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Gorolay VV, Tran NA, Tade R, Baugnon K, Aiken A, Wu X. The ptotic tongue-imaging appearance and pathology localization along the course of the hypoglossal nerve. Neuroradiology 2023; 65:1425-1438. [PMID: 37540288 PMCID: PMC10497427 DOI: 10.1007/s00234-023-03204-y] [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: 05/27/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
CT and MRI findings of tongue ptosis and atrophy should alert radiologists to potential pathology along the course of the hypoglossal nerve (cranial nerve XII), a purely motor cranial nerve which supplies the intrinsic and extrinsic muscles of the tongue. While relatively specific for hypoglossal nerve pathology, these findings do not accurately localize the site or cause of denervation. A detailed understanding of the anatomic extent of the nerve, which crosses multiple anatomic spaces, is essential to identify possible underlying pathology, which ranges from benign postoperative changes to life-threatening medical emergencies. This review will describe key imaging findings of tongue denervation, segmental anatomy of the hypoglossal nerve, imaging optimization, and comprehensive imaging examples of diverse pathology which may affect the hypoglossal nerve. Armed with this knowledge, radiologists will increase their sensitivity for detection of pathology and provide clinically relevant differential diagnoses when faced with findings of tongue ptosis and denervation.
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Affiliation(s)
- Vineet Vijay Gorolay
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143 USA
| | - Ngoc-Anh Tran
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143 USA
| | - Ryan Tade
- Radiology Associates, Springfield, OR USA
| | - Kristen Baugnon
- Department of Radiology and Imaging Science, Emory University, Atlanta, GA USA
| | - Ashley Aiken
- Department of Radiology and Imaging Science, Emory University, Atlanta, GA USA
| | - Xin Wu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143 USA
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Schlafstein A, Goyal S, Aiken A, Remick J, Saba N, Bates J, Rudra S, McDonald M, Kaka A, Stokes W. CLO23-057: The Influence of Operability Status on Outcomes in Patients With T4a Larynx Cancer: An Institutional Experience. J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Abstract
Head and neck squamous cell carcinoma (HNSCC) encompasses a spectrum of heterogeneous diseases originating in the oral cavity, pharynx, and larynx. Within the United States, head and neck cancer (HNC) accounts for 66,470 new cases, or 3% of all malignancies, annually.1 The incidence of HNC is rising, largely driven by increases in oropharyngeal cancer.2-4 Recent molecular and clinical advancements, particularly with regard to molecular and tumor biology, reflect the heterogeneity of the subsites contained within the head and neck. Despite this, existing guidelines for post-treatment surveillance remain broad without much consideration given to different anatomic subsites and etiologic factors (such as human papillomavirus [HPV] status or tobacco exposure).5 Surveillance incorporating the physical examination, imaging, and emerging molecular biomarkers is an essential part of care for patients treated for HNC and allows for the detection of locoregional recurrence, distant metastases, and second primary malignancies aiming for better functional and survival outcomes. Additionally, it allows for evaluation and management of post-treatment complications.
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Affiliation(s)
- Glenn J Hanna
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Nirali Patel
- Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL
| | - Sara G Tedla
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Kristen L Baugnon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Ashley Aiken
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Nishant Agrawal
- Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL
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Singhal A, Aiken A. Call to Action: Women in Neuroradiology's Group (WINNERS)-Is There a Need? AJNR Am J Neuroradiol 2022; 43:1396-1399. [PMID: 36574333 PMCID: PMC9575528 DOI: 10.3174/ajnr.a7626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 01/14/2023]
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Bartonjo G, Ngata E, Revathi G, Aiken A. P16 Strengthening surveillance systems for antimicrobial resistance in urinary tract infections in Kenya. JAC Antimicrob Resist 2022. [PMCID: PMC9155992 DOI: 10.1093/jacamr/dlac053.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Urinary tract infections (UTIs) are amongst the most common conditions leading to outpatient visits and are also one of the most common causes of inappropriate antibiotic usage. Addressing antimicrobial resistance (AMR) requires strengthening surveillance system in Kenya where UTI is a problem with health systems having limited capacity for accurate laboratory identification of UTI pathogens. Empirical treatment to manage UTIs is the most common problem due to limited microbiology capacity. These include shortages of suitable training, equipment, quality control procedures and professional expertise to make an accurate clinical interpretation of urine cultures. This leads to reporting normal flora as pathogens. Objectives To deliver training on the identification and antibiotic susceptibility testing of bacterial isolates from urine infections at participating hospitals in the Kenyan AMR surveillance network and measure competency levels in staff participating in the training with the aim of strengthening the Kenyan surveillance system. Methods A 1 day baseline visit to the five sites was made between October and November 2021 using a standardized checklist to assess laboratory capacity. This was followed by urine processing training conducted between November 2021 and January 2022 in Malindi, Jaramogi, Kitale, Nakuru and Nyeri County Hospitals. Training materials were developed with the input of Aga Khan University Hospital. A 5 day in-person training course was delivered at each of the five hospitals, which targeted an average of 2–3 laboratory staff per hospital. The competencies of the laboratory staff were assessed by written pre-assessment and post-assessment tests. A standardized practical assessment was achieved by use of five different control organisms. The scores were done by doing an average performance score at each hospital laboratory. Results Out of 13 trainees, 8 were male and 5 were female. The median number of years since qualification for these staff was 6 (IQR 2–9). The median number of total months of microbiology training time was 2.3 (IQR 1–7). The median pre-training and post-training scores were 46% and 90%, respectively; non-parametric Wilcoxon rank test showed statistical difference (P < 0.0001) between pre-training and post-training. All participants improved from pre-to post- training assessment from the 5 day training with marked improvement amongst from staff with lowest previous level of laboratory training. Conclusions Training microbiology staff in the accurate processing of urine sample will be an important activity for a Kenyan AMR surveillance system. These training materials, if delivered by an experienced trainer, can achieve a clear improvement in knowledge levels and practical competence for real-life microbiology identifications.
