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Nteyumwete H, Civantos AM, Stanford-Moore GB, Yau J, Tuyishimire G, Umutoni J, Nyabyenda V, Ncogoza I, Shaye DA. Factors Influencing Delay in Diagnosis of Head and Neck Cancer in Rwanda. Laryngoscope 2024; 134:1663-1669. [PMID: 37847111 DOI: 10.1002/lary.31103] [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: 05/22/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE Head and neck cancer is a significant contributor to global otolaryngologic disease burden, with a disproportionate impact on low- and middle-income countries. This study investigates the factors contributing to delays in head and neck cancer diagnosis at the University Teaching Hospital of Kigali (CHUK). METHODS Cross-sectional study of all patients with a pathologic diagnosis of head and neck cancer presenting to CHUK between January 2021 and June 2022. Sociodemographic data, tumor characteristics, and reasons for delay were collected. Univariate and multivariable analyses were undertaken to evaluate risk factors for delays. RESULTS Eighty-one patients met criteria for inclusion. Median duration from patient first reported symptoms to initial medical consultation was 52 weeks, from initial medical consultation to referral to CHUK was 4 weeks, and from referral to final pathologic diagnosis was 6 weeks. The most common reason for delay to referral to CHUK was financial (37.04%). Patients who visited traditional healers had higher odds of delay between symptom onset and medical consultation (OR 3.51, CI 1.05-11.70). Delays in final diagnosis after referral were most commonly due to OR availability for biopsy (37.04%) and time for pathology results after biopsy (35.80%). OR availability had a significant impact on duration to final diagnosis (OR 59.48, CI 7.17-493.67). Stage 4 disease had the shortest time to final diagnosis (OR 0.05, CI 0.01-0.45). CONCLUSION Understanding the reasons for delayed diagnosis of head and neck cancer may help guide improvements in care, with the goal of reducing global head and neck burden of disease. LEVEL OF EVIDENCE 3; prospective non-random follow-up study Laryngoscope, 134:1663-1669, 2024.
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Affiliation(s)
- Hirwa Nteyumwete
- Department of ENT, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Alyssa M Civantos
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Gaelen B Stanford-Moore
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Jenny Yau
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Gratien Tuyishimire
- Department of ENT, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Josiane Umutoni
- Department of ENT, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Victor Nyabyenda
- Department of ENT, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Isaie Ncogoza
- Department of ENT, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - David A Shaye
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
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Civantos AM, Callander J, Czechowicz J, Jacobson L, Rosbe KW. Management of Newborn Traumatic Nasal Deformity with a Nostril Retainer. Laryngoscope 2024; 134:1469-1471. [PMID: 37642380 DOI: 10.1002/lary.30956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Alyssa M Civantos
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jacquelyn Callander
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Josephine Czechowicz
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Lia Jacobson
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kristina W Rosbe
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, USA
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Civantos AM, Prasad A, Carey RM, Bur AM, Mady LJ, Brody RM, Rajasekaran K, Cannady SB, Hartner L, Ibrahim SA, Newman JG, Brant JA. Palliative care in metastatic head and neck cancer. Head Neck 2021; 43:2764-2777. [PMID: 34018648 DOI: 10.1002/hed.26761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/10/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to inherent impact on quality of life, metastatic head and neck cancer patients are well-suited to benefit from palliative care (PC). Our objective was to examine factors that shape PC utilization and implications for overall survival in stage IVc head and neck cancer patients. METHODS A retrospective study of patients with stage IVc head and neck cancer in the National Cancer Database from 2004 and 2015 was conducted. RESULTS 7794 cases met inclusion criteria, of which 19.3% received PC. PC use was associated with more recent years of diagnosis, Northeast facility geography, and non-private insurances (p < 0.05). Compared to no PC, "interventional" PC, defined as palliative surgery, radiation, and/or chemotherapy, and "pain management only" PC were associated with lower overall survival (p < 0.05). CONCLUSIONS PC use increased over time and was associated with demographic and clinical factors. There remains opportunity for improvement in optimal implementation of palliative care.
