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Abbasi AB, Wu V, Lang JE, Esserman LJ. Precision Oncology in Breast Cancer Surgery. Surg Oncol Clin N Am 2024; 33:293-310. [PMID: 38401911 DOI: 10.1016/j.soc.2023.12.011] [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] [Indexed: 02/26/2024]
Abstract
Outcomes for patients with breast cancer have improved over time due to increased screening and the availability of more effective therapies. It is important to recognize that breast cancer is a heterogeneous disease that requires treatment based on molecular characteristics. Early endpoints such as pathologic complete response correlate with event-free survival, allowing the opportunity to consider de-escalation of certain cancer treatments to avoid overtreatment. This article discusses clinical trials of tailoring treatment (eg, I-SPY2) and screening (eg, WISDOM) to individual patients based on their unique risk features.
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Affiliation(s)
- Ali Benjamin Abbasi
- Department of Surgery, San Francisco Breast Care Center, University of California, Box 1710, UCSF, San Francisco, CA 94143, USA
| | - Vincent Wu
- Department of Surgery, Cleveland Clinic Breast Services, 9500 Euclid Avenue, A80, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Julie E Lang
- Department of Surgery, Cleveland Clinic Breast Services, 9500 Euclid Avenue, A80, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Laura J Esserman
- Department of Surgery, San Francisco Breast Care Center, University of California, Box 1710, UCSF, San Francisco, CA 94143, USA
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2
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Peruzzotti-Jametti L, Willis CM, Krzak G, Hamel R, Pirvan L, Ionescu RB, Reisz JA, Prag HA, Garcia-Segura ME, Wu V, Xiang Y, Barlas B, Casey AM, van den Bosch AMR, Nicaise AM, Roth L, Bates GR, Huang H, Prasad P, Vincent AE, Frezza C, Viscomi C, Balmus G, Takats Z, Marioni JC, D'Alessandro A, Murphy MP, Mohorianu I, Pluchino S. Mitochondrial complex I activity in microglia sustains neuroinflammation. Nature 2024; 628:195-203. [PMID: 38480879 PMCID: PMC10990929 DOI: 10.1038/s41586-024-07167-9] [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: 10/03/2022] [Accepted: 02/06/2024] [Indexed: 03/17/2024]
Abstract
Sustained smouldering, or low-grade activation, of myeloid cells is a common hallmark of several chronic neurological diseases, including multiple sclerosis1. Distinct metabolic and mitochondrial features guide the activation and the diverse functional states of myeloid cells2. However, how these metabolic features act to perpetuate inflammation of the central nervous system is unclear. Here, using a multiomics approach, we identify a molecular signature that sustains the activation of microglia through mitochondrial complex I activity driving reverse electron transport and the production of reactive oxygen species. Mechanistically, blocking complex I in pro-inflammatory microglia protects the central nervous system against neurotoxic damage and improves functional outcomes in an animal disease model in vivo. Complex I activity in microglia is a potential therapeutic target to foster neuroprotection in chronic inflammatory disorders of the central nervous system3.
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Affiliation(s)
- L Peruzzotti-Jametti
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK.
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
| | - C M Willis
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - G Krzak
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - R Hamel
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - L Pirvan
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - R-B Ionescu
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - J A Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, CO, USA
| | - H A Prag
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - M E Garcia-Segura
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - V Wu
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Y Xiang
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - B Barlas
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
- UK Dementia Research Institute, University of Cambridge, Cambridge, UK
| | - A M Casey
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - A M R van den Bosch
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - A M Nicaise
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - L Roth
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - G R Bates
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - H Huang
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - P Prasad
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - A E Vincent
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - C Frezza
- University Hospital Cologne, Cologne, Germany
| | | | - G Balmus
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
- UK Dementia Research Institute, University of Cambridge, Cambridge, UK
- Department of Molecular Neuroscience, Transylvanian Institute of Neuroscience, Cluj-Napoca, Romania
| | - Z Takats
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - J C Marioni
- European Molecular Biology Laboratory, European Bioinformatics Institute, EMBL-EBI, Wellcome Genome Campus, Hinxton, UK
| | - A D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, CO, USA
| | - M P Murphy
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - I Mohorianu
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - S Pluchino
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK.
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3
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Wu V, Chichura AM, Dickard J, Turner C, Al-Hilli Z. Perioperative genetic testing and time to surgery in patients with breast cancer. Surgery 2024; 175:712-717. [PMID: 37848355 DOI: 10.1016/j.surg.2023.08.043] [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] [Received: 05/15/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Time to treatment has been identified as a quality metric, with longer time to treatment associated with poorer outcomes. Genetic evaluation is an integral part of treatment counseling for patients with breast cancer. With expanding indications for genetic testing and consideration of expansion of genetic testing to all patients with a personal history of breast cancer, this study aims to evaluate the effect of genetic evaluation on the time interval from initial surgical visit to surgery. METHODS A retrospective review of patients undergoing upfront surgery for stage 0-3 breast cancer from June 2022 to December 2022. Patient demographics, treatment characteristics, National Comprehensive Cancer Network criteria for genetic testing, and results were obtained. RESULTS The study included 492 patients (489 females). Eighty-one (16.2%) were ≤50 years of age at diagnosis. In total, 281 patients (57.1%) met National Comprehensive Cancer Network criteria for genetic testing and 199 consulted with a genetic counselor (72.4%). Seventy-six patients (27.6%) not meeting National Comprehensive Cancer Network criteria pursued genetic counseling. In total, 218 patients (79.3%) referred for genetic counseling completed testing. Mean turnaround time to genetic testing result was 11 days (range, 6-66 days). Twenty-six patients (11.9%) had a pathogenic or likely pathogenic variant. Twenty-four of these patients met National Comprehensive Cancer Network testing criteria (92.3%) and 2 did not (7.7%). The time to treatment for patients undergoing genetic testing was 33 vs 34 days in those without testing (P = .45). Three patients (11.5%) with pathogenic or likely pathogenic variants altered their initial surgical plan due to their genetic testing results. Seven patients with pathogenic or likely pathogenic variant results returning postoperatively did not undergo additional surgery. CONCLUSION Hereditary breast cancer evaluation and genetic testing did not appear to delay time to treatment for patients with breast cancer in our study cohort.
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Affiliation(s)
- Vincent Wu
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Anna M Chichura
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH; Department of Benign Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Jennifer Dickard
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Christine Turner
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH.
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4
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Leon D, Tanaka M, Thabet A, Bozorgzadeh A, Pratt DS, Kalva SP, Wu V. Intracardiac Echocardiography Guidance for Percutaneous Closure of Surgical Portocaval Shunt after Liver Transplant. Cardiovasc Intervent Radiol 2024; 47:273-276. [PMID: 37902856 DOI: 10.1007/s00270-023-03582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023]
Affiliation(s)
- David Leon
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRB 290, Boston, MA, 02114, USA
| | - Mari Tanaka
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRB 290, Boston, MA, 02114, USA
| | - Ashraf Thabet
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRB 290, Boston, MA, 02114, USA
| | - Adel Bozorgzadeh
- Transplantation Unit, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Daniel S Pratt
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRB 290, Boston, MA, 02114, USA
| | - Vincent Wu
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRB 290, Boston, MA, 02114, USA.
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5
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Peruzzotti-Jametti L, Willis CM, Hamel R, Krzak G, Reisz JA, Prag HA, Wu V, Xiang Y, van den Bosch AMR, Nicaise AM, Roth L, Bates GR, Huang H, Vincent AE, Frezza C, Viscomi C, Marioni JC, D'Alessandro A, Takats Z, Murphy MP, Pluchino S. Mitochondrial reverse electron transport in myeloid cells perpetuates neuroinflammation. bioRxiv 2024:2024.01.03.574059. [PMID: 38260262 PMCID: PMC10802366 DOI: 10.1101/2024.01.03.574059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Sustained smouldering, or low grade, activation of myeloid cells is a common hallmark of several chronic neurological diseases, including multiple sclerosis (MS) 1 . Distinct metabolic and mitochondrial features guide the activation and the diverse functional states of myeloid cells 2 . However, how these metabolic features act to perpetuate neuroinflammation is currently unknown. Using a multiomics approach, we identified a new molecular signature that perpetuates the activation of myeloid cells through mitochondrial complex II (CII) and I (CI) activity driving reverse electron transport (RET) and the production of reactive oxygen species (ROS). Blocking RET in pro-inflammatory myeloid cells protected the central nervous system (CNS) against neurotoxic damage and improved functional outcomes in animal disease models in vivo . Our data show that RET in myeloid cells is a potential new therapeutic target to foster neuroprotection in smouldering inflammatory CNS disorders 3 .
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6
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Wu V, Cusimano M, Marsden P, Lee JM. Levels of nasal nitric oxide and nitric oxide synthase expression in chronic rhinosinusitis with nasal polyposis. Int Forum Allergy Rhinol 2024; 14:127-129. [PMID: 37395064 DOI: 10.1002/alr.23233] [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: 04/10/2023] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 07/04/2023]
Abstract
KEY POINTS CRSwNP patients had decreased nNO and increased SNOT-22, endoscopy, and CT scores. CRSwNP patients exhibited decreased nNO despite elevated iNOS and eNOS mRNA expression. The mechanism behind lowered nNO in CRSwNP may not be related to NOS expression.
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Affiliation(s)
- Vincent Wu
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Michael Cusimano
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Philip Marsden
- Keenan Research Centre, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
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7
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Wu V, Lee JM. Response to Letter to the Editor: Nasal nitric oxide and chronic rhinosinusitis with nasal polyps: Is it a matter of inflammation or mechanical obstruction? Int Forum Allergy Rhinol 2023; 13:2268. [PMID: 37847648 DOI: 10.1002/alr.23292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Vincent Wu
- Department of Otolaryngology-Head and Neck Surgery, Trillium Health Partners, University of Toronto, Mississauga, Ontario, Canada
| | - John M Lee
- Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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8
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Al-Hilli Z, Noss R, Dickard J, Wei W, Chichura A, Wu V, Renicker K, Pederson HJ, Eng C. A Randomized Trial Comparing the Effectiveness of Pre-test Genetic Counseling Using an Artificial Intelligence Automated Chatbot and Traditional In-person Genetic Counseling in Women Newly Diagnosed with Breast Cancer. Ann Surg Oncol 2023; 30:5990-5996. [PMID: 37567976 DOI: 10.1245/s10434-023-13888-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 04/24/2023] [Accepted: 06/04/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Alternative service delivery models are critically needed to address the increasing demand for genetics services and limited supply of genetics experts available to provide pre-test counseling. METHODS We conducted a prospective randomized controlled trial of women with stage 0-III breast cancer not meeting National Comprehensive Cancer Network (NCCN) criteria for genetic testing. Patients were randomized to pre-test counseling with a Chatbot or a certified genetic counselor (GC). Participants completed a questionnaire assessing their knowledge of breast cancer genetics and a survey assessing satisfaction with their decision regarding pre-test counseling. RESULTS A total of 39 patients were enrolled and 37 were randomized to genetic counseling with an automated Chatbot or a GC; 19 were randomized to Chatbot and 18 to traditional genetic counseling, and 13 (38.2%) had a family member with breast cancer but did not meet NCCN criteria. All patients opted to undergo genetic testing. Testing revealed six pathogenic variants in five patients (13.5%): CHEK2 (n = 2), MSH3 (n = 1), MUTYH (n = 1), and BRCA1 and HOXB13 (n = 1). No patients had a delay in time-to-treatment due to genetic testing turnaround time, nor did any patients undergo additional risk reducing surgery. There was no significant difference in median knowledge score between Chatbot and traditional counseling (11 vs. 12, p = 0.09) or in median patient satisfaction score (30 vs. 30, p = 0.19). CONCLUSION Satisfaction and comprehension in patients with breast cancer undergoing pre-test genetic counseling using an automated Chatbot is comparable to in-person genetic testing. Utilization of this technology can offer improved access to care and a much-needed alternative for pre-test counseling.
