bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends Following Implementation of an Otolaryngology Hospitalist Model in a Tertiary Care Setting
Authors: Willingham Elizabeth , Shelly Sandeep , Wise Sarah K. 
Published: January 2023

AbstractObjectivesThe otolaryngology hospitalist (OH) model is an emerging paradigm for inpatient and acute patient care. This study presents encounter volume before and after the implementation of an OH service. Postimplementation trends are evaluated.Study DesignRetrospective administrative and clinical database review.SettingTertiary care university hospital.MethodsThis review includes 2 distinct time frames (2008‐2012, 2014‐2018), representing periods before and after OH implementation. The number of billed patient encounters is compared between these 2 periods using the hospital data warehouse. Additional data is evaluated for the postimplementation period, using a clinical database. Encounter type, the reason for consultation, procedures, and requesting service/location are described.ResultsAfter the OH implementation, there was a 451% increase in evaluation and management encounters submitted for billing. Since the OH model inception, there was an overall increase in encounters (849‐910), procedures performed (319‐345), and operative cases (46‐54) per year. Each inpatient consultation request generates one or more procedures on average. Common reasons for consultation include sinonasal pathology (20.3%), dysphonia/dysphagia (17.5%), and airway evaluation (15%). Critical Care (24%), Emergency Medicine (21%), and Hospital Medicine (21%) requested most of the Otolaryngology consults. Most consults were seen on the inpatient medical/surgical floor (46%), with the ICU (27%) and the Emergency Department (22%) being the next most common locations.ConclusionsThe OH model is an evolving paradigm that is viable and offers timely, specialized care for patients in a hospital or acute care setting.
Frailty, Age, ASA Classification, and BMI on Postoperative Morbidity in Mandibular Fracture ORIF
Authors: Nguyen Theodore V. , Torabi Sina J. , Goshtasbi Khodayar , Lonergan Ashley R. , Salehi Parsa P. , Haidar Yarah M. , Tjoa Tjoson , Kuan Edward C. 
Published: January 2023

AbstractObjectiveTo assess how traditional, simple markers of health independently affect postoperative morbidity of mandibular fracture open reduction‐internal fixations (ORIFs).Study DesignCohort study.SettingNational Surgical Quality Improvement Project (NSQIP) Database.MethodsThe 2005 to 2017 NSQIP database was queried for patients who underwent mandibular ORIF. To control for the severity of the trauma, an additional “concurrent surgery” variable was created. A modified 5‐item frailty index was calculated based on the following: presurgery‐dependent functional status, chronic hypertension, diabetes mellitus, history of chronic obstructive pulmonary disease, and history of congestive heart failure.ResultsAmong 1806 patients with mandibular ORIFs (mean age 34.8 ± 15.4 years), modified frailty index (mFI) was associated with 30‐day medical complications (p < .001), reoperation (p < .001), and readmission (p = .005) on univariate analysis. Increased age was associated with prolonged hospitalization (p < .001) and medical complications (p < .001). The increased American Society of Anesthesiologists (ASA) score was associated with all endpoints (p ≤ .003), while increased body mass index (BMI) was associated with none. On multivariate analysis, only increased ASA was associated with any adverse event (reference: ASA 1; ASA 2, odds ratio [OR]: 2.17 [95% confidence interval, CI: 2.17‐3.71],p = .004; ASA 3‐4, OR: 3.63 [95% CI: 1.91‐6.91],p < .001). Similarly, mFI and BMI were not independently associated with prolonged hospitalization (≥2 days) (p ≥ .015), but 65+ age (reference: 18‐49; OR: 2.33 [95% CI: 1.40‐3.86],p = .001) and ASA 3 to 4 groups (reference: ASA 1; OR: 3.26 [95% CI: 2.06‐5.14],p < .001) were.ConclusionASA status and age are more useful modalities than mFI or BMI in predicting poor postoperative morbidity in mandibular ORIF. These simple metrics can assist with managing surgeons' expectations for mandibular ORIF patients.
Bell's Palsy in Pregnancy and Postpartum: A Retrospective Case‐Control Study of 182 Patients
Authors: Lansing Lovisa , Wendel Sophia B. , Hultcrantz Malou , Marsk Elin 
Published: January 2023

