搜索结果：Current opinion in otolaryngology & head and neck surgery

The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published the updated "Clinical Practice Guideline: Adult Sinusitis" as a supplement to this issue of Otolaryngology-Head and Neck Surgery. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 developed recommendations address diagnostic accuracy for adult rhinosinusitis, the appropriate use of ancillary tests to confirm diagnosis and guide management (including radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function), and the judicious use of systemic and topical therapy. Emphasis was also placed on identifying multiple chronic conditions that would modify management of rhinosinusitis, including asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia. An updated guideline is needed as a result of new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group. METHODS: This executive summary describes the guideline developed using the 55-page protocol published as the American Academy of Otolaryngology-Head and Neck Surgery Foundation's Clinical Practice Guideline Development Manual (3rd edition), which summarizes the methodology for assessments of current data, topic prioritization, development of key action statements, application of value judgements, and related procedures. The guideline update group represented the disciplines of otolaryngology-head and neck surgery, infectious disease, family medicine, allergy and immunology, advanced practice nursing, and a consumer advocate. DIFFERENCES FROM PRIOR GUIDELINE: This clinical practice guideline is as an update, and replacement, for an earlier guideline published in 2015 by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF).1 An update was planned for 5 years after the initial publication date and was further necessitated by new primary studies and systematic reviews that might suggest a need for modifying clinically important recommendations.2 Changes in content and methodology from the prior guideline include the following: New evidence from 14 guidelines, 194 systematic reviews, and 133 RCTs. Emphasis on patient education and counseling with new explanatory tables. Expanded action statement profiles to explicitly state quality improvement opportunities, confidence in the evidence, intentional vagueness, and differences of opinion. Enhanced external review process to include public comment and journal peer review. New algorithm to clarify decision making, watchful waiting, action statement relationships. Extension of watchful waiting (without antibiotic therapy) as an initial management strategy to all patients with uncomplicated acute bacterial rhinosinusitis (ABRS) regardless of severity, not just patients with "mild" illness (prior guideline). Clarified the recommended timeline for the diagnosis, conservative management and antibiotic treatment of ABRS. Change in recommendation to first-line antibiotic therapy for ABRS amoxicillin, with or without clavulanate, from amoxicillin alone (prior guideline). Addition of aspirin exacerbated respiratory disease (AERD) as a chronic condition that modifies management of chronic rhinosinusitis (CRS). Three new key action statements on managing CRS that focus on the use of biologics (recommend against when patients do not have polyps and educate patients about them when they do) and a recommendation against the empiric use of antibiotics for CRS solely as a third-party requirement for surgery or imaging.

Intersystem medical error discovery (IMED) involves clinicians identifying errors that occurred outside of their facility while a patient was under another clinician's care. Despite its major implications for safety and quality of care, explicit guidance is limited. Given the complexity of disorders and specialization within otolaryngology, IMED is a considerable concern, yet little is known about current practices or management strategies. To explore otolaryngologists' perceptions and practices around feedback and reporting of IMED and to identify strategies for preventing or responding to these errors. This qualitative study used semistructured, virtual interviews of 24 otolaryngologists with expertise in patient safety and quality improvement across the US from July to October of 2023. Purposive sampling ensured diversity in subspecialty, career stage, geography, practice context, and demographics. Otolaryngologist perceptions of IMED, encompassing barriers and facilitators to providing feedback or reporting IMED, and strategies for improving practices. Analysis followed an iterative inductive approach of interpretive description. Among the 24 participants (median [IQR] age, 51 [43-59] years; 13 [54%] female), several barriers, facilitators, and strategies emerged. Barriers included logistical (eg, lack of proximity, unavailable contact information, time constraints), psychosocial (eg, interpersonal discomfort, fear of retaliation, burnout), and structural factors (eg, fragmented systems, lack of incentives, leadership modeling, perceived conflict of interest). Facilitators that were associated with increased feedback or reporting included severe, egregious, fraudulent, or repetitive errors and preexisting relationships with the involved clinician. Most participants believed that IMED was inadequately addressed, with proposed strategies encompassing feedback training, standardized guidelines, interoperable medical records, oversight by national or state bodies, and intersystem safety reporting mechanisms. This qualitative study shows that the absence of standardized processes and resources hampers effective responses to IMED, such as feedback and reporting. While egregious errors or preexisting relationships may trigger action, opportunities exist to enhance clinical practice and policies across health systems.

