Surgery-first orthognathic approach vs conventional orthognathic approach: A systematic review of systematic reviews.

Surgery-first approach (SFA) has been introduced as an alternative for conventional orthognathic approach (COA) in the treatment of patients with dentoskeletal deformities. This review aimed to evaluate skeletal stability, treatment time, surgical complications, and quality of life in SFA and COA. Six databases were accessed up to May 2020 to obtain all systematic reviews (SRs). After title and abstract reading, data extraction was performed from eligible SRs. The methodological quality was calculated for the included SRs using the last version of A Measurement Tool to Assess Systematic Review (AMSTAR-2). Ten SRs were included in this review. A good stability of the jaws was assessed both with SFA and COA by most of low- or critically low-quality SRs. Less treatment time was reported for SFA than COA with a moderate quality level. Slightly higher complications rate was recorded with SFA than COA by SRs with low or moderate quality. A better quality of life with SFA than COA was reported by moderate- or low-quality SRs. SFA may represent a reasonable alternative to COA. However, for the heterogeneity of the included SRs, well-designed studies with a long term follow-up are needed to clarify the findings of this analysis.

Cancer-Induced Bone Pain Management Through Buddhist Beliefs.

Dealing with physical pain represents a huge public health expenditure, especially for cancer-induced bone pain, one of the most difficult health issues, which impairs appetite, sleep, and mobility, negatively impacting quality of life and evoking mental problems. Although some literature has reported positive correlation between religion and pain management, there is a dearth of research examining the effectiveness of Buddhism on this topic. This study investigates the usefulness of Buddhist beliefs in managing cancer-induced bone pain through a case example. It illustrates how an advanced cancer patient, with the assistance of a counsellor, perceived pain and coped with it and pain-induced mental problems via Buddhist teachings and practices, including the four noble truths, the law of dependent origination, and karma. It offers alternative perspectives for helping professionals (such as physicians, nurses, counsellors, social workers, hospice and palliative service providers, and pain management practitioners) who are keen to equip themselves with a wider worldview and life view to better serve their clients.

Validation of the psychometric properties of cognitive fusion questionnaire. A study of the factorial validity and factorial invariance of the measure among osteoarticular disease, diabetes mellitus, obesity, depressive disorder, and general populations.

BACKGROUND: The cognitive fusion questionnaire (CFQ) is a self-report questionnaire that assesses the extent to which individuals are psychologically entangled with, and dominated by the form-content of their thoughts. The aim of this study was to replicate the factor structure of CFQ in osteoarticular disease, diabetes mellitus, obesity, depressive disorder, and normative population. It further examined the factorial invariance of the CFQ across these 5 groups. METHOD: Data from 299 participants (N General Population  = 67, N Osteoarticular Disease  = 73, N Diabetes Mellitus  = 47, N Depressive Disorder  = 45, and N Obesity  = 60) were subjected to confirmatory factorial analysis (CFA) to replicate the structural model of CFQ dimensionality. RESULTS: CFA supported a 1-factor structure with good internal consistency and construct related validity. The 1-factor solution was also supported by a second independent data set, which showed a configural, strict measurement, and structural invariance of the 1-factor solution proposed. Multigroup CFA showed the configural invariance, strict measurement invariance, and structural invariance of CFQ across the 5 groups under study. CONCLUSIONS: The unidimensional model has both similar meanings and the same structure, but the measurement model across the groups was not the same. The study provides the first approach to CFQ to Portuguese population, as a reliable tool of general cognitive fusion. Furthermore, results indicated that CFQ has a coherent structure across multiple samples and clinical utility, as it discriminate individuals with psychological distress from those who do not.

Awareness, concern, and communication between physicians and patients on bone health in cancer.

