Surgical debridement in long bone chronic osteomyelitis: is wide tumour-like resection necessary?

Aims: The standard of wide tumour-like resection for chronic osteomyelitis (COM) has been challenged recently by adequate debridement. This paper reviews the evolution of surgical debridement for long bone COM, and presents the outcome of adequate debridement in a tertiary bone infection unit. Methods: We analyzed the retrospective record review from 2014 to 2020 of patients with long bone COM. All were managed by multidisciplinary infection team (MDT) protocol. Adequate debridement was employed for all cases, and no case of wide resection was included. Results: A total of 53 patients (54 bones) with median age of 45.5 years (interquartile range 31 to 55) and mean follow-up of 29 months (12 to 59) were included. In all, ten bones were Cierny-Mader type I, 39 were type III, and five were type IV. All patients were treated with single-staged management, except for one (planned two-stage stabilization). Positive microbial cultures grew in 75%. Overall, 46 cases (85%) had resolution of COM after index procedure, and 49 (90.7%) had resolution on last follow-up. Four patients (7%) underwent second surgical procedure and six patients (11%) had complications. Conclusion: We challenge the need for wide tumour-like resection in all cases of COM. Through detailed preoperative evaluation and planning with MDT approach, adequate debridement and local delivery of high concentration of antibiotic appears to provide comparable outcomes versus radical debridement.

Can a complex adaptive systems perspective support the resiliency of the heart failure patient - informal caregiver dyad?

PURPOSE OF REVIEW: A holistic palliative approach for heart failure care emphasizes supporting nonprofessional informal caregivers. Informal caregivers play a vital role caring for heart failure patients. However, caregiving negatively affects informal caregivers' well being, and in turn heart failure patients' health outcomes. This opinion article proposes that complex adaptive systems (CAS) theory applied to heart failure models of care can support the resiliency of the heart failure patient - informal caregiver dyad. RECENT FINDINGS: Heart failure care is enacted within a complex system composed of patients, their informal caregivers and a variety of health professionals. In a national study, we employed a CAS perspective to explore how all parts of the heart failure team function interdependently in emergent and adaptive ways. Salient in our data were the severe vulnerability of elderly heart failure patients and their long-term partners who suffered from a chronic illness. Novel approaches are needed that can quickly adapt and reorganize care when unpredictable disturbances occur in the couples' functional capacity. SUMMARY: The linear protocol-driven care models that shape heart failure guidelines, training and care delivery initiatives do not adequately capture heart failure patients' social environment. CAS is a powerful theoretical tool that can render visible the most vulnerable members of the heart failure team, and incite robust specialized holistic palliative heart failure care models.

The Cross-Canada Quintet presents variations on music: movements in the keys of H, P and E.

Whether it is rock playing in the background during a surgery, cool jazz that wafts from our office computer speakers as we write up our clinical notes, or the soaring of a symphony on the radio that inspires that perfect flourish to an article, music is woven throughout much of our clinical and academic lives. For the five of us, however, music alternates between the background and foreground in our lives as health professions educators. Music balances the working day, illuminates our research, and reconciles the utility of our training with the originality of our practice. We invite you to discover the interplays, dissonances and harmonies inspired by and reflected in this leitmotif. Pull up a chair, sit back, put on one of your own favourite pieces and explore these ideas as we riff and rhapsodise on variations on this theme.

Hip dislocation following minor trauma in a patient with neurofibromatosis type 1: a case report and review of the literature.

Neurofibromatosis type 1 (NF-1) is a common autosomal dominant disorder which is known to have associated skeletal manifestations. There are documented cases of hip dislocation in NF-1, although it is a rare occurrence. Previous cases have been associated with intra-articular neurofibromas, acetabular protrusio and femoral deformities such as coxa valga and in one case increased femoral offset.The authors review the literature on pelvic manifestations and report a case of hip dislocation in a 19-year-old woman with neurofibromatosis-one following minor trauma believed to be secondary to markedly increased femoral offset.This case illustrates the effect the NF-1 can have on the anatomy of the proximal femur and one of the complications that can present to the orthopaedic surgeon, without the presence on an intra-articular neurofibroma. In a review of the literature the authors found only two other cases of hip dislocation associated with NF-1 that occurred without the presence of an intra-articular neurofibroma.

Psicoterapia por videoconferencia: Una revisión crítica de los estudios de tratamiento / Psychotherapy via teleconferencing

Dado que los recursos en salud mental no están igualmente distribuidos a lo largo del país (Canadá), algunas regiones geográficas carecen de adecuados servicios. El uso de la videoconferencia puede dar respuesta a esta inequidad y facilitar la provisión de servicios de salud mental a distancia. Con el advenimiento de la psicoterapia suministrada vía videoconferencia, han surgido inquietudes acerca de su eficacia. Por lo tanto, el propósito de este trabajo fue revisar los estudios de tratamientos (N=13) publicados y no publicados que examinaron la eficacia de la psicoterapia brindada mediante videoconferencias. Esta investigación sustenta la posibilidad y potencial eficacia de los tratamientos provistos vía videoconferencia para algunas condiciones específicas. En vista de sus falencias metodológicas, se hacen recomendaciones para el futuro.