Purpose: The ICF (International Classification of Functioning, Disability and Health) framework (used worldwide to describe 'functioning' and 'disability'), including the ICF scheme (visualization of ...functioning as result of interaction with health condition and contextual factors), needs reconsideration. The purpose of this article is to discuss alternative ICF schemes.
Method: Reconsideration of ICF via literature review and discussions with 23 Dutch ICF experts. Twenty-six experts were invited to rank the three resulting alternative schemes.
Results:The literature review provided five themes: 1) societal developments; 2) health and research influences; 3) conceptualization of health; 4) models/frameworks of health and disability; and 5) ICF-criticism (e.g. position of 'health condition' at the top and role of 'contextual factors'). Experts concluded that the ICF scheme gives the impression that the medical perspective is dominant instead of the biopsychosocial perspective. Three alternative ICF schemes were ranked by 16 (62%) experts, resulting in one preferred scheme.
Conclusions: There is a need for a new ICF scheme, better reflecting the ICF framework, for further (inter)national consideration. These Dutch schemes should be reviewed on a global scale, to develop a scheme that is more consistent with current and foreseen developments and changing ideas on health.
Implications for Rehabilitation
We propose policy makers on community, regional and (inter)national level to consider the use of the alternative schemes of the International Classification of Functioning, Disability and Health within their plans to promote functioning and health of their citizens and researchers and teachers to incorporate the alternative schemes into their research and education to emphasize the biopsychosocial paradigm.
We propose to set up an international Delphi procedure involving citizens (including patients), experts in healthcare, occupational care, research, education and policy, and planning to get consensus on an alternative scheme of the International Classification of Functioning, Disability and Health.
We recommend to discuss the alternatives for the present scheme of the International Classification of Functioning, Disability and Health in the present update and revision process within the World Health Organization as a part of the discussion on the future of the International Classification of Functioning, Disability and Health framework (including ontology, title and relation with the International Classification of Diseases).
We recommend to revise the definition of personal factors and to draft a list of personal factors that can be used in policy making, clinical practice, research, and education and to put effort in the revision of the present list of environmental factors to make it more useful in, e.g., occupational health care.
Highlights • Pazopanib with cyclophosphamide had a MTD of 600 mg per day. • Main side effects were elevation of the liver enzymes, diarrhea, leukopenia. • Quality of life was not reduced during ...treatment. • One patient experienced durable benefit from therapy for more than two years.
Purpose
Breast-conserving therapy (BCT) is the standard procedure for most patients with primary breast cancer (BC). By contrast, axillary management is still under transition to find the right ...balance between avoiding of morbidity, maintaining oncological safety, and performing a staging procedure. The rising rate of primary systemic therapy creates further challenges for surgical management.
Methods
Patients with primary, non-metastatic BC treated between 01.01.2003 and 31.12.2016 under guideline-adherent conditions were included in this study. For this prospectively followed cohort, breast and axillary surgery patterns are presented in a time-trend analysis as annual rate data (%) for several subgroups.
Results
Overall, 6700 patients were included in the analysis. While BCT rates remained high (mean 2003–2016: 70.4%), the proportion of axillary lymph node dissection has declined considerably from 80.1% in 2003 to 16.0% in 2016, while the proportion for sentinel lymph node biopsy (SLND) has increased correspondingly from 10.3 to 76.4%. Among patients with cT1-2, cN0 breast cancer receiving BCT with positive SLND, the rate of axillary completion has decreased from 100% in 2008 to 24.4% in 2016.
Conclusions
In the past decade, SLNB has been established as the standard procedure for axillary staging of clinically node-negative patients. Surgical morbidity has been further reduced by the rapid implementation of new evidence from the ACOSOG Z0011 trial into clinical routine. The results reflect the transition towards more individually tailored, less invasive treatment for selected patient subgroups, especially in regards to axillary lymph node management.