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Affiliation(s)
- Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Ryan Noss
- Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer Dickard
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Wei Wei
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Anna Chichura
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Benign Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Vincent Wu
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kayla Renicker
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Holly J Pederson
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Charis Eng
- Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Sidiqi BU, Nosrati JD, Wu V, Kobritz M, La Gamma N, Whelan RL, Parashar B, King D, Tchelebi L, Herman JM. The Prevalence and Management of Synchronous Prostate and Rectal Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e339. [PMID: 37785185 DOI: 10.1016/j.ijrobp.2023.06.2398] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Synchronous prostate and rectal cancer is rare and guidelines for co-management are not well established. This case series explores the prevalence of synchronous diagnosis and different treatment paradigms to propose a standardized approach to management. MATERIALS/METHODS We retrospectively reviewed all radiation treatments between 1/2017 and 12/2022 for curative intent treatment to both prostate and rectal cancer. Synchronous was defined as rectal or prostate cancer diagnosed within a 6-month period of each other. We collected baseline characteristics and treatment paradigms including the sequencing of chemoradiation (CRT), chemotherapy (CT), prostate boost, and surgery. RESULTS There were 10 out of 2204 total treated patients with prostate or rectal primary noted to have a synchronous diagnosis (0.45%). Table 1 shows characteristics and treatment approach for all patients with 50% receiving CRT and 50% CT alone first. At a median FU of 21.4 months, 2 patients did not complete therapy due to patient choice and both had progression of disease (POD). After completion of CRT, 6 patients underwent rectal surgery with 2 pathological complete response, and 2 patients proceeded with a Watch and Wait approach with clinical complete response on MRI. Prostate boost was delivered equally as often pre-surgery as post-surgery with both SBRT, EBRT and Seed Implant used. There was no grade 3+ RT related toxicity in the patients who completed all therapy. CONCLUSION This series represents one of the largest synchronous prostate and rectal cancer cohorts treated with curative intent. Future collaborative work is needed to develop guidelines in the treatment of synchronous prostate and rectal cancers. Although a rare diagnosis, the heterogeneity of approaches has led us to propose a standardized approach to management of synchronous diagnosis with upfront chemotherapy followed by EBRT inclusive of prostate and rectum followed by boost via brachytherapy (SBRT in non-candidates).
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Affiliation(s)
- B U Sidiqi
- Department of Radiation Medicine, Northwell Health Cancer Institute, New Hyde Park, NY
| | - J D Nosrati
- Department of Radiation Medicine, Northwell Health Cancer Institute, New Hyde Park, NY
| | - V Wu
- Division of Medical Oncology/Hematology, Northwell Health Cancer Institute, New Hyde Park, NY
| | - M Kobritz
- Division of Surgery, Northwell Health Cancer Institute, New Hyde Park, NY
| | - N La Gamma
- Division of Surgery, Northwell Health Cancer Institute, New Hyde Park, NY
| | - R L Whelan
- Division of Surgery, Northwell Health Cancer Institute, New Hyde Park, NY
| | - B Parashar
- Department of Radiation Medicine, Northwell Health Cancer Institute, New Hyde Park, NY
| | - D King
- Department of Medical Oncology/Hematology, Northwell Health Cancer Institute, New Hyde Park, NY
| | - L Tchelebi
- Department of Radiation Medicine, Northwell Health Cancer Institute, New Hyde Park, NY
| | - J M Herman
- Department of Radiation Medicine, Northwell Health Cancer Institute, New Hyde Park, NY
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Al-Hilli Z, Noss R, Dickard J, Wei W, Chichura A, Wu V, Renicker K, Pederson HJ, Eng C. ASO Visual Abstract: A Randomized Trial Comparing the Effectiveness of Pre-test Genetic Counseling Using an Artificial Intelligence Automated Chatbot and Traditional In-person Genetic Counseling in Women Newly Diagnosed with Breast Cancer. Ann Surg Oncol 2023; 30:5997-5998. [PMID: 37599298 DOI: 10.1245/s10434-023-13989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Affiliation(s)
- Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Ryan Noss
- Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer Dickard
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Wei Wei
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Anna Chichura
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Benign Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Vincent Wu
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kayla Renicker
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Holly J Pederson
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Charis Eng
- Center for Personalized Genetic Healthcare, Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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11
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Tanaka M, Dai R, Randhawa A, Smolinski-Zhao S, Wu V, Walker TG, Daye D. Catheter Directed Thrombectomy and Other Deep Venous Interventions in Cancer Patients. Tech Vasc Interv Radiol 2023; 26:100900. [PMID: 37865450 DOI: 10.1016/j.tvir.2023.100900] [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: 10/23/2023]
Abstract
Treating cancer patients with deep venous thrombosis/venous thromboembolism (DVT/VTE) can be challenging as patients are frequently unable to receive the standard therapy of anticoagulation due to the increased risk of bleeding complications seen in this population. Similarly, the hesitation of interventionalists to use thrombolytic agents due to bleeding risks limits percutaneous intervention options as well. Further, outcome data and guidelines do not exist for oncologic patients and often treatment is tailored to patient-specific factors after multidisciplinary discussion. This article reviews specific factors to consider when planning percutaneous treatment of cancer patients with DVT/VTE, focusing on the iliocaval system.
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Affiliation(s)
- Mari Tanaka
- Department of Radiology - Interventional Radiology, Massachusetts General Hospital, Boston, MA
| | - Rui Dai
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Animan Randhawa
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | | | - Vincent Wu
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - T Gregory Walker
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Dania Daye
- Department of Radiology, Massachusetts General Hospital, Boston, MA.
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12
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Yu S, Grose E, Lee DJ, Wu V, Pellarin M, Lee JM. Evaluation of inverted papilloma recurrence rates and factors associated recurrence after endoscopic surgical resection: a retrospective review. J Otolaryngol Head Neck Surg 2023; 52:34. [PMID: 37106391 PMCID: PMC10134596 DOI: 10.1186/s40463-023-00638-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Sinonasal inverted papillomas (IP) are benign tumours arising from the mucosal lining of the nasal cavity and paranasal sinuses with a high propensity for recurrence and malignant transformation. Advances in endoscopic surgery and improved radiologic navigation have increased the role of endoscopic surgical resection in the treatment of IPs. The current study aims to evaluate the rate of IP recurrence after endoscopic endonasal resection and to evaluate factors which impact recurrence. METHODS This was a single-centre retrospective chart review of all patients who underwent endoscopic sinus surgery for management of IP between January 2009 and February 2022. Primary outcomes were the rate of IP recurrence and time to IP recurrence. Secondary outcome measures were patient and tumour factors that contributed to IP recurrence. RESULTS Eighty-five patients were included. The mean age was 55.7 and 36.5% of patients were female. The mean follow-up time was 39.5 months. Of the 85 cases, 13 cases (15.3%) had recurrence of their IP and the median time to recurrence was 22.0 months. All recurrent tumours recurred at the attachment site of the primary tumour. The univariate analysis did not identify any significant demographic, clinical, or surgical predictors of IP recurrence. There were no significant changes in sinonasal symptoms at the time IP recurrence was detected. CONCLUSION Endoscopic endonasal resection of IPs represents an effective surgical approach, however, the relatively high rate of recurrence and lack of symptomatic changes at the time of recurrence necessitates long term follow up. Better delineation of risk factors for recurrence can help identify high-risk patients and inform postoperative follow up strategies.
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Affiliation(s)
- Sheila Yu
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, 8 Cardinal Carter Wing, Toronto, ON, M5B 1W8, Canada
| | - Elysia Grose
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, 8 Cardinal Carter Wing, Toronto, ON, M5B 1W8, Canada
| | - Daniel J Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vincent Wu
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, 8 Cardinal Carter Wing, Toronto, ON, M5B 1W8, Canada
| | - Mitchell Pellarin
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, 8 Cardinal Carter Wing, Toronto, ON, M5B 1W8, Canada.
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Wu V, Samargandy S, Philteos J, Pasternak JD, de Almeida JR, Monteiro E. Evaluation of Preference and Utility Measures for Transoral Thyroidectomy. Ann Otol Rhinol Laryngol 2023; 132:381-386. [PMID: 35503808 PMCID: PMC9989232 DOI: 10.1177/00034894221094950] [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: 11/16/2022]
Abstract
BACKGROUND Traditional, trans-cervical thyroidectomy results in the presence of a neck scar, which has been shown to correlate with lower quality of life and lower patient satisfaction. Transoral thyroid surgery (TOTS) has been utilized as an alternative approach to avoid a cutaneous incision and scar by accessing the neck and thyroid through the oral cavity. This study was designed to evaluate patient preference through health-state utility scores for TOTS as compared to conventional trans-cervical thyroidectomy. METHODS In this cross-sectional study, patient preferences were elicited for TOTS and trans-cervical thyroidectomy with the use of an online survey. Respondents were asked to consider 4 hypothetical health scenarios involving thyroid surgery with varying approaches. Health-state utility scores were elicited using visual analog scale and standard gamble exercises. RESULTS Overall, 516 respondents completed the survey, of whom 261 (50.6%) were included for analysis, with a mean age of 41.5 years (SD 14.9 years), including 171 (65.5%) females. Health utility scores were similar for TOTS and conventional transcervical techniques. Statistically significant differences in the standard gamble utility score were noted for gender and ethnicity across all scenarios. Comparisons of visual analog score utilities were not statistically significant based on respondent demographics. CONCLUSION Preferences for TOTS and trans-cervical thyroidectomy did not significantly differ in the current study. Females and white ethnicity indicated stronger preference for a TOTs approach compared to males and other ethnicities, respectively. Some literature suggests certain types of patients who might prefer minimally invasive thyroidectomy more so than other patients-in keeping with the current findings of this study.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Shireen Samargandy
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Jesse D Pasternak
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
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Sunba S, Levin M, Wu V, Campisi P. The educational value of thyroidectomy YouTube videos for surgical trainees. Am J Otolaryngol 2023; 44:103799. [PMID: 37190995 DOI: 10.1016/j.amjoto.2023.103799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To evaluate the usefulness of thyroidectomy videos posted on YouTube for surgical training. METHODS The following keywords were searched on YouTube: "thyroidectomy", "conventional thyroidectomy", "hemithyroidectomy", and "thyroid lobectomy". The first 30 videos from each search were selected for a total of 120 videos. Included videos were those displaying a conventional approach to thyroidectomy and real, non-animated patient surgery. Two independent reviewers assessed each video using the LAParoscopic surgery Video Educational Guidelines (LAP-VEGaS) and a thyroidectomy-specific grading score (TSS). RESULTS The search yielded 22 videos that met the selection criteria. The inter-rater agreement was excellent for the grading systems (ICC = 0.910). The average LAP-VEGaS score was of medium quality (8.82 ± 3.56 standard deviation (SD)). The highest average score (11.00 ± 1.68 SD) was assigned to videos published from academic institutions. There was no statistically significant difference in LAP-VEGaS scores when comparing the type of publisher between videos (p = 0.132). The majority of the videos (12/22, 55 %) did not include all hallmarks of thyroidectomy according to the novel TSS score. There was a significant positive correlation between TSS markers and the overall LAP-VEGaS score (r = 0.577, p = 0.005). CONCLUSION YouTube videos as an educational resource for thyroidectomy instructions vary in quality. Most of the thyroidectomy videos were medium quality according to the LAP-VEGaS score. YouTube sourced thyroidectomy videos should be used to supplement traditional educational methods.
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15
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Wu V, Quinonez S, Myers M, Borodunovich K, Shamsi A, Stocker P, Fink B, Ferreira S. Risk Factor Analysis of Hospital Readmissions at St. Petersburg General Hospital. HCA Healthc J Med 2023; 4:35-42. [PMID: 37426563 PMCID: PMC10327956 DOI: 10.36518/2689-0216.1415] [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] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background Decreased readmission rates are largely seen as an indicator of effective care and improved resource management. The case management team at St. Petersburg General Hospital in St. Petersburg, Florida identified chronic obstructive pulmonary disease (COPD) exacerbation, pneumonia, and sepsis as 3 of the leading diagnoses on index admission that later led to 30-day readmissions. By examining patients with these 3 diagnoses on index admission, we decided to investigate potential readmission risk factors including patient age, sex, race, body mass index (BMI), length of stay during the index admission, insurance type during index admission, discharge placement after index admission, coronary artery disease, heart failure, and type 2 diabetes. Methods We conducted a retrospective study with data from 4180 patients at St. Petersburg General Hospital from 2016 through 2019 with index admission diagnoses of COPD exacerbation, pneumonia, and sepsis. A univariate analysis was conducted on patient sex, race, BMI, length of stay during the index admission, health insurance type during the index admission, discharge placement after the index admission, presence of coronary artery disease, presence of heart failure, and presence of type 2 diabetes. Subsequently, a bivariate analysis was run on these variables in relation to 30-day readmissions. Then a multivariable analysis was completed using binary logistic regression and pairwise analysis to determine the significance between variables within the categories of discharge disposition and insurance type. Results Of the 4180 patients included in this study, 926 (22.2%) were readmitted within 30 days of discharge. In the bivariate analysis race, BMI, mean length of stay during the index admission, coronary artery disease, heart failure, and type 2 diabetes were not significantly associated with readmission. The bivariate analysis revealed that patients discharged to skilled nursing facilities had the highest readmission rates (28%), followed by home care (26%) (P = .001). Medicaid patients (24%) and Medicare patients (23%) demonstrated higher read-mission rates than those with private insurance (17%) (P = .001). Readmitted patients were slightly younger (62.14 vs. 63.69 years; P = .02) in the bivariate analysis. However, in the multi-variable analysis, only patients with type 2 diabetes and patients with non-private insurance were associated with increased readmission rates. Pairwise analysis of the variables within insurance and discharge disposition categories demonstrates decreased readmission for individuals with Private/Other when compared to other insurance subtypes and decreased readmission for Other when compared to discharge disposition subtypes. Conclusion Our data demonstrate that hospital readmissions are associated with a diagnosis of type 2 diabetes and having a non-private insurance status. Our findings lead us to suggest further investigation into changes in hospital policies and procedures for these groups that will aim to decrease readmission rates in the future.
