The probability of refilling prescription opioids after surgery was not correlated with initial prescription strength, suggesting surgeons could prescribe smaller prescriptions without influencing refill requests. Future research that examines the interplay between pain, substance abuse, and mental health could inform strategies to tailor opioid prescribing for patients.

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Background: Despite advances in multimodality treatment of head and neck squamous cell carcinoma (HNSCC), survival outcomes have improved minimally. This may be attributable to the increased risk of secondary primary malignancies. We conducted a retrospective analysis of patients treated at Fremantle Hospital, Western Australia with HNSCC to investigate the incidence of second primary malignancy (SPM), the epidemiological risk factors and survival outcome. Methods: We analyzed 790 patients from our departmental head and neck oncology database with the diagnosis of synchronous and/or metachronous HNSCCs between 1993 and 2011. We analyzed for an association between the risk factors and survival outcomes using the Statistical Package for Social Sciences for statistical analysis. Results: The commonest HNSCC was lip and oral cavity (37.8%), followed by oropharynx (28.1%) and larynx (26.5%). Of the 790 patients, 55.9% were smokers, 36.8% had a smoking history of over 50 pack-years, and 41.1% had a history of alcohol use. Primary treatment included surgery, surgery/ radiotherapy, chemotherapy, surgery/chemotherapy, surgery/chemo-radiotherapy, radiotherapy, chemoradiotherapy, and palliative, or no treatment. Synchronous tumour occurred in 29 patients (3.7%). Eighteen patients (2.3%) had metachronous tumour: median follow-up period was 25 months; 178 patients (22.5%) were dead at the end of follow-up. Conclusions: While this study found a lower rate of secondary primary malignancies in patients with HNSCCs than other studies, there was a clear association between patients with significant smoking histories and the development of HNSCCs. Progression to synchronous or metachronous malignancy was associated with a poorer overall survival rate.

BackgroundGiven the increasing morbidity and mortality related to prescription opioids in the United States, it is critical for patients to understand the risks and proper usage of opioid analgesics.MethodsWe surveyed 166 patients undergoing elective surgery at a single tertiary care facility preoperatively. We queried patients regarding aspects of prescription opioid use, side effects and adverse effects, and storage and disposal behaviors.ResultsOverall knowledge regarding prescription opioids was high (mean score = 8.05/12, range 0–12). The average number of questions answered correctly was not significantly different based on opioid use at the time of the survey (65% vs 67.5%, p = 0.52). Characteristics significantly associated with higher knowledge included young age (p = 0.01), female gender (p < 0.01), and white race (p = 0.01).ConclusionsPatient knowledge regarding prescription opioids is high preceding surgery, but gaps remain regarding side effects and adverse effects. Knowledge did not differ by prior or current opioid use, and these findings may help target important knowledge gaps to improve patient education regarding opioids during the preoperative period.

This study had a counterbalanced within-subjects design with random assignment to testing sequences. The system was capable of displaying 2D or 3D images with the same setup. A Howard-Dolman apparatus assessed precision of depth judgments and 3 laparoscopic tasks (peg transfer, navigation in space, and suturing) assessed performance (time to completion). Participants completed tasks in all combinations of 2 viewing modes (2D, 3D) and 2 viewing distances (1 m, 3 m). Other measures administered included the NASA TLX (perceived workload) and the Randot Stereotest (stereoacuity). RESULTS: Depth judgments were 6.2 times more precise at 1 m and 3.0 times more precise at 3 m using 3D vs 2D displays (p < 0.001). Participants performed all laparoscopic tasks faster in 3D at both 1 m and 3 m (p < 0.001), with mean completion times up to 64.5% shorter for 3D vs 2D displays. Workload was lower for 3D displays (up to 33.4%) than 2D displays at both viewing distances (p < 0.001). Greater viewing distance inhibited performance for 2 laparoscopic tasks, and increased perceived workload for all 3 (p < 0.001). Higher stereoacuity was associated with shorter completion times for the navigating in space task performed in 3D at 1 m (r ¼ À0.4, p < 0.01). CONCLUSIONS: 3D displays offer large improvements over 2D displays in precision of depth judgments, technical performance, and perceived workload.