Objective
Cancer patients are increasingly involved in decision‐making for cancer treatment. General practitioners' (GPs) support in this process is advocated. Therefore, GPs need to be aware of ...patients' treatment decision‐making process and their potential role. We aim to understand the treatment decision‐making process and to explore the added value of GP involvement, from the perspective of cancer patients treated with curative intent.
Methods
An explorative qualitative study was performed. Semi‐structured interviews were conducted with 20 purposively sampled Dutch cancer patients treated with curative intent.
Results
Patients' treatment decision‐making process was dominated by a focus on ‘safeguarding survival’. Patients generally followed the treatment plan as proposed by their physician and did not always experience having a treatment choice. The majority of patients expressed added value for GP involvement, mainly to provide psychological support, but also for providing shared decision‐making (SDM) support.
Conclusion
The treatment decision‐making process of cancer patients treated with curative intent is dominated by the urge to ‘safeguard survival’. GPs should be aware of their added value in providing psychological support and their potential role to support SDM following a cancer diagnosis.
Introduction
Recently, a new classification system for sternal fractures has been published in the Journal of Orthopedic trauma by the Arbeitsgemeinschaft für Osteosynthesefragen (AO) foundation and ...the Orthopaedic Trauma Association (OTA). The aim of this study was to evaluate inter- and intra-observer variability of the AO/OTA classification for sternal fractures.
Materials and methods
Twenty multidetector computed tomography (CT) scans of patients with sternal fractures were classified independently by six senior and six junior orthopedic trauma surgeons of two level-1 trauma centers. Assessment was done on two occasions with an interval of 6 weeks. The kappa value was calculated to determine variability.
Results
The inter-observer variability of the AO/OTA classification for sternal fractures showed fair-to-moderate agreement (kappa = 0.364). There was no significant difference between junior and senior surgeons. Analyses of the separate components of the classification demonstrated that agreement was lowest for classifying fracture type within the sternal body (kappa = 0.319) followed by manubrium (kappa = 0.525). The intra-observer variability showed moderate agreement with a mean kappa of 0.414.
Conclusion
The inter- and intra-observer variability of the AO/OTA classification for sternal fractures shows fair-to-moderate agreement. The overall performance of the classification might be improved with minor modifications.
Level of evidence
Diagnostic cross-sectional study (level I).
•No effect of 6 months exercise on brain volume in breast cancer patients.•Positive relation between physical fitness and brain (volume) at baseline.•A decrease in hippocampal volume post ...intervention in highly fatigued patients.•Effects on volume, related to improved memory functioning, in highly fatigued women.•Exercise is important for brain health and is more profitable for some patients.
Physical exercise in cancer patients is a promising intervention to improve cognition and increase brain volume, including hippocampal volume. We investigated whether a 6-month exercise intervention primarily impacts total hippocampal volume and additionally hippocampal subfield volumes, cortical thickness and grey matter volume in previously physically inactive breast cancer patients. Furthermore, we evaluated associations with verbal memory.
Chemotherapy-exposed breast cancer patients (stage I-III, 2–4 years post diagnosis) with cognitive problems were included and randomized in an exercise intervention (n = 70, age = 52.5 ± 9.0 years) or control group (n = 72, age = 53.2 ± 8.6 years). The intervention consisted of 2x1 hours/week of supervised aerobic and strength training and 2x1 hours/week Nordic or power walking. At baseline and at 6-month follow-up, volumetric brain measures were derived from 3D T1-weighted 3T magnetic resonance imaging scans, including hippocampal (subfield) volume (FreeSurfer), cortical thickness (CAT12), and grey matter volume (voxel-based morphometry CAT12). Physical fitness was measured with a cardiopulmonary exercise test. Memory functioning was measured with the Hopkins Verbal Learning Test-Revised (HVLT-R total recall) and Wordlist Learning of an online cognitive test battery, the Amsterdam Cognition Scan (ACS Wordlist Learning). An explorative analysis was conducted in highly fatigued patients (score of ≥ 39 on the symptom scale ‘fatigue’ of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), as previous research in this dataset has shown that the intervention improved cognition only in these patients.
Multiple regression analyses and voxel-based morphometry revealed no significant intervention effects on brain volume, although at baseline increased physical fitness was significantly related to larger brain volume (e.g., total hippocampal volume: R = 0.32, B = 21.7 mm3, 95 % CI = 3.0 – 40.4). Subgroup analyses showed an intervention effect in highly fatigued patients. Unexpectedly, these patients had significant reductions in hippocampal volume, compared to the control group (e.g., total hippocampal volume: B = −52.3 mm3, 95 % CI = −100.3 – −4.4)), which was related to improved memory functioning (HVLT-R total recall: B = −0.022, 95 % CI = −0.039 – −0.005; ACS Wordlist Learning: B = −0.039, 95 % CI = −0.062 – −0.015).
