Postoperative Recall Research Articles

Patients Have Poor Postoperative Recall of Information Provided the Day of Surgery but Report Satisfaction With and High Use of an E-mailed Postoperative Digital Media Package

To understand what portions of the surgical day patients remember, what parts of an e-mailed media package regarding their surgery patients are used, and how that information affects their surgical experience. Patients undergoing an outpatient arthroscopic procedure were approached in the preoperative area and asked to remember 3words. Postoperatively, they were seen by the surgeon to discuss surgical findings and instructions. They were then e-mailed a multimedia package containing a thank you letter, postoperative instructions, annotated arthroscopy images, and a personalized video from the surgeon. Patients were called 2 to 5 days after surgery to answer survey questions and recall the 3 words they were told on the day of surgery. Of the 160 patients, 100% received and accessed the e-mail. When asked if they remembered the postoperative conversation, 125 (78.1%) patients responded yes and 35 (21.9%) responded no. When asked to rate how well they remembered the postoperative conversation, 75.2% patients rated their memory very poor (48, 38.4%) or poor (46, 36.8%). Similarly, 129 (80.6%) patients were unable to remember the 3 surgeon-related words. One hundred percent of patients strongly agreed (145, 90.6%) or agreed (15, 9.4%) the e-mail package enhanced their experience. In addition, 100% of patients strongly agreed (150, 93.8%) or agreed (10, 6.2%) the surgeon video enhanced their experience. The average e-mail shares per patient was 2.5, with 158 (98.7%) of patients sharing the e-mail at least once. This study shows that patients had poor memory of in-person conversations on the day of surgery. However, patients were satisfied with a postoperative multimedia package provided via e-mail after surgery. Patients interacted with the e-mail primarily on their cell phones, liked the surgeon video, and shared the e-mail with others. Level IV, therapeutic case series.

Use of an educational video with mobile technology for the informed consent process: A randomised controlled trial on patients undergoing surgery for an impacted lower third molar

The purpose of this study was to determine whether audiovisual presentation of consent information would significantly improve patients’ postoperative recall of risks and complications regarding surgical removal of impacted lower third molars compared to the presentation of traditional written consent information. A randomised controlled study on 59 patients undergoing third molar removal was conducted. Patients in the intervention group (n = 30) viewed an educational video on risks and complications related to surgery using mobile tablets. Control-group patients (n = 29) received written information of the risks and complications. Patients’ postoperative recall of potential risks for dysesthesia of the lower lip and tongue, infection, and bleeding along with surgical complications of facial oedema, trismus, and pain were assessed using true-false tests. The effect of audiovisual information on postoperative recall of the risks and complications was determined by comparing accuracy scores between the intervention group and control group using the independent t-test. The intervention group was found to have significantly better recall scores of the potential risks and complications, due to much higher accuracy in their recall of bleeding and dysesthesia of the lower lip and/or tongue, compared to the control group [mean (SD) 4.70 (0.94) vs 3.76 (1.50), p = 0.003]. The use of an educational video played on mobile tablets rather than a written pamphlet may lead to better understanding of the informed consent process in patients.

A randomized controlled trial of patient recall after detailed written consent versus standard verbal consent in adults with routine orthopaedic trauma.

