bluuebunny/crossref_metadata_2025 huggingface dataset:
Obstetric Outcomes in Pregnancies Complicated by Prior Renal Transplant or Chronic Kidney Disease [26N]
Authors: Morgan Jessica C. , DiGiovanni Laura M. , Della Torre Micaela
Published: April 2020

INTRODUCTION:

Compare antepartum admissions and outcomes in pregnancies complicated by renal transplant (RT) versus chronic kidney disease (CKD).

METHODS:

Retrospective cohort study at University of Illinois at Chicago from 2010 to 2019. Electronic medical record queried for women age 18 to 51 with pregnancy, RT or CKD. SPSS used for statistical analysis. IRB approval was obtained.

RESULTS:

577 charts reviewed, 57 pregnancies complicated by RT or CKD. Of 33 women with RT, 20 had live births, 11 miscarried, 2 had elective terminations. Of 24 women with CKD, 14 had live births, 6 miscarried, 2 had ectopic pregnancies, 2 had elective terminations. Average time from RT to pregnancy was 7.45 years. Subjects with CKD had higher rates of preterm delivery and hypertensive disorders of pregnancy. No difference in rate of cesarean delivery (CD) between groups. Gestational age (GA) at delivery lower in women with CKD than RT, 31 vs 34 weeks. Rate of antepartum admission not statistically significant between groups. Subjects with RT admitted for obstetric complications compared to women with CKD admitted for worsening medical problems. Pregnancies 1 to 3 years posttransplant had lower rates of preeclampsia and CD, and later GA at delivery (36.3 vs 34.4 weeks) compared to those greater than 3 years posttransplant.

CONCLUSION:

Women with RT are not admitted antepartum at a higher rate than women with CKD and overall had better obstetrical outcomes. An area of further study is the ideal time between transplant and pregnancy, as we found improved obstetric outcomes in women with pregnancy closer to RT.
How Much Is Too Much? Intrapartum Interventions in a Term Singleton US Birth Cohort [19N]
Authors: Nethery Elizabeth , Painter Ian , Sitcov Kristin , Souter Vivienne
Published: April 2020

INTRODUCTION:

Ideal rates of intrapartum interventions are unknown. Contemporary data from the US on the prevalence of these interventions is limited. The aim of this study was to evaluate rates of intervention in term singleton pregnancies.

METHODS:

This study uses a retrospective cohort of births at 17 hospitals in the Northwest US between 04/01/2017 and 03/31/2019. We report mode of delivery (cesarean with no labor/cesarean following labor/vaginal) and labor onset (spontaneous/induced). For spontaneous labors, we report rates of artificial rupture of the membranes (in those with intact membranes at admission), oxytocin augmentation, operative delivery, anesthesia (regional or general) and episiotomy. The proportion of pregnancies subject to none of these interventions was also evaluated.

RESULTS:

Of 47,770 singleton term pregnancies in this cohort, 8,485 (17.8%) had a cesarean without labor and 13,857 (29.0%) underwent induction of labor. Spontaneous labor occurred in 25,428 (53.2%) of all singleton term births. Interventions in spontaneous labor included: artificial rupture of the membranes in 63.9% (10,509/16,454) with intact membranes at admission, oxytocin augmentation in 9,227 (36.3%), cesarean birth in 2,594 (10.2%), operative vaginal birth in 1,250 (5.8%), anesthesia in 16,458 (64.7%) and episiotomy in 594 (2.3%). Only 4.6% (2,229) of all singleton term births followed spontaneous labor without any of the interventions evaluated.

CONCLUSION:

Intervention is common in this population and only 1 in 20 singleton term births occurred without any of the evaluated interventions. More research is needed into the effectiveness of obstetric interventions, particularly in spontaneous term labor.
Anticipation of Exclusive Formula Feeding Is a Risk Factor for Postpartum Depression [04O]
Authors: Smithson Sarah , Mirocha James , Horgan Rebecca , Graebe Robert , Massaro Robert , Accortt Eynav
Published: April 2020

INTRODUCTION:

Breastfeeding may have protective effects against postpartum depression (PPD), although there is debate amongst the literature. We aimed to determine if prenatal intent to exclusively formula feed was a risk factor for higher PPD risk.

METHODS:

This is a secondary analysis of delivery data from a cohort study conducted between 8/2015–1/2016. Women were asked to report their feeding intention upon admission (prior to delivery). Women were then screened in the hospital for PPD risk using the Edinburgh Postnatal Depression Scale (EPDS), approximately 1–4 days post-delivery. Women who planned to breastfeed (either exclusively or in combination with formula) were analyzed separately from those who intended to exclusively formula feed. Fisher exact test was used to compare rates of PPD risk between groups (EPDS score ≥10 indicating moderate risk for PPD).

RESULTS:

A total of 2083 women had complete data for analysis. A total of 128 (6%) intended to formula feed only. Of these women, 4.48% screened at risk for PPD. This is significantly higher than the 1.85% at-risk rate in the group of women who anticipated they would breastfeed after delivery (P=.049). Of note, this relationship did not remain significant in multivariate analysis (including age and BMI).

