bluuebunny/crossref_metadata_2025 huggingface dataset:
LUMBAR SPINE RADIOGRAPHY: LOWER ORGAN DOSE WITH THE USE OF PA PROJECTION
Authors: Alukić Erna , Mekiš Nejc
Published: March 2019

The purpose of the research was to determine the effect of the posteroanterior (PA) patient position in lumbar spine imaging on effective dose and the absorbed organ dose. The study was performed on 100 patients that were referred to the lumbar spine radiography that were divided into two equal groups of 50. Body Mass Index, Dose Area Product (DAP), exposure index (EXI), tube time-current (mAs), image field size and the source-patient distance were acquired for each patient. The entrance surface dose (ESD), the effective dose and the absorbed organ doses were calculated. There was no statistically significant difference in the BMI and EXI between the AP and PA projection. The results showed a significant reduction of ESD by 33% and the effective dose by 53% when the PA projection was used. Furthermore, there was a 64% average reduction of the absorbed organ doses to the selected organs.
How to evaluate innovation strategies with a transformative ambition? A proposal for a structured, process-based approach
Authors: Kroll Henning
Published: March 2019

In recent years, policymakers have increased their ambitions to shape the development of national and regional innovation systems. More often than was, innovation strategies now come with the ambition to support economic transformation and societal change in a way that requires the rearrangement of existing policy mixes. With a view to policy assessment, these developments raise new, so far untackled challenges. Against this background, this article illustrates that standard approaches to programme evaluation must be unfit to assess overarching strategies. It finds that this is not only a function of their complexity but also of the open-ended nature of processes required to translate strategic ambitions into concrete actions. To better grasp those, it puts forward a novel heuristic to structure our understanding of the discursive process preceding the definition of tangible policy measures at three levels: strategy agenda setting, thematic orientation, and instrumentation. Subsequently, it demonstrates how this approach helps localize and clarify instances of failure for later assessment. Based on a detailed case study, it underlines that efforts to ensure the consequential translation of ambitions into corresponding measures will lead to better results than the futile attempt to keep the resulting policy mixes free of any formal inconsistencies.
Perioperative management of immunosuppression in patients with rheumatoid arthritis
Authors: George Michael D. , Baker Joshua F.
Published: March 2019

Purpose of review

Patients with rheumatoid arthritis are at increased risk of infection after surgery. Recent literature has provided more data and updated guidelines to guide the management of immunosuppression in the perioperative period.

Recent findings

Studies over the past few years have confirmed that patients with rheumatoid arthritis are at increased risk of infection after surgery. Patients treated with biologics are at greater risk of postoperative infection, but this risk might be explained by the comorbidities and greater disease severity often seen in these patients. Recent observational studies have suggested that interruption of biologic therapies before surgery may not be associated with better outcomes. Glucocorticoids, however, have consistently been found to be risk factors for infection. Recent guidelines from the American College of Rheumatology/American Association of Hip and Knee Surgeons recommend continuing conventional disease-modifying drugs and holding biologics for one dosing interval before surgery.

Prolonged interruption of conventional and biologic therapies before surgery does not appear to substantially reduce infection risk. Guidelines now recommend continuing conventional DMARDs and holding biologics for just one dosing interval before surgery. Glucocorticoids are strongly associated with the risk of postoperative infection and should be minimized before surgery.
Socioeconomic Position and Health Outcomes Following Critical Illness: A Systematic Review
Authors: Jones Jennifer R. A. , Berney Sue , Connolly Bronwen , Waterland Jamie L. , Denehy Linda , Griffith David M. , Puthucheary Zudin A.
Published: March 2019

Objectives:

Systematically review evidence examining association between preadmission socioeconomic position and physical function, health-related quality of life and survival following critical illness.

Data Sources:

Four electronic databases (MEDLINE, Embase, CINAHL, CENTRAL) and personal libraries were searched. Reference lists of eligible articles were cross-checked.

Study Selection:

Primary quantitative studies reporting association between socioeconomic position and physical function, health-related quality of life, or survival of adults admitted to the ICU were included.

Data Extraction:

Performed by two reviewers independently in duplicate using a prepiloted data extraction form. Quality appraisal was completed by two reviewers independently in duplicate using standardized algorithms and checklists. The Preferred Reporting Items for Systematic Reviews guidelines were followed.

Data Synthesis:

From 1,799 records, 10 studies were included, one examining association of socioeconomic position with health-related quality of life and five with survival. Four studies accounted for socioeconomic position in survival analyses. Patients with lower socioeconomic position were found to have higher ICU, in-hospital, 30-day, and long-term mortality and lower 6-month Short Form-12 Mental Component Summary scores. No articles examined socioeconomic position and performance-based physical function. Notable variability in methods of socioeconomic position assessment was observed.

