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Mirzamohammadi F, Nnamani Silva ON, Leaf RK, Eberlin KR, Valerio IL. Chemoprophylaxis and Management of Venous Thromboembolism in Microvascular Surgery. Semin Plast Surg 2023; 37:57-72. [PMID: 36776808 PMCID: PMC9911223 DOI: 10.1055/s-0042-1760381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This review aims to highlight the common pharmacological and nonpharmacological interventions utilized for thromboprophylaxis as well as flap salvage in microsurgery. A literature review was conducted in PubMed/National Center for Biotechnology Information, Scopus, Web of Science, and MEDLINE databases. Articles with a focus on thromboprophylaxis in microsurgical procedures spanning head and neck surgery, breast and extremity microvascular reconstruction, deep venous thrombosis/pulmonary embolus in microvascular surgery, and flap thrombosis and salvage were included in this review. The majority of available evidence supports mechanical venous thromboembolism (VTE) prophylaxis in all patients undergoing microsurgery given the presence of multiple risk factors for VTE within this particular patient population. Based on the literature review, addition of VTE chemoprophylactic agents is beneficial and an algorithmic approach to thromboprophylaxis in microsurgery patients and management of patients with thrombosis based on literature review and senior authors' experience is recommended and outlined.
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Affiliation(s)
- Fatemeh Mirzamohammadi
- Wright State University Plastic Surgery Residency Program, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | | | - Rebecca K. Leaf
- Division of Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kyle R. Eberlin
- Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Ian L. Valerio
- Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Edwards CS, Ammanuel SG, Silva ONN, Greeneway GP, Bunch KM, Meisner LW, Page PS, Ahmed AS. Academics versus the Internet: Evaluating the readability of patient education materials for cerebrovascular conditions from major academic centers. Surg Neurol Int 2022; 13:401. [PMID: 36128118 PMCID: PMC9479524 DOI: 10.25259/sni_502_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/09/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Health literacy profoundly impacts patient outcomes as patients with decreased health literacy are less likely to understand their illness and adhere to treatment regimens. Patient education materials supplement in-person patient education, especially in cerebrovascular diseases that may require a multidisciplinary care team. This study aims to assess the readability of online patient education materials related to cerebrovascular diseases and to contrast the readability of those materials produced by academic institutions with those of non-academic sources.
Methods:
The readability of online patient education materials was analyzed using Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) assessments. Readability of academic-based online patient education materials was compared to nonacademic online patient education materials. Online patient education materials from 20 academic institutions and five sources from the web were included in the analysis.
Results:
Overall median FKGL for neurovascular-related patient online education documents was 11.9 (95% CI: 10.8–13.1), reflecting that they are written at a 12th grade level, while the median FRE was 40.6 (95% CI: 34.1–47.1), indicating a rating as “difficult” to read. When comparing academic-based online patient education materials to other internet sources, there was no significant difference in FRE and FKGL scores (P = 0.63 and P = 0.26 for FKGL and FRE, respectively).
Conclusion:
This study demonstrates that online patient education materials pertaining to cerebrovascular diseases from major academic centers and other nonacademic internet sites are difficult to understand and written at levels significantly higher than that recommended by national agencies. Both academic and nonacademic sources reflect this finding equally. Further study and implementation are warranted to investigate how improvements can be made.
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Affiliation(s)
- Caleb Simpeh Edwards
- Department of Neurological Surgery, School of Medicine, University of California, San Francisco,
| | - Simon Gashaw Ammanuel
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison,
| | | | - Garret P. Greeneway
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison,
| | - Katherine M. Bunch
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison,
| | - Lars W. Meisner
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison,
| | - Paul S. Page
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison,
| | - Azam S. Ahmed
- Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison,
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Badiee RK, Hernandez S, Valdez JJ, Nnamani Silva ON, Campbell AR, Alseidi AA. Corrigendum to "Advocating for a New Residency Application Process: A Student Perspective". J Surg Educ. 2022 January-February; 79(1): 20-24. J Surg Educ 2022; 79:1082. [PMID: 35597760 PMCID: PMC9115625 DOI: 10.1016/j.jsurg.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Ryan K Badiee
- School of Medicine, University of California, San Francisco, California
| | - Sophia Hernandez
- Department of Surgery, University of California, San Francisco, California
| | - Jessica J Valdez
- School of Medicine, University of California, San Francisco, California
| | - Ogonna N Nnamani Silva
- Harvard Plastic Surgery Residency Program, Harvard Medical School, Boston, Massachusetts
| | - Andre R Campbell
- Department of Surgery, University of California, San Francisco, California
| | - Adnan A Alseidi
- Department of Surgery, University of California, San Francisco, California.
