Surgical Management of Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory disease of the skin, characterized by recurrent draining sinuses and abscesses, predominantly in skin folds carrying terminal hairs and apocrine glands. Treatment for this debilitating disease has been medical management with antibiotics and immune modulators. With the advent of better reconstructive surgical techniques, the role of surgery in the treatment of HS has expanded, from being a last resort to a modality that is deployed earlier. Larger defects can be more easily reconstructed, allowing for a more radical excision of diseased areas. Locoregional flaps, perforator flaps, and propeller flaps that use the fasciocutaneous tissue allow reconstruction of defects with similar tissue, and provide better cosmetic and functional outcomes. They are easy to execute and can be performed even in resource-poor settings with concurrent use of immune modulators and postoperative antibiotics. Hidradenitis can be successfully treated with surgery in early stages as well as severe disease, due to the advances in understanding disease behavior, multidisciplinary care, and advanced reconstructive techniques. Coupled with a multidisciplinary care team, surgery offers a durable, lasting cure for HS, significantly reducing disease morbidity.

Prevalence of Regret in Gender-Affirming Surgery: A Systematic Review.

INTRODUCTION: Gender-affirmation surgeries are a rapidly growing set of procedures in the field of plastic surgery. This study is novel in that a thorough analysis has not been performed quantifying, identifying, and recognizing the reasons and factors associated with regret in a largely US population. METHODS: A systematic review of several databases was conducted. After compiling the articles, we extracted study characteristics. From the data set, weighted proportions were generated and analyzed. RESULTS: A total of 24 articles were included in this study, with a population size of 3662 patients. A total of 3673 procedures were conducted in the United States, 514 in European nations, 97 in Asian nations, which included only Thailand, and 19 in South American nations, which included only Brazil. The pooled prevalence of regret was 1.94%. The prevalence of transfeminine regret was 4.0% while the prevalence of transmasculine regret was 0.8%. CONCLUSIONS: Both transfeminine and transmasculine patients had significantly lower rates of regret in the United States when compared with the rest of the world. Our study largely excluded facial gender-affirming surgeries as most of its articles did not fall into our inclusion search criteria. To our knowledge, this is the most recent review performed on the topic of regret among gender-affirming surgery patients with an emphasis on a US cohort. This analysis can help shed light on better ways to enhance patient selection and surgical experience.

Pubic Aneurysmal Bone Cyst Following Penile Inversion Vaginoplasty: A Case Report.

Background: Aneurysmal bone cysts (ABCs) are aggressive, expansile, and locally destructive vascular lesions. The exact etiology of ABCs is currently unknown and hypothesized to be related to vascular malformations or disruption of osseous vascularity. To date, there have been no reports describing the development of pubic ABCs following penile inversion vaginoplasty (PIV). Methods: This report describes the development of a pubic ABC in a transgender patient who had previously undergone PIV, possibly indicating a very rare complication of this gender-affirming operation. Results: A 37-year-old transgender female was initially referred to the orthopedic oncology clinic for evaluation of a 12-month history of left hip and groin pain. She had undergone gender-affirming PIV about 19 months prior to presentation. Magnetic resonance imaging (MRI) with contrast revealed a low T1 signal intensity and heterogenous T2 hyperintensity 7.5 × 4.9 × 4.3-cm destructive mass in the left superior pubic ramus extending across the pubic symphysis into the right superior pubic ramus. A needle core bone biopsy demonstrated a variably cellular spindle and round lesion with islands of osteoid formation and focal necrosis. The cells were negative for CD34, S100, and desmin. There was no evidence suggesting osteosarcoma, and final review favored the diagnosis of an ABC. Given the highly destructive nature of the mass, it was resected, and the resulting wound was reconstructed with a biologic dermal mesh. Conclusions: Although it is impossible to distinguish coincidence from causation in this case, the patient's recency of PIV and development of a rare ABC in a nearby bone warrants the speculation and discussion provided in this report.

Gender dysphoria and gender-affirming surgery: The New York state experience.

