Effect of a Lifestyle-Focused Web-Based Application on Risk Factor Management in Patients Who Have Had a Myocardial Infarction: Randomized Controlled Trial.

BACKGROUND: Cardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction. However, the fulfillment of guideline-recommended cardiac rehabilitation targets is unsatisfactory. eHealth offers new possibilities to improve clinical care. OBJECTIVE: This study aims to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to center-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care). METHODS: All 150 patients participated in cardiac rehabilitation. Patients randomized to the intervention group (n=101) received access to the application for 25 weeks where information about lifestyle (eg, diet and physical activity), risk factors (eg, weight and blood pressure [BP]), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was a change in submaximal exercise capacity (Watts [W]) between follow-up visits. Secondary outcomes included changes in modifiable risk factors between baseline and follow-up visits and uptake and adherence to the application. Regression analysis was used, adjusting for relevant baseline variables. RESULTS: There was a nonsignificant trend toward a larger change in exercise capacity in the intervention group (n=66) compared with the usual care group (n=40; +14.4, SD 19.0 W, vs +10.3, SD 16.1 W; P=.22). Patients in the intervention group achieved significantly larger BP reduction compared with usual care patients at 2 weeks (systolic -27.7 vs -16.4 mm Hg; P=.006) and at 6 to 10 weeks (systolic -25.3 vs -16.4 mm Hg; P=.02, and diastolic -13.4 vs -9.1 mm Hg; P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs +1.4 points; P=.05), mostly owing to an increase in the consumption of fish and fruit. At 6 to 10 weeks, 64% (14/22) versus 46% (5/11) of smokers in the intervention versus usual care groups had quit smoking, and at 12 to 14 months, the respective percentages were 55% (12/22) versus 36% (4/11). However, the number of smokers in the study was low (33/149, 21.9%), and the differences were nonsignificant. Attendance in cardiac rehabilitation was high, with 96% (96/100) of patients in the intervention group and 98% (48/49) of patients receiving usual care only attending 12- to 14-month follow-up. Uptake (logging data in the application at least once) was 86.1% (87/101). Adherence (logging data at least twice weekly) was 91% (79/87) in week 1 and 56% (49/87) in week 25. CONCLUSIONS: Complementing cardiac rehabilitation with a web-based application improved BP and dietary habits during the first months after myocardial infarction. A nonsignificant tendency toward better exercise capacity and higher smoking cessation rates was observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03260582; https://clinicaltrials.gov/ct2/show/NCT03260582. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-018-3118-1.

Use of eHealth in the management of pulmonary arterial hypertension: review of the literature.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a severe chronic condition associated with poor quality of life and high risks of mortality and hospitalisation. The utilisation of novel diagnostic technologies has improved survival rates although the effectiveness of Electronic Health (eHealth) interventions in patients with a chronic cardiopulmonary disease remains controversial. As the effectiveness of eHealth can be established by specific evaluation for different chronic health conditions, the aim of this study was to explore and summarise the utilisation of eHealth in PAH. METHOD: We searched PubMed, CINAHL and Embase for all studies reporting clinical trials on eHealth solutions for the management of PAH. No limitations in terms of study design or date of publication were imposed. RESULTS: 18 studies (6 peer-reviewed journal papers and 12 conference papers) were identified. Seven studies addressed the accuracy, safety or reliability of eHealth technologies such as intra-arterial haemodynamic monitoring of the pulmonary artery pressure, self-administered 6-Minute walk test App, computerised step-pulse oximeter and ambulatory impedance cardiography. Two studies evaluated eHealth as part of the medical management and showed a reduction in hospitalisation rate. CONCLUSIONS: The evidence of eHealth supporting the management of people with PAH is limited and only embraced through a few studies of small sample size and short-term duration. Given the proposed clinical benefits in heart failure, we postulate that the evaluation of eHealth for the clinical management of PAH is highly warranted.

International feasibility trial on the use of an interactive mobile health platform for cardiac rehabilitation: protocol of the Diversity 1 study.

INTRODUCTION: The implementation of home-based cardiac rehabilitation has demonstrated potential to increase patient participation, but the content and the delivering of the programmes varies across countries. The objective of this study is to investigate whether an Australian-validated mobile health (mHealth) platform for cardiac rehabilitation will be accepted and adopted irrespectively from the existing organisational and contextual factors in five different European countries. METHODS AND ANALYSIS: This international multicentre feasibility study will use surveys, preliminary observations and analysis to evaluate the use and the user's perceptions (satisfaction) of a validated mHealth platform in different contextual settings. ETHICS AND DISSEMINATION: This study protocol has been approved by the Australian research organisation CSIRO and the respective ethical committees of the European sites. The dissemination of this trial will serve as a ground for the further implementation of an international large randomised controlled trial which will contribute to an effective global introduction of mHealth into daily clinical practice.

A Review of Randomized Controlled Trials Utilizing Telemedicine for Improving Heart Failure Readmission: Can a Realist Approach Bridge the Translational Divide?

