Search

Vitamin A plays a key role in lung development, but there is no consensus regarding the optimal vitamin A dose and administration route in extremely low birthweight (ELBW) infants. We aimed to assess whether early postnatal additional high-dose fat-soluble enteral vitamin A supplementation versus placebo would lower the rate of moderate or severe bronchopulmonary dysplasia or death in ELBW infants receiving recommended basic enteral vitamin A supplementation.

Hintergrund: Tumoren im Kopf-Hals-Bereich und deren Behandlung führen oftmals zu erheblichen funktionellen und ästhetischen Einschränkungen. Der Einsatz von digitalen Patient-Reported Outcome Measures (PROM) kann helfen, die Behandlungsqualität von Kopf-Hals-Tumorpatienten zu verbessern. Fragestellung: Die Vorteile von PROM sind bekannt und immanent. Im vorliegenden Artikel werden die Implementierung von digitalen PROM sowie potenzielle Hürden beschrieben. Fraglich ist, welche Hürden der Implementierung digitaler PROM entgegenstehen und wie ein optimales Aufwand-Nutzen-Verhältnis erreicht werden kann. Material und Methoden: Anhand des erfolgreich implementierten PROM „OncoFunction“ soll die generelle Machbarkeit illustriert werden. Aus der Literatur werden Vorteile der Nutzung, aber auch Hindernisse und Möglichkeiten zur Vermeidung dieser Barrieren vorgestellt. Ergebnisse: Die Digitalisierung mit allen Möglichkeiten und Chancen kann helfen, die Betreuung von Kopf-Hals-Tumorpatienten zu verbessern. Um die Akzeptanz zu stärken, muss eine transparente Kommunikation bezüglich der persönlichen Daten und die Sicherstellung eines hohen Datensicherheitsstandards gewährleistet werden. Die Einführung eines stationären Systems wie „OncoFunction“ wird in Zukunft ergänzt werden durch Systeme, die ein Symptommonitoring auch zu Hause erlauben. Ob ein verbessertes Gesamtüberleben aus einer näheren Anbindung mittels PROM resultieren kann, ist wissenschaftlich zu untersuchen.

Overcoming the flaws of current data management conditions in head and neck oncology could enable integrated information systems specifically tailored to the needs of medical experts in a tumor board meeting. Clinical dashboards are a promising method to assist various aspects of the decision-making process in such cognitively demanding scenarios. However, in order to provide extensive and intuitive assistance to the participating physicians, the design and development of such a system have to be user-centric. To accomplish this task, conceptual methods need to be performed prior to the technical development and integration stages. We have conducted a qualitative survey including eight clinical experts with different levels of expertise in the field of head and neck oncology. According to the principles of information architecture, the survey focused on the identification and causal interconnection of necessary metrics for information assessment in the tumor board. Based on the feedback by the clinical experts, we have constructed a detailed map of the required information items for a tumor board dashboard in head and neck oncology. Furthermore, we have identified three distinct groups of metrics (patient, disease and therapy metrics) as well as specific recommendations for their structural and graphical implementation. By using the information architecture, we were able to gather valuable feedback about the requirements and cognitive processes of the tumor board members. Those insights have helped us to develop a dashboard application that closely adapts to the specified needs and characteristics, and thus is primarily user-centric.

Objectives:There is international consensus that elderly patients with head and neck cancer should be treated curatively, like younger patients. Because of common comorbidities in elderly patients, perioperative complications are likely. The McPeek postoperative outcome score was used to evaluate the success of surgical interventions in patients with head and neck cancer.Methods:We included 168 patients in the study (56 in the study group, 75 years of age or more; and 112 in the control group, less than 60 years of age). All patients underwent major surgery for head and neck cancer.Results:The median McPeek scores were 8 in the study group and 9 in the control group (p = 0.04). Regression analysis revealed that neither age (p = 0.085) nor the American Society of Anesthesiologists physical status score (p = 0.342) were independent predictors of the McPeek score. Synchronous surgical interventions (p = 0.00051) and duration of surgery (p = 0.0015) had a significant impact on McPeek score performance.Conclusions:The McPeek score seems to be an appropriate tool for comparing major surgeries for head and neck cancer in different age groups. It is possible to assess the influence of anesthetic and surgical interventions and complications that affect the length of hospitalization. The results confirm that the overall complication rate after surgery in elderly patients does not differ significantly from that in their younger counterparts. Therefore, extended surgical treatment should be offered to both age groups when no serious comorbidities are present. The postoperative outcome seems to depend on the duration and extent of the surgical intervention.