Challenges of practical training in otorhinolaryngology: contribution of Health Simulation in a University Hospital

Ear, nose and throat (ENT) is a discipline that requires both theoretical knowledge and technical and procedural skills. The anatomy of the head and neck region is complex and requires visualization and orientation skills in a restricted three-dimensional space. These anatomical regions are accessible through specific instruments: microscopes, angledendoscopes.... In Belgium, the specialization master's degree lasts five years after the end of medical school and varies from four to five years in other European countries. Moreover, the training is only a small part of the life of young doctors, who also deal with the daily clinical responsibilities of hospital work. The idea for this project arose from a reality on the ground, contrasting two facts: On the one hand, the training methods for assistants have undergone reorganization with an overall trend towards standardisation at European level with the formation of the European Examination Board and the establishment of a training convention. On the otherhand, there is a trend towards a shorter theoretical training period for new candidates (medical studies in 6 years). There has also been an increase in the number of clinical assistants and trainees in universities, with the particular case of the double cohort in 2018. These facts are associated with an overall stable number of senior operating theatresupervisors, who are subject to hospital profit and safety constraints. This situation therefore seems to limit the possibilities for practical learning during specialization, since they are mainly based on the principle of companionship (see dedicated section). This may therefore lead to disappointment at the end of the training with gaps and alimitation of the efficiency of the training as it is currently proposed. When trying to reconcile increased training requirements with limited training time, the current literature offers an increasing number of teaching tools, some of which are simulation-based, at different stages of validation, accessible and available. It was therefore important to define the notion of « simulation ». The simulation techniques specific to ENT will then be described via a review of the literature which retains the essential points with an evaluation of their interest for initial and continuing education. We will also compare international practices, also through the literature. A visit to a reference centre in this field (Nancy School of Surgery, Professor Cécile Parietti) enabled us to clarify the reality of these practices in the field. Some notions of educational psychology applied to hospital environment and to surgery will be discussed in order to broaden our vision and understand how the operating theatre remains a very specific learning environment. We will then present three studies conducted in our institution. The first was a survey toestablish a national overview of the quality assessment of practical ENT training from the point of view of trainee in Belgium, in the different language communities. This survey also assessed the potential role of simulation in this respect. The other two studies aimed toclarify the interest and the place of simulation tools available in our department such as the Voxel-Man tempo  for middle ear surgery based on virtual reality and the evaluation of the10 psychometric scale of visualization capacity in space (« Vandenberg and Kuse mental rotation test ») in the learning of sinus endoscopic surgery.The objectives of our work evolve in stages : firstly, to take stock of learning, particularly surgical learning, during ENT specialisation from the point of view of the learners. Secondly,to highlight the factors that have a significant impact on surgical procedural skills using a validated scale, and to study the possible impact of the use of simulation on these factors. At the end of this work, we wish to propose a concrete training project exploiting and articulating the different simulation tools in a structured way and based on objective scientific dat

N-Aryl-N'-(chroman-4-yl)ureas and thioureas display in vitro anticancer activity and selectivity on apoptosis-resistant glioblastoma cells: screening, synthesis of simplified derivatives, and structure-activity relationship analysis.

A series of chroman derivatives previously reported as potassium channel openers, as well as some newly synthesized simplified structures, were examined for their in vitro effects on the growth of three human high-grade glioma cell lines: U373, T98G, and Hs683. Significant in vitro growth inhibitory activity was observed with 2,2-dimethylchroman-type nitro-substituted phenylthioureas, such as compounds 4o and 4p. Interestingly, most tested phenylureas were found to be slightly less active, but more cell selective (normal versus tumor glial cells, such as 3d, 3e, and 3g), thus less toxic, than the corresponding phenylthioureas. No significant differences were observed in terms of chroman-derivative-induced growth inhibitory effects between glioma cells sensitive to pro-apoptotic stimuli (Hs683 glioma cells) and glioma cells associated with various levels of resistance to pro-apoptotic stimuli (U373 and T98G glioma cells), a feature that suggests non-apoptotic-mediated growth inhibition. Flow cytometry analyses confirmed the absence of pro-apoptotic effects for phenylthioureas and phenylureas when analyzed in U373 glioma cells and demonstrated U373 cell cycle arrest in the G0/G1 phase. Computer-assisted phase-contrast videomicroscopy revealed that 3d and 3g displayed cytostatic effects, while 3e displayed cytotoxic ones. As a result, this work identified phenylurea-type 2,2-dimethylchromans as a new class of antitumor agents to be further explored for an innovative therapeutic approach for high-grade glioma and/or for a possible new mechanism of action

