Good long-term results after tonsillectomy in ear, nose and throat practices.

INTRODUCTION: The objective was to evaluate the long-term results of outpatient tonsillectomy in Danish ear, nose and throat (ENT) practices in terms of satisfaction, quality of life (QoL) and relief of symptoms. MATERIAL AND METHODS: A telephone interview was carried out at least three years after tonsillectomy. Alternatively, a questionnaire was filled in by the patients. The answers were compared to a pre-operative questionnaire. RESULTS: The response rate was 63% (386/614). No differences were found between the responders and the non-responders except that the proportion of smokers was higher in the non-responder group. QoL improved significantly and 93% were satisfied with having chosen tonsillectomy. 95% experienced complete or partial relief from their former throat-related symptoms. Eight to 11% had developed new symptoms from the throat including sleep-disordered breathing. CONCLUSION: With regard to QoL, satisfaction and relief of symptoms, the long-term results of outpatient tonsillectomy in Danish ENT practices are comparable to those obtained among hospitalized patients and they are in conformity with international standards. However, as approximately 10% develop new symptoms, it is important that physicians are aware of the indication as well as of any information received during shared decision-making with the patients/parents to adjust expectations. FUNDING: none. TRIAL REGISTRATION: none.

Need for better analgesic treatment after tonsillectomy in ear, nose and throat practices.

INTRODUCTION: The objective of this study was to investigate patient-reported outcomes on quality (PRO) of outpatient tonsillectomy in Danish ear, nose and throat practices in terms of indicators, standards and prognostic factors. MATERIAL AND METHODS: Patients filled in a post-operative questionnaire three weeks after tonsillectomy. The questions were focused on the preoperative information about the procedure. Unscheduled contacts to Danish health care after the tonsillectomy and number of days absent from work/school were reported. A pain score was indicated daily during the first 14 post-operative days. RESULTS: A total of 89% of the 614 enrolled patients returned the questionnaire. 30% were dissatisfied with the information they had been afforded about post-operative complications and risks and 23% had unscheduled contacts to Danish health care. The daily pain score and absence from work/school were significantly higher among adults (> 15 years) than among children. The pain score correlated significantly with absence from work/school, unscheduled contacts and short observation time. PRO was significantly influenced by the length of the observation time before discharge, and a higher pain score was associated with a lower satisfaction with preoperative information about complications/risks. CONCLUSION: Most patients/parents are satisfied with outpatient tonsillectomy. However, the post-operative pain control needs revision, the preoperative information should be intensified and the observation of the patients before discharge should be extended. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Pain and bleeding are the main determinants of unscheduled contacts after outpatient tonsillectomy.

INTRODUCTION: The objective of this prospective cohort study was to measure the medical technical quality of outpatient tonsillectomy in Danish ear, nose & throat practices by indicators, standards and prognostic factors. MATERIAL AND METHODS: According to standardised and validated specific questionnaires, quality of surgery was measured in terms of postoperative bleeding, pain, gastrointestinal problems and infection. RESULTS: A total of 614 patients were included. 11% were younger than four years, and 93% were observed for less than four hours. A total of 23% had unscheduled postoperative contacts. Almost 12% of the patients contacted a physician due to pain; a percentage that exceeds the chosen standard of 10%. 4% were hospitalised due to bleeding exceeding the chosen standard of 1%. Secondary haemostatic procedures were performed in 2% of the patients. The indication chronic tonsillitis, being an adult, and a postoperative observation shorter than four hours increased the risk of unscheduled contacts. CONCLUSION: Outpatient tonsillectomy seems safe in Denmark. A minimum postoperative observation period of four hours will reduce the need for postoperative contacts. Because of the potentially life-threatening risk related to tonsillectomy, careful patient selection is mandatory and continuous monitoring of the quality of the procedure is essential. FUNDING: Not relevant. TRIAL REGISTRATION: Not relevant.

What you see is not what you get in the PDF document format.

The sharing and storage of scientific knowledge, information and data are today mainly in digitized form, which will become the predominant means of communicating scientific work in the future. One of the best-established formats is the open standard of PDF (Portable Document Format), which is renowned for its flexibility and stability. In this article, we expose a major flaw in the format with respect to the security of confidential information, such that even organizations responsible for safeguarding and setting the standards for data management were unintentionally revealing confidential patient data. By collecting and analysing a random sample of files from a health informatics organization, we demonstrate the extent of the problem and determine its cause by code analysis of an example. In conclusion, we suggest the development of a knowledge-sharing format that does not demand expert skills for safe usage: WYSIWYS (What You See Is What You Store).

[Personal data and confidentiality on the Internet]. / Personhenførbare og fortrolige data og resultater på internettet.

