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Problems and Proposals of Their Solutions in Dermatology Residency Training: A Survey of Residents’ Opinions in Turkey  [PDF]
Sad?k Y?lmaz,Vahide Baysal Akkaya
Turkderm , 2009,
Abstract: Background and Design: There are many problems in dermatology residency training. The purpose of this study was to describe dermatology residents’ opinions about problems and proposals of their solutions of dermatology residency training programs in Turkey. In addition, by means of these estimations to propose efficient and standard curriculum components are aimed. Material and Method: A descriptive pilot study was designed and a questionnaire was prepared to describe the problems and suggestions for the solution in dermatology residency education. The survey was conducted between 20 June 2006 and 09 August 2006. The questions were prepared in accordance with a 1 to 5 Likert-type scale to evaluate the level of importance and sufficiency of the residents’ opinions. Results: Sixty seven (52 female, 15 male) residents responded to the survey. Based on the importance evaluation, although clinical-pathological meetings were the most important educational component, all other educational components were also indicated as important. Based on the sufficiency evaluation, the least sufficient educational components were photodermatology/laser therapy training (score, 1,82 of 5,0 ) and cosmetic dermatology (1,83). Sufficiency levels of educational components such as textbook review, translation and discussion (3,86) journal club (4,04), preparation of seminar (4,03) and allergy training (2,95) were evaluated as sufficient. All other educational components were determined as insufficient. Overall, the greatest discrepancies between the importance and sufficiency for all educational components were observed in cosmetic dermatology education (2,50).Conclusion: This is the first study to assess dermatology residency education based on the residents’ perspectives, in Turkey. These results show the necessity for review and revise of some of the elements and the necessity to prepare a standard curriculum of dermatology residency education. It is appropriate to concentrate on this item in the new program which will be prepared.
Dermatology Procedural and Surgical Skills Workshop for Medical and Physician Assistant Students  [PDF]
Julie Martin, Sheila Z. Jalalat, Richard F. Wagner
Journal of Cosmetics, Dermatological Sciences and Applications (JCDSA) , 2013, DOI: 10.4236/jcdsa.2013.33A2011
Abstract:

Background: Evidence indicating the limited amount of hands-on experience in the current era of medical training has raised concern regarding students’ development and potential deficiencies in the performance of basic procedural skills. Studies have demonstrated the value of surgical workshops for medical students; however evaluation of improved student performance during future clerkships or residencies has yet to be assessed. We initiated and evaluated a resident-led surgical skills workshop for students through the Department of Dermatology. Methods: Participants received instructions on surgical tools/techniques followed by hands-on practice. Anonymous surveys administered to 24 medical and physician assistant students assessed their skill level, confidence level, and likelihood of using surgical skills in future practice preand post-workshop using a 1 - 5 Likert scale. Overall experience was also assessed. Non-parametric bivariate tests were used for analysis to account for non-normal distribution of the data. Results: There was a statistically significant change in skill (p

Anterior Cranial Base Reconstruction with a Reverse Temporalis Muscle Flap and Calvarial Bone Graft  [PDF]
Seung Gee Kwon,Yong Oock Kim,Dong Kyun Rah
Archives of Plastic Surgery , 2012, DOI: http://dx.doi.org/10.5999/aps.2012.39.4.345
Abstract: Background Cranial base defects are challenging to reconstruct without serious complications.Although free tissue transfer has been used widely and efficiently, it still has the limitation ofrequiring a long operation time along with the burden of microanastomosis and donor sitemorbidity. We propose using a reverse temporalis muscle flap and calvarial bone graft as analternative option to a free flap for anterior cranial base reconstruction.Methods Between April 2009 and February 2012, cranial base reconstructions using anautologous calvarial split bone graft combined with a reverse temporalis muscle flap wereperformed in five patients. Medical records were retrospectively analyzed and postoperativecomputed tomography scans, magnetic resonance imaging, and angiography findings wereexamined to evaluate graft survival and flap viability.Results The mean follow-up period was 11.8 months and the mean operation time forreconstruction was 8.4±3.36 hours. The defects involved the anterior cranial base, includingthe orbital roof and the frontal and ethmoidal sinus. All reconstructions were successful. Viableflap vascularity and bone survival were observed. There were no serious complications exceptfor acceptable donor site depressions, which were easily corrected with minor procedures.Conclusions The reverse temporalis muscle flap could provide sufficient bulkiness to fill deadspace and sufficient vascularity to endure infection. The calvarial bone graft provides a rigidframework, which is critical for maintaining the cranial base structure. Combined anteriorcranial base reconstruction with a reverse temporalis muscle flap and calvarial bone graftcould be a viable alternative to free tissue transfer.
