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International Journal of Language &... Jan 2023Pre- and post-operative voice therapy may improve voice and quality-of-life outcomes for patients undergoing phonosurgery to remove benign vocal fold lesions (BVFLs)....
BACKGROUND
Pre- and post-operative voice therapy may improve voice and quality-of-life outcomes for patients undergoing phonosurgery to remove benign vocal fold lesions (BVFLs). However, what constitutes voice therapy in this population is poorly described, resulting in a poor evidence base, lack of clinical guidelines and unwarranted variation in management. In order to develop the evidence base, a robust, iterative process of intervention development work should precede feasibility testing and effectiveness studies.
METHODS & PROCEDURES
Guidance for developing complex interventions, drawing on evidence, theory and modelling, was used to inform the development of a pre- and post-operative voice therapy intervention entitled 'PaPOV'. Data from four sources of evidence were synthesized using a published triangulation protocol. Data from a systematic review, national survey of current practice, expert interview study, and patient and public involvement conversations were used to populate a triangulation matrix, outlining components of a PaPOV. Data were coded to reflect areas of agreement, dissonance and silence with each component of the intervention. Based on this evidence, an assessment of convergence for each intervention component could be made.
OUTCOMES & RESULTS
In total, 61 components of the PaPOV intervention were explored. Of these, 27 were categorized as having stability of consensus according to a priori criteria. A total of 34 failed to meet the criteria. This was more frequently due to silence (27) rather than dissonance (seven) in the data. By evidencing areas of agreement and stability of consensus across data sources, the validity of individual findings has been enhanced. Furthermore, the study has exposed specific areas of the intervention that lack consensus and require exploration through further intervention development studies.
CONCLUSIONS & IMPLICATIONS
This systematic triangulation process has contributed to the development of a PaPOV intervention for patients with BVFLs. Exploration of specific components relating to the intervention will allow outstanding questions to be answered in preparation for feasibility testing.
WHAT THIS PAPER ADDS
What is already known on the subject BVFLs cause dysphonia by preventing vocal fold closure, impacting on vibratory characteristics and increasing compensatory muscle tension. Management for these patients is variable with them being offered phonosurgery, voice therapy, pharmacological management or a combined approach. Pre- and post-operative voice therapy may improve both voice and quality-of-life outcomes. This patient group has unique complexities when considering voice therapy, including surgical preparation, wound healing and epithelial mobilization. What this paper adds to existing knowledge This study uses a robust triangulation process to synthesize current evidence and patient experiences in order to inform the development of a PaPOV. It outlines some of the key components and considerations when delivering pre- and post-operative voice therapy to adults with BVFLs. Furthermore, it serves as a methodological example for intervention development in complex interventions, highlighting key guidance and recommended processes for developing and evaluating complex interventions. What are the potential or actual clinical implications of this work? The 61 components discussed as potential 'ingredients' for a PaPOV enable clinicians to reflect on key considerations when planning and delivering voice therapy to adults with BVFLs. This study highlights the pitfalls both clinically and in research of failing to describe interventions adequately and the benefits of using accurate, specific and agreed terminology in clinical practice, such as that outlined in the Rehabilitation Treatment Specification System (TRSS).
Topics: Adult; Humans; Vocal Cords; Dysphonia; Voice; Voice Quality; Postoperative Period
PubMed: 36047250
DOI: 10.1111/1460-6984.12771 -
OncoTargets and Therapy 2017The voice quality assessment of laser surgery (LS) in comparison with radiotherapy (RT) remains uncertain in T1a glottic carcinoma treatment. This systematic review and...
BACKGROUND AND OBJECTIVES
The voice quality assessment of laser surgery (LS) in comparison with radiotherapy (RT) remains uncertain in T1a glottic carcinoma treatment. This systematic review and meta-analysis were conducted to compare the voice quality of the two treatments.
METHODS
Searches were conducted in PubMed, EMBASE, and Cochrane with the following index words: glotti*, layn*, vocal cord, vocal, surgery, cordectomy, laser, radiation, irradiation, radiotherapy, cancer, and carcinoma for relative studies that compared the voice quality between LS and RT. Random-effect models were used, and heterogeneity was assessed.
RESULTS
A total of 14 studies were included in the analysis, consisting of 1 randomized controlled trial, 1 prospective study, and 12 retrospective studies. RT has increased the maximum phonation time (MPT; mean difference [MD] =-1.89, 95% confidence interval [CI] =-3.66 to -0.11, =0.04) and decreased the fundamental frequency (MD =14.06, 95% CI =10.30-17.83, <0.00001) in comparison with LS. No statistical difference was observed between the two groups in terms of Voice Handicap Index, Jitter, Shimmer, and airflow rate.
