Optimizing Specimen Distribution for Residency Training in a Subspecialty-Based Surgical Pathology Rotation in a Tertiary-Care Academic Center

Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. In the past, we organized this rotation based on subjective insight. When faced with the recent need to restructure the rotation, we strove for a more evidence-based process. Our approach involved 2 primary sources of data. We quantified the number of cases and blocks submitted per case type to estimate workload and surveyed residents about the time required to gross specimens in all organ systems. A multidisciplinary committee including faculty, residents, and staff evaluated the results and used the data to model how various changes to the rotation would affect resident workload, turnaround time, and other variables. Finally, we identified rotation structures that equally distributed work and created a point-based system that capped grossing time for residents of different experience. Following implementation, we retrospectively compared turnaround time and duty hour violations before and after these changes and surveyed residents about their experiences with both systems. We evaluated the accuracy of the point-based system by examining grossing times and comparing them to the assigned point values. We found overall improvement in the rotation following the implementation. As there is essentially no literature on the subject of surgical pathology rotation organization, we hope that our experience will provide a road map to improve pathology resident education at other institutions.

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Primary Care Approach to Hearing Loss: The Hidden Disability

Ear Nose & Throat Journal ◽

10.1177/014556130508400111 ◽

2005 ◽

Vol 84 (1) ◽

pp. 26-44 ◽

Cited By ~ 40

Author(s):

Seth M. Cohen ◽

Robert F. Labadie ◽

David S. Haynes

Keyword(s):

Primary Care ◽

Hearing Loss ◽

Cochlear Implants ◽

Hearing Aids ◽

Primary Care Physicians ◽

Care Center ◽

Tertiary Care ◽

Local Resources ◽

Academic Center ◽

Care Approach

We report the results of a survey designed to investigate audiologic referral patterns of primary care physicians and, more specifically, their referral of patients for hearing aids and cochlear implants. Three hundred internal medicine and family medicine physicians were identified from a referral basin of a tertiary care center and chosen randomly to be faxed questionnaires concerning their views about patients with hearing loss, hearing loss screening and referral practices, and availability of local resources. Of the 260 physicians who received a questionnaire, 85 (32.7%) responded. Of their communities (60% of which had populations of fewer than 50,000), 82.4% had an otolaryngologist and 40% had access to an academic center. Although 97.6% of the responding physicians indicated that hearing loss affected patients’ quality of life, only 60% assessed patients for hearing loss. “Lack of time” and “more pressing issues” were the most common reasons given for not evaluating patients for hearing loss. Although 76 physicians (89.4%) said they were aware of cochlear implants, only 22 (25.9%) had referred patients for implant evaluation. Lack of referral most commonly resulted from uncertainties about “where to refer” and “which patients were potential candidates.” The results of this survey suggest that a large percentage of primary care physicians do not routinely test for hearing impairment in adults.

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Patient Perception and Duration of Pain after Microdirect Laryngoscopy

Otolaryngology ◽

10.1177/0194599820907904 ◽

2020 ◽

Vol 162 (5) ◽

pp. 702-708

Author(s):

Trylon Matthew Tsang ◽

Oliver Brett ◽

Amanda Hu

Keyword(s):

Short Form ◽

Tertiary Care ◽

Case Series ◽

Patient Perception ◽

Mcgill Pain Questionnaire ◽

Academic Center ◽

Mallampati Score ◽

Sensory Score ◽

Present Pain Intensity ◽

Pain History

Objective Postoperative pain is an important part of the patient’s surgical experience. The objective was to evaluate patient perception and duration of pain after microdirect laryngoscopy (MDL). Study Design Case series with planned data collection. Setting Tertiary care, academic center. Subjects and Methods Adult patients undergoing MDL were administered the short-form McGill Pain Questionnaire (SF-MPQ) before surgery and on postoperative days (PODs) 1, 3, and 7. Demographic and clinical data were collected. Results In total, 130 patients (mean age 52.6 years, 84 male) participated in the study. About 46.2% required analgesia on POD 1, but only 23.1% required opioids. Overall, mild levels of pain were reported on the SF-MPQ: sensory score, affective score, total score, present pain intensity (PPI), and visual analog scale (VAS). Patients reported a significant increase in pain on POD 1, with decreases in pain on PODs 3 and 7. Pain score returned to preoperative values for total score and affective score on POD 7 but remained significantly elevated for PPI, VAS, and sensory score. None of the following factors were associated with increased pain: age, sex, body mass index, Mallampati score, Cormack score, laryngoscope used, type of MDL, time under anesthesia, employment status, intubation, Voice Handicap Index 10, and chronic pain history. Conclusion Although mild levels of pain were reported after MDL, the pain persisted for up to 7 days. No demographic or clinical factors were found to be associated with increased pain. This study was one of the few prospective studies evaluating pain after MDL.

