Secondary Cleft Rhinoplasty in 1720 Patients: Are National Practices Consistent With Guidelines?

2019 ◽  
Vol 57 (4) ◽  
pp. 438-443
Author(s):  
Fouad Chouairi ◽  
Sina J. Torabi ◽  
Kyle S. Gabrick ◽  
John A. Persing ◽  
Michael Alperovich
Keyword(s):  
Cleft Lip ◽  
Tube Placement ◽  
National Database ◽  
Fisher Exact Test ◽  
Improvement Program ◽  
Surgical Quality ◽  
Exact Test ◽  
Chi Squared ◽  
Cleft Rhinoplasty ◽  
Tip Rhinoplasty

Objective: To assess the timing, type, and associated adjunct procedures for secondary cleft rhinoplasty nationally. Design: Data were extracted from a national database of all secondary cleft rhinoplasty procedures (Current Procedural Terminology [CPT] codes 30460 and 30462). Frequency statistics were utilized to analyze demographics, comorbidities, surgical procedures, and timing. Chi-squared analysis and Fisher exact test were used for analysis. Setting: National Surgical Quality Improvement Program-Pediatric Database. Participants: A total of 1720 patients met inclusion criteria for secondary cleft rhinoplasty repair. Interventions: No relevant intervention. Main Outcomes and Measures: Age, demographics, comorbidities, and associated procedures. Results: Over 5 consecutive years, 1720 patients underwent secondary cleft lip rhinoplasty nationally. Mean patient age was 9.3 ± 5.3 years. Unilateral cleft rhinoplasty patients were older (9.0 years) than bilateral patients (7.8 years; P = .001). Rib grafting was performed in 6.3% of patients at a mean age of 10.6 years with a higher proportion of Asian and female patients. Auricular grafts were more commonly performed by otolaryngology than plastic surgery. The most common adjunct procedures included secondary cleft lip revision (33.1%) and tympanostomy tube placement (10.2%). When subdividing by type of cleft rhinoplasty, tip rhinoplasty was performed at a mean age of 7.3 years compared to rhinoplasty with osteotomies and a major septal component at 12.1 years ( P < .001). Conclusions: This study reveals that a large proportion of cleft rhinoplasties are performed in skeletally immature patients. Although patients undergoing rib grafting, nasal osteotomies, and a major septal component were older, these procedures are still performed in a large proportion of patients who are younger than expected.

scholarly journals Comparison of the Level of Awareness about the Transmission of Echinococcosis and Toxocariasis between Pet Owners and Non-Pet Owners in Greece

2020 ◽  
Vol 17 (15) ◽  
pp. 5292 ◽  
Author(s):  
Christina Kantarakia ◽  
Maria E. Tsoumani ◽  
Antonis Galanos ◽  
Alexander G. Mathioudakis ◽  
Eleni Giannoulaki ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Linear Regression Analysis ◽  
Signs And Symptoms ◽  
Knowledge Score ◽  
Fisher Exact Test ◽  
Pet Ownership ◽  
Cross Sectional ◽  
Exact Test ◽  
Pet Owners ◽  
Chi Squared

Ζoonotic parasitic diseases that can occur through animal contact pose risks to pets, their owners and to their bond. This study aims to assess the level of knowledge about zoonoses, specifically echinococcosis and toxocariasis, among cat/dog owners and non-pet owners in Greece. Multiple-choice questionnaires were designed to obtain data regarding the knowledge of pet and non-pet owners on echinococcosis and toxocariasis, including signs and symptoms of these zoonoses, ways of transmission and precautions that need to be taken into account in order to avoid it. A total of 185 questionnaires were retrieved and data was expressed as absolute (Ν) and relative frequencies (%). Associations between pet ownership, residence and outcome variables were evaluated using the Fisher exact test and Chi-squared test, respectively. Multifactorial linear regression analysis was used to investigate the cross-sectional association between demographic characteristics and the awareness of helminthic zoonoses. All tests were two-sided and statistical significance was set at p < 0.05. Our study revealed a disturbing lack of awareness of echinococcosis and toxocariasis (mean zoonotic knowledge score 8.11 ± 3.18) independently of pet ownership. Surprisingly, in some cases the ignorance of pet owners exceeded that of non-pet owners. Given the progressive impact of toxocariasis in public health and the high prevalence of echinococcosis in the Mediterranean region, measures should be taken to inform people about zoonoses and eliminate their putative transmission.

