The Humboldt County sheriff says training through 4-H may have helped them survive in the wilderness where the sisters say they drank water from huckleberry leaves and used a rain coat for shelter.

UCF medical students have been benefiting from similar training recently thanks to UCF 麻豆精品 S檚 chapter of the Wilderness Medical Society, a group devoted to educating physicians, residents and medical students on health safety in the outdoors. The group holds wilderness medical challenges across the country.

The group held such an event on Feb. 23 within the wooded confines of Southeast Orlando 麻豆精品 S檚 Moss Park where medical students hiked a 7.5-mile trail without the aid of maps and responded to wilderness emergencies, including an alligator attack, a broken bone and an allergic reaction to a bee sting.

麻豆精品 S淵ou just never know when you 麻豆精品 S檙e going to be faced with an emergency outdoors, 麻豆精品 S� says second-year UCF medical student Brandon Marshall. 麻豆精品 S淎s a physician you have to be able to think on your feet when you 麻豆精品 S檙e tired. That 麻豆精品 S檚 why we wanted to bring this event to our medical school. 麻豆精品 S�

麻豆精品 S淎s a physician you have to be able to think on your feet when you 麻豆精品 S檙e tired. That 麻豆精品 S檚 why we wanted to bring this event to our medical school. 麻豆精品 S� 麻豆精品 S� Brandon Marshall, UCF medical student

Marshall participated in a similar event in the foothills of Georgia last year and came away impressed with the combination of testing participants 麻豆精品 S� physical endurance and medical knowledge. So he organized this year 麻豆精品 S檚 event.

Marshall is no stranger to grueling physical activity. He was a Greco-Roman wrestler who competed worldwide before coming to medical school. Marshall points out that Florida has more than 8,900 miles of hiking trails and 5,200 miles of bicycle trails, so there are plenty of opportunities for illness and injury to happen in the wilderness.

Students faced six of those real-life scenarios during the training while fellow students served as patients.

In one scenario, a hiker was attacked by an alligator near the edge of a lake and dragged in, suffering head trauma and a broken, bleeding arm. In another scenario, a hiker was stung by a bee, had an extreme allergic reaction and couldn 麻豆精品 S檛 speak to tell rescuers what was wrong.

Martin Klapheke, assistant dean for medical education, whose hobby is mountain climbing, 听helped supervise the outdoor challenges.

麻豆精品 S淵ou could see the growth in communication and teamwork as each group worked its way from medical station to station, 麻豆精品 S� he says. 麻豆精品 S淪uch teamwork is critical in medical care today. 麻豆精品 S�

麻豆精品 S淵ou could see the growth in communication and teamwork as each group worked its way from medical station to station. 麻豆精品 S� 麻豆精品 S� Martin Klapheke, assistant dean for medical education

Dumas, a third-year medical student, said the Wilderness Medical Society event challenged students 麻豆精品 S� medical knowledge and their ability to work quickly as a team, especially in emergency situations when things can get hectic.

麻豆精品 S淚t 麻豆精品 S檚 important to verbalize loudly what 麻豆精品 S檚 happening and what you 麻豆精品 S檙e doing 麻豆精品 S� telling people, 麻豆精品 S業 麻豆精品 S檓 checking pulses, 麻豆精品 S� or 麻豆精品 S業 麻豆精品 S檓 checking breathing, 麻豆精品 S� 麻豆精品 S� he says.

Dumas says one of the most challenging scenarios involved a patient who had fallen out of a tree, breaking his pelvis and injuring his head. The patient complained of a stiff neck and spine pain.

麻豆精品 S淏oth of those can be life-threatening emergencies. Which do you handle first? 麻豆精品 S� Dumas says. 麻豆精品 S淎nd that 麻豆精品 S檚 where the team dynamic came in. We had someone stabilizing the head, and we had somebody assessing neurologic status, and another team member checking pulses.

麻豆精品 S淜nowing how to keep calm, how to assess the situation and go from there, I think is what really makes you a great physician. 麻豆精品 S�

A new Psychiatry Residency Program, based at Osceola Regional Medical Center and the Orlando VA Medical Center has received initial ACGME accreditation and is seeking immediate applicants.

