> ## Content Index > Fetch the complete content index at: https://www.theplasticsfella.com/llms.txt > Use this file to discover other available public pages before exploring further. # 💌 Copy-Paste Medical Crisis, BCC Insights & AI Advances - URL: https://www.theplasticsfella.com/june-25th/ - Published: 2023-06-25T19:15:26.000Z - Updated: 2024-11-19T14:01:39.000Z - Description: Explore the impact of copy-pasting in medical records, understand high-risk BCC, and discover upcoming AI-driven advancements in plastic surgery in this week's thePlasticsPaper edition - Author: PlasticsFella - Tags: thePlasticsPaper #### In this week's edition 1. ****✍️** [****Letter from P'Fella**](https://www.theplasticsfella.com/june-25th/#a-letter-from-pfella) +50% of medical records are now copy-paste. 2. ****🤓** [****The Sunday Quiz**](https://www.theplasticsfella.com/june-25th/#the-sunday-quiz) What actually is a high-risk BCC? 3. ****🎭**[ **New & Upcoming**](https://www.theplasticsfella.com/june-25th/#new-and-upcoming) Educational tools and new events 4. 📸 [****Image of the Week**](https://www.theplasticsfella.com/june-25th/#image-of-the-week) AI-generated keratotic horn 5. ****🐣** [****Tweets of the Week**](https://www.theplasticsfella.com/june-25th/#tweets-of-the-week) P'Fella's 3 favourite tweets 6. 🤔 [****Ask P'Fella**](https://www.theplasticsfella.com/june-25th/#ask-pfella) Submit & I'll answer! 7. ****📝** [****Articles of the Week**](https://www.theplasticsfella.com/june-25th/#articles-of-the-week) 3 hot reads on fingers, face and infections. 8. 💕 [****Feedback**](https://www.theplasticsfella.com/june-25th/#feedback) Always looking to improve :) ****BTW: Did you know you can** [****Ask P'Fella?**](https://www.theplasticsfella.com/june-25th/#ask-pfella) ## A Letter from P'Fella ### +50% of medical records are copy-paste. **Imagine if half of what you wrote was just copied from your past work, and not only that, but the amount you copied kept increasing each year!** Sounds crazy, right? Well, that's exactly what's happening in the world of electronic medical records (EMRs). A study by [JAMA](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796664?ref=theplasticsfella.com) found that about **50% of all text in EMRs was duplicated from previous entries**, and that the fraction of duplicated content increased from 33% in 2015 to over **54% in 2020!** ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2023/06/Screenshot-2023-06-25-at-15.21.27.png) More notes, more duplication. This not only wastes our precious time but also casts doubt on the veracity of the information in the medical record. Try finding and verifying information when you're wading through a sea of repetition! It's not just about our frustration, though. At the end of the day, it's about providing the best care for our patients, and this, folks, is a hurdle in that path. So what do we do about it? Well, we have a couple of hazards to tackle, namely **information overload** and information **scatter**. **Overload** is when there's so much information (in this case, thanks to duplication) that it's like trying to find a needle in a haystack. **Scatter**, on the other hand, is when the info is fragmented across many locations, making it tough to retrieve and synthesize. Both of these problems are, frankly, a royal pain. These issues stem from the way our EMRs are organized, the old note paradigm, where every encounter with a patient needs a separate document and different authors have separate documents. This system may have worked wonders in the era of paper-based charts, but in the digital age, it's like using a horse-drawn carriage on a superhighway. It's clear we need to rethink this system and consider more modern software advances like document editing, collaborative documentation, or version history tracking. **Lots of love,** **P'Fella** ❤️ ****TL;DR:**Duplication in electronic medical records is a growing issue, compromising efficiency and record accuracy. Rooted in an antiquated system, a shift towards modern, collaborative documentation methods is necessary to improve patient care ## The Sunday Quiz ### High risk vs Low Risk BCC It can be hard to remember what actually is a high risk BCC. The followsection came from thePlasticsFella's [clinical cases](https://www.theplasticsfella.com/periocular-bcc-clinical-case/) . ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2023/06/high-risk-bcc.png) High Risk BCC The NICE and RCPath Guidelines provide clinical and pathological risk assessments, respectively. This equates to the NCCN guidelines. **Clinical Factors: (DRIP)** - **D**imensions: Any size "mask areas of face", genitals, distal limbs (hands, nails, feet), >10mm in non-"mask areas", neck and pretibial, >20mm trunk and proximal limbs - **R**ecurrence or Radiotherapy - **I**mmunosuppression - **P**oorly defined borders **Pathological Factors: (SHIELD)** - **S**tage**: ≥**pT2 (pT2 = tumour 20mm-40mm) - **H**istological Type: infiltrating, morphoeic, micronodular, basosquamous - **I**nvasion Perineural: Named nerve, *or* ≥0.1mm, *or* beyond the dermis - **E**xcisional Margins: positive or narrow (< 1 mm) - **L**evel of Invasion: beyond subcutaneous fat - **D**epth: > 6 mm (granular layer of the nearest adjacent normal epidermis to the deepest point of the tumour) - **D**ifferentiation: present Reveal this week's question Which of the following is not a clinical or pathological factor in the NICE and RCPath Guidelines for risk assessments? - A. Dimensions: Any size "mask areas of face", genitals, distal limbs (hands, nails, feet), >10mm in non-"mask areas", neck and pretibial, >20mm trunk and proximal limbs - B. Recurrence or Radiotherapy - C. Invasion Perineural: Named nerve, or ≥0.1mm, or beyond the dermis - D. Patient's age and gender Name: Email: ## New and Upcoming ### Educational Tools, Events & Courses P'Fella spotlights impactful events, crucial webinars, and hand-picked courses we know you'll love. Also, if there's a new feature, you'll be the first to know right here. ## Upcoming Events #### 4 Recommendations 1. [****BAAPS**](https://baaps.org.uk/about/events/1663/baaps%5Fsupport%5Fnonsurgical%5Fwebinar?ref=theplasticsfella.com)****:** Non-surgical webinar 28th June 2. [****ASSH**](https://www.assh.org/annualmeeting/s/?ref=theplasticsfella.com) Annual Meeting - Toronto, 5th October 3. [****Plastic Surgery**](https://www.plasticsurgerythemeeting.com/?ref=theplasticsfella.com) \- The Meeting: Texas, 26th Oct 4. [****BAPRAS Congress**](http://www.bapras.org.uk/professionals/training-and-education/bapras-events/bapras-congress-2023?ref=theplasticsfella.com) \- 29th Nov ["Connect" with more Events](https://connect.theplasticsfella.com/?ref=theplasticsfella.com) ## New Features P'Fella has been coding hard these past few months. Here's a sneakpeak of what is coming in version 3 of thePlasticsFella.com (hint: AI space repetition flashcards that learn your study style). 0:00 /0:32 1× ## Image of the Week ### AI-generated clinical images ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2023/06/cyst-eyelid.png) AI-generated image: keratotic horn on the upper eyelid ## Tweets of the Week ### Don't forget to follow [P'Fella](http://twitter.com/plasticsfella?ref=theplasticsfella.com)! > Data on [#swearing](https://twitter.com/hashtag/swearing?src=hash&ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) in clinical setting[https://t.co/iXAy0fDx7Z](https://t.co/iXAy0fDx7Z?ref=theplasticsfella.com) [pic.twitter.com/tWJeYwIHCw](https://t.co/tWJeYwIHCw?ref=theplasticsfella.com) > > — Jack Iwashyna🫁 (@iwashyna) [June 24, 2023](https://twitter.com/iwashyna/status/1672613275161477120?ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) > The top photo holds great historical significance as it captures a pivotal moment in medical history. Dr. Zbigniew Religa, a renowned heart surgeon, is seen resting in the photo after completing the first successful heart transplant in Poland in 1987\. This groundbreaking surgery… [pic.twitter.com/5xJ3LpZa3N](https://t.co/5xJ3LpZa3N?ref=theplasticsfella.com) > > — Historic Vids (@historyinmemes) [June 21, 2023](https://twitter.com/historyinmemes/status/1671629475996467201?ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) > Is this classified as a ‘herd’? [pic.twitter.com/LkwRQZIwbX](https://t.co/LkwRQZIwbX?ref=theplasticsfella.com) > > — Silas 🫀 (@GenerallyUnwell) [June 15, 2023](https://twitter.com/GenerallyUnwell/status/1669315342928158721?ref%5Fsrc=twsrc%5Etfw&ref=theplasticsfella.com) ## Ask P'Fella ### You ask, I'll answer Every Sunday, you can ask P'Fella anything related to plastic surgery. You'll be answered the following week. Let's check out what questions came in. Ask P'Fella ****Inno's Question:**What study tips can you share in order to identify the key areas tested in plastic surgery examinations and to maximize retention of knowledge in the background of the ever rapidly growing body of knowledge. It’s no longer one or two textbooks in plastics we have numerous and there are multiple journals with enormous amount of publications monthly. How does one remember it all? Please help. #### P'Fella's Answer Hey, that's a really solid question! We all know the world of plastic surgery is huge, and it feels like it's only getting bigger, right? That's actually why thePlasticsFella was created, to help navigate this ocean of knowledge without having to juggle a library of textbooks or chase a thousand different sources. But let's dive into some handy tips to help tackle this beast: 1. ****Do the Basics:** Start with the core principles and common procedures. Foundation first, the fancy stuff later. 2. ****Check Old Exams:** Sneak a peek at old exams. They're a goldmine for figuring out what gets tested often. 3. ****Be Active:** Don't just read. Get active. Make flashcards, teach others, quiz yourself. 4. ****Keep Tidy:** Organized notes = organized mind. It's science (probably). 5. ****Review Often:** Remember that friend who only shows up once in a while but you never forget their face? Be that friend to your notes. Use spaced repetition. 6. ****Find a Squad:** Get a study group together. Different perspectives, more fun, and less chance of missing something important. 7. ****Self-care:** Don't forget to eat your veggies, catch those Z's, and break a sweat. A healthy brain is a learning machine. 8. ****Keep Going:** This is a marathon, not a sprint. Keep at it, step by step. And remember, it's okay to take a breather. ## Articles of the Week ### 3 must-read articles, 1 deep-dive! 📚 #### 3 Must-reads 1. [****What's the best reconstruction for nasal defects?**](https://journals.lww.com/plasreconsurg/Abstract/2023/06000/Outcomes,%5FConcepts,%5FTechnical%5FRefinements,%5Fand.33.aspx?ref=theplasticsfella.com) Menick et al. Outcomes, Concepts, Technical Refinements, and Challenges in the Microvascular Repair of Full-Thickness Nasal Defects. PRS. June 2023\. 2. [****How to reconstruct a fingertip.**](https://journals.lww.com/prsgo/Fulltext/2023/05000/P3%5FFlap%5F%5FTechnique%5Ffor%5FFingertip%5FReconstruction.32.aspx?ref=theplasticsfella.com) Petrella et al. Technique for Fingertip Reconstruction. Plastic & Reconstructive Surgery-Global Open 11(5):p e5002, May 2023 3. [****Hand surgery performed in the "procedure room"**](https://www.jhandsurg.org/article/S0363-5023%2823%2900117-X/fulltext?ref=theplasticsfella.com) Zhuang T et al. Is Hand Surgery in the Procedure Room Setting Associated With Increased Surgical Site Infection? J Hand Surg Am. 2023 ![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/06/Deep-3.png) #### New update coming soon! In this upcoming new update, the focus will be more on infographics and generating discussion - so people can share their own experiences and critiques. [Check back next week](https://www.theplasticsfella.com/june-25th/) ## Feedback ### P'Fella is always looking to make this weekly newsletter as good as can be!Let me know your thoughts below :)