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1.
J Laryngol Otol ; 136(6): 562-567, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1852319

ABSTRACT

OBJECTIVE: In the wake of the 2019 coronavirus disease pandemic, elective cases and opportunities for clinical application have decreased, and the need for useful simulation models has become more apparent for developing surgical skills. A novel myringotomy with ventilatory tube insertion simulation model was created. METHODS: Residents across all levels at our institution participated in the simulation. Participants were evaluated in terms of: time of procedure, microscope positioning, cerumen removal, identification of middle ear effusion type, canal wall trauma, tympanic membrane damage and tube placement. RESULTS: Eleven residents participated. Scores ranged from 14 to 34, out of a maximum of 40. The average score among junior and senior residents was 24 and 31, respectively. The simulation was felt to be representative of the operating theatre experience. CONCLUSION: This study demonstrates a low-cost simulation model that captures several important, nuanced aspects of myringotomy with tube insertion, often overlooked in previously reported simulations.


Subject(s)
Internship and Residency , Otolaryngology , Simulation Training , Clinical Competence , Computer Simulation , Humans , Middle Ear Ventilation/methods , Otolaryngology/education , Tympanic Membrane/surgery
2.
JAMA Otolaryngol Head Neck Surg ; 148(5): 399-401, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1843831
3.
Niger Postgrad Med J ; 29(2): 110-115, 2022.
Article in English | MEDLINE | ID: covidwho-1835283

ABSTRACT

Background: The novel coronavirus pandemic has influenced the working practice of health-care professionals who come across symptomatic and asymptomatic COVID patients in their day-to-day practice. Especially, among HCWs in otorhinolaryngology, with the risk of exposure being high, hence were mandated to use personal protective equipment (PPE). Materials and Methods: The change in perceptions and patterns of PPE use throughout the COVID-19 pandemic was studied in detail through interviews conducted among 15 key informants, and the data were analyzed using health belief model in our study. Results: A health belief model explains the trajectory of PPE use by otorhinolaryngology health care providers during the COVID-19 pandemic. The course of usage of PPE by otorhinolaryngology health-care professionals during the COVID-19 pandemic was explained through the health belief model. During the initial days of the COVID-19 pandemic, intense perceived severity and susceptibility to COVID infection led to PPE use, and otorhinolaryngology HCWs resorted to higher grade PPEs which gave optimal protection; but in course of time with a better understanding of the natural course of illness, minimal PPEs without compromising HCW safety were used with minimal discomfort. Perceived severity of COVID infection on self and family, health knowledge, influence of peers, and support from the institution encouraged them in using PPEs. Conclusion: We found that various aspects of health belief model such as the perceived susceptibility, perceived severity of the disease, perceived barriers and benefits in PPE use, self-efficacy, health-related knowledge, and the cues to action influence PPE use among otorhinolaryngology HCWs. The key findings can be applied in behavior change models to promote the use of PPE in the hospitals, especially during the time of pandemic.


Subject(s)
COVID-19 , Otolaryngology , Anxiety/prevention & control , COVID-19/prevention & control , Health Personnel , Humans , Nigeria , Pandemics/prevention & control , Personal Protective Equipment
4.
Int J Pediatr Otorhinolaryngol ; 156: 111097, 2022 May.
Article in English | MEDLINE | ID: covidwho-1804289

