The modular endoprosthesis for mandibular body replacement. Part 2: Finite element analysis of endoprosthesis reconstruction of the mandible

10.1016/j.jcms.2012.03.010JOURNAL OF CRANIO-MAXILLOFACIAL SURGERY408E487-E49

The modular endoprosthesis for mandibular body replacement - Part 1: Mechanical testing of the reconstruction

10.1016/j.jcms.2012.03.009JOURNAL OF CRANIO-MAXILLOFACIAL SURGERY408E479-E48

Nurse-Patient Communication in Follow-up Consultations After Head and Neck Cancer Treatment

BACKGROUND: Adequate provider-patient communication is viewed as an important aspect of good quality (cancer) care, supports patients' stress control, and can positively influence health outcomes. OBJECTIVE: The objective of this study was to describe nurse-patient communication in 2 consecutive follow-up consultations after head and neck cancer, with or without a partner present. METHODS: This was a descriptive observational study of 17 video-recorded, coded, and analyzed consultations of 10 head and neck cancer patients and 6 partners. RESULTS: Nurses adequately responded to about 25% of patients' and partners' emotional cues. In almost 75%, nurses responded to cues using distancing behaviors. The majority of informational questions of both patients and partners were adequately answered. Comparison of consecutive visits showed small differences for patients' and partners' cue-emission and for nurses' responsive behaviors between visits 1 and 2. CONCLUSION: Nurses adequately responded to informational questions from patients and partners. However, they seemed to be less observant of and able to address emotional cues. Communication on nurse-patient-partner interaction deserves further research in a much larger sample and over a longer time period. IMPLICATION FOR PRACTICE: Nurses' awareness of the importance of adequate cue responding is vital, as is the choice to "unlearn" the predominant distancing behaviors. The needs and the role of the patients' partner in consultations and managing consultations require further attention in training and professional practice.status: publishe

Functional Outcomes and Quality of Life After Segmental Mandibulectomy and Reconstruction with a Reconstruction Plate or Bone Graft Compared to a Digitally Planned Fibula Free Flap

PURPOSE: To compare oral function and health-related quality of life (HRQoL) in patients reconstructed with either a reconstruction plate or a free vascularized bone flap with or without 3D planning. MATERIALS AND METHODS: Patients from the Institute for Reconstructive Sciences in Medicine, University Medical Center Utrecht, and Radboud University Medical Center were included. This cross-sectional study assessed objective masticatory performance with the mixing ability test (mixing ability index [MAI]), maximum bite force, maximum mouth opening, and HRQoL. Differences between groups were analyzed using analysis of variance or Kruskal-Wallis test for continuous variables and chi-square test for categorical variables. RESULTS: Six patients with digitally planned resections and reconstructions were included. For comparison, five patients treated with freehand bone reconstruction and four patients treated with plate reconstruction were also included. Mixing ability was superior in 3D-planned reconstructions (MAI: 20.7 ± 6.7) compared to plate reconstructions (MAI: 30.0 ± 0.1, P = .017) and freehand reconstructions (MAI: 29.5 ± 1.1, P = .017). Maximum mouth opening, bite force, and HRQoL differences did not reach statistical significance. CONCLUSION: This study indicated a possible benefit to masticatory performance of adequate surgical planning for one-phase reconstruction using 3D technology. A larger prospective study is necessary to gain more evidence regarding this finding

Weight loss in head and neck cancer patients little noticed in general practice

Introduction: In head and neck cancer patients, weight loss increases morbidity and mortality, and decreases treatment tolerance and quality of life. Early nutritional intervention has beneficial effects on these factors. Aim: We observed patients' weight courses after specialists' care and surveyed nutrition-related documentation by general practitioners (GPs). Methods: From a Head and Neck Oncology Centre (HNOC) study, 68 patients were asked to participate in an extended general practice cohort. Twenty-six patients participated in the prospective three-monthly weight measurements during the year after HNOC care. We extracted nutritional information contained in referral letters (n=24) and medical records from the year before referral (n=45) and after HNOC care (n=26). An impaired nutritional status was assigned to weight loss ≥10% within six months or Body Mass Index (BMI) <18.5 kg/m 2 and 'at risk' to weight loss ≥5% but <10% within six months. Results: Three (12%) participants were nutritionally impaired and two (8%) were deemed 'at risk'. Although GPs suspected a (pre-) malignancy in 11 cases (46%), only two (8%) documented weight loss or BMI and four (17%) nutrition-related complaints in their referral letters. Medical records more often contained information on nutrition-related complaints and tube feeding later in the disease course, as opposed to concern over weight loss or BMI. discussion: Therefore, we call for nutritional management in general practice, by urging practitioners to assess patients' nutritional status throughout the disease course and intervene if necessary. The passing on of related information in case of referral promotes continuity of care

Improving nutritional management within high-risk groups

The current pitfalls and future possibilities of nutritional management are discussed by two patients with tongue cancer who have suffered from substantial weight loss. Their nutritional problems are illustrative of those among other (cancer) patient groups. The main concerns are the lack of early case finding and dietary treatment, and insufficient nutritional information transfer through referral letters. The GP as a central and longitudinal caretaker faces challenges in improving nutritional management