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Skeletal advancement surgery with sagittal split ramus osteotomy (SSRO) or mandibular distraction osteogenesis (MDO) is effective in treating patients with obstructive sleep apnoea (OSA) and may improve their quality of life (QoL). This study aimed to evaluate the longitudinal QoL changes in moderate-to-severe OSA patients after skeletal advancement surgery. Eighteen patients were randomized to receive SSRO (n = 9) or MDO (n = 9) alone or as part of the skeletal advancement surgery. Baseline QoL was compared with that of a control group (n = 36). QoL was compared between the SSRO group and MDO group over a period of 2 years postoperative. The Epworth Sleepiness Scale (ESS), Calgary Sleep Apnea Quality of Life Index (SAQLI), Functional Outcomes of Sleep Questionnaire (FOSQ), and Short Form Health Survey (SF-36) were used as instruments. The OSA group had worse ESS, SF-36, FOSQ, and SAQLI preoperatively than the control group. The MDO and SSRO groups showed significant improvements in ESS at all postoperative time points (P ≤ 0.021). The FOSQ, SAQLI, and SF-36 of both groups at 2 years postoperative were similar to those of the control group. No differences in QoL were found between the SSRO and MDO groups. This study showed QoL was improved in patients with moderate-to-severe OSA after skeletal advancement surgery by SSRO or MDO. [ABSTRACT FROM AUTHOR]

The ideology underpinning Paediatric Early Warning systems (PEWs) is that earlier recognition of deteriorating in-patients would improve clinical outcomes. Objective: To explore how the introduction of PEWs at a tertiary children's hospital affects emergency admissions to the Paediatric Intensive Care Unit (PICU) and the impact on service delivery. To compare 'in-house' emergency admissions to PICU with 'external' admissions transferred from District General Hospitals (without PEWs). Method: A before-and-after observational study August 2005--July 2006 (pre), August 2006--July 2007 (post) implementation of PEWs at the tertiary children's hospital. Results: The median Paediatric Index of Mortality (PIM2) reduced; 0.44 vs 0.60 (p < 0.001). Fewer admissions required invasive ventilation 62.7% vs 75.2% (p = 0.015) for a shorter median duration; four to two days. The median length of PICU stay reduced; five to three days (p = 0.002). There was a non-significant reduction in mortality (p = 0.47). There was no comparable improvement in outcome seen in external emergency admissions to PICU. A 39% reduction in emergency admission total beds days reduced cancellation of major elective surgical cases and refusal of external PICU referrals. Conclusions: Following introduction of PEWs at a tertiary children's hospital PIM2 was reduced, patients required less PICU interventions and had a shorter length of stay. PICU service delivery improved. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to examine the effect of dentofacial deformity on quality of life (QOL) as assessed by generic health, generic oral health and condition-specific approaches. A case-control study was performed involving 154 subjects: 76 with dentofacial deformity (non-cleft) and 76 without dentofacial deformity. Generic health-related QOL was assessed employing the 36-item Short Form Health Survey (SF-36), generic oral health-related QOL was assessed by the 14-item short form Oral Health Impact Profile (OHIP-14) and condition-specific QOL was assessed by the 22-item Orthognathic Quality of Life Questionnaire (OQLQ). No significant difference in SF-36 scores between case and control groups was observed (P >0.05). There were significant differences in overall OHIP-14 scores (P <0.001) and overall OQLQ scores (P <0.001) between case and control groups. The results suggest that dentofacial deformity affects individuals in many aspects of their lives, and that generic oral health and condition-specific approaches to assessing QOL are able to discriminate patients with dentofacial deformities from those without, and thus have value in determining the impact of dentofacial deformities on QOL. [Copyright &y& Elsevier]

Summary: Objectives: To assess the sensitivity and responsiveness of an oral health related quality of life measure to tooth whitening. Methods: Following screening at a clinic, 87 subjects were given an array of tooth whitening products to use at home and reviewed 8 weeks later. Subjects self-completed the 49-item Oral Health Impact Profile (OHIP) at baseline and follow-up, and rated their satisfaction with the whiteness of their teeth compared to baseline on a global transition scale. Results: In terms of sensitivity, observed changes were apparent in overall OHIP scores (P&#60;0.05) and across several domains, notably functional limitation (P&#60;0.01). However, the magnitude of change (effect size) was generally small except for the functional domain. There was an observed gradient in observed change in OHIP scores and in the magnitude of such changes (effect sizes) in relation to global rating of satisfaction with the outcome, supporting the responsiveness of the measure. Conclusion: The OHIP scale is sensitive and responsive to the effects of tooth whitening. Greatest sensitivity and responsiveness was in relation to functional limitations. These findings have implications for the use of oral health related quality of life measures as an outcome measure of interventions aimed at improving dental aesthetics through tooth whitening. [Copyright &y& Elsevier]

