International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

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

Dying Safely

The burden of deaths due to noncommunicable disease, particularly in the elderly, is projected to rise from 59% in 2002 to 69% in 2030. The ageing population has increased the use of medical technology and life support systems for the support of elderly complex cases—the so-called “sick elderly.” Public expectations believe modern medicine and its associated miracles can prolong life almost indefinitely. Sophisticated technology and the way media portrays the latest miracles generates unrealistic expectations by relatives and often causes potential conflict at the end of life (EoL). The medicalization of death and dying, despite its inevitability has contributed to the disappearance of the concept of a dignified natural death. Dying and death are seen as the ultimate challenge for successful ageing or as a failure of medicine if doctors cannot offer hope of recovery. Unfortunately, in many terminal cases, efforts are made to prolong life under pressure from families as well as the culture of acute hospitals and their concentration on “curing.” Clinicians are often reluctant to recommend limitations of treatment and instead, often administer inappropriate treatment in the face of futility. This chapter is not about assisted dying, euthanasia, nor about the “right to die.” It is about recognition of dying by clinicians; acceptance of death as a natural part of the cycle of life; understanding what constitutes a “good death”; considering the ethical aspects of futile interventions; and reviewing best practice in providing quality of EoL. We discuss the role of doctors, nurses, and the health system in supporting patients and family through the transition