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Rosenberg JM, Bellucci CC, Edwards TC, Heike CL, Leroux BG, Jones SM, Stueckle LP, Patrick DL, Albert M, Aspinall CL, Kapp-Simon KA. Caregiver Observations of Infant Well-Being Before and After Cleft Lip Surgery. Cleft Palate Craniofac J 2024; 61:271-283. [PMID: 36112919 PMCID: PMC11037889 DOI: 10.1177/10556656221125371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To evaluate the sensitivity to change of daily ratings of the comfort (COMF) and behavioral/emotional health (BEH) domains of the Infants with Clefts Observation Outcomes Instrument (iCOO) at 3 time points, and to assess the association of post-surgical interventions on iCOO ratings. DESIGN The COMF and BEH domains were completed by caregivers before (T0), immediately after (T1), and 2-months after (T2) cleft lip (CL) surgery. Analyses included descriptive statistics, correlations, t-tests, and generalized estimating equations. PARTICIPANTS Caregivers (N = 140) of infants with CL with/without cleft palate. MAIN OUTCOME MEASURES The COMF and BEH domain scores of the iCOO: Scale (SCALE), a summary of observable signs; and Global Impression (IMPR), a single item measuring caregivers' overall impression. RESULTS Daily COMF and BEH SCALE and IMPR scores changed significantly during T1 (P's < 0.001) but not T0 or T2. Day 1 and 7 T0 scores were significantly higher than Day 1 and 7 T1 scores (P's <0.001 to <0.012) but similar at T2 (P's > 0.05). After CL surgery, the combined use of immobilizers and nasal stents and the use of multiple feeding methods with treatment for gastroesophageal reflux were associated with lower daily scores in COMF and BEH SCALE and IMPR (P's: 0.040 to <0.001). CONCLUSIONS COMF and BEH iCOO scores were sensitive to daily changes in infant well-being following CL surgery. Future studies should further investigate impact of post-surgical treatments on infant well-being.
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Affiliation(s)
- Janine M Rosenberg
- Craniofacial Center, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | | | - Todd C Edwards
- Health Services, University of Washington, Seattle, Washington, USA
| | - Carrie L Heike
- Seattle Children's Hospital, Craniofacial Center, Seattle, Washington, USA
| | | | - Salene M Jones
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Laura P Stueckle
- Seattle Children's Hospital, Craniofacial Center, Seattle, Washington, USA
| | - Donald L Patrick
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Meredith Albert
- Shriners Hospitals for Children, Chicago Cleft/Craniofacial, Chicago, Illinois, USA
| | | | - Kathleen A Kapp-Simon
- Shriners Hospitals for Children, Cleft/Craniofacial Chicago, Illinois and University of Illinois at Chicago, Chicago, Illinois, USA
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Ombashi S, Kurniawan MSIC, Koudstaal MJ, Allori AC, Jansson K, Rogers-Vizena CR, Mathijssen IMJ, Klassen AF, Versnel SL. Most Efficient and Meaningful Patient-Reported Appearance Assessment in Different Cleft Types and Age Groups with CLEFT-Q. Plast Reconstr Surg 2024; 153:120e-129e. [PMID: 37054385 DOI: 10.1097/prs.0000000000010523] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND The CLEFT-Q, a questionnaire developed and validated specifically for cleft patients, contains seven appearance scales. The International Consortium of Health Outcomes Measurement (ICHOM) has incorporated only some CLEFT-Q appearance scales in the Standard Set to minimize burden. This study evaluates which appearance scales provide the most meaningful information in the different cleft types at specific ages, for the most efficient cleft appearance outcome assessment. METHODS Within this international multicenter study, outcomes of the seven appearance scales were collected, either as part of the ICHOM Standard Set, or as part of the field test study performed to validate the CLEFT-Q. Analyses were performed in separate age groups and cleft types, and involved univariate regression analyses, trend analyses, t tests, correlations, and floor and ceiling effects. RESULTS A total of 3116 patients were included. Scores for most appearance scales showed a downward trend by age group, with the exception of the Teeth and Jaw scales. In all cleft types, several scales correlated strongly with each other. No floor effects were observed, but ceiling effects were found in several scales in different age groups, most often in the CLEFT-Q Jaw scale. CONCLUSIONS A proposition for the most meaningful and efficient appearance outcome assessment in cleft patients is made. It was composed so that recommendations are of value for different cleft protocols and initiatives. Suggestions for the use of scales in the ICHOM Standard Set at different ages are given, and also from a clinical perspective. Use of the CLEFT-Q Scar, Lips, and Nose scales will provide additional relevant information.
