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Carvalho M, Perez-Lopez LM, Farr S, Catena N. Trigger thumb treatment approach: Results of a survey of EPOS members. J Child Orthop 2024; 18:64-71. [PMID: 38348431 PMCID: PMC10859122 DOI: 10.1177/18632521231214312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose The aim of this study is to analyze the clinical reality of pediatric trigger thumb among members of the European Paediatric Orthopaedic Society. Methods A 35-question survey was sent to all European Paediatric Orthopaedic Society members, focusing on surgeon's profile and experience, trigger thumb diagnostic and trigger thumb treatment approach. Descriptive statistics were performed. Results A total of 99 responses were analyzed. Most important factor considered in the therapeutic approach was the presence of a locked interphalangeal joint (52%). Regarding treatment, 41.4% opt for conservative approach as the first line of treatment, while 30.3% consider surgery and 28.3% just observe. Nevertheless, 76% mention to treat conservatively their patients and 99% to consider surgery at some stage. Regarding surgical technique, 96% do it open and 56% consider 2 years as the minimum age for procedure. Most surgeons perform this procedure in out-patient care (87%), don't administer prophylactic antibiotherapy (80%), use a tourniquet (75%), don't use any postoperative immobilization (64%), and report complications related to surgery (64%), mainly recurrence/incomplete division (59%) and superficial wound infection (30%). Conclusion Our study shows a significant variability in the initial management of pediatric trigger thumb with a predominance of conservative management, followed by surgery and observation without treatment. The disparity in treatment options and timing, or waiting times before moving on to different therapeutic options, shows us that this is a controversial issue and that the development of prospective randomized controlled studies is needed to analyze the different treatment methods and determine which ones give the best outcomes.
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Affiliation(s)
- Marcos Carvalho
- Department of Pediatric Orthopedics - Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra (CHUC), EPE, Coimbra, Portugal
| | - Laura M Perez-Lopez
- Department of Pediatric Orthopaedic Surgery and Traumatology, Sant Joan de Deu Barcelona Children’s Hospital, University of Barcelona, Barcelona, Spain
- Sant Joan de Deu Research Foundation, Barcelona, Spain
| | - Sebastian Farr
- Department of Pediatric Orthopedics and Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
| | - Nunzio Catena
- Head Reconstructive Surgery and Hand Surgery Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Samoliński B, Wojas O, Lipiec A, Krzych-Fałta E, Walkiewicz A, Borowicz J, Samoliński K. Intranasal combo: fixed-dose combination of mometasone furoate and olopatadine hydrochloride in therapeutic strategies for rhinosinusitis. Otolaryngol Pol 2023; 77:43-50. [PMID: 38706259 DOI: 10.5604/01.3001.0054.0941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
A novel strategy for the treatment of allergic rhinitis results from the innovative combination of antihistamine and intranasal corticosteroid drugs. By combining two preparations with different mechanism of action, this novel approach facilitates quick and effective controls of all upper respiratory tract allergy symptoms. The article presents the results of a study of olopatadine hydrochloride and mometasone furoate fixed-dose combination (GSP301) administered intranasally from a spray formulation, with an attempt at positioning the treatment within the ARIA and EPOS guidelines.
