bluuebunny/crossref_metadata_2025 huggingface dataset:
Forensic medicine experts' opinion on medico-legal autopsies in hospital deaths: A questionnaire survey
Authors: D'Souza Deepak Herald , Pant Sadip , Menezes Ritesh George
Published: August 2013

Objective

Medico-legal autopsy is conducted routinely in some countries and selectively in others in hospital deaths. This study was conducted to evaluate the views of the forensic medicine experts regarding this matter.

Methods

A questionnaire pro forma was sent to sixty-five forensic medicine experts practicing in different medical institutions all around India. Designations and experiences of the participants were noted by requests in the same questionnaire. Their specific experience in conducting medico-legal autopsy in hospital deaths was also requested for. Responses were charted in frequency distribution tables and analyzed using SPSS, version 17.0.

Results

One-third of the participants felt that a medico-legal autopsy was necessary in all the hospital death cases as defined in the present study. Ten percent of the participants opined that a medico-legal autopsy was unnecessary in hospital deaths. The majority of the experts mentioned finding the cause of death, followed by finding the manner of death and collecting the evidentiary materials, as the reasons for medico-legal autopsy in hospital deaths. Twenty percent of the participants felt that internal findings at autopsy poorly matched with the case records. All the experts agreed that external autopsy findings matched with the hospital case records. Nearly two-third of the participants felt that it was difficult in some cases to interpret the autopsy findings without case records from the hospital where the deceased was treated.

Conclusion

Our findings suggest that the exercise of carrying out medico-legal autopsy routinely in every hospital death as evident in the Indian framework is often unnecessary as per the experts’ opinion. Autopsy findings in hospital deaths often correlate with hospital case records.
The Contested Energy Future of Amman, Jordan: Between Promises of Alternative Energies and a Nuclear Venture
Authors: Verdeil Éric
Published: August 2013

Metropolitan authorities and local business elites are often seen as major players in the energy transition in the city. Such energy transitions are mostly conceived of as low carbon technologies, which permit the retrofitting of urban infrastructure and the rebundling of metabolic circuits. This article contests these views by highlighting the major role of non-urban energy sector institutions and actors. By examining the connections between technology, space and energy politics, and by using a relational understanding of the urban, this article explores the case of Amman’s energy transition. The growth of consumption coupled with new energy practices face a problematic supply because of shifts in regional geopolitics. This situation has prompted energy transition policies, among which are a green growth programme and the building of a nuclear power plant at the edge of the city. The article analyses the socio-political assemblages that shape those policies and unravels the competing interests at stake. It demonstrates the political and highly unruly nature of energy transitions.
Does Haste Make Waste? How Long Does It Take to Do a Good Regulatory Impact Analysis?
Authors: Shapiro Stuart , Morrall John
Published: August 2013

We examine the relationship between the amount of information in a Regulatory Impact Analysis (RIA) and the time it takes to write and review the RIA. We find that the longer an agency spends developing the regulation and the longer that the Office of Information and Regulatory Affairs (OIRA) spends reviewing it, the more information in the analysis. However, the direction of causality is unclear. Better analyses may take more time to review. Or more review may make analyses better. We recommend increasing OIRA staff, which has advantages regardless of the direction of causality.
Evaluating the Message or the Messenger? Implications for Self-Validation in Persuasion
Authors: Clark Jason K. , Wegener Duane T. , Sawicki Vanessa , Petty Richard E. , Briñol Pablo
Published: August 2013

Characteristics of persuasive message sources have been extensively studied. However, little attention has been paid to situations when people are motivated to form an evaluation of the communicator rather than the communicated issue. We postulated that these different foci can affect how a source validates message-related cognitions. Participants focused on the source (Studies 1 and 2) or the issue (Study 2) while reading weak or strong message arguments. Later, the communicator was described as low or high in credibility. When focused on the source, highly motivated participants were more confident and their attitudes were more reflective of thoughts when argument quality matched (e.g., weak arguments-low credibility) rather than mismatched (e.g., weak arguments-high credibility) source credibility. Conversely, when participants were focused on the issue, self-validation was greater when credibility was high rather than low—regardless of argument quality. Implications of these findings for the study and practice of persuasion are discussed.
Facilitators and Barriers to Survey Participation by Physicians
Authors: Klabunde Carrie N. , Willis Gordon B. , Casalino Lawrence P.
Published: August 2013

Surveys of health care providers are a well-established tool for obtaining information about the organization and delivery of care as well as about provider knowledge and attitudes. However, declining response rates to provider surveys are a widely acknowledged concern. Although a number of studies have identified specific methods for increasing response rates in health care provider—and particularly physician—surveys, few have addressed the more fundamental question of what motivates or deters providers from survey participation. We briefly review theoretical perspectives concerning why providers choose to participate in surveys, and what is known about facilitators and barriers to participation. We then describe several research designs (i.e., focus groups, key informant interviews, diary and office workflow studies, surveying the surveyors, and follow-back studies of respondents/nonrespondents) for obtaining empirical data on facilitators and barriers to survey participation, particularly by physicians and medical groups. Researchers must begin to build an evidence base for understanding provider decisions concerning survey participation.
Sample Frame and Related Sample Design Issues for Surveys of Physicians and Physician Practices
Authors: DiGaetano Ralph
Published: August 2013

