Self-reported assessment of outcome-based education in Philippine Otolaryngology - Head and Neck Surgery residency training programs by consultants and residents

Objective@#To determine the self-reported assessment of initial implementation of the 3 domains of Outcome-Based Education in accredited Otolaryngology - Head and Neck Surgery residency training programs in the Philippines by consultants and residents and explore any associations between their demographic profiles and assessments. @*Methods@#Design: Mixed Method Research Design Setting: Multicenter - 30 accredited ORL-HNS residency training institutions in the Philippines- National Capital Region (NCR) 19, Luzon 7, Visayas 2, and Mindanao 2. Participants: A total of 129 consultants and 82 second to fourth year residents in training were included in the study by convenience sampling. First-year residents who started their residency training in January 2020 were excluded. Respondents answered self-reported questionnaires to assess implementation of the 3 domains of OBE: intended learning outcomes (ILO), teaching and learning activities (TLA) and assessment tasks (AT) using the 4-point scale score from “fully implemented” (4) to “not implemented” (1). Results of questionnaires were confirmed using open-ended questions on the challenges of OBE with a focused group discussion among 4 consultants and 1 resident. @*Results@#The self-reported assessment of respondents on OBE implementation was “fully implemented” in the 3 domains. However, low numerical scores were seen for “managing community health and social need” in the ILO and “laboratory activities and workshops” in the TLA for both consultants and residents, in the assessment task (AT “multisource feedback by nurses and administrative staff” for the consultants, and “direct observation of performance skills for patient encounter” for residents. Among the 7 modules, “research methodology” had the lowest score for both consultants’ and residents’ self-perception. Challenges of OBE revealed included “mastery,” “time” and “data keeping.” Consultants younger than 60 years of age who had been in the department longer than 3 years and residents who attended an OBE workshop / lecture tended to give higher scores. @*Conclusion@#Two years after distribution of the manual on OBE to ORL-HNS residency training institutions, the consultants’ and residents’ self-reported assessment on implementation in all the 3 domains of OBE was “fully implemented.

A linguistic validation study on the Filipino dizziness handicap inventory

@#Objective: To determine the validity and reliability of the Filipino Dizziness Handicap Inventory (FDHI) questionnaire among geriatric patients with dizziness. Methods: Design: Linguistic Validation Setting: Tertiary Government Training Hospital Participants: Twenty-five (25) patients Results: The dizziness handicap inventory was translated into Filipino by a Filipino language specialist and an ENT specialist who are experts in their field. The translated version was easily understood by the 25 geriatric patients with Cronbach α scores of .957 overall [M = 2.16; SD = 1.93]. Sub-domain item-total correlation scores (physical M = 2.6, SD = 1.90, Cronbach α = .860; emotional M = 1.66, SD = 1.84, Cronbach α = .901; and functional M = 2.5, SD = 1.97, Cronbach α = .902) demonstrated validity of the respective subdomains. Conclusion: The Filipino Dizziness Handicap Inventory questionnaire is an internally valid tool for assessment of dizziness among geriatric patients. External validity and reliability can be evaluated in future studies employing corroborative measures and repeated testing.

An impacted live fish in the oropharynx of an 8-year old child

OBJECTIVE: To present an atypical case of a live fish lodged in the throat of a pediatric patient and discuss its management. METHODS: Study Design: Case Report    Setting:                        Tertiary Government HospitalSubject:                       One RESULTS: An 8-year-old girl swallowed a live fish when she accidentally fell in a body of water. Failed attempts to remove the live fish prompted consult in the emergency room of our hospital, where removal of the foreign body was successfully done using Mixter right angle forceps assisted with a gloved finger. Transient cyanosis and unresponsiveness during extraction was overcome with oxygen by mask, and she regained consciousness. She was allowed to go home as no other untoward events or complications were observed.   CONCLUSION:  All ingested foreign bodies, particularly in children, require immediate attention. The survival of patients with upper aerodigestive and airway foreign bodies depends on early recognition and prompt multidisciplinary management. 

An impacted live fish in the oropharynx of an 8-year-old child

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present an atypical case of a live fish lodged in the throat of a pediatric patient and discuss its management.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULT:</strong> An 8-year-old girl swallowed a live fish when she accidentally fell in a body of water. Failed attempts to remove the live fish prompted consult in the emergency room of our hospital, where removal of the foreign body was successfully done using Mixter right angle forceps assisted with a gloved finger. Transient cyanosis and unresponsiveness during extraction was overcome with oxygen by mask and she regained consciousness. She was allowed to go home as no other untoward events or complications were observed.<br /><strong>CONCLUSION:</strong> All ingested foreign bodies particularly in children require immediate attention. The survival of patients with upper aerodigestive and airway foreign bodies depends on early recognition and prompt multidisciplinary management.</p>

Adult acute epiglottitis: An eight - year experience in a Philippine tertiary government hospital

