BACKGROUND The World Health Organisation declared the coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.While globally,the relative caseload has been high,Australia’s has been relatively low.During the pa...BACKGROUND The World Health Organisation declared the coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.While globally,the relative caseload has been high,Australia’s has been relatively low.During the pandemic,radiology services have seen significant changes in workflow across modalities and a reduction in imaging volumes.AIM To investigate differences in modality imaging volumes during the COVID-19 pandemic across a large Victorian public health network.METHODS A retrospective analysis from January 2019 to December 2020 compared imaging volumes across two periods corresponding to the pandemic’s first and second waves.Weekly volumes across patient class,modality and mobile imaging were summed for periods:wave 1(weeks 11 to 16 for 2019;weeks 63 to 68 for 2020)and wave 2(weeks 28 to 43 for 2019;weeks 80 to 95 for 2020).Microsoft Power Business Intelligence linked to the radiology information system was used to mine all completed examinations.RESULTS Summed weekly data during the pandemic’s first wave showed the greatest decrease of 29.8%in adult outpatient imaging volumes and 46.3%in paediatric emergency department imaging volumes.Adult nuclear medicine demonstrated the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 47.8%,with angiography increasing by 50%.The pandemic’s second wave demonstrated the greatest decrease of 23.5%in adult outpatient imaging volumes,with an increase of 18.2%in inpatient imaging volumes.The greatest decrease was 28.5%in paediatric emergency department imaging volumes.Nuclear medicine showed the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 36.7%.Mobile imaging utilisation increased between 57.8%and 135.1%during the first and second waves.A strong correlation was observed between mobile and nonmobile imaging in the emergency setting(Spearman’s correlation coefficient=-0.743,P=0.000).No correlation was observed in the inpatient setting(Spearman’s correlation coefficient=-0.059,P=0.554).CONCLUSION Nuclear medicine was most impacted,while computed tomography and angiography were the least affected by the pandemic.The impact was less during the pandemic’s second wave.Mobile imaging shows continuous growth during both waves.展开更多
Vasospastic angina(VSA)is a distinct endotype of ischemia with non-obstructive coronary arteries characterized by transient coronary artery spasm and myocardial ischemia in the absence of significant fixed stenosis.It...Vasospastic angina(VSA)is a distinct endotype of ischemia with non-obstructive coronary arteries characterized by transient coronary artery spasm and myocardial ischemia in the absence of significant fixed stenosis.It is an underdiagnosed and often challenging condition that can lead to recurrent angina,myocardial infarction,and sudden cardiac death.VSA arises from a multifactorial interplay of endothelial dysfunction,vascular smooth muscle hyperreactivity,inflammation,and autonomic dysregulation.While calcium channel blockers and nitrates remain the mainstay of therapy,there is a growing body of evidence in the use of novel and emerging treatments including Rho-kinase inhibitors,endothelin receptor antagonists,and anti-inflammatory agents for refractory cases.Diagnostic evaluation relies on clinical features and,when necessary,invasive coronary pharmacological provocation testing.This narrative review examines the current understanding of VSA,discusses current international guideline-based diagnostic and therapeutic strategies,and highlights novel and investigational approaches that may broaden the treatment armamentarium against it.展开更多
1|Introduction Theranostics is quickly establishing itself as a key component in the field of cancer diagnosis and treatment^([1]).It is now considered the fifth pillar of contemporary oncology manage-ment alongside s...1|Introduction Theranostics is quickly establishing itself as a key component in the field of cancer diagnosis and treatment^([1]).It is now considered the fifth pillar of contemporary oncology manage-ment alongside surgery,chemotherapy,radiotherapy,and immunotherapy^([2]).As theranostics continues to evolve,it is essential for clinicians and radiologists to be aware of the cur-rent landscape and trends in the field^([3-5]).This article aims to highlight the importance for global radiology training colleges to formally introduce theranostics into their training curricula.This is to ensure that their trainees will gain adequate exposure to this growing branch of precision medicine and to enable them to contribute effectively to the field of oncology.展开更多
Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, ...Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, with lesser incidences of retinopathy of prematurity, intraventricular haemorrhage, and necrotising enterocolitis. Many studies have shown correlations between the receipt of blood transfusions and the development of these conditions, but little is known of the underlying pathophysiology of this relationship. Recent studies are beginning to provide some answers. This review examines recent findings with regard to the influence of preparation and storage of paediatric packed red blood cell units on heme, iron, and oxidative status of the units and relates these to the ability of the premature baby to deal with these changes following the receipt of blood transfusions. Paediatric packed red blood cell units are a potential source of heme, redox active iron and free radicals, and this increases with storage age. Haemolysis of transfused red blood cells may add further iron and cell free haemoglobin to the recipient baby. Premature babies, particularly those with low birth weight and gestational age appear to have littlereserve to cope with any additional iron, heme and/or oxidative load. The consequences of these events are discussed with regard to their contribution to the major complications of prematurity and a novel hypothesis regarding transfusion-related morbidity in premature babies is presented. The review concludes with a discussion of potential means of limiting transfusion related iron/heme and oxidative load through the preparation and storage of packed red blood cell units and through modifications in clinical practice.展开更多
Objective To examine general practitioners’(GPs)referral patterns to allied health services for people with dementia compared with those without dementia across two large Australian Primary Health Networks(PHNs).Desi...Objective To examine general practitioners’(GPs)referral patterns to allied health services for people with dementia compared with those without dementia across two large Australian Primary Health Networks(PHNs).Design A retrospective cohort study using routinely collected general practice data.Logistic regression was used to compare odds of allied health referrals,adjusting for age,sex and socioeconomic status.Setting De-identified patient and episode activity data from 537 GP practices across two PHNs in Australia between 2018 and 2023.Participants Data from 1153304 patients and 28667517 GP episodes of care were analysed.After merging records,693328 unique patients were identified,including 16610 patients with dementia.Subcohorts included patients with dementia,stroke,Parkinson’s disease and combinations of these conditions.Results The dementia cohort(n=16610)had a similar overall allied health referral rate(36.1%)to the control cohort(n=48977)(35.4%).Patients with dementia only were significantly less likely to receive any allied health referral compared with those with stroke(adjusted OR(aOR)0.76,95%CI 0.72 to 0.80;p<0.001)or Parkinson’s disease(aOR 0.72,95%CI 0.66 to 0.78;p<0.001).Those with dementia and stroke were also less likely to receive referrals than those with stroke only(aOR 0.71,95%CI 0.61 to 0.82;p<0.001).No significant difference was found between dementia with Parkinson’s and Parkinson’s only groups(p=0.48).Patients with dementia were consistently less likely to be referred to key allied health services(p<0.05).Conclusion Despite strong evidence supporting allied health interventions for dementia,referral rates remain comparatively low.Enhancing GP referral resources and education,integrating dementia-specific care pathways and implementing supportive policy changes are needed to improve access and equity in dementia care.展开更多
Floseal Hemostatic Matrix is a topical hemostatic agent used across specialties and commonly applied to the renal bed during partial nephrectomy.Here we present the first adult case of Floseal allergy in the literatur...Floseal Hemostatic Matrix is a topical hemostatic agent used across specialties and commonly applied to the renal bed during partial nephrectomy.Here we present the first adult case of Floseal allergy in the literature.A 62-year-old man underwent partial nephrectomy for a Bosniak type Ⅳ cyst.After unclamping the kidney,the patient declined precipitously,later determined due to an anaphylactic reaction to the Floseal placed on the renal bed.The patient had a prolonged anaphylactic reaction that required ionotropic support for over 24 h,possibly due to continued exposure.His tryptase level was elevated,and allergy testing revealed an allergy to the gelatin matrix component of the Floseal.Floseal anaphylaxis should be considered during episodes of cardiovascular collapse after drug administration.However,consideration should be given to removing it to prevent continued exposure and weighed against the risk of prolonged surgery in an anaphylactic patient.展开更多
This study evaluated three prominent Large Language Models(LLMs)-Google’s AI BARD,Bing’s AI,and ChatGPT-4 in providing patient advice for hand laceration.Five simulated patient inquiries on hand trauma were prompted...This study evaluated three prominent Large Language Models(LLMs)-Google’s AI BARD,Bing’s AI,and ChatGPT-4 in providing patient advice for hand laceration.Five simulated patient inquiries on hand trauma were prompted to them.A panel of Board-certified plastic surgical residents evaluated the responses for accuracy,comprehensiveness,and appropriate sources.Responses were also compared against existing literature and guidelines.This study suggests that ChatGPT outperforms BARD and Bing AI in providing reliable,evidence-based clinical advice,but they still face limitations in depth and specificity.Healthcare professionals are essential in interpreting LLM recommendations,and future research should improve LLM performance by integrating specialized databases and human expertise to advance nerve injury management and optimize patient-centred care.展开更多
