The benefit of silicone stents in primary endonasal dacryocystorhinostomy: a systematic review and meta-analysis.

OBJECTIVE: To critically evaluate the evidence comparing success rates of endonasal dacryocystorhinostomy (EN-DCR) with and without silicone tubing and to thus determine whether silicone intubation is beneficial in primary EN-DCR. DESIGN: Systematic review and meta-analysis. SEARCH STRATEGY: A literature search was performed on AMED, EMBASE, HMIC, MEDLINE, PsycINFO, BNI, CINAHL, HEALTH BUSINESS ELITE, CENTRAL and Cochrane Ear, Nose and Throat disorders groups trials register using a combination of various MeSH. The date of last search was January 2016. This review was limited to randomised controlled trials (RCTs) in English language. Risk of bias was assessed using the Cochrane Collaboration's risk of bias tool. Chi-square and I2 statistics were calculated to determine the presence and extent of statistical heterogeneity. EVALUATION METHOD: Study selection, data extraction and risk of bias scoring were performed independently by two authors in concordance with the PRISMA statement. RESULTS: Five RCTs (447 primary EN-DCR procedures in 426 patients) were included for analysis. Moderate interstudy statistical heterogeneity was demonstrated (Chi2 = 6.18; d.f. = 4; I2 = 35%). Bicanalicular silicone stents were used in 229 and not used in 218 procedures. The overall success rate of EN-DCR was 92.8% (415/447). The success rate of EN-DCR was 93.4% (214/229) with silicone tubing and 92.2% (201/218) without silicone tubing. Meta-analysis using a random-effects model showed no statistically significant difference in outcomes between the two groups (P = 0.63; RR = 0.79; 95% CI = 0.3-2.06). CONCLUSIONS: Our review and meta-analysis did not demonstrate an additional advantage of silicone stenting. A high-quality well-powered prospective multicentre RCT is needed to further clarify on the benefit of silicone stents.

On the minimum requirements for otolaryngology clinics in National Health Service hospitals.

OBJECTIVE: This paper, a report by the Clinical Governance and Audit Committee of the Scottish Otolaryngological Society, presents a consensus view of the minimal requirements for ENT clinics in National Health Service hospitals. RESULTS AND CONCLUSION: The provision of adequate equipment and staff has gained increasing importance as the vast majority of ENT procedures can be safely performed in the out-patient or office setting.

A literature review and meta-analysis of drug company-funded mental health websites.

OBJECTIVE: The pharmaceutical industry exercises pervasive influence in the mental health field. The internet has become a primary source of mental health information for the public and practitioners. This study therefore compared mental health websites funded and not funded by drug companies. METHOD: A systematic literature review of studies examining the role of drug companies in the funding of mental health websites was conducted, followed by a meta-analysis of studies comparing drug company-funded (DCF) sites with sites not funded by the industry. RESULTS: Mental health websites, in general, overemphasize biogenetic causal explanations and medication. Many mental health websites (42%) are either drug company owned (6%) or receive funding from drug companies (36%). A meta-analysis found that DCF sites are significantly more biased toward biogenetic causes (P < 0.01) and toward medication (P < 0.0001) than sites that are financially independent of the industry. CONCLUSION: Practitioners are encouraged to inform patients about the bias inherent in industry-sponsored websites and to recommend, instead, more balanced websites that present a range of evidence-based information about causes and treatments.

Ear presentation of Lyme borreliosis in a child.

OBJECTIVE: This case report aims to raise awareness amongst clinicians of ear presentation of cutaneous borrelia. CASE REPORT: We report a recent case of borrelia lymphocytoma cutis benigna in a child presenting with unilateral earlobe swelling, who was otherwise well. A review of the English language literature, including management of the disease, is also presented. CONCLUSION: This case highlights the fact that borrelia lymphocytoma should be included in the differential diagnosis of a persistent, unilateral, inflamed, swollen earlobe in an otherwise healthy child.

Prospectively predicting dietary restraint: the role of interpersonal self-efficacy, weight/shape self-efficacy, and interpersonal stress.