Introduction Tracheostomy is a critical and common intervention for respiratory support. The complexity of cases requires vigilance, skilled personnel, and close interdisciplinary collaboration. Objective This study aims to highlight the complexity and interdisciplinary nature of tracheostomy care. By exploring healthcare professionals' perspectives on which specialties are most suitable for each stage of management, the study seeks to identify current clinical practices, uncover limitations, and suggest improvements in care delivery. Methodology The first part of the study involved a literature review, providing a scientific overview of the essential and multifaceted demands of tracheostomy care. In the second part, a quantitative approach was applied, utilizing a well-structured questionnaire to collect data from 101 healthcare professionals regarding their views on tracheostomy management. The research was conducted from September 1, 2023, to October 20, 2023, in public hospitals in Athens, Greece. The questionnaires were electronically distributed via Google Forms, and responses were analyzed using IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, NY, USA). Results The literature indicates that tracheostomy cases are encountered frequently in clinical practice and require complex, specialized, and multidisciplinary care. Despite their frequency and impact, there is a lack of standardized guidelines for their management, leading to inconsistent practices and preventable complications, often resulting in prolonged hospitalizations, Intensive Care Unit (ICU) readmissions, increased healthcare costs, and elevated morbidity and mortality rates. The questionnaire examined 20 key clinical actions across different care stages. Most participants identified the otolaryngologist as the most appropriate for half of these tasks, including tracheostomy placement, patient education, tube selection, cuff decisions, fistula management, hygiene, swallowing assessment, and cuff explanation. Nurses were associated with direct patient care - stoma management, suctioning, oral hygiene, and safe feeding practices. Speech therapists were linked to communication support and alternative communication training. Pulmonologists were assigned respiratory function oversight, dietitians, nutrition planning, and psychologists, emotional support. Research hypotheses were developed to explore differences in opinions based on demographic and professional variables, including gender, age, education, experience, specific training, and engagement with current practices. These findings emphasized both the importance of experience and the lack of standardized role definitions in tracheostomy care. Conclusions Tracheostomy management places a significant burden on healthcare systems due to its intensive and multifaceted demands. Effective resource and personnel management can reduce complications, enhance patient safety and the quality of care, and improve patient outcomes, while simultaneously contributing to the economic sustainability of the healthcare system. While the specialization of Otorhinolaryngology appears most suitable for many actions, there is a recognized need for other professionals for specific vital tasks. It is the responsibility of healthcare units to establish interdisciplinary teams with specialized knowledge, proper training, and clearly defined roles to ensure safe, efficient, and high-quality care delivery.

Service delivery of post-treatment surveillance in head and neck cancer (HNC) varies across institutions in Australia. To better understand current practices and develop protocols that maximize service capacity or incorporate emerging technologies, especially in under-resourced regional and remote communities, it is important to obtain the perspectives of clinicians that regularly manage patients with HNC. This cross-sectional study utilized an online survey distributed via email to specialists recruited from HNC-associated networks across Australia. The survey captured information on current practices and explored clinician perspectives towards re-designing the current surveillance model to incorporate telehealth or patient-reported outcome measures (PROMs). Quantitative data was analyzed using descriptive statistics while open-ended survey comments were analyzed using a content analysis approach. Forty participants completed the survey (25 surgeons, 9 medical oncologists, 5 radiation oncologists and 1 oral medicine specialist). Most clinicians used either institution-specific guidelines (44%) or National Comprehensive Cancer Network guidelines (39%), with the remaining 17% using surveillance intervals based on patient symptoms. Following treatment, 53% of participants imaged patients only when there was clinical suspicion of recurrence or new symptoms. Planned surveillance imaging was conducted at 6 or 12-monthly intervals based on the HNC subtype. Fifty-seven percent of clinicians were open to redesigning the surveillance model, specifically in low-risk patients who did not require nasoendoscopic examination. Seventy-one percent had concerns regarding the feasibility of telehealth appointments, citing disparities in digital health equity. Additionally, 61% felt PROMs are currently underutilized and were open to incorporating HNC-specific PROMS into surveillance. Open-ended responses indicated that within the current surveillance model, "fragmented service provision" and "administration issues" were significantly impacting on timing of care. Surveyed HNC clinicians feel that current post-treatment surveillance can be fragmented and potentially lead to delayed care. They are open to incorporating PROMS to assist in surveillance scheduling, especially in low-risk patients.

