Objective

A preliminary comparison of the program experience and costs associated with the virtual interview season during the 2020-2021 COVID-19 pandemic against the traditional in-person interview process during the 2019-2020 interview season.

Study design

Cross-sectional survey.

Setting

Our institutional program launched an online survey via REDCap to otolaryngology programs across the country.

Methods

A 33-item survey was sent to otolaryngology residency program directors regarding their experience and costs associated with virtual interviews during the 2020-2021 cycle and in-person interviews during the previous 2019-2020 cycle. Purchasing cost and opportunity cost were calculated for each program.

Results

Twenty-two programs sent back completed survey responses. Program responses were equally represented among all regions of the United States. In the 2020-2021 interview season, programs received more applications (mean, 400 vs 336 the year prior, P < .001) for a similar number of residency spots per program (3.04 in 2020-2021 vs 3.0 2019-2020, P = .715). The virtual interview led to more half-day interviews, a shorter duration of each interview, and fewer interviews completed per interview date. Purchasing cost decreased by $1940.46 (73%), and person-hours dedicated to the interview process decreased by 52.36 with the virtual interview. Total savings per program with virtual interviews were an estimated $6941.66.

Conclusions

Virtual interviews in the setting of the COVID-19 pandemic led to a shift in application and interview patterns and was associated with a reduction in costs for programs when compared with the in-person interview format.

Background The COVID-19 pandemic forced an abrupt reevaluation of traditional subinternship models in surgical education, with the adoption of virtual subinternships (VSIs) emerging as a prominent response. This review assesses VSIs as a cost-effective, equitable alternative, especially as virtual education continues since the end of the Federal COVID-19 Public Health Emergency and may be crucial in future crises. Objective Our research question asks how curriculum delivery, learner outcomes, and interpretation of program fit occur within the VSI model. Methods A thorough systematic review was conducted across multiple databases, including PubMed, Web of Science, Google Scholar, and Embase, adhering to PRISMA guidelines, and spanning publications in English from January 2020 to June 2023. Studies were selected based on review of VSI curriculum content, delivery formats, evaluation techniques, and student outcomes. Exclusion criteria encompassed non-original research or articles lacking comprehensive curriculum descriptions and associated outcomes. We assessed bias in study selection through independent double review and synthesized findings using thematic analysis. Results Of 1436 articles, 13 met the inclusion criteria. They encompassed a range of surgical fields and highlighted the diverse approaches to VSI implementation. Key themes included the integration of interactive learning sessions, balance between imparting knowledge and program familiarization, and mixed methods of program evaluation. Despite high student satisfaction reported, faculty feedback indicated it was difficult to provide an evaluation of student skills in this context and more challenging to assess students fit for residency programs. Conclusions VSIs were effective in delivering curriculum and engaging learners, highlighting diverse implementation approach challenges in assessing student skills and program fit.

BACKGROUND: The COVID-19 pandemic has made facial masks an essential part of daily life. While protective facial masks are crucial to help the spread of viral infections, they are common causes of facial skin breakdown, acne, and superficial injuries. Masks with elastic ear loops are also particularly likely to cause ear pressure injuries. CASE REPORT: Herein, we present a case of a patient experiencing homelessness found to have significant postauricular wounds due to prolonged mask use in the context of the Covid-19 pandemic. These injuries led to bilateral erosion of the helix with partial avulsion of the ear and mask ear loops eroding into cartilage. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We describe a rare complication of mask use and highlight the difficulties the COVID pandemic has made in providing adequate care for chronic head and neck wounds amongst the homeless population. While PPE remains an important part of decreasing the risk of the spread of infections, it is important to recognize the vulnerabilities of the homeless population during the COVID pandemic and how best to care for novel auricular wounds.

Objective

There exists a paucity of data regarding the mechanism and manometric findings in retrograde cricopharyngeal dysfunction (RCPD). In this study, we aimed to compare esophageal physiologic findings between patients with RCPD compared to an asymptomatic cohort.

Study design

Case-control study.

Setting

Tertiary Care Center.

Methods

Esophageal high-resolution impedance manometry was completed preoperatively in patients diagnosed with RCPD. Manometric data were compared between the RCPD and asymptomatic cohorts. A 2:1 age-sex-matched asymptomatic cohort was used as the control group. Treatment response was assessed among the RCPD cohort.

Results

Thirty-nine patients are included: 13 RCPD [mean age: 31.1 (SD: 12.6) years, female sex: 11 (85%)] and 26 asymptomatic [mean age: 32.1 (SD: 1.5) years, female sex: 22 (85%)]. The RCPD cohort, compared to the asymptomatic cohort, exhibited significantly greater upper esophageal sphincter (UES) length [4.5 (SD: 0.7) vs 3.7 (0.9) cm, P = .01] and higher UES basal pressures [91.9 (35.0) vs 49.7 (25.5) mm Hg, P = .002]. Patients with RCPD demonstrated higher rates of ineffective swallows [70.0% (31.6%) vs 15.4% (21.6%), P < .001] and incomplete bolus clearance [81% (22.0%) vs 21.8% (30.0%), P < .001]. All patients who underwent cricopharyngeal botulinum injections experienced initial improvement of symptoms with 3 patients requiring repeat intervention.

Conclusion

RCPD is associated with a longer UES, elevated UES basal pressures, and an increased incidence of ineffective esophageal motility. This study is the first to compare preoperative manometry results among patients with RCPD to those of an asymptomatic cohort, providing insights into the mechanism of RCPD.

Epidemiologic evidence indicates that regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) provides a protective effect against the development of colorectal, breast, and head and neck cancers. Genomic characterization of these cancers has lent considerable insight into the subpopulations of cancer patients who are most likely to benefit from NSAID therapy. The PIK3CA gene encodes the catalytic subunit of phosphatidylinositol 3-kinase (PI3K) and is among the most frequently mutated genes in solid tumor malignancies. Cancer-associated mutations in PIK3CA promote signaling via the PI3K pathway and stimulate tumor cell growth. In addition, activation of the PI3K pathway leads to induction of cyclooxygenase-2 (COX-2) enzyme and production of immunosuppressive prostaglandin E₂ (PGE₂). Notably, in both colorectal cancer and head and neck cancer the subpopulation of patients that benefit from NSAID use is restricted to those whose tumors exhibit PIK3CA genomic alterations. Preclinical studies, particularly in models of head and neck cancer, support the hypothesis that the chemopreventive impact of NSAIDs may be due, in part, to inhibition of COX-2 and reduction of PGE₂ levels in the tumor microenvironment.