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BJS Open May 2024Umbilical hernias, while frequently asymptomatic, may become acutely symptomatic, strangulated or obstructed, and require emergency treatment. Robust evidence is... (Review)
Review
BACKGROUND
Umbilical hernias, while frequently asymptomatic, may become acutely symptomatic, strangulated or obstructed, and require emergency treatment. Robust evidence is required for high-quality care in this field. This scoping review aims to elucidate evidence gaps regarding emergency care of umbilical hernias.
METHODS
EMBASE, MEDLINE and CENTRAL databases were searched using a predefined strategy until November 2023. Primary research studies reporting on any aspect of emergency umbilical hernia care and published in the English language were eligible for inclusion. Studies were excluded where emergency umbilical hernia care was not the primary focus and subsets of relevant data were unable to be extracted. Two independent reviewers screened abstracts and full texts, resolving disagreements by consensus or a third reviewer. Data were charted according to core concepts addressed by each study and a narrative synthesis was performed.
RESULTS
Searches generated 534 abstracts, from which 32 full texts were assessed and 14 included in the final review. This encompassed 52 042 patients undergoing emergency umbilical hernia care. Most were retrospective cohort designs (11/14), split between single (6/14) and multicentre (8/14) with only one randomized trial. Most multicentre studies were from national databases (7/8). Themes arising included risk assessment (n = 4), timing of surgery (n = 4), investigations (n = 1), repair method (n = 8, four mesh versus suture; four laparoscopic versus open) and operative outcomes (n = 11). The most commonly reported outcomes were mortality (n = 9) and morbidity (n = 7) rates and length of hospital stay (n = 5). No studies included patient-reported outcomes specific to emergency umbilical hernia repair.
CONCLUSION
This scoping review demonstrates the paucity of high-quality data for this condition. There is a need for randomized trials addressing all aspects of emergency umbilical hernia repair, with patient-reported outcomes.
Topics: Humans; Hernia, Umbilical; Herniorrhaphy; Emergencies
PubMed: 38898709
DOI: 10.1093/bjsopen/zrae068 -
Research Involvement and Engagement Jun 2024In light of the FDA's Project Optimus initiative, there is fresh interest in leveraging Patient-reported Outcome (PRO) data to enhance the assessment of tolerability for...
BACKGROUND
In light of the FDA's Project Optimus initiative, there is fresh interest in leveraging Patient-reported Outcome (PRO) data to enhance the assessment of tolerability for investigational therapies within early phase dose-finding oncology trials. Typically, dose escalation in most trial designs is solely reliant on clinician assessed adverse events. Research has shown a disparity between patients and clinicians when assessing whether an investigational therapy is tolerable, leading to the recommendation of potentially intolerable doses for further investigation in subsequent trials. It is also increasingly recognized that patient and public involvement and engagement (PPIE) plays a pivotal role in enriching trial design and conduct. However, to our knowledge, no PPIE has explored the optimal integration of PROs in the development of advanced statistical trial designs within early phase dose-finding oncology trials.
METHODS
A virtual PPIE session was held with nine participants on 18th October 2023 to discuss the incorporation of PROs within a dose-finding trial design. This cross disciplinary session was developed and led by a team of statisticians, clinical specialists, qualitative experts, and trial methodologists. Following the session, in-depth perspectives were provided by two patient advocates who actively engaged in the PPIE session. We discuss the importance of PPIE in shaping advanced dose-finding trial designs, share insights from patients on integrating PROs to inform treatment tolerability, and present a template for meaningful patient involvement in trial design development.
RESULTS
Participants generally supported the introduction of PROs within dose-finding trials but showed some apprehensiveness as to how PROs may reduce the size of the recommended dose (and potentially efficacious effect). Some participants shared that they may be reluctant to record the real severity of their symptoms via PROs if it would mean that they would have to discontinue treatment. They discussed that PROs could be used to assess tolerability rather than toxicity of a dose.
CONCLUSIONS
Amplifying patient voice in the development of patient-centric dose-finding trial designs is now essential. This paper offers an exemplary illustration of how trialists and methodologists can effectively incorporate patient voice in the future development of advanced dose-finding trial designs.
