Prospective evaluation of multidimensional health-related quality of life after endoscopic endonasal surgery for pituitary adenomas using the endoscopic endonasal sinus and skull base surgery questionnaire

Objective: Social functioning is an important factor in the evaluation of postoperative health-related quality of life (HRQoL) for pituitary adenoma patients. In a prospective cohort study multidimensional HRQoL of non-functioning (NFA) and functioning (FA) pituitary adenoma patients were evaluated following endoscopic endonasal surgery using the endoscopic endonasal sinus and skull base surgery questionnaire (EES-Q). Methods: Prospectively, 101 patients were included. The EES-Q was completed preoperatively and postoperatively (2 weeks, 3 months, 1 year). Sinonasal complaints were completed daily during the first week postoperatively. Preoperative and postoperative scores were compared. A generalized estimating equation (uni- and multivariate) analysis was performed to identify significant HRQoL changes related to selected covariates. Results: Two weeks postoperatively, physical (p &lt;.05) and social (p &lt;.05) HRQoL are worse and psychological (p &lt;.05) HRQoL improved compared with preoperatively. Three months postoperatively, psychological HRQoL (p =.01) trended back to baseline and no differences in physical or social HRQoL were reported. One year postoperatively, psychological (p =.02) and social (p =.04) HRQoL improved while physical HRQoL remained stable. FA patients report a worse HRQoL preoperatively (social, p &lt;.05) and 3 months postoperatively (social, p &lt;.02 and psychological, p &lt;.02). Sinonasal complaints peak in the first days postoperatively and gradually return to presurgical levels 3 months postoperatively. Conclusions: The EES-Q provides meaningful information on multidimensional HRQoL to improve patient-centred health care. Social functioning remains the most difficult area in which to achieve improvements. Despite the relatively modest sample size, there is some indication that the FA group continues to show a downward trend (and thus improvement) even after 3 months, when most other parameters reach stability. Level of evidence: Level II—B.</p

The effect of three-dimensional visualisation on performance in endoscopic sinus surgery:A clinical training study using surgical navigation for movement analysis in a randomised crossover design

Objectives: Endoscopic imaging techniques and endoscopic endonasal surgery (EES) expertise have evolved rapidly. Only few studies have assessed the effect of three-dimensional (3D) endoscopy on endoscopic sinus surgery (ESS). The present study aimed to objectively and subjectively assess the additional value of 3D high-definition (HD) endoscopy in ESS. Design: A randomized crossover study of endoscopic surgery performance, using five ESS tasks of varying complexity, performed on Thiel embalmed human specimens. Setting: Simulated surgical environment. Participants: Thirty participants, inexperienced in ESS. Main outcome measures: Performance was assessed using video imaging, surgical navigation and questionnaires. Main outcome measures were as follows: efficiency (defined by time to task completion), distance covered inside the nose, average velocity towards target, accuracy (measured by error rate), and subjective assessment of endoscope characteristics. Results: During ESS tasks, both efficiency and accuracy did not differ significantly between 2D HD and 3D HD endoscopy. Subjectively, imaging characteristics of the 3D HD endoscope were rated significantly better. Conclusions: ESS performance of inexperienced participants was not significantly improved by the use of 3D HD endoscopy during ESS tasks, although imaging characteristics of the 3D HD endoscope were rated significantly better. Surgical field characteristics and surgical techniques are likely to influence any additional value of 3D HD endoscopy

Age of discovery and evaluation of consequences of submucous cleft palate

Aim: Evaluation of the frequency of submucous cleft palate (SMCP) in a group of children with clefts, reason for suspecting SMCP, typical symptoms, age at time of diagnosis and the effect of age on speech development. Methods: Retrospective chart review. Out of 33 patients with SMCP, who were registered by the Groninger cleft lip and palate team of the University Medical Center Groningen (UMCG) over approximately 20 years (1990 until July 2011), 29 nonsyndromic patients with a proven diagnosis of SMCP were included in this study: 17 males and 12 females. From these patients, speech and hearing were examined as part of the routine diagnostic and treatment protocol on communicative abilities. The number of patients with SMCP and the age at time of diagnosis were evaluated. The percentages of problems in resonance, articulation and hearing, present at time of diagnosis, were compared with the percentages of problems found after surgical treatment. Results: Out of 800 patients with clefts, 29 patients (4%) were diagnosed with SMCP. SMCP was initially diagnosed at a median age of 3;8 years (0;0-42;3 years). All patients presented one or more of the following symptomatic complaints at time of diagnosis: hypernasality (66%), problems in articulation (45%), conductive hearing loss (38%) and / or nutritional problems (31%). A typical anatomical variation of the palate was a bifid uvula (96%). Following surgery, a hypernasal speech and nutritional problems were no longer observed. The articulation problems remained persistent after plastic surgery and the age of diagnosis appeared to be no significant predictor of these articulation problems. Hearing problems appeared more difficult to treat effectively. An improvement in hearing was observed but normal hearing was not achieved. During the intervening period, often a combination of treatments was performed. Pharyngoplasty appeared to be successful in treating hypernasality, with a success rate of 78% after 1 operation and 100% after 2 operations. Conclusion: SMCP is a rare cleft of the palate which is, despite symptoms of velopharyngeal insufficiency and the presence of a bifid uvula, often diagnosed late. The age at time of diagnosis has only lasting consequences for speech development with regard to problems in articulation. Hearing problems are more difficult to treat effectively on the long term. Recommended is to examine throat, nose and ears in children with obvious anatomical variations of the palate and mild problems in speech, hearing and / or nutrition. In this examination, assessment of the velum can be of important diagnostic value because these problems can be caused by a submucous cleft of the palate.

