The Africa Temporal Scalp Flap: A Novel Flap for Facial Reconstruction.

Although a number of flaps exist for nasal reconstruction, severe scarring of the forehead after burn injury led to the development of a novel two-stage flap based on the superficial temporal artery. The Africa Temporal Scalp (ATS) flap is composed of an axial ascending part on the superficial temporal artery, and a descending anterior extension for reconstruction of the midface. This is a retrospective analysis of all patients who underwent ATS flap surgery on the MV Africa Mercy. During the 7.5-year period, the ATS flap was applied to 45 facial reconstructions, with a median age of 28 years (range 19 months to 51 years). The main indications were previous burn injury (n = 27, 60%) and noma (n = 15, 33.3%). The majority of the flaps were used to reconstruct the lower third of the nose (n = 39, 86.7%), and the remaining six were for the lips or cheek. Experience allowed for earlier division than 3 weeks depending on the length of the flap, and the recipient site. There was one partial flap loss, one infection requiring revision, and two injuries to frontal branch of the facial nerve. The ATS flap is a novel two-stage flap that has proved especially versatile when forehead flaps are unavailable for nasal reconstruction due to extensive forehead scarring. The ATS flap reliably provides ample supple skin, and the donor site is effectively obscured from view, located in the periphery of the face.

Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta-analysis.

OBJECTIVE: Current data on the role of the umbilical cord in pregnancy complications are conflicting; estimates of the proportion of stillbirths due to cord problems range from 3.4 to 26.7%. A systematic review and meta-analysis were undertaken to determine which umbilical cord abnormalities are associated with stillbirth and related adverse pregnancy outcomes. METHODS: MEDLINE, EMBASE, CINAHL and Google Scholar were searched from 1960 to present day. Reference lists of included studies and grey literature were also searched. Cohort, cross-sectional, or case-control studies of singleton pregnancies after 20 weeks' gestation that reported the frequency of umbilical cord characteristics or cord abnormalities and their relationship to stillbirth or other adverse outcomes were included. Quality of included studies was assessed using NIH quality assessment tools. Analyses were performed in STATA. RESULTS: This review included 145 studies. Nuchal cords were present in 22% of births (95% CI 19, 25); multiple loops of cord were present in 4% (95% CI 3, 5) and true knots of the cord in 1% (95% CI 0, 1) of births. There was no evidence for an association between stillbirth and any nuchal cord (OR 1.11, 95% CI 0.62, 1.98). Comparing multiple loops of nuchal cord to single loops or no loop gave an OR of 2.36 (95% CI 0.99, 5.62). We were not able to look at the effect of tight or loose nuchal loops. The likelihood of stillbirth was significantly higher with a true cord knot (OR 4.65, 95% CI 2.09, 10.37). CONCLUSIONS: True umbilical cord knots are associated with increased risk of stillbirth; the incidence of stillbirth is higher with multiple nuchal loops compared to single nuchal cords. No studies reported the combined effects of multiple umbilical cord abnormalities. Our analyses suggest specific avenues for future research.

The value of SPaCE in delivering patient feedback.

BACKGROUND: The use of simulated patients (SPs) within undergraduate medical curricula is an established and valued learning opportunity. Within the context of simulation, it is imperative to capture feedback from all participants within the simulation activity. The Simulated Patient Candidate Evaluation (SPaCE) tool was developed to deliver SP feedback following a simulation activity. SpaCE is a closed feedback tool that allows SPs to rate a student's performance, using a five-point Likert scale, in three domains: attitude; interaction skills; and management. This research study examined the value of the SPaCE tool and how it contributes to the overall feedback that a student receives. METHODS: Classical test theory was used to determine the reliability of the SPaCE tool. An evaluation of all SP responses was conducted to observe trends in scoring patterns for each question. Qualitative data were collected via a free-text questionnaire and subsequent focus group discussion. It is imperative to capture feedback from all participants within the simulation activity RESULTS: Classical test theory determined that the SPaCE tool had a reliability co-efficient of 0.89. A total of 13 SPs replied to the questionnaire. A thematic analysis of all questionnaire data identified that the SPaCE tool provides a structure that allows patient feedback to be given effectively following a simulation activity. These themes were discussed further with six SPs who attended the subsequent focus group session. DISCUSSION: The SPaCE tool has been shown to be a reliable closed feedback tool that allows SPs to discriminate between students, based on their performance. The next stage in the development of the SPaCE tool is to test the wider applicability of this feedback tool.