The integration of artificial intelligence(AI)into plastic surgery is transforming the field by enhancing precision in preoperative planning,diagnostic accuracy,intraoperative assistance,and postoperative care.AI enco...The integration of artificial intelligence(AI)into plastic surgery is transforming the field by enhancing precision in preoperative planning,diagnostic accuracy,intraoperative assistance,and postoperative care.AI encompasses machine learning,natural language processing,computer vision,and artificial neural networks,each offering unique advancements to surgical practice.This narrative review explores the ethical challenges of AI in plastic surgery,addressing concerns such as data protection,algorithmic bias,transparency,accountability,and informed consent.A comprehensive search adhering to PRISMA guidelines identified 63 studies,with 15 selected for in-depth analysis.Findings indicate significant ethical issues:data privacy needs stringent cybersecurity,biases in AI models must be mitigated,and transparency in AI decision making is essential.The review emphasizes the necessity for updated Health Insurance Portability and Accountability Act(HIPAA)regulations,robust validation mechanisms,and the development of explainable AI models.It also highlights the need for an independent regulatory body to oversee AI integration,ensuring ethical standards and protecting patient welfare.Although AI presents promising benefits,its successful application in plastic surgery hinges on addressing these ethical challenges comprehensively.展开更多
The increasing adoption and widespread acceptance of negative pressure wound therapy(NPWT)have paralleled the expansion of its indications in clinical practice.The spectrum of indications for NPWT now extends to encom...The increasing adoption and widespread acceptance of negative pressure wound therapy(NPWT)have paralleled the expansion of its indications in clinical practice.The spectrum of indications for NPWT now extends to encompass soft tissue defects arising from trauma,infection,surgical wound care,and soft tissue grafting procedures.Recent advancements in NPWT devices have introduced various adjuncts,such as instillation of fluids or antibiotics into the wound.These additions empower surgeons to enhance the wound healing environment and contribute to combatting infections more effectively.This review delves into the latest literature addressing the proposed mechanisms underlying NPWT's action,its cost-effectiveness,its impact on patient quality of life,and the essential components necessary for its safe use.The review examines the evidence supporting NPWT's application in managing traumatic extremity injuries,controlling infections,and wound care.While NPWT generally exhibits a low complication rate,surgeons must remain aware of the potential risks linked to its utilization.Moreover,the review explores the widening scope of indications for NPWT,shedding light on prospective avenues for innovation and research in this field.展开更多
The introduction of generative artificial intelligence(AI)has revolutionized healthcare and education.These AI systems,trained on vast datasets using advanced machine learning(ML)techniques and large language models(L...The introduction of generative artificial intelligence(AI)has revolutionized healthcare and education.These AI systems,trained on vast datasets using advanced machine learning(ML)techniques and large language models(LLMs),can generate text,images,and videos,offering new avenues for enhancing surgical education.Their ability to produce interactive learning resources,procedural guidance,and feedback post-virtual simulations makes them valuable in educating surgical trainees.However,technical challenges such as data quality issues,inaccuracies,and uncertainties around model interpretability remain barriers to widespread adoption.This review explores the integration of generative AI into surgical training,assessing its potential to enhance learning and teaching methodologies.While generative AI has demonstrated promise for improving surgical education,its integration must be approached cautiously,ensuring AI input is balanced with traditional supervision and mentorship from experienced surgeons.Given that generative AI models are not yet suitable as standalone tools,a blended learning approach that integrates AI capabilities with conventional educational strategies should be adopted.The review also addresses limitations and challenges,emphasizing the need for more robust research on different AI models and their applications across various surgical subspecialties.The lack of standardized frameworks and tools to assess the quality of AI outputs in surgical education necessitates rigorous oversight to ensure accuracy and reliability in training settings.By evaluating the current state of generative AI in surgical education,this narrative review highlights the potential for future innovation and research,encouraging ongoing exploration of AI in enhancing surgical education and training.展开更多
