Competency-Based Assessment Tool for Pediatric Esophagoscopy: International Modified Delphi Consensus.

OBJECTIVES/HYPOTHESIS: Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal. STUDY DESIGN: Blinded modified Delphi consensus process. SETTING: Tertiary care center. METHODS: A list of 25 potential items was sent via the Research Electronic Data Capture database to 66 expert surgeons who perform pediatric esophagoscopy. In the first round, items were rated as "keep" or "remove" and comments were incorporated. In the second round, experts rated the importance of each item on a seven-point Likert scale. Consensus was determined with a goal of 7 to 25 final items. RESULTS: The response rate was 38/64 (59.4%) in the first round and returned questionnaires were 100% complete. Experts wanted to "keep" all items and 172 comments were incorporated. Twenty-four task-specific and 7 previously-validated global rating items were distributed in the second round, and the response rate was 53/64 (82.8%) with questionnaires returned 97.5% complete. Of the task-specific items, 9 reached consensus, 7 were near consensus, and 8 did not achieve consensus. For global rating items that were previously validated, 6 reached consensus and 1 was near consensus. CONCLUSIONS: It is possible to reach consensus about the important steps involved in rigid esophagoscopy with foreign body removal using a modified Delphi consensus technique. These items can now be considered when evaluating trainees during this procedure. This tool may allow trainees to focus on important steps of the procedure and help training programs standardize how trainees are evaluated. LEVEL OF EVIDENCE: 5. Laryngoscope, 131:1168-1174, 2021.

Parental assessment of pain control following pediatric adenotonsillectomy: Do opioids make a difference?

INTRODUCTION: Postoperative prescribing of opioids following pediatric adenotonsillectomy can have negative consequences including unnecessary opioid exposure and potential for respiratory depression. While guidelines from The American Academy of Otolaryngology/Head & Neck Surgery recommend treatment of post adenotonsillectomy pain using acetaminophen and ibuprofen, many providers continue to prescribe opioids and may do so, in part with concern for parental dissatisfaction with post-operative analgesia. Our aim was to determine whether a post-operative prescription for opioids affects parental assessment of pain control following pediatric adenotonsillectomy. METHODS: This post-operative survey assessed the parental assessment of pain control in 324 patients, ages 1-17 years undergoing adenotonsillectomy. This study was conducted at a quaternary care children's hospital in Houston, Texas from December 1, 2018 through March 31, 2019. Post-operative pain regimens included acetaminophen and ibuprofen or combination hydrocodone/acetaminophen in addition to ibuprofen for post-operative analgesia based on the attending surgeons prescribing preferences. The primary study outcome was identification of the proportion of parents rating their child's analgesia following pediatric adenotonsillectomy as poor or inadequate based on the post-operative analgesic regimen including opioids. RESULTS: Of the 798 surveys sent, the response rate was 42% (324/775) of those who received the survey email, and 69% (324/470) for those who opened the email. Between the opioid and non-opioid groups, there was no difference in gender (male; 48% vs. 51.3%; p = 0.58), race/ethnicity (white; 53% vs. 46%; p = 0.35) or insurance status (insured; 62% vs. 50.9%; p = 0.06). The proportion of parents who rated their child's pain as poor or inadequately controlled following adenotonsillectomy was relatively rare: 9% and 5% in the non-opioid and opioid groups, respectively. Parents rating their child's pain as excellent with regards to pain control following adenotonsillectomy were 58% and 50% in the non-opioids and opioid groups respectively. CONCLUSION: The results of this study indicate that non-opioid analgesic regimens following pediatric adenotonsillectomy were not associated with decreased parental satisfaction or an increasing assessment of poor or inadequately controlled pain. Limiting opioid exposure following pediatric adenotonsillectomy is feasible and does not result in worse parental satisfaction with the analgesic plan.

Competency-Based Assessment Tool for Pediatric Tracheotomy: International Modified Delphi Consensus.

OBJECTIVES/HYPOTHESIS: Create a competency-based assessment tool for pediatric tracheotomy. STUDY DESIGN: Blinded, modified, Delphi consensus process. METHODS: Using the REDCap database, a list of 31 potential items was circulated to 65 expert surgeons who perform pediatric tracheotomy. In the first round, items were rated as "keep" or "remove," and comments were incorporated. In the second round, experts were asked to rate the importance of each item on a seven-point Likert scale. Consensus criteria were determined a priori with a goal of 7 to 25 final items. RESULTS: The first round achieved a response rate of 39/65 (60.0%), and returned questionnaires were 99.5% complete. All items were rated as "keep," and 137 comments were incorporated. In the second round, 30 task-specific and seven previously validated global rating items were distributed, and the response rate was 44/65 (67.7%), with returned questionnaires being 99.3% complete. Of the Task-Specific Items, 13 reached consensus, 10 were near consensus, and 7 did not achieve consensus. For the 7 previously validated global rating items, 5 reached consensus and two were near consensus. CONCLUSIONS: It is feasible to reach consensus on the important steps involved in pediatric tracheotomy using a modified Delphi consensus process. These items can now be considered to create a competency-based assessment tool for pediatric tracheotomy. Such a tool will hopefully allow trainees to focus on the important aspects of this procedure and help teaching programs standardize how they evaluate trainees during this procedure. LEVEL OF EVIDENCE: 5 Laryngoscope, 130:2700-2707, 2020.

