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Two-Eyed Seeing and other Indigenous perspectives for neuroscience
No full textThe integration of Indigenous perspectives and knowledge with biomedical approaches in neurosciences can significantly broaden the understanding of the human brain and mind. Drawing upon the writings of Elders in Canada, we refer to this integration as Two-Eyed Seeing or Etuaptmumk. We discuss how Two-Eyed Seeing and other dual perspectives can bring both breadth of knowledge and humility to the development of research and clinical practices for brain health. In this forward-looking discussion, we include both traditional academic and non-academic traditions and the work of Indigenous scholars on methodologies, life, health, culture, language and history. To describe challenges and consider solutions, we offer broad strategies for allyship, humility and universalism and situate them in four specific examples pertaining to disability, suicide, migration and the environment. We further advance the power of Two-Eyed Seeing in the context of new considerations for communication and public engagement. Two-Eyed Seeing, per se, is only one approach, but as neuroscience becomes ever more global, inclusive and ethically proactive, it must universally see the world of brain and mental health through the eyes of both reductionism and holism
Patients’ and plastic surgeons’ experiences with an online patient decision aid for breast reconstruction: considerations for nationwide implementation
Full text linkBackground: Women diagnosed with breast cancer undergoing a mastectomy often have the option to undergo breast reconstruction (BR). BR decisions are complex and have considerable impact. We developed a patient decision aid (pDA) to support patients’ BR decision-making. Here, we assess patients’ and physicians’ use of the BR pDA and their views on the barriers and facilitators for widespread implementation. Methods: Participants completed a questionnaire, and back-end data of the pDA was analyzed. Results: Of 116 eligible patients, 113 patients accessed the BR pDA (median age: 50 years and 50% were highly educated. Most patients (72%) were satisfied with the pDA and 74% would recommend the BR pDA to other women facing the same choice. Patients’ preferences regarding how much, what kind and how to present information varied. Plastic surgeons (N = 22; 71% response) were satisfied with the pDA. Their key factors for implementation included the perceived match between information and clinical practice, costs, impact on patients, and support from peers and management for the tool. Conclusions: As the BR pDA was highly valued by its end users, the identified factors for implementation should be taken into account
Poison Center Surveillance of Occupational Incidents with Hazardous Materials (2016-2023): Insights for Risk Mitigation and Incident Preparedness
Full text linkIncidents involving hazardous materials (HAZMAT incidents) can impact human health and the environment. For the development of risk mitigation strategies, it is essential to understand the circumstances of such incidents. A retrospective study (2016-2023) of acute occupational HAZMAT incidents involving multiple patients (>1, including workers, emergency responders and bystanders) reported to the Dutch Poisons Information Center was conducted. We only included incidents that occurred during the performance of work or as a result of a disruption of a work-related process. Patient characteristics, exposure circumstances (such as the substances involved, chemical phase, and type of release (e.g., spill/release or fire/explosion)) and business classes were analyzed to identify risk factors. From 2016 to 2023, the DPIC was consulted about 516 HAZMAT incidents. Inhalation was the most common route of exposure (89%). Patients were often exposed to chemical asphyxiants (n = 156) and acids ( n = 151). Most incidents occurred in fixed facilities ( n = 447), while 49 incidents occurred during transport. The primary cause was a spill/release ( n = 414), followed by a fire/explosion ( n = 65). Most patients were exposed to a gas/vapor ( n = 421), followed by a liquid ( n = 59) or solid ( n = 28). Incidents frequently occurred in industry (20%). The majority of patients reported mild to moderate health effects. Surveillance data on HAZMAT incidents are essential for incident preparedness. Poison Center data can help identify risk factors, which can be used to develop risk mitigation strategies to prevent future incidents
The positive impact of a quality improvement collaborative on process indicators for geriatric hip fracture care