Citizenship development of adolescents during the lower grades of secondary education

The present study focuses on the development of citizenship competences of Dutch adolescents, including the political and social aspects as part of adolescents' daily lives. We followed 5070 adolescents aged 12-16 years across a three-year period in lower secondary education. The variance on school and student level was estimated and a three-level mixed-effects regression model was fit to analyze differences in citizenship development. The results indeed show development of citizenship competences during secondary school, but the observed patterns were not always positive. Students generally showed an increase in their citizenship knowledge, but a decline in their societal interest, prosocial ability and reflective thinking. Differences between groups of students could be explained by both schools and student characteristics. Especially girls and minority students developed the most citizenship competences. Understanding these differences is important for schools to improve their practices in ways that support the development of citizenship competences of various groups of students

Evaluation of the psychometric properties of the endoscopic endonasal sinus and skull base surgery questionnaire (EES-Q) in a prospective cohort study

OBJECTIVES: The patients' perspective on health has become increasingly important when assessing treatment outcomes. Recently, the Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire (EES-Q) was developed to determine the impact of endoscopic endonasal surgery on health-related quality of life (HRQoL). The aim of this study was to evaluate the test-retest reliability, construct validity, and responsiveness of the EES-Q. DESIGN: Prospective cohort study. SETTING: University Medical Center Groningen, tertiary referral hospital, the Netherlands. PARTICIPANTS: One hundred patients who underwent endoscopic endonasal surgery because of sinus or anterior skull base pathology. MAIN OUTCOME MEASURES: Test-retest reliability, construct validity and responsiveness. RESULTS: The EES-Q domains exhibited good test-retest reliability (ICC > 0.90). Construct validity was corroborated by significant positive and negative correlations between the EES-Q and the SNOT-22 and postoperative health status (p < 0.01) respectively. The correlation between the social EES-Q domain and the ability to move and perform usual activities (EQ-5D-3L) was significant positive (p < 0.01). In patients with paranasal sinus pathology, the EES-Q was responsive to clinical change (Cohen's d = 0.6). CONCLUSION: The EES-Q is a reliable and acceptable responsive disease-specific HRQoL instrument. The expected construct validity of the EES-Q is supported by the results in this study. Inconveniences in social functioning had the greatest negative impact on postoperative health status rating. This reflects the importance of a multidimensional HRQoL assessment after EES. The results indicate that the EES-Q is a promising disease-specific tool for the HRQoL assessment after endoscopic endonasal sinus or anterior skull base surgery. This article is protected by copyright. All rights reserved

Calculating nasoseptal flap dimensions:a cadaveric study using cone beam computed tomography

We hypothesize that three-dimensional imaging using cone beam computed tomography (CBCT) is suitable for calculating nasoseptal flap (NSF) dimensions. To evaluate our hypothesis, we compared CBCT NSF dimensions with anatomical dissections. The NSF reach and vascularity were studied. In an anatomical study (n = 10), CBCT NSF length and surface were calculated and compared with anatomical dissections. The NSF position was evaluated by placing the NSF from the anterior sphenoid sinus wall and from the sella along the skull base towards the frontal sinus. To visualize the NSF vascularity in CBCT, the external carotic arteries were perfused with colored Iomeron. Correlations between CBCT NSFs and anatomical dissections were strongly positive (r > 0.70). The CBCT NSF surface was 19.8 cm(2) [16.6-22.3] and the left and right CBCT NSF lengths were 78.3 mm [73.2-89.5] and 77.7 mm [72.2-88.4] respectively. Covering of the anterior skull base was possible by positioning the NSF anterior to the sphenoid sinus. If the NSF was positioned from the sella along the skull base towards the frontal sinus, the NSF reached partially into the anterior ethmoidal sinuses. CBCT is a valuable technique for calculating NSF dimensions. CBCT to demonstrate septum vascularity in cadavers proved to be less suitable. The NSF reach for covering the anterior skull base depends on positioning. This study encourages preoperative planning of a customized NSF, in an attempt to spare septal mucosa. In the concept of minimal invasive surgery, accompanied by providing customized care, this can benefit the patients' postoperative complaints

Itching in dialysis patients: impact on health-related quality of life and interactions with sleep problems and psychological symptoms - results from the RENINE/PROMs registry

BACKGROUND: Itching (pruritus) is common in dialysis patients, but little is known about its impact on health-related quality of life (HRQOL), sleep problems and psychological symptoms. This study investigates the impact of itching in dialysis patients by looking into the persistence of itching, the effect of itching on the course of HRQOL, and the combined effect of itching with sleep problems and with psychological symptoms on HRQOL. METHODS: Data were obtained from the RENINE/PROMs registry and included 2978 dialysis patients who completed patient-reported outcome measures between 2018-2020. Itching, sleep problems and psychological symptoms were assessed with the DSI, and HRQOL with the SF-12. Effects of itching on HRQOL and interactions with sleep problems and psychological symptoms were investigated cross-sectionally and longitudinally, using linear regression and linear mixed models. RESULTS: Half of the patients experienced itching and in 70% of them, itching was persistent. Itching was associated with a lower physical and mental HRQOL (-3.35 [95%CI: -4.12; -2.59] and -3.79 [95%CI: -4.56; -3.03]). HRQOL remained stable during two years and trajectories did not differ between patients with or without itching. Sleep problems (70% vs 52%) and psychological symptoms (36% vs 19%) were more common in patients with itching. These symptoms had an additional negative effect on HRQOL, but did not interact with itching. CONCLUSIONS: The persistence of itching, its impact on HRQOL over time, and the additional effect on HRQOL of sleep problems and psychological symptoms, emphasize the need for recognition and effective treatment of itching to reduce symptom burden and improve HRQOL