Patient decision aids have previously demonstrated an improvement in the quality of the informed consent process. This study assessed the effectiveness of detailed written patient information, compared to standard verbal consent, in improving postoperative recall in adult orthopaedic trauma patients. This randomized controlled feasibility trial was conducted at two teaching hospitals within the South Eastern Sydney Local Health District. Adult patients (age ≥ 18 years) pending orthopaedic trauma surgery between March 2021 and September 2021 were recruited and randomized to detailed or standard methods of informed consent using a random sequence concealed in sealed, opaque envelopes. The detailed group received procedure-specific written information in addition to the standard verbal consent. The primary outcome was total recall, using a seven-point interview-administered recall questionnaire at 72 hours postoperatively. Points were awarded if the participant correctly recalled details of potential complications (maximum three points), implants used (maximum three points), and postoperative instructions (maximum one point). Secondary outcomes included the anxiety subscale of the Hospital and Anxiety Depression Scale (HADS-A) and visual analogue scale (VAS) for pain collected at 24 hours preoperatively and 72 hours postoperatively. Additionally, the Patient Satisfaction Questionnaire Short Form (PSQ-18) measured satisfaction at 72 hours postoperatively. A total of 60 patients were randomized, 32 to the standard group and 28 to the detailed group. Patients in the detailed group had significantly higher total recall score compared to the standard group (mean difference 1.29 points (95% confidence interval (CI) 0.51 to 2.08); p = 0.002). There were no differences in HADS-A (mean difference 0.39 (95% CI -2.11 to 2.88); p = 0.757), VAS pain (mean difference 5.71 (95% CI -22.25 to 11.11); p = 0.499), or PSQ-18 (mean difference 0.499; 95% CI -1.6 to 3.42; p = 0.392). Detailed written tools are useful in improving postoperative recall in adult orthopaedic trauma patients.

Recovery time in target controlled infusion versus manual infusion of propofol in total intravenous anaesthesia for endoscopic retrograde cholangio-pancreatography procedure using laryngeal mask airway-gastro: A randomised comparative study.

This study aimed to compare manual infusion versus target-controlled infusion (TCI) in total intravenous anaesthesia (TIVA) utilising laryngeal mask airway (LMA)-gastro during endoscopic retrograde cholangio-pancreatography (ERCP) procedures. This was a single-blind randomised trial. Patients were randomly allocated into two groups. TCI group included 27 patients, where TCI of propofol was implemented with the Schnider pharmacokinetic model driven by a computer-controlled syringe pump. The TIVA group included 27 patients with a loading dose of 2 mg/kg of propofol, followed by manual infusion of 15 mg/kg/h for the first 15 min, 13 mg/kg/h for the next 15 min, then 11 mg/kg/h for 30 min and 10 mg/kg/h for 60 min and finally maintained at 9 mg/kg/h. The primary objective was to compare recovery time following cessation of propofol infusion in both groups. The difference in the total dose of propofol, time to achieve anaesthesia induction, first attempt success rate, ease of LMA-gastro insertion, ease of insertion, success rate of endoscope device and post-anaesthesia care unit (PACU) discharge time were the secondary objectives. T-test and Chi-square test were used for statistical analysis. The time required for the recovery was significantly less in the TCI group than in the TIVA group (mean ± standard deviation; 11.60 ± 2.27 versus 15.4 ± 3.25 minutes, P < 0.001). The duration of ERCP, ease of LMA and endoscope insertion were comparable between the groups. There was no post-operative recall of intra-operative events in the groups. TCI offers earlier recovery than TIVA in patients undergoing ERCP procedures using LMA-gastro.

Bispectral index: the current tool for monitoring unintended awareness and depth of anesthesia

BackgroundAwareness under general anesthesia is an unpleasant phenomenon that usually goes unnoticed and neglected. Numerous incidences of intraoperative awareness are not reported. Reasons for awareness might be the inadequate depth of anesthesia, less effective drugs, lack of proper anesthesia monitoring equipment, and untrained medical staff.The purpose of this study is to evaluate intraoperative awareness during general anesthesia and titrate the amount of anesthetic agents according to BIS values among patients and monitor hemodynamic parameters throughout the surgery.ResultsThe intraoperative awareness reported was 2% in the BIS group and 8% in the non-BIS group. The total propofol consumption in the BIS group was significantly less as compared to the non-BIS group (P value<0.0001).ConclusionsThe incidence of definite awareness with postoperative recall and propofol consumption was reduced in the BIS group as compared to the non-BIS group.