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Affiliation(s)
- Bolesław Samoliński
- Department of the Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Poland
| | - Oksana Wojas
- Department of the Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Poland
| | - Agnieszka Lipiec
- Department of the Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Poland
| | | | - Artur Walkiewicz
- Department of the Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Poland
| | - Jacek Borowicz
- Department of the Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Poland
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Sedaghat AR, Caradonna DS, Chandra RK, Franzese C, Gray ST, Halderman AA, Hopkins C, Kuan EC, Lee JT, McCoul ED, O'Brien EK, Pletcher SD, Pynnonen MA, Wang EW, Wise SK, Woodworth BA, Yao WC, Phillips KM. Determinants of physician assessment of chronic rhinosinusitis disease control using EPOS 2020 criteria and the importance of incorporating patient perspectives of disease control. Int Forum Allergy Rhinol 2023; 13:2004-2017. [PMID: 37042828 DOI: 10.1002/alr.23168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/21/2023] [Accepted: 04/09/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND We identify chronic rhinosinusitis (CRS) manifestations associated with how rhinologists assess CRS control, with a focus on patient perspectives (patient-reported CRS control). METHODS Fifteen rhinologists were provided with real-world data from 200 CRS patients. Participating rhinologists first classified patients' CRS control as "controlled," "partly controlled," and "uncontrolled" using seven CRS manifestations reflecting European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) CRS control criteria (nasal obstruction, drainage, impaired smell, facial pain/pressure, sleep disturbance, use of systemic antibiotics/corticosteroids in past 6 months, and nasal endoscopy findings) and patient-reported CRS control. They then classified patients' CRS control without knowledge of patient-reported CRS control. Interrater reliability and agreement of rhinologist-assessed CRS control with patient-reported CRS control and EPOS guidelines were determined. RESULTS CRS control classification with and without knowledge of patient-reported CRS control was highly consistent across rhinologists (κw = 0.758). Rhinologist-assessed CRS control agreed with patient-reported CRS control significantly better when rhinologists had knowledge of patient-reported CRS control (κw = 0.736 vs. κw = 0.554, p < 0.001). Patient-reported CRS control, nasal obstruction, drainage, and endoscopy findings were most strongly associated with rhinologists' assessment of CRS control. Rhinologists' CRS control assessments weakly agreed with EPOS CRS control guidelines with (κw = 0.529) and without (κw = 0.538) patient-reported CRS control. Rhinologists classified CRS as more controlled than EPOS guidelines in almost 50% of cases. CONCLUSIONS This study directly demonstrates the importance of patient-reported CRS control as a dominant influence on rhinologists' CRS control assessment. Knowledge of patient-reported CRS control may better align rhinologists' CRS control assessments and treatment decisions with patients' perspectives.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David S Caradonna
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christine Franzese
- Department of Otolaryngology, University of Missouri, Columbia, Missouri, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashleigh A Halderman
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Claire Hopkins
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Jivianne T Lee
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Erin K O'Brien
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven D Pletcher
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Melissa A Pynnonen
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | | | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Kang JS, Herrero C, Castañeda P. What is the degree of variability in formal training for pediatric orthopedic surgeons performing scoliosis surgery? Acta Ortop Mex 2022; 36:367-372. [PMID: 37669656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
INTRODUCTION although pediatric orthopedic surgeons worldwide perform scoliosis surgery, the training received is variable and poorly understood. By surveying the European Pediatric Orthopedic Society (EPOS) and the Sociedad Latinoamericana de Ortopedia (SLAOTI), we aim to characterize this variability. MATERIAL AND METHODS in 2021, we distributed an anonymous online questionnaire to EPOS and SLAOTI. RESULTS 43% EPOS and 22% SLAOTI perform scoliosis procedures (p < 0.05). 18% EPOS and 2% SLAOTI performed > 35 procedures annually (p < 0.05). 70% EPOS and 27% SLAOTI received formal training in spinal deformity surgery (p < 0.005). CONCLUSIONS results show significant differences in training and performance of scoliosis procedures between societies.
