When inflammation is not just inflammation-A review of systemic diseases of the nose and sinuses part 2: Granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis.

BACKGROUND: Chronic rhinosinusitis is a very common condition. Granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (eGPA) are systemic diseases which can contribute to the development of chronic rhinosinusitis in select patients. OBJECTIVE: Characterize the presenting features, diagnostic criteria, workup, and management of granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis as they are encountered in otolaryngology clinics. METHODS: Full length manuscripts published 2000 or later were reviewed. A separate search was conducted for each disease. Pertinent clinical features related to sinonasal manifestations of GPA and eGPA were collected and reported in this review. RESULTS: 467 references were discovered during literature review process. In total, 42 references for GPA and 35 references for eGPA were included in this review. CONCLUSION: GPA and eGPA are vasculitis syndromes which commonly present in the context of multisystem disease. For GPA, pulmonary and renal disease are common; for eGPA a history of asthma is nearly ubiquitous. Sinonasal disease is a very common feature for both disease processes and may precede the development of systemic symptoms in many patients. Clinical work up and diagnosis is complex and generally requires multidisciplinary care. Treatment primarily consists of immunosuppressive agents, and a number of steroids, steroid sparing agents, and biologics have been shown to be effective. The role of sinus surgery includes tissue biopsy for diagnosis, functional surgery for symptom management in select cases, and reconstruction of cosmetic and functional defects.

When inflammation is not just inflammation-A review of systemic diseases of the nose and sinuses part 1: IgG4-related disease and sarcoidosis.

BACKGROUND: Chronic rhinosinusitis is a very common condition. IgG4-related disease (IgG4-RD) and sarcoidosis are systemic diseases which can contribute to the development of chronic rhinosinusitis in select patients. OBJECTIVE: Characterize the presenting features, diagnostic criteria, workup, and management of sinonasal IgG4-RD and sarcoidosis as they are encountered in otolaryngology clinics. METHODS: Full length manuscripts published 2000 or later were reviewed. A separate search was conducted for each disease. Pertinent clinical features related to sinonasal manifestations of IgG4-RD and sarcoidosis were collected and reported in this review. RESULTS: 404 references were discovered during literature review process. In total, 42 references for IgG4-RD and 34 references for sarcoidosis were included in this review. CONCLUSION: IgG4-RD and sarcoidosis are autoimmune inflammatory conditions that can affect many systems of the body. For both disease entities, sinonasal disease is a less common presentation which can lead to delayed diagnosis. Sinonasal IgG4-RD commonly presents in the setting of multisystem disease. All with other clinical features, biopsy plays a key role in the diagnosis for both diseases. Treatment for IgG4-RD consists primarily of steroids and rituximab which can lead to excellent and durable remission. A variety of immunosuppressive agents are used in the management of sarcoidosis. Surgery for IgG4-RD is primarily utilized for tissue biopsy, although resection or debulking may be considered. For sarcoidosis, surgery can be used for tissue biopsy and functional sinus surgery can offer symptomatic relief in many patients.

Does gender affect experiences in the operating room for surgeons and anesthesiologists at a large academic center?

BACKGROUND: Although the number of women medical trainees has increased in recent years, they remain a minority of the academic workforce. Gender-based implicit biases may lead to deleterious effects on surgical workforce retention and productivity. METHODS: All 440 attending surgeons and anesthesiologists employed at our institution were invited to complete a survey regarding perceptions of the perioperative work environment and resources. Odds ratios for dichotomous variables were calculated using logistic regressions, and for trichotomous variables, polytomous regressions. RESULTS: 243 participants (55.2%) provided complete survey responses. Relative to men, women faculty reported a greater need to prove themselves to staff; less respect and fewer resources and opportunities; more frequent assumptions about their capabilities; and a greater need to adjust their demeanor to connect with their team (p â€‹< â€‹0.05). CONCLUSION: Perceived gender bias remains present in the perioperative environment. We need greater efforts to address barriers and create an equitable work environment.

An Updated Patient-Centered Sialadenitis Instrument: The Obstructive Salivary Problem Impact Test (SPIT).

