Resident Attrition in Plastic Surgery: A National Survey of Plastic Surgery Program Directors.

BACKGROUND: Attrition in plastic surgery is poorly characterized in the literature with previous data indicating that independent residents may have a higher rate of voluntary attrition with integrated residents having a higher rate of involuntary attrition. The aim of this study is to identify risk factors, note differences between pathways, and provide insight into resident attrition from plastic surgery residencies. METHODS: An institutional review board-approved anonymous, multiple-choice and short answer, online survey regarding resident attrition was sent to all plastic surgery program directors (PDs) in the United States focusing from 2003 to 2013. Outcomes measured included demographics of the program and attritional resident, timing and reasons for attrition, and possibility of preventing attrition. RESULTS: Thirty-three (35%) of 95 PDs responded. Average attrition rates were calculated at 2.15% for independent and 0.85% for integrated programs. Risk factors for attrition included being single, divorced, male, and having no dependents. One hundred percent of independent residents left by year 2, and 86% of integrated residents left by year 4. Lifestyle and loss of interest were most sited reasons for attrition. Most independent residents returned to their original field of training, whereas integrated residents were more likely to transfer to another integrated program. Only 17% of PDs believed attrition could have been prevented. CONCLUSIONS: Approximately 3.0% of all plastic surgery residents underwent attrition. Being single, male, divorced, or having no dependents increases the risk of attrition in plastic surgery residencies. This is the first study to demonstrate potential risks factors for plastic surgery residents undergoing attrition.

A Brief History of Two Common Surgical Drains.

The use of surgical drains is commonplace in all types of surgical procedures, and rarely do we take the time to contemplate or investigate the origins of these critical devices. Every surgeon should be familiar with the Jackson-Pratt drain and Blake drain, 2 of the most frequently used closed suction, negative-pressure drainage devices in surgery. These drains are used throughout the body in a wide variety of surgical procedures. The development and differences between these 2 devices are seldom known by the practicing surgeon. In this article, we delve into the ancient history of drains, the creation and alterations of the closed suction, negative-pressure drain that paved the way for the Jackson-Pratt and Blake drain. Finally, we will discuss the variety of reservoirs that attach to these drains and the origin of the well-known adage of when to pull a drain.

Burn Center Barrier Protocols During Dressing Change: A National Survey.

Infection control is a critical component of post-burn care with prevention of infection serving as a major cause of decreasing morbidity and mortality. One potential deterrent for infection is barrier protection during dressing changes; however, no evidence-based standard has been established among burn centers. The purpose of this study is to describe the current barrier techniques of American burn centers. A 24-question survey was sent to 121 burn center nurse managers within the United States. The survey was comprised of yes or no questions with comment sections available for further detail. Questions were constructed to gain insight into the variation and commonality that may exist between burn center barrier protocols. Forty-one out of 121 centers (34%) responded. Centers reported the use of head covers, masks, gowns, and gloves during admission of a new burn (71%, 82%, 95%, and 100% respectively); daily dressing changes (64%, 80%, 97%, and 100% respectively); postoperative dressing changes (64%, masks 80%, 97%, and 100% respectively); and dressing changes of a nonburn (66%, 82%, 97%, and 100% respectively). Burn centers reported their use of sterile gloves and gowns during typical burn dressing changes as occurring 20% and 10% of the time, respectively. Estimates for costs of these garments annually ranged from $0 to $250,000. A calculation performed for this study demonstrated that barrier garments used for dressing changes nationwide is approximately $2.43 million. We demonstrated the immense cost, to an institution and nationwide, of barrier garments used solely for dressing changes.

A retained foreign body mimicking colon cancer.

Retained foreign bodies can be a challenging diagnosis due to the wide array of presentations and greatly varied range of time to detection. Here we report a case of a retained surgical sponge detected 5 years postoperatively after an extensive workup for colon cancer. This case demonstrates the novel finding of a retained surgical sponge appearing as colon cancer and serves as a reminder that symptoms that cannot be explained by a standard workup, in any patient who has undergone previous surgery, must have retained surgical instruments as a differential diagnosis.

Sleep loss changes microRNA levels in the brain: a possible mechanism for state-dependent translational regulation.

MicroRNAs (miRNAs) are small ( approximately 22 nucleotides) non-coding RNA strands that base pair with mRNA to degrade it or inhibit its translation. Because sleep and sleep loss induce changes in many mRNA species, we hypothesized that sleep loss would also affect miRNA levels in the brain. Rats were sleep-deprived for 8h then decapitated; hippocampus, prefrontal and somatosensory cortices and hypothalamus tissues were harvested and frozen in liquid nitrogen. miRNA was extracted and then characterized using microarrays. Several let-7 miRNA microarray results using hippocampus and prefrontal cortex samples were verified by PCR. From the array data it was determined that about 50 miRNA species were affected by sleep loss. For example, in the hippocampus of sleep-deprived rats, miRNA expression increased compared to cage control samples. In contrast, the majority of miRNA species in the somatosensory and prefrontal cortices decreased, while in the hypothalamus miRNA species were both up- and down-regulated after sleep deprivation. The number of miRNA species affected by sleep loss, their differential expression in separate brain structures and their predicted targets suggest that they have a role in site-specific sleep mechanisms. Current results are, to our knowledge, the first demonstration of the homeostatic process, sleep, altering brain miRNA levels.