Perioperative Teaching and Feedback: How are we doing in Canadian OTL-HNS programs?

BACKGROUND: Discrepancies between resident and faculty perceptions regarding optimal teaching and feedback during surgery are well known but these differences have not yet been described in Otolaryngology - Head and Neck Surgery (OTL-HNS). The objectives were thus to compare faculty and resident perceptions of perioperative teaching and feedback in OTL-HNS residency programs across Canada with the aim of highlighting potential areas for improvement. METHODS: An anonymous electronic questionnaire was distributed to residents and teaching faculty in OTL-HNS across Canada with additional paper copies distributed at four institutions. Surveys consisted of ratings on a 5-point Likert scale and open-ended questions. Responses among groups were analysed with the Wilcoxon-Mann Whitney test, while thematic analysis was used for the open-ended questions. RESULTS: A total of 143 teaching faculty and residents responded with statistically significant differences on 11 out of 25 variables. Namely, faculty reported higher rates of pre and intra-operative teaching compared to resident reports. Faculty also felt they gave adequate feedback on residents' strengths and technical skills contrary to what the residents thought. Both groups did agree however that pre-operative discussion is not consistently done, nor is feedback consistently given or sought. CONCLUSION: Faculty and residents in OTL-HNS residency programs disagree on the frequency and optimal timing of peri-operative teaching and feedback. This difference in perception emphasizes the need for a more structured approach to feedback delivery including explicitly stating when feedback is being given, and the overall need for better communication between residents and staff.

Effective implementation of a patient blood management programme for platelets.

OBJECTIVES: To implement a patient blood management (PBM) programme in platelet transfusion. AIMS: To improve the appropriate use of blood components, reduce wastage and generate savings. BACKGROUND: PBM is a multidisciplinary, evidence-based approach to optimising the care of patients who need blood transfusion and to use blood products appropriately. Strategies for PBM ensure that patients receive the best possible treatment with the transfusion of components when indicated, at the same time avoiding or reducing unnecessary transfusions. Typically, PBM initiatives have addressed the use of red cells. PBM initiatives in platelets (PBM-P) are an important aspect of Transfusion Medicine. METHODS: We present data from an initiative for PBM-platelets (PBM-P) comprising a service improvement programme through the role of a 'platelet co-ordinator' (PBM-Pc) to optimise the use of platelets in a large complex tertiary care hospital in a National Health Service (NHS) setting. RESULTS: Analysis at 18 months of the role showed sustained improvement in compliance with quality standards defined by British Committee for Standards in Haematology (BCSH) guidelines and significant financial savings due to improved use and reduced wastage. The appropriate use of platelets increased by 17, 23 and 18% in the prophylactic, pre-procedure and peri-procedure categories, respectively. Importantly, despite concurrent increases of patient activity, platelet issues and cost reduced by 21% over the period of analysis. CONCLUSIONS: Our model has been efficacious in delivering the effective stewardship of platelets and can be successfully implemented in NHS.

A systematic review of commercial weight loss programmes' effect on glycemic outcomes among overweight and obese adults with and without type 2 diabetes mellitus.

OBJECTIVE: We examined the glycemic benefits of commercial weight loss programmes as compared with control/education or counselling among overweight and obese adults with and without type 2 diabetes mellitus (T2DM). METHODS: We searched MEDLINE, Cochrane Database of Systematic Reviews, and references cited by individual programmes. We included randomized controlled trials of ≥12 weeks duration. Two reviewers extracted information on study design, population characteristics, interventions, and mean changes in haemoglobin A1c and glucose. RESULTS: We included 18 randomized controlled trials. Few trials occurred among individuals with T2DM. In this population, Jenny Craig reduced A1c at least 0.4% more than counselling at 12 months, Nutrisystem significantly reduced A1c 0.3% more than counselling at 6 months, and OPTIFAST reduced A1c 0.3% more than counselling at 6 months. Among individuals without T2DM, few studies evaluated glycemic outcomes, and when reported, most did not show substantial reductions. DISCUSSION: Few trials have examined whether commercial weight loss programmes result in glycemic benefits for their participants, particularly among overweight and obese individuals without T2DM. Jenny Craig, Nutrisystem and OPTIFAST show promising glycemic lowering benefits for patients with T2DM, although additional studies are needed to confirm these conclusions. © 2016 World Obesity.

