bluuebunny/crossref_metadata_2025 huggingface dataset:
A Summary of Recommendations for Plastic Surgeons during the Coronavirus Disease 2019 Outbreak
Authors: Schoenbrunner Anna R. , Sarac Benjamin A. , Janis Jeffrey E.
Published: January 2021

Background:

The coronavirus disease 2019 outbreak presents unique challenges to the healthcare system. The lack of unified guidelines on what constitutes elective surgery left plastic surgeons without a clear framework to guide their practices. More urgently, the ambiguity in defining elective surgery leaves plastic surgeons without clear guidance as states begin to phase in these procedures.

Methods:

Recommendations issued by state governing bodies as of April 28, 2020, were reviewed. National society and federal guidelines pertaining to postponement and resumption of elective surgeries affected by the coronavirus disease 2019 outbreak were also reviewed. Recommendations based on the above are collated for plastic surgeons.

Results:

Thirty-six states and the District of Columbia provide recommendations regarding elective surgery. Cosmetic surgery is considered an elective surgery and should be postponed; this may be among the first elective surgeries to safely resume. Societal guidelines provide disease-specific recommendations for cancer-related surgery and breast reconstruction. Trauma, other cancer-related reconstruction, and hand surgeries are considered nonelective if postponement threatens life or limb or if a patient is highly symptomatic. Postponement and resumption of oncology, trauma, and hand surgery cases depend on disease stage and complexity of reconstruction. Pediatric craniofacial surgery presents unique challenges due to the time-sensitive nature of the interventions.

Conclusions:

Guidance on elective surgery is vague for plastic surgeons. Government recommendations and societal guidelines provide a framework for plastic surgeons to assess the elective nature of a surgical intervention and safety of resumption; however, a nuanced assessment must be made on local disease transmission, supply availability, and hospital capacity.
Reconstruction of Bilateral Mandibular Condyles Using a Single Vascularized Fibula
Authors: Tiongco Rafael P. , Hui Amy , Stern-Buchbinder Zachary , Stalder Mark W. , St. Hilaire Hugo
Published: January 2021

Patients with end-stage temporomandibular joint (TMJ) pathology present with loss of vertical ramus height with resulting retrognathia, anterior open bite, and restricted jaw function requiring joint reconstruction. Costochondral grafts, long considered the gold standard for TMJ reconstruction, carry risks of bony ankylosis and resorption. Custom-made alloplastic TMJ prostheses show excellent objective and subjective outcomes but are also associated with complications such as infection or metal sensitivity, and necessitate hardware explantation in some cases. Revision surgeries are rare but present a real challenge. We present the case of a 50-year-old woman with longstanding TMJ arthritis, having undergone many surgical procedures to her TMJ, including explantation of failed alloplastic replacement, who presented with bilateral facial weakness as well as difficulty chewing and swallowing food. She had class II malocclusion with retrodisplacement of her mandible and anterior open bite, and moderate trismus with an inter-incisal opening of only 15 mm, consistent with fibrous ankylosis. After weighing all the reconstructive options, bilateral mandibular condyle and ramus reconstruction with a single fibula free flap (FFF) was planned with the use of preoperative virtual surgical planning (VSP) and 3D-printing of osteotomy and repositioning guides. A 2-team approach increases efficiency of the procedure and decreases operative time. The procedure and postoperative recovery were uncomplicated, and at her 2-month follow-up, she had increased range of motion and maintained the planned position of her mandible. Her masticatory function and deglutition were also improved due to the correction of her malocclusion and repair of her anterior open bite.
Preoperative Flap Surgery Simulation for a Case of Cryptotia Using a 3D Printer
Authors: Tsuge Takuya , Kuwahara Hiroaki , Akaishi Satoshi , Ogawa Rei
Published: January 2021

Cryptotia is a congenital auricular deformity. Common methods of surgical reconstruction involve creating an auricular temporal groove using local flaps and/or a skin graft. However, it can be difficult to determine which method is most suited to the unique 3-dimensional (3D) structure of each cryptotic ear. Here, we showed that creating 3D ear models of a cryptotic ear with a 3D camera and printer and using these models to simulate surgery with two different flap methods (cat’s-ear and square) allowed selection of a reconstruction method that led to good outcomes after the actual surgery. The patient was a 7-year-old girl with left cryptotia. A 3D camera was used to acquire 3D data for the ear. After structural analysis, a home 3D printer was used to print the data into 3D ear models using an elastic material. These models exhibited good plasticity. After subjecting the models to simulated cat’s-ear and square flap surgeries, the cat’s-ear flap method was considered to better reproduce the healthy side of the ear compared with the square flap method for this particular case. Ear morphology during and after the actual surgery closely resembled the model-ear morphology during and after the simulated cat’s-ear flap surgery. We successfully created a full-scale 3D model with good plasticity using a 3D camera and 3D printer. This allowed easy, noninvasive preoperative evaluation and identification of the most suitable operation for the specific case, facilitating easier, more successful surgery.
Hidden Costs in Resident Training: Financial Cohort Analysis of First Assistants in Reduction Mammaplasty
Authors: Malloy Shannon M. , Sanchez Karl , Cho Jonathan , Mulcahy Sarah E. , Labow Brian I.
Published: January 2021

Background:

Graduate medical education (GME) programs are vital to developing future plastic surgeons. However, their cost-efficiency has yet to be contextualized. This cohort quality improvement (QI) project aimed to measure the indirect costs an institution assumes in training surgical residents, by comparing the differences in operative time and procedural charges between a resident and a physician assistant (PA) first-assisting during adolescent reduction mammaplasty.

