bluuebunny/crossref_metadata_2025 huggingface dataset:
Errors in Breast Imaging: How to Reduce Errors and Promote a Safety Environment
Authors: Sivarajah Rebecca , Dinh Mary L , Chetlen Alison
Published: January 2021

Medical errors have a significant impact on patient care, worker safety, and health care finances. Breast imaging has the most common cause of organ-related misdiagnosis subject to malpractice suits. In order to effectively develop strategies to prevent errors, breast imaging radiologists must first understand the underlying causes of the errors that occur in the breast imaging setting. Errors in breast imaging can be related to errors in interpretation, improper workup of imaging findings, procedural errors, or errors in communication to the patient or other medical staff. The Yorkshire contributory factors framework was developed to identify factors that contribute to the errors in a hospital setting and can be adapted for use in the breast imaging setting. Within this framework, active failures refer to errors that directly affect the patient. Active errors include slips (including biases), lapses, and mistakes. The framework describes how active errors often result from factors that occur uphill from these active errors at different levels within the system. Once error causes are understood, there are concrete strategies and tools that breast imaging radiologists can implement to decrease adverse events, reduce medical errors, and promote a safety environment in the breast imaging clinic. Error mitigation tools can be summarized using the acronym SAFE, which includes support the team, ask questions, focus on a task, and effectively communicate/ensure equipment optimization/safe environment. Knowledge of errors commonly seen in a breast imaging clinic represent an opportunity for constructive changes and, ultimately, improved health care delivery.
Impact of COVID-19 on Breast Imaging Practice Operations and Recovery Efforts: A North American Study
Authors: Dodelzon Katerina , Grimm Lars J , Tran Khai , Dontchos Brian N , Destounis Stamatia , Dialani Vandana , Dogan Basak , Sonnenblick Emily , Zuley Margarita , Milch Hannah S
Published: January 2021

Objective

To assess the impact of the COVID-19 pandemic on breast imaging facilities’ operations and recovery efforts across North America.

Methods

A survey on breast imaging facilities’ operations and strategies for recovery during the COVID-19 pandemic was distributed to the membership of the Society of Breast Imaging and National Consortium of Breast Centers from June 4, 2020, to July 14, 2020. A descriptive summary of responses was performed. Comparisons were made between demographic variables of respondents and questions of interest using a Pearson chi-square test.

Results

There were 473 survey respondents (response rate of 13%). The majority of respondents (70%; 332/473) reported 80%–100% breast imaging volume reduction, with 94% (447/473) reporting postponement of screening mammography. The majority of respondents (97%; 457/473) continued to perform biopsies. There were regional differences in safety measures taken for staff (P = 0.004), with practices in the West more likely reporting no changes in the work environment compared to other regions. The most common changes to patients’ experience included spacing out of furniture in waiting rooms (94%; 445/473), limiting visitors (91%; 430/473), and spacing out appointments (83%). A significantly higher proportion of practices in the Northeast (95%; 104/109) initiated patient scheduling changes compared to other regions (P = 0.004).

Conclusion

COVID-19 had an acute impact on breast imaging facilities. Although common national operational patterns emerged, geographic variability was notable in particular in recovery efforts. These findings may inform future best practices for delivering breast imaging care amid the ongoing and geographically shifting COVID-19 pandemic.
Burden of Behavioral Health Comorbidities on Outpatient Health Care Utilization by Active Duty Service Members With a First Documented mTBI
Authors: Kasuske Lalon M , Hoover Peter , Wu Tim , French Louis M , Caban Jesus J
Published: January 2021

Objective

More than 280,000 Active Duty Service Members (ADSMs) sustained a mild traumatic brain injury (mTBI) between 2000 and 2019 (Q3). Previous studies of veterans have shown higher utilization of outpatient health clinics by veterans diagnosed with mTBI. Additionally, veterans with mTBI and comorbid behavioral health (BH) conditions such as post-traumatic stress disorder, depression, and substance use disorders have significantly higher health care utilization than veterans diagnosed with mTBI alone. However, few studies of the relationship between mTBI, health care utilization, and BH conditions in the active duty military population currently exist. We examined the proportion of ADSMs with a BH diagnosis before and after a first documented mTBI and quantified outpatient utilization of the Military Health System in the year before and following injury.

Materials and Methods

Retrospective analysis of 4,901,840 outpatient encounters for 39,559 ADSMs with a first documented diagnosis of mTBI recorded in the Department of Defense electronic health record, subsets of who had a BH diagnosis. We examined median outpatient utilization 1 year before and 1 year after mTBI using Wilcoxon signed rank test, and the results are reported with an effect size r. Outpatient utilization is compared by BH subgroups.

Results

Approximately 60% of ADSMs experience a first mTBI with no associated BH condition, but 17% of men and women are newly diagnosed with a BH condition in the year following mTBI. ADSMs with a history of a BH condition before mTBI increased their median outpatient utilization from 23 to 35 visits for men and from 32 to 42 visits for women. In previously healthy ADSMs with a new BH condition following mTBI, men more than tripled median utilization from 7 to 24 outpatient visits, and women doubled utilization from 15 to 32 outpatient visits.

