JAMA otolaryngology-- head & neck surgery
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JAMA Otolaryngol Head Neck Surg · Mar 2016
Observational StudyFluorescence Visualization-Guided Surgery for Early-Stage Oral Cancer.
The prevalence of genetically altered cells in oral cancers has a negative influence on the locoregional recurrence rate and lowers survival. Fluorescence visualization (FV) can identify clinically occult, high-risk oral lesions by allowing health care professionals and surgeons to visualize and map occult disease. This process may improve overall survival by decreasing rates of locoregional recurrence. ⋯ In this study, the use of FV as part of the surgical margin decision process significantly reduced the rate of local recurrence in preinvasive high-grade and early-stage oral cancers. An ongoing multicenter, phase 3, randomized surgical trial has completed accrual, and the data will be used to validate the results of this study.
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JAMA Otolaryngol Head Neck Surg · Mar 2016
Association of Fellowship Training With Otolaryngology Training Examination Scores.
No prior studies have evaluated whether residents who pursue fellowship training achieve higher performance on the Otolaryngology Training Examination (OTE) and whether a specific fellowship will demonstrate a correlation with the corresponding specialty-specific OTE score. ⋯ Residents who pursued fellowship training did not achieve higher scores on the OTE in any examination year compared with residents who did not pursue fellowship training and did not achieve higher scores within the OTE section that matched their chosen subspecialty in their last year of training. Fellowship choice does not appear to influence OTE scores among residents.
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JAMA Otolaryngol Head Neck Surg · Feb 2016
Inpatient Nursing and Parental Comfort in Managing Pediatric Tracheostomy Care and Emergencies.
Tracheostomy is a critical and often life-saving intervention, but associated risks are not negligible. The vulnerability of the pediatric population underlies the importance of caregiver comfort and competence in tracheostomy care. ⋯ Nurses' comfort with tracheostomy was higher among nurses with at least 5 years' experience and primary ICU location. Whereas parental comfort with tracheostomy care was high, lack of consistent instruction highlights the role for standardized education in tracheostomy care.
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JAMA Otolaryngol Head Neck Surg · Feb 2016
Use of Bronchoscopy in Percutaneous Dilational Tracheostomy.
A modified percutaneous dilational tracheostomy (PDT) is a relatively new alternative method of performing PDTs in which tissues overlying the trachea are dissected, but needle entry is still performed blindly. Many centers use bronchoscopy-assisted PDT, but the necessity of bronchoscope assistance for modified PDTs has not been examined. Discontinuing bronchoscopy for this procedure could potentially decrease cost and increase efficiency with similar outcomes compared with bronchoscopy-assisted PDT. ⋯ Percutaneous dilational tracheostomy can be performed with similarly low complication rates with or without the use of bronchoscopy. Discontinuing the use of bronchoscopy in these procedures appears to be a safe, cost-effective alternative with reassuring outcomes and low complication rates.
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JAMA Otolaryngol Head Neck Surg · Jan 2016
Assessment of Vocal Fold Function Using Transcutaneous Laryngeal Ultrasonography and Flexible Laryngoscopy.
Evaluation of preoperative and postoperative vocal fold function is important in patients undergoing thyroid or parathyroid surgical procedures. Transcutaneous laryngeal ultrasonography (TLUSG) has been proposed as a promising noninvasive technique and alternative to flexible fiberoptic laryngoscopy. ⋯ When evaluation of vocal fold function is indicated in patients undergoing thyroid and parathyroid surgery, TLUSG should not be considered as an alternative to the current practice of flexible fiberoptic laryngoscopy. Adequate ultrasonographic visualization of the vocal folds and arytenoids is challenging, especially in overweight and obese patients and in the postoperative setting.