Factors Contributing to Missed Appointments in a Pediatric Otolaryngology Clinic

xlomafota13 shared this article with you from Inoreader Factors Contributing to Missed Appointments in a Pediatric Otolaryngology Clinic Via The Laryngoscope Objective To understand why pediatric otolaryngology patients do not attend scheduled clinic appointments and identify factors correlated with no-show status. Study Design Retrospective cohort study. Methods This is a retrospective cohort study that uses medical record data extraction of patients that was scheduled to attend new patient appointments at a pediatric otolaryngology clinic in 2018. Results Factors associated with no-shows included complex psychiatric history (OR (95% CI) 0.789 (0.71–0.88), P < .001), increased appointment lead time (OR (95% CI) 0.981 (0.976–0.987), P < .001), afternoon appointments (OR (95% CI) 0.783 (0.64–0.99), P = .038), and complex maternal medical history (OR (95% CI) 0.987 (0.979–0.996), P < .005). In contrast, factors associated with attendance included complex patients' medical history (OR (95% CI) 1.058 (0.98–1.02), P < .001), primary care physician at the same hospital (OR (95% CI) 2.766 (2.25–3.39), P < .001), and primary language being Spanish (OR (95% CI) 2.536 (1.75–3.67) P < .001). The factors of distance from the hospital (OR (95% CI) 1.001 (0.99–1.01), P = .868), season of appointment (P = .997), race (P = .623), and ethnicity (P = .804) were not as sociated with attendance or no-shows. Conclusion Patient and maternal medical problems, mental health history, primary care location, appointment lead time, hour of appointment, and primary language, all contribute to appointment attendance, while appointment timing, race, and ethnicity are not associated with attendance. Further work must be performed to overcome these barriers to minimize healthcare risks and improve patient outcomes. Quality of Evidence Level 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long‐Term Voice Outcomes Following Cricotracheal Resection for Subglottic Stenosis: A Retrospective Analysis

xlomafota13 shared this article with you from Inoreader Long‐Term Voice Outcomes Following Cricotracheal Resection for Subglottic Stenosis: A Retrospective Analysis Via The Laryngoscope Objectives/Hypothesis Cricotracheal resection (CTR) is an effective treatment for refractory idiopathic subglottic stenosis (iSGS) but is associated with persistent dysphonia. Outcomes were measured longitudinally to characterize how patients' voices and self-perceived voice handicaps changed after CTR. Study Design Retrospective case-series. Methods We conducted a retrospective cohort study of patients with refractory iSGS treated by CTR from 2006 to 2017. Voice Handicap Index (VHI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and acoustic analysis were prospectively collected preoperatively and postoperatively at 1, 3, 6, 12, and 24-month intervals. A linear mixed model was used to evaluate temporal change. Results Thirty-three patients (97% female) were included. VHI scores increased significantly from baseline preoperative score (27.2 ± 22.7) to a mean value of 44.3 ± 25.6 (P < .001) 1-month postoperatively but decreased below preoperative scores after 2 years (18.8 ± 11.9, P = .795). Mean fundamental frequency (F0) values in speech decreased significantly from 192.0 ± 24.9 Hz preoperatively to 167.1 ± 19.8 Hz at a 2-year follow-up (P = .002), with a nadir value at 1-month postoperatively (148.4 ± 20.5, P < .001). CAPE-V scores increased significantly from preoperative to 1-month postoperative (3.0 ± 2.3 vs. 21.9 ± 17.3, P < .001) but returned toward baseline values at 24 months after CTR (6.9 ± 4.8, P = .027). CAPE-V measurements postoperatively were correlated with VHI and F0 (Pearson coefficient = 0.54 (VHI), −0.46 (F0), P&n bsp;< .001). Conclusions Following CTR, mean F0 values were significantly and consistently lower but did increase over time, correlating with patients' improving VHI and CAPE-V scores. VHI values indicate that patient's perception of their voice is not significantly impacted in long term. These results provide a framework to counsel patients about long term voice expectations. Level of Evidence Level 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparative Effectiveness of Recurrent Laryngeal Nerve Monitoring Techniques in Pediatric Surgery.

