ChatGPT-4 Can Help Hand Surgeons Communicate Better With Patients.

The American Society for Surgery of the Hand and British Society for Surgery of the Hand produce patient-focused information above the sixth-grade readability recommended by the American Medical Association. To promote health equity, patient-focused content should be aimed at an appropriate level of health literacy. Artificial intelligence-driven large language models may be able to assist hand surgery societies in improving the readability of the information provided to patients. The readability was calculated for all the articles written in English on the American Society for Surgery of the Hand and British Society for Surgery of the Hand websites, in terms of seven of the commonest readability formulas. Chat Generative Pre-Trained Transformer version 4 (ChatGPT-4) was then asked to rewrite each article at a sixth-grade readability level. The readability for each response was calculated and compared with the unedited articles. Chat Generative Pre-Trained Transformer version 4 was able to improve the readability across all chosen readability formulas and was successful in achieving a mean sixth-grade readability level in terms of the Flesch Kincaid Grade Level and Simple Measure of Gobbledygook calculations. It increased the mean Flesch Reading Ease score, with higher scores representing more readable material. This study demonstrated that ChatGPT-4 can be used to improve the readability of patient-focused material in hand surgery. However, ChatGPT-4 is interested primarily in sounding natural, and not in seeking truth, and hence, each response must be evaluated by the surgeon to ensure that information accuracy is not being sacrificed for the sake of readability by this powerful tool.

Efficacy of a bacterial fluorescence imaging device in an outpatient wound care clinic: a pilot study.

OBJECTIVE: Subsurface bacterial burden can be missed during standard wound examination protocols. The real-time bacterial fluorescence imaging device, MolecuLight i:X, visualises the presence of potentially harmful levels of bacteria through endogenous autofluorescence, without the need for contrast agents or contact with the patient. The intended use of the imaging device is to assist with the management of patients with wounds by enabling real-time visualisation of potentially harmful bacteria. The aim of this study was to establish the accuracy of the wound imaging device at detecting pathogenic bacteria in wounds. METHODS: A single-centre, prospective observational study was conducted in Cork University Hospital in an outpatient plastic surgery wound care clinic. Patients had their wounds photographed under white and autofluorescent light with the imaging device. Auto-fluorescent images were compared with the microbiological swab results. RESULTS: A total of 33 patients and 43 swabs were included, of which 95.3% (n=41) were positive for bacteria growth. Staphylococcus aureus was the most common bacterial species identified. The imaging device had a sensitivity of 100% and specificity of 78% at identifying pathological bacteria presence in wounds on fluorescent light imaging. The positive predictive value (PPV) was 95.4%. The negative predictive value (NPV) was 100%. It demonstrated a sensitivity and specificity of 100% at detecting the presence of Pseudomonas spp. CONCLUSION: The imaging device used could be a safe, effective, accurate and easy-to-use autofluorescent device to improve the assessment of wounds in the outpatient clinic setting. In conjunction with best clinical practice, the device can be used to guide clinicians use of antibiotics and specialised dressings.

Trapezius flaps for reconstruction of head and neck defects following oncological resection - A systematic review.

OBJECTIVE: Head and neck (H&N) reconstruction after cancer resection is challenging. Myocutaneous trapezius flaps provide an alternative reconstruction for patients not suitable for microvascular free tissue transfer. METHODS: A systematic review was performed on studies involving trapezius flaps for H&N reconstruction post oncological resection between the years 1985-2015. Data extracted included patient numbers and demographics, operative technique and complications. Complication rates, for the study cohort, were calculated and a univariate analysis was preformed evaluating patient and flap-related risk factors. RESULTS: Seventeen studies met the inclusion criteria, with a total of 157 trapezius flaps. Intraoral defects were the most frequent recipient site (74.5%). The mean skin paddle width was 6.84 cm (range 3-15 cm) and length was 11.1 cm (range 4-25 cm). Type 2 (superficial branch of transverse cervical artery) accounted for 77.1% (118/153) of all trapezius flaps performed. The complication rate was 15.9%, with 15 reported flap related and 7 donor site complications. Skin paddle size, pedicle selection, primary versus salvage reconstruction and radiotherapy were not identified risk factors for complications. CONCLUSION: Trapezius flaps are a reliable and versatile myocutaneous flap for both primary and salvage surgery reconstruction of H&N defects following oncological resection.

Trends in the Level of Evidence in Clinical Hand Surgery Research.

BACKGROUND: The application of evidence-based medicine (EBM) to the practice of hand surgery has been limited. Production of high-quality research is an integral component of EBM. With considerable improvements in the quality evidence in both orthopedic and plastic and reconstructive surgery, it is imperative that hand surgery research emulates this trend. METHODS: A systematic review was performed on all hand surgery articles published in 6 journals over a 20-year period. The journals included Plastic and Reconstruction Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, Journal of Hand Surgery-European Volume, Journal of Hand Surgery-American Volume, Journal of Bone & Joint Surgery, and the Bone & Joint Journal. The level of evidence of each article was determined using the Oxford level of evidence. The quality of methodology of randomized controlled trials (RCTs) was assessed using Jadad scale. Statistical analysis involved chi-squares and Student t test (P < .05). RESULTS: A total of 972 original hand surgery research articles were reviewed. There was a significant increase in the average level of evidence of articles published between1993 and 2013. High-quality evidence only accounted for 11.2% of evidence published, with a significant increase over the study period (P = 0.001). Quantitative evaluation of the 26 published RCTs, using Jadad scale, revealed a progressive improvement in study design from 0.3 in 1993 to 3.33 in 2013. CONCLUSIONS: Hand surgery research has mirrored trends seen in other surgical specialties, with a significant increase in quality of evidence over time. Yet, high-quality evidence still remains infrequent.