Role of corticosteroids in Functional Endoscopic Sinus Surgery - a systematic review and meta-analysis

Background: The aim of our study is to systematically review the existing evidence on the role of corticosteroids in patients undergoing functional endoscopic sinus surgery (FESS).  Methodology: Systematic search of MEDLINE (1950- 2014), EMBASE (1980-2014), metaRegister, Cochrane Library and ISI conference proceedings was carried out.  Results: Eighteen randomised controlled trials with 1309 patients were included. Use of local and/or systemic corticosteroids with FESS was reported in four categories; operative, anaesthesia related, post-operative outcomes and risk of recurrence. Metaanalysis for operative outcomes demonstrated that, mean operative time (MD -10.70 minutes; 95% CI -15.86, -5.55; P <0.0001) and mean estimated blood loss (MD -28.32 mls; 95% CI -40.93, -15.72; P <0.0001) was significantly lower; and surgical field quality (MD -0.81; 95% CI -1.32, -0.30; P = 0.002) was significantly better in corticosteroid group. Meta-analysis showed that post-operative endoscopic scores (SMD -0.39; 95% CI -0.60, -0.17; P = 0.0004) were significantly better in corticosteroid group compared to no corticosteroid group. There was no increase in risk of sinusitis (RR 0.64; 95% CI 0.32, 1.30; P = 0.22) between use of corticosteroids and no corticosteroids; There was no significant difference in recurrence risk of chronic rhinosinusitis (CRS) in mixed population studies (RR 0.77; 95% CI 0.35, 1.70; P = 0.52) between the two groups but analysis of studies reporting on chronic rhinosinusitis with nasal polyps (CRSwNP) (RR 0.64;95% CI 0.45,0.91;P=0.01) showed significant difference in favour of the corticosteroid group.  Conclusion: Pre-operative use of local and/or systemic corticosteroids in FESS, results in significantly reduced blood loss, shorter operative time and improved surgical field quality. Studies are limited on the intra-operative use of corticosteroids to reduce postoperative pain. Postoperative corticosteroids improve postoperative endoscopic scores in CRS and recurrence rates in cases of CRSwNP

EUFOREA Rhinology Research Forum 2016: report of the brainstorming sessions on needs and priorities in rhinitis and rhinosinusitis

The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016

Experiences in participatory ergonomics: Results of a roundtable session during the 11th IEA congress, Paris, July 1991

In order to review recent experiences of participatory ergonomics, and to identify common themes, a roundtable session was organized, the results of which are presented in this paper. Eighteen ergonomists with experience in participatory ergonomics and who applied the approach mostly in large companies and less frequently in smaller companies or branches of ttrade were present. During the session, the groups who participate in the process were described, and the discussion centered on the various stages of the initiative, problem identification, solution choice, and implementation

Wildgroei bewegingsprogramma's maakt aanbod onoverzichtelijk

In dit derde en laatste artikel in een serie over bewegingsprogramma's in het bedrijfsleven wordt een overzicht gegeven van de aard van leveranciers, die deze 'gezond bewegen' programma's aan bedrijven aanbieden. Ook wordt de inhoud van die programma's belicht

Direct and indirect costs of adult patients with chronic rhinosinusitis with nasal polyps

Background: European direct and indirect cost data is missing for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). This study was aimed to establish the economic burden of CRSwNP based on a Dutch cohort of patients. Methods: A cross-sectional study was performed in adult patients with CRSwNP (N=115) to calculate mean annual direct medical costs and indirect costs per patient with CRSwNP. Outpatient visits, general practitioner visits, first aid visits, hospitalisation and patient travel expenses were measured with the iMTA medical consumption questionnaire. Missed workdays (absenteeism) and decreased productivity during paid work (presenteeism) or during daily life were measured with the and the iMTA productivity cost questionnaire. Results: Total direct costs were €1501 per patient/year, primarily due to outpatient department visits and hospitalisation. Indirect costs were €5659 per patient/year, with productivity losses as major cost expense. Conclusion: Adult patients with CRSwNP have higher indirect costs than direct costs and this forms a substantial burden to society. Total annual costs of patients with CRSwNP are estimated to be 1,9 billion/year in the Netherlands

