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Shen SA, Perez-Heydrich CA, Xie DX, Nellis JC. ChatGPT vs. web search for patient questions: what does ChatGPT do better? Eur Arch Otorhinolaryngol 2024; 281:3219-3225. [PMID: 38416195 DOI: 10.1007/s00405-024-08524-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/31/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Chat generative pretrained transformer (ChatGPT) has the potential to significantly impact how patients acquire medical information online. Here, we characterize the readability and appropriateness of ChatGPT responses to a range of patient questions compared to results from traditional web searches. METHODS Patient questions related to the published Clinical Practice Guidelines by the American Academy of Otolaryngology-Head and Neck Surgery were sourced from existing online posts. Questions were categorized using a modified Rothwell classification system into (1) fact, (2) policy, and (3) diagnosis and recommendations. These were queried using ChatGPT and traditional web search. All results were evaluated on readability (Flesch Reading Ease and Flesch-Kinkaid Grade Level) and understandability (Patient Education Materials Assessment Tool). Accuracy was assessed by two blinded clinical evaluators using a three-point ordinal scale. RESULTS 54 questions were organized into fact (37.0%), policy (37.0%), and diagnosis (25.8%). The average readability for ChatGPT responses was lower than traditional web search (FRE: 42.3 ± 13.1 vs. 55.6 ± 10.5, p < 0.001), while the PEMAT understandability was equivalent (93.8% vs. 93.5%, p = 0.17). ChatGPT scored higher than web search for questions the 'Diagnosis' category (p < 0.01); there was no difference in questions categorized as 'Fact' (p = 0.15) or 'Policy' (p = 0.22). Additional prompting improved ChatGPT response readability (FRE 55.6 ± 13.6, p < 0.01). CONCLUSIONS ChatGPT outperforms web search in answering patient questions related to symptom-based diagnoses and is equivalent in providing medical facts and established policy. Appropriate prompting can further improve readability while maintaining accuracy. Further patient education is needed to relay the benefits and limitations of this technology as a source of medial information.
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Affiliation(s)
- Sarek A Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.
| | | | - Deborah X Xie
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Jason C Nellis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
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2
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Shen SA, Goyal MM, Lane K, Lehar M, Sun DQ. Guinea Pig Round Window Membrane Explantation for Ex Vivo Studies. J Vis Exp 2024. [PMID: 38465931 DOI: 10.3791/65816] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Efficient and minimally invasive drug delivery to the inner ear is a significant challenge. The round window membrane (RWM), being one of the few entry points to the inner ear, has become a vital focus of investigation. However, due to the complexities of isolating the RWM, our understanding of its pharmacokinetics remains limited. The RWM comprises three distinct layers: the outer epithelium, the middle connective tissue layer, and the inner epithelial layer, each potentially possessing unique delivery properties. Current models for investigating transport across the RWM utilize in vivo animal models or ex vivo RWM models which rely on cell cultures or membrane fragments. Guinea pigs serve as a validated preclinical model for the investigation of drug pharmacokinetics within the inner ear and are an important animal model for the translational development of delivery vehicles to the cochlea. In this study, we describe an approach for explantation of a guinea pig RWM with surrounding cochlear bone for benchtop drug delivery experiments. This method allows for preservation of native RWM architecture and may provide a more realistic representation of barriers to transport than current benchtop models.
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Affiliation(s)
- Sarek A Shen
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine;
| | - Mukund Madhav Goyal
- Department of Chemical and Biomolecular Engineering, Johns Hopkins Whiting School of Engineering
| | - Kelly Lane
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine
| | - Mohamed Lehar
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine
| | - Daniel Q Sun
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine
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3
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Goyal MM, Shen SA, Lehar M, Martinez A, Hiel H, Wang C, Liu Y, Wang C, Sun DQ. A Benchtop Round Window Model for Studying Magnetic Nanoparticle Transport to the Inner Ear. Laryngoscope 2024. [PMID: 38379206 DOI: 10.1002/lary.31345] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/09/2024] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION The round window membrane (RWM) presents a significant barrier to the local application of therapeutics to the inner ear. We demonstrate a benchtop preclinical RWM model and evaluate superparamagnetic iron oxide nanoparticles (SPIONs) as vehicles for magnetically assisted drug delivery. METHODS Guinea pig RWM explants were inset into a 3D-printed dual chamber benchtop device. Custom-synthesized 7-nm iron core nanoparticles were modified with different polyethylene glycol chains to yield two sizes of SPIONs (NP-PEG600 and NP-PEG3000) and applied to the benchtop model with and without a magnetic field. Histologic analysis of the RWM was performed using transmission electron microscopy (TEM) and confocal microscopy. RESULTS Over a 4-h period, 19.5 ± 1.9% of NP-PEG3000 and 14.6 ± 1.9% of NP-PEG600 were transported across the guinea pig RWM. The overall transport increased by 1.45× to 28.4 ± 5.8% and 21.0 ± 2.0%, respectively, when a magnetic field was applied. Paraformaldehyde fixation of the RWM decreased transport significantly (NP-PEG3000: 7.6 ± 1.5%; NP-PEG600: 7.0 ± 1.6%). Confocal and electron microscopy analysis demonstrated nanoparticle localization throughout all cellular layers and layer-specific transport characteristics within RWM. CONCLUSION The guinea pig RWM explant benchtop model allows for targeted and practical investigations of transmembrane transport in the development of nanoparticle drug delivery vehicles. The presence of a magnetic field increases SPION delivery by 45%-50% in a nanoparticle size- and cellular layer-dependent manner. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- Mukund M Goyal
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sarek A Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mohamed Lehar
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Angela Martinez
