bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-Care Posters Serve as a Low-Cost Option for Physical Activity Promotion of Hospital Nurses
Authors: Raney Marcella , Van Zanten Erin
Published: March 2018

Hospital nurses play an important role in the nation’s short- and long-term patient care. At the same time, nurses often experience high levels of occupational stress and participate in low levels of physical activity (PA). The purpose of this study was to examine the impact of self-monitoring and a poster campaign on the PA behaviors of hospital nurses. Motivational and instructional exercise posters were hung in break rooms of experimental units and replaced biweekly for 8 weeks. A total of 26 nurses (control: n = 13; experimental: n = 13) wore accelerometers for 3 workdays pre-, mid-, and postintervention. Participants were provided a step counter at baseline and a PA report at each stage. Moderate to vigorous PA (MVPA) and step count (SC) increased pre- to midintervention for control (MVPA: 14.8 ± 7.6%; SC: 19.1 ± 7.8%) and experimental (MVPA: 26.7 ± 18.5%, SC: 17.6 ± 8.3%) participants. Physical activity levels returned to baseline postintervention for control ( p > .05) and increased mid- to postintervention for experimental (MVPA: 16.2 ± 5.2%, SC: 10.7 ± 4.7%, p < .05) participants. In conclusion, a low-cost, self-care poster campaign may increase PA levels of hospital nurses when combined with personalized PA feedback.
Partisan Predispositions and Public Support for Making It Easier to Vote
Authors: Bowler Shaun , Donovan Todd
Published: March 2018

Public opinion on high-visibility election rules can be expected to reflect elite-level party divisions. We explain how partisanship affects support for, and opposition to, low-visibility convenience voting reforms. We find state-level factors such as quality of polling-place voting and party polarization explain some variance in support. However, individual-level factors are paramount. Attitudes about election reforms are strongly conditioned by partisan predispositions, with Democrats more supportive and Republicans more opposed. In addition, we find younger people, those with lower incomes, nonvoters, and people with disabilities were more likely to support proposals that might make voting easier. Although this cannot demonstrate that increased convenience voting would alter the composition of the electorate, it shows that, above and beyond partisanship, people who faced greater barriers to voting were most supportive of making voting easier. However, the dominant role of partisan predispositions suggests limits to rules changes that might make voting easier.
Defeating Cancers’ Adaptive Defensive Strategies Using Thermal Therapies: Examining Cancer’s Therapeutic Resistance, Ablative, and Computational Modeling Strategies as a means for Improving Therapeutic Outcome
Authors: Baust John M. , Rabin Yoed , Polascik Thomas J. , Santucci Kimberly L. , Snyder Kristi K. , Van Buskirk Robert G. , Baust John G.
Published: March 2018

Background:

Diverse thermal ablative therapies are currently in use for the treatment of cancer. Commonly applied with the intent to cure, these ablative therapies are providing promising success rates similar to and often exceeding “gold standard” approaches. Cancer-curing prospects may be enhanced by deeper understanding of thermal effects on cancer cells and the hosting tissue, including the molecular mechanisms of cancer cell mutations, which enable resistance to therapy. Furthermore, thermal ablative therapies may benefit from recent developments in computer hardware and computation tools for planning, monitoring, visualization, and education.

Methods:

Recent discoveries in cancer cell resistance to destruction by apoptosis, autophagy, and necrosis are now providing an understanding of the strategies used by cancer cells to avoid destruction by immunologic surveillance. Further, these discoveries are now providing insight into the success of the diverse types of ablative therapies utilized in the clinical arena today and into how they directly and indirectly overcome many of the cancers’ defensive strategies. Additionally, the manner in which minimally invasive thermal therapy is enabled by imaging, which facilitates anatomical features reconstruction, insertion guidance of thermal probes, and strategic placement of thermal sensors, plays a critical role in the delivery of effective ablative treatment.

Results:

The thermal techniques discussed include radiofrequency, microwave, high-intensity focused ultrasound, laser, and cryosurgery. Also discussed is the development of thermal adjunctive therapies—the combination of drug and thermal treatments—which provide new and more effective combinatorial physical and molecular-based approaches for treating various cancers. Finally, advanced computational and planning tools are also discussed.

Conclusion:

This review lays out the various molecular adaptive mechanisms—the hallmarks of cancer—responsible for therapeutic resistance, on one hand, and how various ablative therapies, including both heating- and freezing-based strategies, overcome many of cancer’s defenses, on the other hand, thereby enhancing the potential for curative approaches for various cancers.
Obstructive sleep apnea and risk of aortic dissection: A meta-analysis of observational studies
Authors: Zhou Xiushi , Liu Fei , Zhang Wei , Wang Guili , Guo Daqiao , Fu Weiguo , Wang Lixin
Published: March 2018

Objectives

Obstructive sleep apnea acts as a potential risk factor for the development of cardiovascular disease. We undertook collaborative meta-analyses to clarify the risk of aortic dissection among adults suffering obstructive sleep apnea.