A sample frame is the listing of the units from which a sample is to be selected. When deciding upon a file to serve as a source for a sample frame for a survey, perhaps the most important consideration is the extent to which the target population will be covered by the frame. However, other issues also come into play such as the accuracy of contact and other information appearing on the file as well as its cost. The American Medical Association Masterfile has long been considered the preferred choice for surveys of physicians, although it does have drawbacks. Here we consider two alternative files, discussing their relative advantages and disadvantages. For surveys of physician practices (or other organizations that employ physicians), there have been no files that are obvious choices to serve as the basis for a sample frame. Here we discuss data collection on physician practices from an analytic perspective and consider how sampling physicians to obtain practice level data may be a desirable approach.
Surveying Clinicians by Web
Authors: Dykema Jennifer , Jones Nathan R. , Piché Tara , Stevenson John
Published: August 2013

The versatility, speed, and reduced costs with which web surveys can be conducted with clinicians are often offset by low response rates. Drawing on best practices and general recommendations in the literature, we provide an evidence-based overview of methods for conducting online surveys with providers. We highlight important advantages and disadvantages of conducting provider surveys online and include a review of differences in response rates between web and mail surveys of clinicians. When administered online, design-based features affect rates of survey participation and data quality. We examine features likely to have an impact including sample frames, incentives, contacts (type, timing, and content), mixed-mode approaches, and questionnaire length. We make several recommendations regarding optimal web-based designs, but more empirical research is needed, particularly with regard to identifying which combinations of incentive and contact approaches yield the highest response rates and are the most cost-effective.
Submersed in Social Segregation
Authors: DeLuca Jaime R.
Published: August 2013

This article examines the ways in which upper middle class families acquire, transmit, and preserve their social and cultural capitals through membership at the Pine View Swim and Tennis Club, a semiprivate facility located near a major mid-Atlantic city in the United States. Drawing on Cultural theorist Pierre Bourdieu’s theorizing on sport participation and social class position, as well as 4 years of ethnographic investigation, I argue that the pool, as a cultural field, maintains socially segregated boundaries offering members a significant, yet hidden vehicle through which they can facilitate their class and race-based privilege. Specifically, Pine View fosters an important sense of community and belonging in and through members, as well as an exclusive social learning opportunity, thus contributing to the (re)production of their White, privileged habitus.
Black Skiing, Everyday Racism, and the Racial Spatiality of Whiteness
Authors: Harrison Anthony Kwame
Published: August 2013

This article examines how structural and symbolic forces combine to produce racialized discourses of belonging and geographies of exclusion in and around downhill skiing. Drawing from literatures in Whiteness studies, sports sociology, leisure studies, and environmental history, I advance the concept of racial spatiality to illustrate how processes of everyday racism work to secure skiing’s social spaces as predominantly White, thereby restricting the participation and representation of Black skiers. Skiing’s hegemony of Whiteness is discussed in relation to parallel integration strategies of Black ski organizations, racialized representations of extreme skiing and snowboarding, and exclusionary residential development tactics. As a provisional effort to promote research on racism and leisure–sports–tourism, I argue that skiing offers a valuable site for considering the ongoing and overlooked saliencies of race and racial segregation in America.
Big Patients, Big Worries
Authors: Skinner Margaret L. , Wohl Daniel L.
Published: August 2013

Program Description:

The obesity epidemic is resulting in more obese adults and children presenting for routine surgery. Obese patients present additional risks related to surgery and perioperative care, and may experience additional morbidity and mortality. This session will focus on reviewing the unique requirements of obese patients to ensure quality care. We will review obesity as an independent factor for increased morbidity, informed consent, preoperative assessments; intraoperative concerns, including anesthesia, airway, medication dosing and ergonomics; postoperative needs including deep venous thrombosis (DVT) prophylaxis, wound healing and management of tracheotomy, and difficult airway concerns. Views of anesthesiologists and adult, pediatric, and private practitioners will be discussed.

Educational Objectives:

1) Describe the preoperative considerations of the obese patient, including anesthesia clearance, management of comorbid conditions and thorough surgical counseling and planning. 2) Recognize intraoperative risks, including anesthesia concerns, medication dosing, positioning, ergonomics, and DVT prophylaxis. 3) Analyze the postoperative course of the obese patient, including tracheotomy and airway management, wound healing and complications, DVT prevention, perioperative infection, and indications for intensive care unit (ICU) admissions.
In‐Office Safety: Are You Putting Your Patient at Risk?
Authors: Stachler Robert J. , Ferguson Berrylin J. , Kopelovich Jonathan C. , Hennessey Patrick T.
Published: August 2013

Program Description:

This one‐hour miniseminar will focus on three important office procedures: Compounded pharmaceuticals: Many office‐based pharmaceuticals are used by otolaryngologists daily. Otolaryngologists need to know what common drug preparations are compounded for use in the office. This 15‐minute segment will provide tips to physicians to ensure their pharmaceuticals are safe. Allergy vial preparation and injections: A 15‐minute presentation will explore current allergy practices and emphasize current safety concerns. Sterilization and safe use of equipment: Best evidence and recommendations for safe equipment reuse and sterilization techniques for office based procedures will be reviewed during this 15‐minute segment.

Educational Objectives:

1) Recognize the dangers associated with the use of compounded pharmaceuticals in the office and safe practices for use of these substances. 2) Implement recommendations for enhancing safe allergy practice, including vial preparation, advancement, and office injections. 3) Apply safe sterilization and device reuse and hygienic practice for the office and steps to implement safe office practice.
Major Complications in FESS: Tips from Expert Surgeons
Authors: Tewfik Marc A. , Wormald Peter J. , Valentine Rowan , Carrau Ricardo , Hwang Peter H. , Stamm Aldo E. C.
Published: August 2013

Program Description:

Identify high‐risk situations pre‐operatively in patients undergoing FESS.