Malignant CTA collateral profile is highly specific for large admission DWI infarct core and poor outcome in acute stroke.

BACKGROUND AND PURPOSE: Large admission DWI lesion volumes are associated with poor outcomes despite acute stroke treatment. The primary aims of our study were to determine whether CTA collaterals correlate with admission DWI lesion volumes in patients with AIS with proximal occlusions, and whether a CTA collateral profile could identify large DWI volumes with high specificity. MATERIALS AND METHODS: We studied 197 patients with AIS with M1 and/or intracranial ICA occlusions. We segmented admission and follow-up DWI lesion volumes, and categorized CTA collaterals by using a 5-point CS system. ROC analysis was used to determine CS accuracy in predicting DWI lesion volumes >100 mL. Patients were dichotomized into 2 categories: CS = 0 (malignant profile) or CS>0. Univariate and multivariate analyses were performed to compare imaging and clinical variables between these 2 groups. RESULTS: There was a negative correlation between CS and admission DWI lesion volume (ρ = -0.54, P < .0001). ROC analysis revealed that CTA CS was a good discriminator of DWI lesion volume >100 mL (AUC = 0.84, P < .001). CS = 0 had 97.6% specificity and 54.5% sensitivity for DWI volume >100 mL. CS = 0 patients had larger mean admission DWI volumes (165.8 mL versus 32.7 mL, P < .001), higher median NIHSS scores (21 versus 15, P < .001), and were more likely to become functionally dependent at 3 months (95.5% versus 64.0%, P = .003). Admission NIHSS score was the only independent predictor of a malignant CS (P = .007). CONCLUSIONS: In patients with AIS with PAOs, CTA collaterals correlate with admission DWI infarct size. A malignant collateral profile is highly specific for large admission DWI lesion size and poor functional outcome.

Interobserver reliability of baseline noncontrast CT Alberta Stroke Program Early CT Score for intra-arterial stroke treatment selection.

BACKGROUND AND PURPOSE: Early ischemic changes on pretreatment NCCT quantified using ASPECTS have been demonstrated to predict outcomes after IAT. We sought to determine the interobserver reliability of ASPECTS for patients with AIS with PAO and to determine whether pretreatment ASPECTS dichotomized at 7 would demonstrate at least substantial κ agreement. MATERIALS AND METHODS: From our prospective IAT data base, we identified consecutive patients with anterior circulation PAO who underwent IAT over a 6-year period. Only those with an evaluable pretreatment NCCT were included. ASPECTS was graded independently by 2 experienced readers. Interrater agreement was assessed for total ASPECTS, dichotomized ASPECTS (≤ 7 versus >7), and each ASPECTS region. Statistical analysis included determination of Cohen κ coefficients and concordance correlation coefficients. PABAK coefficients were also calculated. RESULTS: One hundred fifty-five patients met our study criteria. Median pretreatment ASPECTS was 8 (interquartile range 7-9). Interrater agreement for total ASPECTS was substantial (concordance correlation coefficient = 0.77). The mean ASPECTS difference between readers was 0.2 (95% confidence interval, -2.8 to 2.4). For dichotomized ASPECTS, there was a 76.8% (119/155) observed rate of agreement, with a moderate κ = 0.53 (PABAK = 0.54). By region, agreement was worst in the internal capsule and the cortical areas, ranging from fair to moderate. After adjusting for prevalence and bias, agreement improved to substantial or near perfect in most regions. CONCLUSIONS: Interobserver reliability is substantial for total ASPECTS but is only moderate for ASPECTS dichotomized at 7. This may limit the utility of dichotomized ASPECTS for IAT selection.

A study on the prevalence of a tick-transmitted pathogen, Theileria annulata, and hematological profile of cattle from Southern Punjab (Pakistan).

