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This meta-analysis suggests that scleral buckling for macular detachment must preferably be performed within 3 days to optimize visual outcome.

Rapid accumulation of drug resistance occurred when ART was continued despite virological failure. Treatment options were lost, even when WHO-defined failure criteria were not met. This study calls for wider access to virological monitoring.

Conclusions If surgical treatment for metacarpal shaft fractures is considered, we recommend antegrade intramedullary K-wire fixation. This technique results in low complication rates and excellent functional outcome.

RationaleWhile theoretical frameworks for optimization of the outpatient processes are abundant, practical step‐by‐step analyses to give leads for improvement, to forecast capacity, and to support decision making are sparse.Aims and objectivesThis article demonstrates how to evaluate and optimize the triad of demand, (future) capacity, and access time of the outpatient clinic using a structured six‐step method.MethodsAll individual logistical patient data of an orthopaedic outpatient clinic of one complete year were analysed using a 6‐step method to evaluate demand, supply, and access time. Trends in the data were retrospectively analysed and evaluated for potential improvements. A model for decision making was tested. Both the analysis of the method and actual results were considered as main outcomes.ResultsMore than 25 000 appointments were analysed. The 6‐step method showed to be sufficient to result in valuable insights and leads for improvement. While the overall match between demand and capacity was considered adequate, the variability in capacity was much higher than in demand, thereby leading to delays in access time. Holidays and subsequent weeks showed to be of great influence for demand, capacity, and access time. Using the six‐step method, several unfavourable characteristics of the outpatient clinic were revealed and a better match between demand, supply, and access time could have been reached with only minor adjustments. Last, a clinic specific prediction and decision model for demand and capacity was made using the 6‐step method.ConclusionsThe 6‐step analysis can successfully be applied to redesign and improve the outpatient health care process. The results of the analysis showed that national holidays and variability in demand and capacity have a big influence on the outpatient clinic. Using the 6‐step method, practical improvements in outpatient logistics were easily found and leads for future decision making were contrived.

Background: Silicone radial head prostheses (SRHP) are considered obsolete due to reports of frequent failure and destructive silicone-induced synovitis. Considering the good outcomes of modern non-radial silicone joint implants, the extent of scientific evidence for this negative view is unclear. The aim of this research was to systematically analyze the clinical evidence on complications and outcomes of SRHP and how SRHP compare to both non-SRHP and silicone prostheses of other joints. Methods: A systematic literature review was conducted through the Cochrane, PubMed, and Embase databases. Results: Eight cohort studies were included, consisting of 142 patients and follow-up periods ranging from 23 months to 8 years. Average patient satisfaction was 86%, range of 71–100%, and 58 complications were seen, but no cases of synovitis. These outcomes were in line with non-SRHP. Four case series with 11 cases of synovitis were found, all due to implant fractures years to decades after implantation. Six systematic reviews of currently used non-radial silicone joint implants showed excellent outcomes with low complication rates.Conclusions: Since SRHP have satisfactory clinical results and an acceptable complication rate when selecting a patient group in suitable condition for surgical indications, it is considered that SRHP can still be chosen as a potential surgical treatment method in current clinical practice.

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Background: The objective of this study was to analyze complications and patient-reported functional outcome after antegrade intramedullary Kirschner-wire fixation of displaced subcapital fractures of the fifth metacarpal bone. Methods: All consecutive patients treated from January 2010 to December 2015 were retrospectively identified using patient logs and radiographic images. Indications for operative fixation were angulation greater than 40 degrees, shortening less than 2 mm, or rotational deficit. Complications were registered from the patient logs. Functional outcome was assessed with the Patient-Rated Wrist/Hand Evaluation (PRWHE) and Disabilities of the Arm, Shoulder and Hand Score (DASH) questionnaires, both ranging from 1-100. Results: Fifty-one patients could be included, with two patients lost to follow-up. The mean outpatient follow-up was 9 wk, and the interval for functional assessment was 34 mo with 40 patients (78%) having responded to the questionnaires. Forty-seven patients (92%) proceeded to fracture union, while the recovery of two patients was complicated by migration of the Kirschner wires through the distal cortex into the metacarpophalangeal joint respectively 5 and 6 wk after primary surgery. Eight minor complications were registered, including a superficial skin infection, mild local dysesthesia or a 10- to 20-degree extension lag at the end of outpatient follow-up. Overall, in 41 patients (80%) the Kirschner wires were removed. Long-term functional outcome was excellent with mean PRWHE and DASH scores of, respectively, 3 and 6 points. Conclusions: If surgical treatment is considered, we recommend temporary antegrade intramedullary Kirschner wire fixation as a reliable therapeutic method with a low complication rate and excellent long-term functional outcome. Level of Evidence: Level III.