This program is part of the -Hospital Corporation of America North Florida Division Consortium seeking to add more than 600 residency slots to Florida by 2020. In the last three years, the consortium has added 20 graduate medical education programs that are currently training about 250 physicians in Central and North Central Florida. The addition of the Psychiatry program will increase the number of programs to 21.

The Accreditation Council for Graduate Medicine Education (ACGME) approved the Psychiatry Residency program for 6 residents per year of the four-year program, for a total of 24 residents. The program will be directed by Dr. 听Martin Klapheke, Assistant Dean and Professor of Psychiatry at the UCF College of Medicine.

UCF and HCA started the residency programs to help address Florida 麻豆精品 S檚 and the nation 麻豆精品 S檚 physician shortage. Dr. Klapheke noted that a 2014 Florida workforce report showed that by 2025, Psychiatry will be the physician specialty with the highest shortage 麻豆精品 S� a deficit of about 2,000 psychiatrists statewide. 麻豆精品 S淭he faculty, staff and residents in this new UCF/HCA Residency have the opportunity to make a major impact on mental health care in Central Florida by providing more services and more practitioners in the coming years, 麻豆精品 S� he said.

Osceola Regional Medical Center is a 396-bed tertiary hospital that is part of the HCA hospital group and includes 500 affiliated physicians. The hospital had more than 18,000 annual admissions and 86,000 Emergency Department visits in the last year. Of those, 446 direct hospital admissions and about 1,400 patients to the Emergency Department needed psychiatric care. Osceola Regional offers a range of mental health programs, including inpatient, partial hospitalization and intensive outpatient services

The new Orlando VA Medical Center is a state-of-the-art, 1.2 million square foot facility featuring a large multi-specialty outpatient clinic which includes a wide-range of adult psychiatry and counseling services and 130-inpatient beds that include psychiatry services. The VA also has a 60-bed domiciliary and a 120-bed outpatient living center with in-house psychiatric and counseling services, including geriatric psychiatry.

Residents will also rotate at Nemours Children 麻豆精品 S檚 Hospital in Lake Nona to gain experience in Child and Adolescent Psychiatry.

The program will be participating in the NRMP Supplemental Offer and Acceptance Program (SOAP). Applications following SOAP should be submitted through Krystal D. Hernandez, GME Program Coordinator, Psychiatry Residency Program, Osceola Regional Medical Center, at krystal.hernandez@hcahealthcare.com. Qualified applicants will be selected for interviews.

The Orange County Heroin Task Force Advisory Committee invited Dr. Klapheke to discuss the college 麻豆精品 S檚 new opioid and pain management curriculum. The task force includes community leaders from law enforcement, healthcare, education and addiction treatment who are struggling to deal with increasing overdoses and deaths from opioids.

According to the Centers for Disease Control, more than 60 percent of drug-related deaths in the U.S. involve an opioid. In Florida, at least five people die from an opioid overdose every day. And increasingly, officials are seeing overdose deaths from combining heroin with fentanyl, an extremely potent synthetic opioid.

Most heroin addicts became addicted after misusing prescription opioids. Opioids include prescription painkillers like OxyContin and Vicodin.

Based on those statistics, the College of Medicine revised its curriculum about a year ago to give students more information on when and whether to prescribe opioids. Opioid education is now included in all four years of medical school training. Students learn the dangers of prescribing opioids for conditions like chronic pain and arthritis. They learn how to devise strategies to reduce the risk of addiction. Working with standardized patients 麻豆精品 S� actors 麻豆精品 S� students learn how to resuscitate someone who has overdosed and how to educate family members of addicted patients. They also learn about alternatives to painkillers such as biofeedback and exercise therapy. Dr. Klapheke has shared UCF 麻豆精品 S檚 curriculum with medical schools across the state and with medical school educators across the country.

