Symptoms and General Pathology

All Conditions

Emergencies

Disease Attributes

Olivier Peyrony, MD

Patients with cancer or hematological malignancy are susceptible to present acute complications linked to their disease or to their specific treatments (dyspnea, sepsis, coma, hemorrhagic syndrome). Emergency physicians are in first line when these complications arise and have to face with some complex situations in which informations about patient malignancy or prognosis may be lacking. Nowadays, there is very few epidemiological data published concerning how cancer patient use Emergency Departments (EDs) and cancer patient care delivery in the EDs.

Thus, an observational multicenter prospective cross-sectional study is conducted to study the prevalence of cancer patients admitted to French EDs, and to describe the different reasons for cancer patients to seek care in EDs with their prevalence and underscore those linked to cancer or treatment complication

Epidemiological Characteristics and Prognosis Factors of Cancer Patients Admitted at French Emergency Departments

Assistance Publique - Hôpitaux de Paris

Reach MEWS Alarm, Not reach MEWS Alarm, With 7 day mortality, Without 7 day mortality

AU HANG CHING

Hang Ching Au

This study is to validate the use of the modified early warning score (MEWS) in an adult oncology ward as a predictor of 7 day mortality or intensive care unit (ICU) admission. It is expected that either a MEWS score ≥4 or a change in score of ≥2 from the initial reading will be associated with an increased risk of death or ICU admission, and should be regarded as a MEWS Alarm. If MEWS is proof to be a reliable alternative tool, early diagnosis and aggressive management of life-threatening complications in oncology patients, results in dramatic improvements in overall survival rates.

This is a prospective, single centre, observational, cohort study. Objective of this study is to investigate the ability of the Modified Early Warning Score (MEWS) to predict 7 day mortality in adult clinical oncology ward patients.

The alternate hypothesis of this study is a significant difference in 7 day mortality between adult oncology ward patients with a MEWS Alarm and adult oncology ward patients without a MEWS alarm.

The null hypothesis is a no significant difference in 7 day mortality between adult oncology ward patients with a MEWS Alarm and adult oncology ward patients without a MEWS alarm.

The primary outcome measure in this study is the number of patients who die within 7 days of a MEWS Alarm (7 day mortality).

The secondary outcome measure in this study is the number of patients admitted to ICU within 7 days of a MEWS Alarm.

This study will be conducted in a 26-bedded clinical oncology ward, a university teaching hospital in the Hong Kong Island of Hong Kong.

The patients consecutively admitted to clinical oncology ward from 18 January to 7 February 2015 are included in the study, the patients was counted 7 day mortality or 7 day ICU admission from the on set of reaching the MEWS Alarm. The patients with incomplete MEWS or discharge data are excluded.

A pilot study was conducted from 13 July at the time of 0am to 18 July at the time of 0am, 2014, 41 patients were admitted consecutively to the clinical oncology ward during the study period. 10 of them were excluded because of their incomplete MEWS chart, leaving 31 patients in the pilot study. 18 of them are male and 13 of them are female. 1 patient was transfer to ICU on her second day from admission, as the MEWS score increased by 3 from initial. Six patients had 7 day mortality with MEWS alarm and one patient had 7 day mortality without MEWS alarm in the study period. According to the sample size formulas and the calculators, the estimated sampling is 171 patients from 18 January to 7 February 2015.

MEWS is a standard nursing routine measurement by calculating the sum of five physiological parameters: systolic blood pressure, pulse rate, respiratory rate, body temperature and level of consciousness. The calculated MEWS score is being charted on an observation chart sheet. Nursing staff routinely collect MEWS score on admission and then once every day during hospital stay. The date of admission to ICU, and date of death are also collected .

In detail, blood pressure and pulse rate are measured electronically (Dinamap Pro 200 Critikon Vital Signs Monitor, U.S.A). The respiratory rate is counted over one minute. The tympanic temperature is recorded (ThermoScan, Type 6014, Braun, Germany), and the level of consciousness is based on the AVPU score: A is 'alert', V is 'response to verbal', P is 'response to pain' and U for 'unresponsive').

