Pilot Survey of Shared Decision-Making Between Orthopaedic Surgeons and Their Patients in Guatemala.

BACKGROUND: Shared decision-making (SDM) is widely accepted as an essential feature of patient-centered care. However, to our knowledge, there has been no empirical research on the factors that influence orthopaedic surgeons' use of SDM in Guatemala. METHODS: Questions about physician attributes and SDM were included in a 2016 electronic survey distributed to the 221 members of the Asociación Guatemalteca de Ortopedia y Traumatología (AGOT). RESULTS: A total of 114 (52%) of the AGOT-registered orthopaedic surgery residents and orthopaedic surgeons who were sent surveys returned them, and 79 of these surveys contained complete responses to study variables of interest. Of the 79 participants with complete responses, 73% reported that they discussed treatment options most of the time or always with their patients and 81% reported that they explained the reasons for treatment choices. Compared with residents, surgeons who had completed their residency in orthopaedic surgery or had subspecialty training had greater odds (odds ratio [OR] = 9.62; 95% confidence interval [CI] = 1.35, 68.53; p < 0.05) of explaining the reasons for their decisions rather than using other strategies when patients expressed different preferences. Residents and surgeons who discussed treatment choices with their patients were more likely to allow their patients to participate in treatment decisions than those who did not (OR = 2.88; 95% CI = 1.90, 4.36; p < 0.001). CONCLUSIONS: While findings from this exploratory study are limited by its small sample size and its narrow focus on physicians rather than on both patients and physicians, they nonetheless establish a roadmap for future study, particularly with respect to challenges in Guatemala to meaningful SDM that arise from context-specific cultural norms and practices. CLINICAL RELEVANCE: SDM as a tool of practice remains underutilized by orthopaedic surgeons in clinical practice in Guatemala. This study may encourage more discussions regarding SDM in orthopaedic surgery elsewhere in Central America and prompt discussion in the region on the value of and need for postgraduate training in this area.

Osteocondromatose em gato: relato de caso / Osteochondromatosis in a cat: case report

A osteocondromatose é caracterizada por nódulos únicos ou múltiplos decorrentes de um crescimento ósseo excessivo benigno. É encontrada em cães, gatos, equinos e humanos. Em felinos, tem maior incidência dos dois aos quatro anos de idade. A etiologia em gatos está relacionada ao vírus da leucemia felina, e também já foi encontrada relação com o fibrossarcoma. A manifestação clínica depende do local acometido e do tamanho da lesão. O diagnóstico definitivo é por meio de histopatologia e o prognóstico é desfavorável, pois ocorrem muitas recidivas. Este relato de caso objetiva descrever a apresentação dessa enfermidade em um felino jovem.(AU)

Osteochondromatosis is characterized by single or multiple nodules resulting from benign excessive bone growth. It is found in cats and dogs, horses and humans. In cats, a higher incidence is found in individuals from 2 to 4 years of age. The etiology in cats is related to the virus of feline leukemia, and is also related to fibrosarcoma. The clinical presentation depends on the area affected and the size of the lesion. The definitive diagnosis is by histopathology and the prognosis is poor because many relapses occur. This case report aims to describe the presentation of the disease in a young cat.(AU)

Osteocondromatose em gato: relato de caso / Osteochondromatosis in a cat: case report

A osteocondromatose é caracterizada por nódulos únicos ou múltiplos decorrentes de um crescimento ósseo excessivo benigno. É encontrada em cães, gatos, equinos e humanos. Em felinos, tem maior incidência dos dois aos quatro anos de idade. A etiologia em gatos está relacionada ao vírus da leucemia felina, e também já foi encontrada relação com o fibrossarcoma. A manifestação clínica depende do local acometido e do tamanho da lesão. O diagnóstico definitivo é por meio de histopatologia e o prognóstico é desfavorável, pois ocorrem muitas recidivas. Este relato de caso objetiva descrever a apresentação dessa enfermidade em um felino jovem.(AU)

Osteochondromatosis is characterized by single or multiple nodules resulting from benign excessive bone growth. It is found in cats and dogs, horses and humans. In cats, a higher incidence is found in individuals from 2 to 4 years of age. The etiology in cats is related to the virus of feline leukemia, and is also related to fibrosarcoma. The clinical presentation depends on the area affected and the size of the lesion. The definitive diagnosis is by histopathology and the prognosis is poor because many relapses occur. This case report aims to describe the presentation of the disease in a young cat.(AU)

Gallbladder sludge in children with sickle cell disease.

Ultrasonographic records of 75 children with sickle cell disease and hepatobiliary symptoms were reviewed. Seventeen had gallbladder sludge, nine with concurrent stones and eight with sludge alone. Because all the children eventually had gallstones, we recommend that elective cholecystectomy be performed on patients with gallbladder sludge.

Differential diagnosis of adult hemoglobin A, F, and S conditions. A case of G gamma-beta(+)-hereditary persistence of fetal hemoglobin.

Hemoglobin (Hb) S/beta(+)-thalassemia is a hemoglobinopathy of variable but potentially severe clinical course. The condition is usually confirmed by the presence of a microcytic anemia and elevated levels of Hbs S, F, and A2 by electrophoresis. However, other less common disorders of Hb structure and synthesis may exhibit laboratory findings that mimic Hb S/beta(+)-thalassemia but have a more favorable prognosis. We present a case occurring in a man with clinical and laboratory features that were suggestive of Hb S/beta(+)-thalassemia but with normocythemia. Although nonmicrocytic variants of beta(+)-thalassemia, including concomitant nutritional deficiencies, were considered, high-pressure liquid chromatography revealed nearly all of the patient's fetal Hb to contain only G gamma chains. This pattern is most consistent with the rate but clinically benign condition of Hb S/G gamma-beta(+)-hereditary persistence of fetal Hb, a nondeletional type of hereditary persistence of fetal Hb. We discuss a diagnostic approach to adult Hb A, F, and S conditions, including thalassemias and thalassemia-like syndromes.