ABSTRACT

OBJECTIVES: 1) Evaluate the caregiver-perceived benefits and barriers of a tertiary pediatric otolaryngology telemedicine service using the validated Telemedicine Satisfaction Questionnaire (TSQ); 2) Explore the provider's perception and experience on the current telemedicine platform using a modified Physician Satisfaction Questionnaire (PSQ). METHODS: Caregivers of patients ≤18 years of age who received telemedicine services from May 4 to June 18, 2020 (duration of telemedicine use) were eligible for this study. Caregivers were contacted via telephone and given the option to answer the TSQ over the phone, receive a link via email, or decline participation. Providers were administered the modified PSQ as an anonymous, self-report online instrument on the 2 nd week of telemedicine implementation. The study authors were excluded from the PSQ. RESULTS: 58/148 caregivers completed the TSQ. The TSQ questions were grouped into three categories: quality of care, similarity to in-person care, and perception of the interaction. Caregivers felt the most satisfied with the perception of the interaction (mean response 4.84, SD 0.08, p < 0.05). With the PSQ, providers had less favorable responses when compared to the TSQ across all categories (p < 0.05 for all categories) but did report satisfaction for the perception of the interaction (mean response 3.37, SD 0.85). CONCLUSION: Our study demonstrates further evidence that the telemedicine may provide positive benefits. Caregivers were supportive of this service due to its convenience. Providers felt confident using this service, but they also felt the care provided was different from that in the clinic. Improvement in the telemedicine platforms and associated technology for physical exams may help improve the quality of telemedicine care, and similarity to in-person care.


Subject(s)
COVID-19 , Otolaryngology , Physicians , Telemedicine , Child , Humans , Patient Satisfaction , Personal Satisfaction
5.
Otolaryngol Head Neck Surg ; 166(6): 1013-1021, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1794199

ABSTRACT

The coronavirus pandemic has illuminated long-standing inequities in America's health care system and societal structure. While numerous studies have identified health care disparities within our specialty, few have progressed beyond detection. Otolaryngologists have the opportunity and the responsibility to act. Within this article, leaders from otolaryngology share their experience and perspective on health care disparities, including (1) a discussion of disparities in otolaryngology, (2) a summary of health care system design and incentives, (3) an overview of implicit bias, and (4) practical recommendations for providers to advance their awareness of health care disparities and the actions to mitigate them. While the path forward can be daunting, it should not be a deterrent. Throughout the course of this article, numerous resources are provided to support these efforts. To move ahead, our specialty needs to advance our level of understanding and develop, implement, and disseminate successful interventions toward the goal of eliminating health care disparities.


Subject(s)
Coronavirus Infections , Otolaryngology , Healthcare Disparities , Humans , Otolaryngologists , Pandemics/prevention & control
7.
Clin Otolaryngol ; 47(3): 447-454, 2022 05.
Article in English | MEDLINE | ID: covidwho-1707376

ABSTRACT

OBJECTIVE: To determine the impact of the COVID-19 pandemic on acute admissions and inpatient activity at a tertiary referral centre. DESIGN: Retrospective review of coding-based inpatient electronic records. SETTING: An otolaryngology and head and neck surgery department at a major UK trauma and tertiary referral centre. PARTICIPANTS: Otolaryngology patients admitted as an emergency over a period of 10 months pre-COVID19 (01/04/2019-23/01/2020) and 10 months post-COVID19 (01/04/2020-23/01/2021). MAIN OUTCOME MEASURES: Baseline characteristics, admission rates, length of stay (LoS), overall mortality and 30-day mortality. RESULTS: A total of 1620 records were reviewed; (1066 pre-COVID19, 554 post-COVID19). Admissions across all age groups were reduced, with an increase in mean age from 39.88 to 47.4 years (p = .018). LoS remained unchanged (3.85 vs 3.82 days, p = .160). Infection remained the most common presentation, followed secondly by epistaxis which entailed an increased LoS compared to the pre-COVID19 cohort. GP referrals reduced from 18.3% to 4.2% (n = 195 vs n = 23, p < .001) and ED referrals proportionally increased from 71.9% to 85.9% (n = 766 vs n = 476, p < .001). Critical care admissions were higher in the post-COVID19 cohort (OR 1.78 (1.07-2.98) [95% CI], p = .027). There was no significant difference in overall mortality between groups (n = 60, 5.6% vs. n = 33, 6.0%; p = .844). Thirty-day mortality increased from 0.9% (n = 12) pre-COVID19 to 2.3% (n = 13) post-COVID19 (p = .039). CONCLUSIONS: This study demonstrates significant changes and a reduction in acute otolaryngology presentations. Our findings may suggest that sicker, frailer patients were admitted during the pandemic. This study reports the observational effect that the pandemic has had on acute otolaryngology admissions, which may be relevant in addressing unmet care needs in the post-pandemic period.


