Wiet, Gregory J.; Stredney, Don; Wan, Dinah
This article focuses on key issues surrounding the needs and application of simulation technologies for technical skills training in otolaryngology. The discussion includes an overview of key topics in training and learning, the application of these issues in simulation environments, and the subsequent applications of these simulation environments to the field of otolaryngology. Examples of past applications are presented, with discussion of how the interplay of cultural changes in surgical training in general, along with the rapid advancements in technology have shaped and influenced their adoption and adaptation. The authors conclude with emerging trends and potential influences advanced simulation and training will have on technical skills training in otolaryngology. PMID:22032486
Hull, Benjamin P; Darrow, David H; Derkay, Craig S
To evaluate the financial impact of pursuing a fellowship in otolaryngology. Retrospective financial analysis using American Academy of Otolaryngology-Head and Neck Surgery survey data. The American Academy of Otolaryngology-Head and Neck Surgery report, entitled Socioeconomic Study among Members April 2011, gives a financial profile of respondents who reported their primary area of specialization as either general otolaryngology or a specific area of subspecialization. Weighted averages were calculated from the reported data. The weighted averages were used to calculate a net present value (NPV) over a 30-year contiguous career. The NPV for general otolaryngology was $4.73 million. The NPV for the following subspecialties in relation to general otolaryngology were (in hundred thousands) as follows: otolaryngologic allergy (-$1153), sleep medicine (-$677), otology/neurotology (-$339), laryngology (-$288), head and neck (-$191), pediatric otolaryngology (-$176), facial plastic surgery (-$139), skull base surgery ($122), rhinology ($285), and allergy and immunology ($350). Ninety-four percent of general otolaryngology respondents were in private practice. Most subspecialists worked in an academic setting. Fellowship training in otolaryngology will affect career earnings of prospective fellows. The overall financial impact of fellowship training, calculating in the delay in receiving a full clinical salary, should be factored into the decision to pursue fellowship training.
Bent, John P; Fried, Marvin P; Smith, Richard V; Hsueh, Wayne; Choi, Karen
Although residency training offers numerous leadership opportunities, most residents are not exposed to scripted leadership instruction. To explore one program's attitudes about leadership training, a group of otolaryngology faculty (n = 14) and residents (n = 17) was polled about their attitudes. In terms of self-perception, more faculty (10 of 14, 71.4%) than residents (9 of 17, 52.9%; P = .461) considered themselves good leaders. The majority of faculty and residents (27 of 31) thought that adults could be taught leadership ability. Given attitudes about leadership ability and the potential for improvement through instruction, consideration should be given to including such training in otolaryngology residency.
And Others; Rood, Stewart R.
The faculty of the Department of Otolaryngology, University of Pittsburgh School of Medicine, has designed a rotation in the otolaryngology service, that is a basic clinical orientation to ear, nose and throat medicine, to fit the one-month block committed by the local family practice residency training program. The program is described and its…
Akinboyewa, Ibukun; Cabrera-Muffly, Cristina
No prior studies have evaluated whether residents who pursue fellowship training achieve higher performance on the Otolaryngology Training Examination (OTE) and whether a specific fellowship will demonstrate a correlation with the corresponding specialty-specific OTE score. To determine whether residents pursuing fellowship training achieve higher performance on the OTE and whether fellowship choice is correlated with higher scores on the related subspecialty section of the OTE. This retrospective analysis included 35 residents training in an academic otolaryngology residency program from July 1, 2003, to June 30, 2014. The OTE scores for postgraduate years 2 through 5 and the type of fellowship were collected for all residents meeting inclusion criteria. Data were collected from September 1 to October 15, 2014, and analyzed from October 16 to December 1, 2014. Residents were divided by whether they pursued fellowship training and by the type of fellowship chosen. Outcome measures included comparison of scores between residents who pursued vs those who did not pursue fellowship training and comparison of subspecialty OTE scores between residents who pursued the corresponding fellowship and those who did not. Of the 35 residents who met the inclusion criteria (24 men and 11 women), 17 (49%) pursued fellowship training. The 3 most common fellowship choices were facial plastic and reconstructive surgery, pediatric otolaryngology, and rhinology (4 residents each [24%]). For all residents, mean scores on the OTE improved each subsequent training year, but this difference was only significant between postgraduate years 2 and 3 (from 60.9% to 68.6% correct; P otolaryngology, 72.9% vs 71.3% [P = .79]; and for rhinology, 72.2% vs 71.2% [P = .91]). Residents who pursued fellowship training did not achieve higher scores on the OTE in any examination year compared with residents who did not pursue fellowship training and did not achieve higher scores within the OTE
Espinel, Ali; Poley, Marian; Zalzal, George H; Chan, Kenny; Preciado, Diego
Interest in pediatric otolaryngology fellowship training is growing. The workforce implications of this growing interest are unclear and understudied. To analyze trends in pediatric otolaryngology training, determine where fellows who graduated over the past 10 years are currently practicing, and test the hypothesis that graduates from Accreditation Council for Graduate Medical Education (ACGME)–accredited programs were more likely to have academic tertiary positions with faculty appointments. We conducted a web-based analysis of pediatric otolaryngology fellowship graduates. The names of all 274 applicants who were matched to pediatric otolaryngology fellowships from May 31, 2003, to May 31, 2014, were obtained from the SF Match website. Accreditation status of each program for each match year was obtained from the ACGME website. We then performed an Internet search for the current practice location of each matched applicant. Analysis was conducted from January 1, 2015, to May 1, 2015. Practice setting per year of fellowship match and accreditation status of program. For the 2003 to the 2014 match years, there was an increase from 5 to 22 accredited pediatric otolaryngology fellowship programs overall; simultaneously, the number of yearly matched applicants increased from 14 to 35. More graduates with ACGME accreditation practice at academic settings compared with graduates without ACGME accreditation although the difference was not statistically significant (67.1% vs. 50.7%; P = .15). Graduates from accredited programs, however, were significantly more likely to practice at a hospital-based setting compared with those from nonaccredited programs (81.7% vs. 65.5%; P = .003). Fellows trained in the last 10 years are relatively well distributed across the country. The number of pediatric otolaryngology fellowship applicants as well as total number of matched applicants and ACGME-accredited positions has risen in the last 10 years. It appears that a higher
McMains, Kevin Christopher; Peel, Jennifer; Weitzel, Erik K; Der-Torossian, Hirak; Couch, Marion
This survey was developed to assess the prevalence and effects of the perception of shame in otolaryngology-head and neck surgery residency training in the United States. Survey. US otolaryngology training programs. Faculty and trainees in US otolaryngology training programs. A 14-item survey to assess the prevalence of the experience of shame and the attitudes toward use of shame in otolaryngology residency training was sent to all otolaryngology-head and neck surgery program directors for distribution among their respective faculty and resident cohorts. A total of 267 responses were received (women, 24.7%; men, 75.3%): 42.7% of respondents were trainees; 7.0% of trainees thought that shame was a necessary/effective tool, compared with 11.4% of faculty; 50% of respondents felt that they had been personally shamed during residency; and 69.9% of respondents had witnessed another trainee being shamed during residency training. Trainees were most commonly shamed in the operating room (78.4%). Otolaryngology faculty members did the shaming 95.1% of the time. Although shaming prompted internal reflection/self-improvement in 57.4% of trainees, it also caused loss of self-confidence in 52.5%. Trainees who had been shamed were more likely to view shame as an appropriate educational tool (P Otolaryngology—Head and Neck Surgery Foundation 2015.
Sethi, Rosh K V; Kozin, Elliott D; Remenschneider, Aaron K; Lee, Daniel J; Gliklich, Richard E; Shrime, Mark G; Gray, Stacey T
There is a paucity of data on junior resident training in common otolaryngology procedures such as ear debridement, nasal and laryngeal endoscopy, epistaxis management, and peritonsillar abscess drainage. These common procedures represent a critical aspect of training and are necessary skills in general otolaryngology practice. We sought to determine how a dedicated otolaryngology emergency room (ER) staffed by junior residents and a supervising attending provides exposure to common otolaryngologic procedures. Retrospective review. Diagnostic and procedural data for all patients examined in the Massachusetts Eye and Ear Infirmary ER between January 2011 and September 2013 were evaluated. A total of 12,234 patients were evaluated. A total of 5,673 patients (46.4%) underwent a procedure. Each second-year resident performed over 450 procedures, with the majority seen Monday through Friday (75%). The most common procedures in our study included diagnostic nasolaryngoscopy (52.0%), ear debridement (34.4%), and epistaxis control (7.0%) An otolaryngology-specific ER provides junior residents with significant diagnostic and procedural volume in a concentrated period of time. This study demonstrates utility of a unique surgical education model and provides insight into new avenues of investigation for otolaryngology training. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Iravani, Kamyar; Amini, Mitra; Doostkam, Aida; Dehbozorgian, Mahnaz
The script concordance test (SCT) is one the best tools used to evaluate clinical reasoning in ill-defined clinical situations. The aim of this study was to demonstrate SCT application in otolaryngology residency training. A 20 item otolaryngology SCT containing 60 questions was administered to 26 otolaryngology residents. The test was prepared by two otolaryngologists familiar to medical education. These questions have been validated by otolaryngology experts. The panel consisted of 9 academic staff in the field of otolaryngology. Pearson correlation test was used to assess the reliability of the test. The obtained mean scores were 68.4±5.8 (out of 100) for residents and 78.2±6.4(out of 100) for experts. There was a significant difference between the two scores (preliable tool to evaluate clinical reasoning in otolaryngology residents. It should be included in otolaryngology residency training.
Georgalas, Christos; Hadjihannas, Edward; Ghufoor, Khalid; Pracy, Paul; Papesch, Michael
OBJECTIVE: To assess the current status of operative training for otolaryngology specialist registrars in the United Kingdom. DESIGN: Web-based questionnaire survey. PARTICIPANTS: All otolaryngology specialist registrars in the United Kingdom. MAIN OUTCOME MEASURES: The overall satisfaction with
Awad, Zaid; Hayden, Lindsay; Robson, Andrew K; Muthuswamy, Keerthini; Tolley, Neil S
To investigate the reliability and construct validity of procedure-based assessment (PBA) in assessing performance and progress in otolaryngology training. Retrospective database analysis using a national electronic database. We analyzed PBAs of otolaryngology trainees in North London from core trainees (CTs) to specialty trainees (STs). The tool contains six multi-item domains: consent, planning, preparation, exposure/closure, technique, and postoperative care, rated as "satisfactory" or "development required," in addition to an overall performance rating (pS) of 1 to 4. Individual domain score, overall calculated score (cS), and number of "development-required" items were calculated for each PBA. Receiver operating characteristic analysis helped determine sensitivity and specificity. There were 3,152 otolaryngology PBAs from 46 otolaryngology trainees analyzed. PBA reliability was high (Cronbach's α 0.899), and sensitivity approached 99%. cS correlated positively with pS and level in training (rs : +0.681 and +0.324, respectively). ST had higher cS and pS than CT (93% ± 0.6 and 3.2 ± 0.03 vs. 71% ± 3.1 and 2.3 ± 0.08, respectively; P reliable and valid for assessing otolaryngology trainees' performance and progress at all levels. It is highly sensitive in identifying competent trainees. The tool is used in a formative and feedback capacity. The technical domain is the best predictor and should be given close attention. NA. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
McMains, Kevin C; Peel, Jennifer
Most faculty members undergo ad hoc training in education. This survey was developed to assess the prevalence and type of dedicated training in education received by academic otolaryngology-head and neck surgery (OTO-HNS) faculty in the United States. Survey. An 11-item survey was developed to assess the prevalence of dedicated instruction in education theory and practice, the types of instruction received, and the barriers to receiving instruction. The survey was sent to all OTO-HNS program directors for distribution among their respective faculty. A total of 216 responses were received. Seventy respondents (32.7%) serve as program director, associate program director, or assistant program director in their respective programs. Forty-six respondents (21.8%) had received dedicated training in education. Of the respondents who described the type of education training received, 48.7% participated in didactics/seminar, 35.9% in degree/certificate programs, 10.3% in multimodality training, and 5.1% online training. Among the barriers encountered to participation in instruction in education, time/productivity pressures was the most commonly cited reason (60.2%), followed by not knowing about the opportunity to receive training (36.4%), lack of departmental support (26.2%), lack of available training (22.3%), and the perception that such training would not be useful (7.8%). Presently, only a minority of surveyed academic otolaryngologists in the United States have received any dedicated instruction in the theory and practice of education. Personal, departmental, and institutional barriers exist in many practice environments that hinder otolaryngology faculty from participating in education training. N/A. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Shin, Jennifer J; Cunningham, Michael J; Emerick, Kevin G; Gray, Stacey T
Surgical competency requires sound clinical judgment, a systematic diagnostic approach, and integration of a wide variety of nontechnical skills. This more complex aspect of clinician development has traditionally been difficult to measure through standard assessment methods. This study was conducted to use the Clinical Practice Instrument (CPI) to measure nontechnical diagnostic and management skills during otolaryngology residency training; to determine whether there is demonstrable change in these skills between residents who are in postgraduate years (PGYs) 2, 4, and 5; and to evaluate whether results vary according to subspecialty topic or method of administration. Prospective study using the CPI, an instrument with previously established internal consistency, reproducibility, interrater reliability, discriminant validity, and responsiveness to change, in an otolaryngology residency training program. The CPI was used to evaluate progression in residents' ability to evaluate, diagnose, and manage case-based clinical scenarios. A total of 248 evaluations were performed in 45 otolaryngology resident trainees at regular intervals. Analysis of variance with nesting and postestimation pairwise comparisons were used to evaluate total and domain scores according to training level, subspecialty topic, and method of administration. Longitudinal residency educational initiative. Assessment with the CPI during PGYs 2, 4, and 5 of residency. Among the 45 otolaryngology residents (248 CPI administrations), there were a mean (SD) of 5 (3) administrations (range, 1-4) during their training. Total scores were significantly different among PGY levels of training, with lower scores seen in the PGY-2 level (44 ) compared with the PGY-4 (64 ) or PGY-5 level (69 ) (P otolaryngology (mean [SD], 72 ) than in subspecialties (range, 55 , P = .003, to 56 , P < .001). Neither administering the examination with an electronic scoring system, rather than a
Bobian, Michael R; Shah, Noor; Svider, Peter F; Hong, Robert S; Shkoukani, Mahdi A; Folbe, Adam J; Eloy, Jean Anderson
To evaluate whether formalized research training is associated with higher researcher productivity, academic rank, and acquisition of National Institutes of Health (NIH) grants within academic otolaryngology departments. Each of the 100 civilian otolaryngology program's departmental websites were analyzed to obtain a comprehensive list of faculty members credentials and characteristics, including academic rank, completion of a clinical fellowship, completion of a formal research fellowship, and attainment of a doctorate in philosophy (PhD) degree. We also recorded measures of scholarly impact and successful acquisition of NIH funding. A total of 1,495 academic physicians were included in our study. Of these, 14.1% had formal research training. Bivariate associations showed that formal research training was associated with a greater h-index, increased probability of acquiring NIH funding, and higher academic rank. Using a linear regression model, we found that otolaryngologists possessing a PhD had an associated h-index of 1.8 points higher, and those who completed a formal research fellowship had an h-index of 1.6 points higher. A PhD degree or completion of a research fellowship was not associated with a higher academic rank; however, a higher h-index and previous acquisition of an NIH grant were associated with a higher academic rank. The attainment of NIH funding was three times more likely for those with a formal research fellowship and 8.6 times more likely for otolaryngologists with a PhD degree. Formalized research training is associated with academic success in otolaryngology. Such dedicated research training accompanies greater scholarly impact, acquisition of NIH funding, and a higher academic rank. NA Laryngoscope, 127:E15-E21, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Awad, Z; Hayden, L; Muthuswamy, K; Tolley, N S
To investigate the utilisation, reliability and validity of clinical evaluation exercise (CEX) in otolaryngology training. Retrospective database analysis. Online assessment database. We analysed all CEXs submitted by north London core (CT) and speciality trainees (ST) in otolaryngology from 2010 to 2013. Internal consistency of the 7 CEX items rated as either O: outstanding, S: satisfactory or D: development required. Overall performance rating (pS) of 1-4 assessed against completion of training level. Receiver operating characteristic was used to describe CEX sensitivity and specificity. Overall score (cS), pS and the number of 'D'-rated items were used to investigate construct validity. One thousand one hundred and sixty CEXs from 45 trainees were included. CEX showed good internal consistency (Cronbach's alpha= 0.85). CEX was highly sensitive (99%), yet not specific (6%). cS and pS for ST was higher than CT (99.1% ± 0.4 versus 96.6% ± 0.8 and 3.06 ± 0.05 versus 1.92 ± 0.04, respectively P reliable in assessing early years otolaryngology trainees in clinical examination, but not at higher level. It has the potential to be used in a summative capacity in selecting trainees for ST positions. This would also encourage trainees to master all domains of otolaryngology clinical examination by end of CT. © 2015 John Wiley & Sons Ltd.
Deutsch, Ellen S; Wiet, Gregory J; Seidman, Michael; Hussey, Heather M; Malekzadeh, Sonya; Fried, Marvin P
Simulation has become a valuable tool in medical education, and several specialties accept or require simulation as a resource for resident training or assessment as well as for board certification or maintenance of certification. This study investigates current simulation resources and activities in US otolaryngology residency programs and examines interest in advancing simulation training and assessment within the specialty. Web-based survey. US otolaryngology residency training programs. An electronic web-based survey was disseminated to all US otolaryngology program directors to determine their respective institutional and departmental simulation resources, existing simulation activities, and interest in further simulation initiatives. Descriptive results are reported. Responses were received from 43 of 104 (43%) residency programs. Simulation capabilities and resources are available in most respondents' institutions (78.6% report onsite resources; 73.8% report availability of models, manikins, and devices). Most respondents (61%) report limited simulation activity within otolaryngology. Areas of simulation are broad, addressing technical and nontechnical skills related to clinical training (94%). Simulation is infrequently used for research, credentialing, or systems improvement. The majority of respondents (83.8%) expressed interest in participating in multicenter trials of simulation initiatives. Most respondents from otolaryngology residency programs have incorporated some simulation into their curriculum. Interest among program directors to participate in future multicenter trials appears high. Future research efforts in this area should aim to determine optimal simulators and simulation activities for training and assessment as well as how to best incorporate simulation into otolaryngology residency training programs. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
Lesko, David; Showmaker, Jason; Ukatu, Ceisha; Wu, Qiwei; Chang, C W David
Objective To evaluate recent tracheostomy surgical experience among otolaryngology residents and general surgery residents. Study Design Retrospective database review. Setting Accreditation Council for Graduate Medical Education otolaryngology and general surgery programs. Subjects and Methods Accreditation Council for Graduate Medical Education case log data from 2005 to 2015 for resident graduates in otolaryngology and general surgery were used to obtain mean graduate tracheostomy numbers, mean graduate composite case numbers, and number of graduating residents. Market share for each specialty was estimated through the derived metric of nationwide total tracheostomy graduate experience, calculated by multiplying the number of graduating residents by the mean number of graduate tracheostomies. Linear regression analysis was used to calculate trends. Multiple linear regression analysis was used for pairwise comparison of trends. Results From 2005 to 2015, mean graduate tracheostomy numbers for otolaryngology residents declined 2.3% per year, while those for general surgery residents increased 1.8% per year. Accounting for changes in number of resident graduates, market share of tracheostomy decreased 1.0% per year for otolaryngology and increased 3.0% per year for general surgery. Mean graduate composite case numbers increased significantly by 1.8% and 1.0% per year for otolaryngology and general surgery residents, respectively. Conclusion Tracheostomy case volume in otolaryngology residency has decreased steadily in comparison with general surgery residency. However, current otolaryngology graduates have more experience in tracheostomy when compared with general surgery graduates. While otolaryngology residents have excellent exposure to tracheostomy, otolaryngology programs should be made aware of this declining trend as well as changing procedural trends, which may affect training needs.
Cabrera-Muffly, Cristina; Bryson, Paul C; Sykes, Kevin J; Shnayder, Yelizaveta
Otolaryngology residents need concise, easily accessible modules to expand educational opportunities between surgical cases. These modules should be inexpensive to create and improve learning outcomes. The purpose of this pilot study was to assess whether otolaryngology residents at multiple institutions used online video modules to supplement their studying for the Otolaryngology Training Exam, whether the modules had any effect on their Otolaryngology Training Examination Scores, and to obtain survey feedback about the modules. This randomized trial was conducted in 3 academic departments of otolaryngology in the United States among 37 residents enrolled in 3 otolaryngology residency programs. Residents were randomized into 2 groups, one with access to the educational modules and the other with no access. Otolaryngology training examination scores were obtained from the year prior to the intervention (2012) and the year following module access (2013). Residents with access to the modules were also surveyed to assess use and obtain feedback about the modules. Otolaryngology training examination scores improved significantly from 2012 to 2013 among both residents who had access to the modules and those who did not in the sections of head and neck, laryngology, and sleep medicine. However, scores in the sections of pediatric otolaryngology (8% increase, P = .03), otology (7% increase, P = .02), and facial plastic surgery (10% increase, P = .02) improved from 2012 to 2013 only among residents with access to the modules. All respondents rated the videos as very helpful, with a rating of 4 of 5 on a Likert scale. Online otolaryngology educational modules are an inexpensive way to expand resident learning opportunities. Despite the lack of quantifiable improvement in otolaryngology training examination scores in this study, use of online modules sends a message to otolaryngology residents that their education is a priority; self-study outside the hospital
Hughes, Charles Anthony; McMenamin, Patrick; Mehta, Vikas; Pillsbury, Harold; Kennedy, David
The number of trained otolaryngologists available is insufficient to supply current and projected US health care needs. The goal of this study was to assess available databases and present accurate data on the current otolaryngology workforce, examine methods for prediction of future health care needs, and explore potential issues with forecasting methods and policy implementation based on these predictions. Retrospective analysis of research databases, public use files, and claims data. The total number of otolaryngologists and current practices in the United States was tabulated using the databases of the American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Board of Otolaryngology, American College of Surgeons, Association of American Medical Colleges, National Center for Health Statistics, and Department of Health and Human Services. Otolaryngologists were identified as surgeons and classified into surgical groups using a combination of AMA primary and secondary self-reported specialties and American Board of Medical Specialties certifications. Data gathered were cross-referenced to rule out duplications to assess total practicing otolaryngologists. Data analyzed included type of practice: 1) academic versus private and 2) general versus specialty; and demographics: 1) urban versus rural, 2) patient age, 3) reason for visit (referral, new, established, surgical follow-up), 4) reason for visit (diagnosis), and 5) payer type. Analysis from the above resources estimates the total number of otolaryngologists practicing in the United States in 2011 to be 12,609, with approximately 10,522 fully trained practicing physicians (9,232-10,654) and 2,087 in training (1,318 residents and 769 fellows/others). Based on 2011 data, workforce projections would place the fully trained and practicing otolaryngology workforce at 11,088 in 2015 and 12,084 in 2025 unless changes in training occur. The AAO-HNS Physicians Resource Committee
Gebhard, Grant M; Hauser, Leah J; Dally, Miranda J; Weitzenkamp, David A; Cabrera-Muffly, Cristina
To determine whether there is an association between the geographic location of an applicant's undergraduate school, medical school, and residency program among matched otolaryngology residency applicants. Observational. Otolaryngology residency program applications to our institution from 2009 to 2013 were analyzed. The geographic location of each applicant's undergraduate education and medical education were collected. Online public records were queried to determine the residency program location of matched applicants. Applicants who did not match or who attended medical school outside the United States were excluded. Metro area, state, and region were determined according to US Census Bureau definitions. From 2009 to 2013, 1,089 (78%) of 1,405 applicants who matched into otolaryngology residency applied to our institution. The number of subjects who attended medical school and residency in the same geographic region was 241 (22%) for metropolitan area, 305 (28%) for state, and 436 (40%) for region. There was no difference in geographic location retention by gender or couples match status of the subject. United States Medical Licensing Exam step 1 scores correlated with an increased likelihood of subjects staying within the same geographic region (P = .03). Most otolaryngology applicants leave their previous geographic area to attend residency. Based on these data, the authors recommend against giving weight to geography as a factor when inviting applicants to interview. NA. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Meyer, J E; Wollenberg, B; Schmidt, C
A concept for an ORL residency training program is necessary because of personnel bottlenecks, quality assurance and benchmarkings. We have created a 2.5 years' program, which is based on 6 pillars: 1. Acquisition of the necessary specialist knowledge by the resident in self-study. 2. Weekly attendance of training lectures according to a study timetable, a monthly specialist seminar to discuss case examples. 3. Weekly presentation by the resident on an article from the current literature, alternating with a presentation on cases and a morbidity and mortality conference. 4. Annual 60 min learning target test. 5. Definition of a surgical training calendar oriented to the new national ORL training regulations. 6. Internal operation course with preparative exercises in anatomy and visit to an operations course at a renowned otolaryngology clinic each year. After 2.5 years of the training time a revision course is introduced. In this way a basic training will be guaranteed for all residents, which can be assessed by the annual test. Finally, the construction of a further training curriculum should lead to an improved transparent training, a higher standard of quality and improved staff satisfaction.
Cass, Nathan D; Okland, Tyler S; Rodriguez, Kenny; Mann, Scott E
Objectives (1) Evaluate peer-reviewed publications regarding education in otolaryngology since 2000. (2) Analyze publication trends as compared with overall otolaryngology publications. Study Design Bibliometric analysis. Setting Academic medical center. Subjects and Methods A search for articles regarding education in otolaryngology from 2000 to 2015 was performed with MEDLINE and EMBASE databases, yielding 1220 articles; 362 relevant publications were categorized by topic, subspecialty, subject, article type, and funding source. Impact factors for each journal by year were obtained, and trends of each category over time were analyzed. These were then compared with publication numbers and impact factors for all otolaryngology journals. Results From 2000 to 2015, publications in otolaryngology education increased more rapidly than the field of otolaryngology overall. The most published topics included operative skills training, surgical simulation, and professionalism/career development. Recently there has been a decline in publications related to residency administration and duty hours relative to other topics. Only 12.2% of publications reported a funding source, and only 12.2% of studies were controlled. Conclusion Recent trends in otolaryngology literature reflect an increasing focus on education; however, this work is underfunded and often lacks high-quality evidence.
Varela, David A Diaz Voss; Malik, Mohammad U; Laeeq, Kulsoom; Pandian, Vinciya; Brown, David J; Weatherly, Robert A; Cummings, Charles W; Bhatti, Nasir I
Previous studies have identified a predominant learning style in trainees from different specialties, more recently in otolaryngology residents. The purpose of our study was to determine a predominant learning style within otolaryngology fellowships and to identify any differences between otolaryngology fellows and residents. We conducted a survey of otolaryngology fellows at 25 otolaryngology fellowship programs accredited by the Accreditation Council for Graduate Medical Education. We emailed Kolb's Learning Style Index version 3.1 to 16 pediatric otolaryngology (PO) and 24 otology/neurotology (ON) fellows. This index is a widely used 12-item questionnaire. The participants answered each item in the questionnaire as it applied to their preferred learning style: accommodating, converging, diverging, or assimilating. Results were then analyzed and compared between each subspecialty and the previously reported preferred styles of otolaryngology residents. Ten PO and 20 ON fellows completed the survey, with an overall response rate of 75%. PO and ON fellows (60% of each group) preferred a learning style that was "balanced" across all four styles. For ON fellows, 35% preferred converging and 5% preferred accommodating styles. For PO fellows, converging and accommodating styles accounted for 20% each. It was previously reported that 74.4% of otolaryngology residents prefer either converging or accommodating styles. We believe that the fellowship training environment calls for fellows to use more than one learning style to become proficient physicians, hence the trend toward potentially developing a balanced style when at this level. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Butts, Sydney C; Truong, Alan; Forde, Christina; Stefanov, Dimitre G; Marrinan, Eileen
To assess the ability of otolaryngology residents to rate the hypernasal resonance of patients with velopharyngeal dysfunction. We hypothesize that experience (postgraduate year [PGY] level) and training will result in improved ratings of speech samples. Prospective cohort study. Otolaryngology training programs at 2 academic medical centers. Thirty otolaryngology residents (PGY 1-5) were enrolled in the study. All residents rated 30 speech samples at 2 separate times. Half the residents completed a training module between the rating exercises, with the other half serving as a control group. Percentage agreement with the expert rating of each speech sample and intrarater reliability were calculated for each resident. Analysis of covariance was used to model accuracy at session 2. The median percentage agreement at session 1 was 53.3% for all residents. At the second session, the median scores were 53.3% for the control group and 60% for the training group, but this difference was not statistically significant. Intrarater reliability was moderate for both groups. Residents were more accurate in their ratings of normal and severely hypernasal speech. There was no correlation between rating accuracy and PGY level. Score at session 1 positively correlated with score at session 2. Perceptual training of otolaryngology residents has the potential to improve their ratings of hypernasal speech. Length of time in residency may not be best predictor of perceptual skill. Training modalities incorporating practice with hypernasal speech samples could improve rater skills and should be studied more extensively. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
Gross, Neil D.; Holsinger, F. Christopher; Magnuson, J. Scott; Duvvuri, Umamaheswar; Genden, Eric M.; Ghanem, Tamer AH.; Yaremchuk, Kathleen L.; Goldenberg, David; Miller, Matthew C.; Moore, Eric J.; Morris, Luc GT.; Netterville, James; Weinstein, Gregory S.; Richmon, Jeremy
Training and credentialing for robotic surgery in otolaryngology - head and neck surgery is currently not standardized, but rather relies heavily on industry guidance. This manuscript represents a comprehensive review of this increasingly important topic and outlines clear recommendations to better standardize the practice. The recommendations provided can be used as a reference by individuals and institutions alike, and are expected to evolve over time. PMID:26950771
Lango, Miriam N; Handorf, Elizabeth; Arjmand, Ellis
To describe the deployment of otolaryngologists and evaluate factors associated with the geographic distribution of otolaryngologists in the United States. Cross-sectional study. The otolaryngology physician supply was defined as the number of otolaryngologists per 100,000 in the hospital referral region (HRR). The otolaryngology physician supply was derived from the American Medical Association Masterfile or from the Medicare Enrollment and Provider Utilization Files. Multiple linear regression tested the association of population, physician, and hospital factors on the supply of Medicare-enrolled otolaryngologists/HRR. Two methods of measuring the otolaryngology workforce were moderately correlated across hospital referral regions (Pearson coefficient 0.513, P = .0001); regardless, the supply of otolaryngology providers varies greatly over different geographic regions. Otolaryngologists concentrate in regions with many other physicians, particularly specialist physicians. The otolaryngology supply also increases with regional population income and education levels. Using AMA-derived data, there was no association between the supply of otolaryngologists and staffed acute-care hospital beds and the presence of an otolaryngology residency-training program. In contrast, the supply of otolaryngology providers enrolled in Medicare independently increases for each HRR by 0.8 per 100,000 for each unit increase in supply of hospital beds (P otolaryngology residency-training program (P = .006), accounting for all other factors. Irrespective of methodology, the supply of otolaryngologists varies widely across geographic regions in the United States. For Medicare beneficiaries, regional hospital factors-including the presence of an otolaryngology residency program-may improve access to otolaryngology services. NA Laryngoscope, 127:95-101, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Hu, Amanda; Sardesai, Maya G.; Meyer, Tanya K.
Objective Otolaryngic disorders are very common in primary care, comprising 20–50% of presenting complaints to a primary care provider. There is limited otolaryngology training in undergraduate and postgraduate medical education for primary care. Continuing medical education may be the next opportunity to train our primary care providers (PCPs). The objective of this study was to assess the otolaryngology knowledge of a group of PCPs attending an otolaryngology update course. Methods PCPs enrolled in an otolaryngology update course completed a web-based anonymous survey on demographics and a pre-course knowledge test. This test was composed of 12 multiple choice questions with five options each. At the end of the course, they were asked to evaluate the usefulness of the course for their clinical practice. Results Thirty seven (74%) PCPs completed the survey. Mean knowledge test score out of a maximum score of 12 was 4.0±1.7 (33.3±14.0%). Sorted by area of specialty, the mean scores out of a maximum score of 12 were: family medicine 4.6±2.1 (38.3±17.3%), pediatric medicine 4.2±0.8 (35.0±7.0%), other (e.g., dentistry, emergency medicine) 4.2±2.0 (34.6±17.0%), and adult medicine 3.9±2.1 (32.3±17.5%). Ninety one percent of respondents would attend the course again. Conclusion There is a low level of otolaryngology knowledge among PCPs attending an otolaryngology update course. There is a need for otolaryngology education among PCPs. PMID:22754276
Schulz, Kristine; Puscas, Liana; Tucci, Debara; Woodard, Charles; Witsell, David; Esclamado, Ramon M; Lee, Walter T
Surgical Training and Education in Promoting Professionalism (STEPP) was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of this research was: (i) to compare the virtue profiles of our residents with that of the military cohort using a standardized virtue assessment tool; and (ii) to assess the value of virtue education on residents. As part of STEPP, otolaryngology residents participated in a virtue-based validated assessment tool called Virtue in Action (VIA) Inventory. This was completed at the initiation of STEPP in July 2011 as well as 1 year later in June 2012. Comparison of the VIA to a military cohort was performed. Leadership 'Basic Training' is a series of forums focused on virtues of initiative, integrity, responsibility, self-discipline, and accountability. A pre- and post-test was administered assessing resident perceptions of the value of this 'Basic Training'. Virtues are shared between otolaryngology residents (n=9) and military personnel (n=2,433) as there were no significant differences in strength scores between two military comparison groups and otolaryngology-head and neck surgery (OHNS) residents. There was a significant improvement (pvirtue-based approach is valued by residents as a part of leadership training during residency.
Wong, Kevin; Jang, Minyoung; Gilad, Amir; Levi, Jessica R
Involvement by residents in professional medical organizations can enrich their training, but little data exist regarding the number and types of involvement opportunities available to otolaryngology residents. We sought to fill this gap in knowledge by quantifying the extent to which major otolaryngology-related organizations in the United States provide involvement opportunities to otolaryngology residents. Our analysis included 23 organizations and subspecialty societies. Results showed that many opportunities exist for residents to attend conferences and present research; however, fewer involvement and funding opportunities existed in any other leadership, health policy, or service-learning experiences. These findings were consistent across general and subspecialty societies. Given the many purported benefits of resident involvement in otolaryngology outside of the standard training environment, future efforts may be warranted to increase the number and type of involvement opportunities currently available in professional societies.
Villwock, Jennifer A; Hamill, Chelsea S; Nicholas, Brian D; Ryan, Jesse T
Objective To delineate research resources available to otolaryngology residents and their impact on scholarly productivity. Study Design Survey of current otolaryngology program directors. Setting Otolaryngology residency programs. Subjects and Methods An anonymous web-based survey was sent to 98 allopathic otolaryngology training program directors. Fisher exact tests and nonparametric correlations were used to determine statistically significant differences among various strata of programs. Results Thirty-nine percent (n = 38) of queried programs responded. Fourteen (37%) programs had 11 to 15 full-time, academic faculty associated with the residency program. Twenty (53%) programs have a dedicated research coordinator. Basic science lab space and financial resources for statistical work were present at 22 programs (58%). Funding is uniformly provided for presentation of research at conferences; a minority of programs (13%) only funded podium presentations. Twenty-four (63%) have resident research requirements beyond the Accreditation Council for Graduate Medical Education (ACGME) mandate of preparing a "manuscript suitable for publication" prior to graduation. Twenty-five (67%) programs have residents with 2 to 3 active research projects at any given time. None of the investigated resources were significantly associated with increased scholarly output. There was no uniformity to research curricula. Conclusions Otolaryngology residency programs value research, evidenced by financial support provided and requirements beyond the ACGME minimum. Additional resources were not statistically related to an increase in resident research productivity, although they may contribute positively to the overall research experience during training. Potential future areas to examine include research curricula best practices, how to develop meaningful mentorship and resource allocation that inspires continued research interest, and intellectual stimulation.
Awad, Z; Hayden, L; Muthuswamy, K; Ziprin, P; Darzi, A; Tolley, N S
UK surgical trainees are required to undertake work-based assessments each year in order to progress in their training. Direct Observation of Procedural Skills (DOPS) is one of these assessments. We aim to investigate the validity of DOPS in assessing otolaryngology trainees at all levels. A retrospective search of the portfolios of all otolaryngology trainees in North Thames was carried out to identify otolaryngology-specific DOPS. A score (Cs) was calculated for each DOPS based on the percentage of satisfactorily-rated items. The overall performance rating (Ps) was analysed as a separate variable and compared with Cs. The Ps and Cs results were then compared across trainee grades and levels within each grade: Core trainees (CT1-CT2) and specialty trainees (ST3-ST8). Seven hundred and sixty-seven otolaryngology DOPS were completed between August 2008 and September 2013. The tool was found to be reliable and internally consistent. Trainees in ST grade had higher Cs and Ps scores than CT grade (P Otolaryngology DOPS is a useful tool in assessing otolaryngology trainees especially from CT1-ST3 level. DOPS can also differentiate between junior and senior trainees. However, it was not able to demonstrate progress at levels above ST3, most likely due to the simplicity of the procedures which trainees tend to master in the first few years of training. © 2014 John Wiley & Sons Ltd.
O'Connell Ferster, Ashley P; Hu, Amanda
Advances in gender equality have been sought in the field of medicine for centuries, including the specialty of otolaryngology. Currently, about 14.5% of practicing otolaryngologists are women. Strides have been made to support equality by the American Academy of Otolaryngology-Head and Neck Surgery through the development of the Women in Otolaryngology Section in 2010, among other efforts. This article reviews the literature of women in otolaryngology, as well as current trends toward equality among otolaryngologists of all genders.
Chun, Robert; Jabbour, Noel; Balakrishnan, Karthik; Bauman, Nancy; Darrow, David H; Elluru, Ravindhra; Grimmer, J Fredrik; Perkins, Jonathan; Richter, Gresham; Shin, Jennifer
The field of vascular anomalies presents diverse challenges in diagnosis and management. Although many lesions involve the head and neck, training in vascular anomalies is not universally included in otolaryngology residencies and pediatric otolaryngology (POTO) fellowships. To explore the education in, exposure to, and comfort level of otolaryngology trainees with vascular anomalies. A survey was distributed to 39 POTO fellows and 44 residents in postgraduate year 5 who matched into POTO fellowships from April 22 through June 16, 2014. Survey responses from trainees on exposure to, education on, and comfort with vascular anomalies. Forty-four residents in postgraduate year 5 who applied to POTO fellowships and 39 POTO fellows were emailed the survey. Fourteen respondents were unable to be contacted owing to lack of a current email address. Thirty-six of 69 residents and fellows (18 fellows and 18 residents [52%]) responded to the survey. Twenty-seven trainees (75%) reported no participation in a vascular anomalies clinic during residency; 6 of these 27 individuals (22%) trained at institutions with a vascular anomalies clinic but did not participate in the clinic, and 28 of the 36 respondents (78%) reported that they had less than adequate or no exposure to vascular anomalies in residency. Among POTO fellows, 11 of 17 (65%) did not participate in a vascular anomalies clinic during fellowship, even though 8 of the 11 had a vascular anomalies clinic at their fellowship program. During fellowship training, 12 of 18 fellows (67%) reported that they had adequate exposure to vascular anomalies. Only 20 respondents (56%) felt comfortable distinguishing among diagnoses of vascular anomalies, and only 4 residents (22%) and 9 fellows (50%) felt comfortable treating patients with vascular anomalies. All fellows believed that training in vascular anomalies was important in fellowship, and 100% of respondents indicated that increased exposure to diagnosis and management of
Boscoe, Elizabeth F; Cabrera-Muffly, Cristina
To identify trends in medical school otolaryngology curriculum requirements. Survey of United States allopathic medical schools. A survey was sent to deans of curriculum at allopathic medical schools. We identified opportunities for medical students to learn basic concepts in otolaryngology during their undergraduate medical training. The opportunities were classified into preclinical and clinical as well as elective and mandatory rotations. Of the schools surveyed, 60% responded. Mean class size was 149 students. Sixty-eight percent of surveyed schools noted that 75% to 100% of their students participated in preclinical otolaryngology experiences, with 59% reporting a mandatory preclinical otolaryngology module for all students. Eighty-nine percent of schools offered otolaryngology as a clinical elective rotation, with a mean of 12 students participating yearly. Only 7% of schools required a mandatory otolaryngology clinical rotation. Our data suggest that medical students do not receive sufficient exposure to otolaryngology during medical school. Increased requirements for otolaryngology curriculum may be beneficial to all medical students, regardless of their specialty choice. NA. Laryngoscope, 00:000-000, 2016 127:346-348, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Cass, Nathan; Kominsky, Alan; Cabrera-Muffly, Cristina
(1) Ascertain the most important concepts and topics for otolaryngology resident education in sleep medicine and surgery, as determined by faculty who teach sleep medicine to otolaryngology residents. (2) Create learning objectives within the area of otolaryngologic sleep medicine in order to design a sleep medicine curriculum for otolaryngology residents. Two web-based surveys were sent to 163 academic otolaryngologists who teach sleep medicine. The first survey determined the topics, and their relative importance, considered most vital to learn during otolaryngology training. Using the Delphi method, the second clarified questions regarding topics determined by the first survey. Sleep medicine learning objectives for residents were ascertained from responses. The response rate of first and second surveys were 24.5% and 19%, respectively. Topics ranked most important for resident education included upper airway anatomy, polysomnogram interpretation, and understanding the range of medical and surgical therapies used to treat sleep disorders. Respondents listed surgical therapy as the most critical topic that most residents do not understand well. The second survey clarified the specific anatomic features, surgical techniques, and polysomnography data points deemed most critical for resident learning. Academic otolaryngology sleep experts hold opinions regarding relative value of different topics for teaching sleep medicine, which is useful in creating a curriculum for otolaryngology residents. Otolaryngology learning objectives related to sleep medicine identified during this study are being used to create an online curriculum to supplement resident education. Copyright © 2016 Elsevier Inc. All rights reserved.
Lu-Myers, Yemeng; Myers, Christopher G
Increasing attention has been paid to the selection of otolaryngology residents, a highly competitive process but one with room for improvement. A recent commentary in this journal recommended that residency programs more thoroughly incorporate theory and evidence from personnel psychology (part of the broader field of organizational science) in the resident selection process. However, the focus of this recommendation was limited to applicants' cognitive abilities and independent work-oriented traits (eg, conscientiousness). We broaden this perspective to consider critical interpersonal skills and traits that enhance resident effectiveness in interdependent health care organizations and we expand beyond the emphasis on selection to consider how these skills can be honed during residency. We advocate for greater use of standardized team-based care simulations, which can aid in assessing and developing the key interpersonal leadership skills necessary for success as an otolaryngology resident.
Hauser, Leah J; Gebhard, Grant M; Blumhagen, Rachel; Carlson, Nichole E; Cabrera-Muffly, Cristina
To identify resident applicant characteristics that increase the odds of matching to otolaryngology residency. Cross-sectional analysis. Residency applications to our institution from 2009 through 2013 were reviewed. The available data represented 81.1% of applicants to otolaryngology programs nationwide. Online public records were searched to determine whether an applicant matched to an otolaryngology residency position. Factors that were significantly associated with the odds of matching were determined using logistic regression. A total of 1,479 unique applications were analyzed. On univariate analysis, 27 demographic, academic, personal, medical school, prior training, and application-specific factors were associated with the odds of matching into otolaryngology. On multivariate analysis, indicators of academic achievement, such as Alpha Omega Alpha Honor Medical Society (AOA) status, whether applicant received awards, and publications, were significantly associated with the odds of matching (odds ratio [OR] 2.03, 1.39, 1.66, respectively). The odds of matching increased with increasing step 1 scores (P otolaryngology residency. Although this information allows medical students to determine the strength of their application, these criteria have not been correlated with resident success. We urge selection committees to begin identifying applicant selection methods that reflect the values we want to cultivate in our future colleagues. N/A. Laryngoscope, 127:1052-1057, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Dermody, Sarah M; Gao, William; McGinn, Johnathan D; Malekzadeh, Sonya
Objective (1) Evaluate the consistency and manner in which otolaryngology residents log surgical cases. (2) Assess the extent of instruction and guidance provided by program directors on case-logging practices. Study Design Cross-sectional national survey. Setting Accreditation Council for Graduate Medical Education otolaryngology residency programs in the United States. Subjects and Methods US otolaryngology residents, postgraduate year 2 through graduating chiefs as of July 2016, were recruited to respond to an anonymous questionnaire designed to characterize surgical case-logging practices. Program directors of US otolaryngology residency programs were recruited to respond to an anonymous questionnaire to elucidate how residents are instructed to log cases. Results A total of 272 residents and 53 program directors completed the survey, yielding response rates of 40.6% and 49.5%, respectively. Perceived accuracy of case logs is low among residents and program directors. Nearly 40% of residents purposely choose not to log certain cases, and 65.1% of residents underreport cases performed. More than 80% of program directors advise residents to log procedures performed outside the operating room, yet only 16% of residents consistently log such cases. Conclusion Variability in surgical case-logging behaviors and differences in provided instruction highlight the need for methods to improve consistency of logging practices. It is imperative to standardize practices across otolaryngology residency programs for case logs to serve as an accurate measure of surgical competency. This study provides a foundation for reform efforts within residency programs and for the Resident Case Log System.
Waller, B; Larsen-Reindorf, R; Duah, M; Opoku-Buabeng, J; Edwards, B M; Brown, D; Moyer, J; Prince, M; Basura, G J
Medical and educational partnerships between high- and low-resourced countries provide opportunities to have a long-term meaningful impact on medical training and healthcare delivery. An otolaryngology partnership between Komfo Anokye Teaching Hospital in Kumasi, Ghana, and the University of Michigan Department of Otolaryngology/Head and Neck Surgery has been undertaken to enhance healthcare delivery at both institutions. A temporal bone dissection laboratory, with the equipment to perform dedicated otological surgery, and academic platforms for clinical and medical education and residency training have been established. This article describes the details of this partnership in otological surgery and hearing health, with an emphasis on creating in-country surgical simulation, training on newly acquired medical equipment and planning regarding the formulation of objectified metrics to gauge progress going forward.
Villwock, Jennifer A; Hamill, Chelsea S; Ryan, Jesse T; Nicholas, Brian D
Objective To determine the availability and purpose of away rotations during otolaryngology residency. Study Design Cross-sectional survey. Setting Otolaryngology residency programs. Subjects and Methods An anonymous web-based survey was sent to 98 allopathic otolaryngology training program directors, of which 38 programs responded. Fisher exact tests and nonparametric correlations were used to determine statistically significant differences among various strata of programs. A P value of 151 miles from the home institution and typically used to address deficiencies in clinical exposure (67%) or case volume (50%). Participants of mandatory away rotations were universally provided housing, with other consideration such as stipend (33%), relocation allowance (33%), or food allowance (16%) sometimes offered. In contrast to mandatory rotations, half of elective rotations were to obtain a unique international mission trip experience. Nearly one-third of surveyed program directors (29%) would consider adding an away rotation to their curriculum in the next 3 years. Conclusions Mandatory and elective away rotations play a role in a small, but not insignificant, number of training programs. The rationale for these rotations is variable. Given that nearly one-third of program directors would consider adding an away rotation in the near future, further research into components of a meaningful away rotation and how to optimize the away rotation experience is warranted.
Full Text Available Introduction: Surgical Training and Education in Promoting Professionalism (STEPP was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of this research was: (i to compare the virtue profiles of our residents with that of the military cohort using a standardized virtue assessment tool; and (ii to assess the value of virtue education on residents. Methods: As part of STEPP, otolaryngology residents participated in a virtue-based validated assessment tool called Virtue in Action (VIA Inventory. This was completed at the initiation of STEPP in July 2011 as well as 1 year later in June 2012. Comparison of the VIA to a military cohort was performed. Leadership ‘Basic Training’ is a series of forums focused on virtues of initiative, integrity, responsibility, self-discipline, and accountability. A pre- and post-test was administered assessing resident perceptions of the value of this ‘Basic Training’. Results: Virtues are shared between otolaryngology residents (n=9 and military personnel (n=2,433 as there were no significant differences in strength scores between two military comparison groups and otolaryngology-head and neck surgery (OHNS residents. There was a significant improvement (p<0.001 in the understanding of components of the leadership vision and a significant improvement in the understanding of key leadership concepts based on ‘Basic Training’. All residents responded in the post-test that the STEPP program was valuable, up from 56%. Conclusions: A virtue-based approach is valued by residents as a part of leadership training during residency.
Schulz, Kristine; Puscas, Liana; Tucci, Debara; Woodard, Charles; Witsell, David; Esclamado, Ramon M.; Lee, Walter T.
Introduction Surgical Training and Education in Promoting Professionalism (STEPP) was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of this research was: (i) to compare the virtue profiles of our residents with that of the military cohort using a standardized virtue assessment tool; and (ii) to assess the value of virtue education on residents. Methods As part of STEPP, otolaryngology residents participated in a virtue-based validated assessment tool called Virtue in Action (VIA) Inventory. This was completed at the initiation of STEPP in July 2011 as well as 1 year later in June 2012. Comparison of the VIA to a military cohort was performed. Leadership ‘Basic Training’ is a series of forums focused on virtues of initiative, integrity, responsibility, self-discipline, and accountability. A pre- and post-test was administered assessing resident perceptions of the value of this ‘Basic Training’. Results Virtues are shared between otolaryngology residents (n=9) and military personnel (n=2,433) as there were no significant differences in strength scores between two military comparison groups and otolaryngology-head and neck surgery (OHNS) residents. There was a significant improvement (p<0.001) in the understanding of components of the leadership vision and a significant improvement in the understanding of key leadership concepts based on ‘Basic Training’. All residents responded in the post-test that the STEPP program was valuable, up from 56%. Conclusions A virtue-based approach is valued by residents as a part of leadership training during residency. PMID:24172053
Svider, Peter F; Gupta, Amar; Johnson, Andrew P; Zuliani, Giancarlo; Shkoukani, Mahdi A; Eloy, Jean Anderson; Folbe, Adam J
Prior to applying or interviewing, most prospective applicants turn to the Internet when evaluating residency programs, making maintenance of a comprehensive website critical. While certain "intangibles" such as reputation may not be communicated effectively online, residency websites are invaluable for conveying other aspects of a program. Prior analyses have reported that certain criteria such as research experience and didactics are important considerations for applicants. To evaluate the comprehensiveness of otolaryngology residency websites. Review of otolaryngology residency program websites. Websites of 99 civilian residency programs were searched for the presence of 23 criteria. Presence of 23 criteria for application process, incentives, instruction, research, clinical training, and other. Only 5 programs contained at least three-quarters of the criteria analyzed; on average programs reported less than 50% of information sought. Among the 99 residency program websites, a description of the following criteria was noted: comprehensive faculty listing (88%), didactics (80%), contact e-mail (77%), current residents (74%), description of facilities (70%), intern schedule (70%), research requirements (69%), otolaryngology rotation schedule (64%), other courses (61%), ERAS (Electronic Residency Application Service) link (55%), year-to-year responsibility progression (47%), call schedule (40%), active/past research projects (37%), area information (34%), message from the program director (33%) or chair (23%), selection criteria (30%), salary (directly on site) (23%), surgical statistics (18%), parking (9%), and meal allowance (7%). The mean (SD) percentage present of factors encompassing "clinical training" was 55% (23%), significantly higher than the mean (SD) percentage of factors covered under the "incentives" category (19% [11%]; P = .01). The proportion of overall criteria present on websites did not differ on organizing programs by region (range, 42
Platt, Michael P; Davis, Elizabeth M; Grundfast, Kenneth; Grillone, Gregory
Within otolaryngology residency training, the annual Otolaryngology Training Examination (OTE) is the primary method used to assess, quantify, and compare the factual knowledge acquired by each resident. The objective of this study was to develop a more frequent method for tracking of factual knowledge to prevent educational delay. Retrospective analysis of educational scores. For each didactic lecture within a single otolaryngology residency training program, multiple choice questions were provided before and after each lecture. Questions were based on lecture objectives that were derived from the American Board of Otolaryngology curriculum. Scores were tracked over the course of 1 academic year and compared to the scores of residents on the OTE administered in that year to determine correlation with a validated measure of factual knowledge. The effect of remedial measures on improvement in OTE scores was determined. Over the course of 1 academic year, there were 328 questions presented to 12 residents before and after 32 lectures in the didactic program. Ten residents completed an average of 244 questions. Overall OTE scores demonstrated a significant and very strong correlation to lecture question scores (Pearson r = 0.86, P = .002). Remedial measures for residents during the previous 5 years who had inadequate OTE scores were successful in improving scores (P = .002). A structured didactic program that uses review questions to assess knowledge can be used to track acquisition of factual knowledge. Early identification of residents with deficiencies facilitates the development of individualized learning plans that result in successful remediation. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Faucett, Erynne A; Barry, Jonnae Y; McCrary, Hilary C; Saleh, Ahlam A; Erman, Audrey B; Ishman, Stacey L
To date, there have been no reports in the current literature regarding the use of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in otolaryngology residency training. An evaluation may help educators address these core competencies in the training curriculum. To examine the quantity and nature of otolaryngology residency training literature through a systematic review and to evaluate whether this literature aligns with the 6 core competencies. A medical librarian assisted in a search of all indexed years of the PubMed, Embase, Education Resources Information Center (via EBSCOhost), Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Methodology Register), Thomson Reuters Web of Science (Science Citation Index Expanded, Social Sciences Citation Index Expanded, Conference Proceedings Citation Index-Science, and Conference Proceedings Citation Index-Social Science and Humanities), Elsevier Scopus, and ClinicalTrials.gov databases to identify relevant English-language studies. Included studies contained original human data and focused on otolaryngology resident education. Data regarding study design, setting, and ACGME core competencies addressed were extracted from each article. Initial searches were performed on May 20, 2015, and updated on October 4, 2016. In this systematic review of 104 unique studies, interpersonal communication skills were reported 15 times; medical knowledge, 48 times; patient care, 44 times; practice-based learning and improvement, 31 times; professionalism, 15 times; and systems-based practices, 10 times. Multiple studies addressed more than 1 core competency at once, and 6 addressed all 6 core competencies. Increased emphasis on nonclinical core competencies is needed, including professionalism, interpersonal and communication skills, and systems-based practices in the otolaryngology residency training curriculum. A formal curriculum
Gnagi, Sharon H; Gnagi, Forrest T; Schraff, Scott A; Hinni, Michael L
Demonstrate the need for increased education regarding otolaryngology-related manifestations of human papillomavirus (HPV). Highlight a need to incorporate otolaryngology-related manifestations of HPV in vaccine counseling. Survey. Tertiary care academic children's hospital. Pediatric residents, fellows, and staff. An online survey was made available regarding HPV education and vaccination. Participants (N = 348) initiated the survey representing 28.4%, 25.6%, and 19.0% postgraduate year 1, 2, and 3 residents, respectively, as well as 17.5% chief residents/fellows and 9.5% attendings. Participants rated their prior education as none or fair regarding recurrent respiratory papillomatosis (63.8%) and oropharyngeal squamous cell carcinoma (68.3%). In contrast, 60.6% and 70.9% rated their education on genital warts and cervical cancer correspondingly as good or excellent. When asked what was routinely discussed during HPV vaccine counseling, 63.3% reported "never" discussing recurrent respiratory papillomatosis and 52.9% "never" discussing oropharyngeal squamous cell carcinoma. A range from 92.7% to 95.5% responded that there was a need for increased education regarding HPV and its role in recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinoma. Increased education about HPV and its otolaryngology-related manifestations should be undertaken to increase provider, patient, and parent awareness of recurrent respiratory papillomatosis and oropharyngeal squamous cell carcinoma. We propose that discussing the risks of otolaryngology-related disease be routinely included in HPV vaccination counseling. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
Musbahi, Omar; Aydin, Abdullatif; Al Omran, Yasser; Skilbeck, Christopher James; Ahmed, Kamran
Otolaryngology is a highly technical and demanding specialty and the requirements for surgical trainees to acquire proficiency remains challenging. Simulation has been purported to be an effective tool in assisting with this. The aim of this systematic review is to identify the available otolaryngology simulators, their status of validation, and evaluation the level of evidence behind each training model and thereby establish a level of recommendation. PubMed, ERIC, and Google Scholar databases were searched for articles that described otolaryngology simulators or training models between 1980 and April 2016. Any validation studies for simulators were also retrieved. Titles and abstracts were screened for relevance using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Level of evidence (LoE) and Level of recommendation (LoR) was awarded to each study and model, respectively. A total of 70 studies were identified describing 64 simulators. Out of these, at least 54 simulators had 1 validation study. Simulators for the ear and temporal bone surgery were the most common (n = 32), followed by laryngeal and throat (n = 20) and endoscopic sinus surgery (n = 12). Face validity was evaluated by 29 studies, 20 attempted to show construct, 20 assessed content, 20 transfer, and only 2 assessed concurrent validity. Of the validation assessments, 2 were classified as Level 1b, 10 Level 2a, and 48 Level 2b. No simulators received the highest LoR, but 8 simulators received a LoR of 2. Despite the lack of evidence in outcome studies and limited number of high-validity otolaryngology simulators, the role of simulation continues to grow across surgical specialties Hence, it is imperative that the simulators are of high validity and construct for trainees to practice and rehearse surgical skills to develop confidence. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Navarro Newball, Andrés A; Hernández, Carlos J; Velez, Jorge A; Munera, Luis E; García, Gregorio B; Gamboa, Carlos A; Reyes, Antonio J
Distance learning can be enhanced with the use of virtual reality; this paper describes the design and initial validation of a Web Environment for Surgery Skills Training on Otolaryngology (WESST-OT). WESST-OT was created aimed to help trainees to gain the skills required in order to perform the Functional Endoscopic Sinus Surgery procedure (FESS), since training centers and specialist in this knowledge are scarce in Colombia; also, it is part of a web based educational cycle which simulates the stages of a real procedure. WESST-OT is one from the WESST family of telesimulators which started to be developed from an architecture proposed at the Medicine Meets Virtual Reality conference 2002; also, it is a step towards the use of virtual reality technologies in Latin America.
