Inpatient pain assessment and decision-making in internal medicine and general surgery residents: A qualitative analysis.

Background: Understanding physician approaches to pain treatment is a critical component of opioid and analgesic stewardship. Practice patterns learned in residency often persist longitudinally into practice. Objective: This study sought to identify salient factors and themes in how resident physicians assess and manage pain. Methods: Video-recorded focus groups of internal medicine and general surgery residents were conducted via videoconferencing software. Data were analyzed using a ground theory approach and constant comparative method to identify themes and subthemes. Focus groups occurred in September and October 2020. Results: 10 focus groups including 35 subjects were conducted. Four general themes emerged: (1) Assessment considerations; (2) Education & Expectations; (3) Systems Factors; and (4) Management considerations. Participants indicated that while it is important to treat pain, its inherently subjective nature makes it difficult to objectively quantify it. The 0-10 numeric rating scale was problematic and infrequently utilized. Patient expectations of no pain following procedures was viewed as particularly challenging. The absence of formal best practices to guide pain assessment and management was noted in every group. Management approaches overall very highly variable, often relying on word-of-mouth relay of the preferences of specific attending physicians. Conclusions: Pain is highly nuanced and resident physicians struggle to balance pain's subjectivity with a desire to quantify and appropriately treat it. The 0-10 numeric rating pain scale, though ubiquitous, is problematic. Priority areas of improvement identified include education for both patients and physicians, functional pain scales, and expansion of existing effective resources like the nursing pain team.

Evaluating olfactory function and quality of life in patients with traumatic brain injury.

KEY POINTS: Patients with traumatic brain injury (TBI) had worse olfactory quality of life (QoL) and Sino-Nasal Outcome Test-22 scores compared to a normal cohort. A worse olfactory QoL correlated with concussion symptom burden. Olfactory dysfunction among TBI patients should be addressed to improve overall outcomes.

Development and Validation of The Activity-Based Checks (ABCs) of Pain: A Functional Pain Scale.

The Activity-Based-Checks of Pain (ABCs) is a pain assessment tool incorporating activities of daily living and instrumental activities of daily living. Unlike widely used pain scales which are oftentimes unidimensional and highly subjective, the ABCs was designed to focus on function capabilities and limitations of patients due to pain. This study sought out to validate the factorial structure of the ABCs and assess its use in participants with chronic pain. Participants were recruited in two phases from Prolific - an online service designed to identify research participant recruitment based on study criteria. Phase one optimized the design of the ABCs, with 297 subjects selecting their preferred icon for each function and rating its understandability. The most preferred and understandable icons were then used in phase two, where 304 chronic pain participants completed the ABCs, PROMIS-29, additional PROMIS items that were analogous to the ABCs functions but not represented in the PROMIS-29, and the Brief Pain Inventory (BPI). Data was analyzed using exploratory factor analysis and confirmatory factor analysis demonstrating four factor loadings: multi-planal activities, sitting/hip flexor pain, walking/ambulation, and pain interference with lightweight unilateral activities. High internal consistency was demonstrated with all four factor loadings. Correlations between items in the ABCs, PROMIS, and BPI resulted in moderate to strong correlations demonstrating strong evidence for the validity of the ABCs as a functional pain assessment tool.

Disparities in Olfactory Dysfunction in African Americans.