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Hernandez S, Song S, Nnamani Silva ON, Anderson C, Kim AS, Campbell AR, Kim EH, Alseidi A, Wick EC, Sosa JA, Gosnell J, Lin MY, Roman SA. Third year medical student knowledge gaps after a virtual surgical rotation. Am J Surg 2022; 224:366-370. [PMID: 35397920 PMCID: PMC9701087 DOI: 10.1016/j.amjsurg.2022.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION This study describes perceived knowledge gaps of third-year medical students after participating in a virtual surgical didactic rotation (EMLR) and shortened in-person surgery rotation during the COVID-19 Pandemic. METHODS Open-ended and Likert questions were administered at the end of the virtual rotation and inperson-surgical rotation to medical students. Three blinded coders identified themes by semantic analysis. RESULTS 82 students (51% of all MS3s) participated in the EMLR. Semantic analysis revealed gaps in perioperative management (Post-EMLR:18.4%, Post-Inpatient:26.5%), anatomy (Post-EMLR:8.2%, PostInpatient:26.5%). and surgical skills (Post-EMLR: 43.0%, Post-Inpatient: 44.1%). Students also described gaps related to OR etiquette (Post-EMLR: 12.2%, Post-Inpatient: 8.8%) and team dynamics/the hidden curriculum (Post- Inpatient:26.6%). There was a significant improvement in perceived confidence to perform inpatient tasks after completing the inpatient clinical experience (p ≤ 0.01). CONCLUSION Virtual interactive didactics for cognitive skills development cannot replace a full clinical surgical experience for third-year medical students. Future curricula should address perceived gaps.
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Affiliation(s)
- Sophia Hernandez
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Siyou Song
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Chelsie Anderson
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Alexander S. Kim
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Andre R. Campbell
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Edward H. Kim
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Adnan Alseidi
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Elizabeth C. Wick
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Julie Ann Sosa
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Jessica Gosnell
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Matthew Y.C. Lin
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Sanziana A. Roman
- Division of Surgical Oncology, University of California, San Francisco, San Francisco, CA, USA,Corresponding author. FACS Professor of Surgery and Medicine Section of Endocrine Surgery Division of Surgical Oncology University of California, San Francisco 1600 Divisadero Street, Room A726 Box 1674 San Francisco, CA, 94143, USA
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Hernandez S, Nnamani Silva ON, Conroy P, Weiser L, Thompson A, Mohamedaly S, Coe TM, Alseidi A, Campbell AR, Sosa JA, Gosnell J, Lin MYC, Roman SA. Bursting the Hidden Curriculum Bubble: A Surgical Near-Peer Mentorship Pilot Program for URM Medical Students. J Surg Educ 2022; 79:11-16. [PMID: 34315681 PMCID: PMC9308488 DOI: 10.1016/j.jsurg.2021.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/11/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Abstract
The hidden curriculum of unspoken professional expectations negatively impacts medical student interest in surgery. Medical student mentorship and early surgical exposure have been shown to demystify the hidden curriculum. Although residents and faculty play a vital role, near-peer mentorship may aid in uncovering the hidden curriculum and promoting medical student interest in surgery, especially for those learners who are underrepresented in medicine. We developed and implemented a formalized near-peer mentorship program composed of quarterly small group Surgical Peer Teacher led lessons and one-on-one Surgical Support Team mentorship meetings covering surgical curriculum topics for medical students at an academic medical school. This structured near-peer mentorship model provides a mechanism to demystify surgical culture, increase early access to surgical mentorship, and develop mentorship skills amongst students. This program aims to uncover the surgical hidden curriculum to improve surgical career support and interest among medical students with less exposure and access to physician role models. This longitudinal mentorship model is student-run and can be easily adapted to enhance existing support models at medical schools. Future studies will evaluate utilization, impact on surgical specialty interest, and efficacy in demystifying the surgical hidden curriculum.