scholarly journals Exploring Subclinical Phenotypic Features in Twin Pairs Discordant for Cleft Lip and Palate

2017 ◽  
Vol 54 (1) ◽  
pp. 90-93 ◽  
Author(s):  
Elizabeth J. Leslie ◽  
Jenna C. Carlson ◽  
Margaret E. Cooper ◽  
Kaare Christensen ◽  
Seth M. Weinberg ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Monozygotic Twins ◽  
Fisher Exact Test ◽  
Orofacial Cleft ◽  
Exact Test ◽  
History Of ◽  
Orbicularis Oris Muscle ◽  
The Difference ◽  
Larger Sample

Objective Monozygotic twins of an individual with an orofacial cleft have a significantly elevated risk for orofacial cleft compared with the general population, but still the concordance rate for orofacial cleft in monozygotic twins is about 40% to 50%. The goal of this study was to determine whether unaffected cotwins have an increased frequency of orbicularis oris muscle defects, a subclinical form of orofacial cleft. The presence of such defects may reduce the overall rate of discordance. Method A total of 63 discordant monozygotic and dizygotic twin pairs, 262 unaffected nontwin siblings, and 543 controls with no history of orofacial clefts were assessed for orbicularis oris defects by high-resolution ultrasound. Frequencies were compared by the Fisher exact test. Results Unaffected cotwins from discordant monozygotic pairs had a higher frequency of defects (12.5%) than the other test groups (6.38% to 6.99%), but the difference was not statistically significant ( P = .74). Conclusions In this study, orbicularis oris defects were not statistically significantly more common among the unaffected twins from orofacial cleft discordant twin pairs. The trends in the results warrant future studies with larger sample sizes and additional subclinical phenotypes.

Effect of foot reflexology and slow stroke back massage on the severity of fatigue in patients undergoing hemodialysis: A semi-experimental study

2018 ◽  
Vol 15 (4) ◽  
Author(s):  
Sudabeh Ahmadidarrehsima ◽  
Reza Mohammadpourhodki ◽  
Hossein Ebrahimi ◽  
Maryam Keramati ◽  
Mostafa Dianatinasab
Keyword(s):  
Experimental Study ◽  
Alternative Medicine ◽  
Repeated Measures ◽  
Nursing Intervention ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Chi Squared ◽  
Quasi Experimental ◽  
Bonferroni Test ◽  
Back Massage

Abstract Background Fatigue is one of the most disturbing and the most common symptoms reported by patients dialyzed. There are methods available on complementary and alternative medicine, through which nurses can help patients to promote their health. Reflexology is a treatment which has a long history and is considered as one of the most popular and the most widespread methods of alternative medicine. In this study, the effects of foot reflexology and slow stroke back massage on the severity of fatigue in patients treated with hemodialysis were measured. Methods This is a quasi-experimental study that performed on 52 patients chosen from Imam Khomeini dialysis center in Zabol and divided into control and intervention groups by randomize allocation method. Required information collected from a demographic and fatigue severity questionnaire. After completing questionnaires by the study subjects, foot massage and slow stroke back massage was performed during three weeks, two sessions each week (5 sessions in total). At the end of intervention data of two groups was collected. Data was analyzed using independent sample t-Test, Chi-squared test, Fisher exact test, oneway ANOVA with repeated measures and Bonferroni test by SPSS software version 21. Results The mean [±SD] fatigue in patients with foot reflexology massage and slow stroke back massage reflect on the 53.61[±10.12] and 52.20 [±10.37], and the differences were not significant, but after the intervention, fatigue in the group receiving foot reflexology massage was reduced significantly compared to slow stroke back massage group (p<0.0001). Conclusions The result of this study showed that reflexology massage is a safe and economical nursing intervention for decreasing fatigue in hemodialysis patients.

Risk Factors for Postoperative Unplanned Intubation: Analysis of a National Database

2015 ◽  
Vol 81 (8) ◽  
pp. 820-825 ◽  
Author(s):  
Martin P. Alvarez ◽  
Andres X. Samayoa-Mendez ◽  
Mary C. Naglak ◽  
James V. Yuschak ◽  
Kenric M. Murayama
Keyword(s):  
Risk Factors ◽  
Multivariate Logistic Regression Analysis ◽  
National Database ◽  
Chronic Obstructive ◽  
Multivariate Logistic Regression ◽  
Improvement Program ◽  
Surgical Quality ◽  
Obstructive Pulmonary Disease ◽  
National Rate ◽  
Independent Risk Factors

