The burden of severe asthma in France: a case-control study using a medical claims database

Publication date: Available online 25 January 2019

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Arnaud Bourdin, Caroline Fabry-Vendrand, Juliette Ostinelli, Malik Ait-Yahia, Elsa Darnal, Stéphane Bouee, Caroline Laurendeau, Isabelle Bureau, Julie Gourmelen, Christos Chouaid

Abstract

Background

Severe asthma (SA) is defined by treatment intensity. The availability of national databases allows accurate estimation of the prevalence, long term outcomes and costs of SA.

Objective

To provide accurate information on SA, focussing on comorbidities, mortality, health care resource consumption and associated costs.

Methods

A cohort of SA patients identified in 2012 was extracted from a French representative claims database and followed for three years. Their characteristics, comorbidities, mortality and direct costs were compared with a matched control group without asthma.

Results

690 SA patients were matched to 2070 patients without asthma (mean age 61 years, 65.7% women). The prevalence of SA was estimated to be 0.18% to 0.51% of the French adult population.

Comorbidities were more frequent in SA patients (73.9% suffered from cardiovascular disease vs. 54.3% in controls, p<0.001). 58.7% of SA patients used oral corticosteroids (OCS) in 2012 with a mean intake of 3.3 box/year/patient and 9% received ≥6 dispensings of OCS. 6.7% were treated by omalizumab. SA patients were more frequently hospitalised (33.2% vs 19.7%, p<0.001), more frequently consulted a general practitioner (GP) (97.8% vs 83.9%, p<0.001) (9.8±6.8 vs 6.2±5.3 consultations/year, p<0.001) and 31% have consulted a private respiratory physician.

Compared to controls, 3-year cumulative mortality was higher in SA (7.1% vs 4.5%, p=0.007). Direct medical cost was $9,227 vs. $3,950 (p<0.001) mostly driven by medication costs.

Conclusion

The prevalence of SA in the French adult population is at least 18/10,000. Burden of disease is high with respect to comorbidities, mortality and asthma-related healthcare resource use.

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Relevance of the basophil high-affinity IgE receptor in chronic urticaria: Clinical experience from a tertiary care institution

Publication date: Available online 25 January 2019

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Gustavo Deza, Alvaro March-Rodríguez, Silvia Sánchez, Clara Ribas-Llauradó, Dulce Soto, Ramon M. Pujol, Ramon Gimeno, Ana M. Giménez-Arnau

Abstract

Background

The high-affinity IgE receptor (FcεRI) expression on effector cells has been poorly characterized in patients with chronic urticaria (CU) to date.

Objectives

To investigate the FcεRI expression on blood basophils in a large cohort of CU patients and its potential relationship with relevant features of the disease.

Methods

Basophil FcεRI expression was measured by flow cytometry in 287 CU patients (192 with Chronic Spontaneous Urticaria and 95 with Chronic Inducible Urticaria) at their initial evaluation in our Department. A control group of healthy non-atopic individuals was included to provide reference data, and the effect of antihistamine and anti-IgE therapy on the basophil FcεRI expression was also evaluated in a cohort of CU patients.

Results

The median FcεRI expression was found significantly higher in CU patients compared to healthy controls (p<0.0001). A positive correlation was found between serum IgE levels and basophil FcεRI expression (R=0.422; p<0.001). Significantly higher FcεRI levels on basophils were detected in CU patients who presented with concomitant atopic features (p=0.003), negative autologous serum skin test (p=0.002), negative autologous plasma skin test (p=0.009) or undetected levels of anti-thyroid antibodies (p=0.01). Baseline FcεRI expression was not related with the activity and duration of the disease, and was not significantly modified during antihistamine therapy; however, it correlated with the clinical response to omalizumab (p=0.003).

Conclusion

Although further multicenter studies are needed to corroborate these findings, the assessment of basophil FcεRI levels might be relevant in daily clinical practice supporting an autoimmune pathogenesis and predicting response to anti-IgE treatment.

