scholarly journals Use of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurrent sinonasal polyposis after FESS in poor candidates for revision surgery

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Mohamed M. ElSheikh
Keyword(s):  
Revision Surgery ◽  
Statistical Significance ◽  
Poor Quality ◽  
Post Treatment ◽  
Sinus Surgery ◽  
Post Intervention ◽  
Hypotensive Anesthesia ◽  
Clinical Scoring ◽  
Grade 3 ◽  
Sinonasal Polyposis

Abstract Background Chronic rhinosinusitis with nasal polyps recurs frequently after functional endoscopic sinus surgery (FESS), with resultant poor quality of life with persistence of nasal obstruction, sinus aches, and discharge as well anosmia and dysgysia; revision FESS is usually the treatment of choice referred to relief patients’ suffering, yet it is not always the case, patients preference as well as fitness for general hypotensive anesthesia, patients age, cardiopulmonary status, and concurrent bronchial asthma might render unfit for an elective procedure. The aim of this study was to evaluate the efficacy of triamcinolone-soaked absorbable gelatin foam (gelfoam) as a treatment for recurrent sinonasal polyposis after FESS in poor candidates for revision surgery. Results Thirty patients suffering from recurrent sinonasal polyposis after single or multiple FESS procedures were selected; all patients were subjected to intranasal application of gelfoam soaked with triamcinolone as a conservative medical office procedure using triamcinolone-soaked absorbable gelatin foam (gelfoam) weekly for a period of 8 weeks followed by intranasal steroid nasal spray for maintenance and as anti-recurrence measure. Patients were followed up for 4 months post-intervention; Meltzer Clinical Scoring System was used to analyze the patients’ pre- and post-intervention via office endoscopy (0° 4-mm Hopkins endoscope). All patients tolerated the procedure well. The study group showed no statistical significance pre-intervention which comprised 17 (56.7%) patients with grade 4 sinonasal polyposis extent and 13 (43.3%) patients with grade 3 sinonasal polyposis extent (P=0.795), denoting no difference between patients pending treatment option. Post-treatment, both groups showed a significant reduction in the extent of polyposis (P<0.001) where post-treatment showed 21 (70%) patients with grades 0 no polyps and 9 (30%) patients with grade 1 sinonasal polyposis extent. Conclusion Triamcinolone-soaked gelfoam packing is an effective and safe method for managing recurrent sinonasal polyposis after FESS. Intervention contributed to a successful result, decreased the need for surgery in poor candidates for hypotensive anesthesia, and could be used as a sole treatment of recurrent sinonasal polypsis in elderly patients whose general condition could not tolerate invasive procedures.

S281 – Closure of Anterior Skull Base Cerebrospinal Fluid Fistulas

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P169-P169
Author(s):  
Yadiel A Alameda ◽  
Jose Busquets ◽  
Juan C. Portela
Keyword(s):  
Skull Base ◽  
Revision Surgery ◽  
Statistical Significance ◽  
Anterior Skull Base ◽  
Sinus Surgery ◽  
Fisher Exact Test ◽  
Endoscopic Repair ◽  
Presenting Symptoms ◽  
Surgical Data

Objectives 1) Describe the presenting symptoms, etiology, treatment, and long-term outcomes of patients with anterior skull base CSF fistulas treated endoscopically at our institution. 2) Study the association between closure techniques and complications, and between the use of image guidance surgery (IGS) and complications. Methods A retrospective analysis of patients with anterior CSF fistulas treated endoscopically from November 2004 to December 2007. Demographic and surgical data were collected. Postoperative complications, recurrence, and need for revision surgery were determined. Associations between the use of IGS and complications, and between the closure technique and complications were analyzed using Fisher Exact Test. Results Endoscopic repair of anterior skull base defect was performed in 19 cases. The etiology was spontaneous leak in 10 patients, menigoencephalocele in 7 patients, previous sinus surgery in 1 patient, and trauma in 1 patient. 5 patients had suffered bacterial meningitis before surgery. The most common location of leak was the cribiform plate (9 patients), followed by the ethmoid roof (5 patients). An overlay technique was used for repair in 61% of the procedures. One patient presented with leak recurrence, and underwent successful revision surgery. No statistical significance was found between the use of IGS and complications. The mean follow-up was 17 months. Our overall initial rate of closure was 94%, and 100% after a second procedure. At the last follow-up, none of the patients reported episodes of meningitis postoperatively. Conclusions Endoscopic repair of anterior skull base CSF fistulas has a high success rate and lower morbidity and mortality when compared with open approaches.