麻豆精品 S淭here 麻豆精品 S檚 some evidence that there 麻豆精品 S檚 been a decrease in the prescription of opioids in the United States, 麻豆精品 S� Dr. Klapheke told the heroin panel. 麻豆精品 S淗owever, the bad news is there 麻豆精品 S檚 been an increase in overdose deaths. We need to not only focus on the appropriate prescription of opioids, but also identifying individuals who become addicted and making sure they get into treatment, so that they don 麻豆精品 S檛 move from prescribed opioids to street drugs like heroin and fentanyl. 麻豆精品 S�

Orlando Police Deputy Chief Robert Anzueto said he was impressed at how UCF 麻豆精品 S檚 opioid curriculum is preparing future physicians.

麻豆精品 S淚t was very interesting to see what the new medical students are going through, 麻豆精品 S� Anzueto said. 麻豆精品 S淚t 麻豆精品 S檚 like, hands-on from day one. And that 麻豆精品 S檚 great to see, because we want to make sure that the future physicians and leaders of this world have great training behind them to combat this kind of issue 麻豆精品 S� because this is going to be an issue for many, many decades, moving forward. 麻豆精品 S�

Dr. Martin Klapheke, assistant dean for medical education and professor of psychiatry, is leading UCF 麻豆精品 S檚 efforts and working to share them with medical schools across the state and nation. Last March, UCF was one of 60 medical schools in the nation 麻豆精品 S� and the only in Florida 麻豆精品 S� that pledged to teach medical students about the dangers of prescribing opioids throughout their four years of training in an effort to curb the growing epidemic of prescription opioid and heroin abuse.

On Wednesday, Dec. 7, the U.S. Department of Health and Human Services will host a group including physicians and medical educators at the White House to discuss plans for developing new strategies for dealing with the opioid crisis and identifying ways the healthcare community can collaborate to find more effective solutions.

Klapheke will share UCF 麻豆精品 S檚 expanded curriculum. It includes opioid training in subjects from psychiatry to pediatrics, where physicians are seeing an increase in the number of opioid-addicted newborns whose mothers used the pain medication during pregnancy. Neurology includes a mandatory module on when and when not to use opioids for headaches, back pain and diabetic neuropathy.

A new module, taught by Klapheke and Family Medicine specialist, Dr.听 Magdalena Pasarica, requires students to devise a treatment plan for a typical case that could, without attention to risk-mitigation strategies, lead to addiction:听 A patient comes to the doctor in acute pain from an injury, is prescribed opioids for a short time and then returns to the doctor weeks and months later still complaining of pain and seeking more of the drug. In the module, students work in teams to discuss whether to prescribe opioids, for how long, how to implement follow-up safeguards, identify patients who may be in danger of addiction and identify听 non-narcotic treatments for pain.

麻豆精品 S淥ur students have a unique opportunity 麻豆精品 S� and a duty 麻豆精品 S� to help address this public health crisis, 麻豆精品 S� Klapheke said. 麻豆精品 S淲e need to address this issue in medical schools, residencies and continuing medical education for practicing physicians. Everything we do has to raise awareness because people are dying. 麻豆精品 S�

Opioid and heroin overdoses killed more than 28,000 people in America in 2014, according to the American Society of Addiction Medicine. The Centers for Disease Control reports that that 75 percent of heroin users became addicted to the street drug after being prescribed opioids. The CDC says more than 50 percent of those prescriptions came from primary care physicians who prescribed opioids for conditions including back pain, chronic headaches and arthritis symptoms.

The latest CDC guidelines that the UCF College of Medicine teaches say opioids generally should only be used for acute pain and usually for less than a week and that physicians should have detailed treatment plans when they prescribe opioids, including follow-up urine screens and determinations of whether the medication is actually improving the patient 麻豆精品 S檚 functioning, not just reducing pain.

While the CDC acknowledges that opioids have a place in cancer and end-of-life pain relief, it is urging physicians听 to not use the highly addictive drugs for chronic pain unless there are clear improvements in both symptoms and function and if there are no reasonable alternatives.

The stance is a new approach, after physicians had been urged to keep their patients pain-free and received heavy marketing from drug companies on the benefits of opioids, including claims that they were not addictive. Klapheke noted that when he attended medical school, he received more information on prescribing antibiotics than on prescribing pain pills.

