Decline and decadence in Iraq and Syria after the age of Avicenna? : ʿAbd al-Laṭīf al-Baghdādī (1162–1231) between myth and history

‘Abd al-Laṭīf al-Baghdādī’s (d. 1231) work Book of the Two Pieces of Advice (Kitāb al Nasīḥatayn) challenges the idea that Islamic medicine declined after the twelfth century AD. Moreover, it offers some interesting insights into the social history of medicine. ‘Abd al-Laṭīf advocated using the framework of Greek medical epistemology to criticize the rationalist physicians of his day; he argued that female and itinerant practitioners, relying on experience, were superior to some rationalists. He lambasted contemporaneous medical education because it put too much faith in a restricted number of textbooks such as the Canon by Ibn Sīnā (Avicenna, d. 1037) or imperfect abridgments

Observation Versus Embolization in Patients with Blunt Splenic Injury after Trauma: A Propensity Score Analysis

Background: Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE with historical controls. The aim of this study was to investigate whether SAE improves success rate compared to observation alone in contemporaneous patients with blunt splenic injury. Methods: We included adult patients with blunt splenic injury admitted to five Level 1 Trauma Centers between January 2009 and December 2012 and selected for NOM. Successful treatment was defined as splenic salvage and no splenic re-intervention. We calculated propensity scores, expressing the probability of undergoing SAE, using multivariable logistic regression and created five strata based on the quintiles of the propensity score distribution. A weighted relative risk (RR) was calculated across strata to express the chances of success with SAE. Results: Two hundred and six patients were included in the study. Treatment was successful in 180 patients: 134/146 (92 %) patients treated with observation and 48/57 (84 %) patients treated with SAE. The weighted RR for success with SAE was 1.17 (0.94-1.45); for complications, the weighted RR was 0.71 (0.41-1.22). The mean number of transfused blood products was 4.4 (SD 9.9) in the observation group versus 9.1 (SD 17.2) in the SAE group. Conclusions: After correction for confounders with propensity score stratification technique, there was no significant difference between embolization and observation alone with regard to successful treatment in patients with blunt splenic injury after trauma

The Quality of Dying in Frail Institutionalized Older Patients After Nonoperative and Operative Management of a Proximal Femoral Fracture:An In-Depth Analysis

Proximal femoral fractures in frail patients have a poor prognosis. Despite the high mortality, little is known about the quality of dying (QoD) while this is an integral part of palliative care and could influence decision making on nonoperative- (NOM) or operative management (OM). To identify the QoD in frail patients with a proximal femoral fracture. Data from the prospective FRAIL-HIP study, that studied the outcomes of NOM and OM in institutionalized older patients ≥70 years with a limited life expectancy who sustained a proximal femoral fracture, was analyzed. This study included patients who died within the 6-month study period and whose proxies evaluated the QoD. The QoD was evaluated with the Quality of Dying and Death (QODD) questionnaire resulting in an overall score and 4 subcategory scores (Symptom control, Preparation, Connectedness, and Transcendence). In total 52 (64% of NOM) and 21 (53% of OM) of the proxies responded to the QODD. The overall QODD score was 6.8 (P25-P75 5.7-7.7) (intermediate), with 34 (47%) of the proxies rating the QODD ‘good to almost perfect’. Significant differences in the QODD scores between groups were not noted (NOM; 7.0 (P25-P75 5.7-7.8) vs OM; 6.6 (P25-P75 6.1-7.2), P =.73). Symptom control was the lowest rated subcategory in both groups. The QoD in frail older nursing home patients with a proximal femoral fracture is good and humane. QODD scores after NOM are at least as good as OM. Improving symptom control would further increase the QoD.</p

Comparison of the predictive performance of the BIG, TRISS, and PS09 score in an adult trauma population derived from multiple international trauma registries

