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1.
J Craniofac Surg ; 35(4): 1129-1133, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38688025

RESUMO

Understanding rhinoplasty characteristics important to patients, physicians, and society is essential for evaluating outcomes and designing optimal treatment plans. The authors aimed to elucidate specific rhinoplasty-related outcomes that are most important to patients, surgeons, and the general population. A cross-sectional survey comprising 11 rhinoplasty-specific characteristics, was distributed to patients, facial plastic surgeons, and the general population. Adult patients presenting for rhinoplasty consideration or follow-up after undergoing rhinoplasty were recruited. Characteristics rankings were compared between the 3 respondent groups using Spearman's rank correlation coefficient (ρ). Responses from 150 surgeons, 111 patients, and 102 lay individuals from the general population were included for analysis. When ranking rhinoplasty-specific characteristics in order of importance, patients and the general population ranked "ability to breathe through nose while awake" first and "overall appearance of nose" as second. Surgeons ranked "overall appearance of nose" first and "ability to breathe through nose while awake" second. There were strong correlations between patients' and surgeons' rankings (Spearman's ρ=0.836, P =0.002), between patients' and the general population's rankings (Spearman's ρ=0.773, P =0.007), and between surgeons' and the general population's rankings (Spearman's ρ=0.782, P =0.006). Our results highlight a significant correlation between characteristics of the "ideal" nose as determined by patients, surgeons, and the general population.


Assuntos
Rinoplastia , Humanos , Feminino , Masculino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários , Resultado do Tratamento , Satisfação do Paciente , Estética
3.
Laryngoscope ; 134(2): 629-636, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37466290

RESUMO

OBJECTIVES: As the volume of research publications in the field of otolaryngology has increased, so has the need to qualify articles through bibliometric analyses to identify the most important and impactful work in the field. Herein, we aim to identify the 100 most disruptive articles in ENT over a 60-year period and examine how disruption index (DI) compares with other bibliometrics in identifying impactful works in the field. METHODS: In this cross-sectional bibliometric analysis, articles published between 1954 and 2014 in commonly referenced otolaryngology-head and neck surgery (OHNS) journals were queried in PubMed. Publications were characterized by DI, journal, subspecialty discipline, and status as an impactful article in the field as determined by other bibliometrics such as citation count, the "Sleeping Beauty Index," and those derived by the modified Delphi process. RESULTS: Of the 122,094 articles queried, 67,561 (55.3%) had available citation count as well as disruption score data, meeting inclusion criteria. The most represented subspecialty disciplines within the top 100 most disruptive articles were Otology/Neurotology (28%), General (Comprehensive) (27%), Head and Neck Surgery (12%), and Laryngology (11%). Fifty percent of articles identified as Sleeping Beauties and impactful via modified Delphi approach had scores in the top 86th percentile. CONCLUSION: DI in otolaryngology can be appreciated as an added dimension to existing indices and can unearth seminal research, which serve as early foundations of evidence-based management in the field of OHNS today. LEVEL OF EVIDENCE: NA Laryngoscope, 134:629-636, 2024.


Assuntos
Laringoscópios , Otolaringologia , Humanos , Estudos Transversais , Bibliometria , Publicações
4.
J Craniofac Surg ; 34(8): 2453-2454, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37772877

RESUMO

Facial rejuvenation outcomes have not been well studied in patients with granulomatosis with polyangiitis (GP)-formerly Wegener granulomatosis. This report highlights a case of a 49-year-old female with a history of GP, presenting with facial aging and functional nasal concerns. The patient underwent facial rejuvenation and nasal reconstruction procedures, including primary open functional rhinoplasty, septal perforation repair with Alloderm, deep-plane rhytidectomy, platysmaplasty, nanofat grafting, and fractionated erbium laser to the face (sparing the nose and peri-incisional areas). Despite a routine operation, postoperative course was complicated by wound healing and vascular congestion issues related to her underlying autoimmune disease. This case highlights the risks associated with postsurgical healing in patients with GP undergoing esthetic surgery. To the best of our knowledge, this report is the first to discuss management considerations in a patient with GP undergoing facial rejuvenation surgery.


