Objectives
This study assesses the levels of grit (the perseverance and passion for long‐term goals), and resilience (the ability to bounce back or recover from stress), reported by U.S. dental ...students, and its possible association with academic achievements.
Methods
An anonymous 27 question cross‐sectional online survey with sections on demographics, grit, resilience, and academic achievement was e‐mailed to all dental students in the U.S. The Short Grit and Brief Resilience scales were used. Scores for both scales ranged from 1 to 5, and were grouped into low, moderate, and high tertiles based on distribution. Dental school grade point average (GPA), and class rank were used to measure academic achievement, and were similarly grouped. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from multinomial logistic regression models assessing the relationship of grit and resilience to the outcomes adjusting for gender, dental school year, race, geographic origin, and a variable combining education and income.
Results
Of the 3292 (17%) respondents, 58% were female. Hispanics reported significantly higher grit and resilience scores while Asian students reported the lowest. 18% of Hispanics were ranked in the top 20 percentile versus 37% of whites.
Conclusion
Results indicate that dental students with high grit (high vs. low scores: OR 95% CI: 2.06 1.57–2.72) and resilience (high vs. low scores: 1.36 1.04–1.76) achieved higher GPA and better class ranks. Therefore, it is crucial for students wanting to achieve academic success to consider the value that these non‐cognitive characteristics might have on their overall progress.
Objective
To assess the utility of deep learning analysis using
18
F-fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET/CT) to predict disease-free survival (DFS) in patients with ...oral cavity squamous cell carcinoma (OCSCC).
Methods
One hundred thirteen patients with OCSCC who received pretreatment FDG-PET/CT were included. They were divided into training (83 patients) and test (30 patients) sets. The diagnosis of treatment control/failure and the DFS rate were obtained from patients’ medical records. In deep learning analyses, three planes of axial, coronal, and sagittal FDG-PET images were assessed by ResNet-101 architecture. In the training set, image analysis was performed for the diagnostic model creation. The test data set was subsequently analyzed for confirmation of diagnostic accuracy. T-stage, clinical stage, and conventional FDG-PET parameters (the maximum and mean standardized uptake value (SUVmax and SUVmean), heterogeneity index, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were also assessed with determining the optimal cutoff from training dataset and then validated their diagnostic ability from test dataset.
Results
In dividing into patients with treatment control and failure, the highest diagnostic accuracy of 0.8 was obtained using deep learning classification, with a sensitivity of 0.8, specificity of 0.8, positive predictive value of 0.89, and negative predictive value of 0.67. In the Kaplan-Meier analysis, the DFS rate was significantly different only with the analysis of deep learning–based classification (
p
< .01).
Conclusions
Deep learning–based diagnosis with FDG-PET images may predict treatment outcome in patients with OCSCC.
Key Points
• Deep learning
–
based diagnosis of FDG-PET images showed the highest diagnostic accuracy to predict the treatment outcome in patients with oral cavity squamous cell carcinoma.
• Deep learning
–
based diagnosis was shown to differentiate patients between good and poor disease-free survival more clearly than conventional T-stage, clinical stage, and conventional FDG-PET-based parameters.
Abstract Purpose Shame is an ineffective tool in residency education that often results in depression, isolation and worse patient care. This study aims to assess burnout, depersonalization and ...personal achievement levels in current oral and maxillofacial surgery (OMS) residents, to assess the prevalence of the use of shame in OMS residency training, and to determine whether there is a relationship between shame exposure and resident burnout, depersonalization and personal achievement levels. Methods An anonymous 20-question cross sectional survey was developed incorporating the Maslach-Burnout-Index and a previously-validated shame questionnaire, and sent to all AAOMS affiliated OMS program directors for distribution amongst their respective residents in 2016. Univariate analyses were used to determine the distribution of the predictor (shame) and outcome (burnout) by gender and by frequency of shaming events. Multivariable logistic regression analysis was used to assess the relationship of shame to burnout. A two-sided p-value <0.05 was considered to be statistically significant. Results 217 responses were received, 82% were males (n= 178), 95% were aged 25-34 (n= 206), and 58% of respondents (n = 126) are enrolled in a 4-year program. Frequently shamed residents are more likely to suffer from depression (58 vs. 22%; p < 0.0001), isolation (55 vs. 22%; p < 0.0001), and poor job performance (50 vs. 30%; p < 0.0001). Residents that are frequently shamed are more likely to experience moderate/severe burnout (odds ratio, 4.6 95 % CI, 2.1 to 10.0; P < 0.001), and severe depersonalization (odds ratio, 5.1 95 % CI, 2.1 to 12.0; P < 0.0001) than residents that are never shamed/ infrequently shamed. Conclusion There is a clear relationship between number of shame events and burnout and depersonalization levels. It is important to understand the negative impact that the experience of shame has on residents, including its unintended consequences.
