Comparison of Outcomes Between Surveillance Ultrasound and Completion Lymph Node Dissection in Children and Adolescents With Sentinel Lymph Node-Positive Cutaneous Melanoma.

OBJECTIVE: To determine the impact of nodal basin ultrasound (US) surveillance versus completion lymph node dissection (CLND) in children and adolescents with sentinel lymph node (SLN) positive melanoma. BACKGROUND: Treatment for children and adolescents with melanoma are extrapolated from adult trials. However, there is increasing evidence that important clinical and biological differences exist between pediatric and adult melanoma. METHODS: Patients ≤18 years diagnosed with cutaneous melanoma between 2010 and 2020 from 14 pediatric hospitals were included. Data extracted included demographics, histopathology, nodal basin strategies, surveillance intervals, and survival information. RESULTS: Of 252 patients, 90.1% (n=227) underwent SLN biopsy (SLNB), 50.9% (n=115) had at least 1 positive node. A total of 67 patients underwent CLND with 97.0% (n=65/67) performed after a positive SLNB. In contrast, 46 total patients underwent US observation of nodal basins with 78.3% (n=36/46) of these occurring after positive SLNB. Younger patients were more likely to undergo US surveillance (median age 8.5 y) than CLND (median age 11.3 y; P =0.0103). Overall, 8.9% (n=21/235) experienced disease recurrence: 6 primary, 6 nodal, and 9 distant. There was no difference in recurrence (11.1% vs 18.8%; P =0.28) or death from disease (2.2% vs 9.7%; P =0.36) for those who underwent US versus CLND, respectively. CONCLUSIONS: Children and adolescents with cutaneous melanoma frequently have nodal metastases identified by SLN. Recurrence was more common among patients with thicker primary lesions and positive SLN. No significant differences in oncologic outcomes were observed with US surveillance and CLND following the identification of a positive SLN.

Management and Outcomes of Wilms Tumor With Suprarenal Intravascular Extension: A Pediatric Surgical Oncology Research Collaborative Study.

OBJECTIVE: The purpose of this study was to describe management and outcomes from a contemporary cohort of children with Wilms tumor complicated by inferior vena caval thrombus. BACKGROUND: The largest series of these patients was published almost 2 decades ago. Since then, neoadjuvant chemotherapy has been commonly used to manage these patients, and outcomes have not been reported. METHODS: Retrospective review of 19 North American centers between 2009 and 2019. Patient and disease characteristics, management, and outcomes were investigated and analyzed. RESULTS: Of 124 patients, 81% had favorable histology (FH), and 52% were stage IV. IVC thrombus level was infrahepatic in 53 (43%), intrahepatic in 32 (26%), suprahepatic in 14 (11%), and cardiac in 24 (19%). Neoadjuvant chemotherapy using a 3-drug regimen was administered in 82% and postresection radiation in 90%. Thrombus level regression was 45% overall, with suprahepatic level showing the best response (62%). Cardiopulmonary bypass (CPB) was potentially avoided in 67%. The perioperative complication rate was significantly lower after neoadjuvant chemotherapy [(25%) vs upfront surgery (55%); P =0.005]. CPB was not associated with higher complications [CPB (50%) vs no CPB (27%); P =0.08]. Two-year event-free survival was 93% and overall survival was 96%, higher in FH cases (FH 98% vs unfavorable histology/anaplastic 82%; P =0.73). Neither incomplete resection nor viable thrombus cells affected event-free survival or overall survival. CONCLUSIONS: Multimodal therapy resulted in excellent outcomes, even with advanced-stage disease and cardiac extension. Neoadjuvant chemotherapy decreased the need for CPB to facilitate resection. Complete thrombectomy may not always be necessary.

The Intersection of Family Planning and Perception of Career Advancement in General Surgery.

