An artificial intelligence language model improves readability of burns first aid information.

AIMS: This study aimed to assess the potential of using an artificial intelligence (AI) large language model to improve the readability of burns first aid information. METHODS: An AI language model (ChatGPT-3) was used to rewrite content from the top 50 English-language webpages containing burns first aid information to be understandable by an individual with the literacy level of an 11-year-old, as recommended by the American Medical Association and Health Education England. The assessment of readability was conducted using five validated tools. RESULTS: In their original form, only 4% of the patient education materials (PEMs) met the target readability level across all tools. The median grade was 6.9 (SD=1.1). One-sample one-tailed t-test revealed that this was not significantly below the target (p = .31). After AI-modification, 18% of PEMs reached the target level using all tools, with a median grade of 6 (SD=0.9), which was significantly below the target level (p < .001). Once rewritten using AI, paired t-test demonstrated that all readability scores improved significantly (p < .001). CONCLUSION: Utilising an AI language model proved an effective and viable method for enhancing readability of burns first aid information.

Cold burn injuries in the United Kingdom: retain-->A 5-year cohort study of patients presenting to a regional burn unit.

AIMS: To assess the aetiology, management and outcomes of cold burn injuries presenting to a regional burn unit in the United Kingdom. METHODS: Retrospective cohort study of consecutive patients over a 5-year period (2018-2022). RESULTS: Sixty-two patients (M:F 34:38; median age 23.5 years) were identified. The most common aetiology was aerosol (n = 28, 45.2%). Seven (11.5%) injuries were sustained during a social media or peer 'challenge' and 19 (31.2%) were self-harm, of whom 5 (26.3%) were inpatients on a mental health ward at the time of injury. All 'challenge' and self-harm injuries were caused by aerosol. Patients with 'challenge' injury were younger than those with self-harm (p = .007) and non-intentional injuries (p < .001). A greater proportion of self-harm injuries were in female patients compared with non-intentional injuries (p < .001). Median total body surface area (TBSA) was 0.35% (IQR: 0.3). Most burns were superficial partial thickness (n = 35, 56.5%), followed by deep dermal (n = 18, 29.0%), full-thickness (n = 8, 12.9%), and superficial (n = 1, 1.6%). The upper limb was most frequently affected (n = 35, 56.5%). Aetiology and a non-intentional, 'challenge' or self-harm injury did not affect TBSA (p = 0.776 and p = 0.364) or depth (p = 0.353 and p = 0.381). Five (8.1%) patients underwent autografting. The median time to healing was 17 days (range: 7-45, IQR: 22.75). Follow-up ranged from 1 to 173 weeks. CONCLUSIONS: The incidence of cold burns has increased when compared with previous literature. A disproportionate number of cold burns are self-inflicted using aerosols, either as self-harm or because of social media or peer 'challenges'. Other emerging aetiologies include non-intentional skin contact with nitrous oxide containers during its recreational use.

Assessing the effect of the cost-of-living crisis on hot water bottle-related burns in the United Kingdom, a single-centre retrospective observational study.

Background: The cost-of-living crisis (CoLC) is an economic climate that the United Kingdom (UK) has been experiencing since late 2021, characterized by an increase in the price of essential goods faster than real-term incomes. Food and fuel poverty has ensued. This study aimed to assess whether the CoLC is associated with an increase in hot water bottle (HWB)-related burns as patients seek alternative heating sources to keep warm. Methods: Records of patients treated for HWB burns between December 2019 and March 2023 were reviewed for patient demographics, burn depth and surface area, patient comorbidities, and patient index of multiple deprivation (IMD). The incidence of admissions, IMD, and severity of injury were compared prior to and during the CoLC using either independent t-test or Kruskal-Wallis H test. Results: Between December 2019 and March 2023, 177 patients were treated for HWB burns, 79 prior to the CoLC, and 98 during. Of the patients, 55 patients were male and 122 females. An independent t-test comparing average monthly admissions prior and during the CoLC identified a significant difference (p = 0.042), with a mean increase of 1.85 cases (95% CI: 0.71-3.63). Additionally, a Kruskal-Wallis H test showed statistically significant difference in the number of patients treated for HWB burns between the seasons (p = 0.001). An independent t-test comparing average patient IMD prior and during the CoLC identified no difference (p = 0.33). Conclusion: The increase in HWB burns coincides with the increase in energy costs and general cost of living that has occurred in the UK since October 2021.

