bluuebunny/crossref_metadata_2025 huggingface dataset:
The Psychosocial Interactions of Adolescent and Young Adult Cancer Survivors and the Possible Relationship With Their Development
Authors: Cameron Nicole , Ross Kirsty , Baken Don , Bimler David
Published: July 2019

Background

Adolescents and young adults (AYAs; 16–25 years old) with cancer may be particularly affected by social interactions, as they can be grappling with a serious illness and normal developmental challenges.

Objectives

The aims of this study were to explore interactions relevant to AYA survivors and cancer and to investigate whether specific interactions are experienced as more and less helpful.

Methods

Ten semistructured interviews were conducted with AYAs, with questions pertaining to their psychosocial interactions and any developmental effects from having cancer. Five follow-up interviews were conducted approximately 12 months later, a 50% response rate.

Results

Thematic analysis identified a range of themes including the importance of personal privacy and controlled sharing of information, independence, identity formation, positivity, acknowledgement of cancer versus being treated normally, and receiving support instead of supporting others. In the 1-year follow-up interviews, half of these themes remained constant; however, the personal privacy, independence, and supporting others themes changed.

Conclusions

Overall, social support, social interactions, and developmental stage seem to influence the overall cancer experience. Development seems to be impacted by cancer for both adolescents and young adults, but this impact lessened over a 1-year period for the 50% of participants who participated in both interviews.

Implications for Practice

It is believed that a more comprehensive understanding of AYA patients’ psychosocial experiences related to cancer will enable those who interact with this group to provide more positive support through their interactions with individuals.
Burnout and Its Relationships With Alexithymia, Stress, Self-Esteem, Depression, Alcohol Use Disorders, and Emotional Intelligence
Authors: Lahoud Nathalie , Zakhour Maha , Haddad Chadia , Salameh Pascale , Akel Marwan , Fares Kassandra , Hallit Souheil , Obeid Sahar
Published: July 2019

Our aim was to assess the relationship between personality and psychological traits, and burnout among the Lebanese population. A questionnaire-based cross-sectional study was conducted with multiple validated scales used to measure burnout and other characteristics. A cluster analysis was then performed to split the population into mutually exclusive groups with different profiles according to the burnout scales using the K-mean method. A multivariate analysis of covariance was carried out to compare multiple measures between the cluster groups under comparison. The study, conducted between November 2017 and March 2018, enrolled 789 participants. The results showed that 100 (14.0%) had high emotional work fatigue, whereas 443 (62.5%) and 680 (95.4%) had high mental and physical work fatigue, respectively. People with high physical work fatigue (cluster 1) had lower alcohol dependence (β = −2.78), alexithymia (β = −3.16), depression (β = −7.20), anxiety (β = −6.99), perceived stress (β = −2.53), social phobia (β = −11.49), suicidal ideation (β = −0.35), emotional awareness (β = −4.54), emotional managament (β = −1.71), social emotional awareness (β = −9.27), and relationship management (β = −9.12). People with high emotional work fatigue (cluster 2) had higher alcohol dependence (β = 2.11), alexithymia (β = 6.51), depression (β = 2.48), anxiety (β = 4.11), perceived stress (β = 4.30), and lower emotional awareness (β = −6.68), emotional management (β = −7.80), social emotional awareness (β = −3.71), and relationship management (β = −3.05). Higher levels of burnout were found to be associated with multiple psychological factors. The results would help understand the burnout dimensions and their correlated factors in the Lebanese population.
Serum Uric Acid Level and Outcome of Patients With Ischemic Stroke
Authors: Lei Zhihao , Cai Jingjing , Hong Hua , Wang Yidong
Published: July 2019

Background:

The issue of whether serum uric acid (SUA) is associated with the outcome of acute ischemic stroke is controversial. This study aimed to evaluate the correlation between the SUA level and outcome of patients with ischemic stroke by performing a meta-analysis.

Materials and Methods:

Studies were included by a systematic search of several databases through December 01, 2018, followed by reviewing reference lists of obtained articles. Studies that included odds ratios (ORs) for ischemic stroke outcome per unit SUA level with 95% confidence intervals (95% CIs) were eligible for the meta-analysis. A random-effects model was used to calculate the pooled risk estimate. Publication bias was detected by Begg’s test.

Results:

Fifteen studies with a total of 12,739 cases of stroke were included. Overall, higher SUA levels were associated with a significantly better outcome of ischemic stroke (OR, 1.13; 95% CI, 1.07-1.18; P<0.00001). For patients receiving thrombolytic therapy, a subgroup meta-analysis showed a positive association between SUA level and patient outcome (OR, 1.26; 95% CI, 1.14-1.40; P<0.00001). In addition, the pooled estimate of patients with a modified Rankin Scale score ≤2 at 90 days also showed a positive association (OR, 1.07; 95% CI, 1.01-1.133; P<0.00001). Furthermore, we found that the average SUA level in patients with a good outcome was higher than in those with a poor outcome (mean difference, 0.24 µmol/L; 95% CI, 0.16-0.32; P<0.00001).

Conclusions:

This meta-analysis suggested that there was a significant positive association between SUA level and the outcome of ischemic stroke.
The Public’s Preferences on Plastic Surgery Social Media Engagement and Professionalism: Demystifying the Impact of Demographics
Authors: Fan Kenneth L. , Graziano Francis , Economides James M. , Black Cara K. , Song David H.
Published: July 2019

Background:

Social media discussions are alive among plastic surgeons. This article represents a primer on beginning to understand how the public would seek out plastic surgeons and how demographics shape their preferences.

