6 results on '"Shindo M"'
Search Results
2. Advanced head and neck surgery training during the COVID-19 pandemic.
- Author
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Givi B, Moore MG, Bewley AF, Coffey CS, Cohen MA, Hessel AC, Jalisi S, Kang S, Newman JG, Puscas L, Shindo M, Shuman A, Thakkar P, Weed DT, and Chalian A
- Subjects
- COVID-19, Communicable Disease Control organization & administration, Education, Medical, Graduate organization & administration, Employment statistics & numerical data, Female, Head and Neck Neoplasms surgery, Humans, Male, Occupational Health statistics & numerical data, Pandemics statistics & numerical data, Patient Safety statistics & numerical data, Risk Assessment, United States, Clinical Competence, Coronavirus Infections epidemiology, Curriculum, Fellowships and Scholarships organization & administration, Otolaryngology education, Pneumonia, Viral epidemiology, Surveys and Questionnaires
- Abstract
Background: The COVID-19 pandemic has significantly impacted medical training. Here we assess its effect on head and neck surgical education., Methods: Surveys were sent to current accredited program directors and trainees to assess the impact of COVID-19 on the fellow's experience and employment search. Current fellows' operative logs were compared with those of the 2018 to 2019 graduates., Results: Despite reduction in operative volume, 82% of current American Head and Neck Society fellows have reached the number of major surgical operations to support certification. When surveyed, 86% of program directors deemed their fellow ready to enter practice. The majority of fellows felt prepared to practice ablative (96%), and microvascular surgery (73%), and 57% have secured employment to follow graduation. Five (10%) had a pending job position put on hold due to the pandemic., Conclusions: Despite the impact of the COVID-19 pandemic, current accredited trainees remain well-positioned to obtain proficiency and enter the work-force., (© 2020 Wiley Periodicals, Inc.)
- Published
- 2020
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3. Ethical framework for head and neck endocrine surgery in the COVID-19 pandemic.
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Chen AY and Shindo M
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- COVID-19, Communicable Disease Control methods, Coronavirus Infections prevention & control, Elective Surgical Procedures methods, Endocrine Surgical Procedures statistics & numerical data, Female, Humans, Male, Occupational Health, Pandemics prevention & control, Patient Safety, Pneumonia, Viral prevention & control, Risk Assessment, United States, Coronavirus Infections epidemiology, Elective Surgical Procedures ethics, Endocrine Surgical Procedures ethics, Pandemics statistics & numerical data, Pneumonia, Viral epidemiology, Time-to-Treatment ethics
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- 2020
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4. Evaluating contemporary pain management practices in thyroid and parathyroid surgery: A national survey of head and neck endocrine surgeons.
- Author
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Ferrell JK, Singer MC, Farwell DG, Stack BC Jr, and Shindo M
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- Ambulatory Surgical Procedures statistics & numerical data, Analgesics, Opioid therapeutic use, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Counseling statistics & numerical data, Hospitalists statistics & numerical data, Humans, Surveys and Questionnaires, United States, Drug Prescriptions statistics & numerical data, Pain, Postoperative drug therapy, Parathyroidectomy, Practice Patterns, Physicians' statistics & numerical data, Surgeons, Thyroidectomy
- Abstract
Background: There is currently a lack of evidence-based guidelines regarding postoperative opioids after thyroid and parathyroid surgery. This study aimed to objectively characterize contemporary postoperative pain management practices via a national survey of head and neck endocrine surgeons., Methods: A standardized electronic survey was distributed to the membership of the American Head and Neck Society's Endocrine section., Results: A total of 102 surgeons completed the survey representing a 34% response rate. In all, 65.7% of respondents utilize opioids with wide variations in the total morphine equivalents prescribed. Practice environment (χ
2 = 10.0; P = 0.04) and performing preoperative pain counseling (χ2 = 9.7; P = 0.002) were significantly associated with a decreased likelihood of prescribing postoperative opioids. Utilization of non-opioid pain management strategies was common and significantly associated with performing outpatient surgery (χ2 = 6.2; P = 0.013) and preoperative pain counseling (χ2 = 4.5; P = 0.034)., Conclusions: Pain management practice patterns vary significantly among head and neck endocrine surgeons which further emphasize the need for evidence-based guidelines., (© 2019 Wiley Periodicals, Inc.)- Published
- 2019
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5. Comparison of Opioid Utilization Patterns After Major Head and Neck Procedures Between Hong Kong and the United States.