Hsueh, Wayne D; Bent, John P; Moskowitz, Howard S
Technological change is leading to an evolution in medical education. The objective of our study was to assess the impact of a medical knowledge app, called PulseQD, on resident education within our otolaryngology-head and neck surgery department at Montefiore Medical Center, Albert Einstein College of Medicine (Bronx, NY). A prospective cohort study was conducted within the Department of Otolaryngology-Head and Neck Surgery from July 2016 to June 2017. All faculty attendings and residents were asked to participate in the study and were included. A Web and mobile-based app, PulseQD, that allowed for collaborative learning was implemented. Questionnaires were given at the beginning and end of the academic year. Otolaryngology Training Exam (OTE) scores were collected RESULTS: A total of 20 residents and 13 faculty members participated in the study. Residents used online sources of medical information significantly more often than faculty (90% and 54%, respectively, P = 0.0179). Residents and faculty felt that PulseQD offered a valuable perspective on clinically relevant medical information (P = 0.0003), was a great way to test clinical and medical knowledge (P = 0.0001), and improved the sharing and discussing of medical knowledge (P academic year. The implementation of a novel mobile app, PulseQD, was well received by residents and faculty in the Department of Otolaryngology-Head and Neck Surgery. Preliminary data suggest that app-based learning may lead to improved performance on knowledge-based assessments. NA. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Henderson, A H; Upile, T; Pilavakis, Y; Patel, N N
Journals increasingly use reporting guidelines to standardise research papers, partly to improve quality. Although defining journal quality is difficult, various calculated metrics are used. This study investigates guideline adoption by otolaryngology journals and whether a relationship exists between this and journal quality. Retrospective MEDLINE database review for English language, Index Medicus, journals of interest to otolaryngologists (October 2013). The resulting journals were examined for the number of guidelines endorsed and then tabulated against surrogate measures of journal quality (Impact factor, Eigenfactor, SCImago, Source-Normalised rank). The primary outcome measure was the number of recognised reporting guidelines endorsed per journal. This was then correlated against journal quality scores. For comparison, a further small sample correlation was performed with 6 randomly selected and 6 high-profile clinical non-otolaryngology journals. 37 otolaryngology journals were identified. Number of guidelines used and quality scores were not normally distributed. Mean guideline usage was 1.0 for otolaryngology journals, 1.5 for randomly selected, and 5.5 for the high-profile journals. Only 18/37 (49%) otolaryngology journals endorsed any guidelines, compared with 11/12 non-otolaryngology journals. Within otolaryngology, Eigenfactor positively correlated with guideline use (r = 0.4, n = 44, p otolaryngology journals is low. Although it might be expected that use of reporting guidelines improved quality, this is not reflected in the derived quality scores in otolaryngology. This may reflect low levels of use/enforcement, that quality indicators are inherently flawed, or that generalised guidelines are not always appropriate or valued by editors. © 2015 John Wiley & Sons Ltd.
Tabrizi, Pooneh R.; Sang, Hongqiang; Talari, Hadi F.; Preciado, Diego; Monfaredi, Reza; Reilly, Brian; Arikatla, Sreekanth; Enquobahrie, Andinet; Cleary, Kevin
Cochlear implantation is the standard of care for infants born with severe hearing loss. Current guidelines approve the surgical placement of implants as early as 12 months of age. Implantation at a younger age poses a greater surgical challenge since the underdeveloped mastoid tip, along with thin calvarial bone, creates less room for surgical navigation and can result in increased surgical risk. We have been developing a temporal bone dissection simulator based on actual clinical cases for training otolaryngology fellows in this delicate procedure. The simulator system is based on pre-procedure CT (Computed Tomography) images from pediatric infant cases (hospital. The simulator includes: (1) simulation engine to provide the virtual reality of the temporal bone surgery environment, (2) a newly developed haptic interface for holding the surgical drill, (3) an Oculus Rift to provide a microscopic-like view of the temporal bone surgery, and (4) user interface to interact with the simulator through the Oculus Rift and the haptic device. To evaluate the system, we have collected 10 representative CT data sets and segmented the key structures: cochlea, round window, facial nerve, and ossicles. The simulator will present these key structures to the user and warn the user if needed by continuously calculating the distances between the tip of surgical drill and the key structures.
Otolaryngology is concerned with the diagnosis and treatment of diseases which affect the mucosal structures of the upper aerodigestive tract and adnexial organs. This editorial outlines the current rate of nuclear medicine in otolaryngology with particular reference to diseases of the thyroid, the parathyroid, the salivary glands, the lacrimal glands, bones of the head and neck, tumours of the head and neck and CSF leaks. (UK)
Bell, Jason R; Ruch-Ross, Holly; Hotaling, Andrew J
This study represents up-to-date information on the current status of and future projections for the pediatric otolaryngology workforce. To provide an update on the practice patterns of and projections for the US pediatric otolaryngology workforce. An online survey was sent to all 172 members of the American Academy of Pediatrics Section on Otolaryngology-Head and Neck Surgery and fielded from May 29, 2014, to September 17, 2014. Current status of and perceived trends in the pediatric otolaryngology workforce. Eighty-four (48.8%) of the 172 members responded to the survey. Not all respondents answered all questions, and so totals and percentages might not reflect a total of 84 for any given response. The demographics and practice characteristics of the responding pediatric otolaryngologists were similar to those noted in a 1997 workforce survey. Fifty-four percent of respondents (n = 38) planned to continue full-time work over the next 5 years, and 47% (n = 31) believed that the number of patients in their practice was increasing. The proportion of those who believed that the need for pediatric otolaryngologists in their community was increasing (31%; n = 21) or decreasing (13%; n = 9) remained relatively constant from the 1997 survey (34% and 12%, respectively). Forty-nine percent (n = 35) reported believing that the number of pediatric otolaryngologists being trained was appropriate and that the need in their community was stable. Eighty-three percent (n = 55) reported believing that employment opportunities for pediatric otolaryngologists in the United States would be plentiful in the near future. The overall state of the pediatric otolaryngology workforce appears stable. The perceived current and future needs for pediatric otolaryngologists appear to be met by the current number of trainees. Employment opportunities appear promising for future pediatric otolaryngologists based on our respondents' opinions. This represents up
Banglawala, Sarfaraz M; Lawrence, Lauren A; Franko-Tobin, Emily; Soler, Zachary M; Schlosser, Rodney J; Ioannidis, John
To assess recent trends in the prevalence and quality of reporting of randomized controlled trials (RCTs) in 4 otolaryngology journals. Methodology and reporting analysis. Randomized controlled trials in 4 otolaryngology journals. All RCTs published from 2011 to 2013 in 4 major otolaryngology journals were examined for characteristics of study design, quality of design and reporting, and funding. Of 5279 articles published in 4 leading otolaryngology journals from 2011 to 2013, 189 (3.3%) were RCTs. The majority of RCTs were clinical studies (86%), with the largest proportion consisting of sinonasal topics (31%). Most interventions were medical (46%), followed by surgical (38%) and mixed (16%). In terms of quality, randomization method was reported in 54% of RCTs, blinding in 33%, and adverse events in 65%. Intention-to-treat analysis was used in 32%; P values were reported in 87% and confidence intervals in 10%. Research funding was most often absent or not reported (55%), followed by not-for-profit (25%). Based on review of 4 otolaryngology journals, RCTs are still a small proportion of all published studies in the field of otolaryngology. There seem to be trends toward improvement in quality of design and reporting of RCTs, although many quality features remain suboptimal. Practitioners both designing and interpreting RCTs should critically evaluate RCTs for quality. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
Nida, Andrew M; Googe, Benjamin J; Lewis, Andrea F; May, Warren L
Resident fatigue has become a point of emphasis in medical education and its effects on otolaryngology residents and their patients require further study. The purpose of our study was to evaluate the prevalence and nature of fatigue in otolaryngology residents, evaluate various quality of life measures, and investigate associations of increased fatigue with resident safety. Anonymous survey. Internet based. United States allopathic otolaryngology residents. None. The survey topics included demographics, residency structure, sleep habits and perceived stress. Responses were correlated with a concurrent Epworth Sleep Scale questionnaire to evaluate effects of fatigue on resident training and quality of life. 190 residents responded to the survey with 178 completing the Epworth Sleep Scale questionnaire. Results revealed a mean Epworth Sleep Scale score of 9.9±5.1 with a median of 10.0 indicating a significant number of otolaryngology residents are excessively sleepy. Statistically significant correlations between Epworth Sleep Scale and sex, region, hours of sleep, and work hours were found. Residents taking in-house call had significantly fewer hours of sleep compared to home call (p=0.01). Residents on "head and neck" (typically consisting of a large proportion of head and neck oncologic surgery) rotations tended to have higher Epworth Sleep Scale and had significantly fewer hours of sleep (p=.003) and greater work hours (potolaryngology residents are excessively sleepy. Our data suggest that the effects of fatigue play a role in resident well-being and resident safety. Copyright © 2016 Elsevier Inc. All rights reserved.
Stavrakas, M; Karkos, P D; Markou, K; Grigoriadis, N
Platelet-rich plasma is a novel material that is being used more frequently in many surgical specialties. A literature review on the current and potential uses of platelet-rich plasma in otolaryngology was performed. There is limited evidence on the use of platelet-rich plasma in otolaryngology compared with other specialties: only 11 studies on various subspecialties (otology, rhinology and laryngology) were included in the final review. Based on the limited number of studies, we cannot draw safe conclusions about the value of platelet-rich plasma in otolaryngology. Nevertheless, the available literature suggests that platelet-rich plasma holds promise for future research and may have a number of clinical applications.
Badran, Karam W; Kelley, Kanwar; Conderman, Christian; Mahboubi, Hossein; Armstrong, William B; Bhandarkar, Naveen D
To identify the prevalence and management of problematic residents. Additionally, we hope to identify the factors associated with successful remediation of unsuccessful otolaryngology residents. Self-reported Internet and paper-based survey. An anonymous survey was distributed to 152 current and former program directors (PDs) in 2012. The factors associated with unsuccessful otolaryngology residents and those associated with the successful remediation of problematic residents were investigated. An unsuccessful resident is defined as one who quit or was removed from the program for any reason, or one whose actions resulted in criminal action or citation against their medical license after graduation from residency. Remediation is defined as an individualized program implemented to correct documented weaknesses. The overall response rate was 26% (40 PDs). Seventy-three unsuccessful or problematic residents were identified. Sixty-six problematic or unsuccessful residents were identified during residency, with 58 of 66 (88%) undergoing remediation. Thirty-one (47%) residents did not graduate. The most commonly identified factors of an unsuccessful resident were: change in specialty (21.5%), interpersonal and communication skills with health professionals (13.9%), and clinical judgment (10.1%). Characteristics of those residents who underwent successful remediation include: poor performance on in-training examination (17%, P otolaryngology PDs in this sample identified at least one unsuccessful resident. Improved methods of applicant screening may assist in optimizing otolaryngology resident selection. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Cabrera-Muffly, Cristina; Chang, C W David; Puscas, Liana
Objectives To identify how applicants to otolaryngology residency determine how to apply to, interview with, and rank programs on the interview trail and to determine the extent of the financial burden of the otolaryngology interview trail. Study Design Web-based survey distributed in March and April 2016. Setting Otolaryngology residency applicants throughout the United States. Subjects and Methods Applicants to otolaryngology residency during the 2016 match cycle and current otolaryngology residents were surveyed. Results Median number of applications, interview offers, interviews attended, and programs ranked was not different during the 2016 match and the previous 5 match years. The most important factor affecting the number of applications was the need to apply widely to ensure sufficient interview offers. The most common reason for declining an interview offer was scheduling conflict. Applicants during the 2016 match spent a median of $5400 applying and interviewing for otolaryngology residency. Conclusions Median number of applications, interview offers, interviews attended, and programs ranked has not changed. The most cited reason for applying to many programs was to increase the chances of matching, but this is not statistically likely to increase match success. We advocate for continued attempts to make the otolaryngology match process more transparent for both applicants and resident selection committees, but recognize that applicants are likely to continue to overapply for otolaryngology residency positions.
Chin, C J; Chin, C A; Roth, K; Rotenberg, B W; Fung, K
In otolaryngology, surgical emergencies can occur at any time. An annual surgical training camp (or 'boot camp') offers junior residents from across North America the opportunity to learn and practice these skills in a safe environment. The goals of this study were to describe the set-up and execution of a simulation-based otolaryngology boot camp and to determine participants' confidence in performing routine and emergency on-call procedures in stressful situations before and after the boot camp. There were three main components of the boot camp: task trainers, simulations and an interactive panel discussion. Surveys were given to participants before and after the boot camp, and their confidence in performing the different tasks was assessed via multiple t-tests. Participants comprised 22 residents from 12 different universities; 10 of these completed both boot camp surveys. Of the nine tasks, the residents reported a significant improvement in confidence levels for six, including surgical airway and orbital haematoma management. An otolaryngology boot camp gives residents the chance to learn and practice emergency skills before encountering the emergencies in everyday practice. Their confidence in multiple skillsets was significantly improved after the boot camp. Given the shift towards competency-based learning in medical training, this study has implications for all surgical and procedural specialties.
Lin, Jiahui; Kacker, Ashutosh; Trujillo, Oscar; Stewart, Michael G
This article focuses on the hiring trends of academic general otolaryngology practices to clarify the status of academic general otolaryngology in the face of today's changing medical landscape. Cross-sectional study. We conducted a survey to evaluate past, present, and projected hiring issues in academic otolaryngology, specifically related to general otolaryngology. Surveys were sent via e-mail to all academic chairpersons of accredited otolaryngology residency programs in the United States. Data included faculty appointments, work hours, clinical and research roles, academic productivity, patient load, promotions, and criteria for future hires. The response rate was 34.3%. On average, general otolaryngologists (generalists) represented 17% of otolaryngology faculty in academic practices. Whereas most generalists were employed as assistant professors (65%), nearly half of promotions in recent years were given to generalists (49%). Between 2009 and 2014, there was an average of six new hires per academic otolaryngology practice (range: 1-13); of these new hires, 21% were generalists. Chairpersons estimated that in the next 5 years they would hire an average of three new otolaryngologists per practice (range: 0-7), of whom 39% would be generalists. Although 82% of chairpersons reported an increase in subspecialty hires, 94% reported that they would also require the same or increasing numbers of generalists. Despite the increase in subspecialization in academic otolaryngology, the role of general otolaryngologists in academic practices will continue to be important and perhaps will increase. N/A. Laryngoscope, 126:1995-1998, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Bhattacharyya, Neil; Lin, Harrison W
The Medicare provider utilization and payment public use datafile for 2012 was analyzed with respect to otolaryngology specialty providers to characterize otolaryngology services billed to and reimbursed by Medicare, both overall and according to provider characteristics. Among 8450 otolaryngology specialty providers submitting claims, the top 5 billed services were (count in millions): 99213 (2.23), 95165 (1.81), 99203 (0.92), 99214 (0.83), and 69210 (0.71), and the top 5 total reimbursed services were (aggregate total reimbursements in millions): 99213 ($114), 99203 ($68), 99214 ($63), 31231 ($60), and 31575 ($47). There was a mean of 1567 services billed per provider with an average (yearly) total reimbursement from Medicare of $76,068 per provider. These data characterize the current level of provision of otolaryngology services to the Medicare population. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.
Encinas-Vicente, Alberto; Prim-Espada, María Pilar; Cenjor-Español, Carlos; de Diego-Sastre, Juan Ignacio
The writing of a thesis has 2 main objectives: the appropriate training to be a good researcher and the publication of the first original research work. This study attempted to check this statement applied to theses in Otolaryngology by analysing the variation in the authors' publications. We used the database TESEO to obtain the data relative to Otolaryngology theses in Spain published between 1993 and 2003. We found the publications of each author by using de programme "Publish or Perish" and we analysed the variations in their work in 3 periods (prior to, around and after thesis publication). The publications, the citations and the parameters analysed all increased in the second and third periods (around and after) with regard to the first period. However, there were no significant differences in some of them in the first 2 periods. The elaboration of a thesis in Otolaryngology increased the scientific production of its author. Almost a third of the authors did not publish any work. There was a significant increase in all the parameters studied and the bibliometric indices between the period before thesis publication and the around and after thesis periods. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.
Gettelfinger, John D; Paulk, P Barrett; Schmalbach, Cecelia E
Objective The breadth and depth of patient safety/quality improvement (PS/QI) research dedicated to otolaryngology-head and neck surgery (OHNS) education remains unknown. This systematic review aims to define this scope and to identify knowledge gaps as well as potential areas of future study to improved PS/QI education and training in OHNS. Data Sources A computerized Ovid/Medline database search was conducted (January 1, 1965, to May 15, 2015). Similar computerized searches were conducted using Cochrane Database, PubMed, and Google Scholar. Review Methods The study protocol was developed a priori using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were classified by year, subspecialty, Institute of Medicine (IOM) Crossing the Chasm categories, and World Health Organization (WHO) subclass. Results Computerized searches yielded 8743 eligible articles, 267 (3.4%) of which met otolaryngology PS/QI inclusion criteria; 51 (19%) were dedicated to resident/fellow education and training. Simulation studies (39%) and performance/competency evaluation (23.5%) were the most common focus. Most projects involved general otolaryngology (47%), rhinology (18%), and otology (16%). Classification by the IOM included effective care (45%), safety/effective care (41%), and effective and efficient care (7.8%). Most research fell into the WHO category of "identifying solutions" (61%). Conclusion Nineteen percent of OHNS PS/QI articles are dedicated to education, the majority of which are simulation and focus on effective care. Knowledges gaps for future research include facial plastics PS/QI and the WHO category of "studies translating evidence into safer care."
Scalzitti, Nicholas; Brennan, Joseph; Bothwell, Nici; Brigger, Matthew; Ramsey, Mitchell; Gallagher, Thomas; Maturo, Stephen
During the wars in Iraq and Afghanistan, the US military has continued to train medical residents despite concern that postgraduate medical education at military training facilities has suffered. This study compares the experience of otolaryngology residents at military programs with the experience of their civilian counterparts. Retrospective review. Academic military medical centers. Resident caseload data and board examination passing rates were requested from each of the 6 Department of Defense otolaryngology residency programs for 2001 to 2010. The American Board of Otolaryngology and the Accreditation Council for Graduate Medical Education provided the national averages for resident caseload. National board passing rates from 2004 to 2010 were also obtained. Two-sample t tests were used to compare the pooled caseloads from the military programs with the national averages. Board passing rates were compared with a test of proportions. Data were available for all but one military program. Regarding total cases, only 2001 and 2003 showed a significant difference (P < .05), with military residents completing more cases in those years. For individual case categories, the military averages were higher in Otology (299.6 vs 261.2, P = .033) and Plastics/Reconstruction (248.1 vs 149.2, P = .003). Only the Head & Neck category significantly favored the national average over the military (278.3 and 226.0, P = .039). The first-time board passing rates were identical between the groups (93%). Our results suggest that the military otolaryngology residency programs are equal in terms of caseload and board passing rates compared with civilian programs over this time period.
Schmalbach, Cecelia E
Current otolaryngology literature and future scientific direction rely heavily on a rigorous peer review process. Just as manuscripts warrant thoughtful review with constructive feedback to the authors, the same can be said for critiques written by novice peer reviewers. Formal scientific peer review training programs are lacking. Recognizing this knowledge gap, Otolaryngology-Head and Neck Surgery is excited to offer its new Resident Reviewer Development Program. All otolaryngology residents who are postgraduate year 2 and above and in excellent academic standing are eligible to participate in this mentored program, during which they will conduct 6 manuscript reviews under the direction of a seasoned reviewer in his or her subspecialty area of interest. By completing reviews alongside a mentor, participants gain the required skills to master the peer review process-a first step that often leads to journal editorial board and associate editor invitations. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
Verkerk, M M; Wagner, R; Fishchuk, R; Fagan, J J
The present humanitarian crisis in Ukraine is putting strains on its healthcare system. This study aimed to assess services and training in otolaryngology, audiology and speech therapy in Ukraine and its geographical neighbours. Survey study of 327 otolaryngologists from 19 countries. Fifty-six otolaryngologists (17 per cent) from 15 countries responded. Numbers of otolaryngologists varied from 3.6 to 12.3 per 100 000 population (Ukraine = 7.8). Numbers of audiologists varied from 0, in Ukraine, to 2.8 per 100 000, in Slovakia, and numbers of speech therapists varied from 0, in Bulgaria, to 4.0 per 100 000, in Slovenia (Ukraine = 0.1). Ukraine lacks newborn and school hearing screening, good availability of otological drills and microscopes, and a cochlear implant programme. There is wide variation in otolaryngology services in Central and Eastern Europe. All countries surveyed had more otolaryngologists per capita than the UK, but availability of audiology and speech and language therapy is poor. Further research on otolaryngology health outcomes in the region will guide service improvement.
Golub, Justin S; Ossoff, Robert H; Johns, Michael M
Assess fellowship and academic/private practice career track preferences in residents of otolaryngology-head and neck surgery. Cross-sectional survey. A total of 1,364 U.S. otolaryngology residents were surveyed. Questions addressed demographics, work hours and sleep, fellowship preference, and career track preference (academic/private practice). Trends in fellowship and career track preference were analyzed by year of clinical otolaryngology training. Data were additionally analyzed after stratification by sex. The response rate was 50%. The desire to complete a fellowship declined from 62% (year 2) to 58% (year 5), whereas the desire to not complete a fellowship increased from 31% (year 2) to 41% (year 5). Fellowship interest increased for rhinology and head and neck surgery by training year, whereas interest declined for neurotology and facial plastics. Expectation of an academic path increased from 29% (year 2) to 38% (year 5), whereas expectation of private practice declined slightly from 59% (year 2) to 57% (year 5). Women were initially more interested in both completing a fellowship (69% women, 60% men) and academics (40% women, 27% men). At the end of training, these sex differences were eliminated or reversed (59% men, 54% women for fellowship; 39% men, 35% women for academics). Residents interested in pursuing fellowship or academics reported working 2 hr/week more than those interested in no fellowship or private practice, respectively (P career track preferences suggest trends that may be useful to residency/fellowship program directors and residents making career choices. Inequalities producing differences according to sex should be addressed. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Stepan, L; Shaw, C-K L; Oue, S
Temporomandibular disorder poses a diagnostic challenge to otolaryngologists as orofacial pain, headache and otology symptoms are very common in temporomandibular disorder, and mimic a number of otolaryngological conditions. Missed diagnosis of temporomandibular disorder can lead to unnecessary investigation and treatment, resulting in further patient suffering. To review the current literature and propose management pathways for otolaryngologists to correctly differentiate temporomandibular disorder from other otolaryngological conditions, and to initiate effective treatment for temporomandibular disorder in collaboration with other health professionals. A systematic review using PubMed and Medline databases was conducted, and data on temporomandibular disorder in conjunction with otolaryngological symptoms were collected for analysis. Of 4155 potential studies, 33 were retrieved for detailed evaluation and 12 met the study criteria. There are questionnaires, examination techniques and radiological investigations presented in the literature to assist with distinguishing between otolaryngological causes of symptoms and temporomandibular disorder. Simple treatment can be initiated by the otolaryngologist. Initial temporomandibular disorder treatment steps can be undertaken by the otolaryngologist, with consideration of referral to dentists, oral and maxillofacial surgeons, or physiotherapists if simple pharmacological treatment or temporomandibular disorder exercise fails.
Eloy, Jean Anderson; Mady, Leila J; Svider, Peter F; Mauro, Kevin M; Kalyoussef, Evelyne; Setzen, Michael; Baredes, Soly; Chandrasekhar, Sujana S
To identify whether regional differences exist in gender disparities in scholarly productivity and faculty rank among academic otolaryngologists. Academic otolaryngologists' bibliometric data analyses. Online faculty listings from 98 otolaryngology departments were organized by gender, academic rank, fellowship training status, and institutional location. The Scopus database was used to assess bibliometrics of these otolaryngologists, including the h-index, number of publications, and publication experience. Analysis included 1127 otolaryngologists, 916 men (81.3%) and 211 women (18.7%). Female faculty comprised 15.4% in the Midwest, 18.8% in the Northeast, 21.3% in the South, and 19.0% in the West (P = .44). Overall, men obtained significantly higher senior academic ranks (associate professor or professor) compared to women (59.8% vs. 40.2%, P .05). Gender disparities in academic rank and scholarly productivity exist most notably in the Northeast, where women in otolaryngology are most underrepresented relative to men at senior academic ranks and in scholarly productivity.
Kaper, N M; Swart, K M A; Grolman, W; Van Der Heijden, G J M G
High-quality trials have the potential to influence clinical practice. Ten otolaryngology journals with the highest 2011 impact factors were selected and publications from 2010 were extracted. From all medical journals, the 20 highest impact factor journals were selected, and publications related to otolaryngology for 2010 and 2011 were extracted. For all publications, the reporting quality and risk of bias were assessed. The impact factor was 1.8-2.8 for otolaryngology journals and 6.0-101.8 for medical journals. Of 1500 otolaryngology journal articles, 262 were therapeutic studies; 94 had a high reporting quality and 5 a low risk of bias. Of 10 967 medical journal articles, 76 were therapeutic studies; 57 had a high reporting quality and 8 a low risk of bias. Reporting quality was high for 45 per cent of otolaryngology-related publications and 9 per cent met quality standards. General journals had higher impact factors than otolaryngology journals. Reporting quality was higher and risk of bias lower in general journals than in otolaryngology journals. Nevertheless, 76 per cent of articles in high impact factor journals carried a high risk of bias. Better reported and designed studies are the goal, with less risk of bias, especially in otolaryngology journals.
Bowe, Sarah N
The Clinical Learning Environment Review focuses on the responsibility of the sponsoring institution for quality and patient safety. Very little information is known regarding the status of quality improvement (QI) education during otolaryngology training. The purpose of this survey is to evaluate the extent of resident and faculty participation in QI and identify opportunities for both resident curriculum and faculty development. Cross-sectional survey A 15-item survey was distributed to all 106 otolaryngology program directors. The survey was developed after an informal review of the literature regarding education in QI and patient safety. Questions were directed at the format and content of the QI curriculum, as well as barriers to implementation. There was a 39% response rate. Ninety percent of responding program directors considered education in QI important or very important to a resident's future success. Only 23% of responding programs contained an educational curriculum in QI, and only 33% monitored residents' individual outcome measures. Barriers to implementation of a QI program included inadequate number of faculty with expertise in QI (75%) and competing resident educational demands (90%). Every program director considered morbidity and mortality conferences as an integral component in QI education. Program directors recognize the importance of QI in otolaryngology practice. Unfortunately, this survey identifies a distinct lack of resources in support of these educational goals. The results highlight the need to generate a comprehensive and stepwise approach to QI for faculty development and resident instruction. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
Moore, Eric J; Price, Daniel L; Van Abel, Kathryn M; Carlson, Matthew L
Application to otolaryngology-head and neck surgery residency is highly competitive, and the interview process strives to select qualified applicants with a high aptitude for the specialty. Commonly employed criteria for applicant selection have failed to show correlation with proficiency during residency training. We evaluate the correlation between the results of a surgical aptitude test administered to otolaryngology resident applicants and their performance during residency. Retrospective study at an academic otolaryngology-head and neck surgery residency program. Between 2007 and 2013, 224 resident applicants participated in a previously described surgical aptitude test administered at a microvascular surgical station. The composite score and attitudinal scores for 24 consecutive residents who matched at our institution were recorded, and their residency performance was analyzed by faculty survey on a five-point scale. The composite and attitudinal scores were analyzed for correlation with residency performance score by regression analysis. Twenty-four residents were evaluated for overall quality as a clinician by eight faculty members who were blinded to the results of surgical aptitude testing. The results of these surveys showed good inter-rater reliability. Both the overall aptitude test scores and the subset attitudinal score showed reliability in predicting performance during residency training. The goal of the residency selection process is to evaluate the candidate's potential for success in residency and beyond. The results of this study suggest that a simple-to-administer clinical skills test may have predictive value for success in residency and clinician quality. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Gradzki, J.; Paprzycki, W.
In the paper authors describe fundamental physical properties of a phenomenon of the radio-frequency excitation and relaxation of nuclei ordered in a strong magnetic field and the usefulness of MRI in medical diagnostic procedures. Basic interpretations principles of MR imaging due to signal intensity differences between organs and tissues in T 1 - and T 2 - weighted sequences and proton density are presented. Both, literature review and experience of authors suggest application of MRI in otolaryngology, it is illustrated by a lot of examples. The MR imaging studies were compared with results obtained from CT in otolaryngology field. (author)
Parekh, Jai; Pankratov, Michail M.; Poe, Dennis S.; Rebeiz, Elie E.; Shapshay, Stanley M.
Endoscopy has revolutionized the field of medicine and surgery by aiding the clinician in diagnostic and therapeutic modalities of patient care. Endoscopy in Otolaryngology has provided the surgeon with unique access to areas of the head and neck which were previously inaccessible for direct inspection in an atraumatic and minimally invasive fashion. Specific areas of Otolaryngology where endoscopy has made advances are the rhinology and otology. The relevant anatomy, clinical requirements, and `state of the art' endoscopic techniques are discussed for these areas. Further advances in endoscopy for otolaryngology requires the cooperation from both the clinical and technical standpoints.
Cabrera-Muffly, Cristina; Sheeder, Jeanelle; Abaza, Mona
To examine fluctuations in supply and demand of otolaryngology residency positions after the shift from an "early match" coordinated by the San Francisco match to a "conventional" matching process through the National Residency Matching Program (NRMP). To determine whether competition among otolaryngology residency positions have changed during this time frame. Database analysis. Matching statistics from 1998 to 2013 were obtained for all first-year residency positions through the NRMP. Matching statistics from 1998 to 2005 were obtained for otolaryngology residency positions through the San Francisco match. Univariate analysis was performed, with a P value less than .05 determined as significant. The number of otolaryngology positions and applicants remained proportional to the overall number of positions and applicants in the NRMP match. Otolaryngology applicants per position and the matching rate of all applicants did not change between the 2 time periods studied. The overall match rate of US seniors applying to otolaryngology did not change, while the match rate of non-US seniors decreased significantly following initiation of the conventional match. There was no significant change in United States Medical Licensing Exam step 1 scores or percentage of unfilled otolaryngology residency positions between the 2 time periods. When comparing the early versus conventional otolaryngology match time periods, the only major change was the decreased percentage of matching among non-US senior applicants. Despite a significant shift in match timing after 2006, the supply, demand, and competitiveness of otolaryngology residency positions have not changed significantly. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
Lennon, Christen J; Hunter, Jacob B; Mistry, Akshitkumar M; Espahbodi, Mana; Deasey, Matthew; Niesner, K J; Labadie, Robert F
Objective Analyze grants awarded between 2005 and 2014 to otolaryngology departments that appear in the National Institutes of Health (NIH) RePORTER database, summarize characteristics of grant recipients associated with otolaryngology departments as listed in the RePORTER between 2005 and 2014, and identify trends in otolaryngology NIH funding between 2005 and 2014 by topic. Study Design Case series. Setting NIH database inquiry. Subjects Grant recipients. Methods The RePORTER was queried for all grants awarded to otolaryngology departments between 2005 and 2014. All grants classified as new, renewal, or revision were included while duplicates were excluded. Results In total, 475 grants to 51 institutions were categorized by topic and subtopic. Internet searches were conducted for characteristics of 352 principal investigators. Sixty-seven percent of awardees had a PhD, 22% had an MD, and 11% had an MD/PhD. Sex ratios varied by degrees held. Although 31% of all grant recipients were women, this ratio was not seen when recipients were classified by degree type, with 78% of women holding a PhD compared with 55% of men ( P = .0013). Of the award types, 39% were R01s, 15% were R21s, and 10% were R03s. The top 3 represented topics were otology/neurotology (52%), audiology (25%), and head and neck surgery (14%). The mean annual award amount, after adjusting for inflation to 2014 dollars, was $226,495.76, with 72.8% awarded by the National Institute of Deafness and Communication Disorders. Twenty percent of awardees received multiple grants. Conclusion NIH funding in otolaryngology tends to be awarded to those with PhDs studying the hearing sciences, with 1 in 5 having multiple awards. As in other areas of NIH funding, women are underrepresented overall.
Smith, Alden; Handorf, Elizabeth; Arjmand, Ellis; Lango, Miriam N
To describe geographic variation in spending and evaluate regional Medicare expenditures for otolaryngologist services with population- and beneficiary-related factors, physician supply, and hospital system factors. Cross-sectional study. The average regional expenditures for otolaryngology physician services were defined as the total work relative value units (wRVUs) collected by otolaryngologists in a hospital referral region (HRR) per thousand Medicare beneficiaries in the HRR. A multivariable linear regression model tested associations with regional sociodemographics (age, sex, race, income, education), the physician and hospital bed supply, and the presence of an otolaryngology residency program. In 2012, the mean Medicare expenditure for otolaryngology provider services across HRRs was 224 wRVUs per thousand Medicare beneficiaries (standard deviation [SD] 104), ranging from 31 to 604 wRVUs per thousand Medicare beneficiaries. In 2013, the average Medicare expenditures for each HRR was highly correlated with expenditures collected in 2012 (Pearson correlation coefficient .997, P = .0001). Regional Medicare expenditures were independently and positively associated with otolaryngology, medical specialist, and hospital bed supply in the region, and were negatively associated with the supply of primary care physicians and presence of an otolaryngology residency program after adjusting for other factors. The magnitude of associations with physician supply and hospital factors was stronger than any population or Medicare beneficiary factor. Wide variations in regional Medicare expenditures for otolaryngology physician services, highly stable over 2 years, were strongly associated with regional health system factors. Changes in health policy for otolaryngology care may require coordination with other physician specialties and integrated hospital systems. NA. Laryngoscope, 127:1312-1317, 2017. © 2016 The American Laryngological, Rhinological and Otological Society
Hu, Amanda; Sibert, Thomas; Zhao, Wei; Zarro, Vincent
To determine the otolaryngology needs in a free clinic providing care to medically indigent patients, as perceived by the patients and health care providers. Cross-sectional survey. A survey was administered to patients and health care providers of a free clinic from September 2014 through January 2015 in an urban, inner-city location. One hundred and thirty-seven patients (35.8% male, age 50.8 ± 13.0 years) completed the survey. Mean household income was $29,838 ± $10,425; 32.1% spoke English; 54.7% were employed; 10.2% had health insurance; and 37.2% had seen a primary care provider outside of the free clinic. The top three otolaryngology symptoms among patients were sleep apnea/snoring (39.4%), heartburn/reflux (30.7%), and dizziness (29.9%). Eleven health care providers (45% male, age 50.5 ± 15.3 years, 63.6% physician, 36% nurse) completed the survey. Providers perceived the following otolaryngology complaints as the most prevalent, in descending order: cough, nasal congestion, reflux/heartburn, sore throat, and ear infection/otalgia. Providers felt that sleep apnea and hearing loss were the less common otolaryngology complaints, whereas surveyed patients indicated these symptoms with high frequency. The most requested diagnostic tool among patients and providers was chest X-rays. There are unmet otolaryngology needs in a free clinic. Medically indigent patients have significant barriers to accessing health care. Patient and provider perceptions of top otolaryngology complaints differed, but both identified access to chest X-rays as a major unmet need. Knowledge of patient perceptions may help providers elicit the breadth of otolaryngology complaints. 4. Laryngoscope, 126:1321-1326, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Cheung, Veronique Wan Fook; Lam, Gilbert O A; Wang, Yun Fan; Chadha, Neil K
Duplicate publication--deemed highly unethical--is the reproduction of substantial content in another article by the same authors. In 1999, Rosenthal et al. identified an 8.5% incidence of duplicate articles in two otolaryngology journals. We explored the current incidence in three otolaryngology journals in North America and Europe. Retrospective literature review. Index articles in 2008 in Archives of Otolaryngology-Head and Neck Surgery, Laryngoscope, and Clinical Otolaryngology were searched using MEDLINE. Potential duplicate publications in 2006 through 2010 were identified using the first, second, and last authors' names. Three authors independently investigated suspected duplicate publications--classifying them by degree of duplication. Of 358 index articles screened, 75 (20.9%) had 119 potential duplicates from 2006 to 2010. Full review of these 119 potential duplicates revealed a total of 40 articles with some form of redundancy (33.6% of the potential duplicates) involving 27 index articles (7.5% of 358 index articles); one (0.8%) "dual" publication (identical or nearly identical data and conclusions to the index article); three (2.5%) "suspected" dual publications (less than 50% new data and same conclusions); and 36 (30.3%) publications with "salami-slicing" (portion of the index article data repeated) were obtained. Further analysis compared the likelihood of duplicate publication by study source and subspecialty within otolaryngology. The incidence of duplicate publication has not significantly changed over 10 years. "Salami-slicing" was a concerning practice, with no cross-referencing in 61% of these cases. Detecting and eliminating redundant publications is a laborious task, but it is essential in upholding the journal quality and research integrity. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.
Wong, Kevin; Grundfast, Kenneth M; Levi, Jessica R
Previous studies have suggested that musculoskeletal symptoms are common among practicing otolaryngologists. Early training can be the ideal time to foster knowledge of ergonomics and develop safe work habits, however, little data exists regarding musculoskeletal symptoms in residents. The purpose of this study was to identify and characterize musculoskeletal symptoms in a preliminary sample of otolaryngology residents. A cross-sectional survey incorporating the Nordic Musculoskeletal Questionnaire was sent to 30 Otolaryngology-Head and Neck Surgery residencies to examine musculoskeletal symptoms among residents. A two-sample test of proportions was performed to compare symptoms between male and female residents. In total, 141 respondents (response rate=34.7%) completed the survey. Fifty-five percent of survey respondents were male and 45% were female. Musculoskeletal symptoms were most frequently reported in the neck (82.3%), followed by the lower back (56%), upper back (40.4%), and shoulders (40.4%). The most common symptoms were stiffness in the neck (71.6%), pain in the neck (61.7%), and pain in the lower back (48.2%). In total, 6.4% of residents missed work and 16.3% of residents stopped during an operation at some point due to their symptoms. Most residents (88.3%) believed their musculoskeletal symptoms were attributed to their surgical training. Female residents were significantly more likely to experience neck (p<0.0001) and wrist/hand (p=0.019) discomfort compared to male residents. Musculoskeletal symptoms were common among residents, approaching rates similar to those previously identified in practicing otolaryngologists. Increased emphasis on surgical ergonomics is warranted to improve workplace safety and prevent future injury. Copyright © 2017. Published by Elsevier Inc.
Whittemore, Kenneth R; Dargie, Jenna M; Dornan, Briana K; Boudreau, Brian
To determine the usage of otolaryngology services by children with cleft palate at a pediatric tertiary care facility. Retrospective case series. Specialty clinic at a pediatric tertiary care hospital. Children born between January 1, 1999, and December 31, 2002, with the diagnosis of cleft palate or cleft lip and palate. A total of 41 female and 48 male patients were included. Total number of otolaryngology clinic visits and total number of otolaryngologic surgeries (tympanostomy tube placements and other otologic or upper airway procedures). In the first 5 years of life, these children utilized an average of 8.2 otolaryngology clinic visits (SD = 5.0; range: 1-22) and underwent 3.3 tympanostomy tube surgeries (SD = 2.0; range: 0-10). Seventy-three had their first tube placed at the time of palate repair, and 4 at the time of lip repair. Fifty-one (57.3%) required other otologic or upper airway procedures, including tonsillectomy and/or adenoidectomy (27 children), removal of tympanostomy tubes (24 children), tympanomastoidectomy (3 children), and tympanoplasty (14 children). Of the children who underwent other procedures, they underwent a mean of 1.67 (SD = 0.84; range: 1-4) surgeries. Children with cleft palate are at increased risk for eustachian tube dysfunction, frequently utilize otolaryngology care, and typically receive multiple sets of tympanostomy tubes. This study found that children with cleft palate receive on average of approximately 3 sets of tympanostomy tubes, and the majority required another otologic or upper airway surgery.
Tolisano, Anthony M; Song, Sungjin A; Cable, Benjamin B
To determine the prevalence of author self-citation in the field of otolaryngology. A retrospective review of bibliographic references in 5 otolaryngology journals. Five high-impact otolaryngology journals were reviewed over a 3-month period between January and March 2014 to identify the pattern of author self-citations. Data included study type, otolaryngology topic, authorship, total citations, author self-citations, and country of origin. Nearly two-thirds of articles contained at least 1 self-citation, with an average of 2.6 self-citations per article. Self-citations represented nearly 10% of total citations. Articles with at least 1 self-citation had more authors (5.8 vs 4.9, P otolaryngology literature is common and compares similarly to other medical specialties previously studied. Self-citation should not be considered inappropriate, as it is often done to expand on earlier research. Nevertheless, editors, researchers, and readers should be aware of this increasingly recognized phenomenon and its associated potential implications to the process of scientific inquiry. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
Naunheim, Matthew R; Kozin, Elliot D; Sethi, Rosh K; Ota, H Gregory; Gray, Stacey T; Shrime, Mark G
Dedicated otolaryngology emergency rooms (ERs) provide a unique mechanism of health care delivery. Relative costs and willingness to pay (WTP) for these services have not been studied. This study aims to provide a cost-benefit analysis of otolaryngology-specific ER care. Cost-benefit analysis based on contingent valuation surveys. An otolaryngology-specific ER in a tertiary care academic medical center. Adult English-speaking patients presenting to an otolaryngology ER were included. WTP questions were used to assess patient valuations of specialty emergency care. Sociodemographic data, income, and self-reported levels of distress were assessed. State-level and institution-specific historical cost data were merged with WTP data within a cost-benefit analysis framework. The response rate was 75.6%, and 199 patients were included in the final analysis. Average WTP for otolaryngology ER services was $319 greater than for a general ER (95% CI: $261 to $377), with a median value of $200. The historical mean cost per visit at a general ER was $575, and mean cost at the specialty ER was $551 (95% CI: $529 to $574). Subtracting incremental cost from incremental WTP yielded a net benefit of $343. Dedicated otolaryngology ER services are valued by patients for acute otolaryngologic problems and have a net benefit of $343 per patient visit. They appear to be a cost-beneficial method for addressing acute otolaryngologic conditions. This study has implications for ER-based otolaryngologic care and direct-to-specialist services. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.
Powell, J; Powell, S; Robson, A
Recently, there has been increased emphasis on the development and application of patient-reported outcome measures. This drive to assess the impact of illness or interventions, from the patient's perspective, has resulted in a greater number of available questionnaires. The importance of selecting an appropriate patient-reported outcome measure is specifically emphasised in the paediatric population. The literature on patient-reported outcome measures used in paediatric otolaryngology was reviewed. A comprehensive literature search was conducted using the databases Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo, using the terms: 'health assessment questionnaire', 'structured questionnaire', 'questionnaire', 'patient reported outcome measures', 'PROM', 'quality of life' or 'survey', and 'children' or 'otolaryngology'. The search was limited to English-language articles published between 1996 and 2016. The search yielded 656 articles, of which 63 were considered relevant. This included general paediatric patient-reported outcome measures applied to otolaryngology, and paediatric otolaryngology disease-specific patient-reported outcome measures. A large collection of patient-reported outcome measures are described in the paediatric otolaryngology literature. Greater standardisation of the patient-reported outcome measures used in paediatric otolaryngology would assist in pooling of data and increase the validation of tools used.
ANCA MARIA CIMPEAN
Full Text Available Otolaryngology is mainly associated with clinical practice. Despite of this actual evidence, otolaryngology can be considered, from historical point of view as a complex speciality made up of a mixture of several preclinical specialities as anatomy, histology, pathology and physiology. Several scientists who studied these specialities first, became then otolaryngologists and others were known in the medical literature because of their studies in other specialities than otolaryngology. Most of the historical papers were focused on the ear, other regions being neglected. This review presents the forgotten part of otolaryngology, especially its preclinical facts with importance in etiology and pathogenesis of various disease of the ear, nose and throat structures and thus, present work can be considered as a particular overview of „forgotten” otolaryngology
Cohen, Seth M; Kim, Jaewhan; Roy, Nelson; Courey, Mark
To evaluate the frequency, timing, and factors that influence referral of patients with laryngeal/voice disorders to otolaryngology following initial evaluation by a primary care physician (PCP). Retrospective analysis of a large, national administrative US claims database. Patients with a laryngeal disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by a PCP as an outpatient (with or without otolaryngology involvement), and continuously enrolled for 12 months were included. Patient age, gender, geographic region, last PCP laryngeal diagnosis, comorbid conditions, time from first PCP visit to first otolaryngology visit, number of PCP outpatient visits, and number of PCP laryngeal diagnoses were collected. Cox and generalized linear regressions were performed. A total of 149,653 unique patients saw a PCP as an outpatient for a laryngeal/voice disorder, with 136,152 (90.9%) only seeing a PCP, 6,013 (4.0%) referred by a PCP to an otolaryngologist, and 3,820 (2.6%) self-referred to an otolaryngologist. Acute laryngitis had a lower hazard ratio (HR) for otolaryngology referral than chronic laryngitis, nonspecific dysphonia, and laryngeal cancer. Having multiple comorbid conditions was associated with a greater HR for otolaryngology referral than having no comorbidities. Patient age, gender, and geographic region also affected otolaryngology referral. The time to otolaryngology evaluation ranged from 3 months. PCP-referred patients had less time to the otolaryngology evaluation than self-referred patients. Multiple factors affected otolaryngology referral for patients with laryngeal/voice disorders. Further education of PCPs regarding appropriate otolaryngology referral for laryngeal/voice disorders is needed. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.
Megwalu, Uchechukwu C; Lee, Jennifer Y
To assess health literacy in an adult tertiary care otolaryngology clinic population and to explore potential determinants of inadequate health literacy. Cross-sectional study. Tertiary care otolaryngology clinic. The study population included all adult patients treated at 3 of Stanford University's adult otolaryngology clinic sites between March 1 and 11, 2016. Data were collected via an anonymous questionnaire. Health literacy was assessed with the Brief Health Literacy Screen. Ten percent of patients had inadequate health literacy. White race (odds ratio [OR], 0.23) and having English as the primary language (OR, 0.12) were associated with adequate health literacy, while high school or lower level of education (OR, 3.2) was associated with inadequate health literacy. Age, sex, and Hispanic ethnicity were not associated with health literacy. Our study highlights the need for health literacy screening in the otolaryngology clinic setting and identifies sociodemographic risk factors for inadequate health literacy. Further studies are needed to assess the impact of health literacy on patient outcomes and to test specific interventions to address health literacy and health outcomes. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
Royer, Mark C; Royer, Allison K
The objective of this study was to develop an otolaryngology consult cart system to ensure prompt delivery to the bedside of all the unique equipment and medications required for emergent and urgent otolaryngology consults. An otolaryngology practice responsible for emergency room and hospital consult coverage sought to create a cart containing all equipment, medications, and supplies for otolaryngology consults. Meetings with hospital administration and emergency room, nursing, pharmacy, central processing, and operating room staff were held to develop a system for the emergent delivery of the cart to the needed location, sterilization and restocking of equipment between uses, and appropriate billing of supplies. Two months were required from conception to implementation. All equipment was purchased new, including flexible scopes and headlights. The cart is sterilized, restocked, and maintained by central processing after each use. The equipment is available to handle all airway emergencies as well as all common otolaryngology consults and is delivered bedside in less than 5 minutes. The development of a self-contained otolaryngology consult cart requires coordination with a wide variety of hospital departments. This system, while requiring initial monetary and time investment, has resulted in improved patient care, cost containment, and surgeon convenience. © The Author(s) 2015.
Eloy, Jean Anderson; Li, Shawn; Kasabwala, Khushabu; Agarwal, Nitin; Hansberry, David R; Baredes, Soly; Setzen, Michael
Various otolaryngology associations provide Internet-based patient education material (IPEM) to the general public. However, this information may be written above the fourth- to sixth-grade reading level recommended by the American Medical Association (AMA) and National Institutes of Health (NIH). The purpose of this study was to assess the readability of otolaryngology-related IPEMs on various otolaryngology association websites and to determine whether they are above the recommended reading level for patient education materials. Analysis of patient education materials from 9 major otolaryngology association websites. The readability of 262 otolaryngology-related IPEMs was assessed with 8 numerical and 2 graphical readability tools. Averages were evaluated against national recommendations and between each source using analysis of variance (ANOVA) with post hoc Tukey's honestly significant difference (HSD) analysis. Mean readability scores for each otolaryngology association website were compared. Mean website readability scores using Flesch Reading Ease test, Flesch-Kincaid Grade Level, Coleman-Liau Index, SMOG grading, Gunning Fog Index, New Dale-Chall Readability Formula, FORCAST Formula, New Fog Count Test, Raygor Readability Estimate, and the Fry Readability Graph ranged from 20.0 to 57.8, 9.7 to 17.1, 10.7 to 15.9, 11.6 to 18.2, 10.9 to 15.0, 8.6 to 16.0, 10.4 to 12.1, 8.5 to 11.8, 10.5 to 17.0, and 10.0 to 17.0, respectively. ANOVA results indicate a significant difference (P < .05) between the websites for each individual assessment. The IPEMs found on all otolaryngology association websites exceed the recommended fourth- to sixth-grade reading level.
Redmann, Andrew J; Tawfik, Kareem O; Myer, Charles M
Describe the association of USMLE Step 1 scores and the institution of a dedicated board review curriculum with resident performance on the Otolaryngology training examination. Retrospective cross sectional study. We reviewed American Board of Otolaryngology Training Examination (OTE) scores for an otolaryngology residency program between 2005 and 2016. USMLE Step 1 scores were collected. In 2011 a resident-run OTE review curriculum was instituted with the goal of improving test preparation. Scores were compared before and after curriculum institution. Linear regression was performed to identify predictors of OTE scores. 47 residents were evaluated, 24 before and 23 after instituting the curriculum. There was a moderate correlation between USMLE step 1 scores and OTE scores for all years. For PGY-2 residents, mean OTE scores improved from 25th percentile to 41st percentile after institution of the review curriculum (p = 0.05). PGY 3-5 residents demonstrated no significant improvement. On multivariate linear regression, after controlling for USMLE step 1 scores, a dedicated board review curriculum predicted a 23-point percentile improvement in OTE scores for PGY-2 residents (p = 0.003). For other post-graduate years, the review curriculum did not predict score improvement. USMLE step 1 scores are moderately correlated with OTE performance. A dedicated OTE review curriculum may improve OTE scores for PGY-2 residents, but such a curriculum may have less benefit for intermediate- and senior-level residents. 4. Copyright © 2017 Elsevier B.V. All rights reserved.
Wynn, Rhoda; Rosenfeld, Richard M; Lucente, Frank E
To evaluate the otolaryngology residency experience with attention to operative experience, career guidance, and gender. Otolaryngology residents were anonymously surveyed by mail about their residency experience. The 22-item survey was scored on a 5-point ordinal Likert scale. Responses were analyzed with respect to gender and postgraduate year (PGY) level. Complete surveys were returned by 261 otolaryngology residents (24% female). PGY level correlated with confidence that surgical skills were appropriate (P = 0.003), establishment of solid career network (P = 0.003), and confidence that surgical abilities are adequate for practice (P = 0.028). Female residents reported less confidence that surgical skills were appropriate (P = 0.050) and that surgical abilities were adequate for postresidency practice (P = 0.035). Women were encouraged to enter private practice more often (P = 0.012), were less likely to have a solid career network ( P = 0.025), and were less confident about being able to run their own practice (P = 0.036) Significant differences exist for several questions regarding surgical confidence and career issues, even after correction for PGY level.
Woloszko, Jean; Kwende, Martin; Stalder, Kenneth R.
Coblation is a unique method of delivering radiofrequency energy to soft tissue for applications in Otolaryngology (ENT). Using radiofrequency in a bipolar mode with a conductive solution, such as saline. Coblation energizes the ions in the saline to form a localized plasma near the target tissue. The plasma has enough energy to dissociate water molecules from the saline, as well as ionizing the saline salt species, thus forming chemical conditions leading to the breaking of the tissue's molecular bonds. Energetic electrons in the plasma also possess enough energy to directly dissociate tissue chemical bonds. The overall effect results in tissue ablation and localized removal or reduction of tissue volume. The heat dissipated in the process, aided by continual cooling from the surrounding saline solution, produces tissue temperature raises of approximately 45 - 85°C, significantly lower than traditional radio-frequency techniques. Coblation has been used for Otolaryngological applications such as Uvulopalatopharyngoplasty (UPPP), tonsillectomy, turbinate reduction, palate reduction, base of tongue reduction and various Head and Neck cancer procedures. The decreased thermal effect of Coblation has led to less pain and faster recovery for cases where tissue is excised. Several clinical studies have shown the benefits of using Coblation for both extra and intra-capsular tonsillectomy.
Kuczkowski, J.; Barcinski, G.; Narozny, W.
The authors describe clinical material of 49 patients treated in period 1960-1992 at the Dept. of Otolaryngology Medical Acad. of Gdansk on reason various granulomatous diseases. On the ground of retrospective analysis 44 cases with mild granulomas disease and 5 cases with malignant granulomatous disease were separated. Clinical course diagnosis, treatment and prognosis were discussed. (author)
Oyewumi, Modupe; Isaac, Kathryn; Schreiber, Martin; Campisi, Paolo
The aim of Canadian medical school curricula is to provide educational experiences that satisfy the specific objectives set out by the Medical Council of Canada. However, for specialties such as otolaryngology, there is considerable variability in student exposure to didactic and clinical teaching across Canadian medical schools, making it unclear whether students receive sufficient teaching of core otolaryngology content and clinical skills. The goal of this review was to assess the exposure to otolaryngology instruction in the undergraduate medical curriculum at the University of Toronto. Otolaryngology objectives were derived from objectives created by the Medical Council of Canada and the University of Toronto. The University of Toronto's recently developed Curriculum Mapping System (CMap) was used to perform a keyword search of otolaryngology objectives to establish when and to what extent essential topics were being taught. All (10 of 10) major topics and skills identified were covered in the undergraduate medical curriculum. Although no major gaps were identified, an uneven distribution of teaching time exists. The majority (> 90%) of otolaryngology education occurs during year 1 of clerkship. The amount of preclerkship education was extremely limited. Essential otolaryngology topics and skills are taught within the University of Toronto curriculum. The CMap was an effective tool to assess the otolaryngology curriculum and was able to identify gaps in otolaryngology education during the preclerkship years of medical school. As a result, modifications to the undergraduate curriculum have been implemented to provide additional teaching during the preclerkship years.
