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INTRODUCTION: Core Surgical Training has become increasingly competitive over the last 5 years with the competition ratio reaching 4.16 in 2021 compared to 2.31 in 2015. This is thought to be due to two key factors: a large yearly increase in the number of applicants and an unchanging number of jobs. Steps are taken by HEE to ensure the process is as standardised and fair as possible. Interview date and time selection remains the only aspect of the process that candidates currently control. We aim to explore whether time and date of an interview has any impact on interview scores within CST. METHODS: This study is a national, retrospective cohort study. A freedom of information act request was submitted to HEE to acquire anonymised interview scores and date/time of interview for all CST interviews conducted for the 2022-2023 cohort. RESULTS: Across the two-week period whereby interviews were held 1264 interviews were undertaken. Candidates with morning interviews had a mean score of 111 (±16) and candidates in the afternoon had a mean score of 108 (±18.5) (p = 0.023). Candidates interviewing in week 1 had a mean score of 107 (±18) and candidates interviewing in week 2 had a mean score of 112 (±16.4) (p < 0.001). DISCUSSION: A small difference in score has a significant impact for candidates with their geographical location, specialty choice or event enrolment in the core training programme potentially impacted. It is therefore imperative that these findings receive further evaluation going forward to ensure the process is fair and robust for all participants.
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Internado y Residencia , Humanos , Estudios RetrospectivosRESUMEN
BACKGROUND: Hyaluronidase is used as an adjunct or main treatment to manage complications associated with cosmetic hyaluronic acid (HA) filler injections such as necrosis, blindness, hypersensitivity, delayed nodules, and poor aesthetic outcomes. OBJECTIVE: To systematically map the available evidence and identify the gaps in knowledge on the effectiveness of hyaluronidase use in managing the aesthetic complications associated with HA injections (vascular occlusion, blindness, nodules, delayed hypersensivity, granuloma, poor aesthetic outcome). METHODS: PubMed, Medline, Embase and Cochrane databases were used up to May 2022, to look for randomized clinical trials (RCTs), clinical trials, and retrospective case-control studies reporting on the use of hyaluronidase for managing the HA filler injection complications. RESULTS: The database search yielded 395 studies; of those 5 RCTs (all carried out in the USA) were selected (53 subjects), indicating the effectiveness of hyaluronidase for removal of un-complicated injected HA nodules (forearm, upper arm, or back skin). The follow-ups ranged from 14 days to 4 years. The amount of HA filler injected into each site varied from 0.2 to 0.4 mL. A dose dependent response was observed for most HA fillers. No major adverse reactions were reported. Overall, for removal of every 0.1 mL of HA filler they injected 1.25-37.5 units of hyaluronidase (single injections). When 3 consecutive weekly hyaluronidase injection was used much lower doses of 0.375-2.25 unit was utilised. There was no evidence in a form of RCTs, clinical trials, and retrospective case-control studies on the removal/reversal of HA injections in the facial skin, or management of over-corrections, inflammatory nodules, or tissue ischemia/necrosis associated with HA filler injection. CONCLUSION: Based on studies on the forearm, upper arm and back skin, hyaluronidase can be used for the reversal of uncomplicated HA filler injection nodule. However, further adequately powered studies are warranted to establish the ideal treatment protocol/dose of hyaluronidase for reversal of HA filler injections in the facial region or management of complications associated with aesthetic HA injection. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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INTRODUCTION: The face is a cosmetically sensitive region where the process of ageing is most clearly manifested. With increased focus on anti-ageing and longevity, more anti-senescent treatments are being proposed despite limited evidence. This study outlines the pathways and mechanisms underpinning the biological process of ageing in the face. METHODS: Comprehensive searches of MEDLINE, EMBASE, Cochrane Library and CINAHL from inception to 2020. Inclusion criteria included all empirical human research studies specific to facial ageing features, written in the English language. RESULTS: A total of 65 papers met inclusion criteria for analysis. Pathways were subdivided into intrinsic and extrinsic senescence mechanisms. Intrinsic pathways included genetics, generation of reactive oxygen species and hormonal changes. Extrinsic pathways included photoageing and damage to skin layers. The combined intrinsic and extrinsic pathway alterations result in wrinkles, higher laxity, slackness and thinning of the skin. Skin functions such as barrier immune function, wound healing, thermoregulation and sensory function are also impaired. CONCLUSION: The ageing process is unique to the individual and depends on the interplay between an individual's genetics and external environmental factors. Through understanding the molecular and cellular mechanisms, an appreciation of the consequent structural and functional changes can be achieved. Based on this knowledge, further research can focus on how to slow or impede the ageing process and identify specific targets to develop and evolve new treatment strategies.