CONCLUSION:

Exclusive formula feeding intention may be one of several important risk factors for moderate PPD risk. Therefore, feeding intention warrants inclusion in future PPD studies. Future studies may also investigate the association of postpartum feeding decisions with later PPD risk (e.g. 2–6 weeks).
Fetal Head Rotation During Instrumented Delivery: What Risks Do We Face? [16N]
Authors: Davila Jose Luis , Ortiz Marco Antonio , de Lourdes Gomez Maria , Nieto Vizhñay Karina P. , Avila Leidy Gavaleth , Ruiloba Francisco J.
Published: April 2020

INTRODUCTION:

According to the degree of rotation of the cephalic pole, forceps are divided into exit forceps (rotation less than 45°), low (less than 45°) and medium (rotation up to 180°); Our objective was to determine the association between the degree of rotation required during instrumented delivery and the presence of severe perineal tears.

METHODS:

Retrospective Cohort study, patients in which an instrumental delivery was performed from January 2017 to June 2019 on a single center were included. Patients with incomplete clinical records were excluded. The degree of rotation was evaluated depending on the variety of position prior to placement. Descriptive statistics were performed, χ2 for qualitative variables and Student t for quantitative variables; to determine association, the odds ratio and 95% CI were obtained

RESULTS:

131 instrumented deliveries were included; in 100, rotations less than 45° were performed and in 31, rotations equal to or greater than 45° were performed. Severe perineal tears showed no significant difference, however association with lesions of the vaginal wall OR 2.19 (1.31–3.69 95% CI) were observed, with no difference in the amount of bleeding, atony or the presence of obstetric hemorrhage. Of the fetal outcomes, no difference was significant.

CONCLUSION:

The use of forceps with rotations greater than 45° was not associated with the presence of severe perineal tears only associated with vaginal wall tears, so the decision to perform an instrumented delivery should be conditioned by the development of the work of delivery and not for the degree of rotation that is required.
Characteristics and Outcomes Among Pregnant Women With ESRD on Hemodialysis: A Population-Based Study [05N]
Authors: Lavie Anat , Czuzoj-Shulman Nicholas , Spence Andrea , Abenhaim Haim Arie
Published: April 2020

INTRODUCTION:

Dialysis patients historically have had poor pregnancy outcomes, but these have improved over the years with better delivery of dialysis care. The purpose of our study is to describe baseline characteristics and pregnancy outcomes among women with end stage renal disease (ESRD) on hemodialysis (HD).

METHODS:

We carried out a cohort study on all births using the United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database between 2005 and 2015. Descriptive statistics were used to measure baseline characteristics and maternal and neonatal outcomes of women with ESRD under HD treatment. We created a composite measure of vascular mediated adverse pregnancy outcomes which included intrauterine growth restriction (IUGR), preeclampsia and intrauterine fetal death (IUFD). Then, using this composite measure, multivariate logistic regression analyses were used to identify risk factors for the development of vascular mediated adverse outcomes of pregnancy among women with ESRD who were on HD.

RESULTS:

We identified 307 birth records to women with a ESRD on HD among 8,765,973 births. There was an increase in the number of patients with ESRD on HR over the 10-year study period. None of the baseline characteristics were found to be significantly correlated to the occurrence of the composite outcome.

CONCLUSION:

The incidence of pregnant women with ESRD on HD in the US is rising, with adverse pregnancy complications for both the mother and fetus. Since no specific predictors for the adverse outcomes were found, this entire group of patients should be considered at high risk, strengthening the need for an early multidisciplinary team management.
Life, Interrupted
Authors: Kennedy Maureen Shawn
Published: April 2020

The effects of COVID-19 are still unfolding.
The Cult of the Colossus: A Dramatic Rise in Hospital Mergers and Acquisitions
Authors: Sofer Dalia
Published: April 2020

Patients, health care providers, and communities are all affected.
First Targeted Therapy for Rare Form of GI Stromal Tumors
Authors: Aschenbrenner Diane S.
Published: April 2020

The targeted chemotherapy avapritinib (Ayvakit) has been approved to treat a rare form of gastrointestinal stromal tumor that hasn't been responsive to previous drug therapies.
A Case of Bradycardia and Extreme Fatigue
Authors: Kupchik Nicole , Green Joel
Published: April 2020

Editor's note: This is the first in a new series on electrocardiography (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Margretta Madden Styles
Authors: Blakeney Barbara A.
Published: April 2020

EDITOR'S NOTE

In recognition of the Year of the Nurse and the Midwife initiative, AJN will periodically highlight the works of key nursing leaders. Sometimes it will be in the form of articles from our archives, at other times it will be excerpts from or summaries of nurses' work with related commentary. Here, courtesy of Margretta Madden Styles's daughter, we've reprinted Styles's “Declaration of Belief About the Nature and Purpose of Nursing,” originally published in her book, On Nursing: Toward a New Endowment (C.V. Mosby Company, 1982). We hope it will inspire you.
A Pancreatic Enzyme Medication Self-Management Initiative
Authors: Gallagher-Ford Lynn , Tucker Sharon J. , Gettis Margaret , Dye Betsy Anne
Published: April 2020

This is the seventh article in a new series about evidence-based practice (EBP) that builds on AJN's award-winning previous series—Evidence-Based Practice, Step by Step—published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series features exemplars illustrating the various strategies that can be used to implement EBP changes—one of the most challenging steps in the EBP process.
Ureteroscopy for Urinary Calculi with or Without Ureteral Stents
Authors: Kane Terri D.
Published: April 2020

