Alexander M.C. Goodson

A Review Of Current Clinical Photography Guidelines In Relation To Smartphone Publishing Of Medical Images

The rise in popularity of smartphones has seen a surge in the number of smartphone-specific software applications (apps) available. Among these apps, many are medical and healthcare related, of benefit to both the general public and healthcare staff. With this improved technology comes the ability to display full-colour images and videos, for which medical images could be utilised. We reviewed current clinical photography guidelines in relation to the publishing of medical images in smartphone apps. Of the 5 relevant guidelines, none discussed hand-held electronic media or smartphone app publishing. This creates confusion for clinicians as to how to interpret current guidelines for this purpose. Medical illustrators, clinicians and NHS Trusts need to be aware of the changes in technology and the ethical considerations of allowing medical images to be published within smartphones. We discuss the issues surrounding consent and provide practical tips for obtaining informed consent from patients to publish medical images in smartphone apps.

Using The iBook In Medical Education And Healthcare Settings - The iBook As A Reusable Learning Object; A Report Of The Author's Experience Using iBooks Author Software

The recently launched iBooks 2 from Apple has created a new genre of ‘interactive multimedia eBook’. This article aims to dscribe the benefit of the iBook in a medical education and healthcare setting. We discuss the attributes of an iBook as compared with the requirements of the conventional web-based Reusable Learning Object. The structure and user interface within an iBook is highlighted, and the iBook-creating software iBooks Author is discussed in detail. A report of personal experience developing and distributing an iBook for junior trainees in oral and maxillofacial surgery is provided, with discussion of the limitations of this approach and the need for further evidence-based studies.

A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012

This review summarises the articles relating to the temporomandibular joint (TMJ) that were published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) between January 2011 and December 2012. In total 24 papers were published. Of these, 16 (67%) were full-length articles, which included prospective, retrospective, and laboratory-based studies as well as reviews. The remaining 8 papers were short communications, technical notes, and letters to the editor, which report on, amongst other things, unusual cases, rare complications, and novel surgical techniques.

A review of trauma and trauma-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2010-2011.

This review summarises all trauma and related papers published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) from January 2010 to December 2011. In total 45 articles were published, of which 42% (19) were full-length articles. These articles primarily focused on the management of mandibular condyle and orbital fractures, with several papers discussing maxillofacial surgery by the British military. There were no articles discussing midfacial fractures or massive facial trauma. The remaining papers included short communications, technical notes, and letters; and provided discussion of interesting cases, new surgical techniques and fracture classifications. The number of trauma papers published in BJOMS appears to be less than other sub-specialties such as head and neck oncology. The number of prospective and randomised studies remains low, highlighting a need to foster further research within maxillofacial trauma.

Minimally invasive treatment of oral ranulae: adaption to an old technique

Oral ranulas are cysts in the floor of the mouth that result from the extravasation of mucous. Historically there has been little consensus on the ideal first-line treatment, but currently, definitive treatment involves excision of the sublingual gland, which can injure the lingual nerve and submandibular duct. Minimally invasive surgical alternatives such as marsupialisation have been proposed, but so far have been associated with a high rate of recurrence. The aim of this pilot study was to evaluate the success of a simple, modified suture technique for the treatment of oral ranulas that can be done in the outpatient department. We retrospectively analysed outcomes after the technique was used as a first-line treatment in 15 consecutive patients between 2011 and 2013. Although 2 attempts were needed in 4 patients, complete resolution of the ranula was seen in 13. Other than the need for a second attempt, and recurrent failure in 2 cases, there were no complications. This minimally invasive and quick procedure is a suitable first-line alternative to other less successful or higher risk options.

