Fundamentals of Clinical Decision-Making Analysis for SLPs and Audiologists: Evidence-Based Approach

Statistical Methods and Reasoning for the Clinical Sciences: Evidence-Based PracticeDr. Satake Photo

By: Eiki B. Satake, PhD, author of Statistical Methods and Reasoning for the Clinical Sciences: Evidence-Based Practice

Over the past decade or so, interest in evidence-based practice (EBP) has steadily increased in many clinical fields—a movement that has emphasized the importance of providing empirical evidence to support various therapy interventions. To succeed in meeting the goals of EBP, clinicians must rely on more than intuition and clinical experience. In addition, they must be well versed in the methods of research and statistics to accurately evaluate and apply evidence that seems to support a particular intervention. As Guyatt et al. (2002) noted, the ability to critically appraise research literature and apply such findings is an essential skill for scientifically based treatment. Yet, my observations suggest that this concern is often neglected in graduate training programs as well as by many clinical practitioners and researchers. Furthermore, in this EBP era, all clinical professionals, not only clinical researchers but also clinical practitioners, are almost required to have the substantial knowledge of (1) how to measure the strength of clinical evidence accurately, and (2) how to interpret and report the findings. These are the essential components of EBP that will lead to improvement of one’s scientific literacy.

Scientific literacy is fundamental to the understanding of research methodology as well as the statistical assumptions and techniques used for the analysis and interpretation of data. In the absence of such understanding, it will be impossible for professionals to stay abreast of a rapidly flowing and ever-changing stream of information related to the study and treatment of speech, language, and hearing disorders. What is ultimately at stake is the credibility of the field to function as an independent discipline that presumably prides itself on contributing to a fund of knowledge leading to scientific advancements, not only in its own specialty areas but also for its contributions to the arena of the health science specialties at large. In the absence of such credibility, we will practice “unethically” by failing to provide the best possible services for the people we serve.

So, how does a clinician determine whether or not she is making an accurate, reliable, and credible EBP-oriented diagnosis and improves scientific literacy? One effective way is to learn how to evaluate the results of a diagnostic test accurately to find out the presence (or absence) of a particular disorder.

According to Hawkins (2005), EBP consists of the following four major steps: 1. Formulate a clear clinical question from a client’s problem; 2. Search the literature for relevant clinical articles; 3. Evaluate or clinically appraise the evidence for its validity and usefulness; 4. Implement useful findings into clinical practice. So, let us apply Hawkins’s principle to the diagnostic screening test process.

Despite the many applications of diagnostic test findings, the primary objective of any such test is to detect a particular disorder or disease when present. A good diagnostic test normally identifies people who have the particular disorder or disease of interest and excludes people who do not. To accurately measure the outcomes of a new test or a screening test, results obtained from it are generally compared with some other established test(s) viewed as the gold standard in yielding valid results. Even though such tests may not prove to be 100% accurate, they serve as the standard against which the merit of a new test can be judged. A logical question to ask is “If a test judged as the gold standard is doing a good job in accurately diagnosing a particular disorder or disease, why not use it in all cases?” The answer is that the gold standard for diagnosis can be time-consuming, expensive, and more difficult to perform. For this reason, a screening test is often used as an option during initial testing to decide who should be given a more definitive evaluation and who should not. Thus, an audiologist might give an audiometric screening test to decide when a more complete audiometric evaluation might be warranted. There are several major probabilities that constitute a screening test for determining the accuracy of the results. They are, namely, as follows:

  1. Prevalence of a disorder (denoted by D): P (D+) = Probability that the disorder (or disease) is present, whereas P (D−) = Probability that the disorder is absent.
  2. Test Results (denoted by T): P (T+) = Probability that the test is positive, whereas P (T−) = Probability that the test is negative.
  3. True Positive: P (D+ and T+) = Probability that the disorder is present and the test result is positive. People with the disorder are correctly identified as test positive.
  4. False Positive: P (D− and T+) = Probability that the disorder is absent but the test result shows positive. People without the disorder are falsely labeled as test positive.
  5. True Negative: P (D− and T−) = Probability that the disorder is absent and the test result is negative. People without the disorder are correctly identified as test negative.
  6. False Negative: P (D+ and T−) = Probability that the disorder is positive but the test result is negative. People with the disorder are falsely identified as test negative.
  7. Sensitivity of a test: It is defined as the probability that the test result is positive (T+) given that the disorder actually exists (D+). Symbolically, it is written as:
    Sensitivity of a test formulaIf a test has high sensitivity, it will have a low false-negative rate, that is, the probability that a subject who tests out as negative but who is actually positive, denoted by P (T− | D+). In such a case, the test result will seldom indicate that the disorder is not present when in fact it is present.
  8. Specificity of a test: It is defined as the probability that the test result is negative (T−) given that the disorder actually does not exist (D−). Symbolically, this is written as follows:
    Specificity of a test formulaA test that has high specificity is one that has a low false-positive rate, denoted by P (T+ | D−), meaning that it will seldom predict the presence of a disorder that does not exist.Although test sensitivity and specificity are important preliminary steps in constructing a diagnostic screening test, these indices alone have limited application to actual diagnosis and clinical decision making. More specifically, although these values may be used to estimate the accuracy of a particular diagnostic test, it is the predictive values of a test that actually have practical/clinical values in detecting a disorder or disease. In the case of measures of sensitivity and specificity, in contrast with predictive values, the disorder or disease status is already known. However, as noted previously, what a clinician really wants to obtain is whether or not a disorder or disease actually exists based on the test result of a diagnostic screening test. Only the predictive values allow for forecasting actual clinical outcomes (EBP) based on test results. There are two major components of predictive values of a diagnostic screening test, namely, predictive value positive (PV+), and predictive value negative (PV−). In short, PV+ and PV− can be viewed as a calculus of evidence to further explore the accuracy of a screening test in a more precise manner.
  9. Predictive Value Positive (PV+): It refers to the probability that a disorder or disease exists when the test result is positive (T+). Symbolically, this is expressed as follows:Predictive Value Positive formula
  10. Predictive Value Negative (PV−): It refers to the probability that a disorder or disease does not exist when the test result is negative. Symbolically, this is written as follows:Predictive Value Negative formula

All probabilities defined above are summarized in Table 1 shown below.

TABLE 1: Probability Estimates of Test Results

Table 1: Probability Estimates of Test Results

Additionally, in communication disorders, clinical practitioners often look at the results of clinical trials they are investigating and are interested in the association (or relationship) between a treatment and an outcome. In some cases, they may find a strong association or, in another case, there may be no significant association. When clinical investigators try to show the degree of association between two events (control versus experimental, treatment A versus treatment B, etc.), they need to know how to measure the strength of association based on what they observed. To answer the question pertaining to measuring the strength of association, we often use such advanced measures as relative risk, absolute/relative risk reduction, and odds ratio.

In summary, the clinical professionals in the field of SLP and audiology have not quite caught up to the level that medical professionals have achieved in terms of EBP statistics education. At the time of my writing, EBP education has become well established as a component of both undergraduate, graduate, and postgraduate medical education. So, why not us? Now is the right time to check our scientific literacy skills and promote better understanding of EBP statistics to a much larger extent, so that all clinical researchers and practitioners in our field are able to interpret the results and make a diagnosis more accurately.

References

Guyatt, G. H., & Rennie, D. (2002). User’s guide to the medical literature: A manual for evidence-based clinical practice. Chicago, IL: AMA Press.

Hawkins, R. C. (2005). The evidence based medicine approach to diagnostic testing: Practicalities and limitations. The Clinical Biochemist Reviews, 26(2), 7–18.

Satake, E. (2014). Evidence-based statistics for clinical professionals: What really prevents us from moving forward. Keynote presentation at the annual research symposium of LSU-School of ALLIED Health, New Orleans, LA.

Satake, E. (2014). Statistical methods and reasoning for the clinical sciences: Evidence-based approach. San Diego, CA: Plural Publishing.

About the Author

Eiki Satake, PhD, is an associate professor of mathematics and statistics at Emerson College in Boston, Massachusetts. He has conducted several research seminars and short courses on evidence-based statistics at national and international academic conferences. His research interests include Bayesian statistical methods and probabilistic approaches to evidence-based practice. He has also written numerous scholastic articles and instructional textbooks on statistical methods and statistics education. His most recent textbook, Statistical Methods and Reasoning for the Clinical Sciences: Evidence-Based Practice, provides practitioners with the scientific literacy needed to understand statistical methods in order to increase the accuracy of their diagnoses.

