107 research outputs found
Oesophageal cancer: preoperative diagnostic strategies, prognostication and treatment outcome
No full textMark van Heijl onderzocht diagnostiek en behandeling van slokdarmkanker. In een vroeg stadium kan op basis van PET- en CT-scans niet worden voorspeld welke patiënten zullen reageren op chemoradiotherapie. Bij iedere nieuwe patiënt met slokdarmkanker dient voorafgaand aan de operatie een echo van de hals te worden gemaakt. Het percentage patiënten dat na de ingreep een vernauwing ontwikkelt, is relatief hoog (42%). In het AMC bleef het sterftecijfer na een slokdarmverwijdering de afgelopen zestien jaar laag: tussen 3,2 en 3,4 procent. De langetermijnoverleving nam significant toe, tot een driejaarsoverleving van 53 procent in de meest recente periode
sj-pdf-1-han-10.1177_15589447211040879 – Supplemental material for Effect of Tendon Strip (FCR vs APL) on Outcome of CMC Thumb Joint Arthroplasty With Pyrocarbon Disk Interposition
No full textSupplemental material, sj-pdf-1-han-10.1177_15589447211040879 for Effect of Tendon Strip (FCR vs APL) on Outcome of CMC Thumb Joint Arthroplasty With Pyrocarbon Disk Interposition by Cecile Maria Cornelia Agnes van Laarhoven, Marcus Chen Yee Tong, Mark van Heijl, Arnold Herman Schuurman and Brigitte Egeberta Petronella Adriana van der Heijden in HAND</p
Opportunities for effective communication in musculoskeletal care
Get PDFEffective communication, based on patient engagement and trust, facilitates patient-physician decision-making and leads to more satisfied patients, better treatment adherence, alleviated symptoms and concerns, and faster recovery from illness. When done right, patients in musculoskeletal care often need just one consultation. Misperceptions of symptoms of disease, and lower patient health literacy present opportunities for effective communication, which faciliates patient-physician decision-making. This thesis describes (1) effective communication opportunities involved with certain patient behaviour, thoughts, and emotions (2) level and perspectives of effective patient-physician communication, and (3) the value of digital health technologies in contributing to effective communication and patient involvement. Effective communication thrives by taking a genuine interest in what makes each person unique (perceptive for disparities), anticipating misconceptions and concerns, and guiding rather than directing. The goal is to establish a trusting relationship that empowers patients to make better health dicisions based on preferences that matches their values. It requires active listening, breaking old habits, and some efficiency. When expertise is delivered in a brief, scripted manner health-care providers should not be too concerned about running behing on schedule. Physicians and researchers should focus on training programs that teach to adapt communication to patient values and needs. Health technologies, like patient portals, have potential to assist in this goal by enhancing care delivery, and improving patient autonomy and engagement
Evaluation and improvement of prehospital trauma triage
No full textWorldwide, every five seconds a life is cut short as a result of an injury. Additionally, many more lives are affected by injury-related disabilities. In first world countries, systems of trauma care have been shown to substantially reduce the mortality associated with injury. In these trauma systems, different levels of trauma centers exist. In general, two levels of trauma centers can be distinguished; higher-level and lower-level trauma centers. Ensuring transport of severely injured patients to higher-level trauma center has a profound impact on these patients’ survival. At the same time, transport of patients without severe injuries to lower-level trauma centers should be warranted, in order to lower the preventable burden on higher-level trauma centers and unnecessary high costs. Every single day, emergency medical services (EMS) providers assess and make decisions for each individual patient: they have to start initial care, decide whether treatment at a trauma center is necessary, and if so, transport that patient to the most appropriate trauma center. This process of prehospital trauma triage plays a central role in every trauma system. The goal is to identify the at-risk patients and to timely transport them to the most appropriate trauma center. However, identification of severely injured patients is a challenging task. Prehospital trauma triage protocols have been developed to aid EMS providers in identifying severely injured patients. This thesis showed that currently used prehospital trauma triage protocols and triage quality are falling short and desperately need improvement. Evaluation of the prehospital trauma triage in different regions of the Netherlands showed that the triage protocol in use functioned so poorly; even flipping a coin had a higher chance of correctly identifying a severely injured patient. Fortunately, the EMS providers also rely on their clinical judgment and experience to assess the patient. Consequently, a large proportion of the severely injured patients are transported to higher-level trauma centers. Yet, work remains to be done, since 22%-27% of the severely injured patients were not transported to a higher-level trauma center. The newly developed and validated prediction model, as described in this thesis, could identify about 90% of the severely injured patients. This triage prediction model could aid EMS providers in their transport decisions. Furthermore, addition of EMS provider judgment could enhance the accuracy even more. The current trauma system is well designed; however, it can be improved substantially by accurate prehospital trauma triage. Inadequate prehospital trauma triage has a negative impact on the whole trauma system chain, such as a decreased functional outcome for the patient and relatively higher trauma care costs. Innovation, education, and regional collaboration are the three pillars on which this improvement is based. A newly developed triage tool serves as an important first step on the road ahead to optimize prehospital trauma triage. This road will lead to an improvement of the entire trauma care chain and provide future patients with the care they deserve
Fractures around the shoulder girdle : Unsolved fractures?
