Commentary on: Productivity and Efficiency of a Department Resident Aesthetic Plastic Surgery Clinic.
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SUBMITTER: Sinclair NR
PROVIDER: S-EPMC10021066 | biostudies-literature | 2023
REPOSITORIES: biostudies-literature
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Commentary on: Productivity and Efficiency of a Department Resident Aesthetic Plastic Surgery Clinic.
Aesthetic surgery journal. Open forum 20230125
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Project description:BackgroundThere has been increasing demand for aesthetic surgery procedures in the United States, highlighting the critical importance of the competence of plastic surgery residents and rigorous methods of aesthetic surgery training.ObjectivesThe objective of this study was to review procedures and outcomes from our plastic surgery resident aesthetic clinic. Outcomes and costs were compared to national averages and reports from the literature.MethodsA retrospective chart review identified all adult patients who presented to the Resident Aesthetic Surgery Clinic at NYU Langone Health in 2021. Patient demographics, comorbidities, procedural data, postoperative complications, revisions, and surgeon fees were compiled. A brief confidence survey was distributed to participating residents before and after their clinic rotation. Data were analyzed using IBM SPSS software (Armonk, NY).ResultsIn 2021, 144/379 consultations led to an operation (38.0% conversion rate), resulting in 420 distinct surgical procedures. The majority (53.3%) of procedures involved the head and neck. Complication and revision rates were 5.5% and 1.0%, respectively, with surgeon fees consistently below the national average. Residents reported being significantly more confident performing face lifts, rhinoplasties, and aesthetic surgery in general following their clinic rotation.ConclusionsThese data represent the largest annual reported study of plastic surgery resident aesthetic procedures and outcomes, demonstrating the high volume and productivity of the NYU Resident Aesthetic Surgery Clinic. These results further support resident aesthetic clinics as a robust training modality.Level of evidence 4
| S-EPMC9750105 | biostudies-literature
Project description: Not available
| S-EPMC9897167 | biostudies-literature
Project description:ObjectivesThe wide variety of operations that a plastic surgeon can deal with creates confusion regarding its proper scope. This confusion was observed in primary physicians as well as medical students. Increasing the perception of medical students toward plastic surgery can aid in career decision-making and early referral patterns. The aim of this study is to gauge a holistic overview of how medical students and interns perceive the plastic and aesthetic surgical specialty in King Faisal University and to suggest a recommended plan.MethodsAn online questionnaire was distributed equally to male and female medical students and interns in a local medical institute. The questionnaire constituted three sections; the first included the biographical data. The second is concerned with the different case scenarios and specialties to be chosen. The third is concerned with the previous clinical exposures. The data were analyzed by SPSS version 21. Between comparison, chi-square tests, Mann-Whitney U-test, and Kruskal-Wallis tests were applied. Normality tests were conducted using the Shapiro-Wilk's test.ResultsTwo hundred ninety-two students and interns have participated and completed the questionnaire. There were 189 males and 103 females. Plastic surgery was most commonly chosen in the following case scenarios; burn of the hand (74%), broken nose (64.7%), and cosmetic nose reshaping (80.8%). However, plastic surgery was infrequently chosen (selected by <30% of students) in many areas of hands and peripheral neuropathies (severed finger extensor tendon (26.4%), fractured scaphoid (12.7%), carpal tunnel syndrome (14.4%), brachial plexus injury (16.1%)). The most common source of information was the social media, and the least one is meeting with doctors and professors.ConclusionMedical students and interns lack a full view of plastic and reconstructive surgery, especially in hand and peripheral neuropathies. Improving the education of medical students and interns is recommended and needed.
| S-EPMC8558811 | biostudies-literature
Project description:Poly-L-lactic acid (PLLA) is a biocompatible synthetic polymer that induces neocollagenesis by fibroblasts after placement into the reticular dermis and subcutaneous plane. We present an innovative use of this product to treat brassiere strap grooves. The size and weight of hypertrophied breasts can cause physical and psychological problems that can be corrected with reduction mammaplasty. However, bra strap grooving remains an unsightly consequence of brassiere use with large and heavy breasts. PLLA provides an innovative way to treat this deformity in a minimally invasive way, while maintaining relatively long-term results of two years or more. We studied 10 patients who presented to resident filler and neuromodulator clinic to help improve the bra strap groove deformity. The average number of clinic visits was 3.1. The average total number of vials injected was 2.58 on the right and 2.92 on the left. There were no complications or side effects, apart from one patient who reported injection site bruising. Patient surveys demonstrated 70% satisfied with the results and 30% very satisfied. We also discuss resident filler and neuromodulator clinic as an opportunity for resident research.
