1
|
Dionyssiou D, Nguyen D, Topalis A, Deptula P, Paukshto M, Zaitseva T, Demiri E, Cheva A, Rockson S. Treatment of Rat Lymphedema by Propeller Lymphatic Tissue Flap Combined with Nanofibrillar Collagen Scaffolds. J Reconstr Microsurg 2024; 40:145-155. [PMID: 37142251 DOI: 10.1055/a-2086-0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/06/2023]
Abstract
BACKGROUND The aim of our study was to evaluate a new propeller vascularized lymphatic tissue flap (pVLNT) combined with aligned nanofibrillar collagen scaffolds (CS) (BioBridge) in reducing lymphedema in the rat lymphedema model. METHODS Unilateral left hindlimb lymphedema was created in 15 female Sprague-Dawley rats following inguinal and popliteal lymph nodes (LN) resection and radiation. An inguinal pVLNT was elevated from the contralateral groin and transferred through a skin tunnel to the affected groin. Four collagen threads were attached to the flap and inserted in the hindlimb at the subcutaneous level in a fan shape. The three study groups consisted of group A (control), group B (pVLNT), and group C (pVLNT + CS). Volumetric analysis of both hindlimbs was performed using micro-computed tomography imaging before the surgery (at initial time point) and then at 1 and 4 months, postoperatively, and the relative volume difference (excess volume) was measured for each animal. Lymphatic drainage was assessed by indocyanine green (ICG) fluoroscopy for number and morphology of new collectors and the time required for ICG to move from injection point to the midline. RESULTS Four months after the induction of lymphedema, an increased relative volume difference remained in group A (5.32 ± 4.74%), while there was a significant relative volume reduction in group B (-13.39 ± 8.55%) and an even greater reduction in group C (-14.56 ± 5.04%). ICG fluoroscopy proved the functional restoration of lymphatic vessels and viability of pVLNT in both B and C groups. Notably, only group C demonstrated statistically significant improvements in lymphatic pattern/morphology and in the number of lymphatic collectors as compared with the control group A. CONCLUSION The pedicle lymphatic tissue flap combined with SC is an effective procedure for the treatment of lymphedema in rats. It can be easily translated into treatment of humans' lower and upper limb lymphedema and further clinical studies are warranted.
Collapse
Affiliation(s)
- Dimitrios Dionyssiou
- Department of Plastic Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dung Nguyen
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California
| | - Anastasios Topalis
- Department of Plastic Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Peter Deptula
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California
| | | | | | - Efterpi Demiri
- Department of Plastic Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Cheva
- Laboratory of Pathology, Medical School, Aristotle University, Thessaloniki, Greece
| | - Stanley Rockson
- Center for Lymphatic and Venous Disorders, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
2
|
Yedikian T, Yoshida R, McCullough M, Deptula P, Kulber D. An Uncommon Case of Upper-Extremity Mucormycosis in a Patient With Acute Myeloid Leukemia. J Hand Surg Glob Online 2024; 6:123-125. [PMID: 38313606 PMCID: PMC10837283 DOI: 10.1016/j.jhsg.2023.11.001] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 02/06/2024] Open
Abstract
Upper-extremity mucormycosis is a rare, life-threatening fungal infection mainly affecting immunocompromised patients. We report a case of a 30-year-old woman with acute myelogenous leukemia who developed this infection during her hospital stay. The culprit was Mucorales, a subgroup of Zygomycetes species known for fast-progressing, highly lethal infections. She presented with fever, chills, and a lesion on her left forearm that worsened despite initial broad-spectrum antibiotics. A punch biopsy confirmed the diagnosis, leading to antifungal therapy with isavuconazonium sulfate and later amphotericin B, combined with surgery. Timely intervention is critical because delayed treatment can result in severe complications and death. Early suspicion, histology, microscopy, and fungal cultures are vital for accurate diagnosis. Treatment primarily involves amphotericin B, whereas adjunctive therapies such as topical amphotericin B and hyperbaric oxygen show promise. This case underscores the importance of prompt medical and surgical action, enhancing early detection of mucormycosis in immunocompromised patients.
