David O. Francis
University of Wisconsin-Madison
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Annals of Otology, Rhinology, and Laryngology | 2010
David O. Francis; Ernest A. Weymuller; Upendra Parvathaneni; Albert L. Merati; Bevan Yueh
Objectives Dysphagia-related sequelae are common after head and neck cancer treatment. Our aims were 1) to document overall and site-specific dysphagia, stricture, and pneumonia rates in a Medicare population, 2) to calculate treatment-specific rates and adjusted odds of developing these complications, and 3) to track changes in rates between 1992 and 1999. Methods Head and neck cancer patients between 1992 and 1999 were identified in combined Surveillance Epidemiology and End Results (SEER) registry and Medicare databases. Multivariate analyses determined odds of dysphagia, stricture, and pneumonia based on modality. Results Of 8,002 patients, 40% of experienced dysphagia, 7% stricture, and 10% pneumonia within 3 years of treatment. In adjusted analyses, patients treated with chemoradiation had more than 2.5-times-greater odds of dysphagia than did those treated with surgery alone. Combined therapy was associated with increased odds of stricture (p < 0.05). The odds of pneumonia were increased in patients treated with radiation with or without chemotherapy. Temporally, the dysphagia rates increased 10% during this period (p < 0.05). Conclusions Sequelae of head and neck cancer treatment are common and differ by treatment regimen. Those treated with chemoradiation had higher odds of experiencing dysphagia and pneumonia, whereas patients treated with any combined therapy more commonly experienced stricture. These sequelae represent major sources of morbidity and mortality in this population.
The American Journal of Gastroenterology | 2013
David O. Francis; Jennifer A. Rymer; James C. Slaughter; Yash A. Choksi; Pawina Jiramongkolchai; Evbu Ogbeide; Christopher Tran; Marion Goutte; C. Gaelyn Garrett; David Hagaman; Michael F. Vaezi
OBJECTIVES:Extraesophageal symptoms are common manifestations of gastroesophageal reflux disease (GERD). Lack of a definitive diagnostic or treatment standards complicate management, which often leads to multiple specialty consultations, procedures, pharmaceuticals and diagnostic tests. The aim of this study was to determine the economic burden associated with extraesophageal reflux (EER).METHODS:Direct costs of evaluation were estimated for patients referred with symptoms attributed to EER between 2007 and 2011. Medicare payment for evaluation and management and pharmaceutical prices was used to calculate first year and overall costs of evaluating and treating extraesophageal symptoms attributed to reflux.RESULTS:Overall, 281 patients were studied (cough (50%), hoarseness (23%), globus/post-nasal drainage (15%), asthma (9%), and sore throat (3%)). Over a median (interquartile range) of 32 (16–46) months follow-up, patients had a mean (95% confidence interval) of 10.1 (9.4–10.9) consultations with specialists and underwent 6.4 (3–9) diagnostic procedures. Overall, the mean initial year direct cost was
Gastroenterology | 2015
Fehmi Ates; Elif Saritas Yuksel; Tina Higginbotham; James C. Slaughter; Jerry E. Mabary; Robert T. Kavitt; C. Gaelyn Garrett; David O. Francis; Michael F. Vaezi
5,438 per patient being evaluated for EER. Medical and non-medical components contributed
Laryngoscope | 2015
Alexander Gelbard; David O. Francis; Vlad C. Sandulache; John C. Simmons; Donald T. Donovan; Julina Ongkasuwan
5,154 and
Laryngoscope | 2011
David O. Francis; Charles Maynard; Ernest A. Weymuller; Gayle E. Reiber; Albert L. Merati; Bevan Yueh
283. Of the overall cost, 52% were attributable to the use of proton pump inhibitors. During the initial year, direct costs were 5.6 times higher than those reported for typical GERD (
Journal of Orthopaedic Trauma | 2009
Rajshri Maheshwari; Christopher D. Mack; Robert Kaufman; David O. Francis; Eileen M. Bulger; Sean E. Nork; M. Bradford Henley
971). A total of 54% of patients reported improvement of symptoms. Overall cost per improved patient was
Otolaryngology-Head and Neck Surgery | 2014
David O. Francis; Elizabeth C. Pearce; Shenghua Ni; C. Gaelyn Garrett; David F. Penson
13,700.CONCLUSIONS:EER contributes substantially to health-care expenditures. In this cohort, the cost for initial years evaluation and treatment of EER symptoms was quintuple that of typical GERD. Prescription costs and, in particular, proton pump inhibitors were the single greatest contributor to the cost of EER management.