BACKGROUND: Transgender and gender nonconforming (TGNC) individuals experience incongruence between their self-identified gender versus their birth-assigned sex. In some cases, TGNC patients undergo gender-affirming surgical (GAS) procedures. Although GAS is an evolving surgical field, there is currently limited literature documenting patient characteristics and procedures. Addressing this knowledge gap, this retrospective cohort analysis described the characteristics of New York State's TGNC residents with gender dysphoria (GD) diagnosis, including patients undergoing at least one gender-affirming surgical procedure. METHODS: Using the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2002 to 2018, we identified patients' first-time TCNC records and their risk characteristics. Patients who received GAS procedures were sub-classified as top-only, bottom-only, or combined top/bottom procedures and were compared with TGNC patients who did not receive GAS. RESULTS: Of 24,615 records extracted from TGNC SPARCS database, 11,427 (46.4%) were transmasculine (female-to-male) and 13,188 (53.6%) were transfeminine (male-to-female). Overall, 2.73% of transgender patients received at least one GAS procedure. Of these patients, 78.2% had masculinizing and 21.8% had feminizing surgeries. After a diagnosis of GD, the positive predictors for a GAS-based procedure included female birth sex, pediatric age (<18 years) or older age (60+ years), commercial insurance coverage, and Hispanic race. In contrast, negative GAS predictors included male birth sex and government insurance coverage (i.e., Medicare and Medicaid). CONCLUSIONS: Compared with transgender women, transgender men were more likely to receive at least one GAS procedure. Because the race, ethnicity, and payor status of TGNC patients can impact GAS treatment rates, additional research is warranted to examine post-diagnosis GAS treatment disparities among TGNC patients.

Impact of surgical technique on outcome measures in chest masculinization: A systemic review and meta-analysis.

BACKGROUND: Among plastic surgeons, there are several conventional techniques for performing chest surgery. Research on surgical approaches has focused cis-gender patients with medical conditions, such as breast cancer or gynecomastia, but has never studied transgender populations. The aim of this study is to perform the first systematic review of gender-affirming surgery (GAS) in transgender populations and determine postoperative outcomes differences in relation to surgical technique. METHODS: Two reviewers independently searched Medline, Embase, CINAHL, Web of Science, and Cochrane databases for studies published prior to 2021. Studies selected for inclusion were retrospective or prospective studies of adult transgender men undergoing GAS that utilized appropriate operative techniques and reported complications and/or patient-reported outcomes. RESULTS: A total of 26 randomized controlled trials, including 40 distinct populations and 3055 patients, were identified. Surgical techniques compared double incision free nipple graft (DIFNG) (2053 patients [67.20%]), pedicled nipple techniques (PNT) (297 [9.72%]), and periareolar techniques (PAT) (705 [23.08%]). Pairwise analysis found the lowest complication rates associated with procedures utilizing DIFNG, followed by PNT, then PAT. Patients with PAT had significantly higher satisfaction scores than DIFNG. CONCLUSIONS: This is the first systematic review to evaluate outcomes of chest surgery techniques among the transgender population. Results indicate significantly more complications for PAT compared to DIFNG or PNT. Analysis of patient-reported outcomes was limited due to heterogeneity in reporting.

Risk Factors Associated with Adverse Outcomes after Ablative Surgery for Lymphedema.

