Potential for health care cost savings with preoperative gastrostomy tube placement in the head and neck cancer population

Abstract

Background

The purpose of this study was to examine the cost differences between preoperative and postoperative placement of gastrostomy tubes (G-tubes) in patients with head and neck cancer.

Methods

We conducted a retrospective chart review of patients with aerodigestive tract cancers from 2010 to 2015. Data included inpatient and postdischarge costs, demographics, tumor characteristics, surgical treatment, length of stay (LOS), time spent in the intensive care unit (ICU), and readmissions.

Results

Five hundred ninety patients were included in this study. There was a $7624 inpatient cost savings (P = .002) for those G-tubes placed preoperatively ($26 060) versus postoperatively ($33 754). Postdischarge costs did not differ significantly between groups (P = .60). There was a $9248 total costs savings (P = .009) for those patients with G-tubes placed preoperatively ($39 751) versus postoperatively ($48 999), despite patients with preoperative G-tubes having lower body mass index (BMI; P = .009), higher Association of Anesthesiologist (ASA) class (P = .02), more preoperative radiation (P < .001), and more free tissue transfer reconstruction (P = .007).

Conclusion

There is potential for savings by placing G-tubes preoperatively, possibly driven by decreased LOS, despite data suggesting that patients with G-tubes placed preoperatively are higher risk.

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Usability of advanced pneumatic compression to treat cancer-related head and neck lymphedema: A feasibility study

Abstract

Background

This functional usability study assessed ease of use, fit, comfort, and potential clinical benefits of advanced pneumatic compression treatment of cancer-related head and neck lymphedema.

Methods

Patient-reported comfort and other treatment aspects were evaluated and multiple face and neck measurements were obtained on 44 patients with head and neck lymphedema before and after 1 treatment session to assess usability and treatment-related lymphedema changes.

Results

A majority of the patients (82%) reported the treatment was comfortable; most patients (61%) reported feeling better after treatment, and 93% reported that they would be likely to use this therapy at home. One treatment produced overall small but highly statistically significant reductions in composite metrics (mean ± SD) of the face (82.5 ± 4.3 cm vs 80.9 ± 4.1 cm; P < .001) and neck (120.4 ± 12.2 cm vs 119.2 ± 12.1 cm; P < .001) with no adverse events.

Conclusion

Results found the treatment to be safe, easy to use, and well tolerated while demonstrating edema reduction after a single initial treatment.

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Reviewers 2017

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miR-140-5p-mediated regulation of the proliferation and differentiation of human dental pulp stem cells occurs through the lipopolysaccharide/toll-like receptor 4 signaling pathway

Human dental pulp stem cells (DPSCs) are oral mesenchymal stem cells with potential to differentiate into various cell types. Recent studies of DPSCs have focused on microRNAs (miRNAs), a class of small noncoding RNAs that play crucial roles in regulating DPSC phenotypes. In the current study, the expression of miR-140-5p was significantly decreased during lipopolysaccharide (LPS)-mediated differentiation of DPSCs in vitro. Overexpression of miR-140-5p enhanced proliferation of DPSCs and inhibited DPSC differentiation, whereas suppression of miR-140-5p produced the opposite effect. Moreover, the expression of toll-like receptor 4 (TLR-4), a critical regulator of DPSCs, was negatively correlated with the levels of miR-140-5p. A luciferase reporter analysis confirmed that miR-140-5p could regulate TLR-4 by directly binding to the 3′-untranslated region (3′-UTR) of the TLR4 mRNA. Additionally, we suppressed TLR-4 expression by treating cells with a TLR-4 inhibitor, CLI-095, and demonstrated that the effect of the miR-140-5p inhibitor on DPSC proliferation and differentiation could be partially reversed by blocking TLR-4. Taken together, our data suggest that miR-140-5p is a novel miRNA that regulates DPSC proliferation and differentiation.

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Volume content for 2017

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Author Guidelines

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Oral health-related quality of life, measured using the five-item version of the Oral Health Impact Profile, in relation to socio-economic status: a population survey in Sweden

Oral health-related quality of life (OHRQoL) is an important patient-reported outcome measure in dental research. This study was conducted to analyse the association between OHRQoL, as measured using the five-item version of the Oral Health Impact Profile (OHIP-5), and different socio-economic indices. A national survey of randomly selected adult individuals in Sweden (n = 3,500) was performed using telephone interviews. The questions asked for the purpose of this study were defined by the items of the OHIP-5, just as questions were asked regarding socio-economic variables, including education, income, and economic resources. Poor OHRQoL, as identified by an OHIP-5 score of 3 or higher on at least two of the five items, was statistically significantly associated in multivariate analysis with low income (OR = 1.84) and having no economic resources (OR = 2.19). The statistical models were adjusted for age, gender, ethnicity, marital status, dental-care utilization, dental anxiety, and smoking. The OHIP-5 may be used in larger epidemiological surveys because it demonstrates the ability to discriminate for a range of important areas of measurement in dental public health, including social determinants.