Methods:

An anonymous 31-question survey was crowdsourced by means of MTurk.

Results:

There were a total of 527 respondents. Of these respondents, 33 percent follow plastic surgeons on social media, with those aged younger than 35 years 3.9 times more likely to do so. Google was the first place people would look for a plastic surgeon (46 percent). When asked what was the most influential of all online methods for selecting a surgeon, practice website ranked first (25 percent), but social media platforms ranked higher as a whole (35 percent). Those considering surgical or noninvasive procedures are thee times more likely to select social media platforms as the most influential online method in selecting a surgeon and five times more likely to follow a plastic surgeon on social media. The majority would prefer not seeing the surgeon’s private life displayed on social media (39 percent). Respondents were evenly split regarding whether graphic surgical images would lead them to unfollow accounts. Ninety-six percent of the general public were unclear of the type of board certification a plastic surgeon should hold.

Conclusions:

Clear differences in engagement and perception exist in the public based on age, sex, parental status, and reported country of origin. Social media will soon become a critical strategy in outreach and engagement and a valuable tool in clearing misconceptions within plastic surgery.
Efficacy of Surgical Treatment of Migraine Headaches Involving the Auriculotemporal Nerve (Site V)
Authors: Long Tobias , Ascha Mona , Guyuron Bahman
Published: July 2019

Background:

This study reports the surgical technique and efficacy of treatment for the less commonly studied auriculotemporal nerve (site V). The aim was to evaluate symptom relief and differences in migraine headache parameters (i.e., intensity, duration, and migraine-free days) after site V surgery.

Methods:

Patients undergoing site V surgery for auriculotemporal nerve–triggered migraine headaches were analyzed. Charts were reviewed retrospectively for age, sex, dates of surgery and follow-up, preoperative migraine data, types of surgery, and laterality. Postoperatively, patients completed a migraine headache questionnaire by means of office visit, phone, e-mail, or video conference.

Results:

Forty-three patients were included in the study (36 women; median age, 50 years; interquartile range, 40 to 57 years). The majority of patients underwent bilateral surgery (n = 36) and reported site-specific relief (n = 34). The average follow-up was 17.2 months. The number of migraine-free days (per month) increased from 12.6 days before surgery to 25.1 days after surgery (median increase, 12.6 days; p < 0.005). Median migraine intensity scores decreased from 8.3 to 3.2 after surgery (median decrease, 5.1; p < 0.005) on 10-point severity scale. Migraine duration decreased from 1.2 hours/day to 0.5 hour/day after surgery (median decrease, 0.7 hour/day, p < 0.005). The median difference in migraine duration was the only value found not to be statistically significant, defined as p < 0.005. On both univariate and multivariate analyses, patient-reported site relief was significantly associated with decreased migraine intensity.

Conclusions:

Surgery for auriculotemporal nerve–triggered migraine headaches improves migraine headache parameters. This study is the first to examine surgical efficacy of this less commonly studied trigger site.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A Head-to-Head Comparison of the Vascular Basis of the Transverse Myocutaneous Gracilis, Profunda Artery Perforator, and Fasciocutaneous Infragluteal Flaps: An Anatomical Study
Authors: Zaussinger Maximilian , Tinhofer Ines E. , Hamscha Ulrike , Meng Stefan , Weninger Wolfgang J. , Pollhammer Michael S. , Huemer Georg M. , Schmidt Manfred
Published: July 2019

Background:

Perforator flaps of the upper thigh or buttock provide a valuable secondary choice in autologous breast reconstruction. The purpose of this study was to compare the vascular territories and supplying vessels of the transverse myocutaneous gracilis flap, the profunda artery perforator flap, and the fasciocutaneous infragluteal flap.

Methods:

In total, 26 lower limbs from 13 fresh specimens were investigated. All flap pedicles were selectively injected with methylene blue, eosin red, or green ink. The pedicle external diameters, lengths, and locations were measured. The dimensions of angiosomes, their intraindividual and interindividual correlations, and their relations to anatomical landmarks were analyzed.

Results:

The profunda artery perforator pedicle had the greatest mean external diameter with 3.6 ± 0.7 mm, followed by the transverse myocutaneous gracilis and fasciocutaneous infragluteal pedicles with 2.9 ± 0.6 mm and 2.9 ± 0.7 mm, respectively. The fasciocutaneous infragluteal pedicle was longest with a mean length of 12.5 ± 1.5 cm, whereas the profunda artery perforator and transverse myocutaneous gracilis pedicles had lengths of 8.8 ± 1.0 cm and 6.7 ± 1 cm on average. The profunda artery perforator angiosome provided the largest size, with a mean area of 98.5 ± 26.7 cm2, followed by the fasciocutaneous infragluteal angiosome (77.2 ± 9.0 cm2) and the transverse myocutaneous gracilis angiosome (74.1 ± 32.1 cm2).

