The Effect of Inferior Turbinate Surgery on Quality of Life: A Randomized, Placebo-Controlled Study.

OBJECTIVE: The purpose of this prospective, randomized, single-blinded, placebo-controlled study was to investigate the effects of radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT) techniques on patients' quality of life (QOL) and to compare the techniques with a placebo procedure. METHODS: A total of 98 consecutive patients with enlarged inferior turbinates due to persistent year-round rhinitis were randomized into placebo, RFA, diode laser, and MAIT groups at a ratio of 1:2:2:2. All the procedures were carried out under local anesthesia with the patients' eyes covered. Assessments were conducted prior to surgery and 3 months subsequent to the surgery. Quality of life was assessed with the Glasgow Health Status Inventory (GHSI). RESULTS: The GHSI total score increased statistically significantly in all the groups, including placebo. There were no significant differences in the GHSI total score change between RFA, diode laser, and MAIT groups. The MAIT procedure improved the GHSI total score significantly more than the placebo procedure (P = .04). CONCLUSION: All inferior turbinate surgery techniques lead to a significant improvement in the patients' QOL, and no significant differences were found between the techniques. The placebo treatment also improved the QOL significantly. Only the MAIT technique improved the QOL significantly more compared to placebo.

Development and validity of the Burns-Child Adult Medical Procedure Interaction Scale (B-CAMPIS) for young children.

BACKGROUND: Young children are at increased risk of burn injury and of procedural distress during the subsequent wound care. There are currently few observational measures validated for use with young children during medical procedures. The aim of this research was to adapt the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R) to assess parent-young child interactions during burn wound care by including nonverbal behavioral coding. METHOD: Eighty-seven families of children (1-6years old) were recruited at their first burn dressing change. Potential behaviors were identified through a literature review, consulting health professionals, and direct observation of parents and children during burn wound care. Nonverbal behaviors were coded live, and verbal behaviors were audio recorded for later assessment. RESULTS: Inter-coder reliability was good to excellent for the Burns-CAMPIS (B-CAMPIS). The additional behaviors were correlated with the hypothesized coping, distress, coping-promoting and distress-promoting categories of the CAMPIS-R. Some behaviors differed in frequency across child age groups, with older children demonstrating more verbal behaviors. Convergent validity was demonstrated through correlations with previously validated observational parent-child behavior measures, and parent- and nurse- reported measures of child pain and anxiety. Univariate regression analyses demonstrated the child categories of the B-CAMPIS accounted for equal or more of the variance of parent- and nurse- reported child pain and anxiety, compared to the CAMPIS-R. CONCLUSIONS: The B-CAMPIS is a reliable and valid measure, for assessing coping and distress relationships in young children and their families. Pending further validation, the B-CAMPIS assists researchers and clinicians to recognize and target important behaviors to improve young child coping during pediatric burn wound care.

Survey of patients of the Tver region of Russia regarding maggots and maggot therapy.

The 21st century is seeing a resurgence in the use of maggot therapy-using the physical and biochemical benefits of fly larvae to debride and heal chronic, problematic wounds. Maggots are repulsive to many people, and this could interfere with the acceptance of this modality. Before instituting a maggot therapy programme at our institution, we sought to better understand the psychological barriers that may exist among patients in the Tver region of Russia. Between 2014 and 2016, all patients with arterial insufficiency and trophic ulcers at City Clinical Hospital No. 7 in Tver were administered a survey consisting of six images. Subjects were asked to rank the images in the order of least to most repulsive or disgusting. A total of 576 subjects were recruited for this study: 414 (72%) women and 162 (28%) men. Nearly 60% of subjects considered the images of maggots to be more repulsive than images of gangrenous wounds. This finding is significant because it indicates that much education and support will need to be conducted to address patient fears and anxiety if patients are to be comfortable with a maggot therapy programme.

The EVerT2 (Effective Verruca Treatments 2) trial: a randomized controlled trial of needling vs. nonsurgical debridement for the treatment of plantar verrucae.