Gabapentin as an adjunct for pain management during dilation and evacuation: A double-blind randomized controlled trial

ObjectivesTo assess the analgesic efficacy of preoperative gabapentin among patients undergoing dilation and evacuation (D&E) with moderate sedation. Study designWe conducted a randomized, controlled, double-blind trial among patients undergoing same-day D&E at 14 to 19 weeks gestation under moderate sedation. We randomized participants 1:1 to gabapentin 600 mg or placebo after cervical preparation at least 1 hour prior to D&E. We assessed pain using a 100-mm visual analog scale before, during, and after the procedure. The primary outcome was postoperative recall of maximum procedural pain with a 13-mm a priori threshold for clinical significance. We standardized initial fentanyl and midazolam dosing. We assessed satisfaction with pain control, nausea, and vomiting via Likert scales and anxiety using a validated instrument. ResultsWe enrolled 126 participants and randomized 61 to gabapentin and 65 to placebo, with study medication administered a mean of 211 (SD 64) minutes preoperatively. Recall of maximum pain was 41 mm for gabapentin and 49 mm for placebo (p = 0.24). Gabapentin resulted in reduced pain during uterine aspiration (56 vs 71 mm, p= 0.003) compared to placebo, but not for any other time points. The gabapentin group had higher satisfaction (78% vs 65% very or somewhat satisfied, p= 0.01). Median fentanyl dose was lower in the gabapentin group (75 vs 100 mcg, p = 0.005). Midazolam dose, nausea, vomiting, and anxiety did not differ between groups. No serious adverse events occurred in the gabapentin group. Sedation reversal was not required. ConclusionsThe addition of gabapentin to moderate sedation during D&E did not result in lower maximum recalled procedural pain. Gabapentin resulted in reduced intra-operative pain during uterine aspiration and increased satisfaction with pain control. ImplicationsGabapentin reduces intraoperative pain and improves satisfaction with pain management when administered prior to second-trimester surgical abortion and may be considered as an adjunct to intravenous sedation. Moderate sedation may impair assessment and recall of pain. Additional research is needed to identify the most effective pain management regimens for D&E.

Comparative Study of Pain on Injection of Propofol MCT-LCT with Propofol Nanoemulsion for General Anaesthesia

Introduction: Pain during injection of propofol continues to be a major discomfort for patients. Different propofol formulations have been introduced to reduce the incidence of pain.&#x0D; Aims: To know the incidence, severity of pain at induction and post operative amnesic effect of two different formulations of propofol.&#x0D; Methods: This double-blinded comparative study involved randomly selected 100 patients undergoing elective surgery under general anesthesia with physical status score I or II (American Society of Anesthesiologists). Out of 100 patients, 50 received medium and long chain triglyceride Propofol (Group A) while another 50 received nanoemulsion Propofol (Group B) intravenously. Parameters measured and compared were the gender, age, weight, physical status score, pain on injection and postoperative recall of pain during injection of propofol.&#x0D; Results: Both groups were comparable with regards to age, gender, physical status score, mean duration of surgery. The presence of pain during injection with propofol in group A was 76% (38 patients) while 36% (18 patients) in group B which was statistically significant (p =0.0001). Severity of pain was more in group A which was statistically significant in comparison to group B (p=0.0001). The arm withdrawal during the injection of propofol was found more in Group A than Group B, 24% vs 0% (p=0.0002). Recall of pain after 4 hours postoperatively was found in 5 patients of Group A (10%) and 3 patients of Group B (6%) which came out to be statistically insignificant (p=0.715). There was no significant difference between groups regarding heart rate, mean arterial pressure, respiratory rate and arterial hemoglobin oxygenation at all assessed times (p &gt; 0.05) intraoperatively.&#x0D; Conclusion: This study clearly shows the incidence and severity of pain on intravenous administration in nanoemulsion Propofol is significantly less. However, amnestic effect was equally present in both the groups.

