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Patient Perspectives on Interdisciplinary Peripheral Nerve Trauma Care. 跨学科周围神经创伤护理的患者观点
IF 0.7 4区 医学 Q4 SURGERY Pub Date : 2025-02-01 Epub Date: 2023-07-04 DOI: 10.1177/22925503231184265
Aidan Pye, Suzy Stanton, Sean Bristol, Kristine M Chapman, Michael J Berger

Introduction: Peripheral nerve injury (PNI) is a complex, debilitating condition that is increasingly being treated in interdisciplinary clinics. Patients see peripheral nerve surgeons, neurologists, physiatrists, and electrodiagnostic technicians in a single encounter. No studies have evaluated patient experience within this unique interdisciplinary care model. This study aims to assess patients' perceptions of the effectiveness of delivery of care and health care information in an interdisciplinary PNI clinic. Methods: A cross-sectional mixed-methods study was conducted using a 23-question survey that was by a lived-experience partner (an individual who had a brachial plexus injury) in research who helped design the survey. Participants attended an interdisciplinary clinic for PNI 1-2 days prior to taking the survey. The survey included 5-point Likert scales for measuring patient understanding and qualitative questions that were categorized into themes, using conventional content analysis. Results: Of the 20 participants, 65% were male, 35% were female and the mean age was 42.6 ± 17.8. Median scores of 4 were obtained for the patient understanding of the testing purposes, test results, nerve recovery after PNI, and surgical decision-making (full understanding = 5). On improving the clinical experience, 58% indicated no improvements were necessary, while 17% indicated the clinic felt rushed or overwhelming. When asked about positive aspects of their clinical experience, 64% appreciated the team approach to care, 27% valued the informative nature of the clinic, and 27% appreciated the progress they felt when providers at the clinic performed nerve testing. Conclusions: The results demonstrate that patients with PNI have overall positive perceptions of the delivery of care and information in an interdisciplinary PNI clinic. These results provide new insight into how interdisciplinary care may be beneficial to PNI patients based on the perceived effectiveness of knowledge translation.

简介:周围神经损伤(PNI)是一种复杂的,使人衰弱的疾病,越来越多地被跨学科诊所治疗。患者可以在一次会面中看到周围神经外科医生、神经科医生、物理医生和电诊断技术人员。没有研究在这种独特的跨学科护理模式中评估患者体验。本研究旨在评估患者对跨学科PNI诊所提供护理和卫生保健信息的有效性的看法。方法:采用横断面混合方法研究,采用23个问题的调查,由一位帮助设计调查的有实际经验的研究伙伴(有臂丛损伤的个体)进行调查。参与者在调查前1-2天参加了PNI的跨学科诊所。该调查包括5点李克特量表,用于测量患者的理解和定性问题,这些问题被分类为主题,使用传统的内容分析。结果:20例患者中,男性占65%,女性占35%,平均年龄42.6±17.8岁。患者对检测目的、检测结果、PNI术后神经恢复和手术决策的理解中位数为4分(完全理解= 5分)。在改善临床体验方面,58%的人表示没有必要改善,而17%的人表示诊所感到匆忙或不堪重负。当被问及他们临床经验的积极方面时,64%的人赞赏团队护理方法,27%的人重视诊所的信息性,27%的人赞赏诊所提供者进行神经测试时他们感受到的进步。结论:结果表明,PNI患者对跨学科PNI诊所提供的护理和信息总体上持积极态度。这些结果为跨学科护理如何基于知识转化的感知有效性对PNI患者有益提供了新的见解。
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引用次数: 0
Exploring Skin Tone Diversity in a Plastic Surgery Resident Education Curriculum. 在整形外科住院医师教育课程中探讨肤色多样性
IF 0.7 4区 医学 Q4 SURGERY Pub Date : 2025-02-01 Epub Date: 2023-09-06 DOI: 10.1177/22925503231195023
Jane Zhu, Raahulan Rathagirishnan, Chantal Valiquette, Alexander Adibfar, Laura Snell

