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Farlow JL, Abouyared M, Rettig EM, Kejner A, Edwards HA, Patel R. Portrait of a Surgeon: Artificial Intelligence Reflections. OTO Open 2024; 8:e139. [PMID: 38633142 PMCID: PMC11022959 DOI: 10.1002/oto2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Text-to-image artificial intelligence (AI) programs are popular public-facing tools that generate novel images based on user prompts. Given that they are trained from Internet data, they may reflect societal biases, as has been shown for text-to-text large language model programs. We sought to investigate whether 3 common text-to-image AI systems recapitulated stereotypes held about surgeons and other health care professionals. All platforms queried were able to reproduce common aspects of the profession including attire, equipment, and background settings, but there were differences between programs most notably regarding visible race and gender diversity. Thus, historical stereotypes of surgeons may be reinforced by the public's use of text-to-image AI systems, particularly those without procedures to regulate generated output. As AI systems become more ubiquitous, understanding the implications of their use in health care and for health care-adjacent purposes is critical to advocate for and preserve the core values and goals of our profession.
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Affiliation(s)
- Janice L. Farlow
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Marianne Abouyared
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California DavisSacramentoCaliforniaUSA
| | - Eleni M. Rettig
- Department of Otolaryngology–Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Alexandra Kejner
- Department of Otolaryngology–Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Heather A. Edwards
- Department of Otolaryngology–Head and Neck SurgeryBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Rusha Patel
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Oklahoma College of MedicineOklahoma CityOklahomaUSA
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Batool S, Hansen EE, Sethi RKV, Rettig EM, Goguen LA, Annino D, Uppaluri R, Edwards HA, Faden DL, Dohan D, Dhand A, Reich AJ, Bergmark RW. Personal Social Networks and Care-Seeking for Head and Neck Cancer: A Qualitative Study. Otolaryngol Head Neck Surg 2024; 170:457-467. [PMID: 38079157 DOI: 10.1002/ohn.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES To investigate the role of patients' personal social networks (SNs) in accessing head and neck cancer (HNC) care through patients' and health care workers' (HCWs) perspectives. STUDY DESIGN Qualitative study. SETTING Tertiary HNC centers at 2 academic medical centers, including 1 safety net hospital. METHODS Patients with newly diagnosed HNC, and HCWs caring for HNC patients, aged ≥18 years were recruited between June 2022 and July 2023. Semistructured interviews were conducted with both patients and HCWs. Inductive and deductive thematic analysis was performed with 2 coders (κ = 0.82) to analyze the data. RESULTS The study included 72 participants: 42 patients (mean age 57 years, 64% female, 81% white), and 30 HCWs (mean age 42 years, 77% female, 83% white). Four themes emerged: (1) Patients' SNs facilitate care through various forms of support, (2) patients may hesitate to seek help from their networks, (3) obligations toward SNs may act as barriers to seeking care, and (4) the SN composition and dedication influence care-seeking. CONCLUSION Personal SNs play a vital role in prompting early care-seeking among HNC patients. SN-based interventions could enhance care and improve outcomes for HNC patients.
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Affiliation(s)
- Sana Batool
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elisabeth E Hansen
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Rosh K V Sethi
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Eleni M Rettig
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Laura A Goguen
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Donald Annino
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ravindra Uppaluri
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Heather A Edwards
- Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Daniel L Faden
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School and Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Boston Medical Center, Boston, United States
| | - Daniel Dohan
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - Amar Dhand
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Network Science Institute, Northeastern University, Boston, Massachusetts, USA
| | - Amanda J Reich
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Regan W Bergmark
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital; Center for Head and Neck Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
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Bloom JC, Kaufmann N, Koss S, Edwards HA, Perkins RB, Faden DL. Deciphering Knowledge and Opinions of Human Papillomavirus and Human Papillomavirus Vaccination for Facilitation of Point-of-Care Vaccination in Adults. JAMA Otolaryngol Head Neck Surg 2023; 149:870-877. [PMID: 37651109 PMCID: PMC10472267 DOI: 10.1001/jamaoto.2023.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/11/2023] [Indexed: 09/01/2023]
Abstract
Importance Human papillomavirus (HPV) vaccination rates remain significantly below rates for other common childhood vaccines, which has implications for future rates of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). Objective To assess whether individuals who were aware of the association between HPV and OPSCC would be more likely to have been previously vaccinated. Design, Setting, and Participants This survey study included patients aged 18 to 45 years who sought routine outpatient care at the otolaryngology clinic at Boston Medical Center from September 1, 2020, to May 19, 2021. A survey (HPV-Associated Head and Neck Cancer Epidemiology, Awareness and Demographics) [HEAD]) composed of validated questions to assess patient knowledge of HPV and HPV vaccination and barriers to vaccination was delivered to participants. The survey was paired with a novel point-of-care vaccination program housed within an otolaryngology department. Main Outcomes and Measures The main outcome was prevalence of knowledge of the relationship between HPV infection and OPSCC based on survey responses. The association of knowledge of HPV-associated OPSCC with likelihood of having been vaccinated was assessed in the overall cohort and by demographic characteristics using multivariate logistic regression. Results Of 405 patients given the survey, 288 (71.1%) responded. Of these patients, 271 (94.1%) had surveys included; 158 (58.3%) were female, and median age was 29 years (IQR, 24-35 years). The baseline vaccination rate in the surveyed population was low (26.6%; n = 72) overall (10.6% among men [12 of 113]; 37.9% among women [60 of 158]). Few participants understood the relationship between HPV infection and OPSCC (63 of 271 [23.3%]) or that HPV-associated OPSCC is the most common HPV-associated cancer type (9 of 121 [7.4%]). Compared with men, women were more likely to have been previously vaccinated (odds ratio [OR], 6.5; 95% CI, 3.0-13.9), more aware that HPV causes cancer (OR, 3.7; 95% CI, 1.9-7.1), and more likely to have heard about HPV and HPV vaccination from their health care practitioner (OR, 2.6; 95% CI, 1.2-5.7). Knowledge of the relationship between HPV infection and cancer and between HPV and OPSCC was associated with increased likelihood of having been vaccinated (HPV and cancer: OR, 4.1 [95% CI, 1.8-9.5]; HPV and OPSCC: OR, 3.7 [95% CI, 1.8-7.6]). Among 156 unvaccinated participants, 12 of 98 men (12.2%) and 7 of 131 women (5.3%) received point-of-care vaccination. Conclusions Most participants in this survey study were unaware that HPV causes OPSCC. Understanding that HPV causes OPSCC was associated with increased likelihood of having been vaccinated. However, most patients surveyed were not informed of this relationship by their health care practitioners. Targeted education aimed at unvaccinated adults establishing the relationship between HPV infection and OPSCC, paired with point-of-care vaccination, may be an innovative strategy for increasing HPV vaccination rates in adults.
