Evidence-Based Medicine in Aesthetic Surgery

Two years ago this month, when I began my tenure as Editor-in-Chief following the official indexing of Aesthetic Surgery Journal (ASJ) in Medline/PubMed, I wrote about my goals for the Journal and my commitment to you, ASJ ’s readers.1 At that time, I reaffirmed my belief that the Journal was “well-positioned to stay at the forefront of clinical, scientific, and technological advances and to bring you the information you need to stay ahead of the curve.” It remains my desire, as it was then, that ASJ be “the Journal to which you consistently turn for information that has real value to your aesthetic surgery practice.”In keeping with that mission, it is with great excitement and pride that we begin a dialogue with you about integrating evidence-based medicine (EBM) into the pages of ASJ and into our daily clinical practices. In August 2010, I was privileged to participate in a two-day EBM Summit in Colorado Springs, during which leaders in the aesthetic surgery field, representatives from our sister specialties, and experts in the application of EBM came together to discuss how we might begin incorporating EBM principles to our clinical practices. A full summary of this meeting appears in this month’s issue as a Special Topic in on page 137; it will also appear in the pages of Plastic and Reconstructive Surgery . This demonstrates our cooperative efforts in ensuring that professional societies and scholarly Journals are speaking with one voice, working together to support you in your efforts to continually improve patient outcomes and satisfaction—which I know is of the utmost importance to all of us as practicing physicians.I hope the background information on the EBM Summit will be as helpful, exciting, and encouraging to you as …

Multiple Goal Conveyance in a State Park Interpretive Boat Cruise

The qualitative case study examined interpretive programs for four sets of management goals. A proposed model, Four Conceptions of Interpretation, previously tested in national parks, was retested in a state park. The four conceptions are (a) connecting visitors to resources, (b) conveying agency mission and influencing behavior, (c) encouraging environmental literacy, and (d) promoting tourism. The hypothesis was that evidence of all four conceptions would be found in visitor recall of interpretive programs. Analysis found conceptions one and two strongly recalled by visitors. Conception three, environmental literacy, was conveyed by staff and moderately recalled by visitors. Conception four, tourism, identified in the Arkansas State Parks mission and opening dedication speeches, did not find its way into programs. Findings suggest that all four conceptions identified in foundational literature, mission, overall park vision, and staff interview did not trickle down into interpretive practice; it was not recalled by visitors in programs.

Occupational image, organizational image and identity in dirty work: Intersections of organizational efforts and media accounts

This article proposes that media representations of an occupational category may intersect with organizations’ efforts to construct a positive organizational identity and image. We fuse three streams of literature namely, organizational identity and image, media and the social construction of reality, and dirty work to extend extant literature on organizational identity and image. Attention is drawn to occupational image as the position of an occupational category in society. We contend that occupational image is likely to influence the decisions and actions taken by organizations and its members, in particular when the occupation is central to the organization’s mission. Occupational image is partly informed by the media. We analyse one year of media coverage of a dirty work occupation, specifically exotic dancing, and identify various ways in which the media portrays the exotic dancing occupation and the organizations providing these services. We focus upon two of these categories, namely Public (dis) Order and Art and Entertainment. We also draw upon a variety of data from one organization, For Your Eyes Only, to explore how organizational efforts to construct a positive organizational identity (based upon professionalism and legitimacy) and image (based upon fantasy, exclusivity and high quality service) intersect these media representations.