Readability, accountability, and quality of burns first aid information available online.

AIM: To assess the readability, accountability, and quality of burns first aid information available online. METHODS: The top 50 English language webpages containing burns first aid information were compiled and categorised. Readability was measured using five validated tools. Accountability was assessed using the Journal of the American Medical Association (JAMA) benchmarks. Quality was evaluated using a scale based on previous literature. RESULTS: Two (4%) webpages were judged to be at the target reading level using all tools. Median grade ranged from 4.6 to 9.6 (M = 6.9, SD = 1.1). One-sample one-tailed t-test determined that median grade was not significantly below the target grade of ≤ 6.9 (p = 0.314). Only seven (14%) webpages satisfied all the JAMA accountability benchmarks. No webpages fulfilled all 15 quality criteria. Mean quality score was 9.8 (SD = 2.4). Only 27 (54%) advised 20 min of cooling. One-way analysis of variance demonstrated that accountability was influenced by source (p = 0.01). Pearson's correlation coefficient revealed that accountability and quality had a positive correlation (r = 0.32, p = 0.02). CONCLUSION: Much of the burns first aid information available online is written above the recommended reading level and fails to meet standards of accountability or quality.

Surgical site infection following surgery for hand trauma: a systematic review and meta-analysis.

Surgical site infection is the most common healthcare-associated infection. Surgical site infection after surgery for hand trauma is associated with increased antibiotic prescribing, re-operation, hospital readmission and delayed rehabilitation, and in severe cases may lead to amputation. As the risk of surgical site infection after surgery for hand trauma remains unclear, we performed a systematic review and meta-analysis of all primary studies of hand trauma surgery, including randomized controlled trials, cohort studies, case-control studies and case series. A total of 8836 abstracts were screened, and 201 full studies with 315,618 patients included. The meta-analysis showed a 10% risk of surgical site infection in randomized control trials, with an overall risk of 5% when all studies were included. These summary statistics can be used clinically for informed consent and shared decision making, and for power calculations for future clinical trials of antimicrobial interventions in hand trauma.

The certificate of readiness to enter higher surgical training (CREHST) route: Proportion of applicants and likelihood of success.

OBJECTIVE: To compare the distribution of Higher Surgical Training (HST) applications received through the Certificate of Readiness for Higher Surgical (CREHST) route with the traditional Core Surgical Training (CST) route and to evaluate the likelihood of success in obtaining an HST post for each route across all surgical specialities. METHODS: A national, retrospective cohort study was conducted to compare the proportion of applications and likelihood of success in obtaining an HST post between the two routes during the 2021-22 application cycle in the United Kingdom. Univariate statistical analysis was performed for categorical variables using the chi-squared test, or Fisher exact test. Relative risk was calculated for each route and each surgical speciality. RESULTS: The study included 1964 HST applicants, of which 46% (n = 904) were via the CREHST route. This proportion varied from 23% for otolaryngology to 66% for vascular surgery. The study found that 20% (n = 98) of the available HST posts were awarded to CREHST applicants, ranging from 0% for cardiothoracic surgery to 39% for vascular surgery. For most specialities, applicants from the CREHST route were significantly less likely to be awarded a training post, with relative risks ranging from 0.07 (95% CI 0.01-0.51, p < 0.0001) for otolaryngology to 0.4 (95% CI 0.25-0.79, p = 0.0032) for urology. CONCLUSIONS: This study provides valuable insight into the proportion and success of HST applications via the CREHST route. The findings demonstrate that the use of the CREHST route is commonplace across all surgical specialties, but the likelihood of a successful application is significantly lower when compared to the traditional CST route for most specialties.

