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Carnino JM, Pellegrini WR, Willis M, Cohen MB, Paz-Lansberg M, Davis EM, Grillone GA, Levi JR. Assessing ChatGPT's Responses to Otolaryngology Patient Questions. Ann Otol Rhinol Laryngol 2024:34894241249621. [PMID: 38676440 DOI: 10.1177/00034894241249621] [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: 04/28/2024]
Abstract
OBJECTIVE This study aims to evaluate ChatGPT's performance in addressing real-world otolaryngology patient questions, focusing on accuracy, comprehensiveness, and patient safety, to assess its suitability for integration into healthcare. METHODS A cross-sectional study was conducted using patient questions from the public online forum Reddit's r/AskDocs, where medical advice is sought from healthcare professionals. Patient questions were input into ChatGPT (GPT-3.5), and responses were reviewed by 5 board-certified otolaryngologists. The evaluation criteria included difficulty, accuracy, comprehensiveness, and bedside manner/empathy. Statistical analysis explored the relationship between patient question characteristics and ChatGPT response scores. Potentially dangerous responses were also identified. RESULTS Patient questions averaged 224.93 words, while ChatGPT responses were longer at 414.93 words. The accuracy scores for ChatGPT responses were 3.76/5, comprehensiveness scores were 3.59/5, and bedside manner/empathy scores were 4.28/5. Longer patient questions did not correlate with higher response ratings. However, longer ChatGPT responses scored higher in bedside manner/empathy. Higher question difficulty correlated with lower comprehensiveness. Five responses were flagged as potentially dangerous. CONCLUSION While ChatGPT exhibits promise in addressing otolaryngology patient questions, this study demonstrates its limitations, particularly in accuracy and comprehensiveness. The identification of potentially dangerous responses underscores the need for a cautious approach to AI in medical advice. Responsible integration of AI into healthcare necessitates thorough assessments of model performance and ethical considerations for patient safety.
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Affiliation(s)
- Jonathan M Carnino
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - William R Pellegrini
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Megan Willis
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Michael B Cohen
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Marianella Paz-Lansberg
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Elizabeth M Davis
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Gregory A Grillone
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Jessica R Levi
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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Danis DO, Cohen MB, Levi JR. Relationship between otolaryngology interest groups and residency match results. Am J Otolaryngol 2024; 45:104326. [PMID: 38704948 DOI: 10.1016/j.amjoto.2024.104326] [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: 01/24/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Many students have limited exposure to otolaryngology-head and neck surgery (OTOHNS) throughout medical school, limiting recruitment of medical students early in their medical careers. OBJECTIVE To assess the association between otolaryngology interest groups (OIGs) at medical schools and percentage of students matching into OTOHNS residency programs. To characterize specific aspects of OIGs that may impact the percentage of students matching into OTOHNS residency programs from a given medical school. METHODS Data was obtained from web searches of 141 accredited U.S. allopathic medical schools to see if they possessed OIGs. Information on the various activities and opportunities that OIGs participated in was collected through medical school websites. 2020 NRMP® match results data were obtained. RESULTS Web searches found that 73 % (103 out of 141) of U.S. allopathic medical schools have OIGs. Medical schools with OIGs were associated with a 35 % increase in the median percentage of OTOHNS matches (P = 0.022). Of the 103 medical schools with OIGs, 53 % (55) of the schools had information on their websites describing activities and opportunities that their OIGs participate in. OIGs with research and/or mentorship opportunities were associated with increases in OTOHNS matches by 32 % (P = 0.043) and 83 % (P = 0.012), respectively. CONCLUSION The presence of an OIG at a medical school is associated with an increased percentage of students matching into OTOHNS from that medical school. OIGs that provide research or mentorship opportunities are associated with an increased percentage of students matching into OTOHNS from those medical schools.
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Affiliation(s)
- David O'Neil Danis
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Michael B Cohen
- Department of Otolaryngology-Head and Neck Surgery, Veterans Affair Hospital Boston, 150 South Huntington Avenue, Boston, MA 02130, USA; Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA 02118, USA.
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA 02118, USA
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Rodriguez Lara F, Carnino JM, Cohen MB, Levi JR. Advances in the Use of Hypoglossal Nerve Stimulator in Adolescents With Down Syndrome and Persistent Obstructive Sleep Apnea-A Systematic Review. Ann Otol Rhinol Laryngol 2024; 133:317-324. [PMID: 38062678 DOI: 10.1177/00034894231216287] [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] [Indexed: 02/15/2024]
Abstract
INTRODUCTION The Hypoglossal Nerve Stimulator (HNS) is a novel therapy that has been extensively studied in adults and more recently, it has been incorporated in children with Down Syndrome (DS) with persistent obstructive sleep apnea after adenotonsillectomy and trial of continuous positive airway pressure treatment. This systematic review article aims to examine the existing literature on HNS use in children to explore the benefits, efficacy, and parental experiences. METHODS MEDLINE, Web of Science and EMBASE were searched to include all studies published up to March 2nd, 2023, on the topic of HNS use in pediatric population under 21 years old. RESULTS A total of 179 studies were initially identified from which 10 articles were consistent with the inclusion criteria. Nine articles addressed outcomes after implantation of the HNS device in children with DS and 1 article explored the parental experiences. Findings were similar across studies where after implantation of HNS, there was marked improvement in polysomnographic outcomes and quality of life scores with high level of compliance. CONCLUSIONS HNS holds promise as an effective treatment option for pediatric patients with DS and persistent OSA after AT and CPAP trials. It significantly improves sleep-disordered breathing, quality of life, and neurocognitive measures, leading to substantial and sustained benefits for these children. While the findings are encouraging, further research is needed to explore the potential of HNS in other pediatric populations without DS and to raise awareness among healthcare providers about this treatment option. Overall, HNS may offer significant long-term benefits for the overall well-being and health of pediatric patients with DS and persistent OSA.
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Affiliation(s)
| | - Jonathan M Carnino
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Michael B Cohen
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
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Garvey EA, Jamil TL, Levi JR, Cohen MB. Demographic disparities in children with retropharyngeal and parapharyngeal abscesses. Am J Otolaryngol 2024; 45:104140. [PMID: 38070379 DOI: 10.1016/j.amjoto.2023.104140] [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: 09/27/2023] [Accepted: 12/03/2023] [Indexed: 03/16/2024]
Abstract
PURPOSE To explore the impact that demographic and socioeconomic factors such as age, gender, race, and insurance status have on the diagnosis of retropharyngeal (RPA) and parapharyngeal abscesses (PPA) in the pediatric population. METHODS The 2016 HCUP KID was searched for all RPA/PPA discharges using the joint ICD-10 code J39.0. Descriptive statistics, univariate, and multivariate analyses were performed to assess the relationship between demographic factors and their impact on RPA/PPA diagnosis. Results were reported with their corresponding odds ratio with a 95 % confidence interval and p-value. RESULTS 56.4 per 100,000 weighted discharges were discharged with a diagnosis of a RPA/PPA, the average age was 5.7 years old, with a male predominance. Pediatric discharges diagnosed with a RPA/PPA were less likely to identify as Hispanic or Asian/Island Pacific. They were also less likely to be insured by Medicaid and reside in zip codes with a lower median income. CONCLUSION The analysis of this national pediatric database demonstrated significant demographic differences in children diagnosed with RPA/PPAs. Following the multivariate analysis, children from a higher socioeconomic background and those with private insurance were more likely to be diagnosed with a RPA/PPAs. However, disparities in children's overall hospital course and complications is a potential area for future research.
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Affiliation(s)
- Emily A Garvey
- Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, USA
| | - Taylor L Jamil
- Boston University School of Medicine, 72 East Concord St, Boston, MA 02118, USA; Department of Otolaryngology - Head and Neck Surgery, University of Colorado, 12631 E 17th Ave, Aurora, CO 80045, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA 02118, USA
| | - Michael B Cohen
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, 830 Harrison Ave, Boston, MA 02118, USA.
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Haberberger JF, Pegram W, Britt N, Schiavone K, Severson E, Sharaf R, Albacker LA, Williams E, Lechpammer M, Hemmerich A, Lin D, Huang RSP, Hiemenz M, Elvin J, Graf R, Lesser G, Kram D, Strowd R, Bi WL, Ramkissoon LA, Cohen MB, Reddy P, Creeden J, Ross JS, Alexander BM, Ramkissoon SH. A Retrospective Genomic Landscape of 661 Young Adult Glioblastomas Diagnosed Using 2016 WHO Guidelines for Central Nervous System Tumors. Oncologist 2024; 29:e47-e58. [PMID: 37619245 PMCID: PMC10769808 DOI: 10.1093/oncolo/oyad224] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 05/21/2023] [Indexed: 08/26/2023] Open
Abstract
The authors present a cohort of 661 young adult glioblastomas diagnosed using 2016 WHO World Health Organization Classification of Tumors of the Central Nervous System, utilizing comprehensive genomic profiling (CGP) to explore their genomic landscape and assess their relationship to currently defined disease entities. This analysis explored variants with evidence of pathogenic function, common copy number variants (CNVs), and several novel fusion events not described in literature. Tumor mutational burden (TMB) mutational signatures, anatomic location, and tumor recurrence are further explored. Using data collected from CGP, unsupervised machine-learning techniques were leveraged to identify 10 genomic classes in previously assigned young adult glioblastomas. The authors relate these molecular classes to current World Health Organization guidelines and reference current literature to give therapeutic and prognostic descriptions where possible.
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Affiliation(s)
| | - Worthy Pegram
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
| | - Nicholas Britt
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
| | | | - Eric Severson
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
| | - Radwa Sharaf
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Lee A Albacker
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Erik Williams
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | | | | | - Douglas Lin
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
| | | | - Matthew Hiemenz
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Julia Elvin
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Ryon Graf
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Glenn Lesser
- Pathology Department, Section on Hematology-Oncology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - David Kram
- Pathology Department, Section on Hematology-Oncology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Roy Strowd
- Pathology Department, Section on Hematology-Oncology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Lori A Ramkissoon
- Pathology Department, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael B Cohen
- Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Prasanth Reddy
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - James Creeden
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
| | - Jeffrey S Ross
- Pathology Department, Foundation Medicine, Cambridge, MA, USA
- Pathology Department, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Shakti H Ramkissoon
- Pathology Department, Foundation Medicine, Morrisville, NC, USA
- Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Gross DJ, Robboy SJ, Cohen MB, Vernon L, Park JY, Crawford JM, Karcher DS, Wheeler TM, Black-Schaffer WS. Strong Job Market for Pathologists: Results From the 2021 College of American Pathologists Practice Leader Survey. Arch Pathol Lab Med 2023; 147:434-441. [PMID: 35776913 DOI: 10.5858/arpa.2022-0023-cp] [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] [Accepted: 02/23/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— There has long been debate about whether and when there may be a shortage of pathologists in the United States. One way to assess this is to survey the hiring experiences of pathology practices. A 2018 survey revealed a strong demand for pathologists, with expectations of continued strength. This study updates that prior analysis using data from a 2021 survey of pathology practice leaders. OBJECTIVE.— To assess the US pathologist job market and examine implications. DESIGN.— We analyzed data from the 2021 College of American Pathologists Practice Leader Survey. This survey queried practice leaders, including regarding the hiring of pathologists, the level of experience being sought, success in filling positions, and expectations for hiring in the next 3 years. RESULTS.— Among the 375 surveyed practice leaders (about one-third of all US pathology practices), 282 provided information about pathologist hiring in 2021. A total of 157 of these 282 practices (55.7%) sought to hire at least 1 pathologist in 2021, up from 116 of 256 practices (45.3%) in 2017; the mean number of pathologists hired per practice also increased. In 2021, a total of 175 of 385 positions (45.5%) were to fill new positions, compared with 95 of 249 positions (38.2%) in 2017. Most practice leaders were comfortable hiring pathologists with less than 2 years of posttraining experience. Practice leaders anticipated continued strong demand for hiring pathologists during the next 3 years. CONCLUSIONS.— Our analysis confirms that the demand in pathologist hiring is strong and much increased from 2017. We believe, in combination with other job market indicators, that demand may outstrip the supply of pathologists, which is limited by the number of trainees and has remained constant during the past 20 years.