BACKGROUND: Verrucae are a common foot skin pathology, which can in some cases persist for many years. Plantar verrucae can be unsightly and painful. There are a range of treatment options including needling. OBJECTIVES: The EVerT2 (Effective Verruca Treatments 2) trial aimed to evaluate the clinical and cost-effectiveness of the needling procedure for the treatment of plantar verrucae, relative to callus debridement. METHODS: This single-centre randomized controlled trial recruited 60 participants (aged ≥ 18 years with a plantar verruca). Participants were randomized 1 : 1 to the intervention group (needling) or the control group (debridement of the overlying callus). The primary outcome was clearance of the index verruca at 12 weeks after randomization. Secondary outcomes included recurrence of the verruca, clearance of all verrucae, number of verrucae, size of the index verruca, pain and participant satisfaction at 12 and 24 weeks. A cost-effectiveness analysis was carried out from the National Health Service perspective over 12 weeks. RESULTS: Sixty eligible patients were randomized (needling group n = 29, 48%; debridement group n = 31, 52%) and 53 were included in the primary analysis (needling n = 28, 97%; debridement n = 25, 81%). Clearance of the index verruca occurred in eight (15%) participants (needling n = 4, 14%; debridement n = 4, 16%; P = 0·86). The needling intervention costs were on average £14·33 (95% confidence interval 5·32-23·35) more per patient than for debridement. CONCLUSIONS: There is no evidence that the needling technique is more clinically or cost-effective than callus debridement. The results show a significant improvement in pain outcomes after needling compared with the debridement treatment alone.

Measuring distress in South African children during burns dressing changes: A pilot study.

OBJECTIVES: To establish and trial a practical, evidence-based, sensitive, language-fair, and culture-fair test battery to measure South African children's distress during burns dressing change. METHODS: We previously identified a broad test battery for pediatric procedural distress from the literature. This comprised child and parent heart rate; three instruments for observed distress behaviors-(1) Face, Legs, Activity, Cry, Consolability (FLACC); (2) Pain Behavior Check List (PBCL); and (3) Children's Hospital Eastern Ontario Pain Scale (CHEOPS); and dressing change time, number of nurses required, and nurses' perspectives of child's distress. A consecutive cohort of South African inpatient children with burns was recruited. In the first study, three observers independently piloted the broad set of measures on four children. This set was subsequently modified to increase practicality of application and measurement sensitivity. In the second study, the modified battery was tested on 16 children for sensitivity to different children's distress levels during burns dressing change phases. RESULTS: The modified test battery was comprised of the CHEOPS, dressing change time, number of nurses required, and nurses' qualitative perspectives of child's distress. In combination, these tests were practical and sensitive to children's distress. DISCUSSION: South African children's distress during burn dressing changes manifests in different ways. Adequate capture of it requires a comprehensive set of objective, observational, and qualitative measures, which are independent of language and culture.

Kinematic analysis of the indirect femoral insertion of the anterior cruciate ligament: implications for anatomic femoral tunnel placement.

