Education during Surgical Outreach Trips in Vietnam: A Qualitative Study of Surgeon Learners.

Visiting educator trips teach surgical care in low-resource settings to develop sustainable global surgery. Surgery has been integral in these volunteer activities, but it is unknown whether surgeon learners receive suitable education during these trips. We sought to describe the educational experiences of surgeon learners during a visiting educator trip to better understand the perceptions of surgical outreach education. METHODS: We conducted semistructured interviews of 18 surgeon learners participating in a visiting educator trip to 2 hospitals in Thai Nguyen, Vietnam. Each interview was conducted in Vietnamese, translated into English, and transcribed. Narratives were content coded using thematic analyses. RESULTS: We identified 3 main themes. First, participants noted the value in surgical outreach and believed that these trips provided a thorough understanding of surgical care from patient evaluation to complications management. Second, participants described key barriers to education. Participants desired to focus on "learning one topic in depth" rather than learning in breadth. Furthermore, they described the paucity of translated resources, a lack of English proficiency, and rudimentary translator services. Finally, participants provided substantive guidance in improving surgical outreach education, specifically regarding the limited nature of current international partnerships to foster long-term, sustainable relationships. CONCLUSIONS: Although Vietnamese surgeon learners felt that visiting educator trips were beneficial, they recognized important areas for improvement. The language barrier was a major impediment to effective learning with materials and lectures commonly provided in English, highlighting the need for improved language concordance. Additionally, participants desired continued relationships with the visiting surgeons to build long-term collaboration.

Quality Measures in Postmastectomy Breast Reconstruction: Identifying Metrics to Improve Care.

BACKGROUND: Specific measures tailored to the properties of individual procedures will ensure the appropriate evaluation of quality. Because postmastectomy breast reconstruction (PMBR) is becoming increasingly common, a review of the literature is timely to identify potential breast reconstruction-specific measures that can be applied by institutions and national healthcare organizations to improve quality. METHODS: We searched PubMed and Embase for studies examining the quality of care for patients undergoing PMBR. Data extracted from the articles include basic study characteristics, the number of quality metrics, type of quality metric (defined by Donabedian model), and the domain of quality (defined by the National Academy of Medicine). RESULTS: A total of 2,158 articles were identified in the initial search, and 440 studies were included for data extraction. The most common type of quality measure was outcome measures (91%), and the least common measure was structure measures (1%). The most common metrics were operative time (41%), hospital type (28%), and aspects of the patient-provider interactions (20%). Additionally, we found that timeliness and equity were least common among the 6 National Academy of Medicine domains. CONCLUSIONS: We identified metrics utilized in the PMBR, some of which can be further investigated through high-level evidence studies and incorporated into policy. Because many factors influence surgical outcomes and breast reconstruction is driven by patient preferences, an inclusion of structure, process, and outcome metrics will help improve care for this patient population. Moreover, nonpunitive initiatives, specifically quality collaboratives, may provide an avenue to improve care quality without compromising patient safety.

Critical Assessment of Surveys in Plastic and Reconstructive Surgery: A Systematic Review.

BACKGROUND: Surveys are a fundamental research tool used in the field of plastic surgery. Although inherent biases within surveys have been recognized, the extent to which this problem exists in the plastic surgery literature remains unknown. The authors aim to (1) determine the extent to which common survey biases occur in plastic surgery surveys and (2) identify areas of improvement for survey researchers. METHODS: The authors conducted a systematic review of surveys in the plastic surgery literature from 1997 to 2017. After applying their inclusion and exclusion criteria, two reviewers examined a total of 199 studies containing a survey. A modified checklist based on the published literature was used to determine the presence, type, and severity of biases in plastic surgery surveys. RESULTS: The mean percentage of biased questions in each survey was 24 percent. The most common biases were moderate- (12 percent) and low-impact biases (10 percent). Specifically, the most common biases were forced choice questions (6 percent), horizontal responses (6 percent), and double-barreled questions (1 percent). Only 13 percent of the articles that fit the authors' inclusion criteria contained a full-length survey. CONCLUSIONS: Although surveys in plastic surgery do not contain high-impact biases, the authors have identified areas of improvement for surveys used in this specialty. The authors found that the surveys contain biases in question structure and the survey design, which can be improved through minor revisions to the question stem or responses. Moreover, journals should require researchers to submit a full-text survey for research transparency.

Hand and Wrist Injuries in Golfers and Their Treatment.

A thorough understanding of the swing phases and mechanisms of injury in golf allows accurate diagnosis, treatment, and future prevention of injuries. Recommended initial treatment starts with cessation of practice to rest the wrist, a splint or orthotic brace, and nonsteroidal antiinflammatory drug medication with corticosteroid injection and swing modification. Pisiform excision is the best treatment of the most severe chronic cases of pisiform ligament complex syndrome. Delayed diagnosis of hook of hamate fracture may lead to complications, including flexor tendon rupture. Prompt surgical resection is recommended to hasten return to sport and to prevent further complications.