One-stage posterior transpedicular debridement, hemi-interbody and unilateral-posterior bone grafting, and instrumentation for the treatment of thoracic spinal tuberculosis: a retrospective study.

PURPOSE: To investigate the clinical efficacy and feasibility of the surgical treatment of thoracic spinal tuberculosis using one-stage posterior instrumentation, transpedicular debridement, and hemi-interbody and unilateral posterior bone grafting. METHODS: Fifty-six patients with thoracic spinal tuberculosis who underwent surgery performed by a single surgeon between September 2009 and August 2020 were enrolled in this study. Based on data from the erythrocyte sedimentation rate (ESR), Visual Analog Scale (VAS), and Cobb angle before surgery, after surgery, and at the most recent follow-up, clinical effectiveness was assessed using statistical analysis. The variables investigated included operating time, blood loss, complications, neurological function, and hemi-interbody fusion. RESULTS: None of the patients experienced significant surgery-associated complications. At the last follow-up, 23 of the 25 patients (92%) with neurological impairment showed improvement. The thoracic kyphotic angle was significantly decreased from 24.1 ± 9.9° to 13.4 ± 8.6° after operation (P < 0.05), and the angle was 14.44 ± 8.8° at final follow-up (P < 0.05). The Visual Analog Scale significantly decreased from 6.7 ± 1.4 preoperatively to 2.3 ± 0.8 postoperatively (P < 0.05) and finally to 1.2 ± 0.7 at the last follow-up (P < 0.05). Bone fusion was confirmed in 56 patients at 3-6 months postoperatively. CONCLUSIONS: One-stage posterior transpedicular debridement, hemi-interbody and unilateral posterior bone grafting, and instrumentation are effective and feasible treatment methods for thoracic spinal tuberculosis.

Results from the AAPM Task Group 324 respiratory motion management in radiation oncology survey.

PURPOSE: To quantify the clinical practice of respiratory motion management in radiation oncology. METHODS: A respiratory motion management survey was designed and conducted based on clinician survey guidelines. The survey was administered to American Association of Physicists in Medicine (AAPM) members on 17 August 2020 and closed on 13 September 2020. RESULTS: A total of 527 respondents completed the entire survey and 651 respondents completed part of the survey, with the partially completed surveys included in the analysis. Overall, 84% of survey respondents used deep inspiration breath hold for left-sided breast cancer. Overall, 83% of respondents perceived respiratory motion management for thoracic and abdominal cancer radiotherapy patients to be either very important or required. Overall, 95% of respondents used respiratory motion management for thoracic and abdominal sites, with 36% of respondents using respiratory motion management for at least 90% of thoracic and abdominal patients. The majority (60%) of respondents used the internal target volume method to treat thoracic and abdominal cancer patients, with 25% using breath hold or abdominal compression and 13% using gating or tracking. CONCLUSIONS: A respiratory motion management survey has been completed by AAPM members. Respiratory motion management is generally considered very important or required and is widely used for breast, thoracic, and abdominal cancer treatments.

Marijuana use among patients with epilepsy at a tertiary care center.

The expansion of medical and recreational marijuana legalization facilitates patient access to cannabis, and many patients with epilepsy pursue marijuana as a treatment for seizures. We administered a nine-item survey on marijuana use to patients seen in an epilepsy clinic over a 9 month period at a tertiary care center in Oregon where recreational use was legalized in 2015. The majority of respondents (n = 39) reported cannabis use for the purpose of treating epilepsy (87.2%, n = 34), and strongly agreed (53.8%, n = 21) or agreed (28.2%, n = 11) that cannabis use improved seizure control. The most commonly selected cannabis strains were high cannabidiol (CBD) (30.8%, n = 12) or multiple types (30.8%, n = 12), with administration methods of smoking (66.7%, n = 26), edibles (48.7%, n = 19), and concentrates (43.6%, n = 17). More participants reported using marijuana with primarily CBD than primarily tetrahydrocannabinol (THC) or equal CBD:THC content, and very few women reported using marijuana with primarily THC compared with men (10% of female versus 47% of male respondents). Only 2 of 39 participants were able to give an exact dosage used in milligrams. Medical and recreational dispensaries were the most common cannabis sources, followed by homegrown and friends/family members. Although pharmaceutical CBD extract is now Food and Drug Administration (FDA)-approved for certain epilepsy types, access remains limited. Further research is needed to understand recreational cannabis use among patients with epilepsy while clinical research for pharmaceutical cannabis products continues.

