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Kahmke, Russel Roy

Positions:

Assistant Professor of Surgery

Surgery, Head and Neck Surgery and Communication Sciences
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2010

M.D. — SUNY Upstate Medical University

Publications:

Utility of Daily Mobile Tablet Use for Residents on an Otolaryngology Head & Neck Surgery Inpatient Service.

The objective of this study was to investigate the utility of electronic tablets and their capacity to increase hospital floor productivity, efficiency, improve patient care information safety, and to enhance resident education and resource utilization on a busy Otolaryngology - Head & Neck Surgery inpatient service. This was a prospective cohort study with a 2-week pre-implementation period with standard paper census lists without mobile tablet use, and a 2-week post-implementation period followed with electronic tablets used to place orders, look up pertinent clinical data, educate patients as appropriate, and to record daily to-dos that would previously be recorded on paper. The setting for the study was Duke University Medical Center in Durham, North Carolina, with 13 Otolaryngology residents comprising the study population. The time for inpatient rounding was shorter with the use tablets (p = 0.037). There was a non-significant trend in the number of times a resident had to leave rounds to look up a clinical query on a computer, with less instances occurring in the post-implementation study period. The residents felt that having a tablet facilitated more detailed and faster transfer of information, and improved ease of documentation in the medical record. Seventy percent felt tablets helped them spend more time with patients, 70 % could spend more time directly involved in rounds because they could use the tablet to query information at point-of-care, and 80 % felt tablets improved morale. The utility of a mobile tablet device coupled with the electronic health record appeared to have both quantitative and qualitative improvements in efficiency, increased time with patients and attendance at academic conferences. Tablets should be encouraged but not mandated for clinical and educational use.

Authors
Crowson, MG; Kahmke, R; Ryan, M; Scher, R
MLA Citation
Crowson, MG, Kahmke, R, Ryan, M, and Scher, R. "Utility of Daily Mobile Tablet Use for Residents on an Otolaryngology Head & Neck Surgery Inpatient Service." Journal of medical systems 40.3 (March 2016): 55-.
PMID
26645319
Source
epmc
Published In
Journal of Medical Systems
Volume
40
Issue
3
Publish Date
2016
Start Page
55
DOI
10.1007/s10916-015-0419-8

Incidence of Retrocochlear Pathology Found on MRI in Patients With Non-Pulsatile Tinnitus.

To identify the incidence of retrocochlear pathology on MRI in patients with non-pulsatile tinnitus.Retrospective review.Tertiary referral center.Adults with MRIs performed between March 1, 2008 and February 1, 2014 for non-pulsatile tinnitus with or without hearing loss.MRI.Incidence of retrocochlear pathology.Of the 218 patients who met inclusion criteria, 198 (91.3%) had unremarkable MRIs. Six patients (2.7%) had MRI findings that accounted for their tinnitus. Of these patients, five had unilateral tinnitus with asymmetric hearing loss because of acoustic neuroma found on MRI. One patient presented with bilateral tinnitus with asymmetric hearing loss and was found to have a right acoustic neuroma. Twenty (9.2%) patients had bilateral or unilateral tinnitus without hearing loss, all with unremarkable MRIs. Fourteen patients (6.4%) had incidental findings including two acoustic neuromas that were identified contralateral to the side of presenting tinnitus.Imaging should be used judiciously in the evaluation of tinnitus. Patients with unilateral tinnitus and asymmetric hearing loss were most likely to have abnormal findings. The majority of MRIs performed for tinnitus were normal in our study. Given the low incidence of MRI findings in the workup of tinnitus, every effort should be made to optimize screening protocols. Noncontrasted fast spin-echo T2-weighted MRI should be used to assess patients with tinnitus when there is low suspicion for retrocochlear pathology. Patients with unilateral non-pulsatile tinnitus with symmetric hearing may be observed, but clinical judgement should determine the need for further imaging.

Authors
Choi, KJ; Sajisevi, MB; Kahmke, RR; Kaylie, DM
MLA Citation
Choi, KJ, Sajisevi, MB, Kahmke, RR, and Kaylie, DM. "Incidence of Retrocochlear Pathology Found on MRI in Patients With Non-Pulsatile Tinnitus." Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 36.10 (December 2015): 1730-1734.
PMID
26496672
Source
epmc
Published In
Otology and Neurotology
Volume
36
Issue
10
Publish Date
2015
Start Page
1730
End Page
1734
DOI
10.1097/mao.0000000000000890

Dysphagia, hoarseness, and globus in a postoperative patient.

