That's not how the learning works - the paradox of Reverse Innovation: a qualitative study.

Background: There are significant differences in the meaning and use of the term 'Reverse Innovation' between industry circles, where the term originated, and health policy circles where the term has gained traction. It is often conflated with other popularized terms such as Frugal Innovation, Co-development and Trickle-up Innovation. Compared to its use in the industrial sector, this conceptualization of Reverse Innovation describes a more complex, fragmented process, and one with no particular institution in charge.

'They hear "Africa" and they think that there can't be any good services'--perceived context in cross-national learning: a qualitative study of the barriers to Reverse Innovation.

Background: Country-of-origin of a product can negatively influence its rating, particularly if the product is from a low-income country. It follows that how non-traditional sources of innovation, such as low-income countries, are perceived is likely to be an important part of a diffusion process, particularly given the strong social and cognitive boundaries associated with the healthcare professions.

Methods: Between September and December 2014, we conducted eleven in-depth face-to-face or telephone interviews with key informants from innovation, health and social policy circles, experts in international comparative policy research and leaders in Reverse Innovation in the United States.

The use of a prefabricated radial forearm free flap for closure of a large tracheocutaneous fistula: a case report and review of the literature.

Introduction: The closure of complex tracheocutaneous fistulae is a surgical challenge. We describe a staged approach for management of a patient with a large tracheocutaneous fistula in the setting of prior surgery and local radiation therapy.

Case Presentation: A 66-year-old Caucasian man who had undergone prior surgery and radiation therapy to the lower neck presented to our hospital for treatment of a large tracheocutaneous fistula that had developed with an adjacent area of tracheal stenosis.

Neoadjuvant chemotherapy first, followed by chemoradiation and then surgery, in the management of locally advanced rectal cancer.

Standard therapy for locally advanced rectal cancer (LARC) is preoperative chemoradiotherapy and postoperative chemotherapy. At Memorial Sloan-Kettering Cancer Center (MSKCC) the authors began offering FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) as initial treatment for patients with high-risk LARC to target micrometastases while treating the primary tumor. The purpose of this study is to report the safety and efficacy of initial FOLFOX given before chemoradiotherapy on tumor downsizing and pathologic complete response (pathCR) in LARC.

Presentation and patterns of late recurrence of olfactory groove meningiomas.

The objective of this article is to present the recurrence pattern of olfactory groove meningiomas after surgical resection. Four patients, one female and three males, with surgically resected olfactory groove meningiomas presented with tumor recurrence. All patients underwent resection of an olfactory groove meningioma and later presented with recurrent tumors.

Management of airway in patients with laryngeal tumors.

Study Objective: To describe our systematic approach to securing the airway in patients with laryngeal tumors, developed over a 10-year period.

Design: Retrospective analysis.

Setting: University-affiliated veterans administration medical center.

Anesthetic management of a patient with tracheal neurofibroma.

A 43-year-old man with neurofibromatosis and tracheal neurofibroma of the mid-trachea and respiratory difficulty was brought to the operating room for tracheostomy. After talking to the surgeons and viewing the computerized axial tomography, tracheal intubation was done under local anesthesia. Then, general anesthesia was provided for biopsy and debulking of the tumor, followed by tracheostomy.

Sentinel node biopsy for high-risk nonmelanoma cutaneous malignancy.

Objective: To evaluate the feasibility of sentinel node staging for detection of occult regional lymph node metastasis in high-risk cutaneous nonmelanoma malignancies.

Design: Consecutive clinical case series.

Setting: Referral university medical center.

Polymorphisms of xenobiotic metabolizing genes in oropharyngeal carcinoma.

Objective: The objective was to determine the prevalence of the polymorphisms of the microsomal epoxide hydrolase (Ephx1), glutathione S-transferase mu1 (GSTM ), theta1 (GSTT1), and pi1 (GSTP1) genes in patients with oropharyngeal carcinoma.

