Francisco Javier Bonilla-Escobar

Voice and Swallowing Outcomes of Unilateral Vocal Fold Paralysis: Comparing Younger Adult and Geriatric Patients:

Objective To compare voice and swallowing outcomes after treatment in younger adult (<65 years) and geriatric (≥65 years) patients with unilateral vocal fold paralysis (UVFP). Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods The cases of patients presenting to a tertiary voice clinic with UVFP between June 2005 and February 2015 were reviewed. Clinical characteristics and outcomes in a geriatric subset were compared with those in younger adult group. Results A total of 206 patients met our inclusion criteria (n = 110, <65 years; n = 96, ≥65 years). Etiology was most commonly iatrogenic (59.2%), and computed tomography led to diagnosis for 62.3% of patients for whom it was obtained. The Voice Handicap Index improved on average by 31.3 points after treatment (P < .001), with equal improvement between the patient subsets (P = .71). Swallowing, as objectively assessed by the National Outcomes Measurement System for modified barium swallow, showed a statistically significant improvement in the patient population as a whole (–0.9, P = .02) but was not significantly different within the subgroups (younger, P = .07; geriatric, P = .25). Conclusion Geriatric patients have similar voice and swallowing outcomes as younger adults and should be treated equally aggressive.

Trauma Care and Surveillance: International “eCapacity” Efforts and Honduras Experience

Dear Editor, In order to advance trauma care in lowand middle-income countries (LMIC), innovative approaches must be utilized that build capacity and allow for successful implementation and dissemination of strategies. Recently, in the World Journal of Trauma, Dasari et al. [1] published a qualitative study about the implementation process of an innovative electronic surgery registry in Paraguay. The experience of Paraguay, an upper-middle-income country, is crucial for other Latin-American countries to understand potential barriers for the implementation of electronic registries in the region. The authors analyzed the hospital infrastructure and healthcare staff perspectives of the implementation process, but a missing component in the discussion was the historical local surveillance strategies. Therefore, experiences from LMIC provide a new perspective about the implementation process of injury prevention tools. The case of Jamaica, Cali-Colombia and Honduras is relevant to understand the evolution and the different pathways of injury prevention/surveillance systems. In Jamaica, in 1998 a trauma registry (TR) was created at the University Hospital of the West Indies to document detailed information on all trauma admissions, and the Violence-Related Injury Surveillance System (VRISS, in 1999 expanded to all injuries in the Jamaica Injury Surveillance System, JISS) to register all cases of injuries in the hospital emergency departments [2]. In Colombia, in 1995, Dr. Rodrigo Guerrero established in Cali a Violence Surveillance System (VSS) to capture city-wide injury information [3]. Through an initiative by the Center for Disease Control and Prevention (CDC), the Pan-American Health Organization (PAHO) and the Cisalva Institute at the Universidad del Valle, a paperbased trauma surveillance system (TSS) was created in 2000 to register all injuries in Cali’s hospital emergency departments. This TSS was also implemented in other Latin-American countries, including El Salvador, Peru, Jamaica and Honduras [2, 4]. Most recently, the International TR of the Pan-American Trauma Society was implemented in Cali [5]. Honduras created a surveillance system similar to the VSS in Cali called the University Institute on Democracy, Peace and Security (IUDPAS, http://www.iudpas.org/ index.php). There have been few international initiatives to work on trauma care improvement in Honduras, including collaborations with Harvard University and the International Committee of the Red Cross (ICRC). However, Honduras’ initiatives have been largely overlooked because the country lacks an organized trauma system and does not have the capacity to carry out significant trauma research. It also offers few opportunities for public health scientists and surgeons to collaborate, which is necessary for comprehensive trauma systems, contrary to the situation in Jamaica or Cali, or the new situation in Paraguay [1], where they have been collaborating actively [2, 5]. The NIH and the Fogarty International Center created new funding opportunities to develop ‘‘eCapacity’’ through training grants that combine innovative electronic health & Francisco J. Bonilla-Escobar fjb9@pitt.edu

Chemical Ocular Burn Epidemiology—Dealing With Missing Values

Chemical Ocular Burn Epidemiology— Dealing with Missing Values To the Editor We read with interest the article by Haring et al.1 Ocular burns are a relevant public health issue, especially those attributed to chemical agents. This article highlights the need to conduct epidemiologic studies because the existing information on ocular burns is dependent mainly on case series. There is a gap in knowledge of the national and international incidence of ocular burns. The authors provide evidence about the incidence of ocular chemical burns with interesting assumptions and conclusions. However, we would like to highlight some issues that could potentially affect the validity of the study results. Haring et al1 concluded that the residence of patients was the most common site for chemical injuries to occur in the United States; however, the percentage of missing values of locations was close to 50%. Also, the nature of the chemical agents was analyzed, but up to 88.2% of the chemical agents were unknown. The nature of those missing values was not described and given their amount, estimations and conclusions made about these aspects could be biased. Missing values can undermine the validity of research results and conclusions.2 Identifying reasons, patterns, and the distribution of missing data is part of the process of analyzing missing values. Their description clarifies the assumptions for the analysis and the strengths of the study methods and guides the use of imputation techniques. In fact, using imputation techniques in clinical trials and observational studies is a growing trend. Multiple imputation methods improve the approach to missing values and enhance estimations.3 Haring et al1 did valuable work in describing the emergency department visits that involved the diagnosis of chemical ocular burns; however, further data descriptions and analyses seem warranted to identify accurate and valid estimates of the epidemiologic trends of chemical burns in the United States.

Medical student researchers in Colombia and associated factors with publication: a cross-sectional study

BackgroundGaps between evidence-based research and clinical-public health practice have been evident for decades. One of the aims of medical student research is to close this gap. Accordingly, evaluating individual and environmental factors that influence participation of medical students in research are needed to understand and identify potential targets for action. This study aims to identify characteristics of medical student researchers in Colombia and the associated factors with scientific publications.MethodsA cross-sectional study of Colombian medical students involved in research using a validated, self-administered, online survey. The survey was distributed through the Colombian Association of Medical Students’ Associations (ASCEMCOL). Data sets were analyzed using descriptive and summary statistics. Bivariate analysis and a multiple logistic regression model were conducted to identify predictors of scientific publications.ResultsA total of 133 responses were analyzed from students at 12 Colombian cities and 20 higher-education institutions. Although 94% of responders had at least one research proposal, only 57% had completed a project, and 17% had published their findings. Barriers for undertaking research included time restrictions and a lack of mentorship. Motivational factors included opportunity to publish findings and good mentorship. Students planning to do a specialization (OR = 3.25; 95% Confidence interval [CI] = 1.27–8.30), innovators (OR = 3.52; 95%CI = 1.30–9.52) and committed (OR = 3.39; 95%CI = 1.02–11.29), those who had previously published their findings (OR 9.13 IC95% 2.57–32.48), and were further in their medical education (OR 2.26 IC95% 1.01–5.07), were more likely to publish scientific papers.ConclusionsOur findings describe medical students understanding of the process of conducting research in Colombia. Although there appears to be motivation to participate in research, very few students achieve publication. Barriers such as time constraints and mentorship seem to play a critical role. This highlights opportunities where barriers to research can be overcome in medical school and other levels.