Natural history and quality of life in patients with cystine urolithiasis: a single centre study.

OBJECTIVE: To describe the natural history and quality of life (QoL) in patients with cystine urolithiasis. PATIENTS AND METHODS: A cohort study was carried out involving participants recruited from a single surgeon's case mix. Patients with cystinuria and related urolithiasis were invited to complete a questionnaire involving demographic information, use of medical treatment, surgical interventions and the 36-item short-form 36-item short-form health survey (SF-36). RESULTS: In all, 14 patients completed the survey. The SF-36 survey showed lower QoL than the general public in seven of eight domains. The mean interventional rate in patients with cystinuria was 10.6 procedures per patient. Most patients reported previous use of d-penicillamine and urinary alkalinisation medications, with most ceasing due to side-effects or lack of perceived efficacy. CONCLUSION: Cystinuria is associated with a high rate of surgical intervention and lower QoL than the general public. Individuals with this condition report that medical management is either ineffective or poorly tolerated. There is a need for further improvements in medical management of cystinuria, to reduce the rate of operative intervention.

Flow-through flap for salvage of fibula osseocutaneous vascular variations: a surgical approach and proposed modification of its classification.

The osseocutaneous fibula free flap is commonly used in mandibular reconstruction. Clinically important anatomic variants of the donor vessels have been reported. The authors describe a rare variant encountered while raising an osseocutaneous fibula flap. The fibula was supplied by the peroneal vessels and the overlying skin paddle was supplied by musculocutaneous perforators arising from the posterior tibial vessels. By raising 2 separate free flaps and configuring them in microvascular series with the fibula acting as a flow-through flap, the reconstruction was successful. Although the anatomic variant has been described, the authors' approach to it has not. The benefits of this method over other options include preservation of a skin paddle for monitoring and watertight oral closure and a long pedicle to the skin paddle permitting a wide arc of movement. The authors suggest a modification to the existing classification of perforators to the lateral leg skin to guide intraoperative decision making.

Operative Autonomy in a Gender-Balanced Cohort of Surgical Trainees.

BACKGROUND: Gender inequity continues to be a major focus of improvements within surgical education. Female trainees are fewer and experience reduced quality of surgical training. Prior studies have demonstrated that surgical autonomy for female trainees in a range of surgical disciplines is less than that of male trainees. As a unique example among Australasian specialty training boards, the New Zealand Board of Plastic and Reconstructive Surgery has boasted a gender-balanced cohort of surgical trainees since 2013. The authors sought to examine the effect of gender on surgical autonomy in a cohort of trainees where gender balance has been achieved. METHODS: A retrospective cohort study was undertaken. Anonymized logbook data for New Zealand plastic surgery trainees were analyzed, for the study period, consisting of rotations from December of 2013 to June of 2020. Self-reported levels of trainee supervision were compared against gender. Outcomes were tested using multivariate analysis. RESULTS: Thirty-eight trainees were included in the study (58% female), with a total of 81,178 cases recorded over the 6.5-year study period. No overall statistically significant difference in surgical autonomy was identified when analyzed by gender. Male and female trainees showed similar trends of increasing surgical autonomy throughout the course of surgical training. CONCLUSIONS: In a cohort of surgical trainees that has reached gender balance, the negative impact of gender on surgical autonomy was not identified. These findings suggest that where women make up an equal proportion of trainees, the implicit gender bias within surgical training may be ameliorated.

Anterolateral thigh versus pectoralis major flaps in reconstruction of the lateral temporal bone defect.

BACKGROUND: Free tissue reconstruction is reliable in suitable patients but patient selection remains a challenge for the reconstructive surgeon. The anterolateral thigh (ALT) free flap and pedicled pectoralis major myocutaneous flap (PMMF) are two common reconstructive options for a lateral temporal bone resection defect. The threshold at which free tissue reconstruction should be considered over locoregional reconstruction is not defined. We sought to define reconstructive flap choice in the setting of medical comorbidities that may dissuade free tissue transfer. METHODS: A retrospective analysis of lateral temporal bone defects at a single institution was undertaken. The primary outcomes were flap survival, surgical complications and durations of surgery and stay. Data regarding medical comorbidities and potential confounders were examined. RESULTS: Sixty patients with lateral temporal bone defects were identified. Twenty-four (40%) patients underwent PMMF reconstruction and 36 (60%) were reconstructed with ALT. The former were significantly older (73 versus 62 years), though with similar Anesthesiologists Risk Classification System status. Free-flap reconstruction resulted in significantly less flap loss (two versus six) but a longer operating time (790 versus 671 min). CONCLUSION: Patients suffering head and neck cancer with medical comorbidities can make selection of a suitable reconstruction difficult. We found that while patients undergoing ALT reconstruction were typically younger, the comorbidity profile of those patients was similar to patients undergoing PMMF reconstruction. ALT flaps were more reliable than the PMMF, lending credence to the view that free tissue transfer should be the preferred reconstructive option in suitable candidates and defects.

Medical Graduates, Tertiary Hospitals, and Burnout: A Longitudinal Cohort Study.

BACKGROUND: Burnout among junior doctors can affect patient care. We conducted a longitudinal cohort study designed to explore the incidence of burnout in medical interns and to examine the changes in burnout during the course of the intern year. METHODS: Interns were recruited at two tertiary hospitals in Brisbane, Australia (n=180). Participants completed surveys at four time points during their internship year. All interns (100%) completed the baseline survey during their orientation. Response rates were 85%, 88%, and 79%, respectively, at 5-week, 6-month, and 12-month follow-up. RESULTS: Interns reported high levels of personal and work-related burnout throughout the year that peaked at 6 months with mean scores of 42.53 and 41.81, respectively. Increases of 5.1 points (confidence interval [CI] 2.5,7.7; P=0.0001) and 3.5 points (CI 1.3,5.6; P=0.0015) were seen at 6 months for personal and work-related burnout, respectively. The mean score for patient-related burnout at 12 months was 25.57, and this number had increased significantly by 5.8 points (CI 3.2,8.5; P<0.0001) throughout the year. Correlation with demographic variables (age, sex) were found. The total incidence of burnout was 55.9%. CONCLUSION: Our study showed that burnout is a common problem among interns. The high incidence of burnout demonstrates the need for appropriate strategies to prevent adverse effects on doctors' quality of life and on the quality of care patients receive.