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Affiliation(s)
- J S Kang
- Department of Orthopedic Surgery, NYU Langone Health, New York, N.Y. USA
| | - C Herrero
- Department of Orthopedic Surgery, NYU Langone Health, New York, N.Y. USA
| | - P Castañeda
- Department of Orthopedic Surgery, NYU Langone Health, New York, N.Y. USA
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Jaume F, Alobid I, Mullol J, Quintó L. Direct Costs of Acute Rhinosinusitis in Spain: A Prospective and Observational Study (PROSINUS). J Investig Allergol Clin Immunol 2021; 31:481-488. [PMID: 32694096 DOI: 10.18176/jiaci.0525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The incidence of acute rhinosinusitis (ARS) is high throughout the world. Although diagnosis is clinical and disease course is mostly self-limiting, diagnostic tools and medications are overused by physicians, thus increasing the direct medical costs of the disease. Objective: The aim of the PROSINUS study was to quantify the direct medical costs of management of ARS in Spain. METHODS We performed a prospective observational study of 1610 patients with a clinical diagnosis of nonbacterial, uncomplicated ARS. According to the duration of symptoms by the European Position Paper on Rhinosinusitis and Nasal Polyps, patients were classified as having viral or postviral ARS with different levels of severity. Direct medical costs were calculated based on medical visits, use of diagnostic tools, and medications prescribed. RESULTS Overall, the mean (SD) direct medical costs per episode were €322.3 (301.2) vs €441.1 (344.3) for viral and postviral ARS episodes, respectively (P<.001). When viral and postviral disease were compared, the medical costs per episode were €245.0 (265.4) vs €328.4 (301.9) for medical visits (P<.001), €38.1 (64.0) vs €61.9 (78.8) for diagnostic tools (P<.001), and €39.2 (25.9) vs €50.8 (25.3) for medications prescribed (P<.001). CONCLUSION The direct medical costs of postviral ARS episodes were higher than those of viral episodes (common cold). Uncomplicated nonbacterial ARS represents an important socioeconomic burden owing to the excessive number of medical visits, use of diagnostic tools, and medications prescribed.
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Affiliation(s)
- F Jaume
- Servei de Otorrinolaringologia, Hospital Comarcal d'Inca, Inca, Balears, Spain
| | - I Alobid
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Immunoal.lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES)
| | - J Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Immunoal.lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES)
| | - L Quintó
- Institut de Salut Global de Barcelona (ISGlobal) de Recerca en Salut Internacional de Barcelona (CRESIB). Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica En Red en Epidemiología y Salud Pública (CIBERESP).,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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Arcimowicz M. Acute sinusitis in daily clinical practice. Otolaryngol Pol 2021; 75:40-50. [PMID: 34552023 DOI: 10.5604/01.3001.0015.2378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Understanding the appropriate use of diagnostics and treatment in acute rhinosinusitis is of immense importance given the high prevalence of this disease in the general population. The ability to differentiate between the principal phenotypes of acute sinusitis, namely acute viral infection (cold), acute post-viral sinusitis and acute bacterial sinusitis, determines the future management and is fundamental to providing rational therapeutic recommendations - especially as regards antibiotic treatment, which is very often overused in acute sinusitis even though bacterial phenotypes only account for 0.5-2% of all cases of the disease. The latest therapeutic recommendations contained in the EPOS2020 position paper introduce a system based on integrated care pathways (ICPs), which comprise pharmacy-supported self-care and e-health as the first level, followed by primary care as the second, with specialist care being reserved for patients who develop a more severe course of the disease, have suspected complications or suffer from recurrent acute sinusitis. Management of acute sinusitis is primarily based on symptomatic treatment modalities, with phytotherapeutic support, as well as on antiinflammatory treatment, while antibiotic therapy is used in very specific and limited indications. Complications are relatively rare in acute sinusitis and they are not considered to be associated with antibiotic intake. Considering the high prevalence of acute forms of sinusitis, their significant impact on quality of life and high direct and indirect costs of treatment, the right diagnosis and management, without unnecessary escalation of therapy, can substantially translate into a number of public health benefits.