No full textThis thesis is about the treatment of clavicle and proximal humeral fractures and is the result of a Swiss-Dutch collaboration. Clavicle and proximal humeral fractures are very common and used to be treated non-operatively. The last two decades we have seen a shift however towards more operative treatment. Despite many trials and other studies, until now there is still an ongoing debate about what the best treatment modality is for these fractures. ‘Patient selection’ together with ‘shared decision making’ are hot topics and are probably the key to future indications for operative or non-operative treatment of these fractures. This thesis presents several studies that aim to provide further evidence that can aid in making a decision for the best treatment for every single patient. The first part is about medial, shaft and lateral clavicle fractures. Medial clavicle fractures are rare injuries and generally treated non-operatively. We present an operative technique for displaced medial clavicle fractures. In this retrospective study we found excellent functional results. Furthermore, two studies about the intramedullary treatment of clavicle fractures were performed. One about the application of an end cap and one about the suitability of displaced clavicle shaft fractures. We concluded that the application of an end cap did not result in less implant related irritation and that fractures more lateral from the middle were less suitable for this technique from medial. Another study compared two implants for the treatment of instable lateral clavicle fracture. We concluded that whenever possible the superior plate with lateral extension should be used but that the Hook plate was a good alternative for very lateral fractures. And lastly, the current concepts for the treatment of collar bone fractures are discussed and treatment algorithms proposed. The second part covers the treatment of proximal humeral fractures. A systematic review and meta-analysis on displaced proximal humeral fractures (DPHF) was performed comparing the operative and non-operative treatment. As we found no difference in functional outcome, we concluded that for the typical patient presenting with a DPHF we recommend the non-operative treatment. In addition, a study on the long-term functional outcome and implant-related irritation after minimally invasive plate osteosynthesis (MIPO) of DPHF was performed. Satisfying functional outcomes after a mean of 8 years follow-up were found. However, about one third of the patients had a second operation for implant removal due to implant-related irritation. We also present a minimally invasive technique for proximal humeral fracture-dislocations. Functional results were promising and in 86% the humeral head was preserved. However, there is a high rate of re-operations either because of complications or for implant removal. In a last study we present the current concepts of proximal humeral fracture treatment. In general, non- or slightly-displaced proximal humeral fractures are treated non-operatively. Also, DPHF with elderly, osteoporotic and polymorbid patients can be treated conservatively. Older patients with a proximal humeral fracture-dislocation should be treated with a prosthesis, young and active patients with an osteosynthesis. For active and fit patients with a DPHF there is no consensus
Operative treatment of displaced clavicle fractures: optimising treatment options
No full textWith an overall incidence of 29 to 64 per 100.000 people a year, clavicle fractures are one of the most common fractures around the shoulder girdle. They account for 2.6% to 4% of all fractures in adults. About 80% of all clavicle fractures are located in the middle third of the clavicle. Although it is an ongoing topic of debate whether a displaced midshaft clavicle fracture (DMCF) should be treated conservatively or operatively, over the last decade, surgical fixation of DMCF’s has been increasing. Open reduction and plate fixation (PF) or intramedullary pin fixation (IMF) are two the most commonly used operative techniques. In this thesis, clinical and biomechanical properties of both operative techniques are reported. The main focus is on the optimal surgical approach for treating DMCF’s and minimizing implant-related irritation
Evaluating and optimizing pre-hospital triage: Towards tailored decision-support
No full textAdequate pre-hospital trauma triage is crucial to enable optimal care in inclusive trauma systems. Transporting patients requiring specialized care to lower-level trauma centers (i.e., undertriage), results in preventable mortality and morbidity. Conversely, transporting mildly and moderately injured patients to higher-level trauma centers (i.e., overtriage), leads to unnecessary utilization of resources and costs. In general, reducing undertriage is prioritized over decreasing overtriage. The American College of Surgeons Committee on Trauma (ACSCOT) and the Dutch Health Care Institute recommend maximum undertriage rates of 5% and 10%, respectively. A recent systematic review revealed that no trauma system worldwide is currently capable of adhering to these guidelines while maintaining acceptable overtriage rates (i.e., maximum of 35%). To evaluate and