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- Smeele, Hansje P., et al.
(author)
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Breast reconstruction timing and modality in context : A cross-sectional study in Uppsala, Maastricht, and Rome
- 2023
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In: European journal of plastic surgery. - : Springer. - 0930-343X .- 1435-0130. ; 47:1
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Journal article (peer-reviewed)abstract
- BackgroundWith the development and refinement of techniques most mastectomy patients nowadays are candidates for breast reconstruction. No one surgical technique fits all, however. Treatment choices are driven by patient characteristics and preferences, alongside policy and operational factors. These, in turn, might be expected to differ on several levels of aggregation, for example, countries, regions, and hospitals. The aim of this study was to compare choices for breast reconstruction timing and modality in Uppsala (Sweden), Maastricht (the Netherlands), and Rome (Italy).MethodsIn this cross-sectional study, patients presenting for first-time post-mastectomy breast reconstruction in three teaching hospitals were included. The primary study outcomes were breast reconstruction timing and modality. Covariables were body habitus (i.e., body mass index, waist circumference, and mastectomy weight), health-related quality of life assessed with the BREAST-Q Reconstruction module, patient preferences assessed with a self-constructed questionnaire, and shared decision making assessed with the CollaboRATE questionnaire. Statistical tests were used to compare data across study sites.ResultsSixty-six participants were included. The most common choices for breast reconstruction timing and modality were delayed DIEP flaps in Uppsala (53%), immediate DIEP flaps in Maastricht (44%), and immediate prepectoral implants in Rome (92%). Participants in Rome were much slenderer than participants in Uppsala and Maastricht (mean body mass index 21.6, 26.2, and 26.3 kg/m2, respectively; p < 0.05). Participants in Uppsala and Maastricht highly valued material used for the reconstruction; participants in Rome were significantly more concerned with complications, scars, and recovery duration associated with the reconstruction.ConclusionsThis study shows large differences in choices for breast reconstruction timing and modality in Uppsala, Maastricht, and Rome. Possible reasons for the observed variation include differences in patient characteristics, patient preferences, reconstructive techniques available, and reimbursement.Level of evidenceLevel IV, Therapeutic study.
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| 4. |
- Wevers-de Boer, K. V. C., et al.
(author)
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Four-month metacarpal bone mineral density loss predicts radiological joint damage progression after 1 year in patients with early rheumatoid arthritis: exploratory analyses from the IMPROVED study
- 2015
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In: Annals of the Rheumatic Diseases. - : BMJ Publishing Group. - 0003-4967 .- 1468-2060. ; 74:2, s. 341-346
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Journal article (peer-reviewed)abstract
- Aim To assess whether in early (rheumatoid) arthritis (RA) patients, metacarpal bone mineral density (BMD) loss after 4 months predicts radiological progression after 1 year of antirheumatic treatment. Methods Metacarpal BMD was measured 4 monthly during the first year by digital X-ray radiogrammetry (DXR-BMD) in patients participating in the IMPROVED study, a clinical trial in 610 patients with recent onset RA (2010 criteria) or undifferentiated arthritis, treated according to a remission (disease activity scoreless than1.6) steered strategy. With Sharp/van der Heijde progression greater than= 0.5 points after 1 year (yes/no) as dependent variable, univariate and multivariate logistic regression analyses were performed. Results Of 428 patients with DXR-BMD results and progression scores available, 28 (7%) had radiological progression after 1 year. Independent predictors for radiological progression were presence of baseline erosions (OR (95% CI) 6.5 (1.7 to 25)) and early DXR-BMD loss (OR (95% CI) 1.5 (1.1 to 2.0)). In 366 (86%) patients without baseline erosions, early DXR-BMD loss was the only independent predictor of progression (OR (95% CI) 2.0 (1.4 to 2.9)). Conclusions In early RA patients, metacarpal BMD loss after 4 months of treatment is an independent predictor of radiological progression after 1 year. In patients without baseline erosions, early metacarpal BMD loss is the main predictor of radiological progression.
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