Plastic Surgery or Facial Plastic Surgery: Can the Public Tell the Difference?

Background: Social media and online advertising are increasingly used by plastic surgeons (PSs) to educate patients and obtain referrals, but it remains unclear whether the general public can distinguish the difference in training and accreditation among medical professionals advertising online. Our study elucidates the public's expectations regarding the distinction between plastic surgery and facial plastic surgery. Methods: A survey was distributed via MTurk, an Amazon surveying service, to collect information about demographics and assumptions that would be made solely based on the terminology "facial PS" (FPS) and "PS." Participants were restricted to those residing in the United States. Results: A total of 253 responses were collected. Based on the term FPS, respondents on average moderately to strongly agreed that they would expect an FPS to have completed a plastic and reconstructive surgery residency program (mean = 1.81; scale from 1= strongly agree to 5= strongly disagree) and would feel moderately to strongly misled if they visited an FPS for a consultation and later learned that the provider did not complete a plastic and reconstructive surgery residency (mean = 3.62; scale from 1 = not misled at all to 5 = extremely misled). Conclusions: Despite increasing advocacy by professional societies and the member societies of the American Board of Medical Specialties, this study demonstrated that the lay public is unaware of factually different training and certification pathways given similarity in nomenclature. This study was notably not designed to draw conclusions or imply superiority of one specialty, certifying board, or training model over the other.

Development and Evaluation of Patient Safety Interventions: Perspectives of Operational Safety Leaders and Patient Safety Organizations.

OBJECTIVES: The purpose of this study is to understand how patient safety professionals from healthcare facilities and patient safety organizations develop patient safety interventions and the resources used to support intervention development. METHODS: Semistructured interviews were conducted with patient safety professionals at nine healthcare facilities and nine patient safety organizations. Interview data were qualitatively analyzed, and findings were organized by the following: patient safety solutions and interventions, use of external databases, and evaluation of patient safety solutions. RESULTS: Development of patient safety interventions across healthcare facilities and patient safety organizations was similar and included literature searches, internal brainstorming, and interviews. Nearly all patient safety professionals at healthcare facilities reported contacting colleagues at other healthcare facilities to learn about similar safety issues and potential interventions. Additionally, less than half of patient safety professionals at healthcare facilities and patient safety organizations interviewed report data to publicly available patient safety databases. Finally, most patient safety professionals at healthcare facilities and patient safety organizations stated that they evaluate the effectiveness of patient safety interventions; however, they mentioned methods that may be less rigorous including audits, self-reporting, and subjective judgment. CONCLUSIONS: Patient safety professionals often utilize similar methods and resources to develop and evaluate patient safety interventions; however, many of these efforts are not coordinated across healthcare organizations and could benefit from working collectively in a systematic fashion. Additionally, healthcare facilities and patient safety organizations face similar challenges and there are several opportunities for optimization on a national level that may improve patient safety.

Safe and Equitable Pediatric Clinical Use of AI.

This Viewpoint provides recommendations and stakeholder actions to support safe and equitable use of artificial intelligence (AI) in pediatric clinical settings.

Network pharmacology prediction and molecular docking-based strategy to explore the potential mechanism of squalene against inflammation.

Squalene (SQ) has been documented in the past for its ability to reduce inflammation, but its mechanism needs more information. In this study, we investigated squalene as an anti-inflammatory drug candidate and the framework involved in treating inflammation (INF) using the network pharmacology concept. The molecular targets of SQ and INF that are available in databases and the overlaps between these targets were demonstrated using InteractiVenn. The protein-protein networks were generated that in turn revealed several key targets and were further processed with Cytoscape. The gene ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) studies were performed. We also performed molecular docking tests that validated the binding affinity of molecular targets and drugs. A total of 100 SQ targets and 11,417 INF-related targets yielded 93 overlapping targets. Seven core targets, CRHR1, EGFR, ERBB2, HIF1A, SLC6A3, MAP2K1, and F2R were found to be relevant with respective to SQ's anti-inflammatory activity. The underlying mechanism of SQ with regard to INF was interpreted by analyzing various enrichment analyses along with the KEGG pathway. In conclusion, SQ played a vital role in the management of INF by regulating CRHR1, EGFR, ERBB2, HIF1A, SLC6A3, MAP2K1, and F2R. The research outcomes are crucial as they offer significant insights into the use of SQ for combating inflammation. Supplementary Information: The online version contains supplementary material available at 10.1007/s40203-024-00217-0.

Telemedicine and In-Person Visit Modality Mix and Electronic Health Record Use in Primary Care.

This cross-sectional study investigates the association between day-to-day changes in telemedicine share and clinician time spent on electronic health record (EHR) use.

Cleft Summit 2022: The Impact of a Unified Voice.