Patient expectations are a critical factor in determining cochlear implant (CI) candidacy. However, minimal data are available on how potential CI recipients develop their expectations and if expectations can be modified by providers. In addition, there is little insight into the resources patients use to inform their decision to undergo implantation. This project aims to assess (1) the role of the CI evaluation (CIE) process on patients' expectations, (2) the extent to which patients' pre-CI outcome expectations can be modified, (3) the information patients use to inform their expectations, and patients' preferences for the discussion/display of potential CI outcomes. Prospective mixed methods study of 32 adult CI patients undergoing CIEs. Outcome measures included: pre-CI Cochlear Implant Quality of Life-35 Profile scores (CIQOL-35 Profile); pre-CIE/post-CIE/day of surgery CIQOL-Expectations scores; post-CIE/day of surgery Decisional Conflict Scale (DCS) scores; and pre-CI aided CNC-word and AzBio sentence scores. Thematic analyses of key informant interviews with 19 potential CI recipients were also performed. In aim 1, CI CIQOL-Expectation domain scores remained essentially unchanged following the CIE when averaged across all participants ( d = 0.01 to 0.17). However, changes in expectations were observed for many participants at the individual level. Regarding the second aim, participants with higher pre-CIE expectations showed a decrease in expectations following the CIE for all CIQOL domains except emotional and social ( d = -0.27 to -0.77). In contrast, the only significant change in participants with lower expectations was an increase in expectations in the environment score from pre-CIE to the day of surgery ( d = 0.76). Expectations remained essentially unchanged or continued to change in the same direction between the post-CIE and the day of surgery, narrowing the gap between participants with higher and lower expectations. Overall, participants demonstrated low overall conflict related to their decision to proceed with cochlear implantation (mean DCS of 11.4 post-CIE and 14.2 at time of surgery out of 100) but DCS scores were higher for participants with lower pre-CIE expectations ( d = 0.71). In aim 3, key informant interviews demonstrated no differences between the low- and high expectation cohorts regarding resources used to develop their perception of CI outcomes. Potential CI recipients placed high value in talking with patients who had previously received a CI, and preferred discussing CI functional abilities via clinical vignettes described in the CIQOL Functional Staging System rather than by discussing speech recognition or CIQOL-35 Profile scores. The results of the present study suggest that, although overall expectations averaged across the cohort remained essentially unchanged, individual participants' pre-CI expectations can be modified and there is value in measuring these expectations using the CIQOL-Expectations tool to determine if they are realistic. This information can then be utilized during personalized counseling to present a more accurate representation of likely CI outcomes for each patient. Discussions between potential CI recipients and current CI users may also provide valuable information to inform their expectations. In addition, communicating potential CI benefits using CIQOL functional stages and associated clinical vignettes may result in more realistic patient expectations and support shared decision-making related to CI surgery.