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Affiliation(s)
- David J Gross
- From the Policy Roundtable, College of American Pathologists, Washington, District of Columbia (Gross)
| | - Stanley J Robboy
- The Department of Pathology, Duke University Medical Center, Durham, North Carolina (Robboy)
| | - Michael B Cohen
- The Department of Pathology, Wake Forest Medical Center, Winston-Salem, North Carolina (Cohen)
| | - Lori Vernon
- Research and Insights, Market Analysis, College of American Pathologists, Northfield, Illinois (Vernon)
| | - Jason Y Park
- The Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Park)
| | - James M Crawford
- The Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Crawford)
| | - Donald S Karcher
- The Department of Pathology, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia (Karcher)
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Choi Y, Bloom J, Levi J, Cohen MB. Geographic Diversity Among Otolaryngology Residency Programs. J Surg Educ 2022; 79:1546-1552. [PMID: 35701301 DOI: 10.1016/j.jsurg.2022.05.019] [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] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/18/2022] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze geographic trends in the otolaryngology residency match. DESIGN Cross-sectional study of 116 otolaryngology residency programs, including 1657 residents. SETTING Internet. PARTICIPANTS Medical school, undergraduate institution, and hometown of otolaryngology residents in the academic year 2019 to 2020 were recorded from programs' websites. Six military programs and 1 program in Puerto Rico were excluded. RESULTS Of 1402 residents, 784 (55.9%) and 556 (39.6%) matched in the same region as their medical school for general and specific divisions, respectively. Residency programs in the South, Northeast, and Midwest had significantly more residents who went to medical school in the same division (p-value <0.02). 17.9% (252 of 1402) of residents matched at their same medical institution or an affiliated program, while 34.8% (208 of 597) and 44.8% (268 of 597) of residents matched at a division with no previous affiliation for general and specific divisions, respectively. CONCLUSIONS Programs in the South, Midwest, and Northeast are more likely to have residents who graduated from medical schools in these respective divisions, while programs in the West are more likely to have residents who graduated from medical schools outside this division. Over a third of residents matched at programs in divisions with no previous affiliation. This information may be useful for applicants in deciding on application strategies and for programs seeking to improve their diversity.
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Affiliation(s)
- Yeyoon Choi
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts.
| | - Jacob Bloom
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts; Department of Otolaryngology Head and Neck Surgery, Boston, Massachusetts
| | - Jessica Levi
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts; Department of Otolaryngology Head and Neck Surgery, Boston, Massachusetts
| | - Michael B Cohen
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts; Department of Otolaryngology Head and Neck Surgery, Boston, Massachusetts; Division of Otolaryngology, Department of Surgery, VA Boston Health Care System, Boston, Massachusetts
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Cohen MB, Saint Martin M, Gross DJ, Johnson K, Robboy SJ, Wheeler TM, Johnson RL, Black-Schaffer WS. Features of burnout amongst pathologists: A reassessment. Acad Pathol 2022; 9:100052. [PMID: 36247711 PMCID: PMC9554805 DOI: 10.1016/j.acpath.2022.100052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/06/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 10/29/2022] Open
Abstract
There has been little rigorous assessment of burnout among pathologists and pathology trainees. Given this relative dearth of relevant literature on pathologist burnout, this report aims to raise awareness of the issue among those working in and around this specialty. Our results are based on a survey given in conjunction with the American Board of Pathology's (ABPath) biennial Continuing Certification (CC) reporting of activities required of diplomates to maintain certification. The survey was voluntary, open to all diplomates participating in CC, and conducted over two consecutive years (2019 and 2020), with alternate years comprising different sets of diplomates. The data are based on 1256 respondents (820 from 2019 to 436 from 2020). The three highest aggregate reported rates of burnout (reported as experienced nearly all of the time, most of the time, or part of the time) occurred when respondents were in their first year of residency training (41.1%) and when they were in (47.6%) and beyond (46.6%) their first three years of practice. We considered this high-low-high, or U-shaped distribution in recollected burnout over time among pathologists a notable finding and investigated its distribution among respondents. Conversely at every point in their training and practice, from half to three-quarters of respondents reported never or infrequently experiencing burnout. This study represents the largest pathologist cohort survey to date about pathologists' burnout. Importantly, especially for those considering pathology as a career, these data are on the low end of the distribution of burnout among specialties for those in practice.
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Affiliation(s)
- Michael B. Cohen
- Department of Pathology, Atrium Health Wake Forest Baptist, Wake Forest, NC, USA,Corresponding author. Department of Pathology, Medical Center Boulevard, Atrium Health Wake Forest Baptist, Winston-Salem, NC, 27157, USA.
| | | | - David J. Gross
- Policy Roundtable, College of American Pathologists, Washington, DC, USA
| | - Kristen Johnson
- CAP Learning, College of American Pathologists, Northfield, IL, USA
| | | | - Thomas M. Wheeler
- Department of Pathology, Baylor College of Medicine, Houston, TX, USA
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Ward LM, LaRosa AH, Prakash Y, Cohen MB, Levi JR. Internet and social media research by parents of pediatric otolaryngologic patients. Am J Otolaryngol 2022; 43:103518. [PMID: 35696816 DOI: 10.1016/j.amjoto.2022.103518] [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: 04/08/2022] [Accepted: 05/30/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Public access to medical information has increased dramatically with the growth and accessibility of the Internet. The goal of this study is to characterize how parents use the Internet to understand and make decisions about their child's otolaryngologic surgery. MATERIALS AND METHODS A survey was distributed to parents of pediatric patients undergoing otolaryngologic procedures to assess if and how parents gather information about their child's surgery. RESULTS 105 parents completed the survey. 59.4% of parents gathered online information about their child's surgery. 86% of these parents used Google, 36% used YouTube, 16% used Wikipedia, and 9% used a hospital website. Most searched for general information about the surgery, followed by risks, pain/recovery, and specifics about the surgery. 69% reported that the information found influenced the healthcare decisions they made for their child. 86% felt the information was trustworthy. 21% discussed the information with their child's surgeon. 17% gathered information about their child's surgeon, of which 73% were interested in the surgeon's experience. 69% reported this influenced their choice of surgeon. CONCLUSIONS Most parents of pediatric otolaryngologic patients use the Internet to gather information about their child's surgery, view that information as accurate, and use that information to make healthcare decisions. However, less than one quarter of parents discuss the information with their child's surgeon. It is critical to understand how parents use the Internet for healthcare information so otolaryngologists can better direct their patients' parents to appropriate and accurate resources.
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10
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Ward LM, LaRosa AH, Prakash Y, Cohen MB, Levi JR. Opioid use in pediatric otolaryngologic surgery: A survey of caregivers' attitudes. J Opioid Manag 2022; 18:237-242. [PMID: 35666480 DOI: 10.5055/jom.2022.0715] [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: 06/15/2023]
Abstract
OBJECTIVE Given the current opioid epidemic and the fact that children continue to be undertreated for pain following surgeries, it is important to understand care-givers' attitudes toward post-operative opioid use. DESIGN A survey was distributed to caregivers of pediatric patients undergoing otolaryngologic procedures. SETTING An academic hospital in Boston, Massachusetts. PARTICIPANTS Sixty-eight caregivers completed the survey. MAIN OUTCOME MEASURE Caregiver attitudes toward post-operative opioid use. RESULTS The study results are as follows: 38.1 percent of parents stated they would feel comfortable giving their child opioids post-operatively, 30.2 percent would not feel comfortable, and 31.7 percent were unsure. For every increase in 1 year of age of the child, there was an increase in the odds of a parent being comfortable giving opioids. Caregivers who had taken opioids in the past were more likely to feel comfortable, while those who were employed were less likely to feel comfortable. The most common reason reported for not feeling comfortable was addiction potential. The comfort level did not differ based on the caregivers' education level, income, race, or language. CONCLUSION The majority of caregivers are unsure about or do not feel comfortable giving their child opioids post-operatively. Most are specifically concerned about the risk of addiction. Understanding caregivers' views on opioids in a diverse patient population is essential, so surgeons can counsel caregivers and provide appropriate post-operative pain management in their patients.
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Affiliation(s)
- Libby M Ward
- Boston University School of Medicine, Boston, Massachusetts. ORCID: https://orcid.org/0000-0003-0720-1115
| | | | - Yash Prakash
- Boston University School of Medicine, Boston, Massachusetts
| | - Michael B Cohen
- Boston University School of Medicine, Boston, Massachusetts; Department of Otolaryngology, Boston Medical Center, Boston, Massachusetts
| | - Jessica R Levi
- Boston University School of Medicine, Boston, Massachusetts; Department of Otolaryngology, Boston Medical Center, Boston, Massachusetts. ORCID:https://orcid.org/0000-0002-5594-9374
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11
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Uppalapati AV, Hubbell RD, Cheung AY, Kakarlapudi S, Cohen MB, Levi JR. Severe Versus Very Severe Pediatric Obstructive Sleep Apnea Outcomes After Adenotonsillectomy. Laryngoscope 2021; 132:1855-1860. [PMID: 34704621 DOI: 10.1002/lary.29916] [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: 06/19/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Adenotonsillectomy (AT) is generally considered the first line treatment for pediatric patients with obstructive sleep apnea (OSA). Pediatric patients with severe OSA have worse outcomes after AT than patients with milder OSA. It is currently unclear if this group of higher morbidity patients should be subdivided further. This study investigates patients with severe pediatric OSA to determine if there are differences in postsurgical outcomes based on initial severity of sleep disordered breathing, medical comorbidities, or demographic factors. STUDY DESIGN Retrospective cohort study at a single tertiary referral center. METHODS Patients aged 2-18 who underwent polysomnogram (PSG) from October 2012 to January 2019, had an apnea-hypopnea index (AHI) >10, and subsequently underwent AT were identified using a filter through electronic medical record. A total of 112 patients underwent both pre- and postoperative PSG. Bivariate analysis was conducted via Pearson chi-square test. Univariate and multivariate analyses via binary logistic and multinomial linear regressions were performed using SPSS. RESULTS Of the 112 patients included in this study, 68 patients were identified as having severe OSA (AHI = 10-20) and 44 as having very severe OSA (AHI > 20). Very severe OSA patients were significantly less likely to be cured of sleep disordered breathing or have their OSA reduced to mild OSA. Obese patients were found to have less reduction in AHI after AT. CONCLUSIONS The postsurgical outcomes of patients with severe and very severe OSA are significantly different indicating that patients traditionally categorized as having severe OSA may need to be further subcategorized. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Akhil V Uppalapati
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Richard D Hubbell
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Anthony Y Cheung
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Sraavya Kakarlapudi
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Michael B Cohen
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, U.S.A
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12
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Abstract
OBJECTIVE Social media is playing an increasingly important role in medicine as a tool for patients and their families to find information and connect with others. The goal of this study is to understand parental views on if and how social media should be incorporated into pediatric otolaryngology by physicians and hospitals. METHODS A survey was distributed to parents of pediatric otolaryngologic patients to assess views on professional social media use by physicians and hospitals. The proportion of parents who answered with specific responses in the survey was computed using the SPSS frequency analysis function. RESULTS One hundred five parents completed the survey. Ninety-six percent of respondents use social media, of which 92% use social media at least once a day (n = 93). Eighty-five percent of respondents said they definitely or probably would visit their physician's professional social media page (n = 90). Seventy-four percent would be interested in obtaining more information about the physician (n = 76). Forty-one percent would be interested in patient stories (n = 76). Twenty-eight percent would visit out of curiosity (n = 76). Twenty-six percent would want to gather more information about the hospital (n = 76). Seventeen percent would want to connect with other patients and their family members (n = 76). Sixty-seven percent of respondents believe it is important for physicians to have a professional social media page, and 79% of respondents believe it is important for hospitals to have a public social media page (n = 93). CONCLUSION The vast majority of parents of pediatric otolaryngologic patients use social media regularly and would want to gather information about their physician and hospital through social media. Therefore, physicians and hospitals should consider using social media as a valuable tool to connect with and relay information to patients and their family members.
