Outcome measures associated with perceived stress

We tend to think of situations in life as stressful when they are unpredictable, uncontrollable or overloading. Stress is a very personal experience. Perceived stress is a reflection of how such external stressful events and everyday hassles are ‘filtered’ according to our individual personality traits and coping strategies. People with tinnitus describe various stress-related complaints, but these symptoms are not just restricted to tinnitus. Poor concentration, sense of loss of control, sleep disturbance and irritability are also shared with people who are experiencing a state of generalised anxiety or depression. Whatever their origin, the goal of any clinical intervention for people with tinnitus should be to reduce these negative symptoms. This chapter takes a look at the way in which perceived stress associated with tinnitus has been measured. My focus is on clinical trials, but I start from the perspective of questionnaire construction by describing and comparing tinnitus-specific and general stress measures. I then evaluate how these instruments have been applied in a range of contemporary tinnitus trials. The chapter includes tutorials that introduce the reader to fundamental concepts in clinical trial design, understanding the purpose of questionnaires and appreciating the relevance of sample size calculations

Avaliação da utilidade do exame histopatológico como rotina em tonsilectomias Evaluation of the utility of histopathologic exam as a routine in tonsillectomies

A tonsilectomia é uma das cirurgias mais realizadas em todo o mundo. Apresenta uma grande variedade de indicações, seja em adultos ou crianças. É comum o envio do material retirado para exame histopatológico, seja para análise de material suspeito ou como documentação médico-legal de prova de remoção. OBJETIVO: Avaliar a necessidade e o custo do exame histopatológico de rotina para tonsilectomias. METODOLOGIA: Revisado o resultado histopatológico de todas as tonsilectomias no período de 1978 a 2004 num hospital universitário e analisado o prontuário dos casos encontrados de malignidade. RESULTADOS: Um total de 2.103 resultados de análise histopatológica foi analisado. Desta amostra, apenas quatro casos apresentaram algum tipo de malignidade, sendo todas elas linfomas do tipo não-Hodgkin e já suspeitados antes da cirurgia. DISCUSÃO: A literatura mundial encontra resultados semelhantes e cada vez mais se avalia o envio para análise de todos os casos de tonsilectomia. O custo do exame é alto e seu resultado, nos casos de malignidade, pôde ser previsto em todos os casos antes da cirurgia. CONCLUSÃO: Análise histopatológica de todas as tonsilectomias de rotina não está indicada. Os fatores de risco estabelecidos por Beaty deveriam guiar a solicitação de análise histopatológica, para assim conseguirmos diminuir os custos com exames desnecessários.<br>Tonsillectomy is one of the most commonly performed procedures of the head and neck. It is performed for a wide variety of indications in both adults and children. It is common to send the material achieved in the surgery to routine histopathologic exam, as to analyze suspected material or for a medical-legal documentation. OBJECTIVE: Analyze the utility and cost of routine histopathologic diagnosis for tonsillectomy. METHODOLOGY: retrospective study of the histopathologic result of all tonsillectomies between 1978 and 2004 in a university hospital and analyzed the files of the patients with cancer. RESULTS: 2103 results of histopathologic exams were analyzed. Of these, only four cases presented any case of malignancy, being all of these non-Hodgkin lymphoma and already suspected before the surgery. DISCUSSION: The world literature has encountered similar results and each time more the histopathologic analysis of all cases is questioned. The cost of the exam is high and your results, in the case of malignancy were already knew before the surgery. CONCLUSION: Histopathologic analysis of all tonsillectomies is not indicated. The risks factors established by Beaty should guide the solicitation of the exam, to try to low the costs with unnecessary exams