Post-operative morbidity and 1-year outcomes in CO2-laser tonsillotomy versus dissection tonsillectomy

Objective: In this study a type of partial tonsil surgery, CO2-laser tonsillotomy, was compared to regular tonsillectomy. The effectiveness and post-operative recovery rate of both interventions in adult patients was assessed by using a questionnaire.Study design: Prospective follow-up non-randomized cohort study.Method: One hundred and seven adults were included; 46 tonsillectomies and 61 tonsillotomies were performed. Patients in the tonsillectomy group underwent general anaesthesia, while tonsillotomy was performed in an ambulatory setting with local anaesthesia. Post-operative questionnaires were administered by mail after 2 weeks, 6 months, and 1 year to assess recovery rate and symptom recurrence.Results: In total, 72.5% of patients were cured from their initial symptoms after tonsillotomy. Three patients (7.5%) required re-surgery for their initial complaints. After tonsillectomy, 97.2% of patients were cured. Both groups showed equally high satisfaction scores after treatment. Post-operative evaluation after 2 weeks showed a mean pain-intensity score of 5.4 (Visual Analogue Scale 0-10) after tonsillotomy and a mean pain-intensity score of 7.7 after tonsillectomy. The post-operative use of analgesics was twice as long in the tonsillectomy group compared to the tonsillotomy group and the tonsillectomy group required twice as many days for full recovery. After tonsillectomy a higher rate of major post-operative haemorrhage was seen.Conclusion: CO2-laser tonsillotomy is associated with a shorter and less painful recovery period. Both surgical methods are equal in terms of long-term satisfaction, although tonsillotomy comes with a higher recurrence rate of mild symptoms. A strict pre-operative patient selection for CO2-laser tonsillotomy is necessar

Nederlandse werknemer beweegt alleen onder voorwaarde(n) : 'Japanse toestanden' passen niet in onze cultuur

Door de mechanisering, automatisering en informatisering is er een groeiend aantal werknemers wat langdurig zit. Dit 'fysiek lichte' werk blijkt in de praktijk net zo zwaar te zijn als zwaar lichamelijk werk. De inactiviteit moet gecompenseerd worden, wat bijvoorbeeld kan door bedrijfsbewegingsprogramma's. TNO Preventie en Gezondheid heeft samen met NIA TNO het project KIB (Kantoorwerkers in Beweging) opgezet. Doel van dit project is een programma voor bewegingsadvies te ontwikkelen om lichamelijk inactieve werknemers tot meer en/of anders bewegen te stimuleren. Zowel op het werk als in de vrije tijd. Dit artikel gaat nader in op dit project

Endoscopic sinus surgery with medical therapy versus medical therapy for chronic rhinosinusitis with nasal polyps: a multicentre, randomised, controlled trial

