[Profitability of reconstructive microsurgery: position paper of the German-Speaking Group for Microsurgery of Peripheral Nerves and Vessels]. / Wirtschaftlichkeit der rekonstruktiven Mikrochirurgie: Positionspapier der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie ­ (DAM).

The profitability of medical treatment has gained increasing importance in health politics and likewise has become a considerable part of a microsurgeon's daily practice. The resulting cost pressure leads to microsurgeons having to justify their often complex and expensive treatments against hospital providers and health insurances. In this position paper of the German Speaking Group for Microsurgery of Peripheral Nerves and Vessels, we analyze the current status of profitability of microsurgical extremity and breast reconstruction, and its impact on choice of therapy and residency training. We specifically highlight the available literature, that shows often reduced long-term treatment costs after microsurgical reconstruction in comparison to cheaper initial treatments. The statements are based on a consensus workshop on the 40th meeting of the DAM in Lugano, Switzerland.

[German linguistic validation of the BODY-Q: standardised PRO instrument after bariatric and bodycontouring surgery]. / Deutschsprachige Validierung des Body-Q ­ standardisiertes PRO-Messinstrument nach bariatrischen und körperformenden Eingriffen.

One of the most important parts of result evaluation in plastic surgery, especially postbariatric and body-contouring surgery, is the appraisal of changes in patients' quality of life after treatment. Standardised assessments of patient-reported outcomes (PROs) are indispensable.BODY-Q (A. Klassen et al.) is a multifaceted, valid PRO instrument comprising a total of 26 scales for the evaluation of multiple factors of everyday life in order to quantify well-being, satisfaction and functionality. Each scale contains 4-10 statements, which have to be rated by patients.The BODY-Q was created pursuant to ISPOR (International Society for Pharmacoeconomics and Outcomes Research) standards and subjected to psychometric tests with great results. It is considered a standard PRO instrument for quality of life in postbariatric and body-contouring surgery.In order to expand the applicability of standardised questionnaires, ISPOR established linguistic validation guidelines, which have been applied to the BODY-Q in Dutch, Danish, Finnish and Polish.In this study, German linguistic validation was completed applying the standardised guidelines. First the BODY-Q was translated in consensus with medical expertise. Then a certified translator produced a backwards translation, which was commented on by the author. After appropriate changes were made in due consideration of these comments, interviews with patients were conducted to remove any sources of content-related misconception. Finally, the translated version was applied on patients. All the scales were translated to an easily understandable questionnaire reliable in form and content. An international collaboration aiming to centralise the results has started. Further linguistic validation procedures in other languages have been initiated, and an international cohort structure is planned to be established for body-contouring procedures in order to systematically improve treatment quality in plastic surgery.

Burn Scar Evaluation Using the Cutometer® MPA 580 in Comparison to "Patient and Observer Scar Assessment Scale" and "Vancouver Scar Scale".

The effect of the "Patient and Observer Scar Assessment Scale" (POSAS) and "Vancouver Scar Scale" (VSS) on patients' quality of life and their correlation with objective scar assessment tools, such as the Cutometer®, is not fully elucidated. In addition, long-term results of the dermal substitute Matriderm® used in combination with split-thickness skin grafting (STSG) remain unclear. We evaluated burn scars of 45 patients at least 2 years postburn injury using the Cutometer® MPA 580, the VSS, and the POSAS with three additional questions regarding quality of life and correlated the results. Study groups were: 1) scars following conservative treatment, 2) scars following STSG, and 3) scars following STSG in combination with Matriderm®. Cutometer® measurements demonstrated better elastic qualities in the Matriderm® group compared with the STSG group. VSS and extended POSAS were rated best for the conservative group, followed by the STSG group and the Matriderm® group. There was a significant correlation between POSAS and VSS, quality of life and the objective Cutometer® measurements. Conservatively treated superficial dermal burns do not reach the elastic qualities of healthy skin, and the use of Matriderm® significantly improves the long-term elastic qualities of STSG in deep dermal and full-thickness burns 2 years post injury. Results from the VSS and the POSAS correlate with restrictions in the quality of life of patients and also with objective Cutometer® measurements and are therefore useful tools in scar evaluation following burn injury.

The Kinect Recording System for objective three- and four-dimensional breast assessment with image overlays.

INTRODUCTION: We investigated the application of the validated portable Kinect camera for three- and four-dimensional breast assessment in female life models. METHOD: Breast images from six life models were captured using the Kinect camera. Capture was conducted with taking three different arm positions while standing upright: with the arms straight down, straight up to the side at 90° and straight all the way up. Images of the volunteers were superimposed on each other. Digital linear distances between sternal notch and nipple-areola complexes were obtained and compared. The views of plastic and breast surgeons to arm positions were questioned. An example for clinical application was provided. RESULTS: Successful capture of images of the female life breast models was achieved. Digital breast measurements at the three different arm positions revealed considerable variation in linear distances measured on the images obtained with the Kinect camera. The dynamic of breast movements could be demonstrated by image overlay and the first ever four-dimensional breast assessment was demonstrated. Fourteen plastic and breast surgeons were found to have nine different opinions regarding their favoured arm positions for breast capture. Even though precision of image sharpness still needs improvement, the images were satisfactory for clinical patient use. The Kinect data were shown to be applicable to surgery planning by designing a planar flap from the 3D mesh. CONCLUSION: The portable and low-cost Kinect camera proved to be easy to use for the first application in life models for three- and four-dimensional breast assessment.

