The three trapezius myocutaneous flaps remain valuable adjuncts in head and neck reconstructive s... more The three trapezius myocutaneous flaps remain valuable adjuncts in head and neck reconstructive surgery. Overall, the lower vertical trapezius flap has the most versatility and reliability, and the least morbidity. There are several advantages of this flap compared to the pectoralis myocutaneous (PMC) flap. It has a thin vascular pedicle, and thus does not add excessive bulk to the neck, as the PMC can. Also, the skin island has less subcutaneous tissue and therefore more pliability than the PMC, which is a definite advantage for oral cavity and oropharyngeal defects. The trapezius flap generally has less hair than the PMC flap, and the donor scar is better hidden.
Residents and fellows frequently care for patients from diverse populations but often have limite... more Residents and fellows frequently care for patients from diverse populations but often have limited familiarity with the cultural preferences and social determinants that contribute to the health of their patients and communities. Faculty physicians at academic health centers are increasingly interested in incorporating the topics of cultural diversity and healthcare disparities into experiential education activities; however, examples have not been readily available. In this report, we describe a variety of experiential education models that were developed to improve resident and fellow physician understanding of cultural diversity and healthcare disparities. Experiential education, an educational philosophy that infuses direct experience with the learning environment and content, is an effective adult learning method. This report summarizes the experiences of multiple sponsors of Accreditation Council for Graduate Medical Education-accredited residency and fellowship programs that ...
There have been colossal technological advances in the use of simulation in anesthesiology in the... more There have been colossal technological advances in the use of simulation in anesthesiology in the past 2 decades. Over the years, the use of simulation has gone from low fidelity to high fidelity models that mimic human responses in a startlingly realistic manner, extremely life-like mannequin that breathes, generates E.K.G, and has pulses, heart sounds, and an airway that can be programmed for different degrees of obstruction. Simulation in anesthesiology is no longer a research fascination but an integral part of resident education and one of ACGME requirements for resident graduation. Simulation training has been objectively shown to increase the skill-set of anesthesiologists. Anesthesiology is leading the movement in patient safety. It is rational to assume a relationship between simulation training and patient safety. Nevertheless there has not been a demonstrable improvement in patient outcomes with simulation training. Larger prospective studies that evaluate the improvement...
A homosexual man with AIDS developed multifocal KS with involvement of the palate, larynx, trache... more A homosexual man with AIDS developed multifocal KS with involvement of the palate, larynx, trachea, and esophagus. Symptoms included dysphagia and gagging with resultant inanition. Short-course local radiation therapy effectively resolved the mucosal KS lesions in the treated areas. Other otolaryngologic manifestations included herpes stomatitis and oral candidiasis.
Salivary gland neoplasms found within cervical lymph nodes and occurring as neck masses probably ... more Salivary gland neoplasms found within cervical lymph nodes and occurring as neck masses probably represent primary tumors of heterotopic salivary gland tissue. Five new cases of cervical heterotopic salivary gland neoplasms having appropriate clinical follow‐up are added to the literature from ten case reports reviewed at the Armed Forces Institute of Pathology from 1956 to 1980. The rarity of these tumors precludes a definitive statement regarding the treatment of this primary tumor of the neck. The most appropriate follow‐up may be long‐term serial clinical evaluations of the head and neck after excision of the neck mass.
Health care as a sector has recently become aware that it is a major user of energy and generator... more Health care as a sector has recently become aware that it is a major user of energy and generator of waste. Now, many institutions are taking steps to curb their energy consumption, reduce waste, and design processes and facilities that are more environmentally friendly and, as a result, healthier. This article describes these trends as well as specific efforts underway in Minnesota that could serve as models for providers in other parts of the United States.