•Several texture features demonstrated differences between dentigerous cysts and odontogenic keratocysts.•Several texture features demonstrated differences between odontogenic keratocysts and ...ameloblastomas.•Several texture features demonstrated differences between dentigerous cysts and ameloblastomas.•Texture analysis provides quantitative information to differentiate cystic odontogenic lesions.
Cystic and cystic-appearing odontogenic lesions of the jaw may appear similar on CT imaging. Accurate diagnosis is often difficult although the relationship of the lesion to the tooth root or crown may offer a clue to the etiology. The purpose of this study was to evaluate CT texture analysis as an aid in differentiating cystic and cystic-appearing odontogenic lesions of the jaw.
This was an IRB-approved retrospective study including 42 pathology-proven dentigerous cysts, 37 odontogenic keratocysts, and 19 ameloblastomas. Each lesion was manually segmented on axial CT images, and textural features were analyzed using an in-house-developed Matlab-based texture analysis program that extracted 47 texture features from each segmented volume. Statistical analysis was performed comparing all pairs of the three types of lesions.
Pairwise analysis revealed that nine histogram features, one GLCM feature, three GLRL features, two Laws features, four GLGM features and two Chi-square features showed significant differences between dentigerous cysts and odontogenic keratocysts. Four histogram features and one Chi-square feature showed significant differences between odontogenic keratocysts and ameloblastomas. Two histogram features showed significant differences between dentigerous cysts and ameloblastomas.
CT texture analysis may be useful as a noninvasive method to obtain additional quantitative information to differentiate cystic and cystic-appearing odontogenic lesions of the jaw.
To describe the clinical, radiologic, and pathologic features and risk factors for osteonecrosis of the jaw (ONJ) in multiple myeloma (MM) patients.
A retrospective review of 90 MM patients who had ...dental assessments, including 22 patients with ONJ. There were 62 men; the median age was 61 years in ONJ patients and 58 years among the rest. Prior MM therapy included thalidomide (n = 67) and stem-cell transplantation (n = 72). Bisphosphonate therapy included zoledronate (n = 34) or pamidronate (n = 17) and pamidronate followed by zoledronate (n = 33). Twenty-seven patients had recent dental extraction, including 12 patients in the ONJ group. Median time from MM diagnosis to ONJ was 8.4 years for the whole group.
Patients usually presented with pain. ONJ occurred posterior to the cuspids (n = 20) mostly in the mandible. Debridement and sequestrectomy with primary closure were performed in 14 patients; of these, four patients had major infections and four patients had recurrent ONJ. Bone histology revealed necrosis and osteomyelitis. Microbiology showed actinomycetes (n = 7) and mixed bacteria (n = 9). More than a third of ONJ patients also suffered from long bone fractures (n = 4) and/or avascular necrosis of the hip (n = 4). The variables predictive of developing ONJ were dental extraction (P = .009), treatment with pamidronate/zoledronate (P = .009), longer follow-up time (P = .03), and older age at diagnosis of MM (P = .006).
ONJ appears to be time-dependent with higher risk after long-term use of bisphosphonates in older MM patients often after dental extractions. No satisfactory therapy is currently available. Trials addressing the benefits/risks of continuing bisphosphonate therapy are needed.