CONCLUSION
RT may be a better choice for T1a glottic carcinoma treatment compared with LS because patients undergoing RT may have the advantage of increased MPT and decreased fundamental frequency. However, more multicenter, randomized, controlled trials are urgently needed to verify these differences.
PubMed: 28496338
DOI: 10.2147/OTT.S137210 -
The Cochrane Database of Systematic... Jun 2021Neonates born through meconium-stained amniotic fluid (MSAF) are at risk of developing meconium aspiration syndrome (MAS). Neonates who are non-vigorous due to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Neonates born through meconium-stained amniotic fluid (MSAF) are at risk of developing meconium aspiration syndrome (MAS). Neonates who are non-vigorous due to intrapartum asphyxia are at higher risk of developing MAS. Clearance of meconium from the airways below the vocal cords by tracheal suction before initiating other steps of resuscitation may reduce the risk of development of MAS. However, conducting tracheal suction may not only be ineffective, it may also delay effective resuscitation, thus prolonging and worsening the hypoxic-ischaemic insult. OBJECTIVES: To evaluate the efficacy of tracheal suctioning at birth in preventing meconium aspiration syndrome and other complications among non-vigorous neonates born through meconium-stained amniotic fluid.
SEARCH METHODS
We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 11) in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) (1946 to 25 November 2020) for randomised controlled trials (RCTs) and quasi-randomised trials. We also searched clinical trials databases and the reference lists of retrieved articles for RCTs and quasi-randomised trials (up to November 2020).
SELECTION CRITERIA
We included studies enrolling non-vigorous neonates born through MSAF, if the intervention being tested included tracheal suction at the time of birth with an intent to clear the trachea of meconium before regular breathing efforts began. Tracheal suction could be performed with an endotracheal tube or a wide-gauge suction catheter. Neonates in the control group should have been resuscitated at birth with no effort made to clear the trachea of meconium.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and extracted data, consulting with a third review author about any disagreements. We used standard Cochrane methodological procedures, including assessment of risk of bias for all studies. Our primary outcomes were: MAS; all-cause neonatal mortality; and incidence of hypoxic-ischaemic encephalopathy (HIE). Secondary outcomes included: need for mechanical ventilation; incidence of pulmonary air leaks; culture-positive sepsis; and persistent pulmonary hypertension. We used the GRADE approach to assess the certainty of evidence.
MAIN RESULTS
We included four studies (enrolling 581 neonates) in the review. All four studies were conducted in tertiary care hospitals in India. Three of the four studies included neonates born at and beyond term gestation, whereas one included neonates born at and beyond 34 weeks of gestation. Due to the nature of the intervention, it was not possible to blind the healthcare personnel conducting the intervention. Tracheal suction compared to no suction in non-vigorous neonates born through MSAF In non-vigorous infants, no differences were noted in the risks of MAS (RR 1.00, 95% CI 0.80 to 1.25; RD 0.00, 95% CI -0.07 to 0.08; 4 studies, 581 neonates) or all-cause neonatal mortality (RR 1.24, 95% CI 0.76 to 2.02; RD 0.02, 95% CI -0.03 to 0.07; 4 studies, 575 neonates) with or without tracheal suctioning. No differences were reported in the risk of any severity HIE (RR 1.05, 95% CI 0.68 to 1.63; 1 study, 175 neonates) or moderate to severe HIE (RR 0.68, 95% CI 0.43 to 1.09; 1 study, 152 neonates) among non-vigorous neonates born through MSAF. We are also uncertain as to the effect of tracheal suction on other outcomes such as incidence of mechanical ventilation (RR 0.99, 95% CI 0.68 to 1.44; RD 0.00, 95% CI -0.06 to 0.06; 4 studies, 581 neonates), pulmonary air leaks (RR 1.22, 95% CI 0.38 to 3.93; RD 0.00, 95% CI -0.02 to 0.03; 3 studies, 449 neonates), persistent pulmonary hypertension (RR 1.29, 95% CI 0.60 to 2.77; RD 0.02, 95% CI -0.03 to 0.06; 3 studies, 406 neonates) and culture-positive sepsis (RR 1.32, 95% CI 0.48 to 3.57; RD 0.01, 95% CI -0.03 to 0.05; 3 studies, 406 neonates). All reported outcomes were judged as providing very low certainty evidence.
AUTHORS' CONCLUSIONS
We are uncertain about the effect of tracheal suction on the incidence of MAS and its complications among non-vigorous neonates born through MSAF. One study awaits classification and could not be included in the review. More research from well-conducted large trials is needed to conclusively answer the review question.