Editor's note: The mission of Cochrane Nursing is to provide an international evidence base for nurses involved in delivering, leading, or researching nursing care. Cochrane Corner provides summaries of recent systematic reviews from the Cochrane Library. For more information, see https://nursing.cochrane.org.
Further Treatment, or Hospice? Three Deaths Compared
Authors: Bonazzoli Laura
Published: April 2020

Hope is a double-edged sword when it comes to end-of-life choices.
Primary care of children with autism spectrum disorders
Authors: Kilmer Michele
Published: April 2020

This series of articles aims to equip primary care providers (PCPs) with the tools to become healthcare leaders managing patients with pediatric autism spectrum disorder (ASD). Individuals with ASD can experience optimal health outcomes when timely, evidence-based interventions are implemented in the primary care setting. PCPs are uniquely situated to institute changes that redirect the trajectory of ASD.
Infertility management in primary care
Authors: Thable Angela , Duff Elsie , Dika Cheryl
Published: April 2020

Infertility is a growing issue for couples. Primary care NPs can manage initial treatment as well as address the emotional and financial burdens of patients experiencing infertility. NPs can provide timely access to investigations and treatment, helping patients achieve their goal of pregnancy sooner.
Understanding acute upper gastrointestinal bleeding in adults
Authors: Pezzotti William
Published: April 2020

Acute upper gastrointestinal bleeding (UGIB) is common in both acute care and primary care settings. It can range from self-limited bleeding to life-threatening hemorrhagic emergencies. This article discusses the assessment and management of adults with acute UGIB, including pharmacologic and nursing interventions.
New Drugs 2020, part 2
Authors: Hussar Daniel A.
Published: April 2020

This article reviews seven drugs recently approved by the FDA, including indications, precautions, adverse reactions, and nursing considerations.
Preparing nurses for fieldwork in tropical nursing
Authors: Schmid Alexis , Wood Frances
Published: April 2020

Due to factors related to increasing globalization, geopolitical conflicts, and climate change, tropical nursing is increasingly important. This article offers an overview of the Diploma in Tropical Nursing program and explores the challenges facing nurses who serve patients in tropical settings with limited resources.
Dilution is no solution
Authors: Deutsch Lynn
Published: April 2020

Some nurses continue to routinely dilute I.V. push medications, a practice associated with a high risk of errors. This article reviews correct practices for administering I.V. push medications.
Nursing attitudes and practices for routine I.V. catheter resiting
Authors: Evers Frances , Morelock Skip , Walsh Judith , Khoja Sharifa
Published: April 2020

Purpose:

To understand nursing perceptions of hospital requirements for routine resiting of short peripheral catheters (SPCs).

Methods:

This exploratory research project at the authors' medium-sized regional referral and trauma center utilized an online survey to assess the perceived efficacy and patient disruption related to SPC resiting among acute care nurses.

Results:

Out of 203 eligible nurses, 81 participated. The survey results support the perception that SPC insertions and resiting can be time-consuming and disruptive to the flow of care. The strongest correlation occurred between patients who had requested no SPC resiting and the reported disruption from SPC resiting.

Conclusion:

Based on the survey results, a formal recommendation was made within the hospital system to amend the existing policy and remove the requirement for SPC resiting after 96 hours in favor of the nurses' best clinical judgment.
Rapid Deployment of a Drive-Through Prenatal Care Model in Response to the Coronavirus Disease 2019 (COVID-19) Pandemic
Authors: Turrentine Mark , Ramirez Mildred , Monga Manju , Gandhi Manisha , Swaim Laurie , Tyer-Viola Lynda , Birsinger Michele , Belfort Michael
Published: April 2020

Coronavirus disease 2019 (COVID-19) has been declared a public health emergency for the entire United States. Providing access to prenatal health care while limiting exposure of both obstetric health care professionals and patients to COVID-19 is challenging. Although reductions in the frequency of prenatal visits and implementation of telehealth interventions provide some options, there still remains a need for patient–health care professional visits. A drive-through prenatal care model was developed in which pregnant women would remain in their automobiles while being assessed by the health care professional, thus reducing potential patient, health care professional, and staff exposure to COVID-19. Drive-through prenatal visits would include key elements that some institutions cannot perform by telehealth encounters, such as blood pressure measurements for evaluation for hypertensive disorders of pregnancy, fetal heart rate assessment, and selected ultrasound-based measurements or observations, as well as face-to-face patient–health care professional interaction, thereby reducing patient anxiety resulting from the reduction in the number of planned clinic visits with an obstetric health care professional as well as fear of virus exposure in the clinic setting. We describe the rapid development of a drive-through prenatal care model that is projected to reduce the number of in-person clinic visits by 33% per patient compared with the traditional prenatal care paradigm, using equipment and supplies that most obstetric clinics in the United States can access.
Effect of Wound Closure Technique in Proximal Femoral Fractures: A Prospective Cohort Study
Authors: Badres Inas Azzah , Suen Kary , Tran Phong
Published: April 2020

Objectives:

To compare the effect of different wound closure techniques on wound drainage, postoperative length of stay, and complications in patients with proximal femoral fractures, including femoral neck fractures (31A fractures) and peritrochanteric fractures (31B fractures).

Design:

Prospective cohort study.

Setting:

Footscray Hospital, Western Health, Victoria, Australia; an acute teaching hospital.

