Garrison Clinical Setting Inadequate for Maintenance of Procedural Skills for Emergency Medicine Physicians: A Cross-Sectional Study.

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Garrison Clinical Setting Inadequate for Maintenance of Procedural Skills for Emergency Medicine Physicians: A Cross-Sectional Study.

J Spec Oper Med. 2015;15(4):67-70

Authors: Schauer SG, Varney SM, Cox KL

Abstract
BACKGROUND: Emergency medicine physicians (EPs) are often placed in far-forward, isolated areas in theater. Maintenance of their emergency intervention skills is vital to keep the medical forces deployment ready. The US Army suggests that working at a Military Treatment Facility (MTF) is sufficient to keep emergency procedural skills at a deployment-ready level. We sought to compare the volume of emergency procedures that providers reported necessary to maintain their skills with the number available in the MTF setting.
METHODS: EPs were surveyed to quantify the number of procedures they reported they would need to perform yearly to stay deployment-ready. We obtained procedure data for their duty stations and compared the procedure volume with the survey responses to determine if working at an MTF is sufficient to keep providers' skills deployment ready.
RESULTS: The reported necessary average numbers per year were as follows: tube thoracostomy (5.9), intubation (11.4), cricothyrotomy (4.2), lumbar puncture (5.2), central line (10.0), focused assessment with sonography for trauma (FAST) (21.3), reductions (10.6), splints (10.5), and sedations (11.7). None of the procedure volumes at MTFs met provider requirements with the exception of FAST examinations at the only trauma center.
CONCLUSIONS: This suggests the garrison clinical environment is inadequate for maintaining procedure skills. Further research is needed to determine modalities that will provide adequate training volume.

PMID: 26630097 [PubMed - as supplied by publisher]

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Orofacial pain and the prospects of precision medicine.

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Orofacial pain and the prospects of precision medicine.

J Oral Facial Pain Headache. 2015;29(4):321

Authors: Stohler CS

PMID: 26625499 [PubMed - in process]

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A case of laryngeal paraganglioma and literature review.

A case of laryngeal paraganglioma and literature review.

Int J Clin Exp Med. 2015;8(9):16934-16936

Authors: Zhou X, Jiang S, Li H

Abstract
Paragangliomas are common in carotid body, jugular tympanic cavity and cervical vagus nerve, but uncommon in larynx. We report clinical and pathological features of a 40-year-old woman with laryngeal paraganglioma. Tracheotomy combined with vein anesthesia was performed to isolate tumors. The patient was followed up for 3 months after surgery treatment and recovered well. We also provide a better understanding of this disease through a review of relevant literature. Largnx paraganglioma is rare, but should require long-term follow-up for possible recurrence.

PMID: 26629246 [PubMed - as supplied by publisher]

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Survival Impact of Increasing Time to Treatment Initiation for Patients With Head and Neck Cancer in the United States.

Survival Impact of Increasing Time to Treatment Initiation for Patients With Head and Neck Cancer in the United States.

J Clin Oncol. 2015 Nov 30;

Authors: Murphy CT, Galloway TJ, Handorf EA, Egleston BL, Wang LS, Mehra R, Flieder DB, Ridge JA

Abstract
PURPOSE: To estimate the overall survival (OS) impact from increasing time to treatment initiation (TTI) for patients with head and neck squamous cell carcinoma (HNSCC).
METHODS: Using the National Cancer Data Base (NCDB), we examined patients who received curative therapy for the following sites: oral tongue, oropharynx, larynx, and hypopharynx. TTI was the number of days from diagnosis to initiation of curative treatment. The effect of TTI on OS was determined by using Cox regression models (MVA). Recursive partitioning analysis (RPA) identified TTI thresholds via conditional inference trees to estimate the greatest differences in OS on the basis of randomly selected training and validation sets, and repeated this 1,000 times to ensure robustness of TTI thresholds.
RESULTS: A total of 51,655 patients were included. On MVA, TTI of 61 to 90 days versus less than 30 days (hazard ratio [HR], 1.13; 95% CI, 1.08 to 1.19) independently increased mortality risk. TTI of 67 days appeared as the optimal threshold on the training RPA, statistical significance was confirmed in the validation set (P < .001), and the 67-day TTI was the optimal threshold in 54% of repeated simulations. Overall, 96% of simulations validated two optimal TTI thresholds, with ranges of 46 to 52 days and 62 to 67 days. The median OS for TTI of 46 to 52 days or fewer versus 53 to 67 days versus greater than 67 days was 71.9 months (95% CI, 70.3 to 73.5 months) versus 61 months (95% CI, 57 to 66.1 months) versus 46.6 months (95% CI, 42.8 to 50.7 months), respectively (P < .001). In the most recent year with available data (2011), 25% of patients had TTI of greater than 46 days.
CONCLUSION: TTI independently affects survival. One in four patients experienced treatment delay. TTI of greater than 46 to 52 days introduced an increased risk of death that was most consistently detrimental beyond 60 days. Prolonged TTI is currently affecting survival.