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hakim Hiel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Canhui Wang
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yulin Liu
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chao Wang
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Q Sun
- Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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4
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Lehmann AE, Sneidern M, Shen SA, Humphreys IM, Abuzeid WM, Jafari A. Does reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors: A systematic review with meta‐analysis. World J Otorhinolaryngol Head Neck Surg 2022; 8:25-35. [PMID: 35619927 PMCID: PMC9126164 DOI: 10.1002/wjo2.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/22/2021] [Indexed: 11/25/2022] Open
Abstract
Objective As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread, high‐quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection. The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices. Methods Data Sources: PubMed, EMBASE, Web of Science. A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted. Articles not reporting orbital reconstruction details were excluded. Patient and tumor characteristics, operative details, and outcomes were recorded. Variables were compared using χ2, Fisher's exact, and independent t tests. Results Of 60 patients included from 24 studies, 34 (56.7%) underwent orbital reconstruction following resection. The most common types of reconstruction were pedicled flaps (n = 15, 44.1%) and free mucosal grafts (n = 11, 32.4%). Rigid reconstruction was uncommon (n = 3, 8.8%). Performance of orbital reconstruction was associated with preoperative vision compromise (p < 0.01). The tendency to forego orbital reconstruction was associated with preoperative proptosis (p < 0.001), larger tumor size (p = 0.001), and operative exposure of orbital fat (p < 0.001) and extraocular muscle (p = 0.035). There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short‐ or long‐term outcomes when considering all patients. In patients with intraconal tumors, however, there was a higher rate of short‐term postoperative diplopia when reconstruction was foregone (p = 0.041). This potential benefit of reconstruction did not persist: At an average of two years postoperatively, all patients for whom reconstruction was foregone either had improved or unchanged diplopia. Conclusion Most outcomes assessed did not appear affected by orbital reconstruction status. This general equivalence may suggest that orbital reconstruction is not a necessity in these cases or that the decision to reconstruct was well‐selected by surgeons in the reported cases included in this systematic review. Question: Does orbital reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors? Findings: In this systematic review and meta‐analysis of 60 patients included from 24 studies, there were no statistically significant differences between the reconstruction (n = 34, 56.7%) and non‐reconstruction groups in terms of short‐ or long‐term outcomes when considering all patients. In patients with intraconal tumors, however, there was a higher rate of short‐term (<2 years) post‐operative diplopia when reconstruction was foregone (p = 0.041). Meaning: Most outcomes assessed did not appear affected by orbital reconstruction status. This general equivalence may suggest that orbital reconstruction is not a necessity in these cases or that the decision to reconstruct was well‐selected by surgeons in the reported cases included in this systematic review.
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Affiliation(s)
- Ashton E. Lehmann
- Department of Otolaryngology‐Head and Neck Surgery Vanderbilt University Medical Center Nashville Tennessee USA
- Department of Otolaryngology‐Head and Neck Surgery Geisinger Medical Center Danville Pennsylvania USA
| | - Manuela Sneidern
- Department of Otolaryngology‐Head and Neck Surgery New York University School of Medicine New York New York USA
| | - Sarek A. Shen
- Department of Otolaryngology‐Head and Neck Surgery Johns Hopkins Hospital Baltimore Maryland USA
| | - Ian M. Humphreys
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology‐Head and Neck Surgery University of Washington Seattle Washington USA
| | - Waleed M. Abuzeid
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology‐Head and Neck Surgery University of Washington Seattle Washington USA
| | - Aria Jafari
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology‐Head and Neck Surgery University of Washington Seattle Washington USA
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von Sneidern M, Lehmann AE, Jafari A, Vlasakov IK, Shen SA, Goss D, Bleier BS. Reflecting on the COVID-19 Surgical Literature Surge: A Scoping Review of Pandemic Otolaryngology Publications. Otolaryngol Head Neck Surg 2021; 167:65-72. [PMID: 34491871 DOI: 10.1177/01945998211041933] [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: 12/23/2022]
Abstract
OBJECTIVE To assess the high-volume 2020 COVID-19-related surgical literature, with special attention to otolaryngology articles in regard to content, level of evidence, citations, and public attention. STUDY DESIGN A scoping literature review was performed with PubMed and Web of Science, including articles pertaining to COVID-19 and surgical specialties (March 20-May 19, 2020) or otolaryngologic subspecialties (March 20-December 31, 2020). SETTING Scoping literature review. METHODS Otolaryngology-specific COVID-19-related articles were reviewed for publication date, county of origin, subspecialty, content, level of evidence, and Altmetric Attention Score (a weighted approximation of online attention received). Data were analyzed with Pearson correlation coefficients, analysis of variance, independent t tests, and univariable and logistic regressions. RESULTS This review included 773 early COVID-19 surgical articles and 907 otolaryngology-specific COVID-19-related articles from 2020. Otolaryngology was the most represented surgical specialty within the early COVID-19-related surgical literature (30.4%). The otolaryngology-specific COVID-19 surgical literature responsively reflects the unique concerns within each otolaryngologic subspecialty. Although this literature was largely based on expert opinion (64.5%), articles with stronger levels of evidence received significantly more citations (on Web of Science and Google Scholar, P < .001 for both) and public attention (according to Altmetric Attention Scores, P < .001). CONCLUSION Despite concerns of a surge in underrefereed publications during the COVID-19 pandemic, our review of the surgical literature offers some degree of reassurance. Specifically, the COVID-19 otolaryngology literature responsively reflects the unique concerns and needs of the field, and more scholarly citations and greater online attention have been given to articles offering stronger levels of scientific evidence.