Patients and Participants:

All inpatients receiving surgery for proximal femoral fractures at our facility between May 2016 and August 2017. A total of 486 consecutive patients who presented during the study period were included in the study.

Intervention:

Three cohorts of consecutive patients were assigned to use either skin staples, monofilament absorbable subcuticular sutures (Monocryl), or, sutures with the addition of 2-octylcyanoacrylate (OCA) (Monocryl and Dermabond), respectively, for skin closure according to when the patients entered the study.

Main Outcome Measurements:

The primary outcome of interest was prolonged wound drainage measured using a standardized technique after postoperative day 3. Secondary outcomes included inpatient length of stay and overall complications.

Results:

We found a statistically significant increase in prolonged wound drainage in the staples cohort compared with the subcuticular sutures cohort and the sutures and OCA cohort (21.1% vs. 8.5% vs. 4.4%, P < 0.001). Inpatient length of stay was also significantly increased in the staples cohort (5.83 days vs. 4.78 days vs. 5.5 days, P = 0.005). There were no statistically significant differences between the 3 cohorts when comparing incidence of any medical complications, withholding of thromboprophylactic agents, or usage of topical negative pressure dressings.

Conclusions:

In patients with proximal femoral fractures, closure with staples has the highest rate of prolonged wound drainage and length of stay. Subcuticular sutures in combination with OCA result in the lowest incidence of prolonged wound drainage.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Predicting Length of Stay and Readmissions After an Ankle Fracture Using a Risk Stratification Tool (STTGMA)
Authors: Simske Natasha M. , Benedick Alex , Kavanagh Michael D. , Vallier Heather A.
Published: April 2020

Objectives:

To determine the usefulness of a validated trauma triage score to stratify short-term outcomes including hospital length of stay (LOS), in-hospital complications, discharge location, and rate of readmission after an ankle fracture.

Design:

Retrospective cohort.

Setting:

Level 1 trauma center.

Patients:

Four hundred fifteen patients, age ≥55 with 431 ankle fractures.

Intervention:

Closed or open reduction.

Main Outcome Measurements:

Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA).

Results:

Of the 415 patients, 38% were male, 72% were white, and the mean age was 66 years. The mean LOS was 4.4 days, and this increased from 2.6 days in the minimal-risk group to 11.8 days in the high-risk group (P < 0.001). Similarly, 74% of minimal-risk patients were discharged home versus 13% of high-risk patients (P < 0.001). There were 19 readmissions (4.6%) within 30 days, ranging from 1.5% to 10% depending on the risk cohort (P = 0.006). Seventy-three patients (18%) experienced an in-hospital complication. On multiple linear regression, moderate- and high-risk STTGMA stratification was predictive of a longer hospital LOS, and moderate-risk STTGMA stratification was predictive of subsequent readmission after injury.

Conclusions:

Calculation of the STTGMA score is helpful for stratifying patients according to hospital LOS and readmission rates, which have substantial bearing on resource utilization and cost of care. The STTGMA tool may allow for effective identification of patients to potentially ameliorate these common issues and to inform payers and policymakers regarding patients at risk for greater costs of care.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Motorized Intramedullary Lengthening Nails: Outcomes and Complications
Authors: Fragomen Austin T.
Published: April 2020

The outcomes of motorized intramedullary lengthening nails are overwhelmingly good with acceptable complication rates and high surgeon satisfaction. While patients report overwhelming approval to surgeons, universal orthopedic outcomes scores fail to capture the true benefits of these procedures. Many studies have been cited in table format in this report. Pearls from experienced surgeons are reviewed and include the benefits of antegrade nailing over retrograde, prophylactic soft tissue release, and blocking screw use. Pitfalls are explored to keep the reader vigilant for mechanical failure of the nail, delayed healing, and common tibial difficulties. Through compiling data, estimates of collective complication incidence are presented.
Birth weight and perfluorooctane sulfonic acid: a random-effects meta-regression analysis
Authors: Dzierlenga Michael W. , Crawford Lori , Longnecker Matthew P.
Published: April 2020

Background:

Perfluorooctane sulfonic acid (PFOS) is a ubiquitous environmental contaminant. Most people in developed countries have detectable serum concentrations. Lower birth weight has been associated with serum PFOS in studies world-wide, many of which have been published only recently.

Methods:

To facilitate a causal assessment of the birth weight and PFOS association, we updated previous meta-analyses of the association and employed a method that facilitated inclusion of all available data in one analysis. Our analysis was based on observations from 29 studies.

Results:

The random effects summary was −3.22 g/ng/ml (95% confidence interval [CI] = −5.11, −1.33). In a subgroup analysis stratified by when in pregnancy the PFOS concentration was measured, the summary for the early group was −1.35 (95% CI = −2.33, −0.37) and for the later group was −7.17 (95% CI = −10.93, −3.41). In a meta-regression model including a term for timing of blood draw, the intercept was slightly positive but essentially zero (0.59 g/ng/ml, 95% CI = −1.94, 3.11). In other words, the model indicated that when blood was drawn at the very beginning of pregnancy, there was essentially no relation of birth weight to PFOS. The results from the subgroup analyses differed from those from the model because the average gestational age at blood draw in the early group was 14 weeks, when bias would still be expected. A stronger inverse association in Asian studies was not completely explained by their blood draws being from later in pregnancy.