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The burden of severe asthma in France: a case-control study using a medical claims database

Publication date: Available online 25 January 2019

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Arnaud Bourdin, Caroline Fabry-Vendrand, Juliette Ostinelli, Malik Ait-Yahia, Elsa Darnal, Stéphane Bouee, Caroline Laurendeau, Isabelle Bureau, Julie Gourmelen, Christos Chouaid

Abstract

Background

Severe asthma (SA) is defined by treatment intensity. The availability of national databases allows accurate estimation of the prevalence, long term outcomes and costs of SA.

Objective

To provide accurate information on SA, focussing on comorbidities, mortality, health care resource consumption and associated costs.

Methods

A cohort of SA patients identified in 2012 was extracted from a French representative claims database and followed for three years. Their characteristics, comorbidities, mortality and direct costs were compared with a matched control group without asthma.

Results

690 SA patients were matched to 2070 patients without asthma (mean age 61 years, 65.7% women). The prevalence of SA was estimated to be 0.18% to 0.51% of the French adult population.

Comorbidities were more frequent in SA patients (73.9% suffered from cardiovascular disease vs. 54.3% in controls, p<0.001). 58.7% of SA patients used oral corticosteroids (OCS) in 2012 with a mean intake of 3.3 box/year/patient and 9% received ≥6 dispensings of OCS. 6.7% were treated by omalizumab. SA patients were more frequently hospitalised (33.2% vs 19.7%, p<0.001), more frequently consulted a general practitioner (GP) (97.8% vs 83.9%, p<0.001) (9.8±6.8 vs 6.2±5.3 consultations/year, p<0.001) and 31% have consulted a private respiratory physician.

Compared to controls, 3-year cumulative mortality was higher in SA (7.1% vs 4.5%, p=0.007). Direct medical cost was $9,227 vs. $3,950 (p<0.001) mostly driven by medication costs.

Conclusion

The prevalence of SA in the French adult population is at least 18/10,000. Burden of disease is high with respect to comorbidities, mortality and asthma-related healthcare resource use.

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Relevance of the basophil high-affinity IgE receptor in chronic urticaria: Clinical experience from a tertiary care institution

Publication date: Available online 25 January 2019

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Gustavo Deza, Alvaro March-Rodríguez, Silvia Sánchez, Clara Ribas-Llauradó, Dulce Soto, Ramon M. Pujol, Ramon Gimeno, Ana M. Giménez-Arnau

Abstract

Background

The high-affinity IgE receptor (FcεRI) expression on effector cells has been poorly characterized in patients with chronic urticaria (CU) to date.

Objectives

To investigate the FcεRI expression on blood basophils in a large cohort of CU patients and its potential relationship with relevant features of the disease.

Methods

Basophil FcεRI expression was measured by flow cytometry in 287 CU patients (192 with Chronic Spontaneous Urticaria and 95 with Chronic Inducible Urticaria) at their initial evaluation in our Department. A control group of healthy non-atopic individuals was included to provide reference data, and the effect of antihistamine and anti-IgE therapy on the basophil FcεRI expression was also evaluated in a cohort of CU patients.

Results

The median FcεRI expression was found significantly higher in CU patients compared to healthy controls (p<0.0001). A positive correlation was found between serum IgE levels and basophil FcεRI expression (R=0.422; p<0.001). Significantly higher FcεRI levels on basophils were detected in CU patients who presented with concomitant atopic features (p=0.003), negative autologous serum skin test (p=0.002), negative autologous plasma skin test (p=0.009) or undetected levels of anti-thyroid antibodies (p=0.01). Baseline FcεRI expression was not related with the activity and duration of the disease, and was not significantly modified during antihistamine therapy; however, it correlated with the clinical response to omalizumab (p=0.003).

Conclusion

Although further multicenter studies are needed to corroborate these findings, the assessment of basophil FcεRI levels might be relevant in daily clinical practice supporting an autoimmune pathogenesis and predicting response to anti-IgE treatment.