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Affiliation(s)
- G Bartonjo
- National Public Health Laboratory , Nairobi, Kenya
| | - E Ngata
- Aga Khan University Hospital , Nairobi, Kenya
| | - G Revathi
- Aga Khan University Hospital , Nairobi, Kenya
| | - A Aiken
- London School of Hygiene &Tropical Medicine , London, UK
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Vijayvargiya P, Trivedi S, Rupji M, Song H, Liu Y, Jiang R, Kaka AS, Chen GZ, Stokes W, Steuer C, Shin DM, Beitler JJ, Patel MR, Aiken A, Saba NF. Comparison of the Seventh and Eighth Edition of American Joint Committee on Cancer (AJCC) Staging for Selected and Nonselected Oropharyngeal Squamous Cell Carcinomas. Oncologist 2022; 27:48-56. [PMID: 35305095 PMCID: PMC8842371 DOI: 10.1093/oncolo/oyab001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/15/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The eighth edition American Joint Committee on Cancer (AJCC) Staging incorporates significant changes to the seventh edition in the staging of oropharyngeal squamous cell carcinomas (OPSCC). An important change was the inclusion of OPSCC associated with the human papilloma virus (HPV). Our goal is to compare the performance of both staging systems for patients with HPV-selected and unselected clinical characteristics for OPSCC. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) database, 2004-2016, we identified patients with likely HPV-associated OPSCC based on surrogate markers (white males aged <65 years old with squamous cell carcinomas of the tonsil and base of tongue), excluding those who underwent surgery. We re-classified these patients using seventh and eighth edition staging for HPV-selected OPSCC and compared the prediction performance of both staging editions for overall survival (OS) and disease-specific survival (DSS). We performed the same analysis for clinically unselected patients with OPSCC. RESULTS Our analysis included 9554 patients with a median follow-up of 67 months. Comparing the eighth versus seventh edition for our HPV-selected cohort, clinical staging changed for 92.3% of patients and 10-year OS was 62.2%, 61.2%, 35.3%, and 15.5% for Stage I, II, III, and IV, versus 52.9%, 59.2%, 61.6%, 55.1%, 38.3%, and 15.5% for stage I, II, III, IVA, IVB, and IVC, respectively. A similar pattern was observed for 10-year DSS. The concordance statistics for our HPV-selected cohort were improved for both AJCC 7 (0.6260) and AJCC 8 (0.6846) compared with the unselected cohort, 0.5860 and 0.6457 for AJCC 7 and 8, respectively. CONCLUSION The overall performance of discrimination improved from AJCC 7 to AJCC 8 for both clinically selected and unselected patients, but more notably for our HPV-selected cohort. Despite the lack of statistically significant differentiation between Stages I and II in AJCC 8 in either groups, markedly improved discrimination was observed between Stages I/II, III, and IV in the HPV-selected cohort.
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Affiliation(s)
- Pooja Vijayvargiya
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sumita Trivedi
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Manali Rupji
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Haocan Song
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Renjian Jiang
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Azeem S Kaka
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Georgia Z Chen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - William Stokes
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jonathan J Beitler
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Mihir R Patel
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Ashley Aiken
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Taylor MA, Switchenko J, Stokes W, Patel MR, McDonald M, Steuer C, Aiken A, Beitler JJ, Shin DM, Saba NF. Incidence trends of squamous cell carcinoma of the head and neck (SCCHN) in the aging population--A SEER-based analysis from 2000 to 2016. Cancer Med 2021; 10:6070-6077. [PMID: 34288563 PMCID: PMC8419769 DOI: 10.1002/cam4.4134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Tobacco and alcohol use are risk factors for Squamous Cell Carcinoma of the Head and Neck (SCCHN); however, there is growing recognition of HPV as a risk factor for SCCHN. HPV‐related SCCHN is thought to affect mostly middle‐aged individuals but as the US population ages, it is important to evaluate the change in incidence of HPV‐ and non‐HPV‐related SCCHN in individuals who are ≥65 years old. Methods This was a retrospective study using data from a population‐based cancer registry (SEER) to identify individuals ≥65 years old diagnosed with SCCHN between 2000 and 2016 also stratified by sex, race, and birth cohort. The subgroups of HPV‐associated and non‐HPV associated sites were analyzed independently. The incidence per year was calculated and joinpoint detection was used to identity significant changes in incidence trends and annual percent change (APC). Results For HPV‐associated sites from 2000 to 2016, there was an average annual rate of 10.8 per 100,000 individuals with an APC of 2.92% (p = <0.05). For HPV‐ and non‐HPV‐related SCCHN males had a higher annual rate compared to females, 54.5 versus 18.0 in non‐HPV‐related and 19.1 versus 4.4 in HPV‐related sites. For non‐HPV‐related sites there was a decrease in APC across all stratified groups. For HPV‐related sites there was an increase in APC across all stratified groups, especially males (APC 8.82% 2006–2016 p < 0.05) and White individuals (APC 8.19% 2006–2016 p < 0.05). When stratified by birth cohort, HPV‐related SCCHN sites had a higher APC in ages 65–69 (8.38% p < 0.05) and 70–74 (8.54% p < 0.05). Conclusion Among the population ≥65 years old from 2000 to 2016, the incidence rate for HPV‐related SCCHN sites has increased across all stratified groups, especially in White individuals, males, and age groups 65–74. The incidence rate for non‐HPV‐related sites has decreased across all stratified groups during this time.
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Affiliation(s)
| | - Jeffery Switchenko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - William Stokes
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | - Mihir R Patel
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | - Mark McDonald
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | - Conor Steuer
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | - Ashley Aiken
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | | | - Dong M Shin
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
| | - Nabil F Saba
- Emory University, Winship Cancer Institute, Atlanta, GA, USA
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Abunimer A, Aiken A, Baugnon K, Wu X. Central Skull Base Anatomy and Pathology: A Review. Semin Ultrasound CT MR 2021; 42:266-280. [PMID: 34147162 DOI: 10.1053/j.sult.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The central skull base is an anatomically complex region of the head and neck which hosts a variety of neoplastic, vascular, infectious, inflammatory, and developmental pathologies. Evaluation of its intricate anatomy requires dedicated and complementary imaging modalities of MRI and CT. This article will provide a brief review of the anatomy of the central skull base, followed by an overview of common pathologies encountered in this region and their characteristic radiological characteristics.
