bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adherence to PAP and Subspecialist Referral for PAP Intolerance Following Polysomnogram
Authors: Russell Jonathon O. , Gales Jordan , Bae Charles , Kominsky Alan 
Published: September 2014

Objectives:Obstructive sleep apnea (OSA) is a serious medical condition that adds to patient morbidity and mortality. While treatment with positive airway pressure (PAP) is the standard of care, a significant portion of patients fail to adhere. Little is known about the subsequent management of patients who have refused or failed continuous positive airway pressure. We sought to identify rates of acceptance and adherence to PAP, as well as management and referral patterns of those who failed.Methods:Retrospective cohort study in an academic hospital. All patients undergoing polysomnogram at a single institution during the months of March and April 2010 (n = 1174) were screened for OSA. Adult patients with apnea‐hypopnea index (AHI) > 15 or 5 < AHI < 15 as well as Epworth Sleepiness Scale (ESS) >10 were included for subsequent analysis. Patients undergoing polysomnography were screened for OSA retrospectively using the electronic medical record (EMR). The subsequent management history including tolerance of PAP and referral to specialists upon failure was collected.Results:Of 1174 patients screened, 566 met inclusion criteria. Of 416 patients (74%) with follow‐up information, 237 (57%) were ultimately adherent to PAP. Of 205 nonadherent patients, 86 had refused PAP immediately (42%). Sixty‐one (30%) were referred upon failure or refusal. A total of 139 patients (68%) suffered from untreated OSA without referral to a specialist during a 3‐year follow‐up.Conclusions:Despite the known sequellae of OSA, clinicians are neither treating nor referring a significant percentage of patients with OSA. Therapies other than PAP may be warranted in this population.
Comparison of Efficacy and Safety of Intranasal Midazolam with Syrup Chloral Hydrate for Procedural Sedation
Authors: Mathew John 
Published: September 2014

Objectives:Evaluate the efficacy and safety of intranasal midazolam and syrup chloral hydrate for procedural sedation in children.Methods:A prospective, randomized, double‐blinded placebo controlled trial, in a tertiary care hospital over 18 months. A total of 82 children, ages 1 to 6 years, undergoing auditory brainstem response testing, were randomized to receive either midazolam nasal spray with oral placebo or syrup chloral hydrate with placebo nasal spray. Midazolam at 0.5 mg/kg delivered as 100 mcg per spray and oral syrup at a dose of 50 mg/kg. Children not sedated at 30 minutes had a second dose at half the initial dose. The primary outcomes measured were safety and efficacy. Secondary outcomes were time to onset of sedation, parental separation, nature of parental separation, parental satisfaction, audiologists satisfaction, time to recovery, and number of attempts.Results:There were 41 children in each group. No major adverse events noted. The chloral hydrate group showed earlier onset of sedation (66%) compared with midazolam group (33%). A significant difference in the time to recovery in the chloral hydrate (78 min) group compared with the midazolam group (108 min). Parental and audiologist satisfaction was higher for chloral hydrate (95 % and 75%) than for midazolam (49% and 29%). Overall, sedation with chloral hydrate was 95% compared with 51% with midazolam. Both the drugs maintained sedation.Conclusions:Both intranasal midazolam and oral chloral hydrate are safe and efficacious for pediatric procedural sedation. Chloral hydrate was superior to intranasal midazolam with an earlier time to onset of sedation, a faster recovery, better parental and audiologist satisfaction, and successful sedation.
Does OSA in Children with Small Tonsils Improve after Adenotonsillectomy?
Authors: Tang Alice L. , Benke James R. , Ishman Stacey L. 
Published: September 2014

