Effects of a geriatrician-led hip fracture program: improvements in clinical and economic outcomes.

The hip fracture service (HFS) is an interdisciplinary, geriatrician-led program instituted to improve the care of frail elderly people who present to the hospital with acute hip fracture. The HFS pilot project used existing hospital personnel and facilities and initiated new practices, including set protocols, preprinted orders, and standardized assessments, to achieve and evaluate patient triage and care and hospital cost savings. Outcome measures for 91 patients with acute hip fracture consecutively admitted to the HFS were compared with those of 72 historical controls managed under standard care in the prior year.

Meeting the imperative to improve physician well-being: assessment of an innovative program.

Background: Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative.

Objective: To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being.

A 30-year prospective follow-up study of hyperactive boys with conduct problems: adult criminality.

Objective: To compare the official arrest records for a large number of hyperactive boys (N = 179), most with conduct problems, and 75 control boys; to examine childhood IQ, socioeconomic status, and parent reports of childhood hyperactivity and conduct problems for their contribution to criminal behavior in adulthood; and to compare adult outcome for multimodality-treated (MMT) and drug-treated-only (DTO) hyperactives.

Method: We report on the official arrest history from early to mid- (18 to 38 years of age) adulthood in these 254 white subjects.

Results: Ninety one percent of subjects were followed up.

Tongue cancer: Is there a difference in survival compared with other subsites in the oral cavity?

Purpose: Advances in the management of patients with oral squamous cell carcinoma (OSCC) have confounded the importance of site in predicting overall prognosis. The purpose of this retrospective study was to review the outcome of patients with OSCC and to determine if site is a significant predictor of survival or disease-free survival.

Patients And Methods: The records of 233 patients that underwent surgery for resectable OSCC treated at a single institution from 1993 to 2003 were identified.

Prognostic factors in intraoral squamous cell carcinoma: the influence of histologic grade.

Purpose: The purpose of this retrospective study was to review the outcome of patients with oral cavity squamous cell carcinoma treated at a single institution by primary surgical resection with or without adjuvant radiotherapy or chemoradiotherapy and to identify factors affecting survival and locoregional control.

Patients And Methods: The records of 233 patients with oral cavity squamous cell carcinoma treated at a single institution from 1993 to 2003 were identified from the Legacy Emanuel Hospital and Health Center's cancer registry (Portland, OR). All patients undergoing surgical resection as a primary treatment modality were included in the study.

Management and outcome of patients with malignant salivary gland tumors.

Purpose: Refined imaging technology, the use of external beam radiation, neutron beam therapy, and chemotherapy, has altered management strategies for patients with salivary gland malignancies during the past 2 decades. Although treatment remains primarily surgical, optimal therapeutic regimens have yet to be fully realized. The purpose of this investigation is to report our experience with the management of patients with a variety of malignant salivary gland neoplasms that were treated with various combinations of surgery, radiation, and chemotherapy and to review treatment outcome in an effort to identify predictors of survival and locoregional control.

Combination glutathione and anthocyanins as an alternative for skin care during external-beam radiation.

Objective: Radiation dermatitis during therapy for breast malignancy can cause significant morbidity and delay treatment. RayGel (reduced glutathione and anthocyanins; Integrative Therapies, Portland, OR) appears to decrease this skin reaction, prompting us to undertake an objective evaluation of RayGel's effectiveness.

Methods: Patients undergoing whole breast external-beam irradiation were randomized to treatment with placebo or RayGel.

Geographic variation in sentinel node adaptation by practicing surgeons in Oregon.

Background: The sentinel node biopsy (SNB) technique is an important tool in the diagnosis and treatment of breast cancer and melanoma. However, surgeons in Oregon have not universally adopted its use.

Methods: Mailed questionnaire.

Risk counseling and management in patients with lobular carcinoma in situ.

Background: The understanding of lobular carcinoma in situ (LCIS) has evolved since it was first described. LCIS once was thought to be a premalignant condition, but now it is considered a marker for increased risk for developing invasive breast cancer. We evaluated patient perception of risk, counseling, and subsequent management.