AbstractObjectiveTo assess the incidence of Bell's palsy in pregnant and postpartum women. Additionally, to compare facial outcomes in terms of Sunnybrook score following Bell's palsy with regard to corticosteroid treatment and other confounding factors.Study DesignRetrospective case‐control study.SettingUniversity Hospital, Stockholm, Sweden.MethodsAll women with Bell's palsy in pregnancy or postpartum (6 weeks after birth) with a computerized medical chart in the Stockholm Region 2005 to 2015 were included. The total number of births in the region during this period was retrieved from the Swedish Medical Birth Register. Nonpregnant age‐matched women with Bell's palsy served as controls. Characteristics, medication, and Sunnybrook scores were collected. Risk factors for incomplete recovery (Sunnybrook score <96) at 3 months were calculated by logistic regression.ResultsIn total, 182 pregnant and postpartum women with Bell's palsy were identified. The estimated incidence among pregnant and postpartum women was 60.5/100,000 person‐years. The mean Sunnybrook score at 3 months was 74 among pregnant and postpartum women and 83 for controls (p = .002). At 12 months, Sunnybrook score was 81 and 89, respectively (p = .017). Only one‐third of the pregnant women received corticosteroid treatment.ConclusionThe incidence of Bell's palsy in pregnancy and postpartum was 60.5 per 100,000 women and year in the Stockholm Region. Sunnybrook score was poorer in pregnant women compared with postpartum and nonpregnant women throughout. Corticosteroid treatment had little effect on any patients, however, only one‐third of the pregnant women received this treatment.
Prognostic Assessment and Risk Stratification in Patients With Postoperative Major Salivary Acinar Cell Carcinoma
Authors: Zhang Di , Wei Yuce , Chai Yue , Qi Fei , Dong Mei 
Published: January 2023

AbstractObjectiveTo investigate the clinicopathological features and prognosis of postoperative major salivary acinar cell carcinoma (MSACC) and develop a prognostic model.Study DesignRetrospective cohort analysis of a public database.SettingPatients with MSACC were identified from the Surveillance, Epidemiology, and End Results database (1975‐2019).MethodsOverall survival (OS) was evaluated using Kaplan‐Meier curves and a log‐rank test. Univariate and multivariate Cox analyses were performed to explore independent prognostic factors. The prognostic model was constructed using screened variables and further visualized with a nomogram and web calculator, and assessed by concordance index, the area under the curve, calibration curve, and decision‐making curve analysis.ResultsAn upward trend in the incidence of MSACC was observed throughout the study period. A total of 1398 patients were enrolled (training cohort: 978; validation cohort: 420), and the 5‐ and 10‐year OS rates were 97.7% and 81.6%, respectively. Age, marital status, sex, histological grade, T stage, and lymph node status were identified as prognostic factors for OS. A novel nomogram was developed and showed excellent discrimination and clinical applicability. Additionally, a web calculator was designed to dynamically predict patient survival. Based on the nomogram‐based score, a risk stratification system was constructed to distinguish patients with different risks. The OS of high‐risk patients was significantly lower than that of the low‐risk subgroup.ConclusionLong‐term survival in postoperative MSACC was influenced by 6 prognostic factors. The proposed model enables individualized survival prediction and risk stratification, prompting us to be vigilant in high‐risk subgroups and consider timely adjustment of subsequent treatment.
The Clinical Impact of Vagal Nerve Stimulator Implantation on Laryngopharyngeal Function in Children: A Single‐Center Experience
Authors: Hazkani Inbal , Farje Doris , Alden Tord , DiPatri Arthur , Tennant Amy , Ghadersohi Saied , Thompson Dana M. , Rastatter Jeffrey 
Published: January 2023

