Velasquezlysgaard8927

Background The shift in the medical education system from a time-based to a competency-based model has encouraged its adoption and application in competency-based education in anatomy classrooms, such as team-based learning models and flipped classroom models. This pilot study aimed to build on previous work of the linkages between anatomy-based learning (a flipped classroom model inspired by a modified team-based learning) and student learning and engagement, and further to assess the linkage between anatomy-based learning and academic performance. Methods A sequential mixed-methods design was employed to first gather and analyse quantitative data, including confidential student first semester scores in anatomy gender, stream, anatomy-based learning, and final anatomy overall mark. The quantitative phase was followed by a qualitative phase in which a series of 8 anatomy laboratories were observed (4 anatomy-based learning and 4 traditional). Thematic analysis was performed on the observation data. Results Agn anatomy-based learning and traditional designs, it was possible to observe the potential of flipped classroom model in engaging students in individual preparation, in team-based learning, and in consensus-based learning approaches. © The Author(s) 2020.Over the past 30 years in the United States, increasing identification of small thyroid nodules has led to a dramatic rise in the detection of small thyroid cancers, many of which are unlikely to progress to overt clinical disease. Because autopsy studies reveal that up to 30% of people harbor clinically occult thyroid cancers, the growing use of diagnostic technologies has identified an increasing number of small, clinically low risk papillary thyroid cancers (PTCs). In recent years, clinical practice has evolved to de-intensify the treatment for PTCs, with fewer total thyroidectomy and nodal dissection procedures being performed, in favor of more limited operations. In addition, vigilant observation of selected low risk cancers has demonstrated outcomes comparable to those patients who undergo immediate surgical intervention. Active surveillance has emerged as a new option within the treatment algorithm of PTCs. There is now robust data from cancer centers in Japan and Korea which have reported excellent oncologic outcomes among patients undergoing active surveillance for PTC, as well as more recent, similar data from the United States. American Thyroid Association guidelines now include the option of active surveillance for appropriately selected patients with low-risk PTC. With active surveillance now one option within the standard of care for patients with certain thyroid cancers, surgeons have become critical to facilitating shared decision-making for patients facing this diagnosis. © 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. see more on behalf of The Triological Society.Objectives Postoperative respiratory adverse events (PRAEs) are known complications following adenotonsillectomy (AT). Clinical data at a single institution were reviewed to investigate the factors that may contribute to PRAEs in the postanesthesia care unit (PACU). The relationship between PRAEs in the PACU and escalation of care, defined as either an unplanned admission for outpatient surgery or unplanned pediatric intensive care unit (PICU) admission, was investigated. Methods The perioperative records for all patients who underwent AT from 2016 to 2018 were reviewed. The surgical procedure was performed at both the main campus and the ambulatory surgery center in accordance with the institutional obstructive sleep apnea (OSA) guidelines. Patient characteristics and intraoperative medications were compared. Categorical variables were summarized as counts with percentages and compared using chi-square tests or Fisher's exact tests. Continuous variables were summarized as medians with interquartile ranges and compared using rank-sum tests. Multivariable logistic regression was performed to evaluate the association of intraoperative dosing with the occurrence of PRAEs. Results The study cohort included 6110 patients. Ninety-three patients (2%) experienced PRAEs in the PACU. Of these 93 patients, 14 (15%) resulted in an escalation of care, nearly all of which were unplanned PICU admissions. PRAEs tended to occur in younger patients, non-Hispanic black patients, and those with a higher American Society of Anesthesiologists (ASA) status. Conclusions PRAEs are infrequent after AT at a tertiary institution with OSA guidelines in place. However, when PRAEs do occur, escalation of care may be required. Risk factors include age, ethnic background, and ASA physical status. Level of Evidence III. © 2019 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.Introduction Benign paroxysmal positional vertigo (BPPV) of the horizontal semicircular canal (hSCC) can present with otoconia blocking its lumen (canalith jam), with signs and symptoms that make it difficult to distinguish from central nervous system pathology. Objective Here we report two cases of canalith jam affecting the hSCC and offer a theoretical mechanism based on known vestibular neurophysiology. Methods We use video-oculography to document the canalith jam and show the moment the otoconia loosen. Results Canalith jam is a rare form of BPPV remedied with repositioning maneuvers. Conclusion Clinicians should consider canalith jam as a mechanism for BPPV