INTRODUCTION: Women in surgery face unique challenges, particularly as it relates to family planning, parental leave, infant feeding, and career advancement. This study highlights disparities in present day general surgery training to tackle longstanding gender inequities. METHODS: An open, anonymous online survey was distributed to Canadian residents, fellows, and practicing general surgeons through the Canadian Association of General Surgeons e-mail list from November 2021-March 2022. Data were analyzed descriptively and chi-square tests were performed to examine categorical outcomes across gender. RESULTS: A total of 89 general surgery respondents (13.8% response rate) completed the survey (22 cisgender men; 65 cisgender women). Twenty six percent of participants had accessed fertility services or used assistive reproductive technologies. Of the participants with children, 36.4% of men and 100.0% of women took at least one parental leave during residency or clinical practice. A greater proportion of women compared to men agreed that their training/practice influenced their decision to have children (P = 0.002) and when to have children (P < 0.001). Similarly, a greater proportion of women indicated they had concerns about future family planning (P = 0.008), future fertility (P = 0.002), and future parental leave (P = 0.026). Fifty nine percent of women and zero men agreed that taking parental leave impacted their career advancement (P = 0.04). CONCLUSIONS: Women surgeons and surgical trainees continue to face challenges with respect to family planning, parental leave, infant feeding, and career advancement. Further research is needed to explore the experiences of women surgeons. By providing surgeons with the support required to achieve their family planning goals, surgeons can accomplish their family and career goals with less conflict.

Survival outcomes in pediatric patients with metastatic Ewing sarcoma who achieve a rapid complete response of pulmonary metastases.

PURPOSE: Our objectives were to compare overall survival (OS) and pulmonary relapse between patients with metastatic Ewing sarcoma (EWS) at diagnosis who achieve rapid complete response (RCR) and those with residual pulmonary nodules after induction chemotherapy (non-RCR). PATIENTS AND METHODS: This retrospective cohort study included children under 20 years with metastatic EWS treated from 2007 to 2020 at 19 institutions in the Pediatric Surgical Oncology Research Collaborative. Chi-square tests were conducted for differences among groups. Kaplan-Meier curves were generated for OS and pulmonary relapse. RESULTS: Among 148 patients with metastatic EWS at diagnosis, 61 (41.2%) achieved RCR. Five-year OS was 71.2% for patients who achieved RCR, and 50.2% for those without RCR (p = .04), and in multivariable regression among patients with isolated pulmonary metastases, RCR (hazards ratio [HR] 0.42; 95% confidence interval [CI]: 0.17-0.99) and whole lung irradiation (WLI) (HR 0.35; 95% CI: 0.16-0.77) were associated with improved survival. Pulmonary relapse occurred in 57 (37%) patients, including 18 (29%) in the RCR and 36 (41%) in the non-RCR groups (p = .14). Five-year pulmonary relapse rates did not significantly differ based on RCR (33.0%) versus non-RCR (47.0%, p = .13), or WLI (38.8%) versus no WLI (46.0%, p = .32). DISCUSSION: Patients with EWS who had isolated pulmonary metastases at diagnosis had improved OS if they achieved RCR and received WLI, despite having no significant differences in rates of pulmonary relapse.

Assessment of finger dexterity through the DIGITS joint tracking web application-An evaluation study with comparison to the nine-hole pegboard test.

BACKGROUND: Hand dexterity is an important clinical marker after hand surgery as it can greatly impact one's ability to perform their day-to-day activities. With the increased focus on remote patient monitoring after hand surgery, new technologies are required to remotely monitor hand dexterity. PURPOSE: The purpose of this study is to identify dexterity outcomes using the web application "DIGITS" and compare these outcomes to the nine-hole-pegboard test (NHPT). STUDY DESIGN: Cross-sectional observational study. METHODS: This was a two-part study with a pilot of our remote dexterity design using DIGITS followed by a validation study comparing DIGITS to a gold-standard metric of dexterity, NHPT. The pilot study recruited 42 healthy subjects between the ages of 18-65 to perform a remote finger tapping exercise using DIGITS. The second part of the study included 50 subjects between the ages of 18-65. Participants completed a demographic questionnaire and then completed three finger tapping sequences for 20 seconds using DIGITS and three trials of the NHPT with each hand. Correlational analyses were done to compare the DIGITS dexterity test with the NHPT. RESULTS: Four outcome measures to assess dexterity were identified, which included (1) total sequences completed in 20 seconds, (2) time to complete 10 sequences, (3) average frequency per sequence, and (3) sequence accuracy. Significant negative correlations were found with the NHPT and total sequences completed in 20 seconds in both dominant and non-dominant hand trials. Additionally, significant negative correlations were found between the NHPT and the time to complete 10 sequences and average frequency in the non-dominant hand trials. CONCLUSIONS: This study shows promising results for the use of DIGITS as a remote measure of hand dexterity. The total number of sequences completed significantly correlates with the NHPT and should be further explored in representative patient populations.

