scholarly journals Post-operative Pain: An audit of patient reported pain scores after endoscopic and microscopic ear surgery

2021 ◽  
Author(s):  
Rhona McCallum ◽  
Mohd Afiq Mohd Slim ◽  
Arunachalam Iyer
Keyword(s):  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Endoscopic Ear Surgery ◽  
Ear Surgery ◽  
Patient Counselling ◽  
Pain Scores ◽  
Patient Reported ◽  
Endoscopic Group

Objectives The aim of this study was to compare patient reported pain scores and analgesia requirements between endoscopic and microscopic ear surgery. Design Prospective cohort study Setting Secondary care setting from June 2017 to December 2020. Participants Patients undergoing ear surgery performed by a single surgeon. Main outcome measures The primary outcome measure was patient reported pain as recorded by a visual analogue scale (VAS) at days 1,2,3 and 7 post-operatively. Secondary outcome measure was post-operative analgesia requirement. Results Overall, forty-nine patients encompassing 65.3 % (32/49) endoscopic and 34.7% (17/49) microscopic procedures were audited. Endoscopic procedures have statistically significant lower VAS pain threshold outcomes when compared against the microscopic procedures on post- operative day one (endoscopic group median VAS 1.5 [0.00;11.5] mm versus microscopic group median VAS 27.0 [15.0;65.0] mm); to day seven (endoscopic group median VAS 0.5 [0.00;2.75] mm versus microscopic group median VAS 9.00 [2.00;52.0] mm).  Requirement for analgesia was greater in the microscopic group at day one compared to the endoscopic group (64.5 %, 20/31 endoscopic group vs. 100 %, 17/17 microscopic; p= 0.004). Conclusion Endoscopic ear surgery is less painful and requires less analgesia in the initial post-operative period than microscopic surgery in this cohort. The overall results of this study are useful for pre-operative patient counselling and pain management in the clinical setting. Given the differing applications of microscopic and endoscopic ear surgery, further research is required to study the influence of bone removal, type of operation, and incision type on pain after ear surgery.

scholarly journals Success of trabeculectomy surgery in relation to cataract surgery: 5-year outcomes

2018 ◽  
Vol 103 (10) ◽  
pp. 1395-1400 ◽  
Author(s):  
Rashmi G Mathew ◽  
Sahar Parvizi ◽  
Ian E Murdoch
Keyword(s):  
Cataract Surgery ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Risk Of Failure ◽  
Increased Risk ◽  
Significant Difference ◽  
Measure Change ◽  
Group 2

AimsTo compare success proportions at 5 years in three surgical groups: group 1, trabeculectomy alone; group 2, trabeculectomy followed by cataract surgery within 2 years; and group 3, trabeculectomy performed on a pseudophakic eye.MethodsA retrospective cohort study. 194 eyes of 194 patients were identified with at least 5 years’ follow-up post trabeculectomy (N=85, 60 and 49 in groups 1, 2 and 3, respectively).Main outcome measures1. Primary outcome measure: intraocular pressure (IOP) at 5 years post-trabeculectomy surgery, 2.Secondary outcome measure: change in visual acuity at 5 years.ResultsAt 5 years, the mean IOP (SD) was 12.9 (3.5), 12.5 (4.8) and 12.7 (4.8) mm Hg in groups 1, 2 and 3, respectively. Overall success was almost identical, 58%, 57% and 59% in groups 1, 2 and 3, respectively. There was no significant difference between the groups in terms of percentage IOP reduction, number of medications, proportion restarting medication and reoperation rates at 5 years. Logistic regression for an outcome of failure showed men to be at increased risk of failure OR 1.97 (95% CI 1.10 to 3.52, p=0.02). Nearly 80% of patients retained or improved their vision following their initial trabeculectomy.ConclusionsThe sequence in which surgery is carried out does not appear to affect trabeculectomy function at 5 years, success being similar to trabeculectomy alone. In our study, men may be at increased risk of failure.

scholarly journals Serological prevalence of antibodies to SARS CoV-2 amongst cancer centre staff

2020 ◽  
Author(s):  
Karol Sikora ◽  
Ian Barwick ◽  
Ceri Hamilton
Keyword(s):  
Outcome Measure ◽  
Seroconversion Rate ◽  
Proton Beam Therapy ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Sample Population ◽  
Secondary Outcome Measure ◽  
Buffer Solution ◽  
South Korean ◽  
Vulnerable Patient

