Otorhinolaryngology Patients Research Articles

Managing pediatric otorhinolaryngology patients in coronavirus disease-19 pandemic – A real challenge to the clinicians

The novel coronavirus disease (COVID-19) pandemic is posing unprecedented challenges among the otolaryngologists during managing the pediatric patients. COVID-19 infection is caused by novel coronavirus called severe acute respiratory syndrome coronavirus-2. This infection is transmitted primarily through human contact and by droplet route. The pediatric otolaryngologists have a critical role for managing nose, paranasal sinus, ears, oral cavity, pharynx, and larynx, which are important sites for generating aerosols and virus transmission. Asymptomatic pediatric patients have high risk for viral shedding. In COVID-19 pandemic, the surgical procedure by pediatric otolaryngologists should be limited to the emergency condition. The surgical interventions should limit the viral dissemination. This review article provides an overview of common methods to limit the viral transmission to the otolaryngologists and assisting health-care staffs from COVID-19 infections during the management of the pediatric patients.

Pathogenetic mechanisms of hirudotherapy and its use in otorhinolaryngology

Data from studies on the pathogenetic mechanisms of saliva secretion of medical leeches, which is an important producer of unique biological active substances (BAS), is summarized. These substances have a wide range of therapeutic effects, providing a prodounced anti-inflammatory, bacteriostatic, bactericidal, fibrinolytic, neurotropic, regenerative, energetic, immunomodulatory, anti-sclerotic effects. They regulate homeostasis, the circulatory system, lymph flow, all types of metabolic processes in the body and have no analogues in nature. We have presented the results of more than 20 years of effective experience in the use of hirudotherapy in otorhinolaryngology patients for medical, rehabilitation, and health purposes. Promising is the further study and application of hirudotherapy as a type of naturopathy and homeopathy in the 21st century of advanced technologies, significantly changing the conditions of the internal and external environment of the inhabitants of our planet.

Pathogenetic mechanisms of hirudotherapy and its use in otorhinolaryngology

Data from studies on the pathogenetic mechanisms of saliva secretion of medical leeches, which is an important producer of unique biological active substances (BAS), is summarized. These substances have a wide range of therapeutic effects, providing a prodounced anti-inflammatory, bacteriostatic, bactericidal, fibrinolytic, neurotropic, regenerative, energetic, immunomodulatory, anti-sclerotic effects. They regulate homeostasis, the circulatory system, lymph flow, all types of metabolic processes in the body and have no analogues in nature. We have presented the results of more than 20 years of effective experience in the use of hirudotherapy in otorhinolaryngology patients for medical, rehabilitation, and health purposes. Promising is the further study and application of hirudotherapy as a type of naturopathy and homeopathy in the 21st century of advanced technologies, significantly changing the conditions of the internal and external environment of the inhabitants of our planet.

Assessment of diagnosis and treatment of geriatric patients in otorhinolaryngology