Readability of Online Patient Education Materials for Congenital Hand Differences.

BACKGROUND: The aim of the study is to assess the readability of online patient education materials (PEMs) for congenital hand differences. METHODS: The top 10 online, English-language PEMs for 10 conditions (polydactyly, syndactyly, trigger finger/thumb, clinodactyly, camptodactyly, symbrachydactyly, thumb hypoplasia, radial dysplasia, reduction defect, and amniotic band syndrome) were compiled and categorized by source and country. Readability was assessed using 5 tools: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook Index (SMOG). To account for the potential effect of each condition's name in the aforementioned formulas, the analysis was repeated after replacing the name with a monosyllabic word/s. RESULTS: The mean readability scores of the 100 PEMs were FRES 56.3, where the target was ≥80, FKGL 8.8, GFI 11.5, CLI 10.9, and SMOG 8.6, and the median grade score was 9.8, where the target grade was ≤6.9. Following adjustment, all readability scores improved significantly (P < .001). Postadjustment scores were FRES 63.8, FKGL 7.8, GFI 10.7, CLI 9.1, and SMOG 8.0, and the median grade score was 8.6. Only 1 webpage met the target level using all tools. Two-sample t test for country of publication (the United States and the United Kingdom) demonstrated that PEMs originating from the United Kingdom were easier to read using the preadjustment CLI (P = .009) and median grade metrics (P = .048). A 1-way analysis of variance revealed no influence of condition or source on readability. CONCLUSION: Most online PEMs for congenital hand differences are written above the recommended reading level of sixth grade, even when adjusted for the effect of the condition's name.

Readability of online monkeypox patient education materials: Improved recognition of health literacy is needed for dissemination of infectious disease information.

BACKGROUND: Health literacy is key to navigating the current global epidemic of misinformation and inaccuracy relating to healthcare. The American Medical Association (AMA) suggests health information should be written at the level of American sixth grade. With the monkeypox outbreak being declared a Public Health Emergency of International Concern (PHEIC) in July 2022, we sought to assess the readability of online patient education materials (PEMs) relating to monkeypox to see if they are at the target level of readability. METHODS: A search was conducted on Google.com using the search term 'Monkeypox'. The top 50 English language webpages with patient education materials (PEMs) relating to monkeypox were compiled and categorised by country of publication and URL domain. Readability was assessed using five readability tools: Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and, Simple Measure of Gobbledygook Index (SMOG). Unpaired t-test for URL domain, and one-way ANOVA for country were performed to determine influence on readability. RESULTS: Three of the five tools (FRES, GFI, CLI) identified no webpages that met the target readability score. The FKGL and SMOG tools identified one (2%) and two (4%) webpages respectively that met the target level. County and URL domain demonstrated no influence on readability. CONCLUSION: Online PEMs relating to monkeypox are written above the recommended reading level. Based on the previously established effect of health literacy, this is likely exacerbating health inequalities. This study highlights the need for readability to be considered when publishing online PEMs.

Distal Entrapment of Regenerating Peripheral Nerves After a Proximal Injury: A Case Series and Review of the Literature.

