Long-term outcomes of slipped capital femoral epiphysis treated with in situ pinning

PURPOSE: Slipped capital femoral epiphysis (SCFE) is the commonest hip disorder in adolescents. In situ pinning is commonly performed, yet lately there has been an increase in procedures with open reduction and internal fixation. These procedures, however, are technically demanding with relatively high complication rates and unknown long-term outcomes. Nevertheless, reports on long-term results of in situ fixation are not equivocal. This study evaluates the possible higher risk of worse outcome after in situ pinning of SCFE. METHODS: All patients treated for SCFE with in situ fixation between 1980 and 2002 in four different hospitals were asked to participate. Patients were divided into three groups, based on severity of the slip. Patients were invited to the outpatient clinic for physical examination and X-rays, and to fill out the questionnaires HOOS, EQ5D, and SF36. ANOVA and chi-squared tests were used to analyze differences between groups. RESULTS: Sixty-one patients with 78 slips filled out the questionnaires. Patients with severe slips had worse scores on HOOS, EQ5D, and SF36. 75 % of patients with severe slips had severe osteoarthritis, compared to 2 % of mild and 11 % of moderate slips. CONCLUSION: Hips with mild and moderate SCFE generally had good functional and radiological outcome at a mean follow-up of 18 years, and for these hips there seems to be no indication for open procedures. However, severe slips have a significantly worse outcome, and open reduction and internal fixation could therefore be considered

Thuis na een CVA: ‘Dan begint het pas’. Een kwalitatief onderzoek naar de behoefte aan nazorg van CVA-patiënten na terugkeer naar huis

Onderzoeksdoel Exploreren welke behoefte aan zorg CVA-patiënten hebben na terugkeer naar huis uit het ziekenhuis of het revalidatiecentrum. Methode Semigestructureerde interviews met twintig CVA-patiënten en hun partners in de regio Midden-Kennemerland. Resultaten ‘Dan begint het pas’: Thuis wordt het vaak pas duidelijk wat de consequenties van het CVA voor het dagelijks leven zijn. Gevolg hiervan is dat patiënten en hun mantelzorgers/partners na terugkeer naar huis (1) meer informatie en begeleiding hadden willen hebben en dat deze behoefte aan begeleiding langdurig blijft bestaan. Verder hadden ze (2) ook later de gelegenheid willen hebben om terug te vallen op nazorg (na aanvankelijk nee gezegd te hebben). Anderzijds zijn er ook (3) patiënten die geneigd zijn om zelf naar oplossingen te zoeken. Conclusies Patiënten die een CVA doorgemaakt hebben en hun mantelzorgers/partners kunnen thuis pas goed beoordelen waar hun behoefte aan nazorg ligt. De behoefte aan nazorg zou daarom pas na verloop van tijd na terugkeer naar huis beoordeeld moeten worden en langdurig toegankelijk moeten blijven. Omdat patiënten wat de neuropsychologische gevolgen betreft niet beseffen dat ze hier hulp voor kunnen krijgen, is het belangrijk dat het initiatief voor de nazorg bij de hulpverlener ligt

Women receiving massive transfusion due to postpartum hemorrhage: A comparison over time between two nationwide cohort studies

Introduction Incidence of massive transfusion after birth was high in the Netherlands between 2004 and 2006 compared with other high-income countries. This study investigated incidence, causes, management and outcome of women receiving massive transfusion due to postpartum hemorrhage in the Netherlands in more recent years. Material and methods Data for all pregnant women who received eight or more units of packed red blood cells from a gestational age of 20 weeks and within the first 24 hours after childbirth, during 2011 and 2012, were obtained from a nationwide retrospective cohort study, including 61 hospitals with a maternity unit in the Netherlands. Results Incidence of massive transfusion due to postpartum hemorrhage decreased to 65 per 100 000 births (95% CI 56-75) between 2011 and 2012, from 91 per 100 000 births (95% CI 81-101) between 2004 and 2006, while median blood loss increased from 4500 mL (interquartile range 3250-6000) to 6000 mL (interquartile range 4500-8000). Uterine atony remained the leading cause of hemorrhage. Thirty percent (53/176) underwent peripartum hysterectomy between 2011 and 2012, compared with 25% (83/327) between 2004 and 2006. Case fatality rate for women who received massive transfusion due to postpartum hemorrhage was 2.3% (4/176) between 2011 and 2012, compared with 0.9% (3/327) between 2004 and 2006. Conclusions The incidence of postpartum hemorrhage with massive transfusion decreased in the Netherlands between both time frames, but remained an important cause of maternal mortality and morbidity, including peripartum hysterectomy. National surveillance of maternal morbidity and mortality due to postpartum hemorrhage through an improved and continuous registration with confidential enquiries may lead to the identification of clear improvements of maternal care

Comparison of outcome between intrauterine balloon tamponade and uterine artery embolization in the management of persistent postpartum hemorrhage: A propensity score-matched cohort study

Research into fetal development and medicin