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The study aimed at developing a deep-learning (DL)-based algorithm to predict the virtual soft tissue profile after mandibular advancement surgery, and to compare its accuracy with the mass tensor model (MTM). Subjects who underwent mandibular advancement surgery were enrolled and divided into a training group and a test group. The DL model was trained using 3D photographs and CBCT data based on surgically achieved mandibular displacements (training group). Soft tissue simulations generated by DL and MTM based on the actual surgical jaw movements (test group) were compared with soft-tissue profiles on postoperative 3D photographs using distance mapping in terms of mean absolute error in the lower face, lower lip, and chin regions. 133 subjects were included - 119 in the training group and 14 in the test group. The mean absolute error for DL-based simulations of the lower face region was 1.0 ± 0.6 mm and was significantly lower (p = 0.02) compared with MTM-based simulations (1.5 ± 0.5 mm). CONCLUSION: The DL-based algorithm can predict 3D soft tissue profiles following mandibular advancement surgery. With a clinically acceptable mean absolute error. Therefore, it seems to be a relevant option for soft tissue prediction in orthognathic surgery. Therefore, it seems to be a relevant options., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Colon cancer survivors experience physical and psychosocial problems that are currently not adequately addressed. This study investigated distress in patients after curative surgery for colon cancer and studied how this corresponds with the need for supportive care., Methods: Prospective cohort of patients with stage I-III colon carcinoma, treated with curative intent, currently in follow-up at 6 different hospitals. A survey recorded symptoms, experienced problems, and (un)expressed needs. Satisfaction with supportive care was recorded., Results: Two hundred eighty four patients were included; 155 males and 129 females, with a mean age of 68 years (range 33-95), and a median follow-up of 7 months. 227 patients completed the survey. Patients experienced a median of 23 symptoms in the week before the survey, consisting of a median of 10 physical, 8 psychological and 4 social symptoms. About a third of these symptoms was felt to be a problem. Patients with physical problems seek supportive care in one in three cases, while patients with psychosocial problems only seek help in one in eight cases. Patients who recently finished treatment, finished adjuvant chemotherapy, or had a stoma, had more symptoms and needed more help in all domains. Patients most frequently consulted general practitioners (GPs) and surgeons, and were satisfied with the help they received., Conclusion: Colon cancer survivors experience many symptoms, but significantly fewer patients seek help for a psychosocial problem than for a physical problem. Consultations with supportive care are mainly with GPs or surgeons, and both healthcare providers are assessed as providing satisfying care., (Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Background: General practitioners can safely exclude pulmonary embolism (PE) by using the Wells PE rule combined with D-dimer testing., Objective: To compare the accuracy of a strategy using the Wells rule combined with either a qualitative point-of-care (POC) D-dimer test performed in primary care or a quantitative laboratory-based D-dimer test., Methods: We used data from a prospective cohort study including 598 adults suspected of PE in primary care in the Netherlands. General practitioners scored the Wells rule and carried out a qualitative POC test. All patients were referred to hospital for reference testing. We obtained quantitative D-dimer test results as performed in hospital laboratories. The primary outcome was the prevalence of venous thromboembolism in low-risk patients., Results: Prevalence of PE was 12.2%. POC D-dimer test results were available in 582 patients (97%). Quantitative test results were available in 401 patients (67%). We imputed results in 197 patients. The quantitative test and POC test missed one (0.4%) and four patients (1.5%), respectively, with a negative strategy (Wells ≤ 4 points and D-dimer test negative) (P = 0.20). The POC test could exclude 23 more patients (4%) (P = 0.05). The sensitivity and specificity of the Wells rule combined with a POC test were 94.5% and 51.0% and, combined with a quantitative test, 98.6% and 47.2%, respectively., Conclusions: Combined with the Wells PE rule, both tests are safe to use in excluding PE. The quantitative test seemed to be safer than the POC test, albeit not statistically significant. The specificity of the POC test was higher, resulting in more patients in whom PE could be excluded., (© 2015 International Society on Thrombosis and Haemostasis.)

Introduction: Follow-up to detect recurrence is an important feature of care after colon cancer treatment. Currently, follow-up visits are surgeon-led with focus on recurrence. To date, there is increasing interest for general practitioners (GPs) providing this care, as GPs might provide more holistic care. The present study assessed how surgeons, GPs, and patients evaluate current surgeon-led colon cancer follow-up and to list their views on possible future GP-led follow-up., Methods: The study consists of a cross-sectional survey including colorectal surgeons, patients who participate or recently finished a follow-up programme, and GPs in the Netherlands., Results: Eighty-seven out of 191 GPs, 113 out of 238 surgeons, and 186 out of 243 patients responded. Patients are satisfied about current surgeon-led follow-up, especially about recurrence detection and identification of physical problems (94% and 85% respectively). However, only 56% and 49% of the patients were satisfied about the identification of psychological and social problems respectively. Only 16% of the patients evaluated future GP-led follow-up positively. Regarding healthcare providers, surgeons were more positive compared to GPs; 49% of the surgeons, and only 30% of the GPs evaluated future GP-led follow-up positively (P = 0.002). Furthermore, several reservations and principle requirements for GP-led follow-up were identified., Discussion: The results suggest an unfavourable view among patients and healthcare providers, especially GPs, regarding a central role for GPs in colon cancer follow-up. However, low satisfaction on psychosocial aspects in current follow-up points out a lack in care. Therefore, the results provide a justification to explore future GP-led care further., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Referral for ultrasound testing in all patients suspected of DVT is inefficient, because 80-90% have no DVT., Objective: To assess the incremental cost-effectiveness of a diagnostic strategy to select patients at first presentation in primary care based on a point of care D-dimer test combined with a clinical decision rule (AMUSE strategy), compared with hospital-based strategies., Patients/methods: A Markov-type cost-effectiveness model with a societal perspective and a 5-year time horizon was used to compare the AMUSE strategy with hospital-based strategies. Data were derived from the AMUSE study (2005-2007), the literature, and a direct survey of costs (2005-2007)., Results of Base-Case Analysis: Adherence to the AMUSE strategy on average results in savings of euro138 ($185) per patient at the expense of a very small health loss (0.002 QALYs) compared with the best hospital strategy. The iCER is euro55 753($74 848). The cost-effectiveness acceptability curves show that the AMUSE strategy has the highest probability of being cost-effective., Results of Sensitivity Analysis: Results are sensitive to decreases in sensitivity of the diagnostic strategy, but are not sensitive to increase in age (range 30-80), the costs for health states, and events., Conclusion: A diagnostic management strategy based on a clinical decision rule and a point of care D-dimer assay to exclude DVT in primary care is not only safe, but also cost-effective as compared with hospital-based strategies.