Conclusions:

The authors’ anatomical findings about the transverse myocutaneous gracilis, profunda artery perforator, and fasciocutaneous infragluteal territories provide clinically valuable data for flap selection in breast reconstruction if an abdominal flap is not feasible.
Redefining the Role of Resection Weight Prediction in Reduction Mammaplasty and Breaking the “One-Scale-Fits-All” Paradigm
Authors: Boukovalas Stefanos , Padilla Pablo L. , Spratt Heidi , Tran Jacquelynn P. , Li Ramon T. , Boson Alexis L. , Howland Nicholas , Phillips Linda G.
Published: July 2019

Background:

Reduction mammaplasty is a highly effective procedure for treatment of symptomatic macromastia. Prediction of resection weight is important for the surgeon and the patient, but none of the current prediction models is widely accepted. Insurance carriers are arbitrarily using resection weight to determine medical necessity, despite published literature supporting that resection weight does not correlate with symptomatic relief. What is the most accurate method of predicting resection weight and what is its role in breast reduction surgery?

Methods:

The authors conducted a retrospective review of patients who underwent reduction mammaplasty at a single institution from 2012 to 2017. A senior biostatistician performed multiple regression analysis to identify predictors of resection weight, and linear regression models were created to compare each of the established prediction scales to actual resected weight. Patient outcomes were evaluated.

Results:

Three-hundred fourteen patients were included. A new prediction model was created. The Galveston scale performed the best (R
2 = 0.73; p < 0.001), whereas the Schnur scale performed the worst (R
2 = 0.43; p < 0.001). The Appel and Descamps scales had variable performance in different subcategories of body mass index and menopausal status (p < 0.01). Internal validation confirmed the Galveston scale’s best predictive value; 38.6 percent and 28.9 percent of actual breast resection weights were below Schnur prediction and 500-g minimum, respectively, yet 97 percent of patients reported symptomatic improvement or relief.

Conclusions:

The authors recommend a patient-specific and surgeon-specific approach for prediction of resection weight in breast reduction. The Galveston scale fits the best for older patients with higher body mass indices and breasts requiring large resections. Medical necessity decisions should be based on patient symptoms, physical examination, and the physician’s clinical judgment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
Poly(ε-Caprolactone) Nanofiber Wrap Improves Nerve Regeneration and Functional Outcomes after Delayed Nerve Repair
Authors: Lopez Joseph , Xin Kevin , Quan Amy , Xiang Sinan , Leto Barone Angelo A. , Budihardjo Joshua , Musavi Leila , Mulla Sara , Redett Richard , Martin Russell , Mao Hai-Quan , Lee W. P. Andrew , Ibrahim Zuhaib , Brandacher Gerald
Published: July 2019

Background:

The purpose of this study was to assess the efficacy of biodegradable, electrospun poly(ε-caprolactone) nanofiber nerve conduits in improving nerve regeneration.

Methods:

The authors used a rat forelimb chronic denervation model to assess the effects of poly(ε-caprolactone) conduits on improving nerve regeneration and upper extremity function. Three groups of rats were examined: (1) negative-control animals (n = 5), which underwent 8 weeks of median nerve chronic denervation injury followed by repair with no conduit; (2) experimental animals (n = 5), which underwent 8 weeks of median nerve chronic denervation followed by repair and poly(ε-caprolactone) nerve conduit wrapping of the nerve coaptation site; and (3) positive-control animals (n = 5), which were naive controls. All animals underwent compound muscle action potential and functional testing. At 14 weeks after repair, the median nerve and flexor muscles were harvested for histologic analysis.

Results:

Histomorphometric analysis of regenerating median nerves demonstrated augmented axonal regeneration in experimental versus negative control animals (total axon count, 1769 ± 672 versus 1072 ± 123.80; p = 0.0468). With regard to functional recovery, experimental and negative-control animals (1.67 ± 0.04 versus 0.97 ± 0.39; p = 0.036) had regained 34.9 percent and 25.4 percent, respectively, of baseline hand grip strength at 14 weeks after repair. Lastly, less collagen deposition at the nerve coaptation site of experimental animals was found when compared to control animals (p < 0.05).

Conclusion:

Biodegradable, poly(ε-caprolactone) nanofiber nerve conduits can improve nerve regeneration and subsequent physiologic extremity function in the setting of delayed nerve repair by decreasing the scar burden at nerve coaptation sites.
CLEFT-Q: Detecting Differences in Outcomes among 2434 Patients with Varying Cleft Types
Authors: Wong Riff Karen W. Y. , Tsangaris Elena , Forrest Christopher R. , Goodacre Tim , Longmire Natasha M. , Allen Gregory , Courtemanche Douglas J. , Goldstein Jesse , O’Mahony Aisling , Pusic Andrea L. , Slator Rona , Swan Marc C. , Thoma Achilleas , Vargas Federico , Klassen Anne F.
Published: July 2019

Background:

Measuring the patient perspective is important in evaluating outcomes of cleft care. Understanding how treatment outcomes vary depending on cleft type may allow for better planning of treatments, setting of expectations, and more accurate benchmarking efforts. The CLEFT-Q is a patient-reported outcome measure for patients with cleft lip and/or palate.

Methods:

The 12 CLEFT-Q scales measuring appearance (i.e., face, nose, nostrils, lips, cleft lip scar, teeth, and jaws), function (i.e., speech), and health-related quality of life (i.e., psychological, school, social, and speech-related distress) were field tested in a cross-sectional study in 30 centers in 12 countries. Patients with cleft lip and/or cleft palate aged 8 to 29 years were recruited from clinical settings. Differences in CLEFT-Q scores by cleft subtypes were evaluated using one-way analysis of variance or Kruskal-Wallis H tests, with Tukey or Dunn procedure with Bonferroni corrections post hoc analyses, respectively. Scores are presented using radar charts to visualize all outcomes simultaneously.