The present study was carried out to determine the prevalence of Theileria annulata in large ruminants in Southern Punjab (Pakistan). Blood samples were collected from 144 large ruminants, consisting of 105 cattle and 39 buffaloes, from six districts of Southern Punjab including Multan, Layyah, Muzaffar Garh, Bhakar, Bahawalnagar, and Vehari. Data on the characteristics of the animals and herds were collected through questionnaires. The age of animals (P = 0.02), presence of ticks on animals (P = 0.02), and presence of ticks on dogs associated with herds (P = 0.05) were among the major risk factors involved in the spread of tropical theileriosis in the study area. Two different parasite detection techniques, PCR amplification and screening of Giemsa-stained slides, were compared, and it was found that PCR amplification is a more sensitive tool (19% parasite detection) as compared to smear scanning (3% parasite detection) for the detection of T. annulata. Twenty eight out of 144 animals produced the 721-bp fragment specific for T. annulata from five out of six sampling districts. Different blood (hemoglobin, glucose) and serum (ALT, AST, LDH, cholesterol) parameters of calves and cattle were measured and compared between parasite-positive and parasite-negative samples to assess the effect of T. annulata on the blood and serological profile of infected animals.

Serum sialic acid level in diabetic retinopathy.

BACKGROUND: The purpose of the study was to investigate the previously reported observations that patients with elevated levels of serum sialic acid are more prone to develop retinopathy. METHODS: Fasting blood glucose and serum sialic acid levels were estimated in sixty diabetic patients with and without retinopathy between 30-60 years of age. Thirty normal persons of same age group were included as controls. Fundoscopy was done to confirm retinopathy. Serum sialic acid concentration was elevated in diabetic patients both with and without retinopathy but the increase was much significant in patients with diabetic retinopathy. RESULTS: A significant correlation of serum sialic acid level with duration of diabetes and degree of retinal involvement was noticed in this study.

Oral mucosal leishmaniasis as a presenting feature of HIV infection and its management.

Leishmaniasis is a chronic parasitic protozoal disease transmitted by sandfly vectors and is endemic in some regions of South America, Asia, Africa and Mediterranean countries. This case report describes a British patient who presented with oral mucosal leishmaniasis and in whom it was also the first sign of HIV disease. We believe it is the first reported case of isolated oral mucosal leishmaniasis as a presenting feature of otherwise unknown HIV infection.

Dental manpower: many questions, weak data and inadequate answers.

The 1980s saw much discussion about manpower needs in many spheres of British life, including dentistry. There have been several manpower reviews since then, culminating in the closure of two UK undergraduate dental schools in the past decade. However, since then the number of vacancies in general dental practice appears to have doubled and there has been increasing difficulty obtaining dental associates. There appear therefore to be some manpower problems in general practice. Some of the available manpower data to the end of 1995 are examined and possible factors underlying these trends are considered, raising more questions than answers but suggesting the time has come to seriously review the situation.

Melanocanthoma: a rare cause of oral hyperpigmentation.

The oral features of a black woman with melanocanthoma of the oral mucosa are detailed, and the current literature of melanocanthoma of the oral mucosa is briefly reviewed.

Bilateral metastatic spread of testicular teratoma to mandibular condyles.

The clinical and radiological features of a patient with metastatic spread of testicular teratoma to both mandibular condyles are presented. It is suggested that in patients with known systemic malignancy, a local metastatic deposit should be considered as a possible cause of unexplained pain in the temporomandibular joints.

Interaction of succinate Ubiquinone reductase with sulphate ion.

A new type of slow change of succinate Ubiquinone reductase (EC 1.3.99), activity which is induced by sulphate ion is described. After preincubation of submitochondrial particles or succinate ubiquinone reductase with sulphate both preparations catalyze succinate: phenazine methosulphate reductase reaction with a significant lag. When added to the assay medium sulphate ion induces biphasic time-dependent competitive inhibition of the enzyme. The sulphate-induced inhibition is apparently due to a rapid interaction of the anion with an active site of the enzyme which is followed by a slow pH-dependent (pK = 7.2) transformation of the enzyme inhibitor complex. pH profiles of the overall succinate ubiquinone reductase reaction and of equilibrium between fast and slow enzyme-sulphate complexes suggest that the same protolytic equilibrium step is involved in the formation of an active intermediate and an inactive enzyme-sulphate complex.

Aplastic anemia associated with lithium therapy.

A case is reported of fatal aplastic anemia developing in a 50-year-old woman who received lithium carbonate in the generally accepted dosage for a manic-depressive disorder. The serum lithium had been determined at regular intervals and never exceeded what is considered a safe level. Patients for whom lithium is prescribed should have periodic hematologic examinations.