bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Training and Education: An Unusual Comparison of 2 Departments in a Community Hospital Setting
Authors: Williams Troy C. , Welch Robert 
Published: January 2017

Introduction: General Surgery programs are highly regarded for providing operative procedures to trainees. Obstetrics and Gynecologic Surgery programs also offer a multitude of surgical procedures. We would like to compare and contrast these two types of programs in the hopes of further advancing the art of surgical education and broadening the career options of those considering a career as a cosmetic surgeon. Materials and Methods: Operating room and labor and delivery records from Providence Hospital were collected for the calendar year of 2004. The records were reviewed for total number of cases by service. The procedures were then substratified by recognized surgical difficulty and risk (minor vs. major). Results: Trainees in the General Surgery department participated in 4708 cases; in the Obstetrics and Gynecologic Surgery department, trainees participated in 4474 cases. The 3 most frequent categories for General Surgery trainees were laparoscopic cholecystectomy (515, major procedure), breast biopsy (427, minor procedure), and resection of lipoma (359, minor procedure). In comparison, for the Obstetrics and Gynecologic Surgery trainees, the 3 most frequent categories included cesarean section (1099, major procedure), hysteroscopy with dilation and curettage (632, minor procedure), and total abdominal hysterectomy (475, major procedure). Conclusions: Trainees in both programs enjoy exposure to a large number of major and minor operative procedures. It appears that more major procedures are available to trainees in Obstetrics and Gynecologic Surgery. Applicants should consider either type of training to prepare for a future cosmetic surgery practice.
Deciding the Position of Neoumbilicus in Abdominoplasty: A Novel Idea
Authors: Thomas Mohan , D'Silva James Allen , Menon Hari , Padubidri Ramesh 
Published: January 2017

Introduction: Determining the position of the neoumbilicus in cases of abdominoplasty has always been tricky. Objective: To present a simple method of determining the position of the neoumbilicus in cases of abdominoplasty. Methods: Presentation of a technique used in 50 cases of abdominoplasty. Results: This method has been found to be foolproof in more than 50 patients. Conclusion: The main advantage of this method is that patients get a neoumbilicus that is in its original position every single time.
Nonsurgical Methods for Treatment of Capsule Contracture
Authors: Shiffman Melvin A. 
Published: January 2017

Background: The breast implant is a foreign body that stimulates a “walling-off” response associated with scar formation (fibroblast proliferation). It has been presumed that inflammatory cells, extracellular matrix, and fibroblast proliferation are responsible for capsule contracture following breast augmentation. The possible causes of capsule contracture are described, and nonsurgical methods for relief of the capsule contracture are discussed. Methods: The literature was reviewed for medications and other nonsurgical methods that may possibly be used for relief of capsule contracture or reduction of the incidence of capsule contracture. Conclusion: Additional studies are needed that address the effects of drugs and electrostimulation on capsule contracture following breast augmentation.
BAMBI: Bilateral Augmentation Mammoplasty by Injection; Breast Augmentation Using Autologous Fat Transplantation: The Controversy and Personal Experience
Authors: Roomi Riad 
Published: January 2017

Introduction: Breast augmentation is one of the most sought after cosmetic surgical procedures in developed countries. It is accepted that augmentation by silicone implants is the gold standard. However, it is also acknowledged that this method is not without problems and complications in the best hands. Historical review shows that many materials were used to augment the breast. Needless to say, the majority of those have failed, and some with catastrophic consequences. Autologous fat, the subject of this article, was introduced in 1987. In most practices, no other alternative to implants is being offered to prospective patients. It is undeniably true that there is a group of patients who are not candidates for augmentation by implants. Among this group are patients who categorically refuse implants for one reason or another. Objective: In our expanding and rapidly advancing specialty, the ability to offer an alternative treatment for any presenting problem is an indispensable tool of our profession. However, when it comes to the small breast problem, the majority of surgeons are unable or unwilling to offer women who seek breast augmentation any alternative to implants. The objective of this article is to prompt an interest for a forum to look at this method more objectively to establish whether it can be approved as an alternative to implants. Materials and Methods: Review of the literature.
Long-term Follow-up Study of Intravascular 1320-nm Laser Closure of the Great Saphenous Vein
Authors: Woodhall Katrina E. , Nootheti Pavan K. , Palm Melanie , Goldman Mitchel P. 
Published: January 2017

