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Journal of Surgical Education 2020Choosing a medical specialty is a complex decision comprised of a combination of intrinsic and extrinsic factors that can include economic status, personal interest,...
INTRODUCTION
Choosing a medical specialty is a complex decision comprised of a combination of intrinsic and extrinsic factors that can include economic status, personal interest, input from mentors, and personality traits. The fictional world of Harry Potter, a generational literary phenomenon, describes 4 distinct houses in the wizarding Hogwarts school; each valuing particular traits of mortality that correspond with personality types. As such, we hypothesized that with each medical specialty often attracting particular personalities, the percentage of residents who self-sorted into the different Hogwarts' houses would vary depending on their chosen specialty.
METHODS
A web survey was sent out nationwide to surgical coordinators and residents, collecting demographic information and responses regarding specialty type and Hogwarts' house self-sorting.
RESULTS
The survey was completed by 251 residents (49.4% from surgical specialties) with a 12.6% response rate of surgical coordinator dissemination and a 43.1% resident response rate at Carolinas Medical Center. Surgical specialties were found to have significantly fewer self-sorted Hufflepuffs (p = 0.002) and more Slytherins (p = 0.0061) than nonsurgical specialties. General surgery had significantly more Gryffindors (p = 0.04) and fewer Hufflepuffs (p = 0.0017) whereas orthopedic surgery had significantly more Slytherins (p = 0.0282). Pediatrics had significantly fewer Gryffindors (p = 0.0096) and more Hufflepuffs (p = 0.0006). Obstetrics and gynecology had significantly fewer Gryffindors (p = 0.0082) and the highest percentage of Ravenclaws when compared to all other specialties (35.3% vs 19.9%; p = 0.1344). Family medicine had no self-proclaimed Slytherins.
CONCLUSIONS
The discrepancies between specialties in the ratios of residents per Hogwarts house highlights that certain attributes may be more essential, advantageous, or complementary to a specific specialty. This information may guide medical students in choosing a satisfying and successful career path.
Topics: Career Choice; Child; Humans; Medicine; Specialization; Specialties, Surgical; Stethoscopes; Students, Medical; Surveys and Questionnaires
PubMed: 32033915
DOI: 10.1016/j.jsurg.2020.01.004 -
AANA Journal Apr 2020A "cannot ventilate, cannot intubate" scenario is a rare, high-risk anesthesia event. Cricothyrotomy is the final step, but anesthesia training and maintenance of...
A "cannot ventilate, cannot intubate" scenario is a rare, high-risk anesthesia event. Cricothyrotomy is the final step, but anesthesia training and maintenance of surgical airway skills is variable. The ability to "cut to air" when one performs a cricothyrotomy may be all that prevents a patient from experiencing anoxic brain injury or death. Forty-three Certified Registered Nurse Anesthetists (CRNAs) performed emergency cricothyrotomies on a simulation manikin. Three techniques were available: (1) cricothyrotomy kit, (2) scalpel and tracheostomy, and (3) scalpel/bougie/endotracheal tube. Technique selection and performance were recorded until successful confirmation of placement was achieved in less than 2 minutes. Confidence levels performing cricothyrotomy were also measured before and after simulation. Most CRNAs (53.5%) selected the cricothyrotomy kit, and all but 1 completed the cricothyrotomy in under 2 minutes. The scalpel/bougie/endotracheal tube combination was the fastest, with an average completion time of 86.6 seconds. The confidence of CRNAs in performing a successful cricothyrotomy in less than 2 minutes was significantly increased (P ≤ .001). Simulating airway skills improved performance, speed, and confidence. Because not all CRNAs have had extensive education in performing surgical airways and practicing these skills, simulation may have additional value in developing and maintaining skills and confidence.
Topics: Adult; Airway Obstruction; Clinical Competence; Cricoid Cartilage; Female; Humans; Male; Middle Aged; Nurse Anesthetists; Patient Simulation; Tracheotomy; Young Adult
PubMed: 32234202
DOI: No ID Found -
Progres En Urologie : Journal de... Nov 2023Contraception is a major global health issue, which is still dominated by female contraception. Developments in male contraception could help redistribute the...
CONTEXT
Contraception is a major global health issue, which is still dominated by female contraception. Developments in male contraception could help redistribute the contraceptive burden.
METHODS
A literature search was carried out to review the existing options and the criteria for optimal contraception, to establish the principles of a male pre-contraception consultation, and to review the various research avenues with their advantages and disadvantages.
RESULTS
The new male contraception options are detailed, whether hormonal (androgen therapy, combination of progestins and testosterone) or non-hormonal, particularly thermal, with current results and avenues for improvement. Condom use and vasectomy remain the only 2 validated options. The recent development of minimally invasive vasectomy without the need for a scalpel and of occlusion techniques has simplified the procedure, minimised the risk of complications (pain, haematomas, post-vasectomy pain syndrome) and improved efficacy. The issues of regret and the possibility of repermeabilisation are also raised.