OBJECTIVE: The inaugural Cleft Summit aimed to unite experts and foster interdisciplinary collaboration, seeking a collective understanding of velopharyngeal insufficiency (VPI) management. DESIGN: An interactive debate and conversation between a multidisciplinary cleft care team on VPI management. SETTING: A two-hour discussion within a four-day comprehensive cleft care workshop (CCCW). PARTICIPANTS: Thirty-two global leaders from various cleft disciplines. INTERVENTIONS: Cleft Summit that allows for meaningful interdisciplinary collaboration and knowledge exchange. MAIN OUTCOME MEASURES: Ability to reach consensus on a unified statement for VPI management. RESULTS: Participants agreed that a patient with significant VPI and a dynamic velum should first receive a surgery that lengthens the velum to optimize patient outcome. A global, multicenter prospective study should be done to test this hypothesis. CONCLUSION: The 1st Cleft Summit successfully distilled global expertise into actionable best-practice guidelines through iterative discussions, fostering interdisciplinary collaboration and paving the way for a transformative multi-center prospective study on VPI care.

Reading Room Interruptions are Less Disruptive When Using Asynchronous Communication Methods.

Radiologist interruptions, though often necessary, can be disruptive. Prior literature has shown interruptions to be frequent, occurring during cases, and predominantly through synchronous communication methods such as phone or in person causing significant disengagement from the study being read. Asynchronous communication methods are now more widely available in hospital systems such as ours. Considering the increasing use of asynchronous communication methods, we conducted an observational study to understand the evolving nature of radiology interruptions. We hypothesize that compared to interruptions occurring through synchronous methods, interruptions via asynchronous methods reduce the disruptive nature of interruptions by occurring between cases, being shorter, and less severe. During standard weekday hours, 30 radiologists (14 attendings, 12 residents, and 4 fellows) were directly observed for approximately 90-min sessions across three different reading rooms (body, neuroradiology, general). The frequency of interruptions was documented including characteristics such as timing, severity, method, and length. Two hundred twenty-five interruptions (43 Teams, 47 phone, 89 in-person, 46 other) occurred, averaging 2 min and 5 s with 5.2 interruptions per hour. Microsoft Teams interruptions averaged 1 min 12 s with only 60.5% during cases. In-person interruptions averaged 2 min 12 s with 82% during cases. Phone interruptions averaged 2 min and 48 s with 97.9% during cases. A substantial portion of reading room interruptions occur via predominantly asynchronous communication tools, a new development compared to prior literature. Interruptions via predominantly asynchronous communications tools are shorter and less likely to occur during cases. In our practice, we are developing tools and mechanisms to promote asynchronous communication to harness these benefits.

Validation of ChatGPT 3.5 as a Tool to Optimize Readability of Patient-facing Craniofacial Education Materials.

Background: To address patient health literacy, the American Medical Association recommends that readability of patient education materials should not exceed a sixth grade reading level; the National Institutes of Health recommend no greater than an eigth-grade reading level. However, patient-facing materials in plastic surgery often remain at an above-recommended average reading level. The purpose of this study was to evaluate ChatGPT 3.5 as a tool for optimizing patient-facing craniofacial education materials. Methods: Eighteen patient-facing craniofacial education materials were evaluated for readability by a traditional calculator and ChatGPT 3.5. The resulting scores were compared. The original excerpts were then inputted to ChatGPT 3.5 and simplified by the artificial intelligence tool. The simplified excerpts were scored by the calculators. Results: The difference in scores for the original excerpts between the online calculator and ChatGPT 3.5 were not significant (P = 0.441). Additionally, the simplified excerpts' scores were significantly lower than the originals (P < 0.001), and the mean of the simplified excerpts was 7.78, less than the maximum recommended 8. Conclusions: The use of ChatGPT 3.5 for simplification and readability analysis of patient-facing craniofacial materials is efficient and may help facilitate the conveyance of important health information. ChatGPT 3.5 rendered readability scores comparable to traditional readability calculators, in addition to excerpt-specific feedback. It was also able to simplify materials to the recommended grade levels. With human oversight, we validate this tool for readability analysis and simplification.

Patient Safety and Artificial Intelligence in Clinical Care.

This Viewpoint offers 3 recommendations for health care organizations and other stakeholders to consider as part of the Health and Human Services' artificial intelligence safety program.

Results of a Pilot Virtual Microsurgery Course for Plastic Surgeons in LMICs.