Sore throat, hoarseness, and dysphagia are known and recognized postoperative complications of laryngeal mask airway use during operative procedures. The patient's symptoms, present immediately after surgery, are thought related to airway manipulation. Airway foreign bodies, although low on the differential, can cause similar symptoms. We present a case of a single patient who presented to a tertiary care center after an elective outpatient procedure with postoperative sore throat, hoarseness, and dysphagia. A foreign body was found lodged in the patient's hypopharynx. The differential diagnosis of sore throat, hoarseness, and dysphagia in the postoperative patient is explored in further detail.

Authors
Kahmke, R; Woodard, CR
MLA Citation
Kahmke, R, and Woodard, CR. "Dysphagia, hoarseness, and globus in a postoperative patient." American journal of otolaryngology 36.2 (March 2015): 310-311.
PMID
25498994
Source
epmc
Published In
American Journal of Otolaryngology
Volume
36
Issue
2
Publish Date
2015
Start Page
310
End Page
311
DOI
10.1016/j.amjoto.2014.11.011

FoxP3 and indoleamine 2,3-dioxygenase immunoreactivity in sentinel nodes from melanoma patients.

OBJECTIVE: 1) Assess FoxP3/indoleamine 2,3-dioxygenase immunoreactivity in head and neck melanoma sentinel lymph nodes and 2) correlate FoxP3/indoleamine 2,3-dioxygenase with sentinel lymph node metastasis and clinical recurrence. STUDY DESIGN: Retrospective cohort study. METHODS: Patients with sentinel lymph node biopsy for head and neck melanoma between 2004 and 2011 were identified. FoxP3/indoleamine 2,3-dioxygenase prevalence and intensity were determined from the nodes. Poor outcome was defined as local, regional or distant recurrence. The overall immunoreactivity score was correlated with clinical recurrence and sentinel lymph node metastasis using the chi-square test for trend. RESULTS: Fifty-six sentinel lymph nodes were reviewed, with 47 negative and 9 positive for melanoma. Patients with poor outcomes had a statistically significant trend for higher immunoreactivity scores (p=0.03). Positive nodes compared to negative nodes also had a statistically significant trend for higher immunoreactivity scores (p=0.03). Among the negative nodes, there was a statistically significant trend for a poor outcome with higher immunoreactivity scores (p=0.02). CONCLUSION: FoxP3/indoleamine 2,3-dioxygenase immunoreactivity correlates with sentinel lymph node positivity and poor outcome. Even in negative nodes, higher immunoreactivity correlated with poor outcome. Therefore higher immunoreactivity may portend a worse prognosis even without metastasis in the sentinel lymph node. This could identify a subset of patients that may benefit from future trials and treatment for melanoma through Treg and IDO suppression.

Authors
Ryan, M; Crow, J; Kahmke, R; Fisher, SR; Su, Z; Lee, WT
MLA Citation
Ryan, M, Crow, J, Kahmke, R, Fisher, SR, Su, Z, and Lee, WT. "FoxP3 and indoleamine 2,3-dioxygenase immunoreactivity in sentinel nodes from melanoma patients." American journal of otolaryngology 35.6 (November 2014): 689-694.
PMID
25212103
Source
epmc
Published In
American Journal of Otolaryngology
Volume
35
Issue
6
Publish Date
2014
Start Page
689
End Page
694
DOI
10.1016/j.amjoto.2014.08.009

What are the diagnostic criteria for migraine-associated vertigo?

Authors
Kahmke, R; Kaylie, D
MLA Citation
Kahmke, R, and Kaylie, D. "What are the diagnostic criteria for migraine-associated vertigo?." Laryngoscope 122.9 (2012): 1885-1886.
PMID
22926936
Source
scival
Published In
The Laryngoscope
Volume
122
Issue
9
Publish Date
2012
Start Page
1885
End Page
1886
DOI
10.1002/lary.23335
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