PubMed: 38898479
DOI: 10.1186/s40900-024-00599-7 -
Scientific Reports Jun 2024Dental fear and anxiety (DFA) is known as an immense challenge in oral healthcare, which can result in compromised oral health, pain, and uncomfortable treatment. The... (Randomized Controlled Trial)
Randomized Controlled Trial
Dental fear and anxiety (DFA) is known as an immense challenge in oral healthcare, which can result in compromised oral health, pain, and uncomfortable treatment. The objective of this study was to analyze the effect of essential-oil vaporization on acute anxiety of patients in dental practices. Four dental practices used five weekly cycles of vaporization with each scent: Orange (Citrus sinensis), Swiss Pine (Pinus cembra), Good Mood (blended essential oils: Citrus sinensis, Citrus aurantifolia, Citrus limon, Osmanthus fragrance (5%)), Forest Walk (blended essential oils: Abies grandis, Pinus cembra, Myrtus communis c. t. 1,8-cineol, Abies alba, Citrus paradisi, Abies sibirica, Pseudotsuga menziesii, Vetiveria zizanoides), and water. Acute anxiety was the primary outcome (state-trait-anxiety inventory (STAI-S)). Secondary outcomes were trait anxiety (STAI-T), dental anxiety (Kleinknecht dental fear survey), and pain perception in treatment (numeric rating scale). Across all patients (n = 486), STAI-S was slightly higher in the control group (40.7 ± 11.6) than in the intervention groups (38.4 ± 10.5). Post-hoc analyses revealed that the effect is only robust for the subgroup of female patients (n = 296, p = 0.044). We also conducted a post-hoc additional analysis on a subpopulation with an increased level of STAI-T ≥ 42 (n = 131 patients). For this group the difference in acute anxiety between the control group (51.1 ± 11.9, n = 30) vs. the intervention groups (46.8 ± 9.6, n = 118) was significant (T = 4.39, p = 0.0379). The results of the study indicate a promising potential of essential-oil vaporization to alleviate dental anxiety, particularly in the subgroups of patients with a high level of trait anxiety, and particularly in female patients. The calming effects of the essential-oil vaporization were also highlighted by the anecdotical statements of the dental-practice staff. The anxiety-reducing role of essential-oil vaporization alone and as one part of combined techniques to counter DFA should be further explored using multi-perspective methodological approaches in research.
Topics: Humans; Female; Male; Oils, Volatile; Adult; Dental Anxiety; Middle Aged; Aromatherapy; Volatilization; Single-Blind Method; Young Adult
PubMed: 38898054
DOI: 10.1038/s41598-024-63657-w -
BDJ Open Jun 2024Stroke is a major public health problem, with the disabilities of the patients increasing their risk of poor oral health. Currently, in Ghana and Nigeria, no guideline...
BACKGROUND
Stroke is a major public health problem, with the disabilities of the patients increasing their risk of poor oral health. Currently, in Ghana and Nigeria, no guideline exists for oral health care in stroke patients, while most of our acute stroke care settings have no documented protocol.
AIM
This study sought to understand the perspectives of healthcare professionals in Ghana and Nigeria about oral healthcare in acute stroke patients.
METHODS
A qualitative inductive approach was employed to explore healthcare professionals' perspectives. After obtaining informed consent, in-depth interviews were conducted among doctors, nurses, and physiotherapists using semi-structured question guides. Participants' responses were audiotaped for transcription and analysis. Interviews were conducted until data saturation was reached. Data were analyzed thematically to generate themes and sub-themes using an inductive approach.
THE RESULTS
Twenty-five (25) health care professionals (HCP) aged 25-60 years with a mean age of 36.2 ± 4.2 years were interviewed. There were 15 (60.0%) males and 10 (40.0%) females. HCP included nurse practitioners 14 (56.0%), medical doctors 7 (28.0%), and physiotherapists 4 (16.0%). The HCP demonstrated adequate knowledge of stroke and considered oral health important for esthetic and clinical reasons. They, however, reported being unable to give it the required attention due to inadequate collaboration between the various professional cadres, insufficient equipment, and a skewed focus on other clinical needs of the acute stroke patients.
CONCLUSIONS
The findings indicate that HCPs perceived oral health care as very important among patients with acute stroke. However, they reported a lack of collaboration and integration of oral health care in routine stroke care as a major impediment.
PubMed: 38898008
DOI: 10.1038/s41405-024-00238-z -
The Tohoku Journal of Experimental... Jun 2024
Background Factors that Hospital-Based Geriatricians and General Practitioners Associate with Difficulty in Treating Older People with Multimorbidity: A Cross-Sectional Survey.
PubMed: 38897963
DOI: 10.1620/tjem.2024.J045 -
Health Reports Jun 2024This study explores the link between dental insurance, income, and oral health care access among seniors (aged 65 and over) in Canada. It contributes to the...