Methods:

From 2013 to 2019, adolescent bilateral reduction mammaplasty procedures first-assisted by either a resident or physician assistant were considered for analysis. Financial data, including all hospital and physician expenditures and operation duration, patient demographics, and outcomes data were retrospectively collected.

Results:

A total of 49 reduction mammaplasty cases were included for analysis. Residents had an average of 5.9 ± 1.5 years of post-graduate surgical training, whereas the PA had 2 years of surgical experience. Procedures first-assisted by a surgical resident took a mean/median of 34 minutes longer and were $3750 more expensive, respectively, than cases first-assisted by a PA (P < 0.01, both).

Conclusions:

Reduction mammaplasty procedures were longer and accrued higher charges when first-assisted by a surgical resident than by a PA. Although Graduate Medical Education programs are necessary to train the next generation of surgeons, they may result in unintended opportunity costs for teaching hospitals. Federal support to academic medical centers aims to cushion the cost of residential training, but is insufficient to compensate for resident inefficiency. Hospitals may consider incorporating PAs into the Graduate Medical Education paradigm to alleviate administrative burden, lower operational charges, and enhance resident training curricula.
Impact on Abdominal Skin Perfusion following Abdominoplasty
Authors: Nergård Solveig , Mercer James B. , de Weerd Louis
Published: January 2021

Background:

Wound healing problems following abdominoplasty may be a result of impaired tissue perfusion. This study evaluated the impact a standard abdominoplasty may have on abdominal skin perfusion.

Methods:

A standard abdominoplasty was performed in 16 patients. Dynamic infrared thermography (DIRT) using a mild and a stronger cold challenge was performed pre-, intra-, and postoperatively on day 1, 2, and in week 6. The abdomen was divided into Huger’s vascular zones. A two-tailed t test was used to evaluate differences in mean temperature between zones. Statistical significance was defined as P < 0.05.

Results:

Two patients suffered wound healing problems. Abdominal skin perfusion showed a hyperaemic state on day 1, day 2, and week 6, postoperatively. Hotspots in zones I and II had all disappeared at the end of surgery and on day 1, except in the cranial part of zone I. Hotspots reappeared in zones I and II during day 2. A statistically significant difference between zones I and II was seen on day 1 and 2, with zone II being cooler. This difference had disappeared in week 6 for the mild cold challenge but not for the stronger cold challenge.

Conclusions:

A standard abdominoplasty has a significant impact on abdominal skin perfusion. The skin perfusion is a dynamic process with a gradual improvement over time. The strongest effect was seen in zone II near the lower transverse incision line, where skin perfusion was the least. Such may contribute to impaired wound healing at this site.
A Dynamic Costal Cartilage Platform Promotes Ocular Prosthetic Excursion: Preliminary Report
Authors: Motomura Hisashi , Deguchi Ayaka , Ataka Shinsuke , Fujii Naho , Hatano Takaharu , Fujikawa Heishiro , Maeda Shusaku , Haraoka Goichi
Published: January 2021

Background:

The quality of life of the face involves mainly its configuration, and it plays an important functional role in communication skills. Thus, having artificial eyes is extremely essential in maintaining the quality of life of patients who have lost their eyeballs. We will present the details of the technique, including tips and innovations for eye socket reconstruction using spherical costal cartilage implant, which leads to dynamic and aesthetic results.

Methods:

There were 19 cases of eye socket reconstruction using costal cartilages from 2008 to 2020. The patient age range was 18–77 years old. There were 10 cases of anophthalmia and 9 cases of ocular phthisis. In our operative method, we created the costal cartilage implant by harvesting the sixth costal cartilage of the affected side. If extraocular muscle remained, we sutured each muscle to the cartilage.

Results:

Our method made application of thin artificial eyes possible in all cases. Regarding postoperative complications, there were 1 case of postoperative infection and 1 case of vascular failure of temporoparietal fascial flap. Seventeen cases were wet socket, and 2 cases were dry socket. We had attained movement of the artificial eye in 15 cases.

Conclusions:

Eye socket reconstruction is considered one of the most challenging operations, and various postoperative complications appear in the long term. Costal cartilages are considered as the most suitable materials to create the base of artificial eyes.
Plastic Surgery Fellowship at Nippon Medical School Hospital: An Integrative Approach to Modern Plastic Surgery Education
Authors: Abdelhakim Mohamed , Soto Diez Carolina , Huang Chenyu , Goutos Ioannis , Orgill Dennis P. , Ogawa Rei
Published: January 2021