Objectives: the aim of this study was to test Rutherford Health (RH) staff for the presence of SARS CoV-2 antibodies to reduce the risk of infection to cancer patients. Setting: Between 14 and 24 April 2020 we tested 161 staff at four locations: our cancer centres in Reading - Berkshire, Newport - S Wales, Liverpool - Merseyside, and Bedlington in Northumberland. Participants: Testing was available to all staff who were on site at the four locations named above at the time the study was carried out. 161 staff (80 men, 81 women) gave voluntary consent to have the tests and all testing gave rise to valid results. Interventions: We used the South Korean test for antibodies to SARS CoV-2: Sugentech SGTi-flex COVID-19 IgM/IgG1. For each test, blood was collected and added to the sample well of the test cassette and buffer solution added. The test result was legible after 15 minutes. Outcome measures: The number of tests positive for the presence of antibodies was the primary outcome measure. The ratio of tests positive for the presence of IgM antibodies versus IgG antibodies was the secondary outcome measure. Results: Between 14 and 24 April 2020, 161 staff (age m = 43) were tested at four Rutherford Cancer Care centres that offer proton beam therapy, radiotherapy and chemotherapy. Out of 161, 12 samples (7.50%) tested positive of which 7 samples (4.35%) detected IgM only, 2 samples (1.24%) detected IgG only and 3 samples (1.86%) detected both IgM and IgG. Conclusions: The low seroconversion rate in the sample population limits the current utility of the test as a way of reducing risk to vulnerable patient populations but longitudinal retesting will provide further data.

scholarly journals Algoritm for diagnostics of appendicitis in childhood and SIRS

2018 ◽  
Vol 16 (3) ◽  
pp. 218-223
Author(s):  
Y. Dimcheva ◽  
Kr. Kalinova ◽  
K. Georgiev
Keyword(s):  
Inflammatory Response ◽  
Outcome Measure ◽  
Clinical Symptoms ◽  
Primary Outcome Measure ◽  
Systemic Inflammatory Response ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein

The specific purpose of this study was to describe and characterize the systemic inflammatory response to appendicitis in childhood. The clinical symptoms of SIRS are present in a large proportion of patients . A study of high-risk patients showed that over a given period of time, 44-68% of the patients met the criteria for this condition, while at the same time they had proven infection up to 50%.The incidence of SIRS is even higher in the post-operative period and in trauma regardless of the presence or absence of infection. On the other hand, between 10% and 43% of patients with proven sepsis do not meet the SIRS criteria.The inclusion of a number of biological markers (C-reactive protein, procalcitonin, cytokines) aims to help differentiate SIRS with infectious and noninfectious etiology. Sixty six patients were studied, divided into four groups from onset of symptoms to diagnosis. The primary outcome measure was to determine the systemic inflammatory response to appendicitis according to the established groups of time intervals. The secondary outcome measure was the analysis of C-reactive protein for the same purpose. The variables of the systemic inflammatory response, according to diagnostic intervals, showed non-significant differences in white blood cell count. The temperature rose constantly after 48 h, reaching its peak after 72 h (p = 0.001), and the respiratory rate rose after 72 h (p < 0.0001). After 73 h, most patients had three or four systemic inflammatory response criteria (p < 0.0001). C-reactive protein levels rose progressively, showing higher levels after 48 h (p = 0.005). The inflammatory response to appendicitis is progressive, being more marked along the timeline from onset of symptoms to diagnosis. Key words: appendicitis, diagnostic SIRS, children, algoritm.

scholarly journals Stapes Surgery in Patients with a Small Air-Bone Gap

2018 ◽  
Vol 97 (7) ◽  
pp. 198-212 ◽  
Author(s):  
Jeremy Lavy ◽  
Fiona McClenaghan
Keyword(s):  
Outcome Measure ◽  
Bone Conduction ◽  
Pure Tone Audiometry ◽  
Primary Outcome Measure ◽  
Stapes Surgery ◽  
Secondary Outcome ◽  
Ktp Laser ◽  
Secondary Outcome Measure ◽  
Tertiary Center ◽  
Hearing Outcomes