Otology & Neurotology | 2016
Brendan P. O'Connell; Ahmet Cakir; Jacob B. Hunter; David O. Francis; Jack H. Noble; Robert F. Labadie; Zuniga G; Benoit M. Dawant; Alejandro Rivas; George B. Wanna
BACKGROUND & AIMS Current diagnostic tests for gastroesophageal reflux disease (GERD) are suboptimal and do not accurately and reliably measure chronicity of reflux. A minimally invasive device has been developed to assess esophageal mucosal impedance (MI) as a marker of chronic reflux. We performed a prospective longitudinal study to investigate MI patterns in patients with GERD and common nonreflux conditions, to assess MI patterns before and after treatment with proton pump inhibitors and to compare the performance of MI and wireless pH tests. METHODS We evaluated MI in 61 patients with erosive esophagitis, 81 with nonerosive but pH-abnormal GERD, 93 without GERD, 18 with achalasia, and 15 with eosinophilic esophagitis. MI was measured at the site of esophagitis and at 2, 5, and 10 cm above the squamocolumnar junction in all participants. MI was measured before and after acid suppressive therapy, and findings were compared with those from wireless pH monitoring. RESULTS MI values were significantly lower in patients with GERD (erosive esophagitis or nonerosive but pH-abnormal GERD) or eosinophilic esophagitis than in patients without GERD or patients with achalasia (P < .001). The pattern of MI in patients with GERD differed from that in patients without GERD or patients with eosinophilic esophagitis; patients with GERD had low MI closer to the squamocolumnar junction, and values increased axially along the esophagus. These patterns normalized with acid suppressive therapy. MI patterns identified patients with esophagitis with higher levels of specificity (95%) and positive predictive values (96%) than wireless pH monitoring (64% and 40%, respectively). CONCLUSIONS Based on a prospective study using a prototype device, measurements of MI detect GERD with higher levels of specificity and positive predictive values than wireless pH monitoring. Clinical Trials.gov, Number: NCT01556919.
Pediatrics | 2015
David O. Francis; Shanthi Krishnaswami; Melissa L McPheeters
Laryngotracheal stenosis (LTS) is largely considered a structural entity, defined on anatomic terms (i.e., percent stenosis, distance from vocal folds, overall length). This has significant implications for identifying at‐risk populations, devising systems‐based preventive strategies, and promoting patient‐centered treatment. The present study was undertaken to test the hypothesis that LTS is heterogeneous with regard to etiology, natural history, and clinical outcome.
Laryngoscope | 2016
Alexander Gelbard; Donald T. Donovan; Julina Ongkasuwan; S. A R Nouraei; Guri Sandhu; Michael S. Benninger; Paul C. Bryson; Robert R. Lorenz; William S. Tierney; Alexander T. Hillel; Shekhar K. Gadkaree; David G. Lott; Eric S. Edell; Dale C. Ekbom; Jan L. Kasperbauer; Fabien Maldonado; Joshua S. Schindler; Marshall E. Smith; James J. Daniero; C. Gaelyn Garrett; James L. Netterville; Otis B. Rickman; Robert J. Sinard; Christopher T. Wootten; David O. Francis
The relationship between gastroesophageal reflux disease (GERD) and laryngeal cancer has not been fully elucidated. This case‐control study investigates whether GERD increases the odds of developing these malignancies.