BACKGROUND
This study explores the link between dental insurance, income, and oral health care access among seniors (aged 65 and over) in Canada. It contributes to the understanding of oral health care among seniors before the implementation of the Canadian Dental Care Plan.
DATA AND METHODS
This study uses data from the 2019/2020 Canadian Health Survey on Seniors (n=41,635) to report descriptive statistics and logistic regression model results and examine factors associated with seniors living in the community and access to oral health care services.
RESULTS
At the time of the survey (2019/2020), 72.5% of seniors in Canada reported having had a dental visit in the past 12 months, with 83.0% of insured and 65.3% of uninsured seniors reporting visits. Seniors reporting excellent or very good oral health had a higher prevalence of visits (79.2%) compared with those with good, fair, or poor oral health (62.3%). Among seniors who had not visited a dental professional in three years, 56.3% deemed it unnecessary, and 30.8% identified cost as the major barrier. After sociodemographic characteristics were controlled for, insured seniors were more likely to have had a dental visit in the past 12 months (adjusted odds ratio [OR]: 2.27; 95% confidence interval [CI]: 2.03 to 2.54) and were less likely to avoid dental visits because of cost (OR: 0.18; 95% CI: 0.12 to 0.28) compared with their uninsured counterparts.
INTERPRETATION
This study underscores the role of dental insurance in seniors' oral health care access. While insurance is associated with seniors' access to oral health care services, the study also emphasizes the need to consider social determinants of oral health such as income, gender, age, level of education, and place of residence when assessing oral health care access for seniors.
Topics: Humans; Aged; Female; Male; Canada; Health Services Accessibility; Insurance, Dental; Oral Health; Aged, 80 and over; Dental Health Services; Health Surveys; Income
PubMed: 38896417
DOI: 10.25318/82-003-x202400600002-eng -
Clinical Medicine Insights. Case Reports 2024Intracranial empyema is a rare but serious and life-threatening infection. It is an accumulation of purulent material in the subdural or extradural space leading to...
INTRODUCTION
Intracranial empyema is a rare but serious and life-threatening infection. It is an accumulation of purulent material in the subdural or extradural space leading to development of subdural empyema or intracranial epidural abscess, respectively. The incidence of morbidity and mortality is high because the diagnosis is often unsuspected. Infections of dental origin could be responsible for such condition.
CASE REPORTS
A 22-year-old female and 30-year-old male patients, both with no significant medical history, presented with subdural empyema and intracranial epidural abscess, respectively, both complicating pan-sinusitis of dental origin. Successful outcomes were achieved with surgical drainage of the lesions, antibiotic therapy, and extraction of affected teeth. Female patient underwent further management for neurological sequelae, while male patient was discharged without neurological complications.
DISCUSSION
Intracranial suppuration of odontogenic origin is an uncommon but extremely serious complication. The most common dental origins are caries with periapical involvement and periodontitis. Wisdom tooth extraction is the most common preceding dental procedure for this infection. A multidisciplinary approach is essential for the identification and treatment of suspected oral sources. Antibiotic therapy with surgical approach is the gold standard treatment.
CONCLUSION
This sequel to odontogenic infection is quite rare, but it can be prevented by a good oral hygiene and removal of abscessed teeth.
PubMed: 38895741
DOI: 10.1177/11795476241261883 -
Iranian Journal of Public Health Feb 2024Oral squamous cell carcinoma (OSCC) has numerous physical, psychosocial and financial implications, which significantly affect patients' quality of life. We aimed to...
BACKGROUND
Oral squamous cell carcinoma (OSCC) has numerous physical, psychosocial and financial implications, which significantly affect patients' quality of life. We aimed to determine the health-related quality of life (HRQoL) and identify quality of life (QoL) predictors in patients with OSCC.
METHODS
We included 64 consecutive patients aged 40 to 80 yr treated for OSCC from Jan to Dec 2021. Health-related QoL was evaluated using the 30-item Cancer Quality of Life Questionnaire (QLQ-C30) and the 35-item Head and Neck Cancer-Quality of Life Questionnaire (QLQ-H&N35). The demographic questionnaire and clinical parameters were also presented.
