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1.
OTO Open ; 6(3): 2473974X221113847, 2022.
Article in English | MEDLINE | ID: mdl-35923218

ABSTRACT

Increasing diversity in the physician workforce is important to improving racial and ethnic disparities in health outcomes in the United States. We describe the implementation of a "distance traveled" question (DTQ) in our residency application process. For the 2021-2022 cycle, all applicants to the University of Washington otolaryngology residency program were allowed to complete an optional DTQ. Responses were shared with the application review committee. Following the distribution of interview invites, an anonymous survey was sent to all faculty reviewers. The response rate was 26 of 36 (72%). Among respondents, 20 (77%) felt that the DTQ helped them learn something new about the applicant, and 19 (73%) reported that the DTQ influenced their decision making about the applicant. Thus, a DTQ may provide faculty with new and influential information regarding residency applicants.

2.
Am J Med Genet A ; 185(12): 3694-3700, 2021 12.
Article in English | MEDLINE | ID: mdl-34291880

ABSTRACT

Robin sequence (RS) has many genetic and nongenetic causes, including isolated Robin sequence (iRS), Stickler syndrome (SS), and other syndromes (SyndRS). The purpose of this study was to determine if the presence and type of cleft palate varies between etiologic groups. A secondary endpoint was to determine the relationship of etiologic group, cleft type, and mortality. Retrospective chart review of patients with RS at two high-volume craniofacial centers. 295 patients with RS identified. CP was identified in 97% with iRS, 95% with SS, and 70% of those with SyndRS (p < .0001). U-shaped CP was seen in 86% of iRS, 82% with SS, but only 27% with SyndRS (p < .0001). At one institution, 12 children (6%) with RS died, all from the SyndRS group (p < .0001). All died due to medical comorbidities related to their syndrome. Only 25% of children who died had a U-shaped CP. The most common palatal morphology among those who died was an intact palate. U-shaped CP was most strongly associated with iRS and SS, and with a lower risk of mortality. RS with submucous CP, cleft lip and palate or intact palate was strongly suggestive of an underlying genetic syndrome and higher risk of mortality.


Subject(s)
Arthritis/genetics , Cleft Lip/genetics , Cleft Palate/genetics , Connective Tissue Diseases/genetics , Hearing Loss, Sensorineural/genetics , Pierre Robin Syndrome/genetics , Retinal Detachment/genetics , Arthritis/diagnostic imaging , Arthritis/mortality , Arthritis/pathology , Child , Child, Preschool , Cleft Lip/diagnostic imaging , Cleft Lip/mortality , Cleft Lip/pathology , Cleft Palate/diagnostic imaging , Cleft Palate/mortality , Cleft Palate/pathology , Connective Tissue Diseases/diagnostic imaging , Connective Tissue Diseases/mortality , Connective Tissue Diseases/pathology , Female , Hearing Loss, Sensorineural/diagnostic imaging , Hearing Loss, Sensorineural/mortality , Hearing Loss, Sensorineural/pathology , Humans , Infant , Male , Pierre Robin Syndrome/diagnostic imaging , Pierre Robin Syndrome/mortality , Pierre Robin Syndrome/pathology , Retinal Detachment/diagnostic imaging , Retinal Detachment/mortality , Retinal Detachment/pathology , Retrospective Studies
3.
Laryngoscope ; 131(6): 1392-1397, 2021 06.
Article in English | MEDLINE | ID: mdl-33107991

ABSTRACT

OBJECTIVES: An increasing number of treatment modalities for lymphatic malformations are being described, complicating therapeutic decisions. Understanding lymphatic malformation natural history is essential. We describe management of head and neck lymphatic malformations where decisions primarily addressed lesion-induced functional compromise (ie, breathing, swallowing) to identify factors associated with invasive treatment and active observation. We hypothesize that non-function threatening malformations can be observed. STUDY DESIGN: Retrospective case series. METHODS: Retrospective case series of consecutive head and neck lymphatic malformation patients (2000-2017) with over 2 years of follow-up. Patient characteristics were summarized and associations with invasive treatment (surgery or sclerotherapy) tested using Fisher's exact. In observed patients, factors associated with spontaneous regression were assessed with Fisher's exact test. RESULTS: Of 191 patients, 101 (53%) were male, 97 (51%) Caucasian, and 98 (51.3%) younger than 3 months. Malformations were de Serres I-III 167 (87%), or IV-V 24 (12%), and commonly located in the neck (101, 53%), or oral cavity (36, 19%). Initial treatments included observation (65, 34%) or invasive treatments such as primary surgery (80, 42%), staged surgery (25, 13%), or primary sclerotherapy (9, 5%). Of 65 initially observed malformations, 8 (12%) subsequently had invasive treatment, 36 (58%) had spontaneous regression, and 21 (32%) elected for no invasive therapy. Spontaneous regression was associated with location in the lateral neck (P = .003) and macrocystic malformations (P = .017). CONCLUSION: Head and neck lymphatic malformation treatment selection can be individualized after stratifying by stage, presence of functional compromise, and consideration of natural history. Recognizing the spectrum of severity is essential in evaluating efficacy of emerging treatments, as selected malformations may respond to observation. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1392-1397, 2021.


Subject(s)
Head/abnormalities , Lymphatic Abnormalities/therapy , Neck/abnormalities , Watchful Waiting , Child, Preschool , Clinical Decision-Making , Databases, Factual , Female , Humans , Infant , Lymphatic Abnormalities/pathology , Male , Otorhinolaryngologic Surgical Procedures/statistics & numerical data , Prospective Studies , Retrospective Studies , Sclerotherapy/statistics & numerical data , Treatment Outcome
4.
J Grad Med Educ ; 11(1): 30-35, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30805093

ABSTRACT

BACKGROUND: The residency match process for competitive specialties hinders programs' ability to holistically review applications. OBJECTIVE: A computer simulation model of the residency application process was created to test the hypotheses that (1) it is advantageous to medical students to apply to the maximum number of programs under the current system, and (2) including a medical student's residency program preferences at the beginning of the application process improves the efficiency of the system for applicants and programs as quantified by the number of interview invitations received. METHODS: The study was conducted in 2016 using 2014 Otolaryngology Match data. A computer model was created to perform simulations for multiple scenarios to test the hypotheses. Students were assigned scores representing easy and hard metrics and program preferences, simulating a mixture of individual student preference and general program popularity. RESULTS: We modeled a system of 99 otolaryngology residency programs with 292 residency spots and 460 student applicants. While it was individually advantageous for an applicant to apply to the maximum number of programs, this led to a poor result for the majority of students when all applicants undertook the strategy. The number of interview invitations improved for most applicants when preference was revealed. CONCLUSIONS: Offering applicants an option to provide program preference improves the practical number of interview invitations. This enables programs to review applicants holistically-instead of using single parameters such as United States Medical Licensing Examination scores-which facilitates a selection of applicants who will be successful in residency.


Subject(s)
Computer Simulation , Internship and Residency , Otolaryngology/education , Personnel Selection/methods , Education, Medical, Graduate , Humans , Surveys and Questionnaires , United States
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