OBJECTIVE: The Chronic Obstructive Sialadenitis Symptoms questionnaire (COSS) was created to assess chronic sialadenitis symptoms and treatment response, but its development lacked patient input and validation. We analyzed COSS responses and feedback from sialadenitis patients and physician experts to create the novel obstructive Salivary Problem Impact Test (SPIT), a new standardized measure of sialadenitis-associated symptoms. METHODS: We analyzed COSS responses via exploratory factor analysis (EFA) to identify essential symptom domains and reduce overlap in questions. Sialadenitis patients evaluated the significance of index symptoms identified from the literature review. Expert physicians rated symptom relevance in clinical assessment. An updated questionnaire (SPIT) was piloted with both patient and expert interviews to optimize structure and readability. The SPIT was assessed for internal consistency, construct validity, and test-retest stability. RESULTS: EFA of 310 COSS responses demonstrated 3 main symptom domains (functional impact, pain, swelling) that explained 58.4% of response variance. Results were not statistically different when collapsing from 11 to 5 question response options. Experts (n = 5) ranked gland swelling, mealtime pain, and foul taste as most clinically important, while patients (n = 12) ranked swelling, non-mealtime pain, and difficulty eating as most bothersome. Most patients experienced sialadenitis-related functional or psychosocial impairment. Following interviews for question refinement, a 25-question survey was finalized. SPIT responses from 50 sialadenitis patients demonstrated internal consistency (Cronbach's alpha = 0.96), 14-day stability (p < 0.001), and agreement with Oral Health Impact Profile-14 scores (p < 0.0001). CONCLUSIONS: We developed the SPIT instrument to improve usability and content validity in chronic sialadenitis evaluation. The psychometric assessment demonstrated high construct validity and test-retest reliability. Further work will assess longitudinal changes with treatment. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:539-546, 2023.

Preoperative and postoperative ultrasound elastography findings of the sciatic nerve in patients with unilateral lumbar foraminal disc herniation: a pre-test and post-test design.

OBJECTIVE: The aim of this study was to compare preoperative and postoperative findings of the sciatic nerve by using B-mode ultrasound, strain elastography (SE), and shear wave elastography (SWE) in patients with unilateral lumbar foraminal disc herniation. PATIENTS AND METHODS: In this prospective study group, patients with complaints of foraminal disc herniation due to one level (L4-5 or L5-S1) were included. Preoperative and postoperative (one month after surgery) B-mode ultrasound, SE, and SWE findings of the affected sciatic nerve in patients who underwent unilateral spinal decompression surgery were compared. Evaluations were performed on the axial plane from the gluteal region using a convex probe of 5-9L MHz. The reference method used to assess nerve root compression was 1.5-T Magnetic Resonance Imaging (MRI). RESULTS: A total of 20 patients (9 males, 11 females) with a mean age of 46.2±13.1 years were included. The cross-sectional area (CSA), diameter, SWE values of the sciatic nerve were significantly higher in the affected side compared to those of the non-affected side (all for p<0.05). Blue and blue-green were the most common color codes in the affected side while green and green-yellow-red were the most common color codes in the non-affected side. The CSA, diameter, and SWE values of the sciatic nerve decreased after the surgery in the affected side (all for p<0.05), nonetheless. those did not differ in the non-affected side (all for p>0.05). CONCLUSIONS: Lumbar decompression surgery decreases the sciatic nerve diameter, CSA, and stiffness of the sciatic nerve.

IgG4-Related Disease and the Salivary Glands: A Review of Pathophysiology, Diagnosis, and Management.

IgG4-related disease is a rare, immune-mediated, systemic disease that is characterized by soft tissue lymphocyte infiltration and resultant fibrosis. The salivary glands are among the most commonly affected organs. Patients present with subacute submandibular and/or parotid swelling and sialadenitis. Diagnosis incorporates clinical, serologic, radiologic, and pathologic findings. Most cases respond quickly to systemic glucocorticoids. IgG4-related disease mimics many infectious, inflammatory, and neoplastic diseases. Therefore, IgG4-related disease is frequently misdiagnosed. A knowledge of the pathophysiology, diagnosis, and management of IgG4-related disease is important for providers who treat salivary gland diseases.

Association of Olfactory Training With Neural Connectivity in Adults With Postviral Olfactory Dysfunction.