CONCLUSION
The question of male contraception will become increasingly important in consultations with urologists. The urologist will have to inform the patient, as required by law, before the vasectomy is performed, and provide the best possible advice on the technique, which will often be minimally invasive without the need for a scalpel. New reversible options should also broaden the range of options available on a routine basis, with a view to gradually moving towards contraceptive equity.
Topics: Male; Humans; Female; Contraceptive Agents, Male; Contraception; Vasectomy; Contraceptive Agents; Pain
PubMed: 38012914
DOI: 10.1016/j.purol.2023.09.004 -
Clinical and Experimental Dental... Aug 2021Abnormalities in the maxillary frenum may lead to esthetic or functional limitations and need to be corrected with a surgical intervention called frenectomy. The aim of... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Abnormalities in the maxillary frenum may lead to esthetic or functional limitations and need to be corrected with a surgical intervention called frenectomy. The aim of the study was to compare frenectomies performed using Er:YAG laser technology with those using a conventional scalpel technique. Comparisons were of patients' experiences, treatment times, bleeding during treatment and wound healing.
MATERIAL AND METHODS
The trial was performed as a prospective, randomized and controlled, single-blind investigation. A total of 40 patients requiring frenectomy were randomly assigned to groups which underwent either conventional or Er:YAG laser treatment. Patients' experiences, treatment time, bleeding and wound healing were evaluated immediately after surgery and 5 days, 12 days and 3 months after surgery.
RESULTS
Significant increase in time spent in surgery and bleeding was seen with conventional scalpel surgery. Directly after surgery the wound area was significantly larger in the laser group but at the 5-day evaluation no difference could be observed between the groups. Finally, patients were satisfied with both methods, giving them the same assessments.
CONCLUSION
In the frenectomy procedure, laser surgery is faster and causes less bleeding and may be advantageous in frenectomies.
Topics: Humans; Labial Frenum; Laser Therapy; Lasers, Solid-State; Prospective Studies; Single-Blind Method
PubMed: 33369213
DOI: 10.1002/cre2.374 -
Clinical, Cosmetic and Investigational... 2020Rhinophyma is an advanced stage of rosacea affecting the nasal soft tissues and resulting in disruption of the nasal architecture, airway obstruction, and disfigurement... (Review)
Review
Rhinophyma is an advanced stage of rosacea affecting the nasal soft tissues and resulting in disruption of the nasal architecture, airway obstruction, and disfigurement of the nasal aesthetic units. Rhinophyma presents with hypertrophy of the nasal soft tissues, erythema, telangiectasias, nodules, and lobules with a bulbous appearance. Significant psychosocial morbidity is associated with the disease. Understanding of this disease has improved and multiple treatment options exist. The article is a review of the literature to evaluate the pathophysiology, clinical presentation, and epidemiology of keywords "rhinophyma" and "rosacea" using an OVID Medline and PubMed search along with a systematic review of outcomes pertaining to treatment of rhinophyma with laser therapy, scalpel excision, and the subunit method using an OVID Medline search. The subunit method has the highest complication and revision rates followed by carbon dioxide laser therapy. Outcomes between carbon dioxide laser and scalpel therapy and electrocautery are equivalent. Scalpel excision is a more cost-effective treatment modality with less post-operative complications; however, it risks poor hemostasis intraoperatively. Patient satisfaction is common post-therapy regardless of the treatment method. Over 89% of patients would recommend undergoing treatment for rhinophyma irrespective of treatment type. Treatment options vary, and choice of treatment can be dependent on practitioner and patients' treatment goals.
PubMed: 32848439
DOI: 10.2147/CCID.S201290 -
Missouri Medicine 2023You begin to hear distant rock music playing, people conversing about their weekend. Then the scalpel is requested-incision. Pain sends you reeling and you attempt to...
You begin to hear distant rock music playing, people conversing about their weekend. Then the scalpel is requested-incision. Pain sends you reeling and you attempt to muster a scream. No one seems to hear you and you are unable to lift a finger. The scenario is so rare that numerous movies have been made about awareness under anesthesia. Awareness under anesthesia is a rare event, however, it is a complication that no one ever desires to occur. We will explore how frequent awareness is during surgery, what risk factors are involved, and what tools anesthesia providers utilize to ensure everyone undergoing surgery is adequately anesthetized.
