The role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes

xlomafota13 shared this article with you from Inoreader The role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes Via Head & Neck Abstract Background To assess the role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes. Methods This was a population-based retrospective cohort study. Data were extracted from the Surveillance, Epidemiology, and End Results 18 database. The study cohort included 11 627 patients diagnosed with oropharyngeal squamous cell carcinoma between 2010 and 2015. Results The association between black race and increased risk of unresectable disease was slightly attenuated, but persistent, after including insurance status as a covariate (odds ratio [OR] 1.34, 95%CI 1.10–1.63). Likewise, black race was no longer associated with worse disease-specific survival (hazard ratio [HR] 1.11, 95%CI 0.99–1.26), but remained associated with worse overall survival with a slightly decreased effect size (HR 1.13, 95%CI 1.01–1.25). Conclusions Insurance status plays a significant role in, but does not completely account for, the persistent racial disparities in oropharyngeal cancer outcomes. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Chronic Rhinosinusitis Disease Disparity

xlomafota13 shared this article with you from Inoreader Chronic Rhinosinusitis Disease Disparity in the South Florida Hispanic Population Via The Laryngoscope Objectives/Hypothesis The role of social determinants of health in chronic rhinosinusitis (CRS) is poorly characterized. Limited research examining CRS health disparities indicates that minority status is associated with worse CRS. However, many of these studies are retrospective or performed in populations without substantial ethnic minorities. Rhinologists need to characterize existing CRS disease disparities to develop targeted strategies for improving care in these populations. This prospective study assesses preoperative CRS disease burden in South Florida (SFL) Hispanic and non-Hispanic patients and examines potential factors contributing CRS disease disparities. Study Design Prospective cohort study. Methods The prospective cohort study included consecutive patients having primary endoscopic sinus surgery (ESS) for CRS between September 2019 and February 2020 with complete preoperative data. Data were collected in clinic and surgery. Descriptive statistics compare Hispanic and non-Hispanic cohorts. Linear regression adjusts for confounders. Relative risk (RR) compared CRS severity markers. Results Thirty-eight Hispanic and 56 non-Hispanic patients met inclusion criteria. Age, sex, CT scores, insurance payer, and comorbidities were similar between cohorts. Hispanics presented with worse 22-item Sinonasal Outcome Test (SNOT-22) (55; SD = 18) compared to non-Hispanics (37; SD = 22) (P < .001). Hispanics tended to have a higher risk of severe CRS markers, including nasal polyps RR = 2.5 (95% CI: 1.0–5.9), neo-osteogenesis RR = 1.6 (95% CI: 0.5–4.7), extended procedures (i.e., draft III) RR = 2.97 (95% CI: 1.0–9.1), and tissue eosinophilia RR = 1.46 (95% CI: 0.6–3.5). Hispanics reported longer sinonasal symptom duration. Conclusions SFL hispanic patients presenting for primary ESS have worse sinonasal disease burden. SFL Hispanics have markers of greater CRS severity and report longer delays before receiving CRS care. These factors may contribute to increased sinonasal disease burden in Hispanic patients. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Postoperative Radiation Therapy Refusal in Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Carcinoma

xlomafota13 shared this article with you from Inoreader Postoperative Radiation Therapy Refusal in Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Carcinoma Via The Laryngoscope Objectives/Hypothesis Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a distinct clinical entity with good prognosis, unique demographics, and a trend toward treatment deintensification. Patients with this disease may opt out of recommended postoperative radiation therapy (PORT) for a variety of reasons. The aim of this paper was to examine factors that predict patient refusal of recommended PORT in HPV-associated OPSCC, and the association of refusal with overall survival. Study Design Retrospective population-based cohort study of patients in the National Cancer Database. Methods We conducted a retrospective cohort study of patients in the National Cancer Database diagnosed with OPSCC between January 2010 and December 2015. We primarily assessed overall survival and the odds of refusing PORT based on demographic, socioeconomic, and clinical factors. Analysis was conducted using multivariable logistic regression and multivariable Cox proportional hazards model. Results A total of 4229 patients were included in the final analysis, with 156 (3.7%) patients opting out of recommended PORT. On multivariable analysis, patient refusal of PORT was independently associated with a variety of socioeconomic factors such as race, insurance status, comorbidity, treatment at a single facility, and margin status. Lastly, PORT refusal was associated with significantly lower overall survival compared to receipt of recommended PORT (hazard ratio 1.69, confidence interval 1.02–2.82). Conclusions Patient refusal of recommended PORT in HPV-associated OPSCC is rare and associated with variety of disease and socioeconomic factors. PORT refusal may decrease overall survival in this population. Our findings may help clinicians when counseling patients and identifying those who may be more likely to opt out of recommended adjuvant therapy. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcomes of Robotic Partial Excision of the Levator Ani Muscle for Locally Advanced Low Rectal Cancer Invading the Ipsilateral Pelvic Floor at the Anorectal Ring Level

