Local spikes in COVID-19 cases: Recommendations for maintaining otolaryngology clinic operations.

The Coronavirus Disease-2019 (COVID-19) pandemic has created an unprecedented economic and public health crisis in the United States. Following efforts to mitigate disease spread, with a significant decline in some regions, many states began reopening their economies. As social distancing guidelines were relaxed and businesses opened, local outbreaks of COVID-19 continue to place person on healthcare systems. Among medical specialties, otolaryngologists and their staff are among the highest at risk for becoming exposed to COVID-19. As otolaryngologists prepare to weather the storm of impending local surges in COVID-19 infections there are several practical measures that can be taken to mitigate the risk to ourselves and our staff.

The development and application of an oncology Therapy-Related Symptom Checklist for Adults (TRSC) and Children (TRSC-C) and e-health applications.

BACKGROUND: Studies found that treatment symptoms of concern to oncology/hematology patients were greatly under-identified in medical records. On average, 11.0 symptoms were reported of concern to patients compared to 1.5 symptoms identified in their medical records. A solution to this problem is use of an electronic symptom checklist that can be easily accessed by patients prior to clinical consultations. PURPOSE: Describe the oncology Therapy-Related Symptom Checklists for Adults (TRSC) and Children (TRSC-C), which are validated bases for e-Health symptom documentation and management. The TRSC has 25 items/symptoms; the TRSC-C has 30 items/symptoms. These items capture up to 80% of the variance of patient symptoms. Measurement properties and applications with outpatients are presented. E-Health applications are indicated. METHODS: The TRSC was developed for adults (N = 282) then modified for children (N = 385). Statistical analyses have been done using correlational, epidemiologic, and qualitative methods. Extensive validation of measurement properties has been reported. RESULTS: Research has found high levels of patient/clinician satisfaction, no increase in clinic costs, and strong correlations of TRSC/TRSC-C with medical outcomes. A recently published sequential cohort trial with adult outpatients at a Mayo Clinic community cancer center found TRSC use produced a 7.2% higher patient quality of life, 116% more symptoms identified/managed, and higher functional status. DISCUSSION, IMPLICATIONS, AND FOLLOW-UP: An electronic system has been built to collect TRSC symptoms, reassure patients, and enhance patient-clinician communications. This report discusses system design and efforts made to provide an electronic system comfortable to patients. Methods used by clinicians to promote comfort and patient engagement were examined and incorporated into system design. These methods included (a) conversational data collection as opposed to survey style or standardized questionnaires, (b) short response phrases indicating understanding of the reported symptom, (c) use of open-ended questions to reduce long lists of symptoms, (d) directed questions that ask for confirmation of expected symptoms, (e) review of symptoms at designated stages, and (d) alerting patients when the computer has informed clinicians about patient-reported symptoms. CONCLUSIONS: An e-Health symptom checklist (TRSC/TRSC-C) can facilitate identification, monitoring, and management of symptoms; enhance patient-clinician communications; and contribute to improved patient outcomes.

Making a Major Change: Changing Your Practice Setting, Retirement, and Locums.

The goal of this article is to discuss factors associated with career change and give data and recommendations of how to prepare for a career change in regards to early, mid, and late career.

Subfreezing versus room-temperature balloon dilation of benign tracheal stenosis: a pilot study in rabbits.

We conducted an experiment to compare collagen deposition in tracheal stenoses dilated with room-temperature balloons and stenoses dilated with balloons at a subfreezing temperature (-10°C). Six New Zealand white rabbits underwent endoscopic tracheal injury. Tracheal dilation was performed at 3 weeks postinjury with either a room-temperature balloon or a vascular cryoplasty balloon. Five surviving rabbits were sacrificed at either 2 weeks (n = 3) or 4 weeks (n = 2) postdilation (1 rabbit that was not able to tolerate dilation was euthanized during the procedure). A blinded pathologist graded histologic sections of the injured tracheas for collagen content. The tracheal collagen deposits in the 3 animals sacrificed at 2 weeks postdilation were all graded as moderate. However, at the 4-week postdilation examination, there was a marked difference in collagen deposition between the rabbit that underwent room-temperature dilation and the rabbit that underwent subfreezing dilation; while the former showed moderate collagen deposition, the deposition in the latter was only mild. In conclusion, this pilot study showed that tracheal dilation with balloon cryotherapy decreased collagen deposition in the injured airway of 1 animal. Larger studies are required to determine whether balloon cryotherapy improves the long-term patency of immature tracheal stenosis.

