ABSTRACT
Use of artificial intelligence (AI) is expanding exponentially as it pertains to workflow operations. Otolaryngology-Head and Neck Surgery (OHNS), as with all medical fields, is just now beginning to realize the exciting upsides of AI as it relates to patient care but otolaryngologists should also be critical when considering using AI solutions. This paper highlights how AI can optimize clinical workflows in the outpatient, inpatient, and surgical settings while also discussing some of the possible drawbacks with the burgeoning technology.
Subject(s)
Artificial Intelligence , Otolaryngology , Workflow , Humans , Otorhinolaryngologic Surgical Procedures/methodsABSTRACT
AIM: To compare the effectiveness of total thyroidectomy versus thyroid lobectomy for the treatment of follicular thyroid microcarcinoma. PATIENTS AND METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results 18 Database. The study cohort included patients diagnosed with follicular thyroid microcarcinoma between 1988 and 2009, treated with either total thyroidectomy or thyroid lobectomy. Propensity-score analysis using inverse probability weighting was used to control for allocation bias. RESULTS: A total of 203 patients were identified. The 5-year overall survival was 98% for patients treated with lobectomy and 99% for those treated with total thyroidectomy; this difference was not statistically significant (p=0.13). Unadjusted analysis and propensity-score analysis revealed no difference in overall survival between the two treatment groups (p=0.15 and p=0.49, respectively). CONCLUSION: Total thyroidectomy does not appear to offer any survival advantage over thyroid lobectomy for patients with follicular thyroid microcarcinoma.
Subject(s)
Thyroid Gland/surgery , Thyroid Neoplasms/surgery , Thyroidectomy/methods , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Papillary/surgery , Female , Humans , Male , Middle Aged , Propensity Score , SEER Program , Thyroid Neoplasms/mortalityABSTRACT
PURPOSE: To evaluate the effectiveness of a protocol for management of patients with laryngopharyngeal reflux (LPR) in a multi-provider clinic. MATERIALS AND METHODS: This is a retrospective cohort study of 188 patients treated for LPR. A standardized clinical protocol for diagnosis and management was instituted in 2012. Two cohorts were established: those managed according to the protocol, and those who were not. For patients managed with the LPR protocol, diagnosis was made using clinical judgment, guided by the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). Patients were treated with proton pump inhibitors (PPI) with the goal of weaning therapy after symptom resolution. Response to therapy was rated using a global rating scale with three response levels: no response, partial response, and complete response. The primary outcome measure was complete response to therapy and the secondary outcome measures were any response (complete or partial) and successful wean off PPI therapy. RESULTS: The patients treated with the LPR protocol had higher rates of complete response (p<0.001). There was no statistically significant difference in rates of any response (complete or partial) between the two groups (p=0.08). Patients treated using the LPR protocol were more likely to be successfully weaned off PPI therapy (p=0.006). CONCLUSIONS: The use of an LPR protocol improved treatment effectiveness in our clinic, highlighting the role of clinical protocols in reducing variability in care, thereby improving patient outcomes.
Subject(s)
Clinical Protocols , Laryngopharyngeal Reflux/therapy , Proton Pump Inhibitors/therapeutic use , Adult , Female , Humans , Laryngopharyngeal Reflux/diagnosis , Laryngopharyngeal Reflux/etiology , Laryngoscopy , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To determine the incidence of adenoid cystic carcinoma of the external ear in the United States, and to evaluate the clinical characteristics and survival outcomes associated with the disease. MATERIALS AND METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 18 Database of the National Cancer Institute. The study cohort included patients diagnosed with adenoid cystic carcinoma of the external ear from 1973 to 2012. RESULTS: The incidence of adenoid cystic carcinoma of the external ear was 0.004 per 100,000. The SEER database identified 66 patients meeting the inclusion criteria. Nodal metastasis was noted in 13.1% of patients, while 7.9% had distant metastasis. Distant metastasis was associated with worse overall survival (HR 10.18). However, nodal metastasis had no impact on overall survival (HR 0.15, p = 0.09). Surgery alone was associated with improved overall survival (HR 0.26), compared with combination surgery and radiotherapy, while radiotherapy alone was associated with worse overall survival (HR 20.12). Increasing age (HR 1.12) and black race (HR 6.83) were associated with worse overall survival, while female sex (HR 0.26) was associated with improved overall survival. CONCLUSION: ACC of the external ear is rare. Distant metastasis is a poor prognostic factor. However, nodal metastasis does not appear to impact survival. Advanced age, black race, and male sex are also poor prognostic factors. Surgical resection alone is associated with better survival than combination surgical resection and radiation, or radiotherapy alone.