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Otolaryngologists adhere to evidence-based guidelines for chronic rhinosinusitis

Abstract

Purpose

To assess awareness of, opinion about and adherence to evidence-based guidelines on chronic rhinosinusitis among Dutch Otolaryngologists.

Methods

We assessed implementation of two guidelines, one Dutch and one European, that are both intended for diagnosis and treatment of patients with chronic rhinosinusitis. We invited 485 Otolaryngologists to fill out a questionnaire and report on their opinion on and adherence to the guidelines. The adherence was further tested by 4 clinical case scenarios, derived from guideline recommendations.

Results

166 (34%) completed the questionnaire. 99% of the respondents was aware of one or both guidelines. Most respondents (90%) consider the guidelines as directing or supportive for their clinical practice based on the clinical case scenarios, between 62 and 99% of the respondents act according to guidelines. Concerning diagnosis, CT-imaging is performed more and allergy testing less than recommended. Where multiple treatment options are recommended, the responses are more heterogeneous as a result of this. Nonetheless, high recommended treatment was chosen more often. Otolaryngologists were reluctant in surgical treatment as a first option, which is according to the guidelines.

Conclusions

Overall, both the EPOS and CBO guideline are well known among Dutch Otolaryngologists and 90% indicates that the guideline is important in their daily practice. Adherence to the guidelines is sufficient to high. If multiple treatment or diagnostic options are recommended this leads to a more heterogeneous response pattern. Recommendations with a high grade of recommendation were followed up most often.

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Otolaryngologists adhere to evidence-based guidelines for chronic rhinosinusitis

Abstract

Purpose

To assess awareness of, opinion about and adherence to evidence-based guidelines on chronic rhinosinusitis among Dutch Otolaryngologists.

Methods

We assessed implementation of two guidelines, one Dutch and one European, that are both intended for diagnosis and treatment of patients with chronic rhinosinusitis. We invited 485 Otolaryngologists to fill out a questionnaire and report on their opinion on and adherence to the guidelines. The adherence was further tested by 4 clinical case scenarios, derived from guideline recommendations.

Results

166 (34%) completed the questionnaire. 99% of the respondents was aware of one or both guidelines. Most respondents (90%) consider the guidelines as directing or supportive for their clinical practice based on the clinical case scenarios, between 62 and 99% of the respondents act according to guidelines. Concerning diagnosis, CT-imaging is performed more and allergy testing less than recommended. Where multiple treatment options are recommended, the responses are more heterogeneous as a result of this. Nonetheless, high recommended treatment was chosen more often. Otolaryngologists were reluctant in surgical treatment as a first option, which is according to the guidelines.

Conclusions

Overall, both the EPOS and CBO guideline are well known among Dutch Otolaryngologists and 90% indicates that the guideline is important in their daily practice. Adherence to the guidelines is sufficient to high. If multiple treatment or diagnostic options are recommended this leads to a more heterogeneous response pattern. Recommendations with a high grade of recommendation were followed up most often.

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Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the Critically Ill

