Development, implementation and feedback for an online speciality membership examination in orthodontics during the COVID-19 pandemic.

Introduction The Royal College of Surgeons of England (RCSEng) and the Royal College of Physicians and Surgeons of Glasgow (RCPSG) offer the bi-collegiate Membership in Orthodontics (MOrth) examination, a summative assessment of specialist knowledge, skill and behaviour in orthodontics. The COVID-19 pandemic has had a profound global effect on almost every facet of normal life, including the conduct of face-to-face examinations. We highlight development, implementation and feedback for the bi-collegiate MOrth Part 2 examination delivered remotely to a cohort of candidates in September 2020 by RCSEng/RCPSG.Methods Two anonymised online surveys (Google Forms) were distributed via electronic mail following completion of the examination diet. Forty-two candidates were sent a survey covering four domains and comprising a total of 31 questions. The 20 examiners were sent a survey containing eight questions. In both surveys, free-text responses were also collected. A rating system was used to categorise responses. All survey responses were summarised in an online data collection sheet.Results The response rate was 78.5% (33/42) and 75% (15/20) for candidates and examiners, respectively. Overall, favourable responses in relation to all sections of the assessment were elicited from candidates with the majority (mean 79.8%; 75.8-81.9%) reporting that the online examination format worked well. Equally, favourable responses were reported by examiners. Notably, 80% of examiners felt that the online exam style did not affect the mark a candidate would receive, and 100% were confident that the marks the candidates received were a reflection of their ability and were not affected by the online delivery of the assessment.Conclusions The feedback from both candidates and examiners relating to an online remote assessment of the bi-collegiate MOrth Part 2 was generally positive. Based on the survey responses, this format of a high-stakes examination was acceptable to all stakeholders, and demonstrated a high level of perceived validity and reliability in terms of content.

Analyzing and Characterizing Why Men Seek Care for Lower Urinary Tract Symptoms.

PURPOSE OF REVIEW: The goal of this paper is to summarize existing literature on prevalence of lower urinary tract symptoms (LUTS) that may be attributed to benign prostatic hyperplasia (BPH, LUTS/BPH), factors associated with seeking treatment and treatment success, and subjective and objective methods of evaluating LUTS. RECENT FINDINGS: Men primarily seek treatment for LUTS/BPH because bother overcomes barriers to treatment. Factors such as severity, bother, or persistence of symptoms primarily motivate individuals to seek treatment, while low-symptom severity mainly leads individuals to not seek treatment. Among men that seek treatment, nocturia and storage symptoms predominate. LUTS are assessed with self-report questionnaires; subjective evaluations translate moderately well to objective measurements of LUTS severity. Current symptom classifications and patient groupings may be overly simplified and not evidence-based. Further studies evaluating novel symptom clusters and patient-centered BPH treatment approaches can guide future treatment.

Further Defining the 2012 Multi-Society Task Force Guidelines for Surveillance of High-risk Adenomas: Is a 3-Year Interval Needed for All Patients?

GOALS: We set out to determine whether variation from this 3-year follow-up interval was associated with the finding of subsequent high-risk adenoma (HRA). BACKGROUND: HRAs include the following: (1) an adenoma measuring ≥10 mm, (2) ≥3 adenomas found during a single procedure, and (3) an adenoma with high-grade dysplasia or villous architecture. The current Multi-Society Task Force guideline for timing of surveillance colonoscopy after removal of a HRA is 3 years. STUDY: In 2016, we analyzed 495 patients who had a HRA removed during a 2008 colonoscopy. We compared the frequency of finding another HRA at follow-up intervals. We used the current guidelines as our referent group and performed logistical regression to identify whether any patient characteristics, procedural factors, or type of HRA predicted the development of HRAs on follow-up colonoscopy. RESULTS: Individuals who followed-up at a median of 4.5 years did not have more HRA on follow-up compared with those who followed-up at 3 years (25.2% vs. 21.0%, P=0.062). These groups had similar baseline characteristics. Older individuals, male gender, having a history of polyps, and piecemeal resection of an HRA predicted future HRAs. The removal of ≥3 adenomas in 2008 as well as a combination of multiple, large, and advanced polyps showed a higher risk of future HRAs. CONCLUSIONS: The 2012 Multi-Society Task Force recommendation of 3-year follow-up after removal of HRAs may not apply to all patients. We showed that a combination of patient demographics, procedural factors, and pathology best determines the surveillance colonoscopy interval.