PMID: 26628469 [PubMed - as supplied by publisher]

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Protection and Dissection of Recurrent Laryngeal Nerve in Salvage Thyroid Cancer Surgery to Patients with Insufficient Primary Operation Extent and Suspicious Residual Tumor.

Protection and Dissection of Recurrent Laryngeal Nerve in Salvage Thyroid Cancer Surgery to Patients with Insufficient Primary Operation Extent and Suspicious Residual Tumor.

Asian Pac J Cancer Prev. 2015;16(17):7457-61

Authors: Yu WB, Zhang NS

Abstract
Some thyroid cancer patients undergone insufficient tumor removal in the primary surgery in China . our aim is to evaluate the impact of dissection of the recurrent laryngeal nerve during a salvage thyroid cancer operation in these patients to prevent nerve injury. Clinical data of 49 enrolled patients who received a salvage thyroid operation were retrospectively reviewed. Primary pathology was thyroid papillary cancer. The initial procedure performed included nodulectomy (20 patients), partial thyroidectomy (19 patients) and subtotal thyroidectomy (10 patients). The effect of dissection and protection of the recurrent laryngeal nerve and the mechanism of nerve injury were studied. The cervical courses of the recurrent laryngeal nerves were successfully dissected in all cases. Nerves were adherent to or involved by scars in 22 cases. Three were ligated near the place where the nerve entered the larynx, while another three were cut near the intersection of inferior thyroid artery with the recurrent laryngeal nerve. Light hoarseness occurred to four patients without a preoperative voice change. In conclusion, accurate primary diagnosis allows for a sufficient primary operation to be performed, avoiding insufficient tumor removal that requires a secondary surgery. The most important cause of nerve damage resulted from not identifying the recurrent laryngeal nerve during first surgery , and meticulous dissection during salvage surgery was the most efficient method to avoid nerve damage.

PMID: 26625744 [PubMed - in process]

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Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation.

Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation.

Multidiscip Respir Med. 2015;10:35

Authors: Pasqua F, Nardi I, Provenzano A, Mari A, Lazio Regional Section, Italian Association of Hospital Pulmonologists (AIPO)

Abstract
BACKGROUND: Weaning from tracheostomy has implications in management, quality of life, and costs of ventilated patients. Furthermore, endotracheal cannula removing needs further studies. Aim of this study was the validation of a protocol for weaning from tracheostomy and evaluation of predictor factors of decannulation.
METHODS: Medical records of 48 patients were retrospectively evaluated. Patients were decannulated in agreement with a decannulation protocol based on the evaluation of clinical stability, expiratory muscle strength, presence of tracheal stenosis/granulomas, deglutition function, partial pressure of CO2, and PaO2/FiO2 ratio. These variables, together with underlying disease, blood gas analysis parameters, time elapsed with cannula, comordibity, Barthel index, and the condition of ventilation, were evaluated in a logistic model as predictors of decannulation.
RESULTS: 63 % of patients were successfully decannulated in agreement with our protocol and no one needed to be re-cannulated. Three variables were significantly associated with the decannulation: no pulmonary underlying diseases (OR = 7.12; 95 % CI 1.2-42.2), no mechanical ventilation (OR = 9.55; 95 % CI 2.1-44.2) and period of tracheostomy ≤10 weeks (OR = 6.5; 95 % CI 1.6-27.5).
CONCLUSIONS: The positive course of decannulated patients supports the suitability of the weaning protocol we propose here. The strong predictive role of three clinical variables gives premise for new studies testing simpler decannulation protocols.

PMID: 26629342 [PubMed - as supplied by publisher]

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Acoustic Reflex Screening of Conductive Hearing Loss for Third Window Disorders.

Acoustic Reflex Screening of Conductive Hearing Loss for Third Window Disorders.

