Highlights • Sarcopenia, or muscle mass depletion, predicts adverse outcome in cancer patients. • HNC patients have a high prevalence of sarcopenia. • Skeletal muscle mass can be reliably assessed on ...a head and neck CT scan.
Systematic reviews (SRs) and meta-analyses (MAs) provide the highest possible level of evidence. However, poor conduct or reporting of SRs and MAs may reduce their utility. The PRISMA Statement ...(Preferred Reporting Items for Systematic reviews and Meta-Analyses) was developed to help authors report their SRs and MAs adequately.
Our objectives were to (1) evaluate the quality of reporting of SRs and MAs and their abstracts in otorhinolaryngologic literature using the PRISMA and PRISMA for Abstracts checklists, respectively, (2) compare the quality of reporting of SRs and MAs published in Ear Nose Throat (ENT) journals to the quality of SRs and MAs published in the 'gold standard' Cochrane Database of Systematic Reviews (CDSR), and (3) formulate recommendations to improve reporting of SRs and MAs in ENT journals.
On September 3, 2014, we searched the Pubmed database using a combination of filters to retrieve SRs and MAs on otorhinolaryngologic topics published in 2012 and 2013 in the top 5 ENT journals (ISI Web of Knowledge 2013) or CDSR and relevant articles were selected. We assessed how many, and which, PRISMA (for Abstracts) items were reported adequately per journal type.
We identified large differences in the reporting of individual items between the two journal types with room for improvement. In general, SRs and MAs published in ENT journals (n = 31) reported a median of 54.4% of the PRISMA items adequately, whereas the 49 articles published in the CDSR reported a median of 100.0 adequately (difference statistically significant, p < 0.001). For abstracts, medians of 41.7% for ENT journals and 75.0% for the CDSR were found (p < 0.001).
The reporting of SRs and MAs in ENT journals leaves room for improvement and would benefit if the PRISMA Statement were endorsed by these journals.
To investigate the relationship between the histologic characteristics of head and neck squamous cell carcinoma and apparent diffusion coefficient (ADC) at diffusion-weighted magnetic resonance (MR) ...imaging.
The institutional ethics committee approved this study and waived informed consent. In head and neck squamous cell carcinoma, local failure after chemotherapy and/or radiation therapy correlates with pretreatment ADC. However, the histopathologic basis of this correlation remains unclear. In this study, 16 patients with head and neck squamous cell carcinoma were enrolled (median age, 60 years; range, 49-78 years). Before undergoing total laryngectomy, patients underwent 1.5-T diffusion-weighted MR imaging. After resection, whole-mount hematoxylin-eosin-stained sections were registered to the MR images. Cellular density; nuclear, cytoplasmic, and stromal area; and nuclear-cytoplasmic ratio within the tumor were calculated by using image-based segmentation on four consecutive slices. Mean ADC of the corresponding tumor region was calculated. Spearman correlations between ADC and histologic characteristics were calculated.
ADC was significantly and inversely correlated with cell density (n = 16, r = -0.57, P = .02), nuclear area (n = 12, r = -0.64, P = .03), and nuclear-cytoplasmic ratio (n = 12, r = -0.77, P ≤ .01). ADC was significantly and positively correlated with percentage area of stroma (n = 12, r = 0.69, P = .01). Additionally, the percentage area of stroma was strongly interdependent with the percentage area of nuclei (n = 12, r = -0.97, P ≤ .01).
ADC was significantly correlated with cellularity, stromal component, and nuclear-cytoplasmic ratio. The positive correlation of ADC and stromal component suggests that the poor prognostic value of high pretreatment ADC might partly be attributed to the tumor-stroma component, a known predictor of local failure.
Objectives/Hypothesis
To review which type of cholesteatoma surgery, canal wall up (CWU) or canal wall down (CWD), provides the lowest risk for residual and/or recurrent disease in adults with ...primary acquired cholesteatoma.
Data Sources
PubMed, Embase, CINAHL, the Cochrane Library, Scopus and Web of Science.
Study Design
We selected articles comparing CWU with CWD, reporting on disease recidivism (combined residual and recurrent disease) or independent residual or disease recurrence rates. We included studies with a moderate to high relevance.
Results
Our search yielded 2,060 articles. We selected seven studies that carried a moderate risk of bias. Six studies described higher disease recidivism after the CWU procedure 16.7–61.0% compared to the CWD technique 0–13.2%. Four studies showed statistical significant difference (P < .05). One study showed opposite results: recidivism was found in 7.8% CWU and in 22.1% CWD cases (P < .001). Studies showed CWU recidivism more likely to be residual disease, whereas CWD recidivism tended to be recurrent disease.