BACKGROUND: Postmastectomy breast cancer lymphedema poses an important health threat. Historically, physical therapy was the exclusive treatment option. More recently, lymphedema surgery has revolutionized care. As a first-in-kind, multicenter report, the postmastectomy breast cancer patients' risk factors associated with postlymphedema ablative surgical outcomes were documented. METHODS: Using the New York Statewide Planning and Research Cooperative System database from 2010 to 2018, multivariable models identified the postmastectomy breast cancer lymphedema surgical patients' characteristics associated with major adverse outcomes and mortality. RESULTS: Of 65,543 postmastectomy breast cancer patients, 1,052 lymphedema surgical procedures were performed including 393 (37.4%) direct excisions and 659 (63.6%) liposuctions. Direct excision and liposuction surgical patients had median ages of 58 and 52 years, respectfully (p < 0.001). Although a 30-day operative mortality was rare (0.3%, all direct excisions), major adverse outcomes occurred in 154 patients (28.5% direct excision; 6.4% liposuction; p < 0.0001). Multivariable clinical outcomes model identified that patients with higher Elixhauser's score, renal disease, emergent admissions, and direct excision surgery had higher incidences of adverse outcomes (all p < 0.01). For those patients with 30-day readmissions (n = 60), they were more likely to have undergone direct excision versus liposuction (12.5 vs. 1.7%; p < 0.0001). The important risk factors predictive of future cellulitis/lymphangitis development included diabetes mellitus, Medicaid insurance, renal disease, prior cellulitis/lymphangitis, chronic obstructive pulmonary disease (COPD), and chronic steroid use (all p < 0.01). CONCLUSION: Lymphedema surgery carries a favorable risk profile, but better understanding the "high-risk" patients is critical. As this new era of lymphedema surgery progresses, evaluating the characteristics for adverse postoperative outcomes is an important step in our evolution of knowledge.

Clinical outcome of multidisciplinary treatment of vulvar necrotising fasciitis.

OBJECTIVE: Vulvar necrotising fasciitis (VNF) is a severe soft tissue infection associated with substantial morbidity and high mortality. At Stony Brook Medicine, US, patients with known or suspected VNF are treated by a structured multidisciplinary team consisting of members of the Departments of Emergency Medicine and Medicine, the Divisions of Gynecologic Oncology, Burn and Surgical Intensive Care Units, Infectious Disease and Plastic Surgery, and the nursing, nutrition, physical/occupational therapy and social work services. METHOD: This is a retrospective review of patients presenting to Stony Brook University Hospital with VNF over an 18-month period. RESULTS: A total of 10 patients were treated for VNF during the study period. All patients were treated by the structured multidisciplinary team, including extensive initial surgical debridement by the gynaecologic oncologists. All patients survived to discharge. CONCLUSION: The results of this review demonstrated that prompt diagnosis, rapid implementation of appropriate antibiotic coverage, surgical debridement of necrotic tissue, and comprehensive care delivered by a structured multidisciplinary team contributed to positive clinical outcomes and decreased the risk of death from VNF.

Risk Factors Associated With Postmastectomy Breast Cancer Lymphedema: A Multicenter Retrospective Analysis.

BACKGROUND: Lymphedema is an edematous condition that afflicts the postmastectomy breast cancer population, with diminished quality of life with substantial financial costs. The factors predictive of postmastectomy lymphedema development in breast cancer patients are unknown. The objective was to evaluate the trends over time in lymphedema development and the risk factors predictive of lymphedema-related events within 2 years of mastectomy. METHODS: Using the New York Statewide Planning and Research Cooperative System multicenter deidentified database from 2010 to 2016, a total of 65,543 breast cancer postmastectomy female patients (mean age, 59 ± 20 years) were identified across 177 facilities. The breast cancer patients were followed for any 2-year postmastectomy lymphedema-related events. A multivariable model identified predictors of 2-year lymphedema using eligible variables involving demographics, comorbidities, and complications. Elixhauser score was defined as a comorbidity index based on International Classification of Diseases codes used in hospital settings. RESULTS: Overall, 5.2% (n = 3409) of the breast cancer postmastectomy patients experienced a lymphedema-related event within 2 years of initial surgery. Over time, 2-year postmastectomy lymphedema rates have more than doubled from 4.62% in 2010 to 9.75% in 2016 (P < 0.001). Two-year postmastectomy lymphedema rates varied significantly by mastectomy procedure type: 5.69% of the mastectomy-only procedures, 5.96% of the mastectomies with lymph node biopsies, and 7.83% of the mastectomies with lymph node dissections (P < 0.0001). Full mastectomies had a greater 2-year lymphedema rate of 7.31% when compared with partial mastectomies with 2.79% (P < 0.0001). The top predictive risk factors for a lymphedema-related event included higher Elixhauser score, prolonged hospitalization for mastectomy, more recent mastectomy procedure, obesity, younger age, non-Asian race, Medicaid insurance, and hypertension (all P's < 0.01). CONCLUSIONS: Although more recent postmastectomy lymphedema rates may not be as high as historical estimates, the 2-year postmastectomy lymphedema rates have more than doubled from 2010 to 2016 requiring further elucidation as well as continued focus on treatment. Furthermore, risk factors were identified that predispose postmastectomy breast cancer patients to developing lymphedema. Given these findings, perioperative screening seems warranted to proactively identify, educate, and monitor postmastectomy patients at greatest risk of future lymphedema development.