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Affiliation(s)
- Saranda Ombashi
- From the Department of Plastic and Reconstructive Surgery
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders
| | | | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics
- Dutch Craniofacial Center, Erasmus University Medical Center Rotterdam
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders
| | - Alexander C Allori
- Department of Plastic, Maxillofacial, and Oral Surgery, Duke University Hospital & Children's Health Center
| | - Kristina Jansson
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders
- Department of Reconstructive Plastic Surgery, Stockholm Craniofacial Team, Karolinska University Hospital
| | | | - Irene M J Mathijssen
- From the Department of Plastic and Reconstructive Surgery
- Dutch Craniofacial Center, Erasmus University Medical Center Rotterdam
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders
| | | | - Sarah L Versnel
- From the Department of Plastic and Reconstructive Surgery
- Dutch Craniofacial Center, Erasmus University Medical Center Rotterdam
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders
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Ombashi S, van der Goes PAJ, Versnel SL, Khonsari RH, van der Molen AEM. Guidance to develop a multidisciplinary, international, pediatric registry: a systematic review. Orphanet J Rare Dis 2023; 18:296. [PMID: 37735442 PMCID: PMC10512647 DOI: 10.1186/s13023-023-02901-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
AIM The European Reference Network for craniofacial anomalies and ear, nose and throat disorders (ERN-CRANIO) aims to improve craniofacial care on a European scale. Within ERN-CRANIO, the cleft lip and palate (CL/P) work stream seeks to ameliorate health outcomes for patients with CL/P. This work stream acknowledged the need for a European wide registry for comparable outcome measures and therapy endpoints to achieve this goal. This review aimed to provide a scientific basis for the conceptualization of this registry by studying previous registry initiatives. METHODS This review performed thematic analysis on twenty-four articles through narrative synthesis. An iterative process was used to identify key-themes required for prolonged registry success. RESULTS Analysis of the literature resulted in twenty-one distinct headings including quantitative and qualitative data. Quantitative data including registry characteristics were visualized in a table. The analysis of qualitative data resulted in the identification of fourteen key-themes, which have been summarized and visualized in a guidance. CONCLUSION This review has successfully identified key-themes required for the development of an international, multidisciplinary, pediatric registry for pan-European cleft care. The guidance provided by this review applies to the goals of ERN-CRANIO, but can be used by any initiative developing a registry.
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Affiliation(s)
- S Ombashi
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P A J van der Goes
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - S L Versnel
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R H Khonsari
- Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Faculté de Médecine, Université Paris Cité, Paris, France
- Scientific Committee, ERN CRANIO, Rotterdam, The Netherlands
| | - A E Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center, Utrecht, The Netherlands
- Scientific Committee, ERN CRANIO, Rotterdam, The Netherlands
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Dissaux C, Diop V, Wagner D, Talmant JC, Morand B, Bruant-Rodier C, Ruffenach L, Grollemund B. Aesthetic and psychosocial impact of dentofacial appearance after primary rhinoplasty for cleft lip and palate. J Craniomaxillofac Surg 2021; 49:914-922. [PMID: 34187731 DOI: 10.1016/j.jcms.2021.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 04/23/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022] Open
Abstract
The primary aim of this study was to demonstrate whether primary rhinoplasty shows aesthetic and psychosocial advantages for children with a complete unilateral cleft lip and palate. The second aim was to determine the satisfaction levels concerning the dentofacial appearance. Group A corresponded to patients from a center specialised in primary cheilo-rhinoplasty with 20 years' experience and Group B to patients who did not benefit from primary rhinoplasty. Children and their parents filled in a custom-designed satisfaction questionnaire on dentofacial appearance and its psychosocial impact. The variables studied were the main criterion (the nose) and secondary criteria (the upper lip, the smile, the profile and the face as a whole). 56 families consented to be involved in the study. The children did not rate statistically differently their social relationships if they had primary rhinoplasty or not. Parents however expressed very different views. They considered the nasal appearance of the children who had primary rhinoplasty as statistically more attractive and evaluated their psychosocial experience as significantly better. For the other parts of the face, in both groups, satisfaction levels of dentofacial appearance and psychosocial comfort were good (scores above 80/100). Yet, 44% of the families would go for further interventions, especially concerning the nose (13% of whom were in Group A and 42% in Group B). Within the limitations of this study, primary rhinoplasty seems to improve the patient's well-being and social life and, therefore, should be considered whenever appropriate.
