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Background: In the UK, treatment with antipsychotic medications for children is usually initiated by specialists in secondary care. Recent studies have shown an increase in the prescribing of atypical antipsychotics in children. The severity of possible adverse effects to antipsychotics in adults has lead to awareness of the importance of investigating the potential adverse effects of these agents in children. Additionally, there have been many reports proposing that the newer atypical antipsychotics are associated with many of the same adverse effects seen with the older generation drugs in children. The aim of the Paediatric Atypical Antipsychotic Monitoring Safety (PAMS) study was to determine the feasibility of conducting a prospective targeted pharmacovigilance study to monitor adverse drug reactions (ADRs) associated with atypical antipsychotic therapy in children seen in secondary- and tertiary-care settings.Methods: Participants were identified from the clinical members of the UK Paediatric Psychopharmacology Groups in London and the West Midlands. Participating clinicians reported the number of patients (agedResults: A total of 35 clinicians consented to participate in the study. However, data from 22 of the participating clinicians were excluded because of incomplete reporting. Data from the remaining 13 (37%) clinicians were eligible for the final analysis. There were 281 patients who received atypical antipsychotic treatment under the care of the 13 participating clinicians. From these 281 patients, 40 ADR reports (0.14 ADR reports per patient; 95% CI 0.10, 0.19) from 37 patients were entered into the database. Of the 37 patients, 13 experienced more than one ADR, bringing the total number of ADRs to 56 (0.20 ADR per patient; 95% CI 0.15, 0.25). The most commonly reported ADRs were weight gain, extrapyramidal symptoms and hyperprolactinaemia. Rare ADRs, including neuroleptic malignant syndrome, were also reported. The durations of atypical antipsychotic drug exposure were recorded for 54 of the 56 ADRs reported. The median duration of exposure was 42 days (interquartile range 23.25-90 days).Conclusions: Our study demonstrates that a clinician-based targeted pharmacovigilance study on atypical antipsychotics in children provides useful qualitative data. However, this pilot study raised many methodological issues, which should be addressed for the study to be extended nationally. Specifically, significant funding is needed to improve the reporting rate and the overall data obtained. Furthermore, the study yielded a very high incidence of serious ADRs, thus supporting the need for a larger and improved pharmacovigilance study to evaluate the safety of atypical antipsychotics in children. [ABSTRACT FROM AUTHOR]

Background: The report herein details a prospective audit of a unit's eight-year experience of the Rossetti-Nissen fundoplication using a predominantly laparoscopic technique, selective hiatal repair, no bougie and a standardised protocol of pre- and post-operative functional endoscopic and symptom assessment.Methods: Three hundred and seventy-eight patients underwent the Rossetti-Nissen fundoplication. All patients had documented data on endoscopy, health related quality of life (HR-QoL), surgical details and complications pre-operatively and at six months post-operatively. Repeat physiological testing was performed at six months.Results: At a median follow-up of six (range 3-13) months there was improved symptom scoring and HR-QoL after fundoplication with an 89% patient satisfaction rate. Ninety-five patients (25%) reported some early dysphagia, and 91 of these reported the outcome of surgery to be excellent or good. Thirty-eight patients (10%) had recurrent heartburn and 28 (7%) were back on medication at six months post-operatively. At follow-up pH study at a median of six months, 89% of patients had normalised acid reflux scores.Conclusions: Rossetti-Nissen fundoplication, with no use of an oesophageal bougie and no division of short gastric vessels, is an effective procedure giving 89% patient satisfaction and significant improvement in QoL parameters and physiological measurements. [ABSTRACT FROM AUTHOR]

The responses of 86 preterm infants assessed on the Movement Assessment of Infants (MAI) at four months adjusted age were used to establish two preterm risk profiles according to gestational age at birth: < 32 weeks (n = 40) and 32 to 36 weeks (n = 46). The responses of 21 preterm infants were then scored on these risk profiles and the MAI risk profile. Scheffe multiple comparisons revealed that the majority of significant differences were between the < 32 week risk profile and the 32-36 week risk profile; the 32-36 week risk profile was more similar to the current risk profile. These results suggest the the MAI risk profile may be applicable to infants 32 to 36 weeks gestation but not to infants < 32 weeks gestation. [ABSTRACT FROM AUTHOR]

The article focuses on the use of rhombic flap for cheek reconstruction. It states that cheek reconstruction is a one-stage repair that can be performed with local anesthesia. A rhomboid flap reconstruction was performed on a 58-year-old man who had undergone wide local excision and sentinel lymph node mapping for a Clark level III melanoma.

Background: Treatment of Bell's palsy ranges from medical management with high-dose corticosteroids to complex facial reanimation procedures. Objective: To characterize the number of static, dynamic, and combined facial reanimation procedures for the management of Bell's palsy using a national database over time. Methods: This retrospective cohort study included patients in the 2013-2020 National Surgical Quality Improvement Project database with a postoperative diagnosis of Bell's palsy. Cases were categorized as involving only static, only dynamic, and a combination of static and dynamic procedures. Chi-square or Fisher's exact tests were performed for patient demographics, and linear regressions were created to evaluate utilization trends. Results: In total, 294 patients were identified. There was no significant difference in patient sex and comorbidities between these treatment groups. Of the 294 patients, 101 received both types of procedures, 107 received only dynamic procedures, and 86 received only static procedures. The trendlines for all treatment groups were significantly positive ( B = 1.27 for both, B = 0.89 for dynamic only, and B = 1.01 for static only). Conclusion: In this study of a national surgical database, an increase in static, dynamic, and combined treatments for patients with Bell's palsy was found.

