surgery

Question: Among children who snore without frequent obstructive events, does early adenotonsillectomy compared with watchful waiting with supportive care improve neurodevelopment, behavior, or other symptoms at 12-month follow-up?

Findings: In this randomized clinical trial of 458 children with mild sleep-disordered breathing (SDB), adenotonsillectomy compared with watchful waiting resulted in no significant differences in executive function or attention at 12 months. The adenotonsillectomy group had improved quality of life, symptoms, behavior, and blood pressure, which were among the secondary outcomes measured.

Meaning: In children with mild SDB, adenotonsillectomy resulted in no statistically significant differences in changes in executive function or attention but led to improved secondary outcomes including symptoms, behavior, and blood pressure.

The first question a patient often asks their FP after receiving a diagnosis of breast cancer (BC) is “What will my treatment be?” This article will help FPs answer this complex question by reviewing multimodal therapy for BC, which is contingent on molecular subtype and stage.

Background: This study aims to compare conservative versus surgical management for patients with full-thickness RC tear in terms of clinical and structural outcomes at 1 and 2 years of follow-up.

Methods: A comprehensive search of CENTRAL, MEDLINE, EMBASE, CINAHL, Google Scholar and reference lists of retrieved articles was performed since the inception of each database until August 2020. According to the Cochrane Handbook for Systematic Reviews of Interventions, two independent authors screened all suitable studies for the inclusion, extracted data and assessed risk of bias. Only randomised controlled trials comparing conservative and surgical management of full-thickness RC tear in adults were included. The primary outcome measure was the effectiveness of each treatment in terms of Constant-Murley score (CMS) and VAS pain score at different time points. The secondary outcome was the integrity of the repaired tendon evaluated on postoperative MRI at different time points. The GRADE guidelines were used to assess the critical appraisal status and quality of evidence.

Results: A total of six articles met the inclusion criteria. The average value of CMS score at 12 months of follow-up was 77.6 ± 14.4 in the surgery group and 72.8 ± 16.5 in the conservative group, without statistically significant differences between the groups. Similar results were demonstrated at 24 months of follow-up. The mean of VAS pain score at 12 months of follow-up was 1.4 ± 1.6 in the surgery group and 2.4 ± 1.9 in the conservative group. Quantitative synthesis showed better results in favour of the surgical group in terms of VAS pain score one year after surgery (- 1.08, 95% CI - 1.58 to - 0.58; P < 0.001).

Conclusions: At a 2-year follow-up, shoulder function evaluated in terms of CMS was not significantly improved. Further high-quality level-I randomised controlled trials at longer term follow-up are needed to evaluate whether surgical and conservative treatment provide comparable long-term results.

Early-stage prostate cancer can be treated in different ways. The three main ways are active surveillance, surgery, and radiotherapy. Active surveillance means having your prostate checked every few months to make sure the cancer is not spreading. Surgery would take out the prostate, and radiotherapy uses high-energy rays to kill cancer cells in the prostate.

Two recent PCORI-funded studies compare the effects of these choices on the quality of life for men with early-stage prostate cancer. These studies looked at three effects treatment might have on a man’s quality of life. These are problems having sex, urinary problems, and bowel problems.