NT-proBNP to exclude heart failure in primary care – a pragmatic,cluster-randomized study

Abstract

Heart failure (HF) is difficult to recognize in primary care. N-terminal pro B-type natriuretic peptide (NT-proBNP) can be used as a rule-out test in HF due to its high negative predictive value. We aim to determine whether the number per 1000 patients of HF diagnoses increase among patients referred from primary care to an outpatient HF clinic, if general practitioners (GPs) were offered NT-proBNP in a real-life setting. All GP practices covered by Randers Regional Hospital were randomized to an intervention group (34 GP practices) and a control group (35 GP practices) in this pragmatic, cluster-randomized controlled trial. The main outcome was the number of patients referred to echocardiography and diagnosed with HF in each group. The number of patients per 1000 diagnosed with HF in the two groups was the same (0.09 (0.02–0.16) vs. 0.14 (0.07–0.21), p?=?.3541). A total of 700?NT-proBNP analyses, of which 611 were unique, were requested from 31 GP practices in 17.5?months. A total of 184 patients were referred to echocardiography on suspicion of HF. The number of patients per 1000 referred in the intervention group was significantly higher (p?p?=?.019). Hence, increased diagnostic effectiveness could not be shown in this real-life setting.     

Computer-assisted total knee arthroplasty versus the conventional technique: how precise is navigation in clinical routine?

Restoration of the mechanical leg axis and component positioning are crucial factors affecting long-term results in total knee arthroplasty (TKA). In a prospective study, 1,000 patients were operated on either using a CT-free navigation system or the conventional jig-based technique. Leg alignment and component orientation were determined on postoperative X-rays. The mechanical leg axis was significantly better in the computer-assisted group (95%, within ±3° varus/valgus) compared to the conventional group (74%, within ±3° varus/valgus) (P < 0.001). On average, the operating time was increased by 8 min in the computer-assisted group. No significant differences were seen between senior and younger surgeons regarding postoperative leg alignment and operating time. Computer-assisted TKA leads to a more accurate restoration of leg alignment and component orientation compared to the conventional jig-based technique. Potential benefits in long-term outcome and functional improvement require further investigation.     

Results of long-term follow-up after curative resection of Dukes A colorectal cancer

Patients with Dukes A (UICC I) colorectal cancer have a good prognosis after curative resection. It is not known, however, if the outcome is significantly different for UICC Ia and Ib patients or if patients with reduced risks of recurrences can be identified early after surgery. This is of interest, as it would permit a more cost-effective, patient-oriented, and tumor stage-oriented follow-up program. To study these questions, a prospective follow-up database, including 1375 patients after curative resection of colorectal cancer, was analyzed. A total of 296 patients with Dukes A colorectal cancer with a median follow-up of 44 months were studied. Perioperative and follow-up mortality rates were 3% and 14%, respectively. Recurrent disease developed in 10% of Dukes A patients after a disease-free interval of 16 months. Significantly more patients suffering from pT2 (UICC Ib) cancer had recurrent disease than patients with pT1 (UICC Ia) cancer (13% vs. 4%; p <0.05). Preoperative CEA levels in patients with recurrent disease were significantly higher than in long-term disease-free patients (5.3 +/- 1.8 vs. 3.5 +/- 0.6 ng/ml; p <0.05). Curative resection of recurrent disease was achieved in 38% of the patients with recurrences (4% of all patients). Survival analysis showed significantly better survival in patients with Dukes A cancer than in those at higher tumor stages (log rank, <0.0001), and only 39% of all Dukes A patients who died during follow-up had recurrent disease. Dukes A (UICC Ia and Ib) colorectal cancer was diagnosed in 22% of our patients treated for cure, and long-term survival was 86%. There were significantly fewer cases of recurrent disease after curative resection of UICC Ia (pT1N0M0) cancer, so we propose a novel, less intensive follow-up regimen for these patients, leading to a more cost-effective, patient-oriented, and tumor stage-oriented follow-up program.     

Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery

Introduction  

The quality of surgical treatment of intracranial aneurysms is determined by complete aneurysm occlusion and restoration of flow in the parent, branching and perforating vessels. In postoperative digital subtraction angiography (DSA), unexpected aneurysm residuals and vessel occlusions are frequently detected. Here, the value of two nearly noninvasive and cost-effective techniques for intraoperative flow evaluation (near-infrared indocyanine green video angiography (ICG-VA) and microvascular Doppler sonography (mDs)) is investigated in a prospective study.     

Leg Length and Offset Measures with a Pinless Femoral Reference Array during THA

The bony fixation of reference marker arrays used for computer-assisted navigation during total hip arthroplasty (THA) theoretically involves the risk of fracture, infection, and/or pin loosening. We asked whether intraoperative assessment of leg length (LL) and offset (OS) changes would be accurate using a novel pinless femoral reference system in conjunction with an imageless measurement algorithm based on specific realignment of the relationship between a dynamic femoral and pelvis reference array. LL/OS measurements were recorded during THA in 17 cadaver specimen hips. Preoperatively and postoperatively, specimens were scanned using CT. Linear radiographic LL/OS changes were determined by two investigators using visible fiducial landmarks and image processing software. We found a high correlation of repeated measurements within and between (both 0.95 or greater) the two examiners who did the CT assessments. Pinless LL/OS values showed mean differences less than 1 mm and correlations when compared with CT measurements.     

Cognitive impairment in patients with chronic hepatitis treated with interferon alpha (IFNalpha): results from a prospective study.

BACKGROUND: Treatment with low-dose interferon alpha (IFN-alpha) is often associated with neuropsychiatric side effects. In addition to depression and anxiety, IFN-alpha associated cognitive impairment significantly affects patient's mental health and quality of life. AIMS OF THE STUDY: To measure possible effects of low-dose IFN-alpha on cognitive functioning and its relationship to the development of depression and anxiety. METHOD: We prospectively followed 38 patients with a chronic hepatitis B or C by neuropsychological tests and psychiatric self-rating scales during 12 weeks of low-dose treatment with IFN-alpha. RESULTS: Before IFN-alpha treatment, neuropsychological tests as well as self-ratings in the Beck's Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS) and the Self-Report Symptom Inventory 90 Items-Revised (SCL-90-R) were within the normal range. Following 12 weeks of treatment with IFN-alpha resulted in a slight, but significant increase in depression scores. Neuropsychological assessment after 12 weeks of IFN-alpha treatment showed a significant decrease of the immediate recall in the Auditory-Verbal Learning Test (AVLT) and a significant reduction of words recited in the Controlled Oral Word Association Test (COWA). Cognitive impairment did not significantly correlate with depressive symptoms or anxiety. CONCLUSION: Our results indicate that even low-dose IFN-alpha induces cognitive impairment independent from depressive symptoms, which might be related to functional disturbances in the prefrontal cortex and the hippocampus. We suggest close monitoring of cognitive function during IFN-alpha treatment of chronic hepatitis.