Investigating the Role of Antibiotics on Induction, Inhibition and Eradication of Biofilms of Poultry Associated Escherichia coli Isolated from Retail Chicken Meat.

Background: Widespread use of antibiotics as growth promoters and prophylactic agents has dramatic consequences for the development of antibiotic resistance. In this study, we investigated effects of selected antibiotics on bacterial biofilms and performed extensive antibiotic and VF profiling of poultry-meat associated E. coli strains. Methods: Antibiotic susceptibility was performed by a disc diffusion method, followed by molecular screening of resistance and virulence determinants. Further biofilm formation assays, MIC-p, MIC-b, MBIC and MBEC, were performed using standard tissue culture plate method. Results: In total, 83 (75%) samples were confirmed as E. coli from poultry sources, 26 different antibiotics were tested, and maximum numbers of the isolates were resistant to lincomycin (100%), while the least resistance was seen against cefotaxime (1%) and polymyxin B (1%). Overall, 48% of the isolates were ESBL producers and 40% showed carbapenemase activity; important virulence genes were detected in following percentages: fimH32 (39%), papC21 (25%), iutA34 (41%), kpsMT-II23 (28%), papEF9 (11%), papGII22 (27%) and fyuA13 (16%). Colistin showed remarkable anti-biofilm activity, while at sub-MIC levels, gentamicin, ceftriaxone and enrofloxin significantly (p < 0.01) inhibited the biofilms. A strong induction of bacterial biofilm, after exposure to sub-minimal levels of colistin clearly indicates risk of bacterial overgrowth in a farm environment, while use of colistin aggravates the risk of emergence of colistin resistant Enterobacteriaceae, a highly undesirable public health scenario.

Determinants of resident competence in mastoidectomy: role of interest and deliberate practice.

OBJECTIVES/HYPOTHESIS: This study explores the influence of selected factors on achievement of competency in mastoid surgery. STUDY DESIGN: A prospective study of surgical performance and a retrospective survey of learner and training factors. METHODS: The longitudinal performance of 15 residents was evaluated using the mastoidectomy task-based checklist (TBC). The influence of surgical experience, resident interest, and training factors (course attendance, voluntary use of simulation laboratory) was also examined and compared for the acquisition of distinct levels of technical skill difficulty (cortical mastoidectomy vs. facial recess). RESULTS: Ninety-six observations made during the first otology rotation were analyzed. Cortical mastoidectomy tasks showed positive associations with cumulated case numbers (OR 1.13, CI 1.04-1.23, P = .003) and interest in otology (OR 3.86, CI 1.21-12.27, P = .022). Facial recess tasks showed a larger positive association with interest in otology (OR 10.38, CI 2.25-47.94, P = .003), and negative association with extra time spent in laboratory practice (OR .05, CI 0.011-0.23, P = .000). CONCLUSIONS: Learning trajectory for cortical mastoidectomy and facial recess may be influenced by different factors. Interest in otology, in particular, may have a moderating effect on the acquisition of more complex skills in mastoid surgery. A negative association between self-directed laboratory simulation and performance may reflect the impact of assessment-guided feedback in promoting deliberate practice. Further investigations are suggested to explore the interactions between individual trainee differences, educational models, and learning outcomes.

Spectrum of immune-mediated inner ear disease and cochlear implant results.

OBJECTIVES/HYPOTHESIS: To characterize the progression of hearing loss in patients with immune-mediated inner ear disease (IMIED), and to identify disease- and patient-specific factors associated with cochlear implant (CI) performance. STUDY DESIGN: Retrospective cohort study. METHODS: Subjects consisted of CI patients suspected to have lost their hearing due to IMIED. The primary dependent variable for functional decline was time to deafness, whereas for CI benefit it was post-CI speech perception scores. Independent variables included presence or absence of systemic autoimmune disease, age at CI, and insertion depth of the cochlear electrode. RESULTS: A transient favorable response to immunosuppressive therapy was reported in 16 of 26 patients (66.67%). The time to deafness differed between an organ (ear)-specific immune-mediated group, a systemic immune-mediated group including Cogan syndrome and relapsing polychondritis (subgroup A), and a systemic immune-mediated group associated with other autoimmune diseases (subgroup B; P = .001). Disease group (-15.52; P = .04), insertion depth of the CI electrode (40.71; P = .01), and the age at CI (-0.48, P = .05) were associated with speech perception results. CONCLUSIONS: Triaging IMIED cases based on presence and type of systemic autoimmune disease may aid in selecting a management strategy. Knowledge about the predictors of CI outcome will help clinicians select appropriate patients for CIs. In the setting of significant and irreversible hearing deficit, the restoration of hearing using a cochlear prosthesis may be appropriate earlier rather than later.

Learning curve for competency in flexible laryngoscopy.

OBJECTIVES/HYPOTHESIS: The purpose of our study was to identify the number of attempts required to attain competency in performing flexible laryngoscopy. STUDY DESIGN: Cross-sectional prospective study. METHODS: Fifteen medical students were recruited to perform flexible laryngoscopy on a mannequin. Each participant was given unlimited time and attempts to perform the procedure until considered competent by the evaluator for two consecutive attempts. Three evaluators used a flexible laryngoscopy checklist to score performance on each step of the procedure. Time required to perform the procedure was recorded, as well as number of times the scope hit the mucosa. The criteria for attaining competence were achieving a minimum score of 3 out of 5 on all the items of the checklist and being deemed competent by the evaluator. RESULTS: A total of 105 flexible laryngoscopies were performed by 15 medical students. A mean of six attempts (range, 2-17) were necessary for a medical student to become competent in performing flexible laryngoscopy. An 80% probability of becoming competent was achieved with the 14th attempt. An inverse relationship was noted between the number of times the scope hit the mucosa and the probability of being competent. The time taken to perform the procedure decreased with increasing number of attempts. CONCLUSIONS: Our results suggest that it takes six attempts on average for a novice to become competent in performing flexible laryngoscopy. This finding has implications for residency programs because it indicates the learning curve can be overcome in the laboratory rather than with patients. Laryngoscope, 2010.