Conclusions

Behavioral health comorbidities affect approximately one-third of ADSMs following a first mTBI, and approximately 17% of previously healthy active duty men and women will be diagnosed with a new BH condition in the year following a first mTBI. Post-mTBI outpatient health care utilization is highly dependent on the presence or absence of BH condition and is markedly higher is ADSMs with a BH diagnosis in the year after a first documented mTBI.
A Comparison of Nonhuman Primate Injuries in Horizontal Versus Vertical Sled +Gz (Head-to-Foot) Impact Accelerations
Authors: Abraczinskas Alicia , Olszko Ardyn , Beltran Christine , Baisden Jamie L , Yoganandan Narayan , McGhee James , McGovern Shannon , Lidl Grace , Vasquez Kimberly B , Chancey Valeta C
Published: January 2021

Introduction

Accelerative events commonly expose military pilots to potentially injurious + Gz (axial, caudal to cranial) accelerations. The Naval Biodynamics Laboratory exposed nonhuman primates (NHPs) to + Gz loading in two subject orientations (supine or upright) to assess the effect of orientation and accelerations associated with injury at accelerations unsafe for human participation.

Materials and Methods

Archived care records, run records, and necropsy and pathology reports were used to identify acceleration-related injuries. Injuries were categorized as central nervous system (CNS), musculoskeletal (MSK) system, or thoracic (THR). The occurrence of injuries relative to corresponding peak sled acceleration (PSA) and subject orientation were compared. A t-test was applied within each injury category to test for a significant difference in mean PSA between orientations.

Results

For all 63 + Gz runs conducted, PSA ranged between 6 and 86 G. Of these runs, 17 (6 supine, 11 upright) resulted in acceleration-related injury. The lowest PSAs associated with injury for supine and upright were 69.8 G and 39.6 G, respectively. Individual injury occurrences for supine runs (CNS [n = 5], MSK [n = 6], and THR [n = 6]) occurred at/above 75.7 G, 69.8 G, and 69.8 G, respectively. For upright runs, injury occurrences (CNS [n = 3], MSK injuries [n = 9], and THR injuries [n = 6]) occurred at/above 60.1 G, 39.6 G, and 50.5 G, respectively. The applied t-test showed significant difference between the mean orientation accelerations within each category. Injuries to supine NHPs included compression fracture, organ damage, brain hemorrhage, spinal cord hemorrhage, cervical hemorrhage, paresis/paraplegia, and THR bruising, whereas injuries to upright NHPs included compression fracture, organ damage, spinal cord hemorrhage, paresis/paraplegia, THR bruising, and difficulty breathing.

Conclusions

Axial loading to supine occupants produced more CNS injuries, whereas upright produced more MSK injuries. Both orientations produced equal THR injuries. NHP injuries reported reflected those reported following human + Gz acceleration events, highlighting the importance of orientation during acceleration to mitigate injury for next generation equipment design and testing.
Novel Phototherapy Kiosk Shows Promise as a Treatment Option for Low Vitamin D
Authors: McCarthy Mary S , Elshaw Evelyn B , Szekely Barbara M , Beltran Thomas
Published: January 2021

Introduction

The purpose of this study was to demonstrate the feasibility of a phototherapy kiosk (PK) to engage community adults in health promotion and to stimulate production of circulating 25-hydroxyvitamin (OH)D as effectively as a vitamin D3 oral supplement (OS). Although optimal production of vitamin D comes from sun exposure, ultraviolet B radiation with a wavelength of 290 to 320 nm penetrates exposed skin and may produce vitamin D3 using a PK.

Materials and Methods

A prospective study was conducted with adults randomized to either six PK treatments or D3 OS for 10 weeks. Serum 25(OH)D was drawn at baseline, 10 weeks, and 14 weeks. Primary outcome was serum 25(OH)D level. Mann–Whitney test was used to assess continuous data and Chi squared test for pairwise comparisons of categorical data. Significance was set at P < .05.

Results

With 18% attrition, final sample size was 88; OS, n = 45, PK, n = 43. Sample was mostly female (60%), median age 35 years, with no differences observed between groups for age, race/ethnicity, marital status, military affiliation, or season of enrollment. Median daily intake of calcium and vitamin D was well below the recommended daily allowance for each nutrient, and group. Baseline median serum 25(OH)D levels were similar. By 10 weeks, PK median level was 30 ng/mL (interquartile range [IQR] 25.8-37.0) and OS was 26 ng/mL (IQR 21.5-30.5), P = .02. The difference in 25(OH)D levels persisted at 14 weeks; the PK group returned to baseline, 27 ng/mL (IQR 22.0-32.5), and OS group declined to 21 ng/mL (IQR 17.0-30.0), P = .02.

Conclusion

Programmed ultraviolet B phototherapy appears to be an efficacious alternative to oral vitamin D supplementation with consistent use.
Algorithm Directed Troop Medical Care Manual Application for Desktop and Smartphone
Authors: Chrosniak James , Olsen Christian , Galdi Andrew
Published: January 2021

Introduction

The U.S. Army medics are often the first responders in the care of sick and injured soldiers on the battlefield, sick call in a Role 2 aid station and garrison clinics. Sick call medics are required to utilize the Algorithm Directed Troop Medical Care (ADTMC) to care for and then render a disposition for these soldiers. The current ADTMC manual is a thick, heavy paper manual. A desktop and smartphone application has been developed that contains the entire ADTMC manual algorithm–based content. Our goal is to enhance the medics’ clinical learning and critical thinking skills while improving their evaluation, disposition, and documentation during patient encounters.

