1
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Larenas-Linnemann DES, Mayorga-Butrón JL, Maza-Solano J, Emelyanov AV, Dolci RLL, Miyake MM, Okamoto Y. Global expert views on the diagnosis, classification and pharmacotherapy of allergic rhinitis in clinical practice using a modified Delphi panel technique. World Allergy Organ J 2023; 16:100800. [PMID: 37520611 PMCID: PMC10372170 DOI: 10.1016/j.waojou.2023.100800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/26/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Background Diagnosis, classification, and treatment of allergic rhinitis (AR) varies considerably despite the availability of treatment guidelines. Objectives We aimed to carry out a two-part modified Delphi panel study to elucidate global expert management of AR in real life. Methods The modified Delphi panel study was composed of two ten-minute online questionnaires sent to global AR experts, aiming to identify areas of consensus (defined as >75% respondent agreement) on aspects of their real-world daily practice related to AR diagnosis, classification, and pharmacotherapy. A workshop discussion with respondents held after the first-round questionnaire informed the development of the second-round questionnaire. Results Eighteen experts (from 7 countries across 3 continents) completed both questionnaires in September-October 2021 and January 2022, respectively. The majority of respondents agreed that diagnosis of AR is best confirmed using a mixture of observation and testing (n = 15) and collaborating with colleagues across other specialties (n = 14). Experts agreed that severity (n = 18), upper/lower respiratory tract involvement (n = 15) and symptom frequency (n = 14) are important factors when classifying AR, however consensus was not reached on which classification tool should be used. Although there were mixed opinions on the preferred pharmacotherapy treatment in the presented case studies, respondents largely agreed on which treatments require less monitoring (intranasal corticosteroid therapies [INCS]) and when treatments should be stepped down (≤3 months). Although opinions varied across respondents, some respondents considered as-needed INCS treatment and surgery to be viable treatment options. Conclusion We identified clear differences between real-world practice and treatment guidelines related to the management of AR. Furthermore, we recognized differences among physicians concerning their clinical practice in the pharmacological treatment of AR. These findings highlight the need for greater research into the management of AR and further indicate there is still a major gap between treatment guidelines and daily practice, even among specialists, suggesting a need for local guideline adaptation and implementation plans.
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Affiliation(s)
| | | | - Juan Maza-Solano
- Rhinology/Skull Base Surgery Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Alexander V. Emelyanov
- North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Ricardo LL. Dolci
- Department of Otolaryngology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Marcel M. Miyake
- Department of Otolaryngology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Yoshitaka Okamoto
- Chiba Rosai Hospital, Ichihara, Japan
- Chiba University, Inage Ward, Chiba, Japan
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2
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Saydy N, Moubayed SP, Bussières M, Janjua A, Kilty S, Lavigne F, Monteiro E, Nayan S, Piché M, Smith K, Sommer D, Sowerby L, Tewfik MA, Witterick IJ, Wright E, Desrosiers M. What is the optimal outcome after endoscopic sinus surgery in the treatment of chronic rhinosinusitis? A consultation of Canadian experts. J Otolaryngol Head Neck Surg 2021; 50:36. [PMID: 34134762 PMCID: PMC8210358 DOI: 10.1186/s40463-021-00519-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/14/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Many experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives. METHODS A total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized. RESULTS According to an expert survey, patients' main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes. CONCLUSIONS According to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2).
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Affiliation(s)
- Nadim Saydy
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Sami P Moubayed
- Division of Otolaryngology - Head & Neck Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Marie Bussières
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Sherbrooke - Hôtel-Dieu Hospital, University of Sherbrooke, Quebec, Canada
| | - Arif Janjua
- Division of Otolaryngology - Head & Neck Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaun Kilty
- Division of Otolaryngology - Head & Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - François Lavigne
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Eric Monteiro
- Division of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Smriti Nayan
- Division of Otolaryngology - Head & Neck Surgery, Cambridge Memorial Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Marilou Piché
- Division of Otolaryngology - Head & Neck Surgery, Hôpital Saint-Sacrement, Laval University, Quebec, Quebec, Canada
| | - Kristine Smith
- Division of Otolaryngology - Head & Neck Surgery, Winnipeg Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Doron Sommer
- Division of Otolaryngology - Head & Neck Surgery, Cambridge Memorial Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Leigh Sowerby
- Division of Otolaryngology - Head & Neck Surgery, St-Joseph's Hospital, Western University, London, Ontario, Canada
| | - Marc A Tewfik
- Division of Otolaryngology - Head & Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Ian J Witterick
- Division of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Erin Wright
- Division of Otolaryngology - Head & Neck Surgery, Walter C MacKenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Desrosiers
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada.
