Postoperative Instructions Research Articles

Post-operative instructions following minor oral surgery - the quality and level of evidence: a cross-sectional study.

Aims To assess the quality of information targeting lay people regarding post-operative instructions after minor oral surgery (MOS), and to determine the level of evidence of any scientific articles cited in the instructions.Design and setting A dynamic Internet-based cross-sectional study.Materials and methods An Internet search for professional organisations/specialist dental societies in ten English-speaking countries with a search of their websites was conducted to locate post-operative instructions. Where not readily available, these were requested from each respective organisation/society. Reliability and quality of the instructions were assessed using the DISCERN instrument. Evidence level of cited articles was analysed using the Joanna Briggs Institute Levels of Evidence.Results Of the 59 identified organisations/societies, 26 sets of instructions were assessed. Overall quality of information was low, represented by median scores of 45%, 42.9% and 42.7% for reliability, quality of information and total DISCERN score, respectively. Only two instructions cited articles to support their content; these were of moderate-low level evidence.Conclusion Post-operative instructions following MOS that target the lay public have low quality and cite articles of moderate-low level evidence to support their content. Peak organisations should ensure such content is easily locatable, of high quality and is supported by high-level evidence.

Enhanced rehabilitation guidance after arthroscopic capsulolabral repair of the shoulder: a randomized controlled trial

Objective: To compare the effects of a 12-month home-based exercise program to usual care in patients after arthroscopic capsulolabral repair of the shoulder. Design: Randomized controlled trial. Setting: Outpatient physical and rehabilitation medicine clinic. Subjects: Forty-five patients (mean age: 35 years; standard deviation (SD): 10 years) who underwent arthroscopic capsulolabral repair due to labral lesion were randomized into an exercise group (EG) or a control group (CG). Intervention: The EG received a 12-month home-based additional exercise program with four physiotherapy follow-up visits, while the CG received standard postoperative exercise instructions. Main measures: Self-reported shoulder disability was assessed with the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and quality of life with the Short-Form (SF)-36 Health Survey. The function of the operated shoulder was evaluated with strength and range of motion measurements. Results: No between-group differences were observed in any of the outcomes at the follow-up. Mean ASES score improved by 16 (95% confidence interval (CI): 10–23) points from the baseline 78 (SD: 17) in the EG and 13 (95% CI: 7–19) points from the baseline 79 (SD: 17) in the CG. Both groups achieved a significant improvement in the dimensions of Physical Functioning, Role-Physical, and Bodily Pain of the SF-36 and in every aspect of strength and range of motion measures. In EG, exercise adherence was moderate (52%) during the first six months and poor (22%) during the last six months. Conclusion: Home-based additional exercises with four outpatient follow-up visits did not improve outcome after arthroscopic capsular repair of the shoulder.

What's Important: A Call for a Preoperative Psychiatric Risk-Assessment Metric for Orthopaedic Surgery.

What's Important: A Call for a Preoperative Psychiatric Risk-Assessment Metric for Orthopaedic Surgery.

Predictors of improvement following early exercises rehabilitation program for patients undergoing open lumbar discectomy

Background and aims: Low back pain is mostly due to disc herniation and has a burden upon economy and social aspects of life. Failure to improve after open lumbar discectomy is frustrating. Therefore, identifying predictors of improvement is of great clinical benefit. Aims: This research was conducted to evaluate whether an early exercises rehabilitation program using educational booklet would provide benefit to patients following open lumbar discectomy and determine potential factors of improvement.Patients and methods: Design: Single blind randomized controlled trial. Eighty-eight patients scheduled for open lumbar discectomy from January 2017 to January 2019 at Assiut and Ain Shams Universities hospitals in Egypt were randomly assigned to two groups. Control group (n = 44) received routine postoperative instructions while intervention group (n = 44) received routine instructions in addition to early exercises rehabilitation program and were also provided with a specifically designed educational booklet. Patients were followed up after six months using Oswestry disability index.Results: There was significant improvement among intervention group as compared to control group in several domains of Oswestry disability index (walking, sitting, standing, sleeping, travelling and sexual and social life). Better pre-operative Oswestry disability index score and early application of exercises rehabilitation program using an educational booklet predicted better postoperative Oswestry disability index score after six months.Conclusion: Application of an early exercise rehabilitation program and providing patients with a specifically designed educational booklet would be helpful for patients following open lumbar discectomy. Clinical Relevance: Early exercises rehabilitation program can be used by nursing staff as a reference in management of patients following open lumbar discectomy.

