Clinical learning environment measurement for medical trainees at transitions: relations with socio-cultural factors and mental distress.

Background: Measuring clinical learning environment is crucial for the quality improvement of medical education, especially for medical trainees at transition stages. Medical education in Taiwan is shaped by multiple socio-cultural influences. The aims of this study were to construct an instrument for measuring clinical learning environment in alignment with the local socio-cultural factors and medical training settings, and further investigate the relationship between the quality of the clinical learning environment and the status of mental distress among medical trainees.

A review of intraoperative airway management for midface facial bone fracture patients.

In craniofacial trauma patients, oral route endotracheal intubation may thwart the accuracy of dental occlusion and nasotracheal intubation carries the risk of intracranial invasion in skull base fracture cases. Between November 2005 and June 2006, patients receiving facial bone fracture operations at Kaohsiung Medical University Hospital were enrolled in this study. Intraoperatively, the endotracheal tube was pushed to either the retromolar space or the missing tooth space and secured by two 4.

Experiences of interprofessional implementation of a healthcare matrix.

The Taiwan Joint Commission on Hospital Accreditation endorsed the Institute of Medicine (IOM) dimensions of health care quality as safe, timely, effective, efficient, equitable, and patient-centered. The Taiwan Association of Medical Education has also adopted the Accreditation Council for Graduate Medical Education (ACGME) outcome project and core competencies for Taiwan physicians in training. These schemes focus on patient care, medical knowledge and skills, interpersonal and communication skills, professionalism, system-based practice and practice-based learning and improvement.

Contour refinements of free flaps for optimal outcome in oral reconstruction: combination of modified liposuction technique and w-plasty in one-stage procedure.

Background: Bulkiness and unsightly scarring are the major complaints after oral cancer reconstruction with free flap transfer. Some debulking procedures, such as blunt-tipped cannula liposuction or staged excision, can result in some improvement, but these methods do not provide a one-stage procedure for flap thinning and scar revision due to the concern of flap ischemic change. All suction lipectomy methods were applied on flap resurfacing cases; no through-and-through defect case was used.

A new trend for the treatment of blepharoptosis: frontalis-orbicularis oculi muscle flap shortening technique.

Operation techniques for blepharoptosis have been a great challenge for plastic surgeons. Complications and recurrence in conventional operations of eyelid ptosis cannot be neglected. The finding of the close linkage between the longitudinal-oriented frontalis muscle (FM) and the horizontal-orientated orbicularis oculi (OOM) muscle convinced us of the efficacy to develop the dynamic and powerful Frontalis-Orbicularis Oculi Muscle (FOOM) flap-shortening technique which corrects blepharoptosis with good biomechanics in place of the traditional frontalis muscle sling.

Forehead osteoma excision by endoscopic approach.

Six cases of frontal osteoma had been operated with assistance of endoscopic surgery. Patient age ranged from 34 to 59 years. The diameter of the masses varies from 8 to 14 mm.

Hyperbaric oxygen therapy with topical negative pressure: an alternative treatment for the refractory sternal wound infection.

Sternal osteomyelitis is a potentially lethal complication after cardiac surgery. It may be the cause of postoperative morbidity and mortality. We present a case of deep sternal wound infection after sternotomy.

Surgical treatment of the chronic tophaceous deformity in upper extremities - the shaving technique.

Background: Tophaceous gout is frequently directly related to the duration and the severity of hyperuricaemia. Conventional surgical debridement of the tophaceous lesions carries the risk of overlying skin necrosis. Life-long urate-lowering drugs have become the mainstay of primary treatment.

AQUACEL Ag in the treatment of toxic epidermal necrolysis (TEN).

Toxic Epidermal Necrolysis (TEN) is life-threatening dermatological disease characterized by extensive destruction of the epidermis is associated with a 25-60% mortality rate in adults. We presented one patient with TEN with 86% skin slough treated successfully using AQUACEL Ag exclusively. All of the wounds were healed completely 8 days after onset of TEN.

Continuous arteriovenous hemodialysis and continuous venovenous hemofiltration in burn patients with acute renal failure.

Acute renal failure (ARF) is a very common condition that may occur in patients with major burn injuries. The majority of burn patients with ARF have a high mortality rate, ranging from 73% to 100%. There are several ways to treat ARF in burn patients, including peritoneal dialysis (PD), intermittent hemodialysis, and continuous renal replacement therapy (CRRT).

"Shift to right flypaper technique" a refined method for postage stamp autografting preparation.

"Lack of donor skin" is a challenge condition for autografting in the treatment of extensive burns. The modified Meek technique seems to be a practical solution for this problem. However, the equipment and consumed materials for the modified Meek technique are expensive which limits routine use.

Management of the primary varicose veins with venous ulceration with assistance of endoscopic surgery.

Two hundred sixty-two cases of primary varicose veins in which the lesions extended to the areas of the lower third of the leg and/or the ankle were treated with the assistance of endoscopic surgery. The conditions of varicose veins were classified by the reporting standards in venous disease. The number of cases in lesions of C2, C4, C5, and C6 were 60, 156, 31, and 15, respectively.