Smartphone Applications in Plastic Surgery: A Cross-Sectional Survey of 577 Plastic Surgeons, Fellows, Residents, and Medical Students.

BACKGROUND: There are now over 2.2 million mobile applications (apps) in existence, with more than 250 identifiable by searching "plastic surgery." Unfortunately, only 30% of these are academically relevant, which makes finding useful plastic surgery apps both challenging and inefficient. OBJECTIVES: The authors sought to evaluate the use of digital resources and awareness of available apps within plastic surgery to improve their clinical/educational utilization. METHODS: An extensive search of the Apple and Android databases was performed to identify all relevant plastic surgery apps. An American Society of Plastic Surgeons-sponsored survey was distributed to a random cohort of American Society of Plastic Surgeons members (practicing surgeons, fellows, and residents) and students applying to an integrated plastic surgery residency. The survey queried utilization of resources to access medical information and awareness of apps relevant to clinical/educational plastic surgery. RESULTS: A total 153 relevant applications were identified between the Apple iTunes and Google Play stores. Of the 577 respondents (273 practicing surgeons, 117 residents, 11 fellows, and 177 medical students), 99.31% own a smartphone/tablet. Furthermore, medical students and residents/fellows utilized both smartphones and computers more frequently than practicing physicians (P < 0.0001 and P = 0.0022, respectively). Digital resources were also utilized more frequently than printed material (P < 0.00001). For app awareness, 82.1% of respondents reported knowing of fewer than 10 apps relevant to plastic surgery, and only 8.41% were aware of more than 20. CONCLUSIONS: Smartphone usage is nearly ubiquitous among plastic surgeons, and most utilize these devices daily to access medical information. However, awareness of the many available and relevant plastic surgery apps is extremely limited.

An open, prospective, randomized pilot investigation evaluating pain with the use of a soft silicone wound contact layer vs bridal veil and staples on split thickness skin grafts as a primary dressing.

An open, prospective, randomized, pilot investigation was implemented to evaluate the pain, cost-effectiveness, ease of use, tolerance, efficacy, and safety of a soft silicone wound contact layer (Mepitel One) vs Bridal Veil and staples used on split thickness skin grafts in the treatment of deep partial or full-thickness thermal burns. Individuals aged between 18 and 70 years with deep partial or full-thickness thermal burns (1-25% TBSA) were randomized into two groups and treated for 14 days or until greater than 95% graft take was achieved, whichever occurred first. Data were obtained and analyzed on pain experienced before, during, and after dressing removal. Secondary considerations included the overall cost (direct), graft take and healing, the ease of product use, overall experience of the dressing, and adverse events. A total of 43 subjects were recruited. There were no significant differences in burn area profiles within the groups. The pain level during dressing removal was significant between the groups (P = .0118) with the removal of Mepitel One being less painful. The staff costs were lower in the group of patients treated with Mepitel One (P = .0064) as reflected in the shorter time required for dressing removal (P = .0005), with Mepitel One taking on average less than a quarter of the time to remove. There was no significant difference in healing between the two groups, with 99.0% of the Mepitel One group and 93.1% of the Bridal Veil and staples group showing greater than 95% graft take at post-op day 7 (+/-1) (P = .2373). Clinicians reported that the soft silicone dressing was easier to use, more conformable, and demonstrated better ability to stay in place, compared with the Bridal Veil and staples regime. Both treatments were well tolerated, with no serious adverse events in either treatment group. Mepitel One was at least as effective in the treatment of patients as the standard care (Bridal Veil and staples). In addition, the group of patients treated with the soft silicone dressing demonstrated decreased pain and lower costs associated with treatment.

Reimbursement for out-of-state burn patients is not always lower than that for in-state patients at regional burn centers.

Because burn care in the United States is regionalized, burn patients are often transported across state lines to receive their burn treatment. The authors hypothesized that there are differences between in-state and out-of-state reimbursement for burn care. This project was conducted by the American Burn Association (ABA) Government Affairs Committee through the ABA Multicenter Trials Group. Participation was open to any member of the ABA. This retrospective observational study was approved by the institutional review boards of each participating institution. Subjects were identified using registry of each site, selecting patients hospitalized for burn injuries during FY2004-FY2006 of the hospitals. Once identified by the registry, the ID numbers were used to collect billing and reimbursement data from the financial offices. Data were sorted by age (adult and pediatric), location (in state and out of state), and payor source (Medicare, Medicaid, commercial, workers compensation, and self-pay). The rate of reimbursement was calculated based on charges and recoveries. Comparisons on data of each center were performed using Student's t-test with type I error <1%. Six facilities contributed data. A total of 4850 burn patients were reviewed, of whom 3941 were in-state burn patients and 909 were out-of-state burn patients. When the results from all six states were analyzed together, reimbursement for adults from Medicaid and Medicare was higher for in-state patients than for out-of-state patients. However, when analyzed by state, Medicare reimbursement between in-state and out-of-state patients did not differ significantly. In one state (Kansas), in-state Medicaid reimbursement was higher, but in two others (Arizona and Pennsylvania), in-state Medicaid reimbursement was lower than that for out-of-state reimbursement. Reimbursement for the care of children did not differ significantly based on state of residence. From these data, we conclude that there are indeed variations between in-state and out-of-state reimbursement, but those variations differ regionally. Indeed, in some cases, out-of-state reimbursement exceeds in-state reimbursement. Careful examination of these data is necessary before recommending policy change, although consideration should be given to a national policy that guarantees uniformity of reimbursement across all payors for burn patients regardless of their state of residence.