Conclusions:

The evidence was weakly or not supportive of a causal association.
Estimating the number of excess deaths attributable to heat in 297 United States counties
Authors: Weinberger Kate R. , Harris Daniel , Spangler Keith R. , Zanobetti Antonella , Wellenius Gregory A.
Published: April 2020

Background:

There is a well-established relationship between high ambient temperature and risk of death. However, the number of deaths attributable to heat each year in the United States remains incompletely quantified.

Methods:

We replicated the approach from a large, international study to estimate temperature-mortality associations in 297 United States counties and additionally calculated the number of deaths attributable to heat, a quantity of likely interest to policymakers and the public.

Results:

Across 297 counties representing 61.9% of the United States population in 2000, we estimate that an average of 5,608 (95% empirical confidence interval = 4,748, 6,291) deaths were attributable to heat annually, 1997–2006.

Conclusions:

Our results suggest that the number of deaths related to heat in the United States is substantially larger than previously reported.
Robotically Assisted Omentum Flap Harvest: A Novel, Minimally Invasive Approach for Vascularized Lymph Node Transfer
Authors: Frey Jordan D. , Yu Jason W. , Cohen Steven M. , Zhao Lee C. , Choi Mihye , Levine Jamie P.
Published: April 2020

Background:

The omentum provides abundant lymphatic tissue with reliable vascular anatomy, representing an ideal donor for vascularized lymph node transfer without risk for donor site lymphedema. We describe a novel, robotically assisted approach for omental flap harvest.

Methods:

All patients undergoing robotically assisted omentum harvest for vascularized lymph node transfer from 2017 to 2019 were identified. Patient demographics, intraoperative variables, and postoperative outcomes were reviewed.

Results:

Five patients underwent robotically assisted omentum flap harvest for vascularized lymph node transfer. The average patient age and body mass index were 51.2 years and 29.80 kg/m2, respectively. Indications for lymph node transfer were upper extremity lymphedema following mastectomy, radiation, and lymphadenectomy (60.0%); congenital unilateral lower extremity lymphedema (20.0%); and bilateral lower extremity/scrotal lymphedema following partial penectomy and bilateral inguinal/pelvic lymphadenectomy (20.0%). Four patients (80.0%) underwent standard robotic harvest, whereas 1 patient underwent single-port robotic harvest. The average number of port sites was 4.4. All patients underwent omentum flap transfer to 2 sites; in 2 cases, the flap was conjoined, and in 3 cases, the flap was segmented. The average overall operative time was 9:19. The average inpatient hospitalization was 5.2 days. Two patients experienced cellulitis, which is resolved with oral antibiotics. There were no major complications. All patients reported subjective improvement in swelling and softness of the affected extremity. The average follow-up was 8.8 months.

Conclusions:

Robotically assisted omental harvest for vascularized lymph node transfer is a novel, safe, and viable minimally invasive approach offering improved intra-abdominal visibility and maneuverability for flap dissection.
Trends and Perceptions of Electronic Health Record Usage among Plastic Surgeons
Authors: Seu Michelle , Cho Brian H. , Pigott Rachel , Sarmiento Samuel , Pedreira Rachel , Bhat Deepa , Sacks Justin
Published: April 2020

Background:

Electronic health records (EHRs) should help physicians stay organized, improve patient safety, and facilitate communication with both patients and fellow healthcare providers. However, few studies have directly evaluated physician satisfaction with EHR and its perceived impact on patient care. This study assessed trends and perceptions of EHR within the American plastic surgery community.

Methods:

An Institutional Review Board–approved survey that assessed demographics, patterns of EHR use, and attitudes toward EHR was deployed by the American Society of Plastic Surgeons Member Survey Research Services. Statistical analyses were performed using Stata 14.2 and QDA Miner Lite software (Version 2.0; Provalis, Montreal, Canada). Significance level was P < 0.05.

Results:

Among plastic surgeons who use EHR, EPIC Systems software (Epic, Verona, Wisc.) was the most common vendor, with users noting a net positive effect on the quality of care they provided to patients. Younger age and less years of experience were correlated with a more positive attitude toward EHR. Positive attitude was closely linked to shared responsibility among support staff over data entry, whereas negative attitude was tightly tied to the perceived time wasted because of EHR, followed by poor technical support and design.

Conclusions:

EHR use among plastic surgeons was more common in academic-associated specialties and larger practice groups. Overall, age and practice type had weak associations with perceptions of EHR usage. On average, there were slightly more positive perceptions of EHR usage than negative. The most commonly perceived issues with EHR were wasted time and barriers to user-friendliness. These findings suggest the need for greater physician involvement in EHR optimization.
Achieving a Good Aesthetic Result in the Correction of Giant Nevus of the Labiomental Area
Authors: Safronov Vladimir , Guryanov Robert , Lomaya Marina
Published: April 2020

Summary: Benign skin lesions of the face require appropriate surgical treatment. Giant pigmented skin lesions possess the high risk of malignancy which sometimes is not possible to diagnose preoperatively. Majority of the traditional techniques for lower lip and chin reconstruction were developed for the skin cancer resections and are extensively aggressive and disfiguring in case of benign lesions. Perhaps the less invasive approach based on local skin flaps would lead to better aesthetic and functional outcome. We present a case report of the 67-year-old patient who has passed through numerous unsuccessful attempts of correction of the giant nevus of the chin and lower lip area with continued growth. At the time of our surgery, lesion almost covered the whole chin and lower lip area. Appropriate unaffected skin margins excision was performed, and the defect was addressed with combination of traditional incision patterns with local skin flap technique. We believe that our approach provides a good aesthetic and functional outcome in benign lesions correction of the labiomental area.
Pelvic/Perineal Reconstruction: Time to Consider the Anterolateral Thigh Flap as a First-line Option?
Authors: Perrault David , Kin Cindy , Wan Derrick C. , Kirilcuk Natalie , Shelton Andrew , Momeni Arash
Published: April 2020