PURPOSE: This study aims to explore physician-patient communications about bone metastases and cancer treatment-induced bone loss (CTIBL). METHODS: The study utilizes online survey of patients with breast cancer, prostate cancer, and multiple myeloma, and the physicians who treat them. RESULTS: Even though 69 and 48 % of patients with nonmetastatic breast and prostate cancer aware of treatment-induced bone loss, only 39 and 23 %, respectively, were concerned about bone loss. Yet, 62 and 71 % of oncologists treating breast and prostate cancer felt that their patients were concerned. Among patients with metastatic breast and prostate cancer, two thirds had not discussed treatment for bone metastases with their doctor; when discussed, 88 and 91 % of discussions were initiated by the doctor, usually prior to initiating treatment. Most myeloma patients (77 %) had discussed treatment options with their physicians; 99 % of hematologists reported discussing treatment of bone disease with patients. CONCLUSIONS: Physicians are primary sources of information to patients regarding bone health. There is a gap between what physicians assume their patients know about bone health and the patients' perceptions, presenting a need for systematic awareness and education.

Health state utilities for skeletal-related events secondary to bone metastases.

INTRODUCTION: Patients with bone metastases often experience skeletal-related events (SREs). Although cost-utility models are used to examine treatments for metastatic cancer, limited information is available on utilities of SREs. The purpose of this study was to estimate the disutility of four SREs: spinal cord compression, pathological fracture, radiation to bone, and surgery performed to stabilize a bone. METHODS: General population participants from the UK and Canada completed time trade-off (TTO) interviews to assess the utility of health states drafted based on literature review, clinician interviews, and patient interviews. Respondents first rated a health state describing cancer with bone metastases. Then, the SREs were added to this health state. RESULTS: Interviews were completed with 187 participants (50.8 % male, 80.2 % white). Cancer with bone metastases without an SRE had a mean utility of 0.47 (SD = 0.43) on a standard utility scale (1 = full health, 0 = death). Of the SREs, spinal cord compression was associated with the greatest disutility (i.e., the utility decrease): -0.32 with paralysis and -0.22 without paralysis. Surgery had a disutility of -0.07. Leg, arm, and rib fractures had disutilities of -0.06, -0.04, and -0.03. Two weeks of daily radiation treatment had a disutility of -0.06, while two radiation appointments had the smallest impact on utility (-0.02). CONCLUSION: All SREs were associated with statistically significant utility decreases, suggesting a perceived impact on quality of life beyond the impact of cancer with bone metastases. The resulting disutilities may be used in cost-utility models examining treatments to prevent SREs secondary to bone metastases.

Increased self-transcendence in patients with intractable diseases.

AIMS: Patients with intractable disease require long-term treatment and experience repeated bouts of progressive symptoms and resolutions, which cause them severe suffering. The aim of this study was to elucidate the concepts of self-transcendence and subjective well-being in patients with intractable disease. METHODS: Forty-four patients with intractable disease (men/women: 22/22) participated. The diseases of the participants were classified into five systems: (i) neural/muscle system; (ii) digestive system; (iii) immunity/blood system; (iv) visual system; and (v) bone/joint system. The controls were 1854 healthy individuals (men/women: 935/869). Participants completed the Self-Transcendence Scale (STS) and the Japanese version of the World Health Organization-Subjective Inventory. The Japanese version of the Mini-International Neuropsychiatric Interview was also used for the intractable disease group. RESULTS: Analysis of covariance found a significant increase in STS score among the intractable disease group (P < 0.001). Multiple regression analysis showed that the positive affect measured by the World Health Organization-Subjective Inventory showed the greatest effect on the STS score for the intractable disease group (ß = 0.539, P < 0.001). CONCLUSION: As a life-changing experience, an intractable disease may influence an increase in self-transcendence. The results also showed that there was a strong correlation between self-transcendence and respondents' subjective well-being. Our results suggest that patients with life-changing intractable disease can have a high level of self-transcendence, which may lead them to regain mental well-being, and increase their psychological health even in situations that cause physical and mental suffering.

Can parents rate their children's quality of life? Perspectives on pediatric orthopedic outcomes.