Inflammatory myofibroblastic tumor: A multi-institutional study from the Pediatric Surgical Oncology Research Collaborative.

Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm of intermediate malignancy. We describe the largest cohort of IMT patients to date, aiming to further characterize this rare, poorly understood tumor. This is a multi-institutional review of IMT patients ≤39 years, from 2000 to 2018, at 18 hospitals in the Pediatric Surgical Oncology Research Collaborative. One hundred and eighty-two patients were identified with median age of 11 years. Thirty-three percent of tumors were thoracic in origin. Presenting signs/symptoms included pain (29%), respiratory symptoms (25%) and constitutional symptoms (20%). Median tumor size was 3.9 cm. Anaplastic lymphoma kinase (ALK) overexpression was identified in 53% of patients. Seven percent of patients had distant disease at diagnosis. Ninety-one percent of patients underwent resection: 14% received neoadjuvant treatment and 22% adjuvant treatment. Twelve percent of patients received an ALK inhibitor. Sixty-six percent of surgical patients had complete resection, with 20% positive microscopic margins and 14% gross residual disease. Approximately 40% had en bloc resection of involved organs. Median follow-up time was 36 months. Overall 5-year survival was 95% and 5-year event-free survival was 80%. Predictors of recurrence included respiratory symptoms, tumor size and distant disease. Gross or microscopic margins were not associated with recurrence, suggesting that aggressive attempts at resection may not be warranted.

Incidence and management of pleural effusions in patients with Wilms tumor: A Pediatric Surgical Oncology Research Collaborative study.

Wilms tumor (WT) is the most common renal malignancy in children. Children with favorable histology WT achieve survival rates of over 90%. Twelve percent of patients present with metastatic disease, most commonly to the lungs. The presence of a pleural effusion at the time of diagnosis of WT may be noted on staging imaging; however, minimal data exist regarding the significance and prognostic importance of this finding. The objectives of our study are to identify the incidence of pleural effusions in patients with WT, and to determine the potential impact on oncologic outcomes. A multi-institutional retrospective review was performed from January 2009 to December 2019, including children with WT and a pleural effusion on diagnostic imaging treated at Pediatric Surgical Oncology Research Collaborative (PSORC) participating institutions. Of 1259 children with a new WT diagnosis, 94 (7.5%) had a pleural effusion. Patients with a pleural effusion were older than those without (median 4.3 vs 3.5 years; P = .004), and advanced stages were more common (local stage III 85.9% vs 51.9%; P < .0001). Only 14 patients underwent a thoracentesis for fluid evaluation; 3 had cytopathologic evidence of malignant cells. Event-free and overall survival of all children with WT and pleural effusions was 86.2% and 91.5%, respectively. The rate and significance of malignant cells present in pleural fluid is unknown due to low incidence of cytopathologic analysis in our cohort; therefore, the presence of an effusion does not appear to necessitate a change in therapy. Excellent survival can be expected with current stage-specific treatment regimens.

Implications of Tumor Characteristics and Treatment Modality on Local Recurrence and Functional Outcomes in Children With Chest Wall Sarcoma: A Pediatric Surgical Oncology Research Collaborative Study.