Background:

Abdominoperineal resection (APR) and pelvic exenteration continue to be common procedures for the treatment of colorectal malignancy. The workhorse flap for reconstruction in these instances has been the vertical rectus abdominis myocutaneous flap. The associated donor site morbidity, however, cannot be ignored. Here, we provide a review of the literature and present the senior author’s (A.M.) experience using the pedicled anterolateral thigh (ALT) flap for reconstruction of soft tissue defects following APR and pelvic exenteration.

Methods:

Patients who underwent pelvic/perineal reconstruction with pedicled ALT flaps between 2017 and 2019 were included in the study. Parameters of interest included age, gender, body mass index, comorbidities, history of radiation, extent of ablative surgery, and postoperative complication rate.

Results:

A total of 23 patients (16 men and 7 women) with a median age and body mass index of 66 years (inter-quartile range [IQR]: 49–71 years) and 24.9 kg/m2 (IQR: 24.2–26.7 kg/m2) were included in the study, respectively. Thirteen (56.5%) patients presented with rectal cancer, 5 (21.7%) with anal squamous cell carcinoma (SCC), 4 (17.4%) with Crohn’s disease, and 1 (4.3%) with Paget’s disease. Nineteen patients (82.6%) received neoadjuvant radiation. Nine (39.1%) patients experienced 11 complications (2 major and 9 minor). The most common complication was partial perineal wound dehiscence (N = 6 [26.1%]). Stable soft tissue coverage was achieved in all but one patient.

Conclusions:

The ALT flap allows for stable soft tissue coverage following APR and pelvic exenteration without being associated with abdominal donor site morbidity. Consideration to its use as a first-line reconstructive option should be given in pelvic/perineal reconstruction.
Mitigation of Postsurgical Scars Using Lasers: A Review
Authors: Artzi Ofir , Friedman Or , Al-niaimi Firas , Wolf Yoram , Mehrabi Joseph N.
Published: April 2020

Background:

Most postsurgical scars are considered esthetically and functionally acceptable. Currently, there is no definite consensus treatment for postsurgical scarring. The purpose of this review is to shed some light on the value of scar mitigation and the efficacy of different lasers employed on postsurgical wounds.

Methods:

A systematic literature review and computational analysis were conducted to identify relevant clinical articles that pertained to the use of lasers for mitigating postsurgical scars. Articles included the National Institutes of Health–National Center for Biotechnology Information–PubMed search and sources cited from relevant studies after 1995. Trials that attributed pre- and posttreatment scores of scar severity based on a verified scar evaluation scale (eg, Patient and Observer Scar Assessment Scale, Vancouver Scar Scale, Global Assessment Scale) were chosen. Clinical assessments varied for each study. To adequately assess the efficacy of the modalities, the final scaled scar appearance scores were realigned and normalized to a standard scale for unbiased comparison.

Results:

After filtering through a total of 124 studies, 14 relevant studies were isolated and thus included in the review. Studied lasers were as follows: Pulsed dye laser (PDL), carbon dioxide, diode, potassium titanyl phosphate (KTP), and erbium glass (Er-Glass) lasers.

Conclusion:

Treatment with lasers in the postsurgical wound healing phase is safe, effective, and advised in mitigation of pathologic scar formation.
Liposuction—Gadgets and Widgets: Save Your Money
Authors: Taha Ahmed A. , Tahseen Hossam , Kadry Hamed
Published: April 2020

Summary: In the past few decades, numerous adjunctives and devices have been introduced to body contouring surgeries, especially liposuction. Most of these devices require special maintenance and accessories for their proper functionality, which might be expensive in many parts of the world or for young surgeons starting their own practice. In this article, we suggest some tools that could be used during liposuction to save money, minimize complications rates, and enhance the results without endangering the patient's overall safety.
A Modification of the Webster-Bernard Lip Reconstruction
Authors: D. L. Brougham Nicholas , Adams Brandon M.
Published: April 2020

We report a modification of the Bernard-Webster lip reconstruction technique which uses the Burrows triangles as V-Y advancement flaps rather than excising them. A 44-year-old white, nonsmoking man presented with a 2-cm cutaneous squamous cell carcinoma of the right lower lip. Oncological resection required excision of 40% of the lower lip to the modiolus. A modified Bernard-Webster flap was used to reconstruct the full length of the lip with minimal donor morbidity.
The Role of Resident-Run Clinics for Aesthetic Surgery Training in the Context of Competency-based Plastic Surgery Education
Authors: Al-halabi Becher , Hazan Jessica , Safran Tyler , Gilardino Mirko S.
Published: April 2020