Objective: To determine the long-term efficacy and safety of a 1320-nm intravascular laser to close the great saphenous vein (GSV). Methods: Sixty-four patients with incompetent GSV (0.5–1.44 cm in diameter) associated with distal varicose veins were treated using a 1320-nm intravascular laser at 5–6 W with an automatic pullback mechanism at 1 mm/s. Duplex ultrasound examinations were performed at baseline and patients were followed 1 to 5 years posttreatment. Participants: Of the 64 patients, 84% were women and the average age of the participants was 49 years. Results: The average baseline GSV measured 0.78 cm (range, 0.37–1.95 cm). The average length of follow-up was 25.3 months. A total of 12.5% (8/64) of patients received follow-up sclerotherapy for residual reticular and telangiectatic veins. Seventy-five percent (52/64) of patients had absent GSV after treatment. Twenty-five percent (12/64) of patients had open, patent GSV with no reflux. The failure rate for treatment was 7.8% (5/64). Treatment failures included open GSV with reflux, 2 patients who underwent repeat cool touch endovenous laser treatment, and 1 patient who had ultrasound-guided foam sclerotherapy treatment. Conclusions: The 1320-nm intravascular laser is safe and effective in treating an incompetent GSV up to 1.44 cm in diameter.
Deep Temporal Facelift: Its Indications in Surgery for Aging of the Upper Third of the Face
Authors: Faivre Jacques 
Published: January 2017

This article describes a new technique that is completely different from superficial temporal facelift (also referred to as the mannequin facelift), which is associated with well-known failures and sequelae. The principle of the deep temporal facelift is to approach the deep surface of the musculo-aponeurotic plane by remaining in contact with the bone and to attach the ascension of this plane by means of sutures anchored to the temporalis muscle and fibrin sealant. Essential indications for this technique are: drooping of the tail of the eyebrow dropping of the external canthus of the eye crow's-feet.
Preliminary Results of the Effects of Various Suture Material on the Rat Ear
Authors: Bogner Robin M. , Dedo Douglas D. , Cove Harvey 
Published: January 2017

The re-approximation of septal flaps after septoplasty or septorhinoplasty may be complicated by a septal perforation. In the usual operative sequence the mucoperichondrial flaps are elevated on either side of the septum and after morselization the cartilage is placed back into the septal pocket for support and preservation of the integrity of the septum itself. Re-approximation of the septal flaps, septal suturing, septal splints, and packing have all been used alone or in combination to close the septal pocket and prevent hematoma. In order to determine the effects of suturing the septum on the formation of septal perforations, the rat ear was chosen as the experimental model. Like the nasal septum it is made up of a cartilaginous framework covered on both sides by skin. Unlike the nose, the lining is epithelium and not pseudostratified columnar ciliated respiratory epithelium. However, the healing and absorbing qualities of the two types of epithelium are very similar in nature. Three different types of suture material were placed in the rat ear. Chromic and polyglycolic acid absorbable sutures were placed in the ear and followed grossly and histologically until completely absorbed. A stainless steel staple was used as a control to determine if the epithelium would “pierce” the ear similar to the technique of piercing the ears for earrings. The results of this study show that as the absorbable suture is dissolved the diameter of the tract through the ear gradually decreases and healing occurs without a permanent perforation. However, the stainless steel staple allowed the epithelium to migrate along the shaft, producing a perforation. From these results, the conclusion can be made that suturing the septum with an absorbable suture probably does not contribute significantly to permanent septal perforations.
Cleft Lip Rhinoplasty
Authors: Smith Howard W. 
Published: January 2017

