atUMCG

Background: Pulmonary arterial hypertension (PAH) is a rare but serious and ultimately lethal disease in both adults and children. There has been relatively limited research on pediatric pulmonary arterial hypertension and the research that has been done indicates there are differences in symptoms, histopathology and underlying causes of PAH between pediatric and adult PAH. Thus far, outcome studies in children with PAH are limited and the ones that are conducted in the recent history report different survival rates, with American centers showing better survival rates compared with European centers in London and Groningen. The aim of this study is to investigate whether there in fact is a difference in survival rates, and if so, what are the causes of this survival difference. Methods: We retrospectively compared two cohorts of pediatric PAH patients, seen in the current treatment era in the Columbia University Medical Center New York and the University Medical Center Groningen. We analyzed survival and compared patient-, baseline-, hemodynamic-, and treatment characteristics of all patients that were seen from 2000 to 2010 in the two centers. With univariate COX-regression analysis we investigated which variables were associated with survival. Subsequently, we determined whether there were differences between the centers in these prognostic variables, and which variables could explain the difference in survival rates. Results: Survival rates between the centers differed significantly. 1,3 and 5 year survival rates were 100%, 97%, and 92% in New York versus 85%, 72%, and 60% in Groningen. This difference could largely be explained by a different distribution of diagnoses, with a higher number of patients with a diagnosis associated with a worse prognosis, and a more progressed disease at time of diagnosis in Groningen compared to New York. Patients in Groningen had a higher WHO-class and worse hemodynamic values at time of diagnosis compared with New York. Furthermore there were significant differences in patients receiving mono- and combination therapy, with significantly more patients receiving monotherapy in Groningen and significantly more patients receiving combination therapy in New York. Conclusions: Patients in Groningen had significantly worse survival rates compared with New York, which could largely be explained by significant differences that indicate Groningen has more patients with a diagnosis associated with worse survival and that patients in Groningen have more advanced disease at time of diagnosis.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common medical condition and thus causes a great economic burden on society giving rise to high healthcare and to high workers compensation costs. Because there are different treatment options, costs in treatment may vary. OBJECTIVE: The aim of this study was to determine whether and where there are differences in the management of CTS between different surgical specialties and to assess the current use of infection prevention measures. DESIGN: A transversal descriptive study by means of a survey. METHODS: General surgeons, orthopedic surgeons, plastic surgeons and neurosurgeons who operate on CTS were approached by email to participate in the survey. The survey consisted of questions about diagnosis, treatment and infection prevention measures in CTS surgery. RESULTS: The response rate was 41% (226 responses). On the subject of diagnosis there were differences in the default implementation of electrodiagnostic studies and in the use of provocative tests. In the treatment of CTS differences were found in conservative treatment, tourniquet use, anesthesia and length of incision. There were no differences found in surgical technique, scheduled operating room time and surgery time. Endoscopic surgery, postoperative splinting and searching for the recurrent motor branch during surgery were not often performed. On the subject of infection prevention difference were found in type of operating room, operating theatre clothing, appliance of sterile draping and the use of prophylactic antibiotics. CONCLUSIONS: This study is the first to map out het current treatment of CTS in the Netherlands. Although differences in the treatment of CTS between the specialties are found, it is not possible to determine which treatment is best. This study can be seen as the foundation for further research in cost-effective treatment and can be used in the formation of guidelines for infection prevention.