Other physician leaders agree. 麻豆精品 S淚t is important to recognize that we arrived at this place on a path paved with good intentions, 麻豆精品 S� U.S. Surgeon General Dr. Vivek Murthy wrote recently to 2.3 million U.S. physicians and healthcare providers. 麻豆精品 S淣early two decades ago we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely 麻豆精品 She results have been devastating. Since 1999 opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly, almost enough for every adult in America to have a bottle of pills. 麻豆精品 S�

UCF joins medical schools like Tulane, Tennessee, Ohio State, Rutgers, Louisville, Wisconsin and Baylor, that will require medical students to get increased training in prescribing such pain medications before they graduate. UCF will begin the expanded curriculum 麻豆精品 S� which was unanimously approved by the college 麻豆精品 S檚 curriculum committee 麻豆精品 S� in the fall.

麻豆精品 S淎ll you have to do is pick up the newspaper or watch TV and you see the cases of addiction, deaths and crime we are facing because of the misuse of pain medication, 麻豆精品 S� said Dr. Richard Peppler, associate dean for faculty and academic affairs, who helped lead UCF 麻豆精品 S檚 pledge. We want to be leaders in medicine and this is a public health issue we need to help address. 麻豆精品 S�

The prescriptive use of opioids has direct ties to the nation 麻豆精品 S檚 burgeoning heroin epidemic, as the Centers for Disease Control and Prevention (CDC) report that three of four people using heroin began with prescription opioids, making such prescriptions gateway drugs to the highly addictive street narcotic.

The medical school 麻豆精品 S檚 integrated curriculum already includes longitudinal themes like patient safety, ethics and health disparities, which are woven throughout all four years of education. The dangers of prescribing opioids are already addressed in the curriculum. However, a year ago, Dr. Martin Klapheke, assistant dean for medical education and a psychiatrist by training, asked for a complete accounting of where and how often the topic was addressed in light of the national epidemic of prescription drug deaths and overdoses. And the pledge effort for medical schools provided more opportunity to tighten up the curriculum with even more content.

Dr. Klapheke is leading a UCF task force to recommend, design, and implement an expanded curriculum that will begin with the new school year. In some of these sessions, students will apply what they know to real cases. The pledge says participating medical schools will include in their expanded curriculums new guidelines from the CDC for use of prescription opioids.

Dr. Klapheke said UCF 麻豆精品 S檚 goal is to provide the next generation of physicians with more evidence-based recommendations on issues such as when opioids should be prescribed and for how long, how patients should be monitored, when and how physicians should taper a patient 麻豆精品 S檚 dosage and how patients with previous substance abuse problems should be treated for pain. For example, the new training he is developing advises that except in instances of cancer, end-of-life or palliative care, opioids should generally only be used for short-term treatment of acute pain. The CDC guidelines indicate that three days or less is often sufficient to manage such pain and that more than seven days is not often needed Clinicians should not prescribe extra opioids 麻豆精品 S渏ust in case 麻豆精品 S� pain continues longer than expected; rather, the patient needs to be re-evaluated if pain persists.

The new instruction will also advise students to beware of providing chronic prescription of opioids for chronic non-specific pain, such as low back pain, headaches and fibromyalgia and to ensure that opioids are given only if the patient shows significant improvement in BOTH his or her level of pain and physical function. The curriculum will also include more information on non-opioid pharmacologic treatments for pain as well as non-pharmacologic treatments, such as physical therapy and cognitive behavioral therapy.

Dr. Klapheke said physicians historically have not received a great deal of training on managing pain with prescription drugs, noting that when he attended medical school he received more information on prescribing antibiotics than on prescribing pain killers.

麻豆精品 S淲e needed to make a commitment, a statement, to increase awareness, 麻豆精品 S� he said. 麻豆精品 S淥pioid addiction has been devastating to so many patients and their families across the United States. 麻豆精品 S�

麻豆精品 S淗aving this incredible physical challenge, and at the same time, learning all these cultural facts was amazing, 麻豆精品 S� Dr. Klapheke said of the four-day trek through the Andes mountains, marked by the rich history of the Incan empire. The assistant dean for medical education and psychiatry professor is a veteran climber, who has traversed mountain ranges around the world from Iceland to Nepal. 麻豆精品 S淚 just got hooked on it years ago, after my brother climbed Mount Kilimanjaro. I thought 麻豆精品 S榯hat sounds cool, 麻豆精品 S� so I did it, and I was hooked, 麻豆精品 S� he said.