scholarly journals Comparison of the hypotensive efficacy of propofol infusion versus nitroglycerin infusion in functional endoscopic sinus surgery

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Rasha Gamal Abu-sinna ◽  
Tamer Nabil Abdelrahman
Keyword(s):  
Heart Rate ◽  
Statistical Significance ◽  
Sinus Surgery ◽  
Hypotensive Anesthesia ◽  
Depressant Action ◽  
Duration Of Surgery ◽  
Close Range ◽  
Surgical Bleeding ◽  
The Mean ◽  
Mean Heart Rate

Abstract Background FESS is a common minimally invasive surgery that requires a clear field to be performed well. Hypotensive anesthesia is one of the most common maneuvers performed to help in keeping the field clear. An ideal drug for hypotensive anesthesia should be cheap and familiar to the anesthesiologist. So, being familiar with propofol and by using its cardio-depressant action, the idea of the research was developed. The idea of the study was to compare propofol infusion versus nitroglycerine infusion as a hypotensive agent. Results The mean duration of surgery was longer in the NTG to the propofol group. There was a high statistical significance in the average blood loss in the propofol group compared to the NTG group. The visibility of the operative field also was significant in the propofol group as compared with the NTG group. The mean heart rate in the NTG group was higher than the mean heart rate in the propofol group. The MAP in both groups was within a close range. Conclusion Propofol and NTG can produce a safe and effective controlled hypotension during FESS. Whereas, propofol has better surgical field visibility, less surgical bleeding, and less tachycardia during FESS.

Comparison of Delivery of Topical Medications to the Paranasal Sinuses via “Vertex-to-floor” Position and Atomizer Spray after FESS

2005 ◽  
Vol 133 (5) ◽  
pp. 735-740 ◽  
Author(s):  
Steven B. Cannady ◽  
Pete S. Batra ◽  
Martin J. Citardi ◽  
Donald C. Lanza
Keyword(s):  
Chronic Rhinosinusitis ◽  
Paranasal Sinuses ◽  
Statistical Significance ◽  
Sinus Surgery ◽  
Olfactory Cleft ◽  
Frontal Recess ◽  
Nasal Drop ◽  
Topical Medications ◽  
Sinonasal Symptoms ◽  
Sinonasal Polyposis

INTRODUCTION: Topical nasal medications are frequently employed for persistent sinonasal symptoms after functional endoscopic sinus surgery (FESS) in chronic rhinosinusitis patients. The optimal means for the delivery of these medications is unclear. In this study, the efficacy of the vertex to floor (VF) position compared to atomizer spray was evaluated in post-FESS patients. METHODS: Three trials were performed: two trials in which patients maintained the VF position for 1 and 5 minutes, respectively, after nasal drop administration were compared to a third trial utilizing an atomizer spray in the upright position. Two independent observers rated the distribution of fluorescein-dyed dexamethasone drops at 5 sinonasal sites: maxillary sinus (MS), ethmoid cavity (EC), frontal recess (FR), sphenoid sinus (SS), and olfactory cleft (OC). RESULTS: VF position consistently delivered nasal drops to the MS, EC, SS, and OC. The atomizer distributed drops to the MS, EC, SS, and FR. The greatest difference was noted with the nasal drops in the olfactory cleft in the VF position; statistical significance was achieved with ANOVA testing ( P = 0.012). Student's paired t test comparing trial 1 to 2, 1 to 3, and 2 to 3 demonstrated greater distribution in the OC at 5 minutes compared with 1 minute and spray ( P = 0.042 and 0.003). CONCLUSIONS: The VF position and atomizer spray were both effective in delivery of the dexamethasone drops to the paranasal sinuses. This has significant implications for management of patients suffering from recalcitrant chronic rhinosinusitis and/or sinonasal polyposis through the delivery of topical medications to the paranasal sinuses and olfactory cleft.

scholarly journals Effect of topical furosemide on sinonasal polyposis relapse after endoscopic sinus surgery

2020 ◽  
Vol 7 (1) ◽  
pp. 101
Author(s):  
Souvagini Acharya ◽  
Alka Kapil ◽  
Kamalini Bepari ◽  
Sandrendu Rajan ◽  
Prachi Mohapatra ◽  
...  
Keyword(s):  
Normal Saline ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Statistical Significance ◽  
Saline Group ◽  
Sinus Surgery ◽  
Randomised Control Trial ◽  
Normal Saline Group ◽  
Sinonasal Polyposis

