Correlation between clinical outcomes and patients' satisfaction using tarsoconjunctival - Hughes flap for the reconstruction of eyelid defects

Aim To examine and quantify patients' satisfaction and correlate with the objective clinical presentation after the treatment and to present a comprehensive literature review on tarsoconjunctival/ Hughes flap technique. Methods A review of more than 159 peer-review articles and a combined retrospective-prospective two-centres case series of 17 patients who underwent a two-stage modified Hughes flap procedure (2019-2021) to repair a lower eyelid defect caused by epithelial cancer was conducted. All patients were followed up for a minimum of six months. Patient macroscopic evaluation of redness, lid position, retraction, trichiasis, conjunctival overgrowth, tissue inflammation/infection and hypertrophic scarring were obtained, and findings were graded on a scale of 1 to 5 or binary YES/NO scale. Patients' satisfaction using a Likert-type scale and correlation with the clinical presentation were analysed. Results Pearson correlation coefficient between patients' satisfaction and clinical presentation was 0.534. Out of 510 (the highest summed score for patients' satisfaction), the total score was 479 (93.9%); out of 187 (the highest summed score for clinical presentation), the total score was 162 (86.6%). Although both scores were high, a lower correlation coefficient and the higher satisfaction score can be explained by more realistic expectations in oncological patients compared to cosmetic ones. Conclusion Hughes flaps provide multiple benefits in the reconstruction of selected patients with large defects, especially when poor wound healing is expected, or when local advancement flaps do not provide tension-free reconstruction. The rate of complications is low and manageable, whereas additional therapy is usually observational or symptomatic.

Facilitatory Effect of Extending the Course Duration on Dissemination of Educational Content

The physiological practice course at Saitama Medical University provides students with the opportunity to learn physiological principles through wet labs and discussions. To develop a more effective method for maximizing learning outcomes, we extended the course's schedule from one day (1d) to two days (2d) per theme, evaluated self-administered questionnaires between two different years (pre and post-change), and examined whether the increased course length affected learning outcomes. Within the 2018 curriculum year, every theme of the course was completed in a day, including experiments in the wet lab and discussions. In 2019, each theme was assessed for two days. The second-year undergraduate medical students anonymously submitted the self-assessment questionnaire that addressed several aspects, such as understanding of the theme, through a 5-point Likert scale. The average Likert scores varied from 4 to 4.5 point for all questions, and significant differences were not found between the 1d and 2d courses. However, the ratio of students with the highest points increased for one question of the 2d course: 43.6% (1d) to 53.4% (2d) for understanding. Further, the standard deviation (SD) values decreased in the 2d course for every question: 0.29 (1d) to 0.15 (2d) for interest, 0.33 (1d) to 0.19 (2d) for understanding, 0.30 (d) to 0.17 (d) for communication, 0.34 (1d) to 0.19 (2d) for general evaluation. This reduction in the SD values indicated that the educational content was imparted more efficiently to students in the 2d course. Thus, we concluded that extending the course time facilitated dissemination of educational content for every theme.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01563-4.

Management of Radiologically Indeterminate Magnetic Resonance Imaging Signals in Men at Risk of Prostate Cancer

BACKGROUND

Multiparametric magnetic resonance imaging (mp-MRI) is becoming an increasingly important diagnostic tool for prostate cancer. So far there has been little focus on management for indeterminate mp-MRI results.

OBJECTIVE

To describe outcomes for a cohort of men rated as having an indeterminate mp-MRI result.

DESIGN, SETTING, AND PARTICIPANTS

Patients were identified retrospectively from a single UK centre between October 2010 and January 2015. Patients were included if they had a Likert score of 3/5 on a first MRI scan without any prior prostate biopsy. Patients were offered one of two initial management strategies. Strategy 1 was an immediate targeted biopsy of the MRI lesion. Strategy 2 was a surveillance process comprising prostate-specific antigen monitoring and/or mp-MRI at intervals of 6-12 mo, with biopsy on a for-cause basis.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Cancer detection and treatment outcomes were compared for the two strategies.

RESULTS AND LIMITATIONS

Of 168 patients, 73 (43%) chose strategy 1 and 95 (57%) chose strategy two. The overall proportion of men with clinically significant cancer detected was 14% (23/168). The risk profile for cancer identified in the initial surveillance group was similar to that identified in the immediate biopsy group. Limitations of the study include the short follow-up.

CONCLUSIONS

Men with indeterminate mp-MRI were willing to forego immediate biopsy for a strategy of surveillance involving PSA measurement and/or mp-MRI repeated at intervals. The risk profile of the cancers identified by both strategies appeared similar, but many men in the surveillance group avoided the risks, complications, and costs of biopsy. Long-term results are awaited.

PATIENT SUMMARY

This report compares two approaches for an uncertain magnetic resonance imaging result for clinically important prostate cancer: immediate biopsy versus surveillance with delayed biopsy if required. Delayed biopsy did not result in identification of cancer with adverse features, and many men benefited from avoiding a biopsy and its complications.