Why Do Canadians Travel Abroad for Cosmetic Surgery? A Qualitative Analysis on Motivations for Cosmetic Surgery Tourism.

Background: Canadians are increasingly engaging in medial tourism. The purpose of this study was to review Canadians' experiences with travelling abroad for cosmetic surgery, including primary motivations for seeking care outside of Canada. Methods: A qualitative analysis was conducted using semistructured interviews following a pre-determined topic guide. People who had undergone cosmetic surgery outside of Canada were interviewed. The interviews were transcribed and coded to determine motivational themes. Patients were recruited until thematic saturation was achieved. Results: Thematic saturation was achieved after recruitment of 11 patients. The most common motivational themes identified in this study for seeking cosmetic surgery outside of Canada included cost, post-operative care provided, marketing/customer service, and word-of-mouth. Member checking and theory triangulation were validation techniques used to verify identified themes. Mexico was the most common location for cosmetic tourism. The most common procedures were breast augmentation, mastopexy, and abdominoplasty. Participants gathered pre- and post-operative information primarily through pamphlets and contact with surgeons' offices. Follow-up was only available for half of the participants in this study, and only 5 of the participants felt that they had received informed consent. Conclusions: The majority of participants engaged in cosmetic tourism due to cost reasons and the level of post-operative care provided.

Historique: Les Canadiens font de plus en plus de tourisme médical. La présente étude vise à analyser les expériences des Canadiens qui se rendent à l'étranger pour recevoir des soins de chirurgie esthétique, y compris leur motivation primaire à faire ce choix. Méthodologie: Les chercheurs ont effectué une analyse qualitative au moyen d'entrevues semi-structurées selon un guide de sujets préétablis auprès de personnes ayant subi des chirurgies esthétiques hors du Canada. Les entrevues ont été transcrites et codées pour en tirer les thèmes. Des patients ont été recrutés jusqu'à ce que tous les thèmes aient été abordés. Résultats: Onze patients ont été recrutés pour parvenir au point de saturation des thèmes. Les principales motivations pour obtenir une chirurgie esthétique hors du Canada incluaient les coûts, les soins postopératoires reçus, les services de marketing et à la clientèle et le bouche-à-oreille. Les chercheurs ont utilisé la vérification des membres et la triangulation des théories pour vérifier les thèmes établis. Le tourisme esthétique avait surtout lieu au Mexique. Les interventions les plus courantes étaient l'augmentation mammaire, la mastopexie et l'abdominoplastie. Les participants accumulaient l'information préopératoire et postopératoire d'abord à l'aide de dépliants et de contacts au bureau des chirurgiens. Seulement la moitié des participants à l'étude ont eu accès au suivi, et seulement cinq ont eu l'impression d'avoir donné leur consentement éclairé. Conclusions: La majorité des participants faisaient du tourisme esthétique pour une question d'argent et pour le taux de soins postopératoires fournis.

Skeletal Deformity in Patients With Unilateral Coronal Craniosynostosis: Perceptions of the General Public.

STUDY DESIGN: A two-alternative forced choice design was used to gather perceptual data regarding unicoronal synostosis (UCS). OBJECTIVE: Cranial vault remodeling aims at improving the aesthetic appearance of infants with UCS by reshaping the forehead and reducing the potential for psychosocial discrimination. People's perception of craniofacial deformity plays a role in the stigma of deformity. The purpose of this study is to examine the relationship between objective skull deformity in UCS patients and laypersons' perception of skull normality. METHODS: Forty layperson skull raters were recruited from the general public. Skull raters were asked to categorize 45 infant skull images as normal or abnormal. Twenty-one of the images were UCS skulls, and 24 were normal skulls. Skulls were displayed briefly on a computer to simulate a first impression scenario and generate a perceptual response. A χ 2 analysis and mixed-effects regression model were used to analyze the response data. RESULTS: Members of the general public were good at distinguishing between skull groups, χ 2 (1) = 281.97, P < .001. In addition, skull raters' responses were predicted by the severity of deformity in the UCS skulls (b = -0.10, z = -2.6, P = .010, CI: -0.18, -0.02). A skull with a deformity value of 2.8 mm (CI: 1.8, 4.1) was equally likely to be rated normal or abnormal. CONCLUSIONS: This is the first study to investigate the relationship between objective skull deformity in UCS and public perception. Laypersons were good at distinguishing the difference between normal and UCS skulls, and their perceptions of normality were predicted by the degree of skull deformity.

