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Nagy P, Ojeda-Badillo G, Brook C. Utility of laryngoscopy in liver failure. Am J Otolaryngol 2024; 45:104201. [PMID: 38134853 DOI: 10.1016/j.amjoto.2023.104201] [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: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To determine the utility of laryngoscopy in the evaluation of liver transplant patients. METHODS This study is a single center retrospective cohort review of patients with a diagnosis of liver failure who underwent laryngoscopy or stroboscopy exam as part of a pre-transplant evaluation from 1/1/2010 to 12/31/2022. Patients were identified using ICD 9 and 10 codes for liver failure and CPT codes for flexible laryngoscopy and stroboscopy. Only patients who underwent preoperative liver transplant evaluation were included. Demographic data was collected. Cohort analysis between patients who did or did not undergo further diagnostic intervention was undertaken. RESULTS 1824 patients were identified. 243 of these patients underwent pre-transplant laryngoscopy or stroboscopy. 26 of the 243 (10.7 %) patients had further diagnostic work up for findings during laryngoscopy, stroboscopy, or head and neck examination. There was one patient who was found to have head and neck cancer and was excluded from the transplant list until this was treated. CONCLUSIONS Otolaryngologic evaluation of liver transplant patients may be beneficial to identify head and neck pathology.
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Affiliation(s)
- Peter Nagy
- Beth Israel Deaconess Medical Center Department of Surgery Division of Otolaryngology-Head and Neck Surgery, 330 Brookline Avenue, Shapiro Ground Entrance 98 Binney Street, Boston, MA 02215-5400, USA; Harvard Medical School, 3Blackfan Cir, Boston, MA 02115, USA.
| | - Gabriella Ojeda-Badillo
- Beth Israel Deaconess Medical Center Department of Surgery Division of Otolaryngology-Head and Neck Surgery, 330 Brookline Avenue, Shapiro Ground Entrance 98 Binney Street, Boston, MA 02215-5400, USA; Harvard Medical School, 3Blackfan Cir, Boston, MA 02115, USA.
| | - Christopher Brook
- Beth Israel Deaconess Medical Center Department of Surgery Division of Otolaryngology-Head and Neck Surgery, 330 Brookline Avenue, Shapiro Ground Entrance 98 Binney Street, Boston, MA 02215-5400, USA; Harvard Medical School, 3Blackfan Cir, Boston, MA 02115, USA.
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2
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Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [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: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
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Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
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Abstract
Within otolaryngology, scribes have been utilized as a means of increasing clinic efficiency and easing workload on physicians. During the COVID-19 pandemic, a majority of otolaryngology clinic appointments at academic institutions have been moved to telemedicine in order to limit interpersonal contacts. At the height of the pandemic, our institution has protocolized scribe participation from in-person to remote. Scribes have virtually participated in telemedicine appointments in an effort to facilitate documentation and enhance the patient-physician relationship. Beyond the pandemic, as patients start being evaluated in-person, the risk of contamination and spread through aerosol generating procedures has limited the number of ancillary support staff that can be present in the examination rooms. As such, virtual scribing from a separate location within the clinic has been deemed warranted. This paper documents the protocols on virtual scribing for both telemedicine and a hybrid approach for in-clinic appointments where high-risk procedures are being performed.
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Affiliation(s)
| | - Michal J Plocienniczak
- Boston University School of Medicine, Boston, MA, United States; Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, United States.
| | - Christopher Brook
- Boston University School of Medicine, Boston, MA, United States; Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, MA, United States
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Plocienniczak MJ, Noordzij JP, Grillone G, Platt M, Brook C. Guidelines for Resident Participation in Otolaryngology Telehealth Clinics During the COVID-19 Pandemic. Otolaryngol Head Neck Surg 2020; 163:498-500. [DOI: 10.1177/0194599820932133] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The practice of otolaryngology has changed drastically since the start of the COVID-19 pandemic. To limit exposure and maintain a reserve of caregivers, residency education ceased most clinical activities and shifted to remote lecture consortiums hosted online across the country in lieu of ambulatory and operative experiences. Many practicing university otolaryngologists have transitioned their clinics to telehealth medicine to maintain access to clinical care during the pandemic. The participation of residents in telemedicine visits has not been described. Here we present guidelines and experience-based suggestions for successful resident involvement in telemedicine. While it is unclear what role telehealth medicine may play within the field of otolaryngology beyond the pandemic, our experiences suggest better patient outreach and access. Expanding residents’ skill set with telehealth medicine can enhance their education and better prepare them for future practice.
