The race that never slows: Otolaryngology - Head and Neck Surgery residency applicant parameters over time.

Background: There has been an increasing number of Canadian medical graduates who have gone unmatched in the residency selection process. Medical students have been engaging in extracurricular activities outside the formal curriculum which may help to distinguish themselves from their peers in the selection process. To understand how competitiveness in residency selection shapes applicant demographic characteristics and behaviours, this study set out to explore the demographic characteristics and prevalence of reported extra-curricular activities by applicants to Canadian Otolaryngology - Head & Neck Surgery (OTL-HNS) residency across time. Methods: A retrospective, descriptive study reviewed specific sections of the curriculum vitae (CV) of applicants to OTL-HNS programs in Canada. These sections were self-reported, and included research productivity, involvement in volunteer and leadership activities, membership in associations, and honours or awards granted. Data was quantified and analyzed descriptively. Results: Between 2013 to 2017, a total of 267 applicants reported a median of 12.6 research publications, 9.6 volunteer activities, six leadership activities, six association memberships and 9.8 honours/awards. Applicants were younger over time, with proportions of applicants over 30 years old decreasing from 56% in 2013 to 9% in 2017. Conclusion: Applicants to Canadian OTL-HNS residency programs are reporting consistently high numbers of extracurricular activities and were of increasingly younger ages. Medical students are investing significant time and energy to pursue these activities which are above and beyond the formal curriculum, possibly contributing to decreased diversity in applicants for competitive residencies, increasing the likelihood of misrepresentation in residency applications, and likely contributing to medical student burnout.

Contexte: De plus en plus de diplômés en médecine canadiens demeurent non jumelés à l'issue du processus de sélection des résidents. Certains font des activités hors programme afin de se distinguer de leurs pairs dans le processus de sélection. Pour comprendre comment la compétition dans la sélection de résidents influence les caractéristiques démographiques et les comportements des candidats, cette étude visait à explorer l'évolution des caractéristiques démographiques et la prévalence d'activités hors programme déclarées par les candidats à la résidence en oto-rhino-laryngologie ­ chirurgie cervico-faciale (ORL-CCF) à travers le temps. Méthodes: Dans le cadre d'une étude rétrospective et descriptive, nous avons parcouru des sections pertinentes du curriculum vitae (CV) des candidats aux programmes d'oto-rhino-laryngologie et chirurgie cervico-faciale au Canada. Ces sections étaient auto-déclarées et comprenaient les activités de recherche, la participation à des activités de bénévolat et de leadership, l'appartenance à des associations et les prix et distinctions obtenus. Les données ont été quantifiées et analysées de manière descriptive. Résultats: Entre 2013 et 2017, un total de 267 candidats ont déclaré une médiane de 12,6 publications de recherche, 9,6 activités de bénévolat, 6 activités de leadership, 6 adhésions à des associations et 9,8 prix et distinctions. Au fil du temps, on observe que les candidats sont de plus en plus jeunes ; ainsi, la proportion de candidats âgés de 30 ans et plus a diminué de 56 % en 2013 à 9 % en 2017. Conclusion: Les candidats aux programmes de résidence en ORL-CCF au Canada déclarent d'une année à l'autre un nombre élevé d'activités hors programme et sont de plus en plus jeunes. Les étudiants en médecine investissent beaucoup de temps et d'énergie dans ces activités qui vont au-delà du programme d'études officiel. Cela pourrait nuire à la diversité des candidats aux programmes de résidence fortement contingentés, augmenter la probabilité de fausses déclarations dans les demandes de résidence et probablement contribuer à l'épuisement professionnel des étudiants en médecine.

Review of MIS-C Clinical Protocols and Diagnostic Pathways: Towards a Consensus Algorithm.

Background: The emergence of multisystem inflammatory syndrome in children (MIS-C) during the severe acute respiratory syndrome coronavirus 2 pandemic led to the development of institutional clinical pathways based on expert opinion. We assessed North American paediatric centres' adaptation to MIS-C and analysed the degree of agreement between algorithms on tiered clinical investigations. Methods: This study evaluated MIS-C diagnostic algorithms from 50 tertiary centres developed between May 2020 and December 2021 in the United States and Canada obtained online and through colleagues in various institutions. Descriptive statistics were used to analyse results. Results: All clinical pathways used a tiered approach, and most required coronavirus disease 2019 polymerase chain reaction testing on presentation. Over one-quarter used a 24-hour fever to initiate investigations, and another quarter used 3 days. Basic biochemical workup was performed in all centres on presentation (complete blood count, inflammatory markers, hepatic, and renal functions). Specialized investigation was generally reserved for secondary testing (cardiac biomarkers, electrocardiogram and echo, and coagulation panel). Institutions were divided on several investigations for tier distribution, including urine studies, blood cultures, chest radiograph, and severe acute respiratory syndrome coronavirus 2 serology. Subspecialty consultations were reserved for second-line testing, including cardiology, infectious disease, and rheumatology. Finally, we propose a composite algorithm representative of the consulted pathways. Conclusions: Faced with an unprecedented clinical challenge, paediatric institutions responded swiftly with evaluation standardization, adapting to evolving knowledge. Most pathways agreed on initial basic screening tests followed by secondary workup including cardiac investigations. These protocols, developed during a high level of uncertainty, require comparative assessment on efficacy and superiority.