<p class="abstract"><strong>Background: </strong>Chronic rhinosinusitis with nasal polyposis (CRSwNP) relapse is commonly seen during follow up period after endoscopic sinus surgery. Some studies claim the credibility of topical furosemide in preventing the polyposis recurrence after surgery. This randomised control trial was done to check the effectiveness of topical furosemide on sinonasal polyposis relapse after the endoscopic sinus surgery.</p><p class="abstract"><strong>Methods:</strong> In the current study, 44 patients, attending ENT department, VSSIMSAR, for follow up after endoscopic sinus surgery, were evaluated clinically and endoscopically to demonstrate the prevalence and severity of polyposis relapse using Visual analogue scale (VAS) and meltzer endoscopic grading, before initiating the intervention. Patients were then randomised in two groups- one receiving topical furosemide nebulization and other intranasal normal saline spray, respectively. All patients were evaluated again at 1st, 2nd, 4th and 6th month follow-ups by VAS and MEG, setting statistical significance at p&lt;0.05.</p><p class="abstract"><strong>Results:</strong> The MEG was grade 0 in 77% (17) patients of furosemide group and 32% (7) of normal saline group (p=0.0147). Statistically significant improvement was also observed in VAS for nasal symptoms in former group (p=0.028) than latter. The rate of relapse was less (23.81%) in furosemide group as compared to normal saline group (65%) but result not statistically significant at p&lt;0.05.</p><p class="abstract"><strong>Conclusions:</strong> Topical furosemide can be used as a valid therapeutic approach for reducing the severity of sinonasal polyposis relapse after endoscopic sinus surgery with no known side effects of furosemide when administered topically.</p><p> </p>

Use of SAMe-TT₂R₂ Score to Predict the Quality of Anticoagulation Control in Patients with Atrial Fibrillation Receiving Warfarin in Thailand

2020 ◽  
Vol 103 (6) ◽  
pp. 548-552
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Statistical Significance ◽  
Discrimination Performance ◽  
Poor Quality ◽  
Chi Square ◽  
Exact Test ◽  
Time In Therapeutic Range ◽  
Anticoagulation Control

Objective: To predict the quality of anticoagulation control in patients with atrial fibrillation (AF) receiving warfarin in Thailand. Materials and Methods: The present study retrospectively recruited Thai AF patients receiving warfarin for three months or longer between June 2012 and December 2017 in Central Chest Institute of Thailand. The patients were classified into those with SAMe-TT₂R₂ of 2 or less, and 3 or more. The Chi-square test or Fisher’s exact test was used to compare the proportion of the patients with poor time in therapeutic range (TTR) between the two groups of SAMe-TT₂R₂ score. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics. Results: Ninety AF patients were enrolled. An average age was 69.89±10.04 years. Most patients were persistent AF. An average CHA₂DS₂-VASc, SAMe-TT₂R₂, and HAS-BLED score were 3.68±1.51, 3.26±0.88, and 1.98±0.85, respectively. The present study showed the increased proportion of AF patients with poor TTR with higher SAMe-TT₂R₂ score. The AF patients with SAMe-TT₂R₂ score of 3 or more had a larger proportion of patients with poor TTR than those with SAMe-TT₂R₂ score of 2 or less with statistical significance when TTR was below 70% (p=0.03) and 65% (p=0.04), respectively. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics of 0.60, 0.59, and 0.55 when TTR was below 70%, 65% and 60%, respectively. Conclusion: Thai AF patients receiving warfarin had a larger proportion of patients with poor TTR when the SAMe-TT₂R₂ score was higher. The score of 3 or more could predict poor quality of anticoagulation control in those patients. Keywords: Time in therapeutic range, Poor quality of anticoagulation control, Warfarin, SAMe-TT₂R₂, Labile INR

Improving physician wellness through electronic health record education

2021 ◽  
pp. 009121742110346
Author(s):  
Elizabette Johnson ◽  
Elizabeth Roth
Keyword(s):  
Electronic Health Record ◽  
Statistical Significance ◽  
Resident Physician ◽  
Health Record ◽  
Physician Burnout ◽  
Paired Data ◽  
Post Intervention ◽  
Physician Wellness ◽  
Resident Wellness ◽  
Electronic Health

