Journal of Otolaryngology - Head & Neck Surgery最新文献

{"title":"Reducing Unnecessary X-Rays for Nasal Fractures: A Quality Improvement Project.","authors":"Jess Rhee, Danielle Kelton, Sheena Belisle, Agnieszka Dzioba, Leigh Sowerby, Andrew Simpson, Julie E Strychowsky","doi":"10.1177/19160216251336681","DOIUrl":"10.1177/19160216251336681","url":null,"abstract":"<p><p>BackgroundChoosing Wisely Canada recommends against the use of nasal bone X-rays for the evaluation of nasal fractures. The goal of this quality improvement project was to reduce the number of nasal bone X-rays ordered at our institution by 50% by 1 year.MethodsThe Institute for Healthcare Improvement Model for Improvement was used, and a pre- and post-intervention study was conducted. Change ideas included the following: a clinical decision support tool, provider surveys, and education. The number of X-rays ordered monthly was monitored. Financial cost (labor, materials, and overhead) was assessed. Environmental impact was extrapolated based on carbon dioxide equivalent emissions (CO₂e). Balancing measures included the use of computed tomography (CT) scans. Analysis included summary statistics, statistical process control charting, and unpaired t-tests.ResultsThere was a 73% reduction in total X-rays ordered from 197 pre-intervention (September 2021-November 2022) to 58 post-intervention (December 2022-February 2024). There was a statistically-significant decrease in difference of means of 2.6 X-rays/month (4.9 vs 2.3, pre vs post; <i>P</i> < .001), an average monthly reduction of 53%. There was special cause variation after implementation. Cost savings was $5534.98, and environmental footprint reduction was 111.2 kg of CO₂e. There was no compensatory increase in the number of CT scans ordered.ConclusionImplementation of a clinical decision support tool and education resulted in a significant reduction in the number of nasal bone X-rays ordered for the evaluation of nasal fractures. This Choosing Wisely Canada project ultimately reduces unnecessary investigations for patients, saves health care costs, and reduces environmental impact.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251336681"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Impact of LearnENT's Social Media Team as a Powerful Tool in Otolaryngology Medical Education.","authors":"Gizelle Francis, Youssef Omar, Alexander Moise, Kalpesh Hathi, Dorsa Mavedatnia, Elysia Grose, Timothy Phillips","doi":"10.1177/19160216251345465","DOIUrl":"10.1177/19160216251345465","url":null,"abstract":"<p><p>ImportanceAdvancements in medical education have led to the adoption of virtual learning. Certain medical fields, including Otolaryngology-Head and Neck Surgery (OHNS), are underrepresented in undergraduate medical education curricula. LearnENT, an OHNS educational app, addresses this gap and has gained a global user base through its active social media presence.ObjectivesTo investigate the efficacy of the LearnENT social media team in disseminating OHNS educational resources and engaging users.DesignA longitudinal observational study with data collection conducted over an 8 month period surrounding the implementation of the social media team.SettingThe study utilized 2 platforms: Instagram Business tools and the LearnENT application dashboard.ParticipantsInstagram followers and LearnENT app users globally, with data segmented by demographics and professional backgrounds.Exposures or InterventionAnalysis of Instagram Business data, including trends in followers, accounts reached, accounts engaged, impressions, and activity on the LearnENT application dashboard.Main Outcome MeasuresFollower demographics, audience activity patterns, account interactions, and app usage trends.ResultsThe Instagram account achieved a 49.7% increase in followers (900 total) over 8 months. Engagement metrics showed an 87% rise in accounts reached and a 70% increase in impressions. App usage increased by 12%, reaching a total of 8257 users across 36 countries. Key content types, such as \"Question of the Week,\" received the highest engagement rates.ConclusionThe LearnENT social media team has effectively disseminated OHNS educational resources and engaged learners, as evidenced by a 49.7% increase in followers and 12% increase app users.RelevanceThe global reach and diversity of the LearnENT Instagram community highlight its potential to connect individuals worldwide. Strategies to further enhance engagement include creating visually-appealing graphics, addressing audience preferences, and collaborating with other OHNS-related accounts.