OBJECTIVE: This study investigated how the precursors of interpersonal self-efficacy and weight/shape self-efficacy would interact in the face of interpersonal stress to prospectively predict dietary restraint. Three models were explored, each with a different type of interpersonal stress: stress from same sex friendships, opposite sex friendships, or romantic relationships. METHOD: At Time 1 (T1), participants (N = 406) reported on their typical levels of interpersonal self-efficacy and weight/shape self-efficacy, and recent (past 28 days) dietary restraint. At Time 2 (T2), 11 weeks after T1, participants reported on their recent (past 28 days) levels of dietary restraint at that time. Between T1 and T2, participants completed inventories weekly on the previous week's interpersonal stressors. RESULTS: Consistent with prediction, low interpersonal self-efficacy and high weight/shape self-efficacy combined with high interpersonal stress (whether from same sex friendships, opposite sex friendships, or romantic relationships) to predict the highest levels of T2 dietary restraint after controlling for T1 levels. DISCUSSION: These results further link the interpersonal domain with dietary restraint and elucidate characteristics of women particularly apt to increase dietary restraint in response to interpersonal stress.

The impact of endonasal dacryocystorhinostomy (DCR), on patient health status as assessed by the Glasgow benefit inventory.

OBJECTIVE: To measure the effect of Endonasal DCR on the health status of patients, using a validated outcomes measure, the Glasgow Benefit Inventory. METHOD: Postal questionnaire with telephone follow up of patients undergoing Endonasal DCR in two institutions in Scotland. The same surgical technique is used in both centres. Patients were identified from prospectively collected data on consecutive patients undergoing this procedure. All adult patients, a minimum of twelve months post-intervention, were included. RESULTS: Ninety two of 123 patients (75%) completed the questionnaire, the mean age was 59 years and the sex ratio m:f was 1:1.8. The mean overall GBI for this intervention was + 32.7 (95% confidence intervals 27.8 - 37.6). The patients were grouped according to the indication for intervention: Obstruction of lacrimal system GBI + 32.7 (26.3-37.1), mucoecele + 40.1 (28.7-51.4), dacryocystitis + 19.4 (10.0-28.9). CONCLUSION: The GBI provides a measure of the effect of an ORL intervention on the health of a patient. Endonasal DCR scores highly when compared with a number of other rhinological procedures including rhinoplasty (GBI + 20), endoscopic sinus surgery (GBI + 23), and septal surgery (mean ranges from + 6 to + 24). Endonasal DCR is a successful intervention with demonstrable health benefits to the patient.

Hyperglycemia predicts mortality after CABG: postoperative hyperglycemia predicts dramatic increases in mortality after coronary artery bypass graft surgery.

OBJECTIVE: Risk of morbidity and mortality after coronary artery bypass graft surgery (CABG) is higher in patients with clinical diabetes mellitus (DM). We evaluated whether outcomes are affected by postoperative hyperglycemia in CABG patients independent of preoperative DM diagnosis. RESEARCH DESIGN AND METHODS: A total of 2297 consecutive CABG patients were studied. The first glucose value after surgery completion (mean 15 min) was tested as a predictor of outcome. Primary outcome variables were prolonged ventilation (>24 h), deep sternal wound infection, renal failure, permanent stroke, any reoperation, length of stay (>14 days) and mortality. All outcomes except for prolonged ventilation and length of stay were tracked out to 30 days postoperatively. Patients were stratified by glycemic control: Low (glucose <80), normal (referent, glucose 80-110), high (glucose 111-200) and very high (glucose >200 mg/dl). Multivariable logistic regression was used to determine the independent predictive value of glycemic groups, adjusted for outcome specific risk scores from the Society of Thoracic Surgeons model. RESULTS: Patient distribution among groups low through very high were 44 (1.9%), 476 (20.7%), 1425 (62.0%) and 352 (15.3%). Greater complication rates were noted in the very high group when compared with the referent group: prolonged ventilation (adjusted odds ratio (OR)=2.66, P<.001), length of stay >14 days (adjusted OR=2.06, P=.004) and mortality (adjusted OR=7.71, P<.001). CONCLUSION: Patients with blood glucose values >200 mg/dl immediately after CABG had an increased risk of complications, including mortality, independent of a clinical diagnosis of DM. This study documents the high risk associated with early postoperative hyperglycemia in this group, suggesting the need for prospective trials of glycemic control.

Evidence-based, multifactorial approach to addressing non-adherence to antiretroviral therapy and improving standards of care.