PURPOSE: To determine the effect of debriding the indirect insertion component of the femoral anterior cruciate ligament (ACL) attachment on tibiofemoral kinematics when compared with the intact knee. METHODS: Knee kinematics were measured in 9 cadaveric knees with the ACL intact, after indirect insertion debridement, and after ACL transection. Three loading conditions were used: (1) a 134-N anterior tibial load, (2) a combined 10-Nm valgus and 5-Nm internal tibial torque, and (3) a simulated robotic pivot shift. Anterior tibial translation (ATT) was recorded in response to anterior and combined loads at 0°, 15°, 30°, 45°, 60°, and 90° of flexion. Posterior tibial translation and external tibial rotation were recorded during the simulated pivot shift. RESULTS: With an anterior load, indirect insertion debridement increased ATT by 0.37 ± 0.24 mm at 0° (P = .002) and by 0.16 ± 0.19 mm at 15° (P = .033; increases <1 mm in all specimens). ACL transection increased ATT in response to an anterior load (P = .0001) with maximum effect at 15° compared with the intact and debrided states (11.26 ± 1.15 mm and 11.04 ± 1.08 mm, respectively). With a combined load, indirect insertion debridement increased ATT by 0.17 ± 0.11 mm at 0° (P = .001; increases <0.3 mm in all specimens) with no effect at other angles. ACL transection increased ATT in response to a combined load (P = .001) with maximum effect at 15° (4.45 ± 0.85 mm v ACL intact and 4.44 ± 0.84 mm v debrided indirect insertion). In the ACL intact condition, the pivot shift produced 1.29 ± 1.34 mm of posterior tibial translation and 1.54 ± 1.61° of external tibial rotation, as compared with 1.28 ± 1.34 mm and 1.54 ± 1.47°, respectively, after debridement (P = .68 and P = .99, respectively) and 12.79 ± 3.22 mm and 17.60 ± 4.30°, respectively, after ACL transection (P = .0001). CONCLUSIONS: The indirect femoral ACL insertion contributes minimally to restraint of tibial translation and rotation. CLINICAL RELEVANCE: Femoral tunnel positioning for anatomic ACL reconstruction should aim to recreate the biomechanically significant direct insertion.

Does body mass index affect outcomes of ambulatory knee and shoulder surgery?

PURPOSE: Obesity is highly prevalent among patients with knee and shoulder injuries and is associated with greater odds of surgical treatment for these injuries. The purpose of this systematic review was to summarize the literature that has examined the association between body mass index (BMI) and outcomes of ambulatory knee and shoulder surgery. METHODS: A literature search of PubMed and Medline was conducted up to December 2013. Studies that examined the association between BMI and outcomes after ambulatory knee and shoulder surgery (arthroscopy, repairs, and reconstructions) were included. Outcomes included postoperative functional scores, clinical scores, and complications. RESULTS: Eighteen studies were included in this review; 13 involved knee surgery and 5 involved shoulder surgery. Seven knee studies and 2 shoulder studies found increased BMI to be associated with worse postoperative outcomes, whereas the remaining 9 studies did not find an association. Increased BMI was associated with worse clinical scores and less patient satisfaction after arthroscopic meniscectomy or debridement, and with worse clinical scores and lower activity levels after anterior cruciate ligament (ACL) reconstruction. It was also associated with worse clinical scores and a longer hospital stay after rotator cuff repair and with longer time to return to work after subacromial decompression. Six studies examined the association between BMI and complications, but all reported null findings. CONCLUSIONS: There is a lack of consensus in the literature regarding the association between BMI and ambulatory knee and shoulder surgery. Several factors may have contributed to contradictory findings, including variation in measuring and classifying anthropometry, postoperative outcomes, and follow-up time. LEVEL OF EVIDENCE: Level IV, systematic review of Level I, III, and IV studies.

Maggot therapy: a literature review of methods and patient experience.

Used in wound-bed preparation, larval therapy can be effective both clinically and financially, if used appropriately. In this article,the author reviews contemporary literature and key research on the benefits and challenges of using this therapy for wound care. The article focuses on debridement, as well as associated antimicrobial effects and psychological issues. Considerations and cautions that may affect clinical practice, such as pain management, peri-wound skin care, different methods of application and preparing the patient both physically and psychologically are also explored.

Helping patients see both sides of the story.

Hows this for two contrasting headlines? Maggot therapy hope premature, according to the BBC News Online1 versus When it comes to wound healing, the maggot cleans up, from the more sanguine Times Online.2 Both refer to the same study, of course. As my former publisher commented, I love the media.

[Psychological and behavioural impairment following thermal injury in childhood]. / Psychosoziale Aspekte thermischer Verletzungen im Kindes- und Jugendalter.