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Affiliation(s)
- Alyssa M Civantos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aman Prasad
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrés M Bur
- Department of Otolaryngology: Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Leila J Mady
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert M Brody
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Steven B Cannady
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lee Hartner
- Department of Hematology, Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Said A Ibrahim
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
| | - Jason G Newman
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jason A Brant
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Locke TB, Sweis AM, Douglas JE, Ig-Izevbekhai KI, Stevens EM, Civantos AM, McCarty EB, Kumar A, Kohanski MA, Kennedy DW, Palmer JN, Bosso JV, Adappa ND. Treatment Outcomes in Aspirin-Exacerbated Respiratory Disease Based on the 12-Item Short Form Survey. Am J Rhinol Allergy 2021; 35:790-797. [PMID: 33691498 DOI: 10.1177/19458924211001640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aspirin-exacerbated respiratory disease (AERD) is optimally managed by endoscopic sinus surgery (ESS) followed by aspirin therapy after desensitization (ATAD). Most AERD quality of life (QOL) studies use the 22-item Sinonasal Outcomes Test (SNOT-22), which focuses predominantly on sinonasal outcomes. OBJECTIVE This study seeks to assess QOL outcomes in AERD patients after ESS and ATAD via the 12-item Short Form Survey (SF-12), a well-validated QOL measure for general health status of chronic conditions. METHODS Retrospective review of 112 AERD patients who underwent ESS followed by ATAD at our institution between 2016 and 2019. SF-12 was collected preoperatively, postoperatively/pre-AD, and serially post-AD (1-3, 4-6, 7-12, and >12 months). Optum® PRO CoRE software was used to compare data to national norms. ANOVA was performed comparing physical component summary (PCS), mental component summary (MCS) and eight health domains (physical functioning, role physical, general health, bodily pain, vitality, social functioning, role emotional, and mental health). RESULTS AERD patients showed improvement in PCS scores across all timepoints after ESS and ATAD (p = 0.004). When stratified by gender, women demonstrated an improvement in PCS scores (p = 0.004). Within the domains, there were significant improvements in social functioning (SF), role physical (RP), and bodily pain (BP) at all timepoints (SF: p = 0.006; RP: p = 0.005; BP: p < 0.001). CONCLUSIONS AERD patients undergoing ESS and ATAD show improvement in physical QOL and 3 of the 8 health domains as measured by the SF-12. Future studies can use the SF-12 to study the impact of AERD treatment versus other chronic diseases and health demographics.
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Affiliation(s)
- Tran B Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Auddie M Sweis
- Division of Otolaryngology-Head and Neck Surgery, NorthShore University Health System, The University of Chicago, Pritzker School of Medicine, Evanston, Illinois
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin I Ig-Izevbekhai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth M Stevens
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alyssa M Civantos
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth B McCarty
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ankur Kumar
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David W Kennedy
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John V Bosso
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Sweis AM, Locke TB, Ig-Izevbekhai KI, Lin TC, Kumar A, Douglas JE, Corr AM, Civantos AM, Tripathi SH, Kennedy DW, Kohanski MA, Palmer JN, Adappa ND, Bosso JV. Effectiveness of endoscopic sinus surgery and aspirin therapy in the management of aspirin-exacerbated respiratory disease. Allergy Asthma Proc 2021; 42:136-141. [PMID: 33685558 DOI: 10.2500/aap.2021.42.210002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Aspirin therapy and/or type 2 (T2) biologics are used in the management of aspirin-exacerbated respiratory disease (AERD). Objective: To identify the number of patients with AERD who tolerated aspirin therapy, yet due to persistent symptoms, incorporated T2 biologic management. Methods: A retrospective review was performed between July 2016 and June 2019. Patients with AERD and who underwent endoscopic sinus surgery (ESS), aspirin desensitization (AD), and at least 6 months of aspirin therapy (ATAD) after AD, and who remained biologic-naive up through this timepoint were included in the study. Introduction of a T2 biologic while on ATAD was the primary outcome. The secondary outcome was a change in a validated patient-reported outcome measure for chronic rhinosinusitis score between the postoperative predesensitization timepoint, and the 6-month postdesensitization timepoint, presented as means and compared by using the Student's t-test. Results: A total of 103 patients met inclusion criteria. Two patients (1.9%) ultimately supplemented ATAD with a T2 biologic. The mean outcomes measure test score after 6 months of ATAD for patients who received biologics was 40.5 versus 15 in those who did not receive biologics (p = 0.02). The mean differences between the postoperative predesensitization test score and the 6-month postdesensitization test score for patients who went on to receive biologics was an increase of 13 versus a decrease of 10 for those patients who did not receive biologics (p = 0.12). Conclusion: ESS, coupled with AD and ATAD, was successful in the long-term management of the majority of the patients with AERD, which rarely required the incorporation of T2 biologics. Patient questionnaires, such as outcomes measure test score, may identify aspirin therapy failures and help guide the practitioner in deciding when to introduce T2 biologics into the patient's treatment regimen.