Tobacco smoking history and presentation of oral squamous cell carcinoma.

Purpose: The association between tobacco smoking and oral squamous cell carcinoma is well established. However, few studies have evaluated the smoking history based on a smoking versus never-smoking history or analyzed the relationship between smoking history and site and stage of presentation. The purpose of this study was to examine the relationship between smoking versus never-smoking history and the stage and site of presentation of oral squamous cell carcinoma.

Facial computed tomography use in trauma patients who require a head computed tomogram.

Purpose: Head-injured patients admitted to a trauma center may or may not have associated facial fractures. Most head-injured patients undergo head computed tomography (CT) scan early in their evaluation. The question of adding a facial CT at the time of the head CT can be unclear.

Patterns of maxillofacial injuries related to interaction with horses.

Purpose: Studies of trauma patients have described patterns of injuries sustained from unfortunate encounters with large animals. However, the patterns of maxillofacial injuries have yet to be reported. The goal of this investigation was to describe and report on maxillofacial injuries that are associated with interaction with horses.

Management of cerebrospinal fluid leak associated with craniomaxillofacial trauma.

Purpose: The management of persistent, post-traumatic cerebrospinal fluid (CSF) rhinorrhea and otorrhea remains a surgical challenge. Repair of CSF leaks has evolved from that of an intracranial approach to one that is primarily extracranial and endoscopic. The purpose of this retrospective analysis is to determine the incidence of persistent CSF rhinorrhea and otorrhea and assess the clinical outcomes of patients presenting to a level 1 trauma center with posttraumatic CSF leaks who were managed by both surgical and nonsurgical means.

Benign paroxysmal positional nystagmus in hospitalized subjects receiving ototoxic medications.

Objective: To investigate the occurrence of benign paroxysmal positional nystagmus in subjects undergoing treatment with potentially ototoxic medications.

Study Design: Prospective and retrospective record reviews.

Setting: Tertiary referral neurotology clinic; clinical research and technology center.

Estimating normal optic nerve axon numbers in non-human primate eyes.

Purpose: The goal of the present study is to develop a semi-automated method to estimate accurately, with minimum variance, the total number of axons by counting a subset of the axons within a primate optic nerve.

Methods: Using an imaging analysis system, axons in 50% of the area of cross-sections of the retrobulbar optic nerve from five adult Rhesus monkeys were counted and extrapolated as an estimate of total axon number of the optic nerves. Both neural and non-neural areas were sampled.

Is detection of oral and oropharyngeal squamous cancer by a dental health care provider associated with a lower stage at diagnosis?

Purpose: Stage at diagnosis is the most important prognostic indictor for oral and oropharyngeal squamous cell cancers (SCCs). Unfortunately, approximately 50% of these cancers are identified late (stage III or IV). We set out to examinationine the detection patterns of oral and oropharyngeal SCCs and to determine whether detection of these cancers by various health care providers was associated with a lower stage.

Survey of trauma patients requiring maxillofacial intervention, ages 56 to 91 years, with length of stay analysis.

Purpose: The purpose of this study was to analyze trauma patients, ages 55 and older, sustaining multiple injuries including maxillofacial trauma. Factors influencing length of intensive care unit stay (ICUS) and length of total hospital stay were delineated and examined to determine if specific causes of increased length of stay could be elucidated, and, once known, if these causes could translate into recommendations tailored to the oral and maxillofacial surgery trauma practice.

Patients And Methods: One hundred ninety-six patients, 55 years of age or older, who received either consultation alone, or consultation with surgical treatment, by oral and maxillofacial surgeons, from January 1991 to August 1998 were included in this study.

Perspective on reconstruction after mastectomy.

Background: We sought to evaluate the factors influencing our patients to receive or forego reconstruction after mastectomy and their subsequent satisfaction with their decision.

Methods: A questionnaire was sent to 819 patients who underwent mastectomy from 1994 to 1998 in a community-based health system.

Results: Response rate was 50% (408 of 819).