The BIG score (Admission base deficit (B), International normalized ratio (I), and Glasgow Coma Scale (G)) has been shown to predict mortality on admission in pediatric trauma patients. The objective of this study was to assess its performance in predicting mortality in an adult trauma population, and to compare it with the existing Trauma and Injury Severity Score (TRISS) and probability of survival (PS09) score. A retrospective analysis using data collected between 2005 and 2010 from seven trauma centers and registries in Europe and the United States of America was performed. We compared the BIG score with TRISS and PS09 scores in a population of blunt and penetrating trauma patients. We then assessed the discrimination ability of all scores via receiver operating characteristic (ROC) curves and compared the expected mortality rate (precision) of all scores with the observed mortality rate. In total, 12,206 datasets were retrieved to validate the BIG score. The mean ISS was 15 ± 11, and the mean 30-day mortality rate was 4.8%. With an AUROC of 0.892 (95% confidence interval (CI): 0.879 to 0.906), the BIG score performed well in an adult population. TRISS had an area under ROC (AUROC) of 0.922 (0.913 to 0.932) and the PS09 score of 0.825 (0.915 to 0.934). On a penetrating-trauma population, the BIG score had an AUROC result of 0.920 (0.898 to 0.942) compared with the PS09 score (AUROC of 0.921; 0.902 to 0.939) and TRISS (0.929; 0.912 to 0.947). The BIG score is a good predictor of mortality in the adult trauma population. It performed well compared with TRISS and the PS09 score, although it has significantly less discriminative ability. In a penetrating-trauma population, the BIG score performed better than in a population with blunt trauma. The BIG score has the advantage of being available shortly after admission and may be used to predict clinical prognosis or as a research tool to risk stratify trauma patients into clinical trial

The value of nonoperative versus operative treatment of frail institutionalized elderly patients with a proximal femoral fracture in the shade of life (FRAIL-HIP); protocol for a multicenter observational cohort study

BACKGROUND: Proximal femoral fractures are strongly associated with morbidity and mortality in elderly patients. Mortality is highest among frail institutionalized elderly with both physical and cognitive comorbidities who consequently have a limited life expectancy. Evidence based guidelines on whether or not to operate on these patients in the case of a proximal femoral fracture are lacking. Practice variation occurs, and it remains unknown if nonoperative treatment would result in at least the same quality of life as operative treatment. This study aims to determine the effect of nonoperative management versus operative management of proximal femoral fractures in a selected group of frail institutionalized elderly on the quality of life, level of pain, rate of complications, time to death, satisfaction of the patient (or proxy) and the caregiver with the management strategy, and health care consumption. METHODS: This is a multicenter, observational cohort study. Frail institutionalized elderly (70 years or older with a body mass index < 18.5, a Functional Ambulation Category of 2 or lower pre-trauma, or an American Society of Anesthesiologists score of 4 or 5), who sustained a proximal femoral fracture are eligible to participate. Patients with a pathological or periprosthetic fractures and known metastatic oncological disease will be excluded. Treatment decision will be reached following a structured shared decision process. The primary outcome is quality of life (Euro-QoL; EQ-5D-5 L). Secondary outcome measures are quality of life measured with the QUALIDEM, pain level (PACSLAC), pain medication use, treatment satisfaction of patient (or proxy) and caregivers, quality of dying (QODD), time to death, and direct medical costs. A cost-utility and cost-effectiveness analysis will be done, using the EQ-5D utility score and QUALIDEM score, respectively. Non-inferiority of nonoperative treatment is assumed with a limit of 0.15 on the EQ-5D score. Data will be acquired at 7, 14, and 30 days and at 3 and 6 months after trauma. DISCUSSION: The results of this study will provide insight into the true value of nonoperative treatment of proximal femoral fractures in frail elderly with a limited life expectancy. The results may be used for updating (inter)national treatment guidelines. TRIAL REGISTRATION: The study is re

Routine versus on demand removal of the syndesmotic screw; A protocol for an international randomised controlled trial (RODEO-trial)