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Affiliation(s)
- Auddie M. Sweis
- From the Division of Otolaryngology-Head and Neck Surgery, NorthShore University Health System, University of Chicago, Pritzker School of Medicine, Evanston, Illinois
| | - Tran B. Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Kevin I. Ig-Izevbekhai
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Theodore C. Lin
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Ankur Kumar
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Jennifer E. Douglas
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Andrew M. Corr
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Alyssa M. Civantos
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Siddhant H. Tripathi
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - David W. Kennedy
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Michael A. Kohanski
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - James N. Palmer
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Nithin D. Adappa
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - John V. Bosso
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Byrnes YM, Civantos AM, Go BC, McWilliams TL, Rajasekaran K. Effect of the COVID-19 pandemic on medical student career perceptions: a national survey study. Med Educ Online 2020; 25:1798088. [PMID: 32706306 PMCID: PMC7482653 DOI: 10.1080/10872981.2020.1798088] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND & OBJECTIVE The COVID-19 pandemic and resulting cancellation of medical student clinical rotations pose unique challenges to students' educations, the impact of which has not yet been explored. DESIGN This cross-sectional survey study collected responses from 13 April 2020 until 30 April 2020. Students at US allopathic medical schools completed the survey online. RESULTS 1,668 responses were analyzed. A total of 337 (20.2%) respondents thought the pandemic would affect their choice of specialty, with differences across class years: 15.2% (53) of first-years (MS1s), 26.4% (92) of second-years (MS2s), 23.7% (162) of third-years (MS3s), and 9.7% (22) of fourth-years (MS4s) (p < 0.0001). Among all classes, the most common reason chosen was inability to explore specialties of interest (244, 72.4%), and the second was inability to bolster their residency application (162, 48.1%). Out of the MS3s who chose the latter, the majority were concerned about recommendation letters (68, 81.0%) and away rotations (62, 73.8%). As high as 17.4% (119) of MS3s said they were more likely to take an extra year during medical school as a result of the pandemic. Region of the US, number of local COVID cases, and number of local COVID deaths had no effect on whether respondents thought the pandemic would affect their specialty choice. CONCLUSIONS Our study found that about one-fifth of surveyed medical students currently believe that the COVID-19 pandemic will affect their choice of specialty, with many of these citing concerns that they cannot explore specialties or obtain recommendation letters. With prolonged suspension of clinical rotations, targeted efforts by medical schools to address these concerns through enhanced virtual curriculum development and advising strategies will become increasingly important. Further study is needed to explore whether these cross-sectional student perspectives will manifest as changes in upcoming National Residency Matching Program data.
