Clinical Focus

  • Residency

Research Projects

  • Outcomes of Endoscopic Sinus Surgery in Patients with Minimally Symptomatic Indications (MedScholars Project)

All Publications

  • Impact of demographics and social vulnerability on outcomes in pediatric medullary thyroid cancer. International journal of pediatric otorhinolaryngology Rahman, A., Low, C., Huang, A., Meister, K., Balakrishnan, K. 2024; 187: 112166

    Abstract

    To evaluate the impact of social vulnerability and social determinants of health on outcomes in pediatric medullary thyroid cancer.A SEER database review looking at cases of pediatric medullary thyroid cancer from 1975 to 2016 was conducted and analyzed including data from the American Community Survey.A total of 174 patients were included in analysis. Five-year overall survival was 97.7 % and the disease specific survival (DSS) was 98.3 %. On univariate analysis, male sex was associated with worsened overall survival (HR = 4.2, CI 1.1-15.5, p < 0.05) but did not reach statistical significance on multivariate analysis. Asian or Pacific Islander race was associated with worsened overall survival on both univariate and multivariate analysis (HR = 5.5, CI 1.4-22.2, p < 0.05). Presenting with localized disease without nodal or distant metastasis was found to be a protective factor (HR = 0.2, CI 0.05-0.53, p < 0.01).Asian American/Pacific Islander patients and male patients may have poorer survival in pediatric medullary thyroid cancer. More research should be completed to better understand underlying factors.

    View details for DOI 10.1016/j.ijporl.2024.112166

    View details for PubMedID 39577142

  • Morbidity And Mortality: Delays In My Patient's Cancer Care. Health affairs (Project Hope) Rahman, A. S. 2024; 43 (11): 1605-1608

    Abstract

    A clinician analyzes what caused months-long delays in the care of a patient diagnosed with cancer.

    View details for DOI 10.1377/hlthaff.2024.00513

    View details for PubMedID 39496083

  • Ten-Year Efficacy of Transoral Surgery for Squamous Carcinoma of the Lateral Oropharynx. The Laryngoscope Laccourreye, O., Garcia, D., Rahman, A., Holsinger, F. C. 2024

    Abstract

    To document the 10-year results of transoral mandibular preservation surgery for patients with T1-2 squamous cell carcinoma (SCC) arising from the lateral oropharynx.This was a retrospective 30-year review using STROBE guidelines at an academic, tertiary referral center. A total of 294 patients with T1-2 SCC of the lateral oropharynx were reviewed. Only 19% of patients were never-smokers, suggesting a predominantly HPV-negative population. All patients had transoral mandibular preservation surgery. Follow-up therapy included neck dissection (76.5%), induction chemotherapy (57.8%), and postoperative radiation therapy (31.6%) Local control, survival, and functional endpoints, as well as the consequences of local recurrence, were analyzed.The 10-year local disease control was 88.3%. Local recurrence was salvaged in 50% of cases, resulting in an overall 94.5% local control rate. The overall 10-year survival was 50%. Mortality was related to metachronous second primary cancer (MSPC) (29.2%), medical comorbidities (25.7%), uncontrolled local recurrence (10%), and complications following transoral resection (4.2%). In multivariate analysis, the development of an MSPC significantly increased (p < 0.005) the risk of death. Overall, 95.2% of patients achieved mandibular preservation. However, gastrostomy and tracheostomy dependence occurred in 1% and 0.3% of cases, respectively.For a patient population with a significant percentage of tobacco-associated oropharyngeal cancer (OPC), transoral surgery was associated with long-term minimal postoperative complications and a high rate of local control. MSPC was the main cause of death during the first 10 postoperative years. Such long-term figures support transoral surgery as an effective first-line treatment for early-stage predominantly tobacco-related OPC.4 Laryngoscope, 2024.