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Affiliation(s)
- Manuela von Sneidern
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, New York University, New York, New York, USA
| | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Otolaryngology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Aria Jafari
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | | | - Sarek A Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Deborah Goss
- Howe Library, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Benjamin S Bleier
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Jafari A, Shen SA, Qualliotine JR, Lehmann AE, Humphreys IM, Abuzeid WM, Bergmark RW, Gray ST. Socioeconomic Factors Affect Presentation Stage and Survival in Sinonasal Squamous Cell Carcinoma. Laryngoscope 2021; 131:2421-2428. [PMID: 33844294 DOI: 10.1002/lary.29568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/03/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Socioeconomic factors affect oncologic outcome in sinonasal squamous cell carcinoma (SNSCC). However, the relationship between these factors and stage at presentation (SAP)-a critical, early point in the care cycle-is not known. This study sought to determine the role of race/ethnicity, treatment facility type, insurance status/carrier, and other socioeconomic factors in SAP and survival among patients with advanced SNSCC. STUDY DESIGN Retrospective cohort study. METHODS Using the National Cancer Database, 6,155 patients with SNSCC were identified and divided into those with "early" (Stage I or II; 2,212 (35.9%)) versus "advanced" (Stage III or IV; 3,943 (64.1%)) disease. Associations between sociodemographic and socioeconomic factors on SAP and survival were analyzed using multivariable logistic regression and Cox proportional hazard models. RESULTS Black (odds ratio [OR]: 2.18, CI: 1.74-2.76), Asian and Pacific Islander (API) (OR: 2.37, CI: 1.43-4.14), and Medicaid or uninsured (OR: 2.04, CI: 1.66-2.53) patients were more likely to present with advanced disease. Among patients with advanced disease, API patients demonstrated the highest 10-year survival rate (30.2%), and Black patients had the lowest 2-, 5-, and 10-year survival rates (47.7%, 31.9% and 19.2%, respectively). Older age (HR:1.03, CI:1.03-1.04), Black race (HR:1.39, CI:1.21-1.59), Medicaid or uninsured status (HR:1.48, CI:1.27-1.71), and treatment at a community hospital (HR:1.25, CI:1.14-1.37) were associated with poorer overall survival among patients with advanced disease. CONCLUSIONS Factors including race/ethnicity, treatment facility type, insurance status/carrier, and other socioeconomic factors influence SAP and survival in SNSCC. An improved understanding of how these factors relate to outcomes may elucidate opportunities to address gaps in education and access to care in vulnerable populations. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Sarek A Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Jesse R Qualliotine
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Regan W Bergmark
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Jafari A, von Sneidern M, Lehmann AE, Shen SA, Shishido S, Freitag SK, Bleier BS. Exclusively endoscopic endonasal resection of benign orbital tumors: a systematic review and meta-analysis. Int Forum Allergy Rhinol 2020; 11:924-934. [PMID: 33350602 DOI: 10.1002/alr.22745] [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: 08/13/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Cavernous Hemangioma Exclusively Endonasal Resection (CHEER) classification system was developed to standardize prospective outcome analysis following orbital cavernous hemangioma (OCH) resection. The goal of this study was to retroactively apply the CHEER system to all prior existing reports of endoscopic resection of primary benign orbital tumors (BOTs) to: (1) compare patient presentations, perioperative characteristics, and outcomes between OCH and other BOTs; and (2) determine whether the CHEER categorization regime could be expanded to other BOTs. METHODS A systematic review of studies reporting exclusively endoscopic resections of OCH and other BOTs (eg, solitary fibrous tumor, schwannoma, and meningioma) was performed. Patient, tumor characteristics, and operative outcomes were recorded. All tumors with adequate reporting were retrospectively assigned a CHEER stage. Outcomes were compared using chi-square or Fisher's exact tests. RESULTS Ninety-three studies met inclusion criteria, and sufficient data were available in 36 studies, comprising 105 tumors (n = 87 OCHs; n = 18 other BOTs). Baseline patient and tumor characteristics, as well as intraoperative and short-term postoperative outcomes were not significantly different between OCHs and other BOTs. Long-term outcomes (eg, visual deficits, diplopia, eye position, and recurrence) also did not differ when controlling for CHEER stage. CONCLUSION This review represents the largest collection of outcomes data following exclusively endoscopic endonasal resection of BOTs. Short-term and long-term outcomes appear similar between OCHs and other BOTs. These results suggest that exclusively endoscopic resection of orbital tumors may be effective in a range of benign pathologies. Furthermore, these results support a broader application of the CHEER system to other benign primary orbital tumors.