Conclusions:

Lower socioeconomic position is associated with higher mortality and lower 6-month Short Form-12 Mental Component Summary scores following critical illness. Effect on performance-based physical function is unknown. We make recommendations for consistent socioeconomic position measurement in future ICU studies.
Spindle Cell Predominant Trichodiscoma or Spindle Cell Lipoma With Adnexal Induction? A Study of 25 Cases, Revealing a Subset of Cases With RB1 Heterozygous Deletion in the Spindle Cell Stroma
Authors: Michalova Kvetoslava , Kutzner Heinz , Steiner Petr , Hadravsky Ladislav , Michal Michael , Michal Michal , Kazakov Dmitry V.
Published: March 2019

In our routine and consultative pathology practices, we have noticed that a relatively high proportion of spindle cell predominant trichodiscomas demonstrate a remarkable stromal admixture of adipose tissue, which along with spindle cells, prominent collagen bundles and myxoid change closely resembles spindle cell lipoma (SCL). To clarify their possible relationship to SCL, 25 cases of trichodiscoma and fibrofolliculoma with stromal “lipomatous metaplasia” were collected and examined using immunohistochemical stains [CD34 and retinoblastoma-1 (RB1) protein] and fluorescence in situ hybridization (RB1 deletion). The patients ranged in age from 35 to 81 years (median 64 years). The male to female ratio was almost equal (14:11). All tumors with a known location were situated on the face with a special predilection for the nose. All cases were sporadic, with all patients having a single lesion and showing no clinical features of Birt–Hogg–Dubé syndrome. No case with available follow-up presented with a recurrence or an otherwise aggressive clinical course. Spindle cell stroma was immunohistochemically positive for CD34 in 16 of 20 cases, and 18 of 19 cases showed loss of RB1 staining in lesional spindle cells. Fluorescence in situ hybridization analysis detected RB1 gene heterozygous deletion in 6 of 20 cases. We conclude that despite the SCL-like appearance of the investigated cases, the majority of them supposedly represent genuine spindle cell predominant trichodiscomas with adipose tissue admixture. However, there was a subset of histopathologically indistinguishable cases with proved RB1 deletion, which likely represent SCL with trichodiscoma/fibrofolliculoma-like epithelial/adnexal induction rather than spindle cell predominant variant of trichodiscoma.
The Spectrum of Developmental Disability with Zika Exposure: What Is Known, What Is Unknown, and Implications for Clinicians
Authors: Gordon-Lipkin Eliza , Peacock Georgina
Published: March 2019

Clinicians who treat children with neurodevelopmental disabilities may encounter infants with congenital Zika syndrome or those exposed to Zika virus (ZIKV), either in utero or postnatally, in their practice and may have questions about diagnosis, management, and prognosis. In this special report, we reviewed the current literature to provide a comprehensive understanding of the findings and needs of children exposed to ZIKV in utero and postnatally. The current literature is sparse, and thus, this review is preliminary. We found that infants and children exposed to ZIKV in utero have a variety of health and developmental outcomes that suggest a wide range of lifelong physical and developmental needs. Postnatal exposure does not seem to have significant long-lasting health or developmental effects. We provide a comprehensive examination of the current knowledge on health and developmental care needs in children exposed to Zika in utero and postnatally. This can serve as a guide for health care professionals on the management and public health implications of this newly recognized population.
Combination strategies based on epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors for cancer patients
Authors: Xu Ran , Shao Hong , Zhu Jing , Ju Qianqian , Shi Hui
Published: March 2019

Background:

Combination therapy based on epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is an emerging trend in cancer treatment, but the clinical value of EGFR-TKIs combination therapy remains controversial. Thus, we conducted a comprehensive analysis of randomized controlled trials (RCTs) comparing EGFR-TKIs combination therapies with monotherapies, aiming to evaluate the safety and efficacy of EGFR-TKIs based combination therapy and to find a more beneficial combination strategy.

Methods:

We searched for clinical studies that evaluated EGFR-TKIs combination therapy in cancer. We extracted data from these studies to evaluate the relative risk (RR) of overall response rate (ORR) and grade 3/4 treatment-related adverse events (AEs), the hazard ratios (HRs) of overall survival (OS), and progression-free survival (PFS).

Results:

Fourteen RCTs were identified (n = 3774). Treatments included combinations of EGFR-TKIs and chemotherapy, combinations of EGFR-TKIs and radiotherapy, and combinations of EGFR-TKIs and bevacizumab. EGFR-TKIs combination therapies showed higher ORR [RR: 1.62; 95% confidence interval (95% CI):1.16–2.26; P = .005], PFS (HR: 0.76; 95% CI: 0.64–0.89; P = .001), and OS (HR: 0.88; 95% CI: 0.79–0.97; P = .013) values than monotherapies. However, higher grade 3/4 treatment-related AEs (RR: 1.79; 95% CI: 1.02–3.15; P = .000) were observed in combination therapy than in monotherapy.

Conclusion:

Our pooled analysis and subgroup analysis results showed that the addition of chemotherapy to EGFR-TKIs better benefits PFS and safety. Adding bevacizumab was associated with better ORR and OS. The efficacy and safety of a bevacizumab-EGFR-TKIs-chemotherapy combination should be investigated further.
Predictive value of a modified classification of fallopian tube status on prognosis of tubal factor infertility after laparoscopic surgery
Authors: Yuan Lin , Jingying Huang , Xiujuan Chen , Chengying Lian , Xiaochen Huang , Xiumei Xiong , Yulong Zhang , Zihua Chen
Published: March 2019

Built on 2 existing classification systems, this study was to develop a new classification system to better predict the pregnancy prognosis after laparoscopic surgery in patients with tubal factor infertility and accordingly propose a management strategy.