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Affiliation(s)
- Libby M Ward
- Boston University School of Medicine, Boston, MA, USA
| | | | - Yash Prakash
- Boston University School of Medicine, Boston, MA, USA
| | - Michael B Cohen
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
| | - Jessica R Levi
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
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13
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Bachrach K, Danis DO, Cohen MB, Levi JR. The Relationship Between Obstructive Sleep Apnea and Pediatric Obesity: A Nationwide Analysis. Ann Otol Rhinol Laryngol 2021; 131:520-526. [PMID: 34192945 DOI: 10.1177/00034894211028489] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pediatric obstructive sleep apnea (OSA) can have both acute and chronic consequences when untreated. We hypothesize that a link exists between childhood obesity and OSA at nationwide level, with race, gender, and socioeconomic status conferring their own risk for pediatric OSA. METHODS This study examined nationwide discharges in 2016 using the Kids' Inpatient Database (KID). The International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes for obesity (E66.0) and OSA (G47.33) were used. Prevalence rates and odds ratios (ORs) were used to quantify associations between the obesity and OSA groups in the general pediatric inpatient population. Multiple binary logistic regression was utilized to compare cohorts of pediatric inpatient admissions. RESULTS There were 36 266 285 weighted discharges in the 2016 KID. Among patients included in our dataset, 0.426% (26 684) were diagnosed with obesity and 0.562% (35 242) had OSA. Obesity was independently associated with a significantly increased risk of OSA (OR = 22.89; 95% C.I. = 21.99-23.84). Within the OSA inpatient population, obesity was associated with non-Hispanic black race, Hispanic ethnicity, and Native American race/ethnicity (OR = 1.45, 1.32, 2.51; 95% C.I. = 1.33-1.58, 1.21-1.44, 1.73-3.63). CONCLUSIONS Obesity is independently associated with OSA in children after controlling for adenotonsillar hypertrophy. Non-Hispanic black race and Hispanic ethnicity are independent risk factors for OSA and are associated with obesity in the OSA inpatient population, which suggests that obesity may play a role in the increased risk of OSA within these groups.
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Affiliation(s)
| | | | - Michael B Cohen
- Boston University School of Medicine, Boston, MA, USA.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA.,VA Boston Medical Center, 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
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14
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Li W, Justice-Clark T, Cohen MB. The utility of ThyroSeq ® in the management of indeterminate thyroid nodules by fine-needle aspiration. Cytopathology 2021; 32:505-512. [PMID: 33914382 DOI: 10.1111/cyt.12981] [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] [Received: 07/22/2020] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We aim to evaluate the impact of ThyroSeq® in the management of indeterminate thyroid nodules (ITN), including Bethesda III and IV nodules. METHODS ITNs that underwent ThyroSeq testing between 2016 and 2019 were retrospectively reviewed. A control cohort included ITNs without molecular testing. Cytological, molecular, and histological data were collected. RESULTS We identified 202 ITNs that underwent molecular testing (128 in Bethesda III and 74 in Bethesda IV). Mutations were found in 58 nodules with mutation rates of 21.9% in Bethesda III and 40.5% in Bethesda IV. In this cohort, 49 cases had surgical resection with a resection rate of 24.3% (49/202, 15.6% in Bethesda III and 39.2% in Bethesda IV). Among the resected cases, 42 cases had positive molecular results. Thyroid cancer was diagnosed in 21 nodules with a malignancy detection rate of 10.4%. In the other cohort, we identified 236 ITNs (158 in Bethesda III and 78 in Bethesda IV). Surgical resection was performed in 127 cases, with a resection rate of 53.8% (127/236, 46.2% in Bethesda III and 69.2% in Bethesda IV). Thyroid cancer was diagnosed in 21 nodules, with a malignancy detection rate of 8.9%. The risk of malignancy (ROM) recalculated based on positive ThyroSeq results was significantly higher (21.4%-35.5% in Bethesda III and 50%-60% in Bethesda IV) than that without molecular testing (4.4%-9.6% in Bethesda III and 17.9%-25.9% in Bethesda IV). CONCLUSION We concluded that ThyroSeq significantly decreased the surgical resection rate (from 53.8% to 24.3%) without significantly affecting the malignancy detection rate in ITNs. Furthermore, positive molecular testing significantly increased ROM in ITNs. We believe that the recalculated ROM should be incorporated into the management of ITNs.
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Affiliation(s)
- Wencheng Li
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Tracy Justice-Clark
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael B Cohen
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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15
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Black-Schaffer WS, Robboy SJ, Gross DJ, Crawford JM, Johnson K, Austin M, Karcher DS, Johnson RL, Powell SZ, Sanfrancesco J, Cohen MB. Evidence-Based Alignment of Pathology Residency With Practice II: Findings and Implications. Acad Pathol 2021; 8:23742895211002816. [PMID: 33889716 PMCID: PMC8040604 DOI: 10.1177/23742895211002816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/15/2021] [Revised: 01/15/2021] [Accepted: 02/06/2021] [Indexed: 11/18/2022] Open
Abstract
This article presents findings from a 4-year series of surveys of new-in-practice pathologists, and a survey of physician employers of new pathologists, assessing how pathology graduate medical education prepares its graduates for practice. Using the methodology described in our previous study, we develop evidence for the importance of residency training for various practice areas, comparing findings over different practice settings, sizes, and lengths of time in practice. The principal findings are (1) while new-in-practice pathologists and their employers report residency generally prepared them well for practice, some areas—billing and coding, laboratory management, molecular pathology, and pathology informatics—consistently were identified as being important in practice but inadequately prepared for in residency; (2) other areas—autopsy pathology, and subspecialized apheresis and blood donor center blood banking services—consistently were identified as relatively unimportant in practice and excessively prepared for in residency; (3) the notion of a single comprehensive model for categorical training in residency is challenged by the disparity between broad general practice in some settings and narrower subspecialty practice in others; and (4) the need for preparation in some areas evolves during practice, raising questions about the appropriate mode and circumstance for training in these areas. The implications of these findings range from rebalancing the emphasis among practice areas in residency, to reconsidering the structure of graduate medical education in pathology to meet present and evolving future practice needs.
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Affiliation(s)
- W Stephen Black-Schaffer
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - David J Gross
- College of American Pathologists, Washington, DC, USA
| | - James M Crawford
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Melissa Austin
- Uniformed Services, University of the Health Sciences, Bethesda, MD, USA
| | - Donald S Karcher
- George Washington University Medical Center, Washington, DC, USA
| | | | - Suzanne Z Powell
- Weill Cornell Medical College Houston, TX, USA.,Houston Methodist Hospital, Houston, TX, USA
| | | | - Michael B Cohen
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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16
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Huang RSP, Severson E, Haberberger J, Duncan DL, Hemmerich A, Edgerly C, Ferguson NL, Frampton G, Owens C, Williams E, Elvin J, Vergilio JA, Killian JK, Lin D, Morley S, McEwan D, Holmes O, Danziger N, Cohen MB, Sathyan P, McGregor K, Reddy P, Venstrom J, Anhorn R, Alexander B, Brown C, Ross JS, Ramkissoon SH. Landscape of Biomarkers in Non-small Cell Lung Cancer Using Comprehensive Genomic Profiling and PD-L1 Immunohistochemistry. Pathol Oncol Res 2021; 27:592997. [PMID: 34257540 PMCID: PMC8262230 DOI: 10.3389/pore.2021.592997] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
Comprehensive genomic profiling (CGP) and immunohistochemistry (IHC) are important biomarker tools used for patients with non-small cell lung cancer (NSCLC) given the expanding number of standard-of-care therapies that require companion diagnostic testing. We examined 9450 NSCLC real-world patient samples that underwent both CGP and programmed death-ligand 1 (PD-L1) IHC to understand the biomarker landscape in this patient cohort. By assessing National Comprehensive Cancer Network (NCCN)-recommended biomarkers including genomic alterations, tumor mutational burden (≥10 mutations/Mb cut-off), and PD-L1 expression (Tumor Proportion Score (TPS) ≥ 50% cut-off), we show that CGP + PD-L1 IHC yielded potentially actionable results for 70.5% of the 9,450 patients with NSCLC. Among the remaining 29.5% (2,789/9,450) of patients, 86.7% (2,419/2,789) were potentially eligible for another biomarker-associated therapy and/or clinical trial based on their genomic profile. In addition, in the PD-L1TPS≥50% disease subset, BRAF mutations, MET mutations, MET amplifications, and KRAS mutations were significantly enriched; and in the PD-L1TPS<50%, EGFR mutations, ERBB2 mutations, STK11 mutations, and KEAP1 mutations were enriched. These findings highlight the improved clinical utility of combining CGP with IHC to expand the biomarker-guided therapeutic options available for patients with NSCLC, relative to single biomarker testing alone.