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Affiliation(s)
- Sophia Hernandez
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Ogonna N Nnamani Silva
- Department of Surgery, Division of Plastic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Patricia Conroy
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Lucas Weiser
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Avery Thompson
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Sarah Mohamedaly
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Taylor M Coe
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts
| | - Adnan Alseidi
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Andre R Campbell
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Julie Ann Sosa
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Jessica Gosnell
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Matthew Y C Lin
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Sanziana A Roman
- University of California, San Francisco Department of Surgery, San Francisco, California.
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Nnamani Silva ON, Armijo PR, Feld LD, Mascarenhas Monteiro JS, Pham R, Tenforde AS. Comment on: "Sex-Specific Differences in Running Injuries: A Systematic Review with Meta-analysis and Meta-regression". Sports Med 2021; 52:187-188. [PMID: 34480738 DOI: 10.1007/s40279-021-01548-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Ogonna N Nnamani Silva
- Harvard Plastic Surgery Residency Program, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
| | | | - Lauren D Feld
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Rachel Pham
- Creighton University School of Medicine, Dignity Health St. Joseph's Hospital, Valleywise Health Medical Center, Phoenix, AZ, USA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, USA
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Nnamani Silva ON, Hernandez S, Kim AS, Campbell AR, Kim EH, Alseidi A, Wick EC, Sosa JA, Gosnell J, Lin MYC, Roman SA. Where Do We Go From Here? Assessing Medical Students' Surgery Clerkship Preparedness During COVID-19. J Surg Educ 2021; 78:1574-1582. [PMID: 33485827 PMCID: PMC7836963 DOI: 10.1016/j.jsurg.2021.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/13/2020] [Accepted: 01/14/2021] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The impact of COVID-19 on surgical education has been profound, and clinical learning experiences transitioned to virtual formats. This study investigated the impact of virtual experiences created to facilitate learning during the pandemic for medical students. METHODS We performed a cohort study to determine the perceived clinical preparedness for medical students enrolled in the preclinical surgery pilot course, surgical Extended Mastery Learning Rotation (EMLR), and longitudinal surgical clerkship (LC). The preclinical surgery pilot course took place before COVID-19 disruptions, and the EMLR and LC experiences took place virtually. Specialty choice was examined in the EMLR and LC cohorts. Performance on the NBME surgical assessments was analyzed among students enrolled in the traditional clerkship and pandemic-disrupted courses and compared to national data using a two-sample t-test. RESULTS Compared to preclinical students, EMLR and LC students demonstrated improvements in their perceived surgical clerkship readiness. After the 3-week EMLR course, in the setting of completing only one-third of the clerkship year, students had an average NBME Surgical Self-Assessment Exam score of 72 (SD 12), comparable to the national average of 71 (SD 9) p = 0.33. The average shelf exam score for students (N = 24) enrolled in the traditional clerkship (block 1), prior to COVID-19, disruptions was 66 (SD 9) compared to an average score of 69 (SD 9) for the longitudinal clerkship students (N = 20) that took the shelf exam later in the year (p = 0.36). COVID-19 disruptions did not affect specialty choice. All LC students have decided on a specialty; 50% nonsurgical and 50% surgical. From the EMLR cohort, 36% and 38% plan to pursue surgical and nonsurgical specialties, respectively, with 26% still undecided. CONCLUSIONS Courses were well-liked and will be implemented in future clerkships. Surgical educators demonstrated flexibility and creativity in the development of the EMLR. Despite COVID-19 disruptions, medical students made progress in their clinical skills and foundational science knowledge. COVID-19 disruptions did not appear to impact specialty choice.
