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1.
Laryngoscope ; 126(3): 627-31, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26267427

RESUMO

OBJECTIVES/HYPOTHESIS: With the prevalence of head and neck squamous cell carcinoma (HNSCC) nearly twice as high in veterans (6%) than general populations (3%), the noted problems of long waits and access to care in United States Veterans Affairs (VA) hospitals across the country are pressing. We examined primary outcome measures of timeliness and access to care for our patients with HNSCC assessing a multidisciplinary team approach at our VA hospital. STUDY DESIGN: Retrospective chart review. METHODS: Our patients newly diagnosed with HNSCC were identified from two 24-month periods: diagnosis before (group 1, 2005-2006) and after (group 2, 2008-2009) implementing our multidisciplinary team in 2007. No significant differences in age (P = .13) or disease stage (P = .18) occurred between groups. Primary and secondary outcomes (i.e., treatment modality, imaging, completion of treatment, survival) were compared. RESULTS: Timeliness to care improved for all measures. Improvement was significant for times from consult placed to seen in clinic (27.5-16.5 days; P < 0.0001) and from positive biopsy reported to date of initiating definitive treatment (35-27 days; P = 0.04). Pretreatment consults to various services represented by the multidisciplinary team increased from one to four (P < 0.0001). Two-year mortality was approximately the same between group 1 (33%) and group 2 (36%) (P = 0.035). Five-year mortality was slightly better in group 2 (50%) versus group 1 (61%), although not statistically significant. CONCLUSION: Our veteran population with HNSCC had improved timeliness and access to care with our multidisciplinary approach. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:627-631, 2016.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/terapia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Veteranos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico , Estudos de Coortes , Intervalos de Confiança , Intervalo Livre de Doença , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Equipe de Assistência ao Paciente/organização & administração , Modelos de Riscos Proporcionais , Melhoria de Qualidade , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Listas de Espera
2.
Laryngoscope ; 125(6): 1491-5, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25545468

RESUMO

OBJECTIVES/HYPOTHESIS: To examine the ability of the OSA-18 to predict Obstructive Sleep Apnea (OSA) in a racially diverse population when compared to overnight polysomnography (PSG). STUDY DESIGN: Cross-sectional retrospective. METHODS: Children 2 to 12 years of age diagnosed with OSA who were treated at a tertiary care institution between 2008 and 2013 and had complete PSG and OSA-18 data were included. We performed logistic regression with OSA as the dependent variable and the OSA-18 total symptom score (TSS), age, gender, race, asthma, and body mass index (BMI) as independent variables. RESULTS: Seventy-nine children (32 females) were included (mean age 5.2 ± 2.4 years). The positive predictive value (PPV) was greater than 90 for an obstructive apnea-hypopnea index (oAHI) ≥ 1. The PPV and specificity were higher for white than for nonwhite children; however, sensitivity and negative predictive value (NPV) of OSA-18 TSS were low for mild, moderate, and severe OSA regardless of race. Age, race, and BMI were not significantly associated with oAHI. CONCLUSIONS: This study, conducted in a racially diverse cohort, examined the ability of the OSA-18 to predict OSA when compared to PSG-the gold standard-and found that sensitivity and NPV were extremely low for both white and nonwhite children. This suggests that the OSA-18 is not sufficiently sensitive to detect OSA nor sufficiently specific to determine the absence of OSA. The OSA-18 should be used as a quality-of-life indicator and is not a reliable substitute for PSG. LEVEL OF EVIDENCE: 4.


Assuntos
Indicadores Básicos de Saúde , Polissonografia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Qualidade de Vida , Curva ROC , Sensibilidade e Especificidade
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