ObjectiveTo provide a comprehensive overview of the current use of large language models in clinical medicine and surgery, with emphasis on model characteristics, clinical applications, and readiness for adoption.MethodsA scoping review of studies on the use of large language models in clinical medicine and surgery was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-scoping review and JBI methodology (protocol registration: 10.37766/inplasy2025.3.0102). A comprehensive search of EMBASE, PubMed, CINAHL, and IEEE Xplore identified 3313 articles published between 2018 and 2023. After screening of articles and full-text review, 156 studies were included. Data were extracted for study type, sample size, clinical specialty, model architecture, training methods, application purpose, and performance metrics. Descriptive analyses were performed.ResultsMost studies were proof-of-concept studies (55.8%) or clinical trials (21.2%), with a steady rise in publications since 2022. Large language models were most frequently used for data extraction (69.9%), followed by clinical recommendations (11.5%), report generation (9.0%), and patient-facing chatbots (7.1%). Proprietary models were used in 57.7% of the studies, whereas 39.7% used open-source models. ChatGPT-3.5, ChatGPT-4, and Bidirectional Encoder Representations from Transformers (BERT) were the most commonly reported models. Only 25.0% of the studies reported models as ready for clinical use, whereas 67.9% stated that the models required further validation. F-score (30.8%) and area under the curve (15.4%) were the most common performance metrics; 10.9% of the studies used expert opinion for validation.ConclusionsLarge language models are increasingly being used in clinical medicine. Although most applications focus on data extraction and summarization, emerging studies are beginning to explore higher-level tasks such as clinical decision-making and multidisciplinary simulation. Significant heterogeneity continues to exist in model architecture, evaluation methods, and reporting standards. Further standardization is needed to develop transparent evaluation frameworks and ensure safe, reliable integration of large language models into complex clinical workflows.

The use of online information and communication is globally increasing in the healthcare sector. In addition to known benefits in other medical fields, possible specific potentials of eHealth lie in the monitoring of oncological patients undergoing outpatient therapy. Specifically, the treatment with immune checkpoint inhibitors (ICI) requires intensive monitoring due to various possible negative side effects. The present study explores cancer patients' perspectives on eHealth and demonstrates how eHealth applications, from the patients' point of view, can contribute to further improving outpatient immunotherapy. Our multicenter study was executed at the university hospitals in Bonn and Aachen. A structured questionnaire was distributed to patients receiving outpatient immunotherapy. Contents addressed were (1) the patients' attitude towards eHealth applications, (2) the use of modern information and communications technologies (ICT) in (2a) everyday life and (2b) health-related information search including eHealth literacy, (3) the use of internet-enabled devices as well as (4) socio-demographic data. 164 patients were included in the study, of whom 39.0% were female and 61.0% male and the average age was 62.8 years. Overall, there was a high distribution of internet-enabled devices for everyday use and a great interest in integrating eHealth applications into outpatient immunotherapy. The assessment of eHealth potentials significantly depended on age. The younger participants demonstrated a broader use of modern ICT and a higher affinity for its use in outpatient immunotherapy. In some aspects, level of education and gender were also relevant factors influencing the patients' view on eHealth. This study demonstrates the potential for further integration of eHealth applications into outpatient immunotherapy from the patients' perspective. It indicates a dependency on age and educational level for the further integration of eHealth into patient care in oncology. Due to particular patient needs regarding age, level of education, gender and other subgroups, specific education and training as well as target-group specific digital health interventions are necessary to fully utilize the potentials of eHealth for outpatient immunotherapy. Future studies are required to specifically address target-group specific usability of eHealth applications and eHealth literacy, as well as to address information security and data protection.

Facelift surgery offers aesthetic results that nonsurgical methods cannot achieve. As an elective procedure, facelift surgery requires patients to have a clear understanding of potential postoperative complications and appropriate postoperative care. Nevertheless, timely access to medical care can be challenging in remote areas. Integrating advanced artificial intelligence (AI) tools such as ChatGPT-4 and Gemini into postoperative care may help bridge this gap by offering continuous patient education and support. This study aimed to evaluate the utility of ChatGPT-4 and Gemini in addressing common patient concerns and education following facelift surgery. The five most frequently asked postoperative facelift questions were submitted to ChatGPT-4 and Gemini. Responses were assessed by five expert facial plastic surgeons based on four criteria: accuracy, clarity, relevance, and response time. Both AI models demonstrated strong overall performance. ChatGPT-4 and Gemini each achieved an average accuracy of 88%, closely aligning with current medical guidelines. Clarity ratings were 80% for ChatGPT-4 and 92% for Gemini, indicating generally understandable responses. Relevance scores were high, with ChatGPT-4 at 100% and Gemini at 96%, effectively addressing patient concerns. Both models provided instant responses, earning 100% in response time. ChatGPT-4 and Gemini show promise as supportive tools in postoperative facelift care. They delivered responses that were accurate, clear, relevant, and timely. While not a replacement for medical professionals, both AI models can serve as valuable adjuncts to patient education, particularly where access to care is limited. These findings highlight AI's emerging role in enhancing postoperative care in facial plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

