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ObjectiveLimited English proficiency (LEP) has become increasingly recognized as an independent predictor of adverse health outcomes in the United States. We aim to examine trends and summarize current insights into LEP‐related disparities in adult otolaryngology.Data SourcesWeb of Science, PubMed, and Scopus.MethodsA systematic review of US‐based, peer‐reviewed literature evaluating outcomes in adult otolaryngology across primary language or varying levels of English proficiency; results were analyzed for study design, subspecialty, cohort demographics, and outcomes; findings were further assessed with the Kilbourne conceptual framework for health care disparities.ResultsAn initial search yielded 3886 articles. After removal of duplicates, 2906 articles were screened and 31 studies were included after full‐text analysis. Head and Neck Oncology (25.8%) and Otology (16.1%) were the most highly represented subspecialty topics. Patients with LEP represented an average of 21.71% (Range 2.21% – 51%) of the study populations. Definitions of LEP were variable. Furthermore, studies specifying patient‐reported LEP status reported significant findings more often than those using electronic health record‐derived data (p < 0.01). Under the Kilbourne framework, all studies were “detecting” (N = 21, 67.7%) and “understanding” (N = 10, 32.3%) disparities. In outcomes‐focused studies, patients with LEP presented with a higher burden of oncologic disease, more severe hearing loss, and disparities in treatment access/implementation.ConclusionPatients with LEP are adversely impacted across various otolaryngology subspecialties. Defining these inequities is vital to provide more targeted and comprehensive care for patients with LEP.Level of EvidenceNA Laryngoscope, 2024
ObjectiveLimited English proficiency (LEP) has become increasingly recognized as an independent predictor of adverse health outcomes in the United States. We aim to examine trends and summarize current insights into LEP‐related disparities in adult otolaryngology.Data SourcesWeb of Science, PubMed, and Scopus.MethodsA systematic review of US‐based, peer‐reviewed literature evaluating outcomes in adult otolaryngology across primary language or varying levels of English proficiency; results were analyzed for study design, subspecialty, cohort demographics, and outcomes; findings were further assessed with the Kilbourne conceptual framework for health care disparities.ResultsAn initial search yielded 3886 articles. After removal of duplicates, 2906 articles were screened and 31 studies were included after full‐text analysis. Head and Neck Oncology (25.8%) and Otology (16.1%) were the most highly represented subspecialty topics. Patients with LEP represented an average of 21.71% (Range 2.21% – 51%) of the study populations. Definitions of LEP were variable. Furthermore, studies specifying patient‐reported LEP status reported significant findings more often than those using electronic health record‐derived data (p < 0.01). Under the Kilbourne framework, all studies were “detecting” (N = 21, 67.7%) and “understanding” (N = 10, 32.3%) disparities. In outcomes‐focused studies, patients with LEP presented with a higher burden of oncologic disease, more severe hearing loss, and disparities in treatment access/implementation.ConclusionPatients with LEP are adversely impacted across various otolaryngology subspecialties. Defining these inequities is vital to provide more targeted and comprehensive care for patients with LEP.Level of EvidenceNA Laryngoscope, 2024
Purpose: The use of telehealth in the management of chronic obstructive pulmonary disease (COPD) has demonstrated benefit in addressing some key treatment barriers (e.g., accessibility of health care, costs, frailty, transportation, mobility, time). This modality may hold similar promise for the management of functional impairments in this population. Telehealth has been explored within head and neck cancer and neurological populations in dysphagia; however, less is known about the use of telehealth for biopsychosocial and eating-related impacts in COPD. The purpose of this tutorial is to describe the application of telehealth to this population, discuss the modality in the context of the medical management of COPD and dysphagia management in other populations, and provide considerations for its use. We then report a case implementation of Sudarshan Kriya Yoga as a telehealth approach in this population and describe preliminary biopsychosocial and eating-related and functional outcomes. Conclusions: As grounded in the previous literature and based on the preliminary case implementation findings of a small sample, telehealth for functional biopsychosocial management in the COPD population appears acceptable, appropriate, cost-effective, and feasible. This perspective demonstrates initial proof of concept and advances the diversification of management options that may better address the various complex needs of our clinical populations.
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