What do the results of the DENSE-trial tell? Klinkenbijl, Jean H G; van Leeuwen, Edwin; Verkooijen, Helena M
Nederlands tijdschrift voor geneeskunde,
04/2020, Letnik:
164
Journal Article
The DENSE trial has demonstrated that offering an MRI scan to women with very dense glandular breast tissue and normal results on screening mammography reduces the number of interval cancers by 50%. ...In the women who agreed to undergo an MRI (59%), this reduction was 80% (from 5 per 1000 to 1 per 1000 participants). DENSE will continue in order to answer the only question that is relevant to patients: does additional MRI lead to less invasive treatment and, above all, to a decrease in mortality? Even in the event where additional MRI screening would lead to a decrease in mortality, we still need to have an open discussion on whether investing in additional MRI screening for women with very dense glandular tissue is the most effective way to improve the health of the Dutch female population. Thanks to the great effort of the DENSE research team, such a discussion can be pursued thoroughly, based on facts.
Leakage of adjustable gastric bands Ponson, A E; Janssen, I M; Klinkenbijl, J H
Obesity surgery,
06/1999, Letnik:
9, Številka:
3
Journal Article
Recenzirano
Surgery for morbid obesity has increased since the introduction of the adjustable gastric bands. Their advantage is the adjustability of the band, which can be inflated or deflated percutaneously ...according to weight loss without altering the anatomy of the stomach. We present 5 cases of leakage of the Swedish adjustable gastric band (SAGB) as a result of tearing of the balloon.
In our series, 29 patients received an SAGB; the remaining 20 received the LapBand. All but 4 procedures were performed laparoscopically. The adjustable gastric band (AGB) was inflated according to passage seen on gastro-esophagogram. According to weight loss or complaints of passage, the gastroesophagogram was repeated, and the AGB was inflated or deflated.
No major complications were observed postoperatively. All but 5 patients showed weight loss and restriction of food intake after filling of the AGB. These 5 patients had all received an SAGB. High-pressure filling with contrast medium showed leakage of the SAGB. After removal the SAGB, 4 showed a tear at the site of fixation of the balloon to the band, and 1 showed a puncture of the balloon. The tears most probably occurred as a result of inadequate fixation while the SAGB was positioned around the stomach.
To our knowledge, this complication has not been described before. The manufacturer of the SAGB has been notified, and consequently the fixation site has been reinforced.
To determine whether systematic audit and feedback of information about the process and outcomes improve the quality of surgical care.
Systematic literature review.
Embase, PubMed, and Web of Science ...databases were searched for publications on 'quality assessment' and 'surgery'. The references of the publications found were examined as well. Publications were included in the review if the effect of auditing on the quality of surgical care had been investigated.
In the databases 2415 publications were found. After selection, 28 publications describing the effect of auditing, whether or not combined with a quality improvement project, on guideline adherence or indications of outcomes of care were included. In 21 studies, a statistically significant positive effect of auditing was reported. In 5 studies a positive effect was found, but this was either not significant or statistical significance was not determined. In 2 studies no effect was observed. 5 studies compared the combination of auditing with a quality improvement project with auditing alone; 4 of these reported an additional effect of the quality improvement project.
Audit and feedback of quality information seem to have a positive effect on the quality of surgical care. The use of quality information from audits for the purpose of a quality improvement project can enhance the positive effect of the audit.
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