Educational Objectives:

1) Identify high‐risk situations pre‐operatively in patients undergoing FESS. 2) Apply intra‐operative measures and technical pearls in order to avoid serious complications during FESS. 3) Articulate a clear plan for the management of intraoperative emergencies, including orbital hematoma and internal carotid artery injury.
Longitudinal Analysis of Morbidity and Mortality Conference Data for Head and Neck Cancer Patients
Authors: Lai Stephen Y. , Rashmi Richa , Lewis Carol M. , Hessel Amy C. , Gidley Paul W. , Skoracki Roman , Weber Randal S.
Published: August 2013

Objectives:

Morbidity and mortality (M&M) conferences are an important forum for discussing issues related to patient care and developing potential preventative actions. While this is a valuable educational venue, accurate collection of specific patient events also permits longitudinal analysis of these data that may improve the quality of patient care.

Methods:

We changed our reporting system for M&M conference cases in February 2009 by requiring weekly reporting of events by clinical trainees. A database was created to track specific events and associate them with specific surgeons, trainees, and procedures.

Results:

During a 2‐year period, we recorded 330 events (258 patients), which occurred during 4,659 surgical procedures (overall complication rate: 7.1%). Leading categories of complications included hematologic/vascular (89, 26.9%), wound‐related (68, 20.6%), technical (55, 16.7%), and respiratory (42, 12.7%). One hundred and seven patients required a return to the operating room for intervention, and 29 patients needed hospital re‐admission for continued care. There were 10 mortalities on the service, but 2 of these patients did not have any surgical procedure (overall mortality rate: 0.2%). An initial subset analysis of patients requiring free‐flap reconstruction demonstrated 141 complications in 80 patients, which occurred during 672 surgical cases (11.9%).

Conclusions:

Active tracking of M&M conference cases provides a valuable practice‐based system for clinical education and internal auditing of the quality of patient care. Continued tracking of these data beyond this initial 2‐year foundation will provide a valuable internal benchmark to compare against available data and with institutional/national metrics of quality of care at the department and individual surgeon level.
Outcomes of Transplant Patients Treated Surgically for Node Positive Cutaneous Squamous Cell Carcinoma
Authors: Wester Jacob L. , Hernandez Jose , Stott William , Andersen Peter E. , Wax Mark K. , Gross Neil D.
Published: August 2013

Objectives:

Patients with chronic immune suppression are at increased risk of developing cutaneous squamous cell carcinoma of the head and neck (cSCCHN) and often present with advanced stage disease. The purpose of our study was to investigate the survival of transplant patients on chronic immunosuppressive therapies treated surgically for node‐positive cSCCHN.

Methods:

Patients from a tertiary‐care center with node‐positive cSCCHN were identified from 1993‐2012. Demographic, surgical, and pathological data were extracted from the electronic medical record for all patients treated surgically with curative intent. Outcomes were compared between transplant and non‐transplant patients using Kaplan‐Meier estimates.

Results:

Eighty‐six (80M, 6F) patients with a median age of 73 years were identified. Seven (8%) patients had previous transplant surgery. The median time of immune suppression prior to diagnosis was 8 years (range 5‐19). Four (57%) transplant patients presented with recurrent disease. Surgical pathology showed positive margins in 5 (71%) transplant patients compared to 18 (23%) non‐transplant patients, P = 0.01. Perineural invasion, angiolymphatic invasion, and extracapsular spread were not significantly different on tumor pathology between groups. Four (57%) transplant patients had adjuvant radiotherapy. The median survival of transplant patients was 13.0 months (range 9‐26) vs. 29.9 months (range 1.5‐149) in non‐transplant patients. Patients with recurrent disease demonstrated reduced survival, P = 0.03. Adjuvant radiotherapy improved survival regardless of transplant status, P = 0.001.

Conclusions:

Transplant patients treated surgically for node‐positive cSCCHN have an increased risk of recurrent disease, adverse pathological features, and reduced survival compared to non‐transplant patients.
Parathyroid Hormone as a Predictor for Calcium Replacement after Total or Completion Thyroidectomy
Authors: Yaneza May , Little Mhairi , Kasbekar Anand V. , McAllister Kerrie , Blacoe David , Kang Swee K.
Published: August 2013

Objectives:

1) Analyze whether postoperative parathyroid hormone (PTH) level predicts the need for calcium replacement treatment after total or completion thyroidectomy. 2) Evaluate our calcium replacement regimen that is based on PTH levels.

Methods:

Prospective data collected between April 2010 and April 2011. Study Population: Patients undergoing a total or completion thyroidectomy (n = 40). All patients had calcium (Ca2+) checked at 2200h on day 0 (D0), day 1 (D1), day 3 (D3), and day 6 or onwards (D6+). PTH levels were checked on D1, D3, and D6+. Patients with Ca2+ < 1.95 on D1 were given Calcichew (2 tablets) and 1 microgram 1‐alphacalcidol. On D1, patients with PTH > 1.5 and calcium > 1.95 were discharged with no supplementation, and patients with PTH < 1.5 were started on a calcium supplementation regimen depending on their D1 calcium level. –Twenty‐nine patients had PTH > 1.5 on D1; none had calcium < 1.95 on D0 or D1, 12 had calcium < 2.2 on D0, 9 had calcium < 2.2 but > 1.95 on D1, and 1 patient became normocalcaemic. Thus 68.9% (n = 20) had calcium < 2.2 but > 1.95 by D1. Ten patients (34.8%) had calcium < 2.2 but > 1.95 on D6+. Eleven patients were started on a calcium replacement regimen on D1, as their PTH was < 1.5.