BACKGROUND: Telemedicine and digital health technologies hold great promise for improving clinical care of heart failure. However, inconsistent and contradictory findings from randomized controlled trials have so far discouraged widespread adoption of digital health in routine clinical practice. We undertook this review study to summarize the study outcomes of the use of exploring the evidence for telemedicine in the clinical care of patients with heart failure and readmissions. METHODS: We inspected the references of guidelines and searched PubMed for randomized controlled trials published over the past 10 years on the use of telemedicine for reducing readmission in heart failure. We utilized a modified realist review approach to identify the underlying contextual mechanisms for the intervention(s) in each randomized controlled trial, evaluating outcomes of the intervention and understanding how and under what conditions they worked. To provide uniformity, all extracted data were synthesized using adapted domains from the taxonomy for disease management created by the Disease Management Taxonomy Writing Group. RESULTS: A total of 12 papers were eligible, 6 of them supporting and 6 others undermining the use of telemedicine for improving heart failure readmission. In general terms, those studies not supporting the use of telemedicine were multicentre, publicly funded, with large amount of participants, and long duration. The patients had also better rates of treatment with angiotensin-converting enzyme inhibitors/angiotensin II receptor blocker and beta-blockers, and telemonitoring and automatic transmission of vital signs were less utilized, in comparison with the studies in which telemedicine use was supported. The analysis of the environment, intensity, content of interventions, method of communication, quality of the underlying model of care and the ability, capability, and interest from health workers can help us to envisage probabilities of success of telemedicine use. CONCLUSIONS: A realist lens may aid to understand whom and in which circumstances the use of telemedicine can add any substantial value to traditional models of care. Wider outcome criteria beyond major adverse cardiovascular events, for example, cost efficacy, should also be considered as appropriate for effecting guidelines on care delivery when robust prognostic therapeutics already exist.

Modified facelift approach combined with a superficial musculoaponeurotic system flap in the treatment of benign parotid tumors.

PURPOSE: The purpose of this study was to investigate the adequacy of a modified facelift incision combined with an SMAS flap for the resection of benign parotid lesions in terms of cosmesis and incidence of Frey's syndrome. MATERIALS AND METHODS: A hundred patients who underwent superficial parotidectomy were divided into 2 groups according to approach: Blair incision (57 cases) and modified facelift incision (43 cases). In the latter group, 36 patients were reconstructed with a superficial musculoaponeurotic system (SMAS) flap. During follow-up, patients were asked to rate their satisfaction with their postoperative appearance using a 1 to 3 scale. RESULTS: Clinical Frey's syndrome was present in 8.5% of patients with SMAS flap, and in 19% patients without SMAS flap (p = 0.16). The average cosmetic outcome score for patients who underwent a modified facelift approach combined with an SMAS flap was 2.87, whereas patients whose tumors were approached through a Blair incision reported a lower score of 2.1 (p < 0.005). CONCLUSION: A modified facelift incision combined with an SMAS flap improved the cosmetic appearance of patients who underwent extrafacial or superficial parotidectomy. In addition, this flap seems to reduce the occurrence of Frey's syndrome.

Relevance of level IIb neck dissection in oral squamous cell carcinoma.

BACKGROUND: The purpose of this study was to determine the prevalence of level IIb metastasis in patients with oral squamous cell carcinomas (OSCCs). MATERIAL AND METHODS: A prospective analysis of 56 patients with OSCC who underwent surgical treatment of the primary lesion with simultaneous neck dissection was performed. During neck dissection, level IIb lymph nodes were separately removed and processed. Neck dissection was bilateral in 26 patients (46%) and unilateral in 30 patients (54%). RESULTS: The mean number of nodes found in the level IIb specimens was 4.7 (range: 0-8 nodes). The prevalence of metastasis at level IIb was 0% in pN0 necks and 3.4% in pN+ necks, with an overall prevalence of 1.8%. A significant association between metastasis to level IIb and type of neck dissection was observed. There were no isolated metastases to level IIb without the involvement of other nodes in the remaining neck specimen. Four regional recurrences were observed during follow-up. CONCLUSIONS: Based on our findings, we suggest that dissection of the level IIb region in patients with OSCC may be required only in patients with multilevel neck metastasis or if level IIa metastasis is found intraoperatively.

Prevalence of black stain and associated risk factors in preschool Spanish children.

BACKGROUND: In pediatric clinical practice, it is common to be asked about the presence of black stains on teeth in children and teenagers. According to controversial etiology, it is known to be related to a low rate of caries. The aim of this study was to determine the prevalence of black stain and associated risk factors in Spanish preschool children. METHODS: A total of 3272 children aged 6 years old (3058 non-emigrant and 214 immigrant children) living in Oviedo (Spain), were enrolled in the present study. RESULTS: The prevalence of black stain was 3.1% in the whole group. The index of primary decayed, missing, and filled teeth (dmft index) associated with black stain was 0.35 ± 1.123. A statistical association between black stain and the consumption of iron supplements was noted. CONCLUSIONS: The regular consumption of foods rich in iron and the use of iron supplements during pregnancy and early childhood, could favor the development of chromogenic microbiota. The prevalence of black stain did not differ significantly between non-emigrant and immigrant children in Spain.