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Affiliation(s)
- Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
| | | | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Sarek A Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD
| | - Sachie Shishido
- Faculty of Arts and Sciences, Fung Library, Harvard University, Cambridge, MA
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
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Jafari A, Lehmann AE, Shen SA, Banks CG, Scangas GA, Metson R. Infection After Endoscopic Dacryocystorhinostomy: Incidence and Implications. Am J Rhinol Allergy 2020; 35:375-382. [PMID: 32938219 DOI: 10.1177/1945892420958905] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Endoscopic dacryocystorhinostomy (EN-DCR) is an increasingly common procedure performed by otolaryngologists. While EN-DCR has a high rate of success at relieving blockage of the lacrimal system, little is known regarding associated postoperative infection (POI) rates and risk factors. OBJECTIVE The purpose of this study was to identify factors associated with the occurrence of postoperative orbital and rhinologic infection in a large cohort of patients undergoing EN-DCR. METHODS A retrospective review of 582 patients who underwent EN-DCR was performed. All patients received antibiotic prophylaxis as a single intraoperative intravenous administration and a ten-day postoperative oral course. Clinical and demographic information was reviewed, including the occurrence of acute orbital or rhinologic infection within 30 days of surgery. Multivariable analysis was performed to identify risk factors associated with POI. RESULTS Fifteen of 582 patients (2.6%) developed POI following EN-DCR. The most common POI was acute rhinosinusitis (10/15, 66.7%), followed by acute dacryocystitis (2/15, 13.3%), preseptal cellulitis (2/15,13.3%), and acute bacterial conjunctivitis (1/15, 6.7%). The majority of patients (464/582, 79.7%) underwent concurrent endoscopic sinus surgery (ESS). In most cases (302/464, 65.1%), ESS was performed to address comorbid rhinosinusitis, whereas 7.8% (36/464) of patients underwent surgery to enhance surgical access to the lacrimal sac. Patients who underwent concurrent ESS were less likely to develop POI (OR: 0.17, CI: 0.04-0.80, p < 0.05). Evidence of mucopurulence at surgery increased the likelihood of POI (OR: 6.24, CI: 1.51-25.84, p < 0.05). CONCLUSION Mucopurulence at the time of surgery significantly increased the risk of POI, whereas concurrent ESS, performed most commonly to address comorbid rhinosinusitis, significantly decreased the risk of POI. Awareness of risk factors for POI and appropriate surgical management of concurrent rhinosinusitis can lead to reduced infectious complications after EN-DCR.
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Affiliation(s)
- Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Sarek A Shen
- School of Medicine, University of California San Diego, La Jolla, California
| | - Catherine G Banks
- Department of Otolaryngology, Prince of Wales and Sydney and Sydney Eye Hospital, University of New South Wales, Randwick, Sydney, Australia
| | - George A Scangas
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Ralph Metson
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
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Shen SA, Jafari A, Qualliotine JR, DeConde AS. Incidence and Predictive Factors for Additional Opioid Prescription after Endoscopic Skull Base Surgery. J Neurol Surg B Skull Base 2020; 81:301-307. [PMID: 32500006 DOI: 10.1055/s-0039-1692473] [Citation(s) in RCA: 5] [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] [Received: 02/28/2019] [Accepted: 05/11/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Postoperative pain management and opioid use following endoscopic skull base surgery (ESBS) is not well understood. A subset of patients requires additional opioid prescription (AOP) in the postoperative period. The objective of this study is to describe the incidence of AOP, as well as evaluate patient and surgical characteristics that may predict additional pain management requirements following ESBS. Methods A retrospective review of cases undergoing ESBS between November 2016 and August 2018 was performed. We reviewed patients' sociodemographic and clinical data, and Controlled Substance Utilization Review and Evaluation System (CURES) records. Stepwise multivariable logistic regressions were performed to evaluate the factors associated with AOP within 60 days following surgery. Results A total of 42 patients were identified. Indications for ESBS included intracranial mass (64.2%), sinonasal malignancy (23.8%), and skull base reconstruction (9.5%). AOP were recorded in nine patients (21.4%). There were no significant differences in operative factors, including approach, lesion location, or perioperative analgesia between the two cohorts. On multivariable logistic regression, we found that younger age (odds ratio [OR]: 0.891, 95% confidence interval [CI]: 0.79-1.00, p = 0.050), comorbid depression (OR: 86.48, 95% CI: 1.40-5,379.07, p = 0.034), and preoperative opioid use (OR: 104.45, 95% CI: 1.41-7,751.10, p = 0.034) were associated with additional prescriptions postoperatively. Conclusion The requirement for extended postoperative opioid pain control is common after ESBS. Patient demographics including age and psychosocial factors, such as depression may predict the need for AOP after ESBS. These results suggest that patient-driven factors, rather than surgical characteristics, may determine the need for prolonged pain control requirements after ESBS.
