- Email: [email protected]
A Cross-Sectional Study Evaluating a Facial Palsy Protocol
P141
POSTER PRESENTATIONS
A Cross-Sectional Study Evaluating a Facial Palsy Protocol Ajith George, MBChB, MRCS, DO-HNS (presenter); Emma McFarlane; Churunal Hari OBJECTIVE: 1) Evaluate whether a facial palsy protocol improves the clinical management of facial palsy. 2) Assess the efficacy of the House-Brackmann (HB) scale in prescribing eye care for patients. METHOD: A cross-sectional study of patients presenting with facial palsy was performed in a UK Otolaryngology out-patient department from January 2008 to December 2009. A specific Facial palsy management protocol was followed, developed from outcome assessment data in a previous 20052006 analysis. Documentation of diagnosis, side of palsy, trauma, upper or lower motor neuron lesion, cranial nerve examination, parotid and neck examination, otoscopy, audiology, examination of the oral cavity, HB grade and treatment with eye care, acyclovir and/or prednisolone were recorded, analyzed and compared to previous data. RESULTS: Ninety-four case notes were included with a mean age of 43.56 yrs (range 2-86) and 44/50 male to female ratio. The patients mean delays to initiating treatment and assessment in secondary care were 2.51 and 5.15 days respectively. Following the protocol introduction there was an improvement in documentation of assessment in facial palsy, particularly neck examination 6% to 57.4% and HB documentation from 61% to 83%. Patients diagnosed with a palsy of grade IV or above were 19 times more likely to receive eye care (2 ⫽ 18.056, p ⬎ 0.025) than those with grade III or less. CONCLUSION: The departmental facial palsy protocol for junior inexperienced doctors improves management. Ensuring documentation of the HB scale significantly improves eye care prescription. A Prognostic Multigene Classifier for Larynx Carcinoma Ulrich Pfeffer (presenter); Massimo Dellepiane, MD; Valentina Mirisola; Alessia Esposito; Luca Guastini, MD OBJECTIVE: Improved prognostic classification of laryngeal carcinomas could help to select patients for conservative therapy or radical surgery thereby increasing the disease specific survival while preserving function wherever possible. We therefore developed a microarray based molecular classifier specific for larynx tumors. METHOD: We analyzed the gene expression profiles by means of hybridization to Affymetrix HuGene 1.0 microarrays Otolaryngology-Head and Neck Surgery
of 20 laryngeal squamous cell carcinoma (stages III and IV) of male patients aged 56 to 74 years who underwent surgery between 2004 and 2009. Tumor material was immediately shocked frozen in liquid nitrogen and further conserved at -80C. RNA was extracted, and arrays were hybridized according to the manufacturers instructions. Data were normalized following RMA procedure of Bioconductor. RESULTS: To identify genes differentially expressed between tumors with and without relapse we performed the nearest shrunken centroid classification followed by K-fold cross-validation using Prediction Analysis of Microarrays (PAM). We obtained a list of 60 classifier genes, among which H19, a maternally imprinted non coding RNA that is involved in the regulation of the insulin like growth factor signaling and has been described as a tumor suppressor for Wilms’ tumors, and FOXP2, an imprinted transcription factor whose mutations cause developmental verbal dyspraxia. Both genes are downregulated in tumors that relapsed. CONCLUSION: Upon independent validation on a larger cohort, the 60 gene prognostic classifier for laryngeal tumors may support the choice of the appropriate therapy. Imprinting might be a hallmark of relapsing laryngeal carcinomas. Adherence to Quality Measures for Oral Cavity Cancer Susan Muller, DMD, MS (presenter); Stacey Fedewa, MPH; Amy Chen, MD, MPH OBJECTIVE: 1) Evaluate the feasibility of using a single institution database to measure adherence to pathologic reporting protocols as recommended by the College of American Pathologists (CAP) and the Commission on Cancer. 2) Assess for improved adherence to pathologic reporting protocols after implementation of a formal synoptic report at a single institution. METHOD: Cases of oral cavity cancer treated surgically at Emory University Hospital between 2000-2009 were analyzed. Clinical, demographic, and pathologic elements were recorded and adherence to quality measures was evaluated. RESULTS: 86 and 233 patients treated surgically for oral tongue squamous cell carcinoma between the years 2000 and 2004 and the years 2005 and 2009, respectively, were identified. After implementation of a standard pathologic synoptic reporting process in 2004, improvements were noted in the reporting of pathologic T stage (53% to 76%, p⬍0.0001), perineural invasion (60% to 77%, p⫽0.0037), angiolymphatic invasion (1% to 54%, p⬍0.0001), and extracapsular spread (37% to 62%, p⫽0.0033). Reporting of depth of invasion, extent of invasion (i.e. into muscle), and pathologic N stage were not significantly different between the two groups. ConAugust 2010