Test-retest validation of a cranial deformity index in unilateral coronal craniosynostosis.

Unilateral coronal craniosynostosis (UCS) affects many infants resulting in abnormalities affecting the forehead and orbits. As a result, the deformity caused by UCS is very noticeable and there are several surgical treatment options available to normalize the head shape. However, there is a lack of consistently used outcome measures, resulting in difficulty assessing surgical outcomes and on-going debate over optimal treatments. Current techniques to quantify deformity in UCS are cumbersome, provide limited information, or are based on subjective assessments. In this study, a cranial deformity index was developed to quantify abnormality at the frontal bones for UCS that is accessible, user-friendly, and generates objective surface distance measurements. The cranial deformity index is defined as the Euclidean distance at the point of the largest deviation between the deformed skull compared to a reference skull. In addition, the index was successfully used to quantify post-operative changes in a single case of UCS that underwent corrective surgery. The reproducibility of the index was assessed using test-retest reliability and was demonstrated to be highly reproducible (ICC = 0.93). A user-friendly measurement index that is based on open-source software may be a valuable tool for surgical teams. In addition, this information can augment the consultation experience for patients and their families.

The Utility and Efficiency of a Resident Hand Clinic for the Management of Acute Hand Trauma at the University of Alberta.

BACKGROUND: The University of Alberta established a resident-run hand clinic in 2005 to expeditiously manage the growing numbers of patients with traumatic hand injuries. The purpose of this study was to examine the clinical volume and types of cases assessed and treated in the clinic, as well as gauge patient satisfaction with care received. METHODS: A retrospective chart review and patient satisfaction questionnaire were conducted for patients assessed in the hand clinic in 2015. Demographic data, referral data, and treatment required were recorded. Patients were asked to complete a survey on their experience at the end of their visit. RESULTS: A total of 1022 charts were reviewed. The most common reason for referral was a fracture or dislocation (57%), followed by tendon injury (18%). The average wait time to be seen in clinic was 2.97 ± 2.13 days in the winter and 4.12 ± 2.14 days in the summer. Forty-seven percent of patients required splinting, 17% required a procedure, and 21% of patients were referred for surgery. Patient satisfaction on average was 9.29 ± 0.87 on a satisfaction scale of 10. CONCLUSION: In a 6-month period, residents attending hand clinic assessed and treated 1022 patients, providing timely management of acute injuries. A resident-run hand clinic is an effective model to decrease wait times for patients, to decrease time spent assessing nonemergent injuries in the emergency department, and to concentrate hand trauma in a setting conducive to resident training, while still maintaining high patient satisfaction.

HISTORIQUE: En 2005, l'université de l'Alberta a mis sur pied une clinique de la main dirigée par des résidents pour accélérer la prise en charge du nombre croissant de patients ayant des lésions traumatiques des mains. La présente étude visait à examiner le volume clinique et le type de cas évalués et traités en clinique, ainsi qu'à évaluer la satisfaction des patients à l'égard des soins reçus. MÉTHODOLOGIE: Les chercheurs ont procédé à une analyse rétrospective des dossiers et ont distribué un questionnaire sur la satisfaction des patients qui avaient été évalués dans la clinique de la main en 2015. Ils ont consigné les données démographiques, les données sur l'envoi vers un médecin et le traitement requis. Les patients ont été invités à remplir un sondage sur leur expérience à la fin de leur rendez-vous. RÉSULTATS: Au total, les chercheurs ont examiné 1 022 dossiers. La principale raison de l'orientation vers un médecin était une fracture ou une dislocation (57 %), suivie d'une lésion du tendon (18 %). Le temps d'attente moyen pour être vu en clinique était de 2,97 ± 2,13 jours pendant l'hiver et de 4,12 ± 2,14 jours pendant l'été. De plus, 47 % des patients ont eu besoin d'une attelle, 17 % ont eu besoin d'une intervention et 21 % des patients ont été envoyés en chirurgie. En moyenne, la satisfaction des patients était de 9,29 ± 0,87 sur une échelle de satisfaction de 10. CONCLUSION: Sur une période de six mois, les résidents qui ont travaillé à la clinique de la main ont évalué et traité 1 022 patients, assurant une prise en charge rapide des lésions aiguës. Une clinique de la main dirigée par des résidents est un modèle efficace pour réduire les temps d'attente pour les patients, réduire le temps passé à évaluer des blessures non urgentes à l'urgence et concentrer les traumatismes de la main dans un milieu favorable à la formation des résidents tout en assurant une satisfaction élevée des patients.