Topics: Amniotic Fluid; Bias; Bronchodilator Agents; Cardiopulmonary Resuscitation; Cause of Death; Confidence Intervals; Epinephrine; Humans; Hypertension, Pulmonary; Hypoxia-Ischemia, Brain; Incidence; India; Infant; Infant Mortality; Infant, Newborn; Intubation, Intratracheal; Meconium Aspiration Syndrome; Randomized Controlled Trials as Topic; Respiration, Artificial; Sepsis; Suction; Trachea
PubMed: 34133025
DOI: 10.1002/14651858.CD012671.pub2 -
Journal of Thoracic Disease Feb 2021Though robot-assisted minimally invasive esophagectomy (RAMIE) is demonstrated to offer a better visualization and provide a fine dissection of the mediastinal...
Comparison of short-term clinical outcomes between robot-assisted minimally invasive esophagectomy and video-assisted minimally invasive esophagectomy: a systematic review and meta-analysis.
BACKGROUND
Though robot-assisted minimally invasive esophagectomy (RAMIE) is demonstrated to offer a better visualization and provide a fine dissection of the mediastinal structures to facilitate the complex thoracoscopic operation, the superiorities of RAMIE over MIE have not been well verified. The aim of this study was to explore the actual superiorities through comparing short-term results of RAMIE with that of MIE.
METHODS
PubMed, EMBASE and web of science databases were systematically searched up to September 1, 2020 for case-controlled studies that compared RAMIE with TLMIE.
RESULTS
Fourteen studies were identified, with a total of 2,887 patients diagnosed with esophageal cancer, including 1,435 patients subjected to RAMIE group and 1,452 patients subjected to MIE group. The operative time in RAMIE was still significantly longer than that in MIE group (OR =0.785; 95% CI, 0.618-0.952; P<0.001). The incidence of pneumonia was significantly lower in RAMIE group compared with MIE group (OR =0.677; 95% CI, 0.468-0.979; P=0.038).
CONCLUSIONS
RAMIE has the superiorities over MIE in short-term outcomes in terms of pneumonia and vocal cord palsy. Therefore, RAMIE could be considered as a standard treatment for patients with esophageal cancer.
PubMed: 33717543
DOI: 10.21037/jtd-20-2896 -
JAMA Otolaryngology-- Head & Neck... Nov 2020Hormonal changes during menopause have been associated with significant changes in voice. Although hormone replacement therapy (HRT) is used primarily to manage systemic... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Hormonal changes during menopause have been associated with significant changes in voice. Although hormone replacement therapy (HRT) is used primarily to manage systemic symptoms of menopause, its association with voice in postmenopausal women has not been adequately investigated by large-scale studies.
OBJECTIVE
To compare fundamental frequency between postmenopausal women who used HRT and those who did not use HRT.
DATA SOURCES
PubMed, Ovid MEDLINE, CINAHL, Cochrane EBM Reviews, and Embase were searched from 1946 to February 19, 2020.
STUDY SELECTION
Studies included in the final review were those in English that compared voice outcomes in postmenopausal women who were or were not receiving HRT for treatment of climacteric symptoms associated with menopause.
DATA EXTRACTION AND SYNTHESIS
The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data extraction was performed by 2 independent investigators. Study quality was assessed using a validated quality tool. Whenever possible, data were pooled using random-effects meta-analysis.
MAIN OUTCOMES AND MEASURES
The primary outcome was the difference in speaking fundamental frequency (F0) between HRT users and nonusers. Subgroup analysis of the primary outcome was based on body mass index (BMI) using a cutoff value of 25. A BMI of 18.5 to 24.9 is considered normal, and a BMI of at least 25 is considered overweight. Secondary outcomes included other objective measurements of voice, including jitter and shimmer.
RESULTS
A total of 937 records were screened, 18 full texts were assessed, and 11 studies were included in the final review. All 11 studies were case-control studies and were rated from fair to good quality based on the Newcastle-Ottawa Scale. A total of 5 studies including 154 participants who received HRT and 154 controls were used for meta-analysis. The mean (SD) F0 was 185.9 (8.6) Hz for HRT users compared with 174.6 (6.6) Hz for nonusers. Hormone replacement therapy was associated with a higher mean F0 by a difference of 11.85 Hz (95% CI, 7.35-16.36 Hz). Subgroup analysis showed that the change in F0 was significant in postmenopausal women with a normal body mass index (mean difference, 13.47 Hz; 95% CI, 8.48-18.46 Hz) but not in those with a high body mass index.
CONCLUSIONS AND RELEVANCE
Existing evidence suggests that HRT is associated with a higher F0 in postmenopausal women. The effectiveness of the treatment appeared to be more pronounced in women with a normal body mass index.