Results:

The field test included 2434 patients. Scores on all CLEFT-Q scales varied significantly with cleft subtype. Patients with unilateral or bilateral cleft lip and/or palate scored lower on all appearance scales compared with patients with cleft palate or unilateral incomplete cleft lip. Scores on the speech function and speech-related distress scales decreased with each progressive group in the Veau classification. Patients with complete bilateral cleft lip and palate scored lowest on the social, school, and psychological scales.

Conclusions:

Patient-reported outcomes measured with the CLEFT-Q vary significantly with cleft type. Visualizing multiple outcomes simultaneously with radar charts allows for an understanding of a patient’s overall status in a single graph.
Primary Open Rhinoplasty
Authors: Rohrich Rod J. , Afrooz Paul N.
Published: July 2019

Learning Objectives:

After studying this article and viewing the videos, the participant should be able to: 1. Describe the operative technique necessary to perform open rhinoplasty. 2. Summarize the steps necessary in performing a component dorsal reduction. 3. Develop a surgical plan for nasal tip shaping and cephalic rotation of the nasal tip. 4. Identify the need for aesthetic improvement of the alar base, and perform successful alar base surgery. 5. Demonstrate consistency, safety, and predictability in rhinoplasty.

Rhinoplasty remains one of the most challenging procedures in plastic surgery, and continues to be one of the top five aesthetic surgical procedures, with over 223,000 performed in 2016. Rhinoplasty may be performed by means of the “open” or the “closed” approach, and each approach has its advantages and disadvantages. This article focuses on the open approach, and the principles and techniques necessary to achieve consistent and gratifying results. As with all plastic surgery procedures, successful rhinoplasty begins with a thorough clinical analysis, definition of the goals, meticulous preoperative planning, precise operative execution, vigilant postoperative management, and a critical analysis of one’s results.
The Importance of Tissue Perfusion in Reconstructive Breast Surgery
Authors: Frey Jordan D. , Salibian Ara A. , Choi Mihye , Karp Nolan S.
Published: July 2019

Immediate breast reconstruction relies on healthy mastectomy flaps for success. Tissue perfusion of these mastectomy flaps is dependent on multiple patient-, operative-, and surgeon-specific factors, which must be optimized. Unfortunately, tissue perfusion is also notoriously difficult to accurately assess and investigate. In this review, we discuss the importance of tissue perfusion in successful reconstructive breast surgery with an emphasis on perfusion assessment and techniques to ensure that anatomic mastectomy flap perfusion is maintained for immediate breast reconstruction after mastectomy. Preoperative and patient-specific factors should be considered with operative plans modified to minimize ischemic risk. Intraoperatively, incision planning and mastectomy dissection will dictate skin flap perfusion. Most importantly, mastectomy dissection in a plane at the breast capsule will maximize preservation of the subdermal plexus and subcutaneous perforators that supply the breast skin envelope while also maximizing oncologic parenchymal resection. Such anatomic dissection has been demonstrated to decrease risk of ischemic complications in immediate breast reconstruction. Postoperatively, any potential or actual areas of impaired perfusion and ischemia must be diagnosed appropriately and managed proactively to ensure a successful reconstruction. It is also important for surgeons to be aware of imaging modalities and adjunctive technologies that can help promote and assess optimal mastectomy flap tissue perfusion. Plastic surgeons and breast surgeons must actively and collaboratively work together to ensure their mutual goals are met, and optimal outcomes are attained for patients undergoing immediate breast reconstruction after mastectomy.
Outcomes Utilizing Inspira Implants in Revisionary Reconstructive Surgery
Authors: Sigalove Steven , Maxwell G. Patrick , Gabriel Allen
Published: July 2019

Background:

Inspira round implants have a higher fill ratio than standard round implants and the 3 available implant types have increasing gel cohesivity. Collectively, these features may help provide a fuller upper pole and help reduce the risk of rippling, visible implant edges, and palpability and may be particularly beneficial in patients undergoing prepectoral reconstruction. Patient outcomes after prepectoral revision reconstruction with these implants are reviewed in this study.

Methods:

This retrospective study included consecutive patients who had previously undergone subpectoral (dual plane), implant-based, breast reconstruction and presented for revision reconstruction between June 2015 and January 2018. Reasons for revision included animation deformity, pain, asymmetry implant malposition, size change, capsular contracture, and rippling. Revision reconstruction involved implant removal, site change from subpectoral to prepectoral, and immediate implant replacement in all patients. Complications after revision reconstruction were obtained from patient records.

Results:

A total of 64 patients (124 breasts) met the inclusion criteria. During a mean follow-up period of 18.9 months, complications occurred in 4 breasts (3.2%) and included implant loss (1.6%), seroma (1.6%), hematoma (0.8%), surgical site infection (0.8%), and skin necrosis (0.8%). There was no incidence of capsular contracture and presenting complaints were resolved in all cases.

