Tools for Assessment of Communication Skills of Hospital Action Teams: A Systematic Review.

BACKGROUND: Hospital action teams comprise interdisciplinary health care providers working simultaneously to treat critically ill patients. Assessments designed to evaluate communication effectiveness or "nontechnical" performance of these teams are essential to minimize medical errors and improve team productivity. Although multiple communication tools are available, the characteristics and psychometric validity of these instruments have yet to be systematically compared. OBJECTIVE: To identify assessments used to evaluate the communication or "nontechnical" performance of hospital action teams and summarize evidence to develop and validate these instruments. METHOD: A literature search was conducted using MEDLINE/PubMed database to identify original articles related to assessment of communication skills in teams working in acute care medicine not exclusive to emergency room, operating room, prehospital air and ground transport, or code blue/rapid response resuscitations. RESULTS: Ten communication assessment tools were identified. Six tools (60%) were designed to measure communication performance of the whole team, whereas 4 tools (40%) were created to assess individual team member's communication skills. Regardless of the type of analysis, the most commonly assessed behavior domains were Leadership, Teamwork, Communication, and Situation awareness. Only 1 of 16 articles describing a particular communication assessment tool reported all the validation criteria, other authors underreported efforts to validate their instruments. CONCLUSION: A number of tools designed to measure the communication or "nontechnical" performance of hospital action teams are available. Unfortunately, limited reported validity evidence may hamper the utility of these tools in actual clinical practice until further validation studies are performed.

Distraction Osteogenesis for Surgical Treatment of Craniosynostosis: A Systematic Review.

BACKGROUND: Distraction osteogenesis has been proposed as an alternative to cranial remodeling surgery for craniosynostosis, but technique descriptions and outcome analyses are limited to small case series. This review summarizes operative characteristics and outcomes of distraction osteogenesis and presents data comparing distraction osteogenesis to cranial remodeling surgery. METHODS: A systematic review of the literature was undertaken. Descriptive analysis, operative technical data, outcomes, or postoperative complications of distraction osteogenesis for craniosynostosis were included. RESULTS: A total of 1325 citations were reviewed, yielding 53 articles and 880 children who underwent distraction osteogenesis for craniosynostosis. Distraction plates were used in 754 patients (86 percent), whereas springs were used for the remaining 126 patients (14 percent). Standard and spring distraction osteogenesis was reported to successfully treat the primary condition 98 percent of the time. Suboptimal results were reported in 11 patients (1.3 percent), and minor complications were reported in 19.5 percent of cases (n = 172).Major complications were rare, occurring in 3.5 percent of cases (n = 31), and included two reported deaths. Absolute operative times and blood loss were marginally greater for cranial remodeling surgery cases, but the differences were not statistically significant. CONCLUSIONS: Distraction osteogenesis is an effective cranial vault remodeling technique for treating craniosynostosis. No statistical differences were found with respect to operative time, blood loss, need for transfusion, or intensive care unit resources compared with cranial remodeling surgery. Outcome studies with longer follow-up periods specifically investigating cost, relapse, and reoperation rates are necessary to effectively compare this treatment modality as an alternative to cranial remodeling surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Educational video recording and editing for the hand surgeon.

Digital video recordings are increasingly used across various medical and surgical disciplines including hand surgery for documentation of patient care, resident education, scientific presentations, and publications. In recent years, the introduction of sophisticated computer hardware and software technology has simplified the process of digital video production and improved means of disseminating large digital data files. However, the creation of high-quality surgical video footage requires a basic understanding of key technical considerations, together with creativity and sound aesthetic judgment of the videographer. In this article we outline the practical steps involved in equipment preparation, video recording, editing, and archiving, as well as guidance for the choice of suitable hardware and software equipment.

Enhancing aesthetic outcomes of soft-tissue coverage of the hand.

