Objectives/hypothesis

To quantify the effect of the coronavirus disease 2019 (COVID-19) pandemic upon the 2020 to 2021 residency match for Otolaryngology-Head and Neck Surgery (OHNS).

Study design

Retrospective cohort design.

Methods

Residency match outcomes for all applicants to our institution during 2020 to 2021 were collected from the National Residency Matching Program including medical school of origin and matched program. Matches were categorized as to home-program, within-region, or out-of-region and sorted by US geographic region. Matches from the 2020 to 2021 cycle were compared to those from 2019 to 2020, as well as averages and trends from match cycles 2016 to 2020. Statistical analysis included descriptive statistics and chi-square testing.

Results

During 2020 to 2021, there were 436 applicants to our single OHNS program. From 2019-2020 to 2020-2021, the match rate decreased significantly for groups studied, including: All applicants (72.0% [268/372] to 64.7% [282/436]; P = .025); all US MD Senior applicants (76.5% [254/332] to 68.9% [262/380]; P = .024); and US MD Seniors specifically without a home program (77.5% [31/40] to 56.4% [22/39]; P = .046). The match rate for US MD Seniors with a home program did not change significantly (76.4% [223/292] to 70.4% [240/341]; P = .09). From 2019-2020 to 2020-2021, the proportion of US MD seniors who matched to home-program increased significantly (22.0% [49/223] to 30.0% [72/240]; P = .05).

Conclusion

The COVID-19 pandemic saw high volumes of OHNS applicants with an overall decreased rate of matching compared to previous years. These changes particularly affected applicants without home programs. Home-program matching increased significantly, likely as a consequence of the limitations placed on in-person away experiences including interviews. Laryngoscope, 132:1934-1938, 2022.

OBJECTIVE: Presenting geographic matching trends over 5 match cycles (2016-2020) to serve as a context for changes in residency match outcomes due to the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: Retrospective review. SETTING: Single academic institution-affiliated otolaryngology-head and neck surgery residency program. METHODS: Residency match outcomes for all applicants to our institution (2015-2019) were collected from the National Residency Matching Program, including medical school and matched program. Matches were categorized as home program, home region, or out of region and sorted by US geographic region. Statistical analysis included frequencies, totals, χ2 testing, and binary logistic regression. RESULTS: From 2016 to 2020, the US MD senior match rate was 84.9%: 18.9% to home programs, 35.7% to home region, and 45.3% to out of region. Rates were similar across regions and decreased over time. Westerners matched to home programs more than Southerners or Midwesterners (27.5% vs 16.0% and 16.0%, P < .01). Southerners and Westerners were more likely to match within their regions (South: 63.1%, P = .011, odds ratio [OR] = 1.296, 95% CI, 1.060-1.584; West: 42.0%, P = .018, OR = 1.462, 95% CI, 1.066-2.004). Matching from out of region was more likely in the West and less likely in the South (West: 58.0%, P = .017, OR = 1.379, 95% CI, 1.059-1.796; South: 36.9%, P < .001, OR = 0.584, 95% CI, 0.47-0.727). CONCLUSION: From 2016 to 2020 in otolaryngology-head and neck surgery, about 1 in 5 matches were to home institutions, a trend that appeared to be more common in the West. Over 4 out of 5 trainees match to nonhome programs, and nearly half relocate to a new region for training. Changes to travel, rotations, and interviews due to COVID-19 may influence these trends.