INTRODUCTION: Le visage est une zone du corps esthétiquement importante où le processus de vieillissement se manifeste particulièrement clairement. Avec l'attention croissante portée aux soins anti-âge et à la longévité, de plus en plus de traitements anti-sénescent sont proposés malgré des preuves d'efficacité limitées. Cette étude décrit les voies métaboliques et les mécanismes à la base du processus biologique de vieillissement du visage. MÉTHODES: Recherches exhaustives dans les bases de données bibliographiques MEDLINE, EMBASE, Cochrane Library et CINAHL de leur création à 2020. Les critères d'inclusion comprenaient toutes les études empiriques spécifiques aux caractéristiques du vieillissement du visage chez l'Homme, rédigées en langue anglaise. RÉSULTATS: Un total de 65 articles répondait aux critères d'inclusion pour l'analyse. Les voies métaboliques ont été subdivisées en mécanismes de sénescence intrinsèques et extrinsèques. Les voies intrinsèques comprennent la génétique, la génération de dérivés réactifs de l'oxygène et les changements hormonaux. Les voies extrinsèques comprenaient le photovieillissement et les dommages causés aux couches de la peau. Les altérations combinées des voies intrinsèque et extrinsèque entraînent des rides, une laxité plus importante, un relâchement et un amincissement de la peau. Les fonctions cutanées telles que la fonction de barrière immunitaire, la cicatrisation, la thermorégulation et la fonction sensorielle sont également altérées. CONCLUSION: Le processus de vieillissement est unique à l'individu et dépend de l'interaction entre la génétique d'un individu et les facteurs environnementaux externes. La compréhension des mécanismes moléculaires et cellulaires permet d'appréhender les changements structurels et fonctionnels qui en découlent. Sur la base de ces connaissances, la recherche peut se concentrer sur les moyens de ralentir ou d'entraver le processus de vieillissement et identifier des cibles spécifiques pour élaborer et développer de nouvelles stratégies de traitement.
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Envejecimiento de la Piel , Envejecimiento , Cara , Humanos , Piel , Cicatrización de HeridasRESUMEN
BACKGROUND: Botulinum toxin A (BoNT-A) injections are a popular non-surgical procedure for facial rejuvenation. Its increase in popularity and utilization is met with limited regulations, potentially posing a significant risk to patient safety and public health. OBJECTIVES: The authors sought to assess the safety profile of cosmetic glabellar and forehead BoNT-A injections and evaluate BoNT-A type on complication rate. METHODS: A systematic search of MEDLINE and EMBASE was performed for studies reporting complications after cosmetic BoNT-A in the glabellar or in the forehead region in the glabellar or in the forehead region. A random effects meta-analysis was carried out to assess complication rate. Where there were sufficient randomized-controlled trials, a network meta-analysis was performed. RESULTS: Of 556 identified articles, 24 were included in the final quantitative analysis, with 4268 BoNT-A injection sessions and 1234 placebos. Frequently observed treatment-related complications in the BoNT-A intervention group included headache, local skin reactions, and facial neuromuscular symptoms. The overall BoNT-A complication rate was 16%. The odds ratio of developing complications from abobotulinum toxin injections compared with placebo was 1.62 (1.15, 2.27; P > 0.05) and that from onabotulinum toxin injections compared with placebo was 1.34 (0.52, 3.48; P > 0.05). In 30% of the studies, the injectors were doctors, whereas the training status of the practitioner was not reported in the remaining 70%. CONCLUSIONS: Cosmetic BoNT-A injections in the glabellar and forehead region appear to be safe, and most complications are mild and transient. Nevertheless, the literature demonstrates heterogeneous reporting of complications and a lack of consistency of the definition of treatment-related complications.