Inferior Turbinate Flap Combined with Septal Cartilage Interpositional Graft for Repair of Nasal Septal Perforation
A.M.M.E. Al-Bassiouny
Journal of Medical Sciences , 2008,
Abstract: The present study evaluated the use of inferior turbinate flap as an alternative technique for small to medium sized caudal septal perforations. Many techniques are available for surgical repair of nasal septal perforations. The availability of more than one technique emphasis that no single technique is uniformly suitable for all perforations. In this study, the inferior turbinate flap in addition to interpositional cartilage graft may be a good option that can be helpful in selected cases of caudal septal perforations. Patients were selected from the Dar al Shifa Hospital, Kuwait, complaining of recurrent epistaxis, nasal crustation and nasal blockage with history of septal surgery. Seventeen patients have been treated with this technique between May 2005 and December 2007; patients followed-up for 6 months. Complete closure achieved in 10 (59%) patients, incomplete closure occurred in 7 (41%) patients with flap necrosis. The use of inferior turbinate flap with interpositional cartilage graft for repair of septal perforation is a good option for repair of small to medium sized caudal septal perforations.
Laterally positioned flap associated with subepithelial connective tissue graft for coverage of isolated gingival recession  [PDF]
Thiago Marchi Martins,Alvaro Francisco Bosco,Guilherme Giovani Gazoni,Sabrina Feltrin Garcia
RSBO , 2011,
Abstract: Introduction: The coverage of denuded roots represents one of the challenges of periodontal treatment. Among the several techniques for this purpose is the laterally positioned flap, which has undergone some modifications since its first reports and is currently combined with other techniques such as subepithelial connective tissue graft. Objective: To report a case of a 41-year-old female patient who presented Miller class I gingival recession at labial surface of tooth #43. Case report: The main symptom of the patient was dentin hypersensitivity. Clinical and radiographic exams were performed and gingival inflammation due to the presence of bacterial plaque was diagnosed as the main cause of root recession. After basic periodontal treatment, surgery for root coverage was performed. Since the area adjacent to the recession showed a good amount of attached gingiva and no interproximal bone loss, the surgical technique of choice was a laterally positioned flap associated with a subepithelial connective tissue graft. Conclusion: Postoperative assessment showed complete root coverage, an increased keratinized gingival band, absence of dentin hypersensitivity, and an excellent esthetic outcome.
Repair of Extensive Composite Alar Defects with Single Stage Nasolabial Turnover Flap and Auricular Composite Graft
O.M. Oluwatosin
Nigerian Journal of Surgical Research , 2001,
Abstract: Extensive and total (through and through) loss of ala or lobule of the nose as seen in severe traumas and neglected tumours should be replaced by the three anatomical layers of skin, cartilage and vestibular lining. A technique of nasolabial turnover flap transfer covered by a two layered auricular chondrocutaneous graft is described for reconstructing such total losses >1.5 cm. The method of survival of large volume chondrocutaneous grafts is described as well as the advantages of this technique over other alternatives. (Nig J Surg Res 2001; 3: 133 – 138) KEY WORDS: Alar defects, Repair
Urethral reconstruction in severe hypospadias using buccal mucosa graft and penile skin flap
Majstorovi? Marko,Bi?i? Marta,Kojovi? Vladimir,Stojanovi? Borko
Srpski Arhiv za Celokupno Lekarstvo , 2011, DOI: 10.2298/sarh1110631m
Abstract: Introduction. Hypospadias represents the most frequent penile anomaly. The most challenging part of hypospadias surgery is urethral reconstruction. Many various tissues are used (local skin flaps, bladder mucosa grafts, buccal mucosa grafts etc.) for the reconstruction of the neourethra. Objective. Our aim was to evaluate advantages and disadvantages of combined buccal mucosa graft and penile skin flap in urethral reconstruction in severe hypospadias repair. Methods. Between December 2005 and August 2009, 48 patients with severe hypospadias, aged from nine months to 12 years (mean age 23 months) underwent surgery. Thirty-four (71%) had penoscrotal and 14 (29%) scrotal hypospadias. Ventral penile curvature was present in all cases, and was corrected by incision of the short urethral plate. Urethroplasty was performed using a buccal mucosa graft combined with dorsal penile skin flap. Results. Mean follow-up was 22 months (range from 9 months to 3 years). Satisfactory functional and aesthetic results were achieved in 40 (83%) patients. Fistula was noted in six cases and was solved by minor revision. Urethral stenosis in two cases was resolved by simple dilatation. Conclusion. Urethral reconstruction using the buccal mucosa graft and dorsal penile skin flap in severe hypospadias repair could be the method of choice. Using this technique, single stage urethral reconstruction is possible with satisfactory esthetical and functional results.