Anesthetic Stability of Propofol, Dexmedetomidine, and Isoflurane by Measuring Bispectral Index (BIS) and Hemodynamic Indices: A Comparative Study

BackgroundHemodynamic changes and anesthetic awareness occurring during surgery under general anesthesia is a great concern for both surgeon and anesthesiologist. Maintenance of the adequate depth of anesthesia throughout the intraoperative period is important in maintaining hemodynamic stability, preventing intraoperative awareness, and avoiding postoperative recall.AimThis study aims to predict the anesthetic stability of propofol, dexmedetomidine, and isoflurane by measuring bispectral index (BIS) and hemodynamic indices.Materials and methodsThis is a prospective comparative study. Sixty patients of either sex, aged 18-60 years, with American Society of Anesthesiologist (ASA) physical status classification I and II, undergoing elective surgical procedures requiring general anesthesia were allocated into three groups of 20 each. Patients in each group were administered standard general anesthesia with routine hemodynamic monitoring along with BIS, and values were recorded at baseline and thereafter at every five-minute interval for the duration of surgery. Anesthesia was maintained in Group P using a bolus dose of propofol 1 milligram.kg-1 for 10 minutes followed by propofol infusion 50-75 microgram.kg-1.minute-1, Group D with a bolus dose of dexmedetomidine 1 microgram.kg-1 for 10 minutes followed by infusion 0.2-0.7 microgram.kg-1.hour-1, and Group I with isoflurane at 1 minimum alveolar concentration (MAC) for 10 minutes and then maintained between 0.5 MAC and 1.5 MAC until the duration of surgery. To maintain the surgical plane of anesthesia, the BIS score was monitored between 40 and 65. The quantitative variables were expressed as mean±SD and compared between groups using Student’s unpaired t-test. Data analysis was done using SPSS Statistics for Windows version 20.0 (IBM Corp., Armonk, NY, USA). A p-value of <0.05 was considered statistically significant.ResultsDuring intergroup comparison among study drugs, the mean BIS values were statistically significant among the groups (p<0.05). Hemodynamic indices were significantly better maintained in the dexmedetomidine group as compared to the isoflurane and propofol groups throughout the intraoperative period (p<0.05).ConclusionDexmedetomidine is better than propofol and isoflurane in maintaining the BIS score and hemodynamic parameters during the intraoperative period.

A comparative randomized study of awareness during two anesthetic induction techniques in old aged patients using isolated forearm technique

Background &amp; Objective: Awareness under anesthesia is defined as intraoperative consciousness and/or postoperative recall of surgical events. The isolated forearm technique (IFT) is a technique that has the ability to assess consciousness of the external world through a verbal command during general anesthesia. It provides live information about the presence of consciousness.&#x0D; We compared inhalational induction technique versus intravenous induction technique regarding awareness during laryngoscopy and intubation in elderly patients.&#x0D; Design: A prospective, randomized trial&#x0D; Methodology: A total of 50 patients scheduled for elective surgery under general anesthesia; aged 60 to 80 years were recruited. Patients were randomized into either Group A (inhalational induction group) or Group B (total intravenous induction group). Awareness reaction using IFT technique was observed during laryngoscopy and intubation phase to identify awareness incidence. A patient was considered a responder if IFT score &gt; 2.&#x0D; Results: At laryngoscopy and intubation phase, 32% of cases had an awareness reaction in intravenous induction group (Group B): While in the inhalational induction group (Group A), only 8% of cases had an awareness reaction. Additionally, none of the patients, suffered from postoperative explicit recall as detected by modified Brice questionnaire (MBQ).&#x0D; Conclusions: On the basis of the results of our study, we conclude that intravenous induction of general anesthesia may subject old aged patients to a higher incidence of awareness when compared to inhalational induction technique.&#x0D; Trial Registration: NCT05019560&#x0D; Abbreviations: TIVA - Total intravenous anesthesia; IFT - Isolated forearm technique; MBQ - Modified Brice questionnaire; BISTM -Bispectral Index™; ETAC - End-tidal anesthetic concentration; MAC – Minimum alveolar concentration&#x0D; Key words: Awareness; The modified Brice questionnaire; Elderly patients; Isolated forearm technique; Sevoflurane; TIVA&#x0D; Citation: Ibrahim TH, Ayoub AH, Ibrahim IM, Ismaiel MAA, Mostafa RH. A comparative randomized study of awareness during two anesthetic induction techniques in old aged patients using isolated forearm technique. Anaesth. pain intensive care 2022;26(1):81-88.&#x0D; DOI: 10.35975/apic.v26i1.1772&#x0D; Received: November 14, 2021, Reviewed: December 18, 2021, Accepted: December 22, 2021