Contexte: L'émergence du syndrome inflammatoire multisystémique chez les enfants (SIME) pendant la pandémie de SARS-CoV-2 a amené les établissements de soins pédiatriques à concevoir des approches cliniques fondées sur l'opinion d'experts. Nous avons évalué l'adaptation des établissements de soins pédiatriques nord-américains à la réalité du SIME et analysé le degré de concordance des algorithmes au niveau des paliers d'investigation clinique. Méthodologie: Cette étude a permis d'évaluer les algorithmes de prise en charge du SIME développés entre mai 2020 et décembre 2021 dans 50 établissements de soins tertiaires aux États-Unis et au Canada. Les algorithmes ont été obtenus en ligne et par l'intermédiaire de collègues dans divers établissements. L'analyse des résultats repose sur la statistique descriptive. Résultats: Tous les algorithmes comportaient des paliers d'investigation, et la plupart réclamaient un test de détection moléculaire du SARS-CoV-2 par réaction en chaîne de la polymérase (PCR) lors de la consultation initiale. Plus du quart des établissements amorçaient des investigations lorsqu'une fièvre se manifestait depuis 24 heures; un autre quart des établissements faisaient de même lorsque la fièvre était présente depuis trois jours. Des analyses biochimiques de base étaient demandées dans tous les établissements lors de la consultation initiale (hémogramme, bilans inflammatoire, hépatique et rénal). Les investigations spécialisées étaient généralement réservées aux analyses et examens secondaires (dosage des biomarqueurs cardiaques, électrocardiographie, échocardiographie, tableau de coagulation). Les établissements étaient mitigés quant à la distribution de plusieurs investigations par paliers, dont les analyses d'urine, les hémocultures, les radiographies thoraciques et les tests sérologiques de détection des anticorps dirigés contre le SARS-CoV-2. Les consultations surspécialisées étaient réservées aux investigations de deuxième ligne, notamment en cardiologie, en infectiologie et en rhumatologie. Pour résumer nos observations, nous proposons un algorithme représentatif des différents algorithmes consultés. Conclusions: Face à un défi clinique sans précédent, les établissements de soins pédiatriques ont rapidement réagi en normalisant l'évaluation des patients et en s'adaptant à l'évolution des connaissances. La plupart des algorithmes concordaient en ce qu'ils prévoyaient un dépistage de base lors de la consultation initiale, suivi d'un bilan secondaire relevant notamment de la cardiologie. Ces protocoles, conçus dans un contexte de grande incertitude, doivent être l'objet d'une évaluation comparative de l'efficacité et de la supériorité.

Daily outpatient intravenous antibiotic therapy for the management of paediatric periorbital cellulitis, a retrospective case series.

OBJECTIVE: To evaluate whether outpatient treatment of periorbital cellulitis with daily administration of intravenous antibiotics and physician evaluation is an effective and safe alternative to admission. DESIGN: A retrospective chart review study of paediatric patients treated on an outpatient basis for periorbital cellulitis at a tertiary children's hospital between 2013 and 2015 was performed. Children were assessed day by a paediatrician to monitor for resolution of symptoms or complications. SETTING: The Montreal Children's hospital, a tertiary care centre. PARTICIPANTS: Children diagnosed with an uncomplicated periorbital cellulitis secondary to an acute sinusitis or upper respiratory tract infection. MAIN OUTCOME MEASURES: The number of days of intravenous antibiotics, complications or need for subsequent admission. Complications were defined as formation of an abscess or phlegmon confirmed on computerised tomography scan, worsening or recurrent persistent cellulitis, failure to improve on intravenous antibiotics, and intracranial complications. RESULTS: Sixty-six children with a diagnosis of uncomplicated periorbital cellulitis secondary to sinusitis who received intravenous antibiotics via medical day hospital and who fit the inclusion criteria were identified. The mean duration of intravenous antibiotic therapy was 4.1 days. All children received ceftriaxone, with one patient also receiving cefuroxime. Two of 66 patients developed complications; one patient required admission for failure to improve/subperiosteal phlegmon and later underwent functional endoscopic sinus surgery, and one patient developed an eyelid abscess that did not require admission. No patients developed severe neurological or visual deficits. CONCLUSIONS: Outpatient intravenous therapy with daily reassessment by a physician may be a safe alternative to admission in select cases of periorbital cellulitis without systemic signs of illness.