Objectives:There is conflicting opinion regarding the clinical utility of removing small tonsils in children with obstructive sleep apnea (OSA). We sought to (1) determine if OSA improves after adenotonsillectomy (AT) in children with small tonsils; and (2) investigate the relationship between OSA resolution and tonsil size after AT.Methods:Retrospective study of 1‐ to 18‐year‐old consecutive nonsyndromic children with OSA who underwent polysomnography before and after AT. Complete response was defined as obstructive respiratory disturbance index (RDI) < 1.5.Results:Seventy children (36 female) were included; mean age was 5.9 ± 4.3 years. Tonsils were categorized as 2+ (n = 20), 3+ (n = 36), and 4+ (n = 14). Preoperative RDI, obstructive apnea index (AI), and obstructive hypopnea index (HI) were similar regardless of tonsil size (P >. 05). Overall RDI improved from 18.6 ± 8.6 to 4.0 ± 6.0 with 44% (31/70) complete responders. In the 2+ group, AI and saturation nadir significantly improved (P =. 004‐.033) but HI and RDI did not (P =. 08‐21). All 4 parameters significantly improved for the 3+ (P =. 001‐<.0001) and 4+ (P =. 018‐.003) groups. The mean RDI improvement in the 2+ group was 10.8 ± 5.9 events/hour with 25% (5/20) complete responders, 14.8 ± 2.4 with 56% (20/36) responders in the 3+ and 18.7 ± 5.4 with 43% (6/14) responders in the 4+ group. There was no correlation between OSA severity and tonsil or adenoid size (P >. 32).Conclusions:Tonsil size did not correlate with OSA severity. While a larger proportion of patients with 3+/4+ tonsils had complete response after surgery, significant improvement was seen in AI and saturation nadir even in those with 2+ tonsils.
Development of a Clinical Care Pathway for Severe Epistaxis at a Tertiary‐Care Medical Center
Authors: Kass Jason I. , Vosler Peter S. , Wang Eric W. , Snyderman Carl H. 
Published: September 2014

Objectives:(1) Describe the treatment patterns for the management of severe epistaxis at a tertiary‐care center. (2) Develop a clinical care pathway (CCP) for system‐wide management of severe epistaxis.Methods:A review of patients admitted for epistaxis from August 2012 to December 2013 was performed using: (1) CPT codes and (2) a digital archive of all medical records. Severe epistaxis was defined as persistent bleeding not controlled using local pressure, vasoconstrictive medication, and anterior packing. A root cause analysis identified factors contributing to the morbidity and mortality of patients with severe epistaxis.Results:Of 332 cases of epistaxis, 48 met criteria for severe epistaxis. Of these, 64.6% (31/48) presented via the Emergency Department and 35.4% (17/48) as an inpatient. All were packed initially. Average duration of packing was 3.02 ± 1.88 days. Nearly half (45.8%) failed packing and had either sphenopalatine artery ligation (37.5%) or embolization (8.3%). Intubation was required in 16.7% (8/48) for airway protection. Nearly half (48.9%) were inappropriately admitted to a location where key resources (operating room and interventional radiology) were unavailable after hours. A CCP was then devised in conjunction with emergency medicine that minimizes the duration of nasal packing and length of hospitalization and reduces the total cost of care. Implementation of the pathway required changes in the electronic medical record and educational programs.Conclusions:Implementation of a CCP requires evaluation of current practices and the standard of care followed by input from institutional decision makers. Quantifying improvement requires retrospective normative data with ongoing review of compliance with the CCP.
Functional Outcomes and Quality of Life Associated with Cricopharyngeal Myotomy for Cricopharyngeal Dysfunction: A Prospective Study
Authors: Van Abel Kathryn M. , Moore Eric J. , Kasperbauer Jan L. , Hinni Michael L. , Lott David G. , Baron Todd H. , Ekbom Dale C. 
Published: September 2014

Objectives:(1) Evaluate cricopharyngeal myotomy (CPM) for cricopharyngeal dysfunction (CPD) including Zenkers diverticulum (ZD) and cricopharyngeal bar/hypertrophy (CPB). (2) Analyze functional outcomes and quality of life associated with CPD following CPM.Methods:A prospective multicenter study performed from January 1, 2012, to July 1, 2014, included patients presenting with CPD undergoing CPM. Standardized questionnaires including the 10‐item Eating Assessment Tool (EAT‐10), Functional Outcome of Swallowing Scale (FOSS), and the Reflux Symptom Index (RSI) were completed preoperatively, at 3 and 6 months postoperatively.Results:Thirty‐two patients were included (18F; mean 71 years; range, 53‐86 years). Primary CPD included ZD (17/32; 53.1%), CPB (6/32; 18.8%), and ZD+CPB (9/32; 28.1%). The most common comorbidities included GERD (11/32; 34.4%), hiatal hernia (6/32; 18.8%), and an underlying neurologic disease (5/32; 15.6%). Twenty‐six patients (81.3%) underwent rigid‐endoscopic, 3 (9.4%) underwent flexible‐endoscopic, and 3 (9.4%) underwent open‐transcervical CPM. One patient developed a leak on postoperative day 3. There were no deaths. Three patients experienced treatment failure at 7, 14, and 14 months postoperatively, requiring revision surgery. Mean preoperative RSI was 24.7 (range, 10‐40), FOSS was 2.2 (range, 0‐4), and EAT‐10 was 20.7 (range, 2‐34). The 3‐month questionnaire (32/32, 100%) demonstrated an improved mean RSI of 7.2 (range, 0‐30), FOSS of 0.6 (range, 0‐3), and EAT‐10 of 4.6 (range, 0‐24). A total of 63% (20/32) completed the 6‐month questionnaire, demonstrating a stable/improved mean RSI of 4.95 (range, 0‐17), FOSS of 0.55 (range, 0‐2), and EAT‐10 of 3.1 (range, 0‐15).Conclusions:This represents one of the first prospective studies to demonstrate a significant improvement in functional outcome and quality of life in patients with CPD undergoing CPM.
Human Parafollicular Cancer Cells: A Neuronal Model for Novel Drug Identification to Treat Neuropathic Pain
Authors: Masterson Caleb , Durham Paul L. 
Published: September 2014