... 2005 Dec;26(12):40, 39. Medical simulation makes medical education better and safer. Patow CA... more ... 2005 Dec;26(12):40, 39. Medical simulation makes medical education better and safer. Patow CA. ... MeSH Terms. Computer Simulation*; Computer-Assisted Instruction*; Curriculum; Education,Medical/methods*; Educational Technology*; Humans; Manikins; Software; United States
HealthPartners Institute for Medical Education has developed an innovative continuing medical edu... more HealthPartners Institute for Medical Education has developed an innovative continuing medical education model that uses elements of theater to explore complex issues in health care and increase participant engagement. The model was recently used during a hospital medicine retreat. The learning event included a four-part monologue in which an actor portrayed a patient, interactive didactic sessions, a game show titled "Who Wants to be Hospitalized a MillionTimes," computerized simulations, and a call for clinicians to help patients adopt healthier behaviors. Post-event evaluations demonstrated that participants gained valuable clinical knowledge and appreciated the combination of active learning and theater.
Purpose A design conference with participants from accredited programs and institutions was used ... more Purpose A design conference with participants from accredited programs and institutions was used to explore how the principles of patient- and family-centered care (PFCC) can be implemented in settings where residents learn and participate in care, as well as identify barriers to PFCC and simple strategies for overcoming them. Approach In September 2009, the Accreditation Council for Graduate Medical Education (ACGME) held a conference with 74 participants representing a diverse range of educational settings and a group of expert presenters and facilitators. Small group sessions explored the status of PFCC in teaching settings, barriers that need to be overcome in some settings, simple approaches, and the value of a national program and ACGME support. Findings Participants shared information on the state of their PFCC initiatives, as well as barriers to implementing PFCC in the learning environment. These emerged in 6 areas: culture, the physical environment, people, time and other ...
Since its inception in 2003, the simulation center, the HealthPartners Simulation Center for Pati... more Since its inception in 2003, the simulation center, the HealthPartners Simulation Center for Patient Safety at Metropolitan State University, St. Paul, Minnesota, continues to experience increasing demand for its programs and its expertise in curriculum development. The strength of the partnership has been its collaborative approach, alignment of interests, and willingness to adapt to relatively rapid changes. By consciously defining the center as a place for educating clinicians who are providers of advanced levels of care, with the primary emphasis being on critical care, emergency medicine, and inpatient nursing, the center has been able to retain its focus and not become distracted in producing disparate programs. An academic–industry collaboration can be a successful model for establishing a simulation center supporting the educational needs of both entities. Awareness of operational, educational, and community requirements and continual monitoring of the progress of the center's programs, personnel, and policies are required.
Isolated metastatic malignant melanoma to the facial nerve has never been reported. This presenta... more Isolated metastatic malignant melanoma to the facial nerve has never been reported. This presentation illustrates a primary melanoma of the helix of the ear that was treated by excisional biopsy and then wedge resection in 1983. The primary melanoma was Clark's level IV and 1.3 mm in thickness. In 1985, a facial paresis slowly developed. There was no gross evidence of recurrent melanoma in the ear or neck, but CT scan showed a mass in the region of the stylo mastoid foramen. A reoperation of the primary site revealed metastatic melanoma in the facial nerve, expanding it to approximately 10 times its normal size. A composite resection was done for the melanoma, and the paralyzed face was immediately rehabilitated by a masseter muscle transfer. The patient received 6000 rads to this area postoperatively and has remained free of disease to date, having returned to his profession as a dentist. A detailed study of all the specimens indicated that this represented a primary metastasis to the facial nerve.
JAMA: The Journal of the American Medical Association, 1995
To the Editor. —Dr Bennett responds to the question "How common is it to find a fungus that ... more To the Editor. —Dr Bennett responds to the question "How common is it to find a fungus that causes otitis?" 1 by providing information on extremely uncommon fungal infections of the middle ear and mastoid bone. The most common fungal otitis, fungal infection of the external auditory canal, is only briefly mentioned. His statement, "Rarely, seriously immunosuppressed patients develop invasive otitis externa caused by Aspergillus ," should not be misinterpreted by readers. Saprophytic fungal otitis of the external auditory canal is common, is not usually associated with immunodeficiency, and is readily treated. Otomycosis is particularly common in moist, warm environments (eg, tropical climates) and in patients who have poor hygiene. Pruritus is the most common presenting symptom. Fungi can be isolated in up to 40% of all cases of external otitis. Fungal mycelia are easily recognized on examination of the ear canal. Aspergillus niger is most commonly seen. However, absence of
The three trapezius myocutaneous flaps remain valuable adjuncts in head and neck reconstructive s... more The three trapezius myocutaneous flaps remain valuable adjuncts in head and neck reconstructive surgery. Overall, the lower vertical trapezius flap has the most versatility and reliability, and the least morbidity. There are several advantages of this flap compared to the pectoralis myocutaneous (PMC) flap. It has a thin vascular pedicle, and thus does not add excessive bulk to the neck, as the PMC can. Also, the skin island has less subcutaneous tissue and therefore more pliability than the PMC, which is a definite advantage for oral cavity and oropharyngeal defects. The trapezius flap generally has less hair than the PMC flap, and the donor scar is better hidden.