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Affiliation(s)
- Sarek A Shen
- School of Medicine, University of California San Diego, La Jolla, California, United States
| | - Aria Jafari
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, United States
| | - Jesse R Qualliotine
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, United States
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, United States
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Abstract
BACKGROUND Clinical follow-up after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) allows for assessment of the sinonasal cavity, debridement, and tailoring of medical therapies. Frequency and timing of postoperative clinical visits is debated, but the impact of adherence on disease-specific outcomes is not well understood. In this longitudinal study, we assessed the association between follow-up adherence and quality of life (QOL) outcomes in the 12 months after ESS. METHODS A retrospective review of patients undergoing ambulatory ESS for CRS between 11/2016 and 1/2018 was performed. We assessed sociodemographic characteristics, radiographic severity, and QOL utilizing the 22-item sinonasal outcome test (SNOT-22). Patients were categorized as "non-adherent," "moderately-adherent," and "fully-adherent" to a 1-, 3- and 5-week postoperative visit schedule. RESULTS A total of 166 patients met the inclusion criteria. Of these, 55 (33.1%) were fully-adherent, 105 (63.2%) were moderately-adherent, and 6 (3.6%) were non-adherent within the 6 weeks following ESS. In the immediate postoperative period, fully-adherent patients demonstrated worse QOL (SNOT-22: 31.2 ± 23.1 vs 27.5 ± 17.6, P = .047). This cohort also had greater psychological dysfunction at baseline and 12-months (P < .05) after ESS. Extra-nasal symptom scores increased at a lower rate in the fully-adherent cohort (0.12 vs 1.29 points per 6 months, P = .038), as did ear/facial symptoms (1.17 vs 3.05 points per 6 months, P = .044). CONCLUSION Despite worse symptom severity in the immediate postoperative period, patients who are more adherent to the follow-up schedule demonstrated slower return of symptoms in the extra-rhinological and ear-facial domains. These findings suggest that clinical adherence and management may impact the long-term evolution of ESS outcomes.
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Affiliation(s)
- Sarek A Shen
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Aria Jafari
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA, USA
| | - Jesse R Qualliotine
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA, USA
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA, USA
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Jafari A, Shen SA, Qualliotine JR, Orosco RK, Califano JA, DeConde AS. Impact of margin status on survival after surgery for sinonasal squamous cell carcinoma. Int Forum Allergy Rhinol 2019; 9:1205-1211. [PMID: 31436890 DOI: 10.1002/alr.22415] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 05/12/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sinonasal squamous cell carcinoma (SNSCC) is the most common malignancy of the paranasal sinuses. Surgery is the mainstay of treatment, yet positive surgical margins (PSM) are common and the prognostic impact on overall survival (OS) is mixed. Given the heterogeneity of impact of PSM on OS within the literature, we hypothesized that extent of tumor extirpation (microscopic PSM vs macroscopic PSM) may play a role in OS. METHODS Patients with SNSCC were identified in the National Cancer Database (NCDB, n = 7808). Of these, 4543 patients underwent surgery, 3265 patients underwent nonsurgical therapy. Kaplan-Meier curves were used to compare OS between negative surgical margin (NSM), micro-PSM, and macro-PSM cohorts vs patients undergoing primary nonsurgical therapy in a propensity-score-matched analysis. Multivariable analysis of factors associated with macro-PSM was also performed. RESULTS One thousand thirty-three (22.0%) of the surgery patients had PSM, and approximately half (n = 521, 50.6%) of these had macro-PSM. When compared with nonsurgical treatment, propensity-score-matched results demonstrated improved OS in patients with NSM and micro-PSM (p < 0.001), but macro-PSM patients did not demonstrate improvement (p = 0.20). Tumor within the paranasal sinuses and advanced nodal classification (N2/N3) (odds ratio [OR], 1.18; p = 0.02; and OR, 15.09; p = 005, respectively) was associated with increased odds of macro-PSM on multivariable analysis. CONCLUSION We demonstrate that the degree of tumor extirpation correlates with OS. Macro-PSM did not confer a benefit to OS when compared with nonsurgical therapy, and factors including tumor location and advanced nodal status affect whether surgery will result in macro-PSM. Given these findings, informed, shared decisionmaking between patient and surgeon regarding nonsurgical alternatives should occur before electing to proceed with surgery in SNSCC.
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Affiliation(s)
- Aria Jafari
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA
| | - Sarek A Shen
- School of Medicine, University of California San Diego, La Jolla, CA
| | - Jesse R Qualliotine
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA
| | - Ryan K Orosco
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA.,Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Joseph A Califano
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA.,Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA
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Patel BH, Okoroha KR, Jildeh TR, Lu Y, Idarraga AJ, Nwachukwu BU, Shen SA, Forsythe B. Concussions in the National Basketball Association: Analysis of Incidence, Return to Play, and Performance From 1999 to 2018. Orthop J Sports Med 2019; 7:2325967119854199. [PMID: 31276004 PMCID: PMC6598335 DOI: 10.1177/2325967119854199] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The effect of concussions on professional athletes has been investigated in many sports. However, few studies have evaluated concussions in National Basketball Association (NBA) players. HYPOTHESIS We hypothesized that concussion incidence has increased, yet the return-to-play (RTP) rate will remain high following the institution of the NBA concussion policy (NBACP). We also hypothesized that the incidence of repeat concussions will be similar to first occurrences and that player performance and game availability will not be significantly affected by sustaining a concussion. STUDY DESIGN Descriptive epidemiology study. METHODS Publicly available records were searched to identify all concussions from NBA seasons 1999-2000 to 2017-2018. Player demographics and information regarding career history were tabulated. Incidence of concussion and RTP timing were evaluated before and after institution of the NBACP (2011). Minutes per game and game score per minute were evaluated pre- versus postconcussion. Player availability and performance were also compared with an age-, body mass index-, position-, and experience-matched control group of players who did not sustain a concussion. RESULTS A total of 189 concussions were reported in the NBA from 1999 to 2018, with a mean ± SD incidence of 9.7 ± 7.3 concussions per season. Following implementation of the NBACP, incidence significantly increased from 5.7 ± 2.8 to 16.7 ± 7.5 concussions per season (P = .007). All players returned to play following first-time concussion after missing 7.7 ± 8.6 days and 3.5 ± 4.1 games. RTP time was not significantly different after implementation of the NBACP (games missed, P = .24; days missed, P = .27), and there was no difference in concussion-free time interval (P = .29). Game score per minute and minutes per game were not significantly affected by sustaining a concussion (both P > .05). CONCLUSION Concussion incidence in NBA players is approximately 17 instances per season since the 2011 institution of a league-wide concussion policy. The number of reported concussions significantly increased following the policy, in line with trends seen in other professional sports leagues. Players have retained a high rate of RTP after 3 to 4 missed games. Player performance and availability are not affected by sustaining a concussion following successful RTP.
