The Efficacy of Trigger Site Surgery in the Elimination of Chronic Migraine Headache: An Update in the Rate of Success and Failure

Migraine headache (MH) is a prevalent neurovascular disorder that affects approximately 15% of the global population. They are more common in women and typically affect young and middle-aged individuals. Chronic MH is characterized by headaches occurring on ≥15 days per month for over three months. While only 5% of MHs are refractory, about 20%-50% do not respond to pharmacologic treatments. As a result, surgical interventions have emerged as an alternative method to eliminate MH since 2000 AD. These surgical treatments primarily target the peripheral mechanisms of MH, focusing on common trigger sites. Migraine surgery involves neurolysis of sensory branches of trigeminal and occipital nerves that supply the face and back of the head. Numerous clinical studies conducted between 2000 and 2021 have extensively described surgical interventions and their prognostic outcomes. After surgery, up to 80% of patients reported complete elimination of headaches, while 20%-35% experienced no relief. The failure to achieve complete elimination of MH can be attributed to various factors. The most common reason for a partial clinical response is the failure to identify all trigger sites or inadequate surgery on the trigger sites. In this review, we aim to provide an overview of current surgical interventions for MH at different trigger sites, including recent updates, success and failure rates, and potential causes of failure.

Thickness-Dependent Light Transmittance and Temperature Rise in Dual-Cure Bioactive and Light-Cure Bulk-Fill Composite Resins

This study aimed to assess the light transmittance (T) and temperature increase through different increments of dual-cure bioactive bulk-fill restorative material (ACTIVA), light-cure bulk-fill, and conventional composite resin materials. Cylindrical specimens with a diameter of 8 mm and heights of 1, 2, 3, and 4 mm of ACTIVA, Tetric-N-Ceram bulk-fill (TBF), Filtek One bulk-fill (FBF), and Filtek Z250 (FZ) (n = 6 per group, 96 in total) were light-cured with a visible blue low-intensity light-emitting diode (LED) (650-800 mW/cm² irradiance). T, and the temperature increase, were measured using an optical power meter and a digital thermometer during curing. The T mean values ranged between 0.012 and 0.239 (76.02 to 98.81% light attenuation), while the temperature rise mean values ranged between 9.02 and 20.80 °C. The parameters, including material type (partial eta squared (ηp²) = 0.284, p < 0.0001), thickness (ηp² = 0.284, p < 0.0001), and their interaction (ηp² = 0.185, p = 0.047), significantly affected the T values, whereas only the material type (ηp² = 0.352, p = 0.047) affected the temperature rise values. The T and temperature rise mean values were highest in ACTIVA increments of 1-mm increments, in particular, showing the highest T mean values, followed by similar increments of TBF. A significantly higher T was found in 1-mm increments compared to thicker increments for all materials (p < 0.0001), and a significant positive correlation existed between T and temperature rise values (r = 0.348, p = 0.001). These findings show that the bioactive material ACTIVA and TBF allow for better T than the other materials, with ACTIVA recording a higher temperature rise. However, the large light attenuation observed for all materials, irrespective of thickness, suggests that curing in more than one location with a low-intensity LED is necessary to optimize the curing process. Furthermore, incremental filling of bulk-fill materials using a low intensity LED could be beneficial.

707 RESEARCH PRIORITIES FOR PREHOSPITAL CARE OF OLDER PATIENTS WITH INJURIES: SCOPING REVIEW

Introduction

The use of ambulance services by older patients with injuries increases within the impacts of ageing-related changes leading to adverse patient outcomes. There is increasing recognition of the importance of prehospital trauma care for older patients, but little systematic research to guide practice. We aimed to review the published evidence on prehospital trauma care for older patients, determine the scope of existing research and identify research gaps in the literature.

Methods

A systematic scoping review guided by the Arksey and O’Malley framework reported in line with the PRISMA-ScR checklist. A systematic search was conducted of Scopus, CINAHL, MEDLINE, PubMed and Cochrane library databases to identify articles published between (2001–2021) years. Inclusion and exclusion criteria were applied independently by two reviewers. Data were extracted, charted and summarised from eligible articles.

Results

65 studies were identified and reviewed, and 25 included. Five categories were identified: ‘field triage, “ageing impacts”, ‘decision-making’, ‘paramedic’ awareness’ and ‘paramedic’s behaviour’. Undertriage & overtriage (sensitivity & specificity) were commonly cited as poorly investigated field-triage subthemes. Ageing-related physiologic changes, comorbidities and polypharmacy were the most widely researched. Inaccurate decision-making and poor early identification of major injuries were identified as potentially influencing patient outcomes. More research is required into paramedic knowledge of geriatric care & ageing changes and the potential impact of paramedic care.

Conclusion

This is the first study reviewing the published evidence on prehospital trauma care for older patients and identifying research priorities for future research. This review has identified the prehospital triage for older trauma victims and studies of paramedic knowledge of older trauma care as key priorities. Investigating and understanding these can improve providing prehospital trauma care of older patients.