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As competitiveness to obtain a residency position in the field of Otolaryngology-Head and Neck Surgery (Oto-HNS) has continued to rise, applicants have endeavored to set themselves apart. One increasingly popular strategy is maximizing research output. Over the past 6 years, applicant metrics such as board scores and volunteer and work experiences have risen incrementally, while research production has more than doubled, from 8.4 mean number of abstracts, presentations, and publications in 2016 to 17.2 in 2022. This coincides with the exponential surge of new research fellowships among Oto-HNS departments over a similar period, which is now up to at least 68 advertised positions. With a significant difference between the research production of matched and unmatched applicants, programs may be signaling a positive bias towards research-heavy applicants. Whether this is intended and/or preferable should be examined more closely.
RESUMO
BACKGROUND: Wide local excision with sentinel lymph node biopsy has been the standard of care for melanoma with a Breslow depth greater than 1 mm. Wide local excision with 1- to 2-cm margins can result in large wounds that cannot be primarily closed. Traditionally, management has included reconstruction with autologous flaps and skin grafting. CASE REPORT: The authors of this case report achieved successful closure of a large posterior calf wound after 2-cm-wide local excision of the melanoma biopsy site in a 61-year-old male. The dermal lesion was a Clark level IV superficial spreading malignant melanoma with Breslow depth of 1.1 mm. Wound closure was achieved with a DTS adhesive skin closure device coupled with MTP xenograft powder as a healing adjunct. CONCLUSION: The results of this patient's case indicate that DTS adhesive skin closure device should be considered as an additional option for the closure of large defects following wide local excision in the management of melanoma.
Assuntos
Melanoma , Neoplasias Cutâneas , Técnicas de Fechamento de Ferimentos , Cicatrização , Humanos , Masculino , Pessoa de Meia-Idade , Xenoenxertos , Melanoma/cirurgia , Melanoma/patologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Transplante de Pele/métodos , Suínos , Adesivos Teciduais/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: This study aimed to determine if the energy delivered by the Gold laser impacted postoperative complication rates after adenoidectomy, tonsillectomy, or adenotonsillectomy. METHODS: A retrospective chart review identified 420 patients who met the criteria within the last five years. Indications for the surgeries included recurrent tonsillitis, obstructive sleep apnea, sleep-disordered breathing, adenoiditis, peritonsillar abscess, and other indications. The relationship between the energy delivered (kJ) and various complications such as bleeding, pain, dehydration, readmission, emergency center visits, and clinic calls was evaluated. RESULTS: There was a significant correlation between higher kJ delivered and the incidence of major bleeding requiring cauterization in the operating room (p = 0.0311). In addition, emergency center visits (p = 0.0131) and readmission (p = 0.0210) showed a significant correlation with the amount of energy (kJ) delivered. Furthermore, higher energy correlated to higher maximum post-operative pain scores (p = 0.0302). Attendings displayed a different pattern of energy delivery compared to residents (p < 0.0001), which also differed by PGY (p < 0.0001). CONCLUSION: There are significant correlations between higher energy delivered in kJ using the Gold laser and less desirable post-operative results. In addition, residents tend to utilize higher energy levels than attendings, but this trend tapers off in the 4th and 5th years. Clinicians utilizing the Gold laser during these procedures should be mindful of the amount of kJ they use.
Assuntos
Tonsilectomia , Humanos , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos , Adenoidectomia/efeitos adversos , Adenoidectomia/métodos , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Dor Pós-Operatória/etiologiaRESUMO
While vaccine administration training is included in the curriculum for several health professions, it is not universally incorporated into the medical school preclinical curriculum. To fill this education gap, a pilot vaccine training program for first- and second-year medical students was conducted using an online Centers for Disease Control and Prevention module and an in-person simulation with nursing faculty. The aim of this study was to evaluate the effectiveness of the training program. Pre- and post-surveys used a Likert 5-point scale to assess the training effectiveness. Ninety-four students completed the surveys (response rate, 93.1%). Following the training, students felt more comfortable giving a patient a vaccine under the supervision of a physician (P < 0.0001), volunteering in a community-wide vaccine campaign (P < 0.0001), and administering vaccines during clinical rotations (P < 0.0001). Most students, 93.6%, found the in-person training to be "effective" or "very effective," and 97.8% felt that learning how to administer vaccines should be incorporated into the preclinical medical curriculum. Without this program, 76 students (80.1%) would not have been able to participate in a vaccine training. The interdisciplinary training program outlined in this study may serve as a model for similar initiatives at other medical schools.
RESUMO
The abbreviated injury score (AIS) is commonly used as a grading system for inhalation injuries. While inhalation injury grades have inconsistently been shown to correlate positively with the time mechanical ventilation is needed, grading is subjective and relies heavily on the clinicians' experience and expertise. Additionally, no correlation has been shown between these patients' inhalation injury grades and outcomes. In this paper, we propose a novel inhalation injury grading method which uses deep learning algorithms in bronchoscopy images to determine the injury grade from the carbonaceous deposits, blistering, and fibrin casts in the bronchoscopy images. The proposed method adopts transfer learning and data augmentation concepts to enhance the accuracy performance to avoid overfitting. We tested our proposed model on the bronchoscopy images acquired from eighteen patients who had suffered inhalation injuries, with the degree of severity 1, 2, 3, 4, 5, or 6. As performance metrics, we consider accuracy, sensitivity, specificity, F-1 score, and precision. Experimental results show that our proposed method, with both transfer learning and data augmentation components, provides an overall 86.11% accuracy. Moreover, the experimental results also show that the performance of the proposed method outperforms the method without transfer learning or data augmentation.