Free‐flap telemonitoring to the surgeon's handheld device: Proof of concept

Techniques for free-flap monitoring traditionally rely on clinical examination and experience. A survey of 60 British microsurgical head and neck units suggested that clinical monitoring is the only technique that is universally used. However, 91% used additional tests, including handheld Doppler (55%), temperature probes (50%), laser Doppler flowmetry (5–10%), and near infrared spectroscopy (>5%). Besides the benefit of providing a means to monitor “buried” flaps, such technologies provide quantitative indicators of flap viability in the early postoperative period. However, like clinical monitoring, such measurements may still require experience to interpret fully. Postoperative monitoring needs to be continuous, including when the senior/experienced consultant surgeon is out of the hospital. Consequently, it is often the case that for the first few nights postoperatively, the only on-site surgeon is a junior clinician whose interpretation of the flap status is reliant on a limited amount of experience. In-hospital and community-based cardiac telemetry has proved successful in early recognition of lifethreatening cardiac events and improves survival. Reflecting on this, we sought to create and test a prototype free-flap telemonitoring system for the surgeon using similar technology. We set out to utilize a hospital wireless network (WiFi) and remote desktop software to transmit quantitative data from an electronic flap-monitoring device (the O2C device, LEA Medizintechnik, Germany) to a handheld computer device (personal tablet or smartphone) at the surgeon’s residence. The O2C device has been shown to be a reliable and objective noninvasive technique for free-flap monitoring. It uses laser Doppler and spectrophotometry to

Medical students’ understanding of oral and maxillofacial surgery: an Irish perspective

Oral and Maxillofacial Surgery (OMFS) remains an enigmatic specialty in Irish medicine and many students are unaware of its scope and the unique career pathway involved. We completed a multicentre cross-sectional study to identify their ability to identify the requirements for entry to specialty training year 3 (ST3) in OMFS, to assess their awareness of OMFS surgeons, and their general awareness of, and exposure to, the specialty. Data were collected through an electronic questionnaire. Participants were asked to select the most suitable surgical specialty to treat a number of common conditions in the head and neck, and to choose the requirements they deemed essential for specialist training. Knowledge was measured by the number of correct responses. A total of 443 medical students participated (University College Cork (UCC) n=328, 74%; Royal College of Surgeons in Ireland (RCSI) n=113, 26%). A total of 318/374 (85%) had had no previous experience of OMFS, 38/374 (10%) had had theoretical teaching only, and 18/374 (5%) had had clinical experience. A total of 212/329 (64%) wished for greater exposure as a student, but only 34/329 (9%) would consider a career in the specialty. The median (IQR) number of correct responses for OMFS procedures was 3.0/10 (2.0), with women, direct entrants, and RCSI students scoring highest. Only 11/367 (3%) could identify the minimum entry requirements for a post of specialist registrar. This study has identified a potential gap in the undergraduate curriculum. Although medical students are rarely taught about OMFS, they show an interest in learning more.

A review of oral surgery-related papers published in the British Journal of Oral and Maxillofacial Surgery during 2011 and 2012

This paper is a synopsis of all articles relating to oral surgery that were published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) between January 2011 and December 2012. Of the 57 published, 40 (70%) were full-length articles that predominantly focused on implantology, dentoalveolar surgery, and bisphosphonate osteonecrosis of the jaws (BONJs). In addition, a number of short communications, technical notes, and letters to the editor described rare cases, unusual complications, and novel surgical techniques.

The Impact of the Multi-Disciplinary Team ApproachIn Managing Palliative Head and Neck Cancer Patients: AReview

The World Health Organisation define palliative care as: “an approach that is aimed at improving the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”[1]. For the head and neck cancer patient who presents with advanced, incurable or recurrent disease, the role of palliative therapy is vital to ensure both quality of life and quality of dying, with as far as possible a symptomless end of life. Current estimates are that 60% of patients with head and neck cancer present with stage I or II disease, and of those 40% presenting with advanced disease, 10% will have metastatic “incurable’ disease at presentation [2]. Furthermore, as five-year survival data for head and neck cancer approaches two thirds [3], it should be at the forefront of the head and neck surgeons mind that one third of patients will require some form of palliative care. This essay will discuss the impact of the specialist palliative multi-disciplinary team (MDT) upon the head and neck cancer patient, briefly describing non-oncological palliative care treatment modalities and their application by various members of the palliative MDT. Why the Need for Specialists in Palliative Care medicine and the MDT?

Review of orthognathic surgery and related papers published in the British Journal of Oral and Maxillofacial Surgery 2011-2012.

This review summarises all orthognathic and related papers published between January 2011 and December 2012 in the British Journal of Oral and Maxillofacial Surgery (BJOMS). A total of 36 articles were published, a high proportion of which (78%) were full-length papers. The remainder consisted of short communications and technical notes. The topics included operative planning and postoperative outcomes, and there was a strong focus on distraction osteogenesis. There were fewer orthognathic articles published in BJOMS than articles on other subspecialties such as trauma or head and neck oncology. Only 8 (29%) of the full-length articles were prospective studies or randomised trials, which highlights a need for well-designed clinical studies in orthognathic research.