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251345465"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial Middle Turbinate Resection Versus Preservation on Olfactory Function: A Systematic Review and Meta-Analysis.","authors":"Yen-An Chen, Chih-Hao Chen, Wei-Hsin Wang, Ming-Ying Lan","doi":"10.1177/19160216251351566","DOIUrl":"10.1177/19160216251351566","url":null,"abstract":"<p><p>ObjectivesThe middle turbinate (MT) was considered related to olfactory function. Whether the MT should be partially resected during relevant surgery is still debated. Our primary objective was to compare the olfactory outcome between partial MT resection (MTR) and MT preservation (MTP).MethodsA search was performed on the Cochrane Library, Embase, PubMed, Scopus, and Web of Science databases from their inception through February 10, 2024. Eligible studies included those that compared the olfactory outcome between partial MTR and MTP. Data were extracted manually, and a random-effects model was used to evaluate it. We calculated the standardized mean differences (SMD) in the scores for the olfactory function. Further subgroup analysis was also performed for variables of interest. The pooled results were examined using influence analysis.ResultsAfter systematically reviewing all relevant articles, 7 studies were qualified for inclusion. The pooled results showed no significant difference in olfaction between the partial MTR and MTP (SMD, 0.140; 95% CI, -0.159 to 0.438; <i>P</i> = .359; <i>I</i>² <1%). Subgroup analysis preferred partial MTR in the objective test (SMD, 0.370; 95% CI, 0.17-0.56; <i>P</i> < .001; <i>I</i>² = 0%). No significance was observed in studies with subjective test (SMD, -0.271; 95% CI, -0.604 to 0.63; <i>P</i> = .112; <i>I</i>² <1%), undergoing functional endoscopic sinus surgery (0.10; 95% CI, -0.35 to 0.54; <i>P</i> = .67; <i>I</i>² = 85%), undergoing skull base surgery with endoscopic endonasal approach (SMD, 0.25; 95% CI, -0.04 to 0.53; <i>P</i> = .09; <i>I</i>² = 0%), and following up more than 6 months (SMD, 0.09; 95% CI, -0.21 to 0.39; <i>P</i> = .57; <i>I</i>² = 75%).ConclusionOur findings showed that MTR does not deteriorate olfactory function compared with MTP. Considering the potential benefit, partial MTR might be prioritized in clinical settings.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251351566"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"My Quality of Life is Not There. I'm Dying Here. I Cannot Take This Anymore.\" Exploring Patient Experiences With Surgical Wait Times in Otolaryngology: A Mixed Methods Study.","authors":"Shelley Vanderhout, Shipra Taneja, Amr Hamour, Eric Monterio, Janet Chung","doi":"10.1177/19160216251321456","DOIUrl":"10.1177/19160216251321456","url":null,"abstract":"<p><p>BackgroundNew patient referral models are needed to reduce long wait times for otolaryngology surgical procedures, such as a Single-Entry Model (SEM). However, patient perspectives about SEM in otolaryngology remain unexplored.MethodsIn this mixed methods study, a retrospective chart review was conducted to examine the times from referral to consultation (T1) and from consent to surgery (T2) for all elective otolaryngology surgical procedures at a large community hospital between 2020 and 2023. We then conducted journey mapping interviews with 10 patients and parents of pediatric patients who underwent otolaryngologic surgeries to understand their experiences of waiting for their own or their child's procedure, and perspectives on how an SEM might impact patient experiences. Data were analyzed using descriptive statistics and thematic analysis.ResultsWe identified that average wait times among 2414 elective (oncologic and non-oncologic) otolaryngology procedures often exceeded provincial target wait times. On average, oncology procedures had the shortest wait times (T1: 34 ± 47; T2: 101 ± 161 days), and otologic procedures had the longest (T1: 67 + 72; T2: 355 ± 285 days). While patients often did not wait as long to have a consultation with their surgeon, the time between consenting to and receiving surgery tended to drive wait time duration. Patients who had endured extended wait times experienced poor quality of life, worsening symptoms, and often worried about how long they would need to wait. Systems such as an SEM that could shorten wait times were generally well-perceived. However, patients emphasized the importance of trusting relationships with referring physicians and surgeons, which could be an enabling factor for implementing an SEM.ConclusionLong surgical wait times in otolaryngology are negatively impacting patients. A SEM could offer a way to improve patient experiences and outcomes.