Postoperative unplanned intubation (PUI) is a significant complication and is associated with severe adverse events and mortality. By participating in the National Surgical Quality Improvement Program (NSQIP), we learned that PUI occurred more frequently than expected at our institution. The aim of this study was to identify risk factors that are predictors of PUI at our institution. We reviewed the NSQIP data from our institution and the NSQIP national database for surgery patients from 2010 through 2013. The rate of PUI at our institution was 1.54 per cent compared with the national rate of 1.03 per cent. Perioperative risk factors were analyzed by multivariate logistic regression. Analysis of the national NSQIP database identified 14 independent risk factors for PUI. Analysis of the NSQIP data at our institution demonstrated that emergent cases, preoperative ventilator status, smoking, chronic obstructive pulmonary disease, and older age were independent risk factors. In conclusion, patients at our institution with these five risk factors were at higher risk of requiring PUI. These risk factors could be used to help identify patients at high risk and possibly help prevent postoperative respiratory failure and unplanned intubation.

Meckel’s: A National Surgical Quality Improvement Program Survey in Adults Comparing Diverticulectomy and Small Bowel Resection

2020 ◽  
pp. 000313482095482
Author(s):  
Joseph G. Brungardt ◽  
Brian R. Cummiskey ◽  
Kurt P. Schropp
Keyword(s):  
Quality Improvement ◽  
Small Bowel ◽  
Bowel Resection ◽  
Meckel’S Diverticulum ◽  
Operating Time ◽  
Small Bowel Resection ◽  
Meckel's Diverticulum ◽  
National Database ◽  
Improvement Program ◽  
Surgical Quality

Background Meckel’s diverticulum is a congenital abnormality often associated with the pediatric population. When seen in the adult population, management is controversial. This study sought to determine demographic and outcome differences between diverticulectomy and small bowel resection in adults diagnosed with Meckel’s diverticulum. Methods An analysis of the American College of Surgeons National Surgical Quality Improvement database (2015-2018) was performed, capturing patients with a postoperative diagnosis of Meckel’s diverticulum. Inclusion criteria included diverticulectomy or small bowel resection, and exclusion criteria included other major procedures such as colectomy or concomitant diverticulectomy and a small bowel resection. Demographics and outcomes were analyzed between those receiving diverticulectomy or resection. Results 506 patients undergoing surgical treatment of Meckel’s diverticulum were captured. The majority of these patients were white (79.05%), male (68.77%), and averaged 46 years old. The 2 populations were homogenous, with no significant differences in demographics or comorbidities between populations. Mean operative time was shorter in the diverticulectomy group than the resection group (68.92 ± 35.89 vs. 89.33 ± 40.16 minutes, P < .0001). There were no deaths at 30 days. Length of stay, readmission rate, wound infection, and discharge destination were similar among both groups. Discussion Our analysis of a national database reveals no difference in outcomes between patients receiving a diverticulectomy or resection for Meckel’s diverticulum. Operating time may be slightly increased for resection. However, decision to excise the diverticulum vs. the segment of small bowel should be individualized to each patient, their pathology, and clinical picture.

scholarly journals Congenital Missing Permanent Teeth in Korean Unilateral Cleft Lip and Alveolus and Unilateral Cleft Lip and Palate Patients

2007 ◽  
Vol 77 (1) ◽  
pp. 88-93 ◽  
Author(s):  
Seung-Hak Baek ◽  
Na-Young Kim
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Permanent Teeth ◽  
Fisher Exact Test ◽  
Missing Teeth ◽  
Chi Square ◽  
Exact Test ◽  
Patients Âgés ◽  
Chi Square Test ◽  
Tooth Type

Abstract Objective: To investigate the differences in the congenital missing teeth pattern in terms of tooth type (permanent maxillary lateral incisor [MLI] and maxillary second premolar [MSP]) and sidedness (cleft vs noncleft) between boys and girls in Korean unilateral cleft lip and alveolus (UCLA) and unilateral cleft lip and palate (UCLP) patients. Materials and Methods: This study used the charts, models, radiographs, and intraoral photographs of 90 UCLA patients and 204 UCLP patients (ages 6 to 13 years). Binomial test, chi-square test, Fisher exact test, maximum likelihood analysis of variance, and the odds ratio were performed. Results: According to the relationship between the congenital missing teeth pattern and the cleft type, the UCLP patients had 2.98 times more missing MLIs and 1.80 times more missing MSPs than did the UCLA patients. The MLI was congenitally missing more in boys than in girls, but the MSP showed the opposite tendency. Boys had a higher frequency of congenital missing MLIs and MSPs on the cleft side than did girls. However, on the noncleft side and both sides, girls had a higher frequency of congenital missing MLIs and MSPs than did boys. Results showed a gender-dominant pattern of congenital missing MLIs and MSPs. Conclusion: These results suggest that gender and cleft type might affect the congenital missing teeth pattern in terms of tooth type and sidedness.

