This multisociety, multidisciplinary consensus—formally endorsed by the European Society of Surgical Oncology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology—was developed to standardise the assessment of ablation margins in liver tumour thermal ablation. A modified Delphi process, consisting of two online surveys and a hybrid (online and in-person meeting in Innsbruk) consensus meeting of 72 experts from North America, South America, Europe, and Asia. Formal consensus was reached for 150 (75%) of 199 statements. Strong agreement was observed between interventional and surgical oncologists, with only 12 (6%) of 199 statements showing significantly different ratings. Participants agreed that ablation margins should be assessed and documented for every treated tumour. Margins should be assessed quantitatively in three dimensions, with contrast-enhanced CT or MRI, preferably intraprocedurally with ablation confirmation software. Ablation margins should be categorised as A0 (tumour completely covered with sufficient margin), A1 (tumour completely covered but insufficient margin), or A2 (portion of tumour remains unablated). This effort is, to our knowledge, the first international consensus initiative to define best-practice recommendations for margin assessment in liver tumour thermal ablation to standardise practices, aiming to improve and promote uniform outcomes.
Spirituelle Bedürfnisse spielen beim Erleben von Krankheit eine wichtige Rolle, insbesondere bei existenzieller Bedrohung. Die Mehrheit der Patient:innen in einer Notfallabteilung äußert spirituelle Bedürfnisse, wobei der Wunsch nach innerem Frieden besonders häufig genannt wird. Frauen berichten signifikant häufiger von solchen Bedürfnissen. Die Erfassung dieser Bedürfnisse ist jedoch herausfordernd: Zeitmangel, fehlende Schulung des Personals und Zurückhaltung der Patient:innen erschweren eine ganzheitliche, patientenzentrierte Versorgung. Dennoch wünschen sich viele Patient:innen, dass ihre spirituellen Anliegen wahrgenommen werden. Hinweise darauf können sich aus der Religionszugehörigkeit, Patientenverfügungen oder am Körper getragenen spirituellen Symbolen ergeben. Für eine angemessene Berücksichtigung sollten geschützte Räume geschaffen werden. Angehörige sind wo immer möglich einzubeziehen und gegebenenfalls ist Seelsorge zu organisieren. Das erhöht das Vertrauen der Notfallpatient:innen in eine medizinische Versorgung, die die ganze Persönlichkeit berücksichtigt. Auch für das Behandlungsteam ist die Auseinandersetzung mit Spiritualität bedeutsam: Sie beugt der Gleichgültigkeit sowie dem Burn-out vor und verbessert die Versorgung. Allerdings schätzen viele Mitarbeitende ihre spirituellen Kompetenzen als gering ein, weshalb gezielte Schulungen notwendig erscheinen. Insgesamt profitieren sowohl Patient:innen als auch Teams von einer bewussten Integration spiritueller Aspekte in die Notfallversorgung.
Introduction Idiopathic normal pressure hydrocephalus (iNPH) is increasingly relevant in the aging population. Despite improved diagnostic criteria, postoperative outcome remains variable and difficult to predict. Preoperative expectations may substantially influence perceived treatment success, and caregivers often play a key role in the decision-making process. Research question This study evaluated whether physicians assess postoperative outcomes more accurately than primary caregivers. Material and Methods This single-centre study combined a prospective pre–post interventional cohort design with a cross-sectional component. Patients with iNPH undergoing first-time ventriculoperitoneal shunt surgery were included. Symptom severity was assessed preoperatively and at follow-up using standardized grading scales. Primary caregivers (PCGs), neurosurgical residents, and board-certified neurosurgeons independently predicted postoperative outcomes, which were subsequently compared with observed treatment results. Results Forty-one patients were screened between January 2022 and June 2025. The study cohort had a mean age of 74.1 years (SD 7.3), 57% male, mean symptom duration 23.9 months (SD 14.1) and a mean Charlson comorbidity index of 4.1 (SD 1.3). At a median follow-up of 48 days (range 36–118) after ventriculoperitoneal shunt surgery, mean symptom improvement was Δ 2.2 points (95% CI 1.6–2.7; p < 0.001), with the greatest improvement observed in gait disturbance and urinary incontinence. Revision surgery was required in 17% of patients. Correlation between predicted and observed outcome was strongest among neurosurgical specialists (r=0.79), followed by residents (r=0.74), while PCGs demonstrated only moderate agreement (r=0.56). Discussion and Conclusion Our study supports the efficacy of CSF shunt surgery in iNPH and demonstrates that neurosurgical expertise aligns more closely with actual postoperative outcome than the expectations of PCGs. Structured preoperative counselling may help improve expectation management and reduce discrepancies between anticipated and observed treatment benefit.
