Throat Specialist Research Articles

The Impact of Senior Mobility Funding on Hearing Aid Acquisition and Compliance to Hearing Aid Use in a Singapore Hospital.

Background and ObjectivesIn 2013, the Singapore government reviewed and expanded the Senior Mobility Fund (SMF) to provide subsidy for assistive devices, including hearing aids (HA). While SMF has improved accessibility to HA, its impact on HA acquisition has not been determined. The study aims to elucidate the influence of SMF on HA acquisition and the relationship between financial funding and compliance to HA use.Subjects and MethodsRetrospective review of 643 patients seen between January 2017 to January 2018 at the earnose and throat specialist outpatient clinic, who were referred for a hearing aid evaluation. Of the 643 patients, 109 patients with baseline hearing handicap (HH) scores recorded, and no formal diagnosis of cognitive impairment were included. The patients were grouped according to SMF eligibility and clinical data were obtained.ResultsThe odds ratio for acquiring HA was significantly higher with SMF, regardless of HH scores. When looking at actual degree of hearing loss (DHL), HA uptake was significantly higher in the least severe of DHL categories. There is no relationship between SMF and compliance to HA use. However, HH score is positively correlated with data log in regression analyses.ConclusionsSMF appears to influence HA acquisition. Especially in financially funded patients with low self-perceived HH, the benefits of HA may be underappreciated given the few hours of HA use. Further studies are warranted to investigate the impact of financial funding on outcomes of HA users to help policy planners and clinicians be prudent in the utilization of SMF.

Physicians\u2019 prescribing behaviour and clinical practice patterns for allergic rhinitis management in Italy

BackgroundDespite availability of clinical guidelines, underdiagnosis, undertreatment, and poor adherence are still significant concerns in allergic rhinitis (AR) therapeutic management. We investigated clinical practice patterns and prescribing behavior of Italian healthcare professionals (HCPs) specialized in AR.MethodsOne-hundred allergologists, 100 ear, nose and throat (ENT) specialists, and 150 general practitioners (GPs) were recruited. The survey assessed: socio-demographic, work experience, monthly caseload, prescription drivers. Next, HCPs were invited to retrospectively recover patients’ clinical data to investigate: AR clinical characteristics, therapy management, prescription patterns, patient adherence. Descriptive statistics, Chi square, One-Way analysis of variance, and Two-Way Analysis of Variance were performed.ResultsAllergologists visited more AR patients (31% of monthly caseload) than ENTs (21%, p < 0.001), while GPs’ caseload was the lowest (6%). Clinical information of 2823 patients were retrieved of whom 1906 (67.5%) suffered from moderate/severe AR (discomfort score: 7.7 ± 1.3) and 917 (32.4%) from mild AR (5.7 ± 1.9). About one-third of mild patients had a discomfort score ≥ 7. Main prescription drivers were “effective on all symptoms” (54.3% patients) and “quick symptom relief” (47.8%), whereas minor drivers were “affordable price” (13.4%) and “refundable” (8.7%). The most prescribed drugs were antihistamines and intranasal corticosteroids (79% and 55% prescriptions), followed by fixed-dose-combination of intranasal azelastine/fluticasone (19%). Polytherapy was the most common treatment strategy (59.6%). HCPs’ believe that the majority of the patients was adherent to treatment (88% with score > 7).ConclusionsThis survey describes the therapeutic approach adopted by Italian physicians to cope with AR and shows that HCPs underestimated AR severity and had a non-realistic perception of patients’ adherence. These findings suggest that further efforts are required to improve AR clinical management in Italy.

An ex vivo comparison of over-the-counter cerumenolytics for ear wax

Background: Ear wax (cerumen) impaction is a common reason why patients present to general practitioners (GPs) and ear, nose and throat (ENT) specialists. However, there is no consensus on the effectiveness of the variety of cerumenolytics commonly available. Currently, there are no investigations on the effectiveness of cerumenolytics against cerumen of varying consistencies.

