BACKGROUND:The BaylorScott & White Health Division of Plastic Surgery began a faculty development program designed to train clinicians to be better educators. The program consisted of presession ...reading, 11 small group didactic sessions, and individually chosen educational projects. Cross-discipline collaboration was pursued by enrolling faculty and students from diverse departments. Department chair permission was required for participation. The purpose of this qualitative study was to explore learner perspectives of the Surgical Educators Program.
METHODS:Fourteen physicians completed the Surgical Educators Program. Focus groups were held with the learners who completed the 2011 and 2012 programs 6 months after completion. The groups were moderated by an educational faculty member who was not involved in any aspect of the course. Questions were designed to elicit the components of the course curriculum of significance to the learners. Narrative data were digitally recorded and transcribed verbatim, and the investigators performed independent content analyses to identify themes. The data were thematically coded and summarized using calculation of frequencies.
RESULTS:Thirteen learners participated in the focus groups. Three main themes were identified. First, the program increased the participants’ knowledge and practice of medical education. Second, the structure of the program was a key contributor to the outcomes. Third, the program produced a community of practice.
CONCLUSIONS:This study suggests that a faculty development program comprising a diverse group of physicians consisting of readings, guided small group sessions, and a mandatory project can train plastic surgical faculty to become better surgical educators within the constraints of a busy clinical practice.
The reported prevalence of anemia after malabsorptive bariatric surgery has varied from 5% to 64% in the post-Roux-en-Y gastric bypass (RYGB) population, owing to the small study sample sizes and ...generally poor follow-up in surgical referral practices. The present study estimated the prevalence of anemia in the post-RYGB population and determined whether an integrated healthcare system with a shared electronic medical record could improve postoperative follow-up.
The medical records from 1009 sequential patients who had undergone RYGB from 2000 to 2005 were retrospectively analyzed. All anemia data within the healthcare system's electronic medical record were accessible.
Of the 1009 medical records, 720 contained ≥1 year of follow-up data concerning anemia. Anemia had developed or worsened in 259 patients, for a prevalence of 36% in the present sample. The anemia was moderate to severe (hemoglobin <10 g/dL) in 88 patients (12.2%.), many of whom subsequently required parenteral iron. Of the 1009 patients, the follow-up data for ≥3 years concerning anemia were available for only 357 patients (35.4%).
The results of the present study have shown that in a large population of patients undergoing RYGB, the prevalence of anemia was great enough to justify more intensive long-term screening. We hope the findings from the present report influence the national screening standards for this patient population.
High-dose cytarabine is recommended for re-induction chemotherapy in patients less than 60 years of age with acute myelogenous leukemia. This case describes a patient receiving high-dose cytarabine ...for re-induction and subsequently developed tingling and numbness in her hands and feet followed by severe pain, swelling, and erythema consistent with a diagnosis of palmar-plantar erythrodysesthesia. Furthermore, the patient’s hemoglobin, platelets, and neutrophils did not recover after over 30 days post high-dose cytarabine. The patient was concurrently receiving posaconazole for fungal prophylaxis which was initiated after the induction therapy. We speculate that posaconazole may inhibit the cytarabine efflux through P-glycoprotein inhibition leading to the patient’s palmar-plantar erythrodysesthesia and subsequent aplasia. Future pharmacokinetic studies need to be conducted to ascertain if posaconazole does influence the pharmacokinetics of cytarabine.
Moonlighting during residency training refers to the practice of medicine by residents outside of normal, supervised patient care rotations. The 2011 Accreditation Council for Graduate Medical ...Education common Program Requirements state that moonlighting must not interfere with residents' ability to achieve the goals and objectives of the educational program. Also, internal moonlighting must be considered part of the 80-hour weekly limit on duty hours. Residency program directors are required to monitor the number of hours residents spend moonlighting. Here, Mirkes et al examine the relationship between residents' total number of moonlighting hours, demographic variables, US Medical Licensing Examination scores, and Internal Medicine In-Training Examination scores.
Mantle cell lymphoma of the prostate is rare and is seldom encountered in general urologic practice. It either arises primarily from the prostate or is a result of metastatic spread from another ...site. This specific type of lymphoma has an aggressive course and may respond poorly to traditional chemotherapy with frequent relapses. Mantle cell lymphoma occurs in middle age or older, which is also when symptoms of benign prostatic enlargement begin in men. This overlap makes the diagnosis of lymphoma of the prostate difficult and makes the treatment more complex. We describe a case of mantle cell lymphoma of the prostate that caused significant enlargement and bladder outlet obstruction with urinary retention. The obstruction was treated with holmium laser enucleation of the prostate with good functional results.
This case report presents a newly diagnosed congenital factor VII deficiency treated with recombinant activated factor VII (rFVIIa). Congenital factor VII deficiency is a rare autosomal-recessive ...bleeding disorder that occurs in fewer than 1/500,000 persons. Its presentation can vary from epistaxis to hemarthroses and severe central nervous system bleeding, and correlates poorly with factor VII levels. Our patient had not had a significant hemostatic challenge prior to his presentation and therefore never had any symptomatology suggestive of this disease. He was treated with rFVIIa, and was able to undergo repair of his fractures without bleeding.
A 19-year-old African-American male presented to the emergency room after an altercation that resulted in significant trauma. He sustained bilateral mandibular angle fractures and orbital floor fractures, requiring urgent surgical correction. On initial evaluation, he was noted to have a prolonged prothrombin time of 40.1 seconds, with an International Normalized Ratio of 4.0, a normal activated partial thromboplastin time of 29.9 seconds, and a platelet count of 241. After receiving vitamin K and fresh frozen plasma, he was taken to the operating room for a temporary rigid maxillomandibular fixation. A 1:1 mixing study with normal plasma corrected the prothrombin time (decreasing from 40.7 to 14.7 seconds) and a factor VII assay revealed 5% of the normal factor VII level. The patient was diagnosed with congenital factor VII deficiency. Due to his coagulopathy and the extensive surgical correction needed, rFVIIa was administered and surgery was accomplished without hemorrhagic sequelae.
This case report and review describes a rare congenital disease, the history of rFVIIa use, and its mechanism. rFVIIA use in our patient provided a treatment option that allowed the necessary surgical correction, but further prospective studies on dose optimization would ensure adequate dosing with minimal risk of severe side effects.
Malfunctioning prosthetic heart valves have been previously associated with nonimmune hemolytic anemia; however, disseminated intravascular coagulation has not previously been noted as a complication ...in the absence of infective endocarditis. The authors report the case of an 81-year-old woman who developed disseminated intravascular coagulation associated with a dysfunctional prosthetic heart valve.
JAAD Grand Rounds quiz Flynn, Valerie E., MD; Cable, Christian, MD; Butler, David F., MD ...
Journal of the American Academy of Dermatology,
August 2011, Letnik:
65, Številka:
2
Journal Article
Recenzirano
Instructions: In answering each question, refer to the specific directions provided. Because it is often necessary to provide information occurring later in a series that give away answers to earlier ...questions, please answer the questions in each series in sequence.
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