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Affiliation(s)
| | - Eric Severson
- Foundation Medicine, Inc., Morrisville, NC, United States
| | | | | | | | - Claire Edgerly
- Foundation Medicine, Inc., Morrisville, NC, United States
| | | | | | - Clarence Owens
- Foundation Medicine, Inc., Morrisville, NC, United States
| | - Erik Williams
- Foundation Medicine, Inc., Cambridge, MA, United States
| | - Julia Elvin
- Foundation Medicine, Inc., Cambridge, MA, United States
| | | | | | - Douglas Lin
- Foundation Medicine, Inc., Cambridge, MA, United States
| | | | | | - Oliver Holmes
- Foundation Medicine, Inc., Cambridge, MA, United States
| | | | - Michael B Cohen
- Wake Forest Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | | | | | | | | | - Rachel Anhorn
- Foundation Medicine, Inc., Cambridge, MA, United States
| | | | | | - Jeffrey S Ross
- Foundation Medicine, Inc., Morrisville, NC, United States.,Department of Pathology, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Shakti H Ramkissoon
- Foundation Medicine, Inc., Morrisville, NC, United States.,Wake Forest Comprehensive Cancer Center, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States
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17
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Jaleel Z, Schaeffer T, Trinh C, Cohen MB, Levi JR. Prematurity: A Prognostic Factor for Increased Severity of Pediatric Obstructive Sleep Apnea. Laryngoscope 2021; 131:1909-1914. [PMID: 33629766 DOI: 10.1002/lary.29473] [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] [Received: 10/20/2020] [Revised: 02/01/2021] [Accepted: 02/12/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE/HYPOTHESIS Studies have suggested preterm birth, defined as gestational age (GA) <37 weeks, is a risk factor for obstructive sleep apnea (OSA) in later childhood. However, little is known about the characteristics, severity, and degree of intervention of childhood OSA in former preterm infants compared to term infants. This study compares polysomnographic characteristics and surgical interventions in former preterm and term infants presenting with sleep disordered breathing. STUDY DESIGN Retrospective cohort study from 2015 to 2019 at a single tertiary referral center. METHODS Electronic Medical Records of pediatric patients ages 0 to 18 presenting with sleep disordered breathing were reviewed for gestational age, polysomnographic findings, clinical characteristics, and OSA surgical interventions. Association between gestational age, polysomnographic characteristics, and surgical interventions for OSA were reported. RESULTS A total of 615 patient records were analyzed. Adjusting for covariates, prematurity was associated with a 2.97× higher likelihood of development of severe OSA (aOR (95%CI): 2.97 (1.40-6.32)), increased apneic-hypoxic index (AHI) (mean (SD): 6.5 (9.8) vs. 4.6 (6.4), P < .05), increased end tidal CO2 (50.5 (5.11) vs. 48.5 (5.8), P < .05), decreased REM latency (116 (64.7) vs. 132.4 (69.9), P < .05), and increased number of surgeries for OSA (0.65 (.95) vs. 0.45 (0.69), P < .05) compared to children born at term. Children born with GA < 32 weeks presented at a significantly later age with sleep disordered breathing (7.04 (.80) vs. 5.1 (0.15), P < .05) than children born at term. CONCLUSIONS Prematurity was associated with increased likelihood of severe OSA, increased AHI, as well as increased number of surgical interventions for OSA compared to children born at term. These results suggest an association with preterm birth and increased severity of childhood OSA. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1909-1914, 2021.
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Affiliation(s)
- Zaroug Jaleel
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Tyler Schaeffer
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Caroline Trinh
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Michael B Cohen
- Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Jessica R Levi
- Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
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18
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Abraham EJ, Bains A, Rubin BR, Cohen MB, Levi JR. Predictors of a Normal Sleep Study in Healthy Children with Sleep Disordered Breathing Symptoms. Ann Otol Rhinol Laryngol 2021; 130:1029-1035. [PMID: 33544624 DOI: 10.1177/0003489421990156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the prevalence and characteristics of children with normal elective polysomnography for obstructive sleep disordered breathing (oSDB) based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. STUDY DESIGN In this retrospective cohort study, we identified patients ages 2 to 18 who underwent diagnostic polysomnography (PSG) ordered by our otolaryngology department for SDB between 2012 and 2018. SETTING All patients were seen by otolaryngologists at an urban tertiary safety net hospital. SUBJECTS AND METHODS There were a total of 456 patients studied (average age 5.66 ± 3.19; 263 (57.7%) males, 193 (42.3%) females. Demographic factors (age, gender, race, ethnicity, language, insurance status) and clinical findings (symptom severity, tonsil size) were recorded. The data were analyzed by univariate and multivariate analysis. RESULTS Two hundred four patients (44.7%) had no obstructive sleep apnea (OSA) based on AHI<2 on PSG. Children with a larger tonsil size had 3.18 times the odds of OSA compared to those with a medium tonsil size (95% CI 1.64, 6.19) when adjusting for symptoms, age category, and race (P = .0007). Children ages 4 to 6 years had 0.25 times the odds of OSA compared to those ages 2-3 years (95% CI 0.12, 1.54) when adjusting for symptoms, tonsil size, and race (P = .0011). White children had 0.28 times the odds of OSA compared to Black children (95% CI 0.14, 0.57) when adjusting for symptoms, tonsil size, and age category (P = .0004). CONCLUSION Among our patient population, 44.7% had normal sleep studies. Younger children (ages 2-3) were less likely to have normal polysomnography. This research demonstrates that obtaining sleep studies in otherwise healthy children with SDB can affect management decisions, and they should be discussed with families with a focus on patient centered decision making.
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Affiliation(s)
| | - Ashank Bains
- Boston University School of Medicine, Boston, MA, USA
| | - Batsheva R Rubin
- Boston University School of Medicine, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Michael B Cohen
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Veterans Affairs Hospital, Boston, MA, USA.,Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Jessica R Levi
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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19
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Huang RS, Li X, Haberberger J, Sokol E, Severson E, Duncan DL, Hemmerich A, Edgerly C, Williams E, Elvin J, Vergilio J, Killian JK, Lin D, Hiemenz M, Xiao J, McEwan D, Holmes O, Danziger N, Erlich R, Frampton G, Cohen MB, McGregor K, Reddy P, Cardeiro D, Anhorn R, Venstrom J, Alexander B, Brown C, Pusztai L, Ross JS, Ramkissoon SH. Biomarkers in Breast Cancer: An Integrated Analysis of Comprehensive Genomic Profiling and PD-L1 Immunohistochemistry Biomarkers in 312 Patients with Breast Cancer. Oncologist 2020; 25:943-953. [PMID: 32869930 PMCID: PMC7648336 DOI: 10.1634/theoncologist.2020-0449] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 05/17/2020] [Accepted: 08/04/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We examined the current biomarker landscape in breast cancer when programmed death-ligand 1 (PD-L1) testing is integrated with comprehensive genomic profiling (CGP). MATERIAL AND METHODS We analyzed data from samples of 312 consecutive patients with breast carcinoma tested with both CGP and PD-L1 (SP142) immunohistochemistry (IHC) during routine clinical care. These samples were stratified into hormone receptor positive (HR+)/human epidermal growth factor receptor negative (HER2-; n = 159), HER2-positive (n = 32), and triple-negative breast cancer (TNBC) cohorts (n = 121). RESULTS We found that in the TNBC cohort, 43% (52/121) were immunocyte PD-L1-positive, and in the HR+/HER2- cohort, 30% (48/159) had PIK3CA companion diagnostics mutations, and hence were potentially eligible for atezolizumab plus nab-paclitaxel or alpelisib plus fulvestrant, respectively. Of the remaining 212 patients, 10.4% (22/212) had a BRCA1/2 mutation, which, if confirmed by germline testing, would allow olaparib plus talazoparib therapy. Of the remaining 190 patients, 169 (88.9%) were positive for another therapy-associated marker or a marker that would potentially qualify the patient for a clinical trial. In addition, we examined the relationship between immunocyte PD-L1 positivity and different tumor mutation burden (TMB) cutoffs and found that when a TMB cutoff of ≥9 mutations per Mb was applied (cutoff determined based on prior publication), 11.6% (14/121) patients were TMB ≥9 mutations/Mb and of these, TMB ≥9 mutations per Mb, 71.4% (10/14) were also positive for PD-L1 IHC. CONCLUSION Our integrated PD-L1 and CGP methodology identified 32% of the tested patients as potentially eligible for at least one of the two new Food and Drug Administration approved therapies, atezolizumab or alpelisib, and an additional 61.2% (191/312) had other biomarker-guided potential therapeutic options. IMPLICATIONS FOR PRACTICE This integrated programmed death-ligand 1 immunohistochemistry and comprehensive genomic profiling methodology identified 32% of the tested patients as eligible for at least one of the two new Food and Drug Administration-approved therapies, atezolizumab or alpelisib, and an additional 61.2% (191/312) had other biomarker-guided potential therapeutic options. These findings suggest new research opportunities to evaluate the predictive utility of other commonly seen PIK3CA mutations in hormone receptor-positive breast cancers and to standardize tumor mutation burden cutoffs to evaluate its potentially predictive role in triple-negative breast cancer.
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Affiliation(s)
| | - Xinyan Li
- Foundation Medicine, Inc.MorrisvilleNorth CarolinaUSA
| | | | - Ethan Sokol
- Foundation Medicine, Inc.CambridgeMassachusettsUSA
| | - Eric Severson
- Foundation Medicine, Inc.MorrisvilleNorth CarolinaUSA
| | | | | | | | | | - Julia Elvin
- Foundation Medicine, Inc.CambridgeMassachusettsUSA
| | | | | | - Douglas Lin
- Foundation Medicine, Inc.CambridgeMassachusettsUSA
| | | | - Jinpeng Xiao
- Foundation Medicine, Inc.MorrisvilleNorth CarolinaUSA
| | | | | | | | | | | | - Michael B. Cohen
- Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | | | | | | | | | | | | | | | | | - Jeffrey S. Ross
- Foundation Medicine, Inc.CambridgeMassachusettsUSA
- Department of Pathology, State University of New York (SUNY) Upstate Medical UniversitySyracuseNew YorkUSA
| | - Shakti H. Ramkissoon
- Foundation Medicine, Inc.MorrisvilleNorth CarolinaUSA
- Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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20
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Shehan JN, Du E, Cohen MB. Robot-assisted epiglottopexy as a method for managing adult obstructive sleep apnea. Am J Otolaryngol 2020; 41:102742. [PMID: 32979662 DOI: 10.1016/j.amjoto.2020.102742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Patients who do not tolerate continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnea (OSA) often seek surgical management. A variety of procedures exist to address the nasal passages, oropharynx, hypopharynx, and larynx. Diagnostic studies including drug-induced sleep endoscopy (DISE) are helpful in identifying areas of obstruction. One potential site of obstruction is at the level of the epiglottis. We describe the use of robotic technology to assist with epiglottopexy to manage epiglottic retroflexion as a cause of two patients' OSA. This is the first reported robot-assisted epiglottopexy in the adult otolaryngology literature. METHODS This is a case series of two patients with OSA who demonstrated epiglottis collapse into the airway during DISE. They were evaluated by polysomnographic testing (PSG), Epworth Sleepiness Scale (ESS), and physical exam. Given their epiglottic collapse seen on DISE, they underwent robot-assisted epiglottopexy. RESULTS Both patients had moderate to severe OSA preoperatively. They successfully underwent robot-assisted epiglottopexy as a surgical intervention. They tolerated the procedure, and there have been no complications. Each reported improved symptoms, with patient one showing a decrease in total AHI and a substantial decrease in oxygen desaturations at night. The second patient reported a significant decrease in AHI and ESS. CONCLUSION There are many options for surgical intervention in patients with OSA. Epiglottopexy is one method for addressing collapse of the epiglottis and can be achieved successfully through robot-assisted epiglottopexy in adult patients with OSA. LEVEL OF EVIDENCE IV.
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21
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Yong C, Moose DL, Bannick N, Gutierrez WR, Vanneste M, Svensson R, Breheny P, Brown JA, Dodd RD, Cohen MB, Henry MD. Locally invasive, castrate-resistant prostate cancer in a Pten/Trp53 double knockout mouse model of prostate cancer monitored with non-invasive bioluminescent imaging. PLoS One 2020; 15:e0232807. [PMID: 32986721 PMCID: PMC7521703 DOI: 10.1371/journal.pone.0232807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/10/2020] [Indexed: 11/18/2022] Open
Abstract
Here we have improved an existing mouse model of prostate cancer based on prostate-specific deletion of Pten and Trp53 by incorporating a Cre-activatable luciferase reporter. By coupling the deletion of those genes to the activation of a luciferase reporter, we were able to monitor tumor burden non-invasively over time. We show that, consistent with previous reports, deletion of both Pten and Trp53 on a C57BL/6 background accelerates tumor growth and results in both the loss of androgen receptor expression and castrate resistant tumors as compared with loss of Pten alone. Loss of Trp53 results in the development of sarcomatoid histology and the expression of markers of epithelial-to-mesenchymal transition Zeb1 and vimentin, with kinetics and penetrance dependent on whether one or both alleles of Trp53 were deleted. Homozygous deletion of Trp53 and Pten resulted in uniformly lethal disease by 25 weeks. While we were able to detect locally invasive disease in the peritoneal cavity in aggressive tumors from the double knockout mice, we were unable to detect lymphatic or hematogenous metastatic disease in lymph nodes or at distant sites.