Background: Syndesmotic injuries are common and their incidence is rising. In case of surgical fixation of the syndesmosis a metal syndesmotic screw is used most often. It is however unclear whether this screw needs to be removed routinely after the syndesmosis has healed. Traditionally the screw is removed after six to 12 weeks as it is thought to hamper ankle functional and to be a source of pain. Some studies however suggest this is only the case in a minority of patients. We therefore aim to investigate the effect of retaining the syndesmotic screw on functional outcome. Design: This is a pragmatic international multicentre randomised controlled trial in patients with an acute syndesmotic injury for which a metallic syndesmotic screw was placed. Patients will be randomised to either routine removal of the syndesmotic screw or removal on demand. Primary outcome is functional recovery at 12 months measured with the Olerud-Molander Score. Secondary outcomes are quality of life, pain and costs. In total 194 patients will be needed to demonstrate non-inferiority between the two interventions at 80% power and a significance level of 0.025 including 15% loss to follow-up. Discussion: If removal on demand of the syndesmotic screw is non-inferior to routine removal in terms of functional outcome, this will offer a strong argument to adopt this as standard practice of care. This means that patients will not have to undergo a secondary procedure, leading to less complications and subsequent lower costs. Trial registration: This study was registered at the Netherlands Trial Register (NTR5965), Clinicaltrials.gov (NCT02896998) on July 15th 2016

Afstudeerwerk

Voorwoord bij een nieuwe rubriek met afstudeerwerk Het Bulletin KNOB biedt een podium aan zowel ervaren onderzoekers als aanstormend talent. Met een zekere regelmaat publiceren afgestudeerden een artikel op basis van hun masterscriptie of ander onderzoek dat zij aan de universiteit deden. Maar dit is slechts een topje van de ijsberg. Er is immers veel meer werk van studenten dat de aandacht van de lezer verdient. Daarom starten wij in het Bulletin KNOB een rubriek met afstudeerwerk. Eens in de twee jaar vragen wij een aantal pas afgestudeerden van wie de masterthesis of eindopdracht goed is beoordeeld hiervan een synthese te maken. Voor de eerste aflevering van deze rubriek zijn dat degenen die meedongen naar de KNOB Stimuleringsprijs 2021. Het resultaat vindt u in dit nummer: zeventien bijdragen over uiteenlopende onderwerpen, van Cubex-keuken tot herbestemming van industrieel erfgoed en van klimaatverbetering in steden tot Antwerpse zeemanshuizen. De auteurs zijn alumni van universitaire opleidingen op het gebied van architectuur- en stadsgeschiedenis, erfgoed en (landschaps)architectuur in Nederland en België. Met deze rubriek laten wij onze lezers kennisnemen van door studenten verricht onderzoek en bieden wij beginnende onderzoekers en ontwerpers een gelegenheid hun werk in het Bulletin KNOB te presenteren. Onze dank gaat daarbij uit naar collega Jeroen Goudeau, die ons het idee voor een rubriek met afstudeerwerk aan de hand deed. Wij wensen u veel leesplezier en inspiratie toe. De redactieVoorwoord bij een nieuwe rubriek met afstudeerwerk Het Bulletin KNOB biedt een podium aan zowel ervaren onderzoekers als aanstormend talent. Met een zekere regelmaat publiceren afgestudeerden een artikel op basis van hun masterscriptie of ander onderzoek dat zij aan de universiteit deden. Maar dit is slechts een topje van de ijsberg. Er is immers veel meer werk van studenten dat de aandacht van de lezer verdient. Daarom starten wij in het Bulletin KNOB een rubriek met afstudeerwerk. Eens in de twee jaar vragen wij een aantal pas afgestudeerden van wie de masterthesis of eindopdracht goed is beoordeeld hiervan een synthese te maken. Voor de eerste aflevering van deze rubriek zijn dat degenen die meedongen naar de KNOB Stimuleringsprijs 2021. Het resultaat vindt u in dit nummer: zeventien bijdragen over uiteenlopende onderwerpen, van Cubex-keuken tot herbestemming van industrieel erfgoed en van klimaatverbetering in steden tot Antwerpse zeemanshuizen. De auteurs zijn alumni van universitaire opleidingen op het gebied van architectuur- en stadsgeschiedenis, erfgoed en (landschaps)architectuur in Nederland en België. Met deze rubriek laten wij onze lezers kennisnemen van door studenten verricht onderzoek en bieden wij beginnende onderzoekers en ontwerpers een gelegenheid hun werk in het Bulletin KNOB te presenteren. Onze dank gaat daarbij uit naar collega Jeroen Goudeau, die ons het idee voor een rubriek met afstudeerwerk aan de hand deed. Wij wensen u veel leesplezier en inspiratie toe. De redacti