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Affiliation(s)
- Bhavik H. Patel
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Kelechi R. Okoroha
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Toufic R. Jildeh
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Yining Lu
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander J. Idarraga
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U. Nwachukwu
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarek A. Shen
- School of Medicine, University of California, San Diego, San Diego, California USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Shen SA, Jafari A, Qualliotine JR, DeConde AS. Socioeconomic and demographic determinants of postoperative outcome after endoscopic sinus surgery. Laryngoscope 2019; 130:297-302. [DOI: 10.1002/lary.28036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Sarek A. Shen
- School of MedicineUniversity of California San Diego La Jolla California U.S.A
| | - Aria Jafari
- and the Department of Surgery, Division of Otolaryngology–Head and Neck SurgeryUniversity of California San Diego San Diego California U.S.A
| | - Jesse R. Qualliotine
- and the Department of Surgery, Division of Otolaryngology–Head and Neck SurgeryUniversity of California San Diego San Diego California U.S.A
| | - Adam S. DeConde
- and the Department of Surgery, Division of Otolaryngology–Head and Neck SurgeryUniversity of California San Diego San Diego California U.S.A
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Jafari A, Shen SA, Bracken DJ, Pang J, DeConde AS. Incidence and predictive factors for additional opioid prescription after endoscopic sinus surgery. Int Forum Allergy Rhinol 2018; 8:883-889. [PMID: 29851273 DOI: 10.1002/alr.22150] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 02/27/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Excessive postoperative opioid prescription is a source of prescription diversion in the United States opioid crisis and may contribute to chronic opioid use. Efficient prescription by the surgeon can mitigate opioid abuse and improve postoperative pain control. In this study we sought to better characterize the incidence and predictive baseline characteristics associated with the need for additional opioid prescription after endoscopic sinus surgery (ESS) for chronic rhinosinusitis. METHODS A retrospective review was performed on subjects undergoing ambulatory ESS between November 2016 and August 2017. The medical and Controlled Substance Utilization Review and Evaluation System (CURES) records were reviewed. Uni- and multivariable logistic regressions were performed to evaluate factors associated with additional opioid prescription within 60 days of surgery. RESULTS A total of 121 patients were included. Additional prescriptions were seen in 22 patients (18%). Surgical factors, including sinuses operated, septoplasty, revision, or extended procedure (Draf IIB/III), were not associated with additional prescription. On multivariate logistic regression, preoperative opioid use (odds ratio [OR], 23.45; 95% CI, 1.52-362.63), greater number of prescribed tablets (OR, 1.13; 95% CI, 1.01-1.26), and lower preoperative health status (ASA score) (OR, 11.21; 95% CI, 1.49-84.30) were associated with additional prescription (p < 0.05). CONCLUSION A need for extension of postoperative opioid pain control is not uncommon after ESS. Patient baseline clinical characteristics are predictive of a need for re-prescription of opioids. Surgical extent is not associated with need for prolonged postoperative opioid pain management.
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Affiliation(s)
- Aria Jafari
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA
| | - Sarek A Shen
- School of Medicine, University of California, San Diego, La Jolla, CA
| | - David J Bracken
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA
| | - John Pang
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, CA
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15
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Shen SA, Jafari A, Bracken D, Pang J, DeConde AS. Predictive value of SNOT-22 on additional opiate prescriptions after endoscopic sinus surgery. Int Forum Allergy Rhinol 2018; 8:1021-1027. [PMID: 29722922 DOI: 10.1002/alr.22137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 03/02/2018] [Revised: 04/03/2018] [Accepted: 04/10/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) is generally well tolerated, yet a subset of patients require an additional opiate prescription in the postoperative period. The purpose of this study was to quantify differences in both preoperative and immediate postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores between patients with a single prescription and those requiring additional opiate prescriptions (AOPs). METHODS Patients undergoing ESS between November 2016 and August 2017 were reviewed retrospectively. The Medical and Controlled Substance Utilization Review and Evaluation System (CURES) records were reviewed; patients requiring AOP within 60 days after surgery were identified. The primary and secondary outcomes of interest were the association of baseline and first postoperative visit SNOT-22 total and domain scores with AOP. RESULTS A total of 121 patients were reviewed, 22 (18.2%) required AOP. Baseline SNOT-22 scores were higher in aggregate (58.7 ± 16.0 vs 46.1 ± 22.5) and ear/facial domain (11.4 ± 4.8 vs 8.5 ± 5.4) in the AOP group (p < 0.01). AOP patients also demonstrated higher scores across all SNOT-22 domains (p < 0.001) at the immediate preoperative visit. There was no difference in the absolute improvement between groups (15.5 ± 18.30 vs 12.3 ± 23.9, p = 0.54). AOP patients experienced less relative improvement (20.2% vs 34.8%, p < 0.05) and smaller mean effect size (0.57 vs 0.70, p < 0.001) after ESS. CONCLUSION Patients reporting increased ear and facial symptoms at baseline have an increased risk of additional opiate prescription after surgery; preoperative SNOT-22 scores may provide utility in identifying these patients. Subjects in both cohorts report symptomatic improvement after ESS; however, relative, not absolute, improvement in SNOT-22 scores is more predictive of AOP.