Assuntos
Granulomatose com Poliangiite , Rinoplastia , Ritidoplastia , Envelhecimento da Pele , Humanos , Feminino , Pessoa de Meia-Idade , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/cirurgia , Rejuvenescimento , Ritidoplastia/métodos , Nariz/cirurgia , Rinoplastia/métodos
6.
Otolaryngol Head Neck Surg ; 169(4): 1094-1097, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37003295

RESUMO

With the increasing consolidation of physician practices, private equity (PE) firms have been playing a growing role in healthcare delivery and recently began entering the otolaryngology-head and neck surgery space. To date, no studies have examined the extent of PE investment in otolaryngology. We assessed trends and geographic distribution of US otolaryngology practices acquired by PE using Pitchbook (Seattle, WA), a comprehensive market database. From 2015 to 2021, 23 otolaryngology practices were acquired by PE. The number of PE acquisitions increased over time: 1 practice was acquired in 2015 versus 4 practices in 2019 versus 8 practices in 2021. Nearly half (43.5%, n = 10) of acquired practices were in the South Atlantic region. The median number of otolaryngologists at these practices was 5 (interquartile range: 3-7). As PE investment in otolaryngology continues to grow, further research is needed to assess its impact on clinical decision-making, healthcare costs, physician job satisfaction, clinical efficiency, and patient outcomes.


Assuntos
Otolaringologia , Médicos , Humanos , Otorrinolaringologistas , Custos de Cuidados de Saúde , Padrões de Prática Médica
7.
Otolaryngol Head Neck Surg ; 168(5): 1253-1257, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36939542

RESUMO

Bioabsorbable implants (eg, Latera) have recently been approved for addressing nasal valve collapse. The purpose of this study is to summarize adverse events and treatment sequelae associated with bioabsorbable nasal implants queried in the Manufacturer and User Facility Device Experience (MAUDE) database. Of the 26 device reports entered between March 2017 and April 2022, the most frequently reported complications included abscess (n = 13) and implant protrusion (n = 5). Other common symptoms reported greater than 1-year postimplantation included facial pain/discomfort (n = 3) and failure to absorb (n = 3). Management of adverse events included treatment with antibiotics (n = 9), steroid injections (n = 4), and explantation (n = 20). In 3 reports, adverse reactions required a biopsy of adjacent tissue for pathologic analysis. These findings suggest that further research is required to assess the potential long-term complications and optimize the management of bioabsorbable nasal implants. Furthermore, standardized reporting templates may improve the utility of the MAUDE database.


Assuntos
Implantes Absorvíveis , Humanos , Estados Unidos , Bases de Dados Factuais , United States Food and Drug Administration
8.
Otolaryngol Head Neck Surg ; 168(5): 1006-1014, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36939550

RESUMO

OBJECTIVE: To assess how traditional, simple markers of health independently affect postoperative morbidity of mandibular fracture open reduction-internal fixations (ORIFs). STUDY DESIGN: Cohort study. SETTING: National Surgical Quality Improvement Project (NSQIP) Database. METHODS: The 2005 to 2017 NSQIP database was queried for patients who underwent mandibular ORIF. To control for the severity of the trauma, an additional "concurrent surgery" variable was created. A modified 5-item frailty index was calculated based on the following: presurgery-dependent functional status, chronic hypertension, diabetes mellitus, history of chronic obstructive pulmonary disease, and history of congestive heart failure. RESULTS: Among 1806 patients with mandibular ORIFs (mean age 34.8 ± 15.4 years), modified frailty index (mFI) was associated with 30-day medical complications (p < .001), reoperation (p < .001), and readmission (p = .005) on univariate analysis. Increased age was associated with prolonged hospitalization (p < .001) and medical complications (p < .001). The increased American Society of Anesthesiologists (ASA) score was associated with all endpoints (p ≤ .003), while increased body mass index (BMI) was associated with none. On multivariate analysis, only increased ASA was associated with any adverse event (reference: ASA 1; ASA 2, odds ratio [OR]: 2.17 [95% confidence interval, CI: 2.17-3.71], p = .004; ASA 3-4, OR: 3.63 [95% CI: 1.91-6.91], p < .001). Similarly, mFI and BMI were not independently associated with prolonged hospitalization (≥2 days) (p ≥ .015), but 65+ age (reference: 18-49; OR: 2.33 [95% CI: 1.40-3.86], p = .001) and ASA 3 to 4 groups (reference: ASA 1; OR: 3.26 [95% CI: 2.06-5.14], p < .001) were. CONCLUSION: ASA status and age are more useful modalities than mFI or BMI in predicting poor postoperative morbidity in mandibular ORIF. These simple metrics can assist with managing surgeons' expectations for mandibular ORIF patients.