OBJECTIVES: To examine olfactory performance in African Americans (AA) and Whites by comparing individual scent scores on objective olfactory tests to assess potential racial-ethnic differences of scent detection. METHODS: Cross-sectional study of healthy participants, age 18+ years, and without sinonasal inflammatory disease from June 2021 to April 2022. Included participants self-identified as AA or White. Patients were recruited from outpatient clinics at University of Kansas Medical Center, and the local community. Two smelling tests were employed: Affordable Rapid Olfactory Measurement Array (AROMA) and Sniffin' Sticks (SST-12). Sino-Nasal Outcome Test (SNOT-22) was used for self-reported olfactory function . Pearson correlation and chi-square tests were used to detect statistical significance. RESULTS: Our sample included 102 (46 AA and 56 Whites) participants. AROMA and SST-12 scores were significantly correlated in AA (P < .01, Pearson's Rho = .642) and Whites (P < .05, Pearson's Rho = .297). Mean scores on AROMA were significantly lower for AAs: 64.2 and Whites: 75.5 (P < .01). On AROMA, AA less accurately identified the scents of Licorice, Orange, Lavender, Cinnamon, Clove, and Rosemary (P < .05). Similarly, SST-12 mean scores for AAs: 84.2 were also lower than Whites: 89.9 (P < .01). On SST-12, AA less accurately identified the scent of pineapple Based on SST-12 scoring criteria, 60.9% of AA and 30.4% of Whites were classified as hyposmic (P < .05). SNOT-22 Smell scores were equivalent for both groups. CONCLUSION: On both tests of olfaction, AA performed worse than Whites and a greater proportion of AA were considered hyposmic compared to Whites. This is a discrepancy with self-reported olfaction, which showed no difference between Whites and AA. AA performed significantly worse than their White counterparts on several scents, with possible implications regarding cultural appropriateness of scents used in olfactory testing.

Allyship to Advance Diversity, Equity, and Inclusion in Otolaryngology: What We Can All Do.

Purpose of review: To summarize the current literature on allyship, providing a historical perspective, concept analysis, and practical steps to advance equity, diversity, and inclusion. This review also provides evidence-based tools to foster allyship and identifies potential pitfalls. Recent findings: Allies in healthcare advocate for inclusive and equitable practices that benefit patients, coworkers, and learners. Allyship requires working in solidarity with individuals from underrepresented or historically marginalized groups to promote a sense of belonging and opportunity. New technologies present possibilities and perils in paving the pathway to diversity. Summary: Unlocking the power of allyship requires that allies confront unconscious biases, engage in self-reflection, and act as effective partners. Using an allyship toolbox, allies can foster psychological safety in personal and professional spaces while avoiding missteps. Allyship incorporates goals, metrics, and transparent data reporting to promote accountability and to sustain improvements. Implementing these allyship strategies in solidarity holds promise for increasing diversity and inclusion in the specialty.

Parental Vaccine Hesitancy in a COVID-19 World: A Qualitative Study of Midwestern Parents' Decisions Regarding COVID-19 Vaccination for Their Children.

Introduction: With the launch of the SARS-CoV-2 (COVID-19) vaccines, a new cohort of people exists who do not consider themselves to be completely vaccine-hesitant, but are specifically COVID-19 vaccine hesitant (CVH). There is a need to learn from CVH parents, to ensure their concerns are addressed, and allow them to comfortably vaccinate their children against the COVID-19 virus. Methods: Surveys were used to identify CVH parents. Using semistructured interviews, we assessed the attitudes of CVH parents toward COVID-19 vaccination in children. An inductive coding method was used to analyze transcripts and develop themes. Results: Fourteen parents were interviewed. Seven (50%) had received the COVID-19 vaccine even though they had doubts. Six reported that education about mRNA vaccine production was helpful in deciding to get vaccinated. Parents were reluctant regarding pediatric vaccination due to lack of long-term studies and concerns about adverse impact on childhood development. Personal physicians were the most trusted source of information and direct conversations with them were the most influential, as opposed to public health leaders like the U.S. Centers for Disease Control and Prevention and the National Institutes of Health. Conclusions: Our findings suggested that physicians are among the most trusted sources of information regarding the COVID-19 vaccine for CVH parents. Rather than use broad public health messaging and advertising to increase rates of vaccination, further investigation into training health professionals on how to counsel CVH patients effectively may be a higher impact area of opportunity to improve vaccine response rates.

Patient Perspective on Adherence to Reflux Lifestyle Modifications: A Qualitative Study.