Plastic surgery requires extensive wide-ranging surgical knowledge, special technical dexterity, and personal skills in order to achieve improved quality of life and satisfying outcomes for patients. For decades, international plastic surgery fellowship programs have offered opportunities to enhance the subspecialty training of young plastic surgeons abroad and promote international exchange of information in the field of plastic surgery. However, concerns around enrolling in a nontraditional educational strategy at the postgraduate level have restricted young plastic surgery residents from pursuing comprehensive training opportunities overseas. Therefore, we present a personal experience of a distinct established international fellowship program in plastic, reconstructive, and aesthetic surgery at Nippon Medical School Hospital, Japan, as an example. This institution has adopted the use of highly skilled surgical techniques, providing basic research education along with the teaching of essential personal skills needed in modern plastic surgery. As a mean to promote international educational collaboration in plastic surgery, we discussed the modern plastic surgery educational strategies worldwide that participate in developing a successful plastic surgeon’s career.
Botulinum Toxin Type A as a Tool for Correcting Capsular Contracture after Reconstructive Breast Surgery
Authors: Zikiryakhodzhaev Aziz D. , Alekseeva Galina S. , Reshetov Igor V. , Starkova Marianna V. , Saribekyan Eric K. , Usov Fedor N. , Vlasova Maria Yu.
Published: January 2021

Capsular contracture is one of the most common complications after breast reconstruction. Surgical treatment is the main option for capsular contracture correction and includes capsulotomy, capsulectomy, and removal/replacement of the affected implant. However, the surgical trauma from reoperation, along with reduced quality of life, in patients with clinically significant capsular contracture has prompted a search for alternative treatment options. The use of the botulinum toxin type A in the treatment of neurological diseases and of keloid scars in aesthetic practice nudged the idea of using the same toxin for the correction of capsular contractures in breast cancer patients. Botulinum toxin type A injection is an easy procedure requiring no anesthesia or inpatient care. The treatment has few side effects. In addition, the injection does not cause sensory loss or dysesthesia. We described a clinical case of the capsular contracture correction using incobotulinumtoxin A. Capsular contracture IV developed 4 months post surgery after long-term lymphorrhea. Radiation therapy was not performed. According to the internal protocol, the patient was advised to undergo incobotulinumtoxin A treatment instead of surgery. Within 1 week after the second injection, all symptoms decreased—specifically, the general shape of the reconstructed breast. Also, the pain syndrome disappeared.
Squamous Cell Carcinoma of the Scalp after Artificial Hair Implantation
Authors: Nakayama Satoru , Tsuge Itaru , Katsuragawa Hiroyuki , Fujimoto Masakazu , Fujimori Hideyuki , Katsube Motoki , Sakamoto Michiharu , Morimoto Naoki
Published: January 2021

A 48-year-old man with a protruding tumor on the parietal region had undergone treatment of alopecia using artificial synthetic fibers 2 or 3 times a year for 10 years from 30 to 39 years old. Three months before the first consultation at our hospital, he noticed a small tumor that had gradually shown bleeding and discharge, with expansion of the affected area. A diagnosis of squamous cell carcinoma (SCC) was made based on a biopsy, and we resected the tumor with a 1-cm surgical margin from the reddened area around the protruding tumor (14 × 11 cm), including the periosteum membrane. No tight adhesion was found between the periosteum and skull, so we excised the outer table of the skull of the central part (diameter: 8 cm) for a pathological analysis. A pathological study showed moderately differentiated SCC with a negative surgical margin. The whole tumor was surrounded by scar tissue with buried artificial hair implants. The second surgery was performed on the 15th postoperative day. An anterolateral thigh flap was divided into 2 flaps to fit the circle-shaped wound. This is the second report of SCC developing after artificial hair implantation in the frontal-parietal scalp. The whole protruding tumor was surrounded by scar tissue with buried artificial hair implants. Proving the direct causal relationship between inflammation of scar tissue and SCC generation is difficult; however, our pathological findings support the possibility of the harmful effects of artificial hair implants.
Clinical Analysis of Cultured Epidermal Autograft (JACE) Transplantation for Giant Congenital Melanocytic Nevus
Authors: Takaya Kento , Kato Tatsuya , Ishii Tatsuyuki , Sakai Shigeki , Okabe Keisuke , Aramaki-Hattori Noriko , Asou Toru , Kishi Kazuo
Published: January 2021

Background:

Cultured epidermal transplantation (JACE) is performed for giant congenital melanocytic nevus (GCMN), but there are few reports on its postoperative course and surgical content or indications. We aimed to investigate the postoperative course of GCMN patients undergoing cultured epidermal autograft transplantation and compare the outcomes between 2 nevus tissue resection methods.

Methods:

Twelve GCMN patients aged 0 months to 8 years and 9 months were included in this single-center case series study. Cultured epidermal autograft transplantation was performed at 19 sites of the patients’ extremities and trunks, after excision of the nevus either by using an electric dermatome, which we initially used in 2017, or by curettage with a sharp spoon and use of a hydrosurgery system (Versajet), which we started performing in 2018. Univariate and multivariate analyses were performed for factors associated with postoperative hypertrophic scar formation.

Results:

In all cases, >90% of the grafts survived, and the dark brown color of the nevus was reduced. Average postoperative observation period was 16.5 months. Hypertrophic scar formation was observed postoperatively at 9 wound sites out of the 12 sites with GCMN removed with a dermatome and at only 1 site with GCMN removed by curettage with use of a hydrosurgery system. In the univariate and multivariate analyses, hypertrophic scar formation was associated with age at surgery.

