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Background During the initial months of the COVID-19 pandemic, rapidly rising disease prevalence in the United States created a demand for patient-facing information exchanges that addressed questions and concerns about the disease. One approach to managing increased patient volumes during a pandemic involves the implementation of telephone-based triage systems. During a pandemic, telephone triage hotlines can be employed in innovative ways to conserve medical resources and offer useful population-level data about disease symptomatology and risk factor profiles. Objective The aim of this study is to describe and evaluate the COVID-19 telephone triage hotline used by a large academic medical center in the midwestern United States. Methods Michigan Medicine established a telephone hotline to triage inbound patient calls related to COVID-19. For calls received between March 24, 2020, and May 5, 2020, we described total call volume, data reported by callers including COVID-19 risk factors and symptomatology, and distribution of callers to triage algorithm endpoints. We also described symptomatology reported by callers who were directed to the institutional patient portal (online medical visit questionnaire). Results A total of 3929 calls (average 91 calls per day) were received by the call center during the study period. The maximum total number of daily calls peaked at 211 on March 24, 2020. Call volumes were the highest from 6 AM to 11 AM and during evening hours. Callers were most often directed to the online patient portal (1654/3929, 42%), nursing hotlines (1338/3929, 34%), or employee health services (709/3929, 18%). Cough (126/370 of callers, 34%), shortness of breath (101/370, 27%), upper respiratory infection (28/111, 25%), and fever (89/370, 24%) were the most commonly reported symptoms. Immunocompromised state (23/370, 6%) and age >65 years (18/370, 5%) were the most commonly reported risk factors. Conclusions The triage algorithm successfully diverted low-risk patients to suitable algorithm endpoints, while directing high-risk patients onward for immediate assessment. Data collected from hotline calls also enhanced knowledge of symptoms and risk factors that typified community members, demonstrating that pandemic hotlines can aid in the clinical characterization of novel diseases.

Microvascular free tissue transfer has revolutionized reconstruction and subsequently functional outcomes in the head and neck, but requires suitable recipient vessels for successful results. Recipient vessels can be significantly compromised by prior surgery, radiation therapy, or existing and/or underlying vascular disease in the neck. When further microvascular reconstruction is required in the vessel-depleted neck, identification of appropriate vessels for anastomosis can be difficult and can present complex decisions for the surgeon as well as the patient. In this article, we review the available literature on the vessel depleted neck (VDN) and the possible vessel options. We present critical strategies for preoperative treatment planning and vessel selection in these patients. We also discuss the benefits and limitations of arterial and venous options while commenting on our unique institution's experiences. The external carotid branches as well as the available subclavian artery branches are presented in detail. The venous anatomy is also described, with particular focus on the accompanying veins and cephalic vein. We provide guidance on the selection and modification of free flaps to achieve the greatest function and cosmetic outcomes in the VDN. Our collection of advanced management techniques will provide surgeons with more options to manage the complexity of the VDN, and to further help patients understand the risk and benefits of these selections.

nequities affecting underserved racial and ethnic groups continue to be identified across the spectrum of medical research. [1][2][3][4] From the disproportionate number of Black and Hispanic persons who have been hospitalized or died because of COVID-19 in 2020 [5][6][7][8] to discrimination against Asian American persons 9 and the comparatively poor perioperative outcomes even among low-risk racial and ethnic minority patients, 10,11 attentiveness to race and ethnicity has illuminated inequities and disparities throughout our health care systems. Recognition of health disparities through research has led to recent significant victories, such as the Henrietta Lacks Enhancing Cancer Research Act of 2019, 12 which became public law in January 2021, requiring officials to examine barriers to government-funded clinical trials for traditionally underrepresented groups. Unfortunately, race and ethnicity continue to be infrequently reported in the medical literature to describe study participants, and when race is described, the quality of the reporting is variable. [1][2][3][4][13][14][15][16] In 1978 (updated in 2019), the International Committee of Medical Journal Editors (ICMJE) developed recommendations for uniformity in manuscript submissions and promoting increased frequency and quality reporting of race. Current recommendations are that "[a]uthors should define how they determined race or ethnicity and justify their relevance," 17 and that a study "should aim for inclusion of representative populations into all study types and at a minimum provide descriptive data for these and other relevant demographic variables." [17][18][19] Despite these recommendations, studies examining the reporting of race continue to show infrequent use of race to desc ribe study partic ipants in sc ientific publications. [13][14][15][16] A 2020 article by Moore 14 revealed that in the ophthalmology literature, most articles (88%) reported baseline demographic information on study participants; however, only 43% of articles included data on race and ethnicity, and an even smaller fraction described how the information was determined. IMPORTANCEThe reporting of race provides transparency to the representativeness of data and helps inform health care disparities. The International Committee of Medical Journal Editors (ICMJE) developed recommendations to promote quality reporting of race; however, the frequency of reporting continues to be low among most medical journals.OBJECTIVE To assess the frequency as well as quality of race reporting among publications from high-ranking broad-focused surgical research journals. DESIGN, SETTING, AND PARTICIPANTSA literature review and bibliometric analysis was performed examining all human-based primary research articles

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Hypothesis: Moringa extract, a naturally occurring antioxidant, protects against aminoglycoside-induced hair cell death and hearing loss within the organ of Corti. Background: Reactive oxygen species (ROS) arise primarily in the mitochondria and have been implicated in aminoglycoside-induced ototoxicity. Mitochondrial dysfunction results in loss of membrane potential, release of caspases, and cell apoptosis. Moringa extract has not previously been examined as a protective agent for aminoglycoside-induced ototoxicity. Methods: Putative otoprotective effects of moringa extract were investigated in an organotypic model using murine organ of Corti explants subjected to gentamicin-induced ototoxicity. Assays evaluated hair cell loss, cytochrome oxidase expression, mitochondrial membrane potential integrity, and caspase activity.

BACKGROUND Spine stereotactic body radiotherapy (sSBRT) is commonly limited to 1 or 2 vertebral levels given a paucity of efficacy and toxicity data when more than 2 levels are treated. OBJECTIVE To prove our hypothesis that multilevel sSBRT could provide similar rates of local control (LC) (primary endpoint) and toxicity as single-level treatment using the same clinical target, planning target, and planning organ-at-risk volumes. METHODS We analyzed consecutive cases of sSBRT treated from 2013 to 2017. Time-to-event outcomes for single-level and multilevel cases were compared using mixed effect Cox models and differences in toxicity rates were evaluated using linear mixed effect models. All models incorporate a patient-level random intercept to account for any within-patient correlation across cases. RESULTS There were 101 single-level and 84 multilevel sSBRT cases (2-7 continuous vertebral levels). One-year LC was 95% vs 85%, respectively. After adjusting for baseline covariates, dose delivered, and accounting for within-patient correlation, there was no significant difference in time to local failure (hazard ratio, HR 1.79 [0.59-5.4]; P = .30). Pain improved in 83.5% of the 139 initially symptomatic tumors. There were no significant differences in grade 2+ acute or late toxicities between single-level and multilevel sSBRT. CONCLUSION With rigorous patient immobilization, quality assurance, and image guidance, multilevel sSBRT provides high rates of LC, similar to single-level treatment, without need for larger planning volume margins. Efforts to improve prognostication and case selection for multilevel sSBRT are warranted to ensure that the benefits of improved LC over palliative radiation are justified.

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