Occurrence and Timing of Advance Care Planning in Persons With Dementia in General Practice: Analysis of Linked Electronic Health Records and Administrative Data

Background

Advance care planning (ACP) is a process of communication in which patients and family caregivers discuss preferences for future care with the healthcare team. For persons with dementia, it is crucial to timely engage in ACP. Therefore, we study ACP in dementia using electronic health record data. This study aims to determine how often ACP conversations are recorded, analyze time from dementia diagnosis until the first recorded conversation and time from the first recorded conversation to death, and analyze which factors are associated with the timing of ACP.

Methods

Electronic records of 15,493 persons with dementia in Dutch general practice between 2008 and 2016 were linked to national administrative databases. ACP conversations and indicators of health deficits to determine frailty were obtained from electronic records coded with the International Classification of Primary Care. Socio-demographic characteristics were derived from the national population registry managed by Statistics Netherlands. Date of death was derived from the Personal Records Database (2008–2018).

Results

ACP was recorded as such as 22 (95% CI, 20–23) first conversations per 1,000 person-years of follow-up. The hazard ratio (HR) for the first conversation increased every year after dementia diagnosis, from 0.01 in the first year to 0.07 in the 7th and 8th year after diagnosis. Median time from a first conversation to death was 2.57 years (95% CI, 2.31–2.82). Migrant status [non-Western vs. Western (HR 0.31, 95% CI, 0.15–0.65)] was significantly associated with a longer time from dementia diagnosis to the first conversation. Being pre-frail (HR 2.06, 95% CI, 1.58–2.69) or frail (HR 1.40, 95% CI, 1.13–1.73) vs. non-frail was significantly associated with a shorter time from dementia diagnosis to the first ACP conversation.

Conclusion

ACP conversations in Dutch general practice were rare for persons with dementia, or was rarely recorded as such. In particular among persons with a non-Western migration background and those who are non-frail, it started long after diagnosis. We advise further research into public health and practical strategies to engage persons with dementia with a non-Western migration background and non-frail persons early in the disease trajectory in ACP.

Laparoscopic Radicai Prostatectomy without Ligation of the Santorini's VenousPlexus

Background

The goal of our work is to demonstrate how, in the approach to laparoscopic radical prostatectomy, the ligation of Santorini's dorsal venous complex is not necessary. The retrospective evaluation of video-laparoscopich radical prostatectomy performed at UOC of Jesi with this technical device, showed an increased blood loss compared to a technique that provides for the ligation of Santorini's plexus and, overall, reduced blood loss compared with the average radical open prostatectomy.

Material and Methods

50 video-laparoscopic extraperitoneal radical prostatectomies were evaluated, which were performed with the same technique and by the same operator. The technique involves the non-ligation of Santorini's venous plexus. Surgical, oncological, functional outcomes were considered and in particular blood loss.

Results

The results are consistent with those reported in literature, and without ligation of the Santorini's venous plexus, there has been no increase in blood loss intra-and / or post-operatively or in the percentage of patients with hemotransfusion.

Conclusion

The video-laparoscopic radical prostatectomy, although a not yet codified and standardized technique for the treatment of organ-confined prostate cancer, did show oncological and functional results basically I similar to open-sky technique. But compared to this, it has certainly demonstrated a lower blood loss and a reduction of morbidity. The non ligation of Santorini's venous plexus, always necessary during open prostatectomy, in our experience is not necessary in video-laparoscopy