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3
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Saydy N, Moubayed SP, Desrosiers M. Patient perspectives on endoscopic sinus surgery for chronic rhinosinusitis. J Otolaryngol Head Neck Surg 2021; 50:34. [PMID: 34130732 PMCID: PMC8207753 DOI: 10.1186/s40463-021-00515-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/10/2021] [Indexed: 12/22/2022] Open
Abstract
Background Through shared decision-making, physicians and patients can elect endoscopic sinus surgery (ESS) when maximal medical therapy fails in patients with chronic rhinosinusitis (CRS). In this study, we aim to explore the most important themes with regards to patients’ perspectives on ESS. Our objective was to define the patient experience and ensure that we have congruent physician and patient goals for obtaining success. Methods Semi-structured face-to-face interviews were conducted with 22 patients at a tertiary-care institution in Montreal. Three themes were established a priori: living with CRS, objectives and expectations and criteria for success. This thematic approach allowed the identification, analysis and reporting of patterns found across the data set. A phenomenological methodological orientation was used. Interviews were audio-recorded and transcribed verbatim for continuous analysis. These were coded by hand by a single coder who read the transcripts multiple times and relistened to the recordings. Results Exploration of themes on patients’ perspectives on ESS for CRS yielded multiple anecdotal findings, and some recurring patterns. There is a tendency for patients to focus on one principal symptom that drives their decrease in QoL. Headaches and nasal congestion seemed to impact patients’ QoL the most amongst rhinologic symptoms. Hyposmia was rarely spontaneously by patients but was often a significant source of distress when prompted during interviews. Objectives and expectations seemed to be inversely proportional to number of previous surgeries and severity of symptoms preoperatively. There was a clear association between preoperative expectations and postoperative satisfaction. There was no clear pattern in the improvement magnitude or time improved postoperatively for patients to consider the surgery a success. Conclusions Patients’ level of satisfaction postoperatively and with their care in general is multifactorial. We believe the topic of goals and expectations regarding ESS should be discussed preoperatively for every patient with CRS. This includes patients with seemingly minor disease and patients naive to surgery, as can sometimes have exceedingly high expectations. Preoperative counselling must also include an assessment of what symptom is the most cumbersome to that particular patient, as patients tend to focus a lot on one or two symptoms. Postoperatively, we encourage clinicians to be attentive to the change in each patient’s principal complaints within the context of a personalized approach and to refer back to patients’ preoperative goals in their assessment of operative success. Graphical abstract ![]()
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Affiliation(s)
- Nadim Saydy
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, 1051 Sanguinet Street, Montreal, QC, H2X 3E4, Canada
| | - Sami Pierre Moubayed
- Division of Otolaryngology - Head & Neck Surgery, Sacré-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Martin Desrosiers
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, 1051 Sanguinet Street, Montreal, QC, H2X 3E4, Canada.
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4
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 385] [Impact Index Per Article: 128.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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5
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Beswick DM, Ayoub NF, Mace JC, Mowery A, Hwang PH, Smith TL. Acute Exacerbations in Recurrent Acute Rhinosinusitis: Differences in Quality of Life and Endoscopy. Laryngoscope 2020; 130:E736-E741. [PMID: 31837149 PMCID: PMC7293548 DOI: 10.1002/lary.28460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Research surrounding outcome differences for patients with recurrent acute rhinosinusitis (RARS) is scarce. This investigation explored quality of life (QOL) and sinonasal attributes in patients during acute episodes (AEs) and in-between AEs of RARS. STUDY DESIGN Retrospective outcomes research. METHODS Data from patients with RARS were collected from two academic institutions between 2009 and 2017 using prospective and retrospective methodology. During clinical presentation, subjects were classified as with or without an AEs using guideline definitions of acute bacterial rhinosinusitis (ABRS). Between-group differences in 22-item Sino-Nasal Outcome Test (SNOT-22) survey and Lund-Kennedy (LK) endoscopy scores were assessed. RESULTS Four hundred twenty-three clinical visits from 202 patients were included. Visits during an AE (168/423, 40%) were associated with significantly worse SNOT-22 total scores compared to between AEs (255/423, 60%; median = 53.0 [interquartile range (IQR) = 24.0] vs. 34.0 [IQR = 29.5]) and all SNOT-22 subdomain scores (all P < .001). LK scores were available for 167 visits, with 56 (34%) completed during an AE. Compared to visits without an AE, endoscopy findings associated with an AE were less frequently normal (LK score = 0, 45% vs. 62%, P = .031) with worse median LK scores (2.0 [IQR = 4.0] vs. 0.0 [IQR = 2.0], P = .005). CONCLUSIONS AEs are associated with significantly worse QOL and mildly worse endoscopic findings. Almost half of visits during AEs had negative endoscopy, identifying a disparity between patient symptoms and objective findings and calling into question alternative or concomitant diagnoses. Diagnostic criteria for ABRS or AEs in RARS do not require objective confirmation of inflammation, presenting a conundrum for clinicians. The potential for overdiagnosis of ABRS and AEs should be considered when determining the risk/benefit ratio of treatments for RARS. LEVEL OF EVIDENCE 2c Laryngoscope, 2019.