No exercise intervention effects were found on hippocampal volume, hippocampal subfield volumes, cortical thickness or grey matter volume for the entire intervention group. Contrary to what we expected, in highly fatigued patients a reduction in hippocampal volume was found after the intervention, which was related to improved memory functioning. These results suggest that physical fitness may benefit cognition in specific groups and stress the importance of further research into the biological basis of this finding.
Introduction
This study aims to describe the results of plate fixation in one of the largest single-center cohorts that employs plate fixation as the golden standard. Additionally, risk factors ...related to a negative outcome were identified.
Materials and methods
This was a retrospective cohort study of all patients treated for a humeral shaft fracture in a level-one trauma center between January 2010 and December 2017 with a mean follow-up of 1 year.
Results
Plate fixation was performed in 102 patients with a humeral shaft fracture. The mean age was 50 (SD 20) years with 54.9% (
n
= 56) being male. Forty-eight percent (
n
= 48) had an AO type-A, 34.3% (
n
= 35) type-B, and 18.7% (
n
= 19) type-C fracture. Deep surgical site infections and non-union occurred in 1% (
n
= 1) and 3.9% (
n
= 4) of patients, respectively. Revision of the implant was performed in 15.7% (
n
= 16) mainly due to implant-related complaints. Only one patient developed radial nerve palsy after surgery. The median duration to radiological fracture healing and full-weight bearing was 18 (range 7–65) weeks and 14 (range 6–56) weeks, respectively. Risk factors for negative outcome included higher age, osteoporosis, open and higher AO class fractures, performing surgery during out-office hours, and the use of LCP 3.5-mm plate and an anterolateral approach.
Conclusion
Plate fixation for humeral shaft fractures has low risks of complications. It should be emphasized that the complications can be further minimized with a greater surgical expertise and by refraining from performing a surgery during out-office hours.
Validation of the modified AO sternum classification system Minervini, Fabrizio; van Veelen, Nicole M.; Van de Wall, Bryan J. M. ...
European journal of orthopaedic surgery & traumatology,
05/2023, Letnik:
33, Številka:
4
Journal Article
Recenzirano
Introduction
The
Arbeitsgemeinschaft für Osteosynthesefragen
(AO) foundation along with the Orthopaedic. Trauma Association (OTA) introduced a new classification for sternal fractures in 2018 aiming ...to provide greater uniformity and clinical utility for the surgical community. A previous validation study identified some critical issues such as the differentiation between type A and B fractures and localization of the fracture either in the manubrium or in the body. Due to the moderate agreement in inter- and intra-observer variability, some modifications were proposed in order to improve the performance of the classification. The aim of this study was to re-assess the inter- and intra-observer variability after adding modifications to the classification. Our hypothesis was that a significative improvement of inter- and intra-observer variability could be achieved.
Material and methods
Twenty computed tomography (CT) scans of patients with sternal fractures were analyzed by six. Junior and six senior surgeons independently. Two assessments were performed with an interval of 6 weeks. The kappa (K) value was calculated in order to assess inter- and intra-observer variability.
Results
The overall mean kappa value for inter-observer variability improved from 0.364 to 0.468 (
p
< 0.001). Inter-observer variability mean for location was 0.573 (SD 0.221) and for type was 0.441 (SD: 0.181). Intra-observer variability showed a mean of 0.703 (SD: 0.153) with a statistic significant improvement when compared to the previous study (mean 0.414, SD: 0.256,
p
< 0.001).
Conclusions
By modifying the AO/OTA classification of sternal fractures, the inter- and intra-observer variability improved and now shows moderate to substantial agreement.
Background
Studies comparing laparoscopic and open appendicectomy are difficult to interpret owing to several types of bias, and the results often seem of limited clinical importance. National audits ...can be valuable to provide insight into outcomes following appendicectomy at a population level.
Methods
A prospective, observational, resident‐led, nationwide audit was carried out over a period of 2 months, including all consecutive adult patients who had surgery for suspected acute appendicitis. Complications after laparoscopic and open appendicectomy were compared by means of logistic regression analysis; subgroup analyses were performed for patients with complicated appendicitis.
Results
A total of 1975 patients were included from 62 participating Dutch hospitals. A normal appendix was seen in 3·3 per cent of patients. Appendicectomy was performed for acute appendicitis in 1378 patients, who were analysed. All but three patients underwent preoperative imaging. Laparoscopy was used in 79·5 per cent of patients; the conversion rate was 3·4 per cent. A histologically normal appendix was found in 2·2 per cent. Superficial surgical‐site infection was less common in the laparoscopic group (odds ratio 0·25, 95 per cent c.i. 0·14 to 0·44; P < 0·001). The rate of intra‐abdominal abscess formation was not significantly different following laparoscopic or open surgery (odds ratio 1·71, 0·80 to 3·63; P = 0·166). Similar findings were observed in patients with complicated appendicitis.