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Affiliation(s)
| | - Sophia Hernandez
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Alexander S Kim
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Andre R Campbell
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Edward H Kim
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Adnan Alseidi
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Elizabeth C Wick
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Julie Ann Sosa
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Jessica Gosnell
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Matthew Y C Lin
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Sanziana A Roman
- University of California, San Francisco Department of Surgery, San Francisco, California.
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Johnson CL, Schwartz H, Greenberg A, Hernandez S, Nnamani Silva ON, Wong LE, Martins DB, Broering JM, Kumar SB, Bongiovanni T, Wick EC, Roman SA. Patient Perceptions on Barriers and Facilitators to Accessing Low-acuity Surgery During COVID-19 Pandemic. J Surg Res 2021; 264:30-36. [PMID: 33744775 PMCID: PMC7867400 DOI: 10.1016/j.jss.2021.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The onset of the COVID-19 pandemic led to the postponement of low-acuity surgical procedures in an effort to conserve resources and ensure patient safety. This study aimed to characterize patient-reported concerns about undergoing surgical procedures during the pandemic. METHODS We administered a cross-sectional survey to patients who had their general and plastic surgical procedures postponed at the onset of the pandemic, asking about barriers to accessing surgical care. Questions addressed dependent care, transportation, employment and insurance status, as well as perceptions of and concerns about COVID-19. Mixed methods and inductive thematic analyses were conducted. RESULTS One hundred thirty-five patients were interviewed. We identified the following patient concerns: contracting COVID-19 in the hospital (46%), being alone during hospitalization (40%), facing financial stressors (29%), organizing transportation (28%), experiencing changes to health insurance coverage (25%), and arranging care for dependents (18%). Nonwhite participants were 5 and 2.5 times more likely to have concerns about childcare and transportation, respectively. Perceptions of decreased hospital safety and the consequences of possible COVID-19 infection led to delay in rescheduling. Education about safety measures and communication about scheduling partially mitigated concerns about COVID-19. However, uncertainty about timeline for rescheduling and resolution of the pandemic contributed to ongoing concerns. CONCLUSIONS Providing effective surgical care during this unprecedented time requires both awareness of societal shifts impacting surgical patients and system-level change to address new barriers to care. Eliciting patients' perspectives, adapting processes to address potential barriers, and effectively educating patients about institutional measures to minimize in-hospital transmission of COVID-19 should be integrated into surgical care.
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Affiliation(s)
- Christopher L Johnson
- School of Medicine, University of California San Francisco (UCSF), San Francisco, California
| | - Hope Schwartz
- School of Medicine, University of California San Francisco (UCSF), San Francisco, California
| | - Anya Greenberg
- School of Medicine, University of California San Francisco (UCSF), San Francisco, California
| | - Sophia Hernandez
- School of Medicine, University of California San Francisco (UCSF), San Francisco, California
| | - Ogonna N Nnamani Silva
- School of Medicine, University of California San Francisco (UCSF), San Francisco, California
| | - Laura E Wong
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California
| | - Deborah B Martins
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California
| | - Jeanette M Broering
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California
| | - Sandhya B Kumar
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California; Department of Surgery, Zuckerberg San Francisco General Hospital (ZSFGH), San Francisco, California
| | - Tasce Bongiovanni
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California; Department of Surgery, Zuckerberg San Francisco General Hospital (ZSFGH), San Francisco, California
| | - Elizabeth C Wick
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California
| | - Sanziana A Roman
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California.
