Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): Study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Laparoscopic cholecystectomy in acute calculous cholecystitis in high risk patients can lead to significant morbidity and mortality. Percutaneous cholecystostomy may be an alternative treatment option but the current literature does not provide the surgical community with evidence based advice.</p> <p>Methods/Design</p> <p>The CHOCOLATE trial is a randomised controlled, parallel-group, superiority multicenter trial. High risk patients, defined as APACHE-II score 7-14, with acute calculous cholecystitis will be randomised to laparoscopic cholecystectomy or percutaneous cholecystostomy. During a two year period 284 patients will be enrolled from 30 high volume teaching hospitals. The primary endpoint is a composite endpoint of major complications within three months following randomization and need for re-intervention and mortality during the follow-up period of one year. Secondary endpoints include all other complications, duration of hospital admission, difficulty of procedures and total costs.</p> <p>Discussion</p> <p>The CHOCOLATE trial is designed to provide the surgical community with an evidence based guideline in the treatment of acute calculous cholecystitis in high risk patients.</p> <p>Trial Registration</p> <p>Netherlands Trial Register (NTR): <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2666">NTR2666</a></p

Communication practices in conversations about sexual health in medical healthcare settings: A systematic review

Many healthcare professionals experience difficulties in discussing sexual health with their patients. The aim of this review was to synthesize results of studies on communication practices in interactions about sexual health in medical settings, to offer healthcare professionals suggestions on how to communicate about this topic. Veel zorgprofessionals ervaren problemen bij het bespreken van seksuele gezondheid met hun patiënten. Het doel van deze review was een synthese te presenteren van studies naar communicatiepraktijken in interactie over seksuele gezondheid in medische settings, om zorgprofessionals handreikingen te bieden voor communicatie over dit thema

Accounting for Sexual Issues Related to Cancer: A Discursive Psychological Approach to Online Talk Between Women in Heterosexual Relationships

Cancer and its treatments cause significant changes in sexuality that affect the quality of life of both patients and their partners. As these issues are not always discussed with healthcare professionals, cancer patients turn to online health communities to find answers to questions or for emotional support pertaining to sexual issues. By using a discursive psychological perspective, we explore the social actions that participants in online health forums perform when discussing sexuality. Data were collected by entering search terms in the search bars of three online health forums. Our analysis of 213 threads, containing 1,275 posts, provides insight into how participants who present themselves as women with cancer account for their sexual issues and, in doing so, orient to two intertwined norms: Having untroubled sex is part of a couple’s relationship, and male partners are entitled to having untroubled sex. We discuss the potential harmful consequences of orienting to norms related to sexual behaviour. Yet, our findings can also help healthcare professionals in broaching the topic of sexuality in conversations with cancer patients. The insights of this study into what female patients themselves treat as relevant can assist health professionals in better aligning with patients’ interactional concerns

Resilient flood risk strategies: Institutional preconditions for implementation

textabstractThere is a growing recognition of resilience enhancement as an additional objective for adaptation. This will typically involve enhancing the preparedness and capacity to respond to the impacts of climate change. Within flood risk practice, resilient strategies focus on reducing impacts from flooding through better prevention and preparedness. Such strategies will not only reduce existing risk levels, but could also make the social-ecological system more robust for extreme flood events. This is because they seek to prevent those impacts on the system from which recovery is extremely difficult without outside help. Besides that, resilient strategies increase the prospect for the realization of cobenefits, particularly when measures are selected within the spatial domain. Implementing resilient strategies, however, faces many difficulties, particularly in countries like the Netherlands and Poland where prevalent governance arrangements are aimed to facilitate resistant strategies, focusing exclusively on flood protection. We analyzed these implementation difficulties for the Island of Dordrecht, which is a front-runner case of resilient flood risk governance in the Netherlands. A theoretical framework based on relevant issues regarding governance arrangements was used to reflect on the identified gaps and barriers. Although all issues played a role in the case study, there seem to be no generic institutional design parameters that have to be applied for implementing resilient strategies. Even in the current institutional regime, it is possible to find ways of implementing a resilient strategy. The more general institutional precondition has to do with the political willingness to allow for collaboration and experimentation and to enable a more flexible use of current principles and rules

Resilient flood risk strategies: Institutional preconditions for implementation

There is a growing recognition of resilience enhancement as an additional objective for adaptation. This will typically involve enhancing the preparedness and capacity to respond to the impacts of climate change. Within flood risk practice, resilient strategies focus on reducing impacts from flooding through better prevention and preparedness. Such strategies will not only reduce existing risk levels, but could also make the social-ecological system more robust for extreme flood events. This is because they seek to prevent those impacts on the system from which recovery is extremely difficult without outside help. Besides that, resilient strategies increase the prospect for the realization of cobenefits, particularly when measures are selected within the spatial domain. Implementing resilient strategies, however, faces many difficulties, particularly in countries like the Netherlands and Poland where prevalent governance arrangements are aimed to facilitate resistant strategies, focusing exclusively on flood protection. We analyzed these implementation difficulties for the Island of Dordrecht, which is a front-runner case of resilient flood risk governance in the Netherlands. A theoretical framework based on relevant issues regarding governance arrangements was used to reflect on the identified gaps and barriers. Although all issues played a role in the case study, there seem to be no generic institutional design parameters that have to be applied for implementing resilient strategies. Even in the current institutional regime, it is possible to find ways of implementing a resilient strategy. The more general institutional precondition has to do with the political willingness to allow for collaboration and experimentation and to enable a more flexible use of current principles and rules