Materials and Methods

The application was field-tested with the 173rd IBCT (A) while attending a field exercise at Grafenwoehr, Germany. At the unit’s Role 2 tent setup, the use of the paper manual to the utilization of the same material via the ADTMC application was compared by observing the medics’ workflows directly while they were caring for ill and injured soldiers.

Results

Medics, while examining patients, would demonstrate 50% faster exam time using the application compared to medics using only the manual. Moreover, a 50% decrease in document processing time as a result of digitization of the paper documentation process was confirmed. The application (“app”) enabled the medics to continue their screening assessments and patient disposition duties on a desktop computer or a smartphone without the need to refer to the paper manual.

Conclusion

Medics, by adopting this tool, will become quicker, more efficient, and develop critical thinking skills. In other words, the ability to objectively evaluate patients in order to form a proper disposition of sick and injured soldiers during training, in the field, as well as in garrison. When utilized properly, the ADTMC application ensures that soldiers reporting to sick call are expeditiously routed to the appropriate level of care, and is a vehicle for further training for medics in the care of soldiers.
Manganese Breaks the Immune Tolerance of HBs-Ag
Authors: Lin Mengxin , Guo Ruyi , Ma Cuiping , Zeng Dawu , Su Zhijun
Published: January 2021

Background

Manganese (Mn2+) has been shown to promote type I interferon (IFN) production and activate the cyclic GMP-AMP synthase (cGAS)/Stimulator of Interferon Genes (STING) signaling pathway, suggesting that Mn2+ could be used as an adjuvant for vaccination.

Methods

In present study, the effects of Mn2+ on vaccination against hepatitis B virus (HBV) were evaluated. We treated mouse hepatocytes and kuppfer cells with Mn2+ with or without adeno-associated virus (AAV)–HBV infection. Expression of IFN-α and IFN-β and activation of TBK1 and IRF3 were monitored. Wild-type and STING-/- mice were treated with Mn2+ and then infected with AAV-HBV. Serum levels of HBV surface antigen (HBsAg), alanine aminotransferase (ALT) activity, IFN-α, and IFN-β were detected. Lymphocyte infiltration in the liver was evaluated. HBsAg-Tg mice were vaccinated with Mn2+ and HBsAg. The serum levels of HBsAg antibody, alanine transaminase activity, and IFN-β were monitored after vaccination.

Results

Mn2+ promoted IFN-α and IFN-β production in mouse hepatocytes and kuppfer cells. Mn2+ failed to promote IFN-α and IFN-β production in kuppfer cells deficient in STING. Mn2+ promoted activation/phosphorylation of TBK1 and IRF3 during AAV-HBV infection. Mn2+ decreased serum levels of HBsAG, increased serum levels of alanine aminotransferase (ALT), IFN-α and IFN-β, and enhanced lymphocyte infiltration and the percentage of IFN-γ-producing CD8+ T cells in the liver of AAV-HBV-infected mice. In contrast, Mn2+ treatment did not affect serum levels of HBsAG, ALT, IFN-α, or IFN-β in STING-deficient mice.

Conclusions

Mn2+ promoted HBsAG antibody, ALT, and IFN-β production after HBsAG immunization. Mn2+ promoted type I IFN production in AAV-HBV infection and HBsAG immunization and could be used as an adjuvant for vaccination.
How housing affects the association between low income and living conditions-deprivation across Europe
Authors: Dewilde Caroline
Published: January 2021

To explain an emerging trend towards deteriorating living conditions among low-income households across several (West-)European countries, it makes sense to investigate domains of socio-economic regulation that impact on expenditures, rather than incomes. I focus specifically on the domain of housing. Multilevel analyses for 28 countries (EU-SILC) demonstrate that redistributive housing policies such as rental market regulation and housing allowances weaken the cross-sectional (between-country) positive association between a low-income and living conditions-deprivation, while also benefiting living conditions across the broader population. Regarding changes over time, increased uptake of housing allowances throughout the Great Financial Crisis (2008/2009) seems to have shielded in particular renters from deteriorating living conditions, and might have compensated for declining availability of social housing. Higher house prices and price volatility, indicating housing market financialization, are associated with increased living conditions-deprivation for renters and low-income owners, both cross-sectionally and within countries over time. Anti-poverty policies should thus take a broader perspective, and take better account of provision for housing and other basic needs.
Evaluating the effectiveness of a physical activity social media advertising campaign using Facebook, Facebook Messenger, and Instagram
Authors: Northcott Celine , Curtis Rachel , Bogomolova Svetlana , Olds Timothy , Vandelanotte Corneel , Plotnikoff Ronald , Maher Carol
Published: January 2021

Technology-based physical activity programs are a novel solution to the major public health issue of physical inactivity. However, to be successful, there must be a large and population-appropriate uptake, which depends heavily on promotion. This study evaluates the effectiveness of an advertising campaign to disseminate a physical activity smartphone app. The experiment used a 3 × 3 × 3 full-factorial design, examining platforms (Facebook; Facebook Messenger; Instagram), selling-techniques (hard-sell—sending viewers directly to (a) Apple Store or (b) Google Play, and soft-sell—sending viewers from an ad to a (c) landing-page, then to an app store) and themes (Health and Wellbeing; Body and Self-Confidence; Social Enjoyment). Outcomes were reach, click-through, and app downloads. Advertisements reached 1,373,273 people, achieving 2,989 clicks and 667 downloads. Instagram and Facebook Messenger had higher reach compared to Facebook (F[2,27] = 27.17, p < .001), whilst Facebook and Facebook Messenger both produced higher click-through (F[2,27] = 8.98, p < .001) and downloads (F[2,27] = 4.649, p = .018). Selling-technique differed, with soft-selling ads producing greater reach (F[2,27] = 4,616.077, p < .001); however, both hard-selling ads (Apple Store and Google Play) had greater click-through (F[2,27] = 10.77, p < .001) and downloads (F[2,27] = 3.791, p < .001). Advertising theme varied, with Social Enjoyment themes producing less click-through (F[2,27] = 5.709, p = .009) and downloads (F[2,27] = 5.480, p = .010). We recommend future studies to consider Facebook and Facebook Messenger, using hard-selling techniques, with themes relating to Health and Wellbeing and Body and Self-Confidence.
Lives Come Apart: The Burden of Severe Mental Illness
Authors: Hegdal Juliet
Published: January 2021

