A thorough histological revision is pivotal in retrospective parotid carcinoma studies, and tumor size; histological appearance; T, N, and M status; stage; facial nerve dysfunction; and pain from the face and/or neck seem to be significant prognostic indicators for patients with primary parotid carcinoma.
Background: The Voice Handicap Index 30 (VHI-30) is a much-used voice specific quality of life questionnaire. A shortened ten item version has been developed by eliminating redundant items using item analyses. This is the first Danish translation of the Voice Handicap Index 10 (VHI-10). Objectives: To evaluate the psychometric properties of the Danish VHI-10 questionnaire. Study design: Cross-sectional survey study. Methods: A Danish translation of the VHI-10 was answered by 72 patients with voice disorders of different etiology (neurogenic, functional, and structural) and by a control group of 94 vocally healthy individuals. Thirty-two patients and 68 controls participated in a test-retest reliability analysis. The internal consistency, test-retest reliability, and clinical validity were assessed. Results: Excellent internal consistency was found in the patient group with a Cronbach's α of >0.90. In the control group the internal consistency was good with a Cronbach's α of 0.88. Testretest reliability was good with intra class correlation coefficient of 0.94 (95% confidence interval [95%CI]: 0.88-0.97) for patients and 0.82 (95%CI: 0.73-0.89) for the control group. This indicates a sufficient reliability of the questionnaire. The correlation between the Danish VHI-10 score and the patient's perception of the severity of the voice disorder was 0.75 (p<0.001) indicating good clinical validity of the Danish VHI-10. Conclusion: The newly translated Danish VHI-10 was validated and performs similar to the original VHI-10. It showed good internal consistency, test-retest reliability, and clinical validity. The questionnaire is preferably for use in patients with moderate to severe voice complaints as its ability to distinguish mild voice changes from healthy voices is limited. However, the questionnaire is capable of assessing patients' perception of the severity of their voice disorder and is available for use in daily practice and in research projects.
Objective Vocal cord paralysis (VCP) may be caused by a primary malignancy and associated immune cross‐reactivity. We aimed to illuminate underlying causes of VCP and to assess if onconeural antibodies occur in association to VCP as an early predictor of cancer. Methods A prospective study was performed in patients with newly diagnosed VCP from 2014 to 2016. All patients underwent fiberoptic laryngoscopy, ultrasound of the neck and computed tomography (CT) of the neck and thorax. Patients with idiopathic VCP underwent neurological examination, positron emission tomography/CT, and serum analysis for onconeural antibodies. All patients were offered a one‐year clinical follow‐up. Results In total 53 patients fulfilled the inclusion criteria. Left VCP occurred in 37 (70%), right in 15 (28%), and bilateral in one patient (2%). The cause of VCP was cancer in 27 (51%) patients, of those 15 (56%) had VCP as the primary symptom, including all cases with laryngeal and esophageal cancer. Median time interval between VCP and cancer was 7 days (range 1–30). In 12 (23%) VCP was a secondary symptom. Lung cancer was the most common etiology, 14 of 27 (52%), 12 patients (86%) with non‐small cell lung cancer. Idiopathic VCP was diagnosed in 18 (34%) patients, of those nine patients had a neurological examination and were screened for well‐known onconeural antibodies, which were not detected. Reactions against Purkinje cell nuclei were seen in three patients, none showed symptoms or signs of cancer at follow‐up. Conclusions The causes of VCP were described. VCP was frequently the primary symptom, and also occurred as a secondary symptom of cancer. Exclusion of malignancy is important in patients with VCP. Level of Evidence 1b
The topic of sepsis has been realized among the last 20 years. A majority of patients with sepsis enter the health system through the emergency department, and health professionals need to provide evidence-based care. Within the health system, interdepartmental teams were formed with the purpose to set a system-wide standard to meet the evidence-based practice standards for sepsis. Participants were recruited from every department that was involved with the care delivery of emergency department patients with sepsis. The team developed a team charter to state the group objectives. A gap analysis was completed to set group priorities. The first priority was to develop a system-wide sepsis alert process. The Operational Excellence coach conducted direct observations and interviews at each system facility and then a sepsis alert plan was developed. Two hospitals volunteered to pilot the sepsis alert within their emergency departments, and education was completed at each hospital. Informatics nurses developed electronic medical record workflow and outcome elements to help the team with the process. The pilot process showed an increase in compliance for core measures and laid the groundwork for each hospital to develop an individualized process.
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