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Affiliation(s)
- Caroline Dissaux
- Cleft Competence Center, Maxillofacial and Plastic Surgery Department, Strasbourg University Hospital, Site Hautepierre 2, Av Molière, Strasbourg 67091, France.
| | - Valérie Diop
- Département d'Orthopédie Dento-Faciale, Pôle de médecine et chirurgie buccodentaires, Strasbourg University Hospital, Place de l'Hôpital 1, Strasbourg 67000, France
| | - Delphine Wagner
- Cleft Competence Center, Maxillofacial and Plastic Surgery Department, Strasbourg University Hospital, Site Hautepierre 2, Av Molière, Strasbourg 67091, France; Département d'Orthopédie Dento-Faciale, Pôle de médecine et chirurgie buccodentaires, Strasbourg University Hospital, Place de l'Hôpital 1, Strasbourg 67000, France
| | - Jean-Claude Talmant
- Centre de compétence des fentes labio-palatines des Pays de la Loire, Clinique Jules Verne, Nantes, France
| | - Béatrice Morand
- Centre de compétence des fentes labio-palatines de Grenoble, CHU Michallon, Avenue Maquis du Grésivaudan, 38700, La Tronche, France
| | - Catherine Bruant-Rodier
- Cleft Competence Center, Maxillofacial and Plastic Surgery Department, Strasbourg University Hospital, Site Hautepierre 2, Av Molière, Strasbourg 67091, France
| | - Laeticia Ruffenach
- Cleft Competence Center, Maxillofacial and Plastic Surgery Department, Strasbourg University Hospital, Site Hautepierre 2, Av Molière, Strasbourg 67091, France
| | - Bruno Grollemund
- Cleft Competence Center, Maxillofacial and Plastic Surgery Department, Strasbourg University Hospital, Site Hautepierre 2, Av Molière, Strasbourg 67091, France
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Carvalho NO, Matos MFS, Belchior IFC, Araújo MB, Rocha CT, Neves BG. Parents' Emotional and Social Experiences of Caring a Child with Cleft Lip and/or Palate. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Alighieri C, Peersman W, Bettens K, Van Herreweghe V, Van Lierde K. Parental perceptions and expectations concerning speech therapy-related cleft care - a qualitative study. JOURNAL OF COMMUNICATION DISORDERS 2020; 87:106028. [PMID: 32659479 DOI: 10.1016/j.jcomdis.2020.106028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023]
Abstract
AIMS Speech (i.e., resonance, nasal airflow and articulation) is one of the primary outcomes in individuals with a cleft of the palate with or without a cleft of the lip (CP ± L). Therefore, it is highly important to obtain information regarding parental perceptions and expectations concerning speech therapy-related cleft care. Literature investigating these parental perspectives is scarce. The present study investigated perceptions and expectations of parents of children with CP ± L concerning (outcomes of) speech therapy. METHODS Eleven parents of nine children with CP ± L were recruited from the multidisciplinary craniofacial team at the Ghent University hospital. A qualitative design, using semi-structured interviews, was used to collect data. Data were managed using NVIVO software version 10 and analyzed thematically. RESULTS The analysis resulted in three major themes: (1) service provision, (2) patient-centered care, and (3) seeking health care. Each of these identified themes were divided into three subthemes. Service provision included the effectiveness of the provided service, interdisciplinary collaboration, and expertise of the speech therapist. Information provision, child-friendly attitude and connection were categorized under patient-centered care. Seeking health care included affordability, practical considerations and the selection of a speech therapist. CONCLUSION The most prominent expectation of the parents was that they wanted to see their children progress during the speech intervention. This finding supported the importance of experienced and specialized speech-language pathologists (SLPs) in the provision of care to children with a CP ± L. Moreover, the results showed that the majority of the parents wanted more clear and comprehensive information particularly about the treatment progress, the transfer to the home environment and the prognosis. The present findings might aid SLPs, and more generally all health professionals, in gaining insight into parental perceptions and expectations concerning speech therapy-related cleft care. Thereby, treatment quality might be improved.