OBJECTIVE: Acid reflux disease is a common condition with recurrent symptoms affecting the quality of life of many Americans. Lifestyle/dietary modification is critical for management of acid reflux disease. Adherence to these recommendations is variable. The purpose of this study was to better understand the experience of patients with reflux disease (GERD/LPR) and explore factors that impact the integration of lifestyle modifications into their daily lives. METHODS: Patient with diagnoses of GERD and/or LPR were recruited from an outpatient laryngology clinic and completed the Reflux Symptom Index (RSI) and a semi-structured interview. Interviews were transcribed and underwent thematic analysis. RESULTS: Twenty-three patients-mean age and RSI of 61 and 16.1 respectively-were recruited. Four main themes emerged: (1) Care team interaction-focus and quality of physician counseling, useful educational handouts, dietician/nutritionist counseling; (2) Motivation to change-impact on symptom severity, avoiding undesired interventions, and poor health outcomes; (3) Implementing lifestyle changes; and (4) Impact of disease on patient. No patient had seen a dietician. Patients who experienced dietary counseling for other conditions felt reflux-specific counseling with a dietician would be beneficial. While patients found educational material on diet to be helpful, lists of foods to avoid were discouraging; providing a positive list of preferred foods may be more helpful. CONCLUSION: Lifestyle modification counseling should incorporate multiple aspects of the patient experience. Patients desire information regarding medication side effects. Educational handouts should include prioritized list of recommended dietary restrictions and acceptable/alternative food options. Referral for dedicated dietician counseling can also be considered to increase understanding of the importance of, and adherence to, lifestyle modification.

Longitudinal Olfactory Patterns in Multiple Sclerosis: A Scoping Review and Implication for Use in Management of Disease.

BACKGROUND: Although studies regarding multiple sclerosis (MS) and olfactory dysfunction (OD) have been previously described and summarized, there is not a sole review of longitudinal studies regarding the matter. This review examines the existing literature investigating MS and its effect on olfaction. In addition, the role of OD in the diagnosis and prognosis of MS is explored. METHODS: A scoping review of the literature was performed covering longitudinal studies investigating MS and OD. Systematic searches of PubMed, Google Scholar, Web of Science, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, AgeLine, and MEDLINE were performed using terms that encompassed MS and olfaction. The aim of this review was to build on the existing literature by summarizing only findings that were demonstrated longitudinally. RESULTS: Of 6938 articles identified from the search, 9 met the inclusion criteria: longitudinal observation of relapsing-remitting or progressive MS. Olfaction was measured and scored using various testing arrays, and these scores were then correlated with a multitude of clinical markers. Across all studies, patients with MS demonstrated increased OD. Longitudinally, 2 contrasting patterns were identified: (1) clinical markers of acute inflammation correlated with an increased odor threshold and (2) clinical markers of neurodegeneration, or progression of disease, correlated with a decreased ability to discriminate and identify odors. CONCLUSIONS: These studies suggest that olfaction is a dynamic, dependent variable of neurodegeneration, correlating with inflammation and clinical markers. This opens the door for future exploration of olfaction's relationship with MS diagnosis, characterization, and therapeutic response.

Quantifying Faculty Perception of Diversity, Equity, and Inclusion Within Academic Otolaryngology-Head and Neck Surgery Departments.

OBJECTIVE: Investigating faculty perceptions of diversity, equity, and inclusion (DEI) among academic otolaryngology programs. STUDY DESIGN: Quantitative survey. SETTING: Academic otolaryngology departments. METHODS: The DEI Inventory was developed by a multi-institutional health equity consortium and disseminated within 16 academic otolaryngology programs. The inventory consisted of 25 items graded on a 5-point Likert scale (strongly disagree to strongly agree), 2 yes/no questions, and 5 items reflecting overall DEI, stress, and burnout among academic otolaryngologists. Validated imposter phenomenon and personality trait measures were also included. RESULTS: The inventory received 158 (31.0%) partial and 111 (21.8%) full responses. No significant differences were identified in DEI scores by race. Compared to males, females reported lower scores on the overall DEI Inventory (3.6 vs 4.3, p < .001). Female respondents also reported greater levels of imposter phenomenon than their male counterparts (53.2 vs 47.5, p = .049). CONCLUSION: Preliminary responses to our DEI Inventory suggest that faculty perception of DEI is not impacted by race. Female faculty report considerably lower perceptions of DEI than their male counterparts and experience greater levels of imposter phenomenon. The results of the DEI Inventory can help departments design meaningful interventions to improve levels of DEI among faculty.