Resident-run clinics (RRCs) have been suggested as a clinical teaching tool to improve resident exposure in aesthetic plastic surgery education. In exchange for reduced cost aesthetic services, RRCs offer trainees the opportunity to assess, plan, execute, and follow surgical procedures in an independent yet supervised manner. With the transition into a competency-based medical education model involving a switch away from a time-based into a milestones-based model, the role of RRCs, within the context of the evolving plastic surgery curriculum has yet to be determined. To that end, the present study summarizes current models of aesthetic surgery training and assesses RRCs as an adjunct to aesthetics education within the framework of competency-based medical education. Explored themes include advantages and issues of RRCs including surgical autonomy, feasibility, exposure, learners’ perception, ethics, and quality improvement. In addition, attention is focused on their role in cognitive competency acquisition and exposure to non-surgical techniques. RRCs are considered an effective educational model that provides an autonomous learning platform with reasonable patient satisfaction and safety profiles.
Targeted Muscle Reinnervation following Breast Surgery: A Novel Technique
Authors: O’Brien Andrew L. , Kraft Casey T. , Valerio Ian L. , Rendon Juan L. , Spitz Jamie A. , Skoracki Roman J.
Published: April 2020

Summary: Post-mastectomy pain syndrome is a prevalent chronic pain condition that affects numerous patients following breast surgery. The mechanism of this pain has been proposed to be neurogenic in nature. As such, we propose a novel surgical method for the prophylactic management of postsurgical breast pain: targeted muscle reinnervation of the breast. This article serves to review the relevant current literature of post-mastectomy pain syndrome and targeted muscle reinnervation, describe our current surgical technique for this operation, and present an initial cohort of patients to undergo this procedure.
Use of Decision Analysis and Economic Evaluation in Breast Reconstruction: A Systematic Review
Authors: Bouhadana Gabriel , Safran Tyler , Al-Halabi Becher , Davison Peter G.
Published: April 2020

Background:

Decision analysis allows clinicians to compare different strategies in the context of uncertainty, through explicit and quantitative measures such as quality of life outcomes and costing data. This is especially important in breast reconstruction, where multiple strategies can be offered to patients. This systematic review aims to appraise and review the different decision analytic models used in breast reconstruction.

Methods:

A search of English articles in PubMed, Ovid, and Embase databases was performed. All articles regardless of date of publishing were considered. Two reviewers independently assessed each article, based on strict inclusion criteria.

Results:

Out of 442 articles identified, 27 fit within the inclusion criteria. These were then grouped according to aspects of breast reconstruction, with implant-based reconstruction (n = 13) being the most commonly reported. Decision analysis (n = 19) and/or economic analyses (n = 27) were employed to discuss reconstructive options. The most common outcome was cost (n = 27). The decision analysis models compared and contrasted surgical strategies, management options, and novel adjuncts.

Conclusions:

Decision analysis in breast reconstruction is growing exponentially.The most common model used was a simple decision tree. Models published were of high quality but could be improved with a more in-depth sensitivity analysis. It is essential for surgeons to familiarize themselves with the concept of decision analysis to better tackle complicated decisions, due to its intrinsic advantage of being able to weigh risks and benefits of multiple strategies while using probabilistic models.
Importance of Lifestyle Modification on Cardiovascular Risk Reduction
Authors: Franklin Barry A. , Myers Jonathan , Kokkinos Peter
Published: April 2020

This commentary builds on the unhealthy lifestyle habits, population health, risk factors as harbingers of cardiovascular disease, current provider counseling practices, assessing patient readiness to change, and research-based interventions to facilitate behavior change (eg, the 5A's, motivational interviewing, and overcoming inertia with downscaled goals).
Body Composition Changes During Traditional Versus Intensive Cardiac Rehabilitation in Coronary Artery Disease
Authors: Mirman Alex M. , Nardoni Nolan R. , Chen Alessandra Y. , Horwich Tamara B.
Published: April 2020

Purpose:

Intensive cardiac rehabilitation (CR) was recently approved by Medicare and includes more hours and more focus on nutrition, stress management, and group support than a traditional, exercise-focused CR. The purpose of this study was to compare changes in body composition and cardiovascular (CV) risk factors after intensive versus traditional CR programs in patients with coronary artery disease (CAD).

Methods:

We studied 715 patients with CAD who completed a traditional versus intensive CR program at UCLA Medical Center between 2014 and 2018. Markers of CV health, including body composition using bioelectrical impedance analysis, were assessed pre- and post-program participation.

Results:

In both types of CR programs, body mass index, body fat percentage, blood pressure, and cholesterol levels (total cholesterol and low-density lipoprotein cholesterol) were significantly lower post- compared with pre-program. Exercise capacity was increased in both groups. Intensive CR patients had greater reductions in body mass index, body fat percentage, visceral adipose tissue, and diastolic blood pressure. Traditional CR patients demonstrated greater increases in high-density lipoprotein cholesterol and estimated lean mass.

Conclusions:

In patients with CAD, both traditional and intensive CR programs led to improvements in CV risk factors, though the magnitude of the effects of the program differed between the programs. Further studies, including studies analyzing CV outcomes, are needed to help determine optimal CR program choice for CAD patients based on their risk factor and body composition profile.
Peak Oxygen Uptake Recovery Delay After Maximal Exercise in Patients With Heart Failure
Authors: Kadariya Dinesh , Canada Justin M. , Del Buono Marco Giuseppe , van Wezenbeek Jessie , Tchoukina Inna , Arena Ross , Van Tassell Benjamin , Abbate Antonio
Published: April 2020

Purpose:

Peak oxygen uptake recovery delay (V˙o2peakRD), measured as the time until post-exercise oxygen uptake (V˙o2) decreases below V˙o2peak following maximal cardiopulmonary exercise testing (CPX), has been recognized as an abnormal response, associated with reduced cardiac output reserve during exercise in patients with heart failure (HF). In the current study we examined the association of V˙o2peakRD during routine CPX testing of patients with symptomatic HF across a wide range of left ventricular ejection fraction (LVEF) values with clinical biomarkers.