xlomafota13 shared this article with you from Inoreader Comparative Effectiveness of Recurrent Laryngeal Nerve Monitoring Techniques in Pediatric Surgery. Via The Laryngoscope Objectives/Hypothesis The recurrent laryngeal nerve (RLN) is at risk during pediatric cervical, thoracic, and cardiac surgery. We aim to determine the feasibility and effectiveness of RLN monitoring techniques in all pediatric patients. Study Design Retrospective case series. Methods Retrospective review of patients/procedures with RLN(s) at risk and RLN monitoring at Boston Children's Hospital July 2019–October 2020. Primary outcomes: pre/postoperative vocal fold mobility by awake flexible fiberoptic laryngoscopy (FFL). Results One hundred one patients (median [interquartile range, IQR] age 14.6 months [4.6–49.7 months], weight 10 kg [5.2–16.2 kg]) underwent 122 procedures with RLN(s) at risk. RLN monitoring attempted 111 cases, successful 96 (84%). Surgical indications: esophageal atresia/tracheoesophageal fistula, and tracheobronchomalacia. Sixty-two (56%) procedures in reoperative field. Median follow-up 112 days (IQR 41–230). Pre/postoperative FFL performed 84 procedures (69%), 19 new postoperative RLN injuries (16%), median age 12 months, reoperative fields 11 (18%). Prass probes: 34 cases (28 successful, 82%), 6 injuries (18%), age 12.2 (5.8–23.6) months. Dragonfly electrodes: 45 cases (37 successful, 82%), 8 injuries (18%), age 7.5 (3.8–19) months. Nerve integrity monitoring (NIM) integrated electrode endotracheal tube: 33 cases (33 successful, 100%), 5 injuries (15%), age 90 (58.8–136.7) months. Automatic periodic stimulation (APS): 16 cases, 13 successful (81%), four inju ries (25%), age 7.2 (5.3–20.6) months. NIM RLN monitoring is significantly more successful than Prass, Dragonfly (95%CI −0.3 to 0.02, P = .02; and 95%CI 0.05–0.31, P = .008). Rates of injury are not different between types of RLN monitoring (P = .94), with APS use (P = .47), or with monitoring success (95%CI −0.36 to 0.09, P = .28). Conclusions RLN monitoring is feasible in pediatric patients of all ages. Although NIM type RLN monitoring success is superior, all forms offer similar rates of nerve protection. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anatomical consideration of deep calf veins: application to catheter-directed thrombolysis

xlomafota13 shared this article with you from Inoreader Anatomical consideration of deep calf veins: application to catheter-directed thrombolysis Via radiol anat Surg Radiol Anat. 2021 Aug 25. doi: 10.1007/s00276-021-02821-7. Online ahead of print. ABSTRACT PURPOSE: An antegrade approach is frequently used in catheter-directed thrombolysis to remove deep-vein thrombosis. However, the antegrade approach is difficult when accessing veins with small diameters; therefore, understanding the variation of deep calf vein is important. METHODS: This study measured the diameters and surface areas of the proximal and distal posterior tibi al vein, peroneal vein, and anterior tibial vein to determine which are preferable for venous access. This study dissected 132 legs from Korean and Thai cadavers. The proximal and distal posterior tibial vein, peroneal vein, and anterior tibial vein were scanned and measured. RESULTS: The mean diameter and surface area were largest for the proximal tibial vein, at 6.34 mm and 0.312 cm2, respectively, followed by the anterior tibial vein (5.22 mm and 0.213 cm2), distal posterior tibial vein (3.29 mm and 0.091 cm2), and peroneal vein (3.43 mm and 0.081 cm2). The proximal posterior tibial vein and anterior tibial vein have large diameters and surface areas, which make them ideal for applying an antegrade approach in catheter-directed thrombolysis. CONCLUSIONS: The distal posterior tibial vein and peroneal vein are not recommended due to their smaller surface areas and also the anatomical variations therein. PMID:34432130 | DOI:10.1007/s00276-021-02821-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predisposing conditions for bacterial meningitis in children: what radiologists need to know