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Toxinas Botulínicas Tipo A , Fármacos Neuromusculares , Envejecimiento de la Piel , Toxinas Botulínicas Tipo A/efectos adversos , Cara , Frente , HumanosRESUMEN
Background: Intra-abdominal adhesion formation is still unavoidable and a cause of significant morbidity in abdominal surgery. Platelet-rich plasma gel and hyaluronic acid have been studied for their protective of therapeutic effects on adhesions. The aim of the present study is to compare Platelet-rich plasma and hyaluronic acid in adhesion prevention. Material and method: Twenty-seven Sprague-Dawley rats were randomly allocated into three equal groups(n=9). Surgical trauma was used to induce adhesion formation. After trauma, 1 ml normal saline was instilled in the peritoneal cavity in control group (n=9), 1 ml liquid Hyaluronic acid (25 mg/ml) was instilled in group A (n= 9) and 1 ml of platelet-rich plasma was instilled in group B (n = 9). Four weeks after the laparotomy, a repetitive laparotomy was performed and adhesions were examined microscopically and macroscopically. Results: Platelet-rich plasma gel and hyaluronic acid both reduce the extent and grade of adhesions macroscopically. Interestingly, PRP turns out to be superior in the reduction of tenacity and adhesion area. Moreover, platelet-rich plasma ameliorates abdominal adhesion formation by reducing neutrophils, fibrosis, and inflammation. Conclusion: The results indicate that platelet-rich plasma gel surpasses hyaluronic acid in abdominal adhesion prevention.
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Enfermedades Peritoneales , Plasma Rico en Plaquetas , Ratas , Humanos , Animales , Ácido Hialurónico/farmacología , Ácido Hialurónico/uso terapéutico , Ratas Sprague-Dawley , Resultado del Tratamiento , Adherencias Tisulares/etiología , Enfermedades Peritoneales/complicacionesRESUMEN
Background: Ischeamia reperfusion injury is a frequent challenge during tissue reconstruction. Atorvastatin and Sildenafil, have been studied for their protective and/or therapeutic effects on various organ systems subjected to IRI. The aim of the present study was to compare a single dose of Atorvastatin and Sildenafil pretreatment on acute oxidative/nitrosative stress and the subsequent dermal flap necrosis. Materials and Methods: Forty-five Sprague-Dawley rats, were randomly allocated into three equal groups(n=15): Group A: Control rats treated with intraperitoneal saline, Group B: Sildenafil group, and Group C: atorvastatin group. All rats underwent flap elevation and inferior epigastric artery occlusion thirty minutes after drug administration. Myeloperoxidase activity, malondialdehyde levels and inducible nitric oxide synthase activity were evaluated 12 hours after reperfusion. Flap survivability was analysed 7 days after the procedure. Results: Statistically significant reduction was detected in sildenafil and atorvastation. Measurements of myelopyroxidase followed a similar pattern, interestingly malonadehyde levels measured to be significantly lower in the sildenafil group. Contrary, iNOS activity atorvastatin was significantly elevated in atorvastatin group. Conclusion: The single dose of atorvastatin or sildenafil increase flap survivability almost equally, however only atorvastatin enhances significantly iNOS expression.
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Atorvastatina/farmacología , Óxido Nítrico , Daño por Reperfusión/tratamiento farmacológico , Citrato de Sildenafil/farmacología , Piel/irrigación sanguínea , Vasodilatadores/farmacología , Animales , Atorvastatina/uso terapéutico , Modelos Animales de Enfermedad , Supervivencia de Injerto/efectos de los fármacos , Necrosis/etiología , Necrosis/prevención & control , Óxido Nítrico/biosíntesis , Estrés Oxidativo/efectos de los fármacos , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley , Daño por Reperfusión/metabolismo , Citrato de Sildenafil/uso terapéutico , Piel/efectos de los fármacos , Piel/patología , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/patología , Resultado del Tratamiento , Vasodilatadores/uso terapéuticoRESUMEN
OBJECTIVES: Vascular surgery is in increasing demand due to the higher prevalence of cardiovascular disease in the general population. Meanwhile, applications to join the speciality have been in decline in the last few years. St George's Surgical Society held a one-day conference to expose undergraduates to the speciality in the hope that this will inspire more undergraduates to pursue it as a career. METHODS: The conference consisted of introductory lectures delivered by a consultant vascular surgeon, followed by practical skills workshops simulating aortic anastomosis on porcine aortas. Pre-course and post-course questionnaires assessed positive and negative perceptions of vascular surgery, knowledge of and self-reported confidence in practical surgical skills and utility of the course in their decision to potentially pursue a career in vascular surgery. RESULTS: There was a significant increase of 27% ( p = 0.03) in the positive perception that vascular surgery includes a diverse range of procedures and subspecialties. Attendees reported a 27% significant increase ( p = 0.02) in the perception that vascular surgery had a wide array of opportunity for academic/research work. Finally, there was an 18% decrease ( p = 0.03) in the negative perception that vascular surgery is somehow female-unfriendly or discriminatory against females. There was also a significant rise in both interest (33%) and understanding (73%) of vascular surgery. CONCLUSIONS: A one-day conference can significantly impact students' perception especially when there is a lack of exposure within the undergraduate curriculum. This course helped to increase positive perception and dispute negative misconceptions about the speciality. The simulation workshops held at this conference increased students' confidence and awareness of relevant surgical skills. This conference provided a unique experience that positively impacted and inspired students and thus served as an important supplement to core medical curriculum.