xlomafota13 shared this article with you from Inoreader Outcomes of Robotic Partial Excision of the Levator Ani Muscle for Locally Advanced Low Rectal Cancer Invading the Ipsilateral Pelvic Floor at the Anorectal Ring Level Via The International Journal of Medical Robotics and Computer Assisted Surgery Abstract Purpose The purpose of this study is to evaluate partial excision of the levator ani muscle (PELM) enables preservation of anal sphincter function although levator ani muscle (LAM) was invaded. Methods Functional outcomes and oncologic outcomes of 23 consecutive patients who underwent robotic PELM for low rectal cancer at the anorectal ring level invading or abutting the ipsilateral LAM are analyzed. Results Secured resection margins were achieved, especially for the circumferential resection margin. During a median follow-up of 44 months, the 3-year local recurrence rate was 14.4%. Among patients who underwent diverting ileostomy closure, mean Memorial Sloan Kettering Cancer Center Bowel Function Instrument and Wexner scores were 68.3±11.9 and 10.7±5.3, respectively, at 1 year after closure. Conclusion PELM is a sphincter-preserving alternative to APR or extralevator APR for low rectal cancer invading the ipsilateral LAM at the level of the anorectal ring. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Towards Development of a Tele‐Mentoring Framework for Minimally Invasive Surgeries

xlomafota13 shared this article with you from Inoreader Towards Development of a Tele‐Mentoring Framework for Minimally Invasive Surgeries Via The International Journal of Medical Robotics and Computer Assisted Surgery ABSTRACT Background Tele-mentoring facilitates the transfer of surgical knowledge. The objective of this work is to develop a tele-mentoring framework that enables a specialist surgeon to mentor an operating surgeon by transferring information in a form of surgical instruments' motion required during a minimally invasive surgery. Method A tele-mentoring framework is developed to transfer video stream of the surgical field, poses of the scope, and port placement from the operating room to a remote location. From the remote location, the motion of virtual surgical instruments augmented onto the surgical field is sent to the operating room. Results The proposed framework is suitable to be integrated with laparoscopic as well as robotic surgeries. It takes on average 1.56 seconds to send information from the operating room to the remote location and 0.089 seconds for vice versa over a local area network. Conclusions The work demonstrates a te le-mentoring framework that enables a specialist surgeon to mentor an operating surgeon during a minimally invasive surgery. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intraoperative Ultrasonographic Assessment of Vocal Cord motion under sedation, following pediatric thyroidectomy in the Era of COVID‐19, a double‐blinded preliminary study

xlomafota13 shared this article with you from Inoreader Intraoperative Ultrasonographic Assessment of Vocal Cord motion under sedation, following pediatric thyroidectomy in the Era of COVID‐19, a double‐blinded preliminary study Via Clinical Otolaryngology ABSTRACT Unilateral vocal cord paralysis (UVCP) is a known complication of thyroid surgery, due to iatrogenic recurrent laryngeal nerve injury, with reported rates of 2-5% in children. The gold standard for assessing vocal cord function in flexible nasendoscopy (FNE) examination, which is considered high-risk for contraction of the COVID-19 virus. Intraoperative ultrasonographic assessment (IUA) of vocal cord function is a non-invasive and relatively simple procedure, performed in a supine position, performed during spontaneous breathing, following reversed anesthesia, while the patient is still sedated. Objectives To evaluate the validity of IUA modality in children undergoing thyroidectomy, and to compare it to the standard FNE. Design A prospective double-blind study covering 24 months (March 2019-March 2021). Twenty thyroid lobectomies were performed, during 15 surgeries. Vocal cord function was assessed three times: Preoperatively by FNE, intraoperative (IUA) following extubation, and a second FNE on the first post-operative day. Settings A tertiary pediatric hospital. Results The overall accuracy of IUA results in our study was 92%. IUA sensitivity, specificity, positive and negative predictive values were 100%, 89%, 33%, and 100% respectively. Patient's age demonstrated borderline significance (p= 0.08). The resident's experience was associated with a better correlation between IUA and FNE results (p<0.05). Conclusions IUA of vocal cord motion has a high accuracy rate for detection of iatrogenic vocal cord paralysis, similar to FNE. It is easily learned by residents, well tolerated by children, and it provides a safe and valid alternative modality while ensuring the safety of the medical staff in treating patients, especially in times of COVID-19 pandemic. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management of periprosthetic breast infection: a systematic review and meta-analysis

