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Lobascio P, Laforgia R, Pezzolla A. Results of sclerotherapy and mucopexy with haemorrhoidal dearterialization in II and III degree haemorrhoids. A 4 years' single centre experience. Front Surg 2023; 10:1151327. [PMID: 37405058 PMCID: PMC10317504 DOI: 10.3389/fsurg.2023.1151327] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/10/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Haemorrhoidal disease (HD) affects a considerable portion of the adult population. The aim of this study is to confirm the safety and efficacy of the treatments and to report the long-term outcomes of Sclerotherapy (ST) and Mucopexy and Haemorrhoidal Dearterialization (MHD) performed over the last 4 years in a single tertiary centre. The secondary outcome is to evaluate the usefulness of both techniques and to demonstrate how those can be associated as a bridge to surgery. Materials and methods Patients affected by second-third-degree haemorrhoids and undergoing ST or non-Doppler guided MHD between 2018 and 2021 were enrolled. Safety and efficacy, recurrence rate, Haemorrhoid Severity Score (HSS) and pain resulting from both techniques were evaluated. Results Out of 259 patients, 150 underwent ST. Further, 122 (81.3%) patients were male and 28 (18.7%) were female. The mean age was 50.8 (range 34-68) years. Most of the patients (103, 68.6%) were affected by second-degree HD, while 47 (31.4%) were affected by third-degree HD. The overall success rate was 83.3%. The median pre-operative HSS score was 3 (IQR 0-4, p = 0.04) and at 2 year the median HSS was 0 (IQR 0-1, p = 0.03). No intraoperative complications and no drug-related side effects occurred. The mean follow-up for ST was 2 years (range 1-4; SD ±0.88). MHD was performed on 109 patients. In detail, 80 patients (73.4%) were male while 29 patients (26.6%) were female. The mean age in this group was 51.3 (range 31-69). Further, 72 patients (66.1%) were affected by third-degree HD and 37 (33.9%) by second-degree HD. The median HSS score was 9 (IQR 8-10, p = 0.001) preoperatively two years after treatment was 0 (IQR 0-1, p = 0.004). Major complications occurred in three patients (2.75%). The overall success rate was 93.5% (second degree 89.2% vs. third degree 95.8%). The mean follow-up for MHD was 2 years (range 1-4; SD ±0.68). Conclusions The results confirm the usefulness of those techniques, which can be considered safe and easily repeatable procedures, with a low recurrence rate after 2 years of median follow-up.
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Driessen DAJJ, Arens AIJ, Dijkema T, Weijs WLJ, Draaijer LC, van den Broek GB, Takes RP, Honings J, Kaanders JHAM. Sentinel node identification in laryngeal and pharyngeal carcinoma after flexible endoscopy-guided tracer injection under topical anesthesia: A feasibility study. Head Neck 2023; 45:1359-1366. [PMID: 36942817 DOI: 10.1002/hed.27347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/02/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the feasibility of flexible endoscopy-guided tracer injection for sentinel lymph node (SLN) identification in patients with laryngeal and pharyngeal carcinoma. METHODS Sixteen cT1-4N0-2M0 patients with laryngeal or pharyngeal carcinoma underwent intra- and peritumoral [99m Tc]Tc-nanocolloid injections after topical anesthesia under endoscopic guidance. SPECT-CT scans were performed at two time points. RESULTS Tracer injection and visualization of SLNs was successful in 15/16 (94%) patients. Median number of tracer injections was 1 intratumoral and 3 peritumoral. The median duration of the endoscopic procedure including tracer injection after biopsy taking was 7 min (range 4-16 min). A total of 28 SLNs were identified which were all visualized on the early and late SPECT-CT. Most SLNs were visualized in neck levels II and III. CONCLUSIONS Flexible endoscopy-guided tracer injection for SLN identification is a feasible and fast procedure in laryngeal and pharyngeal carcinoma patients.
