Onur Gilleard

Nasendoscopy: an analysis of measurement uncertainties.

Objective The purpose of this study was to analyze the optical characteristics of two different nasendoscopes used to assess velopharyngeal insufficiency and to quantify the measurement uncertainties that will occur in a typical set of clinical data. Design The magnification and barrel distortion associated with nasendoscopy was estimated by using computer software to analyze the apparent dimensions of a spatially calibrated test object at varying object-lens distances. In addition, a method of semiquantitative analysis of velopharyngeal closure using nasendoscopy and computer software is described. To calculate the reliability of this method, 10 nasendoscopy examinations were analyzed two times by three separate operators. The measure of intraoperator and interoperator agreement was evaluated using Pearsons r correlation coefficient. Results Over an object lens distance of 9 mm, magnification caused the visualized dimensions of the test object to increase by 80%. In addition, dimensions of objects visualized in the far-peripheral field of the nasendoscopic examinations appeared approximately 40% smaller than those visualized in the central field. Using computer software to analyze velopharyngeal closure, the mean correlation coefficient for intrarater reliability was .94 and for interrater reliability was .90. Conclusion Using a custom-designed apparatus, the effect object-lens distance has on the magnification of nasendoscopic images has been quantified. Barrel distortion has also been quantified and was found to be independent of object-lens distance. Using computer software to analyze clinical images, the intraoperator and interoperator correlation appears to show that ratio-metric measurements are reliable.

The influence of breast mound reconstruction type on nipple reconstruction projection

viscoelastic properties of human skin and even though expensive could help surgeons in predicting an N-IMF stretch. However our study has several confounding factors as variation of the skin tension due to variability of implant size, pregnancy or displacement of IMF. The stretching of the nipple to IMF distance is not entirely due to skin expansion, but at least partially due to lowering of this level during surgical intervention. This is a pilot study and cannot be used as a “guide to preoperative planning” due to the other variables that affect the N-IMF distance. Further studies are needed, especially studies with a control group, two-dimensional or three-dimensional measurements that provide more information, a multivariate analysis for considering confounding factors so as to obtain sound evidence concerning skin elasticity and N-IMF stretch. The continued monitoring of our patients over a longer period should confirm these results and encourage the use of the Cutometer in other centers that will promote multicentric data.

Venous thromboembolism prophylaxis for abdominal free tissue breast reconstruction: A multicenter survey

and does not account for the cost of inefficient use of haematology/transfusionservices. If thispracticewas takenupwidely (in centres with similar transfusion rates) significant savings couldbemade.Wehave sincechangedourpractice in-linewith our findings and we would encourage other departments to review their practice as a potential area for improving cost efficiency without any additional increase in risk.

New developments for the delivery of burns care research in the UK

Strategic planning, co-ordination of effort and appropriate funding are required for the progression of modern medical research [2]. At the moment however, it is difficult to ascertain the amount and nature of research being undertaken in burns care, who is conducting it and which organisations are funding it. This lack of information can lead to various inefficiencies, including the duplication and misdirection of effort. In the UK funding for research can be obtained from government bodies, professional and charitable organisations and industry. Through contacting various key organisations (British Association of Plastic Surgeons, British Burns Association, British Medical Association, Healing Foundation, Medical Research Council, National Institute for Health Research, Restoration of Appearance and Function Trust, Restore, Blond McIndoe Research Foundation, Royal College of Surgeons and the Wellcome Trust) we estimate that approximately £5 million has been allocated to burns research over the last 5 years. However without a centralised database detailing individual studies and the funding made available for them, it is difficult to determine how accurate and how comprehensive this estimate is. The following section outlines the recent major developments that have been put into place to help improve national research productivity and the roles of the various organisations supporting and funding burns care research. 2. Government bodies