Methods

A systematic search of the databases (PubMed, Embase, and Cochrane Library) was performed. Studies reporting on the association between obstructive sleep apnea and aortic dissection were included. Information on 424 cases of aortic dissection in 56,291 patients from one cohort, four case–controls, and two cross-sectional studies were included in this study.

Results

The summary suggested that patients with obstructive sleep apnea are associated with an overall significant 60% increase in the risk of aortic dissection, compared to unexposed patients (odds ratios 1.60; 95% confidence interval 1.01–2.53), with a significantly higher apnea–hypopnea index (mean difference 10.71; 95% confidence interval 7.46–13.96). Moreover, a greater relation was found between moderate-to-severe obstructive sleep apnea and aortic dissection (odds ratios 4.43; 95% confidence interval 2.59–7.59). Adverse outcomes obtained by sleep study such as oxygen desaturation index (mean difference 10.51; 95% confidence interval 7.54–13.48), average SaO2 (−1.36; 95% confidence interval −2.63 to −0.09), and minimum SaO2 (−3.63; 95% confidence interval −5.27 to −1.98) were correspondingly related to patients with aortic dissection.

Conclusions

Obstructive sleep apnea, especially moderate-to-severe obstructive sleep apnea, may impose an additional risk of suffering from aortic dissection with a potential mechanism including intermittent hypoxia.
A phenomenological study on the meaning of educational justice for street children
Authors: Nouri Ali , Karimi Yousef
Published: March 2018

A phenomenological study was conducted to obtain an understanding of the meaning of educational justice for street-working children in Tehran, Iran. The data were obtained through observation and semi-structured interview from 22 children aged between 5 and 15 years old (13 male and 9 female) who were selected based on their cooperation through a convenience sampling technique. The children’s responses to the interview questions regarding their perceptions of educational justice and the other related concerns were coded and a set of categories were developed. The results of the study indicated that poverty and parental negligence are the two primary and interrelated reasons that lead children to work on streets and consequently limit their access to formal education. The participants viewed educational justice as providing all children with adequate opportunities for access to formal education and establishing effective mechanisms for a fair distribution of resources and facilities in a way that all disadvantaged children including street children could benefit from and engage in productive activities of the society. They expected that educational system should not only be responsible for providing education for all but also to show greater concern and effort for the children with special needs. The present condition of street children necessitates better future policy-making to develop practical solutions in order to meet the basic educational needs of street children more efficiently and equitably.
Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on rates of ventilator-associated pneumonia in intensive care units of two hospitals in Kuwait
Authors: Al-Mousa Haifaa Hassan , Omar Abeer Aly , Rosenthal Víctor Daniel , Salama Mona Foda , Aly Nasser Yehia , El-Dossoky Noweir Mohammad , Rebello Flavie Maria , Narciso Dennis Malungcot , Sayed Amani Fouad , Kurian Anu , George Sneha Mary , Mohamed Amna Mostafa , Ramapurath Ruby Jose , Varghese Suga Thomas , Orellano Pablo Wenceslao
Published: March 2018

Objective:

To analyse the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in three intensive care units (ICUs) from two hospitals in Kuwait City from January 2014 to March 2015.

Design:

A prospective, before–after study on 2507 adult ICU patients. During baseline, we performed outcome surveillance of VAP applying CDC/NHSN definitions. During intervention, we implemented the IMA through the INICC Surveillance Online System (ISOS), which included: (1) a bundle of infection prevention interventions; (2) education; (3) outcome surveillance; and (4) feedback on VAP rates and consequences. Logistic regression analysis was performed to estimate the effect of the intervention on VAP, controlling for potential bias.

Results:

During baseline, 1990 mechanical ventilator (MV)-days and 14 VAPs were recorded, accounting for 7.0 VAPs per 1000 MV-days. During intervention, 9786 MV-days and 35 VAPs were recorded, accounting for 3.0 VAPs per 1000 MV-days. The VAP rate was reduced by 57.1% (incidence-density ratio = 0.51; 95% CI = 0.28–0.93; p = 0.042). Logistic regression showed a significant reduction in VAP rate during the intervention phase (OR = 0.39, 95% CI = 0.18–0.83), with 61% effectiveness.

Conclusions:

Implementing IMA through ISOS was associated with a significant reduction in the VAP rate in Kuwait ICUs.
Cognitive Control in Depression: Toward Clinical Models Informed by Cognitive Neuroscience
Authors: Grahek Ivan , Everaert Jonas , Krebs Ruth M. , Koster Ernst H. W.
Published: March 2018

Cognitive control dysfunctions are thought to contribute to the onset and maintenance of depression. However, the causes and nature of these dysfunctions remain unknown. Here, we critically review contemporary research on cognitive control in depression. We identify three main conceptual issues in this field: (a) uncritical use of the tripartite model, (b) reliance on descriptive explanations, and (c) lack of integration with emotional and motivational impairments. Recent advances in cognitive neuroscience offer possibilities to resolve these issues. We review this progress focusing on the ability to detect the need for control, the role of motivation, and the flexibility-stability balance. We propose that depression-related dysfunctions arise from issues in detecting when, how, and for how long to engage in goal-oriented processing. In conclusion, we argue that integrating advances in cognitive neuroscience into clinical research can help to move from a descriptive toward a more mechanistic understanding of cognitive dysfunctions in depression.
A simple animal model to learn the techniques of discrepancy vascular microanastomoses
Authors: Leclère Franck Marie P , Kolb Frédéric , Lewbart Gregory A , Casoli Vincent , Vögelin Esther
Published: March 2018

Background

Since the pioneering work of Jacobson and Suarez, microsurgery has steadily progressed and is now used in all surgical specialities, particularly in plastic surgery. Before performing clinical procedures it is necessary to learn the basic techniques in the laboratory.