Objectives: To characterize the effect of facial reanimation using masseteric nerve transfer on the masseter muscle itself, examining whether there is any demonstrable atrophy postoperatively., Methods: Electronic medical records of adult patients who underwent facial reanimation using masseteric nerve transfer at our institution over a 15-year period were reviewed. To account for the impact of postoperative radiation, randomly selected patients who underwent radical parotidectomy without nerve transfer and received postoperative radiation served as controls in a 1:1 fashion against those who underwent masseteric nerve transfer with postoperative radiation., Results: Twenty patients were identified who underwent masseteric nerve transfer and had sufficient pre- and postoperative imaging to assess masseter volume (mean age 58.2, 60% female). Of the four patients who did not receive postoperative radiation, each demonstrated masseteric atrophy on the side of their nerve transfer, with a mean reduction in masseter volume of 20.6%. The remaining 16 patients were included in the case-control analysis accounting for radiation. When compared with controls, those in the study group were found to have a statistically significant difference in atrophy (p = 0.0047) and total volume loss (p = 0.0002). The overall reduction in masseter volume in the study group was significantly higher compared with the control group, at 41.7% and 16.6%, respectively (p = 0.0001)., Conclusion: Facial reanimation utilizing masseteric nerve transfer appears to result in atrophy of the denervated masseter when compared with the contralateral muscle. This volume deficit may lead to further facial asymmetry for patients undergoing comprehensive reanimation surgery., Level of Evidence: 3 Laryngoscope, 134:4514-4520, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: This study aimed to compare acceleration and deceleration demands of intercounty Camogie players, and differences across playing positions and halves of play., Hypothesis: The middle 3 positions will have greatest accelerations and decelerations variables across match play and halves of play., Study Design: Nonrandomized, repeated measures design., Level of Evidence: Level 4., Methods: Global positioning systems (GPS) (10 Hz) collected data from 28 participants during 18 competitive matches across 2 seasons; 206 individual player datasets were analyzed., Results: Half-backs ( P < 0.05; effect size [ES], -1.75) and midfielders ( P < 0.05; ES, -1.68) covered significantly greater total number of accelerations than full-forwards. In acceleration zone 4, midfielders ( P < 0.05; ES, = -1.67) and half forwards covered a significantly greater number than full-forwards ( P < 0.01; ES, = -1.41). Midfielders accumulated a significantly greater distance in acceleration zone 4 than full-backs ( P < 0.05; ES, = -0.57). Significant decrements were observed between halves in total number of accelerations ( P < 0.01; ES, = 0.49), accelerations in zones 1 to 4 ( P < 0.01; ES, 0.16-0.43), total distance of accelerations, and acceleration distance in zones 2 to 4 ( P < 0.05; ES, 0.25; P < 0.01; ES, 0.45; P < 0.01; ES, 0.38). There were significant decrements in the total number of decelerations ( P < 0.01; ES, 0.43), number of decelerations in zones 2 ( P < 0.05; ES, 0.25), 3 ( P < 0.01; ES, 0.45), and 4 ( P < 0.01; ES, 0.38), and total deceleration distance ( P < 0.01; ES, 0.16)., Conclusion: Half-backs and midfielders covered significantly greater total number of accelerations than full-forwards. Significant decrements in several acceleration and deceleration variables were observed between halves., Clinical Relevance: Players competing in intercounty Camogie should receive progressive exposure to acceleration and deceleration-based movement demands to prepare players for intercounty Camogie match play., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

Objective: Mandibular osteoradionecrosis (MORN) is a morbid complication of head and neck radiation therapy. Recent advances in surgical and medical therapies underscore the need for a shift in traditional treatment paradigms and a disease grading system that can guide appropriate management., Data Sources: Pubmed/MEDLINE., Review Methods: We conducted a detailed review of publications related to MORN, specifically focusing on its staging and management techniques. Articles meeting inclusion criteria were synthesized into a final narrative review., Conclusion: There has been a paradigm shift away from hyperbaric oxygen therapy in the management of MORN. Growing evidence for the efficacy of pentoxifylline and tocopherol in early-stage disease and novel surgical techniques to manage moderate and late-stage disease warrant an updated staging stratification which is proposed., Implications for Practice: This review summarizes the clinical efficacy of established and novel therapeutic modalities currently available in treating MORN, emphasizing the significant advances achieved over the last decade. It introduces a contemporary staging and treatment algorithm which incorporates traditional, evidence-supported surgical and medical management with effective early intervention strategies., (© 2024 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: To estimate and adjust for rater effects in operating room surgical skills assessment performed using a structured rating scale for nasal septoplasty., Methods: We analyzed survey responses from attending surgeons (raters) who supervised residents and fellows (trainees) performing nasal septoplasty in a prospective cohort study. We fit a structural equation model with the rubric item scores regressed on a latent component of skill and then fit a second model including the rating surgeon as a random effect to model a rater-effects-adjusted latent surgical skill. We validated this model against conventional measures including the level of expertise and post-graduation year (PGY) commensurate with the trainee's performance, the actual PGY of the trainee, and whether the surgical goals were achieved., Results: Our dataset included 188 assessments by 7 raters and 41 trainees. The model with one latent construct for surgical skill and the rater as a random effect was the best. Rubric scores depended on how severe or lenient the rater was, sometimes almost as much as they depended on trainee skill. Rater-adjusted latent skill scores increased with attending-estimated skill levels and PGY of trainees, increased with the actual PGY, and appeared constant over different levels of achievement of surgical goals., Conclusion: Our work provides a method to obtain rater effect adjusted surgical skill assessments in the operating room using structured rating scales. Our method allows for the creation of standardized (i.e., rater-effects-adjusted) quantitative surgical skill benchmarks using national-level databases on trainee assessments., Level of Evidence: N/A Laryngoscope, 134:3548-3554, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)