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Affiliation(s)
- Jacob C. Bloom
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
| | - Nicole Kaufmann
- Department of Epidemiology, Harvard University School of Public Health, Boston, Massachusetts
| | - Shirley Koss
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
| | - Heather A. Edwards
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
| | - Rebecca B. Perkins
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
| | - Daniel L. Faden
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
- Mass Eye and Ear, Boston, Massachusetts
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Rohlfing ML, Kan K, Tierney WS, Plocienniczak MJ, Edwards HA, Tracy LF. Historical Review and Modern Case of Spontaneous Laryngeal Abscess. Ann Otol Rhinol Laryngol 2022:34894221115757. [PMID: 35923122 DOI: 10.1177/00034894221115757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Laryngeal abscesses are rare in the modern antibiotic era. Historically, they were associated with systemic infections including typhoid fever, measles, gonorrhea, syphilis, and tuberculosis. More recent authors have described cases resulting from iatrogenic injury and immunosuppression. This report presents a novel case of laryngeal abscess in the setting of uncontrolled diabetes and a detailed review of modern, reported cases of spontaneous laryngeal abscess. METHODS Report of a single case. Also, PubMed was queried for cases of laryngeal abscess since 1985. CASE REPORT A 58-year-old male with poorly controlled diabetes presented with odynophagia, dysphagia, and dyspnea. He had biphasic stridor, and flexible laryngoscopy showed reduced mobility of bilateral vocal folds and narrowed glottic airway. He was taken urgently for awake tracheostomy and microdirect laryngoscopy. Laryngoscopy demonstrated fullness and fluctuance of the right hemilarynx. The abscess cavity was entered endoscopically via paraglottic incision extending into the subglottis. The patient was treated with an 8-week course of ampicillin-sulbactam with resolution of infection. RESULTS Seven additional cases of spontaneous laryngeal abscesses published after 1985 were identified. In total, 6 of 8 had some form of immunodeficiency (75%). The most common presenting symptoms were dysphonia (8/8, 100%), odynophagia (5/8, 62.5%), and dyspnea/stridor (4/8, 50%). All cases were treated with surgical incision and drainage. CONCLUSIONS Laryngeal abscesses are rare in the era of modern antibiotics. This review confirms that the majority of recent episodes occurred in the setting of immunodeficiency and are caused by non-tubercular bacteria. These infections are commonly associated with impaired vocal fold mobility which may contribute to dyspnea, stridor, and airway compromise. Surgical intervention is necessary for treatment and culture-directed antimicrobial therapy. Poorly controlled diabetes is a newly described context for development of spontaneous laryngeal abscess.
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Affiliation(s)
- Matthew L Rohlfing
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Krystal Kan
- Department of Otolaryngology, University of Illinois Chicago, Chicago, IL, USA
| | - William S Tierney
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Heather A Edwards
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
| | - Lauren F Tracy
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
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Benchetrit L, Mehra S, Mahajan A, Rahmati RW, Judson BL, Edwards HA. Major Salivary Gland Cancer With Distant Metastasis Upon Presentation: Patterns, Outcomes, and Imaging Implications. Otolaryngol Head Neck Surg 2022; 167:305-315. [PMID: 34784258 DOI: 10.1177/01945998211058354] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Given limited data availability on distant metastasis (DM) in major salivary gland (MSG) malignancy presentation, we aimed to evaluate the rate, histologic patterns, location, and predictors of DM at first MSG cancer presentation and suggest potential implications on diagnostic workup. STUDY DESIGN Retrospective cohort. SETTING Commission on Cancer-accredited hospitals. METHODS We included patients in the National Cancer Database (2010-2016) with MSG malignancy. Site and rate of DM were stratified by histologic subtype. Factors predictive of DM at presentation were determined by multivariate regression analysis. Survival analyses were conducted via the Kaplan-Meier method, log-rank test, and Cox regression analysis. RESULTS Of 5776 patients with MSG carcinoma, 333 (5.8%) presented with DM. The most common DM site was the lung (57.1%), followed by bone (46.8%) and liver (19.5%). DM was most common in adenocarcinoma-not otherwise specified (15.1%, 132/874) and salivary duct carcinoma (10.4%, 30/288). High-grade mucoepidermoid carcinoma had the highest rate of lung metastases (81.6%, 31/38). Conversely, myoepithelial carcinoma had the highest rate of bone metastases (85.7%, 6/7). DM at presentation was independently associated with an increased mortality risk (hazard ratio, 1.62; 95% CI, 1.40-1.90). CONCLUSION We identified a DM rate of 5.8% in MSG malignancy at presentation. Overall 43% of patients presented without DM to the lung but with DM to the bones, liver, and/or brain. The most common metastatic sites differed by tumor histology. Staging with computed tomography neck and chest alone may fail to detect sites of DM; this work can be used for patient counseling in the clinical setting.