Ankyloglossia and its management: A case series

Ankyloglossia or tongue-tie is the result of a short and thick lingual frenulum that causes limited tongue movement. Eventually, it may lead to a series of problems such as difficulties in breastfeeding during infancy, abnormal swallowing pattern, speech impairment, malocclusion, and gingival recession. In this case series, three adult patients with ankyloglossia were treated by performing lingual frenectomy using a scalpel under local anesthesia without any complications. This was followed by post-operative recall and speech therapy sessions. A marked improvement in tongue movement and speech was observed at follow-up visits in all the treated cases.

Accuracy of postoperative recall by degenerative cervical myelopathy patients using the modified Japanese Orthopaedic Association scale

To date, the accuracy of postoperative recall by DCM patients of their pre-operative neurological function, as assessed by the mJOA scale, has not been examined. This study therefore aimed to evaluate recall accuracy in DCM patients using the mJOA scale. Read more at JCTRes.com

Successful Pulp-Preserving Treatment for Peri-invagination Periodontitis of Double Dens Invaginatus With Oehlers Type IIIA and IIIB: A Case Report

Dens invaginatus (DI), which often occurs in the maxillary lateral incisor, is an important issue in endodontics because the treatment complexity increases depending on the degree of invagination and the vitality or nonvitality of the pulp. An 11-year-old female patient with a sinus tract in the gingiva of the maxillary lateral incisors showed peri-invagination periodontitis and double DI on radiography. Cone-beam computed tomographic imaging was used to examine the structure in the root canal in detail, and Oehlers type IIIA and IIIB DI was found. It was also shown that the patient’s bone defect was caused by type IIIA. Because a healthy reaction was observed in the pulp test, the final diagnosis was peri-invagination periodontitis associated with type IIIA of the double DI with vital pulp. We expected the lesion to heal by treating only the type IIIA invaginated pseudo–root canal while preserving the healthy pulp. The invaginated root canal was cleaned under a microscope using ultrasonic instruments and nickel-titanium files to minimize irritation to the pulp. Because the lesion shrinkage was confirmed by cone-beam computed tomographic imaging taken 3 months after the start of treatment, vertical compaction of the warm gutta-percha technique was performed. At the 6-month postoperative recall, the pulp was normal, and the lesions were further improved. Treatment of the main root canal of double DI is complicated. However, proper diagnosis and careful cleaning of the invaginated root canal are essential for healing while preserving the pulp.

The effectiveness of handout assisted versus verbal consent on post-operative recall and understanding - A randomized control study