Background: The Plastic Surgery Foundation's Surgeons in Humanitarian Alliance for Reconstruction, Research and Education (SHARE) program seeks to expand surgical capacity worldwide through mentorship and training for local plastic surgeons. This study aims to define the need for microsurgery training among SHARE global fellows and describe results of a pilot course. Methods: Ten participants of the SHARE Virtual Microsurgical Skills Course were asked to complete an anonymous survey. Pre- and post-course response rates were 100% and 50.0%, respectively. Results: There was a high incidence of microsurgical problems encountered in the clinical setting. Resource availability was varied, with high access to loupes (100%), yet limited access to microsurgery instruments (50%), medications (40%), operating microscope (20%), skilled nursing (0%) and appropriate peri-operative care settings (0%). Participants identified vessel preparation, instrument selection, and suture handling as priority learning objectives for a microsurgery skills course. Post-course satisfaction with learning objectives was high (60% "very good," 40% "excellent"). Participants reported high levels of improvement in suture handling (Likert 4.60±0.55), end-to-end anastomosis (4.40±0.55), instrument selection (4.20±0.45), vessel preparation (4.20±0.45), and economy of motion (4.20±0.45). Conclusions: This study demonstrates a high frequency of reconstructive problems encountered by global fellows yet low access to appropriate resources to perform microsurgical procedures. Initial results from a pilot virtual microsurgery course demonstrate very high satisfaction and high self-rated improvement in key microsurgical skills. The virtual course is an effective and accessible format for training surgeons in basic microsurgery skills and can be augmented by providing longitudinal opportunities for remote feedback.

Vascularized Fibular Epiphyseal Transfer for Pediatric Limb Salvage: Review of Applications and Outcomes.

Vascularized fibular epiphyseal transfer (VFET) offers a functional advantage in pediatric limb salvage due to the preservation of growth potential and an articular surface for remodeling. This review summarizes the available evidence on the clinical characteristics and outcomes of pediatric reconstruction applying VFET at different recipient sites and with varying techniques. VFET was used to reconstruct the proximal humerus, distal radius or ulna, proximal femur, distal fibula, calcaneus, and mandible. Although most often harvested on the anterior tibial artery, VFET has also been performed using the peroneal artery, the inferior lateral genicular artery, and a dual pedicle. Recipient site flap inset most often involved fixation with plates and/or screws as well as soft tissue reconstruction using a retained slip of biceps femoris tendon. Outcomes included limb growth, range of motion, and strength. The most common reported complications were bone flap fracture and peroneal nerve palsy. The anterior tibial artery was the most applied pedicle with reliable limb growth, but with the added risk of postoperative peroneal palsy. Bone flap fracture most often occurred at the proximal humerus and femur recipient sites. Plate fixation and the combined use of allograft had lower instances of bone flap fracture. This review highlights how the anticipated dynamic growth and remodeling this free flap offers in the long term must be weighed against its complexity and potential complications.

A text mining approach to categorize patient safety event reports by medication error type.

Patient safety reporting systems give healthcare provider staff the ability to report medication related safety events and errors; however, many of these reports go unanalyzed and safety hazards go undetected. The objective of this study is to examine whether natural language processing can be used to better categorize medication related patient safety event reports. 3,861 medication related patient safety event reports that were previously annotated using a consolidated medication error taxonomy were used to develop three models using the following algorithms: (1) logistic regression, (2) elastic net, and (3) XGBoost. After development, models were tested, and model performance was analyzed. We found the XGBoost model performed best across all medication error categories. 'Wrong Drug', 'Wrong Dosage Form or Technique or Route', and 'Improper Dose/Dose Omission' categories performed best across the three models. In addition, we identified five words most closely associated with each medication error category and which medication error categories were most likely to co-occur. Machine learning techniques offer a semi-automated method for identifying specific medication error types from the free text of patient safety event reports. These algorithms have the potential to improve the categorization of medication related patient safety event reports which may lead to better identification of important medication safety patterns and trends.

Bio-inspired microfluidics: A review.

Biomicrofluidics, a subdomain of microfluidics, has been inspired by several ideas from nature. However, while the basic inspiration for the same may be drawn from the living world, the translation of all relevant essential functionalities to an artificially engineered framework does not remain trivial. Here, we review the recent progress in bio-inspired microfluidic systems via harnessing the integration of experimental and simulation tools delving into the interface of engineering and biology. Development of "on-chip" technologies as well as their multifarious applications is subsequently discussed, accompanying the relevant advancements in materials and fabrication technology. Pointers toward new directions in research, including an amalgamated fusion of data-driven modeling (such as artificial intelligence and machine learning) and physics-based paradigm, to come up with a human physiological replica on a synthetic bio-chip with due accounting of personalized features, are suggested. These are likely to facilitate physiologically replicating disease modeling on an artificially engineered biochip as well as advance drug development and screening in an expedited route with the minimization of animal and human trials.

Comprehensive analysis of NiFe2O4/MWCNTs nanocomposite to degrade a healthcare waste - tetracycline.

