Walter Lee

Overview:

Global Health, Virtue-Based Professional Development and Leadership, Device Development for Cancer Detection

Positions:

Professor of Head and Neck Surgery & Communication Sciences

Head and Neck Surgery & Communication Sciences
School of Medicine

Professor in Radiation Oncology

Radiation Oncology
School of Medicine

Affiliate, Duke Global Health Institute

Duke Global Health Institute
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1999

The George Washington University

M.H.S. 2015

Duke University

Grants:

Clinical Evaluation of the OncAlert® RAPID in Subjects Presenting for Evaluation and/or Initial Biopsy

Awarded By
Vigilant Biosciences
Role
Principal Investigator
Start Date
End Date

A Quantitative Optical Sensor to Monitor Tumor Vascular Physiology

Administered By
Radiation Oncology
Awarded By
Zenalux Biomedical, Inc.
Role
Investigator
Start Date
End Date

TERT promoter mutation frequency in subsets of oral tongue cancer patients

Awarded By
American Medical Association Foundation
Role
Principal Investigator
Start Date
End Date

CHECKPOINT Head & Neck Nerve Stimulator/Locator Product Validation Study (9394-CSP-000-B)

Awarded By
Checkpoint Surgical
Role
Principal Investigator
Start Date
End Date

A Virtue Based on-line Leadership Curriculum: A Nationwide Resource for Professional Development

Awarded By
Society of University Otolaryngologists
Role
Principal Investigator
Start Date
End Date

Publications:

Professionalism competence: Its role in bringing about high-value care - a case study

The existing medical education paradigm is not structured in a way that prepares future physicians with knowledge or the skill set to excel in professionalism. The authors provide information in the form of a case study of a professionalism competency development program that was undertaken in the Duke University Medical School Division of Head and Neck Surgery and Communications Sciences, barriers found that impede development, and offer five reforms that are necessary in order to bring about the movement toward high-value care. The authors propose to 1) prioritize professionalism competency training in medical education, 2) make curricular revisions to promote professionalism competency training across the continuum, 3) revise selection criteria for entrance to the profession that deals with basic professionalism skills, 4) institute new prerequisite requirements for entrance to the profession centered on professionalism competency, and 5) require professionalism competency training as part of certification and re-certification processes.
Authors
Doublestein, BA; Lee, WT; Pfohl, RM
MLA Citation
Doublestein, B. A., et al. “Professionalism competence: Its role in bringing about high-value care - a case study.” Evaluating Challenges and Opportunities for Healthcare Reform, 2020, pp. 232–47. Scopus, doi:10.4018/978-1-7998-2949-2.ch011.
URI
https://scholars.duke.edu/individual/pub1518288
Source
scopus
Published Date
Start Page
232
End Page
247
DOI
10.4018/978-1-7998-2949-2.ch011

Overview of professionalism competence: Bringing balance to the medical education continuum

Lately, the term 'high-value care' has become a popular mantra among healthcare leaders and policymakers. These people claim that changes are necessary in healthcare to reduce costs, minimize overuse, and optimize outcomes. While few can argue that changes are needed in these areas, there is disagreement as to how to make the largest impact. The authors agree with those who believe that the greatest potential for success is found in professionalism improvements, not through payment or policy reforms. While medical education prides itself on producing highly competent and technically proficient physicians, it has generally neglected professionalism development considering these skills something to be acquired outside of formal medical education. The authors consider recent efforts to define professionalism competency and offer a useful model that brings parity to physician training. If professionalism is the bedrock of high-value care, the time has come to provide physicians with the skills to excel.
Authors
Doublestein, BA; Lee, WT; Pfohl, RM
MLA Citation
Doublestein, B. A., et al. “Overview of professionalism competence: Bringing balance to the medical education continuum.” Evaluating Challenges and Opportunities for Healthcare Reform, 2020, pp. 215–31. Scopus, doi:10.4018/978-1-7998-2949-2.ch010.
URI
https://scholars.duke.edu/individual/pub1518289
Source
scopus
Published Date
Start Page
215
End Page
231
DOI
10.4018/978-1-7998-2949-2.ch010

Building trust: Reflecting on the earliest human experience.