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Affiliation(s)
- Michal J. Plocienniczak
- School of Medicine, Boston University, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - J. Pieter Noordzij
- School of Medicine, Boston University, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Gregory Grillone
- School of Medicine, Boston University, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Michael Platt
- School of Medicine, Boston University, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Christopher Brook
- School of Medicine, Boston University, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
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5
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Abstract
PURPOSE OF REVIEW Allergic rhinitis and allergic asthma are well-described disease entities with broad exposure in clinical and research allergy forums. Associations between allergic inflammation and upper airway diseases of chronic laryngitis, otitis media, obstructive sleep apnea, and oral allergy syndrome are less well understood and described in the literature. RECENT FINDINGS This review discusses the relationship between atopy and diseases of the upper airway, oral cavity, larynx, and ear. The similar respiratory mucosal lining the upper aerodigestive tract, with sensitized mast cells and inflammatory mediators in the submucosa, results in a variety of extranasal manifestations of allergic diseases in the head and neck which are less well characterized. Associations between allergic inflammation and upper airway diseases of chronic laryngitis, otitis media, obstructive sleep apnea, and oral allergy syndrome are less well understood and described in the literature. This review will summarize the relevant pathophysiology and symptomology, association with allergic sensitization, and clinical considerations of these disorders.
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Affiliation(s)
- Taha Mur
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Christopher Brook
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA.,Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Michael Platt
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA. .,Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA.
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6
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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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Maxfield A, Brook C, Miyake M, Bleier B. Compartmental Endoscopic Surgical Anatomy of the Inferior Intraconal Orbital Space. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Abstract
Cancer metastatic to the paranasal sinuses often presents with ophthalmologic and facial deformities, as well as sinonasal complaints. These diminutive tumors are difficult to effectively treat, often leading to poor quality of life. Although breast cancer is a common cancer affecting more than 150,000 women each year, rarely is metastatic breast cancer found within the sinuses. We report our palliative treatment approach and outcomes of a 40-year-old patient with breast cancer metastatic to the paranasal sinuses. While providing a better understanding of this tumor's metastasis through a review of the literature, our report describes the role of palliative surgery for metastases to the paranasal sinuses.
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Affiliation(s)
- Jason M Roberts
- Division of Otolaryngology, Head and Neck Surgery, Albany Medical College, University ENT, 35 Hackett Blvd., Albany, NY 12208.
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9
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Abstract
Objectives: To increase awareness of wire brush bristle ingestion, review the literature relating to wire brush bristle ingestion, and describe an algorithm for management of wire brush bristle foreign bodies as well as a technique for bedside removal. Methods: The authors present a case of an accidental wire bristle ingestion that was successfully treated with bedside removal and describe a successful bedside technique for removal. For the literature review, the PubMed journal database and Google Scholar were queried using the search terms wire bristle, wire brush, grill brush, and grill bristle. Results: Twenty-three wire brush ingestions with upper aerodigestive presentations were identified in the medical literature. Bedside visualization was attempted in 10 patients and successful in 5. The foreign body was able to be removed at the bedside in 3 of these patients. Two patients were managed conservatively. The authors developed an algorithm for management based on these literature findings. Conclusion: Wire brush bristle ingestion is increasingly common in the literature, and a definitive algorithm does not exist for management. The authors present an algorithm for management and describe a technique for successful removal at the bedside.
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Affiliation(s)
- Stephanie Wong
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Christopher Brook
- Department of Otolaryngology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gregory Grillone
- Department of Otolaryngology, Boston University School of Medicine, Boston, Massachusetts, USA
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Brook C, Platt MP, Cabral H, Russell K, Grillone GA, Aliphas A, Noordzij JP. Time to Competency: Reliability of Flexible Transnasal Laryngoscopy by Resident Training Level. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Determine the progression of flexible transnasal laryngoscopy reliability and competency in otolaryngology residency training. Methods: Prospective study of flexible transnasal laryngoscopy interpretations. Seventeen otolaryngology residents from PGY-1 to PGY-5 and 3 attending otolaryngologists viewed 25 selected and digitally-recorded flexible transnasal laryngoscopies. The evaluators were asked to rate 13 items relating to abnormalities in the oropharynx, hypopharynx, larynx, and subglottis. The level of concern and level of comfort with the diagnosis were assessed. Intraclass correlations were calculated for each topic and by level of training to determine reliability within each class, and competency compared to attending interpretations. Results: Intraclass correlation of residents compared with attending physicians demonstrated significant improvements by year for left vocal fold immobility (ICC 0.85-0.96), right vocal cord immobility (ICC 0.80-0.97), subglottic stenosis (ICC 0.70-0.97), and level of concern (ICC 0.72-0.87). There were no trends for base of tongue abnormalities, pharyngeal abnormalities, pharyngeal masses, and hypopharyngeal masses. For vocal cord immobility, subglottic stenosis, and level of concern, resident reliability was found to be statistically similar to attending physicians in all categories by PGY-3. Conclusions: Resident competency for flexible transnasal laryngoscopy progresses during residency to reliability with attending otolaryngologists by PGY-3 over key facets of the examination. Flexible laryngoscopy may be a useful metric for procedural competency assessment during residency training.