Ten Advances in Cochlear Implant Technology and Services

By: Jace Wolfe, PhD

Over the past several years, there have been numerous advances in cochlear implant technology and services. As recent as a decade ago, there were little to no technological solutions available to assist a cochlear implant candidate/recipient, who presented with severe to profound hearing loss, with speech recognition in difficult listening situations—understanding speech in noisy and reverberant settings, over the telephone or television, and when spoken from a distance. Today, cochlear implant manufacturers offer a wide variety of solutions to meet the needs of patients with hearing aids or cochlear implant processors who struggle to communicate. This article identifies ten ways in which cochlear implant technology and services have evolved and improved in the past few years.

10. Automatic scene classification: Hearing aids have featured acoustic scene classifiers for almost a decade. Through these systems, hearing aids classify an environment as one that possesses background noise, speech in quiet or in noise, music, wind, and so forth. Once the listening situation is classified into one of these environments, the hearing aid selects the appropriate form of signal processing that will theoretically optimize performance in the given environment. This technology can be quite valuable as many users are unlikely to manually switch to programs designed for specific, challenging situations. Furthermore, this system will likely be well-received by cochlear implant users as it makes its way to implant sound processors.

9. The development of new speech recognition materials that provide a more realistic assessment of how hearing aid and implant users perform in real-life listening situations: Cochlear implant technology has improved so much that many users score near 100% correct on sentence recognition tests in a quiet environment with a single talker who is male and speaks at a slow to moderate rate. Additionally, many hearing aid users who struggle substantially in realistic situations also often score too well on these tests to meet the indications for cochlear implant candidacy. This fact makes it difficult to distinguish between excellent implant and hearing aid users and good users who may benefit from additional services.

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Invaluable Resources for Anyone Who Uses or Trains the Singing Voice

The Vocal Athlete

The Vocal Athlete by Wendy LeBorgne and Marci Rosenberg

The Vocal Athlete and the companion workbook The Vocal Athlete: Application and Technique for the Hybrid Singer are written and designed to bridge the gap between the art of contemporary commercial music (CCM) singing and the science behind voice production in this ever-growing popular vocal style. These books are a must have for the speech pathologist, singing voice specialist, and vocal pedagogue. Continue reading

Plural joins R2 Digital Library platform

We are pleased to announce that a select number of Plural’s books will now be available for purchase via Rittenhouse Book Distributors’ R2 Digital Library. Visit R2Library.com for the full list of titles currently available.

“The R2 Digital Library is committed to providing highly specialized health sciences content for institutional purchase,” said Jason Hafer, Manager of eContent and ePlatform Support at Rittenhouse. “Plural Publishing’s notable work in a variety of specialized disciplines alone would make them an asset to the platform – that they are also working with us to expand the video collection on R2 adds a great deal of value to the user experience.” Continue reading

Section from Jerger’s “Audiology in the USA” Makes its Online Debut

Hello Plural Community-

This week we are re-posting an article from the Hearing Health & Technology Matters blog regarding Plural author James Jerger. We hope you enjoy.

-Plural Team

Section from Jerger’s “Audiology in the USA” makes its online debut – By David H. Kirkwood, the editor of Hearing News Watch and editor-in-chief of Hearing Health & Technology Matters

James JergerNo one has done more to advance the field of audiology over the past half century than James Jerger. As a researcher, writer/editor, teacher, and founding president of the American Academy of Audiology, Dr. Jerger has played an out-sized role in shaping the history of audiology and in preparing the profession to meet the needs of the 21st century.

That’s why when our blog, Hearing Health & Technology Matters (HHTM), had the unprecedented opportunity to publish an extensive passage from Dr. Jerger’s book, Audiology in the USAonline we seized it. With the permission of the book’s publisher, Plural Publishing, Wayne Staab has posted a 10-page section on rehabilitation from the book on Wayne’s World, his blog at HHMT.

Jerger_AITUHere, Dr. Jerger presents a fascinating and fast-moving chronicle of hearing aids from the carbon granule devices of 1902 through today’s advanced digital instruments. The Distinguished Scholar-in-Residence at the School of Behavioral and Brain Sciences, University of Texas at Dallas, also recounts the development of real-ear measurements, the discovery of the phenomenon of auditory deprivation, and the invention of outcome measures to determine patient benefit. Especially interesting are the portraits Dr. Jerger paints of some of the men and women who made important contributions to audiology.

As Wayne Staab states on his blog, HHTM is honored to have the privilege of being the first to publish a chapter from Audiology in the USA on the Internet. To read it, visit Wayne’s World.

HOLIDAY SALE!