We followed up 423 patients suffering from tubal factor infertility who had undergone hysteroscopic-laparoscopic surgery for 2 years without in vitro fertilization and embryo transfer (IVF/ET). Based on the operative reports, a new, modified classification of fallopian tube status (hereafter referred to as the modified classification) was developed with reference to the 2 existing classification systems (the r-AFS classification of pelvic adhesions and the scoring system of distal tubal obstruction). A score of 0 to 3 was assigned to each of the 4 factors (tubal wall consistency, hydrosalpinx, pelvic adhesions, and tubal patency) for each of the tubes with a total bilateral score of 0 to 24. The patients were classified for the abnormalities of the fallopian tubes into 3 groups: mild (<8), moderate (8–15) and severe (>15). By utilizing SPSS 20.0 Statistic Analysis Software, the data were analyzed withttest, Chi-Square test, ANOVA or ROC as appropriate.

Each of the 4 factors of the modified classification was independently and closely associated with post-surgical prognosis (P < .05). There was a statistically significant difference in postoperative pregnancy prognosis among the 3 groups of patients (P < .05). Patients with a score of <8 (mild) had the highest intrauterine pregnancy rate, reaching 60.1%. In contrast, patients with a score of 8 to 15 (moderate) had a significant increase in ectopic pregnancy (21.5%), while patients with a score of >15 (severe) had a significantly increased infertility rate of 89.5%. When the pregnancy outcomes were divided into intrauterine pregnancy and other outcomes, the modified classification had the largest area under the ROC curve (0.569) (P < .05). With the optimum cutoff of 4.5, the sensitivity was 88.6%, specificity was 74.5% and accuracy was 63.1%.

The modified classification of fallopian tube status is a simple and practical scoring system which can comprehensively and effectively evaluate the function of the fallopian tube and thus is more accurate than the other 2 systems in predicting the postoperative pregnancy outcomes.
Association between weekend catch-up sleep and health-related quality of life of Korean adults
Authors: Oh Yun Hwan , Kim HyeonJu , Kong MiHee , Oh Bumjo , Moon Ji Hyun
Published: March 2019

Sleep debt is known to have harmful effects on health. Weekend catch-up sleep (CUS) is a behavior to cope with weekday sleep debt. However, it is unclear whether weekend CUS has advantageous effects on health because sleep hygiene guidelines recommend regularizing bed time and arousal time. The aim of this study was to identify whether weekend CUS behavior has an association with better health-related quality of life (HRQoL)

According to the inclusion criteria, 4871 participants were selected from the 2016 Korea National Health and Nutrition Examination Survey. Sleep questionnaires and European quality of life scale-5 dimensions (EQ-5D) questionnaire were used to collect data about the participants’ sleep patterns and HRQoL. Odds ratios (ORs) with 95% confidence intervals (95% CIs) for each dimensional problem of EQ-5D were derived by logistic regression. Mean EQ-5D index scores were compared between weekend CUS and non-CUS groups based on their weekday sleep durations and quintile of chronotype.

The ORs of dimensional problems of HRQoL of non-CUS group versus weekend CUS group were 1.63 (95% CI 1.07, 2.47) for usual activities, and 1.45 (95% CI 1.11, 1.90) for anxiety/depression. Mean EQ-5D scores of the weekend CUS group were significantly higher than those of the non-CUS group for sleeping less than 6 hours (0.953 ± 0.004 vs 0.936 ± 0.007, P = .036) and sleeping 6 to 7 hours (0.965 ± 0.003 vs 0.955 ± .0.004, P = .045). These findings were similar in the fourth quintile (Q4) of chronotype (0.965 ± 0.007 vs 0.951 ± 0.008, P = .008) and fifth quintile (Q5) (0.952 ± 0.006 vs 0.941 ± 0.007, P = .022).

Weekend CUS behavior was associated with better HRQoL than non-CUS among Korean adults. Especially, it was significant in participants who slept for less than 7 hours or participants whose chronotype was the fourth or fifth quintile. Attention may be needed for subjects with sleep short time and later chronotype who do not have weekend-CUS behaviors, because there is a risk that their HRQoL might be compromised.
Efficacy and safety of spironolactone in the heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction
Authors: Xiang Yajie , Shi Wenhai , Li Zhuolin , Yang Yunjing , Wang Stephen Yishu , Xiang Rui , Feng Panpan , Wen Li , Huang Wei
Published: March 2019

Background:

Recent studies have shown the efficacy for using spironolactone to treat heart failure with reduced ejection fraction (HFrEF), but the efficacy of spironolactone for heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) is unclear. This meta-analysis investigated the efficacy and safety of spironolactone in patients with HFmrEF and HFpEF.

Methods and results:

We searched several databases including PubMed and the Cochrane Collaboration, for randomized controlled trials (RCTs) that assessed spironolactone treatment in HFmrEF and HFpEF. Eleven RCTs including 4539 patients were included. Spironolactone reduced hospitalizations (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.73–0.95; P = .006), improved New York Heart Association functional classifications (NYHA-FC) (OR, 0.35; 95% CI, 0.19–0.66; P = .001), decreased the levels of brain natriuretic peptide (BNP) (mean difference [MD], − 44.80 pg/mL; 95% CI, −73.44–−16.17; P = .002), procollagen type I C-terminal propeptide (PICP) (MD, −27.04 ng/mL; 95% CI, −40.77–−13.32, P < .001) in HFmrEF and HFpEF. Besides, it improved 6-minute walking distances (6-MWD) (standard weighted mean difference [SMD], 0.45 m; 95% CI, 0.27–0.64; P < .001), decreased amino-terminal peptide of procollagen type-III (PIIINP) (SMD, −0.37 μg/L; 95% CI, −0.59–−0.15; P = .001) in HFpEF only. The risks of hyperkalemia (P<.001) and gynecomastia (P<.001) were increased.