No full textSummary: Adherence to guidelines for geriatric patients with a hip fracture is challenging. With this study, adherence to important quality indicators in geriatric hip fracture care was improved. A quality improvement collaborative including benchmarking and knowledge sharing showed to be effective in improving quality of care. Background: Adherence to guidelines for geriatric patients with an osteoporotic hip fracture is challenging. Therefore, the aim of this study was to improve the adherence to quality indicators (QIs) for these patients using benchmarking and knowledge sharing. Method: A prospective multicenter study was initiated throughout 19 hospitals in Flanders, Belgium. Adherence to 23 QIs was measured. Two retrospective audits (based on patient record analyses) were conducted in 2018–2019 (measurement period (MP) 1) and 2021 (MP 2). Between both audits, anonymous benchmarking was provided to the participating centers and three educative sessions on specific topics were performed. Results: A total of 1044 patients were included in the study. At MP 1, QIs showing the lowest adherence rates were the administration of nerve blocks, steroids, and tranexamic acid, applied in only 8.0%, 9.7% and 22.2% of the patients, respectively. At MP 2, these adherence rates significantly improved up to 25.4%, 26.4% and 30.7%, respectively (p < 0.001). The indication of the start of discharge planning also significantly improved between both periods (89.3% in MP 1 vs. 93.7% in MP 2, p = 0.043), while the avoidance of intra-operative hypotension was less well realized (56.2% in MP 1 vs. 52% in MP2, p = 0.026). Overall adherence significantly increased from 61.7 to 64.5% (p < 0.001). Delirium was significantly reduced (from 22.1% in MP 1 to 17.4% in MP 2, p = 0.030). Conclusion: Benchmarking in combination with a peer-reviewed and knowledge sharing intervention increases the adherence to quality indicators for patients with a geriatric hip fracture
Nationwide implementation of the international multidisciplinary best-practice for locally advanced pancreatic cancer (PREOPANC-4): study protocol
Full text linkBACKGROUND: The introduction of (m)FOLFIRINOX and gemcitabine-nab-paclitaxel has changed the perspective for patients with locally advanced pancreatic cancer (LAPC). Consequently, in experienced centres 23% of patients with LAPC undergo a resection with 5-year overall survival (OS) rates of up to 25%. In the Netherlands, the nationwide resection rate for LAPC remains low at 8%. The PREOPANC-4 program aims for a nationwide implementation of the international multidisciplinary best-practice to improve patient outcome. METHODS: Nationwide program implementing the international multidisciplinary best-practice for LAPC. In the training phase, multidisciplinary and surgical webinars are given by 4 international experts, leading to a clinical protocol, followed by surgical off-site and on-site proctoring sessions. In the implementation phase, the clinical protocol will be implemented in all centres, including a nationwide expert panel (2022-2024). Healthcare professionals will be trained in shared decision-making. Consecutive patients diagnosed with pathology-proven LAPC (i.e., arterial involvement > 90° and/or portomesenteric venous > 270° involvement or occlusion [DPCG criteria]) are eligible. Primary outcomes are median and 5-year OS from diagnosis, resection rate, in-hospital/30-day mortality and major morbidity (i.e., Clavien-Dindo grade ≥ IIIa), and radical resection (R0) rate. Secondary outcomes include quality of life, functioning, side effects, and patients' healthcare satisfaction in all included patients. Outcomes will be compared with patients with borderline resectable pancreatic cancer (BRPC) treated with neoadjuvant FOLFIRINOX in the PREOPANC-2 trial (EudraCT: 2017-002036-17) and a historical cohort of patients with LAPC from the PACAP registry (NCT03513705). The existing prospective LAPC Registry and PACAP PROMs (NCT03513705) will be used for data collection. In qualitative interviews, treatment preferences, values, and experiences of LAPC patients, their relatives, and healthcare professionals will be assessed for the development of shared decision-making supportive tools. It is hypothesized that the program will double the nationwide LAPC resection rate to 16% with major morbidity < 50% and mortality ≤ 5%, and OS following resection similar to that observed in patients with BRPC. DISCUSSION: The PREOPANC-4 program aims to safely implement the international multidisciplinary best-practice for LAPC leading to benchmark outcomes for both short-term morbidity, mortality, and OS. TRIAL REGISTRATION: PREOPANC-4 program was registered at ClinicalTrials.gov (NCT05524090) on September 1, 2022
Building an international network of young surgeons across surgical specialties – Introducing the Young Surgeons Publications Committee
Full text linkRobotic Distal Pancreatectomy with Celiac Axis Resection and SMA Divestment: A Step-by-Step Educational Video
No full textIntroduction: En-bloc celiac axis resection (CAR) was first proposed by Lyon H. Appleby in 1952 for gastric cancer and later modified for pancreatic resections with gastric preservation by Nimura et al. in 1976. CAR remains uncommon, performed in fewer than 0.2 cases annually. Advancements in preoperative imaging and anatomy understanding, ischemic complication management, and centralization of care have improved outcomes. This report presents a robotic distal pancreatectomy (DP) with CAR and superior mesenteric artery (SMA) divestment. Case report: A 65-year-old woman presented with back pain. Imaging revealed biopsy-proven pancreatic adenocarcinoma in the pancreatic body, encasing the celiac, splenic, and common hepatic arteries with SMA abutment. Following four cycles of neoadjuvant FOLFIRINOX, follow-up imaging demonstrated stable disease without metastasis. The need for hepatic artery reconstruction was assessed intraoperatively, with alternative strategies detailed in the accompanying video. Operative technique: The patient underwent a distal pancreatectomy and splenectomy with class Ia CAR. Surgery was conducted in a caudal approach, lasted 420 minutes with minimal blood loss (100 ml). Laparoscopic ultrasound (lapUS) and indocyanine green (ICG) perfusion were used to assess resectability, vascular perfusion, and targeted blood vessels. The postoperative course was uneventful, except for a Grade B chyle leak managed conservatively. No liver or gastric ischemia occurred. Adjuvant chemotherapy was initiated two months postoperatively. Conclusion: Enhanced visualization, improved dexterity, and adjuncts including lapUS and ICG are potential benefits that are available to surgeons with the robotic platform when performing arterial divestment and CAR via a caudal approach