Conclusion:

In cultured epidermal autograft transplantation for GCMN, nevus tissue removal at an early age by curettage with use of a hydrosurgery system can provide good results while reducing complications, including recurrence and hypertrophic scar formation.
Suicidal Risk Following Hospital Discharge: A Review
Authors: Forte Alberto , Buscajoni Andrea , Fiorillo Andrea , Pompili Maurizio , Baldessarini Ross J.
Published: January 2021

Learning objectives

After participating in this activity, learners should be better able to:

• Evaluate risk of suicide and suicide attempts following psychiatric hospitalization

• Assess the relationship between suicide attempts and completed suicides

Background

Suicidal risks among psychiatric patients appear to be especially high soon after hospitalization. Given the importance of such outcomes, and the lack of recent reviews of post-discharge suicide attempt risks, we evaluated reported findings on the risk of suicide and attempts following psychiatric hospitalization.

Methods

With systematic, computerized searching, we identified 48 studies (1964–2017) involving 1,700,785 subjects. Follow-up was limited to ≥12 months after discharge from psychiatric hospitalization to avoid inflation of annualized rates due to shorter exposure times.

Results

The overall observed pooled, annualized rate of completed suicide was 241 (confidence interval, 238–243) per 100,000 person-exposure years in 41 studies, and for attempts, 722 (698–746) in 13 studies. In six studies (64,848 subjects) reporting on both suicides and attempts, the ratio of annualized rates for attempts/completed suicides was 8.79 (6.63–12.0). Among all 48 studies, cumulative distribution of suicidal events included 26.4% (25.9–26.9) within the initial month, 40.8% (40.2–41.4) within 3 months, and 73.2% (72.7–73.7) within 12 months of discharge.

Conclusions

Among patients recently discharged from psychiatric hospitalization, rates of suicide deaths and attempts were far higher than in the general population or even in unselected clinical samples of comparable patients, with a strong inverse association with time post-discharge. Improved monitoring and care of patients discharged from psychiatric hospitalization are needed, ideally with detailed planning and implementation of aftercare prior to discharge.
AUTOLOGOUS RETINA TRANSPLANTATION FOR TREATMENT OF REFRACTORY DOUBLE FULL-THICKNESS MACULAR HOLE IN ALPORT SYNDROME
Authors: Sanjuán Pablo , Samaan Muhsen , Nadal Jeroni
Published: January 2021

Purpose:

To report the structural and functional outcomes of autologous neurosensory retinal transplantation for closure of refractory double full-thickness macular hole in a patient diagnosed with Alport syndrome.

Methods:

Patient with previous pars plana vitrectomy and a failed macular hole surgery (internal limiting membrane removal) underwent pars plana vitrectomy and autologous neurosensory retinal flap transplantation with silicone oil tamponade. Follow-up was performed after one year. The anatomic outcomes were evaluated mainly by fundus examination, optical coherence tomography (OCT), and microperimetry (MAIA). The functional changes were evaluated comparing best-corrected visual acuities preoperative and 1 year after surgery.

Results:

A 35-year-old man with progressive visual loss of two years of evolution presented a double full-thickness macular hole in the left eye. After retinal flap transplantation, the macular hole appeared successfully closed during the entire follow-up. Integration of both retinal flaps into the surrounding retina and regeneration of the external retinal layers were observed in optical coherence tomography. Best-corrected visual acuities improved from 20/200 preoperatively to 20/80 one-year postoperatively.

Conclusion:

Pars plana vitrectomy combined with autologous neurosensory retinal flap transplantation is an effective option to achieve the anatomic closure of recurrent double full-thickness macular hole and significant visual recovery in Alport syndrome.
A cataract, ‘a million cut’ radial keratotomy, and Marfan syndrome February consultation #1
Authors: Fram Nicole R.
Published: January 2021

A 56-year-old man with an ocular history of 20+ cut radial keratotomy (RK) in both eyes and Marfan syndrome presented with blurred vision in both eyes 2 years previously. He was intolerant of contact lenses and was correctable with spectacles for the past 10 years. His presenting photographs and corneal topographies are shown in Figures 1 and 2

JOURNAL/jcrs/04.03/02158034-202102000-00022/figure1/v/2023-08-19T002602Z/r/image-tiff

JOURNAL/jcrs/04.03/02158034-202102000-00022/figure2/v/2023-08-19T002602Z/r/image-tiff

, respectively. His left eye had greater than 270 degrees of zonulopathy and a visually significant cataract. He underwent a planned pars plana lensectomy/vitrectomy and implantation of a scleral-fixated CZ70BD (Alcon Laboratories, Inc.) intraocular lens (IOL). He has enjoyed adequate vision in the left eye and now has a worsening cataract in his right eye. He is a practicing dentist and requested the fastest visual rehabilitation possible.

His corrected distance visual acuity was 20/50 with a manifest refraction of +5.00−4.00 × 90 in the right eye and 20/25 with a manifest refraction of +1.75−2.50 × 180 in the left eye. Intraocular pressure (IOP) was measured at 16 mm Hg in both eyes, and extraocular motility, confrontational visual fields, and pupils were normal in both eyes.

