Exploring implicit bias among ENT surgeons: an analysis of the implicit association test.

OBJECTIVE: This study aimed to investigate the presence of implicit bias among ENT surgeons and explore the impact of the results of the Implicit Association Test on the surgeons' behaviour towards patients. METHOD: Seven ENT surgeons who were not black, Asian or minority ethnic were asked to complete the Race Implicit Association Test. The surgeons also completed a survey about their perceptions of their implicit biases and the impact of the Race Implicit Association Test results on their behaviour towards patients. RESULTS: The mean Race Implicit Association Test score for the ENT surgeons suggested a slight bias that favoured white over black people. Furthermore, 42 per cent of the surgeons thought that they had hidden or unconscious racial bias, 42 per cent said they would change their behaviour towards patients after receiving these results and 85 per cent thought that the Race Implicit Association Test was helpful for appraisal purposes. CONCLUSION: The results suggest that ENT surgeons who are not black, Asian or minority ethnic may have implicit biases towards black patients. These findings highlight the need for interventions to reduce implicit bias among ENT surgeons and improve healthcare outcomes for marginalised populations.

Exploring subconscious bias.

BACKGROUND: Implicit biases may lead to subconscious evaluations of a person based on irrelevant characteristics such as race or gender. This audit investigates the presence of implicit bias in the management of patients who missed appointments in our department. METHODS: This study retrospectively analysed discharge rates in 285 patients who missed an out-patient appointment between 1 May 2020 and 1 April 2021 at Guy's and St Thomas' Hospital. After reading the patients' names, 285 patients were categorised into genders, and ethnic categories of: White British; Black, Asian and minority (non-White) ethnic ('BAME'); and other White. RESULTS: There were no differences in discharge rates in terms of self-reported ethnic and gender groups. However, patients perceived as White British were less likely to be discharged when compared to patients perceived as Black, Asian and minority ethnic (35 per cent vs 58 per cent). Discharge rates for perceived gender did not differ. CONCLUSION: Implicit bias may influence decision-making regarding whether to rebook a patient after missing an appointment.

Hot saline irrigation for haemostasis in functional endoscopic sinus surgery: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to perform a systematic review and meta-analysis of existing evidence on the role of hot saline irrigation in patients undergoing functional endoscopic sinus surgery and its impact on the visibility of the surgical field. METHOD: A search of PubMed, Cochrane, Ovid databases and Google Scholar was performed. RESULTS: Three randomised controlled trials were included. Pooled meta-analysis demonstrated a statistically significant better visibility of the surgical field, and a reduction in total blood loss and operating time during functional endoscopic sinus surgery in the hot saline irrigation group compared with the room temperature irrigation group. Subgroup analysis of studies that did not use vasoconstrictors showed a significant reduction in total blood loss and operating time. CONCLUSION: This is the first systematic review that addresses hot saline irrigation for haemostasis in functional endoscopic sinus surgery. The results suggest that hot saline irrigation in functional endoscopic sinus surgery for chronic rhinosinusitis may significantly improve visibility of the surgical field, reduce total blood loss by 20 per cent and decrease operating time by 9 minutes. However, there are limitations of the study because of the significant heterogeneity of the methods, quality and size of the studies.

Co-morbid anxiety and depression impacts on the correlation between symptom and radiological severity in patients with chronic rhinosinusitis.

BACKGROUND: Previous studies have reported that there is little correlation between sino-nasal outcome test (SNOT-22) score in chronic rhinosinusitis (CRS) and objective radiological scoring, although conclusions vary. We aimed to investigate whether comorbid anxiety and depression, which are highly prevalent in patients with CRS may cause symptom amplification and account for the lack of correlation in previous studies. METHODOLOGY: 100 patients with CRS were evaluated using the General Anxiety Disorder-7 (GAD-7), Patient Health Question- naire-9 (PHQ-9) and SNOT-22 questionnaires as well as the Lund Mackay Score (LMS). RESULTS: Overall correlation analysis did not show a significant relationship between SNOT-22 and LMS scores. Subgroup analysis of patients who do not suffer with anxiety and depression showed a significant correlation between SNOT-22 and LMS scores. The nasal domain of the SNOT-22 showed strongest correlation to LMS in this patient group. We also observed a significant difference in both median SNOT-22 and LMS between patients who suffered both anxiety and depression and patients without either co- morbidity. CONCLUSION: When CRS patients who do not have anxiety and depression are analysed in isolation, or when these conditions are controlled in a multivariable regression, there is a significant correlation between radiological findings and symptom score. This correlation is absent in patients with co-morbid anxiety and depression. Anxiety and depression should be considered in patients in whom there is a mismatch in symptom and radiological disease severity as it is associated with symptom amplification.