Otolaryngol Head Neck Surg. 2015 Dec 1;

Authors: Hong RS, Metz CM, Bojrab DI, Babu SC, Zappia J, Sargent EW, Chan EY, Naumann IC, LaRouere MJ

Abstract
OBJECTIVE: This study examines the effectiveness of acoustic reflexes in screening for third window disorders (eg, superior semicircular canal dehiscence) prior to middle ear exploration for conductive hearing loss.
STUDY DESIGN: Case series with chart review.
SETTING: Outpatient tertiary otology center.
SUBJECTS AND METHODS: A review was performed of 212 ears with acoustic reflexes, performed as part of the evaluation of conductive hearing loss in patients without evidence of chronic otitis media. The etiology of hearing loss was determined from intraoperative findings and computed tomography imaging. The relationship between acoustic reflexes and conductive hearing loss etiology was assessed.
RESULTS: Eighty-eight percent of ears (166 of 189) demonstrating absence of all acoustic reflexes had an ossicular etiology of conductive hearing loss. Fifty-two percent of ears (12 of 23) with at least 1 detectable acoustic reflex had a nonossicular etiology. The positive and negative predictive values for an ossicular etiology were 89% and 57% when acoustic reflexes were used alone for screening, 89% and 39% when third window symptoms were used alone, and 94% and 71% when reflexes and symptoms were used together, respectively.
CONCLUSION: Acoustic reflex testing is an effective means of screening for third window disorders in patients with a conductive hearing loss. Questioning for third window symptoms should complement screening. The detection of even 1 acoustic reflex or third window symptom (regardless of reflex status) should prompt further workup prior to middle ear exploration.

PMID: 26626134 [PubMed - as supplied by publisher]

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Grant-Writing Pearls and Pitfalls: Maximizing Funding Opportunities.

Grant-Writing Pearls and Pitfalls: Maximizing Funding Opportunities.

Otolaryngol Head Neck Surg. 2015 Dec 1;

Authors: Liu JC, Pynnonen MA, St John M, Rosenthal EL, Couch ME, Schmalbach CE

Abstract
This invited article reviews the grant process to include the following objectives: (1) to provide an understanding of otolaryngology funding mechanisms in the context of career progression; (2) to outline key components of a well-written grant; (3) to highlight vital members of a successful research team, with emphasis on the mentor-mentee relationship; and (4) to clarify grant scoring with emphasis on common pitfalls to avoid. Current otolaryngology funding mechanisms and up-to-date resources are provided. The review is aimed to assist otolaryngology residents, faculty new to the grant process, as well as experienced researchers striving to improve their grant review scores.

PMID: 26626133 [PubMed - as supplied by publisher]

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Eustachian Tube Function in 6-Year-Old Children with and without a History of Middle Ear Disease.

Eustachian Tube Function in 6-Year-Old Children with and without a History of Middle Ear Disease.

Otolaryngol Head Neck Surg. 2015 Dec 1;

Authors: Mandel EM, Casselbrant ML, Richert BC, Teixeira MS, Swarts JD, Doyle WJ

Abstract
OBJECTIVE: To test the hypothesis that eustachian tube opening efficiency, measured as the fractional gradient equilibrated (FGE), is lower in 6-year-old children with no middle ear disease but a well-documented history of recurrent acute otitis media, as compared with children with a negative disease history (control).
STUDY DESIGN: Cross-sectional study.
SETTING: Tertiary care pediatric hospital.
SUBJECTS AND METHODS: Bilateral eustachian tube function was evaluated in 44 healthy 6-year-old children (19 boys, 29 white). None had middle ear disease at the time of testing, but 23 had a history of recurrent acute otitis media. Twenty-one had no significant past otitis media. Eustachian tube function was measured with a pressure chamber protocol that established negative middle ear gauge pressures (referenced to the chamber pressure) and recorded that pressure before and after a swallow. FGE was calculated as the change in middle ear gauge pressure with swallowing divided by the preswallow pressure. Between-group comparisons of the preswallow pressures and FGEs were made with a 2-tailed Student's t test.
RESULTS: FGE was independent of the preswallow middle ear gauge pressure. For the 39 and 44 evaluable ears in the control and recurrent acute otitis media groups, the mean preswallow pressures were -194 daPa (95% confidence interval [95% CI] = -211 to -177) versus -203 (95% CI = -216 to -190; P > .40), and FGEs were 0.32 (95% CI = 0.21-0.43) vs 0.16 (95% CI = 0.08-0.24; P = .016), respectively.
CONCLUSION: In children with past recurrent acute otitis media, residual eustachian tube opening inefficiency is maintained after they have "outgrown" their middle ear disease.

