•In laryngeal oncology it is crucial to assess mobility of vocal cord-arytenoid unit.•Current mobility assessment is flawed by weak inter-observer agreement.•Tumor extension assessment by dedicated ...radiologists is recommended.
In clinical practice the assessment of the “vocal cord-arytenoid unit” (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension.
In this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated.
Twenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal.
The current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology.
The Guidelines for Adolescent Preventive Services (GAPS) include recommendations developed and promoted by the American Medical Association's Department of Adolescent Health and are intended to ...organize, restructure and redefine health care delivery for 11- to 21-year-old patients. Data show that health risks in this age group are more social in origin than medical, and that these unhealthy behaviors can be recognized and interventions can be applied at an earlier age to reduce adolescent mortality and morbidity. In fact, evidence suggests that some interventions may result in a decrease in premature adult mortality. GAPS provides physicians with preventive service recommendations and a flow sheet that is useful for implementing and documenting these services during office visits. This system enables the busy physician to identify at-risk adolescent patients and provide them with information about changing unhealthy behaviors
Updated treatment for influenza A and B Montalto, N J; Gum, K D; Ashley, J V
American family physician,
2000-Dec-01, Letnik:
62, Številka:
11
Journal Article
Recenzirano
Influenza causes significant morbidity and mortality and is responsible for considerable medical expenditures. Vaccination is the most effective public health measure to combat this illness. ...Amantadine and rimantadine are older antiviral agents that have been important adjuncts in the prevention and treatment of influenza A outbreaks. Zanamivir and oseltamivir are newer agents indicated for the treatment of both influenza A and B. For antiviral agents to be effective, they must be used within 48 hours of the onset of influenza symptoms. Antiviral agents reduce the duration of fever and illness by one to two and one-half days and also reduce the severity of some symptoms. Use of amantadine or rimantadine is appropriate if influenza virus A is known to be the predominant agent in a particular year or location. Data need to be evaluated on the development of resistance and use of the newer antiviral agents in geriatric patients, high-risk patients and children. For optimal use of antiviral agents, patients with influenza symptoms must present early, and family physicians must accurately and rapidly diagnose the illness.
At a rural community health center, 183 adult patients were invited to participate in an unspecified study. In a closed-door session, interested invitees were told the study required taking the Test ...of Functional Health Literacy in Adults (TOFHLA). After the purpose of the study was privately disclosed, 70 patients agreed to enroll (38.25 percent acceptance rate). Approximately 15 percent demonstrated literacy/numeracy deficits, scoring in the Inadequate and Marginal Functional Health Literacy ranges. Student's t-test comparison of mean scores suggested patients with literacy/numeracy deficits tended to have higher mean ages and completed fewer mean years of school than those scoring in the Adequate range, p = 0.0007 and p = 0.0005, respectively. Pearson's Product Moment Correlations demonstrated a negative correlation between age and TOFHLA score, r = -0.52, a positive correlation between highest year of schooling and TOFHLA score, r = 0.51, and a negative correlation between age and highest grade of schooling, r = 0.39. Regression analysis suggested 27 percent of the variability in TOFHLA score was attributable to age, p = 0.0001, supporting the role of age in cognitive decline. Upon review of these patients' medical records, no information on their literacy/numeracy problems or deficits was identified.
Vaccination is the primary measure for preventing morbidity and mortality from influenza. During the influenza season, family physicians must distinguish influenza from the common cold and other ...flu-like illnesses. Signs and symptoms of influenza include abrupt onset of fever, severe myalgias, anorexia, sore throat, headache, cough, and malaise. Clinical diagnosis can be difficult or nonspecific when patients have other symptoms (e.g., stuffy nose, sneezing, cough, sore throat) that can be caused by various respiratory viruses or bacterial pathogens. Family physicians can improve diagnostic accuracy by being aware of the epidemiology of influenza. During outbreaks of influenza, commercially available rapid assays can be used to identify type A and B viruses. On average, rapid in-office tests are more than 70 percent sensitive and 90 percent specific for viral antigens. The assays vary in complexity, specificity, sensitivity, time to obtain results, specimen analyzed, and cost. The results of rapid viral tests can guide treatment decisions.
Our goal is to optimize the level of medical care delivered to riders on the tour in a comprehensive way. Participation of local EMS squads and advance planning is essential for providing acute, ...prompt medical care at the scene and to provide transport to local or distant hospitals to evaluate or treat more serious conditions. Fortunately the majority of injuries is minor, but when EMS personnel and physicians work closely together, riders and tour staff feel more comfortable with concerns about their health during the event. Based on our experience, we have made suggestions for preventing injuries and have provided a framework for the physician interested in effectively delivering medical care at any recreational cycling event.