We are offering 30% off list price PLUS free ground shipping now through December 24th on any title published before 2012- including Dr. Jerger’s Audiology in the USA. Just enter promotion code HOL1330 at checkout and select DEFAULT SHIPPING METHOD to apply your discount.

Feature Article- Preclinical Speech Science: A Cool Stroll through the Forest

Preclinical Speech Science: A Cool Stroll through the Forest
by Gary Weismer & Jeannette Hoit

forest

Every discipline has its “trial by fire” entry-level courses; in the field of speech-language pathology, the speech science course is one of those. Students often see speech science as a walk across the hot coals of anatomy,  physiology, and acoustic output of the speech apparatus.  Our view is that it should be more like a stroll through a beautiful forest, with vegetation and wildlife that is so interesting you can’t help but stop and admire it, ooh and ah over the relationship between structure and function of a plant here, an animal there, and want to remember the details of this new and intricate world because you just know that understanding it will be useful to you in the future.

Preclinical Speech Science, Second EditionThere have been many great speech science textbooks over the years, and almost certainly many more to come.  When we set out to write the first edition of Preclinical Speech Science:  Anatomy, Physiology, Acoustics, Perception, we asked ourselves the question, ‘Why write yet another speech science text?’  Our answer was that we wanted to  1) present the kind of beautiful images, coordinated with easy-to-read, straightforward text, that would make students want to stroll, stopping frequently, through this beautiful forest of knowledge that is the back country of speech-language pathology,  2) expand greatly on the ‘other A&P’ (Acoustics and Perception),  3) update the speech physiology to include contemporary notions about how speech production works, and why it has clear relevance to the speech-language pathologist’s daily practice, 4) include examples of clinical applications of speech science in the forms of clinical scenarios and sidetracks, and 5) integrate the fundamentals of the anatomy and physiology of human swallowing, a knowledge base that has become increasingly important over the years in the training of speech-language pathologists. We also wanted an accompanying workbook that would contain problems ranging from the easy, memorization type to those requiring a fair amount of thought.

But every rose has its missing petals, as did ours, which even those who admired our text were quick to point out. Our missing petal was a chapter on the brain. The National Institutes of Health (NIH), in coordination with other government agencies, had identified the period between 1990 and 2000 as “The Decade of the Brain,” and indeed during those ten years there was an explosion of research on the relationships among neuroanatomy, neurophysiology, brain lesions in a host of diseases, and behavior. brainThis explosion was heard throughout the speech science world as well, and continues to resonate with speech-language professionals to the present day. The brain processes underlying speech and language behavior, both normal and impaired,
are under heavy scientific and clinical scrutiny and speech-language pathologists need to be well-versed in this area.  With an ever-increasing aging population and its associated neurogenic diseases and their potential to affect speech-language behaviors, most training programs are putting added emphasis on a deep understanding of brain structures and mechanisms as they relate to communication. So in our second edition of Preclinical Speech Science, we have tried to enhance the rose with a new petal—a full chapter devoted to neuroanatomy, neurophysiology, and brain processes and models specific to speech production and perception.  In preparing this chapter, we retained our devotion to high quality images and patient, comprehensive text to make those images relevant and highly accessible as a new source of knowledge for the student.  We also showed how contemporary models of brain function in speech production are relevant to the diagnosis and management of disorders such as dysarthria and apraxia of speech.

In our writing of the new edition of Preclinical Speech Science, we have also updated much of the information in the original chapters, fixed mistakes, and prepared a new workbook to accompany it.  We urge you to give it a try, stop to smell the anatomical,  physiological, acoustic and perceptual roses in the forest.  If you allow your eyes to linger for a while on the wonderful images drawn by Maury Aaseng and think about what’s written in the text, we think you’ll find the ground less like a bed of coals and more like a cool stroll.  And your knowledge of all things speech science will make you cool in the eyes of your fellow health care professionals!

Plural Author in the News: Susan G. Allen

Plural Authors in the News

Plural author Susan G. Allen was recently invited by A.G. Bell to write an article with colleague Shefali Shah about their collaboration on 101 Frequently Asked Questions About Auditory-Verbal Practice. Together they answered question #49: Why is diagnostic work important in auditory-verbal therapy and education? In this article, Perspectives on the Profession: Susan G. Allen and Shefali Shah, they share their experience and knowledge regarding children with hearing loss.

