Functional outcomes assessment following free muscle transfer for dynamic reconstruction of facial paralysis: A literature review.

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Functional outcomes assessment following free muscle transfer for dynamic reconstruction of facial paralysis: A literature review.

J Craniomaxillofac Surg. 2018 Mar 22;:

Authors: Dong A, Zuo KJ, Papadopoulos-Nydam G, Olson JL, Wilkes GH, Rieger J

Abstract
Facial reanimation provides patients affected by chronic facial paralysis a chance to regain basic human functions such as emotional expression, verbal communication, and oral competence for eating and swallowing, but there is still no consensus as to the best way to measure surgical outcomes. We performed a literature review to investigate the different functional outcomes that surgeons use to evaluate facial function after reanimation surgery, focusing on outcomes other than facial expressions such as speech, oral competence, and patient quality of life/satisfaction. A total of 37 articles were reviewed, with the majority reporting outcomes through subjective facial expression ratings and only 15 dealing with other functional outcomes. In particular, outcomes related to oral competence and speech were reported inconsistently. Facial reanimation patients would benefit from a unified movement to create and validate through consensus, an outcomes reporting system incorporating not only facial expression, but also oral competence, speech, and patient-reported quality of life, to enable global patient assessment.

PMID: 29628301 [PubMed - as supplied by publisher]

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The Use of Technology for Phone and Face-to-Face Communication After Total Laryngectomy.

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The Use of Technology for Phone and Face-to-Face Communication After Total Laryngectomy.

Am J Speech Lang Pathol. 2017 Feb 01;26(1):99-112

Authors: Childes JM, Palmer AD, Fried-Oken M, Graville DJ

Abstract
Purpose: The purpose of this article is to describe the characteristics and experiences of individuals who use technology to support telephone or face-to-face communication after total laryngectomy.
Method: An online questionnaire was used to identify potential participants. Seventeen individuals met inclusion criteria and participated in an in-depth survey. They were compared with a reference group matched for age, gender, and time postsurgery who did not use these technologies. Open-ended responses were summarized.
Results: Compared with the matched reference group, individuals who used technology to support verbal communication had undergone more aggressive cancer treatment and used more communication methods. They were less likely to use an alaryngeal speech method, had greater difficulty over the telephone, and used more repair strategies in face-to-face communication. The 2 groups did not differ significantly in the frequency or success of their communication, however. Open-ended responses revealed great variety with regard to their reasons, purposes, and timing of technology use.
Conclusions: There is a subset of individuals using technology to support verbal communication very successfully after laryngectomy. Usage was not limited to those who were unable to communicate verbally and often continued long after the initial postoperative period in many settings, for various purposes, and in combination with other methods of communication.

PMID: 28166547 [PubMed - indexed for MEDLINE]

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Effect of a repeated tongue-lift motor task for tongue function.

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Effect of a repeated tongue-lift motor task for tongue function.

Eur J Oral Sci. 2016 Dec;124(6):540-545

Authors: Honki H, Iida T, Komiyama O, Masuda M, Svensson P, Kawara M

Abstract
This study investigated the effect of repeated tongue motor tasks on suprahyoid muscle activity and tongue pressure. Fourteen participants performed three series of a standardized tongue-lift training (TLT) task on each of five consecutive days. Electromyographic (EMG) activity from suprahyoid muscles and tongue pressure were recorded. In the first and third TLT series, participants were instructed only to target different force levels. During the second TLT series, visual feedback of the force level was given. One series consisted of three measurements [at 10%, 20%, and 40% of maximum voluntary contraction (MVC), respectively]. The coefficient of determination of the target force level-EMG curve and the target force level-tongue pressure curve was calculated from all series. There were no statistically significant day-to-day differences in EMG-root mean square (RMS) values and tongue pressure during MVC. The coefficients of determination of tongue pressure in the first series on day 1 were statistically significantly lower than the coefficients of determination in the first series on day 5. These findings suggest that the control of tongue pressure improved, while the maximum force remained constant. These results could have implications for treatment paradigms related to learning for patients with compromised tongue function, such as swallowing disorders or dysphagia.

PMID: 27696550 [PubMed - indexed for MEDLINE]

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Skepticism towards the Swedish vision zero for suicide: interviews with 12 psychiatrists

Abstract

Background

The main causes of suicide and how suicide could and should be prevented are ongoing controversies in the scientific literature as well as in public media. In the bill on public health from 2008 (Prop 2007/08:110), the Swedish Parliament adopted an overarching "Vision Zero for Suicide" (VZ) and nine strategies for suicide prevention. However, how the VZ should be interpreted in healthcare is unclear. The VZ has been criticized both from a philosophical perspective and against the background of clinical experience and alleged empirical claims regarding the consequences of regulating suicide prevention. This study is part of a larger research project in medical ethics with the overarching aim to explore whether the VZ is ethically justifiable. The aim is to enrich the normative discussion by investigating empirically how the VZ is perceived in healthcare.