Conclusion:

Patients with HFmrEF and HFpEF could benefit from spironolactone treatment, with reduced hospitalizations, BNP levels, improved NYHA-FC, alleviated myocardial fibrosis by decreasing serum PICP in HFmrEF and HFpEF, decreased PIIINP levels and increased 6-MWD only in HFpEF. The risks of hyperkalemia and gynecomastia were significantly increased with the spironolactone treatment.
Primary retroperitoneal liposarcoma with extensive ossification
Authors: Xin Qi , Liu Xingkai , Yu Xiaoyuan , Ye Junfeng , Peng Xiaofan , Zhou Mingming , Zhang Ping
Published: March 2019

Rationale:

Primary retroperitoneal liposarcoma, which originates from mesenchymal tissues, can rarely present with extensive ossification.

Patient concerns:

A 41-year-old male patient presented with a chief complaint of discomfort around the waist for 2 months.

Diagnoses:

Computerized tomography (CT) and magnetic resonance imaging suggested a lesion of approximately 5.6 × 5.1 × 8.7 cm in front of the psoas major muscle, which was considered to be a mesenchymal or neurogenic tumor.

Interventions:

The hard mass was removed by laparotomy, and the pathological investigation revealed that this was an atypical lipomatous tumor/well-differentiated liposarcoma, with extensive ossification.

Outcomes:

The patient was discharged from the hospital after surgery. There was no sign of reoccurrence after 1 year of follow-up.

Lessons:

Retroperitoneal liposarcomas with extensive ossification are rare tumors that can present with nonspecific symptoms, and are difficult to diagnose. CT is the most common imaging technique, and surgical resection has been considered to be the most effective treatment. This rare case can be challenging for diagnosis and treatment.
Surgical and therapeutic advances in the management of voice problems in children and young people
Authors: Cavalli Lesley J. , Cochrane Lesley A.
Published: March 2019

Purpose of review

The current article reviews advances in both the assessment of paediatric voice disorders, as well as surgical, medical and therapeutic treatments.

Recent findings

It is important to evaluate the impact of a voice disorder from both the parent and child perspective. Outpatient laryngoscopy with stroboscopy is very possible even in young children; however, high-speed ultrasound is a plausible alternative. High-speed videolaryngoscopy, videokymography and dynamic computed tomography, offer potential for augmenting the assessment of vocal fold vibratory characteristics in children. The evidence to support the efficacy of both indirect and direct voice therapy interventions is growing. The management of vocal fold palsy has advanced to include laryngeal reinnervation. Intubation injury with/without surgical intervention offers challenge and gives rise to voice disorders that may be lifelong.

Although assessment and management practices of paediatric voice disorders closely follow those applied to adults, there are important differences and a developmental approach is required when considering both surgical and therapeutic management. Children can benefit from both indirect and direct therapy treatments following an ear, nose and throat assessment which utilizes paediatric instrumentation and considers the health of the entire airway. Underlying medical contributory factors should be explored and treated. Voice disorders due to congenital and acquired changes of the vocal tract may be amenable to surgery.
Esophagitis in Pediatric Esophageal Atresia
Authors: Yasuda Jessica L. , Clark Susannah J. , Staffa Steven J. , Blansky Bradley , Ngo Peter D. , Hamilton Thomas E. , Smithers Charles Jason , Jennings Russell , Manfredi Michael A.
Published: March 2019

Objective:

Esophagitis is highly prevalent in patients with esophageal atresia (EA). Peptic esophagitis has long been assumed to be the primary cause of esophagitis in this population, and prolonged acid suppressive medication usage is common; such treatment is of unknown benefit and carries potential risk.

Methods:

To better understand the role of commonly used antireflux treatments in EA, we analyzed all patients with repaired EA who underwent endoscopy with biopsies at our institution between January 2016 and August 2018. Macroscopic erosive and histologic esophagitis on biopsy was graded per predefined criteria. Clinical characteristics including acid suppressive medication usage, type of EA and repair, presence of hiatal hernia, and history of fundoplication were reviewed.

Results:

There were 310 unique patients (33.5% long gap EA) who underwent 576 endoscopies with biopsies during the study period. Median age at endoscopy was 3.7 years (interquartile range 21–78 months). Erosive esophagitis was found in 8.7% of patients (6.1% of endoscopies); any degree of histologic eosinophilia (≥1 eosinophil/high power field [HPF]) was seen in 56.8% of patients (48.8% of endoscopies), with >15 eosinophils/HPF seen in 15.2% of patients (12.3% of endoscopies). Acid suppression was common; 86.9% of endoscopies were preceded by acid suppressive medication use. Fundoplication had been performed in 78 patients (25.2%). Proton pump inhibitor (PPI) and/or H2 receptor antagonist (H2RA) use were the only significant predictors of reduced odds for abnormal esophageal biopsy (P = 0.011 for PPI, P = 0.048 for H2RA, and P = 0.001 for PPI combined with H2RA therapy). However, change in intensity of acid suppressive therapy by either dosage or frequency was not significantly associated with change in macroscopic erosive or histologic esophagitis (P > 0.437 and P > 0.13, respectively). Presence or integrity of a fundoplication was not significantly associated with esophagitis (P = 0.236).