Assuntos
Fragilidade , Fraturas Mandibulares , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Fragilidade/complicações , Estudos de Coortes , Fraturas Mandibulares/cirurgia , Fraturas Mandibulares/complicações , Índice de Massa Corporal , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Morbidade , Estudos Retrospectivos , Fatores de Risco
10.
Otolaryngol Head Neck Surg ; 168(2): 165-179, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-35133919

RESUMO

OBJECTIVE: To perform a literature review on burnout prevalence, factors that affect burnout and well-being, and solutions to address burnout in otolaryngology-head and neck surgery (OTO-HNS) residents and residents in other surgical specialties. DATA SOURCES: Ovid Medline, Embase, and article reference lists. REVIEW METHODS: A literature search was performed to identify articles on resident burnout, distress, wellness, well-being, and quality of life. Articles deemed outside the scope of the current work were excluded. Search was limited to the past 5 years. CONCLUSIONS: Moderate to high burnout has been reported in 35% to 86% of OTO-HNS residents. Among other surgical specialties, resident burnout ranges between 58% and 66% in plastics, 11% and 67% in neurosurgery, 38% and 68% in urology, and 31% and 56% in orthopedics. Highest burnout rates were seen in postgraduate year 2 residents. Factors significantly associated with burnout included hours worked (>80 h/wk), level of autonomy, exercise, and program support. Reported resident work hours have steadily increased: 8% of OTO-HNS residents in 2005 vs 26% in 2019 reported averaging >80 h/wk. Practical implications of resident burnout include decreased empathy, moral distress and injury, poor health, decreased quality of life, increased attrition, decreased desire to pursue fellowship, and increased likelihood of medical errors. Structured mentorship programs, wellness initiatives, and increased ancillary support have been associated with lower burnout rates and improvements in resident well-being across specialties. IMPLICATIONS FOR PRACTICE: Addressing burnout, which is prevalent in OTO-HNS residents, is critical to improving patient care and physician well-being. Surgical specialties can share strategies to effectively address resident burnout through institutional interventions, which can be essential quality improvement initiatives, to promote well-being.


Assuntos
Esgotamento Profissional , Internato e Residência , Otolaringologia , Especialidades Cirúrgicas , Humanos , Qualidade de Vida , Otolaringologia/educação , Esgotamento Profissional/epidemiologia
11.
Ann Otol Rhinol Laryngol ; 132(8): 895-904, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36031814

RESUMO

OBJECTIVE: To evaluate the 2020 to 2021 Otolaryngology residency application cycle in the context of recent trends. STUDY DESIGN: Retrospective data analysis. SETTING: Disruptions caused by the COVID-19 pandemic may significantly alter trends among residency applicants, especially in highly competitive and/or smaller specialties. METHODS: Applicant and residency statistics from Electronic Residency Application Service (ERAS) and National Residency Matching Program (NRMP) were extracted from the 2016 to 2021 and 2011 to 2021, respectively. Trends in Otolaryngology-Head and Neck Surgery (OHNS) were compared to peer specialties (PS) including Dermatology, Neurological Surgery, Orthopedic Surgery, and Integrated Pathway for Plastic and Reconstructive Surgery (PRS). The ratio of the number of applicants per positions (APP) was used to reflect the degree of competition. RESULTS: Between 2011 and 2021, the number of OHNS programs and positions expanded less than those of PS and General Surgery. The increase in the APP ratio was significantly greater for OHNS compared to those Dermatology, Orthopedic Surgery, General Surgery and all PGY1 residency positions for both US MD and all applicants (P < .01 for each). OHNS expansion of US MD (P = .046), but not all applicants (P = .169), outgrew that of Neurosurgery. CONCLUSION: The 2020 to 2021 cycle affected by the COVID-19 pandemic saw a continuation of the recent trend in the expanding OHNS applicant pool. OHNS remains one of the specialties with the highest APP ratio and has observed a significant growth compared to PS since 2018. Understanding and anticipating trends in residency application cycles is critical for designing processes to optimize the best fit between applicants and programs.