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251321456"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Distress in Patients with Long-lasting COVID-19 Olfactory Dysfunction.","authors":"Manon Louvrier, Sven Saussez, Jerome R Lechien","doi":"10.1177/19160216251328960","DOIUrl":"https://doi.org/10.1177/19160216251328960","url":null,"abstract":"<p><p>ObjectiveThe aim of this study was to investigate the psychological distress associated with long-lasting COVID-19 olfactory dysfunction (OD).MethodsPatients with an OD lasting for more than 6 months were consecutively recruited from the Dour Medical Center (Belgium) from August 2023 to January 2024. The olfaction was investigated with the Olfactory Disorder Questionnaires (ODQ) and the threshold, identification, and discrimination (TDI) testing. General Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) were used to investigate the psychological distress of patients. The olfactory and psychological outcomes of patients were compared with a group of individuals without OD.ResultsA total of 220 patients and 102 asymptomatic individuals completed the evaluations. The mean duration of OD was 31.1 ± 25.1 months. The mean GAD-7 and PHQ-9 scores were significantly higher in OD patients than in asymptomatic individuals (<i>P</i> < 0.008). The OD patient prevalence of mild-to-severe depression (51.2% vs. 44.1%) and mild-to-severe anxiety (39.5% vs. 32.4%) disorders was significantly higher than asymptomatic individuals. Severe anxiety was associated with the presence of anosmia. GAD-7 and PHQ-9 scores were higher in females than in males. The severity of depression (PHQ-9) and anxiety (GAD-7) was significantly associated with the severity of OD (ODQ) and nasal symptoms (SNOT-22).ConclusionThe presence of a long-lasting OD in patients consulting in otolaryngology is associated with psychological distress. While the causality relationship remains unclear, depression and anxiety symptoms must be investigated in this subgroup of patients with long COVID-19.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251328960"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Intraoperative Interventions on Hypocalcemia Post-Total Thyroidectomy: A Meta-Analysis.","authors":"Hao-Wei Hsu, Sheng-Hsin Huang, Shao Huai Lee, Shih-Tsang Lin, Mingchih Chen, Ru-Yung Yang, Shyh-Dye Lee, Jeng-Wen Chen","doi":"10.1177/19160216251333355","DOIUrl":"https://doi.org/10.1177/19160216251333355","url":null,"abstract":"<p><p>ImportancePostoperative hypocalcemia following total thyroidectomy (TT) can significantly affect patients' quality of life. However, the most effective intraoperative interventions to mitigate this risk remain uncertain.ObjectiveTo assess the efficacy of parathyroid gland autotransplantation (PTA), near-infrared autofluorescence (NIRAF), and indocyanine green angiography (ICGA) in reducing postoperative hypocalcemia risk after TT.DesignMeta-analysis.SettingThis meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, utilizing data from PubMed, Embase, and the Cochrane Library, with searches conducted through February 2024.ParticipantsPatients undergoing TT with or without intraoperative interventions of PTA, NIRAF, ICGA, or a combined approach.InterventionsPTA, NIRAF, ICGA, or a combination of these methods.Main Outcome MeasuresIncidence of postoperative transient and permanent hypocalcemia.ResultsFrom 582 identified records, 32 studies, including 13,299 TT patients (6386 with benign and 6913 with malignant conditions), met the inclusion criteria. PTA was associated with a higher incidence of transient postoperative hypocalcemia (OR = 1.98; 95% CI: 1.42-2.77; <i>I</i>² = 84%). Conversely, NIRAF (OR = 0.45; 95% CI: 0.35-0.57; <i>I</i>² = 0%) and ICGA (OR = 0.22; 95% CI: 0.07-0.69; <i>I</i>² = 0%) showed reduced incidences of transient hypocalcemia. The combined NIRAF and ICGA approach, evaluated in 2 studies, yielded inconclusive results (OR = 0.62; 95% CI: 0.28-1.37).Conclusions and RelevanceIntraoperative use of NIRAF and ICGA significantly decreased the incidence of transient hypocalcemia following TT, whereas PTA did not demonstrate similar efficacy. Minimal effects on permanent hypocalcemia were observed across interventions. Further research is necessary to clarify the effectiveness of the combined NIRAF and ICGA approach.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251333355"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optokinetic After-Nystagmus: A Marker for Migraine? A Prospective Observational Study.","authors":"Mikaël Kassin-Dufresne, Marie-Catherine Charest Bossé, Margaret Aron","doi":"10.1177/19160216241307553","DOIUrl":"10.1177/19160216241307553","url":null,"abstract":"<p><strong>Introduction: </strong>Vestibular migraine (VM), particularly its chronic variant, poses a diagnostic challenge. Patients suffering from VM may not have the characteristic headaches associated with the dizziness. In these cases, a marker for migraine pathology in general could help appropriately diagnose certain types of dizziness as migrainous despite these patients not meeting current diagnostic criteria for VM. Migraine patients in general (headache and vestibular) are known to share a tendency toward intolerance of certain stimuli, including busy visual stimuli. True optokinetic stimulation, measured by the production of optokinetic after-nystagmus (OKAN) simulates these busy visual stimuli.</p><p><strong>Methods: </strong>Prospective observational study comparing response to optokinetic stimulation between migraine patients and controls. Questionnaires regarding general sensitivities to busy visual stimuli were completed prior to beginning the study. Both subjective and objective markers of stress were measured before and after exposure to the stimulus. Initial slow-phase velocity, slow cumulative eye position, and adjusted time constant of OKAN were compared between the 2 groups.