The radial forearm free flap versus the nasolabial flap in adults having reconstructive surgery for oral cancer : a comparison of quality of life outcomes

Background : Surgical resection is the preferred treatment for tongue cancer. The Radial Forearm Free Flap (RFFF) has classically been used in oral reconstructions, however, there has been research into an alternative option in the form of the Nasolabial Flap (NLF). Surgical research is becoming more and more focussed on Quality of Life (QOL) outcomes as a way to measure a successful recovery. As a result, this review has focused on QOL as well as functional outcomes. Objective : The aim of this review is to determine if there are better QOL outcomes between patients undergoing tongue reconstruction with the NLF or the RFFF. The quality and limitations of the included papers will be discussed. Methods : Four databases were searched using set search terms and inclusion/exclusion criteria. These searches yielded fourteen final papers which were assessed using a CASP checklist and a bias tool for quality. Results : A variety of outcome measures were featured; despite this, all the papers found good functional and QOL results at follow-up. There were problems with bias throughout all the papers and several reoccurring limitations such as small sample size and the retrospective nature of all but one study. Conclusion : Due to the significant amount of bias found, the overall low quality of literature available, and discrepancies between outcome measures, further research is needed in the form of a long-term prospective study with a larger cohort that includes objective outcome measures.Publisher PDFPeer reviewe

The examination of mental toughness, sleep, mood and injury rates in an Arctic ultra-marathon

There is scarcity of research examining the physiological and psychological effects of ultra-endurance racing on athletes in extreme conditions. The purpose of the current study was to identify common injury patterns and illness, profile mood states and sleep patterns and finally examine the relationships between mental toughness, sleep, mood and injury rates during a 120 mile, three-day Arctic ultra-marathon. Twelve participants (3 females, 9 males) with a mean age of 42 ± 5.35 yrs participated in the study. Mental toughness was measured using the MT18 questionnaire. Injuries were clinically assessed and recorded each day. Temperatures ranged from −20 to −6 degrees Celsius throughout the race. Sleep quantity and mood state were recorded using the BRUMS questionnaire. 10 out of the 12 participants experienced injuries; almost half of the participants had injuries that carried over a number of days. Mean sleep duration over the three days was 4.07 h, with an average of 0.78 injuries per day. Significant changes in mood were recorded across the three days, specifically a reduction in vigour (p = .029) and increase in fatigue (p = .014). Neither sleep quantity nor mental toughness was correlated with injury rate. Interestingly, sleep quantity was not related to changes in mood, as previously shown in ultra-marathons. Mental toughness had a moderate negative correlation (p

Injury occurrence and mood states during a desert ultramarathon

Objective: To describe injuries and illnesses presented and profile mood states and sleep patterns during a desert environment ultramarathon.Design: Prospective study gathering data on mood states and injury patterns.Setting: Gobi Desert, Mongolia.Participants: Eleven male competitors (mean mass, 83.7 ± 7.1 kg; body mass index, 24 ± 1.79 kg/m2; age, 33 ± 11 years).Interventions: Injuries were clinically assessed and recorded each day.Main Outcome Measures: Mood state was assessed using the Brunel Mood Scale.Results: All subjects presented with abrasion injuries, dehydration, and heat stress. Vigor decreased over the first 6 days while fatigue increased (P < 0.05). Fatigue and vigor recovered on the final morning. The observed recovery was set against increasing levels of depression, tension, and confusion, which peaked at days 5/6 but returned to day 1 levels on the 7th day morning (P < 0.05). Mean sleep duration (6:17 ± 00:48 hours:minutes; lowest on day 6, 4:43 ± 01:54 hours:minutes) did not vary significantly across the 7 days but did correlate with mood alterations (P < 0.05). Increased anger and fatigue correlated strongly with sleep disruption (r = 0.736 and 0.768, respectively). Vigor and depression displayed a moderately strong correlation to sleep (r = 0.564 and −0.530).Conclusions: Injury patterns were similar to those reported in other adventure/ultradistance events. Consistent with previous work, data show increased fatigue and reduced vigor in response to an arduous physical challenge

Investigating Pre-operative Factors Which Influence Functional Outcomes in Traumatic Brain Injury Patients Undergoing Decompressive Craniectomy: A Systematic Literature Review

