Deploying an ethics needs assessment to inform a navigational tool for research compliance pathways at a provincial Canadian health authority.

Practitioners aim to improve healthcare systems and clinical care through a variety of activities as part of a learning healthcare system. Yet the distinction between projects requiring Research Ethics Board (REB) approval or not is becoming increasingly blurred, making it difficult for researchers and others to classify projects and then navigate the required compliance pathway appropriately. To address this challenge, the Provincial Health Services Authority (PHSA) of British Columbia (BC) created a decision tool called the "PHSA Project Sorter Tool" to serve its diverse community while also meeting the unique needs of the BC regulatory and policy environment. The goal of the tool was to standardize and clarify organizational project review and ensure project leads were referred to the appropriate review body or service provider within the PHSA in the most efficient manner possible. In this paper, we describe the ethics needs assessment that was conducted to inform the tool and the results of our ongoing evaluation of the tool since it was launched in January, 2020. Our project shows that this simple tool can reduce burdens on staff and provide clarity to users by standardizing processes and terms and directing users to appropriate internal resources.

The Use of Botulinum Toxin Type A in the Healing of Thyroidectomy Wounds: A Randomized, Prospective, Placebo-Controlled Study.

BACKGROUND: Recent research has indicated that botulinum toxin type A may have an inhibitory effect on the formation of fibroblasts and thus possibly decreases the severity of scar formation. Therefore, a trial was designed to assess the effects of botulinum toxin type A on scar formation after thyroid surgery. METHODS: A double-blind, randomized, controlled trial was designed. All patients underwent a preoperative survey to assess scar history. All patients underwent a total thyroidectomy, hemithyroidectomy, or parathyroidectomy through a standardized incision. At the conclusion of the case, one half of the incision was injected with botulinum toxin type A, and the other half was injected with saline (placebo). The scars were then evaluated at 4 weeks, 6 months, and 1 year postoperatively using subjective scar analysis scales. RESULTS: A total of 40 patients were enrolled. There was no significant difference in scarring at any of the time points between the botulinum toxin type A-treated and placebo sides of the incision. A subgroup analysis was performed that examined the effects of botulinum toxin type A on those with a severe scar history. This demonstrated a significant decrease in scarring at 6 months postoperatively on the botulinum toxin type A-treated side. CONCLUSIONS: This study indicates that botulinum toxin type A administration immediately after surgical closure of a thyroid incision does not demonstrate a difference in scar outcomes compared with the control side. However, there was less scarring in subjects who had a severe scar history. This study found opposite results to a similarly designed study. Further study is required to determine the optimal use of botulinum toxin type A for wound healing. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Comparison of single photon emission CT (SPECT) with SPECT/CT imaging in preoperative localization of parathyroid adenomas: A cost-effectiveness analysis.

BACKGROUND: Controversy exists regarding the superiority of single photon emission CT (SPECT)/CT over SPECT for preoperative localization of parathyroid adenomas in primary hyperparathyroidism (PHPT), as well as the cost-effectiveness. METHODS: A retrospective review was undertaken of patients undergoing surgery for PHPT from January 2009 to August 2014. Ultrasound and SPECT (ultrasound-SPECT) or SPECT/CT (ultrasound-SPECT/CT) were performed for each patient. Sensitivity and positive predictive value (PPV) of each modality were calculated. Cost-effectiveness was determined by an incremental cost-effectiveness ratio (ICER) analysis. RESULTS: Two hundred fifty-nine patients with 266 parathyroid adenomas were included in the study. Lateralization sensitivity and PPV of ultrasound-SPECT were 85.1% and 98.2%, respectively. The lateralization sensitivity and PPV of ultrasound-SPECT/CT were 86.9% and 99.4%, respectively. A cost of $2499.22 (CAD) per additional parathyroid adenoma detection by ultrasound-SPECT/CT was determined from the ICER analysis. CONCLUSION: Similar sensitivities and PPVs were observed between ultrasound-SPECT and ultrasound-SPECT/CT in preoperatively lateralizing parathyroid adenomas, with relatively equivalent cost-effectiveness. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2062-E2065, 2016.

The effectiveness of modified cottle maneuver in predicting outcomes in functional rhinoplasty.