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Affiliation(s)
- Liliya Benchetrit
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, USA
| | - Saral Mehra
- Section of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Rahmatullah W Rahmati
- Section of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Benjamin L Judson
- Section of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
| | - Heather A Edwards
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, USA.,School of Medicine, Boston University, Boston, Massachusetts, USA
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Duraiswamy S, Rubin SJ, Kim Y, Mur T, Edwards HA. Limited English proficiency and head and neck cancer outcomes. Am J Otolaryngol 2022; 43:103470. [PMID: 35427938 DOI: 10.1016/j.amjoto.2022.103470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Limited English proficiency (LEP) is common among hospitalized patients and may impact clinical care and outcomes. This study aimed to examine the relationship between LEP and clinical oncological outcomes for patients with head and neck cancer (HNC). MATERIALS AND METHODS A single center retrospective review was conducted including adult patients with squamous cell carcinoma of the head and neck who received treatment with curative intent between January 1, 2014 and July 1, 2019. Clinical data collected included patient demographics and clinical variables. Univariate and multivariate analysis was performed to determine whether there was an association between LEP and demographic and clinical factors. RESULTS There were 477 patients included in the study; 426 (81%) were English proficient (EP) while 51 (10.7%) were LEP. The LEP patients were diagnosed with cancer at a later overall stage (p = 0.03) and less frequently treated with surgery alone compared to English speaking patients (p < 0.001). After adjusting for overall stage and primary site, LEP patients were significantly more likely to receive primary surgical management compared to primary non-surgical management [OR = 2.29 95% CI (0.93, 5.58), p = 0.008]. There was also a significant association between LEP and primary site of tumor (p < 0.01). Kaplan-Meyer curves for overall survival and disease specific survival showed no significant differences between the two cohorts (p = 0.8063 and p = 0.4986, respectively). CONCLUSIONS LEP may impact access to care resulting in more advanced overall tumor stage at presentation and treatment with primary surgery compared to non-surgical management after adjusting for tumor stage and primary site. Interventions to provide better access to care, awareness of HNC in the LEP populations, and earlier detection may improve outcomes for LEP patients.
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Affiliation(s)
- Swetha Duraiswamy
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
| | - Samuel J Rubin
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
| | - Yeahan Kim
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
| | - Taha Mur
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
| | - Heather A Edwards
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
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Rubin SJ, Wang JJ, Nodoushani AY, Yarlagadda BB, Wulu JA, Edwards HA. The effect of a statewide prescription drug monitoring program on opioid prescribing patterns. Am J Otolaryngol 2022; 43:103262. [PMID: 34626913 DOI: 10.1016/j.amjoto.2021.103262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Determine whether opioid prescribing patterns have changed as a result of implementation of a prescription drug monitoring program (PDMP) in the state of Massachusetts. MATERIALS AND METHODS A multicentered retrospective study was performed including patients who received tonsillectomy, parotidectomy, thyroidectomy or direct laryngoscopy and biopsy with or without rigid esophagoscopy and/or rigid bronchoscopy at Lahey Hospital and Medical Center (Burlington, MA) or Boston Medical Center (Boston, MA). Opioid prescribing patterns were compared for the 12 months prior to implementation of the Massachusetts Prescription Awareness Tool (MassPAT) to 36 months of prescribing patterns post implementation. Quantity of opioids prescribed was based on morphine milligram equivalents (MME). Continuous variables were compared using analysis of variance (ANOVA) while categorical variables were compared using chi-squared test or Fisher's exact test. Multivariate analysis was performed using linear regression. RESULTS A total of 2281 patients were included in the study. There was a significant association in mean overall MME prescribed comparing pre-MassPAT and post-MassPAT data [tonsillectomy: 635.9 ± 175.6 vs 463.3 ± 177.7 (p < 0.0001), parotidectomy: 250.4 ± 71.33 vs 169.8 ± 79.26 (p < 0.0001), thyroidectomy: 186.2 ± 81.14 vs 118.3 ± 88.79 (p < 0.0001), direct laryngoscopy with biopsy: 308.3 ± 246.9 vs 308.3 ± 246.9 (p = 0.0201)]. There was also a significant association between length of opioid prescription (days) and implementation of MassPAT, but there was no significant difference in the percent of patients requiring refills pre- MassPAT and post-MassPAT. CONCLUSION This study demonstrates that prescribers have been able to significantly decrease the amount of opioids prescribed for tonsillectomy, parotidectomy, thyroidectomy, and direct laryngoscopy and biopsy and patients have not required additional opioid refills.
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Affiliation(s)
- Samuel J Rubin
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 800 Harrison Ave BCD 5th floor, Boston, MA 02118, United States of America; Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, United States of America.
| | - Judy J Wang
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 800 Harrison Ave BCD 5th floor, Boston, MA 02118, United States of America; Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, United States of America
| | - Ariana Y Nodoushani
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 800 Harrison Ave BCD 5th floor, Boston, MA 02118, United States of America; Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, United States of America
| | - Bharat B Yarlagadda
- Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, United States of America; Division of Otolaryngology-Head and Neck Surgery, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01850, United States of America
| | - Jacqueline A Wulu
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 800 Harrison Ave BCD 5th floor, Boston, MA 02118, United States of America; Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, United States of America
| | - Heather A Edwards
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 800 Harrison Ave BCD 5th floor, Boston, MA 02118, United States of America; Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, United States of America
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Shehan JN, Alwani T, LeClair J, Mahoney TF, Agarwal P, Chaudhry ST, Wang JJ, Noordzij JP, Tracy LF, Edwards HA, Grillone G, Salama AR, Jalisi SM, Devaiah AK. Social determinants of health and treatment decisions in head and neck cancer. Head Neck 2021; 44:372-381. [PMID: 34889486 DOI: 10.1002/hed.26931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 10/14/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study compares select social determinants of health (SDOH) with treatment modality selection and treatment completion in head and neck cancer (HNC) patients, to better understand disparities in health outcomes. METHODS A retrospective cohort study of HNC (n = 1428) patients was conducted. Demographic and disease-specific variables were recorded, including treatment modality selection and completion. Data were analyzed using two-sample t tests, chi-square, and Fisher's exact tests. RESULTS Primary language was significantly associated with treatment choice, where non-English speakers were less likely to choose treatment as recommended by the Tumor Board. Lower mean distance from the hospital (37.38 [48.31] vs. 16.92 [19.10], p < 0.0001) and a county-based higher mean percentage of bachelor degree or higher education (42.16 [8.82] vs. 44.95 [6.19], p < 0.0003) were associated with treatment selection. CONCLUSION Language, distance from the hospital, and education affected treatment selection in this study and may be useful in understanding how to counsel patients on treatment selection for HNC.