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Affiliation(s)
- Magdalena Arcimowicz
- Katedra i Klinika Otorynolaryngologii, Chirurgii Głowy i Szyi, Warszawski Uniwersytet Medyczny
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Hart L, Polášková A, Schalek P. Clinical decision support system RHINA in the diagnosis and treatment of acute or chronic rhinosinusitis. BMC Med Inform Decis Mak 2021; 21:239. [PMID: 34372852 PMCID: PMC8350307 DOI: 10.1186/s12911-021-01599-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Rhinosinusitis is an inflammation of the sinonasal cavity which affects roughly one in seven people per year. Acute rhinosinusitis (ARS) is mostly, apart from allergic etiology, caused by a viral infection and, in some cases (30–50%), by a bacterial superinfection. Antibiotics, indicated only in rare cases according to EPOS guidelines, are nevertheless prescribed in more than 80% of ARS cases, which increases the resistant bacterial strains in the population. Methods We have designed a clinical decision support system (CDSS), RHINA, based on a web application created in HTML 5, using JavaScript, jQuery, CCS3 and PHP scripting language. The presented CDSS RHINA helps general physicians to decide whether or not to prescribe antibiotics in patients with rhinosinusitis. Results In a retrospective study of a total of 1465 patients with rhinosinusitis, the CDSS RHINA presented a 90.2% consistency with the diagnosis and treatment made by the ENT specialist. Conclusion Patients assessed with the assistance of our CDSS RHINA would decrease the over-prescription of antibiotics, which in turn would help to reduce the bacterial resistance to the most commonly prescribed antibiotics. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01599-3.
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Affiliation(s)
- L Hart
- Department of Otorhinolaryngology and Head and Neck Surgery, 3rd Faculty of Medicine and University Hospital Královské Vinohrady, Charles University in Prague, Prague, Czech Republic.
| | - A Polášková
- Charles University Computer Centre, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - P Schalek
- Department of Otorhinolaryngology and Head and Neck Surgery, 3rd Faculty of Medicine and University Hospital Královské Vinohrady, Charles University in Prague, Prague, Czech Republic
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Campion NJ, Kohler R, Ristl R, Villazala-Merino S, Eckl-Dorna J, Niederberger-Leppin V. Prevalence and Symptom Burden of Nasal Polyps in a Large Austrian Population. J Allergy Clin Immunol Pract 2021; 9:4117-4129.e2. [PMID: 34265447 DOI: 10.1016/j.jaip.2021.06.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory condition with significant morbidity and financial cost, information regarding prevalence and disease burden of this condition is scarce. OBJECTIVE In this study we determined nasal polyp prevalence, polyp grade, concomitant disease, and symptom burden in > 10,000 central European subjects. METHODS In this retrospective, cross-sectional study, 10,259 patients who had undergone routine examination of their nose by nasal endoscopy during a visit at a publicly accessible ENT outpatient facility in Vienna were included. Patient details including presenting complaint, nasal symptoms, polyp score, age, gender, treatment, asthma and allergic status were extracted retrospectively. A detailed questionnaire including history of nasal symptoms, SNOT-20 GAV, and VAS was available for 101 patients with nasal polyps. RESULTS Nasal polyps were detected in 189 (1.84%) of the 10,259 patients. The calculated prevalence of polyps in Austria, adjusted for age and gender, was 1.95%. The average TPS was 3.4, 72.5% had a TPS of ≤4, with males and asthmatics having significantly larger polyps. Questionnaire analysis revealed that 67% suffered from a low symptom burden of ≤36. According to current EPOS guidelines, 6% of polyp patients fulfilled and another 8% potentially fulfil the eligibility criteria for biological therapy. CONCLUSION Nasal polyp prevalence was calculated to be 1.95% of the Austrian population. Large polyps (TPS>4) were found in 25%, 33% suffered from a high nasal symptom burden, and between 6 to 14% of polyp patients would be eligible for biological therapy according to EPOS guidelines.
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Affiliation(s)
| | - Rebecca Kohler
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Robin Ristl
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Julia Eckl-Dorna
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria.
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Abstract
PURPOSE OF REVIEW The purposes of the review are as follows: (1) to define acute rhinosinusitis (ARS) and their phenotypes, (2) to highlight the ARS management according to international guidelines, (3) to compare the physicians' management with the ARS guideline recommendations, and (4) to report ARS socioeconomic burden. RECENT FINDINGS Bacterial and non-bacterial ARS have similar symptoms, although they can be discriminated by using a combination of specific signs and symptoms. The prescription of antibiotics should be limited to clearly suspected bacterial ARS. There is an overuse of diagnosis tools and treatment prescriptions. The total cost per ARS episode in Europe is over €1000. ARS is mainly an inflammatory disease triggered by viral infection, and few cases end up developing bacterial infection. In most of the cases, it is a self-resolving disease which diagnosis is mainly clinical and the treatment symptomatic. The incidence of complications is low and independent of antibiotic use. There is a high socioeconomic burden associated to ARS.