Three-dimensional(3D)printed models offer potential advantages over traditional teaching methods by providing realistic,tactile learning aids.The overall efficacy of 3D printing in plastic surgery education has not be...Three-dimensional(3D)printed models offer potential advantages over traditional teaching methods by providing realistic,tactile learning aids.The overall efficacy of 3D printing in plastic surgery education has not been previously systematically analysed.A review of PubMed,Web of Science,and Embase databases up to October 2023 identified studies using 3D printed models in plastic surgery education.Inclusion criteria were set to select before-after studies or studies comparing 3D printed models to traditional teaching methods.Outcome measures included Likert scales,Multiple choice quest tests or other scoring systems.37 studies met the inclusion criteria.Learners demonstrated enhanced anatomical understanding and procedural knowledge after engaging with 3D models.The comparative studies included in the review further highlight the superiority of 3D models over traditional learning tools,with average increases in test scores and procedural confidence,quantified through Likert scales and multiple-choice questionnaires.Ultimately,the findings of this review suggest that 3D printing enhances learning,making educational experiences more interactive and effective than traditional methods.While costs,accessibility,and a lack of technical expertise may pose challenges,integrating 3D models into training could enhance plastic surgical education.High-quality randomized controlled trials are necessary to confirm these findings and standardise outcomes for broader applications.展开更多
Lymphoedema is a common and debilitating condition for which there is no single satisfactory management modality.Physiotherapy is accessible and moderately effective but suffers from the necessity for daily adherence....Lymphoedema is a common and debilitating condition for which there is no single satisfactory management modality.Physiotherapy is accessible and moderately effective but suffers from the necessity for daily adherence.Surgery is effective in the earlier stages of disease progression but can be morbid and demanding for patients.An evolving surgical technique known as non-vascularised lymph node transfer(NVLNT)aims to tackle the underlying lymphatic drainage deficit in lymphoedema in a minimally invasive manner.Emerging evidence demonstrates promise in animal models and there is very nascent human evidence with mixed results.This is a narrative review that examines the available animal and human literature on NVLNT and draws comparisons between the two to discover methods of translating animal research to human applications.A systematic search was conducted.PubMed and Embase were searched using MeSH terms for NVLNT.Ultimately,17 papers,including 14 animal and 3 human studies,were found.Within animal studies,NVLNT is efficacious,with results being repeated multiple times.Additionally,methods of optimising lymphangiogenesis,such as the addition of platelet-rich plasma and VEGF-C in addition to fragmentation and pre-inflammation techniques,have been investigated with general success.To date,evidence from human studies is sparse,with few studies,small sample sizes,and variable outcomes.NVLNT is promising as a minimally invasive surgical treatment for lymphoedema;however,further high-quality research in humans with advanced lymphoedema is necessary to prove its validity.Furthermore,adjuvants to grafting explored in animal studies,such as VEGF-C therapy,may increase the efficacy of lymph node grafting in humans.展开更多
Aim:In the digital age,artificial intelligence(AI)platforms have gradually replaced traditional manual techniques for information retrieval.However,their effectiveness in conducting academic literature searches remain...Aim:In the digital age,artificial intelligence(AI)platforms have gradually replaced traditional manual techniques for information retrieval.However,their effectiveness in conducting academic literature searches remains unclear,necessitating a comparative assessment.This study examined the efficacy of AI search engines(Elicit,Consensus,ChatGPT)vs.manual search for literature retrieval,focusing on the surgical management of trapeziometacarpal osteoarthritis.Methods:The study was executed per the Cochrane Handbook for Systematic Reviews and PRISMA guidelines.AI platforms were given relevant keywords and prompts,while manual searches used PubMed,Cochrane CENTRAL,Web of Science,and Scopus databases from January 1901 to April 2024.The study focused on English-language randomized controlled trials(RCTs)comparing surgical management of trapeziometacarpal osteoarthritis(TMCJ OA).Two independent evaluators screened and extracted data from the studies.Primary outcomes involved the quality and relevancy of studies chosen by both search methods,evaluated by false positive rates and number of studies,including outcomes of interest.Results:The manual search yielded the most results(6,018),followed by Elicit(4,980),Consensus(3,436),and ChatGPT(6).Elicit identified the highest number of RCTs(205)but also had the greatest false positive rate(94%).Ultimately,the manual search identified 23 suitable studies,Elicit found 10,Consensus found 9,and ChatGPT identified only 1.No additional studies were found by AI search engines that were not discovered in the manual search.Conclusion:The findings highlight the potential advantages and drawbacks of AI search engines for literature searches.While Elicit was prone to error,Consensus and ChatGPT were less comprehensive.Significant enhancements in the precision and thoroughness of AI search engines are required before they can be effectively utilized in academia.展开更多