Twelve-year trends of increasing overweight and obesity in patients with diabetes: the Shiga Diabetes Clinical Survey.

The prevalence of obesity is increasing globally in patients with diabetes. This study aimed to examine 12-year trends of increasing obesity in Japanese patients with diabetes, and their clinical features. The study used results of the Shiga Diabetes Clinical Survey, which recorded medical performance in diabetic patients in 2000, 2006 and 2012. Data were analyzed from 14,205, 14,407 and 21,449 adult patients in these three years, respectively. Overweight and obesity prevalence and the clinical features of diabetes patients were examined, stratified by body mass index (BMI) and age. The prevalence of overweight (BMI 25-30 kg/m2) and obesity (BMI ≥30 kg/m2) were 27.0% and 5.1% in 2000, 28.9% and 7.3% in 2006 and 30.9% and 10.0% in 2012. Glycemic control, blood pressure and serum lipid profile improved over 12 years in all BMI categories. However, glycemic and triglyceride control were insufficient in obese patients aged <65 years (hemoglobin A1c 7.5 ± 1.4%, triglyceride 197.7 ± 178.4 mg/dL in 2012). The percentage of patients who used antihypertensive and lipid-lowering drugs increased and patients with higher BMI had increased frequency of using these drugs, both in young and old age groups. Higher BMI was significantly and positively associated with albuminuria. In summary, overweight and obesity have increased in Japanese diabetic patients, particularly for younger generations. Findings suggest that obesity may lead to poorer glycemic control, blood pressure and lipid profiles. Overweight and obesity are important modifiable risk factors for diabetes, suggesting that more active weight-control interventions are warranted.

[Research on application status of Chinese herbal decoction pieces based on clinical survey].

Chinese herbal decoction pieces are the basic approaches for clinical traditional Chinese medicine (TCM), reflecting the features and advantages of TCM. In order to investigate the clinical application status and features of Chinese herbal decoction pieces, the questionnaire on application of commonly used Chinese herbal decoction pieces was designed in this study for analysis of the application situations of Chinese herbal decoction pieces from 56 medical institutions in 10 provinces. The results showed 549 varieties of Chinese herbs and 801 varieties of decoction pieces were used on clinic. They can be classified into 19 categories according to their effects. The varieties of Gancao (Glycyrrhizae Radix et Rhizoma), Huangqi (Astragali Radix), Dihuang (Rehmanniae Radix), Chuanxiong (Chuanxiong Rhizoma), Baizhu (Atractylodis Macrocephale Rhizima), Huangqin (Scutellariae Radix), Danggui (Angelicae Sinenses Radix), Baishao (Paeoniae Radix Alba) and Maidong (Ophiopogonis Radix) were most common ones; the application of Chinese herbal decoction pieces from different medical institutions was differentiated from areas to areas. The survey results reflected the general situation about application of decoction pieces, providing the basic data for recording and completing Chinese herbal decoction pieces in essential drug system, with certain reference significance for the production of Chinese medicinal materials and the allocation of the varieties of Chinese herbal decoction pieces.

A Chinese survey of clinical practice on the management of thyroid eye disease.