Background: Gaps remain in surgical education regarding the representation of skin tone diversity. To improve equity and prevent misdiagnosis leading to worsened health outcomes, efforts must be made to ensure educational photographs are representative of the diverse patient populations plastic surgery residents will be treated in their future practices. Methods: Four study investigators examined 96 h of recorded lecture seminars from a Canadian plastic surgery resident education curriculum from May 2020 to December 2021. Using Fitzpatrick skin type to codify skin tone, photographic images were individually classified and compared. Program lecturers and residents were invited to participate in an online anonymized survey to explore related perceptions of the curricula. Results: A total of 1990 images were included for analysis. Of these, 83.2% were Fitzpatrick types I to III, 13.1% were Fitzpatrick types IV to V, and 3.7% were Fitzpatrick type VI. There was a statistically greater proportion of Fitzpatrick I to III compared to types IV to V (P < .01), and type VI (P < .01). Fleiss' Kappa was calculated to be 0.896, representing near-perfect agreement. In the survey, 61% (14/22) of faculty respondents believe they include enough diversity in their photographs, however, 46% (4 of 9) of resident respondents would like to see more diversity in lecturers' photographs. Conclusions: There is an underrepresentation of medium (Fitzpatrick types IV-V) and dark (Fitzpatrick VI) images in plastic surgery resident educational images. Providing a curriculum that represents diverse patient populations is crucial to enabling competency and equity of care, particularly in a highly visual field. Incorporating skin tone diversity into educational curricula should be a priority for all plastic surgery programs.

背景:在肤色多样性的表现方面,外科教育仍然存在差距。为了提高公平性,防止误诊导致健康状况恶化,必须努力确保教育照片能够代表整形外科住院医师在未来的实践中将接受治疗的不同患者群体。方法:四名研究人员检查了96 2020年5月至2021年12月,加拿大整形外科住院医师教育课程的讲座记录。使用Fitzpatrick皮肤类型来编码肤色,对摄影图像进行单独分类和比较。项目讲师和居民被邀请参加一项在线匿名调查,以探索对课程的相关看法。结果:共纳入1990张图像进行分析。其中,83.2%为Fitzpatrick I型至III型,13.1%为Fitzpatrick IV型至V型,3.7%为Fitzmatrick VI型 < .01)和VI型(P < .01)。Fleiss的Kappa被计算为0.896,代表接近完美的一致性。在调查中,61%(14/22)的教职员工受访者认为他们的照片中有足够的多样性,然而,46%(4/9)的常驻受访者希望在讲师的照片中看到更多的多样性。结论:在整形外科住院医师的教育图像中,中等(Fitzpatrick IV-V型)和深色(Fitzpatrick VI型)图像的代表性不足。提供一个代表不同患者群体的课程对于提高护理能力和公平性至关重要,尤其是在高度可视的领域。将肤色多样性纳入教育课程应该是所有整形外科项目的优先事项。
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引用次数: 0
Relaxation and Performance During Microsurgical Learning. 显微外科学习过程中的放松与表现
IF 0.7 4区 医学 Q4 SURGERY Pub Date : 2025-02-01 Epub Date: 2023-07-18 DOI: 10.1177/22925503231184267
Lara Cortellini, Antoine Nogueira, Thierry Christen, Justine Lattion, Sébastien Durand