AbstractObjectiveA vagal nerve stimulator (VNS) has been established as the treatment of choice for children with refractory epilepsy. The outcomes of the procedure have been well documented in adults but are less clear in children. The goal of our study was to review laryngopharyngeal (LP) function following VNS implantation in children.Study DesignCase series with chart review.SettingTertiary‐care children's hospital.MethodsVoice, swallowing, and sleep apnea symptoms were extracted from the charts of children who underwent VNS implantation between 2013 and 2021. A questionnaire was sent to parents of implanted children to ascertain the degree of the social and functional impact of the implant.ResultsThere were 69 patients, aged 2.3 to 21.4 years old, who met the inclusion criteria. LP symptoms were most common during the first year following implantation; 26 patients (37.6%) demonstrated at least 1 symptom (voice alteration, chronic cough, sleep‐disordered breathing, or dysphagia), and 15 patients required adjustments to their implant settings. The incidence of symptoms and the need to adjust VNS settings significantly dropped during years 2 to 5 and 6 to 8 (22% vs 7% and 5%, respectively, p = .0002). The mean score of the Pediatric Voice Handicap Index differed greatly from a normal control group on each subscale and the total score.ConclusionLP dysfunction in children following VNS implantation is comparable to adults, with the most burden noticed during the first year after implantation. The presence of voice alterations did not correlate with the presence of dysphagia and sleep‐disordered breathing. Thorough evaluation, preferably by a multidisciplinary team, is required to assess LP dysfunction postoperatively.
Surgical Treatment in Very Advanced (T4b) Adenoid Cystic Carcinoma of the Head and Neck
Authors: Papazian Michael R. , Chow Michael , Oliver Jamie , Gordon Alex J. , Jacobson Adam , Vaezi Alec , Tam Moses , Givi Babak 
Published: January 2023

AbstractObjectiveTo compare treatment outcomes for T4b head and neck adenoid cystic carcinoma (ACC).Study DesignHistorical cohort study.SettingNational Cancer Database (NCDB).MethodsIdentified all T4b ACC of head and neck origin diagnosed 2004 to 2019 in the NCDB. Demographics, clinical characteristics, treatment details, and survival were analyzed. Treatment outcomes were analyzed using univariable and multivariable Cox regression.ResultsWe identified 606 cases of T4b ACC. Less than half (284, 47.0%) underwent curative‐intent treatment. Among these, most were treated with primary surgery: surgery + radiotherapy (RT) (122, 43.0%) or surgery + chemoradiotherapy (CRT) (42, 14.8%). The positive margin rate was 78.7%, and 90‐day postoperative mortality was zero. Nonsurgical patients were treated with definitive RT (60, 21.1%) or definitive CRT (60, 21.1%). The median follow‐up was 51.5 months. Overall survival was 77.8% at 3 years. Three‐year survival was higher for patients treated with surgery compared to those treated nonsurgically (84% vs 70%; p = .005). Surgical treatment remained associated with higher survival on multivariable analysis (hazard ratio [HR]: 0.47, p = .005). This effect was most pronounced for oral cavity tumors (HR: 0.17, p = .01). Among matched cohorts of surgically treated patients, there was no difference in 3‐year survival between clinical T4a and T4b tumors (83.3% vs 83.0%, p = .99).ConclusionLong‐term survival for T4b ACC of the head and neck could be expected. Primary surgical treatments can be performed safely and are associated with longer survival. A carefully selected subset of patients with very advanced ACC might benefit from the consideration of surgical treatments.
Single Versus Multigene Testing for Hereditary Hearing Loss: Use and Costs in a Commercially Insured Cohort
Authors: Moon Peter K. , Qian Z. Jason , Stevenson David A. , Chang Kay W. 
Published: January 2023

AbstractObjectiveThe objectives of this study were to describe trends in single‐gene GJB2/6 (connexin 26/30) and multigene hearing loss panel (HLP) testing for hereditary hearing loss using real‐world evidence.Study DesignRetrospective study using insurance claims data.SettingOptum Data Mart database from 2015 to 2020.MethodsRates of overall and hearing‐specific genetic testing and costs to insurers and patients were reported. Linear regression models were used to assess the proportion of single‐gene GJB2/6 testing over time. Additional linear regression models were used to assess changes in costs over time.ResultsFrom 2015 to 2020, 91,986 children received genetic testing for any indication, of which 601 (0.65%) received hearing‐specific tests. The proportion of single‐gene GJB2/6 testing remained similar over time (mean difference [MD]: −1.3% per year; 95% confidence interval [CI]: −4.3%, 1.7%), while multigene HLP use increased over time (MD: 4.0% per year; 95% CI: 0.4%, 7.5%). The median charge for single‐gene GJB2/6 testing remained constant during the study period (MD: −$34; 95% CI: −$86, $18), while the median charge for multigene HLP decreased during the study period (MD: −$145 per year; 95% CI: −$278, −$12).ConclusionCompared to molecular testing for GJB2/6, HLPs are becoming more common for hereditary hearing loss. The comprehensiveness of HLP and decreasing costs provide justification for its more widespread adoption moving forward.
Sensitivity and Specificity of US and CT as Diagnostic Tools for Pediatric Lateral Neck Abscesses
Authors: Ramazani Fatemeh , Yunker Warren K. , Liu Che Carrie 
Published: January 2023