A complication of peripheral nerve injuries, of which there exists limited discourse, is the entrapment of the nerve as it regenerates from the site of injury to its end target, resulting in the arrest of axon regeneration and a consequent reduction of functional recovery. This proof-of-concept paper reports a review of the relevant literature alongside a case series of patients who presented with this phenomenon and who were treated with targeted peripheral nerve decompression. Three cases were identified prospectively. The baseline function was recorded pre-and post-operatively. Recovery was assessed using various tools, including the Medical Research Council (MRC) motor grading, ten-test sensory testing, Tinel's sign progression, a visual analogue scale (VAS) for pain, and the Impact of Hand Nerve Disorders (I-HaND) patient-reported outcome measure (PROM). The first case sustained a brachial plexus injury and received decompression at the pronator fascia, carpal tunnel, cubital tunnel, and Guyon's canal. The second case sustained a sciatic nerve injury and was managed with peroneal and tarsal tunnel decompressions. The final case sustained a suprascapular nerve injury and underwent decompression at the suprascapular ligament. In all these cases, motor function, sensory function, and pain (depending on the nerve's original components) improved following decompression. A literature review revealed seven relevant studies, including four case reports, two cohort studies, and a pre-clinical animal study. These cases, and those identified in our review of the literature, suggest that targeted decompressive surgery can be an appropriate treatment for patients who display signs of stalled neural regeneration. This study adds to the limited evidence of this phenomenon and highlights the challenges in proving the efficacy of decompressive surgery for this specific complication. This study is limited by the number of cases included, the heterogeneity of nerve injuries presented, and its observational nature. There is a clear need for further research into this phenomenon, and the authors are working towards developing a prospective study that will investigate the indications, value, predictors of success, and practicality of decompression surgery for this complication of peripheral nerve injury.

Outcomes of Free Flap Reconstruction for Chronic Venous Ulceration in the Lower Limb: A Systematic Review.

BACKGROUND: The mainstay of treatment for venous ulceration is conservative wound management and lifelong compression therapy. For patients with recalcitrant ulcers, free flap reconstruction has been proposed as a treatment option to reconstruct the diseased soft tissues as well as the underlying insufficient venous system. This review systematically evaluates the outcomes of free flap reconstruction for chronic venous ulcers in the lower limb. METHOD: A protocol was developed a priori and registered on the PROSPERO database. A systematic search of literature was performed in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), clinical trials registries, and OpenGrey from inception to April 2020 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies of patients undergoing free tissue transfer reconstruction for chronic venous ulcers in the lower limb were included. RESULTS: A total of 5 noncomparative cohort studies featuring 56 patients with 62 recalcitrant venous ulcers treated with 64 free flaps who had a mean age of 50 years (range, 17-76 years) were included, and a narrative analysis undertaken. Mean defect size following ulcer debridement was 153.3 cm 2 (range, 24-600 cm 2 ). Defects were reconstructed with muscle (n = 39 [60.9%]), fasciocutaneous (n = 23 [35.9%]), and visceral (n = 2 [3.1%]) free flaps, with latissimus dorsi (n = 16, 25%) and rectus abdominis flaps (n = 16, 25%) being the most frequently used. Mean follow-up ranged from 24 to 125 months. Pooled flap survival rate was 95%. No recurrence within the territory of the flap was reported, but there were 20 instances (35.7%) of new ulcers outside of the flap boundaries. CONCLUSION: There is currently an absence of evidence to support the use of free flap reconstruction for recalcitrant venous ulcers compared with conventional management. Although evidence suggests that it is technically feasible, there is no evidence to suggest it prevents ulceration outside the reconstructed region. Further studies are necessary to evaluate its effectiveness for venous ulcers in the lower limb.

Risk of surgical site infection in hand trauma, and the impact of the SARS-CoV-2 pandemic: A cohort study.

