Perception Precedes Reality: A Simulation and Procedural Bootcamp Improves Residents' Comfort With Transitioning to Clinical Anesthesiology Training.

Background The transition from internship to clinical anesthesiology (CA) training is often difficult given the differences in workflow, procedures, environment, and clinical situations. The primary aims of this study were to determine if a standardized introductory bootcamp could improve clinical knowledge and self-perceived comfort level of new anesthesiology residents in performing common operating room procedures and management of common intraoperative problems. The secondary aim of the study was to see if a standardized bootcamp could be replicated at other programs. Methods The introduction to anesthesiology resident bootcamp was developed at one institution in 2015 then expanded to a second program in 2019. The bootcamp was a one-day experience consisting of simulation and task trainers that all rising first-year CA residents (CA-1) participated in during their first month of anesthesiology training. All participating residents were given a survey immediately before and after the bootcamp. The average ratings of the questions were calculated and used as the primary measure. The Anesthesia Knowledge Test (AKT) was used as a surrogate measure of participant knowledge. Results From 2015 to 2020, a total of 105 residents completed the pre-survey and 109 completed the post-survey across the two sites. The improvement in average rating was significant (Pre: 2.04±0.46 versus Post: 3.09±0.52 p<0.0001). Individual item analysis also showed significant improvement on all of the eight items (p<0.0001). Analyses by site revealed the same results at both average score and item level. There was no significant cohort difference in either AKT-0 (Control: 57.84±26.86 versus Intervention 50.13±25.14, p=0.14) or AKT-1 (Control: 41.06±26.42 versus Intervention 41.70±26.60, p=0.90) percentile scores. Conclusions Incorporation of an introduction to anesthesia bootcamp for new residents significantly improves participant comfort level and is reproducible across institutions. However, it does not improve resident performance on standardized tests.

COVID-19 mRNA vaccination, reactogenicity, work-related absences and the impact on operating room staffing: A cross-sectional study.

BACKGROUND: The COVID-19 pandemic has caused disruption to healthcare delivery worldwide including in the delivery of surgical services. The introduction of mRNA COVID vaccines and the significant reactogenicity seen with vaccination has caused an unanticipated impact on the operating room workforce via unanticipated paid time off after employee vaccination. METHODS: A retrospective cross-sectional survey was made available to approximately 33,000 front-line healthcare workers, students and volunteers who were offered voluntary vaccination in a state-wide healthcare system during phase one of the state's vaccine roll-out. The primary study aim was to determine the frequency of unanticipated paid time off, and the secondary study aim was to identify any demographic determinants influencing the need for unanticipated time off work secondary to adverse effects. RESULTS: 4009 responses were received, a 12.15% response rate. When looking specifically at individuals who did not proactively schedule themselves for time off after vaccination, we determined that unanticipated paid administrative leave was required for 4.9% and 19.79% of individuals after the first and second doses of vaccine, respectively. The average lengths of absence were 1.66 days and 1.39 days for the first and second doses, respectively. There were no statistically significant differences found in the need for unanticipated leave when compared by vaccine manufacturer, gender, age, ethnicity, or job description. However, individuals with a bachelor's degree demonstrated a significantly higher unanticipated leave requirement than respondents who reported other educational backgrounds. CONCLUSIONS: The ability to staff operating rooms and other critical healthcare services may be negatively affected as a result of COVID-19 mRNA vaccination reactogenicity and subsequent unanticipated paid administrative leave. For future COVID-19 boosters or during other pandemics in which mRNA vaccination is recommended, employees should proactively schedule their vaccination(s) in conjunction with their work schedules to minimize the impact of reactogenicity and unanticipated time off on the operating room schedule and patient care.

Post-operative budesonide irrigations for patients with polyposis: a blinded, randomized controlled trial.

OBJECTIVE: To compare normal saline (NS) vs. NS+budesonide irrigations in post- functional endoscopic sinus surgery (FESS) patients with chronic rhinosinusitis with polyposis (CRSwNP). Currently, no evidence exists for NS+budesonide irrigation over NS irrigation alone. STUDY DESIGN: Prospective, single-blind, randomized controlled trial. METHODS: Subjects were prospectively enrolled to NS or NS+budesonide arms. Patients were evaluated at pre-operative and three post-operative visits (POV): POV1 (1-2 weeks post-op), POV2 (3-8 weeks post-op), and POV3 (3-6 months post-op). Patients were evaluated by three quality of life (QOL) questionnaires (SNOT-22, RSOM-31, and RSDI) and two olfaction scores (UPSIT and the PEA test). RESULTS: Fifty patients were randomized, with 25 patients in the NS arm and 25 patients in the NS+budesonide arm. Two patients had unexpected pathology and were excluded from the study. By POV2 and POV3, patients experienced a significant improvement in all three QOL surveys, although the degree of improvement between arms was not significant up through POV3. Neither arm experienced significant olfactory improvement up through POV3. CONCLUSIONS: While both NS and NS+budesonide treatments improve QOL for post-FESS patients, neither intervention significantly increases QOL as compared to the other. Olfaction was not significantly improved in either treatment group.

Quantification of airflow into the maxillary sinuses before and after functional endoscopic sinus surgery.

BACKGROUND: The effects of increases in maxillary sinus (MS) airflow following functional endoscopic sinus surgery (FESS) are unknown. The goal of this study was to quantify the effects of FESS on airflow into the MS in a cohort of patients with chronic rhinosinusitis, and compare MS flow rate with patient-reported outcome measures. METHODS: A pilot study was conducted in which preoperative and postoperative computed tomography scans of 4 patients undergoing bilateral or unilateral FESS were used to create 3-dimensional (3D) reconstructions of the nasal airway and paranasal sinuses using Mimics™ (Materialise, Inc.). The size of the maxillary antrostomies post-FESS ranged from 107 to 160 mm(2). Computational meshes were generated from the 3D reconstructions, and steady-state, laminar, inspiratory airflow was simulated in each mesh using the computational fluid dynamics (CFD) software Fluent™ (ANSYS, Inc.) under physiologic, pressure-driven conditions. Airflow into the MS was estimated from the simulations and was compared preoperatively and postoperatively. In addition, patients completed preoperative and postoperative Rhinosinusitis Outcome Measure-31 (RSOM-31) questionnaires and scores were compared with MS airflow rates. RESULTS: CFD simulations predicted that average airflow rate into post-FESS MS increased by 18.5 mL/second, and that average flow velocity into the MS more than quadrupled. Simulation results also showed that MS flow rate trended with total RSOM-31 and all domain scores. CONCLUSION: CFD simulations showed that the healed maxillary antrostomy after FESS can greatly enhance airflow into the MS. Our pilot study suggests that to some extent, increasing airflow into the MS may potentially improve chronic rhinosinusitis patients' quality of life pre-FESS and post-FESS.