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Affiliation(s)
- Yasmeen M. Byrnes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alyssa M. Civantos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Beatrice C. Go
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tara L. McWilliams
- Biostatistics Analysis Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
- CONTACT Karthik Rajasekaran Department of Otorhinolaryngology - Head & Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA19107, USA
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Civantos AM, Bertelli A, Gonçalves A, Getzen E, Chang C, Long Q, Rajasekaran K. Mental health among head and neck surgeons in Brazil during the COVID-19 pandemic: A national study. Am J Otolaryngol 2020; 41:102694. [PMID: 32854041 PMCID: PMC7442010 DOI: 10.1016/j.amjoto.2020.102694] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Head and neck surgeons are among the highest risk for COVID-19 exposure, which also brings great risk to their mental wellbeing. In this study, we aim to evaluate mental health symptoms among head and neck surgeons in Brazil surrounding the time it was declared the epicenter of the virus. MATERIALS AND METHODS A cross-sectional, survey-based study evaluating burnout, anxiety, distress, and depression among head and neck surgeons in Brazil, assessed through the single-item Mini-Z burnout assessment, 7-item Generalized Anxiety Disorder scale, 22-item Impact of Event Scale-Revised, and 2-item Patient Health Questionnaire, respectively. RESULTS 163 physicians completed the survey (74.2% males). Anxiety, distress, burnout, and depression symptoms were reported in 74 (45.5%), 43 (26.3%), 24 (14.7%), and 26 (16.0%) physicians, respectively. On multivariable analysis, female physicians were more likely to report a positive screening for burnout compared to males (OR 2.88, CI [1.07-7.74]). Physicians 45 years or older were less likely to experience anxiety symptoms than those younger than 45 years (OR 0.40, CI [0.20-0.81]). Physicians with no self-reported prior psychiatric conditions were less likely to have symptoms of distress compared to those with such history (OR 0.11, CI [0.33-0.38]). CONCLUSION Head and neck surgeons in Brazil reported symptoms of burnout, anxiety, distress and depression during our study period within the COVID-19 pandemic. Institutions should monitor these symptoms throughout the pandemic. Further study is required to assess the long-term implications for physician wellness.
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Douglas JE, Civantos AM, Locke TB, Sweis AM, Hadjiliadis D, Hong G, Dorgan DJ, Kohanski MA, Palmer JN, Adappa ND. Impact of novel CFTR modulator on sinonasal quality of life in adult patients with cystic fibrosis. Int Forum Allergy Rhinol 2020; 11:201-203. [PMID: 33070454 DOI: 10.1002/alr.22716] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Alyssa M Civantos
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Tran B Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - Auddie M Sweis
- Division of Otolaryngology-Head and Neck Surgery, NorthShore University Health System, The University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Denis Hadjiliadis
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gina Hong
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Dorgan
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
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Civantos AM, Maina IW, Arnold M, Lin C, Stevens EM, Tan LH, Gleeson PK, Colquitt LR, Cowart BJ, Bosso JV, Palmer JN, Adappa ND, Kohanski MA, Reed DR, Cohen NA. Denatonium benzoate bitter taste perception in chronic rhinosinusitis subgroups. Int Forum Allergy Rhinol 2020; 11:967-975. [DOI: 10.1002/alr.22687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Alyssa M. Civantos
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia PA
| | - Ivy W. Maina
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia PA
| | - Monique Arnold
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia PA
| | - Cailu Lin
- Monell Chemical Senses Center Philadelphia PA
| | | | - Li Hui Tan
- Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Patrick K. Gleeson
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia PA
| | | | | | - John V. Bosso
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia PA
| | - James N. Palmer
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia PA
| | - Nithin D. Adappa
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia PA
| | - Michael A. Kohanski
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia PA
| | | | - Noam A. Cohen
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia PA
- Monell Chemical Senses Center Philadelphia PA
- Michael J. Crescenz VA Medical Center Philadelphia PA