Development and pilot testing of an objective structured clinical examination (OSCE) on hoarseness.

OBJECTIVES: To develop a valid and reliable tool for an objective structured clinical examination (OSCE) on hoarseness. To pilot-test the feasibility by assessing residents' clinical skills in various core competencies while assessing hoarseness on a standardized patient (SP). STUDY DESIGN: Educational tool development. METHODS: The OSCE checklists were developed using modified Delphi technique after obtaining feedback from faculty involved in providing care to hoarseness patients. SP-based and rest stations were created to assess clinical skills. Twelve Otolaryngology-Head and Neck Surgery residents participated in the study. Video recordings of residents' performance and their written documentation were rated by faculty members. RESULTS: The OSCE that we developed is a valid method of assessing residents' clinical skills for evaluating hoarseness. Senior residents performed better in all of the tasks such as obtaining history and performing a physical exam on an SP, ability to perform flexible laryngoscopy on a mannequin, and interpretation of radiologic findings. Internal consistency assessed by Cronbach's alpha as measure of inter-item reliability was 0.92 for laryngoscopic station and 0.95 for radiology station. CONCLUSIONS: This OSCE can be effectively used for the objective assessment of clinical competency in hoarseness. Our pilot study evaluated multiple competencies on a single occasion, including medical knowledge, patient care, professionalism, and communication and interpersonal skills. Clinical competence in history taking, physical examination, flexible fiber-optic laryngoscopy, and ability to interpret radiologic findings improved with increasing year of training. This OSCE provides targeted assessment of practice-based learning and feedback for improvement of clinical performance.

Defining milestones toward competency in mastoidectomy using a skills assessment paradigm.

OBJECTIVES/HYPOTHESIS: To establish milestones toward achievement of surgical competency by using an objective assessment tool designed to measure the development of mastoidectomy skills in the operating room (OR). STUDY DESIGN: Prospective longitudinal validation study. METHODS: Fifty-six evaluations were conducted in the OR on nine otolaryngology residents from PGY (postgraduate year) 2 to PGY 5 over a period of 3 years. Technical performance was measured over time using a task-based checklist developed for assessment of mastoidectomy skills. RESULTS: Three sets of technical milestones represented achievement of competency for progressively more complicated procedural steps: the first set was achieved after a mean of 6 +/- 4.3 cases, the second set after 9 +/- 6.7 cases (range of mean = 8-10 cases), and the third set after 13 +/- 6.4 cases (range of mean = 12-14 cases). CONCLUSIONS: The acquisition of mastoidectomy skills can be integrated into surgical teaching in the OR, and this approach yields information that can aid individual skill development and program improvement. The identification of milestones in particular can help establish training benchmarks toward achievement of competency and in identifying trainees in need of remediation.

Barriers to the implementation of competency-based education and assessment: a survey of otolaryngology program directors.

OBJECTIVES/HYPOTHESIS: To identify the barriers faced by otolaryngology program directors as they implement competency-based education and assessment and to identify preferred approaches to meet these challenges as suggested by program directors. STUDY DESIGN: A national survey of otolaryngology-head and neck surgery program directors. METHODS: We developed a 20-item questionnaire that was distributed to 102 otolaryngology program directors through SurveyMonkey. Nonrespondents were reminded by follow-up email and phone calls. Results were analyzed by descriptive statistical analysis. RESULTS: A total of 88 (86%) program directors responded to the survey. There was a marked discrepancy between the income received and time spent performing the duties of the program director. Program director workload was recognized as the most important barrier to the implementation of competency-based education. Creating a practical clearinghouse of existing and emerging assessment tools was given the highest rating among the approaches to meet the challenges faced by program directors. CONCLUSIONS: Program directors in otolaryngology do not have sufficient financial support, protected time, and personnel to fulfill their administrative and educational responsibilities. They should be provided with additional institutional assistance to help them achieve the goals of the Accreditation Council for Graduate Medical Education outcome project.

Objective assessment of mastoidectomy skills in the operating room.

OBJECTIVE(S): To determine the feasibility and validity of an objective assessment tool designed to measure the development of mastoidectomy skills by resident trainees in the operating room. STUDY DESIGN: Prospective longitudinal validation study. SETTING: Tertiary referral center and residency training program. SUBJECTS: Otolaryngology residents. MAIN OUTCOME MEASURE: Technical performance as measured over time using Task-Based Checklist (TBC) and Global Rating Scale (GRS) developed for assessment of mastoidectomy skills. RESULTS: : Seventy pairs of evaluations were completed on 15 residents, showing strong correlation between both instruments (r = 0.93; p < 0.0001). Our instrument demonstrated construct validity for both TBC and GRS, showing higher scores with increasing surgical experience in otology. Both instruments showed high interitem reliability with Cronbach alpha coefficients of 0.98 and 0.95 for TBC and GRS, respectively. Regression analysis showed that thinning posterior external auditory canal (p < 0.05) and opening antrum to deepen dissection at sinodural angle (p < 0.05) were the strongest predictors of overall surgical performance. CONCLUSION: Our assessment tool is a feasible and valid method of evaluating acquisition of mastoidectomy skills in the operating room. It can be integrated into surgical teaching in the operating room and yields information for direct formative feedback.