Objective Our goal is to improve the wellness of our Family Medicine residents now and in the future by educating them on more efficient use of our electronic health record (EHR). Resident physician burnout is a significant problem and is correlated with time spent using an EHR after work hours. Family physicians have the highest rate of burnout of all specialties, and the EHR is a significant contributor to this burnout. Studies have shown that increased EHR education can improve job satisfaction. Method Over 5 months, we provided weekly brief (15 minute) educational sessions covering 6 topics twice and a one-hour individualized meeting of each resident physician with an EHR trainer. We evaluated our intervention with wellness surveys and objective measures of EHR efficiency both pre and post intervention. We further evaluated efficiency by comparing pre and post-intervention values of the following: average keystrokes, mouseclicks, accelerator use, minutes per encounter and percent closed encounters at month’s end. Results Resident questionnaires showed lessons increased knowledge and intention to use EHR accelerators, but this was not statistically significant. Analysis of objective data showed most efficiency metrics worsened, though most not to a degree that was statistically significant. Residents reported subjective increases in efficiency, and paired data from wellness surveys showed an overall decrease in burnout post-intervention vs. baseline. Conclusions Much of the data in this pilot study does not reach statistical significance, but is highly suggestive that increased EHR training can improve at least perceived efficiency and thereby resident wellness.

scholarly journals Long-Term Follow-Up After Maxillary Sinus Balloon Sinuplasty and ESS

2021 ◽  
pp. 014556132098603
Author(s):  
Anni Koskinen ◽  
Marie Lundberg ◽  
Markus Lilja ◽  
Jyri Myller ◽  
Matti Penttilä ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Revision Surgery ◽  
University Hospital ◽  
Sinus Surgery ◽  
Control Group ◽  
University Hospitals ◽  
Balloon Sinuplasty ◽  
Long Term Follow Up

Objectives: The aim of this controlled follow-up study was to compare the need for revision surgery, long-term efficacy, and satisfaction in chronic rhinosinusitis patients who had undergone maxillary sinus operation with either balloon sinuplasty or traditional endoscopic sinus surgery (ESS) technique. Methods: Thirty-nine ESS patients and 36 balloon patients of our previously described cohort, who had been primarily operated in 2008 to 2010, were contacted by phone. Symptoms, satisfaction, and need for revision surgery were asked. In addition, we collected data of patients who had undergone primary maxillary sinus balloon sinuplasty in the Helsinki University Hospital during the years 2005 to 2019. As a control group, we collected data of patients who had undergone primary maxillary sinus ESS at 3 Finnish University Hospitals, and 1 Central Hospital in years 2005, 2008, and 2011. Results: Altogether, 77 balloon patients and 82 ESS patients were included. The mean follow-up time was 5.3 years in balloon group and 9.8 years in ESS group. Revision surgery was performed on 17 balloon patients and 6 ESS patients. In the survival analysis, the balloon sinuplasty associated significantly with a higher risk of revision surgery compared to ESS. According to the phone interviews, 82% of ESS patients and 75% of balloon patients were very satisfied with the primary operation. Conclusion: Although the patient groups expressed equal satisfaction and change in symptoms after the operations, the need for revision surgery was higher after balloon sinuplasty than after ESS. This should be emphasized when counselling patients regarding surgical options.

The Quality Analysis of Hallux Valgus Videos on YouTube

2021 ◽  
Author(s):  
Enes Sari ◽  
Levent FAZLI Umur
Keyword(s):  
Hallux Valgus ◽  
Information Quality ◽  
Statistical Significance ◽  
Poor Quality ◽  
Quality Analysis ◽  
Accurate Information ◽  
Youtube Videos ◽  
The Mean ◽  
The Difference

BACKGROUND:The aim of this study was to evaluate the information quality of YouTube videos on hallux valgus. METHODS:A YouTube search was performed using the keyword 'hallux valgus' to determine the first 300 videos related to hallux valgus. A total of 54 videos met our inclusion criteria and evaluated for information quality by using DISCERN, Journal of the American Medical Association (JAMA) and hallux valgus information assessment (HAVIA) scores. Number of views, time since the upload date, view rate, number of comments, number of likes, number of dislikes, video power index (VPI) values were calculated to determine video popularity. Video length (sec), video source and video content were also noted. The relation between information quality and these factors were statistically evaluated. RESULTS:The mean DISCERN score was 30.35{plus minus}11.56 (poor quality) (14-64), the mean JAMA score was 2.28{plus minus}0.96 (1-4), and the mean HAVIA score was 3.63{plus minus}2.42 (moderate quality) (0.5-8.5). Although videos uploaded by physicians had higher mean DISCERN, JAMA, and HAVIA scores than videos uploaded by non-physicians, the difference was not statistically significant. Additionally, view rates and VPI values were higher for videos uploaded by health channels, but the difference did not reach statistical significance. A statistically significant positive correlation was found between video length and DISCERN (r= 0.294, p= 0.028), and HAVIA scores (r= 0.326, p= 0.015). CONCLUSIONS:This present study demonstrated that the quality of information available on YouTube videos about hallux valgus was low and insufficient. Videos containing accurate information from reliable sources are needed to educate patients on hallux valgus, especially in less frequently mentioned topics such as postoperative complications and healing period.