Effect of Perioperative Instructions on Postoperative Discomforts and Satisfaction Level among Patients Undergoing Thyroidectomy

Context: Thyroidectomy is a type of surgery directed to remove all or part of the thyroid gland. Documented complications after thyroidectomy are rare, but their consequences can often be life-threatening. Patients who receive perioperative instructions about what to expect after the operation often have better coping with postoperative discomforts minimizes post-surgical complications and reduces the duration of hospitalization. It also improves patient safety and reduces the anxiety induced by the intervention. In addition to this, it elevates the patient's satisfaction level. So, perioperative instructions are essential.
 Aim: The present study aims to determine the effect of perioperative instructions on postoperative discomforts and satisfaction levels among patients undergoing thyroidectomy. The study hypothesized that postoperative patients who receive the perioperative instructions exhibit fewer discomforts and more satisfaction than those who do not.
 Methods: The study utilize a quasi-experimental (study/control group) design. It was conducted at the Head and Neck Surgical Department of Alexandria Main University Hospital. A convenience sample included 70 adult patients were selected from the setting mentioned above who have enrolled either study or control groups, 35 patients, for each. Three tools were used for data collection. A structured interview questionnaire aimed to assess the socio-demographic characteristics and clinical data of the study subjects. Discomfort assessment scale to rate the patient's level of discomfort against six common postoperative problems. Perioperative instructions patients’ satisfaction questionnaire developed to determine the patients' ′ satisfaction level regarding perioperative instructions.
 Results: There were statistically significant differences among the study and control groups in the first, second, and third weeks regarding total discomfort score level, where t=3.606, p=<0.001; t=3.049, p=<0.001; t=21.213, p=<0.001respectively. The studied patients had higher level of satisfaction compared to those in the control group with statistically significant differences regarding overall scores of satisfaction, and with preoperative instruction, postoperative instruction, and psychological preparation, where t=48.382, p=<0.001; t=6.023, p=<0.001; t=27.997, p=<0.001; t=32.939, p=<0.001respectively.
 Conclusion: The study hypotheses were accepted as postoperative patients who receive perioperative instructions exhibit less discomfort and a more satisfying level than those who do not. The perioperative instructions should be applied to the care of patients undergoing thyroidectomy to decrease patients' discomfort and increase their satisfaction level.

A commentary on “Impact of postoperative instructions on physical activity following pelvic reconstructive surgery: a randomized controlled trial”

A commentary on “Impact of postoperative instructions on physical activity following pelvic reconstructive surgery: a randomized controlled trial”

Impact of postoperative instructions on physical activity following pelvic reconstructive surgery: a randomized controlled trial.

There is little information on the impact that postoperative instructions have on physical activity to help guide physicians in providing these recommendations after surgery. Our study objective was to evaluate the impact of postoperative instructions on physical activity. We hypothesized that there would be no differential effect of instructions on activity. In this randomized controlled trial, patients undergoing prolapse repair were randomized to receive either liberal or restricted postoperative activity instructions between February 2017 and February 2019. Physical activity was measured using the Activities Assessment Scale (AAS) and tri-axial accelerometers measured at baseline and 2 and 6weeks after surgery. A sample size of 146 patients was planned to compare these activity measurements. AAS scores and accelerometer readings of the two groups were compared using separate variance t tests. A total of 157 women were recruited between February 2017 and February 2019, including 146 patients with completed study data (n= 72 liberal, n= 74 restricted). There was no difference in physical activity at 2weeks between the liberal and the restricted instruction groups, as measured by AAS scores (70.47 ± 12.83, 69.54 ± 12.22, p= 0.66), total steps (4,582.20 ± 2,164.5, 5,014.47 ± 3,025.46, p= 0.32), active minutes (4.22 ± 6.17, 4.96 ± 9.65, p= 0.25), and 10-min intervals (0.76 ± 1.11, 0.77 ± 0.93, p= 0.95) respectively. Similarly, there was no difference in activity at 6weeks between the liberal and the restricted instruction groups. as measured by AAS scores (81.86 ± 8.25, 81.31 ± 10.31, p= 0.72), total steps (6,316.25 ± 3,173.53, 6,589.94 ± 3,826.43, p= 0.64), active minutes (8.79 ± 10.5,11.36 ± 18.18, p= 0.98), and 10-min intervals (1.37 ± 1.34, 1.34 ± 1.40, p= 0.89) respectively. Postoperative instructions do not have an impact on physical activity measures in patients who have undergone pelvic reconstructive surgery.