Investigation of Serum Zinc Level in Patients with Hearing Loss and its Association with Tinnitus

Introduction: This study aims to determine the serum zinc level in patients with hearing loss and its relation with tinnitus. Materials &amp; Methods: In this Cross-Sectional study, 110 patients older than 20 years old with Complaining of hearing loss and tinnitus were involved. Participating patients were first visited by an ear, nose, and throat specialist with a history and physical examination, and were assessed for standard hearing loss as well as the intensity and frequency of tinnitus by standard audiometric tests. Then, fasting blood samples were taken to check serum zinc levels. Results:The mean serum level was 85.32 ± 27 27.62, and the mean frequency of tinnitus was 4.94 ± 2.76, both of which had significant differences between different groups (P = 0.001). The mean intensity of tinnitus was 7.77 ± 4.56, and there was no significant difference between different groups (P = 0.677). Serum zinc level and tinnitus frequency were associated with a correlation coefficient of 0.205 (P = 0.032), and serum zinc level and tinnitus severity were associated with a correlation coefficient of 0.249 (P = 0.009). Conclusion: According to the present study results, the positive effect of serum zinc levels on the severity and frequency of tinnitus has been determined so that with decreasing serum zinc levels, tinnitus occurs at lower frequencies.

Implant loss and sinusitis after sinus lift ‐ an underestimated complication?

Background: Sinus lift is designed to enable the placement of maxillary implants in situations with vertically reduced alveolar bone. It has become a more frequently performed procedure. Possible complications comprise sinusitis, failing grafts and failing of the dental implant. More severe problems and chronic sinusitis have been reported. Aim/Hypothesis: To report on 76 patients with implant loss after sinuslift. To report the reasons, the possibilities for repair in routine cases and in more severe situations of sinusitis with multiple implant loss and damage to surrounding structures. To report the long‐term outcome. Materials and Methods: Between 2000 and 2020 76 patients with failing implants after sinuslift were referred to four Oral Surgery and ENT services in Switzerland. Of 169 implants originally placed 71 implants were already lost before the first consultation. 14 patients had no complaints other than implant loss. The other 62 patients complained about varying degrees of pain, swollen midface, pussy exudates, paresthesia etc. In 3 patients implants had been failing repeatedly. CBCT showed in 58 patients maxillary sinusitis, in 4 patients half‐sided pan‐sinusitis. In 11 patients, nasal fiberoptic endoscopy was carried out. Further investigations consisted of bacteriology, mycology and histology. Reasons for sinusitis were attributable to postoperative blowing of the nose, infection of the graft, antiresorptive drugs, peri‐implantitis reaching the floor of the sinus and allergic reaction to sinus grafting material mixed with collagen. Another reason for implant loss was a failing graft without signs of sinusitis. Results: 53 implants had to be removed under Local Anaesthesia (LA), 9 implants could be left in situ. 8 patients did not need surgical intervention for sinusitis but only antibiotic treatment. 41 patients needed surgical intervention under LA for cleaning the sinus of infected graft material and closing of fistula. 27 patients needed surgical intervention under General Anaesthesia (GA) because of more extensive disease, removal of debris, fungi, dislocated dental implants and nasal endoscopy. 51 patients became pain free. In 11 patients some chronic pain remained. In 18 patients the sinus did not heal to a degree that re‐sinuslift was deemed appropriate. Whilst 29 patients were subsequently treated with dentures, 47 patients underwent a second surgery for new grafting procedures with autologous bone, followed by implant insertion. This was possible in 28 patients under LA, whilst 19 patients needed GA for reconstruction of lost maxillary structures with large mandibular or with hip bone graft. Conclusions and Clinical Implications: Whilst many complications after sinus lift are not severe and can be treated locally, some patients exhibit more severe problems with e.g. pan‐sinusitis and chronic sinusitis. Multidisciplinary cooperation between dentists, oral surgeons, and ear, nose and throat specialists can be very helpful in diagnosing and treating these cases. To estimate the chance for success of redo of sinus lift is rather difficult, especially when bone substitutes were used beforehand which may not have integrated.