OBJECTIVE: To determine the impact of tumor characteristics and treatment approach on (1) local recurrence, (2) scoliosis development, and (3) patient-reported quality of life in children with sarcoma of the chest wall. SUMMARY OF BACKGROUND DATA: Children with chest wall sarcoma require multimodal therapy including chemotherapy, surgery, and/or radiation. Despite aggressive therapy which places them at risk for functional impairment and scoliosis, these patients are also at significant risk for local recurrence. METHODS: A multi-institutional review of 175 children (median age 13 years) with chest wall sarcoma treated at seventeen Pediatric Surgical Oncology Research Collaborative institutions between 2008 and 2017 was performed. Patient-reported quality of life was assessed prospectively using PROMIS surveys. RESULTS: The most common diagnoses were Ewing sarcoma (67%) and osteosarcoma (9%). Surgical resection was performed in 85% and radiation in 55%. A median of 2 ribs were resected (interquartile range = 1-3), and number of ribs resected did not correlate with margin status ( P = 0.36). Local recurrence occurred in 23% and margin status was the only predictive factor(HR 2.24, P = 0.039). With a median follow-up of 5 years, 13% developed scoliosis (median Cobb angle 26) and 5% required corrective spine surgery. Scoliosis was associated with posteriorrib resection (HR 8.43; P= 0.003) and increased number of ribs resected (HR 1.78; P = 0.02). Overall, patient-reported quality of life is not impaired after chest wall tumor resection. CONCLUSIONS: Local recurrence occurs in one-quarter of children with chest wall sarcoma and is independent of tumor type. Scoliosis occurs in 13% of patients, but patient-reported quality of life is excellent.

What is Transferred and How Much is Retained? A Simulation Study of Complex Surgical Skills.

INTRODUCTION: Studies indicate that learning surgical skills on low-fidelity models is equally beneficial to learning on high-fidelity models in terms of skills retention and transfer. However, it is unclear how low-fidelity simulation training impacts retention and transfer in novice learners, particularly on complex surgical tasks that incorporate multiple challenging skills. This study explores the capacity of complete novices to learn and transfer complex surgical skills from a low-fidelity model to a high-fidelity simulation after a delay. METHODS: Task-naïve medical and nonmedical undergraduate students (n = 62) participated in a three-phase prospective double-arm randomized (2:1) experimental study. Participants completed two skills training sessions (end-to-side anastomosis) on a low-fidelity bench model. After a 4-week delay, participants completed the task again either using the low-fidelity model or a high-fidelity model (cadaver) and were assessed using a validated checklist. RESULTS: There was a significant time × fidelity group interaction (P = 0.004). Simple effects analysis indicated the high-fidelity group (Mdiff = 4.18, P < 0.001) performed significantly worse (P = 0.003) in phase 3 relative to phase 2 compared to the low-fidelity group (Mdiff = 0.75, P = 0.39). Post hoc logistic regression analysis indicated that radial suturing technique and economy of motion skills were less likely to be completed correctly for those in the high-fidelity group. CONCLUSIONS: These findings suggest that for novice populations, relying on low-fidelity simulation training as a source of teaching complex skills may not provide a reliable transfer to high-fidelity models and in turn clinical settings.

Impostorism and anxiety contribute to burnout among resident physicians.

