Teach Design to Surgical Trainees: One Small Step for Surgeons, One Giant Leap for Surgery.

The field of surgery faces complex, systemic challenges that will require new academic frameworks. In this paper, we propose design thinking as a useful problem-solving technique to apply to such challenges. We define design thinking and provide a brief history of this practice. Finally, we offer suggestions to introduce design thinking to surgical trainees, drawing from the experience of innovation programs that have incorporated this technique.

Sexual Self-Concept and Psychological Functioning of Women With a History of Childhood Sexual Abuse in Hong Kong.

Sexual self-concept (SSC) is an important component of health that is closely associated with the well-being of survivors of child sexual abuse (CSA). Compared with non-CSA respondents, SSC of CSA survivors was deleteriously affected, resulting in ineffective psychological functioning (negative self-evaluation, psychological ill-health, and difficulties in interpersonal relationships). Negative SSC (sexual anxiety, sexual depression, and sexual fear) played a significant role in mediating the adverse effects of CSA on psychological functioning. Future studies may recruit a sample with greater variation in CSA characteristics and use externalizing problems as outcome measures to cross-validate findings of this study.

Validation of the Gumpel Readiness Inventory for preschool children in Hong Kong.

The aim of this study was to validate the Chinese version of the Gumpel Readiness Inventory (RI). Participants included 653 preschool children aged three to five years old, their teachers and parents, and 49 children with developmental disabilities. Teachers and parents completed the RI and parents completed the Strength and Difficulty Questionnaire (SDQ) as well. Each child was individually assessed on the cognitive domain of Preschool Developmental Assessment Scale (PDAS). The results showed that the parent's and teacher's versions of RI correlated with SDQ and PDAS. The RI scores of the children with developmental disabilities were significantly lower than that of the children with typical development. Older children attained higher RI scores than younger children. The internal consistency and the test-retest reliability (both parent's and teacher's versions) were above .70. To conclude, the Chinese version of the RI is a reliable, valid and quick instrument for measuring the school readiness of Hong Kong preschool children.

Financial impact of surgical site infection after kidney transplantation: implications for quality improvement initiative design.

BACKGROUND: Surgical site infection (SSI) after kidney transplantation has been associated with worse graft and patient survival. Although there are clinical incentives to reduce the incidence of SSI, it is unknown whether these are aligned with financial incentives for payers and providers. We use post-kidney transplant surgical site infection (SSI) to quantify the financial implications of surgical complications. The goal of this study was to quantify the financial costs of SSI after kidney transplantation and to determine the party bearing the brunt of these costs. STUDY DESIGN: This was a retrospective cohort study of all adult, first-time kidney-only transplant recipients at the University of Michigan Health System from September 2003 to April 2008 (n = 869). The primary exposure variable was SSI. SSI was defined as skin dehiscence, fascial dehiscence, or bowel evisceration. Primary outcomes measures were hospital revenue (payer costs), hospital inpatient costs, and hospital margin. We used simple univariate (t-test) analysis and multivariate (generalized linear regression) models to control for donor, recipient, and insurer characteristics. RESULTS: Eighteen percent of patients had documented SSIs. In cases with an SSI hospital revenue increased by $20,176, hospital margin decreased by $4,278, and hospital costs increased by $24,454. When adjusted for donor and recipient characteristics, SSI was independently associated with an $11,132 increase in hospital revenue. CONCLUSIONS: Although SSIs have negative financial effects on both hospitals and payers, the impact is greater on payers. Payers have the primary financial incentive to reduce SSI, and broad-based, quality improvement initiatives can be prudent investments for payers. Quantification of the costs associated with SSI can be used to define financial parameters for such initiatives that might prove beneficial to multiple stakeholders.

Targeted disruption of the glutaredoxin 1 gene does not sensitize adult mice to tissue injury induced by ischemia/reperfusion and hyperoxia.

To understand the physiological function of glutaredoxin, a thiotransferase catalyzing the reduction of mixed disulfides of protein and glutathione, we generated a line of knockout mice deficient in the cytosolic glutaredoxin 1 (Grx1). To our surprise, mice deficient in Grx1 were not more susceptible to acute oxidative insults in models of heart and lung injury induced by ischemia/reperfusion and hyperoxia, respectively, suggesting that either changes in S-glutathionylation status of cytosolic proteins are not the major cause of such tissue injury or developmental adaptation in the Glrx1-knockout animals alters the response to oxidative insult. In contrast, mouse embryonic fibroblasts (MEFs) isolated from Grx1-deficient mice displayed an increased vulnerability to diquat and paraquat, but they were not more susceptible to cell death induced by hydrogen peroxide (H(2)O(2)) and diamide. A deficiency in Grx1 also sensitized MEFs to protein S-glutathionylation in response to H(2)O(2) treatment and retarded deglutathionylation of the S-glutathionylated proteins, especially for a single prominent protein band. Additional experiments showed that MEFs lacking Grx1 were more tolerant to apoptosis induced by tumor necrosis factor alphaplus actinomycin D. These findings suggest that various oxidants may damage the cells via distinct mechanisms in which the action of Grx1 may or may not be protective and Grx1 may exert its function on specific target proteins.

Mice lacking catalase develop normally but show differential sensitivity to oxidant tissue injury.

Catalase plays a major role in cellular antioxidant defense by decomposing hydrogen peroxide, thereby preventing the generation of hydroxyl radical by the Fenton reaction. The degree of catalase deficiency in acatalasemic and hypocatalasemic mice varies from tissue to tissue. They therefore may not be suitable for studying the function of this enzyme in certain models of oxidant-mediated tissue injury. We sought to generate a new line of catalase null mice by the gene targeting technique. The mouse catalase (Cat or Cas1) gene was disrupted by replacing parts of intron 4 and exon 5 with a neomycin resistance cassette. Homozygous Cat knockout mice, which are completely deficient in catalase expression, develop normally and show no gross abnormalities. Slices of liver and lung and lenses from the knockout mice exhibited a retarded rate in decomposing extracellular hydrogen peroxide compared with those of wild-type mice. However, mice deficient in catalase were not more vulnerable to hyperoxia-induced lung injury; nor did their lenses show any increased susceptibility to oxidative stress generated by photochemical reaction, suggesting that the antioxidant function of catalase in these two models of oxidant injury is negligible. Further studies showed that cortical injury from physical impact caused a significant decrease in NAD-linked electron transfer activities and energy coupling capacities in brain mitochondria of Cat knockout mice but not wild-type mice. The observed decrease in efficiency of mitochondrial respiration may be a direct result of an increase in mitochondrion-associated calcium, which is secondary to the increased oxidative stress. These studies suggest that the role of catalase in antioxidant defense is dependent on the type of tissue and the model of oxidant-mediated tissue injury.