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Müller F, Proske A, Füchtmeier B, Wulbrand C. Are Process Changes Measurable? An Analysis of 4136 Proximal Femur Fractures over 16 Year. Z Orthop Unfall 2024. [PMID: 38621696 DOI: 10.1055/a-2276-6440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Prozessänderungen im perioperativen Setting werden selten analysiert, weil ihre Ergebnisse nicht unmittelbar fassbar sind und es einer hohen Fallzahl bedarf. Primäres Ziel war es, Prozessänderungen retrospektiv anhand proximaler Femurfrakturen (PF) zu evaluieren und deren Effekt mit verschiedenen Zielkriterien zu überprüfen. Sekundäres Ziel war die Definition möglicher Qualitätskriterien für die Versorgung von PF.Retrospektive Analyse der Datenbank eines Level-1-Traumazentrums zu PF. Eingeschlossen wurden alle osteosynthetisch und endoprothetisch versorgten PF im Behandlungszeitraum vom 01.01.2006 bis 31.12.2021. Der Zeitraum von 16 Jahren wurde für die Statistik trichotom aufgeteilt und die ersten 6 Jahre als Ausgangsbasis verwendet. Insgesamt 10 Prozessänderungen wurden in den folgenden 10 Jahren vorgenommen. Die Auswirkungen dieser Änderungen wurden anhand 1. der operativen Revisionsrate, 2. der Infektionsrate, 3. der perioperativen Transfusionsrate sowie 4. der 1-Jahres-Letalität überprüft.Insgesamt 4163 PF wurden analysiert. Hinsichtlich der Zielkriterien zeigten die Änderungen der ersten 5 Jahre (2012-2016; intramedulläres Verfahren für Osteosynthesen sowie Einwegabdeckung und Einwegkittel) den stärksten Effekt mit einer erstmaligen Senkung der operativen Revisionsrate unter 10% auf Dauer. Weitere Prozessoptimierungen der letzten 5 Jahre (2017-2021) erbrachten ebenfalls messbare Verbesserungen (Senkung der Infektions- und Transfusionsrate). Die 1-Jahres-Letalität blieb unverändert, auch während der COVID-19-Pandemie.Prozessänderungen bei PF führen nicht unmittelbar zu objektiv messbaren Verbesserungen. Rückblickend erscheint der Paradigmenwechsel von extra- auf intramedulläre Osteosynthese den höchsten Effekt erzielt zu haben, wenngleich über die letzten 10 Jahre eine schrittweise Besserung aller Zielkriterien eintrat - mit Ausnahme der Letalität. Als objektive Qualitätskontrolle sollte eine 1-Jahres-Revisionsrate unter 10% angestrebt sein.
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Affiliation(s)
- Franz Müller
- Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
| | - Andreas Proske
- Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
| | - Bernd Füchtmeier
- Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
| | - Christian Wulbrand
- Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
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Proske A, Link BC, Beeres F, Nebelung S, Füchtmeier B, Knobe M. [Residency program under scrutiny (part 2)-How do residents prepare for emergency operations?]. Chirurg 2021; 92:62-69. [PMID: 33009593 DOI: 10.1007/s00104-020-01286-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Postgraduate medical education in trauma and orthopedic surgery residents largely relates to learning and teaching surgery. During this crucial stage of surgical development some of the didactic challenges are caused by heterogeneous and contradictory expectations of trainees and trainers alike. So how do residents prepare for emergency surgery? To date there is neither an expert consensus nor scientific investigations in the clinical context on this topic. METHODS Between February and April 2015 questionnaires were issued to all physicians active in the field of trauma and orthopedic surgery within the Trauma Network East Bavaria (27 clinics, 255 physicians). The participants were asked to rate the importance of certain elements functioning in the preparation of two emergency operations using a Likert scale. The intensity with which residents generally realize these elements of preparation was also documented. The aim was to objectify if and to what extent the presumed normal practices diverge from clinical reality. RESULTS A total of 150 questionnaires were analyzed (return rate 59%). Discussion with the consultant (85.3%, n = 128), examination of the patient (80.0%, n = 120), surgical approach (76.0%, n = 114) and study of patient files (68.0%, n = 102) were considered to be the most important elements; however, many of the participants admitted that these elements of preparation are not sufficiently performed. CONCLUSION The personal preparation of residents for an emergency operation should be classified as extremely important; however, the requirements and reality do not seem to hold true in the clinical environment. This seems to be most likely due to structural and organizational issues.