International consensus statement on allergy and rhinology: Allergic rhinitis - 2023.

BACKGROUND: In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS: ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS: ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION: The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

Investigation of a Novel Activity-Based Checks (ABC) Functional Pain Scale in the Post-Operative Urologic Surgery Patient.

Introduction: The authors investigated a novel functional pain scale, the Activity-Based Checks (ABCs) of Pain, following open urologic surgery. The primary objectives were to establish the strength of the correlation between the ABCs and the numeric rating scale (NRS) and determine the impact of functional pain on the patient's opioid requirements. We hypothesized that ABC score would correlate strongly with NRS and that the ABC score during hospitalization would be more closely correlated with the number of opioids prescribed and used. Methods: This prospective study included patients at a tertiary academic hospital undergoing nephrectomy and cystectomy. The NRS and ABCs were collected pre-operatively, during the inpatient stay, and at the one-week follow-up. Milligrams of morphine equivalents (MMEs) prescribed at discharge and the MME reportedly taken during the first post-operative week were recorded. Spearman's Rho was used to assess the correlation between scale variables. Results: Fifty-seven patients were enrolled. The ABCs correlated strongly with the NRS at baseline and post-operative appointments (r = 0.716, p < 0.001 and 0.643, p < 0.001). Neither the NRS nor the composite ABCs score was predictive of outpatient MME requirements; the ABCs function, "Walking outside the room" significantly correlated to MMEs taken after discharge (r = 0.471, p = 0.011). The greatest predictor of MMEs taken was the number of MMEs prescribed (0.493, p = 0.001). Conclusions: This study highlighted the importance of post-operative pain assessment that takes functional pain into consideration to evaluate pain, inform management decisions, and reduce opiate reliance. It also emphasized the strong relationship between opioids prescribed and opioids consumed.

Factors affecting adherence to intranasal treatment for allergic rhinitis: A qualitative study.

Objective: To determine the facilitators of and barriers to adherence to use of intranasal pharmacotherapy (daily intranasal corticosteroids and/or antihistamine, and nasal saline irrigation [NSI]), for allergic rhinitis (AR). Methods: Patients were recruited from an academic tertiary care rhinology and allergy clinic. Semi-structured interviews were conducted after the initial visit and/or 4-6 weeks following treatment. Transcribed interviews were analyzed using a grounded theory, inductive approach to elucidate themes regarding patient adherence to AR treatment. Results: A total of 32 patients (12 male, 20 female; age 22-78) participated (seven at initial visit, seven at follow-up visit, and 18 at both). Memory triggers, such as linking nasal routine to existing daily activities or medications, were identified by patients as the most helpful strategy for adherence at initial and follow-up visits. Logistical obstacles related to NSI (messy, takes time, etc.) was the most common concept discussed at follow-up. Patients modified the regimen based on side effects experienced or perceived efficacy. Conclusions: Memory triggers help patients adhere to nasal routines. Logistical obstacles related to NSI can deter from use. Health care providers should address both concepts during patient counseling. Nudge-based interventions that incorporate these concepts may help improve adherence to AR treatment. Level of Evidence: 2.

Qualitative Study Assessing Factors for 30-day Readmissions: A Head and Neck Oncology Cohort.

