17 research outputs found
Een man met een pijnlijke knie na een motorongeval
No full textA 48-year-old male presented with a painful right knee after a motorcycle accident. Peripheral pulsations in the lower right leg were absent. X-ray indicated a dislocation of the knee. Additional CT-scan revealed a dissection of the popliteal artery. Surgical exploration revealed extensive vascular, neurological and ligamentar damage
Consortium Authorship:Ethical Tensions in Emerging Authorship Practices in Interdisciplinary Collaborative Research
No full textTraditional conceptions of academic authorship, e.g., the seemingly self-evident assumption that an author is someone who actually writes a text, is challenged by the complexity, scale, and collaborative nature of scientific research. Authors are expected to make a substantial contribution and to assume accountability for all aspects of the work, but in practice, many individuals listed as authors fail to meet all these criteria, notably in biomedical fields. In view of this tension between norm and practice, new conceptions of authorship have emerged, reflecting the growing importance of team science. This paper assesses whether consortium authorship as an emerging practice (also known as ‘group authorship’ or ‘team authorship’) offers a viable approach. Besides practical benefits, there is a normative dimension behind this concept, as it aims to acknowledge the importance of collaboration (seeing it as more than the sum of contributions attributable to individuals), but it also raises ethical questions concerning the responsibilities of consortium authors for the text as a whole. We opt for a case study approach, zooming in on experiences within a research consortium. Besides a literature review, we analyse the results of a deliberative workshop on consortium authorship and analyse how consortium authorship is currently handled in academic journals, notably in the biomedical field. We argue that consortium authorship works best when used in combination with individual authorship, but also notice that it challenges us to rethink the concept of academic authorship as such, for which we use Donna Haraway’s concept of sympoiesis as a starting point.</p
Increasing abdominal girth in a female patient with a gastric band = Toenemende buikomvang bij patiënte met een maagband
No full textBACKGROUND: Insufficient weight loss after gastric band placement is generally linked to band-related complications or a persistently unhealthy diet. CASE DESCRIPTION: A 47-year-old woman with a history of gastric band placement presented with complaints of decreased mobility, dyspnoea, gastro-oesophageal reflux and a progressive increase in abdominal girth. Initially, these symptoms were attributed to an unhealthy diet. However, additional testing showed a large intra-abdominal multicystic lesion originating from the ovaries. The patient was operated and two large serous cystadenomas were removed, after which the symptoms disappeared almost immediately. CONCLUSION: Abdominal complaints after bariatric surgery can often be explained by surgical complications or unhealthy eating habits. Although the cause of certain complaints is sometimes obvious, alternative diagnoses need to be considered. If the abdominal girth in middle-aged women increases, ovarian disorders must always be considered in the differential diagnosis and appropriate additional diagnostic testing need to be carried out
Calibration of the Gastric Pouch in Laparoscopic Roux-en-Y Gastric Bypass: Does It Matter? The Influence on Weight Loss
No full textPerioperative online weight monitoring in bariatric surgery with a digital internet-connected scale
No full textStrict follow-up after bariatric surgery is an important factor in achieving and maintaining weight loss, whereas regaining weight is the most important threat in long-term follow-up. Stagnation in weight loss or weight regain can be signals of early treatment failure. The aim of this study is to assess the possibility of obtaining frequent objective weight measurements using an Internet-connected home weighing scale.
Internet-connected home weighing scales were used to perform weekly follow-up in bariatric surgery patients during the first postoperative year. For each patient, weight measurements were registered and excess body weight loss was calculated. This follow-up method was deemed successful if weight measurements were available for 80 % of all weeks in the first year.
A total of 14 patients started the protocol. Seven patients (50 %) performed weekly weight measurements for at least 80 % of all weeks in the first year. One-year follow-up was available for 11 patients. Excess weight loss was > 50 % in nine (82 %) of these patients and > 40 % in the remaining two.