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Affiliation(s)
- Courtney Yong
- Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Devon L Moose
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Nadine Bannick
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Wade R Gutierrez
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America.,Medical Scientist Training Program, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Marion Vanneste
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Robert Svensson
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Patrick Breheny
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - James A Brown
- Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - Rebecca D Dodd
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, United States of America
| | - Michael B Cohen
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Michael D Henry
- Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America.,Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, United States of America.,Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America.,Department of Radiation Oncology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
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Patel PN, Levi JR, Cohen MB. Lemierre's syndrome in the pediatric population: Trends in disease presentation and management in literature. Int J Pediatr Otorhinolaryngol 2020; 136:110213. [PMID: 32797805 DOI: 10.1016/j.ijporl.2020.110213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aims to examine literature on Lemierre's Syndrome (LS) in the pediatric population over time in order to describe patterns in disease progression, management, and prognosis. In addition, this study assesses specific rate of literature output and the location of research over the past 10 years. METHODS A literature review was conducted through two databases, PubMed.gov and PMC. A search was conducted using the keywords "Lemierre syndrome" and "postanginal sepsis." Literature was primarily reviewed for demographic, radiographic, and clinical data. Articles were included in the study if they were published in English and within the last 10 years. All types of research studies were recorded, however primary data collection came from case reports and series. Publications were grouped into two time periods: 2009-2013 and 2014-2019, allowing for comparison of various characteristics between these two groups. RESULTS A total of 124 research studies on LS met inclusion criteria and were reviewed. Of these, 98 case reports (79.0%) were examined. Disease Characteristics: Fusobacterium necrophorum was the most common precipitating pathogen isolated from cultures (66.2%). The main primary treatment modalities used were antimicrobials, surgery, anticoagulation, or a combination of these treatments. A total of 63.9% of the case reports indicated use of anticoagulation at some point during treatment. Publication Trends: The number of published studies has not significantly changed in the last decade, with a non-statistically significant decline of 5.6%, when comparing 2014-2019 to 2009-2013 (p = 0.21). Case reports/series were the most common study design (82.2% vs 69.5%) and level of evidence for published studies continued to be stable (level 4-5) through the years (86.9%). The number of publications within an international journal vs US based journal has also remained steady during both time periods (p = 0.698). CONCLUSION LS is an uncommon condition but one that is important for physicians to be aware of in the pediatric population. Treatment regimens including antibiotics and anticoagulation have remained stable through the past 10 years, however the efficacy of anticoagulation in treating LS continues to be debated. Though LS is considered a severe illness with potentially life threatening complications, publications on this topic, in pediatrics specifically, have decreased within the past five years.
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Affiliation(s)
- Prachi N Patel
- Boston Medical Center, Department of Otolaryngology - Head and Neck Surgery, Boston, USA.
| | - Jessica R Levi
- Boston Medical Center, Department of Otolaryngology - Head and Neck Surgery, Boston, USA.
| | - Michael B Cohen
- Boston Medical Center, Department of Otolaryngology - Head and Neck Surgery, Boston, USA.
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Li W, Cohen MB. TTF-1, napsin A and CDX2 co-expression in metastatic rectal adenocarcinoma to the lung. Cytopathology 2020; 32:146-148. [PMID: 32633432 DOI: 10.1111/cyt.12884] [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] [Received: 03/19/2020] [Revised: 06/11/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Wencheng Li
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael B Cohen
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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24
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Kahn CI, Wang R, Shetty K, Huestis MJ, Cohen MB, Levi JR. Assessing the Educational Quality of Facebook Videos as an Informative Resource on Otitis Media. Otolaryngol Head Neck Surg 2020; 164:110-116. [PMID: 32600106 DOI: 10.1177/0194599820933887] [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: 11/17/2022]
Abstract
OBJECTIVE This study analyzes the quality and reliability of otitis media (OM) videos on Facebook and investigates whether the videos shared within the Facebook community are considered to be a valuable educational tool. The results of this study are important for providing clinicians with the necessary understanding about the video content that their patients may be exposed to. STUDY DESIGN Cross-sectional analysis of video content. SETTING A new Facebook account was created to carry out a search for videos on OM. METHODS Inclusion criteria were as follows: videos intended for educating patients or guardians on OM, videos in the English language, and videos with at least 1 share. RESULTS A total of 364 videos were screened, and 62 fit our inclusion criteria for analysis. The majority (56%) of OM videos on Facebook focused on complementary and alternative medication without mentioning any current guidelines. A limited amount of videos (29%) made any mention to surgical treatment options for OM. There was a strong positive correlation (rho = 0.8419, P < .001) between a video's content and its reliability. There was no correlation seen between a video's content and its shares (rho = -0.142, P = .1359). CONCLUSIONS The majority of OM videos on Facebook are inadequate for educational value. Clinicians should know about the existence of videos on OM and the quality of information that parents are exposed to.
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Affiliation(s)
- Chase I Kahn
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Rita Wang
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Kunal Shetty
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | | | - Michael B Cohen
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
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25
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Robboy SJ, Gross D, Park JY, Kittrie E, Crawford JM, Johnson RL, Cohen MB, Karcher DS, Hoffman RD, Smith AT, Black-Schaffer WS. Reevaluation of the US Pathologist Workforce Size. JAMA Netw Open 2020; 3:e2010648. [PMID: 32672830 PMCID: PMC7366184 DOI: 10.1001/jamanetworkopen.2020.10648] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE There is currently no national organization that publishes its data that serves as the authoritative source of the pathologist workforce in the US. Accurate physician numbers are needed to plan for future health care service requirements. OBJECTIVE To assess the accuracy of current pathologist workforce estimates in the US by examining why divergency appears in different published resources. DESIGN, SETTING, AND PARTICIPANTS This study examined the American Board of Pathology classification for pathologist primary specialty and subspecialties and analyzed previously published reports from the following data sources: the Association of American Medical Colleges (AAMC), the Accreditation Council for Graduate Medical Education (ACGME), a 2013 College of American Pathologists (CAP) report, a commercially available version of the American Medical Assoication (AMA) Physician Masterfile, and an unpublished data summary from June 10, 2019. MAIN OUTCOMES AND MEASURES Number of physicians classified as pathologists. RESULTS The most recent AAMC data from 2017 (published in 2018) reported 12 839 physicians practicing "anatomic/clinical pathology," which is a subset of the whole. In comparison, the current AMA Physician Masterfile, which is not available publicly, listed 21 292 active pathologists in June 2019. The AMA Physician Masterfile includes all pathologists in 15 subspecialized training areas as identified by the ACGME. By contrast, AAMC's data, which derive from the AMA Physician Masterfile data, only count physicians primarily associated with 3 general categories of pathologists and 1 subspecialty category (ie, chemical pathology). Thus, the AAMC pathology workforce estimate does not include those whose principal work is in 11 subspecialty areas, such as blood banking or transfusion medicine, cytopathology, hematopathology, or microbiology. An additional discrepancy relates to the ACGME residency (specialties) and fellowship (subspecialties) training programs in which pathologists with training in dermatopathology appear as dermatologists and pathologists with training in molecular genetic pathology appear as medical geneticists. CONCLUSIONS AND RELEVANCE This analysis found that most sources reported only select categories of the pathologist workforce rather than the complete workforce. The discordant nature of reporting may pertain to other medical specialties that have undergone increased subspecialization during the past 2 decades (eg, surgery and medicine). Reconsideration of the methods for determining the pathologist workforce and for all workforces in medicine appears to be needed.
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Affiliation(s)
- Stanley J. Robboy
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - David Gross
- College of American Pathologists, Washington, DC
| | - Jason Y. Park
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas
| | - Elizabeth Kittrie
- US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce, Rockville, Maryland
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | | | - Michael B. Cohen
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Donald S. Karcher
- Department of Pathology, The George Washington University Medical Center, Washington, DC
| | - Robert D. Hoffman
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
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26
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Bains A, Abraham E, Hsieh A, Rubin BR, Levi JR, Cohen MB. Characteristics and Frequency of Children With Severe Obstructive Sleep Apnea Undergoing Elective Polysomnography. Otolaryngol Head Neck Surg 2020; 163:1055-1060. [PMID: 32539583 DOI: 10.1177/0194599820931084] [Citation(s) in RCA: 6] [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] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the prevalence and demographics features of pediatric patients with severe obstructive sleep apnea (OSA) who would not undergo preoperative polysomnography (PSG) under current American Academy of Otolaryngology (AAO) guidelines. STUDY DESIGN In this retrospective cohort study, we identified patients from the electronic medical record who underwent elective polysomnography for evaluation of sleep-disordered breathing between 2012 and 2018. SETTING Urban tertiary safety net hospital. SUBJECTS AND METHODS A total of 456 patients with a mean (SD) age of 5.7 (3.2) years (263 male, 193 female). Demographic factors (age, sex, race, language, insurance status) and clinical findings (symptom severity, tonsil size) were recorded. The data were analyzed by univariate analysis. RESULTS Of 456 patients identified, 66 (14.5%) were found to have severe OSA. African American patients had 3.7 times the odds of severe OSA compared to white patients (95% CI, 1.2-10.8). Patients aged 2 to 3 years had 2.2 times the odds of severe OSA compared to patients aged 4 to 6 years (95% CI, 1.2-4.0). Sex, ethnicity, language, and insurance type were not significantly associated with severity of OSA. The presence of apneic episodes and tonsil size were not found to be statistically significant. CONCLUSION Up to 14.5% of healthy pediatric patients with sleep-disordered breathing may have severe OSA; young age and African American race are statistically significant predictors. Clinical findings, such as tonsil size and symptom severity, were not found to be statistically significant predictors.
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Affiliation(s)
- Ashank Bains
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Adam Hsieh
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Batsheva R Rubin
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jessica R Levi
- Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Michael B Cohen
- Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
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27
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Fard D, Rohlfing ML, Razak A, Cohen MB, Levi JR. Prevalence and natural history of obstructive sleep apnea in pediatric patients with laryngomalacia. Int J Pediatr Otorhinolaryngol 2020; 133:109967. [PMID: 32120133 DOI: 10.1016/j.ijporl.2020.109967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Laryngomalacia is the most common cause of infant stridor, and obstructive sleep apnea (OSA) is sometimes found concurrently in patients with laryngomalacia. OSA has been shown to improve after surgical treatment of laryngomalacia, but the majority of laryngomalacia patients have spontaneous resolution of symptoms. It is unknown whether their comorbid OSA also resolves. This study seeks to define the incidence of OSA in laryngomalacia and assess for resolution of OSA with polysomnography data. METHODS Retrospective cohort study at a tertiary care academic medical center. All pediatric patients with diagnoses of laryngomalacia or stridor were reviewed, and patients with laryngomalacia confirmed by Otolaryngologist exam were included. All patients with laryngomalacia were recommended to undergo polysomnography. RESULTS A total of 108 patients had laryngomalacia confirmed by an Otolaryngologist. Of those patients, 56 completed a polysomnogram, and 44 (79%) were diagnosed with OSA. Among the OSA patients, 34 had no surgery, 5 underwent supraglottoplasty, and 5 underwent adenoidectomy or adenotonsillectomy. Follow-up polysomnograms were performed for 9 non-surgical patients, 4 supraglottoplasty patients, and 4 adenoidectomy or adenotonsillectomy patients. Mean change in AHI was -2.81 without surgery, -8.18 after supraglottoplasty, and -2.94 after adenoidectomy or adenotonsillectomy. CONCLUSION OSA is often present in patients who have laryngomalacia, and the proportion in this population was higher than previous reports. The only significant predictor for obstructive sleep apnea was race, specifically Black/African American. Among patients with follow-up polysomnograms, the largest OSA improvement was in supraglottoplasty patients, but all patients improved.