Ishman, Stacey L; Stewart, C Matthew; Senser, Ethan; Stewart, Rosalyn W; Stanley, James; Stierer, Kevin D; Benke, James R; Kern, David E
Although 25% of primary care complaints are otolaryngology related, otolaryngology instruction is not required in most medical schools. Our aim was to systematically review existing literature on the inclusion of otolaryngology in undergraduate medical education. PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center. Our search encompassed all indexed years through December 29, 2014. Inclusion criteria were English language, original human data, and a focus on medical student education. Data regarding study design, teacher, educational topic, educational methods, and setting were extracted from each article. Two investigators independently reviewed all articles. Our initial search yielded 436 articles; 87 underwent full-text evaluation and 47 remained in the final review. The majority of studies were conducted in the United States (40%), United Kingdom (23%), and Canada (17%) and represented a single institutional experience. Studies were classified as needs assessments (36%), curriculum descriptions (15%), educational methods (36%), and skills assessments (32%); 81% were levels of evidence 3 or 4. Most reports indicated that otolaryngology rotations are not compulsory. Studies indicated the need for increased exposure to otolaryngology. Educational methods such as team-based learning, simulation, online learning, and clinical skills assessments may offer ways to increase exposure without overburdening clinical faculty and require further study. Data suggest that a universal otolaryngology medical student curriculum would be valuable and aid in resource sharing across institutions. We recommend that an assessment be performed to determine topics and skills that should comprise this curriculum. NA. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Shuman, Andrew G.; Hu, Hsou Mei; Pannucci, Christopher J.; Jackson, Christopher R.; Bradford, Carol R.; Bahl, Vinita
Objective The consequences of perioperative venous thromboembolism (VTE) are devastating; identifying patients at risk is an essential step in reducing morbidity and mortality. The utility of perioperative VTE risk assessment in otolaryngology is unknown. This study was designed to risk-stratify a diverse population of otolaryngology patients for VTE events. Study Design Retrospective cohort study. Setting Single-institution academic tertiary care medical center. Subjects and Methods Adult patients presenting for otolaryngologic surgery requiring hospital admission from 2003 to 2010 who did not receive VTE chemoprophylaxis were included. The Caprini risk assessment was retrospectively scored via a validated method of electronic chart abstraction. Primary study variables were Caprini risk scores and the incidence of perioperative venous thromboembolic outcomes. Results A total of 2016 patients were identified. The overall 30-day rate of VTE was 1.3%. The incidence of VTE in patients with a Caprini risk score of 6 or less was 0.5%. For patients with scores of 7 or 8, the incidence was 2.4%. Patients with a Caprini risk score greater than 8 had an 18.3% incidence of VTE and were significantly more likely to develop a VTE when compared to patients with a Caprini risk score less than 8 (P otolaryngology patients for 30-day VTE events and allows otolaryngologists to identify patient subgroups who have a higher risk of VTE in the absence of chemoprophylaxis. PMID:22261490
Chambers, Kyle J; Creighton, Francis; Abdul-Aziz, Dunia; Cheney, Mack; Randolph, Gregory W
Determine trends in global health-related publication in otolaryngology. A review of research databases. A search of publications available on PubMed and nine additional databases was undertaken reviewing two time periods 10 years apart for the timeframes 1998 to 2002 (early time period) and 2008 to 2012 (recent time period) using specific search terms to identify global health-related publications in otolaryngology. Publications were examined for region of origin, subspecialty, type of publication, and evidence of international collaboration. χ and t test analyses were used to identify trends. In the 1998 to 2002 time period, a total of 26 publications met inclusion criteria for the study, with a mean of 5.2 ± 2.8 publications per year. In the 2008 to 2012 time period, a total of 61 publications met inclusion criteria, with a mean of 12.3 ± 5.6 publications per year. The 235% increase in global health-related publications identified between the two study periods was statistically significant (P = .02). The absolute number of publications in which collaboration occurred between countries increased from three in the early time period to nine the recent time period. There has been a significant increase in the volume of global health-related publications in English language otolaryngology journals over the past decade, providing strong evidence of the increasing trend of global health as an academic pursuit within the field of otolaryngology. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Schwan, Josianna; Abaza, Mona; Cabrera-Muffly, Cristina
To determine the attitudes of otolaryngology residency program directors and chairpersons toward unmatched residency applicants, including whether a surgical internship or research year is preferred in considering repeat applicants. Cross-sectional survey. Approval was obtained from the Colorado Multiple Institution Review Board. A 12-question Web-based survey was sent to otolaryngology residency program directors and chairpersons three times over a 6-week period. Responses collected from respondents were anonymous, with no identifying characteristics. Forty-five percent of those contacted responded to the survey. The most commonly recommended course of action for an unmatched applicant was completion of a general surgery intern year (43%) or a year of research (31%). Program directors were more likely than chairpersons to recommend a year of research (P value 0.014). Ninety-seven percent of the respondents felt it was important or essential to obtain new letters of recommendation. Respondents ranked poor interview skills as the most common reason for applicants remaining unmatched (29%). Otolaryngology residency match is even more competitive for previously unmatched applicants. Unmatched applicants should be advised to proceed with either a research year or postgraduate year 1 general surgery year. Before applying again, applicants should obtain new letters of recommendation, and the importance of improving poor interviewing skills should be emphasized by advisors. N/A. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Holtel, Michael R; Burgess, Lawrence P A
More research is needed in otolaryngology telemedicine, but it would be a mistake to stop at only determining if telemedicine is as good as an in-person exam. The digital image recorded in a telemedicine encounter can be manipulated to increase diagnostic information not currently available. Radiologists currently take a chest radiograph in which a chest mass or the tip of an nasogastric tube is difficult to visualize, and by inverting the gray scale or viewing other digital manipulations of that image, the mass or tube tip becomes obvious. Examples in otolaryngology might include images of the larynx manipulated to better demonstrate the inflamed tissue of reflux, or images of the tympanic membrane manipulated to better demonstrate early retraction. Despite dramatic and likely continued decreases, equipment cost is still an issue. Current research points to good consumer acceptance, and certainly with each new generation the technology is more readily accepted. As Nesbitt  points out, it is certainly not difficult to look to the future and see ubiquitous broadband with video as common as telephone, or even extreme broadband enabling robotics and virtual reality TV with three-dimensional touch. Robotics and genomics will eventually play a greater role in telemedicine and our lives in general. Applications for remote diagnosis in biologic warfare defense and homeland security are currently raising interest in telemedicine. Telemedicine will be combined with new technological advances such as virtual "fly-through" computerized axial tomography examinations. Instead of performing an exploratory tympanotomy, surgeons will use computer programs to "fly through" and examine all aspects of a patient's middle or even inner ear. Spectral imaging of the eardrum, larynx, or oropharynx will immediately identify bacteria without cultures, or gram stain, and potential malignancy without biopsy. By measuring fluorescence emitted from an oropharynx illuminated with a specific
Wang, Fang; Li, Wei; Li, Rong; Tan, Guolin; Luo, Dan
To investigate the situation regarding the cleaning and sterilization of endonasal endoscopes in department of otolaryngology in Hunan Province, and to provide strategy for improving the level of sterilization and management of endonasal endoscopes. A total of 100 medical institutions were investigated by spot assessment, check and sampling. Data was analyzed by multivariate analysis. The qualified rate of rules and regulations for endoscopy was 28.8% in the second-class hospitals and 45% in the top-class hospitals. The qualified rate of environment for endoscopy cleaning and sterilization was 36.3% in the second-class hospitals and 85% in the top-class hospitals. The main problems include lack of independent disinfection room, the space not large enough, and/or lack of ventilation system. The qualified rate of bacterial detection for post-sterilized endoscopes and biopsy forceps was 93.8% in the second-class hospitals and 95.0% in the top-class hospitals, and the main pathogenic bacteria was gram-positive cocci and gram-negative bacilli. The multivariate analysis showed that the influencial factors for endoscope cleaning and disinfection are as follows: staffs responsible for the cleaning and sterilization of otolaryngology endoscopes, the standard for cleaning and disinfection process, and the frequency of endoscope use. The present situation of cleaning and sterilization for otolaryngology endoscopes is better in the top-class hospitals than that in the second-class hospitals. The sterilization and management of otolaryngology endoscopy are needed to be improved, and the staff training is needed, especially in the primary hospitals.
Robitschek, Jon; Dresner, Harley; Hilger, Peter
Photographic nasal analysis constitutes a critical step along the path toward accurate diagnosis and precise surgical planning in rhinoplasty. The learned process by which one assesses photographs, analyzes relevant anatomical landmarks, and generates a global view of the nasal aesthetic is less widely described. To discern the common pitfalls in performing photographic nasal analysis and to quantify the utility of a systematic approach model in teaching photographic nasal analysis to otolaryngology residents. This prospective observational study included 20 participants from a university-based otolaryngology residency program. The control and intervention groups underwent baseline graded assessment of 3 patients. The intervention group received instruction on a systematic approach model for nasal analysis, and both groups underwent postintervention testing at 10 weeks. Data were collected from October 1, 2015, through June 1, 2016. A 10-minute, 11-slide presentation provided instruction on a systematic approach to nasal analysis to the intervention group. Graded photographic nasal analysis using a binary 18-point system. The 20 otolaryngology residents (15 men and 5 women; age range, 24-34 years) were adept at mentioning dorsal deviation and dorsal profile with focused descriptions of tip angle and contour. Areas commonly omitted by residents included verification of the Frankfort plane, position of the lower lateral crura, radix position, and ratio of the ala to tip lobule. The intervention group demonstrated immediate improvement after instruction on the teaching model, with the mean (SD) postintervention test score doubling compared with their baseline performance (7.5 [2.7] vs 10.3 [2.5]; P Otolaryngology residents demonstrated proficiency at incorporating nasal deviation, tip angle, and dorsal profile contour into their nasal analysis. They often omitted verification of the Frankfort plane, position of lower lateral crura, radix depth, and ala-to-tip lobule
Cohen, Seth M; Dinan, Michaela A; Roy, Nelson; Kim, Jaewhan; Courey, Mark
Accurate diagnosis of a voice disorder is an essential first step toward its appropriate treatment. We examined differences in laryngeal diagnosis over time in outpatients evaluated by primary care physicians (PCPs) and/or otolaryngologists. Retrospective analysis of data from a large, national administrative US claims database. Patients with laryngeal disorders based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004, to December 31, 2008, with at least 2 outpatient visits by a PCP and/or otolaryngologist and continuously enrolled for 12 months were included. The initial and final laryngeal diagnoses were tabulated. Of approximately 55 million individuals, 29,501 met inclusion criteria. More than half the patients in the PCP to otolaryngology group and one-third of the otolaryngology to otolaryngology group had different laryngeal diagnoses over time. Three-fourths of patients with an initial acute laryngitis diagnosis in the PCP to otolaryngology group and half of the otolaryngology to otolaryngology group had a different final laryngeal diagnosis. Of patients with a final laryngeal cancer diagnosis, one-fourth of the otolaryngology to otolaryngology group had an initial diagnosis of nonspecific dysphonia, and one-fifth of the PCP to otolaryngology group had an initial diagnosis of acute laryngitis. Differential diagnosis of voice disorders often evolves over time. The impact on treatment and health care utilization are important areas of future study.
Woloszko, Jean; Gilbride, Charles
Coblation is a unique method of delivering radio frequency energy to soft tissue for applications in Otolaryngology (ENT). Using radio frequency in a bipolar mode with a conductive solution, such as saline, Coblation energizes the ions in the saline to form a small plasma field. The plasma has enough energy to break the tissue's molecular bonds, creating an ablative path. The thermal effect of this process is approximately 45 - 85 degrees Celsius, significantly lower than traditional radio-frequency techniques. Coblation has been used for Otolaryngological applications such as Uvulopalatopharyngoplasty (UPPP), tonsillectomy, turbinate reduction, palate reduction, base of tongue reduction and various Head and Neck cancer procedures. The decreased thermal effect of Coblation anecdotally has led to less pain and faster recovery for cases where tissue is excised. In cases where Coblation is applied submucosally to reduce tissue volume (inferior turbinate, soft palate), the immediate volume reduction may lead to immediate clinical benefits for the patient. Coblation is currently being tested in various clinical studies to document the benefits for otolaryngological applications.
Kavanagh, Katherine R; Spiro, Jeffrey
Objectives Burnout is a well-described psychological construct with 3 aspects: exhaustion, depersonalization, and lack of personal accomplishment. The objective of this study was to assess whether faculty members of an otolaryngology residency program exhibit measurable signs and symptoms of burnout with respect to their roles as medical educators. Study Design Cross-sectional survey. Setting Otolaryngology-head and neck surgery residency program. Subjects and Methods Faculty members from an otolaryngology residency program, all of whom are involved in resident education, completed the Maslach Burnout Inventory-Educators Survey (MBI-ES). The surveys were completed anonymously and scored with the MBI-ES scoring key. Results Twenty-three faculty members completed the MBI-ES, and 16 (69.6%) showed symptoms of burnout, as evidenced by unfavorable scores on at least 1 of the 3 indices (emotional exhaustion, depersonalization, or low personal accomplishment). The faculty consistently reported moderate to high personal accomplishment and low depersonalization. There were variable responses in the emotional exhaustion subset, which is typically the first manifestation of the development of burnout. Conclusion To our knowledge, this is the first application of the MBI-ES to investigate burnout among otolaryngology faculty members as related to their role as medical educators. Discovering symptoms of burnout at an early stage affords a unique and valuable opportunity to intervene. Future investigation is underway into potential causes and solutions.
Brandt, Michael G; Scott, Grace M; Doyle, Philip C; Ballagh, Robert H
Recently graduated Otolaryngology - Head and Neck Surgeons (OTO-HNS) are facing an employment crisis. To date, there has been no systematic evaluation of the factors contributing to this situation, graduating OTO-HNS trainee employment rates, nor the employment concerns of these graduating residents. This investigation sought to empirically evaluate prospective OTO-HNS graduate employment, identify factors contributing to this situation, and provide suggestions going forward. A cross-sectional survey of the 2014 graduating cohort of OTO-HNS residents was conducted 6-months prior to graduation, and immediately following residency graduation. Surveyed items focused on the demographics of the graduating cohort, their future training and employment plans, and their concerns relative to the OTO-HNS employment situation. All twenty-nine Canadian medical school graduated OTO-HNS residents completed the initial survey, with 93% responding at the completion of residency. Only 6 (22%) indicated confirmed employment following residency training. 78% indicated that they were pursuing fellowship training. 90% identified the pursuit of fellowship training as a moderately influenced by limited job opportunities. The ability to find and secure full-time employment, losing technical skills if underemployed/unemployed, and being required to consider working in a less-desired city/province were most concerning. 34% of the residents felt that they were appropriately counseled during their residency training about employment. 90% felt that greater efforts should be made to proactively match residency-training positions to forecasted job opportunities. Canadian OTO-HN Surgeons lack confirmed employment, are choosing to pursue fellowship training to defer employment, and are facing startling levels of under- and unemployment. A multitude of factors have contributed to this situation and immediate action is required to rectify this slowly evolving catastrophe.
Laury, Adrienne M; Bowe, Sarah N; Lospinoso, Joshua
To date, an otolaryngology-specific morbidity and mortality (M&M) conference has never been reported or evaluated. To propose a novel otolaryngology-specific M&M format and to assess its success using a validated assessment tool. Preintervention and postintervention cohort study spanning 14 months (September 2014 to November 2015), with 32 faculty, residents, and medical students attending the department of otolaryngology M&M conference, conducted at the the San Antonio Uniformed Services Health Education Consortium. A novel quality assurance conference was implemented in the department of otolaryngology at the San Antonio Uniformed Services Health Education Consortium. This conference incorporates patient safety reports, otolaryngology-specific quality metrics, and individual case presentations. The revised format integrates the Accreditation Council for Graduate Medical Education (ACGME) core competencies and Quality Improvement and Patient Safety (QI/PS) system. This format was evaluated by faculty, residents, and medical students every other month for 14 months to assess changes in attitudes regarding the M&M conference as well as changes in presentation quality. Overall, 13 faculty, 12 residents, and 7 medical students completed 232 evaluations. Summary statistics of both resident and faculty attitudes about the success of the M&M format seem to improve over the 14 months between the prequestionnaires and postquestionnaires. General attitudes for both residents and faculty significantly improved from the pretest to posttest (odds ratio, 0.32 per month; 95% CI, 0.29-0.35). In the pretest period, "established presentation format" was considered the most necessary improvement, whereas in the posttest period this changed to "incorporate more QI." For resident presentations evaluated using the situation, background, assessment, and review/recommendations (SBAR) tool, all evaluations, from all participants, improved over time. The M&M conference is an essential
Golub, Justin S; Sharma, Arun; Samy, Ravi N
Access to the medical literature has not kept pace with the mobile revolution. We aimed to (1) gauge interest in a smartphone-optimized Web site for conveniently accessing otolaryngology literature and (2) create an easy-to-access and convenient Web site that displays otolaryngology journal abstracts in a format optimized for smartphones. A survey was sent to physicians of a major US academic otolaryngology-head and neck surgery department. Demographics, literature-browsing habits, and barriers to staying updated were assessed. The response rate was 87%. Ninety-one percent of respondents used a smartphone, and 85% wished they could stay more up to date with the otolaryngology literature. Most respondents believed a convenient smartphone-optimized Web site could help them achieve this goal. A Web site was then developed in collaboration with a university creative department as a proof of concept. The site uses a simple RSS aggregator to display journal abstracts formatted for smartphone-sized screens (www.otosurg.com). © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
Cohen, Seth M; Kim, Jaewhan; Roy, Nelson; Courey, Mark
Despite the accepted role of laryngoscopy in assessing patients with laryngeal/voice disorders, controversy surrounds its timing. This study sought to determine how increased time from first primary care to first otolaryngology outpatient visit affected the health care costs of patients with laryngeal/voice disorders. Retrospective analysis of a large, national administrative claims database was performed. Patients had an International Classification of Diseases, 9(th) Revision-coded diagnosis of a laryngeal/voice disorder; initially saw a primary care physician and, subsequently, an otolaryngologist as outpatients; and provided 6 months of follow-up data after the first otolaryngology evaluation. The outpatient health care costs accrued from the first primary care outpatient visit through the 6 months after the first otolaryngology outpatient visit were determined. There were 260,095 unique patients who saw a primary care physician as an outpatient for a laryngeal/voice disorder, with 8999 (3.5%) subsequently seeing an otolaryngologist and with 6 months postotolaryngology follow-up data. A generalized linear regression model revealed that, compared with patients who saw an otolaryngologist ≤1 month after the first primary care visit, patients in the >1-month and ≤3-months and >3-months time periods had relative mean cost increases of $271.34 (95% confidence interval $115.95-$426.73) and $711.38 (95% confidence interval $428.43-$993.34), respectively. Increased time from first primary care to first otolaryngology evaluation is associated with increased outpatient health care costs. Earlier otolaryngology examination may reduce health care expenditures in the evaluation and management of patients with laryngeal/voice disorders. Copyright © 2015 Elsevier Inc. All rights reserved.
Robotics in otolaryngology and head and neck surgery: Recommendations for training and credentialing: A report of the 2015 AHNS education committee, AAO-HNS robotic task force and AAO-HNS sleep disorders committee.
Gross, Neil D; Holsinger, F Christopher; Magnuson, J Scott; Duvvuri, Umamaheswar; Genden, Eric M; Ghanem, Tamer Ah; Yaremchuk, Kathleen L; Goldenberg, David; Miller, Matthew C; Moore, Eric J; Morris, Luc Gt; Netterville, James; Weinstein, Gregory S; Richmon, Jeremy
Training and credentialing for robotic surgery in otolaryngology - head and neck surgery is currently not standardized, but rather relies heavily on industry guidance. This manuscript represents a comprehensive review of this increasingly important topic and outlines clear recommendations to better standardize the practice. The recommendations provided can be used as a reference by individuals and institutions alike, and are expected to evolve over time. © 2016 Wiley Periodicals, Inc. Head Neck 38: E151-E158. © 2016 Wiley Periodicals, Inc.
Curtis, Stuart H; Miller, Robert H; Weng, Cindy; Gurgel, Richard K
Evaluate the effect of duty hour regulation on graduating otolaryngology resident surgical case volume and analyze trends in surgical case volume for Accreditation Council for Graduate Medical Education (ACGME) key indicator cases from 1996 to 2011. Time-trend analysis of surgical case volume. Nationwide sample of otolaryngology residency programs. Operative logs from the American Board of Otolaryngology and ACGME for otolaryngology residents graduating in the years 1996 to 2011. Key indicator volumes and grouped domain volumes before and after resident duty hour regulations (2003) were calculated and compared. Independent t test was performed to evaluate overall difference in operative volume. Wilcoxon rank sum test evaluated differences between procedures per time period. Linear regression evaluated trend. The average total number of key indicator cases per graduating resident was 440.8 in 1996-2003 compared to 500.4 cases in 2004-2011, and overall average per number of key indicators was 31.5 and 36.2, respectively (P = .067). Four key indicator cases showed statistically significant (P otolaryngology residents. The overall trend in operative volume is increasing for several specific key indicators. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
Javia, Luv; Sardesai, Maya G
The increasing role of simulation in the medical education of future otolaryngologists has followed suit with other surgical disciplines. Simulators make it possible for the resident to explore and learn in a safe and less stressful environment. The various subspecialties in otolaryngology use physical simulators and virtual-reality simulators. Although physical simulators allow the operator to make direct contact with its components, virtual-reality simulators allow the operator to interact with an environment that is computer generated. This article gives an overview of the various types of physical simulators and virtual-reality simulators used in otolaryngology that have been reported in the literature. Copyright © 2017 Elsevier Inc. All rights reserved.
Pollei, Taylor R; Barrs, David M; Hinni, Michael L; Bansberg, Stephen F; Walter, Logan C
Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon. Case series with chart review. Tertiary care center and residency program. Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data. Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs. Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.
Witsell, David L; Schulz, Kristine A; Lee, Walter T; Chiswell, Karen
To describe the conditions studied, interventions used, study characteristics, and funding sources of otolaryngology clinical trials from the ClinicalTrials.gov database; compare this otolaryngology cohort of interventional studies to clinical visits in a health care system; and assess agreement between clinical trials and clinical activity. Database analysis. Trial registration data downloaded from ClinicalTrials.gov and administrative data from the Duke University Medical Center from October 1, 2007 to September 27, 2010. Data extraction from ClinicalTrials.gov was done using MeSH and non-MeSH disease condition terms. Studies were subcategorized to create the following groupings for descriptive analysis: ear, nose, allergy, voice, sleep, head and neck cancer, thyroid, and throat. Duke Health System visits were queried by using selected ICD-9 codes for otolaryngology and non-otolaryngology providers. Visits were grouped similarly to ClinicalTrials.gov for further analysis. Chi-square tests were used to explore differences between groups. A total of 1115 of 40,970 registered interventional trials were assigned to otolaryngology. Head and neck cancer trials predominated. Study models most frequently incorporated parallel design (54.6%), 2 study groups (46.6%), and randomization (69.1%). Phase 2 or 3 studies constituted 46.4% of the cohort. Comparison of the ClinicalTrials.gov database with administrative health system visit data by disease condition showed discordance between national research activity and clinical visit volume for patients with otolaryngology complaints. Analysis of otolaryngology-related clinical research as listed in ClinicalTrials.gov can inform patients, physicians, and policy makers about research focus areas. The relative burden of otolaryngology-associated conditions in our tertiary health system exceeds research activity within the field.
Wong, Kevin; Levi, Jessica R
Evaluate the readability of pediatric otolaryngology-related patient education materials from leading online sources. Cross-sectional analysis. All pediatric otolaryngology-related articles from the online patient health libraries of the top 10 US News & World Report-ranked children's hospitals, top 5 Doximity-ranked pediatric otolaryngology fellowships, and the American Academy of Otolaryngology-Head and Neck Surgery were collected. Each article was copied in plain text format into a blank document. Web page navigation, appointment information, references, author information, appointment information, acknowledgements, and disclaimers were removed. Follow-up editing was also performed to remove paragraph breaks, colons, semicolons, numbers, percentages, and bullets. Readability grade was calculated using the Flesch-Kincaid Grade Level, Flesch Reading Ease Score, Gunning-Fog Index, Coleman-Liau Index, Automated Readability Index, and Simple Measure of Gobbledygook. Intraobserver and interobserver reliability were assessed. A total of 502 articles were analyzed. Intraobserver and interobserver reliability were both excellent, with an intraclass correlation coefficient of 0.99 and 0.96, respectively. The average readability grade across all authorships and readability assessments exceeded the reading ability of the average American adult. Only 142 articles (28.3%) were written at or below the reading ability of the average American adult, whereas the remaining 360 articles (71.7%) were written above the reading level of the average adult. Current online health information related to pediatric otolaryngology may be too difficult for the average reader to understand. Revisions may be necessary for current materials to benefit a larger readership. NA Laryngoscope, 127:E138-E144, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Jabbour, Jad; Bakeman, Anna; Robey, Thomas; Jabbour, Noel
To characterize the nature of surgical preparation among otolaryngology residents nationwide, determine the self-rated effectiveness and efficiency of case preparation practices, and identify potential means for educational improvement. A survey examining the study objectives was developed and distributed to otolaryngology residents nationwide. Survey response data were submitted to descriptive analysis and comparative analyses between junior and senior residents. Literature regarding case preparation among otolaryngology residents was reviewed. Among 108 resident respondents, the most commonly used resources included textbooks (86.1%), surgical education websites (74.1%), and surgical atlases (66.7%). Time was the primary limitation (cited by 84.3%) and convenience the predominant factor influencing resource selection (92.5%). On a 5-point Likert scale, mean scores regarding effectiveness and efficiency of case preparation were 3.53 ± 0.68 and 3.19 ± 0.88, respectively. Senior residents compared to junior residents were more likely to rate their preparation as effective (3.75 ± 0.54 vs 3.40 ± 0.72, P = .008) and efficient (3.45 ± 0.85 vs 3.03 ± 0.86, P = .02). Otolaryngology residents do not consistently rate their case preparation as effective or efficient. While there appears to be progress in self-directed learning throughout residency, room for improvement remains, with potential avenues for such improvement explored here.
Sun, Gordon H
Determine current health services research (HSR) publication trends in major general otolaryngology journals. Bibliometric analysis. All main issues of 8 high-impact general-interest otolaryngology journals published worldwide in 2002, 2005, 2008, and 2011 were searched for HSR-related publications. To qualify as HSR, the abstract of the article must discuss access to care, cost, delivery of care, financing, health organizational or system issues, quality of care, resource utilization, and/or health outcomes. Otolaryngology topics were classified as general, pediatrics, oncology, otology and neurotology, sleep disorders, sinonasal disease, facial plastics, and/or laryngology. Other key measures included study authorship and external sponsorship or mechanism of support. Of 5958 total articles, 449 (7.5%) qualified as HSR. There was a statistically significant increase in the number of HSR publications across all journals from 2002 to 2011 (P research (337, 75.1%) was the most common type of HSR being published. The most common subject was oncology (112, 24.9%), whereas the least represented was trauma and facial plastics (4, 0.9%). First and corresponding authors were based in 31 countries, although the United States was the predominant country of origin. Nearly 95% of HSR articles in the current sample demonstrated multidisciplinary authorship. An estimated 22.9% of first authors and 17.8% of corresponding authors were female. Two-thirds of HSR publications reported no external sponsor, whereas the remainder was supported most commonly by philanthropy and hospital-based sources. Health services research is an international, multidisciplinary field of inquiry with an increasing presence in major otolaryngology journals.
Poon, Charles; Stevens, Shawn M; Golub, Justin S; Pensak, Myles L; Samy, Ravi N
Graboyes, Evan M.; Kallogjeri, Dorina; Saeed, Mohammed J.; Olsen, Margaret A.; Nussenbaum, Brian
Objectives For patients undergoing inpatient otolaryngologic surgery, determine patient and hospital-level risk factors associated with 30-day readmission. Study Design Retrospective cohort study Methods We analyzed the State Inpatient Database (SID) from California for patients who underwent otolaryngologic surgery between 2008 and 2010. Readmission rates, readmission diagnoses, and patient- and hospital-level risk factors for 30-day readmission were determined. Hierarchical logistic regression modeling was performed to identify procedure-, patient-, and hospital-level risk factors for 30-day readmission. Results The 30-day readmission rate following an inpatient otolaryngology procedure was 8.1%. The most common readmission diagnoses were nutrition, metabolic or electrolyte problems (44% of readmissions) and surgical complications (10% of readmissions). New complications after discharge were the major drivers of readmission. Variables associated with 30-day readmission in hierarchical logistic regression modeling were: type of otolaryngologic procedure, Medicare or Medicaid health insurance, chronic anemia, chronic lung disease, chronic renal failure, index admission via the emergency department, in-hospital complication during the index admission, and discharge destination other than home. Conclusions Approximately one out of twelve patients undergoing otolaryngologic surgery had a 30-day readmission. Readmissions occur across a variety of types of procedures and hospitals. Most of the variability was driven by patient-specific factors, not structural hospital characteristics. PMID:27098654
Khalid-Raja, M; Tzifa, K
This study aimed to evaluate the activity of paediatric otolaryngology services required for children with Down's syndrome in a tertiary referral centre. A review of the paediatric otolaryngology input for children with Down's syndrome was performed; data were obtained from the coding department for a two-year period and compared with other surgical specialties. Between June 2011 and May 2013, 106 otolaryngology procedures were performed on children with Down's syndrome. This compared to 87 cardiac and 81 general paediatrics cases. The most common pathologies in children with Down's syndrome were obstructive sleep apnoea, otitis media, hearing loss and cardiac disease. The most common otolaryngology procedures performed were adenoidectomy, tonsillectomy, grommet insertion and bone-anchored hearing aid implant surgery. ENT manifestations of Down's syndrome are common. Greater provisions need to be made to streamline the otolaryngology services for children and improve transition of care to adult services.
Harris, Jeffrey P; Ariessohn, Melanie L
To understand the reasons for the decrease in clinician-scientists in otolaryngology. An anonymous survey was prepared that questioned career preparation and personal demographics as well as motive for having done research in medical school. K awardees were also asked for concerns in choosing the clinician-scientist career path and the obstacles encountered. A survey was conducted of the 2005 National Institute of Deafness and Other Communication Disorders otolaryngologist K-awardees and otolaryngology residents from three research-oriented U.S. medical schools. Residents felt that family issues ranked as a primary concern, followed by the time factor necessary to devote to research that would detract from their family and personal life. The K-awardees' concern also appeared to be family issues; the lack of departmental support ranked second. The K-awardees expressed that protected research time, a mentor, and departmental support were important to success. This survey found that although young otolaryngologists are interested in research, they are deterred by financial and family constraints and a perceived paucity of departmental support.
Bowe, Sarah N; Schmalbach, Cecelia E; Laury, Adrienne M
Objective This State of the Art Review aims (1) to define recent qualifications of otolaryngology resident applicants by focusing on United States Medical Licensing Examination (USMLE) scores, Alpha Omega Alpha (AOA) status, and research/publications and (2) to summarize the current literature regarding the relationship between these measures and performance in residency. Data Sources Electronic Residency Application Service, National Residency Matching Program, PubMed, Ovid, and GoogleScholar. Review Methods Electronic Residency Application Service and National Residency Matching Program data were analyzed to evaluate trends in applicant numbers and qualifications. Additionally, a literature search was performed with the aforementioned databases to identify relevant articles published in the past 5 years that examined USMLE Step 1 scores, AOA status, and research/publications. Conclusions Compared with other highly competitive fields over the past 3 years, the only specialty with decreasing applicant numbers is otolaryngology, with the rest remaining relatively stable or slightly increased. Additionally, USMLE Step 1 scores, AOA status, and research/publications do not reliably correlate with performance in residency. Implications for Practice The consistent decline in applications for otolaryngology residency is concerning and reflects a need for change in the current stereotype of the "ideal" otolaryngology applicant. This includes consideration of additional selection measures focusing on noncognitive and holistic qualities. Furthermore, otolaryngology faculty should counsel medical students that applying in otolaryngology is not "impossible" but rather a feasible and worthwhile endeavor.
Reilly, Brian K; Brandon, Gretchen; Shah, Rahul; Preciado, Diego; Zalzal, George
The goal of this study was to examine the roles of Physician Assistants (PAs) and Nurse Practitioners (NPs) in pediatric academic otolaryngology programs to provide a better understanding of their scope of practice, levels of autonomy, clinical duties, teaching opportunities and research participation. An anonymous web-based electronic survey tool was sent to all pediatric otolaryngology fellowship program directors in the United States. Nurse Practitioners and Physician Assistants are utilized in approximately 3 out of every 4 pediatric otolaryngology practices. The top three job activities of both the PA and NP were: (1) seeing patients independently, (2) working alongside doctors in clinic, and (3) answering phone lines/parental calls. A higher percentage of PAs (83%), worked alongside doctors in clinic, as compared to NPs, where only 55% work alongside MDs. Over half of PAs round with the in-patient team and see consults as compared to just over one third of NPs who participate in such activities. Twenty-five percent of practices reported that PAs cover call and assist in the OR. Most PAs/NPs saw between 11 and 15 patients per clinic which provides a clear productivity advantage when looking to screen patients, provide medical care, generate surgical cases, and maximize billings. NPs and PAs have complimentary skill sets ideal for the pediatric otolaryngology workplace, although job activities and "best fit" are hospital and practice dependent. Our study suggests that the use of PAs and NPs will continue to grow to meet increased demand for services in the field of pediatric otolaryngology. Employing advanced practice providers enables academic centers to improve access, provide additional financial remuneration, reduce wait times for new patients, and allow attending physicians to meet increased practice demands. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Stringer, S P; Cassisi, N J; Slattery, W H
In an effort to improve the otolaryngology matching process at the University of Florida, Gainesville, we sought to obtain the medical student's perspective of the current system. All students who interviewed here over a 3-year period were surveyed regarding the application, interview, and ranking process. In addition, suggestions for improving the system were sought from the students. The application and interviewing patterns of the students surveyed were found to be similar to those of the entire otolaryngology residency applicant pool. We were unable to identify any factors that influence a student's rank list that could be prospectively used to help select applicants for interview. A variety of suggestions for improvements in the match were received, several of which could easily be instituted. A uniform interview invitation date as requested by the students could be rapidly implemented and would provide benefits for both the students and the residency programs.
Sticca, Robert P; Mullin, Brady C; Harris, Joel D; Hosford, Clint C
Specialty procedures constitute one eighth of rural surgery practice. Currently, general surgeons intending to practice in rural hospitals may not get adequate training for specialty procedures, which they will be expected to perform. Better definition of these procedures will help guide rural surgery training. Current Procedural Terminology codes for all surgical procedures for 81% of North Dakota and South Dakota rural surgeons were entered into the Dakota Database for Rural Surgery. Specialty procedures were analyzed and compared with the Surgical Council on Resident Education curriculum to determine whether general surgery training is adequate preparation for rural surgery practice. The Dakota Database for Rural Surgery included 46,052 procedures, of which 5,666 (12.3%) were specialty procedures. Highest volume specialty categories included vascular, obstetrics and gynecology, orthopedics, cardiothoracic, urology, and otolaryngology. Common procedures in cardiothoracic and vascular surgery are taught in general surgical residency, while common procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology are usually not taught in general surgery training. Optimal training for rural surgery practice should include experience in specialty procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology. Copyright © 2012 Elsevier Inc. All rights reserved.
Rodríguez, Maria Claudia; Villamor, Perla; Castillo, Tatiana
Pain is a disease by itself and it's a public health concern of major implication in children, not just because of the emotional component of the child and his family, but also due to the potential morbidity and mortality involving it. A proper assessment of pain it's a challenge in the pediatric population, due to their lack of understanding and verbalization of hurt. Additionally, a satisfactory treatment of pediatric pain can be arduous due to a lack of clinical knowledge, insufficient pediatric research, and the fear to opioid side effects and addiction. The aim of this review is to address the current definitions of pain, its physiological mechanisms and the consequences of its inadequate management, as well as, to guide the clinicians in the assessment and management of pain in the pediatric population at otolaryngology services. Narrative review by selective MeSH search terms: Children, Pediatrics, Otolaryngology, Pain measurement, Pain Management, Analgesics and Analgesia, from databases: MEDLINE/PubMed, Cochrane, ISI, Current Contents, Scielo and LILACS, between January 2000 and May 2016. 129 articles were reviewed according to the requirements of the objectives. Pain measurement is a challenge in children as there are no physical signs that constitute an absolute or specific indicator of pain, and its diagnosis must rely on physiological, behavioral and self-report methods. Regarding treatment, a suitable alternative are the non-pharmacological cognitive/behavioral therapies helped by pharmacological therapies tailored to the severity of pain and the child's age. We provide evidence-based recommendations on pain treatment, including non-opioid analgesics, opioid analgesics and adjuvant medicines to improve the management of pain in children in otolaryngology services. We present a global review about assessment and management of pain in pediatric otolaryngology, which leads to future specific reviews on each topic. Research gaps on pain assessment and
Lyons, George D
George D. Lyons, MD, now becoming "an elder statesman," he decided summarize the early history of otolaryngology as it developed in New Orleans. Francis LeJeune, MD, Sr., a much admired and loved otolaryngologist, has afforded a great insight through his memoirs in the early development of our specialty in his report of Otolaryngology in the South. Dr. LeJune, Sr. began his brief paper just before his death. Excerpts from this paper have been used by the American Laryngological Association. There will be no bibliography. Most of this information was obtained from Dr. LeJeune's memoirs, history departments of the Academy, Touro Infirmary, Eye, Ear, Nose, and Throat (EENT) archives and interviews with descendants of our early leaders. A special thanks to them for their time, research, and generosity of information. There has been some debate regarding the precision of some of the dates, but they are as chronologically accurate as possible.
Background. Concern exists about the quality of specialist training platforms at South African universities and teaching hospitals. Method. We conducted an audit of the quality of training at South African otolaryngology (ENT) training institutions from the perspective of the registrars. Results. Some institutions were deficient in ...
Polacco, Marc A; Lally, Jack; Walls, Andrew; Harrold, Linnea R; Malekzadeh, Sonya; Chen, Eunice Y
Objective To quantify the cost incurred during the match process for otolaryngology applicants, determine sources of expenditures, and highlight potential methods to alleviate financial burden of the match process. Study Design Cross-sectional. Study Setting Online survey. Subjects and Methods An electronic survey was sent via email to those who applied to the otolaryngology residency programs at Dartmouth-Hitchcock Medical Center and MedStar Georgetown University Hospital during the 2016 application cycle. Questions regarding demographics and experiences with the match were multiple choice, and questions regarding cost were open answer. Data were downloaded and analyzed on Excel and Minitab software. Results Twenty-eight percent of the total 370 applicants completed the survey. The mean cost of away rotations was $2500 (95% confidence interval [CI], $2224-$2776). With application fees and the cost of interviewing, the mean total cost of applying for the 2016 otolaryngology match was $6400 (95% CI, $5710-$7090), with a total range of $1200 to $20,000. Twenty-eight percent of students did not have sufficient funds for applying and interviewing despite seeking out additional monetary resources. Conclusion In 2016, otolaryngology applicants spent a mean of $8900 (95% CI, $7935-$9865) on away rotations, applications, and interviewing. Half of the applicants obtained additional funding to cover this cost, while 28% still did not have sufficient funding. Methods of decreasing cost may include instituting a cap on application number, videoconferencing interviews, regionalizing interviews, and adjusting the interview timeline.
Fanous, Amanda; Rappaport, Jamie; Young, Meredith; Park, Yoon Soo; Manoukian, John; Nguyen, Lily H P
To develop, implement, and evaluate a longitudinal, simulation-based ethics and legal curriculum designed specifically for otolaryngology residents. Otolaryngology residents were recruited to participate in a yearly half-day ethical-legal module, the curriculum of which spanned 4 years. Each module included: three simulated scenarios, small-group multisource feedback, and large-group debriefings. Scenarios involved encounters with standardized patients. Residents' ethical-legal knowledge was assessed pre- and postmodule with multiple-choice questions, and ethical reasoning was assessed by a variety of evaluators during the simulated scenario using a locally developed assessment tool. Participants completed an exit survey at the end of each module. Eighteen residents completed four modules from the academic years of 2008 to 2009 to 2011 to 2012. The first year was considered a pilot module, and data were collected for the following 3 years. Knowledge of legal issues improved significantly among residents (mean at pre = 3.40 and post = 4.60, P otolaryngology-head and neck surgery residents. This educational program resulted in a both objective and subjective improvement in legal and ethics knowledge and skills. NA. Laryngoscope, 127:2501-2509, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Brook, Christopher D; Platt, Michael P; Russell, Kimberly; Grillone, Gregory A; Aliphas, Avner; Noordzij, J Pieter
To determine the progression of flexible transnasal laryngoscopy reliability and competency in otolaryngology residency training. Prospective case control study. Academic otolaryngology department. Medical students, otolaryngology residents, and otolaryngology attending physicians. Fourteen otolaryngology residents from PGY-1 to PGY-5 and 3 attending otolaryngologists viewed 25 selected and digitally recorded flexible transnasal laryngoscopies. The evaluators were asked to rate 13 items relating to abnormalities in the oropharynx, hypopharynx, larynx, and subglottis. The level of concern and level of comfort with the diagnosis were assessed. Intraclass correlations were calculated for each topic and by level of training to determine reliability within each class and compare competency versus attending interpretations. Intraclass correlation of residents compared to attending physicians demonstrated significant improvements by year for left and right vocal fold immobility, subglottic stenosis, laryngeal mass, left and right vocal cord abnormalities, and level of concern. Additionally, pooled vocal cord mobility and pooled results in categories with good attending reliability demonstrated stepwise improvement as well. For these categories, resident reliability was found to be statistically similar to attending physicians in all categories by PGY-3. There were no trends for base of tongue abnormalities, pharyngeal abnormalities, and pharyngeal and hypopharyngeal masses. Resident competency for flexible transnasal laryngoscopy progresses during residency to reliability with attending otolaryngologists by the PGY-3 year over key facets of the examination. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.
Choi, Kevin J; Kahmke, Russel R; Crowson, Matthew G; Puscas, Liana; Scher, Richard L; Cohen, Seth M
The consultation patterns of an otolaryngology-head and neck surgery service have not previously been reported. The time, resources, and attention required to operate such a consultation service are unknown. To assess trends in otolaryngology-head and neck surgery consultations conducted in emergency departments (EDs) and inpatient services. A retrospective analysis was conducted of the medical records of patients at a quaternary care center receiving inpatient otolaryngology consultations from January 1 to December 31, 2014. Clinical evaluation and bedside and operative procedures performed by the otolaryngology-head and neck surgery service. Demographics, reason for consultation, diagnosis, bedside procedures, operative interventions, and admission variables. A total of 1491 consultations were completed for adult (1091 [73.2%]; 854 men and 637 women; mean [SD] age 50.3 [19.3] years) and pediatric (400 [26.8%]; 232 boys and 168 girls; mean [SD] age, 4.0 [5.2] years) patients. Of the 1491 consultations, 766 (51.4%) originated from inpatient teams vs 725 (48.6%) from the ED. A total of 995 of all consultations (66.7%) resulted in a bedside procedure, and 243 (16.3%) required operative intervention. Consultations regarding airway evaluation (362 [47.3%] vs 143 [19.7%]), management of epistaxis (78 [10.2%] vs 33 [4.6%]), and rhinologic evaluation (79 [10.3%] vs 18 [2.5%]) were more frequent from inpatient teams than from the ED. Consultations regarding management of head and neck infections (162 [22.3%] vs 32 [4.2%]), facial trauma (235 [32.4%] vs 16 [2.1%]), and postoperative complications (73 [10.1%] vs 2 [0.3%]) were more frequent in the ED. Of the 725 consultations performed in the ED, 212 patients (29.2%) required hospitalization. The consultation volume of an otolaryngology-head and neck surgery service requires significant time and resources. Consultations are most often for rhinologic or laryngologic issues and are reflective of the clinical setting in which
Caulley, Lisa; Kohlert, Scott; Gandy, Hazen; Olds, Janet; Bromwich, Matthew
Conversion disorder refers to functional bodily impairments that can be precipitated by high stress situations including trauma and surgery. Symptoms of conversion disorder may mimic or complicate otolaryngology diseases in the pediatric population. In this report, the authors describe 3 cases of conversion disorder that presented to a pediatric otolaryngology-head and neck surgery practice. This report highlights a unique population of patients who have not previously been investigated. The clinical presentation and management of these cases are discussed in detail. Non-organic otolaryngology symptoms of conversion disorder in the pediatric population are reviewed. In addition, we discuss the challenges faced by clinicians in appropriately identifying and treating these patients and present an approach to management of their care. In this report, the authors highlight the importance of considering psychogenic illnesses in patients with atypical clinical presentations of otolaryngology disorders.
Meller, C; Havas, T E
Piezoelectric technology has existed for many years as a surgical tool for precise removal of soft tissue and bone. The existing literature regarding its use specifically for otolaryngology, and head and neck surgery was reviewed. The databases Medline, the Cochrane Central Register of Controlled Trials, PubMed, Embase and Cambridge Scientific Abstracts were searched. Studies were selected and reviewed based on relevance. Sixty studies were identified and examined for evidence of benefits and disadvantages of piezoelectric surgery and its application in otolaryngology. The technique was compared with traditional surgical methods, in terms of intra-operative bleeding, histology, learning curve, operative time and post-operative pain. Piezoelectric technology has been successfully employed, particularly in otology and skull base surgery, where its specific advantages versus traditional drills include a lack of 'blunting' and tissue selectivity. Technical advantages include ease of use, a short learning curve and improved visibility. Its higher cost warrants consideration given that clinically significant improvements in operative time and morbidity have not yet been proven. Further studies may define the evolving role of piezoelectric surgery in otolaryngology, and head and neck surgery.
Kirkham, Erin M.; Weaver, Edward M.
Objective Multiple hypothesis testing (or multiple testing) refers to testing more than one hypothesis within a single analysis, and can inflate the Type I error rate (false positives) within a study. The aim of this review was to quantify multiple testing in recent large clinical studies in the otolaryngology literature and to discuss strategies to address this potential problem. Data sources Original clinical research articles with >100 subjects published in 2012 in the four general otolaryngology journals with the highest Journal Citation Reports 5-year impact factors. Review methods Articles were reviewed to determine whether the authors tested greater than five hypotheses in at least one family of inferences. For the articles meeting this criterion for multiple testing, Type I error rates were calculated and statistical correction was applied to the reported results. Results Of the 195 original clinical research articles reviewed, 72% met the criterion for multiple testing. Within these studies, there was a mean 41% chance of a Type I error and, on average, 18% of significant results were likely to be false positives. After the Bonferroni correction was applied, only 57% of significant results reported within the articles remained significant. Conclusion Multiple testing is common in recent large clinical studies in otolaryngology and deserves closer attention from researchers, reviewers and editors. Strategies for adjusting for multiple testing are discussed. PMID:25111574
Bowe, Sarah N; Laury, Adrienne M; Gray, Stacey T
There has been a heightened focus on improving the resident selection process, particularly within highly competitive specialties. Previous research, however, has generally lacked a theoretical background, leading to inconsistent and biased results. Our recently published systematic review examining applicant characteristics and performance in residency can provide historical insight into the predictors (ie, constructs) and outcomes (ie, criteria) previously deemed pertinent by the otolaryngology community. Personnel psychology uses evidence-based practices to identify the most qualified candidates for employment using a variety of selection methods. Extensive research in this discipline has shown that integrity tests, structured interviews, work samples, and conscientiousness offer the greatest increase in validity when combined with general cognitive ability. Blending past research knowledge with the principles of personnel selection can provide the necessary foundation with which to engage in theory-driven, longitudinal studies on otolaryngology resident selection moving forward.
Ayiheng, Qukuerhan; Niliapaer, Alimu; Yalikun, Yasheng
To understand the basic situation and development of knowledge structure and ability of master degree of Otolaryngology Head and Neck Surgery in Xinjiang region in order to provide reference to further improve the quality of postgraduate students. Fourty-six papers of Otolaryngology master degree thesis were reviewed at randomly in terms of types, subject selection ranges as well as statistical methods during 1998-2009 in Xinjiang region in order to analyze and explore its advantages and characteristics and suggest a solution for its disadvantages. In 46 degree thesis, nine of them are scientific dissertations accounting for 19.57%, 37 are clinical professional degree thesis, accounting for 80.43%. Five are Experimental research papers, 30 are clinical research papers, 10 are clinical and experimental research papers, 1 of them is experimental epidemiology research paper; in this study, the kinds of diseases including every subject of ENT, various statistical methods are involved; references are 37.46 in average, 19.55 of them are foreign literatures references in nearly 5 years are 13.57; four ethnic groups are exist in postgraduate students with high teaching professional level of tutors. The clinical research should be focused in order to further research on ENT common diseases, the application of advanced research methods, the full application of the latest literature, tutors with high-level, training of students of various nationalities, basic research needs to be innovative and should be focus the subject characteristics, to avoid excessive duplication of research.
Scott, John R; Wong, Eric; Sowerby, Leigh J
No literature exists which examines referral preferences to, or the consultation process with, Otolaryngology. In a recent Canadian Medical Association nation-wide survey of General Practitioners and Family Physicians, Otolaryngology was listed as the second-most problematic specialty for referrals. The purpose of this study was to learn about and improve upon the referral process between primary care physicians (PCPs) and Otolaryngology at an academic centre in Southwestern Ontario. PCPs who actively refer patients to Otolaryngology within the catchment area of Western University were asked to complete a short paper-based questionnaire. Data was analyzed using descriptive statistics. A total of 50 PCPs were surveyed. Subspecialty influenced 90.0% of the referrals made. Specialist wait times altered 58.0% of referrals. All PCPs preferred to communicate via fax. Half of those surveyed wanted clinical notes from every encounter. Seventy-four percent of respondents wanted inappropriate referrals forwarded to the proper specialist automatically. Twenty-two percent of those surveyed were satisfied with current wait times. A central referral system was favored by 74% of PCPs. Improvements could help streamline the referral and consultation practices with Otolaryngology in Southwestern Ontario. A central referral system and reduction in the frequency of consultative reports can be considered.
Schoeff, Stephen; Hernandez, Brian; Robinson, Derek J; Jameson, Mark J; Shonka, David C
To compare the effectiveness of massed versus interval training when teaching otolaryngology residents microvascular suturing on a validated microsurgical model. Otolaryngology residents were placed into interval (n = 7) or massed (n = 7) training groups. The interval group performed three separate 30-minute practice sessions separated by at least 1 week, and the massed group performed a single 90-minute practice session. Both groups viewed a video demonstration and recorded a pretest prior to the first training session. A post-test was administered following the last practice session. At an academic medical center, 14 otolaryngology residents were assigned using stratified randomization to interval or massed training. Blinded evaluators graded performance using a validated microvascular Objective Structured Assessment of Technical Skill tool. The tool is comprised of two major components: task-specific score (TSS) and global rating scale (GRS). Participants also received pre- and poststudy surveys to compare subjective confidence in multiple aspects of microvascular skill acquisition. Overall, all residents showed increased TSS and GRS on post- versus pretest. After completion of training, the interval group had a statistically significant increase in both TSS and GRS, whereas the massed group's increase was not significant. Residents in both groups reported significantly increased levels of confidence after completion of the study. Self-directed learning using a chicken thigh artery model may benefit microsurgical skills, competence, and confidence for resident surgeons. Interval training results in significant improvement in early development of microvascular anastomosis skills, whereas massed training does not. NA. Laryngoscope, 127:2490-2494, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Kimple, Adam J; McClurg, Stanley W; Del Signore, Anthony G; Tomoum, Mohamed O; Lin, Feng-Chang; Senior, Brent A
Historically, narrative letters of recommendation have been utilized in the selection of applicants for otolaryngology residency programs. In the last two application cycles, our specialty adopted a standardized letter of recommendation (SLOR). The intent was to decrease time burden for letter writers and to provide readers with an objective evaluation of applicants. The objective of this study was to determine attributes in the SLOR that correlate with matching into a residency program. We performed a retrospective study using SLOR, United States Medical Licensing Examination (USMLE) step 1 scores, and matched outcomes of applicants who applied to our institution for the 2013 and 2014 match cycle. We included the following variables from the SLOR in the statistical analysis to determine which ones were associated with matching: patient care, medical knowledge, communication skills, procedural skills, research, initiative and drive, commitment to otolaryngology, commitment to academic medicine, match potential, and USMLE1 scores. We identified 532 applicants and 963 SLOR. In successful applicants, scores for patient care, medical knowledge, communication skills, initiative and drive, and match potential were statistically higher (P otolaryngology, commitment to academic medicine, and USMLE step 1 scores were not higher among successfully matched applicants. Although SLOR can save time for letter writers and provide an objective description of applicants, the utility of individual domains within the SLOR is questionable. Additionally, it is concerning that applicants' professionalism and procedural skills are not correlated with matching in our specialty. NA. Laryngoscope, 126:1071-1076, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Baugh, Tiffany P; Franzese, Christine B
Objectives The purpose of this study is to examine the effect of minimum case numbers on otolaryngology resident case log data and understand differences in minimum, mean, and maximum among certain procedures as a follow-up to a prior study. Study Design Cross-sectional survey using a national database. Setting Academic otolaryngology residency programs. Subjects and Methods Review of otolaryngology resident national data reports from the Accreditation Council for Graduate Medical Education (ACGME) resident case log system performed from 2004 to 2015. Minimum, mean, standard deviation, and maximum values for total number of supervisor and resident surgeon cases and for specific surgical procedures were compared. Results The mean total number of resident surgeon cases for residents graduating from 2011 to 2015 ranged from 1833.3 ± 484 in 2011 to 2072.3 ± 548 in 2014. The minimum total number of cases ranged from 826 in 2014 to 1004 in 2015. The maximum total number of cases increased from 3545 in 2011 to 4580 in 2015. Multiple key indicator procedures had less than the required minimum reported in 2015. Conclusion Despite the ACGME instituting required minimum numbers for key indicator procedures, residents have graduated without meeting these minimums. Furthermore, there continues to be large variations in the minimum, mean, and maximum numbers for many procedures. Variation among resident case numbers is likely multifactorial. Ensuring proper instruction on coding and case role as well as emphasizing frequent logging by residents will ensure programs have the most accurate data to evaluate their case volume.
Thomas, Carissa M; Cabrera-Muffly, Cristina
The objectives of this study were to summarize externship experiences among recent graduates and current residents in otolaryngology residency programs and determine whether externships affect the match process. Cross-sectional survey. A survey was distributed to otolaryngology residents in allopathic US residency programs and otolaryngology graduates from the past 5 years (2011-2015). There were 2,141 surveys distributed. There were 654 subjects who responded, for a 30.5% response rate. Most respondents were residents (n = 438, 67%). Of the residents, 85.6% had completed at least one externship compared to 75.9% of graduates (P = .002). The most common reasons for selecting a particular externship were geographic location (74.2%) and program reputation (71.1%), whereas the most common reason for not completing an externship was being advised not to (59.1%). Furthermore, 82.6% of respondents received at least one interview from their externships, 90% went to those interviews, and 89.1% reported that externship experiences affected their rank list. Respondents had a 32.7% match rate to the externship residency program if it was ranked versus a 48.8% match rate if the program was ranked first. Respondents who matched at the externship residency program matched higher on their rank list (P < .001). Of the respondents, 90.7% found externships to be valuable, and 74.5% recommended completing one. Externships are beneficial because they influence the rank list of applicants and are viewed as valuable experiences. Completing an externship is advisable for the experience, but applicants should weigh the benefits versus the possible risk of being judged more harshly during a month-long rotation. NA Laryngoscope, 127:2242-2246, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Wong, Kevin; Jang, Minyoung; Gilad, Amir; Levi, Jessica R
Evaluate the educational and exposure opportunities provided to students by national otolaryngology organizations. Twenty-four otolaryngology organizations and subspecialty societies were reviewed for medical student involvement opportunities, educational and enrichment opportunities, costs of involvement, and available research and travel scholarships. Nine organizations (37.5%) offered membership; 6 charged a membership fee, averaging $73 ± $30 (mean ± SD). Membership was limited to associate status for 7 organizations (77.8%; 7/9). Three organizations (12.5%) provided service opportunities, 4 (16.7%) allowed students to vote, and 1 (4.2%) allowed students to endorse others for membership. Most organizations allowed students to attend conferences (95.8%), and 19 (79.2%) allowed students to present research. Twenty-one (87.5%) organizations charged a conference registration fee ($366 ± $300). Seven organizations (29.2%) offered research scholarships, and 5 (20.8%) offered travel awards. Opportunities exist for medical students to attend conferences and present research; however, educational and enrichment activities in other areas were limited. Future efforts may be warranted to increase the number and type of opportunities for students.
Contrera, Kevin J.; Ishii, Lisa E.; Setzen, Gavin; Berkowitz, Scott A.
Accountable Care Organizations represent a shift in health care delivery, while providing a significant potential for improved quality and coordination of care across multiple settings. Otolaryngologists have an opportunity to become leaders in this expanding arena. However, the field of otolaryngology-head and neck surgery currently lacks many of the tools necessary to implement value-based care, including performance-measurement, electronic health infrastructure and data management. These resources will become increasingly important for surgical specialists to be active participants in population health. This article reviews the fundamental issues that otolaryngologists should consider when pursuing new roles in Accountable Care Organizations. PMID:26044787
Barnes, M L; Hussain, S S M
To present our experience of running a consultant-based otolaryngology emergency care service for more than five years. In 2003, we developed a system of consultant-based emergency service: consultants spent a week on-call providing a dedicated emergency service, with routine commitments cancelled. Our new system had advantages over traditional working practices in terms of consultant involvement, trainee education, continuity and efficiency. It also reduced disruption to elective commitments for both consultants and registrars. This system was fundamental to the successful review of all urgent (and in future elective) cases within target periods. Only 31 per cent of new referrals to the consultant emergency clinics required a further appointment. Good teamwork and flexibility in working arrangements have been essential to the success of this service. Given that health service changes have reduced junior trainee working hours and numbers, and that patients increasingly expect to be treated by trained doctors, our new consultant-based emergency service has merit. Although implementation in other units may differ, we recommend this new service, for the above reasons.
Hancock, Melyssa; Hoa, Michael; Malekzadeh, Sonya
Advances in modern communications and information technology have helped to improve access to, and quality of, health care and education. These enhancements include a variety of World Wide Web-based and mobile learning platforms, such as eLearning, mLearning, and open education resources. This article highlights the innovative approaches that have fostered improved collaboration and coordination of global health efforts in otolaryngology. Copyright © 2018 Elsevier Inc. All rights reserved.
Ward, Matthew; Pingree, Christian; Laury, Adrienne M; Bowe, Sarah N
It has been nearly 25 years since medical students were queried regarding their perspectives on otolaryngology-head and neck surgery (OHNS) residency selection. Understanding this viewpoint is critical to improving the current application process. To evaluate the perceptions of 2016 OHNS residency applicants regarding the application process and offer suggestions for reform. In this cross-sectional study of anonymous online survey data, a 14-question survey was designed based on resources obtained from a computerized PubMed, Ovid, and GoogleScholar database search of the English language from January 1, 1990, through December 31, 2015, was conducted using the following search terms: (medical student OR applicant) AND (application OR match) AND otolaryngology. The survey was administered to 2016 OHNS residency applicants to examine 4 primary areas: current attitudes toward the match, effect of the new Otolaryngology Program Directors Organization personal statement mandate, sources of advice and information, and suggestions for improvement. In January 2016, an email was sent to 100 program directors asking them to distribute the survey to current OHNS applicants at their institution. One follow-up reminder email was sent in February 2016. A link to the survey was posted on the Otomatch.com homepage on January 28, 2016, with the last response received on March 28, 2016. Survey responses regarding the residency application process. A total of 150 of 370 residency applicants (40.5%) responded to the survey. Of these, 125 respondents (90.6%) noted applying to programs in which they had no specific interest simply to improve their chances of matching. Applicants intended to apply to more programs than they actually did (63.6 vs 60.8; r = 0.19; 95% CI, -0.03 to 0.40). Program directors advised fewer applications than other sources; however, 58 respondents (38.7%) did not receive advice from a program director. A total of 121 respondents (80.7%) found online program
Horn, Jarryd; Checketts, Jake Xavier; Jawhar, Omar; Vassar, Matt
Financial relationships between physicians and industry have influence on patient care. Therefore, organizations producing clinical practice guidelines (CPGs) must have policies limiting financial conflicts during guideline development. To evaluate payments received by physician authors of otolaryngology CPGs, compare disclosure statements for accuracy, and investigate the extent to which the American Academy of Otolaryngology-Head and Neck Surgery complied with standards for guideline development from the Institute of Medicine (IOM). This cross-sectional analysis retrieved CPGs from the American Academy of Otolaryngology-Head and Neck Surgery Foundation that were published or revised from January 1, 2013, through December 31, 2015, by 49 authors. Data were retrieved from December 1 through 31, 2016. Industry payments received by authors were extracted using the Centers for Medicare & Medicaid Services Open Payments database. The values and types of these payments were then evaluated and used to determine whether self-reported disclosure statements were accurate and whether guidelines adhered to applicable IOM standards. The monetary amounts and types of payments received by physicians who author otolaryngology guidelines and the accuracy of disclosure statements. Of the 49 physicians in this sample, 39 (80%) received an industry payment. Twenty-one authors (43%) accepted more than $1000; 12 (24%), more than $10 000; 7 (14%), more than $50 000; and 2 (4%), more than $100 000. Mean (SD) financial payments amounted to $18 431 ($53 459) per physician. Total reimbursement for all authors was $995 282. Disclosure statements disagreed with the Open Payments database for 3 authors, amounting to approximately $20 000 among them. Of the 3 IOM standards assessed, only 1 was consistently enforced. Some CPG authors failed to fully disclose all financial conflicts of interest, and most guideline development panels and chairpersons had conflicts. In addition
Yamauchi-Kawaura, C.; Fujii, K.; Aoyama, T.; Yamauchi, M.; Koyama, S.
