Cultural Competency and Surgical Decision Making in Otolaryngology

Ovrom, Erik; Zemene, Yilkal; Gerndt, Sophie P.; Andrade, Victor Piana de; Wiedermann, Joshua

doi:10.1177/01945998221083848

Cited by 3 publications

(5 citation statements)

References 8 publications

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“…For example, there may be alternative medicine practices and beliefs that influence patients' approaches to seeking care and should be accounted for to ensure that culturally competent care is delivered. 24 The limited data on the experiences and perspectives of front-line surgical providers in LMIC's conveys that it is critical to actively seek input from local stakeholders as they have the best contextual understanding of the challenges. 20 There are several limitations to this study.…”

Section: Qualitative Resultsmentioning

confidence: 99%

“…Both should also recognize there is an opportunity for exchange of knowledge and skills particularly relating to unique local pathology and cultural and social determinants of health. For example, there may be alternative medicine practices and beliefs that influence patients' approaches to seeking care and should be accounted for to ensure that culturally competent care is being delivered 24 . The limited data on the experiences and perspectives of front‐line surgical providers in LMIC's conveys that it is critical to actively seek input from local stakeholders as they have the best contextual understanding of the challenges 20 …”

Section: Discussionmentioning

confidence: 99%

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Bidirectional needs assessment of otolaryngology–head and neck surgery short‐term surgical trips to Ethiopia and Kenya

Chweya

Ryder

Fei‐Zhang

et al. 2023

Laryngoscope Investig Oto

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Objectives: To create an otolaryngology-specific needs assessment tool for shortterm global surgical trips and to describe our findings from its implementation.Methods: Surveys 1 and 2 were developed based on a literature review and disseminated to Low-Middle Income (LMIC) hosting institutions in Kenya and Ethiopia and to High-Income surgical trip participants (HIC), respectively. Respondents were otolaryngologists identified online, through professional organizations, and by word-ofmouth, who had participated in a surgical trip of <4 weeks.Results: HIC and LMIC respondents shared similar goals of expanding host surgical skills through education and training while building sustainable partnerships. Discrepancies were identified between LMIC desired surgical skills and supply needs and HIC current practices. Microvascular reconstruction (17.6%), advanced otologic surgery (17.6%), and FESS (14.7%) were most desired skills and high-demand equipment needs were FESS sets (89%), endoscopes (78%), and surgical drills (56%). Frequently taught techniques included advanced otologic surgery (36.6%), congenital anomaly surgery (14.6%), and FESS (14.6%) with the largest gap between LMIC-need and HIC-offerings being in microvascular reconstruction (17.6% vs. 0%). We also highlight the discrepancy in expectations of responsibility for trip logistics, research, and patient follow-up. Conclusion:We created and implemented the first otolaryngology-specific needs assessment tool in the literature. With its implementation in Ethiopia and Kenya, we were able to identify unmet needs as well as attitudes and perceptions of LMIC and HIC participants. This tool may be adapted and utilized to assess specific needs, resources, and goals of both host and visiting teams to facilitate successful global partnerships.

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Section: Qualitative Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bidirectional needs assessment of otolaryngology–head and neck surgery short‐term surgical trips to Ethiopia and Kenya

Chweya

Ryder

Fei‐Zhang

et al. 2023

Laryngoscope Investig Oto

Self Cite

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“…1 Informed consent acquisition process might also be influenced by language barriers, cultural and religious beliefs. 2,3 Evidence exists indicating that several clinical populations are at risk of mental incapacity to give informed consent to treatment, especially those patients characterized by cognitive impairment or those suffering from mental disorders. 4 Among known specific risk factors for incapacity are psychiatric symptoms, such as mania and psychosis, rather than specific psychiatric diagnoses.…”

Section: Introductionmentioning

confidence: 99%

“…To provide valid informed consent several components are required including (a) voluntariness of the decision‐making process, (b) accurate and complete information disclosure and (c) the patient's capacity to consent to treatment or clinical research 1 . Informed consent acquisition process might also be influenced by language barriers, cultural and religious beliefs 2,3 …”