Conclusions:

In EA patients, acid suppressive medication therapy is associated with reduced odds of abnormal esophageal biopsy, though histologic esophagitis is highly prevalent even with high rates of acid suppressive medication use. Esophagitis is likely multifactorial in EA patients, with peptic esophagitis as only one of multiple possible etiologies for esophageal inflammation. The clinical significance of histologic eosinophilia in this population warrants further investigation.
Sensitivity and Specificity of Administrative Medical Coding for Pediatric Eosinophilic Esophagitis
Authors: Robson Jacob , Korgenski Kent , Parsons Karyn , McClain Amber , Barbagelata Carlos , Allen‐Brady Kristina , Patel Raza , O'Gorman Molly , Peterson Kathryn , Guthery Stephen
Published: March 2019

Objectives:

Eosinophilic esophagitis (EoE) is a delayed‐type hypersensitivity with increasing rates among pediatric populations. Although studies have used International Classification of Diseases (ICD) coding to define local cohorts and report disease epidemiology, the accuracy of the EoE ICD code for pediatric EoE is unknown.

Methods:

We searched the Intermountain Healthcare Database for pediatric cases with the EoE ICD code over a 5‐year period. We cross‐referenced these results with a recently published pediatric EoE cohort from the same region and period, where incident cases were identified via retrospective review of pathology reports and medical records. Using the retrospective review cohort as the reference standard, we evaluated the accuracy of the EoE ICD code.

Results:

Via retrospective review, we identified 1129 new pediatric EoE cases in the Intermountain Healthcare system over 5 years. Six hundred ten of these had the EoE ICD code associated with their chart. Out of 878,872 unique pediatric records in the Intermountain Healthcare system, 219 had the EoE ICD code incorrectly applied. The specificity of the EoE ICD code in children was 99%, but sensitivity and positive predictive value were 61% and 79%, respectively.

Conclusions:

The EoE ICD code has strengths and weaknesses in pediatrics. The EoE ICD code is specific, with few false positives across a large population, but not sensitive. The low sensitivity is likely multifactorial and requires further evaluation. Compared to retrospective chart review, which allows for application of clinicopathologic EoE diagnostic criteria, sole use of ICD codes results in underascertainment of EoE cases and key misclassifications.
Development of a Patient‐reported Experience and Outcome Measures in Pediatric Patients Undergoing Bowel Management for Constipation and Fecal Incontinence
Authors: Halleran Devin R. , Lane Victoria A. , Leonhart Karen L. , Fischer Beth , Sebastião Yuri V. , Chisolm Deena J. , Levitt Marc A. , Wood Richard J. , Minneci Peter C. , Deans Katherine J.
Published: March 2019

Aims and Objectives:

The aim of this review is develop a reliable and valid questionnaire that assesses patient‐reported experience measures (PREMs) and patient‐reported outcome measures (PROMs) of caregivers, families, and patients with severe constipation and fecal incontinence who failed conservative treatments and require a formal bowel management program (BMP).

Methods:

A 5‐step iterative process was utilized to ensure the reliability and validity of the final instrument. Parents or guardians of patients undergoing our week‐long BMP were first asked 20 open‐ended questions aimed at understanding the challenges in managing their child's condition. Responses were transformed into an initial 41‐item survey constituted of 2 constructs relating to PREMs (24 items) and PROMs (17 items). Survey items were then administered to 359 parents and guardians undergoing BMP. Cognitive interviews were performed with 20 families to assess face validity and to further refine the survey. Instrument readability and reliability was assessed by Flesch‐Kincaid and Crohnbach α analyses. Items that weakly correlated were deleted to yield a final instrument that was both valid and reliable.

Results:

A 33‐statement survey was developed that encompasses important physical and emotional health concerns, quality of life, treatment success, financial considerations, schooling, parental employment, and social concerns. The final instrument, the Patient‐Reported Experience and Outcome Measure in a Bowel Management Program (PREOM‐BMP), is divided into 2 separate constructs that assess important patient‐reported experience (22 items) and outcome (11 items) measures. Reliability analyses on the final instrument yielded a Crohnbach α of 0.925.