Collapse
Affiliation(s)
- Teren Yedikian
- Department of Hand and Upper Extremity Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ryu Yoshida
- Department of Hand and Upper Extremity Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Meghan McCullough
- Department of Hand and Upper Extremity Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Peter Deptula
- Department of Hand and Upper Extremity Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - David Kulber
- Department of Hand and Upper Extremity Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| |
Collapse
|
3
|
Nguyen D, Dionyssiou D, Zaitseva TS, Zhou AT, Sue G, Deptula P, Moroz MA, Tabada P, Rockson SG, Paukshto MV, Cheng MH, Huang NF. Development of a rat model of lymphedema and the implantation of a collagen-based medical device for therapeutic intervention. Front Cardiovasc Med 2023; 10:1214116. [PMID: 37469481 PMCID: PMC10353614 DOI: 10.3389/fcvm.2023.1214116] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
Secondary lymphedema is a common condition among cancer survivors, and treatment strategies to prevent or treat lymphedema are in high demand. The development of novel strategies to diagnose or treat lymphedema would benefit from a robust experimental animal model of secondary lymphedema. The purpose of this methods paper is to describe and summarize our experience in developing and characterizing a rat hindlimb model of lymphedema. Here we describe a protocol to induce secondary lymphedema that takes advantage of micro computed tomography imaging for limb volume measurements and visualization of lymph drainage with near infrared imaging. To demonstrate the utility of this preclinical model for studying the therapeutic benefit of novel devices, we apply this animal model to test the efficacy of a biomaterials-based implantable medical device.
Collapse
Affiliation(s)
- Dung Nguyen
- Department of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, United States
| | | | | | - Anna T. Zhou
- Department of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, United States
| | - Gloria Sue
- Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Peter Deptula
- Department of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, United States
| | - Maxim A. Moroz
- Department of Radiology, Stanford University, Stanford, CA, United States
| | - Peter Tabada
- Fibralign Corp, Union City, Thessaloniki, CA, United States
| | - Stanley G. Rockson
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
| | | | | | - Ngan F. Huang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States
- Center for Tissue Regeneration, Repair and Restoration, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Chemical Engineering, Stanford University, Palo Alto, CA, United States, United States
| |
Collapse
|
4
|
Deptula P, Zak Y, Dua M, Wapnir I, Nguyen D. Minimizing Postoperative Pain in Autologous Breast Reconstruction With the Omental Fat-Augmented Free Flap. Ann Plast Surg 2022; 88:S374-S378. [PMID: 35180753 DOI: 10.1097/sap.0000000000003084] [Citation(s) in RCA: 0] [Impact Index Per Article: 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
INTRODUCTION The omental fat-augmented free flap (O-FAFF) is a recently developed technique for autologous breast reconstruction. Our aim of the study is to evaluate the outcomes of our early case series. We assess the O-FAFF donor site morbidity in terms of postoperative pain, narcotic, and antiemetic use. METHODS A retrospective analysis of patients undergoing O-FAFF from 2019 to 2021 was performed. Patients were evaluated for demographic data, operative time, hospital course, and complications. Mean pain scores (1-10 scale) and narcotic pain medication use in oral morphine equivalents and doses of antiemetic medications during their hospital course were analyzed. We compared outcomes of our O-FAFF group with those of a control group of patients who underwent breast reconstruction with traditional free abdominal tissue transfer. RESULTS A total of 14 patients underwent O-FAFF breast reconstruction, representing 23 breasts. Patients had an average age of 48.5 years (±2.3 years) and body mass index of 22.6 kg/m 2 (±1.09 kg/m 2 ). Average follow-up was 232 days (±51 days). Average mastectomy weight was 245.6 g (±30.2 g) and average O-FAFF weight was 271 g (±31.7 g). Average pain scores on postoperative day 1 (POD1), POD2, and POD3 were 3.1 (±0.28), 2.8 (±0.21), and 2.1 (±0.35), respectively. The average narcotic use by patients in oral morphine equivalents on POD1, POD2, and POD3 are 24.3 (±5.5), 21.9 (±4.6), and 6.2 (±2.4), respectively. Total narcotic use during hospital stay was 79.4 mg (±11.1 mg). Average pain scores and narcotic use are significantly lower when compared with a previously published cohort of patients who underwent autologous breast reconstruction with free abdominal tissue transfer ( P < 0.05). Average antiemetic use was lower in the O-FAFF group compared with the control group: 3.5 versus 4.8 doses ( P = 0.6). Hospital length of stay was 3.0 days (±0.0 days). No complications were noted (0%). Patients were universally satisfied with their reconstructive outcome (100%). CONCLUSIONS The O-FAFF is proven to be a viable method of autologous breast reconstruction. Early series of patients undergoing O-FAFF reconstruction suggest a lower donor site morbidity as demonstrated by lower postoperative pain scores and lower consumptions of narcotic pain medications.