A novel mutation in the IRF6 gene associated with facial asymmetry in a family affected with Van der Woude syndrome.

This report describes a novel missense mutation in the interferon regulation factor 6 (IRF6) gene associated to facial asymmetry. This new feature widens the phenotype spectrum of Van der Woude syndrome (VWS).

Treatment with removable prosthesis in hypohidrotic ectodermal dysplasia. A clinical case.

Ectodermal dysplasias form part of a wide range of syndromes presenting abnormal development of two or more tissues derived from the ectoderm. Hypohidrotic ectodermal dysplasia is a congenital syndrome, characterized by hypotrichosis (hair is sparse, fine and weak; anomalies in the skin and nails), hypohidrosis (due to the paucity of sweat glands which in turn gives rise to sweat disorders) and hypodontia (partial, and occasionally total, absence of primary and/or permanent dentition). A case of a child with hypohidrotic ectodermal dysplasia with oligodontia and marked resorption of the maxillary and mandibular alveolar ridges is presented. A prosthetic rehabilitation in the form of a removable acrylic prosthesis was made, achieving excellent esthetics, functionality and adaptation, thanks to which a considerable improvement in self-esteem has been obtained.

Sebaceous adenoma of the parotid gland.

Tumors of the salivary glands constitute an important field of oral and maxillofacial pathology. The majority of salivary gland neoplasms are benign, with malignant salivary tumors accounting for 15 to 32 percent. The most common site for salivary gland tumors is the parotid gland, accounting up to 80 percent of all cases. This article reports the pathologic picture in a case of sebaceous adenoma of the parotid gland. The tumor was composed of epithelial cells lining ducts and closely associated with broad areas of sebaceous differentiation. The growth pattern was predominantly cystic, with cavities filled with sebaceous material. Areas of oncocytic metaplasia were also seen. The presence of sebaceous glands in salivary neoplasms is frequent, however, and in spite of this, salivary neoplasms constituted partially or entirely of these cells are rarely observed. To the surgeon and pathologist, the major problem in dealing with sebaceous adenoma is the recognition of this rare entity, avoiding confusing with other more aggressive neoplasms. The treatment involves surgical excision. The addition of the current case to the previously published data brings the total number of parotid sebaceous adenoma to seven.

A study of pathology associated with short lingual frenum.

Ankyloglossia is a developmental anomaly of the tongue characterized by a short, thick, lingual frenum resulting in limitation of tongue movement. The frenum is attached to the tip of the tongue in varying degrees. This study evaluates short lingual frenum and other associated pathologies (dentofacial anomalies and lingual dysglossia) and investigates whether ankyloglossia is related to speech problems. A thorough intraoral examination was carried out using the WHO regulations for dentofacial anomalies and occlusion problems and a new scale of lingual mobility. This article also discusses the difficulty in diagnosing this condition and finally following to the results of our study, describes the indications for nonsurgical and surgical treatment of this anomaly.

Motilidad y daño acrosomal del semen caprino congelado en pajillas de 0.25 ml y 0.5 ml y descongelado a dos diferentes ritmos de temperatura / Motility and acrosomal damage of buck semen frozen in 0.25 ml and 0.5 ml straws and thawed at two different temperature rates

Se colectaron 16 eyacuaciones de 4 sementales caprinos por medio de la vagina artificial y se evaluaron las siguientes características: volumen, concentración espermática, motilidad progresiva y morfología acrosomal. Cada eyaculado se dividió en dos partes y se diluyó con Tris-Yema de huevo. El semen diluido se envasó en pajillas de 0.25 y 0.5 ml, cada una conteniendo 100millones de espermatozoides mótiles. Las pajillas se congelaron en vapores de nitrógeno líquido y se descongelaron a 37ºC/15 seg. o a 55ºC/8 seg. En las muestras descongeladas se determinó la motilidad progresiva, la recuperación de espermatozoides mótiles y el daño acrosomal. La motilidad progresiva al descongelar las pajillas de 0.5 ml fue de 62.8 por ciento (37ºC/15 seg) y 58.7 por ciento (55ºC/8 seg) y en la pajilla de 0.25 ml de 59 por ciento (37ºC/15 seg) y 60 por ciento (55ºC/8 seg) (P> 0.05). El daño acrosomal fue mayor (12.3 por ciento) en las pajillas de 0.5 ml descongeladas a 55ºC/8 seg que en los demás tratamientos (P < 0.05). La descongelación del semen caprino a 37ºC/15 seg es una técnica más sencilla a nivel de campo e implica menor riesgo. La motilidad progresiva y el porcentaje de daño acrosomal del semen caprino obtenidos en este trabajo, se encuentran dentro de los criterios establecidos para su aplicación en la inseminación artificial