Introduction: Microsurgical learning is a difficult and stressful process, requiring self-control to achieve relaxation. The purpose of this study is to evaluate peripheral and central nervous system relaxation during microsurgical training. Methods: This cohort study included ten medical students with no previous experience in microsurgery. The somatic peripheral nervous system was evaluated by the force applied to a custom-designed microsurgical needle holder. The autonomic peripheral nervous system was assessed by a heart rate monitor. Central nervous system relaxation was evaluated by the State and Trait Anxiety Inventory scores. The quality of the anastomosis was graded by the Microsurgical Anastomosis Rating Scale (MARS10). These data were compared to a group of 5 senior microsurgeons who underwent a single assessment. Results: The time to complete the anastomosis and the force decreased significantly with training after only 2 weeks (P < .05). After 4 weeks of training, no statistical difference was observed between students and experts regarding force while the time of suture was still significantly different at 30 days (P = .001). The maximum heart rate decreased significantly at 2 weeks (P = .01). Anxiety scores decreased significantly between days 1 and 15 (P = .002 and P = .036). The MARS10 score demonstrates that the quality of the suture increases significantly during the first 15 days (P = .006). Conclusion: Peripheral and central nervous system relaxation as well as the quality of the microsurgical anastomosis increase significantly after only 15 days of learning. The force-sensing microsurgical needle holder offers a new tool for the evaluation of relaxation and can function as a learning aid.

引言:显微外科学习是一个困难而紧张的过程,需要自我控制才能放松。本研究的目的是评估显微外科训练过程中外周和中枢神经系统的放松。方法:这项队列研究包括10名以前没有显微外科经验的医学生。通过施加在定制设计的显微外科持针器上的力来评估体细胞外周神经系统。自主外周神经系统通过心率监测器进行评估。通过状态和特质焦虑量表评分评估中枢神经系统放松。吻合质量通过显微外科吻合评定量表(MARS10)进行分级。这些数据与5名接受单一评估的资深显微外科医生进行了比较。结果:训练2周后吻合时间和吻合力明显缩短(P < .05)。训练4周后,学生和专家在力量方面没有统计学差异,而缝合时间在30天时仍有显著差异(P = .001)。最大心率在2周时明显下降(P = .01)。焦虑评分在第1天至第15天之间显著下降(P = .002和P = .036)。MARS10评分显示缝线质量在前15天显著提高(P = .006)。结论:学习15天后,周围神经系统和中枢神经系统的放松以及显微外科吻合的质量显著提高。力传感显微外科持针器为评估松弛提供了一种新的工具,可以作为学习辅助工具。
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引用次数: 0
Decreasing Venous Thromboembolism With Anticoagulation in Plastic Surgery.
IF 0.7 4区 医学 Q4 SURGERY Pub Date : 2025-01-31 DOI: 10.1177/22925503251315490
Michael J Stein, Christopher Pannucci

Introduction: Venous thromboembolism (VTE) is a devastating complication in aesthetic plastic surgery. Plastic surgeons are advised to approach VTE prevention proactively by modifying the perioperative risk profile of their patients. Herein, the authors review the evidence of pharmacologic prevention of VTE in plastic surgery, caution surgeons that blanket treatment based on Caprini score alone should be avoided, and advocate for case-by-case individualized therapy for every patient. Methods: A review of evidence for the pharmacologic prevention of VTE in plastic surgery was performed. Results/Conclusion: A proactive approach to VTE prevention can be achieved by employing both nonpharmacologic and pharmacologic evidence-based interventions. While the choice to use anticoagulation medications should be guided by calculation of a Caprini score for each patient, surgeons should continue to maintain their clinical judgment to prevent complications from over and under treatment.

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引用次数: 0
The Incidence of Malignant and High-Risk Pathology Findings in Postreduction Mammaplasty Patients.
IF 0.7 4区 医学 Q4 SURGERY Pub Date : 2025-01-22 DOI: 10.1177/22925503241309928
Bryn L Hoffman, Katrina M Jaszkul, Sarah Sloss, Laryssa Kemp, Rachel Phelan, Douglas R McKay, Glykeria Martou