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Affiliation(s)
- Ayman Abunimer
- Department of Radiology and Imaging Sciences, Division of Neuroradiology, Emory University School of Medicine, Atlanta, GA
| | - Ashley Aiken
- Department of Radiology and Imaging Sciences, Division of Neuroradiology, Emory University School of Medicine, Atlanta, GA
| | - Kristen Baugnon
- Department of Radiology and Imaging Sciences, Division of Neuroradiology, Emory University School of Medicine, Atlanta, GA
| | - Xin Wu
- Department of Radiology and Imaging Sciences, Division of Neuroradiology, Emory University School of Medicine, Atlanta, GA.
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Michel J, Aiken A, Abramowicz S. Iatrogenic cervicofacial emphysema after dental procedures: a case series and radiographic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:e106-e111. [PMID: 32636167 DOI: 10.1016/j.oooo.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/24/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Jonathan Michel
- Oral and Maxillofacial Surgery resident-in-training, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Ashley Aiken
- Professor in Radiology and Imaging Sciences and Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Shelly Abramowicz
- Associate Professor in Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Chief, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA.
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Al-Mulki K, Hamilton J, Kaka AS, Boyce BJ, Baddour HM, El-Deiry M, Solares CA, Magliocca K, Summers K, Aiken A, Saba NF, Beitler JJ, Patel MR. Narrowband Imaging for p16+ Unknown Primary Squamous Cell Carcinoma Prior to Transoral Robotic Surgery. Otolaryngol Head Neck Surg 2020; 163:1198-1201. [PMID: 32571149 DOI: 10.1177/0194599820933204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Our purpose was to assess the potential utility of narrowband imaging (NBI) as a tool in diagnosing and treating unknown primary oropharyngeal squamous cell carcinoma (OPSCC) in patients prior to diagnostic resection with transoral robotic surgery (TORS). Between 2016 and March 2019, 29 patients with carcinoma of unknown primary meeting inclusion criteria were identified and treated with TORS. NBI was used preoperatively in 9 of 29 patients. A suspected tumor site was delineated by NBI in 8 of 9 patients (89%). Of the patients imaged with NBI, 8 of 9 (89%) patients had a pathologically confirmed tumor following TORS, corresponding to the same 8 suspected tumor sites identified with NBI. In contrast, a primary tumor was localized following TORS in 15 of 20 (75%) patients not evaluated with NBI. Thus, we see NBI as a potentially useful tool for the diagnosis and management of p16+ carcinoma of unknown primary.Level of Evidence: IIb.
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Affiliation(s)
| | - James Hamilton
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Azeem S Kaka
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Brian J Boyce
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - H Michael Baddour
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Mark El-Deiry
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Kelly Magliocca
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Kelly Summers
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Ashley Aiken
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Nabil F Saba
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Jonathan J Beitler
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA.,Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Mihir R Patel
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
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11
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Matifat E, Perreault K, Roy JS, Aiken A, Gagnon E, Mequignon M, Lowry V, Décary S, Hamelin B, Ambrosio M, Farley N, Pelletier D, Carlesso L, Desmeules F. Concordance between physiotherapists and physicians for care of patients with musculoskeletal disorders presenting to the emergency department. BMC Emerg Med 2019; 19:67. [PMID: 31707978 PMCID: PMC6842540 DOI: 10.1186/s12873-019-0277-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/11/2019] [Indexed: 11/26/2022] Open
Abstract
Background Overcrowding in emergency departments (ED) is a major concern worldwide. To answer increasing health care demands, new models of care including advanced practice physiotherapists (APP) have been implemented in EDs. The purpose of this study was to assess diagnostic, treatment and discharge plan concordance between APPs and ED physicians for patients consulting to the ED for minor musculoskeletal disorders (MSKD). Methods Patients presenting to two EDs in Montréal (Canada) with a minor MSKD were recruited and independently assessed by an APP and ED physician. Both providers had to formulate diagnosis, treatment and discharge plans. Cohen’s kappa (κ) and Prevalence and Bias Adjusted Kappas (PABAK) with associated 95%CI were calculated. Chi Square and t-tests were used to compare treatment, discharge plan modalities and patient satisfaction between providers. Results One hundred and thirteen participants were recruited, mean age was 50.3 ± 17.4 years old and 51.3% had an atraumatic MSKD. Diagnostic inter-rater agreement between providers was very good (κ = 0.81; 95% CI: 0.72–0.90). In terms of treatment plan, APPs referred significantly more participants to physiotherapy care than ED physicians (κ = 0.27; PABAK = 0.27; 95% CI: 0.07–0.45; p = 0.003). There was a moderate inter-rater agreement (κ = 0.46; PABAK = 0.64; 95% CI: 0.46–0.77) for discharge plans. High patient satisfaction was reported with no significant differences between providers (p = 0.57). Conclusion There was significant agreement between APPs and ED physicians in terms of diagnosis and discharge plans, but more discrepancies regarding treatment plans. These results tend to support the integration of APPs in ED settings, but further prospective evaluation of the efficiency of these types of models is warranted.