Subject(s)
COVID-19 , Otolaryngology , Adult , COVID-19/epidemiology , Emergency Service, Hospital , Humans , Inpatients , Middle Aged , Pandemics , Retrospective Studies , Tertiary Care Centers
8.
BMJ Open Qual ; 11(1)2022 02.
Article in English | MEDLINE | ID: covidwho-1685601

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has catalysed the need to implement the National Health Service Long-Term Plan to deliver more care in the community and to reduce face-to-face hospital appointments by up to 33%. This study aimed to assess the feasibility of a remote otology service from triage through to delivery. METHODS: New adult otology referrals at a tertiary ear, nose and throat (ENT) hospital aged between 18 and 70 with hearing loss or tinnitus were included. Patients attended an audiology-led community clinic where they underwent a focused history, audiometric testing, and a smartphone-based application and otoscope (Tympa System) was used to capture still and video images of their eardrums. The information was reviewed by ENT clinicians using a remote review platform with a subset of patients subsequently undergoing an in-person review to measure concordance between the two assessments. RESULTS: 58 patients participated. 75% of patients had their pathways shortened by one hospital visit with 65% avoiding any hospital attendances. 24% required an additional face-to-face appointment due to incomplete views of the tympanic membrane or need for additional examinations. Electronic validation by a blinded consultant otologist demonstrated a diagnosis concordance of 95%, and concordance between remote-review and in-person consultations in the 12 patients who agreed to attend for an in-person review was 83.3%. 98% of patients were satisfied with the pathway. CONCLUSION: This pilot service is feasible, safe and non-inferior to the traditional outpatient model in the included patient group. There is potential for the development of a community audiology-led service or use for general practioner advice and guidance.


Subject(s)
COVID-19 , Otolaryngology , Adolescent , Adult , Aged , Feasibility Studies , Humans , Middle Aged , Pandemics , SARS-CoV-2 , State Medicine , United Kingdom , Young Adult
10.
Int J Pediatr Otorhinolaryngol ; 153: 111014, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1623364

ABSTRACT

INTRODUCTION: The coronavirus disease of 2019 (COVID-19) pandemic catalyzed an unprecedented redesign and innovative overhaul of health care delivery thrusting from fringe to mainstream virtual care. With a return to conventional practice, we now must create a research and policy agenda using the changes wrought by COVID-19 to help create a better health care system in its aftermath. The purpose of this study was to assess satisfaction of otolaryngology outpatient visits during the pandemic. METHODS: A prospective survey study was performed on caregivers of all patients ages 0-26 years old seen in the Division of Pediatric Otolaryngology at our large tertiary care children's hospital from February-April 2020. The three study groups were those seen in-person 6 weeks before telemedicine was implemented (IBTM), those seen in telemedicine during the first 6 weeks (TM) it was implemented at our hospital, and those seen in-person during the telemedicine period (IDTM) in the same timeframe. The survey consisted of satisfaction questions related to their visit, if their child was recommended surgery at the time of the visit, and if the caregiver agreed with the recommendation. A medical record review was also performed. RESULTS: A total of 176 caregivers completed the survey with 113(64.2%) completing the survey for an IBTM appointment, 59(33.5%) for a TM appointment, and 4(2.3%) for an IDTM appointment. There were 100(56.8%) male patients and 167(94.9%) were white. Families gave a higher response for the statement "The ability to communicate with the physician" (p = .012) and "The overall outpatient experience" (p = .004) in the IBTM cohort compared to the TM group. There were no significant differences for the other statements regarding the ability to understand recommendations, courtesy, and knowledge of the physician. Regardless of group, 98.6% of caregivers agreed with surgical recommendation when surgery was recommended. However, when surgery was not recommended at the appointment, caregivers were 11x more likely to disagree with the surgical recommendations, OR:11.49,95%CI:1.44-91.38,p = .005. CONCLUSION: We conclude that telemedicine was equally well received by patients as compared to traditional live assessments suggesting that virtual care is a viable post-pandemic paradigm change. Satisfaction was rated as "Good" or "Excellent", however, messaging when surgery is not recommended was less acceptable and must be improved to obtain increased caregivers' agreement in an era of shared decision making.


