The Laryngoscope
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Healthcare remunerating agencies in North America require patients with obstructive sleep apnea (OSA) to undergo a continuous positive airway pressure (CPAP) trial before funding surgical therapy. The adherence rate of CPAP is problematic. This study's objective was to determine the proportion of surgically favorable patients who failed CPAP who subsequently benefitted from surgical therapy, and to explore consideration of surgical therapy as first-line treatment in this specific OSA subpopulation. ⋯ 2 Laryngoscope 124:S1-S9, 2014.
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Randomized Controlled Trial Comparative Study
Long-term effects of repetitive transcranial magnetic stimulation in unilateral tinnitus.
We investigated the long-term effects of repetitive transcranial magnetic stimulation (rTMS) delivered to the temporoparietal junction and compared contralateral and ipsilateral application in patients with unilateral tinnitus. ⋯ Daily application of 1-Hz rTMS to the temporoparietal area is safe and has long-term beneficial effects. The laterality of stimulation is not the decisive factor.
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Randomized Controlled Trial
A randomized controlled trial of nasolaryngoscopy training techniques.
Flexible nasolaryngoscopy is an essential skill for otolaryngology trainees to develop, but there is a lack of standardized training for this procedure. The aim of this study was to assess whether using training on a realistic human mannequin together with structured video feedback improved trainees' performance at flexible nasolaryngoscopy. ⋯ Simulation-based training using an anatomically correct model of the upper airway together with formalized video-assisted feedback on that training is a simple and effective way to improve endoscopy skills prior to starting flexible nasolaryngoscopy on patients.
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Quantitative evaluation of phonomicrosurgical manipulations using a magnetic motion tracking system.
To present and evaluate the magnetic-based phonomicrosurgery instrument tracking system, a novel and objective method of acquiring instrument position data during simulated phonomicrosurgery. The position data can be used to compute quantitative motion metrics. This system was used to objectively evaluate the motion performance of novice and expert surgeons during phonomicrosurgical simulations and determine the differences between these groups. ⋯ Parameters derived from magnetic-based motion tracking were able to differentiate between expert and novice surgeons. These parameters have the potential to be used in phonomicrosurgical training as feedback to enhance the training process.
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Comparative Study
Financial incentive of home continuous positive airway pressure machine use in the inpatient hospital setting.
Obstructive sleep apnea (OSA) is increasingly recognized as a significant factor in perioperative and inpatient health. Because of this, hospitalized OSA patients are encouraged to utilize continuous positive airway pressure (CPAP) therapy while inpatients. We investigated the cost difference of patient-owned versus hospital-provided CPAP machine use by admitted adult patients with OSA. ⋯ This is the first study to characterize the magnitude of cost savings from utilization of home versus hospital-provided CPAP machines in patients requiring inpatient CPAP machine use. The use of patient-owned CPAP machines may reflect an opportunity to provide cheaper care while maintaining high patient safety and quality care. The actual economic impact to an individual hospital would vary based on the insurance payer mix.