Introduction: Reduction mammaplasty is often performed to alleviate symptoms of macromastia or for symmetry after a lumpectomy in the contra-lateral breast. Abnormal pathology including breast cancer can be incidentally found in reduction mammaplasty specimens, but there is no consensus on risk factors or detection rates. This study aimed to elucidate the incidence of malignant and high-risk pathology findings in patients undergoing breast reduction in a Canadian context. Methods: We conducted a retrospective review of all reduction mammaplasty cases performed by 5 surgeons between January 2001 and May 2023. Patients were categorized into Group A, those undergoing bilateral reduction for macromastia symptoms, and Group B, those with a history of breast-conserving surgery seeking unilateral reduction postlumpectomy. Results: In total, 1383 breasts from 872 patients were examined: 1022 in Group A and 361 in Group B. Group B was significantly older (56.9 ± 9.3 vs 44.0 ± 13.9 years) whereas Group A had a significantly higher BMI (33.1 ± 8.4 vs 30.1 ± 5.8). High-risk and malignant pathology incidence was 1.4% overall. The sole malignancy detected was in a patient in Group A without prior breast cancer history. Multivariate analysis revealed BMI as a significant predictor for high-risk pathologies (OR 1.134, 95% CI [1.012-1.271]). Conclusions: Our findings align with previously reported incidence rates of pathological findings in mammaplasty specimens and highlight the correlation between BMI and pathology risk. These results underscore the importance of a comprehensive history and preoperative counselling about the possibility of further treatment following pathological discoveries during reduction mammaplasty.

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引用次数: 0
A Comparison of Complication Rates in Flexor Tendon Repair Performed in Operating Rooms Versus Clinic-Based Procedure Rooms.
IF 0.7 4区 医学 Q4 SURGERY Pub Date : 2025-01-17 DOI: 10.1177/22925503241309926
Laurent Tessier, Ariane Gélinas, Alexandra Speak, Donald Lalonde, Jacques Haddad

Background: Wide-awake local anesthesia no tourniquet (WALANT) surgery has demonstrated its value in hand surgery allowing surgeons to safely operate patients in different settings outside of a formal operating room (OR). Flexor tendon lacerations have historically been repaired in the controlled setting of an OR. Plastic surgeons at our university-affiliated center have increasingly been performing flexor repairs in clinic-based procedure rooms (PRs). This study set out to evaluate the safety and complication rates of primary flexor tendon repair performed in PRs compared to those performed in the OR. Method: A unicentric retrospective study was conducted with patients who underwent primary flexor tendon repair between 2019 and 2023 in both clinic-based PRs and the OR. Primary outcomes included presence of tendon rupture and secondary outcomes included infection, adhesion, reintervention, and presence of any complication. Results are reported using odds ratios with 95% confidence intervals. Results: One hundred seventy-four patients underwent flexor tendon repair. There was no association between rupture rate and surgical setting (OR 1.05 95% CI [0.30-3.78]; P = .94). Surgeries performed in clinic-based PRs showed a reduction in the odds of observing at least one complication (OR = 0.49 [0.24-0.97]; P = .041). A subanalysis of single digit cases showed a similar association between the rate of complications and surgical setting (OR = 0.39 [0.16-0.96]; P = .039). Conclusions: This study confirms the safety of performing flexor repair in clinic-based PRs. Such settings also offer the advantage of reduced cost of surgery and minimized delay between diagnosis and surgery.