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Affiliation(s)
- Andreas Proske
- Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeningerstraße 86, 93049, Regensburg, Deutschland.
| | - Björn-Christian Link
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Frank Beeres
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Sven Nebelung
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Bernd Füchtmeier
- Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeningerstraße 86, 93049, Regensburg, Deutschland
| | - Matthias Knobe
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Luzern, Schweiz
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Proske A, Link BC, Beeres FJP, Nebelung S, Füchtmeier B, Knobe M. [Erratum to: Residency program under scrutiny (part 2)-How do residents prepare for emergency operations?]. Chirurg 2020; 92:70. [PMID: 33210157 DOI: 10.1007/s00104-020-01318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Andreas Proske
- Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
| | - Björn-Christian Link
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Frank J P Beeres
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Sven Nebelung
- Institut für diagnostische und interventionelle Radiologie, UniversitätsklinikumDüsseldorf, Düsseldorf, Deutschland
| | - Bernd Füchtmeier
- Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland
| | - Matthias Knobe
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Luzern, Schweiz
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Dafflon C, Craig VJ, Méreau H, Gräsel J, Schacher Engstler B, Hoffman G, Nigsch F, Gaulis S, Barys L, Ito M, Aguadé-Gorgorió J, Bornhauser B, Bourquin JP, Proske A, Stork-Fux C, Murakami M, Sellers WR, Hofmann F, Schwaller J, Tiedt R. Complementary activities of DOT1L and Menin inhibitors in MLL-rearranged leukemia. Leukemia 2016; 31:1269-1277. [PMID: 27840424 DOI: 10.1038/leu.2016.327] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/16/2016] [Accepted: 10/21/2016] [Indexed: 12/16/2022]
Abstract
Chromosomal rearrangements of the mixed lineage leukemia (MLL/KMT2A) gene leading to oncogenic MLL-fusion proteins occur in ~10% of acute leukemias and are associated with poor clinical outcomes, emphasizing the need for new treatment modalities. Inhibition of the DOT1-like histone H3K79 methyltransferase (DOT1L) is a specific therapeutic approach for such leukemias that is currently being tested in clinical trials. However, in most MLL-rearranged leukemia models responses to DOT1L inhibitors are limited. Here, we performed deep-coverage short hairpin RNA sensitizer screens in DOT1L inhibitor-treated MLL-rearranged leukemia cell lines and discovered that targeting additional nodes of MLL complexes concomitantly with DOT1L inhibition bears great potential for superior therapeutic results. Most notably, combination of a DOT1L inhibitor with an inhibitor of the MLL-Menin interaction markedly enhanced induction of differentiation and cell killing in various MLL disease models including primary leukemia cells, while sparing normal hematopoiesis and leukemias without MLL rearrangements. Gene expression analysis on human and murine leukemic cells revealed that target genes of MLL-fusion proteins and MYC were suppressed more profoundly upon combination treatment. Our findings provide a strong rationale for a novel targeted combination therapy that is expected to improve therapeutic outcomes in patients with MLL-rearranged leukemia.
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Affiliation(s)
- C Dafflon
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Basel, Switzerland
| | - V J Craig
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Basel, Switzerland
| | - H Méreau
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - J Gräsel
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Basel, Switzerland
| | - B Schacher Engstler
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Basel, Switzerland
| | - G Hoffman
- Novartis Institutes for BioMedical Research, Developmental and Molecular Pathways, Cambridge, MA, USA
| | - F Nigsch
- Novartis Institutes for BioMedical Research, Developmental and Molecular Pathways, Basel, Switzerland
| | - S Gaulis
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Basel, Switzerland
| | - L Barys
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Basel, Switzerland
| | - M Ito
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Basel, Switzerland
| | - J Aguadé-Gorgorió
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - B Bornhauser
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - J-P Bourquin
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - A Proske
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Basel, Switzerland
| | - C Stork-Fux
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Basel, Switzerland
| | - M Murakami
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Basel, Switzerland
| | - W R Sellers
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Cambridge, MA, USA
| | - F Hofmann
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Basel, Switzerland
| | - J Schwaller
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - R Tiedt
- Novartis Institutes for BioMedical Research, Disease Area Oncology, Basel, Switzerland
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