Million views YouTube is after all not nice - a qualitative study of mandibular third molars on YouTube. [Extracted from the article]

The cancer burden among Circumpolar Inuit is high. Palliative radiotherapy is a mainstay treatment for controlling symptoms of advanced cancers, but Inuit are required to travel far distances to access this service. Access to palliative radiotherapy and time away from home communities have not been explored among this population. We sought to describe the time intervals from symptom onset to the start of palliative radiotherapy among Canadian Inuit patients treated at The Ottawa Hospital (TOH). A retrospective review of Inuit patients from Nunavut treated with radiotherapy between 2005 and 2014 at TOH. Of a total of 152 radiotherapy patients, 88 (58%) were treated palliatively. Of these, 61 (70%) had stage IV disease at diagnosis and 63 (72%) had lung cancer. The median time from referral for specialist care to the patient's first flight to Ottawa was 4 days (range 0–97). The median length of treatment was 7 days (range 0–27), but patients spent a median of 64.5 days (range 14–633) in Ottawa. The median survival from the date of pathological diagnosis was 5.2 months. Most Inuit radiotherapy patients at TOH were treated palliatively. Patients were brought from Nunavut relatively quickly for specialist care, which is encouraging. However, patients spent over 2 months away from home, in the context of a median survival of less than 6 months. Opportunities for improvement include both provider and system-level changes, which may be applicable to other Circumpolar Inuit regions across Europe and North America. • Nearly 60% of Inuit radiotherapy patients from Nunavut were treated palliatively. • A high proportion had stage IV disease at diagnosis (70%) and lung cancer (72%). • Median time from referral for work-up to flight to referral hospital was 4 days. • Patients spent a median of 64.5 days away from home for work-up and treatment. • Survival was poor, with a median survival of 5.2 months from date of biopsy. [ABSTRACT FROM AUTHOR]

We aimed to develop a process for same-day contouring, planning, quality assurance and delivery of volumetric modulated arc therapy (VMAT) for vertebral bone metastases within our institution's rapid-access palliative radiotherapy programme. Two thoracic (T6–7, T3–7) and two lumbar (L2–3, L1–5) targets were contoured on computed tomography images acquired from an anthropomorphic phantom and five patient scans. Inverse planning aimed to provide coverage of a prescribed dose of 8 Gy with a combined lung V2Gy < 25% and a combined kidney mean dose <2 Gy. Serial plans were created to identify an efficient combination of six main planning variables specific to our treatment planning system: (i) voxel size (3 mm versus 5 mm), (ii) Monte Carlo statistical uncertainty (1% per calculation versus 3% per control point), (iii) fluence smoothing (medium versus high), (iv) number of iterations of segment shape changes during optimisation (1 versus 5), (v) dose calculation algorithm (Monte Carlo versus pencil beam) and (vi) number of arcs (single versus multiple). Contouring, planning, quality assurance and treatment delivery were timed. The combination of planning variables deemed efficient and appropriate was: a 3 mm voxel size, statistical uncertainty of 1% per calculation, medium fluence smoothing, five iterations of segment shape changes, Monte Carlo dose calculation and single full arc delivery. Patient scan contouring times ranged from 7 to 9 min (T6–7), 11–13 min (T3–7), 5–7 min (L2–3) and 8–10 min (L1–5) and planning times ranged from 9 to 15 min (T6–7), 13–25 min (T3–7), 18–25 min (L2–3) and 21–31 min (L1–5). Physics quality assurance times ranged from 15 to 21 min and beam-on times ranged from 3 to 6 min. The combined elements of VMAT for thoracic and lumbar vertebral bone metastases were completed in under 2 h. This new process makes same-day contouring, planning, quality assurance and treatment delivery of VMAT feasible within our rapid-access palliative radiotherapy programme. • We studied volumetric modulated arc therapy (VMAT) for vertebral metastases. • VMAT is difficult to plan and deliver in same-day rapid access palliative programmes. • Our process enables same-day contouring, planning, quality assurance and delivery. • All components were completed in less than 2 h. • Same-day VMAT for vertebral metastases appears feasible in our rapid-access programme. [ABSTRACT FROM AUTHOR]