Amac: Otorinolaringolojik problemler, yaslilarin sosyal etkilesimini daha da kotulestirmekte, hastalarda bagimlilik ve depresyona neden olabilmektedir. Literaturde geriatrik populasyonun otorinolaringolojik rahatsizliklarini inceleyen sinirli sayida calisma bulunmaktadir. Bu calisma ile KBB hastaliklari bolumune basvuran yasli hastalarin demografik ozelliklerini, tani dagilimlarini, KBB hastaliklari yatakli servisindeki sureclerini analiz etmek suretiyle gelecekte kendilerine sunulacak hizmetin kalitesini artirmaya yonelik cabalarda yol gosterici olabilecek veriler elde etmeyi amaclanmistir. Yontemler: Bu kesitsel calismada; 01.01.2017 – 31.12.2019 (31.12.2019 dahil) tarihleri arasinda ayaktan poliklinige basvuran ve acil-tip klinigi, yogun bakim gibi farkli branslardan KSBU Evliya Celebi egitim ve arastirma hastanesi KBB bolumune konsulte edilen 65 yas ve ustu hastalarin dosyalari retrospektif olarak tarandi. Calismaya dahil edilen hastalarin tanilari, laboratuvar, radyolojik ve odyo-vestibuler degerlendirmeleri ve tedavi surecleri analiz edildi. Bulgular: Calismaya dahil edilen 12509 hastanin 5792’si kadin (%46,3), 6717’si (%53,7) erkekti. KBB poliklinigine en sik basvurunun 8594 (%68.7) hasta ile otolojik sikayetler nedeniyle yapildigi goruldu. Hastalarin degerlendirilmesinde kullanilan baslica tetkikler 5272 odyometrik test, 1585 laboratuvar testi (hemogram - biyokimya), 508 bilgisayarli tomografidir. Hastaliklar siklik sirasina gore incelendiginde ilk ikisi sirasiyla; isitme kaybi %24,89 ve sikismis serumen %22,07’dir. Calismaya dahil edilen hastalardan 332’sine (%2,65) muhtelif cerrahi mudahaleler yapilmistir. En sik cerrahi operasyonlarin bas/boyun cerrahisi (134 ameliyat), en sik yapilan cerrahi girisimin ise trakeotomi acilmasi (46 hasta) oldugu tespit edildi. Sonuc: Geriatrik hastalarin cogunlugunun ayaktan tedavisinin yapildigi ve siklikla otolojik sikayetlerle basvurduklari gorulmustur. Geriatrik hastalara cogunlukla onkolojik rahatsizliklar nedeniyle cerrahi operasyon yapilmistir.

Diagnostic-combined groups as a personalization tool of doctor’s financial stimulation level and predictor of treatment cost

Introduction: The mechanism of formation and use of clinical-statistical groups and diagnostic-combined groups (DSG) as a tool for determining the cost of physician work, personification of the level of financial stimulation of his quality work is proposed based on the example of ENT diseases of different degrees of complexity. Purpose: As a result of the comparative characterization of physicians' work indicators management of diseases of five degrees of complexity, proposition to recommend the mechanism of substantiation of the levels of financial renumeration of the doctor and the possible options for reimbursement of a certain amount of the total cost of treatment. Material and Methods: We performed retrospective analysis of case histories and outpatient charts of otorhinolaryngological patients of the regional hospital for 10 years. Taking into account certain features of the clinical course of the disease, indicators of the average working time of the doctor for the process of examination and treatment, we recommend clinical-statistical groups, divided into four which amounted to five DCG, ie diseases of five degrees of complexity. Also, a formula is proposed in which, on the basis of official data on the amount of salaries of doctors, the terms of their regulatory expenses, the so-called "increasing" coefficients, an attempt was made to determine the cost of physicians' work according to the degree of complexity of the disease and to identify possible sources of compensation to the patient from the amount of the total cost of treatment. Results and discussion: Appropriate calculations indicated the opportunity to justify certain amounts of financial incentives for physicians, depending on the number of patients treated with varying degrees of complexity. Possible official sources of financial compensation to the patient of a certain amount of the total cost of his treatment were also identified. Conclusions: Given the creation of computer programs that would greatly simplify the corresponding calculations of the tables presented in the article, the recommended algorithm for practical implementation of the clinical-statistical groups and DCG system would be methodologically suitable for use in other (therapy, surgery, etc.) profile services of healthcare establishment.

Health risk factors in the family-members of chlamydiosis patients

To study the characteristics of health state in family-members of ENT-patients with identified Chlamydia infection. We have examined 245 members of 87 families of otorhinolaryngological patients with verified (44 families) and without (44 families) Chlamydia infection. Laboratory methods of the research included the identification of the following types: Chlamydia trachomatis and Chlamydophila pneumoniae. Chlamydia diagnostics involved both direct immune fluorescence and immune enzyme analyses as well as polymerase chain reaction. Health state in ENT-patient family-members has been evaluated by the complex method based on the special questionnaire for every family-member aimed at determining the health category, the calculation of health average coefficient for each family member followed by the determination of family identity with some definite health category. in the families of otorhinolaryngological patients with verified Chlamydia infection there have been revealed considerably more family-members with acute and chronic pathology of different organs and systems associated with functional disorders. The health status of family members of ENT patients with respiratory Chlamydia was significantly worse than in families of patients with negative laboratory results for Chlamydia, which was manifested by a much smaller number of healthy family members and a large number of people with risk factors for health.

