Development of an optimized preoperative computed tomography imaging checklist for endoscopic sinus surgery utilizing a systematic review of the literature and the modified Delphi method.

BACKGROUND: Critical review of computed tomography (CT) imaging is essential in preoperative planning for endoscopic sinus surgery. In this study, we used a systematic review and a modified Delphi method to develop a comprehensive checklist that facilitates preoperative review of sinus CT imaging. METHODS: We performed a systematic review of PubMed, Embase, CINAHL, Cochrane, and Web of Science databases to identify existing checklists developed to evaluate sinus CT imaging. An inclusive list of items from these checklists was compiled and a modified Delphi methodology was used to assign ranked priority. The Delphi process involved 14 rhinologists and had three phases: an initial survey with Likert priority (scale of 1-9) and two rounds of live discussions followed by survey to confirm consensus. RESULTS: Ninety-seven possible checklist items were identified from a systematic review and panelist input. On initial survey, 63 items reached a consensus score of 7+, and 13 items had near consensus scores between 6 and 7; two of these 13 borderline items were retained after subsequent panelist discussion. The resulting items were consolidated into an 11-item disease checklist and a 24-item anatomical checklist; the anatomical checklist was further divided into six subsections: nasal cavity, maxillary, ethmoid, sphenoid, frontal, skull base, and orbit. Additionally, panelists identified six core aspects of patient history to consider prior to surgery. CONCLUSIONS: After establishing content validity through a systematic literature review and a modified Delphi method, we developed a comprehensive checklist for preoperative sinus CT imaging review; implementation and evaluation of validity among trainees will suggest overall utility.

Are Otolaryngology Milestones Predictive of Otolaryngology Training Examination Scores?

IMPORTANCE:: Otolaryngology residents take the otolaryngology training examination (OTE) yearly to assess their fund of knowledge. The Accreditation Council for Graduate Medical Education (ACGME) milestone evaluations are also conducted semiannually. Accurate prediction of training examination performance allows identification of residents who are performing well and those who need targeted remediation. Prior studies in other specialties have attempted to use milestone evaluations to help predict in-training examination scores. OBJECTIVE:: In this study, we aim to identify whether ACGME milestone evaluation scores predict OTE performance. DESIGN:: Milestone ratings and OTE scores for residents at 2 US otolaryngology residency programs were collected. Multivariate analysis was achieved using linear mixed modeling. We considered a 2-tailed P value of ≤ .05 as statistically significant. SETTING:: Two US otolaryngology residency programs. PARTICIPANTS:: Forty-eight otolaryngology residents postgraduate years 2 to 5. RESULTS:: Otolaryngology training examination scores and ACGME milestone evaluations were collected from 48 residents from postgraduate year 2 to 5 between the years 2014 and 2017. One hundred eight OTE scores were available. Linear mixed-effect models were constructed, and after adjusting for level of training and OTE year, the total milestone rating made a negligible impact in estimating OTE percentage correct (ß = -.01, P = .9). Similarly, total milestone rating demonstrated a minimal contribution in approximating OTE national stanine score after adjusting for the level of training (ß = -.003, P = .9). CONCLUSIONS AND RELEVANCE:: In our study, ACGME milestone evaluations are not predictive of residents' OTE performance. What these milestone evaluation data mean and how they should be used continues to be an unanswered question. We should aim to identify the most effective applications of the milestone data collected yearly by otolaryngology programs.

Otolaryngology resident selection: do rank lists matter?

OBJECTIVES: To examine the relationship between National Residency Matching Program (NRMP) rank list position and future otolaryngology residency performance. STUDY DESIGN: Cohort study. METHODS: Eight consecutive residency classes (starting 2001-2008; 4 residents/y) were reviewed. Three hundred and thirty-three applicants (40.6 applicants/y) were interviewed, and 316 (94.9%) were ranked. Residents matching with our program were divided 3 different ways: into quarters, thirds, and halves, based on their rank order. Correlation coefficients were obtained to compare resident rank number and rank group (quarter, third, half) to faculty evaluation, coresident evaluation, and in-service score. Chi-square tests were conducted comparing rank group to chief resident selection and annual teaching award. RESULTS: Resident NRMP rank number was not significantly correlated with faculty evaluation, coresident evaluation, or in-service exam score (-0.21 < r < 0.05; P > .28). There was also no significant correlation between resident quarter, third, or half rank group and faculty evaluation; coresident evaluation; or in-service exam score (-0.29 < r < 0.10; P > .13). Chi-square analysis found no relationship between resident rank group and chief resident (P > .35) or teaching award (P > .13) selection. CONCLUSIONS: Applicant rank number and rank group did not correlate with performance of this otolaryngology residency cohort as assessed by faculty evaluation, coresident evaluation, in-service exam score, or selection for chief resident or the annual teaching award. Resident selection committees should consider reallocating manpower hours from creating rank order to recruiting applicants and selecting interview candidates.

Effect of clenbuterol on cardiac and skeletal muscle function during left ventricular assist device support.

BACKGROUND: High-dose clenbuterol (a selective beta2-adrenergic agonist) has been proposed to promote myocardial recovery during left ventricular assist device (LVAD) support, but its effects on cardiac and skeletal muscle are largely unknown. METHODS: Seven subjects with heart failure (5 ischemic, 2 non-ischemic) were started on oral clenbuterol 5 to 46 weeks post-LVAD implantation and up-titrated to daily doses of 720 microg. The following procedures were performed at baseline and after 3 months of therapy: echocardiography at reduced support (4 liters/min); cardiopulmonary exercise testing; body composition analysis; and quadriceps maximal voluntary contraction (MVC). Myocardial histologic analysis was measured at device implantation and explantation. RESULTS: There were no serious adverse events or arrhythmias. Creatine phosphokinase (CPK) was elevated in 4 subjects, with no clinical sequelae. No change in ejection fraction was seen. End-diastolic dimension increased significantly (4.73 +/- 0.67 vs 5.24 +/- 0.66; p < 0.01), despite a trend toward increased LV mass. Body weight and lean mass increased significantly (75.5 +/- 17.9 vs 79.2 +/- 25.1 kg, 21.1 +/- 8.9 vs 23.6 +/- 9.7 kg, respectively; both p < 0.05). Exercise capacity did not change, but MVC improved significantly from 37.0 +/- 15.7 to 45.8 +/- 20.6 kg (p < 0.05). No significant change in myocyte size or collagen deposition was seen. CONCLUSIONS: Cardiac function did not improve in this cohort of LVAD patients treated with high-dose clenbuterol. However, clenbuterol therapy increased skeletal muscle mass and strength and prevented the expected decrease in myocyte size during LVAD support. Further study will clarify its potential for cardiac and skeletal muscle recovery.