The purpose of this study was to clarify patient doses in the current otolaryngological multi-detector row computed tomography (MDCT) examinations. Patient doses were measured with an in-phantom dosimetry system which was composed of 48 photodiode dosemeters embedded within an anthropomorphic phantom. Organ and effective doses were evaluated according to the International Commission on Radiological Protection Publication 103. In neck CT, doses for salivary glands and for thyroid were high, 7.6-29.9 and 13.4-60.3 mGy, respectively. In sinus CT, brain and lens doses were high, 7.6-24.6 and 10.6-32.0 mGy, respectively, and in inner ear CT, lens dose was 8.0-35.3 mGy. Effective doses were 1.8-6.6 mSv in neck CT, 0.5-0.9 mSv in sinus CT and 0.3-0.6 mSv in inner ear CT. The present dose data would be used to estimate radiation risks for patients undergoing otolaryngological MDCT examinations. (authors)
Full Text Available Abstract Background Reusable nasal-spray devices are frequently used in otolaryngologic examinations, and there is an increasing concern about the risk of cross-contamination from these devices. The aim of our study was to determine, by means of microbiologic analysis, the safety of a positive-displacement or pump-type atomizer after multiple uses. Methods A reusable nasal spray bottle, pump, and tips were used in the nasal physical examination of 282 patients admitted to a tertiary otolaryngology clinic. The effectiveness of 2 different methods of prophylaxis against microbiologic contamination (the use of protective punched caps or rinsing the bottle tip with alcohol was compared with that of a control procedure. Results Although there was no statistically significant difference in positive culture rates among the types of nasal spray bottles tested, methicillin-resistant coagulase-negative staphylococci were isolated in 4 of 198 cultures. Conclusion Given these findings, we concluded that additional precautions (such as the use of an autoclave between sprays, disposable tips, or disposable devices are warranted to avoid interpatient cross-contamination from a reusable nasal spray device.
Naples, James; Schwartz, Marissa; Eisen, Marc
Presidents George Washington and Theodore Roosevelt suffered complications of epiglottitis and otomastoiditis, respectively. The introduction of antibiotics and vaccinations against Haemophilus influenzae and Streptococcus pneumoniae has significantly reduced the incidence of these otolaryngologic infections, such that the natural history of the disease is rarely encountered. However, antibiotic resistance and pathogenic evolution has raised concern about increased virulence of these common organisms. A retrospective evaluation of the complications suffered by Washington and Roosevelt provides valuable insight to the natural history of common otolaryngologic infections that may reemerge as a result of organism evolution in response to antibiotics and vaccines.
Full Text Available Introduction and objective: The present text addresses the most significant aspects to share research data in otolaryngology in the context of open science as an ecosystem. Its aim is to offer a panoramic view that helps the researcher to manage their data as part of enriched science. Method: A bibliographical review and of the own experience in the field of the investigation data was performed. Results: The basic pillars for success are offered: its political, technical and necessary capacities. Discussion: The tasks of making data available should be recognized as part of the researcher's curriculum because documenting them to be reusable is a highly specialized and time-consuming task. Conclusions: It is considered that we are at a crucial moment to begin to share data. It is being considered in all scientific policy scenarios as in the EU through the European Open Science Computing.
Fox, R; Nash, R; Liu, Z-W; Singh, A
Epistaxis is a common and potentially life-threatening emergency. This survey assesses understanding and confidence in epistaxis management amongst current junior doctors. A cross-sectional study was conducted of foundation year one and two doctors based at three National Health Service trusts within a single region of the UK, assessing basic understanding and procedural confidence. A total of 111 foundation doctors completed this survey. The average duration of undergraduate exposure to otolaryngology was 8.1 days. Forty-one per cent of respondents stated that they would apply pressure to the nasal bones to control epistaxis. Seventy-five per cent lacked confidence in their ability to manage epistaxis. Those with two weeks or more of undergraduate exposure to otolaryngology were more confident than those with one week or less of exposure (p epistaxis management, with patient safety implications. Confidence is associated with the duration of undergraduate exposure to otolaryngology. A minimum emergency safe competency should be a priority during foundation training if not achieved in UK medical schools.
Kaper, N.M.; Swart, K.M.A.; Grolman, W.; van der Heijden, G.J.M.G.
Background: High-quality trials have the potential to influence clinical practice. Methods: Ten otolaryngology journals with the highest 2011 impact factors were selected and publications from 2010 were extracted. From all medical journals, the 20 highest impact factor journals were selected, and
Danino, Julian; Muzaffar, Jameel; Metcalfe, Chris; Coulson, Chris
Human evaluation and judgement may include errors that can have disastrous results. Within medicine and healthcare there has been slow progress towards major changes in safety. Healthcare lags behind other specialised industries, such as aviation and nuclear power, where there have been significant improvements in overall safety, especially in reducing risk of errors. Following several high profile cases in the USA during the 1990s, a report titled "To Err Is Human: Building a Safer Health System" was published. The report extrapolated that in the USA approximately 50,000 to 100,000 patients may die each year as a result of medical errors. Traditionally otolaryngology has always been regarded as a "safe specialty". A study in the USA in 2004 inferred that there may be 2600 cases of major morbidity and 165 deaths within the specialty. MEDLINE via PubMed interface was searched for English language articles published between 2000 and 2012. Each combined two or three of the keywords noted earlier. Limitations are related to several generic topics within patient safety in otolaryngology. Other areas covered have been current relevant topics due to recent interest or new advances in technology. There has been a heightened awareness within the healthcare community of patient safety; it has become a major priority. Focus has shifted from apportioning blame to prevention of the errors and implementation of patient safety mechanisms in healthcare delivery. Type of Errors can be divided into errors due to action and errors due to knowledge or planning. In healthcare there are several factors that may influence adverse events and patient safety. Although technology may improve patient safety, it also introduces new sources of error. The ability to work with people allows for the increase in safety netting. Team working has been shown to have a beneficial effect on patient safety. Any field of work involving human decision-making will always have a risk of error. Within
Kaplan, Alyson B; Riedy, Katherine N; Grundfast, Kenneth M
For graduating medical students, securing a residency in otolaryngology-head and neck surgery has become exceedingly difficult. This commentary explores the ways that applicants and residency programs are reacting to the increasing competitiveness in applying to, interviewing for, and matching to an otolaryngology residency. The commonly held perceptions of applicants are compared to perspectives held by residency program directors and resident selection committees. Unintended consequences of the growing trend for medical students to add a research year to their curriculum are presented. Some cautions and suggestions about how to improve the application and selection process are offered. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
Wong, Kevin; Piraquive, Jacquelyn; Troiano, Chelsea A; Sulibhavi, Anita; Grundfast, Kenneth M; Levi, Jessica R
Review the pediatric otolaryngology literature to 1) identify studies in which children completed patient-reported outcome (PRO) measures and 2) appraise the psychometric quality and validity of these PROs as they apply to pediatrics. In October 2016, a systematic review was performed by two reviewers on PubMed/MEDLINE and EMBASE for all otolaryngology-related studies that utilized PROs in children. Inclusion criteria included articles that required children (ageotolaryngology and some studies utilized PROs that were not validated or not validated for use in this age group. Future efforts to design and validate more instruments may be warranted. Copyright © 2017. Published by Elsevier B.V.
Shah, Udayan K.
A new technology (OtoLAM) to fenestrate the tympanic membrane with the carbon dioxide laser (CO2), in the office or the operating room, has been introduced over the last three years. While not new conceptually, this product offers the ability to easily create a precise window into the middle ear using a portable system. Controversy regarding the indications and benefits of this technique, amplified by the costs of the system and the marketing of the technology prior to extensive clinical testing, has plagued the clinical application of this technology. We report our experience over the past year with this system in a busy pediatric otolaryngology practice. Laser fenestration of the tympanic membrane has been useful for the insertion of tympanostomy tubes, and for the minimally invasive evaluation of the middle ear. Our small experience to date reveals that there is a limited role for laser tympanic membrane fenestration in a busy pediatric otolaryngology practice.
Mena Viveros, Nicolás
According to the National Institute of Health of the USA, «more than 60% of all microbial infections are caused by biofilms».'This can surprise us, but it is enough to consider that common infections like those of the genito-urinary tract, infections produced by catheters, middle ear infections in children, the formation of dental plaque and gingivitis are caused by biofilms, for this statement to seem more realistic. At present this is one of the subjects of great interest within medicine, particularly in otolaryngology. Bacteria have traditionally been considered to be in a free state without evident organization, partly perhaps by the ease of studying them in this form. Nevertheless, the reality is that, in nature, the great majority of these germs form complex colonies adhered to surfaces, colonies that have received the name of biofilms. These biofilms are more common than previously thought and almost all of the people have been in contact with them in the form of infections in the teeth or humid, slippery areas. New treatments that can eradicate them are currently being investigated. Copyright © 2012 Elsevier España, S.L. All rights reserved.
Tarpada, Sandip P; Hsueh, Wayne D; Gibber, Marc J
E-learning, in its most rudimentary form, is the use of Internet-based resources for teaching and learning purposes. In surgical specialties, this definition encompasses the use of virtual patient cases, digital modeling, and online tutorials, as well as standardized video and imaging. As new technological frontiers rapidly emerge within otolaryngology, e-learning may be an effective alternative to traditional teaching. Here we present a systematic review of the literature assessing the efficacy of e-learning for otolaryngology education and a discussion of the relevance of these programs for both medical students and residents within the field. Systematic review. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted according to the guidelines defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Twelve studies met inclusion criteria. These studies measured a range of outcomes from basic science anatomical knowledge to clinically relevant endpoints such as diagnostic accuracy. Nearly all of the studies reported greater satisfaction and/or significantly increased objective knowledge using the e-learning intervention compared to traditional techniques. E-learning proves to be a powerful alternative to standard teaching techniques within otolaryngology education for both residents and medical students. Future work should focus on validating specific e-learning programs and accessing long-term knowledge retention using these innovative platforms. NA Laryngoscope, 127:E219-E224, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Oyewumi, Modupe; Lee, John; Vescan, Allan
The objective of this study was to assess the current use of social media tools within Canadian otolaryngology-head and neck surgery (OHNS) programs and to assess the interest within these programs to integrate social media for networking, social, and educational programs. A prospective study from September 2013 to February 2014 was performed involving residents and faculty in Canadian OHNS programs. A 26-item questionnaire was created and sent to staff and resident physicians who met the study inclusion criteria using an online survey tool (http://surveymonkey.com). There were 101 respondents for a 10% response rate. More than half (58.4%) of respondents reported use of social media for personal and/or professional matters. Residents and junior faculty physicians 39 years and younger were more likely to have social media accounts and used them more frequently than their older counterparts. Among staff physicians, pediatric otolaryngologists had the highest rate of use, and otologists exhibited the lowest rate. Cellular phones were the most commonly used devices to access social media sites. Fewer than 35% of social media users failed to separate their personal and professional accounts. Although OHNS trainees and practicing physicians identified the potential benefits of social media tools in their specialty, most were unsure how to apply these tools to their practice. Ours is the first study to assess social media use in OHNS. Otolaryngologists are currently using social media; however, their application as a communication and educational tool in otolaryngology remains to be defined.
Ross, Peter D; Steven, Richard; Zhang, Dong; Li, Heng; Abel, Eric W
This study was undertaken to introduce and establish the value of the Dundee Endoscopic Psychomotor Otolaryngology Surgery Trainer (DEPOST) as a customisable, objective real-time scoring system for trainee assessment. The construct validity of the system was assessed by comparing the performance of experienced otolaryngologists with that of otolaryngology trainees, junior doctors and medical students. Forty two subjects (13 Consultants, 8 senior trainees, 13 junior trainees and 8 junior doctors/medical students) completed a single test on DEPOST. The test involved using a 30° rigid endoscope and a probe with position sensor, to identify a series of lights in a complex 3-dimensional model. The system scored subjects for time, success rate, and economy of movement (distance travelled). An analysis of variance and correlation analysis were used for the data analysis, with statistical significance set at 0.05. Increasing experience led to significantly improved performance with the DEPOST (p < 0.01). Senior trainees' results were significantly better than those of consultant otolaryngologists in success rate and time (p < 0.05 & p < 0.05). Consultants were the most efficient in their movement (p = 0.051) CONCLUSIONS: The system provides an accurate and customisable assessment of endoscopic skill in otolaryngologists. The DEPOST system has construct validity, with master surgeons and senior trainees completing the tasks more accurately without sacrificing execution time, success rate or efficiency of movement.
Tassone, Peter; Georgalas, Christos; Patel, Nimesh N.; Appleby, Esther; Kotecha, Bhik
The Internet has become a very important source of health information. We wanted to determine otolaryngology patients' access to, and use of, the Internet as a medical information resource, to identify factors that make patients more likely to use it, and to determine how useful they find this
Bellmunt, Angela M; Roberts, Rhonda; Lee, Walter T; Schulz, Kris; Pynnonen, Melissa A; Crowson, Matthew G; Witsell, David; Parham, Kourosh; Langman, Alan; Vambutas, Andrea; Ryan, Sheila E; Shin, Jennifer J
There are multiple nationally representative databases that support epidemiologic and outcomes research, and it is unknown whether an otolaryngology-specific resource would prove indispensable or superfluous. Therefore, our objective was to determine the feasibility of analyses in the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) databases as compared with the otolaryngology-specific Creating Healthcare Excellence through Education and Research (CHEER) database. Parallel analyses in 2 data sets. Ambulatory visits in the United States. To test a fixed hypothesis that could be directly compared between data sets, we focused on a condition with expected prevalence high enough to substantiate availability in both. This query also encompassed a broad span of diagnoses to sample the breadth of available information. Specifically, we compared an assessment of suspected risk factors for sensorineural hearing loss in subjects 0 to 21 years of age, according to a predetermined protocol. We also assessed the feasibility of 6 additional diagnostic queries among all age groups. In the NAMCS/NHAMCS data set, the number of measured observations was not sufficient to support reliable numeric conclusions (percentage standard error among risk factors: 38.6-92.1). Analysis of the CHEER database demonstrated that age, sex, meningitis, and cytomegalovirus were statistically significant factors associated with pediatric sensorineural hearing loss (P < .01). Among the 6 additional diagnostic queries assessed, NAMCS/NHAMCS usage was also infeasible; the CHEER database contained 1585 to 212,521 more observations per annum. An otolaryngology-specific database has added utility when compared with already available national ambulatory databases. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
Nassif, Samih J; Wong, Kevin; Levi, Jessica R
Evaluate the reading difficulty of Spanish patient education materials using the validated Índice Flesch-Szigriszt (INFLESZ) and Spanish Lexile Analyzer, and to identify relationships between English and Spanish readability formulas. Cross-sectional analysis. All otolaryngology-related patient education articles written in Spanish from the health libraries of the top 10 US News & World Report-ranked hospitals, top 10 Doximity-ranked otolaryngology residencies, the American Academy of Otolaryngology-Head and Neck Surgery website, and the US National Library of Medicine online section on ears, nose and throat were collected. Reading difficulty was assessed using the INFLESZ and Spanish Lexile Analyzer. Additional readability assessments included the traditional English tools: Flesch-Kincaid Grade Level, Flesch Reading Ease Score, and the Simple Measure of Gobbledygook score. A total of 497 articles were reviewed. The average INFLESZ score for all articles was 57.75, which is considered normal and requires the reading ability of a student who finished Escuela Secundaria Obligatoria or 10th grade equivalent in the United States. The average Spanish Lexile measure for all articles was 1062L, equivalent to a reading level between the 6th and 12th grade. English readability tools calculated a more difficult reading level compared to Spanish tools when performed on the same text. Current Spanish patient education materials in otolaryngology may be too difficult for the average Spanish-speaking reader to understand. Future improvements may be warranted to improve the readability of educational materials and increase health literacy. NA. Laryngoscope, 128:E21-E26, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Lee, J C Y; Siow, J K
Central to the management of a patient with a thyroid nodule is the evaluation of the risk of malignancy. Postoperative morbidity, though rare, remains a concern because of its impact on the quality of the life of the patient. A retrospective audit of 91 consecutive patients who underwent thyroid surgery for thyroid nodules, at the Department of Otolaryngology, Tan Tock Seng Hospital, between January 1995 and December 2000. The sensitivity and specificity of fine-needle aspiration cytology (FNAC) were 60% and 100%, respectively. The sensitivity and specificity of intraoperative frozen section examination was 82% and 100%, respectively. Sixty-four patients experienced no postoperative morbidity. Of the 27 patients with postoperative morbidity, only 1 was permanent. The incidence of transient and permanent biochemical hypocalcaemia was 44% and 0%, respectively. Nodal dissection performed together with total thyroidectomy increased the incidence of postoperative hypocalcaemia (P 0.05). The median hospital stay was 3 days for benign thyroid disease, 4.5 and 16 days for malignant disease with tracheo-oesophageal groove clearance only and with neck dissection, respectively. The combination of clinical examination and FNAC remains the mainstay in selecting patients for surgery. Frozen section examination is an important intraoperative diagnostic adjunct to decide the extent of surgery. With proper surgical training and experience, thyroid surgery for malignancy can be undertaken with minimum postoperative morbidity and a short hospital stay.
Ifeacho, S N; Bajaj, Y; Jephson, C G; Albert, D M
An assessment of the rate of surgical site infections associated with elective paediatric otolaryngology surgical procedures. Prospective data was collected for a 3-week period for all children undergoing surgery where either mucosa or skin was breached. The parents of the children were requested to complete a questionnaire at 30 days after the operation. Data was collected on 80 consecutive cases. The majority of cases were admitted on the day of the procedure. The procedures included adenotonsillectomy (24), grommets (12), cochlear implantation (6), bone-anchored hearing aid (2), submandibular gland excision (1), branchial sinus excision (1), cystic hygroma excision (3), nasal glioma excision (1), microlaryngobronchoscopy (13), tracheostomy (3) and other procedures (14). Nearly half the cases had more than one operation done at the same time. 26/80 (32.5%) patients had a temporary or permanent implant inserted at the time of operation (grommet, bone-anchored hearing aid, cochlear implant). 25/80 (31%) operative fields were classed as clean and 55/80 (68.7%) as clean contaminated operations. The duration of the operation varied from 6 min to 142 min. Hospital antibiotic protocol was adhered to in 69/80 (86.3%) cases but not in 11/80 cases. In our series, 3/80 (3.7%) patients had an infection in the postoperative period. Surgical site infections do occur at an appreciable rate in paediatric otolaryngology. With the potential for serious consequences, reduction in the risk of surgical site infections is important. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Prim-Espada, María Pilar; De Diego-Sastre, Juan Ignacio; Pérez-Fernández, Elia
In last decades women in Spain have a greater access to postgraduate education. The objective of this study was to perform a gender analysis on the Otolaryngology doctoral theses presented in a 25 year-period. The TESEO data base on doctoral theses was searched for theses on Otorhinolaryngology written between 1981 and 2005. As strategy for the research we employed the terms: 1) Otorrinolaringología (Otorhinolaryngology); 2) Cirugía de garganta, nariz y oídos (Ear, nose and throat surgery); 3) Fisiología de la audición (Physiology of hearing); 4) Fisiología del equilibrio (Physiology of balance); 5) Física de la audición (Physics of hearing); and 6) Bioacústica (Bioacoustics). A total of 450 theses (18.0±8.3 theses/year) were found, of which 129 were written by females (28.6%). There was a gender imbalance among authors, with 5.2±3.4 theses/year for women vs. 12.9±6.6 theses/year for men (p=0.0002). Nevertheless, there was a tendency toward equality in the last 10 years (p=0.001). On the other hand, the PhD student's gender was clearly related to the supervisor's gender (p=0.0001). With respect to the main topics in our area (otology, audiology/vestibular diseases, rhinology and pathology of paranasal sinuses and neck diseases), there were no significant differences between males and females (p=0.231). These results indicate a tendency towards equality in the number of men and women successfully completing doctoral studies in Otolaryngology. However, the PhD student's gender is clearly related to the supervisor's gender. Copyright © 2010 Elsevier España, S.L. All rights reserved.
Puram, Sidharth V.; Kozin, Elliott D.; Sethi, Rosh; Alkire, Blake; Lee, Daniel J.; Gray, Stacey T.; Shrime, Mark G.; Cohen, Michael
Background Surgical education remains an important mission of academic medical centers. Financial pressures, however, may favor improved operating room (OR) efficiency at the expense of surgical education. We aim to characterize resident impact on the duration of procedural time using common pediatric otolaryngologic cases which do not necessitate a surgical assistant and assess whether other factors modify the extent to which residents impact OR efficiency. Study Design We retrospectively reviewed resident and attending surgeon total OR and procedural times for isolated tonsillectomy, adenoidectomy, tonsillectomy with adenoidectomy (T&A) and bilateral myringotomy with tube insertion between 2009 and 2013. We included cases supervised or performed by one of four teaching surgeons in children with ASA otolaryngology procedures. While residents may increase operative times, addressing other system-wide issues may decrease impact of time needed for education and added efficiencies of resident participation may exist throughout the perioperative period. Our model is applicable to surgical education across specialties. Level of Evidence 4 PMID:25251257
Naunheim, Matthew R; Kozin, Elliot D; Sethi, Rosh K; Ota, H G; Gray, Stacey T; Shrime, Mark G
Specialty emergency departments (EDs) provide a unique mechanism of health care delivery, but the value that they add to the medical system is not known. Evaluation of patient preferences to determine value can have a direct impact on resource allocation and direct-to-specialist care. To assess the feasibility of contingent valuation (CV) methodology using a willingness-to-pay (WTP) survey to evaluate specialty emergency services, in the context of an ophthalmology- and otolaryngology-specific ED. Contingent valuation analysis of a standalone otolaryngology and ophthalmology ED. Participants were English-speaking adults presenting to a dedicated otolaryngology and ophthalmology ED. The WTP questions were assessed using a payment card format, with reference to an alternative modality of treatment (ie, general ED), and were analyzed with multivariate regression. Validated WTP survey administered from October 14, 2014, through October 1, 2015. Sociodemographic data, level of distress, referral data, income, and WTP. A total of 327 of 423 (77.3%) ED patients responded to the WTP survey, with 116 ophthalmology and 211 otolaryngology patients included (52.3% female; mean [range] age, 46 [18-90] years). The most common reason for seeking care at this facility was a reputation for specialty care for both ear, nose, and throat (80 [37.9%]) and ophthalmology (43 [37.1%]). Mean WTP for specialty-specific ED services was $377 for ophthalmology patients, and $321 for otolaryngology patients ($340 overall; 95% CI, $294 to $386), without significant difference between groups (absolute difference, $56; 95% CI, $-156 to $43). Self-reported level of distress was higher among ear, nose, and throat vs ophthalmology patients (absolute difference, 0.47 on a Likert scale of 1-7; 95% CI, 0.10 to 0.84). Neither level of distress, income, nor demographic characteristics influenced WTP, but patients with higher estimates of total visit cost were more likely to have higher WTP (β coefficient
Fang, Te-Yung; Wang, Pa-Chun; Liu, Chih-Hsien; Su, Mu-Chun; Yeh, Shih-Ching
Virtual reality simulation training may improve knowledge of anatomy and surgical skills. We evaluated a 3-dimensional, haptic, virtual reality temporal bone simulator for dissection training. The subjects were 7 otolaryngology residents (3 training sessions each) and 7 medical students (1 training session each). The virtual reality temporal bone simulation station included a computer with software that was linked to a force-feedback hand stylus, and the system recorded performance and collisions with vital anatomic structures. Subjects performed virtual reality dissections and completed questionnaires after the training sessions. Residents and students had favorable responses to most questions of the technology acceptance model (TAM) questionnaire. The average TAM scores were above neutral for residents and medical students in all domains, and the average TAM score for residents was significantly higher for the usefulness domain and lower for the playful domain than students. The average satisfaction questionnaire for residents showed that residents had greater overall satisfaction with cadaver temporal bone dissection training than training with the virtual reality simulator or plastic temporal bone. For medical students, the average comprehension score was significantly increased from before to after training for all anatomic structures. Medical students had significantly more collisions with the dura than residents. The residents had similar mean performance scores after the first and third training sessions for all dissection procedures. The virtual reality temporal bone simulator provided satisfactory training for otolaryngology residents and medical students. Copyright © 2013. Published by Elsevier Ireland Ltd.
Noyek, A.M.; Friedberg, J.; Fitz, C.R.; Greyson, N.D.; Gilday, D.; Ash, J.; Miskin, M.; Rothberg, R.
This presentation considers the diagnostic role of three major advanced imaging modalities in paediatric otolaryngology: computed tomography, nuclear medicine and ultrasound. These techniques allow for both more specific diagnosis, and for more precise understanding of the natural history of diagnoses already rendered. (Auth.)
Muhammad Ali, Maria; Al Zayer, Maha
Objective. To identify the frequency of typical (headache and dizziness) and common atypical (ear fullness, pressure, pain, tinnitus, facial fullness, and nasal congestion) migraine symptoms as chief complaints among patients presenting to otolaryngology clinic. Methods. This is a descriptive study of prospectively collected data from a general otolaryngology practice. Typical migraine presentations were diagnosed by applying international headache society (IHS) criteria for migraine headache and Neuhauser's criteria for migrainous vertigo. Atypical otologic and rhinologic migraine symptoms were diagnosed using individualized criteria. Charts were reviewed at 6-month interval from the first presentation. Results. Out of 1002 consecutive patients, 10.8% presented with “migrainous chief complaint.” All migrainous chief complaint patients had a history of headache but not all of them presented with headache. Corrected female to male ratio in the migraine group was 3 to 1; age distributions were significantly different between the migraine and nonmigraine groups by applying t-test. Out of the atypical complaints, 86% of the patients had a history of concomitant typical presentation. Conclusion. Actual diagnostic criteria for migraine do not satisfy the diversity of its presentation. Investigating the history of migraine is enough to diagnose most atypical presentations. Sound knowledge about migraine seems essential for any ENT practitioner. PMID:25695049
Smith, Lee P; Roy, Soham
The aim of the study was to characterize the causes of operating room (OR) fires in otolaryngology. A questionnaire was designed to elicit the characteristics of OR fires experienced by otolaryngologists. The survey was advertised to 8523 members of the American Academy of Otolaryngology-Head and Neck Surgery. Three hundred forty-nine questionnaires were completed. Eighty-eight surgeons (25.2%) witnessed at least one OR fire in their career, 10 experienced 2 fires each, and 2 reported 5 fires each. Of 106 reported fires, details were available for 100. The most common ignition sources were an electrosurgical unit (59%), a laser (32%), and a light cord (7%). Twenty-seven percent of fires occurred during endoscopic airway surgery, 24% during oropharyngeal surgery, 23% during cutaneous or transcutaneous surgery of the head and neck, and 18% during tracheostomy; 7% were related to a light cord, and 1% was related to an anesthesia machine. Eighty-one percent of fires occurred while supplemental oxygen was in use. Common fuels included an endotracheal tube (31%), OR drapes/towels (18%), and flash fire (where no substrate burned) (11%). Less common fuels included alcohol-based preparation solution, gauze sponges, patient's hair or skin, electrosurgical unit with retrofitted insulation over the tip, tracheostomy tube, tonsil sponge, suction tubing, a cottonoid pledget, and a red rubber catheter. OR fire may occur in a wide variety of clinical settings; endoscopic airway surgery, oropharyngeal surgery, cutaneous surgery, and tracheostomy present the highest risk for otolaryngologists. Electrosurgical devices and lasers are the most likely to produce ignition. Copyright © 2011 Elsevier Inc. All rights reserved.
Perkins, Jonathan N.; Liang, Conan; McFann, Kim; Abaza, Mona M.; Streubel, Sven-Olrik; Prager, Jeremy D.
Objectives/Hypothesis Develop a standardized letter of recommendation (SLOR) for otolaryngology residency application that investigates the qualities desired in residents and letter writer’s experience. Compare this SLOR to narrative letters of recommendation (NLOR). Study Design Prospective SLOR/NLOR Comparison. Methods The SLOR was sent to a NLOR writer for each applicant. The applicant’s NLOR/SLOR pair was blinded and ranked in seven categories by three reviewers. Inter-rater reliability and NLOR/SLOR rankings were compared. Means of cumulative NLOR and SLOR scores were compared to our departmental rank list. Results Thirty-one SLORs (66%) were collected. The SLORs had higher inter-rater reliability for applicant’s qualifications for otolaryngology, global assessment, summary statement, and overall letter ranking. Writer’s background, comparison to contemporaries/predecessors, and letter review ease had higher inter-rater reliability on the NLORs. Mean SLOR rankings were higher for writer’s background (p=0.0007), comparison of applicant to contemporaries/predecessors (p=0.0031), and letter review ease (p<0.0001). Mean SLOR writing time was 4.17±2.18 minutes. Mean ranking time was significantly lower (p<0.0001) for the SLORs (39.24±23.45 seconds) compared to the NLORs (70.95±40.14 seconds). Means of cumulative SLOR scores correlated with our rank list (p=0.004), whereas means of cumulative NLOR scores did not (p=0.18). Means of cumulative NLOR and SLOR scores did not correlate (p=0.26). Conclusions SLORs require little writing time, save reviewing time, and are easier to review compared to NLORs. Our SLOR had higher inter-rater reliability in 4 of 7 categories and was correlated with our rank list. This tool conveys standardized information in an efficient manner. PMID:23172646
Winters, Ryan; Pou, Anna; Friedlander, Paul
Objectives: Describe the population, Medicaid, uninsured, and otolaryngology practice demographics for 7 representative rural Southeastern states, and propose academic-affiliated outreach clinics as a service to help meet the specialty care needs of an underserved rural population, based on the "medical mission" model employed in…
Kopelovich, Jonathan C
What is "social activism" to you? For older otolaryngologists, the term is likely to signify the tumult of the 1960s. For incoming generations, this connotation is outdated. Rather, it more broadly reflects concerted efforts to improve the public good. Some ally with existing institutions to work toward incremental progress. Some start new organizations, using technological tools to build networks, marshal resources, and leapfrog hurdles. Countering these efforts are the ever-changing challenges of practicing otolaryngology today: electronic health records, shifting incentives, and changes in the practice model. Employment by large conglomerates is more common, decreasing our visibility as community leaders. Burnout is a recognized "hazard," and budding otolaryngologists are particularly susceptible. Adding one more thing, like social activism, to a full plate seems counterintuitive. But it shouldn't be. You don't need a "bigger" plate to get involved in social causes. Start simple. Find a partner. Scale up. You'll find it rewarding.
Ammar R Abu Zuhairah
Full Text Available Aims: The aim was to compare Eastern, Makkah, and Asir regions in term of residents′ perception of the achievement of training objectives, and to assess various rotations based on residents′ perception. Settings and Design: This cross-sectional study was done among family medicine residents in the Eastern, Makkah, and Asir regions. Methodology: A questionnaire was developed by the investigator and validated by two experts. All residents, except R1 residents, were included. All data were collected by the investigator by direct contact with the residents. Statistical Analysis Used: Cronbach′s alpha, analysis of variance, t-test, and univariate regression model as appropriate, were used. Results: Reliability of the questionnaire was found to be 75.4%. One hundred and seven (response rate: 83.6% residents completed the questionnaire. There were 51 (47.7%, 27 (25.2%, and 29 (27.1% residents in the program in the Eastern region, Makkah, and Asir, respectively. The mean age was 29.1 ± 2.5 years; half of the residents were male, most of (83.2% were married, and more than half (54.2% of had worked in primary health care before joining the program. Overall, 45% of the residents perceived that they had achieved the training objectives. The highest rotations as perceived by the residents were psychiatry and otolaryngology while the lowest were orthopedics and ophthalmology. There were significant differences among the study regions with regard to the rotations in family medicine, internal medicine, orthopedics, general surgery, and emergency medicine. Conclusions: Overall, a good percentage of the residents perceived that they had achieved the training objectives. The rotations differed in the studied regions. Psychiatry and otolaryngology had the highest percentage of family medicine residents who perceived that they had achieved the training objectives while lowest was in internal medicine and obstetrics and gynecology. The highest rotations as
Dexter, Sara C; Hayashi, Daichi; Tysome, James R
INTRODUCTION Accurate and legible medical records are essential to good quality patient care. Guidelines from The Royal College of Surgeons of England (RCSE) state the content required to form a complete medical record, but do not address legibility. An audit of otolaryngology emergency clinic record keeping was performed using a new scoring system. PATIENTS AND METHODS The Adjusted Note Keeping and Legibility (ANKLe) score was developed as an objective and quantitative method to assess both the content and legibility of case notes, incorporating the RCSE guidelines. Twenty consecutive otolaryngology emergency clinic case notes from each of 7 senior house officers were audited against standards for legibility and content using the ANKLe score. A proforma was introduced to improve documentation and handwriting advice was given. A further set of 140 notes (20 notes for each of the 7 doctors) was audited in the same way to provide feedback. RESULTS The introduction of a proforma and advice on handwriting significantly increased the quality of case note entries in terms of content, legibility and overall ANKLe score. CONCLUSIONS Accurate note keeping can be improved by the use of a proforma. The legibility of handwriting can be improved using simple advice. The ANKLe score is an objective assessment tool of the overall quality of medical note documentation which can be adapted for use in other specialties. PMID:18430339
Apparent Life-Threatening Events (ALTEs) are a common presentation to paediatric hospitals and represent a significant cause of parental anxiety. Basic Life Support (BLS) training is recommended for all caregivers following ALTEs. This study aimed to assess the rate of caregiver BLS training and reviewed parents experience following discharge. Parents were interviewed by phone following discharge. Over the study period 25 children attended the Emergency Department with ALTE, 17\\/25 (68%) were trained and 13\\/17 (76%) were contactable for interview. All parents found training decreased their anxiety level and were interested in attending for re-training. BLS resuscitation was subsequently required by 2\\/13 (15%) of children. Non-medical grade monitors were in use by 10\\/13 (77%) of caregivers following discharge. Caregivers are eager to engage in BLS training and it effectively reduces their caregiver anxiety. We recommend an increase in instructor staff and use of group re-training post discharge
Macken, W L; Clarke, N; Nadeem, M; Coghlan, D
Apparent Life-Threatening Events (ALTEs) are a common presentation to paediatric hospitals and represent a significant cause of parental anxiety. Basic Life Support (BLS) training is recommended for all caregivers following ALTEs. This study aimed to assess the rate of caregiver BLS training and reviewed parents experience following discharge. Parents were interviewed by phone following discharge. Over the study period 25 children attended the Emergency Department with ALTE, 17/25 (68%) were trained and 13/17 (76%) were contactable for interview. All parents found training decreased their anxiety level and were interested in attending for re-training. BLS resuscitation was subsequently required by 2/13 (15%) of children. Non-medical grade monitors were in use by 10/13 (77%) of caregivers following discharge. Caregivers are eager to engage in BLS training and it effectively reduces their caregiver anxiety. We recommend an increase in instructor staff and use of group re-training post discharge.
Sun, Beatrice J; Tijerina, Jonathan; Nazerali, Rahim S; Lee, Gordon K
In recent years, there has been a push to publish higher level of evidence studies in medicine, particularly in plastic surgery. Well-conducted systematic reviews are considered the strongest level of evidence in medicine, recently becoming the key process indicators for quality delivery. A varying quality of systematic reviews, however, has led to concerns of their validity in clinical decision-making. We perform a quality analysis of systematic reviews published in head and neck microsurgery by the surgical specialties of plastic surgery and otolaryngology. An evaluation of systematic reviews published on microsurgery in 13 high-impact surgical journals was conducted by searching PubMed and Scopus. Two authors independently performed searches, screened for eligibility, and extracted data from included articles. Discrepancies were resolved by discussion and consensus. Assessment of Multiple Systematic Reviews (AMSTAR) criteria were used to assess methodological quality. The initial database search retrieved 166 articles. After removing duplicates, screening titles and abstracts, 26 articles remained for full text review. Seven did not focus on head and neck microsurgery and were further excluded, leaving 19 systematic reviews for final analysis. Of those, 10 systematic reviews were published by otolaryngology, and 9 were published by plastic surgery. Median AMSTAR score was 8 for otolaryngology, 7 for plastic surgery, and 8 overall, reflecting "fair to good" quality. The number of systematic reviews on head and neck microsurgery markedly increased over time. Of note, both the AMSTAR score and the number of systematic reviews published by plastic surgery have steadily increased from 2014 to 2016, whereas those published by otolaryngology have remained relatively stable since 2010. Our review shows a trend toward publishing more systematic reviews. The increasing quantity and quality of systematic reviews published by plastic surgeons indicates recognition in the
Svider, Peter F; Agarwal, Nitin; Choudhry, Osamah J; Hajart, Aaron F; Baredes, Soly; Liu, James K; Eloy, Jean Anderson
The aim of this study was to compare the readability of online patient education materials among academic otolaryngology departments in the mid-Atlantic region, with the purpose of determining whether these commonly used online resources were written at a level readily understood by the average American. A readability analysis of online patient education materials was performed using several commonly used readability assessments including the Flesch Reading Ease Score, the Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Gunning Frequency of Gobbledygook, the New Dale-Chall Test, the Coleman-Liau Index, the New Fog Count, the Raygor Readability Estimate, the FORCAST test, and the Fry Graph. Most patient education materials from these programs were written at or above an 11th grade reading level, considerably above National Institutes of Health guidelines for recommended difficulty. Patient educational materials from academic otolaryngology Web sites are written at too difficult a reading level for a significant portion of patients and can be simplified. Copyright © 2013 Elsevier Inc. All rights reserved.
Davies, Joel; Djelic, Lucas; Campisi, Paolo; Forte, Vito; Chiodo, Albino
To determine the effectiveness of using of an otoscopy stimulator to teach medical students the primary principles of otoscopy in large group training sessions and improve their confidence in making otologic diagnoses. Cross-sectional survey design. In March 2013, the Department of Otolaryngology-Head and Neck Surgery held a large-scale otoscopy simulator teaching session at the MaRS Innovation Center for 92 first and second year University of Toronto medical students. Following the training session, students were provided with an optional electronic, nine-question survey related to their experience with learning otoscopy using the simulators alone, and in comparison to traditional methods of teaching. Thirty-four medical students completed the survey. Ninety-one percent of the respondents indicated that the overall quality of the event was either very good or excellent. A total of 71% of respondents either agreed, or strongly agreed, that the otoscopy simulator training session improved their confidence in diagnosing pathologies of the ear. The majority (70%) of students indicated that the training session had stimulated their interest in otolaryngology-head and neck surgery as a medical specialty. Organizing large-group otoscopy simulator training sessions is one method whereby students can become familiar with a wide variety of pathologies of the ear and improve both their diagnostic accuracy and their confidence in making otologic diagnoses. NA © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Nouraei, S A R; O'Hanlon, S; Butler, C R; Hadovsky, A; Donald, E; Benjamin, E; Sandhu, G S
To audit the accuracy of otolaryngology clinical coding and identify ways of improving it. Prospective multidisciplinary audit, using the 'national standard clinical coding audit' methodology supplemented by 'double-reading and arbitration'. Teaching-hospital otolaryngology and clinical coding departments. Otolaryngology inpatient and day-surgery cases. Concordance between initial coding performed by a coder (first cycle) and final coding by a clinician-coder multidisciplinary team (MDT; second cycle) for primary and secondary diagnoses and procedures, and Health Resource Groupings (HRG) assignment. 1250 randomly-selected cases were studied. Coding errors occurred in 24.1% of cases (301/1250). The clinician-coder MDT reassigned 48 primary diagnoses and 186 primary procedures and identified a further 209 initially-missed secondary diagnoses and procedures. In 203 cases, patient's initial HRG changed. Incorrect coding caused an average revenue loss of 174.90 pounds per patient (14.7%) of which 60% of the total income variance was due to miscoding of a eight highly-complex head and neck cancer cases. The 'HRG drift' created the appearance of disproportionate resource utilisation when treating 'simple' cases. At our institution the total cost of maintaining a clinician-coder MDT was 4.8 times lower than the income regained through the double-reading process. This large audit of otolaryngology practice identifies a large degree of error in coding on discharge. This leads to significant loss of departmental revenue, and given that the same data is used for benchmarking and for making decisions about resource allocation, it distorts the picture of clinical practice. These can be rectified through implementing a cost-effective clinician-coder double-reading multidisciplinary team as part of a data-assurance clinical governance framework which we recommend should be established in hospitals.
Zender, Chad A; Clancy, Kate; Melki, Sami; Li, Shawn; Fowler, Nicole
To assess the impact of a microvascular head and neck (H&N) fellowship on senior residents' surgical experience. Retrospective review of Accreditation Council for Graduate Medical Education-generated operative case log reports, retrospective chart review, and electronic survey. A retrospective review of one institution's residents' H&N operative case logs and free flap operative reports was performed to determine changes in key indicator cases (KICs) after the addition of a H&N fellowship. An electronic survey was distributed to senior residents at all U.S. otolaryngology residency programs to determine residents' perceptions of a H&N fellow's impact on their surgical experience. An electronic survey was distributed to senior medical students applying to surgical residencies to explore the perceived impact that a fellowship has on the desirability of a residency program. The average number of each postgraduate year (PGY)5's H&N KIC before and after the addition of the fellowship were: parotidectomy, 19 versus 17.8; neck dissection, 33.2 versus 40.6; oral cavity resection, 15.3 versus 12.6; thyroid/parathyroid, 45.5 versus 45.6; and flaps/grafts, 56.7 versus 42. PGY5 participation as first assistant in free flaps dropped from 78% to 17%; however, residents still participated in some aspect of 45% of the cases. Seventy percent of senior residents reported a positive perception of the H&N fellow on their H&N operative experience. Eighty-nine percent of senior medical student respondents reported a nonnegative perception of a fellowship in their applied field. The addition of a H&N fellowship did not decrease senior residents' H&N KIC, and most senior residents at programs with fellowships report that the fellow has a positive impact on their H&N operative experience. 4. Laryngoscope, 128:52-56, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Wong, Kevin; Levi, Jessica R
Objective Previous studies have shown that patient education materials published by the American Academy of Otolaryngology-Head and Neck Surgery Foundation may be too difficult for the average reader to understand. The purpose of this study was to determine if current educational materials show improvements in readability. Study Design Cross-sectional analysis. Setting The Patient Health Information section of the American Academy of Otolaryngology-Head and Neck Surgery Foundation website. Subjects and Methods All patient education articles were extracted in plain text. Webpage navigation, references, author information, appointment information, acknowledgments, and disclaimers were removed. Follow-up editing was also performed to remove paragraph breaks, colons, semicolons, numbers, percentages, and bullets. Readability grade was calculated with the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning-Fog Index, Coleman-Liau Index, Automated Readability Index, and Simple Measure of Gobbledygook. Intra- and interobserver reliability were assessed. Results A total of 126 articles from 7 topics were analyzed. Readability levels across all 6 tools showed that the difficulty of patient education materials exceeded the abilities of an average American. As compared with previous studies, current educational materials by the American Academy of Otolaryngology-Head and Neck Surgery Foundation have shown a decrease in difficulty. Intra- and interobserver reliability were both excellent, with intraclass coefficients of 0.99 and 0.96, respectively. Conclusion Improvements in readability is an encouraging finding and one that is consistent with recent trends toward improved health literacy. Nevertheless, online patient educational material is still too difficult for the average reader. Revisions may be necessary for current materials to benefit a larger readership.
Swan, IRC; Guy, FH; Akeroyd, MA
Objective An assessment of the effect of otolaryngological management on the health-related quality of life of patients. Design Application of the Health Utilities Index mark 3 (HUI-3) before and after treatment; application of the Glasgow Benefit Inventory (GBI) after treatment. Setting Six otolaryngological departments around Scotland. Participants A 9005 adult patients referred to outpatient clinics. Main outcome measures Complete HUI-3 data was collected from 4422 patients; complete GBI data from 4235; complete HUI-3 and GBI data from 3884. Results The overall change in health related quality of life from before to after management was just +0.02. In the majority of subgroups of data (classified by type of management) there was essentially no change in HUI-3 score. The major exceptions were those patients provided with a hearing aid (mean change 0.08) and those whose problem was managed surgically (mean change 0.04). The mean GBI score was 5.3 which is low. Those managed surgically reported a higher GBI score of 13.0. Conclusion We found that patients treated surgically or given a hearing aid reported a significant improvement in their health related quality of life after treatment in otolaryngology departments. In general, patients treated in other ways reported no significant improvement. We argue that future research should look carefully at patient groups where there is unexpectedly little benefit from current treatment methods and consider more effective methods of management. PMID:22212609
Smith, Aaron; Braden, Lauren; Wan, Jim
Importance Graduate medical education has undergone a transformation from traditional long work hours to a restricted plan to allow adequate rest for residents. The initial goal of this restriction is to improve patient outcomes. Objective To determine whether duty hour restrictions had any impact on surgery-specific outcomes by analyzing complications following thyroid and parathyroid procedures performed before and after duty hour reform. Design, Setting, and Participants Retrospective cross-sectional analysis of the National Inpatient Sample (NIS).The NIS was queried for procedure codes associated with thyroid and parathyroid procedures for the years 2000 to 2002 and 2006 to 2008. Hospitals were divided based on teaching status into 3 groups: nonteaching hospitals (NTHs), teaching hospitals without otolaryngology programs (THs), and teaching hospitals with otolaryngology programs (THs-OTO). Main Outcomes and Measures Procedure-specific complication rates, length of stay, and mortality rates were collected. SAS statistical software (version 9.4) was used for analysis with adjustment using Charlson comorbidity index. Results Total numbers of head and neck endocrine procedures were 34 685 and 39 770 (a 14.7% increase), for 2000 to 2002 and 2006 to 2008, respectively. THs-OTO contributed a greater share of procedures in 2006 to 2008 (from 18% to 25%). With the earlier period serving as the reference, length of stay remained constant (2.1 days); however, total hospital charges increased (from $12 978 to $23 708; P otolaryngology programs. PMID:28196195
Gorodzinsky, Ayala Y; Hong, Paul; Chorney, Jill MacLaren
To understand the source of parents' knowledge prior to and desire for further information following pediatric otolaryngology surgical consultations. Mixed-methods approach using descriptive and qualitative content analysis of interviews with parents following otolaryngology consultations for children under the age of 6 years was performed. The children were being seen for either tonsillitis, obstructive sleep apnea, otitis media, and/or sinusitis/nasal obstruction. Forty-one parents completed a phone interview two weeks following their child's surgical consultation. The majority of parents indicated that their primary care physician referred their child for either: investigation of symptoms (50%), to have a specific discussion about surgery (27.5%), or because other treatment options were no longer working (20%). Many parents (56.5%) indicated that the Internet was their primary source of information prior to the appointment. Most parents (93%) wanted more information; majority of these parents noted that a technology-based mode of delivery of information available prior to the appointment would be most desirable. Desired information was most often regarding the surgical procedure, including risks and benefits, and symptoms of concern prior to surgery. This study provides a description of parental knowledge and information sources prior to their child's surgical consultation and continued desire for information. This information may lead to decreased knowledge barriers and increased communication to facilitate shared decision-making between the provider and parents. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Schall, G.L.; Smith, R.R.; Barsocchini, L.M.
Radionuclide salivary gland scans were performed on 44 patients using sodium pertechnetate Tc 99m. The accuracy of the scans and their usefulness in the clinical treatment of the patients were reviewed. The scan provided helpful information in 31 of 38 cases in which adequate follow-up data were available, although it proved diagnostic in only six patients. It was particularly useful in the evaluation of primary salivary gland neoplasms, acute and chronic sialadenitis, and sialolithiasis, as well as in the differential diagnosis of xerostomia. The value of this procedure in the elucidation of a variety of morphologic and functional diseases of these glands warrants its greater application in private otolaryngologic practices
Pusz, Max D; Brietzke, Scott E
To assess the quality of the information a patient (parent) may encounter using a Google search for typical otolaryngology ailments. Cross-sectional study. Tertiary care center. A Google keyword search was performed for 10 common otolaryngology problems including ear infection, hearing loss, tonsillitis, and so on. The top 10 search results for each were critically examined using the 16-item (1-5 scale) standardized DISCERN instrument. The DISCERN instrument was developed to assess the quality and comprehensiveness of patient treatment choice literature. A total of 100 Web sites were assessed. Of these, 19 (19%) were primarily advertisements for products and were excluded from DISCERN scoring. Searches for more typically chronic otolaryngic problems (eg, tinnitus, sleep apnea, etc) resulted in more biased, advertisement-type results than those for typically acute problems (eg, ear infection, sinus infection, P = .03). The search for "sleep apnea treatment" produced the highest scoring results (mean overall DISCERN score = 3.49, range = 1.81-4.56), and the search for "hoarseness treatment" produced the lowest scores (mean = 2.49, range = 1.56-3.56). Results from major comprehensive Web sites (WebMD, EMedicinehealth.com, Wikipedia, etc.) scored higher than other Web sites (mean DISCERN score = 3.46 vs 2.48, P advertisement Web sites. Larger, comprehensive Web sites generally provided better information but were less than perfect in presenting complete information on treatment options.
Coco, Laura; Colina, Sonia; Atcherson, Samuel R.
Purpose The purpose of this study was to examine the readability level of the Spanish versions of several audiology- and otolaryngology-related patient-reported outcome measures (PROMs) and include a readability analysis of 2 translation approaches when available—the published version and a “functionalist” version—using a team-based collaborative approach including community members. Method Readability levels were calculated using the Fry Graph adapted for Spanish, as well as the Fernandez-Huerta and the Spaulding formulae for several commonly used audiology- and otolaryngology-related PROMs. Results Readability calculations agreed with previous studies analyzing audiology-related PROMs in English and demonstrated many Spanish-language PROMs were beyond the 5th grade reading level suggested for health-related materials written for the average population. In addition, the functionalist versions of the PROMs yielded lower grade-level (improved) readability levels than the published versions. Conclusion Our results suggest many of the Spanish-language PROMs evaluated here are beyond the recommended readability levels and may be influenced by the approach to translation. Moreover, improved readability may be possible using a functionalist approach to translation. Future analysis of the suitability of outcome measures and the quality of their translations should move beyond readability and include an evaluation of the individual's comprehension of the written text. PMID:28892821
VanKoevering, Kyle K; Malloy, Kelly Michele
Simulation is rapidly expanding across medicine as a valuable component of trainee education. For procedural simulation, development of low-cost simulators that allow a realistic, haptic experience for learners to practice maneuvers while appreciating anatomy has become highly valuable. Otolaryngology has seen significant advancements in development of improved, specialty-specific simulators with the expansion of three-dimensional (3D) printing. This article highlights the fundamental components of 3D printing and the multitude of subspecialty simulators that have been developed with the assistance of 3D printing. It briefly discusses important considerations such as cost, fidelity, and validation where available in the literature. Copyright © 2017 Elsevier Inc. All rights reserved.
Myers, E.N.; Bluestone, C.D.
This book consists of 14 sections. The section titles are: The impact of AIDS on otolaryngology--head and neck surgery; The management of sleep apneas and snoring; Antimicrobial agents for infections in the ear, nose, and throat--head and neck; Nasal allergy: Medical and surgical treatment; Uses of computerized tomography and magnetic resonance imaging in temporal bone imaging; Surgical management of otitis media with effusion; middle ear reconstruction: Current status; Cochlear implants: an overview; Diagnosis and management of acute facial paralysis; The use of the laser in head and neck surgery; The management and prevention of subglottic stenosis in infants and children; Management of the mass in the thyroid; Suction-assisted lipectomy of the head and neck area; and Ambulatory surgery
Myers, E.N. (Univ. of Pittsburgh School of Medicine, Pittsburgh, PA (US)); Bluestone, C.D. (Univ. of Pittsburgh, Pittsburgh, PA (US))
This book consists of 14 sections. The section titles are: The impact of AIDS on otolaryngology--head and neck surgery; The management of sleep apneas and snoring; Antimicrobial agents for infections in the ear, nose, and throat--head and neck; Nasal allergy: Medical and surgical treatment; Uses of computerized tomography and magnetic resonance imaging in temporal bone imaging; Surgical management of otitis media with effusion; middle ear reconstruction: Current status; Cochlear implants: an overview; Diagnosis and management of acute facial paralysis; The use of the laser in head and neck surgery; The management and prevention of subglottic stenosis in infants and children; Management of the mass in the thyroid; Suction-assisted lipectomy of the head and neck area; and Ambulatory surgery.
Dualibi, Ana Paula Fiuza Funicello; Martins, Ana Maria; Moreira, Gustavo Antônio; de Azevedo, Marisa Frasson; Fujita, Reginaldo Raimundo; Pignatari, Shirley Shizue Nagata
Mucopolysaccharidosis (MPS) is a lysosomal storage disease caused by deficiency of α-l-iduronidase. The otolaryngological findings include hearing loss, otorrhea, recurrent otitis, hypertrophy of tonsils and adenoid, recurrent rhinosinusitis, speech disorders, snoring, oral breathing and nasal obstruction. To evaluate the impact of enzymatic replacement therapy with laronidase (Aldurazyme(®)) in patients with mucopolysaccharidosis (MPS I), regarding sleep and hearing disorders, and clinical manifestations in the upper respiratory tract (URT). Nine patients with MPS I (8 Hurler-Scheie, and 1 Scheie phenotypes) of both sexes, ages ranging between 3 and 20 years, were included in this study. Patients were evaluated between seven and 11 months before the treatment and between 16 and 22 months after the onset of the enzymatic replacement. They were all submitted to a clinical and otolaryngological evaluation, including nasofibroscopical, polysomnographic and audiologic exams. The results' data showed decreasing of the frequency of ear, nose and throat infections, with improvement of the rhinorrhea and respiratory quality. No remarkable changes were observed regarding macroglossia and tonsil and adenoid hypertrophy. Audiometric and polysomnographic evaluations did not show statistical significance. Enzymatic replacement therapy in patients with mucopolysaccharidosis I provides control of recurrent URT infections, rhinorrhea and respiratory quality, however it is does not seem to improve audiologic and polisomnographic parameters, with no effect on adenoid and tonsils hypertrophy and macroglossia. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
Jabbour, Noel; Reihsen, Troy; Sweet, Robert M; Sidman, James D
To develop a robust psychomotor skills curriculum to teach pediatric airway foreign body retrieval and to assess the effect of this curriculum on residents' confidence in and ability to perform the complete task in an infant airway mannequin. Instructional course. Objective Structured Assessment of Technical Skills (OSATS). Surgical simulation laboratory. A half-day simulation-based course was developed to train otolaryngology residents in bronchoscopic foreign body retrieval. This complex psychomotor skill was deconstructed into subtasks. The following curricular learning objectives were presented and assessed: understanding of tracheobronchial anatomy, ability to adequately visualize the larynx with laryngoscopy, proficiency in rigid bronchoscopy, and familiarity with foreign body instrumentation. Residents were objectively evaluated on their ability to perform the complete task on a simulator before and after the course using an OSATS grading system. Confidence in successfully assembling the instruments and completing the task was assessed at these time periods. Seventeen otolaryngology residents completed the study. Confidence in assembling the instruments and in performing the complete task increased on average by 81% and 43%, respectively (P < .001). Using a 15-point OSATS grading system, the average score for the precourse was 7 and for the postcourse was 11.3 (P < .001). Simulation-based subtask training shows promise as an effective and reproducible method to teach the complex psychomotor task of airway foreign body retrieval. Completion of the curriculum led to a significant improvement in residents' confidence in and ability to perform bronchoscopic foreign body retrieval in an infant airway mannequin.
Full Text Available BACKGROUND AND OBJECTIVE: Tinnitus is a common symptom associated with hearing loss and its related disorders. Awareness of audiological features is of paramount importance for effective management of tinnitus. This study aimed to evaluate audiological characteristics of tinnitus in patients referring to otolaryngology clinics of Babol, Iran. METHODS: This cross-sectional study was conducted on 120 patients with tinnitus (47 male, 73 female with mean age of 47.12±15.285 years referring to otolaryngology clinics of Babol, Iran. Patients were examined via pure tone audiometry at frequency of 250-8000 Hz to determine the location and type of tinnitus. FINDINGS: In this study, 104 patients (88.7% had hearing loss, 103 patients had tonal tinnitus with dizziness, 17 patients had loud tinnitus with no dizziness, 45 cases (37.5% had bilateral tinnitus, 75 patients (62.5% had unilateral tinnitus, and 17 patients had family history of tinnitus. Among female patients, two cases (1.7% experienced tinnitus during pregnancy, while in four patients (3.3%, it was reported immediately after pregnancy. CONCLUSION: According to the results of this study, bilateral sensorineural hearing loss has a higher prevalence among patients with tinnitus.