Objective: The management of thyroid eye disease (TED) has undergone significant changes for decades. The study sought to investigate current clinical practice on the management of TED in China. Methods: An online questionnaire survey was conducted from April to May 2023. The questionnaire involved diagnostic criteria for TED, multidisciplinary treatment (MDT) collaboration, and treatment preference for mild, moderate, and severe TED. Results: A total of 289 questionnaires were collected, with 165 from endocrinologists and 124 from ophthalmologists. Only 36.7% of participants claimed there was an MDT clinical pattern for TED in their institutions. The coverage of biological agents was around 10% or lower. These were distinctly lower than in Western countries. About 62.6% of participants believed the incidence of TED has increased in recent years. Imaging techniques were used widely to assist in the diagnosis of TED. However, there was still controversy regarding the definition of proptosis in the Chinese population. Most doctors managed risk factors and provided orbital supportive treatments of artificial tears and glasses. For mild active TED, endocrinologists (39.4%) were inclined to recommend therapy for hyperthyroidism alone, while ophthalmologists (43.6%) preferred orbital corticosteroid injections. Currently, the most widely used treatment for moderate to severe active TED was high-dose intravenous corticosteroid (94.8%), while orbital radiotherapy combined with immunosuppressive agents was the most recognized second-line therapy (43.6%). Conclusion: The study documented the consistency and differences between current clinical practices in the management of TED in China and the recently updated guidelines. There was a remarkable difference between ophthalmology and endocrinology departments, warranting management optimization.

Perceived association of mood and symptom severity in adults with mitochondrial diseases.

Individuals with genetic mitochondrial diseases suffer from multisystemic symptoms that vary in severity from day-to-day and week-to-week, but the underlying causes of symptomatic fluctuations are not understood. Based upon observations that: i) patients and their families frequently report that stressful life events either trigger exacerbations of existing symptoms or the onset of new symptoms, ii) psychological states and stress hormones influence mitochondrial energy production capacity, and iii) epidemiological reports document a robust connection between traumatic/stressful life events and various neurologic disorders, we hypothesized that mitochondrial disease symptom severity may vary according to participant's mood. To investigate this we administered the Stress, Health and Emotion Survey (SHES) in 70 adults (majority white (84%) cisgender women (83%), ages 18-74) with self-reported mitochondrial diseases (MELAS, 18%; CPEO, 17%; Complex I deficiency, 13%). Participants rated the severity of each of their symptom(s) over the past year on either good or bad days. On days marked by more stress, sadness and other negative emotions, some but not all symptoms were reported to be worse, including fatigue, exercise intolerance, brain fog, and fine motor coordination. By contrast, on days marked by happiness and calmness, participants reported these and other symptoms to be better, or less severe. Other symptoms including diminished sweating, hearing problems, and dystonia were in general unrelated to mood. Thus, some individuals living with mitochondrial diseases, at times perceive a connection between their mood and symptom severity. These preliminary associative results constitute an initial step towards developing more comprehensive models of the factors that influence the clinical course of mitochondrial diseases.

A 20-year clinical survey of radiotherapy prostheses at the Clinic for Maxillofacial Prosthetics of Tokyo Medical and Dental University Hospital.

PURPOSE: To identify secular trends in the use of radiotherapy prostheses in the Clinic for Maxillofacial Prosthetics at Tokyo Medical and Dental University Hospital and to ascertain patient characteristics and future needs. METHODS: The study included all patients who visited the clinic between January 1, 2000, and December 31, 2019. Data on numbers of cases, gender and age, numbers and types of radiotherapy prostheses, primary cancer site, and time required for prosthesis fabrication during the study period were collected from medical records and retrospectively analyzed. RESULTS: During the 20-year study period, 1,066 prostheses were fabricated for 1,135 cases. In most years, at least 60% of cases were male. The mean age increased from 60.6 to 67.1 years during the study period, and the number of cases older than 70 years increased over time. The most common cancer site was the tongue, and the most common type of radiotherapy prosthesis was a spacer. The mean time for spacer fabrication was 11 days. CONCLUSION: During a recent 20-year period, mean age and the proportion of elderly patients requiring savers increased. When treating elderly patients, prosthodontists responsible for fabricating radiotherapy prostheses must collaborate effectively with radiation oncologists.

Eighteen-year trends in the management of patients with diabetes in the Shiga Diabetes Clinical Survey: overall trends and differences by age group.