| S-EPMC10846764 | biostudies-literature
Project description:ObjectivesProvider efficiency has been reported in the literature but there is a lack of efficiency analysis among emergency medicine (EM) residents. We aim to compare efficiency of EM residents of different training levels and determine if EM resident efficiency is affected by emergency department (ED) crowding.MethodsWe conducted a single-center retrospective observation study from July 1, 2014, to June 30, 2017. The number of new patients per resident per hour and provider-to-disposition (PTD) time of each patient were used as resident efficiency markers. A crowding score was assigned to each patient upon the patient's arrival to the ED. We compared efficiency among EM residents of different training levels under different ED crowding statuses. Dynamic efficiency changes were compared monthly through the entire academic year (July to next June).ResultsThe study enrolled a total of 150,920 patients. A mean of 1.9 patients/hour was seen by PGY-1 EM residents in comparison to 2.6 patients/hour by PGY-2 and -3 EM residents. Median PTD was 2.8 hours in PGY-1 EM residents versus 2.6 hours in PGY-2 and -3 EM residents. There were no significant differences in acuity across all patients seen by EM residents. When crowded conditions existed, residency efficiency increased, but such changes were minimized when the ED became overcrowded. A linear increase of resident efficiency was observed only in PGY-1 EM residents throughout the entire academic year.ConclusionResident efficiency improved significantly only during their first year of EM training. This efficiency can be affected by ED crowding.
| S-EPMC6637007 | biostudies-literature
Project description:BackgroundIn many countries, the worldwide spread of COVID-19 has led to a near total stop of non-urgent, elective surgeries across all specialties during the first wave's peak of the pandemic. For providers of aesthetic surgery procedures or minimal invasive cosmetic treatments, this led to a huge socio-economic impact worldwide. In order to evaluate valid clinical management strategies for future pandemic events and to overcome the challenges imposed by the current pandemic, it is paramount to analyse the socio-economic effects caused by the COVID-19 crisis.MethodsAn online survey comprising 18 questions was sent out five times by e-mail to all members of the International Society of Aesthetic Plastic Surgery (ISAPS) between June and August 2020. The data set was statistically analyzed and grouped into an overall group and into subgroups of countries with high (n = 251) vs. low (n = 440) gross domestic product per capita (GDP p.c.) and five defined world regions (Europe (n = 214); North America (NA; n = 97); South America (SA; n = 206); Asia and Oceania (Asia + OC; n = 99); Africa and Middle East (Africa + ME; n = 75)).ResultsA total of 691 recipients completed the survey. The majority of the participants experienced severe operating restrictions resulting in a major drop of income from surgical patients. Low GDP p.c. countries experienced a bigger negative economic impact with less aesthetic (non-) surgical procedures, whereas the high GDP p.c. subgroup was less affected by the COVID-19 crisis. Most of the survey participants had already adopted the ISAPS guidelines for patient (pre-) appointment screening and clinical/patient-flow management. For surgical and non-surgical aesthetic procedures, in the high GDP p.c. subgroup more basic-level PPE (surgical mask) was used, whereas the low GDP p.c. subgroup relied more on advanced-level PPE (N-95 respirator mask or higher). Comparing the different world regions, Europe and Africa used more basic-level PPE.ConclusionsMeasurable differences in the socio-economic impact and in the adaptation of safety protocols between high and low GDP p.c. subgroups and between different world regions were present. Since the COVID-19 pandemic is an international crisis, aligned, expedient and universal actions should be taken.Level of evidence vThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
| S-EPMC8029606 | biostudies-literature
Project description:Despite an increasing surge of exosome use throughout the aesthetic arena, a paucity of published exosome-based literature exists. Exosomes are membrane-bound extracellular vesicles derived from various cell types, exerting effects via intercellular communication and regulation of several signaling pathways. The purpose of this review was to summarize published articles elucidating mechanisms and potential applications, report available products and clinical techniques, and prompt further investigation of this emerging treatment within the plastic surgery community.MethodsA literature review was performed using PubMed with keywords exosomes, secretomes, extracellular vesicles, plastic surgery, skin rejuvenation, scar revision, hair growth, body contouring, and breast augmentation. Publications from 2010 to 2021 were analyzed for relevance and level of evidence. A Google search identified exosome distributors, where manufacturing/procurement details, price, efficacy, and clinical indications for use were obtained by direct contact and summarized in table format.ResultsExosomes are currently derived from bone marrow, placental, adipose, and umbilical cord tissue. Laboratory-based exosome studies demonstrate enhanced outcomes in skin rejuvenation, scar revision, hair restoration, and fat graft survival on the macro and micro levels. Clinical studies are limited to anecdotal results. Prices vary considerably from $60 to nearly $5000 based on company, source tissue, and exosome concentration. No exosome-based products are currently Food and Drug Administration-approved.ConclusionsAdministered alone or as an adjunct, current reports show promise in several areas of aesthetic plastic surgery. However, ongoing investigation is warranted to further delineate concentration, application, safety profile, and overall outcome efficacy.