Assuntos
COVID-19 , Internato e Residência , Otolaringologia , Humanos , Estudos Retrospectivos , Pandemias , COVID-19/epidemiologia , Otolaringologia/educação
13.
OTO Open ; 5(2): 2473974X211014130, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34031647

RESUMO

OBJECTIVES: The objectives of this study include characterizing the practice patterns and testing strategies of facial plastic and reconstructive surgery (FPRS) fellowship directors (FDs) secondary to COVID-19 and to quantify the impact of COVID-19 on FPRS fellowship training. STUDY DESIGN: Cross-sectional survey. SETTING: Online. METHODS: A survey was sent to all American Academy of Facial Plastic and Reconstructive Surgery FDs and co-FDs in September 2020. Descriptive analyses were performed. RESULTS: Of 77 eligible FDs, 45 responded (58.4%) representing a diverse group across the United States. All but 1 FD routinely screened patients for COVID-19 in the preoperative setting. FDs largely believed that universal preoperative testing was cost-effective (66.7%), improved patient safety (80.0%) and health care worker safety (95.6%), and was not burdensome for patients (53.3%). With regard to volume of cosmetic/aesthetic, reconstructive, facial nerve, and trauma surgery, FDs indicated largely no change in volume (34.9%, 71.0%, 68.4%, and 80.0%, respectively) or fellow experience (67.4%, 80.6%, 84.2%, and 80.0%). Half (50.0%) of the FDs reported decreased volume of congenital/craniofacial surgery, but 75.0% did not believe that there was a change in fellow experience. Overall, of the 15 responses indicating "worsened training" across all domains of FPRS, 14 were located in the Northeast (93.33%). CONCLUSIONS: The COVID-19 pandemic has had the least impact on the volume of reconstructive procedures, facial nerve operations, and trauma surgery and a negative impact on congenital/craniofacial surgery volume, and it has accelerated the demand for cosmetic/aesthetic operations. Overall, the majority of FDs did not feel as though their fellows' trainings would be adversely affected by the ongoing pandemic.

16.
J Craniofac Surg ; 32(4): 1618-1621, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33741887

RESUMO

ABSTRACT: Sports-related injuries contribute to a considerable proportion of pediatric and adolescent craniofacial trauma, which can have severe and longstanding consequences on physical and mental health. The growing popularity of sports within this at-risk group warrants further characterization of such injuries in order to enhance management and prevention strategies. In this study, the authors summarized key trends in 1452 sports-related injuries among individuals aged 16 to 19 using the American College of Surgeon's Trauma Quality Improvement Program database from 2014 to 2016. The authors observed a preponderance of injuries associated with skateboarding, snowboarding, and skiing, with significantly higher percentages of traumatic brain injuries among skateboarding-related traumas. Notably, we observed that traumatic brain injurie rates were slightly higher among subjects who wore helmets. Intensive care unit durations and hospital stays appeared to vary by sport and craniofacial fracture. Altogether, this study contributes to the adolescent sports-related injuries and craniofacial trauma literature.


