Informed consent in otologic surgery: prospective study of risk recall by patients and impact of written summaries of risk

OBJECTIVES: To evaluate how much patients remember of the risks discussed with them about their otologic surgery and to evaluate whether a simple intervention, the addition of an information handout, improves recall. STUDY DESIGN: A prospective, randomized trial was undertaken in the setting of an academic tertiary care centre. METHODS: Fifty patients undergoing a variety of otologic procedures, including mastoidectomy, tympanoplasty, ossiculoplasty, and stapedectomy, were verbally consented by the operating surgeon with a standard checklist of potential surgical complications and side effects. Two surgeons participated in the study (40 patients and 10 patients). Patients were stratified into two groups: a higher education group and a lower education group. Within each group, patients were randomized to either a control group, consisting of a verbal explanation only, or an intervention group, which added a written handout to the verbal explanation. A follow-up telephone interview was conducted at an average of 20.6 days (range 14-53) to survey for recall of the complications discussed. MAIN OUTCOME MEASURES: The main outcome measure is risk recall. This is analyzed by education level and written sheet intervention. Other parameters examined are patient demographics, time elapsed from when the consent was obtained, and surgeon obtaining the consent. RESULTS: All 50 patients were interviewed in follow-up. Twenty-two patients received the handout (intervention arm), and 28 patients served as the control group. Overall recall, expressed as a percentage of risks explained, was 54% for the entire study group. For those who received the handout, the recall rate was 51%, whereas the rate was actually higher, at 56%, for those who did not receive the handout. This difference was not statistically significant. Of the specific risks discussed, patient recall was consistently high for the complications of facial nerve paralysis, 88%, and for complete hearing loss, at 88%. Other risks, such as dizziness, 31%, and change in taste, 36%, were not as commonly recalled. Receiving the handout made only a significant difference with one complication, facial nerve paralysis. CONCLUSION: The addition of a handout did not significantly alter recall of potential complications of otologic surgery with the exception of facial nerve paralysis.     

Informed consent of patients to medical intervention: role in recent medical practice

Legal relations between the patient and his/her doctor should be regulated by informed consent of the patient to medical intervention. This document must be signed by the patient or his/her legal agent after thinking over and be free will. It must be also signed by attending physician and head of the department or senior administration of the hospital.     

The role of virtual reality in surgical training in otorhinolaryngology

PURPOSE OF REVIEW: This article reviews the rationale, current status and future directions for the development and implementation of virtual reality surgical simulators as training tools. RECENT FINDINGS: The complexity of modern surgical techniques, which utilize advanced technology, presents a dilemma for surgical training. Hands-on patient experience - the traditional apprenticeship method for teaching operations - may not apply because of the learning curve for skill acquisition and patient safety expectation. The paranasal sinuses and temporal bone have intricate anatomy with a significant amount of vital structures either within the surgical field or in close proximity. The current standard of surgical care in these areas involves the use of endoscopes, cameras and microscopes, requiring additional hand-eye coordination, an accurate command of fine motor skills, and a thorough knowledge of the anatomy under magnified vision. A surgeon's disorientation or loss of perspective can lead to complications, often catastrophic and occasionally lethal. These considerations define the ideal environment for surgical simulation; not surprisingly, significant research and validation of simulators in these areas have occurred. SUMMARY: Virtual reality simulators are demonstrating validity as training and skills assessment tools. Future prototypes will find application for routine use in teaching, surgical planning and the development of new instruments and computer-assisted devices.     

The use of bipolar electrical instruments for surgical intervention in pediatric otorhinolaryngology

The authors have developed a method for the surgical intervention on ENT organs with the use of bipolar electrical instruments that allowed the efficacy of the treatment to be significantly improved (specifically a significant decrease in the blood loss was achieved and the duration of surgical intervention was reduced). The results of the treatment of 58 patients aged from 1 to 17 years with various diseases of ENT organs are presented. The figures show the bipolar scalpel and bipolar adenotome designed by A.L. Kosakovsky; the results of surgical interventions on the lymphadenoid pharyngeal ring with the use of the electrothermoadhesion technique are illustrated.     

The achievements of Karol Marcinkowski (1800-1846) in otorhinolaryngology

The short biography of Karol Marcinkowski (1800-1846) is presented first of all. His professional, scientific and social activities are described. Karol Marcinkowski was a versatile doctor. He was also the kind doctor who devoted himself completely to his patients. His surgical achievements are well known from the Medical Council at Sisters of Charity Hospital in Poznań Reports. The treatment of hypoacusis, nasal haemorrhage, rhinitis, glossitis, parotitis by K. Marcinkowski are analysed in more detail. Marcinkowski had operated fibroma iuvenile, hare-lips, larynx's abscess. He performed the plastic operations of face after injury and tumour. He removed the foreign body of trachea. His spirit will stay with us forever.