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Selección de Profesión , Especialización , Estudiantes de Medicina/psicología , Procedimientos Quirúrgicos Vasculares , Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Perfil Laboral , Mentores , Percepción , Médicos Mujeres/psicología , Mujeres Trabajadoras/psicología , Equilibrio entre Vida Personal y Laboral , Carga de TrabajoRESUMEN
AIM: To evaluate the features of esthetic-specific Clinic Management Softwares (CMS) and scrutinize these against the General Medical Council (GMC) and Joint Commission (JC) guidance, an indicative CMS framework with GMC and JC compliant features is developed, to improve patient outcomes, service quality, and work toward a centralized database for complications to enable research analysis. METHODS: A systematic search was performed to evaluate the CMS on the market tailored to esthetic clinics. An analysis was made of the GMC guidance for record keeping and the JC standards for Patient Safety Systems. The CMS features were each scrutinized against the GMC and JC guidance including complication capturing. RESULTS: Eighteen esthetic-specific CMS were identified and analyzed. None of the included CMSs were 100% compliant with both GMC and JC guidance. In 2022, the mean monthly cost of the basic packages for each of the CMS was £106.4, with a standard deviation of £83.3. The main users of the CMSs were doctors and nurses. CONCLUSION: CMS are a potentially powerful tool to form a centralized database that will allow for increased transparency on the number of procedures performed as well as complications.
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Seguridad del Paciente , Médicos , Humanos , Programas InformáticosRESUMEN
Introduction: Plastic, reconstructive and aesthetic surgery (PRAS) is a significant yet often overlooked specialty in medical school curricula. The impact of social media and unregulated information sources can distort the perceptions of medical specialties, including PRAS, leading to a decline in student interest, inappropriate referrals and strain on healthcare services. This systematic review aimed to understand the perceptions of medical students towards PRAS, identify influencing factors and explore strategies to address these influences. Methods: The review followed the PRISMA 2020 guidelines. Four databases were searched, and the inclusion and exclusion criteria were applied. Data from 17 relevant studies were analysed in Microsoft Excel using descriptive statistics. The risk of bias was assessed using a modified Newcastle-Ottawa Scale. Results: Medical students generally held positive perceptions about PRAS, particularly regarding career opportunities, specialised skills and the nature of the specialty. However, their awareness of the full scope of plastic surgery is limited, with a focus on cosmetic and aesthetic procedures. Social media and the internet significantly influenced the students' perceptions, whereas personal experiences had a minor impact. Education and training in plastic surgery positively affected the students' perceptions. Nevertheless, there is a need for improved representation of PRAS in medical school curricula and promotion of accurate information through reliable sources. Conclusion: Students exhibited a favourable attitude towards plastic surgery, but their knowledge of the specialty can be enhanced. Strengthening PRAS teaching in medical schools and ensuring accurate information dissemination can foster a deeper understanding and interest in this field. Large-scale studies with standardised protocols should be conducted in different countries to gain comprehensive insights tailored to specific educational contexts.