Collapse
Affiliation(s)
- Peter Deptula
- From the Department of Surgery, Stanford University Medical Center, Stanford, CA
| | | | | | | | | |
Collapse
|
5
|
Nguyen D, Zaitseva TS, Zhou A, Rochlin D, Sue G, Deptula P, Tabada P, Wan D, Loening A, Paukshto M, Dionyssiou D. Lymphatic regeneration after implantation of aligned nanofibrillar collagen scaffolds: Preliminary preclinical and clinical results. J Surg Oncol 2021; 125:113-122. [PMID: 34549427 DOI: 10.1002/jso.26679] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/10/2021] [Accepted: 09/08/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND We tested our hypothesis that implantation of aligned nanofibrillar collagen scaffolds (BioBridge™) can both prevent and reduce established lymphedema in the rat lymphedema model. Our authors report clinical cases that demonstrate new lymphatic formation guided by BioBridge™ as seen by near-infrared (NIR) fluoroscopy and magnetic resonance (MR) lymphography. METHODS A rat lymphedema model was utilized. A prevention group received implantation of BioBridge™ immediately after lymphadenectomy. A lymphedema group received implantation of BioBridge™ with autologous adipose-derived stem cells (ADSC; treatment group) or remained untreated (control group). All subjects were observed for 4 months after lymphadenectomy. The hindlimb change was evaluated using computed tomography-based volumetric analysis. Lymphagiogenesis was assessed by indocyanine green (ICG) lymphography. RESULTS Animals in the treatment group showed a reduction in affected limb volume. Animals in the prevention group showed no increase in the affected limb volume. ICG fluoroscopy demonstrated lymph flow and formation of lymphatics toward healthy lymphatics. CONCLUSIONS In the rat lymphedema model, implantation of BioBridge™ at the time of lymph node removal prevents the development of lymphedema. Treatment of established lymphedema with the BioBridge™ and ADSC reduces lymphedema. New lymphatic vessels are demonstrated by NIR fluoroscopy and MR lymphography. These findings have implications for the treatment of lymphedema in human subjects.
Collapse
Affiliation(s)
- Dung Nguyen
- Division of Plastic Surgery, Stanford University, Stanford, California, USA
| | | | - Anna Zhou
- Division of Plastic Surgery, Stanford University, Stanford, California, USA
| | - Danielle Rochlin
- Division of Plastic Surgery, Stanford University, Stanford, California, USA
| | - Gloria Sue
- Division of Plastic Surgery, Stanford University, Stanford, California, USA
| | - Peter Deptula
- Division of Plastic Surgery, Stanford University, Stanford, California, USA
| | | | - Derrick Wan
- Division of Plastic Surgery, Stanford University, Stanford, California, USA
| | - Andreas Loening
- Division of Plastic Surgery, Stanford University, Stanford, California, USA
| | | | - Dimitrios Dionyssiou
- Department of Plastic Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
6
|
Abstract
Autologous fat grafting is commonly used in plastic and reconstructive surgery, but its indications are less well known in the hand surgery literature. Autologous fat grafting is frequently used for its anti-inflammatory, proangiogenic, and regenerative properties, which can be useful in treating the hand and upper extremity. We present a summary of the current literature on autologous fat grafting in the hand and upper extremity and discuss the applications, outcomes, techniques, safety, and level of evidence.
Collapse
Affiliation(s)
- Peter Deptula
- Division of Plastic and Reconstructive Surgery, Stanford Medical Center, Stanford, CA
| | - Paige Fox
- Division of Plastic and Reconstructive Surgery, Stanford Medical Center, Stanford, CA.