Metallurgical and Hydrogen Effects on the Small Punch Tested Mechanical Properties of PH-13-8Mo Stainless Steel.

PH13-8Mo is a precipitation hardened martensitic stainless steel, known for its high strength but also for its high sensitivity to hydrogen embrittlement. Small punch test, SPT (also referred to as the ball punch test, BPT), is a relatively simple and new technique to assess the mechanical properties of samples under biaxial loading conditions. The current study utilizes the unique loading conditions of SPT to investigate the mechanical behavior and fracture prior to and after the hydrogen charging of PH13-8Mo steel. The mechanical characteristics were investigated at different metallurgical conditions: solution and quenched (SQ); fully-aged (550 °C for 4 h) and over-aged (600 °C for 4 h). Samples were cathodically hydrogen charged in a 1 M H2SO4 solution containing NaAsO2 (0.125 mg/L) at 50 mA/cm² for different durations of 0.5 h, 2 h, and 19 h, and compared to the as-heat-treated condition. A fractographic examination was performed following the SPT measurements by scanning electron microscopy (SEM). Transmission electron microscopy (TEM) and x-ray diffraction (XRD) analyses were used as complementary characterization tools. It is shown that upon hydrogen charging, the SPT fracture mode changes from ductile to completely brittle with a transition of mixed mode cracking also affecting the SPT load-displacement curve.

Assessing non-technical skills on the delivery suite: a pilot study.

BACKGROUND: The importance of non-technical skills (NTS) is a growing area for training and assessment in medicine. Currently there is little formal assessment of these skills in obstetrics and gynaecology. CONTEXT: Non-technical Skills for Surgeons (NOTSS) is perhaps the most psychometrically robust tool for assessing individual NTS in the surgical environment. It has previously been evaluated in our specialty alongside objective structured assessments of technical skills, with promising results. INNOVATION: By removing rankings, NOTSS was adapted for use as a formative feedback tool. This article describes the subsequent Royal College of Obstetricians and Gynaecologists (RCOG) usability pilot of the adapted version of NOTSS in the real delivery suite environment using minimally trained assessors. Twenty-six trainee evaluations and 25 trainer evaluations were completed after 55 assessments. IMPLICATIONS: The number of assessments and evaluations completed was disappointing. However, NOTSS appears promising as a formative NTS assessment tool for use on the delivery suite. Overall satisfaction with NOTSS was high (an average score of 4.5 on a scale of 1-5 for trainers and trainees). Both trainers and trainees consider that it is accep and straightforward to deliver, and that the form takes an average of 10 minutes to complete, including time for feedback (range 5-20 min). There will be considerable challenges to achieving the successful implementation of the NOTSS tool, and its inclusion in the RCOG training matrix: primarily, in training those using it to recognise the behaviours under observation and to give feedback appropriately, and also engaging trainees, although they obviously appreciated the NOTSS process when used.

Objective Structured Assessment of Technical Skill in assessing technical competence to carry out caesarean section with increasing seniority.

Since the incorporation of workplace-based assessment within the specialty training programme in obstetrics and gynaecology, the assessment of technical competence to carry out caesarean section has been undertaken by the Objective Structured Assessment of Technical Skill tool. This requirement has been formalised in the Matrix of Educational Progression, ensuring that the tool must assess trainees' technical competence in caesarean section procedures of varying levels of complexity throughout training. Trainee feedback suggests that the effectiveness of the tool diminishes as the seniority of the trainee increases, with technical competence assessed less effectively in more complex procedures. This seems to be a result of the generic design of the tool and insufficient training on the part of assessors. Both of these are due to be addressed within a division of the Objective Structured Assessment of Technical Skill tool into explicitly formative and summative assessments of technical skill, following a General Medical Council-led consultation on the future of workplace-based assessment.

Full-thickness skin grafts: maximizing graft take using negative pressure dressings to prepare the graft bed.