This study aims to explore the current landscape of mentorship within Canadian Otolaryngology-Head and Neck Surgery (OHNS) programs by investigating the experiences and perspectives of OHNS trainees and program directors (PDs). A cross-sectional survey study. Anonymized online questionnaires were sent to all residents and PDs of the 13 accredited OHNS residency programs across Canada. The questionnaires collected qualitative and quantitative information about the type of mentorship (formal vs informal) programs implemented, as well as individuals' experiences and opinions on mentorship. Of residents, 57.1% (92/161) completed the survey, whereas 84.6% (11/13) of PDs completed the survey. Of residents, 45.7% (42/92) participated in formal mentorship programs and 72.8% (67/92) participated in informal mentorship programs. The PDs perceived the importance of formal mentorship at 3.0/5. Residents reported greater satisfaction with informal mentorship relationships compared to formal mentorship (4.4/5 vs 3.7/5, P&#x2009;<&#x2009;.01) due to a more organic initiation of relationship and a better personality match. The main areas for improvement of current mentorship programs included the availability of mentors, networking opportunities, and protected time for encounters. Surgical residents found informal mentorship to be more beneficial than formal mentorship. However, residency programs should provide more guidance and structure to optimize hybrid mentorship opportunities and mentor selection/availability. Mentorship training or development resources for attending physicians and feedback opportunities are essential for efficient relationships.

ImportanceThe role of artificial intelligence (AI) within medicine has increased exponentially over the last decade. However, adoption across medical specialties remains variable, influenced by institutional support, availability of tools, and concerns about accuracy, privacy, and legal liability. Addressing these barriers is necessary to achieving the full clinical capacity of AI.ObjectivesThis study aimed to explore current AI usage patterns among pediatric otolaryngologists and highlight perceived benefits and barriers to adoption.DesignCross-sectional survey design.SettingAll aspects of the present study were conducted remotely, with the survey link being distributed within a private group chat.ParticipantsParticipants were recruited via an international pediatric otolaryngology WhatsApp group chat. Admission is through invitation only.Intervention or ExposuresThe survey sought to characterize a variety of themes regarding AI, including utilization patterns, attitudes, motivational factors and barriers to adoption, and extent of institutional support.Main Outcome MeasuresResponses were evaluated using chi-squared tests and descriptive statistics.ResultsSurvey responses were analyzed from 50 individuals, reflecting a response rate of 15.2%. More than half of survey respondents (60.9%, n&#x2009;=&#x2009;28/46) use AI in practice, relying on tools like ChatGPT, iScribe, and Gemini to improve workplace efficiency (71.4%, n&#x2009;=&#x2009;20/28) and address administrative burdens (64.2%, n&#x2009;=&#x2009;18/28). Despite current adoption of AI, participants identified a lack of institutional guidelines (66.7%, n&#x2009;=&#x2009;30/45) and support (54.3%, n&#x2009;=&#x2009;25/47) as major barriers to widespread integration across the subspecialty. No statistically-significant association was found between age and likelihood of AI adoption (P&#x2009;=&#x2009;.095) nor was between geographic region and likelihood of AI adoption (P&#x2009;=&#x2009;.505).ConclusionsPediatric otolaryngologists are interested in and enthusiastic about AI tools. This study highlights prominent institutional and educational gaps, limiting widespread integration.RelevanceThe findings guide future efforts to support AI adoption in pediatric otolaryngology through tailored training, policy, and institutional support.

