Κυριακή 16 Οκτωβρίου 2022

InCISE: Instrument for Comprehensive Incisional and Surgical Evaluation

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InCISE: Instrument for Comprehensive Incisional and Surgical Evaluation

The evaluation of healing after head and neck surgery is currently qualitative and non-standardized. We developed InCISE: Instrument for comprehensive incisional and surgical evaluation to assess surgical wounds, which was found to be reliable, reproducible, and consistent.


Objective

The evaluation of healing after head and neck surgery is currently qualitative and non-standardized, limiting the quality of surgical healing assessments in clinical and research settings. We sought to develop an objective, standardized wound assessment score, and hypothesize that a reliable instrument can be developed to evaluate head and neck surgical wounds.

Methods

A prospective cohort study was conducted in a tertiary-care, academic head and neck surgery practice. Patients undergoing head and neck surgery were enrolled. A digital photograph protocol was developed for evaluating healing surgical wounds. A panel of experts developed and refined a wound healing score and established reliability, reproducibility, internal consistency, and validity of the score.

Results

InCISE: Instrument for comprehensive incisional and surgical evaluation was created. The utility of our wound healing score was assessed using classical test theory. We performed the major steps of establishing reliability in head and neck surgeons: (1) internal consistency (Cronbach's α = 0.81), (2) inter-observer reliability (intra-class correlation = 0.76), and (3) intra-rater reliability (intra-class correlation = 0.87), and content validity (through focus groups). Our composite measure was found to have strong internal consistency, inter-rater reliability, and intra-rater reliability. Preliminary work suggests criterion validity via associations with physical health related quality of life (SF-12).

Conclusion

A wound healing score for head and neck surgery, InCISE, has been developed and is reliable, reproducible, and consistent. Although content validity is present and criterion validity is suggested, work continues to establish validity in this instrument to allow for expanded clinical and research use.

Level of Evidence

N/A Laryngoscope, 2022
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A Nationwide Evaluation of Bevacizumab-based Treatments in Paediatric Low-Grade Glioma in the UK: Safety. Efficacy, Visual Morbidity and Outcomes

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Abstract
Background
Bevacizumab is increasingly used in children with Paediatric Low-Grade Glioma (PLGG) despite limited evidence. A nationwide UK service evaluation was conducted to provide larger cohort 'real life' safety and efficacy data including functional visual outcomes.
Methods
Children receiving Bevacizumab-based treatments (BBT) for PLGG (2009-2020) from 11 centres were included. Standardised neuro-radiological (RANO-LGG) and visual (logMAR visual acuity) criteria were used to assess clinical-radiological correlation, survival outcomes and multivariate prognostic analysis.
Results
Eighty-eight children with PLGG received BBT either as 3 rd line with Irinotecan (85%) or alongside 1 st/2 nd line chemotherapies (15%). Toxicity was limited and minimal. Partial response (PR, 40%), stable disease (SD, 49%), and progressive disease (PD, 11%) were seen during BBT. However, 65% progressed at 8 months (median) from BBT cessation, leading to a radiology-based 3yr-progression-free survival (PFS) of 29%. Diencephalic syndrome (p= 0.03) was associated with adverse PFS. Pre-existing visual morbidity included unilateral (25%) or bilateral (11%) blindness. Improvement (29%) or stabilisation (49%) of visual acuity were achieved, more often in patients' best eyes. Vision deteriorated during BBT in 14 (22%), with 3-year visual-PFS of 53%; more often in patients' worst eyes. A superior visual outcome (p=0.023) was seen in Neurofibromatosis type 1-associated Optic Pathway Glioma (OPG). Concordance between visual and radiological responses was 36%; optimised to 48% using only best eye responses.
Conclusions
BBTs provide effective short-term PLGG control and delay further progression, with a better sustained visual (best >worst eye) than radiological response. Further research could optimise the role of BBTs towards a potentially sight-saving strategy in OPG.
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Effects of calcium hydroxide intracanal medicament on push‐out bond strength of endodontic sealers: A systematic review and meta‐analysis

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Abstract

Objective

To investigate the effect of calcium hydroxide intracanal medicament on the push-out bond strength of resin-based and calcium silicate-based endodontic sealers.

Methods

A comprehensive search of was conducted for all relevant in-vitro studies. All randomized controlled in-vitro studies that evaluated the effect of calcium hydroxide on the push-out bond strength of resin-based or calcium silicate-based endodontic sealers were assessed. The variables of interest were extracted, and the risk of the included studies was evaluated. The standardized mean difference was calculated and the significance level was set at p value <0.05.

Results

A total of 26 studies were eligible for analysis. There were 45 independent comparison groups and 1009 recruited teeth. The pooled data showed no significant difference in push-out bond strength between calcium hydroxide and control group in the resin-based group (SMD = 0.03; 95% CI = −0.55, 0.60; p = 0.93), and calcium silicate-based group (SMD = 0.02; 95% CI = −0.31, 0.35; p = 0.90). Most of the studies (21 out of 26) were at medium risk of bias and five studies showed a low risk of bias.

Conclusion

The available evidence suggests that calcium hydroxide used as intracanal medication does not influence the push-out bond strength of the resin- and calcium silicate-based endodontic sealers.

Clinical significance

The results of this meta-analysis suggest that calcium hydroxide used as intracanal medication does not influence the push-out bond strength of resin-based and calcium silicate-based endodontic sealers.
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HBV REPLICATION DURING TENOFOVIR THERAPY IS FREQUENT IN HIV/HBV-COINFECTION

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ABSTRACT
In the Swiss HIV Cohort Study, 61/222 (27%) HIV-suppressed persons with chronic hepatitis B virus (HBV) infection had HBV replication after two years on tenofovir, of whom 77% were suppressed thereafter. Self-reported adherence to therapy and HBV viral load at tenofovir initiation were predictors of persistent replication.
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Perfusion of microvascular free flaps in head and neck reconstruction after prior neck dissection and irradiation

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Microvascular free flaps are frequently used for head and neck reconstruction after prior neck dissection (ND) and neck irradiation (RTX). The aim of this study was to investigate the influence of ND and RTX on flap perfusion as a critical factor for flap success. Overall, 392 patients reconstructed with a microvascular fasciocutaneous flap (FF) or perforator flap (PF) in the head and neck region between 2011 and 2020 were analysed retrospectively. Flap perfusion measured intraoperatively and postoperatively with the O2C tissue oxygen analysis system was compared between patients who had received neither ND nor RTX (controls), patients who had received ND but no RTX (ND group), and patients who had received both ND and RTX (ND+RTX group). (Source: International Journal of Oral and Maxillof...
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