Objectives:This study was conducted to identify the types of functional voltage‐gated calcium channels expressed by the neuronal‐like human parafollicular (CA77) cancer cell line.Methods:CA77 cells were grown in culture and the expression of functional calcium channels studied using Fura‐2 am during live cell imaging to measure changes in intracellular calcium levels in response to stimulation with potassium chloride (KCl) alone and in combination with several voltage‐gated calcium channel blockers. These included: nifedipine, funnel spider toxin (FTX), and ω‐conotoxin, which inhibit L‐type, P/Q‐type, and N‐type voltage‐gated calcium channels, respectively. To investigate transcriptional expression, primers for L‐, N‐, and P/Q‐type channels were used in reverse transcriptase polymerase chain reaction (RT‐PCR).Results:Significant increases in intracellular calcium levels were measured in response to KCl (P <. 001, n = 45), which was not repressed by nifedipine or ω‐conotoxin (P =. 893, n = 34, P =. 957, n = 31). However, KCl‐mediated intracellular calcium increase was repressed by FTX (P <. 001, n = 42). Using RT‐PCR, mRNA for P/Q‐type receptor was detectable but not the mRNA for the N‐ and L‐type voltage‐gated channels.Conclusions:Taken together, our results provide evidence that CA77 cells express functional P/Q (CaV2.1) calcium channels, which are known to promote increased neuronal excitability, inflammation, and nociception. Thus, CA77 cells can provide an efficient and cost‐effective means to screen novel therapeutics to treat migraine and other neurological diseases of the head and neck that involve P/Q channel activation in the underlying pathology.
Medical Malpractice in Sinonasal Disease: An Analysis of Litigation over the Last Ten Years
Authors: Winford Tyler W. , Wallin Jordan L. , Clinger John D. , Graham Aaron M. 
Published: September 2014

Objectives:(1) Review past literature on medical malpractice in rhinology and sinonasal disease in the Unites States of America. (2) Analyze otolaryngology malpractice litigation related to sinonasal disease in the last 10 years. (3) Discuss ways to prevent future malpractice litigation in this area of otolaryngology.Methods:The study is a case series with review of court records pertaining to litigation of otolaryngologic treatment of sinonasal disease using the Westlaw and Lexis Nexis legal databases. The phrase medical malpractice was searched with terms related to sinonasal disease involving court cases in the last 10 years, yielding 26 cases. The cases were analyzed for pertinent data regarding plaintiffs, presenting complaint, practice setting, type of malpractice, resulting injury, result of verdict, and amount of reward or settlement.Results:Chronic sinusitis was the most common presenting symptom. Many cases included multiple types of alleged malpractice with the most common being negligent technique and lack of informed consent. The most common alleged injuries included cerebrospinal fluid leak, meningitis, nasal obstruction, and orbital trauma. Defendants prevailed in 13 of the 18 cases in which outcomes were known, with mean award of $225,000 and mean settlement of $212,500. The cases won by plaintiffs were all in a private practice setting.Conclusions:Otolaryngologists should be aware of the causes of malpractice litigation as it relates to treatment of sinonasal disease and ensure informed consent is obtained and well‐documented. A unified and complete database of medical malpractice cases is needed to allow for further analysis of specialty‐related claims.
The Quality of Economic Evaluations in the Otolaryngology Literature
Authors: Liu C. Carrie , Lui Justin T.H. , Oddone‐Paoluccu Elizabeth , Rudmik Luke 
Published: September 2014

