A Systematic Review and Classification of Factors Influencing Diabetic Foot Ulcer Treatment Adherence, in Accordance With the WHO Dimensions of Adherence to Long-Term Therapies.

PURPOSE: Effective treatment of diabetic foot ulcers (DFUs) involves a multidisciplinary treatment plan to promote wound healing and prevent complications. Given the lack of consensus data on the factors affecting patient adherence, a systematic review was performed to identify and classify factors according to the WHO Dimensions of Adherence to Long-Term Therapies. METHODS: Six hundred and forty-three articles from PubMed, Embase, and Scopus were reviewed. The inclusion criteria included qualitative and quantitative studies which discussed factors affecting patient adherence to DFU treatment, had study populations that comprised patients with either prior history of or existing DFU, and had either prior history of DFU treatment or were currently receiving treatment. Factors, and associated measures of adherence, were extracted and organized according to the WHO Dimensions of Adherence to Long-Term Therapies. RESULTS: Seven quantitative and eight qualitative studies were included. Eleven patient-related factors, seven condition-related factors, three therapy-related factors, five socioeconomic factors, and five health system-related factors were investigated by the included studies. The largest proportion of factors studied was patient-related, such as patient insight on DFU treatment, patient motivation, and patient perception of DFU treatment. There was notable overlap in the range of discussed factors across various domains, in the socioeconomic (including social support, income, social and cultural acceptability of DFU therapy, cost) and therapy-related domains (including duration of treatment, offloading footwear, and reminder devices). Different studies found that specific factors, such as gender and patients having a low internal locus of control, had differing effects on adherence on different cohorts. CONCLUSION: Current literature presents heterogeneous findings regarding factors affecting patient adherence. It would be useful for future studies to categorize factors as such to provide more comprehensive understanding and personalized care to patients. Further research can be done to explore how significant factors can be addressed universally across different cohort populations in different cultural and socioeconomic contexts.

The Efficacy and Safety of High-Intensity Focused Ultrasound (HIFU) Therapy for Benign Thyroid Nodules-A Single Center Experience from Singapore.

BACKGROUND: High-intensity focused ultrasound (HIFU) is a recent noninvasive technique of treating thyroid nodules. Our study aims to investigate the efficacy and safety of HIFU in treating benign thyroid nodules. METHODS: This is a retrospective analysis of consecutive patients who underwent HIFU of benign thyroid nodules at our institution from July 2017-2018. All procedures were performed by a single surgeon. Patients were evaluated immediately post-procedure, and at subsequent intervals of 1 week, 1 month, 3 months, and 6 months. The primary endpoint was thyroid nodule volume reduction at 6 months posttreatment. Secondary endpoints were post-procedure local complications. RESULTS: Ten patients with 13 thyroid nodules were included. The median follow-up period was 426 days (range 238-573). Mean maximum diameter reduced from 2.6 cm (±0.8) pretreatment to 1.4 cm (±0.7, P < 0.05) 6 months posttreatment. Mean nodule volume reduced from 5.2 cm3 (±4.2) pretreatment to 1.5 cm3 (±1.3, P = 0.01) 6 months posttreatment. Mean volume reduction ratio (VRR) at 6 months posttreatment was 63.2% (±22.5, P < 0.05), with volume reduction of ≥50% in 10 of 13 (76.9%) nodules. Two nodules (15.4%) showed size increases from 4 months posttreatment. No patients experienced local skin burns or hematomas. Mean pain scores were 1.5 (±1.2) immediate post-procedure, 0.8 (±1.5) at 1 week, and 0.6 (±1.2) at 1 month post-procedure, respectively, with no reports of pain beyond 1 month. Only two (20.0%) patients had early, temporary posttreatment voice hoarseness. CONCLUSION: Our study shows HIFU ablation to be efficacious and safe-with significant thyroid nodule volume reductions, and no significant or prolonged local complications.

The efficacy of absorbable versus non-absorbable fixation in laparoscopic totally extraperitoneal (tep) repair of large inguinal hernias.

BACKGROUND/OBJECTIVE: Our study aims to compare clinical outcomes of laparoscopic Totally Extra-peritoneal (TEP) repair with mesh fixation in large inguinal hernias using titanium versus absorbable tacks. METHODS: This is a case control study of patients who underwent laparoscopic TEP repair with mesh fixation of large inguinal hernias in our institution from 2010 to 2015. In all patients a standard 10 × 15 cm large-pore polypropylene mesh was used and a standardized fixation technique was followed. Patient demographics, presentation, defect size as per the European Hernia Society Groin Hernia Classification, post-operative complications and recurrence rates were collected and analysed. RESULTS: 20 patients had mesh fixation with titanium tackers (Group TT) were compared with 37 patients who had mesh fixation with absorbable tacks (Group AT). Mean age was 57.00 (±13.78) in Group TT and 49.00 (±17.15) in Group AT. All patients were males. The median defect size was L3M2 in Group TT and L2M2 in Group AT. All patients were followed up for a mean period of 24 months (range: 1-48 months). Post-operatively, one patient in Group AT developed chronic pain. One Group TT patient and four Group AT patients developed seromas, which were treated conservatively. There were no recurrences in Group TT, while one Group AT patient developed a medial recurrence. CONCLUSION: Both titanium and absorbable tacks showed similar post-operative complications and pain scores. As such, they both appear safe and feasible for mesh fixation during laparoscopic repair of large inguinal hernias.

The Stomach: a Rare Site for Metastatic Solid Pseudopapillary Neoplasm of the Pancreas.

Metastatic solid pseudopapillary neoplasms of the pancreas are rare, and the stomach is also a rare site for metastases. We present a case of a lady with solid pseudopapillary neoplasm of the pancreas who previously had a distal pancreatectomy but subsequently had multiple hepatic, adrenal peritoneal and nodal metastases. She developed dyspepsia and on oesophagogastroduodenoscopy, was found to have gastric metastases as well. We believe this is the first reported case of metastatic solid pseudopapillary neoplasm of the pancreas to the stomach.