Pretreatment malnutrition and quality of life - association with prolonged length of hospital stay among patients with gynecological cancer: A cohort study

Background Length of hospital stay (LOS) is a surrogate marker for patients' well-being during hospital treatment and is associated with health care costs. Identifying pretreatment factors associated with LOS in surgical patients may enable early intervention in order to reduce postoperative LOS. Methods This cohort study enrolled 157 patients with suspected or proven gynecological cancer at a tertiary cancer centre (2004-2006). Before commencing treatment, the scored Patient Generated - Subjective Global Assessment (PG-SGA) measuring nutritional status and the Functional Assessment of Cancer Therapy-General (FACT-G) scale measuring quality of life (QOL) were completed. Clinical and demographic patient characteristics were prospectively obtained. Patients were grouped into those with prolonged LOS if their hospital stay was greater than the median LOS and those with average or below average LOS. Results Patients' mean age was 58 years (SD 14 years). Preoperatively, 81 (52%) patients presented with suspected benign disease/pelvic mass, 23 (15%) with suspected advanced ovarian cancer, 36 (23%) patients with suspected endometrial and 17 (11%) with cervical cancer, respectively. In univariate models prolonged LOS was associated with low serum albumin or hemoglobin, malnutrition (PG-SGA score and PG-SGA group B or C), low pretreatment FACT-G score, and suspected diagnosis of cancer. In multivariable models, PG-SGA group B or C, FACT-G score and suspected diagnosis of advanced ovarian cancer independently predicted LOS. Conclusions Malnutrition, low quality of life scores and being diagnosed with advanced ovarian cancer are the major determinants of prolonged LOS amongst gynecological cancer patients. Interventions addressing malnutrition and poor QOL may decrease LOS in gynecological cancer patients.

From ennui to enthusiasm : a playwright’s exploration of dramaturgy

In contemporary Australian theatre there seems to be no precise, universally accepted methodology that defines the dramaturgical process. There is not even agreement as to how a playwright might benefit from dramaturgy. Nevertheless, those engaged in creating original works for the Australian professional theatre have, to varying degrees, come to accept dramaturgical process as something of a necessity. Increasingly, dramaturgical process is evident in the development of new plays by state, flagship and project-based professional theatre producers. Many small to medium theatre companies provide dramaturgical assistance to playwrights although this often occurs in an ad hoc fashion, prescribed by economic restraint rather than artistic sensibility. Through an exploration of the dramaturgical development of two of his plays in several professional play development contexts, the researcher examines issues influencing contemporary dramaturgy in Australia. These plays are presented here as examinable components (weighted 70%) of the research as a whole, and they function in symbiotic relationship with the exegetical enquiry (weighted 30%). The research also presents the findings of a small-scale experiment which tests the hypothesis that a holistic approach to developing new plays might challenge conventional views on dramaturgical process. In terms of its overall conclusions, this research finds that while many playwrights and theatre professionals in Australia consider dramaturgy a distinct and important component of the creative development process, there exist substantial inconsistencies in relation to facilitating dramaturgical models that provide quality artistic outcomes for playwrights and their plays. The study presents unique qualitative and quantitative data as a contribution to knowledge in this field of enquiry, and it is anticipated that the research as a whole will be of interest to a variety of readers, including playwrights, dramaturgs, other theatre practitioners, students and teachers.