{"title":"A Comparison of Complication Rates in Flexor Tendon Repair Performed in Operating Rooms Versus Clinic-Based Procedure Rooms.","authors":"Laurent Tessier, Ariane Gélinas, Alexandra Speak, Donald Lalonde, Jacques Haddad","doi":"10.1177/22925503241309926","DOIUrl":"10.1177/22925503241309926","url":null,"abstract":"<p><p><b>Background:</b> Wide-awake local anesthesia no tourniquet (WALANT) surgery has demonstrated its value in hand surgery allowing surgeons to safely operate patients in different settings outside of a formal operating room (OR). Flexor tendon lacerations have historically been repaired in the controlled setting of an OR. Plastic surgeons at our university-affiliated center have increasingly been performing flexor repairs in clinic-based procedure rooms (PRs). This study set out to evaluate the safety and complication rates of primary flexor tendon repair performed in PRs compared to those performed in the OR. <b>Method:</b> A unicentric retrospective study was conducted with patients who underwent primary flexor tendon repair between 2019 and 2023 in both clinic-based PRs and the OR. Primary outcomes included presence of tendon rupture and secondary outcomes included infection, adhesion, reintervention, and presence of any complication. Results are reported using odds ratios with 95% confidence intervals. <b>Results:</b> One hundred seventy-four patients underwent flexor tendon repair. There was no association between rupture rate and surgical setting (OR 1.05 95% CI [0.30-3.78]; <i>P</i> = .94). Surgeries performed in clinic-based PRs showed a reduction in the odds of observing at least one complication (OR = 0.49 [0.24-0.97]; <i>P</i> = .041). A subanalysis of single digit cases showed a similar association between the rate of complications and surgical setting (OR = 0.39 [0.16-0.96]; <i>P</i> = .039). <b>Conclusions:</b> This study confirms the safety of performing flexor repair in clinic-based PRs. Such settings also offer the advantage of reduced cost of surgery and minimized delay between diagnosis and surgery.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503241309926"},"PeriodicalIF":0.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patient Perspectives of "Failure" in Breast Reconstruction: A Systematic Review of Qualitative Literature: Points de vue des patients sur les «échecs» de la reconstruction mammaire: Revue systématique des publications sur l'aspect qualitatif. 患者对乳房重建“失败”的看法:定性文献的系统综述。
IF 0.7 4区 医学 Q4 SURGERY Pub Date : 2025-01-15 DOI: 10.1177/22925503241311255
Caroline Hircock, Patrick Kim, Abhishek Achunair, Tara Behroozian, Lucas Gallo, Emily Dunn, Achilles Thoma

Introduction: The concept of failure in breast reconstruction can occur when negative outcomes dominate the patient experience. The primary objective of this review was to identify experiences of failure in breast reconstruction from the patient's perspective in the qualitative literature. Methods: MEDLINE, Embase, Psychinfo, Emcare, and CINAHL were searched on July 31, 2023 using terms related to breast reconstruction and qualitative research. Thematic analysis was performed on direct quotations from included studies. Confidence in the Evidence from Reviews of Qualitative (CERQual) Research was used to assess confidence of the final findings. Results: Forty-two studies were identified. The following themes were identified in breast reconstruction failure: (1) failure occurs when expectations of restoring the original breast are not met with reconstruction, (2) failure occurs when unexpected outcomes were associated with the reconstruction, and (3) healthcare providers negatively impact the experience of breast reconstruction failure through lack of transparency when educating patients on expected results and poor relational support in the post-operative period. The evidence supporting themes 1-3 scored high confidence with CERQual. Conclusion: Breast reconstruction failure from the patient perspective arises from the limitations and adverse outcomes of the surgery. They may also arise even when the procedure was deemed "successful" from the surgeon's perspective. Dissatisfaction with result is increased by procedural complications. Healthcare providers can aggravate the perception of failure through inadequate patient education. Incorporating these perceptions of failure into discussions with patients can aid in their decision making.