Do Otolaryngology Patients Show Gender Preference When Choosing a Surgeon? - A Quantitative and Qualitative Analysis.

Introduction Otorhinolaryngology has always been considered a gender-neutral specialty, whereas in several other specialties, such as obstetrics, gynecology and urology, gender preference has been consistently shown by patients when choosing their treating surgeon. To date, no study has been performed to analyze whether this practice of gender preference is prevalent in otorhinolaryngology patients too. Objectives To identify if gender preference exists in the field of otorhinolaryngology, specifically in its four subspecialties, namely otology, pediatric otolaryngology, laryngology and head and neck surgery. Methods Patients attending our outpatient department were asked to complete a preformed proforma. The pro forma consisted of two parts, demographic details of the subjects and gender preference in the following subspecialties: otology, pediatric otolaryngology, laryngology and head and neck oncosurgery. Results A total of 1,112 subjects took part in the study, out of which 1,089 subjects were included in the final analysis. Female gender preference was highest in the field of pediatric otolaryngology, while male preference was highest for head and neck oncosurgery. Conclusion Though otorhinolaryngology and head and neck surgery has been considered a gender-neutral field, subspecialties of this field show considerable gender preference.

The potential of eHealth in otorhinolaryngology—head and neck surgery: patients’ perspectives

The use of modern information and communication technologies (ICT) in daily life has significantly increased during the last several years. These essential online technologies have also found their way into the healthcare system. The use of modern ICT for health reasons can be summarized by the term 'eHealth'. Despite the potential importance of eHealth in the field of otorhinolaryngology (ORL), there is little understanding of patients' attitudes towards the deeper integration of these technologies into intersectoral care. The aim of this study was to gain a better understanding of patients' attitudes towards the use of modern ICT for intersectoral communication and information transfer in the field of ORL. Therefore, a structured interview was developed by an interdisciplinary team of otorhinolaryngologists, public health researchers, and information technology (IT) specialists. Overall, 211 ORL patients were interviewed at the Department of Otorhinolaryngology-Head and Neck Surgery, Tuebingen University Hospital, Germany, and 203 of these patients completed the interview. This study revealed ORL patients' perspectives on the potential of eHealth, especially for appointment scheduling, appointment reminders, and intersectoral communication of personal medical information. Furthermore, this study provides evidence that data security and the impacts of eHealth on the physician-patient relationship and on treatment quality warrant special attention in future research.

Quality of life questionnaires in otorhinolaryngology: a systematic overview

The importance of quality of life (QOL) as an endpoint and the use of validated QOL questionnaires have increased over time. To evaluate health-related quality of life (HR-QOL) measurement instruments used in patients in otorhinolaryngology (ORL). We aimed to establish the use of QOL questionnaires in ORL over a period of time, establish the use of QOL questionnaires within different domains and determine the use of validated QOL questionnaires. We performed a comprehensive search in PubMed up to 1 January 2014. Articles were included that measured HR-QOL questionnaires in clinical practice in children, adolescents or adults in 42 journals of ORL. Multiple unique QOL questionnaires, organised according to domain, time and survey of validation, were extracted from reported articles. Of 2442 articles, we utilised 1196 publications with a total of 2103 QOL questionnaires regarding ORL. We evaluated a variety of 363 unique QOL questionnaires in which 60% (n = 220) QOL questionnaires had been validated. We found a continuing increase in the amount of articles which used QOL questionnaires since the beginning of the 20th century, while the percentage of validated QOL questionnaires remained the same (76%). Most QOL questionnaires were used in the domains oncology (35%), otology (21%) and rhinology (20%). The domain otology had the largest amount of unique QOL questionnaires (n = 122). We identified and evaluated all unique HR-QOL questionnaires utilised in patients in ORL. Recently, the use of validated and non-validated HR-QOL questionnaires has increased within all domains of ORL. The assessment of QOL has become an important outcome measure in clinical practice, in medical research and for healthcare organisations.

Twelve-year survey (2001-2012) of the antimicrobial susceptibility of Streptococcus pneumoniae isolates from otorhinolaryngology clinics in Miyagi Prefecture, Japan.