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Affiliation(s)
- Jennifer N Shehan
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Tooba Alwani
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jessica LeClair
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Taylor F Mahoney
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Pratima Agarwal
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Salil T Chaudhry
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Judy J Wang
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jacob Pieter Noordzij
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren F Tracy
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Heather A Edwards
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gregory Grillone
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
| | - Andrew R Salama
- Department of Oral Maxillofacial Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Scharukh M Jalisi
- Department of Otolaryngology - Head and Neck Surgery, Beth Israel Deaconess, Boston, Massachusetts, USA
| | - Anand K Devaiah
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Boston University School of Medicine, Boston, Massachusetts, USA
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Alwani T, Shehan JN, LeClair J, Mahoney TF, Agarwal P, Chaudhry ST, Wang JJ, Noordzij JP, Tracy LF, Edwards HA, Grillone G, Salama AR, Jalisi SM, Devaiah AK. Geographic Barriers Affect Follow-Up Care in Head and Neck Cancer. Laryngoscope 2021; 132:1022-1028. [PMID: 34762300 PMCID: PMC9007826 DOI: 10.1002/lary.29934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 10/12/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS Follow-up care in head and neck cancers (HNC) is critical in managing patient health. However, social determinants of health (SDOH) can create difficulties in maintaining follow-up care. The study goal is to explore how SDOH impacts maintenance of HNC follow-up care appointments. METHODS A systematic retrospective chart review of 877 HNC patients diagnosed in the past 10 years a safety-net tertiary care hospital with systems to help reduce care disparities. Cohort groups were identified and compared against protocols for follow-up. Data were analyzed using analysis of variance, chi-square tests, Fisher's exact tests, two-sample t-tests, and simple linear regression. RESULTS The average length of follow-up time in months and average total number of follow-ups over 5 years were 32.96 (34.60) and 9.24 (7.87), respectively. There was no significant difference in follow-up care between United States (US) versus non-US born and English versus non-English speaking patients. Race/ethnicity, county median household income, insurance status, and county educational attainment were not associated with differences in follow-up. However, living a greater distance from the hospital was associated with lower follow-up length and less frequency in follow-up (P < .0001). CONCLUSION While income, primary language, country of birth, race/ethnicity, insurance status, and markers of educational attainment do not appear to impact HNC follow-up at our safety-net, tertiary care institution, and distance from hospital remains an important contributor to disparities in care. This study shows that many barriers to care can be addressed in a model that addresses SDOH, but there are barriers that still require additional systems and resources. Laryngoscope, 2021.
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Affiliation(s)
- Tooba Alwani
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
| | | | - Jessica LeClair
- Department of Biostatistics, Boston University School of Public Health, Boston MA
| | - Taylor F. Mahoney
- Department of Biostatistics, Boston University School of Public Health, Boston MA
| | - Pratima Agarwal
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
| | | | - Judy J. Wang
- Boston University School of Medicine, Boston, MA
| | - J. Pieter Noordzij
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Lauren F. Tracy
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Heather A. Edwards
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Gregory Grillone
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Andrew R. Salama
- Department of Oral Maxillofacial Surgery Boston, Medical Center, Boston MA
| | - Scharukh M. Jalisi
- Department of Otolaryngology – Head and Neck Surgery, Beth Israel Deaconess, Boston, MA
| | - Anand K. Devaiah
- Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
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10
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Wang JJ, Rubin SJ, Devaiah AK, Faden DL, Salama AR, Edwards HA. Long-Term Opioid Use in Post-Surgical Management of Patients With Head and Neck Cancer. Ann Otol Rhinol Laryngol 2021; 131:844-850. [PMID: 34521247 DOI: 10.1177/00034894211045771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aims to identify clinical and socioeconomic factors associated with long-term, post-surgical opioid use in the head and neck cancer population. METHODS A single center retrospective study was conducted including patients diagnosed with head and neck cancer between January 1, 2014 and July 1, 2019 who underwent primary surgical management. The primary outcome measure was continued opioid use 6 months after treatment completion. Both demographic and cancer-related variables were recorded to determine what factors were associated with prolonged opioid use. Univariate analysis was performed using chi-squared test for categorical variables and 2-sample t-test for continuous variables. Multivariate analysis was performed using logistic regression. RESULTS A total of 359 patients received primary surgical management. Forty-five patients (12.53%) continued to take opioids 6 months after treatment completion. Using univariate analysis, patients less than 65 years of age (P = .0126), adjuvant chemoradiation (n = 25, P < .001), and overall length of hospital stay (8.60 ± 8.58 days, P = .0274) were significantly associated with long term opioid use. Multivariate logistic regression showed that adjuvant chemoradiation (OR = 3.446, 95% CI [1.742, 6.820], P = .0004) and overall length of hospital stay (OR = 0.949, 95% CI [0.903, 0.997], P = .0373) to be significantly associated with opioid use 6 months after head and neck cancer treatment. CONCLUSION Long-term postoperative opioid use in head and neck cancer patients is significantly associated with adjuvant chemoradiation, and patients with longer length of hospital stay. Therefore, future research should focus on interventions to better manage opioid use during the acute treatment period to decrease long-term use.
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Affiliation(s)
- Judy J Wang
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Samuel J Rubin
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Anand K Devaiah
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Daniel L Faden
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Andrew R Salama
- Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, MA, USA
| | - Heather A Edwards
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
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11
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Bourdillon AT, Mehra S, Rahmati R, Judson B, Edwards HA. Anesthesia screen use may impact operating room communication practices in otolaryngology. Am J Otolaryngol 2021; 42:103000. [PMID: 33812208 DOI: 10.1016/j.amjoto.2021.103000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Failures in communication are a leading contributor to medical error. There is increasing attention on cultivating robust communication practices in the Operating Room (OR) to mitigate against patient injury and optimize efficient patient care. Few studies have evaluated how surgical equipment may introduce barriers to team dynamics. DESIGN We conducted a pilot observational study to examine the relationship between anesthesia screen drapes (which are used inconsistently) and the frequency of verbal exchanges between surgical and anesthesia members. 25 procedures spanning various procedures in Otolaryngology were covertly observed, 12 of which employed a screen. Verbal exchanges were recorded across three stages of the surgery: pre-procedure (before the draping), procedure (drapes placed throughout) and post-procedure (after the removal of the draping). Speaker and content of the exchange was noted as well as various features about the procedure. RESULTS Decreases in rates of exchanges were most pronounced during the procedure stage, although they did not reach significance on T-testing (p = 0.0719). After controlling for attending, table orientation and number of professionals, regression analysis did reveal a statistically significant decrease in rates of verbal exchanges during the procedure in the presence of the anesthesia screen (7.17 (± 6.33) versus 2.23 (± 1.00), p = 0.0318). Differences were also significant among surgeon-initiated and patient-care-related exchanges (p = 0.0168 and p = 0.0432, respectively). Decreases in anesthesiologist-initiated and non-clinical exchanges did not reach significance (p = 0.1530 and p = 0.5120, respectively). CONCLUSION This pilot study suggests that anesthesia screens may negatively impact communication practices in the OR.