OBJECTIVE: To identify factors associated with cervical-thoracic spine posture in otolaryngology surgeries and evaluate the efficacy of a commercially available posture-training device in enhancing surgeon ergonomics. METHODS: Over 3 months, neck and spine posture from individuals performing otolaryngology surgeries was recorded using UpRight Go 2™. Average baseline posture was first recorded and biofeedback was later introduced to attempt to correct posture. The proportion of time spent in upright/neutral cervical-thoracic spine posture was correlated with surgeon and procedure characteristics and compared to proportion of upright posture time after biofeedback intervention. RESULTS: The proportion of upright operating time was significantly different between procedure subtypes and surgical approaches with best performance in rhinology procedures and worst performance in head and neck surgeries (90% vs. 62%; both p < .001). Female gender, shorter stature, and use of sitting stools were associated with greater proportion of surgery spent upright (all p < .05). Loupes use was associated with less time in upright posture (p < .001). With biofeedback intervention, 8 of 10 subjects demonstrated an average of 5% improvement in operating upright, with most improvement found when performing laryngology procedures (7%) and least improvement in head and neck procedures (2%). CONCLUSIONS: While surgeon posture varies across otolaryngology surgeries, sitting and minimizing the use of loupes may help promote a more ergonomic operating environment and improve surgeon posture. Although the efficacy of biofeedback intervention from a commercially available posture-training device differs among otolaryngologists, exploration of alternative interventions and incorporation of an ergonomics curriculum is warranted to address postural issues experienced by many surgeons. LEVEL OF EVIDENCE: 3.

Objective

To describe the issues related to the assignment of surgical wound classification as it pertains to Otolaryngology-Head & Neck surgery, and to present a simple framework by which providers can assign wound classification.

Data sources

Literature review.

Conclusion

Surgical wound classification in its current state is limited in its utility. It has recently been disregarded by major risk assessment models, likely due to inaccurate and inconsistent reporting by providers and operative staff. However, if data accuracy is improved, this metric may be useful to inform the risk of surgical site infection. In an era of quality-driven care and reimbursement, surgical wound classification may become an equally important indicator of quality.

Objective

During the COVID-19 pandemic, away rotations were suspended for safety purposes. This led to the development of online interactive learning modules for students, now known as virtual sub-internships (VSIs). To date, VSIs within otolaryngology-head and neck surgery (OHNS) have been limited in their description and design.

Study design

Cross-sectional survey.

Setting

ACGME-accredited OHNS residency program.

Methods

Our curriculum for an OHNS VSI is presented. Based on the model used by our OHNS residency program, the VSI consisted of a 2-week block of activities and interactive small-group discussions. A post-VSI feedback survey was distributed to participants; results are reported.

Results

Six 2-week VSI sessions were administered. Twenty-one individuals participated from all US regions, median 4 individuals per session. Fifteen participants (71.4%) completed the feedback survey. Of survey respondents, 20% lacked a home OHNS residency program, and no respondents' home-programs featured a VSI. All respondents were satisfied with the schedule and organization of the VSI, and 73.3% (11 of 15) felt it was of appropriate duration. All respondents reported a high degree of familiarity with the program, with a greater (86.7%) or equal (13.3%) level of interest in applying to the residency program as a result of participating in the VSI.

Conclusion

This VSI curriculum offers a well-received virtual learning experience for medical students applying to OHNS residency. It provides an opportunity for programs to expand their appeal to potential applicants who may otherwise be restricted in their ability to travel.

Background

Envenomation by crotaline snakes (rattlesnake, cottonmouth, copperhead) is a complex, potentially lethal condition affecting thousands of people in the United States each year. Treatment of crotaline envenomation is not standardized, and significant variation in practice exists.

Methods

A geographically diverse panel of experts was convened for the purpose of deriving an evidence-informed unified treatment algorithm. Research staff analyzed the extant medical literature and performed targeted analyses of existing databases to inform specific clinical decisions. A trained external facilitator used modified Delphi and structured consensus methodology to achieve consensus on the final treatment algorithm.

Results

A unified treatment algorithm was produced and endorsed by all nine expert panel members. This algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy.

Conclusions

Clinical manifestations and ideal treatment of crotaline snakebite differ greatly, and can result in severe complications. Using a modified Delphi method, we provide evidence-informed treatment guidelines in an attempt to reduce variation in care and possibly improve clinical outcomes.

