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BACKGROUND: In the care of patients with persevering (‘treatment-resistant’) persistant physical symptoms (PPS), problems are common. With this study, we want to identify starting points for improvement of care, including suggestions for the role of mental health care. AIM: Using the profile for persevering PPS we will estimate the prevalence, describe characteristics of this patient group and map problems encountered in their care. METHOD: Online survey in general practitioners (GPs). RESULTS: The response rate to the survey was 12.8%. The mean estimated prevalence of persevering PPS in general practice was 0.7% (corresponding to an estimated 122,500 patients throughout the Netherlands). Many patients encountered iatrogenic harm, experience societal problems and limitations in mobility and ADL independence. Although there was a general increased use of health care in these patients, some also avoided care or were under-treated. In the persistence of symptoms, patient-related factors played a role (like insisting on further somatic diagnostic tests, lack of motivation for PPS-specific treatment), but health-care related factors, like rejection for care or a lack of regional treatment options for patients with PPS, also had a causal role. CONCLUSION: Almost every GP experiences problems in the care for patients with persevering PPS. Mental health care professionals can support the GP better, by optimizing options for consultation and referral.
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Medicina General , Humanos , Países Bajos , Masculino , Femenino , Encuestas y Cuestionarios , PrevalenciaRESUMEN
BACKGROUND: Laryngeal re-innervation in paediatric unilateral vocal fold paralysis is a relatively new treatment option, of which there has been little reported experience in Europe. METHODS: In this European case report of a 13-year-old boy with dysphonia secondary to left-sided unilateral vocal fold paralysis after cardiac surgery, the patient underwent re-innervation using an ansa cervicalis to recurrent laryngeal nerve transfer, in combination with fat augmentation, after 12 years of nerve denervation. Perceptual analysis data, and acoustic and laryngoscopy recordings were acquired pre-operatively, and at one and two years post-operatively. RESULTS: The patient's perceptual voice quality was improved. He experienced subjective improvement and is very satisfied with the result. As expected, laryngoscopy at one and two years after surgery showed no physiological mobility of the vocal fold concerned, but improved closure during phonation was achieved. Electromyography showed evidence of re-innervation. CONCLUSION: Laryngeal re-innervation could be considered as a treatment option for unilateral vocal fold paralysis in children and adolescents, even after a long-term delay.
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Plexo Cervical/cirugía , Procedimientos Neuroquirúrgicos/métodos , Nervio Laríngeo Recurrente/cirugía , Parálisis de los Pliegues Vocales/cirugía , Adolescente , Anastomosis Quirúrgica/métodos , Europa (Continente) , Humanos , MasculinoRESUMEN
OBJECTIVE: Assessment of humidifying function of tracheotomy speaking valves with integrated heat and moisture exchanger. DESIGN: Ex vivo measurement of water exchange and storage capacity of three tracheotomy speaking valves: Humidiphon Plus, Spiro and ProTrach DualCare (with two different heat and moisture exchangers: XtraMoist and Regular). SETTING: Comprehensive Cancer Centre. PARTICIPANT: Healthy volunteer. MAIN OUTCOME MEASURES: Difference between end-inspiratory and end-expiratory weight as measure for water exchange capacity, weight after 10 min breathing as measure for water storage capacity, weighing at 1-min intervals to assess residual water exchange potential in speaking mode and absolute humidity in mg/L as measure for environmental and respiratory humidity. RESULTS: None of the tracheotomy speaking valves provides humidification while in speaking mode. Only the ProTrach DualCare allows blocking the speaking valve and breathing through the heat and moisture exchanger during inhalation and exhalation (heat and moisture exchanger mode). This leads to an increase in inspiratory humidity of 2.5 mg (XtraMoist) and 1.6 mg (Regular). There was no measurable water storage in speaking mode in any of the three tracheotomy speaking valves. In breathing mode, water storage in the DualCare heat and moisture exchangers was 47 and 37 mg, respectively. The remaining humidifying potential in speaking mode after 10 min breathing in heat and moisture exchanger mode for XtraMoist was 38%, 15% and 10% at 1, 2 and 3 min, respectively. For Regular, this was 47%, 24% and 13%, respectively. CONCLUSIONS: Tracheostoma valves with integrated heat and moisture exchanger have no humidification function in speaking mode. Only ProTrach DualCare, allowing blocking the speaking mode, in heat and moisture exchanger mode enables a significant increase in humidification. Regular switching between speaking and heat and moisture exchanger mode with this latter device prolongs the humidification in speaking mode.
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Espiración/fisiología , Calor , Humedad , Laringectomía/rehabilitación , Habla/fisiología , Traqueostomía/instrumentación , Diseño de Equipo , Femenino , Humanos , Masculino , Acústica del Lenguaje , HumectabilidadRESUMEN
After total laryngectomy, inspired air is no longer optimally conditioned by the upper airways. Impaired mucociliary clearance and histological changes of respiratory epithelium, such as loss of ciliated cells, have been described in laryngectomized patients. Heat and moisture exchangers (HMEs) are passive humidifiers that re-condition the inspired air. Aim of this study was to assess the effect of HMEs on tracheal epithelium and tracheal mucus transport velocity (TMV). Tracheal brush biopsies were collected in three groups of TLE patients: 21 long-term HME users, 10 non-HME users, and 16 non-HME users before and after 4-9 months HME use. Tracheal epithelium biopsies were assessed using a digital high-speed camera mounted onto a light microscope. TMV was determined by scintigraphy in the first two patient groups. Significantly more ciliated cells were found in HME users compared to non-HME users (p = 0.05). TMV was higher in HME users (median 2 mm/min; 0-7.9) compared to non-HME users (median 0.8 mm/min; 0-12.3), but this difference was not significant (p = 0.37). One-hour breathing without HME in long-term HME users did not measurably decrease TMV (p = 0.13). The long-term use of an HME restores/prevents the loss of tracheal ciliated cells. A significant improvement in TMV was not found. Short-term (one hour) detachment of an HME has no measurable effect on TMV.