A nurse who grew up in the shadow of her mother's schizophrenia calls for societal acceptance and support.
Recurrent Arrest is Strongest Predictor of Poor Outcomes After In-Hospital Cardiac Arrest
Authors: Rosenberg Karen
Published: January 2021

According to this study:

Among survivors of in-hospital cardiac arrest, recurrent cardiac arrest is the strongest predictor of poor outcomes and is associated with fivefold lower survival chances.
Inside the National Institute on Aging
Authors: Ortelli Tracy A.
Published: January 2021

Supporting older adults' health and well-being.
Becoming an Antiracist Neonatal Community
Authors: Vance Ashlee J. , Bell Tracey
Published: January 2021

Background:

There are pervasive and documented disparities in maternal and infant outcomes related to race and ethnicity. Critical awareness is growing in our current cultural environment about strategies to improve health equity, the need to challenge implicit bias, and dismantle racism in healthcare to decrease racial health inequities.

Methods:

In this article, we provide a summary of health inequities that exist within the perinatal/neonatal population and offer strategies for initiating conversations and improving health equity by challenging bias and increasing diversity.

Results:

Transformative leaders must understand the evidence related to health disparities, understand social drivers of inequity issues, and identify solutions to influence change.

Implications for Practice:

With heightened awareness and examination of implicit bias, we can improve care for all infants and their families.

Implications for Research:

We need to continue research and quality improvement efforts to improve health equity. Furthermore, research is needed that focus on social determinants of health as drivers of preterm delivery and birth complications, rather than biological (eg, racialized) factors.

Video Abstract available at:
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=42
Predictors of Falls in Patients with Degenerative Cervical Myelopathy: A Prospective Multi-institutional Study
Authors: Inose Hiroyuki , Yoshii Toshitaka , Kimura Atsushi , Takeshita Katsushi , Inoue Hirokazu , Maekawa Asato , Endo Kenji , Miyamoto Takuya , Furuya Takeo , Nakamura Akira , Mori Kanji , Kanbara Shunsuke , Imagama Shiro , Seki Shoji , Matsunaga Shunji , Takahashi Kunihiko , Okawa Atsushi
Published: January 2021

Study Design.

Prospective multicenter study.

Objectives.

The purpose of this study was to characterize a population of patients with degenerative cervical myelopathy (DCM) combined with a history of falling, and to identify the predictors associated with those falls.

Summary of Background Data.

Falls among patients with DCM are common and can lead to the worsening of neurological symptoms. However, there are no prospective studies that have investigated the risk factors for falls in these patients.

Methods.

We prospectively enrolled patients scheduled for surgery for DCM and evaluated the significance of various preoperative measures for predicting falls. We then examined the correlation between the number of falls and the preoperative factors. Lastly, we performed stepwise logistic regression analysis to assess the concurrent effects of various factors on the occurrence of falls.

Results.

Among the 135 patients analyzed, 64 experienced one or more falls from the time of enrollment to 1 year postoperatively. Univariate analysis showed that the preoperative potassium and albumin levels, handgrip strength, and the Japanese Orthopaedic Association score for the assessment of cervical myelopathy (C-JOA score) were lower and Nurick grade was higher in the fallers group. Serum potassium level, handgrip strength, C-JOA score, Nurick grade, European Quality of Life-5 Dimensions (EQ-5D) score, t1 pelvic angle, and sagittal vertical axis had weak correlations with the number of falls. The fallers group had a lower C-JOA and EQ-5D scores and a lower recovery rate at one year postoperatively. Stepwise multiple logistic regression analysis identified preoperative potassium level and handgrip strength as the independent preoperative predictors for falling.

Conclusion.

We identified preoperative lower serum potassium level and weaker handgrip strength as significant predictors of falls in patients with DCM. Therefore, DCM patients with these risk factors should be cautious about falls and might be candidates for immediate surgical intervention.

Level of Evidence: 3.
Conceptual Framework for a Plastic Surgery Residency Leadership Curriculum
Authors: Wang Jessica S. , Singh Tanvee , Bruno Evan A. , White John S. , Fan Kenneth L.
Published: January 2021

Background:

Leadership development remains an overlooked component in the plastic surgery residency curriculum. Through a mixed-methods assessment of physician perceptions, this study aims to establish the value and structure of a formal leadership course for trainees.

Methods:

Qualitative interviews were conducted with plastic surgery residents to identify common themes concerning the current state of leadership training and goals for improvement. These themes then guided the design of a quantitative assessment, which surveyed faculty and residents regarding their perceived need for a curriculum, the domains that should be included, and the format of delivery.

