Orthognathic patient perception of 3D facial soft tissue prediction planning.

The primary aim of this study was to explore patients' perceptions regarding the impact of 3D prediction planning (3D PP) of facial soft tissue changes following orthognathic surgery. The study was carried out on 30 patients who were shown photorealistic 3D soft tissue prediction planning before undergoing orthognathic surgery to demonstrate the expected facial changes. Distraction osteogenesis and cleft deformities were excluded from the study before consenting to surgery. Following surgery, the included patients were asked to complete a standard questionnaire to explore their perceptions regarding the impact, accuracy, and value of 3D prediction planning. The majority of the 30 participants perceived 3D PP to be beneficial in reducing their presurgical anxiety, increasing their motivation to undergo surgery, improving the accuracy of their surgical expectations, and enhancing doctor-patient communication. Most of the patients perceived their surgical soft tissue changes to be better than the predictions. Significant positive correlations were detected between satisfaction with the delivered service and the facility of seeing 3D PP (rs = 0.4; p = 0.034). Similarly, 3D PP improved patients' confidence in the surgical decision (rs = 0.4; p = 0.031), as well as increasing their motivation to undergo surgery (rs = 0.5; p = 0.010). 3D PP was found to be effective in improving the quality of orthognathic surgical care.

Medically unexplained symptoms in patients with PNES: Do they explain poor employment outcome in patients with good seizure outcomes?

BACKGROUND: Many patients with psychogenic nonepileptic seizures (PNES) have other medically unexplained symptoms (MUS). In order to assess their long-term contribution to ill-health and unemployment, we recorded MUS, employment, healthcare utilization, and seizure outcomes in a cohort of patients with PNES. METHODS: We had complete computerized healthcare records and employment information in 120 patients with PNES, 5-10years postdiagnosis. We analyzed these data to assess the contribution of MUS to ill-health and to determine whether MUS could explain differences among seizure, employment, and healthcare utilization outcomes in PNES. RESULTS: At 5-10years, 41/120 patients (34.2%) were attending primary or secondary care for seizures, 42/120 patients (35.0%) had MUS other than PNES, and 36/120 patients (30.0%) were employed. Unemployment was predicted by age at presentation (OR: 0.90 (0.86-0.94), p<0.001), presenting to primary or secondary care with seizures (OR: 0.16 (0.05-0.52), p=0.003), and contact with psychiatric services at 5-10years (OR: 0.16 (0.05-0.58), p=0.005). No outcome measures were predicted by additional MUS, though MUS themselves were predicted by psychiatric contact (OR: 2.27 (1.01-5.01), p=0.048). CONCLUSIONS: Our data suggest that MUS do not contribute independently to unemployment in the population with PNES, whereas psychiatric morbidity appears to do so. Nonetheless, MUS and psychiatric morbidity persist in the long term in a substantial minority of patients with PNES. We found no evidence that seizures in patients whose PNES have resolved are replaced with other MUS.

Do patients whose psychogenic non-epileptic seizures resolve, 'replace' them with other medically unexplained symptoms? Medically unexplained symptoms arising after a diagnosis of psychogenic non-epileptic seizures.

BACKGROUND: In clinical practice, it is sometimes observed that patients in whom psychogenic non-epileptic seizures (PNES) cease, develop another medically unexplained symptom (MUS). METHODS: In order to determine how many patients develop new MUS post diagnosis and whether patients whose attacks cease are more likely to do so, new MUS were recorded 6-12 months after the diagnosis of PNES in 187 consecutive patients. RESULTS: Compared with baseline, the overall proportion of patients with MUS increased slightly, from 70.1% to 76.5%, with 44/187 patients (23.5%) developing new MUS. There were no significant differences between attack free and non-attack free patients. Binary logistic regression analysis showed that predictors of new MUS diverged between attack free and non-attack free patients. Among patients continuing to have attacks, those with previous health related psychological trauma were 18.00 times more likely to develop new MUS (p<0.0005). In patients who became attack free, patients drawing disability benefits were 5.04 times more likely to have new MUS (p = 0.011). CONCLUSIONS: The results suggest that almost 25% of patients develop new MUS following a diagnosis of PNES, although most of those have MUS pre-diagnosis. Patients with a history of health related psychological trauma whose attacks continue after diagnosis are at particularly high risk of developing new MUS. The data do not support the hypothesis that PNES that resolve are likely to be 'replaced' by other MUS.