Long-Term Adherence to Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnoea Set Up in a Complete Remote Pathway: A Single-Centre Service Evaluation Project.

Background: Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnoea (OSA). Maintaining adherence to CPAP in the long term is a clinical problem, and numerous factors have been identified that impact adherence. Although fully remote diagnostic and CPAP services were frequently utilised during the COVID-19 pandemic for patients with OSA, long-term adherence data have not been published. The aim of this service evaluation project was to describe the long-term adherence to CPAP. We also analysed factors that are associated with it. Methods: two-hundred and eighty patients diagnosed with OSA and set up on CPAP remotely during the first wave of the COVID-19 pandemic as part of routine clinical practice were analysed. Results: One-hundred and seven patients (38%) were fully adherent to CPAP at 24 months, determined by at least 4 h of usage on at least 70% of the days. Of the factors analysed, body mass index, disease severity, driving status and the presence of depression were related to long-term adherence (all p < 0.05). Conclusions: with the likelihood of future pandemics similar to COVID-19, our data provide evidence that fully remote pathways for management of patients with OSA can be designed and be sustainable with good long-term adherence.

Ethnic and Sex Diversity in Academic Plastic Surgery: A Cross-sectional Study.

Ethnic, racial, and sex disparities continue to persist in medicine despite efforts to diversify the profession. In competitive surgical specialties such as plastic surgery, those disparities are particularly pronounced. This study aims to evaluate racial, ethnic, and sex diversity in academic plastic surgery. Methods: We compiled a list of major plastic surgery professional societies, plastic surgery journal editorial boards, and plastic surgery accreditation boards to evaluate ethnic and sex diversity in society, research, and accreditation domains, respectively. Demographic data were collected and analyzed using the Mann-Whitney U test and the Kruskal-Wallis test. Results: White individuals are significantly overrepresented across the professional and research domains, and Asian individuals are overrepresented in the professional domain when compared to non-white races. White individuals make up a total of 74% of the society domain, 67% of the research domain, and 86% of the accreditation domain when compared to all non-white surgeons. Male surgeons made up 79% of the society domain, 83% of the research domain, and 77% of the accreditation domain when compared to all non-male surgeons. Conclusions: Ethnic, racial, and sex disparities persist in academic plastic surgery. This study, which looked at societies, editorial boards, and accreditation boards, demonstrated a persistent ethnic, racial, and sex homogeneity among leadership. Changes are required to continue to diversify the field and provide women and underrepresented minorities the tools needed to succeed.

A Scoping Review of Mobile Apps in Plastic Surgery: Patient Care, Trainee Education, and Professional Development.

Over the past 10 years, smartphones have become ubiquitous, and mobile apps serve a seemingly endless number of functions in our everyday lives. These functions have entered the realm of plastic surgery, impacting patient care, education, and delivery of services. This article reviews the current uses of plastic surgery mobile apps, app awareness within the plastic surgery community, and the ethical issues surrounding their use in patient care. Methods: A scoping review of electronically available literature within PubMed, Embase, and Scopus databases was conducted in two waves in November and May 2022. Publications discussing mobile application use in plastic surgery were screened for inclusion. Results: Of the 80 nonduplicate publications retrieved, 20 satisfied the inclusion criteria. Articles acquired from the references of these publications were reviewed and summarized when relevant. The average American Society of Plastic Surgeons evidence rating of the publications was 4.2. Applications could be categorized broadly into three categories: patient care and surgical applications, professional development and education, and marketing and practice development. Conclusions: Mobile apps related to plastic surgery have become an abundant resource for patients, attending surgeons, and trainees. Many help bridge gaps in patient care and surgeon-patient communication, and facilitate marketing and practice development. Others make educational content more accessible to trainees and performance assessment more efficient and equitable. The extent of their impact on patient decision-making and expectations has not been completely elucidated.

Outcomes of Lymphovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review.

Lymphovenous anastomosis (LVA) is a microsurgical treatment for lymphedema of the lower extremity (LEL). This study systematically reviews the most recent data on outcomes of various LVA techniques for LEL in diverse patients. Methods: A comprehensive literature search was conducted in the Ovid MEDLINE, Ovid EMBASE, and Scopus databases to extract articles published through June 2021. Studies reporting data on objective postoperative improvement in lymphedema and/or subjective improvement in quality of life for patients with LEL were included. Extracted data comprised demographics, number of patients and lower limbs, duration of symptoms before LVA, surgical technique, duration of follow-up, and objective and subjective outcomes. Results: A total of 303 articles were identified and evaluated, of which 74 were ultimately deemed eligible for inclusion in this study, representing 6260 patients and 2554 lower limbs. The average patient age ranged from 22.6 to 76.14 years. The duration of lymphedema before LVA ranged from 12 months to 11.4 years. Objective rates of improvement in lymphedema ranged from 23.3% to 100%, with the greatest degree of improvement seen in patients with early-stage LEL. Conclusions: LVA is a safe and effective technique for the treatment of LEL of all stages. Several emerging techniques and variations may lead to improved patient outcomes.

Orthopedics and US Politics: Trends in Political Donations by Orthopedic Surgeons.

The political climate surrounding health care policy in the United States has become increasingly controversial over the past two decades. Policies influencing the provision and administration of health care have provoked more political activism among physician stakeholders. Herein we describe the trends in political donations made by US orthopedic surgeons from 2003 to 2020. Political donation data from 2003 to 2020 were obtained from the Federal Election Commission website. Contributions were filtered by occupation matching either "orthopedic surgeon" or "orthopaedic surgeon." Individual contributions were assigned to a beneficiary committee associated with a political party and used to classify donations as Independent, Republican, or Democratic. A total of 71,492 donations amounting to $30,930,242 were made by orthopedic surgeons between 2003 and 2020. The number of donations increased from 1368 in 2003 to 14,961 in 2020, with Independent committees averaging 68.4% of donations over the 18-year period. From 2003 to 2020, monies donated to Independent committees decreased from 71% to 34%, Republican donations increased from 23% to 55%, and Democratic donations increased from 6% to 11%. When stratified by state, orthopedic surgeon contributions favored Independent committees. There has been an increase in political involvement among US orthopedic surgeons in the past 18 years. Contributions to Independent committees were the most common; however, most donations were allocated to the American Academy of Orthopaedic Surgeons Independent political action committee, which has traditionally supported Republican candidates. Contributions became partisan in 2020 in favor of Republican committees. [Orthopedics. 2022;45(3):134-138.].

Surgical Management of Chronic Encapsulated Abdominal Wall Seroma 8 Years after Abdominoplasty.

Seroma is a common complication of body-contouring surgery. Current literature focuses on prevention or initial management of seroma formation; however, no definitive evidence exists to guide management of chronic or recurrent seromas. We describe a case of a recurrent abdominal wall seroma following abdominoplasty. The seroma was present for 8 years despite employing multiple treatment modalities. After presentation to our clinic, the patient was taken to the operating room, where the seroma pseudocapsule was excised, progressive tension sutures were utilized, and drains were placed. To date, there has been no recurrence of the seroma. We propose that chronicity, recurrence, and persistence of seroma are indications for surgical intervention.