Molecular editing such as insertion, deletion, and single atom exchange in highly functionalized compounds is an aspirational goal for all chemists. Here, we disclose a photoredox protocol for the ...replacement of a single fluorine atom with hydrogen in electron-deficient trifluoromethylarenes including complex drug molecules. A robustness screening experiment shows that this reductive defluorination tolerates a range of functional groups and heterocycles commonly found in bioactive molecules. Preliminary studies allude to a catalytic cycle whereby the excited state of the organophotocatalyst is reductively quenched by the hydrogen atom donor, and returned in its original oxidation state by the trifluoromethylarene.
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•COVID-19 resource constraints have resulted in treatment delays for oral cancer.•Non-surgical treatment may be necessary to provide timely access to care.•Definitive CCRT is ...associated with an increased rate of death in early oral cancer.•Neoadjuvant regimens have not shown survival benefit in resectable oral cancer.
Surgery is the preferred treatment modality for oral squamous cell carcinoma (OSCC). However, due to limited resources, re-assessment of treatment paradigms in the wake of the Coronavirus Disease 2019 (COVID-19) pandemic is urgently required. In this rapid review, we described contemporary oncological outcomes for OSCC using non-surgical modalities.
A systematic literature search was conducted for articles published between January 1, 2010 and April 1, 2020 on MEDLINE and Cochrane CENTRAL. Studies were included if they contained patients with OSCC treated with either neoadjuvant, induction, or definitive radiotherapy, chemotherapy, immunotherapy, or combination thereof, and an outcome of overall survival.
In total, 36 articles were included. Definitive radiotherapy or chemoradiotherapy were the focus of 18 articles and neoadjuvant chemotherapy or chemoradiotherapy were the focus of the other 18 articles. In early stage OSCC, definitive radiotherapy, with or without concurrent chemotherapy, was associated with a significantly increased hazard of death compared to definitive surgery (HR: 2.39, 95% CI: 1.56–3.67, I2: 63%). The hazard of death was non-significantly increased with definitive chemoradiotherapy in studies excluding early disease (HR: 1.98, 95% CI: 0.85–4.64, I2: 84%). Two recent randomized control trials have been conducted, demonstrating no survival advantage to neoadjuvant chemotherapy.
This review suggests that primary radiotherapy and chemoradiotherapy are inferior to surgical management for OSCC. Strategies for surgical delay warranting consideration are sparse, but may include several neoadjuvant regimens, recognizing these regimens may not offer a survival benefit over definitive surgery alone.
Importance
Collecting patient-reported outcomes (PROs) in routine cancer care improves patient–clinician communication, decision making, and overall patient satisfaction. Recommendations exist ...regarding standardized ways to collect, store, and interpret PRO data. However, evidence on incorporating PROs into cancer process of care, especially the type of HIs that are warranted after observing a concerning PRO and the effectiveness of these HIs are lacking.
Objective
This study summarizes HIs triggered after PRO completion and their effectiveness in improving patient outcomes for adults being treated for cancer types that are resource intensive and associated with high symptom burden i.e., gastrointestinal (GI), lung, and head and neck cancer (HNC). Secondary outcomes included factors associated with poor implementation of PROs.
Evidence Review
A literature search of peer-reviewed publications on MEDLINE, CINAHL Plus, APA PsycInfo, Scopus, and Cochrane was conducted following PRISMA guidelines from 1 January 2012, to 31 July 2022. Trial and real-world studies describing HIs after PRO completion for adult patients being treated for GI, lung, and HNC were included. Sixteen studies involving 144,496 patients were included. The Joanna Briggs Institute critical appraisal checklist was used to assess risk of bias.
Findings
Of the 16 included studies, 5 included patients with HNC. Commonly used PRO measurement tools were the PRO-CTCAE and ESAS. Only three studies reported specific HIs delivered in response to concerning PROs and measured their effectiveness on patient outcomes. In all three studies, these HIs significantly improved cancer-related care. The most common HIs undertaken in response to concerning PROs were referrals to other specialists/allied healthcare professionals, medication changes, or self-management advice. Provider-related barriers to PRO measurement and delivery included the overwhelming number of alerts, the time required to address each PRO and the unclear role of healthcare providers in response to these alerts. Patient-related barriers included lower digital literacy and socioeconomic status, older age, rural living, and patients suffering from GI and HNC.
Conclusions and Relevance
This review highlights that PRO-triggered HIs are heterogenous and can improve patient quality of life. Further studies are necessary to determine the types of interventions with the greatest impact on patient care and outcomes.