Persaud, R.; Hajioff, D.; Georgalas, C.; Bentley, M.; Silva, S.; Narula, A.
An internet-based audit was conducted to determine how well English otolaryngology departments apply Action on ENT baseline clinical and administrative standards. A total of 91% (97 of 107) departments responded. Only 8% of 97 departments met all 23 standards but the majority complied with most
Earley, Marisa A; Pham, Liem T; April, Max M
Review otolaryngology literature for awareness of neurotoxicity from general anesthesia in children. Recently, there has been increasing focus in anesthesia literature on the long-term effects of general anesthesia on neurodevelopment. Multiple animal models have demonstrated evidence of neurotoxicity from both inhalational and intravenous anesthetics. Cohort studies also have revealed modestly increased risk of adverse neurodevelopmental outcomes in children exposed to a single episode of general anesthesia prior to 3 to 4 years of age, with stronger evidence for multiple exposures in this age range. Otolaryngologists may subject children to general anesthesia via procedures or tests, including computed tomography, magnetic resonance imaging, and auditory brainstem response. PubMed, Embase, Scopus, and Web of Science Review. A scoping review using the above databases was performed limited to January 2005 through December 2015. Articles were screened and reviewed based on predefined inclusion and exclusion criteria. Initial search generated 3,909 articles. After 72 full text articles were reviewed, only seven articles mentioned neurotoxicity as a risk of general anesthesia in pediatric patients. Despite the high volume of pediatric otolaryngologic procedures performed annually, there remains limited awareness in our literature discussing neurotoxicity as an outcome. Prospective data from anesthesia literature is still pending; therefore, specific recommendations cannot be made at this time. Otolaryngologists should be aware of the concerns and work toward defining elective procedures, combining surgical procedures with other procedures or imaging, and reassessing the timing and frequency of various interventions under general anesthesia in young children. Laryngoscope, 127:1930-1937, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Balakrishnan, Karthik; Goico, Brian; Arjmand, Ellis M
(1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy. Prospective cost analysis case study. Tertiary pediatric hospital. All otolaryngology providers and otolaryngology operating room staff at our institution. Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements. Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
Huddle, Matthew G; London, Nyall R; Stewart, C Matthew
To design and implement a formal otolaryngology inpatient consultation service that improves satisfaction of consulting services, increases educational opportunities, improves the quality of patient care, and ensures sustainability after implementation. This was a retrospective cohort study in a large academic medical center encompassing all inpatient otolaryngology service consultations from July 2005 to June 2014. Staged interventions included adding fellow coverage (July 2007 onward), intermittent hospitalist coverage (July 2010 onward), and a physician assistant (October 2011 onward). Billing data were collected for incidences of new patient and subsequent consultation charges. The 2-year preimplementation period (July 2005-June 2007) was compared with the postimplementation periods, divided into 2-year blocks (July 2007-June 2013). Outcome measures of patient encounters and work relative value units were compared between pre- and postimplementation blocks. Total encounters increased from 321 preimplementation to 1211, 1347, and 1073 in postimplementation groups ( P < 0.001). Total work relative value units increased from 515 preimplementation to 2090, 1934, and 1273 in postimplementation groups ( P < 0.001). A formal inpatient consultation service was designed with supervisory oversight by non-Accreditation Council for Graduate Medical Education fellows and then expanded to include intermittent hospitalist management, followed by the addition of a dedicated physician assistant. These additions have led to the formation of a sustainable consultation service that supports the mission of high-quality care and service to consulting teams.
Bowe, Sarah N; Laury, Adrienne M; Gray, Stacey T
Objective This systematic review aims to evaluate which applicant characteristics available to an otolaryngology selection committee are associated with future performance in residency or practice. Data Sources PubMed, Scopus, ERIC, Health Business, Psychology and Behavioral Sciences Collection, and SocINDEX. Review Methods Study eligibility was performed by 2 independent investigators in accordance with the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Data obtained from each article included research questions, study design, predictors, outcomes, statistical analysis, and results/findings. Study bias was assessed with the Quality in Prognosis Studies tool. Results The initial search identified 439 abstracts. Six articles fulfilled all inclusion and exclusion criteria. All studies were retrospective cohort studies (level 4). Overall, the studies yielded relatively few criteria that correlated with residency success, with generally conflicting results. Most studies were found to have a high risk of bias. Conclusion Previous resident selection research has lacked a theoretical background, thus predisposing this work to inconsistent results and high risk of bias. The included studies provide historical insight into the predictors and criteria (eg, outcomes) previously deemed pertinent by the otolaryngology field. Additional research is needed, possibly integrating aspects of personnel selection, to engage in an evidence-based approach to identify highly qualified candidates who will succeed as future otolaryngologists.
Geelan-Hansen, Katie; Anne, Samantha
Noonan syndrome is an autosomal dominant disorder with associated anomalies that include short stature, congenital heart defects, developmental delay, and characteristic facial features among other abnormalities. Articulation deficiency and language delay are often present and require speech therapy. Otitis media and hearing loss have been reported to be common in these patients. We performed a retrospective chart review of pediatric patients who were diagnosed with Noonan syndrome at our tertiary care center from January 1979 through December 2009. We found 19 such patients. Of these, 8 had received single-specialty care at our hospital; it is not known if they had received otolaryngologic care from an outside provider. These 8 patients were not included in our study. The remaining 11 patients-6 boys and 5 girls, aged 1 to 19 years (mean: 9.2)-had all received multidisciplinary care at our institution; 9 of them had received care from an otolaryngologist at our center. Of this group, 7 had history of feeding difficulty, 6 had experienced speech delay that required speech therapy, 6 had undergone placement of a pressure equalization tube, 4 had undergone adenoidectomy with or without tonsillectomy, and 1 had been treated with endoscopic sinus surgery. Although this study is limited by our small number of patients, our results suggest that early otolaryngologist involvement must be considered in the care of children with Noonan syndrome because many have evidence of eustachian tube dysfunction, hearing loss, and speech delay.
Wong, Kevin; Piraquive, Jacquelyn; Levi, Jessica R
Evaluate the use of Twitter by otolaryngology journals and determine the relationship between social media altmetrics and measures of academic impact. Cross-sectional analysis. Twitter profiles from the top 50 otolaryngology journals per 2016 SCImago Journal & Country Rank (SJR) were included. Twitter activity for each profile was calculated using Twitonomy analytics and Riffle software. Social media influence was measured using Klout scores. Annual SJR rank and H-Index scores between 2008 and 2016 were recorded for each journal. Associations between social media influence and academic indices were assessed using Wilcoxon rank sum test, Spearman's rank order test, and Pearson correlation coefficients (α = .05). Average SJR was 0.86 ± 0.3 and H-Index was 50.9 ± 24. Eighteen journals had Twitter profiles. Journals with social media accounts had significantly higher SJR (P = .03) and H-Index (P = .01) scores compared to those without. The average Klout score of Twitter profiles was 32.5 ± 13. There was a significant association between a journal's Klout score and SJR rank (P = .004). Older Twitter profiles had higher Klout scores (P = .04). There was a direct relationship between a journal's total Twitter followers and H-Index score (P = .009), and a direct relationship between tweets and academic influence (P = .03 and .01 for SJR and H-Index, respectively). Social media is often underutilized and remains an untapped resource by many journals to increase readership and disseminate research. Journals with social media profiles had significantly higher academic metrics, and among journals with profiles, increased online activity was a predictor for academic influence. Future studies are warranted to elucidate causal relationships. NA. Laryngoscope, 128:363-368, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Bibas, Athanasios G.; Podoleanu, Adrian Gh.; Cucu, Radu G.; Dobre, George M.; Odell, Edward; Boxer, Aaron B.; O'Connors, Alec F.; Gleeson, Michael J.
Optical coherence tomography is a diagnostic imaging technique allowing two dimensional tomographic imaging of tissue architecture. This is a review article on the use of optical coherence tomography in Otolaryngology including original images from human laryngeal tissue and temporal bones (cochlea) in our laboratory. Tissue specimens from normal larynges were imaged with an 850 nm OCT system. Our results showed good correlation between OCT image s and the corresponding haematoxylin-eosin stained histology sections in the normal larynx. Human temporal bones were also imaged using an 1300 nm OCT system. Limited morphological details were obtained due to the high scattering properties of the bony labyrinth.
Chan, Harley H L; Siewerdsen, Jeffrey H; Vescan, Allan; Daly, Michael J; Prisman, Eitan; Irish, Jonathan C
The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i) a mono-material paranasal sinus phantom for endoscopy training ii) a multi-material skull base simulator and iii) 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and fabrication techniques
Pynnonen, Melissa A.; Hawley, Sarah T.
Patient education is used to engage patients in their own health care and is relevant in most clinical situations. Shared decision making (SDM) is used to engage patients when a choice needs to be made about a diagnostic or therapeutic procedure and the medical evidence does not indicate which choice is best. American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) clinical practice guidelines (CPGs) include multiple action statements that may benefit from patient education or SDM. In this Commentary we discuss patient education and SDM using examples from AAO-HNS CPGs. We believe that use of patient education and decision support materials for SDM will enhance the effectiveness of SDM and improve the uptake of CPG. We issue a call to action for all stakeholders to consider how to put these materials into the hands of our patients. PMID:24718756
Gardner, Aimee K; Scott, Daniel J; Pedowitz, Robert A; Sweet, Robert M; Feins, Richard H; Deutsch, Ellen S; Sachdeva, Ajit K
Simulation-based training is playing an increasingly important role in surgery. However, there is insufficient discussion among the surgical specialties regarding how simulation may best be leveraged for training. There is much to be learned from one another as we all strive to meet new requirements within the context of Undergraduate Medical Education, Graduate Medical Education, and Continuing Medical Education. To address this need, a panel was convened at the 6th Annual Meeting of the Consortium of the American College of Surgeons-Accredited Education Institutes consisting of key leaders in the field of simulation from 4 surgical subspecialties, namely, general surgery, orthopedic surgery, cardiothoracic surgery, urology, and otolaryngology. An overview of how the 5 surgical specialties are using simulation-based training to meet a wide array of educational needs for all levels of learners is presented. Copyright © 2015 Elsevier Inc. All rights reserved.
Elghouche, Alhasan N; Lobo, Brian C; Wannemuehler, Todd J; Johnson, Kimberly E; Matt, Bruce H; Woodward-Hagg, Heather K; Kokoska, Mimi S
Since July 2013, 20 trainee participants have completed the quality improvement curriculum within the Indiana University Department of Otolaryngology-Head & Neck Surgery, including 7 otolaryngology residents, 6 otolaryngology-bound medical students, and 7 psychiatry residents. Nine faculty and staff attended. Participants were highly satisfied with the quality and effectiveness of the program. Following program implementation, 2 otolaryngology residents and 2 medical students initiated their own quality improvement projects. Lean training directly resulted in oral and poster presentations at national conferences, journal publications, and institutional research and quality awards. Students completing the program established a local affiliate group of an international health care quality organization. Quality improvement training can be successfully incorporated into residency training with overwhelming program satisfaction and results in greater scholarly and professional development for motivated participants. The skillset acquired by participants leads to projects that improve patient care, increase value, and justify equipment and personnel retention and expansion. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
Cristiane K. Denis
Full Text Available O Dengue é uma doença febril aguda, causada por um arbovírus, transmitida pelo mosquito Aedes aegypti. Apresenta manifestações clássicas como febre, mialgia, epistaxe, odinofagia, vertigem e zumbido. Constitui um sério problema de saúde pública, chegando a taxas de incidência de 50 a 70% da população no Estado do Rio de Janeiro. OBJETIVO: O objetivo do nosso estudo foi avaliar pacientes com dengue, que apresentam sintomatologia otorrinolaringológica como manifestação inicial. FORMA DE ESTUDO: Coorte Longitudinal. MATERIAL E MÉTODO: Foi realizado um estudo prospectivo, incluindo 30 pacientes com dengue, com sorologia comprovada, que manifestaram queixas otorrinolaringológicas. RESULTADOS: Os sinais e sintomas foram odinofagia (60%, coriza (50%, obstrução nasal (46,6%, otalgia (36,6%, vertigem (20%, epistaxe (13,3% zumbido (6,6%, alteração de glândula salivar (6,6% e gengivorragia (3,3%. CONCLUSÃO: Na vigência de epidemias, a suspeita clínica do dengue é importante, principalmente pelas inúmeras manifestações na área de otorrinolaringologia.Dengue is an acute fever disease caused by an arbovirus, and transmitted by the mosquito Aedes aegypti. Clinical picture usually starts with classic manifestations such as fever, myalgia, epistaxis, sore throat, vertigo and tinnitus. This disease has became a serious health public problem, reaching incidence rates of 50 to 70% in Rio de Janeiro State. AIM: Our objective was to evaluate patients with dengue, presenting otolaryngological symptoms as the first clinical manifestation. STUDY DESIGN: Longitudinal Cohort. MATERIAL AND METHOD: Thirty patients with serologically confirmed Dengue were included in this prospective study. RESULTS: The most important otolaryngological signs and symptoms were sore throat (60%, hyaline rhinorrhea (50%, nasal obstruction (46.6%, earache (36.6%, vertigo (20%, epistaxis (13.3%, tinnitus (6.6%, salivary gland diseases (6.6% and bleeding gum (3
Maan, Zeshaan N; Gibbins, Nick; Al-Jabri, Talal; D'Souza, Alwyn R
Robotic surgery has become increasingly used due to its enhancement of visualization, precision, and articulation. It eliminates many of the problems encountered with conventional minimally invasive techniques and has been shown to result in reduced blood loss and complications. The rise in endoscopic procedures in otolaryngology-head and neck surgery, and associated difficulties, suggests that robotic surgery may have a role to play. To determine whether robotic surgery conveys any benefits compared to conventional minimally invasive approaches, specifically looking at precision, operative time, and visualization. A systematic review of the literature with a defined search strategy. Searches of MEDLINE, EMBASE and CENTRAL using strategy: ((robot* OR (robot*AND surgery)) AND (ent OR otolaryngology)) to November 2010. Articles reviewed by authors and data compiled in tables for analysis. There were 33 references included in the study. Access and visualization were regularly mentioned as key benefits, though no objective data has been recorded in any study. Once initial setup difficulties were overcome, operative time was shown to decrease with robotic surgery, except in one controlled series of thyroid surgeries. Precision was also highlighted as an advantage, particularly in otological and skull base surgery. Postoperative outcomes were considered equivalent to or better than conventional surgery. Cost was the biggest drawback. The evidence base to date suggests there are benefits to robotic surgery in OHNS, particularly with regards to access, precision, and operative time but there is a lack of controlled, prospective studies with objective outcome measures. In addition, economic feasibility studies must be carried out before a robotic OHNS service is established. Copyright © 2012 Elsevier Inc. All rights reserved.
Ten Hoor, Gill A; Peters, Gjalt-Jorn Y; Kalagi, Janice; de Groot, Lianne; Grootjans, Karlijne; Huschens, Alexander; Köhninger, Constanze; Kölgen, Lizan; Pelssers, Isabelle; Schütt, Toby; Thomas, Sophia; Ruiter, Robert A C; Kok, Gerjo
Threatening health messages that focus on severity are popular, but frequently have no effect or even a counterproductive effect on behavior change. This paradox (i.e. wide application despite low effectiveness) may be partly explained by the intuitive appeal of threatening communication: it may be hard to predict the defensive reactions occurring in response to fear appeals. We examine this hypothesis by using two studies by Brown and colleagues, which provide evidence that threatening health messages in the form of distressing imagery in anti-smoking and anti-alcohol campaigns cause defensive reactions. We simulated both Brown et al. experiments, asking participants to estimate the reactions of the original study subjects to the threatening health information (n = 93). Afterwards, we presented the actual original study outcomes. One week later, we assessed whether this knowledge of the actual study outcomes helped participants to more successfully estimate the effectiveness of the threatening health information (n = 72). Results showed that participants were initially convinced of the effectiveness of threatening health messages and were unable to anticipate the defensive reactions that in fact occurred. Furthermore, these estimates did not improve after participants had been explained the dynamics of threatening communication as well as what the effects of the threatening communication had been in reality. These findings are consistent with the hypothesis that the effectiveness of threatening health messages is intuitively appealing. What is more, providing empirical evidence against the use of threatening health messages has very little effect on this intuitive appeal.
ten Hoor Gill A
Full Text Available Abstract Background Threatening health messages that focus on severity are popular, but frequently have no effect or even a counterproductive effect on behavior change. This paradox (i.e. wide application despite low effectiveness may be partly explained by the intuitive appeal of threatening communication: it may be hard to predict the defensive reactions occurring in response to fear appeals. We examine this hypothesis by using two studies by Brown and colleagues, which provide evidence that threatening health messages in the form of distressing imagery in anti-smoking and anti-alcohol campaigns cause defensive reactions. Methods We simulated both Brown et al. experiments, asking participants to estimate the reactions of the original study subjects to the threatening health information (n = 93. Afterwards, we presented the actual original study outcomes. One week later, we assessed whether this knowledge of the actual study outcomes helped participants to more successfully estimate the effectiveness of the threatening health information (n = 72. Results Results showed that participants were initially convinced of the effectiveness of threatening health messages and were unable to anticipate the defensive reactions that in fact occurred. Furthermore, these estimates did not improve after participants had been explained the dynamics of threatening communication as well as what the effects of the threatening communication had been in reality. Conclusions These findings are consistent with the hypothesis that the effectiveness of threatening health messages is intuitively appealing. What is more, providing empirical evidence against the use of threatening health messages has very little effect on this intuitive appeal.
Labbé, Mathilde; Young, Meredith; Nguyen, Lily H P
To support the development of programs of assessment of technical skills in the operating room (OR), we systematically reviewed the literature to identify assessment tools specific to otolaryngology-head and neck surgery (OTL-HNS) core procedures and summarized their characteristics. We systematically searched Embase, MEDLINE, PubMed, and Cochrane to identify and report on assessment tools that can be used to assess residents' technical surgical skills in the operating room for OTL-HNS core procedures. Of the 736 unique titles retrieved, 16 articles met inclusion criteria, covering 11 different procedures (in otology, rhinology, laryngology, head and neck, and general otolaryngology). The tools were composed of a task-specific checklist and/or global rating scale and were developed in the OR, on human cadavers, or in a simulation setting. Our study reports on published tools for assessing technical skills for OTL-HNS residents during core procedures conducted in the OR. These assessment tools could facilitate the provision of timely feedback to trainees including specific goals for improvement. However, the paucity of publications suggests little agreement on how to best perform work-based direct-observation assessment for core surgical procedures in OTL-HNS. The sparsity of tools specific to OTL-HNS may become a barrier to a fluid transition to competency-based medical education. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Jankowska, M.; Rak, J.; Bochnia, M.; Kustrzycka, H.
In years 1977-1992 191 persons with tumors of the nose and paranasal sinuses had been treated in the Otolaryngological Dept. of the Medical Academy in Wroclaw. The presence of malignant neoplasms was confirmed among 79 of them. Histologically the most frequent was the planoepithelial cancer. In 60% of ills the extensive neoplastic infiltration was found. Statistically significant was the males number in the age of 50 years and more. (author)
Alrasheed, Abdulaziz S; Nguyen, Lily H P; Mongeau, Luc; Funnell, W Robert J; Tewfik, Marc A
Endoscopic sinus surgery poses unique training challenges due to complex and variable anatomy, and the risk of major complications. We sought to create and provide validity evidence for a novel 3D-printed simulator of the nose and paranasal sinuses. Sinonasal computed tomography (CT) images of a patient were imported into 3D visualization software. Segmentation of bony and soft tissue structures was then performed. The model was printed using simulated bone and soft tissue materials. Rhinologists and otolaryngology residents completed 6 prespecified tasks including maxillary antrostomy and frontal recess dissection on the simulator. Participants evaluated the model using survey ratings based on a 5-point Likert scale. The average time to complete each task was calculated. Descriptive analysis was used to evaluate ratings, and thematic analysis was done for qualitative questions. A total of 20 participants (10 rhinologists and 10 otolaryngology residents) tested the model and answered the survey. Overall the participants felt that the simulator would be useful as a training/educational tool (4.6/5), and that it should be integrated as part of the rhinology training curriculum (4.5/5). The following responses were obtained: visual appearance 4.25/5; realism of materials 3.8/5; and surgical experience 3.9/5. The average time to complete each task was lower for the rhinologist group than for the residents. We describe the development and validation of a novel 3D-printed model for the training of endoscopic sinus surgery skills. Although participants found the simulator to be a useful training and educational tool, further model development could improve the outcome. © 2017 ARS-AAOA, LLC.
Smith, Matthew E; Leung, Billy C; Sharma, Rishi; Nazeer, Sammar; McFerran, Don J
Flexible nasolaryngoscopy is an essential skill for otolaryngology trainees to develop, but there is a lack of standardized training for this procedure. The aim of this study was to assess whether using training on a realistic human mannequin together with structured video feedback improved trainees' performance at flexible nasolaryngoscopy. Three-armed, single-blinded, randomized controlled study. Thirty-six junior doctors and final-year medical students were randomly allocated to one of three groups. All received a lecture and video presentation on flexible nasolaryngoscopy. One group received additional tuition using a training mannequin. The last group received mannequin training and feedback on their performance using a video recording. The trainees then undertook flexible nasolaryngoscopy on volunteers with these endoscopies recorded. Blinded observers scored the trainees on a range of objective and subjective measures. The volunteers who were also blinded to the candidates' training scored the comfort of the procedure. Adding mannequin training showed a trend toward improvement of performance but did not reach statistical significance. Mannequin training together with video feedback produced significant performance improvement in patient comfort (P = .0065), time to reach the vocal folds (P = .017), and global ability (P = .0006). Inter-rater reliability was excellent with P training using an anatomically correct model of the upper airway together with formalized video-assisted feedback on that training is a simple and effective way to improve endoscopy skills prior to starting flexible nasolaryngoscopy on patients. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Harley H L Chan
Full Text Available The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i a mono-material paranasal sinus phantom for endoscopy training ii a multi-material skull base simulator and iii 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and
... hypertrophy. Conclusion: Day case tonsillectomies in private hospitals settings are safe with few complications that are often not life threatening. It should be encouraged in our environment in private hospitals where the facilities are available. Key Words Day case tonsillectomy, adenotonsillectomy, otolaryngology ...
Fernández, Rodrigo S; Bavassi, Luz; Campos, Jorge; Allegri, Ricardo F; Molina, Victor A; Forcato, Cecilia; Pedreira, María E
Memories can be altered by negative or arousing experiences due to the activation of the stress-responsive sympatho-adrenal-medullary axis (SYM). Here, we used a neutral declarative memory that was acquired during multi-trial training to determine the effect of a threatening event on memory without emotional valence. To this end, participants received a new threatening social protocol before learning pairs of meaningless syllables and were tested either 15 min, 2 days or 8 days after acquisition. We first demonstrated that this threatening social situation activates not only the SYM axis (Experiment 1) and the hypothalamus-pituitary-adrenal axis (HPA; Experiment 2), but also, it improves the acquisition or early consolidation of the syllable pairs (Experiment 3). This improvement is not a transient effect; it can be observed after the memory is consolidated. Furthermore, this modulation increases the persistence of memory (Experiment 4). Thus, it is possible to affect memories with specific events that contain unrelated content and a different valence. Copyright © 2015 Elsevier Inc. All rights reserved.
Maza Solano, Juan Manuel; Benavente Bermudo, Gustavo; Estrada Molina, Francisco José; Ambrosiani Fernández, Jesús; Sánchez Gómez, Serafín
and objectives We have evaluated the training capacity of the Spanish resident training book as an electronic portfolio to achieve the learning objectives of otorhinolaryngology (ENT) residents. A multi-method qualitative investigation with transversal characteristics, temporal and retrospective guidance was performed on Spanish ENT residents using a structured questionnaire, a semi-structured interview, and a computer application on the FORMIR website. A 56.5% of ENT-residents specialising in one of the 63 accredited Spanish hospitals between 2009-2012 participated in the study. The results obtained show that the ENT residents who used the e-portfolio were better able to implement self-guided study, were more aware of their learning objectives, fulfilled the training programme more efficiently, identified the causes of learning gaps more clearly, and considered FORMIR in e-portfolio format to be an ideal training tool to replace the resident training book in paper format. The ENT residents greatly appreciated the training benefits of FORMIR as an e-portfolio, especially its simple and intuitive interface, the ease and comfort with which they could record their activities, the automatic and numeric feedback on the acquisition of their competencies (which facilitates self-guided learning), its storage capacity for evidence, and its ability to be used as UEMS logbook as well as a standard curriculum vitae. All these features make FORMIR a training and evaluation tool that outperforms similar instruments available to ENT residents. They do not hesitate to identify it as the ideal resident training book for facilitating their specialised training. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.
Parhar, Harman S; Thamboo, Andrew; Habib, Al-Rahim; Chang, Brent; Gan, Eng Cern; Javer, Amin R
The Philpott-Javer postoperative endoscopic mucosal staging system for allergic fungal rhinosinusitis has previously demonstrated acceptable interrater reliability among rhinologists. There are, however, numerous learners involved in patient care at tertiary centers. This study aims to analyze the interrater and intrarater reliability of this system among learners in otolaryngology at different stages in training. A prospective analysis of retrospectively collected endoscopic photographs. A tertiary care teaching hospital (January 2013). Fifty patients undergoing routine follow-up. Three photographs from each of 50 patients undergoing routine postsurgical nasoendoscopy were reviewed. Images were played twice, 1 week apart, in 2 differently randomized cycles and scored according to Philpott-Javer criteria by a rhinologist, a rhinology fellow, a senior otolaryngology resident, a junior otolaryngology resident, and a medical student. Interobserver reliability was assessed using the intraclass correlation coefficient, while intrarater reliability was assessed by Shrout-Fleiss κ values. Agreement between each learner and the rhinologist was also assessed using κ values. The interclass correlation among the 5 raters was 0.7600 (95% confidence interval, 0.6917-0.8161) for the Philpott-Javer scoring system, suggesting substantial reliability. Intrarater data showed substantial to almost-perfect reliability (κ values between 0.668 and 0.815) among all raters using this system. There was also moderate to substantial agreement between the learners and the rhinologist (κ values between 0.534 and 0.710). Results suggest that the Philpott-Javer staging system has acceptable intrarater and interrater reliability among learners of differing levels of clinical experience and is suitable for evaluating progress following surgery.
Sobol', E. N.; Baum, O. I.; Omel'chenko, A. I.; Soshnikova, Yu. M.; Yuzhakov, A. V.; Kas'yanenko, E. M.; Tokareva, A. V.; Baskov, A. V.; Svistushkin, V. M.; Selezneva, L. V.; Shekhter, A. B.
We present the results of basic research in laser modification of tissues in otolaryngology (correcting the shape of nasal septum and larynx cartilages), cosmetology (correcting ear and nose shape), orthopaedics and spinal surgery (treatment of diseases of spine disc and joints). The physical processes and mechanisms of laser-induced relaxation of stresses and regeneration of tissues are considered. New results of studies in this fast-developing field of laser surgery are presented, in particular, the results of laser correction of costal cartilage shape in the process of making implants for the treatment of larynx stenosis and controlled regeneration of the hyaline articular cartilage. Presented at the Fundamentals of Laser Assisted Micro- and Nanotechnologies (FLAMN-2016) International Symposium (Pushkin, Leningrad oblast, 27 June to 1 July 2016).
Nieman, Carrie L.; Benke, James R.; Ishman, Stacey L.; Smith, David F.; Boss, Emily F.
Objectives/Hypothesis Despite a national emphasis on patient-centered care and cultural competency, minority and low-income children continue to experience disparities in health care quality. Patient satisfaction scores are a core quality indicator. The objective of this study was to evaluate race and insurance-related disparities in parent participation with pediatric otolaryngology satisfaction surveys. Study Design Observational analysis of patient satisfaction survey respondents from a tertiary pediatric otolaryngology division. Methods Demographics of survey respondents (Press Ganey Medical Practice Survey©) between January and July 2012 were compared to a clinic comparison group using t test and chi-square analyses. Multivariate logistic regression analyses were performed to assess likelihood to complete a survey based on race or insurance status. Results A total of 130 survey respondents were compared to 1,251 patients in the comparison group. The mean patient age for which the parent survey was completed was 5.7 years (6.1 years for the comparison group, P =0.18); 59.2% of children were ≤5 years old. Relative to the comparison group, survey respondents were more often white (77.7% vs. 58.1%; P <0.001) and privately insured (84.6% vs. 60.8%; P <0.001). Similarly, after controlling for confounding variables, parents of children who were white (OR 1.8, 95% CI 1.13–2.78, P =0.013) or privately insured (OR 2.9, 95% CI 1.74–4.85, P <0.001) were most likely to complete a survey. Conclusion Methods to evaluate satisfaction did not capture the racial or socioeconomic patient distribution within this pediatric division. These findings challenge the validity of applying patient satisfaction scores, as currently measured, to indicate health care quality. Future efforts to measure and improve patient experience should be inclusive of a culturally diverse population. Level of Evidence 2c. PMID:23853050
Ukaegbe, Onyinyechi C; Umedum, Nnaemeka G; Chime, Ethel N; Orji, Foster T
Despite a global improvement in health care delivery, rural areas in developing countries still have poor access to specialist care. This study aims to assess the occurrences of ear, nose, and throat (ENT) disorders among rural primary school children in south-eastern Nigeria. Two rural primary schools were selected randomly from one of the rural regions of South Eastern State of Nigeria. All the pupils of the schools who gave consent were recruited. A structured study proforma investigating the pupils' biodata, otolaryngological symptoms, ear, nose and throat examination findings, was used to evaluate each pupil in the presence of the teachers. A total of 246 children participated in the study. 145(58.9%) were males while 101(41.1%) were females with a mean age of 8.5 ± 2.4 years. The commonest symptoms reported were nasal discharge (20%) followed by nasal obstruction (11.1%), itching of the ears (11.1%) and sneezing bouts (10%), while 3.7% had subjective hearing impairment. The commonest ENT finding was cerumen auris (43%) and this was observed in 43.4% of males and 42.4% of females, 11% had abnormal tympanic membranes and 20% had grades 3/4 tonsils(Brodsky grading). ENT disorders are still common in children in the rural areas of developing countries. To avoid the morbidity associated with these preventable and easily manageable disorders, community health workers should be trained to manage common ENT disorders and mobile clinics with scheduled visits made available in areas where ENT services remain inaccessible. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Wattel, Francis; Dubois, François
, fewer voluntary firemen, hospital reorganization, tight funding, difficulties of medical dispatching, and the varying skills of "first-on-the-scene "emergency workers. Grievances include late emergency responses, inappropriate medical care, and dispatching to the wrong facility. This raises the question of equal opportunity for all in a country with widely varying geographic features and population density. Improvement in the system's efficiency will require a series of objectives to be met in varied and complementary--Enhanced functional coordination, by speeding up the deployment of the ANTARES digital radio-frequency transmission network (Adaptation Nationale des Transmissions Aux Risques Et aux Secours).--Implementation of a network of emergency services with varying degrees of emergency healthcare management related to the technical nature of the facilities. Three levels of emergency healthcare must be made available: level 1 is provided by local hospitals, level 2 includes support facilities available in general hospitals (not necessarily the nearest hospital), and level 3 provides specialized healthcare in large and/or training hospitals with specialized departments. Life-threatening emergency situations are to be handled by level 2 or 3 facilities. Specific facilities must be selected as reference centers. In France, the ARS (Agences Régionales de Santé) is in charge of this procedure, as it provide funding for healthcare continuity--Reducing inequalities in access to emergency care. This will involve improving the network of SDIS brigades, making local medical facilities more responsive, delegating more medical procedures, on-site telemedicine, providing more helicopters equipped with healthcare facilities, more automated external defibrillators, and more dedicated neuro-vascular units.--First aid training must be made widely available. The French National Academy of Medicine has approved ten recommendations regarding organization and facilities.
Piker, Erin G.; Schulz, Kris; Parham, Kourosh; Vambutas, Andrea; Witsell, David; Tucci, Debara; Shin, Jennifer J.; Pynnonen, Melissa A.; Nguyen-Huynh, Anh; Crowson, Matthew; Ryan, Sheila E.; Langman, Alan; Roberts, Rhonda; Wolfley, Anne; Lee, Walter T.
Objective We used a national otolaryngology practice–based research network database to characterize the utilization of vestibular function testing in patients diagnosed with dizziness and/or a vestibular disorder. Study Design Database review. Setting The Creating Healthcare Excellence through Education and Research (CHEER) practice-based research network of academic and community providers Subjects and Methods Dizzy patients in the CHEER retrospective database were identified through ICD-9 codes; vestibular testing procedures were identified with CPT codes. Demographics and procedures per patient were tabulated. Analysis included number and type of vestibular tests ordered, stratified by individual clinic and by practice type (community vs academic). Chi-square tests were performed to assess if the percentage of patients receiving testing was statistically significant across clinics. A logistic regression model was used to examine the association between receipt of testing and being tested on initial visit. Results A total of 12,468 patients diagnosed with dizziness and/or a vestibular disorder were identified from 7 community and 5 academic CHEER network clinics across the country. One-fifth of these patients had at least 1 vestibular function test. The percentage of patients tested varied widely by site, from 3% to 72%; academic clinics were twice as likely to test. Initial visit vestibular testing also varied, from 0% to 96% of dizzy patients, and was 15 times more likely in academic clinics. Conclusion There is significant variation in use and timing of vestibular diagnostic testing across otolaryngology clinics. The CHEER network research database does not contain outcome data. These results illustrate the critical need for research that examines outcomes as related to vestibular testing. PMID:27371625
Ryan, Timothy; Specht, Jessica; Smith, Sarah; DelGaudio, John M
Analyze the correlation between online-based review websites and the Press Ganey Patient Satisfaction Survey (PGPSS) in an academic otolaryngology department. Retrospective cross sectional. Tertiary academic institution. All available data were collected for Vitals.com and Healthgrades.com, along with PGPSS data for 16 otolaryngology attending physicians from 2012 to 2014. A mean rating was calculated for each topic category for online websites and compared with 7 PGPSS content questions using zero-order correlations. A paired t test was used to analyze the difference between the PGPSS and online scores. There were no statistically significant correlations between time spent with the patient (r = 0.391, P = .208) and overall provider scores (r = 0.193, P = .508) when compared between Vitals.com and the PGPSS. The correlations were not statistically significant when Healthgrades.com was compared with the PGPSS in the items "probability of recommending the provider" (r = -0.122, P = .666) and "trust in provider" (r = -0.025, P = .929). The most important factors in a patient recommending the provider were as follows, per resource: time spent with the patient for Vitals.com (r = 0.685, P = .014), listening for Healthgrades.com (r = 0.981, P ≤ .001), and trust in the provider for the PGPSS (r = 0.971, P ≤ .001). This study suggests that online-based reviews do not have statistically significant correlations with the widely used PGPSS and may not be an accurate source of information for patients. Patients should have access to the most reliable and least biased surveys available to the public to allow for better-informed decisions regarding their health care. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
Chadwick L. Wright
Full Text Available Worldwide, about 600,000 head and neck squamous cell carcinoma (HNSCC are detected annually, many of which involve high risk human papilloma virus (HPV. Surgery is the primary and desired first treatment option. Following surgery, the existence of cancer cells at the surgical margin is strongly associated with eventual recurrence of cancer and a poor outcome. Despite improved surgical methods (robotics, microsurgery, endoscopic/laparoscopic, and external imaging, surgeons rely only on their vision and touch to locate tumors during surgery. Diagnostic imaging systems like computed tomography (CT, magnetic resonance imaging (MRI, single-photon emission computed tomography (SPECT and positron-emission tomography (PET are too large, slow and costly to use efficiently during most surgeries and, ultrasound imaging, while fast and portable, is not cancer specific. This purpose of this article is to review the fundamental technologies that will radically advance Precision Otolaryngology practices to the benefit of patients with HNSCC. In particular, this article will address the potential for tumor-targeting peptides to enable more precise diagnostic imaging while simultaneously advancing new therapeutic paradigms for next generation image-guided surgery, tumor-specific chemotherapeutic delivery and tumor-selective targeted radiotherapy (i.e., theranostic. Keywords: Squamous cell carcinoma, Peptide, Optical surgical navigation, Diagnostic imaging, Theranostic
Liu, Yu-Qi; Liu, Meng-Yu; Li, Chun; Shi, Nan-Nan; Wang, Yue-Xi; Wang, Li-Ying; Zhao, Xue-Yao; Kou, Shuang; Han, Xue-Jie; Wang, Yan-Ping
This study is to assess the Guidelines for Diagnosis and Treatment of Common Diseases of Otolaryngology in Traditional Chinese Medicine in clinical application and provide evidence for further guideline revision. The assessment was divided into applicability assessment and practicability assessment. The applicability assessment based on questionnaire survey and the traditional Chinese medicine (TCM) practitioners were asked to independently fill the Questionnaire for Applicability Assessment on the Guidelines for Diagnosis and Treatment in Traditional Chinese Medicine. The practicability assessment was based on prospective case investigation and analysis method and the TCM practitioners-in-charge filled the Case Investigation Questionnaire for Practicability Assessment on the Guidelines for Diagnosis and Treatment in Traditional Chinese Medicine. The data were analyzed in descriptive statistics. 151 questionnaires were investigated for applicability assessment and 1 016 patients were included for practicability assessment. The results showed that 88.74% of them were familiar with the guidelines and 45.70% used them. The guidelines quality and related items were similar in applicability assessment and practicability assessment, and scored highly as more than 85.00% except the "recuperating and prevention". The results suggested that the quality of Guidelines for Diagnosis and Treatment of Common Diseases of Otolaryngology in Traditional Chinese Medicine was high and could better guide the clinical practice. The "recuperating and prevention" part should be improved and the evidence data should be included in future guideline revision, so that the clinical utilization rate could be increased. Copyright© by the Chinese Pharmaceutical Association.
Curry, Martin; Malpani, Anand; Li, Ryan; Tantillo, Thomas; Jog, Amod; Blanco, Ray; Ha, Patrick K; Califano, Joseph; Kumar, Rajesh; Richmon, Jeremy
To develop a robotic surgery training regimen integrating objective skill assessment for otolaryngology and head and neck surgery trainees consisting of training modules of increasing complexity leading up to procedure-specific training. In particular, we investigated applications of such a training approach for surgical extirpation of oropharyngeal tumors via a transoral approach using the da Vinci robotic system. Prospective blinded data collection and objective evaluation (Objective Structured Assessment of Technical Skills [OSATS]) of three distinct phases using the da Vinci robotic surgical system in an academic university medical engineering/computer science laboratory setting. Between September 2010 and July 2011, eight otolaryngology-head and neck surgery residents and four staff experts from an academic hospital participated in three distinct phases of robotic surgery training involving 1) robotic platform operational skills, 2) set up of the patient side system, and 3) a complete ex vivo surgical extirpation of an oropharyngeal tumor located in the base of tongue. Trainees performed multiple (four) approximately equally spaced training sessions in each stage of the training. In addition to trainees, baseline performance data were obtained for the experts. Each surgical stage was documented with motion and event data captured from the application programming interfaces of the da Vinci system, as well as separate video cameras as appropriate. All data were assessed using automated skill measures of task efficiency and correlated with structured assessment (OSATS and similar Likert scale) from three experts to assess expert and trainee differences and compute automated and expert assessed learning curves. Our data show that such training results in an improved didactic robotic knowledge base and improved clinical efficiency with respect to the set up and console manipulation. Experts (e.g., average OSATS, 25; standard deviation [SD], 3.1; module 1, suturing
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration 50 CFR Part 223 RIN 0648-XZ58 Endangered and Threatened Species; Proposed Threatened Status for Distinct Population Segments of the Bearded Seal AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric...
... might take place before the 20th week of pregnancy. Causes Some pregnant women have some vaginal bleeding , with ... injuries or stress during the first trimester of pregnancy can cause threatened miscarriage. It occurs in almost half of ...
...-XZ58 Endangered and Threatened Species; Proposed Threatened Status for Distinct Population Segments of..., published a proposed rule to list the Beringia and Okhotsk Distinct Population Segments (DPSs) of the... published a proposed rule to list the Beringia and Okhotsk Distinct Population Segments (DPSs) of the...
Goto, Fumiyuki; Nakai, Kimiko; Kunihiro, Takanobu; Ogawa, Kaoru
Patients suffering from dizziness due to vertigo are commonly encountered in the department of otolaryngology. If various clinical examinations do not reveal any objective findings, then the patients are referred to the department of internal medicine or psychiatry. In many cases, the diagnosis is psychological dizziness. Phobic postural vertigo, which was first reported by Brandt T et al in 1994, is supposed to be a type of psychological dizziness. The diagnosis is based on 6 characteristics proposed by Brandt et al. Patients are usually treated with conventional medical therapy, but some cases may be refractory to such a therapy. Psychotherapy is recommended in some cases; however, psychotherapy including autogenic training, which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of autogenic training in a patient suffering from phobic postural vertigo. We present a case of a patient who suffered from phobic postural vertigo. A 37-year-old female complained of dizziness. She had started experiencing dizziness almost 3 years She was intractable to many sort of conventional therapy. In the end, her symptom disappeared after introduction of autogenic training. Autogenic training can be a viable and acceptable treatment option for phobic postural vertigo patients who fail to respond to other therapies. This case emphasizes the importance of autogenic training as a method to control symptom of phobic postural vertigo.
Fernanda Alves Sanjar
Full Text Available HIV is a pandemic infection with cases notified in almost all countries. The reported prevalence of symptoms in the head and neck is about 80%; otolaryngologists may be the first physician to see such patients. Oral manifestations are the most common, followed by neck and sinus manifestations. Otolaryngologic symptoms may be important signs of antiretroviral therapy failure. Symptoms are present in acute infections and advanced cases. OBJECTIVE: To describe new approaches in the past five years for the treatment of the most frequent otolaryngologic manifestations in HIV patients. METHODS: Systematic reviews and case series published in English and Portuguese from January 2002 to October 2007 including the most common otolaryngology manifestations were selected. CONCLUSION: Otolaryngologic manifestations are common and ENT specialists must be prepared to identify such cases.A infecção por HIV/AIDS é uma pandemia, com casos notificados em quase todos os países. Estudos retrospectivos apontam uma prevalência em torno de 80% dos sintomas na região da cabeça e pescoço, podendo ser o otorrinolaringologista o primeiro médico a ser procurado pelo paciente. As manifestações orais são as mais frequentes, seguidas pelo acometimento cervical, nasossinusal e, menos comumente, otológico. As lesões orais podem representar importantes marcadores clínicos da falha do tratamento antirretroviral. Tais sintomas podem estar presentes desde a infecção aguda até estágios avançados da doença. OBJETIVO: Determinar o avanço e as novas condutas no tratamento das principais manifestações otorrinolaringológicas no paciente soropositivo pelo levantamento de artigos publicados entre 2002 e 2007. MATERIAL E MÉTODO: Foram selecionados artigos de revisão sistemática e séries de caso, na língua inglesa e portuguesa, publicados no período de janeiro de 2002 a outubro de 2007, baseando-se nas manifestações otorrinolaringológicas mais comuns
Full Text Available Aadil Ahmed, Muhammad Abbas Abid, Nasir I Bhatti Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA Abstract: Students pursuing a medical career in the US are subject to standardized testing at regular intervals. These standardized tests not only quantify the milestones students have already achieved, but also define the path for future achievements. The purpose of these examinations is to help students become self-directed, lifelong learners – an essential attribute of a medical professional. However, whether preparing for these examinations actually makes students such disciplined learners needs to be examined. Especially during residency training with its limited time and unpredictable exposure, trainees must learn in the most efficient way for their learning styles, and thus develop attributes that will be helpful to them in their medical career. In this review, we propose that a personalized, learner-centered approach tailored to residents’ educational needs and preferences can not only fulfill learning interests and objectives but also serve as a time-efficient and cost-effective approach for graduate medical education. Keywords: standardized testing, personalized training, surgery
Unger, Bertram J; Kraut, Jay; Rhodes, Charlotte; Hochman, Jordan
Physical models of complex bony structures can be used for surgical skills training. Current models focus on surface rendering but suffer from a lack of internal accuracy due to limitations in the manufacturing process. We describe a technique for generating internally accurate rapid-prototyped anatomical models with solid and hollow structures from clinical and microCT data using a 3D printer. In a face validation experiment, otolaryngology residents drilled a cadaveric bone and its corresponding printed model. The printed bone models were deemed highly realistic representations across all measured parameters and the educational value of the models was strongly appreciated.
Chaiet, Scott R; Yoshikawa, Noriko; Sturm, Angela; Flanary, Valerie; Ishman, Stacey; Streed, Carl G
Currently, there are limited resources and training available for otolaryngologists and otolaryngology practice personnel to provide gender-affirming care for transgender or gender nonconforming patients. This unique patient population may present to our offices for gender-specific care or with complaints of the ear, nose, and throat unrelated to gender identity. Our current practice has unintentional but direct consequences on our patients care, as transgender patients often report negative experiences in the healthcare setting related to their gender identity. The absence of resources and training is also seen in other specialties. Physicians who create an environment where patients of all gender identities feel welcome can better meet their patients' health care needs. In addition, otolaryngologists can play a role in easing the gender dysphoria experienced by transgender patients. We suggest educational content should be created for and made available to otolaryngologists and office staff to provide gender-affirming care.
...; 4500030113] RIN 1018-AY21 Endangered and Threatened Wildlife and Plants; Listing the Lesser Prairie-Chicken... the conservation of the lesser prairie-chicken (Tympanuchus pallidicinctus). In addition, we announce... prairie-chicken as a threatened species under the Act. We also announce the availability of the final...
ten Hoor, Gill A; Peters, Gjalt-Jorn Y; Kalagi, Janice; de Groot, Lianne; Grootjans, Karlijne; Huschens, Alexander; K?hninger, Constanze; K?lgen, Lizan; Pelssers, Isabelle; Sch?tt, Toby; Thomas, Sophia; Ruiter, Robert AC; Kok, Gerjo
Abstract Background Threatening health messages that focus on severity are popular, but frequently have no effect or even a counterproductive effect on behavior change. This paradox (i.e. wide application despite low effectiveness) may be partly explained by the intuitive appeal of threatening communication: it may be hard to predict the defensive reactions occurring in response to fear appeals. We examine this hypothesis by using two studies by Brown and colleagues, which provide evidence th...
Bouhabel, Sarah; Kay-Rivest, Emily; Nhan, Carol; Bank, Ilana; Nugus, Peter; Fisher, Rachel; Nguyen, Lily Hp
Otolaryngology-head and neck surgery (OTL-HNS) residents face a variety of difficult, high-stress situations, which may occur early in their training. Since these events occur infrequently, simulation-based learning has become an important part of residents' training and is already well established in fields such as anesthesia and emergency medicine. In the domain of OTL-HNS, it is gradually gaining in popularity. Crisis Resource Management (CRM), a program adapted from the aviation industry, aims to improve outcomes of crisis situations by attempting to mitigate human errors. Some examples of CRM principles include cultivating situational awareness; promoting proper use of available resources; and improving rapid decision making, particularly in high-acuity, low-frequency clinical situations. Our pilot project sought to integrate CRM principles into an airway simulation course for OTL-HNS residents, but most important, it evaluated whether learning objectives were met, through use of a novel error identification model.
Staugaard, Søren Risløv
A threatening facial expression is a potent social sign of hostility or dominance. During the past 20 years, photographs of threatening faces have been increasingly included as stimuli in studies with socially anxious participants, based on the hypothesis that a threatening face is especially...... salient to people with fears of social interaction or negative evaluation. The purpose of this literature review is to systematically evaluate the accumulated research and suggest possible avenues for further research. The main conclusion is that photographs of threatening faces engage a broad range...... of perceptual processes in socially anxious participants, particularly when exposure times are very short...
Elliott D. Kozin MD
Full Text Available Evaluation of resident operative skills is challenging in the fast-paced operating room environment and limited by lack of validated assessment metrics. We describe a smartphone-based app that enables rapid assessment of operative skills. Accreditation Council for Graduate Medical Education (ACGME otolaryngology taxonomy surgical procedures (n = 593 were uploaded to the software platform. The app was piloted over 1 month. Outcomes included (1 completion of evaluation, (2 time spent completing the evaluation, and (3 quantification of case complexity, operative autonomy, and performance. During the study, 12 of 12 procedures, corresponding to 3 paired evaluated by the resident/attending dyad. Mean ± SD time of evaluation completion was 98.0 ± 24.2 and 123.0 ± 14.0 seconds for the resident and attending, respectively. Mean time between resident and attending evaluation completion was 27.9 ± 26.8 seconds. Resident and attending scores for case complexity, operative autonomy, and performance were strongly correlated ( P < .0001. Rapid evaluation of resident intraoperative performance is feasible using smartphone-based technology.
Farri, A; Enrico, A; Farri, F
In 1988, diagnostic criteria for headaches were drawn up by the International Headache Society (IHS) and is divided into headaches, cranial neuralgias and facial pain. The 2(nd) edition of the International Classification of Headache Disorders (ICHD) was produced in 2004, and still provides a dynamic and useful instrument for clinical practice. We have examined the current IHC, which comprises 14 groups. The first four cover primary headaches, with "benign paroxysmal vertigo of childhood" being the forms of migraine of interest to otolaryngologists; groups 5 to 12 classify "secondary headaches"; group 11 is formed of "headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures"; group 13, consisting of "cranial neuralgias and central causes of facial pain" is also of relevance to otolaryngology. Neither the current classification system nor the original one has a satisfactory collocation for migraineassociated vertigo. Another critical point of the classification concerns cranio-facial pain syndromes such as Sluder's neuralgia, previously included in the 1988 classification among cluster headaches, and now included in the section on "cranial neuralgias and central causes of facial pain", even though Sluder's neuralgia has not been adequately validated. As we have highlighted in our studies, there are considerable similarities between Sluder's syndrome and cluster headaches. The main features distinguishing the two are the trend to cluster over time, found only in cluster headaches, and the distribution of pain, with greater nasal manifestations in the case of Sluder's syndrome. We believe that it is better and clearer, particularly on the basis of our clinical experience and published studies, to include this nosological entity, which is clearly distinct from an otolaryngological point of view, as a variant of cluster headache. We agree with experts in the field of headaches, such as
Rubinstein, Marc; Armstrong, William B.; Djalilian, Hamid R.; Crumley, Roger L.; Kim, Jason H.; Nguyen, Quoc A.; Foulad, Allen I.; Ghasri, Pedram E.; Wong, Brian J. F.
Objectives: To determine the feasibility and accuracy of the Niris Optical Coherence Tomography (OCT) system in imaging of the mucosal abnormalities of the head and neck. The Niris system is the first commercially available OCT device for applications outside ophthalmology. Methods: We obtained OCT images of benign, premalignant and malignant lesions throughout the head and neck, using the Niris OCT imaging system (Imalux, Cleveland, OH). This imaging system has a tissue penetration depth of approximately 1-2mm, a scanning range of 2mm and a spatial depth resolution of approximately 10-20μm. Imaging was performed in the outpatient setting and in the operating room using a flexible probe. Results: High-resolution cross-sectional images from the oral cavity, nasal cavity, ears and larynx showed distinct layers and structures such as mucosa layer, basal membrane and lamina propria, were clearly identified. In the pathology images disruption of the basal membrane was clearly shown. Device set-up took approximately 5 minutes and the image acquisition was rapid. The system can be operated by the person performing the exam. Conclusions: The Niris system is non invasive and easy to incorporate into the operating room and the clinic. It requires minimal set-up and requires only one person to operate. The unique ability of the OCT offers high-resolution images showing the microanatomy of different sites. OCT imaging with the Niris device potentially offers an efficient, quick and reliable imaging modality in guiding surgical biopsies, intra-operative decision making, and therapeutic options for different otolaryngologic pathologies and premalignant disease.
Cracchiolo, Jennifer; Ridge, John A; Egleston, Brian; Lango, Miriam
Medicare Part B physician payment indicates a cost to Medicare beneficiaries for a physician service and connotes physician clinical productivity. The objective of this study was to determine whether there was an association between practice arrangement and Medicare physician payment. Cross-sectional study. Medicare provider utilization and payment data. Otolaryngologists from 1 metropolitan area were included as part of a pilot study. A generalized linear model was used to determine the effect of practice-specific variables including patient volumes on physician payment. Of 67 otolaryngologists included, 23 (34%) provided services through an independent practice, while others were employed by 1 of 3 local academic centers. Median payment was $58,895 per physician for the year, although some physicians received substantially higher payments. Reimbursements to faculty at 1 academic department were higher than to those at other institutions or to independent practitioners. After adjustments were made for patient volumes, physician subspecialty, and gender, payments to each faculty at Hospital C were 2 times higher than to those at Hospital A (relative ratio [RR] 2.03; 95% CI, 1.27-3.27; P = .003); 2 times higher than to faculty at Hospital B (RR 2.04; 95% CI, 1.4-2.7; P = .0001); and 1.6 times higher than to independent practitioners (RR 1.6; 95% CI, 1.04-2.7; P = .03). Payments to physicians in the other groups were not significantly different. Differences in reimbursement corresponded to an emphasis on procedures over office visits but not Medicare case mix adjustments for patient discharges from associated institutions. Variation in the cost of academic otolaryngology care may be subject in part to institutional factors. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
Amir, Nader; Beard, Courtney; Taylor, Charles T.; Klumpp, Heide; Elias, Jason; Burns, Michelle; Chen, Xi
The authors conducted a randomized, double-blind placebo-controlled trial to examine the efficacy of an attention training procedure in reducing symptoms of social anxiety in 44 individuals diagnosed with generalized social phobia (GSP). Attention training comprised a probe detection task in which pictures of faces with either a threatening or…
Roshan, Valiollah Dabidi; Hosseinzadeh, Somayeh; Mahjoub, Soleiman
For many years it has been known that lead is life-threatening, not only as an air pollutant but also because of it has been associated with several conditions including degenerative disease of the nervous system. In the current study we investigated neuroprotection effects of exercise training a...
Full Text Available Abstract The overwhelming majority of animal conservation projects are focused on vertebrates, despite most of the species on Earth being invertebrates. Estimates state that about half of all named species of invertebrates are parasitic in at least one stage of their development. The dilemma of viewing parasites as biodiversity or pest has been discussed by several authors. However, ticks were omitted. The latest taxonomic synopses of non-fossil Ixodidae consider valid 700 species. Though, how many of them are still extant is almost impossible to tell, as many of them are known only from type specimens in museums and were never collected since their original description. Moreover, many hosts are endangered and as part of conservation efforts of threatened vertebrates, a common practice is the removal of, and treatment for external parasites, with devastating impact on tick populations. There are several known cases when the host became extinct with subsequent coextinction of their ectoparasites. For our synoptic approach we have used the IUCN status of the host in order to evaluate the status of specifically associated hard-ticks. As a result, we propose a number of 63 coendangered and one extinct hard-tick species. On the other side of the coin, the most important issue regarding tick-host associations is vectorial transmission of microbial pathogens (i.e. viruses, bacteria, protozoans. Tick-borne diseases of threatened vertebrates are sometimes fatal to their hosts. Mortality associated with pathogens acquired from ticks has been documented in several cases, mostly after translocations. Are ticks a real threat to their coendangered host and should they be eliminated? Up to date, there are no reliable proofs that ticks listed by us as coendangered are competent vectors for pathogens of endangered animals.