The Journal’s 10 year Anniversary - Looking back and moving forward

This issue marks the 10th year of the Journal, whose guiding mission has been, ‘‘To provide a major international forum for social-behavioral research and practice that has direct relevance on improving the quality of life (QOL) and quality of care for people with dementia and their families’’ (Keady & Harris, 2002). For where the main focus of biomedical research has been on the cause of dementia, the focus of social–behavioral research is on the consequences of living with dementia. On a daily basis, persons with dementia and their family members must face alone and together this ‘‘lived experience,’’ with its ever constant changes, surprises, challenges, disappointments, and sometimes rewards; and most of all they must learn to cope. Social–behavioral research can help. Pearlin et al. (2001) identified five research domains essential for future social research on the consequences of dementia: 1) the person with dementia, 2) the family and household, 3) the physical and social environment, 4) effective services and interventions, and 5) directions for health policy. This schematic was presented as a heuristic device to stimulate thinking about future research. Over the years, this Journal has played an important role in publishing articles that further deepened our understanding in all five recommended research areas. Reviewing the Journal’s last 10 years of publications, below are just a few examples of articles that reflect research in each of the domains. Articles in the Journal have increased our understanding of the ‘‘inner worlds’’ of both the person with dementia and their care partner. Articles that explored ‘‘the inner world’’ of people with dementia were ones such as: 1) the very first paper published by the Journal, Sterin’s (2002) eloquent personal essay on how being diagnosed with dementia and the stigma that entailed, forever changed one’s social interactions and self-concept; Krause’s and Moyer’s (2006) discussion on how her diagnosis spurred them into becoming advocates for people with AD, and the meaning such work has brought to their lives; and Fazio’s and Mitchell’s study (2009), which demonstrated through evidence from remaining language and visual recognition that the self of the person with Alzheimer’s disease persists along the journey, expanding the work of Steven Sabat (2001). Each article and many others deepened our understanding of the lived experience. A few notable articles about the ‘‘inner world’’ of carer experience were: 1) Weyl’s (2009) description of her journey with her husband Peter diagnosed with AD, as she loves and cares for him, and copes, recorded in a memoir, entitled, ‘‘Love song at the end of the day’’; 2) Aubeeluck’s and Buchanan’s (2006) article that captured the Huntington’s disease spousal carer experience, a group that is often forgotten, using the methodology of photovoice. This study visually presented the carers’ quality of life, encompassing loss, loneliness, neglected needs and desire for escape; and 3) one of the most unique articles published over the years, Dementia 10(1) 3–6 ! The Author(s) 2011 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1471301211401685 dem.sagepub.com

Online Contract Training: Applying Organization Theory to Reconcile Competing Missions Within Community Colleges

Community colleges in the United States have become major providers of human resource development services, particularly through offering workforce development training to local employers. The addition of workforce development services to community colleges is a fairly recent phenomenon. Some see workforce development efforts as diluting community colleges’ historic mission of providing affordable and accessible opportunities for students to transfer to 4-year institutions. The addition of online training has created additional stressors, because of increases in costs, opportunities for outsourcing, and increased opportunity for serving those outside of the local community. Using an organizational theory framework, this conceptual article addresses the competing emphases in the community college mission and attempts to understand how various types of institutions overcome internal and external barriers in introducing online workforce development through organizational change initiatives.

A National Ceremony

U.S. Census Director Bob Groves sheds light on the scope, mechanics, and mission of his bureau and its most famous project.

No News Is Not Good News

In their respective books, Alex Jones and Jack Fuller examine what news is, how traditional journalism has been threatened, and how it can sustain its mission in the future. Lee Konstantinou's novel brings these theories to life, painting a picture of the “mediasphere” in the not-so-distant future.

Ascending-to-Descending Aortic Bypass and Aortic Valve Replacement for Concomitant Severe Aortic Coarctation and Aortic Stenosis

We present a 33-year-old male with severe, symptomatic aortic coarctation and aortic stenosis assessed on a humanitarian medical mission to a developing country. Contemplating limited time and available resources, we performed a simultaneous single-stage approach with ascending-to-descending aortic bypass with a reinforced gortex graft and concomitant aortic valve replacement through a median sternotomy. The patient had an uneventful postoperative convalescence and was discharged on postoperative day 5. At 1-year follow-up, he was asymptomatic and doing well with good blood pressure control and complete equalization of upper and lower limb blood pressure measurements. Computed tomography and transthoracic echocardiography demonstrated a widely patent ascending-to-descending aortic bypass graft and a normally functioning prosthetic aortic valve, respectively. In developing countries where health care resources are limited, a combined approach with an extra-anatomic, thoracic aortic bypass, and aortic valve replacement resulted in good early and 1-year outcomes. This procedure may represent the most effective surgical option for patients with concomitant aortic coarctation and aortic stenosis.

Volunteers and Collections as Viewed from the Museum Mission Statement

Is It Time for “Baby-Friendly” Pediatric Hospitals?

Because pediatric hospitals provide care for infants and children, a baby-friendly environment must be in place to help support both the initiation and continuation of breastfeeding. Many opportunities exist for the pediatric practitioner and other staff members to assist mothers of pediatric patients to achieve and continue successful breastfeeding. Pediatric hospitals must ensure an environment that protects breastfeeding for established breastfeeding dyads, and also take steps to assist in the initiation of the breastfeeding relationship when the infant presents in the newborn period. Without support from the entire healthcare team that cares for women and children, the 2020 US goals for breastfeeding cannot be attained. Many have outlined ways in which this mission can be carried out in pediatric facilities, and these ideas are utilized in suggesting a plan for use in pediatric environments modeled after the “10 Steps to Successful Breastfeeding,” as outlined in the Baby-Friendly Hospital Initiative by UNICEF/WHO.