Subject(s)
COVID-19 , Otolaryngology , Telemedicine , Adolescent , Adult , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Male , Pandemics , Patient Satisfaction , Prospective Studies , SARS-CoV-2 , Young Adult
11.
J Laryngol Otol ; 136(1): 24-28, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1616898

ABSTRACT

OBJECTIVE: This study aimed to report the changes made to ENT placements across the UK in response to the pandemic and their impact on student experience. METHODS: A questionnaire eliciting how ENT placements were provided before and after coronavirus disease 2019 was disseminated amongst Student and Foundation Doctors in Otolaryngology representatives. RESULTS: Thirty-eight respondents from 27 medical schools across the UK completed the survey (response rate of 90 per cent). Twenty-nine of the 38 respondents (76 per cent) reported a change in ENT placements in response to the pandemic. Six of the 38 students (16 per cent) remained satisfied with their ENT placements, as compared to 12 students prior to the pandemic (32 per cent). CONCLUSION: There is considerable variability in how medical schools responded to the pandemic. Most medical schools placed students into smaller groups, with less direct contact in the hospital. These changes resulted in lower student satisfaction. The increased emphasis on e-learning underscores the need for high quality e-learning materials to promote learning throughout the pandemic and in the future.


Subject(s)
COVID-19 , Education, Medical, Undergraduate/methods , Otolaryngology/education , Schools, Medical , Cross-Sectional Studies , Humans , Surveys and Questionnaires , United Kingdom
12.
Am J Otolaryngol ; 43(2): 103369, 2022.
Article in English | MEDLINE | ID: covidwho-1616357

ABSTRACT

PURPOSE: The pandemic related to the novel coronavirus (COVID-19) has led to a decrease in communicable diseases due to social distancing and mask-wearing. How have the prevalence of otitis media (OM) and its associated procedures changed during the pandemic? STUDY DESIGN: Retrospective Cohort Study. METHODS: This is a retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 48 children's hospitals. Regions were defined according to PHIS rules. We compared proportion of OM to total diagnoses codes, and collected mastoiditis, and MT placements from all encounters through January 1, 2019-June 31, 2021. RESULTS: In April 2020, there was a decrease in mean proportion of OM cases per 100 hospital visits (7 v. 2, p < 0.0001) and this was sustained through 2020 and until June 2021 (6-7 v. 2-4, p < 0.05; p < 0.05). Compared to 2020, the months of April and June 2021 showed an increase in mean proportion of OM cases (6-7 v. 3-4, p < 0.05) while May did not. This relative increase in OM cases through April-June were primarily driven by the South, the Midwest, and the Northeast in April and the South and the Midwest in June. MT procedures followed similar trends. In 2020, there was no difference in mastoiditis as a proportion of OM cases compared to 2019 however there was a statistically higher rate of mastoiditis in 2020 compared to 2021. CONCLUSIONS: The COVID-19 pandemic led to declines in OM and MT case volumes that have started to increase. A geographic relationship may exist, and this connection could be influenced by mask mandates and social distancing.


Subject(s)
COVID-19 , Otitis Media , Otolaryngology , COVID-19/epidemiology , Child , Humans , Otitis Media/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2
13.
Int J Pediatr Otorhinolaryngol ; 153: 111021, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1587591

