Introduction: Microsurgery is a relatively new speciality with steep learning patterns. Before practice in real fields surgeons need adequate training to gain the expertise. Different types of living and non-living simulators are used to gain the efficiency. As the living simulator has issues with complexity, availability, cost, ethical approval and special setting and available resources an alternative less complex, inexpensive, no ethical issues, easily available, effective non-living models are demanded by the trainers.   Objective: Review the relevant articles to see the justification of use of live models for microsurgery training and to see is there any alternative non-living model to replace living model. Materials and Methods: A PubMed and Google Scholar search for key words ‘(microsurgery) AND (training)) AND (live models)) AND (non-living models)) AND (education)’ were performed in February 2021.  Total 422 literatures were found from January 1990 to February 2021. Among them 29 were found relevant with topics. Among them 17 were finally selected for discussion. Conclusion: Evidences showed non-living low fidelity models are as effective as high fidelity living model in microsurgery training. Many of the studies with ex vivo models have showed promising results which support replacement of live models in basic and intermediate courses. However, those are not sufficient to support for total ban of live models specially in advance microsurgery courses. We are hoping, in near future some blended non-living models may come up using digital or virtual reality technology which can replace the live model era. Further research with highest level of evidences are required.

12106 Background: Clinicians often hesitate to discuss prognosis with patients because of prognostic uncertainty. The use of validated prognostic models may enhance prognostic confidence and/or prognostic accuracy. Prognostic confidence is a novel concept that has not been well studied and may support prognosis-based decision making. We examined the impact of a web-based prognostic intervention on physicians’ prognostic confidence. Methods: In this prospective study, palliative care specialists estimated the prognosis of patients with advanced cancer seen at an outpatient supportive care clinic using the temporal, surprise and probabilistic questions for 6 m, 3 m, 2 m, 1 m, 2 w, 1 w and 3 d survival. They then reviewed information from a web-based prognostic calculator ( www.predictsurvival.com ) that provided survival predictions from 7 validated prognostic scores, including the Palliative Prognostic Score, Palliative Prognostic Index, and Palliative Performance Status. The clinicians then provided their prognostic estimates post-intervention. The primary outcome was prognostic confidence (0-10 numeric rating scale, where 0 = not at all, 10 = most confident) before vs. after the study intervention. Secondary outcomes included (1) confidence to share the prognosis with patients, (2) confidence to make prognosis-based care recommendations (agreement = strongly agree or agree) and (3) prognostic accuracy. With 220 patients, we had 80% power to detect an effect size of 0.66 with 2-sided α 0.05. We compared the pre-post data using the Wilcoxon signed-rank test for the primary outcome and McNemar test for secondary outcomes. Results: 216 patients with advanced cancer (mean age 61, 50% female) were included and 154 (71%) died. The median (IQR) actual survival was 90 (39, 178) days; the median (IQR) predicted survival before and after intervention were 90 (60, 90) and 80 (60, 90) days, respectively. Prognostic confidence significantly increased after the intervention (pre vs. post: median 6 vs. 7, P < 0.001). A significantly greater proportion of clinicians reported that they felt confident enough about their prognostic estimate to share it with patients (44% vs. 74%, P < 0.001) and to formulate care recommendations (80% vs. 94%, P < 0.001) after the intervention. Prognostic accuracy did not differ significantly before and after the intervention, ranging from 72-100% for the temporal question, 45-97% for the surprise questions and 38%-100% for the probabilistic questions (P > 0.05). Conclusions: Among patients with advanced cancer seen at a supportive care clinic, the web-based prognostic intervention was associated with greater prognostic confidence and willingness to discuss prognosis, despite not significantly altering clinicians’ prognostic estimate or prognostic accuracy. Further research is needed to examine how prognostic tools may be able to augment prognostic discussions and clinical decision making.

Background: The prevalence of animal bites is high, of which the vast majority are from cats’ and dogs’. There is a wide variation in severity of such bites from mild to lethal. The evidence in the literature with respect to management does not provide a solid ground on which such cases could be managed. Dog and Cat bites are more common and can have dramatic consequences especially for children. Objective: This project is to identify current evidence in the literature on epidemiology, management and prevention of dog and cat bites. This review is aimed at clinicians who deal with dog and cat bites. The basic principles of wound management and indications for use of antimicrobials, tetanus and rabies prophylaxis as well as preventive education are the primary focus of this article to help the clinicians. This aims at updating the management of patients who sustain a dog or a cat bite. Materials and Methods: A literature review on the management of animal bites was performed. UK NICE guidelines, University of Texas bites management guidelines, WHO rabies prophylaxis protocol, UK Green Book and infectious diseases text books also reviewed. Results: The available data in the literature suggest that appropriate wound management is the most important factor for prevention of infection in dog and cat bites. Antibiotic prophylaxis should only be given in high-risk wounds and primary closure should be performed in low-risk wounds. Conclusions: Proper assessment and wound care are the prime consideration for dog and cat bites management.

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