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Affiliation(s)
- Darian Fard
- Boston University School of Medicine, Boston, MA, USA.
| | - Matthew L Rohlfing
- Department of Otolaryngology, Boston Medical Center, Boston, Massachusetts, USA.
| | - Alina Razak
- Boston University School of Medicine, Boston, MA, USA.
| | - Michael B Cohen
- Department of Otolaryngology, Boston Medical Center, Boston, Massachusetts, USA.
| | - Jessica R Levi
- Department of Otolaryngology, Boston Medical Center, Boston, Massachusetts, USA.
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28
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Kohn JL, Rubin SJ, Patel J, Dia R, Levi JR, Cohen MB. Factors affecting completion of sleep studies in pediatric patients with sleep‐disordered breathing. Laryngoscope 2020; 130:E258-E262. [DOI: 10.1002/lary.28091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/05/2019] [Accepted: 05/13/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Jocelyn L. Kohn
- Department of Otolaryngology–Head and Neck SurgeryBoston University Medical Center Boston Massachusetts U.S.A
| | - Samuel J. Rubin
- Department of Otolaryngology–Head and Neck SurgeryBoston University Medical Center Boston Massachusetts U.S.A
| | - Jay Patel
- Boston University School of Medicine Boston Massachusetts U.S.A
| | - Reem Dia
- University of Massachusetts Boston Boston Massachusetts U.S.A
| | - Jessica R. Levi
- Department of Otolaryngology–Head and Neck SurgeryBoston University Medical Center Boston Massachusetts U.S.A
| | - Michael B. Cohen
- Department of Otolaryngology–Head and Neck SurgeryBoston University Medical Center Boston Massachusetts U.S.A
- Department of Otolaryngology–Head and Neck SurgeryVeterans Affairs Hospital Boston Boston Massachusetts U.S.A
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Abstract
OBJECTIVES Acupuncture is a form of Traditional Chinese Medicine that has minimal side effects, is cost-effective, can be easily administered, and may serve as a useful non-pharmaceutical therapy for certain conditions. However, studies and clinical practice guidelines are inconsistent in conclusions and recommendations about acupuncture. This qualitative review addresses the evidence available for acupuncture use in otolaryngology. METHODS A literature review was completed using EMBASE, PubMed, and The Cochrane Collection for conditions within otolaryngology that have used and studied the comparative effects of acupuncture. Thirty studies ultimately fit the inclusion criteria and were used for this qualitative review. RESULTS Studies included in this review contained a variety of conditions within otolaryngology, including allergic rhinitis, chronic rhinitis, tinnitus, sudden sensorineural hearing loss, post-viral olfactory dysfunction, dysphonia, and tonsillectomies. CONCLUSION Given its safety profile, cost, and perceived benefit, recommendations and guidelines supporting acupuncture as an alternative or adjunctive therapy are surfacing for certain conditions such as allergic rhinitis. However, stronger conclusions with specific recommendations are limited by varied methodology between majority of the studies. Additional high-quality randomized control studies with low risk of bias are required to continue to assess the effects of acupuncture in the field of otolaryngology before stronger recommendations can be made on other conditions.
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Affiliation(s)
- Chase I Kahn
- Boston University School of Medicine, Boston, MA, USA
| | | | - Michael B Cohen
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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30
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Gross DJ, Black-Schaffer WS, Hoffman RD, Karcher DS, Estrada EL, Robboy SJ, Cohen MB. The State of the Job Market for Pathologists: Evidence From the College of American Pathologists Practice Leader Survey. Arch Pathol Lab Med 2020; 144:420-426. [PMID: 31971466 DOI: 10.5858/arpa.2019-0356-cp] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Disagreement exists within the pathology community about the status of the job market for pathologists. Although many agree that jobs in pathology were harder to come by earlier this decade, recent evidence suggests improvement is occurring. OBJECTIVE.— To assess the state of the job market for pathologists. DESIGN.— We analyzed data from the 2018 College of American Pathologists Practice Leader Survey. This survey contains data from 253 practice leaders on practices' hiring (and retrenchments) in 2017, the skills and level of experience being sought, success in filling those positions, and expectations for hiring in the next 3 years. RESULTS.— Among the surveyed practice leaders, 115 (45.5%) sought to hire at least 1 pathologist in 2017, and together tried to fill 246 full-time equivalent positions that year, of which 93.5 full-time equivalents (38%) were newly created. This hiring was not limited to larger, academic-based practices, but also occurred among smaller practices and practices based in nonacademic hospitals, independent laboratories, and other settings. Although some practices retrenched (60 full-time equivalents in 2017), the net increase was a healthy 187 full-time equivalents. Practices most frequently sought pathologists who had at least 2 years of experience, but the level of experience identified with the "optimal" candidate varied by desired areas of subspecialty expertise. Practice leaders also reported expected growth in hiring, with the number of positions they hope to fill in the next 3 years exceeding those vacated by retirement. CONCLUSIONS.— Our findings support the proposition that the demand for pathologists is strong, at least at the current time.
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Affiliation(s)
- David J Gross
- From the Policy Roundtable, College of American Pathologists, Washington, DC (Dr Gross and Ms Lopez Estrada); MGH Pathology Service, Massachusetts General Hospital, Boston (Dr Black-Schaffer); the Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Hoffman); the Department of Pathology, School of Medicine and Health Sciences, The George Washington University, Washington, DC (Dr Karcher); the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Robboy); and the Department of Pathology, Wake Forest Medical Center, Winston-Salem, North Carolina (Dr Cohen)
| | - W Stephen Black-Schaffer
- From the Policy Roundtable, College of American Pathologists, Washington, DC (Dr Gross and Ms Lopez Estrada); MGH Pathology Service, Massachusetts General Hospital, Boston (Dr Black-Schaffer); the Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Hoffman); the Department of Pathology, School of Medicine and Health Sciences, The George Washington University, Washington, DC (Dr Karcher); the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Robboy); and the Department of Pathology, Wake Forest Medical Center, Winston-Salem, North Carolina (Dr Cohen)
| | - Robert D Hoffman
- From the Policy Roundtable, College of American Pathologists, Washington, DC (Dr Gross and Ms Lopez Estrada); MGH Pathology Service, Massachusetts General Hospital, Boston (Dr Black-Schaffer); the Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Hoffman); the Department of Pathology, School of Medicine and Health Sciences, The George Washington University, Washington, DC (Dr Karcher); the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Robboy); and the Department of Pathology, Wake Forest Medical Center, Winston-Salem, North Carolina (Dr Cohen)
| | - Donald S Karcher
- From the Policy Roundtable, College of American Pathologists, Washington, DC (Dr Gross and Ms Lopez Estrada); MGH Pathology Service, Massachusetts General Hospital, Boston (Dr Black-Schaffer); the Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Hoffman); the Department of Pathology, School of Medicine and Health Sciences, The George Washington University, Washington, DC (Dr Karcher); the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Robboy); and the Department of Pathology, Wake Forest Medical Center, Winston-Salem, North Carolina (Dr Cohen)
| | - Edith Lopez Estrada
- From the Policy Roundtable, College of American Pathologists, Washington, DC (Dr Gross and Ms Lopez Estrada); MGH Pathology Service, Massachusetts General Hospital, Boston (Dr Black-Schaffer); the Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Hoffman); the Department of Pathology, School of Medicine and Health Sciences, The George Washington University, Washington, DC (Dr Karcher); the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Robboy); and the Department of Pathology, Wake Forest Medical Center, Winston-Salem, North Carolina (Dr Cohen)
| | - Stanley J Robboy
- From the Policy Roundtable, College of American Pathologists, Washington, DC (Dr Gross and Ms Lopez Estrada); MGH Pathology Service, Massachusetts General Hospital, Boston (Dr Black-Schaffer); the Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Hoffman); the Department of Pathology, School of Medicine and Health Sciences, The George Washington University, Washington, DC (Dr Karcher); the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Robboy); and the Department of Pathology, Wake Forest Medical Center, Winston-Salem, North Carolina (Dr Cohen)
| | - Michael B Cohen
- From the Policy Roundtable, College of American Pathologists, Washington, DC (Dr Gross and Ms Lopez Estrada); MGH Pathology Service, Massachusetts General Hospital, Boston (Dr Black-Schaffer); the Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Hoffman); the Department of Pathology, School of Medicine and Health Sciences, The George Washington University, Washington, DC (Dr Karcher); the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Robboy); and the Department of Pathology, Wake Forest Medical Center, Winston-Salem, North Carolina (Dr Cohen)
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Nass SJ, Cohen MB, Nayar R, Zutter MM, Balogh EP, Schilsky RL, Hricak H, Elenitoba-Johnson KSJ. Improving Cancer Diagnosis and Care: Patient Access to High-Quality Oncologic Pathology. Oncologist 2019; 24:1287-1290. [PMID: 31366725 PMCID: PMC6795152 DOI: 10.1634/theoncologist.2019-0261] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/31/2019] [Indexed: 11/18/2022] Open
Abstract
Drawing on discussions at a workshop hosted by the National Cancer Policy Forum, current challenges in pathology are reviewed and practical steps to facilitate high‐quality cancer diagnosis and care through improved patient access to expertise in oncologic pathology are highlighted
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Affiliation(s)
- Sharyl J Nass
- Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine, Washington, District of Columbia, USA
| | - Michael B Cohen
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ritu Nayar
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary M Zutter
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Erin P Balogh
- Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine, Washington, District of Columbia, USA
| | | | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kojo S J Elenitoba-Johnson
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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32
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Plocienniczak MJ, Finlay S, Noordzij JP, Cohen MB. Case report: Complete laryngotracheal separation sustained from a knife wound. Otolaryngology Case Reports 2019. [DOI: 10.1016/j.xocr.2019.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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33
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Kohn JL, Cohen MB, Patel P, Levi JR. Outcomes of Children with Mild Obstructive Sleep Apnea Treated Nonsurgically: A Retrospective Review. Otolaryngol Head Neck Surg 2019; 160:1101-1105. [DOI: 10.1177/0194599819829019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Obstructive sleep apnea (OSA) is characterized by partial or complete obstruction of the upper airway and is commonly caused by adenotonsillar hypertrophy in children. Accordingly, adenotonsillectomy is considered first-line treatment. However, in cases of mild OSA, nonsurgical management has been proposed as an alternative. The purpose of this study was to determine the outcomes of pediatric patients with mild obstructive sleep apnea (OSA) treated without surgical intervention. Study Design Case series with chart review. Setting Tertiary care university medical center. Subjects and Methods The medical records of children ages 2 to 18 years with OSA at Boston Medical Center from January 2000 to April 2017 were reviewed. Children with mild OSA (apnea- hypopnea index [AHI] between 1 and 5), who were managed nonsurgically and had serial polysomnograms, were included. Serial sleep studies were compared to assess for patterns of change. Results Of the 201 patients with mild OSA who were identified, 104 (52%) opted for initial nonsurgical management. Of those, 91 had a follow-up sleep study to reassess their OSA. Forty-two (46 %) had a greater than 20% decrease in AHI and 38 (41%) had a greater than 20% increase on the second sleep study. The remaining 11 had changes less than 20% in either direction. There was not a significant difference in the proportion of patients with an increase vs decrease in AHI on follow-up sleep study ( P > .05). Conclusions Mild pediatric OSA has approximately equal chances of worsening or improvement over time without surgical intervention, which is useful for counseling parents on treatment options.
