A Systematic Review of Smartphone Applications for Plastic Surgery Providers: Target Audience, Uses, and Cost

A microscope in your pocket: can smartphones be used to perform microsurgery?

PURPOSE

To evaluate the use of the latest generation smartphone camera in performing arterial microanastomosis in rats.

METHODS

Ten Wistar rats were divided into 2 groups and underwent anastomosis of the right carotid artery with the aid of magnification from a microscope (group M) and a smartphone camera (group S), to compare patency in 72 hours, as well as to measure the weight of the animals, diameter of the carotid arteries and anastomosis time.

RESULTS

There was no statistical difference between the weight of the animals or the diameter of the carotid arteries. There was a statistical difference for the time spent on anastomoses, which was greater in group S, with higher rates of thrombosis (p < 0.05).

CONCLUSIONS

Although our patency and anastomosis time results were statistically lower in the smartphone group, there was success in some cases. As the segment continues to progress, it is likely that the results will improve in line with the evolution of camera technology.

Temporal trends in burn size estimation and the impact of the NSW Trauma App on estimation accuracy

BACKGROUND

Several studies demonstrated that burn size calculations by referring clinicians are poor. The purpose of this study was to determine if inaccuracies in burn size estimation have improved with time within the same population, and whether widespread roll-out of a smartphone-based TBSA calculator (in the form of the NSW Trauma App) had an impact on accuracy.

METHODS

A review of all burn-injured adult patients transferred to Burn Units from August 2015, following the roll out of the NSW Trauma App, to January 2021 was performed. The TBSA determined by the referring centre was compared with the TBSA calculated by the Burn Unit. This was compared to historical data from the same population between January 2009 and August 2013.

RESULTS

There were 767 adult burn-injured patients transferred to a Burn Unit between 2015 and 2021. The median overall TBSA was 7%. There were 290 patients (37.9%) who had equivalent TBSA calculations by the referring hospital and the Burn Unit. This was a significant improvement compared to the preceding time period (P < 0.005). Overestimation by the referring hospital occurred in 364 cases (47.5%), which was significantly reduced compared to 2009 - 2013 (P < 0.001). Unlike the earlier time period where changes in estimation accuracy were seen in relation to increasing time after the burn injury, burn size estimation accuracy remained relatively consistent in the contemporary time period with no significant change observed (P = 0.86).

CONCLUSIONS

This cumulative, longitudinal study of nearly 1500 adult burn-injured patients over 13 years demonstrates improvements in burn size estimation by referring clinicians over time. It is the largest cohort of patients analysed with respect to burn size estimation and is the first to demonstrate improvements in accuracy of TBSA in association with a smartphone-based app. Adopting this simple strategy into burn retrieval systems will augment early assessment of these injuries and improve outcomes.

A Scoping Review of Mobile Apps in Plastic Surgery: Patient Care, Trainee Education, and Professional Development

Over the past 10 years, smartphones have become ubiquitous, and mobile apps serve a seemingly endless number of functions in our everyday lives. These functions have entered the realm of plastic surgery, impacting patient care, education, and delivery of services. This article reviews the current uses of plastic surgery mobile apps, app awareness within the plastic surgery community, and the ethical issues surrounding their use in patient care.

Methods

A scoping review of electronically available literature within PubMed, Embase, and Scopus databases was conducted in two waves in November and May 2022. Publications discussing mobile application use in plastic surgery were screened for inclusion.

Results

Of the 80 nonduplicate publications retrieved, 20 satisfied the inclusion criteria. Articles acquired from the references of these publications were reviewed and summarized when relevant. The average American Society of Plastic Surgeons evidence rating of the publications was 4.2. Applications could be categorized broadly into three categories: patient care and surgical applications, professional development and education, and marketing and practice development.

Conclusions

Mobile apps related to plastic surgery have become an abundant resource for patients, attending surgeons, and trainees. Many help bridge gaps in patient care and surgeon-patient communication, and facilitate marketing and practice development. Others make educational content more accessible to trainees and performance assessment more efficient and equitable. The extent of their impact on patient decision-making and expectations has not been completely elucidated.

The use of smartphone-application based medical photography for open fractures: A national survey of orthoplastic affiliated Major Trauma Centres in England

INTRODUCTION

BAPRAS/BOAST 4 guidelines recommend the use of medical photography for peri-operative management of open fractures. Smartphones are a common commodity for the modern day plastic surgeon and there is evidence their utilization improves guideline compliance at Major Trauma Centres (MTCs).

AIM

To capture national data assessing the prevalence and intricacies of smartphone app-based photography systems used for open fractures in plastic surgery units at MTCs in England.

METHOD

A structured questionnaire survey was used to collate and analyze the responses of plastic surgeons and trainees at all MTCs in England. The survey included participant demographics, type and use of medical photography systems, and opinions on the usefulness of integrating a dedicated app in practice. We later explore the background, costs, download process, functionality and NHS governance applicability of each application.