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INTRODUCTION: Generative adversarial networks (GANs) are a form of deep learning architecture based on the zero-sum game theory, which uses real data to generate realistic fake data. GANs use two opposing neural networks working: a generator and a discriminator. They represent a powerful tool for generating realistic synthetic patient data sets and can potentially revolutionize research. This systematic literature review evaluated the scale and scope of GANs within plastic surgery, constructing a framework for its use and evaluation within subspecialties. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review was performed for applications of GANs in plastic surgery from 2014 to 2022. Three independent reviewers screened from databases: PubMed, Embase, PsychInfo, Scopus, and Google Scholar. RESULTS: A total of 70 studies were captured by the search, of which seven studies met our criteria. The most common subspecialty was craniofacial (n = 4). Proposed uses of GANs included facial recognition, burn estimation, scar prediction, and post-breast cancer reconstruction anomaly scoring. GANs were conditional, trained on data sets averaging 54,652 ± 112,180 samples, with some sourced publicly and others being primary. CONCLUSION: GANs hold promise for advancing plastic surgery, backed by diverse applications in the literature. Studies should follow a standardized reporting structure for consistency and transparency, as outlined, especially regarding the data sets used to ensure appropriate representation from an ethnic and cultural diversity perspective. Although GANs require specialist computational expertise to create, surgeons need to understand their development by leveraging the full potential of GANs within the emerging field of computational plastic surgery and beyond.
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Procedimientos de Cirugía Plástica , Cirugía Plástica , Humanos , Procedimientos de Cirugía Plástica/métodos , Redes Neurales de la Computación , Aprendizaje ProfundoRESUMEN
Human papillomavirus (HPV) is a common sexually transmitted infection with wide-ranging clinical manifestations. High-risk anogenital HPV genotypes have also been reported to cause extragenital disease. We describe the case of a 69-year-old male patient living with HIV who was diagnosed with HPV-16 associated Bowen's Disease (BD) of the right middle finger nailbed, despite good virologic control and immune reconstitution. The lesion was managed surgically with adjunctive post-exposure HPV vaccination. This case adds to the growing body of evidence of extra-genital HPV disease attributable to anogenital genotypes in people living with HIV.
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Enfermedad de Bowen , Infecciones por VIH , Infecciones por Papillomavirus , Humanos , Masculino , Enfermedad de Bowen/virología , Enfermedad de Bowen/cirugía , Anciano , Infecciones por VIH/complicaciones , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/virología , Resultado del Tratamiento , Neoplasias Cutáneas/virología , Papillomavirus Humano 16/aislamiento & purificación , Papillomavirus Humano 16/genéticaRESUMEN
TikTok (San Jose, CA) is a popular and rapidly growing social media platform. With beauty and skincare among the top 5 most popular categories, TikTok represents an important platform for plastic surgery education and communication. However, given the vast array of content shared daily, regulating content for veracity is challenging. It may also be an important and potentially overlooked avenue for the dissemination of inaccurate information pertaining to plastic surgery. This systematic review evaluates TikTok's impact on plastic surgery. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines, a systematic literature review was performed of the use of TikTok within the plastic surgery field. The following databases were queried: PubMed (National Institutes of Health; Bethesda, MD), EMBASE (Elsevier; Amsterdam, the Netherlands), and PsychInfo (American Psychological Association; Washington, DC). The search captured 31 studies of which 7 were included in the final analysis. The studies examined the following areas: gender-affirming surgery (n = 1), breast reconstruction (n = 1), aesthetic surgical procedures (n = 1), plastic surgeon profiles (n = 1), and profiles of videos relating to plastic surgery hashtags (n = 3). The videos' quality was assessed using the DISCERN scale. Physician videos scored notably higher than nonphysician videos. The mean DISCERN score across all the videos (n = 386) was 1.91 (range: 1.44-3.00), indicating poor quality. TikTok is a popular medium for sharing plastic surgery content. The existing literature has demonstrated overall poor-quality information on plastic surgery, and further study is needed to evaluate its impact in terms of perceptions of the specialty and healthcare behaviors. Future work should focus on promoting accurate, high-quality videos, potentially including a peer-review function for healthcare content. This can leverage TikTok's potential for disseminating content while upholding patient safety.
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Adrenaline auto-injectors are the first line treatment for anaphylaxis in the community setting. Both anaphylaxis and auto-injector carriage are increasing in prevalence. Adrenaline auto-injector injuries are common and most often involve the hand or digits. Such injuries carry a risk of ischemic necrosis due to profound vasoconstriction, especially if there is undying vascular pathology such as Raynaud's disease. The effects can be readily reversed with local infiltration of phentolamine. A survey was circulated to 40 clinicians working in the emergency and hand surgery departments of a major urban center. Knowledge of adrenaline duration of action and its reversal (agent, dose and location in the hospital) was assessed. All clinicians working within the two departments were eligible for participation. Only 25% of clinicians surveyed were aware of the duration of action of adrenaline. Half were aware of the correct reversal agent and only 20% knew the correct dose. Only one person was aware of phentolamine's location within the hospital. There is relatively poor clinician knowledge surrounding adrenaline reversal and a lack of easily accessible information available about dosing and drug location within the hospital. Given the time dependent nature of adrenaline auto-injector injuries Emergency Departments should consider stocking phentolamine in an emergency drugs fridge within the department along with a dosing guide. This is likely to greatly reduce time from presentation to treatment and thus the chances of digital ischemia progressing to necrosis.