Virtual reality surgical simulation as a tuition aid for understanding surgical temporal bone anatomy: trial on 15 ear, nose, and throat registrars

peer reviewe

Benralizumab in severe eosinophilic asthma in real life: confirmed effectiveness and contrasted effect on sputum eosinophilia versus exhaled nitric oxide fraction - PROMISE.

peer reviewedBACKGROUND: Randomised controlled trials have shown that benralizumab, an anti-interleukin-5 receptor monoclonal antibody, reduces exacerbations and oral corticosteroid dose and improves asthma control and lung function in severe eosinophilic asthma. The aim of this study was to confirm results of randomised controlled trials in real life in a population of 73 patients with severe eosinophilic asthma treated with benralizumab for at least 12 months. METHODS: Patients underwent careful monitoring of asthma exacerbations, exhaled nitric oxide fraction, lung function, asthma control and quality of life questionnaire responses and sputum induction, and gave a blood sample at baseline, after 6 months and then every year. RESULTS: We found significant reductions in exacerbations (by 92%, p<0.0001) and oral corticosteroid dose (by 83%, p<0.001) after 6 months that were maintained over time, with 78% of patients able to stop oral corticosteroid therapy. Patients improved their Asthma Control Test (ACT) score (from 11.7±5.1 to 16.9±5.35, p<0.0001), Asthma Control Questionnaire (ACQ) score (from 2.88±1.26 to 1.77±1.32, p<0.0001) and Asthma Quality of Life Questionnaire score (+1.04, p<0.0001) at 6 months and this was maintained during follow-up. Only 35% and 43% of patients reached asthma control according to an ACT score ≥20 and ACQ score <1.5, respectively. We observed stable post-bronchodilation lung function over time and a significant reduction in sputum eosinophil count, with 85% of patients exhibiting sputum eosinophil counts <3% after 6 months (p<0.01) with no effect on exhaled nitric oxide fraction. CONCLUSION: In our real-life study, we confirm the results published in randomised controlled trials showing a sharp reduction in exacerbations and oral corticosteroid therapy, an improvement in asthma control and quality of life, and a dramatic reduction in sputum eosinophil count

Use of Vandenberg and Kuse Mental Rotation Test to Predict Practical Performance of Sinus Endoscopy

peer reviewe

Prise en charge multidisciplinaire des complications rhinogènes de l'orbite : le point de vue de l'ORL

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Traumatismes nasaux et des sinus paranasaux, Congrès annuel du B-ORL Urgences en pathologie rhino-sinusienne

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L'hypertrophie du cornet inférieur dans la pratique : une corde raide ?

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Treatment Options (focus on Surgery)

To avoid empty nose syndrome after turbinoplasty, surgical indication is key. Nose obstruction have many others causes than turbinate hypertrophy. Ensuring a good vision during surgery avoids excessive resection. Minimal resection avoids complications.Empty Nose Syndrom

Management of congenital dacryocystocele: report of 3 clinical cases.

This case study describes three newborns referred to our otolaryngologic service for investigating and treating a cystic dilatation of the lacrimal duct. These dilatations corresponded to unilateral or bilateral dacryocystoceles, with or without complications. The first newborn exhibited respiratory distress at birth and received early surgery and endoscopic marsupialization of intranasal and bilateral cysts. The second newborn did not show any signs of complications, and after conservative treatment for a week, the cyst spontaneously resolved. The third newborn was diagnosed in utero with ultrasonography, and the cyst resolved spontaneously during childbirth. These cases provided an opportunity to review the pathophysiology of this rare congenital lacrimal anomaly and to note responses to different therapeutic approaches. Indeed, these three cases illustrated three different management approaches, and allowed us to address the issue of prenatal diagnosis