when the nystagmus is (a) Direction fixed with fixation removed and during positional testing; (b) Velocity dependent on supine head position; (c) Converts to geotropic directional changing nystagmus. © 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.Postmortem temporal bone computed tomography (CT) and histopathologic findings in an infant with CHARGE syndrome revealed bilateral cochleovestibular hypoplasia, including cochlear pathology relevant to cochlear implant candidacy. Both ears had absence of the superior semicircular canals (SCCs), severely hypoplastic posterior SCCs, and hypoplastic (right ear) or absent (left ear) lateral SCCs seen on CT and histopathology. Histopathology further revealed the absence of all SCC ampullae except the right lateral SCC ampulla and atrophic vestibular neuroepithelium in the saccule and utricle bilaterally. The right cochlea consisted of a basal turn with patent round window, and malformed middle turn (type IV cochlear hypoplasia), with a small internal auditory canal (IAC) but near normal cochlear nerve aperture (fossette). Quantification of spiral ganglion neurons (SGNs) on histologic sections revealed a reduced SGN population (35% of normal for age), but this ear would still have likely achieved benefit from a cochlear implant based on this population. The left cochlea consisted of only a basal turn with patent round window (type III cochlear hypoplasia) with a small IAC and very small cochlear nerve aperture. Notably, histology revealed that there were no SGNs in the cochlea, and therefore, this ear would not have been a good candidate for cochlear implantation. © 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.Objectives Describe the histopathology of the temporal bones in MELAS (myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) syndrome. The syndrome results from a known point mutation in mitochondrial DNA. Methods Histopathology analysis of a pair of temporal bones from the oldest surviving MELAS syndrome temporal bone donor. Histopathologic findings were correlated with known premortem clinical data. Results The inner ears showed severe but incomplete atrophy of the stria vascularis for the length of the cochleae. In contrast, the organ of Corti and inner hair cells appeared intact with some loss of outer hair cells. Other than moderate loss at the basal turn, spiral ganglion cells numbers were normal. The vestibular neuroepithelium was mostly normal with the exception of moderate degeneration of the macula sacculi and partial collapse of the saccular wall on the right. The cerebral cortex had infarct-like lesions with adjacent gliosis. Conclusion This is an analysis of the oldest patient with MELAS syndrome to date, an addition to only two previously published patients. It supports the notion that hearing loss is a result of dysfunction of the stria vascularis and not loss of hair cells or neurons. Patterns of vestibular pathology are in agreement to in-vivo measurements. These findings support auditory rehabilitation with cochlear implants and may be relevant to hearing loss due to other mitochondrial mutations. Level of evidence 4. © 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.Contemporary histopathology of the ear is based on an evolution of equipment and histological techniques over the last 500 years, including the invention of the light microscope and protocols for fixation, embedment, sectioning, and staining of tissue samples, and visual documentation of findings. Several recent techniques which can be utilized in otopathology hold promise for significant improvement in methods and a better understanding of pathologic processes in diseases of the ear. © 2019 The Author. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.Objectives To investigate the landscape of cognitive impairment (CI) screening for adults with age-related hearing loss (ARHL) among otolaryngologists and audiologists. To identify provider factors and patient characteristics that impact rates of CI screening and referral. Methods A 15 question online survey was sent to members of the Georgia Society of Otolaryngology (GSO), Georgia Academy of Audiology (GAA), American Otological Society and American Neurotology Society (AOS/ANS), and posted on the web forum for two hearing disorders special interest groups within the American-Speech-Language-Hearing Association (ASHA). Responses were collected anonymously. Chi-square tests were used to compare responses. Results Of the 66 included respondents, 61% (n = 40) were otolaryngologists and 35% (n = 23) were audiologists. Respondents were significantly more likely to refer patients for CI assessment than to screen (64% vs 21%, respectively, P  less then  .001). The complaint of a neurological symptom, such as memory loss, would prompt screening or referral for only 27.3% (n = 18) and 51.52% (n = 34) of respondents, respectively. Forty-two percent (n = 28) of respondents suggested CI screening with the MMSE vs 20% (n = 13) with the Montreal Cognitive Assessment. Conclusions Despite recommendations for cognitive assessment in high-risk populations, such as older adults with ARHL, the practice of CI screening and referral is not yet commonplace among otolaryngologists and audiologists. These providers have a unique opportunity to assess adults with ARHL for CI and ensure appropriate referral. Level of Evidence 5. © 2019 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.