Onze Lieve Vrouwe Gasthuis

To report the clinical outcomes, return to sport (RTS) and psychological readiness of patients who underwent arthroscopic Bankart repair with knotless all-suture anchors with a minimum follow-up of 2 years. In this retrospective case series, consecutive patients who underwent primary arthroscopic Bankart repair using knotless all-suture anchors between 08/2019 and 07/2022 were included. Patient-reported outcomes were assessed using the Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), Shoulder Instability-Return to Sport after Injury (SI-RSI) scale, subjective shoulder value (SSV), and the visual analogue scale (VAS) for pain. Patient satisfaction, RTS, return to preinjury level of sport, instability recurrence and revisions were recorded. Receiver operating characteristic (ROC) curve was calculated to assess the discriminative performance of the SI-RSI scale, and the Youden’s index was employed to determine the optimal cutoff for prediction of return to preoperative level of sports. Of 57 patients eligible for inclusion, 46 patients (11.1

Polypharmacy (concurrent use of ≥ 5 medications) is common in patients with non-small cell lung cancer and increases the risk of potentially inappropriate medication use, particularly in those with advanced disease. Deprescribing may reduce medication-related harm; however, its implementation in oncology remains limited and is insufficiently informed by stakeholder perspectives. This study aimed to determine the prevalence of potentially inappropriate medications in patients with advanced non-small cell lung cancer and explore the attitudes and beliefs of patients, caregivers, and healthcare professionals regarding deprescribing to inform feasible implementation strategies for routine clinical practice. A retrospective analysis was conducted in a cohort of 817 patients with stage IV non-small cell lung cancer to identify potentially inappropriate medications using the OncoSTRIP checklist. Perspectives on deprescribing were collected using validated questionnaires: the revised Patients’ Attitudes Toward Deprescribing (rPATD) for patients and caregivers and the Comprehensive Healthcare Providers’ Opinions, Preferences, and Attitudes Toward Deprescribing (CHOPPED) for medical clinicians and pharmacists, which were completed by 37 patients, 15 caregivers, 24 medical clinicians (physicians and specialist nurses), and 24 pharmacists. Potentially inappropriate medications were algorithm-flagged in 793 of the 817 (97.1

QuestionCan the addition of radiofrequency ablation (RFA) to chemotherapy improve survival compared with chemotherapy only in patients with nonprogressive locally advanced pancreatic cancer (LAPC) after 2 months of multiagent chemotherapy?FindingsThis international randomized clinical trial, including 188 patients with LAPC after 2 months of multiagent chemotherapy, found that local ablative therapy with RFA did not improve survival compared with chemotherapy only and worsened quality of life.MeaningThe findings in this trial provide evidence against the use of RFA after chemotherapy in patients with LAPC. This randomized clinical trial evaluates the efficacy of radiofrequency ablation (RFA) and chemotherapy compared with chemotherapy only in patients with locally advanced pancreatic cancer. ImportanceThe poor prognosis and limited treatment options in patients with locally advanced pancreatic cancer (LAPC) highlight the need for novel therapies to increase survival.ObjectiveTo assess whether the addition of radiofrequency ablation (RFA) to chemotherapy improves survival when compared with chemotherapy only in patients with nonprogressive LAPC.Design, Setting, and ParticipantsThis international randomized clinical trial was performed from April 7, 2015, through December 6, 2022, in patients with unresectable LAPC with at least stable disease after 2 months of induction chemotherapy. The predefined study protocol reported a follow-up period of 18 months. Data analysis was performed from February 1, 2024, through January 15, 2025.InterventionRandomization to receive either RFA with chemotherapy or chemotherapy alone.Main Outcomes and MeasuresPrimary outcome was overall survival. Secondary outcomes included progression-free survival, adverse events, and quality of life using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and pancreatic cancer module.ResultsOverall, 188 patients (median [IQR] age, 65 [57-70] years; 100 [53%] men) were randomized, 95 to RFA with chemotherapy and 93 to chemotherapy only. Before randomization, induction chemotherapy had consisted of modified FOLFIRINOX (fluorouracil, oxaliplatin, irinotecan, and leucovorin) in 81 patients (85%) and a gemcitabine-based regimen in 14 patients (15%) in the RFA group vs 80 patients (86%) and 13 patients (14%) in the chemotherapy group, respectively. After a median follow-up of 55 months, median overall survival from randomization was 12.1 months (95% CI, 9.9-14.3 months) in the RFA group vs 11.6 months (95% CI, 9.4-13.9 months) in the chemotherapy group (hazard ratio, 1.07; 95% CI, 0.80-1.45; P = .64). Median progression-free survival was 5.8 months (95% CI, 4.4-7.2 months) in the RFA group and 6.9 months (95% CI, 5.3-8.5 months) in the chemotherapy group (P = .47). Grade 3 or higher serious adverse events were reported more often in the RFA group: 26 patients (27%) vs 10 patients (11%) (P = .004). Mean changes from baseline of -14.6, -12.0, and -18.4 were observed for the Global Health Status quality-of-life scores at 1, 3, and 18 months, respectively, numerically exceeding the threshold of 10 points for clinical relevance. In the chemotherapy-only group, mean changes from baseline on the Global Health Status remained below the threshold for clinical relevance.Conclusions and RelevanceThis randomized clinical trial of patients with LAPC after 2 months of multiagent chemotherapy found that local ablative therapy with RFA did not improve survival compared with chemotherapy only and adversely affected patient's quality of life.Trial RegistrationClinicalTrials.gov Identifier: NCT03690323

