JAMA otolaryngology-- head & neck surgery
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JAMA Otolaryngol Head Neck Surg · Nov 2014
Observational StudyLong-term outcome of airway stenosis in granulomatosis with polyangiitis (Wegener granulomatosis): an observational study.
Airway stenosis occurs in patients with granulomatosis with polyangiitis (GPA or Wegener granulomatosis). It produces significant morbidity and contributes to mortality. ⋯ The frequency and distribution of airway stenoses in 44 patients with GPA has been described. In the 39 patients who required intervention, multiple procedures were required, but 97% then achieved a prolonged period of airway patency. The procedures and adjuvant treatments were found to be safe. Our experience with a variety of techniques in this rare presentation has permitted design of a structured approach and an algorithm to manage and evaluate airway stenosis in GPA.
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JAMA Otolaryngol Head Neck Surg · Nov 2014
Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology.
Despite increased emphasis on measuring safety outcomes and quality indicators for surgical care, little is known regarding which operative procedures should be prioritized for quality-improvement initiatives in pediatric otolaryngology. ⋯ While the overall rate of major postoperative morbidity in pediatric otolaryngology is low, areas for targeted quality-improvement interventions include tracheostomy, airway reconstruction, mastoidectomy, and abscess drainage. Measurement of outcomes specific to otolaryngologic procedures will be necessary to further identify and measure the impact of quality-improvement initiatives in pediatric otolaryngology.
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JAMA Otolaryngol Head Neck Surg · Oct 2014
Impact of systemic steroids on posttonsillectomy bleeding: analysis of 61 430 patients using a national inpatient database in Japan.
Although postoperative bleeding after tonsillectomy is rare, it is potentially life-threatening. The association between steroid administration and postoperative bleeding remains controversial. The findings of previous studies were limited by small sample sizes. ⋯ Intravenous steroid administration on the day of tonsillectomy in children was an independent risk factor for severe bleeding requiring reoperation.
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Prior to applying or interviewing, most prospective applicants turn to the Internet when evaluating residency programs, making maintenance of a comprehensive website critical. While certain "intangibles" such as reputation may not be communicated effectively online, residency websites are invaluable for conveying other aspects of a program. Prior analyses have reported that certain criteria such as research experience and didactics are important considerations for applicants. ⋯ While further survey of prospective applicants would be invaluable in determining which factors are of greatest interest, many residency websites appear to be inadequately comprehensive. Despite the relative comprehensiveness of criteria relevant to clinical training when compared with other aspects of websites such as incentives, several crucial aspects of training are still not addressed in many sites.
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JAMA Otolaryngol Head Neck Surg · Sep 2014
A chief of service rotation as an alternative approach to pediatric otolaryngology inpatient care.
Maintaining an outpatient practice and providing high-quality inpatient care pose significant challenges to the traditional call team approach. ⋯ The COS program was created to meet the clinical, educational, and organizational demands of a high-volume and high-acuity inpatient service. It is a financially sustainable model with unique advantages, particularly for the staff who maintain their outpatient practices without disruption and for the trainees who have the opportunity to work closely with the entire faculty. Patients are provided supervised evaluations and continuity of care. This rotating hospitalist program is a viable alternative to the full-time hospitalist staff model.