Topics: Humans; Anesthesia; Intraoperative Awareness
PubMed: 38144931
DOI: No ID Found -
Biomedicines Nov 2022The plasma scalpel is an application of gas discharges in electrosurgery. This paper introduces the device structure and physicochemical parameters of the two types of... (Review)
Review
The plasma scalpel is an application of gas discharges in electrosurgery. This paper introduces the device structure and physicochemical parameters of the two types of plasma scalpels, namely, a single-electrode Ar discharge device (argon plasma coagulation) and a two-electrode discharge device in normal saline. The diagnostic methods, including the voltage and current characteristics, optical emission spectroscopy, electron spin resonance, and high-speed imaging, are introduced to determine the critical process parameters, such as the plasma power, the gas temperature, the electron density, and the density of active species, and study the ignition dynamics of the plasma discharges in water. The efficacy of the plasma scalpel is mainly based on the physical effects of the electric current and electric field, in addition to the chemical effects of high-density energetic electrons and reactive species. These two effects can be adjusted separately to increase the treatment efficacy of the plasma scalpel. Specific guidance on further improvements of the plasma scalpel devices is also provided.
PubMed: 36428535
DOI: 10.3390/biomedicines10112967 -
The Journal of Craniofacial Surgery May 2021The chin is the most prominent and median sector of the lower third of the face giving harmony to nose and lips. The authors present the application of piezoelectric...
BACKGROUND
The chin is the most prominent and median sector of the lower third of the face giving harmony to nose and lips. The authors present the application of piezoelectric scalpel for the correction of different chin deformities. The distinctive characteristics of this device allow us to avoid or reduce the immediate genioplasty complications.
METHODS
Fifty-five patients with defective chin have been treated from January 2006 to April 2008. Intraoral chinplasty was performed during the correction of dentofacial dysmorphisms or associated with nasal surgery. The authors used a piezoelectric cutting device to perform different osteotomies and if necessary, interpositional graft was used to stabilize bony segments.
RESULTS
Piezosurgery has been associated with a fewer number of postoperative complications, especially as regard intraoperative bleeding, nerve injuries (immediate and late), hematomas and seromas, and asymmetry (immediate and early). The mean time for completing the complete procedure of genioplasty with piezosurgery was almost the same compared with the saw and drill.
CONCLUSIONS
Chinplasty represents one of the most common ancillary procedures and may be associated with corrective surgery of dentofacial dysmorphisms. Mental nerve injuries, asymmetries, intraoperative bleeding are the main immediate complications of genioplasty. Distinctive characteristics of ultrasonic piezoelectric osteotomy are selective cut of mineralized structure with less risk of vascular and nervous damage (microvibrations), intraoperative precision (thin cutting scalpel and no macrovibrations), blood free site (cavitation effect). In our experience, piezoelectric scalpel, compared with saw and drill, enables us to reduce or avoid immediate complications of chin surgery, helping the surgeon to reach patients' satisfaction.
LEVEL OF EVIDENCE
IV.
Topics: Chin; Genioplasty; Humans; Osteotomy; Piezosurgery; Surgical Instruments
PubMed: 29944550
DOI: 10.1097/SCS.0000000000003150 -
The Australasian Journal of Dermatology Nov 2022Incision lines placed at cosmetic boundaries and/or in rhytids during surgical procedures provide ideal concealment of scars. We suggest the use of a 30-gauge, half-inch...
Incision lines placed at cosmetic boundaries and/or in rhytids during surgical procedures provide ideal concealment of scars. We suggest the use of a 30-gauge, half-inch needle or alternatively the back edge of a #15 scalpel blade to superficially score the skin to provide markings, which are fine enough to lie exactly within rhytids or at exact cosmetic boundaries such as the nasolabial fold or the junction of the cutaneous and vermillion lip. We measured the average depth of these scores to demonstrate that they are shallow enough to heal without scarring.
Topics: Humans; Cicatrix; Skin Neoplasms; Surgical Wound; Skin; Surgical Instruments
PubMed: 36197678
DOI: 10.1111/ajd.13931 -
Case Reports in Otolaryngology 2019Rhinophyma represents a progressive deformity of the nose which leads to cosmetic disfigurement and has a significant impact on the patient's quality of life. This...
Rhinophyma represents a progressive deformity of the nose which leads to cosmetic disfigurement and has a significant impact on the patient's quality of life. This pathological entity originates from hyperplasia of sebaceous gland tissue, connective tissue, and vessels of the nose and is associated with rosacea and more specifically, stage III rosacea. Surgical treatment is the method of choice. We present five cases of rhinophyma that we treated with microdebrider-assisted excision. The procedure was divided in two main steps: scalpel excision of the main bulk of the rhinophyma and then further contouring with the microdebrider. All patients had weekly follow-up for the first four weeks, and then three-monthly. All patients had uneventful recovery and satisfactory cosmetic outcomes. No postoperative infections or other complications were reported in our case series. The use of the microdebrider reduces the operating time, preserves the islands of skin regeneration, and allows finer manipulations than the standard scalpel techniques. Microdebrider-assisted rhinophyma excision is a safe approach, with good aesthetic results. Larger series of patients need to be examined in order to establish the value of the method.
PubMed: 31885991
DOI: 10.1155/2019/4915416