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Anafilaxia , Epinefrina , Humanos , Anafilaxia/tratamiento farmacológico , Fentolamina/uso terapéutico , Mano/cirugía , Inyecciones Intramusculares , NecrosisRESUMEN
INTRODUCTION: The United Kingdom (UK) injectables market has been growing rapidly with a lack of robust regulation and to date, no information regarding the profile of practitioners has been published. AIM: We aim to provide a descriptive and qualitative analysis of the advertised practitioners in the United Kingdom. METHODS: We performed a systematic search using the internet search engine Google to perform a qualitative descriptive analysis of aesthetic practitioners in the UK. For each contiguous country in the UK: England, Scotland, and Wales, five searches were performed. The list of practitioners was then cross-referenced with professional regulatory bodies, with extraction of registration number, date of registration and presence or absence from the Specialist Register or General Practitioner Register. RESULTS: 3000 websites were visited and evaluated. 1224 independent clinics with 4405 practitioners were identified. 738 were identified as those in business support functions and the remaining 3667 practitioners were undertaking injectable practice. The profile of professions were doctors 32%, nurses 13%, dentists 24% and dental nurses 8%. Of the 1163 doctors identified 481 were on the specialist register (41%) and 219 were on the GP register (19%). 27 specialties were represented in this cohort analysis. Plastic Surgery formed the majority of those who were on the specialist register at 37%, followed by Dermatology at 18%. CONCLUSION: This paper is the first to describe the range of practitioners, their professional backgrounds and experience who perform non-surgical aesthetic interventions. The range of backgrounds may have an impact on the potential risks to patients and will be an important consideration in proposed legislation to introduce licensing to the industry.
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Médicos , Procedimientos de Cirugía Plástica , Humanos , Reino Unido , Inglaterra , Estudios de CohortesRESUMEN
INTRODUCTION: The proliferation of providers and practitioners of cosmetic botulinum toxin and dermal filler has profound public health implications. The Advertising Standards Authority (ASA) regulates the use of advertising materials in the United Kingdom and prohibits the promotion of prescription-only medicines. AIMS: We aim to perform a cross-sectional analysis of the practitioners in London, UK to evaluate the distribution of clinics within Greater London, prices advertised for interventions, and compliance with the ASA code. We also aim to identify whether there are any differences in cost of botulinum toxin or dermal filler between the boroughs. METHODS: Between December 2021 and January 2022, we performed a systematic search using the internet search engine Google. Five searches were performed (1) [london] botox, (2) [london] botulinum toxin, (3) [london] anti wrinkle injection, (4) [london] filler, (5) [london] dermal filler. One hundred websites per search string were systematically reviewed and those which met the inclusion/exclusion criteria of each search string were included and analyzed. Each clinic's product/service range compliance with the ASA/CAP code was assessed. Any reference to Botulinum Toxin or anti-wrinkle injections was noted and analyzed. Further analysis would look to calculate price per milliliter (mL) of botulinum toxin and dermal filler per borough and to calculate whether there were any statistical differences between the 32 different London boroughs. RESULTS: A total of 500 websites were visited and evaluated. After removal of duplicates, a total of 233 independent clinics was identified. A total of 206 out of the 233 clinics sampled (88%) were in direct infringement of the enforcement notice through advertising a prescription medicine. The overall average cost per mL of dermal filler was £330.89 and there was a statistically significant variance across London boroughs (p < 0.05). The overall average cost per mL of Botulinum Toxin was £284.45 and the variance across London boroughs was close to significant (p = 0.058). CONCLUSION: This paper demonstrates poor compliance with the ASA/CAP guidelines and further provides an insight into the industry mechanics associated with aesthetic injectables in a major UK city, identifying regional variance in price and clinic density. The advertising of prescription-only medication may pose a potential risk to patients and will be an important consideration in proposed legislation to introduce licensing to the industry.