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12
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Wang JJ, Levi JR, Edwards HA. Changes in Care Provision During COVID-19 Impact Patient Well-Being. J Patient Exp 2021; 8:23743735211034068. [PMID: 34350341 PMCID: PMC8295945 DOI: 10.1177/23743735211034068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The fast onset and extensive impact of COVID-19 necessitated strict public health measures and temporary diversion of personnel and resources from other types of medical care. This study examined the prevalence of such disruptions and their impacts on patient-perceived well-being using an untargeted survey. The majority of surveyed patients experienced changes in their routine medical care. Of those whose appointments were postponed or canceled, most patients indicated an overall negative impact on their emotional and physical well-being. We highlighted the impact of disruptions in nonurgent medical care during a large-scale public health emergency.
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Affiliation(s)
- Judy J Wang
- Boston University School of Medicine, Boston, MA, USA
| | - Jessica R Levi
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Heather A Edwards
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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13
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Eskander A, Marqueen KE, Edwards HA, Joshua AM, Petrella TM, de Almeida JR, Goldstein DP, Ferket BS. To ban or not to ban tanning bed use for minors: A cost-effectiveness analysis from multiple US perspectives for invasive melanoma. Cancer 2021; 127:2333-2341. [PMID: 33844296 DOI: 10.1002/cncr.33499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/13/2020] [Accepted: 01/29/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Tanning bed use is common among US adolescents, but is associated with increased melanoma risk. The decision to ban tanning bed use by adolescents should be made in consideration of the potential health benefits and costs. METHODS The US population aged 14 to 17 years was modeled by microsimulation, which compared ban versus no ban strategies. Lifetime quality-adjusted life years (QALYs) and costs were estimated from a health care sector perspective and two societal perspectives: with and without the costs of policy enforcement and the economic losses of the indoor-tanning bed industry. RESULTS Full adherence to the ban prevented 15,102 melanoma cases and 3299 recurrences among 17.1 million minors, saving $61in formal and informal health care costs per minor and providing an increase of 0.0002 QALYs. Despite the intervention costs of the ban and the economic losses to the indoor-tanning industry, banning was still the dominant strategy, with a savings of $12 per minor and $205.4 million among 17.1 million minors. Findings were robust against varying inspection costs and ban compliance, but were sensitive to lower excess risk of melanoma with early exposure to tanning beds. CONCLUSIONS A ban on tanning beds for minors potentially lowers costs and increases cost effectiveness. Even after accounting for the costs of implementing a ban, it may be considered cost effective. Even after accounting for the costs of implementing a ban and economic losses in the indoor-tanning industry, a tanning bed ban for US minors may be considered cost effective. A ban has the potential to reduce the number of melanoma cases while decreasing health care costs. LAY SUMMARY Previous meta-analyses have linked tanning bed use with an increased risk of melanoma, particularly with initial use at a young age. Yet, it remains unclear whether a ban of adolescents would be cost effective. Overall, a ban has the potential to reduce the number of melanoma cases while promoting a decrease in health care costs. Even after accounting for the costs of implementing a ban and the economic losses incurred by the indoor-tanning industry, a ban would be cost effective.
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Surgical Oncology, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Michael Garron Hospital, Toronto, Ontario, Canada
| | | | - Heather A Edwards
- Department of Otolaryngology-Head & Neck Surgery, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Anthony M Joshua
- Department of Medical Oncology, Kinghorn Cancer Centre, St. Vincent's Hospital, University of New South Wales, Darlinghurst, Sydney, New South Wales, Australia
| | - Teresa M Petrella
- Department of Medicine, Division of Medical Oncology & Hematology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Surgical Oncology, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Surgical Oncology, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Bart S Ferket
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
OBJECTIVE Probiotics have garnered considerable attention as an intervention for various conditions common to otolaryngology. The purpose of this review is to evaluate the current literature to offer recommendations about the safety and efficacy of probiotic management in otolaryngologic conditions. STUDY DESIGN Narrative review. METHODS PubMed and Google Scholar were queried using pertinent keywords to retrieve relevant studies with particular focus in the recent 5 years. All abstracts were assessed and studies, reviews and meta-analyses achieving evaluation of probiotic therapies or characterization of microbiome changes were included for further review. Studies were categorized by condition or anatomic region across various subspecialties. Key data parameters were extracted and evaluated across studies and treatment types. RESULTS Strong evidence exists for the use probiotic agents to improve symptoms for allergic rhinitis, chronic rhinosinusitis and certain dental conditions. Despite promising results, further investigation is needed to evaluate and optimize probiotic delivery for mitigating otitis media, oropharyngeal inflammation and upper respiratory tract infections. Preclinical studies suggest that probiotics may potentially offer benefit for voice prosthesis maintenance, wound healing and mitigation of oral dysplasia. CONCLUSION Probiotic therapies may offer clinical benefit in a variety of contexts within the field of otolaryngology, especially for short-term relief of certain inflammatory conditions of the oral cavity, auditory and nasal cavities. Further investigation is warranted for evaluation of long-term outcomes and pathogenic deterrence.
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Affiliation(s)
- Alexandra T Bourdillon
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States of America.
| | - Heather A Edwards
- Department of Otolaryngology, Boston University School of Medicine, Boston, MA, United States of America.