On slitlamp examination, he had mild ptosis in both eyes, the corneas had 20+ RK with multiple arcuate incisions at the 3- and 9-o’clock positions in both eyes, the anterior chamber (AC) was deep and quiet in both eyes, both irides had mild iridodonesis, the right lens had a 2 to 3+ nuclear sclerotic cataract with 6 clock hours of superotemporal zonulopathy that was only evident with dilation (Figure 3

JOURNAL/jcrs/04.03/02158034-202102000-00022/figure3/v/2023-08-19T002602Z/r/image-tiff

) and no phacodonesis. The left lens had a well-positioned CZ70BD IOL fixated at 6 and 12 o'clock without extrusion or exposure of the Gore-Tex suture. The posterior segment examination was unremarkable.

What counseling would you provide for this patient in preparation for surgery? How would you plan the IOL calculations? What intraoperative techniques would you use to achieve the safest outcomes given his comorbidities?
Neonatal hyperoxia induces gut dysbiosis and behavioral changes in adolescent mice
Authors: Lo Yu-Chun , Chen Kai-Yun , Chou Hsiu-Chu , Lin I-Hsuan , Chen Chung-Ming
Published: January 2021

Background:

Supplemental oxygen is often required to treat preterm infants with respiratory disorders. Experimental studies have demonstrated that hyperoxia results in the disruption of intestinal and neuronal plasticity and myelination of the brain. The association between the neonatal hyperoxia and changes of phenotypes in gut microbiota and in behaviors is not clear to date.

Methods:

We designed an animal experiment that C57BL/6 mice pups were reared in either room air (RA) or hyperoxia (85% O2) from postnatal days 1 to 7. From postnatal days 8 to 42, the mice were reared in RA. Intestinal microbiota was sampled from the lower gastrointestinal tract on postnatal days 7 and 42, and behavioral tests were performed and brain tissues were collected on postnatal day 42.

Results:

Neonatal hyperoxia decreased intestinal tight junction protein expression and altered intestinal bacterial composition and diversity on postnatal day 7. Among the concrete discriminative features, Proteobacteria and Epsilonbacteraeota were significantly elevated in hyperoxia-reared mice on postnatal days 7 and 42, respectively. Hyperoxia-reared mice exhibited significantly reduced sociability and interest in social novelty and impaired motor coordination compared with RA-reared mice on postnatal day 42. Hyperoxia-reared mice also exhibited significantly reduced myelination and a significantly higher number of apoptotic cells in the brain compared with RA-reared mice on postnatal day 42.

Conclusion:

Neonatal hyperoxia during the first week of life altered gut microbiota and reduced brain myelination that might associate with the deficits of social interaction and motor coordination in adolescent mice.
Overexpression of catechol-O-methyltransferase occurs early in the progression of pancreatic cancer
Authors: Dai Hongmei , Wang Xianze , Hong Xiafei , Wu Huanwen , Di Wenyu , Wang Wenze , Xu Peiran , Jia Congwei , Wang Jing , Chen Hao , Jiang Jialin , Jiang Rui , Wu Wenming , Zhao Yupei
Published: January 2021

Aims:

Catechol-O-methyltransferase (COMT) plays a role in many kinds of cancer, and its high expression in pancreatic cancer has been found to be related to better prognosis. However, the expression and biological significance of COMT in multistep pancreatic cancerogenesis is not clear.

Main methods:

Six LSL-KrasG12D-positive and Pdx1-Cre-positive mice (KrasG12D mice), 6 wild-type mice and 1 human tissue microarray were used in this study. COMT protein expression was measured by immunohistochemistry, and DNA chips were made for use in COMT mRNA assays.

Key findings:

The expression of COMT in pancreatic intraepithelial neoplasias (PanINs) from KrasG12D mice was significantly higher than that in normal pancreatic tissue from wild-type mice, both in terms of protein level and mRNA expression. The median COMT immunohistochemistry expression scores in human PanIN-1 and PanIN-2 were 70 and 160, respectively, which were significantly lower than the score of 170 observed in pancreatic ductal adenocarcinoma (PDAC) (P = .024 and .037, respectively) and significantly higher than the score of 25 observed in pancreatitis (P = .01 and .008, respectively).

Significance:

In the development of pancreatic cancer from chronic pancreatitis and in the transition of PanIN to PDAC, we observed significantly increased expression of COMT. These data predict that the overexpression of COMT is an early event in the multistep process of pancreatic cancerogenesis.
Nurse practitioner students' observations of preceptor engagement in obesity management and weight bias: A mixed-methods approach
Authors: Hauff Caitlyn , Fruh Sharon M. , Sims Brook M. , Williams Susan G. , Herf Cindy , Golden Angela , Graves Rebecca J. , Minchew Leigh A. , Hall Heather R.
Published: January 2021

Background:

Obesity is considered a growing epidemic in the United States. Nurse practitioners (NPs) have the opportunity to serve as leaders in addressing concerns related to disease management, particularly obesity. Currently, we lack an awareness of how NP students are learning obesity management from their preceptors.

Purpose:

Thus, the current study sought to explore how NP students perceive preceptors' behaviors when managing patients with obesity.