PURPOSE: Physician burnout is an issue that has come to the forefront in the past decade. While many factors contribute to burnout the impact of impostorism and self-doubt has largely been ignored. We investigated the relationship of anxiety and impostorism to burnout in postgraduate medical learners. MATERIALS AND METHODS: Postgraduate learners in four diverse training programs: Family Medicine (FM), Paediatric Medicine (PM), Anesthesiology (AN), and General Surgery (GS) were surveyed to identify the incidence of impostorism (IP), anxiety, and burnout. IP, anxiety, and burnout were evaluated using the Clance Impostor Phenomenon Scale (CIPS), Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and the General Anxiety Disorder-7 (GAD-7) questionnaires, respectively. Burnout was defined as meeting burnout criteria on all three domains. Relationships between IP, anxiety, and burnout were explored. RESULTS: Two hundred and sixty-nine residents responded to the survey (response rate 18.8%). Respondents were distributed evenly between specialties (FM = 24.9%, PM = 33.1%, AN = 20.4%, GS = 21.6%). IP was identified in 62.7% of all participants. The average score on the CIPS was 66.4 (SD = 14.4), corresponding to 'frequent feelings of impostorism.' Female learners were at higher risk for IP (RR = 1.27, 95% CI: 1.03-1.57). Burnout, as defined by meeting burnout criteria on all three subscales, was detected in 23.3% of respondents. Significant differences were seen in burnout between specialties (p = 0.02). GS residents were more likely to experience burnout (31.7%) than PM and AN residents (26.7 and 10.0%, respectively, p = 0.02). IP was an independent risk factor for both anxiety (RR = 3.64, 95% CI:1.96-6.76) and burnout (RR = 1.82, 95% CI: 1.07-3.08). CONCLUSIONS: Impostorism is commonly experienced by resident learners independent of specialty and contributes to learner anxiety and burnout. Supervisors and Program Directors must be aware of the prevalence of IP and the impact on burnout. Initiatives to mitigate IP may improve resident learner wellness and decrease burnout in postgraduate learners.

Long-Lived Solid-State Optical Memory for High-Rate Quantum Repeaters.

We argue that long optical storage times are required to establish entanglement at high rates over large distances using memory-based quantum repeaters. Triggered by this conclusion, we investigate the 795.325 nm^{3} H_{6}↔^{3}H_{4} transition of Tm:Y_{3}Ga_{5}O_{12} (Tm:YGG). Most importantly, we find that the optical coherence time can reach 1.1 ms, and, using laser pulses, we demonstrate optical storage based on the atomic frequency comb protocol during up to 100 µs as well as a memory decay time T_{m} of 13.1 µs. Possibilities of how to narrow the gap between the measured value of T_{m} and its maximum of 275 µs are discussed. In addition, we demonstrate multiplexed storage, including with feed-forward selection, shifting and filtering of spectral modes, as well as quantum state storage using members of nonclassical photon pairs. Our results show the potential of Tm:YGG for creating multiplexed quantum memories with long optical storage times, and open the path to repeater-based quantum networks with high entanglement distribution rates.

Foraging as an evidence accumulation process.

The patch-leaving problem is a canonical foraging task, in which a forager must decide to leave a current resource in search for another. Theoretical work has derived optimal strategies for when to leave a patch, and experiments have tested for conditions where animals do or do not follow an optimal strategy. Nevertheless, models of patch-leaving decisions do not consider the imperfect and noisy sampling process through which an animal gathers information, and how this process is constrained by neurobiological mechanisms. In this theoretical study, we formulate an evidence accumulation model of patch-leaving decisions where the animal averages over noisy measurements to estimate the state of the current patch and the overall environment. We solve the model for conditions where foraging decisions are optimal and equivalent to the marginal value theorem, and perform simulations to analyze deviations from optimal when these conditions are not met. By adjusting the drift rate and decision threshold, the model can represent different "strategies", for example an incremental, decremental, or counting strategy. These strategies yield identical decisions in the limiting case but differ in how patch residence times adapt when the foraging environment is uncertain. To describe sub-optimal decisions, we introduce an energy-dependent marginal utility function that predicts longer than optimal patch residence times when food is plentiful. Our model provides a quantitative connection between ecological models of foraging behavior and evidence accumulation models of decision making. Moreover, it provides a theoretical framework for potential experiments which seek to identify neural circuits underlying patch-leaving decisions.

Optimization of percutaneous biopsy for diagnosis and pretreatment risk assessment of neuroblastoma.