A scoping literature review of post-traumatic lymphedema: Where are we now?

Post-traumatic lymphedema of the extremities is a significant source of morbidity largely unrecognized by practitioners. Given the unclear body of evidence on diagnosing and managing post-traumatic lymphedema, we performed a systematic scoping review of the literature for all reports on this topic in order to establish a benchmark for current knowledge, treatment modalities, patient outcomes, and future areas of research. After screening 733 titles and abstracts, 16 relevant articles were ultimately selected for analysis, producing 19 data entries. Study designs largely consisted of case reports and case series. The most frequently reported injuries included burns (n = 12), motor vehicle accidents (n = 7), degloving injuries (n = 6), and open tibial fractures (n = 4). A majority of patients were managed with compression therapy. Among patients pursuing surgical intervention, 15 underwent free tissue transfer and 2 underwent lymphovenous anastomoses. All patients had clinical improvement of their lymphedema.With clinical advances in our understanding of lymphedema and its medical and surgical treatments, it is critical that we identify patients in a timely manner to be able to provide them with the best medical care as well as identify areas of future research. We believe that patients with post-traumatic lymphedema are currently largely unrecognized and that collaboration as well as further research will allow for optimized outcomes in this population.

Safety of Outpatient Shoulder Surgery at a Freestanding Ambulatory Surgery Center in Patients Aged 65 Years and Older: A Review of 640 Cases.

INTRODUCTION: With increasing utilization of surgery centers, it is important to demonstrate the safety of outpatient shoulder surgery in freestanding ambulatory surgery centers. No studies have specifically looked at the Medicare-age population and the rate of outpatient shoulder procedure complications in these patients at an ambulatory surgery center. METHODS: Six hundred forty patients were included in our study between 2000 and 2015. The incidence of major complications was identified, including acute infection requiring intravenous antibiotics or irrigation and débridement, postoperative transfer to a hospital, wrong-site surgical procedures, retention of a foreign object, postoperative symptomatic thromboembolism, medication errors, and bleeding/wound complications. RESULTS: There was a total of seven occurrence reports in seven patients, for a reported adverse event rate of 1.01%. CONCLUSIONS: Our findings are consistent with currently reported outpatient hospital-based data and illustrate the safety of outpatient shoulder procedures at a freestanding ambulatory surgery center in Medicare-age patients.

Implementation of an intern boot camp curriculum to address clinical competencies under the new Accreditation Council for Graduate Medical Education supervision requirements and duty hour restrictions.

