Hughes flap in the management of lower lid retraction.

PURPOSE: We present a retrospective case series on the use of Hughes flap in managing acquired cicatricial lower lid retraction. METHODS: This was a multicentre, retrospective case series. Data was collected from medical records across different sites within Australia (Adelaide, Melbourne, and Sydney) and New Zealand (Hamilton). RESULTS: Fourteen patients were identified. The aetiology of cicatricial lower lid retraction included previous lid lesion excision and reconstruction, eyelid trauma, orbital fracture repair, orbital radiotherapy, and lateral canthal dystopia from previous lid surgeries. 4/14 (29%) cases had undergone other surgery to correct the retraction prior to the Hughes flap. Pre-operative lagophthalmos due to lower lid retraction was noted in 11/14 (79%) cases with a median 2 mm (range: 1-5 mm). Exposure keratopathy was present in 7/14 (50%) cases. There were no peri-operative complications during Hughes flap reconstruction. One patient had post-operative upper eyelid retraction that did not require any further intervention. One patient had persistent lagophthalmos and exposure keratopathy that is being managed conservatively. One patient had wound dehiscence and further lid retraction following flap division, which required further surgery. Median length of follow-up was 15 months (range: 0.5-84 months). At final review, improvement or resolution of symptoms was seen in 13/14 (93%) cases. CONCLUSIONS: A Hughes flap is an effective surgical technique for the management of cicatricial lower lid retraction.

Capacity building of the Australian Aboriginal and Torres Strait Islander health researcher workforce: a narrative review.

BACKGROUND: This paper provides a narrative review that scopes and integrates the literature on the development and strengthening of the Australian Aboriginal and Torres Strait Islander health researcher workforce. The health researcher workforce is a critical, and oft overlooked, element in the health workforce, where the focus is usually on the clinical occupations and capabilities. Support and development of the Australian Aboriginal and Torres Strait Islander health researcher workforce is necessary to realise more effective health policies, a more robust wider health workforce, and evidence-led clinical care. This holds true internationally. It is critical to identify what approaches have resulted in increased numbers of Aboriginal and Torres Strait Islander people in health research, stronger local community partnerships with universities and industry, and research excellence and have contributed to evidence-led health workforce development strategies. METHODS: The search was for peer-reviewed journal articles between 2000 and early 2018 on capacity building of the Aboriginal and Torres Strait Islander health researcher workforce. Databases searched were CINAHL (EBSCO), PubMed, PsychINFO, LIt.search, and Google Scholar, combined with manual searches of select journals and citations in the grey literature. A coding scheme was developed to scan research coverage of various dimensions of health research capacity building. RESULTS: Twenty-four articles were identified. Eight focused on strengthening research capabilities of community members. A recurrent finding was the high research productivity of Aboriginal and Torres Strait Islander health researchers and strong interest in furthering research that makes a substantive contribution to community well-being. Action-based principles were derived from synthesis of the findings. Generally, research capacity building led to numerous gains in workforce development and improving health systems. CONCLUSIONS: There is a shortage of literature on health researcher workforce capacity building. National-level research on capacity building strategies is needed to support the continued success and sustainability of the Australian Aboriginal and Torres Strait Islander health researcher workforce. This research needs to build on the strengths of Aboriginal and Torres Strait Islander researchers. It also needs to identify clear and robust pathways to careers and stable employment in the health workforce, and health researcher workforce more specifically. This need is evident in all settler colonial nations (e.g. Canada, United States of America, New Zealand), and principles can be applied more broadly to other minoritised populations.