The ultimate goal of treatment for children with orthopedic problems is to improve their health-related quality of life. Because children may lack the abilities to effectively interpret and answer the questions used to assess a patient's health-related quality of life, parent proxies have been used in such pediatric cases. Unfortunately, previous studies exploring the efficacy of these parent proxies have been inconsistent. It is therefore important to determine the level of agreement between child-parent dyads and whether agreement is mediated by variables such as disease type, demographics, instrument, and the domain being assessed. The purpose of this study was to examine the degree of agreement between children and their parents' ratings in the Child Health Questionnaire (CHQ) and the Pediatric Orthopaedic Data Collection Instrument (PODCI), two instruments commonly used to assess health-related quality of life in children. The CHQ, PODCI, and standard demographic and clinical data were collected from parents and children between the ages of 5 and 18 years with a wide range of musculoskeletal problems. There was a strong level of agreement between child and parent responses for most of the domains in both instruments. Exceptions included Physical Functioning (PF), General Health (GH), and Mental Health (MH) in the CHQ, and Expectations in the PODCI. All four of these domains exhibited significant differences between the two respondent groups and had medium effect sizes. Children reported a higher level of PF and lower levels of both GH and MH than their parents. Additionally, parents reported significantly higher expectations for treatment than children did. None of the regressions yielded significant ß values for child age, parent sex, match/no match between parent-child sex, and scoliosis/nonscoliosis diagnosis. These significant discrepancies were not driven by specific subsamples; therefore, we concluded that these discrepancies can be generalized to the pediatric orthopedic population. Our results also indicate that the CHQ is more sensitive than the PODCI to the rating differences between children and parents. The results of this study can serve clinicians in pediatric orthopedic surgery as a guide for not only selecting the most appropriate instruments for assessment but also for interpreting treatment outcomes most meaningfully. Level of Evidence is the Level II Prognostic Study.

European orthopaedic and trauma patients' perceptions of nursing care: a comparative study.

AIM: To compare English, Finnish, Greek and Swedish orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation. BACKGROUND: Patient perceptions are important when evaluating nursing care delivery. Evaluations usually take place sub-nationally though European citizens may be treated throughout the European Union. International comparative studies are possible because of the universal nature and philosophical roots of quality in nursing care. They are needed to assist in improving care outcomes. DESIGN: A cross-sectional, comparative study design was used. METHOD: The Schmidt Perception of Nursing Care Survey was used to obtain data from orthopaedic and trauma patients in acute hospitals in four countries: Finland (n = 425, response rate 85%), Greece (n = 315, 86%), Sweden (n = 218, 73%) and UK (n = 135, 85%). Data were first analysed using descriptive statistics, then between-country comparisons were computed inferentially using a one-way analysis of variance and a univariate analysis of covariance. RESULTS: Between-country differences were found in patients' perceptions of the nursing care received. Over the whole Schmidt Perception of Nursing Care Survey the Swedish and Finnish patients gave their care the highest assessments and the Greek patients the lowest. The same trend was seen in each of the four sub-scales: Seeing The Individual Patient, Explaining, Responding and Watching. Responding was given the highest assessments in each participating country and Seeing the Individual Patient the lowest except in Greece. CONCLUSIONS: Further research is needed to consider whether the between-country differences found are caused by differences between cultures, nursing practices, roles of healthcare personnel or patients in the different countries. The Schmidt Perception of Nursing Care Survey is suitable for the assessment of European orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation. RELEVANCE TO CLINICAL PRACTICE: The results are useful in evaluating and developing nursing care in hospitals from different European countries.

Is survival enough for quality of life in Sagliker Syndrome-uglifying human face appearances in chronic kidney disease?

