What are we measuring? A critique of range of motion methods currently in use for Dupuytren's disease and recommendations for practice

Background: Range of motion is the most frequently reported measure used in practice to evaluate outcomes. A goniometer is the most reliable tool to assess range of motion yet, the lack of consistency in reporting prevents comparison between studies. The aim of this study is to identify how range of motion is currently assessed and reported in Dupuytren’s disease literature. Following analysis recommendations for practice will be made to enable consistency in future studies for comparability. This paper highlights the variation in range of motion reporting in Dupuytren’s disease. Methods: A Participants, Intervention, Comparison, Outcomes and Study design format was used for the search strategy and search terms. Surgery, needle fasciotomy or collagenase injection for primary or recurrent Dupuytren’s disease in adults were included if outcomes were monitored using range of motion to record change. A literature search was performed in May 2013 using subject heading and free-text terms to also capture electronic publications ahead of print. In total 638 publications were identified and following screening 90 articles met the inclusion criteria. Data was extracted and entered onto a spreadsheet for analysis. A thematic analysis was carried out to establish any duplication, resulting in the final range of motion measures identified. Results: Range of motion measurement lacked clarity, with goniometry reportedly used in only 43 of the 90 studies, 16 stated the use of a range of motion protocol. A total of 24 different descriptors were identified describing range of motion in the 90 studies. While some studies reported active range of motion, others reported passive or were unclear. Eight of the 24 categories were identified through thematic analysis as possibly describing the same measure, ‘lack of joint extension’ and accounted for the most frequently used. Conclusions: Published studies lacked clarity in reporting range of motion, preventing data comparison and meta-analysis. Percentage change lacks context and without access to raw data, does not allow direct comparison of baseline characteristics. A clear description of what is being measured within each study was required. It is recommended that range of motion measuring and reporting for Dupuytren’s disease requires consistency to address issues that fall into 3 main categories:- Definition of terms Protocol statement Outcome reportin

ESPRAS Survey on Continuing Education in Plastic, Reconstructive and Aesthetic Surgery in Europe

Background Specialty training in plastic, reconstructive and aesthetic surgery is a prerequisite for safe and effective provision of care. The aim of this study was to assess and portray similarities and differences in the continuing education and specialization in plastic surgery in Europe. Material and Methods A detailed questionnaire was designed and distributed utilizing an online survey administration software. Questions addressed core items regarding continuing education and specialization in plastic surgery in Europe. Participants were addressed directly via the European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). All participants had detailed knowledge of the organization and management of plastic surgical training in their respective country. Results The survey was completed by 29 participants from 23 European countries. During specialization, plastic surgeons in Europe are trained in advanced tissue transfer and repair and aesthetic principles in all parts of the human body and within several subspecialties. Moreover, rotations in intensive as well as emergency care are compulsory in most European countries. Board certification is only provided for surgeons who have had multiple years of training regulated by a national board, who provide evidence of individually performed operative procedures in several anatomical regions and subspecialties, and who pass a final oral and/or written examination. Conclusion Board certified plastic surgeons meet the highest degree of qualification, are trained in all parts of the body and in the management of complications. The standard of continuing education and qualification of European plastic surgeons is high, providing an excellent level of plastic surgical care throughout Europe

Outcomes of Early Correction of Congenital Myogenic Ptosis Using Transconjunctival Levator Plication

Introduction: Early correction of congenital ptosis may be indicated due to a risk of amblyopia or because of an abnormal head tilt. One of the main problems, of planning ptosis surgery in very young children, is the inability to measure the levator function. Aim: The aim of the article was to analyze the early correction of congenital myogenic ptosis. Methods: This was a retrospective, interventional, case series study, conducted on 12 eyes of 12 patients with unilateral, mild to moderate, congenital myogenic ptosis. Surgical correction of ptosis was performed by transconjunctival levator muscle plication. Pre- and postoperative measurements of the upper lid margin to central corneal reflex (MRD1) and upper lid skin crease height (UEC) were obtained, as well as the presence or absence of a reaction to topically applied phenylephrine 2.5% solution. Results: The mean age of the patients was 29.83 months (range 14-45 months). A negative phenylephrine test was noted in only 3 (25%) of cases. Equalization of upper lid height was achieved in 6 (50%), and a hypocorrection of up to 1 mm was noted in 4 (33%) of patients. There was only 1 hypercorrection of 1 mm, noted in the first postoperative month. In one case of hypocorrection of 2 mm, the height of the lid dropped between the 1 and 3 months follow up. Subsequent revision surgery was performed, with a good outcome. With regard to the upper lid skin crease height (UEC), the mean preoperative difference in relation to the contralateral (non-operated) lid, was 2.16 mm, whereas the average postoperative or final difference was 0.41 mm. Conclusion: Correction of myogenic ptosis in small children, using transconjunctival levator plication, in whom levator function cannot be measured, may have a satisfactory postoperative outcome

CURRICULUM DESIGN AND INNOVATION IN FIELD-BASED LEARNING: LESSONS FROM THE DOCTORAL PROGRAM IN LEADERSHIP AND SYSTEMIC INNOVATION IN ARGENTINA

12th International Technology, Education and Development Conference, 5-7 March, Valencia, SpainWirtschaf

ESPRAS Survey on Breast Reconstruction in Europe

Zusammenfassun