Zeshaan Maan

Abstract

Normal wound healing mechanisms can be overwhelmed in the setting of complex acute and chronic tissue injury. Biological therapies are designed to augment and/or restore the body's natural wound healing abilities. There are a variety of available and emerging technologies utilizing this approach that have demonstrated the ability to augment wound healing.In this review, the clinical data on launched and emerging biological therapies for wound healing applications are summarized. The methodologies discussed include biological skin equivalents, growth factors/small molecules and stem cell-based therapies.While many products possess convincing clinical data demonstrating their efficacy in comparison to standard treatment options, more robust, controlled studies are needed to determine the relative value among established and emerging biological therapies. Future bioengineering and stem cell-based approaches are of particular interest due to the simultaneous correction of multiple deficiencies present in the nonhealing wound.

View details for DOI 10.1517/14712598.2013.842972

View details for Web of Science ID 000325712100007

View details for PubMedID 24093722

Abstract

In 2009 in the United Kingdom the 48-h working week was introduced for junior doctors. To comply with this traditional working practices have changed. This study aims to assess how much first year (FY1) doctors know about the acute surgical patients they manage and how this is influenced by changes in key working practices.Surgical FY1s working in NHS hospitals answered 16 clinical questions about a standard acute surgical patient under their care 48 h after admission. Scores were analysed according to how long the FY1 had been looking after the patient, whether they had clerked the patient in, attended the post take ward round (PTWR), used a handover sheet to answer the questions and had sole or shared responsibility for the patient.Two hundred and seventy-four FY1s (92% response rate) from 36 hospitals were surveyed. The overall median score was 11/16 (inter-quartile range 8-13). Only 8.4% (23/274) FY1s had clerked in the patient and 58.4% (160/274) had attended the PTWR. Clerking patients and attending the PTWR resulted in significantly higher test scores compared to FY1s who did not perform these activities (p = < 0.001 and 0.001 respectively). The scores of the 67.2% who used a handover sheet were significantly lower than those who did not (p = 0.001). Having sole or shared responsibility and duration of care made no significant difference (p = 0.143 and p = 0.458 respectively)The results demonstrate that junior doctors' knowledge of their patients is significantly enhanced when they have the opportunity to perform the admission clerking and attend the PTWR. Because of working hours' restrictions this is now rare. Although use of handover sheets appears to ensure that certain key facts immediately related to the current admission are passed on, it is associated with significantly poorer wider knowledge of the patient.

View details for DOI 10.1111/ijcp.12082

View details for Web of Science ID 000313688400012

View details for PubMedID 23216806

Abstract

Selection criteria for surgical training are not scientifically proven. There is a need to define which attributes predict future surgical performance. The aim of this study was to examine the predictive value of specific attributes that impact on surgical performance.All studies assessing the predictive power of specified attributes with regard to outcome measures of surgical performance in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Educational Resources Information Centre databases, and bibliographies of selected articles from 1950 to November 2010 were considered for inclusion by two independent reviewers. Information on study identifiers, participant characteristics, predictors assessed, evaluation methods for predictors, outcome measures, results and statistical analysis was collected. Quality assessment was carried out using the Hayden criteria.Visual-spatial perception correlated with both subjective and objective assessments of surgical performance, including rate of skill acquisition. Visual-spatial perception did not correlate with operative ability in experts, although it did with operative ability at the end of a training programme. Psychomotor aptitude, assessed collectively, correlated with rate of skill acquisition. Academic achievement predicted completion of a training programme and passing end-of-training examinations, but did not predict clinical performance during the training programme.Intermediate- and high-level visual-spatial perception, as well as psychomotor aptitude, can be used as criteria for assessing candidates for surgical training. Academic achievement is an effective predictor of successful completion of training programmes and should continue to form part of the assessment of surgical candidates.

View details for DOI 10.1002/bjs.8893

View details for Web of Science ID 000310727300002

View details for PubMedID 23034658

View details for DOI 10.1016/j.bjps.2011.09.004

View details for Web of Science ID 000301982000039

View details for PubMedID 21968282

Abstract

Robotic surgery has become increasingly used due to its enhancement of visualization, precision, and articulation. It eliminates many of the problems encountered with conventional minimally invasive techniques and has been shown to result in reduced blood loss and complications. The rise in endoscopic procedures in otolaryngology-head and neck surgery, and associated difficulties, suggests that robotic surgery may have a role to play.To determine whether robotic surgery conveys any benefits compared to conventional minimally invasive approaches, specifically looking at precision, operative time, and visualization.A systematic review of the literature with a defined search strategy.Searches of MEDLINE, EMBASE and CENTRAL using strategy: ((robot* OR (robot*AND surgery)) AND (ent OR otolaryngology)) to November 2010.Articles reviewed by authors and data compiled in tables for analysis.There were 33 references included in the study. Access and visualization were regularly mentioned as key benefits, though no objective data has been recorded in any study. Once initial setup difficulties were overcome, operative time was shown to decrease with robotic surgery, except in one controlled series of thyroid surgeries. Precision was also highlighted as an advantage, particularly in otological and skull base surgery. Postoperative outcomes were considered equivalent to or better than conventional surgery. Cost was the biggest drawback.The evidence base to date suggests there are benefits to robotic surgery in OHNS, particularly with regards to access, precision, and operative time but there is a lack of controlled, prospective studies with objective outcome measures. In addition, economic feasibility studies must be carried out before a robotic OHNS service is established.

View details for DOI 10.1016/j.amjoto.2011.04.003

View details for Web of Science ID 000298070800025

View details for PubMedID 21658808

Abstract

Subcutaneous emphysema in the head and neck is a rare condition, normally caused by major underlying injury to the airway or gastrointestinal tract. We report a non-traumatic occurrence of spontaneous cervical subcutaneous emphysema in a 30-year-old man who had been snorting mephedrone. The patient made an uneventful recovery, being managed conservatively, and did not require airway support. The occurrence of spontaneous cervical emphysema associated with snorting mephedrone has not been previously described in the literature.

View details for DOI 10.1308/003588412X13171221499108

View details for PubMedID 22524925

Abstract

Simple intratesticular cysts are being reported more commonly due to the wider use of scrotal ultrasonography however, their management remains unclear. Treatment has included enucleation, radical orchidectomy (over fear of an associated malignancy) and a more conservative approach with serial ultrasonography (if a neoplastic cyst is clearly ruled out). In view of the benign nature of such cysts, even serial ultrasonography may be unnecessary. We evaluate the presentation, diagnosis and management of ultrasound-detected simple intratesticular cysts over a 13-year period.Between May 1994 and August 2007, 24 men were found to have simple intratesticular cysts on scrotal ultrasonography. Records were analysed retrospectively to identify the clinicoradiologic findings and the management.Median follow up was 29.5 months (range 4 - 108 months). Only one patient became symptomatic with a cyst which increased in size by 13 mm over 15 months. Orchidectomy performed at the patient's request confirmed a benign simple cyst.In our series, a significant change in size of the cyst with accompanying symptoms was observed in one case only. Asymptomatic patients with simple intratesticular cysts without associated features of bias towards malignancy can be discharged without need for further follow-up.

View details for DOI 10.1186/1746-1596-6-24

View details for Web of Science ID 000289078600001

View details for PubMedID 21435258