简介:乳房重建失败的概念可能发生在负面结果主导患者的经验。本综述的主要目的是在定性文献中从患者的角度确定乳房重建失败的经历。方法:检索MEDLINE、Embase、Psychinfo、Emcare和CINAHL,检索日期为2023年7月31日,检索内容为乳房再造和定性研究。对纳入研究的直接引语进行专题分析。定性研究综述证据置信度(CERQual)用于评估最终结果的置信度。结果:确定了42项研究。乳房再造术失败的主要原因如下:(1)乳房再造术未能达到对原乳房的期望时,就会导致乳房再造术失败;(2)与再造术相关的意外结果会导致乳房再造术失败;(3)医疗保健提供者在教育患者预期结果时缺乏透明度,对乳房再造术失败的体验产生负面影响;支持主题1-3的证据在CERQual中获得了很高的可信度。结论:从患者的角度来看,乳房再造失败的原因是手术的局限性和不良后果。即使从外科医生的角度来看,手术是“成功的”,也可能会出现这种情况。手术并发症增加了对结果的不满。医疗保健提供者可能会因患者教育不足而加重失败的感觉。将这些失败的认知纳入与患者的讨论中可以帮助他们做出决定。
{"title":"Patient Perspectives of \"Failure\" in Breast Reconstruction: A Systematic Review of Qualitative Literature: Points de vue des patients sur les «échecs» de la reconstruction mammaire: Revue systématique des publications sur l'aspect qualitatif.","authors":"Caroline Hircock, Patrick Kim, Abhishek Achunair, Tara Behroozian, Lucas Gallo, Emily Dunn, Achilles Thoma","doi":"10.1177/22925503241311255","DOIUrl":"10.1177/22925503241311255","url":null,"abstract":"<p><p><b>Introduction:</b> The concept of <i>failure</i> in breast reconstruction can occur when negative outcomes dominate the patient experience. The primary objective of this review was to identify experiences of <i>failure</i> in breast reconstruction from the patient's perspective in the qualitative literature. <b>Methods:</b> MEDLINE, Embase, Psychinfo, Emcare, and CINAHL were searched on July 31, 2023 using terms related to breast reconstruction and qualitative research. Thematic analysis was performed on direct quotations from included studies. <i>Confidence in the Evidence from Reviews of Qualitative (CERQual) Research</i> was used to assess confidence of the final findings. <b>Results:</b> Forty-two studies were identified. The following themes were identified in breast reconstruction <i>failure</i>: (1) <i>failure</i> occurs when expectations of restoring the original breast are not met with reconstruction, (2) <i>failure</i> occurs when unexpected outcomes were associated with the reconstruction, and (3) healthcare providers negatively impact the experience of breast reconstruction <i>failure</i> through lack of transparency when educating patients on expected results and poor relational support in the post-operative period. The evidence supporting themes 1-3 scored high confidence with CERQual. <b>Conclusion:</b> Breast reconstruction <i>failure</i> from the patient perspective arises from the limitations and adverse outcomes of the surgery. They may also arise even when the procedure was deemed \"successful\" from the surgeon's perspective. Dissatisfaction with result is increased by procedural complications. Healthcare providers can aggravate the perception of <i>failure</i> through inadequate patient education. Incorporating these perceptions of <i>failure</i> into discussions with patients can aid in their decision making.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503241311255"},"PeriodicalIF":0.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Brachial Plexus Birth Injury: Treatment and Interventions. 臂丛出生损伤:治疗和干预。
IF 0.7 4区 医学 Q4 SURGERY Pub Date : 2025-01-12 DOI: 10.1177/22925503241301719
Grace O'Shea, Sonia S Patel, Brian A Mailey

Introduction: Brachial plexus birth injury (BPBI) is a condition affecting newborns and involves damage to the nerve fibers compromising the brachial plexus during birth. Although most newborns recover spontaneously, a large subset require surgery to regain function, and others will have permanent disability despite intervention. Deciding when to pursue surgical intervention remains a challenge for clinicians treating BPBI. Methods: A comprehensive search of the literature was conducted using PubMed, Scopus, and MEDLINE databases. A total of 24 primary and secondary sources were chosen for inclusion following full-text assessments. All sources were analyzed to provide a comprehensive review on the development of BPBI treatments and interventions over time. Results: Spontaneous recovery can be achieved in many cases of BPBI, but most patients require physical therapy and other forms of treatment to avoid muscle imbalance and prevent contracture formation. In addition to physical therapy, the most common non-surgical interventions include botulinum toxin injections and splinting. In cases requiring surgery, clinicians may use several tests and diagnostic imaging to aid in decision making. Common surgical interventions for BPBI include nerve grafting, nerve transfers, and muscle and tendon transfers. Conclusion: Most newborns recover from BPBI within the first 3 months of life. However, some require treatment to restore optimal function. In general, non-surgical interventions should be the primary course of treatment, and surgery should be avoided unless the patient is deemed unable to recover with any other treatment.