Objective. To assess the outcomes of functional rhinoplasty for nasal valve incompetence and to evaluate an in-office test used to select appropriate surgical techniques. Methods. Patients with nasal obstruction due to nasal valve incompetence were enrolled. The modified Cottle maneuver was used to assess the internal and external nasal valves to help select the appropriate surgical method. The rhinoplasty outcomes evaluation (ROE) form and a 10-point visual analog scale (VAS) of nasal breathing were used to compare preoperative and postoperative symptoms. Results. Forty-nine patients underwent functional rhinoplasty evaluation. Of those, 35 isolated batten or spreader grafts were inserted without additional procedures. Overall mean ROE score increased significantly (P < 0.0001) from 41.9 ± 2.4 to 81.7 ± 2.5 after surgery. Subjective improvement in nasal breathing was also observed with the VAS (mean improvement of 4.5 (95% CI 3.8-5.2) from baseline (P = 0.000)). Spearman rank correlation between predicted outcomes using the modified Cottle maneuver and postoperative outcomes was strong for the internal nasal valve (Rho = 0.80; P = 0.0029) and moderate for the external nasal valve (Rho = 0.50; P = 0.013). Conclusion. Functional rhinoplasty improved subjective nasal airflow in our population. The modified Cottle maneuver was effective in predicting positive surgical outcomes.

Upper airway findings in children with Down syndrome on sleep nasopharyngoscopy: case-control study.

OBJECTIVE: To identify the pattern of upper airway endoscopic findings in Down syndrome (DS) children with sleep-disordered breathing (SDB) spectrum. DESIGN AND SETTING: Retrospective case-control study in a tertiary pediatric centre. METHODS: DS children presenting with persistent snoring or SDB who underwent sleep nasopharyngoscopy (SNP) were identified from a prospectively kept surgical database. All SNPs were performed using a uniform intravenous sedation technique. Controls with persistent snoring or SDB from the same database were identified and pair-matched for age, gender, and body mass index (BMI) percentiles. The video recordings of the SNP for all subjects were reviewed. A comparison of the proportions of obstruction (O), mixed (M), and collapse (C) findings in each group was performed. RESULTS: Over a period of 4.5 years, 23 consecutive DS children were identified (7 girls, 16 boys; mean age 7.09 ± 4.37 years). They were matched with 23 controls (mean age 7.6 ± 4.14 years). The DS group exhibited significantly more pharyngeal collapses than the controls (O:C:M, 2:6:15 and 12:0:10, respectively; p < .005). Lingual collapses were also noted more in DS children (11 vs 4), and a more significant number of collapses were seen (p < .004). Whereas nearly equal numbers exhibited tonsillar obstruction, adenoidal obstruction was significantly less in DS children (p < .05). CONCLUSION: Generalized pharyngeal collapse dominates in DS children who present with SDB and is independent of age, gender, and BMI. Adenoidal hypertrophy causing obstruction is much less encountered than in controls.

Effect of fibula free flap harvest on the gait of head and neck cancer patients: preliminary results.

OBJECTIVE: To determine the impact of fibula free flaps (FFFs) on gait. DESIGN: Prospective trial. SETTING: FFF patients who gave consent were enrolled. METHODS: At preoperative and 3-month postoperative visits, patients walked 30 m with the Walkabout Portable Gait Monitor (WPGM), a portable device developed at Dalhousie University that records acceleration of the centre of mass. Gaitview software provided several outputs for analysis: vertical (VA) and forward (FA) asymmetry, horizontal to vertical power ratio (HVP), vertical to forward power ratio (VFP), velocity, and step length. Patients were compared pre- and postoperatively and to age-matched control data with a Student paired t-test. Patients completed a self-comorbidity questionnaire and a point evaluation system (PES) with subjective questions on gait. PES data were compared to a Mann-Whitney U test using SPSS, version 15.0.1. MAIN OUTCOME MEASURES: Gaitview output and PES questionnaire. RESULTS: From September 2008 to January 2010, 12 patients enrolled in the study. Eight provided 3-month postoperative data. The Gaitview analysis showed that none of the six parameters changed postoperatively. The VA and FA preoperatively and at 3 months postoperatively were 21.3 versus 24.2, p > .50, and 65.4 versus 74.9, p > .50, respectively. The HVP and VFP preoperatively and postoperatively were 133.4 versus 138.9, p > .50, and 129.6 versus 122.8, p > .50, respectively. The velocity and step length preoperatively and postoperatively were 125.9 versus 119.5 cm/s, p > .50, and 76.0 versus 74.9 cm, p > .50, respectively. The subjective PES questionnaire did not change significantly (p  =  .26). CONCLUSION: Preliminary findings confirm that the FFF is associated with little subjective or objective gait impairment.

