Einfluss der CT-Metallartefaktreduktion auf die SPECT/CT-Quantifizierung der Skelettszintigrafie – Retrospektive Studie für ausgewählte Arten von Metallimplantaten

10.1055/a-1883-9281Implantierte Metallprothesen können schwere Artefakte in rekonstruierten Computertomographiebildern (CT) verursachen und so die Bildqualität und den diagnostischen Wert beeinträchtigen. Zudem werden die rekonstruierten CT-Bilder zur Korrektur der Photonenabschwächung bei der Einzelphotonen-Emissions Computertomographie (SPECT) verwendet. Um die diagnostischen Auswirkungen dieser Artefakte zu verringern und die Schwächungskorrektur zu verbessern, wurde ein Algorithmus zur iterativen Reduktion von Metallartefakten (iMAR) entwickelt, der seit einigen Jahren auch für SPECT/CT-Systeme verfügbar ist. Die Bedeutung dieses Algorithmus für die visuelle Interpretation von CT-Bildern ist bereits in mehreren Studien untersucht worden. Über den Einfluss von iMAR auf die Schwächungskorrektur von SPECT-Bildern ist jedoch nur sehr wenig bekannt. Ziel dieser Studie war es, (a) den Unterschied in der visuellen Bildqualität durch den Vergleich von CT- und SPECT-Bildern zu bewerten, die mit und ohne Verwendung von iMAR rekonstruiert wurden, und (b) den Einfluss von iMAR auf die quantitative 99mTc-Aufnahme und die quantitativ gemessenen Hounsfield-Einheiten (HU) in SPECT/CT zu bestimmen

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy – a systematic review and meta-analysis

Investigation if preoperative stoma site marking compared to no preoperative marking in patients undergoing intestinal stoma surgery reduces the risk of stoma-related complication

Evidence-based health policy in Germany: lack of communication and coordination between academia and health authorities?

Abstract Health-care decision making should consider the best available evidence, often in the form of systematic reviews (SRs). The number of existing SRs and their overlap make their identification and use difficult. Decision makers often rely on de novo SRs instead of using existing SRs. We describe two cases of duplicate reviews (minimum volume threshold of total knee arthroplasties and lung cancer screening) and one case of duplicate primary data analysis (transcatheter aortic valve implantation). All cases have in common that unintended duplication of research occurred between health authorities and academia, demonstrating a lack of communication and coordination between them. It is important to note that academia and health authorities have different incentives. Academics are often measured by the number of peer-reviewed publications and grants awarded. In contrast, health authorities must comply with laws and are commissioned to deliver a specific report within a defined period of time. Most replication is currently unintended. A solution may be the collaboration of stakeholders commonly referred to as integrated knowledge translation (IKT). The IKT approach means that research is conducted in collaboration with the end users of the research. It requires active collaborations between researchers and decision-makers or knowledge users (clinicians, managers, policy makers) throughout the research process. Wherever cooperation is possible in spite of requirements for independence or confidentiality, legal regulations should facilitate and support collaborative approaches between academia and health authorities

Re-presenting autism: the construction of 'NT Syndrome'

Autism is a widely researched area and much emphasis has been placed in research on the differences between the autistic and non-autistic populations. Such research commonly draws on proposed deficits within people with autism in order to explain differences. This paper seeks to present an alternative understanding of differences and draws on writings of people with autism in such a discussion. The construction of 'Neurologically Typical syndrome' (NT) will be presented as an inverted construction of diagnosis, which serves to challenge the dominant position of 'NTs' and 'NT traits' over autistic traits. It will be argued that such an alternative representation of people with and without autism has important implications for our construction of and understanding of autism