Streptococcus pneumoniae is one of the most common bacteria causing otorhinolaryngological infections, such as acute otitis media and upper respiratory tract infection. Our group surveyed the drug susceptibility profile of S. pneumoniae isolates from otorhinolaryngology patients. A total of 41,069 S. pneumoniae isolates were detected at Miyagi Medical Association Health Center between May 2001 and December 2012. Specimens were obtained from patients at 40 otorhinolaryngology outpatient clinics in Miyagi Prefecture, Japan. The minimum inhibitory concentrations (MICs) of 8 antimicrobial agents were measured using the broth microdilution method according to Clinical and Laboratory Standards Institute guidelines. In children aged 0-2 years old, the MIC50 values of penicillins decreased after 2010 (PCG: 1 μg/ml (2010) to 0.06 μg/ml (2012); ABPC: 1 μg/ml (2010) to 0.25 μg/ml (2012)). The prevalence of penicillin-resistant S. pneumoniae (PRSP) decreased from 35.2% (2010) to 14.6% (2012) in rhinorrhea specimens and from 43.4% (2010) to 14.3% (2012) in otorrhea specimens. Susceptibility to cephems (ceftriaxone and cefditoren) and carbapenems (panipenem) also showed improvement after 2010. For macrolides (clarithromycin) and lincosamides (clindamycin), MIC50 values increased in all age groups during the study period, and a high level of resistance was seen until 2012. There were no marked changes of susceptibility to fluoroquinolones (LVFX) during the study period. Improvement of susceptibility of S. pneumoniae to β-lactams occurred after 2010 in Miyagi Prefecture, Japan.

Upper Gastrointestinal Endoscopy in ENT Practice: How Worth is It?

ABSTRACTObjectiveThe need for upper gastrointestinal (GI) endoscopy in the evaluation of hoarseness.Study designProspective study, conducted during the period from June 2012 to February 2013.SettingTertiary referral center.ResultsA total of 125 patients were selected for the study and they were evaluated with appropriate history and clinical examination. Out of 125 patients, 41 (32.8%) patients showed laryngeal findings leading to hoarseness, 13 (10.4%) patients showed features of suspected malignancy in other adjacent regions which was confirmed later, two (1.6%) patients showed phonetic gap and 69 (55.2%) patients showed normal laryngeal inlet on indirect laryngoscopy examination. Of the 69 normal patients which were treated conservatively and since they did not show any response they were subjected to upper GI endoscopy. Out of 69 patients, 41 (60%) patients showed features of gastritis, 28 (40%) patients showed features of duodenitis.ConclusionIt is estimated that more than 50% of patients presenting to the ENT OPD for hoarseness are because of GI problems. We strongly advise upper GI endoscopy for the symptomatic otorhinolaryngological patients with a normal laryngeal finding on indirect laryngoscopy for treating the condition accurately or near accurately. Adding to this upper GI endoscopy has the additional advantages of documentation and medicolegal aspect in the present day scenario.How to cite this articleSantosh UP, Kumar MCA, Karanam L. Upper Gastrointestinal Endoscopy in ENT Practice: How Worth is It? Int J Phonosurg Laryngol 2013;3(2):35-38.

Early Evaluation of Granulomatosis with Polyangiitis (Wegeners) in the Patients with Atypical Sinusitis: An Introduction to Amir Alam Hospital Recommendation for Early Detection of Granulomatosis with Polyangiitis in Sinusitis

