Are Duty Hour Restrictions Making Residents Feel Better or Worse?

By Evan J. Propst, MD, MSc, FRCSC co-author of Airway Reconstruction Surgical Dissection Manual

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated an 80 hour work week limit for residents. In 2011, this same body mandated a 16 hour shift limit for first year residents. Both of these mandates were introduced to reduce resident fatigue with an eye towards improving patient safety, resident education and resident wellbeing. These regulations are enforced throughout the US and institutions can be fined if residents are found to be working beyond these duty hour restrictions. Continue reading

Plural’s book donation helps stock library in India

We are proud to announce the inauguration of the Sadanand Singh Library at the Madras ENT Research Foundation (MERF) in Chennai, India. Plural’s donation of books helped stock the new library’s shelves and Plural’s President, Angie Singh, attended the dedication ceremony on December 7 in India.

MERF library dedication

Dr. Mohan Kameshwaran and his wife Mrs. Indira Kameshwaran (pictured with Angie Singh) established the Institute with a clear and determined vision to create a world class institute providing quality education and training to professionals in the field of Audiology and Speech Language Pathology. It is Plural’s hope that our contribution to this library will help further the study and training of India’s future audiologists and speech-language pathologists.

Angie with institute founders

In addition to the library dedication, the event also celebrated the launch of the first CE-approved, software-based app that combines hearing aid and music player with hearing loss compensation in a mobile phone. MERF and Jacoti, Belgium-based hearing technology company, have come up with the mobile app called Jacoti Listen App that can be downloaded for Rs 500.

Feature Article: Toward a More Effective Collaboration

Toward a More Effective Collaboration by Aaron Fletcher, MD

2doctorsAs a discipline Otolaryngology has long recognized the benefits and virtues of a collaborative model of healthcare delivery. In fact, I believe that few other medical specialties collaborate as frequently and as effectively as Otolaryngologists—it is an integral part of our culture. On a daily basis, we are called to collaborate with specialists of diverse expertise (Audiologists, Speech and Language Pathologists, Neurosurgeons, Radiologists, Radiation Oncologist, Medical Oncologists and so on). In consulting these experts, we recognize the knowledge of these specialists as complimentary to our own and no less valuable. In fact, we frequently congregate in multi-disciplinary conferences where everyone has a say, and everyone’s opinion counts.

As our specialty embarks upon a changing healthcare landscape, we are constantly challenged to evolve our collaborative process in order to keep pace with the expanding application of technology across healthcare.This collaborative spirit is one of the major reasons that I enjoy this specialty. One of the things I appreciate most about Otolaryngology is the opportunity to learn the subtle nuances of a diagnostic finding, condition or technique that are afforded by colleagues and other members of the treatment team.  Throughout my very young career, I’ve found that better collaboration invariably leads to better care and that to be successful; collaboration requires shared vision, values, risks, resources, and rewards regardless of function, occupation or level of training. This is truly what collaborative care is all about.

communicationThe ubiquity of internet access via mobile devices and smartphones, along with the rise of social media has changed the way in which health care information is distributed and consumed. This factor has allowed patients ample access to information about their health conditions and associated treatment options. A recent Pew Internet research study found that one in three adults have turned to online sources to figure out a medical condition that they or someone else they know might have1. Combining these internet resources with expanded mobile network technology means that patients are increasingly capable of seeking answers to their healthcare questions instantaneously. This means that patients are now empowered to become more active participants in their care, and this is certainly a good thing.

On the other hand, these factors also exert pressure upon caregivers to keep pace with these changes in health related information consumption by increasing technological sophistication and improving their own access to medical knowledge. By doing so, we are better suited to meet the demands of a patient population that is better equipped to make important healthcare

As the application of technology across the healthcare landscape has led to a greater sense of empowerment among patients, advancements in health IT, (including electronic health records, cloud computing and health information exchange platforms), also hold great promise for clinicians. The advent of these tools has empowered clinicians to mobilize and share clinical information with members of the treatment team at any time and from any location with internet access. Given the intrinsic collaborative nature of our field, it makes perfect sense that we leverage these technologies to expand our approach to coordinating collaborative care. HIPPA compliant hosting and file sharing networks are now working to mitigate the risk of exchanging protected health information (PHI) via the web and mobile devices. These networks work to encrypt PHI both in storage and in-transit, thereby providing a layer of protection against breaches in security. While these platforms should be used with caution to ensure compliance with HIPPA regulations, as these tools continue to evolve, they will create new opportunities for collaboration and partnership across traditional institutional and geographic boundaries.