The incidence of human papillomavirus (HPV)-related oropharyngeal cancers has increased such that they are now the most prevalent HPV-related cancer. In 2020, the Food and Drug Administration (FDA) expanded the indication for Gardasil-9 to include the prevention of oropharyngeal and other head and neck cancers caused by selected HPV types, but uptake remains low. Otolaryngology office interactions may provide opportunities to increase uptake, given the relevance of HPV to clinical practice. This study explored the feasibility of recommending HPV vaccination in otolaryngology clinics. Participants were recruited between February to June of 2022 from the alumni of the residency and fellowship training programs at the University of Iowa Hospitals and Clinics. Participant interviews comprised open-ended questions pertaining to otolaryngologists' attitudes toward HPV vaccination recommendation. Interview recordings were transcribed, coded, and analyzed for themes. Participants were willing to respond if patients asked about the HPV vaccine, although a common attitude toward vaccine discussions was that they were a pediatrician's responsibility. One barrier to recommending HPV vaccination was providers' concern that discussing the vaccine when not directly relevant to the patient's chief complaint could result in patient frustration. Nevertheless, participants endorsed the feasibility of discussing the vaccine during follow-up visits after the patient's needs had been addressed or via the distribution of educational materials to patients. Otolaryngologists do not currently identify recommending HPV vaccine uptake as their clinical responsibility. While such recommendations may not be feasible in every patient encounter, there could be a role for this in the appropriate clinical scenario. These findings can be used to inform interventions aimed at recommending the vaccine in otolaryngology clinics.

To determine the impact of changes in physician behavior on patient experience scores in a tertiary care Otolaryngology practice. Prospective Cohort study. In this prospective trial examining change in patient experience scores before and after 3 specific changes in physician behavior all faculty underwent intensive patient experience training with the System Medical Director of Patient Experience. Closing the clinic room door and indicating this is being done for patient privacy, sitting down during the encounter, and using one of several scripted empathetic phrases were the selected behavioral interventions. Pre-training and post-training patient experience scores were collated. Physicians and their mid-level providers were asked how often they or their supervising physician perform the 3 behaviors before and after the training session. Additional collected variables include physician demographics, presence/absence of a learner, presence/absence of midlevel provider, and type of visit. Eight faculty participated. Prior to the training session, the physicians reported closing the door, sitting down, and using an empathic phrase in 87.5%, 59.4, and 44.4% of clinic visits respectively. There was a significant correlation between door closure rate and patients reporting that concerns were addressed (r&#xa0;=&#xa0;0.81). There was a significant correlation between the rate of empathetic phrase usage and the likelihood to recommend the physician (r&#xa0;=&#xa0;0.92). The patient experience is increasingly important in healthcare as a measure of the quality and as a means of determining compensation. In the current climate, we as physicians must make changes in behavior to improve the patient experience in the outpatient setting.

Head and neck squamous cell carcinoma (HNSCC) remains a treatment challenge, with frequent recurrences following localized disease and guarded outcomes in recurrent/metastatic (R/M) settings. While cytotoxic therapy and immune checkpoint inhibitors (ICIs) have produced incremental survival benefits, many patients still exhibit limited response or acquire resistance to treatment, highlighting a critical need for more personalized and novel therapeutic strategies. This review discusses personalized therapy approaches in HNSCC from 2020 to 2025, focusing on immune checkpoint blockade and newer therapeutic modalities. Additionally, this review highlights key biomarkers that are currently being evaluated for predictive and prognostic value in HNSCC. The literature was sourced through PubMed, Google Scholar, and conference abstracts from ASCO, ESMO, and AACR, covering publications from January 2020-June 2025, with a focus on peer-reviewed trials and translational studies in human subjects. The future of HNSCC treatment lies in the development of novel treatment combinations integrating immunotherapy using immune checkpoint blockade with newer therapeutic approaches. Understanding which agents to use, and when in the course of treatment, stands as a challenge that will shape the future of precision therapy for HNSCC, with integration of biomarkers promising to guide this transition.

