Long-term morbidity of congenital diaphragmatic hernia: A plea for standardization

Congenital diaphragmatic hernia (CDH) survivors present long-term morbidities in several systems, including the neurodevelopmental, gastrointestinal, pulmonary, and musculoskeletal ones, and CDH long-term sequelae are increasingly being recognized. Due to high co-morbidity, health related quality of life in a significant proportion of CDH patients might be compromised. As a consequence of consciousness on the long-term sequelae of CDH survivors, and their consequences for life, several follow-up programs were brought to life worldwide. In this review, we will summarize the long-term sequelae of CDH survivors, the impact of new treatments, and analyze the consistency of follow-up programs.     

Patient preferences for clinical follow-up after primary treatment for soft tissue sarcoma: A cross-sectional survey and discrete choice experiment

BackgroundPatients treated for soft tissue sarcoma (STS) require long-term follow-up to detect recurrent or metastatic disease, yet marked differences exist in clinical approaches to the length of follow-up, frequency of consultations and investigations undertaken at follow-up visits. There has been no published work assessing patient expectations or the acceptability of post-treatment follow-up strategies. This study aimed to assess the patient acceptability of different follow-up strategies following curative surgery for soft tissue sarcoma and to investigate the hypothetical levels of recurrence risk at which different follow-up regimes were acceptable.MethodsPatients were recruited from the Royal Orthopaedic Hospital in Birmingham. The study used a cross-sectional survey incorporating a best-worst scaling discrete choice experiment to assess patient preferences regarding different aspects of follow-up.Results132 patients participated (47% response). The nature of investigations undertaken during follow-up was the most important aspect of post-surgical care. Patients typically preferred appointments routinely consisting of clinical examination and chest X-ray, and for follow-up to remain in secondary care rather than general practice.ConclusionClear protocols for STS patient follow-up can improve consistency and equity of care. In determining the optimum follow-up plan for STS patients from the patient perspective, this study provides valuable information that should be considered alongside the clinical effectiveness of follow-up strategies to maximise patient outcomes and use NHS resources appropriately.     

Cardiovascular response to stress and perceived stress is not altered 40 years after hypertensive pregnancies

Objective: Women experiencing hypertensive pregnancies have an increased risk for cardiovascular disease. Whether stress increase the risk is unknown. The objective was to test if cardiovascular response to stress and/or perceived stress differed in relation to blood pressure status during pregnancy 40 years earlier. Methods: Cardiovascular response was examined with mental stress test, and perceived stress was evaluated with a questionnaire in 105 women. Results: Resting heart rate was higher, and pulse reactivity was lower in women with previous hypertensive pregnancies. Neither blood pressure nor perceived stress differed. Conclusion: Response to physical or psychological stress is not affected many years after pregnancy.     

肺表面活性物质治疗新生儿呼吸窘迫综合征随访调查

目的：观察肺表面活性物质（PS）治疗新生儿呼吸窘迫综合征（NRDS）的疗效及其对患儿体格发育和肺功能的影响。方法：将160例NRDS患儿根据是否应用Ps治疗分为观察组120例和对照组40例。两组采用相同常规药物及呼吸机治疗，观察组在此基础上加用Ps治疗。两组分别于生后3、6、9个月和1、2、6岁进行体格发育随访，于6岁时检测肺功能，并将随访结果进行比较。结果：（1）观察组平均呼吸机使用时间和平均住院时间分别为（46．5±13．2）h和（26．8±12．5）d，对照组分别为（69．8±27．7）h和（42．6±18．2）d，两组比较差异有统计学意义（P〈0．05）。（2）生后3个月观察组平均身高、体重、头围分别为（57．2±2．6）cm、（4．76±0．45）kg、（38．6±1．3）cm，对照组分别为（56．1±2．4）cm、（4．35±O．37）kg、（38．1±1．6）cm，两组比较差异有统计学意义（t分别为2．36、2．78、2．81，P均〈0．05）；但该三项在患儿出生6个月以后的随访结果组间比较差异均无统计学意义（P〉0．05）。（3）观察组有26例、对照组有16例出现反复呼吸道感染，两组比较差异有统计学意义（P〈0．05）。（4）6岁时观察组最大呼气中段流量为（1．6±0．3）L／s，对照组为（1．4±0．2）L／s，两组比较差异有统计学意义（P〈0．05）。结论：Ps治疗NRDS可缩短患儿呼吸机使用时间和住院时间，改善早期体格发育和肺功能，是提高NRDS患儿生存质量的有效方法。     

Temperament and one-year outcome of gastric bypass for severe obesity

BackgroundThe role of temperament traits in shaping the outcome of gastric bypass for severe obesity has not been established yet. This study evaluated whether temperament traits influence weight loss 1 year after gastric bypass, controlling for the potential confounding effect of Axis I and II disorders.MethodsForty-nine patients with severe obesity (body mass index = 46.4±6.7) undergoing gastric bypass completed a thorough psychiatric evaluation before surgery, including structured interviews, rating scales, and questionnaire assessing the presence and severity of co-morbid Axis I and II disorders. Temperament was evaluated with the Temperament and Character Inventory (TCI). Weight loss 1 year after surgery was calculated as percent total weight loss (%TWL). Predictors of weight loss were investigated with multivariate linear hierarchical regression.ResultsAfter accounting for psychiatric covariates, higher TCI persistence scores independently predicted 1-year outcome of gastric bypass and explained 40% of the variance in %TWL. Patients with low persistence scores showed a significantly lesser weight loss than patients with high scores.ConclusionTemperament traits denoting the ability to persevere in one’s goals in spite of immediate frustration (persistence) are associated with greater weight loss 1 year after gastric bypass. These data suggest the utility of preoperatively assessing and reinforcing such capacity to optimize surgical outcome. Future research will clarify the behavioral mechanisms mediating this relationship as well as the influence of temperament on weight maintenance.     

Feasibility of tailored follow-up for patients with early breast cancer

As the number of breast cancer survivors increases, this study prospectively examined whether tailored follow-up with differentiated number of visits per risk group, based on a prognostic index for local recurrence, is feasible and acceptable for patients and professionals.Between March 2007 and March 2010, 180 breast cancer patients (pT1-2N0-2cM0) were included. Primary endpoint was feasibility of tailored follow-up, based on the number of follow-up visits, patient satisfaction, anxiety and attitude towards follow-up. Secondary endpoints were reasons for visits, incidence, time to detection of local recurrences and the use of alternative care.In the second and third year of follow-up, the results show a 22% reduction in visits per patient in the low-risk group compared to the intermediate-risk group; 2.8 versus 3.6 visits. The majority of interval visits in both groups was initiated by the professional. No significant differences were found in attitude towards follow-up, patient satisfaction, anxiety and depression, alternative health care use or local recurrences between the risk groups.In conclusion, implementation of a tailored follow-up programme with decreased number of visits for low-risk patients is feasible and acceptable to patients. Appointing one coordinating professional, possibly a nurse practitioner, could further reduce the number of follow-up visits.