| |
Collapse
|
7
|
Deptula P, Yesantharao P, Wapnir I, Nguyen D. Staged Approach to Autologous Reconstruction in the Ptotic Breast: A Comparative Study. Ann Plast Surg 2021; 86:S395-S402. [PMID: 33470622 DOI: 10.1097/sap.0000000000002725] [Citation(s) in RCA: 0] [Impact Index Per Article: 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 Nipple-sparing mastectomy (NSM) and autologous breast reconstruction are associated with higher patient satisfaction, quality of life, and aesthetic outcome. For patients with naturally ptotic breasts, this ideal reconstructive treatment of NSM and autologous breast reconstruction poses a challenge. We describe our experience in treating patients with ptotic natural breasts using a 2-staged approach: oncoplastic breast reduction in the first stage followed by nipple-sparing mastectomy and immediate autologous reconstruction in a second stage. METHODS We reviewed cases of patients with grade III ptosis who underwent a staged reconstruction approach with reduction mammaplasty followed by NSM and immediate reconstruction with an abdominally based free flap (2014-2019). We compared this group of patients to a second group who underwent staging with a technique of nipple-areola complex (NAC) devascularization. A survey was administered to assess for patient satisfaction and aesthetic outcome 1 year after the second stage procedure. RESULTS Eight patients were identified in our reduction group, and 9 patients were identified in our devascularization group. No cases of total NAC necrosis were noted in either group (0%). Two cases of partial NAC necrosis were noted in the devascularization group (11%), whereas none were observed in the reduction group. All patients were satisfied with final outcome (100%, P = 1.0). Aesthetic scores across all factors were higher in the reduction group. Scores for overall outcome (4.6 vs 3.7, P = 0.04), natural appearance (4.8 vs 3.8, P = 0.01), breast contour (4.8 vs 3.2, P = 0.002), and position of breasts (5.0 vs 3.9, P = 0.03) were significantly higher in the reduction group. CONCLUSIONS Breast ptosis no longer represents a contraindication for patients desiring nipple-sparing mastectomy and immediate autologous reconstruction. This series supports the use of a 2-staged approach with reduction mammaplasty in patients with naturally ptotic breasts. A staged reduction approach may offer fewer NAC complications while also allowing for superior aesthetic outcomes.
Collapse
Affiliation(s)
- Peter Deptula
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA
| | - Pooja Yesantharao
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Irene Wapnir
- Section of Surgical Oncology, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Dung Nguyen
- From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA
| |
Collapse
|
8
|
Abstract
The development of surgical capacity in the developing world is essential to address the global burden of surgical disease. Training local surgeons in low-income and middle-income countries is critical in this endeavor. The challenges to teaching hand surgery in the developing world include a shortage of local faculty, absence of a defined curriculum, no competency-based evaluation systems, few subspecialty training opportunities, and lack of financial support. To teach hand surgery in the developing world effectively, the authors suggest principles and components of a global training curriculum.
Collapse
Affiliation(s)
- Peter Deptula
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA 94304, USA.
| | | | - James Chang
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA 94304, USA
| |
Collapse
|
9
|
Kiang L, Deptula P, Mazhar M, Murariu D, Parsa FD. Muscle-sparing blepharoplasty: a prospective left-right comparative study. Arch Plast Surg 2014; 41:576-83. [PMID: 25276652 PMCID: PMC4179364 DOI: 10.5999/aps.2014.41.5.576] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/22/2014] [Accepted: 07/26/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Standard upper blepharoplasty involves removal of both the skin and a portion of the underlying orbicularis oculi muscle. The senior author had observed sluggishness of eyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patients during the early postoperative period. He postulated that these findings could be due to orbicularis muscle excision. He therefore undertook a prospective study 27 years ago comparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid. METHODS A randomized, prospective, single-blinded study was designed using the fellow eye as an internal control. 22 patients undergoing upper blepharoplasty procedure requiring greater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, or previous eyelid surgery were selected. Upper blepharoplasty was performed with skin-only removal on one side, and combined skin-muscle removal on the other side. Patients were evaluated until six months after surgery except for two patients who were lost to follow-up after three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result were outcome measures scored by patient survey, the operating surgeon, and a blinded expert panel. RESULTS There were comparable aesthetic outcomes in both eyelids. The incidence of sluggish eyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelids where wide segments of muscle had been resected. CONCLUSIONS Muscle-sparing upper blepharoplasty produces similar aesthetic outcomes as conventional blepharoplasty, while significantly reducing the complications of sluggish eyelid closure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty.