Residents and fellows frequently care for patients from diverse populations but often have limite... more Residents and fellows frequently care for patients from diverse populations but often have limited familiarity with the cultural preferences and social determinants that contribute to the health of their patients and communities. Faculty physicians at academic health centers are increasingly interested in incorporating the topics of cultural diversity and healthcare disparities into experiential education activities; however, examples have not been readily available. In this report, we describe a variety of experiential education models that were developed to improve resident and fellow physician understanding of cultural diversity and healthcare disparities. Experiential education, an educational philosophy that infuses direct experience with the learning environment and content, is an effective adult learning method. This report summarizes the experiences of multiple sponsors of Accreditation Council for Graduate Medical Education-accredited residency and fellowship programs that ...
There have been colossal technological advances in the use of simulation in anesthesiology in the... more There have been colossal technological advances in the use of simulation in anesthesiology in the past 2 decades. Over the years, the use of simulation has gone from low fidelity to high fidelity models that mimic human responses in a startlingly realistic manner, extremely life-like mannequin that breathes, generates E.K.G, and has pulses, heart sounds, and an airway that can be programmed for different degrees of obstruction. Simulation in anesthesiology is no longer a research fascination but an integral part of resident education and one of ACGME requirements for resident graduation. Simulation training has been objectively shown to increase the skill-set of anesthesiologists. Anesthesiology is leading the movement in patient safety. It is rational to assume a relationship between simulation training and patient safety. Nevertheless there has not been a demonstrable improvement in patient outcomes with simulation training. Larger prospective studies that evaluate the improvement...
A homosexual man with AIDS developed multifocal KS with involvement of the palate, larynx, trache... more A homosexual man with AIDS developed multifocal KS with involvement of the palate, larynx, trachea, and esophagus. Symptoms included dysphagia and gagging with resultant inanition. Short-course local radiation therapy effectively resolved the mucosal KS lesions in the treated areas. Other otolaryngologic manifestations included herpes stomatitis and oral candidiasis.
Salivary gland neoplasms found within cervical lymph nodes and occurring as neck masses probably ... more Salivary gland neoplasms found within cervical lymph nodes and occurring as neck masses probably represent primary tumors of heterotopic salivary gland tissue. Five new cases of cervical heterotopic salivary gland neoplasms having appropriate clinical follow‐up are added to the literature from ten case reports reviewed at the Armed Forces Institute of Pathology from 1956 to 1980. The rarity of these tumors precludes a definitive statement regarding the treatment of this primary tumor of the neck. The most appropriate follow‐up may be long‐term serial clinical evaluations of the head and neck after excision of the neck mass.
Health care as a sector has recently become aware that it is a major user of energy and generator... more Health care as a sector has recently become aware that it is a major user of energy and generator of waste. Now, many institutions are taking steps to curb their energy consumption, reduce waste, and design processes and facilities that are more environmentally friendly and, as a result, healthier. This article describes these trends as well as specific efforts underway in Minnesota that could serve as models for providers in other parts of the United States.