Objective

To assess an animal model, thereby circumventing the following issues: ethical rules, cost, anesthesia and training time.

Methods

Between July 2012 and September 2012, 182 earthworms were used for 150 microsurgical trainings to simulate discrepancy microanastomoses. Training was undertaken over 10 weekly periods. Each training session included 15 simulations of microanastomoses performed using the Harashina technique (earthworm diameters >1.5 mm [n=5], between 1.0 mm and 1.5 mm [n=5], and <1.0 mm [n=5]). The technique is presented and documented. A linear model with main variable as the number of the week (as a numeric covariate) and the size of the animal (as a factor) was used to determine the trend in time of anastomosis over subsequent weeks as well as differences between the different size groups.

Results

The linear model showed a significant trend (P<0.001) in time of anastomosis in the course of the training, as well as significant differences (P<0.001) between the groups of animal of different sizes. For diameter >1.5 mm, mean anastomosis time decreased from 19.6±1.9 min to 12.6±0.7 min between the first and last week of training. For training involving smaller diameters, the results showed a reduction in execution time of 36.1% (P<0.01) (diameter between 1.0 mm and 1.5 mm) and 40.6% (P<0.01) (diameter <1.0 mm) between the first and last weeks. The study demonstrates an improvement in the dexterity and speed of nodes' execution.

Conclusion

The earthworm appears to be a reliable experimental model for microsurgical training of discrepancy microanastomoses. Its numerous advantages, as discussed in the present report, show that this model of training will significantly grow and develop in the near future.
A reliable frozen section technique for basal cell carcinomas of the head and neck
Authors: Menesi Wisam , Buchel Edward W , Hayakawa Thomas Je
Published: March 2018

Basal cell carcinomas (BCCs) of the head and neck treated by conventional techniques of surgical excision, curettage, cryotherapy and radiation therapy have recurrence rates of up to 42%. Mohs micrographic surgery (MMS) decreases the recurrence rate but can be expensive, delay definitive reconstruction and is limited in its availability.

The authors report a series of 50 patients with head and neck BCCs treated by a surgeon-directed ‘en face’ frozen section technique that immediately evaluates the entire peripheral and deep margins during BCC resection, and potentially offers a more efficient and equally effective alternative to MMS.

Patient demographics, pathology results, operative time, technique and outcomes are all reported. With a mean follow-up of three years, there was only one recurrence (1.7%). Mean total operative time was 1 h 47 min. The authors conclude that this surgeon-directed ‘en face’ frozen section technique does not require any specialized training, enables more rapid and reliable results than standard frozen section techniques that are currently used, and provides outcomes equivalent to MMS in the surgical treatment of head and neck BCCs.
Fibrolipomatous hamartoma of the median nerve: A cause of acute bilateral carpal tunnel syndrome in a three-year-old child: A case report and comprehensive literature review
Authors: Senger Jenna-Lynn , Classen Dale , Bruce Garth , Kanthan Rani
Published: March 2018

A three-year-old boy was investigated for inexplicable incessant crying. On examination, his left wrist was mildly swollen (three to four months) and sensitive. Exploration and carpal tunnel decompression of the left wrist with incisional biopsy was performed for the presence of a fusiform swelling intimately associated with the median nerve. Histopathology revealed the presence of enlarged nerve bundles admixed with mature fat cells and diffuse fibroblastic proliferation. Three months later, he underwent urgent contralateral carpal tunnel decompression for a similar presentation. The final diagnosis was bilateral fibrolipomatous hamartoma (FLH) of the median nerves causing acute bilateral compression neuropathy.

FLH of the median nerve is an extremely unusual cause of acute bilateral carpal tunnel syndrome in a young child presenting with ‘incessant crying’. A comprehensive review of FLH including epidemiology, etiology, clinical presentation, differential diagnosis, imaging, pathology, treatment and prognosis is discussed.
‘Wondering and waiting’ after obstetrical brachial plexus injury: Are we underestimating the effects of the traumatic experience on the families?
Authors: Dematteo Carol , Bain James R , Gjertsen Deborah , Harper Jessica A
Published: March 2018

Background

Obstetrical brachial plexus injury (OBPI) in children can cause great distress to a family due to uncertain recovery, variability in spontaneous recovery and unclear indicators for surgery.

Objective

To investigate the impact of having a child with OBPI on the family and whether the Impact on Family Scale (IoFS) can assist in addressing family concerns.

Methods

A mixed-method (cross-sectional survey and semistructured interviews) study design was used.