Balanitis Xerotica Obliterans: An experience with Buccal Mucosa Onlay Flap Graft.
MD Mchembe, A Kategile, CMA Yongolo, KA Mteta
East and Central African Journal of Surgery , 2011,
Abstract: Background: Balanitis Xerotic obliterans (BXO) or Penile Lichen Sclerosus is a dermatological condition affecting the genitalia and associated with chronic, progressive, sclerosing inflammatory dermatosis of unclear etiology. It was first described by Stuhmer in 1928, as being a rare condition but causes severe tissue destruction and often causes meatal stenosis and urethral stricture. Our objective is to present the experience of treatment of urethral stricture caused by Balanitis Xerotic Obliterans in our hospitals. Methods: Between 2003 and 2008 eighteen patients with LUTS caused by BXO were referred to our hospitals for management. All patients were adults with the age range from 17 to 84 years. One of the patients had diabetes mellitus. Three patients presented with retention of urine, four had difficulty in passing urine and two patients presented with painful erection. One of the patients who had retention of urine presented with “ watering cane” perineum due to fistula and sinuses as a complication of long standing unattended stricture. The majority of the patients had strictures confined to the distal urethra and meatus. Six patients were treated with buccal mucosa onlay graft while one patient was offered for perineal urethrotomy. Results: A total of eighteen (18) patients were attended, two patients were lost to follow up while 5 patients had a mean follow up of 22 months ranging from 8 to 60 months. Fifteen patients are reporting good progress while one patient is being treated with clean intermittent self catheterization and dilatation. Conclusion: BXO is a rare cause of urethral stricture in our institution and buccal mucosa graft offers satisfactory intermediate term results.
THE IMPACT OF AN EVIDENCE-BASED MEDICINE WORKSHOP ON RESIDENTS ATTITUDES TOWARDS AND CONFIDENCE IN THE DAILY PRACTICE OF EVIDENCE-BASED MEDICINE
Karyn Baum, MD
Medical Education Online , 2003,
Abstract: Background: Evidence-based medicine (EBM) is a part of many medical school and residency curricula worldwide, but there is little research into the most effective methods to teach these skills. Purpose: To evaluate whether a course on EBM utilizing adult learning principals leads to both immediate and short-term attitudinal, confidence, and behavioral change. Methods: Seventy-three (73) Internal Medicine and Internal Medicine/Pediatric residents attended a half-day seminar on EBM. Participants completed pre- and post-course 5-point Likert questionnaires, and set two personal goals for integrating EBM into their daily practice. We performed nonparametric two-sample Wilcoxon Rank-Sum tests to compare responses. We also elicited the self-reported success of the residents in meeting their goals one-month post-course. Results: Attitudes about EBM improved (3.5 pre-course vs. 3.7 post-course), as well as self-reported EBM skills (3.0 vs. 3.3). Seventy-two percent of residents reported having met at least one of their two goals for the integration of EBM into their practice. Conclusions: An EBM workshop based upon adult learning principles was successful in meeting multiple educational goals. The links between andragogy, learners internal drive for behavior change, and successful EBM education should be further explored.
Clinical comparision of semilunar coronally positional flap and subepithelial connective tissue graft in root coverage procedure
Mosavi Jazi M.,Haghighati F.,Saave G.
Journal of Dental Medicine , 2009,
Abstract: "nBackground and Aim: Several surgical approaches have been used to achieve root coverage. The Subepithelial Connective Tissue Graft (SCTG) procedure has been shown to be a predictable means to treat gingival recession. Semilunar Coronally Positioned Flap (SCPF) is a simple mucogingival surgery to cover the exposed root surface without harvesting the palatal connective tissue. The purpose of this study is to compare the outcome of gingival recession therapy using SCTG and SCPF. "nMaterials and Methods: Forty Miller class I buccal gingival recessions (≥2mm) were selected. Recessions were randomly assigned to receive either the SCPF or SCTG. Recession Height (RH), Recession Width (RW), Width of Keratinized Tissue (WKT), Probing Depth (PD), Clinical Attachment Level (CAL), were measured at baseline, 1, 3, and 6 months after surgery. The data were analyzed using independent t-test and Repeated Measure ANOVA. "nResults: The average percentages of root coverage for SCPF and SCTG were 88% and 71%, respectively; and the complete root coverage observed were 55% and 45%, respectively. There were no significance differences between the two groups with regard to RW, PD, CAL, WKT (except in the third month after surgery which was slightly greater in SCPF group). RH was significantly decreased from 2 to 6 months after surgery in SCPF group. "nConclusion: The findings from this study indicate that if the tissue thickness and initial width of keratinized tissue are sufficient, SCPF may be a good substitute for SCTG in treatment of Miller class I gingival recessions.
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