Dr. Husain is newer to the sport, but was determined to hit the ground running, preparing for his first major climbing expedition. It was a common sight to see the two doctors scaling the stairs of the College of Medicine after hours, toting a heavy camping backpack and hiking poles. Dr. Klapheke led Dr. Husain through six months of rigorous training, knowing the physical demands of the Andes. 麻豆精品 S淲ithout that training, I don 麻豆精品 S檛 think I would have been able to do it, personally, 麻豆精品 S� Dr. Husain recalled. 麻豆精品 S淵ou have a goal set, and you have motivation. I used every last ounce of my energy to finish. 麻豆精品 S�

Traveling with about a dozen other climbers in a tour group, the duo was sometimes called upon for their medical expertise, helping fellow travelers with issues like gastrointestinal problems and joint pain. Dr. Klapheke finds that the doctor hat never comes off on his adventures, even when it comes to his spirit of inquiry. 麻豆精品 S淚n medical education, you always want to learn new things, and explore new things, 麻豆精品 S� he said. 麻豆精品 S淭his kind of travel just opens your mind up to an incredible stimulus of sites and challenges. 麻豆精品 S�

Both Drs. Klapheke and Husain talked about entering the 麻豆精品 S淪un Gate 麻豆精品 S� as one of the highlights of their adventure. The gate is an opening where hikers see the iconic view of the mountain range, and Incan ruins for the first time. 麻豆精品 S淭hat 麻豆精品 S檚 the moment where everybody was hugging and kissing and crying, 麻豆精品 S� Dr. Husain said of the site revealed after an exhausting day of climbing. 麻豆精品 S淚t was such a relief and sense of accomplishment that I cannot describe in words. 麻豆精品 S�

Near the end of the trip, Dr. Klapheke was called away for an emergency back home, leaving only a very steep mountain, called 麻豆精品 S淗uayna Picchu 麻豆精品 S� for Dr. Husain to climb. 麻豆精品 S淗e climbed it on his own, in support of both of our wishes, and did so in this incredible rain, 麻豆精品 S� Dr. Klapheke said. 麻豆精品 S淚t 麻豆精品 S檚 really telling of what kind of friend Dr. Husain is. 麻豆精品 S�

The duo plans to pursue more climbing challenges in the future, and will continue to be a fixture in the College of Medicine stairwells, staying in shape for their next adventure.

More than 100 students from every Florida medical school, nursing students, healthcare professionals and medical students from as far away as Oklahoma participated in the event.

麻豆精品 S淲e wanted something that encompasses both a global aspect, but also something that we can manage everyday here in America, 麻豆精品 S� said second-year UCF medical student Scott Furer, who helped lead the event.听 麻豆精品 S淲e 麻豆精品 S檙e going to be seeing these types of patients all the time in our future practices. 麻豆精品 S�

The keynote speaker was Dr. Rick Hodes, who has worked with Ethiopian refugees for more than 20 years. Through his work with the Jewish Joint Distribution Committee (JDC), Hodes has been in charge of the health of Ethiopians immigrating to Israel. Over the past two decades, he has served populations in countries like Zaire, Rwanda and Albania as they faced war, genocide and illness. Dr. Hodes detailed those experiences, 听including a deadly Cholera outbreak in Rwanda, and the Goma-Zaire genocide that resulted in more than a half-million deaths. 麻豆精品 S淪ometimes things are just unexpectedly crazy, 麻豆精品 S� he said. 麻豆精品 S淏ut you have to really be dedicated, you have to do the work, and you have to be able to work well with others. 麻豆精品 S�

A panel of actual refugees from around the globe described their experiences moving to the United States. Hailing from countries like Iraq, Cuba and Egypt, one of the panelists had only been in the United States for two weeks, after emigrating from Myanmar.