Aim: To examine the trends in the management of patients with diabetes over an 18-year period in Japan. Participants and methods: We recorded the height, body mass, laboratory data, diabetes treatment, and screening status of diabetic complications from the data collected during the Shiga Diabetes Clinical Survey, which has been performed every 6 years since 2000. We then evaluated the management of patients with diabetes in Shiga Prefecture. The study included 17,870, 18,398, 24,243, and 26,624 participants in each of the 4 years of measurements. Results: The mean age and body mass index (BMI) of the participants gradually increased. The percentage of patients with BMI of ≥ 25 kg/m2 was higher in younger patients. Glycemic control significantly improved over 18 years (hemoglobin A1c: 7.3% ± 1.4% in 2000 to 7.1% ± 1.1% in 2018, P for trend < 0.001). The mean hemoglobin A1c levels were higher in younger patients than in elderly patients and increased from 2012 to 2018 in patients aged ≥ 65 years. The proportion of participants who underwent screening for albuminuria and diabetic retinopathy increased. The mean blood pressure and low-density lipoprotein cholesterol concentration decreased. Conclusions: Glycemic control has been maintained at an acceptable level since the previous survey. Although glycemic control has become less strict in elderly patients with diabetes, glycemic control is poorer in younger patients than in elderly patients. Obesity is an increasingly important problem, particularly in younger patients. The frequency of screening for diabetic complications and the control of blood pressure should be improved. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-022-00573-2.

Clinical survey of a pedigree with hereditary multiple exostoses and identification of EXT­2 gene deletion mutation.

The aim of the present study was to report a clinical survey of hereditary multiple exostoses (HME) in a large Chinese pedigree, and the identification of a novel deletion mutation of exostosin glycosyltransferase 2 (EXT­2) gene. A patient with multiple exostoses with huge cartilage­capped tumors in scapula, knees and ankles received surgery in Department of Orthopedics (Shanghai Changhai Hospital). A total of 20 family members were recruited to the study, with seven members (five male; two female) diagnosed as HME. The family members of the patients with HME were examined, clinical data and peripheral blood samples were collected, and their DNA was sequenced. The incidence of HME in this family pedigree was 35%. Exostoses were most frequently in the tibiae with occurrence in six patients, followed by ribs, femurs, radii, fibulae, scapulae and humeri. DNA sequencing of peripheral blood revealed a novel deletion mutation, c.824­826delGCA, in exon 5 of the EXT­2 gene, which was observed in all the patients with HME, but not in the healthy family members. Several characteristics of HME in the pedigree were observed, such as susceptibility of male gender, decreased average age of onset and height and increased severity of clinical symptoms with generations.

Preliminary Validation of a Food Frequency Questionnaire to Assess Long-Chain Omega-3 Fatty Acid Intake in Eye Care Practice.

Clinical recommendations relating to dietary omega-3 essential fatty acids (EFAs) should consider an individual's baseline intake. The time, cost, and practicality constraints of current techniques for quantifying omega-3 levels limit the feasibility of applying these methods in some settings, such as eye care practice. This preliminary validation study, involving 40 adults, sought to assess the validity of a novel questionnaire, the Clinical Omega-3 Dietary Survey (CODS), for rapidly assessing long-chain omega-3 intake. Estimated dietary intakes of long-chain omega-3s from CODS correlated with the validated Dietary Questionnaire for Epidemiology Studies (DQES), Version 3.2, (Cancer Council Victoria, Melbourne, Australia) and quantitative assays from dried blood spot (DBS) testing. The 'method of triads' model was used to estimate a validity coefficient (ρ) for the relationship between the CODS and an estimated "true" intake of long-chain omega-3 EFAs. The CODS had high validity for estimating the ρ (95% Confidence Interval [CI]) for total long-chain omega-3 EFAs 0.77 (0.31-0.98), docosahexaenoic acid 0.86 (0.54-0.99) and docosapentaenoic acid 0.72 (0.14-0.97), and it had moderate validity for estimating eicosapentaenoic acid 0.57 (0.21-0.93). The total long-chain omega-3 EFAs estimated using the CODS correlated with the Omega-3 index (r = 0.37, p = 0.018) quantified using the DBS biomarker. The CODS is a novel tool that can be administered rapidly and easily, to estimate long-chain omega-3 sufficiency in clinical settings.