Understanding the Surgical Experience for African-Americans and Caucasians With Enhanced Recovery

IntroductionRacial/ethnic disparities in surgical outcomes exist. Enhanced recovery programs (ERPs) have reduced some racial/ethnic disparities, but it remains unclear if disparities in experiences are also reduced. The purpose of this study was to use qualitative methods to better understand the surgical experience for African-American and Caucasian patients in the setting of an ERP. MethodsUsing purposeful sampling at a minority-serving institution, we recruited African-American and Caucasian patients who had undergone colorectal surgery under an ERP to six focus groups. Participants identified barriers and facilitators to a positive, or negative, surgical experience. Audio recordings were transcribed and analyzed using an indicative thematic approach with NVivo 10 software (QSR International). ResultsForty-three patients (15 African-Americans and 28 Caucasians) participated in six focus groups. Six themes were identified by patients to be important in surgery: 1) knowledge about colorectal surgery, 2) obtaining information, 3) quality of information, 4) setting expectations about surgery, 5) following preoperative and postoperative instructions, and 6) confidence in surgery outcomes. For both racial/ethnic groups, patients felt that more information could have been provided, information should be given at their level of understanding, and trust in the physician made them feel confident in a positive outcome. African-American patients described experiences of having incorrect or no expectations on surgical outcomes, being provided inconsistent information, and feeling misled. African-Americans also described following instructions from family members and valued the importance of diet and exercise in recovery. ConclusionsAfrican-American and Caucasian surgical patients have varied surgical experiences even under an ERP. All patients, however, valued the ability to obtain, process, and understand health information during the surgical process. These elements define “health literacy” and suggest the importance of providing health literacy–sensitive care in surgery.

Patient compliance to postoperative instructions after third molar surgery comparing traditional verbally and written form versus the effect of a postoperative phone call follow-up a: A randomized clinical study.

BackgroundThe understanding and adherence to postoperative care instructions may be influenced by how they are presented by the professional interfering the recuperation process after surgery. The aim of this study was to evaluate the effect of a postoperative phone call follow-up compared with a traditional verbally and written instructions regarding compliance of postoperative recommendations after third molar surgery; and secondly, to discover the main points of non-compliance. Material and MethodsA randomized clinical study was performed including patients that underwent surgical extraction of an impacted mandibular or maxillary third molar in the Oral Surgery Unit of the University of Valencia from January 2016 to January 2017. Patients were randomly assigned to one of three different test groups according to how the post-operative instructions were delivered: brief written instructions, written extended instructions or brief written instructions plus a phone call follow-up at 3-day postoperative period. Patients were interviewed about their adherence to the instructions one week after surgery. The significance level was set at p<0.05. ResultsThe higher score of compliance was found to the phone call follow-up group (p=0.001). No statistically significant differences were found between brief written group and the group that received written extended instructions. In the phone call follow-up group all variables assessed to the compliance were fulfilled. To brief written and written extended instructions groups, the main points of non-compliance were hygiene and smoking (p<0.001, p=0.026, respectively), and tended towards significance for chlorhexidine rinses and antibiotic, analgesic and anti-inflammatories medication prescribed. ConclusionsTelephone call follow-up can promote patient adherence to postoperative recommendations after third molar surgery. The main factors of non-compliance were not maintain a proper hygiene and not smoking, followed by not performing chlorhexidine rinses and not following medication prescribed. Key words:Compliance, postoperative instructions, postoperative recommendations, third molar surgery.