Results:

Six residents underwent interviews, which yielded the following themes: (1) surgical residents require a distinct set of leadership skills that warrants more intensive training and (2) leadership training should assume a more structured format. The survey achieved a 76% (29/38) response rate, with residents comprising 55% of respondents. Participants were neutral to slightly satisfied with current resident leadership and “learning on the job” (4.62 and 4.03 on a 7-point Likert scale, respectively). Respondents reported a moderate need for formal leadership training (2.97 on a 5-point scale). Availability was ranked as the greatest barrier to curriculum implementation. Topics considered most important included effective communication, self-awareness/emotional intelligence, and strategic thinking. Formats considered most effective included in-person lectures, small group exercises, and case studies.

Conclusion:

This study presents a conceptual framework for the implementation of a leadership curriculum for plastic surgery residents that may empower the development of stronger physician leaders.
Certification and Accreditation in Plastic Surgery Subspecialty Training
Authors: Xue Erica Y. , Winocour Sebastian , Cen Nicholas , Davis Matthew J. , Buchanan Edward P. , Chu Carrie K. , Reece Edward M.
Published: January 2021

There are multiple subspecialties that residents can pursue after core plastic surgery training, including 5 major fellowship categories: aesthetic, burn, craniofacial, hand, and microsurgery. Hand surgery remains the only plastic surgery subspecialty to date, with a formal accreditation process following fellowship. The purpose of this study was to review the literature regarding the accreditation and match process of plastic surgery fellowship programs, the process of hand surgery certification, and future directions pertaining to certification in other plastic surgery subspecialties.
Ear Molding Therapy: Laypersons’ Perceptions, Preferences, and Satisfaction with Treatment Outcome
Authors: Vu Giap H. , Azzolini Anthony , Humphries Laura S. , Mazzaferro Daniel M. , Kalmar Christopher L. , Zimmerman Carrie E. , Swanson Jordan W. , Taylor Jesse A. , Bartlett Scott P.
Published: January 2021

Background:

This study investigates laypersons’ perceptions of congenital ear deformities and preferences for treatment, particularly with ear molding therapy—an effective, noninvasive, yet time-sensitive treatment.

Methods:

Laypersons were recruited via crowdsourcing to view photographs of normal ears or one of the following ear deformities, pre- and post-molding: constricted, cryptotia, cupped/lopped, helical rim deformity, prominent, and Stahl. Participants answered questions regarding perceptions and treatment preferences for the ear. Statistical analyses included multiple linear and logistic regressions and Wilcoxon signed-rank tests.

Results:

A total of 983 individuals participated in the study. All deformities were perceived as significantly abnormal, likely to impair hearing, and associated with lower psychosocial quality of life (all P < 0.001). For all deformities, participants were likely to choose ear molding over surgery despite the logistical and financial implications of ear molding (all P < 0.02). Participants were significantly more satisfied with the outcome of ear molding in all deformities compared with control, except constricted ears (all P < 0.002, except Pconstricted = 0.073). Concern for hearing impairment due to ear deformity was associated with increased likelihoods of seeing a physician (P < 0.001) and choosing ear molding despite treatment logistics and costs (all P < 0.001).

Conclusions:

Laypersons perceived all ear deformities as abnormal and associated with low psychosocial quality of life. Despite logistical and financial implications, laypersons generally desired molding therapy for ear deformities; treatment outcomes were satisfactory for all deformities except constricted ears. Timely diagnosis of this condition is crucial to reaping the benefits of ear molding therapy.
Effect of Systemic Adipose-derived Stem Cell Therapy on Functional Nerve Regeneration in a Rodent Model
Authors: Schweizer Riccardo , Schnider Jonas T. , Fanzio Paolo M. , Tsuji Wakako , Kostereva Nataliya , Solari Mario G. , Plock Jan A. , Gorantla Vijay S.
Published: January 2021

Background:

Regardless of etiology, peripheral nerve injuries (PNI) result in disruption/loss of neuromuscular junctions, target muscle denervation, and poor sensorimotor outcomes with associated pain and disability. Adipose-derived stem cells (ASCs) have shown promise in neuroregeneration. However, there is a paucity of objective assessments reflective of functional neuroregeneration in experimental PNI. Here, we use a multimodal, static, and dynamic approach to evaluate functional outcomes after ASC therapy in a rodent PNI model.

Methods:

Lewis rats were divided into 3 groups: 10 mm sciatic nerve resection (“CUT” group; n = 10), transection and repair (“REP” group; n = 10), transection and repair plus single-dose ASCs (“ASC” group; n = 12). Allogeneic (Brown Norway rat) ASCs (1 × 106) were administered intravenously on postoperative day 1. Functional outcome was assessed by static sciatic index, toe spread factor, and a dynamic swim test on a weekly basis for 6 weeks. Sciatic nerves and gastrocnemius muscles were harvested at endpoint (6 weeks) for histological analysis.

Results:

The ASC group showed accelerated functional recovery on the swim test at 2 weeks postoperatively, with continued improvement over 4 weeks, culminating in superior overall outcomes at 6 weeks compared with the REP group. The CUT group showed no significant improvement from baseline. Nerve histomorphometry correlated well with the swim test results in the ASC group. Gastrocnemius muscle weights showed no difference between the REP and the ASC groups.

