The authors conclude from these results that trainees perceive significant barriers to error disclosure and that they will enter practice without adequate disclosure skills unless new training programs are implemented. They say that medical educators and institutions should develop and disseminate formal disclosure guidelines regarding the role of trainees in the disclosure process. Formal disclosure curricula, along with closely mentored opportunities to disclose errors to patients, could provide powerful learning opportunities. Disclosure education should include formal lecture material, coaching from attending physicians, and the opportunity to practice disclosure skills and receive feedback.
Explore This IssueMay 2008
Does Maxillary Sinus Wash Improve Adenoidectomy Outcome?
The first line of treatment for chronic rhinosinusitis (CRS) in children is antibiotics, nasal steroid sprays, and nasal saline rinses. However, a small percentage of patients will continue to exhibit disease despite appropriate medical management, and therefore may require surgical intervention. Adenoidectomy as treatment for CRS has a high revision rate in younger children. Previous studies have suggested that a sinus wash be performed at the time of adenoidectomy, and children should be treated with intravenous antibiotics for several weeks postoperatively. No studies have been done, though, on sinus wash independent of antibiotic treatment. Therefore, Hassan H. Ramadan, MD, MSc, and Jamey L. Cost, MD, performed a prospective study comparing children who had adenoidectomy alone with children who underwent adenoidectomy with a maxillary sinus wash but no intravenous antibiotics.
All patients in the study were referred to the tertiary hospital because of refractory CRS that had been treated for at least six months, and had continuous symptoms despite allergy evaluation and CT documentation of rhinosinusitis. After evaluation of the CT scans, either an adenoidectomy or an adenoidectomy with maxillary sinus wash of the opacified sinuses was performed. Allocation of the patients was not random, but rather was based on the surgeon’s and parents’ preferences. All children were followed up after surgery at one, three, six, nine, and 12 months.
Sixty children satisfied the inclusion criteria. Thirty-two had maxillary sinus wash at the time of adenoidectomy (wash/A) and 28 had adenoidectomy only (A). The two groups were comparable with regard to age, sex, presence of allergies, asthma, and smoking in the household. The wash/A group had more severe disease, however-the mean CT score of this group was 7.9, compared with 3.0 for the A group.
Of the 32 children who underwent wash/A, 28 (87.5%) showed improvement of their symptoms at 12-month follow-up, compared with 17 (60.7%) of the patients in the A group. The investigators analyzed the data using CT score as a predictor of which children would do better with A alone and which with wash/A. They found that children with a high CT score had a 93% success rate with wash/A, versus 60% for those who had A only. There was no statistically significant difference between wash/A and A alone for children with a low CT score, however, although there was a trend for better outcome in the wash/A group. Multivariable analysis using logistic regression analysis with age, sex, asthma, allergy, and CT score as covariables showed that the success of wash/A compared with A alone remained significant; none of the other variables demonstrated statistical significance.