Conclusion:

PTH level is a good predictor for the need for calcium replacement after total or completion thyroidectomy, as the patient's calcium levels do not fall to a level that requires treatment if PTH > 1.5 on D1.
Robot/Endoscope–Assisted Selective Neck Dissection by a Postauricular Facelift Approach for cN0 SCCHN
Authors: Tae Kyung , Ji Yong‐Bae , Song Chang‐Myeon
Published: August 2013

Objectives:

We have developed a new novel neck dissection procedure by postauricular facelift incision using the da Vinci robot or endoscope to avoid a long visible neck scar. The aim of this study is to investigate the feasibility and efficacy of this novel procedure in squamous cell carcinoma of head and neck (SCCHN) comparing with conventional neck dissection.

Methods:

We analyzed 30 SCCHN patients with clinically node negative neck (cN0) who underwent robot/endoscope assisted selective neck dissection (SND) by postauricular facelift approach (11 patients, 12 necks) or conventional neck dissection (19 patients, 21 necks).

Results:

The distributions of gender and age did not differ between the two groups. The extent of SND was level I, II, and III in oral cancer, and level II, III, with/without IV, V in oropharynx, larynx, and hypopharynx cancer in both group. The robot/endoscope assisted SND was completed successfully in all patients. The mean operative time of SND was longer in the robot/endoscope group (219 ± 65 min) than the conventional group (144 ± 43 min) (P < 0.05). The mean number of lymph nodes removed was 24.6 ± 8.0 and 28.9 ± 8.2 in the robot/endoscope and conventional group, respectively (P = 0.151), and the number of lymph nodes removed in each levels also did not differ between the two groups. There was no major postoperative complication in both groups.

Conclusions:

Robot or endoscope assisted SND by postauricular facelift approach is a cosmetically excellent procedure and comparable to conventional neck dissection in selected patients with cN0 SCCHN.
Wnt Signaling Pathway Inhibition Enhances Efficacy of Cetuximab
Authors: Schmale Isaac , Thylur David , Yamamoto Vicky , Kalra Vijay , Sinha Uttam K.
Published: August 2013

Objectives:

1) Investigate whether Wnt pathway inhibition via a small molecule inhibitor, ICG‐001, enhances cetuximab efficacy in head and neck squamous cell carcinoma (HNSCC). 2) Elucidate the mechanism of cetuximab sensitization and increased cell death that results from ICG‐001/cetuximab cotreatment.

Methods:

HNSCC cell line SCC‐15 was grown for 24 hours then incubated with: ICG‐001, cetuximab, or both for 48‐72 hrs. Cells grown in media alone served as control. Cell proliferation was analyzed using WST‐1 and clonogenic assays. The mechanism of ICG‐001/cetuximab interaction was investigated using reverse transcription polymerase chain reaction (RT‐PCR), Western blot, immunohistochemistry, and TUNEL staining.

Results:

SCC‐15 cells treated with ICG‐001/cetuximab demonstrated significantly decreased viability (19.9%) as determined by WST‐1 assay compared to control (100%), cetuximab (90.3%), or ICG‐001 (35.1%) treatment (P < 0.05). Additionally, clonogenic assay demonstrated that combination ICG‐001/cetuximab treatment led to significantly decreased cell proliferation (2.6%) compared to control (100%) or monotherapy (cetuximab 94.3%; ICG‐001 20.2%; P < 0.05). ICG‐001 treatment resulted in increased epidermal growth factor receptor (EGFR) expression, as demonstrated by Western blot, RT‐PCR, and immunohistochemistry. TUNEL‐positive cells were shown to be significantly increased in both ICG‐001 and ICG‐001/cetuximab treatment groups. Additionally, combination therapy increased levels of cleaved caspase‐3, a marker of apoptosis.

Conclusions:

ICG‐001/cetuximab cotreatment results in cetuximab sensitization and increased cell death in HNSCC in vitro. Increased EGFR expression and pathway dependence leading to cetuximab vulnerability, along with increased apoptosis, play a major role in this observed effect. ICG‐001/cetuximab cotreatment represents a potential novel therapy in HNSCC management which may offer superior outcomes with fewer side effects compared to existing first‐line treatment.
A Telerobotic System for Transnasal Surgery of the Larynx and Upper Airways
Authors: Dharamsi Latif M. , Bajo Andrea , Netterville James L. , Garrett C. Gaelyn , Simaan Nabil
Published: August 2013

Objectives:

The trend toward minimally invasive surgery has been an historic force driving the development of new surgical technique, specifically endoscopy. Transnasal endoscopic approaches to the larynx have been used but are limited by the precision and accuracy afforded to the surgeon. The objective of this study is to analyze and describe the feasibility, accuracy, and precision of a rapidly deployable telerobotic system for enabling transnasal microsurgery of the larynx and upper airways, specifically injection laryngoplasty.

