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1.
World J Otorhinolaryngol Head Neck Surg ; 2021 Apr 24.
Article in English | MEDLINE | ID: covidwho-1201521

ABSTRACT

OBJECTIVE: To evaluate medical student and attending surgeon experiences with a novel interactive virtual Otolaryngology - Head and Neck Surgery (OHNS) medical student elective during the COVID-19 pandemic. STUDY DESIGN: A virtual OHNS elective was created, with three components: (1) interactive virtual operating room (OR) experience using live-stream video-conferencing, (2) telehealth clinic, (3) virtual didactics. SETTING: OHNS Department at the University of Pennsylvania (May 2020 to June 2020). METHODS: Six medical students from the University of Pennsylvania; five attending otolaryngologists. Two surveys were designed and distributed to participating medical students and attending surgeons. Surveys included 5-point Likert scale items, with 1 indicating "not at all" and 5 indicating "very much so". RESULTS: Response rate was 100% for both surveys. Students on average rated the educational value of the telehealth experience as 4.2 ± 1.2, and the virtual OR experience as 4.0 ± 0.6. Most students (n = 5, 83%) indicated that they had enough exposure to faculty they met on this rotation to ask for a letter of recommendation (LOR) for residency if needed, while attending surgeons had an average response of 3.0 ± 1.0 when asked how comfortable they would feel writing a LOR for a student they met through the rotation. A majority of students (n = 4, 67%) felt they connected enough with faculty during the rotation to ask for mentorship. Half the students (n = 5, 50%) indicated that the rotation allowed them to evaluate the department's culture either "extremely well" or "somewhat well". CONCLUSIONS: Overall, participating students described this innovative virtual surgical rotation as an educationally and professionally valuable experience. With the continued suspension of visiting student rotations due to the COVID-19 pandemic, this virtual model may have continued relevance to medical education.

2.
World J Otorhinolaryngol Head Neck Surg ; 2021 Jan 22.
Article in English | MEDLINE | ID: covidwho-1057471

ABSTRACT

OBJECTIVE: Otolaryngologists are at increased occupational risk of Coronavirus Disease 2019 (COVID-19) infection due to exposure from respiratory droplets and aerosols generated during otologic, nasal, and oropharyngeal examinations and procedures. There have been a variety of guidelines and precautions developed to help mitigate this risk. While many reviews have focused on the personal protective equipment (PPE) and preparation guidelines for surgery in the COVID-19 era, none have focused on the more creative and unusual solutions designed to limit viral transmission. This review aims to fill that need. DATA SOURCES: PubMed, Ovid/Medline, and Scopus. METHODS: A comprehensive review of literature was performed on September 28, 2020 using PubMed, Ovid/Medline, and Scopus databases. All English-language studies were included if they proposed or assessed novel interventions developed for Otolaryngology practice during the COVID-19 pandemic. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS: A total of 41 papers met inclusion criteria and were organized into 5 categories ('General Recommendations for Otolaryngologic Surgery', 'Equipment Shortage Solutions', 'Airway Procedures', 'Nasal Endoscopy and Skull Base Procedures', and 'Otologic Procedures'). Articles were summarized, highlighting the innovations created and evaluated during the COVID-19 pandemic. Creative solutions such as application of topical viricidal agents, make-shift mask filters, three-dimensional (3-D) printable adapters for headlights, aerosol containing separation boxes, and a variety of new draping techniques have been developed to limit the risk of COVID-19 transmission. CONCLUSIONS: Persistent risk of COVID-19 exposure remains high. Thus, there is an increased need for solutions that mitigate the risk of viral transmission during office procedures and surgeries, especially given that most COVID-19 positive patients present asymptomatically. This review examines and organizes creative solutions that have been proposed and utilized in the otolaryngology. These solutions have a potential to minimize the risk of viral transmission in the current clinical environment and to create safer outpatient and operating room conditions for patients and healthcare staff.

4.
Otolaryngol Head Neck Surg ; 164(5): 923-931, 2021 05.
Article in English | MEDLINE | ID: covidwho-647041

ABSTRACT

OBJECTIVE: During the COVID-19 pandemic, there has been unprecedented use of telemedicine for otolaryngology ambulatory visits. Patient satisfaction with telemedicine is an important metric, but survey-based questionnaires do not capture the nuances of the patient experience. This study aims to understand head and neck patients' perceptions about telemedicine clinic visits during COVID-19. METHODS: Fifty-six established patients who had video-based telemedicine visits with an otolaryngology-head and neck surgery faculty member between March 25, 2020, and April 24, 2020, completed unstructured telephone interviews. Conventional content analysis was used to analyze the interview data. Retrospective chart reviews were conducted to determine the patients' demographic, disease, and treatment information. RESULTS: The primary benefits of telemedicine were accessibility and cost and time savings. Primary limitations included the ability to perform a physical examination. Most patients expressed a willingness to participate in future remote visits if appropriate or necessitated by social circumstances. DISCUSSION: Telemedicine is a disruptive process, and long-term adoption requires understanding patient perception of and satisfaction with telemedicine. Head and neck cancer patients were generally satisfied with telemedicine. The study elucidated patient perceived benefits and limitations of telemedicine. IMPLICATIONS FOR PRACTICE: Continued implementation of telemedicine in otolaryngology-head and neck ambulatory clinics will require consideration of contextual features surrounding the virtual delivery of care, with particular attention to visit appropriateness for telemedicine and social circumstances.