Breast reconstruction after mastectomy is a critical aspect of breast cancer treatment.This retrospective study analyzes the efficacy and safety of the sharp needle intradermal fat(SNIF)technique in immediate two-stag...Breast reconstruction after mastectomy is a critical aspect of breast cancer treatment.This retrospective study analyzes the efficacy and safety of the sharp needle intradermal fat(SNIF)technique in immediate two-stage prepectoral breast reconstruction(PPBR)after mastectomy.A retrospective cohort analysis was conducted on patients who underwent SNIF fat grafting after mastectomy and PPBR.Demographics,surgical indications,procedures,and complications were analyzed.The SNIF procedure involves the precise injection of small fat particles into the dermal layer,aiming to improve skin texture and correct minor surface irregularities.Sixty-seven patients underwent the SNIF procedure after PPBR.The mean age was 53.2 years,with a range of 33 to 71 years.No serious complications,such as infection or fat embolism,were observed.Minor complications included ecchymosis in 30 patients and redness with mild swelling in 13 patients,all of which resolved within a few days after surgery.Patients and surgeons reported satisfactory cosmetic results.The SNIF technique,using smalldiameter fat particles injected intradermally,shows promise for improving aesthetic results and minimizing complications in two-stage PPBR.展开更多
文摘BACKGROUND The World Health Organisation declared the coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.While globally,the relative caseload has been high,Australia’s has been relatively low.During the pandemic,radiology services have seen significant changes in workflow across modalities and a reduction in imaging volumes.AIM To investigate differences in modality imaging volumes during the COVID-19 pandemic across a large Victorian public health network.METHODS A retrospective analysis from January 2019 to December 2020 compared imaging volumes across two periods corresponding to the pandemic’s first and second waves.Weekly volumes across patient class,modality and mobile imaging were summed for periods:wave 1(weeks 11 to 16 for 2019;weeks 63 to 68 for 2020)and wave 2(weeks 28 to 43 for 2019;weeks 80 to 95 for 2020).Microsoft Power Business Intelligence linked to the radiology information system was used to mine all completed examinations.RESULTS Summed weekly data during the pandemic’s first wave showed the greatest decrease of 29.8%in adult outpatient imaging volumes and 46.3%in paediatric emergency department imaging volumes.Adult nuclear medicine demonstrated the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 47.8%,with angiography increasing by 50%.The pandemic’s second wave demonstrated the greatest decrease of 23.5%in adult outpatient imaging volumes,with an increase of 18.2%in inpatient imaging volumes.The greatest decrease was 28.5%in paediatric emergency department imaging volumes.Nuclear medicine showed the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 36.7%.Mobile imaging utilisation increased between 57.8%and 135.1%during the first and second waves.A strong correlation was observed between mobile and nonmobile imaging in the emergency setting(Spearman’s correlation coefficient=-0.743,P=0.000).No correlation was observed in the inpatient setting(Spearman’s correlation coefficient=-0.059,P=0.554).CONCLUSION Nuclear medicine was most impacted,while computed tomography and angiography were the least affected by the pandemic.The impact was less during the pandemic’s second wave.Mobile imaging shows continuous growth during both waves.
文摘Vasospastic angina(VSA)is a distinct endotype of ischemia with non-obstructive coronary arteries characterized by transient coronary artery spasm and myocardial ischemia in the absence of significant fixed stenosis.It is an underdiagnosed and often challenging condition that can lead to recurrent angina,myocardial infarction,and sudden cardiac death.VSA arises from a multifactorial interplay of endothelial dysfunction,vascular smooth muscle hyperreactivity,inflammation,and autonomic dysregulation.While calcium channel blockers and nitrates remain the mainstay of therapy,there is a growing body of evidence in the use of novel and emerging treatments including Rho-kinase inhibitors,endothelin receptor antagonists,and anti-inflammatory agents for refractory cases.Diagnostic evaluation relies on clinical features and,when necessary,invasive coronary pharmacological provocation testing.This narrative review examines the current understanding of VSA,discusses current international guideline-based diagnostic and therapeutic strategies,and highlights novel and investigational approaches that may broaden the treatment armamentarium against it.
文摘1|Introduction Theranostics is quickly establishing itself as a key component in the field of cancer diagnosis and treatment^([1]).It is now considered the fifth pillar of contemporary oncology manage-ment alongside surgery,chemotherapy,radiotherapy,and immunotherapy^([2]).As theranostics continues to evolve,it is essential for clinicians and radiologists to be aware of the cur-rent landscape and trends in the field^([3-5]).This article aims to highlight the importance for global radiology training colleges to formally introduce theranostics into their training curricula.This is to ensure that their trainees will gain adequate exposure to this growing branch of precision medicine and to enable them to contribute effectively to the field of oncology.