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Lin C, Civantos AM, Arnold M, Stevens EM, Cowart BJ, Colquitt LR, Mansfield C, Kennedy DW, Brooks SG, Workman AD, Blasetti MT, Kohanski MA, Doghramji L, Douglas JE, Maina IW, Palmer JN, Adappa ND, Reed DR, Cohen NA. Divergent bitter and sweet taste perception intensity in chronic rhinosinusitis patients. Int Forum Allergy Rhinol 2020; 11:857-865. [PMID: 32846055 DOI: 10.1002/alr.22686] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bitter and sweet taste receptors are present in the human upper airway, where they have roles in innate immunity. Previous studies have shown that 1 of the 25 bitter receptors, TAS2R38, responds to specific bacterial signaling molecules and evokes 1 type of a defense response in the upper airway, whereas ligands of sweet receptors suppress other types of defense responses. METHODS We examined whether other bitter taste receptors might also be involved in innate immunity by using sensory responses to bitter compounds that are not ligands of TAS2R38 (quinine and denatonium benzoate) to assess the sensitivity of other bitter receptors in chronic rhinosinusitis (CRS) patients. CRS patients with (n = 426) and without (n = 226) nasal polyps and controls (n = 356) rated the intensity of quinine, denatonium benzoate, phenylthiocarbamide (PTC; a ligand for TAS2R38), sucrose, and salt. RESULTS CRS patients rated the bitter compounds denatonium benzoate and quinine as less intense and sucrose as more intense than did controls (false discovery rate [FDR] <0.05) and CRS patients and controls did not differ in their ratings of salt (FDR >0.05). PTC bitter taste intensity differed between patient and control groups but were less marked than those previously reported. Though differences were statistically significant, overall effect sizes were small. CONCLUSION CRS patients report bitter stimuli as less intense but sweet stimuli as more intense than do control subjects. We speculate that taste responses may reflect the competence of sinonasal innate immunity mediated by taste receptor function, and thus a taste test may have potential for clinical utility in CRS patients.
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Affiliation(s)
- Cailu Lin
- Monell Chemical Senses Center, Philadelphia, PA
| | - Alyssa M Civantos
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - Monique Arnold
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - Elizabeth M Stevens
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | | | | | | | - David W Kennedy
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - Steven G Brooks
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - Alan D Workman
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - Mariel T Blasetti
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - Laurel Doghramji
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - Ivy W Maina
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA
| | | | - Noam A Cohen
- Monell Chemical Senses Center, Philadelphia, PA.,Department of Otorhinolaryngology-Head and Neck Surgery, Division of Rhinology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA.,Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, PA
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11
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Prasad A, Civantos AM, Byrnes Y, Chorath K, Poonia S, Chang C, Graboyes EM, Bur AM, Thakkar P, Deng J, Seth R, Trosman S, Wong A, Laitman BM, Shah J, Stubbs V, Long Q, Choby G, Rassekh CH, Thaler ER, Rajasekaran K. Snapshot Impact of COVID-19 on Mental Wellness in Nonphysician Otolaryngology Health Care Workers: A National Study. OTO Open 2020; 4:2473974X20948835. [PMID: 32839747 PMCID: PMC7415941 DOI: 10.1177/2473974x20948835] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 12/20/2022] Open
Abstract
Objective Nonphysician health care workers are involved in high-risk patient care during the COVID-19 pandemic, placing them at high risk of mental health burden. The mental health impact of COVID-19 in this crucial population has not been studied thus far. Thus, the objective of this study is to assess the psychosocial well-being of these providers. Study Design National cross-sectional online survey (no control group). Setting Academic otolaryngology programs in the United States. Subjects and Methods We distributed a survey to nonphysician health care workers in otolaryngology departments across the United States. The survey incorporated a variety of validated mental health assessment tools to measure participant burnout (Mini-Z assessment), anxiety (Generalized Anxiety Disorder-7), distress (Impact of Event Scale), and depression (Patient Health Questionnaire-2). Multivariable logistic regression analysis was performed to determine predictive factors associated with these mental health outcomes. Results We received 347 survey responses: 248 (71.5%) nurses, 63 (18.2%) administrative staff, and 36 (10.4%) advanced practice providers. A total of 104 (30.0%) respondents reported symptoms of burnout; 241 (69.5%), symptoms of anxiety; 292 (84.1%), symptoms of at least mild distress; and 79 (22.8%), symptoms of depression. Upon further analysis, development of these symptoms was associated with factors such as occupation, practice setting, and case load. Conclusion Frontline otolaryngology health care providers exhibit high rates of mental health complications, particularly anxiety and distress, in the wake of COVID-19. Adequate support systems must be put into place to address these issues.