RESULTS

The most popular clinical imaging modalities included professional photographers (65%) and departmental cameras (60%). Only 6 (26%) of MTCs use the following four smartphone app-based photography systems: Oxford University Hospital FotoApp, Medical Data Solutions and Services, Haiku and Secure Clinical Image Transfer. All systems are GDPR compliant and three systems auto upload images onto hospital databases. Five units report using messaging apps (Forward, Siilo, Whatsapp) with photography functionality. All participants agreed that a dedicated imaging smartphone app would be useful in open fracture management.

CONCLUSION

Plastic surgery is a highly visual specialty and clinical photography complements patient care. In the era of COVID-19 where resources are finite and professional photography not always available, this national survey highlights a demand for integrating smartphone app-based photography to improve guideline compliance, inter- and intra-disciplinary team communication and patient care.

Smartphone applications (apps) in general surgical practice: An insight into their reliability and usefulness

Objective: In today’s day and age with the advent of smartphones along with the handy apps available for download, there is increasing opportunities for surgeons to integrate such technology into clinical practice with great ease. This study aims to provide a systematic classification of apps in order to provide dependable data for choosing the right app by both surgeons and trainees.

Material and Methods: A series of methodical searches were carried out on “Google Play Store” and “Apple’s App Store” with pre-decided keywords. The results were then sorted and segregated into relevant categories like core surgery, apps related to surgical practice, patient utility apps and other surgical branches. Thereafter, the apps that met with our cut-offs, were assessed for their credibility and utility, based on predefined parameters.

Results: There were a lot of variations in between the categories we segregated the apps into. Using predefined cutoff criteria, (rating >3 and reviews >30), 48 of the apps were assessed finally for their utility and credibility. Out of these 48 apps, 42 were on android platform while the remaining 6 were on iOS. Ten apps were found to be having high credibility and 15 apps have high utility.

Conclusion: The role of smartphone apps in surgery and surgical training appears highly promising and using apps with high credibility and utility will provide dependable and updated information for the surgeons and trainees.

Regulation and validation of smartphone applications in plastic surgery: It's the Wild West out there

BACKGROUND AND PURPOSE

The use of smartphone applications is ubiquitous within healthcare. Over recent years there have been multiple applications developed within the field of plastic surgery. In the UK, applications with a medical purpose should be registered with the Medicines and Healthcare products Regulatory Authority (MHRA) as a medical device. The aim of this study was to evaluate plastic surgery specific smartphone applications designed for healthcare professional usage, and determine what proportion meet the criteria of a medical device and are suitably certified.

METHODS

A systematic review of the Apple and Google Play App stores was carried out using search terms relevant to plastic surgery. Data was extracted from the app store listing, developer website and the contents of each application. Each application was evaluated against the criteria given by the MHRA to determine whether it constituted a medical device.

RESULTS

215 applications for plastic surgery healthcare professionals were identified, of which 22 met the definition of a medical device. Only 14% (n = 3) of these applications were appropriately certified, 14% (n = 3) were validated in peer-reviewed literature and 45% (n = 10) had documented medical professional involvement.

CONCLUSION

Most applications with a medical purpose were not certified as a medical device, had not been validated in any peer-reviewed research, and did not have any documented involvement of medical professionals. The potential consequences of such applications operating incorrectly are stark and represent a risk to patient safety. Usage of multiple applications in a single patient encounter may compound error and safety of clinical care.

The role of smartphone applications in clinical practice: a review

OBJECTIVE

The number of medical mobile phone applications continues to grow. Although otorhinolaryngology-specific applications represent a small proportion, there are exciting innovations emerging for the specialty. This article will assess the number of applications available and review how they may be used in clinical practice.

METHOD

The application stores of the two most popular mobile phone platforms, Apple and android, were searched using multiple search terms.

RESULTS

A total of 107 ENT applications were identified and categorised according to intended use. Eight applications were reviewed in more detail and assessed on whether a doctor or allied health professional was involved in their design and if they were evidence-based.

CONCLUSION

There are a number of ENT-specific smartphone applications currently available. As the technology progresses, their scope has extended beyond being purely for reference. Nevertheless, it remains difficult to assess the validity and security of these applications.

Smartphone Applications in Plastic Surgery: A Cross-Sectional Survey of 577 Plastic Surgeons, Fellows, Residents, and Medical Students

BACKGROUND

There are now over 2.2 million mobile applications (apps) in existence, with more than 250 identifiable by searching "plastic surgery." Unfortunately, only 30% of these are academically relevant, which makes finding useful plastic surgery apps both challenging and inefficient.

OBJECTIVES

The authors sought to evaluate the use of digital resources and awareness of available apps within plastic surgery to improve their clinical/educational utilization.

