Going where other methods cannot: A systematic mapping review of 25 years of qualitative research in Otolaryngology.

OBJECTIVE: To map the use of qualitative methods within otolaryngology, providing examples and identifying gaps in the literature. DESIGN: Systematic mapping review of journal-based literature from 1990 to 2015 using Medline, Embase, PsycINFO and CENTRAL. Included studies were categorised according to clinical subspecialty, research aims and qualitative approach. RESULTS: Of 4,061 identified articles, 388 were deemed relevant to qualitative research in ENT. The number of qualitative publications has risen markedly over the last 25 years (r = 0.802), particularly since 2010. The most commonly used method was semi-structured interviews 62.1% (241/388). Head and neck cancer (41.8% (162/388)) and otology (40.2% (156/388)) publish more qualitative research than rhinology (7.0% (27/388)) and laryngology (6.7% (26/388)). CONCLUSIONS: Qualitative research in otolaryngology has increased over time, but laryngology and rhinology remain under-represented. Most studies use interviews, underutilising the strengths of other qualitative methods. There is considerable scope for further application of qualitative methods in otolaryngology.

A systematic review of the effectiveness of alcohol brief interventions for the UK military personnel moving back to civilian life.

BACKGROUND: Higher levels of alcohol consumption have been observed in the UK armed forces compared with the general population. For some, this may increase the risk of using alcohol as a coping strategy when adjusting to multiple life events occurring when moving back into civilian life. METHOD: A systematic review was conducted to determine the effectiveness of alcohol brief interventions for military personnel during transition. Electronic databases including Medline, Central, Healthcare Management Information Consortium (HMIC) and Embase, and grey literature, were searched. Two reviewers independently assessed potential studies for inclusion, extracted data and assessed quality of selected articles using an established instrument. RESULTS: Ten studies met criteria for inclusion. Studies were synthesised narratively. Interventions were heterogeneous, and bias within studies may have acted to increase or decrease their reported effectiveness. The findings suggest some evidence for effectiveness of self-administered web-based interventions, involving personalised feedback over a number of sessions, and system-level electronic clinical reminders. All studies were from the USA. Delivery of interventions by a clinician during motivational interviews was most effective for those with post-traumatic stress disorder symptoms. CONCLUSIONS: A UK trial of web-based interventions with personalised feedback is recommended.

Maternal body mass index and post-term birth: a systematic review and meta-analysis.

Post-term birth is a preventable cause of perinatal mortality and severe morbidity. This review examined the association between maternal body mass index (BMI) and post-term birth at ≥42 and ≥41 weeks' gestation. Five databases, reference lists and citations were searched from May to November 2015. Observational studies published in English since 1990 were included. Linear and nonlinear dose-response meta-analyses were conducted by using random effects models. Sensitivity analyses assessed robustness of the results. Meta-regression and sub-group meta-analyses explored heterogeneity. Obesity classes were defined as I (30.0-34.9 kg m-2 ), II (35.0-39.9 kg m-2 ) and III (≥40 kg m-2 ; IIIa 40.0-44.9 kg m-2 , IIIb ≥ 45.0 kg m-2 ). Searches identified 16,375 results, and 39 studies met the inclusion criteria (n = 4,143,700 births). A nonlinear association between maternal BMI and births ≥42 weeks was identified; odds ratios and 95% confidence intervals for obesity classes I-IIIb were 1.42 (1.27-1.58), 1.55 (1.37-1.75), 1.65 (1.44-1.87) and 1.75 (1.50-2.04) respectively. BMI was linearly associated with births ≥41 weeks: odds ratio is 1.13 (95% confidence interval 1.05-1.21) for each 5-unit increase in BMI. The strength of the association between BMI and post-term birth increases with increasing BMI. Odds are greatest for births ≥42 weeks among class III obesity. Targeted interventions to prevent the adverse outcomes associated with post-term birth should consider the difference in risk between obesity classes.

TMJ Disc Displacement without Reduction Management: A Systematic Review.

