Nonsurgical Practices Research Articles

Autobiography and Transgender Worlds: Body and Queer Corporeality

In the context of rapidly changing biomedical interventions and emerging non-surgical practices of gender transformation, the paper explores various issues associated with trans procedures that trans people in the three autobiographies go through namely, Manobi Bandyopadhyay’s A Gift of Goddess Lakshmi, A. Revathi’s The Truth About Me: A Hijra Life Story, and Living Smile Vidya’s I am Vidya: A Transgender’s journey. One of the main events of the three autobiographies is the sex change surgery that the three protagonists, Somnath (later, Manobi after sex change operation) in A Gift of Goddess Lakshmi, Doraisamy (later, Revathi after sex change operation) in The Truth About Me, and Preeti (later, Vidya after sex change operation) Living Smile Vidya’s I am Vidya: A Transgender’s journey undergo. The paper problematizes various issues related to trans procedures that Somnath, Doraisamy and Preeti undergo and attempts to find answers to questions such as if Somnath’s and Doriaswamy’s undergoing transgender procedures can be ‘simply’ equated with other forms of body modification such as tattooing, piercing and cosmetic surgery, and is not to be considered as a ‘complete, pathological rearrangement of identity’; can these transgender procedures be called a way of reorganizing the protagonists’ body to suit their image of themselves; is it possible to extricate social and political implications of transgender procedures that the three protagonists experience; if ‘trans’ procedures that the three protagonists experience can be seen in context of pseudo-medical accounts of transsexual autobiographies that tolerate body-modificatory practices so far as they enable a move away from strangeness and towards normalcy; do the protagonists opt for ‘trans’ procedures to alleviate the pain of being strange and engender a process of becoming ‘normal’; and whether or not trans practices constitute some form of self-mutilation.

Management of sinonasal cancers: Survey of UK practice and literature overview

IntroductionSinonasal malignancy is a rare and heterogenous disease, with limited evidence to guide management. This report summarises the findings of a UK survey and expert workshop discussion which took place to inform design of a proposed UK trial to assess proton beam therapy versus intensity-modulated radiation therapy. MethodA multidisciplinary working group constructed an online survey to assess current approaches within the UK to surgical and non-surgical practice. Head and neck clinical oncologists, ear nose and throat (ENT) and oral-maxillofacial (OMF) surgeons were invited to participate in the 42-question survey in September 2020. The Royal College of Radiologists Consensus model was adopted in establishing categories to indicate strength of response. An expert panel conducted a virtual workshop in November 2020 to discuss areas of disagreement. ResultsA survey was sent to 140 UK-based clinicians with 63 responses (45% response rate) from 30 centres, representing a broad geographical spread. Participants comprised 35 clinical oncologists (56%) and 29 surgeons (44%; 20 ENT and 9 OMF surgeons). There were variations in preferred sequence and combination of treatment modalities for locally advanced maxillary squamous cell carcinoma and sinonasal undifferentiated carcinoma. There was discordant surgical management of the orbit, dura, and neck. There was lack of consensus for radiotherapy in post-operative dose fractionation, target volume delineation, use of multiple dose levels and treatment planning approach to organs-at-risk. ConclusionThere was wide variation across UK centres in the management of sinonasal carcinomas. There is need to standardise UK practice and develop an evidence base for treatment.

Utilizing Oral Surveys to Better Understand Patient Satisfaction in a Low-Income, Urban Surgical Clinic.

Oral surveys allow patients to elaborate on their experience in the hospital, giving context to numerical values often used to assess patient satisfaction. This allows patients to speak about factors affecting satisfaction, which is important in complex, low-income populations. Spoken surveys were administered to 80 patients in surgery clinics at Temple University Hospital. Responses were transcribed and coded to analyze patient responses. Relationships among patient responses were identified, and responses were categorized to determine the most important factors related to patient satisfaction. Numerical data were also used to assess satisfaction. Patients were satisfied with their experience with the physician and the hospital, reporting averages scores of 9.73 and 9.19, respectively. Regarding physician satisfaction, patients cited effective communication and professionalism as being most important. As long as nothing went wrong, patients scored their experience outside their interactions with the physician highly. Negative experiences were mainly related to wait times and ineffective communication with office staff and were seldom related to the physician. By using a spoken survey, patients could elaborate on their responses which provides context to the numerical data. Despite the positive feedback for physicians, patients spoke openly about communication. In low-income populations, communication failures can be exacerbated by the power differential present between the patient and physician. Our study demonstrates the utility of oral surveys in understanding complex patient populations, and the results can be used to shape surgical and nonsurgical practices in similar patient populations.

Divides of identity in medicine and surgery: A review of duty-hour policy preference

Surgery and Medicine are broadly considered as the two fundamental paths that a physician's career can follow. But their convergence under the singular umbrella of doctoring is relatively recent in the context of medical history. Their co-existence within the structure of medical education and the healthcare system suggest that they bear great similarity to each other, when in reality several differences are intuitively recognizable between them. Here, we discuss recent evidence suggesting a discrepancy between these two streams in the work-hour policy preference of trainees. We argue that these differences betray a more radical divide between them, and one which illuminates an essential difference in the self-identification of surgical and non-surgical medical trainees. Additionally, these findings support a novel claim about the importance of uninterrupted relationships on the formation of professional identity among healthcare professionals. We suggest that the principal separation of surgical and non-surgical practice is significant enough to reconsider their dogmatic unification as well as warrant the adoption of unique rules and policies to govern each stream.