Results

Thirty-eight families of children with OBPI completed the IoFS. Surgery significantly predicted a higher IoFS total impact score (P=0.02). No statistically significant association between the total impact score and severity or age was found, suggesting that impact on family was not dependent on these factors. Themes that emerged from the interviews included traumatic birthing experience, wondering and waiting, and experiencing surgery.

Conclusion

All families should receive support and acknowledgement of the widespread impact of OBPI.
Plastic surgeons' self-reported operative infection rates at a Canadian academic hospital
Authors: Ky Wendy , Kaur Manraj Nirmal , Thoma Achilleas
Published: March 2018

Background

Surgical site infection rates are of great interest to patients, surgeons, hospitals and third-party payers. While previous studies have reported hospital-acquired infection rates that are nonspecific to all surgical services, there remain no overall reported infection rates focusing specifically on plastic surgery in the literature.

Objective

To estimate the reported surgical site infection rate in plastic surgery procedures over a 10-year period at an academic hospital in Canada.

Methods

A review was conducted on reported plastic surgery surgical site infection rates from 2003 to 2013, based on procedures performed in the main operating room. For comparison, prospective infection surveillance data over an eight-year period (2005 to 2013) for nonplastic surgery procedures were reviewed to estimate the overall operative surgical site infection rates.

Results

A total of 12,183 plastic surgery operations were performed from 2003 to 2013, with 96 surgical site infections reported, corresponding to a net operative infection rate of 0.79%. There was a 0.49% surgeon-reported infection rate for implant-based procedures. For non-plastic surgery procedures, surgical site infection rates ranged from 0.04% for cataract surgery to 13.36% for high-risk abdominal hysterectomies.

Discussion

The plastic surgery infection rate at the study institution was found to be <1%. This rate was equal to, or somewhat less than, surgical site infection rates. However, these results do not report patterns of infection rates germane to procedures, season, age groups or sex. To provide more in-depth knowledge of this topic, multicentre studies should be conducted.
Variability of expression of oral-facial-digital syndrome type I in 15 Saudi girls: Why is there a high rate of median cleft lip in the phenotype?
Authors: Al-Qattan Mohammad M , Javed K
Published: March 2018

Background

It is well known that the incidence of nonsyndromal cleft lip and palate varies greatly according to ancestry: 0.3 to 0.4 per 1000 live births in blacks, one in 1000 in Caucasians, and two in 1000 in Asians and individuals from the central province of Saudi Arabia. Median cleft lip is a variable feature in oral-facial-digital syndrome type I (OFD-I).

Objective

To test the hypothesis that genetic factors may determine the lip phenotype in OFD-I patients.

Methods

A study involving 15 Saudi girls (from the central province of Saudi Arabia) with OFD-I showed a high rate (93.3%) of median cleft lip and palate. This rate in OFD-I patients is known to range from 33% to 56% in Caucasians and also known to be very low in blacks. The authors compared the rate of median cleft lip with or without cleft palate in the Arabian series (93.3%) with the rate in Caucasians and blacks.

Results

The difference in median cleft lip with or without cleft palate among the three groups was significant.

Conclusion

This supports the hypothesis that ancestral genetic factors may determine the lip phenotype in OFD-I patients.
Mastopexy for breast ptosis: Utility outcomes of population preferences
Authors: Ibrahim Ahmed MS , Sinno Hani H , Lzadpanah Ali , Vorstenbosch Joshua , Dionisopoulos Tassos , Markarian Mark K , Lee Bernard T , Lin Samuel J
Published: March 2018

Background

Breast ptosis can occur with aging, and after weight loss and breastfeeding. Mastopexy is a procedure used to modify the size, contour and elevation of sagging breasts without changing breast volume. To gain more knowledge on the health burden of living with breast ptosis requiring mastectomy, validated measures can be used to compare it with other health states.

Objective

To quantify the health state utility assessment of individuals living with breast ptosis who could benefit from a mastopexy procedure; and to determine whether utility scores vary according to participant demographics.

Methods

Utility assessments using a visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG) methods were used to obtain utility scores for breast ptosis, monocular blindness and binocular blindness from a sample of the general population and medical students. Linear regression and the Student's t test were used for statistical analysis; P<0.05 was considered to be statistically significant.

Results

Mean (± SD) measures for breast ptosis in the 107 volunteers (VAS: 0.80±0.14; TTO: 0.87±0.18; SG: 0.90±0.14) were significantly different (P<0.0001) from the corresponding measures for monocular blindness and binocular blindness. When compared with a sample of the general population, having a medical education demonstrated a statistically significant difference in being less likely to trade years of life and less likely to gamble risk of a procedure such as a mastopexy. Race and sex were not statistically significant independent predictors of risk acceptance.

Discussion

For the first time, the burden of living with breast ptosis requiring surgical intervention was determined using validated metrics (ie, VAS, TTO and SG). The health burden of living with breast ptosis was found to be comparable with that of breast hypertrophy, unilateral mastectomy, bilateral mastectomy, and cleft lip and palate. Furthermore, breast ptosis was considered to be closer to ‘perfect health’ than monocular blindness, binocular blindness, facial disfigurement requiring face transplantation surgery, unilateral facial paralysis and severe lower extremity lymphedema.