AbstractObjectiveUltrasound (US) and computed tomography (CT) are commonly used in the diagnosis of pediatric neck abscesses. The objective of this study is to determine the sensitivity and specificity of US and CT in the diagnosis of pediatric lateral neck abscesses, with a secondary objective of evaluating the association of specific clinical features with a positive US or CT scan.Study DesignRetrospective review of pediatric patients admitted to a tertiary care center from January 1, 2011, to December 31, 2020, with neck abscesses.SettingTertiary care center.MethodsThe sensitivity and specificity of US and CT were calculated by comparing imaging performed within 24 h of incision and drainage (I&D). Multiple regression was used to evaluate the association of clinical features with a true positive US or CT.ResultsThere were 171 patients included in this study, with a median age of 1.5 years (interquartile range [IQR]: 1‐5 years). I&D was done in 156 patients (91.2%), while 15 (8.8%) were treated with antibiotics. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US were 69.5%, 80%, 96.6%, and 24.2%. The sensitivity, specificity, PPV, and NPV of neck CT were 95.5%, 80%, 95.5%, and 57.1%. Length of symptoms, skin erythema, and fluctuance were not significantly associated with a positive US (F(3, 82) = 0.24, p = .9, R2 = 0.01) or CT scan (F(3, 30) = 0.84, p = .5, R2 = 0.08).ConclusionNeck US has a low sensitivity for diagnosing pediatric neck abscesses, when compared to CT, but remains a useful initial investigation given its high PPV. Clinicians should have a low threshold for pursuing CT if there is a high suspicion of abscess formation.Level of Evidence: Level 4.
The Nasogenital Reflex: Imprudence of the Past as a Lesson for a Wiser Future
Authors: Alrassi James , Islam Albina , Rosenfeld Richard M. 
Published: January 2023

AbstractThe history of the nasogenital reflex, a theory that purports a bidirectional pathway between the nose and genitalia, reveals a complex and diverse record spanning back to antiquity and across the Eurasian continent. This article examines how an antiquated medical theory made its way into early contemporary medicine, and the lesson this account serves as otolaryngology–head and neck surgery continues to work toward making all its interventions based on a hierarchy of evidence.
Metformin Reduces the Risk of Hearing Loss: A Retrospective Cohort Study
Authors: Tseng Chin‐Hsiao 
Published: January 2023

AbstractObjectiveTo compare the risk of hearing loss with regard to metformin exposure.Study DesignRetrospective cohort.SettingTaiwan's National Health Insurance database.MethodsWe enrolled 292,071 ever users and 18,200 never users of metformin with new‐onset diabetes mellitus from 1999 to 2005 and followed them for hearing loss from January 1, 2006, to December 31, 2011. Hazard ratios (HRs) weighted by propensity score were estimated.ResultsHearing loss was newly diagnosed in 10,085 ever users and 1072 never users. Their respective incidence rates (per 100,000 person‐years) were 738.09 and 1366.83. The HR comparing ever‐to‐never users was 0.534 (95% confidence interval [CI]: 0.501‐0.569]. The HR (95% CI) for the first (<27.07 months), second (27.07‐59.13 months), and third (>59.13 months) tertiles of cumulative duration of metformin therapy were 0.912 (0.852‐0.975), 0.544 (0.508‐0.582), and 0.275 (0.255‐0.295), respectively; and were 0.900 (0.841‐0.962), 0.531 (0.496‐0.569), and 0.293 (0.273‐0.315), respectively, for the first (<796.70 g), second (796.70‐2020.15 g), and third (>2020.15 g) tertiles of cumulative dose. The magnitude of risk reduction became more remarkable in corresponding to the increasing tertiles of the defined daily dose prescribed. Subtype analyses suggested that the risk reduction was more significant for sensorineural than conductive hearing loss. Findings derived from a propensity score‐matched cohort did not substantially change the conclusions, and the risk reduction for mixed hearing loss was not statistically significant in the matched cohort as significantly observed in the unmatched cohort.ConclusionThe risk of hearing loss is reduced in a dose‐response pattern in patients who use metformin.
Drawing on local knowledge and attitudes for the conservation of critically endangered rhino rays in Goa, India
Authors: Gupta Trisha , Milner‐Gulland EJ , Dias Andrew , Karnad Divya 
Published: January 2023

