Activity-Based Checks (ABCs) of Pain: A Functional Pain Scale Used by Surgical Patients

Introduction. Increased rates of surgery, combined with concerns about high-risk pain medications, have highlighted the need for improved methods of meaningfully assessing pain. In response to lack of medical context and functional data in existing scales, the Activity-Based Checks (ABCs) was developed. Methods. This prospective, cohort study was deployed at a single-institution, academic center. The primary outcome was to correlate the ABCs to the 0-10 numeric rating scale (NRS) in postoperative general surgery patients. Secondary outcomes included assessing the impact of patient factors and prescribing patterns on opioid consumption, in milligrams of morphine equivalents (MME) after discharge. Results. The function that correlated most to the NRS at discharge was “Out of Bed to Chair”. Indicators of better mental health were inversely correlated with MME consumption. Interestingly, the largest predictor of MME taken was MME prescribed. Over 40% of prescribed opioids goes unused. Conclusions. Functional pain scales, like the ABCs, may be useful adjuncts to evaluate pain. Individual functions, e.g., “Out of Bed to Chair” may be of particular importance. Clinicians must be aware that the strongest predictor of MMEs taken by patients was MMEs prescribed, highlighting the importance of better pain assessments and opioid stewardship

Scholarly research productivity among otolaryngology residency graduates and its relationship to future academic achievement

Background: The Accreditation Council for Graduate Medical Education (ACGME) requires that all residencies participate in research. This growing emphasis on research during residency has made it increasingly important for medical students to gain familiarity with the basic principles of research before beginning residency training. Thus, our goal is to determine if an association exists between publication rates before, during, or after otolaryngology residency training and whether publication efforts may predict future academic achievement. If such an association exists, perhaps otolaryngology residency program directors and education policymakers could use it as a predictive tool to screen future applicants.Methods: In this cross-sectional analysis, we selected a random sample of 50 otolaryngology residency programs listed on Doximity. From these programs, we assembled a list of graduating residents from 2013, 2014, and 2015. Using SCOPUS, PubMed, and Google Scholar, a list of publications for each graduate was compiled and data were extracted in an independent, double-blinded fashion by two investigators.Results: Of the 50 randomly selected otolaryngology residency programs included in this analysis, 27 (54%) programs representing 207 residents were included. Before residency, graduates published a mean of 0.7 (SD=2.3) articles and a mean of 0.2 (SD=0.8) first author publications. During residency, graduates published a mean of 4.1 (SD=5.0) articles and a mean of 2.2 (SD=3.2) first author publications. After residency, graduates published a mean of 5.4 (SD= 9.6) articles and a mean of 1.8 (SD=2.8) first author publications. Residents who pursued a fellowship had more publications (t205=-5.5, p <.001) and more first author publications (t205=-5.3, p <.001) than residents who did not pursue fellowship training. Residents who chose careers in academic medicine had a higher number of mean total publications (t205=-7.2, p <.001) and first author publications (t205=-7.0, p <.001) than those in private practice.Conclusion: Otolaryngology residency graduates are actively involved in research opportunities throughout their medical training. Research productivity significantly correlated with future fellowship training, the pursuit of an academic career, and overall h-index. Residents who published more research were more likely to enter fellowship training and academic careers. Our results indicate that promoting greater physician involvement in the research process may strengthen confidence in the interpretation and application of research findings and ultimately lead to future academic success

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Background: In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. Methods: ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. Results: ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. Conclusion: The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment

Attitudes of Suburban Kansan Parents Regarding School-Required Immunizations and the Influences of the Coronavirus Pandemic

Introduction. Understanding parental attitudes and adherence of recommended childhood vaccination schedules adopts a new level of importance in the era of the Sars-CoV-2019 (COVID-19) pandemic. With hopes for release of a safe and effective COVID-19 vaccine within the near future, understanding parental perception of vaccines is important to design successful vaccination interventions. Methods. A cross-sectional survey was administered to approximately 900 parents in the state of Kansas in May, 2020. Pearson chi square and Mann-Whitney U tests were utilized to analyze the assess the attitudes of Kansas parents towards a potential addition of the influenza vaccine to the required list for K-12 students and furthermore, their general perception of vaccinations, and the impact of COVID-19 on those beliefs. Results. 179 responded. 51% (n=92) were in favor of adding the influenza vaccine to the mandatory list (Pro-Addition). Anti-Addition parents had significantly higher levels of distrust (2.1, p&lt;0.001) and were significantly more concerned about vaccine adverse effects. When presented with a hypothetical situation in which a “safe and effective” COVID-19 vaccine was available, these parents were significantly less likely to indicate they would receive the vaccine or obtain it for their children (53 people, p&lt;0.001).   Conclusions. Pro-Addition and Anti-Addition parents are markedly split on their attitudes towards the addition and the effects of the pandemic. Follow-up qualitative studies of Anti-Addition parents are critical for successful vaccine distribution and coverage in the communities

Investigation of a Novel Activity-Based Checks (ABC) Functional Pain Scale in the Postoperative Urologic Surgery Patient: Functional Peri-Operative Pain Assessment