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Affiliation(s)
- Daphne A J J Driessen
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anne I J Arens
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tim Dijkema
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem L J Weijs
- Department of Oral- and Maxillofacial Surgery and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lisette C Draaijer
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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Michaud JB, Zhuang T, Shapiro LM, Cohen SA, Kamal RN. Out-of-Pocket and Total Costs for Common Hand Procedures From 2008 to 2016: A Nationwide Claims Database Analysis. J Hand Surg Am 2022; 47:1057-1067. [PMID: 35985865 DOI: 10.1016/j.jhsa.2022.06.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/29/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Rising patient out-of-pocket (OOP) costs and financial distress have been associated with reduced access to and delays in care. We evaluated whether OOP and total costs for common hand procedures have increased from 2008 to 2016 and identified key drivers of these costs. METHODS Using the IBM MarketScan Research Databases, we identified patients who underwent trigger finger release, open carpal tunnel release, thumb carpometacarpal joint arthroplasty, cubital tunnel release, or open treatment of distal radius fracture in the outpatient setting between 2008 and 2016. Patient OOP costs included copayment, coinsurance, and deductible payments. Costs not directly related to medical care, such as transportation and childcare costs, were not included. The overall cost was defined as the sum of the patient OOP cost and insurer reimbursements. We calculated changes in OOP and total overall costs over the study period. We also performed multivariable linear regressions to evaluate the associations between costs and procedure type, insurance type, region, and site of service. RESULTS The mean patient OOP cost increased by 55% to 71% and the total overall cost increased by 20% to 45%, depending on the procedure, between 2008 and 2016. Facility overall costs increased by 38%, whereas professional overall costs increased by 9%. Procedures performed in an office-based setting were associated with the lowest patient OOP and total overall costs, whereas high-deductible health plans were associated with the highest OOP costs. CONCLUSIONS Patient OOP and total overall costs increased for the most common hand procedures between 2008 and 2016, driven by a substantial increase in facility costs. Office-based procedures were associated with the lowest costs. CLINICAL RELEVANCE To alleviate the rising patient cost burden, hand surgeons could incorporate OOP cost considerations into shared decision-making tools, identify patients who may benefit from financial counseling, and shift procedures to an office-based setting.
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Affiliation(s)
- John B Michaud
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Thompson Zhuang
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA
| | - Samuel A Cohen
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
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Chang J, Ninan S, Liu K, Iloreta AM, Kirke D, Courey M. Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality. OTO Open 2021; 5:2473974X20975020. [PMID: 33474521 PMCID: PMC7797579 DOI: 10.1177/2473974x20975020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives Virtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures. Study Design Randomized controlled trial. Setting Tertiary care center. Methods Adult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected. Results Eight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively (P = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively (P = .770). Average pain scores were 3.53 and 2.64, respectively (P = .434). Conclusion This pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia. Level of Evidence 1
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Affiliation(s)
- Joseph Chang
- The Permanente Medical Group, Department of Head and Neck Surgery, Kaiser Permanente Santa Clara, California, USA
| | - Sen Ninan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Katherine Liu
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alfred Marc Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Diana Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mark Courey
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
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Filauro M, Vallin A, Fragale M, Sampieri C, Guastini L, Mora F, Peretti G. Office-based procedures in laryngology. ACTA ACUST UNITED AC 2020; 41:243-247. [PMID: 33372918 PMCID: PMC8283403 DOI: 10.14639/0392-100x-n0935] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/28/2020] [Indexed: 11/23/2022]
Abstract
Objective Development of transnasal fiberoptic laryngoscopy, integration of an operative channel (OC), the advent of high-definition television imaging, with improvements in laser technology, cleared the way for office-based laryngology. Three treatment categories can be identified: bioendoscopy-guided biopsy; laryngeal injection; laser-assisted surgery. Methods 26 patients underwent OBPs at the Otolaryngology Clinic of IRCCS Policlinico San Martino, Genoa, Italy. Sixty-eight procedures were performed: 60 for recurrent respiratory papillomatosis (RRP), 5 for unilateral vocal fold paralysis (UVFP) and 3 for glottic leukoplakias. Neoblucaine 5% was administrated through the operative channel, for local anaesthesia. All procedures were carried out with the physician standing behind the patient. Narrow band imaging (NBI – Olympus Medical) or i-scan (Pentax Medical) were used to enhance the accuracy of the biopsy thanks to identification of atypical vascular patterns. Laryngeal injections were made using a 25G flexible needle. Opera Evo (Quanta system IEC/EN 60825-1:2007) is a hybrid fibre laser that is used for “blanching” and vaporisation of RRP lesions and to treat selected leukoplakias that were previously biopsied. Conclusions No major complications occurred during the procedures.
