Quantitative Evaluation of Aerosol Generation During In-Office Flexible Laryngoscopy.

Importance: Despite growing scientific knowledge and research, it is still unknown if office flexible laryngoscopy (FL) is aerosol generating and thereby potentially increases the risk of SARS-CoV-2 transmission. The limited literature that exists is conflicting, precluding formal conclusions. Objective: To determine whether FL is aerosol generating. Design, Setting, and Participants: This prospective cohort study included 134 patients seen in the otolaryngology clinic at a single tertiary care academic institution between February and May 2021. Two optical particle sizer instruments were used, quantifying particles ranging from 0.02 µm to 5 µm. Measurements were taken every 30 seconds, with sample periods of 15 seconds throughout the patient encounter. Instruments were located 12 inches from the patient's nares. Timing of events was recorded, including the start and end of physical examination, topical spray administration, start and end of laryngoscopy, and other potential aerosol-generating events (eg, coughing, sneezing). Data analysis was performed from February to May 2021. Exposures: Office examination and office FL. Main Outcomes and Measures: Bayesian online change point detection (OCPD) algorithm was used to detect significant change points (CPs) in this time-series data. The primary outcome was significant CP after FL compared with baseline physiologic variations, such as breathing and phonation. Results: Data were collected from 134 patients between February and May 2021. Ninety-one encounters involved FL. Of this group, 51 patients (56%) wore no mask over their mouth during FL. There was no statistically significant CP in either visits involving FL or visits where FL was not performed. Use of nasal spray did not result in CP in aerosol levels. Overall, neither the number of people present in the examination room, masks over patients' mouth, the duration of the visit, nor the duration of FL were associated with mean aerosol counts, regardless of the exposure. For larger aerosol sizes (≥1 µm), however, rooms with higher air exchange rates had significantly higher reductions in mean aerosol counts for visits involving FL. Conclusions and Relevance: The findings of this cohort study support that FL, including topical spray administration, is not a significant aerosol-generating procedure. The Bayesian OCPD model has a promising application for future aerosol studies in otolaryngology.

A novel walking cane with haptic biofeedback reduces knee adduction moment in the osteoarthritic knee.

Knee osteoarthritis is a leading cause of ambulatory disability in adults. The most prescribed mobility aid, the walking cane, is often underloaded and therefore fails to reduce knee joint loading and provide symptomatic relief. For this study, a novel walking cane with haptic biofeedback was designed to improve cane loading and reduce the knee adduction moment (KAM). To determine; 1) the short-term efficacy of a novel walking cane using haptic biofeedback to encourage proper cane loading and 2) the effects of the novel cane on KAM. Cane loading and KAM, peak knee adduction moment (PKAM), and knee adduction angular impulse (KAAI)) while walking were calculated under five conditions: 1) naïve, 2A) after scale training (apply 20%BW to cane while standing, using a beam scale), 2B) scale recall (attempt to load the cane to 20%BW), 3A) after haptic training (vibrotactile biofeedback delivered when target cane load achieved), and 3B) haptic recall (attempt to load the cane to 20%BW with vibrotactile biofeedback delivered). Compared to the naïve condition all interventions significantly increased cane loading and reduced PKAM and KAAI. No differences between haptic recall and scale recall condition were observed. The haptic biofeedback cane was shown to be an effective and simple way to increase cane loading and reduced knee loading. Haptic biofeedback and scale training were equally effective at producing immediate short-term improvements in cane loading and knee loading. Future studies should examine the long-term effects of scale training and canes with haptic biofeedback on knee joint health, pain, and osteoarthritis disease progression.

The importance of technical skills assessment during an airway foreign body removal course.

PURPOSE: Surgical simulation has proven useful in training for high-acuity, low frequency events such as airway foreign body removal (AWFBR). Studies have supported the role of simulation to improve trainee confidence and technical proficiency, but rigorous methodology is often lacking. Through a pilot study, we sought to evaluate the feasibility and utility of two-view video capture for rigorous assessment of trainee skill in an educational course setting. METHODS: Participants were asked to perform 1) self-assessment surveys using 5- point Likert scale questions and 2) rigid bronchoscopy with AWFBR on intubation trainers, at the beginning and end of a multi-institution airway course. Video was collected from endoscopic and wide-angle body cameras. The videos were blinded and evaluated in random order by two expert reviewers using a 5-point pediatric airway endoscopy specific objective structured assessment of technical skills (OSATS) instrument. RESULTS: Fourteen trainees submitted pre- and post-course surveys, and eight of these also had complete video data. Faculty feedback indicated the importance of pre- and post-course AWFBR recordings for real-time trainee feedback and post-course curricular refinement. Survey data showed an increase in confidence for AWFBR from 2.0 to 3.3 (p = 0.05). Average OSATS scores increased from 1.84 to 2.58 but this did not reach significance (p = 0.51). Paired improvements in confidence exceeded improvements in OSATS scores (1.29 vs. 0.18, p = 0.058). CONCLUSIONS: Rigorously evaluated two-view video capture was feasible in an educational course setting. The course resulted in improvements in confidence to a greater degree than OSATS scores. This supports the importance of assessing course impact and refining curricula using all available data including objectively assessing technical skills.