Social media is rapidly being incorporated into medical education. We created a small group, reflective practice sessions by integrating specific medical cases to improve awareness about professionalism on social media. Medical scenarios were generated for reflective practice sessions on social media professionalism. Anonymous pre/post-session surveys evaluated residents' use of social media and gathered their opinions on the session. Thirty-eight of 48 (79 %) residents replied to the presession survey with 50 % (19/38) reporting daily digital media use, 76 % (29/38) witnessed unprofessional postings on social media, and 21 % (8/38) posted unprofessional content themselves. Of the 79 % (30/ 38) residents who attended the session, 74 % (28/38) completed the post-session survey. Residents reported the session added to the longevity of their professional career 4.11, 95 % CI (3.89-4.36). As a result of the session, they were more conscious of using the social media more professionally 3.47, 95 % CI (2.88-3.96) and would be proactive in protecting patient privacy and confidentiality on social media sites 3.96, 95 % CI (3.50-4.37). In summary, reflective practice-based sessions regarding the impact of social media on professionalism in surgery was well favored by the residents. The majority agreed that it had important implications for the longevity of their professional career. Participants reported having an increased awareness to protect patient privacy and utilize social media more professionally.
Introduction:The unique challenges of pancreaticoduodenectomy in a patient with altered midgut anatomy secondary to RouxenY gastric bypass are seldom discussed in surgical literature. We discuss two such cases at our institution, in light of experiences of other authors. Case Series: The two cases reported here are different from the majority of previously reported cases as remnant gastrectomy was not performed in either patient. However, one patient did receive a gastrostomy tube in the gastric remnant. The essential differences in existing literature are the removal of the gastric remnant in other reports versus a gastrojejunal anastomosis for remnant drainage in our cases, without any clear advantage in either case. Gastric remnant dissection increases operative time in contrast to gastrojejunal anastomosis, which is a nidus for complications postoperatively. With preservation of gastric remnant however, enteral feeding tube can be placed without manipulation of the altered anatomy, as the need arises. Conculsion: Gastric remnant removal is ideal in decreasing the complexity of pancreaticoduodenectomy by reducing the number of required anastomoses. However, there is an increase in operative time required for dissection of the remnant gastric pouch.
Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.In general, authors of case reports should use the Brief Report format. Hidradenocarcinoma: A Sinister Diagnosis of a Suspected Benign ConditionEccrine glands are sweat glands located in the palms and soles, head, trunk, and extremities. Eccrine carcinoma presents with four types of histology, namely eccrine porocarcinoma, syringoid eccrine carcinoma, mucinous eccrine carcinoma, and clear cell hidradenocarcinoma. Malignant carcinomas of these glands are very rare and occur in one in 13,000 (0.005%). 1 Clear cell hidradenocarcinoma (CCH) was first reported as clear-cell eccrine carcinoma by Keasby and Hadley in 1954. In 1992, The American Joint Committee on Cancer categorized clear CCH as a superficial malignancy and applied the TNM staging system. It has been given several names in the literature like malignant clear cell myoepithelioma, malignant clear cell acrospiroma, clear cell eccrine carcinoma, and malignant clear cell hidradenoma. CCH is usually found associated with hidradenoma, which is differentiated only by its malignant cytoarchitectural features from its benign counterpart, although it can occur de novo as well. Generally, they occur in patients in their fourth decade or older, grows slowly, and can present for several years without apparent change. There can be a heterogenous group of lesions from low-grade, well differentiated to high-grade, poorly differentiated tumors with the potential for repeat local recurrence and distal metastasis. A recurrence rate of hidrad enoccur cinoma has been described to be 10 per cent, which can occur with or without complete excision of tumor. 2 Metastasis appear first in regional lymph nodes, although the most common hematogenic metastases appear in lungs.A 90-year-old man presented with a slowly growing, 2.5-cm cyst on his right calf causing him mild discomfort. On examination, it was found to be firm and cystic, consistent with a diagnosis of a sebaceous cyst.
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