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Affiliation(s)
- E Matifat
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, Québec, Canada.,CIUSSS Est-de-l'Île-de-Montréal, Québec, Canada
| | - K Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, Québec, Canada.,Departement of Rehabilitation, Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - J-S Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, Québec, Canada.,Departement of Rehabilitation, Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - A Aiken
- Faculty of Health, Dalhousie University, Halifax, Canada
| | - E Gagnon
- CIUSSS Est-de-l'Île-de-Montréal, Québec, Canada
| | - M Mequignon
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, Québec, Canada.,Université de Picardie Jules Verne, Amiens, France
| | - V Lowry
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, Québec, Canada.,School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada
| | - S Décary
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, Québec, Canada
| | - B Hamelin
- CIUSSS Est-de-l'Île-de-Montréal, Québec, Canada
| | - M Ambrosio
- CIUSSS Centre-Ouest-de-l'Île-de-Montréal, Québec, Canada
| | - N Farley
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada.,CIUSSS Centre-Ouest-de-l'Île-de-Montréal, Québec, Canada
| | - D Pelletier
- Ordre Professionnel de la Physiothérapie du Québec, Montréal, Québec, Canada
| | - L Carlesso
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, Québec, Canada.,School of Rehabilitation, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - F Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, Québec, Canada. .,School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada.
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Trivedi S, Song H, Liu Y, Steuer CE, Stokes W, Kaka A, Patel M, Chen ZG, Shin DM, Aiken A, Beitler JJ, Saba NF. Comparison of the seventh and eighth editions of the American Joint Committee on Cancer (AJCC) staging for oropharyngeal squamous cell carcinomas (OPSCC): A Surveillance, Epidemiology and End Results Program (SEER) database analysis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e17538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17538 Background: The recently released eighth edition of the American Joint Committee on Cancer (AJCC) Staging Manual, Head and Neck Section, incorporates significant changes to the prior seventh edition. The changes reflect the improved understanding of tumor biology, prognostic factors and molecular markers that effect outcomes in Head and Neck cancers. A key update restages OPSCC by human papilloma virus (HPV) positive and negative cancers as data demonstrated that these tumors have significantly different biology and outcomes. Methods: Using SEER data from 2004 – 2014, we identified male patients with squamous cell carcinomas of the tonsil, base of tongue and soft palate aged between 21 and 64 years old (those clinical characterizes were considered as surrogate markers for HPV positive status). We classified them by the AJCC 8th edition staging for HPV positive OPSCC and by AJCC 7th edition staging. The prediction performance by two staging editions were compared regarding overall survival (OS) and Disease free survival (DFS). Kaplan-Meier method and Cox proportional hazard model were applied, and the discrimination performance was measured by the concordance statistics (C-statistics). Results: A total of 8202 eligible patients were included in the analysis with a median follow up period of 51 months. 7415 (90.4%) patients had previously received radiation and 7038 (85.8%) patients had previously received chemotherapy. The median age of patients was 56 years. Distribution of stage I disease increased from 2% to 19.6% in AJCC 8th edition. 10-year overall survival (OS) for AJCC 8th stages I (74%), II (78%), III (55%) and IV (32%). Using Stage I as reference, the hazard ratio for stage II, III, and IV is 0.98 (95%CI: 0.87-1.09), 2.29 (95%CI: 2.04-2.57), and 5.88 (95%CI: 4.96-6.98). Similar results were noted for ten year disease free survival. The C-statistics measured overall discrimination for 8th edition is 0.68 and 0.63 for the 7th edition (P < 0.001). Conclusions: Based on this SEER analysis, the overall performance of discrimination improved from AJCC 7th to 8th edition; but in this study population, AJCC 8th edition does not distinguish stage I and II sufficiently as expected as it does for stages III and IV disease. Limitations of the SEER database include the surrogate for P16 status and under reported and incomplete data.
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Affiliation(s)
| | | | - Yuan Liu
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA
| | | | | | | | - Mihir Patel
- Department of Otolaryngology Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | | | | | | | - Jonathan Jay Beitler
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Nabil F. Saba
- Winship Cancer Institute of Emory University, Atlanta, GA
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Aiken A, Broussard K, Johnson D, Padron E. Self-managed medication abortion: variation in knowledge, interest and motivations among abortion clients across three Texas cities. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Goyal V, McLoughlin I, Wallace R, Dermish A, Kumar B, Schutt-Aine A, Beasley A, Aiken A, Potter JE. Filling the gap left by HB2: were remaining Texas abortion clinics able to serve the entire state? Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Luctkar-Flude M, Aiken A, McColl MA, Tranmer J. What do primary care providers think about implementing breast cancer survivorship care? ACTA ACUST UNITED AC 2018; 25:196-205. [PMID: 29962837 DOI: 10.3747/co.25.3826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose As cancer centres move forward with earlier discharge of stable survivors of early-stage breast cancer (bca) to primary care follow-up, it is important to address known knowledge and practice gaps among primary care providers (pcps). In the present qualitative descriptive study, we examined the practice context that influences implementation of existing clinical practice guidelines for providing such care. The purpose was to determine the challenges, strengths, and opportunities related to implementing comprehensive evidence-based bca survivorship care guidelines by pcps in southeastern Ontario. Methods Semi-structured interviews were conducted with 19 pcps: 10 physicians and 9 nurse practitioners. Results Thematic analysis revealed 6 themes within the broad categories of knowledge, attitudes, and resources. Participants highlighted 3 major challenges related to providing bca survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden. They also described 3 major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles. Conclusions We identified several important challenges to implementation of comprehensive evidence-based survivorship care for bca survivors, as well as several strengths and opportunities that could be built upon to address those challenges. Findings from our research could inform targeted knowledge translation interventions to provide support and education for pcps and bca survivors.