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Affiliation(s)
- Vincent Wu
- HCA Healthcare/USF Morsani College of Medicine GME Programs, St. Petersburg, FL
- HCA Florida St. Petersburg Hospital, St. Petersburg, FL
| | - Sean Quinonez
- HCA Healthcare/USF Morsani College of Medicine GME Programs, St. Petersburg, FL
- HCA Florida St. Petersburg Hospital, St. Petersburg, FL
| | - My Myers
- HCA Healthcare/USF Morsani College of Medicine GME Programs, St. Petersburg, FL
- HCA Florida St. Petersburg Hospital, St. Petersburg, FL
| | - Kyle Borodunovich
- HCA Healthcare/USF Morsani College of Medicine GME Programs, St. Petersburg, FL
- HCA Florida St. Petersburg Hospital, St. Petersburg, FL
| | - Aisha Shamsi
- HCA Healthcare/USF Morsani College of Medicine GME Programs, St. Petersburg, FL
- HCA Florida St. Petersburg Hospital, St. Petersburg, FL
| | - Patrick Stocker
- HCA Healthcare/USF Morsani College of Medicine GME Programs, St. Petersburg, FL
- HCA Florida St. Petersburg Hospital, St. Petersburg, FL
| | - Bryan Fink
- HCA Healthcare/USF Morsani College of Medicine GME Programs, St. Petersburg, FL
- HCA Florida St. Petersburg Hospital, St. Petersburg, FL
| | - Steven Ferreira
- HCA Healthcare/USF Morsani College of Medicine GME Programs, St. Petersburg, FL
- HCA Florida St. Petersburg Hospital, St. Petersburg, FL
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16
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Wu V, Kalva SP, Cui J. Thrombectomy approach for access maintenance in the end stage renal disease population: a narrative review. Cardiovasc Diagn Ther 2023; 13:265-280. [PMID: 36864975 PMCID: PMC9971289 DOI: 10.21037/cdt-21-523] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/20/2021] [Accepted: 12/15/2021] [Indexed: 11/06/2022]
Abstract
Objective This article reviews current practices and outcomes in endovascular thrombectomy techniques for the treatment of thrombosed arteriovenous grafts (AVGs) and fistulas (AVFs). Background Arteriovenous (AV) access allows patients with end-stage renal disease (ESRD) to receive hemodialysis. Thrombosis of AV access can lead to delay in hemodialysis or abandonment of access requiring dialysis catheter placement. Endovascular approach has become the preferred treatment option for thrombosed access over surgery. Interventions include removal of thrombus from the AV circuit and treatment of the underlying anatomical abnormality, such as an anastomotic stenosis. Thrombolysis, or the act of dissolving thrombus, is performed by using infusion catheters or pulse injector devices for the administration of fibrinolytic agents. Thrombectomy, or the mechanical removal of thrombus, is performed by using embolectomy balloon catheters, rotating baskets or wires, rheolytic and aspiration mechanisms. Adjunctive methods such as cutting balloon angioplasty, drug-coated balloon (DCB) angioplasty, and stent placement are also used to treat stenoses in the AV circuit. Complications of these procedures include vessel rupture, arterial embolism, pulmonary embolism (PE), and paradoxical embolism to the brain. Methods This narrative review article was written based on literature search from electronic databases, including PubMed and Google Scholar. Conclusions The understanding of thrombectomy techniques and their potential complications is essential in the management of patients with thrombosed AV access.
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Affiliation(s)
- Vincent Wu
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Sanjeeva P. Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Jie Cui
- Nephrology Division, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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17
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Hussain S, Almansouri A, Allanqawi L, Philteos J, Wu V, Chan Y. Does the journal impact factor predict individual article citation rate in otolaryngology journals? Ear Nose Throat J 2022:1455613221119051. [PMID: 35951539 DOI: 10.1177/01455613221119051] [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: 11/15/2022] Open
Abstract
OBJECTIVE Citation skew is a phenomenon that refers to the unequal citation distribution of articles in a journal. The objective of this study was to establish whether citation skew exists in Otolaryngology-Head and Neck Surgery (OHNS) journals and to elucidate whether journal impact factor (JIF) was an accurate indicator of citation rate of individual articles. METHODS Journals in the field of OHNS were identified using Journal Citation Reports. After extraction of the number of citations in 2020 for all primary research articles and review articles published in 2018 and 2019, a detailed citation analysis was performed to determine citation distribution. The main outcome of this study was to establish whether citation skew exists within OHNS literature and whether JIF was an accurate prediction of individual article citation rate. RESULTS Thirty-one OHNS journals were identified. Citation skew was prevalent across OHNS literature with 65% of publications achieving citation rates below the JIF. Furthermore, 48% of publications gathered either zero or one citation. The mean and median citations for review articles, 3.66 and 2, respectively, were higher than the mean and median number of citations for primary research articles, 1 and 2.35, respectively (P < .001). A statistically significant correlation was found between citation rate and JIF (r = 0.394, P = 0.028). CONCLUSIONS The current results demonstrate a citation skew among OHNS journals, which is in keeping with findings from other surgical subspecialties. The majority of publications did not achieve citation rates equal to the JIF. Thus, the JIF should not be used to measure the quality of individual articles. Otolaryngologists should assess the quality of research through the use of other metrics, such as the evaluation of sound scientific methodology, and the relevance of the articles.
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Affiliation(s)
- Salman Hussain
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Justine Philteos
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Yvonne Chan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
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18
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Levin M, Wu V, Lee DJ, Cusimano MD, Lee JM. Validity and Usefulness of YouTube Videos Related to Endoscopic Transsphenoidal Surgery for Patient Information. J Neurol Surg B Skull Base 2022; 83:e54-e59. [PMID: 35832957 DOI: 10.1055/s-0040-1722269] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/08/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives This article evaluates the completeness and accuracy of YouTube videos related to endoscopic transsphenoidal surgery (ETS) as a source for patient information. Design YouTube was searched using relevant terms pertaining to ETS. Videos were evaluated independently by two physician reviewers experienced in ETS. Video demographics including uploader source along with validity scores based on predetermined checklists were captured. Setting Internet. Participants Not applicable. Main Outcome Measures A novel ETS scoring checklist, the modified DISCERN criteria, and Journal of the American Medical Association (JAMA) benchmark score were used to measure completeness and accuracy of videos. video power index (VPI) was calculated to reflect popularity. Intraclass correlation coefficient was calculated for rater agreement. Results Seventy-nine videos were included in final scoring and analysis. The ETS score, DISCERN, JAMA, and mean VPI across all included videos were 5.0 ± 2.7, 2.4 ± 0.83, 2.19 ± 0.62, and 8.92 ± 18.1, respectively. Based on the ETS score checklist, 31 (39%) of the videos were rated as poor, 30 (38%) were moderately useful, 17 (22%) were useful, and 1 (1%) was exceptional. There was a significant positive correlation between the ETS, DISCERN, and JAMA scores ( p < 0.001), but no correlation with VPI and the validity scores. There were no significant differences comparing validity scores based on the uploader source. Conclusion YouTube videos related to ETS have limited usefulness and poor overall validity for patient information. Clinicians should direct patients to other validated sources of information and aim to improve the comprehensiveness of ETS-related videos.
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Affiliation(s)
- Marc Levin
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Wu
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Lee
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Cusimano
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Konteti V, Wu V, Smith B, Ramesh Y. An Editorial Review of Prognostic Awareness and Considerations for the Clinical Setting. Clin Oncol (R Coll Radiol) 2022; 34:376-378. [DOI: 10.1016/j.clon.2022.03.004] [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: 11/07/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/03/2022]
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20
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Wu V, Lo N, Lin RJ, Zirkle M, Anderson J, Lee JM. Admission of Patients With Obstructive Sleep Apnea Undergoing Ambulatory Surgery in Otolaryngology-Head and Neck Surgery. Ann Otol Rhinol Laryngol 2021; 131:941-945. [PMID: 34590890 PMCID: PMC9340133 DOI: 10.1177/00034894211048783] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Within Otolaryngology—Head and Neck Surgery (OHNS), obstructive sleep apnea (OSA) patients are frequently encountered. To implement policies and screening measures for admission of OSA patients undergoing ambulatory surgery, actual rates of admission must first be determined. We aimed to evaluate rates and reasons for admission of OSA patients after ambulatory OHNS surgery. Methods: Retrospective chart review was undertaken of all OSA patients undergoing elective day-surgery OHNS procedures at a tertiary center from January 1, 2018 to December 31, 2019. The primary outcome measure was percentage of OSA patients admitted to hospital after ambulatory OHNS surgery. Secondary outcome measures included reasons for admission. American Society of Anesthesiologists (ASA) score, perioperative complications, and patient demographics were captured. Results: There were 118 OSA patients, out of 1942 cases performed during the review period. Thirty-eight were excluded as the procedures were not considered ambulatory. The remaining 80 OSA patients were included for analysis, with an average age of 51.7, SD 13.8, and 30 (38%) females. The admission rate was 47.5% (38/80 patients). Admitted patients were older (P = .0061), and had higher ASA (P = .039). Indication for surgery or type of surgery did not differ among admitted and non-admitted patients. The majority of patients, 97% (37/38 patients), were admitted for post-operative monitoring. Conclusion: More than half of OSA patients did not require admission to hospital after ambulatory OHNS surgery, unaffected by indications for surgery or type of surgery. Higher ASA score and older age were found in admitted as compared to non-admitted patients.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology—Head and Neck Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Nick Lo
- Department of Anesthesiology and Pain Medicine, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - R. Jun Lin
- Department of Otolaryngology—Head and Neck Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Molly Zirkle
- Department of Otolaryngology—Head and Neck Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Jennifer Anderson
- Department of Otolaryngology—Head and Neck Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - John M. Lee
- Department of Otolaryngology—Head and Neck Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- John M. Lee, MD, FRCSC, MSc, Department of Otolaryngology—Head and Neck Surgery, St. Michael’s Hospital, University of Toronto, 30 Bond Street, 8 Cardinal Carter Wing, Toronto, ON M5B 1W8, Canada.