OBJECTIVES: There is a paucity of literature on what contributes to 30-day readmission rates from the patient's perspective in head and neck cancer patients. Post-operatively, these patients are often discharged with multiple surgical sites and home equipment requiring education and a large responsibility upon arriving home. Patients have a unique understanding of the discharge process and rationale behind presenting for care following initial discharge. Understanding the experience of the readmitted patient may be critical in finding effective methods to prevent unnecessary readmissions. METHODS: Through key-informant interviews, we assessed factors that impact readmission rates from the patient perspective. Patients were eligible if they were discharged within the last 30 days and subsequently readmitted following an admission for a head and neck cancer surgery. Inductive coding was used to analyze interview transcripts and develop themes. RESULTS: Thirteen respondents were interviewed. 46% (n = 6) did not feel ready for discharge after the index admission. Out of these 6 patients, 83% (n = 5) felt their readmission could have been avoided. Patients often encountered unexpected events after returning home from the index admission and felt their readmissions were potentially avoidable with more information regarding what to expect at home, prior to discharge. Although medically stable upon discharge, these findings indicate some patients might be discharged sooner than they should be due to factors outside of medical indications. CONCLUSIONS: To address the various biopsychosocial components of patient care in addition to medical aspects, an otolaryngology-specific, prior-to-discharge checklist could aid in lowering 30-day readmissions. Since the amount of education each patient requires to feel competent managing their health at home varies, more work is needed to craft post-education assessments of patient/caregiver competencies for home equipment, prior to discharge to reduce avoidable readmissions.

Implementation of a Near-Peer Surgical Anatomy Teaching Program into the Surgery Clerkship.

OBJECTIVE: The objective of this study was to describe the implementation of Clinical Anatomy Mentorship Program (CAMP), a novel near-peer surgical anatomy teaching program, into the KU School of Medicine (KUSOM) Surgery Clerkship curriculum. DESIGN: Prospective qualitative and quantitative study. SETTING: Single institution, tertiary care hospital. PARTICIPANTS: All M3s at KUSOM on their surgery clerkship were eligible for inclusion for the learner cohort, n = 106. A group of M4s self-identified as CAMP mentors were eligible for inclusion for the teacher cohort, n = 40. RESULTS: M3s have statistically significant higher self-efficacy (p < 0.001) scores after participating in CAMP. Among open-ended comments written by M3s, significant themes highlighted that CAMP taught them a much-needed refresher on anatomy, gave them an introduction to surgical anatomy, and felt peer-to-peer teaching created a safe environment to ask questions. M4 mentors reported statistically significant (p < 0.001) increases in self-efficacy and confidence in teaching skills after teaching CAMP sessions. Among open-ended comments written by M4 mentors, significant themes highlighted that CAMP helped them develop their teaching skills and confidence in the operating room. CONCLUSIONS: In line with current medical education practices, KUSOM has significantly decreased anatomy in the curriculum. We responded to this shift by implementing CAMP, designed to address specific medical student needs for a surgically oriented anatomy instruction. CAMP has been effective at addressing student concerns about anatomy knowledge gaps. CAMP has enhanced self-efficacy, anatomy knowledge, and operating room exposure in M3s, and self-efficacy, teaching skills, surgical anatomy knowledge, and surgical confidence in M4s.

Olfactory, Auditory, and Vestibular Performance: Multisensory Impairment Is Significantly Associated With Incident Cognitive Impairment.