Conclusion
Management of acute appendicitis in the Netherlands is preferably performed laparoscopically, characterized by a low conversion rate. Fewer superficial surgical‐site infections occurred with laparoscopy, although the rate of abscess formation was no different from that following open surgery. A low normal appendix rate is the presumed effect of a mandatory preoperative imaging strategy.
Dutch snapshot of appendicitis care
Diverticulitis in young versus elderly patients: a meta-analysis van de Wall, Bryan JM; Poerink, Jolien A.; Draaisma, Werner A. ...
Scandinavian journal of gastroenterology,
2013-June, 6/1/2013, 2013-Jun, 2013-06-00, 20130601, Letnik:
48, Številka:
6
Journal Article
Recenzirano
Abstract
Objective.
To compare patients younger and older than 50 years with diverticulitis with regard to complications, disease recurrence and to the need for surgery.
Material and methods.
A ...literature review and meta-analysis was conducted according to the PRISMA guidelines. MEDLINE, Embase and the Cochrane databases were searched for longitudinal cohort studies comparing patients younger and older than 50 years with diverticulitis.
Results.
Eight studies were included with a total of 4.751 (male:female 1:0.66) patients younger and 18.328 (male:female 1:1.67) older than 50 years of age. The risk of developing at least one recurrent episode was significantly higher among patients younger than 50 years (pooled RR 1.73; 95% CI 1.40-2.13) with an estimated cumulative risk of 30% compared with 17.3% in older patients. The risk of requiring surgery during hospitalization for a primary episode of diverticulitis was equal in both age groups (pooled RR 0.99; 95% CI 0.74-1.32) and estimated at approximately 20%. Patients younger than 50 years more frequently required urgent surgery during hospitalization for a subsequent recurrent episode (pooled RR 1.46; 95% CI 1.29-1.66); the cumulative risk was 7.3% in younger and 4.9% in patients older than 50 years.
Conclusion.
Patients younger than 50 years only differ substantially in risk for recurrent disease from patients older than 50 years of age. Although the relative risk for requiring urgent surgery for recurrent disease was higher in younger patient, one should consider that the absolute risk difference is relatively small (7.3% vs. 4.9%).
This study sought to compare tissue Doppler imaging (TDI) with velocity-encoded (VE) magnetic resonance imaging (MRI) for left ventricular (LV) dyssynchrony assessment.
Cardiac resynchronization ...therapy (CRT) is proposed for patients with heart failure, depressed LV function, and a wide QRS complex. Selection is based mainly on electrocardiogram criteria, but recent data suggest that intraventricular dyssynchrony may be preferred for selection. An LV dyssynchrony can adequately be assessed with TDI, but this has not been compared directly with other imaging modalities. A VE MRI potentially allows direct myocardial wall motion measurements similar to TDI.
Twenty patients with heart failure, systolic LV dysfunction, and a wide QRS complex were included, as well as 10 normal individuals with normal QRS duration and LV function. The TDI and VE MRI data were acquired to study intraventricular dyssynchrony.
Left ventricular dyssynchrony was not observed in normal individuals (mean dyssynchrony -2 +/- 15 ms on TDI; mean -5 +/- 17 ms on MRI, p = NS). In patients, mean LV dyssynchrony was 55 +/- 37 ms on TDI; 49 +/- 38 ms on MRI (p = NS). Good correlation between both modalities was observed (linear regression TDI = 0.99 x MRI - 5, n = 30, r = 0.98, p < 0.01). The MRI showed a small, nonsignificant underestimation of 5 +/- 8 ms compared with TDI. Agreement between MRI and TDI for classification according to severity of LV dyssynchrony (minimal, intermediate, and extensive) was excellent (kappa +/- SE = 0.96 +/- 0.07, p < 0.01) with 95% of patients classified identical.
Both MRI and TDI yield comparable information on LV dyssynchrony; MRI is useful in the selection of patients for CRT.
Objective
Presentation of a minimally invasive surgical approach for the treatment of scapular fractures and the clinical outcome using this technique.
Indications
Displaced extra-articular fractures ...of the scapula body and glenoid neck (AO 14B and 14F) and simple intra-articular fractures of the glenoid.
Contraindications
Complex intra-articular fractures and isolated fractures of the coracoid base.
Surgical technique
Make a straight or slightly curved incision along the lateral margin of the scapula leaving the deltoid fascia intact. Identify the interval between the teres minor muscle and infraspinatus to visualize the lateral column, whilst retracting the deltoid to visualize the glenoid neck. Reduce and align the fracture using direct and indirect reduction tools. A second window on the medial border of the scapula can be made to aid reduction and/or to augment stability. Small (2.0–2.7 mm) plates in a 90° configuration on the lateral border and, if required, on the medial border are used. Intra-operative imaging confirms adequate reduction and extra-articular screw placement.