SelectStitch: Automated Frame Segmentation and Stitching to Create Composite Images from Otoscope Video Clips

Background and Objective: the aim of this study is to develop and validate an automated image segmentation-based frame selection and stitching framework to create enhanced composite images from otoscope videos. The proposed framework, called SelectStitch, is useful for classifying eardrum abnormalities using a single composite image instead of the entire raw otoscope video dataset. Methods: SelectStitch consists of a convolutional neural network (CNN) based semantic segmentation approach to detect the eardrum in each frame of the otoscope video, and a stitching engine to generate a high-quality composite image from the detected eardrum regions. In this study, we utilize two separate datasets: the first one has 36 otoscope videos that were used to train a semantic segmentation model, and the second one, containing 100 videos, which was used to test the proposed method. Cases from both adult and pediatric patients were used in this study. A configuration of 4-levels depth U-Net architecture was trained to automatically find eardrum regions in each otoscope video frame from the first dataset. After the segmentation, we automatically selected meaningful frames from otoscope videos by using a pre-defined threshold, i.e., it should contain at least an eardrum region of 20% of a frame size. We have generated 100 composite images from the test dataset. Three ear, nose, and throat (ENT) specialists (ENT-I, ENT-II, ENT-III) compared in two rounds the composite images produced by SelectStitch against the composite images that were generated by the base processes, i.e., stitching all the frames from the same video data, in terms of their diagnostic capabilities. Results: In the first round of the study, ENT-I, ENT-II, ENT-III graded improvement for 58, 57, and 71 composite images out of 100, respectively, for SelectStitch over the base composite, reflecting greater diagnostic capabilities. In the repeat assessment, these numbers were 56, 56, and 64, respectively. We observed that only 6%, 3%, and 3% of the cases received a lesser score than the base composite images, respectively, for ENT-I, ENT-II, and ENT-III in Round-1, and 4%, 0%, and 2% of the cases in Round-2. Conclusions: We conclude that the frame selection and stitching will increase the probability of detecting a lesion even if it appears in a few frames.

Transsexualism and transgender medicine - what every internal specialist should know about

The authors present current findings on transsexualism and its treatment. According to the ICD-10, transsexualism is defined as the "desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex." Synonyms of transsexualism are terms such as gender dysphoria reflecting the distress that persons feel due to a mismatch between their gender identity and their sex assigned at birth.The prevalence of transsexualism is estimated to be about 0,6 %. The diagnosis of transsexualism is made by psychiatrists, but at least five more medical specialties (endocrinologist, surgeon, ear, nose and throat specialist, speech therapist and dermatologist) are involved when treating transsexual persons. Hormonal therapy is a very important element of the treatment process; due to the complexity of transsexualism it should be undertaken by endocrinologists with experience and expertise in this field.

Surgical Tracheostomies in COVID-19 Patients: Indications, Technique, and Results in a Second-Level Spanish Hospital.

ObjectiveThe main purpose of this work is to describe the sociodemographic and clinical characteristics of intensive care unit (ICU) patients in a second-level hospital in Madrid, Spain, focusing in those who underwent surgical tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic. The surgical technique and associated complications are also detailed.Study DesignObservational and historical cohort.SettingSingle center.MethodsEighty-three intubated COVID-19 patients were analyzed. Thirty bedside surgical tracheostomies had been performed following our safety protocol.ResultsData from 83 patients admitted to the ICU in Infanta Leonor University Hospital were collected; 74.7% were male. The average age was 59.7 years. The main comorbidities found were hypertension in 51.8%, diabetes mellitus in 25.3%, asthma in 7.2%, and chronic obstructive pulmonary disease in 3.6%. A surgical tracheostomy was carried out in 36.1% of patients who needed a prolonged intubation. The most frequent complication of the surgical procedure, bleeding, occurred in 30%, but the majority were mild and ceased with compression only. The most relevant complication was local infection, which occurred in 26.7% of patients. There were statistically significant differences in the time from the beginning of mechanical ventilation until weaning between tracheostomized and nontracheostomized patients. The mortality rate of patients who underwent tracheostomy was 56.7%. Despite severe acute respiratory syndrome coronavirus 2 being highly contagious and tracheostomy being considered a high-risk procedure, our rate of infected ear, nose, and throat specialists was only 11.8%.ConclusionIn our experience, bedside surgical tracheostomy is a safe procedure in COVID-19 patients when safety protocols are followed.