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Affiliation(s)
| | - A Aiken
- Faculty of Health, Dalhousie University, Halifax, NS
| | - M A McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, ON
| | - J Tranmer
- School of Nursing, Queen's University, Kingston, ON
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Geist C, Sanders J, Everett B, Myers K, Aiken A, Cason P, Turok D. Beyond intentions: the relationship between feelings about pregnancy and contraceptive choices. Contraception 2017. [DOI: 10.1016/j.contraception.2017.07.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Lowe C, Aiken A, Day AG, Depew W, Vanner SJ. Sham acupuncture is as efficacious as true acupuncture for the treatment of IBS: A randomized placebo controlled trial. Neurogastroenterol Motil 2017; 29. [PMID: 28251729 DOI: 10.1111/nmo.13040] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/09/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) patients increasingly seek out acupuncture therapy to alleviate symptoms, but it is unclear whether the benefit is due to a treatment-specific effect or a placebo response. This study examined whether true acupuncture is superior to sham acupuncture in relieving IBS symptoms and whether benefits were linked to purported acupuncture mechanisms. METHODS A double blind sham controlled acupuncture study was conducted with Rome I IBS patients receiving twice weekly true acupuncture for 4 weeks (n=43) or sham acupuncture (n=36). Patients returned at 12 weeks for a follow-up review. The primary endpoint of success as determined by whether patients met or exceeded their established goal for percentage symptom improvement. Questionnaires were completed for symptom severity scores, SF-36 and IBS-36 QOL tools, McGill pain score, and Pittsburg Sleep Quality Index. A subset of patients underwent barostat measurements of rectal sensation at baseline and 4 weeks. KEY RESULTS A total of 53% in the true acupuncture group met their criteria for a successful treatment intervention, but this did not differ significantly from the sham group (42%). IBS symptom scores similarly improved in both groups. Scores also improved in the IBS-36, SF-36, and the Pittsburg Sleep Quality Index, but did not differ between groups. Rectal sensory thresholds were increased in both groups following treatment and pain scores decreased; however, these changes were similar between groups. CONCLUSIONS & INFERENCES The lack of differences in symptom outcomes between sham and true treatment acupuncture suggests that acupuncture does not have a specific treatment effect in IBS.
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Affiliation(s)
- C Lowe
- Gastrointestinal Diseases Research Unit (GIDRU), Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - A Aiken
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - A G Day
- Biostatician, Kingston General Hospital, Kingston, ON, Canada
| | - W Depew
- Gastrointestinal Diseases Research Unit (GIDRU), Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - S J Vanner
- Gastrointestinal Diseases Research Unit (GIDRU), Kingston General Hospital, Queen's University, Kingston, ON, Canada
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Mattick RP, Wadolowski M, Aiken A, Clare PJ, Hutchinson D, Najman J, Slade T, Bruno R, McBride N, Degenhardt L, Kypri K. Parental supply of alcohol and alcohol consumption in adolescence: prospective cohort study. Psychol Med 2017; 47:267-278. [PMID: 27702422 DOI: 10.1017/s0033291716002373] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Parents are a major supplier of alcohol to adolescents, yet there is limited research examining the impact of this on adolescent alcohol use. This study investigates associations between parental supply of alcohol, supply from other sources, and adolescent drinking, adjusting for child, parent, family and peer variables. METHOD A cohort of 1927 adolescents was surveyed annually from 2010 to 2014. Measures include: consumption of whole drinks; binge drinking (>4 standard drinks on any occasion); parental supply of alcohol; supply from other sources; child, parent, family and peer covariates. RESULTS After adjustment, adolescents supplied alcohol by parents had higher odds of drinking whole beverages [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.33-2.45] than those not supplied by parents. However, parental supply was not associated with bingeing, and those supplied alcohol by parents typically consumed fewer drinks per occasion (incidence rate ratio 0.86, 95% CI 0.77-0.96) than adolescents supplied only from other sources. Adolescents obtaining alcohol from non-parental sources had increased odds of drinking whole beverages (OR 2.53, 95% CI 1.86-3.45) and bingeing (OR 3.51, 95% CI 2.53-4.87). CONCLUSIONS Parental supply of alcohol to adolescents was associated with increased risk of drinking, but not bingeing. These parentally-supplied children also consumed fewer drinks on a typical drinking occasion. Adolescents supplied alcohol from non-parental sources had greater odds of drinking and bingeing. Further follow-up is necessary to determine whether these patterns continue, and to examine alcohol-related harm trajectories. Parents should be advised that supply of alcohol may increase children's drinking.
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Affiliation(s)
- R P Mattick
- National Drug and Alcohol Research Centre,University of New South Wales (UNSW) Australia,Sydney, NSW 2052,Australia
| | - M Wadolowski
- The Kirby Institute,University of New South Wales (UNSW) Australia,Sydney, NSW 2052,Australia
| | - A Aiken
- National Drug and Alcohol Research Centre,University of New South Wales (UNSW) Australia,Sydney, NSW 2052,Australia
| | - P J Clare
- National Drug and Alcohol Research Centre,University of New South Wales (UNSW) Australia,Sydney, NSW 2052,Australia
| | - D Hutchinson
- School of Psychology,Deakin University,Melbourne, VIC 3125,Australia
| | - J Najman
- Queensland Alcohol and Drug Research and Education Centre,University of Queensland,Brisbane, QLD 4072,Australia
| | - T Slade
- National Drug and Alcohol Research Centre,University of New South Wales (UNSW) Australia,Sydney, NSW 2052,Australia
| | - R Bruno
- School of Psychology,University of Tasmania,Hobart, TAS 7000,Australia
| | - N McBride
- National Drug Research Institute,Curtin University,GPO Box U1987,Perth, WA 6845,Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre,University of New South Wales (UNSW) Australia,Sydney, NSW 2052,Australia
| | - K Kypri
- Centre for Clinical Epidemiology and Biostatistics,School of Medicine and Public Health,University of Newcastle,Newcastle, NSW 2308,Australia
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Magliocca K, Griffith C, Wadsworth J, El-Deiry M, Beitler J, Saba N, Aiken A, Patel M. SALIVARY DUCT CARCINOMA: AN INSTITUTIONAL EXPERIENCE. Oral Surg Oral Med Oral Pathol Oral Radiol 2016. [DOI: 10.1016/j.oooo.2016.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Sahgal A, Chou D, Ames C, Ma L, Lamborn K, Huang K, Chuang C, Aiken A, Petti P, Weinstein P, Larson D. Image-Guided Robotic Stereotactic Body Radiotherapy for Benign Spinal Tumors: The University of California San Francisco Preliminary Experience. Technol Cancer Res Treat 2016; 6:595-604. [DOI: 10.1177/153303460700600602] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We evaluate our preliminary experience using the Cyberknife® Radiosurgery System in treating benign spinal tumors. A retrospective review of 16 consecutively treated patients, comprising 19 benign spinal tumors, was performed. Histologic types included neurofibroma [11], chordoma [4], hemangioma [2], and meningioma [2]. Three patients had Neurofibromatosis Type 1 (NF1). Only one tumor, recurrent chordoma, had been previously irradiated, and as such not considered in the local failure analysis. Local failure, for the remaining 18 tumors, was based clinically on symptom progression and/or tumor enlargement based on imaging. Indications for spine stereotactic body radiotherapy (SBRT) consisted of either adjuvant to subtotal resection (5/19), primary treatment alone (12/19), boost following external beam radiotherapy (1/19), and salvage following previous radiation (1/19). Median tumor follow-up is 25 months (2–37), and one patient (with NF1) died at 12 months from a stroke. The median total dose, number of fractions, and prescription isodose was 21 Gy (10–30 Gy), 3 fx (1–5 fx), 80% (42–87%). The median tumor volume was 7.6 cc (0.2–274.1 cc). The median V100 (volume V receiving 100% of the prescribed dose) and maximum tumor dose was 95% (77–100%) and 26.7 Gy (15.4–59.7 Gy), respectively. Three tumors progressed at 2, 4, and 36 months post-SR (n=18). Two tumors were neurofibromas (both in NF1 patients), and the third was an intramedullary hemangioblastoma. Based on imaging, two tumors had MRI documented progression, three had regressed, and 13 were unchanged (n=18). With short follow-up, local control following Cyberknife spine SBRT for benign spinal tumors appear acceptable.
