Pediatric Robotic Laryngeal Cleft Repair.

OBJECTIVE: Compare surgical and swallow outcomes in robotic versus traditional laryngeal cleft (LC) repairs. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care pediatric hospital. METHODS: Pediatric patients who underwent robotic or traditional (open or endoscopic) LC repair between 2010 and 2021 were identified. Patient characteristics, operative times, adverse events, hospital length of stay (LOS), and modified barium swallow study (MBSS) results were compared. RESULTS: Eighteen robotic and thirty traditional LC repairs were identified. Mean surgical (149 vs 111 min, P < .05) and OR times (207 vs 139 min, P < .002) were increased for robotic type I LC repairs, but were similar for type II and III LC. Mean hospital LOS was increased for robotic type I LC repairs (2.6 vs 1.2 days, P < .006), but was decreased for type II (4 vs 12.2 days) and type III (4.3 vs 94.5 days) LC. Postoperative MBSS results were improved for robotic type I LC repairs at 12 months (82% vs 43%, P = .05), and trended toward improvement at 6 months for type II (75% vs 22%), and type III (67% vs 50%) LC repairs, although significance was limited for type II and III LC due to the number of subjects. A robotic approach was used successfully to revise all recurrent LC that failed traditional repairs. CONCLUSION: Robotic type 1 LC repairs demonstrated increased operative times and hospital LOS but improved postoperative swallow outcomes compared to traditional approaches may be particularly useful in cases of recurrent clefts.

A Mixed-Methods Needs Assessment for a Longitudinal Surgical Preparation Course in Undergraduate Medical Education.

OBJECTIVE: To assess the unmet needs associated with surgical education and skill development during the pre-clerkship years of medical school. DESIGN: A mixed-methods design was employed that leveraged semi-structured interviews and quantitative surveys followed by qualitative analysis. SETTING: A large midwestern academic medical center. PARTICIPANTS: Eighteen participants were enrolled representing second year medical students with an interest in surgery, surgical residents, and attending surgeons from a diverse array of surgical specialties. RESULTS: Unanimous support for the creation of a pre-clerkship surgical skills course emerged due to 2 main themes: (1) gaps in current surgical education offerings and (2) the value of early exposure to surgery and surgical skills followed by longitudinal practice. The components that participants deemed essential to a well-designed course were also revealed. Each stakeholder group (medical students, residents, surgeons) would benefit across all factors uncovered. CONCLUSIONS: There is a significant unmet need across all stakeholder groups for the creation of a longitudinal surgical skills course for pre-clerkship medical students. Future studies should seek to design a curriculum based on these study results and assess a pilot version of the curriculum to understand its feasibility under application.

Infant mortality inequities for Maori in New Zealand: a tale of three policies.

BACKGROUND: The history of infant mortality inequities among Maori in New Zealand provides a remarkable case study for understanding the shortcomings of policy which fails to consider the differential risks associated with disadvantaged groups. Specifically, the failure of the initial 1991 reform in addressing Maori infant health, followed by the relative success of post-1994 policy, demonstrate that disadvantaged populations carry differential social risks which require adjusting policy accordingly. Literature on these policies show that differential risks may include disparities in representation, access to resources, socioeconomic status, and racism. The consideration of differential risks is important in analyzing the underlying causes of inequities and social policy deficiencies. AIM: To describe and illustrate the need for policy addressing inequities to consider the differential risks associated with disadvantaged groups through an analysis of New Zealand's Maori infant mortality policy progression. METHODS: The article is a commentary on a series of policies aimed at reducing infant mortality in New Zealand. It analyses three policies and how their differences are linked to the corresponding trends in equity between Maori and non-Maori populations. FINDINGS: The progression of Maori infant mortality policy clearly demonstrates that equitable social policy must be culturally sensitive and inclusive towards disadvantaged groups, as well as willing to adapt to changing circumstances and shortcomings of current policy. Prior to 1994, health policy which did not account for the differential risks of Maori populations caused inequities in infant mortality to increase, despite infant mortality decreasing on a national level. After policy was adjusted to account for Maori-specific risks in 1994, infant mortality inequities significantly declined. A comprehensive analysis of these policies shows that the consideration of differential risks is highly related to a decrease in corresponding inequities. CONCLUSIONS: As New Zealand, and other countries facing inequities such as the United States and Australia, move forward in constructing policy, they would do well to consider the lessons of how New Zealand policy changed the frequency of infant mortality in Maori populations. The study shows that the consideration of differential risks associated with disadvantaged groups is necessary for policy to successfully address inequities.