PMID: 26626132 [PubMed - as supplied by publisher]

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Cervical necrotizing fasciitis: management challenges in poor resource environment.

Cervical necrotizing fasciitis: management challenges in poor resource environment.

Eur Arch Otorhinolaryngol. 2015 Dec 1;

Authors: Adekanye AG, Umana AN, Offiong ME, Mgbe RB, Owughalu BC, Inyama M, Omang HM

Abstract
Necrotizing fasciitis of the head and neck is a rare and potentially fatal disease. It is a bacterial infection characterized by spreading along fascia planes and subcutaneous tissue resulting in tissue necrosis and likely death. It is commonly of dental or pharyngeal origin. Factors affecting the success of the treatment are early diagnosis, appropriate antibiotics and surgical debridement. Our study showed eight patients, five males and three females with mean age of 49.25 years (range 20-71 years). Clinical presentations were a rapidly progressing painful neck swelling, fever, dysphagia and trismus. The aetiology varied from idiopathic, pharyngeal/tonsillar infection, trauma and nasal malignancy. There were associated variable comorbidities (diabetes mellitus, HIV infection, hypertension and congestive cardiac failure). All the patients received early and aggressive medical treatment. The earliest time of surgery was 12 h after admission because of the poor financial status of patients. Three cases came in with complications of the disease and were not fit for extensive debridement under general anaesthesia. For them limited and reasonable bed side debridement was done. Mortality was 50 % from multiple organ failure, HIV encephalopathy, aspiration pneumonitis and septicemia. The duration of hospital stay for the patients that died ranged from 1 to 16 days and 4 to 34 days for the survivor. Our study heightens awareness and outlines the management challenges of necrotizing fasciitis of the head and neck in a poor resource setting.

PMID: 26626324 [PubMed - as supplied by publisher]

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Different Types of Luciferase Reporters Show Distinct Susceptibility to T3-Evoked Downregulation.

Different Types of Luciferase Reporters Show Distinct Susceptibility to T3-Evoked Downregulation.

Thyroid. 2015 Dec 2;

Authors: Kollár A, Kvárta-Papp Z, Egri P, Gereben B

Abstract
BACKGROUND: The firefly luciferase reporter protein is a crucial tool for studies targeting a broad range of biological questions. Importantly, luciferase assays are also widely used to explore mechanisms underlying thyroid hormone dependent regulation of gene expression. However, it was demonstrated that the firefly luciferase reporter is subject to triiodothyronine (T3)-evoked, promoter independent downregulation that is mediated by the thyroid hormone receptor. Since this effect can interfere with readout accuracy, the study aimed to find luciferase reporters that are not susceptible to this phenomenon.
METHODS: Luciferase reporter constructs were generated under the control of a minimal thymidine kinase (TK) promoter and transiently transfected into JEG-3 cells to test their activity upon T3 treatment.
RESULTS: Activity of the TK-(dCpG)Luc encoding a synthetic (dCpG)Luciferase and TK-NanoLuc expressing the NanoLuc reporter was not significantly changed by T3 treatment while the firefly luciferase control was suppressed by ∼2.6-fold. T3 also downregulated the activity of Renilla luciferase by ∼30%.
CONCLUSIONS: Novel types of luciferase reporters, especially the synthetic (dCpG)Luciferase, can be more accurate to study T3-regulated gene expression than the classical firefly luciferase reporter. Renilla luciferase, a popular transfection control of dual luciferase assays, should be used with caution in conditions with T3 treatment.

PMID: 26629840 [PubMed - as supplied by publisher]

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Endoscopic management of spontaneous clival CSF leaks: case series and literature review.

Endoscopic management of spontaneous clival CSF leaks: case series and literature review.