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Mitochondrial DNA variations in Austronesian-speaking populations living in the New Georgia Islands, the Western Province of the Solomon Islands

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Genetic predisposition to infection in a case of atypical hemolytic uremic syndrome

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Do overdentures improve nutrient status?

This review comparing the impact of overdentures with conventional dentures on nutritional status included 8 studies finding no difference in relation to BMI, albumin or vitamin B12 6 months 
after treatment among the older population

The post Do overdentures improve nutrient status? appeared first on National Elf Service.

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The relation of CUN-BAE index and BMI with body fat, cardiovascular events and diabetes during a 6-year follow-up: the Hordaland Health Study

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Big Horn Dental collects candy for troops

A dentist's office might be the last place you'd expect to find candy, but Big Horn Dental has quite the collection after its ninth annual Cash for Candy event. Starting the day after Halloween, kids came in with candy and received $1 for every pound they brought in, up to five pounds.

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Citation analysis may well have a role to play in study identification, but more evaluation and systems development is required

Publication date: Available online 11 November 2017
Source:Journal of Clinical Epidemiology
Author(s): James Thomas




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Perspective. Reoperative Bentall: choice of conduits

Abstract

The Bentall procedure represents the gold standard in the treatment of patients requiring aortic root replacement. The most common indications for redo Bentall are structural degeneration or graft infection. Redo aortic root replacement can be performed with low perioperative morbidity and death. The choice of the best conduit is still up for debate but is mandatory to guarantee the best and most durable option for the patient. New options are available to reduce mortality in older or fragile patients and can modify the conduit choice.

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Robot-assisted totally endoscopic coronary bypass surgery

Abstract

Totally endoscopic coronary artery bypass (TECAB) surgery can exclusively be undertaken with the aid of operative robots. In the past two decades, surgical remote manipulator systems—predominantly the daVinci® devices—have brought us the reality of endoscopic internal mammary artery harvesting and coronary bypass anastomoses via minimally invasive thoracic port access. Single up to quadruple TECAB interventions are recently feasible; the procedure can be delivered either as beating heart applying endoscopic vacuum stabilizer or under cardioplegic arrest on heart-lung machine. Significant surgical team learning curves are involved in a stepwise development of these complex procedures, including intense dry- and wet-lab trainings, endoscopic internal mammary artery harvesting and manual coronary anastomosis building through a thoracotomy. Increasing number of papers have been published regarding clinical TECAB series in the past decade. In arrested heart TECAB procedures on cardiopulmonary bypass, the conversion rate from port access to larger thoracic incision measures 15.1% and no perioperative mortality is observed in published records. Stroke, kidney failure and atrial fibrillation rates stay at 0.6, 0.4 and 12.9%, respectively. Analysis of beating heart TECAB procedures revealed a conversion rate of 15.3%, perioperative mortality 0.4%, stroke 0.3%, kidney failure 0.6% and atrial fibrillation 9.2%. Additionally, due to the obviously smaller surgical trauma, a remarkable fast return to normal daily activities can be demonstrated in clinical series of robotic assisted coronary bypass surgery. Short-term freedom of major adverse cardiac and cerebral events (MACCE) stays over 90%. Long-term studies reveal 5-year freedom of MACCE in the 75.2 to 83.1% range. Nowadays, total endoscopic coronary artery bypass grafting is a feasible and reproducible surgical method. Advanced hybrid coronary interventions offer complex multivessel TECAB with support of percutaneous coronary interventions (PCI). Combination of the above techniques widens the spectrum of minimally invasive therapeutic solutions concerning multivessel procedure including bilateral internal mammary grafts and drug-eluting stents.

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Tracheobronchial tear in chest trauma—a diagnostic perplexity

Abstract

Tracheobronchial injuries following blunt chest trauma are uncommon and diagnosed late. Tracheal rupture due to a fall from a height is rare. Early diagnosis and prompt treatment give gratifying results. We present a case of a 42-year-old man who was referred at our hospital with alleged history of fall from a height of about 12 ft from a tree. On presentation, the patient was haemodynamically stable and right-sided ICT was already inserted. There was a minimal surgical emphysema in the neck, a continuous air leak from the chest tube and a partially collapsed right lung on chest X-ray. After a few hours, he desaturated and was intubated. The right lung did not expand in spite of the second apical chest tube, and on ventilation, air leak increased. Tracheabronchial tear was suspected and computerised tomography scan revealed the site of damage and fibreoptic bronchoscopy confirmed the diagnosis. Emergency thoracotomy with primary repair of the right tracheabronchial tear was done. The patient recovered and post-operative course was uneventful.

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Wide awake

In less time than it takes to blink, I went from sound asleep to wide awake. The only perk? I wouldn't be tempted to have a lazy morning.