    View details for DOI 10.1002/lary.31574

    View details for PubMedID 38932658

  • Until Further Notice. JAMA otolaryngology-- head & neck surgery Rahman, A. S. 2024

    View details for DOI 10.1001/jamaoto.2023.4519

    View details for PubMedID 38300614

  • IMPENDING UPPER AIRWAY OBSTRUCTION FROM UNILATERAL TONSILLAR ENLARGEMENT IN A PATIENT WITH MONKEYPOX Rozenbaum, D., Hua, S., Fellion, L., Higgins, T., Rahman, A., Oliveira, F., Boateng, A., Htet, N. LIPPINCOTT WILLIAMS & WILKINS. 2023: 180

    View details for Web of Science ID 000921450900351

  • Risk factors associated with student distress in medical school: Associations with faculty support and availability of wellbeing resources. PloS one Langness, S., Rajapuram, N., Marshall, M., Rahman, A. S., Sammann, A. 2022; 17 (4): e0265869

    Abstract

    It is estimated that over half of medical students experience severe distress, a condition that correlates with low mental quality-of-life, suicidal ideation and serious thoughts of dropping out. While several risk factors for the development of severe distress have been identified, most focus on individual student characteristics. Currently, little is known about the impact medical schools have on student wellbeing.Prospective, observational survey study from 2019-2020 from a national cohort of US medical students. Student wellbeing, school characteristics, and wellbeing resource availability was measured with a 30-question electronic survey. Medical student distress was defined as a Medical Student Wellbeing Index (MS-WBI) of ≥4. Risk factors for the development of severe distress were evaluated in a multivariate logistic regression model. The impact of the number of wellbeing resources available on student wellbeing was measured along multiple wellbeing domains. Independent reviewers categorized free text analysis of survey responses about desired wellbeing resources into themes.A total of 2,984 responses were included in the study, representing 45 unique medical schools. Medical school characteristics independently associated with severe distress included low faculty support (OR 4.24); the absence of mentorship resources (OR 1.63) and the absence of community building programs (OR 1.45) in a multivariate model. Increased availability of wellbeing resources was associated with lower average MS-WBI (4.58 vs. 3.19, p<0;05) and a smaller percentage of students who had taken or considered taking a leave of absence (40% vs. 16%, p<0.05). The resources most desired by students were mental health services and scheduling adjustments.The majority of medical school characteristic that contribute to student distress are modifiable. Improving faculty support and offering more and varied wellbeing resources may help to mitigate medical student distress. Student feedback is insightful and should be routinely incorporated by schools to guide wellbeing strategies.

    View details for DOI 10.1371/journal.pone.0265869

    View details for PubMedID 35395007

  • The Effect of Conflict on Obstetric and Non-Obstetric Surgical Needs and Operative Mortality in Fragile States. World journal of surgery Rahman, A. S., Chao, T. E., Trelles, M. n., Dominguez, L. n., Mupenda, J. n., Kasonga, C. n., Akemani, C. n., Kondo, K. M., Chu, K. M. 2021

    Abstract

    Médecins Sans Frontières (MSF) provides surgical care in fragile states, which are more vulnerable to conflict. The primary objective of this study was to compare the indications for operative intervention in surgical projects in fragile states during periods of active conflict (CON) and non-conflict (NON-CON). In addition, risk factors for non-obstetric and obstetric operative mortality were identified.This was a retrospective analysis of MSF surgical projects in fragile states January 1, 2008-December 31, 2017. Variables considered in the analysis include age, gender, American Society of Anesthesiology physical status, emergency status, re-intervention status, indication for surgical intervention, and conflict/non-conflict time period.There were 30 surgical projects in 13 fragile states with 87,968 surgical interventions in 68,667 patients. Obstetric needs were the most common indication for surgical intervention (n = 28,060, 31.9%) but were more common during NON-CON (n = 23,142, 35.7%) compared to CON periods (n = 4,918, 21.2%, p < 0.001). Trauma was more common during CON (42.0%) compared to NON-CON (23.0%) periods (p < 0.001). Non-obstetric operative mortality was similar during CON (0.2%) compared to NON-CON (0.2%, p = 0.920), but obstetric operative mortality was higher (0.5%) during CON compared to NON-CON (0.2%, p < 0.001) periods. Risk factors for obstetric and non-obstetric mortality included age ≥ 30 years, ASA greater than 1, and emergency intervention.Humanitarian surgeons working in fragile states should be prepared to treat a range of surgical needs including trauma and obstetrics during conflict and non-conflict periods. The mortality in obstetric patients was higher during conflict periods, and further research to understand ways to protect this vulnerable group is needed.