World Neurosurg. 2015 Nov 25;

Authors: Pagella F, Pusateri A, Matti E, Zoia C, Benazzo M, Gaetani P, Cazzador D, Volo T, Borsetto D, Emanuelli E

Abstract
OBJECTIVE: Spontaneous cerebrospinal fluid leaks are most commonly located along the anterior skull base. Sphenoidal localization is less common and, among these, clival localization is even rarer. We analyzed a group of patients with spontaneous leaks and selected patients with clival localization. Surgical management of these entities will be discussed and a brief literature review regarding spontaneous clival leaks will be reported in this paper.
METHODS: Of a cohort of 67 patients who presented to our departments with a spontaneous leak between 2005 and 2014, retrospective data analysis was performed on six patients with clival localization of the defect. Three patients received a skull base repair with a multilayered reconstruction, and three patients underwent a single-layered reconstruction using a pedicled nasoseptal flap.
RESULTS: The patient cohort included six women with a mean age of 60 (36-91 years old). The mean length of the follow-up was 69.5 months (22-114 months). The overall success rate of the primary endoscopic repair was 83.3% (five out of six), this increased to 100% after revision surgery.
CONCLUSIONS: This series, though numerically limited, suggests that a minimally invasive endoscopic repair of idiopathic clival leaks may be accomplished with an acceptable rate of morbidity and excellent outcomes. Moreover, nowadays the pedicled nasoseptal flap has been confirmed to be the "workhorse" for the reconstruction of clival defects.

PMID: 26626813 [PubMed - as supplied by publisher]

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Correlation of the Dysphonia Severity Index (DSI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and Gender in Brazilians With and Without Voice Disorders.

Correlation of the Dysphonia Severity Index (DSI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and Gender in Brazilians With and Without Voice Disorders.

J Voice. 2015 Nov 25;

Authors: Nemr K, Simões-Zenari M, de Souza GS, Hachiya A, Tsuji DH

Abstract
OBJECTIVES: This study aims to analyze the Dysphonia Severity Index (DSI) in Brazilians with or without voice disorders and investigate DSI's correlation with gender and auditory-perceptual evaluation data obtained via the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol.
STUDY DESIGN: A total of 66 Brazilian adults from both genders participated in the study, including 24 patients with dysphonia confirmed on laryngeal examination (dysphonic group [DG]) and 42 volunteers without voice or hearing complaints and without auditory-perceptual voice disorders (nondysphonic group [NDG]).
METHODS: The vocal tasks included in CAPE-V and DSI were performed and recorded. Data were analyzed by means of the independent t test, the Mann-Whitney U test, and Pearson correlation at the 5% significance level.
RESULTS: Differences were found in the mean DSI values between the DG and the NDG. Differences were also found in all DSI items between the groups, except for the highest frequency parameter. In the DG, a moderate negative correlation was detected between overall dysphonia severity (CAPE-V) and DSI value, and between breathiness and DSI value, and a weak negative correlation was detected between DSI value and roughness. In the NDG, the maximum phonation time was higher among males. In both groups, the highest frequency parameter was higher among females.
CONCLUSIONS: The DSI discriminated among Brazilians with or without voice disorders. A correlation was found between some aspects of the DSI and the CAPE-V but not between DSI and gender.

PMID: 26627119 [PubMed - as supplied by publisher]

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Early motor development of children with a congenital cytomegalovirus infection.

Early motor development of children with a congenital cytomegalovirus infection.

Res Dev Disabil. 2015 Nov 26;48:253-261

Authors: De Kegel A, Maes L, Dhooge I, van Hoecke H, De Leenheer E, Van Waelvelde H

Abstract
BACKGROUND: Congenital cytomegalovirus (cCMV) infection is the most important etiology of non-hereditary childhood hearing loss and an important cause of neurodevelopmental delay. The current study aimed to investigate the early motor development of symptomatic and asymptomatic cCMV infected children with and without sensorineural hearing loss (SNHL).
METHODS: Sixty-four children with a cCMV infection, without cerebral palsy, were compared to a control group of 107 normal hearing children. They were assessed around the ages of 6, 12, and 24 months with the Peabody Developmental Motor Scales-2 (PDMS-2), Alberta Infant Motor Scales (AIMS), and Ghent Developmental Balance Test (GDBT). The cCMV infected children were subdivided into a symptomatic (n=26) and asymptomatic cCMV group (n=38) but also into a cCMV group with SNHL (n=19) and without SNHL (n=45).
RESULTS: Symptomatic cCMV infected children and cCMV infected children with SNHL performed significantly weaker for all gross motor outcome measures.
CONCLUSION: A congenital CMV infection is a risk factor for a delay in the early motor development. Follow-up will be necessary to gain insight into the exact cause of this motor delay and to define the predictive value of early motor assessment of cCMV infected children.

PMID: 26630616 [PubMed - as supplied by publisher]

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