Jan Wouter Brunings

Reliability and validity of student peer assessment in medical education: a systematic review.

Background: Peer assessment has been demonstrated to be an effective educational intervention for health science students. Aims: This study aims to give an overview of all instruments or questionnaires for peer assessments used in medical and allied health professional educational settings and their psychometric characteristics as described in literature. Methods: A systematic literature search was carried out using the electronic databases Pubmed, Embase, ERIC, PsycINFO and Web of Science, including all available inclusion dates up to May 2010. Results: Out of 2899 hits, 28 studies were included, describing 22 different instruments for peer assessment in mainly medical educational settings. Although most studies considered professional behaviour as a main subject of assessment and described peer assessment usually as an assessment tool, great diversity was found in educational settings and application of peer assessment, dimensions or constructs as well as number of items and scoring system per questionnaire, and in psychometric characteristics. Conclusions: Although quite a few instruments of peer assessment have been identified, many questionnaires did not provide sufficient psychometric data. Still, the final choice of an instrument for educational purposes can only be justified by its sufficient reliability and validity as well as the discriminative and evaluative purposes of the assessment.

Adverse Laryngeal Effects Following Short-term General Anesthesia: A Systematic Review

OBJECTIVE To conduct a systematic review to determine the occurrence and type of vocal cord injury, as well as the occurrence of hoarseness, in adults using an endotracheal tube or laryngeal mask during routine anesthetic care. DATA SOURCES Two reviewers independently performed a literature search using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. The search was limited to articles published in English, German, French, or Dutch. In addition, reference lists of the included articles were searched manually. DATA EXTRACTION Studies describing vocal cord injury and/or hoarseness following short-term general anesthesia (<5 hours) using an endotracheal tube or any type of laryngeal mask were included. To obtain a reliable outcome regarding the occurrence of anesthesia-related laryngeal morbidity, only studies reporting both preoperative and postoperative measurements of vocal cord function were included. DATA SYNTHESIS A total of 4119 articles were identified; of these, 13 studies met the inclusion criteria. The studies were found to be heterogeneous and hardly comparable. Hoarseness and vocal cord injuries were common findings in most investigations. CONCLUSIONS Hoarseness and vocal cord injuries are clinically relevant complications related to short-term general anesthesia using an endotracheal tube or laryngeal mask. However, more well-designed prospective studies are necessary to generate reliable data as well as to investigate techniques to reduce adverse laryngeal effects. For future research, a proposal to categorize the vocal cord lesions due to general anesthesia is presented. Furthermore, use of a preoperative and postoperative standardized measurement protocol using acoustic analysis and the Voice Handicap Index is advised.

The Expression of Estrogen and Progesterone Receptors in the Human Larynx

OBJECTIVES The human female voice changes in quality during the menstrual cycle and during pregnancy and menopause. The underlying pathophysiological mechanisms are as yet not known. The aim of this study, therefore, was to evaluate the existence of estrogen receptors (ERs) and progesterone receptors (PRs) in the human vocal fold. MATERIAL AND METHODS Biopsies of benign vocal fold lesions from 37 female patients were obtained during surgery. Immunohistochemistry for expression of ERs and PRs was performed and evaluated on a semiquantitative scale by two independent pathologists. RESULTS In series 1, immunohistochemical staining showed six sections positive for ER and three sections for PR. One section had positive staining for both receptors. In series 2, immunohistochemical staining showed 10 of the 15 edema biopsies were positive for ER and six for PR. Six biopsies expressed both receptors. Four of the 10 laryngocele biopsies were positive for ER and two for PR. One was positive for both receptors. CONCLUSION Our study demonstrates that ERs and PRs are expressed in the larynx of the female human vocal fold in conjunction with edema. The function of these receptors has to be elucidated in future studies.

Age of onset of recurrent respiratory papillomatosis: a distribution analysis

Distribution of age of onset of recurrent respiratory papillomatosis (RRP) is generally described to be bimodal, with peaks at approximately 5 years and 30 years. This assumption has never been scientifically confirmed, and authors tend to refer to an article that does not describe distribution. Knowledge of the distribution of age of onset is important for virological and epidemiological comprehension. The objective of this study was to determine the distribution of age of onset of RRP in a large international sample.