Tetracycline (TC), a commonly used antibiotic for studying bacterial illnesses in living organisms, poses a significant risk to the aquatic environment. Despite various conventional methods having been attempted to remove TC antibiotics from water solutions, they have not proven effective. Consequently, the focus of the research is on the photocatalytic degradation of TC. According to the research, MWCNTs were successfully incorporated into NiFe2O4 nanoparticles, which reduced the pace at which charge carriers recombined after joining with MWCNTs. Subsequently, the catalyst's efficacy was assessed in a batch reactor by analyzing the weight percentage change of the nanocomposite, the initial concentration of TC antibiotics, the effects of pH and contact time. The identical operational parameters were employed to investigate the degradation of TC using NiFe2O4 and MWCNTs as individual pure materials. The findings indicated that the photocatalytic process using NiFe2O4/MWCNTs achieved a degradation efficiency of 95.8% for TC at a pH value of 9. This result was obtained after a reaction time of 120 minutes, the concentration of TC solution was 10 mg L-1, with a nanocomposite dose of 0.6 g L-1 of TN 04 and 120 W m-2. The pseudo-first-order approach was used to estimate the rate at which TC degrades. After four consecutive uses, it was observed that the photocatalysts maintained their original properties, with only a slight decrease of approximately 2.4% in the removal efficiency. The study demonstrated that the NiFe2O4/MWCNTs nanocomposite exhibited considerable efficiency in degrading TC. Due to its simple manufacture and useful recovery, it has the potential to function well as a catalyst for the removal and degradation of pharmaceutical organic contaminants.

Ergonomics for Cleft Providers: A Brief Communication.

Musculoskeletal (MSK) injuries are the most common and debilitating work-related injuries among healthcare providers. These injuries often occur due to a lack of awareness and insufficient guidance during the early years of medical training. Recognizing the need to address this issue, the Comprehensive Cleft Care Workshop (CCCW) has taken steps to integrate an ergonomics session into its curriculum. The goal of this initiative is to enhance awareness on ergonomics, improve the integration of ergonomics into daily routine, and ultimately reduce the occurrence of MSK injuries among healthcare professionals.

Effective Local Anesthetic Use in Nasal Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Studies.

Intraoperative nerve blocks have shown promise in managing pain after nasal surgery. The purpose of this systematic review and meta-analysis was to analyze existing level I and II evidence on intraoperative nerve blocks in nasal surgery to optimize postoperative recovery. Methods: The primary outcome of this systematic review and meta-analysis was postoperative pain scores; secondary outcomes included perioperative opioid requirements, patient satisfaction scores, and time to first analgesic requirement. PubMed, Embase, and MEDLINE databases were searched, and two independent reviewers conducted article screening. Methodological quality assessment of studies utilized the Jadad instrument, and interrater reliability was assessed using Cohen kappa. An inverse-variance, fixed-effects model was used for meta-analysis with Cohen d used to normalize effect size between studies. I2 and Q statistics were used to assess interstudy variability. Results: Four studies were included for meta-analysis, totaling 265 randomized patients. The nerve blocks assessed included infraorbital nerve, sphenopalatine ganglion, external nasal nerve, central facial nerve blocks, and total nerve blocks. All demonstrated significantly reduced postoperative pain compared with controls, with a large effect size (P < 0.001). Opioid requirements were lower in the nerve block groups (P < 0.001), and patient satisfaction scores were higher (P < 0.001). Supplemental meta-analyses showed a longer time to first analgesic requirement for patients who received a nerve block (P < 0.001). Conclusions: These findings support the efficacy of nerve blocks in providing postoperative pain relief and enhancing patient satisfaction with pain management. Perioperative nerve blocks, in combination with general anesthesia, should be considered for postoperative pain control.

Electronic health record "gag clauses" and the prevalence of screenshots in peer-reviewed literature.

OBJECTIVE: To determine whether the Office of the National Coordinator's policy change restricting the use of "gag clauses" in contracts between electronic health record (EHR) vendors and healthcare facilities increased the prevalence of screenshots in peer-reviewed literature. MATERIALS AND METHODS: We reviewed EHR usability and safety-related peer-reviewed journal articles from 2015 to 2023 and quantified the number of articles containing screenshots. For those that did not contain screenshots, we identified whether they would have benefited from screenshots. RESULTS: When gag clauses were permitted 6 of 79 (7.6%) of articles contained screenshots and 8 (10.1%) would have benefited from screenshots. When gag clauses were restricted 3 of 40 (7.5%) contained screenshots and 8 (20%) would have benefited from screenshots. DISCUSSION: The policy change does not appear to have an impact on the prevalence of screenshots in peer-reviewed literature. CONCLUSIONS: Additional steps are necessary to promote the use of screenshots in peer-reviewed literature.

Variations in Physician Telemedicine Provision.

This cross-sectional study assesses variation in the provision of telemedicine services among primary care physicians and quantifies the extent to which this variation may be explained by the individual physician vs temporal, patient, or visit factors.