Methodological orientation:

This study used a mixed-methods design. Participants were asked to report how often they observed their preceptors engage in different strategies when interacting with patients with obesity (e.g., calculate body mass index, identify goals). Students were then asked to respond to the statement: “share observations you made of how patients with obesity were treated in this environment.” Students completed 2 clinical rotations during this period and, thus, were asked to answer the questions twice to capture experiences at both clinical sites.

Sample:

Researchers surveyed 225 NP students completing clinical rotations in 3 settings (Family Practice, Pediatrics, and Obstetrics/Gynecology).

Conclusions:

Quantitative results revealed significant differences in the frequency of observed obesity management behaviors by all preceptors. Qualitative results revealed that NP students most often observed preceptors displaying interpersonal warmth without weight bias when working with patients with obesity. Contrary to current literature, this sample of NP students observed their preceptors engaging in positive interactions with individuals with obesity.

Implications for practice:

Educators must continue to teach students to engage in unbiased behavior toward patients. It is critical to continue to improve obesity management content offered in NP programs.
Practical implications for providing physical activity counseling for the older adult: An integrative review
Authors: Otmanowski Jennifer A. , Chase Jo-Ana D.
Published: January 2021

Background:

Physical inactivity in the older adult is associated with functional decline, increased fall risk, and threatens the ability of the older adult to live independently. Nurse practitioners, with their expertise in health promotion and chronic disease management, are well positioned to provide physical activity (PA) counseling. However, there is a gap in the literature describing a practical formula for providing PA counseling and PA prescriptions for clinical practice.

Objective:

The objective of this integrative review was to synthesize the literature related to counseling interventions designed to increase PA among older adults and provide practical recommendations for incorporating recommendations into practice.

Data sources:

Five different databases were searched along with ancestry searching of relevant articles. Eligible studies tested methods of recommending PA for adults age ≥65 years, including in-person counseling, phone calls, written information, and exercise prescriptions.

Conclusions:

Health care providers are able to motivate older adults to increase PA in the short term. Diverse health care disciplines are efficacious at motivating older adults to increase PA. Various counseling interventions can be used with varying amounts of time investment.

Implications for practice:

Physical activity counseling is an underused but effective intervention for increasing PA in older adults. Older adults respond well to advice to increase their PA especially with the addition of a written exercise prescription. Basing PA counseling interventions on a theoretical construct such as social cognitive theory or transtheoretical stages of change theory improves the efficacy of the interventions.
Self-compassion In Hospice and Palliative Care
Authors: Mesquita Garcia Ana Cláudia , Domingues Silva Brenda , Oliveira da Silva Letícia Cristine , Mills Jason
Published: January 2021

Those involved with hospice and palliative care, including nurses, will inevitably experience or be exposed to suffering. Self-compassion represents a personal resource and support for self-care, ensuring that needs are not neglected particularly during times of suffering. However, the empirical evidence for self-compassion in hospice and palliative care is yet to be reviewed systematically. To synthesize the evidence on self-compassion in hospice and palliative care patients, their relatives, and health care professionals, we conducted a systematic integrative review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. For patients, self-compassion was associated with reduced stress, anxiety, shame, depressive symptoms, fear of cancer recurrence, and loneliness. It was also associated with increased social capital, self-soothing, mindfulness, compassion, causal reasoning ability, psychosocial and spiritual well-being, legacy, courage, and commitment. For health care professionals, self-compassion was associated with increased capacity for self-care, mindfulness, and professional quality of life and a decrease in perceived burnout risk and secondary traumatic stress. No studies were found to involve patients' relatives. Self-compassion seems to be an important resource in hospice and palliative care. It supports self-care and alleviates suffering by improving the social, psychosocial, and spiritual well-being of patients and health care professionals, including hospice and palliative care nurses. Future research should include care patients' relatives.
Telepsychiatry in Low- and Middle-Income Countries During COVID-19
Authors: Diwan Mufaddal Najmuddin , Ali Awan Hashir , Aamir Alifiya , de Filippis Renato , Ullah Irfan
Published: January 2021

To date, there is lack of specific effective treatment or vaccine for the SARS-CoV-2, and clinical and laboratory research is still ongoing to find successful drugs. Therefore, prevention to be infected through social distancing and isolation is the most effective way. However, all the other physical and mental illnesses continue to exist, if possible even more burdened by the emergency situation and social distancing. The COVID-19 pandemic, especially in many low- and middle-income countries, has caused a deeper gap in seeking psychiatric help. In this scenario, telepsychiatry could play a decisive role in implementing clinical care for frail patients and ensuring continuous mental care. Therefore, we felt the urge to write this article to express our hope that the old health care system at this time of crisis, as we know it, can offer the chance to implement pervasive care technologies that perfectly fit current psychiatric needs.
Diagnosing Recently Defined and Uncommon Salivary Gland Lesions in Limited Cellularity Specimens: Cytomorphology and Ancillary Studies
Authors: Rossi Esther Diana , Baloch Zubair , Faquin William , Pantanowitz Liron
Published: January 2021