Purpose
Robotic assistance is considered one innovation within abdominal surgery over the past decade that has the potential to compensate for the drawbacks of conventional laparoscopy, such as ...limited degree of freedom, 2D vision, fulcrum, and pivoting effect. Robotic systems provide corresponding solutions as 3D view, intuitive motion and enable additional degrees of freedom. This review provides an overview of the history of medical robotics, experimental studies, clinical state-of-the-art and economic impact.
Methods
The Medline database was searched for the terms “robot*, telemanipulat*, and laparoscop*.” A total of 2573 references were found. All references were considered for information on robotic assistance in advanced laparoscopy. Further references were obtained through cross-referencing the bibliography cited in each work.
Results
In experimental studies, current robotic systems showed superior handling and ergonomics compared to conventional laparoscopic techniques. In gynecology especially for hysterectomy and in urology especially for prostatectomy, two procedures formerly performed via an open approach, the robot enables a laparoscopic approach. This results in reduced need for pain medication, less blood loss, and shorter hospital stay. Within abdominal surgery, clinical studies were generally unable to prove a benefit of the robot. While the benefit still remains open to discussion, robotic systems are spreading and are available worldwide in tertiary centers.
Conclusion
Robotic assistance will remain an intensively discussed subject since clinical benefits for most procedures have not yet been proven. The most promising procedures are those in which the robot enables a laparoscopic approach where open surgery is usually required.
Breast magnetic resonance imaging (MRI) has been introduced in the preoperative management of invasive lobular breast cancer (ILC). We analysed if MRI leads to adequate changes in surgical ...management.
We carried out a single-centre retrospective confirmatory analysis of 92 patients with ILC and a preoperative breast MRI. By applying a blinded tumour board method, we analysed if surgical procedures were altered due to breast MRI. In case of alteration, we analysed whether the change was adequate according to the postoperative pathology findings. We considered an adequate rate of change >5% to be a clinically relevant benefit.
A change in surgical therapy due to the MRI findings occurred in 23 of 92 patients (25%). According to the postoperative pathology findings, this change was adequate for 20 of these patients (22%; 95% confidence interval CI 14%–31%, P < 0.0001). An overtreatment occurred for three patients (3%; 95% CI 0%–6%) who underwent a mastectomy following the results of breast MRI. Patients with larger tumours did likely benefit more from preoperative breast MRI.
Patients with ILC might benefit from a preoperative breast MRI. Possible harm from overtreatment should be minimised by diligent use of preoperative histological clarification.
IMPACT-S is the screener part of the ICF Measure of Participation and ACTivities questionnaire. IMPACT-S consists of 33 items in 9 scales, reflecting the 9 activity and participation chapters of the ...International Classification of Functioning, Disability and Health (ICF). The reliability and validity of IMPACT-S as an independent brief measure of activities and participation was examined.
Repeated administration of a postal questionnaire.
Road accident victims were recruited through several Dutch hospitals and rehabilitation centres. A total of 276 patients participated and 197 took part in both measurements.
Examination of test-retest reliability, reproducibility and construct validity. The World Health Organization Disability Assessment Schedule II (WHODAS-II) was included as criterion measure for concurrent validity.
Types of main injury were fractures (38%), trauma?tic brain injury (37%), spinal cord injury (13%), whiplash (9%) and other (3%). Mean time after injury was 2.2 years. Internal consistency of IMPACT-S was satisfying for all 9 domains (0.75-0.89) and excellent for the total score (0.96). Test-retest reliability was good at item level (0.44-0.72), domain level (0.72-0.92) and total score (0.94). Strong correlations (0.61-0.88) between IMPACT-S and corresponding WHODAS-II scores were found.
IMPACT-S is a reliable and valid generic measure of activity limitations and participation restrictions that fits the ICF.
Purpose
Annual cervical cancer screening is recommended in Germany as a part of the statutory preventive care. Abnormal results can provoke psychological distress and anxiety, compromising women’s ...adherence. Little is known about how a cervical dysplasia impacts adherence follow-up visits and prevention habits over time. To optimize care strategies, this study aims to identify women at risk for nonadherence to follow-up visits after a screening event.