Background: Dysfunction in the olfactory, auditory, and vestibular systems are commonly seen in aging and are associated with dementia. The impact of sensory loss(es) on cognition is not well understood. Our aim was to assess the relationships between performance on objective multisensory testing and quantify the impact of dysfunction on cognition. Methods: Patients presenting with subjective hearing loss presenting to a tertiary care otologic/audiologic clinic were identified and underwent multisensory testing using the Affordable, Rapid Olfactory Measurement Array (AROMA), pure tone audiometric evaluations, and the Timed "Up and Go" test. Cognitive impairment (CI) was assessed via the Montreal Cognitive Assessment (MoCA) was also administered. Key Results: 180 patients were enrolled. Thirty one percentage (n = 57) screened positive for cognitive impairment. When evaluating single sensory impairments, we found that olfactory dysfunction, gait impairment, and sensorineural hearing loss were all statistically significantly (p < 0.05) associated with a higher risk of cognitive impairment (ORs 3.89, 3.49, and 2.78, respectively) for CI. Multisensory impairment was significantly associated with cognitive impairment. Subjects with dysfunction in all domains were at the highest risk for cognitive impairment (OR 15.7, p < 0.001) vs. those with impairment in 2 domains (OR 5.32, p < 0.001). Conclusion: Dysfunction of the olfactory, auditory, and vestibular systems is associated with a significantly increased risk of CI. The dramatically increased risk of CI with multisensory dysfunction in all three systems indicated that MSD may synergistically contribute to CI.

Olfactory dysfunction in type II diabetes: Therapeutic options and lessons learned from other etiologies - A scoping review.

INTRODUCTION: Olfactory dysfunction (OD) is highly prevalent amongst type 2 diabetes mellitus (DM2) patients and has many associated health risks. For example, OD can lead to poor nutrition, safety issues related to diminished hazard detection, and increased mortality rates. While limited research exists about therapeutics for DM2-associated OD, recovery of olfactory function is better studied in other pathologic states. The objectives of this scoping review are to synthesize the existing data on interventions for DM2-associated OD and present the evidence for therapies that have been utilized for non-DM2-associated causes of OD. Additionally, the potential therapeutic opportunities for patients with DM2 are explored. METHODS: A scoping review was conducted with a medical librarian to identify studies investigating treatments of DM2-related OD. 6 databases were searched (Embase, CINAHL, the Cochrane Library, Google Scholar, OVID Medline, and Web of Science). Studies were eligible if the primary discussion involved treatment of olfactory deficits in the context of DM2. All publication dates were included, and studies published in languages other than English were excluded. RESULTS: 3631 articles were identified; 3 articles met inclusion criteria and underwent full text review. Hyperbaric oxygen (HBO), the DPP-4 inhibitor Linagliptin and the GLP-1 agonists Exenatide and Liraglutide are the only therapeutics that have been used in the context of DM2. Only HBO and GLP-1 agonists produced statistically significant improvements in olfactory identification. The literature regarding non-DM2-associated OD supports interventions such as olfactory training, dietary supplements, and intranasal insulin. Specifically, olfactory training was very effective in many contexts such as post-viral and traumatic OD while being affordable and non-invasive. CONCLUSION: This scoping review of olfactory rehabilitation options for DM2-induced OD demonstrates a paucity of prospective investigations of plausible therapeutics. Additionally, treatments for OD related to non-DM2-associated etiologies, such as olfactory training, are well-studied, efficacious, and should be investigated in the context of DM2. Future investigation has the potential to enhance the quality of clinical intervention for OD and improve short- and long-term outcomes for DM2 patients.

Indications for absorbable steroid-eluting sinus implants: Viewpoint via the Delphi method.

Absorbable steroid-eluting sinus implants provide targeted corticosteroid release over a sustained period and are designed to prevent both undesirable adhesion formation and sinus ostia restenosis. Here, we highlight the key evidence of these implants to date and query a group of experts via a Delphi process on the indications and optimal timing for intraoperative or in-office placement of these implants. Six of a total of 12 statements reached consensus and were accepted. Overall, experts largely agree that intraoperative or in-office use of steroid-eluting stents could be considered for patients: (1) who are diabetic or intolerant of oral steroids, (2) undergoing extended frontal sinus surgery, and (3) with recurrent stenosis. Given the lack of expert consensus on other key statements, clinicians should carefully consider these treatment options on a case-by-case basis after shared decision-making.

Activity-Based Checks (ABCs) of Pain: A Functional Pain Scale Used by Surgical Patients.