Methods:

A feasibility study was conducted in which a tele‐operated system composed of a 5 degree of freedom continuum manipulator, 2 instrumentation ports, and a 1.2mm fiberoptic endoscope, to list a few key components, was deployed in both a human intubation trainer mannequin and cadaver using a nasopharyngeal airway as the conduit. Novel control algorithms assist the insertion by autonomously conforming the shape of the robot to the unknown curvature of the anatomy. A flexible needle was passed through the endoscope and used to target specific areas of the vocal folds to simulate injection laryngoplasty in our experimental models. Experiments were recorded with both still and video photography. Our outcome measure was the feasibility of this surgical approach.

Results:

This transnasal telerobotic system is well suited for surgery of the larynx and upper airways.

Conclusions:

Based on our preliminary results, our telerobotic system is suitable for accurate and precise injection laryngoplasty. We propose that such a system has widespread utility for additional surgical procedures of the larynx and upper airway.
Mouse Model to Study the Effect of Noise‐Induced Hearing Loss on the Retrocochlear Auditory Neurons
Authors: Dean Clare , Chen Leon M. , Nahm Edmund A. , Mattiace Linda , Kim Ana H.
Published: August 2013

Objectives:

To create a noise‐induced hearing loss (NIHL) mouse model to examine its effect on neuronal cells in the cochlear nucleus (CN), superior olivary complex (SOC), and lateral lemniscus (LL).

Methods:

Three month old CBA male mice were exposed to 110‐120dB noise over 6 hours. Auditory brainstem response (ABR) tested at 1‐day, 1‐week, 1‐month, and 2‐months after acoustic trauma (AT) confirmed profound hearing loss. Distortion product otoacoustic emission (DPOAE) remained present after AT. FluoroGold (FG) was injected through the right tympanic membrane for retrocochlear neuronal staining.

Results:

The average click ABR threshold shifts were 55dB, 55dB, 45dB, and 48dB after 1‐day, 1‐week, 1‐month, and 2‐months post‐AT, respectively. The average tonal ABR threshold shifts from 8‐28 kHz were 51dB, 50.5dB, 49.8dB, and 43.8dB after 1‐day, 1‐week, 1‐month, and 2‐months, respectively. DPOAE signals from 12‐28 kHz were present at higher thresholds (14.3dB, 12.7dB, 13dB, and 17dB after 1‐day, 1‐week, 1‐month, and 2‐months, respectively) after the NIHL. The average neuronal cell counts in the CN, SOC, LL, and contralateral SOC in deafened mice were 1390 ± 404, 2083 ± 190, 104 ± 21, and 163 ± 27, respectively; compared to 1483 ± 190, 2807 ± 67, 112 ± 20, and 208 ± 23, respectively, in control mice. The SOC yielded the only statistically significant difference between the two groups (P < 0.05).

Conclusions:

A reliable NIHL mouse model has been established. At 2‐months post‐deafening, we found significant decrease in neuronal cells in the SOC. This model serves as a tool to further investigate protective pharmacotherapy against NIHL.
A Novel Rapid‐Prototyped Temporal Bone Model for Surgical Dissection
Authors: Hochman Jordan B. , Unger Bertram , Kraut Jay
Published: August 2013

Objectives:

Temporal bone surgery requires knowledge of complex 3D anatomical features and significant technical skill. An adjunctive training methodology is needed, as educational experiences are limited while public expectations regarding outcome are understandably high. Models employed in training must accurately duplicate the surgical experience, simulating bone structure and procedural drilling qualities. This study describes a novel rapid‐prototyped model made of 3D printed rigid, bone‐like material and includes both face and content validation. In contrast to previous iterations, the model represents requisite subcortical density, and air spaces are void of printing material.

Methods:

Model aeration was assessed. Different harden‐ing agents/resins were compared to sheep femur in accelerometer‐based vibrational properties, penetration depth, and tensile and compressive strength analysis. Two subjective trials provided face validation. Surgeons compared disparate resin agents to sheep femur, while residents compared the model to cadaveric bone. The residents evaluated appearance, mechanical properties, surgical approaches, and educational value.

Results:

The model illustrates comparable aeration to the template images. Hardening resins all compared favorably to sheep bone in mechanical properties and subjective ratings. Face validation found the Rapid Prototyped Model to have realism in appearance, drill character, and surgical approach and significant perceived educational benefit.

Conclusions:

The model performs well in subjective and objective analysis, with representative mechanical properties, and provides a platform for adjunctive training.
Otolith Dysfunction Is Prevalent in Refractory Benign Paroxysmal Positional Vertigo
Authors: Abouyared Marianne , Jethanamest Daniel , Angeli Simon I.
Published: August 2013

Objectives:

Determine the prevalence of otolith dysfunction in patients who have failed treatment for benign paroxysmal positional vertigo (BPPV).

Methods:

Case‐control study of patients with BPPV who failed standard treatment and subsequently underwent vestibular testing and supervised vestibular rehabilitation. Interventions included videonystagmography, rotary chair, subjective visual vertical test (SVV), and cervical vestibular evoked myogenic potentials (VEMP). We compared the prevalence of abnormalities in tests of otolith dysfunction (SVV and VEMP) in patients who responded or failed vestibular rehabilitation.

Results:

In 2012, 46 of 251 patients with BPPV failed initial treatment with canalith repositioning maneuvers performed in the office; of these 46 patients, 28 patients had posterior semicircular canal BPPV and 18 cases had atypical presentations (multicanal BPPV, anterior canal BPPV, or signs of uncompensated unilateral peripheral vestibulopathy). Vestibular testing followed by customized vestibular rehabilitation was completed in 40 patients: 21 patients had resolution of their positional vertigo and nystagmus, and 19 patients did not respond to therapy. Abnormal otolith tests (SVV and/or VEMP) were more common in patients who failed therapy (Pearson Chi square, P = 0.002). Conversely, abnormalities of caloric testing did not predict response to therapy.