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Nnamani Silva ON, Ammanuel SG, Segobiano BM, Edwards CS, Hoffman WY. Assessing the Readability of Online Patient Education Resources Related to Gynecomastia. Ann Plast Surg 2021; 87:123-125. [PMID: 33346559 DOI: 10.1097/sap.0000000000002620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Internet has a plethora of online patient education resources for many symptoms and diseases. National medical governing bodies recommend that patient education materials are written at or below the eighth-grade level, and the literature suggests that health literacy has been linked to increased adherence to treatment regimens and improved outcomes. The primary aim of the study is to assess the readability of online patient materials relating to gynecomastia and ascertain the availability of patient materials in non-English languages. METHODS The readability of patient education materials relating to gynecomastia for academic-based websites and nonacademic websites was assessed using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG). The prevalence of non-English patient education materials was assessed for both academic-based and nonacademic websites. RESULTS Fifty-eight documents were collected across academic websites. Overall median values were 10.7 for the FKGL, 47.0 for the FRE, and 11.4 for the SMOG. For the 10 nonacademic institutions, the overall median values were 10.6 for the FKGL, 45.2 for the FRE, and 10.8 for the SMOG. No appreciable differences were observed for readability when stratified by region or source. The prevalence of non-English patient materials was 19.1% across institutions. None of the noninstitutional materials had information in non-English languages. CONCLUSIONS The readability of patient education materials related to gynecomastia is at higher levels than recommended by national organizations. There are limited non-English patient education materials. Future efforts should focus on improving the readability and accessibility of patient materials.
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Affiliation(s)
| | - Simon G Ammanuel
- From the University of California, San Francisco School of Medicine, San Francisco, CA
| | - Brett M Segobiano
- College of Arts and Letters, University of Notre Dame, South Bend, IN
| | - Caleb S Edwards
- From the University of California, San Francisco School of Medicine, San Francisco, CA
| | - William Y Hoffman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
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Hernandez S, Nnamani Silva ON, Lin MYC, Kim EH, Sosa JA, Campbell AR, O'Sullivan PS, Roman SA. Near-Peer Learning During the Surgical Clerkship: A Way to Facilitate Learning After a 15-Month Preclinical Curriculum. J Surg Educ 2021; 78:828-835. [PMID: 32933886 DOI: 10.1016/j.jsurg.2020.08.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To investigate the performance and perspectives of third-year medical students (MS3s) participating in near-peer learning (NPL) sessions during their core surgical clerkship following a 15-month preclerkship curriculum. DESIGN An evaluation study of 7 NPL sessions developed and implemented by fourth-year medical students (MS4s) held from March 2019 to February 2020. MS4s taught 1-2 sessions per rotation that included test taking strategies, illness script development, radiology review, case-based multiple-choice questions, and rapid review. Participants completed a questionnaire with 11 seven-point Likert and open-ended questions after each session. Analyses included quantitative comparison of shelf score averages between NPL participants and nonparticipants and qualitative content analysis for open-ended questions. SETTING Surgical clerkship at the University of California, San Francisco. PARTICIPANTS Forty-eight (32%) MS3s participated, with an average attendance of 10 students per rotation. Thirty-three (69%) participants completed the questionnaire. RESULTS MS3s enjoyed the session (6.9 ± 0.4), improved their knowledge (6.8 ± 0.5), and felt more prepared for the surgery shelf examination (6.5 ± 0.6). MS4 leaders found that MS3s always wanted radiology review, and their interest in test taking strategies and illness script development declined across the clerkship year. Participants had lower shelf exam scores compared to nonparticipants (68.1 vs 71.4, respectively; p = 0.04, ES = 0.03). Shelf exam scores increased over time in both cohorts. Each group had 2 shelf exam failures. Qualitative analysis suggests that MS3s appreciated the NPL's tailored approach and exam demystification, with a desire for increased NPL integration into the clerkship. CONCLUSION Students participating in NPL were satisfied with the sessions. Participants may have been students who struggled as indicated by shelf exam scores and appreciated the support. The shift in preferred topics across the blocks reflects the students' development during clerkships. Near-peer teachers should adjust sessions over time to fit students' evolving needs.
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Affiliation(s)
- Sophia Hernandez
- University of California, San Francisco School of Medicine, San Francisco, California
| | | | - Matthew Y C Lin
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Edward H Kim
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Julie Ann Sosa
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Andre R Campbell
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Patricia S O'Sullivan
- University of California, San Francisco Department of Surgery, San Francisco, California
| | - Sanziana A Roman
- University of California, San Francisco Department of Surgery, San Francisco, California.
