No abstract

The purpose of this study was to develop a framework for reporting health service models for managing rheumatoid arthritis (RA). We conducted a search of the health sciences literature for primary studies that described interventions which aimed to improve the implementation of health services in adults with RA. Thereafter, a nominal group consensus process was used to synthesize the evidence for the development of the reporting framework. Of the 2,033 citations screened, 68 primary studies were included which described 93 health service models for RA. The origin and meaning of the labels given to these health service delivery models varied widely and, in general, the reporting of their components lacked detail or was absent. The six dimensions underlying the framework for reporting RA health service delivery models are: (1) Why was it founded? (2) Who was involved? (3) What were the roles of those participating? (4) When were the services provided? (5) Where were the services provided/received? (6) How were the services/interventions accessed and implemented, how long was the intervention, how did individuals involved communicate, and how was the model supported/sustained? The proposed framework has the potential to facilitate knowledge exchange among clinicians, researchers, and decision makers in the area of health service delivery. Future work includes the validation of the framework with national and international stakeholders such as clinicians, health care administrators, and health services researchers.

Despite highly developed scanning methods there is no absolute certainty of delineating malignant pancreatic tumor from chronic pancreatitis. Pancreatitis caused by foreign bodies has occasionally been mentioned in literature. Our report is on the first case of a foreign body granuloma of the pancreatic head caused by a fish-bone transduodenally perforating the pancreas. On preoperative CT and ultrasound as well as by intraoperative inspection and palpation the lesion appeared malignant, so we saw the indication for Whipple's operation. Although the histological examination showed a benign state, taking into account the generally bad prognosis, in case of suspected malignant pancreatic tumor we plead for resection as the only possible form of curative therapy.

Background: In most cases of node-negative breast cancer, clinical outcome is relatively good after surgical treatment. It is necessary, however, to determine prognostic factors for the identification of high- and low-risk subgroups concerning recurrence and death, because only patients with excellent prognosis require no further treatment. The objective of the study was to select a few potential factors for a prognostic index that can be used in clinical practice. Patients and Methods: In 108 patients with primary node-negative breast cancer we examined simultaneously the impact of new prognosticators on disease-free survival (DFS) and overall survival (OAS): DNA ploidy, S-phase fraction (SPF), cycling index encoded by Ki 67, estrogen and progesterone receptor status, epidermal growth factor receptor (EGF-R), Her 2b/neu oncoprotein, and GP170 glycoprotein. Only fresh-frozen tissue was used. Median time of follow-up was 42 months. Results: By means of the log-rank analysis we found that patients with a SPF > 5% of the tumor had a significantly shorter DFS (p = 0.01) and OAS (p = 0.01) than patients with a SPF < 5%. Similar results for OAS were obtained for tumors with EGF-R levels > 15 fmol/mg versus < 15 fmol/mg (p = 0.05) and tumors of grade III versus grade I/II (p = 0.03). A low progesterone receptor level ( < 20 fmol/mg) indicated a short DFS (p = 0.06) but was of no prognostic value for OAS. Using a combination of SPF and EGF-R, a group of patients with extremely good prognosis (no patients have died) could be identified, if at least one factor was favorably expressed. If both factors were elevated clinical outcome was poor (DFS: p = 0.003; OAS: p = 0.002). By including histological grading in the analysis, a prognostic index could be described when discriminated patients with good, medium, and high risk for relapse and survival (DFS: p = 0.009; OAS: p = 0.001). Conclusions: Out of 11 parameters, grading, SPF, and EGF-R have been selected for a prognostic index. This prognostic index can be used to classify patients with node-negative primary tumors in different risk categories, so that an individual and risk-adapted adjuvant systemic therapy becomes possible, according to the treatment recommendations outside clinical trials.