Cleft lip rhinoplasty may be performed as an endonasal or an open rhinoplasty procedure. It is helpful for the rhinoplasty surgeon to know the type of lip closure and the extent of nasal surgery performed at the time of primary lip repair. Current methods of primary lip repair attempt to create an esthetic lip scar and leave a minimal degree of nasal tip deformity to allow the child to avoid secondary lip and nasal tip surgery at the preschool age. Single cleft lip rhinoplasty has to deal more with asymmetry than double cleft lip rhinoplasty. The double cleft lip deformity has to deal with a true deficiency in the columella and the possible need for lip augmentation. Closure of the alveolar cleft and the cleft palate in both types of cleft lip and palate often creates scar tissue that retards maxillary growth and introduces the need for cephalometric analysis and possible orthognathic surgery.
Submental Recontouring: An Adjunctive Maxillofacial Aesthetic Procedure
Authors: Ziccardi Vincent B. , Schneider Ronald E. 
Published: January 2017

Introduction: The chin and submental region contribute to facial balance. Inadequate jaw projection and neck definition may compromise the aesthetic results of cosmetic surgical procedures. It was hypothesized that adjunctive mandibular setback procedures and reduction genioplasty would improve the aesthetic results of cosmetic surgery. Materials and Methods: A triangular excision for a V–Y advancement is outlined in the submental region using methylene blue. The triangle is oriented with the apex facing the chin and the base toward the thyroid cartilage in a natural neck crease. The triangle, oriented so that the base is toward the chin at the submental crease, left a small bulge at the apex of the vertical limb of the Y in the neck midline, which required a secondary excision to correct. Incisions in the shape of a pentagon or an ellipse can also be used. Local anesthetic with vascoconstrictor is deposited along the lines of the planned excision. The geometric skin is excised. If the platysma muscle is dehiscent, it can be sutured and platysmaplasty performed. The subplatysmal fat may be removed if visible only in the midline region with caution taken at this juncture not to be too aggressive to avoid potential profuse hemorrhage. The skin flaps are widely undermined. The fat excision is feathered. A two-layer closure is then performed. Discussion: In patients with adequate skin elasticity and thickness, liposuction may be indicated. Submental excision and direct lipectomy is another technique that can address the ptotic chin, lax skin, and submental lipomatosis. This technique is indicated for those patients in whom there is excess submental fat or skin laxity and in whom there is a contraindication or a lack of patient desire to undergo formal neck-lifting procedures. Conclusion: Submental recontouring is a useful adjunctive aesthetic procedure that can be readily performed in the office setting with instrumentation and technique currently available.
Varicosis, Aesthetics, and Pain
Authors: Parish Timothy D. 
Published: January 2017

Introduction: The aesthetic presentation and subsequent management of varicosis are well accepted. However, the association of pain and its impact on varicosis is less well understood. The purpose of this study is to define the interrelationship of pain with the anatomic and physiological presentation of patients with primary varicosis. Materials and Methods: This is an ongoing prospective demographic study of sequential patients presenting randomly at the Varicosis and Laser Center of Alabama for the evaluation of varicosis. All patients were given standard questionnaires to evaluate their reasons for presentation. Later in the study, those who selected pain were asked to identify the perceived intensity of their pain by the use of “smiley faces.” Patients were clinically divided into three groups: group 1, those with spider and reticular vein disease; group 2, those with mixed large- and small-vein disease; and group 3, those with large-vein disease (>4 mm). Results: Seventy-seven percent of patients presenting with varicosis had pain. The correlation of pain with varicosis may indicate a more prevalent association with chronic venous insufficiency. This association was of greater significance in those patients with large-vein disease (>4 mm). The use of smiley faces to monitor perceived intensity of pain revealed a significant result in all clinical groups. The character of the pain was described in multiple terms. Discussion: Pain is a prevalent condition in those patients presenting with primary varicosis. Pain is associated with a greater likelihood of chronic venous insufficiency, in large-vein disease. The association of varicosis with pain and chronic venous insufficiency allows categorization into four functional classes.
Eight Years of Fat Transplantation Experience
Authors: Jackson Robert F. 
Published: January 2017

