Incidence of Severe Osteonecrosis Requiring Total Joint Arthroplasty in Children and Young Adults Treated for Leukemia or Lymphoma: A Nationwide, Register-Based Study in Finland and Denmark.

Purpose: The population-based incidence of severe osteonecrosis (ON) necessitating total joint arthroplasty (TJA) in patients with hematological cancer is unknown. This study assessed the incidence of ON requiring primary TJA in children and young adults treated for leukemia or lymphoma. Methods: Patients diagnosed with leukemia or lymphoma before 31 years of age were identified from the Finnish and Danish Cancer Registries. These data were combined with those from the National Hospital Discharge and the Finnish Arthroplasty Registers. Data on the orthopedic procedures performed and the appropriate diagnosis codes given before the age of 40 were also retrieved. Results: The estimated cumulative incidence of TJA was 4.5% at 20 years for patients treated for chronic myeloid leukemia, followed by 2.1% for patients treated for acute myeloid leukemia. It was considerably lower in patients with acute lymphoblastic leukemia (ALL; 0.4%). Multivariate analysis revealed that allogeneic stem cell transplantation (allo-SCT) increased the risk of TJA (hazard ratio [HR]=9.4; 95% CI: 5.3-16.9). The risk of TJA was higher in patients diagnosed with cancer at 10-19 and 20-30 years of age than in those diagnosed before the age of 10 (HR=24; 95% CI: 3.1-176 and HR=26; 95% CI: 3.6-192 respectively). Conclusion: The incidence of ON requiring TJA was highest among patients with myeloid leukemias and lowest in patients treated for ALL. Allo-SCT and age ≥10 years at diagnosis were the most important risk factors for ON requiring TJA in hematological malignancies.

[Mailed reminders reduce non-attendance at a pediatric outpatient clinic. An intervention study]. / Udeblivelser fra et børneambulatorium reduceres ved hjaelp af påmindelsesbreve.

INTRODUCTION: There is an increased focus on non-attendance for treatment at hospitals as this may lead to poor utilization of resources and hamper the possibility of offering patients treatment within one month. As the rate of non-attendance or very late cancellations of appointments was unacceptably high at the Department of Paediatrics at Kolding Hospital, we decided to examine the effect of mailed reminders. MATERIAL AND METHODS: A controlled intervention study in which families with an appointment at the out-patient clinic in uneven weeks received a mailed reminder. Families with bookings in even weeks served as controls. Late cancellations and non-attendances were registered. Data were analysed for the patients' first planned booking in the project period from September 2002 to February 2003. RESULTS: A total of 1,177 patients were included in the control group and 1,189 in the intervention group. The number of late cancellations and non-attendances were 167 (14.2%) and 68 (5.7%) (p < 0.001), respectively, of which 112 (9.5%) and 29 (2.4%) were non-attendances (p < 0.0001). The study did not identify groups of patients who did not benefit from the reminder. CONCLUSION: In a Danish paediatric out-patient clinic the number of non-attendances and late cancellations can be reduced significantly by mailed reminders two weeks prior to the visit.

[Routine reminders reduce non-attendance at a pediatric outpatient clinic. A follow-up study]. / Påmindelsesbreve reducerer udeblivelser i et børneambulatorium. Et opfölgingsstudie.

INTRODUCTION: We have previously shown that mailed reminders decreased the rate of non-attendance in an outpatient unit in the context of an intervention study. To evaluate the effect of the introduction of routine reminders in a real-life setting, we performed a study based on the routine registration as introduced at the Department of Paediatrics at Kolding Hospital on 1 August 2006. MATERIAL AND METHODS: The number of attending and non-attending children from 1 January 2001 to 30 April 2008 was identified. The diagnosis-related group value of the out-patient production for 2007 was calculated using 2008 prices. The costs of mailing the reminders were estimated in order to calculate the economic benefits of the procedure. RESULTS: The rates of non-attendance before and after 1 August 2006 were 7.7% and 4.1%, respectively (p < 0.0001), corresponding to 36 avoided cases of non-attendance per 1.000 planned appointments. However, the effect of the mailed reminders decreased from 2006 to 2008, though insignificantly (p = 0,087). In 2007 the cost of the avoided nonattendance was 64,337 DKK per 1,000 appointments. The costs associated with the mailed reminders were estimated to 13,824 DKK per 1,000 reminders. Therefore, the overall economic benefit was 50,513 DKK per 1,000 planned appointments. CONCLUSION: Introducing mailed reminders as a routine measure decreased the non-attendance rate, though less than was found in the preceding intervention study. The procedure was evaluated as being cost-effective.

[Reasons for non-attendance and cancellations in a paediatric outpatient clinic]. / Arsager til udeblivelser og afbud i et børneambulatorium.

INTRODUCTION: It is important to identify reasons for non-attendance and late cancellations in the health care system to be able to plan possible interventions. METHOD: Patients with a scheduled visit at the outpatient clinic at the Department of Paediatrics at Kolding Hospital from September 2002 to February 2003 were randomised either to receive or not receive a mailed reminder two weeks prior to their visit. Parents to children cancelling their appointment or not attending were interviewed by telephone to reveal the reasons. >>Early cancellations<< were defined as cancellations after receiving the letter and until the last weekday before the appointment, >>late cancellations<< as any subsequent cancellations. RESULTS: A total of 229 and 250 >>early cancellations<< of the 2.563 and 2.775 booked appointments were received in the control- and the intervention group, respectively (p > 0.05). Only for >>forgot the appointment<<, a difference was found between the reasons given. >>Late cancellation<< and non-attendance occurred for 167/1,177 and 68/1,189 (p < 0,01) of the children. For 118 and 36 (p < 0.01) of these, the reasons given by the parents could be classified as predictable, and 34/1,177 and 27/1,189, respectively as non-predictable (p = 0.4). CONCLUSION: In the control group more than 70% of late cancellations and non-attendances could have been predicted by the parents, receiving a mailed reminder reduced this proportion significantly. It remains a challenge to reduce the number of non-Danish speaking patients not attending.

[Acute hemiparesis after chickenpox]. / Akut hemiparese efter skoldkoppesygdom.

Varicella is a common infectious disease; it is usually benign and self-limited, and complications are believed to be rare. A case is presented of a two-year-old girl who developed a left hemiparesis four weeks after the onset of chickenpox. Laboratory studies ruled out all known causes of stroke. MRI revealed the infarction, and MRA showed segmental narrowing of the right internal carotid artery, compatible with focal vasculitis. Based on the presumed diagnosis of varicella-associated cerebral vasculitis, the patient was treated with acyclovir, methylprednisolone and aspirin.