Ralph F. Wetmore – Pediatric Otolaryngology. Principles and Practice Pathways

Описание

Much has transpired both in medicine in general and in the
field of pediatric otolaryngology since the first edition of
this book was published in 2000. The world has benefited
and been transformed by an explosion of communication
and information technology. The growth in utilization of
the electronic medical record portends a day when everyone
will carry a little chip imbedded with all of their medical
history with them for instant review. The United States
remains the leader in medical technology throughout the
world with advances in pharmacology and the development
of robotic and minimally invasive surgery leading
the way. Unfortunately, the delivery of even some of the
most routine care in the United States remains mired in a
morass of insurance and financial conflicts that threatens
to adversely affect the long-term stability of our economy.
For pediatric otolaryngology, however, the future remains
one of promise. The specialty has continued to grow and
prosper over the past decade as the graduates of an increasing
number of fellowships have taken their places
across the country. The major question for the practitioners
of the specialty at this juncture is whether we should
formalize the fellowship training process by proceeding
with subspecialty certification.
Over a decade ago, the preface of the first edition was
dedicated to the breadth of pediatric otolaryngology and
to the wide variety of practitioners who would find this
textbook of value to them—pediatric otolaryngologists,
general otolaryngologists, primary pediatricians, pediatric
intensivists, and other pediatric medical and surgical
specialists. This second edition is again aimed at the same
population of readers, but this edition also emphasizes
some of the depth of the specialty. At the Children’s Hospital
of Philadelphia (CHOP), half of the faculty devotes a substantial
portion of their practice to subspecialty interests
in airway reconstruction, cochlear implantation, skull base
surgery, or pediatric voice. The Airway Reconstruction and
Cochlear Implantation programs at CHOP are multidisciplinary
teams that bring together a variety of pediatric
specialists including pulmonary, gastroenterology, speech
pathology, and audiology. Patients who enroll in these programs
now benefit from expertise that was not available
30 to 40 years ago, when the specialty of pediatric otolaryngology
was still in its infancy. CHOP is not unique in fostering
the development of subspecialty interests. Similar
programs have prospered at other major children’s hospitals
in Boston, New York, Washington, Pittsburgh, Cincinnati,
Chicago, Seattle, and Utah to name just a few.
The challenge for the next decade lies clearly before
us: to provide high-quality care for the entire population
of the United States at an affordable price. To accomplish
this goal, we need to continue to develop systematic approaches
to medical problems that are based on strong
scientific medical evidence. Many of the clinical decisions
that we make daily are based on experience and judgment,
rather than good science. We need to identify important
clinical problems, study the best approaches to their management,
and then put those principles to use across large
populations. In composing the chapters in this textbook,
the authors have strived to examine the scientific evidence
surrounding many of the clinical problems within pediatric
otolaryngology. They have presented and discussed
that evidence and formulated practice pathways that help
clinicians identify and treat medical problems that are
frequently very complex. By presenting the breadth and
depth of pediatric otolaryngology in a concise and evidence-
based format, this textbook will become a valuable
asset for the pediatric practitioner for the next decade and
beyond