Anti-racism bystander training: A critical need in medical schools.

Despite increasing acknowledgment of racism in both the curricular and clinical spaces, it continues to pervade the medical field, with clear detrimental impacts to the health of our patients. The introduction of anti-racism bystander training (ARBT) may provide a unique opportunity to reduce inequitable care and health disparities that occur secondary to racism in healthcare. ARBT, in its various forms, has been shown to be an effective method to increase participants' confidence and efficacy in intervening on observed racist encounters. This training can take numerous forms, and the authors provide one successful template used with medical students at their own institution. If medical centers, educators, and leaders in the field of medicine truly hope to mitigate the individual racist behaviors that remain in healthcare, ARBT must be employed to a much wider degree in medical education.

Critical Components of Diversity Initiatives.

The importance of diversity is well established and holds important implications for workplace and physician-patient relationships. Evaluation of diversity statistics within otolaryngology-head and neck surgery reveals areas of deficiency that may be improved with targeted proactive approaches. This article provides a general overview of diversity within otolaryngology, highlights key components of diversity initiatives, and provides strategies for implementation.

Multi-Institutional Analysis of Outcomes in Supraglottic Jet Ventilation with a Team-Based Approach.

OBJECTIVES/HYPOTHESIS: To evaluate the safety and complications of endoscopic airway surgery using supraglottic jet ventilation with a team-based approach. STUDY DESIGN: Retrospective cohort study. METHODS: Subjects at two academic institutions diagnosed with laryngotracheal stenosis who underwent endoscopic airway surgery with jet ventilation between January 2008 and December 2018 were identified. Patient characteristics (age, gender, race, follow-up duration) and comorbidities were extracted from the electronic health record. Records were reviewed for treatment approach, intraoperative data, and complications (intraoperative, acute postoperative, and delayed postoperative). RESULTS: Eight hundred and ninety-four patient encounters from 371 patients were identified. Intraoperative complications (unplanned tracheotomy, profound or severe hypoxic events, barotrauma, laryngospasm) occurred in fewer than 1% of patient encounters. Acute postoperative complications (postoperative recovery unit [PACU] rapid response, PACU intubation, return to the emergency department [ED] within 24 hours of surgery) were rare, occurring in fewer than 3% of patient encounters. Delayed postoperative complications (return to the ED or admission for respiratory complaints within 30 days of surgery) occurred in fewer than 1% of patient encounters. Diabetes mellitus, active smoking, and history of previous tracheotomy were independently associated with intraoperative, acute, and delayed complications. CONCLUSIONS: Employing a team-based approach, jet ventilation during endoscopic airway surgery demonstrates a low rate of complications and provides for safe and successful surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2292-2297, 2021.

Development of an interprofessional clinical learning environment report card.

Multiple factors in the learning environment can encourage or impede student learning. Unanswered questions regarding the shared learning environment for graduate nursing and medical education and the desire for an ongoing improvement process drove creation of an interprofessional collaborative and development of an Interprofessional Clinical Learning Environment Report Card (I-CLERC) at one U.S. academic medical center. The I-CLERC offers a process and a product for institutionalizing a shared assessment tool to inform improvement efforts, track progress and promote accountability. In addition, it enhances interprofessional collaboration, with students and faculty from both nursing and medicine working together to define excellence, monitor performance, and identify areas for improvement in the shared clinical learning environment. The purpose of this manuscript is to describe development and implementation of an interdisciplinary, institutional collaborative for ongoing evaluation of the shared clinical learning environment.

Randomized controlled trial of supplemental augmentative and alternative communication versus voice rest alone after phonomicrosurgery.

OBJECTIVE: This randomized trial investigated voice rest and supplemental text-to-speech communication versus voice rest alone on visual analog scale measures of communication effectiveness and magnitude of voice use. STUDY DESIGN: Randomized clinical trial. SETTING: Multicenter outpatient voice clinics. SUBJECTS: Thirty-seven patients undergoing phonomicrosurgery. METHODS: Patients undergoing phonomicrosurgery were randomized to voice rest and supplemental text-to-speech communication or voice rest alone. The primary outcome measure was the impact of voice rest on ability to communicate effectively over a 7-day period. Pre- and postoperative magnitude of voice use was also measured as an observational outcome. RESULTS: Patients randomized to voice rest and supplemental text-to-speech communication reported higher median communication effectiveness on each postoperative day compared to those randomized to voice rest alone, with significantly higher median communication effectiveness on postoperative days 3 (P=.03) and 5 (P=.01). Magnitude of voice use did not differ on any preoperative (P>.05) or postoperative day (P>.05), nor did patients significantly decrease voice use as the surgery date approached (P>.05). However, there was a significant reduction in median voice use pre- to postoperatively across patients (P<.001) with median voice use ranging from 0 to 3 throughout the postoperative week. CONCLUSION: Supplemental text-to-speech communication increased patient-perceived communication effectiveness on postoperative days 3 and 5 over voice rest alone. With the prevalence of smartphones and the widespread use of text messaging, supplemental text-to-speech communication may provide an accessible and cost-effective communication option for patients on vocal restrictions.

Injection versus medialization laryngoplasty for the treatment of unilateral vocal fold paralysis: follow-up at six months.

OBJECTIVES/HYPOTHESIS: To determine whether injection laryngoplasty or medialization laryngoplasty is more effective in the long-term treatment of unilateral vocal fold paralysis (UVFP). STUDY DESIGN: A retrospective study of patients with UFVP who underwent either injection or medialization laryngoplasty at the University of Arkansas for Medical Sciences between July 29, 2003 and November 18, 2005. METHODS: The data analyzed included patient characteristics and type of intervention, along with the pretreatment and post-treatment parameters of videostrobolaryngoscopy, perceptual voice analysis, and patients' subjective assessment of voice handicap. RESULTS: Thirty-four patients were evaluated, 15 new and 19 from a previous study. The average time from intervention to post-treatment evaluation in the new cohort was 4.8 months (range, 1.5-10.5 months). The average time from intervention to post-treatment in the combined cohort was 6.4 months (range, 1-24 months). Improvements were demonstrated in each of the measured voice parameters in both the injection and the medialization groups, and no significant differences were found in the degree of improvement between the two groups. Limited data on aerodynamic and acoustic voice measurements showed a trend toward improvement in each treatment group. CONCLUSIONS: Injection and medialization laryngoplasty were comparable in achieving voice improvement at the average long-term follow-up of 6 months.