Conclusions

Quantifying the health burden of living with breast ptosis requiring mastopexy indicated that is comparable with other breast-related conditions (breast hypertrophy and bilateral mastectomy). Numerical values have been assigned to this health state (VAS: 0.80±0.14; TTO: 0.87±0.18; and SG: 0.90±0.14), which can be used to form comparisons with the health burden of living with other disease states.
Nerve transfers for treatment of isolated axillary nerve injuries
Authors: Wheelock Margie , Clark Tod A , Giuffre Jennifer L
Published: March 2018

Background

The most common neurological defect in traumatic anterior glenohumeral dislocation is isolated axillary nerve palsy. Most recover spontaneously; however, some have persistent axillary neuropathy. An intact rotator cuff may compensate for an isolated axillary nerve injury; however, given the high rate of rotator cuff pathology with advancing age, patients with an axillary nerve injury are at risk for complete shoulder disability.

Objective

To review reconstruction of the axillary nerve to alleviate shoulder pain, augment shoulder stability, abduction and external rotation to alleviate sole reliance on the rotator cuff to move and stabilize the shoulder.

Method

A retrospective review of 10 patients with an isolated axillary nerve injury and an intact rotator cuff who underwent a triceps nerve branch to axillary nerve transfer was performed. Patient demographics, surgical technique, deltoid strength, donor-site morbidity, complications and time to surgery were evaluated.

Result

Ten male patients, mean age 38.3 years (range 18 to 66 years), underwent a triceps to axillary nerve transfer for isolated axillary nerve injury 7.4 months (range five to 12 months) post-traumatic shoulder dislocation. Deltoid function was British Medical Research Council grade 0/5 in all patients preoperatively and ≥3/5 deltoid strength in eight patients at final follow-up (14.8 months [range 12 to 25 months]). There were no complications and no donor-site morbidity.

Conclusion

A triceps to axillary nerve transfer for isolated axillary neuropathy following traumatic shoulder dislocation improved shoulder pain, stability and deltoid strength, and potentially preserves shoulder function with advancing age by alleviating sole reliance on the rotator cuff for shoulder abduction and external rotation.
Meaningful power grip recovery after salvage reconstruction of a median nerve avulsion injury with a pedicled vascularized ulnar nerve
Authors: Van Slyke Aaron C , Jansen Leigh A , Hynes Sally , Hicks Jane , Bristol Sean , Carr Nicholas
Published: March 2018

In cases of median nerve injury alongside an unsalvageable ulnar nerve, a vascularized ulnar nerve graft to reconstruct the median nerve is a viable option. While restoration of median nerve sensation is consistently reported, recovery of significant motor function is less frequently observed. The authors report a case involving a previously healthy man who sustained upper arm segmental median and ulnar nerve injuries and, after failure of sural nerve grafts, was treated with a pedicled vascularized ulnar nerve graft to restore median nerve function. Long-term follow-up showed near full fist, with 12 kg of grip strength, key pinch with 1.5 kg of strength and protective sensation in the median nerve distribution. The present case demonstrates that pedicled ulnar vascularized nerve grafts can provide significant improvements to median nerve sensory and motor function in a heavily scarred environment.
Selecting the best and brightest: A comparison of residency match processes in the United States and Canada
Authors: Krauss EM , Bezuhly M , Williams JG
Published: March 2018

Background

Selecting candidates for plastic surgery residency training remains a challenge. In the United States, academic measures (United States Medical Licensing Exam Step I scores, medical school class rank and publications) are used as primary criteria for candidate selection for residency. In contrast, Canadian medical education de-emphasizes academic measures by using a pass-fail grading system. As a result, choosing residents from many qualified applicants may pose a challenge for Canadian programs without objective measures of academic success.

Methods

A 25-question online survey was distributed to program directors of Canadian plastic surgery residency-training programs. Program directors commented on number of yearly residents and applicants; application sections (ranked in importance using a Likert scale); interview invitation and rank-order list determination; and their satisfaction with the selection process.

Results

Ten Canadian plastic surgery program directors responded (90.9% response rate). The most important application components determining invitation to interview were letters of reference from a plastic surgeon (mean importance of 5.0 on the Likert scale), clinical electives in plastic surgery (mean 4.6) and electives with their program (mean 4.5). Applicants invited for interview were assessed on the quality of their responses to questions, maturity and personality. The majority of program directors agreed that a clinical elective with their program was important for consideration on their rank-order list. Program directors were neutral on their satisfaction with the selection process.

Conclusion

Canadian plastic surgery residency programs emphasize clinical electives with their program and letters of reference from colleagues when selecting applicants for interviews. In contrast to their American counterparts, Canadian program directors rely on clinical interactions with prospective residents in the absence of objective academic measures.
Spreader graft placement in endonasal rhinoplasty: Technique and a review of 100 cases
Authors: Samaha M , Rassouli A
Published: March 2018

Background

Spreader grafts are widely considered to be the mainstay of treatment for insufficient internal nasal valve and are commonly placed preventively during rhinoplasty, after hump removal, to avoid middle vault collapse. Although the placement and suturing of spreader grafts in open rhinoplasty is fairly easy, their positioning and stabilization in endonasal rhinoplasty is associated with a learning curve.