Objectives:(1) Identify factors that may predict the quality of economic evaluations in the otolaryngology literature. (2) Identify current weaknesses in published economic evaluations for the purposes of improving the quality of future studies.Methods:This is a retrospective quality review of published economic evaluations using the validated Quality of Health Economic Studies (QHES) instrument. A systematic review of the Medline, Embase, PubMed, and NHS economic evaluation databases was performed using otolaryngology key terms combined with the terms cost and effectiveness. A manual search of 33 otolaryngology journals was also performed to prevent missed studies. Included studies were graded using the QHES instrument, a 16‐item checklist providing a total quality score of 100.Results:Fifty studies were identified, and the mean QHES rating was 54.7 (SD: 31.0). Higher quality economic evaluations were associated with a higher journal impact factor (correlation coefficient r 0.62, P <. 01), having an author with a PhD in health economics (r 0.56, P <. 01), and having authors who have published prior economic evaluations (r 0.46, P <. 01). The most commonly omitted methodology was lack of defining the cost perspective and lack of a robust sensitivity analysis.Conclusions:The quality of economic evaluations is important to properly inform efficient allocation of scarce health care resources. Our study investigated the overall quality of economic evaluations in the otolaryngology literature and demonstrated that there is potential to improve the quality of published studies. Future studies should follow published methodology guidelines and consider collaborating with authors who have experience with economic evaluation.
Racial Disparities in Incidence of Human Papillomavirus–Associated Oropharyngeal Cancer in an Urban Population
Authors: Ramer Ilana , Varier Indu V. , Zhang David Y. , Demicco Elizabeth , Posner Marshall , Misiukiewicz Krzysztof , Sikora Andrew G. 
Published: September 2014

Objectives:(1) Determine whether there is a difference in the incidence of human papillomavirus (HPV)–associated oropharyngeal carcinoma (OPC) between non‐Hispanic Caucasians and minorities in an institutional series drawn from the highly urbanized population of New York City.Methods:Several recent studies suggest that rates of HPV‐associated OPC are higher in Caucasians than in minorities. We hypothesized that this difference would be lower in the highly diverse, urban population of New York City. This is a retrospective chart review of 240 patients with surgically treated OPC at the Icahn School of Medicine at Mount Sinai (ISMMS) between 1999 to 2013. Researchers determined age, sex, race, ethnicity, and tumor site of study participants. Polymerase chain reaction (PCR) was used to detect the presence of oncogenic HPV‐DNA in paraffin tumor blocks. Incidence of HPV‐positive cancers was compared between Caucasians and minorities (defined as African Americans, Asians, and Hispanics) using Fisher's exact test.Results:We found a higher incidence of HPV‐positive OPC HPV in Caucasians than racial minorities within the ISMMS population (P =. 010). HPV incidence detected by PCR was 149 out of 192 (77.6%) for Caucasians and 28 out of 48 (58.3%) for minorities. Specifically, there was a higher incidence in Caucasians compared with African Americans (P =. 024), but no significant difference between Caucasians and Hispanics (P =. 218). There were no significant differences between the 2 cohorts in sex or age.Conclusions:The incidence of HPV‐positive OPC is higher in non‐Hispanic Caucasians than in minorities in New York City. This observation is consistent with previously reported trends from study populations in less urbanized areas.
Ten Steps to Develop Patient Education Videos for Individuals of All Health Literacy Levels
Authors: Saffarzadeh Areo G. , Verma Sunil P. 
Published: September 2014

Objectives:(1) Create a protocol for developing educational videos for patients of all health literacy levels. (2) Describe National Institutes of Health (NIH) guidelines, evidence‐based principles of instructional design, and industry best practices related to creating educational videos for patients.Methods:Utilizing (1) NIH guidelines for patient education materials, (2) evidence‐based principles of instructional design, and (3) industry best practices, a 10‐step protocol was developed for creating video‐based patient education materials. As a proof‐of‐concept, these 10 steps were used to create a short video to help patients understand flexible laryngostroboscopy.Results:Using NIH guidelines, a script was created with text designed for the sixth‐grade reading level using the SMOG Readability Formula. Evidence‐based principles of instructional design that were incorporated into the video included: the Personalization Principle, Multimedia Principle, Coherence Principle, Contiguity Principle, and Practice Principle. A video was recorded with a high definition camera, and audio narration was recorded separately. A short video describing laryngeal anatomy and showing actual footage laryngostoboscopy was edited on Camtasia Studio 8.0 and produced for optimized viewing on the iPad. The video was pilot tested on patients prior to undergoing flexible laryngostroboscopy at an outpatient otolaryngology–head and neck surgery clinic.Conclusions:There is currently no protocol for creating educational videos for patients with limited health literacy. This 10‐step protocol was created to help those creating educational videos incorporate NIH guidelines, evidence‐based principles of instructional design, and industry best practices into their projects.
Are Patients Undergoing Thyroidectomy in Montreal, Canada, during Winter at Increased Risk for Postoperative Hypocalcemia?
Authors: Mascarella Marco A. , Nhan Carol , Payne Richard J. 
Published: September 2014

