BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Pharmacological management of IPF

Idiopathic pulmonary fibrosis (IPF) is a deadly disease with a median survival of approximately three years in historical cohorts. Despite increased knowledge of disease pathophysiology and selection of more targeted therapy, main clinical trials yielded negative results. However, two agents, pirfenidone and nintedanib, were recently shown to be effective in IPF and received marketing authorization worldwide. Both drugs significantly reduce functional decline and disease progression with an acceptable safety profile. Yet, none of these drugs actually improves or even stabilizes the disease or the symptoms perceived by the patient. Several other treatments and combinations are currently tested, and many more are ready for clinical trials. Their completion is critical for achieving the ultimate goal of curing patients with IPF. © 2016 Asian Pacific Society of Respirology

Résultats périopératoires et oncologiques de la néphro-urétérectomie totale par voie laparoscopique pure versus robot assistée pour le traitement des tumeurs de la voie excrétrice urinaire supérieure

National audienceObjectifs Analyser les résultats périopératoires et oncologiques obtenus après le traitement des tumeurs de la voie excrétrice urinaire supérieure (TVEUS) localisée par néphro-urétérectomie totale selon une technique laparoscopique pure (NUT-L) versus robot-assistée (NUT-R) Méthodes Les données périopératoires et de survie de 111 patients opérés d’une NUT -L (n = 85) ou NUT-R (n = 26) dans 4 centres en France entre 2004 et 2015 ont été rétrospectivement collectées. Le bilan préopératoire mettait en évidence chez chacun d’entre eux une TVEUS localisée sans métastase à distance. Les données périopératoires ont été comparées à l’aide du test du Chi2 pour les variables qualitatives et des tests de Student et de Mann-Whitney pour les variables quantitatives continues. Les survies sans récidive et spécifique ont été analysées en utilisant des courbes de Kaplan-Meier et le test du Log-Rank. Résultats Les durées opératoires moyennes dans le groupe NUT-L et NUT-R étaient de 221 (± 38) min et de 243 (± 47) min, respectivement (p = 0,14). Les taux de complications peropératoires étaient similaires entre les 2 groupes (p = 0,42). Les pertes sanguines moyennes étaient de 320 mL (± 80) et 296 (± 60) mL dans le groupe NUT-L et NUT-R, respectivement (p = 0,22). Les principales caractéristiques anatomopathologiques étaient similaires entre les 2 groupes. Il n’existait aucune différence en termes de complications postopératoire Clavien 1, 2 et 3. Aucune complication Clavien 4 n’a été rapportée. La durée moyenne d’hospitalisation était plus courte après NUT-R (6,1j vs 8,9j ; p = 0,02). Après un suivi moyen de 8 (± 4,5) mois et 58 (± 4,5) mois, les taux de survie sans récidive (p = 0,32) et spécifique (p = 0,28) étaient comparables entre les 2 groupes. Conclusion Les résultats périopératoires et oncologiques de la NUT par voie laparoscopique robot-assistée sont similaires à ceux obtenus par voie laparaoscopique pure. Il s’agit donc d’une intervention chirurgicale présentant un faible taux de complication avec un contrôle local satisfaisan

A Small-Molecule Inhibitor of Lin28

International audienc