Methods

A review of the technique with tips for the novice surgeon is presented, particularly as pertains to correct placement. The technique can be used to insert spreader grafts irrespective of whether the nasal dorsum is addressed. Suturing is usually unnecessary. A retrospective review of 100 patients in whom spreader grafts were placed was undertaken to evaluate complications such as poor placement, displacement or other complications.

Results

Although there is a learning curve to ensure the dorsal mucosal attachment is maintained while developing the pocket sufficiently dorsally for proper graft placement, the technique is easy to learn, effective, quick and technically simple to perform. Of 100 patients, three had a cartilaginous dorsal spur as the cephalic edge of the graft became visible. One patient developed an ecchymosis along the dorsum that caused a hump that resolved in two months. There were no other aesthetic or functional complications.

Conclusion

The endonasal placement technique provides for simple, safe and easy placement, as well as stabilization of spreader grafts during endonasal rhinoplasty, with few complications.
Use of the Derriford Appearance Scale 59 to assess patient-reported outcomes in secondary cleft surgery
Authors: Ricketts Sophie , Regev Eran , Antonyshyn Oleh M , Kiss Alex , Fialkov Jeffrey A
Published: March 2018

Background

Secondary rhinoplasty, one of the final procedures in addressing the stigma of the cleft lip and palate (CLP), has both functional and aesthetic objectives. The way in which physicians evaluate outcomes in surgery concerning aesthetics is changing. Well-designed patient-reported outcome measures to assess health-related quality of life improvements attributable to surgery are increasingly being used. The Derriford Appearance Scale 59 (DAS-59) is currently the only available validated patient-reported outcome measure that assesses concern about physical appearance.

Methods

Twenty patients with CLP presenting between May 2009 and May 2013 for secondary rhinoplasty to Sunnybrook Health Sciences Centre (Toronto, Ontario) were recruited. DAS-59 measures were administered both preoperatively and at least six months after surgery. Pre- and postoperative measures were scored and compared. Item-by-item analysis of the measure was also performed.

Results

Total scores for this CLP group indicated greater concern about appearance than the general population. Across all subscales of the measure, there was a reduction in scores after secondary rhinoplasty suggesting less patient concern with appearance and a positive effect of surgery on patient quality of life. Item-by-item analysis suggested relatively few items in the measure were driving overall change in total scores.

Conclusion

Comparison of pre- and postoperative scores with the DAS-59 in secondary cleft rhinoplasty suggests there is less concern with appearance after surgery. However, a small number of items within this generic scale contributing to this difference may suggest the need for a more patient specific measure for assessment of surgical outcomes in the cleft population.
Shared medical appointments as a new model for carpal tunnel surgery consultation: A randomized clinical trial
Authors: Wong Alison L , Martin Janet , Wong Michael J , Bezuhly Michael , Tang David
Published: March 2018

Background

In chronic disease management, shared medical appointments have been shown to improve clinic access, productivity and patient education. However, adoption of this model in surgical consultation is limited, and its effect on surgical patients' satisfaction, comfort and surgical risk recall is unknown.

Objective

To determine whether shared medical appointments could be applied to carpal tunnel surgery consultation while being equally effective as individual consultation for risk recall, patient comfort and satisfaction.

Methods

A prospective randomized trial involving 80 patients referred for carpal tunnel release consultation, in which patients were assigned to an educational discussion individually or as part of a shared appointment, was conducted. In a blinded fashion, patients were contacted preoperatively to assess their risk recall and postoperatively to rate their overall satisfaction, comfort and satisfaction with the surgeon.

Results

Patient demographics were equal. Surgical risk recall was equivalent between shared and individual consults (2.06±1.15 versus 1.64±1.04; P=0.11). More participants in the shared appointments condition remembered the specific risks of infection (61.1% versus 33.3%; P=0.020) and bleeding (30.6% versus 10.3%; P=0.028). There was no difference in overall satisfaction (8.70 versus 8.88; P=0.75), satisfaction with the surgeon (8.05 versus 8.13; P=0.92) or overall comfort (8.80 versus 8.31; P=0.46).

Discussion

Shared medical appointments for carpal tunnel surgery consultation were equivalent to individual consultation in terms of surgical risk recall, patient satisfaction and comfort.