BACKGROUND: Near-perfect adherence to antiretroviral therapy over time is critical to achieve viral suppression and recovery of functional immunity in individuals infected with HIV. The concept of adherence as a dynamic behaviour influenced by multiple biopsychosocial factors motivated us to implement an integrated, multifactorial programme in our hospital-based setting. The aims of this study were to survey the scope and determinants of non-adherence in patients attending the Ambulatory HIV Service at Royal Perth Hospital, to develop a method for longitudinal monitoring and to implement measures tailored to support individuals. METHODS: The US Adult AIDS Clinical Trials Group self-report baseline adherence, follow-up and side-effect questionnaires were used to survey 247 patients at two time-points between September 2002 and February 2003. A longitudinal monitoring method was developed and the WA HIV Cohort Study database used to collate results with clinical markers up to December 2005. RESULTS: Adherence was associated with viral suppression and CD4 T-cell recovery and improved over the 3-year period under observation (all P < 0.001). Diminishing adherence was associated with younger age (P = 0.002), substance use (P < 0.01), perceived stress (P = 0.04) and indicators of depression (P = 0.03). The analyses showed relationships between personal experience of side-effects and the depression indicator scale in patients on antiretroviral therapy. CONCLUSION: The programme resulted in an improvement in adherence in our cohort even after adjusting for pill burden, dosing frequency and highly active antiretroviral therapy regimen and has enhanced focus on patients vulnerable to non-adherence while supporting those not currently at risk.

Satisfaction with cosmesis following nasal manipulation: do previous fractures matter?

OBJECTIVE: To determine if patients who have had multiple previous nasal fractures and who undergo manipulation of fractured nasal bones under general anaesthetic (MUA) are as likely to be satisfied with their post-operative nasal cosmesis as patients who have only sustained a single injury. DESIGN: Telephone survey. SETTING: District general hospital. PARTICIPANTS: Adult patients who had undergone MUA over the preceding three years. MAIN OUTCOME MEASURES: Patient satisfaction with nasal cosmesis and nasal airway and willingness to consider corrective surgery. RESULTS: One hundred and two patients were contacted. Overall patient satisfaction with cosmesis and nasal airway was 82 and 77 per cent, respectively, with 15 per cent willing to consider a procedure to improve their nasal cosmesis and 12 per cent willing to consider a procedure to improve nasal airway. Twenty-three (22.5 per cent) gave a history of one or more nasal bone fractures, either treated or untreated, prior to the most recently treated injury. Patient satisfaction with cosmesis in this group was 65 per cent, compared with 87 per cent satisfaction in the single injury group (p = 0.03). No statistically significant differences were demonstrated when comparing these groups for: satisfaction with nasal airway (70 vs 80 per cent, p = 0.46); willingness to consider a procedure to improve cosmesis (26 vs 11 per cent, p = 0.16); and willingness to consider a procedure to improve nasal airway (17 vs 10 per cent, p = 0.46). CONCLUSIONS: A history of multiple previous nasal fractures does appear to alter patient satisfaction with the cosmetic outcome of nasal manipulation. These patients should be informed that they have a decreased chance of attaining a cosmetically acceptable result.

Racial disparities and trends in use of colorectal procedures among Tennessee elderly (1996-2000).

BACKGROUND: Blacks are more likely to be diagnosed at a later stage of colorectal cancer (CRC), and have poorer survival than Whites. Colorectal cancer (CRC) is usually curable when diagnosed at an early stage. OBJECTIVES: We compare the use of CRC tests for screening between Whites and Blacks and compare the use of CRC tests for either screening or diagnosis and further check the test results for a diagnosis of CRC. DATA: The data we use are from physician claims files provided by the Centers for Medicare and Medicaid Services (CMS) (1996-2000) for a closed cohort of all Tennesseans eligible for Medicare in 1996, age > or = 6. RESULTS: Half as many Blacks as Whites were screened with fecal occult blood testing (FOBT), sigmoidoscopy, and colonoscopy. Significantly fewer Blacks had any colorectal procedures, sigmoidoscopy, colonoscopy, and/ or barium enema, for screening or diagnosis; however, the test results show that more Blacks were diagnosed with CRC than Whites. The use of CRC tests is low regardless of race. Only 24% of beneficiaries used at least one of the four procedures during the five years. During the five years, FOBT and barium enema use decreased significantly for both Blacks and Whites, while colonoscopy use increased significantly. Sigmoidoscopy use was highest in 1998, which corresponds to the change of Medicare coverage policy in 1998. CONCLUSIONS: Removal of financial barriers to screening alone has failed to substantially improve the use of colorectal procedures. Lack of vigilance and lack of access to good quality of care contribute to the fact that Blacks are more likely to be diagnosed at a late stage of CRC than Whites.

A comparative study of the optical characteristics of commonly used sinoscopes: do you know where you are looking?

