The Medical Student Race to Research: Who Presents More at National Plastic Surgery Conferences?

BACKGROUND: presentations increase research output and facilitate networking for medical students applying to plastic surgery. We aim to determine predictors of increased medical student presentation at national plastic surgery conferences, identifying disparities in access to research opportunities. METHODS: Abstracts presented at the 2 most recent meetings of the American Society of Plastic Surgeons, American Association of Plastic Surgeons, and Plastic Surgery Research Council were extracted from online archives. Presenters without MDs or other professional credentials were classified as medical students. Presenter gender, medical school ranking, plastic surgery division/department, National Institutes of Health funding, number of total and first-author publications, H-index, and research fellowship completion status were recorded. Students with 3 or more (>75th percentile) presentations were compared with those with less by χ2 tests. Univariate and multivariable regressions identified factors associated with 3 or more presentations. RESULTS: Of 1576 abstracts, 549 (34.8%) were presented by 314 students. The gender distribution was 46.5% male and 53.5% female. Most were from the Northeast (36.9%), 35% came from top 20 medical schools, and 85% attended schools with home plastic surgery programs. While 61.8% presented once, 14.6% presented 3 or more times. Those who previously presented, completed research fellowships or had more publications or higher H-indices were likely to present more ( P ≤ 0.007). On multivariable-adjusted analysis, completing research fellowships (odds ratio [OR], 2.34-2.52; P = 0.028-0.045), affiliation with institutions having higher National Institutes of Health funding (OR, 3.47-3.73; P = 0.004-0.006), or having more total number of publications (OR, 3.81; P = 0.018) or first-author publications (OR, 3.84; P = 0.008) was associated with 3 or more presentations. Presenter gender, geographic region, medical school ranking, home program status, and H-indices were not significant predictors on multivariable analysis. CONCLUSIONS: There are several potential inequities in access to research opportunities for medical students, disadvantaging those with less well-funded plastic surgery programs and existing research experience. Improving the equitability of these opportunities is crucial for limiting bias in trainee recruitment and diversifying representation in the field.

Promoting Publications Through Plastic Surgery Journal Instagram Accounts: Is It Worth It?

PURPOSE: Journals are increasingly using social media to increase article engagement. We aim to determine the impact of Instagram promotion on, and identify social media tools that effectively enhance, plastic surgery article engagement and impact. METHODS: Instagram accounts for Plastic and Reconstructive Surgery , Annals of Plastic Surgery , Aesthetic Surgery Journal , and Aesthetic Plastic Surgery were reviewed for posts published by February 8, 2022. Open access journal articles were excluded. Post caption word count and number of likes, tagged accounts, and hashtags were recorded. Inclusion of videos, article links, or author introductions was noted. All articles from journal issues published between the dates of the first and last posts promoting articles were reviewed. Altmetric data approximated article engagement. Citation numbers from the National Institutes of Health iCite tool approximated impact. Differences in engagement and impact of articles with and without Instagram promotion were compared by Mann-Whitney U tests. Univariate and multivariable regressions identified factors predictive of more engagement (Altmetric Attention Score, ≥5) and citations (≥7). RESULTS: A total of 5037 articles were included, with 675 (13.4%) promoted on Instagram. Of posts featuring articles, 274 (40.6%) included videos, 469 (69.5%) included article links, and 123 included (18.2%) author introductions. Promoted articles had higher median Altmetric Attention Scores and citations ( P < 0.001). On multivariable analysis, using more hashtags predicted higher article Altmetric Attention Scores (odds ratio [OR], 1.85; P = 0.002) and more citations (OR, 1.90; P < 0.001). Including article links (OR, 3.52; P < 0.001) and tagging more accounts (OR, 1.64; P = 0.022) predicted higher Altmetric Attention Scores. Including author introductions negatively predicted Altmetric Attention Scores (OR, 0.46; P < 0.001) and citations (OR, 0.65; P = 0.047). Caption word count had no significant impact on article engagement or impact. CONCLUSIONS: Instagram promotion increases plastic surgery article engagement and impact. Journals should use more hashtags, tag more accounts, and include manuscript links to increase article metrics. We recommend that authors promote on journal social media to maximize article reach, engagement, and citations, which positively impacts research productivity with minimal additional effort in designing Instagram content.

Pain management strategies in urethral reconstruction: a narrative review.

Background and Objective: Few investigations explore pain recovery comprehensively following urethral reconstruction, and understanding pain pathways that lead to discomfort following reconstruction has posed challenges. Options for pain control aside from opioids continue to be in the early forms of investigation, and remain an important strategy to combat the well-documented burden of the opioid epidemic. We conduct a detailed assessment of pain pathways in patients undergoing urethral reconstruction and further outline non-narcotic based pain management strategies in those undergoing urethroplasty. Methods: We performed a literature review to describe pain pathways involved in urethral reconstruction with buccal graft, and postoperative pain recovery. We searched for pain management techniques performed by fields similar to urology, and those being utilized in urethroplasty with buccal graft. Key Content and Findings: Innervation of the penoscrotal areas and mouth are well-defined, but understanding postoperative pain after urethroplasty remains a challenge. Preventative analgesia, nerve blocks, and multimodal analgesia have been employed by colorectal and gynecological surgeons. Urologists have utilized similar techniques for patients undergoing urethral reconstruction with buccal graft. Conclusions: Few investigations explore pain recovery comprehensively following urethral reconstruction, but we believe that utilizing a combination of preventative analgesia, nerve blocks, and multimodal analgesia will have acceptable outcomes in post-surgical patients undergoing recovery. Additional work is required to further explore how combined pain management strategies can optimally reduce postoperative pain.