The MEWS score is counterchecked by doctors after doctors' assessment on admission and at the doctors' round everyday.

An ethical approval will be acquired from the CUHK and Queen Mary Hospital Clinical Research Ethics Committee. All the participants involved in the study will not experience any harm. Potential participants will be given written information regarding the nature of the study and the assurances confidentiality for the data collected. Written Consent will be signed. All report copies collected will be kept confidential. Patient can choose whether or not to be in this study. If they volunteer to be in this study, they may withdraw at any time without consequences of any kind of loss or benefits.

For data analysis, the 7 day mortality with reaching MEWS Alarm will compare with the ones without reaching MEWS Alarm by Chi-Squared Test. The relationship between MEWS and the mortality is statistically significant if the P value is lower than 0.05. Besides, same method of data analysis is used on ICU admission with or without reaching MEWS Alarm.

Validation of Modified Early Warning Score (MEWS) in Predicting Outcomes in Clinical Oncology Ward Adult Patients

Chinese University of Hong Kong

Master Student

Digestive System Diseases

Wounds and Injuries

Colonic Diseases

Diverticulitis

Intussusception

Foreign Bodies

Intestinal Volvulus

Gastrointestinal Diseases

Intestinal Diseases

Diverticulum

Diverticular Diseases

Gastroenteritis

Intestinal Obstruction

Herbal and Botanical

All Drugs and Chemicals

Cola

Evaluate the role of Hartmann's procedure in emergency setting for left-sided acute surgical colonic disease (perforated diverticulitis with purulent or fecal peritonitis; colon cancer perforation-obstruction; ischemic colitis; abdominal trauma).

Evaluate the role of colonic resection with primary anastomosis in emergency setting for left-sided acute surgical colonic disease (perforated diverticulitis with purulent or fecal peritonitis; colon cancer perforation-obstruction; ischemic colitis; abdominal trauma).

Hartmann's procedure

mario giuffrida

Hartmann's procedure was described for the first time in 1921 as an alternative to abdominoperineal resection for the treatment of upper rectal tumours.

Although Hartmann's procedure fell out of favour for rectal cancer after the introduction of restorative procedures, it remained the most common procedure in emergency setting for many years. Nowadays Hartmann's procedure is a useful procedure in selected cases e.g. severely ill patients with a high risk of anastomotic failure. However, restoring intestinal continuity for Hartmann patients is often associated with high morbidity, and about 70% will live with a permanent colostomy. Hartmann procedure' is a rapid and simple surgical technique intended to decrease perioperative morbidity and mortality. This technique is often performed by young surgeons Indeed, end colostomy may be necessary in situations where restoration of continuity is risky, either because of unfavorable local conditions or because a more definitive resection must be aborted due to hemodynamic instability. In the last decade the Hartmann's procedure has been revalued in many studies. In diverticular disease the results of DIVA arm of the LADIES trial showed that more patients in the primary anastomosis group were stoma free compared with patients in the Hartmann's procedure group. Other studies have observed no differences in major postoperative complications or postoperative mortality between patients undergoing primary anastomosis versus Hartmann's procedure.

Hartmann's procedure reversals were associated with a higher risk of serious postoperative complications than were stoma reversals after primary anastomosis with ileostomy.

Despite the growing evidence in favour of primary anastomosis and its inclusion as a valid treatment option for perforated diverticulitis or perforated sigmoid colon in recent clinical practice guidelines, some surgeons have been hesitant to undertake anastomosis in the setting of purulent or faecal contamination and continue to choose Hartmann's procedure to eliminate concerns about anastomotic leakage.

Left-sided surgical acute colonic diseases (perforated diverticulitis with generalized peritonitis, colon perforation, large bowel obstruction, colon cancer perforation or obstruction, ischemic colitis, abdominal trauma) are still a life-threatening condition requiring urgent surgical intervention.