BACKGROUND: It is known that secondary hyperparathyroidism (SH) and particularly skeletal changes is a severe condition in chronic kidney disease (CKD). Sagliker syndrome (SS) is a very prominent feature in CKD including uglifying human face appearances, short stature, extremely severe maxillary and mandibulary changes, soft tissues in the mouth, teeth-dental abnormalities, finger tip changes and severe psychological problems. METHODS: In the last 8 years we have confronted 36 extremely incredible SS cases in CKD by performing an international study in Turkey, India, Malaysia, Romania and Egypt. RESULTS: In addition to the uglifying human face appearance, we found extremely severe X-ray and tomographical, pantomographical, histo-pathological changes in the head and whole body. Finally, we compared previous face pictures with recent ones. Just a few years earlier they had been pretty and good-looking young boys and girls. By investigating their history, we understood they had not received proper therapy and were in the late-irreversible period. CONCLUSION: SS is a serious and severe complication of CKD. Late and improper treatment leads to abnormalities throughout skeleton particularly in the skull and face. Changes particularly in children and teens become irreversible-disastrous for appearance and psychological health. Appropriate treatment must begin as early as possible in specialized centers. It is possible that SS patients may survive long-term with dialysis, but with all those particular changes could anyone claim this type of life would continue in an acceptable way without extending their height, correcting all the changes in the skull and face, remodeling new faces and most particularly convincing the patients to deal with all those tragi-dramatic psychological problems?

Psychiatric aspects of orthopaedics.

Although psychiatric problems are seen less frequently than previously, the orthopaedic surgeon must remain aware of their possible effect. A high index of suspicion for the presence of psychiatric disorders is important in treating the orthopaedic patient with multiple trauma, chronic disease, factitious disorder, or suspected malingering or who fails to improve with recognized treatment. Recognition of a psychiatric problem should be part of preoperative planning in orthopaedic practice, and a formal psychiatric referral for diagnosis and treatment should be made for the patient with significant psychiatric involvement. When associated psychiatric disease is diagnosed and controlled before orthopaedic treatment commences, the patient is more likely to comply with the treatment regimen, which may lead to better results.

Long-term outcomes after allogeneic stem cell transplantation for children with hematological malignancies.

We analyzed long-term outcomes and psycho-social aspects in 112 children with malignancies surviving 1 year after hematopoietic stem cell transplantation. At 10 years, overall survival was 75+/-5%, TRM 18+/-4% and relapse 14+/-3%; 10-year cumulative incidence of infections was 31+/-4%, cataract 44+/-4%, pulmonary dysfunction 20+/-4%, bone and joint complications 29+/-5%, hypothyroidism 36+/-4%, cardiac complications 11+/-3% and secondary malignancies 7+/-3%. Total body irradiation (TBI) was the most significant risk factor associated with cataract, pulmonary impairment, osteoarticular complications and hypothyroidism. Chronic graft-versus-host disease was associated with higher incidence of pulmonary dysfunction. The number of complications per patient increased with time. Half of the patients had psychological disturbance, 13 signs of depression and 16 a history of eating behavior disorders; 54% of patients with one or more long-term complications had psychological problems. Sixty-nine patients had learning difficulties and 36 achieved normal scholarship. With increased follow-up, development of late effects and of psycho-social disturbance are of major concern. While the use of single-dose TBI has now been abandoned, other risk factors are still of concern in the early 2000s.

[Effect of secondary prophylaxis on quality of life in gerontologic patients at the rehabilitation center for the disabled Patriotic war veterans in local sanatorium]. / Vliianie vtorichnoi profilaktiki na kachestvo zhizni gerontologicheskikh bol'nykh v usloviiakh tsentra reabilitatsii invalidov Otechestvennoi voiny na baze mestnogo sanatoriia.