Conclusions:

The PREOM‐BMP offers physicians and nursing professionals a brief and valid tool to measure the impact of a bowel management program on both the child and the family unit.
Hospital Admission for Severe Pediatric Dissociative Disorder
Authors: Rinaldi Matthew , Ilzarbe Daniel , Kyriakopoulos Marinos
Published: March 2019

Although children with dissociative disorders (DD) are referred to mental health inpatient units, no research exists to endorse this. We studied the outcomes of patients with DD over a 5-year period on a national inpatient unit for children up to 12 years of age. Demographic, clinical, and satisfaction data were collected and compared with the data of other inpatients not having DD. Eight patients were identified, of whom six were female. All had several comorbidities. Mean Children's Global Assessment Scale scores improved from admission to discharge (from 31 to 61, respectively). Admissions in DD were longer by 53 days (p = 0.059), and parents were statistically less satisfied about professionals' ability to listen to worries they may have about their child (p = 0.049). Referrers should expect children with DD to respond as well to inpatient interventions as those with other diagnoses but potentially with marginally longer admissions and lower parental satisfaction.
Short-Term Effects of Steroid Injection, Kinesio Taping, or Both on Pain, Grip Strength, and Functionality of Patients With Lateral Epicondylitis
Authors: Koçak Fatmanur Aybala , Kurt Emine Eda , Şaş Senem , Tuncay Figen , Erdem Hatice Rana
Published: March 2019

Objective

The aim of the study was to compare the efficacy of steroid injection and kinesio taping (KT) in the treatment of lateral epicondylitis.

Design

A total number of 84 patients were randomized into three groups. Group 1 was given steroid injection, group 2 received KT, and group 3 received both. Pain was measured using a visual analog scale, functional status was measured using a quick form of the Disabilities of Arm, Shoulder and Hand questionnaire, pain-free grip strength was measured using a dynamometer, and the pressure pain threshold was measured using an algometer. All evaluations were performed before treatment and at the third and twelfth weeks after the treatment.

Results

Twenty-eight patients were included in each group. A statistically significant difference was found between the pretreatment and posttreatment evaluations of all groups in the third and twelfth weeks after treatment. When group 1 and group 2 were compared, there was a significant difference only in pain-free grip strength measured in the twelfth week. The results of treatment in group 3 patients were significantly better in almost all evaluation parameters compared with the other groups.

Conclusion

In the treatment of lateral epicondylitis, KT alone was found to be as effective as steroid injection alone. However, co-administration of steroid injection and KT is more effective compared with each treatment alone.
Secondary Abdominoplasty: Management of the Umbilicus after Prior Stalk Transection
Authors: Dean Riley A. , Dean John A. , Matarasso Alan
Published: March 2019

Patients with prior umbilical stalk detachment, secondary to limited abdominoplasty or prior umbilical hernia repair, may in the future be candidates for full abdominoplasty. In these patients, a circumferential incision around the umbilicus detaches the remaining cutaneous blood supply, prompting concern for umbilical viability. Minimal literature exists to guide clinical decision-making for these patients. Inquiries were made to Louisiana Society of Plastic Surgery members and the Plastic Surgery Education Network online forum of the American Society of Plastic Surgeons. Metrics obtained included patient age, sex, nature of primary surgery, time between umbilical stalk detachment and secondary full abdominoplasty, complications, and whether rectus plication was performed at the time of secondary surgery. Eleven physicians provided complete documentation for 18 cases. All patients healed without evidence of umbilical ischemia or necrosis. Average patient age was 40.6 years. Average interval between procedures was 3.6 years. Sixty-seven percent of patients had the umbilicus delayed before the secondary procedure, with the median delay time being 18 days. Rectus fascia was plicated during secondary surgery in 72 percent of patients. This is the first reported series of patients undergoing full abdominoplasty after prior umbilical stalk detachment. It is also the first time the Plastic Surgery Education Network online forum has been used to collect research data, highlighting its potential as a valuable research tool. The data set was obtained from a wide range of practices, which allows for consideration of various technical solutions when this or other diverse clinical scenarios are encountered.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Foundation-Based Cleft Care in Developing Countries
Authors: Kantar Rami S. , Cammarata Michael J. , Rifkin William J. , Diaz-Siso J. Rodrigo , Hamdan Usama S. , Flores Roberto L.
Published: March 2019

Background:

Cleft deformities of the lip and palate affect nearly one in 500 to 700 births, and lead to increased morbidity and mortality if untreated. Nevertheless, significant global disparities in access to timely and appropriate care still exist. The relatively basic infrastructure required to surgically correct these deformities and large unmet disease burden have resulted in a significant number of foundation-based cleft care initiatives focused on developing countries. In this study, the authors evaluate the peer-reviewed literature generated by these foundations in an attempt to assess their clinical, scientific, educational, and economic impact.

Methods:

A comprehensive review of the literature was performed using key search terms, and the level of evidence of identified articles was determined. Data were then analyzed to determine the different models of foundation-based cleft care in developing countries, and their clinical, scientific, educational, and economic impact.

Results:

A total of 244 articles were identified through the authors’ search and reviewed. Foundation-based cleft care initiatives in developing countries have significantly contributed to a better understanding of disease epidemiology, barriers to care, safety considerations, complications and outcomes, and international and local cleft surgery education. The cleft care center model is more cost-effective than the surgical mission model and provides more sustainable care.

Conclusions:

Foundation-based cleft care prevents significant morbidity in developing countries and has provided valuable resources for capacity building. The surgical mission model should be considered as a transitory conduit for establishing the more effective and sustainable cleft care center model of care.
Rheologic and Physicochemical Properties Used to Differentiate Injectable Hyaluronic Acid Filler Products
Authors: Fagien Steven , Bertucci Vince , von Grote Erika , Mashburn Jay H.
Published: March 2019

Background:

Injectable hyaluronic acid fillers are routinely used for correction of soft-tissue volume loss and facial rejuvenation. Product differentiation has primarily been based on the rheologic parameter known as elastic modulus (G′), although other physicochemical properties are being explored to characterize potential product performance. As clinical data regarding product performance are lacking, the practical experience of injectors provides a valuable bridge in the knowledge gap between product rheologic data and product use.