Abstract

Swallowing disorders and respective consequences (including aspiration-induced pneumonia) are often observed in extubated ICU patients with data indicating that a large number of patients are affected. We recently demonstrated in a large-scale analysis that the incidence of post-extubation dysphagia (PED) is 12.4% in a general ICU population and about 18% in emergency admissions to the ICU. Importantly, PED was mostly sustained until hospital discharge and independently predicted 28- and 90-day mortality. Although oropharyngeal/laryngeal trauma, neuromuscular ICU-acquired weakness, reduced sensation/sensorium, dyssynchronous breathing, and gastrointestinal reflux, are all considered to contribute to PED, little is known about the underlying pathomechanisms and risk factors leading to PED in critically ill patients. Systematic screening of all potential ICU patients for oropharyngeal dysphagia (OD) seems key for early recognition and follow-up, as well as the design and testing of novel therapeutic interventions. Today, screening methods and clinical investigations for dysphagia differ considerably. In the context of a recently proposed pragmatic screening algorithm introduced by us, we provide a concise review on currently available non-instrumental techniques that could potentially serve for non-instrumental OD assessment in critically ill patients. Following systematic literature review, we find that non-instrumental OD assessments were mostly tested in different patient populations with only a minority of studies performed in critically ill patients. Due to little available data on non-instrumental dysphagia assessment in the ICU, future investigations should aim to validate respective approaches in the critically ill against an instrumental (gold) standard, for example, flexible endoscopic evaluation of swallowing. An international expert panel is encouraged to addresses critical illness—related definitions, screening and confirmatory assessment approaches, treatment recommendations, and identifies optimal patient-centered outcome measures for future clinical investigations.

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Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the Critically Ill

Abstract

Swallowing disorders and respective consequences (including aspiration-induced pneumonia) are often observed in extubated ICU patients with data indicating that a large number of patients are affected. We recently demonstrated in a large-scale analysis that the incidence of post-extubation dysphagia (PED) is 12.4% in a general ICU population and about 18% in emergency admissions to the ICU. Importantly, PED was mostly sustained until hospital discharge and independently predicted 28- and 90-day mortality. Although oropharyngeal/laryngeal trauma, neuromuscular ICU-acquired weakness, reduced sensation/sensorium, dyssynchronous breathing, and gastrointestinal reflux, are all considered to contribute to PED, little is known about the underlying pathomechanisms and risk factors leading to PED in critically ill patients. Systematic screening of all potential ICU patients for oropharyngeal dysphagia (OD) seems key for early recognition and follow-up, as well as the design and testing of novel therapeutic interventions. Today, screening methods and clinical investigations for dysphagia differ considerably. In the context of a recently proposed pragmatic screening algorithm introduced by us, we provide a concise review on currently available non-instrumental techniques that could potentially serve for non-instrumental OD assessment in critically ill patients. Following systematic literature review, we find that non-instrumental OD assessments were mostly tested in different patient populations with only a minority of studies performed in critically ill patients. Due to little available data on non-instrumental dysphagia assessment in the ICU, future investigations should aim to validate respective approaches in the critically ill against an instrumental (gold) standard, for example, flexible endoscopic evaluation of swallowing. An international expert panel is encouraged to addresses critical illness—related definitions, screening and confirmatory assessment approaches, treatment recommendations, and identifies optimal patient-centered outcome measures for future clinical investigations.

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Reprint of: Mapping human brain lesions and their functional consequences

Publication date: Available online 25 January 2019

Source: NeuroImage

Author(s): Hans-Otto Karnath, Christoph Sperber, Christopher Rorden

Abstract

Neuroscience has a long history of inferring brain function by examining the relationship between brain injury and subsequent behavioral impairments. The primary advantage of this method over correlative methods is that it can tell us if a certain brain region is necessary for a given cognitive function. In addition, lesion-based analyses provide unique insights into clinical deficits. In the last decade, statistical voxel-based lesion behavior mapping (VLBM) emerged as a powerful method for understanding the architecture of the human brain. This review illustrates how VLBM improves our knowledge of functional brain architecture, as well as how it is inherently limited by its mass-univariate approach. A wide array of recently developed methods appear to supplement traditional VLBM. This paper provides an overview of these new methods, including the use of specialized imaging modalities, the combination of structural imaging with normative connectome data, as well as multivariate analyses of structural imaging data. We see these new methods as complementing rather than replacing traditional VLBM, providing synergistic tools to answer related questions. Finally, we discuss the potential for these methods to become established in cognitive neuroscience and in clinical applications.