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Affiliation(s)
- Sarek A Shen
- School of Medicine, University of California, San Diego, La Jolla, CA
| | - Aria Jafari
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA
| | - David Bracken
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA
| | - John Pang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA
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Bird HR, Shrout PE, Davies M, Canino G, Duarte CS, Shen SA, Loeber R. Longitudinal development of antisocial behaviors in young and early adolescent Puerto Rican children at two sites. J Am Acad Child Adolesc Psychiatry 2007; 46:5-14. [PMID: 17195724 DOI: 10.1097/01.chi.0000242243.23044.ac] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This report provides descriptive longitudinal findings over three waves of a study designed to assess the development of antisocial behaviors in young and early adolescent Puerto Rican children at two sites. METHOD Through the use of standard assessment measures, representative samples of Puerto Rican children of both genders 5 to 13 years of age and their adult caretakers were interviewed at two sites: the South Bronx in New York City (n = 1,138) and the Standard Metropolitan Areas in Puerto Rico (n = 1,353; N = 2,491). RESULTS Although no differences in prevalence between the two sites were apparent at baseline, analyses of the longitudinal data show that site differences emerge over time, with a decrease in risk of antisocial behavior over time in the Standard Metropolitan Areas relative to the Bronx. CONCLUSIONS The decreased risk of these disorders in the Standard Metropolitan Areas corroborates the low rates in Puerto Rico reported in previous research. Future analyses of these data are needed to identify the risk and protective factors associated with this difference.
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Affiliation(s)
- Hector R Bird
- Drs. Bird, Duarte, and Shen and Mr. Davies (retired) are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute; Dr. Shrout is with the Department of Psychology at New York University; Dr. Canino is Director of the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA..
| | - Patrick E Shrout
- Drs. Bird, Duarte, and Shen and Mr. Davies (retired) are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute; Dr. Shrout is with the Department of Psychology at New York University; Dr. Canino is Director of the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - Mark Davies
- Drs. Bird, Duarte, and Shen and Mr. Davies (retired) are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute; Dr. Shrout is with the Department of Psychology at New York University; Dr. Canino is Director of the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - Glorisa Canino
- Drs. Bird, Duarte, and Shen and Mr. Davies (retired) are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute; Dr. Shrout is with the Department of Psychology at New York University; Dr. Canino is Director of the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - Cristiane S Duarte
- Drs. Bird, Duarte, and Shen and Mr. Davies (retired) are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute; Dr. Shrout is with the Department of Psychology at New York University; Dr. Canino is Director of the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - S A Shen
- Drs. Bird, Duarte, and Shen and Mr. Davies (retired) are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute; Dr. Shrout is with the Department of Psychology at New York University; Dr. Canino is Director of the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - Rolf Loeber
- Drs. Bird, Duarte, and Shen and Mr. Davies (retired) are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute; Dr. Shrout is with the Department of Psychology at New York University; Dr. Canino is Director of the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA
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Bird HR, Davies M, Duarte CS, Shen SA, Loeber R, Canino GJ. A study of disruptive behavior disorders in Puerto Rican youth: II. Baseline prevalence, comorbidity, and correlates in two sites. J Am Acad Child Adolesc Psychiatry 2006; 45:1042-1053. [PMID: 16926611 DOI: 10.1097/01.chi.0000227879.65651.cf] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This is the second of two associated articles. The prevalence, correlates, and comorbidities of disruptive behavior disorders (DBDs) in two populations are reported. METHOD Probability community samples of Puerto Rican boys and girls ages 5-13 years in San Juan, and the south Bronx in New York City are included (n = 2,491). The Diagnostic Interview Schedule for Children-IV and measures of correlates were employed to look at the association between DBDs and potential correlates, taking comorbidity into account. Data presented in this report were collected primarily between 2002 and 2003 but spanned a 3-year period from August 2000 to August 2003. RESULTS There were no significant age or site differences among males in rates of DBDs, but rates among females increased with age in the south Bronx and decreased with age in Puerto Rico. The salient comorbidity of DBDs was with attention-deficit/hyperactivity disorder. Multiple regression showed lack of parental warmth and approval, poor peer relationships, and parental report of aggressive behavior during the toddler years to be the most significant correlates of DBDs in this population. CONCLUSIONS Cultural factors, such as level of acculturation, were not associated with DBDs. The results suggest that clinical and preventive efforts need to emphasize interpersonal factors such as parent-child relationships and peer interactions.