| S-EPMC10259637 | biostudies-literature
Project description:BackgroundA reliable venous thromboembolism (VTE) risk assessment model (RAM) can assist surgeons in identifying patients who would benefit from VTE prophylaxis. This systematic review was aimed at summarising the current available evidence on VTE RAMs used in aesthetic plastic surgery.MethodsA comprehensive search was performed in the PubMed, EMBASE and Cochrane databases to include primary studies describing VTE RAMs in aesthetic plastic surgery from 1946 to February 2019. The objective was to compare the different VTE RAMs described for aesthetic plastic surgery to recommend a reliable model to stratify patients.ResultsOf the 557 articles identified in the PubMed, EMBASE and Cochrane databases, six articles were included in the final review. Five different RAMs were used in the included studies: Caprini 2005 RAM, Caprini 2010 RAM, Davison-Caprini 2004 RAM, the American Society of Anaesthesiologist's (ASA) physical status grading system and a tool developed by Wes et al. The difference in risk weightage amongst the tools along with the VTE incidences for different categories was compared. The Caprini 2005 RAM was the most widely reported tool and validated in plastic surgery patients.ConclusionAmongst the five different tools currently used, the Caprini 2005 RAM was the most widely reported. This tool was validated in plastic surgery patients and reported to be a sensitive and reliable tool for VTE risk stratification; therefore, current data support its use until further higher quality evidence becomes available. Because of the heterogeneity of the data and low quality of the current evidence, a definitive recommendation cannot be made on the best VTE RAM for patients undergoing aesthetic plastic surgery. This paper highlights the need for randomised controlled trials evaluating the various RAMs which are essential to support future recommendations and guidelines.
| S-EPMC8427088 | biostudies-literature
Project description: Not available
| S-EPMC10120159 | biostudies-literature
Project description:Background: Gaps remain in surgical education regarding the representation of skin tone diversity. To improve equity and prevent misdiagnosis leading to worsened health outcomes, efforts must be made to ensure educational photographs are representative of the diverse patient populations plastic surgery residents will be treated in their future practices. Methods: Four study investigators examined 96 h of recorded lecture seminars from a Canadian plastic surgery resident education curriculum from May 2020 to December 2021. Using Fitzpatrick skin type to codify skin tone, photographic images were individually classified and compared. Program lecturers and residents were invited to participate in an online anonymized survey to explore related perceptions of the curricula. Results: A total of 1990 images were included for analysis. Of these, 83.2% were Fitzpatrick types I to III, 13.1% were Fitzpatrick types IV to V, and 3.7% were Fitzpatrick type VI. There was a statistically greater proportion of Fitzpatrick I to III compared to types IV to V (P < .01), and type VI (P < .01). Fleiss' Kappa was calculated to be 0.896, representing near-perfect agreement. In the survey, 61% (14/22) of faculty respondents believe they include enough diversity in their photographs, however, 46% (4 of 9) of resident respondents would like to see more diversity in lecturers' photographs. Conclusions: There is an underrepresentation of medium (Fitzpatrick types IV-V) and dark (Fitzpatrick VI) images in plastic surgery resident educational images. Providing a curriculum that represents diverse patient populations is crucial to enabling competency and equity of care, particularly in a highly visual field. Incorporating skin tone diversity into educational curricula should be a priority for all plastic surgery programs.
| S-EPMC11770717 | biostudies-literature