IMPORTANCE: Today's general surgery interns are faced with increased duty hour restrictions and stringent competency-based supervision milestone requirements (ie, from direct to indirect supervision). Working within these constraints, we instituted a unique 2-month intern curriculum (boot camp) incorporating knowledge-based, experiential, and practical components. OBJECTIVES: To describe our curriculum and the effect on resident performance and teaching faculty and nursing staff perceptions. DESIGN: All interns underwent a 2-month (July and August 2011) boot camp curriculum consisting of two 2½-hour knowledge-based and procedural skills (SimMan) didactic sessions per week and completion of 25 core intensive introductory American College of Surgeons Fundamentals of Surgery web-based self-study modules, followed by a standardized patient clinical skills assessment. SETTING: Integrated general surgery residency program at the University of Connecticut School of Medicine, Farmington. PARTICIPANTS: Postgraduate year 1 general surgery categorical and preliminary residents. MAIN OUTCOMES AND MEASURES: We used several assessment tools, including an intern boot camp survey, clinical skills assessment scores, intern American Board of Surgeons In-Training Examination scores, and nursing staff and teaching faculty surveys of intern performance and aptitudes compared with the previous year's interns. Data were analyzed by independent group t test, χ2 tests of proportions, and Fisher exact test for small sample cross tables. RESULTS: In total, 84% (91 of 108) of intern respondents agreed or strongly agreed with the usefulness, relevance, and execution of the boot camp. Compared with the previous year's interns, the nursing staff agreed or strongly agreed that the cohort interns were better at patient assessment, collaboration, and effective communication and provided compassionate and respectful patient care. More than 40% (7 of 17) of surveyed teaching faculty agreed or strongly agreed that the cohort interns demonstrated better patient care and procedural skills and self-confidence compared with the previous year's interns. The clinical skills assessment scores after the 2-month boot camp paralleled the scores typically seen at the end of the previous 2 internship years (P > .25 for all). The proportion of nondesignated and categorical interns pursuing careers in general surgery scoring in the top quartile on the American Board of Surgery In-Training Examination increased from 7% (2 of 28) to 50% (5 of 10) compared with the previous 2 internship years (P = .01). CONCLUSIONS AND RELEVANCE: Recent changes in intern duty hours and supervision rules mandate that residency training programs must institute a competency-oriented curriculum to provide interns with the necessary knowledge and practical skills to attain clinical competence.

Pretraining and posttraining assessment of residents' performance in the fourth accreditation council for graduate medical education competency: patient communication skills.

HYPOTHESIS: Structured communication curricula will improve surgical residents' ability to communicate effectively with patients. DESIGN AND SETTING: A prospective study approved by the institutional review board involved 44 University of Connecticut general surgery residents. Residents initially completed a written baseline survey to assess general communication skills awareness. In step 1 of the study, residents were randomized to 1 of 2 simulations using standardized patient instructors to mimic patients receiving a diagnosis of either breast or rectal cancer. The standardized patient instructors scored residents' communication skills using a case-specific content checklist and Master Interview Rating Scale. In step 2 of the study, residents attended a 3-part interactive program that comprised (1) principles of patient communication; (2) experiences of a surgeon (role as physician, patient, and patient's spouse); and (3) role-playing (3-resident groups played patient, physician, and observer roles and rated their own performance). In step 3, residents were retested as in step 1, using a crossover case design. Scores were analyzed using Wilcoxon signed rank test with a Bonferroni correction. RESULTS: Case-specific performance improved significantly, from a pretest content checklist median score of 8.5 (65%) to a posttest median of 11.0 (84%) (P = .005 by Wilcoxon signed rank test for paired ordinal data)(n = 44). Median Master Interview Rating Scale scores changed from 58.0 before testing (P = .10) to 61.5 after testing (P = .94). Difference between overall rectal cancer scores and breast cancer scores also were not significant. CONCLUSIONS: Patient communication skills need to be taught as part of residency training. With limited training, case-specific skills (herein, involving patients with cancer) are likely to improve more than general communication skills.

Post-appendectomy visits to the emergency department within the global period: a target for cost containment.

BACKGROUND: Postoperative visits to the emergency department (ED) instead of the surgeon's office consume enormous cost. HYPOTHESIS: Postoperative ED visits can be avoided. SETTING: Fully accredited, single-institution, 617-bed hospital affiliated with the University of Connecticut School of Medicine. PATIENTS: Retrospective analysis of 597 consecutive patients with appendectomies over a 4-year period. METHODS: Demographic and medical data, at initial presentation, surgery, and ED visit were recorded as categorical variables and statistically analyzed (Pearson chi(2) test, Fisher exact test, and linear-by-linear). Costs were calculated from the hospital's billing department. RESULTS: Forty-six patients returned to the ED within the global period with pain (n = 22, 48%), wound-related issues (n = 6, 13%), weakness (n = 4, 9%), fever (13%), and nausea and vomiting (n = 3, 6%). Thirteen patients (28%) required readmission. Predictive factors for ED visit postoperatively were perforated appendicitis (2-fold increase over uncomplicated appendicitis) and comorbidities (cardiovascular or diabetes). The cost of investigations during ED visits was $55,000 plus physician services. CONCLUSIONS: ED visits during the postoperative global period are avoidable by identifying patients who may need additional care; improving patient education, optimizing pain control, and improving patient office access.