Endoscopic ethmoidectomy is a delicate operation on the thin, honey-comb-like laminae of the ethmoidal sinuses. A high degree of precision is required to minimize disruption of the natural sinus mucociliary clearance system and to reduce the risk of orbital and skull base complications. It is therefore important that surgeons are aware of variation in the optical characteristics of the rod-lens telescopes produced by different manufacturers. A simple but precision endoscope goniometer was designed and manufactured. This was used to carry out a comparative study of the sinus telescopes in common use. The results showed significant variation in the view angle of the four brands of telescopes (Karl Storz, Olympus, Richards Smith & Nephew, and Richard Wolf) tested. Differences in the position of the horizon in the visual field, and different degrees of visuospatial distortion were evident. We also noted and measured the blind angle of telescopes, which, by virtue of a high degree of angulation, cannot view the horizon.

The use of topical nasal anaesthesia before flexible nasendoscopy: a double-blind, randomized controlled trial comparing cophenylcaine with placebo.

The objective was to evaluate the necessity to use topical nasal anaesthesia before flexible nasendoscopy and to compare its use with placebo. The study was carried out using a double-blind randomized controlled trial, with three treatment arms, at the out-patient department at Raigmore Hospital, Inverness. The participants were 90 patients attending the otolaryngology out-patient department who required flexible nasendoscopy as part of their assessment. Each participant was randomized to one of three groups. Group 1 received cophenylcaine spray, group 2 received a placebo spray, and group 3 received no nasal preparation. Flexible nasendoscopy was carried out via a stated protocol and the patient's diagnosis and findings were discussed in the usual way. After the consultation, the patient filled in a questionnaire marking answers on a visual analogue scale. The main outcome measures were pain and overall unpleasantness of procedure. Patient anxiety and willingness to be examined again in the same way if necessary were also assessed. Ease of examination and quality of view were asked from the operator's perspective. The mean scores on a visual analogue scale showed the main outcome measures to be as follows. Pain score measured 1.7 for cophenylcaine, 2.1 for no spray and 2.2 for placebo. Overall unpleasantness scores were 2.0 for cophenylcaine, 1.9 for no spray and 2.4 for placebo. On a visual analogue scale of 0-10, none of these mean main outcome measures reached levels of significance. It was concluded that the use of cophenylcaine spray before flexible nasendoscopy does not give significant advantages over the use of no nasal preparation.

The effect of a church-based breast cancer screening education program on mammography rates among African-American women.

This study examines the effectiveness of breast cancer screening education programs on mammography rates among African-American women 40 years of age and over. We conducted two types of educational programs in community settings, primarily in African-American churches. Three-month follow-up interviews were used to determine whether women who participated in programming were more likely to get a mammogram if they had not had a mammogram in the last year. Our results demonstrate that the educational programs significantly increased the likelihood of getting a mammogram when compared to a control group that received no educational programming. Further, we found that the programs were effective for motivating breast cancer screening in housing projects as well as in the churches, and that the effectiveness of the programs remained even when we controlled for socioeconomic status, depression, and age.

Metachronous bilateral submandibular gland metastases from carcinoma of the breast.

Metastases to the salivary glands from distant neoplasms are unusual, with most reported cases involving the parotid gland. Metastatic deposits in the submandibular gland are extremely rare with bilateral involvement not previously reported. We present the case of a patient with advanced breast carcinoma who has had metachronous involvement of both submandibular glands and review the literature on this subject.

Selective use of whole-lung irradiation for patients with Ewing sarcoma family tumors and pulmonary metastases at the time of diagnosis.

PURPOSE: The benefit of whole-lung irradiation (WLI) for patients who have pulmonary metastases (PM) of Ewing sarcoma family tumors (ESFT) is unclear. At our institution, WLI is reserved for patients with PM that do not respond completely to induction chemotherapy. We reviewed our experience to assess the impact of WLI on clinical outcome. PATIENTS AND METHODS: Twenty-eight patients with ESFT and PM were treated in three consecutive institutional trials (1979-1996). Extent of pulmonary involvement at diagnosis, response of PM after induction chemotherapy, local treatment of PM thereafter, and clinical outcome were recorded. Treatment included primary tumor surgery and/or radiotherapy and 42 to 58 weeks of multiagent chemotherapy. RESULTS: Only eight patients (29%) received WLI. For the entire study group, the estimated 5-year event-free survival was 22.9% +/- 9.0%; the 5-year survival was 37.3% +/- 9.8%. Complete resolution of PM after induction chemotherapy was not correlated with survival (P = 0.53), nor was treatment with WLI (P = 0.87). CONCLUSIONS: The comparable survival of patients with poor and good response of PM to induction chemotherapy suggests that WLI may benefit poor responders. The use of WLI in good responders may provide similar benefit and merits further study.