BACKGROUND: Full thickness skin grafts (FTSGs) remain a good option for resurfacing defects of the face, neck, and dorsum of the feet. It results in soft, pliable, functional skin with minimal contraction. However, FTSG may result in patchy or irregular "take" resulting in recurrent contractures and pigmentary discrepancies. This study examines the use of a negative pressure dressing (NPD) to increase FTSG take. METHODS: Wounds resulting from trauma, postburn contracture release, and an excision of a congenital nevus were included in the study. The wounds were prepared by surgical excision or debridement. A NPD was then applied for a period of 7 days, at which time the wounds were inspected and, if there was sufficient granulation tissue, covered with a FTSG. If the wound had not yet granulated sufficiently another NPD was placed and reassessed in 7 days. The FTSGs were harvested from the groin and abdominal area exactly to the size of the defect. A sponge bolster dressing was then applied. The take of the FTSG was judged using a grid of 1 x 1-cm squares. The wounds were measured and the amount of graft take was calculated as a percentage of the wound size. Complications in both the wound as well as the donor sites were noted. RESULTS: Twenty-four patients were included in the study. The mean age was 6 years (range 1-14 years), including 9 burn contracture excisions, 14 road traffic accident-related injuries, and 1 excision of a congenital nevus. The site involved was the foot (6 patients), ankle (9 patients), axilla (2 patients), forearm (4 patients), face (2 patients), and the neck (1 patient). The average surface area of the defect was 78 cm2 (range 18-264 cm2). Groin skin was harvested in all the cases. The NPD was applied on average for 8 days (range 7-15 days). The mean graft take was 95% (range 70%-100%). Only 1 patient had significant graft loss of 30%. Donor site morbidity was low, attaining primary closure in all but 2. Mean follow-up was 9 months. CONCLUSION: The results of this study confirm that the use of NPD enhances FTSG take.

Choosing the superomedial pedicle for reduction mammaplasty in gigantomastia.

BACKGROUND: The optimal reduction technique for the treatment of macromastia greater than 1 kg remains controversial. Conventionally, breast amputation and free nipple grafting has been used, but this leaves a flat and insensate nipple. Anatomical studies have suggested the superomedial technique to be a safe choice in these patients. METHODS: A retrospective study analyzing the outcome of reduction mammaplasty for macromastia greater than 1 kg using the superomedial pedicle technique was performed. Data were collected over a 10-year period from 1995 to 2005. All reduction mammaplasty patients with resection weights greater than 1 kg per breast were included in the study. RESULTS: Sixty-one patients were included (122 breasts). The mean age was 29 years. The mean suprasternal notch to nipple distance was 35 cm on the left and 35 cm on the right, and the mean nipple to inframammary crease distance was 19 cm on the left and 20 cm on the right. The Wise keyhole reduction pattern technique was used for all patients. Mean follow-up was 12 months. The mean resection weight per breast was 1360 g for the left breast and 1398 g for the right breast. Fifteen different surgeons performed the operations over this period. All patients had viable nipples postoperatively; there was partial areola necrosis in eight breasts (6.5 percent), with only minor other complications, including T-junction breakdown in 22 breasts (18 percent) and dog-ear excisions. CONCLUSIONS: This study has confirmed the superomedial pedicle technique to be safe and reliable for resections greater than 1 kg.

A formula determining resection weights for reduction mammaplasty.

BACKGROUND: Reduction mammaplasty is a frequently performed plastic surgical procedure, yet preoperative assessment usually excludes an estimated resection weight. In this retrospective study, a formula was derived using regression analysis of routinely measured preoperative anthropomorphic measurements and intraoperative resection weights. METHODS: Data were collected from 214 consecutive breast reduction patients operated on at a tertiary referral center between January of 1993 and January of 2006. The operations were performed by 15 plastic surgeons using a variety of reduction pattern techniques. Four variables were recorded for each patient: notch to nipple distance, nipple to inframammary crease distance, body mass index, and age. Regression analysis was performed on the data to establish which preoperative measurements correlated most accurately with the resection weight. RESULTS: The following formula was established relating nipple to inframammary crease distance and notch to nipple distance measurement to the weight removed: Breast weight = (35.4 x notch to nipple distance + 60.66 x nipple to inframammary crease distance) - 1239.64. CONCLUSION: Use of this formula aids the surgeon with patient counseling, insurance company quotes, and intraoperatively in patients with asymmetry or those undergoing reconstruction, as a guide to resection weights.