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We established a series of exercises that evaluated surgeons' marking of excision margins, and we sought to identify factors influencing such marking.
Twenty-four participants were asked to draw preset margins (3, 4, 5, 8 or 10 mm) on a series of life-size images representing noncosmetically and cosmetically sensitive facial sites, and also to draw circles of set diameters (3, 5 and 8 mm) on white paper. Margins were measured with vernier callipers calibrated to 0.05 mm.
In the small margin (3 mm) and noncosmetically sensitive exercises, the mean margins drawn were greater than required. When a 10 mm margin was required in cosmetically sensitive areas and nonsensitive areas, the margin was consistently underestimated in the former group by all participants (p < 0.05).
Surgeons marking facial lesions for excision should use a measurement of scale, in order to eliminate the inherent tendency to underestimate the margin required for large excisions and for cosmetically sensitive areas.
The sino-nasal assessment questionnaire is a system used for scoring the symptoms of chronic rhinosinusitis. However, the range of scores for this questionnaire in the healthy adult population is unknown. We aimed to establish this by recruiting 100 healthy volunteers and comparing their sino-nasal assessment questionnaire scores with those of 100 individuals who had undergone sinus surgery for rhinosinusitis. The difference in mean scores in the symptomatic group (44.62) and the asymptomatic group (8.46) was statistically significant. However, there was substantial overlap between the scores of the two groups. Factors such as age, gender and smoking did not have a statistically significant impact on the eventual score in the asymptomatic group. We believe that symptom scores can only be used effectively when the range in the asymptomatic population is known. This is so that disease severity can be gauged in the context of the normal population and post-operative improvements can be forecast.
Thirty-two members of staff from the Ear, Nose and Throat Department at Warrington General Hospital were asked to estimate blood loss in commonly encountered epistaxis scenarios. Results showed that once the measured volume was above 100 ml, visual estimation became grossly inaccurate. Comparison of medical and non-medical staff showed under-estimation was more marked in the non-medical group. Comparison of doctors versus nurses showed no difference in estimation, and no difference was found between grades of staff.
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