Throughout her professional career Susan G. Allen has found that parents of children with hearing loss often lose their spontaneity with their child because they believe their child will no longer be able to have a normal life. She counsels that it is extremely important for parents to receive professional counseling to help them determine goals for their child, watch as they are accomplished, and thus alleviate their fears.

Circle of Listening

In this article she elaborates on the “Circle of Listening” Method and Hierarchy of Auditory Skills, which will be published in From Assessment to Intervention: A Guidebook for the Auditory Perception Test for the Hearing Impaired-Revised. The circle of listening is a process to assist in learning. “Using the circle, the child is more likely to comprehend AND store it in his/her memory bank for later retrieval by pairing the unknown with the known to generalize the information successfully.”

She also provides examples of how she balances formal and informal assessments to measure children’s progression. She stresses that both informal and formal measurements are critical in monitoring a child’s progress and achievement of goals. The Auditory Perception Test for the Hearing Impaired (APT/HI) allows for specific analysis of the individual’s ability to decode phonemes in isolation and in the context of words and sentences. APT/HI was developed by Susan G. Allen and is available on our website. She finds that formal speech perception tests works well to measure functional speech perception skills when combined with an informal listening skills checklist. “The ultimate goal is for the child to make appropriate progress and to reach performance at and above his/her chronological age so that he/she can be mainstreamed alongside their peers with typical hearing successfully.”

Susan G. AllenAbout the Author:

Susan G. Allen is co-author of the original APT/HI and the founder and director of the Clarke Jacksonville Auditory/Oral Center, one of five campuses of the CLARKE School for Deaf / Center for Oral Education. A speech-language pathologist and teacher of the deaf for over 40 years, Allen earned an undergraduate degree in education from the University of Michigan, a master’s degree in education of the deaf from Smith College and a master’s degree in special education with an emphasis on speech pathology from the University of North Florida. She has taught at universities, mentored staff and interns and presented over 80 papers, workshops and courses on teaching children with hearing loss and on the development of speech perception and speech production. At Clarke Jacksonville, Allen strives to provide children who are deaf or hard of hearing with the English language skills they need to succeed with their hearing peers in mainstream schools. She developed the APT/HI-R to assist interventionists in assessing and managing learning-to-listen skills for improving speech intelligibility and oral language which is published by Plural Publishing, Inc.

About the text:

From Assessment to Intervention: A Guidebook for the Auditory Perception Test for the Hearing Impaired-Revised is one of our most exciting upcoming texts. This guidebook clearly describes step-by-step processes for developing specific goals in audition, speech, and language for children who have completed the assessment. Numerous case studies are used to illustrate this process at various ages and levels of auditory functioning and speech/language development. Included is a DVD that is comprised of a learning module that includes PowerPoint slides and video clips of children with hearing loss being evaluated with the APT-HI-R. Intervention techniques also are demonstrated in the video clips. Practitioners working directly with children with hearing loss will find the DVD, Guidebook, and test (APT-HI-R) to be a tremendous resource, regardless of their employment setting.

 

References:

Allen, Susan G. & Shah, Shefali (2013). Perspectives on the Profession: Susan G. Allen and Shefali Shah. [Web blog post] Retrieved May 1, 2013 from http://www.listeningandspokenlanguage.org/Document.aspx?id=1849

Perigoe, C., Allen, S. G., & Dodson, C. (2012). Why is diagnostic work important in auditory-verbal therapy and education? In W. Estabrooks, 101 Frequently Asked Questions About Auditory-Verbal Practice, 382-387. Washington, D.C.:  Alexander Graham Bell Association for the Deaf and Hard of Hearing.

Feature Article: Why Quality Matters: The Changing Healthcare Delivery Model

Brian Taylor

Why Quality Matters: The Changing Healthcare Delivery Model

By Brian Taylor, AuD

In fits and starts, physicians and other healthcare professionals are beginning to realize that the convergence of wireless sensors, social networking, mobile connectivity and robust data management systems will profoundly impact the future. This transformation of medicine is likely to put a premium on healthcare professionals that place the patient firmly in the center of the clinical experience. These same forces will undoubtedly affect audiologists and their support staffs, and quality is likely to be a key differentiator in a disruptive future.