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Affiliation(s)
| | - Noel F. Ayoub
- Department of Otolaryngology-Head & Neck Surgery,
Stanford University, Stanford, CA
| | - Jess C. Mace
- Division of Rhinology and Sinus/Skull Base Surgery,
Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science
University; Portland, OR
| | - Alia Mowery
- School of Medicine, Oregon Health & Science University;
Portland, OR
| | - Peter H. Hwang
- Department of Otolaryngology-Head & Neck Surgery,
Stanford University, Stanford, CA
| | - Timothy L. Smith
- Division of Rhinology and Sinus/Skull Base Surgery,
Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science
University; Portland, OR
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6
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Cottrell J, Yip J, Chan Y, Chin CJ, Damji A, de Almeida JR, Desrosiers M, Eskander A, Janjua A, Kilty S, Lee JM, Macdonald KI, Meen EK, Rudmik L, Sommer DD, Sowerby L, Tewfik MA, Thamboo A, Vescan AD, Witterick IJ, Wright E, Monteiro E. Quality Indicators for the Diagnosis and Management of Acute Bacterial Rhinosinusitis. Am J Rhinol Allergy 2020; 34:519-531. [DOI: 10.1177/1945892420912158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Acute bacterial rhinosinusitis (ABRS) is a highly prevalent disease that is treated by a variety of specialties, including but not limited to, family physicians, emergency physicians, otolaryngology—head and neck surgeons, infectious disease specialists, and allergy and immunologists. Unfortunately, despite high-quality guidelines, variable and substandard care continues to be demonstrated in the treatment of ABRS. Objective This study aimed to develop ABRS-specific quality indicators (QIs) to evaluate the diagnosis and management that reduces symptoms, improves quality of life, and prevents complications. Methods A guideline-based approach, proposed by Kötter et al., was used to develop QIs for ABRS. Candidate indicators (CIs) were extracted from 4 guiding documents and evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Each CI and its supporting evidence was summarized and reviewed by an expert panel based on validity, reliability, and feasibility of measurement. Final QIs were selected from CIs utilizing the modified RAND/University of California at Los Angeles appropriateness methodology. Results Twenty-nine CIs were identified after literature review and evaluated by our panel. Of these, 5 CIs reached consensus as being appropriate QIs, with 1 requiring additional discussion. After a second round of evaluations, the panel selected 7 QIs as appropriate measures of high-quality care. Conclusion This study proposes 7 QIs for the diagnosis and management of patients with ABRS. These QIs can serve multiple purposes, including documenting the quality of care; comparing institutions and providers; prioritizing quality improvement initiatives; supporting accountability, regulation, and accreditation; and determining pay for performance initiatives.
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Affiliation(s)
- Justin Cottrell
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Yip
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Yvonne Chan
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Christopher J Chin
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ali Damji
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John R. de Almeida
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Martin Desrosiers
- Division of Otolaryngology—Head and Neck Surgery, Centre Hospitalier de l’University de Montreal, Montreal, Quebec, Canada
| | - Antoine Eskander
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Arif Janjua
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaun Kilty
- Department of Otolaryngology—Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - John M. Lee
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kristian I. Macdonald
- Department of Otolaryngology—Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Eric K. Meen
- Department of Otolaryngology—Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Luke Rudmik
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Doron D. Sommer
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Leigh Sowerby
- Department of Otolaryngology—Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Marc A. Tewfik
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Andrew Thamboo
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allan D. Vescan
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ian J. Witterick
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Erin Wright
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Monteiro
- Division of Rhinology, Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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7
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Rudmik L, Beswick DM, Alt JA, Bhattacharyya N, Chester AC, Gray ST, Poetker DM, Stewart MG, Smith TL. Appropriateness Criteria for Surgery in the Management of Adult Recurrent Acute Rhinosinusitis. Laryngoscope 2018; 129:37-44. [PMID: 30284272 DOI: 10.1002/lary.27438] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/23/2018] [Accepted: 06/20/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS Endoscopic sinus surgery (ESS) is frequently performed for recurrent acute rhinosinusitis (RARS). Appropriate indications for surgery among patients with RARS have not yet been rigorously determined. The objective of this study was to define appropriateness criteria for ESS in the management of adult RARS. STUDY DESIGN Application of RAND-UCLA appropriateness methodology. METHODS A panel of nine multidisciplinary experts in RARS was formed to evaluate RARS scenarios generated from current evidence. The panel completed two rounds of a modified Delphi-ranking process and a teleconference. RESULTS A total of 32 clinical scenarios were ranked in each round. For adult patients with RARS, ESS can appropriately be offered as a treatment option when patients experience ≥ four annual episodes, and there is confirmation of at least one episode via computed tomography or nasal endoscopy, and the patient and clinician jointly participate in shared decision making, and the patient has either failed a trial of topical nasal steroids or experienced RARS-related productivity loss. CONCLUSIONS This study has defined appropriateness criteria for ESS as a management option for adult patients with RARS. These criteria are intended to represent a minimum threshold for which ESS should be considered in the treatment of RARS and do not suggest that all patients who meet these criteria should undergo surgery. These criteria may serve as a baseline set of indications for ESS in patients with RARS. LEVEL OF EVIDENCE NA Laryngoscope, 129:37-44, 2019.