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15
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Rubin S, Wulu JA, Edwards HA, Dolan RW, Brams DM, Yarlagadda BB. The Impact of MassPAT on Opioid Prescribing Patterns for Otolaryngology Surgeries. Otolaryngol Head Neck Surg 2021; 164:781-787. [PMID: 33588624 DOI: 10.1177/0194599820987454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Determine whether opioid prescriber patterns have changed for tonsillectomy, parotidectomy, and thyroidectomy after implementation of the Massachusetts Prescription Awareness Tool (MassPAT). STUDY DESIGN Retrospective cohort study. SETTING Single-center tertiary care hospital. METHODS Patients were included if they received tonsillectomy, parotidectomy, or thyroid surgery at Lahey Hospital and Medical Center (Burlington, Massachusetts) between October 1, 2015, and October 1, 2019. Prescribing patterns were compared prior to implementation of MassPAT, October 1, 2015, to October 14, 2016, to postimplementation of MassPAT, October 15, 2016, to October 1, 2019. Quantity of opioids prescribed was described using total morphine milligram equivalents (MME). Data were analyzed using univariate analysis, multivariate analysis, and trend line using line of best fit. RESULTS A total of 737 subjects were included in the study. There was a downward trend in the quantity of opioids prescribed for all 3 surgeries during the study period. There was a significant difference in the quantity of opioids prescribed pre- and postimplementation of MassPAT for tonsillectomy (647.70 ± 218.50 MME vs 474.60 ± 185.90 MME, P < .001), parotidectomy (241.20 ± 57.66 MME vs 156.70 ± 72.99 MME, P < .001), and thyroidectomy (171.20 ± 93.77 MME vs 108.50 ± 63.84 MME, P < .001). There was also a decrease in the number of patients who did not receive opioids for thyroidectomy pre- and post-MassPAT (7.56% vs 24.14%). CONCLUSION We have demonstrated that there is an association with state drug monitoring programs and decrease in the amount of opioids prescribed for acute postoperative pain control for common otolaryngology surgeries.
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Affiliation(s)
- Samuel Rubin
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Jacqueline A Wulu
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Heather A Edwards
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Robert W Dolan
- Division of Otolaryngology-Head and Neck Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - David M Brams
- Division of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Bharat B Yarlagadda
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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16
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Izreig S, Hajek M, Edwards HA, Mehra S, Sasaki C, Judson BL, Rahmati RW. The role of vitamin D in head and neck cancer. Laryngoscope Investig Otolaryngol 2020; 5:1079-1088. [PMID: 33364397 PMCID: PMC7752058 DOI: 10.1002/lio2.469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/03/2020] [Accepted: 09/18/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Head and neck squamous cell carcinoma (HNSCC) describes a set of malignancies of the head and neck that continue to inflict considerable morbidity and mortality. Because HNSCC often presents at an advanced stage, patients frequently undergo intensive multi-modal therapy with an intent to cure. Vitamin D is a precursor to the biologically active hormone calcitriol which governs bone and calcium physiology that is obtained from diet and UV-B exposure. Vitamin D is known to have pleiotropic effects on health and disease. In this review, we examine the role of vitamin D in cancer with emphasis on HNSCC and discuss potential avenues for further research that might better elucidate the role of vitamin D in the management of HNSCC. REVIEW METHODS A review of MEDLINE database indexed literature concerning the role and biology of vitamin D in HNSCC was conducted, with special consideration of recently published work and research involving immunobiology and HNSCC. CONCLUSIONS The available evidence suggests that vitamin D may play a role in protecting against HNSCC, particularly in persons who smoke, although conflicting and limited data exists. Promising initial work encourages the pursuit of further study. IMPLICATIONS FOR PRACTICE The significant morbidity and mortality that HNSCC brings warrants continued research in available and safe interventions that improve patient outcomes. With the rise of immunotherapy as an effective modality for treatment, continued research of vitamin D as an adjunct in the treatment of HNSCC is supported.
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Affiliation(s)
- Said Izreig
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
| | - Michael Hajek
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
| | - Heather A. Edwards
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
- Present address:
Department of Otolaryngology‐Head & Neck SurgeryBoston University School of MedicineBostonMassachusettsUSA
| | - Saral Mehra
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Clarence Sasaki
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Benjamin L. Judson
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Rahmatullah W. Rahmati
- Department of Surgery, Section of OtolaryngologyYale University School of MedicineNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
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17
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Mur TA, Pellegrini WR, Jaleel Z, Edwards HA, Levi JR. Pediatric laryngeal sarcoma: Systematic review and pooled analysis. Int J Pediatr Otorhinolaryngol 2020; 139:110471. [PMID: 33120103 DOI: 10.1016/j.ijporl.2020.110471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sarcomas are a rare, diverse tumor class of mesenchymal origin affecting all age groups. Survival after diagnosis is influenced by disease site. To date, there are no analyses evaluating treatment of pediatric sarcoma within the larynx specifically. METHODS A structured literature review following PRISMA guidelines was preformed to identify case reports of pediatric (age 17 and younger) laryngeal sarcoma. RESULTS Twenty-nine case reports documenting 37 pediatric patients diagnosed with sarcoma in the larynx were identified since 1980. The majority of patients were male (79.4%). The most common histological subtypes were rhabdomyosarcoma (69.4%) and synovial sarcoma (19.4%). The supraglottis was the most common site of disease (62.1%) among laryngeal subsites. Only two patients were known to have succumbed to their disease. Overall survival was not statistically impacted by primary site of tumor, treatment strategy, histology or gender. CONCLUSIONS Soft tissue sarcoma is rarely found in the pediatric larynx. Patient and tumor characteristics studied were not shown to affect outcomes. Increased documenting of high-quality case reports is needed to advance understanding of this disease.
