Distance to a Plastic Surgeon and Type of Insurance Plan Are Independently Predictive of Postmastectomy Breast Reconstruction

The psychosocial benefits of postmastectomy breast reconstruction are well established; however, health care barriers persist. The authors evaluated statewide patient population to further identify obstacles to reconstruction

Trial and error versus errorless learning of functional skills in patients with acute stroke

Objective: To compare the effectiveness of errorless learning versus trial and error learning for teaching activities of daily living to patients with acute stroke with or without explicit memory impairments. Design: Randomized crossover. Setting: Rehabilitation hospital. Participants: 33 adult subjects following an acute stroke. Intervention: Subjects were taught to prepare a wheelchair for a transfer and to put on a sock with a sock-donner. Tasks were taught using errorless learning or trial and error learning. Explicit memory was assessed using the Neurobehavioral Cognitive Status Exam. Main Outcome Measures: Days until subject was able to demonstrate retention of the task, and success or failure at carry-over to a similar task. Results: No significant differences were found in days to retention for either functional task when taught using errorless learning or trial and error learning in subjects with or without explicit memory impairments. Carry-over was significantly better when trial and error learning was used for learning sock donning. Conclusions: When choosing the best learning method for patients undergoing rehabilitation for stroke, the nature of the task should be considered. Additional research is needed to identify the best approach for teaching activities of daily living and facilitating carry-over of learning in individuals with acute stroke

What Do Our Patients Truly Want? Conjoint Analysis of an Aesthetic Plastic Surgery Practice Using Internet Crowdsourcing.

BACKGROUND: What do patients want when looking for an aesthetic surgeon? When faced with attributes like reputation, years in practice, testimonials, photos, and pricing, which is more valuable? Moreover, are attributes procedure-specific? Currently, inadequate evidence exists on which attributes are most important to patients, and to our knowledge, none on procedure-specific preferences. OBJECTIVES: First, to determine the most important attributes to breast augmentation, combined breast/abdominal surgery, and facelift patients using conjoint analysis. Second, to test the conjoint using an internet crowdsourcing service (Amazon Mechanical Turk [MTurk]). METHODS: Anonymous university members were asked, via mass electronic survey, to pick a surgeon for facelift surgery based on five attributes. Attribute importance and preference was calculated. Once pre-tested, the facelift, breast augmentation and combined breast/abdominal surgery surveys were administered worldwide to MTurk. RESULTS: The university facelift cohort valued testimonials (33.9%) as the most important, followed by photos (31.6%), reputation (18.2%), pricing (14.4%), and practice years (1.9%). MTurk breast augmentation participants valued photos (35.3%), then testimonials (33.9%), reputation (15.7%), pricing (12.2%), and practice years (3%). MTurk combined breast/abdominal surgery and facelift participants valued testimonials (38.3% and 38.1%, respectively), then photos (27.9%, 29.4%), reputation (17.5%, 15.8%), pricing (13.9%, 13.9%), practice years (2.4%, 2.8%). CONCLUSIONS: Breast augmentation patients placed higher importance on photos; combined breast/abdominal surgery and facelift patients valued testimonials. Conjoint analysis has had limited application in plastic surgery. To our knowledge, internet crowdsourcing is a novel participant recruitment method in plastic surgery. Its unique benefits include broad, diverse and anonymous participant pools, low-cost, rapid data collection, and high completion rate

Life-threatening Skin Disorders Treated in the Burn Center: Impact of Health care–associated Infections on Length of Stay, Survival, and Hospital Charges

This article reviews a single burn center experience with life-threatening skin disorders, over a 10-year period. It explores the incidence of health care–associated infections and the impact on length of stay, hospital charges, and mortality

Even Better Than the Real Thing? Xenografting in Pediatric Patients with Scald Injury

This article reviews a single burn center experience with porcine xenografts to treat pediatric scald injuries, over a 10-year period. The authors compare xenografting to autografting, as well as wound care only, and provide outcome data on length of stay, incidence of health care–associated infections, and need for reconstructive surgery

Herniation through gastrostomy site: Case report

Introduction: Herniation through gastrostomy site is an extremely rare complication of percutaneous endoscopic gastrostomy (PEG). We present two unusual cases of gastrostomy site herniation, the surgical management thereof, and a corresponding review of the literature. Case presentation: The first patient is a 65 year old Caucasian male who complained of epigastric pain and a bulge at his previous gastrostomy tube incision site three weeks after its removal. Initial exam revealed a hernia measuring approximately 10 cm which was later repaired by laparoscopic surgery with a composite mesh. The second case is 66 year old obese Caucasian male who complained of continued pain in the midepigastric region around his gastrostomy site scar five months after removal of his PEG tube. On physical exam he was found to have a hernia of 6 cm in the midepigastrium. His hernia was later repaired by open surgery with a composite mesh. Both patients recovered uneventfully postoperatively. Conclusion: Herniation through gastrostomy site is a possible complication of PEG tube and clinicians should consider this possibility in patients with ongoing leakage, bulge or pain at the gastrostomy site. This entity can be safely corrected via laparoscopic or open techniques