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Affiliation(s)
- Cassandra Alighieri
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000 Gent, Belgium.
| | - Wim Peersman
- Research Group Social and Community Work, Odisee University College, Warmoesberg 26, 1000 Brussel, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000 Gent, Belgium
| | - Vienna Van Herreweghe
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000 Gent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 2P1, 9000 Gent, Belgium; Faculty of Humanities, Department of Speech-Language Pathology and Audiology, University of Pretoria, Lynnwood Road Hillcrest, Pretoria, South Africa
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7
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Costa B, White P, Stock NM. Satisfaction With Health Care in Families Following a Diagnosis of Cleft Lip and/or Palate in the United Kingdom. Cleft Palate Craniofac J 2019; 57:599-605. [PMID: 31813267 DOI: 10.1177/1055665619888318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Having a child born with a cleft lip and/or palate (CL/P) poses several challenges for new parents and can have a significant psychological impact on the family as a whole. Previous research has indicated that dissatisfaction with health care is a risk factor for poor parental adjustment and family functioning. Yet, knowledge is lacking in regard to which aspects of care parents may be dissatisfied with. The current study aimed to comprehensively evaluate health-care satisfaction in families following a diagnosis of CL/P by utilizing data collected from a UK-wide birth cohort. METHODS Self-reported questionnaire data were obtained from 517 parent dyads enrolled in The Cleft Collective Birth Cohort Study. The "Pediatric Quality of Life Inventory-Healthcare Satisfaction Generic Module" was used as the primary outcome measure. RESULTS Overall, parents were satisfied with the care they had received. However, less favorable scores were identified in relation to the information parents had been given. A good degree of agreement between mothers and fathers was observed. However, marginal evidence suggested that fathers were significantly more dissatisfied than mothers regarding the "Communication" and "Inclusion of Family" subscales. CONCLUSIONS Although the findings of this large-scale study reflect overall health-care satisfaction, issues are raised in relation to the quality of information families received, particularly for fathers. In addition, fathers may feel less included in their child's treatment pathway. These findings offer practical suggestions as to which areas of care could be targeted by all health professionals to improve parents' health-care experiences and promote overall familial adjustment.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Paul White
- Applied Statistics Group, University of the West of England, Bristol, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Stock NM, Costa B. Provision of Care for Families Affected by Craniofacial Conditions: The Views of Nonspecialist Health Professionals. Cleft Palate Craniofac J 2019; 57:470-476. [PMID: 31665891 DOI: 10.1177/1055665619883151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE A diagnosis of a congenital craniofacial condition can have a significant impact on the psychological well-being of the affected family. As the first health professionals likely to come into contact with families, nonspecialists, such as diagnostic sonographers, midwives, and health visitors play a crucial role in facilitating familial adjustment. Yet, previous research has demonstrated parental dissatisfaction with the care delivered by nonspecialists. The aim of this study was to investigate the provision of care for families affected by craniofacial conditions from the perspective of nonspecialist health professionals, with a view to informing the development of educational materials. DESIGN Individual semistructured telephone interviews (n = 14) were conducted with 3 diagnostic sonographers, 2 fetal medicine consultants, 3 midwives, 4 health visitors, and 2 children's nurses. RESULTS Participants identified a range of barriers to the delivery of optimal care, including dealing with parental reactions, time pressure, hospital protocols and resources, a lack of contact with specialist craniofacial teams, and the emotional impact of delivering a diagnosis. Most participants had received no prior training in the area of congenital craniofacial conditions, while those who had felt current training materials were insufficient. All participants expressed a desire for further training and provided guidance regarding preferred content and format. CONCLUSIONS This study provides insight into the challenges faced by nonspecialists, as well as a range of information and training needs that could improve their knowledge and confidence. Suggestions for the development of educational materials for nonspecialist health professionals are made.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, England, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, England, United Kingdom