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Comparison of Referral Pathways in Otolaryngology at a Public Versus Private Academic Center

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419887990 ◽

2019 ◽

Vol 129 (4) ◽

pp. 369-375

Author(s):

Caitlin Bertelsen ◽

Janet S. Choi ◽

Anna Jackanich ◽

Marshall Ge ◽

Gordon H. Sun ◽

...

Keyword(s):

Surgical Intervention ◽

Tertiary Care ◽

Surgical Care ◽

Safety Net ◽

Clinic Visit ◽

Level Of Evidence ◽

Sociodemographic Differences ◽

Academic Center ◽

Safety Net Hospital ◽

Type Of Surgery

Objective: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). Methods: Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. Results: PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. Conclusions: Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. Level of Evidence: 2c

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High Proportion of Indeterminate Qua.jpegERON-TB Gold In-Tube Results in an Inpatient Population Is Related to Host Factors and Preanalytical Steps

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu088 ◽

2014 ◽

Vol 1 (2) ◽

Cited By ~ 7

Author(s):

Valeria Fabre ◽

Shmuel Shoham ◽

Kathleen R. Page ◽

Maunank Shah

Keyword(s):

Skin Testing ◽

Tertiary Care ◽

Latent Tuberculosis ◽

Host Factors ◽

Inpatient Setting ◽

Tuberculin Skin Testing ◽

Sample Collection ◽

Academic Center ◽

Targeted Testing ◽

Mitogen Response

Background. Qua.jpegERON-TB Gold In-Tube test (QFT-GIT) can be used as an alternative to tuberculin skin testing (TST) for the targeted testing of latent tuberculosis. Due to many shortcomings with TST, QFT-GIT usage is increasing. QFT-GIT implementation in the inpatient setting remains unclear. Methods. We retrospectively ide.jpegied patients admitted to a tertiary care academic center who received either a TST or a QFT-GIT in the 18 months prior to and after QFT-GIT implementation in March 2012. Risk factors associated with indeterminate results were evaluated. Results. The proportion of inpatients receiving a test for tuberculosis infection doubled following QFT-GIT implementation (1.4% vs 2.9%). After QFT-GIT became available, 75% of tested people received a QFT-GIT and 25% received a TST. We found indeterminate test results in 19.8%. Independent predictors of indeterminate results were female sex (adjusted odds ratio [AOR], 1.64), lymphopenia (AOR, 2.21), hypoalbuminemia (AOR, 6.81) and sample collection by nonphlebotomists (AOR, 3.0, vs phlebotomists). Of patients who had indeterminate results, 42% had a subsequent indeterminate result on repeat testing. All indeterminate results were due to a low mitogen response. Conclusions. QFT-GIT testing in the inpatient setting is associated with a high proportion of indeterminate results that is associated with host factors and preanalytical errors. Careful selection of patients to be tested and training on sample processing for QFT-GIT testing should be considered to decrease indeterminate results.

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Nerve of Origin, Tumor Size, Hearing Preservation, and Facial Nerve Outcomes in 359 Vestibular Schwannoma Resections at a Tertiary Care Academic Center

The Laryngoscope ◽

10.1097/mlg.0b013e3181453a07 ◽

2007 ◽

Vol 117 (12) ◽

pp. 2087-2092 ◽

Cited By ~ 84

Author(s):

Abraham Jacob ◽

Lawrence L. Robinson ◽

Jared S. Bortman ◽

Lianbo Yu ◽

Edward E. Dodson ◽

...

Keyword(s):

Facial Nerve ◽

Vestibular Schwannoma ◽

Tumor Size ◽

Tertiary Care ◽

Hearing Preservation ◽

Academic Center ◽

Nerve Of Origin

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MON-547 Post-Surgically Discovered Differentiated Thyroid Microcarcinomas Are More Commonly Found in Patients eith Chronic Lymphocytic Thyroiditis Compared to Those with Multinodular Goiter or Graves' Disease

Journal of the Endocrine Society ◽

10.1210/js.2019-mon-547 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Rodis Paparodis ◽

Karvounis Evaggelos ◽

Dimitra Bantouna ◽

Charilaos Chourpiliadis ◽

Hourpiliadi Hara ◽

...