Background: Chronic and Atypical Sinusitis (AtS) is often the initial but frequently neglected presentation of Granulomatosis with Polyangiitis (GPA). These patients are primarily referred to otorhinolaryngology clinics and often receive prolonged antimicrobial medications before gradual development of other GPA symptoms. Objectives: This study was designed to find the number of patients with sinusitis fulfilling the ACR criteria for diagnosis of GPA (Wegener’s). Methods: This cross-sectional study recruited 23 patients with AtS and 32 patients with Typical Sinusitis (TyS). For every patient a through physical examination focusing primarily on the head and neck region, chest X-ray and sinus roentgenograms in Waters and Caldwell views, Complete Blood Count, ESR, BUN, Creatinine, CRP, c-ANCA, p-ANCA and Urinalysis were done. Histopathologic studies were performed on sinus biopsies in AtS patients. Results: Chronicity, recurrence and sinus masses are three major factors to make a sinusitis atypical. The most frequent complaint was purulent/bloody discharge from the nose found in 15 (65%) of patients with AtS. The most frequent signs and symptoms in TyS group were posterior nasal drainage and production of phlegm. Radiographic studies found 5 bony masses in the AtS group. One patient with AtS was found to have pansinusitis and a disappeared nasal septum. Chest radiographs of patients with TyS did not show any pathologic finding but in two patients with AtS ring shadows in the base of both lungs and calcified granulomas were detected respectively. Histopathologic study in two patients with AtS showed chronic inflammatory cells, granulomas and necrosis highly suggestive for GPA. In AtS group, ESR was elevated in three female and two male patients. c-ANCA was found to be very high in a male patient with elevated ESR, BUN, creatinine and CBC impairment. Urinalysis showed microhematuria in one patient and the same male patient mentioned above had RBC casts. No patient in TyS group met the ACR criteria of GPA but in the AtS group, three (13%) patients (two female and one male) were found to have GPA according to ACR criteria and yet another three (13%) were highly suggestive to have GPA but did not fulfill the ACR criteria. Conclusion: Early identification of this high number of patients with GPA, in a limited number of otorhinolaryngological patients confers the advantages of screening and early treatment. Rheumatologic consultation in the treatment of AtS patients is therefore inevitable.

Nutritional risk of hospitalized patients in Turkey

We conducted a multicentre study to assess nutritional risk at hospital admission, hospital-associated iatrogenic malnutrition and the status of nutritional support in Turkish hospitals. A database which allowed for online submission of hospital and patient data was developed. A nutritional risk screening system (NRS-2002) was applied to all patients and repeated weekly in patients with hospital stays greater than one week and no invasive procedures. Patient-specific nutritional support was recorded during the study period. Thirty-four hospitals from 19 cities contributed data from 29,139 patients. On admission, 15% of patients had nutritional risk. Nutritional risk was common (52%) in intensive care unit patients and lowest (3.9%) in otorhinolaryngology patients. Only 51.8% of patients with nutritional risk received nutritional support. Nutritional risk was present in 6.25% of patients at the end of the first week and 5.2% at the end of the second week, independent of nutritional support. In patients with nutritional risk on admission who were hospitalized for two weeks and received nutritional support, the NRS-2002 score remained > or =3 in 83% of cases. Nutritional risk is common in hospitalized Turkish patients. While patients at nutritional risk often do not receive nutritional support when hospitalized, nutritional risk occurs independent of nutritional support.

地方中核病院における気道異物症例の検討―とくに耳鼻咽喉科受診１７例と三次救急搬送６２例の検討―

Foreign-body aspiration (FBA) obstructing the airways may lead to choking and cardiopulmonary arrest without immediate emergency care. We retrospectively reviewed medical records of 17 otorhinolaryngology subjects-8 men and 9 women aged 0 to 84 years-88% of whom were < 3 years old, requiring tracheobronchial FBA between January 1995 and October 2006 and of 62 emergency subjects-43 men and 19 women aged 0 to 91 years--10% of whom were < 3 yeares old 68% of whom > or = 50 years old, admitted between January 2000 and October 2006. Emergency Department personnel saw a mean of 8.9 patients per year versus the mean of 1.4 patients per year seen by Otorhinolaryngology Department personnel. Foreign bodies extracted most frequently from the 17 otorhinolaryngology patients were 9 seen for peanut injestion followed by 1 each seen for bean, screw, and false teeth injestion among other objects. Sixteen of the 17 were discharged without complications. Foreign bodies extracted from the 62 emergency patients most frequently involved food, especially rice cakes. Over half seen had already gone into cardiopulmonary arrest upon arrival and required cardiopulmonary resuscitation. Of the 62, 32 patients died, 13 were sent to another hospital after in-patient care, 9 were sent home without admission, and 7 were discharged without complications.