BackgroundConsent is an important component of surgical care. Poorly attempted consent bears significant ethical and legal implications. We assessed the effectiveness of handouts in improving postoperative consent understanding and recall compared to standard verbal consent during laparoscopic cholecystectomy as a tool that may improve information retention and leads to better treatment satisfaction. MethodsThis is a prospective block randomized, non-blinded study conducted at a single tertiary hospital. Patients undergoing elective laparoscopic cholecystectomy between August 2017 and October 2018 were recruited and randomized into Handout Assisted Consent (HC) and Verbal Consent (VC) group. The HC group was given an adjunct handout on laparoscopic cholecystectomy during consent process in addition to the standard verbal consent. A validated open-ended verbal understanding and recall questionnaire was administered to all patients in both groups at Day 1, 30 and 90 after surgery. Patient satisfaction of the consent process was evaluated with Likert scale. ResultsA total of 79 patients were enrolled, 41 patients and 38 patients in VC and HC groups respectively. Level of understanding among patients were equal and consistent across time in both groups (P > 0.05). There was significant decline (P < 0.0001) for both groups in ability to recall information between Day 1 to Day 30 and Day 30 to Day 90. A slightly higher satisfaction rate was found among patients that received HC (P > 0.05). ConclusionThere is good consistent understanding of the surgery in both groups. However, recall of specific surgical consent items decreased significantly over time in both groups. Handouts may have increased satisfaction among patients but did not improve recall in this preliminary study. Trial registrationMREC No.:201783–5468.

The Study of Postoperative Recall in Patients under Total Intravenous Anesthesia

Background:The incidence of postoperative recall under total intravenous anesthesia (TIVA) is not yet fully established. Avoidance of inhalational agent is a known risk factor for awareness. In addition, lack of reliable technique to monitor drug concentration needed for adequate depth of anesthesia makes TIVA challenging. Hence, we intend to evaluate our standard anesthesia practice for postoperative recall.Methodology:This questionnaire-based observational study was done over the period of 2 years. We enrolled 1080 adult (American Society of Anesthesiologists physical status Class I or II) patients undergoing TIVA for Endoscopic retrograde cholangiopancreatography (ERCP). All patients received fentanyl, midazolam and propofol-based anesthesia. Manual boluses of propofol were given to achieve adequate sedation. (Ramsay sedation scale of 5) in accordance with clinical signs as judged by the primary anesthesiologist. Postoperatively within 12–24 h, patients were assessed for recall using Brice questionnaire. Primary outcome was number of patients reporting postoperative recall in the Brice interview. Secondary outcome was the incidence of dreaming.Results:On postoperative interview, none of the patients reported awareness. 12.5% of patients had dreams which were pleasant. None of the dreams was unpleasant. The worst thing about surgery was pain.Conclusion:Our study suggests that if adequate doses of propofol are adhered to and necessary action is taken against responses indicating wakefulness, postoperative recall under TIVA is an uncommon occurrence.

Management of ankyloglossia using electrosurgery: A case series

Ankyloglossia, or tongue tie, is a congenital oral anomaly with short, tight and thick lingual frenum which may restrict mobility of tongue and may subsequently lead to a range of problems such as difficulties in breast feeding during infancy, difficulty in mastication, speech impairment, poor oral hygiene, malocclusion, behaviour problems during childhood, adolescence and even adulthood. In this case series, four adult patients with ankyloglossia were treated by performing lingual frenectomy using electrosurgery followed by post-operative recall and speech therapy. A marked improvement in tongue movement and speech was observed at follow-up visits in all the treated cases. Electrosurgery proved to be a safe, reliable, effective and patient-friendly alternative treatment option for ankyloglossia.

Evaluation of Efficacy of Free Opioid Anesthesia for Laparoscopic Cholecystectomy: A Prospective, Randomized Double-blinded Study