Conclusions:

Prepectoral reconstruction, in conjunction with Inspira round implants, appears to be a safe and effective approach in suitable patients presenting for revision surgery, at least in the short term. Implant features facilitate prepectoral implant placement, resulting in pleasing aesthetic outcomes. Whether these outcomes will withstand the test of time remains to be seen.
Round Form-Stable Breast Implants: Diagnosis and Management of Complications
Authors: Nahabedian Maurice Y.
Published: July 2019

Silicone gel breast implants have been used for breast augmentation and reconstruction since 1962. Since then, multiple generations of implants have been created in an effort to improve safety and efficacy. Before 1990, silicone gel implants were characterized as having thin shells and non-cohesive gel; however, since then devices are created with cohesive silicone gel and a variety of surfaces. Despite improvements, no implant will last forever; however, these devices are safe and effective based on numerous clinical and epidemiologic studies. As with all medical devices, complications using round form-stable implants for breast reconstruction can occur and will be reviewed in this article.
PrEP Use Among Female Sex Workers: No Evidence for Risk Compensation
Authors: Giguère Katia , Béhanzin Luc , Guédou Fernand A. , Talbot Denis , Leblond François A. , Goma-Matsétsé Ella , Zannou Djimon M. , Affolabi Dissou , Kêkê René K. , Gangbo Flore , Bachabi Moussa , Alary Michel
Published: July 2019

Background:

Little is known about risk compensation among female sex workers (FSW) on HIV pre-exposure prophylaxis (PrEP), and self-report of sexual behaviors is subject to bias.

Setting:

Prospective observational PrEP demonstration study conducted among FSW in Cotonou, Benin.

Methods:

Over a period of 24 months, we assessed and compared trends in unprotected sex as measured by self-report (last 2 or 14 days), by detection of sexually transmitted infections (STIs), and by vaginal detection of prostate-specific antigen and Y-chromosomal DNA, 2 biomarkers of semen exposure in the last 2 or 14 days, respectively. Trends were assessed and compared using a log-binomial regression that was simultaneously fit for all unprotected sex measures.

Results:

Of 255 participants, 120 (47.1%) completed their follow-up. Prevalence of STI decreased from 15.8% (95% confidence interval: 11.8% to 21.0%) at baseline to 2.1% (95% confidence interval: 0.4% to 10.2%) at 24 months of follow-up (P-trend = 0.04). However, we observed no trend in self-report of unprotected sex in the last 2 (P = 0.42) or 14 days (P = 0.49), nor in prostate-specific antigen (P = 0.53) or Y chromosomal DNA (P = 0.25) over the same period. We observed no statistically significant difference between trends in self-report of unprotected sex and trends in biomarkers of semen exposure in the last 2 days (P = 0.14) or in the last 14 days (P = 0.29).

Conclusions:

We observed no evidence of risk compensation, and a decrease in STI among FSW on PrEP. PrEP intervention may be an opportunity to control STI among FSW. Future studies should assess risk compensation with biomarkers of semen exposure when possible.
Predictors of Cost and Incidence of 30-Day Readmissions Following Hospitalizations for Schizophrenia and Psychotic Disorders: A Nationwide Analysis
Authors: Wani Rajvi J. , Kathe Niranjan J. , Klepser Donald G.
Published: July 2019

Background:

Schizophrenia and psychotic disorders (SPDs)-related hospitalizations are the second leading cause of 30-day readmission. This study assessed the effect of patient and hospital-level factors on readmission costs following index hospital discharges for SPDs.

Methods:

2014 Nationwide Readmissions Database was used to identify SPD-related discharges between January 1, 2014, and November 30, 2014. Multivariable logistic regression was used to estimate patient and hospital-level predictors for readmissions. A two part model was used to estimate the predictors of readmission and associated cost for index hospital discharges with SPDs.

Results:

A total of 77 625 of 343 579 (22%) index hospital discharges for SPDs resulted in readmissions. The average index and readmission costs were $9285 and $8593, respectively. Being 25 to 44 years old (odds ratio: 1.14), with nonmental comorbidities (odds ratio: 1.52), and admitted in private hospitals (odds ratio: 1.24) had significantly higher odds of readmission rates. Being males ($105), 25 to 44 years of age ($99), urban residents ($312), Medicare enrollees ($713 over privately insured), high-income area residents ($393), having multiple comorbidities ($923), and those admitted in large metropolitan ($680) and government-owned hospitals ($417) had higher costs of readmission.

Conclusion:

The high SPD-related readmission rates can be reduced by providing integrated behavioral health services for this high-risk cohort.
Combining Clinical Characteristics and Specific Magnetic Resonance Imaging Features to Predict Placenta Accreta
Authors: Chu Caiting , Zhao Shuhui , Ding Ming , Liu Ming , Zhang Yuzheng , Bao Lei , Wang Dengbin , Li Wenhua
Published: July 2019

Objective

The aim of this study was to explore the independent clinical and magnetic resonance imaging (MRI) performance risk factors for predicting placenta accreta.

Methods

From January 2012 to December 2015, we retrospectively reviewed the clinical characteristics and MRI features of 97 patients. Of these, 42 were confirmed to be placenta accreta by pathological results or cesarean delivery findings. We tried to identify the independent risk factors by multivariate logistic regression model for significant differences in variables determined by univariate analysis.

Results

The multivariate logistic regression model indicated that 2 or more instances of previous cesarean deliveries and/or abortions, placenta previa, and placenta-myometrial interface interruption were independent risk factors for placenta accreta. The odd ratios were 3.79 for patients who had 2 or more instances of previous cesarean deliveries and/or abortions, 0.04 for marginal/partial placenta previa, 0.024 for complete placenta previa, and 6.56 for placenta-myometrial interface interruption. The values of accuracy and positive prediction by combination of a single clinical risk factor and placenta-myometrial interface interruption and of positive prediction by a combination of all 3 risk factors for predicting placenta accreta were raised to 83.5%, 75%, and 92.9%, respectively. We obtained 3 different risk groups by different combinations of all 3 risk factors.

