Objectives: To create an otolaryngology-specific needs assessment tool for shortterm global surgical trips and to describe our findings from its implementation.Methods: Surveys 1 and 2 were developed based on a literature review and disseminated to Low-Middle Income (LMIC) hosting institutions in Kenya and Ethiopia and to High-Income surgical trip participants (HIC), respectively. Respondents were otolaryngologists identified online, through professional organizations, and by word-ofmouth, who had participated in a surgical trip of <4 weeks.Results: HIC and LMIC respondents shared similar goals of expanding host surgical skills through education and training while building sustainable partnerships. Discrepancies were identified between LMIC desired surgical skills and supply needs and HIC current practices. Microvascular reconstruction (17.6%), advanced otologic surgery (17.6%), and FESS (14.7%) were most desired skills and high-demand equipment needs were FESS sets (89%), endoscopes (78%), and surgical drills (56%). Frequently taught techniques included advanced otologic surgery (36.6%), congenital anomaly surgery (14.6%), and FESS (14.6%) with the largest gap between LMIC-need and HIC-offerings being in microvascular reconstruction (17.6% vs. 0%). We also highlight the discrepancy in expectations of responsibility for trip logistics, research, and patient follow-up. Conclusion:We created and implemented the first otolaryngology-specific needs assessment tool in the literature. With its implementation in Ethiopia and Kenya, we were able to identify unmet needs as well as attitudes and perceptions of LMIC and HIC participants. This tool may be adapted and utilized to assess specific needs, resources, and goals of both host and visiting teams to facilitate successful global partnerships.
ObjectiveThe purpose of this study is to identify existing literature on recurrent atypical mycobacterial cervicofacial lymphadenitis to augment our understanding of a unique patient who presented to our tertiary‐care center 5‐years posttreatment with recurrence following curettage.Data SourcesOVID Medline, Scopus, and Web of Science.MethodsA literature search was conducted yielding 49 original articles which were screened twice by two independent reviewers resulting in 14 studies meeting inclusion criteria for data extraction using Covidence software. Two independent reviewers extracted data on recurrence of atypical mycobacterial cervicofacial lymphadenitis and consensus was reached on data points from all included studies.ResultsThis study illuminated the paucity of recurrence reporting in the literature regarding atypical mycobacterial lymphadenitis. Sixteen studies identified in our review included discussions on recurrence with few elaborating beyond the rate of recurrence to describe their management. Fourteen out of sixteen studies provided recurrence rates for their cohort, 11 out of 14 specified the initial treatment modality, and only five out of eight studies that described initial treatment with surgery differentiated recurrence rates between complete and incomplete excision. The mean length of follow‐up in the included studies was 20 months. There was one previously reported case of late recurrence at 5‐years.ConclusionsWe identified few reports that discussed the management of recurrence of atypical mycobacterial cervicofacial lymphadenitis. There was minimal data on recurrence rates between surgical treatment modalities. The case discussed in our study showcases that treatment with curettage has the potential to present with late recurrence.
Introduction Pediatric burns are typically accidental, but burns caused by caregiver abuse/neglect represent a significant proportion of patients. Literature on risk factors most associated with these injuries include younger age, male, African American, and larger burns. This study examined child and burn injury factors that were associated with Child Protective Services (CPS) involvement at an urban, academic children’s hospital. Methods At this institution, decision to report a burn patient to CPS is determined by a multi-disciplinary medical team. Criteria for referral is multifactorial and may include burn patterns consistent with forced immersion, a reported mechanism that does not match the burn pattern or the patient’s developmental capabilities, concern for lack of supervision, or a delay in seeking medical care. Data from inpatient admissions over a 3-year period (July 2016 – June 2019) were extracted from hospital charts, and analyses (chi-square, t-tests) examined age, sex, total body surface area (TBSA), burn severity, length of stay, insurance type, race/ethnicity, and whether a CPS report was made (i.e., yes/no). Records for the outcome and disposition of the CPS case, such as whether the CPS investigation confirmed the abuse/neglect allegations, were not readily available as the law requires confidentiality. Results 389 children were admitted for burn treatment. 80% had partial-thickness burns; 33% White, 43% Black, 62% male; 10% had CPS involvement. 72% had Medicaid/other government insurance, 23% had private/commercial, 4% were uncovered, and 1% insurance status unknown. Medicaid/government insurance was overrepresented among burns compared to other inpatients at the hospital (72% vs 51%). Consistent with previous findings, CPS reports involved children who were younger (2.8 vs 4.8 years), had greater TBSA (8.4% vs 4.9%), and had longer admissions (7.5 vs 3.0 days). Children with Medicaid/governmental or no insurance were more likely to have CPS reports than commercial/private insurance (97% vs 3%). Importantly, contrary to prior findings, child sex, child ethnicity, and burn thickness were not significantly different between children with and without CPS reports. Conclusions Younger children with bigger burns and longer admissions were most associated with CPS involvement. Historical findings on risk factors of male sex, African American ethnicity, and greater burn thickness were not replicated. Prior literature may not be generalizable to many settings; the current study provides an important update. Further research is needed to examine outcomes of CPS involvement and long-term patient health outcomes. Findings are limited to only urban, inpatient pediatric burns.
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