Browsing by Author "Dort, Joseph C."

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    Examining the utility of a photorealistic virtual ear in otologic education
    (2023-02-22) Shin, Dongho; Batista, Arthur V.; Bell, Christopher M.; Koonar, Ella R. M.; Chen, Joseph M.; Chan, Sonny; Dort, Joseph C.; Lui, Justin T.
    Abstract Background Otolaryngology–head and neck surgical (OHNS) trainees’ operating exposure is supplemented by a combination of didactic teaching, textbook reading, and cadaveric dissections. Conventional teaching, however, may not adequately equip trainees with an understanding of complex visuospatial relationships of the middle ear. Both face and content validation were assessed of a novel three-dimensional (3D) photorealistic virtual ear simulation tool underwent face and content validation as an educational tool for OHNS trainees. Methods A three-dimensional mesh reconstruction of open access imaging was generated using geometric modeling, which underwent global illumination, subsurface scattering, and texturing to create photorealistic virtual reality (VR) ear models were created from open access imaging and comiled into a educational platform. This was compiled into an educational VR platform which was explored to validate the face and content validity questionnaires in a prospective manner. OHNS post-graduate trainees were recruited from University of Toronto and University of Calgary OHNS programs. Participation was on a voluntary basis. Results Total of 23 OHNS post-graduate trainees from the two universities were included in this study. The mean comfort level of otologic anatomy was rated 4.8 (± 2.2) out of 10. Senior residents possessed more otologic surgical experience (P < 0.001) and higher average comfort when compared to junior residents [6.7 (± 0.7) vs. 3.6 (± 1.9); P = 0.001]. Face and content validities were achieved in all respective domains with no significant difference between the two groups. Overall, respondents believed OtoVIS was a useful tool to learn otologic anatomy with a median score of 10.0 (8.3–10.0) and strongly agreed that OtoVIS should be added to OHNS training with a score of 10.0 (9.3–10.0). Conclusions OtoVIS achieved both face and content validity as a photorealistic VR otologic simulator for teaching otologic anatomy in the postgraduate setting. As an immersive learning tool, it may supplement trainees’ understanding and residents endorsed its use. Graphical Abstract
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    The Feasibility of Patient-Reported Outcomes, Physical Function, and Mobilization in the Care Pathway for Head and Neck Cancer Surgical Patients: A Mixed-Methods Study
    (2020-07-24) Daun, Julia Teresa; Culos-Reed, Susan Nicole; Dort, Joseph C.; Capozzi, Lauren C.; Watson, Linda C.
    Head and neck cancer (HNC) surgical patients experience difficult treatment, high symptom burden, and complex and lengthy recoveries. Initial research has found physical activity (PA) and exercise to be feasible and beneficial post-surgery through to survivorship, yet no studies have addressed the role of PA or exercise in the earlier stages of clinical care. Exercise prehabilitation is a promising tool for this population. Considering the unique nature of the HNC surgical trajectory, it is necessary to first establish whether the number and types of assessments are feasible with this population in advance of piloting an exercise prehabilitation program. The purpose of this work was to therefore explore the feasibility of measuring patient-reported outcomes (PROs), physical function, and in-hospital mobilization as part of the care pathway in HNC surgical patients. A mixed-methods study gathered quantitative and qualitative information from patients and healthcare providers (HCPs) on the feasibility of conducting assessments throughout the clinical timeline for HNC surgical patients. Participants were HNC patients scheduled for oncologic resection with free-flap reconstruction, and HCPs were those involved in immediate HNC patient care. Quantitative data was collected from patients, and included PROs and measures of physical function and in-hospital mobilization. Feasibility included tracking recruitment numbers and completion of measures. Qualitative data captured perspectives around the acceptability of assessment completion and perceptions of a future exercise prehabilitation program. HCPs also provided information on clinical logistics of exercise prehabilitation. The quantitative study revealed that most assessments were feasible, except for pre-operative measures of physical function. The qualitative study demonstrated that both patients and HCPs found the assessments to be acceptable and necessary, and additionally value the potential for an exercise prehabilitation program in the HNC surgical timeline. Based on findings from this study, new workflows were implemented to support recruitment and assessment of outcomes across the HNC surgical timeline, facilitating implementation of a future exercise prehabilitation intervention.
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    Fiber-optic endoscopic evaluation of swallowing to assess swallowing outcomes as a function of head position in a normal population
    (BioMed Central, 2014-04-22) Badenduck, Lucas A; Matthews, T. Wayne; McDonough, Alanna; Dort, Joseph C.; Wiens, Kristin; Kettner, Rachelle; Crawford, Susan; Kaplan, Bonnie J
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    Preoperative hemoglobin and perioperative blood transfusion in major head and neck surgery: a systematic review and meta-analysis
    (2023-01-24) Ali, Munib; Dort, Joseph C.; Sauro, Khara M.