Objective Neck masses are common in adults, but often the underlying etiology is not easily identifiable. While infections cause most of the neck masses in children, most persistent neck masses in ...adults are neoplasms. Malignant neoplasms far exceed any other etiology of adult neck mass. Importantly, an asymptomatic neck mass may be the initial or only clinically apparent manifestation of head and neck cancer, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland cancer. Evidence suggests that a neck mass in the adult patient should be considered malignant until proven otherwise. Timely diagnosis of a neck mass due to metastatic HNSCC is paramount because delayed diagnosis directly affects tumor stage and worsens prognosis. Unfortunately, despite substantial advances in testing modalities over the last few decades, diagnostic delays are common. Currently, there is only 1 evidence-based clinical practice guideline to assist clinicians in evaluating an adult with a neck mass. Additionally, much of the available information is fragmented, disorganized, or focused on specific etiologies. In addition, although there is literature related to the diagnostic accuracy of individual tests, there is little guidance about rational sequencing of tests in the course of clinical care. This guideline strives to bring a coherent, evidence-based, multidisciplinary perspective to the evaluation of the neck mass with the intention to facilitate prompt diagnosis and enhance patient outcomes. Purpose The primary purpose of this guideline is to promote the efficient, effective, and accurate diagnostic workup of neck masses to ensure that adults with potentially malignant disease receive prompt diagnosis and intervention to optimize outcomes. Specific goals include reducing delays in diagnosis of HNSCC; promoting appropriate testing, including imaging, pathologic evaluation, and empiric medical therapies; reducing inappropriate testing; and promoting appropriate physical examination when cancer is suspected. The target patient for this guideline is anyone ≥18 years old with a neck mass. The target clinician for this guideline is anyone who may be the first clinician whom a patient with a neck mass encounters. This includes clinicians in primary care, dentistry, and emergency medicine, as well as pathologists and radiologists who have a role in diagnosing neck masses. This guideline does not apply to children. This guideline addresses the initial broad differential diagnosis of a neck mass in an adult. However, the intention is only to assist the clinician with a basic understanding of the broad array of possible entities. The intention is not to direct management of a neck mass known to originate from thyroid, salivary gland, mandibular, or dental pathology as management recommendations for these etiologies already exist. This guideline also does not address the subsequent management of specific pathologic entities, as treatment recommendations for benign and malignant neck masses can be found elsewhere. Instead, this guideline is restricted to addressing the appropriate work-up of an adult patient with a neck mass that may be malignant in order to expedite diagnosis and referral to a head and neck cancer specialist. The Guideline Development Group sought to craft a set of actionable statements relevant to diagnostic decisions made by a clinician in the workup of an adult patient with a neck mass. Furthermore, where possible, the Guideline Development Group incorporated evidence to promote high-quality and cost-effective care. Action Statements The development group made a strong recommendation that clinicians should order a neck computed tomography (or magnetic resonance imaging) with contrast for patients with a neck mass deemed at increased risk for malignancy. The development group made the following recommendations: (1) Clinicians should identify patients with a neck mass who are at increased risk for malignancy because the patient lacks a history of infectious etiology and the mass has been present for ≥2 weeks without significant fluctuation or the mass is of uncertain duration. (2) Clinicians should identify patients with a neck mass who are at increased risk for malignancy based on ≥1 of these physical examination characteristics: fixation to adjacent tissues, firm consistency, size >1.5 cm, or ulceration of overlying skin. (3) Clinicians should conduct an initial history and physical examination for patients with a neck mass to identify those with other suspicious findings that represent an increased risk for malignancy. (4) For patients with a neck mass who are not at increased risk for malignancy, clinicians or their designees should advise patients of criteria that would trigger the need for additional evaluation. Clinicians or their designees should also document a plan for follow-up to assess resolution or final diagnosis. (5) For patients with a neck mass who are deemed at increased risk for malignancy, clinicians or their designees should explain to the patient the significance of being at increased risk and explain any recommended diagnostic tests. (6) Clinicians should perform, or refer the patient to a clinician who can perform, a targeted physical examination (including visualizing the mucosa of the larynx, base of tongue, and pharynx) for patients with a neck mass deemed at increased risk for malignancy. (7) Clinicians should perform fine-needle aspiration (FNA) instead of open biopsy, or refer the patient to someone who can perform FNA, for patients with a neck mass deemed at increased risk for malignancy when the diagnosis of the neck mass remains uncertain. (8) For patients with a neck mass deemed at increased risk for malignancy, clinicians should continue evaluation of patients with a cystic neck mass, as determined by FNA or imaging studies, until a diagnosis is obtained and should not assume that the mass is benign. (9) Clinicians should obtain additional ancillary tests based on the patient's history and physical examination when a patient with a neck mass is deemed at increased risk for malignancy who does not have a diagnosis after FNA and imaging. (10) Clinicians should recommend evaluation of the upper aerodigestive tract under anesthesia, before open biopsy, for patients with a neck mass deemed at increased risk for malignancy and without a diagnosis or primary site identified with FNA, imaging, and/or ancillary tests. The development group recommended against clinicians routinely prescribing antibiotic therapy for patients with a neck mass unless there are signs and symptoms of bacterial infection.