Importance: Viral upper respiratory tract infections are a major cause of olfactory loss. Olfactory training (OT) is a promising intervention for smell restoration; however, a mechanistic understanding of the changes in neural plasticity induced by OT is absent. Objective: To evaluate functional brain connectivity in adults with postviral olfactory dysfunction (PVOD) before and after OT using resting-state functional magnetic resonance imaging. Design, Setting, and Participants: This prospective cohort study, conducted from September 1, 2017, to November 30, 2019, recruited adults with clinically diagnosed or self-reported PVOD of 3 months or longer. Baseline olfaction was measured using the University of Pennsylvania Smell Identification Test (UPSIT) and the Sniffin' Sticks test. Analysis was performed between December 1, 2020, and July 1, 2020. Interventions: Participants completed 12 weeks of OT using 4 essential oils: rose, eucalyptus, lemon, and clove. The resting-state functional magnetic resonance imaging measurements were obtained before and after intervention. Main Outcome and Measures: The primary outcome measure was the change in functional brain connectivity before and after OT. Secondary outcome measures included changes in UPSIT and Sniffin' Sticks test scores, as well as patient-reported changes in treatment response as measured by subjective changes in smell and quality-of-life measures. Results: A total of 16 participants with PVOD (11 female [69%] and 14 White [88%]; mean [SD] age, 60.0 [10.5] years; median duration of smell loss, 12 months [range, 3-240 months]) and 20 control participants (15 [75%] female; 17 [85%] White; mean [SD] age, 55.0 [9.2] years; median UPSIT score, 37 [range, 34-39]) completed the study. At baseline, participants had increased connectivity within the visual cortex when compared with normosmic control participants, a connection that subsequently decreased after OT. Furthermore, 4 other network connectivity values were observed to change after OT, including an increase in connectivity between the left parietal occipital junction, a region of interest associated with olfactory processing, and the cerebellum. Conclusions and Relevance: The use of OT is associated with connectivity changes within the visual cortex. This case-control cohort study suggests that there is a visual connection to smell that has not been previously explored with OT and that further studies examining the efficacy of a bimodal visual and OT program are needed.

Evidence of a microbial etiology for sialoliths.

OBJECTIVES: Sialolithiasis is the primary etiology for parotid and submandibular swelling, potentially resulting in discomfort, bacterial infections, and hospitalization. The etiology of sialolith formation is unknown. Currently, the proposed etiologies range from inflammation, coalescence of organic molecules, sialomicrolith formation, pH changes, and biofilm formation. In this study, we performed a descriptive analysis of images obtained through electron microscopy of sialoliths. Based on our findings and descriptive analysis, we hypothesize that sialolith formation is likely multifactorial and begins with biofilm formation. Biofilm formation then triggers a host immune response, and it is the interaction of biofilm with host immune cells and calcium nanoparticles that forms the nidus and creates a favorable environment for calcium precipitation. METHODS: Sialoliths were extracted from patients and imaged under light and scanning electron microscopy. Specimens for light microscopy were prepared using a diamond saw. Specimens for electron microscopy were freeze-fractured, thus providing an undisturbed view of the core of the sialolith. RESULTS: We were able to identify clear evidence of biofilm caves at the core of each sialolith. These biofilm caves were complex with the presence of bacteria and dehydrated extrapolysaccharide matrix, host cells (immune cells, platelets and erythrocytes), and calcium nanoparticles. CONCLUSION: The etiology of sialolith formation is likely multifactorial. We propose that biofilm formation within a single salivary gland or duct leads to local ductal injury, which results in the influx of host immune cells that interact with the biofilm and calcium nanoparticles, creating a scaffold upon which further calcium deposition can occur. LEVEL OF EVIDENCE: NA Laryngoscope, 130:69-74, 2020.

Priority setting for adult malnutrition and nutritional screening in healthcare: a James Lind Alliance.

BACKGROUND: Malnutrition is one the greatest global health challenges of our generation, leading to the increased utilisation of healthcare resources, as well as morbidity and mortality. Research has primarily been driven by industry, academia and clinical working groups and has had little involvement from patients and carers. The project described in the present study aimed to establish a priority setting partnership allowing patients, carers and healthcare professionals an opportunity to influence the research agenda. METHODS: A national survey was conducted to gather malnutrition uncertainties and identify key issues (i.e. areas within scope where an evidence-base is lacking) from those with experience of malnutrition. Uncertainties were analysed according to themes. Similar questions were grouped and summary questions were developed. A second survey was conducted and respondents were asked to choose their 10 most important summary questions. A workshop was conducted to finalise the top 10 research priorities from the most frequently indicated uncertainties on the interim survey. RESULTS: Overall, 1128 uncertainty questions were submitted from 268 people. The interim survey had 71 responses and a list of the top 26 questions was generated for the workshop. There were 26 questions discussed, ranked and agreed by healthcare professionals, carers and patients at the workshop. The top 10 research priorities were then chosen. These included questions on oral nutritional supplements, vulnerable groups, screening, community care, use of body mass index and technology. CONCLUSIONS: The top 10 research priorities in malnutrition and nutritional screening have been identified from a robust process involving patients, carers and healthcare professionals.