Postoperative respiratory complications and recovery in obese children following adenotonsillectomy for sleep-disordered breathing: a case-control study.

OBJECTIVE: To compare postoperative respiratory complications in obese and nonobese children following surgery for sleep-disordered breathing. STUDY DESIGN: Case-control study. SETTING: Pediatric tertiary care center. SUBJECTS AND METHODS: All obese children who had undergone adenotonsillectomy for sleep-disordered breathing from 2002 to 2007 were compared with age- and gender-matched controls. Subjects were identified from a prospective surgical database. Length of hospital stay and the incidence, severity, and location of respiratory complications were compared. Multivariable analysis was performed to identify predictive factors. RESULTS: Forty-nine obese children were identified (20:29, female:male). There were no differences in mean age or type of surgical procedures (P > 0.05). Overall, 37 obese children (75.5%) and 13 controls (26.5%) incurred complications (P = 0.000, OR 8.54 [95% CI 3.44-21.19]). Ten obese patients and two controls incurred major events (P = 0.012, OR 6.03 [95% CI 1.25-29.15]); 36 obese children had minor complications versus 12 controls (P = 0.000, OR 8.54 (95% CI 3.44-21.19). Obese children had significantly more upper airway obstruction (19 vs 4, P = 0.0003, OR 7.13 [95% CI 2.20-23.03]), particularly during the immediate postoperative period. The mean hospital stay was significantly longer for the obese group (18 vs 8 hours, P = 0.000, mean difference of 10 hours [95% CI 2.01-17.99]). Male gender, tonsillectomy, and body mass index were significant predictive factors. CONCLUSION: Obesity in children significantly increases the risk of respiratory complications following surgery for sleep-disordered breathing. Overnight hospitalization for obese children is recommended.

Esophageal mucoceles causing airway obstruction as a complication of esophageal diversion: two rare pediatric cases and a review of the literature.

An esophageal mucocele causing airway obstruction is an exceptionally rare complication of esophageal diversion in children. In this instance, they are fluid-filled dilatations of the esophageal remnant following bipolar exclusion of the thoracic esophagus. Only six pediatric cases have been reported previously in the literature. We present two consecutive cases of esophageal mucoceles causing respiratory distress in children following surgical exclusion of the esophagus. Bronchoscopy followed by imaging (computerized tomography or magnetic resonance imaging) was used to reach the diagnosis. Complete resection of the thoracic esophagus was required in both patients. Esophageal mucoceles can occur many years after esophageal exclusion, and the clinical features are often non-specific. Furthermore, complex co-morbidities may mask the underlying etiology of the respiratory distress, thus the diagnosis may be difficult to delineate. A high degree of suspicion, clinical awareness, and the use of the proper diagnostic tools, are essential for a diagnosis of mucoceles in children with a past history of esophageal exclusion.

A floor of mouth teratoid cyst with tract in a newborn--case report and English literature review unraveling erroneous quotes and citations.

Dysontogenetic cysts are thought to fall into one of three classes: epidermoids, dermoids or teratoids. Floor of mouth teratoid cysts are the least common presentation reported. Over the last 70 years, fewer than 20 histologically proven cases have been described in the English literature. We report an infant presenting with this lesion in association with a midline tract. The cyst was identified at birth and interfered with feeding. It was surgically excised with no recurrence at 10 month point of follow-up. A literature search revealed that confusing terminology and indirect quotation disseminated false beliefs regarding the epidemiology. Contrary to most reports, floor of mouth teratoid cysts are most commonly encountered in childhood with only a handful of cases in older age groups.