Rosenthaljohnston3033

BACKGROUND Palate re-repair has been proposed as an effective treatment for velopharyngeal insufficiency (VPI) with a low risk of obstructive sleep apnea (OSA). The authors conducted a systematic review and meta-analysis to determine the proportion of patients achieving normal speech resonance following palate re-repair for VPI, the proportion developing OSA, and the criteria for patient selection that are associated with increased effectiveness. METHODS PubMed, Embase, and Scopus were searched from inception through April 2018 for English language articles evaluating palate re-repair for the treatment of VPI in patients with a repaired cleft palate. Inclusion criteria included reporting of hypernasality, nasal air emission, nasometry, additional VPI surgery, and/or OSA outcomes. Meta-analysis was conducted using random effects models. Risk of bias was assessed regarding criteria for patient selection, blinding of outcome assessors, and validity of speech assessment scale. RESULTS Eighteen studies met inclusion criteria. The incidence of achieving no consistent hypernasality follow palate re-repair was 61% (95% confidence interval [CI] 44%-75%). The incidence of additional surgery for persistent VPI symptoms was 21% (95% CI 12%-33%). The incidence of OSA was 28% (95% CI 13%-49%). Criteria for selecting patients to undergo re-repair varied, with anterior/sagittal position of palatal muscles (33%) and small velopharyngeal gap (22%) being the most common. No specific patient selection criteria led to superior speech outcomes (P = .6572). CONCLUSIONS Palate re-repair achieves normal speech resonance in many but not all patients with VPI. Further research is needed to identify the specific examination and imaging findings that predict successful correction of VPI with re-repair.BACKGROUND Disability resulting from headache disorders is attributable in part to avoidant coping. Acceptance of pain connotes a willingness to experience pain in the service of life values, such that meaningful activities and goals are pursued despite pain. Acceptance facilitates positive health outcomes but has rarely been investigated in headache. Because headache disorders manifest differently than other forms of chronic pain, the present study sought to develop and validate a measure of acceptance of headache. METHODS Forty-five candidate items were developed and, with input from an expert panel, reduced to 24 items. Five items were eliminated following administration to a development sample and exploratory factory analysis. Nineteen items were administered to a validation sample for confirmatory factory analysis and assessment of psychometric properties. RESULTS Factor analysis produced a unidimensional six-item measure, the Headache Acceptance Questionnaire (HAQ). The HAQ evidenced good internal consistency, convergent validity with headache disability and related psychological constructs, and divergent validity with social desirability. The measure also distinguished between headache diagnostic groups. CONCLUSIONS Pending further validation in clinical settings, the HAQ may have utility in assessing psychological responses to headache symptoms, identifying targets of treatment for interventions that focus on reducing avoidance, and studying mechanisms of change.BACKGROUND Random design experiments are a powerful device for estimating average treatment effects, but evaluators sometimes seek to estimate the distribution of treatment effects. For example, an evaluator might seek to learn the proportion of treated units who benefit from treatment, the proportion who receive no benefit, and the proportion who are harmed by treatment. METHOD Imbens and Rubin (I&R) recommend a Bayesian approach to drawing inferences about the distribution of treatment effects. Drawing on the I&R recommendations, this article explains the approach; provides computing algorithms for continuous, binary, ordered and countable outcomes; and offers simulated and real-world illustrations. RESULTS This article shows how the I&R approach leads to bounded uncertainty intervals for summary measures of the distribution of treatment effects. It clarifies the nature of those bounds and shows that they are typically informative. CONCLUSIONS Despite identification issues, bounded solutions provide useful insight into the distribution of treatment effects. We recommend that evaluators incorporate analyses of the distribution of treatment effects into new studies and that evaluators revisit completed studies to estimate the distribution of treatment effects.Somatic symptom disorder is a complex condition linking distress in the mind to physical distress in the body. However, in addition to the disorder itself, experienced clinicians know that children and youth frequently experience somatizing symptoms. With an increasing prevalence of anxiety in the pediatric population, symptoms attributable to process of "somatizing" are common, and early identification and rapport building to address the root causes of a child's distress are critical for a good outcome. In the acute care setting, clinicians are often reluctant to make the diagnosis of somatization. Part of the challenge is encouraging clinicians to see that somatization is not a "diagnosis of exclusion." We want to encourage clinicians to routinely consider risk factors for somatization in their histories, actively discuss the mind-body connection with patients and families, and include somatization in a carefully considered differential diagnosis. The more we can break down the siloing of physical from mental health, the better we will serve our patients.INTRODUCTION AND OBJECTIVES To determine