Section: Introductionmentioning

confidence: 99%

Informed consent and biological agents in rheumatology and internal medicine

Mandarelli

Iannone

Ferracuti

et al. 2022

Eur J Clin Investigation

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Background:The need for highly effective therapies in rheumatologic diseases has led to the widespread and growing use of a heterogeneous class of molecules called biological agents. The increasing experience with biological agents has raised concerns about safety and efficacy issues that need to be discussed in the informed consent acquisition process. Methods:The authors performed a review of the literature on biological agents focusing on their most important characteristics concerning the informed consent procedures. Results:No studies specifically addressed the issue of informed consent in patients receiving biological agents. Several studies reported data about off-label use of biological agents usually with no obvious attention to informed consent shortcomings. Conclusion:The reported association between biological agents and serious infections or malignancies, including reactivation of latent tuberculosis, needs specific disclosure in informed consent acquisition, together with information about the possible efficacy in clinical contexts often characterized by resistance to previous treatments. Ethical and clinical issues bound to the need for experimenting with new agents with potentially serious adverse effects deserve specific attention. Studies aimed at evaluating mental capacity to consent in subjects receiving biological agents are required.

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“…Although an individualized treatment strategy devised in consultation with a multi-disciplinary team (MDT) is now highly recommended, neck cancer surgery is still one of the preliminary therapeutic regimens for patients with LC. Due to the complexity and enlarged incision area of neck cancer surgery, diminishing postoperative complications and promoting wound healing remains an inescapable issue for improving patient survival benefit (4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Characteristics and impact of postoperative surgical site infection on increased antibiotic duration among patients with laryngocarcinoma: a retrospective cohort study

Chen¹,

Yan²,

Huang³

2022

Transl Cancer Res

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Background: Whether increased antibiotic duration is necessary for surgical site infection (SSI) in patients after neck surgery is unclear. We investigated the characteristics of SSI, and the impact of SSI on increased antibiotic duration among patients with laryngocarcinoma (LC).Methods: A retrospective cohort study including consecutive LC patients ≥18 years, undergoing surgery without remote metastasis was conducted from October 2015 to February 2022 in the Department of Otolaryngology-Head and Neck Surgery, Chengdu Second People's Hospital. SSI was defined according to current guidelines. Patients were stratified into 3 groups including no-infection, lower respiratory tract infection (LRTI) and SSI. Patient characteristics was recorded. Patients were followed up until discharge.A multiple linear regression model including SSI and other factors including age, sex, comorbidity and antibiotic treatments was performed to explore the impact of SSI on increased antibiotic duration among LC patients with postoperative infection.Results: A total of 88 patients were included, with 26 (29.5%) in no-infection group, 38 (43.2%) in LRTI group, and 24 (27.3%) in SSI group. Laryngocutaneous fistula occurred in 8 (33.3%) patients with SSI. Thirteen (34.2%) patients in LRTI group and 9 (37.5%) patients in SSI group experienced postoperative infection within 2 days after surgery, and antibiotic susceptibility tests were performed in 18 (47.4%) and 12 (50.0%) patients in LRTI and SSI group, respectively (P>0.05 for both). Levofloxacin and cefoperazonesulbactam were the most commonly used antibiotics for postoperative infection in both LRTI and SSI groups (P>0.05 for both), irrespective of antibiotic susceptibility tests or not. The postoperative antibiotic duration in SSI group was significantly longer than that in LRTI group (13.62±4.28 days in SSI vs. 11.22±3.64 days in LRTI, P=0.021). A multiple linear regression analysis including SSI, age, sex, diabetes, antibiotic susceptibility test and hypoalbuminemia showed that, SSI was independently associated with increased antibiotic duration with LRTI as the reference among LC patients diagnosed [regression coefficient β=3.02, 95% confidence interval (CI): 1.01-5.03, P=0.004], whereas antibiotic susceptibility test was not (P=0.467).Conclusions: SSI may be independently associated with increased postoperative antibiotic duration in patients with LC with or without antibiotic susceptibility test.

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Cultural Competency and Surgical Decision Making in Otolaryngology

Cited by 3 publications

References 8 publications

Bidirectional needs assessment of otolaryngology–head and neck surgery short‐term surgical trips to Ethiopia and Kenya

Bidirectional needs assessment of otolaryngology–head and neck surgery short‐term surgical trips to Ethiopia and Kenya

Informed consent and biological agents in rheumatology and internal medicine

Characteristics and impact of postoperative surgical site infection on increased antibiotic duration among patients with laryngocarcinoma: a retrospective cohort study

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