Transbuccal Approach in Management of Mandible Angle Fracture.

With expanding dimensions and an eminent member of trauma team many Ear Nose Throat specialists are exposed to Oro-maxillofacial trauma. Mandibular angle is a difficult region to operate owing to its unique anatomy. Anglefractures form around 30-40% of the mandibular fracture. Open reduction and internal plating is the management of choice in most angle fractures and various approaches have been described in literature. We conducted a study of trans-buccal approach for management of mandibular angle fractures. It was a non-randomised observational study. 57 patients of mandible angle fractures were included in the study. The ORIF was done in these pts under general anaesthesia after careful surgical planning using trans-buccal approach. This approach included an intraoral exposure with stab incision for the trans-buccal passage of drill and screw diver. Out of 57 cases in our study 33 were males and 24 were females. 23/57 patients were in age group 25-35years whereas 19/57 patients were in age group 15-25years All 57 patients had good fracture healing. Occlusion dysfunction was seen in only 1 case. Infection was seen 3 cases while intraoral exposure of plates occurred in 2 cases. Average mouth opening was 43.3mm at 6weeks with progressive improvement on follow up. Extraoral scar healed well with very good cosmesis in all cases. We strongly suggest the use of transbuccal approach for ORIF in mandibular angle fractures owing to the ease of procedure, comfort of surgeon and less complication rate.

Functional Medicine-Based Dentistry: A Clinical Conversation with Mary Ellen S. Chalmers, DMD, and Robert Rountree, MD

Functional Medicine-Based Dentistry: A Clinical Conversation with Mary Ellen S. Chalmers, DMD, and Robert Rountree, MD

Follow-Up of Head and Neck Cancer Survivors: Tipping the Balance of Intensity.

The traditional concept of post-treatment surveillance in head and neck cancer patients relies on examinations directed at early detection of disease recurrence and/or second primary tumors. They are usually provided by ear, nose and throat specialists with complementary input from radiation oncologists and medical oncologists. Emerging evidence underscores the importance of monitoring and effective management of late adverse events. One of the major drawbacks is a lack of prospective controlled data. As a result, local institutional policies differ, and practice recommendations are subject to continuing debate. Due to the economic burden and impact on emotional comfort of patients, intensity and content of follow-up visits are a particularly conflicting topic. According to the current evidence-based medicine, follow-up of head and neck cancer patients does not prolong survival but can improve quality of life. Therefore, an approach giving priority to a multidisciplinary care involving a speech and swallowing expert, dietician, dentist, and psychologist may indeed be more relevant. Moreover, on a case-by-case basis, some patients need more frequent consultations supplemented by imaging modalities. Human papillomavirus positive oropharyngeal cancer tends to develop late failures at distant sites, and asymptomatic oligometastatic disease, especially in the lungs, can be successfully salvaged by local ablation, either surgically or by radiation. The deep structures of the skull base related to the nasopharynx are inaccessible to routine clinical examination, advocating periodic imaging supplemented by nasofibroscopy as indicated. Anamnesis of heavy smoking justifies annual low-dose computed tomography screening of the thorax and intensive smoking cessation counseling. Finally, some cancer survivors feel more comfortable with regular imaging, and their voice should be taken into consideration. Future development of surveillance strategies will depend on several variables including identification of reliable predictive factors to select those who could derive the most benefit from follow-up visits, the availability of long-term follow-up data, the results of the first randomized trials, resource allocation patterns, infrastructure density, and the therapeutic landscape of locally advanced and recurrent and/or metastatic disease, which is rapidly changing with the advent of immune checkpoint inhibitors and better utilization of local approaches.