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Affiliation(s)
- Aman Prasad
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alyssa M Civantos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yasmeen Byrnes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Chorath
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Seerat Poonia
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Changgee Chang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Evan M Graboyes
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrés M Bur
- Department of Otolaryngology, School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Punam Thakkar
- Department of Otolaryngology, George Washington University, Washington, DC, USA
| | - Jie Deng
- Department of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rahul Seth
- Department of Otolaryngology, University of San Francisco, San Francisco, California, USA
| | - Samuel Trosman
- Department of Otolaryngology, Mt. Sinai Health System, New York City, New York, USA
| | - Anni Wong
- Department of Otolaryngology, Mt. Sinai Health System, New York City, New York, USA
| | - Benjamin M Laitman
- Department of Otolaryngology, Mt. Sinai Health System, New York City, New York, USA
| | - Janki Shah
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vanessa Stubbs
- Department of Otolaryngology, University of Miami, Miami, Florida, USA
| | - Qi Long
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Garret Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher H Rassekh
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica R Thaler
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Locke TB, Sweis AM, Gleeson PK, Lin TC, Civantos AM, Parhar HS, Corr AM, Kumar A, Salmon MK, Kohanski MA, Palmer JN, Bosso JV, Adappa ND. Age as a factor in treatment of aspirin-exacerbated respiratory disease: relationship to required aspirin maintenance dose after desensitization. Int Forum Allergy Rhinol 2020; 10:1180-1181. [PMID: 32761891 DOI: 10.1002/alr.22665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Tran B Locke
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Auddie M Sweis
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Patrick K Gleeson
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, & Critical Care Medicine, University of Pennsylvania, Philadelphia, PA
| | - Theodore C Lin
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA.,Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Alyssa M Civantos
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Harman S Parhar
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Andrew M Corr
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Ankur Kumar
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Mandy K Salmon
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Michael A Kohanski
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - James N Palmer
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - John V Bosso
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
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13
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Sweis AM, Locke TB, Ig-Izevbekhai KI, Lin TC, Gleeson PK, Civantos AM, Kumar A, Corr AM, Kohanski MA, Palmer JN, Bosso JV, Adappa ND. Major complications of aspirin desensitization and maintenance therapy in aspirin-exacerbated respiratory disease. Int Forum Allergy Rhinol 2020; 11:115-119. [PMID: 32671928 DOI: 10.1002/alr.22643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Treatment of aspirin-exacerbated respiratory disease (AERD) includes endoscopic sinus surgery (ESS) and aspirin desensitization (AD) with aspirin therapy after desensitization (ATAD). The objective of this study was to determine the rate of major complications associated with aspirin use that resulted in the discontinuation of aspirin therapy. METHODS This study was a retrospective chart review of patients with AERD who underwent ESS, AD, and ATAD at a single AERD tertiary center between July 2016 and February 2019. Complications associated with aspirin that resulted in the discontinuation of aspirin therapy were analyzed via analysis of variance and logistic regression. RESULTS In total, 109 AERD patients underwent ESS with subsequent AD. Ten patients (9.2%) discontinued therapy after AD, before starting ATAD. Eight patients (7.3%) discontinued therapy after starting ATAD. There were 91 patients (83.5%) with no complications throughout ATAD. Reasons for discontinuation included gastritis, upper gastrointestinal (GI) bleed, anaphylaxis, persistent sinonasal symptoms, recurrent epistaxis, asthma exacerbation, and a nummular rash. There was no significant correlation between complication rate and (1) aspirin doses (analysis of variance [ANOVA] F: 0.69; p = 0.51), (2) gender (odds ratio [OR] 0.56; 95% confidence interval [CI], 0.19 to 1.65; p = 0.30), (3) age (OR 1.04; 95% CI, 0.96 to 1.09; p = 0.06), or (4) race/ethnicity (OR 1.12; 95% CI, 0.88 to 1.44; p = 0.36). CONCLUSION AD with ATAD was associated with only a 0.92% incidence of a clinically significant GI bleed, and only a 0.92% incidence of anaphylaxis. A remaining 16 patients (14.7%) discontinued aspirin therapy due to minor clinical sequelae. These findings demonstrate that the majority of AERD patients tolerate AD with ATAD without any major complications.