Implementation of an Emergency Department Sepsis Bundle and System Redesign: A Process Improvement Initiative.

BACKGROUND: In 2008-2009, the Canadian Institute for Health Information reported over 30,000 cases of sepsis hospitalizations in Canada, an increase of almost 4,000 from 2005. Mortality rates from severe sepsis and septic shock continue to remain greater than 30% in Canada and are significantly higher than other critical conditions treated in the emergency department (ED). Our group formed a multidisciplinary sepsis committee, conducted an ED process of care analysis, and developed a quality improvement protocol. The objective of this study was to evaluate the effects of this sepsis management bundle on patient mortality. METHODS: This before and after study was conducted in two large Canadian tertiary care EDs and included adult patients with suspected severe infection that met at least two systemic inflammatory response syndrome (SIRS) criteria. We studied the implementation of a sepsis bundle including triage flagging, RN medical directive, education campaign, and a modified sepsis protocol. The primary outcomes were 30-day all-cause mortality and sepsis protocol use. RESULTS: We included a total of 167 and 185 patients in the pre- and post-intervention analysis, respectively. Compared to the pre-intervention group, mortality was significantly lower in the post-intervention group (30.7% versus 17.3%; absolute difference, 13.4%; 95% CI 9.8-17.0; p=0.006). There was also a higher rate of sepsis protocol use in the post-intervention group (20.3% versus 80.5%, absolute difference 60.2%; 95% CI 55.1-65.3; p<0.001). Additionally, we found shorter time-intervals from triage to MD assessment, fluid resuscitation, and antibiotic administration as well as lower rates of vasopressor requirements and ICU admission. Interpretation The implementation of our multidisciplinary ED sepsis bundle, including improved early identification and protocolized medical care, was associated with improved time to achieve key therapeutic interventions and a reduction in 30-day mortality. Similar low-cost initiatives could be implemented in other EDs to potentially improve outcomes for this high-risk group of patients.

Comparison between narrow-band UVB with topical corticosteroid and narrow-band UVB with placebo in the treatment of vitiligo: A randomized controlled trial

BACKGROUND: Narrow-band UVB and topical corticosteroids are treatments for vitiligo. The possible synergistic effect of these modalities has not yet been investigated.OBJECTIVE: This study aims to compare the efficacy of combining narrow-band UVB (NB-UVB) and 0.05% clobetasol propionate ointment (CP) with that of NB-UVB and placebo in inducing initial and overall repigmentation and control of disease activity after 6 months of therapy. Moreover, it aims to assess the safety and determine the permanence ofrepigmentation within I year post-treatment in both regimens.METHODS: Randomized, placebo-controlled, double-blind, left-right comparison was conducted on generalized vitiligo patients with 5-50% body surface area involvement, having at least 2 bilateral, comparative lesions. CP or placebo was applied once daily on either side of the body, each combined with NB-UVB thrice weekly for 6 months.OUTCOME MEASURES: (1) number of exposures and cumulative dose (CD) of NB-UVB that induced initial repigmentation; (2) quantity of repigmentation after 6 months estimated by comparing pre- and post-treatment photographs; (3) effect on disease activity by comparing pre- and post-treatment VIDA (vitiligo disease activity) scores; and (4) permanence of repigmentation and development of new lesions within 1 year post-treatment documented by photographs.ANALYSIS: Sample size was calculated using formula for testing two proportions at 0.05 level of significance and a power of 0.80. Data was analyzed with Student t test (paired), Exact test for symmetry and Wilcoxon signed rank test, depending on the data set involved.RESULTS: Twenty-five patients were recruited, but only 20 were evaluable at the end of the study. Initial repigmentation was noted after a mean of 9.30 +/- 3.54 exposures (mean CD 1,887.8 +/- 1195.81 mJ/cm2) of NB-UVB on the CP-treated side, and after a mean of 15.85 +/- 5.61 exposures (mean CD 4,152.2 +/- 2231.9 mJ/cm2) on the placebo side. After 6 months, 55% (11/20) and 40%(8/20) of patients exhibited marked (>75 %) repigmentation in the NB-UVB with CP side, and NB-UVB with placebo side, respectively. Adverse events were minimal and transient. VIDA scores improved and repigmentation induced by both treatment regimens remained stable in majority within one year post-treatment.CONCLUSIONS: Combination NB-UVB and CP induced repigmentation earlier, requiring significantly lower cumulative dose of NB-UVB than NB-UVB plus placebo. Over all quantity and permanence of repigmentation, as well as control of disease activity and safety, were comparable in the two regimens.