Natural history of pituitary apoplexy: a long-term follow-up study.

BACKGROUND AND AIMS: Pituitary apoplexy (PA) is a rare neurosurgical emergency, associated with deficiency of one or more pituitary hormones. Few studies have explored the relative outcomes associated with conservative and neurosurgical intervention. METHODS: A retrospective evaluation of all patients with PA reviewed at Morriston Hospital was undertaken and diagnosis was obtained from Morriston database (Leicester Clinical Workstation database) between 1998 and 2019 from clinic letters and discharge summaries. RESULTS: Thirty-nine patients with PA were identified with a mean age of 74.5 years and 20 (51.3%) patients were women. Patients were followed up for a mean±SD 68.1±61.7 months. Twenty-three (59.0%) patients had a known pituitary adenoma. Commoner clinical presentations of PA were ophthalmoplegia or visual field loss. Following PA, 34 (87.2%) patients were noted to have a non-functioning pituitary adenoma (either pre-existing or new), while 5 (12.8%) patients had a pre-existing functional macroadenoma. Neurosurgical intervention was taken in 15 (38.5%) patients of which 3 (20.0%) patients also received radiotherapy, 2 (13.3%) patients had radiotherapy alone and the remainder managed conservatively. External ophthalmoplegia recovered in all cases. Visual loss remained in all cases. One (2.6%) patient with chromophobe adenoma had a significant second episode of PA requiring repeat surgery. CONCLUSION: PA often occurs in patients with undiagnosed adenoma. Hypopituitarism commonly occurred following conservative or surgical treatment. External ophthalmoplegia resolved in all cases, however, visual loss did not recover. Pituitary tumour recurrence and further PA episodes are rare.

Development of a trigger tool to identify adverse events and harm in Emergency Medical Services.

BACKGROUND: Adverse event(AE) detection in healthcare has traditionally relied upon several methods including: patient care documentation review, mortality and morbidity review, voluntary reporting, direct observation and complaint systems. A novel sampling strategy, known as the trigger tool (TT) methodology, has been shown to provide a more robust and valid method of detection. The aim of this research was to develop and assess a TT specific to ground-based Emergency Medical Services, to identify cases with the potential risk for adverse events and harm. METHODS: The study was conducted between March and December 2015. A literature review identified 57 potential triggers, which were grouped together by experts using an affinity process. Triggers for other areas of potential AE/harm were additionally considered for inclusion. An interim TT consisting of nine triggers underwent five iterative rounds of derivation tests of 20 random patient care records (n=100) in two emergency medical services. A final eight-item trigger list underwent a large sample (n=9836) assessment of test characteristics. RESULTS: The final eight-item TT consisted of triggers divided amongst four categories: Clinical, Medication, Procedural and Return-Call. The TT demonstrated an AE identification rate of 41.5% (sensitivity 79.8% (95% CI, 69.9% to 87.6%); specificity 58.5% (95% CI, 52% to 64.8%)). When identifying potential risk for harm, the TT demonstrated a harm identification rate of 19.3% (sensitivity 97.1% (95% CI, 84.7% to 99.9%); specificity 53.5% (95% CI, 47.7% to 59.3%)). DISCUSSION: The Emergency Medical Services Trigger Tool (EMSTT) may be used as a sampling strategy similar to the Global Trigger Tool, to identify and measure AE and harm over time, and monitor the success of improvement initiatives within the Emergency Medical Services setting.

The impact of idealised facial images on satisfaction with facial appearance: comparing 'ideal' and 'average' faces.

OBJECTIVES: Recent work has demonstrated that female orthognathic patients display more dissatisfaction with their facial appearance after viewing idealised images of facial photographs, than do controls. Patients may request orthognathic surgery because they hope to improve their appearance to conform with ideals portrayed in the mass media, and these hopes may not be realistic. Patients who demonstrate certain personality traits are more likely to hold such hopes. The current study sought to identify the role of dental status (orthognathic patient versus control), personality traits and media images in dissatisfaction with facial appearance. METHODS: Female patients and controls completed a bank of personality measures and then gave repeated measures of satisfaction with their facial appearance after viewing images of 'ideal' and 'average' women. RESULTS: Neither group showed any change in satisfaction with appearance after viewing either set of images. Patients showed lower satisfaction with facial appearance than controls, but did not differ on other personality measures. CONCLUSIONS: Viewing 'ideal' images of other women has no significant impact on satisfaction with appearance compared to viewing images of 'average' women. These results may help inform the development of a psycho-educational intervention to protect women against the negative effects of viewing idealised images in the media.

Characteristics attributed to individuals with dental fluorosis.

BACKGROUND: Previous investigations of the public perception of dental fluorosis have focused mainly on aesthetics. Other characteristics which could potentially be ascribed to fluorosis, such as perceived personality traits, have not been examined. OBJECTIVES: This study aimed to identify personal characteristics (descriptors) attributed to people with fluorosis of varying degrees of severity, as depicted in standardised photographs viewed from different perspectives. METHOD: Extra-oral (full face) and intra-oral images of male and female subjects were digitally manipulated to represent normal dental enamel, mild, moderate, and severe fluorosis. The images were then scored by 90 members of the public (45M, 45F), under different experimental conditions, which varied the level of cueing to the teeth. Participants were asked (i) to record their spontaneous descriptors, (ii) select relevant descriptors from a predefined list of 50 descriptors and traits. RESULTS: 170 different word or phrase descriptors were spontaneously attributed to the images. Characteristics used to describe fluorosis varied with the degree of severity. However, endorsements were significantly influenced by whether participants viewed extra or intraoral images and the degree of cueing. Conditions which most accurately mirrored everyday social interactions, that is viewing extraoral images without cueing to pay particular attention to the mouth, were least likely to result in the attribution of characteristics that varied with levels of fluorosis. CONCLUSIONS: While characteristics varying with severity of dental fluorosis were ascribed, more sophisticated attitudinal measures are required to ascertain the wider social impact of fluorosis beyond the aesthetic.