RESUMEN
The aim of this paper is to report the clinical characteristic of those patients reporting "I have too much saliva" following treatment for head and neck cancer. As a new addition to the saliva question of the University of Washington quality of life questionnaire (UW-QoL), another aim is to make recommendations on how this new option should be scored and handled. Patients treated with curative intent were recruited between April 2017 and October 2019. Assessment was at the first baseline clinic a median (IQR) of 194 (125-249) days after diagnosis and 103 (71-162) days after the end of treatment. Patients completed the modified UW-QoL version 4, the Patient Concerns Inventory (PCI), Distress Thermometer, and the EQ-5D-5L. In 288 patients, saliva was of normal consistency for 80 (28%), less than normal but enough for 57 (20%), too little for 91 (32%), too much for 45 (16%), and there was no saliva at all for 15 (5%). Of patients with too much saliva, two-thirds (31/45, 69%) had tumours located in the oral cavity and 18/40 (45%) had the highest rates of free flap use during surgery. Salivation response was associated strongly with the other measures of health-related quality of life (HRQoL) and the PCI. Of those with too much saliva their results were similar to or worse than those with too little or no saliva at all. In conclusion, having too much saliva is relatively less frequently reported but is an important HRQoL consideration. Its scoring in the UW-QoL should be at a level similar to that of too little saliva.
Asunto(s)
Neoplasias de Cabeza y Cuello , Calidad de Vida , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Saliva , Salivación , Encuestas y CuestionariosRESUMEN
Surgical tracheostomies have a role in the weaning process of COVID-19 patients treated in intensive care units. A multidisciplinary team approach (MDT) is required for decision making. This process is augmented by specific standard operating practices implemented by senior clinicians. Here, we report on our early experience and outcomes with open tracheostomies in a cohort of COVID-19 patients. We outline the criteria that guide decision making and explore the challenges faced by our intensive care colleagues in the management of these patients. The cohort was 100% male with 90% of them having a raised Body Mass Index (BMI) and other comorbidities (hypertension and diabetes). 60% have been decannulated and have been stepped down the intensive care unit. We recorded no surgical complications or adverse events. The service to date has been shown to be effective, safe, largely reproducible and reflective.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/cirugía , Grupo de Atención al Paciente , Neumonía Viral/cirugía , Traqueostomía/efectos adversos , Adulto , Anciano , Índice de Masa Corporal , COVID-19 , Toma de Decisiones Clínicas , Estudios de Cohortes , Infecciones por Coronavirus/virología , Cuidados Críticos , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/virología , SARS-CoV-2 , Resultado del TratamientoRESUMEN
The coronavirus disease (covid19) pandemic (caused by the SARS-CoV-2 virus) is the greatest healthcare challenge in a generation. Clinicians are modifying the way they approach day-to-day procedures. Safety and reduction of transmission risk is paramount. Surgical tracheostomies in covid19 patients are aerosol generating procedures linked with a significant risk of viral contamination. Here, we describe our local approach for these procedures, introducing the "5Ts" of safe tracheostomy practice: Theatre set-up, Team Briefing, Transfer of patient, Tracheostomy Procedure, Team Doffing and De-brief. We identify the critical steps of the procedure and explain how we overcome the risks associated with breaking the transfer circuit to attach the patient to the theatre ventilator. We explain our technique to reduce secretion spillage when opening the trachea. We emphasise the importance of closed tracheal suctioning and mouth suctioning prior to patient transfer. We highlight the importance of maintaining a closed circuit throughout the procedure and describe tips on how to achieve this. We summarise the steps of our protocol in an "easy to reproduce" way. Finally, we emphasise the importance of communication in a constantly changing environment and challenging circumstances.
Asunto(s)
Infecciones por Coronavirus , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Pandemias , Neumonía Viral , Traqueostomía , Aerosoles , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Humanos , Control de Infecciones , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , SARS-CoV-2 , Tráquea/virología , Traqueostomía/métodos , Traqueostomía/normasRESUMEN
UNLABELLED: Careful prescribing is paramount in clinical practice. Potential drug-drug interactions need to be considered. Midazolam is the drug of choice for the purpose of IV sedation. To ensure safe clinical practice, the patient's current medications need to be recorded. CLINICAL RELEVANCE: An update on the drug interactions relating to midazolam are worthy of scrutiny as its use becomes more commonplace in clinical practice. OBJECTIVE: The dentist should understand the possible implications for drug interactions when sedating patients using midazolam.