Head and neck cancer (HNC), primarily head and neck squamous cell carcinomas, originates from the squamous epithelium in areas like the oral cavity, lip, larynx, and oropharynx. With high morbidity impacting critical functions, combined treatments like surgery, radiation, and chemotherapy often fall short in advanced stages, highlighting the need for innovative therapies. This review critically evaluates interleukin (IL) gene therapy for treating HNC. The discussion extends to key ILs in HNC, various gene therapy techniques and delivery methods. We particularly focus on the application of IL-2, IL-12, and IL-24 gene therapies, examining their mechanisms and outcomes in preclinical studies and clinical trials. The final sections address IL gene therapy challenges in HNC, exploring solutions and critically assessing future therapeutic directions. Despite advancements in genomic and immunotherapy, significant challenges in HNC treatment persist, primarily due to the immunosuppressive nature of the tumor microenvironment and the adverse effects of current therapies. The therapeutic efficacy of IL gene therapy hinges on overcoming these hurdles through refined delivery methods that ensure targeted, tumor-specific gene expression. Future strategies should focus on refining gene delivery methods and combining IL gene therapy with other treatments to optimize efficacy and minimize toxicity.

The HIT-CRAD trial (ISRCTN57028065) is the first to combine home-based non-invasive brain stimulation with high-volume strength and skill training over 8&#x2009;weeks in patients with chronic radiation-associated dysphagia (CRAD) following primary (chemo)radiotherapy for head and neck cancer. Fifty-four patients were randomized into three groups. Group 1 performed 8&#x2009;weeks of strength training. Groups 2 and 3 combined 4&#x2009;weeks of strength training with 4&#x2009;weeks of skill training. Group 3 received high-definition transcranial direct current stimulation (HD-tDCS) during training. Group 2 received sham HD-tDCS. Overall adherence and exercise adherence remained above 75% across all groups. Home-based HD-tDCS proved safe and feasible, with mild to moderate side effects (tingling, itching, or burning). Median exercise performance levels for strength training exercises ranged from 94% to 100%. This study confirms the feasibility of high-volume strength and skill training with HD-tDCS in patients with C-RAD. Proactive adherence-supporting factors facilitate high adherence in this population. Both real and sham HD-tDCS proved safe, feasible, and well tolerated. International Standard Randomized Controlled Trials Number (ISRCTN) registry ID ISRCTN57028065.

Physician and trainee experiences with hijab wear in the operating room and associated challenges impact wellness in the workplace. To evaluate physician and trainee experiences with hijab wear and associated barriers in the operating room, and to devise a suitable alternative to current coverage options. A survey-based, cross-sectional analysis of female physicians and trainees who observe hijab in the operating room in the US was performed using convenient-sampling methods. Inclusion criteria included Muslim women who wear hijab and are currently practicing in an operating room setting, a resident or fellow in a surgical specialty, or a medical student. Seventy-five survey respondents, 45 physicians and 30 medical students, were included. A majority of physicians reported an academic clinical practice setting (66.7%) and hospital-based operating room setting (60.0%). Overall, 33.3% of physicians and 26.7% of medical students remove their hijab for the operating room. Bouffant caps were most frequently worn (62.2% of physicians and 53.3% of medical students) in place of or over their hijab. More than half of respondents are unsatisfied with their current amount of hair, neck, and arm coverage in the operating room. The majority of comments made about hijab wear in the surgical setting pertained to the sterility of the hijab. This study highlighted challenges faced by female physicians and medical students who observe hijab in the operating room. We introduce a novel, facility-laundered hijab for sterile areas in healthcare facilities to increase workplace satisfaction and inclusivity while maintaining patient safety.

The Otology Questionnaire Amsterdam (OQUA) is developed to evaluate multiple ear complaints and their impact on patients' daily lives. The current clinical use of this questionnaire is below the potential utilization. To identify the barriers and enablers of using the OQUA as perceived by ENT surgeons and patients and provide recommendations for an implementation strategy. Prospective and qualitative analysis was performed using focus groups and interviews with ENT professionals (n&#x2009;=&#x2009;15) and patients (n&#x2009;=&#x2009;25) with ear complaints of one tertiary referral hospital and two regional hospitals. Barriers and enablers were identified and classified by using the Capability-Opportunity-Motivation-Behavior model and the Theoretical Domains Framework. Suggestions for an implementation strategy will be made accordingly. ENT professionals' barriers included lack of knowledge and skills to use the OQUA, inadequate technological support and perceived time constraints during consultation, uncertainty about the clinical relevance and lack of feedback on the outcomes of the OQUA. Enablers included beneficial consequences of the OQUA for the professional, organization and science. Patients' barriers included lack of knowledge about the objective and usefulness of the OQUA, perceived burden, difficulties in completing the questionnaire and insufficient feedback during consultation. Patient enablers included beliefs about beneficial consequences of the OQUA for the patient, health care and society. Suggested interventions involved education, training, environmental restructuring and incentivisation. Based on the findings, we propose an implementation strategy should focus on education and training about the objective, outcomes and relevance of the OQUA, environmental restructuring regarding the optimal use of the OQUA, and incentivisation with feedback on the valuable outcomes of the OQUA for the patient, professional and healthcare. Future research is needed to determine the feasibility of the implementation strategy.