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Affiliation(s)
- Taha A Mur
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, MA, USA
| | | | - Zaroug Jaleel
- Boston University School of Medicine, Boston, MA, USA
| | - Heather A Edwards
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
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18
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Mohebali J, Edwards HA, Schwartz SI, Ergul EA, Deschler DG, LaMuraglia GM. Multispecialty surgical management of carotid body tumors in the modern era. J Vasc Surg 2020; 73:2036-2040. [PMID: 33253874 DOI: 10.1016/j.jvs.2020.10.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/18/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study was to assess the perioperative and long-term outcomes of carotid body tumor (CBT) resection with a multispecialty (head and neck surgery/vascular surgery) approach. METHODS Our institutional data registry was queried for Current Procedural Terminology codes (60600, 60605) pertaining to CBT excision. These patient records and operative reports were individually reviewed to determine laterality, preoperative tumor embolization, operative time, estimated blood loss, need for intraoperative transfusion, intraoperative electroencephalogram changes, intraoperative division of the external carotid artery, carotid artery repair, resection of the carotid bifurcation, tumor volume, final pathology, cranial nerve injury, stroke, death, and clinical or radiographic evidence of recurrence. RESULTS From 1996 to 2018, 74 CBT resections were identified in 68 patients (41 [60%] females; mean age, 50.83 years). The mean tumor volume was 9.92 ± 14.26 cm3 (range, 0.0250-71.0627 cm3). Embolization was performed by a neurointerventional specialist in 27 CBT resections (36%) based on size (embolization 14.27 ± 16.84 cm3 vs 7.17 ± 11.86 cm3; P = .063) and superior extension. This practice resulted in one asymptomatic vertebral dissection, which postponed the surgery. There was a trend toward greater blood loss in the embolization group (embolization 437 ± 545 mL vs 262 ± 222 mL; P = .17); however, no transfusions were required in any patient. The mean operative time was also significantly longer in the embolization group (198.33 ± 61.13 minutes vs 161.5 ± 55.56 minutes; P = .03). Three resections had reversible intraoperative electroencephalogram changes, one of which occurred during carotid clamping. These changes resolved with shunting. Eight external carotid resections (11%) and 6 carotid reconstructions (8.1%; two primary, two patch, and two primary anastomosis) were required. Malignancy was identified in four tumors (5.4%), accounting for four of the six carotid reconstructions. There were no postoperative cranial nerve injuries, no strokes, no reexplorations, and no deaths. One patient developed transient dysphagia from pharyngeal tumor infiltration. Long-term follow-up (mean, 43 ± 54 months), available in 61 of the 68 patients (89.7%), revealed three (4.4%) recurrences. CONCLUSIONS This large, single-institution series demonstrates that a multispecialty team combining two surgical skill sets for the treatment of this rare, challenging condition yields unparalleled low complication rates with short operative times. This approach, including long-term surveillance for recurrent disease, should be considered to optimize outcomes of CBT resection.
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Affiliation(s)
- Jahan Mohebali
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Heather A Edwards
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Boston University School of Medicine, Boston, Mass
| | - Samuel I Schwartz
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Emel A Ergul
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Daniel G Deschler
- Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Mass
| | - Glenn M LaMuraglia
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
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19
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Mur T, Jaleel Z, Agarwal P, Edwards HA. Adenoid Cystic Carcinoma of the Larynx: A SEER Database Review. Ear Nose Throat J 2020; 101:587-592. [PMID: 33170034 DOI: 10.1177/0145561320970691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adenoid cystic carcinoma (AdCC) of the larynx is an uncommon malignancy of the head and neck with very little literature discussing treatment paradigms and prognostic factors influencing survival. METHODS This retrospective cohort study uses data obtained from the Surveillance, Epidemiology and End Result database comprising of patients diagnosed with laryngeal AdCC from 1978 to 2016. RESULTS A total of 89 records were analyzed. High histologic grade was a significant negative prognostic factor compared to low histologic grade disease for overall survival (OS; 5-year OS: 35.7% vs 90.5%, P < .005) and disease-specific survival (DSS; 5-year DSS: 38.7% vs 95.2%, P < .005). No differences in OS (5-year OS: 88.9% vs 76.4%, P = .287) or DSS (5-year DSS: 100% vs 79.1%, P = .159) were noted between patients with early versus late American Joint Committee on Cancer (AJCC) stage disease. No differences in DSS was noted in cohorts treated with just definitive surgery versus surgery and adjuvant radiation (5-year DSS: 92.9% vs 74.3%, P = .140) even when stratified for late stage disease (5-year DSS: 100% vs 78.6%, P = .290) or high-grade histology (5-year DSS: 100% vs 83.3%, P = .773). CONCLUSIONS Histologic grade may be a more significant prognostic factor than AJCC stage for survival in laryngeal AdCC. Treatment with surgery and radiation may provide no additional survival advantage compared to just definitive surgery in these patients, although further study is warranted.
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Affiliation(s)
- Taha Mur
- Department of Otolaryngology-Head and Neck Surgery, 1836Boston University Medical Center, Boston, MA, USA
| | - Zaroug Jaleel
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Pratima Agarwal
- Department of Otolaryngology-Head and Neck Surgery, 1836Boston University Medical Center, Boston, MA, USA
| | - Heather A Edwards
- Department of Otolaryngology-Head and Neck Surgery, 1836Boston University Medical Center, Boston, MA, USA
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Mur T, Sambhu KM, Mahajan A, Payabvash S, Fernandez J, Edwards HA. Choice of imaging modality for pre-treatment staging of head and neck cancer impacts TNM staging. Am J Otolaryngol 2020; 41:102662. [PMID: 32858370 DOI: 10.1016/j.amjoto.2020.102662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of this retrospective cohort study was to determine whether there is a difference in the sensitivity of chest computed tomography (CT) versus 18F-fluorodeoxyglucose positron emission tomography with low-dose nonenhanced CT (18F-FDG PET/CT or PET/CT) in the detection of distant metastases in head and neck cancer, within a tertiary care setting. MATERIALS AND METHODS Patients with head and neck cancer, and known distant metastases, who underwent both 18F-FDG PET/CT with integrated low-dose nonenhanced CT and diagnostic chest CT prior to initiation of therapy from 2008 to 2017 were included. Two head and neck radiologists, blinded to all patient information and to each other's readings, reviewed the PET/CT or CT chest images for each patient and identified whether distant metastases were present. No radiologist read both modalities for a single patient. Concordance between imaging modalities was quantitatively analyzed using McNemar's test. RESULTS 27 patients were included. McNemar's mid p-value analysis showed no significant difference in the detection of distant metastases (p = .6875). However, PET/CT detected distant metastases in three patients that chest CT did not, while chest CT identified distant metastatic disease in two patients that were negative on PET/CT. CONCLUSIONS While this study did not identify a statistically significant difference in sensitivity, five patients had distant metastases identified on only one of the two modalities. Use of a single modality would have resulted in inaccurate staging in 7-11% of patients in our study. The use of both modalities offers the greatest accuracy when providing stage-adapted oncologic treatment.