Rates of sialoendoscopy and sialoadenectomy in 5,111 adults with private insurance.

OBJECTIVE: To determine frequencies and trends in sialoendoscopy and sialoadenectomy for the treatment of obstructive, nonneoplastic submandibular gland disease in the United States. METHODS: Epidemiologic study of insurance claims from 2006 to 2013 in a large, private insurance claims database. Rates were calculated for patients undergoing one or both index procedures. RESULTS: A total of 5,111 adults with sialadenitis who underwent sialoendoscopy or submandibular gland excision were included. Mean age was 47.6 years, and patients undergoing sialoendoscopy were less likely to be male (relative risk [RR] = 0.84; 95% confidence interval [CI], 0.78-0.89), more likely to have sialoadenitis without stones (RR = 1.60; 95% CI, 1.53-1.66), and had a similar number of comorbidities (RR = 1.00; 95% CI, 0.91-1.06) compared to patients undergoing sialoadenectomy. The most common complication after sialoadenectomy was surgical site infection (1.4%; 95% CI, 1.1-1.8%), and complications after sialoendoscopy were rare. From 2007 to 2013, use of sialoendoscopy increased from 0.13 (95% CI, 0.08-0.18) to 0.42 (95% CI, 0.40-0.45) per 100 thousand people, and sialoadenectomy decreased from 2.41 (95% CI, 2.39-2.42) to 1.43 (95% CI, 1.40-1.44) per 100 thousand. The highest mean rate of sialadenectomy was seen in the south (2.15 per 100,000; 95% CI, 2.13-2.16), the lowest was in the west (1.6 per 100,000; 95% CI, 1.57-1.62), and it decreased in all regions over time. CONCLUSION: Utilization of sialoendoscopy has increased over time, and the overall rate of sialoadenectomy is decreasing. Both procedures are safe for treatment of patients with sialadenitis and sialolithiasis. Future research should examine whether availability of sialoendoscopy leads to a decreased rate of sialoadenectomy in patients with salivary gland disease. LEVEL OF EVIDENCE: 2c Laryngoscope, 129:602-606, 2019.

Sialendoscopy-assisted transfacial removal of parotid sialoliths: A systematic review and meta-analysis.

OBJECTIVE: To review the literature and conduct a meta-analysis to determine the effectiveness and safety of the combined endoscopic-transfacial approach for parotid sialolith management. DATA SOURCES: PubMed 1946-, Embase 1947-, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Review Effects, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, Proquest Dissertations and Theses, and FirstSearch Proceedings to March 2015. REVIEW METHODS: Published prospective or retrospective English-language studies with reported outcomes of more than one patient undergoing the combined endoscopic-transfacial procedure for parotid sialolithiasis were included. Two independent authors screened all eligible studies and reviewed and extracted data from relevant publications. Weighted pooled proportions for stone removal, symptom improvement, gland preservation, and complications were calculated. RESULTS: Ten studies, primarily retrospective single-institution studies, were included in the final analysis, with a total of 184 patients. Overall, the procedure was noted to be successful with low risk; the weighted pooled proportions were 0.99 (95% confidence interval [CI]: 0.97 to 1.00) for stone removal, 0.97 (95% CI: 0.93 to 0.99) for symptom improvement, 1 (95% CI: 0.99 to 1.00) for gland preservation, and 0.06 (95% CI: 0.01 to 0.15) for complications. CONCLUSIONS: Although our analysis is primarily based on retrospective data, the evidence shown here suggests that the combined endoscopic-transfacial technique is an effective treatment for parotid gland sialolithiasis not amenable to intraoral or purely endoscopic removal. This approach results in high rates of symptom improvement and gland preservation. The complication rates are low, further supporting the use of this technique. Laryngoscope, 127:2510-2516, 2017.

Interventional sialendoscopy after sialadenectomy.