ABSTRACT

BACKGROUND: The COVID-19 pandemic has shifted medical practice globally. The objective of this study was to examine the changes to the practice of pediatric otolaryngology internationally due to the COVID-19 pandemic and examine potential contributors. METHOD: An online survey was designed to assess practice demographics, patterns of COVID-19 related restrictions in communities, and changes to practice and referrals. This was disseminated via an international Covid-19 WhatsApp™ group of pediatric otolaryngologists. RESULTS: There were 45 respondents of 177 group members (25.4%) from 15 countries. The mean estimated time spent under strictest lockdown measures was 16.2 (±10.7) weeks (range: 1-45 weeks). Operating room time was reduced for 82.9%, with an average reported reduction of 41.5%. Almost all (>75%) of respondents reported reduced referrals for five common conditions: otitis media with effusion (average reported decrease - 56.1%); acute otitis media (average decrease 62.8%); acute mastoiditis (average decrease 66.6%); recurrent pharyngotonsillitis (average decrease 51.0%); and peritonsillar abscess (average decrease 52.1%). COVID-19 cases per million population significantly influenced the acuity of referrals received (p < .05). No conditions were reported as increased in frequency and the acuity of most conditions was reported as unchanged by the majority of respondents. CONCLUSION: The measures taken to reduce the spread of COVID-19 have resulted in many changes to pediatric otolaryngology practice and the referral patterns of common conditions. Some of these changes may have enduring sequelae.


Subject(s)
COVID-19 , Otolaryngology , Child , Communicable Disease Control , Humans , Pandemics , SARS-CoV-2
14.
Otolaryngol Head Neck Surg ; 166(6): 1192-1195, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1571581

ABSTRACT

The Centralized Otolaryngology Research Efforts (CORE) grant program coordinates research funding initiatives across the subspecialties of otolaryngology-head and neck surgery. Modeled after National Institutes of Health study sections, CORE grant review processes provide comprehensive reviews of scientific proposals. The organizational structure and grant review process support grant-writing skills, attention to study design, and other components of academic maturation toward securing external grants from the National Institutes of Health or other agencies. As a learning community and a catalyst for scientific advances, CORE evaluates clinical, translational, basic science, and health services research. Amid the societal reckoning around long-standing social injustices and health inequities, an important question is to what extent CORE engenders diversity, equity, and inclusion for the otolaryngology workforce. This commentary explores CORE's track record as a stepping-stone for promoting equity and innovation in the specialty. Such insights can help maximize opportunities for cultivating diverse leaders across the career continuum.


Subject(s)
Biomedical Research , Medicine , Otolaryngology , Financing, Organized , Humans , National Institutes of Health (U.S.) , United States , Workforce
16.
BMJ Open ; 11(12): e049687, 2021 12 06.
Article in English | MEDLINE | ID: covidwho-1556235

ABSTRACT

OBJECTIVE: Reliance on webinars for continuing medical education (CME) has increased since the onset of the COVID-19 pandemic. Here, we aimed to evaluate the teaching methods used in these webinars. DESIGN: Retrospective, longitudinal study. SETTING: 20 CME-approved webinars, conducted March-December 2020 in Germany, and lasting 2.25 hours each. PARTICIPANTS: Otorhinolaryngologists pursuing CME credits. INTERVENTIONS: Postwebinar participant assessments of the speaker, effects on practical work, desired scientific content, technical quality, interactions, attention and future training behaviour. RESULTS: On average, 780 participants joined each webinar. The mean survey response rate was 35% (n=282). When asked how well the speaker had mastered the content, 38% responded 'very well', 44% responded 'well', 14% indicated 'satisfactory' and 4% chose 'sufficient'. The frequency of webinars was considered appropriate by 92%, too high by 4% and too low by 4% of participants. The measured attention of the participants was 90%. After the COVID-19 pandemic lockdown, 68% of participants preferred online teaching. The average costs per participant were €3.50 (about $4.25 or £3.15) per webinar. CONCLUSIONS: Although the pandemic context likely influenced the results, we conclude that periodic ear, nose and throat webinar training during COVID-19 in 2020 was an effective alternative delivery method. We found high attention rates, high levels of participant satisfaction and low costs. Evaluations and re-evaluations will be necessary to adapt teaching concepts successfully and ensure high levels of teaching and learning efficiency.