In this new world, physicians and other healthcare professionals are more likely to be reimbursed for the quality of their results, rather than the sheer number of procedures they order. Hospitals and clinics that demonstrate higher-than-average patient satisfaction scores will enjoy higher rates of reimbursement from federally funded programs. Patients are even joining the quality bandwagon as many are demanding greater transparency when shopping for medical services. In essence, patients are demanding to be treated more like customers. Consumer-centered health care is gradually supplanting the antiquated, paternalistic model in which the practitioner is never questioned and has near omnipotent authority over the uninformed patient. Out of this paradigm shift comes the quality movement. For audiologists this means the use of report cards, key performance indicators, and other quality strategies and tactics, if they want to stay relevant in a highly competitive marketplace. If you are like the typical practitioner, there is a good chance these concepts related to quality sound a little strange to you now. This is why I wrote Quality in Audiology: Design and Implementation of the Patient Experience, to help you prepare for some of these changes.

Interestingly, hearing aid manufacturers are very familiar with many of these concepts. In an effort to rise above their fierce competition, manufacturers have been obligated to standardize quality within their production lines by using tools such as Six Sigma and Total Quality Management. At the heart of these quality tools is a drive to eliminate variance. Eliminating variance is a worthy goal for the optimization of medical devices, but clinicians know all-too-well that each patient has built-in variability. Thus, many of the quality concepts and tools device manufacturers have come to rely on to incrementally improve quality don’t work well with patients. This paradox of quality within healthcare, as the book suggests, can be overcome through the standardization of quality around six patient staging areas.

Taylor_QA

The purpose of this book is to bring a level of practicality to the implementation of quality within an audiology clinic. As the book proposes, quality is improved mainly through your grassroots initiatives: procedures, programs, and behaviors you implement, measure, and manage in your clinic. This grassroots perspective requires audiologists and other professionals associated with hearing heath care to reexamine the concept of quality. According to the International Standards Organization, which acts as a sort of quality police for device manufactures, quality is the totality of characteristics, including people, processes, products environments, standards, and learning, of an entity that bear upon its ability to satisfy stated and implied needs. This definition suggests we improve ourselves and our ability to create quality in the world around us through innovation and the judicious use of best practice standards.

From a workaday, clinical standpoint, quality is meeting the requirements and expectations of patients and stakeholders in the business. In short, quality is probably best defined as the standardization of individual excellence. Rather than rely on academic boards and government agencies, the quest for better quality begins with self-motivated and dedicated audiologists and support staff who can use data to make better decisions about their patients. Quality in Audiology will get you on the path to continuous improvement in your clinic.

Oral, Head and Neck Cancer Awareness Week

Oral, Head & Neck Cancer Awareness Week

Oral, Head and Neck Cancer Awareness Week®

The 16th Annual Oral, Head and Neck Cancer Awareness Week® (OHANCAW), sponsored by the Head and Neck Cancer Alliance, is scheduled for April 14-20, 2013. OHANCAW is a weeklong series of events promoting awareness of oral, head, and neck cancer, highlighted by a day of free oral cancer screenings throughout the United States.

According to a brand new Harris Interactive survey, 71 percent of Americans say they have not been examined by a medical professional for oral, head, and neck cancer. Given the rise in oral cancers related to human papillomavirus (HPV), screening for early detection of this disease is more than important than ever. The Academy is urging you to participate by conducting a free screening at your medical practice, clinic, hospital or medical university. To find screening locations in your area, please visit the Head and Neck Cancer Alliance website, www.OHANCAW.com for more information.

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Our Featured Titles

Head and neck cancer is often easily treatable if detected early, but often it is not. For Oral, Head and Neck Cancer Awareness Week we are featuring a few of our related titles. These selected books comprehensively address diagnosis, treatment and patient rehabilitation of head and neck cancers.

Cutaneous Malignancy of the Head and NeckCutaneous Malignancy of the Head and Neck: A Multidisciplinary Approach

Randal Weber, MD, FACS, Brian Moore, MD, FACS

For the first time, a true multidisciplinary approach to cutaneous malignancy of the head and neck is presented, as international experts in head and neck surgical oncology, dermatology, Mohs micrographic surgery, plastic and reconstructive surgery, radiation oncology, and medical oncology present state-of-the-art techniques and promising horizons in the treatment of cutaneous malignancy of the head and neck. Whether in primary care or a specialty practice, this text should prove invaluable to any practitioner who treats patients with skin cancer of the head and neck. This is the only textbook on this subject that comprehensively addresses patient management – from diagnosis, treatment (in all forms, including chemotherapy and radiation), and reconstruction.

 

Practical Head and Neck OncologyPractical Head and Neck Oncology

Edited by: Guy Petruzzelli, M.D., P.h.D.