    View details for DOI 10.1007/s00268-021-05972-1

    View details for PubMedID 33560502

  • Digital Addictions. Academic medicine : journal of the Association of American Medical Colleges Rahman, A. S. 2020

    View details for DOI 10.1097/ACM.0000000000003831

    View details for PubMedID 33177316

  • Catastrophic expenditures in California trauma patients after the Affordable Care Act: reduced financial risk and racial disparities. American journal of surgery Liu, C., Rahman, A. S., Chao, T. E. 2020

    Abstract

    BACKGROUND: Hospital charges due to major injury can result in high out-of-pocket expenses for patients. We analyzed the effect of the Affordable Care Act (ACA) on catastrophic health expenditures (CHE) among trauma patients.METHODS: We identified trauma patients aged 19-64 admitted to a safety-net Level 1 trauma center in California from 2007 to 2017. Out-of-pocket expenditures and income were calculated using hospital charges, insurance status, and ZIP code. CHE was defined using the World Health Organization definition of out-of-pocket spending exceeding 40% of inflation-adjusted income minus food and housing expenditures. Multivariable logistic regression was performed to assess odds of CHE post-ACA (2014-2017) vs. pre-ACA (2007-2013).RESULTS: Of 7519 trauma patients, 20.6% experienced CHE, including 89.0% of uninsured patients. There was a 74% decrease in odds of CHE post-ACA (aOR: 0.26, 95% CI: 0.22-0.30), with greater decreases among Black (aOR: 0.09, 95% CI: 0.04-0.18) and Hispanic (aOR: 0.23, 95% CI: 0.19-0.29) patients.CONCLUSIONS: ACA implementation was associated with markedly decreased odds of catastrophic expenditures and decreased racial disparities in financial protection among trauma patients in our study.

    View details for DOI 10.1016/j.amjsurg.2020.04.012

    View details for PubMedID 32354603

  • Indications and Outcomes for Patients With Limited Symptoms Undergoing Endoscopic Sinus Surgery. American journal of rhinology & allergy Rahman, A. S., Hwang, P. H., Alapati, R., Lin, Y., Nayak, J. V., Patel, Z. M., Yan, C. H. 2020: 1945892420912159

    View details for DOI 10.1177/1945892420912159

    View details for PubMedID 32168996

  • Operative Burden in Conflict vs Nonconflict Settings: Experience of Medecins Sans Frontieres Rahman, A. S., Chao, T. E., Centurion, M., Dominguez, L., Chu, K. M. ELSEVIER SCIENCE INC. 2019: S136

    View details for Web of Science ID 000492740900249

  • Waiting it out: consultation delays prolong in-patient length of stay. Postgraduate medical journal Rahman, A. S., Shi, S., Meza, P. K., Jia, J. L., Svec, D., Shieh, L. 2019

    Abstract

    Decreasing delays for hospitalised patients results in improved hospital efficiency, increased quality of care and decreased healthcare expenditures. Delays in subspecialty consultations and procedures can cause increased length of stay due to reasons outside of necessary medical care.To quantify, describe and record reasons for delays in consultations and procedures for patients on the general medicine wards.We conducted weekly audits of all admitted patients on five Internal Medicine teams over 8 weeks. A survey was reviewed with attending physicians and residents on five internal medicine teams to identify patients with a delay due to consultation or procedure, quantify length of delay and record reason for delay.During the study period, 316 patients were reviewed and 48 were identified as experiencing a total of 53 delays due to consultations or procedures. The average delay was 1.8 days for a combined total of 83 days. Top reasons for delays included scheduling, late response to page and a busy service. The frequency in length of consult delays vary among different specialties. The highest frequency of delays was clustered in procedure-heavy specialties.This report highlights the importance of reviewing system barriers that lead to delayed service in hospitals. Addressing these delays could lead to reductions in length of stay for inpatients.

