Assessing the Quality and Readability of Web-Based Information on Otoplasty.

Introduction: As health care-related internet use expands, parents and patients considering otoplasty frequently turn to online resources for further information to aid their decision making. Objective: In online resources related to otoplasty, what is the quality of the information and how readable is it based on standardized tests? Methods: A web search was performed on the three major search engines, using search terms related to otoplasty. The top 20 results from each search engine were selected. The DISCERN instrument was applied to assess the quality of health information, whereas the Flesch-Kincaid readability tests were used to assess readability. Results: The mean DISCERN score was 28.7 out of a possible score of 80 (poor quality) and commercial bias was common. The Flesch-Kincaid readability test results were significantly higher than the average reading level for adults in the United Kingdom. On the largest search engine, there was a correlation between search engine ranking and both readability and quality. Conclusion: Online patient information resources on otoplasty are generally of poor quality and difficult to read for the average patient.

Occurrence and distribution of pesticides in precipitation as revealed by targeted screening through GC-MS/MS.

Facing the tough challenge of precise measurement of ever-increasing numbers of organic contaminants in the environment, there is an urgent need for more reliable and cost-effective methodologies. In this study, we developed and validated a screening method for analysis of over 450 pesticides in precipitation using gas chromatography with tandem mass spectrometry (GC-MS/MS) in multiple reaction monitoring (MRM) mode. Solid phase extraction (SPE) was applied to extract target analytes from precipitation. Using this targeted approach, we managed to detect 123 pesticides with maximum retention time shifts below 0.1 min (except for DEET) in 101 precipitation samples collected between October 2015 and March 2017 in Singapore. This is probably the first study to report the measurements of a wide range of pesticides in precipitation. A spectrum of insecticides, herbicides, fungicides and their synergists were detected and among them DEET, malathion and carbaryl were the most frequently detected pesticides (detection frequency: 100%, 96% & 67%). The Spearman correlations suggest that some pesticides of different subgroups had significant correlations. It is believed that these finding could shed light on the understanding of the contribution of precipitation to environmental contaminants in water cycle.

Peri-operative management of high-risk paediatric adenotonsillectomy patients: A survey of 35 UK tertiary referral centres.

INTRODUCTION: Peri-operative management of high-risk paediatric patients undergoing adenotonsillectomy for treatment of obstructive sleep apnoea varies between tertiary referral hospitals. 'Day of surgery cancellation' (DoSC) rates of up to 11% have been reported due to pre-booked critical care being unavailable on the day of surgery as a result of competing needs from other hospital departments. We report the results of a survey of peri-operative management in UK tertiary care centres of high-risk paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea (OSA). METHODS: An 8-point questionnaire was developed using a cloud-based software platform (www.surveymonkey.com). A web-link to the survey was embedded in a customised e-mail which was sent via secure server to the Clinical Leads for Paediatric Otolaryngology at 35 United Kingdom (UK) Tertiary referral centres. RESULTS: The survey response rate was 60% (n = 21). Almost all (94.1%) of centres considered paediatric critical care facilities to be limited, with 70.6% (n = 12) stating that DoSC often occurred due to unavailable paediatric critical care capacity. There was variation between tertiary referral units in the practice applied for pre-booking critical care beds (our survey identifies 6 variations) (Table 1). The most frequent selection method reported (47.1%) was at the discretion of the booking clinician at the time of listing the patient for surgery. CONCLUSION: In the context of limited critical care resources, variation in practice and difficulty in accurately predicting which patients will require post-operative critical care beds, a review and consensus on best practice in the peri-operative management of high risk paediatric adenotonsillectomy patients may offer a safe means of reducing cancellations and improving patient care, resource allocation and hospital efficiency.

Bilateral otorrhagia: a rare complication of laparoscopic abdominopelvic surgery.

An 80-year-old woman without any previous otological symptoms underwent laparoscopic abdominoperineal resection for T3N0M0 low rectal carcinoma 4-5 cm from the anal verge. The total operative time was 6 h, of which she spent long hours in the Trendelenburg (35°) position due to difficult pelvic dissection. Midway through the procedure, she developed spontaneous non-traumatic bilateral otorrhagia. This case highlights the potential risk of increased intracranial pressure during prolonged periods of being in a steep Trendelenburg position caused either by the position itself or in combination with carbon dioxide pneumoperitoneum. We also consider the effect of a sudden change from this position to supine as a potential risk.

Is acupuncture beneficial in the treatment of Bell's palsy?: best evidence topic (BET).

A best evidence topic in facial nerve surgery was written according to a structured protocol. The question addressed was: in [patients with Bell's palsy], does [acupuncture] improve [facial nerve function and/or pain]? A total of 43 papers were identified using the reported search protocol, of which three articles represented the best available evidence to answer the clinical question. Two of these articles were review papers and together encompassed 13 primary articles. Publication details, type of study, patients studied, outcomes and results are tabulated. The two level 1 articles concluded that before firm conclusions can be drawn, better designed trials are required in order to establish whether acupuncture confers any benefit to patients with Bell's palsy. The level 2 randomised controlled trial (RCT) suggested that two methods of acupuncture were associated with significant improvements in pain in Bell's palsy, although the trial was poorly controlled and had risk of bias. Therefore, the clinical bottom line is that until well designed trials are able to clearly demonstrate a role for acupuncture in Bell's palsy, its efficacy should be considered to remain unproven.

Are head bandages required post-pinnaplasty?

A best evidence topic in ear, nose and throat surgery was written according to a structured protocol. The question addressed was: In patients who are undergoing pinnaplasty for prominent ears, does the use of post-operative head bandages as compared to not using post-operative head bandages improve clinical outcomes? A total of 121 papers were identified using the reported search protocol, of which five articles represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All five studies showed that no advantage exists in using head bandages with patients who have undergone pinnaplasty. Four of the five studies concluded that head bandages should not be utilised at all, whereas two of the five studies suggested that there is little reason to use head bandages after the first 24 h post-pinnaplasty. Therefore, the clinical bottom line is that provided the pinnaplasty result is good at time of surgery, there is reasonable evidence to suggest that head bandages have no effect on complications or patient satisfaction, so at best they are unnecessary and at worst, their physical drawbacks may actually outweigh any of their perceived benefits.

Fibroblast growth factor receptor expression in aural polyps: predictor of cholesteatoma?

The cytokine, fibroblast growth factor (FGF) and its receptors (FGFR) have a pivotal role in wound repair and have been demonstrated in the perimatrix of active cholesteatoma. Aural polyps are a recognized inflammatory reaction of middle-ear mucosa to cholesteatoma, but may arise in its absence. This study examines 28 archival aural polyp specimens, seeking an increased expression for FGFR1 and FGFR3 in polyps associated with cholesteatoma, when compared with those arising in non-cholesteatomatous, mucosal disease, but produced a null result. There was no difference demonstrated in staining intensity between those polyps associated with cholesteatoma and those without. There was a strong correlation between staining patterns of FGFR1 and FGFR3 (r = 0.4, p <0.03). The expression pattern, of nuclear and perinuclear localization, may support the view that nuclear translocation of growth factors, and their receptors, could be related to the cellular proliferation that is associated with cholesteatoma.