Topical herbal remedies: research opportunities for plastic surgeons.

The use of topical herbal remedies (THRs) among plastic surgery patients is rampant, sometimes indiscriminately, and expanding rapidly. Supporting scientific evidence is low, and most patients who use THRs believe firmly that being 'natural', these agents are 'safe'. The federal regulation of THRs is not uniform. The research potential of these remedies is underexplored, creating a vast opportunity for plastic surgeons to harvest its clinical benefits and help create a regulatory structure that promotes patient safety. This article delineates the critical aspects: essential steps in starting research in THRs, organisational structure to support this work including funding sources, intellectual property and patent protection, federal regulation and patient education and advocacy. These steps create a platform for plastic surgeons to pursue this research work and translate it into the clinical setting effectively.

Phagocytosis: reemerging roles for a primitive function.

BACKGROUND: Described by Metchnikoff, it has been 100 years since the discovery of phagocytosis was awarded the Nobel Prize. Since then, advances in phagocytosis research have vastly expanded its potential clinical application to health and disease. In this article, the authors revisit this process of evolution and chart out its relevance to plastic surgery. METHODS: The discovery and evolution of the concept of phagocytosis are described. Its role in innate and adaptive immune responses is reviewed in the light of converging new discoveries in allied fields. Lastly, how the Rubicon of phagocytosis research could specifically address brittle plastic surgical problems is examined and currently available research tools that would specifically facilitate this work are described. RESULTS: Phagocytosis is centrally important in an expanded repertoire of plastic surgical problems. These include aging, wherein a rapid rate of elimination of apoptotic elements could slow chronologic damage. Other examples include problematic wound repair; skin cancers including melanoma; in radiation and metabolic tissue insult; keloid and hypertrophic scarring; burns and antibiotic-resistant infections; transplantation immunology; regenerative medicine; and lastly "cosmeceuticals," wherein nanoparticle-based drug delivery systems could be explored using novel phagocytic carriers. CONCLUSIONS: For plastic surgeons, phagocytosis research is an attractive opportunity to solve some tough clinical problems. For biologists, the collaboration with plastic surgeons opens a vista of novel translational research. It holds the robust promise of developing a new class of drugs with which to address vast unmet clinical needs. For phagocytosis, its reemergence is a well-deserved encore. Lastly, for Metchnikoff, it is a befitting 100-year anniversary.

Cutaneous myiasis.

Cutaneous myiasis is a unique disease, endemic in tropical areas, and uncommon in the Western world, making its diagnosis difficult for physicians that are unfamiliar with the disease process. Larvae of a two-winged fly are inoculated through normal skin by a mosquito bite. The larvae grow in the subcutaneous tissues, feed off the surrounding tissues and develop into a fly. A patient with a seemingly commonplace cutaneous lesion which was a harbinger of a much more sinister, unique disease process, is presented. Salient features that characterise these lesions, the difficulty in accurate (and timely) diagnosis, treatment and a review of the literature are discussed with the aim of overcoming limitations of diagnosis and management.

Improving surgical residents' performance on written assessments of cultural competency.