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Affiliation(s)
- Marta Filauro
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy.,Department of Experimental Medicine (DIMES), University of Genoa, Italy
| | - Alberto Vallin
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Marco Fragale
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Claudio Sampieri
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Luca Guastini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Francesco Mora
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
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Enver N, Ramaswamy A, Sulica L, Pitman MJ. Office-Based Procedure Training in Laryngology Fellowship Programs. Laryngoscope 2020; 131:2054-2058. [PMID: 33043999 DOI: 10.1002/lary.29170] [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: 04/23/2020] [Revised: 08/18/2020] [Accepted: 09/23/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the current practices and challenges of training office-based procedures to laryngology fellows in the United States. METHODS An anonymous web-based survey study was distributed to laryngology fellowship program directors, as listed by the American Laryngological Association. The survey was a 19-item questionnaire with free-text, Likert scale, and multiple-choice answers. RESULTS Twenty-two of 27 program directors (81.4%) replied to the survey. Many programs (8/16) have three or more laryngologists and do more than 10 procedures each week (10/16). Sixty-nine percent (11/16) of directors had not been trained for office procedures in their fellowship. The fellows are allowed to be primary surgeon on 68.75% and 75% of vocal fold augmentation and laser procedures, respectively. The expected competencies for these procedures on graduation are average-moderate and moderate. When program directors asked about the methods used for training, a minority of them use simulators (2/16), procedural checklists (2/16), or structured debriefing (2/16). The most commonly used methods were case-based troubleshooting (13/16) and unstructured debriefing (13/16). Patients being awake and patients' expectations are seen as the most important obstacles. Most of the directors thought office-based procedure training could be improved (14/16). The most common suggestions were using step-wise checklists, simulator-labs, and formal debriefings. CONCLUSION This is the first study evaluating the training of office-based laryngeal procedures during laryngology fellowship. Given the increasing importance of these procedures in practice and the herein identified barriers and need for improvement, fellowships should investigate the use of systematic training tools to improve fellow competency with office-based procedures. Laryngoscope, 131:2054-2058, 2021.
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Affiliation(s)
- Necati Enver
- Department of Otolaryngology-Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A.,Department of Otolaryngology - Head & Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Apoorva Ramaswamy
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A
| | - Lucian Sulica
- Department of Otolaryngology - Head & Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, U.S.A
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A
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Bacharach T, Panneton JM. Commentary: The OEIS National Registry Has the Potential to Change Office-Based Endovascular Practice: Is That a Cause for Celebration or Trepidation? J Endovasc Ther 2020; 27:964-966. [PMID: 32856517 DOI: 10.1177/1526602820952054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thekla Bacharach
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jean M Panneton
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
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Abstract
Purpose To present a new outcomes-based registry to collect data on outpatient endovascular
interventions, a relatively new site of service without adequate historical data to
assess best clinical practices. Quality data collection with subsequent outcomes
analysis, benchmarking, and direct feedback is necessary to achieve optimal care. Materials and Methods The Outpatient Endovascular and Interventional Society (OEIS) established the OEIS
National Registry in 2017 to collect data on safety, efficacy, and quality of care for
outpatient endovascular interventions. Since then, it has grown to include a peripheral