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Affiliation(s)
- Francesca Jaume
- Servei d'Otorrinolaringologia, Hospital Comarcal d'Inca, Carretera Vella de Llubí, 07300, Inca, Illes Balears, Spain.
| | - Meritxell Valls-Mateus
- Servei d'Otorrinolaringologia, Hospital Universitari Son Espases, Palma, Illes Balears, Spain
| | - Joaquim Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
- Immunoal.lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
- Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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Castillo Vizuete JA, Sastre J, Del Cuvillo Bernal A, Picado C, Martínez Moragón E, Ignacio García JM, Cisneros Serrano C, Álvarez Gutiérrez FJ, Mullol Miret J. Asthma, rhinitis, and nasal polyp multimorbidities. Arch Bronconeumol 2019; 55:146-55. [PMID: 30449614 DOI: 10.1016/j.arbres.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 11/22/2022]
Abstract
The aim of this review is to assist pulmonologists in the management of diseases involving both the upper and lower respiratory tract that are linked by a common, interrelated epidemiology, clinical signs and symptoms, and inflammatory mechanism - asthma, in particular. The document discusses the definitions of the various sinonasal phenotypes associated with asthma: allergic and non-allergic rhinitis and chronic rhinosinusitis with or without nasal polyps. Diagnostic criteria and severity levels are also listed. Particular attention has been given to the 2 main syndromes associated with asthma: (i)allergic rhinitis, the most common, and (ii)chronic rhinosinusitis with nasal polyps, the disease most closely associated with severe asthma. To summarize, the upper respiratory tract should always be evaluated in order to achieve a single diagnosis and comprehensive treatment of the "united airway".
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Alves C, Truong WH, Thompson MV, Suryavanshi JR, Penny CL, Do HT, Dodwell ER. Diagnostic and treatment preferences for developmental dysplasia of the hip: a survey of EPOS and POSNA members. J Child Orthop 2018; 12:236-244. [PMID: 29951123 PMCID: PMC6005222 DOI: 10.1302/1863-2548.12.180034] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this study was to elucidate developmental dysplasia of the hip (DDH) diagnosis and treatment preferences among members of the Pediatric Orthopaedic Society of North America (POSNA) and European Paediatric Orthopaedic Society (EPOS). METHODS A 54-question survey on DDH diagnosis and treatment preferences was distributed to POSNA and EPOS members. Descriptive statistics were performed. RESULTS A total of 459 responses were analyzed. Ultrasound was the preferred modality for diagnosing DDH in infants less than six months old; few surgeons preferred radiographs. In all, 57% of POSNA members had radiology technicians perform ultrasounds, only 7% of EPOS members did. The percent coverage defining a dislocated hip varied greatly, the most frequent response being < 20% for POSNA and < 40% for EPOS members. Pavlik harnesses were the most popular harness/brace, used by 90% of POSNA and 71% of EPOS members. POSNA members were more likely than EPOS members to use a rigid abduction brace following initial harness/brace failure. For residual acetabular dysplasia, POSNA members were twice as likely as EPOS members to institute hip abduction bracing. Most surgeons would not perform closed reduction at less than three months of age or open reduction at less than six months of age. Most EPOS -members used traction prior to reduction; few POSNA members did. Few POSNA and EPOS members believed that reduction should be delayed until the ossific nucleus was visible. CONCLUSION There is great variation in the preferred methods for diagnosing and treating DDH. This survey is the largest transcontinental survey to compile diagnostic and treatment preferences for DDH. With wide variations in practice, there is room for quality improvement.