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When right becomes less right: Neural dedifferentiation during suprasegmental speech processing in the aging brain

Publication date: Available online 24 January 2019

Source: NeuroImage

Author(s): Matthias Keller, Pia Neuschwander, Martin Meyer

Abstract

This study combines event-related sparse-temporal acquisition fMRI with structural MRI to investigate elderly participants (n = 26, mean age = 70.64) with age-typical peripheral hearing. While participants were presented with locally time-reversed sentences of varying temporal integrity, they performed an auditory pattern-matching task. The major aim of the study was to find out whether functional lateralization for speech perception according to the 'Asymmetric Sampling in Time' (AST) hypothesis shows a similar pattern in elderly individuals as has been previously observed in younger adults. Our findings indicate that, unlike results previously obtained from younger adults, older individuals did not demonstrate the same pattern of rightward lateralization in response to suprasegmental speech cues in the three auditory regions of interest (ROI), namely Heschl's gyrus (HG), planum temporale (PT) and posterior lateral superior temporal gyrus (pSTG). A frequentist statistical approach did not yield evidence for functional lateralization in the aging brain, and this was corroborated by Bayesian evidence which supported the absence of lateralization in older adults in response to the suprasegmental manipulation. However, a relationship between structural measurements and functional responses demonstrated that individuals with thicker right PT showed less variance in lateralization. Hence, this study extends the division of labour between the left and the right auditory cortex during the processing of continuous spoken language as proposed by the "AST"-hypothesis in younger adults to a lifespan context.

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Reprint of: Mapping human brain lesions and their functional consequences

Publication date: Available online 25 January 2019

Source: NeuroImage

Author(s): Hans-Otto Karnath, Christoph Sperber, Christopher Rorden

Abstract

Neuroscience has a long history of inferring brain function by examining the relationship between brain injury and subsequent behavioral impairments. The primary advantage of this method over correlative methods is that it can tell us if a certain brain region is necessary for a given cognitive function. In addition, lesion-based analyses provide unique insights into clinical deficits. In the last decade, statistical voxel-based lesion behavior mapping (VLBM) emerged as a powerful method for understanding the architecture of the human brain. This review illustrates how VLBM improves our knowledge of functional brain architecture, as well as how it is inherently limited by its mass-univariate approach. A wide array of recently developed methods appear to supplement traditional VLBM. This paper provides an overview of these new methods, including the use of specialized imaging modalities, the combination of structural imaging with normative connectome data, as well as multivariate analyses of structural imaging data. We see these new methods as complementing rather than replacing traditional VLBM, providing synergistic tools to answer related questions. Finally, we discuss the potential for these methods to become established in cognitive neuroscience and in clinical applications.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FO9dZK

When right becomes less right: Neural dedifferentiation during suprasegmental speech processing in the aging brain

Publication date: Available online 24 January 2019

Source: NeuroImage

Author(s): Matthias Keller, Pia Neuschwander, Martin Meyer

Abstract

This study combines event-related sparse-temporal acquisition fMRI with structural MRI to investigate elderly participants (n = 26, mean age = 70.64) with age-typical peripheral hearing. While participants were presented with locally time-reversed sentences of varying temporal integrity, they performed an auditory pattern-matching task. The major aim of the study was to find out whether functional lateralization for speech perception according to the 'Asymmetric Sampling in Time' (AST) hypothesis shows a similar pattern in elderly individuals as has been previously observed in younger adults. Our findings indicate that, unlike results previously obtained from younger adults, older individuals did not demonstrate the same pattern of rightward lateralization in response to suprasegmental speech cues in the three auditory regions of interest (ROI), namely Heschl's gyrus (HG), planum temporale (PT) and posterior lateral superior temporal gyrus (pSTG). A frequentist statistical approach did not yield evidence for functional lateralization in the aging brain, and this was corroborated by Bayesian evidence which supported the absence of lateralization in older adults in response to the suprasegmental manipulation. However, a relationship between structural measurements and functional responses demonstrated that individuals with thicker right PT showed less variance in lateralization. Hence, this study extends the division of labour between the left and the right auditory cortex during the processing of continuous spoken language as proposed by the "AST"-hypothesis in younger adults to a lifespan context.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FWqIGu