Methods
Between November 2015 and May 2017, participants with an abnormal Pap smear at the Heidelberg and Leipzig University Hospitals received a four-part questionnaire (sociodemographic data, PHQ-D, self-designed fear and prevention habit questions) at the first consultation (T1) and subsequently after 3 (T2) and 6 (T3) months; healthy controls completed the questionnaire at T1.
Results
132 women with an abnormal Pap smear with conization: S1 (
n
= 68, 51.5%), without intervention: S2 (
n
= 64, 48.5%) and healthy controls (
K
,
n
= 101) generally adhered to gynecological checkups, except S1 6 months after the first diagnosis (S1/T3 − 0.47, signed rank
p
< 0.0005). Knowledge of primary prevention information, i.e., HPV vaccination, was significantly higher among
K
(
K
58%, S1 29%, S2 44%, Chi-squared
p
= 0.01) as was vaccine uptake (
K
39% versus S1/S2 7% and 17%, respectively, Chi-squared
p
= 0.0004). Fear of upcoming Pap smears rose significantly over time (S1/T1–S1/T2–S1/T3, Wilcoxon signed-rank test
p
< 0.001) and was higher among those with conization at T2 (Chi-square test,
p
= 0.01) and partially accompanied by panic disorders at T1 (Chi-square test
p
= 0.035). Realization of general preventive habits rose significantly among women without an operative procedure (S2) over the study.
Conclusion
This study advances the understanding of non-participation in follow-up visits after a dysplasia diagnosis, identifying post-conization women as a special risk group for decreased adherence.
Purpose: The aim of this study was to investigate the relations between the ICF components from a subjective perspective. Method: Data on health condition and perceived functioning were collected ...among 2941 individuals with at least one chronic disease or disorder. Path analysis was used with perceived level of participation as the final denominator. Three models were tested: one with the number of chronic diseases and disorders as an indicator of health condition, one with perceived health as indicator of health condition, and one with perceived health as part of the personal factors. Results: Although all models showed a good fit, the model with the best fit was that with perceived health as an indicator of health condition. Conclusions: From a patient's perspective, components of the ICF scheme appear to be associated with each other, with perceived health being the best indicator of the health condition.
Implications for Rehabilitation
The International Classification of Functioning, Disability and Health (ICF) is a international accepted framework to describe human functioning from a health perspective.
In research the ICF components are mostly operationalized using objective measures, for instance Performance tests.
This large scale study shows that also with perceived measures and independent of a specific health condition relations between the ICF components can be found.
Abstract Introduction Evaluation of oncological outcome and prognostic factors of patients with primary breast cancer treated at a certified academic breast unit. Patients and methods We ...prospectively collected data of 3338 patients, diagnosed with primary breast cancer between 01.01.2003 and 31.12.2010 and treated at the Breast Unit Heidelberg, Germany, in order to analyze outcome in clinical practice. We evaluated local control rate (LCR), disease-free survival (DFS), distant disease-free survival (DDFS), observed overall survival (OS) and age-adjusted relative overall survival (ROS). In addition, the impact of known prognostic factors on these outcome variables was examined in univariate and multivariate analyses. Results Of all patients, 368 (11.0%) had carcinoma in situ (CIS) and 197 (5.9%) had bilateral cancers. For the 2970 patients with invasive cancer, of which 49 patients (1.7%) had metastastic disease at time of diagnosis, DFS, LCR, DDFS, OS and ROS at 5 years were 79.8%, 84.7%, 81.2%, 86.3%, and 89.8%, respectively. In multivariate analysis age, pT category, nodal status, hormone receptor status and grading were identified as independent prognostic factors for OS. Conclusion Compared with recent population-based reports from Germany, more favourable patient characteristics and nominally higher survival was found among this large cohort of patients with primary breast cancer treated at a single certified breast unit.
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