Introduction: Increased rates of surgery, combined with concerns about high-risk pain medications, have highlighted the need for improved methods of meaningfully assessing pain. In response to lack of medical context and functional data in existing scales, the Activity-Based Checks (ABCs) was developed. Methods: This prospective, cohort study was deployed at a single-institution, academic center. The primary outcome was to correlate the ABCs to the 0 - 10 numeric rating scale (NRS) in post-operative general surgery patients. Secondary outcomes included assessing the impact of patient factors and prescribing patterns on opioid consumption, in milligrams of morphine equivalents (MME), after discharge. Results: The function that correlated most to the NRS at discharge was "Out of Bed to Chair". Indicators of better mental health were correlated inversely with MME consumption. Interestingly, the largest predictor of MME taken was MME prescribed. Over 40% of prescribed opioids goes unused. Conclusions: Functional pain scales, like the ABCs, may be useful adjuncts to evaluate pain. Individual functions, such as, "Out of Bed to Chair", may be of particular importance. Clinicians must be aware that the strongest predictor of MMEs taken by patients was MMEs prescribed, highlighting the importance of better pain assessments and opioid stewardship.

Identifying Olfactory Phenotypes to Differentiate Between COVID-19 Olfactory Dysfunction and Sinonasal Inflammatory Disease.

The objective of this study was to identify specific olfactory phenotypes-patterns of olfactory performance-across distinct cohorts with or without olfactory dysfunction (OD). Adult patients underwent testing via a novel olfactory testing methodology in 1 of 4 groups based on health status: sinonasal inflammatory condition (chronic rhinosinusitis or allergic rhinitis), ≥4 weeks of self-reported OD after resolved COVID-19 infection, Alzheimer's disease, and healthy control. Participants' scores for each scent were normalized on a scale of 0 to 1 relative to their worst and best scores. Agglomerative hierarchal cluster analysis was performed on normalized data for the COVID-19 and sinonasal cohorts. Resulting clusters from the penultimate merger revealed a sensitivity of 81% and specificity of 63% for the detection of patients with COVID-19. These results support that there are olfactory phenotypes that may discriminate COVID-19 OD from sinonasal inflammatory disease. These phenotypes will likely become increasingly leveraged in the workup and treatment of patients with OD.

Creation of a Novel Preoperative Imaging Review Acronym to Aid in Revision Endoscopic Sinus Surgery.

OBJECTIVES: (1) Identify anatomic contributions to chronic rhinosinusitis (CRS) necessitating revision endoscopic sinus surgery (RESS). (2) Create a clinical acronym to guide imaging review prior to RESS that addresses pertinent sites of disease and potential sites of surgical morbidity. DATA SOURCES: Ovid MEDLINE, Embase and Medline via Embase.com, Web of Science Core Collection, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. REVIEW METHODS: Systematic search was performed using a combination of standardized terms and keywords. Studies were included if they investigated anatomic contributions to persistent CRS requiring RESS or the relationship between anatomic landmarks and surgical morbidity. Identified studies were screened by title/abstract, followed by full-text review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were strictly followed. RESULTS: In total, 599 articles met screening criteria, 89 were eligible for full-text review, and 27 studies were included in the final review. The identified anatomic sites of interests are broad; the most frequently cited anatomic region was retained anterior ethmoid cells (22/27 studies), followed by posterior ethmoid cells (14/27 studies). Using the consolidated information, a clinical acronym, REVISIONS, was created: Residual uncinate, Ethmoid cells (agger, Haller, supraorbital), Vessels (anterior and posterior ethmoid), Infundibulum, Septal deviation, I (eye) compartment, Onodi cell, Natural os, and Skull base slope and integrity. CONCLUSIONS: The REVISIONS acronym was developed as a tool to distill the unique anatomic contributions of primary endoscopic sinus surgery failure into a format that can be easily incorporated in preoperative radiologic review and surgical planning to optimize outcomes and minimize complications.