Practice Patterns of Sleep Otolaryngologists at Training Institutions in the United States.

Objective To assess the practice characteristics of adult sleep otolaryngologists within US otolaryngology residency training programs. Study Design Cross-sectional online survey. Setting Otolaryngology residency training programs. Subjects and Methods Program directors from 106 otolaryngology training programs in the United States were contacted. Program directors were instructed to forward a survey to otolaryngologists within the institution who provided Accreditation Council for Graduate Medical Education (ACGME) Otolaryngology Milestone Project feedback in "sleep-disordered breathing." The survey assessed demographics, nonsurgical practices, and surgical/procedural practices of adult sleep otolaryngologists. Data were collected and analyzed. Results Forty-six surveys met inclusion criteria, representing 40 of 106 (38%) programs. Ninety-three percent of respondents reported that residents gained a significant portion of their sleep medicine training from themselves (ie, the respondents), yet only 36% of respondents spent ≥50% of their time on sleep medicine/surgery. Forty-one percent reported being board certified in sleep, with 18% having completed an ACGME fellowship in sleep medicine. Respondents with board certification were more likely to spend greater portions of their practice on sleep medicine/surgery, χ2(3, n = 44) = 23.161 ( P < .001), treat non-obstructive sleep apnea sleep disorders (13 of 18 vs 1 of 26, P < .001), interpret polysomnograms (13 of 17 vs 1 of 15, P < .001), and perform drug-induced sleep endoscopy, χ2(1, n = 43) = 5.43, ( P = .02). A similar pattern was seen with stratification by ACGME sleep medicine fellowship. Conclusion This study highlights the variance in practice patterns among sleep otolaryngologists who instruct residents. Board certification and fellowship training in sleep medicine significantly influence breadth of trainee exposure to this field. The highly disparate trainee experiences to sleep otolaryngology across US programs require attention.

Non-operative management: An evidence-based approach

Symptomatic lumbar disc herniation is a common problem encountered in both surgical and non-surgical practices. The decision between surgical and non-surgical management of this entity can be challenging for both the patient and the treating physician. A variety of non-surgical treatment options exist, many with poor evidence supporting their efficacy. Treatment algorithms are available to promote improved outcomes and cost-effectiveness and reduce unnecessary interventions. In the absence of progressive neurologic deficit or cauda equina syndrome, non-surgical treatments for symptomatic lumbar disc herniations are typically implemented for at least 6 weeks with good results. The following is an evidence-based review of the non-surgical management of symptomatic lumbar disc herniation.

How Medical Alumni Now See Their Junior Clerkships in Surgery

The purpose of this study is to determine the effectiveness and value of the junior medical student surgical clerkship for physicians now in practice. Questionnaires were sent to all Mercer University School of Medicine alumni (1986-2007) using a five-point Likert scale. One hundred and fifty-seven responses were received from 873 recipients (18%), 71 per cent training in nonsurgical specialties. "Scrubbing in" on cases was the most valuable activity (82%), followed by faculty rounds (76%), resident work rounds (70%), and lectures (69%). Least useful activities were question and answer sessions (54%), grand rounds (53%), and morbidity and mortality conferences (57%). The amount of time in the operating room was appropriate for 61 per cent, but to 8 per cent the operating room was a waste of time. Faculty evaluations gave the most effective feedback (75%). Alumni in surgical specialties and obstetrics and gynecology rated their experiences higher than nonsurgical physicians. Overall, only 44 per cent saw the material learned as important to general medical education. Opinions regarding the value of surgical clerkships to current practices were mixed. Undergraduate surgical education should emphasize common surgical conditions, surgical decision-making, and simple procedures relevant to a nonsurgical practice.

Surgeons in the United States. Practice characteristics.

Data on practice characteristics were obtained as part of a national questionnaire study of surgeons in the United States. These included location and organization of surgeons' practices, use of nonphysician personnel, provision of ambulatory care, other professional activities, and variables associated with work load volume. A multivariate analysis was done to examine the relation between operative work loads and various practice characteristics. The variables associated with larger operative work loads were group or partnership practice, principal office not in a hospital, more nonphysician assistants in direct contact with patients, more hospitals in which operations were regularly done, and smaller proportions of nonsurgical patients. Group or partnership practice and nonsurgical practice were found to be most strongly related to operative work load.

Teaching the Art of Caring for Women

Thend obstetrics as a single specialty has taken place naturally. Their fusion became inevitable when midwifery matured into obstetrics and when increasing knowledge of physiology as well as of technical minutiae made pelvic surgery more reparative than extirpative. As a separate discipline gynecology-obstetrics applies the science and art of both medicine and surgery to ailments peculiar to women, particularly of those involving the reproductive organs. The early history of gynecology is a record of brilliant surgical achievements; its more recent nonsurgical affiliations have created a problem in graduate education. The issue is heightened because increasing specialization has tended to raise higher the wall between surgical and nonsurgical practices. But the gynecologist-obstetrician must tend both sides of the fence. The instruction imparted to a resident in gynecology-obstetrics is such that he is prepared to perform operative obstetrics as well as such surgical procedures as colpoplasty and pelvic laparotomy. These facets of