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Hennein L, Spaulding KA, Karlegan V, Nnamani Silva ON, de Alba Campomanes AG. Follow-Up Rates at a Free Ophthalmology Clinic at a Homeless Shelter. Journal of Academic Ophthalmology 2021. [DOI: 10.1055/s-0041-1726288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Objective Eye health among the homeless community is important, as poor vision makes this population vulnerable and adds significantly to the social and health burden. There is limited knowledge on patient follow-up rates for their eye conditions and barriers to accessing care in this population. The purpose of this retrospective chart review study is to examine follow-up rates and barriers to care for patients referred from a free, medical-student run ophthalmology clinic at a homeless shelter.
Methods All patients evaluated at a free ophthalmology clinic from September 2017 to September 2018 were included; no patients were excluded. If indicated, patients were referred for advanced ophthalmologic care at a local county hospital and free eyeglasses at a nonprofit organization. Primary outcomes were follow-up rates at the county hospital and nonprofit organization. Secondary outcomes included prespecified baseline variables hypothesized to be associated with follow-up rates. These categorical variables were compared with Chi-square testing to determine their association with follow-up rates. The hypothesis being tested was formulated before data collection.
Results Of the 68 patients, 84% were males with a mean age of 50 years. Overall, 40 patients were referred for free eyeglasses and 17 to the county hospital. Of those referred, 14 patients presented for free eyeglasses and 7 presented to the county hospital. About 79% of patients with a pre-established primary care provider presented to their appointment compared with 20% of those without one (p = 0.03). The 44% of patients with a high school diploma presented while all patients without a high school diploma failed to present (p = 0.04). Vision-threatening conditions identified at the shelter clinic did not affect follow-up rates (p = 0.79).
Conclusion Less than half of referred patients in our study presented to their appointments. Barriers to presentation included no primary care provider and lower educational status, with no improvement in follow-up rates among those referred for vision-threatening conditions. Interventions such as health coaching with particular attention to educating patients on the effects of vision-threatening conditions may be warranted, particularly for those not looped into the health care system and those of lower educational attainment.
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Affiliation(s)
- Lauren Hennein
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Kimberly A. Spaulding
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Veronika Karlegan
- Pre-Health Professions Certificate Program, San Francisco State University, San Francisco, California
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Weiser L, Nnamani Silva ON, Thompson A, Hernandez S, Kelly YM, Kim EH, Campbell AR, Sosa JA, Gosnell J, Alseidi A, Lin MYC, Roman SA. Paying it forward: A pilot program for near-peer support for medical students during the surgery clerkship. Am J Surg 2021; 222:501-503. [PMID: 33741184 DOI: 10.1016/j.amjsurg.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Lucas Weiser
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Avery Thompson
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Sophia Hernandez
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Yvonne M Kelly
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Edward H Kim
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Andre R Campbell
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Julie Ann Sosa
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Jessica Gosnell
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Adnan Alseidi
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Matthew Y C Lin
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA
| | - Sanziana A Roman
- University of California, San Francisco Department of Surgery, San Francisco, CA, USA.
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Nnamani Silva ON. A Special Thank You to the Plastic and Reconstructive Surgery Medical Education Community During the COVID-19 Pandemic. Ann Plast Surg 2021; 86:125. [PMID: 33095553 PMCID: PMC7813219 DOI: 10.1097/sap.0000000000002568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/30/2020] [Accepted: 08/30/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT In light of the most competitive match in history, the plastic and reconstructive surgery application process is in the midst of unprecedented times due to the COVID-19 pandemic. In-person visiting subinternships and interview processes have transitioned to online formats. The American Council of Academic Plastic Surgeons, program directors, coordinators, faculty, and residents have demonstrated an outstanding commitment to providing meaningful experiences for prospective applicants. The passion of the field of plastic and reconstructive surgery is palpable, and the innovative virtual experiences have resulted in the formation of a community despite the lack of in-person experiences.