The objective of this study was to determine hearing outcomes in patients undergoing stapes surgery with a preoperative air-bone gap (ABG) <21.25 dB. Patients with a unilateral or bilateral preoperative ABG <21.25 dB undergoing primary stapes surgery were identified from a database of all stapes surgeries performed in a tertiary center over 15 years. A total of 254 ears met the inclusion criteria. The primary outcome measure was the degree of closure of the preoperative ABG. A secondary outcome measure was improvement in bone-conduction thresholds at 4 kHz. All patients underwent stapes surgery under local anesthesia. Ossicular reconstruction was achieved using a SMart 360 nitinol fluoroplastic piston (Gyrus ACMI, Inc.; South-borough, Mass.), and complete posterior crurotomy was performed with a KTP laser. Hearing was assessed with clinical voice testing immediately postoperatively and with pure-tone audiometry at 6 weeks postoperatively. A total of 248 ears (97.6%) demonstrated ABG closure to <10 dB. Bone-conduction thresholds showed an increase in 114 (44.9%), no change 74 (29.1%), and a decrease in 66 (26.0%). There is a slight increase in the risk of stapes mobilization in ears with a small ABG when compared to those with larger ABGs; however, this can be overcome by using a laser-assisted technique in combination with good surgical experience. The benefit in terms of hearing aid avoidance and the restoration of symmetrical hearing is both achievable and significant for the patient.

scholarly journals Effect of Intravitreal Bevacizumab Injection before Panretinal Photocoagulation on the Prevention of Macular Edema Aggravation in Proliferative Diabetic Retinopathy

2020 ◽  
Vol 9 (11) ◽  
pp. 3772
Author(s):  
Wungrak Choi ◽  
Hyun Goo Kang ◽  
Eun Young Choi ◽  
Sung Soo Kim ◽  
Hyoung Jun Koh ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Outcome Measure ◽  
Intravitreal Bevacizumab ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Combination Group ◽  
Panretinal Photocoagulation ◽  
Secondary Outcome Measure ◽  
Intravitreal Bevacizumab Injection

Objective: To investigate the effects of intravitreal bevacizumab (IVB) injection before PRP on the prevention of macular edema (ME) in patients with PDR. Methods: This retrospective observational study included patients diagnosed with PDR treated by PRP with (combination group) or without (PRP alone group) preoperative IVB injection (1.25 mg/0.05 mL). The primary outcome measure was the change in the central macular thickness (CMT), while the secondary outcome measure was the change in visual acuity. Measurements were made before and at one, two, and three months after treatment. Results: In the PRP alone group, the mean baseline CMT of 277.8 μm increased to 290.4 μm at one month (p = 0.201) and 308.8 μm at two months (p = 0.002), followed by a decrease to 271.2 μm at three months (p = 0.437). In the combination group, the values at baseline and one, two, and three months after PRP were 322.9 μm, 295.4 μm (p = 0.002), 330.1 μm (p = 0.906), and 274.5 μm (p = 0.030), respectively. Visual acuity changes were comparable between the two groups at all time points. Conclusion: IVB injection before PRP leads to decreased CMT in comparison to CMT in patients with PRP alone.

scholarly journals ERCP improves mortality in acute biliary pancreatitis without cholangitis

2021 ◽  
Vol 09 (06) ◽  
pp. E927-E933
Author(s):  
Aleksey A. Novikov ◽  
Jennifer H. Fieber ◽  
Monica Saumoy ◽  
Russell Rosenblatt ◽  
Shirley A. Cohen Mekelburg ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Outcome Measure ◽  
Severity Of Illness ◽  
Wait Time ◽  
The United States ◽  
Primary Outcome Measure ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Gallstone Pancreatitis ◽  
Secondary Outcome Measure

