What is the Quality of Information About Bariatric Surgery on the Internet?

Background  The purpose of this study was to evaluate the role of Internet on patients scheduled for bariatric procedures and the quality of information available on different websites. Methods  Between July 2003 to July 2005, patients undergoing bariatric surgical procedures completed a survey. Data were collected prospectively. One hundred valid surveys were returned. Independently, two bariatric surgeons evaluated available French and English websites using major search engines. Results  Forty-two of 100 patients (42%) sought information about bariatric surgery on the Internet. Seventy-four percent of these patients (n = 31/42) used search engines with 81% visiting less than ten websites. According to the patient’s evaluation, 58% of the websites visited did not provide technical details of any surgical bariatric procedures, and only 61% provided information regarding postoperative weight loss. Furthermore, 58% of websites did not provide information about the laparoscopic approach, and 54% did not give any information on potential postoperative complications. Bariatric surgeon’s evaluation was similar except for two differences: laparoscopic approach and postoperative weight loss information were discussed in 90% (p < 0.001) and 43% (p < 0.1) of visited websites, respectively. Conclusion  When the Internet was used to search for information about bariatric surgery, search engines were preferentially used but search duration was short. Available Internet websites can be considered as moderately reliable; however, 25% of visited websites contain misleading information. Comparison between patients and surgeons views showed that patients were effective in detecting misleading information.     

What do Patients Think About Minimally Invasive Total Hip Arthroplasty?

INTRODUCTION

The introduction of minimally invasive techniques for hip replacement into clinical practice has been driven by the perceived benefits of smaller incisions, shorter in-patient stays and faster rehabilitation. This may be at the cost of higher complication rates. The purpose of this study was to explore the opinions and priorities of patients in relation to these techniques.

PATIENTS AND METHODS

A cross-sectional survey was performed in an elective out-patient setting.

RESULTS

Of 44 patients approached, 36 agreed to participate. From most important to least important, patients rated the following items in order: ‘rate of complications’; ‘implant survival’; ‘length of rehabilitation’; ‘time in hospital’ and ‘length of scar’. Despite this, 21 of 35 (60%) responders stated they would accept the offer of minimally invasive techniques if made.

CONCLUSIONS

Patients appear to prioritise long-term outcomes and low complication rates over the shorter scars, reduced in-patient stay and reduced rehabilitation times potentially offered by minimally invasive hip arthroplasty. Despite this, the technique remains popular among patients.     

What is the Role of HbA1c in Diabetic Hemodialysis Patients?

The definition of a good glycemic control in patients with diabetes mellitus on hemodialysis is far from settled. In the general population, hemoglobin A1c is highly correlated with the average glycemia of the last 8–12 weeks. However, in hemodialysis patients, the correlation of hbA1c with glycemia is weaker as it also reflects changes in hemoglobin characteristics and red blood cells half‐life. As expected, studies show that the association between HbA1c and outcomes in these patients differ from the general population. Therefore, the value of HbA1c in the treatment of hemodialysis patients has been questioned. Guidelines are generally cautious in their recommendations about possible targets of HbA1c in this population. Indeed, the risk of not treating hyperglycemia should be weighed against the particularly high risk of precipitating hypoglycemia in dialysis patients. In this review, a critical analysis of the current role of HbA1c in the care of hemodialysis patients is presented.     

Application of Nail Polish During Topical Management of Onychomycosis: Are Data Available to Guide the Clinician About What to Tell Their Patients?

Topical antifungal management of toenail onychomycosis has been fraught with several therapeutic challenges including difficulty gaining access to the site of infection and the need for prolonged durations of therapy. In addition, there has been a marked lack of information on the impact of toenail polish application on drug penetration after application. This article reviews available data from studies evaluating the effect of nail polish on antifungal drag penetration using ex vivo laboratory models with cadaver fingernail plates with both tavaborole 5% solution and efinaconazole 10% solution. In addition, changes in nail polish appearance and color transfer to applicators are also discussed, with changes noted with topical efinaconazole. Importantly, there are no data on whether or not nail polish application alters the efficacy of these topical agents.Management of toenail onychomycosis (T-ON) continues to be a major therapeutic challenge, primarily related to the physical characteristics of the nail unit, the slow growth of the nail plate, the prolonged durations of treatment that are usually required to achieve clearance or marked improvement of infection, and the frequency of incomplete clearance and recurrence.1,2 Additionally, cure rates reported with standardized therapeutic regimens that are approved by the United States Food and Drug Administration (FDA) for dermatophyte T-ON show that although some cases are cleared or markedly improved at the usual 12-month study endpoint, many cases of onychomycosis persist despite the use of therapy as defined in the study protocols.3-6 Because it may take several weeks to at least a few months before visible improvement in T-ON occurs after initiation of therapy with an oral or topical agent, adherence with treatment is extremely important as patients may easily be discouraged if they do not perceive improvement relatively soon after starting treatment.The more recent availability of two new topical agents that are FDA approved for treatment of dermatophyte T-ON, tavaborole 5% solution and efinaconazole 10% solution, have provided additional therapeutic choices, especially in cases of mild-to-moderate severity. The pivotal clinical trials with these agents included once-daily application for 48 weeks without adjunctive nail plate debridement.4-8 Importantly, inclusion in the study mandated that subjects could not utilize other nail products including nail polish throughout the duration of the trial and were required to refrain from pedicures.7,8 Nail trimming was completed at the study sites by designated staff during visits according to the standards allowed within the FDA-approved study protocols. Therefore, there are no data based on clinical trials that provide adequate information about the efficacy of these agents when nail polish is used. Nevertheless, clinicians in “real world” practice encounter primarily female patients who wish to use nail polish to camouflage unsightly nail changes associated with T-ON. This scenario can impact dramatically on whether or not patients choose to proceed or comply with topical treatment.Although exclusions and restrictions are mandated in study protocols, in clinical practice clinicians see “all comers” with T-ON, which includes a wide range of ages, disease severities, comorbid conditions, and psychosocial considerations. Many women express a personal desire to camouflage the condition as best as possible in order to be able to wear open shoes or expose their feet in appropriate social situations. This paper reviews available data on application of nail polish in conjunction with topical application of either tavaborole 5% solution or efinaconazole 10% solution, assessing primarily penetration and permeation characteristics and qualitative appearance of polished nail plates. Application and testing methodologies are explained, primarily using in vitro and ex vivo models. It is important to recognize from the outset that data from clinical trials on efficacy of treatment of T-ON with either of these topical agents in subjects applying nail polish are not available. The data are presented to inform the clinician on what is reported to date to assist in clinical decision making and in educating patients as best as possible, especially those who are emphatic about wanting to use nail polish during treatment. Efficacy, tolerability, and safety of topical application of tavaborole 5% solution and efinaconazole 10% solution for treatment of T-ON are discussed elsewhere.5-8 This paper discusses data related to penetration of the nail unit with these two topical antifungal solutions with emphasis on application in the presence of nail polish, and the effects of application of either topical agent on the appearance of polished nails and/or removal of nail polish.     