基金Supported by The Northcott Devon Medical FoundationThe NHS SW Researchand Development Fund
文摘Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, with lesser incidences of retinopathy of prematurity, intraventricular haemorrhage, and necrotising enterocolitis. Many studies have shown correlations between the receipt of blood transfusions and the development of these conditions, but little is known of the underlying pathophysiology of this relationship. Recent studies are beginning to provide some answers. This review examines recent findings with regard to the influence of preparation and storage of paediatric packed red blood cell units on heme, iron, and oxidative status of the units and relates these to the ability of the premature baby to deal with these changes following the receipt of blood transfusions. Paediatric packed red blood cell units are a potential source of heme, redox active iron and free radicals, and this increases with storage age. Haemolysis of transfused red blood cells may add further iron and cell free haemoglobin to the recipient baby. Premature babies, particularly those with low birth weight and gestational age appear to have littlereserve to cope with any additional iron, heme and/or oxidative load. The consequences of these events are discussed with regard to their contribution to the major complications of prematurity and a novel hypothesis regarding transfusion-related morbidity in premature babies is presented. The review concludes with a discussion of potential means of limiting transfusion related iron/heme and oxidative load through the preparation and storage of packed red blood cell units and through modifications in clinical practice.
基金funded by the Australian Government Medical Research Future Fund(MRFF),Grant number 2015947.
文摘Objective To examine general practitioners’(GPs)referral patterns to allied health services for people with dementia compared with those without dementia across two large Australian Primary Health Networks(PHNs).Design A retrospective cohort study using routinely collected general practice data.Logistic regression was used to compare odds of allied health referrals,adjusting for age,sex and socioeconomic status.Setting De-identified patient and episode activity data from 537 GP practices across two PHNs in Australia between 2018 and 2023.Participants Data from 1153304 patients and 28667517 GP episodes of care were analysed.After merging records,693328 unique patients were identified,including 16610 patients with dementia.Subcohorts included patients with dementia,stroke,Parkinson’s disease and combinations of these conditions.Results The dementia cohort(n=16610)had a similar overall allied health referral rate(36.1%)to the control cohort(n=48977)(35.4%).Patients with dementia only were significantly less likely to receive any allied health referral compared with those with stroke(adjusted OR(aOR)0.76,95%CI 0.72 to 0.80;p<0.001)or Parkinson’s disease(aOR 0.72,95%CI 0.66 to 0.78;p<0.001).Those with dementia and stroke were also less likely to receive referrals than those with stroke only(aOR 0.71,95%CI 0.61 to 0.82;p<0.001).No significant difference was found between dementia with Parkinson’s and Parkinson’s only groups(p=0.48).Patients with dementia were consistently less likely to be referred to key allied health services(p<0.05).Conclusion Despite strong evidence supporting allied health interventions for dementia,referral rates remain comparatively low.Enhancing GP referral resources and education,integrating dementia-specific care pathways and implementing supportive policy changes are needed to improve access and equity in dementia care.
文摘Floseal Hemostatic Matrix is a topical hemostatic agent used across specialties and commonly applied to the renal bed during partial nephrectomy.Here we present the first adult case of Floseal allergy in the literature.A 62-year-old man underwent partial nephrectomy for a Bosniak type Ⅳ cyst.After unclamping the kidney,the patient declined precipitously,later determined due to an anaphylactic reaction to the Floseal placed on the renal bed.The patient had a prolonged anaphylactic reaction that required ionotropic support for over 24 h,possibly due to continued exposure.His tryptase level was elevated,and allergy testing revealed an allergy to the gelatin matrix component of the Floseal.Floseal anaphylaxis should be considered during episodes of cardiovascular collapse after drug administration.However,consideration should be given to removing it to prevent continued exposure and weighed against the risk of prolonged surgery in an anaphylactic patient.
文摘This study evaluated three prominent Large Language Models(LLMs)-Google’s AI BARD,Bing’s AI,and ChatGPT-4 in providing patient advice for hand laceration.Five simulated patient inquiries on hand trauma were prompted to them.A panel of Board-certified plastic surgical residents evaluated the responses for accuracy,comprehensiveness,and appropriate sources.Responses were also compared against existing literature and guidelines.This study suggests that ChatGPT outperforms BARD and Bing AI in providing reliable,evidence-based clinical advice,but they still face limitations in depth and specificity.Healthcare professionals are essential in interpreting LLM recommendations,and future research should improve LLM performance by integrating specialized databases and human expertise to advance nerve injury management and optimize patient-centred care.