Efficient and economic process for the production of bacterial cellulose from isolated strain of Acetobacter pasteurianus of RSV-4 bacterium.

In the present investigation, several residues from agro-forestry industries such as rice straw acid hydrolysate, corn cob acid hydrolysate, tomato juice, cane molasses and orange pulp were evaluated as the economical source for the production of bacterial cellulose. The bacterial cellulose attained the significant yield of 7.8 g/L using tomato juice, followed by 3.6 g/L using cane molasses and 2.8 g/L using orange pulp after 7 days of incubation. Furthermore, the optimum pH and temperature of fermentation for maximum production of bacterial cellulose was 4.5 and 30 ±â€¯1 °C. The identified bacterium Acetobacter pasteurianus RSV-4 has been deposited at repository under the accession number MTCC 25117. The produced bacterial cellulose was characterized through FTIR, SEM, TGA and DSC and found to be of very good quality. The bacterial cellulose produced by identified strain on these various agro-waste residues could be a cost effective technology for commercial its production.

Influence of Different Enamel Shades and Thickness on Chroma and Value of Dentin Vita Shade: An in vitro Comparative Assessment Study.

BACKGROUND: The aim of the present study is to determine the influence of different enamel shades of various thickness on chroma and value of vita shade of dentin. MATERIALS AND METHODS: Three enamel composite resin shades (Enamel white, grey and neutral) and one dentin shade (A 2) from A melogen Plus (Ultradent) was used. Ninety Enamel disk specimens of 0.5, 0.75 and 1 mm thickness and 10 mm in diameter for each shade and 90 dentin disk specimens of 2 mm in thickness and 10 mm in diameter was used for the study. The spectrophotometric values of the dentin shade with and without enamel specimens were recorded and the values were converted to CIEL*a*b values. RESULTS: Statistical analysis was done using Pearson correlation coefficients to verify the effect of thickness on Chroma and value, and the significance was evaluated by one-way ANOVA and Tukey post hoc test. Two way ANOVA and Tukey post hoc was done to verify the variation within the groups. Results revealed a significant positive correlation between thickness and chroma and a negative correlation between thickness and value. There was a statistically significant variation in between the groups. CONCLUSION: All groups produced a significant increase in chroma with increase in thickness of enamel shade upto a thickness of 0.75 mm after which the behavior of each shade was erratic. Hence, the optimum thickness would be 0.75 mm. All groups produced a significant decrease in value with increase in thickness of enamel shade. Enamel white produced the greatest reduction in value, enamel neutral the least and enamel grey demonstrated an intermediate result. CLINICAL SIGNIFICANCE: There is a need to have a knowledge of the effect on chroma and value when dentin is layered with different enamel shades, it is also important to understand the effect of these enamel shades at different thicknesses to better control the color and reproduce esthetic simulating natural teeth.

Assessment of constipation in children with tracheostomy.

OBJECTIVE: To determine the prevalence of constipation among children with tracheostomy tubes compared with children without tracheostomy tubes. We theorize that patients with tracheostomy may be unable to achieve adequate subglottic pressure for the Valsalva maneuver, which may contribute to constipation. DESIGN: Prospective cohort study. SETTING: Tertiary care children's hospital. PATIENTS: Consecutive series of 36 children with tracheostomy and 72 general pediatric otolaryngology patients without tracheostomy. INTERVENTIONS: A pediatric constipation questionnaire (from previously published references) was given to parents of the study participants. Data were collected regarding patient medications, neurological status, and use of positive pressure airway assistance, speaking valves, and feeding tubes. Data were evaluated using chi(2) and t tests. Logistic regression analysis was used to search for independent variables impacting presence of constipation. RESULTS: The mean ages for the tracheostomy and control groups were 6.8 and 4.7 years, respectively (P = .07). A history of constipation was elicited in 60% of children with tracheostomy compared with only 16.7% of controls (P < .001). More patients with tracheostomy tubes (80.0%) than controls (20.8%) were taking medication to treat constipation (P < .001). Constipation was also significantly associated with older age (P = .02), use of medications with constipation as a known adverse effect (P = .02), and the presence of neurodevelopmental impairment (P < .001). Constipation was still independently associated with the presence of a tracheostomy tube when correcting for age and the use of constipation-causing medications. When controlling for neurodevelopmental impairment, the presence of a tracheostomy tube was not proven to be an independent predictor of constipation. CONCLUSION: Children with tracheostomy tubes are more likely to have a history of constipation, although a causal relationship between tracheostomy and constipation could not be determined due to the potentially confounding variable of neurodevelopmental delay.