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Affiliation(s)
- Jocelyn L. Kohn
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael B. Cohen
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, VA Boston Medical Center, Boston, Massachusetts, USA
| | - Prachi Patel
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jessica R. Levi
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
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Abstract
Background Historically, there has been uncertainty in the treatment of inferior turbinate hypertrophy (ITH) in children. Although management always begins with medical therapy, the decision to offer surgery in resistant cases is becoming more widely practiced. In the pediatric population, turbinate reduction can be achieved with turbinectomy, electrocautery, lasers, submucous microdebridement, and radiofrequency volumetric tissue reduction (RVTR). However, there remains a lack of consensus on the preferred approach to treatment. Objective To compare how the efficacy, duration, and complications of different surgical methods has changed the management of inferior turbinate hypertrophy in children over time. Methods In March 2018, a comprehensive literature search was performed in PubMed for all inferior turbinate hypertrophy management-related studies in children. Inclusion criteria included children (age, 1–17 years). Exclusion criteria included reviews and abstracts. Results Each technique has experienced a period of popularity over the last 30 years in parallel with the technology available at the time as well as evidence from studies in adults. The literature for ITH management in children has largely followed these trends, with a recent improvement in the quality of studies mirroring the overall increase in surgical practice. Of all methods currently used, RVTR and submucous microdebridement offer the least invasive and most efficacious relief of nasal obstruction. Conclusion This review provides an overview of the evolution of ITH management in children and, based on historic and current evidence, proposes the following graduated recommendation to treatment: (1) a 3-month trial of medical management, (2) evaluation for adenoid hypertrophy for consideration of concurrent adenoidectomy, and (3) RVTR or submucous microdebridement as the first-line surgical approach.
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Affiliation(s)
- Sevan R. Komshian
- Department of Otolaryngology-Head and Neck Surgery, Boston University, School of Medicine, Boston, Massachusetts
| | - Michael B. Cohen
- Department of Otolaryngology-Head and Neck Surgery, Boston University, School of Medicine, Boston, Massachusetts
- Department of Surgery, VA Medical Center, Boston, Massachusetts
| | - Christopher Brook
- Department of Otolaryngology-Head and Neck Surgery, Boston University, School of Medicine, Boston, Massachusetts
| | - Jessica R. Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston University, School of Medicine, Boston, Massachusetts
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Gross DJ, Kennedy M, Kothari T, Scamurra DO, Wilkerson ML, Crawford JM, Cohen MB. The Role of the Pathologist in Population Health. Arch Pathol Lab Med 2018; 143:610-620. [PMID: 30398912 DOI: 10.5858/arpa.2018-0223-cp] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
CONTEXT.— As part of its value-based care initiative, the College of American Pathologists has pursued research to better understand the role pathologists can have in population health. OBJECTIVES.— To answer the following questions: (1) what is the impact of population health and population health management on pathologists; (2) what roles are pathologists playing in population health management; (3) is population health something that pathologists in both larger and smaller settings can engage in; (4) are pathologists in a position to analyze laboratory data for population health, and, if so, what are the key information sources those pathologists must access; and (5) what steps can a pathologist take to become involved in population health? DESIGN.— We conducted 10 semistructured interviews with pathologists and other medical laboratory leaders who have been active in population health. These interviews were supplemented with a review of the medical literature. RESULTS.— Pathologists have demonstrated that laboratory data can provide unique value-added contributions to improving the health of populations. These contributions are not limited to pathologists in large, integrated settings. However, pathologists need to be proactive to contribute to health systems' population health efforts and may need to both enhance their own skills and the quality of their data to maximize the value of their contributions. CONCLUSIONS.— Although not necessarily a definitive summary of the roles that pathologists are playing in population health, this article identifies some of the promising and innovative activities occurring among pathologists and laboratorians.
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Affiliation(s)
| | | | | | | | | | | | - Michael B Cohen
- From the Policy Roundtable, College of American Pathologists, Washington, DC (Dr Gross); Clinical Informatics, College of American Pathologists, Northfield, Illinois (Ms Kennedy); the Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York (Drs Kothari and Crawford); Eastern Great Lakes Pathology, Amherst, New York (Dr Scamurra); the Division of Laboratory Medicine, Geisinger Medical Laboratories, Danville, Pennsylvania (Dr Wilkerson); and the Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina (Dr Cohen)
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Severson EA, Vergilio JA, Gay LM, Daniel S, Hemmerich AC, Elvin JA, Britt N, Nahas M, Cohen MB, Brown C, Sathyan P, Rankin A, Miller V, Ross JS, Ramkissoon SH. Genomic Landscape of Adult and Pediatric BCR-ABL1-Like B-Lymphoblastic Leukemia Using Parallel DNA and RNA Sequencing. Oncologist 2018; 24:372-374. [PMID: 30181314 DOI: 10.1634/theoncologist.2018-0272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/18/2018] [Indexed: 11/17/2022] Open
Abstract
BCR-ABL1-like B-Acute Lymphoblastic Leukemia (B-ALL) is a subset of B-ALL with a poor prognosis that is found in all age groups. Definitive identification of these patients is difficult in routine clinical practice as gene expression profiling, the gold standard test, is not widely available. Comprehensive genomic profiling performed on 450 patients with extensive fusion profiling revealed a wide range of genomic alterations which were consistent with a classification of BCR-ABL1-like B-ALL in 29% of cases. This manuscript highlights a clinically available alternative method for identifying a large subset of patients with BCR-ABL1-like B-ALL.
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Affiliation(s)
| | | | - Laurie M Gay
- Foundation Medicine, Cambridge, Massachusetts, USA
| | | | | | | | | | | | - Michael B Cohen
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | | | | | | | - Jeffrey S Ross
- Foundation Medicine, Cambridge, Massachusetts, USA
- The State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Shakti H Ramkissoon
- Foundation Medicine, Morrisville, North Carolina, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Black-Schaffer WS, Gross DJ, Crawford JM, Robboy SJ, Johnson K, Cohen MB, Austin M, Sanfrancesco J, Karcher DS, Powell SZ, Johnson RL. Evidence-Based Alignment of Pathology Residency With Practice: Methodology and General Consideration of Results. Acad Pathol 2018; 5:2374289518790501. [PMID: 30151423 PMCID: PMC6104218 DOI: 10.1177/2374289518790501] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 04/10/2018] [Revised: 05/24/2018] [Accepted: 06/19/2018] [Indexed: 11/26/2022] Open
Abstract
Few medical specialties engage in ongoing, organized data collection to assess how graduate medical education in their disciplines align with practice. Pathology educators, the American Board of Pathology, and major pathology organizations undertook an evidence-based, empirical assessment of what all pathologists need to learn in categorical residency. Two challenges were known when we commenced and we encountered 2 others during the project; all were ultimately satisfactorily addressed. Initial challenges were (1) ensuring broad representation of the new-in-practice pathologist experience and (2) adjusting for the effect on this experience of subspecialty fellowship(s) occurring between residency and practice. Additional challenges were (3) needing to assess and quantify degree and extent of subspecialization in different practice settings and (4) measuring changing practice responsibilities with increasing time in practice. We instituted annual surveys of pathologists who are relatively new (<10 years) in practice and a survey of physician employers of new pathologists. The purpose of these surveys was to inform (1) the American Board of Pathology certification process, which needs to assess the most critical knowledge, judgment, and skills required by newly practicing pathologists, and (2) pathology graduate medical education training requirements, which need to be both efficient and effective in graduating competent practitioners. This article presents a survey methodology to evaluate alignment of graduate medical education training with the skills needed for new-in-practice physicians, illustrates an easily interpreted graphical format for assessing survey data, and provides high-level results showing consistency of findings between similar populations of respondents, and between new-in-practice physicians and physician-employers.
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Affiliation(s)
- W Stephen Black-Schaffer
- MGH Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David J Gross
- Policy Roundtable, College of American Pathologists, Washington, DC, USA
| | - James M Crawford
- Department of Pathology and Laboratory Medicine, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Stanley J Robboy
- Pathology Department, Duke University Medical Center, Durham, NC, USA
| | - Kristen Johnson
- CAP Learning, College of American Pathologists, Northfield, IL, USA
| | - Michael B Cohen
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Melissa Austin
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Donald S Karcher
- The George Washington University Medical Center, Washington, DC, USA
| | - Suzanne Z Powell
- Weill Cornell Medical College and Texas A&M University, Houston, TX, USA
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Longacre TA, Broaddus R, Chuang LT, Cohen MB, Jarboe EA, Mutter GL, Otis CN, Zaino RJ. Template for Reporting Results of Biomarker Testing of Specimens From Patients With Carcinoma of the Endometrium. Arch Pathol Lab Med 2017; 141:1508-1512. [DOI: 10.5858/arpa.2016-0450-cp] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Teri A. Longacre
- From the Department of Pathology, Stanford Medicine, Stanford, California (Dr Longacre); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Broaddus); the Department of Obstetrics, Gynecology and Reproductive Science, Hess Center for Science and Medicine, Sinai Medical Center, New York, New York (Dr Chuang); the Department of Pathology, Huntsman Cancer Hospital, Salt Lake City, Utah (Dr Cohen); the Department of Pathology, University of Utah, Salt Lake City (Dr
| | - Russell Broaddus
- From the Department of Pathology, Stanford Medicine, Stanford, California (Dr Longacre); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Broaddus); the Department of Obstetrics, Gynecology and Reproductive Science, Hess Center for Science and Medicine, Sinai Medical Center, New York, New York (Dr Chuang); the Department of Pathology, Huntsman Cancer Hospital, Salt Lake City, Utah (Dr Cohen); the Department of Pathology, University of Utah, Salt Lake City (Dr
| | - Linus T. Chuang
- From the Department of Pathology, Stanford Medicine, Stanford, California (Dr Longacre); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Broaddus); the Department of Obstetrics, Gynecology and Reproductive Science, Hess Center for Science and Medicine, Sinai Medical Center, New York, New York (Dr Chuang); the Department of Pathology, Huntsman Cancer Hospital, Salt Lake City, Utah (Dr Cohen); the Department of Pathology, University of Utah, Salt Lake City (Dr
| | - Michael B. Cohen
- From the Department of Pathology, Stanford Medicine, Stanford, California (Dr Longacre); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Broaddus); the Department of Obstetrics, Gynecology and Reproductive Science, Hess Center for Science and Medicine, Sinai Medical Center, New York, New York (Dr Chuang); the Department of Pathology, Huntsman Cancer Hospital, Salt Lake City, Utah (Dr Cohen); the Department of Pathology, University of Utah, Salt Lake City (Dr
| | - Elke A. Jarboe
- From the Department of Pathology, Stanford Medicine, Stanford, California (Dr Longacre); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Broaddus); the Department of Obstetrics, Gynecology and Reproductive Science, Hess Center for Science and Medicine, Sinai Medical Center, New York, New York (Dr Chuang); the Department of Pathology, Huntsman Cancer Hospital, Salt Lake City, Utah (Dr Cohen); the Department of Pathology, University of Utah, Salt Lake City (Dr
| | - George L. Mutter
- From the Department of Pathology, Stanford Medicine, Stanford, California (Dr Longacre); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Broaddus); the Department of Obstetrics, Gynecology and Reproductive Science, Hess Center for Science and Medicine, Sinai Medical Center, New York, New York (Dr Chuang); the Department of Pathology, Huntsman Cancer Hospital, Salt Lake City, Utah (Dr Cohen); the Department of Pathology, University of Utah, Salt Lake City (Dr
| | - Christopher N. Otis
- From the Department of Pathology, Stanford Medicine, Stanford, California (Dr Longacre); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Broaddus); the Department of Obstetrics, Gynecology and Reproductive Science, Hess Center for Science and Medicine, Sinai Medical Center, New York, New York (Dr Chuang); the Department of Pathology, Huntsman Cancer Hospital, Salt Lake City, Utah (Dr Cohen); the Department of Pathology, University of Utah, Salt Lake City (Dr
| | - Richard J. Zaino
- From the Department of Pathology, Stanford Medicine, Stanford, California (Dr Longacre); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Broaddus); the Department of Obstetrics, Gynecology and Reproductive Science, Hess Center for Science and Medicine, Sinai Medical Center, New York, New York (Dr Chuang); the Department of Pathology, Huntsman Cancer Hospital, Salt Lake City, Utah (Dr Cohen); the Department of Pathology, University of Utah, Salt Lake City (Dr
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Schmid RL, Cohen MB. Partial Verification Distorts Estimates of Sensitivity in Diagnostic Accuracy Studies for Fine-Needle Aspiration Cytology. Ann Surg Oncol 2017; 24:634-636. [PMID: 29067604 DOI: 10.1245/s10434-017-6155-1] [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] [Received: 10/13/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Robert L Schmid
- University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Michael B Cohen
- University of Utah School of Medicine, Salt Lake City, UT, USA
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Caron JE, March JK, Cohen MB, Schmidt RL. A Survey of the Prevalence and Impact of Reporting Guideline Endorsement in Pathology Journals. Am J Clin Pathol 2017; 148:314-322. [PMID: 28967948 DOI: 10.1093/ajcp/aqx080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine the prevalence of reporting guideline endorsement in pathology journals and to estimate the impact of guideline endorsement. METHODS We compared the quality of reporting in two sets of studies: (1) studies published in journals that explicitly mentioned a guideline vs studies published in journals that did not and (2) studies that cited a guideline vs studies that did not. The quality of reporting in prognostic biomarker studies was assessed using the REporting recommendations for tumor MARKer prognostic studies (REMARK) guideline. RESULTS We found that six (10%) of the 59 leading pathology journals explicitly mention reporting guidelines in the instructions to authors. Only one journal required authors to submit a checklist. There was significant variation in the rate at which various REMARK items were reported (P < .001). Journal endorsement was associated with more complete reporting (P = .04). Studies that cited REMARK had greater adherence to the REMARK reporting guidelines than studies that did not (P = .02). CONCLUSIONS The prevalence of guideline endorsement is relatively low in pathology journals, but guideline endorsement may improve the quality of reporting.