Clinical survey over the past 35 years at the clinic for maxillofacial prosthetics Tokyo Medical and Dental University.

PURPOSE: The purpose of this survey was to examine the overview of maxillofacial prosthetic treatment at our department, in order to ascertain the actual status of patients and discuss future needs. METHODS: Subjects were all patients who visited Clinic for Maxillofacial Prosthetics, Dental Hospital, Tokyo Medical and Dental University (TMDU) in the period from January 1, 1980 to December 31, 2014. Using medical records of the Clinic for Maxillofacial Prosthetics, Dental Hospital, TMDU, patients' data including sex, address, referring institution, and primary condition were analyzed throughout the period. RESULTS: The number of patients over 35 years was 6219, with a man-to-woman ratio of 6:4. The number of patients in their 60s, 70s, and 80s showed an increasing trend. Patients with tumors accounted for about 50 % of cases in 1980-1984 and increased to 80 % in 2010-2014. CONCLUSIONS: The survey showed an increasing number of elderly patients and patients with tumors. This suggests that more awareness and education about maxillofacial prosthetics are needed.

Subjective Assessment of Head and Facial Appearance in Children with Craniosynostoses after Surgical Treatment.

BACKGROUND: Craniosynostoses are congenital defects in the construction of the skull involving premature fusion of one or more cranial sutures. Premature fusion of sutures causes characteristic skull deformation(s). This affect the structure and thus the appearance of the entire head and face. The aim of this study was to analyze parents' subjective assessments of head and facial appearance in children with craniosynostoses before and after surgery. Parents also assessed the interpersonal relationship of their children with peers and adults (after surgery). METHODS: This study was conducted among parents of 230 children treated in Poland, in two multidisciplinary centers. Detailed statistical analysis was conducted among children who had undergone surgery. Independent variables were age (at survey) of the child (three years and less, four years, and five years and more) and type of craniosynostosis (isolated and syndromic). A chi-square independence test was used. Data was collected using surveys. RESULTS: In the opinion of most parents, the appearance of their child's head and face after surgery did not differ or differed only slightly from that of their peers. The results of subjective assessment of appearance of children's face and head after reconstructive treatment remains comparable in three subgroups of patients according to the age. It seems that specific head shape according to the type of craniosynostosis does not have an impact on relations with peers and adults. CONCLUSION: Surgical treatment of children with craniosynostoses improves the appearance of their head and face. This improvement seems not to depend on the type of isolated craniosynostosis, and is constant over time.

Trends in medical performance in diabetic patients in primary care clinics compared with those in hospitals: Shiga Diabetes Clinical Survey, Japan, 2000-2012.

AIMS: This study aimed to clarify trends in clinical performance in diabetic patients over a 12-year period in primary care clinics and hospitals in Japan. MATERIALS AND METHODS: The Shiga Diabetes Clinical Survey records medical performance in diabetic patients in primary care clinics and hospitals in Shiga Prefecture, Japan. In this study, laboratory data, modality of treatment for diabetes, and status of examination for diabetic complications were examined using results of surveys in 2000, 2006, and 2012. The study included 17,870, 18,398, and 24,219 patients for those years, respectively. RESULTS: Mean glycated hemoglobin (HbA1c) level significantly improved over 12 years and was significantly lower in the primary care clinics group than the hospitals group (7.3 ± 1.5 vs. 7.4 ± 1.4 % in 2000, 7.2 ± 1.2 vs. 7.4 ± 1.3 % in 2006, and 6.9 ± 1.0 vs. 7.1 ± 1.1 % in 2012). With regard to diabetic treatment modality, patients treated in hospitals used insulin more frequently than those in primary care clinics. The proportion of patients examined for diabetic complications increased but did not reach 50 % in 2012. Mean blood pressure and low-density lipoprotein cholesterol levels were lowered, but blood pressure control was worse than that of low-density lipoprotein cholesterol. CONCLUSIONS: This study shows that glycemic control in both primary care clinics and hospitals has improved and was almost acceptable. However, examinations for diabetic complications and the control of blood pressure were still insufficient.

