Purpose To determine whether an advance care planning (ACP) decision aid for could improve communication about end-of-life treatment wishes between patients with amyotrophic lateral sclerosis (ALS) and their clinicians. Methods Fourty-four patients with ALS (≥21, English-speaking, without dementia) engaged in ACP using an interactive computer-based decision aid. Before participants completed the intervention, and again 3 months after, their clinicians reviewed 3 clinical vignettes, and made treatment decisions (n=18) for patients. After patients indicated their agreement with the team’s decisions, concordance was calculated. Results The mean concordance between patient wishes and the clinical team decisions was significantly higher post-intervention (post=91.9%, 95% CI=87.8, 96.1, vs. pre=52.4%, 95% CI=41.9, 62.9; p <.001). Clinical team members reported greater confidence that their decisions accurately represented each patient’s wishes post-intervention (mean=6.5) compared to pre-intervention (mean=3.3, 1=low, 10=high, p<.001). Patients reported high satisfaction (mean=26.4, SD=3.2; 6=low, 30=high) and low decisional conflict (mean=28.8, SD=8.2; 20=low, 80=high) with decisions about end-of-life care, and high satisfaction with the decision aid (mean=52.7, SD=5.7, 20=low, 60=high,). Patient knowledge regarding ACP increased post-intervention (pre=47.8% correct responses vs. post=66.3%; p <.001) without adversely effecting patient anxiety or self-determination. Conclusion A computer-based ACP decision aid can significantly improve clinicians’ understanding of ALS patients’ wishes regarding end-of-life medical care.

IV.

BackgroundFacial aging is a concern for many patients. Wrinkles, loss of volume, and discoloration are common physical manifestations of aging skin. Genetic heritage, prior ultraviolet light exposure, and Fitzpatrick skin type may be associated with the rate and type of facial aging. Although many clinical trials assess the correlates of skin aging, there is heterogeneity in the outcomes assessed, which limits the quality of evaluation and comparison of treatment modalities. To address the inconsistency in outcomes, in this project we will develop a core set of outcomes that are to be evaluated in all clinical trials relevant to facial aging.Methods/designA long list of measureable outcomes will be created from four sources: (1) systematic medical literature review, (2) patient interviews, (3) other published sources, and (4) stakeholder involvement. Two rounds of Delphi processes with homogeneous groups of physicians and patients will be performed to prioritize and condense the list. At a consensus meeting attended by physicians, patients, and stakeholders, outcomes will be further condensed on the basis of participant scores. By the end of the meeting, members will vote and decide on a final recommended set of core outcomes. Subsequent to this, specific measures will be selected or created to assess these outcomes.DiscussionThe aim of this study is to develop a core outcome set and relevant measures for clinical trials relevant to facial aging. We hope to improve the reliability and consistency of outcome reporting of skin aging, thereby enabling improved evaluation of treatment efficacy and patient satisfaction.Trial registrationCore Outcome Measures in Effectiveness Trials (COMET) Initiative, accessible at http://www.comet-initiative.org/studies/details/737. Core Outcomes Set Initiative, (CSG-COUSIN) accessible at https://www.uniklinikum-dresden.de/de/das-klinikum/universitaetscentren/zegv/cousin/meet-the-teams/project-groups/core-outcome-set-for-the-appearance-of-facial-aging. Protocol version date is 28 July 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2104-3) contains supplementary material, which is available to authorized users.

This technical note describes a method of biceps tenodesis called the Modified Norwegian Method that is an allarthroscopic, intra-articular, bony biceps tenodesis that uses a suture shuttle passer through an anterosuperolateral portal. It allows for easy passage of suture through the long head of the biceps tendon while one is viewing through the posterior portal. We believe this method to be a very reasonable and simple method of biceps tenodesis that has complication rates similar to those described for subpectoral and other methods of fixation.

Human-to-monkey penetrating xenokerato-plasties remained transparent for up to six months without the use of drugs. The human donor cornea cleared in 1–3 weeks to yield a transparency comparable to that of the host monkey cornea. A corneal button 5 mm in diameter was determined the optimal graft size, and early suture removal was required.