Authors
Lee, W; Canick, J
MLA Citation
Lee, Walter, and Julia Canick. “Building trust: Reflecting on the earliest human experience.Am J Otolaryngol, vol. 43, no. 3, May 2022, p. 103411. Pubmed, doi:10.1016/j.amjoto.2022.103411.
URI
https://scholars.duke.edu/individual/pub1523972
PMID
35216851
Source
pubmed
Published In
Am J Otolaryngol
Volume
43
Published Date
Start Page
103411
DOI
10.1016/j.amjoto.2022.103411

Postoperative changes in cognition and cerebrospinal fluid neurodegenerative disease biomarkers.

OBJECTIVE: Numerous investigators have theorized that postoperative changes in Alzheimer's disease neuropathology may underlie postoperative neurocognitive disorders. Thus, we determined the relationship between postoperative changes in cognition and cerebrospinal (CSF) tau, p-tau-181p, or Aβ levels after non-cardiac, non-neurologic surgery in older adults. METHODS: Participants underwent cognitive testing before and 6 weeks after surgery, and lumbar punctures before, 24 h after, and 6 weeks after surgery. Cognitive scores were combined via factor analysis into an overall cognitive index. In total, 110 patients returned for 6-week postoperative testing and were included in the analysis. RESULTS: There was no significant change from before to 24 h or 6 weeks following surgery in CSF tau (median [median absolute deviation] change before to 24 h: 0.00 [4.36] pg/mL, p = 0.853; change before to 6 weeks: -1.21 [3.98] pg/mL, p = 0.827). There were also no significant changes in CSF p-tau-181p or Aβ over this period. There was no change in cognitive index (mean [95% CI] 0.040 [-0.018, 0.098], p = 0.175) from before to 6 weeks after surgery, although there were postoperative declines in verbal memory (-0.346 [-0.523, -0.170], p = 0.003) and improvements in executive function (0.394, [0.310, 0.479], p < 0.001). There were no significant correlations between preoperative to 6-week postoperative changes in cognition and CSF tau, p-tau-181p, or Aβ42 changes over this interval (p > 0.05 for each). INTERPRETATION: Neurocognitive changes after non-cardiac, non-neurologic surgery in the majority of cognitively healthy, community-dwelling older adults are unlikely to be related to postoperative changes in AD neuropathology (as assessed by CSF Aβ, tau or p-tau-181p levels or the p-tau-181p/Aβ or tau/Aβ ratios). TRIAL REGISTRATION: clinicaltrials.gov (NCT01993836).
Authors
Berger, M; Browndyke, JN; Cooter Wright, M; Nobuhara, C; Reese, M; Acker, L; Bullock, WM; Colin, BJ; Devinney, MJ; Moretti, EW; Moul, JW; Ohlendorf, B; Laskowitz, DT; Waligorska, T; Shaw, LM; Whitson, HE; Cohen, HJ; Mathew, JP; MADCO-PC Investigators,
MLA Citation
Berger, Miles, et al. “Postoperative changes in cognition and cerebrospinal fluid neurodegenerative disease biomarkers.Ann Clin Transl Neurol, vol. 9, no. 2, Feb. 2022, pp. 155–70. Pubmed, doi:10.1002/acn3.51499.
URI
https://scholars.duke.edu/individual/pub1509218
PMID
35104057
Source
pubmed
Published In
Annals of Clinical and Translational Neurology
Volume
9
Published Date
Start Page
155
End Page
170
DOI
10.1002/acn3.51499

Incidence and Risk of Suicide Among Patients With Head and Neck Cancer in Rural, Urban, and Metropolitan Areas.