Conclusions:

Abnormalities of utricle and saccular function are prevalent in patients with refractory BPPV. This fact is important to take into account when designing rehabilitation strategies for BPPV patients who fail canalith repositioning maneuvers.
The Correlation between Presenting Features and Surgical Outcomes in Pediatric Cholesteatoma
Authors: Vilchez Luis D. , Cushing Sharon L. , Papsin Blake C. , Jamesg Adrian L.
Published: August 2013

Objectives:

Determine how presenting features of cholesteatoma in children influence surgical outcome.

Methods:

A prospective database of 319 consecutive children with cholesteatoma was analyzed to compare features of cholesteatoma at presentation with patient‐focused outcome measures. Features of disease included the presence of otorrhea, hearing loss (mean 4 tone air conduction audiogram more than 30dB HL), the type and extent of cholesteatoma, and ossicular status. Outcomes included hearing threshold, number of surgeries, and canal wall preservation. Cases with cholesteatoma surgery or tympanoplasty prior to referral were excluded.

Results:

Of 200 children with cholesteatomas, 32 ears presented with congenital lesions and 178 ears presented with acquired lesions. The mean age at diagnosis was 6.6 years for congenital and 11.5 years for acquired cholesteatoma. A history of continuous otorrhea had a sensitivity of 0% for diagnosis of congenital cholesteatoma and 37% for acquired. Hearing loss had a sensitivity of 57% for congenital and 72% for acquired cholesteatoma. The canal wall was preserved in 181 (86%) ears at first surgery. Mean hearing level was unchanged after surgery at 36dB HL. More extensive cholesteatoma correlated with more ossicular erosion, more canal wall down surgery, worse postoperative hearing, and more repeated surgeries (P < 0.05; multiple regression analysis).

Conclusions:

Better outcomes for children with cholesteatoma can be achieved by early identification and surgery when lesions are smaller. As cholesteatoma can be relatively silent in children, without otorrhea or hearing loss. Physicians must be trained to identify otoscopic features of congenital and acquired cholesteatoma and initiate prompt referral.
A Prospective Assessment of Biomechanical Changes in Skin after the Injection of Onabotulinum Toxin
Authors: Bonaparte James P. , Ellis David A.
Published: August 2013

Objectives:

Although primarily used as a neuromodulator, a recent case series suggests that botulinum toxin A (onabotulinum) may also improve skin elasticity. The purpose of this study was to test the hypothesis that the administration of onabotulinum for lateral orbital and glabellar rhytides will result in an increase in patient's skin elasticity and reduce the pliability.

Methods:

Forty patients were prospectively enrolled for administration of onabotulinum to their lateral orbit and glabella. To assess skin biomechanics, we used the Cutometer MP580. All patients were assessed pre‐treatment and at 2‐weeks and 2‐months post‐treatment. An analysis of variance (ANOVA) with repeated measures was used to assess for differences between assessments.

Results:

There was a significant increase in both skin elasticity (f = 46.9, P = 0.001) and pliability (f=46.8, P < 0.001) with a mean (+/‐SE) increase in elastic recoil of the skin by 20% (4.4%) for the glabellar region (P < 0.001) and 18% (4.0%) for the lateral orbit (P < 0.0001) while there was an increase in skin pliability of 26% (5.4%) for the lateral orbit (P = 0.001) and 52% (8.3%) for the glabellar region (P < 0.001). There was no significant difference on the patients forearm (control site) for both elasticity (P = 0.57) and pliability (P = 0.16).

Conclusions:

Injection of onabotulinum results in skin that has increased pliability as well as increased elastic recoil. Although this study demonstrates the positive effect of onabotulinum on skin elasticity, it is unclear whether this is due to specific histological changes.
Impact of Evolution of the Eardrum Bridge on the Healing Process of Traumatic Eardrum Perforation
Authors: Lou Zheng C.
Published: August 2013

Objectives:

Characterize the otoendoscopic features of traumatic tympanic membrane perforations (TMPs) with an “eardrum bridge” and evaluate the evolution of the eardrum bridge during the spontaneous healing process.

Methods:

Data for 427 patients with barotrauma‐associated traumatic TMPs who met the case selection criteria were retrieved and categorized into two groups: those with and those without an eardrum bridge.

Results:

Of the 427 patients with traumatic TMPs during the two‐year study period between January 2006 and December 2007, only 36 (8.4%) had an eardrum bridge. For small‐sized perforations, the overall closure rate was significantly different (100% versus 87.7%, P=0.03) between those with and without an eardrum bridge. However, the average closure time was not significantly different (21.2 versus 26.8 days, P>0.05), although the mean closure in cases with an eardrum bridge was shortened by 5 days compared to that in cases without an eardrum bridge. For medium and large perforations, statistical analysis was not performed due to the much smaller number of cases with eardrum bridges.

Conclusions:

Eardrum bridge with traumatic TMP can result in necrosis, migration of stratified epithelium, and epithelium proliferation during the healing process. However, the eardrum bridge seems to improve the healing rate of traumatic perforations.
Postoperative Tonsillectomy Pain Management: A Prospective Randomized Trial
Authors: Standring Robert T. , Guglielmo Robert , Yaremchuk Kathleen L. , Gardner Glendon M. , Ko Alvin B. , Seidman Michael D. , Darrat Ilaaf
Published: August 2013

Objectives:

Examine the efficacy of three separate pain regimen groups for patients who have undergone tonsillectomies by multiple otolaryngologic surgeons at one institution.