</p><p><strong>Results: </strong>The groups differed only with regard to sensitivity to blinking lights and history of motion sickness on initial questionnaire. Regarding subjective symptoms of discomfort, migraine patients tended to report higher scores than controls both before and after testing, but there was no significant difference from before to after stimulus in each group's scores. There were no statistically-significant differences between initial slow-phase velocity, slow cumulative eye position, and adjusted time constant of OKAN between groups.</p><p><strong>Conclusions: </strong>In this study, OKAN measurements were not useful in differentiating migraine patients at large from control subjects. We hypothesize that there may be a distinct subgroup of migraine patients that are more sensitive to visually-disturbing situations that may differ from other migraine sufferers. Future studies will aim to identify such patients and compare them to controls.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216241307553"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Economic Burden of Management of Pituitary Adenomas: A Propensity-Score-Matched Cost Analysis.","authors":"Lisa Caulley, Andrea Lasso, Brandon Zagorski, Andrew S Wilton, Refik Saskin, Nick Sahlollbey, Jeanne M Séguin, Kednapa Thavorn, Mary-Anne Doyle, Janine Malcolm, Fahad Alkherayf, Stephanie Johnson-Obaseki, David Schramm, Shaun Kilty","doi":"10.1177/19160216251314793","DOIUrl":"10.1177/19160216251314793","url":null,"abstract":"<p><strong>Importance: </strong>Pituitary adenomas (PAs) present a notable economic burden on healthcare systems due to their management's reliance on multimodal, often costly interventions.</p><p><strong>Objective: </strong>To determine total and relative healthcare costs for PAs at Ontario-based institutions.</p><p><strong>Design: </strong>A retrospective, propensity-score-matched cohort analysis.</p><p><strong>Setting: </strong>Ontario, Canada, encompassing public healthcare facilities and covering costs over a 6-year study period.</p><p><strong>Participants: </strong>Adults diagnosed with PA (n = 1675) between April 1, 2013, and March 31, 2019, compared to a general population cohort and a hospitalized control cohort matched on demographics and health factors.</p><p><strong>Intervention/exposures: </strong>Analysis of healthcare cost components (inpatient, outpatient, and diagnostic services) and cost trajectories postsurgery for PAs.</p><p><strong>Main outcome measures: </strong>Primary outcome was total annualized healthcare costs for patients with PA relative to the general and hospitalized cohorts. Relative costs were estimated using a negative binomial regression model.</p><p><strong>Results: </strong>Of 1675 patients with PA, total annualized costs were $49,992. Highest total costs were associated with inpatient hospitalization ($24,796) and physician services/diagnostic evaluations ($20,075). After propensity score matching, patients with PA had 12.7 times higher costs [95% confidence interval (CI) (10.9, 14.8), <i>P</i> < .0001] during the preadmission/admission period, which remained elevated postoperatively (<i>P</i> < .05). Total costs did not differ between patients with PA and the hospitalized cohort [RR 0.97, 95% CI (0.92, 1.03); <i>P</i> = .3271] in the preadmission/admission period; however, follow-up costs were 37% lower for patients with PA in the 1st follow-up year [RR 0.63, 95% CI (0.51, 0.77); <i>P</i> < .0001], and up to 50% lower by the 5th year [RR 0.50, 95% CI (0.36, 0.68); <i>P</i> < .0001].</p><p><strong>Conclusions: </strong>This study provided a comprehensive assessment of the economic burden of PAs on the publicly-funded healthcare system. Patients with PA had higher annualized total costs across all observed time periods compared to the general population and lower annualized total costs compared to patients admitted to a surgical ward.</p><p><strong>Relevance: </strong>This study highlights the financial impact of PA management on healthcare resources and provides a basis for future research aimed at cost-efficiency improvements in long-term PA care.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251314793"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomogram Prediction of Response to Neoadjuvant Chemotherapy Plus Pembrolizumab in Locally Advanced Hypopharyngeal Squamous Cell Carcinoma.","authors":"Zhangwei Hu, Yi Chen, Renqiang Ma, Wei Sun, Lin Chen, Zhimou Cai, Weiping Wen, Wenbin Lei","doi":"10.1177/19160216251318255","DOIUrl":"10.1177/19160216251318255","url":null,"abstract":"<p><strong>Importance: </strong>The objective response (ORR) rate in patients with locally advanced hypopharyngeal squamous cell-carcinoma (LA-HPSCC) following neoadjuvant chemotherapy (NACT) of albumin-bound paclitaxel plus carboplatin is low. At present, it is unclear whether the addition of pembrolizumab could increase the ORR or not.