The moderating effect of gender on the association between E-cigarette use and smoking status: A cross-sectional study

Publication date: Available online 25 January 2019

Source: Addictive Behaviors

Author(s): Jusung Lee, Mihyun Oh

Abstract

Introduction

The novel features of e-cigarettes in the recent vaping boom are appealing to females. Given increasing concerns about using e-cigarettes among females, understanding the patterns of using e-cigarettes in females compared to males is critical. We investigate the moderating effect of gender on the association between ever vaping and smoking status and gender differences in reason for ever vaping and in having ever stopped smoking.

Methods

We used population data (n = 38,661) from the 2015, 2016, and 2017 Texas Behavioral Risk Factor Surveillance System (BRFSS) to examine a gender difference in ever vaping associated with smoking status. Additionally, we restricted the sample to current smokers who have ever vaped (n = 4733) to examine the association of gender with quitting smoking as reason for ever vaping and with having ever stopped smoking.

Results

We found a significant association between ever vaping and gender (OR = 0.77, 95%CI = 0.65, 0.91). When smoking status was considered, female never-smokers had a significantly lower likelihood of ever vaping than male never-smokers (OR = 0.43, 95%CI = 0.27, 0.76). No significant gender difference was found in ever vaping to quit smoking (OR = 1.12, 95%CI = 0.73, 1.74) and having ever stopped smoking (OR = 1.41, 95%CI = 0.95, 2.10).

Conclusions

The findings of this study provide evidence of gender differences in vaping patterns. Female never-smokers are less likely than male never-smokers to experiment with e-cigarettes. However, there is no evidence of a gender difference in both ever vaping to quit smoking and having ever stopped smoking. Consistent monitoring of gender differences in using e-cigarettes and stratified policy approaches tailored for genders are necessary.

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The moderating effect of gender on the association between E-cigarette use and smoking status: A cross-sectional study

Publication date: Available online 25 January 2019

Source: Addictive Behaviors

Author(s): Jusung Lee, Mihyun Oh

Abstract

Introduction

The novel features of e-cigarettes in the recent vaping boom are appealing to females. Given increasing concerns about using e-cigarettes among females, understanding the patterns of using e-cigarettes in females compared to males is critical. We investigate the moderating effect of gender on the association between ever vaping and smoking status and gender differences in reason for ever vaping and in having ever stopped smoking.

Methods

We used population data (n = 38,661) from the 2015, 2016, and 2017 Texas Behavioral Risk Factor Surveillance System (BRFSS) to examine a gender difference in ever vaping associated with smoking status. Additionally, we restricted the sample to current smokers who have ever vaped (n = 4733) to examine the association of gender with quitting smoking as reason for ever vaping and with having ever stopped smoking.

Results

We found a significant association between ever vaping and gender (OR = 0.77, 95%CI = 0.65, 0.91). When smoking status was considered, female never-smokers had a significantly lower likelihood of ever vaping than male never-smokers (OR = 0.43, 95%CI = 0.27, 0.76). No significant gender difference was found in ever vaping to quit smoking (OR = 1.12, 95%CI = 0.73, 1.74) and having ever stopped smoking (OR = 1.41, 95%CI = 0.95, 2.10).

Conclusions

The findings of this study provide evidence of gender differences in vaping patterns. Female never-smokers are less likely than male never-smokers to experiment with e-cigarettes. However, there is no evidence of a gender difference in both ever vaping to quit smoking and having ever stopped smoking. Consistent monitoring of gender differences in using e-cigarettes and stratified policy approaches tailored for genders are necessary.