AIM: To study efficacy of sanatorium treatment of aged patients with gastroenterological and locomotor diseases in the heriatric center. MATERIAL AND METHODS: 100 patients were investigated for effects of sanatorium treatment on quality of life. RESULTS: Clinical symptoms depended on the patients' age. Patients under 70 years of age had leading symptoms from gastrointestinal organs and locomotor system. These patients were most responsive to rehabilitation measures. In 70-year-olds and older patients cardiovascular and cerebral pathologies are of special importance limiting usage of physiotherapy and necessitating wider application of medicines: hypotensive, antianginal, circulation correcting, etc. The sanatorium stage of rehabilitation creates a positive emotional background in these patients. CONCLUSION: Sanatorium treatment resulted in improvement of life quality in gerontological patients.

Uncertainty in illness. An integrative review.

The purpose of this article is to report an integrative review of uncertainty in the illness experience, describe the uncertainty in illness theory, and to discuss the importance of assessing the appraisal of uncertainty experienced in illness with individuals and families faced with illness.

Bony pathology in the cancer patient.

Bony pathology in the cancer patient represents a significant source of morbidity and mortality. Complications include insufficiency and pathological fractures resulting from either medical treatments or bony metastases that can cause significant functional limitations. Additional complications include spinal cord compression, hypercalcemia, and bone marrow failure. Rehabilitation management of such conditions is reviewed, with an emphasis on diagnostic and therapeutic management. Bracing and focused rehabilitation programs facilitate maximal participation and functional outcomes, which can result in an enhanced quality of life. Specific rehabilitation goals and strategies are discussed, with an emphasis on tailoring these according to the functional staging of the patient.

Influence of osteoarticular pathology (OAP) on the quality of life of elderly people.

BACKGROUND: In elderly people the concept of quality of life includes health status, ability to perform daily tasks and social activities, financial position, emotional status and absence of aches and pains. OBJECTIVE: To evaluate the degree of incapacity related to osteoarticular pathology (OAP), one of the most common diseases among old people, and to ascertain to what extent this affects their quality of life. DESIGN: The sample was made up of 59 men (76.1+/-8.1 years) and 104 women (79.7+/-6.2 years) from a geriatric home depending on the Generalitat Valenciana (Spain). Data obtained from the individual clinical histories and personal interviews made it possible to evaluate their: global health status, ability to perform daily tasks and social activities, food intake and the quality of the geriatric home. In addition, body mass index (BMI), arm muscle area (AMA) and arm fat area (AFA) were estimated. RESULTS: The number of chronic diseases, drug consumption, and values of the fat-mass indicators (BMI and AFA) were significantly higher (p<0.05) in people with OAP (61% of women and 25% of men of the sample), and their global health status and manual ability were significantly worse (p<0.05) than that of the other residents. Both groups (with and without OAP) obtained similar scores (p>0.05) on all indicators of quality of life evaluated, and only the catering services was disliked by the majority of the residents. CONCLUSIONS: From a subjective point of view, OAP does not seem to affect the quality of life of people suffering from it, except insofar as it diminishes their manual ability.

[Osteoarticular disease in adults in France. A survey of 2000 persons]. / Pathologie ostéo-articulaire de l'adulte en France. Enquête auprès d'un énchantillon de 2000 personnes.

