interventions: inguino-femoral lymph node dissection and primary radiotherapy of the inguino-femoral lymph nodes. Type of outcome measurements: incidence of Groin recurrences, survival and morbidity DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed study quality and extracted results MAIN RESULTS: Out of nine reviewed papers only three met the selection criteria. From these studies, (one randomised controlled trial ?RCT? one case-control and one observational study) it became clear from the RCT that the incidence of Groin recurrences after primary radiotherapy is higher compared with surgery. survival was also worse in the radiotherapy group. The other two studies showed a higher than expected number of Groin recurrences after primary radiotherapy. Morbidity after primary radiotherapy was lower compared with surgery. The conclusion of the RCT was criticized on the grounds of the depth of the radiotherapy administered. The depth of 3 cm used in the RCT, is too shallow to administer an optimal dose to the deeper Groin nodes. REVIEWER'S CONCLUSIONS: As shown in an RCT, primary radiotherapy to the Groin results in less morbidity but also in a higher number of Groin recurrences compared with surgery. Although the technique of radiotherapy in the RCT was criticized, other uncontrolled data do not give evidence for a similar or better Groin control for radiotherapy when compared to surgery. This means that surgery is still to be considered the cornerstone of therapy for the Groin nodes in women with vulvar cancer. Individual patients not fit enough to withstand surgery can be treated with primary radiotherapy.