Despite several published randomized trials, showing that primary anastomosis with or without protective ileostomy is feasible and randomized trials for laparoscopic lavage with conflicting results, the Hartmann's procedure, described for the first time in 1921 as an alternative to abdominoperineal resection for the treatment of upper rectal tumours, is still performed in many hospitals worldwide. It remained the most common procedure for acute diverticulitis and colonic perforation in emergency setting for many years. Hartmann's procedure is safe for severely ill patients; however, restoring intestinal continuity for such patients is often associated with high morbidity leaving a great percentage of patients with (up to 50%) with a permanent stoma.

Hartmann procedure' is a rapid and simple surgical technique intended to decrease perioperative morbidity and mortality. This technique is often performed by young surgeons Indeed, end- colostomy may be necessary in situations where restoration of continuity is risky, either because of unfavourable local conditions (Hinchey IV peritonitis) or because a more definitive resection must be aborted due to hemodynamic instability. Although anastomosis at the time of surgery is an alternative approach to Hartmann's procedure, there have been concerns about the safety of this approach.

In the last decade the Hartmann's procedure has been revalued and the results of different studies \[DIVA arm of the LADIES trial; DIVERTI study; Halim et Al\] showed that more patients in the primary anastomosis group were stoma free compared with patients in the Hartmann's procedure group.

Several studies have observed no differences in major postoperative complications or postoperative mortality between patients undergoing primary anastomosis versus Hartmann's procedure. Hartmann's procedure reversals were associated with a higher risk of serious postoperative complications than were stoma reversals after protected primary anastomosis. The management of colorectal cancer emergencies is challenging. WSES guidelines recommend in case of perforation resection with anastomosis, with or without ileostomy. Hartmann's procedure should be preferred to simple colostomy, since colostomy appears to be associated with longer overall hospital stay and need for multiple operations, without a reduction in perioperative morbidity in patients with colorectal cancer obstruction. Resection with primary anastomosis should be preferred for uncomplicated malignant left-sided large bowel obstruction in absence of other risk factors. Patients with high surgical risk are better managed with Hartmann's procedure Despite the growing evidence in favour of primary anastomosis and its inclusion as a valid treatment option for perforated diverticulitis or perforated sigmoid colon cancer in recent clinical practice guidelines, surgeons have been reluctant to perform anastomosis. Moreover, the postoperative course of the septic patient is unpredictable and it very hard to estimate it intraoperatively.

In the setting of purulent or fecal contamination most surgeons choose Hartmann's procedure to eliminate also legal concerns about anastomotic leakage. It's important to note that most of these procedures are performed off normal working hours when maybe best colorectal expertise is lacking for decision making regarding anastomosis.

Primary study objective:

1. To evaluate the role of Hartmann's procedure in emergency setting for left-sided colonic acute surgical disease (perforated diverticulitis with purulent or fecal peritonitis; colon cancer perforation-occlusion; ischemic colitis; abdominal trauma) and the type of surgery commonly performed in different level of care hospitals.
2. To investigate which factors contribute in the choice of Hartmann's procedure instead of colon resection with primary anastomosis (Hospital characteristics, surgeon experience, time of surgery, age of patients, comorbidities, etc ) Study design: International multicenter prospective cohort study. Study population: Adult patients with left-sided colonic acute surgical disease who need surgery in an emergency setting (perforated diverticulitis with purulent or fecal peritonitis; colon cancer perforation-occlusion; ischemic colitis; abdominal trauma).

GOODBYE HARTMANN TRIAL: 100 YEARS OF HARTMANN'S PROCEDURE

GOODBYE HARTMANN. AFTER 100 YEARS HARTMANN'S PROCEDURE IS GOING TO BE ABANDONED?

* Etiology: perforated diverticulitis; perforated colonic cancer; large bowel perforation- obstruction; colon cancer perforation-obstruction; colon ischemia; abdominal trauma.
* Treatment: Hartmann's procedure, colonic resection with primary anastomosis with or without diverting stoma, stoma without colic resection.

- Hospital Characteristics: hospital type (academic, non-academic teaching, categorical, secondary hospital, tertiary hospital, level 4- trauma center); annual volume of

emergency surgical procedures; annual volume of left-sided colonic disease; types of diagnostic and treatment modalities that are available in the hospital.