Progressive Disease With Low Survival in Adult Patients With Pulmonary Fibrosis Carrying Surfactant-Related Gene Mutations: an observational study

BACKGROUND: In some patients with progressive fibrosing interstitial lung disease (ILD), disease is caused by carriage of a mutation in a surfactant-related gene (SRG) such as SFTPC, SFTPA2, or ABCA3. However, no aggregated data on disease evolution and treatment outcome have been presented for these patients. RESEARCH QUESTION: In adult patients with ILD with an SRG mutation, what is the course of lung function after diagnosis and during treatment and the survival in comparison with patients with sporadic idiopathic pulmonary fibrosis (sIPF) and familial pulmonary fibrosis (FPF)? STUDY DESIGN AND METHODS: We retrospectively examined the clinical course of a cohort of adults with an SRG mutation by screening 48 patients from 20 families with an SRG mutation for availability of clinical follow-up data. For comparison, 248 patients with FPF and 575 patients with sIPF were included. RESULTS: Twenty-three patients with ILD (median age: 45 years; 11 men) with an SRG mutation fulfilled criteria. At diagnosis, patients with an SRG mutation were younger and less often male, but had lower FVC (72% predicted) and diffusing capacity of the lungs for carbon monoxide (46% predicted) compared with patients with FPF or sIPF. In the SRG mutation group, median FVC decline 6 months after diagnosis was -40 mL and median transplant-free survival was 44 months and not different from patients with FPF or sIPF. FVC course was not different among the three cohorts; however, a significantly larger decrease in FVC was found while patients received immunomodulatory or antifibrotic treatment compared with those receiving no treatment. Subsequent analysis in the SRG group showed that patients with a surfactant mutation (n = 7) treated for 6 months with antifibrotic drugs showed stable lung function with a median change in FVC of +40 mL (interquartile range, -40 to 90 mL), whereas patients with an SRG mutation treated with immunomodulatory drugs showed a variable response dependent on the gene involved. INTERPRETATION: This study showed that patients with ILD carrying an SRG mutation experience progressive loss of lung function with severely reduced survival despite possible beneficial effects of treatment

The role of GH in adipose tissue:Lessons from adipose-specific GH receptor gene-disrupted mice

GH receptor (GHR) gene-disrupted mice (GHR−/−) have provided countless discoveries as to the numerous actions of GH. Many of these discoveries highlight the importance of GH in adipose tissue. For example GHR−/− mice are insulin sensitive yet obese with preferential enlargement of the sc adipose depot. GHR−/− mice also have elevated levels of leptin, resistin, and adiponectin, compared with controls leading some to suggest that GH may negatively regulate certain adipokines. To help clarify the role that GH exerts specifically on adipose tissue in vivo, we selectively disrupted GHR in adipose tissue to produce Fat GHR Knockout (FaGHRKO) mice. Surprisingly, FaGHRKOs shared only a few characteristics with global GHR−/− mice. Like the GHR−/− mice, FaGHRKO mice are obese with increased total body fat and increased adipocyte size. However, FaGHRKO mice have increases in all adipose depots with no improvements in measures of glucose homeostasis. Furthermore, resistin and adiponectin levels in FaGHRKO mice are similar to controls (or slightly decreased) unlike the increased levels found in GHR−/− mice, suggesting that GH does not regulate these adipokines directly in adipose tissue in vivo. Other features of FaGHRKO mice include decreased levels of adipsin, a near-normal GH/IGF-1 axis, and minimal changes to a large assortment of circulating factors that were measured such as IGF-binding proteins. In conclusion, specific removal of GHR in adipose tissue is sufficient to increase adipose tissue and decrease circulating adipsin. However, removal of GHR in adipose tissue alone is not sufficient to increase levels of resistin or adiponectin and does not alter glucose metabolism

Villes inondables : prévention, adaptation, résilience

International audienceLes villes européennes, souvent installées le long de fleuves ou sur des rivages maritimes, s’inquiètent de leur vulnérabilité aux inondations, un risque accru aujourd’hui par les dérèglements climatiques, la pression démographique et la compétitivité urbaine. La mise en valeur récréative et environnementale de ces rives par des projets urbains, en cherchant à mieux articuler la ville avec la présence de l’eau, entraîne des débats sur l’acceptabilité de ces aménagements potentiellement inondables. Entre prise en compte du risque et attractivité, de nouvelles stratégies innovantes voient le jour qui, tout en renforçant les techniques de prévention traditionnelles, proposent des dispositifs urbains et des modes de vie mieux adaptés à la présence de l’eau sur le territoire. Les exemples étudiés dans cet ouvrag montrent une forte capacité d’innovation de la part de ces villes pour gérer les ressources liées à l’eau, optimiser des stratégies fonctionnelles et temporelles d’aménagement du territoire, imaginer des dispositifs architecturaux et techniques résistants à l’eau, et mettre en valeur ces nouveaux paysages [d'après éd.