Short- and long-term management of cases of venom-induced anaphylaxis is suboptimal.

BACKGROUND: Venom-induced anaphylaxis (VIA) accounts for severe reactions. However, little is known about the short- and long-term management of VIA patients. OBJECTIVE: To assess the short- and long-term management of VIA. METHODS: Using a national anaphylaxis registry (C-CARE), we identified VIA cases presenting to emergency departments in Montreal and to emergency medical services (EMSs) in western Quebec over a 4-year period. Data were collected on clinical characteristics, triggers, and management. Consenting patients were contacted annually regarding long-term management. Univariate and multivariate logistic regressions were used to identify factors associated with epinephrine use, allergist assessment, and administration of immunotherapy. RESULTS: Between June 2013 and May 2017, 115 VIA cases were identified. Epinephrine was administered to 63.5% (95% confidence interval [CI], 53.9%-72.1%) of all VIA cases by a health care professional. Treatment of reactions without epinephrine was more likely in reactions occurring at home and in nonsevere cases (no hypotension, hypoxia, or loss of consciousness). Among 48 patients who responded to a follow-up questionnaire, 95.8% (95% CI, 84.6%-99.3%) were prescribed epinephrine auto-injector, 68.8% (95% CI, 53.6%-80.9%) saw an allergist who confirmed the allergy in 63.6% of cases, and 81.0% of those with positive testing were administered immunotherapy. Among cases with follow-up, seeing an allergist was less likely in patients with known ischemic heart disease. CONCLUSION: Almost 30% of patients with suspected VIA did not see an allergist, only two thirds of those seeing an allergist had allergy confirmation, and almost one fifth of those with confirmed allergy did not receive immunotherapy. Educational programs are needed to bridge this knowledge-to-action gap.

Development, psychometric properties and preliminary clinical validation of a brief, session-by-session measure of eating disorder cognitions and behaviors: The ED-15.

OBJECTIVE: In the treatment research literature on other psychological disorders, there is a move towards session-by-session symptom measurement. The necessary measures need to be brief, focused on core features since the last session, and readily available to clinicians. There is no measure in the eating disorders that meets those criteria. This research reports the development and validation of such a self-report questionnaire. METHOD: The authors generated and refined a brief set of attitudinal and behavioral items. The resulting questionnaire (the ED-15) and an existing measure (Eating Disorders Examination-Questionnaire; EDE-Q) were completed by a large nonclinical adult sample (N = 531), a group of self-reported eating disorder sufferers (N = 63), and a group of women (N = 33) diagnosed with bulimia nervosa or atypical bulimia nervosa and undertaking cognitive-behavioral therapy. RESULTS: Factor analysis identified two scales (Weight and Shape Concerns; Eating Concerns), with strong internal consistency and test-retest reliability. Correlations with the EDE-Q (r = 0.889) indicates that the ED-15 and EDE-Q measure near-identical constructs. The ED-15 differentiated self-reported eating-disordered and nonclinical groups to the same degree as the longer EDE-Q. Session-by-session analysis of the CBT treatment group demonstrated that the different ED-15 scales changed in different patterns across therapy. DISCUSSION: The ED-15 is not proposed as an alternative to existing measures, but as a complementary tool, used to measure session-by-session change for clinical and research purposes. Future research will track changes in ED-15 scores across therapy, to determine the importance of very early response to therapy and sudden changes.

Patients' experiences of clinicians' crying during psychotherapy for eating disorders.

Many psychotherapists have cried in a therapy session. Those clinicians who do cry see it as likely to have a positive impact on the therapy or to have no impact, and therapist personality characteristics have not shown reliable associations to crying in therapy. However, it is not known how patients experience therapists' crying, or whether the patient's view of the therapist's characteristics is related to that experience. This study used an online survey, recruiting 202 patients with eating disorders, 188 of whom had received therapy for an eating disorder, and 105 of whom had experienced a therapist crying. Retrospective data from those 105 individuals indicated that therapists' crying tended to be seen positively, by patients but that perception was influenced by the patients' perceptions of the demeanor of their therapist and their understanding of the meaning of the crying. Although they need to be extended to other disorders, these findings suggest that therapists' crying needs to be understood in the context of the therapist's perceived characteristics and demeanor, rather than being assumed to be positive or to have no impact on the therapy.