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21
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Forner D, Noel CW, Grant A, Hong P, Corsten M, Wu V, Taylor SM, Trites JRB, Rigby MH. Management of Peritonsillar Abscesses in Adults: Survey of Otolaryngologists in Canada and the United States. OTO Open 2021; 5:2473974X211044081. [PMID: 34541442 PMCID: PMC8445538 DOI: 10.1177/2473974x211044081] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The management of peritonsillar abscess (PTA) has evolved over time. We sought to define contemporary practice patterns for the diagnosis and treatment of PTA. Study Design Cross-sectional survey. Setting The 15-question survey was distributed to members of the Canadian Society of Otolaryngology–Head and Neck Surgery (CSO) and the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS). Methods An iterative, consensus-based process was used for survey development. Primary outcomes were to determine methods of diagnosis and first-line treatments for PTA. Exploratory, secondary outcomes were analyzed using multivariable logistic regression models. Results The survey response rate was 12.6% (n = 1176). Most participants were attending staff (86%) in a community hospital setting (60%) and had been in practice for more than 20 years (38%). Most respondents (78%) indicated that at least half of the time, cross-sectional imaging had already been performed before they were consulted. Half of respondents (49%) indicated that they perform incision and drainage of the abscess as first-line treatment, while few (16%) provide medical management alone. In exploratory analysis, participants from the AAO-HNS had higher odds of imaging already being performed before consultation (odds ratio [OR], 11.7; 95% CI, 4.6-29.4) and increased odds of using medical management alone as a first-line treatment (OR, 2.4; 95% CI, 1.3-4.2) compared to respondents from the CSO. Conclusion There is wide practice variation in the diagnosis and management of acute, uncomplicated PTA among otolaryngologists in Canada and the United States. The use of cross-sectional imaging and medical management alone may differ between countries of practice.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.,Maritime SPOR (Strategy for Patient-Oriented Research) Support Unit (MSSU), Halifax, Nova Scotia, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amy Grant
- Maritime SPOR (Strategy for Patient-Oriented Research) Support Unit (MSSU), Halifax, Nova Scotia, Canada
| | - Paul Hong
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.,Maritime SPOR (Strategy for Patient-Oriented Research) Support Unit (MSSU), Halifax, Nova Scotia, Canada.,IWK Health Center, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - S Mark Taylor
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan R B Trites
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew H Rigby
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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22
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Hamour AF, Yang W, Lee JJW, Wu V, Ziai H, Singh P, Eskander A, Sahovaler A, Higgins K, Witterick IJ, Vescan A, Freeman J, de Almeida JR, Goldstein D, Gilbert R, Chepeha D, Irish J, Enepekides D, Monteiro E. Association of the Implementation of a Standardized Thyroid Ultrasonography Reporting Program With Documentation of Nodule Characteristics. JAMA Otolaryngol Head Neck Surg 2021; 147:343-349. [PMID: 33570552 DOI: 10.1001/jamaoto.2020.5233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Although most thyroid nodules are benign, the potential for malignant neoplasms is associated with unnecessary workup in the form of imaging, fine-needle aspiration, and diagnostic surgery. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is commonly used to assess the malignant neoplasm risk potential of thyroid nodules imaged by ultrasonography. However, standardized reporting of ACR TI-RADS descriptors is inconsistent. Objective To increase the documentation rate of ACR TI-RADS thyroid nodule characteristics to 80% in 18 months. Design, Setting, and Participants This prospective interrupted time series quality improvement study was conducted from December 1, 2018, to March 31, 2020, at a tertiary outpatient head and neck clinic among 229 patients who had at least 1 documented thyroid nodule identified on bedside clinic ultrasonography. Data analysis was performed throughout the entire study period because this was a quality improvement study with iterative small cycle changes; final analysis of the data was performed in April 2020. Main Outcomes and Measures The primary outcome was the documentation rates of 6 ACR TI-RADS ultrasonographic descriptors. Secondary outcomes included nodule fine-needle aspiration biopsy rate and physician-reported clinic flow efficiency. Results A total of 229 patients had at least 1 documented thyroid nodule and were included in the analysis. Size was the most frequently documented nodule characteristic (72 of 74 [97.3%]) at baseline, followed by echogenic foci (31 of 74 [41.9%]), composition (23 of 74 [31.1%]), echogenicity (17 of 74 [23.0%]), margin (6 of 74 [8.1%]), and shape (1 of 74 [1.4%]). After 3 Plan, Do, Study, Act (PDSA) cycles, the final intervention consisted of a standardized ultrasonography reporting form and educational initiatives for surgical trainees. After the third PDSA cycle (n = 36), reporting of nodule size, echogenic foci, and composition increased to 100%. Similarly, reporting of echogenicity (34 of 36 [94.4%]), shape (28 of 36 [77.8%]), and margin (25 of 36 [69.4%]) all increased. This represented a cumulative 90.3% documentation rate (195 of 216), a 56.5% increase from baseline (95% CI, 50.0%-61.9%). The standardized reporting form was used in 83.3% of eligible thyroid ultrasonography cases (30 of 36) after PDSA cycle 3, demonstrating good fidelity of implementation. There were no unintended consequences associated with clinic workflow, as a balancing measure, reported by staff surgeons. Conclusions and Relevance This study suggests that implementation of an ACR TI-RADS-based reporting form in conjunction with educational initiatives improved documentation of ultrasonographic thyroid nodule characteristics, potentially allowing for improved bedside risk stratification and communication among clinicians.
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Affiliation(s)
- Amr F Hamour
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John J W Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Praby Singh
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Scarborough Hospital, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Allan Vescan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - David Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Douglas Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
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Kim JH, Grose E, Philteos J, Forner D, Noel CW, Wu V, Eskander A. Readability of the American, Canadian, and British Otolaryngology-Head and Neck Surgery Societies' Patient Materials. Otolaryngol Head Neck Surg 2021; 166:862-868. [PMID: 34372717 PMCID: PMC9066686 DOI: 10.1177/01945998211033254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 01/08/2023]
Abstract
Objective Patient education materials across 3 national English otolaryngology–head and neck surgery (OHNS) societies: the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), the Canadian Society of Otolaryngology–Head and Neck Surgery (CSOHNS), and Ear, Nose, and Throat United Kingdom (ENT UK) were examined to determine whether they are written at a level suitable for patient comprehension. Study Design Cross-sectional study. Setting Online patient materials presented through OHNS national societies. Methods Readability was calculated using the Flesch-Kincaid Grade Level, Flesch-Kincaid Reading Ease Score, and Simple Measure of Gobbledygook Index. All public patient education materials available through the CSOHNS, AAO-HNS, and ENT UK websites were assessed. Patient education materials were grouped into categories by subspecialty. Results In total, 128 patient materials from the 3 societies were included in the study. All 3 societies required a minimum grade 9 reading comprehension level to understand their online materials. According to Flesch-Kincaid Grade Level, the CSOHNS required a significantly higher reading grade level to comprehend the materials presented when compared to AAO-HNS (11.3 vs 9.9; 95% CI, 0.5-2.4; P < .01) and ENT UK (11.3 vs 9.4; 95% CI, 0.9-2.9; P < .01). Patient education materials related to rhinology were the least readable among all 3 societies. Conclusion This study suggests that the reading level of the current patient materials presented through 3 national OHNS societies are written at a level that exceeds current recommendations. Promisingly, it highlights an improvement for the readability of patient materials presented through the AAO-HNS.
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Affiliation(s)
- Joo Hyun Kim
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elysia Grose
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Department of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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24
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Wu V, Lee JM, Vozoris NT, Faughnan ME. Weekly epistaxis duration as an indicator of epistaxis severity in hereditary hemorrhagic telangiectasia-Preliminary results from a randomized controlled trial. Laryngoscope Investig Otolaryngol 2021; 6:370-375. [PMID: 34195356 PMCID: PMC8223446 DOI: 10.1002/lio2.561] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/04/2021] [Accepted: 03/29/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES There is great interest in developing and studying novel therapies for epistaxis in hereditary hemorrhagic telangiectasia (HHT) given its associated morbidity and impact on patients' quality of life. Several recent randomized controlled trials (RCTs) have been negative, likely attributed to poorly characterized outcome measures. This study reported on and evaluated an epistaxis outcome measure, weekly epistaxis duration (WED) in an ongoing RCT, with the aim of better characterizing the measurement of epistaxis for clinical trials. MATERIALS AND METHODS Patients were recruited to an ongoing phase II, double-blind, cross-over RCTs of oral doxycycline for HHT-associated epistaxis. Patients were included for the epistaxis measures analysis if they had already completed the initial 3-month run-in period, and had received treatment of either study drug doxycycline or placebo for a minimum of 6 months. The primary measure of interest was patient-reported outcome (PRO)-WED, captured from prospective daily diaries. Epistaxis severity score (ESS) was collected as a secondary outcome. RESULTS Seven patients were included for analysis, with 98% completion of the daily diary. The average PRO-WED across all patients was 85.0 minutes, SD 93.2 at baseline, and 65.6 minutes, SD 59.5 during treatment/placebo. Coefficient of variance for PRO-WED at baseline and during treatment/placebo was 0.49, SD 0.1 and 0.58, SD 0.2, respectively. Statistically significant changes in the mean PRO-WED from baseline to treatment/placebo was noted in six patients (86%). Only two patients (29%) had a significant change in ESS, with both reporting decreased (improved) scores after treatment/placebo as compared to baseline. CONCLUSIONS PRO-WED was a feasible clinical trials measure, was reasonably stable during baseline measurement, and appeared to be variable with treatment state, suggesting it may provide a sensitive clinical trials PRO in HHT.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology – Head and Neck SurgerySt. Michael's Hospital, University of TorontoTorontoCanada
| | - John M. Lee
- Department of Otolaryngology – Head and Neck SurgerySt. Michael's Hospital, University of TorontoTorontoCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoCanada
| | - Nicholas T. Vozoris
- Division of Respirology, Department of MedicineSt. Michael's Hospital, University of TorontoTorontoCanada
| | - Marie E. Faughnan
- Division of Respirology, Department of MedicineSt. Michael's Hospital, University of TorontoTorontoCanada
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25
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Wu V, Manojlovic Kolarski M, Kandel CE, Monteiro E, Chan Y. Current trend of antibiotic prescription and management for peritonsillar abscess: A cross-sectional study. Laryngoscope Investig Otolaryngol 2021; 6:183-187. [PMID: 33869749 PMCID: PMC8035939 DOI: 10.1002/lio2.538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/11/2021] [Accepted: 02/03/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE There are no consensus guidelines for managing peritonsillar abscess (PTA) despite its prevalence. In order to devise best practice guidelines, current practice patterns must first be established. METHODS This was a cross-sectional study, surveying Otolaryngology-Head & Neck Surgery trainees (residents and fellows) and consultant (academic and community). The primary outcome was the type and duration of outpatient antibiotic prescription. Secondary outcomes included differences in workup, management, prescription, and follow-up. RESULTS There were 57 respondents to the survey; 24 (42%) trainees (residents/fellows) and 33 (58%) consultants. On average, each respondent managed an average of 15.2 (SD 11.2) PTAs within the last year. All respondents prescribed oral antibiotics, with amoxicillin-clavulanic acid being the most common (61%). Trainees prescribed amoxicillin-clavulanic acid more often than consultants (n = 21, 88% vs n = 14, 42%, P = .0084), respectively. Duration of antibiotic therapy ranged from 5 to 14 days. Most commonly, a 10-day course of antibiotics was prescribed (n = 31, 54%). Regarding the management of PTAs, a majority of respondents requested blood work (n = 39, 68%), performed needle aspiration (n = 42, 72%) and performed incision and drainage (n = 52, 91%). Culture and sensitivity of the aspirate/drainage fluid was frequently performed (n = 41, 72%). Patients were often provided non-opioid analgesics (n = 46, 81%), but more than half still received prescription opioids (n = 36, 63%). The majority of clinicians arranged for follow-up (n = 42, 74%), most often with Otolaryngology - Head & Neck Surgery (n = 27, 64%), with an average follow-up of 12.5 (SD 8.2) days. CONCLUSION We found heterogeneity in the management of PTAs, with variability in the outpatient antibiotic prescription. This study highlighted the wide range of management strategies employed along with differences in workup, investigation, post-discharge analgesic prescription, and follow-up arrangements. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology – Head & Neck SurgeryUniversity of TorontoTorontoCanada
| | | | - Christopher E. Kandel
- Division of Infectious Diseases, Department of Medicine, Sinai Healthcare SystemsUniversity of TorontoTorontoCanada
| | - Eric Monteiro
- Department of Otolaryngology – Head & Neck SurgeryUniversity of TorontoTorontoCanada
| | - Yvonne Chan
- Department of Otolaryngology – Head & Neck SurgeryUniversity of TorontoTorontoCanada
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26
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Grose EM, Holmes CP, Aravinthan KA, Wu V, Lee JM. Readability and quality assessment of internet-based patient education materials related to nasal septoplasty. J Otolaryngol Head Neck Surg 2021; 50:16. [PMID: 33731227 PMCID: PMC7970817 DOI: 10.1186/s40463-021-00507-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/05/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Given that nasal septoplasty is a common procedure in otolaryngology - head and neck surgery, the objective of this study was to evaluate the quality and readability of online patient education materials on septoplasty. METHODS A Google search was performed using eight different search terms related to septoplasty. Six different tools were used to assess the readability of included patient education materials. These included the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning-Fog Index, Simple Measure of Gobbledygook Index, Coleman-Liau Index, and Automated Readability Index. The DISCERN tool was used to assess quality and reliability. RESULTS Eighty-five online patient education materials were included. The average Flesch-Reading Ease score for all patient education materials was 54.9 ± 11.5, indicating they were fairly difficult to read. The average reading grade level was 10.5 ± 2.0, which is higher than the recommended reading level for patient education materials. The mean DISCERN score was 42.9 ± 10.5 and 42% (36/85) of articles had DISCERN scores less than 39, corresponding to poor or very poor quality. CONCLUSION The majority of online patient education materials on septoplasty are written above the recommended reading levels and have significant deficiencies in terms of their quality and reliability. Clinicians and patients should be aware of the shortcomings of these resources and consider the impact they may have on patients' decision making.