Keyword(s):

Thyroid Cancer ◽

Thyroid Surgery ◽

Multinodular Goiter ◽

Tertiary Care ◽

Surgical Pathology ◽

Follicular Neoplasm ◽

Graves Disease ◽

Tumor Diameter ◽

Chronic Lymphocytic Thyroiditis ◽

Lymphocytic Thyroiditis

Abstract Introduction: Incidental finding of differentiated thyroid microcarcinomas (DTMc) in patients with thyroid nodules, undergoing thyroid surgery for benign indications, have become increasingly common. Even though carcinogenesis might relate to the background disease of the gland, the incidence of DTMc in the setting of various thyroid disorders remains unclear. We designed the present study to address this question. Methods/ Subjects: We reviewed the data from two prospectively collected databases of patients undergoing thyroid surgery in two high-volume tertiary care referral centers, one in the USA (A) and the other one in Greece (B) over 14 consecutive years. We collected data on the preoperative surgical indication, FNA cytology and surgical pathology. We excluded subjects operated for thyroid cancer or indications at high risk for malignancy (FNA suspicious for thyroid cancer, follicular neoplasm, suspicious for follicular neoplasm, FLUS/AUS, cellular specimen or sonographic features of malignancy), and those with post-surgical pathology consistent with PTC >9mm in largest diameter. We split our subjects based on pathology data in those with chronic lymphocytic thyroiditis (CLT), Graves disease (GR) or multinodular goiter (MNG). Incidence of DTMc or features of tumor aggressiveness were compared among groups, using Fischer’ s exact test and odds ratios (OR) were calculated. Categorical values were compared with Kruskal Wallis test. P values <0.05 were deemed significant. Results: We reviewed 6096 cases of thyroid surgery (A:2711, B:3385). We included 3909 subjects. Overall 609 (15.6%) DTMc were identified [A:256/2003 (12.8%), B:353/1906(18.5%) OR 0.79, p<0.0001]. CLT was present in 626 subjects; where DTMc was present in 155 (24.8%) [A:83/410 (20.2%), B: 72/216 (33.3%), OR 0.51 p<0.001]. GR was present in 377 subjects; where DTMc was present in 39 (10.3%) subjects [A:14/209 (6.7%) B: 25/168 (14.9%) OR 0.41, p=0.01]. MNG was present in 1964 subjects; where DTMc was present in 314 (15.9%) subjects [A: 58/686 (8.5%), B:256/1278 (20.0%)]. The incidence of DTMc was significantly higher in CLT compared to MNG (OR 1.73) or GR (OR 2.85) (p<0.001 for both) and in MNG compared to GR (OR 1.64, p=0.0064). Maximal tumor diameter was not significantly different among groups (CLT 0.46cm, MNG 0.44cm, GR 0.44cm, p=0.56). Conclusions: Incidentally discovered differentiated thyroid microcarcinomas are more commonly identified in surgical specimens from subjects with chronic lymphocytic thyroiditis as compared to patients with multinodular goiter, while patients with Graves' disease present with a much smaller incidence compared to both groups. This data supports previously published findings that euthyroid Hashimoto thyroiditis could allow for carcinogenesis, while Graves disease could have a protective role.

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Prospective Evaluation of Infection Episodes in Cancer Patients in a Tertiary Care Academic Center: Microbiological Features and Risk Factors for Mortality

Turkish Journal of Hematology ◽

10.4274/tjh.2015.0216 ◽

2016 ◽

Vol 33 (4) ◽

pp. 311-319 ◽

Cited By ~ 3

Author(s):

Nursel Çalık Başaran ◽

Ergun Karaağaoğlu ◽

Gülşen Hasçelik ◽

Mine Durusu Tanrıöver ◽

Murat Akova

Keyword(s):

Risk Factors ◽

Cancer Patients ◽

Tertiary Care ◽

Prospective Evaluation ◽

Academic Center

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Ambulatory neurosurgery in the COVID-19 era: patient and provider satisfaction with telemedicine

Neurosurgical FOCUS ◽

10.3171/2020.9.focus20596 ◽

2020 ◽

Vol 49 (6) ◽

pp. E13

Author(s):

Alina Mohanty ◽

Visish M. Srinivasan ◽

Jan-Karl Burkhardt ◽

Jeremiah Johnson ◽

Akash J. Patel ◽

...