Dongol, A; Mool, S; Tiwari, P
Threatened abortion is the most common complication in the first half of pregnancy. Most of these pregnancies continue to term with or without treatment. Spontaneous abortion occurs in less than 30% of these women. Threatened abortion had been shown to be associated with increased incidence of antepartum haemorrhage, preterm labour and intra uterine growth retardation. This study was to asses the outcome of threatened abortion following treatment. This prospective study was carried out in Dhulikhel Hospital - Kathmandu University Hospital from January 2009 till May 2010. Total 70 cases of threatened abortion were selected, managed with complete bed rest till 48 hrs of cessation of bleeding, folic acid supplementation, uterine sedative, and hormonal treatment till 28 weeks of gestation. Ultrasonogram was performed for diagnosis and to detect the presence of subchorionic hematoma. Patients were followed up until spontaneous abortion or up to delivery of the fetus. The measures used for the analysis were maternal age, parity, gestational age at the time of presentation, previous abortions, presence of subchorionic hematoma, complete abortion, continuation of pregnancy, antepartum hemorrhage, intrauterine growth retardation and intrauterine death of fetus. Out of 70 cases subchorionic haematoma was found in 30 (42.9%) cases. There were 12 (17.1%) patients who spontaneously aborted after diagnosis of threatened abortion during hospital stay, 5 (7.1%) aborted on subsequent visits while 53 (75.8%) continued pregnancy till term. Among those who continued pregnancy intrauterine growth retardation was seen in 7 (13.2%), antepartum hemorrhage in 4 (7.5%), preterm premature rupture of membrane in 3 (5.66%) and IUD in 3 (5.66%). Spontaneous abortion was found more in cases with subchorionic hematoma of size more than 20 cm2. In cases of threatened abortion with or without the presence of subchorionic hematoma, prognostic outcome is better following treatment with bed rest
Nouraei, S A R; Hudovsky, A; Virk, J S; Chatrath, P; Sandhu, G S
To audit the accuracy of clinical coding in otolaryngology, assess the effectiveness of previously implemented interventions, and determine ways in which it can be further improved. Prospective clinician-auditor multidisciplinary audit of clinical coding accuracy. Elective and emergency ENT admissions and day-case activity. Concordance between initial coding and the clinician-auditor multi-disciplinary teams (MDT) coding in respect of primary and secondary diagnoses and procedures, health resource groupings health resource groupings (HRGs) and tariffs. The audit of 3131 randomly selected otolaryngology patients between 2010 and 2012 resulted in 420 instances of change to the primary diagnosis (13%) and 417 changes to the primary procedure (13%). In 1420 cases (44%), there was at least one change to the initial coding and 514 (16%) health resource groupings changed. There was an income variance of £343,169 or £109.46 per patient. The highest rates of health resource groupings change were observed in head and neck surgery and in particular skull-based surgery, laryngology and within that tracheostomy, and emergency admissions, and specially, epistaxis management. A randomly selected sample of 235 patients from the audit were subjected to a second audit by a second clinician-auditor multi-disciplinary team. There were 12 further health resource groupings changes (5%) and at least one further coding change occurred in 57 patients (24%). These changes were significantly lower than those observed in the pre-audit sample, but were also significantly greater than zero. Asking surgeons to 'code in theatre' and applying these codes without further quality assurance to activity resulted in an health resource groupings error rate of 45%. The full audit sample was regrouped under health resource groupings 3.5 and was compared with a previous audit of 1250 patients performed between 2007 and 2008. This comparison showed a reduction in the baseline rate of health resource
Włodarczyk, Elżbieta; Szkiełkowska, Agata; Skarżyński, Henryk; Piłka, Adam
To assess effectiveness of the auditory training in children with dyslalia and central auditory processing disorders. Material consisted of 50 children aged 7-9-years-old. Children with articulation disorders stayed under long-term speech therapy care in the Auditory and Phoniatrics Clinic. All children were examined by a laryngologist and a phoniatrician. Assessment included tonal and impedance audiometry and speech therapists' and psychologist's consultations. Additionally, a set of electrophysiological examinations was performed - registration of N2, P2, N2, P2, P300 waves and psychoacoustic test of central auditory functions: FPT - frequency pattern test. Next children took part in the regular auditory training and attended speech therapy. Speech assessment followed treatment and therapy, again psychoacoustic tests were performed and P300 cortical potentials were recorded. After that statistical analyses were performed. Analyses revealed that application of auditory training in patients with dyslalia and other central auditory disorders is very efficient. Auditory training may be a very efficient therapy supporting speech therapy in children suffering from dyslalia coexisting with articulation and central auditory disorders and in children with educational problems of audiogenic origin. Copyright © 2011 Polish Otolaryngology Society. Published by Elsevier Urban & Partner (Poland). All rights reserved.
Coelho, Daniel H; Edelmayer, Luke W; Fenton, John E
Citation classics have traditionally been defined in the smaller medical specialties as any article published in a peer-reviewed journal that has received 100 or more citations from other articles also published in peer-reviewed journals. This study aimed to determine patterns of citation classics changes in the medical field otorhinolaryngology and head and neck surgery (OHNS) over the past decade and serves as a follow-up to an original study published in 2002, "A Century of Citation Classics in Otolaryngology-Head & Neck Surgery." Bibliometric analysis. Using the Journal Citation Reports and Web of Science, OHNS journals were selected and assessed for the content of citation classics. Nine-hundred five citation classics were found, over 11-fold more than 1 decade prior. Other significant changes were seen in country of origin, decade of publication, number of authors per article, subspecialty of article, and most frequently discussed topics. The dramatic rise in quantity and nature of citation classics in the past decade may be due to unprecedented advancements in information technology and communication, allowing studies and experiments to be performed, written, reviewed, published, and cited at rapid rates. NA. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.
Background Increasing focus is being placed on Clerkship curriculum design and implementation in light of new undergraduate medical education research and accreditation standards. Canadian Otolaryngology-Head and Neck Surgery (OTOHNS) Clerkship programs are continually but independently evolving towards a common goal of improving Clerkship curriculum. Methods An electronic survey was sent to undergraduate OTOHNS directors at all Canadian medical schools (n = 17) examining their Clerkship curricula. Themes included Clerkship format, teaching methods, faculty support and development, program strengths, and barriers. Results Survey response rate was 76%. All responding schools had OTOHNS Clerkship programs ranging in type (mandatory, selective or elective) and length (<1 to 4 weeks). Learning modalities varied. Electronic learning tools were identified as increasingly important to curriculum delivery. Common strengths included wide clinical exposure and one-on-one mentoring. Multiple challenges were identified in curriculum implementation and evaluation. All schools expressed interest in developing national standards, objectives and e-learning resources. Conclusions Significant variation exists in OTOHNS Clerkship experiences between Canadian medical schools. Many schools perceive barriers of insufficient time, space and curriculum standardization. Interested Canadian OTOHNS educators are eager to collaborate to improve the collective OTOHNS Clerkship experience. PMID:23663703
The International Union for Conservation of Nature (IUCN) announced on 9 September that it will develop a new Red List of Ecosystems that will identify which ecosystems are vulnerable or endangered. The list, which is modeled on the group's Red List of Threatened Species™, could help to guide conservation activities and influence policy processes such as the Convention on Biological Diversity, according to the group. “We will assess the status of marine, terrestrial, freshwater, and subterranean ecosystems at local, regional, and global levels,” stated Jon Paul Rodriguez, leader of IUCN's Ecosystems Red List Thematic Group. “The assessment can then form the basis for concerted implementation action so that we can manage them sustainably if their risk of collapse is low or restore them if they are threatened and then monitor their recovery.”
Oker, N; Alotaibi, N H; Herman, P; Bernal-Sprekelsen, M; Albers, A E
Europe-wide efforts are being initiated to define quality standards and harmonize Otolaryngology, Head and Neck Surgery (ORL-HNS)-specialty-training by creating an European board examination. However, differences within and between countries remain and are underinvestigated making comparisons and further improvement more difficult. The study aimed at assessing quality of training, satisfaction and quality of life of residents and recent ORL-HNS specialists in Spain and to trace similarities and differences to France and Germany administering anonymous online-questionnaire to ORL-HNS-residents and recent specialists. 146 questionnaires were returned with answers of 75.6 % of residents, a mean age of 30 years and a female to male ratio of 1.46:1. The global satisfaction of training was high as 76 % would choose the same ENT training again, 86 % confirmed that responsibilities which were given to them were adapted to their level of training and 97 % felt well considered in their department. Ninety-two confirmed that helpful seniors contributed to a good work environment (75 %) and to a good organization within the department (69 %). The respondents spent on average 8.8 h per day at the hospital and covered on average 4.8 night duties or week-end shifts per month with mostly no post-day off (86 %). Seventy-four percent participated regularly at complementary training sessions. Research work was supported and guided in 59 %. This study is the first one, to our best of knowledge, to assess the ORL-HNS-training in Spain and to trace parallelisms and differences to other European countries, such as France and Germany. The satisfaction of training and supervision was high in Spain, but there are still efforts to make concerning resident's quality of life. Compared to France and Germany, satisfaction with ORL-HNS-training and the support and guidance provided by seniors was similar. Work conditions were comparable to those in France. Motivation, teaching and
E.W. Lindstedt (Eric); G.S. Baarsma (Seerp); R.W.A.M. Kuijpers (Robert); P.M. van Hagen (Martin)
textabstractAIM: To describe the effect of additional treatment with anti-TNF-alpha therapy in a case series of 13 patients with serious sight threatening uveitis. METHODS: 13 patients with serious sight threatening uveitis were included, of whom six had Behcet's disease, five had idiopathic
Goto, Fumiyuki; Nakai, Kimiko; Ogawa, Kaoru
Data are limited on the role of psychotherapy in the treatment of Ménière disease. We sought to document the effect of a psychotherapeutic technique known as autogenic training on clinical outcome in Ménière disease. Six patients with Ménière disease were studied. Retrospective chart review was conducted. All patients were refractory to conventional therapy and completed a course of autogenic training, which was offered as a complementary treatment. Autogenic training with initial psychological counseling was conducted by a clinical psychologist during 45-min sessions. Outcome measures assessed were the frequency of vertigo and functional levels 2 years after initiation of autogenic training. Functional levels were evaluated according to the 1995 guidelines of the American Academy of Otolaryngology-Head Neck Surgery (AAO-HNS). As a personality measure, we used the Maudsley Personality Inventory (MPI), devised by Eysenck, which measures neuroticism (N), extraversion (E), and propensity to lie (L). Five of six patients showed improved functional level after three to eight sessions of psychotherapy; hearing level did not change. The score of the N scale of the MPI was closely related to the number of psychotherapy sessions. Prognosis was evaluated based on the AAO-HNS reporting guidelines, as follows: A = 3, B = 1, C = 1, F = 1. The value of N in MPI was closely related to the number of psychological counseling sessions (R = 0.97, P autogenic training may enhance the mental well-being of patients with Ménière disease and improve clinical outcome.
Spatz, Dena R; Zilliacus, Kelly M; Holmes, Nick D; Butchart, Stuart H M; Genovesi, Piero; Ceballos, Gerardo; Tershy, Bernie R; Croll, Donald A
Global biodiversity loss is disproportionately rapid on islands, where invasive species are a major driver of extinctions. To inform conservation planning aimed at preventing extinctions, we identify the distribution and biogeographic patterns of highly threatened terrestrial vertebrates (classified by the International Union for Conservation of Nature) and invasive vertebrates on ~465,000 islands worldwide by conducting a comprehensive literature review and interviews with more than 500 experts. We found that 1189 highly threatened vertebrate species (319 amphibians, 282 reptiles, 296 birds, and 292 mammals) breed on 1288 islands. These taxa represent only 5% of Earth's terrestrial vertebrates and 41% of all highly threatened terrestrial vertebrates, which occur in vertebrates was available for 1030 islands (80% of islands with highly threatened vertebrates). Invasive vertebrates were absent from 24% of these islands, where biosecurity to prevent invasions is a critical management tool. On the 76% of islands where invasive vertebrates were present, management could benefit 39% of Earth's highly threatened vertebrates. Invasive mammals occurred in 97% of these islands, with Rattus sp. as the most common invasive vertebrate (78%; 609 islands). Our results provide an important baseline for identifying islands for invasive species eradication and other island conservation actions that reduce biodiversity loss.
Bunting, Morgan; Cagle, John G
Hospital social workers are often the fulcrum of communication between physicians, patients, and families especially when patients are facing life-threatening illness. This study aims to understand the impact of a brief training for hospital social workers. The training is designed to improve communication skills and self-efficacy, as well as lessen fears of death and dying. Repeated-measures tests were used to assess outcomes across three time points. Twenty-nine university-based hospital social workers participated. Results trended in the desired directions. Communication self-efficacy improved immediately following the training, and this was sustained 1 month following training completion. Although participants were relatively experienced, improvement was still demonstrated and maintained suggesting brief communication training is promising for hospital social workers across the career.
... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Threatened and endangered species. 230... Impacts on Biological Characteristics of the Aquatic Ecosystem § 230.30 Threatened and endangered species. (a) An endangered species is a plant or animal in danger of extinction throughout all or a...
Although illegal, sexual harassment is frequent in the American workplace and extremely disruptive and costly to employees and employers alike. Most organizational responses to the problem have been hard line, short term, after-the-fact measures that inform, threaten, or discipline employees. What is needed, however, is a training program with an…
This paper presents the status of East African dragonfly species (Odonata) listed globally as threatened on "The IUCN Red List of Threatened Species". The area considered includes Ethiopia, Kenya, Uganda, Burundi, Rwanda, Tanzania and Malawi. From a total of 323 species known from these countries, 31 are listed in ...
Such a constitution of face is referred to as a Face Threatening Act. This paper studies the face threatening acts in the interactional space among characters in Adichie's Purple Hibiscus and establishes how those acts aid or mar the illocutionary goals of participants. The study concludes that the 'face' is inseparable from ...
Igado, Manuel Fandos; Aguaded Gómez, José Ignacio
The development and implementation of web 2.0 or social web are threatening the basis of the ways of mixing with other people. These changes are affecting everybody and, in particular, companies and institutions related to people's education, teaching and training for their inclusion in society and labour market. This article brings up some…
Full Text Available To determine whether adverse events extend the duration of hospitalization, and to evaluate the effectiveness of medical intervention in ameliorating adverse events and reducing the prolonged hospital stay associated with adverse events.A single arm intervention study was conducted from October 2012 to March 2014 in the otolaryngology ward of a 614-bed, university-affiliated hospital. Adverse events were monitored daily by physicians, pharmacists and nurses, and recorded in the electronic medical chart for each patient. Appropriate drug management of adverse events was performed by physicians in liaison with pharmacists. The Kaplan-Meier method was used to assess the length of hospitalization of patients who underwent medical intervention for adverse events.Of 571 patients admitted to the otolaryngology ward in a year, 219 patients (38.4% experienced adverse events of grade ≥2. The duration of hospitalization was affected by the grade of adverse events, with a mean duration of hospital stay of 9.2, 17.2, 28.3 and 47.0 days for grades 0, 1, 2, and 3-4, respectively. Medical intervention lowered the incidence of grade ≥2 adverse events to 14.5%. The length of hospitalization was significantly shorter in patients who showed an improvement of adverse events after medical intervention than those who did not (26.4 days vs. 41.6 days, hazard ratio 1.687, 95% confidence interval: 1.260-2.259, P<0.001. A multivariate Cox proportional hazard analysis indicated that insomnia, constipation, nausea/vomiting, infection, non-cancer pain, oral mucositis, odynophagia and neutropenia were significant risk factors for prolongation of hospital stay.Patients who experienced adverse events are at high risk of prolonged hospitalization. Medical intervention for adverse events was found to be effective in reducing the length of hospital stay associated with adverse events.
Maithani, Tripti; Pandey, Apporva; Dey, Debraj; Bhardwaj, Aparna; Singh, V P
First branchial cleft anomalies (FBCA) represent a small subset of congenital malformations in neck. Prime objective of this study is to share our experience with FBCA, emphasize its relevance in otolaryngology and deal with its pediatric perspective. Embryology, pathologic anatomy and varied spectra of clinical presentations of FBCA are discussed. Along with this we have illustrated three different cases; all of them were of pediatric age group and were misdiagnosed by their treating specialists elsewhere. In this article we have also laid special emphasis on its pediatric considerations. FBCA are mostly misdiagnosed due to their unfamiliar clinical signs and symptoms. Swellings may masquerade as other neck masses. Majority of patients give a history of previous incision and drainage. While dealing with pediatric patients the important factors to be kept in mind are the age of child, superficial course of facial nerve, any associated agenesis of parotid gland. Alteration in surgical technique may be required in children. A thorough medical examination with high index of clinical suspicion should be kept in mind while dealing with such anomalies. Owing to their complex presentation and close relation with facial nerve they are challenging lesions for surgeons.
Zsido, Andras N; Deak, Anita; Losonci, Adrienn; Stecina, Diana; Arato, Akos; Bernath, Laszlo
Numerous objects and animals could be threatening, and thus, children learn to avoid them early. Spiders and syringes are among the most common targets of fears and phobias of the modern word. However, they are of different origins: while the former is evolutionary relevant, the latter is not. We sought to investigate the underlying mechanisms that make the quick detection of such stimuli possible and enable the impulse to avoid them in the future. The respective categories of threatening and non-threatening targets were similar in shape, while low-level visual features were controlled. Our results showed that children found threatening cues faster, irrespective of the evolutionary age of the cues. However, they detected non-threatening evolutionary targets faster than non-evolutionary ones. We suggest that the underlying mechanism may be different: general feature detection can account for finding evolutionary threatening cues quickly, while specific features detection is more appropriate for modern threatening stimuli. Copyright © 2018 Elsevier B.V. All rights reserved.
The appropriate use of forceps, vacuums or spatulas facilitates the rapid delivery of foetuses faced with life-threatening situations. It also makes possible the relief of certain cases of prolonged second-stage labor. In France, operative vaginal delivery (OVD) accounts for approximately 10% of all births. OVD training aims to optimize maternal, as well as neonatal safety. It should enable trainees to indicate or contraindicate an OVD safely, as well as to choose the appropriate instrument, use it correctly, and master quality control principles. Traditional OVD training is confronted with both spatial and time-related limitations. Spatial constraints involve both the teacher and trainee who only have limited visual access to the pelvic canal, and the head of the foetus; the time constraint occurs whenever the OVD occurs in an emergency setting. These limitations have been further aggravated by new constraints: decreasing time dedicated to training (European safety rules prohibit work the day after night duty), increasing litigation, and constraints imposed by society. Training by means of simulation removes such limitations making it possible to both avoid exposing pregnant women to the hazards of traditional training, and adapt the training to the skills of each trainee. OVD training should include forceps, vacuums and the use of spatulas. The OVD skills of obstetricians should be audited regularly on both a personal and a confidential level. Such audits could be based on a method using a simulator. Prospective studies comparing traditional and simulation-based training should be encouraged.
Colligyrus n. sp. 2 Masked Duskysnail invertebrate Cordia rupicola Puerto Rico manjack plant Cordulegaster sayi Say’s Spiketail invertebrate Coreopsis...threatened and endangered plants and animals. Balancing threatened and endan- gered species (TES) management with training requirements is an increas...nation’s threatened and endangered plants and animals. A recent lawsuit settled by the U.S. Fish and Wildlife Service (USFWS) requires a review of 757
Hertz, J B; Heisterberg, L
A prospectively collected group of 93 pregnancies complicated by threatened abortion was carefully monitored throughout pregnancy, during birth and in the perinatal period, and any deviation from a completely uneventful course was registered. Comparison was made with a selected group of 282 non-risk pregnant women. A significant association was found between threatened abortion and the overall number of complications in the second half of pregnancy requiring medical intervention and/or admission to hospital, impending pre-term birth requiring betamimetics, pre-term birth, retention of the placenta, birth weight below 2000 g, light-for-dates infants in case of pre-term birth or birth weight below 2000 g, and hyperbilirubinemia in infants with birth weight below 2000 g. The incidences of perinatal mortality and congenital malformations did not differ significantly from those of the control group. Pregnancies complicated by threatened abortion constitute a risk group requiring careful obstetric and perinatal supervision and follow-up.
Full Text Available Trauma literature regarding management of genitalia trauma affecting future fertility and gonadal function in the face of coexisting life-threatening injuries is underdeveloped. We present a unique case that necessitated integrative management of a 24-year-old male who became entangled within the blades of a manure spreader and presented with life-threatening trauma in addition to severe genital trauma, including penile degloving, bilateral testicular avulsion and bilateral spermatic cord laceration. During the initial stabilization and surgical management, urology and plastic surgery were consulted to assess the urogenital injuries. Together, the surgical team orchestrated potentially life-saving interventions while successfully performing both a testicular sperm extraction and a testicular revascularization. Viable sperm was collected on the day of surgery and initial follow-up showed preserved sexual function and adequate perfusion to the testicle. This report presents a case and provides a review discussing the management of traumatic genital injuries and the importance of early involvement of surgical specialties in genitalia trauma to optimize future fertility and gonadal function. The literature search was performed in August 2008 using Medline for articles only in English, including any of the following terms: polytrauma, trauma, penis, testicle, degloving, avulsion, spermatic cord, laceration, fertility, reproduction or revascularization.
Hung Tamin; Sun Tienlung; Yang Chihwei; Yang Lichen; Cheng Tsungchieh; Wang Jyhgang
Nuclear power plant's safety is very important problem. In this very conscientious environment if operator has a little mistake, they may threaten with many people influence their safety. Therefore, operating training of control room is very important. However, the operator training is in limited space and time. Each operator must go to simulative control room do some training. If we can let each trainee having more time to do training and does not go to simulative control room. It may have some advantages for trainee. Moreover, in the traditional training ways, each operator may through the video, teaching manual or through the experienced instructor to learn the knowledge. This training way may let operator feel bored and stressful. So, in this paper aims, we hope utilizing virtual reality technology developing a game-based virtual training environment of control room. Finally, we will use presence questionnaire evaluating realism and feasibility of our virtual training environment. Expecting this initial concept of game-based virtual training environment can attract trainees having more learning motivation to do training in off-hour. (author)
Aldrees, Turki; Badri, Motasim; Islam, Tahera; Alqahtani, Khalid
Determine the prevalence of, and associated risk factors for, burnout among otolaryngologist residents in Saudi Arabia. A cross-section study of multicenter hospitals in Saudi Arabia conducted in March 2013. Registered residents in Saudi Otolaryngology Board Program. The Maslach Burnout Inventory was used to measure burnout status. Questions supplementary to the Maslach Burnout Inventory were also included to identify associated potential risk factors such as demographic data, resident satisfaction, and work conditions. Of the initial 123 questionnaires that were distributed, 85 yielded responses, a rate of 69%. The mean age (standard deviation [SD]) of respondents was 29 (2.3) years. Of those, 67% (57/85) were men and 66% (55/85) were married. Resident levels were delineated: level 2, 19%; level 3, 33%; level 4, 29%; and level 5, 19%. The mean number of on-call days/month (SD) was 7 (2), clinics/week (SD) was 3 (1), sleep hours/day (SD) was 6 (1), and operations/week (SD) was 2 (1). The mean emotional exhaustion (EE) and depersonalization scores were high at 29.5 (SD = 9.6) and 10.7 (SD = 6), respectively. The mean personal accomplishment was low at 32.33 (SD = 6). The mean of all subscales did not differ by sex (EE p = 0.5; depersonalization p = 0.09; personal accomplishment p = 0.4). Mean EE differed by marital status, which was 31.2, 31.3, and 25.6 for married, divorced, and single, respectively, analysis of variance test p = 0.045. Burnout prevalence was found to be high among otolaryngologist residents in Saudi Arabia. The associated variables examined in this study should be addressed to decrease this level of burnout and provide residents with a less stressful work environment. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Sanchez, Diana T; Chaney, Kimberly E; Manuel, Sara K; Wilton, Leigh S; Remedios, Jessica D
In the current research, we posited the stigma-by-prejudice-transfer effect, which proposes that stigmatized group members (e.g., White women) are threatened by prejudice that is directed at other stigmatized group members (e.g., African Americans) because they believe that prejudice has monolithic qualities. While most stigma researchers assume that there is a direct correspondence between the attitude of prejudiced individuals and the targets (i.e., sexism affects women, racism affects racial minorities), the five studies reported here demonstrate that White women can be threatened by racism (Study 1, 3, 4, and 5) and men of color by sexism (Study 2). Robust to perceptions of liking and the order in which measures were administered, results showed that prejudice transfers between racism and sexism were driven by the presumed social dominance orientation of the prejudiced individual. In addition, important downstream consequences, such as the increased likelihood of anticipated stigma, expectations of unfair treatment, and the attribution of negative feedback to sexism, appeared for stigmatized individuals.
Conerty, Michelle D.; Castracane, James; Cacace, Anthony T.; Parnes, Steven M.; Gardner, Glendon M.; Miller, Mitchell B.
Electronic Speckle Pattern Interferometry (ESPI) is a nondestructive optical evaluation technique that is capable of determining surface and subsurface integrity through the quantitative evaluation of static or vibratory motion. By utilizing state of the art developments in the areas of lasers, fiber optics and solid state detector technology, this technique has become applicable in medical research and diagnostics. Based on initial support from NIDCD and continued support from InterScience, Inc., we have been developing a range of instruments for improved diagnostic evaluation in otolaryngological applications based on the technique of ESPI. These compact fiber optic instruments are capable of making real time interferometric measurements of the target tissue. Ongoing development of image post- processing software is currently capable of extracting the desired quantitative results from the acquired interferometric images. The goal of the research is to develop a fully automated system in which the image processing and quantification will be performed in hardware in near real-time. Subsurface details of both the tympanic membrane and vocal cord dynamics could speed the diagnosis of otosclerosis, laryngeal tumors, and aid in the evaluation of surgical procedures.
... Population Segments of the Bearded Seal AGENCY: National Marine Fisheries Service (NMFS), National Oceanic... population segments (DPS) of the bearded seal (Erignathus barbatus) as threatened species under the... posed to this population by the projected habitat changes. Extension of Final Listing Determination The...
California Natural Resource Agency — A compiled density of threatened and endangered species built around 2000m wide hexagonal cells. The dataset was created by generating a blank hex grid, intersecting...
Bosse, T.; Gerritsen, C.; de Man, J.; Treur, J.
Learning to regulate one's emotions under threatening circumstances is important, among others, for professionals like police officers and military personnel. To explore the opportunities of Virtual Reality-based training for such professionals, this paper describes an experiment performed to
Watson, James E M; Evans, Megan C; Carwardine, Josie; Fuller, Richard A; Joseph, Liana N; Segan, Dan B; Taylor, Martin F J; Fensham, R J; Possingham, Hugh P
The acquisition or designation of new protected areas is usually based on criteria for representation of different ecosystems or land-cover classes, and it is unclear how well-threatened species are conserved within protected-area networks. Here, we assessed how Australia's terrestrial protected-area system (89 million ha, 11.6% of the continent) overlaps with the geographic distributions of threatened species and compared this overlap against a model that randomly placed protected areas across the continent and a spatially efficient model that placed protected areas across the continent to maximize threatened species' representation within the protected-area estate. We defined the minimum area needed to conserve each species on the basis of the species' range size. We found that although the current configuration of protected areas met targets for representation of a given percentage of species' ranges better than a random selection of areas, 166 (12.6%) threatened species occurred entirely outside protected areas and target levels of protection were met for only 259 (19.6%) species. Critically endangered species were among those with the least protection; 12 (21.1%) species occurred entirely outside protected areas. Reptiles and plants were the most poorly represented taxonomic groups, and amphibians the best represented. Spatial prioritization analyses revealed that an efficient protected-area system of the same size as the current protected-area system (11.6% of the area of Australia) could meet representation targets for 1272 (93.3%) threatened species. Moreover, the results of these prioritization analyses showed that by protecting 17.8% of Australia, all threatened species could reach target levels of representation, assuming all current protected areas are retained. Although this amount of area theoretically could be protected, existing land uses and the finite resources available for conservation mean land acquisition may not be possible or even effective
Lischke, Alexander; Gamer, Matthias; Berger, Christoph; Grossmann, Annette; Hauenstein, Karlheinz; Heinrichs, Markus; Herpertz, Sabine C; Domes, Gregor
The neuropeptide oxytocin (OT) is well known for its profound effects on social behavior, which appear to be mediated by an OT-dependent modulation of amygdala activity in the context of social stimuli. In humans, OT decreases amygdala reactivity to threatening faces in males, but enhances amygdala reactivity to similar faces in females, suggesting sex-specific differences in OT-dependent threat-processing. To further explore whether OT generally enhances amygdala-dependent threat-processing in females, we used functional magnetic resonance imaging (fMRI) in a randomized within-subject crossover design to measure amygdala activity in response to threatening and non-threatening scenes in 14 females following intranasal administration of OT or placebo. Participants' eye movements were recorded to investigate whether an OT-dependent modulation of amygdala activity is accompanied by enhanced exploration of salient scene features. Although OT had no effect on participants' gazing behavior, it increased amygdala reactivity to scenes depicting social and non-social threat. In females, OT may, thus, enhance the detection of threatening stimuli in the environment, potentially by interacting with gonadal steroids, such as progesterone and estrogen. Copyright © 2012 Elsevier Ltd. All rights reserved.
Full Text Available OBJECTIVE: To assess the Outcome of pregnancy in patients with threatened abortion. METHODS: A Prospective observational study was done on 106 pregnant women with threatened abortion. Out comes in the form of antenatal complications, mode of delivery and postnatal co mplications were noted. Analysis of the data was done using SPSS version 13. RESULTS: In the study of 106 patients 18% had spontaneous abortion. Pre - labour rupture of membranes were seen in 20% of patients and 21% had preterm labour. Threatened abortion di d not affect mode of delivery. PPROM, preterm births were more in women presenting with first trimester bleeding; PIH, PROM, and postpartum complications were more in women presenting beyond 20 weeks gestation though statistically not significant. 13.2% of women had heavy bleeding at admission out of which 50% aborted subsequently – significantly higher than the light bleeding group. CONCLUSION: The overall maternal and perinatal outcome in women with threatened abortion is suboptimal. Women with heavy blee ding are more likely to abort than women with light bleeding. Among the prognostic factors, only the amount of bleeding had significant prognostic accuracy
Rafferty, Michael F
There has been little consensus between the pharmaceutical industry and academic communities concerning the best approach to train medicinal chemists for drug discovery. For decades the pharmaceutical industry has shown preference for synthetic organic graduates over candidates with degrees from medicinal chemistry programs on the assumption that medicinal chemistry expertise will be acquired on the job. However, ongoing changes to pharmaceutical drug discovery organizations and practices threaten to undermine this training model. There is a compelling argument to be made for establishment of a strong industry-academic partnership to train new candidates with sophisticated knowledge of contemporary drug design concepts and techniques to ensure that the future needs of both industry and academic drug discovery research can be served.
Schwartz, Marissa A; Kavanagh, Katherine R; Frampton, Steven J; Bruce, Iain A; Valdez, Tulio A
There has been a growing shift towards endoscopic management of laryngeal procedures in pediatric otolaryngology. There still appears to be a shortage of pediatric otolaryngology programs and children's hospitals worldwide where physicians can learn and practice these skills. Laryngeal simulation models have the potential to be part of the educational training of physicians who lack exposure to relatively uncommon pediatric otolaryngologic pathology. The objective of this study was to assess the utility of pediatric laryngeal models to teach laryngeal pathology to physicians at an international meeting. Pediatric laryngeal models were assessed by participants at an international pediatric otolaryngology meeting. Participants provided demographic information and previous experience with pediatric airways. Participants then performed simulated surgery on these models and evaluated them using both a previously validated Tissue Likeness Scale and a pre-simulation to post-simulation confidence scale. Participants reported significant subjective improvement in confidence level after use of the simulation models (p easy manipulated with surgical instruments. These models allow both trainees and surgeons to practice time-sensitive airway surgeries in a safe and controlled environment. Copyright © 2017 Elsevier B.V. All rights reserved.
... and Plants; Listing as Endangered and Threatened and Designation of Critical Habitat for Texas Golden... habitat determination for these two East Texas plants. The final listing rule will publish under the... reopening of the public comment period on the September 11, 2012, proposed endangered status for the Texas...
Dev, Parvati; Youngblood, Patricia; Heinrichs, W Leroy; Kusumoto, Laura
An important component of all emergency medicine residency programs is managing trauma effectively as a member of an emergency medicine team, but practice on live patients is often impractical and mannequin-based simulators are expensive and require all trainees to be physically present at the same location. This article describes a project to develop and evaluate a computer-based simulator (the Virtual Emergency Department) for distance training in teamwork and leadership in trauma management. The virtual environment provides repeated practice opportunities with life-threatening trauma cases in a safe and reproducible setting.
Full Text Available We conducted a detailed review of threatened bird and mammal occurrence records obtained from surveys across Mato Grosso do Sul, midwestern region of Brazil which has an extent of 357,145 km2, aiming to support environmental and biodiversity conservation initiatives, as strategic plans to protect threatened species in this region. We included all records of species categorized as threatened by the Brazilian and global red list of threatened species. We collected 760 records of threatened birds and mammals in Mato Grosso do Sul State, with 319 records of 40 bird’s species and 441 records of 24 mammal’s species. The status of the 40 bird species under de Brazilian threat category were as follow: 1 Critically Threatened (CR, 6 Endangered (EN, 11 Vulnerable (VU, 11 Near Threatened (NT, and 11 species only in the IUCN red list. Under the IUCN category for the bird´s species, were as follow: 3 EN, 13 VU, 18 NT, 5 Least Concern (LC and 1 taxon has not yet been assessed for the IUCN Red List. Regarding mammal’s species under the Brazilian threat category were as follow: 2 EN, 18 VU, 2 NT and 1 only in the IUCN red list. Under the IUCN status the species ranged from 2 EN, 6 VU, 10 NT, and 6 LC. Each record identified corresponds to the existence of at least one occurrence of threatened birds or mammals in a particular region. The records of threatened species belongs to the three biomes in the state: 269 mammal’s records and 147 bird’s records from Cerrado (Neotropical Savanna biome, 117 mammal’s records and 162 bird’s records from Pantanal (Wetland biome, and 55 mammal’s records and 10 bird’s records from Atlantic Forest biome. In addition, we also included in the dataset environmental information where each record was obtained. Supplementary Files 1- Records of Threatened Mammals_MS_Brazil and Supplementary File 2. Records of Threatened Birds of_MS_Brazil Keywords: Threatened species, Protected areas, Database, Brazil
Full Text Available We analyzed the role of taboos for the protection of species listed as "threatened" by the World Conservation Union (IUCN, and also for species known to be endemic and keystone. The study was limited to taboos that totally avoid or prohibit any use of particular species and their populations. We call them specific-species taboos . Through a literature review, 70 currently existing examples of specific-species taboos were identified and analyzed. The species avoided were grouped into biological classes. Threat categories were determined for each species, based on the IUCN Red Data Book. We found that ~ 30% of the identified taboos prohibit any use of species listed as threatened by IUCN. Of the specific-species taboos, 60% are set on reptiles and mammals. In these two classes, ~ 50% of the species are threatened, representing all of the threatened species in our analysis, with the exception of one bird species. Both endemic and keystone species that are important for ecosystem functions are avoided by specific-species taboos. Specific-species taboos have important ecological ramifications for the protection of threatened and ecologically important populations of species. We do not suggest that specific-species taboos are placed on species because they are, or have been, endangered; instead, we emphasize that species are avoided for a variety of other reasons. It is urgent to identify and analyze resource practices and social mechanisms of traditional societies, such as taboos, and to investigate their possible ecological significance. Although it may provide insights of value for conservation, not only of species, but also of ecosystem processes and functions, such information is being lost rapidly.
Tukiainen, Helena; Bailey, Joseph J; Field, Richard; Kangas, Katja; Hjort, Jan
Understanding threatened species diversity is important for long-term conservation planning. Geodiversity-the diversity of Earth surface materials, forms, and processes-may be a useful biodiversity surrogate for conservation and have conservation value itself. Geodiversity and species richness relationships have been demonstrated; establishing whether geodiversity relates to threatened species' diversity and distribution pattern is a logical next step for conservation. We used 4 geodiversity variables (rock-type and soil-type richness, geomorphological diversity, and hydrological feature diversity) and 4 climatic and topographic variables to model threatened species diversity across 31 of Finland's national parks. We also analyzed rarity-weighted richness (a measure of site complementarity) of threatened vascular plants, fungi, bryophytes, and all species combined. Our 1-km 2 resolution data set included 271 threatened species from 16 major taxa. We modeled threatened species richness (raw and rarity weighted) with boosted regression trees. Climatic variables, especially the annual temperature sum above 5 °C, dominated our models, which is consistent with the critical role of temperature in this boreal environment. Geodiversity added significant explanatory power. High geodiversity values were consistently associated with high threatened species richness across taxa. The combined effect of geodiversity variables was even more pronounced in the rarity-weighted richness analyses (except for fungi) than in those for species richness. Geodiversity measures correlated most strongly with species richness (raw and rarity weighted) of threatened vascular plants and bryophytes and were weakest for molluscs, lichens, and mammals. Although simple measures of topography improve biodiversity modeling, our results suggest that geodiversity data relating to geology, landforms, and hydrology are also worth including. This reinforces recent arguments that conserving nature's stage
... Oregon Coast Coho Salmon Evolutionarily Significant Unit AGENCY: National Marine Fisheries Service (NMFS... the Oregon Coast (OC) Evolutionarily Significant Unit (ESU) of coho salmon (Oncorhynchus kisutch... coho salmon ESU as threatened under the ESA in 1995 (60 FR 38011; July 25, 1995). Since then, we have...
Medical students graduate with the knowledge and skills to be undifferentiated general physicians. Otolaryngology-head and neck surgery (OtoHNS) is an essential component of primary healthcare, but is disproportionately under-represented in undergraduate medical education (UME). Advances and innovations in educational technology may represent an exciting and creative solution to this important problem. Failure to meet this educational need will result in substantial downstream effects in primary healthcare delivery. The objectives of this study were to 1) demonstrate current deficits in OtoHNS teaching at the UME level; 2) develop, validate, and critically appraise educational innovations that may enrich OtoHNS teaching in medical school curricula; and 3) propose a process for standardization of learning objectives for OtoHNS in UME as it relates to development and deployment of such educational tools. A white paper, prepared as a Triological Society thesis, which consolidates a prospective 10-year investigation of the problem of and potential solutions for under-representation of OtoHNS in UME. Cited datasets include multicenter surveys, cohort studies, and prospective, randomized controlled trials. A series of published and unpublished data were synthesized that addresses the following: 1) the current state of OtoHNS teaching at the UME level with respect to content, volume, structure, and methods; and 2) educational innovations including e-learning and simulation with emphasis on validity and learning effectiveness. Educational innovations specific to postgraduate (residency) training were excluded. Data support the observation that there is uniformly disproportionate under-representation of OtoHNS within UME curricula. Medical school graduates, especially those pursuing primary care specialties, report poor overall comfort levels in managing OtoHNS problems. A series of novel teaching methods were developed and validated using e-learning and simulation
U.S. Environmental Protection Agency — These data represent predicted current distributions of all U.S. listed threatened and endangered mammals, birds, reptiles, and amphibians in the Middle-Atlantic...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... available for review pursuant to section 10(c) of the Endangered Species Act (ESA). DATES: Comments and... the ESA. NMFS regulations governing permits for threatened and endangered species are promulgated at...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS..., importing, and exporting of endangered and threatened species (50 CFR parts 222-226). Permits Permit 15926... will be captured by fyke net, identified to species, enumerated and measured. Dead or moribund fish...
Wallach, A. D.
Full Text Available The introduction of alien mesopredators and herbivores has been implicated as the main driver of mammalian extinction in Australia. Recent studies suggest that the devastating effects of invasive species are mitigated by top-order predators. The survival of many threatened species may therefore depend on the presence and ecological functioning of large predators. Australia’s top predator, the dingo (Canis lupus dingo, has been intensively persecuted across the continent and it is extremely rare to find dingo populations that are not being subjected to lethal control. We predicted that the presence of threatened species point out places where dingo populations are relatively intact, and that their absence may indicate that dingoes are either rare or socially fractured. A comparison of a site which harbors a threatened marsupial, the kowari (Dasyuroides byrnei, and a neighboring site where the kowari is absent, offers support for this suggested pattern.
Anderson, S G
Real-time sonography was used to evaluate 158 patients with threatened abortion. Fetal motion was first detected during the seventh gestational week and with increasing frequency thereafter in 73 patients with viable pregnancies continuing to term. Only 2 of 65 patients who aborted demonstrated fetal motion. The presence or absence of fetal motion was most reliable after 7 weeks' gestation for establishing a prognosis for a given pregnancy. Seventy-two of 74 pregnancies with fetal motion continued to term, whereas 63 of 64 pregnancies without fetal motion aborted. A method for using real-time sonography in the management of threatened abortion is presented.
Full Text Available Abstract Background Threatened miscarriage involves vaginal bleeding in a pregnancy that remains viable. This is a common early pregnancy complication with increased risk factors for early pregnancy loss, preterm premature rupture of membranes (PPROM, preterm delivery, low birth weight babies and maternal antepartum haemorrhage. Currently there are no recommended medical treatment options, rather women receive advice that centres on a 'wait and see' approach. For women with a history of unexplained recurrent miscarriage providing supportive care in a subsequent pregnancy improves live birthing outcomes, but the provision of supportive care to women experiencing threatened miscarriage has to date not been examined. Discussion While it is known that 50-70% of miscarriages occur due to chromosomal abnormalities, the potential for therapeutic intervention amongst the remaining percentage of women remains unknown. Complementary and alternative medicine (CAM therapies have the potential to provide supportive care for women presenting with threatened miscarriage. Within fertility research, acupuncture demonstrates beneficial hormonal responses with decreased miscarriage rates, raising the possibility acupuncture may promote specific beneficial effects in early pregnancy. With the lack of current medical options for women presenting with threatened miscarriage it is timely to examine the possible treatment benefits of providing CAM therapies such as acupuncture. Summary Despite vaginal bleeding being a common complication of early pregnancy there is often reluctance from practitioners to discuss with women and medical personal how and why CAM may be beneficial. In this debate article, the physiological processes of early pregnancy together with the concept of providing supportive care and acupuncture are examined. The aim is to raise awareness and promote discussion as to the beneficial role CAM may have for women presenting with threatened miscarriage.
Sight threatening changes in the retina are a well-recognized complication of sickle cell disease (SCD). However they usually occur in older patients with Haemoglobin SC or Sβ+thal patterns. It is rarely found under the age of 20 years in patients who are Hb SS or Sβ<°thal. This is a report of sight threatening retinopathy in ...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS..., in the form of Hatchery and Genetic Management Plans (HGMPs) pursuant to the Endangered Species Act... the ``taking'' of a species listed as endangered or threatened. The term ``take'' is defined under the...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS..., in the form of Hatchery and Genetic Management Plans (HGMPs) pursuant to the Endangered Species Act... the ``taking'' of a species listed as endangered or threatened. The term ``take'' is defined under the...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... Endangered Species Act of 1973, as amended (ESA). The proposed modification is to extend the existing permit... regulations prohibit the ``taking'' of a species listed as endangered or threatened. The term ``take'' is...
Wabnitz, Pascal; Martens, Ulla; Neuner, Frank
Human information processing is sensitive to aversive stimuli, in particular to negative cues that indicate a threat to physical integrity. We investigated the extent to which these findings can be transferred to stimuli that are associated with a social rather than a physical threat. Event-related potentials were recorded during silent reading of neutral, positive, physically threatening, and socially threatening words, whereby socially threatening words were represented by swear words. We found facilitated processing of positive and physically threatening words in contrast to both neutral and socially threatening words at a first potential that emerged at about 120 ms after stimulus onset. At a semantic processing stage reflected by the N400, processing of all classes of affective words, including socially threatening words, differed from neutral words. We conclude that socially threatening words as well as neutral words capture more attentional resources than positive and physically threatening words at early stages. However, social threatening words are processed in a manner similar to other emotional words and different from neutral words at higher levels.
Peters, Jan H; Hock, Michael; Krohne, Heinz Walter
Dispositional styles of coping with threat influence memory for threatening information. In particular, sensitizers excel over repressors in their memory for threatening information after long retention intervals, but not after short ones. We therefore suggested that sensitizers, but not repressors, employ active maintenance processes during the retention interval to selectively retain threatening material. Sensitive maintenance was studied in 2 experiments in which participants were briefly exposed to threatening and nonthreatening pictures (Experiment 1, N = 128) or words (Experiment 2, N = 145). Following, we administered unannounced recognition tests before and after an intervening task that generated either high or low cognitive load, assuming that high cognitive load would impede sensitizers' memory maintenance of threatening material. Supporting our hypotheses, the same pattern of results was obtained in both experiments: Under low cognitive load, sensitizers forgot less threat material than repressors did; no such differences were observed under high cognitive load.
Recent on station and on-farm studies suggest the major diseases threatening banana biodiversity in Uganda include: 1)Black sigatoka which severely affects all East African Highland (EA-AAA) banana cultivars and a range of introduced genotypes; 2) Fusarium wilt which affects several introduced genotypes though all EA ...
Factor, Stewart A; Molho, Eric S
Psychotic symptoms are commonly reported in patients with Parkinson disease (PD). In particular, patients experience nonthreatening visual hallucinations that can occur with insight (so called hallucinosis) or without. Auditory hallucinations are uncommon, and schizophrenialike symptoms such as pejorative and threatening auditory hallucinations and delusions that are persecutory, referential, somatic, religious, or grandiose have rarely been reported. The authors present 2 PD patients who experienced threatening auditory hallucinations, without visual hallucinations, and schizophrenialike delusions with detailed description of the clinical phenomenology including 1 patient with Cotard syndrome.
Wróbel, Maciej; Kopeć, Tomasz; Juszkat, Robert; Szyfterl, Witold; Borucki, Łukasz
Angiography is an invasive, radiological investigation of vascular system. It plays an important role within variety of diagnostic tools in head and neck pathologies. In selected cases with well defined tumor supply vessels, angiography may be combined with intravascular obliteration. This possibility widen indications, which comprise diagnostic arteriographies - visualization of blood supply and extension of vascularization; therapeutic and diagnostic arteriographies - palliative or radical in character, dependent on pathology; and therapeutic angiographies as adjuvant therapy prior to surgical treatment. Authors present their experience with endovascular techniques application in head and neck pathologies. Material comprised 59 angiographies performed in patients treated at Otolaryngology Department at Poznań University of Medical Sciences between 2000-2007. In conclusion authors emphasize advantages and disadvantages, as well as, the role of the endovascular treatment in head and neck surgery.
Tershy, Bernie R.; Newton, Kelly M.; Spatz, Dena R.; Swinnerton, Kirsty; Iverson, John B.; Fisher, Robert N.; Harlow, Peter S.; Holmes, Nick D.; Croll, Donald A.; Iverson, J.B.; Grant, T. D.; Knapp, C. R.; Pasachnik, S. A.
Iguanas are a particularly threatened group of reptiles, with 61% of species at risk of extinction. Primary threats to iguanas include habitat loss, direct and indirect impacts by invasive vertebrates, overexploitation, and human disturbance. As conspicuous, charismatic vertebrates, iguanas also represent excellent flagships for biodiversity conservation. To assist planning for invasive vertebrate management and thus benefit threatened iguana recovery, we identified all islands with known extant or extirpated populations of Critically Endangered and Endangered insular iguana taxa as recognized by the International Union for Conservation of Nature (IUCN) Red List of Threatened Species. For each island, we determined total area, sovereignty, the presence of invasive alien vertebrates, and human population. For the 23 taxa of threatened insular iguanas we identified 230 populations, of which iguanas were extant on 185 islands and extirpated from 45 islands. Twenty-one iguana taxa (91% of all threatened insular iguana taxa) occurred on at least one island with invasive vertebrates present; 16 taxa had 100% of their population(s) on islands with invasive vertebrates present. Rodents, cats, ungulates, and dogs were the most common invasive vertebrates. We discuss biosecurity, eradication, and control of invasive vertebrates to benefit iguana recovery: (1) on islands already free of invasive vertebrates; (2) on islands with high iguana endemicity; and (3) for species and subspecies with small total populations occurring across multiple small islands. Our analyses provide an important first step toward understanding how invasive vertebrate management can be planned effectively to benefit threatened insular iguanas.
Feraco, Angela M.; Brand, Sarah R.; Mack, Jennifer W.; Kesselheim, Jennifer C.; Block, Susan D.; Wolfe, Joanne
Communication is central to pediatric oncology care. Pediatric oncologists disclose life-threatening diagnoses, explain complicated treatment options, and endeavor to give honest prognoses, to maintain hope, to describe treatment complications, and to support families in difficult circumstances ranging from loss of function and fertility to treatment-related or disease-related death. However, parents, patients, and providers report substantial communication deficits. Poor communication outcomes may stem, in part, from insufficient communication skills training, overreliance on role modeling, and failure to utilize best practices. This review summarizes evidence for existing methods to enhance communication skills and calls for revitalizing communication skills training within pediatric oncology. PMID:26822066
Feraco, Angela M; Brand, Sarah R; Mack, Jennifer W; Kesselheim, Jennifer C; Block, Susan D; Wolfe, Joanne
Communication is central to pediatric oncology care. Pediatric oncologists disclose life-threatening diagnoses, explain complicated treatment options, and endeavor to give honest prognoses, to maintain hope, to describe treatment complications, and to support families in difficult circumstances ranging from loss of function and fertility to treatment-related or disease-related death. However, parents, patients, and providers report substantial communication deficits. Poor communication outcomes may stem, in part, from insufficient communication skills training, overreliance on role modeling, and failure to utilize best practices. This review summarizes evidence for existing methods to enhance communication skills and calls for revitalizing communication skills training within pediatric oncology. © 2016 Wiley Periodicals, Inc.
Crafts, Trevor D; Ellsperman, Susan E; Wannemuehler, Todd J; Bellicchi, Travis D; Shipchandler, Taha Z; Mantravadi, Avinash V
Objective Three-dimensional (3D)-printing technology is being employed in a variety of medical and surgical specialties to improve patient care and advance resident physician training. As the costs of implementing 3D printing have declined, the use of this technology has expanded, especially within surgical specialties. This article explores the types of 3D printing available, highlights the benefits and drawbacks of each methodology, provides examples of how 3D printing has been applied within the field of otolaryngology-head and neck surgery, discusses future innovations, and explores the financial impact of these advances. Data Sources Articles were identified from PubMed and Ovid MEDLINE. Review Methods PubMed and Ovid Medline were queried for English articles published between 2011 and 2016, including a few articles prior to this time as relevant examples. Search terms included 3-dimensional printing, 3 D printing, otolaryngology, additive manufacturing, craniofacial, reconstruction, temporal bone, airway, sinus, cost, and anatomic models. Conclusions Three-dimensional printing has been used in recent years in otolaryngology for preoperative planning, education, prostheses, grafting, and reconstruction. Emerging technologies include the printing of tissue scaffolds for the auricle and nose, more realistic training models, and personalized implantable medical devices. Implications for Practice After the up-front costs of 3D printing are accounted for, its utilization in surgical models, patient-specific implants, and custom instruments can reduce operating room time and thus decrease costs. Educational and training models provide an opportunity to better visualize anomalies, practice surgical technique, predict problems that might arise, and improve quality by reducing mistakes.
Arora, Asit; Khemani, Sam; Tolley, Neil; Singh, Arvind; Budge, James; Varela, David A Diaz Voss; Francis, Howard W; Darzi, Ara; Bhatti, Nasir I
To validate the VOXEL-MAN TempoSurg simulator for temporal bone dissection. Prospective international study. Otolaryngology departments of 2 academic health care institutions in the United Kingdom and United States. Eighty-five subjects were recruited consisting of an experienced and referent group. Participants performed a standardized familiarization session and temporal bone dissection task. Realism, training effectiveness, and global impressions were evaluated across 21 domains using a 5-point Likert-type scale. A score of 4 was the minimum threshold for acceptability. The experienced group comprised 25 otolaryngology trainers who had performed 150 mastoid operations. The referent group comprised 60 trainees (mean otolaryngology experience of 2.9 years). Familiarization took longer in the experienced group (P = .01). User-friendliness was positively rated (mean score 4.1). Seventy percent of participants rated anatomical appearance as acceptable. Trainers rated drill ergonomics worse than did trainees (P = .01). Simulation temporal bone training scored highly (mean score 4.3). Surgical anatomy, drill navigation, and hand-eye coordination accounted for this. Trainees were more likely to recommend temporal bone simulation to a colleague than were trainers (P = .01). Transferability of skills to the operating room was undecided (mean score 3.5). Realism of the VOXEL-MAN virtual reality temporal bone simulator is suboptimal in its current version. Nonetheless, it represents a useful adjunct to existing training methods and is particularly beneficial for novice surgeons before performing cadaveric temporal bone dissection. Improvements in realism, specifically drill ergonomics and visual-spatial perception during deeper temporal bone dissection, are warranted.
Urso, Annmarie; Rozalski, Michael
The number of students with special health care needs (SHCN; McPherson, Arango & Fox, 1998) and the frequency of life-threatening health emergencies in schools (e.g., asthma, diabetes, severe allergic reactions, cardiac arrest, seizure disorders), continues to increase. It has become increasingly important for teachers to be trained in…
...; 4500030113] RIN 1018-AY21 Endangered and Threatened Wildlife and Plants; Listing the Lesser Prairie-Chicken... the lesser prairie-chicken (Tympanuchus pallidicinctus). In addition, we announce the reopening of the public comment period on the December 11, 2012, proposed rule to list the lesser prairie-chicken as a...
Luther, David A; Brooks, Thomas M; Butchart, Stuart H M; Hayward, Matt W; Kester, Marieke E; Lamoreux, John; Upgren, Amy
Conservation actions, such as habitat protection, attempt to halt the loss of threatened species and help their populations recover. The efficiency and the effectiveness of actions have been examined individually. However, conservation actions generally occur simultaneously, so the full suite of implemented conservation actions should be assessed. We used the conservation actions underway for all threatened and near-threatened birds of the world (International Union for Conservation of Nature Red List of Threatened Species) to assess which biological (related to taxonomy and ecology) and anthropogenic (related to geoeconomics) factors were associated with the implementation of different classes of conservation actions. We also assessed which conservation actions were associated with population increases in the species targeted. Extinction-risk category was the strongest single predictor of the type of conservation actions implemented, followed by landmass type (continent, oceanic island, etc.) and generation length. Species targeted by invasive nonnative species control or eradication programs, ex situ conservation, international legislation, reintroduction, or education, and awareness-raising activities were more likely to have increasing populations. These results illustrate the importance of developing a predictive science of conservation actions and the relative benefits of each class of implemented conservation action for threatened and near-threatened birds worldwide. © 2016 Society for Conservation Biology.
Full Text Available Introduction Optimization of the selection, adaptation, and benefit of hearing aids is necessary to characterize and manage hearing loss, user expectations, otolaryngologic symptoms, and systemic comorbidities. Objective To compare the occurrence of otologic complaints, systemic diseases, and effective use of hearing aids in men and women with deafness. Methods Patients from a Unified Health System–accredited hearing health service, who reported problems in adapting to their hearing aids, were evaluated by a physician and audiologist. An anamnesis, ENT evaluation, and audiological evaluation were performed. Results During the data collection period, 278 subjects came in for follow-up visits; of these, 61 (21% reported otologic or operational problems with their equipment. The most prevalent type of hearing loss was basocochlear, a characteristic of presbycusis, in both men and women; the most frequently reported comorbidities were hypercholesterolemia (more significant in women and hypertension (more significant in men. Fourteen subjects reported using their device discontinuously, with no significant difference between genders; the reasons for discontinuation of use were itching and ringing, with more complaints from women. Conclusion The incidence of systemic and audiological complaints is high in this population. These patients should be evaluated thoroughly, as resolutions of these complaints can contribute to improving the quality of life and assist in the process of hearing aid fitting.
..., Kansas, Nebraska, and South Dakota, for the purpose of enhancing the species' survival. Permit... certain activities with endangered or threatened species. The Endangered Species Act of 1973, as amended (Act), prohibits activities with endangered and threatened species unless a Federal permit allows such...
Abt, Nicholas B; Reh, Douglas D; Eisele, David W; Francis, Howard W; Gourin, Christine G
Patients may perceive resident procedural participation as detrimental to their outcome. Our objective is to investigate whether otolaryngology-head and neck surgery (OHNS) housestaff participation is associated with surgical morbidity and mortality. Case-control study. OHNS patients were analyzed from the American College of Surgeons National Surgical Quality Improvement Program 2006 to 2013 databases. We compared the incidence of 30-day postoperative morbidity, mortality, readmissions, and reoperations in patients operated on by resident surgeons with attending supervision (AR) with patients operated on by an attending surgeon alone (AO) using cross-tabulations and multivariable regression. There were 27,018 cases with primary surgeon data available, with 9,511 AR cases and 17,507 AO cases. Overall, 3.62% of patients experienced at least one postoperative complication. The AR cohort had a higher complication rate of 5.73% than the AO cohort at 2.48% (P < .001). After controlling for all other variables, there was no significant difference in morbidity (odds ratio [OR] = 1.05 [0.89 to 1.24]), mortality (OR = 0.91 [0.49 to 1.70]), readmission (OR = 1.29 [0.92 to 1.81]), or reoperation (OR = 1.28 [0.91 to 1.80]) for AR compared to AO cases. There was no difference between postgraduate year levels for adjusted 30-day morbidity or mortality. There is an increased incidence of morbidity, mortality, readmission, and reoperation in OHNS surgical cases with resident participation, which appears related to increased comorbidity with AR patients. After controlling for other variables, resident participation was not associated with an increase in 30-day morbidity, mortality, readmission, or reoperation odds. These data suggest that OHNS resident participation in surgical cases is not associated with poorer short-term outcomes. 3b Laryngoscope, 126:2263-2269, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Lin, Harrison W; Quesnel, Alicia M; Holman, Allison S; Curry, William T; Rho, Michael B
Hyperostosis of anterior cervical vertebral osteophytes can produce otolaryngological symptoms ranging from mild dysphagia, dysphonia, and foreign body sensation to severe food impaction and stridulous dyspnea. Airway compromise necessitating a tracheostomy is very rare. We discuss the case of an elderly man who presented with progressive dysphagia and a large hypopharyngeal mass as his initial manifestations of hypertrophic anterior cervical osteophytes. After a biopsy of the mass, the patient went into airway distress due to bilateral vocal fold fixation by the enlarging mass and consequently required a surgical airway. A combined team approach to the removal of the osteophytes successfully resolved his symptoms. The clinical, diagnostic, radiologic, and therapeutic principles involved in this case are presented and discussed. The recognition of hypertrophic osteophytes as a potential cause of common otolaryngological symptoms in the elderly population is paramount, as these symptoms can rapidly progress and lead to life-threatening airway obstruction. Medical and surgical interventions can be employed for the treatment of hypertrophic anterior cervical osteophytes, and they often result in favorable outcomes.