Introduction: I have used fat as a transplantation filler following liposuction approximately 8 years. Six years ago, I began freezing fat to be used later. The results of both frozen and fresh fat as transplant material is dependent on many variables, not the least of which is technique. I describe the background of this procedure, its evolution, my personal techniques, and the results. Materials and Methods: For this study, only 30 randomly chosen patients who could be followed for at least 6 months were considered. Twenty-eight patients received fresh fat transferred at the time of surgery. Fourteen patients received frozen fat. Five patients received a second injection of frozen fat. Three received 3 or more injections. Two patients received frozen fat injected as the initial filler. One patient received a subsequent injection of frozen fat. My technique for harvesting fat either to be used as fresh transplant material or later as frozen transplant material is the same. Tumescent infiltration is carried out using the standard Klein solution, 0.05% lidocaine, in normal saline with 1:1000000 epinephrine. Originally a 2- or 2.5-mm cannula with a 35 mL or 60-mL syringe technique was used; however, recently, the Coleman harvesting needle and 10-mL syringe have been used. The fat is stored in 5- and 10 mL syringes. Conclusion: I have found fat to be an acceptable filler for both congenital and surgical defects as well as a good method for augmentation. I found frozen fat to survive as well as fresh fat.
Use of Autocollagen
Authors: Takasu Katsuya , Takasu Shizu 
Published: January 2017

Introduction: We developed an efficient procedure for separating autocollagen from adipose tissue. This involved the use of an electrical ultrasonic generator to break up fat cells and subsequent centrifugation. We have been using autocollagen as a dermal filler, substituting it for the popular bovine collagen, for the last 10 years. This study was performed to evaluate the actual amount of collagen content in autocollagen obtained with our method and to evaluate the clinical efficacy of our technique. Materials and Methods: Autologous fat harvested with liposuction is treated with ultrasonic homogenation for 2 minutes and then centrifuged at 1000 rpm for 3 minutes. The second layer of material present after centrifugation is autocollagen, which contains fragments of collagen fiber, elastic tissue, and disrupted fat cells. The extracted samples were subjected to hydroxyproline assay. One hundred sixty cases were followed after receiving autocollagen injections into the dermis to smooth out wrinkles. Results: The collagen content in our autocollagen was 4.0% (3.4–6.1%). Of the 169 patients treated with autocollagen injections, no infections or allergic reactions occurred during the follow-up. Most of the cases showed a recurrence of wrinkles after 6 months to 2 years. A few patients demonstrated a long-term improvement of their wrinkles (up to 6 years). Discussion: Autocollagen obtained by destroying fat tissue is a devitalized tissue and it is unlikely that it will survive after replantation in the human body. However, some patients showed pesistent corrections. Autocollagen is a safer and less expensive material and may provide a longer-term correction than bovine collagen implants for the correction of wrinkles.
Umbilicoplasty in Abdominoplasty: A Demonstration
Authors: Risk Benito B. , Prado Angel 
Published: January 2017

Introduction: The purpose of this paper is to demonstrate a new technique in performing umbilicoplasty at the time of abdominoplasty that avoids the formation of a thickened or contracted circular scar. Materials and Methods: After a routine abdominoplasty and isolation of the umbilical stalk with extra redundant skin surrounding the umbilicus, a V-incision is made in the abdominal wall skin at a site selected for the new umbilical site. The superior or cephalic part of the umbilicus is split and spread, creating the appearance of a wedge that has been removed. The umbilicus is brought through the abdominal wall opening. The inferior point created by the abdominal V is sutured to the slit point of the umbilicus, which is cephalic, and is also sutured to the fascia at the base of the stalk, thus rotating the point of the V deep into the umbilicus and avoiding a circular scar. Results: The resultant umbilicus has no scar superiorly, as the tip of the V is completely buried. Thus, a visible circular scar is avoided. Discussion: The described procedure is simple, and the results are cosmetically acceptable both to the patient and the surgeon.
Hospital-Physician Integration: Case Studies of Community Hospitals
Authors: Lemieux-Charles Louise , Leatt Peggy 
Published: January 2017