文摘The integration of artificial intelligence(AI)into plastic surgery is transforming the field by enhancing precision in preoperative planning,diagnostic accuracy,intraoperative assistance,and postoperative care.AI encompasses machine learning,natural language processing,computer vision,and artificial neural networks,each offering unique advancements to surgical practice.This narrative review explores the ethical challenges of AI in plastic surgery,addressing concerns such as data protection,algorithmic bias,transparency,accountability,and informed consent.A comprehensive search adhering to PRISMA guidelines identified 63 studies,with 15 selected for in-depth analysis.Findings indicate significant ethical issues:data privacy needs stringent cybersecurity,biases in AI models must be mitigated,and transparency in AI decision making is essential.The review emphasizes the necessity for updated Health Insurance Portability and Accountability Act(HIPAA)regulations,robust validation mechanisms,and the development of explainable AI models.It also highlights the need for an independent regulatory body to oversee AI integration,ensuring ethical standards and protecting patient welfare.Although AI presents promising benefits,its successful application in plastic surgery hinges on addressing these ethical challenges comprehensively.
文摘The increasing adoption and widespread acceptance of negative pressure wound therapy(NPWT)have paralleled the expansion of its indications in clinical practice.The spectrum of indications for NPWT now extends to encompass soft tissue defects arising from trauma,infection,surgical wound care,and soft tissue grafting procedures.Recent advancements in NPWT devices have introduced various adjuncts,such as instillation of fluids or antibiotics into the wound.These additions empower surgeons to enhance the wound healing environment and contribute to combatting infections more effectively.This review delves into the latest literature addressing the proposed mechanisms underlying NPWT's action,its cost-effectiveness,its impact on patient quality of life,and the essential components necessary for its safe use.The review examines the evidence supporting NPWT's application in managing traumatic extremity injuries,controlling infections,and wound care.While NPWT generally exhibits a low complication rate,surgeons must remain aware of the potential risks linked to its utilization.Moreover,the review explores the widening scope of indications for NPWT,shedding light on prospective avenues for innovation and research in this field.
文摘The introduction of generative artificial intelligence(AI)has revolutionized healthcare and education.These AI systems,trained on vast datasets using advanced machine learning(ML)techniques and large language models(LLMs),can generate text,images,and videos,offering new avenues for enhancing surgical education.Their ability to produce interactive learning resources,procedural guidance,and feedback post-virtual simulations makes them valuable in educating surgical trainees.However,technical challenges such as data quality issues,inaccuracies,and uncertainties around model interpretability remain barriers to widespread adoption.This review explores the integration of generative AI into surgical training,assessing its potential to enhance learning and teaching methodologies.While generative AI has demonstrated promise for improving surgical education,its integration must be approached cautiously,ensuring AI input is balanced with traditional supervision and mentorship from experienced surgeons.Given that generative AI models are not yet suitable as standalone tools,a blended learning approach that integrates AI capabilities with conventional educational strategies should be adopted.The review also addresses limitations and challenges,emphasizing the need for more robust research on different AI models and their applications across various surgical subspecialties.The lack of standardized frameworks and tools to assess the quality of AI outputs in surgical education necessitates rigorous oversight to ensure accuracy and reliability in training settings.By evaluating the current state of generative AI in surgical education,this narrative review highlights the potential for future innovation and research,encouraging ongoing exploration of AI in enhancing surgical education and training.
文摘Three-dimensional(3D)printed models offer potential advantages over traditional teaching methods by providing realistic,tactile learning aids.The overall efficacy of 3D printing in plastic surgery education has not been previously systematically analysed.A review of PubMed,Web of Science,and Embase databases up to October 2023 identified studies using 3D printed models in plastic surgery education.Inclusion criteria were set to select before-after studies or studies comparing 3D printed models to traditional teaching methods.Outcome measures included Likert scales,Multiple choice quest tests or other scoring systems.37 studies met the inclusion criteria.Learners demonstrated enhanced anatomical understanding and procedural knowledge after engaging with 3D models.The comparative studies included in the review further highlight the superiority of 3D models over traditional learning tools,with average increases in test scores and procedural confidence,quantified through Likert scales and multiple-choice questionnaires.Ultimately,the findings of this review suggest that 3D printing enhances learning,making educational experiences more interactive and effective than traditional methods.While costs,accessibility,and a lack of technical expertise may pose challenges,integrating 3D models into training could enhance plastic surgical education.High-quality randomized controlled trials are necessary to confirm these findings and standardise outcomes for broader applications.