Subject(s)
COVID-19/epidemiology , Head and Neck Neoplasms/therapy , Otolaryngology/methods , Patient Acceptance of Health Care , Telemedicine , Adult , Ambulatory Care , Female , Humans , Male , Middle Aged , Pandemics , Patient Satisfaction , Retrospective Studies , SARS-CoV-2 , Surveys and Questionnaires
5.
J Surg Educ ; 78(1): 346-350, 2021.
Article in English | MEDLINE | ID: covidwho-623724

ABSTRACT

OBJECTIVE: During the coronavirus 2019 pandemic, medical student involvement in direct patient care has been severely limited. Rotations mandatory not only for core curricula but also for informing decisions regarding specialty choice have been postponed during a critical window in the application cycle. Existing virtual rotations are largely observational or lack patient-facing components. SETTING: A virtual Otolaryngology - Head and Neck Surgery rotation at the University of Pennsylvania (Philadelphia, Pennsylvania) was implemented for medical students, comprising interactive live-streamed surgeries, outpatient telehealth visits, and virtual small group didactics. RESULTS: Medical students enrolled in the virtual surgical rotation were able to engage with attending surgeons and operating room staff while remotely viewing surgical procedures captured with first-person audiovisual technology. Students participated in several different aspects of care delivery in both the inpatient and outpatient setting, similar to their typical responsibilities of an in-person rotation. CONCLUSIONS: The authors will continue to develop the virtual surgical education methodology to further disseminate an interactive video-based medical student elective to other procedural specialties and institutions.


Subject(s)
COVID-19/epidemiology , Education, Medical, Undergraduate/methods , Otolaryngology/education , Telemedicine , Videoconferencing , Curriculum , Humans , Pandemics , SARS-CoV-2
6.
Head Neck ; 42(7): 1507-1515, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-614117

ABSTRACT

INTRODUCTION: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has altered the health care environment for the management of head and neck cancers. The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits. METHODS: Creation of consensus document. RESULTS: The process yielded a consensus statement among a wide range of practitioners involved in the management of patients with head and neck cancer in a multihospital tertiary care health system. CONCLUSIONS: These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Head and Neck Neoplasms/therapy , Infection Control/standards , Medical Oncology/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Ambulatory Care/standards , COVID-19 , Combined Modality Therapy , Continuity of Patient Care/standards , Coronavirus Infections/diagnosis , Head and Neck Neoplasms/diagnosis , Humans , Multi-Institutional Systems , Otorhinolaryngologic Surgical Procedures/standards , Palliative Care/standards , Patient Safety , Pennsylvania , Personal Protective Equipment , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Terminal Care/standards , Tertiary Care Centers
7.
Head Neck ; 42(7): 1681-1689, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-457322

ABSTRACT

BACKGROUND: In light of the COVID-19 pandemic, there has been a rapid increase in telemedicine visits. Otolaryngology patient satisfaction with these visits has not yet been extensively studied using a validated survey. METHODS: All patients who had telemedicine visits with three head and neck surgeons, by phone or video-based platform, between March 25, 2020 and April 24, 2020. Retrospective chart reviews were conducted to determine demographic, disease, and treatment information. Patients who had a video visit were contacted by telephone and, if they could be reached and consented, were administered the telehealth usability questionnaire (TUQ). RESULTS: Hundred surveys were completed. The average score across all questions was 6.01 on a scale from 1 to 7, where 7 indicated the highest level of patient agreement. The highest scores were for questions related to satisfaction with telehealth (6.29), while the lowest were related to reliability (4.86). CONCLUSIONS: Patients are generally highly satisfied with telemedicine.


Subject(s)
Ambulatory Care , Betacoronavirus , Coronavirus Infections/epidemiology , Otorhinolaryngologic Diseases/epidemiology , Patient Satisfaction , Pneumonia, Viral/epidemiology , Telemedicine , COVID-19 , Female , Humans , Male , Middle Aged , Pandemics , Pennsylvania/epidemiology , Retrospective Studies , SARS-CoV-2 , Surveys and Questionnaires
8.
Head Neck ; 42(7): 1497-1502, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-264234