Naturally, I believe that Otolaryngologists should be at the forefront of integrating these tools into clinical practice, as we continue to seek new ways of perfecting collaborative care.  I believe ubiquitous data accessibility and sharing (cloud computing) coupled with HIPPA-compliant hosting platforms have the ability not only to facilitate, but to enhance the way we collaborate. Using these tools we can share best practices and treatment protocols, coordinate video conferences with colleagues outside our geographic area, and obtain outside expertise about challenging cases. These tools also allow us to interface with patients about their care, and to provide them a portal to share relevant updates on their condition from the comfort of their home. All of these efforts are critical to the long-term success of our collaborative efforts as a specialty, and familiarity with the tools by which we accomplish these aims is imperative.

So as we embark upon a continually evolving paradigm of healthcare consumption and delivery, we must continue in the spirit of collaboration, and seek out the new tools of our trade.  By doing so, we can continue to demonstrate that better collaboration leads to better care.

References:

1.            Fox, Susannah, Duggan, Maeve: Health Online 2013. Accessed online via http://  pewinternet.org/Reports/2013/Health-online.aspx

 

Dr. Fletcher is the author of the just-published Comprehensive Otolaryngology Review: A Case-Based Approach Fletcher_COR

Oral, Head and Neck Cancer Awareness Week

Oral, Head & Neck Cancer Awareness Week

Oral, Head and Neck Cancer Awareness Week®

The 16th Annual Oral, Head and Neck Cancer Awareness Week® (OHANCAW), sponsored by the Head and Neck Cancer Alliance, is scheduled for April 14-20, 2013. OHANCAW is a weeklong series of events promoting awareness of oral, head, and neck cancer, highlighted by a day of free oral cancer screenings throughout the United States.

According to a brand new Harris Interactive survey, 71 percent of Americans say they have not been examined by a medical professional for oral, head, and neck cancer. Given the rise in oral cancers related to human papillomavirus (HPV), screening for early detection of this disease is more than important than ever. The Academy is urging you to participate by conducting a free screening at your medical practice, clinic, hospital or medical university. To find screening locations in your area, please visit the Head and Neck Cancer Alliance website, www.OHANCAW.com for more information.

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Our Featured Titles

Head and neck cancer is often easily treatable if detected early, but often it is not. For Oral, Head and Neck Cancer Awareness Week we are featuring a few of our related titles. These selected books comprehensively address diagnosis, treatment and patient rehabilitation of head and neck cancers.

Cutaneous Malignancy of the Head and NeckCutaneous Malignancy of the Head and Neck: A Multidisciplinary Approach

Randal Weber, MD, FACS, Brian Moore, MD, FACS

For the first time, a true multidisciplinary approach to cutaneous malignancy of the head and neck is presented, as international experts in head and neck surgical oncology, dermatology, Mohs micrographic surgery, plastic and reconstructive surgery, radiation oncology, and medical oncology present state-of-the-art techniques and promising horizons in the treatment of cutaneous malignancy of the head and neck. Whether in primary care or a specialty practice, this text should prove invaluable to any practitioner who treats patients with skin cancer of the head and neck. This is the only textbook on this subject that comprehensively addresses patient management – from diagnosis, treatment (in all forms, including chemotherapy and radiation), and reconstruction.

 

Practical Head and Neck OncologyPractical Head and Neck Oncology

Edited by: Guy Petruzzelli, M.D., P.h.D.

Otolaryngologists-head and neck surgeons, plastic/reconstructive and oral/maxillofacial surgeons, radiation and medical oncologists, and other clinicians interested in caring for patients with tumors of the head and neck will find this text to be a concise resource providing critical and useful information for the systematic and efficient evaluation, diagnosis, and comprehensive treatment planning and monitoring therapy for patients with malignant head and neck tumors. Bringing together experts in the management of patients with malignant tumors of the upper aerodigestive tract, students and residents will find this text an excellent reference for preparing to care for these challenging and fascinating patients.