the optimal guidewire for bypassing an impacted ureteral stone. METHODS Three different benchtop models of varying impaction (300, 362, and 444 mmHg pressure) were used to compare the ability of 13 different guidewires to bypass an impacted ureteral stone. In the first and second models, we recorded the maximum force required to bypass the stone. In the first model (300 mmHg) 10 new wires for each of the 13 types were advanced past a ureteral stone using a Series 5 digital force gauge. In the second model (362 mmHg), the top 5 performing guidewires were similarly tested. In the third model (444 mmHg), 5 attending urologists and 5 urology residents (blinded to wire type) compared the 13 guidewires and rated the wire performance using a Likert scale. Statistical analysis was performed with ANOVA and the Chi-square test. RESULTS In the first model, there was a significant difference between wires (p less then 0.001) with the lowest mean force to bypass a stone seen in the Glidewire (0.117±0.02 lbs) and HiWire (0.130±0.01 lbs). Of the 5 wires tested in the second model, the Glidewire (0.24±0.09 lbs) and UltraTrack (0.40±0.35 lbs) both required less force than the other 3 wires (p=0.018). In the third model, only two wires (Roadrunner and Glidewire) bypassed the impacted stone in 100% of trials. When comparing standard, hybrid, and hydrophilic wires, the hydrophilic had the highest success rate (standard0%, hybrid36.67%, and hydrophilic70.67%; p=0.000) and Likert score (standard1.03, hybrid2.38, and hydrophilic3.24; p=0.000). Hydrophilic wires required the least time to bypass the stone (hybrid82.81 seconds vs. hydrophilic45.37 seconds, p=0.000). CONCLUSIONS In this bench-top study, standard wires performed poorly and hybrid wires were not as effective as hydrophilic wires. The Glidewire required the least force, the shortest insertion time, and had the highest surgeon satisfaction rating.OBJECTIVES The purpose of this study is to explore the curative effect of open surgical excision and endoscopic radiofrequency ablation (RA) in the treatment of piriform fossa fistula (PSF). METHODS Retrospective study of 80 cases of PSF in the Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, from June 2009 to June 2017. RESULTS In this series, there were 43 males and 37 females, and the mean age was 5.2 years (17 days to 12 years). Surgical excision was performed for 62 patients. Radiofrequency ablation was performed for 18 patients. Six cases of postoperative temporary hoarseness occurred, and the hoarseness rates were not significantly different between the excision and RA groups (6.4% vs 11.1%, respectively, P = .88). Two cases of temporary neck abscess occurred in the RA group. After the mean follow-up period of 3.1 years (1-8 years), no recurrence was found between the excision and RA groups. CONCLUSIONS The curative effect of excision and RA for PSF is not significantly different; each of the 2 methods has its advantages and disadvantages. However, RA for PSF has the merit of being minimally invasive, easy to operate, and safe; this procedure seems to be more suitable in the clinic.OBJECTIVE To evaluate a group-based music intervention in patients with Parkinson's disease. DESIGN Parallel group randomized controlled trial with qualitative triangulation. SETTING Neurorehabilitation in primary care. SUBJECTS Forty-six patients with Parkinson's disease were randomized into intervention group (n = 26), which received training with the music-based intervention, and control group (n = 20) without training. INTERVENTIONS The intervention was delivered twice weekly for 12 weeks. MAIN MEASURES Primary outcome was Timed-Up-and-Go subtracting serial 7's (dual-task ability). Secondary outcomes were cognition, balance, concerns about falling, freezing of gait, and quality of life. All outcomes were evaluated at baseline, post-intervention, and three months post-intervention. Focus groups and individual interviews were conducted with the intervention group and with the delivering physiotherapists. RESULTS No between-group differences were observed for dual-task ability. Adavosertib ic50 Between-group differences were observed for Falls Efficacy Scale (mean difference (MD) = 6.5 points; 95% confidence interval (CI) = 3.0 to 10.0, P = 0.001) and for Parkinson Disease Questionnaire-39 items (MD = 8.3; 95% CI = 2.7 to 13.8, P = 0.005) when compared to the control group post-intervention, but these were not maintained at three months post-intervention. Three themes were derived from the interviews Expectations versus Results, Perspectives on Treatment Contents, and Key Factors for Success. CONCLUSION Patient-reported outcomes and interviews suggest that the group-based music intervention adds value to mood, alertness, and quality of life in patients with Parkinson's disease. The study does not support the efficacy in producing immediate or lasting gains in dual-tasking, cognition, balance, or freezing of gait.Mucosal melanoma arising in the middle ear or eustachian tube is uncommon. We present a patient with hearing loss and otalgia found to have mucosal melanoma which occurred in the eustachian tube with extension into the middle ear cavity and external ear canal. Otologic clinics was consulted and biopsy of the mass located at the external canal was performed to ascertain the pathological diagnosis. The patient refused immunotherapy and surgery instead of undergoing radiotherapy and died from hepatic metastasis 8 months later. The mucosal melanoma originated from the eustachian tube with extension into the external ear canal is exceedingly rare, and the differential diagnosis should be considered for tumors in external ear canal.