Various interventions have been used for the management of patients with temporomandibular joint (TMJ) disc displacement without reduction (DDwoR), but their clinical effectiveness remains unclear. This systematic review investigated the effects of these interventions and is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic and manual searches up to November 1, 2013, were conducted for English-language, peer-reviewed, publications of randomized clinical trials comparing any form of conservative or surgical interventions for patients with clinical and/or radiologic diagnosis of acute or chronic DDwoR. Two primary outcomes (TMJ pain intensity and maximum mouth opening) and a number of secondary outcomes were examined. Two reviewers performed data extraction and risk of bias assessment. Data collection and analysis were performed according to Cochrane recommendations. Twenty studies involving 1,305 patients were included. Data analysis involved 21 comparisons between a variety of interventions, either between interventions, or between intervention and placebo or no intervention. Meta-analysis on homogenous groups was conducted in 4 comparisons. In most comparisons made, there were no statistically significant differences between interventions relative to primary outcomes at short- or long-term follow-up (p > .05). In a separate analysis, however, the majority of reviewed interventions reported significantly improved primary outcome measures from their baseline levels over time (p < .05). Evidence levels, however, are currently insufficient for definitive conclusions, because the included studies were too heterogeneous and at an unclear to high risk of bias. In view of the comparable therapeutic effects, paucity of high-quality evidence, and the greater risks and costs associated with more complex interventions, patients with symptomatic DDwoR should be initially treated by the simplest and least invasive intervention.

Implementation of pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals' barriers and facilitators using the Theoretical Domains Framework.

Obesity in pregnancy is rising and is associated with severe health consequences for both the mother and the child. There is an increasing international focus on guidelines to manage the clinical risks of maternal obesity, and for pregnancy weight management. However, passive dissemination of guidelines is not effective and more active strategies are required for effective guideline implementation into practice. Implementation of guidelines is a form of healthcare professional behaviour change, and therefore implementation strategies should be based on appropriate behaviour change theory. This systematic review aimed to identify the determinants of healthcare professionals' behaviours in relation to maternal obesity and weight management. Twenty-five studies were included. Data synthesis of the existing international qualitative and quantitative evidence base used the Theoretical Domains Framework to identify the barriers and facilitators to healthcare professionals' maternal obesity and weight management practice. The domains most frequently identified included 'knowledge', 'beliefs about consequences' and 'environmental context and resources'. Healthcare professionals' weight management practice had the most barriers compared with any other area of maternal obesity practice. The results of this review will be used to inform the development of an intervention to support healthcare professional behaviour change.

Leiomioma benigno metastizante: caso clínico con nodulos pulmonares e histerectomía 4 años antes por leiomiomas uterinos / Pulmonary benign metastasizing leiomyoma

Se presenta un caso de leiomioma pulmonar metastizante en una mujer de 48 años. El estudio histológico reveló múltiples nódulos pulmonares de musculatura lisa de aspecto benigno. El seguimiento a 8 años mostró una paciente en buenas condiciones generales sin síntomas respiratorios. La historia clínica reveló antecedentes de histerectomía cuatro años antes debido a múltiples leiomiomas. Se hace una revisión clínico patológica de los tumores musculares lisos uterinos en sus formas clásicas y en sus presentaciones inusuales.

A case of pulmonary benign metastasizing leiomyoma in a 48 years old female is presented. The histological study showed pulmonary nodules formed by smooth muscle cell of benign appearance. The 8 years follow up revealed a patient in a good fashion without respiratory symptoms. There was a 4 years history of previous hysterectomy due to multiple uterine leiomyomas. A clinico pathological review of the classical and unusual forms of smooth muscle tumors of the uterus is also presented.

Neurofibromatosis de los niños / Neurofibromatosis of the children

Analiza que la neurofibromatosis o enfermedad de Von Reckilghausen es un trastorno hereditario (autosómico dominante) que produce manchas pigmentadas o tumores en la piel, tumores en los nervios periféricos, óptico y acústico y deformidades subcutáneas y óseas. Importante decir que 1/3 de los pacientes con neurofibromatosis son asintomáticos y se descubren en exploración de rutina, en 1/3 de los pacientes los probelmas estéticos constituyen el padecimiento inicial. Las lesiones cutáneas características ya al nacer o que aparecen en la primera infancia en más de 90xciento de los pacientes, son manchas de color pardo (manchas de café con leche), localizadas la mayoría de veces en el tronco, pelvis y pliegues flexores de codo y rodillas, la presencia de 60 o más de estas manchas semejantes a pecas, una de las cuales tenga un tamaño superior a 1.5 cm., establece el diagnóstico de neurofibromatosis. Dentro de los problemas neurológicos se manifiesta por neurofibromas (tumores de las células de Schwann y los fibroblastos nerviosos), tumores de los nervios craneales que pueden provocar una ceguera progresiva (glioma óptico) y sordera (neurinoma del acústico). Se demostró que la incidencia es mayor en mujeres. Se han descrito dos tipos de neurofibromatosis: tipo 1 (NF1) forma clásica y tipo 2 la forma central o acústica bilateral. En la actualidad los tumores profundos se tratan con extirpación quirúrgica o irradiación; y buen consejo genético es lo recomendable.