Assuntos
Traumatismos em Atletas , Esqui , Esportes Juvenis , Adolescente , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/prevenção & controle , Criança , Humanos , Tempo de Internação , Melhoria de Qualidade , Estados Unidos
17.
Ann Otol Rhinol Laryngol ; 130(8): 929-940, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33435722

RESUMO

PURPOSE: To evaluate the recent Otolaryngology-Head and Neck Surgery (OTO-HNS) applicant characteristics, to identify which applicant characteristics are associated with successful match into OTO-HNS, and to compare OTO-HNS applicant trends and characteristics to that of peer surgical specialties (PS). MATERIALS AND METHODS: Data were obtained from official reports by the National Residency Matching Program (NRMP) for OTO-HNS, plastic and reconstructive surgery, orthopedic surgery, neurosurgery, and dermatology from 2006 to 2019. Alpha Omega Alpha (AOA) membership, United States Medical Licensing Examination (USMLE) scores, research productivity, graduation from a top-40 NIH-funded U.S. medical school, and additional graduate degree were recorded. Odds ratios (OR) were calculated to evaluate the relationship between applicant qualifications and match success. RESULTS: From 2014 to 2018, the OTO-HNS applicant pool shrunk from 443 to 333, representing the largest drop of all PS. Furthermore, OTO-HNS reported the most unfilled positions and highest match rates in 2017 (n = 14; 92.1%) and 2018 (n = 12; 94.6%) among any PS. Despite recent trends, 2019 NRMP data revealed a 38.74% increase in OTO-HNS applicant numbers compared to 2018. AOA membership (OR, 7.3; P = .030), USMLE Step 2 scores between 241 and 260 (OR, 6.5; P = .009), and research productivity (OR, 5.6; P = .005) significantly increased the odds of matching into OTO-HNS. CONCLUSIONS: Despite recent fluctuations in application trends, OTO-HNS continues to successfully match highly qualified applicants, including applicants with AOA membership, high Step 2 scores, and high research productivity. An understanding of the qualifications used to evaluate residency applicants may be helpful to both applicants and residency programs of OTO-HNS.


Assuntos
Internato e Residência , Otolaringologia/educação , Critérios de Admissão Escolar , Escolha da Profissão , Humanos , Estados Unidos
18.
Otolaryngol Head Neck Surg ; 164(5): 909-910, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33019883

RESUMO

Telemedicine use among otolaryngologists-head and neck surgeons and facial plastic and reconstructive surgeons has accelerated as a result of the COVID-19 pandemic. Yet, it is unclear what impact the increased adoption of telehealth will have on the doctor-patient relationship, patients' perceptions of individual practices, and the likelihood of patients proceeding with the next steps toward surgery. While an understanding of these complex questions is imperative for all otolaryngologists, it is extremely important for facial plastic surgeons who focus on elective procedures, particularly cosmetic/aesthetic operations. The use of telemedicine has the potential to reduce bias among patients seeking facial plastic surgery, especially cosmetic procedures. As reports of this phenomenon are anecdotal thus far, we recommend further study into the specific criteria that patients consider when selecting a facial plastic surgeon.


Assuntos
Viés , COVID-19/epidemiologia , Face/cirurgia , Aceitação pelo Paciente de Cuidados de Saúde , Procedimentos de Cirurgia Plástica , Telemedicina , Técnicas Cosméticas , Humanos , Pandemias , Relações Médico-Paciente , SARS-CoV-2
20.
Otolaryngol Head Neck Surg ; 164(1): 9-10, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32838643

RESUMO

The Federation of State Medical Boards and the National Board of Medical Examiners recently announced a change in the United States Medical Licensing Examination Step 1 scoring convention to take effect, at the earliest, on January 1, 2022. There are many reasons for this change, including decreasing medical student stress and incentivizing students to learn freely without solely focusing on Step 1 performance. The question remains how this will affect the future of the otolaryngology-head and neck surgery match. By eradicating Step 1 grades, other factors, such as research, may garner increased importance in the application process. Such a shift may discriminate against students from less well-known medical schools, international medical graduates, and students from low socioeconomic backgrounds, who have fewer academic resources and access to research. Residency programs should try to anticipate such unintended consequences of the change and work on solutions heading into 2022.


Assuntos
Avaliação Educacional/métodos , Internato e Residência , Otolaringologia/educação , Seleção de Pessoal/tendências , Educação de Graduação em Medicina , Humanos , Licenciamento em Medicina , Estados Unidos
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