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- Centre for Appearance Research, University of the West of England, Bristol, England, United Kingdom
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Incidence of Secondary Lip Correction for Children With Unilateral Cleft Lip: A Single-Center Retrospective Study. Ann Plast Surg 2019; 83:424-428. [PMID: 31524736 DOI: 10.1097/sap.0000000000001935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous reports have described the incidence of secondary lip correction for patients with cleft lip (CL), and this incidence broadly varies among centers. The purpose of this study was to determine this revision rate for a reasonably large number of patients in our center and identify the clinical factors that contribute to the revision rate. METHODS A retrospective chart review was conducted for all infants with unilateral CL with or without cleft palate who underwent primary cheiloplasty at our cleft center from 2006 to 2012. Four surgeons were in charge of almost all operations. We investigated how many children underwent lip revisions by the end of 2017. RESULTS In total, 490 infants underwent primary lip repair, and 47 underwent revision surgery by the age of 8 years. Half of them (24 children) underwent revisions at the age of 5 or 6 years. There was no significant difference in the revision rate by sex or cleft side. The revision rate in children with CL only tended to be lower than that in children with alveolar cleft or cleft palate, but it was not significantly associated with the cleft type. The revision rate ranged from 2.8% to 15.2% among surgeons. CONCLUSIONS The overall revision rate was 9.6%, which is relatively lower than that in other cleft centers. However, the repair technique and cleft care program should not be evaluated using the revision rate only. Various factors, including surgeons' preference, contribute to the indications for revision, and these factors can change with age. We plan to follow up the patients until our completion of the cleft care program and report the final revision rate.
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Shaw W, Semb G, Lohmander A, Persson C, Willadsen E, Clayton-Smith J, Trindade IK, Munro KJ, Gamble C, Harman N, Conroy EJ, Weichart D, Williamson P. Timing Of Primary Surgery for cleft palate (TOPS): protocol for a randomised trial of palate surgery at 6 months versus 12 months of age. BMJ Open 2019; 9:e029780. [PMID: 31300507 PMCID: PMC6629401 DOI: 10.1136/bmjopen-2019-029780] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Cleft palate is among the most common birth abnormalities. The success of primary surgery in the early months of life is crucial for successful feeding, speech, hearing, dental development and facial growth. Over recent decades, age at palatal surgery in infancy has reduced. This has led to palatal closure in one-stage procedures being carried out around the age of 12 months, but in some cases as early as 6 months. The primary objective of the Timing Of Primary Surgery for Cleft Palate (TOPS)trial is to determine whether surgery for cleft palate performed at 6 or 12 months of age is most beneficial for speech outcomes. METHODS AND ANALYSIS Infants with a diagnosis of non-syndromic isolated cleft palate will be randomised to receive standardised primary surgery (Sommerlad technique) for closure of the cleft at either 6 months or 12 months, corrected for gestational age. The primary outcome will be perceived insufficient velopharyngeal function at 5 years of age. Secondary outcomes measured across 12 months, 3 years and 5 years will include growth, safety of the procedure, dentofacial development, speech, hearing level and middle ear function. Video and audio recordings of speech will be collected in a standardised age-appropriate manner and analysed independently by multiple speech and language therapists. The trial aims to recruit and follow-up 300 participants per arm. Data will be analysed according to the intention-to-treat principle using a 5% significance level. All analyses will be prespecified within a full and detailed statistical analysis plan. ETHICS AND DISSEMINATION Ethical approval has been sought in each participating country according to country-specific procedures. Trial results will be presented at conferences, published in peer-reviewed journals and disseminated through relevant patient support groups. TRIAL REGISTRATION NUMBER NCT00993551; Pre-results.