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To review cases of adult acute epiglottis in a tertiary government hospital and describe the clinical presentations, diagnostics performed, management and outcomes. <br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective Chart Review<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Participants:</strong> Records of patients admitted by or referred to the Department of Otolaryngology Head and Neck Surgery with a diagnosis of acute epiglottis from January 2008 to August 2014 were identified from the department census and charts were retrieved from the Hospital Record Section and evaluated according to inclusion and exclusion criteria. Information regarding demographic data, clinical features, laboratory and other diagnostic examinations, medical management, and length of hospital stay were collected.<br /><strong>RESULTS:</strong> There were 20 cases in 7 years and 8 months. Most were male, 18 to 37-years-old, presenting with dysphagia, odynophagia and a swollen epiglottis on laryngoscopy. Abnormal soft-tissue lateral radiographs of the neck and leukocytosis were seen in 73% and 83%, respectively. Intravenous antibiotics and corticosteroids were administered in all cases, and mean hospital stay was 11.2 days.<br /><strong>CONCLUSION:</strong> Adult acute epiglottis should be highly suspected in patients presenting with dysphagia, odynophagia, and muffling of the voice even with a normal oropharyngeal examination. History of respiratory infection, co-morbidities, smoking and alcohol intake, concomitant laryngeal pathology and supraglottic structure insults contribute to development of the disease. Laryngoscopy is still the gold standard in diagnosis. Airway protection is mandatory but prophylactic intubation or tracheostomy are not advised. Intravenous antibiotics are necessary and corticosteroids may be of benefit. </p>

The effectiveness of intravenous tranexamic acid on blood loss and surgical time during endoscopic sinus surgery: A systematic review

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To review the effectiveness of intravenous tranexamic acid in reduction of blood loss, surgical time and field visualization among patients who underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis  (CRS).<br /><strong>METHODS:</strong> <br /> <strong>Data Sources:</strong> MEDLINE (PubMed), EMBASE, ScienceDirect, HERDIN, and the Cochrane Library.<br /><strong> Eligibility Criteria: </strong>Randomized controlled trials (RCT) between 2005-2014 that evaluated the effects of   tranexamic  acid or placebo in patients undergoing ESS for CRS.<br /> <strong>Appraisal and Synthesis Methods:</strong> Articles were selected by 2 independent reviewers and methodological quality was blindly evaluated using a Jadad scale. Data were compiled in tables for analysis of outcome measures (estimated blood loss, length of surgery and intraoperative surgical field visualization).<br /><strong>RESULTS:</strong> Two trials were included in the study, enrolling 128 patients. One arm of the study had been given tranexamic acid while the other arm was given placebo (saline solution). Results varied for both studies. The summary of the observed difference for blood loss had a standardized mean difference of -51.20 (Cl95 [-59.44, -42.95]) showing that the blood loss in millimeters was less in the tranexamic group compared to saline solution. The summary of the observed difference in surgical time had a standardized mean difference of -19.32   (Cl95 [-24.21, -14.43]) showing that the surgical time in minutes was shorter in the tranexamic group compared to saline solution.  The secondary outcome on surgical field visualization was not pooled together because the studies used different measurement scales.<br /><strong>LIMITATIONS:</strong> The most important weaknesses of the 2 included studies were the differences in dose of tranexamic acid, scales of measurement of field visibility and age groups of the patients. <br /><strong>CONCLUSION:</strong> Tranexamic acid reduced blood loss and shortened surgical time after ESS among patients with CRS. However, the additional benefit of tranexamic acid for better field visualization was not clear. Adverse effects were not considered in the study, however, results support the use of intravenous tranexamic acid intraoperatively as an option for ESS with blood loss  as a concern. Further randomized clinical trials and an update on the systematic review will strengthen the evidence on the effectivity of tranexamic acid for ESS.<br /><br /><br /><br />               </p>

Large nasopharyngeal true teratoma in a Filipino newborn: A case report

OBJECTIVES: 1. To present a rare case of a true teratoma of the nasopharynx in a Filipino newborn. 2. To present a rational diagnostic and management approach to the case. DESIGN: Case report SETTING: Tertiary Government Hospital PATIENT: One female newborn RESULTS: A newborn presented with a congenital large naso-oropharyngeal mass. She did not present with signs of airway obstruction. The oral mass was found to be attached to the nasopharynx. The initial consideration was a teratoma. The patient also manifested with an incomplete cleft palate and dermoid cyst on the left eye. Contrast CT scan confirmed the attachment of the mass to the left nasopharyngeal wall. The mass was subsequently resected and delivered transorally. The final histopathology showed teratoma. Otorhinolaryngologic management of this case encompassed the following priorities: (1) ensuring vital & vegetative function (airway & feeding), (2) examination of the newborn for concomitant congenital anomalies, (3) resection of the mass after accurate delineation of its extent and dimensions and (4) planning for future repair of the palatal defect. CONCLUSION: True teratomas of the nasopharynx are rare lesions (originating from the 3 embryonic germ cell layers). Airway management is the first priority of the otorhinolaryngologist in these cases because of potential to cause upper airway obstruction. (Author)