Using an Internet-connected weighing scale at home is feasible in postsurgery bariatric patients. It can provide the treating physicians with valuable information about weight loss over time. This could possibly offer opportunities for timely interventions during follow-up in case of insufficient weight loss or weight regain
Diagnosis and management of acute appendicitis. EAES consensus development conference 2015
No full textUnequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis
Retrospective analysis of enhancer activity and transcriptome history
No full textCell state changes in development and disease are controlled by gene regulatory networks, the dynamics of which are difficult to track in real time. In this study, we used an inducible DCM–RNA polymerase subunit b fusion protein which labels active genes and enhancers with a bacterial methylation mark that does not affect gene transcription and is propagated in S-phase. This DCM–RNA polymerase fusion protein enables transcribed genes and active enhancers to be tagged and then examined at later stages of development or differentiation. We apply this DCM-time machine (DCM-TM) technology to study intestinal homeostasis, revealing rapid and coordinated activation of enhancers and nearby genes during enterocyte differentiation. We provide new insights in absorptive–secretory lineage decision-making in intestinal stem cell (ISC) differentiation and show that ISCs retain a unique chromatin landscape required to maintain ISC identity and delineate future expression of differentiation-associated genes. DCM-TM has wide applicability in tracking cell states, providing new insights in the regulatory networks underlying cell state changes.</p
Post-Pandemic Needs of Unpaid Family and Friend Caregivers to Effectively Continue Caregiving Duties in one Northern Ontario Health Authority
No full textThe Covid-19 pandemic had a significant impact on the support networks for older adults and caregivers as health and social care systems were forced to dramatically change the ways patients and clients interacted with providers, services, and programs. In Northern Ontario, caregivers are older, caring in more intense situations, more likely to be caring for multiple care recipients simultaneously and less likely to be in contact with health professionals. This research sought to explore the post-pandemic needs of caregivers in a Northern Ontario health catchment to better understand the needed supports. Using a collaborative and co-design approach with caregiver advisors within a qualitative description design, seven focus groups were conducted with 36 participants in total in February 2023. Reflexive thematic analysis was used to generate five themes from the transcripts: caregivers as the invisible but vital backbone of health and social care; amplified distress: navigating overwhelming demands; family fault lines exposed; contextualized care: the need for personalized supports; and empowering caregivers through training and supports. Our findings suggest that the pandemic significantly impacted the already vulnerable support networks for older adults and caregivers, as health and social care systems had to adapt to new restrictions and limitations. Caregivers were forced to take on additional responsibilities and cope with social isolation, leading to detrimental effects on their mental health and overall well-being
A scoring system to predict the severity of appendicitis in children
No full textIt appears that two forms of appendicitis exist. Preoperative distinction between the two is essential to optimize treatment outcome. This study aimed to develop a scoring system to accurately determine the severity of appendicitis in children. Historical cohort study of pediatric patients (aged 0-17 y old) with appendicitis treated between January 2010 and December 2012. Division into simple, complex appendicitis, or another condition based on preset criteria. Multiple logistic regression analysis was used to build the prediction model with subsequent validation. There were 64 patients with simple and 66 with complex appendicitis. Five variables explained 64% of the variation. Independent validation of the derived prediction model in a second cohort (55 simple and 10 complex appendicitis patients) demonstrated 90% sensitivity (54-99), 91% specificity (79-97), a positive predictive value of 64% (36-86), and an negative predictive value of 98% (88-100). The likelihood ratio+ was 10 (4.19-23.42), and likelihood ratio- was 0.11 (0.02-0.71). Diagnostic accuracy was 91% (84-98). Our scoring system consisting of five variables can be used to exclude complex appendicitis in clinical practice if the score is <
Optimal stump management in laparoscopic appendectomy: A network meta-analysis by the Minimally Invasive Surgery Synthesis of Interventions and Outcomes Network
No full textBackground. Laparoscopic appendectomy is the predominant method of treatment of acute appendicitis. There is insufficient evidence on the most effective management of the appendix stump. The aim of this study was to investigate the relative effectiveness and provide a treatment ranking of different options for securing the appendix stump. Methods. Electronic databases were searched to identify randomized controlled trials comparing ligation methods of the appendix. The primary outcomes were organ/space infection and superficial operative site infection. We performed a network meta-analysis and estimated the pairwise relative treatment effects of the competing interventions using the odds ratio and its 95 % confidence interval. We obtained a hierarchy of the competing interventions using rankograms and the surface under the cumulative ranking curve. Results. Forty-three randomized controlled trials were eligible and provided data for >5,000 patients. Suture ligation seemed to be the most effective treatment strategy, in terms of both organ/space infection and superficial operative site infection. Statistical significance was reached for the comparisons of clip versus endoloop (odds ratio 0.56, 95% confidence interval, 0.32-0.96) for organ/space infection; and suture versus clip. (odds ratio 0.20, 95 % confidence interval 0.08-0.55) and clip versus endoloop (odds ratio 2.22, 95% confidence interval 1.56-3.13) for superficial operative site infection. The network was informed primarily by indirect treatment comparisons. Conclusion. The use of suture ligation of the appendix in laparoscopic appendectomy seems to be superior to other methods for the composite parameters of organ/space and superficial operative site infectio