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Affiliation(s)
- William Shaw
- School of Medical Sciences, Division of Dentistry, The University of Manchester, Manchester, Greater Manchester, UK
| | - Gunvor Semb
- School of Medical Sciences, Division of Dentistry, The University of Manchester, Manchester, Greater Manchester, UK
| | - Anette Lohmander
- Functional Area Speech and Language Pathology, Division of Speech and Language Pathology, Karolinska Institute, Stockholm, Sweden
| | - Christina Persson
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Willadsen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
| | - Jill Clayton-Smith
- Division of Evolution and Genomic Sciences and Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, St Mary’s Hospital, Manchester, Greater Manchester, UK
| | - Inge Kiemle Trindade
- Hospital de Reabilitação de Anomalias Craniofaciais Universidade de São Paulo, 5Facu Faculdade de Odontologia de Bauru, Bauru-SP, Brazil
| | - Kevin J Munro
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, Greater Manchester, UK
| | - Carrol Gamble
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Nicola Harman
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | | | - Dieter Weichart
- School of Medical Sciences, Division of Dentistry, The University of Manchester, Manchester, Greater Manchester, UK
| | - Paula Williamson
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
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Caregiver-Reported Outcomes and Barriers to Care among Patients with Cleft Lip and Palate. Plast Reconstr Surg 2019; 142:884e-891e. [PMID: 30489528 DOI: 10.1097/prs.0000000000004987] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND For children with cleft lip and/or palate, access to care is vital for optimizing speech, appearance, and psychosocial outcomes. The authors posited that inadequate access to care negatively impacts outcomes in this population. METHODS Sixty caregivers of children with cleft lip and palate were surveyed to assess perceived barriers using the validated Barriers to Care questionnaire. The questionnaire includes 39 items divided into five subscales, with higher scores indicating fewer barriers. Caregiver-reported outcomes were assessed using the Cleft Evaluation Profile, which captures cleft-specific appearance- and speech-related outcomes. Higher scores correspond to less satisfactory outcomes. Desire for revision surgery was assessed as a binary outcome among caregivers. Multivariable regression was used to evaluate the relationship of barriers to care, caregiver-reported outcomes, and desire for revision, adjusting for clinical and demographic covariates. RESULTS Sixty percent of caregivers perceived barriers to care, and caregivers who reported poorer access to care described poorer cleft-related outcomes (r = 0.19, p = 0.024). Caregivers with poorer skills (r = 0.17, p = 0.037), expectations (r = 0.17, p = 0.045), and pragmatics (r = 0.18, p = 0.026) subscale scores were associated with worse Cleft Evaluation Profile scores. Barriers were also negatively associated with aesthetic item scores (r = 0.11, p = 0.025). Finally, caregivers reporting fewer barriers were 21.2 percent less likely to express interest in revision surgery. CONCLUSIONS Barriers to care were associated with poorer appearance-related outcomes and increased interest in revision among caregivers of cleft patients. Enhancing access to care is critical in order to effectively meet goals of care for these families.
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Collection of Bilateral Cleft Lip and Palate Standard Set Variables: Establishing a Baseline. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1894. [PMID: 30324072 PMCID: PMC6181501 DOI: 10.1097/gox.0000000000001894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/13/2018] [Indexed: 11/27/2022]
Abstract
Background The International Consortium for Healthcare Outcomes Measurement recently published a consensus Standard Set of clinical and patient-centered metrics to measure outcomes for patients with cleft lip and/or palate (CLP). This study aims to evaluate how the Standard Set compares to existing data collected to anticipate the impact that the Standard Set may have on quality and quantity of outcome data. Methods Extraction of the Standard Set data points was attempted retrospectively for all nonsyndromic patients with bilateral cleft lip and/or palate who underwent primary lip and/or palate repair by a single surgeon (JGM) between June 2007 and June 2014. Results Bilateral cleft lip repair was performed on 32 patients of which 29 also underwent palate repair. All but one of the baseline demographic and phenotypic variables were available. All perioperative variables were collected, but data quality was heterogeneous. There were no early complications. At 5 years, 29.6% of patients were lost to follow-up; however, a degree of data was available on 11 of the 12 clinical metrics for those remaining. Of patients with Veau IV cleft palate and follow-up at age 5, 1 patient (6.7%) had an oronasal fistula and 1 had velopharyngeal incompetence requiring Furlow palatoplasty (6.7%). No patient-reported data were collected for any time point. Conclusion Prospective collection of the International Consortium for Healthcare Outcomes Measurement Standard Set will improve consistency of clinical data and add the patient perspective currently lacking in outcome measures collected for patients with bilateral cleft.
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