... 2005 Dec;26(12):40, 39. Medical simulation makes medical education better and safer. Patow CA... more ... 2005 Dec;26(12):40, 39. Medical simulation makes medical education better and safer. Patow CA. ... MeSH Terms. Computer Simulation*; Computer-Assisted Instruction*; Curriculum; Education,Medical/methods*; Educational Technology*; Humans; Manikins; Software; United States
HealthPartners Institute for Medical Education has developed an innovative continuing medical edu... more HealthPartners Institute for Medical Education has developed an innovative continuing medical education model that uses elements of theater to explore complex issues in health care and increase participant engagement. The model was recently used during a hospital medicine retreat. The learning event included a four-part monologue in which an actor portrayed a patient, interactive didactic sessions, a game show titled "Who Wants to be Hospitalized a MillionTimes," computerized simulations, and a call for clinicians to help patients adopt healthier behaviors. Post-event evaluations demonstrated that participants gained valuable clinical knowledge and appreciated the combination of active learning and theater.
Purpose A design conference with participants from accredited programs and institutions was used ... more Purpose A design conference with participants from accredited programs and institutions was used to explore how the principles of patient- and family-centered care (PFCC) can be implemented in settings where residents learn and participate in care, as well as identify barriers to PFCC and simple strategies for overcoming them. Approach In September 2009, the Accreditation Council for Graduate Medical Education (ACGME) held a conference with 74 participants representing a diverse range of educational settings and a group of expert presenters and facilitators. Small group sessions explored the status of PFCC in teaching settings, barriers that need to be overcome in some settings, simple approaches, and the value of a national program and ACGME support. Findings Participants shared information on the state of their PFCC initiatives, as well as barriers to implementing PFCC in the learning environment. These emerged in 6 areas: culture, the physical environment, people, time and other ...
Since its inception in 2003, the simulation center, the HealthPartners Simulation Center for Pati... more Since its inception in 2003, the simulation center, the HealthPartners Simulation Center for Patient Safety at Metropolitan State University, St. Paul, Minnesota, continues to experience increasing demand for its programs and its expertise in curriculum development. The strength of the partnership has been its collaborative approach, alignment of interests, and willingness to adapt to relatively rapid changes. By consciously defining the center as a place for educating clinicians who are providers of advanced levels of care, with the primary emphasis being on critical care, emergency medicine, and inpatient nursing, the center has been able to retain its focus and not become distracted in producing disparate programs. An academic–industry collaboration can be a successful model for establishing a simulation center supporting the educational needs of both entities. Awareness of operational, educational, and community requirements and continual monitoring of the progress of the center's programs, personnel, and policies are required.
Isolated metastatic malignant melanoma to the facial nerve has never been reported. This presenta... more Isolated metastatic malignant melanoma to the facial nerve has never been reported. This presentation illustrates a primary melanoma of the helix of the ear that was treated by excisional biopsy and then wedge resection in 1983. The primary melanoma was Clark's level IV and 1.3 mm in thickness. In 1985, a facial paresis slowly developed. There was no gross evidence of recurrent melanoma in the ear or neck, but CT scan showed a mass in the region of the stylo mastoid foramen. A reoperation of the primary site revealed metastatic melanoma in the facial nerve, expanding it to approximately 10 times its normal size. A composite resection was done for the melanoma, and the paralyzed face was immediately rehabilitated by a masseter muscle transfer. The patient received 6000 rads to this area postoperatively and has remained free of disease to date, having returned to his profession as a dentist. A detailed study of all the specimens indicated that this represented a primary metastasis to the facial nerve.
JAMA: The Journal of the American Medical Association, 1995
To the Editor. —Dr Bennett responds to the question "How common is it to find a fungus that ... more To the Editor. —Dr Bennett responds to the question "How common is it to find a fungus that causes otitis?" 1 by providing information on extremely uncommon fungal infections of the middle ear and mastoid bone. The most common fungal otitis, fungal infection of the external auditory canal, is only briefly mentioned. His statement, "Rarely, seriously immunosuppressed patients develop invasive otitis externa caused by Aspergillus ," should not be misinterpreted by readers. Saprophytic fungal otitis of the external auditory canal is common, is not usually associated with immunodeficiency, and is readily treated. Otomycosis is particularly common in moist, warm environments (eg, tropical climates) and in patients who have poor hygiene. Pruritus is the most common presenting symptom. Fungi can be isolated in up to 40% of all cases of external otitis. Fungal mycelia are easily recognized on examination of the ear canal. Aspergillus niger is most commonly seen. However, absence of
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