Validation of the Kinect device as a new portable imaging system for three-dimensional breast assessment.

AIM: The aim of this study was the evaluation of a new, simple, touchless, low-cost and portable three-dimensional (3D) measurement system for objective breast assessment. METHOD: The Kinect Recording System by Microsoft was used. Coloured and depth images were captured of nine silicone breast implants of known volumes. The data were processed using Matlab(®) software. Volume measurements were obtained in a blinded calculation on the 3D images. For further comparison, implant volumes were assessed with the Arthur Morris device, a manual measurement tool. RESULTS: Four tests revealed that the true breast implant volumes were calculated within an error margin of 10%. Reproducibility of measurements was satisfactory. Overall, the accuracy and reproducibility of the measurements of the Kinect System were better than those of the Arthur Morris device. Accuracy of volume assessments with the Kinect System was satisfactory for clinical application. Our new portable 3D imaging system was successfully validated. DISCUSSION: The portable and easy-to-use system has several advantages against the currently available commercial systems. Despite a slight overestimation of the volume data, we felt that these results were very promising due to the repeatability of the measurements. After validating the measurement accuracy of the system in a simpler case, we aim to conduct further studies on 3D breast assessment. CONCLUSION: The results obtained with the Kinect System were sufficiently accurate and reproducible for application in 3D breast capture. We successfully validated the portable 3D imaging system for the first ever use in 3D breast assessment.

Too little appreciation for great expenditure? Workload and resources in ICUs.

PURPOSE: The aim of this study was providing descriptive information and the comparative examination of job strain and mental health of nurses and physicians in different intensive care units (ICU). METHODS: The Effort-Reward Imbalance Questionnaire by Siegrist and standardized psychometric questionnaires, like Hospital Anxiety and Depression Scale, Impact of Event Scale, Brief Symptom Inventory, Social Support Questionnaire, and Life Satisfaction Questionnaire were used. Five ICUs of the same German medical school were included (N = 142). RESULTS: For all ICUs investigated, a significantly lower mental health and a high effort-reward imbalance were found when compared with other samples. Only a few differences between the wards or both professional groups (nurses vs. physicians) were noted. The values for social support were comparable with those of healthy controls but differed between the wards. The life satisfaction in our cohort was lower compared to a population-based sample but was significant different between the wards. CONCLUSIONS: Our study demonstrates the high job strain in an ICU, largely independent of the professional group. Noteworthy, a high effort-reward imbalance was found that stands in positive relation to adverse health effects (anxiety, depression, and general mental health). As a consequence, necessary interventions like stress management, supervision, and communication trainings should consider ward-specific conditions of employment rather than professional affiliation. After these interventions, a follow-up study will be performed to examine beneficial effects on job strain and health.

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias.

Publication bias is a major problem in evidence based medicine. As well as positive outcome studies being preferentially published or followed by full text publication authors are also more likely to publish positive results in English-language journals. This unequal distribution of trials leads to a selection bias in evidence l level studies, like systematic reviews, meta-analysis or health technology assessments followed by a systematic failure of interpretation and in clinical decisions. Publication bias in a systematic review occurs mostly during the selection process and a transparent selection process is necessary to avoid such bias. For systematic reviews/meta-analysis the PRISMA-statement (formerly known as QUOROM) is recommended, as it gives the reader for a better understanding of the selection process. In the future the use of trial registration for minimizing publication bias, mechanisms to allow easier access to the scientific literature and improvement in the peer review process are recommended to overcome publication bias. The use of checklists like PRISMA is likely to improve the reporting quality of a systematic review and provides substantial transparency in the selection process of papers in a systematic review.

Composite tissue allotransplantation in Europe. Logistics and infrastructure of a centre.

BACKGROUND: Composite Tissue Allotransplantation (CTA) is a new medical field of growing importance. This paper focuses on the infrastructure and organisation of European CTA centres and discusses the differences between national health systems. MATERIAL/METHODS: Eight European centres (Valencia, Innsbruck, Munich, Lyon, Amiens, Creteil, Wroclaw, Monza) were sent with a specially-designed, standardized, 20-item questionnaire. RESULTS: Five of the eight centres returned our questionnaire: Munich, Innsbruck, Lyon, Amiens, Wroclaw. Since 1998, CTA has been performed at these centres. In both French centres and the Polish centre public funding is available in addition to the coverage provided by health insurers. In Munich the costs for a double upper-arm transplantation were Euro 150,000 with an additional Euro 50,000-70,000 per year. In Lyon the costs for a singular hand transplantation were Euro 70,000 per year and in Wroclaw (Poland) the costs for a hand or upper arm transplantation were Euro 20,000-30,000. As many as 17 different medical professions are involved in the CTA at the different centres. CONCLUSIONS: CTA is an innovative promising therapeutic tool that is based on the experiences of solid organ transplantation and profound microsurgical skills. Due to the complexity of the infrastructure, sourcing and the organisation CTA can only be successfully performed at specialized centres. A European network with an international European waiting list and a central coordination for CTA should be established. In order to advance CTA as an important tool in reconstructive surgery we must turn our attention to how the costs will be met, the legal environment for procurement of adequate donors and open ethical questions.