Conclusions

The study suggested that 2 or more instances of previous cesarean deliveries and/or abortion, placenta previa, and placenta-myometrial interface interruption were independent risk factors for placenta accreta. A combination of a single clinical risk factor and an MRI risk factor can improve the diagnosis of placenta accreta, and a combination of all 3 risk factors could help recognize patients with placenta accreta.
Differentiation of Gastric Schwannoma From Gastric Gastrointestinal Stromal Tumor With Dual-Phase Contrast-Enhanced Computed Tomography
Authors: Li Ruimin , Gan Hualei , Ni Shujuan , Fu Yi , Zhu Hui , Peng Weijun
Published: July 2019

Objective

To identify the computed tomographic features to differentiate gastric schwannoma from gastric gastrointestinal stromal tumor.

Methods

Computed tomographic images of 103 pathologically confirmed patients with gastric schwannoma (n = 23) or gastric gastrointestinal stromal tumor (n = 80) were retrospectively studied. Sex, morphology, location, border, growth pattern, enhancement pattern, necrosis, calcification, ulceration, and perigastric lymph nodes were analyzed. Age, short diameter, long diameter, and the degree of enhancement were measured. Statistical analyses were performed, and receiver operating characteristic curve, sensitivity, and specificity values were analyzed.

Results

Female, age younger than 57.5 years, round or ovoid morphology, extraluminal growth, homogeneous enhancement, lack of necrosis, presence of perigastric lymph nodes, and an enhancement degree of less than 15.4 Hounsfield units in the arterial phase were significant variables for differentiating gastric schwannoma from gastric gastrointestinal stromal tumor (P < 0.05).

Conclusions

Dual-phase contrast-enhanced computed tomography can help to differentiate gastric schwannoma from gastric gastrointestinal stromal tumor.
Diffuse Pulmonary Metastases From Prostate Cancer on 68Ga PSMA PET/CT
Authors: Seniaray Nikhil , Verma Ritu , Belho Ethel , Malik Dharmender , Mahajan Harsh
Published: July 2019

A 63-year-old man, recently diagnosed with carcinoma of the prostate (Gleason’s score 4+4), with serum prostate-specific antigen 189.2 ng/mL, underwent 68Ga PSMA PET/CT scan for pretreatment staging. The study revealed abnormal tracer uptake in the prostatic bed region, the pelvic, abdominal, and mediastinal lymph nodes and diffuse metastases to the bilateral lungs. The lung metastasis was proved to be metastatic adenocarcinoma from analysis of bronchoalveolar lavage.
The Innovator of Electrosurgery
Authors: Marrero Katie , Fingeret Abbey
Published: July 2019

Hemostasis has been a major risk in the surgical field, causing Halsted to preach for the need for better control of bleeding to improve the morbidity and mortality many surgeons faced at the time. This problem, while combated by suturing methods for many, remained an issue in the neurosurgical field. Dr. Cushing sought out the help of William Bovie, leading to the creation of electrosurgery. This invention changed the way surgery could be performed and remains to be a mainstay in the operating room and countless other procedures, withstanding the test of time and proving its importance in the surgical world.
Narcotic Free Cervical Endocrine Surgery
Authors: Ruffolo Luis I. , Jackson Katherine M. , Juviler Peter , Kaur Roma , Chennell Todd , Glover Danielle M. , Linehan David C. , Moalem Jacob
Published: July 2019

Background and Objective:

The opioid epidemic has stimulated initiatives to reduce the number of unnecessary narcotic prescriptions. We adopted an opt-in prescription system for patients undergoing ambulatory cervical endocrine surgery (CES). We hypothesized that empowering patients to decide whether or not to receive narcotics for pain control would result in fewer unnecessary opioid prescriptions.

Methods:

We enrolled all patients scheduled for outpatient CES between July 2017 and June 2018 in a narcotic opt-in program. Patient demographics, procedure characteristics, and postoperative pain scores were collected prospectively. Statistical analyses were performed to correlate clinical predictors with narcotic request. Results were compared against a historical control group. The study was approved by the University IRB.

Results:

A total of 216 consecutive patients underwent outpatient CES following implementation of the program. Only nine (4%) requested prescription narcotic medication at discharge, and no patient called after discharge to request analgesic medications. Compared with our prior treatment paradigm, we achieved a 96.6% reduction in the number of narcotic tablets prescribed, and a 98% reduction in unconsumed tablets. Univariate analysis suggested history of substance abuse (P < 0.001), anxiety (P = 0.01), depression (P < 0.001), baseline narcotic use (P = 0.004), highest pain postoperatively (P = 0.004), and incision length (P = 0.007) as predictive for narcotic request. Multivariate analysis retained significance with incision length and history of substance abuse.

Conclusion:

By empowering patients undergoing ambulatory CES to accept or decline a prescription, we reduced the number of prescribed narcotic tablets by 96.6%. Although longer incisions and prior substance abuse predict higher likelihood of requesting pain medication on discharge, 207 of 216 patients were treated with acetaminophen alone.
Perioperative FOLFOX 4 Versus FOLFOX 4 Plus Cetuximab Versus Immediate Surgery for High-Risk Stage II and III Colon Cancers
Authors: Karoui M. , Rullier A. , Piessen G. , Legoux J. L. , Barbier E. , De Chaisemartin C. , Lecaille C. , Bouche O. , Ammarguellat H. , Brunetti F. , Prudhomme M. , Regimbeau J. M. , Glehen O. , Lievre A. , Portier G. , Hartwig J. , Goujon G. , Romain B. , Lepage C. , Taieb J.
Published: July 2019

Background:

Perioperative chemotherapy has proven valuable in several tumors, but not in colon cancer (CC).