Oral Health-related Quality of Life and Oral Hygiene Practice of Adults with Fixed Dental Prostheses in Riyadh, Saudi Arabia.

Objectives:Missing teeth are routinely replaced with fixed dental prostheses (FDPs); thus, knowing the patient’s oral health–related quality of life (OHRQoL) after placement of FDP and factors affecting their quality of life in addition to their oral hygiene practices is important. This study aimed to measure OHRQoL with FDPs and oral hygiene practices of adults in Riyadh, Saudi Arabia.Materials and Methods:A survey was distributed in hard and soft copy forms. Target subjects were adults older than 18 years with FDP and living in Riyadh. The questionnaire contained four domains: demographic data, medical history, characteristics of the prostheses and oral hygiene practices, and Oral Health Impact Profile (OHIP)-14 questionnaire, which measures OHRQoL.Results:The study included 528 subjects. More than half of the participants (56.6%) had poor OHRQoL, which was associated with female gender, full-time employment, and low income. The presence of toothache, periodontal diseases, oral abscess, and broken teeth were all associated with poor OHRQoL. Participants with diabetes were also found to have poor OHRQoL. As for oral hygiene practices, 47% of subjects did not receive oral hygiene instructions after the placement of their FDP. It was also found that 53.4% of the study population brush only once daily.Conclusion:Many factors can have an influence on OHRQoL. Both dentist and patient awareness regarding postoperative oral hygiene instructions should be increased to ensure the durability of the prosthodontic appliances and improve patients’ OHRQoL.

Bridging the Knowledge Gap: An Examination of the Ideal Postoperative Autologous Breast Reconstruction Educational Material with A/B Testing.

Poor health literacy is an epidemic in the United States, associated with higher mortality rates and poor postoperative care. Autologous breast reconstruction is highly complex, and the identification of complications is difficult even for non-plastic surgeon practitioners. The authors sought to explore the problem of health literacy in this context and identify the ideal postoperative patient education materials. Available online postoperative patient education materials for autologous breast reconstruction and corresponding readability scores were assessed. To derive the ideal formula for materials, the authors crowd-sourced quizzes with A/B testing, a method to examine the outcome of two versions of a single variable. The authors implemented their findings and compared performance on postoperative quizzes with and without oral reinforcement. Of the 12 postoperative flap complication patient education materials found through an Internet search, the average grade level readability level was 9.9. Only one of 12 (8.3 percent) mentioned symptoms and signs of flap compromise. The A/B tests result revealed that text approximately 400 to 800 words written on a sixth-grade level led to the highest quiz scores. Patients scored significantly higher on the postoperative day-2 quiz when patient education materials, modeled after these findings, were reinforced with oral presentation (p = 0.0059). Retention of high quiz scores remained at postoperative day 10. Currently available patient education materials are at a high reading level and lack specific information on the identification of flap compromise. The authors propose the most effective postoperative instructions to be approximately 400 to 800 words written on a grade-six level with images and oral reinforcement.

Assessment of Nurses’ Knowledge and Practice for Patients Undergoing Radical Cystectomy Surgeries

Background: The patient who undergoing radical cystectomy has needs many nursing care because of alterations in the functional health patterns of elimination, health, management, cognitive, self-perception and role relationships. Aim of the study: This study aimed to assess nurse’s knowledge and practice regarding patients undergoing Radical cystectomy surgeries. Research design: Descriptive research design was utilized in this study. Setting: The study was conducted at the Surgical Oncology Department at South Egypt Cancer Institute. Sample: A convenience sample including (60) nurses working at surgical oncology department who are willing to participate in the study. Tools: Structured interview questionnaire sheet, and observation checklist sheet. Results: the majority of nurses had unsatisfactory knowledge as regarding radical cystectomy surgeries. The score knowledge about specific care after procedure was higher (Mean±SD= 2.42±3.2) in compared to other items including; Radical cystectomy surgeries, nursing care before cystectomy, and general care after cystectomy. The majority of nurses were inadequate of their practice regarding postoperative instruction before discharge with (mean±SD= 33.78±3.77). Conclusion: a significant statistical difference between nurses knowledge in relation to total mean knowledge score, a significance statistical difference between nurses practice in relation to total mean practice score. Recommendations: nurses need for in- service training programs and refreshing courses to improve knowledge which will reflect into their knowledge and practice while work with patients.