    Abstract Background There is a growing concern with inappropriate, excessive perioperative blood transfusions. Understanding the influence of low preoperative hemoglobin (Hgb) on perioperative blood transfusion (PBT) in head and neck cancer (HNC) surgery with free flap reconstruction may help guide clinical practice to reduce inappropriate treatment among these patients. The objective is to synthesize evidence regarding the association between preoperative Hgb and PBT among major HNC free flap surgeries. Methods Terms and synonyms for HNC surgical procedures, Hgb and PBT were used to search MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Cochrane Database of Reviews from inception to February 2020. Reference lists of included full texts and studies reporting the preoperative Hgb, anemia or hematocrit (exposure) and the PBT (outcome) in major HNC surgery with free flap reconstruction were eligible. Studies examining esophageal, thyroid and parathyroid neoplasms were excluded; as were case reports, case series (n < 20), editorials, reviews, perspectives, viewpoints and responses. Two independent, blinded reviewers screened titles, abstracts and full texts in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was followed. A random-effects model was used to pool reported data. The primary outcome was the proportion of patients who had a PBT. Subgroup analysis examined sources of heterogeneity for perioperative predictors of PBT (age, sex, flap type, flap site and preoperative Hgb). We also examined mean preoperative Hgb in the PBT and no PBT groups. Results Patients with low preoperative Hgb were transfused more than those with normal Hgb (47.62%, 95% CI = 41.19–54.06, I2 = 0.00% and 13.92%, 95% CI = 10.19–17.65, I2 = 20.69%, respectively). None of the predictor variables explained PBT. The overall pooled mean preoperative Hgb was 12.96 g/dL (95% CI = 11.33–14.59, I2 = 0.00%) and was 13.58 g/dL (95% CI = 11.95–15.21, I2 = 0.00%) in the no PBT group and 12.05 g/dL (95% CI = 10.01 to 14.09, I2 = 0.00%) in the PBT group. Conclusions The heterogeneity between studies, especially around the trigger for PBT, highlights the need for additional research to guide clinical practice of preoperative Hgb related to PBT to enhance patient outcomes and improve healthcare stewardship. Graphical abstract
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    Temporal Bone Drilling Simulation Boot Camp Course
    (2020-03-26) Hoy, Monica; Oddone-Paolucci, Elizabeth; Dort, Joseph C.; Matthews, Thomas Wayne; Lopushinsky, Steven R.
    Competency by design is changing the surgical landscape. Virtual reality simulation appears to be a promising training tool to assist in achieving surgical competency. This study was designed to determine if a boot camp style virtual reality (VR) mastoidectomy drilling course could be developed to improve a novice learner’s mastoidectomy drilling technique. Forty medical students were randomized to a traditional curriculum (control) group or a VR curriculum (intervention) group. Participants performed pre- and post-intervention knowledge testing, and mastoidectomy drilling sessions. Results of the study are an encouraging first step in demonstrating that a VR simulation boot camp course may improve a novice learners’: (i) understanding of the temporal bone anatomy as demonstrated by a significant difference between pre- and post-intervention knowledge testing (p < 0.01), (ii) drilling technique, as demonstrated by a significant difference between pre- and post-intervention drilling testing (p < 0.01), and (iii) ability to recognize dangerous or red flag areas in drilling a temporal bone. Future directions include a recommendation to implement a mastoidectomy VR simulation boot camp course at the annual Canadian Oto-HNS boot camp.
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    The feasibility of patient-reported outcomes, physical function, and mobilization in the care pathway for head and neck cancer surgical patients
    (2022-05-27) Daun, Julia T.; Twomey, Rosie; Capozzi, Lauren C.; Crump, Trafford; Francis, George J.; Matthews, T. W.; Chandarana, Shamir; Hart, Robert D.; Schrag, Christiaan; Matthews, Jennifer; McKenzie, C. D.; Lau, Harold; Dort, Joseph C.; Culos-Reed, S. N.
    Abstract Background Head and neck cancer (HNC) patients are an understudied population whose treatment often includes surgery, causing a wide range of side effects. Exercise prehabilitation is a promising tool to optimize patient outcomes and may confer additional benefits as a prehabilitation tool. The primary objective of this study was to assess the feasibility of measuring patient-reported outcomes (PROs), physical function, and in-hospital mobilization across the HNC surgical timeline in advance of a future prehabilitation trial. The secondary objective was to examine potential changes in these outcomes across the surgical timeline. Methods HNC patients scheduled to undergo oncologic resection with free-flap reconstruction completed assessments of PROs and physical function at three timepoints across the surgical timeline (baseline, in-hospital, and postsurgical/outpatient). Mobilization was measured during the in-hospital period. The feasibility of recruitment and measurement completion was tracked, as were changes in both PROs and physical function. Results Of 48 eligible patients, 16 enrolled (recruitment rate of 33%). The baseline and in-hospital PROs were completed by 88% of participants, while the outpatient assessments were completed by 81% of participants. The baseline and in-hospital assessment of physical function were completed by 56% of participants, and 38% completed the outpatient assessment. Measuring in-hospital mobilization was completed for 63% of participants. Conclusion Measuring PROs and in-hospital mobilization is feasible across the surgical timeline in HNC; however, the in-person assessment of physical function prior to surgery was not feasible. A multidisciplinary collaboration between exercise specialists and clinicians supported the development of new clinical workflows in HNC surgical care that will aid in the implementation of a future prehabilitation trial for this patient population.