Collapse
Affiliation(s)
- Lee Kiang
- Department of Ophthalmology, W.K. Kellogg Eye Center and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Peter Deptula
- Department of Surgery, Division of Plastic Surgery, University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA
| | - Momal Mazhar
- Department of Surgery, Division of Plastic Surgery, University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA
| | - Daniel Murariu
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Fereydoun Don Parsa
- Department of Surgery, Division of Plastic Surgery, University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA
| |
Collapse
|
10
|
Chun MBJ, Deptula P, Morihara S, Jackson DS. The refinement of a cultural standardized patient examination for a general surgery residency program. J Surg Educ 2014; 71:398-404. [PMID: 24797857 DOI: 10.1016/j.jsurg.2013.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 07/25/2013] [Revised: 09/21/2013] [Accepted: 10/11/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Recent articles have documented the importance of cultural competency in surgery. Surgical residency programs have used the Objective Structured Clinical Examinations or cultural standardized patient examinations as a training tool. Past studies evaluating cultural competency have noted the importance of including an observational (control) arm, which would allow for a more objective assessment of a resident's competency in this area. The purpose of our article is to present the results of a follow-up study to a pilot cultural standardized patient examination for surgery residents. METHODS All first-year surgery residents were required to participate in the videotaped cultural SP examination as part of the general surgery residency curriculum. Two measures were used to assess resident performance. On the day of the examination, the Cross-Cultural Care Survey was administered. The examination was assessed by the residents themselves, faculty observers, and standardized patients, using a written checklist that was developed to evaluate residents on all 6 Accreditation Council for Graduate Medical Education competencies. RESULTS The current study includes 20 first-year surgery residents from academic years 2011 to 2012 and 2012 to 2013. The examination of pretest differences in groups found that students born outside of the United States had significantly higher scores on attitude (t = -2.68, df = 18, p = 0.02), but no statistically significant differences were found in skillfulness or knowledge or in the overall rating scale. For the overall rating scale, change from pretest to posttest was statistically significant (t = -2.25, df = 18, p = 0.04). Further analysis revealed that students who were born in the United States demonstrated a significant increase in ratings (t = -3.08, df = 10, p = 0.01) whereas students who were not born in the United States showed little change (t = -0.35, df = 7, p = 0.74). These results show that the means in attitude scales changed little for all groups, but both white and US-born students showed greater improvement on skillfulness and knowledge. CONCLUSIONS Training and measurement of cross-cultural health care skills remains challenging. However, studies like these provide a good starting point from which to build.
Collapse
Affiliation(s)
- Maria B J Chun
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii.
| | - Peter Deptula
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Sarah Morihara
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | | |
Collapse
|
11
|
Deptula P, Chun MBJ. A literature review of professionalism in surgical education: suggested components for development of a curriculum. J Surg Educ 2013; 70:408-422. [PMID: 23618453 DOI: 10.1016/j.jsurg.2012.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/04/2012] [Accepted: 11/12/2012] [Indexed: 06/02/2023]
Abstract
BACKGROUND While it is evident that a surgeon must master medical knowledge and technical skill, there are other "soft skills" that are essential to a successful surgeon. One of these skills is professionalism. The challenge in surgical education lies in developing an effective professionalism curriculum and a related method of evaluation. OBJECTIVE Our review updates the literature and provides recommendations for improving instruction and evaluation of professionalism. DESIGN A literature review was conducted using PubMed, Google Scholar, and Web of Knowledge. We restricted our search to documents published from 2009 to 2012 that address methods of teaching and tools for assessing professionalism in surgical education. RESULTS Sixty-three documents were reviewed, with 14 fitting our search criteria for professionalism in surgical education completely. Other articles focused on the topics of professionalism in surgery, medical professionalism, and professionalism education in medical specialties other than surgery. CONCLUSIONS Development of a professionalism curriculum for surgical residents might begin with defining professionalism in terms of tangible behaviors. The program might also include a precurriculum preparatory course and simulation-based training. Residency programs must also maintain professionalism among its faculty. Assessment in the form of multisource feedback that is consistent with observable behavioral definitions of professionalism should also be considered in evaluating resident professionalism.
Collapse
Affiliation(s)
- Peter Deptula
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Hawaii, USA
| | | |
Collapse
|
12
|
Abstract
The ability of younger adults (mean age = 35.4 years) and older adults (mean age = 74.12 years) to use syntactic-semantic structure to identify words was examined by presenting word strings in random order and sentence order at subnormal speech rate, and at the speech reception threshold of the participant. Significant facilitation of word recognition occurred in the sentence strings in both age groups. Further, although the younger participants recognized more words in both the scrambled and sentences strings than the elderly, there was no significant difference in the percent benefit to word recognition in the sentence strings. The total pattern of results suggests that the deficit in the elderly participants was due either to age differences in memory and attention, high frequency hearing loss, response bias, or the application by the younger participants of linguistic rules not directly deriving from the presence of sentential structure.
Collapse
|