Otolaryngologists-head and neck surgeons, plastic/reconstructive and oral/maxillofacial surgeons, radiation and medical oncologists, and other clinicians interested in caring for patients with tumors of the head and neck will find this text to be a concise resource providing critical and useful information for the systematic and efficient evaluation, diagnosis, and comprehensive treatment planning and monitoring therapy for patients with malignant head and neck tumors. Bringing together experts in the management of patients with malignant tumors of the upper aerodigestive tract, students and residents will find this text an excellent reference for preparing to care for these challenging and fascinating patients.

 

Head and Neck UltrasonographyHead and Neck Ultrasonography

Edited by: Lisa Orloff, M.D.

Beautifully illustrated in full-color, Head and Neck Ultrasonography is regarded as the first, as well as the definitive, English-language textbook of head and neck ultrasonography by and for clinicians and surgeons. This book comprehensively and effectively addresses fundamentals of ultrasound physics, equipment, normal head and neck ultrasound anatomy, and technique. Individual chapters cover specific anatomy and pathology. Interventional ultrasonography and dynamic ultra-sonography is discussed and new directions and techniques in ultrasonography are presented. Head and Neck Ultrasonography is unique in both its thoroughness and in its relevance to the clinical setting, where ultrasonographic examination is a dynamic and interactive process between physician and patient. In addition to numerous valuable examples of still ultrasound images throughout the text, a CD-ROM with video clips illustrating both the process and the interpretation of specific examinations and procedures is provided with the text.

 

Head and Neck CancerHead and Neck Cancer: Treatment, Rehabilitation, and Outcomes

Elizabeth Ward, Ph.D., Corina van As Brooks, Ph.D.

A team of expert authors from the medical and allied health communities describe recent advances in the management of head and neck cancer through a greater understanding of cancer cell growth and mechanisms, as well as the expansion of rehabilitation strategies across the allied health profession. In addition to introducing new information, the book covers both the theoretical and clinical knowledge from an international perspective to support basic training of therapists in practice as well as graduate students, all illuminated with case examples – from swallowing disorders, through non-surgical voice restoration, to rehabilitation following total laryngeal surgery – on an accompanying DVD. As the first book in recent years to cover both current theory and clinical practice, this will prove an essential textbook and practical clinical reference for the H&N cancer rehabilitation team.

 

Meeting the Challenges of Oral and Head and Neck CancerMeeting the Challenges of Oral and Head and Neck Cancer: A Guide for Survivors and Caregivers, Second Edition

Co-Editors: Nancy Leupold, M.A., James Sciubba, D.M.D., Ph.D.

This volume has been expanded, updated, and polished and thus constitutes an even more comprehensive resource of valuable scientific, psychological, sociological, therapeutic, financial, and practical information for the patient afflicted with head and neck cancer and his or her family. Appreciation of these principles [in this book] and others too numerous to mention will soften the impact of the cancer and facilitate the care of, as well as the caring for, the patient afflicted with head and neck cancer. Concise, practical, and packed with information, Meeting the Challenges of Oral and Head and Neck Cancer: A Guide for Survivors and Caregivers, Second Edition is a valuable resource to assist those who need help overcoming the many difficult issues that confront them or their loved ones struggling with oral or head and neck cancer. This book has been helpful for parents and survivors; doctors often buy or recommend it for their patients.

 

Otolaryngology- Head and Neck SurgeryOtolaryngology-Head and Neck Surgery: Clinical Reference Guide, Third Edition

Edited by: Raza Pasha, M.D.

The bestselling pocketguide – Otolaryngology-Head and Neck Surgery: Clinical Reference Guide – is back in an extensively revised, up-to-date, and expanded third edition. Spanning the breadth of the entire field, this “high-yield” book retains a “by residents, for residents” feel, while also including expert content useful to accomplished physicians. Students, residents, attendings, and speech/hearing professionals will find the highly organized, outline format to be useful for clinical situations as well as a last minute cram for morning rounds. The guide has proven essential for board review as well as a quick source for primary care providers. In addition to all the great features that have made this sought after book a runaway success, the new edition features A comprehensive update featuring the latest diagnostic and treatment information A brand new sleep medicine chapter, providing critical information for this rapidly expanding subspecialty Expanded and revised information, notably in sections covering plastics; rhinology; otology/neurotology; H&N cancer; and general otolaryngology.