Patients who survive an episode of necrotizing fasciitis are at continued risk for premature death; many of these deaths were due to infectious causes such as pneumonia, cholecystitis, urinary tract infections, and sepsis. These patients should be counseled, followed, and immunized to minimize chances of death. Modification of other risk factors for death such as obesity, diabetes, smoking, and atherosclerotic disease should also be undertaken. The sex difference in long-term survival is intriguing and needs to be addressed in further studies.

Background This study is an evaluation of survival in patients with upper aerodigestive tract (UADT) cancer who did not receive guideline-directed therapy. Methods The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database was examined to identify patients with invasive cancer of the UADT. Patients were classified as “untreated” if they received neither surgery nor radiotherapy. Kaplan-Meier observed survival estimates were computed and stage-specific actuarial estimates of relative survival were computed. Results Of 3589 untreated patients, 13.7% were black, compared to 9.5% white, and 9.2% all other races (p < 0.0001). Patients with Stage IV disease were more likely to be untreated than those with Stage I disease (11.9% vs 3.8%, p < 0.0001). Median survival was 39 months for treated patients and 4 months for untreated patients. Conclusion The median survival for untreated patients was 4 months. Stage, race, and primary site were independently associated with untreated status.

Background Survivorship is a critical part of head and neck cancer (HNC) care. In order to design better processes, we assessed care provided to long‐term HNC survivors and their priorities for ongoing care. Methods A survey was provided to HNC survivors at clinic appointments, including our HNC survivorship clinic. Questions focused on priorities for care in the otolaryngology clinic, types of care provided, and opioid use. Results Of 168 respondents, the most common priority for survivors was surveillance for recurrence (first priority in 75%), with general health the next most common (8%). Few respondents reported active primary care involvement in survivorship. About 10% of patients reported current opioid use. Conclusion Survivors face a large burden of symptoms and deficits, but our data show that most survivors focus on recurrence. Few survivors reported recall of survivorship care plan delivery or discussing cancer care needs with primary care providers.

Objective-The role of autopsy in evaluating missed injury after traumatic death is well established and discussed in the literature. The frequency of incidental findings in trauma patients has not been reported. We believe that incidental findings are under recognized and reported by trauma surgeons.Design-Prospective, descriptive, cohort study.Setting-Level 1 trauma center in a rural state.Patients-Four hundred ninety-six deaths over a 4-year period were identified from the trauma registry. Two hundred four complete autopsies were available for review.Interventions-One thousand eighteen traumatic diagnoses were identified from two hundred four autopsies and corresponding medical records by trauma surgeons blinded to patient identity. The surgeons recorded missed diagnoses, incidental diagnoses identified at autopsy, and diagnoses known at the time of death confirmed by autopsy.Measurements and Main Results-The surgeons had a kappa score of 0.82-0.84. Forty-two patients (21% of patients) had 68 severe missed injuries; sixty-seven patients (33% of patients) had 94 minor missed injuries. Twenty-eight patients (14%) had significant incidental findings including premature atherosclerosis, multiple endocrine neoplasia, tuberculosis, and others.Conclusions-The autopsy after traumatic death is more than a mechanism of quality control and teaching. A high proportion of patients will have incidental findings important to family members and have of public health importance. Systems need to be developed to review autopsy results with attention to identifying and communicating incidental findings. Given the incidence of significant missed injuries and incidental findings, the autopsy continues to have an important role in health care.

No abstract

Background: Oral disease is highly prevalent in persons receiving palliative care (PRPC). Yet, little is known about how PRPC perceive their oral health status and related treatment needs. Methods: This mixed-method study included 49 English-speaking PRPC (age≥18) recruited from the University of Iowa Palliative Care Clinic. Participants first completed a structured review of oral symptoms, followed by an oral exam. A nested sample of 11 participants also completed a semi-structured, in-depth interview querying their perceived oral health concerns and related treatment needs. Quantitative and qualitative data was analyzed and integrated for interpretation. Results: Participants averaged 58.4 years. Nearly 70% had terminal cancer and 25% had advanced organ failure. Eighty-six percent of participants reported at least one oral symptom, including dry mouth (83.7%), a pain-related symptom (40.8%), or oral function difficulties (51.0%). Among the 31 dentate participants, 52% had untreated decayed/broken teeth and 33.3% had oral soft tissue lesions. Ill-fitting dentures and denture sores were common among denture users. About 40% of participants reported compromised health and/or quality of life due to oral conditions; however, the perceived impacts were modest. With the exception of painful conditions, oral treatment was not a priority for most of the participants. Conclusion: Oral disease was highly prevalent in PRPC, yet its overall impact was modest. In the absence of painful symptoms, most participants reported limited desire to seek treatment for oral health conditions. However, given the serious impacts of untreated oral diseases, oral healthcare decision should not be based solely on self-reported symptoms or distress.

No abstract

We sought to determine if small plastinated specimens would be sufficient to replace traditional dissection/prosection methods. A small group of pre‐M1 students (n=26) participated in labs and learned from dissection (D), or plastinated prosections (PP) of body regions/organs. Students who learned the heart from PP performed slightly better on the final identification exam than those who dissected the heart (67.0±6.2 PP vs. 60.3±8.6 D). The exam consisted of tags on both PP and non‐plastinated (NP) hearts. The difference between the groups was due to higher scores from PP students on NP heart tags (70.0±7.2 PP vs. 54.8±8.3 NP). Both groups performed equally on PP heart tags. Other control regions where both groups used the same learning modality had identical scores between groups. To assess differences in learning from PP vs. NP prosections, groups studied the axilla from PP or NP prosections. Students using PP slightly outperformed those learning from traditional NP prosections (51.1±7.9 PP vs. 43.0±6.8 NP). Interestingly, when asked to rank usefulness of the modalities (1–5 Likert scale), students ranked PP significantly lower than D or NP (3.36±0.4 PP vs. 4.36±0.2 NP and 4.46±0.4 D, p<0.05). Reasons ranged from physical properties of the stiffer plastinates to changes in engagement level. These data support use of PP in the medical‐level anatomy curriculum, but student response data indicate limitations.Grant Funding Source: University of Iowa OCRME