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Nnamani Silva ON, Hernandez S, Kim EH, Kim AS, Gosnell J, Roman SA, Lin MYC. Surgery Clerkship Curriculum Changes at an Academic Institution during the COVID-19 Pandemic. J Surg Educ 2021; 78:327-331. [PMID: 32888850 PMCID: PMC7430287 DOI: 10.1016/j.jsurg.2020.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/23/2020] [Accepted: 07/13/2020] [Indexed: 06/02/2023]
Abstract
PROBLEM The COVID-19 pandemic has suspended the surgery clinical clerkship for third-year medical students at numerous institutions across the world. As a result, educators and students have adapted rapidly. There is a paucity of precedents regarding urgent and brusque formal curricular changes for medical students enrolled in surgical clinical rotations. APPROACH The University of California, San Francisco Department of Surgery created a surgically focused extended mastery learning rotation (EMLR). The surgery clerkship leadership designed a curriculum consisting of multiple learning strategies compatible with virtual learning environments. The primary aims of the newly developed EMLR were to help students consolidate their foundational science knowledge before their return to clinical medicine in an altered learning environment. The EMLR is currently underway, and further studies are necessary to evaluate its effectiveness.
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Affiliation(s)
- Ogonna N Nnamani Silva
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Sophia Hernandez
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Edward H Kim
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Alexander S Kim
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Jessica Gosnell
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Sanziana A Roman
- Department of Surgery, University of California San Francisco, San Francisco, California.
| | - Matthew Y C Lin
- Department of Surgery, University of California San Francisco, San Francisco, California
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Nnamani Silva ON, Nguyen AB, Hoffman WY. Craniectomy with microvascular flap reconstruction in a patient taking infliximab for vasculitis. BMJ Case Rep 2020; 13:13/12/e238614. [PMID: 33298502 DOI: 10.1136/bcr-2020-238614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
For patients whose vasculitis is managed with biologic medications, no reports or evidence-based guidance exists regarding the perioperative management of microvascular flaps. We present a case of a 78-year-old patient with Takayasu's arteritis (TA) and diabetes mellitus who was taking infliximab and underwent wide local excision of squamous cell carcinoma, craniectomy and reconstruction with a latissimus dorsi flap. TA, an immune-mediated large cell vasculitis characterised by granuloma formation, tends to affect larger vessels and aortic branches. The typical localisation of this condition raises concerns about potentially compromised pedicle and recipient vessels (ie, superficial temporal arteries), which could hinder postoperative flap success. Discontinuation of infliximab 4 weeks before surgery and resumption 6 weeks after led to favourable results. This case addresses the gap in the literature concerning stopping and restarting biologic drugs in the perioperative setting and documents a successful course of a microvascular procedure in a patient with vasculitis.
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Affiliation(s)
- Ogonna N Nnamani Silva
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Audrey B Nguyen
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California, USA
| | - William Y Hoffman
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California, USA
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Nnamani Silva ON, Hennein L, Ramanathan S. Ophthalmology Clinic for the Homeless in San Francisco: Experiences and Findings. Journal of Academic Ophthalmology 2020. [DOI: 10.1055/s-0040-1718563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Background Homelessness is a growing area of concern for communities around the world and homeless individuals are often not connected to healthcare and, consequently, this population is often left out of crucial studies that influence the care provided at public hospitals. The main aim of this study is to examine the prevalence of eye disease, demographics, and common comorbidities of patients who utilized the student-run, institution-sponsored ophthalmology clinic for homeless individuals across a 2-year period. A secondary aim was to elucidate the role that student-run clinics can play in connecting the homeless population to healthcare and community services.
Methods A retrospective cohort study examined individuals who utilized a student-run, free ophthalmology clinic at two homeless shelters in an urban community for 2 years, from 2017 to 2019.
Results A volunteer sample consisting of 123 residents at two homeless shelters who signed up to receive an eye examination at the free eye clinic. The average age of participants was 51 years, with 74% identifying as male, and the largest number of patients identified as African-American/Black (33%) and White (27%). The most prevalent eye disease was refractive error at a prevalence rate of 70% with presbyopia and myopia accounting for 77% and 42% of the refractive error diagnoses, respectively. A visually significant cataract was the second most prevalent pathology, which was diagnosed in 13% of patients. Diabetic retinopathy had a prevalence rate of 11%. Glaucoma had a prevalence rate of 20%. When stratifying the prevalence of glaucoma by race/ethnicity, Black/African-Americans had a prevalence rate of 30% and Asians had a prevalence rate of 29%.