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Brook C, Noordzij JP, Russell K, Aliphas A, Platt M. Predictive findings of allergic disease in fiberoptic nasolaryngoscopy. Laryngoscope 2014; 125:286-90. [DOI: 10.1002/lary.24880] [Citation(s) in RCA: 10] [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: 05/25/2014] [Revised: 07/09/2014] [Accepted: 07/16/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Christopher Brook
- Department of Otolaryngology-Head and Neck Surgery; Boston University School of Medicine; Boston Massachusetts U.S.A
| | - J. Pieter Noordzij
- Department of Otolaryngology-Head and Neck Surgery; Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Kimberly Russell
- Department of Otolaryngology-Head and Neck Surgery; Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Avner Aliphas
- Department of Otolaryngology-Head and Neck Surgery; Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Michael Platt
- Department of Otolaryngology-Head and Neck Surgery; Boston University School of Medicine; Boston Massachusetts U.S.A
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Brook C, Buch K, Kaufmann M, Sakai O, Devaiah A. The Prevalence of High-Riding Jugular Bulb in Patients with Endolymphatic Hydrops. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1370683] [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: 10/25/2022]
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Brook C, Devaiah AK, Mahoney E. Angioedema of the Upper Aerodigestive Tract: Risk Factors for Intubation and Review of Management Algorithm. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813495815a41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To define the risks associated with angioedema related airway obstruction and intervention, and to delineate the treatment algorithm used at our institution for airway management in patients with angioedema. Methods: Retrospective chart review of consecutive otolaryngology consultations for angioedema in the emergency department (ED) from 1999-2003. All patients were evaluated by an otolaryngologist and underwent fiberoptic laryngoscopy. Results: 177 patients were included in our study. 32 (18%) patients required intubation, 25 (14%) on initial presentation and 7 (4%) patients progressed from an initially stable airway to requiring intervention after reevaluation. ANOVA analysis demonstrated a statistically significant variance between location of edema and rate of intubation, with higher rates in the pharynx and larynx versus the lip and face. There was no difference between pharyngeal and laryngeal edema in rate of intubation, and there was no difference between oral cavity edema and other subsite in rate of airway intervention. Patients who required intubation after progression between serial evaluations were more statistically more likely to have edema that involved deeper portions of the aerodigestive tract. Patients who required intubation were statistically more likely to be older (average age 61.8 vs 55.1, P=0.03). Conclusions: In this large series of patients managed for aerodigestive angioedema we demonstrate risk factors associated with airway intervention and risk factors associated with clinical progression on serial examination to airway intervention. In addition, we demonstrate a successful management algorithm for patients with aerodigestive angioedema.
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Brook C, Chomut A, Jeanmonod RK. Physician assistants contribution to emergency department productivity. West J Emerg Med 2012; 13:181-5. [PMID: 22900110 PMCID: PMC3415808 DOI: 10.5811/westjem.2011.6.6746] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 04/16/2011] [Accepted: 07/13/2011] [Indexed: 11/17/2022] Open
Abstract
Introduction The objective of this report is to determine physician assistant (PA) productivity in an academic emergency department (ED) and to determine whether shift length or department census impact productivity. Methods A retrospective chart review was conducted at a tertiary ED during June and July of 2007. Productivity was calculated as the mean number of patients seen each hour. Analysis of variance was used to compare the productivity of different length shifts, and linear regression analysis was used to assess the relationship between productivity and department volume. Results One hundred sixty PA shifts were included. Shifts ranged from 4 to 13 hours. Mean productivity was 1.16 patients per hour (95% confidence interval [CI] = 1.12–1.20). Physician assistants generated a mean of 2.35 relative value units (RVU) per hour (95% CI = 1.98–2.72). There was no difference in productivity on different shift lengths (P = 0.73). There was no correlation between departmental census and productivity, with an R2 (statistical term for the coefficient of determination) of 0.01. Conclusion In the ED, PAs saw 1.16 patients and generated 2.35 RVUs per hour. The length of the shift did not affect productivity. Productivity did not fluctuate significantly with changing departmental volume.
