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  • 1
    Online Resource
    Online Resource
    Opioid prescribing practices in patients undergoing surgery for oral cavity cancer
    Wiley ; 2018
    In:  The Laryngoscope Vol. 128, No. 10 ( 2018-10), p. 2361-2366
    Details
    In: The Laryngoscope, Wiley, Vol. 128, No. 10 ( 2018-10), p. 2361-2366
    Abstract: Opioids have been overprescribed after general and orthopedic surgeries, but prescribing patterns have not been reported for head and neck surgery. The objectives of this retrospective review are to describe postoperative opioid prescriptions after oral cancer surgery and determine which patients receive higher amounts. Methods A single institution retrospective review was performed for 81 adults with oral cavity tumors undergoing surgery. Opioid prescriptions upon discharge were reported in daily oral morphine equivalents (OME). High opioids were defined as  〉  90 mg daily and  〉  200 mg total, commensurate with U.S. Center for Disease Control and Prevention and state guidelines. Multivariable logistic regression was performed to investigate factors associated with high opioids. Results The median number of doses dispensed was 30 (interquartile range [IQR] 30–45; range 3–120). The median daily dose was 30 mg (IQR 20–45 mg; range 15–240 mg). Five patients (6%) received higher than the recommended daily dose. The median total dispensed amount was 225 mg (IQR 150–250 mg; range 15–1200 mg). Fifty‐one (63%) received greater than the recommended total dose. On multivariable logistic regression, advanced tumor stage (odds ratio [OR] 11.5; 95% confidence interval [CI] 1.2–109.4; P  = 0.034) and inpatient pain scores (OR 1.3 per 1‐unit increase; 95% CI 1.0–1.7; P  = 0.039) were associated with receiving high total opioids after surgery. Conclusion The majority of patients received greater than the recommended 200 mg total OME. Advanced stage and higher inpatient pain scores were associated with receiving more opioids for discharge. Consensus‐driven analgesic plans are needed to reduce excess opioids after discharge following head and neck surgery. Level of Evidence 4. Laryngoscope , 128:2361–2366, 2018
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v128.10
    DOI: 10.1002/lary.27215
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2026089-1
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  • 2
    Online Resource
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    Surgical salvage improves overall survival for patients with HPV‐positive and HPV‐negative recurrent locoregional and distant metastatic oropharyngeal cancer
    Wiley ; 2015
    In:  Cancer Vol. 121, No. 12 ( 2015-06-15), p. 1977-1984
    Details
    In: Cancer, Wiley, Vol. 121, No. 12 ( 2015-06-15), p. 1977-1984
    Abstract: To the authors' knowledge, few clinical data currently are available regarding the clinical behavior and treatment of recurrent oropharyngeal cancer, particularly distant metastatic disease, within the context of human papillomavirus tumor status. In this retrospective analysis, surgical salvage is associated with prolonged overall survival for patients with recurrent locoregional and distant metastatic oropharyngeal cancer, independent of human papillomavirus tumor status.
    Type of Medium: Online Resource
    ISSN: 0008-543X , 1097-0142
    URL: Issue
    URL: Article
    DOI: 10.1002/cncr.v121.12
    DOI: 10.1002/cncr.29323
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 1479932-7
    detail.hit.zdb_id: 2599218-1
    detail.hit.zdb_id: 2594979-2
    detail.hit.zdb_id: 1429-1
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  • 3
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    Circulating tumor HPV DNA assessments after surgery for human papilloma virus-associated oropharynx carcinoma
    Elsevier BV ; 2024
    In:  American Journal of Otolaryngology Vol. 45, No. 2 ( 2024-03), p. 104184-
    Details
    In: American Journal of Otolaryngology, Elsevier BV, Vol. 45, No. 2 ( 2024-03), p. 104184-
    Type of Medium: Online Resource
    ISSN: 0196-0709
    URL: Article
    DOI: 10.1016/j.amjoto.2023.104184
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
    detail.hit.zdb_id: 2041649-0
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  • 4
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    Self‐removing passive drain to facilitate postoperative care via telehealth during the COVID ‐19 pandemic
    Wiley ; 2020
    In:  Head & Neck Vol. 42, No. 6 ( 2020-06), p. 1305-1307
    Details
    In: Head & Neck, Wiley, Vol. 42, No. 6 ( 2020-06), p. 1305-1307
    Abstract: Telehealth postoperative visits are an attractive strategy to minimize exposure, especially during the SARS‐CoV‐2 (COVID‐19) pandemic. The use of a surgical drain often prevents this minimal‐exposure approach in that patients return to the outpatient clinic for drain removal. Methods and Results Following unilateral neck dissection, the customary closed‐suction drain was replaced with a self‐removing, passive drain dressing to facilitate same‐day discharge and telehealth postoperative follow‐up. The patient removed the dressing and drain at home during a telehealth visit on postoperative day 4 and she healed favorably without any signs of infection or seroma. Conclusions When thoughtfully applied in the appropriate clinical context, small practice adaptations like this can facilitate telehealth solutions that diminish unnecessary exposure for patients, their caregivers, and health care staff.