Zungenbelag, Mundgeruch und Schmeckstörung – bisherige Behandlungsmethoden und neue Therapieoption durch mechanische Zungenreiniger

The tongue is said to be the mirror of physical health. The tongue dorsum is most delicate regarding the sense of touch. Pathologic coating of the tongue accounts for paresthesia during chewing, swallowing, speaking, tasting, and also may result in mouth odor. Tongue coating can result from increased formation or decreased natural abrasion, and from xerostomia or dyschylia. In clinical otorhinolaryngology pathologic tongue coating often is idiopathic or present after surgery of the oral cavity or pharynx. Critical analysis of published studies reveals that effectivity and justification to administer xenobiotics or vitamins in that condition is doubtful. Recently, it has been shown that tongue fur was able to be reduced by an easy-to-handle mechanical tongue cleaner or tongue scraper. Due to its simple use, tongue scrapers could be a welcome supplement for the treatment of tongue fur, mouth odor, and in particular cases, to enhance gustatory sense. Preliminary results of an ongoing prospective trial showed that tongue scrapers can effectively be applied after surgery of the oral cavity or pharynx. After tonsillectomy, tongue fur seemed to be reduced and gustatory sense to be enhanced when tongue scrapers were applied during postoperative care. After confirming these promising results in further investigations, an inexpensive and simple option for the treatment of a large amount of patients in clinical otorhinolaryngology would exist.

Latex allergy, a special risk for patients of otorhinolaryngology and head and neck surgery?

A total of 206 patients of the otorhinolaryngology (ORL) department and 204 of the visceral surgery department of the Ludwig Maximilians University of Munich were preoperatively evaluated for latex-specific sensitization. A prick test, a questionnaire, and an enzyme-linked immunosorbent assay immunoprecipitation for IgE antibodies were performed. Latex is a widely spread allergen, and it does not only concern healthcare populations. Within the ORL surgery group, 43 (20.9%) patients were sensitized against latex allergen, and 2 of them were reported to manifest symptoms in consorting with latex. In the cohort of visceral surgery patients, we detected only 23 patients (11.3%) with sensitization against latex. Moreover, most patients were positively detected with the skin prick test (86.4%), whereas the enzyme-linked immunosorbent assay method was less sensitive (18.3%). Patients of the ORL department were considerably more frequently exposed to latex protein particles than patients of the visceral surgery department. This difference attributes to their significant difference in mean age: 44 years in the ORL patients group versus 58 years in the visceral patients cohort. Furthermore, we did not find any correlation to the number of past operations—although undergoing any surgical procedures is a well-known risk factor in other studies about latex sensitization in surgical patients.

Use of hydroxy‐methyl‐glutaryl coenzyme A reductase inhibitors is associated with risk of lymphoid malignancies

It has been speculated that the use of hydroxy-methyl-glutaryl coenzyme A reductase inhibitors (statins) is associated with the risk of malignant diseases. Considering their immunosuppressive activities, malignant diseases that are associated with an immunosuppressive status seem feasible to examine the association. We therefore examined the association between statin use and development of lymphoid malignancies in a case-control study. Cases were 221 consecutive incident cases with histopathologically proven lymphoid malignancies (lymphoma and myeloma), hospitalized in the Department of Hematology of Toranomon Hospital (Tokyo, Japan) between 1995 and 2001. Two independent control groups, comprising 442 and 437 inpatients without malignancies from the Departments of Orthopedics and Otorhinolaryngology of the same hospital, were selected to test for consistency of association. Controls were matched individually with cases for age, sex and year of admission. Subject information, including statin use, was abstracted from medical records at the time of hospitalization. Strength of association was evaluated as an adjusted odds ratios (aOR) using a conditional logistic regression model. A higher frequency of statin use was found among patients with lymphoid malignancies in comparison with both orthopedic (aOR 2.11, 95% CI 1.20-3.69, P = 0.009) and otorhinolaryngology patients (aOR 2.59, 95% CI 1.45-4.65, P = 0.001), the significance being maintained when the two control groups were combined (aOR 2.24, 95% CI 1.37-3.66, P = 0.001). In conclusion, we observed an elevated risk of lymphoid malignancy with statin use among Japanese patients. Further evaluations in different populations are required to draw conclusions as to the carcinogenicity of lymphoid malignancies with statin use.