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Stinson G, Brook C. Simulating the Milky Way is hard. EPJ Web of Conferences 2012. [DOI: 10.1051/epjconf/20121901005] [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: 11/14/2022] Open
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Stein J, Besley J, Brook C, Hamill M, Klein E, Krewski D, Murphy G, Richardson M, Sirna J, Skinner M, Steiner R, van Aken P, Devine D. Risk-based decision-making for blood safety: preliminary report of a consensus conference. Vox Sang 2011; 101:277-81. [DOI: 10.1111/j.1423-0410.2011.01526.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mesfin FB, Perkins NW, Brook C, Foyt D, German JW. Epidural Hematoma After Tympanomastoidectomy and Bone-Anchored Hearing Aid (BAHA) Placement: Case Report. Neurosurgery 2010; 67:E1451-3; discussion E1453. [DOI: 10.1227/neu.0b013e3181f34f66] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Epidural hematoma (EDH) has never been reported as a complication after placement of a bone-anchored hearing aid (BAHA). To our knowledge, this is the first case report of an EDH after placement of a BAHA.
CLINICAL PRESENTATION:
We report the case of a 15-year-old girl with an EDH after placement of a BAHA. Initially, she presented with a history of right ear conductive hearing loss and had a tympanomastoidectomy and placement of a BAHA at an outpatient surgical facility. Postoperatively, the patient was transferred to the postoperative care unit in stable neurological condition but was subsequently noted to be lethargic with dilated, nonreactive pupils and extensor posturing. A computed tomography scan revealed a large right temporal EDH with midline shift. She was then taken to the operating room emergently for craniotomy and evacuation of the EDH. After evacuation, she was admitted to the pediatric intensive care unit and slowly emerged from her coma with supportive care. She was discharged to inpatient rehabilitation and has made a good recovery.
CONCLUSION:
This report emphasizes the need for a high index of suspicion of this rare, but life-threatening complication of an EDH after the placement of a BAHA.
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Affiliation(s)
- Fassil B Mesfin
- Division of Neurosurgery, Albany Medical Center, Albany, New York
| | - Nora W Perkins
- Division of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York
| | | | - David Foyt
- Division of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York
| | - John W German
- Division of Neurosurgery, Albany Medical Center, Albany, New York
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Jeanmonod RK, Brook C, Winther M, Pathak S, Boyd M. Dedicated Shift Wrap-up Time Does Not Improve Resident Sign-out Volume or Efficiency. West J Emerg Med 2010; 11:35-9. [PMID: 20411073 PMCID: PMC2850851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 08/02/2009] [Accepted: 08/22/2009] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Sign-out (SO) is a challenge to the emergency physician. Some training programs have instituted overlapping 9-hour shifts. The residents see patients for eight hours, and have one hour of wrap-up time. This hour helps them complete patient care, leaving fewer patients to sign-out. We examined whether this strategy impacts SO burden. METHODS This is a retrospective review of patients evaluated by emergency medicine (EM) residents working 9-hour (eight hours of patient care, one hour wrap-up time) and 12-hour shifts (12 hours patient care, no reserved time for wrap-up). Data were collected by reviewing the clinical tracker. A patient was assigned to the resident who initiated care and dictated the chart. SO was defined as any patient in the ED without disposition at change of shift. Patient turn-around-time (TAT) was also recorded. RESULTS One-hundred sixty-one postgraduate-year-one resident (PGY1), 264 postgraduate-year-two resident (PGY2), and 193 postgraduate-year-three resident (PGY3) shifts were included. PGY1s signed out 1.9 patients per 12-hour shift. PGY2s signed out 2.3 patients on 12-hour shifts and 1.8 patients on 9-hour shifts. PGY3s signed out 2.1 patients on 12-hour shifts and 2.0 patients on 9-hour shifts. When we controlled for patients seen per hour, SO burden was constant by class regardless of shift length, with PGY2s signing out 18% of patients seen compared to 15% for PGY3s. PGY1s signed out 18% of patients seen. TAT for patients seen by PGY1s and PGY2s was similar, at 189 and 187 minutes, respectively. TAT for patients seen by PGY3s was significantly less at 175 minutes. CONCLUSION The additional hour devoted to wrapping up patients in the ED had no affect on SO burden. The SO burden represented a fixed percentage of the total number of patients seen by the residents. PGY3s sign-out a smaller percentage of patients seen compared to other classes, and have faster TATs.