INTRODUCTION: Health sciences have a solid foundation for collecting, storing and processing data from individuals. To ensure the confidentiality of the data, a series of laws, guidelines and rules have been implemented. Professionals use computers and the internet when communicating information or results. When preparing a presentation, a serious and non-intentional mistake may take place. Research data are analysed and transferred into informative graphs, charts or tables using MS Excel or MS Word. Afterwards, the graph can be pasted into MS PowerPoint or MS Word for publication. The publication can be uploaded or distributed in the formats: PowerPoint Presentation (.ppt), PowerPoint Show (.pps) or as a Word document (.doc). Typically, however, the entire Excel document used is also pasted and is unintentionally available. In other cases, the usage of pictures, x-rays or screen dumps in presentations compromises the confidentiality of personal data. MATERIALS AND METHODS: We conducted simple searches on the internet using the Google.dk search engine on health-related topics and restricted to PPT files and DOC files. We downloaded and tested sample files for hidden data. RESULTS: We found hidden data in 37% (26-49%) of the downloaded sample PowerPoint files but not in the Word files. A number of these files contained very sensitive personal health information. CONCLUSION: We were easily able to find personal information on the internet although laws and rules prohibit this. We provide some advices on data management to avoid this.

Survey of attitudes towards curriculum reforms among medical teachers in different socio-economic and cultural environments.

BACKGROUND: Curriculum reforms in medical schools require cultural and conceptual changes from the faculty. AIMS AND METHODS: We assessed attitudes towards curriculum reforms in different academic, economic, and social environments among 776 teachers from 2 Western European medical schools (Belgium and Denmark) and 7 medical schools in 3 countries in post-communist transition (Croatia, Slovenia, Bosnia and Herzegovina). The survey included a 5-point Likert-type scale on attitudes towards reforms in general and towards reforms of medical curriculum (10 items each). RESULTS: Teaching staff from medical schools in Bosnia and Herzegovina had a more positive attitude towards reforms of medical curriculum (mean score 36.8 out of maximum 50 [95% CI 36.1 to 37.3]) than those from medical schools in Croatia or Slovenia (30.7 [29.8 to 31.6]) or Western Europe (27.7 [27.1 to 28.3]) (P < 0.001, ANOVA). Significant predictors of positive attitudes towards medical curriculum reform in post-communist transition countries, but not in Western European schools, was younger age, as well as female gender in Bosnia and Herzegovina. CONCLUSIONS: Factors influencing faculty attitudes may not be easy to identify and may be specific for different settings. Their identification and management is necessary for producing sustainable curriculum reform.

Characterization of recombinant mannan-binding lectin-associated serine protease (MASP)-3 suggests an activation mechanism different from that of MASP-1 and MASP-2.

Mannan-binding lectin (MBL)-associated serine proteases (MASP-1, -2, and -3) are homologous modular proteases that each associate with MBL and L- and H-ficolins, which are oligomeric serum lectins involved in innate immunity. To investigate its physicochemical, interaction, and enzymatic properties, human MASP-3 was expressed in insect cells. Ultracentrifugation analysis indicated that rMASP-3 sedimented as a homodimer (s(20,w) = 6.2 +/- 0.1 S) in the presence of Ca(2+), and as a monomer (s(20,w) = 4.6 +/- 0.1 S) in EDTA. As shown by surface plasmon resonance spectroscopy, it associated with both MBL (K(D) = 2.6 nM) and L-ficolin (K(D) = 7.2 nM). The protease was produced in a single-chain, proenzyme form, but underwent slow activation upon prolonged storage at 4 degrees C, resulting from cleavage at the Arg(430)-Ile(431) activation site. Activation was prevented in the presence of protease inhibitors iodoacetamide and 1,10-phenanthroline but was not abolished upon substitution of Ala for the active site Ser(645) of MASP-3, indicating extrinsic proteolysis. In contrast, the corresponding mutations Ser(627)-->Ala in MASP-1 and Ser(618)-->Ala in MASP-2 stabilized the latter in their proenzyme form. Likewise, the MASP-1 and MASP-2 mutants were each activated by their active counterparts, but MASP-3 S645A was not. Activated MASP-3 did not react with C1 inhibitor; had no activity on complement proteins C2, C4, and C3; and only cleaved the N-carboxybenzyloxyglycine-L-arginine thiobenzyl ester substrate to a significant extent. Based on these observations, it is postulated that MASP-3 activation and control involve mechanisms that are different from those of MASP-1 and -2.

The mannan-binding lectin-associated serine proteases (MASPs) and MAp19: four components of the lectin pathway activation complex encoded by two genes.

Mannan-binding lectin (MBL) and ficolins (L-ficolin and H-ficolin) initiate the lectin pathway of complement activation upon binding to microbial carbohydrates. The activation is mediated by associated serine proteases, termed MASPs, since they were discovered as MBL-associated serine proteases. The MASP family comprises three serine proteases, MASP-1, MASP-2 and MASP-3 and a non-enzymatic protein, MAp19. The MASPs show identical domain structure, shared also with C1r and C1s. MASP-1 and MASP-3 are alternative splice products of a single gene, MASP1/3, and have identical A chains, whereas they have individual B chains, encompassing the serine protease domain. MASP2 and MAp19 are alternative splice products of the MASP-2 gene, with MAp19 consisting of the first two domains of MASP-2 plus additional four amino acid residues. MASP-2 is the protease responsible for activating C4 and C2 to generate the C3 convertase, C4bC2b. The biological function of the remaining three proteins has not yet been resolved.