Identification of the anatomy of the deep temporal vein using computed tomography imaging: A retrospective cross-sectional review of patient imaging.

PURPOSE: The deep temporal vein (DTV) can be used in free flap procedures when the superficial temporal vein is inadequate. Despite its potential utility, its branching patterns have only been examined in one small anatomic study. The purpose of this study was to examine computed tomography angiography (CTA) images to determine DTV location, variation, and suitability as a microvascular recipient, to provide surgeons with a guide for its use in head and neck defects. METHODS: A retrospective chart review identified 152 patient CTA images (76 female; 76 male) in a single academic center imaging database, selected consecutively from January 2017 to April 2020. Patients under 19 years were excluded; ages ranged from 19 to 80 years (average 51.6 years). Reason for imaging, DTV caliber, laterality, distance to zygomatic arch (ZA [coronal and sagittal]), distance to lateral orbital rim (LOR), and branching pattern were recorded. RESULTS: The predominant reason for imaging was to rule out cerebrovascular accident (96.2%). Average caliber was 3.46 ± 1.29 mm (95% confidence interval [CI] [3.32, 3.61]; range, 1.00-10.8). Bilateral DTVs were observed in 98.7% of patients. Average distance to landmarks were as follows: ZA (coronal), 13.8 ± 5.85 mm (95% CI [13.2, 14.5]; range, 2.7-33.8); ZA (sagittal), 15.1 ± 6.12 mm (95% CI [14.1, 16.1]; range, 2.8-47.2); LOR, 47.1 ± 9.09 mm (95% CI [46.0, 48.1]; range, 10.8-62.9). Seven branching patterns were identified, including a posterior vertical variant that bypasses the superficial temporal fat pad. CONCLUSIONS: The DTV is a "lifeboat" option for head and neck reconstruction. Its average caliber is sufficient for use in microsurgery. Knowledge of both its typical and aberrant courses allow for efficient preoperative planning and surgical dissection. CTA is a useful adjunct when planning to use the DTV for free tissue transfer.

Comparing digital replantation versus revision amputation patient reported outcomes for traumatic digital amputations of the hand: A systematic review and meta-analysis.

PURPOSE: Adults with traumatic digital amputation (TDA) of the hand may be managed with replantation or revision amputation. To date, there is no systematic review evaluating patient reported outcomes (PROs) comparing replantation versus revision amputation. METHODS: Three databases (MEDLINE, EMBASE, and PubMed) were systematically searched in duplicate from inception until June 13, 2019 using Covidence software. Studies comparing replantation versus revision amputation outcomes were considered for inclusion. Methodological quality was assessed using Methodologic Index for Nonrandomized Studies (MINORS) criteria. Data were pooled in a random-effects meta-analysis model using Revman software. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). RESULTS: Of 4350 studies identified, 12 retrospective cohort studies met inclusion criteria and compared TDA outcomes for replantation (n = 717; 82.9% male; mean age 40.3) versus revision amputation (n = 1046; 79.8% male; mean age 41.7). The overall replantation survival rate was 85.3%. The average MINORS score was 57% (13.75/24). Replantation of the thumb had a superior Michigan Hand Questionnaire (MHQ) score (+11.88, 95% CI [7.78-15.99], I2 = 21%) compared with revision amputation. Replantation of single non-thumb digits had a superior MHQ score (+5.31, 95% CI [3.10-7.51], I2 = 67%) and Disability of Arm, Shoulder, and Hand (DASH) score (-5.16, 95% CI [-8.27 to -2.06], I2 = 0%) compared with revision amputation. Most patients in the meta-analysis were from Asian populations (87.9%). CONCLUSION: There is low-quality evidence that thumb replantation achieves superior PROs compared with revision amputation, which may be clinically important. Replantation of single non-thumb digits also yielded superior PROs, which is likely not clinically important and based on very low-quality evidence. Future studies with populations outside Asia are required to determine if PROs vary based on cultural differences toward digital amputation.

'It's not the form; it's the process': a phenomenological study on the use of creative professional development workshops to improve teamwork and communication skills.

INTRODUCTION: Past research has demonstrated the positive effects of visual and performing arts on health professionals' observational acuity and associated diagnostic skills, well-being and professional identity. However, to date, the use of arts for the development of non-technical skills, such as teamwork and communication, has not been studied thoroughly. METHODS: In partnership with a community print and media arts organisation, Centre[3], we used a phenomenological approach to explore front-line mental health and social service workers' experiences with a creative professional development workshop based on the visual and performing arts. Through preworkshop and postworkshop interviews with participants and postworkshop interviews with their managers, we sought to examine how participants' perceptions of the workshop compared with their preworkshop expectations, specific impacts of the workshop with respect to participants' teamwork and communication skills and changes in their perceptions regarding the use of the arts in professional development. RESULTS: Our workshops were successful in enhancing teamwork skills among participants and showed promise in the development of communication skills, though observable changes in workplace communication could not be confirmed. The workshop facilitated teamwork and collegiality between colleagues, creating a more enjoyable and accepting work environment. The workshops also helped participants identify the strengths and weaknesses of their communication skills, made them more comfortable with different communication styles and provided them with strategies to enhance their communication skills. CONCLUSIONS: Participation in the arts can be beneficial for the development of interpersonal skills such as teamwork and communication among health professionals.

Video-Based Assessment in Surgical Education: A Scoping Review.