Methods

Interviews based on a semi-structured interview guide were performed with 12 Swedish psychiatrists. The interviews were analysed with descriptive qualitative content analysis aiming for identifying perceptions of the Vision Zero for Suicide as well as arguments for and against it.

Results

Though most of the participants mentioned at least some potential benefit of the Vision Zero for Suicide, the overall impression was a predominant skepticism. Some participants focused on why they consider the VZ to be unachievable, while others focused more on its potential consequences and normative implications.

Conclusions

The VZ was perceived to be impossible to realize, nonconstructive or potentially counterproductive, and undesirable because of potential conflicts with other values and interests of patients as well as the general public. There were also important notions of the VZ having negative consequences for the working conditions of psychiatrists in Sweden, in increasing their work-related anxiety and thwarting the patient-physician relationship.

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Forensic psychiatry, one subspecialty with two ethics? A systematic review

Abstract

Background

Forensic psychiatry is a particular subspecialty within psychiatry, dedicated in applying psychiatric knowledge and psychiatric training for particular legal purposes. Given that within the scope of forensic psychiatry, a third party usually intervenes in the patient-doctor relationship, an amendment of the traditional ethical principles seems justified.

Results

Thus, 47 articles, two book chapters and the guidelines produced by the World Psychiatric Association, the American Association of Psychiatry and the Law, as well as by the Royal Australian and New Zealand College of psychiatrists, were analyzed. The review revealed that the ethics of correctional forensic psychiatry and those of legal forensic psychiatry do not markedly differ from each other, but they are incongruent in terms of implementation.

Methods

In an effort to better understand which ethical principles apply to forensic psychiatry, a chronological review of the literature published from 1950 to 2015 was carried out.

Conclusion

The ethics of correctional forensic psychiatry are primarily deontological. The principle of justice translates into the principle of health care equivalence, the principle of beneficence into providing the best possible care to patients, and the principle of respect of autonomy into ensuring confidentiality and informed consent. The ethics of legal forensic psychiatry are rather consequentialist. In this latter setting, the principle of justice is mainly characterized by professionalism, the principle of beneficence by objectivity and impartiality, and the principle of respect of autonomy by informed consent. However, these two distinct fields of forensic psychiatry share in common the principle of non maleficence, defined as the non collaboration of the psychiatrist in any activity leading to inhuman and degrading treatment or to the death penalty.

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Healthcare resources utilisation in primary progressive multiple sclerosis

Abstract

Epidemiological data on primary progressive multiple sclerosis (PPMS) are scarce. This study was aimed to evaluate the burden of PPMS in Italy with healthcare resources utilisation and costs for Italian National Health System (INHS). A 2-year cross-sectional analysis of real-world data collected in the ARCO database, covering > 10 million Italian inhabitants, was performed. From a cohort of patients affected by MS in 2014, those supposedly affected by PPMS were defined by the concurrent matching of absence of disease-modifying treatments and use of rehabilitation services. Any other drug prescriptions, outpatient services and hospitalisations were analysed in 2015 for each subject. The average annual cost per patient was provided both for each expenditure item and by integrating these. Of 13,253,591 inhabitants, 18,453 resulted affected by MS (prevalence 139 × 100,000). Of these, 1849 agreed with additional criteria to identify PPMS (10% of MS population). The 26.8% of these experienced at least one admission in 1 year, 97.3% used at least one outpatient service and 94.3% received at least one reimbursed drug. In the perspective of INHS, PPMS generated an average annual cost of € 3783 per person: 49% for hospitalisations, 28% for outpatient services and 23% for drugs. This study provides a reliable estimation of the PPMS burden in Italy, in terms of healthcare utilisation and direct costs. These findings could be useful to estimate the changes in health expenditure following the incoming of new drugs to treat PPMS with increase of pharmaceutical cost and potential decrease of rehabilitation and hospitalisation costs.

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The analgesic efficacy of subcostal transversus abdominis plane block with Mercedes incision

Conventional perioperative analgesic modalities (e.g. opioids, epidural analgesia) have their own drawbacks, which limit their clinical application. This study investigated the opioid-sparing effectsof the obl...

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