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Affiliation(s)
- Arjun Sahgal
- Department of Radiation Oncology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Dean Chou
- Department of Neurologic Surgery University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Christopher Ames
- Department of Neurologic Surgery University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Lijun Ma
- Department of Radiation Oncology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Kathleen Lamborn
- Department of Epidemiology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Kim Huang
- Department of Radiation Oncology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Cynthia Chuang
- Department of Radiation Oncology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Ashley Aiken
- Department of Radiology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Paula Petti
- Department of Radiation Oncology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Phil Weinstein
- Department of Neurologic Surgery University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - David Larson
- Department of Radiation Oncology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
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Loftus PA, Wise SK, Nieto D, Panella N, Aiken A, DelGaudio JM. Intranasal volume increases with age: Computed tomography volumetric analysis in adults. Laryngoscope 2016; 126:2212-5. [DOI: 10.1002/lary.26064] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/24/2016] [Accepted: 04/01/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Patricia A. Loftus
- Department of Otolaryngology-Head and Neck Surgery; Emory University; Atlanta Georgia U.S.A
| | - Sarah K. Wise
- Department of Otolaryngology-Head and Neck Surgery; Emory University; Atlanta Georgia U.S.A
| | - Daniel Nieto
- Department of Otolaryngology-Head and Neck Surgery; Emory University; Atlanta Georgia U.S.A
| | - Nicholas Panella
- Department of Otolaryngology-Head and Neck Surgery; Emory University; Atlanta Georgia U.S.A
| | - Ashley Aiken
- Department of Otolaryngology-Head and Neck Surgery; Emory University; Atlanta Georgia U.S.A
| | - John M. DelGaudio
- Department of Otolaryngology-Head and Neck Surgery; Emory University; Atlanta Georgia U.S.A
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Ntumba P, Mwangi C, Barasa J, Aiken A, Kubilay Z, Allegranzi B. Multimodal approach for surgical site infection prevention – results from a pilot site in Kenya. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474905 DOI: 10.1186/2047-2994-4-s1-p87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Affiliation(s)
- Susan Muller
- Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Ashley Aiken
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Kelly Magliocca
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Amy Y. Chen
- Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA 30322 USA
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Aiken A, Dillaway C, Mevs-Korff N, Hubert C, Hopkins K. Legends, lies and litigation: influences on the trajectory of postpartum contraceptive desires. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Aiken A, Dillaway C, Mevs-Korff N. A blessing I can't afford: the paradox of happiness about unintended pregnancy and its relationship to contraceptive use. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Potter J, Hopkins K, Aiken A, Hubert C, Stevenson A, White K, Grossman D. Rapid repeat pregnancies among women reporting a preference for long-acting or permanent contraception in Texas. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Aiken A, Garrette D. The factors underlying the 82nd Texas Legislature’s decision to restrict access to family planning in Texas. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Potter J, Hopkins K, Aiken A, White K, Stevenson A, Lopez CH, Grossman D. UNMET DEMAND FOR HIGHLY EFFECTIVE POSTPARTUM CONTRACEPTION IN TWO CITIES IN TEXAS. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stevenson A, White K, Hubert Lopez C, Hopkins K, Aiken A, Grossman D, Potter J. Spatial variation in the impact of family planning cuts in Texas. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Geddes LH, McQuillan HJ, Aiken A, Vergoz V, Mercer AR. Steroid hormone (20-hydroxyecdysone) modulates the acquisition of aversive olfactory memories in pollen forager honeybees. Learn Mem 2013; 20:399-409. [DOI: 10.1101/lm.030825.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Aiken A. P259: What is the impact of hospital acquired bacteraemia in sub-Saharan Africa? Antimicrob Resist Infect Control 2013. [PMCID: PMC3687955 DOI: 10.1186/2047-2994-2-s1-p259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Coriolano K, Aiken A, Harrison M, Pukall C, Brouwer B, Groll D. Changes in knee pain, perceived need for surgery, physical function and quality of life after dietary weight loss in obese women diagnosed with knee osteoarthritis. Osteoarthritis Cartilage 2013. [DOI: 10.1016/j.joca.2013.02.542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Noorian AR, Bryant K, Aiken A, Nicholson AD, Edwards AB, Markowski MP, Dehkharghani S, Bouloute JC, Abney J, Nahab F. Initial experience with upfront arterial and perfusion imaging among ischemic stroke patients presenting within the 4.5-hour time window. J Stroke Cerebrovasc Dis 2013; 23:220-4. [PMID: 23352684 DOI: 10.1016/j.jstrokecerebrovasdis.2012.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 11/25/2012] [Accepted: 12/15/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Although perfusion imaging is being evaluated as a tool to select acute ischemic stroke patients who are most likely to benefit from reperfusion therapies beyond the standard time windows, there are limited data on the utility of perfusion imaging within the intravenous (IV) thrombolytic time window. METHODS A new stroke imaging protocol was initiated at Emory University Hospital including computed tomographic angiography (CTA) and computed tomographic perfusion (CTP). All patients presenting within 4.5 hours from last known normal time with suspected stroke were prospectively identified. Impact of CTA and CTP on the clinical management was recorded prospectively by stroke team members. RESULTS During the study period, 87 patients met eligibility criteria for the CTA/CTP protocol, of which 83 (95%) underwent this upfront comprehensive imaging protocol and 30 (34%) received IV thrombolytics. Overall, stroke team members reported that CTA and/or CTP aided their clinical management in 39 (47%) cases, including aiding in identification of a nonstroke diagnosis (n = 18), triage to the neurologic intensive care unit (n = 9), early triage to endovascular therapy (n = 4), and initiation of IV thrombolytic for low National Institutes of Health Stroke Scale score with large vessel occlusion (n = 3). Door to needle time ≤60 minutes was achieved in only 18% of patients receiving IV thrombolysis during the study period, but had improved to 44% in the subsequent 6-month period. CONCLUSIONS An upfront CTA/CTP protocol aided stroke team decision-making in nearly half of cases. Implementation of a CTA/CTP protocol was associated with a learning curve of 6 months before door to needle time ≤60 minutes returned to similar rates as the pre-CTA/CTP protocol.