Objectives: To evaluate efficacy and side effects of free opioid anesthesia for laparoscopic cholecystectomy. Methods: A prospective study was performed on 94 patients undergoing laparoscopic cholecystectomy in Military Hospital 103 from May 2018 to February 2019. These patients were randomly allocated into two groups: patients in FOA (free - opioid anesthesia) group were administered lidocaine (2 mg/kg before induction and 1.5 mg/kg/h for maintenance), magnesium (30 mg/kg before induction and 1.5 g infusion for maintenance) combined with Intravenous (IV) injection of ketamine (0.5 mg/kg), and ketorolac (30 mg); while patients in OA group (opioid anesthesia) were provided with IV fentanyl (5 mcg/kg for induction and 1.5 mcg/kg every 30 minutes for maintenance of anesthesia). Both groups received total intravenous anesthesia by propofol. The depth of anesthesia was monitored by the entropy module during surgery. Neuromuscular blockade was reversed by sugammadex 2 mg/kg at the end of surgery. The postoperative analgesia was delivered using IV fentanyl for 48 to 72 hours. Visual Analog Scale (VAS) score was measured 10 mins, 20 mins, 1 hour, 2 hours and 3 hours after surgery. Results: All patients had an excellent quality of anesthesia with RE (Respond Entropy), SE (State Entropy) always under 60 from induction to abdominal closure without intraoperative awareness and postoperative recall of the operation; 100% of the patients were extubated immediately after surgery. In the first three postoperative hours fentanyl consumption in Group FOA was significantly lower than in Group OA (31.91 ± 3.98 mcg versus 34.47 ± 7.17 mcg, p=0,035). In the OA group, the rate of intraoperative hypotension was higher compared to its counterpart. Despite the higher risk of hypersalivation, group FOA had a significantly lower incidence of nausea and vomiting. Conclusion: Free opioid anesthesia provided adequate sedation and amnesia and may be an alternative approach to opioid anesthesia for laparoscopic cholecystectomy. Patients under free opioid anesthesia experienced a lower incidence of intraoperative hypotension, lower rate of nausea, vomiting and lower demand for analgesia in the early postoperative period (0 - 3 h) compared to those receiving opioid anesthesia.

ART with high viscosity GIC and composite restorations in class II cavities: can they thrive in the post-amalgam era?

Design This study is a parallel group randomised un-blinded trial with equal allocation to evaluate and compare the success of ART with HVGIC and composite restorations in class II cavities in permanent molars. Study population The study populations included 154 participants who were selected from 17 different schools of Bauru and adjoining areas in Sao Paulo, Brazil. Children with good general and oral health and having 1 or 2 class II cavities were chosen. Only one restoration per child which exhibited good occlusal contact was finally chosen for the purpose of study. The participants were then stratified as per DMFT-score and cavity size. After stratifying the participants in four conglomerates, they were randomly allocated to either ART with HVGIC or composite restoration group. Later, the participants were recalled at 6 and 12 months and the restorations were evaluated using ART and modified-USPHS criteria. Data analysis Frequency statistics, which included chi square, chi square for trend and Fisher's exact test, were used for determining the association between restoration type and different baseline variables and for determining the association between distribution of scores obtained with ART and composite restorations for different evaluation criteria. Results With ART criteria, success rates of ART and composite restoration were found to be 98.7% and 100% at 6 months while at 12 months the success rates were observed to be 98.7% and 95.8%, respectively. The distribution of scores at both the time periods was found to be statistically significant (p = 0.033). Same success rates were observed when the restorations were evaluated using modified-USPHS criteria, with statistical difference at the 6 month post-operative recall (p = 0.001), and non-significant difference at the 12 month recall visit (p = 0.310). Survival rates of ART and composite restoration were observed to be 94.8% and 98.7% with no-significant difference in the survival curves (p = 0.173)Conclusions In class II cavities in permanent molars, ART restorations with high viscosity GIC, done in a school setting exhibited similar success rates as composite restoration done in a clinical setting.

The effects of chronic subthalamic stimulation on nonmotor symptoms in advanced Parkinson's disease, revealed by an online questionnaire program.