Intervención mínima en tabaquismo en España

To determine the percentage of smokers who have been counseled by a physician to quit, among patients who visit a variety od specialist clinica; to identify the characteristics associated with a history of minimal intervention. An anonymous survey of 501 patients over 14 years of age (230 men, 271 women; mean age of 51.4 yr) who were out patients in cardiology (61), neurology (68), digestive medicine (124), endocrinology (22), internal medicine (14), otorhinolaryngology (53) and dermatology (159) over a period of one week. The questionnaire asked if the patient smoked currently and if so, if a physician had ever recommended quitting. The association between a history or minimal intervention and other variables was evaluated using Spearman a correlation coefficient. 1) One hundred fifteen (22.9%) were smokers. 2) Only 49 (42.6%) of the smokers reported that a physician had advised quitting and 66 (57.4%) reported that none had done so. 3) We found an association between a history of minimal intervention and older age (rs = -0.246; p = 0.008) and male sex (rs = 0.244; p = 0.009). The infrequency with which physicians counsel patients to quit in our setting suggests an urgent need for the Spanish health authorities to develop programs aimed at minimal intervention.

Einfluß von Funktionsbeeinträchtigungen und vegetativen Symptomen auf die Lebensqualität nach Tumortherapie im Kopf-Hals-Bereich

Life quality in tumour patients has received growing scientific and public attention. While most studies focus on patients with tumours in the thorax or abdomen, less is known about determinants of life quality in patients with tumours in the head-neck region. In this report, we focus on the role of tumour localisation, clinical staging, functional impairments, and vegetative symptoms on the rating of life quality. In a structured interview, 222 tumour patients regularly followed-up by the Department of Otorhinolaryngology were asked about aspects of their illness, especially with regard to life quality. The results show that clinical stage of tumour had an U-shaped effect on life quality. Patients on stage 1 or on stage 3 had higher life quality ratings than patients on stage 2, which may indicate divergent coping styles of the patients. Patients with impairments of swallowing, tasting, whispering or breathing rated significant lower on life quality. Moreover, patients suffering from pain, with sleeping problems, with impairments of their bodily appearance or of their sex life rated significantly lower on life quality. Tumour localisation had no effect on ratings of life quality. In conclusion, it can be stated that life quality of tumour patients in otorhinolaryngology is influenced by clinical stage of the tumour, functional impairments and vegetative symptoms.

Cost-effective use of microcomputers for quality assurance and resource utilization in the surgical intensive care unit

Need for organ system support, severity of illness, and the risk of life-threatening complications are major factors in determining the need for ICU care and directly affect ICU costs. Using a microcomputer and a relational database program, an ICU database was developed to study ICU utilization. The following information was collected for each ICU patient on admission, then daily, and on ICU discharge: demographic data, procedures, monitors used, laboratory tests, complications, outcome, and Acute Physiology and Chronic Health Evaluation (APACHE II) score as a measure of acuity. In our study, this information was used as a first step in an attempt to define categories of patients who might benefit most from intensive care and those who would not. From September 1, 1987 to March 1, 1989, 1,062 patients were admitted to the surgical ICU (SICU). Otorhinolaryngology (ENT) patients with major head and neck resections, routinely admitted to the SICU, were compared with those from other surgical services. The ENT patients had the lowest mean admission APACHE II (6.8 +/- 0.4 vs. 11.4 +/- 0.3), lowest mean daily APACHE II (7.8 +/- 0.4 vs. 13.2 +/- 0.1), lowest percent of ventilated patients (7.6% vs. 39.4%) and ventilator days (18.9% vs. 64.6%), and had the least monitoring by central venous catheters (20.9% vs. 57.1%) or pulmonary artery catheters (0.9% vs. 29.8%) (p less than .0001 for all of above). They also had the shortest mean ICU stay (1.2 +/- 0.1 vs. 3.3 +/- 0.2 days, p less than .05). The only complication in 105 ENT patients was one uncomplicated myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)