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To minimize the risk of viscera exposure for parietal or calverial reconstruction after tumor removal, we used the two-stage free flap strategy. The flap was transferred a few days before tumor resection and left in a standby position until the second stage. We conducted a retrospective monocentric study. All patients who underwent reconstruction with the two-stage free flap strategy after tumor resection since 2000 were included. We performed 14 two-stage flaps (8 for calvaria, 3 for abdomen, and 3 for thorax) on 12 patients. The average skin paddle surface was 318 cm . The mean operative time was 274min for the first stage and 172min for the second stage. The average time between the two stages was 8.8 days (2 to 24 days). One flap necrosis, one venous thrombosis, and one hematoma were observed after the first stage. Partial skin paddle necrosis (2 flaps) and infections (3 flaps) occurred after the second stage. The mean follow-up was 20 months (6 to 61 months), and two patients had tumor recurrence. The two-stage free flap strategy is another option for major oncological reconstructions, to be safe and reliable some rules must be followed. The flap must contain a large skin paddle to ensure flap autonomization and to allow for complete tight plication of the flap between the two stages, which limits germ colonization. A short delay between the two stages (<12 days) decreases the risk of infection. The presence of a plastic surgeon during the second stage decreases the risk of pedicle trauma. The two-stage free flap strategy is another option for major oncological reconstructions, to be safe and reliable some rules must be followed. The flap must contain a large skin paddle to ensure flap autonomization and to allow for complete tight plication of the flap between the two stages, which limits germ colonization. A short delay between the two stages ( less then 12 days) decreases the risk of infection. The presence of a plastic surgeon during the second stage decreases the risk of pedicle trauma.Over the last 15-20 years, the scope of medical education has broadened to include disciplines other than the biomedical. Many educators from the humanities and social sciences are thus currently teaching in the faculty of medicine. But how should we understand and communicate the position from which we - as 'non-doctors' - teach in this field? This article provides a reflection on how both doctors and 'non-doctors' in medical education seem to confirm and reproduce an underlying norm, namely that doctors are the most suitable teachers in medical education. I argue that these norms could and should be challenged. I provide examples of how a 'gaze from the outside' is fruitful and may be necessary in medical education, and highlight the potential strength of cross-disciplinary teaching that involves medical educators 'within and outside' medicine. To provide a cogent summation of the evidence base of the key barriers and facilitators to implementing shared decision making (SDM). An umbrella review of existing reviews on SDM was adopted. Databases were searched from 1997 to December 2018. https://www.selleckchem.com/products/Erlotinib-Hydrochloride.html Studies were included if they performed a review of barriers and facilitators to SDM. 7 eligible reviews were identified. The five themes identified were patient factors, professional factors, environmental factors, relationship factors, and factors related to information provision. Lack of time was the main factor hindering the implementation of SDM. Encouragement and motivation of providers to use SDM was a significant enabler of SDM implementation. The provision of time and resources are insufficient if not accompanied by efforts to support and motivate providers to use SDM. Healthcare providers need to be educated on the importance of building a relationship with their patients. To enhance this relationship, physicians may need to improve their interaction skills. They need to be curious and explore their patients' preferences, listen to them and respect their opinions, explain options and outcomes, and encourage them to participate in the decision making. Healthcare providers need to be educated on the importance of building a relationship with their patients. To enhance this relationship, physicians may need to improve their interaction skills. They need to be curious and explore their patients' preferences, listen to them and respect their opinions, explain options and outcomes, and encourage them to participate in the decision making. To generate a self-report instrument to capture clinically relevant variations in expectant parents' caregiving development, specified by how they are preparing to parent an infant with a major congenital anomaly. Recent literature structured domains to guide item generation. Evaluations by experts and expectant parents led to a refined instrument for field testing. Psychometric testing included exploratory factor analysis, internal consistency, and test-retest reliability. Samples included expert evaluators (n = 9), and expectant parent evaluators (n = 20) and expectant mother field testers (n = 67) with fetal anomaly diagnoses. Preparing to Parent-Act, Relate, Engage (PreP-ARE) resulted from a three factor solution that explained 71.8 % of the total variance, with global Cronbach's α = 0.72, and sub-scales 0.81, 0.65, 0.72 respectively. Cohen's weighted kappa indicated all items were acceptably reliable, with 14 of 19 items showing moderate (≥ 0.41) or good (≥ 0.61) reliability. Convergent validity was found between the maternal antenatal attachment and Act scales (r = 0.39, p = 0.001). This empirically-based instrument was demonstrated to be valid and reliable, and has potential for studying this transitional time. PreP-ARE could be used to understand patient responses to the diagnosis, level of engagement, readiness to make decisions, and ability to form collaborative partnerships to manage healthcare. PreP-ARE could be used to understand patient responses to the diagnosis, level of engagement, readiness to make decisions, and ability to form collaborative partnerships to manage healthcare.
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