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Importancia de la cuantificación del desplazamiento hioideo en la valoración del estadio y evolución de la disfagia orofaríngea

Publication date: Available online 24 January 2019

Source: Acta Otorrinolaringológica Española

Author(s): Gemma Garmendia Merino, Helena Bascuñana Ambrós

Resumen

Introducción y objetivos

El objetivo de este trabajo es mostrar nuestra experiencia y consideraciones al cuantificar el desplazamiento hioideo, así como observar su correlación con las escalas cualitativas de valoración de la disfagia.

Métodos

Se mide el desplazamiento hioideo mediante el método descrito por el grupo de Molfenter y Steele 2014 en una serie de 14 pacientes con disfagia orofaríngea antes y después del tratamiento, y se valora su correlación con la Escala de penetración y aspiración de Rosenbek de 1996, y con la Functional Oral Intake Scale de Crary de 2005.

Resultados

Todos los pacientes variaron el desplazamiento total del hioides tras el tratamiento aplicado. Esta variación se correlacionó con las variaciones de la Escala de penetración y aspiración en todos los pacientes que presentaban aspiración o penetración. Sin embargo, las modificaciones del desplazamiento total hioideo no se correlacionaron con las variaciones de la Functional Oral Intake Scale.

Conclusiones

La mejora en el desplazamiento total del hioides es un indicador clínico de la mejora en la aspiración del paciente con disfagia orofaríngea, y puede ser utilizado en su diagnóstico y seguimiento. Sin embargo, no lo es como indicador de la tolerancia de la dieta oral.

Abstract

Introduction and objectives

The objective of this paper was to show our experience and considerations when quantifying hyoid bone displacement and to observe its correlation with the qualitative scales that evaluate dysphagia.

Methods

Hyoid displacement was assessed using the method described by Molfenter and Steele's group in 2014 in a series of 14 patients affected by oropharyngeal dysphagia. The degree of dysphagia was also qualitatively assessed with the Rosenbek Penetration and Aspiration Scale (PAS) of 1996 and with the Functional Oral Intake Scale (FOIS) of Crary of 2005. All assessments were done before and after treatment.

Results

All patients increased their hyoid bone total displacement after the treatment. These variations were highly correlated with the variations in the PAS scale with aspiration or penetration. However, the variations of hyoid bone displacement did not correlate with the FOIS scale.

Conclusions

The improvement in total hyoid bone displacement is a clinical indicator of improved aspiration of patients suffering dysphagia. However, the improvement of this displacement is not related to the oral intake tolerance of the patients.

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Importancia de la cuantificación del desplazamiento hioideo en la valoración del estadio y evolución de la disfagia orofaríngea

Publication date: Available online 24 January 2019

Source: Acta Otorrinolaringológica Española

Author(s): Gemma Garmendia Merino, Helena Bascuñana Ambrós

Resumen

Introducción y objetivos

El objetivo de este trabajo es mostrar nuestra experiencia y consideraciones al cuantificar el desplazamiento hioideo, así como observar su correlación con las escalas cualitativas de valoración de la disfagia.

Métodos

Se mide el desplazamiento hioideo mediante el método descrito por el grupo de Molfenter y Steele 2014 en una serie de 14 pacientes con disfagia orofaríngea antes y después del tratamiento, y se valora su correlación con la Escala de penetración y aspiración de Rosenbek de 1996, y con la Functional Oral Intake Scale de Crary de 2005.

Resultados

Todos los pacientes variaron el desplazamiento total del hioides tras el tratamiento aplicado. Esta variación se correlacionó con las variaciones de la Escala de penetración y aspiración en todos los pacientes que presentaban aspiración o penetración. Sin embargo, las modificaciones del desplazamiento total hioideo no se correlacionaron con las variaciones de la Functional Oral Intake Scale.

Conclusiones

La mejora en el desplazamiento total del hioides es un indicador clínico de la mejora en la aspiración del paciente con disfagia orofaríngea, y puede ser utilizado en su diagnóstico y seguimiento. Sin embargo, no lo es como indicador de la tolerancia de la dieta oral.