</p><p><strong>Objective: </strong>To investigate whether the addition of pembrolizumab could increase the ORR, and to develop a nomogram to predict the response of pembrolizumab addition.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>This study was conducted at a single institution.</p><p><strong>Participants: </strong>This study included 129 patients who conformed to the inclusion criteria.</p><p><strong>Intervention or exposures: </strong>NACT with or without pembrolizumab for patients with LA-HPSCC.</p><p><strong>Main outcome measures: </strong>The ORR was analyzed according to the RECIST 1.1 criteria and a nomogram was developed based on least absolute shrinkage and selection operator and multivariable Cox regression analysis. Predictive accuracy and discriminative ability of the nomogram were evaluated by receiver operating characteristics, precision recall, calibration curves, and decision curve analysis.</p><p><strong>Results: </strong>Eighty-two patients received NACT and 47 also received pembrolizumab. ORR was higher in patients receiving additional pembrolizumab (66.0% vs 47.6%, χ² = 4.074, <i>P</i> = .044). The nomogram identified pretreatment levels of lymphocytes and red blood cells as independent predictors of a high ORR, while basophil levels were an independent predictor of a low ORR. Calibration curve showed that the nomogram-based predictions corresponded well with actual observations. C-index of the nomogram was 0.925 (0.848-1.002) and the area under curve was 0.925. Decision curve analysis affirmed that the nomogram had important clinical value.</p><p><strong>Conclusions and relevance: </strong>Pembrolizumab could improve the ORR in LA-HPSCC patients treated with NACT. Furthermore, a risk-prediction nomogram incorporating readily assessable routine pretreatment blood parameters can accurately estimate the response to NACT with pembrolizumab, leading to precise treatment and minimizing the waste of medical resources.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251318255"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resource Utilization and Cost Analysis of Pediatric Esophageal Foreign Bodies.","authors":"Tanya Chen, Jennifer M Siu, Yasmine Madan, Gar-Way Ma, Peter J Gill, Nicholas Carman, Evan J Propst, Nikolaus E Wolter","doi":"10.1177/19160216251318256","DOIUrl":"10.1177/19160216251318256","url":null,"abstract":"<p><strong>Objective: </strong>Impacted esophageal foreign bodies (EFBs) are a common but preventable presentation in children, requiring prompt removal in the operating room by esophagoscopy. Our objective was to describe the overall cost of impacted pediatric EFBs and determine factors that increase resource burden.</p><p><strong>Methods: </strong>A cost analysis of pediatric patients undergoing esophagoscopy for EFB removal from 2010 to 2021 was performed. Characteristics of each EFB, patient transfer, and hospital course were collected. Direct and indirect healthcare costs were calculated using hospital-specific costs and provincial fees. Amounts were calculated in Canadian dollars.</p><p><strong>Results: </strong>Six hundred and eighty patients were included. The total amount spent on pediatric EFBs from 2010 to 2021 was $2,673,288. The mean total cost per child with an EFB was $3469. An extra hour of delay before Otolaryngology-Head and Neck Surgery (OHNS) consultation at a tertiary hospital corresponded to an $816 cost [95% confidence interval (CI; 244.7-1287.4)]. On average, children requiring transfer to a tertiary care center cost $1965 more than those initially presenting to a tertiary care center (<i>P</i> = .001). Higher-risk EFBs (n = 165, 24%) were associated with a longer hospital stay and greater complication rate and resulted in a $4095 increase in overall cost compared to lower-risk EFBs [$6829 (standard deviation (SD) $11,347) vs $2734 (SD $10,451), <i>P</i> = .02]. Button battery ingestions cost 8.8 times more than non-dangerous EFBs, such as coins. Longer distance for transfer was associated with a higher likelihood of having complications [odds ratios (OR) 1.5, 95% CI (1.1-1.8)].</p><p><strong>Conclusion: </strong>EFBs pose a significant economic burden to the healthcare system, driven by transfer to a tertiary care center, delays in transfer to the operating room, and high-risk EFBs. It is critical to identify areas for improved efficiency such as increased parental education for primary prevention, early involvement of the OHNS team and improving the capacity of community hospitals to manage EFB to limit transfers when possible.</p>","PeriodicalId":16615,"journal":{"name":"Journal of Otolaryngology - Head & Neck Surgery","volume":"54 ","pages":"19160216251318256"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11811963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}