Fine-needle aspiration (FNA) has proven to be an essential step in the preoperative evaluation of patients with salivary gland lesions. The diagnosis rendered on FNA specimens helps streamline clinical and/or surgical management. However, despite its usefulness, FNA has known limitations. Fine-needle aspiration may fail to provide a specific diagnosis in some cases because of limited aspirated material, cellular makeup, and/or morphologic heterogeneity. The field of salivary gland pathology is rapidly changing because of the identification of new entities and reclassification of existing lesions based on morphologic features and emerging antigenic and molecular profiles. A management-based cytological diagnosis of these newly reclassified and/or uncommon neoplasms is possible using characteristic morphologic features and specific translocations. Herein, we review the salient morphologic features, immunohistochemistry, and molecular profile of several recently described salivary gland neoplasms in light of clinical management.
Now Is the Time
Authors: Bosques Glendaliz , Ankam Nethra Sridhara , Kasi Ravi , Rydberg Leslie , Sauter Carley , Therattil Maya , Tolchin Dorothy W.
Published: January 2021

One in four noninstitutionalized adults in the United States lives with a disability. People with disabilities have frequent interactions with the medical community and the healthcare system yet experience disparities in access and outcomes. The Association of American Medical Colleges has included disability in its definition of diversity as one of the aspects of patient care that may affect health equity. However, training in the lived experience of disability is not always included in medical education. Physiatrists make excellent disability champions in medical schools, given their training and experience in the care of individuals with disabilities. Here, we describe strategies for physiatrists to increase disability education in medical schools and an overview of standards and tools (Liaison Committee on Medical Education standards; Commission on Osteopathic College Accreditation standards; International Classification of Functioning, Disability and Health language; and the Core Competencies on Disability for Health Care Education published by the Alliance for Disability in Health Care Education) physiatrists can use to facilitate interactions with medical school educational leadership. Specific examples are provided along with a framework to guide the development of disability champions in medical schools.
The Important Impact of COVID-19 Pandemic on the Reorganization of a Rehabilitation Unit in a National Healthcare System Hospital in Italy
Authors: Maccarone Maria Chiara , Masiero Stefano
Published: January 2021

Since March 2020, when COVID-19 pandemic broke out, the world’s healthcare systems’ main concern has been fighting the pandemic. However, patients with other diseases, also requiring rehabilitation evaluations and treatments, continued to need care. Our rehabilitation unit managed to maintain contact with patients through alternative communication methods even during the lockdown period and in a situation of staff shortage. If face-to-face evaluations and treatments were necessary, preventive measures were followed to avoid hospital-associated contagion. Rehabilitation beds were cleared to leave them to the acute wards, and consultations for the acute care patients were carried out using personal protective equipment. In the future, the lessons from our experience could contribute toward drawing a plan of measures applicable in similar situations and some of these actions could become part of the rehabilitative practice.
Extending the Depth and Breadth of Physiatry Care
Authors: Brooks Forrest A. , Tolchin Dorothy W.
Published: January 2021

Hospice and palliative medicine is one of seven accredited fellowship subspecialties available to graduates of physical medicine and rehabilitation residency programs. Hospice and palliative medicine and physical medicine and rehabilitation share many of the same principles and practices, and physical medicine and rehabilitation residency training can be excellent preparation for hospice and palliative medicine fellowship. However, unlike the other six physical medicine and rehabilitation subspecialties, there is currently no requirement for hospice and palliative medicine training during physical medicine and rehabilitation residency. As a result, physical medicine and rehabilitation residents may encounter limited hospice and palliative medicine exposure or education, and lack explicit opportunities to develop the basic set of palliative care symptom management and communication tools that can be applied across the spectrum of physiatry care. Here, we provide five strategies that residents can use within their own programs to develop knowledge and experience in hospice and palliative medicine.
The Association of Overall Annual Hospital Volume and Perioperative Outcomes following Free Flap Breast Reconstruction
Authors: Shammas Ronnie L. , Ren Yi , Thomas Samantha M. , Phillips Brett T. , Hollenbeck Scott T. , Greenup Rachel A.
Published: January 2021

Background:

Hospital volume has been correlated with improved outcomes in oncologic care and complex surgical procedures. The authors sought to determine the relationship between overall annual hospital volume and perioperative outcomes following free flap breast reconstruction.

Methods:

Free flap breast reconstruction patients (n= 7991) were identified at 1907 centers using the Healthcare Cost and Utilization Project National Inpatient Sample database. Logistic regression characterized the association of hospital volume (total discharges per year) with systemic, surgical, and microsurgical complications. Patients were categorized as being treated at low- versus high-volume hospitals based on identified threshold volumes, and the association with the incidence of complications was estimated.

Results:

Initially, restricted cubic spline analysis suggested potential threshold volumes of 13,018 (95 percent CI, 7468 to 14,512) and 7091 (95 percent CI, 5396 to 9918) discharges per year, at which the risk for developing systemic and microsurgical complications may change, respectively. However, further patient-level evaluation of treatment at low- versus high-volume hospitals demonstrated that hospital volume did not predict the risk of developing perioperative systemic (OR, 1.28; 95 percent CI, 0.75 to 2.18;p= 0.36) or microsurgical complications (OR, 1.06; 95 percent CI, 0.78 to 1.44;p= 0.73).