ABSTRACT

AIM: The COVID-19 pandemic has resulted in society experiencing unprecedented challenges for health care practitioners and facilities serving at the frontlines of this pandemic. With regard to oral cancer, there is a complete absence of literature regarding the long-term impact of pandemics on patients with oral potentially malignant disorders (OPMDs). The objective of this article is to put forth an institutional multidisciplinary approach for the evaluation and management of OPMDs. METHODS: A multidisciplinary approach was put formalized within our institution to risk stratify patients based on need for in-person assessment vs telehealth assessment during the COVID-19 pandemic. RESULTS: With judicious risk stratification of patients based on clinical features of their OPMD and with consideration of ongoing mitigation efforts and regional pandemic impact, providers are able to safely care for their patients. CONCLUSIONS: The COVID-19 pandemic has required health care practitioners to make novel decisions that are new to us with development of creative pathways of care that focused on patient safety, mitigation efforts, and clinical management of disease processes. The care of patients with OPMDs requires special considerations especially as patients at high risk for severe COVID-19 illness are also higher risk for the development of OPMDs.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Infection Control/methods , Mouth Neoplasms/diagnosis , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Risk Assessment , Administration, Topical , Anti-Infective Agents, Local/administration & dosage , COVID-19 , Clinical Decision-Making , Coronavirus Infections/transmission , Critical Pathways , Diagnosis, Differential , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Leukoplakia, Oral , Personal Protective Equipment , Pneumonia, Viral/transmission , Povidone-Iodine/administration & dosage , SARS-CoV-2 , Telemedicine
9.
Head Neck ; 42(7): 1411-1417, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-209697

ABSTRACT

BACKGROUND: The COVID-19 pandemic has significantly impacted medical training. Here we assess its effect on head and neck surgical education. METHODS: Surveys were sent to current accredited program directors and trainees to assess the impact of COVID-19 on the fellow's experience and employment search. Current fellows' operative logs were compared with those of the 2018 to 2019 graduates. RESULTS: Despite reduction in operative volume, 82% of current American Head and Neck Society fellows have reached the number of major surgical operations to support certification. When surveyed, 86% of program directors deemed their fellow ready to enter practice. The majority of fellows felt prepared to practice ablative (96%), and microvascular surgery (73%), and 57% have secured employment to follow graduation. Five (10%) had a pending job position put on hold due to the pandemic. CONCLUSIONS: Despite the impact of the COVID-19 pandemic, current accredited trainees remain well-positioned to obtain proficiency and enter the work-force.


Subject(s)
Clinical Competence , Coronavirus Infections/epidemiology , Curriculum , Fellowships and Scholarships/organization & administration , Otolaryngology/education , Pneumonia, Viral/epidemiology , Surveys and Questionnaires , COVID-19 , Communicable Disease Control/organization & administration , Education, Medical, Graduate/organization & administration , Employment/statistics & numerical data , Female , Head and Neck Neoplasms/surgery , Humans , Male , Occupational Health/statistics & numerical data , Pandemics/statistics & numerical data , Patient Safety/statistics & numerical data , Risk Assessment , United States
10.
Head Neck ; 42(6): 1317-1321, 2020 06.
Article in English | MEDLINE | ID: covidwho-133492

ABSTRACT

The COVID-19 epidemic has resulted in many hospitals and practices to cancel in-person outpatient clinic visits, where head and neck patients receive their critical longitudinal care. Out of necessity, most practices have been encouraged to use telemedicine as a method to maintain a continuum of care with their patients. As a result, the prevalence of telemedicine has grown rapidly during this pandemic, without allowing the physicians and patients to be adequately educated on how best to utilize the services. There is a steep learning curve as we have learned, and our goal is to provide guidelines for both patients and physicians, as well as a valuable patient handout in preparation for their visit.


Subject(s)
Ambulatory Care , Coronavirus Infections/epidemiology , Head and Neck Neoplasms/therapy , Otolaryngology , Pneumonia, Viral/epidemiology , Telemedicine , Betacoronavirus , COVID-19 , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Humans , Office Visits , Pandemics/prevention & control , Patient Education as Topic , Physical Examination , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , SARS-CoV-2
11.
Head Neck ; 42(6): 1268-1272, 2020 06.
Article in English | MEDLINE | ID: covidwho-116903

ABSTRACT

AIM: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has put health care workers at risk when exposed to aerosolized viral particles during upper airway mucosal surgery. The objective of this review was to discuss topical preparations that could be utilized preoperatively to help to decrease viral load and potentially reduce the risks of viral transmission. METHODS: A PubMed/MEDLINE database review of articles was performed querying topical preparations with virucidal activity against coronaviruses. RESULTS: Povidone-iodine (PVP-I) solutions ranging from 0.23% to 7% have been found to demonstrate highly effective virucidal activity against a broad range of viruses including several coronaviruses responsible for recent epidemics including SARS-CoV-1 and MERS-CoV. CONCLUSIONS: While specific evidence regarding SARS-CoV-2 is lacking, PVP-I-based preparations have been successfully demonstrated to reduce viral loads of coronaviruses. They are relatively safe to use in the upper airway and may reduce risk of SARS-CoV-2 aerosolization during upper airway mucosal surgery.


Subject(s)
Anti-Infective Agents, Local/therapeutic use , Betacoronavirus , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Otolaryngology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Administration, Topical , Aerosols , COVID-19 , Humans , Mucous Membrane/surgery , SARS-CoV-2
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