Assessment of feasibility of Objective Structured Clinical Examination for Final BDS students in Conservative Dentistry and Endodontic at Government Dental College and Hospital, Nagpur.

Objective structured clinical examination (OSCE) have become established as reliable, valid and objective methods of assessing practical and clinical skills in dental schools. This study explored the perceptions of dental undergraduates regarding OSCE. After a clinical course in Conservative Dentistry and Endodontics, 32 Final year dental students were assessed summatively, using OSCE. The students were informed beforehand about the assessment formats. The self-assessed clinical competence, study time and strategies (i.e. practice with a manikin, peers and patient case) were evaluated by means of a questionnaire. After a comprehensive dental care course, all 32 students were assessed by OSCE, in which Five stations were included ‘Cavity Preparation’, ‘Base application’ ‘Restoration’, &amp;; educating patients; and; Post-Operative Instructions; Each Student was evaluated separately in each Station with predetermined structured questions. Data was collected and send for statistical analysis. The results were obtained using SPSS-17 and comparison done with Conventional Exam. Implementation of an OSCE in undergraduate Conservative Dentistry and Endodontics Curriculum helps in greater achievement of specific clinical competence and greater level of realistic self-assessment.

Evolution of Full Facial Feminization Surgery: Creating the Gendered Face With an All-in-one Procedure.

Facial feminization surgery (FFS) has recently gained popularity to enhance the female facial profile and promote a real transformation of the male to female face in transgender patients. The term involves overlapping of the surgical procedures devoted to feminization and represents a dual and reversible procedure unique in plastic and reconstructive surgery. Indeed, FFS envisages modifications of the hard and soft tissues and is both reductive and augmentative. For these reasons, full FFS (F-FFS) is used by surgeons with special expertise in FFS. This study describes a novel approach to F-FFS performed in a single surgery and thus renamed, de facto, all-in-one and representing its most recent evolution. Forty-nine consecutive nonrandomized patients underwent FFS at a private clinical practice (Face Surgery Center, Parma, Italy) between January 2003 and December 2017. Following a retrospective review according to specific inclusion criteria, the authors identified 9 patients aged 19 to 33 years (mean age, 21 years) who underwent all-in-one F-FFS. Patients were discharged the day after surgery with written postoperative care instructions. No reports of wound infection/dehiscence or nerve/vessel damage were recorded. Patients typically returned to work within 30 days following surgery. The mean operative time was 281 minutes (range, 245-305 minutes). The evolved all-in-one F-FFS provides a further step technically (overlapping several procedures) in terms of surgical outcome (higher satisfaction rate) and reduced overall costs and low morbidity.

Effect of Drug Disposal Bag Provision on Proper Disposal of Unused Opioids by Families of Pediatric Surgical Patients

