Patient experience of long term recovery after open fracture of the lower limb : a qualitative study using interviews in a community setting

Objectives Treatment of open fractures is complex and patients may require muscle and skin grafts. The aim of this study was to gain a greater understanding of patient experience of recovery from open fracture of the lower limb 2–4 years postinjury. Design A phenomenological approach was used to guide the design of the study. Interviews took place between October 2016 and April 2017 in the participants’ own homes or via telephone. Setting England, UK. Participants A purposive sample of 25 patients were interviewed with an age range of 26–80 years (median 51), 19 were male and six female, and time since injury was 24–49 months (median 35 months). Results The findings identified a focus on struggling to recover as participants created a new way of living, balancing moving forward with accepting how they are, while being uncertain of the future and experiencing cycles of progress and setbacks. This was expressed through three themes: (i) ‘being disempowered’ with the emotional impact of dependency and uncertainty, (ii) ‘being changed’ and living with being fragile and being unable to move freely and (iii) ‘being myself’ with a loss of self, feeling and looking different, alongside recreation of self in which they integrated the past, present and future to find meaningful ways of being themselves. Conclusion This study identified the long-term disruption caused by serious injury, the hidden work of integration that is required in order to move forward and maximise potential for recovery. Supportive strategies that help people to self-manage their everyday emotional and physical experience of recovery from injury are required. Research should focus on developing and testing effective interventions that provide support and self-management within a holistic rehabilitation plan

SIDA et lésions cutanéo-muqueuses.

English AbstractJournal Articleinfo:eu-repo/semantics/publishe

SPECT/CT bone imaging after hip resurfacing arthroplasty

Background In hip resurfacing arthroplasty a metal implant (prosthesis) is used to resurface the patient's native femoral head. The assessment of bone function around theimplant is important in evaluating any subsequent complications. The use of bone single photon emission computed tomography/computed tomography (SPECT/CT) imaging may enhance this evaluation. Objectives The primary objective of this study was to ascertain whether SPECT/CT imaging is feasible in the presence of the metal implant. A secondary objective wasto deduce the impact attenuation correction has on thedetected counts originating from bone covered by themetal implant. Methods A phantom was constructed to allow assessment of counts obtained from a point source (PS) imaged in thevicinity of a hip resurfacing implant. Three implant cup sizes (4, 8 and 10) were assessed and images acquired with a PS positioned adjacent to the implant pin and under the cup. Multiple acquisitions were undertaken both with and without surrounding soft tissue equivalent material. The images were analysed with and without attenuation correction and the recovered counts compared with that ofa PS imaged in free space (control). Results Attenuation-corrected counts did not vary significantly with cup size (P=0.427), PS position (P=0.999), presence of soft tissue equivalent material (P=0.193) or a combination of PS position and soft tissue(P=0.193). The attenuation-corrected counts recovered from a PS (soft tissue equivalent material present) showed an overestimation, compared with the control, both when positioned adjacent to the pin and under the cup; mean 8% (4–16%) and 4% (1–6%), respectively. Conclusion The results of the study suggest that the application of the attenuation correction technique is applicable to bone SPECT/CT images of the femoral head–neck junction acquired in the presence of a hip resurfacing implant

Sarcome de Kaposi

suppl. 2info:eu-repo/semantics/publishe

Discriminative power of salivary gland ultrasound in relation to symptom-based endotypes in suspected and definite primary Sjögren's Syndrome

Objectives: Salivary gland ultrasound (SGUS) is emerging as essential tool in primary Sjögren's Syndrome (pSS), but its link to symptom-based endotypes is unknown. Therefore, we explored SGUS outcomes in relation to endotypes in patients with definite and suspected pSS. Methods: Definite pSS patients (n = 171) fulfilling the 2016 ACR/EULAR classification criteria, and suspected pSS patients (n = 119), positive for at least one criterion, were included in the Belgian Sjögren's Syndrome Transition Trial (BeSSTT). Stratification into endotypes according to the Newcastle Sjögren's Stratification Tool resulted in low symptom burden (LSB), pain dominant with fatigue (PDF), dryness dominant with fatigue (DDF) and high symptom burden (HSB). SGUS was assessed with Hocevar score (0-48). The dataset was randomly divided into a discovery (n = 203) and replication (n = 87) cohort. Results: SGUS had strong discriminative power for pSS classification (AUC=0.74), especially in DDF (AUC=0.89). In definite pSS, Hocevar scores in DDF were high compared to other endotypes (38 (20-44) versus 18 (9-33); p < 0.001). Patients with highest SGUS-scores showed more sicca and laboratory abnormalities. Moreover, a subset of young, anti-SSA/Ro positive patients not fulfilling classification criteria showed clear SGUS abnormalities. Replication showed similar results. Conclusions: SGUS-scores were significantly higher in definite pSS with DDF endotype, providing the first evidence of imaging abnormalities in salivary glands matching distinct biological profiles ascribed to pSS endotypes. Additionally, a subset of patients with potential early disease was detected based on presence of anti-SSA antibodies and high SGUS-scores. These results underscore the role of SGUS as powerful tool both in pSS classification and stratification

Le syndrome d'immunodéfience acquise

info:eu-repo/semantics/publishe

Identification of infants with increased type 1 diabetes genetic risk for enrollment into Primary Prevention Trials-GPPAD-02 study design and first results

Primary prevention of type 1 diabetes (T1D) requires intervention in genetically at-risk infants. The Global Platform for the Prevention of Autoimmune Diabetes (GPPAD) has established a screening program, GPPAD-02, that identifies infants with a genetic high risk of T1D, enrolls these into primary prevention trials, and follows the children for beta-cell autoantibodies and diabetes. Genetic testing is offered either at delivery, together with the regular newborn testing, or at a newborn health care visits before the age of 5 months in regions of Germany (Bavaria, Saxony, Lower Saxony), UK (Oxford), Poland (Warsaw), Belgium (Leuven), and Sweden (Region Skåne). Seven clinical centers will screen around 330 000 infants. Using a genetic score based on 46 T1D susceptibility single-nucleotide polymorphisms (SNPs) or three SNPS and a first-degree family history for T1D, infants with a high (>10%) genetic risk for developing multiple beta-cell autoantibodies by the age of 6 years are identified. Screening from October 2017 to December 2018 was performed in 50 669 infants. The prevalence of high genetic risk for T1D in these infants was 1.1%. Infants with high genetic risk for T1D are followed up and offered to participate in a randomized controlled trial aiming to prevent beta-cell autoimmunity and T1D by tolerance induction with oral insulin. The GPPAD-02 study provides a unique path to primary prevention of beta-cell autoimmunity in the general population. The eventual benefit to the community, if successful, will be a reduction in the number of children developing beta-cell autoimmunity and T1D.status: publishe