POSTERS
Business of Medicine
POSTER PRESENTATIONS
A Cross-Sectional Study Evaluating a Facial Palsy Protocol Ajith George, MBChB, MRCS, DO-HNS (presenter); Emma McFarlane; Churunal Hari OBJECTIVE: 1) Evaluate whether a facial palsy protocol improves the clinical management of facial palsy. 2) Assess the efficacy of the House-Brackmann (HB) scale in prescribing eye care for patients. METHOD: A cross-sectional study of patients presenting with facial palsy was performed in a UK Otolaryngology out-patient department from January 2008 to December 2009. A specific Facial palsy management protocol was followed, developed from outcome assessment data in a previous 20052006 analysis. Documentation of diagnosis, side of palsy, trauma, upper or lower motor neuron lesion, cranial nerve examination, parotid and neck examination, otoscopy, audiology, examination of the oral cavity, HB grade and treatment with eye care, acyclovir and/or prednisolone were recorded, analyzed and compared to previous data. RESULTS: Ninety-four case notes were included with a mean age of 43.56 yrs (range 2-86) and 44/50 male to female ratio. The patients mean delays to initiating treatment and assessment in secondary care were 2.51 and 5.15 days respectively. Following the protocol introduction there was an improvement in documentation of assessment in facial palsy, particularly neck examination 6% to 57.4% and HB documentation from 61% to 83%. Patients diagnosed with a palsy of grade IV or above were 19 times more likely to receive eye care (2 ⫽ 18.056, p ⬎ 0.025) than those with grade III or less. CONCLUSION: The departmental facial palsy protocol for junior inexperienced doctors improves management. Ensuring documentation of the HB scale significantly improves eye care prescription. A Prognostic Multigene Classifier for Larynx Carcinoma Ulrich Pfeffer (presenter); Massimo Dellepiane, MD; Valentina Mirisola; Alessia Esposito; Luca Guastini, MD OBJECTIVE: Improved prognostic classification of laryngeal carcinomas could help to select patients for conservative therapy or radical surgery thereby increasing the disease specific survival while preserving function wherever possible. We therefore developed a microarray based molecular classifier specific for larynx tumors. METHOD: We analyzed the gene expression profiles by means of hybridization to Affymetrix HuGene 1.0 microarrays Otolaryngology-Head and Neck Surgery
of 20 laryngeal squamous cell carcinoma (stages III and IV) of male patients aged 56 to 74 years who underwent surgery between 2004 and 2009. Tumor material was immediately shocked frozen in liquid nitrogen and further conserved at -80C. RNA was extracted, and arrays were hybridized according to the manufacturers instructions. Data were normalized following RMA procedure of Bioconductor. RESULTS: To identify genes differentially expressed between tumors with and without relapse we performed the nearest shrunken centroid classification followed by K-fold cross-validation using Prediction Analysis of Microarrays (PAM). We obtained a list of 60 classifier genes, among which H19, a maternally imprinted non coding RNA that is involved in the regulation of the insulin like growth factor signaling and has been described as a tumor suppressor for Wilms’ tumors, and FOXP2, an imprinted transcription factor whose mutations cause developmental verbal dyspraxia. Both genes are downregulated in tumors that relapsed. CONCLUSION: Upon independent validation on a larger cohort, the 60 gene prognostic classifier for laryngeal tumors may support the choice of the appropriate therapy. Imprinting might be a hallmark of relapsing laryngeal carcinomas. Adherence to Quality Measures for Oral Cavity Cancer Susan Muller, DMD, MS (presenter); Stacey Fedewa, MPH; Amy Chen, MD, MPH OBJECTIVE: 1) Evaluate the feasibility of using a single institution database to measure adherence to pathologic reporting protocols as recommended by the College of American Pathologists (CAP) and the Commission on Cancer. 2) Assess for improved adherence to pathologic reporting protocols after implementation of a formal synoptic report at a single institution. METHOD: Cases of oral cavity cancer treated surgically at Emory University Hospital between 2000-2009 were analyzed. Clinical, demographic, and pathologic elements were recorded and adherence to quality measures was evaluated. RESULTS: 86 and 233 patients treated surgically for oral tongue squamous cell carcinoma between the years 2000 and 2004 and the years 2005 and 2009, respectively, were identified. After implementation of a standard pathologic synoptic reporting process in 2004, improvements were noted in the reporting of pathologic T stage (53% to 76%, p⬍0.0001), perineural invasion (60% to 77%, p⫽0.0037), angiolymphatic invasion (1% to 54%, p⬍0.0001), and extracapsular spread (37% to 62%, p⫽0.0033). Reporting of depth of invasion, extent of invasion (i.e. into muscle), and pathologic N stage were not significantly different between the two groups. ConAugust 2010
POSTERS
Business of Medicine