Objective:

The aim of this study was to evaluate the efficacy and safety of perioperative chemotherapy in patients with locally advanced nonmetastatic CC.

Methods:

This is a French multicenter randomized phase II trial in patients with resectable high-risk T3, T4, and/or N2 CC on baseline computed tomography (CT) scan. Patients were randomized to receive either 6 months of adjuvant FOLFOX after colectomy (control) or perioperative FOLFOX for 4 cycles before surgery and 8 cycles after (FOLFOX peri-op). In RAS wild-type patients, a third arm testing perioperative FOLFOX-cetuximab was added. Tumor Regression Grade (TRG1) of Ryan et al was the primary endpoint. Secondary endpoints were toxicity, perioperative morbidity, and quality of surgery.

Results:

A total of 120 patients were enrolled. At interim analysis, the FOLFOX-cetuximab arm was stopped (lack of efficacy). The remaining 104 patients (control, n = 52; FOLFOX preop n = 52) represented our intention-to-treat population. In the FOLFOX perioperative group, 96% received the scheduled 4 cycles before surgery. R0 resection and complete mesocolic excision rate were 94% and 93%, respectively. Overall mortality and morbidity rates were similar in both groups. Perioperative FOLFOX chemotherapy did not improve major pathological response rate (TRG1 = 8%) but was associated with a significant pathological regression (TRG1-2 = 44% vs 8%, P < 0.001) and a trend to tumor downstaging as compared to the control group. CT scan criteria were associated with a 33% rate of overstaging in control group.

Conclusions:

Perioperative FOLFOX for locally advanced resectable CC is feasible with an acceptable tolerability but is not associated with an increased major pathological response rate as expected. However, perioperative FOLFOX induces pathological regression and downstaging. Better preoperative staging tools are needed to decrease the risk of overtreating patients
An Assessment of Patient, Caregiver, and Clinician Perspectives on the Post-discharge Phase of Care
Authors: Dowzicky Phillip M. , Shah Arnav A. , Barg Frances K. , Eriksen Whitney T. , McHugh Matthew D. , Kelz Rachel R.
Published: July 2019

Objective:

We sought to elicit patients’, caregivers’, and health care providers’ perceptions of home recovery to inform care personalization in the learning health system.

Summary Background Data:

Postsurgical care has shifted from the hospital into the home. Daily care responsibilities fall to patients and their caregivers, yet stakeholder concerns in these heterogeneous environments, especially as they relate to racial inequities, are poorly understood.

Methods:

Surgical oncology patients, caregivers, and clinicians participated in freelisting; an open-ended interviewing technique used to identify essential elements of a domain. Within 2 weeks after discharge, participants were queried on 5 domains: home independence, social support, pain control, immediate, and overall surgical impact. Salience indices, measures of the most important words of interest, were calculated using Anthropac by domain and group.

Results:

Forty patients [20 whites and 20 African-Americans (AAs)], 30 caregivers (17 whites and 13 AAs), and 20 providers (8 residents, 4 nurses, 4 nurse practitioners, and 4 attending surgeons) were interviewed. Patients and caregivers attended to the personal recovery experience, whereas providers described activities and individuals associated with recovery. All groups defined surgery as life-changing, with providers and caregivers discussing financial and mortality concerns. Patients shared similar thoughts about social support and self-care ability by race, whereas AA patients described heterogeneous pain management and more hopeful recovery perceptions. AA caregivers expressed more positive responses than white caregivers.

Conclusions:

Patients live the day-to-day of recovery, whereas caregivers and clinicians also contemplate more expansive concerns. Incorporating relevant perceptions into traditional clinical outcomes and concepts could enhance the surgical experience for all stakeholders.
Is Bigger Better?
Authors: Cerullo Marcelo , Sheckter Clifford C. , Canner Joseph K. , Rogers Selwyn O. , Offodile Anaeze C.
Published: July 2019

Objectives:

To examine the relationship between hospital market competition and inpatient costs, procedural markup, inpatient complications, and length of stay among privately insured patients undergoing immediate reconstruction after mastectomy.

Methods:

A retrospective cross-sectional analysis of privately insured female patients undergoing immediate breast reconstruction in the 2009 to 2011 Nationwide Inpatient Sample was performed. The Herfindahl–Hirschman index was used to describe hospital market competition; associations with outcomes were explored via hierarchical models adjusting for patient, hospital, and market characteristics.

Results:

A weighted total of 42,411 patients were identified; 5920 (14.0%) underwent free flap reconstruction. In uncompetitive markets, 6.8% (n=857) underwent free flap reconstruction, compared with 13.6% (n=2773) in highly competitive markets and 24.6% (n=2290) in moderately competitive markets. For every 5 additional hospitals in a market, adjusted costs were 6.6% higher (95% CI: 2.8%–10.5%), for free flap reconstruction, and 5.1% higher (95% CI: 2.0%–8.4%) for nonfree flap reconstruction. Similarly, higher procedural markup was associated with increased hospital market competition both for nonfree flap reconstruction (5.5% increase, 95% CI: 1.1%–10.1%) and for free flap reconstruction (8.2% increase, 95% CI: 1.8%–15.0%). Notably, there was no association between incidence of inpatient complications or extended length of stay and hospital market competition among either free flap or nonfree flap reconstruction patients.