Attitudes and preferences for the clinical management of hypertension and hypertension-related cerebrovascular disease in the general practice: results of the Italian hypertension and brain survey.

BACKGROUND: The aim of this survey was to evaluate attitudes and preferences for the clinical management of hypertension and hypertension-related cerebrovascular diseases (CVD) in Italy. METHODS: A predefined 16-item survey questionnaire was anonymously administered to a large community sample of general practitioners (GPs), trained by specialized physicians (SPs), who have been included in an educational program between January and November 2015. RESULTS: A total of 591 physicians, among whom 48 (8%) training SPs and 543 (92%) trained GPs, provided 12,258 valid answers to the survey questionnaire. Left ventricular hypertrophy was considered the most frequent marker of hypertension-related organ damage, whereas atrial fibrillation and carotid atherosclerosis were considered relatively not frequent (10-20%). The most appropriate blood pressure (BP) targets to be achieved in hypertensive patients with CVD were <140/90 mmHg for SPs and <135/85 mmHg for GPs. To achieve these goals, ACE inhibitors were considered the most effective strategies by GPs, whereas SPs expressed a preference for ARBs, both in monotherapies and in combination therapies with beta-blockers. CONCLUSIONS: This survey demonstrates that Italian physicians considered left ventricular hypertrophy frequently associated to CVD and that drugs inhibiting the renin-angiotensin system the most appropriate therapy to manage hypertension and hypertension-related CVD.

Design and conduct of a provider survey to determine a clinically persuasive effect size in planning VA Cooperative Study #590 (Li+).

BACKGROUND: The estimation of an effect size is an important step in designing an adequately powered, feasible clinical trial intended to change clinical practice. During the planning phase of VA Cooperative Study #590, "Double-Blind Placebo-Controlled Study of Lithium for Preventing Repeated Suicidal Self-Directed Violence in Patients with Depression or Bipolar Disorder (Li+)," it was not clear what effect size would be considered large enough to influence prescribing behavior among practicing clinicians. METHODS: We conducted an online survey of VA psychiatrists to assess their interest in the study question, their clinical experience with lithium, and their opinion about what suicide reduction rate would change their prescribing habits. The 9-item survey was hosted on SurveyMonkey© and VA psychiatrists were individually emailed an invitation to complete an anonymous online survey. Three email waves were sent over three weeks. RESULTS: Overall, 862 of 2713 VA psychiatrists (response rate = 31.8%) responded to the anonymous survey. 74% of the respondents would refer a patient to the proposed trial, 9% would not, and 17% were unsure. Presented with suicide reduction rates in 10% increments ranging from 10 to 100%, 61% of respondents indicated that they would use lithium if suicide attempts were reduced by at least 40%; 83% would use lithium if it reduced attempts by at least 50%. CONCLUSIONS: Even with the limitations of response bias and the reliability of responses on future prescribing behavior, a survey of potential users of a clinical trial's results offers a convenient, empirical method for determining and justifying clinically relevant effect sizes.

Geriatric surgery--evolution of a clinical community.

BACKGROUND: We reviewed the current scientific data and opinions from thought leaders in the field of surgery in the elderly population and queried whether a new society should be formed. METHODS: The science of geriatric surgery (GS) was reviewed, including topics scientific sessions focused on GS. A town hall meeting was held, which included geriatric surgical scholars. A survey was created to define the interest in GS as a specialty society was sent to surgical scholars. RESULTS: As the volume of GS scholarly work has increased, the focus of geriatric science has migrated toward clinical studies on frailty and geriatric syndromes. Our town hall meeting outlined the need for a multidisciplinary GS team. Our survey documented more interest in multidisciplinary sessions at national meetings rather than a new, unique society. CONCLUSIONS: GS as a discipline is a multidisciplinary practice. Our data suggest that this unique characteristic speaks to the development of a clinical community rather than an independent society.