xlomafota13 shared this article with you from Inoreader Predisposing conditions for bacterial meningitis in children: what radiologists need to know Via leak of cerebrospinal fluid Jpn J Radiol. 2021 Aug 25. doi: 10.1007/s11604-021-01191-9. Online ahead of print. ABSTRACT A variety of underlying diseases can predispose infants and children to bacterial meningitis (BM). For the diagnosis, treatment, and prevention of its recurrence, radiologists should be familiar with its predisposing conditions so that they can suggest the appropriate imaging approach. Predisposing conditions of BM can be broadly classified into two categories: infection spread from the adjacent tissue to the cerebrospinal fluid (CSF) space and immunodeficiency. Diseases in the former category are further divided according to regardless of whether there is a structural defect between the CSF space and the adjacent tissue. When a structural defect is suspected in a patient with BM, computed tomography (CT) of the head and magnetic resonance (MR) imaging are first-line imaging examinations. Radionuclide cisternography should be implemented as a second-li ne step to identify the CSF leak site. In patients with suspected parameningeal infection without any structural defect, such as sinusitis or otitis media/mastoiditis, CT or MR images can identify not only the disease itself but also the associated intracranial complications. The purpose of this article is to discuss the diagnostic approach and imaging findings associated with the variety of conditions predisposing patients to recurrent BM, focusing on the role of radiology in their management. PMID:34432172 | DOI:10.1007/s11604-021-01191-9 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Persistent otorrhoea caused by cerebrospinal fluid leakage

xlomafota13 shared this article with you from Inoreader Persistent otorrhoea caused by cerebrospinal fluid leakage Via leak of cerebrospinal fluid Ned Tijdschr Geneeskd. 2021 Jun 10;165:D5456. ABSTRACT Persistent otorrhoea is a common issue for both children and adults, which can be caused by leakage of cerebrospinal fluid from the lateral skull base. Bacterial superinfection of the chronically humid middle ear, arising from continuous cerebrospinal fluid leakage, may contribute to an atypical clinical presentation. That is, otogenous cerebrospinal fluid leakage may mimic serious otitis media with concomitant conductive hearing loss, leading to a serious diagnostic delay in some patients. On the basis of three cases with cerebrospinal fluid leakage, resulting in persistent otorrhoea, we underline the importance of its timely diagnosis and treatment. PMID:34346583 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Role of primary tumor resection in patients with metastatic medullary thyroid cancer who have unresectable distant metastases

xlomafota13 shared this article with you from Inoreader Role of primary tumor resection in patients with metastatic medullary thyroid cancer who have unresectable distant metastases Via Head & Neck Abstract Background Whether patients with medullary thyroid carcinoma (MTC) who have unresectable synchronous distant metastases should undergo primary surgical resection (PTR) remains controversial. This study aimed to identify predictive factors associated with the survival of such patients. Methods We conducted a retrospective study of patients with MTC who were registered in the Surveillance, Epidemiology, and End Results registry. The overall and cancer-specific mortality rates were assessed using risk-adjusted Cox proportional hazards regression modeling and stratified propensity score matching. Results One hundred and eight matched patients were assessed. Patients in the PTR group had lower overall mortality than did those in the non-PTR group. The 1-, 3-, and 5-year overall and cancer-specific survival rates in the PTR group were significantly higher. Conclusions PTR appears to be the most appropriate intervention for patients with good performance status. Such patients are likely to benefit from surgery and to experience long-term stable disease. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.