BACKGROUND: Despite the ubiquity of hand trauma, there remains insufficient published data to reliably inform these patients of surgical site infection (SSI) risk. We describe the risk of SSI in a single-centre cohort of patients with hand trauma, with an analysis of the impact of the coronavirus disease-2019 (COVID-19) pandemic. METHODS: Retrospective data collection of consecutive patients who underwent surgery for hand and wrist trauma in a single plastic surgery centre over two, three-month periods. Demographic, injury and operative details, alongside prophylactic antibiotic use, were recorded. Burn injuries and wounds infected at presentation were excluded. Presence of SSI at 30 days (90 days if a surgical implant was used) was assessed. RESULTS: Overall, 556 patients - 'Pre-COVID-19' (n = 310) and 'During COVID-19' (n = 246) - were included. Risk of SSI was 3.6% in the aggregated cohort. Female patients were more likely to develop an SSI, even when adjusted for their greater prevalence of bite aetiologies (adj OR 2.5; 95% CI, 1.00-6.37 and p < 0.05). The absolute risk of SSI in the 'Pre-COVID-19' group was 2.3% and 5.3% in the 'During COVID-19' group. The relative risk of developing an SSI in the 'During COVID-19' group was 2.34 (95% CI, 0.95-5.78 and p = 0.06). Baseline characteristics were equivalent between the two groups. CONCLUSION: The risk of SSI in hand trauma is the same as the nationally estimated risk for all surgeries; 3-5%. Changes in presentation and practice associated with the first wave of the COVID-19 pandemic did not appear to alter the risk of SSI in patients undergoing surgery for hand trauma.

'Food for thought': The importance of nutrition to patient care and the role of the junior doctor.

Good nutrition is an integral component of patient care. Not only does eating correctly provide substantial physical benefits, it also ensures psychological comfort throughout admission. Nevertheless, our formative years as medical students, and now as junior doctors, have shown us that patient nutrition is frequently neglected both in the clinical setting and in the subject matter of our education.Amid the coronavirus pandemic, this is especially problematic; older, frailer patients, with multiple comorbidities and higher rates of malnutrition, are faring much worse with the virus. Combined with the fact that 40% of patients admitted to hospital are malnourished to some degree, we are looking at a huge population of potential COVID-19 patients facing a further decline in nutritional status and higher mortality as a result of this, making attention to nutrition more important than ever.As junior doctors, we have a role in the nutritional assessment of and support for our patients by ensuring that all patients are suitably assessed using a scoring tool with the appropriate ensuing actions taken. We must also ensure that our knowledge regarding nutritional assessment and support is adequate and aim to supplement this via additional learning to meet the minimum requirements for our curriculum.

FiY101: A quick guide for newly qualified doctors.

Final-year medical students in the UK have been allowed to voluntarily apply for early provisional registration in response to the COVID-19 pandemic, allowing these foundation interim year-1 (FiY1) doctors to assist in service provision in hospitals where resources and staffing may be strained. The authors, as recently qualified foundation year-1 (FY1) doctors, use this article to draw on their own experiences, and those of their colleagues, to provide advice on key topics that may not have been covered, or not covered sufficiently, in medical education, such as prescribing, rotas, wellbeing, and useful apps and websites.

Mollie Lentaigne, the nurse who drew McIndoe's Guinea pigs: Exploring the role of a medical artist at the Queen Victoria Hospital, 1940-1945.

Mollie Lentaigne was a medical artist who worked at the Queen Victoria Hospital in East Grinstead during the Second World War alongside Archibald McIndoe and his dedicated team. She drew hundreds of medical illustrations for McIndoe and his fellow surgeons during the years between 1940 and 1945. Her illustrations depict the plastic surgery that was carried out in that hospital on the badly burnt RAF servicemen injured during the war that took place in the skies over Europe, which included many aircrew injured during the Battle of Britain. This project looks at the career of Lentaigne and her role within the surgical team in East Grinstead during that era and explores a number of Lentaigne's illustrations whilst providing context as to the procedures and patients depicted. An examination of Lentaigne's story, using an interview conducted by the author with the artist offers an alternative perspective with which to observe the events that unfolded in East Grinstead during that conflict. An analysis of these images shows the ability of this artist to portray relatively complex operations with a series of simple pencil or ink diagrams whilst also skilfully engaging the observer's sense of touch. The ability of a medical artist to be selective with her illustrations allowed them to provide clearer, less cluttered images that were preferred by McIndoe when recording the specific surgical procedures for use in the patient's medical records.