Methods:

This study was an institutional review board (IRB) approved prospective randomized cohort study comparing the efficacy of nonsteroidal anti‐inflammatory drugs (NSAIDs), acetaminophen/hydrocodone, and acetaminophen/codeine for post‐operative tonsillectomy pain control. Setting: A tertiary referral hospital. Patients of any age undergoing tonsillectomy from June 2011 until the present were randomized into one of three post‐op pain regimen groups. All tonsillectomy procedures were performed using the same technique, no preoperative local anesthetic injections were given, and no post‐operative antibiotics were provided. Patients/families were given a packet of information to complete that included pain control, time to return to diet, school/work, and baseline activity. Pain control was measured using a validated faces pain scale as well as the amount of drug being administered.

Results:

Eighty‐five patients were enrolled in the study, and twenty‐four patients completed the study packet: 11 patients from the ibuprofen arm, 7 patients from the acetaminophen/hydrocodone arm, and 6 patients from the acetaminophen/codeine arm. The preliminary data were analyzed with Kruskal‐Wallis tests and demonstrated no significant difference in time to return to regular diet (p =0.867), time to return to work (p=0.849), or time to return to work/school (p=0.915).

Conclusions:

These preliminary results demonstrate efficacy of all three pain modalities with no significant difference in returning to pre‐operative function.
Patient Satisfaction as a Quality Indicator in Pediatric Surgical Care: A Systematic Review
Authors: Espinel Alexandra G. , Shah Rahul , McCormick Michael E. , Boss Emily F.
Published: August 2013

Objectives:

Synthesize evidence‐based findings related to patient satisfaction as a quality indicator in pediatric surgical care.

Methods:

We conducted a qualitative systematic review, querying 4 standard search engines (1992‐2013) for studies specific to pediatric surgical fields in which patient/parent satisfaction or experience‐of‐care was a primary outcome measure. Data were systematically analyzed to determine study characteristics, setting, parent/patient focus, measure of experience, and bias. Two independent investigators independently reviewed all articles.

Results:

The initial search yielded 4678 publications (1433 duplicates) of which 170 underwent full text review. Thirty‐five were included for analysis; the majority (24/35,77%) were published in the last 5 years. Studies examined experience of the child (4/35), parent (19/35), or both (12/35). Experience and satisfaction were evaluated either by validated self‐assessment instruments (9) or satisfaction tools (13), or by non‐standard institutional or author‐developed tools (20). Experience was measured in the outpatient (7), pre‐operative (11), peri‐operative (14), and post‐operative care (3) settings. Specific findings were unique to setting; however, pooled conclusions revealed that continuous communication with parents and an empathetic care team are associated with increased satisfaction with care.

Conclusions:

Experience‐of‐care is a valuable quality measure which is being more frequently evaluated as a mechanism to improve pediatric surgical care processes. Future investigation of patient experience in this discipline should employ validated tools for measurement. This review emphasizes that communication with families in each stage of the surgical process improves the patient experience and parent satisfaction. These findings bear significance as patient experience measures become routinely integrated with quality and reimbursement.
Impact of VEGF‐C Gene Polymorphisms and Environmental Factors on Oral Cancer Susceptibility in Taiwan
Authors: Chen Mu‐Kuan
Published: August 2013

Objectives:

Oral cancer, which is the fourth most common male cancer, is associated with environmental carcinogens in Taiwan. Vascular endothelial growth factor (VEGF)‐C, an angiogenic/lymphangiogenic factor with high expression levels in tumor tissues, plays important roles in the development of several malignancies. This study was designed to examine associations of five VEGF‐C gene polymorphisms with the susceptibility to and clinicopathological characteristics of oral squamous cell carcinoma.

Methods:

Five single‐nucleotide polymorphisms (SNPs) of VEGF‐C were analyzed by a real‐time polymerase chain reaction (PCR) in 470 male patients with oral cancer and 426 cancer‐free controls.

Results:

In this study, we found that the VEGF‐C rs7664413and rs2046463 polymorphisms were associated with oral‐cancer susceptibility but not with any clinicopathological parameters. The GGACA or GACTG haplotype of five VEGF‐C SNPs (rs3775194, rs11947611, rs1485766, rs7664413, and rs2046463) combined was also related to the risk of oral cancer. Among 611 male smokers, VEGF‐C polymorphism carriers who also chewed betel quid were found to have a 14.5‐24.2‐fold risk of having oral cancer compared to the VEGF‐C wild‐type carrier who did not chew betel quid. Among 461 male betel‐quid chewers, VEGF‐C polymorphism carriers who also smoked had a 2.7‐18.1‐fold risk of having oral cancer compared to those who carried the wild type but did not smoke.

Conclusions:

Our results suggest that the two SNPs of VEGF‐C (rs7664413andrs2046463) and either of two haplotypes of five SNPs combined have potential predictive significance in oral carcinogenesis. Gene‐environmental interactions among VEGF‐C polymorphisms, smoking, and betel‐quid chewing might alter one's susceptibility to oral cancer.
Personalized Cancer Care for Head and Neck Squamous Cell Carcinoma
Authors: Geltzeiler Mathew N. , Andersen Peter E. , Gross Neil D. , Cantor Emma L. , Berlow Noah , Pal Ranadip , Keller Charles
Published: August 2013

Objectives:

Tumor resistance to single‐agent chemotherapy is ubiquitous, and recurrence after initial therapy remains a therapeutic challenge. The objectives of our study are: 1) Characterize functional therapeutic targets for primary tumor cells from a recurrent head and neck squamous cell carcinoma (SCCa) patient. 2) Determine a personalized drug combination accomplished by mathematical modeling.