Objective:
This study aims to identify clinical and socioeconomic factors associated with long-term, post-surgical opioid use in the head and neck cancer population.
Methods:
A single center ...retrospective study was conducted including patients diagnosed with head and neck cancer between January 1, 2014 and July 1, 2019 who underwent primary surgical management. The primary outcome measure was continued opioid use 6 months after treatment completion. Both demographic and cancer-related variables were recorded to determine what factors were associated with prolonged opioid use. Univariate analysis was performed using chi-squared test for categorical variables and 2-sample t-test for continuous variables. Multivariate analysis was performed using logistic regression.
Results:
A total of 359 patients received primary surgical management. Forty-five patients (12.53%) continued to take opioids 6 months after treatment completion. Using univariate analysis, patients less than 65 years of age (P = .0126), adjuvant chemoradiation (n = 25, P < .001), and overall length of hospital stay (8.60 ± 8.58 days, P = .0274) were significantly associated with long term opioid use. Multivariate logistic regression showed that adjuvant chemoradiation (OR = 3.446, 95% CI 1.742, 6.820, P = .0004) and overall length of hospital stay (OR = 0.949, 95% CI 0.903, 0.997, P = .0373) to be significantly associated with opioid use 6 months after head and neck cancer treatment.
Conclusion:
Long-term postoperative opioid use in head and neck cancer patients is significantly associated with adjuvant chemoradiation, and patients with longer length of hospital stay. Therefore, future research should focus on interventions to better manage opioid use during the acute treatment period to decrease long-term use.
Background
This study compares select social determinants of health (SDOH) with treatment modality selection and treatment completion in head and neck cancer (HNC) patients, to better understand ...disparities in health outcomes.
Methods
A retrospective cohort study of HNC (n = 1428) patients was conducted. Demographic and disease‐specific variables were recorded, including treatment modality selection and completion. Data were analyzed using two‐sample t tests, chi‐square, and Fisher's exact tests.
Results
Primary language was significantly associated with treatment choice, where non‐English speakers were less likely to choose treatment as recommended by the Tumor Board. Lower mean distance from the hospital (37.38 48.31 vs. 16.92 19.10, p < 0.0001) and a county‐based higher mean percentage of bachelor degree or higher education (42.16 8.82 vs. 44.95 6.19, p < 0.0003) were associated with treatment selection.
Conclusion
Language, distance from the hospital, and education affected treatment selection in this study and may be useful in understanding how to counsel patients on treatment selection for HNC.
To determine if adjuvant radiation therapy for patients with pT2N0 oral cavity tongue cancer affects overall survival.
Retrospective cohort study.
National Cancer Database.
Cases diagnosed between ...2004 and 2013 with pathologic stage pT2N0 oral cavity tongue cancer with negative surgical margins were extracted from the National Cancer Database. Data were stratified by treatment received, including surgery only and surgery + postoperative radiation therapy. Univariate analysis was performed with a 2-sample t test, chi-square test, or Fisher exact test and log-rank test, while multivariate analysis was performed with Cox regression models adjusted for individual variables as well as a propensity score.
A total of 934 patients were included in the study, with 27.5% of patients receiving surgery with postoperative radiation therapy (n = 257). In univariate analysis, there was no significant difference in 3-year overall survival between the patient groups ( P = .473). In multivariate analysis, there was no significant difference in survival between the treatment groups, with adjuvant radiation therapy having a hazard ratio of 0.93 (95% CI, 0.60-1.44; P = .748). Regarding tumors with a depth of invasion >5 mm, there was no survival benefit for the patients who received postoperative radiation therapy as compared with those who received surgery alone (hazard ratio = 0.93; 95% CI, 0.57-1.53; P = .769).
An overall survival benefit was not demonstrated for patients who received postoperative radiation therapy versus surgery alone for pT2N0 oral cavity tongue cancer, irrespective of depth of tumor invasion.
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