Methods:

Rheologic and physicochemical measurements (swelling factor and cohesion) were collected for 18 products. To observe the impact of G′ and hyaluronic acid concentration on swelling factor and cohesion, proportional relationships were evaluated. Contributing authors were queried regarding their G′-based selection of products when considering skin quality, degree of correction, injection depth, and anatomical location.

Results:

Relationships were observable between G′ and swelling factor and G′ and cohesion only when limited to products manufactured by the same crosslinking technology and the same concentration. No relationship between isolated hyaluronic acid concentration and swelling factor or cohesion was apparent. Although rheological parameters and the assumptions of ex vivo data translating to in vivo performance are oftentimes not completely aligned, in the clinical experience of the authors, in general, higher G′ products are better suited for thicker skin and deeper injection planes, whereas lower G′ products are better for more superficial planes, although exceptions to these trends are also made based on technical experience.

Conclusions:

While rheologic and physicochemical characteristics can vary widely between products and the methods and measurements of these parameters are often difficult to correlate, G′ represents a useful and consistent parameter for product differentiation. Understanding how to select products based on G′ is valuable knowledge for customizing injection plans and contributes to an optimal aesthetic outcome.
Dual-Anchor Cog Threads in Fat Grafting Breast Augmentation: A Novel Scarless Method for Defining Breast Footprint and Enhancing Shape
Authors: Visconti Giuseppe , Salgarello Marzia
Published: March 2019

Background:

Modern fat grafting breast augmentation allows successful breast enhancement. However, there is no fine control of breast footprint, shape, and inframammary fold. The purpose of this article is to report a novel scarless technique and to evaluate its beneficial effect by retrospectively reviewing case-control consecutive data from 51 patients.

Methods:

Fifty-one consecutive patients undergoing cosmetic breast augmentation with fat only between September of 2012 and August of 2016 were retrospectively reviewed. In the first 29 cases (56 percent), the authors did not use threads (group A, control group), whereas in the remaining 22 cases (44 percent), the authors used dual-anchor cog threads (group B, case group). Breast shape analysis was performed separately by a blinded group of plastic surgeons and by the attending surgeon using a standardized evaluation method. The BREAST-Q was used to study patient satisfaction. The Mann-Whitney U and chi-square tests were used for categorical variables, and the independent-samples t test was used for continuous variables.

Results:

No significant difference in mean graft take was found (group A, 71.2 percent; group B, 71.6 percent; p < 0.05). Group B showed a significantly higher rating than group A for lower pole profile, inframammary fold, and lateral footprint definition. No major postoperative complications were experienced in either group. In group B, no thread-related complications were experienced.

Conclusions:

The dual-anchor thread suture is a novel, effective, simple, reliable, safe, and scarless method of improving breast shape in fat grafting breast augmentation. Larger series are needed to further confirm the authors’ findings.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Oral Surgeons as Cosmetic Surgeons and Their Scope of Practice
Authors: Davison Steven P. , Hancock Melyssa , Sinkiat Matt , Enchill Zenaida
Published: March 2019

Background:

In recent years, the practice of cosmetic surgery has expanded to include oral and maxillofacial surgeons. The groundwork for this scope-of-practice expansion was laid in part by the American Dental Association’s definition change of the practice of dentistry. This change modified the scope of dentistry from the earlier “teeth and surrounding and supporting structures” to the maxillofacial area and beyond. A number of states adopted this new definition into legislation, giving practitioners the premise on which to perform cosmetic and other medical procedures on the face and potentially other parts of the body. This expansion has created legal and regulatory issues over scope and truth in advertising. The authors hypothesize that this is confused by a lack of federal guidelines and state-by-state variations in scope-of-practice laws for oral and maxillofacial surgeons.

Methods:

This article provides a brief overview of the key legal issues and their impact on legislation in some of the battleground states. The authors review the national distribution of scope of practice for oral and maxillofacial surgeons.

Results:

The most successful path to expanded scope for dentistry has been through control of certification and credentialing. This has marginalized medicine boards from contributory oversight, thus circumventing any arguments over practice parameters. The scope-of-practice dispute is further complicated by the existence of dual-degree oral and maxillofacial surgeons.

Conclusions:

With increasing demand for cosmetic surgical interventions, establishing scope-of-practice standards for single-degreed oral and maxillofacial surgeons is critically important. As physicians, the oral and maxillofacial surgery graduates of the dual M.D./D.D.S. degree programs have no such scope-of-practice restrictions. Furthermore, if plastic surgery is to effectively argue against expanded scope of practice for oral and maxillofacial surgeons, more objective data will be necessary.
Increased Incidence of Symptomatic Venous Thromboembolism following Pedicled Lower Extremity Flap Harvest for Abdominal and Perineal Reconstruction in Patients Receiving Mechanical Prophylaxis and Chemoprophylaxis: A Case for Heightened Awareness
Authors: Broyles Justin M. , Khavanin Nima , Walia Gurjot S. , Ostrander Benjamin T. , Bello Ricardo , Carl Hannah M. , Pedreira Rachel A. , Sacks Justin M.
Published: March 2019

Background:

Postsurgical venous thromboembolism remains a leading cause of hospital morbidity. Data to support venous thromboembolism prophylaxis guidelines in lower extremity flap surgery are lacking. The purpose of this study was to explore the effect of pedicled lower extremity flap harvest on venous thromboembolism development in the setting of abdominal or perineal reconstruction.

