Social distancing guidelines during the coronavirus disease 2019 (COVID-19) pandemic have created substantial changes in undergraduate medical education in the United States. Specifically, the Coalition for Physician Accountability recommended that all programs transition to online interviews and visits for the 2020-21 application cycle. Current literature lacks concrete recommendations with visual examples for how interviewees should best prepare their interview rooms. The authors present cost-conscious recommendations addressing three main areas: the interview room background/environment, audiovisual quality, and virtual interview etiquette, while providing two before and after intervention photographs. Through optimization of these three domains, applicants can present the best versions of themselves during virtual residency interviews.
As the magnitude of the opioid epidemic grew in recent years, individual states across the United States of America enacted myriad policies to address its complications. We conducted a qualitative examination of the structure, successes, and challenges of enacted state laws and policies aimed at the opioid epidemic, with an in-depth focus on prescription drug monitoring programs (PDMPs) and naloxone access efforts.A set of 10 states (Florida, Kentucky, Massachusetts, Michigan, Missouri, New York, North Carolina, Tennessee, Washington, and West Virginia) was chosen a priori to achieve a varied sample of state policies and timing, as well as population opioid complications. Archival research was conducted to identify state-level policies aimed at the opioid epidemic and semi-structured interviews were conducted with 31 key stakeholders between March and September 2016.The most frequently mentioned key to success was an identifiable champion instrumental in leading the passage of these policies. The lack of a unified legislature and physician pushback were challenges many states faced in implementing policies.Champion-led task forces, stakeholders' personal stories garnering buy-in, ongoing education and feedback to PDMP users, and inclusive stakeholder engagement are critical aspects of passing and implementing state policies aimed at combating the opioid epidemic. Engaging all interested stakeholders and providing continuing feedback are ongoing challenges in all states. Leveraging stakeholders' personal stories of how opioids affected their lives helped propel state efforts.
Objectives/Hypothesis The expiratory disproportion index (EDI) is the ratio of forced expiratory volume in 1 second divided by peak expiratory flow rate multiplied by 100. An elevated EDI (>50) can help differentiate upper airway stenosis from other dyspnea etiologies, but this has not been verified when considering body habitus. We hypothesize that the predictive value of elevated EDI in diagnosing airway stenosis will be lower in obese patients as compared to nonobese patients. Study Design Retrospective cohort study. Methods Patients >18 years old with recorded pulmonary function test values, body mass index (BMI), and airway imaging were reviewed retrospectively from January 2011 to October 2018. EDI was recorded for four cohorts: nonobese and nonstenotic, obese and nonstenotic, nonobese and stenotic, and obese and stenotic, to determine the mean EDI and the sensitivity and specificity of an elevated EDI. Results Mean EDI values were 66.53 ± 17.66 and 49.55 ± 2.04 in the nonobese stenotic and nonstenotic groups, respectively (P < .01). They were 58.00 ± 10.79 and 45.02 ± 1.42 in the obese stenotic and nonstenotic groups, respectively (P < .01). At a threshold of >50, EDI had a sensitivity of 83.3% and specificity of 56.2% in differentiating between stenotic and nonstenotic cases in the nonobese cohort and 50.0% and 71.9% in the obese cohort. Conclusions As previously established, mean EDI values were significantly different in stenotic and nonstenotic patients in both BMI cohorts. However, at the established threshold of >50, EDI was not as sensitive at identifying stenotic cases in obese patients as in nonobese patients. This suggests that the EDI remains useful in obese patients when elevated but should not be relied upon to rule out stenosis. Level of Evidence 4 Laryngoscope, 131:606–609, 2021
Objectives: To determine whether patients undergoing in-office laryngologic procedures on antithrombotic therapy are at increased risk for treatment-related complications. Methods: Patients were those who underwent at least one in-office laryngologic procedure with any of three fellowship-trained laryngologists. Procedures were identified by current procedural terminology (CPT) code and included biopsies, excisions, laser ablations, and injections (therapeutic and augmentative). Patients were divided into two groups based on the use of antithrombotic therapy at the time of their procedure. Retrospective chart review was performed to identify any complications, with an average follow-up of 186 days. Results: Five hundred-sixty-four unique individuals were identified with ages ranging from 18 to 93 years old and with a relatively even distribution between females (45%) and males (55%). They underwent 647 procedures in total, 310 of which were performed while on some form of antithrombotic therapy. Sixteen procedures were associated with complications either during or after the procedure. In comparing overall complication rates, there was no significant difference between nonantithrombotic (2.4%) and antithrombotic (3.3%) cohorts (OR 1.09, 95% CI [0.46-2.60], P = .8454). Conclusions: In spite of known risks in other settings, antithrombotic agents do not appear to confer increased risk of treatment-related complications during in-office laryngologic procedures, obviating the need for cessation of therapy prior to these interventions.
Objectives: The Airway Alert banner at our institution alerts physicians to patients with the potential for a difficult intubation. Difficult airway guidelines can reduce intubation complications in the operating room, but little research has been done in the emergency department (ED). We hypothesize that patients meeting criteria for the banner will have a more difficult intubation and increased complications.Methods: Patients greater than 18 years old who presented to the ED for any complaint and required intubation were reviewed from January 2015 to January 2020 and divided into those meeting criteria for a difficult airway ("criteria cohort") and those who did not ("non-criteria cohort"). Past medical history and details of the intubation were collected. Results:The mean number of attempts for intubation was 1.60 in the criteria cohort and 1.36 in the non-criteria cohort (P > .05). The mean grade of view was 1.73 and 1.39, respectively (P < .05). The average size of endotracheal tube was 7.50 and 7.74 in the criteria and non-criteria cohorts (P < .05). The use of adjuncts was 28.6% and 12.5%, respectively (P < .01). The average number of intubation attempts and complication rate did not differ significantly.Conclusions: Intubations in patients meeting criteria for the banner are associated with a more difficult view, use of smaller endotracheal tube, and increased use of adjuncts, but not with a significantly higher rate of complications or attempts. Physicians should prepare with additional endotracheal tube sizes, adjuncts, and a plan for secondary strategies in these patients.
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