artery disease (PAD) module with plans to expand to include cardiac, venous, dialysis
access, and other procedures in future modules. As a Qualified Clinical Data Registry
approved by the Centers for Medicare and Medicaid Services, this application also
supports new quality measure development under the Quality Payment Program. All
physicians operating in an office-based laboratory or ambulatory surgery center can use
the Registry to analyze de-identified data and benchmark performance against national
averages. Major adverse events were defined as death, stroke, myocardial infarction,
acute onset of limb ischemia, index bypass graft or treated segment thrombosis, and/or
need for urgent/emergent vascular surgery. Results Since Registry inception in 2017, 251 participating physicians from 64 centers located
in 18 states have participated. The current database includes 18,134 peripheral
endovascular interventions performed in 12,403 PAD patients (mean age 72.3±10.2 years;
60.1% men) between January 2017 and January 2020. Cases were performed primarily in an
office-based laboratory (85.1%) or ambulatory surgery center setting (10.4%). Most
frequently observed procedure indications from 16,086 preprocedure form submissions
included claudication (59%), minor tissue loss (16%), rest pain (9%), acute limb
ischemia (5%), and maintenance of patency (3%). Planned diagnostic procedures made up
12.2% of cases entered, with the remainder indicated as interventional procedures
(87.6%). The hospital transfer rate was 0.62%, with 88 urgent/emergent transfers and 24
elective transfers. The overall complication rate for the Registry was 1.87% (n=338),
and the rate of major adverse events was 0.51% (n=92). Thirty-day mortality was 0.03%
(n=6). Conclusion This report describes the current structure, methodology, and preliminary results of
OEIS National Registry, an outcomes-based registry designed to collect quality
performance data with subsequent outcome analysis, benchmarking, and direct feedback to
aid clinicians in providing optimal care.
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Affiliation(s)
- Samuel S Ahn
- DFW Vascular Group, Dallas, TX, USA.,University Vascular Associates, Los Angeles, CA, USA.,TCU School of Medicine, Ft. Worth, TX, USA
| | | | - Lauren E Jones
- Outpatient Endovascular and Interventional Society, Hoffman Estates, IL, USA
| | | | - John Blebea
- Central Michigan University College of Medicine, Saginaw, MI, USA
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Frank E, Carlson B, Hu A, Randall DR, Tamares S, Inman JC, Crawley BK. Assessment and Treatment of Pain during In-Office Otolaryngology Procedures: A Systematic Review. Otolaryngol Head Neck Surg 2019; 161:218-226. [PMID: 30885070 DOI: 10.1177/0194599819835503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To qualitatively assess practices of periprocedural pain assessment and control and to evaluate the effectiveness of interventions for pain during in-office procedures reported in the otolaryngology literature through a systematic review. DATA SOURCES PubMed, CINAHL, and Web of Science searches from inception to 2018. REVIEW METHODS English-language studies reporting qualitative or quantitative data for periprocedural pain assessment in adult patients undergoing in-office otolaryngology procedures were included. Risk of bias was assessed via the Cochrane Risk of Bias or Cochrane Risk of Bias in Non-Randomized Studies of Interventions tools as appropriate. Two reviewers screened all articles. Bias was assessed by 3 reviewers. RESULTS Eighty-six studies describing 32 types of procedures met inclusion criteria. Study quality and risk of bias ranged from good to serious but did not affect assessed outcomes. Validated methods of pain assessment were used by only 45% of studies. The most commonly used pain assessment was patient tolerance, or ability to simply complete a procedure. Only 5.8% of studies elicited patients' baseline pain levels prior to procedures, and a qualitative assessment of pain was done in merely 3.5%. Eleven unique pain control regimens were described in the literature, with 8% of studies failing to report method of pain control. CONCLUSION Many reports of measures and management of pain for in-office procedures exist but few employ validated measures, few are standardized, and current data do not support any specific pain control measures over others. Significant opportunity remains to investigate methods for improving patient pain and tolerance of in-office procedures.