Minimally Invasive Ponto Surgery compared to the linear incision technique without soft tissue reduction for bone conduction hearing implants: study protocol for a randomized controlled trial.

BackgroundOver the last years, less invasive surgical techniques with soft tissue preservation for bone conduction hearing implants (BCHI) have been introduced such as the linear incision technique combined with a punch. Results using this technique seem favorable in terms of rate of peri-abutment dermatitis (PAD), esthetics, and preservation of skin sensibility. Recently, a new standardized surgical technique for BCHI placement, the Minimally Invasive Ponto Surgery (MIPS) technique has been developed by Oticon Medical AB (Askim, Sweden). This technique aims to standardize surgery by using a novel surgical instrumentation kit and minimize soft tissue trauma.MethodsA multicenter randomized controlled trial is designed to compare the MIPS technique to the linear incision technique with soft tissue preservation. The primary investigation center is Maastricht University Medical Center. Sixty-two participants will be included with a 2-year follow-up period. Parameters are introduced to quantify factors such as loss of skin sensibility, dehiscence of the skin next to the abutment, skin overgrowth, and cosmetic results. A new type of sampling method is incorporated to aid in the estimation of complications. To gain further understanding of PAD, swabs and skin biopsies are collected during follow-up visits for evaluation of the bacterial profile and inflammatory cytokine expression.The primary objective of the study is to compare the incidence of PAD during the first 3 months after BCHI placement. Secondary objectives include the assessment of parameters related to surgery, wound healing, pain, loss of sensibility of the skin around the implant, implant extrusion rate, implant stability measurements, dehiscence of the skin next to the abutment, and esthetic appeal. Tertiary objectives include assessment of other factors related to PAD and a health economic evaluation.DiscussionThis is the first trial to compare the recently developed MIPS technique to the linear incision technique with soft tissue preservation for BCHI surgery. Newly introduced parameters and sampling method will aid in the prediction of results and complications after BCHI placement.Trial registrationRegistered at the CCMO register in the Netherlands on 24 November 2014: NL50072.068.14. Retrospectively registered on 21 April 2015 at ClinicalTrials.gov: NCT02438618. This trial is sponsored by Oticon Medical AB.

Short-term results from seventy-six patients receiving a bone-anchored hearing implant installed with a novel minimally invasive surgery technique

Short-term results from seventy-six patients receiving a bone-anchored hearing implant installed with a novel minimally invasive surgery technique

Using lean thinking at an otorhinolaryngology outpatient clinic to improve quality of care

Although Lean Thinking has led to considerable improvement in a variety of healthcare settings, its effects on otorhinolaryngology remain underexposed. This study reports on how the implementation of Lean Thinking at an otorhinolaryngology outpatient clinic has affected patient and provider satisfaction, waste reduction, and organizational culture.

Experiences and preferences of patients visiting an otorhinolaryngology outpatient clinic: a qualitative study

Patient‐centred care has received considerable attention in the last few decades, but the patients’ perspective remains underexposed. This study reports on an in‐depth evaluation of patients’ experiences and preferences at an otorhinolaryngology outpatient department.

Percutaneous bone-anchored hearing system implant survival after 550 primary implant surgeries

The Bone-Anchored Hearing System (BAHS) has become an established option for rehabilitation of several type of hearing impairment such as conductive hearing loss, mixed hearing loss and single-sided deafness. Overall good outcomes have been reported. Nevertheless, complications such as inflammation of the skin around the percutaneous abutment, pain and implant loss are related to BAHS. For implant loss stability, primary and secondary stability are important concepts. Primary stability is defined as implant stability immediately after surgery. Dental studies show that primary stability is influenced by implant design, surgical technique, bone quantity and bone quality. Secondary stability is defined as stability over time and is determined by primary stability and osseointegration. In dental implants, osseointegration is influenced by surgical trauma, implant design, smoking status and other subject-related factors such as diabetes and hygiene. In BAHS, implant loss rates of 8.3%-18% have been reported. 3-mm implants, young age, age of 60 or higher and male status have been described as risk factors for implant loss. In this study, we aimed to analyse implant survival rates for BAHS surgery including risk factors for the population in Maastricht University Medical Centre+ (MUMC), the Netherlands.