Conclusion
The majority of included studies showed CWU to result in more disease recidivism compared to the CWD technique in adult patients with a primary acquired cholesteatoma. If recidivism risk is the most important factor to consider a certain surgical technique, we recommend application of the CWD procedure. However, many additional factors in patient care will define the best treatment decision, such as residual hearing and access to health care. Our recommendations are based on Level II evidence, which underlines the need for future high‐level evidence studies. Laryngoscope, 126:980–987, 2016
Single-sided deafness (SSD) leads to difficulties with speech perception in noise, sound localisation, and sometimes tinnitus. Current treatments (Contralateral Routing of Sound hearing aids (CROS) ...and Bone Conduction Devices (BCD)) do not sufficiently overcome these problems. Cochlear implants (CIs) may help. Our aim was to evaluate these treatments in a Randomised Controlled Trial (RCT). Adult SSD patients were randomised using a web-based randomisation tool into one of three groups: CI; trial period of 'first BCD, then CROS'; trial period of 'first CROS, then BCD'. After these trial periods, patients opted for BCD, CROS, or No treatment. The primary outcome was speech perception in noise (directed from the front (S.sub.0 N.sub.0 )). Secondary outcomes were speech perception in noise with speech directed to the poor ear and noise to the better ear (S.sub.pe N.sub.be) and vice versa (S.sub.be N.sub.pe ), sound localisation, tinnitus burden, and disease-specific quality of life (QoL). We described results at baseline (unaided situation) and 3 and 6 months after device activation. 120 patients were randomised. Seven patients did not receive the allocated intervention. The number of patients per group after allocation was: CI (n = 28), BCD (n = 25), CROS (n = 34), and No treatment (n = 26). In S.sub.0 N.sub.0, the CI group performed significantly better when compared to baseline, and when compared to the other groups. In S.sub.pe N.sub.be, there was an advantage for all treatment groups compared to baseline. However, in S.sub.be N.sub.pe, BCD and CROS groups performed worse compared to baseline, whereas the CI group improved. Only in the CI group sound localisation improved and tinnitus burden decreased. In general, all treatment groups improved on disease-specific QoL compared to baseline. This RCT demonstrates that cochlear implantation for SSD leads to improved speech perception in noise, sound localisation, tinnitus burden, and QoL after 3 and 6 months of follow-up. For most outcome measures, CI outperformed BCD and CROS. Trial registration: Netherlands Trial Register (www.trialregister.nl): NTR4580, CINGLE-trial.
Calculating a modelled workload based on objective measures. Exploring the relation between this modelled workload and workload as perceived by nurses, including the effects of specific job demands, ...job resources and personal resources on the relation.
Academic hospital in the Netherlands. Six surgical wards, capacity 15-30 beds. Data collected over 15 consecutive day shifts.
Modelled workload is calculated as a ratio of required care time, based on patient characteristics, baseline care time and time for non-patient related activities, and allocated care time, based on the amount of available nurses. Both required and allocated care time are corrected for nurse proficiency. Five dimensions of perceived workload were determined by questionnaires. Both the modelled and the perceived workloads were measured on a daily basis. Linear mixed effects models study the longitudinal relation between this modelled and workload as perceived by nurses and the effects of personal resources, job resources and job demands. ANOVA and post-hoc tests were used to identify differences in modelled workload between wards.
Modelled workload varies roughly between 70 and 170%. Significant differences in modelled workload between wards were found but confidence intervals were wide. Modelled workload is positively associated with all five perceived workload measures (work pace, amount of work, mental load, emotional load, physical load). In addition to modelled workload, the job resource support of colleagues and job demands time spent on direct patient care and time spent on registration had the biggest significant effects on perceived workload.
The modelled workload does not exactly predict perceived workload, however there is a correlation between the two. The modelled workload can be used to detect differences in workload between wards, which may be useful in distributing workload more evenly in order prevent issues of over- and understaffing and organizational justice. Extra effort to promote team work is likely to have a positive effect on perceived workload. Nurse management can stimulate team cohesion, especially when workload is high. Registered nurses perceive a higher workload than other nurses. When the proportion of direct patient care in a workday is higher, the perceived workload is also higher. Further research is recommended. The findings of this research can help nursing management in allocating resources and directing their attention to the most relevant factors for balancing workload.
Randomised Controlled Trials (RCTs) are the preferred study design when comparing therapeutical interventions in medicine. To improve clarity, consistency and transparency of reporting RCTs, the ...Consolidated Standards of Reporting Trials (CONSORT) statement was developed.
(1) To assess the quality of reports and abstracts of RCTs in otorhinolaryngologic literature by using CONSORT checklists, (2) to compare the quality of reports and abstracts of otorhinolaryngologic RCTs between the top 5 general medical journals and top 5 otorhinolaryngologic journals, and (3) to formulate recommendations for authors and editors of otorhinolaryngologic ('ENT') journals.