Objective
Patient education materials across 3 national English otolaryngology–head and neck surgery (OHNS) societies: the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), the ...Canadian Society of Otolaryngology–Head and Neck Surgery (CSOHNS), and Ear, Nose, and Throat United Kingdom (ENT UK) were examined to determine whether they are written at a level suitable for patient comprehension.
Study Design
Cross-sectional study.
Setting
Online patient materials presented through OHNS national societies.
Methods
Readability was calculated using the Flesch-Kincaid Grade Level, Flesch-Kincaid Reading Ease Score, and Simple Measure of Gobbledygook Index. All public patient education materials available through the CSOHNS, AAO-HNS, and ENT UK websites were assessed. Patient education materials were grouped into categories by subspecialty.
Results
In total, 128 patient materials from the 3 societies were included in the study. All 3 societies required a minimum grade 9 reading comprehension level to understand their online materials. According to Flesch-Kincaid Grade Level, the CSOHNS required a significantly higher reading grade level to comprehend the materials presented when compared to AAO-HNS (11.3 vs 9.9; 95% CI, 0.5-2.4; P < .01) and ENT UK (11.3 vs 9.4; 95% CI, 0.9-2.9; P < .01). Patient education materials related to rhinology were the least readable among all 3 societies.
Conclusion
This study suggests that the reading level of the current patient materials presented through 3 national OHNS societies are written at a level that exceeds current recommendations. Promisingly, it highlights an improvement for the readability of patient materials presented through the AAO-HNS.
Active and passive transcutaneous devices (tBCHDs) have been introduced in an effort to address complication concerns with percutaneous devices. Direct comparison of active and passive devices ...through evidence synthesis practices is incomplete. This systematic review and meta-analysis sought to synthesize and compare available evidence on audiological, quality of life, and complication-related outcomes of active and passive tBCHDs.
MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL were searched from inception to September 23, 2019. Observational and experimental studies investigating active or passive tBCHDs in adults were eligible. Studies were screened independently in duplicate. This study is reported in accordance with the PRISMA guidelines. Risk of bias and quality assessments were completed using the Newcastle-Ottawa Scale and the Quality Appraisal Tool for Case Series. Meta-analysis was performed with random-effects models. Audiological outcomes included changes in pure-tone average, functional hearing, and high-frequency hearing. Quality of life outcomes included patient-reported results. Complications included minor, major, and total complications experienced.
One thousand five hundred forty-two nonduplicate articles were screened. Twenty-eight studies were included. Quality of included studies was low overall. The pooled complication rate for active devices was 14.8% (95% confidence interval: 0.09-0.21, I2: 0%). The pooled improvement in functional hearing for active devices among those with mixed or conductive hearing loss was 31.8 dB (95% confidence interval: 27.7-35.9, I2: 44.6). Improvement in functional hearing ranged from 25.2 to 44.3 dB for passive devices. Active devices provided improved high-frequency hearing compared to passive devices: the weighted average hearing gains at 2, 3, 4, and 6 kHz were 26.5, 25.7, 31.8, and 34.3 dB for active devices and 26.2, 21.1, 16.8, and 6.4 dB for passive devices, respectively. Both device types demonstrated improvement in ease of communication, reverberation, and understandability in background noise.
Both active and passive tBCHDs demonstrate acceptable safety profiles and QoL improvements. Active devices may provide better hearing outcomes, especially in high frequencies, but high-quality comparative studies are lacking. Future work is needed in this regard.
Edema affects outcomes in Rhinoplasty. Edema and bruising influences patient satisfaction in the perioperative period.
A qualitative analysis of edema comparing piezoelectric and conventional ...osteotome, and a qualitative comparison of bruising between these methods.
A prospective cohort study of 31 aesthetic Rhinoplasty cases. Participants act as their own control measure. An osteotome is used on one side of the nasal bone and a piezoelectric is used contralaterally.
Edema is calculated by comparing a pre and post-operative 3-D image with volumetric analysis. Ecchymosis is scored and compared.
The mean volume of the piezoelectric was 1.37 cc (SD 0.87) and the mean volume of the osteotome was 1.17 cc (SD 0.70) (0.19 absolute difference 95 % CI 0.3 to 0.35, p = 0.02). Bruising scores were 0.35 points lower for the piezoelectric arm (−0.35 absolute difference 95%CI -0.7 to 0.06, p < 0.01). This corresponded to 26 % of lateral piezo osteotomies having significant bruising compared to 38 % of the lateral osteotomies using the conventional technique.