BACKGROUND: Image-guided percutaneous core needle biopsy (PCNB) is increasingly utilized to diagnose solid tumors. The objective of this study is to determine whether PCNB is adequate for modern biologic characterization of neuroblastoma. PROCEDURE: A multi-institutional retrospective study was performed by the Pediatric Surgical Oncology Research Collaborative on children with neuroblastoma at 12 institutions over a 3-year period. Data collected included demographics, clinical details, biopsy technique, complications, and adequacy of biopsies for cytogenetic markers utilized by the Children's Oncology Group for risk stratification. RESULTS: A total of 243 children were identified with a diagnosis of neuroblastoma: 79 (32.5%) tumor excision at diagnosis, 94 (38.7%) open incisional biopsy (IB), and 70 (28.8%) PCNB. Compared to IB, there was no significant difference in ability to accurately obtain a primary diagnosis by PCNB (95.7% vs 98.9%, P = .314) or determine MYCN copy number (92.4% vs 97.8%, P = .111). The yield for loss of heterozygosity and tumor ploidy was lower with PCNB versus IB (56.1% vs 90.9%, P < .05; and 58.0% vs. 88.5%, P < .05). Complications did not differ between groups (2.9 % vs 3.3%, P = 1.000), though the PCNB group had fewer blood transfusions and lower opioid usage. Efficacy of PCNB was improved for loss of heterozygosity when a pediatric pathologist evaluated the fresh specimen for adequacy. CONCLUSIONS: PCNB is a less invasive alternative to open biopsy for primary diagnosis and MYCN oncogene status in patients with neuroblastoma. Our data suggest that PCNB could be optimized for complete genetic analysis by standardized protocols and real-time pathology assessment of specimen quality.

Pancreaticoduodenectomy for the treatment of pancreatic neoplasms in children: A Pediatric Surgical Oncology Research Collaborative study.

BACKGROUND: To better characterize short-term and long-term outcomes in children with pancreatic tumors treated with pancreaticoduodenectomy (PD). METHODS: Patients 21 years of age or younger who underwent PD at Pediatric Surgical Oncology Collaborative (PSORC) hospitals between 1990 and 2017 were identified. Demographic, clinical information, and outcomes (operative complications, long-term pancreatic function, recurrence, and survival) were collected. RESULTS: Sixty-five patients from 18 institutions with a median age of 13 years (4 months-22 years) and a median (IQR) follow-up of 2.8 (4.3) years were analyzed. Solid pseudopapillary tumor of the pancreas (SPN) was the most common histology. Postoperative complications included pancreatic leak in 14% (n = 9), delayed gastric emptying in 9% (n = 6), marginal ulcer in one patient, and perioperative (30-day) death due to hepatic failure in one patient. Pancreatic insufficiency was observed in 32% (n = 21) of patients, with 23%, 3%, and 6% with exocrine, or endocrine insufficiencies, or both, respectively. Children with SPN and benign neoplasms all survived. Overall, there were 14 (22%) recurrences and 11 deaths (17%). Univariate analysis revealed non-SPN malignant tumor diagnosis, preoperative vascular involvement, intraoperative transfusion requirement, pathologic vascular invasion, positive margins, and need for neoadjuvant chemotherapy as risk factors for recurrence and poor survival. Multivariate analysis only revealed pathologic vascular invasion as a risk factor for recurrence and poor survival. CONCLUSION: This is the largest series of pediatric PD patients. PD is curative for SPN and benign neoplasms. Pancreatic insufficiency is the most common postoperative complication. Outcome is primarily associated with histology.

Changes in social engagement and depression predict incident loneliness among seriously ill home care clients.

ABSTRACTObjective:This study identified the predictors of incident loneliness in a group of seriously ill older adults (aged 65+) receiving home care. METHOD: Existing data collected with the Resident Assessment Instrument for Home Care (RAI-HC) were utilized. A cohort of clients (N = 2,499) with two RAI-HC assessments and no self-reported loneliness at time 1 were included. Self-reported loneliness, upon reassessment, was the outcome of interest. Clients with a prognosis of less than six months or severe health instability were included. RESULTS: The average length of time between assessments was 5.9 months (standard deviation = 4.10). During that time, 7.8% (n = 181) of the sample developed loneliness. In a multivariate regression model, worsening symptoms of depression, a decline in social activities, and not living with a primary caregiver all increased the risk of loneliness. SIGNIFICANCE OF RESULTS: These results highlight how changes in psychosocial factors over time can contribute to loneliness, which can inform clinicians as they seek to identify those who may be at risk for loneliness.