Knowledge and Practice of Hearing Screening and Hearing Loss Management among Ear, Nose, and Throat Physicians in Jordan.

Introduction One of the main factors that affect the early diagnosis and intervention of hearing loss is inadequate knowledge by the health care workers. Ear, nose, and throat (ENT) specialists are the main source of information about hearing loss and its management in most developing countries, such as Jordan. Objective The purpose of the present study is to explore the level of knowledge and the practice of hearing screening and hearing loss management for children among ENT physicians in Jordan as an example of health care providers in developing countries of the Middle East. Methods This was a cross-sectional study, adapting a questionnaire of knowledge and the practice of hearing screening and hearing loss management for children. The questionnaire consisted of 2 sections with 20 questions. A total of 40 ENT physicians completed the questionnaire. Results The majority of the respondents acknowledged the importance of hearing screening for children; however, there was limited knowledge regarding hearing loss management and testing. Only 10 of the ENT physicians believed that a referral to an audiologist is warranted, and the majority of the respondents were not aware that a child with a confirmed permanent hearing loss should be referred to a speech pathologist or to a rehabilitation center. Managing unilateral and mild sensorineural hearing loss (SNHL) was another area about which ENT physicians have limited knowledge. Conclusion There is a strong need for professional intervention programs, providing the latest updates and standardizations in the field of audiology and pediatric rehabilitation for ENT physicians.

Applications of qualitative grounded theory methodology to investigate hearing loss: protocol for a qualitative systematic review

IntroductionHearing loss is a chronic condition affecting 12 million individuals in the UK. People with hearing loss regularly experience difficulties interacting in everyday conversations. These difficulties in communication can result...

EP09 Bamboo nodes in a patient with mixed connective tissue disease

Abstract Background Vocal cord lesions related to autoimmune diseases have been described as early as 1959, when Scarpelli et.al described a case of a woman with systemic lupus erythematosus (SLE) presented with laryngeal oedema. Pathological examination of the tissue revealed inflammatory cells and the lesions were labeled as “inflammatory nodules”. Since then numerous case reports were published describing patients with rheumatic diseases and abnormal vocal cords with Hosako et al. in 1993 proposing the term “bamboo nodes”. Methods A 27 year old female, lifelong nonsmoker, developed a husky voice which persisted through the day. She had no odynophagia or dysphagia and occasionally suffered from heartburn.She reported feeling fatigue and described a non-blanching purpuric rash affecting her lower limbs. She was referred to rheumatology and also to ear, nose and throat (ENT) specialist for further assessments including laryngeal endoscopy and autoimmune screen. Results The video laryngeal endoscopy revealed an area of linear thickening of the left mid-vocal fold. There was no evidence of reflux or muscle tension. Immunological test's revealed positive antinuclear, ribonuclear and Sm antibodies, with normal serum complement. The erythrocyte sedimentation rate was raised with normal C-reactive protein and there was a polyclonal increase of immunoglobulins. A diagnosis of mixed connective tissue disease with bamboo nodes was made. Her treatment consisted of local corticosteroid injections into the vocal cords with prednisolone 5mg (Solu-DecortinR) and systemic corticosteroids followed by hydroxychoroquine 5mg/kg and azathioprine 2mg/kg. Patient improved clinically but still requires speech therapy as adjunctive to the pharmacological treatment. Conclusion Bamboo nodes are a rare manifestation of autoimmune diseases and currently there is no gold standard on how to manage them. This case highlights the need of close collaboration between ENT, rheumatology and speech&amp;language therapy. Disclosures D.C. Christidis None. M. Lloyd None.