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Affiliation(s)
- Ethan Frank
- 1 Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Bradley Carlson
- 2 School of Medicine, Loma Linda University, Loma Linda, California, USA
| | - Amanda Hu
- 3 Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derrick R Randall
- 4 Section of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Shanalee Tamares
- 5 University Libraries, Loma Linda University, Loma Linda, California, USA
| | - Jared C Inman
- 1 Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Brianna K Crawley
- 1 Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
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Stolovitzky JP, Mehendale N, Matheny KE, Brown WJ, Rieder AA, Liepert DR, Tseng E, Gould A. Medical Therapy Versus Balloon Sinus Dilation in Adults With Chronic Rhinosinusitis (MERLOT): 12-Month Follow-up. Am J Rhinol Allergy 2018; 32:294-302. [PMID: 29781286 DOI: 10.1177/1945892418773623] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Chronic rhinosinusitis (CRS) is a devastating disease affecting nearly 30 million people in the United States. An interim analysis of data from the present study suggested that, in patients who had previously failed medical therapy, balloon sinus dilation (BSD) plus medical management (MM) provides a significant improvement in the quality of life (QOL) at 24 weeks postprocedure compared to MM alone. Objective The primary objective of this final analysis was to evaluate the durability of treatment effects through the 52-week follow-up. Methods Adults aged 19 and older with CRS who had failed MM elected either BSD plus MM or continued MM. Patients were evaluated at 2 (BSD arm only), 12, 24, and 52 weeks posttreatment. Balloon dilations were performed either as an office-based procedure under local anesthesia or in the operating room per physicians' and patients' discretion. The primary end point was change in patient-reported QOL as measured by Chronic Sinusitis Survey (CSS) total score from baseline to the 24-week follow-up. Secondary outcomes including changes in CSS, Rhinosinusitis Disability Index (RSDI), and Sino-Nasal Outcome Test (SNOT) total and subscores, sinus medication usage, missed days of work/school, number of medical care visits, and sinus infections from baseline to the 52-week follow-up are reported here within. Results BSD led to sustained greater improvements in self-reported QOL using the CSS and RSDI total scores with a trend toward improvement in the SNOT-20 total score from baseline to the 52-week follow-up compared to continued MM. There were no changes in medication usage apart from nasal steroid usage for which the MM cohort had an increase in usage. There were no device-related serious adverse events. Conclusion The current analysis highlights the safety, effectiveness, and durability of BSD in CRS patients aged 19 and older who had previously failed MM.
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Affiliation(s)
- J Pablo Stolovitzky
- 1 Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Douglas R Liepert
- 6 Allied Physicians of Michiana-Otolaryngology Associates, South Bend, Indiana
| | | | - Andrew Gould
- 7 Advanced ENT and Allergy, Louisville, Kentucky
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Urman RD, Punwani N, Shapiro FE. Office-based surgical and medical procedures: educational gaps. Ochsner J 2012; 12:383-388. [PMID: 23267269 PMCID: PMC3527870] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Over the past decade, the number of procedures performed in office-based settings by a variety of practitioners-including surgeons, gastroenterologists, ophthalmologists, radiologists, dermatologists, and others-has grown significantly. At the same time, patient safety concerns have intensified and include issues such as proper patient selection, safe sedation practices, maintenance of facilities and resuscitation equipment, facility accreditation and practitioner licensing, and the office staff's ability to deal with emergencies and complications. An urgent need exists to educate practitioners about safety concerns in the office-based setting and to develop various educational strategies that can meet the continued growth of these procedures. This review outlines educational needs and possible solutions such as simulation exercises and education during residency training.
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Affiliation(s)
- Richard D. Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | | | - Fred E. Shapiro
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
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12
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Kedia KR. Local anesthesia during interstitial laser coagulation of the prostate. Rev Urol 2005; 7 Suppl 9:S23-8. [PMID: 16985900 PMCID: PMC1477640] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
With the emergence of minimally invasive therapies for the management of symptoms of benign prostatic hyperplasia (BPH), as well as the reality of a changing medical economic environment, there is a need for a reliable local anesthesia protocol. The protocol described here for prostate anesthetic block is a safe, economical, and effective way to perform interstitial laser coagulation and other minor endoscopic urologic procedures in the office setting. Most patients experience little discomfort and recover quickly, with prompt return to normal activities. Urologists should be aware of and comfortable with these techniques.
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