The efficacy and safety of ankle blocks for foot and ankle surgery: A systematic review with meta-analysis and trial sequential analysis.

BACKGROUND: Peripheral nerve blocks may be essential elements in a multimodal pain management regime following foot and ankle surgery. We assessed the effects of ankle blocks compared with no intervention/sham block or a sciatic nerve block in patients undergoing surgery of the foot or ankle. METHODS: We searched CENTRAL, Medline, and Embase for randomised clinical trials comparing ankle block with no intervention/sham block or a sciatic nerve block for patients undergoing surgery of the foot or ankle. Our primary outcomes were duration of analgesia and cumulative 24-hour opioid consumption. We followed the recommendations of the Cochrane Handbook, and performed meta-analysis, Trial Sequential Analysis (TSA), and assessed the risk of bias and certainty of the evidence using the GRADE approach. RESULTS: We included five trials (362 participants) comparing ankle block with no intervention/sham block and three trials (247 participants) comparing ankle block with a sciatic nerve block. Ankle block may increase the duration of analgesia when compared with no intervention/sham block (MD 431 min; 96.7% CI 208 to 654), but the evidence was very uncertain. Duration was decreased when compared with a sciatic nerve block (MD -410 min; 96.7% CI -462 to -358). The ankle block duration was probably important in both comparisons. The effects on cumulative 24-hour opioid consumption were very uncertain in both comparisons. CONCLUSIONS: Ankle block may increase the duration of analgesia when compared with no intervention/sham block, but the evidence was very uncertain, and decrease the duration of analgesia when compared with a sciatic nerve block. The ankle block duration was probably clinically important in both comparisons. The effects on cumulative 24-hour opioid consumption were very uncertain.

Evaluating the validity of the Index of Dental Anxiety and Fear (IDAF-4C+) in adults with severe dental anxiety.

Dental anxiety is a common condition with severe consequences for oral health and health-related quality of life. The aim of this study was to evaluate the recently developed self-report scale Index of Dental Anxiety and Fear (IDAF-4C+) in adults with severe dental anxiety. A sample of 147 adults (age 20-71 yr) with severe dental anxiety completed a questionnaire including the IDAF-4C+ and three other dental anxiety scales. In a clinically assessed subgroup (n = 93), 95% had an International classification of diseases and related health problems 10th version (ICD-10) diagnosis of specific phobia for dentistry. Agreement between the scales was analysed using Spearman's correlation, the Kappa measure of agreement and the intraclass correlation coefficient. The agreement of dental phobia according to the IDAF-4C+ phobia module and the ICD-10 was very low (ĸ = 0.02). The anxiety and fear module of the IDAF-4C+ showed acceptable agreement with the other scales (rs 0.69-0.75; ICC 0.90, 95% CI 0.87-0.93). We conclude that the IDAF-4C+ offers more information to clinicians and researchers than the older dental anxiety scales, but the phobia module needs further development.

Dental pain and oral health-related quality of life in individuals with severe dental anxiety.

OBJECTIVES: To analyze the prevalence and level of dental pain among adult individuals with severe dental anxiety (DA), and the association between dental pain and oral health-related quality of life (OHRQoL). METHODS: The study was based on 170 adult individuals with DA referred to a specialized DA clinic. All patients answered a questionnaire including questions on DA (DAS, DFS), OHRQoL (OIDP) and dental pain. An adapted clinical examination and a panoramic radiograph revealed the present oral status. RESULTS: The prevalence of dental pain was high (77.6%) and among those reporting pain the intensity was high (49.0-61.0 on a VAS). One or more problems during the last 6 months with the mouth or teeth affecting the individual's daily activities were reported in 85.3% of the participants. Individuals who reported dental pain had lower OHRQoL compared with those who did not report dental pain (p < .001). Dental pain and number of decayed teeth were associated with the probability of poor OHRQoL (OR = 8.2, p < .001, OR = 3.8, p = .008). CONCLUSION: This study revealed a high prevalence and a high level of dental pain among adult individuals with severe DA. Having dental pain was associated with poor OHRQoL.

Vigilance adjustments in relation to long- and short term risk in wild fallow deer (Dama dama).

The risk allocation hypothesis predicts that vigilance should be adjusted to the temporal variation in risk. We test this hypothesis in wild fallow deer exposed to short term (disturbance) and long term (presence of a fawn after parturition) changes in risk. We recorded the proportion, frequency and type of vigilance and size of used area before and after parturition, in GPS-collared wild female fallow deer. Vigilance was divided in two main groups: "non-grazing vigilance" and "grazing vigilance". The latter group was divided into "grazing vigilance while chewing" and a "grazing vigilance when chewing was interrupted". By recording external disturbance in form of passing cars, we were able to investigate if this altered the amount, and type of vigilance. We found that females increased the proportion and frequency of "grazing vigilance stop chewing" after parturition. The "grazing vigilance chewing" was unaffected, but "non-grazing vigilance" decreased. Disturbance increased the proportion "grazing vigilance stop chewing" to the same extent before and after parturition. We found a clear decrease in female home range size after parturition as a possible behavioural adjustment. The increase in "grazing vigilance stop chewing" after parturition is a rarely described but expected cost of reproduction.

How children experience brief-exposure treatment of specific phobias.

Examined how 56 children who had received brief-exposure treatment for specific phobias experienced the treatment. It was also investigated whether there was a relation between the children's reported experiences before, during, and after the treatment and therapy outcome. Results indicated that the treatment was experienced as something positive, and the large majority of the children appreciated the pace and degree of control they had during treatment, as well as the therapist and the treatment outcome. The response patterns did not differ between sexes, diagnostic groups, mode of treatment, or age groups. The therapy outcome of the children was not found to differ according to the children's pretreatment expectations and feelings during the treatment, neither according to the children's evaluations of the pace of the treatment nor of the therapist's. However, children's reports about their feelings upon termination of the treatment and the satisfaction with the treatment differed significantly depending on the treatment outcome. Results and tentative explanations of these are discussed and implications for future lines of research are suggested.