Blog Archive

Αλέξανδρος Γ. Σφακιανάκης

Monday, November 22, 2021

Honesty and Transparency, Indispensable to the Clinical Mission—Part I

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At the foundation of clinical medicine is the relationship among patients, families, and health care professionals. Implicit to that social contract, professionals pledge to bring clinical excellence to advance their patients' wellness and healing—and to prevent harm. Patients trust that those privileged to deliver care will do so unwaveringly in service of patients' best interests; however, the incentives and infrastructure surrounding health care delivery can promote or undermine individual performance, teamwork, and patient safety. Modeling professionalism and identifying slips and lapses supports pursuit of high reliability. Part 1, Promoting Professionalism, introduces the first of 3 pillars of advancing the clinical mission.
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The Value of Diversity, Equity, and Inclusion in Otolaryngology

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Diversity impacts performance of our teams, fosters innovation, and improves outcomes of our patients in otolaryngology head and neck surgery. In addition to the moral imperative, increasing the otolaryngology diversity workforce will decrease health care disparities while equity and justice can increase the culture humility to take care of an increasingly diverse patient population. To move toward justice, otolaryngology departments need to end biases in faculty hiring, development, research evaluations, and publication practices. The more intentional our efforts, the more benefit to our patients, providers, staff, learners, and society.
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Honesty and Transparency, Indispensable to the Clinical Mission—Part III

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The hidden epidemic of burnout exacts a staggering toll on professionals and patients, reflected in increased risk of medical errors, complications, and staff turnover. For surgeons, nurses, and other team members working at the sharp end of care, adverse events can amplify work exhaustion, interpersonal disengagement, and risk of moral adversity. Visionary leaders are not content to mitigate burnout and moral injury; they elevate the human experience throughout health care by modeling wellness, fostering moral courage, promoting safety of professionals, and restoring joy in work. Part 3, Health Professional Wellness and Resilience, introduces the final pillar for advancing the clinical mission.
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“Business” Is not a Four-Letter Word

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Remember back to when you decided you wanted to be a physician? You made the conscious decision to study instead of going out, to spend your weekends and evenings buried in books and memorization, maybe even foregoing that really interesting humanities course because you had to "ace" organic chemistry. You did this because you wanted to be a doctor to help people and make a difference in this world, and that's what you told your medical school interviewers. Me, too. Not one of us said, "I want to be a doctor and make sure I run my business profitably so that I can pay my staff and myself fairly and stay in business to continue to help more patients and provide for my family and retire comfortably." Likewise, our curricula in medical school were rich in basic and clinical sciences, and more recently in ethics and communication, but, all along training, information continues to be sparse regarding business basics, employment and insurance negotiations, the intricacies o f human resource management, billing, coding and getting paid, what to do in case you are sued, and how to plan for your and your family's financial future.
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The log odds of positive neck lymph nodes is a superior lymph node predictor for overall survival in head and neck cancer: a population-based analysis in Germany

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Eur Arch Otorhinolaryngol. 2021 Nov 22. doi: 10.1007/s00405-021-07176-8. Online ahead of print.

ABSTRACT

BACKGROUND: This population-based study investigated the influence of different lymph node (LN) classifications on overall survival (OS) in head and neck cancer (HNC).

METHODS: 401 patients (median age: 57 years; 47% stage IV) of the Thuringian cancer registries with diagnosis of a primary HNC receiving a neck dissection (ND) in 2009 and 2010 were included. OS was assessed in relation to total number of LN removed, number of positive LN, LN ratio, and log odds of positive LN (LODDS).

RESULTS: Mean number of LODDS was 0-0.96 ± 0.57. When limiting the multivariate analysis to TNM stage, only the UICC staging (stage IV: HR 9.218; 95% CI 2.721-31.224; p < 0.001) and LODDS > - 1.0 (HR 2.120; 95% CI 1.129-3.982; p = 0.019) were independently associated with lower OS.

CONCLUSION: LODDS was an independent and superi or predictor for OS in HNC in a population-based setting with representative real-life data.

PMID:34807283 | DOI:10.1007/s00405-021-07176-8

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The log odds of positive neck lymph nodes is a superior lymph node predictor for overall survival in head and neck cancer: a population-based analysis in Germany

xlomafota13 shared this article with you from Inoreader

Eur Arch Otorhinolaryngol. 2021 Nov 22. doi: 10.1007/s00405-021-07176-8. Online ahead of print.

ABSTRACT

BACKGROUND: This population-based study investigated the influence of different lymph node (LN) classifications on overall survival (OS) in head and neck cancer (HNC).

METHODS: 401 patients (median age: 57 years; 47% stage IV) of the Thuringian cancer registries with diagnosis of a primary HNC receiving a neck dissection (ND) in 2009 and 2010 were included. OS was assessed in relation to total number of LN removed, number of positive LN, LN ratio, and log odds of positive LN (LODDS).

RESULTS: Mean number of LODDS was 0-0.96 ± 0.57. When limiting the multivariate analysis to TNM stage, only the UICC staging (stage IV: HR 9.218; 95% CI 2.721-31.224; p < 0.001) and LODDS > - 1.0 (HR 2.120; 95% CI 1.129-3.982; p = 0.019) were independently associated with lower OS.

CONCLUSION: LODDS was an independent and superi or predictor for OS in HNC in a population-based setting with representative real-life data.

PMID:34807283 | DOI:10.1007/s00405-021-07176-8

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A multicentre retrospective cohort study on COVID-19-related physical interventions and adult hospital admissions for ENT infections

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Eur Arch Otorhinolaryngol. 2021 Nov 22. doi: 10.1007/s00405-021-07180-y. Online ahead of print.

ABSTRACT

PURPOSE: To report changes in adult hospital admission rates for acute ENT infections following the introduction of COVID-19-related physical interventions such as hand washing, use of face masks and social distancing of 2-m in the United Kingdom.

METHODS: Retrospective cohort study comparing adult admissions with acute tonsillitis, peritonsillar abscess, epiglottitis, glandular fever, peri-orbital cellulitis, acute otitis media, acute mastoiditis, retropharyngeal abscess and parapharyngeal abscess in the 1-year period after the introduction of COVID-related physical interventions (2020-2021) with a 1-year period before this (2019-2020) in three UK secondary care ENT departments.

RESULTS: In total, there were significantly fewer admissions for ENT infections (n = 1073, 57.56%, p < 0.001; RR 2.36, 95% CI [2.17, 2.56]) in the 2020-2021 period than in the 2019-2020 period. There were significant reductions in admissions for tonsillitis (64.4%; p < 0.001), peritonsillar abscess (60.68%; p < 0.001), epiglottitis (66.67%; p < 0.001), glandular fever (38.79%; p = 0.001), acute otitis media (26.85%; p = 0.01) and retropharyngeal and/or parapharyngeal abscesses (45.45%; p = 0.04).

CONCLUSION: Our study demonstrates a sizeable reduction in adult admissions for ENT infections since the introduction of COVID-19-related physical interventions. There is evidence to support the use of physical interventions in the prevention of viral transmission of respiratory disease. Preventing ENT infections requiring admission through simple physical interventions could be of great benefit to the quality of life of patients and economical benefit to healthcare systems.

PMID:34807284 | DOI:10.1007/s00405-021-07180-y

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