xlomafota13 shared this article with you from Inoreader Management of periprosthetic breast infection: a systematic review and meta-analysis Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 17:S1748-6815(21)00329-6. doi: 10.1016/j.bjps.2021.05.070. Online ahead of print. ABSTRACT BACKGROUND: The current management of an infected breast implant is varied. This systematic review and meta-analysis aim to synthesise the current evidence and establish the efficacy of the various managements of infected breast implants. METHODS: A comprehensive search in the MEDLINE, EMBASE and CENTRAL databases was conducted for primary clinical studies that report on the management of infected breast implants from 1946 to September 2019. The primary outcome measure was the proportion of patients with successful treatment. RESULTS: Nineteen articles that involve 1044 patients were included. Overall, 29.00% (95% CI = from 11.51% to 50.58%) of the patients with mild infection were treated exclusively with antibiotics, of which, 81.41% (95% CI = from 57.82% to 96.63%) were successfully treated w ithout the need for surgical intervention. Another 39.01% (95% CI = from 21.41% to 58.23%) of the patients underwent surgical salvage of the infected breast implants, of which 84.56% (95% CI = from 74.92% to 92.20%) successfully retained the salvaged implants without infection recurrence. Meanwhile, 35.01% (95% CI = from 27.01% to 43.57%) of the patients underwent explantation of the infected breast implant, of which, only 39.02% (95% CI = from 23.93% to 55.28%) had re-insertion of a new implant on a later date and 4.99% (95% CI = from 1.66% to 9.99%) of these patients had recurrence of infection requiring removal of the infected implant. The commonest complication was capsular contracture, which was reported in 10.78% (95% CI = from 4.41% to 19.49%) of the patients. Changes in the quality of life and cost implications were not reported. CONCLUSION: This study consolidates current available evidence on the management of infected breast implants, which could assist decision-mak ing and improve patient education; however, current data are limited because of the lack of level-1 evidence. PMID:34257035 | DOI:10.1016/j.bjps.2021.05.070 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nerve gaps repaired with acellular nerve allografts recellularized with Schwann-like cells: Preclinical trial

xlomafota13 shared this article with you from Inoreader Nerve gaps repaired with acellular nerve allografts recellularized with Schwann-like cells: Preclinical trial Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 17:S1748-6815(21)00323-5. doi: 10.1016/j.bjps.2021.05.066. Online ahead of print. ABSTRACT BACKGROUND: Acellular nerve allografts (ANA) recellularized with mesenchymal stem cells (MSC) or Schwann cells (SC) are, at present, a therapeutic option for peripheral nerve injuries (PNI). This study aimed to evaluate the regenerative and functional capacity of a recellularized allograft (RA) compared with autograft nerve reconstruction in PNI. METHODS: Fourteen ovines were randomly included in two groups (n=7). A peroneal nerve gap 30 mm in length was excised, and nerve repair was performed by the transplantation of either an autograft or a recellularized allograft with SC-like cells. Evaluations included a histomorphological analysis of the ANA, MSC pre differentiated into SC-like cells, at one year follow-up functional limb recovery (support and gait), and nerve regeneration using neurophysiologi cal tests and histomorphometric analysis. All evaluations were compared with the contralateral hindlimb as the control. RESULTS: The nerve allograft was successfully decellularized and more than 70% of MSC were pre differentiated into SC-like cells. Functional assessment in both treated groups improved similarly over time (p <0.05). Neurophysiological results (latency, amplitude, and conduction velocity) also improved in both treated groups at twelve months. Histological results demonstrated a less organized arrangement of nerve fibers (p <0.05) with an active remyelination process (p <0.05) in both treated groups compared with controls at twelve months. CONCLUSIONS: ANA recellularized with SC-like cells proved to be a successful treatment for nerve gaps. Motor recovery and nerve regeneration were satisfactorily achieved in both graft groups compared with their contralateral nontreated nerves. This approach could be useful for the clinical therapy of PNI. PMID:34257032 | DOI:10.1016/j.bjps.2021.05.066 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Application of real-time surgical navigation for zygomatic fracture reduction and fixation