Study Design: Gene polymorphisms in 137 patients with oropharyngeal carcinoma were determined by polymerase chain reaction and restriction enzyme digestion for xenobiotic metabolizing enzymes that have been implicated in the carcinogenesis of tobacco-related neoplasias and compared with a population sample of 99 persons.

Results: At Ephx1 (microsomal epoxide hydrolase) codon 113, an overrepresentation of the greater activity genotype (Tyr/Tyr) was observed for male ever-smokers alone, both male and female ever-smokers, female never-smokers alone, and in both male and female never-smokers, compared with a control population sample.

Intraoperative microwave processing of bone margins during resection of head and neck cancer.

Objective: To develop an accurate method for performing histopathologic analysis for a full cross-section of cortical bone within 2 to 3 hours.

Methods: Microwave technology was used to augment and to more rapidly perform fixation and decalcification of cortical bone.

Results: Using the methods described, slides suitable for histopathologic analyses regarding the presence or absence of malignant tumor were prepared in 2 to 3 hours and, in 10 patients studied, had a 100% correlation with slides prepared in 7 days using the standard decalcification technique.

Isolated cervical recurrence of squamous cell carcinoma in the previously treated neck.

Purpose: Our study goal was to identify clinical factors associated with, and that might predict, treatment outcome for patients with an isolated cervical recurrence of squamous cell carcinoma in the previously treated neck (ICR-PTN).

Materials And Methods: We reviewed all patients with noncutaneous head and neck squamous cell carcinoma treated at our tertiary care center between 1987 and 1997, and identified 17 patients (2%) who later developed an isolated recurrence in a previously treated neck. These patients made up our study group, and their charts were thoroughly reviewed.

Factors related to outcome of salvage therapy for isolated cervical recurrence of squamous cell carcinoma in the previously treated neck: a multi-institutional study.

Objective: The goal was to identify factors associated with the outcome of salvage therapy for patients with isolated cervical recurrences of squamous cell carcinoma in the previously treated neck (ICR-PTN).

Study Design And Settings: A tumor registry search for ICR-PTN patients was performed at 7 participating institutions, and the charts were reviewed. Kaplan-Meier plots for survival and time until re-recurrence were used to evaluate the significance of associated variables.

Endoscopic stapled diverticulotomy: treatment of choice for Zenker's diverticulum.

Objective: To evaluate the efficacy and safety of endoscopic stapled diverticulotomy in the treatment of patients with Zenker's diverticulum.

Study Design: Cohort study.

Methods: Fourteen elderly patients (11 men and 3 women) with Zenker's diverticulum were evaluated in a community hospital setting from July 1996 to November 1999.

Modified neck dissection for metastatic nonseminomatous testicular carcinoma.

Objective: To examine the role of neck dissection in the treatment of metastatic stage 3 nonseminomatous germ-cell tumors (NSGCTs) of testicular origin.

Method: A retrospective review was made of 45 patients with metastatic NSGCT who underwent 48 unilateral and 3 bilateral neck dissections. Only level III-VI nodes were dissected, often with concomitant or staged mediastinal dissection, thoracotomy, and/or retroperitoneal node dissection.

Zenker's diverticulum: analysis of surgical complications from diverticulectomy and cricopharyngeal myotomy.

Objective: To identify risk factors for postoperative complications in patients undergoing diverticulectomy and cricopharyngeal (CP) myotomy for Zenker's diverticulum.

Study Design: Retrospective.

Materials And Methods: A chart review was conducted of all patients with a Zenker's diverticulum who were treated with diverticulectomy and cricopharyngeal myotomy at three tertiary care centers in central Indiana between 1988 and 1998.

Predictive factors for functional recovery after free tissue transfer oromandibular reconstruction.

Background: Recovery of upper aerodigestive tract function after reconstruction of segmental oromandiblectomy defects is frequently incomplete. The purpose of this study was to quantitate postreconstruction function and define variables that predict functional outcome in this population.

Methods: A prospective study of 21 patients who underwent microvascular free tissue transfer reconstruction of segmental oromandibular defects was performed.

Radiologic percutaneous gastrostomy: results in 56 patients with head and neck cancer.