Goto, Fumiyuki; Nakai, Kimiko; Murakami, Masato; Ogawa, Kaoru
Patients suffering from ear discomfort are commonly encountered in the department of otolaryngology. If various clinical examinations do not reveal any objective findings, then the patients are referred to the department of internal medicine or psychiatry. Psychotherapy is recommended in some cases. This paper describes the successful administration of autogenic training in a patient suffering from ear discomfort due to major depression. We present a case of intractable depression that was successfully treated with a combination of psychotherapy, administered by a clinical psychologist, and high-dose antidepressant. The patient was a 36-year-old female with hearing discomfort in her left ear. In 2003, she experienced insomnia and an appetite loss, and her condition was diagnosed as major depression along with an avoidant personality disorder. Her depression has not been improved with antidepressant treatment for 3 years in department of psychosomatic medicine. She was referred to our department because of ear discomfort in her left ear. There was no abnormality in her physical examinations. She wanted to be treated in department of otorhinolaryngology. We increased the dose of fluvoxamine maleate up to 200 mg/day, and introduced cognitive therapy and autogenic training by a clinical psychologist. Eventually, her depressive state as well as the hearing complaint was markedly alleviated. Autogenic training can be a viable and acceptable treatment option for patients who fail to respond to other therapies. This case emphasizes the importance of autogenic training as a method to control physical symptom of depression.
Smith-Jentsch, Kimberly A.; Sierra, Mary Jane
The success of future long-duration exploration missions (LDEMs) will be determined largely by the extent to which mission-critical personnel possess and effectively exercise essential teamwork competencies throughout the entire mission lifecycle (e.g., Galarza & Holland, 1999; Hysong, Galarza, & Holland, 2007; Noe, Dachner, Saxton, & Keeton, 2011). To ensure that such personnel develop and exercise these necessary teamwork competencies prior to and over the full course of future LDEMs, it is essential that a teamwork training curriculum be developed and put into place at NASA that is both 1) comprehensive, in that it targets all teamwork competencies critical for mission success and 2) structured around empirically-based best practices for enhancing teamwork training effectiveness. In response to this demand, the current teamwork-oriented training needs analysis (TNA) was initiated to 1) identify the teamwork training needs (i.e., essential teamwork-related competencies) of future LDEM crews, 2) identify critical gaps within NASA’s current and future teamwork training curriculum (i.e., gaps in the competencies targeted and in the training practices utilized) that threaten to impact the success of future LDEMs, and to 3) identify a broad set of practical nonprescriptive recommendations for enhancing the effectiveness of NASA’s teamwork training curriculum in order to increase the probability of future LDEM success.
Full Text Available Threatened miscarriage is the commonest complication of early pregnancy and affects about 20% of pregnancies. It presents with vaginal bleeding with or without abdominal cramps. Increasing age of women, smoking, obesity or polycystic ovary syndrome (PCOS and a previous history of miscarriage are risk factors for threatened miscarriage. The pathophysiology has been associated with changes in levels of cytokines or maternal immune dysfunction. Clinical history and examination, maternal serum biochemistry and ultrasound findings are important to determine the treatment options and provide valuable information for the prognosis. Bed rest is the commonest advice, but there is little evidence of its value. Other options include progesterone, human chorionic gonadotropin (HCG and muscle relaxants. The complementary and alternative medicine (CAM therapies such as acupuncture and Chinese herbs have also been tried. There is some evidence from clinical studies indicating that CAM therapies may reduce the rate of miscarriage, but the quality of studies is poor. Thus, further double-blind, randomized-controlled trials are necessary to confirm its effectiveness, especially acupuncture and Chinese herbs.
Premo, Julie E; Sarfan, Laurel D; Clerkin, Elise M
The current study provided an initial test of a Cognitive Bias Modification for Interpretations (CBM-I) training paradigm among a sample with elevated BDD symptoms (N=86). As expected, BDD-relevant interpretations were reduced among participants who completed a positive (vs. comparison) training program. Results also pointed to the intriguing possibility that modifying biased appearance-relevant interpretations is causally related to changes in biased, socially relevant interpretations. Further, providing support for cognitive behavioral models, residual change in interpretations was associated with some aspects of in vivo stressor responding. However, contrary to expectations there were no significant effects of condition on emotional vulnerability to a BDD stressor, potentially because participants in both training conditions experienced reductions in biased socially-threatening interpretations following training (suggesting that the "comparison" condition was not inert). These findings have meaningful theoretical and clinical implications, and fit with transdiagnostic conceptualizations of psychopathology. Copyright © 2015 Elsevier Ltd. All rights reserved.
Clerkin, Elise M; Teachman, Bethany A
The current study investigates an experimental anxiety reduction intervention among a highly socially anxious sample (N=108; n=36 per Condition; 80 women). Using a conditioning paradigm, our goal was to modify implicit social anxiety associations to directly test the premise from cognitive models that biased cognitive processing may be causally related to anxious responding. Participants were trained to preferentially process non-threatening information through repeated pairings of self-relevant stimuli and faces indicating positive social feedback. As expected, participants in this positive training condition (relative to our two control conditions) displayed less negative implicit associations following training, and were more likely to complete an impromptu speech (though they did not report less anxiety during the speech). These findings offer partial support for cognitive models and indicate that implicit associations are not only correlated with social anxiety, they may be causally related to anxiety reduction as well. (c) 2010 Elsevier Ltd. All rights reserved.
Renwick, Anna R; Robinson, Catherine J; Garnett, Stephen T; Leiper, Ian; Possingham, Hugh P; Carwardine, Josie
Much biodiversity lives on lands to which Indigenous people retain strong legal and management rights. However this is rarely quantified. Here we provide the first quantitative overview of the importance of Indigenous land for a critical and vulnerable part of biodiversity, threatened species, using the continent of Australia as a case study. We find that three quarters of Australia's 272 terrestrial or freshwater vertebrate species listed as threatened under national legislation have projected ranges that overlap Indigenous lands. On average this overlap represents 45% of the range of each threatened species while Indigenous land is 52% of the country. Hotspots where multiple threatened species ranges overlap occur predominantly in coastal Northern Australia. Our analysis quantifies the vast potential of Indigenous land in Australia for contributing to national level conservation goals, and identifies the main land management arrangements available to Indigenous people which may enable them to deliver those goals should they choose to do so.
Routine training is not enough: structured training in family planning and abortion improves residents' competency scores and intentions to provide abortion after graduation more than ad hoc training.
Macisaac, Laura; Vickery, Zevidah
Abortion provision remains threatened by the paucity of physicians trained to provide them. Lack of training during residency has been cited by obstetrician and gynecologist (ob-gyn) physicians as a reason for not including abortion in their practice. We administered surveys on interest, competency and intention to provide abortions to two groups of ob-gyn residents: one experiencing a new comprehensive and structured family planning rotation, and another group at our affiliate hospital's residency program receiving "ad hoc" training during their routine gynecology rotations. Surveys were anonymous and blinded to investigator. The structured family planning rotation group compared to the ad hoc group reported significantly increased competency score using a Likert scale in manual vacuum aspiration (MVA) (4.5 vs. 1; p=.003) and had a higher proportion reporting intent to provide office MVA postresidency (100% vs. 39%; p=.01) and being trained to 22.5 weeks' vs. 12 weeks' gestation (p=.005). In bivariate analysis, competency in MVA was associated with higher intentions to provide MVA after residency (p=.007). A structured rotation in family planning and abortion for obstetrics/gynecology residents results in increases in competency and intentions to provide abortion, and an association between the two. In-hospital structured training proved to be superior to ad hoc training in our affiliate institution in improving competency and intention to provide abortion after residency. Copyright © 2012 Elsevier Inc. All rights reserved.
however; otolaryngology practice in developing. 4 countries has remained inadequate. In the Niger delta region of the country, there are no available published data however, there are even fewer ORL surgeons and residents in training with inadequate diagnostic and therapeutic facilities. Niger Delta University teaching ...
... 50 Wildlife and Fisheries 2 2010-10-01 2010-10-01 false Import exemption for threatened, CITES Appendix-II wildlife. 17.8 Section 17.8 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE..., EXPORTATION, AND IMPORTATION OF WILDLIFE AND PLANTS (CONTINUED) ENDANGERED AND THREATENED WILDLIFE AND PLANTS...
Pellicane, P.J.; Gutkowski, R.M.; Czarnock, J.
Polands once considerable forest resource suffered destruction during World War II and is now a victim of the legacy of past forest practices, the toxic effects of industrial pollution, and the urgent needs of its people today. Polish forest are threatened by a variety of abiotic, biotic and anthropogenic factors. Extremes of climate and declining groundwater tables add to the problem. Pollution is the most serious problem, particularly air pollution. Much of the air pollution in Poland is attributable to mining and burning high-sulfur coal. Besides describing the causes of the forest decline, this article discusses solutions
Roubroeks, M. A. J.; Ham, J. R. C.; Midden, C. J. H.
Persuasive technology can take the form of a social agent that persuades people to change behavior or attitudes. However, like any persuasive technology, persuasive social agents might trigger psychological reactance, which can lead to restoration behavior. The current study investigated whether interacting with a persuasive robot can cause psychological reactance. Additionally, we investigated whether goal congruency plays a role in psychological reactance. Participants programmed a washing machine while a robot gave threatening advice. Confirming expectations, participants experienced more psychological reactance when receiving high-threatening advice compared to low-threatening advice. Moreover, when the robot gave high-threatening advice and expressed an incongruent goal, participants reported the highest level of psychological reactance (on an anger measure). Finally, high-threatening advice led to more restoration, and this relationship was partially mediated by psychological reactance. Overall, results imply that under certain circumstances persuasive technology can trigger opposite effects, especially when people have incongruent goal intentions.
Fortini, Lucas B.; Dye, Kaipo
For many species the threats of climate change occur in a context of multiple existing threats. Given the current focus of global change ecology in identifying and understanding species vulnerable to climate change, we performed a global analysis to characterize the multi-threat context for species threatened by climate change. Utilizing 30,053 species from the International Union for Conservation of Nature’s (IUCN) Red List of Threatened Species, we sought to evaluate if species threatened by climate change are more likely threatened by a greater number of non-climatic threats than species not threatened by climate change. Our results show that species threatened by climate change are generally impacted by 21% more non-climatic threats than species not threatened by climate change. Across all species, this pattern is related to IUCN risk status, where endangered species threatened by climate change face 33% more non-climatic threats than endangered species not threatened by climate change. With the clear challenges of assessing current and projected impacts of climate change on species and ecosystems, research often requires reductionist approaches that result in downplaying this multi-threat context. This cautionary note bears relevance beyond climate change threatened species as we also
Glauco Alves Pereira
Full Text Available The Atlantic Forest of northeast Brazil hosts a unique biota which is among the most threatened in the Neotropics. Near-total conversion of forest habitat to sugar cane monocultures has left the region's endemic forest-dependent avifauna marooned in a few highly-fragmented and degraded forest remnants. Here we summarise the current status of 16 globally threatened species based on surveys conducted over the last 11 years. We found a bleak situation for most of these species and consider that three endemics: Glaucidium mooreorum (Pernambuco Pygmy-owl, Cichlocolaptes mazarbarnetti (Cryptic Treehunter and Philydor novaesi (Alagoas Foliage-gleaner are most likely globally extinct. Some positive news can, however, be reported for both Leptodon forbesi (White-collared Kite and Synallaxis infuscata (Pinto's Spinetail which may warrant re-evaluation of their respective red list statuses. We outline a road map to prioritise conservation interventions in the region directed at preventing the extinction of this suite of threatened bird species and their companion biota.
Fuller, Trevon L.; Thomassen, Henri A.; Peralvo, Manuel; Buermann, Wolfgang; Milá, Borja; Kieswetter, Charles M.; Jarrín-V, Pablo; Devitt, Susan E. Cameron; Mason, Eliza; Schweizer, Rena M.; Schlunegger, Jasmin; Chan, Janice; Wang, Ophelia; Schneider, Christopher J.; Pollinger, John P.; Saatchi, Sassan; Graham, Catherine H.; Wayne, Robert K.; Smith, Thomas B.
Predicting where threatened species occur is useful for making informed conservation decisions. However, because they are usually rare, surveying threatened species is often expensive and time intensive. Here, we show how regions where common species exhibit high genetic and morphological divergence among populations can be used to predict the occurrence of species of conservation concern. Intraspecific variation of common species of birds, bats and frogs from Ecuador were found to be a significantly better predictor for the occurrence of threatened species than suites of environmental variables or the occurrence of amphibians and birds. Fully 93 per cent of the threatened species analysed had their range adequately represented by the geographical distribution of the morphological and genetic variation found in seven common species. Both higher numbers of threatened species and greater genetic and morphological variation of common species occurred along elevation gradients. Higher levels of intraspecific divergence may be the result of disruptive selection and/or introgression along gradients. We suggest that collecting data on genetic and morphological variation in common species can be a cost effective tool for conservation planning, and that future biodiversity inventories include surveying genetic and morphological data of common species whenever feasible. PMID:23595273
Tongsong, T; Srisomboon, J; Wanapirak, C; Sirichotiyakul, S; Pongsatha, S; Polsrisuthikul, T
Pregnancy with visible fetal heart beat complicated by first trimester threatened abortion had significant increased risk of subsequent spontaneous abortion compared with normal pregnancy. To compare pregnancy outcomes in cases complicated by first trimester threatened abortion with those that were not. Prospective cohort study of 255 cases of first trimester threatened abortions but with visible heart beat and 265 other normal pregnancies. Spontaneous abortion rates of 5.5% (with relative abortal risk of 2.91) was found for study group, compared to 1.88% for controls (p abortion rate than those without.
Carey J. Fitzgerald
Full Text Available Many studies on Hamilton's (1964 inclusive fitness theory have used the burning house and kidney donation examples of life-threatening altruism. However, these examples may not be sufficiently exhibiting the risk involved with life-threatening altruism that would have occurred in hunter-gatherer societies, such as fighting off attackers and/or predators. The present study examined participants' estimated likelihood to perform altruistic acts for specific kin members/friends in two violent life-threatening situations (i.e., being mugged and being chased and two non-violent life-threatening situations (i.e., the burning house and kidney donation examples. Participants were 216 undergraduate students who completed a questionnaire on altruism toward an actual kin member/friend. Each questionnaire contained four life-or-death scenarios (two violent and two non-violent in which either the participant's sibling, cousin, or best friend was in danger and needed help. Results indicated that people were more likely to help siblings than cousins and friends in both the violent and non-violent hypothetical scenarios. Participants indicated a greater likelihood to help people in violent situations than in non-violent situations. Women indicated a greater estimated likelihood than men to help people in non-violent situations while men indicated a greater estimated likelihood than women to help people in violent situations. Both male and female participants indicated a greater estimated likelihood to help women than men in violent situations.
Lin, C Huie; Hegde, Sanjeet; Marshall, Audrey C; Porras, Diego; Gauvreau, Kimberlee; Balzer, David T; Beekman, Robert H; Torres, Alejandro; Vincent, Julie A; Moore, John W; Holzer, Ralf; Armsby, Laurie; Bergersen, Lisa
Continued advancements in congenital cardiac catheterization and interventions have resulted in increased patient and procedural complexity. Anticipation of life-threatening events and required rescue measures is a critical component to preprocedural preparation. We sought to determine the incidence and nature of life-threatening adverse events in congenital and pediatric cardiac catheterization, risk factors, and resources necessary to anticipate and manage events. Data from 8905 cases performed at the 8 participating institutions of the Congenital Cardiac Catheterization Project on Outcomes were captured between 2007 and 2010 [median 1,095/site (range 133-3,802)]. The incidence of all life-threatening events was 2.1 % [95 % confidence interval (CI) 1.8-2.4 %], whereas mortality was 0.28 % (95 % CI 0.18-0.41 %). Fifty-seven life-threatening events required cardiopulmonary resuscitation, whereas 9 % required extracorporeal membrane oxygenation. Use of a risk adjustment model showed that age events. Using this model, standardized life-threatening event ratios were calculated, thus showing that one institution had a life-threatening event rate greater than expected. Congenital cardiac catheterization and intervention can be performed safely with a low rate of life-threatening events and mortality; preprocedural evaluation of risk may optimize preparation of emergency rescue and bailout procedures. Risk predictors (age < 1, hemodynamic vulnerability, and procedure risk category) can enhance preprocedural patient risk stratification and planning.
Das, A G; Gopalan, S; Dhaliwal, L K
The present study was conducted with the aim to find out the effect of threatened abortion in the current pregnancy on the subsequent perinatal outcome and follow the growth pattern of the fetuses of such complicated pregnancies. The study group consisted of 55 women with threatened abortion and 55 women with normal pregnancies formed the control group. Most of the patients presented at 6-12 weeks' gestation. The fetal growth was monitored by both clinical as well as ultrasound (USG) parameters. The mean growth rates were almost identical throughout gestation. The mean values of each parameter of the study group were found lying with 95% confidence limit values of their control group. The apparent increased incidence of low lying placenta in early pregnancy probably contributed to threatened abortion. There was no significant difference in preterm delivery, low birth-weight and overall perinatal outcome.
Angela Francisca Marques Guerra
.OBJECTIVE: To assess the suitability of referral from primary to secondary care in pediatric Otolaryngology. METHODS: The study was performed in the city of Belo Horizonte, in the state of Minas Gerais, from March 2004 to May 2005. A total of 408 pre-school children referred from primary care to secondary care in the department of Otolaryngology presenting with otitis, tonsillitis, sinusitis, allergic rhinitis, and tonsillar/adenoidal hypertrophy was assessed. The studied variables were: agreement between diagnoses in primary and secondary care; waiting time for doctor's appointment; follow-up, and professional (pediatrician or family physician that examined children in primary care. Agreement of diagnoses was assessed using kappa statistics. RESULTS: Patients were five years old on average, 214 (52.5% were boys, mean waiting time for appointment was 3.7 months. Diagnoses in primary and secondary care were respectively: otitis (44%, 49%, tonsillar/adenoidal hypertrophy (22%, 33%, tonsillitis (18%, 23%, sinusitis (13%, 21%, allergic rhinitis (3%, 33%. Agreement analysis of kappa was 0.15 for otitis with effusion, 0.35 for recurrent otitis, 0.04 for tonsillar/adenoidal hypertrophy, 0.43 for tonsillitis, 0.05 for allergic rhinitis, and 0.2 for sinusitis. Diagnoses in primary care referred to secondary care were in agreement when given either by pediatrician or family physician. CONCLUSIONS: Unsuitability of referrals from primary to secondary care in otolaryngology was expressed by the long time waiting for appointments and by the low agreement between diagnoses in different level of care for the same patients. Primary health care could be more efficient if professionals were better qualified in Otolaryngology.
The Biodiversity and Threatened and Endangered Species Experts (BioTES), version 1.0 helps installation and government personnel locate points of contact for experts in the areas of biodiversity and threatened and endangered species...
Van de Vliert, Evert
Places of residence have multiple, yet largely unintegrated, cultural characteristics. Here I make a distinction between human environments that offer demanding winters or summers together with collective poverty (threatening ecologies), undemanding temperate climates irrespective of income per head
On the 2015 Red List there are 43 globally threatened species of birds occurring in the ..... Total amphibian species richness increased with increased habitat ...... In Kilengwe Forest, a forest in Morogoro Rural District that is dominated by J.
Dr. Farhad Farahani
Full Text Available Background and Aim: Recently, more attention was paid to the direct protective effect of aldosterone against hearing impairment in elderly patients. The aim of this study was determination of possible correlation between serum aldosterone level and hearing condition of elderly patients that referred to the Otolaryngology services of Hamadan in 2005-2006.Methods: In this case control study 54 (27 males,27 females persons above 60 years old were evaluated. They contained twenty eight cases with normal hearing and 26 cases with presbycusis. Persons with any abnormal biochemical finding or history of conditions that predispose them to the sensorineural hearing loss (SNHL were excluded. In both groups serum level of sodium, potassium and aldosterone were measured and hearing condition evaluated by puretone, speech and immitance audiometry.Results: Statistical relationship between serum aldostrone level and hearing condition, sex, configuration of audiogram and speech discrimination score (SDS were not significant. In addition, no significant relationship between sodium and potassium levels with hearing condition was found (p>0.05.Conclusion: This study could not confirm protective effect of aldostrone against presbycusis. This discrepancy may originate from epidemiologic differences, laboratory errors or small sample size.
Hayakawa, Itaru; Sakakibara, Hiroshi; Atsumi, Yukari; Hataya, Hiroshi; Terakawa, Toshiro
Abdominal pain is common in children, but expeditious diagnosis of life- or organ-threatening diseases can be challenging. An evidence-based definition of tachycardia in children was established recently, but its diagnostic utility has not yet been studied. To test the hypothesis that abdominal pain with tachycardia may pose a higher likelihood of life- or organ-threatening diseases in children. A nested case-control study was conducted in a pediatric emergency department in 2013. Tachycardia was defined as a resting heart rate of more than 3 standard deviations above the average for that age. Life- or organ-threatening diseases were defined as "disorders that might result in permanent morbidity or mortality without appropriate intervention." A triage team recorded vital signs before emergency physicians attended patients. Patients with tachycardia (cases) and without tachycardia (controls) were systematically matched for age, sex, and month of visit. The groups were compared for the presence of life- or organ-threatening diseases. There were 1683 visits for abdominal pain, 1512 of which had vital signs measured at rest. Eighty-three patients experienced tachycardia, while 1429 did not. Fifty-eight cases and 58 controls were matched. Life- or organ-threatening diseases were more common in the case group (19%) than the control group (5%, p=0.043). The relative risk of tachycardia to the presence of the diseases was 3.7 (95% confidence interval 1.2-12.0). Tachycardia significantly increased the likelihood of life- or organ-threatening diseases. Tachycardia in children with abdominal pain should alert emergency physicians to the possibility of serious illness. Copyright © 2017 Elsevier Inc. All rights reserved.
Purviance, Donna; Ray, Bradley; Tracy, Abigail; Southard, Erik
Opioid intoxication and overdoses are life-threatening emergencies requiring rapid treatment. One response to this has been to train law enforcement to detect the signs of an opioid overdose and train them to administer naloxone to reverse the effects. Although not a new concept, few studies have attempted to examine this policy. At 4 different locations in Indiana, law enforcement personnel were trained to detect the signs of an opioid-related overdose and how to administer naloxone to reverse the effects of the overdose. Pre and post surveys were administered at each location (N = 97). To examine changes in attitudes following training, the authors included items from the Opioid Overdose Attitudes Scale (OOAS), which measures respondents' competency, concerns, and readiness to administer naloxone. Among the full sample, naloxone training resulted in significant increases in competency, concerns, and readiness. Examining changes in attitudes by each location revealed that the training had the greatest effect on competency to administer naloxone and in easing concerns that law enforcement personal might have in administering naloxone. This study adds to others in showing that law enforcement personnel are receptive to naloxone training and that the OOAS is able to capture these attitudes. This study advances this literature by examining pre-post changes across multiple locations. As the distribution of naloxone continues to proliferate, this study and the OOAS may be valuable towards the development of an evidence-based training model for law enforcement.
Lucas B. Fortini
Full Text Available For many species the threats of climate change occur in a context of multiple existing threats. Given the current focus of global change ecology in identifying and understanding species vulnerable to climate change, we performed a global analysis to characterize the multi-threat context for species threatened by climate change. Utilizing 30,053 species from the International Union for Conservation of Nature’s (IUCN Red List of Threatened Species, we sought to evaluate if species threatened by climate change are more likely threatened by a greater number of non-climatic threats than species not threatened by climate change. Our results show that species threatened by climate change are generally impacted by 21% more non-climatic threats than species not threatened by climate change. Across all species, this pattern is related to IUCN risk status, where endangered species threatened by climate change face 33% more non-climatic threats than endangered species not threatened by climate change. With the clear challenges of assessing current and projected impacts of climate change on species and ecosystems, research often requires reductionist approaches that result in downplaying this multi-threat context. This cautionary note bears relevance beyond climate change threatened species as we also found other (but not all anthropogenic threats are also similarly associated with more threats. Our findings serve as a reminder that ecological research should seriously consider these potential threat interactions, especially for species under elevated conservation concern.
Mahmoud, Sahar; Elaziz, Nahla Ahmed Abd
Leukemia is a significant public health and life-threatening problem for pediatric cancer patients. Family caregivers of cancer patients receive little preparation, information, or support to perform their care giving role. This study aims to assess the effect of psycho-educational training program to enhancing practice and psychosocial adaptation…
LI Jing-xia; XIE Gan-gong
In the present paper, the authors review recent development of acupuncture treatment of threatened abortion from 1) clinical application of "Linggui Bafa"(灵龟八法Eight Methods of Intelligent Turtle), 2) body acupoints, and 3) acupuncture combined with Chinese materia medica, and clinical study from 1) effect of acupuncture on the blood flow of uterus, and 2) effect of acupuncture on plasma progesterone level. In addition, acupuncture therapy is also used to help women in gestation and can effectively raise the pregnant rate. "Linggui Bafa" is rather effective in preventing threatened abortion and should be studied further.
Schmader, Toni; Forbes, Chad E.; Zhang, Shen; Mendes, Wendy Berry
Three studies tested the hypothesis that negative metacognitive interpretations of anxious arousal under stereotype threat create cognitive deficits in intellectually threatening environments. Study 1 showed that among minority and White undergraduates, anxiety about an intelligence test predicted lower working memory when participants were primed with doubt as compared to confidence. Study 2 replicated this pattern with women and showed it to be unique to intellectually threatening environme...
U.S. Environmental Protection Agency — These data represent predicted current distributions of all US listed Threatened and Endangered freshwater fish and freshwater mussels in the Middle-Atlantic region....
Sofue, Keitaro; Takeuchi, Yoshito; Arai, Yasuaki; Sugimura, Kazuro
A71-year-old man with advanced lung cancer developed a life-threatening cerebral edema caused by the acute occlusion of a superior vena cava (SVC) stent and was successfully treated by an additional stent placement. Although stent occlusion is a common early complication, no life-threatening situations have been reported until now. Our experience highlights the fact that acute stent occlusion can potentially lead to the complete venous shutdown of the SVC, resulting in life-threatening cerebral edema, after SVC stent placement. Immediate diagnosis and countermeasures are required.
Nadia Claudia CANTEMIR-STOICA
Full Text Available First, I wish to make a presentation of historically institution and subsequently parallels between past and current regulators to expose whether the legislature has reached desire - namely ensuring effective protection of witnesses threatened and vulnerable. Also, I decided to analyze the topic from the perspective of the criminal procedural provisions of Law 682/2002 and witness protection, which are republished to expose the conditions and criteria by which to ensure this status. I also want to present besides theoretical and practical ways in which the National Office for Witness Protection gives effective legal provisions. Not least, I will bring criticism of current regulation and not by law ferenda proposals.
... 7 Agriculture 6 2010-01-01 2010-01-01 false Rare, threatened, and endangered species of plants and... Related Environmental Concerns § 650.22 Rare, threatened, and endangered species of plants and animals. (a) Background. (1) A variety of plant and animal species of the United States are so reduced in numbers that...
Review of the available literature concerning the previous distribution of animals now considered to be threatened or endangered suggests that the following species may once have occupied the project area in Webster and Bienville Parishes, Louisiana: Florida panther, bald eagle, Arctic peregrine falcon, red-cockaded woodpecker, ivory-billed woodpecker, red wolf, and Eskimo curlew. The Louisiana pine snake is not officially listed at this time although it is considered to be a candidate for inclusion on the federal list pending further research on its population and distribution. Based on previous experience within northwestern Louisiana and other recent evidence, it is concluded that the red-cockaded woodpecker (Picoides borealis) is the only animal listed or proposed as threatened or endangered which may actually now be found there
Jeroen J A van Boxtel
Full Text Available The ability to find and evade fighting persons in a crowd is potentially life-saving. To investigate how the visual system processes threatening actions, we employed a visual search paradigm with threatening boxer targets among emotionally-neutral walker distractors, and vice versa. We found that a boxer popped out for both intact and scrambled actions, whereas walkers did not. A reverse correlation analysis revealed that observers' responses clustered around the time of the "punch", a signature movement of boxing actions, but not around specific movements of the walker. These findings support the existence of a detector for signature movements in action perception. This detector helps in rapidly detecting aggressive behavior in a crowd, potentially through an expedited (subcortical threat-detection mechanism.
Hartmannsgruber, M; Good, M; Carovano, R; Lampotang, S; Gravenstein, J S
Simulators and training devices are used extensively by educators in 'high-tech' occupations, especially those requiring an understanding of complex systems and co-ordinated psychomotor skills. Because of advances in computer technology, anaesthetised patients can now be realistically simulated. This paper describes several training devices and a simulator currently being employed in the training of anaesthesia personnel at the University of Florida. This Gainesville Anesthesia Simulator (GAS) comprises a patient mannequin, anaesthesia gas machine, and a full set of normally operating monitoring instruments. The patient can spontaneously breathe, has audible heart and breath sounds, and palpable pulses. The mannequin contains a sophisticated lung model that consumes and eliminates gas according to physiological principles. Interconnected computers controlling the physical signs of the mannequin enable the presentation of a multitude of clinical signs. In addition, the anaesthesia machine, which is functionally intact, has hidden fault activators to challenge the user to correct equipment malfunctions. Concealed sensors monitor the users' actions and responses. A robust data acquisition and control system and a user-friendly scripting language for programming simulation scenarios are key features of GAS and make this system applicable for the training of both the beginning resident and the experienced practitioner. GAS enhances clinical education in anaesthesia by providing a non-threatening environment that fosters learning by doing. Exercises with the simulator are supported by sessions on a number of training devices. These present theoretical and practical interactive courses on the anaesthesia machine and on monitors. An extensive system, for example, introduces the student to the physics and clinical application of transoesophageal echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)
Tabata, Shogo; Suzuki, Yukio; Azuma, Koichiro; Matsumoto, Hideo
Tabata, S, Suzuki, Y, Azuma, K, and Matsumoto, H. Rhabdomyolysis after performing blood flow restriction training: a case report. J Strength Cond Res 30(7): 2064-2068, 2016-Rhabdomyolysis is a serious and potentially life-threatening condition related to resistance training. Despite numerous reports of low-intensity blood flow restriction (BFR) training inducing muscle hypertrophy and increasing strength, few reports of rhabdomyolysis related to BFR training have been published. Here, we report a 30-year-old obese Japanese man admitted to our hospital the day after his first BFR training session with complaints of severe muscle pain in his upper and lower extremities, high fever, and pharyngeal pain. He was diagnosed with acute rhabdomyolysis based on a serum creatine phosphokinase level of 56,475 U·L and a urine myoglobin level of >3,000 ng·ml, and with acute tonsillitis based on a white blood cell count of 17,390 and C-reactive protein level of 10.43 mg·dl. A number of factors are suspected to be related to the onset and exacerbation of rhabdomyolysis, including excessive muscular training with BFR, bacterial infection, and medication. After 10 days of hospitalization with intravenous fluids and antibacterial drugs, he recovered without complications. This case indicates that BFR training should be conducted with careful consideration of the physical condition and strength of the individual to prevent serious complications, such as rhabdomyolysis.
Begossi, Alpina; Salivonchyk, Svetlana; Hallwass, Gustavo; Hanazaki, Natalia; Lopes, Priscila F M; Silvano, Renato A M
Small-scale fisheries of the Brazilian Atlantic Forest Coast (BAFC) depend on fish resources for food and income. Thus, if the catch diminishes or if fish species that are a target for fishers are overexploited or impacted, this could affect fishers' livelihoods. The exclusion of threatened fish species from the catch is believed to be a threat to small-scale fisheries, which is likely to be the case along the BAFC. Many fish species are currently listed as threatened or vulnerable, whereas there is not enough biological information available to determine the status of the majority of the other species. Failure to protect the BAFC biodiversity might negatively impact fishers' income and the regional economy of local small-scale fisheries. We collected data from 1986 to 2009 through 347 interviews and 24-h food recall surveys at seven southeastern coastal sites of the Atlantic Forest. We show that important species of consumed fish are currently threatened: of the 65 species mentioned by fishers as the most consumed fishes, 33% are decreasing and 54% have an unknown status. Thus, biological and ecological data for BAFC marine species are urgently needed, along with co-management, to promote fish conservation.
...). Since the DoD mission has not required large-scale urbanization of the coast, these ecosystems also provide high quality habitat for several federally threatened and endangered plant and animal species (TES...
Nualart, Neus; Ibáñez, Neus; Luque, Pere; Pedrol, Joan; Vilar, Lluís; Guàrdia, Roser
This data paper describes a specimens' dataset of the Catalonian threatened vascular plants conserved in five public Catalonian herbaria (BC, BCN, HGI, HBIL and MTTE). Catalonia is an administrative region of Spain that includes large autochthon plants diversity and 199 taxa with IUCN threatened categories (EX, EW, RE, CR, EN and VU). This dataset includes 1,618 records collected from 17 th century to nowadays. For each specimen, the species name, locality indication, collection date, collector, ecology and revision label are recorded. More than 94% of the taxa are represented in the herbaria, which evidence the paper of the botanical collections as an essential source of occurrence data.
Stress is an integral element of the operational conditions experienced by combat medics. The effects of stress can compromise the performance of combat medics who must reach and treat their comrades under often threatening circumstances. Examples of these effects include tunnel vision, loss of motor control, and diminished hearing, which can result in an inability to perceive further danger, satisfactorily treat the casualty, and communicate with others. While many training programs strive to recreate this stress to aid in the experiential learning process, stress inducement may not always be feasible or desired. In addition, live simulations are not always a practical, convenient, and repeatable method of training. Instead, presenting situational training on a personal computer is proposed as an effective training platform in which the effects of stress can be addressed in a different way. We explore the cognitive and motor effects of stress, as well as the benefits of training for mitigating these effects in real life. While many training applications focus on inducing stress in order to "condition" the stress response, the author explores the possibilities of modeling stress to produce a similar effect. Can presenting modeled effects of stress help prepare or inoculate soldiers for stressful situations in which they must perform at a high level? This paper investigates feasibility of modeling stress and describes the preliminary design considerations of a combat medic training system that utilizes this method of battlefield preparation.
Ruben, Robert J
During the last third of the 20th century, pediatric otolaryngology became a defined specialty in many nations, resulting in focused training, fellowships, societies, journals, textbooks, etc. This development occurred as a result of an interaction between the changing sociological and economic status of the child and medical advances. In this paper the history of the status of children is investigated during the Reformation/Counter-Reformation, Enlightenment and Romantic periods, and during the recent era of Entitlement, and an analysis is made of the relationships between otolaryngological care of children during these periods, including a consideration of selected medical advances made during the 17th to 21st centuries, and the evolving status of children. Advances in education of the deaf, understanding the role of the adenoid and care of the airway were applied to the child patient not directly, as it may sometimes seem to physicians caring for a patient in a hands-on fashion, but rather via the bridge of the social and economic context of the time. This interactive process created a special body of knowledge that is now applied in a society that places a high value on the child. In the second half of the 20th century, i.e. during the period of Entitlement, the otolaryngological needs of the child became a demand, based in part upon a need for care of airway pathology in the premature infant, which fostered the establishment of pediatric otolaryngology as a specialty.
Sarah J. Corey
Full Text Available Rapid, global declines among amphibians are partly alarming because many occur for apparently unknown or enigmatic reasons. Moreover, the relationship between phylogeny and enigmatic declines in higher clades of the amphibian phylogeny appears at first to be an intractable problem. I present a working solution by assessing threatening processes potentially underlying enigmatic declines in the family, Hylidae. Applying comparative methods that account for various evolutionary scenarios, I find extreme concentrations of threatening processes, including pollution and habitat loss, in the clade Hylini, potentially influenced by traits under selection. The analysis highlights hotspots of declines under phylogenetic influence in the genera Isthmohyla, Plectrohyla and Ptychohyla, and geographically in Mexico and Guatemala. The conservation implications of concentrated phylogenetic influence across multiple threatening processes are twofold: Data Deficient species of threatened clades should be prioritized in future surveys and, perhaps, a greater vulnerability should be assigned to such clades for further consideration of clade-level conservation priorities.
Roghaieh Rahmani Beilondi
Full Text Available This study is about a patient with a history of infertility and polycystic ovarian disease who was admitted with spotting and severe abdominal pain, There was one misdiagnosis about this patient and progesterone was prescribed for treating of threatened abortion, following transvaginal ultrasound, one heterogeneous echogenic mass with dimensions of 5.8 × 18 in the vicinity of the left ovary was reported in favor of ectopic pregnancy. The patient was hospitalized and treated with methotrexate with diagnosis of an ovarian ectopic pregnancy. Pregnant women with complaints of bleeding and spotting in early pregnancy should be evaluated in terms of ectopic pregnancy in addition of abortion and molar pregnancy. The aim of this study was to introduce a new case of misdiagnosed ovarian pregnancy instead of threatened abortion.
Ralf C Buckley
Full Text Available Many threatened species rely on ecotourism for conservation funding, but simultaneously suffer direct ecological impacts from ecotourism. For a range of IUCN-Redlisted terrestrial and marine bird and mammal species worldwide, we use population viability analyses to calculate the net effects of ecotourism on expected time to extinction, in the presence of other anthropogenic threats such as poaching, primary industries and habitat loss. Species for which these calculations are currently possible, for one or more subpopulations, include: orangutan, hoolock gibbon, golden lion tamarin, cheetah, African wild dog, New Zealand sealion, great green macaw, Egyptian vulture, and African penguin. For some but not all of these species, tourism can extend expected survival time, i.e., benefits outweigh impacts. Precise outcomes depend strongly on population parameters and starting sizes, predation, and ecotourism scale and mechanisms. Tourism does not currently overcome other major conservation threats associated with natural resource extractive industries. Similar calculations for other threatened species are currently limited by lack of basic population data.
Buckley, Ralf C; Morrison, Clare; Castley, J Guy
Many threatened species rely on ecotourism for conservation funding, but simultaneously suffer direct ecological impacts from ecotourism. For a range of IUCN-Redlisted terrestrial and marine bird and mammal species worldwide, we use population viability analyses to calculate the net effects of ecotourism on expected time to extinction, in the presence of other anthropogenic threats such as poaching, primary industries and habitat loss. Species for which these calculations are currently possible, for one or more subpopulations, include: orangutan, hoolock gibbon, golden lion tamarin, cheetah, African wild dog, New Zealand sealion, great green macaw, Egyptian vulture, and African penguin. For some but not all of these species, tourism can extend expected survival time, i.e., benefits outweigh impacts. Precise outcomes depend strongly on population parameters and starting sizes, predation, and ecotourism scale and mechanisms. Tourism does not currently overcome other major conservation threats associated with natural resource extractive industries. Similar calculations for other threatened species are currently limited by lack of basic population data.
Conclusion: Although the majority of the participants scored highly in their level of knowledge regarding life threatening arrhythmias, they scored poorly in most of the observed skills when identifying and treating this patient group. It is important that hospital administration take into consideration the identified areas of ...
Miranda C Jones
Full Text Available Global climate change is affecting the distribution of marine species and is thought to represent a threat to biodiversity. Previous studies project expansion of species range for some species and local extinction elsewhere under climate change. Such range shifts raise concern for species whose long-term persistence is already threatened by other human disturbances such as fishing. However, few studies have attempted to assess the effects of future climate change on threatened vertebrate marine species using a multi-model approach. There has also been a recent surge of interest in climate change impacts on protected areas. This study applies three species distribution models and two sets of climate model projections to explore the potential impacts of climate change on marine species by 2050. A set of species in the North Sea, including seven threatened and ten major commercial species were used as a case study. Changes in habitat suitability in selected candidate protected areas around the UK under future climatic scenarios were assessed for these species. Moreover, change in the degree of overlap between commercial and threatened species ranges was calculated as a proxy of the potential threat posed by overfishing through bycatch. The ensemble projections suggest northward shifts in species at an average rate of 27 km per decade, resulting in small average changes in range overlap between threatened and commercially exploited species. Furthermore, the adverse consequences of climate change on the habitat suitability of protected areas were projected to be small. Although the models show large variation in the predicted consequences of climate change, the multi-model approach helps identify the potential risk of increased exposure to human stressors of critically endangered species such as common skate (Dipturus batis and angelshark (Squatina squatina.
20 Submarine Medicine 08 Obstetrics/Gynecology 21 General Dentistry 09 Ophthalmology 22 Endodontics 10 Orthopedics 23 Periodontics 11 Otolaryngology...SUPERFICIAL ABSCESS 13 IINCISE AND DRAIN DEEP ABSCESS I 14 ICLEAN WOUND, CUT, ABRASION J : 15 IPACK INCISION/WOUND/CAVITY 16 1IRRIGATE WOUND 17
Garnett, Stephen T; Joseph, Liana N; Watson, James E M; Zander, Kerstin K
In many sectors, freedom in capital flow has allowed optimization of investment returns through choosing sites that provide the best value for money. These returns, however, can be compromised in countries where corruption is prevalent. We assessed where the best value for money might be obtained for investment in threatened species that occur at a single site, when taking into account corruption. We found that the influence of corruption on potential investment decisions was outweighed by the likely value for money in terms of pricing parity. Nevertheless global conservation is likely to get best returns in terms of threatened species security by investing in "honest" countries than in corrupt ones, particularly those with a high cost of living.
Kurjak, A; Zudenigo, D; Predanic, M; Kupesic, S; Funduk, B
Transvaginal color Doppler was used to investigate blood flow in the fetomaternal circulation of 60 women with threatened abortion and 90 women with normal intrauterine pregnancy. The obtained Doppler sonograms were analyzed and the resistance index (RI) was calculated in the maternal circulation, while in the fetal circulation the pulsatility index (PI) was used. There was no significant difference in the RI values of the maternal circulation between women with normal pregnancies and pregnancies complicated by bleeding, but with normal pregnancy outcome (p > 0.05). No differences in RI values of the uterine, arcuate and radial arteries were found between pregnancies with threatened abortion and normal pregnancy outcome and women with abnormal outcome (p > 0.05). In 9 of 21 women with visible retrochorionic hematoma, the RI of the spiral arteries was higher on the hematoma side in comparison to the opposite side (p abortion, the RI of the spiral arteries was lower in comparison to the control group. Such findings could be caused by the vasodilatating products of inflammation which probably exist in such areas. There was no significant difference in terms of the PI of fetal blood vessels between normal pregnancy and threatened abortions with normal outcome, as well as between threatened abortions with normal outcome and subsequent abortions of live fetuses (p > 0.05).
... Atmospheric Administration Endangered and Threatened Wildlife and Plants; Endangered Species Act Listing...; Endangered Species Act Listing Determination for Alewife and Blueback Herring AGENCY: National Marine... (Alosa aestivalis) as threatened under the Endangered Species Act (ESA) throughout all or a significant...
... nesting habitat of endangered and threatened sea turtle species in Sarasota County, Florida, for the... nesting habitat of the threatened loggerhead sea turtle (Caretta caretta), endangered leatherback sea turtle (Dermochelys coriacea), endangered green sea turtle (Chelonia mydas), endangered hawksbill sea...
Gould, D.A.; Kessel, D.O.; Healey, A.E.; Johnson, S.J.; Lewandowski, W.E.
Training in interventional radiology (IR) relies on a traditional apprenticeship; to protect patients, expert supervision is mandatory until knowledge, attitudes and practical skills have been certified as satisfactory. However, the current quality of IR training is threatened by reduced time for trainees to learn, as well as a loss of basic diagnostic, training cases to non-invasive imaging. At the same time, IR techniques are becoming a focus of interest to a range of other clinical specialities. To address this training shortfall there is a need to develop novel training alternatives such as simulator models. Few simulator models in any medical field have been successfully validated to show improved clinical skills in treating patients. To date no endovascular simulator has met this standard. A good simulator must be based around key performance measures (metrics) derived from careful analysis of the procedure to be replicated. Metrics can be determined by trained psychologists from a direct analysis of the content of the job or task to be tested. The identification of these critical measures of performance is a complex process which must be tailored to a training curriculum to be effective. Simulators based on flawed metrics will invariably lead to unsatisfactory assessment. It follows that simulator development must involve the statutory licensing authorities. Equally it is essential that we do not assume that training on a particular simulator will correlate with the ability to perform the task in the real world. This 'transfer of training' must be rigorously proven by validation studies
... Endangered Species Act of 1973, as amended (16 U.S.C. 1531 et seq.). Dated: November 21, 2011. Lynn M. Lewis...-FF03E00000] Endangered and Threatened Species; Permits AGENCY: Fish and Wildlife Service, Interior. ACTION... permits to conduct certain activities with endangered species under the authority of the Endangered...
...). Authority: The authority for this notice is the Endangered Species Act of 1973, as amended (16 U.S.C. 1531...-FF03E00000] Endangered and Threatened Species; Permits AGENCY: Fish and Wildlife Service, Interior. ACTION... permits to conduct certain activities with endangered species under the authority of the Endangered...
Mild to moderate trauma to the spinal cord that is complicated by existing cervical canal stenosis or spondylosis can be a life threatening event. It is against this background that we present a 41 year old male with cervical spinal stenosis who developed marked quadriparesis and respiratory embarrassment following ...
The Madagascar Plover Charadrius thoracicus is a threatened wader endemic to Madagascar. We report the first detailed study of its distribution and breeding ecology. Madagascar Plovers breed on the west coast of Madagascar between the Mahavavy delta in the north and Fort-Dauphin in the south-east. Between 2002 ...
Full Text Available Abstract Main progresses in endocrinology, gastroenterology, hemato-oncology, infectious diseases, otolaryngology, pharmacotherapy, and respiratory tract illnesses selected from articles published in The Italian Journal of Pediatrics in 2011 were reviewed. Risk factors for gastroenteritis and appendicitis in developing countries may be useful in improving our understanding of these diseases. Childhood hearing impairment is a world-wide problem which continues to have an high prevalence in newborns. Among the mechanisms of diseases, obese children often have asthma and high hepcidin levels that may reduce serum iron concentrations. In cystic fibrosis, 18q distal deletion has been described as a novel mutation. Hypothyroidism in children with central nervous system infections may increase mortality rates. Infrared tympanic thermometer (IRTT in oral mode for the measurement of body temperature may be useful in fever screening in a busy setup. In newborns, the transmission of CMV infection through breast milk may be prevented through freezing or pasteurization. Recent advances in treatment of constipation, urinary tract infections, leukemia, pain in children with cancer, neonates with sepsis or difficult weaning from mechanical ventilation will likely contribute towards optimizing management of these common disorders. The work of the Family Pediatricians Medicines for Children Research Network aims to develop competence, infrastructure, networking and education for pediatric clinical trials.
The present volume 2 of the radiology compendium discusses clinical radiology with the list of subjects to be studied in the 2nd section of clinical training. It is dealing with the following themes: Internal medicine, paediatrics, urology, general surgery, radiological methods in gynaecology and obstetrics, orthopaedics, neurology, ophthalmology, otolaryngology, dentistry and orthodontology, radiotherapy in dermatology.
Full Text Available Trauma is a life-threatening “modern disease”. The outcomes could only be optimized by cost-efficient and prompt trauma care, which embarks on the improvement of essential capacities and conceptual revolution in addition to the disruptive innovation of the trauma care system. According to experiences from the developed countries, systematic trauma care training is the cornerstone of the generalization and the improvement on the trauma care, such as the Advance Trauma Life Support (ATLS. Currently, the pre-hospital emergency medical services (EMS has been one of the essential elements of infrastructure of health services in China, which is also fundamental to the trauma care system. Hereby, the China Trauma Care Training (CTCT with independent intellectual property rights has been initiated and launched by the Chinese Trauma Surgeon Association to extend the up-to-date concepts and techniques in the field of trauma care as well to reinforce the generally well-accepted standardized protocols in the practices. This article reviews the current status of the trauma care system as well as the trauma care training. Keywords: Trauma care system, Trauma care training, China
Kosztyła-Hojna, Bozena; Rogowski, Marek; Ruczaj, Jan; Pepiński, Witold
Occurrence of professional dysphonia was analysed in a group of 309 patients treated in the Phoniatric Outpatient Clinic, Department of Otolaryngology, Medical Academy in Białystok through the period of 1999-2001. In a group of professional voice users female teachers of primary schools and lower secondary schools predominated. Obtained results were compared with those from a group of 65 persons of other occupations. In the both groups other harmful factors affecting the voice organ were excluded. The clinical assessment included subjective and objective laryngological examination using videolaryngostroboscopy. The clinical material was evaluated in a view of functional and organic disorders of the voice organ. Early occurrence and aggravation of functional changes in the larynx was recorded in non professional voice users in the course of their seniority. In professional patients organic changes were more common and occurred earlier than functional disorders. Severity of dysphonia was related to the larynx pathology, especially of a functional character.
exact etiology is still unclear, however, associated risk factors include maternal hypertension, advanced maternal age, polyhydramnios, multiparity, abdominal trauma, intrauterine growth restriction, intrauterine infection, premature rupture of membranes, threatened miscarriage, and cocaine abuse.. According to Sher and ...
Pande, Sushma; Pande, Santosh; Parate, Vrushali; Pande, Sanket; Sukhsohale, Neelam
Poor awareness among medical graduates about basic life support (BLS) is a matter of great concern. The presence of a trained rescuer is the key determinant of ultimate survival from life-threatening emergencies. To achieve this goal, early exposure to such life-saving skills is the right decision to foster these skills for medical students, which…
Wotman, Michael; Levinger, Joshua; Leung, Lillian; Kallush, Aron; Mauer, Elizabeth
Background Preoperative anxiety is a common problem in hospitals and other health care centers. This emotional state has been shown to negatively impact patient satisfaction and outcomes. Aromatherapy, the therapeutic use of essential oils extracted from aromatic plants, may offer a simple, low‐risk and cost‐effective method of managing preoperative anxiety. The purpose of this study was to evaluate the efficacy of lavender aromatherapy in reducing preoperative anxiety in ambulatory surgery patients undergoing procedures in general otolaryngology. Methods A prospective and controlled pilot study was conducted with 100 patients who were admitted to New York‐Presbyterian/Weill Cornell Medical Center for ambulatory surgery from January of 2015 to August of 2015. The subjects were allocated to two groups; the experimental group received inhalation lavender aromatherapy in the preoperative waiting area while the control group received standard nursing care. Both groups reported their anxiety with a visual analog scale (VAS) upon arriving to the preoperative waiting area and upon departure to the operating room. Results According to a Welch's two sample t‐test, the mean reduction in anxiety was statistically greater in the experimental group than the control group (p = 0.001). Conclusion Lavender aromatherapy reduced preoperative anxiety in ambulatory surgery patients. This effect was modest and possibly statistically significant. Future research is needed to confirm the clinical efficacy of lavender aromatherapy. Level of Evidence 2b PMID:29299520
... Loggerhead Sea Turtles as Endangered or Threatened AGENCIES: National Marine Fisheries Service (NMFS... Distinct Population Segments (DPS) of loggerhead sea turtles, Caretta caretta, as endangered or threatened... populations of loggerhead sea turtle'' as an endangered species under the ESA. NMFS published a notice in the...
Parham, Kourosh; Chapurin, Nikita; Schulz, Kris; Shin, Jennifer J.; Pynnonen, Melissa A.; Witsell, David L.; Langman, Alan; Nguyen-Huynh, Anh; Ryan, Sheila E.; Vambutas, Andrea; Wolfley, Anne; Roberts, Rhonda; Lee, Walter T.
Objectives 1) Describe thyroid-related diagnoses and procedures in CHEER across academic and community sites. 2) Compare management of malignant thyroid disease across these sites, and 3) Provide practice based data related to flexible laryngoscopy vocal fold assessment before and after thyroid surgery based on AAO-HNSF Clinical Practice Guidelines. Study Design Review of retrospective data collection (RDC) database of the CHEER network using ICD-9 and CPT codes related to thyroid conditions. Setting Multisite practice based network. Subjects and Methods There were 3,807 thyroid patients (1,392 malignant; 2,415 benign) with 10,160 unique visits identified from 1 year of patient data in the RDC. Analysis was performed for identified cohort of patients using demographics, site characteristics and diagnostic and procedural distribution. Results Mean number of patients with thyroid disease per site was 238 (range 23–715). In community practices, 19% of patients with thyroid disease had cancer versus 45% in the academic setting (pVocal fold function was assessed by flexible laryngoscopy in 34.0% of pre-operative patients and in 3.7% post-operatively. Conclusion This is the first overview of malignant and benign thyroid disease through CHEER. It shows how the RDC can be used alone and with national guidelines to inform of clinical practice patterns in academic and community sites. This demonstrates the potential for future thyroid related studies utilizing the Otolaryngology-H&N Surgery’s practice-based research network. PMID:27371622
Garnett, Stephen T.; Joseph, Liana N.; Watson, James E. M.; Zander, Kerstin K.
In many sectors, freedom in capital flow has allowed optimization of investment returns through choosing sites that provide the best value for money. These returns, however, can be compromised in countries where corruption is prevalent. We assessed where the best value for money might be obtained for investment in threatened species that occur at a single site, when taking into account corruption. We found that the influence of corruption on potential investment decisions was outweighed by the likely value for money in terms of pricing parity. Nevertheless global conservation is likely to get best returns in terms of threatened species security by investing in “honest” countries than in corrupt ones, particularly those with a high cost of living. PMID:21818383
Khanna, Maya M; Badura-Brack, Amy S; McDermott, Timothy J; Shepherd, Alex; Heinrichs-Graham, Elizabeth; Pine, Daniel S; Bar-Haim, Yair; Wilson, Tony W
We examined two groups of combat veterans, one with post-traumatic stress disorder (PTSD) (n = 27) and another without PTSD (n = 16), using an emotional Stroop task (EST) with word lists matched across a series of lexical variables (e.g. length, frequency, neighbourhood size, etc.). Participants with PTSD exhibited a strong EST effect (longer colour-naming latencies for combat-relevant words as compared to neutral words). Veterans without PTSD produced no such effect, t .37. Participants with PTSD then completed eight sessions of attention training (Attention Control Training or Attention Bias Modification Training) with a dot-probe task utilising threatening and neutral faces. After training, participants-especially those undergoing Attention Control Training-no longer produced longer colour-naming latencies for combat-related words as compared to other words, indicating normalised attention allocation processes after treatment.
Wu, Olivia; Briggs, Andrew; Kemp, Tom; Gray, Alastair; MacIntyre, Kate; Rowley, Jack; Willett, Keith
The potential health benefits of mobile phone use have not been widely studied, except for telemedicine-type applications. This study seeks to determine whether initial contact with emergency services via a mobile phone in life-threatening situations is associated with potential health benefits when compared to contact via a landline. A record-linkage study was carried out in which data from all emergency dispatches for immediately life-threatening events from a United Kingdom county ambulance service were linked to the Patient Admission System at two major local hospitals. Mortality (at the scene, at the emergency department [ED], and during hospitalization); transfer to the ED; admission (inpatient care, and intensive care unit); and length of stay were analyzed for calls classified as Code Red (immediately life-threatening) by initial exposure (mobile phone vs. landline), while controlling for potential confounding variables. Of 354,199 ambulances dispatched to attend emergency incidents, 66% transported patients to the hospital while 2% stood down due to death at the scene. Mobile phone compared to landline reporting of emergencies resulted in significant reductions in the risk of death at the scene (odds ratio [OR] 0.77), but not for death in the ED or during inpatient admission. The risk of being transferred to the ED and subsequent inpatient admission were significantly lower with reporting from mobile phones compared to landline (OR 0.93 and OR 0.82, respectively). In this study, evidence of statistical association was demonstrated between the use of mobile phones to alert ambulance services in life-threatening situations and improved outcomes for patients. Copyright Â© 2012 Elsevier Inc. All rights reserved.
Ragucci, Kelly R; O'Bryant, Cindy L; Campbell, Kristin Bova; Buck, Marcia L; Dager, William E; Donovan, Jennifer L; Emerson, Kayleigh; Gubbins, Paul O; Haight, Robert J; Jackevicius, Cynthia; Murphy, John E; Prohaska, Emily
The American College of Clinical Pharmacy and other stakeholder organizations seek to advance clinical pharmacist practitioners, educators, and researchers. Unfortunately, there remains an inadequate supply of residency-trained clinical specialists to meet the needs of our health care system, and nonspecialists often are called on to fill open specialist positions. The impact of clinical pharmacy specialists on pharmacotherapy outcomes in both acute care and primary care settings demonstrates the value of these specialists. This commentary articulates the need for postgraduate year two (PGY2)-trained clinical specialists within the health care system by discussing various clinical and policy rationales, interprofessional support, economic justifications, and their impact on quality of care and drug safety. The integrated practice model that has grown out of the American Society of Health-System Pharmacists Pharmacy Practice Model Initiative (PPMI) could threaten the growth and development of future clinical specialists. Therefore, the ways in which PGY2-trained clinical pharmacist specialists are deployed in the PPMI require further consideration. PGY2 residencies provide education and training opportunities that cannot be achieved in traditional professional degree programs or postgraduate year one residencies. These specialists are needed to provide direct patient care to complex patient populations and to educate and train pharmacy students and postgraduate residents. Limitations to training and hiring PGY2-trained clinical pharmacy specialists include site capacity limitations and lack of funding. A gap analysis is needed to define the extent of the mismatch between the demand for specialists by health care systems and educational institutions versus the capacity to train clinical pharmacists at the specialty level. © 2014 Pharmacotherapy Publications, Inc.
... Oceanic and Atmospheric Administration 50 CFR Parts 223 and 224 RIN 0648-AY49 Endangered and Threatened Species; Proposed Listing of Nine Distinct Population Segments of Loggerhead Sea Turtles as Endangered or... loggerhead sea turtles as endangered or threatened, which was published on March 16, 2010, until September 13...
Beer, G.; Sobinkovic, B.