Importance: Patients with head and neck cancer (HNC) are known to be at increased risk of suicide compared with the general population, but there has been insufficient research on whether this risk differs based on patients' rural, urban, or metropolitan residence status. Objective: To evaluate whether the risk of suicide among patients with HNC differs by rural vs urban or metropolitan residence status. Design, Setting, and Participants: This cross-sectional study uses data from the Surveillance, Epidemiology, and End Results database on patients aged 18 to 74 years who received a diagnosis of HNC from January 1, 2000, to December 31, 2016. Statistical analysis was conducted from November 27, 2020, to June 3, 2021. Exposures: Residence status, assessed using 2013 Rural Urban Continuum Codes. Main Outcomes and Measures: Death due to suicide was assessed by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes (U03, X60-X84, and Y87.0) and the cause of death recode (50220). Standardized mortality ratios (SMRs) of suicide, assessing the suicide risk among patients with HNC compared with the general population, were calculated. Suicide risk by residence status was compared using Fine-Gray proportional hazards regression models. Results: Data from 134 510 patients with HNC (101 142 men [75.2%]; mean [SE] age, 57.7 [10.3] years) were analyzed, and 405 suicides were identified. Metropolitan residents composed 86.6% of the sample, urban residents composed 11.7%, and rural residents composed 1.7%. The mortality rate of suicide was 59.2 per 100 000 person-years in metropolitan counties, 64.0 per 100 000 person-years in urban counties, and 126.7 per 100 000 person-years in rural counties. Compared with the general population, the risk of suicide was markedly higher among patients with HNC in metropolitan (SMR, 2.78; 95% CI, 2.49-3.09), urban (SMR, 2.84; 95% CI, 2.13-3.71), and rural (SMR, 5.47; 95% CI, 3.06-9.02) areas. In Fine-Gray competing-risk analyses that adjusted for other covariates, there was no meaningful difference in suicide risk among urban vs metropolitan residents. However, compared with rural residents, residents of urban (subdistribution hazard ratio, 0.52; 95% CI, 0.29-0.94) and metropolitan counties (subdistribution hazard ratio, 0.55; 95% CI, 0.32-0.94) had greatly lower risk of suicide. Conclusions and Relevance: The findings of this cross-sectional study suggest that suicide risk is elevated in general among patients with HNC but is significantly higher for patients residing in rural areas. Effective suicide prevention strategies in the population of patients with HNC need to account for rural health owing to the high risk of suicide among residents with HNC in rural areas.
Authors
Osazuwa-Peters, N; Barnes, JM; Okafor, SI; Taylor, DB; Hussaini, AS; Adjei Boakye, E; Simpson, MC; Graboyes, EM; Lee, WT
MLA Citation
Osazuwa-Peters, Nosayaba, et al. “Incidence and Risk of Suicide Among Patients With Head and Neck Cancer in Rural, Urban, and Metropolitan Areas.Jama Otolaryngol Head Neck Surg, vol. 147, no. 12, Dec. 2021, pp. 1045–52. Pubmed, doi:10.1001/jamaoto.2021.1728.
URI
https://scholars.duke.edu/individual/pub1489727
PMID
34297790
Source
pubmed
Published In
Jama Otolaryngol Head Neck Surg
Volume
147
Published Date
Start Page
1045
End Page
1052
DOI
10.1001/jamaoto.2021.1728

Research Areas:

Academic Medical Centers
Adjuvants, Immunologic
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Alcohol Drinking
Algorithms
Ambulatory Care
Anastomosis, Surgical
Animals
Antigen Presentation
Antigens
Antigens, Neoplasm
Attitude of Health Personnel
Attitude to Health
Breast Neoplasms
Cancer Vaccines
Carcinoma, Squamous Cell
Career Choice
Caregivers
Cation Transport Proteins
Cell Differentiation
Cell Fusion
Cell Movement
Cell Separation
Cell Transplantation
Cells, Cultured
Chemotherapy, Adjuvant
Chi-Square Distribution
Child
Clinical Competence
Clinical Trials as Topic
Clinical trials
Cohort Studies
Combined Modality Therapy
Computer Simulation
Conflict of Interest
Constriction, Pathologic
Cranial Nerve Neoplasms
Critical Care
Cross-Sectional Studies
Curriculum
Cysts
Cytoskeletal Proteins
DNA Methylation
Data Interpretation, Statistical
Database
Debridement
Dendritic Cells
Diagnosis, Differential
Disease Models, Animal
Disease-Free Survival
Dose-Response Relationship, Drug
Drug Evaluation, Preclinical
Drug Therapy, Combination
Early Detection of Cancer
Edema
Education, Medical, Graduate
Electric Stimulation
Electrofusion
Electrophoresis
Emergency Treatment
Endoscopy
Enzyme-Linked Immunosorbent Assay
Esophageal Stenosis
Ethics
Evidence-Based Medicine
False Negative Reactions
Female
Fractures, Bone
GTP-Binding Proteins
Genes, Tumor Suppressor
Goiter
Head and Neck Neoplasms
Health Care Surveys
Health Priorities
Heart Defects, Congenital
Hemoglobins
Hernia
Herniorrhaphy
Hoarseness
Homeodomain Proteins
Hospitalization
Human papillomavirus 16
Humans
Hybrid Cells
Hypopharynx
Immunotherapy
Industry
Infant
Interferon-gamma
Interleukin-10
Interleukin-12
Internet
Internship and Residency
Intubation
Intubation, Intratracheal
Inventions
Laryngeal Diseases
Laryngeal Neoplasms
Laryngectomy
Laryngoplasty
Laryngoscopy
Laryngostenosis
Larynx
Laser Therapy
Leadership
Lung Neoplasms
Lymph Nodes
Lymphatic Metastasis
Lymphocyte Activation
Male
Mandibular Diseases
Melanoma
Melanoma, Experimental
Metals
Mice
Mice, Inbred BALB C
Mice, Inbred C57BL
Microsurgery
Microtubule-Associated Proteins
Middle Aged
Military Personnel
Monocytes
Monte Carlo Method
Moral Development
Mouth Neoplasms
Neck Dissection
Neoplasm Metastasis
Neoplasm Recurrence, Local
Neoplasm Staging
Neoplasm Transplantation
Neoplasms
Neoplastic Stem Cells
Nerve Tissue Proteins
Nerve Transfer
Nose
Nose Neoplasms
Organ Sparing Treatments
Organophosphorus Compounds
Osteoradionecrosis
Otolaryngology
Otorhinolaryngologic Diseases
Oxygen
Oxygen Consumption
Pain
Palliative Care
Papillomavirus Infections
Personnel Selection
Phantoms, Imaging
Physicians
Pilot Projects
Politics
Postoperative Care
Postoperative Complications
Prejudice
Preoperative Care
Professional Competence
Prognosis
Program Development
Program Evaluation
Promoter Regions, Genetic
Proto-Oncogene Proteins
Publication Bias
Questionnaires
Radiation Injuries
Radiometry
Radiotherapy
Radiotherapy, Adjuvant
Randomized Controlled Trials as Topic
Recombinant Fusion Proteins
Reconstructive Surgical Procedures
Recovery of Function
Reference Values
Registries
Resource Allocation
Respiratory Tract Neoplasms
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Sentinel Lymph Node Biopsy
Septins
Sex Factors
Signal Transduction
Skin Neoplasms
Smoking
Software
Specialties, Surgical
Specific Pathogen-Free Organisms
Spectrum Analysis
Statistics, Nonparametric
Surgical Procedures, Operative
Surveys and Questionnaires
Survival Analysis
Survival Rate
Suture Techniques
T-Lymphocytes
Tensile Strength
Terminally Ill
Thyroid Nodule
Time Factors
Toll-Like Receptors
Tongue
Tongue Diseases
Tongue Neoplasms
Tonsillar Neoplasms
Trachea
Tracheal Diseases
Tracheostomy
Tracheotomy
Transcription Factors
Treatment Outcome
Tumor Cells, Cultured
Tumor Markers, Biological
United States
Vaccines
Vaccines, Synthetic
Ventilators, Mechanical
Vestibulocochlear Nerve Diseases
Video Recording
Virtues
Vocal Cord Paralysis
Voice Disorders
Wounds, Nonpenetrating
Young Adult