 

Head and Neck UltrasonographyHead and Neck Ultrasonography

Edited by: Lisa Orloff, M.D.

Beautifully illustrated in full-color, Head and Neck Ultrasonography is regarded as the first, as well as the definitive, English-language textbook of head and neck ultrasonography by and for clinicians and surgeons. This book comprehensively and effectively addresses fundamentals of ultrasound physics, equipment, normal head and neck ultrasound anatomy, and technique. Individual chapters cover specific anatomy and pathology. Interventional ultrasonography and dynamic ultra-sonography is discussed and new directions and techniques in ultrasonography are presented. Head and Neck Ultrasonography is unique in both its thoroughness and in its relevance to the clinical setting, where ultrasonographic examination is a dynamic and interactive process between physician and patient. In addition to numerous valuable examples of still ultrasound images throughout the text, a CD-ROM with video clips illustrating both the process and the interpretation of specific examinations and procedures is provided with the text.

 

Head and Neck CancerHead and Neck Cancer: Treatment, Rehabilitation, and Outcomes

Elizabeth Ward, Ph.D., Corina van As Brooks, Ph.D.

A team of expert authors from the medical and allied health communities describe recent advances in the management of head and neck cancer through a greater understanding of cancer cell growth and mechanisms, as well as the expansion of rehabilitation strategies across the allied health profession. In addition to introducing new information, the book covers both the theoretical and clinical knowledge from an international perspective to support basic training of therapists in practice as well as graduate students, all illuminated with case examples – from swallowing disorders, through non-surgical voice restoration, to rehabilitation following total laryngeal surgery – on an accompanying DVD. As the first book in recent years to cover both current theory and clinical practice, this will prove an essential textbook and practical clinical reference for the H&N cancer rehabilitation team.

 

Meeting the Challenges of Oral and Head and Neck CancerMeeting the Challenges of Oral and Head and Neck Cancer: A Guide for Survivors and Caregivers, Second Edition

Co-Editors: Nancy Leupold, M.A., James Sciubba, D.M.D., Ph.D.

This volume has been expanded, updated, and polished and thus constitutes an even more comprehensive resource of valuable scientific, psychological, sociological, therapeutic, financial, and practical information for the patient afflicted with head and neck cancer and his or her family. Appreciation of these principles [in this book] and others too numerous to mention will soften the impact of the cancer and facilitate the care of, as well as the caring for, the patient afflicted with head and neck cancer. Concise, practical, and packed with information, Meeting the Challenges of Oral and Head and Neck Cancer: A Guide for Survivors and Caregivers, Second Edition is a valuable resource to assist those who need help overcoming the many difficult issues that confront them or their loved ones struggling with oral or head and neck cancer. This book has been helpful for parents and survivors; doctors often buy or recommend it for their patients.

 

Otolaryngology- Head and Neck SurgeryOtolaryngology-Head and Neck Surgery: Clinical Reference Guide, Third Edition

Edited by: Raza Pasha, M.D.

The bestselling pocketguide – Otolaryngology-Head and Neck Surgery: Clinical Reference Guide – is back in an extensively revised, up-to-date, and expanded third edition. Spanning the breadth of the entire field, this “high-yield” book retains a “by residents, for residents” feel, while also including expert content useful to accomplished physicians. Students, residents, attendings, and speech/hearing professionals will find the highly organized, outline format to be useful for clinical situations as well as a last minute cram for morning rounds. The guide has proven essential for board review as well as a quick source for primary care providers. In addition to all the great features that have made this sought after book a runaway success, the new edition features A comprehensive update featuring the latest diagnostic and treatment information A brand new sleep medicine chapter, providing critical information for this rapidly expanding subspecialty Expanded and revised information, notably in sections covering plastics; rhinology; otology/neurotology; H&N cancer; and general otolaryngology.