The Influence of Physical and Psychosocial Factors on Disruptive Pain Among Seriously Ill Home Care Patients.

OBJECTIVES: To estimate the prevalence and correlates of disruptive pain in a sample of seriously ill home care patients in the Canadian province of Ontario. METHODS: The design was a cross-sectional analysis of secondary data from 2757 patients aged 65+. RESULTS: Overall, 69.0% (n = 1902) had any level of pain and 41.6% (n = 1146) indicated that their pain disrupted their usual activities. In the univariate analysis of demographics, the risk of disruptive pain decreased significantly with increasing age ( P < .0001) and was significantly less common among men ( P = .0015). Multivariate analysis showed that unsteady gait (relative risk [RR] = 1.37; 95% confidence interval [CI], 1.18-1.59), arthritis (RR = 1.35; 95% CI, 1.23-1.49), symptoms of depression (RR = 1.24; 95% CI, 1.13-1.37), and declines in social activity that the patient rated as distressing (RR = 1.19; 95% CI, 1.08-1.31) were independently associated with disruptive pain. CONCLUSION: Disruptive pain is highly prevalent in this group, and the key factors associated with this outcome represent physical as well as psychosocial domain areas.

Knowledge and attitudes surrounding breastfeeding in pediatric otolaryngology: A survey study.

OBJECTIVE: This survey study seeks to understand the knowledge and attitudes of pediatric otolaryngologists around breastfeeding to potentially inform future educational efforts. METHODS: This cross-sectional survey recruited 59 pediatric otolaryngologists from an international WhatsApp group comprising 213 members over a four-week period. Demographics, knowledge, attitudes, and experiences with breastfeeding were investigated using Likert scales. Descriptive statistics and correlational analyses were conducted. Statistical significance was set at p < 0.05. RESULTS: The majority of participants were women (59%) and had children (86%). Most participants and/or their partners breastfed for 4-12 months (67%). Previous breastfeeding education was limited in both medical school (20%) and residency (15%). Most agreed that otolaryngologists should be knowledgeable about breastfeeding (83%), however men respondents felt significantly less comfortable counselling (p < 0.003), addressing difficulties (p < 0.044), and suggesting means to change milk supply (p < 0.007). Knowledge gaps were identified with assessing aspiration risk and airway anomalies. Breastfeeding experience did not significantly influence attitudes and comfort around breastfeeding, or the knowledge of participants. CONCLUSION: While attitudes towards breastfeeding amongst pediatric otolaryngologists are very positive, degrees of comfort and knowledge are more limited, especially amongst men otolaryngologists. Future research should consider exploring the efficacy of educational efforts in Otolaryngology for improving the support offered to breastfeeding dyads.

A Social Media Blueprint - Understanding What Makes the Optimal Social Media Account for Paediatric Surgical Families.

BACKGROUND: Social media is one of the most common sources of information for parents seeking information on their child's health. The purpose of this study was to better understand the social media habits of parents of paediatric surgery patients through surveys and focus groups. METHODS: An online survey was distributed to parents visiting paediatric surgery clinics at a tertiary care hospital. Surveys were distributed via QR code and social media. Two virtual focus groups were conducted with parents of paediatric patients. Descriptive statistics were used for survey analysis and focus group transcripts were thematically analyzed. RESULTS: A total of 107 respondents completed the online survey. Median age of respondents was 36 (interquartile range: 32-41). 81.3% of the respondents were female. Facebook was the preferred social media platform (47.2%), followed by Instagram (41.5%) then other platforms (4.7%). Respondents indicated that their preferred length of video was 30 s (41.2%). When asked which type of video content they prefer, participants indicated animated video as most popular (66.0%) followed by a physician speaking (60.0%), and slides with voiceover (45.0%). The focus groups revealed themes of: (1) functionality and content; (2) branding, aesthetic and legitimacy; (3) unmasking of physicians; (4) peer and community support. CONCLUSION: Creating a successful social media account for parents must take into consideration their social media habits. A Facebook account that features brief videos may be most likely to engage parents. Additionally, physicians need to establish credibility and legitimacy of their content to attract their target audience. LEVEL OF EVIDENCE: III.