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Affiliation(s)
- Elysia M Grose
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Connor P Holmes
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Vincent Wu
- Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Sykes EA, Lemke M, Potter D, Li T, Mir ZM, Sheahan G, Wu V, Zevin B. Evaluating bowel enterotomy closures in simulated deep body cavities using the reversing half-hitch alternating post and square knots: a randomized controlled trial. Can J Surg 2021; 64:E59-E65. [PMID: 33533581 PMCID: PMC7955827 DOI: 10.1503/cjs.016719] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Square knots can be difficult to construct in deep body cavities. The reversing half-hitch alternating post (RHAP) surgical knot has noninferior tensile strength and performance characteristics in deep body cavities. We compared the enterotomy repairs of novice learners in simulated deep body cavities using RHAP versus square knots after proficiency-based training. Methods Undergraduate students were randomized to RHAP (n = 10) or square knot (n = 10) groups and trained to defined proficiency. They then performed hand-sewn enterotomy repairs of cadaveric porcine small bowels on flat surfaces and in simulated deep body cavities. We recorded time to knot-tying proficiency and to enterotomy repair, and burst pressures for the repair. Results Mean time-to-proficiency in knot tying was equivalent between the RHAP and square knot groups (23 [standard deviation (SD) 3] v. 21 [SD 2] min, p = 0.33). Mean time for enterotomy repair in deep cavities was shorter for the RHAP group (16 [SD 2] min v. 21 [SD 1] min, p = 0.02). Mean burst pressures for enterotomy repair were equivalent on flat surfaces (128 [SD 41] v. 101 [SD 36] mm Hg, p = 0.31), and were significantly higher for the RHAP group in simulated deep body cavities (32 [SD 13] v. 105 [SD 37] mm Hg, p = 0.05). Conclusion The RHAP knots appear to have superior performance versus square knots when tied in a deep body cavity by novice learners. Future work should focus on demonstrating the clinical relevance and broad utility of the RHAP knot in abdominal surgery. Both knot types should be taught to novice learners.
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Affiliation(s)
- Edward A Sykes
- From the School of Medicine, Queen's University, Kingston, Ont. (Sykes, Lemke, Potter, Zevin); the Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ont. (Li); the Department of Surgery, Division of General Surgery, Queen's University, Kingston, Ont. (Mir, Sheahan, Zevin); and the Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ont. (Sykes, Wu)
| | - Madeline Lemke
- From the School of Medicine, Queen's University, Kingston, Ont. (Sykes, Lemke, Potter, Zevin); the Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ont. (Li); the Department of Surgery, Division of General Surgery, Queen's University, Kingston, Ont. (Mir, Sheahan, Zevin); and the Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ont. (Sykes, Wu)
| | - Daniel Potter
- From the School of Medicine, Queen's University, Kingston, Ont. (Sykes, Lemke, Potter, Zevin); the Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ont. (Li); the Department of Surgery, Division of General Surgery, Queen's University, Kingston, Ont. (Mir, Sheahan, Zevin); and the Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ont. (Sykes, Wu)
| | - Terry Li
- From the School of Medicine, Queen's University, Kingston, Ont. (Sykes, Lemke, Potter, Zevin); the Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ont. (Li); the Department of Surgery, Division of General Surgery, Queen's University, Kingston, Ont. (Mir, Sheahan, Zevin); and the Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ont. (Sykes, Wu)
| | - Zuhaib M Mir
- From the School of Medicine, Queen's University, Kingston, Ont. (Sykes, Lemke, Potter, Zevin); the Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ont. (Li); the Department of Surgery, Division of General Surgery, Queen's University, Kingston, Ont. (Mir, Sheahan, Zevin); and the Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ont. (Sykes, Wu)
| | - Guy Sheahan
- From the School of Medicine, Queen's University, Kingston, Ont. (Sykes, Lemke, Potter, Zevin); the Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ont. (Li); the Department of Surgery, Division of General Surgery, Queen's University, Kingston, Ont. (Mir, Sheahan, Zevin); and the Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ont. (Sykes, Wu)
| | - Vincent Wu
- From the School of Medicine, Queen's University, Kingston, Ont. (Sykes, Lemke, Potter, Zevin); the Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ont. (Li); the Department of Surgery, Division of General Surgery, Queen's University, Kingston, Ont. (Mir, Sheahan, Zevin); and the Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ont. (Sykes, Wu)
| | - Boris Zevin
- From the School of Medicine, Queen's University, Kingston, Ont. (Sykes, Lemke, Potter, Zevin); the Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ont. (Li); the Department of Surgery, Division of General Surgery, Queen's University, Kingston, Ont. (Mir, Sheahan, Zevin); and the Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ont. (Sykes, Wu)
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Bulman JC, Zurkiya O, Wu V, Wehrenberg-Klee E, Palmer E, Chow D, Brook A, Ganguli S. Repeat Evaluation of Lung Shunt Fraction is Unnecessary: A Retrospective Observational Study of Successive Lung Shunt Fractions from Variable Arterial Distributions in Patients Undergoing Radioembolization of Primary and Secondary Liver Tumors. J Vasc Interv Radiol 2020; 32:412-418. [PMID: 33341340 DOI: 10.1016/j.jvir.2020.11.005] [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] [Received: 07/16/2020] [Revised: 10/15/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate whether the recalculation of lung shunt fraction (LSF) is necessary prior to next-stage or same lobe repeat radioembolization. MATERIALS AND METHODS Retrospective chart review was performed for patients who underwent radioembolization between February 2008 and December 2018. Eighty of 312 patients had repeat mapping angiograms and LSF calculations. A total of 160 LSF calculations were made using planar imaging (155, [97%]) and single-photon emission computed tomography (5 [3%]) technetium-99m macroaggregated albumin hepatic arterial injection imaging. The mean patient age was 61.8 years ± 12.7; 69 (86%) patients had metastatic disease and 11 (14%) had hepatocellular carcinoma. RESULTS Patients had a median LSF of 5% (interquartile range [IQR] 3%-9%) with a median absolute difference of 1.25 (IQR 0.65-3.4) and a median of 76 days (IQR 42.5-120 days) between repeat LSF calculations. There was a median change in LSF of 0.2% between mapping studies (P = .11). There was no statistical significance between the repeat LSFs regardless of the arterial distribution (P = .79) or between tumor types (P = .75). No patients exceeded lung dose limits using actual or predicted prescribed dose amounts. The actual median lung dose was 2.6 Gy (IQR 1.8-4.4 Gy, maximum = 20.5) for the first radioembolization and 2.0 Gy (IQR 1.3-3.7 Gy, maximum = 10.1) for the second radioembolization. CONCLUSIONS No significant difference in LSF was identified between different time points and arterial distributions within the same patient undergoing repeat radioembolization. In patients who receive well under 30-Gy lung dose for the initial treatment and a 50-Gy cumulative lung dose, repeat radioembolization treatments in the same patient may not require a repeat LSF calculation.
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Affiliation(s)
- Julie C Bulman
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02215.
| | - Omar Zurkiya
- Massachusetts General Hospital, 55 Fruit Street GRB 298, Boston, MA 02114
| | - Vincent Wu
- Massachusetts General Hospital, 55 Fruit Street GRB 298, Boston, MA 02114
| | | | - Edwin Palmer
- Massachusetts General Hospital, 55 Fruit Street GRB 298, Boston, MA 02114
| | - David Chow
- Massachusetts General Hospital, 55 Fruit Street GRB 298, Boston, MA 02114
| | - Alexander Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02215
| | - Suvranu Ganguli
- Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118
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Noel CW, Forner D, Wu V, Enepekides D, Irish JC, Husain Z, Chan KKW, Hallet J, Coburn N, Eskander A. Predictors of surgical readmission, unplanned hospitalization and emergency department use in head and neck oncology: A systematic review. Oral Oncol 2020; 111:105039. [PMID: 33141060 DOI: 10.1016/j.oraloncology.2020.105039] [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: 07/21/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To identify predictors of unplanned hospitalization and emergency department (ED) use among head and neck oncology patients. METHODS Peer reviewed publications were identified through a systematic search of MEDLINE, Embase and Cochrane CENTRAL. Studies describing a cohort of HNC patients that detailed predictors of unplanned hospitalization or ED use in risk-adjusted models were eligible for inclusion. The methodologic quality of included studies was assessed using the Quality In Prognostic Studies (QUIPS) tool and an adapted version of the GRADE framework. RESULTS Of the 932 articles identified, 39 studies met our inclusion criteria with 31/39 describing predictors of surgical readmission and 10/39 describing predictors of ED use or unplanned hospitalization during radiation/chemoradiation treatment. Risk factors were classified into either 'patient-related', 'cancer severity' or 'process' factors. In the subset of studies looking at readmission following surgery wound complications (10/14 studies), presence of comorbidity (16/28 studies), low socioeconomic status (8/17 studies), cancer stage (9/14 studies), and prolonged hospital stay (7/18 studies) were the variables most frequently associated with readmission on multivariable analysis. Presence of comorbidity (6/10) and chemotherapy use (4/10) were more frequently associated with ED use and unplanned hospitalization. CONCLUSIONS Several consistent predictors have been identified across a variety of studies. This work is a critical first step towards the development of readmission and ED prediction models. It also enables meaningful comparison of hospital readmission rates with risk adjustment in HNC patients.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Natalie Coburn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
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Gerolami J, Wu V, Fauerbach PN, Jabs D, Engel CJ, Rudan J, Merchant S, Walker R, Anas EMA, Abolmaesumi P, Fichtinger G, Ungi T, Mousavi P. An End-to-End Solution for Automatic Contouring of Tumor Region in Intraoperative Images of Breast Lumpectomy. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:2003-2006. [PMID: 33018396 DOI: 10.1109/embc44109.2020.9176505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Breast-conserving surgery, also known as lumpectomy, is an early stage breast cancer treatment that aims to spare as much healthy breast tissue as possible. A risk associated with lumpectomy is the presence of cancer positive margins post operation. Surgical navigation has been shown to reduce cancer positive margins but requires manual segmentation of the tumor intraoperatively. In this paper, we propose an end-to-end solution for automatic contouring of breast tumor from intraoperative ultrasound images using two convolutional neural network architectures, the U-Net and residual U-Net. The networks are trained on annotated intraoperative breast ultrasound images and evaluated on the quality of predicted segmentations. This work brings us one step closer to providing surgeons with an automated surgical navigation system that helps reduce cancer-positive margins during lumpectomy.
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31
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Tsai YC, Lai SH, Ho CJ, Wu FM, Henrickson L, Wei CC, Chen I, Wu V, Chen J. High Accuracy Respiration and Heart Rate Detection Based on Artificial Neural Network Regression. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:232-235. [PMID: 33017971 DOI: 10.1109/embc44109.2020.9175161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 24GHz Doppler radar system for accurate contactless monitoring of heart and respiratory rates is demonstrated here. High accuracy predictions are achieved by employing a CNN+LSTM neural network architecture for regression analysis. Detection accuracies of 99% and 98% have been attained for heart rate and respiration rate, respectively.Clinical Relevance- This work establishes a non-contact radar system with 99% detection accuracy for a heart rate variability warning system. This system can enable convenient and fast monitoring for daily care at home.
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Abstract
OBJECTIVE To evaluate the quality of information presented on YouTube regarding functional endoscopic sinus surgery (FESS) for patients. METHODS YouTube was searched using FESS-specific keywords under the setting of "relevance." The first 50 videos from each keyword were reviewed and analyzed by 2 independent physician reviewers. Videos not related to FESS and duplicates were excluded. Outcome measures included the modified DISCERN score (range 0-5), the Journal of the American Medical Association (JAMA) benchmark criteria (range: 0-4), a novel scoring checklist for FESS assessing usefulness (range: 0-16), and the Video Power Index (VPI). Intraclass correlation coefficient (ICC) was calculated. RESULTS Of the 200 videos identified, 95 videos were analyzed after exclusions. Videos had an average VPI of 40.8 and SD 133.2. Average scores from the 3 objective checklists among all videos were low: modified DISCERN: 1.91, SD: 1.15; JAMA benchmark: 1.91, SD: 0.76; and FESS score: 3.54, SD: 1.77. The ICC between the 2 independent reviewers was excellent for all 3 checklists. We noted significant positive Pearson correlation between all 3 checklist scores (P < .001). In between-group comparisons of mean scores, there was significantly higher DISCERN and JAMA scores for videos from university/professional organizations, as compared to videos from medical advertising/for-profit companies and independent users. There were no significant differences in FESS scores noted between the 3 groups. CONCLUSION There were overall low scores across the modified DISCERN, JAMA benchmark criteria, and FESS scoring checklists, reflecting the poor quality of YouTube videos as a source of patient information for FESS.