This study was designed to detect and assess the frequency and severity of nonmotor symptoms (NMSs) in advanced Parkinson's disease (PD) and to investigate the effects of subthalamic nucleus deep brain stimulation (STN-DBS) on NMSs. We developed an online PC-based questionnaire program to assess NMSs in PD. Twenty-six PD patients who underwent bilateral STN-DBS were assessed. The NMS questionnaire consisted of 54 NMSs in three categories, based on Witjas et al. (2002). For each NMS, the patients were asked whether or not it was present, whether or not the fluctuating manifestations correlated with the timing of levodopa-induced motor fluctuations, and how severe the NMS was. Patients were assessed by this system before surgery and at the follow-up visit, 3 to 6months after surgery. At the postoperative assessment, patients were also assessed on preoperative NMSs using recall. The most frequent preoperative NMSs were constipation and visual disorders, while the most frequent postoperative NMSs were difficulty in memorizing and pollakiuria. The ranking of most frequent NMSs changed from before to after surgery. NMSs of drenching sweats, dysphagia, and constipation were significantly ameliorated, while NMSs of dyspnea and slowness of thinking were significantly deteriorated after surgery. The preoperative assessment by postoperative recall gave very different results from that of the preoperative assessment. An online questionnaire system to assess NMSs in patients with advanced PD suggested that STN-DBS might influence the frequencies of some kinds of NMSs.

A novel patient-centered protocol to reduce hospital readmissions for dehydration after ileostomy.

Early hospital readmission for dehydration represents a relevant problem among patients with diverting or terminal ileostomy. The aim of the study was to evaluate the efficacy of a new multidisciplinary individualized multistep protocol in terms of reduction of hospital readmission for dehydration. Since January 2016, our institution adopted a new protocol for patients with ileostomy. Protocol key points were: preoperative personalized education in stoma management; early recognition of dehydration symptoms; multidisciplinary counseling; patient autonomy in stoma management through post-operative recall schedule. The study compared a series of consecutive patients treated before (2014-2015) and after (2016-2017) the protocol application. The primary endpoint was hospital readmission rate after protocol use. The secondary endpoint was the identification of possible risk factors for readmission. The entire cohort was composed of 296 patients, 129 in the protocol group and 167 in the control one. The two groups were homogeneous for baseline characteristics. Hospital readmission rate within 30days post-discharge for dehydration dropped from 9 to 3.9% after protocol application. Specifically, the number of avoided potential readmissions was 29/129 (22.4%). The number needed to treat (NNT) was 20. Univariate analysis identified three relevant variables: patient comorbidities, diuretics use as risk factors and protocol application as the protective one. The multivariate analysis confirmed patient comorbidity as the risk factor. Dehydration related to ileostomy is a potentially avoidable problem, by employing preventive strategies, especially in high-risk patients. Our new protocol could be a simple and cost-saving method, effective in preventing hospital readmissions.

Autotransplantation of Impacted Third Molar Using 3D Printing Technology: A Case Report

Here, we describe a case of autotransplantation of a mandibular horizontally impacted third molar using a 3-dimensional (3D) model based on limited cone-beam computed tomography (CBCT) images for diagnosis, 3D morphological evaluation, preoperative treatment planning, and surgical simulation. A 27-year-old woman visited this hospital for conservative treatment of the mandibular left second molar. Intraoral radiography and CBCT images revealed a C-shaped root canal in the mesial root, and compressive resorption of the distal root due to impingement of the crown of the horizontally impacted lower left third molar. Extraction was therefore planned. Multiple tooth-jaw bone 3D models for preoperative diagnosis were fabricated using a low-cost desktop 3D printer and surgical simulation of autotransplantation performed. The autotransplantation was then performed accordingly. Cone-beam computed tomography images and 3D models were extremely useful in obtaining a stereoscopic understanding of the morphology of the transplanted tooth and its surrounding anatomical structures. At the one-year postoperative recall, the patient was able chew with the transplanted tooth without pain, and no significant abnormalities were detected on intraoral radiographs, indicating a successful postoperative clinical course. Our experience of using 3D models fabricated based on CBCT images using a desktop 3D printer for preoperative diagnosis and surgical simulation suggests that this technique is useful in tooth autotransplantation.