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Affiliation(s)
- Luke Rudmik
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Daniel M Beswick
- The Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.,Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jeremiah A Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | | | | | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - David M Poetker
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Michael G Stewart
- Department of Otorhinolaryngology, Weill Medical College of Cornell University, New York City, New York, U.S.A
| | - Timothy L Smith
- The Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
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8
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Mattos JL, Soler ZM, Rudmik L, Manes PR, Higgins TS, Lee J, Schneider J, Setzen M, Parasher AK, Smith TL, Stokken JK. A framework for quality measurement in the presurgical care of chronic rhinosinusitis: a review from the Quality Improvement Committee of the American Rhinologic Society. Int Forum Allergy Rhinol 2018; 8:1380-1388. [DOI: 10.1002/alr.22154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/23/2018] [Accepted: 05/14/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jose L. Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; University of Virginia; Charlottesville VA
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary AB Canada
| | - Peter R. Manes
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery; Yale School of Medicine; New Haven CT
| | - Thomas S. Higgins
- Department of Otolaryngology-Head and Neck Surgery; University of Louisville; Louisville KY
| | - Jivianne Lee
- Department of Otolaryngology-Head and Neck Surgery University of California; Los Angeles David Geffen School of Medicine; Los Angeles CA
| | - John Schneider
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis MO
| | - Michael Setzen
- Department of Otolaryngology-Head and Neck Surgery; Weill Cornell University, College of Medicine; New York NY
| | - Arjun K. Parasher
- Department of Otolaryngology-Head and Neck Surgery; University of South Florida; Tampa FL
| | - Timothy L. Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University; Portland OR
| | - Janalee K. Stokken
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic, Rochester; MN
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9
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Cottrell J, Yip J, Chan Y, Chin CJ, Damji A, de Almeida JR, Desrosiers M, Janjua A, Kilty S, Lee JM, Macdonald KI, Meen EK, Rudmik L, Sommer DD, Sowerby L, Tewfik MA, Vescan AD, Witterick IJ, Wright E, Monteiro E. Quality indicators for the diagnosis and management of chronic rhinosinusitis. Int Forum Allergy Rhinol 2018; 8:1369-1379. [PMID: 29999592 DOI: 10.1002/alr.22161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) has been identified as a high-priority disease category for quality improvement. To this end, this study aimed to develop CRS-specific quality indicators (QIs) to evaluate diagnosis and management that relieves patient discomfort, improves quality of life, and prevents complications. METHODS A guideline-based approach, proposed in 2012 by Kötter et al. was used to develop QIs for CRS. Candidate indicators (CIs) were extracted from 3 practice guidelines and 1 international consensus statement on the diagnosis and management of CRS. Guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Each CI and its supporting evidence was summarized and reviewed by an expert panel based on validity, reliability, and feasibility of measurement. Final QIs were selected from CIs utilizing the modified RAND Corporation-University of California, Los Angeles (RAND/UCLA) appropriateness methodology. RESULTS Thirty-nine CIs were identified after literature review and evaluated by our panel. Of these, 9 CIs reached consensus as being appropriate QIs, with 4 requiring additional discussion. After a second round of evaluations, the panel selected 9 QIs as appropriate measures of high-quality care. CONCLUSION This study proposes 9 QIs for the diagnosis and management of patients with CRS. These QIs can serve multiple purposes, including documenting the quality of care; comparing institutions and providers; prioritizing quality improvement initiatives; supporting accountability, regulation, and accreditation; and determining pay-for-performance initiatives.
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Affiliation(s)
- Justin Cottrell
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Jonathan Yip
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Yvonne Chan
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Christopher J Chin
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Ali Damji
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Martin Desrosiers
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'University de Montreal, Montreal, QC, Canada
| | - Arif Janjua
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Shaun Kilty
- Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Kristian I Macdonald
- Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Eric K Meen
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Doron D Sommer
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Leigh Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Marc A Tewfik
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Allan D Vescan
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Ian J Witterick
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Erin Wright
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Eric Monteiro
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
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