Description of Otolaryngology (OTO) Disease in Houseless Patients on O'ahu, Hawai'i.

This retrospective study assesses the prevalence of otolaryngology (OTO) disease in houseless patients on O'ahu based on data from the Houseless Outreach and Medical Education (HOME) clinics, a medical student-run, primary health care service. It is important to note that this data represents only a snapshot in time of the OTO diseases present in this population. Records were examined from September 3, 2020 to September 30, 2021.

Complications of Corticosteroid Therapy: A Comprehensive Literature Review.

Corticosteroids are among the most prescribed medications, particularly during the COVID-19 era. The literature has clearly highlighted the dangers of prolonged, high-dose corticosteroid use, which is important for clinicians to consider before treating patients in their clinical practices. The objective of this article is to review the literature on complications of corticosteroid use, review corticosteroid pharmacokinetics, and provide an updated reference on risks associated with corticosteroid therapy, especially at higher doses.

Medicolegal Considerations Regarding Steroid Use in Otolaryngology: A Review of the Literature.

Objective: To review the literature on corticosteroid use and provide recommendations on patient counseling and/or consent to promote judicious prescribing and reduce the incidence of corticosteroid-related lawsuits.

Method: A conventional literature search of PubMed on corticosteroid-related medicolegal cases was undertaken. Search terms included "medicolegal," "otolaryngology," and "adrenocorticosteroids.

Oral and intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss.

Objective: To investigate the role of intratympanic (IT) therapy in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL).

Methods: This study was a retrospective review. Patients were treated for ISSNHL from January 1, 2011 to April 12, 2015 with the following: pre/posttreatment audios, treatment initiated ≤90 days and idiopathic etiology.

Sudden Sensorineural Hearing Loss: Primary Care Update.

The primary care physician's role in recognizing sudden sensorineural hearing (SSNHL) loss and delivering initial treatment is critical in the management of the syndrome. This role involves recognizing its clinical symptoms, distinguishing it from conductive hearing loss with the Weber tuning fork or the Rauch hum test, and urgent administration of high dose oral corticosteroids. Diagnosis and treatment should not be delayed for audiometric testing or referral to otolaryngology.

Developing next-generation telehealth tools and technologies: patients, systems, and data perspectives.

The major goals of telemedicine today are to develop next-generation telehealth tools and technologies to enhance healthcare delivery to medically underserved populations using telecommunication technology, to increase access to medical specialty services while decreasing healthcare costs, and to provide training of healthcare providers, clinical trainees, and students in health-related fields. Key drivers for these tools and technologies are the need and interest to collaborate among telehealth stakeholders, including patients, patient communities, research funders, researchers, healthcare services providers, professional societies, industry, healthcare management/economists, and healthcare policy makers. In the development, marketing, adoption, and implementation of these tools and technologies, communication, training, cultural sensitivity, and end-user customization are critical pieces to the process.

Alarm limit settings for early warning systems to identify at-risk patients.

Aim: This paper is a report of a study conducted to provide objective data to assist with setting alarm limits for early warning systems.

Background: Early warning systems are used to provide timely detection of patient deterioration outside of critical care areas, but with little data from the general ward population to guide alarm limit settings. Monitoring systems used in critical care areas are known for excellent sensitivity in detecting signs of deterioration, but give high false positive alarm rates, which are managed with nurses caring for two or fewer patients.

Impact of continuous vigilance monitoring on nursing workflow.

Background: Increasing nursing time in patient care is beneficial in improving patient outcomes, but this is proving increasingly difficult with the nursing shortage, budgetary constraints, and higher patient acuity.

Objective: Nursing workflow was evaluated after the implementation of a continuous vigilance monitoring system to determine if the system enhanced patient-centric nursing care.

Methods: Work sampling observations were conducted at 3 hospitals for 6 categories of nursing activities (direct and indirect nursing, documentation, administrative, housekeeping, and miscellaneous) at baseline and at 3 and 9 months.

Evaluating a virtual reality motor-skills simulator.

Evaluation was performed on a prototype low-cost virtual-reality motor-skills simulator (VRMSS) created at the Telehealth Research Institute, John A. Burns School of Medicine, in conjunction with the National Biocomputation Center, Stanford University. The VRMSS is specifically designed to teach baseline fine-motor skills used in surgery that are based on a matrix of elemental technical skills that comprise the tenets of surgical technique.

