No abstract

Traumatic TMP represents a common reason for evaluation in the ED. Despite common warnings regarding risk of injury to the tympanic membrane with use of a cotton-tipped applicator, it is still a major cause of traumatic TMPs. Other injury mechanisms also play an important role in the teenage and young adult populations.

Cultural competency has become a keystone in forming a successful doctor-patient relationship to provide culturally appropriate services that respect patients' ethno-cultural beliefs, values, attitudes, and conventions. In cosmetic surgery, an often-overlooked aspect of a patient's cultural is his and her religious beliefs. In response to this paucity of resources for cosmetic surgeons to enable them to properly service their religious patients, this project was undertaken. This review article covers the three main Abrahamic religions (Judaism, Christianity, and Islam) and was written with the assistance of a prominent bioethicist from each religion (see Acknowledgements). In discussing each religion, the article has been divided into two sections. The first section is a general overview of the religion's relationship with cosmetic surgery as summary provided by the consulting bioethicist. The second portion is an annotated review of additional resources providing the reader further details on that religion. For example, our bioethicists provide a general perspective on Christianity as a whole, and the annotated review focuses on differences between Catholics and Protestants. We recognize the heterogeneity that is inherent in religion and the cultural and geographic biases that affect it. However, we aim to provide the reader a broad and basic foundation of the relationship between Judaism, Christianity, and Islam with cosmetic surgery to begin to create common ground between the physician and the patient and improve the process of shared decision-making and thus our outcomes. This paper should be seen as a foundation to build upon rather than an authoritative source, and specific patient concerns should be addressed with the patient's own religious advisor. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: The Bethesda System standardized the reporting of thyroid cytopathology and created categories to provide an estimation of a nodule's risk of malignancy. There are limited data describing their utility in different racial-ethnic groups. Methods: A retrospective chart review of thyroid fine-needle aspirations (FNA) was performed within our health-care systems. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPVs) were calculated for the total cohort, and racial-ethnic groups. Results: The sensitivity, specificity, PPV, and NPV of the entire cohort was 93%, 77%, 57%, and 97%. Among patients who underwent surgery, African Americans contained a high number of Bethesda II FNAs (63%) compared to Hispanics (48%) and whites (45%). The sensitivity, specificity, and NPV were comparable among groups, the PPV was lowest for African Americans (43%), followed by Hispanics (60%) and whites (69%). Conclusions: The Bethesda system's predictive value may differ among racialethnic groups.

Objectives/Hypothesis To evaluate the “July effect,” as a possible risk factor for perioperative complications in otolaryngology microvascular reconstruction during the transitional period in the academic calendar. Study Design Retrospective database review. Methods Microvascular reconstruction outcomes in the National Surgical Quality Improvement Program (2005–2016) database were compared between the first academic quarter (July–September) to the last academic quarter (April–June). The primary outcome was 30‐day morbidity, and secondary outcomes included 30‐day mortality, operative complications, or postoperative adverse events. Results There were 612 and 580 patients who underwent microvascular reconstruction during the first and last academic quarters, respectively. There was no significant difference between the 30‐day mortality between the first academic quarter (1.5%) and the last academic quarter (0.7%) (P = .194). There was no difference in 30‐day morbidity (47.9% vs. 49.5%, P = .586), operative complications (wound disruption, P = .151; bleeding, P = .526; operative time, P = .162), or postoperative adverse events (deep vein thrombosis, P = .460; pneumonia, P = .737; reintubation, P = .201; pulmonary embolism, P = .452; ventilation for >48 hours, P = .769; acute renal failure, P = .500; urinary tract infection, P = .693; unplanned readmission, P = .202; and mean length of stay, P = .497). Conclusions There appears to be no July effect in microvascular reconstruction. Further studies should identify the mechanisms that preserve the safety of this operation year‐round for application to other areas of medicine who have observed the July effect. Level of Evidence NA Laryngoscope, 130:893–898, 2020