    View details for DOI 10.1136/postgradmedj-2018-136269

    View details for PubMedID 30674619

  • Family. Annals of internal medicine Rahman, A. S. 2019; 171 (1): 66–67

    View details for DOI 10.7326/M19-0395

    View details for PubMedID 31261404

  • The Beige Room. Academic medicine : journal of the Association of American Medical Colleges Rahman, A. S. 2019; 94 (2): 181

    View details for PubMedID 30694904

  • Impact of Affordable Care Act Implementation on Catastrophic Health Expenditures among Trauma Patients Liu, C., Rahman, A. S., Chao, T. E. ELSEVIER SCIENCE INC. 2018: S148–S149

    View details for DOI 10.1016/j.jamcollsurg.2018.07.315

    View details for Web of Science ID 000447760600286

  • Adipocyte arrestin domain-containing 3 protein (Arrdc3) regulates uncoupling protein 1 (Ucp1) expression in white adipose independently of canonical changes in beta-adrenergic receptor signaling PLOS ONE Carroll, S. H., Zhang, E., Wang, B. F., Leclair, K. B., Rahman, A., Cohen, D. E., Plutzky, J., Patwari, P., Lee, R. T. 2017; 12 (3)

    Abstract

    Adaptive thermogenesis and cold-induced activation of uncoupling protein 1 (Ucp1) in brown adipose tissue in rodents is well-described and attributed to sympathetic activation of β-adrenergic signaling. The arrestin domain containing protein Arrdc3 is a regulator of obesity in mice and also appears linked to obesity in humans. We generated a mouse with conditional deletion of Arrdc3, and here we present evidence that genetic ablation of Arrdc3 specifically in adipocytes results in increased Ucp1 expression in subcutaneous and parametrial adipose tissue. Although this increase in expression did not correspond with significant changes in body weight or energy expenditure, adipocyte-specific Arrdc3-null mice had improved glucose tolerance. It was previously hypothesized that Arrdc3 ablation leads to increased β-adrenergic receptor sensitivity; however, in vitro experiments show that Arrdc3-null adipocytes responded to β-adrenergic receptor agonist with decreased Ucp1 levels. Additionally, canonical β-adrenergic receptor signaling was not different in Arrdc3-null adipocytes. These data reveal a role for Arrdc3 in the regulation of Ucp1 expression in adipocytes. However, this adipocyte effect is insufficient to generate the obesity-resistant phenotype of mice with ubiquitous deletion of Arrdc3, indicating a likely role for Arrdc3 in cells other than adipocytes.

    View details for DOI 10.1371/journal.pone.0173823

    View details for Web of Science ID 000396094700043

    View details for PubMedID 28291835

    View details for PubMedCentralID PMC5349670

  • Radiologists' Role in the Communication of Imaging Examination Results to Patients: Perceptions and Preferences of Patients AMERICAN JOURNAL OF ROENTGENOLOGY Mangano, M. D., Rahman, A., Choy, G., Sahani, D. V., Boland, G. W., Gunn, A. J. 2014; 203 (5): 1034-1039

    Abstract

    It has been suggested that radiology reporting practices would be improved if radiologists were to discuss the results of an examination directly with the patient. The attitudes and preferences of patients with regard to direct communication with the radiologist are not well-defined. The purpose of this study was to survey patients about their preferred method of receiving radiologic results.An anonymous survey was distributed to adult patients undergoing contrast-enhanced CT or MRI over a 2-week period in June 2013.The response rate was 58.4% (642 responses). For normal examination results, the preferred mode of communication was a telephone call from the ordering physician (34.1%); only 12% of respondents opted for a telephone call from the radiologist, and 2.6% chose a face-to-face meeting with the radiologist. For abnormal test results, the preferred mode of communication was also a telephone call from the ordering physician (49.8%); 14.4% of respondents selected a telephone call from the radiologist, and 8.3% chose a face-to-face meeting with the radiologist. Patients preferred receiving very detailed versions of radiology reports for both normal (46.4%) and abnormal (81.8%) test results. Patients also expressed a desire to have access to at least key images from their examinations.Patients prefer receiving both normal and abnormal examination results from the physicians who ordered the examination rather than the radiologist. They also prefer to receive very detailed examination results rather than a brief summary in lay terms.

    View details for DOI 10.2214/AJR.14.12470

    View details for Web of Science ID 000347415700042

    View details for PubMedID 25341142