improve pre-hospital trauma triage, within this thesis the Trauma Continuum of Care Cohort (TRACCC) was developed, in which eight Emergency Medical Services (EMS) and seven inclusive trauma regions participated. On-scene decision-making by EMS professionals was found to be influenced by several factors. A first pre-hospital triage decision is made at the dispatch center, and the initial assigned priority seems to affect a patient’s chance to be undertriaged. Similarly, the distance to the nearest higher-level trauma center seems to influence EMS professionals’ decision-making, as patients in need of specialized trauma care are less likely to be transported to such centers as the driving distance increases. Alternative causes for transport to a lower-level trauma centers were identified in severely injured patients who died within 30 days post-trauma: hemodynamic instability (13%) and patient requests not to receive specialized trauma care due to pre-injury health status (7%). Also, was found that secondary transfers to higher-level trauma centers occur in a minority of the undertriaged patients and may improve their survival rates. Apart from evaluating whether the absolute criteria for higher-level trauma care are present, EMS professionals assess which injuries might be present. Pre-hospital injury recognition is difficult, which was found to be especially the case in patients with serious abdominal and/or pelvic injury. Certain pre-hospital clinical factors, such as suspicion of alcohol intoxication, could be of influence on a patient’s chance to suffer from certain of injury and potentially influence injury recognition by the EMS professional. Various types of pre-hospital protocols (i.e., decision-support for pre-hospital triage in children, spinal immobilization, and administration of tranexamic acid) were found to be suboptimal in aiding Dutch EMS professionals. This could potentially be improved by implementing full prediction models in pre-hospital clinical practice. Within this thesis, such models were developed in simulated military trauma population, to provide a prioritized overview of wounded patients and to predict injuries. Additionally, the implementation of the trauma triage intervention was investigated, which involved introducing a pre-hospital prediction model, incorporated in mobile application, used as a decision-support tool by EMS professionals. The intervention resulted in a significant reduction of undertriage (5%), with no increase in overtriage. Utilizing such a model at the scene of injury to estimate the probability of a patient being severely injured is worldwide a novel and promising approach to optimize pre-hospital trauma triage
Prehospital triage in trauma patients: ambulance care and deployment of a mobile medical team
No full textThe prehospital trauma triage system consisting of regional ambulance services and overarching availability of mobile medical teams, the level criteria for trauma centres and inhospital care for trauma patients are wellorganised in the Netherlands. However, the quality of prehospital triage in the Netherlands is inadequate at the moment, with an average undertriage rate of more than 30%. There is, thus, much room for improvement in the quality of prehospital triage. Research in this area is now taking off, partly because of the arrival of a new quality indicator from the Netherlands National Health Care Institute, which states that at least 90% of multipletrauma patients should be primarily taken to a level 1 trauma centre
Prehospital triage in trauma patients; ambulance care and deployment of a mobile medical team
Get PDFThe prehospital trauma triage system consisting of regional ambulance services and overarching availability of mobile medical teams, the level criteria for trauma centres and inhospital care for trauma patients are wellorganised in the Netherlands. However, the quality of prehospital triage in the Netherlands is inadequate at the moment, with an average undertriage rate of more than 30%. There is, thus, much room for improvement in the quality of prehospital triage. Research in this area is now taking off, partly because of the arrival of a new quality indicator from the Netherlands National Health Care Institute, which states that at least 90% of multipletrauma patients should be primarily taken to a level 1 trauma centre.</p
Prehospital triage in trauma patients; ambulance care and deployment of a mobile medical team
Get PDFThe prehospital trauma triage system consisting of regional ambulance services and overarching availability of mobile medical teams, the level criteria for trauma centres and inhospital care for trauma patients are wellorganised in the Netherlands. However, the quality of prehospital triage in the Netherlands is inadequate at the moment, with an average undertriage rate of more than 30%. There is, thus, much room for improvement in the quality of prehospital triage. Research in this area is now taking off, partly because of the arrival of a new quality indicator from the Netherlands National Health Care Institute, which states that at least 90% of multipletrauma patients should be primarily taken to a level 1 trauma centre.</p
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