CONTEXT: The pressure to implement cultural-competency training at the level of GME is high. The rapidly diversifying American population and the ACGME demand it, and cultural competency is recognized as a core competency under "Professionalism." OBJECTIVES: The objectives for this study were (1) to assess residents' baseline levels of cultural competence, (2) define barriers to skill-acquisition, and (3) examine efficacy of educational programs in improving cultural competence. SETTING & PARTICIPANTS: In all, 43 residents from the University of Connecticut School of Medicine participated in a prospective, Institutional Review Board (IRB)-approved study. DESIGN: During Step 1 (pretest), baseline performance was recorded using 3 assessments: (1) Healthcare Cultural Competency Test (HCCT), (2) Cultural skills acquisition (CSA), and (3) Clinical Scenarios Test (CSE). During Step 2 (Educational Intervention), a 2-part lecture that focused on principles of cultural competency and continued self-learning was presented. Last, for Step 3 (posttest), the post-program evaluation was administered as in Step 1. MAIN OUTCOME MEASURES: Answers for Step 1 (pretest) and Step 3 (posttest) were compared using a paired t-test for HCCT and CSE and the chi-square test for CSA. RESULTS: Thirty-five replies were evaluated. Every resident performed better on the posttest than the pretest. Specifically, participants showed 88% improvement in their scores on the HCCT (pretest: 360, posttest: 696; p < 0.01), 2-fold improvement on the CSA (pretest: 6, posttest: 12; p < 0.009), and 40% improvement in CSE (pretest mean score = 23.3, posttest = 34.6; p < 0.01). Commonly identified barriers to learning included inadequate teaching tools and absence of formal training. CONCLUSIONS: Surgery residents tested for 3 aspects of cultural competence prior to and after teaching sessions showed marked improvement on all 3 assessment measures after this brief intervention.

Pasteur's Quadrant: preparing training programs for "use-inspired" surgical research.

Ensuring that scientific research is an integral element of surgical residency training is critical to the future viability of the field. The ability to nurture surgeon-scientists, invoke them to ask pertinent questions, design experiments, and translate these findings into clinical applications will set this specialty apart from competing fields. Involving residents and younger faculty in this process of translational research is crucial to develop academic leaders and improve patient care. It is as critical as it is complex. Here, we propose that this objective can be attained only if academic departments of surgery recognize its value, create a solid framework of support, encourage partnerships, and above all provide the patient and essential mentorship that residents and young faculty need to pursue meaningful surgical research. To provide usable frameworks, a unique 2-dimensional quadrant termed "Pasteur's Quadrant" is generated based on the original work of Stokes. Briefly, it creates 4 quadrants that separate pure basic science or discovery (X-axis) from applied research or innovation (Y-axis). In doing so, it also defines a median-research that satisfies both goals: scientific advancement AND clinical improvement. This novel use-inspired method of categorizing research provides guidelines to select research programs prudently. Using the Pasteur's Quadrant approach to the conduct of resident-performed surgical research offers several advantages: It is clinically applicable; it advances goals of fundamental scientific research; it is provocative, productive, and retains high visibility; and it makes it attractive to funding agencies and industry alike. Lastly, it charts a vibrant course for their main beneficiaries, residents and academic surgical programs.

Assisting women to learn myocardial infarction symptoms.

OBJECTIVE: The purpose of this study was to test how teaching format (factual versus storytelling) and restructuring the social norm of caring for others to caring for self affects how women learn to identify and respond to myocardial infarction (MI) symptoms. DESIGN: The study was a randomized pretest posttest full factorial experiment. SAMPLE: One hundred and thirteen women participated. MEASURES: Before and after reading the intervention pamphlet, the women wrote all the MI symptoms that they knew and rated their intention to call 911 if symptoms occurred. INTERVENTION: The women read one of the four MI pamphlets corresponding to the four conditions. RESULTS: No significant effects for learning MI symptoms resulted from teaching format or social norms. Women learned three additional MI symptoms. All responded with high intention to call 911 if MI symptoms occurred. CONCLUSIONS: Women can learn additional MI symptoms from reading a brief pamphlet about MI symptoms. Use of a storytelling format and the social norm of caring for self might not impact how many MI symptoms women learn. Studies using audiovisuals and larger samples are needed to clarify whether storytelling format and the social norm of caring for self-impact learning MI symptoms.