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Affiliation(s)
- Vincent Wu
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Daniel J Lee
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Allan Vescan
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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Brickman AR, Wu V, Zevin B. Preparing for Surgery Observerships During Medical School: A Cross-Sectional Study. J Surg Educ 2020; 77:1097-1105. [PMID: 32434687 DOI: 10.1016/j.jsurg.2020.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Observerships are self-organized experiences for medical students to accompany a university affiliated physician in a clinical setting. Our study's objective was to evaluate year 1 and 2 medical students' experience with and preparation methods for surgery observerships at a Canadian medical school. DESIGN A cross-sectional online survey of preclerkship students, capturing resources used to prepare for observerships, types of observerships completed, and reasons for participating. Descriptive statistics were used to report demographics, observership types, and preparation methods. Gender differences in observership types were analyzed using two-way analysis of variance. SETTING Queen's University. PARTICIPANTS All preclerkship medical students (years 1 and 2) were invited to participate. RESULTS Of the 64 respondents (64/202), 46 (71.9%) were female and 53 (82.8%) participated in at least 1 surgery observership. The most common observerships were General Surgery (53.8%, 28/53), Obstetrics and Gynecology (50.1%), and Orthopedic Surgery (37.7%). There was no significant difference between genders in the number of surgery versus nonsurgery observerships. Common reasons for participating in surgery observerships included: "may not have opportunities in the future" (52.8%) and "rule in surgery as a career" (50.9%). Majority (64.2%) of students prepared for observerships and spent on average 1.3 ± 0.6 hours preparing. Commonly used resources included class notes (82.4%), and online videos (73.5%). Most respondents (91.0%) who prepared noted preparation was associated with a positive learning experience. Most respondents (67.1%) reported a lack of resources provided on how to prepare. CONCLUSIONS Preparing for observerships was associated with a positive experience and most students used class notes and online videos. There was a lack of instructions and resources on how to prepare. Developing appropriate resources for pre-clerkship medical students to prepare may improve overall experiences and increase interest in surgery.
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Affiliation(s)
- Arielle R Brickman
- Department of Surgery, Kingston General Hospital, Queen's University School of Medicine, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Vincent Wu
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Boris Zevin
- Department of Surgery, Kingston General Hospital, Queen's University School of Medicine, Faculty of Health Sciences, Kingston, Ontario, Canada.
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Wu V, Noel CW, Forner D, Mok F, Zirkle M, Eskander A, Lin V, Lee JM. Otolaryngology needs among an adult homeless population: a prospective study. J Otolaryngol Head Neck Surg 2020; 49:47. [PMID: 32646479 PMCID: PMC7346481 DOI: 10.1186/s40463-020-00445-2] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/30/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Homeless individuals frequently experience poor access to healthcare, delayed clinical presentation, and higher disease burden. Providing subspecialty otolaryngology care to this population can be challenging. We previously reported on the prevalence of hearing impairment in Toronto's homeless community. As a secondary objective of this study, we sought to define otolaryngology specific need for this population. METHODS One hundred adult homeless individuals were recruited across ten homeless shelters in Toronto, Canada using a stratified random sampling technique. An audiometric evaluation and head and neck physical examination were performed by an audiologist and otolaryngology resident, respectively. Basic demographic and clinical information was captured through verbal administration of a survey. Descriptive statistics were used to estimate frequency of otolaryngology specific diseases for this population. RESULTS Of the 132 individuals who were initially approached to participant, 100 (76%) agreed. There were 64 males, with median age of 46 years (IQR 37-58 years). The median life duration of homelessness was 24 months (IQR 6-72 months). Participants had a wide range of medical comorbidities, with the most common being current tobacco smoking (67%), depression (36%), alcohol abuse (32%), and other substance abuse (32%). There were 22 patients with otolaryngology needs as demonstrated by one or more abnormal findings on head and neck examination. The most common finding was nasal fracture with significant nasal obstruction (6%). Eleven patients required referral to a staff otolaryngologist based on concerning or suspicious findings, including two head and neck masses, 6 were later seen in follow-up. CONCLUSION There were substantial otolaryngology needs amongst a homeless population within a universal healthcare system. Future research should focus on further elucidating head and neck related issues in this population and expanding the role of the otolaryngologist in providing care to homeless individuals.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Christopher W Noel
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - David Forner
- Department of Otolaryngology, Head & Neck Surgery, Dalhousie University, Halifax, Canada
| | - Florence Mok
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Molly Zirkle
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, Toronto, Canada.,Department of Otolaryngology, Head & Neck Surgery, St. Michael's Hospital, Toronto, Canada
| | - Antoine Eskander
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada.,Department of Otolaryngology, Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Vincent Lin
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada. .,Department of Otolaryngology, Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - John M Lee
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada. .,Li Ka Shing Knowledge Institute, Toronto, Canada. .,Department of Otolaryngology, Head & Neck Surgery, St. Michael's Hospital, Toronto, Canada.
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Wu V, Kell E, Faughnan ME, Lee JM. In-Office KTP Laser for Treating Hereditary Hemorrhagic Telangiectasia-Associated Epistaxis. Laryngoscope 2020; 131:E689-E693. [PMID: 32557619 DOI: 10.1002/lary.28824] [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] [Received: 04/08/2020] [Revised: 05/01/2020] [Accepted: 05/18/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluated the efficacy and safety of in-office potassium titanyl phosphate (KTP) laser treatment for the management of epistaxis in hereditary hemorrhagic telangiectasia (HHT) patients. METHODS A retrospective case series of all HHT patients over age of 18 who underwent in-office KTP laser treatment from July 1, 2017 to December 31, 2019 was performed. The primary outcome measure was the epistaxis severity score (ESS) pre- and post-procedure. Secondary outcome measures included patient reported pain (on a 10-point Likert-type scale), and procedural adverse events and complications. RESULTS A total of 16 patients underwent KTP in-office laser treatment during the review period. There was both a clinically and statistically significant decrease in the ESS after in-office laser treatment, baseline ESS -7.24, SD 1.71, follow up ESS -4.92, SD 1.83 (mean difference 2.94, 95% confidence interval, 1.83-4.04, P < .0001). There were no reported adverse events or complications associated with the procedure. The mean pain score reported was 0.19, SD 0.75. The average blood loss was 10.8 mL, SD 37.3. The majority of patients (62.5%, 10/16) had no blood loss during the procedure. CONCLUSION Clinically and statistically significant decreases were noted in the ESS of HHT patients after in-office KTP laser photocoagulation. The procedure was well tolerated by patients, without any adverse events or complications. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E689-E693, 2021.
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Affiliation(s)
- Vincent Wu
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Erika Kell
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Marie E Faughnan
- Toronto HHT Centre, Division of Respirology, Department of Medicine, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Wu V, Noel CW, Forner D, Zhang Z, Higgins KM, Enepekides DJ, Lee JM, Witterick IJ, Kim JJ, Waldron JN, Irish JC, Hua Q, Eskander A. Considerations for head and neck oncology practices during the coronavirus disease 2019 (COVID-19) pandemic: Wuhan and Toronto experience. Head Neck 2020; 42:1202-1208. [PMID: 32338807 PMCID: PMC7267482 DOI: 10.1002/hed.26205] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 12/16/2022] Open
Abstract
The practices of head and neck surgical oncologists must evolve to meet the unprecedented needs placed on our health care system by the Coronavirus disease 2019 (COVID-19) pandemic. Guidelines are emerging to help guide the provision of head and neck cancer care, though in practice, it can be challenging to operationalize such recommendations. Head and neck surgeons at Wuhan University faced significant challenges in providing care for their patients. Similar challenges were faced by the University of Toronto during the severe acute respiratory syndrome (SARS) pandemic in 2003. Herein, we outline our combined experience and key practical considerations for maintaining an oncology service in the midst of a pandemic.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Christopher W. Noel
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and Evaluation, University of TorontoTorontoOntarioCanada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, University of TorontoTorontoOntarioCanada
- Division of Otolaryngology—Head and Neck SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - Zhi‐Jian Zhang
- Department of Otolaryngology—Head and Neck SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Kevin M. Higgins
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Danny J. Enepekides
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - John M. Lee
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Ian J. Witterick
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - John J. Kim
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
| | - John N. Waldron
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
| | - Jonathan C. Irish
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Qing‐Quan Hua
- Department of Otolaryngology—Head and Neck SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Antoine Eskander
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and Evaluation, University of TorontoTorontoOntarioCanada
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Dendy Case M, Ghodadra A, Novelli PM, Wu V, Ganguli S, Wildgruber M, Kohler M, Robinson C, Kim C, Wang DS, Sze DY, Kolbeck K, Russell L, Ludwig JM, Uhlig J, Kim K. Genomic biomarkers to determine survival in Multicenter Study of RAS mutations (MURAS) in patients with colorectal liver metastases receiving Y90 radioembolization treatment. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16119] [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: 11/20/2022] Open
Abstract
e16119 Background: Assessment of the clinical outcomes and prognostic value of genomic mutations in colorectal liver metastases treated with Y90 radioembolization. Methods: Multi-institution retrospective study of patients who underwent Y-90 radioembolization treatment after tumor genotyping was completed for CRLM. Patients treated between 2008 and 2019 were included from 7 institutions within the United States and Europe. Patient demographics, tumor characteristics, pre- and post- treatment regimens, serum laboratory evaluation and overall survival were analyzed between patients with differing histopathologic and genomic status. Tumor genotyping was obtained for KRAS, BRAF, PIK3CA, AKT, MEK, NRAS and MMR genes. Kaplan-Meier survival estimation and multivariate Cox regression were analyzed. Results: 434 patients treated with Y90 radioembolization fulfilled the inclusion criteria. Of the total cohort, 399 patients were available who had sufficient documented tumor profiling data. Average age at diagnosis was found to be 58.8 years for all patients (60.1% male, 39.9% female). Decreased survival post Y-90 treatment was shown in those patients with increased number of documented tumor mutations (n = 0,1 or ≥2 mutations: median OS 9.63 mos vs. 6.2 mos vs. 5.3 mos; p < 0.0001). Additionally, the median survival in patients with mutated BRAF was 5.0 months, as compared to 9.4 months in those patients with wild-type BRAF (p = 0.0009). Primary colon cancer sidedness was also shown to demonstrate significant difference in survival post-Y90 treatment with left sided primaries showing improved median overall survival (left = 7.5 mos vs. right = 6.3 mos; p = 0.04.) Patient demographics including gender, age and race were not shown to be significant in overall survival post-Y90 treatment (p-values > 0.05). Number of tumor mutations (p < 0.0001, HR = 1.69 CI: 1.39-2.05), BRAF status (p = 0.02, HR = 2.6 CI:1.20-4.9), primary sidedness (p = 0.01, HR = 0.65 CI:0.47-0.90), pre-treatment neutrophil-lymphocyte ratio (p = 0.04, HR = 1.42 CI: 1.02-1.98) and KRAS mutation status (p < 0.0001, HR = 1.81 CI: 1.45-2.26) all persisted as significant predictors of survival on multivariate analysis. Conclusions: Number of tumor mutations, BRAF mutation status, primary tumor sidedness, neutrophil-lymphocyte ratio and KRAS mutation status are all shown to be significant prognostic factors in patients with colorectal liver metastases receiving Y90 radioembolization.
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Affiliation(s)
| | | | - Paula M. Novelli
- Department of Interventional Radiology, University of Pittsburgh, Pittsburgh, PA
| | - Vincent Wu
- Massachusetts General Hospital, Boston, MA
| | | | | | | | | | - Charles Kim
- Duke University School of Medicine, Durham, NC
| | - David S. Wang
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | - Johannes M. Ludwig
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr, Essen, Germany
| | - Johannes Uhlig
- University Medical Center Goettingen, Goettingen, Germany
| | - Kevin Kim
- Yale School of Medicine, New Haven, CT
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Fu T, Wu V, Campisi P, Witterick IJ, Chan Y. Academic benchmarks for leaders in Otolaryngology - Head & Neck Surgery: a Canadian perspective. J Otolaryngol Head Neck Surg 2020; 49:27. [PMID: 32375901 PMCID: PMC7201551 DOI: 10.1186/s40463-020-00419-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study summarizes the demographics, subspecialty training, and academic productivity of contemporary leaders in Canadian Otolaryngology - Head & Neck Surgery (OHNS) training programs across Canada. METHODS Demographic data regarding chairpersons (CPs) and program directors (PDs) were obtained from publicly-available faculty listings and online sources, and included employment institution, residency training, fellowship training status, gender, and years of post-graduate experience. Research productivity was measured using the h-index and number of publications, obtained from Scopus. Characteristics of CPs and PDs were compared using statistical analysis. RESULTS Cross-sectional data was obtained from a total of 27 CPs and PDs from 13 accredited OHNS training programs across Canada active on July 1, 2019. All academic leaders completed at least 1 year of fellowship training. Head and neck oncology represented 77% of CPs and 59% of academic leaders overall, while pediatric otolaryngology represented 43% of PDs. Females represented 11% of academic leaders. There was a significant association between location of residency training and employment, with 56% (15/27) of physicians working where they had trained (p = 0.001, Fisher's exact test; φ = 2.63, p = 0.001). On average, individuals with a graduate (Master's) degree had a significantly higher H-index (17.7 vs 7.4, p = 0.001) and greater number of publications (106 vs. 52, p = 0.02). Compared to PDs, CPs had a significantly higher average h-index score (14.5 vs. 8.14, p = 0.04) and accrued more years of post-graduate experience (29.7 vs. 21.3 years, p = 0.008). There were no differences in the proportions of CPs and PDs with graduate degrees. There appeared to be a decline in research productivity beginning 3 years after academic appointment. CONCLUSIONS This cross-sectional overview of academic leaders in Canadian OHNS programs demonstrates the following key findings: 1) all leaders completed fellowship training; 2) head and neck surgical oncology was the most common fellowship training subspecialty; 3) leaders were likely to be employed at the institution where they trained; 4) a Master's degree may be associated with increased research productivity; 5) there is a potential risk of decreased productivity after appointment to a leadership position; and 6) women are underrepresented in academic leadership roles.