The Safety of the Laryngeal Mask Airway in Adenotonsillectomy: A Systematic Review and Meta-Analysis.

BACKGROUND: Adenotonsillectomy is one of the most common surgical procedures worldwide. The current standard for securing the airway in patients undergoing adenotonsillectomy is endotracheal tube (ETT) intubation. Several studies have investigated the use of the laryngeal mask airway (LMA) in this procedure. We conducted a systematic review and meta-analysis to compare the safety and efficacy of the LMA versus ETT in adenotonsillectomy. METHOD: Databases were searched from inception to 2022 for randomized controlled trials and comparative studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The primary outcome is the rate of perioperative respiratory adverse events (PRAEs). Secondary outcomes included the rate of conversion to ETT, desaturations, nausea/vomiting, and surgical time. A subgroup analysis, risk of bias, publication bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessments were also performed. RESULTS: Twelve studies were included in the analysis (4176 patients). The mean overall conversion to ETT was 8.36% [95% confidence interval (CI) = 8.17, 8.54], and for the pediatric group 8.27% (95% CI = 8.08, 8.47). The mean rate of conversion to ETT secondary to complications was 2.89% (95% CI = 2.76, 3.03) while the rest was from poor surgical access. Overall, there was no significant difference in PRAEs [odds ratio (OR) 1.16, 95% CI = 0.60, 2.22], desaturations (OR 0.79, 95% CI = 0.38, 1.64), or minor complications (OR 0.89, 95% CI = 0.50, 1.55). The use of LMA yielded significantly shorter operative time (mean difference -4.38 minutes, 95% CI = -8.28, -0.49) and emergence time (mean difference -4.15 minutes, 95% CI = -5.63, -2.67). CONCLUSION: For adenotonsillectomy surgery, LMA is a safe alternative to ETT and requires less operative time. Careful patient selection and judgment of the surgeon and anesthesiologist are necessary, especially given the 8% conversion to ETT rate.

A Canadian National Survey Study of Harassment in Surgery-Still a Long Way to Go.

OBJECTIVES: Previous literature has consistently documented harassment and discrimination in surgery. These experiences may contribute to the continuing gender inequity in surgical fields. The objective of our study was to survey Canadian surgeons and surgical trainees to gain a greater understanding of the experience of harassment across genders, career stage, and specialty. METHODS: A cross-sectional, online survey was distributed to Canadian residents, fellows, and practicing surgeons in general surgery, plastic surgery, and neurosurgery through their national society email lists and via social media posts. RESULTS: There were 194 included survey respondents (60 residents, 11 fellows, and 123 staff) from general surgery (44.8%), plastic surgery (42.7%), and neurosurgery (12.5%). 59.8% of women reported having experienced harassment compared to only 26.0% of men. Women were significantly more likely to be harassed by colleagues and patients/families compared to men. Residents (62.5%) were two times more likely to report being harassed compared to fellows/staff (38.3%). Residents were significantly more likely to be harassed by patients/families while fellows/staff were more likely to be harassed by colleagues. There were no significant differences in self-reported harassment across the three surgical specialties. There was no significant difference in rates of reported harassment between current residents (62.5%), and fellow/staff recollections of their experiences of harassment during residency (59.2%). CONCLUSIONS: The prevalence of gender-based discrimination remains high and harassment prevalence remains largely unchanged from when current staff were in residency. Our findings highlight a need to implement systemic changes to support the increasing number of women entering surgery, and to improve surgical culture to continue to attract the best and brightest to the field.