Feature Article: Technology helps patients with hearing loss thrive

Seilesh BabuBy Seilesh Babu, M.D., Michigan Ear Institute

Hearing loss is one of the most common conditions affecting otology patients whether as a newborn or aging patient. Hearing loss can significantly impact one’s ability to communicate leading to reduced quality of life, isolation, and even depression. Seeking medical help to assist with this hearing loss can be the biggest obstacle for many patients who do not want to acknowledge a hearing issue. However, if the problem is properly managed with hearing aid assistance or surgical therapy, improvement in the patient’s quality of life including anxiety, depression, frustration, and social isolation will be positively impacted.

In our practice at the Michigan Ear Institute, we see thousands of patients annually with hearing loss concerns in all age groups. Some of unilateral hearing loss and many have bilateral hearing loss, ranging from mild to profound. Unilateral hearing loss can be caused by not having an ear canal form (canal atresia) or, from nerve damage of unknown etiology. These patients have several options to improve their hearing such as using CROS hearing aids, bone anchored devices, dental implanted devices, or surgical repair of the poorly formed ear canal in the case of atresia. Many patients have significant improvement in their hearing in various situations using these technologies and surgeries.

Recently, a patient of ours received a scholarship from Cochlear Americas, the global leader in implantable hearing solutions. This scholarship recognizes bone anchored device and cochlear implant recipients who have shown academic accomplishments as well as a commitment to leadership and humanity. Using the technology of hearing devices, patients are able to complete advanced academic pursuits despite having hearing impairment that may have proven to be an obstacle. We are proud to be a part of this successful path for this patient who is currently enrolled in a Ph.D. program.

Hearing technology continues to improve. Advances in hearing aids have occurred with smaller, more powerful processors and noise canceling technology, as well as masking technology that treats tinnitus or ringing in the ear. Middle ear implants provide a surgical treatment option for patients who do not want to wear conventional hearing aids. Cochlear implantation has revolutionized the ability to treat patients with complete hearing loss either as a newborn or for patients in their 80s.

baby_hearing_aidChildren born with complete deafness are able to be treated with a cochlear implant with near normal function from speech and language development to academic performance. Adults with late onset profound hearing loss are also able to obtain a cochlear implant in order to maintain excellent quality of life, independence, and social interactions. Some elderly patients diagnosed with Alzheimer’s disease may in fact be suffering from severe hearing loss that needs to be diagnosed and managed.

In the future, advances in stem cell development and treatments will improve the quality of life of hearing loss sufferers. In addition to these new technologies, it is the collaborative effort of otologists, audiologists, and speech-language pathologists in treating patients with hearing loss that continues to have a positive impact in the lives of these patients every day.

Just Published!

This week two new books came into the warehouse! First we have Evidence-Based Practice in Audiology: Evaluating Interventions for Children and Adults with Hearing Impairment by Lena Wong, PhD, and Louise Hickson, PhD. Also released this week is Cochlear Implants and Other Implantable Hearing Devices by Michael J. Ruckenstein, MD.

  

Be sure to check them out and order your copies today!

Practical HNO References

We take pleasure in sending you details of three outstanding, practical references for your Cancer team. Check them out here!

First up is Biel’s book on PDT. Increasingly, PDT is moving from the domain of the dermatology team and onto your caseload. This practical book offers hints and tips as well as a solid grounding in successful technique. Also detailed are Weber and Moore’s outstanding new work on cutaneous malignancies and Guy Petruzzelli’s bestselling practical reference for all head and neck surgeons. Order your copies today!

Best-Selling Pediatric Craniofacial Reference

Charles Moore’s multi-disciplinary reference offers you a range of perspectives in diagnosing, assessing and successfully treating pediatric facial trauma.

This practical reference offers the viewpoints of a team of clinicians distills the wisdom and expertise of an oral surgeon, neurosurgeon, dentist, ophthalmologist, otolaryngologist, radiologist, plastic surgeon, and craniomaxillofacial surgeon. Order your copy today!

Resource books for the ear, nose, and throat

Take advantage of three pocket-sized references that certainly punch above their weight – from KJ Lee’s outstanding manual of best practice, through Raza Pasha’s famed guide for the Boards (now in its third successful edition), to a great 10-minute assessment guide that your ER, nursing and allied health teams should have at their fingertips.

All three ready references will help save your time, as well as offering valuable hints, tips and guidance in your daily clinical practice. Click here for more info and to order your copies today!