Alternative and non-opioid options for pain management are necessary in perioperative patient care. Opioids are no longer touted as cure-all medications, and furthermore, there have been tremendous advances in alternative therapies such as in interventional pain, physical therapy, exercise, and nutritional counseling that have proven benefits to combat pain. The center for disease control now strongly recommends the use of multimodal analgesia and multidisciplinary approaches based on the individual needs of patients: personalized medicine. In this manuscript, the specifics of non-opioid pharmacological and non-pharmacological analgesic approaches will be discussed as well as their possible indications and uses to reduce the need for excessive use of opioids for adequate pain control.
Objective: To evaluate the association between patient socioeconomic and demographic factors and tertiary care utilization for dysphonia in a localized metropolitan area of the American Midwest.Methods: Multivariate regression analysis was used to correlate patient demographics and population level data (e.g., age, gender, race, insurance, median income, education level) with tertiary laryngology utilization for dysphonia care at our institution between 2000 and 2019. Initial analyses characterized tertiary laryngology utilization rates for all regional ZIP codes and correlated these data with census information for household income and education. Dysphonia patient demographics were compared among populations cared for in our entire academic Otolaryngology department, our health system, and the regional population.Results: Among 1,365,021 patients in our health system, there were 7066 tertiary laryngology visits with a diagnosis of dysphonia. Dysphonia patients as compared to the overall health system were older (62.0 vs. 50.8 years), more likely to be female (63.7 vs. 50.2%) and more likely to have insurance (98.4 vs. 87.5%, all p < .001).Patient and population-level factors including insurance status, education, and black race showed positive correlation with laryngology utilization while median income did not.
Conclusions and Relevance:Insurance status, education level, and race correlated with utilization of tertiary laryngology services for the evaluation of dysphonia in our community, while median income did not. Black patients utilized tertiary laryngology care at higher rates compared to departmental and regional population utilization data. These results underscore important demographic and disease-specific factors that may affect utilization of subspecialty care in Otolaryngology.
lymphangiography, identification of the liver lymphatic abnormalities, volume of injected contrast, fluoroscopy time, and complications were recorded. Results: The indications for liver lymphangiography included refractory chylous effusion (6 patients), refractory ascites in patients with heart failure and liver cirrhosis (6), protein losing enteropathy (4), refractory chylothorax (1), and refractory plastic bronchitis (1). Technical success rate was 16/18 (89%). Lymphangiography identified abnormal findings in 16/25 (64%) procedures. All patient's liver lymphangiograms demonstrated an abnormal connection to either the duodenum or mesentery. Mean fluoroscopy time was 49.9 minutes (8-98.6 minutes). Mean lipiodol volume was 6.4 mL (1.5-15 mL). In 17 patients, postprocedural liver function testing (LFTs) was available. Four procedures resulted in a Grade 1 transaminitis, 4 procedures resulted in a Grade 2 transaminitis, and 4 procedures resulted in a Grade 3 transaminitis. All patients remained clinically asymptomatic, and LFTs returned to baseline values within several weeks of the procedure (SIR complication classification 1a). Conclusions: Liver lymphangiography with embolization is a technically feasible and safe procedure that provides important diagnostic information and guidance for interventional therapy.
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