Methods:

A patient with stage IVa floor of mouth SCCa refused surgery and received cytotoxic chemoradiation in 2012. Following progression, the patient underwent radical excision at OHSU. A portion of the specimen was converted to a primary‐cell culture. Tumor cells were screened for functional therapeutic targets with a custom high‐throughput 60‐drug panel of molecularly‐targeted agents. A personalized drug combination was generated using a probabilistic Boolean algorithm which cross‐correlates drug‐screen results with known drugs targets.

Results:

Twelve drugs decreased tumor cell growth to less than 20% of control. Inhibitors of cyclin‐dependent kinases, proteasomes, Hsp90, vascular endothelial growth factor, and platelet‐derived growth factor receptor had the lowest IC50 values. Dinaciclib was the most potent (absolute IC50 of 4nM). The Boolean algorithm predicted 7 two‐target, synergistic combinations that should result in tumor cell death. An example is ALK inhibition simultaneously with WEE1 or PRCKD. Absolute IC50 for crizotinib (ALK inhibitor) and pelitinib (PRCKD and WEE1 inhibitor) were 1.57uM and 1.43uM, respectively.

Conclusions:

Molecularly‐targeted drug screening and mathematical modeling may provide a feasible mechanism for choosing combinations of targeted therapies that abrogate tumor cell resistance. Once validated, this treatment paradigm may be a powerful method for guiding therapy when a patient develops resistance to the standard‐of‐care.
Prognostic Factors in Recent Head and Neck Squamous Cell Carcinoma of Unknown Primary Site (HNSCCUP)
Authors: Kobayashi Kenya , Omura Go , Saito Yuki , Ebihara Yasuhiro , Asakage Takahiro , Yamasoba Tatsuya
Published: August 2013

Objectives:

HNSCCUP is heterogeneous and the treatment strategies remain controversial. Recently p16 overexpression may be becoming a good prognostic surrogate marker in oropharyngeal carcinoma. We investigated prognostic factors for HNSCCUP, including p16 status.

Methods:

Forty patients with HNSCCUP who visited our department from 1996 to 2010 were retrospectively reviewed. The nodal stage was N1, N2, and N3 in 4, 22, and 14 patients, respectively. Neck dissection alone was performed in 19 patients, neck dissection together with adjuvant irradiation in 14 patients, and chemoradiotherapy in 7 patients with unresectable nodes. We immunohistochemically assessed p16 expression in neck metastasis. As prognostic factors, we analyzed N stage, location, extracapsular spread (Ex), primary site, heavy smoking and drinking, and p16 expression.

Results:

The primary cancer eventually emerged in 15 patients. Eight patients were p16‐positive, among whom oropharynx was the most frequent primary site (P = 0.02). The 3‐year disease‐specific survival (DSS) and overall survival rates were 74% and 65%, respectively. For DDS, N3 (56% vs 84%), level IV V metastasis (50% vs 83%), Ex (59% vs 100%), and heavy smoking and drinking (55% vs 95%) were significant adverse prognostic factors. p16‐negative patients had a low DSS (68% vs 100%), but it was not statistically significant. In multivariate analysis, N3 and Ex had significant correlations with prognosis.

Conclusions:

p16 overexpression can predict the primary site in the oropharynx and may become a positive prognostic factor. N stage, Ex, location of neck metastasis, smoking and drinking status, and p16 expression should be considered in the treatment for HNSCCUP.
Safety and Quality Considerations in Transoral Surgery for Neoplastic Disease
Authors: Stoddard Timothy R. , Haughey Bruce H. , Holsinger F. Christopher , Nussenbaum Brian , Stadler Michael E.
Published: August 2013

Objectives:

1) Review the importance of quality and patient safety initiatives in surgical care, identifying the specific role that these play in transoral surgical (TOS) procedures. 2) Describe the usefulness of a surgical safety checklist designed for TOS procedures.

Methods:

Expert opinion, clinical consensus, and a comprehensive literature search were conducted in this project. A systematic review of the literature between 1946 and January 2013 was performed using Pubmed and Medline. Search terms included: quality, patient safety, otolaryngology, head and neck surgery, Surgical checklist, clinical care pathway, transoral laser microsurgery, transoral robotic surgery. Altogether, 200 abstracts were initially reviewed, and 51 studies were selected based on their relevance to the objectives listed above.

Results:

A comprehensive review of quality and patient safety initiatives in surgical care revealed that clinical care pathways and surgical safety checklists are effective tools in reducing perioperative morbidity, mortality, and cost of care. In otolaryngology‐head and neck surgery, checklists have only been described for endoscopic sinus surgery. A comprehensive, yet usable, surgical quality and safety checklist for TOS procedures was then developed by the authors based on previously successful models from the literature, as well as from expert opinion.

Conclusions:

Transoral surgery (TOS), including the use of lasers and/or robotics, is an increasingly used and important treatment option for the management of neoplastic diseases of the head and neck. We propose a comprehensive surgical safety checklist that addresses the unique risks and technical requirements of TOS procedures.