Exercise intensity and markers of inflammation during and after (neo-) adjuvant cancer treatment

2021 ◽  
Vol 28 (3) ◽  
pp. 191-201
Author(s):  
Tim Schauer ◽  
Anne-Sophie Mazzoni ◽  
Anna Henriksson ◽  
Ingrid Demmelmaier ◽  
Sveinung Berntsen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Exercise Intensity ◽  
Interleukin 1 ◽  
Secondary Analysis ◽  
Post Treatment ◽  
Moderate Intensity ◽  
Post Intervention ◽  
Necrosis Factor Alpha ◽  
Markers Of Inflammation

Exercise training has been hypothesized to lower the inflammatory burden for patients with cancer, but the role of exercise intensity is unknown. To this end, we compared the effects of high-intensity (HI) and low-to-moderate intensity (LMI) exercise on markers of inflammation in patients with curable breast, prostate and colorectal cancer undergoing primary adjuvant cancer treatment in a secondary analysis of the Phys-Can randomized trial (NCT02473003). Sub-group analyses focused on patients with breast cancer undergoing chemotherapy. Patients performed 6 months of combined aerobic and resistance exercise on either HI or LMI during and after primary adjuvant cancer treatment. Plasma taken at baseline, immediately post-treatment and post-intervention was analyzed for levels of interleukin 1 beta (IL1B), IL6, IL8, IL10, tumor-necrosis factor alpha (TNFA) and C-reactive protein (CRP). Intention-to-treat analyses of 394 participants revealed no significant between-group differences. Regardless of exercise intensity, significant increases of IL6, IL8, IL10 and TNFA post-treatment followed by significant declines, except for IL8, until post-intervention were observed with no difference for CRP or IL1B. Subgroup analyses of 154 patients with breast cancer undergoing chemotherapy revealed that CRP (estimated mean difference (95% CI): 0.59 (0.33; 1.06); P  = 0.101) and TNFA (EMD (95% CI): 0.88 (0.77; 1); P  = 0.053) increased less with HI exercise post-treatment compared to LMI. Exploratory cytokine co-regulation analysis revealed no difference between the groups. In patients with breast cancer undergoing chemotherapy, HI exercise resulted in a lesser increase of CRP and TNFA immediately post-treatment compared to LMI, potentially protecting against chemotherapy-related inflammation.

scholarly journals Damaging Real Lives through Obstinacy: Re-Emphasising Why Significance Testing is Wrong

2016 ◽  
Vol 21 (1) ◽  
pp. 102-115 ◽  
Author(s):  
Stephen Gorard
Keyword(s):  
Statistical Significance ◽  
Poor Quality ◽  
Significance Testing ◽  
Significance Tests ◽  
Statistical Significance Testing ◽  
Wrong Answer ◽  
Repeated Calls ◽  
Numeric Data ◽  
Quality Of Research

This paper reminds readers of the absurdity of statistical significance testing, despite its continued widespread use as a supposed method for analysing numeric data. There have been complaints about the poor quality of research employing significance tests for a hundred years, and repeated calls for researchers to stop using and reporting them. There have even been attempted bans. Many thousands of papers have now been written, in all areas of research, explaining why significance tests do not work. There are too many for all to be cited here. This paper summarises the logical problems as described in over 100 of these prior pieces. It then presents a series of demonstrations showing that significance tests do not work in practice. In fact, they are more likely to produce the wrong answer than a right one. The confused use of significance testing has practical and damaging consequences for people's lives. Ending the use of significance tests is a pressing ethical issue for research. Anyone knowing the problems, as described over one hundred years, who continues to teach, use or publish significance tests is acting unethically, and knowingly risking the damage that ensues.

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