Assessing the Applicability of the TALK Score: A Modification for Concurrent Tobacco Use During Treatment.

OBJECTIVE: The previously described TALK score (T-stage, Albumin, Liquor, Karnofsky Performance Status) has been proposed as a method to predict laryngectomy-free survival (LFS) in patients undergoing definitive chemoradiation (CRT). This study assesses its use as well as a modification to include continued tobacco use. STUDY DESIGN: Retrospective chart review. SETTING: Academic institution from 2004 to 2020. METHODS: Patients diagnosed with larynx or hypopharynx cancer undergoing CRT were reviewed. Clinically relevant variables were collected (TALK), which were dichotomized per previously set cutoffs. Concurrent tobacco use was evaluated and also dichotomized as 0 or 1. Multivariate analysis was conducted to determine which factors were most predictive of the key outcomes of survival and LFS. RESULTS: A total of 2514 patient charts were evaluated. Patients treated for larynx cancer with primary CRT with complete data were included, ultimately totaling 300. Of these, 78 patients required salvage total laryngectomy (TL). Multivariate analysis demonstrated that LFS was best predicted by tobacco use during treatment (odds ratio [OR] 0.3465, 95% confidence interval [CI] 0.1862-0.6300) and Karnofsky Performance Status (OR 0.1646, 95% CI 0.0673-0.3662). Tobacco use during treatment was also strongly predictive of survival. Excluding T4 tumors, the utilization of tobacco in place of T-stage improved the accuracy of the predictive model in this cohort. CONCLUSION: Given that a T-stage of 4 is typically treated with total laryngectomy, modification of the TALK score to include tobacco use during treatment (tALK) for patients with T < 4 can be used to improve prediction of 3-year LFS and overall survival.

ACGME Operative Case Log Accuracy Varies Among Surgical Programs.

OBJECTIVE: This study evaluates the accuracy of reported the Accreditation Council for Graduate Medical Education (ACGME) operative case logs from graduated residents compared to institutional operating room electronic records (ORER). We hope this will help guide review committees and institutions develop complete, accurate resident case logs. DESIGN: This is a retrospective, cross-sectional study of general surgery (GS), neurosurgery (NS), and orthopedic surgery (OS) resident physicians. ACGME and ORER cases from 2009 to 2010 were analyzed and each case and current procedural terminology (CPT) code directly compared (ORER vs. ACGME). SETTING: Single academic tertiary-care medical center (University of Kentucky, Lexington, KY). PARTICIPANTS: Eleven thousand nine hundred and twenty-three cases for 46 residents among the 3 residency programs were analyzed. RESULTS: There was an overall logging accuracy of 72% for ORER cases reflected in the ACGME case logs. OS residents had a higher rate of logging accuracy (OS 91%, GS 69%, NS 58%, chi-square p = 0.014) and mean annual number of cases compared to the other 2 programs (OS 452, GS 183, NS 237, ANOVA p = 0.001). NS residents had higher accuracy of CPT codes than post-graduate years 2 to 5 in other programs (p < 0.017). There was a strong positive correlation between the number of cases completed per resident and case logging accuracy, (rho = 0.769, p < 0.001) consistent for NS and GS, but not OS. CONCLUSIONS: This study shows only 72% of a residents' operative experience is captured in the ACGME case log across 3 surgical programs. There is significant variability among surgical programs and among post-graduate year cohorts regarding case log and CPT code accuracy. There is a strong correlation with the total number of cases performed and increasing case log accuracy. Low case log accuracy may reflect individual resident behavior instead of program operative exposure. Further studies are needed to determine if ORER may serve as a more complete assessment of the operative experience of a resident and program.

Recognition of Regional Water Table Patterns for Estimating Recharge Rates in Shallow Aquifers.

We propose a new method for groundwater recharge rate estimation in regions with stream-aquifer interactions, at a linear scale on the order of 10 km and more. The method is based on visual identification and quantification of classically recognized water table contour patterns. Simple quantitative analysis of these patterns can be done manually from measurements on a map, or from more complex GIS data extraction and curve fitting. Recharge rate is then estimated from the groundwater table contour parameters, streambed gradients, and aquifer transmissivity using an analytical model for groundwater flow between parallel perennial streams. Recharge estimates were obtained in three regions (areas of 1500, 2200, and 3300 km2 ) using available water table maps produced by different methods at different times in the area of High Plains Aquifer in Nebraska. One region is located in the largely undeveloped Nebraska Sand Hills area, while the other two regions are located at a transition zone from Sand Hills to loess-covered area and include areas where groundwater is used for irrigation. Obtained recharge rates are consistent with other independent estimates. The approach is useful and robust diagnostic tool for preliminary estimates of recharge rates, evaluation of the quality of groundwater table maps, identification of priority areas for further aquifer characterization and expansion of groundwater monitoring networks prior to using more detailed methods.