Methods:

In this retrospective study, 80 clinically stable symptomatic HF patients across a wide range of LVEF at our institution were evaluated that put forth a minimally acceptable effort during CPX testing (respiratory exchange ratio ≥ 1.00). The V˙o2peakRD was measured in 10-sec intervals following maximal CPX testing. Markers of elevated cardiac filling pressures (N-terminal pro-brain natriuretic peptide [NTproBNP] and echocardio-Doppler E/e') and other key CPX parameters were explored for their association with V˙o2peakRD.

Results:

The mean V˙o2peakRD and V˙o2peak were 10 (interquartile range 10, 40) sec and 13.9 (11.6, 16.4) mL· kg−1 · min−1, respectively. V˙o2peakRD demonstrated a positive linear trend with serum NTproBNP levels and E/e' (T
JT = 1239.500, z = 2.634, P < .01; T
JT = 1081.000, z = 2.046, P = .04, respectively).

Conclusion:

Prolonged V˙o2peakRD following exercise is associated with markers of greater disease severity in patients with HF.
Design and Characterization of an Extremely-Sensitive, Large-Volume Gamma-Ray Spectrometer for Environmental Samples
Authors: Seekamp James M. , Noey Jordan D. , Kwapis Emily H. , Chung Long Kiu , Shubayr Nasser A. , Smith Travis , Trimas David J. , Kearfott Kimberlee J.
Published: April 2020

A large volume gamma spectrometer was designed and constructed to analyze foodstuffs and environmental samples having low radionuclide concentrations. This system uses eight 11-cm × 42.5-cm × 5.5-cm NaI(Tl) detectors, chosen due to their relatively high sensitivity and availability and arranged in an octagonal configuration. The sensitive volume of the system is ~28 cm in diameter and ~42 cm deep. Shielding consists of an 86-cm × 86-cm square, 64-cm-tall lead brick enclosure with 18-cm-thick lead walls lined by 0.3-cm-thick copper plates. An aluminum top was machined to suspend the detectors within this shield. The shielding reduces background counts by 72% at 100 keV and 42% at 1,000 keV. The positional variability in sensitivity of the well was determined by both simulation and experiment. A 2.1-L volume of nearly uniform sensitivity, varying less than 10%, exists in the well's center. Energy resolutions of 14.6% and 7.8% were measured for 241Am and 137Cs, respectively. Energy resolution shows a 0.2% variation for both 241Am and 137Cs as a function of position within all regions of the well’s central sensitive volume. Dead time was also determined to be less than 35% for all sources measured in the system, the largest of which had an activity of 1,760 kBq. Simulated results for various source geometries show higher counts for smaller samples, especially at lower energies due to less attenuation of low energy photons. Minimum detectable activities were determined for all source energies used, less than 5.1 Bq kg−1 for reasonable background and sample counting times.
The Efficacy of the After-visit Summary in Medication Recall Among Glaucoma Patients
Authors: Hirabayashi Kyle J. , Pomerantz Madison , Radell Jake E. , Chadha Nisha , Thomas Stephanie , Serle Janet B.
Published: April 2020

Précis:

To assess the after-visit summary (AVS) as a tool for glaucoma medication recall. Medication recall was associated with level of education and complexity of medication regimen. Receiving an AVS was not associated with better medication recall.

Purpose:

The purpose of this study was to determine whether patients given the AVS have better or worse glaucoma medication recall.

Materials and Methods:

Observational clinical study. Adults on ≥1 glaucoma medications examined between June 30, 2017 and August 2, 2017. Data collection: in-person questionnaire and retrospective chart review. Self-reported glaucoma medications compared with prescribed glaucoma medication regimen verified by electronic medical record. Medication recall assessed using 3-point scoring: 1 point each for; (1) name or color of bottle or cap; (2) treatment eye(s); and (3) dosing regimen. Data analysis: 2-sample Welch t test, 2-proportion z-test, analysis of variance, univariate, and multivariate regression.

Results:

A total of 118 patients enrolled: age 69.7±12.9 years (mean±SD), 55.9% of patients had received an AVS at the previous visit. Of these, 33.3% reported receiving an AVS, 51.2% reported not receiving one (15.1% did not recall or respond). Patients who had received AVSs had lower medication recall scores than those who did not (2.4±1.0 vs. 2.7±0.6, P=0.04). Receipt of an AVS was associated with having Nisha Chadha as their provider (P=0.01), fewer days since prior visit (P=0.0001), and medication regimen change at prior visit (P<0.0001). Multivariate analysis revealed completion of associate’s degree or higher and fewer prescribed medications to be independent predictors of higher recall score (P=0.0002 and 0.002).

Conclusions:

AVSs were conceived to enhance patient care. This study indicates this goal is not achieved consistently. Less education and more complex medication regimens were identified as barriers to medication recall. Additional investigations should explore if modifying this document and enhanced explanation of its use will impact medication recall and health outcomes.