臂丛出生损伤(Brachial plexus birth injury, BPBI)是一种影响新生儿的疾病,涉及出生时臂丛神经纤维受损。虽然大多数新生儿会自发康复,但仍有很大一部分需要手术来恢复功能,还有一些即使经过干预也会永久残疾。对于治疗BPBI的临床医生来说,决定何时进行手术干预仍然是一个挑战。方法:采用PubMed、Scopus和MEDLINE数据库进行文献检索。在全文评估后,共选择了24个主要和次要来源纳入。对所有来源进行分析,以全面回顾BPBI治疗和干预措施的发展。结果:许多BPBI病例可以实现自发恢复,但大多数患者需要物理治疗和其他形式的治疗,以避免肌肉失衡和防止挛缩形成。除了物理治疗,最常见的非手术干预包括注射肉毒杆菌毒素和夹板。在需要手术的情况下,临床医生可能会使用几种测试和诊断成像来帮助决策。常见的BPBI手术干预包括神经移植、神经转移、肌肉和肌腱转移。结论:大多数新生儿在出生后3个月内从BPBI中恢复。然而,有些需要治疗才能恢复最佳功能。一般来说,非手术干预应作为治疗的主要方法,除非认为患者无法通过其他治疗恢复,否则应避免手术。
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引用次数: 0
Improving Equity, Diversity, and Inclusion in Plastic, Reconstructive, and Aesthetic Surgery in Canada: A Call to Action-Part II. 改善加拿大整形、重建和美容手术的公平性、多样性和包容性:行动的呼吁——第二部分。
IF 0.7 4区 医学 Q4 SURGERY Pub Date : 2025-01-08 DOI: 10.1177/22925503241307650
Emma Avery, Chantal R Valiquette, Syena Moltaji, Laura Snell

Background: In May 2022, we challenged our colleagues to evaluate their educational approaches, policies, recruitment strategies, and leadership organizations with an Equity, Diversity, and Inclusion (EDI) lens. Methods: Two virtual national round table meetings were held in 2023 to discuss approaches to integration of the EDI principles into current Canadian plastic surgery training programmes. Additionally, integrative documents and processes were established within our programme to act as a guide for integration of the principles of EDI in the areas of resident education, recruitment, and retention. Results: There is an increasing awareness amongst Canadian plastic surgeons of the importance of integrating EDI education into our plastic surgery training programmes, yet there is a lack of experience and/or lack of resources available to facilitate these changes. Our taskforce (Division of Plastic Surgery at the University of Toronto) implemented an EDI curriculum in our programme in 2 main domains: Education and Recruitment Strategies. Conclusions: Breaking down some of the long-entrenched inequities in our healthcare system is an ongoing process. More work needs to be done toward increasing our trainee and faculty exposure to EDI principles, so that they can integrate these skills into their clinical practice, leadership, and beyond. Our taskforce's successes and challenges can act as a useful resource to other programmes desiring to initiate similar change.