PURPOSE OF THE STUDY: Seeking for a global epidemiology data on bone and joint disease in adults in France, we analyzed the problems related to bone and joint disease in a sample population to determine healthcare needs. We also examined patient referral and demand for surgical care for bone and joint disease and the degree of patient satisfaction. MATERIAL AND METHODS: A telephone interview was conducted in a randomly sampled population of adults living in France to determine their demographic characteristics and bone and joint conditions and surgical care reported by the interviewees. Before standardizing, the sample population in the 60-year and older group was increased in order to obtain more precise information concerning degenerative joint disease. The sample included 1000 persons aged under 60 years and another 1000 persons aged over 60 years. The sample populations were matched to the French population for sex and age distribution. One hundred personal face-to-face interviews were also conducted with 100 persons residing in a nursing home. The two surveys were conducted in June and July 1999. RESULTS: Extrapolation of the data obtained to the French population yielded a total of 12 million adults affected by a bone and joint condition during the year preceding the survey. Considering both study samples, the most frequent localizations concerned the spine and the knees. The distribution of the other localizations was age and sex dependent. The percentage of trauma-induced conditions was 31%, predominantly in men under the age of 60 years and in institutionalized individuals. Extrapolation yielded a total of 5.4 million persons who had (or expected to have) a surgical intervention due to a bone and joint condition. The percentage of surgical treatment was highest for fractures (41%) and extravertebral osteoarthritis (18%). Extrapolation to the French population yielded 0.55 million persons aged over 60 years with a hip prosthesis and 0.27 million with a knee prosthesis. Seventy-six percent of the individuals who had undergone surgery for a conditions unrelated to trauma felt their quality of life had been improved. For those who had surgery for a trauma-induced condition, 85% considered they had minimal or no sequelae. Information provided by the surgeon concerning surgical care was thought to be insufficient by 23% of the operated individuals and 43% of those who had a joint prosthesis stated they had not been informed that their implant might be changed. Management of postoperative pain was thought to be insufficient by 36% of the operated individuals. DISCUSSION: Due to the wide field of investigation and the methodology used to collect these data, our findings cannot be easily compared with other epidemiological data. They must be considered with caution due to the sampling bias of a telephone interview and also to the bias introduced by the simplified nosology scheme used for the questionnaire and the fact that no medical validation was performed. These data do however show that a large number of adults are concerned, notwithstanding conditions occurring before the age of 18 years with the frequency of accidents during childhood and adolescence. The data collected confirm the priorities set within the framework of the Bone and Joint Decade 2000-2010.

[Treatment of bone disorders in renal diseases]. / Lechenie patologii kostnoi sistemy pri zabolevaniiakh pochek.

AIM: To study possible correction of bone disorders (osteopenia, Ca/P-imbalance, bone pain, limited volume of indolent movements) which are still a serious complication associated with renal diseases and pathogenic therapy (steroids). MATERIALS AND METHODS: The bone disorders were treated in 10 uremic hemodialyzed patients (8 men, 2 women; group 1) with vitamin D3 (calcitriol made in Russia) + rhEPO (recormon; Boehringer Mannheim), in 15 patients (15 women, 0 men) with lupus-nephritis (group 2) with vitamin D3 (n = 5, group 2a) or miscalcic (Sandoz) (n = 10, group 2b), in 2 patients (2 men, 0 women) with glomerulonephritis (group 3) with vitamin D3 + miacalcic. Additionally all the patients received Ca salts. In groups 2 and 3 renal function was normal. The duration of the treatment was 3-6 months. RESULTS: In all the groups we obtained an analgetic effect (attenuation of bone pain and more indolent movements), improvement of life quality, diminished need in analgetics, elevation of serum Ca level (p > 0.05). CONCLUSION: Treatment of renal patients with bone affection with vitamin D3 and miacalcic has an analgetic effect, improves life quality.

'Cloze' procedure refined and modified. 'Modified Cloze', 'reverse Cloze' and the use of predictability as a measure of communication problems in psychosis.

BACKGROUND: 'Cloze' procedure assesses the predictability of text by deleting words at set intervals and having a panel of raters fill the blanks. Two refinements to the procedure are described: 'modified Cloze' and 'reverse Cloze', the latter examining the subject's ability to interpret a partial transcript. METHOD: Samples of speech were obtained from patients with schizophrenia, manic-depression and orthopaedic disorders using a standard prompt, and the output analysed using modified Cloze. In addition, subjects completed a reverse Cloze passage. RESULTS: Both modified Cloze and reverse Cloze discriminated the performance of patient groups, with patients with schizophrenia performing worst. CONCLUSIONS: These techniques extend earlier findings suggesting reduced predictability in psychotic speech, particularly for patients with schizophrenia. The reverse Cloze procedure suggests a 'mirror-image' deficit and is a potential objective index of psychopathology that is much simpler to apply than traditional Cloze.