RESUMEN
INTRODUCTION: Adenotonsillar hypertrophy is the main cause of childhood sleep disordered breathing (SDB) and adenotonsillectomy (TA) the most common treatment. Polysomnography (PSG) for diagnosing SDB is often difficult to obtain with Otolaryngologists usually relying on history and examination when recommending TA. Questionnaires assessing quality of life (QoL) may assist the Otolaryngologists decision making. AIMS: To explore changes in QoL tools following TA for SDB in children aged 3 to 15 with the aim of identifying whether the Pediatric Sleep Questionnaire (PSQ) or Obstructive Sleep Apnoea -18 (OSA-18) is a better predictor of outcome following TA. METHODS: QoL was assessed using OSA-18, PSQ and the Pediatric Quality of Life Inventory™ (PedsQL™). Four groups were recruited from three research databases, those with: SDB, recurrent tonsillitis (RT), SDB and RT, or no disease (controls). Children either received TA or underwent observation. QoL questionnaires were administered at recruitment and 3 months later. Test-retest reliability was assessed using Bland-Altman plots. Pre-intervention scores were plotted against changes in scores, with pre-established cut-offs and cut-offs indicated by control group variability. RESULTS: There were 120 children, 25 had no intervention, and 19 were controls. All questionnaires showed test-retest reliability over time. Using the distribution of scores from the control group we estimated the 95th percentile to redefine the cut-off for OSA-18 (reduced from 60 to 46) and PSQ (unchanged from 0.33). Higher pre-operative scores predicted greater reduction following TA, with OSA-18 the most consistent predictor of QoL change. The PSQ classified 86.8% of children undergoing TA above the 0.33 cut-off; whereas OSA-18 classified 73.7% above the 46 cut-off. Of these, 71.2% and 87.5% showed improvement after TA, respectively. Using the 95% confidence interval for change in the control group to identify a 'meaningful' change in score, children with OSA-18 scores >46 had a 93% chance of a meaningful improvement, whereas PSQ scores >0.33 were associated with an 80% chance of a meaningful improvement. CONCLUSIONS: OSA-18 is a better predictor of improved QoL than PSQ for TA in children with SDB. We propose a new cut off score (>46) for OSA-18. This may assist Otolaryngologists' decision making when assessing a child with SDB.
Asunto(s)
Síndromes de la Apnea del Sueño , Tonsilectomía , Adenoidectomía , Niño , Humanos , Calidad de Vida , Reproducibilidad de los Resultados , Sueño , Síndromes de la Apnea del Sueño/diagnóstico , Síndromes de la Apnea del Sueño/cirugía , Encuestas y CuestionariosAsunto(s)
Fascitis Necrotizante/tratamiento farmacológico , Fascitis Necrotizante/mortalidad , Fascitis Necrotizante/cirugía , Extremidad Superior/microbiología , Administración Intravenosa , Adulto , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica/métodos , Amputación Quirúrgica/estadística & datos numéricos , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Desbridamiento/métodos , Desbridamiento/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Fascitis Necrotizante/diagnóstico , Humanos , Persona de Mediana Edad , Mortalidad/tendencias , Nueva Zelanda/epidemiología , Evaluación de Resultado en la Atención de Salud , Satisfacción del Paciente/estadística & datos numéricos , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Estudios Retrospectivos , Streptococcus pyogenes/aislamiento & purificación , Extremidad Superior/patologíaRESUMEN
A case of nasal myiasis that occurred in February 2017 in the Northland region was the first involving L. cuprina naturally-acquired in New Zealand.
Asunto(s)
Carcinoma de Células Escamosas/patología , Dípteros , Larva , Miasis/etiología , Enfermedades Nasales/parasitología , Neoplasias Nasales/patología , Anciano , Animales , Humanos , Masculino , Nueva Zelanda , OviposiciónRESUMEN
BACKGROUND: To review experience with partial superficial parotidectomy (PSP) and retrograde dissection of the facial nerve as a treatment for benign parotid tumors. METHODS: Retrospective cohort study of all patients presenting with a suspected benign primary parotid tumor undergoing parotid surgery. RESULTS: There were 214 cases retrieved. Postoperative facial nerve weakness occurred in 33% of patients; all were temporary. Increased extent of surgical resection (P < .001), deeper tumors (P = .05), and close tumor proximity to the facial nerve (P = .007) significantly correlated with postoperative facial weakness. The surgical margin was clear in 54%; 31% had capsule exposed in at least 1 point, and 13.5% had tumor at the margin. Cases with close proximity of tumor to facial nerve were more likely to have tumor at the margin (P = .034). CONCLUSION: Partial superficial parotidectomy with retrograde dissection is a suitable method for benign appearing parotid tumors.
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Adenolinfoma/cirugía , Adenoma/cirugía , Músculos Faciales , Parálisis Facial/epidemiología , Debilidad Muscular/epidemiología , Neoplasias de la Parótida/cirugía , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Estudios de Cohortes , Disección , Nervio Facial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
CONCLUSION: Some variation from the 'classical' clinical picture for Warthin's tumours is evident in these patients. A predilection for the parotid tail and a propensity for multiplicity has been confirmed. OBJECTIVES: This study sought to analyse demographic and clinical features of a Warthin's patient population. METHODS: Retrospective review of patients presenting with a benign parotid tumour. The group of Warthin's tumours was compared with the group of patients with other benign parotid tumours. RESULTS: Of 170 primary parotid tumours, 41 (24%) were Warthin's tumour. Mean age of Warthins patients was significantly older (60 years vs 48 years, p = 0.001) and male gender more prevalent (61% vs 33%, p = 0.015) than in other benign tumours. Most (86%) Warthin's tumours were found in the parotid tail, compared with 61% of other benign tumours (p = 0.002). There was no significant ethnic predilection for Warthin's tumours. Bilaterality (30%) and multiplicity (27%) were common. Significance of gender differences disappeared with logistic regression analysis.
Asunto(s)
Adenolinfoma/epidemiología , Adenoma/epidemiología , Neoplasias de la Parótida/epidemiología , Neoplasias de la Parótida/patología , Adenolinfoma/patología , Adenoma/patología , Adulto , Anciano , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , FumarRESUMEN
AIM: To investigate the reliability and intra-professional variation of senior and junior doctors in the assessment of a junior doctor's clinical skills via video simulation. METHODS: Simulation video was created showing 4 clinical scenarios. This video was shown to consultants, registrars and junior doctors in various forms at Auckland City Hospital. Participants evaluated each scenario against a modified version of the current assessment form used by the Medical Council of New Zealand. RESULTS: 103 Respondents completed the survey: 22 Senior Medical Officers, 17 registrars (PGY3+), 43 junior doctors (PGY1-2) and 21 undergraduates (medical students). Statistical significance between groups was reached only for Question 6 in which Senior Medical Officers rated communication skills and respect for patients lower than postgraduate students (p=0.005). Large variability was noted in ratings for 'presentation of history' and 'clinical knowledge'. CONCLUSION: There is marked variation between Senior Medical Officers in the assessment of a junior doctor's clinical practice as demonstrated by the use of a simulation video. This variation is of potential major concern. Quality training methods of assessors may need to be implemented for standardisation of assessment if a summative component exists.