In this issue an exploitation of biomass in Slovak Republic is analysed. Some new projects of constructing of the stoke-holds for biomass processing are published. The grants for biomass are ascending the prices of wood raw material, which is thus becoming less accessible for the wood-processors. An excessive wood export threatens the domestic processors
Zeijlmans van Emmichoven, Ingeborg A; van IJzendoorn, Marinus H; de Ruiter, Corine; Brosschot, Jos F
To investigate the effect of the mental representation of attachment on information processing, 28 anxiety disorder outpatients, as diagnosed by the Anxiety Disorders Interview Schedule-Revised, were administered the Adult Attachment Interview and the State-Trait Anxiety Inventory. They also completed an emotional Stroop task with subliminal and supraliminal exposure conditions, a free recall memory task, and a recognition test. All tasks contained threatening, neutral, and positively valenced stimuli. A nonclinical comparison group of 56 participants completed the same measures. Results on the Stroop task showed color-naming interference for threatening words in the supraliminal condition only. Nonclinical participants with insecure attachment representations showed a global response inhibition to the Stroop task. Clinical participants with secure attachment representations showed the largest Stroop interference of the threatening words compared to the other groups. Results on the free recall task showed superior recall of all types of stimuli by participants with secure attachment representations. In the outpatient group, participants with secure attachment representations showed superior recall of threatening words on the free recall task, compared to insecure participants. Results on the recognition task showed no differences between attachment groups. We conclude that secure attachment representations are characterized by open communication about and processing of threatening information, leading to less defensive exclusion of negative material during the attentional stage of information processing and to better recall of threatening information in a later stage. Attachment insecurity, but not the type of insecurity, seems a decisive factor in attention and memory processes.
Optimal management and conservation programs of the threatened Cabrera's vole require investigating potential molecular genetic markers in the genomic background, if the few remaining fragile populations are to ... The results described Cabrera's vole populations as a single genetic unit with slightly restricted gene flow.
Clerkin, Elise M; Teachman, Bethany A
The current study tested the causal premise underlying cognitive models of obsessive compulsive disorder (OCD) that negative interpretations of intrusive thoughts lead to the distress and impairment associated with symptoms of OCD. Specifically, we sought to determine: (a) whether it was possible to train healthier (defined as more benign/less threatening) interpretations regarding the significance of intrusive thoughts; and (b) whether there was a link between modifying negative interpretations and subsequent emotional vulnerability to an OC stressor. A nonclinical sample of students high in OC symptoms completed either a Positive (n = 50) or Neutral (n = 50) interpretation training procedure designed to alter OC-relevant interpretations and beliefs. As expected, participants in the Positive (versus Neutral) training condition endorsed healthier OC-relevant interpretations and beliefs following training. Additionally, when controlling for baseline affect, participants in the Positive (versus Neutral) training condition reported less negative affect during the OC-stressor task (at the level of a non-significant trend) and reported less desire to perform neutralizing activities. In general, results provide some support for cognitive models of obsessions and suggest that negative interpretations of intrusive thoughts may be causally related to symptoms of OCD. Published by Elsevier Ltd.
Pedler, Reece D; Brandle, Robert; Read, John L; Southgate, Richard; Bird, Peter; Moseby, Katherine E
Funding for species conservation is insufficient to meet the current challenges facing global biodiversity, yet many programs use expensive single-species recovery actions and neglect broader management that addresses threatening processes. Arid Australia has the world's worst modern mammalian extinction record, largely attributable to competition from introduced herbivores, particularly European rabbits (Oryctolagus cuniculus) and predation by feral cats (Felis catus) and foxes (Vulpes vulpes). The biological control agent rabbit hemorrhagic disease virus (RHDV) was introduced to Australia in 1995 and resulted in dramatic, widespread rabbit suppression. We compared the area of occupancy and extent of occurrence of 4 extant species of small mammals before and after RHDV outbreak, relative to rainfall, sampling effort, and rabbit and predator populations. Despite low rainfall during the first 14 years after RHDV, 2 native rodents listed by the International Union for Conservation of Nature (IUCN), the dusky hopping-mouse (Notomys fuscus) and plains mouse (Pseudomys australis), increased their extent of occurrence by 241-365%. A threatened marsupial micropredator, the crest-tailed mulgara (Dasycercus cristicauda), underwent a 70-fold increase in extent of occurrence and a 20-fold increase in area of occupancy. Both bottom-up and top-down trophic effects were attributed to RHDV, namely decreased competition for food resources and declines in rabbit-dependent predators. Based on these sustained increases, these 3 previously threatened species now qualify for threat-category downgrading on the IUCN Red List. These recoveries are on a scale rarely documented in mammals and give impetus to programs aimed at targeted use of RHDV in Australia, rather than simply employing top-down threat-based management of arid ecosystems. Conservation programs that take big-picture approaches to addressing threatening processes over large spatial scales should be prioritized to maximize
Williams, M.; Lunsford, A.; Ellis, D.; Robinson, J.; Coronado, P.; Campbell, W.
In 1990, a joint effort of two U.S. federal agencies, NASA Goddard Space Flight Center (GSFC) and the Patuxent Wildlife Research Center, began. We initially joined forces in a project that used satellite telemetry to discover the winter home of a tiny dwindling population of Siberian Cranes. Since then several projects have emerged, and a web site was created to follow some of these activities. This web site is called the Satellite Tracking of Threatened Species and its location is http://sdcd.gsfc.nasa.gov/ISTO/satellite_tracking. It describes the overall program, and links you to three subsections that describe the projects in more detail: Satellite Direct Readout, Birdtracks, and Birdworld.
Zhang, Qian; Zhong, Jin-Xin
Based on the related published papers, and by using Geographic Information System (ArcGIS 9.3), this paper analyzed the species composition and geographical distribution of threatened fishes in Yunnan Province of Southwest China. There were 83 threatened species living in the Province, belonging to 5 orders, 13 families, and 47 genera. Cypriniformes was absolutely dominant, with 64 species, followed by Siluriformes, with 16 species. Cyprinidae fishes had 51 species, accounting for 79.7% of Cypriniformes. The most species of Cyprinid fishes were of Barbinae (14 species), Cyprininae (10 species), and Cultrinae (10 species). The threatened fishes could be divided into two zoogeographical regions, i. e., Tibetan Plateau region and Oriental region, and their species composition and geographical distribution were resulted from the historical evolution adapted to the related environments. Whatever in rivers and in lakes, the Cyprinid fishes were both absolutely dominant, occupying 36.1% and 31.3% of the total, respectively. The Cyprinid fishes in rivers were mostly of endangered species, while those in lakes were mostly of vulnerable species. The factors affecting the threatened fishes in the Province were discussed from the two aspects of geodynamic evolution and present situation.
Bhatti, Nasir I; Ahmed, Aadil; Stewart, Michael G; Miller, Robert H; Choi, Sukgi S
Despite careful selection processes, residency programs face the challenge of training residents who fall below minimal performance standards. Poor performance of a resident can endanger both patient safety and the reputation of the residency program. It is important, therefore, for a program to identify such residents and implement strategies for their successful remediation. The purpose of our study was to gather information on evaluation and remediation strategies employed by different otolaryngology programs. Cross-sectional survey. We conducted a national survey, sending a questionnaire to the program directors of 106 otolaryngology residency programs. We collected information on demographics of the program, identification of problematic residents, and remediation strategies. The response rate was 74.5%, with a 2% cumulative incidence of problematic residents in otolaryngology programs during the past 10 years. The most frequently reported deficiencies of problematic residents were unprofessional behavior with colleagues/staff (38%), insufficient medical knowledge (37%), and poor clinical judgment (34%). Personal or professional stress was the most frequently identified underlying problem (70.5%). Remediation efforts included general counseling (78%), frequent feedback sessions (73%), assignment of a mentor (58%), and extra didactics (47%). These remediation efforts failed to produce improvement in 23% of the identified residents, ultimately leading to their dismissal. The apparent deficiencies, underlying causes, and remediation strategies vary among otolaryngology residency programs. Based on the results of this survey, we offer recommendations for the early identification of problematic residents and a standardized remediation plan. NA. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Kersey, David C; Dehnhard, Martin
Endocrinology is an indispensable tool in threatened species research. The study of endocrinology in threatened species not only advances knowledge of endocrine mechanism but also contributes to conservation efforts of studied species. To this end, endocrinology has been traditionally used to understand reproductive and adrenocortical endocrine axes by quantifying excreted steroid metabolites. From these studies a large body of knowledge was created that contributed to the field of endocrinology, aided conservation efforts, and created a template by which to validate and conduct this research for other species. In this regard noninvasive hormone monitoring has become a favored approach to study the basic endocrinology of wildlife species. Due to the increased understanding of endocrine physiology of threatened species, breeding rates of captive population have improved to levels allowing for reintroduction of species to restored natural ecosystems. Although these approaches are still employed, advances in biochemical, molecular, and genomic technologies are providing inroads to describe lesser known endocrine activity in threatened species. These new avenues of research will allow for growth of the field with greater depth and breadth. However, for all approaches to endocrinology, limitations on resources and access to animals will require innovation of current methodologies to permit broad application for use in threatened species research. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.
King, A.L.; Awl, D.J.; Gabrielsen, C.A.
The Endangered Species Act (originally passed in 1973) is a Federal statute that protects both animal and plant species. The Endangered Species Act identifies species which are, without careful management, in danger of becoming extinct and species that are considered threatened. Along with the designation of threatened or endangered, the Endangered Species Act provides for the identification of appropriate habitat for these species. Since 1993, the United States Department of Energy`s (DOE) Environmental Restoration (ER) Program has supported a program to survey the Oak Ridge Reservation (ORR) for threatened and endangered species. The Environmentally Sensitive Areas Surveys Program initiated vascular plant surveys during fiscal year 1993 and vertebrate animal surveys during fiscal year 1994 to determine the baseline condition of threatened and endangered species on the ORR at the present time. Data collected during these surveys are currently aiding Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) Remedial Investigations on the ORR. They also provide data for ER and Waste Management decision documents, ensure that decisions have technical and legal defensibility, provide a baseline for ensuring compliance with principal legal requirements and will increase public confidence in DOE`s adherence to all related environmental resources rules, laws, regulations, and instructions. This report discusses the progress to date of the threatened and endangered species surveys of the ORR.
Full Text Available Appropriate response to companions' emotional signals is important for all social creatures. The emotional expressions of humans and non-human animals have analogies in their form and function, suggesting shared evolutionary roots, but very little is known about how animals other than primates view and process facial expressions. In primates, threat-related facial expressions evoke exceptional viewing patterns compared with neutral or positive stimuli. Here, we explore if domestic dogs (Canis familiaris have such an attentional bias toward threatening social stimuli and whether observed emotional expressions affect dogs' gaze fixation distribution among the facial features (eyes, midface and mouth. We recorded the voluntary eye gaze of 31 domestic dogs during viewing of facial photographs of humans and dogs with three emotional expressions (threatening, pleasant and neutral. We found that dogs' gaze fixations spread systematically among facial features. The distribution of fixations was altered by the seen expression, but eyes were the most probable targets of the first fixations and gathered longer looking durations than mouth regardless of the viewed expression. The examination of the inner facial features as a whole revealed more pronounced scanning differences among expressions. This suggests that dogs do not base their perception of facial expressions on the viewing of single structures, but the interpretation of the composition formed by eyes, midface and mouth. Dogs evaluated social threat rapidly and this evaluation led to attentional bias, which was dependent on the depicted species: threatening conspecifics' faces evoked heightened attention but threatening human faces instead an avoidance response. We propose that threatening signals carrying differential biological validity are processed via distinctive neurocognitive pathways. Both of these mechanisms may have an adaptive significance for domestic dogs. The findings provide a novel
... from Helianthus paradoxus (Pecos sunflower) from plants in Texas. Permit TE-829761 Applicant: Bureau of... for endangered plant species, and 50 CFR 17.72 for threatened plant species. Applications Available...: Texas A & M University, Galveston, Texas. Applicant requests a new permit for husbandry and holding of...
Redelmeier, Donald A; Raza, Sheharyar
Aerial perspective illusion is a feature of visual perception where landscapes appear relatively close in clear light and distant in dim light. We hypothesized that bright sunlight might cause drivers to perceive distant terrain as relatively close and misinterpret the approach speed of surrounding landscape as unduly slow. This hypothesis would mean, in turn, that drivers in bright sunlight may underestimate their progress on the road, compensate by traveling at a faster baseline speed, and ultimately increase the prevailing risk of a life-threatening traffic crash. We conducted three pilot studies to illustrate how the illusion might contribute to a life- threatening traffic crash. The first illustration used a questionnaire to demonstrate that most respondents were mistaken when judging the distance between simple balls in different positions. The second illustration involved an experimental manipulation to assess whether aerial perspective influenced judgments about the relative positions of vehicles in traffic. The third illustration analyzed a segment of high-volume fast-speed traffic and found an increased frequency of speeding under bright sunlight. Together with past work based on the visual arts, these examples illustrate how an aerial perspective illusion can affect distance perception, may appear in realistic traffic situations, and could potentially contribute to the risk of a life-threatening traffic crash. An awareness of this hypothesis might lead to applications on how optical illusions could extend to everyday traffic and might potentially inform safety warnings to prevent life- threatening crashes. Copyright © 2018 Elsevier Ltd. All rights reserved.
Hartvich, P.; Lusk, Stanislav; Rutkayová, J.
Roč. 87, č. 1 (2010), s. 39-40 ISSN 0378-1909 Institutional research plan: CEZ:AV0Z60930519 Keywords : threatened fishes * Europe * Cobitidae Subject RIV: EH - Ecology, Behaviour Impact factor: 0.792, year: 2010
Patricia L. Winter; George T. Cvetkovich
This paper presents an examination of trust in the Forest Service to manage threatened and endangered species as measured through a survey of residents of four Southwestern States. Of particular interest were variations by ethnic/racial group, gender, concern about threatened and endangered species, and self-assessed knowledge. Increasing diversity in the United States...
The montane forests of northern Mozambique and southern Malawi support several bird species of global conservation concern, and particularly in Malawi are seriously threatened by deforestation. However, the status of these in northern Mozambique remains poorly known. We report that some 1 600 ha of mid-altitude and ...
Jul 3, 2011 ... She currently works with funding support from the Red Cross War Memorial Children's Hospital and the ... Children with life-limiting illnesses may also develop life-threatening ... bodies in an age-appropriate manner a basic.
... EPA's policy to include all comments it receives in the public docket without change and to make the... Categorizing the Relative Vulnerability of Threatened and Endangered Species to Climate Change AGENCY... Framework for Categorizing the Relative Vulnerability of Threatened and Endangered Species to Climate Change...
Forde, Emer; Bromilow, J.; Jackson, S.; Wedderburn, Clare
General Practitioners (GPs) have a responsibility to provide prompt and effective care when attending to life threatening emergencies in their GP surgeries. Primary care staff undertake mandatory, annual basic life support training. However, most emergencies are peri-arrest situations, and this is an area where GPs lack confidence and competence [1, 2]. The importance of effective, early intervention in peri-arrest scenarios was highlighted by the NCEPOD report “Time to Intervene (2012)” ....
Catalina Vásquez-Carrillo; R. William Henry; Laird Henkel; M. Zachariah. Peery
Population monitoring programs for threatened species are rarely designed to disentangle the effects of movements from changes in birth and death rates on estimated trends in abundance. Here, we illustrate how population and genetic monitoring can be integrated to understand the cause of large changes in the abundance of a threatened species of seabird, the Marbled...
Steven V Vollmer
Full Text Available Disease epidemics have caused extensive damage to tropical coral reefs and to the reef-building corals themselves, yet nothing is known about the abilities of the coral host to resist disease infection. Understanding the potential for natural disease resistance in corals is critically important, especially in the Caribbean where the two ecologically dominant shallow-water corals, Acropora cervicornis and A. palmata, have suffered an unprecedented mass die-off due to White Band Disease (WBD, and are now listed as threatened under the US Threatened Species Act and as critically endangered under the IUCN Red List criteria. Here we examine the potential for natural resistance to WBD in the staghorn coral Acropora cervicornis by combining microsatellite genotype information with in situ transmission assays and field monitoring of WBD on tagged genotypes. We show that six percent of staghorn coral genotypes (3 out of 49 are resistant to WBD. This natural resistance to WBD in staghorn corals represents the first evidence of host disease resistance in scleractinian corals and demonstrates that staghorn corals have an innate ability to resist WBD infection. These resistant staghorn coral genotypes may explain why pockets of Acropora have been able to survive the WBD epidemic. Understanding disease resistance in these corals may be the critical link to restoring populations of these once dominant corals throughout their range.
Threatened species' recovery planning is applied globally to stem the current species extinction crisis. Evidence supports a key role of genetic processes, such as inbreeding depression, in determining species viability. We examined whether genetic factors are considered in threa...
Geoff M. Hilton; Phil W. Atkinson; Gerard A.L. Gray; Wayne J. Arendt; David W. Gibbons
Prior to 1995, the Montserrat oriole (Icterus oberi) was confined to ca. 30 km2 of hill forest on the Lesser Antillean island of Montserrat, but was not listed as globally threatened. Since then, the eruption of the Soufriere Hills volcano has destroyed more than half of the speciesâ range. Recent intensive monitoring has indicated that the species has also declined...
... list of endangered and threatened wildlife and plant species at 50 CFR 17.11 (for animals) and 17.12... endangered nor threatened for one or more of the following reasons: (1) the species is considered extinct; (2...
Colley, Patrick; Mace, Jess C.; Schaberg, Madeleine R.; Smith, Timothy L.; Tabaee, Abtin
OBJECTIVE Nasal endoscopy is integral to the evaluation of sinonasal disorders. However, prior studies have shown significant variability in the inter-rater agreement of nasal endoscopy interpretation amongst practicing rhinologists. The objective of the current study is to evaluate the inter-rater agreement of nasal endoscopy amongst otolaryngology residents from a single training program at baseline and following an educational intervention. METHODS 11 otolaryngology residents completed nasal endoscopy grading forms for 8 digitally recorded nasal endoscopic examinations. An instructional lecture reviewing nasal endoscopy interpretation was subsequently provided. The residents then completed grading forms for 8 different nasal endoscopic examinations. Inter-rate agreement amongst residents for the pre- and post-lecture videos was calculated using the unweighted Fleiss’ kappa statistic (Kf) and intra-class correlation agreement (ICC). RESULTS Inter-rater agreement improved from a baseline level of fair (Kf range 0.268–0.383) to a post-educational level of moderate (Kf range 0.401–0.547) for nasal endoscopy findings of middle meatus mucosa, middle turbinate mucosa, middle meatus discharge, sphenoethmoid recess mucosa, sphenoethmoid recess discharge and atypical lesions (ICC, pendoscopy interpretation amongst otolaryngology residents. The inter-rater agreement for the majority of the characteristics that were evaluated improved after educational intervention. Further study is needed to improve nasal endoscopy interpretation. PMID:25781864
Full Text Available Eeva Tuunainen,1 Jyrki Rasku,1 Pirkko Jäntti,2 Päivi Moisio-Vilenius,3 Erja Mäkinen,3 Esko Toppila,4 Ilmari Pyykkö1 1Department of Otolaryngology, Section of Hearing and Balance Research Unit, University of Tampere and University Hospital of Tampere, Finland; 2Department of Geriatric Medicine, Hatanpää City Hospital, Tampere, Finland; 3Koukkuniemi Residential Home, Tampere, Finland; 4Finnish Institute of Occupational Health, Helsinki, Finland Purpose: To evaluate whether rehabilitation of muscle force or balance improves postural stability and quality of life (QoL, and whether self-administered training is comparable with guided training among older adults residing in an institutional setting. Patients and methods: A randomized, prospective intervention study was undertaken among 55 elderly patients. Three intervention groups were evaluated: a muscle force training group; a balance and muscle force training group; and a self-administered training group. Each group underwent 1-hour-long training sessions, twice a week, for 3 months. Postural stability was measured at onset, after 3 months, and after 6 months. Time-domain-dependent body sway variables were calculated. The fall rate was evaluated for 3 years. General health related quality of life (HRQoL was measured with a 15D instrument. Postural stability was used as a primary outcome, with QoL and falls used as secondary outcomes. Results: Muscle force trainees were able to undertake training, progressing towards more strenuous exercises. In posturography, the number of spiky oscillations was reduced after training, and stationary fields of torque moments of the ankle increased, providing better postural stability in all groups; in particular, the zero crossing rate of weight signal and the number of low variability episodes in the stabilogram were improved after training. While no difference was found between different training groups in posturography outcomes, a reduction of fall rate
Adil, Eelam; Xiao, Roy; McGill, Trevor; Rahbar, Reza; Cunningham, Michael
Maintaining an outpatient practice and providing high-quality inpatient care pose significant challenges to the traditional call team approach. To introduce a unique rotating hospitalist inpatient program and assess its clinical, educational, and financial impact. The chief of service (COS) program requires 1 attending physician to rotate weekly as chief of the inpatient service with no conflicting elective duties. This was a retrospective internal billing data review performed at a tertiary pediatric hospital. A total of 1241 patients were evaluated by the COS from October 2012 through October 2013. All patients were treated by the inpatient service under the supervision of the COS. A retrospective analysis of patient encounters and procedures, including International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes, locations of service, clinicians, service dates, and average weekly relative value units (RVUs). Over the study period, the COS was involved in the care of 1241 patients, generating 2786 billable patient encounters. The COS averaged 11.2 patient encounters per day. The most common reasons for consultation were respiratory distress, dysphagia, and stridor. Of patient encounters, 63.0% resulted in a procedure; 82.8% of those procedures were performed in the operating room with the most common being lower airway endoscopy (340 [19.4%]). The average weekly RVUs for the COS (232) were comparable with those of the average weekly outpatient clinic and procedural RVUs of the other otolaryngology faculty in the group (240). The COS program was created to meet the clinical, educational, and organizational demands of a high-volume and high-acuity inpatient service. It is a financially sustainable model with unique advantages, particularly for the staff who maintain their outpatient practices without disruption and for the trainees who have the opportunity to work closely with the entire faculty. Patients are
Peters, Gjalt-Jorn Y; Ruiter, Robert A C; Kok, Gerjo
Threatening communication is a widely applied method in behavior change interventions, which at the same time has been heavily criticized in the psychological literature. The current paper describes a study of the reasons for this persistent wide application of threatening communication. We conducted qualitative interviews with 33 key actors in behavior change intervention development in The Netherlands. Specifically, we interviewed intervention developers, policymakers, politicians, scientists, and advertising professionals. The interviews were transcribed and subsequently coded using NVivo. We found that participants most closely involved with the actual intervention development were generally convinced that threatening information was to be prevented, but often did not understand the exact processes involved. They were often under the impression that rather than a potent efficacy enhancing element, a behavioral suggestion would suffice to prevent threatening communication from backfiring. As participants were further removed from the actual intervention development, they generally tended to be more in favor of threatening communication. The main reasons for use of threatening information were to attract attention or prompt self-reflection through confrontation, because target population members were assumed to like threatening information and respond rationally to increased risk perceptions by changing their behavior, or simply because no alternatives were available. In addition, intervention developers frequently had to deal with supervisors or funders who preferred threatening communication. Thus, when communicating with practitioners, it seems fruitful to provide them with a toolbox of evidence-based behavior change methods that promote adaptive, rather than maladaptive, behavior; to promote basing interventions on the most relevant behavioral determinants as identified by determinant analyses; and to equip intervention developers with the tools to persuade
Hammond, Kendra; You, David; Collins, Eileen G; Leehey, David J; Laghi, Franco
A 56-year-old woman with a history of paraplegia and chronic pain due to neuromyelitis optica (Devic's syndrome) was admitted to a spinal cord injury unit for management of a sacral decubitus ulcer. During the hospitalization, she required emergency transfer to the intensive care unit (ICU) because of progressive deterioration of respiratory muscle function, severe respiratory acidosis, obtundation and hypotension. Upon transfer to the ICU, arterial blood gas revealed severe acute-on-chronic respiratory acidosis (pH 7.00, PCO2 120 mm Hg, PO2 211 mm Hg). The patient was immediately intubated and mechanically ventilated. Intravenous fluid boluses of normal saline (10.5 L in about 24 h) and vasopressors were started with rapid correction of hypotension. In addition, she was given hydrocortisone. Within 40 min of initiation of mechanical ventilation, there was improvement in acute respiratory acidosis. Sixteen hours later, however, the patient developed life-threatening hypokalemia (K(+) of 2.1 mEq/L) and hypomagnesemia (Mg of 1.4 mg/dL). Despite aggressive potassium supplementation, hypokalemia continued to worsen over the next several hours (K(+) of 1.7 mEq/L). Urine studies revealed renal potassium wasting. We reason that the recalcitrant life-threatening hypokalemia was caused by several mechanisms including total body potassium depletion (chronic respiratory acidosis), a shift of potassium from the extracellular to intracellular space (rapid correction of respiratory acidosis with mechanical ventilation), increased sodium delivery to the distal nephron (normal saline resuscitation), hyperaldosteronism (secondary to hypotension plus administration of hydrocortisone) and hypomagnesemia. We conclude that rapid correction of respiratory acidosis, especially in the setting of hypotension, can lead to life-threatening hypokalemia. Serum potassium levels must be monitored closely in these patients, as failure to do so can lead to potentially lethal consequences
Schafer, D.W.; Robeck, K.E.
This report contains information of federally-listed endangered and/or threatened fish and wildlife occurring in the midwestern states of Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, and Wisconsin. The information was compiled as a support document for the Regional Issue Identification and Assessment (RIIA) project sponsored by the Regional Assessments Division of the Office of Technology Impacts within the Department of Energy. The information on midwestern endangered species distribution, habitats, and reasons for population decline included in this document are designed to help assess the potential for adverse impacts if energy activities are sited within the general range of an endangered species. It is hoped that this document will thereby enhance the reliability of one portion of energy-related assessments performed in the Midwest. This report considers only those species listed prior to October 1979 as endangered and/or threatened in the federal endangered species list published in the Federal Register and that have been known to occur in the region in the last 20 years.
Tajmir-Riahi, Azadeh; Wörl, Petra; Harrer, Thomas; Schliep, Stefan; Schuler, Gerold; Simon, Miklos
Antibiotics are known to cause severe cutaneous adverse reactions, such as the rare acute generalized exanthematous pustulosis (AGEP). Unlike Stevens-Johnson syndrome or toxic epidermal necrolysis, AGEP is rarely life-threatening. Systemic involvement is not typical, and if present usually coincides with a mild elevation of the hepatic enzymes and a decrease in renal function. Hence, AGEP is known to have a good prognosis and to be life-threatening only in elderly patients or patients with chronic diseases. Herein, we report a case of AGEP in a young healthy male leading to systemic inflammatory response syndrome and to treatment in an intensive care unit after being treated with 5 different antibiotics. Initial symptoms were not indicative for AGEP and the patient's course of disease led promptly to critical cardiorespiratory symptoms and systemic inflammatory response syndrome. We assume that the administration of the 5 different antibiotics resulted in type IV allergy as well as secondary infection with Enterococcus faecium and Staphylococcus aureus, while the underlying periodontitis also contributed to the severity of this case. © 2017 S. Karger AG, Basel.
Macedonia, Christian R; Gherman, Robert B; Satin, Andrew J
Simulations have been used by the military, airline industry, and our colleagues in other medical specialties to educate, evaluate, and prepare for rare but life-threatening scenarios. Work hour limits for residents in obstetrics and gynecology and decreased patient availability for teaching of students and residents require us to think creatively and practically on how to optimize their education. Medical simulations may address scenarios in clinical practice that are considered important to know or understand. Simulations can take many forms, including computer programs, models or mannequins, virtual reality data immersion caves, and a combination of formats. The purpose of this commentary is to call attention to a potential role for medical simulation in obstetrics and gynecology. We briefly describe an example of how simulation may be incorporated into obstetric and gynecologic residency training. It is our contention that educators in obstetrics and gynecology should be aware of the potential for simulation in education. We hope this commentary will stimulate interest in the field, lead to validation studies, and improve training in and the practice of obstetrics and gynecology.
... Threatened or Endangered Under the Endangered Species Act AGENCY: National Marine Fisheries Service (NMFS... carcharias) as a threatened or endangered distinct population segment (DPS) under the Endangered Species Act... under the U.S. Endangered Species Act'' because NatureServe assessments ``have different criteria...
Paudel, Prakash Kumar; Sipos, Jan; Brodie, Jedediah F
A crucial step in conserving biodiversity is to identify the distributions of threatened species and the factors associated with species threat status. In the biodiversity hotspot of the Himalaya, very little is known about which locations harbour the highest diversity of threatened species and whether diversity of such species is related to area, mid-domain effects (MDE), range size, or human density. In this study, we assessed the drivers of variation in richness of threatened birds, mammals, reptiles, actinopterygii, and amphibians along an elevational gradient in Nepal Himalaya. Although geometric constraints (MDE), species range size, and human population density were significantly related to threatened species richness, the interaction between range size and human population density was of greater importance. Threatened species richness was positively associated with human population density and negatively associated with range size. In areas with high richness of threatened species, species ranges tend to be small. The preponderance of species at risk of extinction at low elevations in the subtropical biodiversity hotspot could be due to the double impact of smaller range sizes and higher human density.
Full Text Available Background. Duodenal gastrointestinal stromal tumours (GISTs are an uncommon malignancy of the gastrointestinal (GI tract. We present a case of life-threatening haemorrhage caused by a large ulcerating duodenal GIST arising from the third part of the duodenum managed by a limited duodenal wedge resection. Case Presentation. A 61-year-old patient presented with acute life-threatening gastrointestinal bleeding. After oesophagogastroduodenoscopy failed to demonstrate the source of bleeding, a 5 cm ulcerating exophytic mass originating from the third part of the duodenum was identified at laparotomy. A successful limited wedge resection of the tumour mass was performed. Histopathology subsequently confirmed a duodenal GIST. The patient remained well at 12-month followup with no evidence of local recurrence or metastatic spread. Conclusion. Duodenal GISTs can present with life-threatening upper GI haemorrhage. In the context of acute haemorrhage, even relatively large duodenal GISTs can be treated by limited wedge resection. This is a preferable alternative to duodenopancreatectomy with lower morbidity and mortality but comparable oncological outcome.
In The Netherlands, heathlands and species-rich grassland are strongly reduced in both area and habitat quality mainly due to fragmentation, eutrophication and acidification. As a result, many plant and animal species have become (locally) extinct, or are threatened by extinction as they are forced
... during a state of war or threatened war? 1229.12 Section 1229.12 Parks, Forests, and Public Property... § 1229.12 What are the requirements during a state of war or threatened war? (a) Destruction of records... war between the United States and any other nation or when hostile action appears imminent, the head...
Peters, Gjalt-Jorn Y; Ruiter, Robert A C; Kok, Gerjo
Threatening communication is a widely applied method in behavior change interventions, which at the same time has been heavily criticized in the psychological literature. The current paper describes a study of the reasons for this persistent wide application of threatening communication. We conducted qualitative interviews with 33 key actors in behavior change intervention development in The Netherlands. Specifically, we interviewed intervention developers, policymakers, politicians, scientists, and advertising professionals. The interviews were transcribed and subsequently coded using NVivo. We found that participants most closely involved with the actual intervention development were generally convinced that threatening information was to be prevented, but often did not understand the exact processes involved. They were often under the impression that rather than a potent efficacy enhancing element, a behavioral suggestion would suffice to prevent threatening communication from backfiring. As participants were further removed from the actual intervention development, they generally tended to be more in favor of threatening communication. The main reasons for use of threatening information were to attract attention or prompt self-reflection through confrontation, because target population members were assumed to like threatening information and respond rationally to increased risk perceptions by changing their behavior, or simply because no alternatives were available. In addition, intervention developers frequently had to deal with supervisors or funders who preferred threatening communication. Thus, when communicating with practitioners, it seems fruitful to provide them with a toolbox of evidence-based behavior change methods that promote adaptive, rather than maladaptive, behavior; to promote basing interventions on the most relevant behavioral determinants as identified by determinant analyses; and to equip intervention developers with the tools to persuade
Full Text Available Preterm labour and prematurity are still a main cause of perinatal morbidity nowadays. The aim of our study was to assess the role of MMP-8 as a predictive marker of preterm delivery. Four groups of patients were involved to the study: I - pregnant women at 24-34 weeks of gestation with any symptoms of threatened preterm labour; II - threatened preterm labour patients between 24-34 weeks of gestation; III - preterm vaginal delivery patients; IV - healthy term vaginal delivery patients. Serum concentration of total MMP-8 was measured using two enzyme-linked immunosorbent assays. There were no significant differences in the median concentrations of total MMP-8 between physiological pregnancy and threatened preterm labour patients with existing uterine contractility. No significant differences of total MMP-8 were either found between healthy term and preterm labouring patients. The studies on a larger population are needed to reject the hypothesis that preterm labour is connected with increased MMP-8 plasma concentrations of women in preterm labour and threatened preterm delivery.
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... regulations governing listed fish and wildlife permits (50 CFR 222-226). NMFS issues permits based on findings... conduct water quality, [[Page 60255
Klorer, E.; Stepan, M.
Vocational education and training (VET) is the Achilles' heel of the restructuring of the Chinese economic model. With the “Made in China 2025” strategy, China wants to transform into an innovation-driven industrial nation. This can only be achieved with a highly qualified workforce. Reform of the
Meningococcal septicaemia is a life-threatening condition that all nurses working in emergency and urgent care settings are likely to come across during their careers. This article presents, and reflects on, a case study involving a woman with the disease whose signs and symptoms were atypical, and who was not therefore diagnosed with the condition immediately. The author aims to raise awareness among emergency nurses and nurse practitioners of the atypical signs and symptoms of the infection, and its consequences. The article also discusses how referring to patient scenarios can improve practice.
Schweizer, Manuel; Ayé, Raffael; Kashkarov, Roman; Roth, Tobias
Although phylogenetic diversity has been suggested to be relevant from a conservation point of view, its role is still limited in applied nature conservation. Recently, the practice of investing conservation resources based on threatened species was identified as a reason for the slow integration of phylogenetic diversity in nature conservation planning. One of the main arguments is based on the observation that threatened species are not evenly distributed over the phylogenetic tree. However this argument seems to dismiss the fact that conservation action is a spatially explicit process, and even if threatened species are not evenly distributed over the phylogenetic tree, the occurrence of threatened species could still indicate areas with above average phylogenetic diversity and consequently could protect phylogenetic diversity. Here we aim to study the selection of important bird areas in Central Asia, which were nominated largely based on the presence of threatened bird species. We show that although threatened species occurring in Central Asia do not capture phylogenetically more distinct species than expected by chance, the current spatially explicit conservation approach of selecting important bird areas covers above average taxonomic and phylogenetic diversity of breeding and wintering birds. We conclude that the spatially explicit processes of conservation actions need to be considered in the current discussion of whether new prioritization methods are needed to complement conservation action based on threatened species. PMID:25337861
Full Text Available In the last decade, the desire for safer oral anticoagulants (OACs led to the emergence of newer drugs. Available clinical trials demonstrated a lower risk of OACs-associated life-threatening bleeding events, including intracranial hemorrhage, compared to warfarin. Nontraumatic spinal hematoma is an uncommon yet life-threatening neurosurgical emergency that can be associated with the use of these agents. Rivaroxaban, one of the newly approved OACs, is a direct factor Xa inhibitor. To the best of our knowledge, to date, only two published cases report the incidence of rivaroxaban-induced nontraumatic spinal subdural hematoma (SSDH. Our case is the third one described and the first one to involve the cervicothoracic spine.
Redelmeier, Donald A.; Raza, Sheharyar
Abstract Bright sunlight may create visual illusions that lead to driver error, including fallible distance judgment from aerial perspective. We tested whether the risk of a life-threatening motor vehicle crash was increased when driving in bright sunlight. This longitudinal, case-only, paired-comparison analysis evaluated patients hospitalized because of a motor vehicle crash between January 1, 1995 and December 31, 2014. The relative risk of a crash associated with bright sunlight was estim...
Full Text Available Chiara Zecca,1,* Matteo Caporro,1,* Sandor Györik,2 Claudio Gobbi11Neurocenter of Southern Switzerland, Department of Neurology, Ospedale Regionale di Lugano, Lugano, Switzerland; 2Department of Internal Medicine, Ospedale Regionale di Bellinzona, Bellinzona, Switzerland*These authors contributed equally to this workBackground: Fingolimod (FTY mediates bronchoconstriction by interacting with sphingosine-1-phosphate receptors. The majority of the reported adverse respiratory events occur during the first weeks of treatment.Case presentation: A 49-year-old woman developed a life-threatening asthma attack after 6 months of continuous FTY treatment. The adverse event required prolonged hospitalization, and the patient recovered without sequelae after FTY interruption. A history of previous airway hyperreactivity and a concurrent viral respiratory infection possibly acted as predisposing factors.Conclusion: This first description of a severe, life-threatening asthma attack during prolonged FTY treatment suggests the need for long-term clinical surveillance, especially in patients with known predisposing factors.Keywords: multiple sclerosis, bronchial hyper-reactivity
Regimar Carla Machado
Full Text Available Theoretical and reflective study based on scientific literature and critical analysis of authors related to teaching strategies through simulation for training in cardiopulmonary resuscitation (CPR. Current teaching methodologies CPR involve realistic simulation strategies and simulations in virtual environments, but the first method provides the best results, allowing proactivity of individuals in their teaching-learning process and bringing them the experience of a life threatening situation. It is noteworthy that health professionals need to be able to assist a victim in cardiac arrest, but even existing effective teaching methodologies to enable them in this subject, is not fully applicable in the Brazilian context of health education.
... and Threatened Wildlife and Plants (List). Recovery plans help guide our recovery efforts by...] Endangered and Threatened Wildlife and Plants; Notice of Availability of a Draft Recovery Plan, First... plan, you may submit your comments in writing by any one of the following methods: U.S. mail: Field...
...-FF06E00000] Endangered and Threatened Wildlife and Plants; Revised Recovery Plan for the Utah Prairie Dog... Utah prairie dog (Cynomys parvidens). This species is federally listed as threatened under the... recovery plan for the Utah prairie dog. The Service and other Federal agencies also will take these...
...] Endangered and Threatened Wildlife and Plants; Draft Revised Recovery Plan for Utah Prairie Dog AGENCY: Fish... recovery plan for the Utah prairie dog (Cynomys parvidens). This species is federally listed as threatened... and peer reviewers in an appendix to the approved recovery plan. The Utah prairie dog (Cynomys...
Endemic crime and corruption in Bosnia are threatening the successful implementation of the Dayton Peace Agreement and until the situation is satisfactorily addressed the conditions for the complete...
... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R6-ES-2011-N021; 60120-1113-0000-D2] Endangered and Threatened Wildlife and Plants; Permits AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of receipt of applications for permits. SUMMARY: We announce our receipt of applications to...
... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R6-ES-2011-N112; 60120-1113-0000-D2] Endangered and Threatened Wildlife and Plants; Permits AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of receipt of applications for permits. SUMMARY: We announce our receipt of applications to...
... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R6-ES-2010-N181; 60120-1113-0000-D2] Endangered and Threatened Wildlife and Plants; Permits AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of receipt of applications for permits. SUMMARY: We announce our receipt of applications to...
... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R6-ES-2010-N010; 60120-1113-0000-D2] Endangered and Threatened Wildlife and Plants; Permits AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of receipt of applications for permits. SUMMARY: We announce our receipt of applications to...
... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R6-ES-2011-N056; 60120-1113-0000-D2] Endangered and Threatened Wildlife and Plants; Permits AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of receipt of applications for permits. SUMMARY: We announce our receipt of applications to...
... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R6-ES-2011-N026; 60120-1113-0000-D2] Endangered and Threatened Wildlife and Plants; Permits AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of receipt of applications for permits. SUMMARY: We announce our receipt of applications to...
... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R6-ES-2010-N095; 60120-1113-0000-D2] Endangered and Threatened Wildlife and Plants; Permits AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of receipt of applications for permits. SUMMARY: We announce our receipt of applications to...
Patients undergoing treatment of acute lymphoblastic leukemia are at risk for fungal infections including disseminated candidiasis. We describe a case of systemic Candida albicans infection associated with life-threatening gastrointestinal hemorrhage due to unusual necrotizing vasculitis involving the gastrointestinal tract. We explore the association between Candida and such vasculopathy.
Basbaum, Marcos A.; Fonseca, Renata A.A. [SEEBLA - Servicos de Engenharia Emilio Baumgart Ltda., Rio de Janeiro, RJ (Brazil)], e-mail: email@example.com, e-mail: firstname.lastname@example.org; Torggler, Bianca F.; Fernandes, Renato; Guimaraes, Ricardo Z.P. [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil)], e-mail: email@example.com, e-mail: firstname.lastname@example.org, e-mail: email@example.com
One of the major problems related to the protection of threatened species in Brazil is the current lack of primary data on their occurrence. PETROBRAS, due to the processes of environmental licensing of new pipelines, held numerous studies on the occurrence of several species. Most of these studies took place in Atlantic Forest remnants located in the states of Sao Paulo, Rio de Janeiro, Minas Gerais, Espirito Santo, Bahia, Sergipe, Alagoas and Pernambuco. This study compared primary data from these Environmental Impact Assessments with the Brazilian list of threatened species published by MMA (Brazilian Ministry of Environment). Many threatened species were recorded in areas where native forest fragments are reduced in number and size, such as those in the Northeastern region. (author)
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XC767 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration, Commerce. ACTION: Notice of availability. SUMMARY: This...
...] Endangered and Threatened Wildlife and Plants; 5-Year Status Reviews of 14 Southwestern Species AGENCY: Fish... species or subspecies of fish, wildlife, or plant, and any distinct population segment of any species of... extinction throughout all or a significant portion of its range. C. Threatened species (T) means any species...
Beard, Kenya V
Some nurse educators lack training in the educational methods that facilitate learning among underrepresented groups. Limited awareness of equitable pedagogical practices could threaten the academic achievement of underrepresented groups and hinder efforts to make the nursing profession more heterogeneous. Training in multicultural education could strengthen the capacity of educators to create culturally responsive learning environments. This quasi-experimental study examined the impact that training in critical multicultural education had on the multicultural attitudes, awareness, and practices of 37 nurse educators. A pre-posttest design without a control group found that the training was an effective way to strengthen the multicultural awareness and attitudes of nurse educators, although there was little impact on the multicultural practices. The nation's capacity to improve the quality of health care hinges upon educators who can create inclusive learning environments and graduate diverse nurses. The findings could inform policies seeking to promote diversity and inclusion in nursing education. Copyright © 2016 Elsevier Inc. All rights reserved.
Tropical forests all over the world are disappearing at high rates primarily due to anthropogenic ecosystem changes. A high number of tropical tree species is threatened with extinction due to deforestation and unsustainable levels of logging, and the implementation of effective conservation plans...... is often hindered by the lack of basic knowledge of their biology. This study represents the first region-wide analysis of population genetic diversity for tree species in Indochina and provides valuable knowledge on how threatened tree species are affected by landscape features, ancient or recent habitat...... as several separate species and accurately identified the CITES-listed D. cochinchinensis. The results can be used to update threat assessments with correct taxonomic information and the method can be implemented as an identification tool in field studies as well as in enforcement of CITES regulations...
Kleider-Offutt, Heather M; Bond, Alesha D; Williams, Sarah E; Bohil, Corey J
Prior research indicates that stereotypical Black faces (e.g., wide nose, full lips: Afrocentric) are often associated with crime and violence. The current study investigated whether stereotypical faces may bias the interpretation of facial expression to seem threatening. Stimuli were prerated by face type (stereotypical, nonstereotypical) and expression (neutral, threatening). Later in a forced-choice task, different participants categorized face stimuli as stereotypical or not and threatening or not. Regardless of prerated expression, stereotypical faces were judged as more threatening than were nonstereotypical faces. These findings were supported using computational models based on general recognition theory (GRT), indicating that decision boundaries were more biased toward the threatening response for stereotypical faces than for nonstereotypical faces. GRT analysis also indicated that perception of face stereotypicality and emotional expression are dependent, both across categories and within individual categories. Higher perceived stereotypicality predicts higher perception of threat, and, conversely, higher ratings of threat predict higher perception of stereotypicality. Implications for racial face-type bias influencing perception and decision-making in a variety of social and professional contexts are discussed.
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XC717 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration, Commerce. ACTION: Notice of decision and availability of...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... steelhead promulgated under the Endangered Species Act (ESA). The plan specifies fishery management...: January 17, 2013. Angela Somma, Chief, Endangered Species Division, Office of Protected Resources...
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XC049 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS..., 2012. Angela Somma, Chief, Endangered Species Division, Office of Protected Resources, National Marine...
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XA631 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS.... Therese Conant, Acting Chief, Endangered Species Division, Office of Protected Resources, National Marine...
Ambikabai Raghavanpillai Sivu
Full Text Available Memecylon clarkeanum Cogn., an endemic and threatened species of Sri Lanka characterized by narrowly filiform foliar sclereids is reported and described as a new record for India from Wayanad, Kozhikode, Malappuram and Palakkad districts of Kerala.
... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R6-ES-2010-N149; 60120-1113-0000-D2] Endangered and Threatened Wildlife and Plants; Permits AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of receipt of applications for permits. SUMMARY: We announce our receipt of an application to...
... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R3-ES-2009-N0054]; [30120-1113-0000-F6] Endangered and Threatened Wildlife and Plants; Permits AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of availability of permit applications; request for comments. SUMMARY: We, the U.S. Fish and...
A study was carried out in Mara River and Lake Kirumi in January/February, 2005 to investigate the importance oJ. the wetland as a refuge site for indigenous cichlids particularly tilapiines which have either disappeared from Lake Victoria or threatened. Fish samples were obtained using experimental gillnets whose ...
... Hind as Threatened or Endangered Under the Endangered Species Act AGENCY: National Marine Fisheries... speckled hind (Epinephelus drummondhayi) as threatened or endangered under the Endangered Species Act (ESA... under the U.S. Endangered Species Act'' because NatureServe assessments ``have different criteria...
Barber, Samuel R; Kozin, Elliott D; Dedmon, Matthew; Lin, Brian M; Lee, Kyuwon; Sinha, Sumi; Black, Nicole; Remenschneider, Aaron K; Lee, Daniel J
Surgical simulators are designed to improve operative skills and patient safety. Transcanal Endoscopic Ear Surgery (TEES) is a relatively new surgical approach with a slow learning curve due to one-handed dissection. A reusable and customizable 3-dimensional (3D)-printed endoscopic ear surgery simulator may facilitate the development of surgical skills with high fidelity and low cost. Herein, we aim to design, fabricate, and test a low-cost and reusable 3D-printed TEES simulator. The TEES simulator was designed in computer-aided design (CAD) software using anatomic measurements taken from anthropometric studies. Cross sections from external auditory canal samples were traced as vectors and serially combined into a mesh construct. A modified tympanic cavity with a modular testing platform for simulator tasks was incorporated. Components were fabricated using calcium sulfate hemihydrate powder and multiple colored infiltrants via a commercial inkjet 3D-printing service. All components of a left-sided ear were printed to scale. Six right-handed trainees completed three trials each. Mean trial time (n = 3) ranged from 23.03 to 62.77 s using the dominant hand for all dissection. Statistically significant differences between first and last completion time with the dominant hand (p 3D-printed simulator is feasible for TEES simulation. Otolaryngology training programs with access to a 3D printer may readily fabricate a TEES simulator, resulting in inexpensive yet high-fidelity surgical simulation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XA183 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... regulations (50 CFR parts 222-226) governing listed fish and wildlife permits. [[Page 5339
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XD040 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... NMFS regulations (50 CFR parts 222-226) governing listed fish and wildlife permits. [[Page 77660...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS...) and 14092 (applicant: California Department of Fish and Game). In that notice, the permit application... American green sturgeon associated with conducting surveys measuring fish response to initial and...
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XA110 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... and the Washington Department of Fish and Wildlife submitted to NMFS, pursuant to the protective...
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XC444 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... species. Dated: January 16, 2013. Angela Somma, Chief, Endangered Species Division, Office of Protected...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... under the Endangered Species Act (ESA). The proposed research program is intended to increase knowledge.... Lisa Manning, Acting Chief, Endangered Species Division, Office of Protected Resources, National Marine...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... and steelhead under the Endangered Species Act (ESA). The HGMPs specify the operations of four... Somma, Chief, Endangered Species Division, Office of Protected Resources, National Marine Fisheries...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... is intended to increase knowledge of species listed under the Endangered Species Act (ESA) and to..., Chief, Endangered Species Division, Office of Protected Resources, National Marine Fisheries Service...
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XW33 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: NOAA's National Marine Fisheries Service (NMFS... permit. Dated: May 4, 2010. Therese Conant, Acting Chief, Endangered Species Division, Office of...
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XC342 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... NMFS regulations governing listed fish and wildlife permits (50 CFR parts 222-226). Those individuals...
Sheetz, Anne H.; Goldman, Patricia G.; Millett, Kathleen; Franks, Jane C.; McIntyre, C. Lynne; Carroll, Constance R.; Gorak, Diane; Harrison, Christanne Smith; Carrick, Michele Abu
During the past decade, prevalence of food allergies among children increased. Caring for children with life-threatening food allergies has become a major challenge for school personnel Prior to 2002, Massachusetts did not provide clear guidelines to assist schools in providing a safe environment for these children and preparing for an emergency…
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XA182 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... are issued in accordance with and are subject to the ESA and NMFS regulations governing listed fish...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... and steelhead, and natural juvenile green sturgeon while carrying out a study measuring fish response... species, taking of length measurements), tissue sampling, release of moribund fish or fish carcasses back...
Oosterhuis, J. K.; van den Berg, G.; Monteban-Kooistra, W. E.; Ligtenberg, J. J. M.; Tulleken, J. E.; Zijlstra, J. G.; Meertens, John
We describe two patients with a severe Cushing's syndrome due to ectopic production of ACTH. Both patients developed a life-threatening Pneumocystis jiroveci pneumonia (PCP) shortly after treatment of the hypercortisolism was started by means of inhibition of production of glucocorticoids and
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... River fall Chinook salmon under the Endangered Species Act (ESA). The FMEP specifies the future... fish, sturgeon, carp, and other species.'' The FMEP describes the management of recreational fisheries...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... promulgated under the Endangered Species Act (ESA). The plans specify the propagation of five species of... 10, 2000). Dated: December 17, 2012. Angela Somma, Chief, Endangered Species Division, Office of...
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XA866 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... Endangered Species Act (ESA) and to help guide management and conservation efforts. The application may be...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... regulations promulgated for Pacific salmon and steelhead under the Endangered Species Act (ESA). The HGMPs...). Dated: May 3, 2012. Angela Somma, Chief, Endangered Species Division, Office of Protected Resources...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... research permit application request relating to salmonids listed under the Endangered Species Act (ESA... research activities. The purpose of the research program is to collect warmwater fish species to analyze...
...] Endangered and Threatened Wildlife and Plants; Permit Applications AGENCY: Fish and Wildlife Service... Regional Director, Attn: Lisa Mandell, U.S. Fish and Wildlife Service, Ecological Services, 5600 American... Butterfly (Lycaeides melissa samuelis) adults, eggs and larvae to test interactions with wild lupine of...
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XC630 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: NOAA's National Marine Fisheries Service (NMFS... CFR parts 222-226) governing listed fish and wildlife permits. Species Covered in This Notice This...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... regulations governing listed fish and wildlife permits (50 CFR parts 222-226). NMFS issues permits based on.... This project will examine predation by introduced fishes (striped bass, largemouth bass, smallmouth...
... Marlin as Threatened or Endangered Under the Endangered Species Act AGENCY: National Marine Fisheries... white marlin (Kajikia albidus) as threatened or endangered under the Endangered Species Act (ESA). We... do ``not constitute a recommendation by NatureServe for listing under the U.S. Endangered Species Act...
Liu, Dong; Wang, Li; Wang, Ying; Jiang, Yi
Previous research has demonstrated that emotional information processing can be modulated by what is being held in working memory (WM). Here, we showed that such content-based WM effects can occur even when the emotional information is suppressed from conscious awareness. Using the delayed-match-to-sample paradigm in conjunction with continuous flash suppression, we found that suppressed threatening (fearful and angry) faces emerged from suppression faster when they matched the emotional valence of WM contents than when they did not. This effect cannot be explained by perceptual priming, as it disappeared when the faces were only passively viewed and not held in WM. Crucially, such an effect is highly specific to threatening faces but not to happy or neutral faces. Our findings together suggest that WM can modulate nonconscious emotion processing, which highlights the functional association between nonconsciously triggered emotional processes and conscious emotion representation. © The Author(s) 2016.
Lazarov, Amit; Abend, Rany; Seidner, Shiran; Pine, Daniel S; Bar-Haim, Yair
Current attention bias modification (ABM) procedures are designed to implicitly train attention away from threatening stimuli with the hope of reducing stress reactivity and anxiety symptoms. However, the mechanisms underlying effective ABM delivery are not well understood, with awareness of the training contingency suggested as one possible factor contributing to ABM efficacy. Here, 45 high-anxious participants were trained to divert attention away from threat in two ABM sessions. They were randomly assigned to one of three training protocols: an implicit protocol, comprising two standard implicit ABM training sessions; an explicit protocol, comprising two sessions with explicit instruction as to the attention training contingency; and an implicit-explicit protocol, in which participants were not informed of the training contingency in the first ABM session and informed of it at the start of the second session. We examined learning processes and stress reactivity following a stress-induction task. Results indicate that relative to implicit instructions, explicit instructions led to stronger learning during the first training session. Following rest, the explicit and implicit groups exhibited consolidation-related improvement in performance, whereas no such improvement was noted for the implicit-explicit group. Finally, although stress reactivity was reduced after training, contingency awareness did not yield a differential effect on stress reactivity measured using both self-reports and skin conductance, within and across sessions. These results suggest that explicit ABM administration leads to greater initial learning during the training protocol while not differing from standard implicit administration in terms of off-line learning and stress reactivity. Copyright © 2017. Published by Elsevier Ltd.
Chi, Xiu-Lian; Yuan, Yi-Kai; Fang, Bo; Zhang, Xiao-Bo; Yang, Han-Yu; Zhao, Zhi-Ping; Li, Guo; Fu, Kai-Cong; Guo, Lan-Ping; Huang, Lu-Qi
The rich diversity in medicinal plants provides an important material basic for the development of Traditional Chinese medicine in China. It is important to explore the present situation of medicinal plants within special regions in order to provide scientific instructions for their sustainable protection and exploitation and utilization. In this study, we carried out the field survey according to the guideline of national survey of Chinese material medica resources and the guideline of plant species diversity survey and estimation at county level with the line transect method. With the field surveyed data, we explored the diversity and distribution of the threatened medicinal vascular plants in Lancang. We found that there were 33 species of the threatened medicinal vascular plants in this county. These species were from 23 genera and 17 families, and were composed of one critical endangered, 10 endangered and 22 vulnerable species. They were widely distributed across the whole county and were most concentrated in the town of Nuozhadu, Fazhanhe, Nuofu and Zhutang, which were located in the southeastern, southwestern and western of Lancang, respectively. We also found that the plant species richness followed a unimodal pattern along elevation. In addition, we found that the areas of Nuozhadu Nature Reserve in Lancang only covered six threatened medicinal vascular plants, while most of the regions with high species richness were not well protected. Therefore, we proposed to make more efforts to improve the protection measurements in order to better protect and utilize the medicinal plants in Lancang. Copyright© by the Chinese Pharmaceutical Association.
Jasmine R Lee
Full Text Available Effective conservation management for climate adaptation rests on understanding the factors driving species' vulnerability in a spatially explicit manner so as to direct on-ground action. However, there have been only few attempts to map the spatial distribution of the factors driving vulnerability to climate change. Here we conduct a species-level assessment of climate change vulnerability for a sample of Australia's threatened species and map the distribution of species affected by each factor driving climate change vulnerability across the continent. Almost half of the threatened species assessed were considered vulnerable to the impacts of climate change: amphibians being the most vulnerable group, followed by plants, reptiles, mammals and birds. Species with more restricted distributions were more likely to show high climate change vulnerability than widespread species. The main factors driving climate change vulnerability were low genetic variation, dependence on a particular disturbance regime and reliance on a particular moisture regime or habitat. The geographic distribution of the species impacted by each driver varies markedly across the continent, for example species impacted by low genetic variation are prevalent across the human-dominated south-east of the country, while reliance on particular moisture regimes is prevalent across northern Australia. Our results show that actions to address climate adaptation will need to be spatially appropriate, and that in some regions a complex suite of factors driving climate change vulnerability will need to be addressed. Taxonomic and geographic variation in the factors driving climate change vulnerability highlights an urgent need for a spatial prioritisation of climate adaptation actions for threatened species.
... Petitions To List the Pinto Abalone as Threatened or Endangered Under the Endangered Species Act AGENCY... kamtschatkana) as a threatened or endangered species under the Endangered Species Act (ESA) and to designate... recommendation by NatureServe for listing under the U.S. Endangered Species Act'' because NatureServe assessments...
Hendriks, K.S.W.H.; Van Langen, I.M.; Van Tintelen, J.P.; Grosfeld, F.J.M.; Wilde, A.A.M.; Ten Kroode, H.F.J.
Objective. This exploratory study serves to illustrate the psychological impact on an extended family in the process of genetic counselling and testing for a potentially life-threatening arrhythmia, the long-QT syndrome (LQTS). Method. All members of the third generation and their partners (n=11)
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... number of predicted adults increase, the number of fish escaping to the spawning grounds will also... fish; and (3) application of a sliding scale approach to determine appropriate ESA take limits on...
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XC690 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... Department of Fish and Wildlife (ODFW), Washington Department of Fish and Wildlife (WDFW), and U.S. Bureau of...
... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XA928 Endangered and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... advises the public that a direct take permit has been issued to the Washington Department of Fish and...
... and Threatened Species; Take of Anadromous Fish AGENCY: National Marine Fisheries Service (NMFS... plans and request for comment. SUMMARY: Notice is hereby given that the Oregon Department of Fish and... River and Columbia River basins by providing hatchery fish to support fishing opportunities while...