BACKGROUND: Thermal injuries are a major hazard in the early childhood. The aim of our study was to determine psychological behavioural disorders following burn and scald injuries in the childhood and to estimate their dependence on the formation of scar tissue and the social background of the children. PATIENTS: 83 patients aged 0 to 18 years who had been treated for thermal injuries in our clinic between September 2002 and December 2005 were included in the follow-up study. The standardised questionnaires CBCL/4-18 and TACQOL-PF were used to evaluate psychological behavioural disorders and quality of life. The follow-up examinations also served to gain information about the social status of the patient's parents and the current physical complaints. Scars were assessed by the Vancouver Scar Scale (VSS). RESULTS: 50 out of 83 patients took part in our follow-up examinations. 21 children suffered from physical complaints following thermal injury. Dryness of the skin as well as heat and cold intolerance were named most frequently. Internalising (p < 0.04) and externalising (p < 0.03) behavioural problems correlated significantly with the severity of scar formation defined by the VSS. Quality of life and social status were inferior to the comparison group. CONCLUSION: The incidence of thermal injuries is highest in the first three years of childhood. The risk for burn and scald injuries is augmented by a poor social status. In children who suffered such injuries we observed a higher rate of internalising and externalising behavioural problems which correlated with the extent of scar formation.

A new clinical trial of the effect of larval therapy.

The VenUS II trial is the first large, prospective clinical study to investigate the effect of larval therapy and hydrogel on both the bacteriology and healing of leg ulcers. This trial will compare the clinical and cost effectiveness of two types of larval therapy (loose and bagged) with a standard debridement intervention (hydrogel) in terms of effects on time to complete healing, time to debridement, wound microbiology, cost of treatment and health-related quality of life. This paper describes the aims and design of the trial, outlines the eligibility criteria for patients and discusses the nurses' role in the study. This article has not been subject to peer review.

Maggot debridement therapy: a primer.

Treatment of chronic wounds of the lower extremity requires a systematic, multidisciplinary approach as well as flexibility in order to achieve acceptable, consistent short-term and long-term results. Maggots, once considered an obsolete therapeutic modality, can be a useful addition to the armamentarium of the foot and ankle specialist. This article describes the use of maggot debridement therapy for intractable wounds of the lower extremity.

Maggot débridement therapy in outpatients.

OBJECTIVE: To identify the benefits, risks, and problems associated with outpatient maggot therapy. DESIGN: Descriptive case series, with survey. SETTING: Urban and rural clinics and homes. PARTICIPANTS: Seven caregivers with varying levels of formal health care training and 21 ambulatory patients (15 men, 6 women; average age, 63 yr) with nonhealing wounds. INTERVENTION: Maggot therapy. MAIN OUTCOME MEASURE: Therapists' opinions concerning clinical outcomes and the disadvantages of therapy. RESULTS: More than 95% of the therapists and 90% of their patients were satisfied with their outpatient maggot débridement therapy. Of the 8 patients who were advised to undergo amputation or major surgical débridement as an alternative to maggot débridement, only 3 required surgical resection (amputation) after maggot therapy. Maggot therapy completely or significantly débrided 18 (86%) of the wounds; 11 healed without any additional surgical procedures. There was anxiety about maggots escaping, but actual escapes were rare. Pain, reported by several patients, was controlled with oral analgesics. CONCLUSIONS: Outpatient maggot débridement is safe, effective, and acceptable to most patients, even when administered by nonphysicians. Maggot débridement is a valuable and rational treatment option for many ambulatory, home-bound, and extended care patients who have nonhealing wounds.

Emotional responses of hospitalized patients with burns to debridement during the acute phase.

The objectives of this descriptive study were to investigate anxiety and depressed mood of patients with burns associated with debridement and their preferences for and perceptions of control during the debridement procedure. Measurements began within 48 hours of hospital admission, continuing every 3 days over 2 weeks for subjects with small burn injuries (less than 30% of total body surface area). Data suggested the possibility of a mildly depressed mood for some subjects during the first week in the hospital and high levels of association between depressed mood and anxiety based on the large number of significant correlations (p < .05). Over time, the amount of control that patients preferred and the amount of choice they perceived during debridement increased. These findings about responses of patients with burns to debridement suggest that their emotional responses were well managed for the most part and support their involvement in the debridement procedure.