Karl Payne

Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): a regional survey

BackgroundSmartphone usage has spread to many settings including that of healthcare with numerous potential and realised benefits. The ability to download custom-built software applications (apps) has created a new wealth of clinical resources available to healthcare staff, providing evidence-based decisional tools to reduce medical errors.Previous literature has examined how smartphones can be utilised by both medical student and doctor populations, to enhance educational and workplace activities, with the potential to improve overall patient care. However, this literature has not examined smartphone acceptance and patterns of medical app usage within the student and junior doctor populations.MethodsAn online survey of medical student and foundation level junior doctor cohorts was undertaken within one United Kingdom healthcare region. Participants were asked whether they owned a Smartphone and if they used apps on their Smartphones to support their education and practice activities. Frequency of use and type of app used was also investigated. Open response questions explored participants’ views on apps that were desired or recommended and the characteristics of apps that were useful.Results257 medical students and 131 junior doctors responded, equating to a response rate of 15.0% and 21.8% respectively. 79.0% (n=203/257) of medical students and 74.8% (n=98/131) of junior doctors owned a smartphone, with 56.6% (n=115/203) of students and 68.4% (n=67/98) of doctors owning an iPhone.The majority of students and doctors owned 1–5 medical related applications, with very few owning more than 10, and iPhone owners significantly more likely to own apps (Chi sq, p<0.001). Both populations showed similar trends of app usage of several times a day. Over 24hours apps were used for between 1–30 minutes for students and 1–20 minutes for doctors, students used disease diagnosis/management and drug reference apps, with doctors favouring clinical score/calculator apps.ConclusionsThis study found a high level of smartphone ownership and usage among medical students and junior doctors. Both groups endorse the development of more apps to support their education and clinical practice.

Tissue engineering technology and its possible applications in oral and maxillofacial surgery

Tissue engineering is a rapidly advancing discipline that combines the attributes of biochemical and biomaterial engineering with cell transplantation to create bio-artificial tissues and organs. For the oral and maxillofacial surgeon, the reconstruction of maxillofacial defects in hard and soft tissues is an ongoing challenge. While autologous grafts and vascularised free flaps are the current gold standard, they are not without complications at both the donor and reconstructed sites. Tissue engineering, which aims to create tissue-matched, prefabricated, prevascularised bony or soft tissue composite grafts, or both, therefore has the potential to revolutionise practice in maxillofacial surgery. We review the technology of tissue engineering and its current and future applications within the specialty, and discuss contemporary obstacles yet to be overcome.

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.

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

Open Access Publishing: A Study of Current Practice in Oral and Maxillofacial Surgery Research

IntroductionOpen access (OA) publication has become an increasingly common route for dissemination of scientific research findings. However, it remains a contentious issue with continued debate as to its impact on the peer-review process and a potential change in the quality of subsequent evidence published. There is little research that looks into OA in oral and maxillofacial surgery.MethodsWe investigated the OA policy in the 30 relevant journals listed in the Institute for Scientific Information Web of Knowledge journal citation report, comparing bibliometric data and quality of evidence produced in journals offering OA and those with subscription-only policies.Results3474 articles were graded for evidence level and the results correlated to journal OA status. 76.7 % of journals offered authors OA services. There was no difference between impact factor, self-citation rate, total citations or quality of evidence between OA and subscription journals.DiscussionThese findings should send clear messages to both clinicians and researchers and should re- assure readers that scientific findings that are disseminated in open access form do not differ in quality to those in subscription-only format. It should reinforce that open access formats are a credible way to display research findings in oral and maxillofacial surgery.

Implantable doppler signal distortion from a calcified arterial pedicle.

Dear Sir, We would like to present an interesting finding relating to signal distortion of an implantable Doppler in a well-perfused free-flap. A 69-yearold male underwent resection of metastatic squamous cell carcinoma skin deposits from the right parotid and upper cervical region. The patient had previously undergone local resection with a neck dissection and a course of chemo-radiotherapy. The defect was reconstructed using a right-sided fasciocutaneous anterolateral thigh (ALT) free-flap. The pedicle of the ALT flapwas raised in a standard fashion. Upon starting the anastomosis it was noted that the artery was calcified, with a rigid appearance and an obvious pale white color when compared to the donor artery (Figure 1). Despite these findings, a decision was made to proceed with the anastomosis. The anastomosis was performed with some difficulty due to the calcified vessel tissue, but was able to be completed using 7-0 microsutures instead of the normal 9-0microsutures. As the thinner 9-0 needle repeatedly deformed andwas unable to pierce the calcified vessel wall. Upon the completion of the anastomosis, a Cooke-Schwartz implantable Doppler probe was placed around the arterial pedicle. It was noted that the audio output was considerably different to that normally observed. Instead of the triphasic pedicle audio output, we observed a decidedly dampened monophasic output. This is a sound that we ordinarily associate with poor flow through the artery. At this point the venous outflow of the pedicle was low and the decision was taken to re-do the arterial anastomosis. Despite a second anastomosis and observation of better venous outflow, the dampened audio output remained. We reflected at the time that the change in signal must be a result of the vessel calcification as the flap appeared well-perfused and maintained ideal venous outflow, so we completed the procedure. The signal remained in that form in the immediate post-operative period, but despite this the flap was a long-term success. The phenomenon of calcification of the vascular pedicle after reconstruction has been well described (Myon, Ferri, Genty, & Raoul, 2012). However, we are unable to find a report that details the impact of existing vessel calcification on the anastomosis or post-operative monitoring. Research into the impact of arterial calcification on ultrasound signal has focused on coronary artery disease (Mintz, 2015). Within this field it is known that calcium is a reflector of ultrasound, causing an echodense acoustic shadow on imaging (Mintz, 2015). We believe this to be the mechanism whereby our Doppler signal was impeded, thus creating an altered dampened audio output. Our case highlights the fact that microvascular surgeons should be aware that whilst a calcified arterial pedicle could be successfully anastomosed, the presence of calcification will alter the implantable Doppler signal and thus may impact upon post-operative free-flap monitoring. As shown in this case, a change in the audio output from an implantable Doppler is not always associated with a failing flap and the reasons for a change in signal in a well-perfused flap should be noted.

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.