Subject(s)
COVID-19 , Otolaryngology , Communicable Disease Control , Education, Medical, Continuing , Germany/epidemiology , Humans , Longitudinal Studies , Pandemics , Retrospective Studies , SARS-CoV-2
17.
Curr Opin Otolaryngol Head Neck Surg ; 29(6): 504-509, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1546080

ABSTRACT

PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID-19) has changed the face of healthcare. The current review is to discuss the major aspects that have changed in pediatric otolaryngology, from surgical operations management, to clinic workflow, to procedural precautions. RECENT FINDINGS: There have been many studies over the past year describing different ways to improve the safety of healthcare delivery in pediatric otolaryngology amidst a global pandemic, as well as ways to improve clinic and surgical logistics along with guidelines for telehealth of a surgical specialty. SUMMARY: COVID-19 has forever altered how healthcare is viewed and practiced, and pediatric otolaryngology was not exempt. With an increased focus on provider safety, as well as novel ways of utilizing changes in methods of communication, the practice of pediatric otolaryngology has evolved with the rest of healthcare to take on the new challenges brought on by this global pandemic.


Subject(s)
COVID-19 , Otolaryngology , Telemedicine , Child , Humans , Pandemics , SARS-CoV-2
18.
Curr Opin Otolaryngol Head Neck Surg ; 29(6): 517-525, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1546079

ABSTRACT

PURPOSE OF REVIEW: This article will provide an overview of recent disruptions to the otolaryngology residency match process and conclude with questions and resources that can guide future selection system design. RECENT FINDINGS: During the implementation of the single accreditation system, the loss of osteopathic programs, reduction of osteopathic leadership positions, and lack of interest in Osteopathic Recognition represent serious threats to the profession; this has implications for the distribution of the otolaryngology workforce, plausibly decreasing healthcare access in less-populated communities. Next, the impacts of COVID-19 reverberated throughout the application process, including the reduction/elimination of away rotations, modification of application requirements, conversion to virtual interviews, and initiation of preference signaling. Soon, the transition to pass/fail scoring for the United States Medical Licensing Exam Step 1 could stimulate a paradigm shift, with a heightened emphasis on holistic review. SUMMARY: The last two match cycles have been the most dynamic and unpredictable in decades. Out of the commotion, the otolaryngology community has an opportunity for a fresh start, combining insights from past literature with recent articles compiled for this review. Moving forward, it will be advantageous to approach residency selection as a well-executed quality improvement project, requiring continuous assessment and adjustment.


Subject(s)
COVID-19 , Internship and Residency , Otolaryngology , Humans , Otolaryngology/education , Personnel Selection , SARS-CoV-2 , United States
20.
HNO ; 70(2): 140-147, 2022 Feb.
Article in German | MEDLINE | ID: covidwho-1530270

ABSTRACT

BACKGROUND: The first wave of the SARS-CoV­2 pandemic required substantial changes in the teaching of medical students, with strict avoidance of direct contact between students and patients. Therefore, the teaching format "bedside teaching" was implemented and conducted as an interactive video-based distance bedside teaching. OBJECTIVE: The objective of this study was to analyze a students' evaluation of this teaching concept in otorhinolaryngology. MATERIALS AND METHODS: From an ENT examination room, the situation was transmitted live to the students in a lecture hall, who could interact with the patients through a video connection. Macro-, micro-, and endoscopic images were transmitted into the lecture hall in real time. Evaluation was performed by means of an online questionnaire with 13 questions (Likert scale) as well as by free-text feedback. RESULTS: The response rate was 16.8% (42 of 250 students). Overall, 85.7% had a positive impression, and it was generally considered that the concept was well implemented in light of the special situation. However, students would rather not renounce direct patient contact, even if a certain compensation by video transmission was reported. Overall, this teaching concept was considered as educative, and students could imagine using such a teaching concept more often in the future. CONCLUSION: This teaching model cannot replace classical bedside teaching, but represents a good alternative-particularly in otorhinolaryngology-if classical bedside teaching is not possible due to the pandemic situation. Aspects of the interactive video-based distance bedside teaching could be implemented into classical teaching concepts in the future.


Subject(s)
COVID-19 , Otolaryngology , Students, Medical , Humans , Pandemics , SARS-CoV-2 , Teaching
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