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Affiliation(s)
- C. Alves
- Hospital Pediatrico - CHUC, EPE, Avenida Afonso Romao, 3000-602, Coimbra, Portugal
| | - W. H. Truong
- Gillette Children’s Specialty Healthcare, St Paul, Minnesota, USA
| | | | | | - C. L. Penny
- Hospital for Special Surgery, New York, New York, USA
| | - H. T. Do
- Hospital for Special Surgery, New York, New York, USA
| | - E. R. Dodwell
- Hospital for Special Surgery, New York, New York, USA, Correspondence should be sent to E. Dodwell, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021, United States. E-mail:
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Abstract
CONCLUSION By consulting an ENT-doctor, patients with chronic rhinosinusitis (CRS), in the general population, receive disease information and adjustment of treatment which can improve disease-specific Quality-of-Life and may improve objective measurements. OBJECTIVES This study aims to follow persons with clinical diagnosed CRS from the general population, to evaluate their benefit from consultation with an ENT-doctor in terms of severity of symptoms and Quality-of-Life. METHODS As part of a trans-European study, selected respondents to a survey questionnaire were invited for a clinical visit. Based on the European Position Paper on Rhinosinusitis and Nasal Polyps, persons were diagnosed with CRS and followed for 2 years. Quality-of-Life was measured using the Sino Nasal Outcome Test 22 and European Quality-of-Life - 5 Dimensions. Clinical examination included rhinoscopy, acoustic rhinometry, peak nasal inspiratory flow, smell test, and skin prick test. RESULTS Out of 91 persons with CRS, only 42% had previously consulted an ENT-doctor, and 51% were in current treatment for CRS. Most patients were advised medical treatment and 20% underwent surgery. Disease-specific Quality-of-Life, peak nasal inspiratory flow, olfactory function, and the nasal volume significantly increased over the 2-year period.
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Affiliation(s)
- Bibi Lange
- Department of Otorhinolaryngology, Odense University Hospital, University of Southern Denmark , Odense , Denmark
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Lind H, Joergensen G, Lange B, Svendstrup F, Kjeldsen AD. Efficacy of ESS in chronic rhinosinusitis with and without nasal polyposis: a Danish cohort study. Eur Arch Otorhinolaryngol 2015; 273:911-9. [PMID: 26031891 DOI: 10.1007/s00405-015-3667-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/22/2015] [Indexed: 11/25/2022]
Abstract
Endoscopic sinus surgery (ESS) for patients with severe chronic rhinosinusitis (CRS) has become a well-established treatment in cases where medical therapy fails. Even though CRS patients are divided into two subgroups, CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP), most studies present only results for the total cohort. This prospective cohort study evaluated the efficacy of ESS on both quality of life and olfactory function measures, in a cohort of Danish CRS patients diagnosed according to the EPOS criteria, with results analysed separately for the CRSwNP and CRSsNP subgroups. All 97 CRS patients who underwent ESS over an 18-month trial period were evaluated preoperative by SNOT-22 score, Sniffin' Sticks score, modified Lund-Kennedy endoscopic score and Lund-Mackay CT score. Patient outcomes were reevaluated at clinical follow-up 1 and 6 months postoperative. ESS efficiently and immediately improved quality of life for both CRSwNP and CRSsNP patients, with over 50 % reduction in SNOT-22 score 1 month after surgery, which sustained 6 months postoperative. Olfactory function measured by Sniffin' Sticks score showed overall improvement in both groups. ESS efficiently improved quality of life in both CRSwNP and CRSsNP patients, and surgery lead to an overall improvement in olfactory function. However, a minor proportion of patients experienced deterioration in olfactory function after ESS.
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Affiliation(s)
- Henrik Lind
- Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark.
| | - G Joergensen
- Department of Otorhinolaryngology, Svendborg Hospital, Svendborg, Denmark
| | - B Lange
- Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark
| | - F Svendstrup
- Department of Otorhinolaryngology, Svendborg Hospital, Svendborg, Denmark
| | - A D Kjeldsen
- Department of Otorhinolaryngology, Odense University Hospital, Odense, Denmark
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