European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
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Eur Arch Otorhinolaryngol · Jan 2009
A new indicator-guided percutaneous emergency cricothyrotomy device: in vivo study in man.
There is presently no ideal method of securing an airway during acute upper airway obstruction. A new cricothyrotomy device has been developed, which has theoretical advantages. The goal of this clinical study in a head and neck cancer centre was to assess the safety of the device in man. ⋯ Two were performed by doctors who had received a limited explanation of the technique and it did not achieve a secure airway. With adequate prior training, this new cricothyrotomy procedure achieves a secure airway quickly with little trauma. This study supports the use of the new cricothyrotomy device by trained staff, but prospective audit of its application in real trauma settings is required.
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Eur Arch Otorhinolaryngol · Jan 2009
Are trainees being adequately taught myringoplasty? A prospective study of Eastern Deanery otolaryngology trainees' surgical experience.
Reviewing surgical training is an important function of a modern ENT unit, even more so following recent reform of postgraduate medical training in the UK. We have developed a tool to review otology training of Eastern Deanery trainees by constructing a middle ear surgery data base and use a commonly performed procedure, myringoplasty, to illustrate its function. ⋯ Trainees at all stages of training are being exposed to myringoplasty with an adequate de-escalation of supervision. Myringoplasty outcomes are independent of seniority, if appropriately supervised, implying that otology training in the Eastern Deanery is appropriate.
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With the exception of distant metastases, the presence of lymph node metastasis in the neck is accepted as the single most important adverse independent prognostic factor and an indicator of survival in squamous carcinoma of the head and neck. Neck dissection in its various forms is the standard surgical treatment for clinical, subclinical and subpathologic metastatic cancer to the neck. The pertinent literature from the beginning of the nineteenth century to the middle of the twentieth century was reviewed. ⋯ The greatest impetus to the status of this surgical procedure came from Martin and colleagues, who published a monumental report in 1951 of 1,450 cases that established the place and technique of radical neck dissection in the modern treatment of head and neck cancer. Neck dissection, for treatment of cervical lymph node metastases in head and neck cancer, was conceived and attempted in the nineteenth century, with some limited success reported by the end of that era. An effective operation was described and reported in the early twentieth century and evolved by the mid century into a fundamental tool in the management of patients with head and neck cancer.
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Ear nose and throat oral and maxillofacial surgery service provision is undergoing major changes within the United Kingdom Healthcare System (NHS) with devolution of many treatments to primary care. Epistaxis, active bleeding from the nose, is a common ear nose and throat/oral and maxillofacial surgery emergency, and can be severe or even fatal. The causes can be from local or systemic illnesses. ⋯ This is a change to the current standard UK management. We discuss the case for and against the adoption of this policy by the main healthcare components (primary and secondary) of the NHS. We present an economic argument.
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Eur Arch Otorhinolaryngol · Sep 2008
Using information technology to reduce the inappropriate use of surgical prophylactic antibiotic.
Despite implementation of practical guidelines, continuing education programs in our hospital, the percentage of inappropriate prophylactic antibiotic usage remains high. The aim of this study was to investigate whether information technology can reduce the misuse of surgical prophylactic antibiotic. We started physician continuing education programs in January 2005 and initiated feedback system in July 2005. ⋯ In parotidectomy, submandibular gland surgery and thyroidectomy patients, the percentage even reached 100% at the end of this study. In clean-contaminated procedures, the duration of prophylactic antibiotic after surgery was also reduced except in laryngectomized patients at the end of this study. Information technology such as feedback and reminder systems is an effective method to reduce inappropriate usage of surgical prophylactic antibiotic.