Objective: The establishment of a direct enteral feeding route is critical in the overall treatment of many patients with head and neck cancer. Use of radiologic percutaneous gastrostomy (RPG), the newest technique for gaining enteral access, has not been studied in such patients extensively. This study evaluated the indications, technique, success rate, and complications associated with RPG in patients with head and neck cancer.

Cable grafting of the spinal accessory nerve after radical neck dissection.

Background: From January 1981 through March 1996, 20 patients with head and neck cancer underwent radical neck dissection with sacrifice of the spinal accessory nerve and immediate reconstruction of the nerve using a microsurgical technique and a cable graft of the great auricular nerve.

Methods: Postoperative shoulder function was assessed via a subjective questionnaire, objective strength testing, and/or postoperative electromyography. The latter was used to evaluate for the presence and amplitude of voluntary motor potentials, the presence of fibrillation potentials, and nerve conduction latency.

The pectoralis major myofascial flap: clinical applications in head and neck reconstruction.

Purpose: The pectoralis major myofascial (PMMF) flap, a simple variant of the pectoralis major myocutaneous (PMMC) flap, has been underemphasized as a reconstructive method in head and neck surgery.

Materials And Methods: In the present study, we review our experience using 18 PMMF flaps for a variety of reconstructive purposes in 15 head and neck cancer patients treated at a tertiary care hospital. Twelve of the study patients were undergoing surgical salvage of a recurrent cancer, and 10 had received previous radiation.

The value of ultrasound with ultrasound-guided fine-needle aspiration biopsy compared to computed tomography in the detection of regional metastases in the clinically negative neck.

Purpose: Head and neck oncologists have not reached consensus regarding the role of contemporary imaging techniques in the evaluation of the clinically negative neck in patients with head and neck squamous cell carcinoma (HNSCC). The purpose of the present study was to compare the accuracy of ultrasound with guided fine-needle aspiration biopsy (UGFNAB) and computed tomography (CT) in detecting lymph node metastasis in the clinically negative neck.

Methods And Materials: Sixty-four neck sides of patients with HNSCC were examined preoperatively by ultrasound/UGFNAB and CT at one of five participating tertiary care medical centers.

Wound complications associated with brachytherapy for primary or salvage treatment of head and neck cancer.

Brachytherapy can be employed in the primary or salvage treatment of head and neck cancer. The advantage of brachytherapy is the stereotactic limitation of radiation exposure to noninvolved tissues. Wound complications associated with brachytherapy have been discussed only sporadically in the literature.

Comparison of ultrasound-fine needle aspiration and computed tomography in patients undergoing elective neck dissection.

Background: Ultrasound of the neck with fine needle aspiration (US-FNA) of suspicious lymph nodes has potential advantages over other radiologic techniques as a screening method for the NO neck in head and neck cancer.

Methods: Twenty-five patients with head and neck cancer who underwent both US of the neck with FNA of any suspicious lymph nodes and neck computed tomography (CT) prior to elective neck dissection were studied. The majority of patients had squamous cell carcinoma (SCC) of the upper aerodigestive tract.

Resorbable fixation plates in head and neck surgery.

A skeletal fixation system employing plates made of polylactic and polyglycolic acid has been employed at Indiana University Medical Center since July 1993 in 105 craniofacial reconstructions, 45 cases of maxillofacial trauma, 10 craniotomy flap repairs, and five cases involving reconstruction of the laryngotrachea. Because these plates eventually resorb, they offer significant theoretical advantages. No inhibition of structural growth should occur when using this system in children.

Apneic anesthesia with intermittent ventilation for microsurgery of the upper airway.

Apneic anesthesia with intermittent ventilation (AAIV) has been used in 250 procedures on the larynx and trachea at Indiana University Medical Center since October 1989. Initially employed for laryngeal papilloma removal in children, this anesthetic technique is now used for other procedures and in adult patients. The advantages of AAIV include improved visualization of the airway, absence of combustible material, and lack of vocal cord motion during surgery.