xlomafota13 shared this article with you from Inoreader Application of real-time surgical navigation for zygomatic fracture reduction and fixation Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 12:S1748-6815(21)00311-9. doi: 10.1016/j.bjps.2021.05.052. Online ahead of print. ABSTRACT BACKGROUND: Inappropriate treatment of zygomatic fractures can reduce esthetic and functional outcomes. The aim of this study was to answer the research question: "Among patients with a unilateral zygomatic fracture, is the use of computer-assisted real-time navigation system during fracture reduction precise and accurate to create postoperative facial symmetry?" METHODS: Using a retrospective cohort study design, we enrolled a cohort of unilateral zygomatic fractures undergoing open reduction and internal fixation (ORIF) with the aid of the computer-based navigation system at Chang Gung Memorial Hospital, Taiwan, during January 2015 and March 2018. The predictor variable was the comparison before and after surgery. The main outcome variables included (1) two-dimensional (2D) reduction of the displace ment at five anatomical landmarks: zygomaticofrontal, inferior orbital rim, zygomaticosphenoidal, zygomaticomaxillary, and zygomaticotemporal lines/buttresses and (2) three-dimensional (3D) differences on distances between zygomatic surface to the porion plane and the midpoint of zygomatic arch (ZA) to the mid-porion (MP) plane. The Wilcoxon signed-rank test was computed to compare between pre- and postoperative data, and a p-value less than 0.05 was considered statistically significant. RESULTS: The cohort comprised 24 subjects (50% females, 75% left-sided) with a mean age of 30.5 +/- 13.8 years. On 2D analysis, the significant fracture reduction was found: 4.78 vs. 1.22 mm, 1.78 vs. 0.40 mm, 3.50 vs. 0.07 mm, 3.06 vs. 0.55 mm, and 2.55 vs. 0.50 mm at zygomaticomaxillary, zygomaticofrontal, inferior orbital rim, zygomaticosphenoidal, and zygomaticotemporal landmarks. The 3D evaluations revealed the significant reduction of the differences between the left and right zygomatic surface to the porion plane (4.09 ± 2.12 vs. 0.46 ± 0.35 mm) and between the left and right ZA midpoints to the MP plane (4.89 ± 2.59 vs. 0.71 ± 0.44 mm) (p<0.001 for both 2D and 3D analyses). CONCLUSIONS: The results of this study suggest that the real-time surgical navigation system can effectively guide the ORIF of zygomatic fractures. Future research studies should focus on the learning curve and cost-effectiveness analysis of this technique. PMID:34257033 | DOI:10.1016/j.bjps.2021.05.052 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ototoxicity in Patients of Advanced Head and Neck Malignancies Receiving Chemoradiation Versus Radiation Alone: Comparative Study

xlomafota13 shared this article with you from Inoreader Ototoxicity in Patients of Advanced Head and Neck Malignancies Receiving Chemoradiation Versus Radiation Alone: Comparative Study Via Otolaryngology Indian Abstract To evaluate ototoxicity in patients receiving combined cisplatin and radiotherapy in comparison to patients receiving radiotherapy alone. A prospective study was conducted in sixty (60) cases of advanced Head and Neck malignancy (stage III and IV). Patient were divided in two randomized groups (30 each), group I received chemoradiation and group II received radiation alone. Inclusion criteria were histopathologically confirmed head & neck malignancy, normal baseline audiograms. Exclusion criteria were defined as: previously treated cases with chemotherapy/radiotherapy, patients who didn't complete treatment or lost to follow up. Ototoxicity was evaluated as per criterion established by the American speech-language-hearing association. Study participants were evaluated for ototoxicity at intervals defined as per study design. Sensorineural hearing loss (SNHL) was noticed in 56.6% and 36.6% of subjects in Group I & II respectively at 6 months follow up post completion of treatment. Incidence of sensorineural hearing loss increased significantly with cumulative dosages of chemoradiotherapy in group I and radiotherapy in group II. Incidence of SNHL in both study groups was found to be higher in patients older than 50 years. Incidence of ototoxicity in chemoradiated patients was found to be higher in comparison to patients receiving radiation alone. Ototoxicity occurred more with cumulative doses, with higher speech frequencies affected earlier in comparison to middle range frequencies. Lower frequencies were spared. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

“Association of High Risk Factors and Hearing Impairment in Infants—A Hospital Based Study”

xlomafota13 shared this article with you from Inoreader "Association of High Risk Factors and Hearing Impairment in Infants—A Hospital Based Study" Via Otolaryngology Indian Abstract The aim of the study was to find the association of various risk factors with permanent hearing impairment in infants. A case–control study was designed on 420 infants with permanent hearing impairment and normal hearing. The case control ratio was 1:1. Alternate sampling method was used for selecting the control group. Review of medical records and parent interview was done to collect the information of risk factors. Family history(adj. OR 7.5; 95% CI 3, 14; P = 0.000), Consanguinity (adj. OR: 4; 95% CI 2,4; P = 0.000), intra uterine infection (adj. OR 18, 95% CI: 2.3–126.5, P = 0.000), post natal infection (adj. OR 3, 95% CI: 1.3–5, P = 0.004), low Apgar score (adj.OR: 4.6, 95% CI: 1.3–15), craniofacial anomaly (OR-4.6, 95% CI: 1.4–9.5, P = 0.005) and low birth weight (adj. OR: 2.3, 95% CI: 1.2–3.8) were significantly associated with hearing impairment. Among the risk factors, int ra uterine infection was having highest significant association with permanent hearing impairment. This is followed by family history, low Apgar score, craniofacial anomaly, consanguinity, post natal infection and low birth weight. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.