Hand aesthetics in general and aesthetic refinements of soft-tissue coverage of the hand in particular have been increasingly considered over the past few years. Advancements of microsurgery together with the traditional methods of tissue transfer have expanded the number of techniques available to the reconstructive surgeon, thus shifting the reconstructive paradigm from simply "filling the defect" to reconstructive refinement to provide the best functional and aesthetic results. However, drawing the boundary between what does and what does not constitute "aesthetic" reconstruction of the hand is not straightforward. The selection among the vast amount of currently available reconstructive methods and the difficulties in objectively measuring or quantifying aesthetics have made this task complex and rather arbitrary. In this article, the authors divide the hand into several units and subunits to simplify the understanding of the basic functional and aesthetic requirements of these regions that may ultimately bring order to complexity.

The Importance of Hand Appearance as a Patient-Reported Outcome in Hand Surgery.

Hand appearance is meaningful to patients because hands are an essential part of human interactions, communication, and social integration. Recent literature indicates that hand aesthetics is an important, measurable patient-reported outcome. In hand surgery, several outcome instruments exist that accurately measure functional outcomes, but aesthetics is often overlooked or imprecisely measured. This makes comparison of disease burden and effectiveness of therapies, as they pertain to aesthetics, difficult. This special topic article outlines the aesthetic features of the hand, how literature is evaluating the appearance of the hand in outcomes research, and proposes a novel approach to assessing hand aesthetics.

Guyon canal: the evolution of clinical anatomy.

Guyon canal refers to the ulnar tunnel at the wrist named for the French surgeon Jean Casimir Félix Guyon, who described this space in 1861. After Guyon's description, clinicians have focused their interest on symptoms caused by compression of structures occupying this canal (later named ulnar tunnel syndrome or Guyon syndrome). However, disagreement and confusion persisted over the correct anatomical boundaries and terminology used to describe the ulnar tunnel. Through anatomical investigation and evolving clinical case studies, the current understanding of the anatomy of the ulnar tunnel was established. This article examines the evolution of the anatomical description of the ulnar tunnel and its relevant clinical associations and casts light on the life and contributions of Guyon.

Monteggia fracture dislocations: a historical review.

The eponym Monteggia fracture dislocation originally referred to a fracture of the shaft of the ulna accompanied by anterior dislocation of the radial head that was described by Giovanni Battista Monteggia of Italy in 1814. Subsequently, a further classification system based on the direction of the radial head dislocation and associated fractures of the radius and ulna was proposed by Jose Luis Bado of Uruguay in 1958. This article investigates the evolution of treatment, classification, and outcomes of the Monteggia injury and sheds light on the lives and contributions of Monteggia and Bado.

Local flaps of the hand.

A local flap consists of skin and subcutaneous tissue that is harvested from a site near a given defect while maintaining its intrinsic blood supply. Local skin flaps can be a used as a reliable source of soft tissue replacement that replaces like with like. Flaps are categorized based on composition, method of transfer, flap design, and blood supply, but flap circulation is considered the most critical factor for the flap survival. This article reviews the classification of local skin flaps of the hand and offers a practical reconstructive approach for several soft tissue defects of the hand and digits.

Dermal skin substitutes for upper limb reconstruction: current status, indications, and contraindications.

Dermal skin substitutes are a group of biologically engineered materials composed of collagen and glycosaminoglycans and are devoid of cellular structures. These biodegradable materials act as an artificial dermis to promote neovascularization and neodermis formation. Their applications in soft tissue reconstructions are rapidly expanding. In this article, the indications, advantages, and limitations of dermal skin substitutes for reconstruction of soft tissue defects of the upper extremity are reviewed.

Applying evidence in the care of patients with rheumatoid hand and wrist deformities.

The traditional approach in managing rheumatoid hand deformities is based on the individual surgeon's experiences. In the current era of evidence-based medicine, formulating treatment for the rheumatoid hand fits perfectly within the framework of evidence-based medicine by leveraging the best evidence from the literature, incorporating surgeons' experience and considering patients' preferences. In this Special Topic article, we use a case example to illustrate how evidence-based medicine can be practiced within the framework of treating rheumatoid hand deformities by distilling the best evidence from the literature to guide surgeons in a rational approach for treating this common condition.