* Surgeon experience (surgeon in training: less than 50 colorectal resections performed; less than 5 resections per year in the last 5 years; Trained surgeon: more than 50 colorectal resections performed; more than 10 resections per year in the last 5 years)
* Time of surgery: weekdays, weekend, public holidays, night shift (day: 8am- 8pm; night: 8pm-8am)

1 year follow up to evaluate the number of patients treated with Hartmann's procedure have a permanent stoma after one year.

Fausto Catena

Gennaro Perrone

Parma University Hospital

MD- General Surgery Resident

Laparoscopic operation

Open operation

Marie Grönroos-Korhonen, MD

Jyrki Kössi, adj Prof

Marie Grönroos-Korhonen

Jyrki Kössi, Doc

Marie T Grönroos-Korhonen, MD

This is a randomized, controlled, parallel, multicenter trial to compare post-operative complications and long-term results between open and laparoscopic technique in emergency colorectal surgery.

Laparoscopic technique in elective colorectal surgery has been shown to be advantageous for patients compared to open technique. However, the feasibility and potential benefits of laparoscopic colorectal surgery in emergency setting has not been evaluated sufficiently.

The aim of this study is to compare laparoscopic and open technique in emergency colon resections. Primary outcome is the immediate recovery after operation and secondary outcome is long-term overall and cancer-specific survival.

This is a prospective randomized controlled multicenter trial

Laparoscopic Approach for Emergency Colon Resection

Laparoscopic Approach for Emergency Colon Resection: a Randomized Controlled Trial

Postoperative morbidity evaluated by Clavien-Dindo classification

Surgical site infections, superficial and deep

Long-term overall and cancer-specific survival

Kanta-Häme Central Hospital

Joint Authority for Päijät-Häme Social and Health Care

Behaviors and Mental Disorders

Aggression

Conventional strategy: patients will be managed regardless of their PALLIA-10 score. The need for additional care, including palliative care, will be assessed by the team in charge of the patient, as per routine practice.

Experimental strategy: patients will be systematically referred to a palliative care team.

Patients randomized in the experimental arm will be systematically referred to a palliative care team.

A follow-up in palliative care will be initiated for all within a maximum of 15 days after the date of randomization.

Systematic referral to a palliative care team

Gisèle CHVETZOFF, MD, PhD

Julien GAUTIER

Gisèle CHVETZOFF, MD,PhD

Muriel THOMASO, MD

Carole BOULEUC, MD

Marie-Ange MASSIANI, MD

Aline HENRY, MD

Christine MATEUS, MD

This is a randomized, multicenter, prospective, phase III study conducted in daily emergency rooms of French Regional Comprehensive Cancer Centers.

In the standard arm, patients will be managed regardless of their PALLIA-10 score, following conventional strategy. In the experimental arm, patients will be systematically referred to a palliative care team.

This is a randomized, multicenter, prospective, phase III study conducted in daily emergency rooms of French Regional Comprehensive Cancer Centers.

All patients undergoing a visit in the daily emergency room of a participating center and who need for palliative management (PALLIA 10 score \> 3/10) will be considered for inclusion in the PALLU study. After signing the written informed consent, patients will be randomized (1:1 ratio) in one of the following arms:

* Standard arm : conventional strategy; patients will be managed regardless of their PALLIA-10 score. The need for additional care, including palliative care, will be assessed by the team in charge of the patient, as per routine practice.
* Experimental arm : experimental strategy; patients will be systematically referred to a palliative care team.

Randomization will be stratified according to the investigation center and pre-existing follow-up by pain management team.

The difference of intervention will lie in the fact that patients will be referred or not to a palliative care team but patients from the standard arm may receive palliative care as deemed necessary by the medical oncology team. In this case, the content of palliative care for patients included in both groups will be identical.

The end of the study will be the Last Patient Last Visit (LPLV), defined as the date of the 6-month visit of the last patient still alive or when the 192nd death has occurred, whichever occurs first.

Randomization (ratio 1:1) will be stratified according to the investigation center and pre-existing follow-up by pain management team.