BACKGROUND AND OBJECTIVE: Video-based assessment of residents' surgical skills may offer several advantages over direct observations of clinical performance in terms of objectivity, time-efficiency, and feasibility. Although video-based assessment is becoming more common in surgical training, a broad understanding of its utility is lacking. This scoping review explores video-based assessment in surgical training and presents the evidence supporting its use. DESIGN: A literature search was conducted using the Web of Science database with key words related to video-based assessment and surgical training. Exclusion criteria included articles not published in English and articles on undergraduate medical education, continuing professional development, or non-surgical disciplines. Initially, 702 articles were identified; after title, abstract, and full-text screening by two independent reviewers (SM and VM), 199 articles remained. RESULTS: We present the benefits of video-based assessment, including the ability to capture clinical ability in the operating room without decreasing intraoperative efficiency, as well as the potential to improve formative assessment and feedback practices. We describe the validity, reliability, and challenges of video-based assessment, as well as the use of video-based methods in clinical and simulated settings. We conclude by discussing questions that remain to be addressed. CONCLUSIONS: Although further research and cost-benefit analyses are required, greater adoption of video-based assessment into surgical training may help meet increased assessment demands in an era of competency-based medical education.

A systematic review of quality of reporting in registered intimate partner violence studies: where can we improve?

BACKGROUND: Reporting quality is paramount when presenting clinical findings in published research to ensure that we have the highest quality of evidence. Poorly reported clinical findings can result in a number of potential pitfalls, including confusion of the methodology used or selective reporting of study results. There are guidelines and checklists that aim to standardize the way in which studies are reported in the literature to ensure transparency. The use of these reporting guidelines may aid in the appropriate reporting of research, which is of increased importance in highly complex fields like intimate partner violence (IPV). The primary objective of this systematic review is to assess the reporting quality of published IPV studies using the CONSORT and STROBE checklists. METHODS: We performed a systematic review of three large study registries for IPV studies. Of the completed studies, we sought full text publications and used reporting checklists to assess the quality of reporting. RESULTS: Of the 42 randomized controlled trials, the mean score on the CONSORT checklist was 63.5% (23.5/37 items, SD 4.7 items). There were also 12 pilot trials in this systematic review, which scored a mean of 49.3% (19.7/40 items; SD 3.3 items) on the CONSORT extension for pilot trials. We included 12 observational studies which scored a mean of 56.1% (18.5/33 items; SD: 4.1 items). CONCLUSIONS: We identified an opportunity to improve reporting quality by encouraging adherence to reporting guidelines. There should be a particular focus on ensuring that pilot studies report pilot-specific items. All researchers have a responsibility to ensure commitment to high quality reporting to ensure transparency in IPV studies.

Use of negative-pressure wound therapy and split-thickness skin autograft to cover an exposed renal transplant.

Exposure of a renal transplant through the abdominal wall is a rare event. A search of the literature reveals only six documented cases which used skin autograft for coverage, with none reported since 1981, and none which used negative-pressure wound therapy (NPWT) to prepare the recipient bed. This case report demonstrates that NPWT followed by split thickness skin graft is a reconstructive option which is feasible in patients who are at high risk for surgical complications in prolonged flap surgery.

A Shift on the Horizon: A Systematic Review of Assessment Tools for Plastic Surgery Trainees.

BACKGROUND: As plastic surgery programs transition toward competency-based medical education curricula, it is important to critically assess current methods of evaluating trainee competence. The purpose of this systematic review was to identify and evaluate assessment tools for technical and nontechnical competencies in plastic surgery. METHODS: A systematic search using keywords related to competency-based medical education, assessment, and plastic surgery was conducted. Two independent reviewers extracted data pertaining to study characteristics, study design, and psychometric properties. Data pertaining to the establishment of competence and barriers to tool implementation were noted. RESULTS: Twenty-three studies were included in this review. Technical competencies were assessed in 16 studies. Nontechnical competencies were assessed in five studies. Two studies assessed both technical and nontechnical competence. Six tools were implemented in a simulated setting and 17 tools were implemented in a clinical setting. Thirteen studies (57 percent) did not report reliability scores and nine (39 percent) did not report validity scores. Two tools established clear definitions for competence. Common barriers to implementation included high demands on resources and time, uncertainty about simulation transferability, and assessor burnout. CONCLUSIONS: A number of tools exist to assess a range of plastic surgery skills, in both clinical and simulated settings. There is a need to determine the transferability of simulated assessments to clinical practice, as most available tools are simulation-based. Although additional psychometric testing of current assessment tools is required, particularly in the nontechnical domain, this review provides a base on which to build assessment frameworks that will support plastic surgery's transition to competency-based medical education.

Examining the barriers to meaningful assessment and feedback in medical training.

BACKGROUND: Recent reports from both accreditation bodies in North America highlight problems with current assessment practices in postgraduate medical training. Previous work has shown that educators might be reluctant to report poor performance or fail underperforming trainees. This study explores the barriers perceived by medical educators to providing more meaningful assessment and feedback to trainees. METHODS: Semistructured interviews were conducted with 22 physician educators. Interviews were audiotaped and transcribed verbatim. Three researchers analyzed the transcripts using a grounded theory approach. RESULTS: Participants expressed a reluctance to provide poor assessments or feedback to trainees. Fifty-five percent of the participants reported passing trainees who could have benefited from additional training. Our data revealed a number of barriers which may account for these findings. Implementing more frequent formative assessments could help educators more effectively evaluate trainees and provide feedback, although a shift in the culture of medicine may be required. CONCLUSION: It is imperative that the barriers to effective assessment and feedback identified in this study be addressed to improve postgraduate medical training and enhance patient care.