Functional endoscopic sinus surgery: do ratings of appropriateness predict patient outcomes?

Sinus surgery appropriateness ratings were recently developed by Value Health Sciences in cooperation with AAO-HNS. The goal of this study was to assess the relationships among three ratings of sinus surgery appropriateness (Appropriate, Inappropriate, or Equivocal) and symptom response. The enrolled population included 49 patients who completed the Smo-Nasal Outcome Test-20 (SNOT-20) presurgery and 6 months postsurgery. The SNOT-20 is a patient-based measure of sinusitis-related health status and quality of life. Overall, the mean percent difference (delta %) between pre- and postsurgery SNOT scores was 38%, a statistically and clinically significant improvement. However, there was no relationship between the appropriateness rating for the surgery and the delta % SNOT score (i = 1.83, p-value = 0.171); 20 patients with an Equivocal rating demonstrated the greatest delta % (49%), 20 patients with an Appropriate rating showed the least delta % (26%), and 9 patients with an Inappropriate rating had an intermediate delta % (39%). Furthermore, those patients having an Appropriate rating at the time of surgery reported a greater persistence of bothersome symptoms at 6 months (p-value = 0.02) then patients in either the Equivocal or Inappropriate rating. These results suggest that appropriateness ratings may not predict which patients will obtain the greatest symptom improvement from sinus surgery.

Assessment of two objective voice function indices.

In the care of patients with voice disorders, physicians, speech pathologists, and other health care professionals routinely make diagnoses, recommend treatment, and evaluate outcomes. Although objective and subjective measures exist, unfortunately, there is no widely accepted, valid method for classifying voice disorders and assessing outcome after voice treatment. In the present research, the relationship between two previously created multivariate objective voice function indices, the weighted odds ratio index and the multivariate logistic regression index, and subjective assessment of voice function was evaluated. Twenty-three adult patients presenting to a speech science laboratory for evaluation of voice disorders were studied in this prospective observational study together with 12 normal volunteers as controls. Vocal function was measured on 14 different parameters with a protocol that included a multichannel input for simultaneous assessment of acoustic and physiological parameters. Each patient was recorded reading the standard passage "The North Wind and the Sun," and recordings were then evaluated by the GRBAS scale. Overall, there was a statistically significant relationship between the weighted odds ratio index and multivariate logistic regression index and mean GRBAS scores. This research demonstrates that the voice function values calculated from two different multivariate objective voice function indices are significantly associated with subjective voice assessments. These multivariate objective voice indices may be appropriate for use in clinical trials and outcomes research on treatment effectiveness for voice disorders.

Indications for sinus surgery: how appropriate are the guidelines?

Sinusitis is the most commonly reported chronic disorder in America. More than 75,000 sinus surgical procedures were performed in 1993. Evaluating the appropriateness of procedures is a major focus of health care reform. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) collaborated with Value Health Sciences, Inc. (VHS) to develop guidelines for the use of sinus surgery. The clinical utility of these guidelines is presented. Patients undergoing sinus surgery at Barnes Hospital in St. Louis, Missouri, between November 1994 and July 1995 were eligible. Relevant patient information was used to prospectively rate surgery on the nine-point VHS appropriateness scale (1 to 3, inappropriate; 4 to 6, equivocal; 7 to 9, appropriate). Of 55 patients, 37 (67%) had chronic sinusitis, 10 (18%) recurrent sinusitis, five (9%) chronic sinusitis with nasal polyps, and three (6%) sinusitis with moderate to severe asthma; 27 (49%) had previous sinus surgery. Appropriateness ratings ranged from 1 to 9, with nine (16%) procedures rated as inappropriate, 22 (40%) uncertain, and 24 (44%) appropriate. There were no significant differences in the ratings of appropriateness between the group of patients who had undergone previous sinus surgery and the group of patients who had not. Overall, the guidelines were easily applied and clinically pertinent.

[Report of experiences with high dosage Hydiphen infusion treatment of depressive syndromes]. / Erfahrungsbericht über hochdosierte Hydiphen-Infusionsbehandlung bei depressiven Syndromen.

25 patients with therapy-resistant depressive syndromes of various origins were treated by the infusion of high Hydiphen doses, a very effective thymoleptic drug with no dissociation between its drive increasing and spirit raising actions. The results yielded by this treatment varied from good to very good in respect of endogenic depressions, in which the mood was observed to change at doses between 150 and 425 mg/d, depending on the severity of the depression. The results of this treatment were less satisfactory in the case of reactive and bran-organically induced depressions.

[Study approach and initial results of the effect of sleep deprivation on the depressive syndrome]. / Untersuchungsansatz und erste Ergebnisse zur Wirkung des Schlafentzugs beim depressive Syndrom.

After a brief review of previous investigations into the antidepressant effect of sleep withdrawal, attention is drawn to problems arising from simultaneous treatment with antidepressants. A method for recording the effects of sleep withdrawal alone is also described. The results indicate that treatment by partial withdrawal of sleep during the second half of the night, tends to have a positive effect on the symptoms of depression and on the psychophysical status of the patients. The author concludes with an overview of the problems still outstanding.

[Catamnestic studies of normally intelligent encephalopathy patients among children and adults]. / Katamnestische Untersuchungen an normalintelligenten Enzephalopathen im Kindes- und Erwachsenenalter.

Our studies show that the special features in the psychic development of encephalopaths showing normal intelligence consist in delayed motor, intellectual and educational progress. While motor retardation is reduced with age, as a result of such factors as rhythmical and psychomotor musico-therapy, individual intelligence test results drop more frequently at school age. The drop is less marked in students attending special classes, although they go back to their original schools after grade 4. The trend toward deterioration in intellectual development is reduced with age, i.e. when educational progress as encouraged by society, slows down. Despite their normal performance with regard to intelligence these students markedly lag behind their healthy contemporaries as far as performance at school is concerned.