Based on 2012 ISI Web of Knowledge impact factors, the top 5 general medical and ENT journals were selected. On 25 June 2014, using a highly sensitive Cochrane RCT filter and ENT filter, possibly relevant articles since January 1st, 2010 were retrieved and relevant RCTs were selected. We assessed how many CONSORT items were reported adequately in reports and abstracts and compared the two journal types.
Otorhinolaryngologic RCTs (n = 15) published in general medical journals reported a mean of 92.1% (95% confidence interval: 89.5%-94.7%) of CONSORT items adequately, whereas RCTs (n = 18) published in ENT journals reported a mean of 71.8% (66.7%-76.8%) adequately (p < 0.001). For abstracts, means of 70.0% (63.7%-76.3%) and 32.3% (26.6-38.0%) were found respectively (p < 0.001). Large differences for specific items exist between the two journal types.
The quality of reporting of RCTs in otorhinolaryngologic journals is suboptimal. RCTs published in general medical journals have a higher quality of reporting than RCTs published in ENT journals. We recommend authors to report their trial according to the CONSORT Statement and advise editors to endorse the CONSORT Statement and implement the CONSORT Statement in the editorial process to ensure more adequate reporting of RCTs and their abstracts.
Observational studies are the most frequently published studies in literature. When randomized controlled trials cannot be conducted because of ethical or practical considerations, an observational ...study design is the first choice. The STROBE Statement (STrengthening the Reporting of OBservational studies in Epidemiology) was developed to provide guidance on how to adequately report observational studies.
The objectives were 1) to evaluate the quality of reporting of observational studies of otorhinolaryngologic literature using the STROBE Statement checklist, 2) to compare the quality of reporting of observational studies in the top 5 Ear, Nose, Throat (ENT) journals versus the top 5 general medical journals and 3) to formulate recommendations to improve adequate reporting of observational research in otorhinolaryngologic literature.
The top 5 general medical journals and top 5 otorhinolaryngologic journals were selected based on their ISI Web of Knowledge impact factors. On August 3rd, 2015, we performed a PubMed search using different filters to retrieve observational articles from these journals. Studies were selected from 2010 to 2014 for the general medical journals and from 2015 for the ENT journals. We assessed all STROBE items to examine how many items were reported adequately for each journal type.
The articles in the top 5 general medical journals (n = 11) reported a mean of 69.2% (95% confidence interval (CI): 65.8%-72.7%; median 70.6%), whereas the top 5 ENT journals (n = 29) reported a mean of 51.4% (95% CI: 47.7%-55.0%; median 50.0%). The two journal types reported STROBE items significantly different (p < .001).
Quality of reporting of observational studies in otorhinolaryngologic articles can considerably enhance. The quality of reporting was better in general medical journals compared to ENT journals. To improve the quality of reporting of observational studies, we recommend authors and editors to endorse and actively implement the STROBE Statement.
Objectives/Hypothesis
To prospectively evaluate surgical findings and hearing results in children undergoing surgery for congenital oval or round window malformations (class IV malformations).
Study ...Design
A nonrandomized, nonblinded, case series of prospectively collected data.
Methods
Fourteen consecutive pediatric patients who underwent 17 surgical procedures for congenital oval or round window malformations in a tertiary referral center were included. Postoperative pure‐tone audiometry was available in 15 cases. The surgical technique for repair of the ossicular chain was dictated by the surgical findings at the time of surgery. The majority of the cases underwent ossiculoplasty using a Teflon piston, bucket‐handle prosthesis, or total ossicular replacement prosthesis. Associated surgical techniques included malleus relocation and oval window drill‐out procedure. The main outcome measures were preoperative and postoperative hearing status using four‐frequency (0.5, 1, 2, and 4 kHz) audiometry. Air‐conduction thresholds, bone‐conduction thresholds, and air‐bone gap were measured. Postoperative audiometry was performed at 3, 6, 9, 12, 18, and 24 months after surgery and at a yearly interval thereafter.
Results
Postoperative air‐bone gap closure to 10 dB or less was achieved in 47%. A postoperative air‐bone gap closure to within 20 dB or less was achieved in 60%. Postoperative sensorineural hearing loss did not occur in this series.
Conclusions
Middle ear surgery for class IV abnormalities is feasible, but success percentages are much lower compared to other types of congenital ossicular malformations. Surgeons should be particularly careful in case of facial nerve abnormalities on computed tomography or during middle ear exploration.
Level of Evidence
4 Laryngoscope, 126:2552–2558, 2016
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