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Affiliation(s)
- Héctor R Bird
- Drs. Bird, Shen, and Duarte and Mr. Davies are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute, New York; Dr. Canino is with the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh.
| | - Mark Davies
- Drs. Bird, Shen, and Duarte and Mr. Davies are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute, New York; Dr. Canino is with the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh
| | - Cristiane S Duarte
- Drs. Bird, Shen, and Duarte and Mr. Davies are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute, New York; Dr. Canino is with the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh
| | - S A Shen
- Drs. Bird, Shen, and Duarte and Mr. Davies are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute, New York; Dr. Canino is with the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh
| | - Rolf Loeber
- Drs. Bird, Shen, and Duarte and Mr. Davies are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute, New York; Dr. Canino is with the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh
| | - Glorisa J Canino
- Drs. Bird, Shen, and Duarte and Mr. Davies are with the Department of Psychiatry, Division of Child Psychiatry, Columbia University/New York State Psychiatric Institute, New York; Dr. Canino is with the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan; and Dr. Loeber is with the Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh
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Hill SY, Lowers L, Locke-Wellman J, Shen SA. Maternal smoking and drinking during pregnancy and the risk for child and adolescent psychiatric disorders. J Stud Alcohol 2000; 61:661-8. [PMID: 11022804 PMCID: PMC4128282 DOI: 10.15288/jsa.2000.61.661] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the relative importance of prenatal exposure to cigarettes and alcohol and familial/genetic susceptibility for alcohol dependence in the etiology of childhood psychopathology. METHOD A longitudinal prospective study of 150 children/adolescents (51.3% male), who were at either high or low risk for developing alcohol dependence because of their familial loading for alcoholism, provided multiple diagnostic assessments (N = 318) of these subjects. High-risk families were identified through the presence of two adult alcoholic sisters; low-risk control families were selected from the community. Annual assessments of offspring from these families included an in-depth psychiatric interview of each child and his/her parent to determine the presence or absence of childhood disorders. Mothers were interviewed concerning their prenatal use of substances, and information was gathered concerning their personal and familial loading for psychiatric disorders. RESULTS Using conventional logistic regression analyses, internalizing and externalizing disorders were found to be associated with familial loading for alcoholism and prenatal exposure to cigarettes and alcohol. In addition, a specialized statistical analysis, a multivariate confounder score approach, was conducted using familial risk status and the child's exposure to maternal prenatal use of alcohol and cigarettes. This analysis demonstrated that only one relationship between a single variable and a childhood disorder was significant while controlling for the other two variables: Oppositional disorder remained significant in association with familial risk status. Three additional analyses were performed to evaluate the effects of familial risk status, prenatal alcohol exposure and prenatal cigarette exposure on childhood psychopathology while controlling for two known risk factors (SES and parental ASPD) for externalizing disorders. Results of these analyses revealed that the only childhood disorder that was elevated was ADHD, and that this was the result of the familial risk variable only. CONCLUSIONS Familial loading for alcohol dependence is an important risk factor for the development of childhood psychopathology and may account for the previously reported associations between prenatal exposure to nicotine and alcohol. Studies of substance abuse/dependence etiology and childhood psychopathology need to include consideration of both prenatal exposures and familial loading for alcohol dependence and other psychiatric disorders.
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Affiliation(s)
- S Y Hill
- Department of Psychiatry, University of Pittsburgh School of Mediicne, Pennsylvania 15213, USA
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Yuan HS, Shen SA, Chen JW, Jone KY, Ko YC. An in-service education program as a means to improve nurses' knowledge and attitude about AIDS and to increase their willingness to care for AIDS patients. Gaoxiong Yi Xue Ke Xue Za Zhi 1993; 9:508-17. [PMID: 8271324] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study evaluates changes in nurses' knowledge and attitudes about AIDS and changes in their willingness to care for AIDS patients following a 2 hour educational program. The nursing staff of Kaohsiung Medical College Hospital was divided into two groups: an experimental group (n = 280) and a control group (n = 119). Scores were obtained from a pre-test and from a post-test. The questionnaire that was given to both groups. The results were analyzed by 2-way ANOVA with repeated measures. The experimental group's overall pre-test score on their knowledge of AIDS was 25.9 +/- 4.5 (66.4% of the maximal score of 39) and the post-test score showed an improvement to 28.7 +/- 4.2 (73.6% of the maximal score). The difference between the pre-test and post-test scores of the experimental group was statistically significant (P < 0.01). The difference in the post-test scores between the experimental group and the control group (26.0 +/- 4.0) was also statistically significant (P < 0.01). Pertaining to attitudes towards AIDS, the experimental group had a pre-test score of 47.2 +/- 5.2 and a post-test score of 47.3 +/- 5.5, and there was neither a significant difference between the pre-test score and the post-test score of the experimental group nor in the post-test scores between the experimental group and the control group (47.6 +/- 4.3). The post-test score of willingness to care for AIDS patients was slightly higher than the pre-test score in both groups, but the difference was not significant. Nurses who originally were willing to care for AIDS patients had a more positive attitude toward AIDS than did nurses who had originally refused to care for AIDS patients in the pre-test and post-test (p < 0.01). In conclusion, the in-service education apparently enhanced the knowledge of AIDS, however, no statistical difference was established for changes in nurses' attitudes or in their willingness to care for AIDS patients. In order to provide better nursing care, we believe, AIDS knowledge needs to be further promoted.
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Affiliation(s)
- H S Yuan
- School of Nursing, Kaohsiung Medical College, Taiwan, Republic of China
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