Use of the Internet by patients attending hospital for oral and maxillofacial procedures

Information obtained on the Internet regarding medical procedures is largely unregulated and can be confusing. The aims of this study were to assess use of the Internet by patients attending hospital for oral and maxillofacial procedures, and to assess the quality of information provided at consultation. Data were collected prospectively using a confidential questionnaire, which was distributed to consecutive patients attending for elective operations at 2 oral and maxillofacial units: Crosshouse Hospital, Kilmarnock, and Queen Alexandra Hospital, Portsmouth (n = 100 at each unit). All the distributed questionnaires were returned. At both units, 95% of patients thought that discussion at the initial consultation was good or very good, and 84% at both units stated that they had access to the Internet. Internet access was consistently high among all age groups up to the age of 65, but in those aged over 65 it was considerably lower. A total of 22/84 patients (26%) at Crosshouse, and 14/84 (17%) at Queen Alexandra used the Internet to gain further information regarding their condition or procedure. All of those (n = 14) at Queen Alexandra, and 21/22 at Crosshouse had used Google to search for the information. Those who used the Internet to find information on their medical condition or procedure found it to be a useful resource, but they also stated that the information caused some concerns. With use of the Internet and access to it increasing we highlight the need for regulated and appropriate websites to which patients should be directed.     

The impact of COVID-19 on the provision of cardiac surgical services

The global pandemic caused by COVID-19 has had a significant global impact on healthcare systems. One implication of this pandemic is the cancellation of elective cardiac surgeries and the centralization of services. As a result, hospitals in Europe, North America, and the United Kingdom have had to alter the services offered to patients to be able to cope with service provision for COVID infected patients. Data should be collected during this period to provide a good insight following the lockdown period to understand the implication of such service alteration. Future research should also focus on the effects on long-term mortality and morbidity as well as financial implications on hospitals as a result of these changes.     

An unusual cause of heart failure in a young female: a case of massive left atrial mxyoma

Benign cardiac tumors are rare; they can present with nonspecific symptoms and represent a diagnostic challenge to the clinician. We describe an interesting case of a 26-year-old female who presented with a 6-month history of cough, breathlessness, palpitations, dizziness, and fever. Despite repeated clinical reviews in the community, diagnosis of cardiac tumor was not made until she developed decompensated cardiac failure with bilateral pleural effusions and pulmonary edema. Echocardiogram revealed an enormous left atrial mass that extended one-third into left ventricle during systole. The patient underwent successful surgical resection with histological confirmation of a benign atrial myxoma.     

New Strategies in Enhancing Spinal Fusion

HSS Journal ® - The biologic steps involved in creating a bony fusion between adjacent segments of the spine are a complex and highly coordinated series of events. There have been significant...     

The VITOM® exoscope in oculoplastic surgery: the 5 year Coventry experience

BackgroundIntraoperative imaging is a desirable tool in oculoplastic surgery; however, there are few modalities which allow surgeons to capture and edit the images in real time without compromising the sterility of the surgical field. We describe the set-up of the VITOM® exoscope system based on our 5 years’ experience of using it as an effective intraoperative video imaging and teaching modality for extraocular surgery.MethodsThe VITOM® is a specially designed exoscope mounted onto a versatile mechanical arm. It is attached to a high definition (HD) digital camera displayed on the HD video monitor of a standard endoscopy stack. This technology has been utilised in other surgical subspecialties, but there is no documented use within extraocular surgery.ResultsThe exoscope was simple to set-up and allowed real-time recording and editing with an HD image display system. The theatre team were able to view the precise surgical steps, contributing to improved theatre flow. Trainees reported that the VITOM® images significantly improved their visualisation and understanding of key surgical anatomy and steps.ConclusionsOur experience showed that the VITOM® exoscope is an excellent intraoperative video imaging and teaching aid, as it allows real-time capture and editing of open surgery and seems to improve theatre flow. With newer models using 3D stereoscopic vision, it could be further evaluated as a heads-up viewing system within extraocular and oculoplastic surgery.Subject terms: Education, Medical imaging     

Advancing the Neurophysiological Understanding of Delirium

Delirium is a common problem associated with substantial morbidity and increased mortality. However, the brain dysfunction that leads some individuals to develop delirium in response to stressors is unclear. In this article, we briefly review the neurophysiologic literature characterizing the changes in brain function that occur in delirium, and in other cognitive disorders such as Alzheimer's disease. Based on this literature, we propose a conceptual model for delirium. We propose that delirium results from a breakdown of brain function in individuals with impairments in brain connectivity and brain plasticity exposed to a stressor. The validity of this conceptual model can be tested using Transcranial Magnetic Stimulation in combination with Electroencephalography, and, if accurate, could lead to the development of biomarkers for delirium risk in individual patients. This model could also be used to guide interventions to decrease the risk of cerebral dysfunction in patients preoperatively, and facilitate recovery in patients during or after an episode of delirium.