OBJECTIVES/HYPOTHESIS: To evaluate the use of diagnostic and interventional sialendoscopy in patients with prior parotidectomy or submandibular gland excision and persistent sialadenitis and/or sialolithiasis. STUDY DESIGN: Retrospective case series. METHODS: Retrospective review of medical records, including demographic data, clinical presentation and exam, radiologic studies, and operative reports. RESULTS: Five patients, who had undergone prior sialadenectomy for sialadenitis and/or sialolithiasis, underwent sialendoscopy for persistent symptoms during the study period. Three patients were female and two were male, with ages ranging from 39 to 63 years (median, 47 years). Three patients had prior parotidectomy, and two had prior submandibular gland excision. The duration of time from sialadenectomy to sialendoscopy was 3.25 months to 6 years (median, 26 months). Four of the five patients had successful interventional sialendoscopy, with resolution of their symptoms. These four patients underwent extraction of stones, one of which was previously unrecognized. In one patient, duct cannulation and subsequent sialendoscopy could not be performed owing to scarring at the Stensen's papilla; the patient's symptoms initially persisted after the attempted procedure with gradual improvement. No complications occurred in any patients. Importantly, no sequelae resulted from endoscopic instrumentation and irrigation of salivary ducts that ended in blind pouches. CONCLUSIONS: Sialendoscopy is a safe and frequently effective intervention for persistent sialolithiasis and sialadenitis after salivary gland excision. LEVEL OF EVIDENCE: 4.

Predictors of future success in otolaryngology residency applicants.

OBJECTIVE: To evaluate the information available about otolaryngology residency applicants for factors that may predict future success as an otolaryngologist. DESIGN: Retrospective review of residency applications; survey of resident graduates and otolaryngology clinical faculty. SETTING: Otolaryngology residency program. PARTICIPANTS: Otolaryngology program graduates from 2001 to 2010 and current clinical faculty from Barnes-Jewish Hospital/Washington University School of Medicine. MAIN OUTCOME MEASURE: Overall ratings of the otolaryngology graduates by clinical faculty (on a 5-point scale) were compared with the resident application attributes that might predict success. The application factors studied are United States Medical Licensing Examination part 1 score, Alpha Omega Alpha Honor Medical Society election, medical school grades, letter of recommendation, rank of the medical school, extracurricular activities, residency interview, experience with acting intern, and extracurricular activities. RESULTS: Forty-six graduates were included in the study. The overall faculty rating of the residents showed good interrater reliability. The objective factors, letters of recommendation, experience as an acting intern, and musical excellence showed no correlation with higher faculty rating. Rank of the medical school and faculty interview weakly correlated with faculty rating. Having excelled in a team sport correlated with higher faculty rating. CONCLUSIONS: Many of the application factors typically used during otolaryngology residency candidate selection may not be predictive of future capabilities as a clinician. Prior excellence in a team sport may suggest continued success in the health care team.

Mainstream smoke chemistry analysis of samples from the 2009 US cigarette market.

A survey of selected mainstream smoke constituents from commercially marketed US cigarettes was conducted in 2009. The US cigarette market was segmented into thirteen (13) strata based on Cambridge Filter Method (CFM) "tar" category and cigarette design parameters. Menthol and non-menthol cigarettes were included. Sixty-one (61) cigarette brand styles were chosen to represent the market. Another thirty-four (34) brand styles of interest were included in the survey along with a Kentucky 3R4F reference cigarette. Twenty mainstream smoke constituents were evaluated using the Health Canada smoking regimen. By weighting the results of the 61 brand styles using the number of brand styles represented by each stratum, the mainstream smoke constituent means and medians of the US cigarette market were estimated. For nicotine, catechol, hydroquinone, benzo(a)pyrene and formaldehyde the mean yields increased with increasing "tar" yields. Constituent yields for the ultra-low "tar" and low "tar" cigarettes were not significantly different for most other analytes as ventilation blocking defeated any filter air dilution design features. In contrast, normalization per mg nicotine provided an inverse ranking of cigarette yields per CFM "tar" categories. Menthol cigarette mean constituent yields were observed to be within the range of the non-menthol cigarettes of similar "tar" categories.

Against the odds: idiopathic sudden sensorineural hearing loss-results from delayed treatment.

A 79-yr-old male was evaluated by the authors 4-6 wk following a rapid decline in perceived hearing in the right ear. Initial treatment with self-administered external ear canal irrigations and topical antibiotic prescribed by the patient's primary care physician resulted in no apparent improvement. The initial hearing evaluation revealed a mild-to-severe sloping sensorineural loss above 1000 Hz in the left ear and a moderately severe to severe sensorineural loss with a "flat" configuration in the right ear. There was normal word recognition in the left ear, with no measurable word recognition in the right ear. Initial treatment with oral steroids suggested some subjective improvement, and an intratympanic dexamethasone injection was performed. A repeat audiogram obtained approximately 1 mo postinjection showed significant improvement in pure tone thresholds and significant improvement in the word recognition score in the right ear. One week later a second intratympanic injection was completed, again, with follow-up in 1 mo. This case report reviews treatment options for idiopathic sudden sensorineural hearing loss (ISSNHL), including usual time lines for treatment and expected outcomes and the specific treatments and evaluation results for this patient for whom delayed treatment was unusually effective.