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Affiliation(s)
- Terence Fu
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Vincent Wu
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Paolo Campisi
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Yvonne Chan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada.
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Sykes EA, Wu V, Beyea MM, Simpson MTW, Beyea JA. Pharyngitis: Approach to diagnosis and treatment. Can Fam Physician 2020; 66:251-257. [PMID: 32273409 PMCID: PMC7145142] [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: 06/11/2023]
Abstract
OBJECTIVE To provide family physicians with an updated approach to diagnosis and treatment of pharyngitis, detailing key symptoms, methods of investigation, and a summary of common causes. SOURCES OF INFORMATION The approach described is based on the authors' clinical practice and peer-reviewed literature from 1989 to 2018. MAIN MESSAGE Sore throat caused by pharyngitis is commonly seen in family medicine clinics and is caused by inflammation of the pharynx and surrounding tissues. Pharyngitis can be caused by viral, bacterial, or fungal infections. Viral causes are often self-limiting, while bacterial and fungal infections typically require antimicrobial therapy. Rapid antigen detection tests and throat cultures can be used with clinical findings to identify the inciting organism. Pharyngitis caused by Streptococcus pyogenes is among the most concerning owing to its associated severe complications such as acute rheumatic fever and glomerulonephritis. Hence, careful diagnosis of pharyngitis is necessary to provide targeted treatment. CONCLUSION A thorough history is key to diagnosing pharyngitis. Rapid antigen detection tests should be reserved for concerns about antibiotic initiation. Physicians should exercise restraint in antibiotic initiation for pharyngitis, as restraint does not delay recovery or increase the risk of S pyogenes infections.
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Affiliation(s)
- Edward A Sykes
- First-year resident, Department of Otolaryngology-Head and Neck Surgery at the University of Toronto in Ontario
| | - Vincent Wu
- Second-year resident, Department of Otolaryngology-Head and Neck Surgery at the University of Toronto in Ontario
| | - Michael M Beyea
- Fifth-year resident in the Department of Emergency Medicine at Western University in London, Ont
| | - Matthew T W Simpson
- Family physician in the Department of Family Medicine at Queen's University in Kingston, Ont
| | - Jason A Beyea
- Assistant Professor and Research Director in the Department of Otolaryngology at Queen's University and Adjunct Scientist with ICES Queen's.
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Sykes EA, Wu V, Beyea MM, Simpson MTW, Beyea JA. [Not Available]. Can Fam Physician 2020; 66:e119-e126. [PMID: 32273424 PMCID: PMC7145122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objectif Offrir aux médecins de famille une approche diagnostique et thérapeutique actualisée de la pharyngite, en décrivant en détail les principaux symptômes, les méthodes d’investigation et un résumé des causes courantes. Sources d’information L’approche décrite est basée sur la pratique clinique des auteurs et sur les publications revues par les pairs de 1989 à 2018. Message principal Le mal de gorge causé par la pharyngite est couramment observé dans les cliniques de médecine familiale; il est causé par l’inflammation du pharynx et des tissus environnants. La pharyngite est causée par une infection virale, bactérienne ou fongique. Les causes virales sont souvent spontanément résolutives, alors que les infections bactériennes et fongiques nécessitent habituellement l’antibiothérapie. Le test de détection rapide de l’antigène et la culture de gorge sont jumelés aux observations cliniques pour identifier l’organisme en cause. La pharyngite causée par streptococcus pyogenes fait partie des organismes les plus préoccupants en raison de ses complications graves, telles la fièvre rhumatismale aiguë et la glomérulonéphrite. Ainsi, il est nécessaire de poser un diagnostic attentif de pharyngite afin de pouvoir dispenser un traitement ciblé. Conclusion L’anamnèse détaillée est la clé du diagnostic de pharyngite. Le test de détection rapide de l’antigène doit être réservé aux cas où l’instauration de l’antibiothérapie est préoccupante. Les médecins doivent user de retenue lorsqu’ils instaurent l’antibiothérapie contre la pharyngite, puisque la retenue ne retarde pas le rétablissement ni n’augmente le risque d’infection à s. pyogenes.
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Affiliation(s)
| | - Vincent Wu
- Résident de deuxième année au département d'oto-rhino-laryngologie - Chirurgie de la tête et du cou à l'Université de Toronto, en Ontario
| | - Michael M Beyea
- Résident de cinquième année au département de médecine d'urgence à l'Université Western à London, Ontario
| | - Matthew T W Simpson
- Médecin de famille au département de médecine familiale à l'Université Queen's à Kingston, Ontario
| | - Jason A Beyea
- Professeur adjoint et directeur de la recherche au département d'oto-rhino-laryngologie de l'Université Queen's, et scientifique agrégé à l'ICES de l'Université Queen's.
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Dendy Case M, Ghodadra A, Novelli P, Wu V, Ganguli S, Wildgruber M, Kohler M, Robinson C, Kim C, Wang D, Sze D, Kolbeck K, Russell L, Ludwig J, Uhlig J, Kim K. 3:45 PM Abstract No. 27 Neutrophil-lymphocyte ratio correlates with survival in MUlticenter Study of RAS Mutations (MURAS) in patients with colorectal liver metastases receiving Y90 radioembolization treatment. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.048] [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: 11/27/2022] Open
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Lastwika K, Zhang Y, Shipley M, Kinahan P, Pipovath S, Wu V, Massion P, Houghton A, Lampe P. IA07 Plasma Proteomic, Glycomic, and Autoantibody Biomarkers for Lung Cancer Early Detection. J Thorac Oncol 2020. [DOI: 10.1016/j.jtho.2019.12.008] [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: 11/29/2022]
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Dendy Case M, Ghodadra A, Novelli PM, Wu V, Ganguli S, Wildgruber M, Kohler M, Robinson C, Kim C, Wang DS, Sze DY, Kolbeck K, Russell L, Uhlig J, Ludwig JM, Kim HS. KRAS status and survival in multicenter study of RAS mutations (MURAS) in patients with colorectal liver metastases receiving Y90 radioembolization treatment. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.239] [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: 11/20/2022] Open
Abstract
239 Background: Assessment of the clinical outcome and prognostic factors of patients receiving Y90 radioembolization to treat colorectal liver metastases. Methods: Multi-institution retrospective study of patients with CRLM who received Y-90 radioembolization after undergoing molecular testing was performed. Patients treated between 2008 and 2019 were included from 7 institutions within the United States and Europe. Patient demographics, systemic therapy regimens, tumor characteristics, laboratory values and overall survival were analyzed between patients with differing histopathologic and genomic status. Genomic profiling was obtained for KRAS, BRAF, PIK3CA, AKT, MEK, NRAS and MMR genes. Kaplan-Meier survival estimation and multivariate Cox regression were analyzed. Results: 445 patients treated with Y90 radioembolization fulfilled the inclusion criteria. Of the total cohort, 430 patients were available who had documented KRAS mutation status. Average age at diagnosis was found to be 58.4 years for all patients (57.6% male, 42.4% female). Decreased survival post Y90 treatment was shown in those patients with mutant KRAS. The median survival in patients with mutated KRAS was 5.7 months, as compared to 8.0 months in those patients with wild-type KRAS (p< 0.0001). Patient demographics including age, gender and race were not shown to be significant in overall survival post-Y90 treatment (p-values >0.05). The average number of systemic chemotherapy treatments prior to Y90 was 2.15 and was similar between KRAS groups (mutant vs wild type.) KRAS status persisted as a significant predictor of survival on multivariate analysis (p< 0.0001; HR 2.1 CI: 1.54-2.85). Conclusions: KRAS status is shown as a significant prognostic factor in patients with colorectal liver metastases receiving Y90 radioembolization.
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Affiliation(s)
| | | | - Paula M. Novelli
- Department of Interventional Radiology, University of Pittsburgh, Pittsburgh, PA
| | - Vincent Wu
- Massachusetts General Hospital, Boston, MA
| | | | | | | | | | - Charles Kim
- Duke University School of Medicine, Durham, NC
| | - David S. Wang
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | - Johannes Uhlig
- University Medical Center Goettingen, Goettingen, Germany
| | - Johannes M. Ludwig
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
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Noel CW, Mok F, Wu V, Eskander A, Yao CMKL, Hwang SW, Lichter M, Reekie M, Smith S, Syrett I, Zirkle M, Lin V, Lee JM. Hearing loss and hearing needs in an adult homeless population: a prospective cross-sectional study. CMAJ Open 2020; 8:E199-E204. [PMID: 32184284 PMCID: PMC7082104 DOI: 10.9778/cmajo.20190220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Given that hearing loss is associated with increased social isolation, reduced earning potential and neurocognitive disease, findings of uncorrected hearing loss in the homeless population have important policy implications. We sought to estimate the prevalence of hearing impairment in an adult homeless population. METHODS We recruited adult (age ≥ 18 yr) homeless people across 10 homeless shelters in Toronto between April and June 2018 using a 2-stage sampling technique. Participants were interviewed by 1 interviewer using a modified survey that had been used in previous studies looking at other health needs in homeless populations. A comprehensive head and neck examination and audiometric evaluation were performed in each participant by an otolaryngologist and an audiologist. Descriptive statistics were estimated. Audiometric data were standardized directly for age and sex to facilitate direct comparisons with the general Canadian population. RESULTS Of the 132 people invited, 100 (75.8%) agreed to participate. The median age was 46 (interquartile range [IQR] 37-58) years. The median duration of homelessness was 24 (IQR 6-72) months. Although most participants (78) had some form of extended health care benefits through social assistance, only 22/78 (28%) were aware that hearing tests and hearing aids were covered through these programs. After direct standardization for age and sex, the proportions of participants with a speech-frequency and high-frequency hearing loss were 39.5% (95% confidence interval [CI] 30.4%-49.3%) and 51.9% (95% CI 42.2%-61.4%), respectively. Nineteen participants were hearing aid candidates, only 1 of whom owned functional hearing aids. Rates of speech-frequency hearing loss (39.5%, 95% CI 30.4%-49.3% v. 19.2%, 95% CI 16.9%-21.7%) and high-frequency hearing loss (51.9%, 95% CI 42.2%-61.4% v. 35.5%, 95% CI 33.1%-37.7%) were substantially higher than in the general Canadian population. INTERPRETATION Our results suggest that homeless adults have a high prevalence of hearing impairment, even when living within a system of universal health insurance; awareness of health care benefits through social assistance programs was poor. Results from this study may prompt initiatives surrounding homeless outreach and health screening.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont
| | - Florence Mok
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont
| | - Vincent Wu
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont
| | - Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont
| | - Christopher M K L Yao
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont
| | - Stephen W Hwang
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont
| | - Myrna Lichter
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont
| | - Melissa Reekie
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont
| | - Sean Smith
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont
| | - Ian Syrett
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont
| | - Molly Zirkle
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont
| | - Vincent Lin
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont.
| | - John M Lee
- Department of Otolaryngology - Head and Neck Surgery (Noel, Mok, Wu, Eskander, Yao, Zirkle, Lin), University of Toronto; Institute of Health Policy, Management and Evaluation (Noel), Dalla Lana School of Public Health, University of Toronto; Department of Otolaryngology - Head & Neck Surgery (Eskander, Syrett, Lin), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (Hwang, Lee); Division of General Internal Medicine (Hwang), Department of Medicine, University of Toronto; Departments of Ophthalmology (Lichter), Audiology (Reekie, Smith) and Otolaryngology - Head & Neck Surgery (Zirkle, Lee), St. Michael's Hospital, Toronto, Ont.
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Lin CJ, Chen YY, Pan CF, Wu V, Wu CJ. Dataset supporting blood pressure prediction for the management of chronic hemodialysis. Sci Data 2019; 6:313. [PMID: 31819065 PMCID: PMC6901464 DOI: 10.1038/s41597-019-0319-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/25/2019] [Accepted: 11/12/2019] [Indexed: 11/09/2022] Open
Abstract
Hemodialysis (HD) is a treatment given to patients with renal failure. Notable treatment-related complications include hypotension, cramps, insufficient blood flow, and arrhythmia. Most complications are associated with unstable blood pressure during HD. Physicians are devoted to seeking solutions to prevent or lower the incidence of possible complications. With advances in technology, big data have been obtained in various medical fields. The accumulated dialysis records in each HD session can be gathered to obtain big HD data with the potential to assist HD staff in increasing patient wellbeing. We generated a large stream of HD parameters collected from dialysis equipment associated with the Vital Info Portal gateway and correlated with the demographic data stored in the hospital information system from each HD session. We expect that the application of HD big data will greatly assist HD staff in treating intradialytic hypotension, setting optimal dialysate parameters, and even developing an intelligent early-warning system as well as providing individualized suggestions regarding dialysis settings in the future.
