BACKGROUND: A congenital anomaly of the hand can affect both function and appearance, and places a stressful psychological burden on the family, especially parents. Surgery during infancy may prevent later disabilities, but little is known of the importance of parents\' involvement in these decisions in terms of psychological adjustment or treatment satisfaction.
OBJECTIVE: To understand parents\' perceptions of involvement in their child\'s surgery for limb anomaly, and their preferences for the support of healthcare professionals. Results should lead to recommended interventions to improve familial adjustment to the child\'s condition.
METHODS: Qualitative data was collected from semi-structured confidential self-reported interviews of 35 parents (65.7 % mothers) of children who had received reconstructive surgery for congenital hand anomaly (at age 24.89 ± 9.26 months); interviews were coincident with the 1-month postoperative follow-up. The parents ranged in age, gender, educational background, economic status, and type of anomaly. Data analysis referenced Colaizzi\'s phenomenological approach.
RESULTS: The concerns of the parents were consolidated into three themes: attitudes toward Parental involvement in surgical decision-making; status of parental involvement in Surgical decision-making; and need for help and support.
CONCLUSIONS: Some parents were comfortable leaving surgical decisions entirely to the medical staff, but most preferred active participation and were disappointed at their lack of inclusion. The maximum benefit from surgery for congenital abnormalities in infancy is achieved when the parents and extended families have access to the expertise, skills, encouragement, and psychological support of healthcare providers.

OBJECTIVE: To retrospectively investigate the postoperative clinical and radiographic outcomes in elderly patients with degenerative lumbar spinal stenosis (DLSS) and severe global sagittal imbalance who underwent different fusion levels.
METHODS: A total of 214 patients with DLSS and severe global sagittal imbalance were included. Sagittal imbalance syndrome was defined as the severe decompensated radiographic global sagittal imbalance accompanied with the following symptoms: severe back pain in naturel posture that disappears or significantly relieves in support position, living disability with ODI score > 40% and dynamic sagittal imbalance. Thereinto, 54 patients were found with sagittal imbalance syndrome and were performed the lumbar decompression with a long thoracolumbar fusion (Group A) or a short lumbar fusion (Group B). Thirty patients without sagittal imbalance syndrome who underwent short lumbar decompression and fusion were selected as the control (Group C).
RESULTS: Patients with sagittal imbalance syndrome were detected to have more paraspinal muscle degeneration and less compensatory potentials for sagittal imbalance (smaller thoracic kyphosis and larger pelvic tilt) than those without this diagnosis. Postoperative comparisons revealed significant restoration of global sagittal alignment and balance and improvement of living quality in Groups A and C at the final follow-up. Six patients in Group B and one in Group A were found to have proximal junctional complication during follow-up.
CONCLUSIONS: Our results indicated that DLSS patients with sagittal imbalance syndrome had inferior surgical outcomes in terms of living quality and proximal junctional complication after lumbar decompression with a short fusion.

Due to the diversified and high sensitivity of breast cancer surgical treatment, various decision making styles show different functions in making trade-offs and sharing information. Shared decision making is the best practice paradigm to promote health outcomes. This study aimed to determine the overall frequency of shared decision making and explore influencing factors during the surgical decision-making process from breast cancer patients\' perspectives. We searched 8 databases for studies about breast cancer patients\' surgical decisional control preferences and shared decision making preference. Two researchers screened the literature, extracted the data, and evaluated the literature quality. Meta-analysis of the frequency of preferred and actual shared decision making and decision congruence was performed. Due to the limited studies of influencing factors, descriptive analysis was used. Fourteen original studies were included in this study. We found the overall pooled frequency of the preferred shared decision making of 48.1% (95%CI 33.5%, 62.6%) and the actual shared decision making of 38.1% (95%CI 33.9%, 42.2%). Moreover, the pooled frequency of the decision congruence between preferred and actual decision styles was 61.7% (95%CI 54.6%, 68.8%). The descriptive analysis findings indicated that the influencing factors of shared decision making included individual factors, surgeon-patient communication factors, and health setting factors. There was a gap between the preferred and actual decision styles in the surgical context. Therefore, health care providers should identify potential shared decision making barriers and facilitators, and advocate the clinical shared decision making model to embed shared decision making into routine practice.