Conclusion:

Our study confirms that early, single dose, systemic administration of ASC after PNI accelerates and enhances overall motor recovery on static and dynamic functional tests as evidenced by improvements in voluntary as well as involuntary motions.
Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly
Authors: Lee Jasmine , Alfonso Allyson R. , Kantar Rami S. , Diep Gustave K. , Berman Zoe P. , Ramly Elie P. , Daar David A. , Levine Jamie P. , Ceradini Daniel J.
Published: January 2021

Background:

Due to the high complication rate of panniculectomies, preoperative risk stratification is imperative. This study aimed to assess the predictive value of the 5-item modified frailty index (mFI-5) for postoperative complications in the elderly following panniculectomy.

Methods:

A retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database for patients over the age of 65 years who underwent a panniculectomy between 2010 and 2015 was conducted. The mFI-5 score was calculated for each patient based on the presence of diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent functional status, and an mFI-5 score of 2 was used as a cutoff. Multivariate logistic and linear regression analysis was used to determine the validity of the mFI-5 as a predictor of postoperative complications.

Results:

A total of 575 patients were analyzed. Patients with an mFI-5 score of 2 or more (421; 73.2%) had significantly higher rates of wound complications (19.5% versus 12.8%; P = 0.03), overall complications (33.8% versus 19.5%; P < 0.001), and significantly longer hospital length of stay (3.6±5.0 versus 1.9±3.0; P < 0.001). mFI-5 score of 2 or more was an independent risk factor for wound complications (odds ratio, 1.26; 95% confidence interval, 1.08–2.20; P = 0.04) and overall complications (odds ratio, 1.34; 95% confidence interval, 1.09–2.15; P = 0.02).

Conclusions:

Frailty, as measured by the mFI-5, holds a predictive value regarding outcomes of wound complications and overall complications in elderly patients after panniculectomy. The mFI-5 score can be used to identify high-risk patients before surgery.
Flap Venous Congestion and Salvage Techniques: A Systematic Literature Review
Authors: Boissiere Florian , Gandolfi Silvia , Riot Samuel , Kerfant Nathalie , Jenzeri Abdesselem , Hendriks Sarah , Grolleau Jean-Louis , Khechimi Myriam , Herlin Christian , Chaput Benoit
Published: January 2021

Background:

Venous congestion is a frequent problem in flap surgery. Other than surgical revision, there are a multitude of procedures in the literature to tackle this problem, but their effectiveness is not clear. Through a systematic review, we aimed to identify and evaluate the different interventions available for managing flap venous congestion.

Methods:

The MEDLINE, PubMed central, Embase, and Cochrane databases were searched. The study selection process was adapted from the PRISMA statement. All English and French original articles describing or comparing a method for managing flap venous congestion were included. For each article, a level of evidence was assigned, as defined by the Oxford Centre for Evidence-based Medicine. Lastly, we specifically analyzed the effectiveness of postoperative non-surgical methods. No formal analysis was performed.

Results:

Through literature searches carried out in various databases, we identified 224 articles. Finally, 72 articles were included. The majority of these studies had a low-level evidence. A total of 17 different methods (7 pre- and intraoperative, and 10 postoperative) were found. Concerning non-surgical methods, the most represented were leeches, local subcutaneous injection of heparin with scarification, venocutaneous catheterization, negative pressure therapy, and hyperbaric oxygen therapy.

Conclusions:

Risks of venous congestion of flaps must always be present in a surgeon’s mind, at every stage of flap surgery. Apart from studies on the use of leeches, which have a significant follow-up and large enough patient numbers to support their efficacy, the low-level evidence associated with studies of other methods of venous congestion management does not allow us to draw a scientifically valid conclusion about their effectiveness.
Observations Concerning the Match between Breast Implant Dimensions, Breast Morphometry, and a Patient-reported Outcome
Authors: Brown Tim
Published: January 2021

Background:

Outcome studies in breast augmentation do not assess how an implant has been matched to the soft tissue envelope. The study hypothesis is that there is a relationship between breast and implant dimensions and the subjective outcome of patient satisfaction.

Methods:

In a study of patients undergoing subfascial breast augmentation (n = 341), morphometric measurements and a postsurgical survey of satisfaction with breast size were performed 3 months postoperatively. A ratio empirically derived from breast width, implant width, and projection (Rib) was calculated in patients who wished to have smaller, bigger, or no change in their implant size.

Results:

76% were content with breast size, 16.7% wished to be larger, and 7.3% wished to be smaller. Rib differed between groups who did not want to change size (n = 259, mean = 5.8, SD = 0.9), those who wished to be bigger (n = 57, mean = 5.6, SD = 1.1), and those who wished to be smaller (n = 25, mean = 5.3, SD = 1.3, H(341) = 14.0, P < 0.01). Rib differed between groups whose result was as expected (mean = 5.6, SD = 0.9), compared with those who expected to be bigger (mean = 5.4, SD = 1.2) or who expected a smaller outcome (mean = 5.6 SD = 1.0, H(341) = 18.3, P < 0.01).

Conclusions:

These data provide an objective measurement by which studies concerning breast augmentation can be reported and compared. The method may guide standardization of clinical research regarding breast implant surgery.
Dual Reconstruction of Lumbar and Gluteal Defects with Freestyle Propeller Flap and Muscle Flap
Authors: Ellabban Mohamed A. , Wyckman Alexander , Abdelrahman Islam , Steinvall Ingrid , Elmasry Moustafa
Published: January 2021

Background:

The reconstruction of complex tissue defects in the lumbar and gluteal areas is a surgical challenge. The use of freestyle perforator-based flaps has gained popularity in the reconstruction of these defects due to several advantages: versatility, minimal donor-site morbidity, and tension-free closure. The present study reports the outcome of using a dual coverage of lumbar and gluteal defects with a gluteus maximus rotation flap as a deep layer and a freestyle propeller perforator-based flap as a superficial layer.