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Affiliation(s)
- Auddie M Sweis
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Tran B Locke
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | | | - Theodore C Lin
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA.,Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Patrick K Gleeson
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Alyssa M Civantos
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Ankur Kumar
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Andrew M Corr
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Michael A Kohanski
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - James N Palmer
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - John V Bosso
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
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14
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Sweis AM, Locke TB, Douglas JE, Lin TC, Sweis BM, Civantos AM, Kennedy DW. Management of chronic rhinosinusitis with steroid nasal irrigations: A viable nonsurgical alternative in the COVID-19 era. Int Forum Allergy Rhinol 2020; 10:1108-1109. [PMID: 32573106 PMCID: PMC7361584 DOI: 10.1002/alr.22646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Auddie M Sweis
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Tran B Locke
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Jennifer E Douglas
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Theodore C Lin
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA.,Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Brian M Sweis
- Department of Neuroscience, University of Minnesota, Minneapolis, MN
| | - Alyssa M Civantos
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - David W Kennedy
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
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15
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Katz AP, Civantos FJ, Sargi Z, Leibowitz JM, Nicolli EA, Weed D, Moskovitz AE, Civantos AM, Andrews DM, Martinez O, Thomas GR. False-positive reverse transcriptase polymerase chain reaction screening for SARS-CoV-2 in the setting of urgent head and neck surgery and otolaryngologic emergencies during the pandemic: Clinical implications. Head Neck 2020; 42:1621-1628. [PMID: 32530131 PMCID: PMC7307014 DOI: 10.1002/hed.26317] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 12/24/2022] Open
Abstract
Background No reports describe falsepositive reverse transcriptase polymerase chain reaction (RT‐PCR) for novel coronavirus in preoperative screening. Methods Preoperative patients had one or two nasopharyngeal swabs, depending on low or high risk of viral transmission. Positive tests were repeated. Results Forty‐three of 52 patients required two or more preoperative tests. Four (9.3%) had discrepant results (positive/negative). One of these left the coronavirus disease (COVID) unit against medical advice despite an orbital abscess, with unknown true disease status. The remaining 3 of 42 (7.1%) had negative repeat RT‐PCR. Although ultimately considered falsepositives, one was sent to a COVID unit postoperatively and two had urgent surgery delayed. Assuming negative repeat RT‐PCR, clear chest imaging, and lack of subsequent symptoms represent the “gold standard,” RT‐PCR specificity was 0.97. Conclusions If false positives are suspected, we recommend computed tomography (CT) of the chest and repeat RT‐PCR. Validated serum immunoglobulin testing may ultimately prove useful.
