Primary mode of communication for people with total laryngectomy in the UK: a cross-sectional survey.

OBJECTIVE: This study aimed to report on the UK rate of surgical voice restoration usage and investigate the factors that influence its uptake. METHOD: A national multicentre audit of people with total laryngectomy was completed over a six-month period (March to September 2020) in response to the coronavirus disease 2019 pandemic. This study is a secondary analysis of the data collected, focusing on the primary communication methods used by people with total laryngectomy. RESULTS: Data on surgical voice restoration were available for 1196 people with total laryngectomy; a total of 852 people with total laryngectomy (71 per cent) used surgical voice restoration. Another type of communication method was used by 344 people. The factors associated with surgical voice restoration in the multiple regression analysis were sex (p = 0.003), employment (employed vs not employed, p < 0.001) and time post-laryngectomy (p < 0.001). CONCLUSION: This study provides an important benchmark for the current status of surgical voice restoration usage across the UK. It found that 71 per cent of people with total laryngectomy used surgical voice restoration as their primary communication method.

Adherence to swallowing recommendations during (chemo)radiotherapy in head and neck cancer survivors: a scoping review.

PURPOSE OF REVIEW: There is a paucity of knowledge regarding patient adherence to dysphagia recommendations. It is recognized that unique barriers and facilitators contribute to poor treatment adherence in head and neck cancer (HNC) survivors. This review aims to identify the key themes and knowledge gaps regarding adherence to swallowing recommendations in HNC survivors during (chemo)radiotherapy (C)RT. RECENT FINDINGS: Seven studies were identified. Six facilitators to adherence were extracted, namely pain relief, behavioural intervention, attendance at multidisciplinary clinic, individualised swallowing therapy, absence of prophylactic percutaneous endoscopic gastronomy (PEG) and positive social control from a spouse. Barriers to adherence included pain, depression and presence of prophylactic PEG. Adherence to swallowing recommendations positively impacted swallowing outcomes in one study. SUMMARY: Little is known about adherence to swallowing recommendations during (C)RT in HNC survivors. Capturing adherence is challenging. Several knowledge gaps were identified. Further research is needed to better understand the barriers and facilitators from the survivors' perspective. This will inform development of best practice regarding how swallowing recommendations are provided to promote adherence and improve outcomes.

Activated Monomer Polymerization of an N-Sulfonylazetidine.

Previously, N-(methanesulfonyl)azetidine (MsAzet) was found to polymerize anionically via ring-opening at temperatures >100 °C to form p(MsAzet) in the presence of an anionic initiator. In the current report, potassium(azetidin-1-ylsulfonyl) methanide (KMsAzet), formed from deprotonation of the methanesulfonyl group of MsAzet by KHMDS, is shown to undergo spontaneous AROP at room temperature to form p(N-K-MsAzet). The structure of p(N-K-MsAzet) differs from that of p(MsAzet), as the sulfonyl groups are incorporated into the polymer backbone of p(N-K-MsAzet). Reaction of p(N-K-MsAzet) with MeOH produces p(N-H-MsAzet), a semicrystalline polymer with a structure like that of polyamides, but with sulfonylamides in place of the carboxamides found in polyamides. Reaction of p(N-K-MsAzet) with benzyl bromide results in the formation of amorphous p(N-Bn-MsAzet). P(N-K-MsAzet) is hypothesized to form via an activated monomer anionic polymerization; this is supported by polymerization kinetic data and structural characterization of the resulting polymers.

Anionic Ring-Opening Polymerization of N-(tolylsulfonyl)azetidines To Produce Linear Poly(trimethylenimine) and Closed-System Block Copolymers.

The anionic ring-opening copolymerization of N-( p-tolylsulfonyl)azetidine ( pTsAzet) and N-( o-tolylsulfonyl)azetidine ( oTsAzet) produces poly( pTsAzet- co- oTsAzet) as a statistical copolymer. The pTsAzet/ oTsAzet copolymerization is living and allows for the synthesis of poly(sulfonylazetidine) of target molecular weights with narrow dispersities. 1H NMR spectroscopy was used to monitor the kinetics of the polymerization and estimate the monomer reactivity ratios. It was found that the reactivity ratios for oTsAzet and pTsAzet at 180 °C are 1.66 and 0.60, respectively. The tosyl groups of p( pTsAzet- co- oTsAzet) were reductively removed to produce linear poly(trimethylenimine) (LPTMI). This represents the first route to LPTMI of controlled molecular weight and low dispersity. Finally, the slow kinetics of the sulfonylazetidine polymerization facilitated the synthesis of a block copolymer without requiring the sequential addition of monomer. Specifically, pTsAzet, oTsAzet, and ( N- p-toluenesulfonyl-2-methylaziridine) ( pTsMAz) were combined in solution. pTsMAz selectively polymerizes to form the first block at moderate temperature. After consumption of pTsMAz, the temperature was increased to copolymerize pTsAzet and oTsAzet and produce the block copolymer p( pTsMAz)- b-p( pTsAzet- co- oTsAzet).

Pap smear versus speculum examination: can we teach providers to educate patients?

OBJECTIVE: To test whether provider-based training in focused patient communication can improve patient knowledge about Pap screening as part of the speculum examination in an urban urgent care setting. METHODS: A separate samples pretest, posttest study evaluated the intervention. Before the intervention, we surveyed a convenience sample of 383 consecutive patients who received a speculum examination in a gynecology urgent care clinic of an urban public hospital about their understanding of the Pap smear and its correct use. The intervention trained healthcare providers to briefly explain speculum examinations and Pap smears. After the intervention, we surveyed 130 additional consecutive patients. RESULTS: The intervention was associated with improved identification that a Pap smear had not been performed (57.7% preintervention vs. 70.7% postintervention, p = 0.013) and improved knowledge that the Pap smear screens only for cervical cancer (12.0% preintervention vs. 23.8% postintervention, p = 0.002). In logistic regression analysis controlling for age and other potential confounders, being in the postintervention group and speaking Spanish predicted correct identification of Pap test use (odds ratio [OR], 95% confidence interval [CI] 2.70, 1.54-4.75, and 2.98, 1.48-5.98, respectively). CONCLUSIONS: In an urban urgent care setting, patients may lack awareness that screening tests are not being performed at the time of a problem-oriented pelvic examination. A targeted intervention to improve physician counseling was associated with partial improvement in patient awareness and knowledge.