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Essangri H, Majbar MA, Benkabbou A, Amrani L, Mohsine R, Souadka A.

Background: Sphincter sparing surgery is oftentimes associated with bowel dysfunction complaints, namely the low anterior resection syndrome (LARS). The LARS questionnaire is widely used to assess this syndrome. The aim of this observational study is to translate this tool into arabic and test its psychometric properties in rectal cancer patients, in order to ease its use in clinical practice and future research.

Methods: The LARS questionnaire was translated to arabic and administered to a total of 143 patients. A subgroup of 42 patients took the test twice for test-retest reliability. Internal consistency was examined through cronbach’s alpha. The score results were correlated to the EORTC QLQ-C30 questionnaire for convergent validity assessment, while discriminant validity was established through the ability of the LARS score to differentiate patients with different clinical and pathological criteria.

Results: The Moroccan Arabic version of the LARS score was completed by 143 patients. The internal consistency was demonstrated through a cronbach alpha score of 0.66. The agreement between the test and retest was established by a Bland Altman plot with 95% limits of agreement. 85.6% of patients remained in the same LARS category. The LARS score showed negative correlation with all five of the QLQ-C30 functional scales as well as positive correlation to the diarrhea symptom scale. The questionnaire score differed between patients according to their tumor location, chemoradiotherapy, type of mesorectal excision and anastomosis.

Conclusion: The Moroccan Arabic version of the LARS score shows good psychometric properties and can be used for bowel dysfunction assessment in clinical and research settings.



Amine Souadka, Mohammed Anass Majbar, Khalid El Himdi, Ismail Kassou, Hind Mrabti, Tijani El Harroudi, Mohammed Ahallat, Abdelkader Belkouchi, Raouf Mohsine, Abdelmalek Hrora, Amine Benkabbou

JOURNAL OF MEDICAL AND SURGICAL RESEARCH – Vol. VII, n 1, June, 2020; Pages: 748-754

Abstract:

Background: Surgical audit experiments have shown a positive, rapid and cost-effective impact on complication rates, recurrence rates, and overall survival even in the absence of interventional measures in digestive cancers. This study audit the quality of surgical procedures for digestive cancers.

Methods: This is a multicentric prospective non-comparative observational study performed in 4 surgical departments in 2 university centers. Eligible patients are adults scheduled for elective surgery for a proven or suspected digestive cancer, in a curative or palliative intent; or included no later than 72 hours after surgery in case of an emergent procedure. The Cancer should be proven or suspected in the following digestive tract: colon, appendix, anus, rectum, esophagus, stomach, esogastric junction, bile ducts, ampulla of Vater, pancreas, duodenum, small intestine and liver. Patients are excluded in case of 1) surgical intervention indicated for: a condition that is not a digestive tract cancer; 2) proven or suspected cancer of non-digestive location 3) a proven or suspected cancer of peritoneal localization. 4) surgical intervention indicated for a progressive disease or a local recurrence proven or suspected of a digestive localization cancer having already been resected (with the exception of situations of iterative liver resection for liver metastasis hepatic and recovery of the tumor bed after the discovery of vesicular cancer on cholecystectomy specimen); 5) intervention is for diagnostic purposes without any curative or palliative intention

A total of 1500 patients is expected. The primary objectives of this study are to assess both 90 days of post-operative outcomes and three years oncological outcomes for patient operated for each included digestive cancer. Secondary objectives arre 1)to analyze treatment decisions made within multidisciplinary team meeting/tumour board for every localization and the completion of preoperative workup staging according to local guidelines and 2) to determine the impact of reporting anonymous trimestrial feedback to surgeons on improving their surgical performance and outcomes 3) To assess quality of life in patient operated for colorectal cancer in curative intent.

Discussion: This is the first multicentric north african registry assessing the quality of surgical procedures for digestive tract cancer and analyzing the impact of reporting sequential anonymous feedback to the surgeon on quality improvement.

Keywords: Qualtiy, Rectal Neoplasms, Digestive cancer, obsergatory, Multicentric cohort study, Surgical procedures



Anass M. Majbar, Amine Benkabbou, Raouf Mohsine, Amine Souadka

JOURNAL OF MEDICAL AND SURGICAL RESEARCH – Vol. VI, n 3, February 2020; Pages: 724-733;

Abstract:

The COVID 19 outbreak has caused the cancellation of most elective oncological surgery around the world to limit the risk of virus dissemination. As we are exiting the crisis, surgical teams will face strong challenges while resuming normal elective surgery. The accumulation of cases will have to be managed by defining strong selection criteria, taking into account the patient and the disease conditions. In order to reduce the risk of infection, non-COVID patients should be treated in dedicated non-COVID areas, preferably in separate buildings or hospitals. Departments, units and operative theaters should put in place rigorous actions and protocols to protect the patient and healthcare workers. Adequate protective equipment must be readily available for healthcare workers and patients. Finally, teams should keep an adaptive mindset by preparing strategies to maintain surgical activity in case of repeated COVID 19 waves.

Keywords: COVID 19, Guidelines, Lockdown ease, Surgical oncology



Chaimae Charoui, Amine Souadka, Saber Boutayeb, Rachida Latib, Laila Rifai, Laila Amrani, Amine Benkabbou, Raouf Mohsine, Mohammed Anass Majbar

JOURNAL OF MEDICAL AND SURGICAL RESEARCH – Vol. VII, n 1, June, 2020. Pages: 764-769

Abstract:

Introduction: The multidisciplinary team oncology meeting (MDT) has become a standard in oncology. The objective of this study was to evaluate the value of a validated tool, the Metric for the Observation of Decision-Making, in the evaluation of the decision-making mode during the digestive cancer MDT in order to reach recommendations for improvement.

Results: Eight consecutive MDTs were observed (N = 228 patients). On average, 32 patients were discussed by MDT with an average of 2 min 55 s (interval: 30 s-10 min 16 s) per patient. A decision was reached in 84.6% of the cases. Although the medical information was judged to be of good quality, the psychosocial information (average 1.29) and the patients’ point of view (average 1.03) were judged to be of low quality. For teamwork, the contribution of surgeons (average 4.56) and oncologists (average 3.99) was greater than radiologists (3.12), radiotherapists (1.74) and pathologists (1.02).

Conclusions: The tool made it possible to identify a disparity in the quality of the different aspects of the information and in the participation of specialists, making it possible to identify specific improvement measures. Its regular use would improve the quality of patient care.

Keywords: Decision making, Quality improvement, Multidisciplinary concertation meeting, MDT-MODe, Morocco



Said Bensbih, Amine Souadka, Amalia Giuliani Diez, Otmane Bouksour

JOURNAL OF MEDICAL AND SURGICAL RESEARCH – Vol. VII, n 1, June, 2020. Pages: 755-763

Abstract:

The health system is a fundamental building block of a country’s social project. Approaches and strategies differ but some concepts such as Patient Centred Care (PCC) seem to be more and more popular nowadays as the customer centric advocated in the industry. The research has focused on this trend of PCC with several different definitions but without having a particular focus on the context of Low and Middle Income Countries (LMICs). The objective of this study is, through an extensive literature review, to analyze this concept, to unify the dimensions described by different authors, to define a concept that can be proposed to LMICs and to determine facilitating factors as well as obstacles for its implementation.

Keywords: Conceptual model, Health system, Low and middle income countries (LMICs), Patient Centered Care


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