Complications Associated with Mortality after Head and Neck Surgery: An Analysis of the NSQIP Database

2017 ◽  
Vol 156 (3) ◽  
pp. 504-510 ◽  
Author(s):  
Carolyn L. Mulvey ◽  
Jason A. Brant ◽  
Andrés M. Bur ◽  
Jinbo Chen ◽  
John P. Fischer ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
National Database ◽  
Multivariate Logistic Regression ◽  
Improvement Program ◽  
Surgical Quality ◽  
Increased Risk ◽  
American College Of Surgeons ◽  
Progressive Renal Insufficiency

Objective To determine which complications, as defined by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, correlate with 30-day mortality in surgery for malignancies of the head and neck. Study Design Retrospective review of prospectively collected national database. Setting NSQIP. Subjects and Methods NSQIP data from 2005 to 2014 were queried for ICD-9 codes head and neck malignancies. Multivariate logistic regression was used to examine the correlation of individual complications with 30-day mortality. Results In total, 15,410 cases met criteria with 3499 complications in 2235 cases. After controlling for patient and surgical variables, postoperative pneumonia ( P = .02; odds ratio [OR], 2.39; 95% confidence interval [CI], 1.15-4.72), progressive renal insufficiency ( P < .001; OR, 21.28; 95% CI, 4.22-87.94), bleeding requiring transfusion ( P = .02; OR, 2.10; 95% CI, 1.12-3.84), sepsis ( P = .02; OR, 2.86; 95% CI, 1.15-6.46), septic shock ( P = .045; OR, 2.87; 95% CI, 0.98-7.81), stroke ( P < .001; OR, 19.81; 95% CI, 6.23-56.03), and cardiac arrest ( P < .001; OR, 135.59; 95% CI, 65.00-286.48) were independently associated with increased odds of 30-day mortality. Conclusion The NSQIP database has been extensively validated and used to examine surgical complications, yet there is little analysis on which complications are associated with death. This study identified complications associated with increased risk of 30-day mortality following head and neck cancer surgery. These associations may be used as a measure of complication severity and should be considered when using the NSQIP database to evaluate outcomes in head and neck surgery.

scholarly journals Evidence for the Continued Occurrence of Chorioretinopathy in Working Sheep Dogs in New Zealand in 2010

Animals ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 2229
Author(s):  
Adam B. O’Connell ◽  
A. Craig Irving ◽  
Paul L. Hughes ◽  
Naomi Cogger ◽  
Boyd R. Jones ◽  
...  
Keyword(s):  
New Zealand ◽  
Cross Sectional Study ◽  
P Value ◽  
Fisher Exact Test ◽  
Cross Sectional ◽  
Exact Test ◽  
South West ◽  
Chi Squared ◽  
The Relationship

A study in conducted 1987 by Hughes et al., found that 39% of working sheep dogs had multifocal retinitis. One of the identified causes was ocular larval migrans, which were a result of migrating ascarid larvae. Since that paper was published, anthelmintic use in farm dogs has been highly recommended. There has been no follow-up study to determine if fundic lesions are still present. The current study aimed to investigate the prevalence of chorioretinopathy in working sheep dogs in the South-West, Waikato, New Zealand. This was a cross-sectional study of 184 working sheep dogs and 51 owners, undertaken in 2010 with owners sampled from New Zealand’s South-West Waikato and Tux North Island Dog Trial Championship. Two-way tables were used to explore the relationship between variables. Significance of association was assessed using a Chi-squared or Fisher exact test as appropriate, with a p-value of <0.05 considered significant. Overall prevalence of chorioretinopathy in the working sheep dogs was 44/184 (24%). A significantly higher prevalence of chorioretinopathy was shown in dogs with increasing age, from 2 years to >8 years (p = 0.0007) and in males (p < 0.0001). This study concluded that lesions of chorioretinopathy are still present in working sheep dogs in New Zealand.

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