Abstract

Introduction and objectives

The objective of this paper was to show our experience and considerations when quantifying hyoid bone displacement and to observe its correlation with the qualitative scales that evaluate dysphagia.

Methods

Hyoid displacement was assessed using the method described by Molfenter and Steele's group in 2014 in a series of 14 patients affected by oropharyngeal dysphagia. The degree of dysphagia was also qualitatively assessed with the Rosenbek Penetration and Aspiration Scale (PAS) of 1996 and with the Functional Oral Intake Scale (FOIS) of Crary of 2005. All assessments were done before and after treatment.

Results

All patients increased their hyoid bone total displacement after the treatment. These variations were highly correlated with the variations in the PAS scale with aspiration or penetration. However, the variations of hyoid bone displacement did not correlate with the FOIS scale.

Conclusions

The improvement in total hyoid bone displacement is a clinical indicator of improved aspiration of patients suffering dysphagia. However, the improvement of this displacement is not related to the oral intake tolerance of the patients.

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Systematic review and meta‐analysis of the impact of dosimetry to dysphagia and aspiration related structures

Abstract

Background

Technological advances in radiotherapy have allowed investigations into new methods to spare healthy tissue in those treated for head and neck cancer. This systematic review with meta‐analysis demonstrates the effect that radiation has on swallowing.

Methods

Selection and analysis of studies examining the effect of radiation to swallowing structures. A fixed effects meta‐analysis calculated the pooled proportions for select outcomes of dysphagia, common across many studies.

Results

The majority of the papers found a correlation between radiation dose to the swallowing structures and dysphagia, however a meta‐analysis found the studies carried a significant degree of heterogeneity. The appraisal demonstrates the need for large‐scale studies using a randomized design and instrumental dysphagia assessments.

Conclusions

Radiation dose to dysphagia and aspiration structures is correlated with incidence of dysphagia and aspiration. The variables in this population contribute to the heterogeneity within and cross studies and future studies should consider controlling for this.

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Rationale and budget impact of bimonthly use of Cetuximab in patients with recurrent and/or metastatic head and neck cancer

Abstract

Background

In recurrent and/or metastatic head and neck squamous cell cancer, Cetuximab is administered once a week, followed by weekly doses. We present the clinical rationale of a different schedule of maintenance Cetuximab and we estimate the potential economic benefits on the health care budget from a societal perspective in Italy.

Methods

A budget impact (BI) excel‐based model was developed comparing a base case scenario of 100% weekly administration with a dose of 250 mg/m² to an every‐other‐week (EOW) administration at 50% or 100% with a dose of 500 mg/m².

Results

In the EOW, 50% scenario it was calculated a cost reduction of €347 000 of which 70% attributable to indirect costs, increasing to €694 000 after 4 months.

Conclusions

In our analysis, we showed that this simplified schedule could also reduce the costs of treatments both for the health system (direct costs) and for the society (indirect costs).

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RNL37T

Response to Letter to the Editor regarding follow‐up for NIFTP

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CFWmVo

Systematic review and meta‐analysis of the impact of dosimetry to dysphagia and aspiration related structures

Abstract

Background

Technological advances in radiotherapy have allowed investigations into new methods to spare healthy tissue in those treated for head and neck cancer. This systematic review with meta‐analysis demonstrates the effect that radiation has on swallowing.

Methods

Selection and analysis of studies examining the effect of radiation to swallowing structures. A fixed effects meta‐analysis calculated the pooled proportions for select outcomes of dysphagia, common across many studies.

Results

The majority of the papers found a correlation between radiation dose to the swallowing structures and dysphagia, however a meta‐analysis found the studies carried a significant degree of heterogeneity. The appraisal demonstrates the need for large‐scale studies using a randomized design and instrumental dysphagia assessments.

Conclusions

Radiation dose to dysphagia and aspiration structures is correlated with incidence of dysphagia and aspiration. The variables in this population contribute to the heterogeneity within and cross studies and future studies should consider controlling for this.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CKh32l