Patients with neck lumps: can they be managed in a ‘one‐stop’ clinic setting?

The present government has stated its intentions to expand the application of “one‐stop” assessments for out‐patients. To decide if this is an appropriate strategy for managing patients with neck lumps, we prospectively assessed 110 patients referred to the Neck Lump Clinic of the Otolaryngology Department of a teaching hospital. Patients were assessed clinically and with immediately reported fine needle aspiration cytology (FNAC). The accuracy of immediately reported FNAC was later compared with a final report and histology, when available. A “one‐stop” visit was defined as patients who were discharged, or placed on a waiting list, after a single consultation. Eight‐three (76%) patients did not have to return to the outpatient department, of which 59 (54%) were discharged. No changes occurred from immediate to final FNAC reports. If certain criteria are met, patients with neck lumps can be successfully managed in a “one‐stop” setting.     

Anticipated absence from work (‘sick leave’) following routine ENT surgery: are we giving the correct advice? A postal questionnaire survey

In the UK patients who undergo common ear, nose and throat (ENT) operations, and are employed, are advised to take 2 weeks sick leave before returning to their employment. A retrospective postal questionnaire survey (of adult patients who had undergone four common specific ENT operations) was conducted, to validate whether this preoperative advice given, was appropriate, and to attempt to assess the patient factors, which influenced the amount of postoperative absence from work. Among 218 questionnaires sent, 156 (71.6%) responses were returned and 132 (60.6%) were used. Analysis of the data for absence from work, showed that 58.3% had taken ≤ 2 weeks and 41.7% had taken > 2 weeks. The majority of patients (70.5%) stated that 2 weeks absence following their surgery was appropriate, whereas 5.3% reported that the period was excessive and 24.2% felt that it was inadequate. Postoperative pain (30.3%), infection (30.3%), bleeding (7.6%) and other causes (15.2%) were reported as the reasons for the delay to return to work. Nearly 31% of men and 55% of women had taken > 2 weeks of sick leave. In conclusion, the current practice of advising employed adults to take 2 weeks time off work following routine ENT surgery is appropriate. However, nearly 42% had taken > 2 weeks to return to their employment. Patients who underwent tonsillectomy and laser palatoplasty in general, required more time to recuperate prior to returning to work, when compared to those who had undergone septoplasty and functional endoscopic sinus surgery (FESS). Postoperative pain and infection were reported to be the main reasons for the delay in returning to work. Men, and self‐employed patients returned to work earlier than women and other employed groups.     

Eosinophilic Mucus Chronic Rhinosinusitis: Clinical Subgroups or a Homogeneous Pathogenic Entity?

BACKGROUND: Eosinophilic mucus chronic rhinosinusitis (EMCRS) can be subclassified using the criteria of detection of fungi in eosinophilic mucus and systemic fungal allergy. Allergic fungal sinusitis (AFS), a subgroup of EMCRS characterized by the presence of fungal allergy, is proposed to be an immunoglobulin (Ig)E-driven disease, distinct from other EMCRS subgroups. However, our recent studies cast doubt on the central pathogenic role of allergy in AFS. The purpose of this study was to examine the clinical features of EMCRS patients from the different subcategories to determine the relevance of this classification system. METHOD: The demographic, clinical, and immunologic characteristics of the EMCRS subgroups were examined prospectively and compared with three control groups: healthy volunteers, allergic rhinitis with fungal allergy, and chronic rhinosinusitis without eosinophilic mucus. RESULTS: EMCRS patients with allergy were younger than those without. There was no significant difference in clinicopathologic parameters between EMCRS subgroups. As a single group, EMCRS had a more severe sinus disease compared with chronic rhinosinusitis patients. CONCLUSIONS: AFS was not clinically distinct from other subgroups of EMCRS. However, eosinophilic mucus may mark a more severe and distinct form of sinus disease.     

The Resident 80‐Hour Work Week: How Has It Affected Surgical Specialties?

OBJECTIVES: To identify strategies employed by surgical departments to address recently implemented resident duty hour regulations, and to assess resident and faculty acceptance of these changes. METHODS: Attendees to the 2003 Residency Program Coordinator/Administrator Workshop for sub-specialties (Denver, CO) were surveyed. RESULTS: The study population included 46 respondents spanning 9 surgical sub-specialties. Forty-eight percent of programs instituted at least 1 administrative change specifically to comply with duty hour regulations. The most commonly employed strategies were the hiring of nurse practitioners or physician assistants (30%) and the use of Internet-based software to track resident duty hours (30%). Other changes included giving call responsibilities to residents on research rotations (19%), institution of home-call (13%), and assignment of a night-float resident (11%). Perceptions of program coordinators indicated that junior residents and junior faculty accepted changes better than did senior residents and senior faculty (P=.025). CONCLUSION: The resident 80-hour work week is a major health care policy change that has required academic sub-specialty departments to make significant alterations in their administrative structure. Further study is necessary to determine how these changes affect both quality of training and patient care in the short and long term.