Background: Endoscopic sinus surgery (ESS) is a common operation for patients with chronic rhinosinusitis with nasal polyps (CRSwNP) when medical therapy alone is insufficient. No randomised controlled trials on the efficacy of ESS have been published. We aimed to assess the efficacy of ESS plus medical therapy versus medical therapy alone in patients with CRSwNP. Methods: We performed an open-label, multicentre, pragmatic, randomised, controlled trial in three tertiary care centres and 12 secondary care centres in 11 cities in the Netherlands (Almere, Amstelveen, Amsterdam, Blaricum, Den Haag, Deventer, Haarlem, Hoofddorp, Hoorn, Leiderdorp, and Rotterdam). Adults (aged ≥18 years) with CRSwNP and an indication for ESS were randomly assigned (1:1) using block randomisation (block sizes of six), stratified by study centre, to receive either ESS plus medical therapy or medical therapy. ESS was performed according to local practice, although anterior ethmoidectomy was mandatory. Medical therapy was prescribed at the patient's otorhinolaryngologist's discretion, and could be, but was not limited to, nasal corticosteroids, nasal rinsing, systemic corticosteroids, or systemic antibiotics. The primary outcome was disease-specific health-related quality of life (HRQoL) at 12 months of follow up, measured with the validated Sinonasal Outcome Test 22 (SNOT-22; where each item is scored from 0 to 5, where 0 indicated no problems and 5 indicates problems as bad as can be, with a total score of 0–110 points), and the minimal clinically important difference of the SNOT-22 is 9·0 points. Primary and safety analyses were performed on an intention-to-treat (ITT) basis. The ITT population comprised all patients who were randomly assigned to treatment according to their randomisation group and without any protocol violation. This study is registered with the Netherlands Trial Register, NTR4978, and is ongoing. Findings: Between Feb 15, 2015, and Aug 27, 2019, 371 patients were screened for eligibility, of whom 238 were eligible, willing to participate, and randomly assigned to ESS plus medical therapy (n=121) or medical therapy (n=117) and 234 were included in the baseline ITT population (n=118 ESS plus medical therapy; n=116 medical therapy). 142 (61%) of 234 patients at baseline were men and 92 (39%) were women, and the mean age was 50·4 years (SD 12·7). 206 participants were analysed at 12 months for the primary outcome (n=103 in the ESS plus medical therapy group; n=103 in the medical therapy group). At 12 months follow-up, the mean SNOT-22 score in the ESS plus medical therapy group was 27·9 (SD 20·2; n=103) and in the medical therapy group was 31·1 (20·4; n=103), with an adjusted mean difference of –4·9 (95% CI –9·4 to –0·4), favouring ESS plus medical therapy. Adverse events were similar between the groups. The most common adverse events were minor epistaxis or gastrointestinal problems. No treatment-related deaths occurred, but one patient died due to congestive heart failure. Interpretation: ESS plus medical therapy is more efficacious than medical therapy alone in patients with CRSwNP, although the minimal clinically important difference was not met. Long-term follow-up data are needed to determine whether the effect persists. The current results are a basis for further development of evidence-based guidelines. Funding: The Netherlands Organisation for Health Research and Development (ZonMw)

Emotional Exhaustion Among Hotel Employees: The Interactive Effects of Affective Dispositions and Positive Work Reflection

Hospitality employees inevitably face emotional exhaustion when performing their jobs. The purpose of this study was to investigate dispositional antecedents of hospitality employees’ emotional exhaustion, including self-instability, pessimism, and affect variability, and how employees’ affect variability mediates the relations between self-instability and pessimism and emotional exhaustion. In addition, we explored the moderating role of positive work reflection on the relation between affect variability and emotional exhaustion. A total of 224 frontline employees in 18 four- and five-star hotels in Ecuador responded to surveys about their emotions and work lives. The findings suggest that (a) emotional exhaustion was influenced by affect variability, (b) affect variability mediated the relations between self-instability and pessimism and emotional exhaustion, and (c) the relation between affect variability and emotional exhaustion was weakened by positive work reflection. The results highlight the impor...Hospitality employees inevitably face emotional exhaustion when performing their jobs. The purpose of this study was to investigate dispositional antecedents of hospitality employees’ emotional exhaustion, including self-instability, pessimism, and affect variability, and how employees’ affect variability mediates the relations between self-instability and pessimism and emotional exhaustion. In addition, we explored the moderating role of positive work reflection on the relation between affect variability and emotional exhaustion. A total of 224 frontline employees in 18 four- and five-star hotels in Ecuador responded to surveys about their emotions and work lives. The findings suggest that (a) emotional exhaustion was influenced by affect variability, (b) affect variability mediated the relations between self-instability and pessimism and emotional exhaustion, and (c) the relation between affect variability and emotional exhaustion was weakened by positive work reflection. The results highlight the impor..