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Li RJ, Loyo Li M, Leon E, Ng CWK, Shindo M, Manzione K, Andersen P, Clayburgh D, Wax M, and Chan JYK
- Subjects
- Analgesics, Non-Narcotic therapeutic use, Anti-Anxiety Agents therapeutic use, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Female, Hong Kong, Humans, Male, United States, Analgesics, Opioid therapeutic use, Drug Utilization Review, Head and Neck Neoplasms surgery, Pain Management methods, Pain, Postoperative drug therapy
- Abstract
Importance: The current opioid abuse epidemic in the United States requires evaluation of prescribing practices within all medical specialties. This examination includes a review of postoperative pain management for patients undergoing major head and neck procedures., Objective: To report differences in postoperative pain regimens between an international and domestic head and neck surgical program., Design, Setting, and Participants: Pain management patterns after head and neck surgery in the programs at Chinese University of Hong Kong (CUHK) and Oregon Health and Science University (OHSU) were compared with a focus on opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen or paracetamol, and anxiolytics. Cases from July 1, 2013, through August 31, 2017, were reviewed. Standing medication orders the day before surgery (PRE1), postoperative day 6 (POD6), and postoperative day 14 (POD14) were compared between institutions., Exposures: Head and neck surgery., Results: A total of 253 cases from CUHK and 567 cases from OHSU were analyzed (mean [SD] age, 59.4 [14.3] and 60.1 [16.4] years, respectively). Patients from OHSU had a significantly higher frequency of opioid orders on PRE1 (15.3% vs 1.6%; odds ratio [OR], 11.3; 95% CI, 4.09-31.10), POD6 (86.8% vs 0.4%; OR, 1653.12; 95% CI, 228.51-11 959.01), and POD14 (71.4% vs 0.8%; OR, 313.75; 95% CI, 77.12-1276.52). There were no significant differences in acetaminophen or paracetamol, NSAID, or anxiolytic orders between institutions. Institution was the most significant indicator for the presence of opioid orders on POD6 (OR, 4271.10; 95% CI, 380.04-47 999.70) and POD14 (OR, 330.35; 95% CI, 79.67-1369.82). In addition to treating institution, multivariate analysis showed that PRE1 opioid orders indicated a significant increase in likelihood of opioid orders on POD6 (OR, 4.77; 95% CI, 1.23-18.57) but not POD14. POD6 anxiolytic orders remained a significant indicator of opioid orders for POD6 (95% CI, 1.49-113.10) and POD14 (95% CI, 1.17-5.03), respectively., Conclusions and Relevance: A significantly lower frequency of postoperative opioid orders was observed from CUHK compared with OHSU across similar major head and neck procedures. This contrast encourages a careful examination of (1) cultural and patient expectations of pain control, (2) the metrics by which control is assessed, (3) industry and economic drivers of opioid use, and (4) alternatives to opioid pain regimens. A thoughtful shift in postoperative pain protocols that deemphasizes opioid use may be an opportunity to counter the epidemic of opioid abuse in the United States.
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- 2018
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6. Clinical and serological differentiation of autoimmune and hepatitis C virus-related chronic hepatitis.
- Author
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Fried MW, Draguesku JO, Shindo M, Simpson LH, Banks SM, Hoofnagle JH, and Di Bisceglie AM
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- Adult, Autoantibodies blood, Autoimmune Diseases blood, Autoimmune Diseases epidemiology, Biomarkers blood, Diagnosis, Differential, Female, Hepacivirus immunology, Hepatitis Antibodies blood, Hepatitis C blood, Hepatitis C epidemiology, Hepatitis, Chronic blood, Hepatitis, Chronic epidemiology, Humans, Male, Middle Aged, Prevalence, RNA, Viral blood, United States epidemiology, Autoimmune Diseases diagnosis, Hepatitis C diagnosis, Hepatitis, Chronic diagnosis
- Abstract
Recent reports have focused on the difficulty in differentiating autoimmune hepatitis from chronic hepatitis C due to the high prevalence of anti-HCV in autoimmune hepatitis. The aim of this study was to identify clinical, biochemical, and serological variables that would help distinguish these two diseases. Pretreatment clinical and biochemical variables were compared from 17 patients with steroid-responsive autoimmune chronic active hepatitis and 62 patients with chronic hepatitis C. Serum samples from these patients were tested for autoantibodies and for anti-HCV by first- and second-generation ELISA, recombinant immunoblot assay, and HCV RNA by polymerase chain reaction. Patients with autoimmune hepatitis were more likely to be symptomatic (94% vs 47%, P < 0.005) and jaundiced (76% vs 0%, P < 0.005) at the time of referral. Anti-HCV was found in 53% of patients with autoimmune hepatitis, but only two were positive by immunoblot assay and only one of these had detectable HCV RNA. Antinuclear antibody (ANA) was detected in 21% of patients with chronic hepatitis C, although usually at a lower titer than in autoimmune hepatitis (geometric mean titer = 1:160 vs 1:500, P < 0.003). Patients with chronic hepatitis C who were ANA positive were older than those who were ANA negative, although there were no other differences in clinical or biochemical features between these groups. In particular, there was no difference in response rate to antiviral therapy. Thus, autoantibodies are frequently found in chronic hepatitis C, especially in older subjects, but appear to be clinically insignificant. Anti-HCV is frequently present in autoimmune hepatitis but is rarely confirmed by tests of higher specificity.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1993
- Full Text
- View/download PDF
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