Topics: Body Mass Index; Female; Hormone Replacement Therapy; Humans; Postmenopause; Vocal Cords; Voice Quality
PubMed: 32790826
DOI: 10.1001/jamaoto.2020.2174 -
Endocrinology and Metabolism (Seoul,... Feb 2023There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of...
BACKGRUOUND
There have concerns related with the potential harms of fine-needle aspiration biopsy (FNAB). We aimed to summarize the clinical complications and evaluate the safety of FNAB.
METHODS
Studies related with the harms of FNAB were searched on MEDLINE, Embase, Cochrane library, and KoreaMed from 2012 to 2022. Also, studies reviewed in the previous systematic reviews were evaluated. Included clinical complications were postprocedural pain, bleeding events, neurological symptoms, tracheal puncture, infections, post-FNAB thyrotoxicosis, and needle tract implantation of thyroid cancers.
RESULTS
Twenty-three cohort studies were included in this review. Nine studies which were related with FNAB-related pain showed that most of the subjects had no or mild discomfort. The 0% to 6.4% of the patients had hematoma or hemorrhage after FNAB, according to 15 studies. Vasovagal reaction, vocal cord palsy, and tracheal puncture have rarely described in the included studies. Needle tract implantation of thyroid malignancies was described in three studies reporting 0.02% to 0.19% of the incidence rate.
CONCLUSION
FNAB is considered to be a safe diagnostic procedure with rare complications, which are mainly minor events. Thorough assessement of the patients' medical condition when deciding to perform FNABs would be advisable to lower potential complications.
Topics: Humans; Thyroid Nodule; Biopsy, Fine-Needle; Thyroid Neoplasms; Cohort Studies; Pain
PubMed: 36891657
DOI: 10.3803/EnM.2023.1669 -
Neurology Oct 2019Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by a combination of autonomic failure, cerebellar ataxia, and parkinsonism. Laryngeal stridor...
Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by a combination of autonomic failure, cerebellar ataxia, and parkinsonism. Laryngeal stridor is an additional feature for MSA diagnosis, showing a high diagnostic positive predictive value, and its early occurrence might contribute to shorten survival. A consensus definition of stridor in MSA is lacking, and disagreement persists about its diagnosis, prognosis, and treatment. An International Consensus Conference among experts with methodological support was convened in Bologna in 2017 to define stridor in MSA and to reach consensus statements for the diagnosis, prognosis, and treatment. Stridor was defined as a strained, high-pitched, harsh respiratory sound, mainly inspiratory, occurring only during sleep or during both sleep and wakefulness, and caused by laryngeal dysfunction leading to narrowing of the rima glottidis. According to the consensus, stridor may be recognized clinically by the physician if present at the time of examination, with the help of a witness, or by listening to an audio recording. Laryngoscopy is suggested to exclude mechanical lesions or functional vocal cord abnormalities related to different neurologic conditions. If the suspicion of stridor needs confirmation, drug-induced sleep endoscopy or video polysomnography may be useful. The impact of stridor on survival and quality of life remains uncertain. Continuous positive airway pressure and tracheostomy are both suggested as symptomatic treatment of stridor, but whether they improve survival is uncertain. Several research gaps emerged involving diagnosis, prognosis, and treatment. Unmet needs for research were identified.
Topics: Consensus Development Conferences as Topic; Humans; Multiple System Atrophy; Prognosis; Respiratory Sounds; Treatment Outcome
PubMed: 31570638
DOI: 10.1212/WNL.0000000000008208 -
Annals of the Royal College of Surgeons... Mar 2021Hashimoto's thyroiditis (HT) is one of the most common immune-mediated diseases. It makes thyroid surgery more complicated and difficult because there may be adhesions... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Hashimoto's thyroiditis (HT) is one of the most common immune-mediated diseases. It makes thyroid surgery more complicated and difficult because there may be adhesions between the thyroid gland and surrounding structures. However, it is still controversial whether HT patients carry a high risk for postoperative complications of thyroid surgery. The purpose of this study was to investigate the significance of HT for the postoperative complications of thyroid surgery.
METHODS
A search for studies assessing the postoperative complication risks of HT patients compared with that of patients with benign nodules (BNs) was performed in PubMed, EMBASE and Web of Science. Nine studies (20,118 cases, 1,582 cases of HT and 18,536 cases of BN) were identified, and the data from the relevant outcomes were extracted and analysed.
RESULTS
There were no significant differences between the HT group and BN group in recurrent laryngeal nerve palsy (RLNP) and permanent hypoparathyroidism (PHP). The rate of transient hypocalcaemia (THC) was significantly higher in the HT group (16.85%) than in the BN group (13.20%).
