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Burnout and well-being in otolaryngology trainees:A systematic review

World Journal of Otorhinolaryngology-Head and Neck Surgery 2022年第2期8卷 118-125页

作者： Skye K.Lawlor Christopher M.Low Matthew L.Carlson Karthik Rajasekaran garret choby Department of Otolaryngology-Head and Neck Surgery Mayo ClinicRochesterMinnesotaUSA Department of Neurologic Surgery Mayo ClinicRochesterMinnesotaUSA Department of Otolaryngology-Head and Neck Surgery University of PennsylvaniaPennsylvaniaUSA

Objective:To comprehensively review the recent published literature to characterize current trends of burnout and well-being among otolaryngology trainees.Methods:Study design:systematic review and meta-analysis.A comprehensive literature review from 2000 to 2021 of studies related to otolaryngology resident burnout and well-being,as well as the general topic of well-being among surgical residents was completed.All included studies were summarized qualitatively.For the quantitative analysis,only articles reporting a Maslach burnout inventory(MBI),modified MBI or Mini-Z-Burnout assessment were included.Results:Twenty-five articles were included in the qualitative summary and nine articles in the quantitative analysis.In the qualitative summary,trainees were reported to have increased levels of distress and emotional hardening compared to attending otolaryngologists.Total hours worked per week and female gender were associated with worsened well-being.Residency program strategies to improve trainee well-being include program-sponsored wellness activities,dedicated wellness champions,and assistance with clerical burden.Implementation of protected nonclinical time has been shown to decrease burnout and increase well-being among trainees.Moreover,formal trainee mentorship programs have also been shown to reduce trainee burnout and stress.In the quantitative analysis,rates of trainee burnout ranged from 29.7%to 86%with an overall trend towards reduced rates of burnout from 2006 to 2021.Utilizing a weighted average,the overall burnout among otolaryngology residents was 58.6%.Conclusions:Rates of burnout remain high among otolaryngology trainees.Implementing formal mentorship programs and providing protected time during regular work hours appear to be effective tools to improve resident well-being.

关键词： burnout ENT otolaryngology residents wellness

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Three-hundred and sixty degrees of surgical approaches to the maxillary sinus

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2022年第1期8卷 42-53页

作者： Natalia C.Rezende Carlos D.Pinheiro-Neto Luciano C.P.C.Leonel Jamie J.Van Gompel Maria Peris-Celda garret choby Division of Rhinology and Skull Base Surgery Department of Otolaryngology-Head&Neck SurgeryMayo ClinicRochesterMinnesotaUSA Department of Neurologic Surgery Mayo ClinicRochesterMinnesotaUSA

Objectives:To demonstrate three-hundred and sixty degrees of maxillary sinus(MS)surgical approaches using cadaveric dissections,highlighting the step-by-step anatomy of each procedure.Methods:Two latex-injected cadaveric specimens were utilized to perform surgical dissections to demonstrate different approaches to the MS.The procedures were documented with macroscopic images and endoscopic pictures.Results:Dissections were performed to approach the MS medially(endoscopic maxillary antrostomy and ethmoidectomy),anteriorly(Caldwell-Luc),superiorly(transconjunctival/transorbital approach),inferiorly(transpalatal approach),and posterolaterally(preauricular hemicoronal approach).Conclusion:A number of approaches have been described to address pathology in the MS.Surgeons should be familiar with indications,limitations,and surgical anatomy from different perspectives to approach the MS.This paper illustrates anatomic approaches to the MS with detailed step-by-step cadaveric dissections and case examples.

关键词： anatomy Caldwell-Luc dissection endoscopic sinus surgery infratemporal fossa maxillary sinus pterygopalatine fossa

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Presentation and outcomes of chronic rhinosinusitis following liver and kidney transplant

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2021年第9期7卷 139-145页

作者： Aviv Spillinger Christopher M.Low Byron M.Smith Janalee K.Stokken Erin K.O'Brien garret choby Deportment of Otoloryngolosy-Head and Neck Surgery Mayo ClinicRochesterMN55905USA Biomedical Statistics and Informatics Mayo ClinicRochesterMN55905USA

non-invasive chronic rhinosinusitis(CRS)following liver or kidney transplant and determine factors associated with disease-related complications,selection of endoscopic sinus surgery(ESS),and disease resolution in this population.Study design:Retrospective chart review.Setting:An academic tertiary care center(Mayo Clinic,Rochester,Minnesota).Subjects and methods:Liver and kidney transplant recipients evaluated by Mayo Clinic otolaryngologists for CRS between 1998 and 2018 were identified.Univariate and multivariate logistic regression analyses were used to determine patient factors and treatment modalities associated with developing complications,selection of ESS,and disease resolution.Results:Fifty-seven patients met inclusion criteria.No patients developed intraorbital or intracranial complications of their CRS.Multivariate modeling demonstrated that the presence of polyps(P=0.036)was associated with undergoing ESS within one year of presentation.A higher Lund-Mackay(LM)computed tomography score(P=0.023)and older age(P=0.018)were significantly associated with decreased disease resolution.No other factors were significantly associated with the use of endoscopic sinus surgery within one year of otolaryngology presentation or resolution of CRS in this cohort.Conclusion:The risk of developing CRS-related intraorbital or intracranial complications in this immunecompromised patient cohort may be lower than originally thought.For liver-and kidney-recipients stable on immunosuppressive medication for many years,prognostic factors for CRS may mirror those for immunocompetent patients.

关键词： Rhinosinusitis Chronic rhinosinusitis Non-invasive rhinosinusitis Kidney transplant Liver transplant Immunocompromised Immunosuppressed

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Evidence for a ‘preinvasive’ variant of fungal sinusitis: Tissue invasion without angioinvasion

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2017年第1期3卷 -页

作者： Hassan Paknezhad Nicole A.Borchard Greg W.Charville Noel F.Ayoub garret W.choby Andrew Thamboo Jayakar V.Nayak Division of Rhinology Department of Otolaryngology-Head and Neck SurgeryStanford University School of MedicineUSA

Clinical experience has suggested the existence of an intermediate form of fungal sinusitis between the categories of non-invasive fungal sinusitis (non-IFS) and invasive fungal sinusitis (IFS). This fungal sinusitis variant demonstrates unhealthy mucosa by endoscopy with fungal invasion, but lacks angioinvasion microscopically, representing what clinically behaves as a 'pre-invasive' subtype of fungal sinusitis. Unlike non-IFS disease, patients with pre-invasive fungal sinusitis were still felt to require anti-fungal medications due to histologic presence of invasive fungus. While sharing some clinical features of IFS, these 'intermediate' patients were successfully spared extended and repeated surgical debridements given the microscopic findings, and have been successfully treated with shorter courses of antifungal therapy. These select patients have had favorable outcomes when managed in a judicious and semi-aggressive manner, in an undefined zone between the treatments for routine fungal ball and aggressive IFS.

关键词： Antifungal therapy Chronic rhinosinusitis Fungal ball Fungal sinusitis IFS Immunocompromised Immunosuppressed Invasive fungal sinusitis Visual loss

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