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Affiliation(s)
- Ali Reza Noorian
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.
| | - Katja Bryant
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Ashley Aiken
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Andrew D Nicholson
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Adam B Edwards
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Mason P Markowski
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Seena Dehkharghani
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Jemisha C Bouloute
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Jacquelyn Abney
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Fadi Nahab
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
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Aiken A, Potter J. The prospect of pregnancy in a cohort of Latina women using the oral contraceptive pill. Contraception 2012. [DOI: 10.1016/j.contraception.2012.05.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
MR imaging allows detailed evaluation of temporomandibular (TMJ) anatomy because of its inherent tissue contrast and high resolution. Joint biomechanics can be assessed through imaging patients in the closed and open jaw positions. Despite the accuracy of MR imaging in detecting disc position, results must be interpreted together with clinical findings, because an anteriorly displaced disc can be seen in up to one-third of asymptomatic patients, and a normal disc position can be seen in up to one-quarter of symptomatic patients. Interpretation of MR imaging requires knowledge of the normal anatomy and an understanding of normal and abnormal biomechanics.
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Affiliation(s)
- Ashley Aiken
- Department of Radiology and Imaging Sciences, Neuroradiology Division, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA 30322, USA.
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Kats SS, Muller S, Aiken A, Hudgins PA, Wadsworth JT, Shin DM, Khuri F, Beitler JJ. Laryngeal tumor volume as a predictor for thyroid cartilage penetration. Head Neck 2012; 35:426-30. [PMID: 22488941 DOI: 10.1002/hed.22995] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Review of laryngectomy specimens demonstrated that preoperative CT scanning is suboptimal in predicting both thyroid cartilage penetration and extralaryngeal spread. We investigated the association between the CT-based gross tumor volume (GTV) with pathologic evidence of thyroid cartilage penetration among patients undergoing laryngectomy for squamous cell carcinoma (SCC) of the larynx. METHODS Ninety-four patients were identified who underwent total laryngectomy for SCC of the larynx. GTV, as defined by preoperative diagnostic CT scan, was contoured and analyzed using treatment-planning software. RESULTS Among the 49 nonirradiated patients, the mean GTVs of patients with (n = 15) and without (n = 34) thyroid cartilage penetration was 60.1 and 28.0 cm(3) (p = .004). When the nonirradiated patients were divided into 3 GTV groups (≤25 cm(3), 25-50 cm(3), >50 cm(3)), the rates of thyroid cartilage penetration were 23%, 17%, and 78%, respectively (p = .003). CONCLUSIONS Laryngeal tumor volume is associated with pathologic evidence of thyroid cartilage penetration in nonirradiated patients.
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Affiliation(s)
- Svetlana S Kats
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia 30322-1013, USA
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Noorian AR, Aiken A, Nicholson AD, Edwards AB, Markowski MP, Bouloute JC, Abney J, Nahab F. Abstract 2215: Utility of Upfront Arterial and Perfusion Imaging among Ischemic Stroke Patients Presenting within the 4.5 hour Time Window. Stroke 2012. [DOI: 10.1161/str.43.suppl_1.a2215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Although perfusion imaging is being evaluated as a tool to select acute ischemic stroke patients who are most likely to benefit from reperfusion therapies beyond the standard time windows, there is limited data on the utility of perfusion imaging within the IV thrombolytic time window.
Methods:
A new upfront comprehensive stroke imaging protocol was initiated at Emory University Hospital on July 1, 2010 to include CT angiography (CTA) of the head and neck and CT perfusion (CTP) of the head after non-contrast head CT. All patients presenting within 4.5 hours from last known normal time to Emory University Hospital with suspected stroke were prospectively identified from July 1 to December 31, 2010. Patients with POC Creatinine >1.7, allergy to contrast dye, current metformin use, pregnancy, intracranial hemorrhage (ICH) on non-contrast head CT or who declined consent were excluded from the protocol. Impact of CTA and CTP on the clinical management was recorded prospectively by stroke team members.