Segmental resections of the mandible may cause severe functional and aesthetic problems due to continuity loss. The morbidity after mandibular resection can be minimized after microvascular transfer of vascularized bone grafts. Although free flaps have become the gold standard in the past decades for reconstruction of oral cavity defects, regional flaps can also be a reliable option in certain cases, especially for those belonging to the lower socioeconomic corridor and or with coexisting chronic comorbidities which will not allow lengthier procedures. (Milenovi&#x107; A, Virag M, Ugle&#x161;i&#x107; V, Aljinovi&#x107;-Ratkovi&#x107; N (2006) The pectoralis major flap in head and neck reconstruction: first 500 patients. J Cranio-Maxillofacial Surg 34(6):340-343); (Sabri A (2003) Oropharyngeal reconstruction: current state of the art. Current opinion in otolaryngology & head and neck surgery. 11(4):251-254); (Porcuna DV, Vintr&#xf3; XL, Vilas ML, Olmo AP, Ayala JM, Agust&#xed; MQ (2008) Pectoralis major flaps. Evolution of their use in the age of microvascularized flaps. Acta Otorrinolaringologica (English Edition) 59(6):263-268) There are a very few reports of early oral cancers being reconstructed by PMMC flap. In this article, however, we have exclusively reviewed 247 cases of early oral cancer requiring marginal mandibulectomy and their reconstruction with PMMC flap thus justifying the name, the "workhorse flap" even in early oral cancers. This is a retrospective analysis of 5-year patient data collected from our institutional data register of 247 patients undergoing marginal mandibulectomy and reconstruction with PMMC flap between April 2017 to June 2022. No flap loss was reported. No cases were re-explored either for hematoma or for congestion. All patients recovered uneventfully. Although, in this era, free flaps dominate in the soft tissue reconstruction and PMMC is used only in certain advanced oral cancers, our study proves that it can be used safely in effectively in early oral cancer patients as well. Being a quicker procedure, PMMC flap reconstruction should be considered as a valid alternative in early oral cancers requiring marginal mandibulectomy, to overcome the increasing oral malignancy patient load belonging to low socioeconomic regions. To the best of our knowledge, this is the largest data ever published.

Influenza is a serious underestimated viral infection in Pakistan and influenza vaccination and vaccination awareness are low. The current work aimed to develop consensus on influenza epidemiology, prevention, vaccination, and awareness in Pakistan. A systematic literature search was conducted to develop recommendations on influenza vaccines in Pakistan. Experts' feedback was incorporated using the modified Delphi method. A three-step process was used, with 18 experts from different specialties from Pakistan who participated in voting rounds to achieve a minimum 75% agreement level. Pakistan has a low-immunization-rate and is susceptible to serious influenza outbreaks and influenza-related complications. Influenza circulates year-round in Pakistan but peaks during January and February. The subtype A/H1N1 is predominant. The experts urged vaccination in all individuals &#x2265; 6 months of age and with no contraindications. They highlighted special considerations for those with comorbidities and specific conditions. The experts agreed that the inactivated influenza vaccine is safe and efficient in pregnant women, immunocompromised, and comorbid respiratory and cardiovascular patients. Finally, the experts recommended conducting promotional and educational programs to raise awareness on influenza and vaccination. This is the first regional consensus on influenza and influenza vaccination in Pakistan with experts' recommendations to increase influenza vaccination and decrease influenza cases and its associated detrimental effects.