    Type of Medium: Online Resource
    ISSN: 1043-3074 , 1097-0347
    URL: Issue
    URL: Article
    DOI: 10.1002/hed.v42.6
    DOI: 10.1002/hed.26203
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2001440-5
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  • 5
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    Association of Ultrasound Characteristics With Extranodal Extension in Metastatic Papillary Thyroid Carcinoma
    American Medical Association (AMA) ; 2016
    In:  JAMA Otolaryngology–Head & Neck Surgery Vol. 142, No. 3 ( 2016-03-01), p. 263-
    Details
    In: JAMA Otolaryngology–Head & Neck Surgery, American Medical Association (AMA), Vol. 142, No. 3 ( 2016-03-01), p. 263-
    Type of Medium: Online Resource
    ISSN: 2168-6181
    URL: Article
    DOI: 10.1001/jamaoto.2015.3558
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2016
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  • 6
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    Follow-Up Adherence Is Associated with Outcomes After Endoscopic Sinus Surgery
    SAGE Publications ; 2020
    In:  Annals of Otology, Rhinology & Laryngology Vol. 129, No. 7 ( 2020-07), p. 707-714
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 129, No. 7 ( 2020-07), p. 707-714
    Abstract: Clinical follow-up after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) allows for assessment of the sinonasal cavity, debridement, and tailoring of medical therapies. Frequency and timing of postoperative clinical visits is debated, but the impact of adherence on disease-specific outcomes is not well understood. In this longitudinal study, we assessed the association between follow-up adherence and quality of life (QOL) outcomes in the 12 months after ESS. Methods: A retrospective review of patients undergoing ambulatory ESS for CRS between 11/2016 and 1/2018 was performed. We assessed sociodemographic characteristics, radiographic severity, and QOL utilizing the 22-item sinonasal outcome test (SNOT-22). Patients were categorized as “non-adherent,” “moderately-adherent,” and “fully-adherent” to a 1-, 3- and 5-week postoperative visit schedule. Results: A total of 166 patients met the inclusion criteria. Of these, 55 (33.1%) were fully-adherent, 105 (63.2%) were moderately-adherent, and 6 (3.6%) were non-adherent within the 6 weeks following ESS. In the immediate postoperative period, fully-adherent patients demonstrated worse QOL (SNOT-22: 31.2 ± 23.1 vs 27.5 ± 17.6, P = .047). This cohort also had greater psychological dysfunction at baseline and 12-months ( P  〈  .05) after ESS. Extra-nasal symptom scores increased at a lower rate in the fully-adherent cohort (0.12 vs 1.29 points per 6 months, P = .038), as did ear/facial symptoms (1.17 vs 3.05 points per 6 months, P = .044). Conclusion: Despite worse symptom severity in the immediate postoperative period, patients who are more adherent to the follow-up schedule demonstrated slower return of symptoms in the extra-rhinological and ear-facial domains. These findings suggest that clinical adherence and management may impact the long-term evolution of ESS outcomes.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/0003489420908291
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2033055-8
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  • 7
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    Socioeconomic Factors Affect Presentation Stage and Survival in Sinonasal Squamous Cell Carcinoma
    Wiley ; 2021
    In:  The Laryngoscope Vol. 131, No. 11 ( 2021-11), p. 2421-2428
    Details
    In: The Laryngoscope, Wiley, Vol. 131, No. 11 ( 2021-11), p. 2421-2428
    Abstract: Socioeconomic factors affect oncologic outcome in sinonasal squamous cell carcinoma (SNSCC). However, the relationship between these factors and stage at presentation (SAP)—a critical, early point in the care cycle—is not known. This study sought to determine the role of race/ethnicity, treatment facility type, insurance status/carrier, and other socioeconomic factors in SAP and survival among patients with advanced SNSCC. Study Design Retrospective cohort study. Methods Using the National Cancer Database, 6,155 patients with SNSCC were identified and divided into those with “early” (Stage I or II; 2,212 (35.9%)) versus “advanced” (Stage III or