Efficacy of a Systematic Referral to Palliative Care of Patients Who Need for Palliative Care During an Unscheduled Visit in Comprehensive Anticancer Centers

A Randomized Comparative Prospective Multicenter Study of the Efficacy of a Systematic Referral to Palliative Care of Patients Who Need for Palliative Care During an Unscheduled Visit in Comprehensive Anticancer Centers

Percentage and number of patients who meet at least one of the following criteria :

* More than 1 hospitalization in the last 30 days of life;
* More than 1 visit in an emergency unit in the last 30 days of life;
* More than 14 days in hospital in the last 30 days of life;
* Hospitalization in a resuscitation unit in the last 30 days of life;
* Treatment with chemotherapy in the last 14 days of life;
* New chemotherapy regimen starting in the last 30 days of life;
* Patients dying in an acute care setting.

Percentage and number of patients having more than 1 hospitalization in the last 30 days of life

Percentage and number of patients having more than 1 visit in an emergency unit in the last 30 days of life

Percentage and number of patients having more than 14 days in hospital in the last 30 days of life

Percentage and number of patients having a hospitalization in a resuscitation unit in the last 30 days of life

Percentage and number of patients having a treatment with chemotherapy in the last 14 days of life

Percentage and number of patients having a new chemotherapy regimen starting in the last 30 days of life

Percentage and number of patients dying in an acute care setting

Medical resources mobilized in terms of palliative care (psychologist, social worker, nutritional counselling, etc.) will be described for the interventional group in terms of number and percentage of patients with at least one consultation with each specialist

The total score ranges from 0 and 28, with a higher score indicates better quality of life. Scores will be described per randomized group at each measurement time (inclusion,3 months and 6 months) using same criteria as for other quantitative variables (number of observations, mean, standard deviation, median, minimum and maximum values).

One score is generated for anxiety and one score for depression on a 0 to 21 points, with a higher score indicates higher level of trouble. Scores will be described per randomized group at each measurement time (inclusion,3 months and 6 months) using same criteria as for other quantitative variables (number of observations, mean, standard deviation, median, minimum and maximum values). Number and percentage of patients without anxiety or depression trouble (i.e. with a score of 7 or lower), moderate trouble (score between 8 to 10) and severe trouble (score of 11 or more) will be reported.

Pain, tiredness, drowsiness, nausea, lack of appetite, depression, anxiety, shortness of breath, and wellbeing and patient-specific symptoms are each described on a scale ranging from 0 to 10 (10 being the worst). The mean change in symptoms will be estimated from baseline and at each follow-up time. The ESAS symptom scores will be calculated according to the authors' recommendations and described per randomized group at each time point by mean, standard deviation, median and range.

Hospital and type of unit or home will be described per randomized group

Defined as the time from the date of inclusion to the date of death due to any cause.

Centre Leon Berard

Rare Diseases

Acute Graft Versus Host Disease

All adult patients with solid or hematological malignancies and receiving systemic therapy or having received systemic therapy within the last 3 months that are admitted to the emergency department of the Erasmus medical center for the oncology, hematological, lung- and neuro-oncology medical unit are eligible for inclusion.

The interview focuses on several parts of the emergency care process: The first part is regarding the actions that are executed during an emergency department visit. We will establish which actions are executed and why. The second part is regarding the suspected outcome for the patient. The third part will be about any potential improvements to the emergency care process for the patient.

Emergency department caregivers interview

Jason den Duijn

The goal of this Single center prospective cross-sectional study is to identify the facilitators and barriers among caregivers in the emergency department that influence disposition of patients with solid and hematology malignancies. The main question it aims to answer is to categorize the facilitators and barriers identified by three groups of emergency department (ED) staff. Participants will be asked for permission, afterwards a short interview will be held with the different ED caregivers (ED nurse, attending physician and supervising physician).