Many fled their home countries because war and political conflict threatened the safety of their families. 麻豆精品 S淭he place I came from is filled with violence, and it is unpleasant for many people, 麻豆精品 S� said Ali Al Shammarl, a recent refugee from Iraq.听 麻豆精品 S淵ou have your family, your job, and at one point, you have to decide to leave all of that behind and go into the darkness. 麻豆精品 S�

Their stories of pain 麻豆精品 S� and hope through the assistance of Catholic Charities of Central Florida 麻豆精品 S� were especially impactful to conference participants. 麻豆精品 S淚 lot of people thought it was an eye-opening experience because they didn 麻豆精品 S檛 know there were so many refugees around us, 麻豆精品 S� said second year UCF medical student Neesha Patel, another conference leader. 麻豆精品 S淚t makes you think more about the people that you 麻豆精品 S檙e treating. There could be something else going on in their lives. 麻豆精品 S�

The second half of the day involved workshops and simulations.听A giant hospital tent stood on the front lawn of the College of Medicine, filled with actor-patients wearing professionally-applied makeup to simulate illnesses like jaundice and cholera. Others had bloody gashes and lacerations from an earthquake. Conference attendees interviewed and triaged the patients, often dealing with language barriers and panic.

In the Clinical Skills and Simulation Center, students interviewed costumed standardized patients 麻豆精品 S� actors displaying symptoms of PTSD after coming to the United States from Syria. PTSD is a common mental health issue for refugees dealing with the combined stress of violence, natural disasters and leaving their homeland and support network, said College of Medicine Professor Dr. Martin Klapheke, a psychiatrist by specialty who led the simulation. 听 麻豆精品 S淚t definitely takes the student out of their comfort zone because not only are they doing medical interviewing, but they have to look through the lens of how the trauma 麻豆精品 S檚 affecting the presentation, how cultural differences are affecting the presentation, and how being a refugee further complicates the presentation. 麻豆精品 S� Dr. Klapheke said. After the simulation, the standardized patients provided feedback to the students. They urged the doctors-in-training to give them a chance to grieve before going on to the next question and praised them for not being put off by their angry outbursts and guilt.

The conference was made possible with the help of the Diebel Legacy Fund, a fund at the Community Foundation of Central Florida. The听 organization was founded by the family of the late Dr. Don Diebel Jr., who was killed after stopping to help accident victims on the Florida Turnpike. The charitable group 麻豆精品 S檚 goal is to provide humanitarian support both domestically and abroad and to honor the good Samaritan role that Dr. Diebel embodied. His father, Dr. Don Diebel Sr. helped introduce the day 麻豆精品 S檚 events by saying, 听 麻豆精品 S淲e welcome the opportunity to support the development of physicians who share these values of the Good Samaritan as exemplified by Dr. Diebel Jr. You 麻豆精品 S檙e fortunate to be in a place where your intelligence and curiosity can really be developed and allowed to blossom. 麻豆精品 S�

Many of those students in attendance are members of MedPACt, a UCF College of Medicine group for students who are interested in caring for local and international communities in need. Dr. Deborah German, vice president for medical affairs and dean of the medical school, commended the students for their commitment to service. 听 麻豆精品 S淲hether you serve patients overseas or practice medicine in your hometown, you will see patients from all over the globe whose life experiences are drastically different from your own, 麻豆精品 S� she said. 麻豆精品 S淭o be a healthy community, we must ensure that the weakest and the most in need receive compassionate and quality care. 麻豆精品 S�

To see a video version of this story, visit

Dr. Klapheke and his colleagues are having the modules peer reviewed and plan to submit them to MedEdPORTAL, making them available online as a free national database for use by medical schools across the country. Dr. Klapheke and the CSI Task Force have produced five modules so far and plan to produce a total of 14 that encompass the major disorders in Psychiatry.

麻豆精品 S淭hese modules utilize educational technology and state-of-the-art simulation in a most effective way for educators and students, 麻豆精品 S� Dr. Klapheke said.

The Liaison Committee on Medical Education (LCME), which accredits medical schools, requires third- and fourth-year students to learn through actual clinical experiences. Finding a sufficiently broad variety of such experiences at available clinical placement sites for students can at times be a challenge. As Dr. Klapheke explained, a medical student in a six-week psychiatric rotation may well see multiple patients with depression, but might not see sufficient patients with more uncommon disorders. 麻豆精品 S淭hese self-learning modules can help fill in those gaps, 麻豆精品 S� he said.