背景:在2022年5月,我们要求我们的同事用公平、多样性和包容性(EDI)的视角来评估他们的教育方法、政策、招聘策略和领导组织。方法:在2023年举行了两次虚拟国家圆桌会议,讨论将EDI原则纳入当前加拿大整形外科培训计划的方法。此外,在我们的项目中建立了综合文件和流程,作为在住院医师教育、招聘和保留方面整合EDI原则的指南。结果:加拿大整形外科医生越来越意识到将EDI教育纳入我们的整形外科培训计划的重要性,但缺乏经验和/或缺乏可用的资源来促进这些变化。我们的工作组(多伦多大学整形外科分部)在我们的项目中实施了一个EDI课程,主要涉及两个领域:教育和招聘策略。结论:打破我们医疗体系中一些长期根深蒂固的不平等是一个持续的过程。需要做更多的工作来增加我们的实习生和教师对EDI原则的了解,以便他们能够将这些技能整合到他们的临床实践、领导以及其他方面。我们工作队的成功和挑战可以作为希望发起类似变革的其他方案的有用资源。
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引用次数: 0
How Can Non-Hospital Surgical Centres Improve Their Environmental Footprint (and Reduce Costs)? 非医院外科中心如何改善其环境足迹(并降低成本)?
IF 0.7 4区 医学 Q4 SURGERY Pub Date : 2025-01-03 DOI: 10.1177/22925503241305635
Barinder Bajwa, Zach Zhang, Young Ji Tuen, Rebecca Courtemanche, Jugpal S Arneja

Introduction: Every industry has greenhouse gas emissions, with healthcare a significant contributor. In Canada, the healthcare sector is directly and indirectly responsible for 4.6% of the country's greenhouse gas emissions. Operating rooms (ORs) are major contributors to hospital waste, making the OR low hanging fruit for analyzing environmental practices. The OR can adopt a green mindset to reduce its carbon footprint, yet barriers to going green exist. Herein we study non-hospital surgical centres in British Columbia to assess current green practices, attitudes towards environmental sustainability, and barriers to implementation.

Methods: All accredited non-hospital surgical centres in BC were invited to complete a survey on current practices and plans to reduce their environmental impact.

Results: Of 56 non-hospital surgical centres contacted, 18 responded, with 89% willing to adapt their practice to promote environmental sustainability, yet lacked current knowledge (56%) and formal plans (0%). The wide use of anesthetic gases with high global warming potential (64%) and disposable drapes/ gowns (78%/ 67%) were noted. Barriers to adopting green practices included: cost (44%), infrastructure (44%), regulatory guidelines (39%), knowledge (39%), and safety (28%).

Conclusions: Transitioning to more environmentally sustainable practices in ORs can enhance healthcare value by reducing both costs and greenhouse gas emissions. The greatest effect can be achieved through prudent choice of anesthetic gas agent, followed by reusable linens and drapes. Education and regulatory leadership were identified as crucial for overcoming these barriers. This study underscores the need for education, guidelines, and economically viable options to transition from awareness to action.

导言:每个行业都有温室气体排放,医疗保健是一个重要的贡献者。在加拿大,医疗保健部门直接和间接地为该国4.6%的温室气体排放负责。手术室(OR)是医院浪费的主要来源,这使得手术室成为分析环境实践的容易实现的目标。手术室可以采用绿色思维来减少碳足迹,但走向绿色的障碍依然存在。本文研究了不列颠哥伦比亚省的非医院外科中心,以评估当前的绿色实践、对环境可持续性的态度以及实施的障碍。方法:邀请BC省所有认可的非医院外科中心完成一项关于减少其环境影响的现行做法和计划的调查。结果:在我们联系的56家非医院外科中心中,有18家做出了回应,其中89%的中心愿意调整其实践以促进环境可持续性,但缺乏当前的知识(56%)和正式计划(0%)。注意到广泛使用具有高全球变暖潜势的麻醉气体(64%)和一次性窗帘/长袍(78%/ 67%)。采用绿色实践的障碍包括:成本(44%)、基础设施(44%)、监管指南(39%)、知识(39%)和安全(28%)。结论:通过降低成本和温室气体排放,向更具环境可持续性的手术室实践过渡可以提高医疗保健价值。通过谨慎选择麻醉气体剂,其次是可重复使用的亚麻布和窗帘,可以达到最大的效果。教育和监管领导被认为是克服这些障碍的关键。这项研究强调需要教育、指导方针和经济上可行的选择,将意识转变为行动。
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引用次数: 0
期刊
Plastic surgery
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