Abstract Background Envenomation by crotaline snakes (rattlesnake, cottonmouth, copperhead) is a complex, potentially lethal condition affecting thousands of people in the United States each year. Treatment of crotaline envenomation is not standardized, and significant variation in practice exists. Methods A geographically diverse panel of experts was convened for the purpose of deriving an evidence-informed unified treatment algorithm. Research staff analyzed the extant medical literature and performed targeted analyses of existing databases to inform specific clinical decisions. A trained external facilitator used modified Delphi and structured consensus methodology to achieve consensus on the final treatment algorithm. Results A unified treatment algorithm was produced and endorsed by all nine expert panel members. This algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy. Conclusions Clinical manifestations and ideal treatment of crotaline snakebite differ greatly, and can result in severe complications. Using a modified Delphi method, we provide evidence-informed treatment guidelines in an attempt to reduce variation in care and possibly improve clinical outcomes.

Ciguatera Fish Poisoning (CFP) is the most frequently reported seafood-toxin illness in the world. It causes substantial human health, social, and economic impacts. The illness produces a complex array of gastrointestinal, neurological and neuropsychological, and cardiovascular symptoms, which may last days, weeks, or months. This paper is a general review of CFP including the human health effects of exposure to ciguatoxins (CTXs), diagnosis, human pathophysiology of CFP, treatment, detection of CTXs in fish, epidemiology of the illness, global dimensions, prevention, future directions, and recommendations for clinicians and patients. It updates and expands upon the previous review of CFP published by Friedman et al. (2008) and addresses new insights and relevant emerging global themes such as climate and environmental change, international market issues, and socioeconomic impacts of CFP. It also provides a proposed universal case definition for CFP designed to account for the variability in symptom presentation across different geographic regions. Information that is important but unchanged since the previous review has been reiterated. This article is intended for a broad audience, including resource and fishery managers, commercial and recreational fishers, public health officials, medical professionals, and other interested parties.

The advent of high-resolution magnetic resonance imaging (MRI) has enabled in vivo research in a variety of populations and diseases on the structure and function of hippocampal subfields and subdivisions of the parahippocampal gyrus. Because of the many extant and highly discrepant segmentation protocols, comparing results across studies is difficult. To overcome this barrier, the Hippocampal Subfields Group was formed as an international collaboration with the aim of developing a harmonized protocol for manual segmentation of hippocampal and parahippocampal subregions on high-resolution MRI. In this commentary we discuss the goals for this protocol and the associated key challenges involved in its development. These include differences among existing anatomical reference materials, striking the right balance between reliability of measurements and anatomical validity, and the development of a versatile protocol that can be adopted for the study of populations varying in age and health. The commentary outlines these key challenges, as well as the proposed solution of each, with concrete examples from our working plan. Finally, with two examples, we illustrate how the harmonized protocol, once completed, is expected to impact the field by producing measurements that are quantitatively comparable across labs and by facilitating the synthesis of findings across different studies. © 2016 Wiley Periodicals, Inc.

Objective

An increasing number of human in vivo magnetic resonance imaging (MRI) studies have focused on examining the structure and function of the subfields of the hippocampal formation (the dentate gyrus, CA fields 1-3, and the subiculum) and subregions of the parahippocampal gyrus (entorhinal, perirhinal, and parahippocampal cortices). The ability to interpret the results of such studies and to relate them to each other would be improved if a common standard existed for labeling hippocampal subfields and parahippocampal subregions. Currently, research groups label different subsets of structures and use different rules, landmarks, and cues to define their anatomical extents. This paper characterizes, both qualitatively and quantitatively, the variability in the existing manual segmentation protocols for labeling hippocampal and parahippocampal substructures in MRI, with the goal of guiding subsequent work on developing a harmonized substructure segmentation protocol.

Method

MRI scans of a single healthy adult human subject were acquired both at 3 T and 7 T. Representatives from 21 research groups applied their respective manual segmentation protocols to the MRI modalities of their choice. The resulting set of 21 segmentations was analyzed in a common anatomical space to quantify similarity and identify areas of agreement.

Results

The differences between the 21 protocols include the region within which segmentation is performed, the set of anatomical labels used, and the extents of specific anatomical labels. The greatest overall disagreement among the protocols is at the CA1/subiculum boundary, and disagreement across all structures is greatest in the anterior portion of the hippocampal formation relative to the body and tail.

Conclusions

The combined examination of the 21 protocols in the same dataset suggests possible strategies towards developing a harmonized subfield segmentation protocol and facilitates comparison between published studies.