Visualization versus Neuromonitoring of Recurrent Laryngeal Nerves during Thyroidectomy: What About the Costs?

Background  

The objective of the present study was to evaluate costs for thyroidectomy performed with the aid of intraoperative neural monitoring (IONM), which has gained widespread acceptance during thyroid surgery as an adjunct to the gold standard of visual nerve identification.     

What is the Quality of Online Resources About Pain Control After Total Knee Arthroplasty?

Background

With the growing opioid crisis in the United States, there has been a push to reduce the utilization of opioids in favor of multimodal analgesia options. The purpose of this study was to evaluate the quality of online resources that patients may use to learn about pain control after total knee arthroplasty (TKA).

What Becomes of Patients One Year after the Intragastric Balloon has been Removed?

Background:The BioEnterics Intragastric Balloon (BIB) is a saline-filled balloon recommended to remain in the gastric cavity for a maximum of 6 months. Is this short period sufficient to change patients' lifestyle and eating practices to maintain weight reduction after BIB removal? Methods: 100 patients who received a BIB were included in this prospective study and followed for 1 year after BIB removal. The post-implantation follow-up visits took place monthly, during which the patient was seen by the surgeon, dietitian, and if necessary, psychologist. Results: At BIB removal, mean weight loss for the group was 12.0 kg. Mean percent excess weight loss (%EWL) was 39.8%. 12 months after removal of the BIB, mean weight loss was 8.6 kg and mean %EWL was 26.8% for the group as a whole. Conclusions: The results 1 year after removal of the BIB were encouraging. Because the BIB is a temporary non-surgical and non-pharmaceutical treatment for obesity that is reversible and repeatable, we recommend it to patients who have previously failed traditional methods of weight reduction. Careful patient follow-up is of primary importance in avoiding complications and supporting efficacy of the treatment. Although 1 year follow-up cannot be considered long term, these results are encouraging. Concurrent behavior modification is needed for durable weight loss.     

What is the Proportion of Patients With Multiple Hereditary Exostoses Who Undergo Malignant Degeneration?

Background

Multiple hereditary exostoses is an autosomal-dominant skeletal disorder that has a wide-ranging reported risk of malignant degeneration to chondrosarcoma.

Questions/purposes

The aims of our study were to use a large, web-based survey approach to characterize (1) the demographic distribution of patients with multiple hereditary exostoses, (2) the number of surgeries performed related to one’s diagnosis of multiple hereditary exostoses, and (3) the proportion of survey respondents who described experiencing malignant degeneration in a large international, heterogeneous cohort of patients with multiple hereditary exostoses.

Methods

An anonymous web-based survey was distributed to several online support groups and social media networks designed to support and educate patients with multiple hereditary exostoses and their families. The survey collected demographic and epidemiologic data on 779 respondents. Data were recorded to assess respondents’ disease burden and the rate of malignant degeneration.

Results

Females represented a slightly greater proportion of those with multiple hereditary exostoses who responded (56% female; 419 of 742 patients). Median age for all respondents was 28 years (range, < 1–85 years). Median age for males was 25 years (range, < 1–85 years), while median age for females was 29 years (range, < 1–82 years). The mean age at diagnosis of male and female respondents was in the mid-first decade (5.4 years ± 7.2 years). The mean number of surgeries a patient had undergone was 7.3 (± 7.1 surgeries). The proportion of respondents who experienced malignant transformation was 2.7% (21 of 757 respondents), at a mean age of 28.6 years (± 9.3 years). The most common sites of malignant change from benign exostoses included the pelvis (eight of 21 respondents) and scapula (four of 21 respondents).

Conclusions

In the largest and most geographically diverse study of patients with multiple hereditary exostoses of which we are aware, we found the proportion of patients with multiple hereditary exostoses who have undergone malignant degeneration to be consistent with those reported in prior studies. Our study perhaps more accurately assessed the proportion of patients who undergo malignant transformation of multiple hereditary exostoses. As with prior studies on this topic, the proportion of malignant change may be expected to represent a high-end estimate as recruitment and selection bias likely predisposes for patients with more severe disease, whereas patients with lesser disease may be unaware of their diagnosis. In discussing the sequelae of multiple hereditary exostoses, clinicians perhaps might use this study to offer an unspecific statement of risk of malignant degeneration of multiple hereditary exostoses among the population at large.

Level of Evidence

Level IV, prognostic study.