Abstract Background and study aims Acute pancreatitis (AP) is an increasingly common indication for hospitalization in the United States. The necessity for endoscopic retrograde cholangiopancreatography (ERCP) and the timing of ERCP in acute gallstone-related pancreatitis without cholangitis (AGPNC) is controversial. The aim of this study was to evaluate the association of ERCP and its performance during admission with mortality and length of stay (LOS) in patients with AGPNC. Patients and methods We queried the Nationwide Inpatient Sample (NIS) from 2004 to 2014 to identify all patients with admissions for gallstone AP. We excluded patients with chronic pancreatitis or concurrent cholangitis, and those who were transferred from elsewhere for treatment. Our primary outcome measure was inpatient mortality. Our secondary outcome measure was hospital length of stay (LOS). Results We identified 491,011 records eligible for analysis. Of the patients, 30.6 % (150,101) had AGPNC. There were 1.34 deaths per 100 admissions in patients with AGPNC. The average LOS was 5.88 (± 6.38) days with a median stay of 4 days (range, 3–7). When adjusted for age, Elixhauser Comorbidity Index, and severe pancreatitis, patients with ERCP during admission were 43 % less likely to die. ERCP performed between Days 3 and 9 of hospitalization resulted in a significant mortality benefit. Among those who had ERCP, a shorter wait time for ERCP was associated with a shorter LOS after adjustment for demographics and severity of illness. Conclusion ERCP performed during inpatient admission for AGPNC was associated with decreased mortality. These data support early ERCP in patients with acute gallstone pancreatitis without cholangitis.

scholarly journals Comparison of Outcomes of Intra-operative Neuromonitoring of Recurrent Laryngeal Nerve Versus Visualisation Alone during Thyroidectomies: A Singapore Experience

2020 ◽  
Vol 49 (11) ◽  
pp. 870-875
Author(s):  
Yao Guang Leow ◽  
Caroline CY Lee ◽  
Jereme Y Gan ◽  
Lilleen M Huang
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Laryngeal Nerve ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Tertiary Institution ◽  
Nerve Monitoring ◽  
Operative Duration ◽  
The Difference

Introduction: Although intra-operative neuromonitoring (IONM) has become commonly used to identify the recurrent laryngeal nerve (RLN) during thyroid surgeries, its value is still debatable. This study aimed to evaluate the outcomes of thyroid surgery using IONM versus visualisation alone (VA). Methods: We conducted a retrospective analysis of all the open thyroidectomies performed by the otolaryngology department in a tertiary institution in Singapore (Khoo Teck Puat Hospital) from 1 January 2014 to 31 December 2018. There were 301 nerves-at-risk (NAR), 139 in the IONM group and 162 in the VA group. The primary outcome measure was the incidence of RLN injury and the secondary outcome measure was operative duration. Results: There were 33 NAR with immediate post-operative RLN injury, of which 7 had permanent (>6 months) injury. There were minor improvements in the respective rates of immediate and permanent injury in the IONM group (7.9%, 0.7%) compared to the VA group (13.6%, 3.8%), but these were not statistically significant (P=0.14, 0.13). The average operative duration of total thyroidectomies in the IONM group was 37 minutes shorter than in the VA group, but the difference was not statistically significant (P=0.40). Conclusion: The current study shows that the use of intra-operative neuromonitoring shows a tendency towards better RLN outcome and operative duration for total thyroidectomies, but the study may be too small to demonstrate a statistical difference. Keywords: Nerve monitoring, otorhinolaryngology, surgery, thyroid, vocal cord paralysis

Hypokalemia Measurement and Management in Patients With Status Asthmaticus on Continuous Albuterol

2022 ◽  
Author(s):  
Courtney Cox ◽  
Krishna Patel ◽  
Rebecca Cantu ◽  
Chary Akmyradov ◽  
Katherine Irby
Keyword(s):  
Potassium Level ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Status Asthmaticus ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Treatment Frequency ◽  
Care Costs

