Diagnostic criteria and core outcome set development for necrotising otitis externa: the COSNOE Delphi consensus study.

OBJECTIVE: Evidence for necrotising otitis externa (NOE) diagnosis and management is limited, and outcome reporting is heterogeneous. International best practice guidelines were used to develop consensus diagnostic criteria and a core outcome set (COS). METHODS: The study was pre-registered on the Core Outcome Measures in Effectiveness Trials (COMET) database. Systematic literature review identified candidate items. Patient-centred items were identified via a qualitative study. Items and their definitions were refined by multidisciplinary stakeholders in a two-round Delphi exercise and subsequent consensus meeting. RESULTS: The final COS incorporates 36 items within 12 themes: Signs and symptoms; Pain; Advanced Disease Indicators; Complications; Survival; Antibiotic regimes and side effects; Patient comorbidities; Non-antibiotic treatments; Patient compliance; Duration and cessation of treatment; Relapse and readmission; Multidisciplinary team management.Consensus diagnostic criteria include 12 items within 6 themes: Signs and symptoms (oedema, otorrhoea, granulation); Pain (otalgia, nocturnal otalgia); Investigations (microbiology [does not have to be positive], histology [malignancy excluded], positive CT and MRI); Persistent symptoms despite local and/or systemic treatment for at least two weeks; At least one risk factor for impaired immune response; Indicators of advanced disease (not obligatory but mut be reported when present at diagnosis). Stakeholders were unanimous that there is no role for secondary, graded, or optional diagnostic items. The consensus meeting identified themes for future research. CONCLUSION: The adoption of consensus-defined diagnostic criteria and COS facilitates standardised research reporting and robust data synthesis. Inclusion of patient and professional perspectives ensures best practice stakeholder engagement.

Significance of Basal Cell Carcinomas Exhibiting Intravascular Invasion.

ABSTRACT: Intravascular invasion of tumor cells can be associated with metastasis in many cancers. Basal cell carcinomas (BCCs), however, rarely metastasize; therefore, the clinical impact of intravascularly invasive BCC (IVBCC) is currently unclear. Because of these facts and the rarity of IVBCC, questions have arisen on whether IVBCC truly exists. We present 4 cases of IVBCC: one case with obvious tumor islands within immunolabeled blood vessels in the context of advanced disease and 3 cases found incidentally during Mohs micrographic surgery. We discuss the difficulty in studying IVBCC, the idea that it could be due to artifact, and the lack of direct clinical-pathological correlation. Given these challenges, we propose diagnostic criteria for IVBCC to decrease ambiguity for pathological diagnosis. Such criteria may facilitate further studies on the clinical significance of IVBCC.

Auditory symptoms and autistic spectrum disorder: A scoping review and recommendations for future research.

Introduction: Auditory symptoms in individuals with Autistic Spectrum Disorder (ASD) are well described within the neurodevelopmental literature, yet there is minimal mention of ASD in Otolaryngology literature. This is surprising considering the potential clinical and diagnostic implications of this link, and the potential for ASD to present to Otolaryngologists in the form of unexplained auditory symptoms. The aims of this literature review were to explore the intersection of auditory symptoms and ASD from the perspective of clinical Otolaryngology, and to outline a clinically focused research agenda based on emerging themes relevant to Otolaryngology. Methods: We searched Pubmed, Embase, Ovid and Cochrane library for studies until November 2021. Four authors independently reviewed 227 publications identified. 39 were filtered into the final analysis. The PRISMA 2020 guidelines were followed. The heterogeneity of literature meant that a Systematic Review was not feasible. Included studies were therefore classified thematically, forming the basis of the scoping review. Results: Diagnostic theories for auditory symptoms in ASD include the entire auditory pathway and brain. There is a growing body of literature on auditory symptoms in ASD, suggesting that a primary diagnosis of ASD should be considered in patients presenting with otherwise unexplained auditory symptoms, and indicating a learning need for Otolaryngologists and audiologists, to whom these patients may present. Conclusion: We recommend a research agenda focusing on multidisciplinary collaboration, stakeholder engagement, responsible clinical screening, and clarification of pathophysiological mechanisms and terminology.

Teaching, reflecting, and learning: The value of an intercalated medical education programme.

Objectives: Teaching programmes within medicine focus primarily on pathways of a shorter length with little regard to teaching lasting longer than a month. This study is different from other studies as it examines the benefits of a nine month-long medical education degree programme and its impact beyond graduation. This study set out to explore the impact of a medical education intercalated degree programme for its graduates and their careers.Methods: A small scale, exploratory qualitative case study was conducted with 10 graduates of an intercalated degree programme.Results: The findings highlight the longer term value of an intercalated degree programme with particular emphasis on academic and personal skills; research and teaching skills; independence and confidence; its impact on future practice and the notion that 'student as teacher' programmes are a valuable asset to medical education as a whole. Participants advocated more teaching opportunities as a core longitudinal teaching component in preparation for the teaching responsibilities in their working lives.Conclusions: The programme enables the development of a range of academic and personal skills, with particular emphasis on research and teaching skills, independence and confidence.