文摘Lymphoedema is a common and debilitating condition for which there is no single satisfactory management modality.Physiotherapy is accessible and moderately effective but suffers from the necessity for daily adherence.Surgery is effective in the earlier stages of disease progression but can be morbid and demanding for patients.An evolving surgical technique known as non-vascularised lymph node transfer(NVLNT)aims to tackle the underlying lymphatic drainage deficit in lymphoedema in a minimally invasive manner.Emerging evidence demonstrates promise in animal models and there is very nascent human evidence with mixed results.This is a narrative review that examines the available animal and human literature on NVLNT and draws comparisons between the two to discover methods of translating animal research to human applications.A systematic search was conducted.PubMed and Embase were searched using MeSH terms for NVLNT.Ultimately,17 papers,including 14 animal and 3 human studies,were found.Within animal studies,NVLNT is efficacious,with results being repeated multiple times.Additionally,methods of optimising lymphangiogenesis,such as the addition of platelet-rich plasma and VEGF-C in addition to fragmentation and pre-inflammation techniques,have been investigated with general success.To date,evidence from human studies is sparse,with few studies,small sample sizes,and variable outcomes.NVLNT is promising as a minimally invasive surgical treatment for lymphoedema;however,further high-quality research in humans with advanced lymphoedema is necessary to prove its validity.Furthermore,adjuvants to grafting explored in animal studies,such as VEGF-C therapy,may increase the efficacy of lymph node grafting in humans.
文摘Aim:In the digital age,artificial intelligence(AI)platforms have gradually replaced traditional manual techniques for information retrieval.However,their effectiveness in conducting academic literature searches remains unclear,necessitating a comparative assessment.This study examined the efficacy of AI search engines(Elicit,Consensus,ChatGPT)vs.manual search for literature retrieval,focusing on the surgical management of trapeziometacarpal osteoarthritis.Methods:The study was executed per the Cochrane Handbook for Systematic Reviews and PRISMA guidelines.AI platforms were given relevant keywords and prompts,while manual searches used PubMed,Cochrane CENTRAL,Web of Science,and Scopus databases from January 1901 to April 2024.The study focused on English-language randomized controlled trials(RCTs)comparing surgical management of trapeziometacarpal osteoarthritis(TMCJ OA).Two independent evaluators screened and extracted data from the studies.Primary outcomes involved the quality and relevancy of studies chosen by both search methods,evaluated by false positive rates and number of studies,including outcomes of interest.Results:The manual search yielded the most results(6,018),followed by Elicit(4,980),Consensus(3,436),and ChatGPT(6).Elicit identified the highest number of RCTs(205)but also had the greatest false positive rate(94%).Ultimately,the manual search identified 23 suitable studies,Elicit found 10,Consensus found 9,and ChatGPT identified only 1.No additional studies were found by AI search engines that were not discovered in the manual search.Conclusion:The findings highlight the potential advantages and drawbacks of AI search engines for literature searches.While Elicit was prone to error,Consensus and ChatGPT were less comprehensive.Significant enhancements in the precision and thoroughness of AI search engines are required before they can be effectively utilized in academia.
文摘Breast reconstruction after mastectomy is a critical aspect of breast cancer treatment.This retrospective study analyzes the efficacy and safety of the sharp needle intradermal fat(SNIF)technique in immediate two-stage prepectoral breast reconstruction(PPBR)after mastectomy.A retrospective cohort analysis was conducted on patients who underwent SNIF fat grafting after mastectomy and PPBR.Demographics,surgical indications,procedures,and complications were analyzed.The SNIF procedure involves the precise injection of small fat particles into the dermal layer,aiming to improve skin texture and correct minor surface irregularities.Sixty-seven patients underwent the SNIF procedure after PPBR.The mean age was 53.2 years,with a range of 33 to 71 years.No serious complications,such as infection or fat embolism,were observed.Minor complications included ecchymosis in 30 patients and redness with mild swelling in 13 patients,all of which resolved within a few days after surgery.Patients and surgeons reported satisfactory cosmetic results.The SNIF technique,using smalldiameter fat particles injected intradermally,shows promise for improving aesthetic results and minimizing complications in two-stage PPBR.
