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Introduction: Surgery, the cornerstone of most cancer treatments, is associated with considerable postoperative complications1. Adjusting patients' health behavior before surgery may have beneficial effects on postoperative outcomes. The objective of this trial is to investigate the feasibility and safety of, and patient-satisfaction and adherence with, patient-centered teleprehabilitation in patients undergoing breast cancer (BC) surgery. Methods: Women (n = 50) who will undergo breast surgery because of stage I-III BC are eligible. All participants will receive multimodal patient-centered teleprehabilitation comprising of motivational interviewing, education, exercise therapy, and stress management. Feasibility, participation rate, patient satisfaction, intervention safety, and treatment adherence will be monitored as primary outcomes. Fatigue, pain, quality of life (QoL), self-efficacy, and healthcare utilization will be assessed by self-reported questionnaires at baseline, 0-, 2-, and 6-months post-intervention. Results: Proof of concept for using telecommunication and exercise therapy in prehabilitation prior to BC surgery is available2,3. We expect the proposed intervention to be feasible and effective at reducing fatigue, pain, and healthcare use, and at improving treatment adherence, QoL, and self-efficacy. Discussion: Effective prehabilitation interventions can reduce the long-term symptoms that arise/persist beyond treatment completion, improving patients' QoL. By using telecommunication technologies, socio-economic barriers can be reduced, making care accessible to all. Process evaluation: With timely recruitment being the greatest challenge, a thorough mitigation strategy was put in place. Recruitment, drop-out, and loss-to-follow-up will constantly be monitored. Additional study centers confirmed their willingness to participate, and other study centers can easily be contacted through our collaboration with the Belgian Society of Medical Oncology. [ABSTRACT FROM AUTHOR]

Objectives: Errors in the registration or extraction of patient outcome data, such as in-hospital mortality, may lower the reliability of the quality indicator that uses this (partly) incorrect data. Our aim was to measure the reliability of in-hospital mortality registration in the Dutch National Intensive Care Evaluation (NICE) registry. Methods: We linked data of the NICE registry with an insurance claims database, resulting in a list of discrepancies in in-hospital mortality. Eleven Intensive Care Units (ICUs) were visited where local data sources were investigated to find the true in-hospital mortality status of the discrepancies and to identify the causes of the data errors in the NICE registry. Original and corrected Stand - ardized Mortality Ratios (SMRs) were calculated to determine if conclusions about quality of care changed compared to the national benchmark. Results: In eleven ICUs, 23,855 records with 460 discrepancies were identified of which 255 discrepancies (1.1% of all linked records) were due to incorrect in-hospital mortality registration in the NICE registry. Two programming errors in computer software of six ICUs caused 78% of errors, the remainder was caused by manual transcription errors and failure to record patient outcomes. For one ICU the performance became concordant with the national benchmark after correction, instead of being better. Conclusions: The reliability of in-hospital mortality registration in the NICE registry was good. This was reflected by the low number of data errors and by the fact that conclusions about the quality of care were only affected for one ICU due to systematic data errors. We recommend that registries frequently verify the software used in the registration process, and compare mortality data with an external source to assure consistent quality of data. [ABSTRACT FROM AUTHOR]

In the Intensive Care Unit, clinicians are continuously faced with the difficult task of prognosis, but their predictions of patient survival status may not always be consistent. Specifically very little is known about consistency of predictions over time. The aim of this paper is to assess the consistency of nurses' daily predictions of survival in terms of inter-observer variance and variance of observers over time. We found a low consistency of these predictions between observers and over time, even though changes in the patients' condition are considered. Our findings have implications to the process of end-of-life decision-making, which pertains to withholding or withdrawing intensive care treatment. [ABSTRACT FROM AUTHOR]

