Disposition to pediatric intensive care unit post supraglottoplasty repair: a systematic review.

BACKGROUND: Patients undergoing supraglottoplasty are often routinely admitted post-operatively to the pediatric intensive care unit (PICU) due to rare but potentially fatal complications such as airway compromise. A systematic review was performed to determine the rate of post-operative PICU-level respiratory support required by pediatric patients following supraglottoplasty, to identify risk factors for patients who may benefit from post-operative PICU admission and limit unnecessary use of intensivist resources. REVIEW METHODS: Key search terms 'supraglottoplasty' OR 'supraglottoplasties' were queried on three databases: CINHAL, Medline and Embase. Inclusion criteria were pediatric patients under 18 years of age who underwent a supraglottoplasty procedure with either an admission to PICU or requirement for PICU-level respiratory support. Risk of bias was assessed by two independent reviewers using QUADAS-2. Findings were critically appraised by three independent reviewers and pooled proportions of criteria meeting PICU admission were calculated for meta-analysis. RESULTS: Nine studies met inclusion criteria, totaling 922 patients. Age at time of surgery ranged from 19 days to 15.7 years with mean age of 5.65 months. A weighted pooled estimate suggested that 19% (95% CI 14-24%) of patients who underwent supraglottoplasty required PICU-admission. The included studies revealed several patient and surgical factors have been linked to postoperative respiratory issues requiring PICU admission, including: neurological disease, perioperative oxygen saturation < 95%, prolonged surgical time and age < 2 months. CONCLUSIONS: This study found that the majority of supraglottoplasty patients do not require significant postoperative respiratory support and suggests that routine PICU admission of these patients may be avoided by careful patient selection. Given the wide heterogeneity of outcome measures, further studies are needed to determine the ideal PICU admission criteria following supraglottoplasty.

Adding a dose of empathy to healthcare: What can healthcare systems do?

RATIONALE, AIMS AND OBJECTIVES: Healthcare practitioners often note system-level barriers to empathy between patients and practitioners. These include burnout-inducing administrative workloads, unfriendly meeting times, burdensome protocols, lack of wellbeing spaces, and undervaluing empathy as a core part of an institution's mission. The need for empathy in healthcare has been magnified with the current SARS-COV-2 outbreak which has limited the expression of interpersonal empathy due to rigid isolation protocols and the use of personal protective equipment. METHOD: This study-the first of its kind that we are aware of-outlines the details of a facilitated workshop run with the leadership of a tertiary level pediatric center in Canada. The workshop used a modified nominal group technique to discuss and prioritize actions to enhance empathy into the hospital system. RESULTS: Inter-professional and inter-disciplinary group of healthcare leader participants agreed on several immediately actionable steps, including embedding patient satisfaction with care measures as standard, and streamlining booking appointments. A roadmap was created to implement the other priorities. CONCLUSION: A systematic approach to infusing empathy into the structure of our healthcare system is much needed. Furthermore, inter-professional and inter-disciplinary educational workshops was well-received as a way to facilitate discussion and drive change.

Integration of Gross Anatomy Laboratory Sessions into Medical Physics Curriculum.

BACKGROUND: Gross anatomy laboratory sessions with hands-on activities using specimens are essential for teaching anatomy in the medical field. However, they are not seen in medical physics programs. The objective of this pilot study at McGill University was to explore the educational potential of integrated gross anatomy laboratory sessions tailored to the medical physics curriculum. METHODS: The study included 21 medical physics and 11 radiation oncology participants. It was conducted over four 2-h laboratory sessions on pelvic, thoracic, and head and neck anatomy. A radiotherapy applicator device and augmented reality tools were brought in to focus on radiological anatomy and radiation therapy. Students' lab experiences were evaluated through post-laboratory surveys using a mixed methodology. Qualitative data from short-answer questions were analyzed using an inductive coding approach. Quantitative data from Likert scale questions were analyzed with descriptive statistics. RESULTS: All participants reported gross anatomy laboratory sessions as a superior method of learning anatomy compared with a single didactic course (mean Likert: 4.38; median = 5; SD = 0.74). Participants also expressed greater comfort with radiological anatomy and the lab environment with gradual exposure from pelvic prosections to full-body cadavers. Lastly, all participants showed enthusiasm for multidisciplinary activities. CONCLUSION: Carefully designed gross anatomy laboratory sessions were very well received by medical physics students as they transition into a clinical role in healthcare. This pilot study serves as a foundation for future studies exploring anatomical education in medical physics. These sessions will continue to be offered at our school and could be adopted also by other medical physics departments in their courses.