Abstract

In the context of marine species declines in data‐limited regions, local ecological knowledge (LEK) is a valuable source of information on species ecology and historical trends. LEK can also help understand how threatened species exist within a local culture, in terms of their uses and values, and reveal attitudes towards their conservation. Rhino rays (guitarfish and wedgefish) are highly threatened by overfishing with most species critically endangered, yet poorly studied in countries like India that fish them the most.

We drew on LEK to understand the socio‐ecological status of rhino rays in Goa, on the west coast of India. We investigated their habitat use and seasonality, interaction with fisheries, socio‐economic uses and relational values. We also explored attitudes of fishers towards rhino rays and their conservation. A combination of semistructured interviews and key informant interviews (88 in total) was conducted with fishers at multiple sites.

Local knowledge suggests that nearshore habitats around river mouths form important nursery grounds for some rhino rays, and provided insights on their seasonality and breeding. Rhino rays appeared to be targeted historically but are entirely bycaught at present, with highest catches in gillnets and in the South Goa district, during September and October. LEK indicated that taxa like sawfish (Pristis spp.) and wedgefish (Rhynchobatus spp.) have severely declined or disappeared from this region. We coded different relational values, from recreation (rhino rays are consumed and enjoyed with alcohol) to symbolic values (rhino rays are considered lucky). All key informants expressed positive attitudes towards rhino ray conservation and stated that a ban on landing these species would have little to no impact on fisher earnings.

The usefulness of LEK suggests it should be brought into the scientific mainstream to support development of more equitable and socially appropriate management plans. Fostering relational values can reinforce fishers' positive attitudes, thereby enhancing rhino ray conservation. Their low commercial value and potentially high post‐capture survival suggest that using norm‐based approaches to promote live release may be successful. Further research on rhino ray ecology and human dimensions can support the development of appropriate conservation interventions.

Read the free Plain Language Summary for this article on the Journal blog.
Comprehensive quality evaluation of processed Scrophulariae Radix from different regions of China using HPLC coupled with chemometrics methods
Authors: Zhang Mina , Chen Kaixian , Wang Pan , Zhang Liuqiang , Li Yiming 
Published: January 2023

AbstractIntroductionScrophulariae Radix (SR) has been extensively used in traditional Chinese medicine (TCM) for thousands of years. However, the processing methods and production areas of Scrophularia ningpoensis have undergone notable historic changes. Thus, their effects on the bioactive constituents of SR still need to be studied further.ObjectivesThis study aimed to establish an objective and comprehensive method to identify the correlation of bioactive constituents of SR with variety, place of origin and processing method for evaluating their qualities.MethodologyAn accurate and rapid high‐performance liquid chromatography‐diode array detector (HPLC‐DAD) method for the simultaneous determination of 11 marker components (aucubin, harpagide, 6‐O‐methyl‐catalpol, harpagoside, verbascoside, isoverbascoside, angoroside C, cinnamic acid, l‐tyrosine, l‐phenylalanine, and l‐tryptophan) was established to evaluate the quality of SR for the first time. In addition, the effects of different production areas and processed methods on the target compounds were studied by analysing 66 batches of SR samples with chemometrics methods, including similarity evaluation of chromatographic fingerprints of TCM, principal component analysis (PCA), and partial least squares‐discriminant analysis (PLS‐DA).ResultsCompared with “sweating”, short‐term “steaming” and “slice‐drying” could largely preserve the bioactive constituents of SR. When using the model established through PLS‐DA, five components were identified as the most significant variables for discrimination. Furthermore, the score plots of PCA and the similarity evaluation revealed that variety had a more notable influence on the quality of SR than the place of origin.ConclusionAn objective approach of HPLC fingerprint coupled with chemometrics analysis and quantitative assessment could be applied to discriminate different processed SR and evaluate the qualities of SR rapidly.