Purpose: Hyperoxia may induce pulmonary injury and may increase oxidative stress. In this retrospective database study we aimed to evaluate the response to hyperoxia by intensivists in a Dutch academic intensive care unit.Methods: All arterial blood gas (ABG) data from mechanically ventilated patients from 2005 until 2009 were extracted from an electronic storage database of a mixed 32-bed intensive care unit in a university hospital in Amsterdam. Mechanical ventilation settings at the time of the ABG tests were retrieved.Results: The results of 126,778 ABG tests from 5,498 mechanically ventilated patients were retrieved including corresponding ventilator settings. In 28,222 (22%) of the ABG tests the arterial oxygen tension (PaO(2)) was >16 kPa (120 mmHg). In only 25% of the tests with PaO(2) >16 kPa (120 mmHg) was the fraction of inspired oxygen (FiO(2)) decreased. Hyperoxia was accepted without adjustment in ventilator settings if FiO(2) was 0.4 or lower.Conclusion: Hyperoxia is frequently seen but in most cases does not lead to adjustment of ventilator settings if FiO(2) <0.41. Implementation of guidelines concerning oxygen therapy should be improved and further research is needed concerning the effects of frequently encountered hyperoxia. [ABSTRACT FROM AUTHOR]

The article presents a study on the impact of an ultrasound training course on pattern recognition's performance when used by examiners who have less experience. It says that malignancy of selected adnexal masses was classified as benign or malignant by two trainees with the use of pattern recognition before and after they had undergone a theoretical gynecological ultrasound course. It says that the performance of pattern recognition was not improved by the theoretical ultrasound teaching.

Objectives: To develop a predictive model for the outcome length of stay at the Intensive Care Unit (ICU LOS), including the choice of an optimal dichotomization threshold for this outcome. Reduction of prediction problems of this type of outcome to a two-class problem is a common strategy to identify high-risk patients.Methods: Threshold selection and model development are performed simultaneously. From the range of possible threshold values, the value is chosen for which the corresponding predictive model has maximal precision based on the data. To compare the precision of models for different dichotomizations of the outcome, the MALOR performance statistic is introduced. This statistic is insensitive to the prevalence of positive cases in a two-class prediction problem.Results: The procedure is applied to data from cardiac surgery patients to dichotomize the outcome ICU LOS. The class probability tree method is used to develop predictive models. Within our data, the best model precision is found at the threshold of seven days.Conclusions: The presented method extends existing procedures for predictive modeling with optimization of the outcome definition for predictive purposes. The method can be applied to all prediction problems where the outcome variable needs to be dichotomized, and is insensitive to changes in the prevalence of positive cases with different dichotomization thresholds. [ABSTRACT FROM AUTHOR]

Objective: To report short-term and long-term mortality of very elderly ICU patients and to determine independent risk factors for short-term and long-term mortalityDesign and Setting: Retrospective cohort study in the medical/surgical ICU of a tertiary university teaching hospital.Patients: 578 consecutive ICU patients aged 80 years or older.Results: Demographic, physiological, and laboratory values derived from the first 24h after ICU admission. ICU mortality of unplanned surgical (34.0%) and medical patients (37.7%) was higher than that of planned surgical patients (10.6%), as was post-ICU hospital mortality (26.5% and 29.7% vs. 4.4%). Mortality 12 months after hospital discharge, including ICU and hospital mortality, was 62.1% in unplanned surgical and 69.2% in medical patients vs. 21.6% in planned patients. Only median survival of planned surgical patients did not differ from survival in the age- and gender-matched general population. Independent risk factors for ICU mortality were lower Glasgow Coma Scale score, higher SAPS II score, the lowest urine output over 8 h, abnormal body temperature, low plasma bicarbonate levels, and higher oxygen fraction of inspired air. High urea concentrations and admission type were risk factors for hospital mortality, and high creatinine concentration was an independent risk factor for 12-month mortality.Conclusion: Mortality in very elderly patients after unplanned surgical or medical ICU admission is higher than after planned admission. The most important factors independently associated with ICU mortality were related to the severity of illness at admission. Long-term mortality was associated with renal function. [ABSTRACT FROM AUTHOR]

The article presents information on a study related to the usability of medical terminological systems (TSs). It also provides an overview of what aspects determine the quality of a TS content and how these aspects can be evaluated. The usability of TSs strongly depends on the coverage and correctness of their content. Several developments in health care, such as accountability of care and increased use of electronic patient records, have led to an increased need for accurate, detailed and structured registration of medical data. A list of standard requirements for TS was developed and approved in 2000 by the International Organization for Standardization. A number of methods to evaluate the content of a TS have been described in literature. A literature study was performed to gain insight into the several types of evaluation methods. A case study provides a comparison of three methods that can be applied to evaluate the coverage and or the correctness of the content of TSs. As an increasing number of medical terminological systems is based on formal representation, it is important to understand the potential of readily available reasoning algorithms exploiting the formal representation.