Objectives:(1) Review the rate of postoperative hypocalcemia in patients undergoing thyroidectomy in the summer and winter. (2) Identify the association between the season when surgery was completed and the risk of postoperative hypocalcemia.Methods:A retrospective chart review of 436 patients undergoing thyroidectomy at the McGill University Thyroid Cancer Centre from 2006 to 2014 was performed. Patients undergoing total or completion thyroidectomy in the winter months (December to February) and summer months (July to September) were included in the study. Parathyroid hormone (PTH) and serum corrected calcium were recorded according to the McGill post‐thyroidectomy protocol. Preoperative PTH and 25‐hydroxyvitamin D (25‐OHD) were measured. Hypocalcemia was defined as a corrected calcium level <1.9 mmol/L.Results:The rate of postoperative hypocalcemia was 8% for patients operated on in the winter and 1.8% for those in the summer (P =. 01). Patients undergoing surgery in the winter were 4.3 times more likely to develop postoperative hypocalcemia than those in the summer (P =. 01, 95% confidence interval [1.5 to 1 5]). Surgery during the summer months showed a higher preoperative 25‐OHD level (P =. 04). Preoperative PTH levels were significantly greater in the winter months as compared with the summer (5 pmol/L and 4.5 pmol/L, respectively; P =. 01). Patients with 25‐OHD deficiency (≤70nmol/L) were not found to have a higher rate of postoperative hypocalcemia (5.2% and 13.8%, respectively; P =. 22).Conclusions:In this study, patients undergoing thyroidectomy during the winter months were 4.3 times more likely to develop postoperative hypocalcemia when compared with patients operated in the summer.
The Diagnostic Accuracy of Fine‐Needle Aspiration for Parotid Malignancy
Authors: Stein Andrew P. , Britt Christopher J. , Hartig Gregory K. 
Published: September 2014

Objectives:Determine the sensitivity and specificity of fine‐needle aspiration (FNA) in the diagnosis of parotid malignancy and analyze those histologies most often associated with false negative and false positive results.Methods:A retrospective chart review was performed for all patients who had a parotidectomy at the University of Wisconsin from 1994 to 2013. Patients who underwent preoperative FNA were identified, and FNA results were categorized as benign, malignant, or indeterminate. Surgical pathology was utilized as the gold standard.Results:A total of 771 patients underwent parotidectomy from 1994 to 2013, and 280 patients (36.3%) had a preoperative FNA. Based on surgical pathology, 178 (63.6%) patients had benign disease and 102 (36.4%) had malignant parotid neoplasms. 174 (62.1%) FNAs were benign, 94 (33.6%) were malignant, and 12 (4.3%) were indeterminate. Excluding indeterminate cases, the sensitivity and specificity for FNA in the diagnosis of parotid malignancy were 83.7% (95% confidence interval [CI]: (74.8%, 90.4%)) and 93.0% (95% CI: (88.0%, 96.3%)), respectively. Moreover, FNA correctly categorized malignancy in 83.7% (n = 82) and benign in 92.9% (n = 158) of cases. There were 16 false negatives (16.3%) with mucoepidermoid carcinoma having a diagnostic accuracy of 60% and acinic cell carcinoma 50%. Both were most commonly mistaken for pleomorphic adenoma. There were 12 false positives (7.1%), most commonly pleomorphic adenoma (n = 4) and warthins (n = 3).Conclusions:This study demonstrates that FNA has high sensitivity (83.7%) and specificity (93.0%) for the diagnosis of parotid malignancy. However, mucoepidermoid carcinoma and acinic cell carcinoma are more commonly associated with a false negative FNA.