Conclusions:

Decreasing market competition was associated with lower inpatient costs and equivocal clinical outcomes. This suggests that some of the economies of scale, access to capital and care delivery efficiencies gained from increased market power following hospital mergers are passed onto payers and consumers as lower costs.
Survival and Scoliosis Following Resection of Chest Wall Tumors in Children and Adolescents
Authors: Saltsman James A. , Danzer Enrico , Hammond William J. , Rhee Daniel , Berhe Simon , Monteagudo Julie , Price Anita P. , Heaton Todd E. , Jones David R. , LaQuaglia Michael P.
Published: July 2019

Objective:

We reviewed our experience with pediatric chest wall tumors (CWTs) to identify variables associated with survival, scoliosis development, and need for corrective scoliosis surgery.

Background:

Chest wall neoplasms in children or adolescents are rare. Consequently, there are few large series that detail survival or quality of life indicators, like scoliosis.

Methods:

Medical records were reviewed for all chest wall resections for primary and metastatic CWT performed from October 1, 1986 to September 30, 2016 on patients 21 years or younger at diagnosis. Kaplan-Meier distributions were compared using the log-rank test. Variables correlated with survival, scoliosis development, or need for corrective surgeries were analyzed using competing-risk analysis.

Results:

Seventy-six cases [57 (75%) primary, 19 (25%) metastatic] were identified. Median age at diagnosis was 15.6 years (range: 0.5–21 years). Tumor types were Ewing sarcoma family tumors (54%), other soft tissue sarcomas (21%), osteosarcoma (11%), rhabdomyosarcoma (7%), and other (8%). A median of 3 (range: 1–5) contiguous ribs were resected. Surgical reconstruction included composite Marlex mesh and methyl-methacrylate, Gore-Tex, or primary closure in 57%, 28%, and 14% of procedures, respectively. Overall 5-year survival was 61% (95% confidence interval: 50%–75%). Scoliosis developed in 19 (25%) patients; 6 patients required corrective surgery. Variables associated with overall survival were the presence of metastatic disease at diagnosis, and whether the chest tumor itself was a primary or metastatic lesion. Younger age at chest wall resection was associated with the need for corrective surgery in patients who developed scoliosis.

Conclusions:

Among pediatric and adolescent patients with CWTs, survival depends primarily on the presence of metastases. Age, type of chest wall reconstruction, and tumor size are not associated with scoliosis development. Among patients who develop scoliosis, younger patients are more likely to require corrective surgery.
You’re How Old? Correlating Perioperative Complication Risk in Octogenarians Undergoing Colpocleisis for Pelvic Organ Prolapse
Authors: Sifuentes Romina , Wolff Birte Johanna , Barnes Hayley Catherine , Wozniak Amy , Mueller Elizabeth R. , Pham Thythy T.
Published: July 2019

Objectives

Colpocleisis is a surgical treatment of pelvic organ prolapse for elderly women who are no longer sexually active. The risk calculator of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) predicts perioperative complications. We aim to determine if the NSQIP calculated risk correlates with true perioperative complications in women 80 years or older undergoing colpocleisis.

Methods

Octogenarian women who underwent colpocleisis at our institution from 2007 to 2017 were included in this retrospective chart review. Medical comorbidities were entered into ACS NSQIP calculator, and the calculated risk was compared with actual complications.

Results

One hundred twenty-six octogenarians were included in the analysis. The true complication rate was higher than predicted by NSQIP (28.6% [36/126] vs 4.3% (SD, ±1.1%), which we attribute to our relatively high detection rate of urinary tract infection (32/36). Four patients (3.2%) had serious complications (pulmonary embolus, deep vein thrombosis, sepsis, and reintubation). In only 57% of cases, NSQIP risk calculation was concordant with true complication, showing significant departure from correct classification (P < 0.0001). The sensitivity and specificity of the NSQIP calculator were 66.7% and 53.3%, respectively. Multivariable analysis showed higher-than-predicted incidence of complications for patients requiring antiplatelet medication (Plavix or aspirin >81 mg vs none; odds ratio, 4.84, 95% confidence interval, 1.72–13.60; P = 0.002) and a diagnosis of hypertension (odds ratio, 4.24; 95% confidence interval, 1.31–13.72; P = 0.016).

Conclusion

Serious complication rates are low in octogenarians undergoing colpocleisis. The ACS NSQIP risk calculator does not strongly correlate with actual complications. Further refinement and evolvement of the database may improve its predictive value.
The Modified Valsalva Maneuver for Reversion of Stable Supraventricular Tachycardia
Authors: Davis Wesley D. , Norris Kimberly C. , Fiebig William
Published: July 2019

The REVERT trial was a randomized multicenter trial that investigated the efficacy of using a modified Valsalva maneuver for the reversion of stable supraventricular tachycardia back to a sinus rhythm. Although no improvement in discharge to home from the emergency department (ED) or ED length of stay was observed, the REVERT trial demonstrated that the modified Valsalva maneuver was superior to the standard Valsalva maneuver. The modified Valsalva maneuver should be considered first-line treatment for patients who present with a stable supraventricular tachycardia. A case presentation illustrates the methodology for utilizing the modified Valsalva maneuver to treat supraventricular tachycardia in a hemodynamically stable patient who presents to the ED.