Objective To develop a chronic heart failure (CHF) module for the Assessment of Burden of Chronic Conditions (ABCC) tool and evaluate its psychometric properties.Design Mixed methods study.Setting The study was conducted in the Netherlands.Participants Healthcare providers (ie, general practitioners (GPs), practice nurses, cardiologists, heart failure nurse practitioners, heart failure specialist nurses) and patients with CHF were involved in the developmental phase. In the psychometric evaluation, patients with CHF were included.Results The ABCC-CHF module comprised 26 items across CHF-specific domains, accompanied by associated advice. It demonstrated high convergent validity with the Kansas City Cardiomyopathy Questionnaire (KCCQ) (97%) and successfully differentiated most known-groups. Internal consistency yielded a Cronbach’s α of 0.92 for the total scale, while test-retest reliability showed an intraclass correlation coefficient (ICC) of 0.97.Conclusion The CHF-specific module is developed and validated. It aims to integrate disease burden into routine healthcare, supporting person-centred care for people with CHF and multimorbidity.

BACKGROUND:DNA methylation analysis provides a promising triage strategy for cervical intraepithelial neoplasia (CIN) and cancer detection following Human Papillomavirus (HPV) testing on self-collected samples, including urine. METHODS:This study aimed to develop an entirely molecular cervical screening approach based on HPV and DNA methylation analysis in at-home collected first-void urine from healthy females (n = 69) and a referral population (n = 385; CIN-cancer). CIN3+ detection was analyzed by multivariate logistic regression. RESULTS:Here we show that urinary ASCL1/LHX8 methylation levels increase significantly in relation to disease severity, with AUC-values for CIN3+ of 0.81 (95% CI: 0.74-0.88) and 0.83 (95% CI: 0.74-0.92) in the training (n = 285) and validation cohort (n = 160), respectively. This corresponds to a validated CIN3+ sensitivity of 73.0% (95% CI: 57.0-84.6%) at 81.9% specificity (95% CI: 73.5-88.1%; <CIN2). Urinary HPV testing is more sensitive (83.8%; 95% CI: 68.9-92.3%) although less specific (59.6%; 95% CI: 50.0-68.5%). For triage of HPV positives, ASCL1/LHX8 methylation and HPV16/18 genotyping have a similar CIN3+ sensitivity (75.0%; 95% CI: 62.8-84.2% vs 73.3%; 95% CI: 61.0-82.9%), with lower genotyping specificity. Combining ASCL1/LHX8 methylation with HPV16/18 genotyping yield a 85.0% sensitivity (95% CI: 73.9-91.9%) at 50.5% specificity (95% CI: 40.8-60.1%). CONCLUSIONS:The ASCL1/LHX8 methylation test detects nearly all cancers and a majority of CIN3 in first-void urine, supporting the potential of full molecular screening in urine by primary HPV testing and methylation triage.