RESUMEN
PURPOSE: The aim of this study was to report on the safety (complications) and efficacy (oncological and functional outcomes) of robot-assisted radical prostatectomy (RARP), performed at our institution, in patients aged over 70. PATIENTS AND METHODS: Review of our prospectively collected database [Cancer Information Systems (CAISIS)] identified two hundred and fifteen (215) patients, aged > 70, who underwent RARP for localized prostate cancer between July 2003 and August 2017. A propensity score-matched analysis, with multiple covariates, was performed to stratify the patients into Age ≤ 70 and Age > 70 comparison groups. RESULTS: Apart from Age (mean ± SD years: 73.5 ± 2.1 vs 59.5 ± 5.9, p < 0.0001) and nerve-sparing status, the two groups were evenly matched for all covariates (p values > 0.05). Median follow-up was 10.6 years. There were no 90-day mortalities in either group. Minor complications (Clavien ≤ 2) were more common in the Age > 70 group (p = 0.0002). Operating room time (p = 0.83), length of hospital stay (p = 0.06) and catheterization duration (p = 0.13) were similar. On final pathology, a higher pT stage (p < 0.0001) and pN1 (p = 0.003) were observed in the Age > 70 group. However, this did not translate adversely into higher rates of positive surgical margin (p = 0.41) or biochemical relapse (p = 0.72). Allowing for the follow-up duration (median 10.6 years), cancer-specific survival was marginally significant (p = 0.05) with an observed lower rate in the Age > 70 group. In terms of functional outcomes, post-operative erectile dysfunction and pad-free continence were significantly better in the younger cohort (p < 0.0001). CONCLUSIONS: Robot-assisted radical prostatectomy should not be denied to those over 70 years solely on the basis of age. Older men need to be counseled about the likelihood of encountering higher-risk features on final pathology and that their functional outcomes may be worse compared to a younger person.
Asunto(s)
Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Procedimientos Quirúrgicos Robotizados , Anciano , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Prostatectomía/efectos adversos , Recuperación de la Función , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
School nurses are in a unique position to monitor and influence not only the health of students but also the health of school employees. The National Association of School Nurses (NASN) provides support and evidence-based best practice guidelines for the specialty practice of school nursing. NASN's Framework for 21st Century School Nursing Practice™ provides a road map for a healthy and safe school environment. With a focus on student health and academic success, the framework also aligns with the whole school, whole community, whole child model to provide a collaborative structure to learning and health. Both models are student centered and include family, the school community, and school employees. A group of school nurses from the Alexandria City Public Schools (ACPS) in Alexandria, Virginia, attended the Johnson and Johnson School Health Leadership Program and were challenged to create sustainable change in their community. Their goal was to develop a plan for the school division that would affect employee wellness and ultimately improve student achievement and educational outcomes. This article will describe the current ACPS Employee Wellness Program, Finding Fit, and the strategies and tools used to develop the program.