Conclusion

These results support the use of shared appointments for large-volume, low-variation surgery.
Low-Frequency Ultrasound Debridement in Chronic Wound Healing: A Systematic Review of Current Evidence
Authors: Chang Ying-Ju Ruby , Perry Julie , Cross Karen
Published: March 2018

Chronic wounds are painful and debilitating to patients, pose a clinical challenge to physicians, and impose financial burden on the health-care system. New treatment options are therefore highly sought after. Ultrasound debridement is a promising technology that functions to disperse bacterial biofilms and stimulate wound healing. In this review, we focus on low-frequency ultrasound (20-60 kHz) and summarize the findings of 25 recent studies examining ultrasound efficacy. Ultrasound debridement appears to be most effective when used 3 times a week and has the potential to decrease exudate and slough, decrease patient pain, disperse biofilms, and increase healing in wounds of various etiology. Although current studies are generally of smaller size, the results are promising and we recommend the testing of low-frequency ultrasound therapy in clinical practice on a larger scale.
The Role of Local Bupivacaine Irrigation in Postoperative Pain Control After Augmentation Mammoplasty: A Systematic Review and Meta-Analysis
Authors: Qiu Shan Shan , Roque Marta , Chen Yi-Chieh
Published: March 2018

Background:

The objective of this study is to analyze the efficacy of local bupivacaine irrigation after augmentation mammoplasty for the control of postoperative pain.

Methods:

A systematic review and meta-analysis was conducted including all randomized controlled trials (RCTs) that compared the irrigation of bupivacaine (±ketorolac) versus normal saline or no irrigation for pain control after breast augmentation. The primary outcome was postoperative pain measured by visual analog scale. The study protocol was established a priori according to the recommendations of the Cochrane Collaboration. A bibliographical search was conducted in September 2015 in the following Cochrane Library databases: CENTRAL, MEDLINE, EMBASE, and Scielo. The strategy used for the search was ((augmentation AND (“mammoplasty”[MeSH Terms] OR “mammoplasty”)) OR ((“breast”[MeSH Terms] OR “breast”) AND augmentation)) AND ((“pain, postoperative”[MeSH Terms])).

Results:

Four RCTs with a total of 264 participants were included. Two trials compared bupivacaine alone versus placebo (normal saline or no irrigation) and 3 trials compared bupivacaine plus ketorolac versus placebo. The combined irrigation of bupivacaine and ketorolac showed a clinically significant reduction of pain in the first postoperative hour and on postoperative day 5. The irrigation with bupivacaine compared with placebo significantly reduced pain assessed on postoperative day 4.

Conclusion:

The irrigation of bupivacaine with or without ketorolac was associated with a reduction of postoperative pain compared with control groups for the first 5 postoperative days. Due to the few number of trials included, these results should be correlated further clinically.
Intraoperative Nerve Stimulation During Brachial Plexus Surgery: Comparison Between a Totally Disposable Nerve Stimulator and Nerve Stimulator Normally Used for Nerve Blocks
Authors: Thallaj Ahmed , Alotaibi Wadha M. , AlZahrani Tariq , Abaalkhail Abdulaziz S. , El-Sayed Amel A. F. , Al-Qattan Mohammad M.
Published: March 2018

Background:

Intraoperative nerve stimulation is done routinely in brachial plexus and peripheral nerve surgery as well as in selective neurectomy in spastic patients.

Objective:

The current study compares the use of 2 different devices for nerve stimulation: a totally disposable nerve stimulator and a nerve stimulator used for nerve blocks by anesthetists.

Methods:

A retrospective study of 60 patients who underwent brachial plexus surgery: In 30 patients, we used the totally disposable nerve stimulator (group 1) and in another 30 patients, we used the anesthesia device (group 2). The cost of disposable materials used for nerve stimulation was calculated in each group. The same surgeon performed all operations, and he was asked to give his subjective opinion regarding the convenience and ease of use of the device in each group.

Results:

The main advantages of the totally disposable device are its placement totally within the sterile field, and it is operated by the surgeon without the need to communicate with the anesthetist. However, the totally disposable device had several major disadvantages when compared to the anesthesia device. Firstly, the disposable stimulator can only deliver 0.5, 1.0, and 2.0 mA stimuli, while the anesthesia device can deliver stimuli of 0.1 to 5 mA (in 0.1 mA increments). Secondly, the disposable stimulator frequently fails to operate during surgery, and this is not experienced with the anesthesia device. Finally, the cost of disposables is less using the anesthesia device.

Conclusion:

Our center has stopped using the disposable nerve stimulator in favour for the anesthesia device.
The Role of Dynamic Ultrasound in the Immediate Conservative Treatment of Volar Plate Injuries of the PIP Joint: A Series of 78 Patients
Authors: Leclère Franck Marie , Mathys Lukas , Juon Bettina , Vögelin Esther
Published: March 2018

Introduction:

The management of volar plate avulsion fractures in the context of a stable joint and a bony fragment of less than 30% has traditionally been conservative. This study was performed to assess volar plate healing with high-resolution ultrasound in order to provide early full mobilization.

Material and Methods:

Between January 2012 and December 2013, 78 patients with volar plate injuries of the proximal interphalangeal (PIP) joints (42 distortions and 36 dislocations) were treated conservatively in our department for volar plate avulsion fracture associated with stable joint and bony fragment inferior to 30% of the intra-articular surface assessed both by radiography and ultrasound. Conservative treatment included extension stop splinting for the first 2 weeks and Coban bandage until 6 weeks postinjury. However, it may be possible to modify the duration of extension stop splinting based on clinical and ultrasound findings (with no additional X-ray) performed every 2 weeks for the first 3 months and then at 4 months postinjury. Only patients with residual contracture at the 4-month assessment had prolonged follow-up in order to ensure adequate dynamic splint therapy.