Methods:

A retrospective analysis of 18 patients who had a dual coverage of complex wounds of the lumbar and the gluteal areas was conducted. Different propeller flaps were used as superior gluteal artery perforator flap (SGAP), inferior gluteal artery perforator flap (IGAP), and posterior thigh perforator flap (PTP).

Results:

The study included 15 men and 3 women. The mean age was 26.3 years. The causes of the defects were: pressure ulcers in 14 patients and post-traumatic in 4 patients. A total of 28 freestyle flaps was used: 11 patients had 1 flap, 4 had 2 flaps, and 3 had 3 flaps. The mean postoperative follow-up was 12.2 months. The complications registered in the medical records were venous congestion in 2 patients, partial flap necrosis in 2 patients, and wound dehiscence in 1 patient.

Conclusions:

A freestyle propeller perforator-based flap combined with a gluteus maximus muscle flap is a solution that provides well-padding over bony prominence with a low complication rate. However, a long-term follow-up is needed to verify these results.
A Phase 3, Randomized, Investigator-blinded Trial Comparing Ceftobiprole With a Standard-of-care Cephalosporin, With or Without Vancomycin, for the Treatment of Pneumonia in Pediatric Patients
Authors: Bosheva Miroslava , Gujabidze Rusudan , Károly Éva , Nemeth Agnes , Saulay Mikael , Smart Jennifer I. , Hamed Kamal A.
Published: January 2021

Background:

The advanced-generation, broad-spectrum, intravenous (IV) cephalosporin, ceftobiprole, is an effective and well-tolerated treatment for adults with hospital-acquired pneumonia (HAP) or community-acquired pneumonia (CAP), but its effects in pediatric patients have not been established.

Methods:

In this multicenter, investigator-blinded, active-controlled, phase 3 study, patients 3 months to <18 years old with HAP or CAP requiring hospitalization were randomized (2:1) to ceftobiprole versus standard-of-care (SoC) IV cephalosporin treatments (ceftazidime or ceftriaxone), with or without vancomycin. After at least 3 days’ IV treatment, patients demonstrating clinical improvement could be switched to an oral antibiotic, to complete a minimum of 7 days’ treatment.

Results:

Overall, 138 patients were randomized to ceftobiprole (n = 94) or a SoC cephalosporin (n = 44). Median time to oral switch was 6.0 days in the ceftobiprole group and 8.0 days in the SoC cephalosporin group. While on IV therapy, adverse events and treatment-related adverse events were reported by 20.2% and 8.5% of ceftobiprole-treated patients and 18.2% and 0% of SoC cephalosporin-treated patients. Early clinical response rates at day 4 in the intention-to-treat population were 95.7% and 93.2% (between-group difference, 2.6%; 95% confidence interval, –5.5% to 14.7%) in the ceftobiprole and comparator groups, and clinical cure rates at the test-of-cure visit were 90.4% and 97.7% (between-group difference, –7.3%; 95% confidence interval, –15.7% to 3.6%), respectively.

Conclusions:

Ceftobiprole was well tolerated and, in this small phase 3 study, demonstrated similar efficacy to SoC cephalosporins in pediatric patients with HAP or CAP requiring hospitalization.
Deaths of Despair Among Healthcare Workers, Massachusetts, 2011 to 2015
Authors: Kaki Sahith , Hawkins Devan
Published: January 2021

Objective:

To explore mortality rates and trends according to the occupation of healthcare workers who died from the deaths of despair (DoD).

Methods:

Death certificates for deaths from 2011 to 2015 due to poisonings, suicides, alcholic liver disease and cirrhosis were collected and coded based on the decedent's occupation. Mortality rates and rate ratios were calculated according to occupations for healthcare workers.

Results:

There were 540 DoDs among Massachusetts healthcare workers, accounting for an average annual rate of 32.4 deaths per 100,000 workers. The highest mortality rate for DoDs were among medical assistants; nursing, psychiatric, and home health aides; miscellaneous; health technologists and technicians; emergency medical technicians, and paramedics.

Conclusions:

Further research should examine factors contributing to elevated rates for DoDs among healthcare workers. Interventions targeted for these workers should be developed.
Conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma: where do we stand in 2018?
Authors: Satoi Sohei , Yamamoto Tomohisa , Matsui Yoichi
Published: January 2021