Although opioids are an important component of pain management for children recovering from surgery, postoperative opioid prescribing has contributed to the current opioid crisis in the United States because these medications are often prescribed in excess and are rarely properly disposed. One potential strategy to combat opioid misuse is to remove excess postoperative opioids from circulation by providing patients with drug disposal products that enable safe disposal of opioids in the home garbage. To determine whether the provision of a drug disposal bag increases proper opioid disposal among the families of pediatric patients undergoing ambulatory surgery. This randomized clinical trial enrolled 202 parents or guardians of children 1 to 17 years of age who underwent otolaryngologic or urologic surgery at the outpatient surgery centers of a tertiary children's hospital in Columbus, Ohio, from June to December 2018 and who received an opioid prescription prior to discharge. Families randomized to intervention were provided a drug disposal bag containing activated charcoal and instructions for use plus standard postoperative discharge instructions on opioid use, storage, and disposal. Families in standard care arm received standard postoperative discharge instructions only. All participants completed a baseline survey and a follow-up survey 2 to 4 weeks postoperatively. Primary outcome was proper opioid disposal, defined as disposal using a drug disposal bag or a disposal method recommended by the US Food and Drug Administration. Of 202 parents or guardians enrolled, 181 completed follow-up (92 in intervention arm and 89 in standard care arm). Most patients in both groups were white (75 [73.5%] vs 79 [80.6%]) and male (63 [61.2%] vs 54 [54.6%]), and the median (interquartile range) age was 6 (5-9) years in the intervention arm and 7 (6-10) years in the standard care arm. For intention-to-treat analyses, 92 families receiving a disposal bag and 89 families not receiving a disposal bag were included. Among them, 66 families (71.7%) randomized to receive a disposal bag reported properly disposing of their child's opioids, whereas 50 parents (56.2%) who did not receive a disposal bag reported proper opioid disposal (difference in proportions, 15.5%; 95% CI, 1.7%-29.3%; P = .03). Among only those families who filled an opioid prescription and had leftover opioids after resolution of their child's pain, 66 of 77 parents or guardians (85.7%) who had received a disposal bag and 50 of 77 parents or guardians (64.9%) who had received standard care reported properly disposing of their child's opioids (difference in proportions, 20.8%; 95% CI, 7.6%-34.0%). Results of this study indicated that providing drug disposal bags to families of children receiving postoperative opioids increased the likelihood of excess opioid disposal. Greater availability of disposal products may complement ongoing prescribing reduction efforts aimed at decreasing opioid misuse. ClinicalTrials.gov identifier: NCT03575377.

Scarf osteotomy for the treatment of moderate to severe hallux valgus: Analysis of predictors for midterm outcomes and recurrence

BackgroundControversies remain regarding the predictors for outcomes and recurrence after scarf osteotomy for hallux valgus deformity. MethodsSixty-two patients (70 feet) underwent scarf osteotomy for hallux valgus deformity. The radiological angles, tibial sesamoid position, articular congruence, demographics, comorbidities, AOFAS, VAS and SF-12 scores, and the postoperative compliance were tested as predictors for outcomes and recurrence. ResultsAfter a mean 38±15.4 months follow-up, all of the radiological angles, the total AOFAS, PCS-12 and VAS scores significantly improved (all P<0.001). Preoperative MCS-12 was directly related to the total postoperative AOFAS score (P=0.003). A higher number of cardiovascular risk factors negatively affected the postoperative total AOFAS score, VAS and PCS-12 (β=−3.42, P=0.030; β=0.262, P=0.022; β=−0.181, P=0.025, respectively). The BMI influenced postoperative PCS-12 (β=−0.244, P=0.002). Preoperative HVA was directly related to postoperative DMAA (P=0.002) and tibial sesamoid position (P=0.005). Preoperative joint incongruence and postoperative noncompliance were associated with recurrence (P=0.043 and P=0.035, respectively). ConclusionsSatisfactory results can be expected after scarf osteotomy. Higher BMI and number of cardiovascular risk factors, and low mental status should be carefully considered when counselling patients for this procedure. Adherence to postoperative care instructions influences deformity recurrence.

Success and Survival of Endodontically Treated Cracked Teeth with Radicular Extensions: A 2- to 4-year Prospective Cohort

IntroductionThere are no long-term, prospective clinical studies assessing outcomes of endodontically treated cracked teeth with radicular extensions. The purpose of this prospective study was to examine the 2- to 4-year success and survival rates of endodontically treated, coronally restored, cracked teeth, specifically where the crack extends beyond the level of the canal orifice internally. MethodsSeventy consecutive teeth requiring endodontic treatment with cracks extending to the level of the canal orifice and up to 5 mm beyond were included in the cohort. Treatment was performed by a single endodontist using current techniques, and cases were followed over time. Specific treatment and posttreatment protocols were used. A tooth was “survived” if it was present, asymptomatic, and functional. The category of “success” was given to a case if strict radiographic and clinical criteria were met. ResultsFifty-nine teeth were eligible for survival analysis, and 53 teeth were available for success analysis. There was a 100% survival rate in the first 2 years and 96.6% survival up to the 4-year period; 90.6% were classified as “success” in the 2- to 4-year term. No significant differences (P < .05) were found for periodontal pocketing (up to 7 mm) at the site of the crack, marginal ridge involvement, crack depth, or pretreatment diagnoses. ConclusionsThis study showed that the success and survival rates for cracked teeth with radicular extensions may be similar to endodontically treated teeth in general and may be higher than previously reported in cracked tooth studies. Treatment outcomes in cracked teeth with radicular extensions may be improved by using the following protocols: microscope-assisted intraorifice barriers placed apical to the extent of the crack, complete occlusal reduction, specific postoperative instructions, and expeditious placement of a full-coverage restoration.