From digital harm to recovery: a multidisciplinary framework for First Aid after Online Sexual Abuse
Full text linkOnline sexual abuse in adolescence encompasses various forms of digital exploitation, including grooming, sexting, sextortion, and image-based sexual abuse. Current research indicates that a significant proportion of minors are exposed to online sexual abuse. The psychological impact on victims includes severe mental health issues, such as depression, anxiety, and post-traumatic stress symptoms. Responses to online sexual abuse disclosures often require a multidisciplinary approach. In the Netherlands, Sexual Assault Centers (SACs) utilize the First Aid after Online Sexual Abuse protocol. This approach addresses immediate safety and (forensic) medical concerns, facilitates the removal of image-based content, and supports natural recovery while providing referrals for psychological treatment if needed. This paper highlights the urgent need for a comprehensive, multidisciplinary response to online sexual abuse, emphasizing the importance of integrating psychological, medical, and legal support to tackle the complex challenges posed by online abuse, ensuring effective, context-sensitive interventions, and supporting victims' recovery and well-being
Amplitude coupling is altered in delirium of various etiologies: Results from a retrospective multi-center case-control EEG study
Full text linkOBJECTIVE: Delirium manifests with comparable clinical presentations, regardless of its heterogeneous etiology. This suggests a final common pathway such as decreased electroencephalography (EEG) phase coupling. This study investigates if amplitude coupling, another mode of neural communication, is altered in delirium due to different etiologies. METHODS: We analyzed EEGs of patients from three sites with either postoperative, poststroke or medical delirium and non-delirious control patients. Amplitude envelope correlation corrected for spatial leakage (AECc) was calculated and Mann-Whitney U-tests were used to compare patients with or without delirium. AECc differences among delirium types were compared using Kruskal-Wallis tests. RESULTS: AECc was significantly increased in delirious (n = 173, age 79.2±9.3 years, 46 % female) as compared to non-delirious (n = 204, age 72.9±13.1 years, 45 % female) patients in the delta (median, effect size of difference: 0.16 vs. 0.12, r = 0.28, p 0.05). CONCLUSIONS: We found modestly higher delta and beta band AECc in delirium compared to non-delirious control patients, regardless of the presumed etiology. SIGNIFICANCE: This study provides evidence for altered amplitude coupling as mode of impaired neuronal communication in delirium, the role of which should be investigated in future studies of neural network pathophysiology
Implementation of blood pressure telemonitoring in high-risk pregnancies; a multicenter quantitative analysis of patient experiences in the SAFE@home study
Full text linkOBJECTIVE: This study evaluates patient experiences with the SAFE@home platform for telemonitoring of blood pressure (BP) and symptom tracking in patients high-risk pregnancies. We hypothesized patients would perceive telemonitoring as usable and patient-centered and aimed to identify barriers and facilitators to aid future digital health scale-up. METHODS: A quantitative analysis within a cohort study across 11 hospitals was conducted. Patients with a high risk of or established HDP home monitored their BP and symptoms daily via the SAFE@home platform. The SAFE@home group had less composite adverse outcomes (17.2 % vs. 21.5) compared to the usual care group. The patient satisfaction and perceived quality of care (PSPQC) questionnaire and client centered care questionnaire (CCCQ) were answered on a 5-point Likert-scale. Primary outcomes were usability and client-centeredness, with ≥ 20 % disagreement indicating barriers and ≥ 80 % agreement indicating facilitators. RESULTS: Of the 606 participants, 376 (62%) completed the survey. The majority indicated high usability for SAFE@home: 98% found it useful for BP monitoring, and 86-95% rated it easy to use. Around 68% felt more in control, 81% appreciated the alignment with personal preferences and 92% would recommend SAFE@home to others. However, 51% of the patients felt they could independently manage their care and 25% did not know who to contact with technical issues. CONCLUSION: Telemonitoring of BP and symptoms in high-risk pregnancies demonstrates high usability and acceptance among patients, improving engagement and control. While autonomy and technical support require improvement, SAFE@home represents a feasible and scalable model for integrating digital care into obstetrics