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Affiliation(s)
- Cheng-Jui Lin
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Ying-Ying Chen
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chi-Feng Pan
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Vincent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Jen Wu
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan. .,Department of Medicine, Mackay Medical College, New Taipei, Taiwan. .,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
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Wu CH, Wu V, Yang YW, Lin YH, Yang SY, Lin PC, Chang CC, Tsai YC, Wang SM, Wu VC, Wu CH, Hu YH, Kiaw L, Chang CH, Chang YL, Tsai YC, Yu CC, Lin YH, Chan CK, Lin JH, Wang WJ, Ho YL, Chang HW, Lin LY, Hu FC, Chang CC, Liu KL, Wang SM, Huang KH, Jeff Chueh SC, Liao SC, Lu CC, Yen RF, Wu KD. Plasma Aldosterone After Seated Saline Infusion Test Outperforms Captopril Test at Predicting Clinical Outcomes After Adrenalectomy for Primary Aldosteronism. Am J Hypertens 2019; 32:1066-1074. [PMID: 31216359 DOI: 10.1093/ajh/hpz098] [Citation(s) in RCA: 9] [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: 05/22/2019] [Revised: 06/08/2019] [Accepted: 06/17/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The saline infusion test (SIT) and the captopril test (CT) are widely used as confirmatory tests for primary aldosteronism (PA). We hypothesized that post-SIT and post-CT plasma aldosterone concentrations (PAC) indicate the severity of aldosterone-producing adenoma (APA) and might predict clinical outcome. METHODS We recruited 216 patients with APA in the Taiwan Primary Aldosteronism Investigation (TAIPAI) registry who received both seated SIT and CT as confirmatory tests. The data of 143 patients who underwent adrenalectomy with complete follow-up after diagnosis were included in the final analysis. We determined the proportion of patients achieving clinical success in accordance with the Primary Aldosteronism Surgical Outcome consensus. Logistic regression analysis was conducted to identify preoperative factors associated with cure of hypertension. RESULTS Complete clinical success was achieved in 48 (33.6%) patients and partial clinical success in 59 (41.2%) patients; absent clinical success was seen in 36 (25.2%) of 143 patients. Post-SIT PAC but not post-CT PAC was independently associated with clinical outcome. Higher levels of post-SIT PAC had a higher likelihood of clinical benefit (complete plus partial clinical success; odds ratio = 1.04 per ng/dl increase, 95% confidence interval = 1.01, 1.06; P = 0.004). Patients with post-SIT PAC > 25 ng/dl were more likely to have a favorable clinical outcome after adrenalectomy. This cutoff value translated into a positive predictive value of 86.0%. CONCLUSIONS We suggest that post-SIT PAC is a better predictor than post-CT PAC for clinical success in PA post adrenalectomy.
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Affiliation(s)
- Che-Hsiung Wu
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Vincent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Wen Yang
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shao-Yu Yang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chih Lin
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Chen Chang
- Medical Imagine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yao-Chou Tsai
- Department of Surgery, Taipei Tzuchi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Shuo-Meng Wang
- Fu Jen Catholic University, New Taipei City, Taiwan
- Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
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Lee JM, Wu V, Faughnan ME, Lasso A, Figol A, Kilty SJ. Prospective pilot study of Floseal® for the treatment of anterior epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT). J Otolaryngol Head Neck Surg 2019; 48:48. [PMID: 31615556 PMCID: PMC6794791 DOI: 10.1186/s40463-019-0379-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/24/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Epistaxis is the most common symptom of hereditary hemorrhagic telangiectasia (HHT), affecting more than 98% of adults with HHT, with significant impact on quality of life. Floseal® has been shown to be effective for the management of anterior epistaxis, but has yet to be thoroughly evaluated in this population. Our goal was to evaluate the efficacy of Floseal® for managing acute anterior epistaxis in patients with HHT. METHODS A pilot prospective clinical trial was conducted at two tertiary referral centres, St. Michael's Hospital, Toronto, Canada and The Ottawa Hospital, Ottawa, Canada. All patients with HHT presenting with acute anterior epistaxis to the two study centres, who enrolled in the study, received Floseal® treatment. The primary outcome measures were achievement of hemostasis and changes in the Epistaxis Severity Score (ESS) between baseline and one-month follow up. Secondary outcome measure included clinical assessment of the nasal cavity. RESULTS Seven patients were included in the final analysis. All patients underwent treatment of anterior epistaxis with Floseal® and achieved control of epistaxis within 15-min post-application. Application of Floseal® was well tolerated, with patients reporting a pain score of 3 ± 3.13 out of 10. There was no statistically significant difference noted in ESS scores pre-treatment and one-month follow up, 6.27 ± 2.42 vs. 4.50 ± 2.44, p = 0.179. There was a significant improvement clinically on exam of the nasal cavity between baseline and at one-month follow up, indicated by a decrease in the clinical assessment score, 17.29 ± 7.70 vs. 9.57 ± 7.81 (p = 0.0088). CONCLUSIONS Patients with HHT presenting with acute epistaxis were able to achieve hemostasis with one application of Floseal®, with the procedure being very well tolerated with minimal pain. Although there was no significant change in ESS scores, clinical assessment of the nasal cavity revealed significant improvement at one-month follow up post treatment with Floseal®. TRIAL REGISTRATION This multi-centered prospective clinical trial was registered with ClinicalTrials.gov ( NCT02638012 ). Registered on December 22, 2015.
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Affiliation(s)
- John M Lee
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, University of Toronto, 190 Elizabeth Street, Rm 3S-438, TGH RFE Building, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Vincent Wu
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, University of Toronto, 190 Elizabeth Street, Rm 3S-438, TGH RFE Building, Toronto, Canada.
| | - Marie E Faughnan
- Toronto HHT Centre, Division of Respirology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Andrea Lasso
- Department of Otolaryngology - Head and Neck Surgery, Ottawa Hospitals, University of Ottawa, Ottawa, Canada
| | - Andrea Figol
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, University of Toronto, 190 Elizabeth Street, Rm 3S-438, TGH RFE Building, Toronto, Canada
| | - Shaun J Kilty
- Department of Otolaryngology - Head and Neck Surgery, Ottawa Hospitals, University of Ottawa, Ottawa, Canada
- Dr. S. Kilty Medicine Professional Corporation, Ottawa, Canada
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Duke L, Gallahue C, Lin J, Shah D, Wu J, Wu V. A-07 The Potential Impact of Nuclear History of Micronesia in Neuropsychological Functioning. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
As a result of 67 nuclear tests in the Marshall Islands between 1946 and 1958, inhabitants of Micronesia exposed to radiation exhibited chronic health issues and birth defects that persist to this day. This patient’s presentation may be an example of the continued residual impact of nuclear testing in Micronesia and demonstrates the importance of historical and biological factors when considering differential diagnoses.
Method
Patient is a six-year-old Micronesian male referred for assessment of psychological functioning. He was developmentally delayed since birth, exhibited unusual facial features, and previously diagnosed with Autism Spectrum Disorder (ASD). Presenting problems included speech delays, limited attention span, difficulty coping with challenges, narrow interests, impulsivity, difficulties interacting with peers, and toileting issues (i.e., defecating on the floor). Mother immigrated to Hawaii from Micronesia in 2006 and primarily speaks Chuukese. While pregnant, mother was on medications for diabetes, hospitalized with high blood pressure, and chewed tobacco daily. Patient experienced some difficulties during the neonatal period.
Results
Average nonverbal intelligence; moderately low receptive single word vocabulary; possible somatization, tendency to withdraw, and atypical behavior; problems with functional communication and daily living activities; and learning-related problems at school. Probability of autism within the Possibly/Very Likely range. Age-inappropriate projective drawings, with indications of potential genetic or developmental dysfunction.
Conclusions
Patient was diagnosed with ASD, with accompanying language impairment. Due to family history of radiation exposure in Micronesia and prenatal concerns, a rule out of other neurodevelopmental disorders and various genetic conditions were considered.
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Wu V, Sykes EA, Beyea MM, Simpson MTW, Beyea JA. Approach to Ménière disease management. Can Fam Physician 2019; 65:463-467. [PMID: 31300426 PMCID: PMC6738466] [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: 06/10/2023]
Abstract
OBJECTIVE To provide family physicians with an updated approach to the diagnosis and management of Ménière disease (MD), detailing the natural course of MD and describing how to initiate medical therapy while awaiting consultation with otolaryngology-head and neck surgery. SOURCES OF INFORMATION The approach is based on the authors' clinical practices and review articles from 1989 to 2018. Most of the cited studies provided level II or III evidence. MAIN MESSAGE Ménière disease is an uncommon disorder of the inner ear causing vertigo attacks with associated unilateral hearing loss, tinnitus, and aural fullness. It has a degenerative course that often results in permanent sensorineural hearing loss. On average, MD stabilizes with no further vestibular attacks by about 8 years after the onset of symptoms; however, this is highly variable. Vertigo symptoms can be controlled through a combination of dietary salt restriction, stress reduction, and medical therapy (betahistine, diuretics, or both). These can be initiated by family physicians before consultation with otolaryngology-head and neck surgery. Symptoms refractory to such strategies can be treated using nonablative, and occasionally ablative, therapies. CONCLUSION A thorough history is key to the approach to and management of MD and permits differentiating MD from other vestibular and nonvestibular conditions.
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Affiliation(s)
- Vincent Wu
- First-year resident in the Department of Otolaryngology-Head and Neck Surgery at the University of Toronto in Ontario.
| | - Edward A Sykes
- Medical student in the Department of Otolaryngology at Queen's University in Kingston, Ont
| | - Michael M Beyea
- Fourth-year resident in the Department of Emergency Medicine at Western University in London, Ont
| | | | - Jason A Beyea
- Otologist, neurotologist, and cranial base surgeon, Clinician Scientist, and Assistant Professor in the Department of Otolaryngology at Queen's University, and Adjunct Scientist at ICES Queen's
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50
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Wu V, Sykes EA, Beyea MM, Simpson MTW, Beyea JA. [Not Available]. Can Fam Physician 2019; 65:468-472. [PMID: 31300427 PMCID: PMC6738464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objectif Fournir aux médecins de famille une approche actualisée pour le diagnostic et la prise en charge de la maladie de Ménière, décrivant en détail l’évolution naturelle de la maladie de Ménière et la façon d’instaurer un traitement médical en attendant une consultation en otorhinolaryngologie–chirurgie cervico-faciale. Sources de l’information L’approche se base sur les pratiques cliniques des auteurs et sur des articles de synthèse publiés entre 1989 et 2018. La plupart des études citées ont fourni des données probantes de niveau II ou III. Message principal La maladie de Ménière est une affection peu fréquente de l’oreille interne, qui cause des crises de vertige et qui est associée à une perte auditive unilatérale, un acouphène et une sensation de plénitude auditive. La maladie est dégénérative et entraîne souvent une perte auditive neurosensorielle permanente. En moyenne, la maladie de Ménière se stabilise sans autre crise vestibulaire environ 8 ans après l’apparition des symptômes; cela est cependant très variable. Les symptômes de vertige peuvent être maîtrisés en combinant une alimentation hyposodée, une réduction du stress et un traitement médical (bétahistine, diurétiques ou les 2). Ces interventions peuvent être instaurées par le médecin de famille avant la consultation en otorhinolaryngologie–chirurgie cervico-faciale. Les symptômes réfractaires à ces interventions sont traités par l’entremise de traitements non ablatifs et, occasionnellement, ablatifs. Conclusion Une anamnèse détaillée est la clé de l’approche à adopter pour la prise en charge de la maladie de Ménière et permet de différencier la maladie de Ménière des autres affections vestibulaires et non vestibulaires.
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Affiliation(s)
- Vincent Wu
- Résident de première année au Département d'otorhinolaryngologie-chirurgie cervico-faciale à l'Université de Toronto, en Ontario.
| | - Edward A Sykes
- Étudiant en médecine au Département d'otorhinolaryngologie à l'Université Queen's à Kingston, en Ontario
| | - Michael M Beyea
- Résident de quatrième année au Département de médecine d'urgence à l'Université Western à London, en Ontario
| | - Matthew T W Simpson
- Médecin de famille au Département de médecine familiale à l'Université Queen's
| | - Jason A Beyea
- Otologiste, neuro-otologiste et chirurgien de la base du crâne, scientifique clinicien et professeur adjoint au Département d'otorhinolaryngologie de l'Université Queen's, et scientifique adjoint à l'Institute for Clinical Evaluative Sciences de l'Université Queen's
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