A post-Soviet Republic in Transition: A Novel Amplification Programme to Address the Crisis of Continuing Medical Education and Challenges Facing Regional Physicians in the Republic of Armenia.

BACKGROUND: After the fall of the Soviet Union in 1991, the existing process of Continuing Medical Education (CME) was decimated. The Fund for Armenian Relief (FAR) was able to leverage competitive educational fellowship programmes in existence, and harness new knowledge gained by returning fellows thus amplifying the impact on education and patient care in the regions of the republic of Armenia. AIMS: This manuscript describes a replicable novel amplification programme using a "train the trainer" model for CME in the republic of Armenia. We sought to identify challenges specific to physicians from the regions, and to examine the strengths of the CME programme that can serve as a model for programme development and improvement in countries facing similar challenges. METHODS: The manuscript details a descriptive and mixed method study that includes in-depth interviews and focus group discussions from 2015-2016. Conceptual content analysis was used to identify major themes from the transcripts. RESULTS: Challenges facing regional physicians in post-Soviet counties in transition, exemplified by Armenia, are profound. Exploration of themes related to perceived barriers to care in the regions included, physicians' personal financial constraints, lack of up-to-date knowledge and equipment, lack of confidence, fear of criticism and of making incorrect diagnoses. CONCLUSIONS: The FAR/CME programme presents an innovative way to amplify the knowledge of Armenian physicians upon their return from educational programme participation abroad in order to address challenges facing regional physicians.

Continuing Medical Education and Continuing Professional Development in the Republic of Armenia: The Evolution of Legislative and Regulatory Frameworks Post Transition.

The collapse of the Soviet Union in 1991 left many ex-republics in a financial and administrative crisis for the ensuing two decades. Previously centralised processes like recertification of doctors and healthcare workers and continuing medical education fell by the wayside. Continuing medical education and continuing professional development in Armenia have evolved through multiple phases from Soviet, to immediate, mid and late-transitional post-Soviet periods, to current modernising efforts. This manuscript describes the phases of evolution of continuing medical education chronologically and details the legislative and regulatory framework surrounding each stage of development. Armenia is currently implementing a credit system of continuing medical education with the aim to introduce and adopt new and efficient approaches in this field. Continuing education credits fall into three categories: didactic or theoretical knowledge, practical skills and self-education/self-development. To recertify, professionals must collect credits from all three groups with specified minimum amounts according to their degrees. Armenia's guiding principle is to harmonise the continuing medical education and professional development model with internationally accepted criteria in order to contribute to the international mobility of healthcare workers and to provide for true on-going professional development and knowledge that will benefit our doctors, nurses and above all our patients.

The effect of core temperature on the success of free tissue transfer.

During free tissue transfer, much effort is made to keep patients normothermic. It is feared that hypothermia, which is common in patients having such operations, can induce vasospasm leading to stasis and ultimately thrombogenesis. The present study was undertaken to determine the effect of core body temperature on the survival of free flaps in an animal model. Rats were anesthetized with inhaled isoflurane and randomly assigned to one of the following four core temperature groups: 34 degrees C, 35 degrees C, 37 degrees C, and 39 degrees C (n = 10 animals per group). Bilateral groin free flaps were then performed (n = 20 flaps per group) while each animal was maintained at the temperature of its assigned group. Flap survival was evaluated on postoperative day 5 by a blinded observer. The best flap survival occurred in the 34 degrees C group, with an overall flap survival rate of 95%. There was a statistical difference between the survival rate of the combined 34 degrees C and 35 degrees C group (survival rate 90%, n = 40) and the combined 37 degrees C and 39 degrees C group (survival rate 67.5%, n = 40; P = 0.027). Hypothermia may have a beneficial effect on the success of free tissue transfer.

Supraorbital artery myocutaneous island flap for forehead defect reconstruction.

The frontalis musculocutaneous island flap offers advantages of immediate repair for small to medium-sized forehead defects (0.5-5 x 0.5-5 cm). Based on the supraorbital artery, the flap is both adaptable and dependable. Advantages of this flap include the ability to perform the procedure immediately and in one stage, rapid aesthetic restoration, minor donor-site morbidity, and technical ease. A clinical report demonstrating the use of this flap for repair of an electrothermal injury to the glabella is presented.