Methods:

One hundred twenty-six patients undergoing unilateral lower extremity flap harvest for abdominal or perineal reconstruction were included. The contralateral leg served as an internal control. Sixty comorbidity-matched patients who underwent abdominal/perineal resection without flap reconstruction provided an external control. Bivariate analyses included chi-square and t tests; logistic regression adjusted for confounding variables on venous thromboembolism development.

Results:

All patients underwent flap reconstruction for an oncologic defect of the abdomen or perineum, with 80 percent undergoing perineal reconstruction. Most patients underwent anterolateral thigh (41 percent) or gracilis flap (40 percent) harvest. Eleven patients developed deep venous thromboses in one or more legs (9 percent): 10 of 11 (90.9 percent) in the donor extremity and five (45.5 percent) contralaterally (p = 0.022). Patients who underwent flap harvest had a 10-fold higher odds of venous thromboembolism formation when compared to comorbidity-matched controls without flap reconstruction (OR, 10.64; 95 percent CI, 1.11 to 102.34; p = 0.041).

Conclusions:

The rate of venous thromboembolism is higher than previously appreciated for reconstructive procedures of the abdomen and/or perineum that use pedicled lower extremity flaps—particularly in the operative extremity. Additional research can clarify the role for further prophylaxis or screening.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Teamwork Among Medicine House Staff During Work Rounds: Development of a Direct Observation Tool
Authors: Weingart Saul N. , Coakley Meagan , Yaghi Omar , Shayani Ariella , Sweeney Megan
Published: March 2019

Objective

Teamwork is integral to effective health care but difficult to evaluate. Few tools have been tested outside of classroom or medical simulation settings. Accordingly, we aimed to develop and pilot test an easy-to-use direct observation instrument for measuring teamwork among medical house staff.

Methods

We performed direct observations of 18 inpatient medicine house staff teams at a teaching hospital using an instrument constructed from existing teamwork tools, expert panel review, and pilot testing. We examined differences across teams using the Kruskal-Wallis statistic. We examined interrater reliability with the κ statistic, domain scales using Cronbach α, and construct validity using correlation and multivariable regression analyses of quality and utilization metrics. Observers rated team performance before and after providing feedback to 12 of the 18 team leaders and assessed changes in team performance using paired two-tailed t tests.

Results

We found variation in team performance in the situation monitoring, mutual support, and communication domains. The instrument evidenced good interrater reliability among concurrent, independent observers (κ = 0.7, P < 0.001). It had satisfactory face validity based on expert panel review and the assessments of resident team leaders. Construct validity was supported by a positive correlation between team performance and the Hospital Consumer Assessment of Healthcare Providers and Systems physician communication score (r = 0.6, P = 0.03). Providing resident physicians with information about their teams’ performance was associated with improved mean performance in follow-up observations (3.6–3.8/4.0, P = 0.001).

Conclusions

Direct observation of teamwork behaviors by medicine house staff on ward rounds is feasible and feedback may improve performance.
Impact of Medication Reviews Delivered by Community Pharmacist to Elderly Patients on Polypharmacy: A Meta-analysis of Randomized Controlled Trials
Authors: Tasai Sudprattana , Kumpat Nattikarn , Dilokthornsakul Piyameth , Chaiyakunapruk Nathorn , Saini Bandana , Dhippayom Teerapon
Published: March 2019

Objective

The aim of the study was to assess the impact of medication reviews delivered by community pharmacists to elderly patients on polypharmacy.

Methods

A systematic literature search was performed in four bibliographic databases/search engine (PubMed, Embase, CENTRAL, and IPA) and three gray literature sources (OpenGrey, ClinicalTrials.gov, and Digital Access to Research Theses – Europe) from inception to January 2018. Randomized controlled trials were selected if they met the following criteria: (a) studied in patients 65 years or older who were taking four or more prescribed medications; (b) the “test” interventions were delivered by community pharmacists; and (c) measured one of these following outcomes: hospitalization, emergency department (ED) visit, quality of life, or adherence. Quality of the included studies was assessed using the Cochrane Effective Practice and Organization of Care Group risk of bias tool. Random-effects model meta-analyses were performed.

Results

Of the 3634 articles screened, four studies with a total of 4633 participants were included. The intervention provided in all included studies was clinical medication review. Three studies were at low risk of bias, and the remaining study had unclear risk of bias. When compared with usual care, medication reviews provided by community pharmacist significantly reduced risk of ED visits (risk ratio = 0.68; 95% confidence interval = 0.48–0.96). There was also a tendency that pharmacist interventions decreased risk of hospitalizations (risk ratio = 0.88; 95% CI = 0.78–1.00), although no statistical significant.

Conclusions

The current evidence demonstrates that clinical medication reviews for older people with polypharmacy reduces the risk of ED visits. Medication reviews can be considered as another area where community pharmacists can contribute to improve patient safety.