[Colorectal carcinoma - How can we improve prevention?] / Kolonkarzinom.

Colorectal carcinoma - How can we improve prevention? Abstract. Colorectal cancer (CRC) is the second leading cause of cancer-related death in Europe. Comprehensive screening is useful and cost-effective. However, participation in screening programs in Switzerland is low and falls below 20 %. Immunological stool tests (FIT tests) can - when carried out every two years - detect tumours and advanced adenomas, and thus reduce mortality. These tests have replaced older guaiac faecal tests (e. g. Hämoccult®). The detection and removal of small colon polyps is still only possible through colonoscopy, which is applied for diagnostic and therapeutic purposes and continues to be the gold standard for CRC screening. The decisive factors for screening are risk-adapted prevention with stratification of patients according to risk groups and the general optimization of risk factors. Educating the patient about the advantages and disadvantages of the various screening procedures and making a shared decision are necessary prerequisites for greater participation in screening programs.

Usefulness of concomitant biceps tenodesis in total shoulder arthroplasty: a prospective cohort study.

The purpose of this report is to assess the association of concomitant biceps tenodesis in total shoulder arthroplasty with treatment success 1 year after total shoulder arthroplasty. Of 136 consecutive shoulders (124 patients) undergoing primary total shoulder arthroplasty between 2003 and 2006, 54 (39.7%) underwent biceps tenodesis. For each patient, we obtained potential preoperative confounding data, such as age; gender; presence of rheumatoid arthritis; Short Form 36; number of previous shoulder operations; Disabilities of the Arm, Shoulder and Hand score; Shoulder Pain and Disability Index score; and insurance status. At the 1-year follow-up, we calculated the Constant score of all patients (ranging from 0 [worst] to 100 [best]). We first determined the crude association of concomitant biceps tenodesis with 1-year treatment success (Constant score > or =80) and then fitted a multivariate model correcting for potential confounders to assess the adjusted association of the biceps tenodesis on treatment success. The total number of treatment successes was 46 of 136 shoulders (33.8% of all prosthesis implantations). The crude association (odds ratio) of a concomitant biceps tenodesis with treatment success was 2.38 (95% confidence interval [CI] 1.15 to 4.93; P = .02). When adjusting for potential confounders, we found that this association slightly increased to 2.97 (95% CI 1.00 to 8.85; P = .05). Concomitant biceps tenodesis appears to have a favorable effect on 1-year treatment success after total shoulder arthroplasty.

Adherence to transfusion guidelines: are we prepared for the Smarter Medicine or Choosing Wisely initiative?

OBJECTIVE: To determine, whether a restrictive transfusion strategy is followed in our hospital and to identify differences in activities within departments and patient groups. METHOD: Over a period of 15 months, RBC transfusions were prospectively recorded including the haemoglobin level prior to transfusion and were grouped in the different departments of our hospital (internal medicine ward, department of surgery, emergency room, intensive care unit, gynaecology ward, medical outpatient clinic and oncology outpatient clinic). Indications and co-morbidities were assessed retrospectively by reviewing the patient's charts. RESULTS: There were 1,832 RBC products transfused in total. The overall mean level of haemoglobin before transfusion was 7.61 g/dl (±1.1). These haemoglobin levels differed significantly between the departments (p <0.001), with the lowest threshold in the internal medicine ward (7.30 g/dl ± 1.0) compared to the surgery ward (7.73 g/dl ± 1.0) and to the intensive care unit (7.82 g/dl ± 0.9). In general, mean pre-transfusion haemoglobin levels did not differ significantly between patients with coronary artery disease (CAD) and patients without (7.64 g/dl ± 1.0 vs 7.59 g/dl ± 1.1, p = 0.48). In transfusions for patients with acute coronary syndrome a tendency to a higher transfusion threshold than in patients with stable CAD could be found (7.84 g/dl ± 0.7 vs 7.58 g/dl ± 1.0, p = 0.05). Patients with haematological disorders were transfused at a higher threshold when compared to patients without (7.77 g/dl vs 7.56 g/dl, p = 0.006). CONCLUSION: All wards in our analysis are following the current guidelines based on restrictive transfusion strategies. At the same time, we were able to detect significant differences between different departments and patient characteristics.