OBJECTIVE: Status asthmaticus is commonly treated in pediatric patients by using continuous albuterol, which can cause hypokalemia. The primary aim of this study was to determine if serial potassium monitoring is necessary by examining treatment frequency of hypokalemia. METHODS: This retrospective analysis was performed in 185 pediatric patients admitted with status asthmaticus requiring continuous albuterol between 2017 and 2019. All patients were placed on intravenous fluids containing potassium. The primary outcome measure was the treatment of hypokalemia in relation to the number of laboratory draws for potassium levels. The secondary outcome measure was hypokalemia frequency and relation to the duration and initial dose of continuous albuterol. RESULTS: Included were 156 patients with 420 laboratory draws (average, 2.7 per patient) for potassium levels. The median lowest potassium level was 3.40 mmol/L (interquartile range, 3.2–3.7). No correlation was found between initial albuterol dose and lowest potassium level (P = .52). Patients with hypokalemia had a mean albuterol time of 12.32 (SD, 15.76) hours, whereas patients without hypokalemia had a mean albuterol time of 11.50 (SD, 12.53) hours (P = .29). Potassium levels were treated 13 separate times. CONCLUSIONS: The number of laboratory draws for potassium levels was high in our cohort, with few patients receiving treatment for hypokalemia beyond the potassium routinely added to maintenance fluids. Length of time on albuterol and dose of albuterol were not shown to increase the risk of hypokalemia. Serial laboratory measurements may be decreased to potentially reduce health care costs, pain, and anxiety surrounding needlesticks.

scholarly journals The Effects of Acupuncture Combined with Auricular Acupressure in the Treatment of Chloasma

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Xing Wu ◽  
Yu Xiang
Keyword(s):  
Outcome Measure ◽  
Safety Evaluation ◽  
Effective Rate ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Therapeutic Effects ◽  
Secondary Outcome Measure ◽  
Auricular Acupressure ◽  
Group A ◽  
And Control

Objective. To investigate the effectiveness of acupuncture combined with auricular acupressure in chloasma treatment. Methods. A prospective, randomized controlled assessor-blind clinical trial was performed and 135 patients were assigned into acupuncture combined with auricular acupressure (A), acupuncture (B), and control (C) groups, each with 45 patients. For groups A and B, body and facial acupuncture were applied for 2 months. For group A, auricular acupressure was applied concomitantly. For group C, vitamins C and E were prescribed for 3 months. Primary outcome measure was the therapeutic effects while secondary outcome measure was safety evaluation. Results. The total effective rate was 95.6%, 91.1%, and 75.6% for groups A, B, and C (P<0.01 between groups A and C; P<0.05 between groups B and C). The posttreatment estradiol (E2) levels in groups A and B were significantly decreased while the progesterone (P4) levels were significantly increased compared to pretreatment (P<0.01 and P<0.05, resp.). The differences were significant compared to group C (P<0.01 and P<0.05, resp.). No adverse events occurred. Conclusion. Acupuncture combined with auricular acupressure could significantly increase the therapeutic effect of chloasma treatment and could be better than vitamins C and E.

A randomized, controlled, equivalence study of authorized versus non-authorized deception in a model of pain following third molar extraction

2020 ◽  
Vol 15 (2) ◽  
pp. 104-110
Author(s):  
Nithya Gogtay ◽  
Mukta Sunil Kuyare ◽  
Nanda Pai ◽  
Lopa Mehta ◽  
Pranali Rajapure ◽  
...  
Keyword(s):  
Rescue Medication ◽  
Outcome Measure ◽  
Research Question ◽  
Third Molar ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Pain Model ◽  
Third Molar Extraction ◽  
Molar Extraction

Background and rationale When deception is used, a conflict ensues between the need to use it to answer a research question scientifically whilst protecting the participants’ autonomy simultaneously. Authorized deception (where participants are told they will be deceived) is a method that has been proposed to address the traditional “non-authorized” deception. Our study evaluated authorized versus non-authorized deception in a pain model of third molar extraction. Methods Adult patients requiring surgery for third molar extraction were enrolled after consent and randomized to either the authorized or “non-authorized” deception group. Within each group, they were further randomized to receiving either an “expensive” or an “inexpensive” painkiller. All participants actually received the same painkiller. The primary outcome measure was pain, while the proportion of patients taking rescue medication was the secondary outcome measure. All patients were debriefed at study completion. Results The median peak pain score was not significantly different between the groups. A little over 21% patients in the authorized deception group relative to 32.4% patients in the non-authorized group took rescue medication (p = 0.09). In the non-authorized deception group, 30% patients in the “inexpensive” group relative to 34.5% patients in the “expensive” group took rescue medication (p > 0.05). In the authorized deception group, 12.5% patients who received “expensive” relative to 30.4% who received the “inexpensive” painkiller took rescue medication (p = 0.04). Conclusions While our study showed equivalence of the two deception modalities, authorized deception may not be truly sterile.

Sign in / Sign up

Export Citation Format

Share Document