Teaching and assessing endoscopic sinus surgery skills on a validated low-cost task trainer.

OBJECTIVES/HYPOTHESIS: To evaluate a previously validated low-cost sinus surgery task trainer as a means of acquiring basic endoscopic sinus surgery skills and as an objective structured assessment of technical skills (OSATS) to determine procedural competency. STUDY DESIGN: Prospective blinded study. METHODS: Medical students (N = 52) with no sinus surgery experience learned to perform nasal endoscopy and five specific sinus surgery tasks using the validated task trainer. Training included regimented expert instruction, peer instruction/observation, and experienced-based learning. Pre- and post-training video recordings of nasal endoscopy and five sinus surgery skills were obtained. Two blinded expert otolaryngologists compared pre- and post-training performance using a checklist and global rating scale. RESULTS: Medical student post-training performance was significantly better than pre-training performance for each checklist item and global rating scale as calculated by paired t test (P < .001). Interrater reliability and internal consistency were confirmed by Kendall's coefficient of concordance and Cronbach's α calculations, respectively. CONCLUSIONS: The sinus surgery task trainer provides an effective means of teaching and evaluating nasal endoscopy and basic sinus surgery skills for novice surgeons. With repeated practice, there was significant improvement in performance. An OSATS using the sinus surgery task trainer suggests that we can effectively measure endoscopic sinus surgery ability with the potential to reliably determine competency outside the operating room.

Face, content, and construct validity of a low-cost sinus surgery task trainer.

OBJECTIVE: To assess the face, content, and construct validities of a low-cost sinus surgery task trainer in acquisition of skills for endoscopic sinus surgery. STUDY DESIGN: Prospective validation study. SETTING: Tertiary academic center. SUBJECTS AND METHODS: Attending otolaryngologists, otolaryngology residents at various levels of training, and medical students performed nasal endoscopy and 5 specific tasks using this model. Face and content validities were assessed based on the attendings' responses to a questionnaire evaluating the task trainer. Construct validity was determined by comparing novice to experienced performance using a validated checklist and globalized rating scale. RESULTS: A total of 77 subjects participated in the study. Attending otolaryngologists responded to a survey after completing the tasks. Eighty percent of evaluators rated the trainer as realistic and agreed that this model correlates with the essential skills needed for endoscopic sinus surgery, 90% felt this model provided adequate training and would increase resident competency, and 90% were interested in using the model to train residents. On the task trainer, experienced otolaryngologists and senior residents scored significantly higher than junior residents and medical students using the objective measures of the globalized rating scale and checklist. CONCLUSION: This study demonstrates face, content, and construct validity of the low-cost sinus surgery task trainer. This model has the potential to be a valuable tool in endoscopic sinus surgery training for otolaryngology residents.

Induction of tracheal stenosis in a rabbit model-endoscopic versus open technique.

OBJECTIVE: To evaluate and compare open versus endoscopic methods of inducing tracheal stenosis in the New Zealand white rabbit model. STUDY DESIGN: Prospective randomized control, pilot study. SUBJECTS AND METHODS: Fifteen New Zealand white rabbits were used in the study. Induction of tracheal stenosis was performed through an open incision in 6 rabbits, an endoscopic approach was utilized in 8 rabbits, and 1 rabbit served as the control. The open approach was performed by brushing the tracheal mucosa 10 times through an anterior tracheotomy with a nylon brush. The endoscopic method was achieved using a rigid bronchoscope and at a measured distance below the cricoid cartilage, passing the same nylon brush four times in each of four quadrants. Repeat endoscopies for evaluation of stenosis progression were performed at 2 and 3 weeks on all rabbits. RESULTS: In the open group, we observed no stenosis with one mortality as a result of gastroenteritis due to antibiotic use. In the endoscopic group, all animals achieved some degree of stenosis by 14 days, with a mean airway narrowing of 43%. The two deaths in the endoscopic group occurred in the immediate postoperative period secondary to laryngeal edema. The endoscopic procedure was 5 minutes in duration. CONCLUSION: The endoscopic technique is an effective method of achieving circumferential tracheal stenosis in the rabbit model. Advantages include simple instrumentation, an endoscopic approach, potential for decreased costs, and more reliable results.