METHODS

An extensive search of the Apple and Android databases was performed to identify all relevant plastic surgery apps. An American Society of Plastic Surgeons-sponsored survey was distributed to a random cohort of American Society of Plastic Surgeons members (practicing surgeons, fellows, and residents) and students applying to an integrated plastic surgery residency. The survey queried utilization of resources to access medical information and awareness of apps relevant to clinical/educational plastic surgery.

RESULTS

A total 153 relevant applications were identified between the Apple iTunes and Google Play stores. Of the 577 respondents (273 practicing surgeons, 117 residents, 11 fellows, and 177 medical students), 99.31% own a smartphone/tablet. Furthermore, medical students and residents/fellows utilized both smartphones and computers more frequently than practicing physicians (P < 0.0001 and P = 0.0022, respectively). Digital resources were also utilized more frequently than printed material (P < 0.00001). For app awareness, 82.1% of respondents reported knowing of fewer than 10 apps relevant to plastic surgery, and only 8.41% were aware of more than 20.

CONCLUSIONS

Smartphone usage is nearly ubiquitous among plastic surgeons, and most utilize these devices daily to access medical information. However, awareness of the many available and relevant plastic surgery apps is extremely limited.

Avoiding Breach of Patient Confidentiality: Trial of a Smartphone Application That Enables Secure Clinical Photography and Communication

Background

To evaluate a smartphone application for clinical photography that prioritizes and facilitates patient security.

Methods

Ethics was obtained to trial the application Sharesmart. Calgary plastic surgeons/residents used the application for clinical photography and communication. Surveys gauging the application usability, incorporated consent process, and photograph storage/sharing were then sent to surgeons and patients.

Results

Over a 1-year trial period, 16 Calgary plastic surgeons and 24 residents used the application to photograph 84 patients. Half (56%) of the patients completed the survey. The majority of patients found the applications consent process acceptable (89%) and felt their photograph was secure (89%). Half (51%) of the surgeons/residents completed the survey and would use the application as is (67%) or with modifications (33%). The consent process was felt to be superior (73%) or equivalent (23%) to participant's prior methods and was felt to resolve issues present with current photography practices of secure transmission and storage of photographs by 100% and 95% of respondents, respectively. Perceived limitations of the application included difficulties in use with poor cellphone service or Internet, decreased speed compared to current practices, the lack of a desktop platform, video capability, and ability to transmit the photograph directly to the patient's medical record.

Conclusions

A smartphone clinical photography application addresses the risks of patient confidentiality breach present with current photography methods; broad implementation should be considered.

Highly sensitive immunodiagnostics at the point of care employing alternative recognition elements and smartphones: hype, trend, or revolution?

Immunodiagnostic tests performed at the point of care (POC) today usually employ antibodies for biorecognition and are read out either visually or with specialized equipment. Availability of alternative biorecognition elements with promising features as well as smartphone-based approaches for signal readout, however, challenge the described established configuration in terms of analytical performance and practicability. Assessing these developments' clinical relevance and their impact on POC immunodiagnostics is demanding. The first part of this review will therefore give an overview on suitable diagnostic biosensors based on alternative recognition elements (such as nucleic acid-based aptamers or engineered binding proteins) and exemplify advantages and drawbacks of these biomolecules on the base of selected assays. The second part of the review then focuses on smartphone-connected diagnostics and discusses the indispensable considerations required for successful future clinical POCT implementation. Together, the joint depiction of two of the most innovative and exciting developments in the field will enable the reader to cast a glance into the distant future of POC immunodiagnostics.

Balancing the Need for Clinical Photography With Patient Privacy Issues: The Search for a Secure SmartPhone Application to Take and Store Clinical Photographs

Background

Physicians are increasingly using smartphones to take clinical photographs. This study evaluates a smartphone application for clinical photography that prioritizes and facilitates patient security.

Methods

Ethics approval was obtained to trial a smartphone clinical photography application, PicSafe Medi. Calgary plastic surgeons and residents used the application to obtain informed consent and photograph patients. Surveys gauging the application's usability, consent process, and photograph storage/sharing were then sent to surgeons and patients.

Results

Over a 6-month trial period, 15 plastic surgeons and residents used the application to photograph 86 patients. Over half of the patients (57%) completed the survey. The majority of patients (96%) were satisfied with the application's consent process, and all felt their photographs were secure. The majority (93%) of surgeons/residents completed the survey. The application was felt to overcome issues with current photography practices: inadequate consent and storage of photographs (100%), risk to patient confidentiality (92%), and unsecure photograph sharing (93%). Barriers to regular use of the application included need for cellphone service/Internet (54%), sanitary concerns due to the need for patients to sign directly on the phone (46%), inability to obtain proactive/retroactive consent (85%), and difficulty viewing photographs (80%). The majority of surgeons (85%) believe a smartphone application would be suitable for clinical patient photography, but due to its limitations, only 23% would use the trialed application.

Conclusions

A smartphone clinical photography application addresses the patient confidentiality risks of current photography methods; however, limitations of the trialed application prevent its broad implementation.