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Volcanism in slab tear faults is larger than in island-arcs and back-arcs

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Mapping functional diversity from remotely sensed morphological and physiological forest traits

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How to Create Your Own Compelling Dental Website Content

Over the years, as I've written and lectured to dentists about website marketing, the concept I have the most difficulty conveying to them is about the value of self-written, unique content.  Dentists resist the idea of writing their own content … Continue reading →

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Beverly Hills Dentist Rodney Raanan Receives Numerous Reviews From Yelp and Google

Renowned Beverly Hills Cosmetic Dentist, Dr Rodney Raanan attained his Bachelor of Science degree in Anthropology at the University of California-Los Angeles . He went on to pursue a career in dentistry and obtained his Doctor of Dental Surgery degree from University of Southern California School of Dentistry .

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New Bern's big heart shines bright Updated at

Craven County has a long tradition of fundraising events, four of which last weekend raised more than $200,000, helping thousands of people. A number of charitable events spanning three days provided funding and services totaling more than $200,000, with an outreach to thousands of people.

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The utility of oral brush cytology in the early detection of oral cancer and oral potentially malignant disorders: A systematic review

Abstract

Objectives

This systematic review aimed to analyze the published evidence for the use of oral brush cytology for the early detection of oral cancer and oral potentially malignant disorders (OPMDs).

Methods

Literature was systematically searched through several databases: MEDLINE, EMBASE, PubMed, SCOPUS, Cochrane Library and Web of Science. Additional review was performed through cross checks on the bibliographies of selected articles. The inclusion criteria involved studies assessing the utility of oral brush cytology on human tissues and its applications in the diagnosis, screening or surveillance of oral cancer or OPMDs.

Results

The search strategy resulted in 343 abstracts or full-text articles, of which 36 met the inclusion criteria. The year of publication ranged from 1994 to 2017, and a total of 4302 samples from OPMDs, oral squamous cell carcinoma, and healthy controls have been investigated. Baby toothbrush, Cytobrush, OralCDx^®, and Orcellex^® are the brushes that were used to obtain transepithelial mucosal samples for conventional and liquid-based cytology evaluation.

Conclusions

Findings from this paper indicate that meaningful evidence-based recommendations for the implementation of a minimally-invasive technique to be utilized as an adjunctive tool for screening and early detection of oral cancer and OPMDs are complicated from the reported studies in the literature. There is need for well-designed clinical studies to assess the accuracy of oral brush cytology utilizing validated cytological assessment criteria for the diagnosis and prediction of OPMDs.

This article is protected by copyright. All rights reserved.

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Hundreds line up for free medical and dental care Read Story Shannon Valladolid

Hundreds of people in the Bay area received free dental, vision and medical service thanks to RAM, Remote Area Medical. RAM is the largest provider of free mobile medical clinics delivering high-quality dental, vision and medical care to underserved and uninsured individuals, children and families.

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Dental Management of Patients Who Have Undergone Oral Cancer Therapy.

Dental Management of Patients Who Have Undergone Oral Cancer Therapy.

Dent Clin North Am. 2018 Jan;62(1):131-142

Authors: Villa A, Akintoye SO

Abstract
Oral cancer therapies are associated with orofacial complications that could result in dose-limiting cancer treatment and consequent suboptimal tumor control. Oral cancer treatment complications include oral mucositis, salivary gland hypofunction, odontogenic infections, pain, dermatitis, neurotoxicity, soft tissue fibrosis, trismus, osteoradionecrosis, and potential cancer recurrence. These complications significantly affect cancer survivorship, quality of life, and psychosocial status. Effective dental management of patients with oral cancer involves the coordination of care among several health care professionals before, during, and after cancer therapy. The goal is to minimize complications, and establish optimal quality of life for survivors.

PMID: 29126490 [PubMed - in process]

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Dental Treatment Planning for the Patient with Oral Cancer.

Dental Treatment Planning for the Patient with Oral Cancer.

Dent Clin North Am. 2018 Jan;62(1):121-130

Authors: Levi LE, Lalla RV

Abstract
Oral cancer therapy is associated with a multitude of head and neck sequelae that includes, but is not limited to, hyposalivation, increased risk for dental caries, osteoradionecrosis of the jaw, radiation fibrosis syndrome, mucositis, chemotherapy-induced neuropathy, dysgeusia, dysphagia, mucosal lesions, trismus, and infections. Preparing a comprehensive treatment plan for patients undergoing cancer therapy is essential to help minimize their risks for developing these oral and dental complications. In addition, dentists must take into account a patient's ongoing oncologic therapy for those patients who present to the dentist while concurrently receiving cancer treatment.

PMID: 29126489 [PubMed - in process]

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Even if your child is a little bit older, it's never too late to arrange their first dental visit.

Even if your child is a little bit older, it's never too late to arrange their first dental visit. Most parents do not realise the importance of beginning early dental care.

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