RESULTS
The functioning scale in the QLQ-C30 questionnaire with the lowest average score was Global health status. The mean QLQ-C30 summary score (80.92 ± 10.4) was higher than the Global health status score (50.5 ± 22.2). In the QLQ-H&N35 questionnaire, the symptoms with highest scores were weight loss, dry mouth, and social eating. Linear regression analysis demonstrated that Global health status score was associated with education level [β-coefficient = 19.33 (95% CI: 10.7-24.9, =0.004], alcohol consumption [β-coefficient=10.04 (95% CI: 4.5-14.8), =0.023] and invasive surgical procedure [β-coefficient=22.75 (95% CI: 15.0-30.5), =0.002]. The QLQ-C30 summary score was associated with living alone [β-coefficient= -20.05 (95% CI: -29.91-(-10.21), =0.018], smoking status [β-coefficient=4.35 (95% CI: 1.8-6.91), =0.043] and alcohol consumption [β-coefficient =4.59 (95% CI: 1.99-7.19), =0.037].
CONCLUSION
We found several significant predictors of worse perception of HRQoL among patients with OSCC, which may be useful for specific prevention and treatment in order to achieve better QoL.
PubMed: 38894846
DOI: 10.18502/ijph.v53i2.14926 -
Cureus May 2024Background Studies evaluating the quality of life (QoL) among oral cancer patients in the Indian population are scarce. Regular follow-ups and QoL assessment in oral...
Background Studies evaluating the quality of life (QoL) among oral cancer patients in the Indian population are scarce. Regular follow-ups and QoL assessment in oral squamous cell carcinoma (OSCC) patients can aid in comprehensive support strategies to improve their QoL outcomes. Aim and objectives This study aimed to assess the QoL of oral cancer patients and correlate the QoL with demographic and treatment parameters. Materials and methods The study included oral cancer patients who had previously reported to the Department of Oral and Maxillofacial Surgery. QoL assessment was done using the EORTC QLQ-C30 and QLQ-HN43 questionnaires before and after treatment. The clinico-demographic details, treatment data, follow-up data, and recorded mean QoL were procured from the patient records in Dental Information Archival Software. Assessment of QoL was done before treatment and at intervals of one month, three months, six months, 12 months, 24 months, and 36 months postoperatively after treatment. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23 (released 2015; IBM Corp., Armonk, New York, United States). A repeated measures analysis of variance (ANOVA) was utilized for comparing the average QoL scores and frequency of follow-ups across various intervals. Chi-square tests assessed differences in mean QoL among genders, across different sites, and between primary closure and graft placement. The significance was set at a p-value of less than 0.05. Results A total of 90 OSCC patients had reported to the department. A preoperative assessment of QoL was done for 90 (100%) patients. Out of these patients, surgery has been performed on 41 (45%). Twenty-five out of 41 (60%) patients had responded to regular follow-up, and QoL was assessed for these patients. After the immediate postoperative phase, only 12 (48%) had reported after three months. Only six (24%) had a 12-month follow-up, five (20%) had a two-year follow-up, and one (4%) had a three-year follow-up. There was a constant decrease in the number of follow-ups after the treatment of OSCC (p=0.00). Prior to treatment, the mean QoL index was 4.64. Females had a slightly higher preoperative QoL of 4.76 compared to males, with a score of 4.67 (p=0.157). Immediately after the treatment of OSCC, a decline in QoL scores was noted, with a mean score of 4.25 (p=0.32). Patients who underwent primary closure after excision had a mean post-op QoL score of 4.9, while patients who underwent graft placement had a mean score of 4.6 (p=0.157). Conclusion This study highlights the enduring impact of oral cancer on a patient's quality of life and emphasizes the need for ongoing research to explore specific interventions that can contribute to sustained improvement in QoL. It emphasizes personalized, holistic care approaches for such patients.
PubMed: 38894763
DOI: 10.7759/cureus.60596 -
Diagnostics (Basel, Switzerland) May 2024Technological improvements have introduced significant innovations in dentistry and broadened the array of tools and techniques in dental care. One technological...
Technological improvements have introduced significant innovations in dentistry and broadened the array of tools and techniques in dental care. One technological development that has been widely researched over the past 20 years is the use of Near-Infrared Transillumination (NIRT) imaging for the diagnosis of dental caries. This paper aims to introduce a comprehensive collection of NIRT images, intended as a reference tool for routine dental examinations, dental research, pedagogical activities, and forensic odontology. The collection presents pairwise clinical and NIRT images categorized as follows: (a) healthy teeth, (b) carious teeth, (c) restored teeth, (d) enamel defects, and (e) diverse findings. This atlas could be a valuable tool for the dental community as it is designed as an identification guide of NIRT illustrated dental features.
PubMed: 38893679
DOI: 10.3390/diagnostics14111154