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Affiliation(s)
- Rebecca K. Jeanmonod
- Address for Correspondence: Rebecca Jeanmonod MD, FACEP, Department of Emergency Medicine, St. Luke’s Hospital and Health Network, 801 Ostrum St., Bethlehem, PA 18015.
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Governato F, Brook C, Mayer L, Brooks A, Rhee G, Wadsley J, Jonsson P, Willman B, Stinson G, Quinn T, Madau P. Bulgeless dwarf galaxies and dark matter cores from supernova-driven outflows. Nature 2010; 463:203-6. [PMID: 20075915 DOI: 10.1038/nature08640] [Citation(s) in RCA: 774] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 11/05/2009] [Indexed: 11/09/2022]
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Brook C, Chomut A, Jeanmonod R. 12: When the Emergency Department Is Packed Can Physician Assistants Pick Up the Pace? An Analysis of Physician Assistant Productivity Related to Patient Volume. Ann Emerg Med 2009. [DOI: 10.1016/j.annemergmed.2009.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
BACKGROUND It has been shown that residents' ability to see more patients and patients of higher acuity improves with level of training. AIMS No published study has reviewed whether residents become less productive with consecutive shifts. Determining peak resident productivity can optimize staffing to manage patient flow and enhance resident exposure to patients, which is critical to their education. We examine the relationship between resident productivity and number of consecutive shifts worked. METHODS This is a retrospective review of emergency medicine (EM) resident productivity defined as patients evaluated per hour per shift. Data were collected utilizing patient tracker software which provides a record of physician assignment and checked against the computerized medical record. Residents were credited with a patient if they initiated the workup and dictated the chart. Productivity was tallied for 188 first-year shift strings, 303 second-year shift strings, and 224 third-year shift strings beginning 1 November 2006. Analysis of variance (ANOVA) was used to assess for productivity differences based on the shift number, with the first shift in a series being designated "1," the second consecutive shift being designated "2," and so on. RESULTS First-year residents saw 0.82, 0.81, and 0.91 patients per hour on consecutive shifts (F((2,175))=2.89, p = 0.06), second-year residents saw 1.12, 1.08, 1.17, and 1.28 patients per hour on consecutive shifts (F((3,292))=4.19, p = 0.006), and third-year residents saw 1.19, 1.24, and 1.33 patients per hour on consecutive shifts (F((2,211))=4.08, p = 0.02). CONCLUSIONS Instead of tiring, residents maintain or improve productivity over consecutive shifts.
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Affiliation(s)
- Rebecca Jeanmonod
- Department of Emergency Medicine, St. Luke’s Hospital, 801 Ostrum St., Bethlehem, PA 18015 USA
| | - Sara Damewood
- Albany Medical Center, 43 New Scotland Ave., Albany, NY 12208 USA
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Jeanmonod R, Brook C, Winther M, Pathak S, Boyd M. Resident productivity as a function of emergency department volume, shift time of day, and cumulative time in the emergency department. Am J Emerg Med 2009; 27:313-9. [PMID: 19328376 DOI: 10.1016/j.ajem.2008.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 02/29/2008] [Accepted: 03/01/2008] [Indexed: 10/21/2022] Open
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Debnath D, Westall H, Brook C, Frecker P. Late presentation of breast cancer: is modification of screening programme the way forward? Eur J Surg Oncol 2008. [DOI: 10.1016/j.ejso.2008.06.154] [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: 10/21/2022] Open
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Hines M, Fane BA, Pasterski VL, Mathews GA, Conway GS, Brook C. Spatial abilities following prenatal androgen abnormality: targeting and mental rotations performance in individuals with congenital adrenal hyperplasia. Psychoneuroendocrinology 2003; 28:1010-26. [PMID: 14529705 DOI: 10.1016/s0306-4530(02)00121-x] [Citation(s) in RCA: 173] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In most mammals, behaviors that show sex differences are influenced by androgen during early life. In the current study, the hypothesis that androgen influences the development of human spatial abilities was investigated. Participants included 40 females and 29 males with congenital adrenal hyperplasia (CAH), a genetic disorder that causes overproduction of adrenal androgens beginning prenatally, and 29 unaffected female and 30 unaffected male relatives of individuals with CAH. Participants ranged in age from 12-45 years. Measures of spatial abilities included two mental rotations tasks and two targeting tasks, all of which showed large sex differences favoring males in the unaffected relative controls. Females with CAH (exposed to higher than normal levels of androgen prenatally) performed better than unaffected females on the targeting tasks, and resembled unaffected males and males with CAH in this respect. However, females with CAH did not perform better than unaffected females on the measures of mental rotations abilities. Males with CAH showed unaltered performance on the targeting tasks, and impaired performance on the mental rotations tasks. Results are discussed in terms of differences in experiential and hormonal contributions to different spatial abilities, as well as in terms of possible differences in critical periods for hormonal influences on targeting versus mental rotations abilities. Specifically, we speculate that, although androgen may influence targeting abilities prenatally, if hormones influence the development of mental rotations ability, they do so at some other time, perhaps during the first six months of postnatal life.