Marked extrinsic staining following microabrasion: a case report of a boy with dental fluorosis

A 12-year-old boy, born and raised in Iran, presented with dental fluorosis affecting all his teeth. The defects were predominantly opaque white in appearance with brown opacities on the maxillary central incisors. The treatment plan entailed microabrasion of the maxillary central incisors followed by vital bleaching, if required. Despite providing post-operative instructions, the patient had a drink containing turmeric later that day. He subsequently presented with yellow staining of his maxillary central incisors. A further course of microabrasion as well as vital bleaching provided a satisfactory final result. The teeth remained unchanged in a two-month review appointment. CPD/Clinical Relevance: This case presents a rare complication following microabrasion for dental fluorosis which occurred because post-operative instructions were not followed.

Assessment of Postural Compliance After Pneumatic Retinopexy.

PurposeWe describe the functioning of a novel device, aimed to assess patient head position after a pneumatic retinopexy.MethodsWe enrolled patients with the clinical diagnosis of rhegmatogenous retinal detachment. All patients were asked to wear a specially designed headband with a monitoring device composed of an accelerometer, gyroscope, and magnetometer, powered by a 3.7V lithium battery. Every 200 ms, the device measured neck flexion and extension, left and right rotation, and left and right flexion. Patients were asked to come back the next morning for follow-up and headband retrieving.ResultsThe device was worn an average of 19.17 ± 2.1 hours and performed a mean number of 57,670 ± 8663 measurements without power failures or program errors. An acceptable head position was kept for a mean of 3.33 ± 1.8 hours. The hardest axis to maintain was the right and left flexion of the neck (5.5 ± 2.54 hours of acceptable positioning).ConclusionReal-time monitoring of patient head position after a vitreoretinal procedure is feasible. Maintaining a fixed head position for more than 5 consecutive hours is difficult to achieve and physicians should consider this difficulty when planning treatment.Translational RelevanceIn addition to a significant improvement to the basic design of similar devices, our device allows for assessment of patient adherence to postoperative instructions objectively for the first time to our knowledge. This information could be used in the future to elaborate more detailed position nomograms to improve outcomes

Treatment of Bicondyler Tibial Plateau Fracture by Single Lateral Locked Plate

Background : bicondylar tibial plateau fractures need surgical treatment to achieve good clinical results. The locking plate combines the technical advantages of an angular stable plate with those of the modern biological plating technique. Aim of the study: to verify management of bicondylar tibial plateau fractures by single lateral locked plate including patient selection, fracture type suitable for this kind of surgery, timing of surgery, operative technique, postoperative instructions and follow up. Patients and Methods: between January 2018 and February 2019, 20 patients with a mean age of 38 years (Range: 24-57 years) with bicondylar tibial plateau fractures with or without metaphyseal extension. Patients were diagnosed clinically, checked with standard X-rays, CT was done for all cases. Patients were treated by single lateral anatomically contoured locked plate through LISS or polyaxial locking plate systems with or without additional screws from medial side. Results: the mean Functional Rasmussen Knee score at last follow-up was 94.7% ranged between 83.3% and 100%. The mean Anatomical Rasmussen Knee score at last follow-up was 92.2% ranged between 77.7% and 100%. Mean Functional Rasmussen Knee score of patients had (Schatzker V fractures) was 96%, however it was 82.5% in those had (Schatzker VI fractures). Conclusion: surgical treatment of bicondylar tibial plateau fractures with the single lateral locked plate that was evaluated in our study can lead to a good functional and anatomical outcome and considered an effective system for providing fracture stabilization provided that the correct surgical technique is used.