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Affiliation(s)
- Taha Mur
- Department of Otolaryngology, Boston Medical Center, Boston, MA, United States of America
| | | | - Amit Mahajan
- Neuroradiology Section, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Seyedmehdi Payabvash
- Neuroradiology Section, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Jeyanth Fernandez
- Department of Otolaryngology, Yale New Haven Hospital, New Haven, CT, United States of America
| | - Heather A Edwards
- Department of Otolaryngology, Boston Medical Center, Boston, MA, United States of America; Boston University School of Medicine, Boston, MA, United States of America.
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Bourdillon AT, Tower JI, Edwards HA. Progressive Trigeminal Hypoesthesia. JAMA Otolaryngol Head Neck Surg 2020; 146:756-757. [PMID: 32614378 DOI: 10.1001/jamaoto.2020.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alexandra T Bourdillon
- Section of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jacob I Tower
- Section of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Heather A Edwards
- Division of Head & Neck Surgery, Department of Otolaryngology, Boston University School of Medicine, Boston, Massachusetts
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Saeed NA, Kelly JR, Deshpande HA, Bhatia AK, Burtness BA, Judson BL, Mehra S, Edwards HA, Yarbrough WG, Peter PR, Holt EH, Decker RH, Husain ZA, Park HS. Adjuvant external beam radiotherapy for surgically resected, nonmetastatic anaplastic thyroid cancer. Head Neck 2020; 42:1031-1044. [PMID: 32011055 DOI: 10.1002/hed.26086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 01/02/2020] [Accepted: 01/10/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND EBRT in resected, nonmetastatic anaplastic thyroid cancer (ATC) remains undefined. We evaluated patterns/outcomes with EBRT and chemotherapy in this setting. METHODS This retrospective analysis included patients identified from the National Cancer Database with nonmetastatic ATC from 2004 to 2014 who underwent non-palliative resection. RESULTS Our analysis included 496 patients, including 375 who underwent adjuvant EBRT (among whom 198 received concurrent chemotherapy). The median age was 68 years. On MVA, EBRT was associated with sex (OR 0.5, 95% CI 0.3-0.8, P = .002) and income (OR 2.2, 95% CI 1.4-3.3, P < .001). EBRT was associated with longer OS on UVA (12.3 vs 9.1 months, P = .004) and MVA (HR 0.7 [CI 0.6-0.9], P = .004). Concurrent chemoradiation was associated with longer OS on UVA (14.0 vs 9.1 months, P = .003) and MVA (HR 0.6 [CI 0.5-0.8], P < .001). CONCLUSION Adjuvant EBRT is associated with longer OS in resected, nonmetastatic ATC, with additional improved survival with concurrent chemotherapy.
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Affiliation(s)
- Nadia A Saeed
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Jacqueline R Kelly
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Hari A Deshpande
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Aarti K Bhatia
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Barbara A Burtness
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin L Judson
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston
| | - Saral Mehra
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston
| | - Heather A Edwards
- Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine, Boston
| | - Wendell G Yarbrough
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Patricia R Peter
- Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth H Holt
- Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Zain A Husain
- Department of Radiation Oncology, University of Toronto, Stewart Building, Toronto, Ontario, Canada
| | - Henry S Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
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Edwards HA, Bell ER. Technology transfer in Europe: a case study of invertebrate neuroscience research. Trends Neurosci 1994; 17:332-7. [PMID: 7526501 DOI: 10.1016/0166-2236(94)90172-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Originally identified and defined as a concept in industrial and business communities, technology transfer is now being recognized as an important factor within the scientific research community. A recent study undertaken within the field of UK invertebrate neuroscience research generates several interesting conclusions. In this article, Huw A. Edwards and Elizabeth R.J. Bell discuss the study and its conclusions of a need for increased post-doctoral research mobility, the formation of consortia of research laboratories to apply for funding on an international scale, and the increased interest of the pharmaceutical industry in molecular and cellular techniques developed from fundamental invertebrate research.
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Affiliation(s)
- H A Edwards
- Oxford Trust, Oxford Centre for Innovation, UK
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Abstract
In embryological terms the anal papillae are the product of eversion of the hindgut tissues. The rectum and the anal papillae have the same origin and have a marked structural similarity. The insect hindgut is very labile being able to produce salt transporting or 'chloride cells' from any of the tissues of which it is composed. The hindgut consists of four distinct regions: the ileum and part of the anal canal have a mechanical function, the rectum and the posterior anal canal contain transporting cells. Two new types, 'interstitial' and 'tertiary' are reported in the rectum. The structure of the anal papillae changes with increased salinity. Changes in the plasma membranes alter the surface area for transport. Changes in the number of mitochondria are not accompanied by changes in oxygen consumption. If mitochondria are the site of oxidative metabolism then their number does not control the level of oxygen consumption. In Aedes aegypti the papillary epithelium appears to be a syncytium. Across the lumen of the papillae there are cellular sheets supporting the tracheoles. At the base of the papillae there is a cellular transition zone; circular muscles in this region may be used to occlude the papillae. The control of salt transport may be hormonal.
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Jones N, Booth PJ, Chawner J, Cockman NG, Crompton G, Davies RH, Edwards HA, Harris TJB, Hodges NG, Korn HET, Maxwell RT, Mehta HK, Roberts DPW, Richards E, Wayte DM, Williams JG, Williams JP, Woolley VL. Incremental payments for consultants. West J Med 1976. [DOI: 10.1136/bmj.1.6018.1149-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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