How could the service delivery process of dynamic arm supports be optimized?

BACKGROUND: The service delivery process of dynamic arm support (DAS) is complex. Obtaining an optimal match between user and DAS depends on a variety of interrelated factors, different professionals are involved, and the market of available solutions is evolving. OBJECTIVE: To determine how the service delivery process of DAS could be optimized. METHODS: Interviews with DAS users that retrospectively focused on the experienced service delivery process, which was compared to the general Dutch prescription guideline. Results were presented in a focus group session to seven DAS consultants, and subsequently verified by a member-check. RESULTS: Sixteen people who considered the Gowing (a DAS new on the market) as a solution and seven DAS consultants participated. Aspects that can be optimized in the current service delivery process included an improved cooperation between clients, professionals and consultants, increased knowledge of DAS in professionals, an embedded user evaluation, and timely delivery. CONCLUSIONS: It is recommended that the service delivery process is optimized by developing a DAS specific prescription framework. The issues identified in this study should be addressed in this framework. For this additional knowledge on how to optimally match persons and DAS is needed

Is it possible to assess the effects of dynamic arm supports on upper extremity range of motion during activities of daily living in the domestic setting using a portable motion capturing device? - A pilot study

BACKGROUND: Understanding how dynamic arm supports affect the ability to perform activities of daily living (ADL) in daily life situations is essential for improved prescription. OBJECTIVE: To determine whether the newly developed MMAAS is a useful tool to assess the RoM at home. Secondly, to investigate differences in RoM and ADL performance with and without dynamic arm support. METHODS: Five dynamic arm support users performed nine activities with and without dynamic arm support at home. A reference group of five participants was included. Shoulder and elbow RoM were assessed for the three most difficult tasks. RESULTS: The measurement of the elbow joint RoM appeared unreliable. In most participants shoulder RoM increased with dynamic arm support, but the magnitude of change differed. Variation was also found regarding whether people could perform ADL with and without support. CONCLUSIONS: In its current state the MMAAS is not regarded a useful tool for assessing the RoM in the domestic setting. The ability to perform ADL and RoM seem influenced by the environment, users' needs and abilities. Future studies investigating effects and benefits of dynamic arm supports should be conducted in a broader daily life context

Guideline thyroid cancer including diagnostics of the nodule

Thyroid cancer is comparatively rare. Thyroid nodules, on the other hand, are frequently diagnosed as a result of increasing use of diagnostic imaging. Cytological investigation of small nodules that have been found by chance often reveals micropapillary carcinoma that is probably not clinically relevant. The new guideline 'Thyroid cancer' advises that cytological investigation of these non-palpable, incidentally discovered thyroid nodules should only be performed on indication. The standard treatment for patients with papillary or follicular thyroid cancer consists of thyroidectomy followed by, if indicated, lymph-node dissection, ablation therapy with radioactive iodine and TSH-suppression. The extent of this treatment is determined on the basis of known prognostic factors and the results of initial treatment. Targeted systemic therapy is available for patients with metastatic progressive disease. There is more focus on the effects of short- and long-term treatment, in order to optimise quality of life.</p

Effectiveness and cost-effectiveness of an optimized process of providing assistive technology for impaired upper extremity function::Protocol of a prospective, quasi-experimental non-randomized study (OMARM)

Background: Impaired upper extremity function due to muscle paresis or paralysis has a major impact on independent living and quality of life (QoL). Assistive technology (AT) for upper extremity function (i.e. dynamic arm supports and robotic arms) can increase a client’s independence. Previous studies revealed that clients often use AT not to their full potential, due to suboptimal provision of these devices in usual care. Objective: To optimize the process of providing AT for impaired upper extremity function and to evaluate its (cost-)effectiveness compared with care as usual. Methods: Development of a protocol to guide the AT provision process in an optimized way according to generic Dutch guidelines; a quasi-experimental study with non-randomized, consecutive inclusion of a control group (n = 48) receiving care as usual and of an intervention group (optimized provision process) (n = 48); and a cost-effectiveness and cost-utility analysis from societal perspective will be performed. The primary outcome is clients’ satisfaction with the AT and related services, measured with the Quebec User Evaluation of Satisfaction with AT (Dutch version; D-QUEST). Secondary outcomes comprise complaints of the upper extremity, restrictions in activities, QoL, medical consumption and societal cost. Measurements are taken at baseline and at 3, 6 and 9 months follow-up

Richtlijn schildkliercarcinoom inclusief diagnostiek van de nodus

Thyroid cancer is comparatively rare. Thyroid nodules, on the other hand, are frequently diagnosed as a result of increasing use of diagnostic imaging. Cytological investigation of small nodules that have been found by chance often reveals micropapillary carcinoma that is probably not clinically relevant. The new guideline 'Thyroid cancer' advises that cytological investigation of these non-palpable, incidentally discovered thyroid nodules should only be performed on indication. The standard treatment for patients with papillary or follicular thyroid cancer consists of thyroidectomy followed by, if indicated, lymph-node dissection, ablation therapy with radioactive iodine and TSH-suppression. The extent of this treatment is determined on the basis of known prognostic factors and the results of initial treatment. Targeted systemic therapy is available for patients with metastatic progressive disease. There is more focus on the effects of short- and long-term treatment, in order to optimise quality of life

Pancreatic Uptake by F-18-FDOPA PET/CT in Patients With Hypoglycemia After Gastric Bypass Surgery Compared With Controls With or Without Carbidopa Pretreatment

Purpose: The use of 18Fluorine-labeled dihydroxy-phenyl-alanine (F-18-FDOPA) PET/CT in patients with hypoglycemia suspected to be caused by pancreatic disease can be helpful to localize the source of excess insulin production. In this setting, carbidopa pretreatment is not recommended. However, quantitative comparisons of pancreatic tracer uptake in patients with or without carbidopa pretreatment and in diffuse pancreatic disease are lacking. Therefore, we aimed to describe and quantify pancreatic F-18-FDOPA uptake in patients without pancreatic disease with or without carbidopa pretreatment and in patients with hypoglycemia after gastric bypass surgery. Patients and Methods: This is a retrospective data analysis of F-18-FDOPA PET/CT scans performed at a university medical center in the period from 2009 to 2015. All scans were reconstructed and calculated based on the European Association of Nuclear Medicine/EANM Research Ltd guidelines. Of 358 patients without evidence of pancreatic disease or hypoglycemic disorders, 344 received carbidopa and 14 did not. Another 9 patients had post-gastric bypass hypoglycemia. The main outcome measurement was F-18-FDOPA SUVmax for pancreatic head, body, and tail regions. Results: Carbidopa pretreated patients had a lower median SUVmax (-1.15, -1.20, and -0.84 in pancreatic head, body, and tail [all P <0.01]) than patients without carbidopa pretreatment. Patients with post-gastric bypass hypoglycemia scanned without carbidopa pretreatment had higher median SUVmax (+1.18, + 1.39, and + 1.63, all P <0.03) compared with controls without pretreatment. Conclusions: Patients with post-gastric bypass hypoglycemia have increased uptake in all pancreatic regions. Carbidopa pretreatment lowers pancreatic F-18-FDOPA uptake in the nonaffected pancreas and may therefore mask disease activity in post-gastric bypass hypoglycemia