Hospitals are attempting more meaningfully to involve physicians in management as one approach to increasing the efficiency and effectiveness of their operations. The purpose of this research was to explore the relationship between the structure of the medical staff organization, the extent to which physicians are integrated into hospital decision making and the hospital's financial performance. A measure of hospital-physician integration was developed based on Alexander et al's (1986) dimensions of hospital-physician integration which were based on Scott's (1982) organizational models, ie, autonomous, heteronomous and conjoint. A multiple case study design, which comprised eight community non-teaching hospitals over 200 beds located in the Province of Ontario, Canada, was used to examine the relationship between variables. Study results suggest that there is variation among community hospitals on both contextual and organization factors. Hospitals with high levels of hospital-physician integration were located in highly populated areas, had formulated and implemented a strategic plan, had highly structured medical staff organizations, and had no budgetary deficit. In contrast, hospitals with moderate or low levels of integration were more likely to be located in lowly populated areas, had little planning activity, had a moderately structured medical staff organization, and had deficit budgeting. Suggested areas for future research include examining the role of the Board of Trustees in determining physicians' organizational roles and identifying differences in commitments, characteristics, and motivations of physicians working in rural versus urban hospitals and their impact on integrative strategies.
Adopting an Information Management Approach to the Design and Implementation of Information Systems
Authors: Hepworth John B. , Griffin Elaine , Vidgen Grant A. , Woodward Tony 
Published: January 2017

As the NHS adopts an information management approach to coordinated handling of total information resources, methods of systems analysis and design require assessment to ensure that they are appropriate. Mandatory use of Structured Systems Analysis and Design Methodology (SSADM) may be encouraging a damagingly narrow view of information systems. Research is described in which an holistic view of information systems is applied, allowing the needs of information users to play a stronger role in determining how information will be supplied to them. The techniques may also assist the training activities associated with implementing new systems.
Resource Management in Community Residential Facilities for Adults with Learning Disabilities
Authors: Shiell Alan , Wright Ken , Pettipher Catherine , Raynes Norma 
Published: January 2017

The trend towards community living for people with learning disabilities puts pressure on traditional hierarchical lines of resource management. A sample of 150 community residential facilities is surveyed in order to describe the systems used to manage resources in the community and to assess the impact they have on the quality of service provided. There are marked differences amongst provider agencies in the degree to which responsibility for resource management is devolved to facility managers and this has a direct effect on the quality of care. Residential homes which operate under centralised management systems are more institutional in their care practices and less responsive to individual clients' needs. In contrast, homes in which responsibility is delegated to the facility manager provide a service more in keeping with current philosophies of care. The results of this survey suggest that more responsibility for resource management can be delegated to facility managers without losing control of expenditure and with improvements in the efficiency and effectiveness of care.
Comparative Attributes of Effective Health Services Managers and Definitions of Organizational Effectiveness in Australia, the UK and the USA
Authors: Boldy D. , Jain S. , Chen G. 
Published: January 2017

This paper explores and contrasts the perceptions of 855, mainly health services managers and 1452 students from three major English-speaking countries regarding the attributes needed for becoming effective managers in their country. Also addressed are country differences and similarities in the perceived relevance of particular indicators of organizational effectiveness. Despite Australia's British heritage, respondents from this country were found to be more similar to those from the USA, than those from the UK, in their views regarding the attributes of effective managers. Australian and American respondents rated ‘nurturing’ personality skills relatively highly, as they did ‘classical’ management skills. UK respondents rated ‘classical’ management skills as more important than ‘political’ skills.