Pancreatic ductal adenocarcinoma (PDAC) continues to have a dismal prognosis, with a 5-year survival rate of <5%. Most (70%–80%) patients are classified as unresectable (UR) disease. Recent progress in chemotherapeutic approaches has provided a high response rate and improved short-term survival. Recently, conversion surgery (CS), which is defined as an additional surgery during multimodal therapy in patients with initially UR-PDAC who respond favorably to anti-cancer treatments, has been successfully introduced as a novel treatment option for locally advanced (UR-LA) and metastatic (UR-M) PDAC. Several studies have demonstrated high resectability rates (UR-LA, 20%–57%; UR-M, 2%–24%), high margin-negative resection rates (27%–91%), and high negative lymph node rates (29%–83%) in patients who underwent CS. Most studies also demonstrated acceptable mortality and morbidity. Median survival time (MST) varied between 24.9 and 35.3 months for patients with UR-LA, 19.5 and 64 months for UR-LA/M, and 26 and 56 months for UR-M, which is better than the MST of patients who did not undergo CS. The presence of M disease did not affect survival in patients who underwent CS. However, the actual clinical benefits of resection have not yet been fully investigated. There are still several issues to be resolved in this area. Therefore, sustained efforts to conduct appropriately designed clinical trials for confirming the efficacy of CS in the subset of patients with initially UR-PDAC are warranted.
Three Sessions of Radial Extracorporeal Shockwave Therapy Gives No Additional Benefit Over “Minimal-Dose” Radial Extracorporeal Shockwave Therapy for Patients With Chronic Greater Trochanteric Pain Syndrome: A Double-Blinded, Randomized, Controlled Trial
Authors: Wheeler Patrick C. , Dudson Chloe , Calver Rachel , Goodall Duncan , Gregory Kim M. , Singh Harjinder , Boyd Kevin T.
Published: January 2021

Objective:

To investigate the outcomes following 3 weekly sessions of radial extracorporeal shockwave therapy (rESWT) in patients with chronic greater trochanteric pain syndrome (GTPS) presenting to an NHS Sports Medicine Clinic in the United Kingdom.

Design:

Double-blinded randomized controlled trial.

Setting:

A single NHS Sports Medicine Clinic, in the United Kingdom.

Patients:

One hundred twenty patients in an NHS Sports Medicine clinic presenting with symptoms of GTPS who had failed to improve with a minimum of 3 months of rehabilitation were enrolled in the study and randomized equally to the intervention and treatment groups. Mean age was 60.6 ± 11.5 years; 82% were female, and the mean duration of symptoms was 45.4 ± 33.4 months (range, 6 months to 30 years).

Interventions:

Participants were randomized to receive either 3 sessions of ESWT at either the “recommended”/“maximally comfortably tolerated” dose or at “minimal dose.” All patients received a structured home exercise program involving flexibility, strength, and balance exercises.

Main Outcome Measures:

Follow-up was at 6 weeks, 3 months, and 6 months. Outcome measures included local hip pain, validated hip PROMs (Oxford hip score, non-arthritic hip score, Victorian Institute of Sport assessment questionnaire), and wider measures of function including sleep (Pittsburgh sleep quality index) and mood (hospital anxiety and depression scale).

Results:

Results were available for 98% of patients at the 6-month period. There were statistically significant within-group improvements in pain, local function, and sleep seen in both groups. However, fewer benefits were seen in other outcome measures, including activity or mood.

Conclusion:

There were no time × group interaction effects seen between the groups at any time point, indicating that in the 3 sessions, the “recommended-dose” rESWT had no measurable benefit compared with “minimal dose” rESWT in this group of patients with GTPS. The underlying reason remains unclear; it may be that rESWT is ineffective in the treatment of patients with chronic GTPS, that “minimal dose” rESWT is sufficient for a therapeutic effect, or that a greater number of treatment sessions are required for maximal benefit. These issues need to be considered in further research.
Use of angiotensin II receptor blocker during pregnancy
Authors: Wei Qiang , Zhang Li , Duan Mei-fan , Wang Yue-mei , Huang Nan , Song Chun-rong
Published: January 2021

Background:

Drugs that affect the renin-angiotensin system, such as angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors are not typically recommended for pregnant women because of their potential fetal toxicity.

Case study:

A 32-year-old pregnant woman with nephrotic syndrome lasting more than 5 years became pregnant for the first time. She had been taking losartan tablets before and during pregnancy. Ultrasound at 24+2 weeks of pregnancy showed oligohydramnios, and the maximum vertical depth of amniotic fluid volume was 1.4 cm. Follow-up ultrasound examinations every 2 weeks showed persistent oligohydramnios [amniotic fluid volume: 1.1–3.4 cm, amniotic fluid index 1.9–6.9 cm]. B-ultrasound at 30+2 weeks showed slightly enhanced fetal renal cortex echo. The patient was treated at 32+2 weeks of pregnancy at our hospital.

Diagnoses:

Nephrotic syndrome and oligohydramnios.

Interventions:

Losartan was discontinued and replaced by nifedipine controlled-release tablets to lower blood pressure. The amount of amniotic fluid gradually increased to normal levels within 8 days. The patient was discharged at 33+2 weeks of pregnancy for follow-up. At 34+4 weeks, blood pressure had increased to 177/113 mm Hg and the patient was re-hospitalized with nephrotic syndrome complicated by preeclampsia. Due to progression of severe preeclampsia, elective cesarean section was performed at 35+3 weeks. After delivery, losartan and nifedipine were prescribed to continue lowering blood pressure. The patient was discharged 4 days after surgery.

Outcomes:

Losartan use was terminated at 32+2 weeks of pregnancy. Amniotic fluid returned to normal after 8 days and the baby was delivered after 22 days. At last follow-up, the infant was 24 months old and healthy.

Conclusion:

Although ARBs are effective for treating hypertension, they should be replaced by other classes of anti-hypertensive drugs in pregnant women. Pregnant women who elect to continue using ARBs should be informed about risks, they should be carefully monitored during pregnancy, and their pregnancy should be allowed to proceed as long as clinically feasible in order to optimize maternal and infant outcomes.