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Toxinas Botulínicas Tipo A , Rellenos Dérmicos , Envejecimiento de la Piel , Humanos , Estudios Transversales , Londres , Toxinas Botulínicas Tipo A/uso terapéuticoRESUMEN
INTRODUCTION: Medical simulation has provided favorable outcomes in the improvement of clinical competence at both the undergraduate and postgraduate levels. The recall of information demonstrably increases when it has been taught in environments similar to the workplace. This study aimed to evaluate the role of a one-day burn simulation session in improving students' knowledge of burn management and interest in plastic surgery as a specialty. METHOD: A one-day course was designed to deliver multiple lectures covering surgical topics such as the classification and management of burns, followed by a series of practical workshops. Participants were instructed to undergo a pre-course knowledge assessment and a survey focusing on interest in plastic surgery. Students were subsequently instructed to complete a post-course assessment and a survey of knowledge and confidence in managing burns as well as interest in plastic surgery both immediately and 6 weeks post-course. RESULTS: The students' knowledge demonstrated a 54.2% increase in the post-course assessment (p < 0.01). 27% of participants (n = 14) participated in a 6-week post-course quiz. The knowledge assessment of these participants at 6 weeks post-course also demonstrated a sustained increase of 61.0% (p < 0.01). Interest in plastic surgery was increased by 31.4% post-course (p < 0.01). At 6 weeks post-course, a sustained increase of 14.7% was demonstrated in comparison to pre-course data (p = 0.03). CONCLUSION: Simulation teaching provides good outcomes in both information retention and interest in plastic surgery as a specialty. Therefore, medical school curriculums may benefit from including burn simulations.
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Quemaduras , Educación de Pregrado en Medicina , Procedimientos de Cirugía Plástica , Estudiantes de Medicina , Cirugía Plástica , Humanos , Curriculum , Quemaduras/cirugía , Cirugía Plástica/educación , Competencia ClínicaRESUMEN
Introduction: In the United Kingdom (UK), complications that arise following the administration of Botulinum Toxin are reported to the Medicines and Health Regulatory Agency (MHRA) via the Yellow Card Reporting Scheme. Over the past decade, there has been a significant increase in the number of non-surgical aesthetic procedures. Concerns have been raised that the MHRA is not fully capturing complications in terms of volume and impact on patients. Aim: This novel study explores the lived experiences of individuals who have experienced an adverse event following administration of Botulinum Toxin for aesthetic purposes. Using a combination of qualitative and quantitative methodologies, this analysis evaluates data relating to long-lasting physical, psychological, emotional, and financial sequelae of complications arising from cosmetic Botulinum Toxin injections in the UK. Methods: A mixed method, qualitative and quantitative approach was adopted to gain comprehensive insights into patients' experiences. A focus group which comprised patient representatives, psychologists, and researchers reached a consensus on a 17-question survey which was disseminated via social media channels. Deductive thematic analysis was used to analyse coded themes. Furthermore, for secondary analysis, sentiment analysis was used computationally as an innovative approach to identify and categorise free text responses associated with sentiments using natural language processing (NLP). Results: In the study, 655 responses were received, with 287 (44%) of respondents completing all questions. The mean age of respondents was 42.6 years old. 94.1% of respondents identified as female. In the sample, 79% of respondents reported an adverse event following their procedure, with the most common event being reported as 'anxiety'. Findings revealed that 69% of respondents reported long-lasting adverse effects. From the responses, 68.4% reported not having recovered physically, 63.5% of respondents stated that they had not recovered emotionally from complications, and 61.7% said that they have not recovered psychologically. In addition, 84% of respondents stated that they do not know who regulates the aesthetics industry. Furthermore, 92% of participants reported that their clinic or practitioner did not inform them about the Yellow Card Reporting Scheme. The sentiment analysis using the AFINN Lexicon yielded adjusted scores ranging from -3 to +2, with a mean value of -1.58. Conclusion: This is the largest survey in the UK completed by patients who experienced an adverse outcome following the aesthetic administration of Botulinum Toxin. Our study highlights the extent of the challenges faced by patients who experience an adverse event from physical, emotional, psychological, and financial perspectives. The lack of awareness of MHRA reporting structures and the lack of regulation within the UK's cosmetic injectables sector represent a significant public health challenge.