CONCLUSIONS
The meta-analysis showed that HT only increased the risk of the postoperative complication THC compared to BN. Understanding the significance of HT in postoperative hypoparathyroidism after thyroid surgery would help clinicians perform sufficient preoperative (and postoperative) assessments and to optimise surgical planning.
Topics: Case-Control Studies; Hashimoto Disease; Humans; Hypocalcemia; Hypoparathyroidism; Postoperative Complications; Thyroid Nodule; Thyroidectomy; Vocal Cord Paralysis
PubMed: 33645288
DOI: 10.1308/rcsann.2020.7013 -
Ear, Nose, & Throat Journal Feb 2021The aim of the current systematic review is to update the pooled survival outcome of patients with T2 glottic carcinoma treated with either laser surgery (CO transoral... (Comparative Study)
Comparative Study
INTRODUCTION
The aim of the current systematic review is to update the pooled survival outcome of patients with T2 glottic carcinoma treated with either laser surgery (CO transoral laser microsurgery [CO TOLMS]), radiotherapy (RT), or open partial laryngectomy (OPL).
METHODS
A systematic search was performed using the MEDLINE database, Scopus, and Google scholar. The inclusion criteria were studies of patients with T2N0 glottic tumor, treated with either primary CO TOLMS, definitive curative RT, or primary OPL, and with reported oncological outcome at 5 years calculated with a Kaplan-Meier or Cox regression method.
RESULTS
The results of the current review show that local control (LC) is higher with OPL 94.4%, while there are no differences in LC at 5-year posttreatment for patients treated with RT, compared to those treated with CO TOLMS (respectively, 75.6% and 75.4%). Primary treatment with OPL and CO TOLMS results in higher laryngeal preservation than primary treatment with RT (respectively 95.8%, 86.9%, and 82.4%).
CONCLUSION
First-line treatment with OPL and CO TOLMS should be encouraged in selected T2 patients, because it results in higher laryngeal preservation and similar LC compared to primary treatment with RT. The involvement of the anterior commissure in the craniocaudal plane and T2b impaired vocal cord mobility have a poorer prognosis and LC compared to patients with T2a tumors for both CO TOLMS and RT.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma; Disease-Free Survival; Female; Glottis; Humans; Kaplan-Meier Estimate; Laryngeal Neoplasms; Laryngectomy; Larynx; Laser Therapy; Lasers, Gas; Male; Microsurgery; Middle Aged; Neoplasm Staging; Proportional Hazards Models; Radiotherapy; Treatment Outcome; Vocal Cords
PubMed: 32511005
DOI: 10.1177/0145561320928198 -
Journal of Vascular Surgery Oct 2019Coverage of the left subclavian artery (LSA) is often required to achieve complete proximal sealing during thoracic endovascular aortic repair. However, whether LSA... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Coverage of the left subclavian artery (LSA) is often required to achieve complete proximal sealing during thoracic endovascular aortic repair. However, whether LSA revascularization should be performed remains controversial.
METHODS
MEDLINE, Embase, and Cochrane databases were systematically searched to identify all the relevant studies. A random-effects model was applied to pool the effect measures. Dichotomous data were presented using an odds ratio (OR).
RESULTS
There were 32 studies included for qualitative analysis and 31 studies for quantitative analysis. We found that patients who underwent LSA revascularization had a significantly decreased risk of spinal cord ischemia (OR, 0.62; 95% confidence interval [CI], 0.41-0.92; P = .02; I = 0%), cerebrovascular accident (OR, 0.63; 95% CI, 0.42-0.95; P = .03; I = 22%), and left upper extremity ischemia (OR, 0.18; 95% CI, 0.09-0.36; P < .00001; I = 0%). However, no significant differences were found in the risk of paraplegia (OR, 0.91; 95% CI, 0.55-1.51; P = .71; I = 0%) and 30-day mortality (OR, 0.89; 95% CI, 0.59-1.36; P = .60; I = 21%) between the groups of patients with and without LSA revascularization.
CONCLUSIONS
Revascularization of the LSA is associated with decreased risks of cerebrovascular accident, spinal cord ischemia, and left upper limb ischemia in thoracic endovascular aortic repair with LSA coverage at the cost of higher local complications, such as possible vocal cord paresis.
Topics: Aorta, Thoracic; Aortic Diseases; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Postoperative Complications; Risk Assessment; Risk Factors; Subclavian Artery; Treatment Outcome
PubMed: 31176636
DOI: 10.1016/j.jvs.2019.03.022