Conclusion This study demonstrated a high prevalence of eye disease among the homeless population highlighting the major role that social determinants of health play in patient outcomes. Student-run ophthalmology clinics provide rich educational experiences, and most importantly, connect homeless populations to essential ophthalmologic care.
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Affiliation(s)
| | - Lauren Hennein
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Saras Ramanathan
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
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Huang L, Nnamani Silva ON, Wu Y, Zeng Y, Chen T, Yan Y, Chen X, Yu Y, Shi W, Ye W, Song L, Yang X, Chen X, Zeng J, Han Y, Hu J. Causes of vision loss at China's largest blind school during a period of significant economic growth: 2008-2016. J AAPOS 2020; 24:153.e1-153.e5. [PMID: 32473287 DOI: 10.1016/j.jaapos.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/12/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the different causes of vision loss and school-based treatment regimens at Quanzhou Blind School (QBS), China's largest blind school, in 2008 and 2016. METHODS In 2008, 144 students received comprehensive eye examinations along with a complete family and ophthalmic history; in 2016, 125 students were examined. Vision loss was categorized into visual impairment and blindness classifications based on WHO guidelines. The etiologies of impairment and blindness in 2008 were compared to those in 2016 using the Fisher exact test. The prevalence and type of visual aids were also analyzed during this period. RESULTS The leading cause of visual impairment significantly shifted from corneal scarring in 2008 to retinopathy of prematurity (ROP) in 2016 (P = 0.020). Congenital cataracts remained the leading cause of blindness in 2008 and 2016. In 2016 there was a significant increase in the use of visual aids, with 63.2% of students using them in 2016 compared to 8.3% in 2008 (P = 0.0001). CONCLUSIONS Between 2008 and 2016, the leading cause of visual impairment shifted from corneal scarring to ROP, while congenital cataracts remained the leading cause of blindness.
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Affiliation(s)
- Lijuan Huang
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China; Institute of China Assistive Technology, Research Center for Assistive Technology in Visual Impairment, Fujian Medical University, Fuzhou, Fujian, China
| | | | - Yuyu Wu
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China; Institute of China Assistive Technology, Research Center for Assistive Technology in Visual Impairment, Fujian Medical University, Fuzhou, Fujian, China
| | - Yiming Zeng
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China; Institute of China Assistive Technology, Research Center for Assistive Technology in Visual Impairment, Fujian Medical University, Fuzhou, Fujian, China
| | - Ting Chen
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China; Institute of China Assistive Technology, Research Center for Assistive Technology in Visual Impairment, Fujian Medical University, Fuzhou, Fujian, China
| | - Yuyuan Yan
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China; Institute of China Assistive Technology, Research Center for Assistive Technology in Visual Impairment, Fujian Medical University, Fuzhou, Fujian, China
| | - Xuelan Chen
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China; Institute of China Assistive Technology, Research Center for Assistive Technology in Visual Impairment, Fujian Medical University, Fuzhou, Fujian, China
| | - Yang Yu
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China; Institute of China Assistive Technology, Research Center for Assistive Technology in Visual Impairment, Fujian Medical University, Fuzhou, Fujian, China
| | - Wenjian Shi
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China; Institute of China Assistive Technology, Research Center for Assistive Technology in Visual Impairment, Fujian Medical University, Fuzhou, Fujian, China
| | - Wenwen Ye
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China; Institute of China Assistive Technology, Research Center for Assistive Technology in Visual Impairment, Fujian Medical University, Fuzhou, Fujian, China
| | - Lei Song
- Institute of China Assistive Technology, Research Center for Assistive Technology in Visual Impairment, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Xiang Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Junwen Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Ying Han
- Department of Ophthalmology, University of California San Francisco School of Medicine, San Francisco, California.
| | - Jianmin Hu
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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