The goal of this to identify the facilitators and barriers among caregivers in the emergency department (ED) that influence disposition of patients with solid and hematology malignancies. Participants will be asked for permission, afterwards a short interview will be held with the different caregivers (ED nurse, attending physician and supervising physician) in the ED. The interviews will be held in the order of the ED care pathway, meaning ED nurse first, treating physician second and supervising physician at last. The interviews will be conducted for every patient with each of the caregivers. Each interview will be conducted after the caregiver has made the first examination of the patient. The interview focuses on several parts of the emergency care process: The first part is regarding the actions that are executed during an ED visit. We will establish which actions are executed and why. The second part is regarding the suspected outcome for the patient. The third part will be about any potential improvements to the emergency care process for the patient.

Potential Improvements in Emergency Department Care for Cancer Patients According to Clinical Staff

Identification of Potential Improvements in the Acute Care Pathway for Cancer Patients in the Emergency Department (OVERSEE - II Trial)

age, sex, type of cancer, type of treatment, main complaint, triage category, number of prior ED visits.

(Sub)Clusters of facilitator and barriers identified by the ED nurse for the ED care of patients with cancer

(Sub)Clusters of facilitator and barriers identified by the treating physician for the ED care of patients with cancer

(Sub)Clusters of facilitator and barriers identified by the supervising physician for the ED care of patients with cancer

Outcome after ED admission, being home or admission

Correlation between ED-LOS and disposition

Number of years a medical staffmember is working in health care

Was imaging ordered during ED visit and which kind

Agreement between ED nurse expected disposition and the actual disposition

Agreement between treating physician expected disposition and the actual disposition

Agreement between supervising physician expected disposition and the actual disposition

The time between patient's arrival at the ED and the decision to disposition

The time between the decision to hospitalize and the arrival at the ward

Correlation between time-to-disposition and the ED-LOS

Correlation between time-to-ward and the ED-LOS

The difference in the percentages in categories between the different caregivers

Summary of actions taken by ED nurse in the ED care for patients with cancer

Summary of actions taken by attending physician in the ED care for patients with cancer

Summary of actions taken by supervising physician in the ED care for patients with cancer

Degree of crowding in the ED, consisting of number of patients in the ED and the ED crowding color code

Difference in clusters per ED staff group between day, evening and night

Difference in clusters per group between weekdays (Monday 08:00 till Friday 16:00) and weekend (Friday 16:01 till Monday 7:59)

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Epidemiological Characteristics and Prognosis Factors of Cancer Patients Admitted at French Emergency Departments	NCT03393260	Cancer Patients Emergencies		18 Years -	Assistance Publique - Hôpitaux de Paris
Validation of Modified Early Warning Score (MEWS) in Predicting Outcomes in Clinical Oncology Ward Adult Patients	NCT02336828	Oncologic Compl... Cancer Emergencies		18 Years -	Chinese University of Hong Kong
GOODBYE HARTMANN TRIAL: 100 YEARS OF HARTMANN'S PROCEDURE	NCT04829032	Emergencies Colon Disease Colo-rectal Can... Volvulus Colon Intussusception Diverticulitis Foreign Bodies	Hartmann's proc...	18 Years -	Parma University Hospital
Laparoscopic Approach for Emergency Colon Resection	NCT05005117	Laparoscopic Su... Colorectal Canc... Colorectal Diso... Emergencies Complication of... Long-term Effec...	Laparoscopic op... Open operation	18 Years - 100 Years	Joint Authority for Päijät-Häme Social and Health Care
Efficacy of a Systematic Referral to Palliative Care of Patients Who Need for Palliative Care During an Unscheduled Visit in Comprehensive Anticancer Centers	NCT06150027	Cancer Emergencies	Systematic refe...	18 Years -	Centre Leon Berard
Potential Improvements in Emergency Department Care for Cancer Patients According to Clinical Staff	NCT05974800	Cancer Emergencies	Emergency depar...	18 Years -	Erasmus Medical Center

Spots Global Cancer Trial Database for emergencies

Every month we try and update this database with for emergencies cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Spots Global Cancer Trial Database for emergencies

Every month we try and update this database with for emergencies cancer trials from around the world to help patients and their families find trials that might be right for them. We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Every month we try and update this database with for emergencies cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.