Introduction. The authors investigated a novel functional pain scale, the Activity-Based Checks (ABCs) of Pain, following open urologic surgery. The primary objectives were to establish the strength of the correlation between the ABCs and the numeric rating scale (NRS) and determine the impact of functional pain on the patient’s opioid requirements. We hypothesized that ABC score would correlate strongly with NRS and that the ABC score during hospitalization would be more closely correlated with the number of opioids prescribed and used. Methods. This prospective study included patients at a tertiary academic hospital undergoing nephrectomy and cystectomy. The NRS and ABCs were collected pre-operatively, during the inpatient stay, and at the one-week follow-up. Milligrams of morphine equivalents (MMEs) prescribed at discharge and the MME reportedly taken during the first post-operative week were recorded. Spearman's Rho was used to assess the correlation between scale variables. Results. Fifty-seven patients were enrolled. The ABCs correlated strongly with the NRS at baseline and post-operative appointments (r = 0.716, p &lt; 0.001 and 0.643, p &lt; 0.001). Neither the NRS nor the composite ABCs score was predictive of outpatient MME requirements; the ABCs function, “Walking outside the room” significantly correlated to MMEs taken after discharge (r = 0.471, p = 0.011). The greatest predictor of MMEs taken was the number of MMEs prescribed (0.493, p = 0.001). Conclusions. This study highlighted the importance of post-operative pain assessment that takes functional pain into consideration to evaluate pain, inform management decisions, and reduce opiate reliance. It also emphasized the strong relationship between opioids prescribed and opioids consumed

Investigation of a Novel Activity-Based Checks (ABC) Functional Pain Scale in the Postoperative Urologic Surgery Patient: Functional Peri-Operative Pain Assessment

Introduction. The authors investigated a novel functional pain scale, the Activity-Based Checks (ABCs) of Pain, following open urologic surgery. The primary objectives were to establish the strength of the correlation between the ABCs and the numeric rating scale (NRS) and determine the impact of functional pain on the patient’s opioid requirements. We hypothesized that ABC score would correlate strongly with NRS and that the ABC score during hospitalization would be more closely correlated with the number of opioids prescribed and used. Methods. This prospective study included patients at a tertiary academic hospital undergoing nephrectomy and cystectomy. The NRS and ABCs were collected pre-operatively, during the inpatient stay, and at the one-week follow-up. Milligrams of morphine equivalents (MMEs) prescribed at discharge and the MME reportedly taken during the first post-operative week were recorded. Spearman's Rho was used to assess the correlation between scale variables. Results. Fifty-seven patients were enrolled. The ABCs correlated strongly with the NRS at baseline and post-operative appointments (r = 0.716, p &lt; 0.001 and 0.643, p &lt; 0.001). Neither the NRS nor the composite ABCs score was predictive of outpatient MME requirements; the ABCs function, “Walking outside the room” significantly correlated to MMEs taken after discharge (r = 0.471, p = 0.011). The greatest predictor of MMEs taken was the number of MMEs prescribed (0.493, p = 0.001). Conclusions. This study highlighted the importance of post-operative pain assessment that takes functional pain into consideration to evaluate pain, inform management decisions, and reduce opiate reliance. It also emphasized the strong relationship between opioids prescribed and opioids consumed

Parental Vaccine Hesitancy in a COVID-19 World: A Qualitative Study of Midwestern Parents’ Decisions Regarding COVID-19 Vaccination for Their Children : Parental COVID Vaccine Hesitancy

Introduction. With the launch of the SARS-CoV-2 (COVID-19) vaccines, a new cohort of people exist who do not consider themselves to be totally vaccine-hesitant, but are specifically COVID-19 vaccine (CVH) parents. There is a need to learn from CVH parents, to ensure their concerns are addressed allowing them to comfortably vaccinate their children against the COVID-19 virus. Methods. Surveys were used to identify CVH parents. Via semi-structured interviews, we assessed the attitudes of CVH parents towards COVID-19 vaccination in children. An inductive coding method was used to analyze transcripts and develop themes. Results. Fourteen parents were interviewed. 50% (n=7) had received the COVID-19 vaccine even though they had doubts. Six reported that education about mRNA vaccine production was helpful in deciding to get vaccinated. Parents were reluctant regarding pediatric vaccination due to lack of long-term studies and concerns about adverse impact on childhood development. As opposed to public health leaders like the CDC and Dr. Fauci, personal physicians were the most trusted source of information and direct conversations with them were the most influential. Conclusions. Doctors are the most trusted source of information regarding the COVID-19 vaccine. Personal conversations with health professionals were the most influential factors in vaccine-hesitant individuals deciding to proceed with vaccination. Rather than broad public health messaging and advertising to increase rates of vaccination, these findings indicate that training for health care professionals in how to effectively counsel COVID-19 hesitant patients may be a high-impact area of opportunity to improve adherence to vaccine recommendations

Delayed Diagnosis of Nasal Natural Killer/T-Cell Lymphoma

Midline destructive lesions of the face have multiple possible etiologies. The majority of these cases are found to be due to an extranodal lymphoma of natural killer/T-cell-type non-Hodgkins lymphoma (NKTL). Unfortunately, diagnosis is often delayed. With variable presenting complaints, including nonspecific issues like chronic rhinosinusitis or nasal congestion, initial treatments are aimed at these presumed diagnoses. Only as the lesion progresses do overt signs of destruction occur. As with our patient, who was initially treated for presumed infection and abscess, final diagnosis often does not occur until several months, and several antibiotic courses, from initial presentation. As such, it is important for this rare entity to remain in the clinician’s differential diagnosis for nasal lesion

sj-docx-1-aor-10.1177_00034894221147809 – Supplemental material for Qualitative Study Assessing Factors for 30-day Readmissions: A Head and Neck Oncology Cohort

Supplemental material, sj-docx-1-aor-10.1177_00034894221147809 for Qualitative Study Assessing Factors for 30-day Readmissions: A Head and Neck Oncology Cohort by Simon Beatty, Joseph Penn, Mackenzie O’Donnell and Jennifer Villwock in Annals of Otology, Rhinology & Laryngology</p