Introduction: Traumatic brain injury (TBI) is a global issue which affects millions of people and often leaves lasting consequences. Decompressive craniectomy (DC) is a surgical approach for TBI with varied outcomes. Some patients make excellent functional recovery, while others survive with severe disability or fail to recover. If links between pre-operative factors and outcomes are better delineated, clinicians will be better placed to identify patients who are most likely to benefit from DC. By systematically and critically analysing relevant literature, this work aims to identify pre-operative factors linked to better functional outcomes in patients who have undergone DC, resulting in tailored patient-centred approach to TBI management that links with the ethos of precision medicine. Methods &amp; Materials: A research question was set using the PICO framework and key search terms were generated. A literature search was performed using the following databases: Ovid Medline, Ovid EMBASE and Web of Science. The review period was set between 2008 and 2018. Overall, 1811 articles were retrieved and systematically assessed using the PRISMA algorithm, SIGN study-design algorithm, CASP checklists and defined inclusion criteria. 10 articles were included in the critical analysis. Results: A considerable heterogeneity in the published evidence was noted. Critical analysis of the selected papers identified five factors which may influence functional outcomes: age, admission GCS, timing, imaging and pupil reactivity. Higher admission GCS and lower patient age have been linked with better functional outcomes; however the statistical significance of these findings is ambiguous. Discussion: While there is data available, much of it lacks appropriate and robust statistical analysis. Furthermore, studies often fail to reflect current best clinical practice and therefore do not provide tangible and realistic results. Accessing the existing raw data and putting it through rigorous statistical analysis, as a meta-analysis, would allow for more meaningful conclusions to be drawn

An Investigation Into The Effectiveness Of Ratings Of Perceived Exertion In Cardiac Rehabilitation Exercise

INTRODUCTION: Within Scotland, Cardiac Rehabilitation Phase IV (CRIV) exercise classes are widely utilised to deliver community-based exercise utilising traditional circuit type exercise for both genders. Currently no gender specific rating of perceived exertion (RPE) scale has been developed for different exercise types or environments.PURPOSE:To investigate the effectiveness of current RPE scales in Cardiac Rehabilitation Phase IV groups utilising different environments and exercise.METHODS: 62 subjects (m/f n= CX 12, 12; WB 12, 10; ZF 8, 8; mean body mass: 72±13kg, age:58 ±6yrs) were recruited and randomly allocated to traditional Circuit Based (CX), Water Based (WB) or ZonefitTM (ZF) exercise classes. Weight and balance were recorded pre and post exercise intervention. Subjects participated in two classes per week for a period of four consecutive weeks. During exercise, RPE values (Borg 6-20 scaling) were collected with Heart Rate (Hr) continuously recorded using Suunto Team System. Berg’s Balance Scale (BBS) (1989) was used prior to, and post, main exercise period. Eight different exercises were standardised for time, type and order (4 predominantly lower body, 2 upper body, 2 balance) with all exercise patterns and movements transferrable across each group. Subjects were asked to maintain their level of exertion in zones (RPE 10-12 or 5-7 and verbally report actual perceived values) while Hr was recorded.RESULTS: No significant change in weight pre to post exercise intervention was reported in any group (P>0.05). All groups balance scores improved. Overall group improvements were 0.3 CX; 1.8 WB; 2.4 ZF however values were not statistically significant. Females reported higher Hr and perceived exertion values than males (P=0.000) with the exception of ZF (exercises predominantly lower body) suggesting a gender bias when using current common RPE scales. No learning effect was discerned.CONCLUSIONS: There was a significant gender difference in reported values for aquatic and circuit based exercises with females reporting higher perceived exertion than males. Non-traditional environments can provide comparable cardiovascular benefits to traditional CR exercise formats but require revision of current perceived exertion scaling to ensure accurate perception of workload in female participants

The impact of COVID-19 on the delivery of interprofessional education: it's not all bad news

During the COVID-19 outbreak, most face-to-face teaching and practice-based learning placements were suspended. Universities provided ongoing health and social care education, including interprofessional education, using online technology. Focusing on changes in the delivery of interprofessional education, this second article in a series on interprofessional education provides an international perspective through facilitators' case reports. It considers the key factors that enabled a rapid shift from face-to-face to online interprofessional education, and the key aspects that had to change. The significant changes reported from literature and case reports reflect on remote and online learning, the duration of education sessions, individual and team learning aspects and facilitation skills