Objectives To audit nuchal translucency thickness (NT) measurements for fetal aneuploidy screening in Flanders, and to estimate the impact of small variations in NT measurement on the screening result of two first-trimester screening algorithms: maternal age + NT (Algorithm A), and maternal age + NT + pregnancy associated plasma protein-A + free β-human chorionic gonadotropin (Algorithm B). Methods We used the database of first-trimester combined screening, as collected by the General Medical Laboratory AML in Antwerp, Belgium, between 1 January 2001 and 1 April 2004. Audit was performed by establishing a delta-NT distribution curve for one trainee of The Fetal Medicine Foundation (FMF) and for a group of 263 other sonographers, in comparison with the FMF reference values. Risks for fetal aneuploidy were calculated at a cut-off value of 1:300 for Algorithm A and 1: 150 for Algorithm B. These risks were recalculated in both algorithms after a modeled increase of all NT values by 0.1 or 0.2 mm. Results In a total of 592 measurements performed by the FMF trainee, the 5th, 50th and 95th percentiles of delta-NT measurements were at -0.41, + 0.03 and + 0.68 mm, respectively. These values were close to the FMF reference values. The screen-positive rate for this set of data was 4.4% (2 6/592) in both algorithms. For the 12555 measurements of the 263 other sonographers, the 5th, 50th and 95th percentiles of delta-NT were at -0.81, -0.14 and + 0.73 mm, respectively, which clearly indicates underestimation of NT in the lower range. In this set of data the screen-positive rate was 3.5% for both algorithms (439/12 555 for Algorithm A and 436/12 555 for Algorithm B). Also in this group, 5% (59/1186) of negative screening results at maternal age ⩾ 35 years in Algorithm A became positive after a modeled 0.1-mm increase in NT, whereas this was only in 1.2% (134/11 369) of tests at maternal age <35 years (P < 0.0001). The overall increase of screen-positive rate in Algorithm A after an NT modification of + 0.1 mm was 1.2% (1 52/12 555), significantly more than in Algorithm B (86/12 555; 0.7%) (P < 0.0001). Conclusion In Flanders, there is a systematic underestimation of NT in comparison with the FMF reference range. Attempts to change these measurements according to the FMF criteria are crucial. This will mainly influence the screening results of women at advanced maternal age and of NT-based algorithms without the use of other parameters. [ABSTRACT FROM AUTHOR]

Objective: Impairment of haemostasis has been described with slowly degradable medium molecular weight hydroxyethyl starch (MMW-HES), whereas rapidly degradable MMW-HES is generally considered to have no important effects on blood coagulation. This study was undertaken to investigate the effects of a rapidly degradable MMW-HES plasma substitute on primary haemostasis and blood coagulation in human subjects. Design: Randomised, cross-over study. Setting: Research unit of a university hospital. Participants: Nine healthy, adult male volunteers. Interventions: A 60-min intravenous infusion of 1 l HES 200/0.5/6 (HAES-steril 6%) or 4% albumin (control). Measurement and results: The infusion of HES resulted in decreased circulating levels of von Willebrand factor antigen (from 85±8% to 59±6% after HES vs from 80±7% to 69±8% after albumin, p<0.05) and ristocetin cofactor activity (from 93±4 to 67±4% after HES vs from 79±5 to 75±5% after albumin, p<0.01). This was associated with an impairment of in vitro platelet function as determined with the PFA-100 platelet function analyser (closure time with collagen/epinephrine from 120±7 to 159±14 s after HES vs from 121±7 to 137±10 s after albumin, p<0.05; with collagen/ADP from 88±3 to 116±9 s and from 103±4 to 114±7 s after HES and albumin, respectively, p=0.01). Conclusions: The infusion of 1 l of HES 200/0.5/6 in healthy human subjects results in moderately decreased plasma levels of von Willebrand factor associated with impairment of platelet function. [ABSTRACT FROM AUTHOR]