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Affiliation(s)
- Justin E Caron
- Department of Pathology and ARUP Laboratories, University of Utah Health Sciences Center, Salt Lake City
| | - Jordon K March
- Department of Pathology and ARUP Laboratories, University of Utah Health Sciences Center, Salt Lake City
| | - Michael B Cohen
- Department of Pathology and ARUP Laboratories, University of Utah Health Sciences Center, Salt Lake City
| | - Robert L Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah Health Sciences Center, Salt Lake City
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Wong K, Gilad A, Cohen MB, Kirke DN, Jalisi SM. Patient education materials assessment tool for laryngectomy health information. Head Neck 2017; 39:2256-2263. [DOI: 10.1002/hed.24891] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/16/2017] [Accepted: 06/16/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kevin Wong
- Department of Otolaryngology-Head and Neck Surgery; Boston University Medical Center; Boston Massachusetts
| | - Amir Gilad
- Department of Otolaryngology-Head and Neck Surgery; Boston University Medical Center; Boston Massachusetts
| | - Michael B. Cohen
- Department of Otolaryngology-Head and Neck Surgery; Boston University Medical Center; Boston Massachusetts
- Division of Otolaryngology; Department of Surgery, Veterans' Affairs Boston Healthcare System; Boston Massachusetts
| | - Diana N. Kirke
- Department of Otolaryngology-Head and Neck Surgery; Boston University Medical Center; Boston Massachusetts
| | - Scharukh M. Jalisi
- Department of Otolaryngology-Head and Neck Surgery; Boston University Medical Center; Boston Massachusetts
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Rubin SJ, Cohen MB, Kirke DN, Qureshi MM, Truong MT, Jalisi S. Comparison of facility type outcomes for oral cavity cancer: Analysis of the national cancer database. Laryngoscope 2017; 127:2551-2557. [DOI: 10.1002/lary.26632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Samuel J. Rubin
- Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Michael B. Cohen
- Department of Otolaryngology Head and Neck Surgery; Boston Massachusetts U.S.A
- Division of Otolaryngology, Department of Surgery; VA Boston Healthcare System; Boston Massachusetts U.S.A
| | - Diana N. Kirke
- Department of Otolaryngology Head and Neck Surgery; Boston Massachusetts U.S.A
| | - Muhammad M. Qureshi
- Department of Radiation Oncology, Boston Medical Center; Boston Massachusetts U.S.A
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center; Boston Massachusetts U.S.A
- Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Scharukh Jalisi
- Department of Otolaryngology Head and Neck Surgery; Boston Massachusetts U.S.A
- Boston University School of Medicine; Boston Massachusetts U.S.A
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Abstract
INTRODUCTION Breastfeeding difficulty from ankyloglossia can affect both the mother and baby in a breastfeeding dyad. With renewed emphasis in today's culture on breast milk, mothers may feel increasing pressure to breastfeed, and the inability for some to do so may cause significant distress. Recently, online parenting forums have seen exponential growth; these forums allow mothers to connect with peers undergoing similar life transitions. The purpose of this study was to review online discussions regarding ankyloglossia to understand mothers' experiences with breastfeeding. MATERIALS AND METHODS We performed an ethnographic content analysis of 76 online threads and 501 posts regarding ankyloglossia based on six domains: (1) initial expectations, (2) breastfeeding complications, (3) questions, (4) diagnosis, (5) treatment, and (6) outcomes. RESULTS About one-fourth of women who participated in online forum discussions had initial expectations to breastfeed, however, many found it impossible due to poor latch or pain. Concerns were frequently exacerbated by healthcare providers who reportedly missed or overlooked ankyloglossia. Although these complications made breastfeeding a challenging experience, mothers often described both subjective and physical improvements after frenotomy. CONCLUSION Breastfeeding difficulty was a commonly voiced concern in online ankyloglossia forums. Forum analysis is an effective way to gain insight into patients' experiences, which allows providers to anticipate concerns and provides more effective counseling.
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Affiliation(s)
- Kevin Wong
- 1 Boston University School of Medicine , Boston, Massachusetts
| | - Punam Patel
- 1 Boston University School of Medicine , Boston, Massachusetts
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Cohen MB, Saunders SS, Wise SK, Nassif S, Platt MP. Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement. Int Forum Allergy Rhinol 2016; 7:276-286. [DOI: 10.1002/alr.21884] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/19/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Michael B. Cohen
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston MA
- Division of Otolaryngology; Department of Surgery; Veterans’ Affairs Boston Healthcare System; Boston MA
| | - Stefanie S. Saunders
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston MA
| | - Sarah K. Wise
- Department of Otolaryngology-Head and Neck Surgery; Emory University; Atlanta GA
| | - Samih Nassif
- School of Medicine; Boston University; Boston MA
| | - Michael P. Platt
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston MA
- School of Medicine; Boston University; Boston MA
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Robboy SJ, Gupta S, Crawford JM, Cohen MB, Karcher DS, Leonard DGB, Magnani B, Novis DA, Prystowsky MB, Powell SZ, Gross DJ, Black-Schaffer WS. The Pathologist Workforce in the United States: II. An Interactive Modeling Tool for Analyzing Future Qualitative and Quantitative Staffing Demands for Services. Arch Pathol Lab Med 2016; 139:1413-30. [PMID: 26516939 DOI: 10.5858/arpa.2014-0559-oa] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Pathologists are physicians who make diagnoses based on interpretation of tissue and cellular specimens (surgical/cytopathology, molecular/genomic pathology, autopsy), provide medical leadership and consultation for laboratory medicine, and are integral members of their institutions' interdisciplinary patient care teams. OBJECTIVE To develop a dynamic modeling tool to examine how individual factors and practice variables can forecast demand for pathologist services. DESIGN Build and test a computer-based software model populated with data from surveys and best estimates about current and new pathologist efforts. RESULTS Most pathologists' efforts focus on anatomic (52%), laboratory (14%), and other direct services (8%) for individual patients. Population-focused services (12%) (eg, laboratory medical direction) and other professional responsibilities (14%) (eg, teaching, research, and hospital committees) consume the rest of their time. Modeling scenarios were used to assess the need to increase or decrease efforts related globally to the Affordable Care Act, and specifically, to genomic medicine, laboratory consolidation, laboratory medical direction, and new areas where pathologists' expertise can add value. CONCLUSIONS Our modeling tool allows pathologists, educators, and policy experts to assess how various factors may affect demand for pathologists' services. These factors include an aging population, advances in biomedical technology, and changing roles in capitated, value-based, and team-based medical care systems. In the future, pathologists will likely have to assume new roles, develop new expertise, and become more efficient in practicing medicine to accommodate new value-based delivery models.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - W Stephen Black-Schaffer
- From the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Robboy); The Smart Cube, Noida, India (Mr Gupta); the Department of Pathology and Laboratory Medicine, North Shore-Long Island Jewish Health System, Manhasset, New York (Dr Crawford); the Department of Pathology, Huntsman Cancer Hospital, University of Utah, Salt Lake City (Dr Cohen); the Department of Pathology, George Washington University, Washington, DC (Dr Karcher); the Department of Pathology, University of Vermont College of Medicine, Burlington (Dr Leonard); the Department of Pathology, Tufts University School of Medicine, Boston, Massachusetts (Dr Magnani); Novis Consulting, Lee, New Hampshire (Dr Novis); the Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York (Dr Prystowsky); the Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, Texas (Dr Powell); Policy Roundtable, College of American Pathologists, Washington, DC (Dr Gross); the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston (Dr Black-Schaffer)
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Affiliation(s)
- Michael Laposata
- From the Department of Pathology, University of Texas Medical Branch-Galveston, Galveston (Dr Laposata); and the Department of Pathology, University of Utah, Salt Lake City (Dr Cohen)
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Schmidt RL, Cohen MB. Nakhleh RG, Ed.Error Reduction and Prevention in Surgical Pathology. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/aqv090] [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: 11/13/2022] Open
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McCroskey Z, Pambuccian SE, Kleitherms S, Antic T, Cohen MB, Barkan GA, Wojcik EM. Accuracy and Interobserver Variability of the Cytologic Diagnosis of Low-Grade Urothelial Carcinoma in Instrumented Urinary Tract Cytology Specimens. Am J Clin Pathol 2015; 144:902-8. [DOI: 10.1309/ajcpe1o9ykmrsqkg] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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