Catalytic wet peroxide oxidation of phenol over ZnFe2O4 nano spinel

The catalytic wet peroxide oxidation of phenol was investigated over ZnFe2O4 nano spinels under different conditions designed by the experimental design. ZnFe2O4 nano oxide was synthesized by the sol-gel combustion method and characterized by X-ray diffraction, Fourier transform infrared spectroscopy, and scanning electron microscope techniques. The mean particle size was determined to be around 80–90 nm. The experiments were designed by the Box–Behnken type of response surface methodology by considering four process variables: CH2O2 (mol L−1), ZnFe2O4 amount (g), temperature (°C), and reaction time (min). The optimum condition for the degradation of the phenol was predicted by the response surface methodology. The optimal conditions for phenol degradation were at 0.144 M, 0.156 g, 70 °C, and 300 min of peroxide concentration, catalyst amount, temperature, and reaction time, respectively. The predicted response under these conditions was 99%, whereas the experimental test of predicted condition led to 97% degradation of phenol. Pareto analysis predicted that the order of relative importance of model terms is as follows: reaction temperature (29%) > catalyst amount – reaction temperature (19%) > reaction temperature – reaction time (14%) > reaction time (10.9%) > catalyst amount (9.8%). The study revealed that zinc ferrite nano spinels could be promising for removal of pollutants by the catalytic wet peroxide oxidation process.

Shoulder-Mounted Robot for MRI-guided arthrography: Accuracy and mounting study

A new version of our compact and lightweight patient-mounted MRI-compatible 4 degree-of-freedom (DOF) robot for MRI-guided arthrography procedures is introduced. This robot could convert the traditional two-stage arthrography procedure (fluoroscopy-guided needle insertion followed by a diagnostic MRI scan) to a one-stage procedure, all in the MRI suite. The results of a recent accuracy study are reported. A new mounting technique is proposed and the mounting stability is investigated using optical and electromagnetic tracking on an anthropomorphic phantom. Five volunteer subjects including 2 radiologists were asked to conduct needle insertion in 4 different random positions and orientations within the robot's workspace and the displacement of the base of the robot was investigated during robot motion and needle insertion. Experimental results show that the proposed mounting method is stable and promising for clinical application.

SILS extraperitoneal radical prostatectomy

AIM

This paper presents the surgical technique for video-laparoscopic extraperitoneal radical prostatectomy carried out through a single incision of 2.5 cm below the navel.

METHODS

The technique involves the placement of a port of a new concept, the SILS-port, which has three channels through which you can insert instruments and camera. The study results were evaluated from the surgical, oncological and functional point of view. Ten patients undergoing prostatectomy were compared with the last 10 patients treated at our facilities with increasingly radical prostatectomy video-laparoscopic extraperitoneal, defined "conventional".

RESULTS

There were no substantial differences between the two techniques, except for a modest lengthening of the operative time, at least initially.

CONCLUSION

The results achieved with the adoption of this technique have shown its feasibility, security and undoubted advantages in terms of mini-invasiveness.

[Endoscopic treatment of vesicoureteral reflux in adults with bovine collagen]

Endoscopic subureteral collagen injection has become widely accepted a practiced method for the treatment of vesico-ureteral reflux in children. The aim of this study was to evaluate the efficacy of the treatment in adult patients affected by vesico-ureteral reflux. We have selected 45 patients with primary e 10 patients with secondary reflux (tot. 76 ureters) treated by endoscopic subureteric injection of collagen. The success rate after one injection in primary reflux was 74%. 13 ureters required a 2nd or 3rd injection to achieves success. The minimum follow-up time for the successfully treated patients was 12 months; we did not observe no reflux in 92% of ureters. Endoscopic injection of collagen is a reliable alternative to open surgery.

Renal oncocytoma. Pathological evaluation and clinical implications

Renal oncocytoma is a benign tumour of renal tubular origin; oncocytes are transformed epithelial cells rich in mitochondria, probably representing senescent degenerative cellular changes. Most of renal oncocytomas usually follow a benign clinical course and partial nephrectomy or enucleation has been advocated as curative. By immunohistological staining of tissue sections using monoclonal antibodies (DBA, SBA, PNA, UEA, Cytocheratine), we can suppose the histogenetic origin of renal oncocytomas from a region other than the proximal tubular epithelium, and in particular from the collecting duct epithelium. We believe that it is most important to perform flow cytometry to study the chromosomal pattern of the tumour, once intra-operative frozen sections have advanced the suspicion of renal oncocytoma; if oncocytic cells show a diploid pattern, and the tumour mass is well circumscribed and has not an excessive diameter, we favour renal sparing surgery.