Diagnosis of cholesteatoma by the b1000 value DWI MRI according to the signal intensity

Objective: The cholesteatoma (CL) can be evaluated visually or numerically on an apparent diffusion coefficient (ADC) map, which obtained from at least two different b-valued diffusion-weighted imaging (DWI). In this study, we aimed to evaluate the signal intensity (SI) of the lesion both visually and numerically only on the DWI image without ADC. In case of positive results a second ‘b’ value is not required, so this method could be shorten the duration of the MRI examination.&#x0D; Material and Methods: Between January 2017 and May 2018, we included patients with chronic otitis media (COM) with a clinical suspicion of primary CL who underwent DWI. Two radiologists and one ear, nose, throat specialist evaluated the radiological images and the pathology results.&#x0D; Results: The mean SI measurement was significantly higher in the CL group by both observers (observer LR; CL: 107.94 ± 53.36, COM: 37.34 ± 14.70, observer FC; CL: 108.56 ± 50.00, COM: 37.06 ± 15.44; p&lt;0001). ROC analysis showed that a mean SI value of 48.6 was the cut-off value in predicting the diagnosis of CL. The mean SI was significantly higher in the CL group (p&lt;0.001).&#x0D; Conclusion: We demonstrated a significant difference between CL and COM concerning the diagnosis by visual and numerical signal evaluation only via b1000 valuable images. In false-positive cases, ADC is still confirmatory for high diagnostic accuracy.

MISDIAGNOSED OF NASOPHARYNGEAL CARCINOMA

Introduction : &#x0D; Nasopharyngeal carcinoma is the most common head and neck malignancy in Indonesia. Diagnosis errors often occur in nasopharyngeal carcinoma due to non-specific symptoms such as symptoms of an infectious disease that resemble the symptoms of nasopharyngeal carcinoma.&#x0D; Case Report :&#x0D; In this case, it was explained how this diagnostic error occurred. A man, 39 years old with complaints of right and left neck lumps, the patient initially came to an ear nose throat (ENT) specialist and performed fine needle aspiration (FNA) and suggested a biopsy. But the patient did not continue his treatment at an ENT doctor. The patient continued his treatment at pulmonologist and was diagnosed with glandular Tuberculosis (TB) and received TB treatment. In the following 4th month on TB therapy, a lump in the right and left neck was felt getting bigger, then the pulmonary expert refers the patient to the oncology surgeon, the oncology surgeon department then refers to the ENT specialist because of the suspicion towards nasopharyngeal carcinoma. In the ENT department biopsy is performed on the nasopharynx and the result is bilateral nasopharyngeal Non-Keratinizing Cell Carcinoma, undifferentiated (WHO type III).&#x0D; Conclusion:&#x0D; The patient was diagnosed with stage IV B nasopharyngeal carcinoma (T1N3M0). Currently, the patient has undergone chemotherapy with the paclitaxel and cisplatin regimen, and the 3rd cycle chemotherapy has been done.

An exploration of recorded otological manifestations in South African children with HIV/AIDS: A pilot study

ContextThe human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a pandemic currently presenting as one of South Africa's largest health challenges. Within the pediatric population, hearing plays a vital role in appropriate speech, language and scholastic development; therefore, unidentified and untreated otologic manifestations require exploration in this population. AimThe current study aimed to identify recorded otological manifestations in pediatric patients with HIV/AIDS attending an HIV/AIDS clinic in Johannesburg. MethodA qualitative retrospective record review design was adopted where data were collected from 100 medical records from a pediatric HIV/AIDS clinic in a public hospital in Johannesburg. Data were analyzed using qualitative statistical measures. ResultsFindings revealed that almost half (43%) of the sample presented with otological manifestations. Otitis media 15 (15%) and otorrhea 15 (15%) were the most common manifestations. A few (only 7%) of the participants with otological manifestations were referred to Audiologists and/or Ear, Nose and Throat Specialists (ENTs) for assessment and management. ConclusionsCurrent findings raise important implications for the clinical assessment and management of pediatric patients with HIV/AIDS, for the role of all team members, and for the importance of early detection and intervention of these manifestations in this population group where speech-language development is still occurring and where successful learning at school is still key.