Results:

The amount of soft tissue oedema and the mobility of the volar plate were factors used to determine return to full mobilization. Mean extension-stop-splint wear was 16 ± 2 days. During the first 2 follow-up assessments, 4 patients were excluded from the study because of the instability of the PIP joint. One patient required refixation of a large fragment of 30%, 2 patients required superficial flexor tendon (FDS) tenodesis of the unstable volar plate in hyperextension and 1 other patient required arthrodesis of the PIP joint. In 51 patients, the postoperative follow-up was free of complications at 4 months. In 18 patients, flexion contracture of 20° (range 11°-40°) and oedema during follow-up required dynamic extension splints for 3 to 5 months. After this time, 5 patients had a residual contracture of 10° to 15°.

Conclusion:

Avulsion fractures of the volar plate at the PIP joint are common. In general, they have a good outcome using the conservative treatment with extension block splints. Flexion contracture is a common complication and may be reduced by immediate splints in full extension at night and Coban bandage during the day. High-resolution sonography is a convenient tool to evaluate palmar plate stability, to assess reduction of oedema, and thus to guide safe return to full range of movement.
A Qualitative Assessment of the Journey to Delayed Breast Reconstruction
Authors: Cheng Ho Man , McMillan Catherine , Lipa Joan E. , Snell Laura
Published: March 2018

Background:

Canada has low immediate breast reconstruction (IBR) rates compared to the United States and Europe. Breast cancer survivors live with mastectomy defects sometimes for years, and this represents an area for improvement in cancer care.

Purpose:

This study qualitatively assessed (1) information provided about breast reconstruction at the time of cancer diagnosis among women seeking delayed breast reconstruction (DBR) and (2) referral practices for plastic surgery consultation for DBR.

Methods:

Fifty-two consecutive patients seen in consultation for DBR at a single Canadian tertiary care centre completed questionnaires regarding their experience in seeking breast reconstruction. Seven semi-structured interviews were conducted to further explore themes identified through questionnaires. Questionnaire responses and interview transcripts were analyzed for recurring themes using standard qualitative techniques.

Results:

A significant portion of women (43%) was interested in reconstruction prior to mastectomy, yet IBR was infrequently discussed (14%) or discouraged by their oncologic surgeons (33%). Common patient reasons for not pursuing IBR were referring physician objection and not having adequate knowledge. Women expressed wanting to discuss reconstruction at the time of cancer diagnosis. Half of the patients had attended another consultation, but the initial plastic surgeon either did not offer procedures for which these women were candidates or had prohibitively long surgical wait times.

Conclusion:

Lack of information about reconstructive options at the time of cancer diagnosis and perceived access barriers to plastic surgeons may contribute to underutilization of IBR in Canada. Access to breast reconstruction can be improved by reducing inefficiencies in plastic surgery referrals.
Objective Outcomes of Minimally Invasive Temporalis Tendon Transfer for Prolonged Complete Facial Paralysis
Authors: Brichacek Michal , Sultan Babar , Boahene Kofi D. , Ishii Lisa , Byrne Patrick J.
Published: March 2018

Objectives:

We describe an approach to reanimation of complete, prolonged facial paralysis using minimally invasive temporalis tendon transfer (MIT3) by the melolabial or transoral approach. Objective outcome measures are evaluated based on symmetry, and grading of preoperative/post-operative results and the scar at the melolabial fold.

Study Design:

Retrospective cohort study.

Methods:

Twenty-five patients undergoing the MIT3 technique were studied. Photographic analysis was used to determine the percentage of difference between the 2 sides (symmetry). Using the Delphi method to achieve consensus, a panel of experts graded pre/post-operative photos using the Terzis’ Facial Grading System and a 1 to 10 Likert-type scale and the melolabial scar using the Beausang Scar Scale.

Results:

Percentage of difference (symmetry) with smiling improved from 18.6% ± 1.5% (mean ± standard error of the mean [SEM]) preoperatively to 5.0 ± 0.9% (mean ± SEM) post-operatively. Expert grading by the Terzis system showed improvement post-operatively (mean 3.7/5; median 3.6/5) versus preoperatively (mean 1.5/5; median 1.2/5). Perceived improvement was also largely favourable (mean 8.1/10; median 8.0/10). Melolabial scar grading was favourable in terms of colour (mean 1.53/4), surface character (mean 1.05/2), contour (mean 1.60/4), and distortion (mean 1.74/4).

Conclusions:

The MIT3 technique offers immediate, predictable, and symmetrical return of smile function. Objective symmetry analysis and favourable expert grading of both pre-/post-operative photographs and the scar at the melolabial fold demonstrate applicability for facial reanimation in patients where other procedures have failed, or when a direct return to function is desired. Both the melolabial approach and transoral approach were found to be acceptable and effective, although applicability varies.