There is a difference in postoperative edema and bruising with the piezoelectric and conventional osteotome for lateral osteoetomy in Rhinoplasty. There is more edema with the piezoelectric and more ecchymosis with the conventional osteotome.
•Question: Is edema and bruising different with piezoelectric osteotomy during rhinoplasty?•Findings: Edema is greater with the piezoelectric and bruising is less with the piezoelectric.•Meaning: The piezoelectric has a different healing profile with regards to edema and bruising than the conventional osteotome in rhinoplasty.
The increasing number of multidrug resistant bacteria has revitalized interest in seeking alternative sources for controlling bacterial infection. Silver nanoparticles (AgNPs), are amongst the most ...promising candidates due to their wide microbial spectrum of action. In this work, we report on the safety and efficacy of the incorporation of collagen coated AgNPs into collagen hydrogels for tissue engineering. The resulting hybrid materials at AgNPs < 0.4 μM retained the mechanical properties and biocompatibility for primary human skin fibroblasts and keratinocytes of collagen hydrogels; they also displayed remarkable anti-infective properties against S. aureus, S. epidermidis, E. coli and P. aeruginosa at considerably lower concentrations than silver nitrate. Further, subcutaneous implants of materials containing 0.2 μM AgNPs in mice showed a reduction in the levels of IL-6 and other inflammation markers (CCL24, sTNFR-2, and TIMP1). Finally, an analysis of silver contents in implanted mice showed that silver accumulation primarily occurred within the tissue surrounding the implant.
Abstract
Introduction
Cancer symptom screening has the potential to improve cancer outcomes, including reducing symptom burden among patients with major mental illness (MMI). We determined rates of ...symptom screening with the Edmonton Symptom Assessment System (ESAS‐r) and risk of severe symptoms in cancer patients with MMI.
Methods
This retrospective cohort study used linked administrative health databases of adults diagnosed with cancer between 2007 and 2020. An MMI was measured in the 5 years prior to cancer diagnosis and categorized as inpatient, outpatient, or no MMI. Outcomes were defined as time to first ESAS‐r screening and time to first moderate‐to‐severe symptom score. Cause‐specific and Fine and Gray competing events models were used for both outcomes, controlling for age, sex, rural residence, year of diagnosis and cancer site.
Results
Of 389,870 cancer patients, 4049 (1.0%) had an inpatient MMI and 9775 (2.5%) had an outpatient MMI. Individuals with inpatient MMI were least likely to complete an ESAS‐r (67.5%) compared to those with outpatient MMI (72.3%) and without MMI (74.8%). Compared to those without MMI, individuals with an inpatient or outpatient MMI had a lower incidence of symptom screening records after accounting for the competing risk of death (subdistribution Hazard Ratio 0.77 (95% CI 0.74–0.80) and 0.88 (95% CI 0.86–0.90) respectively). Individuals with inpatient and outpatient MMI status consistently had a significantly higher risk of reporting high symptom scores across all symptoms.
Conclusions
Understanding the disparity in ESAS‐r screening and management for cancer patients with MMI is a vital step toward providing equitable cancer care.
Objectives
The Fragility Index (FI) is a novel tool for evaluating the robustness of statistically significant findings in a randomized control trial (RCT). It measures the number of events upon ...which statistical significance depends. We sought to calculate the FI scores for RCTs in the head and neck cancer literature where surgery was a primary intervention.
Data Sources
Potential articles were identified in PubMed (MEDLINE), Embase, and Cochrane without publication date restrictions.
Review Methods
Two reviewers independently screened eligible RCTs reporting at least one dichotomous and statistically significant outcome. The data from each trial were extracted and the FI scores were calculated. Associations between trial characteristics and FI were determined.
Results
In total, 27 articles were identified. The median sample size was 67.5 (interquartile range IQR = 42–143) and the median number of events per trial was 8 (IQR = 2.25–18.25). The median FI score was 1 (IQR = 0–2.5), meaning that changing one patient from a nonevent to an event in the treatment arm would change the result to a statistically nonsignificant result, or P > .05. The FI score was less than the number of patients lost to follow‐up in 71% of cases. The FI score was found to be moderately correlated with P value (ρ = −0.52, P = .007) and with journal impact factor (ρ = 0.49, P = .009) on univariable analysis. On multivariable analysis, only the P value was found to be a predictor of FI score (P = .001).
Conclusions
Randomized trials in the head and neck cancer literature where surgery is a primary modality are relatively nonrobust statistically with low FI scores. Laryngoscope, 128:2094–2100, 2018
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