Keyword(s):

Quality Improvement ◽

Tertiary Care ◽

Provider Satisfaction ◽

Academic Center ◽

Effective Form ◽

High Satisfaction ◽

Positive Experiences ◽

Provider Survey ◽

Future Practice ◽

Question Survey

OBJECTIVETelemedicine has rapidly expanded in the recent years as technologies have afforded healthcare practitioners the ability to diagnose and treat patients remotely. Due to the COVID-19 pandemic, nonessential clinical visits were greatly limited, and much of the outpatient neurosurgical practice at the authors’ institution was shifted quickly to telehealth. Although there are prior data suggesting that the use of telemedicine is satisfactory in other surgical fields, data in neurosurgery are limited. This study aimed to investigate both patient and provider satisfaction with telemedicine and its strengths and limitations in outpatient neurosurgery visits.METHODSThis quality improvement study was designed to analyze provider and patient satisfaction with telemedicine consultations in an outpatient neurosurgery clinic setting at a tertiary care, large-volume, academic center. The authors designed an 11-question survey for neurosurgical providers and a 13-question survey for patients using both closed 5-point Likert scale responses and multiple choice responses. The questionnaires were administered to patients and providers during the period when the clinic restricted in-person visits. At the conclusion of the study, the overall data were analyzed qualitatively and quantitatively.RESULTSDuring the study period, 607 surveys were sent out to patients seen by telehealth at the authors’ academic center, and 122 responses were received. For the provider survey, 85 surveys were sent out to providers at the authors’ center and other academic centers, and 40 surveys were received. Ninety-two percent of patients agreed or strongly agreed that they were satisfied with that particular telehealth visit. Eighty-eight percent of patients agreed that their telehealth visit was more convenient for them than an in-person visit, but only 36% of patients stated they would like their future visits to be telehealth. Sixty-three percent of providers agreed that telehealth visits were more convenient for them than in-person visits, and 85% of responding providers stated that they wished to incorporate telehealth into their future practice.CONCLUSIONSAlthough the authors’ transition to telehealth was both rapid and unexpected, most providers and patients reported positive experiences with their telemedicine visits and found telemedicine to be an effective form of ambulatory neurosurgical care. Not all patients preferred telemedicine visits over in-person visits, but the high satisfaction with telemedicine by both providers and patients is promising to the future expansion of telehealth in ambulatory neurosurgery.

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Pandemic and medical education of surgical residents in a tertiary care hospital in India: a cross-sectional study

International Surgery Journal ◽

10.18203/2349-2902.isj20213979 ◽

2021 ◽

Vol 8 (10) ◽

pp. 2974

Author(s):

Raghul Sekar ◽

Arun Alexander ◽

Kalaiarasi Raja ◽

Sunil Kumar Saxena

Keyword(s):

Medical Education ◽

Residency Training ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Working Hours ◽

Maslach Burnout Inventory ◽

Care Hospital ◽

Cross Sectional ◽

Surgical Residents ◽

Hands On

Background: COVID-19 pandemic has brought tremendous changes in the functioning of residency training. The impact was maximal on surgical residents whose hands-on training was affected. This study aimed to assess the effect of COVID-19 pandemic on medical education and training of surgical residents. Methods: A single institutional cross-sectional survey was conducted in a large tertiary care hospital in India. It included residents in various surgical specialties. The survey was divided into six sections to cover all the aspects of their residency.Results: Out of 106 residents who participated in the study, 95 (59.3%) had worked in the dedicated COVID-19 facility, and 97 (91.5%) feared transmitting the infection to their family members. There was a considerable reduction in both elective and emergency surgeries performed by residents (p<0.05).There was a significant reduction in the working hours per day, helping residents get more time for research work. Further Maslach burnout inventory score was 7.43±2.35 after the pandemic, which shows a statistically significant reduction (p<0.001) in residents' burnout.Conclusions: Surgical residents had to balance their residency training with caring for COVID-19 patients. There had been a decrease in their hands-on training, clinical exposure, and working hours. Both theoretical and practical training of surgical residents has been affected during this pandemic. This survey can be used as a tool to improve the lives of surgical residents in any pandemic situation or during further waves of COVID-19.

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