The effect of dynamic intermittent hypoxic conditioning on arterial oxygen saturation.

Background: Increases in arterial oxygen saturation (SaO2) in response to intermittent hypoxic exposure (IHE) are well established. However, IHE protocols have historically involved static hypoxic environments. The effect of a dynamic hypoxic environment on SaO2 is not known.

Teaching mass casualty triage skills using iterative multimanikin simulations.

Objective: Effective mass casualty triage requires rapid and accurate decision making. First responders need to be trained, but opportunities to practice triage and receive individualized feedback during traditional mass casualty (MC) exercises are uncommon. It was hypothesized that novice learners would improve in speed, accuracy, and self-efficacy after deliberate practice triaging multiple simulated casualties in a MC exercise using high-fidelity manikins.

Teaching mass casualty triage skills using immersive three-dimensional virtual reality.

Objectives: Virtual reality (VR) environments offer potential advantages over traditional paper methods, manikin simulation, and live drills for mass casualty training and assessment. The authors measured the acquisition of triage skills by novice learners after exposing them to three sequential scenarios (A, B, and C) of five simulated patients each in a fully immersed three-dimensional VR environment. The hypothesis was that learners would improve in speed, accuracy, and self-efficacy.

Centralized data recording for a distributed surgical skills trainer to facilitate automated proficiency evaluation.

Virtual reality simulators have the capability to automatically record user performance data in an unbiased, cost effective manner that is also less error prone than manual methods. Centralized data recording simplifies proficiency evaluation even more; however is not commonly available to date for surgical skills trainers. We will detail our approach in implementing a framework for distributed score recording over the Internet using a database for persistent storage.

Project hydra--a new paradigm of internet-based surgical simulation.

Computer-based surgical simulation systems have produced tremendous benefits and demonstrated validity as a better method for many areas of surgical skills acquisition. However, despite these benefits, broad proliferation of these systems has continued to be elusive. While in large part this lag in adoption of this technology is due to social factors (organizational momentum, curriculum integration difficulties, etc), the cost of computer-based simulation systems has certainly remained a major deterrent toward broad deployment.

A surgical and fine-motor skills trainer for everyone? Touch and force-feedback in a virtual reality environment for surgical training.

Access to the laboratory component of a class is limited by resources, while lab training is not currently possible for distance learning. To overcome the problem a solution is proposed to enable hands-on, interactive, objectively scored and appropriately mentored learning in a widely accessible environment. The proposed solution is the Virtual-Reality Motor-Skills trainer to teach basic fine-motor skills using Haptics for touch and feel interaction as well as a 3D virtual reality environment for visualization.

Distance learning on the Internet: web-based archived curriculum.

Web-based education through archived educational modules offers a significant opportunity to provide didactic education. By archiving lectures and teaching materials, it reduces the educators' time of preparation, especially when many students will need to take the same curriculum over a long period of time. The site can package educational material in multiple formats including audio, video, and readable text, allowing the student to tailor the educational experience to his/her learning preferences.

Telehealth: voice therapy using telecommunications technology.

Telehealth offers the potential to meet the needs of underserved populations in remote regions. The purpose of this study was a proof-of-concept to determine whether voice therapy can be delivered effectively remotely. Treatment outcomes were evaluated for a vocal rehabilitation protocol delivered under 2 conditions: with the patient and clinician interacting within the same room (conventional group) and with the patient and clinician in separate rooms, interacting in real time via a hard-wired video camera and monitor (video teleconference group).

Telemedicine in otolaryngology.

More research is needed in otolaryngology telemedicine, but it would be a mistake to stop at only determining if telemedicine is as good as an in-person exam. The digital image recorded in a telemedicine encounter can be manipulated to increase diagnostic information not currently available. Radiologists currently take a chest radiograph in which a chest mass or the tip of an nasogastric tube is difficult to visualize, and by inverting the gray scale or viewing other digital manipulations of that image, the mass or tube tip becomes obvious.

Telemedicine: teleproctored endoscopic sinus surgery.

Objective/hypothesis: Teleproctored surgery projects a surgeon's expertise to remote locations. The objective of the present study was to evaluate the safety and feasibility of this technique as compared with the current standard of care.

Study Design: Prospective.