Postoperative management
Direct postoperative free functional nonweight-bearing rehabilitation limited to 90° abduction for the first 6 weeks. Sling for comfort. Free range of motion and permissive weight-bearing after 6 weeks.
Results
We collected data from 35 patients treated with minimally invasive plate osteosynthesis (MIPO) between 2011 and 2021. Average age was 53 ± 15.1 years (range 21–71 years); 17 had a type B and 18 a type F fracture according the AO classification. All patients suffered concomitant injuries of which thoracic (
n
= 33) and upper extremity (
n
= 25) injuries were most common. Double plating of the lateral border (
n
= 30) was most commonly performed as described in the surgical technique section. One patient underwent an additional osteosynthesis 3 months after initial surgery due to pain and lack of radiological signs of healing of a fracture extension into the spine of the scapula. In the same patient, the plate on the spine of scapula was later removed due to plate irritation. In 2 patients postoperative images showed a screw protruding into the glenohumeral joint requiring revision surgery. After standardisation of intra-operative imaging following these two cases, intra-articular screw placement did not occur anymore. No patient suffered from iatrogenic nerve injury and none developed a wound infection.
Intramedullary screw (IMS) fixation is increasingly used as an alternative treatment option in metacarpal and phalangeal fractures of the hand. However, this technique is currently the subject of ...controversy among hand surgeons. The aim of this systematic review was to gain insight on radiological, functional and patient-rated outcomes reported in literature. A comprehensive literature search of PubMed, Embase, CENTRAL and CINAHL databases was conducted on March 1st, 2021. All studies reporting on fracture union, complications, and functional and patient-rated outcome in IMS fixation of metacarpal and/or phalangeal fractures were selected. Two prospective and 16 retrospective cohort studies were included, encompassing a total of 837 patients with 958 fractures (693 metacarpal, 222 proximal phalangeal and 43 middle phalangeal). Mean surgery duration was 26.4 min (range 5–60 min). Union was ultimately achieved in all fractures in a mean of 5.7 weeks (range 2–12 weeks). The procedure-related complication rate was 3.2%. The most frequently reported complication was limitation of joint motion, occurring in 2.0% of cases. Incidence of other complications, including loss of reduction, infection and screw protrusion did not exceed 1%. Overall mean total active motion averaged 243° and grip strength reached 97.5% of the contralateral side. The Disabilities of the Arm, Shoulder and Hand (DASH) score averaged 3.7 points. Duration of sick leave was 7.3 weeks. According to the findings of this systematic review, IMS fixation is a time-saving and safe minimally invasive solution for both metacarpal and phalangeal fractures, with a low rate of complications and promising functional and patient-rated results.
La fixation intramédullaire avec des vis de compression canulées est de plus en plus utilisée comme option de traitement alternative lors de fractures métacarpiennes et phalangiennes de la main. Cependant, cette nouvelle technique provoque des réactions controversées parmi les chirurgiens de la main. L'objectif de cette analyse systématique était d'obtenir un aperçu des résultats décrits dans la littérature. Une recherche systématique des bases de données PubMed, Embase, CENTRAL et CINAHL a été effectuée le 1er mars 2021. Toutes les publications décrivant la consolidation de la fracture, les complications, les résultats fonctionnels et subjectifs de la fixation par vis intramédullaire (VIM) des fractures métacarpiennes et/ou phalangiennes ont été sélectionnées. Deux études de cohortes prospectives et 16 études rétrospectives ont été analysées, rassemblant un total de 837 patients et patientes présentant 958 fractures (693 métacarpiennes, 222 phalangiennes proximales et 43 phalangiennes moyennes). La durée moyenne d'opération était de 26,4 min (5–60 min). Toutes les fractures s’étaient finalement consolidées dans un délai moyen de 5,7 semaines (2–12 semaines). Le taux de complications liées à l'intervention était de 3,2%. La complication la plus fréquemment observée était une limitation de mobilité au niveau de l'articulation, survenue dans 2,0% des cas. L'incidence des autres complications, notamment la perte de réduction, l’infection, et la protrusion de la vis, ne dépassait pas 1%. L’amplitude totale du mouvement actif était de 243 degrés et la force de préhension atteignait 97,5% comparée au côté opposé. Le score Disabilities of the Arm, Shoulder and Hand (DASH) était en moyenne de 3,7 points et l’arrêt de travail s'élevait à 7,3 semaines. D'après les résultats de cette analyse systématique, la fixation par VIM est une méthode minimalement invasive, rapide et sûre pour le traitement des fractures métacarpiennes et phalangiennes, avec un faible taux de complications et des résultats fonctionnels et subjectifs prometteurs.
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