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Affiliation(s)
- M Hines
- Department of Psychology, City University, EC1V 0HB London, UK.
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Tate R, Iddenden R, Harnden P, Morris E, Craigs C, Bennett C, Brook C, Haward RA, Forman D. Increased incidence of renal parenchymal carcinoma in the Northern and Yorkshire region of England, 1978-1997. Eur J Cancer 2003; 39:961-7. [PMID: 12706365 DOI: 10.1016/s0959-8049(03)00070-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [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: 12/16/2022]
Abstract
Kidney cancer remains relatively rare, but incidence and mortality rates are reported to be rising steadily across the world. To determine if such increases were occurring in the UK, we examined the rates of incidence and mortality in different histological subtypes of kidney cancer in the Northern and Yorkshire region of England. Details of all 8741 cases diagnosed between 1978 and 1997 were extracted from the population-based Northern and Yorkshire Cancer Registry. For all types of tumour, both incidence and mortality rates increased over the study period. Overall age-standardised incidence rates increased by 86% for renal parenchymal carcinoma (RPC) (80% for males, 90% for females) from 2.8 to 5.2 cases per 100000 (3.8-6.8 male, 2.0-3.8 female). There were incidence increases in all age groups, all Carstairs index groups and in both urban and rural populations. Although increased incidental detection of kidney tumours by improved investigational techniques may account for some of this rise, we believe it unlikely that it accounts for all of the increase observed. Potential aetiological causes for the increased rates include hypertension, smoking, a diet lacking fruit and vegetables, analgesic use and, particularly, obesity.
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Affiliation(s)
- R Tate
- Northern and Yorkshire Cancer Registry and Information Service, Arthington House, Hospital Lane, Leeds LS16 6QB, UK
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Abstract
This paper discusses the evaluation of educational activities developed and implemented in a tertiary based, pre-endorsement midwifery program in Brisbane, Australia. The development of the experience-based activities outlined was driven by the feminist philosophy of the curriculum and a commitment to helping students develop as woman-centred practitioners. The activities focused on enabling students to hear women's stories of childbearing firsthand and understand these stories from the women's perspective, thus validating personal experience.
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Affiliation(s)
- C Brook
- School of Social Work and Social Policy, University of Queensland, St Lucia 4075.
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Brook C. Severity variations within DRGs. AUST HEALTH REV 1999; 21:283-5. [PMID: 10537566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Brook C. International Society for Quality in Health Care, Inc. Annual Report to Members. Int J Qual Health Care 1999. [DOI: 10.1093/intqhc/11.1.83] [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: 11/14/2022] Open
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Abstract
In this paper a critical analysis of two popular perineal management techniques used during birth, flexing the baby's head and the Ritgen manoeuvre, are presented. Each technique claims to reduce perineal trauma by reducing the presenting diameter of the fetal skull through the woman's vaginal opening. These two techniques are, however, contradictory and act against the normal mechanisms of labour. In normal labour, the smallest diameter of the fetal skull, the suboccipito-bregmatic, presents through the woman's vaginal opening. In order to negotiate the 90 degrees curve in the birth canal, the baby must change from an attitude of flexion to an attitude of extension during birth. The Ritgen manoeuvre encourages early extension of the fetal head which causes a larger fetal head diameter, the occipito-frontal diameter, to present. Flexing the fetal head cannot cause a smaller diameter to present, and the pressure the birth attendant applies to flex the head serves only to retard the emergence of the baby and unnaturally force the emerging fetal head down toward the stretched perineum. The discussion outlines the implications of this analysis for practice.