Results:
During the study period, 87 patients met eligibility criteria for the CTA/CTP protocol of which 83 (95%) underwent this upfront comprehensive imaging protocol and 30 (34%) received IV thrombolytic. CTA identified large vessel occlusion in 24 (29%) patients, including 5 with NIHSS ≤ 10 and 3 with NIHSS ≤ 5. CTP identified decreased cerebral blood volume > 1/3 of the ipsilateral MCA territory in 38% of anterior circulation large vessel occlusions. Overall, stroke team members reported that CTA and/or CTP aided their clinical management in 39 (47%) cases, including aiding in identification of a non-stroke diagnosis (n=18), triage to the NICU (n=9), early triage to endovascular therapy (n=4) and initiation of IV thrombolytic for low NIHSS with large vessel occlusion (n=3). There were no symptomatic ICHs and no contrast-induced nephropathy requiring dialysis during the study period. Door-to-needle time ≤ 60 minutes was achieved in only 23% of patients receiving IV thrombolysis during the study period but had improved to 39% in the subsequent 6 month period, similar to the pre-CTA/CTP protocol.
Conclusions:
An upfront CTA/CTP protocol to evaluate patients with acute ischemic stroke presenting within 4.5 hours aided stroke team decision making in nearly half of cases. Implementation of a CTA/CTP protocol was associated with a learning curve of 6 months before door-to-needle time ≤ 60 minutes returned to similar rates as the pre-CTA/CTP protocol.
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Affiliation(s)
| | | | | | | | | | | | | | - Fadi Nahab
- Emory Univ Dept of Neurology, Atlanta, GA
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Aiken A, Brouwer B, Pukall C, Harrison M, Coriolano K, Groll D. Psychological variables associated with initiation and completion of a weight-loss program in morbidly obese women. Can J Diabetes 2011. [DOI: 10.1016/s1499-2671(11)52200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Jong BC, Hill PC, Aiken A, Jeffries DJ, Onipede A, Small PM, Adegbola RA, Corrah TP. Clinical presentation and outcome of tuberculosis patients infected by M. africanum versus M. tuberculosis. Int J Tuberc Lung Dis 2007; 11:450-6. [PMID: 17394693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
SETTING A tuberculosis (TB) case contact study in the Gambia. OBJECTIVE To test whether Mycobacterium africanum, which has lost around 68 kb compared with M. tuberculosis sensu stricto, causes less severe TB disease. DESIGN We genotyped mycobacterial isolates and compared clinical and radiological characteristics as well as outcome data of M. africanum-infected TB patients with those infected with M. tuberculosis. RESULTS Of 317 index cases, 301 had a mycobacterial isolate available, 290 of which had an interpretable spoligotype pattern. Of these, 110 isolates (38%) were M. africanum and 180 (62%) were M. tuberculosis. M. africanum cases had lower body mass indices (17 vs. 17.45 for M. tuberculosis-infected patients, P = 0.029) and their radiographic disease was more extensive (96% vs. 89% had at least moderately severe radiographic changes, P = 0.031). Outcome on treatment was similar (2.8% of human immunodeficiency virus [HIV] negative M. africanum patients died on treatment vs. 3.0% of M. tuberculosis patients, P = 0.95). CONCLUSION M. africanum causes sputum smear-positive tuberculosis disease that is at least as severe as that caused by M. tuberculosis sensu stricto. Further clinical comparisons may be helpful in smear-negative patients and HIV-TB co-infected patients, and to identify whether there is any difference in time to develop disease.
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Affiliation(s)
- B C de Jong
- Bacterial Diseases Programme, Medical Research Council Laboratories, Banjul, The Gambia.
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Poston R, Marshall M, Aiken A, Fennes A, Louis H. W12-P-057 CD14 dependent adhesion of monocytes to oxidised LDL and HSP60 via lipid rafts. ATHEROSCLEROSIS SUPP 2005. [DOI: 10.1016/s1567-5688(05)80300-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Littlejohn IH, Tarling MM, Flynn PJ, Ordman AJ, Aiken A. Post-operative pain relief in children following extraction of carious deciduous teeth under general anaesthesia: a comparison of nalbuphine and diclofenac. Ugeskr Laeger 1996; 13:359-63. [PMID: 8842656 DOI: 10.1046/j.1365-2346.1996.d01-380.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In a randomized double-blind study 60 children, undergoing the extraction of carious deciduous teeth under day-case general anaesthesia, were assigned to receive either intravenous nalbuphine hydrochloride 0.3 mg kg-1 (n = 21), one or more diclofenac suppositories 12.5 mg to a dose of 1-2 mg kg-1 (n = 19), or no analgesia (n = 20). The duration of anaesthesia was longer in the diclofenac group (9.6 min, SD 3.5) compared with control (7.2 min, SD 2.6) and nalbuphine (6.9 min, SD 3.0) groups respectively (P < 0.05). There were no statistically significant differences in post-operative pain scores during the 45 min post-operative period studied between the three groups using an objective pain score. We conclude that using this methodology we were unable to demonstrate any statistically significant differences between the analgesic effects of either intravenous (i.v.) nalbuphine or diclofenac suppositories compared with control.
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MESH Headings
- Acetaminophen/administration & dosage
- Acetaminophen/therapeutic use
- Administration, Rectal
- Ambulatory Surgical Procedures
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/therapeutic use
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Anesthesia, Dental
- Anesthesia, General
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Child
- Child Behavior
- Child, Preschool
- Dental Caries/surgery
- Diclofenac/administration & dosage
- Diclofenac/therapeutic use
- Double-Blind Method
- Female
- Humans
- Injections, Intravenous
- Male
- Nalbuphine/administration & dosage
- Nalbuphine/therapeutic use
- Pain, Postoperative/prevention & control
- Suppositories
- Time Factors
- Tooth Extraction/adverse effects
- Tooth, Deciduous/surgery
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Affiliation(s)
- I H Littlejohn
- Anaesthetics Unit, London Hospital Medical College, Royal London Hospital, Whitechapel, UK
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Aiken A. Surgery for dental students. J Dent 1985. [DOI: 10.1016/0300-5712(85)90075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Aiken A. Killey's fracture of the mandible (dental practitioner handbook no. 5). J Dent 1983. [DOI: 10.1016/0300-5712(83)90134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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