Risk-stratified multidisciplinary ambulatory management of malignant bowel obstruction (MAMBO) program in women with advanced gynaecological cancers: A prospective study.
Notice bibliographique
Résumé
12076 Background: Malignant bowel obstruction (MBO) is a dreaded complication encountered in patients (pts) with advanced gynaecological cancers. Survival is short, with most pts requiring long hospital stay for managing symptoms. The aim of this study was to validate prospectively the feasibility of the MBO outpatient management by a systematic risk-stratified multidisciplinary ambulatory approach in pts with advanced gynaecological cancers. Methods: This prospective single site study enrolled pts diagnosed with or at risk of MBO due to gynaecological cancers (NCT03260647) and actively managed by the MBO interdisciplinary team including the outpatient nurse led program (PMID 31550202). Eligible pts underwent comprehensive assessments, and the team provided tailored management recommendations. Those identified as "at-risk" were systematically followed by the nursing team for 4 weeks (wks) and discharged upon complete symptom resolution. MBO patients were proactively monitored for ≥ 4 wks, transitioning to the "at-risk" category upon MBO resolution. The primary endpoint of the study was the ratio of days alive and out of the hospital to days in the hospital within the initial 60 days post-MBO diagnosis. Secondary endpoints included overall survival (OS), the rate of total parenteral nutrition (TPN) administration, and the rate of symptom resolution. Results: A total of 92 pts were enrolled, predominantly with ovarian cancer (91%), median age of 62 years (range, 31-83). At enrolment, 49% (n=45) presented with MBO, while 51% (n=47) were deemed "at risk." Proactive outpatient management by the nursing team resulted in symptom resolution in 93% of "at-risk" pts, with 7% progressing to develop MBO during the first 4 wks in the program. Throughout the study, 62% (n=57) of pts experienced MBO. At the onset of MBO, 81% (n=46) were platinum-resistant with a median of 4 prior lines of therapy (range, 0-11). While 93% of pts (n=53) required in-patient management, the median time for hospitalization durations within the first 30 and 60 days after MBO diagnosis were 7 (range, 0-30) and 12.5 (range, 0-57) days respectively. Ratio of days in hospital/days out hospital within 60 days, median (range): 0.3 (0-19). During MBO, systemic therapy was administered to 77% (n=44) of pts, predominantly with weekly paclitaxel (38%, n=21). Surgical intervention was performed in 11% of pts, included primarily diverting ileostomy in 4 pts. TPN was administered to 33% (n=19) of pts. MBO resolution occurred in 42% (n=24) pts within 60 days, with recurrent episodes in 11% (n=6) pts and MBO symptoms persisted in 58% (n=33). The median OS in pts who had an episode of MBO was 5.7 months (95% CI, 3.6-8.4). Conclusions: This study confirms the feasibility of the ambulatory MBO management with pts managed mainly outside hospital during the 60 days with reduced hospitalization days. Clinical trial information: NCT03260647 .
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».