Predictive performance of the Domino, Hijazi, and Clements models during low-dose target-controlled ketamine infusions in healthy volunteers.

BACKGROUND: Healthy volunteers received low-dose target-controlled infusions (TCI) of ketamine controlled by the Domino model while cognitive function tests and functional neuroimaging were performed. The aim of the current study was to assess the predictive performance of the Domino model during these studies, and compare it with that of three other ketamine models. METHODS: Fifty-eight volunteers received ketamine administered by a TCI device on one or more occasions at target concentrations of either 50, 100, or 200 ng ml-1. At each target concentration, two or three venous blood samples were withdrawn during infusion, with a further sample after the infusion ended. Ketamine assays were performed by gas chromatography. The plasma concentration time courses predicted by the Hijazi, Clements 125, and Clements 250 models were calculated retrospectively, and the predictive performance of each of the models was assessed using Varvel methodology. RESULTS: For the Domino model, bias, inaccuracy, wobble, and divergence were - 2.7%, 33.9%, 24.2%, and 0.1463% h-1, respectively. There was a systematic increase in performance error over time. The Clements 250 model performed best by all criteria, whereas the Hijazi model performed least well by all criteria except for bias. CONCLUSIONS: Performance of the Domino model during control of low-dose ketamine infusions was sub-optimal. The Clements 250 model may be a better model for controlling low-dose TCI ketamine administration.

Implementation of a tight glycaemic control protocol using a web-based insulin dose calculator.

We describe the implementation of a glucose control protocol supported by a web-based insulin dose calculator in a 16-bedded intensive care unit. The protocol was introduced and then modified after 15 months' use. Glucose concentrations were retrospectively reviewed and compared for the 9-month period before introduction of the protocol (288 patients), for 15 months after its introduction (502 patients) and for a further 5 months after its modification to increase insulin dose (101 patients). The mean (SD) blood glucose concentrations decreased from 7.3 (1.8) mmol.l(-1) to 6.6 (1.6) mmol.l(-1) and then to 6.2 (1.3) mmol.l(-1). The proportion of values < 8.0 mmol.l(-1) increased from 69% to 81% and then to 89%. Blood glucose concentrations were increased by the use of intravenous nutrition and by vasoactive drugs but not by the administration of propofol. The odds ratio [95% CI] for death for glucose values > 8.0 mmol.l(-1) was 2.10 [1.19-3.73] compared to values < 6.1 mmol.l(-1). However, patient mortality remained constant during the study. Glycaemic control was improved outside a research setting using a protocol supported by a web-based insulin dose calculator.

A rapid LC-MS-MS method for the determination of nicotine and cotinine in serum and saliva samples from smokers: validation and comparison with a radioimmunoassay method.

The development and validation of a rapid liquid chromatography (LC)-tandem mass spectrometry (MS-MS) method for determination of nicotine and cotinine in smokers' serum is described. The method is based on solid-phase extraction in a 96-well plate format and requires only 100 microL of serum. Using normal-phase chromatography, both analytes elute in less than 1 min, which permits high sample throughput applications. The calibrated range is 2-100 ng/mL nicotine and 20-1,000 ng/mL cotinine. For known samples, recovery is 95-116% for nicotine and 93-94% for cotinine. The method is extended to rat serum and human saliva (cotinine only) using partial validation techniques. When compared with an existing radioimmunoassay method in our laboratory, the LC-MS-MS method gives improved accuracy, precision, and sample throughput.

The Hamilton SPE Evaluation Tool (HSET): is it any good?

Presents the Hamilton Supervised Pastoral Evaluation Tool (HSET). HSET is a self-report that evaluates student learning in a basic SPE unit utilizing six areas: supervisory relationship, personal growth, professional growth, theological reflection, learning context, and overall growth. Reviews statistics involving seven regional units consisting of 18 SPE units with 101 students. Utilizes methodological, investigator, and data triangulation by drawing on qualitative study and CAPPE accreditation review. Discusses strengths and weaknesses of HSET and makes recommendations for further use.