IV; 3,943 (64.1%)) disease. Associations between sociodemographic and socioeconomic factors on SAP and survival were analyzed using multivariable logistic regression and Cox proportional hazard models. Results Black (odds ratio [OR]: 2.18, CI: 1.74–2.76), Asian and Pacific Islander (API) (OR: 2.37, CI: 1.43–4.14), and Medicaid or uninsured (OR: 2.04, CI: 1.66–2.53) patients were more likely to present with advanced disease. Among patients with advanced disease, API patients demonstrated the highest 10‐year survival rate (30.2%), and Black patients had the lowest 2‐, 5‐, and 10‐year survival rates (47.7%, 31.9% and 19.2%, respectively). Older age (HR:1.03, CI:1.03–1.04), Black race (HR:1.39, CI:1.21–1.59), Medicaid or uninsured status (HR:1.48, CI:1.27–1.71), and treatment at a community hospital (HR:1.25, CI:1.14–1.37) were associated with poorer overall survival among patients with advanced disease. Conclusions Factors including race/ethnicity, treatment facility type, insurance status/carrier, and other socioeconomic factors influence SAP and survival in SNSCC. An improved understanding of how these factors relate to outcomes may elucidate opportunities to address gaps in education and access to care in vulnerable populations. Level of Evidence 4 Laryngoscope , 131:2421–2428, 2021
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v131.11
    DOI: 10.1002/lary.29568
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2026089-1
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  • 8
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    Predictors of Quality‐of‐Life Improvements Following Global Head and Neck Surgery Trips to Underserved Regions
    Wiley ; 2021
    In:  The Laryngoscope Vol. 131, No. 9 ( 2021-09), p. 2006-2010
    Details
    In: The Laryngoscope, Wiley, Vol. 131, No. 9 ( 2021-09), p. 2006-2010
    Abstract: To conduct longitudinal postoperative follow‐up and discern health‐related quality‐of‐life (HR‐QoL) changes using a validated questionnaire among patients undergoing head and neck surgeries during a short‐term, global surgical trip in a resource‐limited setting. To identify clinicodemographic predictors of post‐operative HR‐QoL improvements in this setting. Study Design Retrospective observational study with prospective follow‐up. Methods Patients undergoing surgery at Moi Teaching and Referral Hospital in Eldoret, Kenya through the authors' short‐term surgical trip (STST) between 2016 and 2019 were asked to complete preoperative Short Form‐36 (SF‐36) HR‐QoL questionnaires, and postoperative SF‐36 questionnaires during subsequent follow‐up. Preoperative and postoperative SF‐36 domain scores, and two composite scores (mental component summary [MCS] and physical component summary [PCS] ) were compared. Linear regression models were fit to identify clinicodemographic factors predictors of general health (GH), MCS, and PCS scores. Results Among the 26 participating patients, significant improvements were seen in post‐operative GH (mean change = 19.8) and MCS (mean change = 11.2) scores. Lower pre‐operative GH, MCS, and PCS scores were predictive of greater improvement in the corresponding post‐operative scores. Longer time to follow‐up was associated with greater improvement in GH score. Mean follow‐up interval was 23.1 months (SD = 1.8 months). Conclusions Utilizing the SF‐36 questionnaire, we found that patients' perception of their general and psychosocial health improved after undergoing head and neck surgeries through a global STST. This study provides important, preliminary evidence that that elective surgeries performed in low‐resource settings convey substantial benefit to patient QoL. Level of Evidence 4 Laryngoscope , 131:2006–2010, 2021
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v131.9
    DOI: 10.1002/lary.29522
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2026089-1
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  • 9
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    Socioeconomic and demographic determinants of postoperative outcome after endoscopic sinus surgery
    Wiley ; 2020
    In:  The Laryngoscope Vol. 130, No. 2 ( 2020-02), p. 297-302
    Details
    In: The Laryngoscope, Wiley, Vol. 130, No. 2 ( 2020-02), p. 297-302