Dr. Klapheke 麻豆精品 S檚 module was filmed in the College of Medicine 麻豆精品 S檚 Clinical Skills and Simulation Center, where standardized patients received scripts detailing their symptoms. During the self-learning module, students see video clips showing how a psychiatrist interviews and interacts with the patient. These interactive modules have students take a series of quizzes to test their learning, offers feedback on their answers, and allows them to study at their own pace.

Dr. Klapheke and the CSI group showed the modules on laptop computers at the ADMSEP conference:听 麻豆精品 S淧eople were waiting in line to get a look at them. It was a delight to get name recognition for UCF and for both the College of Medicine 麻豆精品 S檚 Educational Technology staff and Clinical Skills and Simulation Center. 麻豆精品 S�

Dr. Klapheke credited Dale Voorhees, director of learning systems, who filmed and edited the training videos, and Alex Chacon, classroom support specialist, for the graphics and design of the winning poster. 麻豆精品 S淭his was a team effort, 麻豆精品 S� he said. 麻豆精品 S淒ale, Alex and the Clinical Skills team did a spectacular job. 麻豆精品 S�

Solid organ transplants 麻豆精品 S� of the kidney, liver, heart and lungs 麻豆精品 S� have become almost commonplace. Virtually everyone knows someone who has received such a transplant and communities often have support groups who help transplant patients cope with the physical and emotional aspects of their condition. But 麻豆精品 S渃omposite tissue 麻豆精品 S� transplants 麻豆精品 S� of the face, hand and larynx 麻豆精品 S攁re innovative and unique, meaning doctors and patients must confront more unknowns and uncertainties as to how to assess candidates and anticipate outcomes.听

Candidates for hand transplantation have experienced the physical and psychological trauma of amputation, and frequently even those who have adjusted extremely well still feel incomplete, Dr. Klapheke said. They may raise mirrors in their homes to avoid seeing the missing hand, and they talk openly of missing the wonders of human touch (hugging loved ones with both hands) or even 麻豆精品 S渢he little things 麻豆精品 S� like buttoning a shirt or throwing a ball with their children.听听

Innovative transplants can have a futuristic or even 麻豆精品 S渟cience fiction 麻豆精品 S� aspect for patients that psychiatrists must address with patients.听 For example, unlike a transplanted kidney, a transplanted hand is constantly visible to the patient, who notices the new limb 麻豆精品 S檚 different skin, texture and coloring. In assessing candidates for hand transplantation, the patient 麻豆精品 S檚 coping skills and level of personality organization (potential for psychological regression in the face of marked stress) must be carefully assessed.

As part of Grand Rounds, Dr. Klapheke presented the case of a health care professional who experienced a traumatic loss of his hand. The patient was assessed pre-transplant as having a well integrated sense of self despite the amputation, but he still felt 麻豆精品 S渄amaged 麻豆精品 S� and longed to feel 麻豆精品 S渨hole again. 麻豆精品 S� After the transplant he was delighted and felt full ownership of the new hand, but four days after his surgery, the media breached confidentiality and reported that the transplant donor had died while in prison for manslaughter. Now the patient, whose job had been to save lives, had the hand of a man who had killed two people. 麻豆精品 S淚 was obviously even more concerned about how well the patient would be able to integrate this new hand into his sense of himself, 麻豆精品 S� Dr. Klapheke said, but the patient was able to immediately respond to the news story by stating, 麻豆精品 S淚t 麻豆精品 S檚 okay. This is my hand now.听 It is my blood that courses through it, and I control what it does.听 It is my hand. 麻豆精品 S�

After the transplant and rehabilitation, this patient carried his son onto the baseball field and with his new hand threw out the first pitch at a professional game featuring his favorite team, the Philadelphia Phillies. Over ten years later, he has continued to demonstrate psychological resilience and remains delighted with 麻豆精品 S渕y (new) hand. 麻豆精品 S