Attitudes and preferences for the clinical management of patients with hypertension and hypertension with chronic obstructive pulmonary disease in Italy: main results of a survey questionnaire.

Hypertension treatment and control represent a clinical challenge, particularly in case of concomitant risk factors and comorbidities, including chronic obstructive pulmonary disease (COPD). To evaluate attitudes and preferences for the clinical management of hypertension and hypertension associated with COPD by a large community sample of physicians in Italy. A predefined 18-item survey questionnaire was anonymously administered to both specialised physicians (SPs) and general practitioners (GPs), who have been included in an educational programme, performed between January and June 2014. A total of 1181 physicians (767 males, mean age 55.8 ± 7.3 years, average age of medical activity 27.6 ± 8.3 years), among whom 64 (5.4 %) SPs and 1117 (94.6 %) GPs, provided 21,809 valid answers to the survey questionnaire. Concomitant presence of hypertension and COPD was frequently associated (21-40 %) with hypertension-related organ damage and comorbidities. Concomitant presence of hypertension and COPD was able to affect physicians' ability to achieve the recommended therapeutic targets. To achieve the recommended BP goals, ACE inhibitors or ARBs were considered the most effective antihypertensive strategies, both in monotherapies and in combination therapies with either diuretics or calcium-channel blockers. This observational, cross-sectional survey provides useful information on physicians' attitudes and preferences for the clinical management of patients with hypertension and hypertension associated with COPD.

Patients' perceptions of vocal problems: results from a survey in the Tokyo area.

Laryngoscopy in cases of sulcus vocalis reveals bowed vocal folds, resulting in a spindle-shaped chink with glottal incompetence. The anatomic and functional problems and resulting incomplete glottal closure during phonation lead to the presenting symptoms of breathy hoarseness, decrease in maximum phonation time (MPT), and vocal fatigue. These symptoms, however, have been reported from the physician's viewpoint, not the patient's. Furthermore, no standardized guidelines for the treatment of sulcus vocalis have been established. Because the general attitude toward sulcus vocalis appears to have become 'It is only a vocal problem and does not significantly affect the patient's well-being,' knowledge of sulcus vocalis has decreased and knowledge about choices of therapy remain limited. We therefore conducted an epidemiological questionnaire survey on this pathological condition in voice clinics in seven hospitals in the Tokyo area to establish preliminary guidelines for the management of sulcus vocalis, in reference to the opinion of the patients. Here we report the summary of our preliminary study 'a survey for sulcus vocalis' and suggest guidelines for the management of such pathological conditions. Although these management guidelines may result in improvement in the symptoms of sulcus vocalis, patients and physicians should be aware that treatment of this condition is difficult and improvement is not guaranteed.

A survey on polypharmacy and use of inappropriate medications.

In the past, polypharmacy was referred to the mixing of many drugs in one prescription. Today polypharmacy implies to the prescription of too many medications for an individual patient, with an associated higher risk of adverse drug reactions (ADRs) and interactions. Situations certainly exist where the combination therapy or polytherapy is the used for single disease condition. Polypharmacy is a problem of substantial importance, in terms of both direct medication costs and indirect medication costs resulting from drug-related morbidity. Polypharmacy increases the risk of side effects and interactions. Moreover it is a preventable problem. A retrospective study was carried out at Bhopal district (Capital of Madhya Pradesh, India) in the year of September-November 2009 by collecting prescriptions of consultants at various levels of health care. The tendency of polypharmacy was studied and analyzed under the various heads in the survey. Available data suggests that polypharmacy is a widespread problem, and physician, clinical pharmacists and patients are all responsible. These risks can be minimized through identifying the prevalence of this potential problem in a high-risk population and by increasing awareness among patients and healthcare professionals. Physicians and clinical pharmacists have the potential to combating this problem through a variety of interventions such as reducing the number of medications taken, reducing the number of doses taken, increasing patient adherence, preventing ADRs, improving patient quality of life and decreasing facility and drug costs.