Conclusions:

Perioperative complications after free flap breast reconstruction did not differ between patients treated at low- versus high-volume hospitals after in-depth multiprong analysis. Patient outcomes are more likely associated with surgeon and programmatic experience. Overall annual hospital volume should not serve as a proxy for high-quality breast free flap care. 

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
An Option for Shaft-Only Gender-Affirming Phalloplasty: Vaginal Preservation and Vulvoscrotoplasty. A Technical Description
Authors: Chen Wendy , Cylinder Isabel , Najafian Alireza , Dugi Daniel D. , Berli Jens U.
Published: January 2021

Genital masculinizing gender-affirming surgery is a growing field. Because of a spectrum of gender identity, gender expression, sexual expression, patient desires, and patient tolerance for complications, options for surgery vary accordingly. Shaft-only phalloplasty avoids urethral lengthening, but may still be accompanied by hysterectomy, vaginectomy, scrotoplasty, clitoroplasty (burying of the clitoris), glansplasty, and placement of erectile devices and testicular implants. Patients who desire retention of vaginal canal patency are candidates for vaginal preservation vulvoscrotoplasty; however, there is a paucity of literature describing the procedure and its outcomes. In this article, the authors review the technique used by the senior author at Oregon Health and Science University and report surgical outcomes for four patients. Future studies regarding patient-recorded outcome measures, aesthetics, sexual function, urologic function, patient satisfaction, and conversion to other options will help surgeons better understand patients pursuing gender-affirming surgery through shaft-only phalloplasty.
Laser-Assisted Rhinoplasty: The Future Generation Rhinoplasty Technique to Preserve Anatomy? A Series of Patients Compared to Patients Undergoing Standard Open Rhinoplasty
Authors: Bertossi Dario , Marchetti Alberto , Sbarbati Andrea , Nocini Pierfrancesco
Published: January 2021

Background:

Rhinoplasty is the cosmetic procedure that is most difficult to master. Anatomical preservation should represent the main goal of rhinoplasty. One emerging tool appears to be erbium:yttrium-aluminum-garnet laser bone and cartilage reshaping. The authors developed a new small laser hand probe to perform what we called laser-assisted rhinoplasty. The authors evaluate the feasibility of the laser-assisted rhinoplasty and the aesthetic and functional result of laser-assisted rhinoplasty compared to classic rhinoplasty.

Methods:

A total of 50 patients were enrolled and randomized into two cohorts: the first cohort of patients was submitted to classic rhinoplasty, and the second cohort to laser-assisted rhinoplasty. The laser beam was used to perform both the resection of the crura and the resection of the nasal hump and osteotomies.

Results:

Laser-assisted rhinoplasty is a safe and reproducible technique. At a clinical assessment, lateral crura reshaping showed a visible step or excessive skin retraction in 12 percent of the classic rhinoplasty population with thick cartilage and/or thin skin, and this was not present in the laser-assisted rhinoplasty population at 12-month follow-up. The patient satisfaction rate was higher in the laser-assisted rhinoplasty population compared with standard open rhinoplasty. The authors also clinically noted a reduction in edema in the immediate postoperative period in the laser-assisted rhinoplasty population and a more rapid complete resolution of the swelling.

Conclusion:

The laser-assisted rhinoplasty technique is feasible and safe and has no major complication, and the aesthetic and functional results can be superimposed onto classic rhinoplasty but with a higher degree of intraoperative precision, higher patient satisfaction, a cleaner field, and less bleeding.
Application of Spare Parts in Combination with Targeted Muscle Reinnervation Surgery
Authors: Valerio Ian L. , Larsen Michael , Eberlin Kyle R.
Published: January 2021

Targeted muscle reinnervation is a contemporary technique designed to enhance an amputee’s ability to operate a myoelectric prosthesis. This technique has been shown to decrease neuropathic pain, including neuroma and phantom limb pain. In certain amputations, especially forequarter and hindlimb levels, there may be no nearby recipient muscle sites, or the residual nerve may be too short to perform targeted muscle reinnervation. Applying the spare parts concept can help solve this problem by providing nerve autograft or additional muscle recipient sites within the spare parts flap for successful targeted muscle reinnervation surgery procedures. A retrospective review of all patients that underwent spare parts targeted muscle reinnervation reconstructions between 2016 and 2019 at two institutions was performed. Patients were assessed for healing, neuroma and phantom limb pain, and function. Twelve patients underwent targeted muscle reinnervation during spare parts reconstruction; eight were male and four were female. The mean patient age was 55.3 years (range, 16 to 72 years). For those with known soft-tissue deficit size, the surface area of the donor site spared by using spare parts reconstruction ranged from 216 to 856 cm2. None of the 12 patients subsequently experienced neuroma, and 75 percent had no phantom limb pain after 3 months. Three patients have obtained insurance-approved myoelectric prosthetics, and all three demonstrated intuitive control of targeted muscles. Using a spare parts reconstruction in conjunction with targeted muscle reinnervation may optimize reconstructive efforts in the setting of major limb amputations and aid in decreasing phantom limb and neuroma pain, and facilitate the possibility of functional prosthetic and/or myoelectric prosthesis use.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.