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Affiliation(s)
- Andrew P Katz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Francisco J Civantos
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zoukaa Sargi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jason M Leibowitz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Elizabeth A Nicolli
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Alexander E Moskovitz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alyssa M Civantos
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David M Andrews
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Octavio Martinez
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Giovana R Thomas
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
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16
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Civantos AM, Byrnes Y, Chang C, Prasad A, Chorath K, Poonia SK, Jenks CM, Bur AM, Thakkar P, Graboyes EM, Seth R, Trosman S, Wong A, Laitman BM, Harris BN, Shah J, Stubbs V, Choby G, Long Q, Rassekh CH, Thaler E, Rajasekaran K. Mental health among otolaryngology resident and attending physicians during the COVID-19 pandemic: National study. Head Neck 2020; 42:1597-1609. [PMID: 32496637 PMCID: PMC7300862 DOI: 10.1002/hed.26292] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background Otolaryngologists are among the highest risk for COVID‐19 exposure. Methods This is a cross‐sectional, survey‐based, national study evaluating academic otolaryngologists. Burnout, anxiety, distress, and depression were assessed by the single‐item Mini‐Z Burnout Assessment, 7‐item Generalized Anxiety Disorder Scale, 15‐item Impact of Event Scale, and 2‐item Patient Health Questionnaire, respectively. Results A total of 349 physicians completed the survey. Of them, 165 (47.3%) were residents and 212 (60.7%) were males. Anxiety, distress, burnout, and depression were reported in 167 (47.9%), 210 (60.2%), 76 (21.8%), and 37 (10.6%) physicians, respectively. Attendings had decreased burnout relative to residents (odds ratio [OR] 0.28, confidence interval [CI] [0.11‐0.68]; P = .005). Females had increased burnout (OR 1.93, CI [1.12.‐3.32]; P = .018), anxiety (OR 2.53, CI [1.59‐4.02]; P < .005), and distress (OR 2.68, CI [1.64‐4.37]; P < .005). Physicians in states with greater than 20 000 positive cases had increased distress (OR 2.01, CI [1.22‐3.31]; P = .006). Conclusion During the COVID‐19 pandemic, the prevalence of burnout, anxiety, and distress is high among academic otolaryngologists.
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Affiliation(s)
- Alyssa M Civantos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yasmeen Byrnes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Changgee Chang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aman Prasad
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Chorath
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Seerat K Poonia
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carolyn M Jenks
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrés M Bur
- Department of Otolaryngology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Punam Thakkar
- Department of Otolaryngology, George Washington University, Washington, District of Columbia, USA
| | - Evan M Graboyes
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rahul Seth
- Department of Otolaryngology, University of San Francisco, San Francisco, California, USA
| | - Samuel Trosman
- Department of Otolaryngology, Mt. Sinai Health System, New York, New York, USA
| | - Anni Wong
- Department of Otolaryngology, Mt. Sinai Health System, New York, New York, USA
| | - Benjamin M Laitman
- Department of Otolaryngology, Mt. Sinai Health System, New York, New York, USA
| | - Brianna N Harris
- Department of Otolaryngology, Scripps Health/Senta Clinic, San Diego, California, USA
| | - Janki Shah
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vanessa Stubbs
- Department of Otolaryngology, University of Miami, Miami, Florida, USA
| | - Garret Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Qi Long
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher H Rassekh
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica Thaler
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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17
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Civantos AM, Carey RM, Lichtenstein GR, Lukens JN, Cohen RB, Rassekh CH. Care of immunocompromised patients with head and neck cancer during the COVID-19 pandemic: Two challenging and informative clinical cases. Head Neck 2020; 42:1131-1136. [PMID: 32298006 PMCID: PMC7262192 DOI: 10.1002/hed.26165] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/18/2022] Open
Abstract
Background and Methods There is an added level of complexity in the management of head and neck cancer patients with underlying immunosuppressive disorders during the COVID‐19 pandemic. Head and neck oncologists are tasked with balancing the dual risks of cancer progression in the setting of impaired tumor immunity and increased susceptibility to life‐threatening complications from exposure to viral infection for patients and providers. Through two cases of immunocompromised patients with newly diagnosed head and neck malignancies, we aim to provide guidance to clinicians struggling with how to best counsel and manage this unique subset of patients under these difficult circumstances. Results After careful consideration of the options, we took different approaches in the care of these two patients. Conclusions Ultimately, there is no uniform set of rules to apply to this heterogeneous group of immunocompromised patients. We provide some general principles to help guide patient management during the current pandemic.
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Affiliation(s)
- Alyssa M Civantos
- Perelman School of Medicine, the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gary R Lichtenstein
- Department of Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roger B Cohen
- Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher H Rassekh
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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