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Affiliation(s)
- K Myrfield
- School of Nursing, Faculty of Health and Behavioural Sciences, Griffith University, Nathan, Queensland, Australia.
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Buchan H, Brook C. Quality in Australian hospitals--who cares? Int J Qual Health Care 1997; 9:243-4. [PMID: 9304421 DOI: 10.1093/intqhc/9.4.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Abstract
Consumers regard access to hospital services as one of the key components of quality in health care delivery. A mixed public/private system operates in Victoria, but a morbidity collection from private hospitals was commenced only relatively recently. In 1993-94 the collection covered 82 per cent of private hospital separations, and it was considered timely to examine the utilisation patterns in the private system and compare them with those in the public system. Medical and surgical emergencies and other complex conditions and procedures are serviced largely in the public sector, whereas private hospitals are utilised for elective and less complex surgery and non-urgent conditions. Occupancy rates are around 79 per cent in public hospitals and 67 per cent in private hospitals. Elective surgery waiting list data suggest that while urgent cases are treated within a month, significant proportions wait six months or more for non-urgent surgery. Private health insurance is the main factor in determining access to and the utilisation private hospitals. The current Medicare Agreement and the move to separate the role of purchaser and provider may allow the maximal utilisation of private hospitals and diminish the burden of chronic illness.
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Affiliation(s)
- D O'Hara
- Department of Human Services, Victoria
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Buchan H, Brook C. Snakes and ladders: getting patients into public hospitals. Med J Aust 1995; 163:396. [PMID: 7476604 DOI: 10.5694/j.1326-5377.1995.tb124650.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
A preliminary survey of 34 suicides among patients attending community services for the chronically mentally ill revealed a rate of 520 per 100,000 admitted. In contrast to earlier hospital surveys, no risk variables were identified for patients dying by suicide. Thirty-four percent of suicides occurred within one week of the last treatment and 59% within 3 months of service entry. It appears that early and intensive follow-up may be necessary to prevent suicide among patients receiving community psychiatric care.
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Affiliation(s)
- C H Cantor
- Mental Health Branch, Queensland Department of Health, Brisbane, Australia
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Abstract
The study compared two equivalent groups of 11 diabetic children with grossly abnormal blood glucose profiles necessitating repeated admissions to a hospital. Patients in the treatment group were offered an intensive inpatient treatment program including psychoanalytic psychotherapy three to four times a week, which took place on the hospital ward and lasted an average of 15 weeks. The intervention was highly effective in improving the diabetic control of the children, and this was maintained at a 1 year follow-up. Patients in the comparison group, who were offered only inpatient medical intervention, returned to their prehospitalization level of metabolic control within a period of 3 months from discharge.
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Affiliation(s)
- G Moran
- Anna Freud Centre, London, and at the Department of Psychology, University College, London
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Jacobs J, Cunningham J, Brook C. The professionalisation of nursing: influences & implications. Qld Nurse 1989; 8:22-3. [PMID: 2501832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Jacobs J, Cunningham J, Brook C. Professionalism, power & society. Qld Nurse 1988; 7:18-9. [PMID: 3148967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Brook C. Puberty: growing pains. Nurs Mirror 1980; 151:19-21. [PMID: 6905113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Kelnar CJ, Brook C. Children with small stature. Br Med J 1978; 2:1790. [PMID: 737506 PMCID: PMC1610028 DOI: 10.1136/bmj.2.6154.1790-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Brook C. Letter: Abortion and maternal deaths. Br Med J 1976; 2:524-5. [PMID: 953662 PMCID: PMC1687980 DOI: 10.1136/bmj.2.6034.524-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Brook C. Rebuttal to Butt. Med Gynaecol Androl Sociol 1973; 7:6-9. [PMID: 12306560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Brook C, Brook I. Equal Pay for Women Doctors. West J Med 1964. [DOI: 10.1136/bmj.2.5422.1466-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brook C. College of General Practice. West J Med 1951. [DOI: 10.1136/bmj.2.4741.1223-a] [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: 11/03/2022]
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