    Abstract: Socioeconomic and demographic factors have a significant impact on healthcare utilization and surgical outcomes. The effect of these variables on baseline symptom severity and quality of life (QOL) after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) is not well established. Our goal was to investigate the association of sociodemographic factors on QOL before and after ESS, as reflected by the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) score. Study Design Retrospective case series. Methods From October 2016 to August 2018, 244 patients with chronic rhinosinusitis who underwent ESS were included. Socioeconomic and demographic data, surgical characteristics, and baseline and postoperative SNOT‐22 scores were recorded. Univariate and multivariate regression were performed to identify determinants of baseline symptom severity and improvement following ESS. Results Nonwhite patients reported worse baseline symptoms severity (SNOT‐22, 52.06 vs. 43.76, P = .021) compared to white patients, yet lower CRS symptoms at follow‐up (SNOT‐22, 23.38 vs. 28.63, P = .035). Relative improvement was higher in nonwhite patients as well (41.2% vs. 36.5%, Mann‐Whitney U = 1,747, P = .015). In an adjusted multivariate logistic regression model, below‐median income ($71,805 [California] ) was associated with worse baseline symptom severity (β = 7.72; 95% confidence interval [CI]: 1.10, 14.26). Nonmarried patients (β = 6.78; 95% CI: 2.22, 13.48) and white patients (β = 8.45; 95% CI: 0.40, 13.97) had worse QOL at follow‐up. Conclusions Nonwhite patients and those with below‐median income present with more severe CRS symptoms at baseline. However, a greater degree of absolute and relative QOL improvement was found in nonwhite and married patients following ESS. Improved understanding of the significance of socioeconomic and demographic factors and attention to cultural differences/marital status could have a substantial impact on ESS outcomes. Level of Evidence 4 Laryngoscope , 130:297–302, 2020
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v130.2
    DOI: 10.1002/lary.28036
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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  • 10
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    Caspase-1 from MDSC promote MyD88 dependent carcinogenesis that is T-cell independent
    The American Association of Immunologists ; 2016
    In:  The Journal of Immunology Vol. 196, No. 1_Supplement ( 2016-05-01), p. 211.21-211.21
    Details
    In: The Journal of Immunology, The American Association of Immunologists, Vol. 196, No. 1_Supplement ( 2016-05-01), p. 211.21-211.21
    Abstract: Myeloid-derived-suppression cells (MDSC) are functionally defined to suppress T-cells in their primary means of immune evasion mechanism in cancer. However, we have discovered that MDSC can have direct, T-cell independent pro-carcinogenic effect on tumor cells. Sorted monocytic CD14+/CD11b+/HLA-DRlowMDSCs from head and neck squamous cell carcinoma (HNSCC) patients were found to increase the proliferation index of HNSCC cells. This induction of tumor proliferation was not dependent on MDSC-tumor cell contact. Exome analysis showed that these human MDSC from cancer patients expressed high levels of inflammasome complex, and supernatant from the MDSCs were found to secrete IL-1b and IL-18. When we probed the functional significance of these inflammasome complex, we found that MDSC’s promotion of tumor proliferative index of the tumor was found to be caspase-1 dependent. To test this in vivo, T-cell depleted caspase-1 null mice showed significant decrease in tumor growth rate. To confirm the importance of myeloid inflammasome signaling in carcinogenesis, we suppressed MyD88 gene in tumor cell line Cal27 and found that the ability of MDSC to promoting tumor proliferation is diminished. Taken together, our findings demonstrate that tumor infiltrating MDSCs may play a prominent role in chronic inflammation associated carcinogenesis.
    Type of Medium: Online Resource
    ISSN: 0022-1767 , 1550-6606
    URL: Article
    DOI: 10.4049/jimmunol.196.Supp.211.21
    RVK:
    XA 54100
    RVK:
    XA 10000
    Language: English
    Publisher: The American Association of Immunologists
    Publication Date: 2016
    detail.hit.zdb_id: 1475085-5
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