Sinus floor elevation or referral for further diagnosis and therapy: A comparison of maxillary sinus assessment by ENT specialists and dentists using cone beam computed tomography.

To compare ear, nose, and throat (ENT) specialists and dentists assessing health or pathology of maxillary sinuses using cone beam computed tomography (CBCT). Two ENT specialists and two oral surgeons assessed 100 CBCT datasets of healthy patients referred for dental implant placement in the posterior maxilla and decided on the possibility of sinus floor elevation or the necessity for further diagnostic examinations based solely on radiographic findings. Inter-rater agreements within the same specialty were calculated with Cohen's kappa and overall agreements with Fleiss kappa, and factors influencing the decisions taken were evaluated using regression analyses. The correlation between all four raters was generally fair to moderate. The intra-specialty comparison showed a lower correlation between dentists than between ENT specialists. Absence of membrane thickening and total or subtotal sinus opacification showed the highest predictive value for a consensus in favor of sinus floor elevation and ENT referral, respectively. Flat membrane thickening with an irregular surface morphology was associated with disagreement between the examiners. Dome-shaped membrane thickenings were often considered as to be referred by dentists but not by ENTs. The assessment of maxillary sinuses using CBCT imaging exhibited unsatisfactory agreement between ENT specialists and oral surgeons. Referral guidelines based on accidental CBCT findings that aim to diagnose relevant sinus pathologies early and avoid unnecessary diagnostics and/or therapies are needed, and an initial proposal for such recommendations is provided. Further research on correct interpretation of sinus findings and a validation of the present recommendations are required.

Supervisors’ pedagogies for supporting interns to learn intra- and interprofessional collaboration: a qualitative and quantitative ego network analysis

ABSTRACT This work aims to understand intra- and interprofessional networks of general practitioners (GPs) and ear, nose, and throat specialists (ENT specialists), and in what manner supervisors in these specialties involve interns in their professional network to help them learn intra- and interprofessional collaboration. An egocentric social network approach was used to collect and analyze quantitative as well as qualitative data. For this, semi-structured interviews were held with ten GP and ten ENT specialists. GPs had significantly more interprofessional contacts than ENT specialists (p < .01), with no significant difference in the network sizes of both professions (p = .37). All supervisors involved interns in their (ego)network actively as well as more passively. They actively discussed how collaboration with other professionals evolved, or passively assumed that an intern would learn from observing the supervisors’ network interactions. Many supervisors considered the interns’ initiative essential in deciding to involve an intern in their network. Although the workplace of GPs differed notably from hospital settings where ENT specialists work, the network sizes of both were comparable. Clerkships at the general practice seemed to provide more opportunities to learn interprofessional collaboration, for example with the medical nurse. Supervisors in both specialties could involve interns more actively in their intra- and interprofessional network while interns could take more initiative to learn collaboration from their supervisors’ network.

Awareness of obstructive sleep apnea and its effects on daily life among health professionals from Karachi, Pakistan.

Sleep disturbances are be poorly documented by primary care physicians. Our objective for this survey was to assess the awareness level amongst medical and dental house officers, medical and dental practitioners, and ear, nose and throat specialists (ENTs) regarding OSA and its effects on daily life. This was a questionnaire-based survey with yes and no and true and false type questions. In order to assess knowledge, questions related to the most common signs and symptoms of OSA were selected. Questionnaires were distributed in seven medical and dental colleges in Karachi, Pakistan under graduates and above. Stratified random sampling technique was used to assess specific professionals which made a total sample size of 614. The data of this descriptive study was compiled and analyzed using SPSS version 20. 84% of the participants stated their awareness about OSA. After analyzing a detailed response in the form of questionnaires, an average of only 15% showed adequate knowledge of the problem in question, the rest was unaware of the pathophysiology, signs, symptoms and management of a patient suffering from OSA. knowledge about pathophysiology of obstructive sleep apnea and its effect on daily routine work is insufficient among health professionals. It is essential to create awareness among medical and dental fraternity regarding OSA as it is often not diagnosed and treated.